Prenatal diagnosis of aberrant right subclavian artery in an unselected population

PURPOSE: The purpose of this study was to determine the frequency of aberrant right subclavian artery (ARSA) among unselected fetuses and to evaluate its association with chromosomal abnormalities and other congenital anomalies. METHODS: In all, 7,547 fetuses (gestational age, 20 to 34 weeks) were examined using routine antenatal sonography at our institution between April 2014 and September 2015. The right subclavian artery was assessed using grayscale and color Doppler ultrasonography in the transverse 3-vessel and tracheal view, and confirmed in the coronal plane. RESULTS: ARSA was found in 28 fetuses (0.4%). Further, 27 of these 28 fetuses were euploid (96.4%). Trisomy 18 was the only chromosomal anomaly (3.6%) found in the study sample. ARSA was an isolated finding in 23 of the 28 cases (82.1%). In the remaining three cases (10.7%), ARSA was accompanied with extracardiac anomalies. Other cardiac defects were present in three cases (10.7%). CONCLUSION: Isolated ARSA does not seem to be associated with a significantly increased risk of aneuploidy. However, the possibility of fetal karyotyping, which is a more invasive procedure, should be discussed in the light of the overall risk of the fetus.

Dacryocystocele on prenatal ultrasonography: diagnosis and postnatal outcomes

PURPOSE: To report the incidence of dacryocystoceles detected by prenatal ultrasonography (US) and their postnatal outcomes and to determine the factors associated with the postnatal persistence of dacryocystoceles at birth. METHODS: We retrospectively reviewed the prenatal US database at our institution for the period between January 2012 and December 2013. The medical records of women who had fetuses diagnosed with dacryocystocel larger than 5 mm were reviewed for maternal age, gestational age (GA) at detection, size and side of the dacryocystoceles, delivery, and postnatal information, such as GA at delivery, delivery mode, and gender of the neonate. RESULTS: A total of 49 singletons were diagnosed with a dacryocystocele on prenatal US, yielding an overall incidence of 0.43%. The incidence of dacryocystoceles was the highest at the GA of 27 weeks and decreased toward term. Of the 49 fetuses including three of undeter mined gender, 25 (54%) were female. The mean GA at first detection was 31.2 weeks. The dacryocystocele was unilateral in 29 cases, with a mean maximum diameter of 7 mm. Spontaneous resolution at birth was documented in 35 out of 46 neonates (76%), including six with prenatal resolution. Multivariate analysis demonstrated that GA at delivery was a significant predictor of the postnatal persistence of dacryocystoceles (P=0.045). CONCLUSION: The overall incidence of prenatal dacryocystoceles was 0.43%; the incidence was higher in the early third trimester and decreased thereafter. Prenatal dacryocystoceles resolved in 76% of the patients at birth, and the GA at delivery was a significant predictor of postnatal persistence.

Paleoparasitological Surveys for Detection of Helminth Eggs in Archaeological Sites of Jeolla-do and Jeju-do

A paleoparasitological survey to detect helminth eggs was performed in archaeological sites of Jeolla-do and Jeju-do, the Republic of Korea. Total 593 soil samples were collected in 12 sites of Jeolla-do and 5 sites of Jeju-do from April to November 2011, and examined by the methods of Pike and coworkers. A total of 4 helminth eggs, 2 eggs each for Trichuris trichiura and Ascaris sp., were found in soil samples from 1 site, in Hyangyang-ri, Jangheung-eup, Jangheung-gun, Jeollanam-do. The egg-recovery layer was presumed to represent a 19th century farm, which fact suggested the use of human manures. This is the third archaeological discovery of parasite eggs in Jeolla-do. Additionally, no helminth eggs in archaeological sites of Jeju-do is an interesting problem to be solved in the further investigations.

Prenatal Ultrasonographic Diagnosis of Frequent Congenital Fetal Anomalies

We have an increasing interest in the congenital anomaly, caused by an increasing number of pregnancies in elderly women and exposure to hazard environmental factors. Our aim is to analyze the frequency of congenital anomaly based on prenatal ultrasonography, and to describe the major ultrasonographic findings. Findings of fetal anomalies on prenatal ultrasound examination always lead to stressful times for women and families; when a fetal anomaly is identified, the pregnant woman should be offered a timely consultation in order to optimize prenatal management options. Providing accurate information and early detection to these women and families will allow them to make informed decisions.

