[Thrombolysis in acute ischemic stroke in basic hospitals. four cases reports]. / Trombolisis en el ictus isquémico agudo en hospitales básicos. A propósito de cuatro casos.

Thrombolytic drugs have been used in recent years as an effective therapeutic option in ischemic stroke. There are several experiences with the administration of thrombolytic therapy in basic and rural hospitals. We are describing our experience with four cases in which this treatment was used in our basic hospital during the last three years. We used a strict protocol described in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA stroke study. No intracranial hemorrhage or protocol violations were detected. We conclude that this protocol has allowed us to offer safe treatment to our ischemic stroke patients.

Correlation between catecholamine levels and outcome in patients with severe head trauma.

Some studies have shown that catecholamines and the changes in their levels during and after head trauma can be useful in predicting the outcome in head trauma patients. The goal of this study is to search for a probable relation between urine levels of catecholamines and prognosis in patients with severe head trauma. Fifty four patients with severe head trauma Glasgow Coma Scale (GCS < or = 8) on admission time were recruited in Imam Reza Hospital within one. These patients were included when having no major accompanying trauma in other organs. Twenty four hour urine was collected after admission and levels of metanephrine and nor-metanephrine were measured. The relation between urine levels of these metabolites with final outcome and also with GCS at admission, 24, 48 h and 1 week after admission and discharge time and Glasgow Outcome Scale (GOS) were studied. Fifty two patients, 48 males and 4 females with a mean age of 32.3 +/- 14.7 (3-72) years were included. The main underlying etiologies were motorcycle (46.2%) and car accidents (25%). Diffuse axonal injury, brain contusion and subdural hematoma were three main diagnoses (28.8, 17.3 and 15.4% of the cases, respectively). 19 (36.5%) of the patients expired within the study period. The mean level of metanephrine and normetanephrine in urine were 207.9 +/- 200.5 and 330.2 +/- 218.4 microg in 24 h, respectively. There was no meaningful relation between urine levels of these metabolites and any of GCS and GOS. There was also no meaningful relation between these parameters and final prognosis in patients.

Incidence of insulin-dependent diabetes mellitus in Jordanian children aged 0-14 y during 1992-1996.

An attempt was made by the Jordanian National Center for Diabetes, Endocrine and Genetic Diseases (NCDEGD) to identify all cases of type 1 diabetes among Jordanian children aged 0-14 y. Data were obtained retrospectively for the years 1992-1994 and prospectively for the years 1995 and 1996, including full name, national identifying number, date of birth, date of diagnosis and family history. The incidence was calculated as the number of cases per 100,000 population, according to the national census of 1994. The incidence rate for these years (1992 through 1996) was 2.8, 2.9, 3.2, 3.6 and 3.6 per 100,000 population, respectively. The male:female ratio was (1:1.03). Seasonal variation at clinical onset was noticed, with maximum incidence in the winter months and minimum incidence in the summer months. In conclusion, the incidence of type 1 diabetes mellitus in Jordanian children aged 0-14 y is among the lowest in the region, but is rising.

Adrenogenital syndrome due to 11-beta-hydroxylase deficiency with skeletal abnormalities and pulmonary stenosis.

This report describes a 13-year-old female patient with 11-beta-hydroxylase deficiency who was found to have short fourth metatarsals and pulmonary stenosis. The unusual association between these abnormalities and this rare form of congenital adrenal hyperplasia is presented.

The response of growth hormone and prolactin to oral diazepam in diabetics.

We studied 8 insulin dependent stable young diabetics with a mean age of 20 yr. Each patient received 10 mg of diazepam orally after with drawing the baseline blood sample. Subsequent samples were obtained at 30 min intervals for 150 min. The oral administration of diazepam resulted in a significant increase in serum GH concentration from a baseline value of 5.3 +/- 1.2 ng/ml (mean +/- SE) at 0 point to a peak response of 16.5 +/- 5.9 ng/ml at 60 min (p less than 0.001). The plasma glucose concentration remained in the range of 200-267 mg/dl and did not change significantly during the entire testing period indicating that diazepam stimulates GH release in diabetics despite endogenous hyperglycemia. Eight normal subjects were also studied in an identical fashion. Although the mean baseline serum GH concentration in these normal subjects was significantly lower than that observed in the diabetics, (1.3 +/- 0.4 vs 5.3 +/- 1.2 ng/ml, p less than 0.05), the peak response did not differ significantly between the two groups (10.7 +/- 2.6 vs 16.5 +/- 5.9 ng/ml; NS). The baseline concentration of serum prolactin was similar in the diabetic and nondiabetic groups and the administration of diazepam resulted in no significant changes in both groups. Diazepam may be a useful agent in testing for GH reserve in normal subjects as well as in stable insulin dependent young diabetics.

Maternal thyroid function is the major determinant of amniotic fluid 3,3',5'-triiodothyronine in the rat.

3,3',5'-triiodothyronine, (rT(3)), is easily measured in human amniotic fluid (AF) during the second and third trimesters. To determine if AF rT(3) levels are maintained by either maternal or fetal thyroid function, or both, models of fetal hypothyroidism (FH), maternal hypothyroidism (MH), and combined maternal and fetal hypothyroidism (MFH) were developed in pregnant rats. Hormone analyses of maternal and fetal serum and AF were performed at term. Thyroxine (T(4)) and 3,3',5-triiodothyronine (T(3)) were not detectable in the sera and AF of term fetuses in all groups. MFH rats were prepared by administration of methimazole to the dams, and in some experiments, by maternal thyroidectomy and a low iodine diet as well. In the MFH groups from the three experiments serum thyrotropin (TSH) was markedly elevated in the dams and in the fetuses. FH rats were prepared by administering T(4) by various routes to dams treated according to the MFH protocols and serum TSH was elevated in fetal serum. Analysis of FH maternal serum T(4), T(3), and TSH concentrations suggested mild maternal hyperthyroidism or hypothyroidism depending upon the schedule of T(4) administration. The MH groups were prepared by maternal thyroidectomy and in all experiments the fetuses had normal serum TSH concentrations. The degree of maternal hypothyroidism in the MH and MFH groups was equivalent. The mean concentration of AF rT(3) in normal rats in three experiments was 28.4+/-2.5 ng/dl (+/-SEM). In the three experiments, AF rT(3) was undetectable or markedly reduced in the MH and MFH rats and was normal in the FH rats. These results in the amniotic fluid could not be explained by transfer of rT(3) from fetal serum to the AF because fetal serum rT(3) concentrations in these various models did not correlate with AF rT(3) concentration. Furthermore, infusion of large doses of rT(3) in MFH dams resulted in a 35-fold elevation in maternal serum rT(3) concentration, a twofold elevation in fetal serum rT(3) concentration, and only a minimal increase in AF rT(3). These studies demonstrated that, in the rat, the maternal thyroid has the dominant role in maintaining AF rT(3), whereas little effect of fetal thyroid status on AF rT(3) could be demonstrated. Transfer of maternal rT(3) or of fetal rT(3) derived from maternal T(4) to the AF do not appear to be the mechanisms whereby the maternal thyroid maintains AF rT(3).