- Myasthenia gravis is caused by an interruption of communication between nerves and muscles, following a lack of a neurotransmitter linked to muscle contraction.
- Thanks to these interventions, the children’s hospital improves its learning curve, so that more and more children can be taken care of in order to prevent their quality of life from deteriorating, by not being able to carry out vital functions, such as breathing, in the face of progressive fatigue during the day
Thanks to advances in neurology and minimally invasive surgery technology, doctors at Children’s Hospital have managed to remove a minor’s thymus without having to open the chest, which is the best option for children. children reactivate their immune system and recover muscle functions, such as walking or talking, that they lose due to fatigue throughout the day.
This immune deficiency is called myasthenia gravis, which is caused by an interruption in communication between nerves and muscles as a result of the absence of a neurotransmitter linked to muscle contraction.
Medical science has discovered that the best option to counter this autoimmune problem is thymectomy, which involves removing the thymus, but at the children’s hospital, according to its director, Silvia Gutiérrez Lucatero, he has been venturing for five years with minimal invasion of surgeries, instead of opening the trunk.
“In this case, the transcendental of what concerns us is that this girl underwent minimally invasive surgery, which is very relevant and very important for us who deal with these types of cases. So that’s what is relevant, the type of technique that was used and that we are sure or sure all in the institution that, well, it is going to be part of the daily life of this hospital, “he pointed out.
With this practice, he argues, in which the children’s hospital improves its learning curve more frequently, more and more children can be cared for in order to prevent myasthenia gravis from deteriorating their quality of life. , unable to perform vital functions, such as breathing, in the face of progressive fatigue during the day.
“This type of condition which is myasthenia gravis. This causes these patients to suddenly lose strength, as the day progresses and strength decreases, which can lead to the loss of even respiratory effort. And we agree that a child who is not breathing a human being who is not breathing follows, that a cardiac arrest happens and that the patient becomes very ill,” he said.
José Ovidio Cornelio Nieto, head of the department of pediatric neurology, which is the area that diagnoses this condition, explains that the origin is an autoimmune reaction of the individual, which inhibits the production of a neurotransmitter that facilitates muscle functions .
“In this disease, autoantibodies are triggered against the acetylcholine receptor. Imagine that if the muscle had 20 little gloves, these antibodies leave nothing more than five gloves, where the acetylcholine will enter. Thus, the site where this neurotransmitter will act is diminished and the phenomenon of muscle contraction cannot occur,” he pointed out.
In this regard, he added that “myasthenia gravis is a disease that affects 10 to 20 people in 100,000, but in pediatrics, 15% of children with diseases who come to the pediatric neuromuscular neurology clinic have this condition”.
He explains that even if the treatment of this condition improves with medication than that of thymectomy, at the Children’s Hospital, for five years, it has evolved so much that this surgery is the least invasive and thus avoids opening the thorax, which meant being in intensive care after the operation, and more recovery time.
“Before, it was a drug treatment. When we started to have a little more experience, the removal of the thymus could produce a total improvement in the patient, because it is suspected that these antibodies are produced there. So it was a very bloody operation because the whole sternum had to be opened and the doctor, who is the expert in the matter, will take care of explaining it well. But now that must not be done,” he said.
And which children are candidates for thymectomy? According to Dr. Cornelio Nieto, those who have myasthenia gravis so marked that throughout the day they suffer from muscle fatigue that practically prevents them from performing certain functions, for which he described the following characteristics:
“The child may well get up in the morning, but as the morning goes by, his eyelids start to droop and he has to raise his head like that to look. Or sometimes he lifts his eyelids to see. They are starting to have difficulty, sometimes moving their arms, and early in the morning they could comb their hair. During the day, they can’t even lift it anymore because the muscles get weak, the facial muscles also get weak, they start to have an expressionless face. If in the morning they gestured at noon or you can’t see their faces anymore, their faces look sad, maybe they even have it. Sometimes the voice starts to change throughout the day,” he explained.
Vicente Sánchez Paredes, head of the department of thoracic surgery and endoscopy, points out that Irma is a young woman diagnosed with this condition at the hospital’s neuromuscular clinic, therefore, after studies in neurology, it has been determined that this suited him for thymus extraction, an option that until a few years ago was done with an opening in the sternum area, so it was very bloody.
“It’s something very painful to open a bone, not to mention the aesthetic aspect which ultimately for a child is also very important. It’s not the same to have surgery that you don’t notice, than to have surgery that, unfortunately, in this procedure that was done before, was immediately noticeable, no matter how much they wore a shirt. Finally, when they got dressed, they looked in the mirror and saw the huge scar on that part,” he said.
Now, he points out, the children’s hospital has made advancements in minimally invasive technology, and in the past five years has performed four other similar surgeries.
“Today we have the appropriate technology at Children’s Hospital to be able to perform this procedure using a so-called minimally invasive technique. Minimal invasion means that through some very small holes, two very small holes of five millimeters and one of just over a centimeter. Through this, we introduce a camera and special instruments that we have in the hospital and we receive this gland without having to open it,” he said.
The advantage of this type of operation, explains Vicente Sánchez Paredes, is that the patient recovers immediately and is discharged in 4 days, which also represents a saving in hospitalization.
“The patient is first extubated. This means that those patients, when they had surgery, before, due to the pain caused by the rib cage, which is responsible for breathing, could not move due to the operation, because the patient had to going out with a small tube in their throat so that a machine could breathe for them, which lessened the pain, in that it improved the union of the sternum a little and therefore, the patient could breathe on their own. This involved at least three or four days of intensive therapy and the use of a ventilator, which, if we were to talk about costs, we are talking about 50 to 100,000 pesos a day, in costs for nurses, medication, equipment use, monitoring”, held.
Sánchez Paredes assures that with this type of surgery, with which Tabasco is at the forefront in the Southeast, it is also satisfying for the children’s hospital to know that they will recover more quickly from the operation , as well as their motor skills, so that, he presumes, relates to a “boom” in surgical technology.
He says that it is also the “boom” of the psychological state of children who go through this disease, because their anemic state improves immediately, when they regain their functions.
From Irma, he said, the next day he went up to another floor to see his parents, and he asked where he had been operated on, as he felt no discomfort.
Because of these results, Lorena Martínez Trejo, mother of the young patient, says she is very grateful for the whole process given to her daughter by the specialists at the children’s hospital, from the diagnosis of myasthenia gravis, the observation period in his recovery arrange.
“The institution responded to us very well and the treatment that Dr. Ovidio and Dr. Vicente gave us, which is one, is not very common, but it has been satisfactory for my daughter’s health and, well , continue to help children with this severe myasthenia gravis,” he concluded.