Hypokalemic periodic paralysis as a manifestation of thyrotoxicosis.

OBJECTIVE: To study the clinical characteristics of patients who suffer from hypokalemic periodic paralysis, as the presenting symptoms of thyrotoxicosis. MATERIAL AND METHOD: A retrospective review of 29 patients who presented with the syndrome of hypokalemic periodic paralysis as the symptom of thyrotoxicosis at Ratchaburi Hospital between January 1,1995 and December 31, 2007. Patients'data, diagnosis, blood chemistry, and thyroid function test were collected from medical records. RESULTS: All patients exhibited muscle weakness for a duration of one to two days, while all patients with hypokalemic periodic paralysis were determined to have high serum thyroid hormone and diagnosed with thyrotoxicosis. Patients with hypokalemic periodic paralysis were the first symptom leading to diagnosis of thyrotoxicosis. The attack of weakness occurred during the night in all patients. The patients, 96.6% being male, showed improvement of their symptoms through potassium replacement and thyrotoxicosis treatment using propylthiouracil and non selective beta adrenergic blocker All patients recovered and did not demonstrate reoccurring hypokalemic periodic paralysis. The degree of muscle weakness was found to correlate significantly (p < 0.05) with level of serum potassium, magnesium, and duration of weakness. CONCLUSION: It is important to determine blood thyroid hormone in all patients with hypokalemic periodic paralysis.

Prognosis in hypoxic ischemic encephalopathy.

A retrospective review of survivors of cardiopulmonary arrest included 56 patients. Twenty two had a good outcome and thirty four were seriously impaired. Depth and duration of post arrest coma correlated significantly with poor neurologic outcome. Seventy percent of the seriously impaired patients never regained consciousness and non emerged from coma within five days; all of the patients with good outcome were alert within twenty hours after resuscitation. Coma, motor unresponsiveness, absent brainstem reflexes were closely associated with dismal prognosis for neurologic outcome. This study cannot provide a basis for discontinuation of life support at any specific time.

Epilepsia partialis continua as a manifestation of hyperglycemia.

A review of 22 patients who presented with the syndrome of epilepsia partialis continua as symptoms of hyperglycemia and occurred during the phase of hyponatremia and mild hyperosmolality. Epilepsia partialis continua persisted for an average of 9 days,and its duration correlated with the degree of hyponatremia, low blood urea nitrogen(BUN) and measured serum osmolality. In all patients, epilepsia partialis continua was the first symptom leading to the diagnosis of diabetes mellitus. The epilepsia partialis continua ceased by normalization of blood glucose level. All patients survived and did not have any complications. The majority of the patients had evidence of a localized structural brain lesions and low serum sodium. Metabolic abnormalities including hyperglycemia,mild hyperosmolality and hyponatremia contribute to the development of epilepsiapartialis continua in an area of focal brain damage. It is important to determine blood glucose levels in all cases of epilepsia partialis continua.

Outcome after transsternal radical thymectomy for myasthenia gravis: 14-year review at Ratchaburi Hospital.

OBJECTIVE: To determine predictability factors, clinical features and outcome in the patients after transsternal radical thymectomy (TRT) for Myasthenia Gravis (MG). METHOD: A 14-year retrospective review (1990-2004) and analysis of medical data on 32 patients with MG who underwent TRT. Two patients were lost to follow-up. Preoperative medication included anticholinesterase drugs and steroids. Plasmaphereses were used in 2 cases before operation. The modified Osserman clinical classification (Table 1) was used to define disease severity. The status of the patients was evaluated as follows: A (remission), B (improvement), C (no change), D (deterioration), E (death due to myasthenia gravis). Using univariate analysis, sex, age, onset, Osserman class and pathology correlated with outcome and statistical significance is defined as P < 0.05. RESULTS: Among the 30 patients in the present study with MG who underwent TRT women comprised 70% (21 of 30 patients), and mean age was 42.87 +/- 12.16 year (19-65 years). The preoperative duration of the disease ranged from 0.5 to 120 months (mean = 25.72 +/- 30.68 months). Clinical statuses of patients as assessed on initial evaluation were 13 patients (43.3%) were in class IIA, 6 (20%) in class IIB, and 11 (36.7%) in class III. (Table 2) The histology of thymus glands consisted of hyperplasia in 22 patients, normal in 2, atrophic thymus in 3, thymomas in 3, (2 were malignant thymomas). Hospital mortality was 0, but 9-month mortality was 3.33% (1 of 30 patients). The mean follow-up period was 41.80 +/- 53.89 months. Complete remission (A) was achieved in 40% of patients (12 of 30), and marked improvement (B) of MG in 40% (12 of 30), for a total benefit rate of 80%. 6.7% (2 of 30) were unchanged (C), 10% (3 of 30) were worse (D) and 3.3% died because of MG (E). Using univariate analysis on sex, clinical status by Osseman classification, and histopathology correlated significantly with outcome (P < 0. 05); 95.2% of women (20 of 21) benefited from the procedure, versus 44.4% of men (4 of 9). 100% (19 of 19) of patients in class IIA and IIB benefited from the procedure, versus 45.5% (4 of 9) of patients in class III. All patients with thymoma presented a less favorable outcome (deteriorated in 2, and died in 1) versus 11.1% (3 of 24) of patients without thymomas were deteriorated. CONCLUSION: The remission and improvement in 80% of patients suggested that adequate thymic tissue were removed with radical thymectomy. Female, absence of thymoma, thymic hyperplasia, patients in class IIA, and IIB (non-respiratory involvement) are favorable predictability prognostic factors.