12:48,2,Nov,2006 | (864/0/0) | Original

thymomatous myasthenia gravis

218.7.123 .*
Jiamusi City, 10th Floor, Western aid specialist out-patient of myasthenia gravis in love
First, the myasthenia gravis: myasthenia gravis (myasthenia) is the acetylcholine receptor antibody (ACHR_Ab) mediated immune dependent and complement in the nerve - muscle joints (NMI) is passing the disorder of autoimmune diseases. Lesions mainly involving the NMJ after the conflict at the acetylcholine receptor membrane (acytylcholine recepyor, AChR). As part of the clinical features or general muscle fatigue, muscle weakness was fluctuating, with activities after the increase, after the break and the morning light evening to reduce weight and other characteristics.
MG in the general population in the incidence rate of 8-20/10 million, estimates there are 60 million of MG patients, higher incidence of the South. Any age group can be the disease, common in the 29-40 year-old female prevalence was 40 men before the age of 2-3 times the incidence of those in middle-aged males, thymoma in common in elderly patients 50-60 years of age, 10 before the age of onset accounted for only 10% of the rare familial cases.
Second, the clinical manifestations: Myasthenia gravis in the general population the prevalence rate is about 50/10 million, can occur at any age, but young women and older males. The first peak is 20 years old, the second peak about 50 years old, male to female ratio is 1:2, while the proportion of young patients up to 1:4 for this. Striated muscle weakness, fatigue, morning, evening light weight, activity after the increase, after the break to reduce the main symptoms of this disease. MG onset, daily and even hourly fluctuations. Gradual or rapid onset of muscle weakness can attack, can be completely restored or partially restored. More than simply the first symptom of extraocular muscle paralysis was not simply physical, bulbar or neck muscle weakness are. About 56% to 60% of patients with myasthenia gravis prominent muscle involvement. Finally, 90% of the patients had ocular myasthenia gravis symptoms in the upper eyelid ptosis, diplopia, ptosis in the inspection process can be volatile. Cogan syndrome (upward gaze, the mention sagging eyelid muscles) with ocular involvement, also appears unable to Central ophthalmoplegia, other cranial nerves are also affected, causing difficulty swallowing and breathing difficulties potentially fatal complications. Late onset patients often masticatory muscle injury, can not swallow, by nasogastric feeding, do not extend outside the exit of the tongue, muscle atrophy and not typical of the three surface groove. Dysarthria, voice low, nasal weight, surface gravis, there smile face, neck flexion weakness forced the patient to support their head with both hands. More than 80% of the patients developed ocular damage to a systemic weakness during the year.
Third, the clinical types: Osserman classification is widely used at home and abroad, for clinical treatment and prognosis quite
Ι type: ocular (15% -20%), only the ocular involvement.
Type II A: mild systemic (30%), slow progress, no crisis can be combined eye muscle involvement, drug-sensitive.
Type II B: moderate body type (25%), skeletal muscle and bulbar muscular severely affected, poor drug sensitivity without crisis.
Type III: severe aggressive type (15%), symptoms severe, progress rapidly, within a few weeks to several months to reach the peak, a high incidence of thymoma, crisis can occur, efficacy is poor, often require tracheotomy or assisted breathing, high mortality .
Type IV: Delayed severe type (10%), symptoms of the same type III, type Ι development from type II A, II B-type, after 2 years of advanced gradually evolved.
Fourth, auxiliary examination:
1, imaging studies, chest X ray or CT, check whether the thymoma, the thymus was raw.
2, the electrophysiological examination, with or without neuromuscular transmission disorder.
3, blood tests, ACHR-Ab, IgG is normal.
Fifth, love rescue
Jiamusi city to explore with Chinese and Western medicine treatment specialist out-patient type Ι, II A myasthenia gravis, and achieved ideal results. We offer a spirit of love, doing good deeds for the purpose, decided to part Ι type, II A free treatment in patients with myasthenia gravis.
(A) relief conditions
1, Ι type, ocular eye muscle involvement in patients only.
2, II A, mild systemic, slow, non-crisis patients.

3, there are three additional tests, and without thymoma patients.
4, the top three hospitals reported the original diagnosis, diagnostic classification of the report subject to the above standards and supporting test results clearly belong to several types of myasthenia gravis.
(B) assistance required
1, should I hold the three patients and diagnosis of the original inspection report submitted for our files.
2, prior telephone appointment treatment time to ensure timely treatment of patients.
3, does not meet the conditions of free treatment for patients without reception.
Contact Mr. Zhu Mobile 0454-6831660
Plane. 0454-6121711
2009-3-26 08:28 Reply
thymomatous myasthenia gravis

Myasthenia gravis should be treated?
(A) treatment
1. Treatment
(1) the preferred solution: the thymus removed, if the condition deteriorated significantly after surgery, can be supplemented with plasma exchange, high dose of immune globulin, adrenal corticosteroids and cholinesterase inhibitor and other treatment.
(2) the second best solution: a serious condition can not be removed by the thymus can be used in plasma exchange or high-dose immunoglobulin therapy with adrenal steroids, a gradual transition to corticosteroids alone, the condition improved and the stability 2 months later the thymus removed, surgery maintain the original dose after 2 months, then a slow reduction of 2 to 4 years, to the disabled.
(3) three alternatives: removal of the thymus can not or refuse to MG patients, who preferred critical plasma exchange or high dose immunoglobulin, non-critical are the preferred corticosteroids, reduction in the course of corticosteroids may be appropriate azole plus sulfur purine and other immunosuppressive drugs, reduce or mitigate rebound phenomenon.
(4) four alternatives: the thymus can not be refused or removed, they refused or can not tolerate corticosteroid treatment of MG patients, cyclophosphamide and other immunosuppressive drugs can be treated.
