Outcome of management of differentiated thyroid carcinoma.

A prospective study was done on 93 cases of differentiated thyroid carcinoma to find out the outcome of management according to the protocol followed in the Department of ENT-Head and Neck Surgery of Bangabandhu Sheikh Mujib Medical University Hospital. Here Papillary carcinoma is more common (76.35%) than follicular carcinoma. Papillary carcinoma affected in the younger patients more commonly than the follicular carcinoma with a mean age of 34.37years (SD=12.81) for papillary carcinoma and 44.93 years (SD=16.01) for follicular carcinoma; but age as a risk factor showed no significant difference between two histological types (p>0.05). Female was the predominant sex with a ratio of 3.04:1. In this series majority of patients were categorized as high risk group (75.27%). There is strong association between histological type & risk group (P<0.05). High risk group is more common in follicular carcinoma (95.45% Vs 69.01%). There was a significant differences between the two histological types for extrathyroidal extention and distant metastasis as risk factors (p<0.01 and p<0.001); but tumour size and lymphatic metastasis showed no significant difference (p>0.05). All low risk patients were treated by hemithyriodectomy followed by life long thyroxine. All high risk cases were treated with total thyroidectomy with (35.71%) or without (62.86%) different types of neck dissection (according to the degree of lymph node involvement) followed by radioiodine ablasion and lifelong thyroxine therapy routinely. Overall rate of complication of thyroid surgery was 23.08%. The commoner complications were vocal cord palsy (5.5%), hypoparathyroidism (5.5%) and haemorrhage (4.4%). Less common complications were laryngeal oedema (2.2%), wound infection (2.2%), tracheal injury (1.1%) and death (2.2%). Many cases lost to follow up. Sixty seven cases (73.64%) responded well for follow-up. Mean duration of follow up was 3.40 years (SD=1.41). There was recurrence in thyroid remnant in 9.09% of hemithyroidectomy cases and were treated by completion thyroidectomy followed by radioiodine ablasion. Regional lymphatic metastasis was seen in six cases and was treated by different types of neck dissection. Recurrence at distal site was seen in 4 cases (18.18% of follicular carcinoma). These were treated by radioiodine ablation; two of them died during the period of follow-up.

Assessment of the available obstetrical resources, all hospitals [40] in Gezira state, Sudan

This study was done for the purpose of assessing the available Obstetrical resources [materials and human] in 40 hospitals in Gezira State, Sudan. The results were used in preparing a major health project; University of Gezira Initiative for Safe Motherhood and Childhood [UGISMC].The aim of [UGISMC] is to reduce maternal mortality rate [MMR] and perinatal mortality rate [PMR] in Gezira State by 50% in 5 years [2005-0210]. are to [1] assess the available delivery resources in all hospitals [40] in Gezira State. [2] to identify deficiencies in the provision of obstetrical care particular attention was given for the availability of appropriate supplies equipments, facilities and manpower. All the hospitals in Gezira State [40] were included in this descriptive observational field survey. All major theatres, minor theatres, labour rooms were visited by the principal investigator and their resources were assessed thoroughly by direct observation, each hospital was assessed in the presence of the medical officer in charge.The relevant information were obtained and compared with the standard lists which were developed and prepared by a group of experts. In the 5 specialized hospitals all the obstetrical emergencies could managed safely,namely [Madani,Hisahisa, Alkamleen, Rufaa, and Almnagil].However, out of the 35 rural hospitals studied, in only[11/34] 33% emergencies could be managed safe, where the facilities are not adequate to deal with obstetrical emergencies and maintain safe delivery. The majority of rural hospitals are not equipped with enough facility and man power to manage obstetric emergency

Serum amino acid concentrations and factors affecting them in infants and children with different forms of protein-energy malnutrition

We have measured the concentrations of the circulating free amino acids, albumin, cortisol, growth hormone [GH] and insulin-like factor-1 [IFG-1] in forty children with protein-energy malnutrition [PEM]: ten with kwashiorkor, ten with marasmic kwashiorkor, ten with marasmus and ten underweight for age. Eight age-matched normal children served as controls. In the kwashiorkor and marasmic kwashiorkor groups the non essential/essential amino acid ratio was markedly altered due to significant depression of some essential amino acids [leucine, isoleucine, lysine and tyrosine]. Some of the non-essential amino acid concentrations were elevated [glycine, serine, and glutamic acid] and the rest were unaltered. Serum albumin and basal insulin levels were significantly decreased in both edematous groups of PEM. High serum GH and cortisol levels, and low serum IGF-1 concentrations have been demonstrated in all forms of severe malnutrition, the possible etiology of the amino acid alterations has been discussed in relation to the concomitant hormonal changes and dietary patterns in different forms of severe PEM

Defective arginine-induced insulin secretion in children with nutritional rickets

We evaluated arginine-induced insulin and growth hormone secretion in 10 children with proved vitamin-D-deficiency rickets and compared these values with those of eight normal age-matched control children. Thirty minutes after an intravenous infection of arginine hydrochloride [10% solution, 0.5 g/kg], the mean serum insulin level was 159.3 +/- 122.7 pmol/L for the rachitic children, which was significantly lower than that for the normal children. Neither the fasting insulin level nor any others after the arginine infusion differed significantly from those the control children. There were no significant differences in the fasting or the arginine-stimulated growth hormone levels between the rachitic and control children. The concentrations of insulinlike growth factor I and II did not differ between the two groups. These data suggest that there is not a major role for circulating growth hormone [and by implication somatomedin] on bone mineralization

