Gross out time again!
First up: Cocaine Induced Palatal Perforation:
A healthy 25-year-old man presented to the surgical clinic with a hole in the roof of his mouth that allowed nasal regurgitation of food when he ate. The hole had been present for a year, and he requested surgical correction. The patient reported a 5-year history of nasal cocaine use from which he had recently abstained. Physical examination revealed a large perforation of the nasal septum and midline palate. Local complications of intranasal cocaine abuse include chronic rhinitis, sinusitis, epistaxis, ossification or necrosis of the nasal septum, and in rare cases, palatal perforation. Use of cocaine, a potent vasoconstrictor, can lead to ischemia, necrosis, and ulceration, as seen in this case. Other causes of palatal perforation to consider include infection (syphilis, tuberculosis, or fungal infection), Wegener's granulomatosis, sarcoidosis, neoplasms (salivary or squamous cell), and midline lethal granuloma, a type of T-cell lymphoma. After consultation, the patient did not return for follow-up.
And now: Trichobezoar. I'm going to give those of you with a working knowledge of Latin a small amount of time to deduce just what that might be.
Not just an urban myth, guys:
A previously healthy 18-year-old woman presented with a 5-month history of pain in the left upper quadrant of the abdomen, abdominal distention, postprandial emesis, and weight loss of 18 kg. Physical examination revealed a firm, tender, epigastric mass but was otherwise unremarkable. Computed tomography showed a large gastric mass extending from the fundus to the antrum (Panel A, arrow), with no indication of obstruction of the gastric outlet. Esophagogastroduodenoscopy revealed a large bezoar occluding nearly the entire stomach, without extension into the duodenum (Panel B). On questioning, the patient stated that she had had a habit of eating her hair for many years - a condition called trichophagia. Owing to the large size of the trichobezoar (37.5 by 17.5 by 17.5 cm), endoscopic removal was not attempted. Laparoscopic removal was attempted; however, conversion to an open procedure was required to completely remove the 4.5-kg trichobezoar (Panel C). The patient was tolerating a general diet by postoperative day 5 and was discharged to her home, with psychiatric and surgical follow-up. One year after the surgery, she has no abdominal pain or vomiting. She has regained approximately 9 kg of body weight and reports that she has stopped eating her hair.
I have a physio appointment at 0830hrs. This means leaving at 0700hrs to get through the traffic. This means getting up at a time I don't even wish to contemplate. This means that I am not even remotely sleepy yet! *eyetwitch* My body's contrariness. Let me show you it.
And yes, arse was kicked at my audition on Monday, even if I dislike with extreme prejudice self-criticism and felt a tad adrift when trying to write such a piece as part of the process. "I came, I saw, I kicked butt!" was not, I sensed, they were looking for. So I admitted that the props that the auditioner said he liked so much had actually only been acquired that morning ("Mum, do you have a powder compact? And some gloves? And ... like a handbag? What else should she have in her handbag?"), but went on to give some bullshit explanation about not wanting to rehearse with props only to wake to find myself having the kind of day where liquid consumption is going to be done on table-top through straws. Not entirely untrue, and I had had known that the monologue was one that would work better if the character were distracted by other physical tasks and all but talking to herself, but then the whole accent bullshit stepped in. Sigh. At least in the interview when I was able to tell the (Northern) auditioner that I'd had to abandon the accent attempt because my Irish kept interfering he'd nodded and smiled knowingly ... HEY GUYS IS MY ACCENT REALLY IRISH AND I SOMEHOW NEVER NOTICED?
Anyway, the monologue went fantastically. Improvisation remains one of my least favourite forms of artistic expression, especially when I'm involved in it and doubly especially when the other participants are all very eager school-leavers ... But meh. We shall know before Christmas, apparently. And of course I threw myself into the audition because one doesn't hold back at these times. Hence the physio appointment at fuck-off-o'clock. Swings and roundabouts.
A healthy 25-year-old man presented to the surgical clinic with a hole in the roof of his mouth that allowed nasal regurgitation of food when he ate. The hole had been present for a year, and he requested surgical correction. The patient reported a 5-year history of nasal cocaine use from which he had recently abstained. Physical examination revealed a large perforation of the nasal septum and midline palate. Local complications of intranasal cocaine abuse include chronic rhinitis, sinusitis, epistaxis, ossification or necrosis of the nasal septum, and in rare cases, palatal perforation. Use of cocaine, a potent vasoconstrictor, can lead to ischemia, necrosis, and ulceration, as seen in this case. Other causes of palatal perforation to consider include infection (syphilis, tuberculosis, or fungal infection), Wegener's granulomatosis, sarcoidosis, neoplasms (salivary or squamous cell), and midline lethal granuloma, a type of T-cell lymphoma. After consultation, the patient did not return for follow-up.
And now: Trichobezoar. I'm going to give those of you with a working knowledge of Latin a small amount of time to deduce just what that might be.
Not just an urban myth, guys:
A previously healthy 18-year-old woman presented with a 5-month history of pain in the left upper quadrant of the abdomen, abdominal distention, postprandial emesis, and weight loss of 18 kg. Physical examination revealed a firm, tender, epigastric mass but was otherwise unremarkable. Computed tomography showed a large gastric mass extending from the fundus to the antrum (Panel A, arrow), with no indication of obstruction of the gastric outlet. Esophagogastroduodenoscopy revealed a large bezoar occluding nearly the entire stomach, without extension into the duodenum (Panel B). On questioning, the patient stated that she had had a habit of eating her hair for many years - a condition called trichophagia. Owing to the large size of the trichobezoar (37.5 by 17.5 by 17.5 cm), endoscopic removal was not attempted. Laparoscopic removal was attempted; however, conversion to an open procedure was required to completely remove the 4.5-kg trichobezoar (Panel C). The patient was tolerating a general diet by postoperative day 5 and was discharged to her home, with psychiatric and surgical follow-up. One year after the surgery, she has no abdominal pain or vomiting. She has regained approximately 9 kg of body weight and reports that she has stopped eating her hair.
I have a physio appointment at 0830hrs. This means leaving at 0700hrs to get through the traffic. This means getting up at a time I don't even wish to contemplate. This means that I am not even remotely sleepy yet! *eyetwitch* My body's contrariness. Let me show you it.
And yes, arse was kicked at my audition on Monday, even if I dislike with extreme prejudice self-criticism and felt a tad adrift when trying to write such a piece as part of the process. "I came, I saw, I kicked butt!" was not, I sensed, they were looking for. So I admitted that the props that the auditioner said he liked so much had actually only been acquired that morning ("Mum, do you have a powder compact? And some gloves? And ... like a handbag? What else should she have in her handbag?"), but went on to give some bullshit explanation about not wanting to rehearse with props only to wake to find myself having the kind of day where liquid consumption is going to be done on table-top through straws. Not entirely untrue, and I had had known that the monologue was one that would work better if the character were distracted by other physical tasks and all but talking to herself, but then the whole accent bullshit stepped in. Sigh. At least in the interview when I was able to tell the (Northern) auditioner that I'd had to abandon the accent attempt because my Irish kept interfering he'd nodded and smiled knowingly ... HEY GUYS IS MY ACCENT REALLY IRISH AND I SOMEHOW NEVER NOTICED?
Anyway, the monologue went fantastically. Improvisation remains one of my least favourite forms of artistic expression, especially when I'm involved in it and doubly especially when the other participants are all very eager school-leavers ... But meh. We shall know before Christmas, apparently. And of course I threw myself into the audition because one doesn't hold back at these times. Hence the physio appointment at fuck-off-o'clock. Swings and roundabouts.