syndrome of resistance of thyroid hormone, misdiagnosed as thyrotoxicosis

to report two cases of resistance to thyroid hormone to increase the awareness of this syndrome, which is frequently misdiagnosed and incorrectly treated. we described two siblings, both of whom were diagnosed as having thyrotoxicosis and one of them was treated with carbamazole and subsequently developed hypothyroidism. Both patients showed features of resistance to thyroid hormone and required additional L-thyroxine to normalize the thyroid stimulating hormone level while remaining clinically euthyroid. Laboratory evaluation revealed increased serum thyroxine and tri-iodothyroxine levels as well as increased thyroid stimulating hormone [TSH] levels. The free alpha subunit/TSH ratio was normal, and CT of the pituitary gl and showed no tumour. Metabolic studies using graded doses of tri-iodothyroxine supported the diagnosis. The two patients have resistance to thyroid hormone but were erroneously diagnosed as thyrotoxic and one of them inappropriately treated. Patients with elevated plasma levels of thyroid hormones with high or normal TSH level need careful evaluation of the hypothalamic-pituitary function and peripheral action of thyroid hormones

Superior mesenteric artery syndrome: an uncommon cause of intestinal obstruction; report of two cases and review of literature

Superior mesenteric artery [SMA] syndrome is caused by the compression of the third part of the duodenum leading to upper intestinal obstruction which is aggravated when the patient is lying in the supine position. Predisposing factors include rapid weight loss, application of a body cast after spinal surgery, prolonged recumbency, and abnormal position of the ligament of Treitz. Diagnosis may be difficult but can be confirmed by upper gastrointestinal contrast studies. Treatment is mainly conservative and if failed, surgical intervention is warranted. We report two children who were diagnosed with SMA syndrome and discuss the clinical picture, ways of diagnosis and methods of treatment

Recurrent splenic sequestration in a Kuwaiti boy with sickle cell disease

Children suffering from sickle cell disease are susceptible to different types of crises, such as acute vaso-occlusive, haemolytic, aplastic and sequestration crises. The classic acute sequestration crisis is a serious condition usually affecting black children, in which large amounts of blood are suddenly pooled into the spleen. The spleen suddenly enlarges markedly and signs of circulatory collapse rapidly develop, leading to death unless an emergency splenectomy is performed. Minor recurrent sequestration episodes have been recently reported in patients with sickle cell disease and a high fetal haemoglobin concentration. These episodes are of a milder presentation and outcome can be managed with repeated blood transfusions and later, elective splenectomy In this case report, we describe an Arab Kuwaiti boy with recurrent splenic sequestration who was treated with elective splenectomy, and propose a policy for the management of such patients

Childhood nocturnal enuresis: a problem to be solved

Nocturnal enuresis is a common problem in paediatrics which causes concern for the child, his parents, and the treating paediatrician. Although the physiopathology is not yet well understood, the most accepted theory is that there is a delay in the development of the micturation reflex, a condition with a genetic predisposition. Management includes a detailed history, a thorough physical examination, and investigations to exclude pathologic causes. Treatment is based on achieving a good communication with the child and his parents by explanation of the benign course and the high spontaneous remission rate, behavioral and conditioning therapy with the use of a buzzer alarm and the gold star chart, and finally the introduction of drugs to accelerate remission; these include imipramine, oxybutinine, and desmopressin

Cholinergics - aromatic amino acids and amines interactions a spectroscopic investigation

UV absorption spectroscopic methods were used for the studies of interaction between some cholinergic compounds; acetylcholine, acetyl- beta methylcholine, and carbacholine, with indolic compounds; L-tryptophan and tryptamine in order to elucidate the mechanism of action for these neurohumoral compounds at the molecular level. This was done through calculation of thermodynamic parameters [K, delta G°, delta H°, and delta S°] for 1:1 complex which is predominated. The K values were mostly less than one and were found to be temperature and wavelength dependent, which reflect the values of other thermodynamic parameters. A charge transfer [CT] complex formation between cholinergic compounds [electron- donors], and L- tryptophan and tryptamine [electron- acceptors] was concluded

