mbt schuhe Pediatric diagnosis and treatment of my

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Pediatric diagnosis and treatment of myasthenia gravis

) To discuss 1. Etiology and pathogenesis. Myasthenia gravis is a muscle joint of neural physiology and structural defects of the lesion, but the reason of muscle dysfunction is not clear. MG patients with thymoma accounted for 10 to 15%, 70% of thymus hypertrophy, only 20% of the normal thymus. Thymus in the human immune system plays a vital role, 75% to 93 found in patients with myasthenia gravis anti-B antibodies Jian choline increased by the break, and the home of thymoma associated with autoimmune diseases. 1960, Simpson made the pathogenesis of MG is due to the antibody, blocked the acetylcholine receptor, causing the nerve cell immunity together with a muscle at the joint damage. According to the literature, AchRab through the following mechanisms may play a role t ④ postsynaptic membrane antibody-mediated} @ AchR (postsynaptic acetylcholine receptor) accelerated degradation of a direct blocking effect} ③ It1. AchRab postsynaptic membrane by binding with the AchR, causing the latter to increase the consumption and degradation of degradation, resulting in a muscle joint nerve AchR at the decline in the number of effective,[link widoczny dla zalogowanych], resulting in symptoms of myasthenia gravis. 4 patients in this group higher than normal AchRab titer, the titers decreased to normal after surgery, and 1 patients had IgG, IEA increased. Speculated that more than one rate of disease and immune complexes on, it was confirmed that the motor end plate of the patients may have IgG and C3 immune complexes and antigen-antibody complex AchR exist, it was also found in serum of patients did not have AchRab, rate of group 1 in patients with a preoperative normal level 【AchRab. Thymus produced in AchRab role in the process has not yet clear, but certainly at least have the same thymus and AchRab close relationship. West AchRab patients with high titers of more than a thymic hyperplasia and germinal centers with more, face AchRab thymus of patients with low titers were more degradation of 1, so the clinical setting AchRab l O titer to determine whether MG patients JL thymic hyperplasia. 2. Surgical indications and results. Blalock first unlucky with thoracic surgery treatment of myasthenia gravis, the surgical indications for the t ① clinical symptoms with myasthenia gravis, the medical therapy; ② course of more than 6 to 12 months; ③ x-ray showed increased thymic too; ④ CT Tips thymoma; ⑤ serum of Pediatric Surgery Volume 14, 1993 increased 2 AchRab, ⑥ recurrent MG crisis. The group of 5 patients with a preoperative anticholinesterase drugs are used, results are poor,[link widoczny dla zalogowanych], as the thymus after cutting amidine, a more satisfactory long-term effects, symptoms after 4 months to 1 year gone,[link widoczny dla zalogowanych], no longer need medication. Because of the delay after thymectomy immune response, that immune activity in long-term survival of small lymphocytes. Therefore subject to a long time to show its maximum effect,[link widoczny dla zalogowanych], if the amount of prednisone given after surgery can speed up the removal of such cells, the symptoms quickly disappeared Ⅲ. The patients with postoperative respiratory crisis can cause death, respiratory management is the key to improve the curative effect. The routine postoperative indwelling tracheal intubation, and supported by mechanical ventilator and close monitoring Ba respiratory function, strengthen the suction. Keep breathing was unobstructed. Who have received anti-cholinesterase drugs before surgery for early withdrawal, and avoid the use of a muscle may interfere with nerve conduction and increase the muscle weakness between the drugs, such as aminoglycoside and narcotic sedatives. Central immune organs thymus, thymic atrophy or absence can be directly or indirectly affect the cellular and humoral immunity. So that the body in a primary or secondary immunodeficiency or incompetent state, the body's defense mechanisms exist in damage, occur repeatedly and refractory infections suffered a few deaths. Small long-term efficacy of several thymectomy how the accumulation of data and long-term remains to be seen.
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