Asymptomatic Gangrenous Acute Cholecystitis: A Life-Threatening Condition

Gangrenous gallbladder (GGB) is a life-threatening complication of acute cholecystitis, which happens due to gallbladder (GB) wall ischemia and necrosis. Delaying the diagnosis of GGB is life-threatening and may happen in asymptomatic patients. We present a case of an elderly male patient with a history of gastric carcinoid tumor, with partial gastric resection, who presented with generalized weakness and jaundice. His total bilirubin was elevated and an ultrasonography and computed tomography (CT) scan of the abdomen showed evidence of acute cholecystitis. An endoscopic retrograde cholangiopancreatography (ERCP) the day after admission showed no evidence of choledocholithiasis or cholangitis. It was during laparoscopic cholecystectomy three days later that the diagnosis of GGB was made as the GB was found to be necrotic with extensive adhesions. The patient also required intravenous antibiotics prior to discharge. This case illustrates risk factors for the development of gangrenous cholecystitis, physical findings in asymptomatic patients, and the importance of early diagnosis in order to reduce morbidity in this patient population.

Right Upper Extremity Idiopathic Primary Lymphedema in a 2-Year-Old Child

Lymphedema of an extremity at birth can be an alarming finding. Our patient presented with difficulty breathing and productive cough and was found to have primary lymphedema of the right upper extremity since birth. Further testing was mostly unremarkable except for imaging that revealed many splenic lesions.

Phytochrome in etiolated annual rye : II. Distribution of photoreversible phytochrome in the coleoptile and primary leaf

Phytochrome per fresh weight in the apical 0.5 cm of the 1.5-cm coleoptile was twice that in the basal 0.5 cm; phytochrome per dry weight and phytochrome per DNA did not vary significantly from the base to the apex. Ratios of phytochrome to fresh or dry weight in the 6-cm coleoptile were nearly constant in the basal 5 cm, but increased in the two apical 0.5-cm sections. Phytochrome per DNA in the 6-cm coleoptile did not vary significantly in the apical 4 cm, but decreased by one-half in the basal 2 cm.In the 5-cm first leaf, phytochrome per fresh or dry weight was greatest in the basal 0.5 cm (zone of cell division). Phytochrome per DNA in the leaf decreased from apex to base; the phytochrome per DNA in the basal 0.5 cm (zone of cell division) was one-third as high as in the apical 0.5 cm.Pytochrome per cell was greater in all parts of the 6-cm coleoptile compared to the 1.5-cm coleoptile, although no cell division had occurred during this elongation. Phytochrome per cell was higher in the sections of the first leaf wihch were growing primarily by cell expansion rather than by cell division. Phytochrome expressed per unit dry weight was more constant than any of the other parameters studied.It was concluded (1) that the phytochrome content of all coleoptile cells is the same at any given age (length); (2) that the phytochrome content of all nondividing leaf cells is equal at any given age (but lower than that of coleoptile cells); (3) that the phytochrome content of all cells increases in direct proportion to their expansion (increase in dry weight).