Older maternal age and pregnancy outcome

A prospective study of 357 pregnancy women 35 uears older who were delivered at Baghdad Teaching Hospital from August 1,1993, to June 30, 1994 was undertaken. Pregnancy was compared with a control group of 380 women whose ages were 20-29 years at delivery. There was a significant increase in the incidence of the following complications: hypertension, diabetes, varicose veins, pretem delivery and post partum haemorrhage. The incidence of operative deliveries was increased in old pregnant women compared to the control group. Infants of older women had a significant increase in macrosomia, low birth weight, low Apgar scores, anomalies and perinatal death. Pohysicians caring for older pregnant women must be aware of the risks in order to provide comprehensive medical and obstetrical care

Serodiagnosis of human hydatidosis

In this study a compartive evaluation of indirect fluorescent antibody test [IFAT] and enzyme linked immunosorbent assay [ELISA] techniques have been done on 15 patients for hydatidosis, using sheep hydatid antigen in serodiagnosis of hydatidosis. It was found that the sensitivity of IFAT was 80.0% and ELISA was 86.7%. Stastically there were no significant differences between the two tests. A total of 658 blood samples were collected on filter paper from individuals representig seven section of the population of Al-Taameem province [veterinarians, animal breeders, medical official, children, labourers, housewives and officials]. They were examined for hydatid cyst antibody using both IFAT and ELISA techniques hydatid cyst antibody was found in 17 individuals [2.58%]. The positive cases were 15 animal breeders [6.4%] and 2 veterinarians [5.0%]

effects of some prostaglandin synthesis inhibitor drugs on serum glucose and insulin levels in diabetic patients

The effect of conventional doses of prostaglandin synthesis inhibitors [FGSIS] on serum glucose and insulin levels was studied in 30 diabetic patients. The results show that treatment with aspirin [one gram tds] for three days did not cause a significant change in fasting serum glucose and insulin levels, but it caused a significant drop in serum glucose and elevation in serum insulin following glucose load. Mefenamic acid [250 mg tds] given for three days did not alter significantly the fasting serum glucose or insulin and it did not change the serum glucose or insulin levels following glucose load. Diclofenac [25 mg tds] given for three days again did not alter fasting serum glucose or insulin and it did not affect significantly the serum glucose or insulin levels following the glucose loads

effects of proglumide and cimetidine on ulcer production and serum calcium level of reserpinized rats

In rats, dose response studies for reserpine were carried out to obtain a 100% rate of gastric ulcer induction. Reserpine 200mg/kg i.p. induced within 20hrs. a 100% gastric ulceration accompanied by a significant rise in serum calcium level above normal. The subcutaneous administration of two antiulcer agents namely proglumide and cimetidine to two groups of reserpinized rats resulted in a significant fall in serum calcium level and the extent of ulceration in the proglumide treated reserpinized rats. These parameters were not changed in the cimetidine treated group.It is therefore concluded that proglumide significantly reduced the extent of [UI] in reserpine induced gastric ulcers in rats, and the association between [SCL] and peptic ulceration has to be further investigated

Effects of bees honey, zahdi date and its syrup on blood glucose and serum insulin of normal subjects

Postprandial glycemia and rise in serum insulin after bees honey, zahdi dates and zahdi date syrup, were compared with those after glucose alone and with mixtures of sugars having the same ratio found in honey and syrup; in 21 healthy volunteers. In the honey-study group [10 subjects], the lowest level of blood glucose was after honey, while the level after F.G.S. was not significant in comparison to the levels after glucose and honey. In the syrup-study [9 subjects], the lowest level of blood glucose was after the syrup followed by the F.G. mixture and lastly after glucose. On the other hand there was both a gradual rise and declination after date [12 subjects], with a much lower level than after glucose. - The serum insulin responses after honey and syrup, and their corresponding mixtures were lower than after glucose alone. In the meantime, the two mixtures F.G.S. and F.G. caused a significant higher level of serum insulin than glucose alone at the end of the test period. The serum -insulin after dates was significantly lower than after glucose in the first half of the test period, but higher at 120 mm. Interval