Status epilepticus: recent experience at the Port of Spain General Hospital, Trinidad

In this retrospective study, experience in status epilepticus (SE) over an 18-month period at the Port-of-Spain General Hospital is reported. Sixty-three episodes in 41 patients were studied. Fifty-one per cent of patients were under 10 years of age. Fifty-one per cent of patients were classified as remote symptomatic, 29 per cent idiopathic, 15 per cent acute symptomatic and 5 per cent febrile. Bolus doses of diazepam were used in 62 of 63 episodes, phenytoin in 18, diazepam infusion in 9, paraldehyde in 12 and phenobarbitone in 9. Seizures were controlled within half-hour of starting treatment in 55 episodes (87 per cent). In 3 episodes in 2 patients (5 per cent), control was poor and exceeded 18 hours. No deaths were recorded. Two neurological deficits and 8 other morbid events were recorded. Mean hospital stay was 2.9 days. No patient was ventilated or admitted to the Intensive Care Unit. Current drug therapy is highly effective in SE even in institutions where modern intensive care technology is limited. Prognosis is excellent in patients whom the underlying aetiology is benign. (AU)

The lupus anticoagulant and deep venous thrombosis

A paradoxical situation exists in patients with the lupus anticoagulant in that there is a tendency for them to develop clinically significant thrombosis in the presence of this circulating anticoagulant. Vascular thrombosis is usually venous but arterial thrombosis, manifested mainly by hemiplegia or recurrent transient ischaemic attacks is also observed; and in one series a high incidence (42 percent) of arterial thrombosis complicating this condition is reported. We describe 2 patients with recurrent deep venous thrombosis who were positive for the lupus anticoagulant and we believe these to be the first reported in the West Indian medical literature (AU)

Acute renal failure following multiple stings by africanized bees - abstract

From 1979 to October 1990, Africanized bees have stung 3,955 humans with 10 deaths and 1,071 animals with 715 deaths in Trinidad and Tobago. The medical records of all patients seen at the General Hospital, Port-of-Spain, who developed acute renal failure following stings by Africanized bees were included in the study. Of the 5 patients in the study, 4 were males and 1 was female. One patient was stung by just over 500 bees while the rest were stung by over 1,000 bees. All patients had grossly elevated muscle enzymes. Two of the 5 patients died within 48 hours and causes of death were acute pancreatitis with acute renal failure, and acute pulmonary failure with acute renal failure. Two of the three patients who survived were desperately ill and had to be dialyzed. Renal function in these survivors did not return to normal under 50 days. It is likely that other islands of the Caribbean will soon be presented with this syndrome (AU)

Acute intermittent porphyria in a 17-year-old Trinidadian girl

We report the first case of acute intermittent porphyria in Trinidad and Tobago. This condition is most commonly described in people of European origin and is considered to be rare in blacks. This girl is of African descent and has no family history of acute intermittent porphyria (AU)