superglue for your brain

A few interesting tidbits. Apparently in Emergency, there are patients known as "camels." These individuals behave poorly and consistently spit on health care workers. As a result, a safety mesh is up over their head - basically a thin, loose burlap sack to prevent the individual from contaminating health care workers with possibly diseased bodily fluids.

I heard another story about a patient today who went to the MR for a scan. Scans kept getting this gigantic artifact across the screen, so one of the techs figured there must have been metal on the person. They went to check for metal electrode leads, such as those in a pacemaker, but couldn't find anything. They ran the scan again and the artifact was still there, so the tech removed the armboards and the headrest, thinking there might be some metal in it. The artifact still remained. Thinking it might be something on the scanner, they removed the patient and ran a quick test scan, but there was no artifact! The tech asked the patient who was both groggy and old, who stated he once had a barium milkshake. The tech thus concluded the barium was the source of the artifact, that the metal must have been interfering with the scan.

It turned out the patient's barium milkshake had been over two years ago, and so the techs were left puzzled. Days later, patient visited the OR, where it was discovered that he neglected to mention that he had been eating coins. The metal from the coin bezoar (remember bezoars???) was causing the artifact, and surprisingly hadn't been pulled out of his body and caused massive internal bleeding from the field.

***

I learned a new word today: Nidus. It basically is the medical term for anything resembling a nest. Remember arteriovenous malformations (AVM)? A 10 year old patient was in our clinic the other day with a crazy AVM, and they use this product called the EV3 Onyx Liquid Embolic System to treat it. Basically they send a catheter into the AVM, inject this compound made of ethylene vinyl alcohol, and let it travel throughout the nidus of the AVM. It ends up plugging blood flow and the AVM becomes harmless, degenerating with time; basically a superglue for your brain.

pica

There's this fascinating childhood psychiatric disorder called pica, which is basically the continuous ingestion of non-food items. It's commonly a dual diagnosis (mental retardation + mental illness). Children who have pica tend to develop one of my favourite words in the English language, bezoars. Basically a bezoar is a mass of something that cannot pass through the digestive system. An example is a phytotrichobezoar, which is what it sounds like if you break the latin down: Phyto refers to something plantlike (seeds, skins of fruits, vegetables), tricho meaning hair, and bezoar - a mass of plant+hair in the GI tract.

Obviously, children with pica have the potential to develop some lifethreatening gastro illnesses, but what's curiously interesting is that pica is a strong predictor for bulimia nervosa later in life. Why eating weird non-foods would translate to binge eating + compensatory mechanism is beyond me, but it's statistically significant. I could understand if it led to binge eating disorder (currently eating disorder NOS until DSM-V comes out), what with it being an impulse control issue, but this doesn't seem to be the case.


This guy liked to eat coins.

Here's a beauty, a giant trichobezoar being removed on operation of an 18 year old with pica. Not for the faint of heart.