[Features of the clinical picture, course and treatment of myasthenia in late middle-aged and aged persons]. / Osobennosti kliniki, techeniia i lecheniia miastenii u lits pozhilogo i starcheskogo vozrasta.

On the basis of many-year observation of 345 patients with myasthenia (M) developing in elderly and old age (from 50 to 82 years) the authors analyzed the characteristics of the clinical picture of myasthenia in this age group and determined changes in the ratio between males and females first presenting M at this age. The effect of different types of treatment and their combinations employed in these patients was determined. The authors recommend the use of pathogenetic methods of M treatment (thymectomy, X-ray therapy, and prednisolone therapy) in this age group. The most effective method is a combination of thymectomy and X-ray therapy with prednisolone administration.

[Strategy for using glucocorticoid preparations in neuromuscular diseases]. / Strategiia primeneniia gliukokortikoidnykh preparatov pri nervno-myshechnykh zabolevaniiakh.

A total of 1630 patients with various neuromuscular diseases of autoimmune genesis were treated. Glucocorticoid drugs taken every other day were shown to be highly effective. On the basis of a large experience the authors propose recommendations for the management of patients in relation to the form, severity and course of the disease with the objective of achieving the maximum therapeutic effect.

[Immunologic pathology in patients with disorders of neuromuscular transmission]. / Immunologicheskaia patologiia u bol'nykh s narusheniem nervno-myshechnoi peredachi.

The article presents an analysis of long-term follow up studies of more than 2500 patients with various forms of neuromuscular transmission impairments. The results of repeated observations, employing electromyographic and immunologic techniques made it possible to raise a question about the homogeneity and differences in the mechanisms of myasthenia formation, and also about combinations of myasthenia with other autoimmune diseases and with the myasthenic syndrome of Lambert- Iton 's type.

[Efficacy and adverse effects of using large doses of corticosteroid preparations administered every other day]. / Effektivnost' i pobochnye iavleniia primeneniia kortikosteroidnykh preparatov v bol'shikh skheme po cherez den'.

The authors analyze the efficacy and side effects of prednisolone administered to 600 patients for myasthenia and polymyositis in a dose of 0.8 to 1.5 mg per kg body weight every other day for a period ranging from 3 months to 10 years. Practically complete remissions and substantial improvement were attained in 74% of the patients. None of them showed pronounced symptoms of hypercorticism. Of the side effects the most frequent were luniform face, vegetative disturbances, hirsutism. It is shown that the degree of the side effects is associated not with the duration of the prednisolone treatment, but with initially large doses of the hormone. Transition to supporting therapy in a dose of 0.4 to 0.6 mg/kg led to a substantial diminution and disappearance of the corticosteroid-produced side effects.

[Clinical and electromyographic characteristics of syndromes of pathologic muscular fatigue of the myasthenic type]. / Klinicheskaia i élektromiograficheskaia kharakteristkika sindromov patologicheskoi myshechnoi utomliaemosti miastenicheskogo tipa.

On the basis of the follow-up study of more than 2000 patients with different forms of pathological muscular fatiguability of the myasthenic type, the authors emphasize the heterogeneity of this group of patients. The detailed study of clinical and electromyographic picture permitted them to distinguish the following clinical forms; myasthenia, myasthenic syndrome in terminal polyneuropathy, the myastheniapolymyositis complex, myasthenic syndrome of Lambert--Etone type.

[Pathogenetic therapy of nervous system and muscular diseases using large doses of prednisolone on alternate days]. / Patogeneticheskaia terapiia zabolevanii nervnoi sistemy i myshts bol'shimi dozami prednizolona cherez den'.

A total of 230 patients with myasthenia, polymositis, disseminated sclerosis and myeloradiculopolyneuronitis were administered high doses of prednisolone (up to 100 mg) every other day. The treatment efficacy and low incidence of side effects and complications are emphasized. High doses of prednisolone given every other day do not inhibit secretions of endogenic ACTH and cortisol. The immunodepressant effect of the drug remains unchanged.

[Neuro-muscular synapse ultrastructure in the Lambert-Eaton myasthenic syndrome]. / Issledovanie ul'trastruktury nervno-myshechnykh sinapsov pri miastenicheskom sindrome Lamberta--Itona

A study was made of the ultrastructure of the neuro-muscular synapses in the patients with the myasthenic Lambert-Eaton syndrome. Most of the synapses displayed an increased content of synaptic vesicles in the axon terminals, and the anastomosing synaptic folds were increased in number and depth. Local destructive changes were found in the terminals of some synapses. The data obtained confirmed the fact that this syndrome was underlied by disorder of the transmitter release from the presynaptic structures.

[Ultrastructure of the neuromuscular junction in myasthenia]. / Ul'trastruktura nervno-myshechnogo soedineniia pri miastenii

The ultrastructure of neuromuscular synapses were investigated in bioptic specimens of muscles in 15 patients with myasthenia. Changes were detected in the pre- and postsynaptic structures. As a rule, the process initiates with appearance of destructive changes in the terminals of axones and in the adjacent to them areas of the "sole" of the neuromuscular junction, which may lead to destruction of synaptic contacts. In some part of synapses, together with destructive changes, there were observed also regenerative changes. The most representative group of synapses were those possessing the following characteristics of the ultrastructure: an increased electron density of the axoplasm and a greater number of mitochondria in the terminals of the axones; changes in the organization of the symaptic cleft and folds; impoverishment of the "sole" in organellas; all these signs, according to the literature reports, should be considered as typical of myasthenic lesions of the neuromuscular synapses. Collation of the changes observed with the duration periods of the disease, as well as the fact that these changes can be seen in the same patients, justify the assumption about the existence of different stages of the synaptic defect: destructive, destructive-regenerative and myasthenic. From this point of view, the appearance of "myasthenic" synapses may be considered as a result of the proceding destructive-regenerative process.