Solitary rectal ulcer syndrome: a clinicopathological study of 13 cases

Solitary rectal ulcer syndrome [SRUS] is a rare disorder that has a wide spectrum of clinical presentation and variable endoscopic findings. To further characterize the clinical and pathological features, a retrospective, hospital-based clinicopathological study was conducted. All cases of SRUS diagnosed at Farwania Hospital, Kuwait, between 2002 and 2007 were retrieved from the computerized filing system. The histological slides were reviewed by two authors to confirm the diagnosis. Immunohistochemical stain for smooth muscle actin [SMA] was performed. The clinical files were reviewed for clinical features and endoscopic findings. Thirteen cases were identified: 8 males and 5 females. The age range was 15-85. Rectal bleeding, constipation, and abdominal pain were the most common presenting symptoms and were seen, either alone or in various combinations, in 12 of the 13 cases. Rectal ulceration was the most common endoscopic finding, being seen in 9 of thel3 cases; 3 of these cases had multiple ulcerations. Two patients had rectal polyps, with one of them having multiple polyps. The histological examination revealed surface serration, fibromuscular obliteration of the lamina propria, and crypts' distortion in all the cases. Seven of the cases had diamond crypts. Ectatic mucosal vessels were a common finding. Positivity for SMA in the lamina propria was seen in all examined cases. SRUS is a rare disorder and only 13 cases were diagnosed in Farwania hospital over a 6-year period. The clinical presentation of our patients was variable. The presence of polyps and multiple ulcerations on endoscopy is further evidence that SRUS is a misnomer. Surface serration, fibromuscular obliteration, and crypts' distortion are the most characteristic features. The presence of diamond crypts is an additional diagnostic feature

Pyridoxine for severe metabolic acidosis and seizures due to isoniazid [INH] overdose

Isoniazid [INH] overdose can be effectively treated, only if, suspected. Seizures and coma are due to INH unless proved otherwise in patients with access to the drug. Acute INH intoxication is characterized by a clinical triad consisting of metabolic acidosis resistant to treatment with sodium bicarbonate, seizure which may be fatal and refractory to standard anticonvulsant therapy, and coma. Pyridoxine is the specific antidote for INH overdose. We report a case of a 25-yr-old lady, who in a suicidal attempt ingested a toxic dose of INH resulting in status epilepticus and was successfully treated with pyridoxine [Vit B6]

Cholestatic jaundice induced by carbimazole in grave's disease

Antithyroid medications are one of the treatment options for Grave's disease. Carbimazole [the pro drug for methimazole] is widely used as the drug of choice, except in pregnancy where propythiouracil is preferred by many. It is generally well-tolerated. Its side-effects include allergy, upper gastrointestinal upset, the rare occurrence of a granulocytosis and others. Hepatitis is another rare but serious side-effect. We report a previously healthy 65-year-old female patient with Grave's disease who developed cholestatic jaundice after carbimazole therapy. She made a full recovery after the drug was discontinued

Primary infarction of the gastro-colic omentum and review of the literature

A 31-year-old male patient presented with epigastric pain and right-sided abdominal pain of one-day duration. He was later diagnosed as having a gastro-colic omental infarction [fixed part of the omentum]. To our knowledge this is the first case to be reported in the literature. In all other reports, infarctions were localized to the free omentum. We report this case to highlight the importance of omental infarction in the differential diagnosis of acute abdominal pain, since the management is mainly conservative