Tricholithobezoar Causing Gastric Perforation

A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. Trichobezoar is a rare condition seen almost exclusively in young women with trichotillomania and trichotillophagia. When not recognized, the trichobezoar continues to grow, which increases the risk of severe complications such as gastric ulceration and even perforation. Formation of a gallstone within the trichobezoar (tricholithobezoar) is an event that has not yet been described. We report the case of a 22-year-old woman admitted to the emergency room with signals and symptoms of an epigastric mass and perforative acute abdomen. Radiological study revealed bilateral pneumoperitoneum. Personal history revealed depressive syndrome, trichotillomania and trichophagia. With a diagnosis of visceral perforation, an urgent exploratory laparotomy was performed. This confirmed the diagnosis of gastric perforation due to a large trichobezoar with the formation of a gastrolith that was removed by anterior gastrotomy. Biochemical study of the gastric stone revealed that it was composed of bile salts. There were no complications. The patient was discharged on the 5th postoperative day and was referred for psychiatric treatment

Evaluation of nasal capacity before and after rapid maxillary expansion

Background: This study analyzed the effects of orthodontic maxillary expansion on the nasal cavity dimensions measured by acoustic rhinometry.Methods: A prospective study was performed. Fifty patients (27 male and 23 female patients) who had maxillary hypoplasia in relation to the mandible were studied. Patients presented either deciduous or mixed dentition, with age ranging from 4 to 14 years old. Twenty patients (11 male and 9 female patients) between the ages of 4 and 11 years, who also had deciduous or mixed dentition but without maxillary hypoplasia, served as a control group. A modified Biederman appliance was used for similar to 20 days to achieve the maxillary expansion in the treatment group. Acoustic rhinometry, with measurements of the right and the left nasal cavity, was performed before starting the maxillary expansion (T1) and at its conclusion (T2). This procedure was conducted also at a comparable time interval in the control group.Results: the treated group showed a significant increase in the majority of the values of transversal areas and nasal volumes when compared with the nontreated group.Conclusion: in children with maxillary hypoplasia, rapid maxillary expansion can not only move the maxilla and alveolar arches laterally but it can also increase the size of the nasal cavities.Universidade Federal de São Paulo, UNIFESP Escola Paulista Med EPM, Discipline Pediat Otolaryngol, Dept Otorhinolaryngol Head & Neck Surg, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP Escola Paulista Med EPM, Discipline Pediat Otolaryngol, Dept Otorhinolaryngol Head & Neck Surg, São Paulo, BrazilWeb of Scienc