Thyrotoxic periodic paralysis

Acute hypokalemic paralysis is an uncommon cause of acute muscle weakness. This disease is associated with high morbidity and mortality secondary to acute respiratory failure. Thyrotoxic hypokalemic paralysis [THP] is a potentially reversible phenomenon after establishment of euothyroid state with appropriate therapy. The clinical presentation of THP is similar to familial periodic paralysis [FPP] except for older age at the oncet of disease and lack of family history. This disease is more common in Orientals and Asians. The initial presentation of THP is not different from that seen in [FPP] and constitute a medical emergency. Patients should be treated aggressively with potassium supplimentation until serum potassium is normalized and hyperthyroidism is controlled. In this report, we describe our experience with 3 Asian patients who manifested severe attacks of THP. After establishment of euothyroid state, none of the patients experienced subsequent attacks after 2-7 years of follow-up

Hashitoxicosis with renal artery stenosis

A13 year old Kuwaiti girl who had thyrotoxicosis and hypertension is described. She had Hashitoxicosis [Graves disease and Hashimoto's thyroiditis] as evidenced by the presence of a high titre of antithyroid antibodies in addition to elevated thyroxin level. Subsequent investigations of hypertension disclosed the presence of right focal renal artery stenosis caused by fibromuscular dysplasia. Percutaneous transluminal angioplasty was done and blood pressure fell within 24 hours of the angioplasty and was maintained satisfactorily for 18 months without medication.The association, to our knowledge, between Hashitoxicosis and renal artery stenosis has not previously been reported. It could be an interesting coincidence

Precipitation of hepatic encephalopathy by propranolol

Propranolol is used to prevent recurrent variceal bleeding in patients with periportal hypertension and cirrhosis. Though controversy still exist regarding its efficacy in these conditions, its potential to precipitate hepatic encephalopathy is rarely reported. In this case report, we describe a patient who developed severe hepatic encephalopathy shortly after porpanolol treatment and recurred on rechallenge with the drug

Risk factors for acute myocardial infarction as seen in coronary care unit, Farwania hospital in Kuwait

In order to assess the hazard ratio of serum cholesterol concentration, hypertension, diabetes mellitus and smoking as risk factors for acute myocardial infarction associated solely with males, a case-control study was carried out on 252 male patients admitted with acute myocardial infarction on the coronary care unit [CCU], Farwania Hospital in 1986. Two hundred and fifty-two males of similar age were seen in the medical outpatient department [MOPD] who had functional dyspepsia during 1986. Being proved to be free of heart disease, they were studied as a control group. We found that the hazard ratios of acute myocardial infarction with respect to risk factors were as follows: for serum cholesterol above 6.5 mmol/L versus below 5.2 mmol/L, 9.95 [99% confidence limit 3.86 to 25.61]; for blood pressure in the highest quintile, 2,01 [99% confidence limit 1.15 to 3.49]; for smoking 10 or more cigarettes daily versus never smoking 2.26[99% confidence limit 1.43 to 3.56]; for diabetics versus non-diabetics, 1.74 [99% confidence limit 1.04 to 2.92]

Acute coronary care-One year report

A one year experience in the coronary care area is summarized, and arrythmias and other complications of acute myocardial infarction were analysed in 196 patients. The relative rates of acute myocardial infarction in Kuwaitis and expatriates were estimated. They range between 1.4 times [95% confidence interval 0.39 to 6.8; P < 0.05] to 2.5 times [95% confidence interval 1.4 to 4.7; P < 0,05] higher in Kuwaiti males than in expatriates. This is in contrast to females where the relative rate of acute myocardial infarction is 0.69 times [95% confidence interval 0.066 to 12.2; P < 0.05] to 0.85 times [95% confidence interval 0.158 to 4.06; P < 0.05] lower in Kuwaitis than in expatriates. To our knowledge this is the first study dealing with this topic in Kuwait. The present and future status of the coronary unit and the coronary care nurse are discussed. Unsolved problems related to the care of patients and to mortality in myocardial infarction are briefly touched upon