Elias Makhoul

Electroencephalographic mapping and 99mTc HMPAO single-photon emission computed tomography in carbon monoxide poisoning

STUDY OBJECTIVE To investigate whether topographic analysis of EEG mapping and technetium-99m (99mTc) hexamethylpropylenamine oxide (HMPAO) brain single-photon emission computed tomography (SPECT) can detect cerebral anomalies in the acute phase of carbon monoxide poisoning. DESIGN Twelve patients aged 18 to 55 years with severe carbon monoxide poisoning and no history of neurologic disorder were evaluated. Either nasal (5 patients) or hyperbaric (7 patients) oxygen therapy was administered. Criteria for hyperbaric oxygen therapy were blood CO of more than 20%, loss of consciousness, pregnancy, or signs of cardiac injury. After oxygen treatment, all patients had a blood CO value of 0% and no patient had persistent acute signs of toxicity. Patients then were investigated by confentional EEG, EEG mapping, and 99mTc HMPAO brain SPECT. These procedures were performed on the day of admission. PARTICIPANTS After nasal (5 patients) or hyperbaric (7 patients) oxygen therapy was administered, 12 adults with severe carbon monoxide poisoning were evaluated. All studies were performed on the day of admission. MEASUREMENTS Conventional EEG, EEG mapping, and 99mTc HMPAO brain SPECT. RESULTS While classic EEG was normal in 9 of 12 patients and showed diffuse anomalies in 3, EEG mapping and 99mTc HMPAO brain SPECT demonstrated unilateral or bilateral regional anomalies in 8 of 12 patients. Anomalies were localized in temporo-parieto-occipital areas, the watershed areas of the major cerebral arteries, or in temporal cortex. CONCLUSION These preliminary results suggest that EEG mapping and 99mTc HMPAO brain SPECT can be complementary tools to diagnose early regional cerebral anomalies in carbon monoxide-poisoned patients.

Pancreatic panniculitis: A rare complication of pancreatitis secondary to ERCP

Panniculitis is an uncommon and rare complication of systemic fat necrosis in patients with pancreatic diseases. The skin manifestations are independent of the severity of the pancreatic pathology and can occur at any time. The lesions can precede, be concomitant with or rarely follow the pancreatic illness. We report a case of acute pancreatitis post Endoscopic Retrograde Cholangio Pancreatography (ERCP) for common bile duct stone, with subcutaneous panniculitis. We noted a complete resolution within two weeks after the treatment of the pancreatic pathology.

Primary Gallbladder and Rectal Neoplasms: Rare Synchronous Digestive Tumors

Colorectal cancer, the third most common cause of cancer worldwide and the fourth leading cause of cancer death is known to be a major cause of morbidity and mortality. Furthermore, the gallbladder cancer, a rare tumor, occupies the fifth place among the cancers of the gastrointestinal tract.

Schwannoma of the psoas: An unusual cause of abdominal pain

Schwannomas are usually benign tumours arising from Schwann cells of peripheral nerve sheath. Retroperitoneal location is extremely rare compromising 0.5-5% of all schwannomas, except in patients having von Recklinghausens disease, in whom retroperitoneal location is more frequent and malignant cases are known to occur. Complete surgical excision with negative margins is the definitive treatment on which the diagnosis is usually made due to nonspecific radiologic appearance. In this article we would like to present an unusual cause of recurrent, abdominal pain in an eighty-six-year-old male.

Percutaneous Endoscopic Gastrostomy and Buried Bumper Syndrome

Percutaneous Endoscopic Gastrostomy (PEG) is a method of placing percutaneously a tube into the stomach by endoscopy. This technique is a relatively safe and effective method indicated in the treatment of neurologic diseases with irreversible swallowing problem or proximal esophageal pathology. Complications can occur including pain at the site, leakage of stomach contents and malfunction of the tube. Possible complications include infections of the PEG site, aspiration, bleeding and perforation. In this article we would like to bring to attention a rare complication of PEG, the Buried Bumper Syndrome (BBS) that presented in an 86-year-old female with gradual migration of the internal bumper alongside the stoma tract outside the stomach.

Nitrofurantoin: Is a Rare Cause of Autoimmune Hepatitis

Auto-immune hepatitis is of unknown origin. The detection of non-organ and liverrelatedautoantibodies in the absence of viral, toxic, metabolic and genetic causes constitutes the hallmark for the diagnosis.