2. The main treatment
(1) cholinesterase inhibitors: common neostigmine, pyridostigmine Ming, Imber chloramine (enzyme inhibition Ning), pyridostigmine next most common side effects small, the initial dose 60mg oral adult Each 4h1 times, can increase the dose based on clinical manifestations, if patients have difficulty eating medication in 30min before meals, such as difficulty walking early morning patients can get up before the service in the long-term pyridostigmine Ming 180mg, the muscarinic showed side effects abdominal pain, diarrhea, nausea, vomiting, salivation, increased bronchial secretions, tears, sweat and other benefits miosis, pre-atropine 0.4mg can ease the muscarinic symptoms, but the spirit of atropine can cause excessive symptoms, there is no evidence that combination of two drugs is better than monotherapy, although the efficacy of anticholinergic drugs is better, but there are limited cases, such as ocular MG can be improved ptosis after treatment, some patients often sustained double vision existence; systemic symptoms of MG can improve, but it is difficult to eliminate, these drugs can inhibit cholinesterase, so that from hydrolysis of Ach, can improve the transmission of neuromuscular transmitter, so that the temporary improvement in muscle strength for effective symptomatic therapy, usually pyridostigmine (pyridostigmine) 60 ~ 120mg, 3 ~ 4 times / d, taking half an hour before meals, start small dose and gradually increase the amount raised to improve muscle strength, to maintain appropriate eating and activities of daily living to avoid overdose, in order to alleviate the abdominal pain, salivation and other side effects, which can service a small amount of atropine, in addition, should prevent long-term abuse of cholinesterase inhibitors, so as not to impede the restoration nAchR.
(2) immunosuppressive drugs:
â‘  corticosteroids: a strong inhibitory effect on T cells and inhibit the formation of thymic germinal centers, reducing the synthesis of nAchR-Ab, for all types of MG, ocular patients was markedly fast, but each relapse in a cold, can also be used before and after surgery in thymoma, adrenal corticosteroids are usually all ages of patients with moderate to severe MG, especially in middle-aged people over the age of 40, whether done thymectomy, are more effective and safe, and often also combined with anti-bile alkaline esterase drugs, commonly used in the preoperative thymectomy treatment, or because of surgery appeared later, after thymectomy can also use the transition period, patients with this therapy should be intake of high protein, low sugar, and added with potassium-rich diet, if necessary, need to take acid drugs, the treatment methods currently used 3; â‘  decreasing every other day high-dose therapy: prednisone every other day service 60 ~ 80mg / d beginning, symptoms improved more in one month there , often at the peak effects after a few months, then you can gradually reduce the dose until the next day service 20 ~ 40mg / d maintenance dose, maintenance dose of the selection criteria is the minimum dose causing symptoms worsen, â‘¡ small dose increments every other day therapy: service every other day prednisone 20mg / d beginning, increasing weekly 10mg, until the next day service 70 ~ 80mg / d or to obtain significant effects so far; slow down the law to improve conditions, the maximum effect is common in 5 months after treatment; made it worse less likely, but the date may be delayed disease progression, so that the vigilance of physicians and patients weakened, so the next day than the respected high-dose therapy, â‘¢ high-dose pulse therapy: high-dose therapy can not be relieved the next day or recurrent cases of crisis, to try methylprednisolone 1000mg / d, the impact of therapy used in conjunction 3d, experience shows that a course of treatment often can not obtain satisfactory results, every 2 weeks you can repeat a course of treatment, can be 2 to 3 course of treatment, dosage, interval time and frequency of treatment should be done according to the specific circumstances of individual patient treatment, side effects of corticosteroids, such as Cushing's syndrome, hypertension, diabetes, ulcers, cataracts, osteoporosis, and withdrawal syndrome, should not be ignored .
â‘¡ cytotoxic drugs: the treatment of corticosteroid medicines ineffective or associated with thymoma patients, can be used cytotoxic drugs, cyclophosphamide (CTX) on the more significant inhibition of B cells, adult common amount of 100 mg / d, on recurring crisis by intravenous infusion of 200 ~ 400mg / d, 10g total about effective, those in poor efficacy of thymoma resection can be combined with chemotherapy: cyclophosphamide 800mg/m2, adriamycin 50mg/m2, vincristine 1.4mg/m2, can also be added with prednisone 40mg/m2, every 3 to 4 week cycle, and some were a significant effect, should be noted that side effects and blood, azathioprine (AZA) inhibition of CD4 T cells, usually markedly after 8 weeks.
(3) plasma exchange: plasma exchange or thymectomy commonly used in the preoperative management of patients in order to avoid or improve postoperative respiratory crisis, the general body of 5% of the preoperative blood replacement to ensure that patients can withstand surgery; also used other types of crisis, most of the patients had symptoms of varying degrees of improvement for days or months, although the safety of the Act, but expensive.
(4) immunoglobulin: 0.4g / (kg
Myasthenia Gravis worry about 3 points (rich) edit the term myasthenia gravis Myasthenia gravis is a summary of nerve - muscle joints due to a decrease in acetylcholine receptor appear to pass their own barriers to autoimmune diseases. The main clinical features of striated muscle is local or systemic weakness in the activities easy to fatigue by rest or with anti-choline esterase drugs can be mitigated. Cardiac and smooth muscle may also be involved, showing symptoms of the corresponding organs. Can have a family history of myasthenia gravis (myasthenia gravis familial genetic).
Edit Summary List - [hide] 1 myasthenia gravis myasthenic crisis 2 Mental Care Prevention 4 3 myasthenia gravis myasthenia gravis myasthenia gravis dialectical Category 5 must be treated as soon as possible 7 6 food care can be complicated by myasthenia gravis 8 myasthenia gravis disease which the diseases easily confused with the genetic susceptibility to 9 of 10 myasthenia gravis myasthenia gravis common symptoms Edit this paragraph of 9 | Back to the top of the myasthenic crisis as a sudden increase or improper treatment of the disease, causing respiratory muscle weakness or paralysis Erzhi severe respiratory difficulties, known as myasthenic crisis. There are three:
1. Myasthenic crisis: the lack of neostigmine crisis, reduction by a variety of incentives and drug induced. Weak breathing, cyanosis, trouble bath, difficulty swallowing and nuclear sputum, low language can not say anything until the last breath stopped completely. Can become chronic recurrent or persistent.
