ABSTRACT
Gallbladder volvulus is a rare condition that disproportionately affects elderly women. It occurs in patients with aberrant anatomy that results in a hypermobile gallbladder free to twist on the mesentery, leading to ischemia and necrosis. Due to its close resemblance to cholecystitis, it is difficult to diagnose preoperatively, thus most cases are diagnosed intraoperatively. In our case, a 90-year-old female was transferred to the hospital from an outside facility after being diagnosed with acute cholecystitis. A robotic-assisted laparoscopic approach was used to gain entry into the abdomen. Upon entry, the gallbladder was gangrenous, detached from the liver bed, and twisted on the cystic duct. Despite the presence of severe inflammatory changes and adhesions, the gallbladder was resected without complications, and the patient was discharged on postoperative day five.
ABSTRACT
It is known that polymorphisms of beta (2)-glycoprotein I (beta (2)GPI) in exon 7 affect interaction between the phospholipid binding site and the antibodies, and that other polymorphisms in exon 8 increase the generation of antibodies. In this study, we analyzed genetic polymorphisms of beta (2)GPI in unselected Chilean patients to determine the prevalence of beta (2)GPI polymorphisms in the phospholipid domain in patients with venous and arterial thrombosis and the clinical correlation with thromboembolic complications. This study comprised 149 patients with venous and arterial thrombosis (62 with venous thrombosis and 87 with arterial thrombosis) and 160 healthy controls with no previous history of thrombosis. Polymorphisms of exons 7 and 8 of beta (2)GPI, which encode for its fifth domain, were determined by PCR-RFLP. The presence of aPL or anti-beta (2)GPI in the patients was detected by ELISA. Anti-beta (2)GPI were present in 8/149 patients (5.4%); of these, five had aCL antibodies of low titer. The allele containing Val/Leu(247) and Trp/Ser(316) was significantly more frequent in patients with thrombosis than in the control group (OR=3.1, CI 1.6-6.0, p=0.0003; OR=2.9, CI 1.1-8.6, p=0.027, respectively). These polymorphisms did not correlate with aPL or anti-beta (2)GPI but significant differences were observed with venous thrombosis (p=<0.0001) and arterial thrombosis (p=0.026). In conclusion, the beta (2)GPI polymorphisms Val/Leu(247) and Trp/Ser(316) are not related to the presence of anti-beta (2)GPI antibodies in unselected Chilean patients with venous and arterial thrombosis, but they are significantly associated with venous and arterial thrombosis.
