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

On the interconnectedness of value network maturity and new technology-based firm survival

We examine to what extent a transaction relation-based value network maturity status of New Technology-Based Firms (NTBFs) is related to their survival. A specific challenge of NTBFs is their lack of market-orientation, which is why the maturity of the ties they form towards the market in terms of customers, financiers, personnel and partners is supposed to be a strong indicator for survival. We analyze a sample of 170 NTBFs by capturing their value network status from business plans and defining their survival status using secondary research. Simple statistical tests and regressions suggest that the official registration of the business is a pre-step for survival that requires industry-specific value network dimension strengths. A sub-sample survival analysis shows that for all NTBFs that have reached registration, regardless of their industry, a stronger customer value network maturity dimension prevents from failure and is thus a significant predictor for survival. Moreover, the analyses partly support the idea that NTBFs from the IT sector are less dependent on a strong value network in the financier dimension to survive. The results are of relevance for both practitioners and researchers in the innovation system: a better understanding of the factors impacting on NTBF survival can help to provide more tailored support services for young firms, increase the effectiveness of resource allocations, and provide a basis for further research

Laser Doppler Skin Perfusion Pressure in the Assessment of Raynaud's Phenomenon

AbstractObjectives. In the assessment of Raynaud's phenomenon, objective evaluation of digital microcirculatory flow is important, and so we investigated whether the measurement of laser Doppler skin perfusion pressure could be of use.Materials and methods. Ten fingers of five patients with secondary Raynaud's phenomenon due to systemic sclerosis, 22 fingers of 11 patients with primary Raynaud's phenomenon and 10 fingers of five control patients were examined. Skin perfusion pressure was measured on the third finger of both hands at rest, and then again 3 min after local cold exposure.Results. Laser Doppler skin perfusion pressure at rest in patients with secondary Raynaud's phenomenon was significantly lower than that in patients with primary Raynaud's phenomenon and the control patients (p<0.05). Skin perfusion pressure decreased significantly in both patient groups upon local cold exposure (p=0.005). There were significant differences in perfusion pressure after cold exposure among both groups (p<0.05).Conclusions. The low skin perfusion pressure at rest in patients with secondary Raynaud's phenomenon suggested the presence of obstructive arterial lesions. The marked pressure decrease in all Raynaud's patients after local cold exposure might be due to vasospasm of the microvasculature in the digits. These results indicate that the measurement of laser Doppler skin perfusion pressure is valuable in the diagnosis of Raynaud's phenomenon