The Rapunzel syndrome: a hairy tale.

BACKGROUND: Trichobezoars are a rare medical condition, often requiring a surgical approach and commonly associated with an underlying psychiatric disorder. The Rapunzel syndrome is a rare variant of trichobezoar in the stomach extending from the stomach into the small intestine causing a bowel obstruction. CASE PRESENTATION: In this case report, the clinical presentation, diagnostic approach, and surgical removal of a large-size bezoar (Rapunzel syndrome) in a young and otherwise healthy female is described. Different surgical strategies are discussed. Psychiatric exploration gives an insight on development of trichophagia ultimately leading to the forming of the trichobezoar. CONCLUSIONS: This brief report sheds light on the importance of the collective mind of a multidisciplinary team preventing a potentially fatal outcome.

[Hernia surgery on patients with co-morbidities]. / Hernienchirurgie beim Risiko-Patienten.

Hernia surgery on patients with co-morbidities Abstract. Establishing a correct diagnosis and choosing the right surgical treatment is already a challenge for the healthy hernia-patient. But for them a clearly structured guideline already exists, according to international hernia societies the decision-making process should be done according to a patient-tailored approach. For sick hernia-patients with multiple risk factors for surgery, the challenge is even greater. In particular many different medical issues are incorporated into the therapeutic decision. The following article intends to provide an overview of the therapy-relevant secondary diagnoses to be observed and treated in advance.

The dorsal tangential X-ray view to determine dorsal screw penetration during volar plating of distal radius fractures.

PURPOSE: To evaluate whether the dorsal tangential view (DTV) allows for reliable and valid in vivo measurement of the distance between screw tips and the dorsal radial cortex (STCD) during volar plating of distal radius fractures. METHODS: Subjects included 22 patients with displaced distal radius fractures who had volar plate osteosynthesis. We performed standardized DTV images intraoperatively. After surgery, we performed computed tomography (CT) scans with reconstructions parallel to the distal screws. Three independent observers blinded to the study protocol measured the STCD on the basis of the DTV images and CT reconstructions. We calculated inter- and intraobserver reliability and the correlation between STCD values measured with DTV images and CT scans. RESULTS: Eleven screws were changed intraoperatively. We observed no cases of postoperative screw perforations. Inter- and intraobserver reliability of STCD measurement was good when measured with DTV images and excellent when measured on the basis of CT reconstructions. Statistical analysis showed a good correlation between mean STCD values measured with DTV and CT. CONCLUSIONS: The DTV allowed in vivo evaluation of the dorsal radial cortex and enabled reliable assessment of the distance between the screw tip and the dorsal cortex. It may allow detection of dorsal screw perforation during volar plating of distal radial fractures.