Sonographic assessment of congenitally hypothyroid children in Iran

Introduction: Considering the high prevalence of congenital hypothyroidism (CH) in Isfahan, it seems that it is necessary to investigate the aetiology of the disorder and its related factors. The aim of this study was to determine the aetiology of CH among children in Isfahan province. Material and methods: In this cross-sectional study, the aetiology of CH and the volume of the thyroid was assessed using neck ultrasonography. The results of thyroid function screening tests were additionally recorded. The correlation between ultrasonographic findings and the level of TSH and as well as T4 was determined. Results: During this study 385 CH patients aged 0-3 years were studied. According to ultrasonographic findings, in 19.9% of patients the aetiology of CH was dysgenesis (agenesis, ectopy, and hemiagenesis) and 80.1% had normal thyroid. Mean thyroid gland volume in all studied patients was 0.78 &#177; 0.44 mL. The prevalence of ultrasonographic findings was as follows: normal 80.1%, agenesis 12.7%, hemiagenesis 5.8%, and ectopy 1.4%. There was a significant correlation between thyroid volume and TSH and T4 and as well as between TSH and ultrasonographic findings (p < 0.05). Conclusions: In spite of the limitations of ultrasonography in the field of determining the aetiology of CH, it is an appropriate imaging tool for determining the volume of the thyroid gland in children. Considering that the rate of goitrous gland was low, it seems that iodine deficiency could not be responsible for the high rate of CH in this region. (Pol J Endocrinol 2010; 61 (6): 665-670)Wstęp: Z uwagi na częste występowanie w Isfahanie wrodzonej niedoczynności tarczycy (CH, congenital hypothyroidism) należy wyjaśnić przyczyny powstania tego zaburzenia i sprzyjające jego rozwojowi czynniki. Celem badania było ustalenie etiologii CH u dzieci zamieszkałych w prowincji Isfahan. Materiał i metody: W tym przekrojowym badaniu przeprowadzono badanie ultrasonograficzne szyi w celu oceny wielkości tarczycy i ustalenia etiologii niedoczynności tego narządu. W ramach programu badań przesiewowych wykonano testy oceniające czynność tarczycy. Zbadano korelacje między wynikami badań ultrasonograficznych a stężeniami TSH i T4. Wyniki: Do badania włączono 385 dzieci z CH w wieku 0-3 lat. Badania obrazowe wykazały, że u 19,9% chorych przyczyną CH były zaburzenia rozwoju tarczycy (agenezja, ektopia i hemiagenezja). Średnia objętość gruczołu tarczowego w badanej grupie wynosiła 0,78 &#177; 0,44 ml. Uzyskano następujące wyniki badań ultrasonograficznych: obraz prawidłowy u 80,1% dzieci, agenezja - 12,7%, hemiagenezja - 5,8%, ektopia - 1,4%. Stwierdzono istotną korelację między wielkością tarczycy a stężeniem TSH i T4 oraz między stężeniem TSH a wynikami badań ultrasonograficznych (p < 0,05). Wnioski: Mimo ograniczeń ultrasonografii, jako metody określania etiologii CH, ten rodzaj badań obrazowych jest przydatny do oceny wielkości tarczycy u dzieci. Biorąc pod uwagę rzadkie występowanie wola u dzieci z CH, można przypuszczać, że niedobór jodu nie jest przyczyną wysokiej zachorowalności na tę chorobę w prowincji Isfahan. (Endokrynol Pol 2010; 61 (6): 665-670

Admission Dysnatremia in Citically ill Children

Introduction: Many causes of admission to the pediatric intensive care unit (PICU) may potentially induce hyponatremia. This study was aimed at evaluating the incidence of admission dysnatremia in the PICU and its relationship with the underlying disease and demographic factors.Materials and Methods: This observational prospective study was conducted in a 12-bed medical PICU in a tertiary governmental teaching hospital for six months. The study group comprised patients aged 1 month to 18 years. Patients who received intravenous fluid within 24 hours before admission were excluded. Serum sodium was checked on admission and concentrations below 135 and above 145 mEq/L were considered hyponatremia and hypernatremia, respectively.Results: One hundred and ninety-five patients (117 males, 60%) were included in the study. The mean serum sodium level was 137.8 mEq/L ± 5.2. Forty-two patients (20.5%) were hyponatremic and 10 (5.1%) werehypernatremic. The most prevalent diagnosis in hyponatremic patientswas pulmonary diseases followed by renal diseases, central nervoussystem (CNS) diseases, diabetic ketoacidosis (DKA), gastrointestinal (GI)diseases, and cardiovascular and hematologic-oncologic diseases. Fiftypercent of nephrologic patients were hyponatremic. Hyponatremia wasfound in 26.5%, 23.5%, 20%, 16.6%, and 14.2%of the children with lungdiseases, DKA, hematologic-oncologic diseases, cardiovascular diseases,and CNS and GI diseases, respectively. Moreover, 20%, 16.6%, 11.7%,7.1%, and 2.9%of the patients with infectious diseases, cardiovasculardiseases, DKA, CNS diseases, and pulmonary diseases hadhypernatremia, respectively.Conclusions: Hyponatremia is frequent in our PICU. Patients suffering from renal diseases, pulmonary problems, DKA, and hematologic-oncologic diseases have a higher chance of hyponatremia (≥20%).Keywords: Sodium; Hyponatremia; Fluid Therapy; Children; Intensive Care