2. Cholinergic crisis: the crisis over neostigmine, multi-drug overdose in a moment after, in addition to breathing difficulties and other symptoms mentioned above, there are too many signs of acetylcholine accumulation include: alkali-like toxin poisoning symptoms (vomiting, abdominal pain, diarrhea, miosis, sweating, salivation, increased airway secretions, heart rate slows down), nicotine-like symptoms (muscle tremors, cramps and tightening feeling, etc.) and central nervous system symptoms (anxiety, insomnia, mental disorder, awareness clear, descriptive twitch, coma, etc.).
3. Anti-bend of the crisis: the nature of crisis is difficult to distinguish without stopping or increase the amount of drugs can improve symptoms. Large multi-agent management in the long term after treatment.
Identification of three kinds of crisis can be the following methods: â‘  Tang Xi-Long Test. â‘¡ atropine test. â‘¢ electromyography.
Check â‘· myasthenia gravis
Not difficult to diagnose based on clinical features. Muscle fatigue test, such as repeated open eyes closed eyes, make a fist or two upper flat, more pronounced muscle weakness can help diagnosis. Can be used for the diagnosis of the following tests:
Drug test:
1. â‘  neostigmine test.
â‘¡ edrophonium test.
2. Electrophysiology: continuous electrical stimulation of common sense, impaired muscular response and fast disappearing.
EMG: EMG prompt muscle strength decreased, the amplitude becomes smaller. Muscle action potential amplitude decreased by 10% or more, single-fiber excitatory transmission delay or block.
3. Serum tests: serum anti-AchR-Ab determination of about 85% of patients increased.
4. Chest X-ray or CT examination of thymus, thymic hyperplasia, or associated with thymic tumor, but also diagnostic value.
Physical examination of myasthenia gravis
Not difficult to diagnose based on clinical features. Muscle fatigue test, such as repeated open eyes closed eyes, make a fist or two upper flat, more pronounced muscle weakness can help diagnosis. Can be used for the diagnosis of the following tests:
Drug test:
1. â‘  neostigmine test. â‘¡ edrophonium test.
2. Electrophysiology: continuous electrical stimulation of common sense, impaired muscular response and fast disappearing.
EMG: EMG prompt muscle strength decreased, the amplitude becomes smaller. Muscle action potential amplitude decreased by 10% or more, single-fiber excitatory transmission delay or block.
3. Serum tests: serum anti-AchR-Ab determination of about 85% of patients increased.
4. Chest X-ray or CT examination of thymus, thymic hyperplasia, or associated with thymic tumor, but also diagnostic value.
Physical examination of myasthenia gravis
1, EMG: EMG tips reduce muscle contraction force, the amplitude becomes smaller. Muscle action potential amplitude decreased by 10% or more, single-fiber excitatory transmission delay or block.
2, the blood test: TH / TS ratio increased, 80% of the patients AchR-Ab titer, 2 / 3 of patients with elevated IgG; with hyperthyroidism T3, T4 increased.
Immunological tests :70-93% of patients can be detected serum anti-acetylcholine receptor antibodies.
3, anti-cholinesterase drug trials: Symptoms may be a transient improvement. Anti-cholinesterase drugs test: positive
4, thymus imaging: 90% of patients have thymic hyperplasia or thymoma, possible X-ray, CT or MRI.
5, muscle biopsy: the neuromuscular junction folds at the postsynaptic membrane decreased, changing flat, AchR reduced the number.
The treatment of myasthenia gravis
Western medicine treatment of myasthenia gravis are primarily used anticholinesterase drugs and immunosuppressants.
1, anti-cholinesterase drug neostigmine, pyridine Stalin Ming, Ning or inhibiting enzymes called the United States neostigmine, these drugs reduce the side effects include dilated pupils, more saliva, sweating, abdominal pain, diarrhea, etc., can taking atropine to fight.
2, immunosuppressive agents are corticosteroids and cyclophosphamide.
3, surgical treatment for thymoma patients.
Food conditioning myasthenia gravis
About diet with myasthenia gravis, such as patients in different stages of change to dietary nursed back to health grade, no fever symptoms, ability to chew normally, with normal digestive function, using ordinary food, you can set the standard daily calories, and the proportion of a balanced diet For severe, affecting digestive function and chewing ability, muscle weakness after the 0-2 level or major surgery (eg, thymectomy) or poor feeding and other types of patients, were given soft food, semi-liquid, liquid, and tube feeding liquid diet . Looking to indulge in white, drooling, limbs not warm the spleen and spinal numbness virtual muscle weakness, muscle atrophy can be used in patients with some black sesame porridge, brown sugar, cinnamon, porridge, chicken liver, beef bone marrow to take. For dizziness, ringing in the ears, throat, hypochondriac pain, weak waist, five upset hot, zygomatic red sweats, red tongue, little coating, less urine, the whole body weakness, muscle atrophy can wolfberry water, Eucommia praise kidney, black date, etc. strengthening the physical achievements.
For shortness of breath lazy words, fatigue, spontaneous sweating, heart palpitations, insomnia, pale or atrophy, mouth tongue pale, blood insufficiency insensitive limb weakness, muscle atrophy, can be used Guiqi mutton soup, caramel lamb royal jelly and so on. For the spleen and stomach deficiency of soft limb atrophy, weakness, muscle atrophy, or muscle leap moving target, ptosis, less gas lazy words, the language of low weak, unable to chew, mouth Zhang flow Festival, eat less, loose stools, pale complexion minimalist or mouth yellow, pale tongue, the tongue has scalloped edges. Can be found in ocular myasthenia gravis and motor neuron disease part of the symptoms can be long-term use of silver fish soup, sand lotus root starch, lotus seed rice soup and so on. Regardless of the treatment period or rehabilitation can be nursed back to health with the diet to achieve the best match for therapeutic purposes. Edit this section | Back to the top of myasthenia gravis psychological care to maintain a happy state of mind, eliminate pessimism, fear, depression, impatience and other negative mental harm, to establish with confidence, strong will and optimism, to improve efficacy, promote rehabilitation essential. Psychological nursing of myasthenia gravis may take the following methods.
