Endoscopic minimally invasive cholecystolithotomy in a patient with duplicate gallbladder: a case report

Gallstone disease is common in China and is generally treated with laparoscopic cholecystectomy. For some patients with normal contraction function and a small number of stones, endoscopic minimally invasive cholecystolithotomy is an additional possible treatment method that avoids complications related to laparoscopic cholecystectomy. Here, we describe a 45-year-old woman who underwent endoscopic minimally invasive cholecystolithotomy and was found to have duplicate gallbladder, which was not diagnosed preoperatively. We discuss the usefulness of the endoscopic minimally invasive cholecystolithotomy procedure and the management of duplicate gallbladder in patients undergoing endoscopic minimally invasive cholecystolithotomy.

Myotonia

Myotonia is a slow relaxation phase after normal contraction. Patients report dystonia as muscle stiffness and sometimes pain. They usually adapt to it well. Falls due to myotonia may lead to accidents. Examination for percussion myotonia should be part of neuromuscular examination. Percussion of the thenar muscles with the reflex hammer is the most productive method. Electrically silent myotonia is a sign of Brody myopathy. Myotonia may be incidentally discovered during electromyography (EMG). The most important task is to differentiate between myotonia from paramyotonia clinically and electrically. There has been a significant understanding of the underlying channelopathies lately. Severe myotonia respond well to mexiletine.

Myotonia

Myotonia is a slow relaxation phase of a muscle after normal contraction. Patients report myotonia as muscle stiffness and sometimes pain. They usually adapt to it well. Falls due to myotonia may lead to accidents. Checking for percussion and action myotonia should be part of neuromuscular examination. Electrically silent myotonia is a sign of Brody’s syndrome. Myotonia may be incidentally discovered during EMG. The most important task is to differentiate between myotonia and paramyotonia clinically and electromyographically. Most myotonic disorders are caused by mutations of sodium, and chloride channels. There has been a significant understanding of the underlying channelopathies recently. Severe myotonia respond well to Mexiletine.

The Patterned Organization Of Thick And Thin Microfilaments In The Contracting Pseudopod Of Difflugia

The lobopodial pseudopods of the shelled amoeba Difflugia undergo a rapid active contraction and length shortening which results in movement of the organism, or rapid pseudopod retraction. In polarized light, the pseudopod shows high birefringence before and during this normal contraction, suggesting a high degree of linear organization, and a complex pattern of changes. Immediately conventional fixation begins, pseudopods retract rapidly, and show changes in birefringence. When longitudinal sections are viewed in the electron microscope, such fixed, contracting pseudopods are seen to contain thick (14-16 nm) and thin (5-8 nm) microfilaments. Montages demonstrate that these microfilaments are found in close parallel association with each other, and lie parallel and peripheral to the longitudinal axis of the pseudopod, which is the axis of contraction. This distribution suggests that the patterned microfilaments could be involved in the shortening process and that they could account for the birefringence seen in the contracting pseudopod. Rapid alignment, or assembly, is also suggested.

2. On the After-glow of Cooling Iron at a Dull-Red Heat

The facts to be explained were observed by Messrs Gore and Barrett, and were described by the latter gentleman in the “Philosophical Magazine” for 1873.The experiments are performed on an iron or steel wire of no great thickness. When this is heated to an intense white heat and allowed to cool, the following facts appear at the instant it has cooled down to a dull-red heat:—1. The wire expands for an instant, and then continues its normal contraction.2. The glow from the wire is at the same instant seen to increase.