Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report

Background

Trichotillomania and trichophagia cause trichobezoars, which are masses made of hair. The main presentation of this condition is abdominal pain. However, other complications include gastric outlet obstruction, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhea, and constipation.

Case presentation

A 57-year-old woman with trichotillomania was admitted to the Emergency Department with the chief complaints of dyspnea on exertion, shortness of breath, dysphagia, generalized weakness, and hoarseness. Spiral chest computed tomography (CT) scan did not reveal any parenchymal lesions Pulmonary CT angiography did not reveal pulmonary embolism. The patient was admitted to the Surgery Department for hand fasciotomy due to contrast leakage, and during laryngoscopy, a trichobezoar was detected that was removed with Magill forceps.

Conclusions

Rare cases of trichobezoars can be observed in humans with gastrointestinal and respiratory symptoms. Precise and timely diagnosis are key for the prevention of more invasive diagnostic procedures.

The Effect of Total Knee Arthroplasty on Hindfoot Alignment in Patients with Severe Genu Varum and Genu Valgum

Background

The maintenance of deformity in the ankle and hindfoot after correction of knee deformity following knee arthroplasty may cause abnormal tension in the knee and patient dissatisfaction. The aim of this study was to determine the effect of knee arthroplasty on the hindfoot alignment in patients with severe genu varum and valgum.

Methods

A total of 84 patients with primary osteoarthritis, were enrolled in the study. The knee deformity was measured using a long leg film before surgery. The long axial radiographic view of hindfoot was taken in the standing position for all patients, before and six months after surgery. Comparisons were made on changes in the hindfoot angles measured before and after surgery.

Results

A total of 84 patients with mean age of 62.28 ± 7.77 years, 77 (92%) and seven patients (eight percent) had knee varus and valgus deformity, respectively. In the knee varus group, the mean preoperative hindfoot angle was + 5.32 ± 6.12 ° (valgus) which was changed to - 0.25 ± 4.91 ° (varus) in the postoperative phase. In the knee valgus group, the mean pre and postoperative hindfoot angles were - 7.71 ± 7.06° (varus) and - 2.14 ± 5.92 ° (varus), respectively. The mean preoperative hindfoot angle in severe and very severe varus knee groups were + 5.45 ± 3.30 and + 5.28 ± 6.86 °, respectively. These angles were changed to + 0.21± 5.17 and -1.60 ± 3.89° six months after surgery, respectively. The mean preoperative hindfoot angle in severe and very severe valgus knee deformity groups were - 7.00 ± 4.69 and -8.66 ± 10.69 °, respectively. These angles were changed to - 2.00 ± 5.71 and - 2.33 ± 7.50 °after surgery, respectively. There was no significant difference between patients with severe and very severe deformity in terms of pre and post-operative hindfoot angle.

Conclusion

The hindfoot alignment is significantly corrected after knee arthroplasty. The severity of knee deformity does not correlate with the severity of the hindfoot deformity before and after surgery.

Relationship between Femoral Intercondylar Notch Narrowing in Radiography and Anatomical and Histopathologic Integrity of Anterior Cruciate Ligament in Patients Undergoing Total Knee Replacement Surgery

BACKGROUND

The presence of cruciate ligaments is very important for normal knee kinematics. Knee arthroplasty prostheses, in which these ligaments are maintained, have better kinematics. The aim of the present study was to investigate the association between femoral intercondylar notch (FIN) narrowing in radiography and clinical and histopathologic integrity of anterior cruciate ligament (ACL) in patients undergoing knee replacement surgery.

METHODS

FIN index was measured in tunnel view radiography of the knees of 102 candidates of knee replacement surgery. The anatomical status of ACL was also examined during total knee arthroplasty (TKA). ACL was removed and sent for histopathologic examination to assess its degeneration rate. The association between the FIN index and the clinical and histopathological health of ACL was investigated.

RESULTS

Among 102 patients with mean age of 69.73 ± 7.81 years , 39 patients (38.32%) had no or torn ACL, 31 patients (30.39%) had weak ACL, and 32 (31.37%) had normal ACL. There was a significant association between age and clinical status of ACL during surgery (P=0.017). There was a significant difference in FIN and ACL health status during surgery between the two groups with an index of more and less than 0.252 (P=0.019 and P=0.019, respectively). There was no significant difference in the mean total degeneration score (TDS) of ACL between the two groups with FIN more and less than 0.252 (P=0.816).

CONCLUSION

There was a significant difference between the age and FIN narrowing (less than 0.252) as well as ACL clinical status during surgery. FIN narrowing had no significant effect on the severity of ACL degeneration and there was no significant difference in the severity of degenerative histopathologic changes between healthy and attenuated ACLs. This indicates that if ACL exists, although apparently attenuated, it has the histologic characteristic of a healthy ligament.