Acute spontaneous tumor-lysis syndrome in a pregnant woman with non-Hodgkin's lymphoma.

Both non-Hodgkin's lymphoma (NHL) in pregnancy and acute spontaneous tumor-lysis (ASTL) syndrome are rare. Here we present a 32-year-old Egyptian woman in the 27th week of pregnancy, who was admitted with epistaxis, lethargy, vomiting and dehydration. This patient developed ASTL syndrome secondary to undiagnosed NHL, but was not on any medication associated with the syndrome. At 28 weeks, she gave birth to a healthy baby who, unfortunately, died within a few days. To our knowledge, this is the first case of ASTL syndrome in a pregnant woman.

Primary spontaneous pneumothorax in Arabs: does its frequency differ from elsewhere?

No data are available on primary spontaneous pneumothorax (PSP) in Arabs. Hence we sought to determine its characteristics in Arabs of the Al-Ahmadi Governorate in Kuwait. All patients over 10 years of age with pneumothorax who were admitted to the only free general hospital serving Ahmadi area from 1985 to 1996 were reviewed retrospectively. The study included all patients' medical records, investigations, treatment, morbidity, and mortality. Any patient with secondary pneumothorax was excluded. Primary spontaneous pneumothorax was rare in female Arabs, as they are almost never smokers. There were only two females out of total 58 patients with an incidence of 0.3 per 100,000 per year. Its incidence in male Arabs was 8.8 per 100,000 per year, similar to that in other studies. The distribution had a monophasic pattern, the average age being 23 (+/- 7.3 SD) years at the first episode. Smoking, a tall, asthenic (slim, relatively weak in appearance, ectomorphic) body build, and a positive family history are the most important risk factors and are not different from most studies conducted in other parts of the world.

Intracranial tuberculoma in Kuwait.

OBJECTIVE: To study the manifestations of intracranial tuberculoma in Kuwait and to provide guidelines for the diagnosis and management of intracranial tuberculoma in developing countries, where the disease is common and facilities are limited. DESIGN: Data were collected from patients with intracranial space-occupying lesions admitted to Adan Hospital Medical Department and the Neurosurgery and Neuromedical Departments at Ibn-Sina Hospital, Kuwait, from January 1987 to December 1995. RESULTS: Intracranial tuberculomas represented 1.4% of all cases with intracranial space-occupying lesions in these hospitals (13/925); 77% of the patients were males, and seizures were the most frequent presenting symptom. Nine patients (66.6%) responded well to medical treatment and four (33.3%) failed to respond. Those who responded to medical treatment showed remarkable improvement of the intracranial lesions within 6 weeks, and almost complete resolution within 12 weeks. Seven patients required surgery, three due to failure of medical treatment. We report a patient who needed emergency shunt operation, a patient with pituitary tuberculoma, and two patients whose lesions recurred several years after surgery. CONCLUSION: Bearing in mind the non-specific nature of computed tomography and magnetic resonance imaging in the diagnosis of intracranial tuberculoma, and the lack of advanced neurosurgical facilities in developing countries where the disease is common, we recommend a 6-week therapeutic test for patients with solitary or multiple enhancing intracranial space-occupying lesions without mass effect. Stereotactic biopsy is recommended in selected cases wherever facilities are available.

Stroke in Kuwait: a three-year prospective study.

To study the pattern of stroke in Kuwait, prospective data were collected from all patients admitted with first-ever stroke to our hospital over 3 years: 1989, 1992 and 1993. The primary-care registry over the same period was examined to ascertain that all cases of stroke seen by the primary-care doctors were referred to a hospital. Death certificates issued for people who died outside the hospital were also examined. The study included: clinical evaluation, computed tomography, electrocardiography, blood laboratories, serum chemistry and other investigations as required. The overall annual crude incidence rate was 27.6/100,000 population. The age-adjusted annual crude incidence rate was 145.6/100,000 population. No seasonal variation in the stroke incidence was observed in our study. Carotid-territory large infarction represented 46.5% of all strokes followed by intracerebral haemorrhage in 19.9%, lacunar infarction in 17%, basilar infarction in 8.3% and subarachnoid haemorrhage in 1.7%. The overall case fatality rate was 10%. Mortality increased with age and when loss of consciousness was present. The study demonstrated that stroke incidence in Kuwait is very low due to the young average age of the Kuwaiti population.

