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HTTS diagnosis is easy to make when the clinical picture is recognized. It is however very important that HTTS is not missed, because prolonged HTTS can cause necrosis[3]. Therefore, it is important to always assess capillary refill in such patients[3]. Treatment for HTTS is simple: removal of the strangulating hair or thread. This may be difficult with extensive local swelling, and often surgical incision is required. This incision should be to the bone, to be certain that all the constricting material is dissected[3]. As turned out in this case, after such treatment the symptoms quickly disappear. COMMENTS Case characteristics An 18 mo old girl with a painful swollen third toe was seen at the emergency ward. Clinical diagnosis A strangulated third toe was seen, presumably by a hair. Differential diagnosis Hair Selleck MK 2206 thread tourniquet syndrome is a clinical diagnosis with a very typical representation. Treatment Treatment for hair thread tourniquet syndrome consists of incision of the tourniquet. Related reports Hair thread tourniquet syndrome usually occurs in little children en generally affects toes, fingers or external genitalia. Term explanation Hair thread tourniquet syndrome is abbreviated as hair thread tourniquet syndrome. Experiences and lessons Hair thread tourniquet syndrome is a clinical diagnosis and is easily treated when recognized. Peer-review This is a nice case and well documented paper about the hair thread tourniquet. Footnotes P- Reviewer: Drosos Ibrutinib solubility dmso GI, Grimalt R S- Editor: Ji FF L- Editor: A E- Editor: Lu YJ Ethics approval: The study was reviewed and approved by the Spaarne Ziekenhuis Institutional Review Board. Informed consent: All study participants, or their legal guardian, provided informed written consent TRIB1 prior to study enrollment. Conflict-of-interest: No conflicts of interest to be declared. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Peer-review started: December 29, 2014 First decision: January 20, 2015 Article in press: February 12, 2015""AIM: To investigate whether endoscopic papillary large balloon dilation (EPLBD) can be safety and effectively performed in patients aged �� 80 years. METHODS: Lithotomy by EPLBD was conducted in 106 patients with bile duct stones �� 13 mm in size or with three or more bile duct stones �� 10 mm. The patients were divided into group A (