Ultrasonography of Gynecologic Causes of Acute Pelvic Pain

Acute pelvic pain is one of the most common complaints of woman presenting in the emergency department. When gynecologic disorders are suspected, ultrasonography (US) is the modality of choice, enabling rapid diagnosis and decision making with regard to appropriate management. Frequent gynecologic etiologies include a large or enlarging simple ovarian cyst, hemorrhagic ovarian cyst or rupture of an ovarian cyst, acute pelvic inflammatory disease, and ovarian torsion. Endometriosis, uterine leiomyoma, and peritoneal inclusion cyst can also present as acute pelvic pain. Gynecologic disorders that cause acute pelvic pain frequently show characteristic ultrasonographic findings that enable specific diagnosis. In this review, the authors review ultrasonographic findings of gynecologic causes of acute pelvic pain.

Prenatal Diagnosis of Chromosome 22q11.2 Deletions: Experiences in a Single Institution

PURPOSE: This study was designed to determine the frequency and echocardiographic findings of 22q11.2 deletions in fetuses with cardiac defects on fetal ultrasound or familial backgrounds of 22q11.2 deletions. MATERIALS AND METHODS: We retrospectively reviewed the medical and ultrasonographic records of 170 fetuses that underwent fluorescence in situ hybridization (FISH) analysis for chromosome 22q11.2 deletions between February 2001 and April 2013. RESULTS: Among 145 fetuses with cardiac defects, six (4.1%) had 22q11.2 deletions. Deletions of 22q11.2 were detected in 6 (5%) of the 120 fetuses with conotruncal defects: 5 (8.9%) of 56 with tetralogy of Fallot (TOF) and 1 (5.9%) of 17 with double outlet right ventricle (DORV). No deletions were found in cases of pulmonary atresia, truncus arteriosus, right aortic arch, or transposition of the great arteries. No 22q11.2 deletions were found in non-conotruncal cardiac malformations. Among 25 fetuses with familial backgrounds of 22q11.2 deletions, one (4%) had a maternally inherited 22q11.2 deletion with no cardiac findings. CONCLUSION: Knowledge of the frequency and echocardiographic findings of 22q11.2 deletions might be helpful for prenatal genetic counseling. It is advisable to perform FISH analysis for 22q11.2 deletions in pregnancies exhibiting conotruncal cardiac defects such as TOF or DORV.

Intralobar Pulmonary Sequestration Showing Increased Serum CA19-9 / 결핵및호흡기질환

Carbohydrate antigen 19-9 (CA19-9) is a specific tumor marker of the biliary, pancreatic and gastrointestinal tracts. CA19-9 is occasionally elevated in serum in patiens with benign pulmonary diseases such as bronchiectasis, idiopathic interstitial pneumonia or collagen disease-associated pulmonary fibrosis. Intralobar pulmonary sequestration is an uncommon congenital lung anomaly. It is dissociated from the normal tracheobronchial tree and is supplied by an anomalous systemic artery. There have been some reports of elevation of CA19-9 in this lesion. We report a case of intralobar pulmonary sequestration with elevated serum CA19-9 in a 29-year-old man who was diagnosed with bronchiectasia of left lower lung field on general check up. He had no evidence of any malignant disease in pancreatobiliary or gastrointestinal tracts. Elevated serum CA19-9 level might be encountered with benign pulmonary disease such as pulmonary sequestration.

Inhibitory Effects of 1',2'-Dihydrorotenone on Osteoclast Differentiation and Bone Resorption In Vitro and In Vivo / 체질인류학회지

It is important to identify therapeutic compounds with no adverse effects for use in the chemotherapy of patients with bone-related diseases. The aim of this study was to identify a new compound that inhibits osteoclast differentiation and bone resorption. Herein, we examined the effects of 1',2'-dihydrorotenone on osteoclast differentiation and bone resorption in vitro and in vivo. 1',2'-dihydrorotenone inhibited receptor activator of NF-kappaB ligand (RANKL)-induced osteoclast differentiation of cultured bone marrow macrophages (BMMs) in a dose-dependent manner. However, 1',2'-dihydrorotenone did not exert cytotoxic effect on BMMs. 1',2'-dihydrorotenone suppressed the expression of c-fos and NFATc1 as well as osteoclast-specific genes in BMMs treated with RANKL. Treatment with RANKL inhibited the expression of inhibitors of differentiation/DNA binding (Id)1, 2, and 3; however, in the presence of 1',2'-dihydrorotenone, RANKL did not suppress the expression of Id1, 2, and 3. Furthermore, 1',2'-dihydrorotenone inhibited bone resorption and considerably attenuated the erosion of trabecular bone induced by lipopolysaccharide treatment. Taken together, these results suggest that 1',2'-dihydrorotenone has the potential to be applied in therapies for bone-related diseases.

