Background Gallstone ileus (GSI) is a rare form of small bowel obstruction (SBO) in patients with cholelithiasis, which is often poorly managed. Enhanced abdominal computed tomography (CT) with contrast is considered the most helpful diagnostic tool, as it is highly sensitive, specific, and accurate. We report an interesting case of recurrent GSI that was not detected by CT but diagnosed intraoperatively. Case Presentation A 49-year-old female with a previous history of choledocholithiasis and ERCP presented to the emergency department following episodes of sudden cramping, epigastric pain, and nausea. An abdominal CT revealed evidence of SBO with clear evidence of GSI and a cholecystoduodenal fistula. Laparoscopic exploration of the small bowel revealed a large, calcified 3.5 cm × 3 cm gallstone with evidence of pressure necrosis; segmental bowel resection with stapled anastomosis was performed and patient recovered appropriately after surgery. Cholecystectomy was not performed due to multiple co-morbidities and absence of gallbladder stones. However, she presented two months later with signs and symptoms of SBO. A repeat abdominal CT showed dilated bowel with no clear transition point. This was suspected to be due to adhesions. After an initial conservative treatment which produced mild improvement, laparotomy was performed which revealed a second large non-calcified gallstone and necrotic small bowel with a pocket of abscess. Conclusion The most sensitive diagnostic tool for GSI is enhanced abdominal CT but dilemma arises when GSI is not detected on CT. A high index of suspicion and further exploration are required in order not to miss other vital findings.

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Aims: Non-small cell lung cancer (NSCLC) accounts for high lung cancer death that is mostly associated with advanced disease stage at diagnosis and resistance to chemotherapy. In the present study, we investigated whether xanthohumol, a prenylated flavonoid of hop plant, induces metastatic lung cancer H1299 cell death, and whether in combination with cisplatin there are additive effects. Methodology: H1299 cells were grown and treated with xanthohumol (6.25, 12.5, or 25 µM), cisplatin (12.5, 25, or 50 µM) and the combination of cisplatin and xanthohumol for 24 h. Cell viability, cell morphology, chromatin condensation, ɣH2AX, cPARP-1, capsase-3, p21WAF1/CIP1 and p14ARF genes were analyzed. Results: Xanthohumol, cisplatin, and the combination of cisplatin and xanthohumol inhibited H1299 cells viability.  Cisplatin growth inhibitory effects were potentiated by xanthohumol.  Xanthohumol induced chromatin condensation and apoptosis and potentiated cisplatin’s effect vs cisplatin alone. Further investigation of growth inhibitory effects, xanthohumol alone induced γH2AX foci formation and the combination potentiated γH2AX foci formation. Cisplatin, xanthohumol at 25 μM, and the combination of cisplatin and xanthohumol at 6.25 and 12.5 μM increased cPARP-1 level.  Active caspase-3 was increased by cisplatin, 12.5 μM of xanthohumol, and the combination of xanthohumol and cisplatin. Xanthohumol at 6.25 or 12.5 μM potentiated cisplatin effect on active caspase-3 and cPARP-1, respectively.  Xanthohumol at 25 µM significtly induced the expression cell cycle control genes p21WAF1/CIP1 and p14ARF.  These results indicate that xanthohumol inhibits proliferation of H1299 cells and induces cell death through cleavage of PARP-1 and activation of caspase-3. The combination of cisplatin and xanthohumol potentiated cytotoxic effects of each other compound. Conclusion: The present study suggests that xanthohumol poses apoptotic effects and potentiates cisplatin’s growth inhibitory effects on metastatic lung cancer cells.

Reconstruction of the face often requires the grafting of costal cartilage. The size of the facial defect determines the size and shape of cartilage needed to be harvested. Because females and males have differing facial size and shape, sex must be taken into consideration with regard to cartilage need. While myriad information exists that describes facial sexual dimorphism, little information exists regarding sexual dimorphism of costal cartilage. Therefore, this study assessed 312 costal cartilages from the most commonly harvested levels (i.e., fifth, sixth, and seventh rib cartilages) from 20 female and 32 male cadaveric ribcages for anatomical comparison. The fifth costal cartilage offers the smallest measurements in terms of area and length (Mean ± SD) for both females (1119 ± 248.8 mm2 and 69.48 ± 10.29 mm) and males (1525 ± 353.1 mm2 and 79.67 ± 14.62 mm). The seventh costal cartilage offers the largest surface area and total length measurements among both sexes (Females: 1836 ± 271.1 mm2 and 123.4 ± 14.62 mm; Males: 2390 ± 409.3 mm2 and 137.5±20.49 mm, respectively). Measurements of male cartilages were consistently larger than those of females in nearly all parameters studied. However, there was no significant difference between the sternum‐to‐curve length of the 5th cartilage (t(50) = 1.579; p = 0.1205) or the rib‐to‐curve length of the 7th cartilage between sexes (t(50) = 0.9609; p = 0.3412). In summary, females can afford, on average, less cartilage to harvest than males. The information provided in this study will aid surgeons in making informed decisions in their pre‐surgical planning of costal cartilage harvesting and grafting.Support or Funding InformationWest Virginia University Initiation to Research Opportunities (WVU – INTRO); WV Research Challenge Fund [HEPC.dsr.17.06] and [HEPC.dsr.14.13]This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Gantzer muscles are inconsistent muscular variations in the anterior forearm. When present, Gantzer muscles usually arise from the flexor digitorum superficialis (FDS) and insert into the flexor pollicis longus (FPL) or, less often, the flexor digitorum profundus (FDP). The presence of Gantzer muscles can cause a compressive neuropathy affecting the anterior interosseous nerve (Kiloh‐Nevin syndrome), and these muscles must be considered when anterior forearm fasciotomies are performed for the management of acute compartment syndrome. While Gantzer muscles have been commonly reported, many studies neglect to report the innervation of the muscle and its relationship with nearby nerves. This study assessed 40 forearms from 20 cadaveric specimens to determine the prevalence of the origin and insertion of the Gantzer muscle. Furthermore, innervation was assessed along with the potential for nearby nerve compression. Gantzer muscles were present in 26 of 40 (65.0%) forearms, and all of the 22 intact muscles originated from the FDS, after noting four proximal attachments were damaged during student dissections. Concerning the 24 intact distal attachments of the Gantzer muscles, 20 (83.3%) muscles inserted into the FPL, two (8.3%) muscles inserted into the FDP solely, and one (4.2%) inserted at both the FDP and FPL. In addition, one forearm presented with duplicated and bifurcated Gantzer muscles with one tendon inserting into the FDP and the other one into the FPL. The innervation of the 21 Gantzer muscles was identified with the anterior interosseous nerve innervating 16 muscles (76.2%). In the five remaining Gantzer muscles, four (19.0%) were innervated solely by the median nerve, and one (4.8%) had a dual innervation from both of the two aforementioned nerves. In the one forearm with a bifurcated Gantzer muscle, the authors agreed upon an inherent anatomical predisposition for median nerve entrapment.Support or Funding InformationWest Virginia University Initiation to Research Opportunities (WVU – INTRO); WV Research Challenge Fund [HEPC.dsr.17.06] and [HEPC.dsr.14.13]This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.