Immediate repeated testing (IRT) for BPPV: A cost-effective examination.

Objective: To show that a negative Dix-Hallpike test or Pagnini-McClure test may convert into positive after head shaking in cases of semicircular canalith jam. Methods: This is a retrospective study, where 768 cases of BPPV were studied of which 36 were found to have canalith jam. Results: Thirty-six patients (4.7%) presented with canalith jam; 4.8% of posterior canal BPPV and 3.7% of lateral canal BPPV were attributed to canalith jam. Conclusion: Immediate repeated testing for BPPV allows us to identify undiagnosed cases of BPPV where canalith jam has occurred. It is a cost-effective technique that provides benefits for clinicians, patients, and the healthcare system.

Unusual presentation of a clinically isolated temporal region mass: Non-Hodgkin lymphoma.

Non-hodgkins lymphoma is a systemic disease that may present in multiple sites, rarely does it present primarily as a temporal fossa swelling. Only four cases have been reported in the English literature. We report a case of a patient who presented with a rapidly progressive swelling of the temporal fossa.

Encephalopathy induced by antihelminthic use of levamisole: report of two patients.

BACKGROUND: The antihelminthic Levamisole (LVM) is actually used as an immunomodulator in colon cancer. Its neurological toxicity is well known when used concomitantly with 5-Fluorouracil (5 FU) and, rarely when used solely at high doses. Antihelminthic imidazoles induced encephalopathy (AIIE), has been reported only in China. METHODS: We report two Lebanese patients with AIIE, with literature review concerning the pathophysiology, clinical presentation, laboratory, imaging and prognosis of this entity. RESULTS: AIIE supervenes after sensitization and re-exposure to the drug. It resembles the acute disseminated encephalomyelitis (ADEM) and the differentiation from multiple sclerosis is primarily based on the monophasic clinical and radiological (MRI) pattern of the disease. The treatment consists of steroids, and it has a good prognosis. The immunomodulatory role of Levamisole is evident but the pharmacokinetics remain unknown. CONCLUSION: This disease entity has to be considered anytime a patient, in an endemic area for helminthiasis, develops an encephalopathy, especially after a documented exposure to imidazoles, even at low doses and particularly after re-exposure to the drug that has to be prudent.

Endoscopy in Barrett's esophagus. Surveillance during reflux management and new advances in the diagnosis and early detection of dysplasia.

Given the alarming rise in the incidence of esophageal cancer and the fact that Barrett's esophagus is clearly a precursor to this disease, effective surveillance is desirable. Endoscopic surveillance is recommended by major endoscopic and gastrointestinal societies based on the available data and hypothetic models suggest that the costs of endoscopic surveillance for Barrett's esophagus may be reasonable when compared with other commonly applied cancer screening strategies. Although, however, most implicated physicians agree that surveillance is warranted, recommended guidelines often are not followed. This occurrence may reflect the importance of some of the practical limitations inherent to carrying out intensive endoscopic biopsy protocols in large numbers of eligible patients. In an effort to improve the surveillance process, several new techniques have been tested and are in development. These techniques are aimed at facilitating the histologic sampling of larger areas of metaplastic epithelium, at better targeting sites more likely to harbor dysplasia and cancer, and at replacing endoscopic biopsies with nonhistologic tissue analysis. Although many of these newer techniques are promising, however, none are currently close to widespread clinical application. The current standard for surveillance remains the use of systematic endoscopic biopsies, with the frequency of surveillance endoscopies determined by the severity of any dysplastic changes that are found. Given the large number of patients that are likely to be eligible for screening and the current constraints in terms of physician availability and health-care resources, endoscopic biopsy will remain the cornerstone of Barrett's esophagus surveillance strategies unless newer alternatives are clearly advantageous in terms of accuracy, cost, availability, and ease of application. In the future, however, advances in techniques for minimally invasive ablation of Barrett's epithelium may make endoscopic surveillance obsolete altogether.