Laparoscopic cholecystectomy and laparoscopic common bile duct exploration for cholecystolithiasis and choledocholithiasis in a patient with situs inversus totalis: A case report.

Situs inversus complicates diagnosis and treatment due to the mirrored organ placement in relation to normal anatomy. This report describes a 78-year-old female patient with situs inversus totalis who underwent laparoscopic cholecystectomy and laparoscopic common bile duct exploration for cholecystolithiasis and choledocholithiasis. Utilizing the "French mirror technique" for port placement, the surgeon adeptly mirrored standard maneuvers with a 2-mm needle forceps in the left hand and a 5-mm forceps in the right in a reversed anatomical setting. This technique maintained familiar hand movements, despite the patient's unique anatomy. The surgeon applied transcystic ductal bile duct exploration, using choledochoscopy for duct exploration and a basket catheter for stone removal. Laparoscopic cholecystectomy and common bile duct exploration through the transcystic ductal route are viable and effective for patients with situs inversus.

Rapidly growing double cancer of the gallbladder: A case report.

INTRODUCTION: Gallbladder cancer is a rare malignancy and double cancer of the gallbladder is extremely rare. Biliary tree malignancies including cholangiocarcinoma and gallbladder cancer are aggressive cancers and have a poor prognosis. This reports a rare case of double adenocarcinoma of the gallbladder. PRESENTATION OF CASE: A 77-year old woman with a cholelithiasis and decreased body weight was diagnosed with rapidly growing gallbladder tumor by abdominal computed tomography scan. A combined resection of the gallbladder, extrahepatic bile duct, segments 4a and 5 of the liver and regional lymph node dissection were performed. Pathologic examination revealed double poorly differentiated adenocarcinoma of the gallbladder. The patient had no evidence of recurrence for 40 months after resection. DISCUSSION: This patient had double cancer of the gallbladder. Gallbladder cancer is an aggressive cancer and has a poor prognosis. The only curative therapy is radical resection. In this patient, radical laparotomy and adjuvant chemotherapy were performed. The pathological diagnosis of the resected specimen was double cancer of the gallbladder. CONCLUSION: This is a report of rapidly growing double cancer of the gallbladder. Patients with gallbladder cancer may benefit from aggressive surgical resection and adjuvant chemotherapy.

Intussusception of the third portion of the duodenum secondary to a primary duodenal malignancy: A case report.

INTRODUCTION AND IMPORTANCE: Intussusception is invagination of the bowel and is rare in adults, representing only 5% of all cases of intussusception. Duodenal intussusception is also very rare. To the best of our knowledge, there is only one previous report of a malignant tumor in the fourth portion of the duodenum as the lead point of intussusception (Vaibhav et al., 2021 [1]). This reports a duodenal-duodenal intussusception caused by a malignant tumor in the third portion of the duodenum. CASE PRESENTATION: A 36-year-old woman with abdominal pain was diagnosed with duodenal intussusception by abdominal ultrasonography and computed tomography scan. Double balloon endoscopy showed that the intussusception had spontaneously reduced, and a tumor was found in the third portion of the duodenum. Open resection was performed because of the tumor location. Pathologic examination revealed adenocarcinoma with an adenoma of the duodenum. The patient had no evidence of recurrence for 4 years after resection. CLINICAL DISCUSSION: This patient had a primary duodenal malignancy and presented with intussusception, Duodenal intussusception is a rare condition requiring prompt intervention, usually requiring surgery. In this patient, since endoscopic resection was difficult, partial resection of duodenum was performed by open surgery assisted by double balloon enteroscopy. The pathological diagnosis of the resected specimen was primary duodenal malignancy. CONCLUSION: This is a report of adult duodenal intussusception caused by a primary duodenal malignancy. This rare condition posed an intriguing challenge for the optimal operative approach.

Phospholipase C-delta1 is an essential molecule downstream of Foxn1, the gene responsible for the nude mutation, in normal hair development.

Nude mice exhibit athymia and hairlessness by a loss-of-function mutation in the transcription factor Foxn1 gene. Although the immunological functions of Foxn1 have been studied intensively, there have been relatively few studies of its functions in skin. Foxn1 regulates expression of hair keratins, which is essential for normal hair structure; however, how Foxn1 regulates hair keratin expression and hair formation is largely unknown. In the present study, we found that mice lacking phospholipase C (PLC)-delta1, a key molecule in the phosphoinositide signaling pathway, and nude mice show similar hair abnormalities, such as lack of cuticle and bending. We also found that expression of hair keratins was remarkably decreased in skin of PLC-delta1 knockout mice. Furthermore, expression of PLC-delta1 was induced in Foxn1-transfected U2OS cells. In addition, we showed that PLC-delta1 expression was remarkably decreased in skin of nude mice. In skin and keratinocytes of nude mice as well as PLC-delta1 KO mice, activation of PLC downstream effectors, such as PKC and nuclear factor of activated T cells, was impaired. These results indicate that PLC-delta1 is an essential molecule downstream of Foxn1 in normal hair formation, and strongly suggest that hairlessness in nude mice is caused by insufficient expression of PLC-delta1.