(1) intelligence system intelligence law: is the doctor with the words and deeds, things as a means to provoke some kind of emotional changes in patients in order to control the morbid mood, promote physical and psychological rehabilitation methods. Such as depression and low expression of atrophy syndrome, laughter, law enforcement is quite suitable for transfer. Can be taken to tell stories, tell jokes, listen to dialogues, to see funny drama, so that some patients with laughter, happy state of mind, or even joyous way to organize wedding, bringing joy to patients, or talk with the patient's methods, with care, thoughtfulness, or with plenty of examples, enlighten patient, let see the light of hope, sorrow turn to joy, summon the courage to live, thus contributing to the situation as soon as possible to improve the symptoms, physical rehabilitation.
(2) The Civic refreshing method: patients with medical advice is the use of traditional cultural methods or on its own, to look Cheong Yee, joint activities, medicinal properties, were raised for the purpose of God to form a method. Such as various games, dance, chess, hook fish, paintings, toys and music, both for cultural and refreshing approach. Patients according to the evidence of their situation and look different, and their hobbies, civic projects were selected accordingly. Psychological characteristics of children with a good novel, it is appropriate to use new toys, puzzles and to support activities such as base building blocks, open recreational vehicles, horse riding, catching chickens and so on.
(3) Environmental cool divine law: refers to the choice environment, beautiful scenery and pleasant place to rule nature Tao, Shuang Yang Xin God, to promote rehabilitation methods. Specific environmental option quiet forests, clear springs, majestic mountains, abundant sunshine, fresh air and pleasant flowers, or natural caves, artificial caves and so on. Room should be air and light, quiet, wide cover, color, mood and arrangements should be based on syndromes may be, to cool heart pleasing to the eye better.
Children with myasthenia gravis
1. Newborn - had the mother suffering from myasthenia gravis, such as myasthenia gravis, was delivered of newborns in the 1 / 9 patients of the disease. Children a few hours to 3 days after birth, can express the cry of weakness, sucking, swallowing, respiration was difficult. Muscle relaxants, tendon reflexes diminish or disappear. Few children with external ophthalmoplegia and ptosis. Without attention to family history, brain damage and birth easily, myasthenic syndrome and other confusion. Intramuscular injection of neostigmine (see below) or Tang Xi-Long, symptoms of immediate relief. Children acetylcholine receptor antibodies in blood can be increased. Children with this disease can be restored 5 weeks after birth. Can naturally relieve mild, but severe, use anti-cholinesterase drugs.
2. Congenital myasthenia gravis, also known as neonatal persistent myasthenia. Mothers of children without myasthenia gravis. This disease have a family history of autosomal recessive inheritance may be presented. After birth, mainly for children with ptosis, extraocular muscle paralysis, general weakness, weak cry and breathing difficulties are low is not common. MG mild but persistent. Acetylcholine receptor antibodies in the blood level is not high, plasma exchange treatment and anti-cholinesterase drugs were ineffective.
3. Children up to see myasthenia gravis, the minimum age of onset of 6 months, the peak age of onset of the first 2 years after birth and 3 years. According to the clinical features can be divided into ocular, brainstem-type and body type. â‘  ocular: the most common means of extraocular muscle involvement alone, without the involvement of other muscles of the clinical and electrophysiological findings. Most of the side of the first symptom or bilateral ptosis vision, twilight morning light weight, but also the performance of the eye movement disorder, diplopia, strabismus. The performance of children with severe bilateral eye barely move. â‘¡ body type: more than a group of muscles affected, mainly involving the limbs. Light were slightly affected limb muscles, leading to walk and raise your hand and can not be sustained, on the stairs fatigue. Often accompanied by involvement of extraocular muscles, usually without chewing, swallowing, dysarthria. In severe cases often require bed rest, with the exception associated with extraocular muscle involvement, but often accompanied by chewing, swallowing, dysarthria, and varying degrees of respiratory weakness. It should be noted that although children with limb weakness, most patients tendon reflexes reduced or lost, but the small number of children tendon reflexes may be normal. Muscular atrophy disease-free, non-fiber of the vibration and feel normal. Furthermore Western radiotherapy, immunosuppression and other methods, will affect the person's own "righteousness", tantamount to "vent", but Chinese medicine is supposed to "fill", which is like horse riding, horses do not run, Western medicine to whip it with a whip , let it rerun a little faster; However, Chinese medicine is to first feed it, then let it slowly. Effect is not the same. Many patients are not stand to give up the high cost of treatment. When a patient respiratory disease crisis, the cost is high, just enter the ICU on the ventilator, will cost 4,000 yuan a day, if not cure, who can bear? So the hope is that as soon as possible to lift the patient breathing crisis of the disease. As long as over time, the terminally ill can be cured! Of course, that medical patients receiving treatment had less effect will be greater use of Chinese medicine, if the thymus have been removed, it will affect the.
