Clinical trial of riboflavin in sickle cell disease.

The effect of riboflavin supplementation (5mg twice daily for 8 weeks) on reduced blood glutathione (GSH) and iron status was assessed in 18 patients with sickle cell disease (SCD-HbSS). Twelve SCD patients and 13 normal (Hb-AA) subjects served as the control. The total iron binding capacity (TIBC) and serum ferritin (SF) were significantly higher (p < 0.01), but GSH level, haemoglobin and transferrin saturation (TS) were significantly lower (p < 0.001) in SCD patients than in normal subjects. The administration of riboflavin elicited a significant increase (p < 0.01) in serum iron and TS but a non significant increase in SF and circulating Hb. The GSH level varied little in riboflavin supplemented but decreased significantly in unsupplemented SCD. The disparity in GSH concentration might reflect availability of FAD for regeneration of GSH from glutathione. Likewise, the haematological improvement in the supplemented group supports the assertion that riboflavin enhances erythropoiesis. For an effective management of SCD in Africa, a closer attention should be directed to the riboflavin status in haemolytic disorders.

Idiopathic hypereosinophilic syndrome: a report of four cases in Arabs, and a review of the literature.

We report four Arab patients with idiopathic hypereosinophilic syndrome (IHES). They presented with varied clinical pictures simulating chronic inflammatory bowel disease (IBD), pulmonary tuberculosis (TB), meningioma, peripheral neuropathy, and infective endocarditis (IE). All had significant peripheral and bone marrow eosinophilia, histological confirmation of eosinophilic infiltration of multiple organs, and clinical evidence of multi-organ dysfunction. Extensive laboratory investigations excluded other possible causes of eosinophilia. All were treated with steroids, with complete response in two. Two others were treated additionally with hydroxyurea, and one with methotrexate, cyclophosphamide, vincristine and alpha-interferon. The pathogenesis, varied clinical, laboratory, and histopathological features, and the management of IHES are reviewed.

Experience in cardiac catheterisation and angiocardiography in the diagnosis and management of heart diseases in Lagos university teaching hospital.

The present set up of the Cardiovascular Laboratory of Lagos University Teaching Hospital and our experience in cardiac catheterisation and angiocardiography in the laboratory between 1972--1976 are documented. Most of the patients studied were adults and all but one had both right and left heart catheterisation. Trans-septal procedure and selective coronary angiography were not undertaken during the period under review. In about 25% of the cases studied the clinical diagnosis was proved incorrect or incomplete at cardiac catheterisation. There were no major complications during or following any of the procedures probably because of the limited procedures; the point is however made that cardiac catheterisation is not innocuous, and while it offers an important and valueable means of establishing the diagnosis of specific cardiac malformation and haemodynamics, it must be used indiscriminately.

Favourable prognosis of prolonged coma associated with large doses of diazepam in severe tetanus.

A report is made of five tetanus patients who were treated with large repetitive doses of Diazepam and became comatose. The period of impaired consciousness varied from thirteen to twenty-one days. None had significant respiratory depression, and full recovery occurred in all. It is proposed that Diazepam-induced prolonged coma should be regarded as a side-effect rather than a toxic effect and should caution rather than contra-indicate further use of large doses of the drug in the management of tetanus.

M-mode echocardiographic features of endomyocardial fibrosis.

M-mode echocardiographic findings are described in 21 patients with endomyocardial fibrosis. Features associated with right ventricular endomyocardial fibrosis include: (i) exaggerated motion and thickening of the anterior right ventricular wall; (ii) increased right ventricular end-diastolic dimension; and (iii) paradoxical septal motion. Pericardial effusion (viz an echo-free space behind the posterior left ventricular wall) was shown in three patients. The tricuspid valve was easily recorded in all. Six patients with left ventricular endomyocardial fibrosis had diminished left ventricular end-diastolic dimension. Three had echo features of pulmonary hypertension (viz reduced e-f slope, absent a wave in sinus rhythm, and systolic notching of the pulmonary valve echogram). Fine fluttering of the anterior mitral valve and tricuspid valve echo was observed in two patients (one of whom was in sinus rhythm) with biventricular endomyocardial fibrosis, and no angiographic evidence of aortic regurgitation.