Between 1976 and 1984, 136 patients with portal hypertension due to extrahepatic obstruction were operated on. Twenty two patients had emergency and 114 elective operations. The operative mortality was 90/o and 1%, respectively. Altogether 117 patients (86%) were followed up for from two to 10 years: 17 rebled, none developed encephalopathy or sepsis after splenectomy, and 90% and 75% were alive at five and 10years

Hyperthyroidism is rare in early childhood and most commonly caused by Graves' disease. We report 14 children (4 boys, 10 girls) aged 3.4-7.5 yr. At diagnosis, all patients had weight loss, hyperkinetic activity, tachycardia, difficulty sleeping, and poor concentration and 11 presented with proptosis. Four patients developed long-term neuropsychological problems. There was a family history in 7 cases. All patients had goiters, clinically assessed to be large and diffuse in 21%, medium-sized in 43%, and small in 36%. At diagnosis, height was increased with median (range) height; 1.25 standard deviation score (SDS) (-0.2-5.24) and body mass index (BMI) was decreased; -0.48 SDS (-1.65-1.26). Height and BMI SDS values were statistically different (p<0.032) Bone age was advanced in 4 of 5 children, who had assessments. Total or free T4 levels were elevated and TSH was undetectable. Ninety percent of patients (12/14) had positive thyroid peroxidase autoantibodies, mean level 680 IU/ml (range 50-1347). Initial treatment was with antithyroid medication using carbimazole; median dose 0.75 mg/kg/day (no.=13) or propylthiouracyl 15 mg/kg/day (no.=1). T4 was added in 6 patients. Normalisation of serum T4 occurred at 4 months (1- 9) and TSH at 7 months (3-24) after start of therapy. Treatment was discontinued after a minimum of 2 yr in 11 patients, relapse occurring in 9. Median duration of total therapy was 58 months (18-132). During adolescence, 4 patients had curative therapy by surgery (no.=2) or radioiodine (no.=2). In conclusion, disturbance of growth, behavioral difficulties and infrequent spontaneous remission are key features of Graves' disease in early childhood.

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Background: Hyperthyroidism refers to over activity of the thyroid gland leading to high synthesis and excessive production of thyroid hormone the extent and severity of the clinical manifestations of thyrotoxicosis are not strongly correlated with its biochemical severity. Surgery should be proposed as an immediate and completely effective solution for thyrotoxicosis, especially when compared with prolonged medical therapy, because it can provide a demonstrable improvement in the quality of life (QOL) of the patients. Methods: prospective study was done to clarify the surgical indications and the effectiveness of total thyroidectomy in the treatment of thyrotoxicosis and quality of life after surgery. Results: A Totally thirty patients with varied clinical presentations are confirmed to be suffering from the thyrotoxicosis and tests were appropriately evaluated and Thyrotoxicosis controlled and consented patients were operated In this study quality of life is assessed by regular follow up of patient by initial weekly follow up for 1month, there after once in 3 months over a period of 2yrs. Conclusion: Surgery should be proposed as an immediate and completely effective solution for thyrotoxicosis, especially when compared with prolonged medical therapy, because it can provide a demonstrable improvement in the quality of life (QOL) of the patients.

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