Fetal Sonography for the Detection of Chromosomal Abnormality

Over the past decade, women's health clinicians have witnessed a shift of the paradigm for the approach to prenatal screening for chromosomal abnormalities. From an emphasis on age-based invasive diagnostic tests, women are now being offered a variety of noninvasive screening tests. Although there is exciting research and innovation in the field of noninvasive testing for fetal aneuploidy, there are currently two tests, and both are invasive, that are used in a routine manner to determine the presence of fetal aneuploidy: chorionic villous sampling and amniocenthesis. The aim of this review was to investigate the effectiveness of prenatal sonography, including first trimester nuchal translucency screening and second trimester genetic sonography, for obtaining valid chromosomal abnormality screening test results.

Sonoembryology

The recent development of ultrasound technology has resulted in remarkable progress in the visualization of early embryos and fetuses and in the development of sonoembryology. With the use of three-dimensional ultrasound, structural developments in the first 12 weeks of gestation can be assessed more objectively and reliably. The new technology allowed for the evolution of embryology from postmortem studies to the in vivo environment. The purpose of this review to illustrate the potential of sonography in the study of structural and functional early human development.

Ultrasonographic Diagnosis of a Uterine Fusion Anomaly Associated with Neonates with Unilateral, Ectopic, Multicystic, Dysplastic Kidney

PURPOSE: The purpose of this paper is to reinforce the necessity of careful ultrasonographic evaluation of the uterus to detect uterine fusion anomaly in female neonates who were detected as having a unilateral, ectopic, multicystic, dysplastic kidney (MCDK) on fetal US. MATERIALS AND METHODS: We detected eight unilateral ectopic MCDK on fetal US of second trimester and neonatal ultrasonography between October 2003 and February 2009; neonatal US were taken at 2 to 10 days after birth for the initial evaluation of MCDK. Uterine fusion anomaly, vaginal obstruction and other associated urogenital anomalies were evaluated by neonatal US. RESULTS: Four of eight female neonates with unilateral ectopic MCDK showed a double uterus on neonatal US. They all showed hemivaginal fluid collection. Obstruction of the hemivagina and vaginal septum were depicted in two cases. A perivaginal cyst was seen in three cases, and in two cases the cyst was connected with the vaginal cavity. An ipsilateral perivaginal tubular structure was seen in one case, which was indicative of a ureteral remnant. There was no associated anomaly in the contralateral kidney except for a tiny cortical cyst in one case. CONCLUSION: The careful ultrasonographic evaluation of the uterus is important in female neonates who showed the ectopic MCDK on fetal US. In addition, it may help to detect the fusion anomaly that is otherwise difficult to detect on fetal US and to devise a treatment plan to prevent upcoming complications.

Rare Complications with Monochorionic Twins: Ultrasonography and Pathology Correlations

We reviewed the sonographic features of rare complications with monochorionic twins and we correlated these features with the pathologic findings. The complications, including the twin reversed arterial perfusion sequence, the twin embolization syndrome, the conjoined twins and umbilical cord entanglement. A better understanding of these complications can aid making an accurate prenatal diagnosis and predicting the fetal outcome.