Predictors for surgical outcome in patients with Tumor-Associated epilepsy

This study aimed to evaluate possible predictors for postoperative outcome in patients with tumorassociated epilepsy. Methods: In this study, patients with tumor-associated epilepsy who were candidates for epilepsy surgery were included. After required presurgical evaluations, they underwent surgical resection of the tumor. Patients were followed 24-57 months after the surgery and were divided to two groups of seizure-free and not-seizure-free. Demographic data, medical history, seizure characteristics and tumor features were compared between the two groups to find possible predictors. Findings: Thirty-five patients (17 men and 18 women) with the mean age of 22.8 years (8 to 45 years) were enrolled this study. Most of the patients had temporal lobe tumors (68.0%) followed by frontal and parietal lobe tumors. Ganglioglioma was seen in 62.9% of the patients, followed by astrocytoma and dysembryoplastic neuroepithelial tumour (DNET). We found a non-significant positive correlation between better surgical outcome and being male, younger age at epilepsy onset, longer duration of epilepsy, more seizure frequency, tumors in right hemisphere, tumor type of ganglioglioma, and seizures with secondary generalization. Furthermore, we found that history of head trauma, infection of centeral nervous system (CNS), febrile convulsion, natural vaginal delivery, familial history of epilepsy, tumors in temporal lobe, having auras, developing more seizure types and ipsilateral temporal spikes on preoperative electroencephalogram (EEG) were associated with worst surgical outcome (P > 0.05 for all). Conclusion: In this study, we found no statistically significant predicting factor for surgical outcome; however, we found that being male, smaller ages at seizure onset, longer duration of epilepsy, higher seizure frequency before surgery, involvement of right hemisphere, ganglioglioma, and secondary generalization are more seen in patients with better surgical outcome while history of head trauma, CNS infection, family history of epilepsy, temporal lobe tumors, presence of aura, having multiple types of seizures, and epileptic discharges from temporal lobe in preoperative EEG were seen more in patients with poor outcome. Studies with larger sample sizes are suggested to confirm these findings

An Undiagnosed Case of Hypothalamic Hamartoma with a Rare Presentation.

Background. Hypothalamic hamartomas (HHs) are rare tumor-like malformations that may present with complex partial seizures refractory to anticonvulsants in adulthood. The condition may be misdiagnosed because of rarity. Case Presentation. We report a 25-year-old man with complaint of seizures presented by falling, tonic spasm of limbs, oral automatism, vocalization, and hypermotor activities. His seizures started at the age of one month and presented as eye deviation and upper limbs myoclonic jerk, followed by frequent seizures with variable frequency. The patient had delayed developmental milestones and was mentally retarded. He was hospitalized and underwent video-EEG monitoring and neuroimaging, and the diagnosis of HH was made. The patient became candidate for surgery after that. Conclusion. In this case, the underlying etiology of seizures was diagnosed after 25 years. HH is a rare condition and neurologists may encounter very small number of these cases during their practice. Therefore, they should consider it in patients who present with suspected signs and symptoms