For myasthenia gravis, Chinese medicine treatment of stomach fill rule is steep, note that samples of urgency. In the process, when the patient breathing crisis, the display of lung infection, to borrow a certain Western ways, with "No Restriction righteousness" of antibiotics to fight infection, coupled with Beiqi, Angelica, white peony root in Chinese to uphold, and then developed our own oral nasal feeding, this method very high success rate of rescue, and many patients will soon be able to spend "breathing crisis," the gate of hell, free breathing machine. In this way we save a lot to Western "surrender" patients, because according to the practice of Western medicine, may be able to temporarily control the disease, or patients with a breathing machine to help sustain life, but the patient was virtually no hope of cure. Edit this section | Back to the top of the prevention of a myasthenia gravis, be inspired, to keep emotions comfortable
Mental activities and emotions is closely related to the body's physiological changes, fine blog happy and cheerful, the air-flow, blood reconcile, organs function coordination, upright vigorous, less prone to disease, even if the disease occurs, it will soon resume; On the contrary, if the situation go rather smooth, depressed, will enable the air-against the chaos, yin and yang, qi and blood disorders, dysfunctional organs, upright weakened, which occurred in disease. Clinically, the disease often occurs in patients with long-term mental stress or too thoughtful, sad and so emotional changes, and if the recovery period, patients often can cause fluctuations in emotional development or deterioration of the disease, so patients in the treatment and recovery process, must pay attention to the spirit nursed back to health, to maintain ideological purity and stability, not greed and paranoia, so infuriating rolls, keep within the spirit, the only way to make the patient a speedy recovery.
2, food is reasonable, not partial addicted
Diet and adequate nutrition is to ensure that the necessary conditions for human growth and development. "Gomi entrance, hidden in the stomach, in order to keep Wu Zang gas." Inadequate diet or lack of nutrition, biochemistry of blood, the result of weak constitution, on the contrary, eating too much can also damage the spleen and stomach, the course of time lead to physical decline, therefore, should gravis patients with meat and vegetables in the diet, with coarse flour and rice, children must To correct under the bad eating habits, so as to enhance the patient body, upright strong, so quick recovery of the disease.
3, work and rest, living there often
The incidence of muscle weakness and excessive fatigue has a lot to the disease were often associated with overwork, overuse, toil day and night, or run around the living due to disorders, Hao Shang qi and blood, physical decline evils take advantage of the lead Benbingfasheng and development, so the patients in the recovery process, must be living there often, work and rest, the only way to meet the drug treatment, and gradually increase Taiwan constitution, soon. Edit this section | Back to the top of the dialectical categories of myasthenia gravis 1. Spleen and stomach symptoms: ptosis, atrophy of soft limb weakness, more severe, the case of labor Zeshen, rest after mitigation, fatigue fatigue, less gas lazy words, eating less , choking cough, difficulty swallowing fraudulent claims, loose stools thin, floating face minimalist.
Thin white fur, thready and weak pulse.
Signs Analysis: weak stomach, the gas settlement, the eyelids drooping, floating face minimalist; weak stomach, lack of qi and blood source, the soft body atrophy, weakness, gradually increased, the case of labor Zeshen, rest after mitigation; the gas shortage, Qing Yang did not rise, then the fatigue fatigue, less gas lazy words, loose stools thin; spleen movements disorders, is eating less, eating cough, difficulty swallowing fraudulent claims; thin white fur, thready and weak pulse is weak spleen and stomach of the elephant.
2. Liver and kidney symptoms: ptosis, limb weakness, can not long stand, even if the adverse action, lumbar and knees, tinnitus head paste, women, irregular menstruation, nocturnal emission male impotence, hot flushes and night sweats. Little red tongue, bitter, rapid pulse.
Syndrome analysis: liver and kidney, tendons and essence of the loss of support in filling, then see ptosis, limb weakness, can not long stand, even if the adverse action;
Back to the House of kidney, kidney, so lumbar limp; liver opens into the eyes, kidneys open into the ears, liver and kidney deficiencies, so head paste tinnitus; essence kidney, liver blood, liver and kidney loss, lack of energy and blood can be a man nocturnal emission, impotence, irregular menstruation women;
Yin deficiency heat, hot flushes and night sweats can be seen; red tongue, little bitter, pulse breakdown for signs of liver and kidney. Edit this section | Back to the top of the early treatment of myasthenia gravis myasthenia gravis must be passed at the neuromuscular junction dysfunction caused by autoimmune diseases, most of the early performance of ptosis, diplopia, strabismus. The disease is rare in the clinical incidence rate of about 6 to 10/10 million, has an increasing trend in recent years. The disease progressed very quickly, about 40% of patients within a few months to two years into a systemic weakness, could easily lead to severe muscle weakness, muscle atrophy. If the later stages of disease development will lead to paralysis, dysphagia, dysarthria, difficulty breathing, or even severe hypoxia, life-threatening. Therefore, we must be treated early, control the disease, once involving the bulbar muscles, spinal muscles, trunk muscles, respiratory muscles such as Western medicine would be very difficult, regardless of treatment.
Treatment is a major feature of traditional Chinese medicine, the treatment of myasthenia gravis start from the dialectical effect. According to TCM theory, mainly spleen and liver of the disease closely related to congenitally dystrophy can be made for this disease, especially the spleen and stomach, and limbs, muscle nutrition and functional activities are closely related, over the years to spleen Qi, Zi liver and kidney, Huoxuetongluo principle to form an experience side, addition and subtraction with the disease condition of patients, to identifying diseases and differentiation into the equally important role, the effect is indeed satisfactory. Of course, adjust the dose according to the disease is also crucial. According to Minister Li introduced her patients, nearly half of the patients achieved a clinical cure can be removed hormones, stop taking the medicine, Western medicine, the symptoms disappeared more than two years follow-up without recurrence.
In fact, medicine is very simple medicine side side is very common, method is very commonly used method, but the symptoms did improve significantly, patients can really normal life, study and work. Pure Chinese medicine treatment of myasthenia gravis should have good prospects.
Can fertility in patients with myasthenia gravis?
Myasthenia gravis is a chronic disease, the treatment will take time, even after treatment has reached clinical cure, still adhere to the 1-2 years of treatment can be completely cured, so a stable condition who can edge treatment, edge work study, young people can married women can bear children.
