No abstract

Heterotopic gastric tissue in the gallbladder is an extremely rare condition. There is not any specific clinical or laboratory finding and correct diagnosis is not possible before histopathological examination. Preoperative diagnosis usually resembles a polypoid Lesion or a fixed gallstone. We reported a 34-year-old female patient with heterotopic gastric mucosa in the gallbladder associated with congenital hip dysplasia and kidney agenesis. Laparoscopic cholecystectomy was performed and histopathology of the resected specimen showed that the "polyp" consisted of heterotopic gastric mucosa with glands of body and fundic type. Some cases of heterotopia in the gallbladder come from metaplasia, and may be one of the causes of gall bladder cancer. We discussed the clinical and histologic features of heterotopic gastric tissues and reviewed reported cases in the literature.

Melatonin may have a therapeutic or protective effect on acute pancreatitis and obstructive jaundice.

A 74-year-old female patient, who developed a hypoxic brain injury after cardiopulmonary arrest, was diagnosed with brain death on the 4th day of the clinical onset depending on the absence of brainstem reflexes and the intracranial blood circulation in magnetic resonance angiography, and positive apnea test. Bilateral plantar flexion response to the neck flexion was observed while lifting the head for the examination of oculocephalic reflex during the in-service nurse training. The plantar flexion response was observed every time the neck flexion was performed. This finding was interpreted primarily in favor of spinal reflex and the repeated brain death tests confirmed the diagnosis. Regarding the literature, spinal reflexes may emerge in patients with brain death and plantar flexion is among the most common reflexes. These reflexes are usually observed following painful stimuli, during the apnea test or when the patient is taken off the mechanical ventilation. Although the nuchal rigidity examination is not included in the routine diagnosis procedure of brain death, in this paper we report bilateral plantar flexion as a response to the neck flexion in a patient with brain death in the light of the studies found in the literature. We conclude that the introduction of the above-mentioned examination to the diagnosis of brain death will contribute to the improvement of the diagnosis procedure and prevent delays in the preparation of the potential donors.