Recurrent trichobezoar due to trichophagia: a case report

Objective

Trichobezoar, a hair ball in the gastrointestinal tract, is usually the result of the urge to pull out one's own hair (trichotillomania) and swallow it (trichophagia). It is almost exclusively seen in young females and may cause serious medical complications. This case report will describe an adult female patient with recurrent trichobezoars.

Method

Data for this case report was collected from peer-reviewed literature and treatment encounters by the consultation–liaison psychiatry unit; subsequent to obtaining informed consent.

Results

The personality characteristics, familial structure and domestic stress found in this case mirror the literature. We initiated behavioral interventions including habit reversal training and patient education in combination with pharmacologic therapy with clomipramine.

Conclusion

Left untreated, trichophagia can cause a life-threatening emergency, requiring surgery. Recurrence of tichobezoars can be anticipated when the underlying emotional disorder is not addressed using multimodal management including psychiatric evaluation and treatment combined with surgical procedures.     

The influence of shift work on cognitive functions and oxidative stress

Shift work influences health, performance, activity, and social relationships, and it causes impairment in cognitive functions. In this study, we investigated the effects of shift work on participants' cognitive functions in terms of memory, attention, and learning, and we measured the effects on oxidative stress. Additionally, we investigated whether there were significant relationships between cognitive functions and whole blood oxidant/antioxidant status of participants. A total of 90 health care workers participated in the study, of whom 45 subjects were night-shift workers. Neuropsychological tests were administered to the participants to assess cognitive function, and blood samples were taken to detect total antioxidant capacity and total oxidant status at 08:00. Differences in anxiety, depression, and chronotype characteristics between shift work groups were not significant. Shift workers achieved significantly lower scores on verbal memory, attention–concentration, and the digit span forward sub-scales of the Wechsler Memory Scale-Revised (WMS-R), as well as on the immediate memory and total learning sub-scales of the Auditory Verbal Learning Test (AVLT). Oxidative stress parameters were significantly associated with some types of cognitive function, including attention–concentration, recognition, and long-term memory. These findings suggest that night shift work may result in significantly poorer cognitive performance, particularly working memory.     

Well-Developed Coronary Collateral Circulation Is Associated With Higher Thrombus Burden in the Setting of ST-Segment Elevation Myocardial Infarction

BackgroundThis study investigated the relationship between coronary collateral circulation (CCC) and intracoronary thrombus burden in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). CCC and thrombus burden are predictive of clinical outcomes in patients with STEMI.MethodsPatients with STEMI undergoing primary percutaneous coronary intervention were enrolled (n = 172). CCC was graded according to the Cohen–Rentrop classification. Patients were classified as insufficient (grade 0 or 1, n = 134) or well-developed (grade 2 or 3; n = 38) CCC. The Thrombolysis in Myocardial Infarction scale was used to evaluate intra-coronary thrombus burden. The low-thrombus-burden group comprised those with grades 0 to 2, and the high-thrombus-burden group comprised those with grades 3 or 4.ResultsRight coronary artery infarcts had a 13.830-fold higher chance of having well-developed CCC than did left anterior descending artery infarcts (P < .001). Circumflex artery infarcts had a 7.904-fold higher chance of well-developed CCC than did left anterior descending artery infarcts (P = .016). High thrombus burden was associated with a 4.393-fold higher chance for well-developed CCC than was low thrombus burden (P = .030). Low albumin levels were related to a greater chance of having well-developed CCC (P = .046).ConclusionPatients with well-developed CCC have higher thrombus burden than do those with insufficient CCC. Because well-developed CCC is an indicator of more severe underlying lesions, we speculate that patients with severe lesions are more prone to experience more complicated STEMI with high thrombus burden.     

A New Insight Into Pathophysiological Mechanism of Abdominal Aortic Aneurysm With Novel Parameters Salusin-β and Arterial Stiffness

BackgroundAbdominal aortic aneurysm (AAA) has risk factors similar to those of atherosclerosis. Salusin-β and arterial stiffness are novel parameters that have been shown to predict atherosclerosis and related cardiovascular disorders. However, their predictive value for detecting AAA remains unclear.MethodsForty-eight patients with AAA and 47 age- and sex-matched participants without AAA were enrolled in the study. Arterial stiffness parameters were obtained via an oscillometric Mobil-O-Graph PWA Monitor device (IEM GmbH) with integrated ARCSolver software (Australian Institute of Technology). Plasma salusin-β levels were analyzed using an enzyme-linked immunosorbent assay reagent kit (Abbkine, Inc). The measured salusin-β levels and arterial stiffness parameters of the AAA and control groups were compared.ResultsSalusin-β levels were significantly lower in patients with AAA (P = .014). There was a significant negative correlation between salusin-β levels and abdominal aorta diameter. No significant difference was detected between AAA and control groups in terms of arterial stiffness parameters (P > .05). In backward multiple regression analysis, the presence of AAA, platelet count, and augmentation index were found to be independent predictors of salusin-β levels (P = .006 and P = .023, respectively).ConclusionArterial stiffness parameters were not found to be associated with AAA. Contrary to previous results regarding atherosclerosis and related cardiovascular disorders, salusin-β levels were found to be lower in patients with AAA. Although AAA is thought to have similar risk factors as atherosclerosis, the exact pathophysiologic mechanism remains unclear.     

Clinical and laboratory findings of multisystem inflammatory syndrome in children (MIS-C) below age 1

Clinical Rheumatology -     

Fetal survival despite unrecognized uterine rupture resulting from previous unknown corporeal scar

Cesarean scar rupture of a gravid uterus with unknown corporeal scar is common. Our case was a 35 year woman, gravida 2, para 1 presented at 38 weeks gestation. She was admitted to our hospital for routine follow up. She had no signs or symptoms of labor. However eight hours after the initial examination, she came back to hospital with the signs of shock and acute abdomen. Immediately she was referred to surgery. Intraoperatively a complete rupture of the classical corporeal incision was observed, but the fetus was enclosed within the anterior lying plasenta. The fetus was delivered with one minute apgar score 3, and five minute apgar score 8. According to this case, we conclude that spontaneous uterine rupture of the classical uterine scar can be observed even without uterine contractions. So women with the possibility of previous classical uterine incision should be delivered once fetal maturity is documented.