Cholecystitis, Concealment of Hepatobiliary-Pancreatic Pathology: The Role of Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound.

Cholecystitis is an inflammation of the gallbladder with classic symptoms of right upper quadrant abdominal pain and fever. The most common precipitating factor is cholelithiasis; however, it sometimes appears in conjunction with other hepatobiliary-pancreatic pathology. Management is generally done with antibiotics and supportive care with or without cholecystectomy. The surgical management in practice is often limited by surgery time and patient suitability considering their likely overall outcome. We have outlined two cases with different etiologies presenting as cholecystitis. The aim was to further understand the benefits of multidisciplinary team meetings to optimize patient care and emphasize the roles of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in hepatobiliary pathology.

Cocaine-Induced Pituitary and Subdural Brain Abscesses and the Treatment Challenges.

Cocaine is a well-known recreational drug with stimulant effects associated with relevant social, economic, and clinical implications. The most common route of abuse is via snorting. It has high addictive potential. Furthermore, one of the most well-known symptoms of a chronic user is chronic rhinitis. In the medical journals, there are numerous reports of complications, including lesions affecting the nasal septum, nasal sinuses, and even brain abscesses. We came across a 41-year-old male patient with severe manifestations of chronic cocaine use involving nasal, paranasal, and visual symptoms and signs. However, the most devastating was the complication of pituitary abscess, as a sequela to chronic cocaine sniffing. This case highlights the clinical, diagnostic, and management challenges with a multi-disciplinary approach. Last but not least, was the role of patient counselling and education. This ensured compliance towards management with a favourable outcome, which was rewarding for both the patient and the medical team involved in the care of the patient. It would hopefully create more awareness and assist in abstinence. We also hope it would incite more effort towards data collection and analysis, as well as allow us to explore the actual incidence of its use and devastating complications, which to date, for reasons of disguise and denial, remain somewhat ambiguous.

Caterpillar Climbing: Robust, Tension-Based Omni-Directional Locomotion.

Animals that must transition from horizontal to inclined or vertical surfaces typically change their locomotion strategy to compensate for the relative shift in gravitational forces. The species that have been studied have stiff articulated skeletons that allow them to redistribute ground reaction forces (GRFs) to control traction. Most also change their stepping patterns to maintain stability as they climb. In contrast, caterpillars, most of which are highly scansorial, soft-bodied, and lack rigid support or joints, can move with the same general kinematics in all orientations. In this study, we measure the GRFs exerted by the abdominal prolegs of Manduca sexta (Linnaeus) during locomotion. We show that, despite the orthogonal shift in gravitational forces, caterpillars use the same tension-based environmental skeleton strategy to crawl horizontally and to climb vertically. Furthermore, the transition from horizontal to vertical surfaces does not seem to require a change in gait; instead gravitational loading is used to help maintain a stance-phase body tension against which the muscles can pull the body upwards.