Surgical treatment of gastric outlet obstruction from a large trichobezoar: A case report.

INTRODUCTION: Bezoars are concretions of foreign indigestible material accumulating in the gastrointestinal tract leading to intraluminal mass formation that impairs the gastrointestinal motility and can lead to gastric obstruction of the small or the large bowel. There are different types of bezoars, named according to the material they are made of. These include phytobezoar, lactobezoar, pharmacobezoar, trichobezoar, and polybezoar. Trichobezoars (hair ball) are usually located in the stomach but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). CASE PRESENTATION: Herein, we report a case of a young adult female known to have a long-standing trichophagia who presented with gastric outlet obstruction due to a large trichobezoar. Endoscopy revealed a large and hard gastric trichobezoar not amenable to endoscopic retrieval leading to surgical extraction as a last resort. DISCUSSION: They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. Trichobezoar can be treated either surgically by laparotomy/laparoscopy or by endoscopic intervention. CONCLUSION: Treatment should be coupled to psychiatric evaluation and therapy to prevent recurrence.

Role of ATP sensitive potassium channels in long term adaptation to metabolic stress.

Cardiac KATP channel activation during metabolic inhibition has been implicated in effects ranging from malignant arrhythmogenesis and sudden cardiac death to reduction in infarct size, preconditioning, and a more rapid recovery of contractile ability. Given these disparate consequences, and the repeated observation that KATP currents are altered under a wide variety of metabolically stressful conditions, it becomes increasingly more critical to determine whether the changes described are part of the underlying pathology, or whether they reflect an endogenous adaptation to protect cardiac function. We support the view that enhanced KATP channels are intrinsically altered during long term metabolic inhibition, at least in part through a reduction in channel sensitivity to ATP, and that the change manifests itself in most cases as an adaptive mechanism. Increased channel activity in a chronically ischaemic environment could serve to maintain resting potential, limit calcium influx, conserve [ATP]i, and prevent excessive prolongation of action potential duration.

Temperature dependence of the dissociation rate constants for 8 S, 4 S, and meroreceptor forms of the estrogen receptor from rat uterus.

Conversion of a steroid receptor complex from the 8 S to the 4S form results in new interactions between the steroid and the receptor and/or formation of new intra-protein bonds within the receptor molecule itself. These bonds must be broken before the steroid is released. In order to localize these newly formed interactions, the dissociation kinetics of meroreceptors derived from 4 S and 8 S (molybdate-stabilized) receptor complexes were examined. At temperatures between 6 and 30 degrees C, no differences in the rates of dissociation were observed for the meroreceptors derived from the two forms of estrogen receptor, whereas approximately a twofold difference in dissociation rates for 4 S intact receptor versus 8 S intact receptor was detected. These findings indicate that the new interactions accompanying this conversion are likely to occur in regions of the receptor molecule other than the C-terminal portion of the steroid-binding site. The thermodynamic parameters of the dissociation reaction for the intact 4 S, and 8 S, and meroreceptor forms, respectively were: delta H [symbol; see text] = 26.2 +/- 1.3, 19.7 +/- 1.7, and 23.2 +/- 1.0 kcal/mol; +T delta S [symbol; see text] = 9.4 +/- 1.2, 3.2 +/- 1.7 and 6.6 +/- 0.9 kcal/mol (at 25 degrees C); and delta G [symbol; see text] = 16.8 +/- 2.5, 16.5 +/- 3.4, and 16.7 +/- 1.9 kcal/mol. As is the case for other steroid receptors, an increase in the enthalpy of steroid-receptor interaction after this conversion reflects the stability of the 4 S estrogen receptor complex.