Myasthenia gravis can occur at any age, and relevant information from clinical point of view, there are two peak age of onset, first 10 years of age, the incidence of the total number of about 40%; the second is the total population aged 20-30 incidence of about 40% of the number, but more women than men, male to female ratio: 2:3. With increasing age, the age of onset of myasthenia gravis have changed, women 20-35 years of age from the onset of most cases; men 40-55 years of age from the onset of most. Without timely diagnosis of myasthenia gravis and treatment, the patient will lose the ability to work, life can not take care of themselves, even life-threatening to the family and society heavy burden.
Shen served patients with myasthenia gravis drugs (1), gentamicin, streptomycin, kanamycin, neomycin, tetracycline, oxytetracycline, bacitracin, polymyxin.
(2) Non-Flanagan, stability, morphine, ether, procaine (caution).
(3) quinine, quinidine, procaine amide.
(4), curare, succinylcholine chloride, carbachol.
(5) and proprietary Chinese medicines such as Chan Su Liushen, laryngomalacia balls.
(6) of the cold taste of Chinese medicine. Edit this section | Back to the top of the food care 1, Eat cold, avoid eating mustard, radish, mung bean, kelp, seaweed, watercress, lily, Jianhua, watermelon, bitter gourd of cold products. So as not to damage the spleen and stomach to eat less cold, hard goods should eat less food, hard to diarrhea fever, easy Shang Wei.
2, eat Warming: stomach wasting in patients with myasthenia gravis, should eat Gan Wen Buyi of the goods, can play a benefit, and in the role of urgency, often tonic food:
â‘  meat: beef, pork, dog, rabbit, chicken, etc.;
â‘¡ fish, eggs, milk, the daily diet in patients with myasthenia gravis are an important food;
â‘¢ vegetables: cabbage, leeks, ginger, lotus root, tomatoes, potatoes, chestnuts, walnuts, peanuts, etc.
â‘£ fruit: myasthenia gravis patients fit for human consumption the following fruits: apples, oranges, grapefruit, grapes, red bayberry, pomegranate, peach, loquat fruit, longan and so on.
On the sexual life of patients with myasthenia gravis
1, myasthenia gravis on the impact of sexual function and libido
Because muscle weakness, fatigue, depression and other reasons are pessimistic, the sexual function of patients with myasthenia gravis often have different levels of obstacles. Also applied therapeutic immunosuppressive drugs may seriously damage the gonads, leading to a series of sexual barriers.
2, the sex life of myasthenia gravis
Sexual adverse effects of myasthenia gravis, because fatigue is often a predisposing factor for this disease. In addition, we know that many of the genitourinary system infection and sexual activity have a certain relationship, and infection is another trigger for myasthenia gravis. Patients with myasthenia gravis is not smooth the patient's sex life can increase anxiety, irritability, frustration, and these feelings further promote the development of the disease to the bad aspects.
3, sex guide
Patients generally mild sexual intercourse in order not to feel very tired for the degree. Sick of the party should play a passive sexual role, pose the following position is appropriate, it can save your energy consumption, so that the muscles have enough time to maintain functional status. Critically ill patients, if not the requirement, do not bite the bullet, or more can increase the mental pressure. The general idea of the method can be used instead of hugging each other sexual intercourse, but not too long time to pay attention, I feel tired you should rest. Spouses must fully understand this. Sex life before you can take some amount of anti-cholinesterase drugs such as neostigmine, pyridostigmine, Ning and other enzyme inhibition, which helped the successful completion of the normal sexual intercourse. Patients with myasthenia gravis, or if the condition was severe sexual development, should avoid pregnancy, childbirth, to prevent disease progression. Edit this section | Back to the top of the diseases can be complicated by myasthenia gravis patients because of respiratory muscle weakness and difficulty swallowing can not maintain basic vital signs referred to as myasthenia gravis crisis about the total incidence of 9.8% to 26.7%
According to the causes myasthenic crisis can be divided into 3 types: myasthenic crises, and anti-cholinergic crisis bend of the crisis
1. Myasthenic crises, and by the development of the disease caused by lack of anti-cholinesterase drugs clinical manifestations of respiratory distress can cough, difficulty swallowing and even stop the serious situation of medical examination shows dilated pupils, sweating, normal bowel sounds and abdominal distention New Sri Lanka Ming improved so after injection,
2. Cholinergic crisis of crisis about the number of cases of 1.0% and 6.0% caused by the excessive anti-cholinesterase in common than myasthenia gravis patients miosis outside sweating muscle muscle hyperactivity beating bowel sounds After injection of neostigmine increased symptoms and other characteristics
3. Anti-bend of the crisis is infection caused by poisoning and electrolyte disturbances with anti-cholinesterase drugs can temporarily reduce the critical state followed by another increase this section edit | Back to the top of myasthenia gravis and the diseases easily confused with a . oropharyngeal limb weakness associated with the disease: such as muscular dystrophy and amyotrophic lateral sclerosis caused by neurological disease or hyperthyroidism, weakness of other causes of ophthalmoplegia with mild eye eye muscle cramps occasionally but the eyelid weakness weak closed eyelids of these diseases involve the nervous system under the checked history of electrophysiological examination and neostigmine test is not difficult to identify with the MG
2.Lambert-Eaton syndrome: onset after the age of 50 most common male; more associated with small cell lung cancer the most common; main trunk proximal limb muscle weakness in lower extremity symptoms and upper extremity; fatigue, slow and easy weight loss muscle fatigue after the event but the continuation of muscle contraction but may be temporarily improved; occasionally dominated the extraocular muscles and bulbar muscle involvement; about 1 / 2 cases have limb paresthesia dry mouth, impotence; Yang alkaline esterase inhibitor diminished tendon reflexes of ineffective treatment, but without muscle atrophy and myasthenia gravis more common in women under 40 years of age; often accompanied by thymic tumors; muscles may be involved in activities of the muscles most affected first; gravis activities of the morning light, after re-aggravating afternoon break reduce or disappear after; tendon reflexes are usually not affected; cholinesterase inhibitor treatment is effective
3. Poisoning: organophosphorus pesticides botulism caused by snake bites in the nerve - muscle transmission barriers by neostigmine or by phenol chloride will improve the clinical symptoms of these diseases have a clear history of one of the meat poisoning bacteria poisoning epidemic in the history of the toxin affects the nervous presynaptic membrane - the transfer function of the neuromuscular skeletal muscle paralysis occurs; shall promptly give the guanidine hydrochloride intravenous glucose and saline treatment
Why are the symptoms of myasthenia gravis easily repeated?