Ultrasonographic alterations of pancreas in diabetic patients

&lt;strong&gt;BACKGROUND&lt;/strong&gt;: Pancreas as the insulin-producing gland is subjected to destruction and change in the diabetes-producing process. Realtime sonography can assess the gland in 95% of cases and its accuracy in diagnosis of pancreatic disease matches that of CT-scan. The purpose of this study was to evaluate pancreatic diameter and echogenicity by sonography and to examine the correlation of these two factors with duration of disease in diabetes types I and II in comparison with controls.&lt;br /&gt;&lt;strong&gt;METHODS&lt;/strong&gt;: In two groups of 60 diabetic patients and healthy controls, diameter and echogenicity of pancreas was determined.&lt;br /&gt;&lt;strong&gt;RESULTS&lt;/strong&gt;: Diameter of pancreas was significantly different in diabetic patients and correlated with duration of disease.&lt;br /&gt;&lt;strong&gt;CONCLUSIONS&lt;/strong&gt;: In type I diabetes, decrease in the size of pancreas was more prevalent than in type II diabetes and these&lt;br /&gt;changes become more prominent over time

The comparative study on diagnostic validity of cerebral aneurysm by computed tomography angiography versus digital subtraction angiography after subarachnoid hemorrhage*

Background: In order to declare the preoperative diagnostic value of brain aneurysms, two radiological modalities, computed tomographic angiography and digital subtraction angiography were compared. Methods: In this descriptive analytic study, diagnostic value of computed tomographic angiography (CTA) was com-pared with digital subtraction angiography (DSA). Sensitivity, specificity, positive and negative predictive values were calculated and compared between the two modalities. All data were analyzed with SPSS software, version 16. Results: Mean age of patients was 49.5 ± 9.13 years. 57.9 % of subjects were female. CTA showed 89% sensitivity and 100% specificity whereas DSA demonstrated 74% sensitivity and 100% specificity. Positive predictive value of both methods was 100%, but negative predictive value of CTA and DSA was 85% and 69%, respectively. Conclusions: Based on our data, CTA is a valuable diagnostic modality for detection of brain aneurysm and su-barachnoid hemorrhage

The role of ultrasonography in primary congenital hypothyroidism

The aim of this study was to compare the usefulness of ultrasonography and scintigraphy in diagnosing the etiology of primary congenital hypothyroidism (CH). Methods&58; The newborns that were examined by both thyroid scintigraphy and ultrasonography during CH screening program in Isfahan were included in this study. The ultrasonographic findings were compared with the scintigraphic findings and the sensitivity and specificity of the ultrasonography was determined. Results&58; During this study, 102 CH newborns were studied. According to the ultrasonographic results, 61.8%, 26.5%, 2.9% and 8.8% of them had normal thyroid gland, agenesia, ectopia and hypoplasia, respectively, and according to scintigraphic results, 55.9%, 35.3% and 8.8% of them had normal thyroid gland, agenesia and ectopia, respectively. Ultrasound detected sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio were 77%, 92%, 89%, 84%, 9.6 and 0.25, respectively. The sensitivity and specificity of ultrasonography compared with thyroid scintigraphy in diagnosis of thyroid gland ectopia was 33% and 100%, respectively. Conclusions&58; Though thyroid ultrasonography failed to diagnose 67% of ectopic cases and nonfunctioning thyroid gland, it had the ability to determine the anatomy of thyroid gland. So, considering some limitations of scintigraphy, we concluded that ultrasonography is a relati

Outcome of lesional epilepsy surgery

BackgroundWe investigated the utility of epilepsy surgery and postoperative outcome in patients with lesional epilepsy in Iran, a relatively resource-poor setting.MethodsThis prospective longitudinal study was conducted during 2007-2017 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with a diagnosis of intractable focal epilepsy, with MRI lesions, who underwent epilepsy surgery and were followed up ≥ 24 months, were included and evaluated for postoperative outcome.ResultsA total of 214 patients, with a mean age of 26.90 ± 9.82 years (59.8% men) were studied. Complex partial seizure was the most common type of seizure (85.9%), and 54.2% of the cases had auras. Temporal lobe lesions (75.2%) and mesial temporal sclerosis (48.1%) were the most frequent etiologies. With a mean follow-up of 62.17 ± 19.33 months, 81.8% of patients became seizure-free postoperatively. Anticonvulsants were reduced in 86% of the cases and discontinued in 40.7%. In keeping with previous studies, we found that seizure freedom rates were lower among patients with longer follow-up periods.ConclusionsWe found high rates of seizure freedom after surgery in lesional epilepsy patients despite limited facilities and infrastructure; antiepileptic medications were successfully tapered in almost half of the patients. Considering the favorable outcome of epilepsy surgery in our series, we believe that it is a major treatment option, even in less resource-intensive settings, and should be encouraged. Strategies to allow larger scale utility of epilepsy surgery in such settings in the developing world and dissemination of such knowledge may be considered an urgent clinical need, given the established mortality and morbidity in refractory epilepsy