Vitamin D deficiency in veiled Kuwaiti women.

OBJECTIVE: To study vitamin D deficiency in veiled Kuwaiti women. DESIGN: Prospective on cases and volunteers. SETTING: The medical department in a general hospital in Kuwait serving about 300000 persons (Adan Hospital). SUBJECTS: The authors saw four cases of unexplained vitamin D deficiency osteomalacia in otherwise healthy veiled Kuwaiti women. This stimulated us to study 50 veiled volunteer Kuwaiti women aged between 14 and 45 years old who had three children or less, and 22 unveiled volunteer Kuwaiti women with matched age and number of children as control. INTERVENTIONS: Blood samples were taken to check levels of 25-hydroxy cholecalciferol, calcium, phosphorus and alkaline phosphatase. Blood urea, serum creatinine, serum bilirubin, serum alanine transaminase, serum aspartate transaminase, serum lactic dehydroginase, prothrombin time, urine for proteins and pH were checked to exclude renal and hepatic disease. RESULTS: showed subclinical vitamin D deficiency among veiled women and two cases of clinically overt osteomalacia were discovered among the veiled volunteers suggesting a high prevalence of the disease among veiled Kuwaiti women.

Microcytosis: guidelines for family doctors.

In our studies of microcytosis, the complete blood count (CBC) of 82,830 randomly selected patients was analysed. Of these 34.3% showed microcytosis, and 5.5% were not anaemic. Emphasis was given to study the extent, causes and patterns of non-iron deficient microcytosis. Haematological data was adequate to differentiate iron deficient (ID) from non-iron deficient (NID) patients with microcytosis in 285 subjects. Of these 21.4% were found to be NID. A majority (73.8%) had showed a form of haemoglobinopathy, the commonest being beta-thalassaemia minor (60.7%). Of non-invasive investigations, mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), red cell size distribution width (RDW), anisocytosis in blood smears, serum iron (SI) and haemoglobin electrophoresis, the parameter which separated ID from NID patients most effectively was haemoglobin electrophoresis. It showed an abnormal pattern in 82% of NID subjects and normal pattern in 96.4% ID subjects. In the 18% of the NID subjects with a normal pattern, raised serum iron levels characterized 11% additional subjects with NID.

Multiple intracranial tuberculomas mimicking brain metastases.

A 50-year-old woman was admitted to our hospital with upper gastro-intestinal tract (GIT) bleeding, and complaining of severe headache and recurrent generalized tonic clonic seizures for the last year. Physical examination showed no focal neurological deficits. The patient was diagnosed with multiple brain metastases with occult primary depending on computerised tomography (CT) findings. Biopsy of enlarged left axillary lymph nodes showed caseating tuberculoid lymphadenitis compatible with tuberculosis. Intracranial lesions resolved completely on antituberculosis treatment.

Hypokalaemic paralysis precipitated by working in hot weather.

Twenty-two cases of hypokalaemic paralysis seen over the past 7 years, are presented here. They included five Chinese, five Bangladeshis, six Arabs, four Philippinos and two Indians. The number of cases related to the population of each nationality in our area showed that the Chinese had the biggest number of cases in relation to their population in our area, followed by Philippinos then Bangladeshis. All patients were men admitted in the hot season, dehydrated and not able to walk. It seems that dehydration was an important precipitating factor in our cases. Although family history was positive in one patient, apart from four thyrotoxic patients, the others were apparently healthy. Patients improved dramatically with i.v. potassium and rehydration. Four patients were readmitted with the same picture.