Myasthenia gravis is autoimmune disease, one of the characteristics of these diseases were chronic persistent course of disease and ease worsening alternating with the most patients to achieve clinical recovery after treatment (the patient's clinical symptoms and signs disappeared, and normal as to normal life, study, work, and stop all the drug treatment of myasthenia gravis.) Some patients may have a long remission, but the patients often due to trauma, systemic infections, excessive fatigue, endocrine disorders, immune disorders, women's menstrual period, and so a variety of factors, recurrence or aggravate the condition, Thus, recurrent symptoms of myasthenia gravis as the characteristics of this disease. Only aware of this, understanding the symptoms caused by repeated incentives to take appropriate preventive measures and active treatment, thus avoiding or reducing the symptoms of myasthenia gravis repeated.
Fas / FasL and Bcl-2 in myasthenia gravis in them?
Thymus in the Fas / Fas L (Fas Ligand) anomalies in the pathogenesis of myasthenia gravis may have an important relationship. It has been reported in recent years, the expression of Fas protein in autoimmune disorders and certain related diseases and MG. Fas antigen, also known as Apo-1 antigen, is a type I transmembrane protein belonging to tumor necrosis factor (Tumor Necrosis Factor, TNF) and nerve growth factor receptor protein superfamily. Fas L is a type â…¡ membrane protein, also belongs to TNF family is the natural Fas ligand in vivo. Fas and Fas L binding only to induce apoptosis. Has confirmed that the main expression of Fas in the thymus in the medulla, is involved in thymocyte negative selection of important molecules. Fas / Fas L pathway induced apoptosis in the removal of autoreactive T cells, regulation of lymphocyte activation and T lymphocyte toxicity (Cytotoxic T Lymphocyte, CTL) kill target cells play an important role.
HE staining cytoplasm thymoma cells do not appear condensed, smaller in size, cell shrinkage and nuclear density, etc. The morphological changes of apoptosis. Fas expression in thymoma was significantly higher than the normal thymus tissue, not only in the tumor cell membrane but also in the cytoplasm is uniform distribution. Thymoma cells, soluble Fas and Fas L binding to Fas L binding site depletion, thereby blocking the cell apoptosis. Fas gene is highly conserved homology between different patients was 99.6% ~ 100%, Fas molecular homology of 98.7% to 99.7%. MG patients with thymus cells may be related to abnormal proliferation of Fas gene mutation, 75% of MG patients with thymus Fas gene mutation and amino acid mutation, gene mutation type 164 AG, corresponding to 55 amino acid mutations Asp-Gly, 96   His -Arg, 192   Arg-Lys and 251 Lys-Arg.
Thymic hyperplasia and thymoma may be associated B cell lymphoma gene -2 (B cell lymphoma-2, Bcl-2) related. Bcl-2 is the first one recognized human longevity genes resistant to various forms of cell death and prolong cell life, but may also lead to increased accumulation of the number of cells and promote tumor formation. In the immune system, immune cell maturation in Bcl-2 plays an important regulatory role. In the thymoma protein Bcl-2 expression level is extremely elevated, significantly higher than the normal thymus; Bcl-2 expression, accompanied by the thymoma thymoma MG is higher than the simple, and accompanied by thymoma cells The infiltration of surrounding tissue. Because the regulation of Bcl-2 gene, MG patients was inhibited apoptosis.
Myasthenia gravis contagious?
Under normal circumstances Myasthenia gravis is not contagious.
Myasthenia gravis is a neuromuscular junction in skeletal muscle damage consisting mainly of common neuromuscular diseases, but also a nerve myopathy in a representative autoimmune disease. Mainly as highly involved in skeletal muscle fatigue, the body can be involved in skeletal muscle disease, the most common extraocular muscle involvement, manifested as ptosis, diplopia and so on. Bulbar muscle involvement manifested as eating cough, stiff facial expression, drums gills leak, shut up and not tight, unclear articulation, severe inability to chew and swallow completely, no expectoration. The patient can not comb the hair of limbs Sin face, his arms on the move difficult, or from the squatting difficulty, easy to fall down the stairs difficult, and even respiratory muscle weakness, respiratory failure, life-threatening. TCM attributable to atrophy card, meat atrophy. The main cause is due to external injury or by the parents of the kidney in patients with intrinsic lack of precision led to the gas shortage in patients with congenital liver loss; acquired dystrophy, temper weak and sick.
The cause of myasthenia gravis is inconclusive immunology, autoimmune disease occurred in the genetic basis to their internal genetic Ke; in external factors, most people think and the thymus of chronic viral infection. With HLA-A1, A8, B8, B12, Dw3, the myasthenia gravis patients are female, young onset, thymic hyperplasia, no tumor, acetylcholine receptor antibody detection is low, with anti-cholinesterase drugs ineffective good effect of early removal of the thymus. With HLA-A2, A3 of the disease myasthenia gravis patients are male, 40 years after the onset, multi-thymoma, acetylcholine receptor antibody detection rate.
These are not cases of myasthenia gravis thymectomy invalid, may be due to: ① incomplete resection; ② at the neuromuscular junction has been irreversible damage; ③ place in the thymus, spleen and lymph nodes in the lymphocyte population in the thymus of class still causes ; ④ long-term survival of T cells are still active around; ⑤ different mechanisms of the original disease, each patient reacts differently to the impact of the thymus.
