ABSTRACT
AIMS OF THE STUDY: To assess the significance of clinical versus biochemical diagnosis of hypothyroidism using a clinical scoring index and optimize the therapeutic dose of levothyroxine in Indian patients. METHODOLOGY: Three hundred and eighty eight cases of primary hypothyroidism (male:female ratio 1:5.8) were clinically classified as hypothyroid, euthyroid or inconclusive by Billewicz score. TSH estimation was repeated at 6-8 week intervals and appropriate adjustments in levothyroxine dosage made till the TSH was within the normal range. RESULTS: Of 388 biochemically confirmed hypothyroid subjects less than one fourth (21.6%) could be classified as hypothyroid, almost one half were euthyroid (48.4%) and the remaining (29.9%) fell in the inconclusive category according to Billewiz score. Of 227 patients who returned for complete follow up there was a positive correlation of replacement dose with age and initial weight in females, but not in males. Baseline TSH values were not found to have a significant correlation with the initial dose. The mean replacement dose of levothyroxine (T4) in our subjects was 109.4 +/- 24.05 microg/d (range 1.25-3.84 microg/kg). CONCLUSION: Clinical parameters alone fare poorly in establishing an unequivocal diagnosis of hypothyroidism. A biochemical confirmation is mandatory. The replacement done of T4 was found to be independent of the basal TSH level.
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Hypothyroidism/diagnosis , Infant , Infant, Newborn , Male , Middle Aged , Reference Values , Thyroid Function Tests , Thyroid Hormones/blood , Thyrotropin/blood , Thyroxine/therapeutic useABSTRACT
Renal artery stenosis after renal transplant is a dreaded complication. We report two cases of post-renal transplant stenosis in internal iliac artery used for end-to-end anastomosis with the graft renal artery. Both patients were successfully treated by percutaneous transluminal angioplasty with stenting of the internal iliac artery.
Subject(s)
Adult , Anastomosis, Surgical , Angioplasty, Balloon , Humans , Iliac Artery , Kidney Transplantation/adverse effects , Male , Middle Aged , Renal Artery Obstruction/therapyABSTRACT
A total of 661 esophageal motility studies were performed in 568 patients over a five year period in a tertiary care hospital. Patients referred for investigation generally presented with one of three symptoms: dysphagia, reflux or chest pain. Dysphagia was more closely identified with organic esophageal dysfunction than other symptoms. Normal studies were recorded in 201 instances (30%). Studies demonstrating either a major or minor non-specific motor disorder were found in 380 cases (58%). Achalasia was found in 48 patients who underwent 65 procedures (10%). Scleroderma was diagnosed in 7 patients (1%). Elderly patients were not found to have diminished esophageal function when compared to a young group.