Circulating gonadotropins and prolactin levels in different forms of protein energy malnutrition

The circulating levels of lutenizing hormone [LH], follicle stimulating hormone [FSH] and prolactin [PRL] were estimated in 61 children between 6 and 36 months of age who were suffering from different forms of protein energy malnutrition [PEM], namely kwashiorkor, marasmic kwashiorkor, marasmus and underweight. Eight age matched well nourished children served as controls. LH levels were found to be significantly low in all the three forms of severe PEM. FSH levels did not differ between malnourished and wellnourished children. Circulating PRL levels were significantly raised in all the study children with severe PEM, with no difference among the different forms excluding a main role of prolactin in the development of nutritional edema. The PRL and LH levels returned to normal with refeeding the prolactin response to arginine HCL infusion was reduced in all forms of severe PEM and returned to normal after nutritional rehabilitation denoting easy reversibility of PRL reserve function with proper nutrition

Protein losing enteropathy in acute infantile diarrhea

One hundred and sixteen well-nourished infants, 3-24 months of age, with acute diarrhea, as well as 20 healthy infants of matching age and sex were studied for protein losing enteropathy [PLE]. PLE was assessed by measuring random fecal excretion of alpha -antitrypsin [AT] and determination of fecal alpha 1- AT/ serum alpha 1- AT ratio, where a ratio of > 1 is indicative of PLE. Forty one [35.3%] out of the 116 diarrheic infants showed evidence of PLE. This intestinal protein loss was of short duration, and had no impact on serum proteins. There was no relation between the causative organism and the frequency of PLE

Urinary tract infection in infants and young children with unexplained fever

The present study was carried out to determine the frequency of urinary tract infection [UTI] in infants and young children with unexplained fever. Urine cultures were obtained from hundred children younger than five years of age presenting to the out-patient clinic of El-Shatby Children's hospital with fever of no-source. Five children [5%] had significant bacteruria. The results support the advisability of obtaining urine culture from every infant or young child with unexplained fever

clinico radiological study on children with chronic wheezy chest

Roentgenographic examination of 30 children suffering from chronic wheezy chest for at least 6 months duration demonstrated that 86.66% were suffering from chronic bronchial asthma, 10% were tuberculous and one case had evidence of foreign body aspiration. There was a positive statistical correlation, in asthmatic patients, between both the degree of radiological overaeration. One of the asthmatic patients had radiological evidence of pneumonitis which could not be detected clinically

heart in mumps: electrocardiographic and enzymatic studies

The frequency and extent of cardiac involvement were evaluated in 30 children during the course of mumps infection. Clinical examination, electrocardiographic tracing and laboratory estimation of the specific and sensitive enzyme creatine kinase [CK] and its myocardial CK-MB band were considered. None of the cases showed clinical evidences of cardiac affection. ECG changes suggestive of myocarditis were recorded in 7 patients. The mean total CK and its ios-enzyme CK-MB were significantly higher in mumps cases than controls. The significance of these findings was discussed

Study on some liver functions in children with kerosene poisoning

Some aspects of liver functions in children with accidental kerosene poisoning were studied on 30 cases and compared with those of normal healthy controls. Some degree of hepatic dysfunction does occure in kerosene poisoning and may be attributed to mild hepatocellular affection and intrahepatic cholestasis

Renal involvement in children with varicella

The urine, blood urea, endogenous creatinine clearance, and plasma and urine osmolality were studied in 40 children with apparently uncomplicated varicella and 10 healthy reference children. The study has presented evidence for renal involvement in the course of varicella infection. Abnormal urinary findings were found in 17 children with this disease. Four cases with low ASO titers, had findings consistent with acute glomerulonephritis. The kidney function studies revealed mild reduction of glomerular filtration and impaired renal concentrating ability in children with varicella. These renal changes are apparently benign and transient, but should be considered in managing children with this disease

study on group A streptococcal upper respiratory infection in infants and young children

Among 120 children less than 3 years of age with upper respiratory infection [URI], group A streptococcus was responsible for the disease in 20 cases [16.7%]. In contrast, only one [2%] out of 50 healthy reference children was a carrier for this organism. From the clinical data, it was concluded that streptococcal URI should be suspected in any infant or young child presenting with fever, mucopurulent or purulent rhinitis and intense pharyngeal redness; especially if associated with enlarged tonsils, tonsillar or pharyngeal exudate, petechiae on the palate and anterior cervical lymphadenitis

Intestinal obstruction in the new-born

This paper deals with 20 cases of neo-natal intestinal obstruction admitted in the paediatric surgical unit during the period from 1958 to 1965. Of these, 5 cases were due to Hirschsprung's disease; 9 cases were due to intestinal atresia, 4 cases were due to malrotation and 2 were due to obstructed Omphalocele. The clinical picture, diagnosis and management are described. Intestinal obstruction in the newborn is a difficult and important pediatric and surgical problem. Most cases are due to congenital obstructive anomalies. Twenty cases of intestinal obstruction in the neonatal period are presented and discussed. The operative management and results of treatment are outlined

haemolytic uraemic Syndrome report of a case with a comment on the pathogenesis of the syndrome

An eight months old male infant with the haemolytic uraemie syndrome is described. The aetiology, pathogenesis, prognosis and management of this syndrome are discussed