Myasthenia gravis accompanied with hypokalemic periodic paralysis.

Myasthenia gravis and hypokalemic periodic paralysis are commonly related with hyperthyroidism but rarely occur together. Here, the authors reported a case of hypokalemic periodic paralysis in a Northeastern Thai woman accompanied with myasthenia gravis. She had motor weakness despite a normal level of serum potassium. Prostigmine test was positive. She dramatically improved after pyridostigmine treatment. Autoantibodies to nicotinic AchR-Ab and dihydropyridine receptor or L-type voltage gated calcium channel were postulated to explain these associated diseases.

The rate of checking urine microalbumin and aspirin primary prevention in type 2 DM.

BACKGROUND: The American Diabetic Association recommends type 2 Diabetes Mellitus (DM) to take aspirin therapy as a primary preventive way. It should be implemented in cases that are aged over 40 with at least one additional risk such as hypertension, obesity, dyslipidemia. Urine microalbumin now also ranks as a major risk factor for atherosclerosis. OBJECTIVES: The authors aimed to evaluate the rate of urine microalbumin determination and the use of such preventative aspirin therapy at Srinagarind Hospital. MATERIAL AND METHOD: The authors randomly selected the charts of type 2 diabetics treated for at least one year at the hospital a outpatient department by a block of four techniques. The inclusion criteria were aged more than 40 years old and never had any atherosclerotic events. Cases were excluded if they had a history of aspirin allergy or active upper gastrointestinal bleeding. By the end of July, 2004, 109 patients were enrolled (44 males). RESULTS: The mean age and duration of diagnosed diabetes mellitus was 60.8 and 7.4 years, respectively. Forty-four cases (40.4%) were checked for urine microalbumin. Eight cases had microalbuminuria and four cases had macroalbuminuria. Every case was treated with aspirin because they had at least one additional atherosclerotic risk factor, mostly more than two. But aspirin therapy was used in only 35 cases (32.1%) with the appropriate dose in only six cases (17.1%). CONCLUSION: Physicians should consider more about checking urine microalbumin and aspirin as primary prevention in type 2 DM.

Seizure presenting to the emergency department, Srinagarind Hospital.

The authors would like to evaluate the incidence, clinical manifestation, the appropriateness of treatment, and outcome of seizure at the emergency department (ED). All charts of patients who visited the ED of Srinagarind Hospital from 1 January 2003 to 31 December 2003 were reviewed. The profiles of patients and management at the ED were recorded. There were 33,508 cases who visited the ED with 104 cases (0.31%) presenting with seizure. Four cases (3.9%) were diagnosed as status epilepticus. Generalized tonic-clonic seizure was the most common type. Poor antiepileptic drug (AED) compliance with the low AED level was the main precipitating factor. The normal physical examination and routine laboratory tests were normal in the majority of patients. Phenytoin intravenous loading was the commonest initial treatment even in patients with non-status epilepticus. Fourteen patients (13.5%) were treated with intravenous diazepam even though seizures were discontinued. Sixty patients (57.7%) were discharged after seizure was controlled. The advice in seizure control was recorded in only 11 cases (10.6%). From this review, 12 patients presented at the ED for continuing medication without any seizures. In conclusion, seizure at the ED should be treated more appropriately with both laboratory investigation and drug treatment. Futhermore, patient education should be implemented.

Horizontal conjugate gaze palsy in eosinophilic meningitis.

Two cases of eosinophilic meningitis who presented with headache and strabismus are reported. Pertinent physical examination revealed unilateral horizontal conjugate gaze palsy with absence of doll's eye maneuver and hemiparesis. The etiologic agent of eosinophilic meningitis is presumed to be Angiostrongylus cantonensis and the infected location that produce horizontal conjugate gaze palsy was a pontine lesion.