Thus, myasthenia gravis is a hereditary disease, but does not have a contagious nature. Edit this section | Back to the top of the genetic susceptibility to myasthenia gravis
Myasthenia gravis have a certain genetic predisposition, in part through the investigation of patients with positive family history. About 12% to 20% suffering from myasthenia gravis patients newborns born to mothers with myasthenia gravis, usually there are signs that at birth, but occasionally delayed 12 ~ 18h, the difficulties often associated with sucking and swallowing difficulties, weak cry, acetylcholine receptor antibody through the placenta into the fetal blood is the main cause. Antibody degradation in the destruction of fetal blood constantly, also the corresponding improvement in clinical symptoms, so type as temporary, the symptoms disappeared spontaneously within 3 weeks more, when the gradual reduction of drug dosage or discontinuation, the risk of recurrence was not found. Of critically ill infants should be given treatment immediately, according to the disease to the oral neostigmine 1 ~ 5mg, and maintained on respiratory function and nutritional support.
(A) of congenital myasthenia gravis
This type refers to the normal mothers of newborns suffering from myasthenia gravis, the family often patients with myasthenia gravis. 42% of cases at 2 years old, 66% of the disease before the age of 20. Infants in the non-acetylcholine receptor antibodies, its pathogenesis and heredity. Postsynaptic membrane abnormalities; almost complete lack of functional joint fold, tiny structures reduced endplate acetylcholine receptor deficiency. This type of transient neonatal myasthenia gravis with different symptoms of persistent, non-complete remission. Symptoms is at birth or shortly after the emergence of significant involvement of extraocular muscles, usually involving the facial muscles can be affected by food intake. Systemic weakness rare.
(B) of the familial infantile myasthenia gravis
Refers to the normal infants and mothers suffering from myasthenia gravis, there are other families of patients with myasthenia gravis, such as brother or sister, for the autosomal recessive born with severe respiratory difficulties and feeding problems, especially apnea characteristics are different in the first two types, often resulting in infant death due to respiratory failure. More than symptom onset within 2 years of age, have a natural tendency to ease, with age could be better, but it can also be caused by infection and then nearly died of suffocation. Anticholinesterase drugs effective, it should be diagnosed early.
(C) the lack of cholinesterase
This type of myasthenia gravis is due to the lack of end plate AChE sub-neural structures caused by eye muscle involvement in children and cranial nerve â…¨ ~ â…« dominated muscles, trunk muscles are affected, proximal than distal limb weight. Tang Hei Long test was negative, with anti-swelling medication or increase the base of acetylcholine esterase release guanidine invalid, and prednisone treatment obvious.
(D) Youth gravis
4% of all MG patients before the onset of 10 years of age, 24% of the cases before the onset of the age of 20, female dominant (4:1). The type and infantile contrast, relatively small genetic factors, mainly immunological mechanisms play a role in the pathogenesis. Slow disease progression, there was ups and downs. Thymoma rare. Edit this section | Back to the top of the myasthenia gravis common symptoms of 9
1. Ptosis: drooping eyelids, also known as. According to our analysis of 3100 cases of myasthenia gravis found to ptosis as first symptom of up to 73%. Can be seen at any age, especially children, more common. More to the side of the early and late, mostly on both sides, there are a lot of eyes stare up the side of the patient, the other side of the eyelids and drooping down, namely, the phenomenon appeared around the turn of ptosis.
2. Double vision: as the weight of the film. Together with the two eyes see one thing as two; if the cover one eye, then see is a. Very young children will not be described as on the complex and often compensatory to head tilt, torticollis, in order to see clearly the disappearance of diplopia, severe cases can also be expressed as strabismus.
3. General weakness: good skin from the outside it seems a good meat, and no muscle atrophy, as if not ill; but the patient often feels severe generalized weakness, can not lift the shoulder, the hand can not be mentioned, squatted stand up, even wash your face and hair have to rely on others for help. Symptoms of myasthenia gravis patients significantly improved rest, and do a little living will significantly increase, seemed to work out like. The patients are mostly accompanied by ptosis, diplopia and other symptoms.
4. Masticatory weakness: good teeth, but bite boring, and even bite bread felt effortless. How many heads can be fixed more bite more bite. Pancakes, eating barbecue even harder.
5. Swallowing difficulties: there is no gastrointestinal disease, appetite good, eat good food but a good meal but not swallow, even water can not enter the pharynx. Water into the trachea when not choking cough that flow out from the nostrils. Some patients with swallowing difficulties due to the serious need to rely on feeding tube to eat.
6. Face weakness: weakness of the whole facial expression, the patient is not touched upon during sleep are often closed. Normal expression of indifference, laughing very natural, like crying, like, also known as laughing and crying face. This makes face look very hard to accept, the patient is also very painful.
7. Speak nasal, hoarse voice: as suffering from a cold or influenza-like. Some patients speak or read newspapers meetings, the first few minutes of sound can be, a little longer, the sound becomes hoarse, low, and finally completely unable to pronounce the sound. You can also call the beginning of time, over time others will not hear what he said. This is due to the weak throat muscles.
8. Breathing difficulties: This is one of the worst myasthenia gravis symptoms, the patient can be fatal in a short time, it is also known that it is myasthenic crisis. This is due to respiratory muscle weakness due to severe. Was breathing very difficult patients, can not lie flat to sleep at night, only sitting breath. Cough with phlegm could not, not, like he
art disease, unlike asthma, but not due to lung cancer. Patients have such difficulty in breathing accompanied by most of dysphagia, limb weakness or drooping eyelids and so on.
9. Neck weakness: the performance of serious neck muscle weakness more prominent, the patient when sitting nutation phenomenon, summarized his hand to his chin up and head quite, if the patient supine (no pillow pillows) can not bend his neck rise. Edit entry Open Category:
Immunology, immune disease, atrophy, myasthenia gravis Reference prevention and treatment of myasthenia gravis knowledge: http://www.k901.com/a/114/362
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