Management of trichobezoar: case report and literature review

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. We present our experience with four patients and provide a review of the recent literature. According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. In addition, psychiatric consultation is necessary to prevent relapses

Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomes

Louis de Jong,1 Veronique AJIM van Rijckevorsel,1 Jelle W Raats,1 Taco MAL Klem,2 Tjallingius M Kuijper,3 Gert R Roukema11Surgery Department, Maasstad Hospital, 3079 DZ Rotterdam, the Netherlands; 2Surgery Department, Franciscus Hospital, 3045 PM Rotterdam, the Netherlands; 3Science Board, Maasstad Hospital, 3079 DZ Rotterdam, the NetherlandsBackground: The primary aim of the present study was to verify the potential risk factors for developing a delirium after hip fracture surgery. The secondary aim of this study was to examine the related clinical outcomes after a delirium developed post-hip fracture surgery.Patients and methods: Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records. A total of 463 patients undergoing hip fracture (hip hemiarthroplasty) surgery in a level II trauma teaching hospital between January 2011 and May 2016 were included. Delirium was measured using the Delirium Observation Screening Scale, the confusion assessment method, and an observatory judgment by geriatric medicine specialists.Results: The results showed that 26% of the patients (n=121) developed a delirium during hospital stay with a median duration during admission of 5 days (IQR 3–7). The multivariable model showed that the development of delirium was significantly explained by dementia (OR 2.75, P=0.001), age (OR 1.06, P=0.005), and an infection during admission (pneumonia, deep surgical site infection, or urinary tract infection) (OR 1.23, P=0.046). After 1 year of follow-up, patients who developed delirium after hip fracture surgery were significantly more discharged to (semi-independent) nursing homes (P<0.001) and had a significantly higher mortality rate (P<0.001) compared to patients without delirium after hip fracture surgery.Conclusions: The results showed that 26% of the patients undergoing hip fracture surgery developed a delirium. The risk factors including age, dementia, and infection during admission significantly predicted the development of the delirium. No association was confirmed between delirium and time of admission or time to surgery. The development of delirium after hip fracture surgery was subsequently found to be a significant predictor of admission to a nursing home and mortality after 1 year.Keywords: delirium, hip fracture, femoral neck fracture, mortality, risk and prognostic factors, hemi athroplasty, fragil

Critical Importance of Standardized Nomenclature and Classification in Venous Surgery and Interventional Treatments

In this chapter the authors explain the need for standardization of nomenclature and classification of deep venous disease in patients selected for venous surgery and/or (minimally invasive) interventional treatment. For both acute deep vein obstruction (deep vein thrombosis) and chronic deep vein obstruction (deep vein stenosis or occlusion), the concept behind treatment selection and classification of disease is explained and illustrated with figures.keywordsinferior vena cavavaricose veiniliac veinvenous diseasevenous insufficiencythese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves

Tradução e adaptação cultural do Questionário Aberdeen para Veias Varicosas Translation and cultural adaptation of Aberdeen Varicose Veins Questionnaire

CONTEXTO: Atualmente há um crescente interesse por instrumentos de avaliação em saúde produzidos e validados em todo o mundo. Apesar disso, ainda não temos no Brasil instrumentos que avaliem o impacto da doença venosa crônica na vida de seu portador. Para utilização dessas medidas torna-se necessária a realização da tradução e da adaptação cultural ao idioma em questão. OBJETIVO: Traduzir e adaptar culturalmente para a população brasileira o Aberdeen Varicose Veins Questionnaire (AVVQ- Brasil). MÉTODOS: O processo consistiu de duas traduções e duas retrotraduções realizadas por tradutores independentes, da avaliação das versões seguida da elaboração de versão consensual e de pré-teste comentado. RESULTADOS: Os pacientes do pré-teste eram do sexo feminino, com média de idade de 49,9 anos, média de tempo de resposta 7,73 minutos, que variou entre 4,55 minutos (tempo mínimo) a 10,13 minutos (tempo máximo). Escolaridade: 20% analfabetismo funcional, 1º grau completo e 2º grau completo; 30% 1º grau incompleto; e 10% 3º grau completo. Gravidade clínica 40% C3 e C6S, 10% C2 e C5, havendo cinco termos incompreendidos na aplicação. CONCLUSÕES: A versão na língua portuguesa do Aberdeen Varicose Veins Questionnaire está traduzida e adaptada para uso na população brasileira, podendo ser utilizada após posterior análise de suas propriedades clinimétricas.<br>BACKGROUND: Currently there is a growing interest in health assessment tools produced and validated throughout the world. Nevertheless, it is still inadequate the number of instruments that assess the impact of chronic venous disease in the life of its bearer. To use these measures it is necessary to accomplish the translation and cultural adaptation to the language in question. OBJECTIVE: Translate to Portuguese and culturally adapted for the Brazilian population the Aberdeen Varicose Veins Questionnaire (AVVQ-Brazil). METHODS: The process consisted of two translations and two back-translations performed by freelance translators, then the evaluation versions of the development of consensual version and commented pretest. RESULTS: The patients in the pre-test were female, mean age 49.9 years, average response time of 7.73 minutes, which ranged from 4.55 minutes (minimum) to 10.13 minutes (maximum time). Education: 20% functional illiteracy and first and second complete degrees; 30% first incomplete degree, and 10% third complete degree. Clinical severity: 40% C3 and C6s, 10% C2 and C5, with five misunderstood terms in the application. CONCLUSION: The Portuguese version of the Aberdeen Varicose Veins Questionnaire has been translated and adapted for use in the Brazilian population, and can be used after further analysis of their clinimetric properties, which is underway