The results with five pediatric patients (6-15 years) who underwent laparoscopic cholecystectomy for symptomatic cholecystolithiasis are reported here. One patient had associated hematological disease (sickle-cell anemia). All five children were submitted to surgery using the laparoscopic technique. Intraoperative cholangiography was performed in two cases with uncertain ductal and vascular intraoperative anatomy. None of the operations was converted to open cholecystectomy, and there were no operative complications. The mean hospital stay was 2.2 days (range 2-3 days). All five children were able to return to normal activity within a week. No long-term complications were seen in any of the patients during an average follow-up period of 10.6 months (range 8-14). We believe that laparoscopic cholecystectomy in children is safe and effective, and that it is an important alternative to open cholecystectomy. However, prospective comparative studies of the procedure are necessary.
The skeletal muscle channelopathies represent a rare group of neuromuscular disorders which are caused by genetic mutations regarding voltage-gated ion channels, which play an important role in muscle membrane depolarization. Muscle channelopathies are broadly divided into 2 main categories: nondystrophic myotonias (NDM) and periodic paralysis (PP). Periodic paralysis (PP) are rare autosomal dominant neuromuscular disorders, characterized clinically by periodic attacks of muscle weakness in concomitance with serum potassium level alterations. It is possible to distinguish normokalemic, hyperkalemic and hypokalemic paralysis. PP is caused by genetic mutations in voltage-gate ion channels like sodium, potassium, and calcium channels, which are determinant for muscle membrane depolarization. The most common genes involved in pathogenesis are CACN1S, SCN4A and KCNJ2, encoding calcium, sodium, and potassium channels (Table 1). Moreover, paralysis related to serum potassium values may also occur in thyreotoxicosis [1], Liddle syndrome, Gitelman syndrome, primary hyperaldosteronism, and acid-base balance disorders. In this case report, we describe a case of transient paralysis and muscular weakness of both upper and lower limbs after a high carbohydrate meal on the day before clinical presentation. Potassium level was normal at the hospital admission, while high levels of creatine phosphokinase, (CPK), Myoglobin, and Aspartate Aminotransferases (AST) was observed.A missense mutation in CACNA1S exon 11 was identified. This case supports the importance of a correct family history, muscular enzyme analysis and genetic study in a normokalemic presentation of periodic paralysis.
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