The Effect of Hyperglycemia Induced by Oral Glucose Loading on Coronary Flow Reserve

BACKGROUND AND OBJECTIVES: Patients with chronic diabetes mellitus (DM) have an increased risk of cardiac dysfunction and mortality. There is some evidence that suggests acute hyperglycemia may cause vascular dysfunction. However, it is unknown whether acute, short-term hyperglycemia affects coronary microcirculation function in healthy subjects. The present study was undertaken to explore this issue. SUBJECTS AND METHODS: We evaluated 20 healthy males who had no history of DM or impaired glucose tolerance, ranging in age from 23 to 36 years (25.9+/-3.3 years). We checked blood sugar, 12-lead electrocardiography, pulse wave velocity, and coronary flow reserve using echocardiography during fasting, and 30, 60, 90, and 120 minutes after ingestion of 75 g of glucose orally. RESULTS: Non-significant prolongation of the QTc dispersion was observed after the 75 g glucose loading. No significant difference in the pulse wave velocity of the carotid-to-femoral artery, carotid-to-radial artery, or femoral-to-dorsalis pedis artery was observed after the 75 g glucose loading. There was a significant reduction in the coronary flow reserve at 60 (4.06+/-0.75 vs. 3.54+/-0.82, p=0.021) and 90 minutes (4.06+/-0.75 vs. 3.59+/-0.63, p=0.021) after the 75 g glucose loading compared to that on fasting. CONCLUSION: The results of this study suggest that acute exposure to high circulating glucose levels does not affect heterogeneity of the ventricular repolarization or arterial stiffness, but it does reduce the coronary flow reserve in healthy young men.

A Case of Transverse Colon Perforation after Colonoscopy in a Patient withEnterocolitis Caused by Non-typhoidal Group D Salmonella / 대한소화기내시경학회지

Clinical manifestations of Salmonella infection are variable such as enterocolitis, bacteremia, enteric fever, focal infection and asymptomatic carrier status. Among these presentations, enterocolitis is the most common clinical manifestation and can be diagnosed by the use of fecal specimens. Patients with severe infectious colitis are at increased risk of developing a colon perforation after colonoscopy due to colon trauma. We report a case of a 31-year-old woman with transverse colon perforation after colonoscopy that was diagnosed with enterocolitis caused by infection with non-typhoidal group D Salmonella.

Prenatal Diagnosis and Outcome of Congenital Lung Mass

With the widespread use of high-resolution ultrasound examinations, congenital lung masses are frequently detected during a routine prenatal ultrasound examination. The purpose of this pictorial review is to demonstrate the natural history of congenital lung masses through the evaluation of serial prenatal ultrasound examinations and postnatal examinations, and to suggest adequate prenatal management.

The peroxisome proliferator-activated receptor-gamma agonist, Rosiglitazone, improves aortic wall stiffness in type 2 diabetic patients / 대한내과학회지

BACKGROUND: Diabetes is a major risk factor for the development of coronary artery disease. Atherosclerosis is thought to arise as a result of a chronic inflammatory process within the arterial wall. Insulin resistance is central to the pathogenesis of type 2 diabetes and may contribute to atherosclerosis, either directly or through associated risk factors. Rosiglitazone, a peroxisome proliferator-activated receptor gamma agonist, is used in the treatment of type 2 diabetes mellitus, and previous findings suggest that it may have anti-inflammatory effects on atherosclerosis. This study was performed to evaluate whether rosiglitazone can improve arterial stiffness in type 2 diabetic patients. METHODS: This study consisted of 40 patients with type 2 diabetes. These subjects were classified into two groups either medicated with glimepiride (GLIME group, 61.5+/-8.2 years, M:F = 9:11) or with glimepiride and rosiglitazone (ROSI group, 65.6+/-9.5 years, M:F = 4:16). For each group, plasma a hsCRP, lipid profile, HOMAIR and HbA1c were measured before and after 12 months of medical treatment. At the same time, pulse wave velocity (PWV) using an automatic device (PP 1000, Hanbyul, Jeonju, Korea) was measured. RESULTS: The plasma hsCRP level was significantly decreased in the ROSI group as compared with the GLIME group (4.22+/-4.65 vs. 1.07+/-0.80 mg/L, p=0.025). The carotid-femoral PWV of the ROSI group improved significantly as compared with the GLIME group (8.29+/-1.25 vs. 7.26+/-1.49 m/sec, p=0.024). The changes of PWV were correlated with the changes of hsCRP (r=0.412, p=0.033). CONCLUSIONS: These findings suggest that rosiglitazone can improve the arterial stiffness in type 2 diabetic patients.

Comparison of Efficacy and Safety after Administering High Potency Statin to High Risk Patients: Rosuvastatin 10 mg versus Atorvastatin 20 mg

BACKGROUND AND OBJECTIVES: Although the rate of prescribing hydroxylmethyglutaryl-CoA reductase inhibitors (statin) has recently increased, there is a large treatment gap between the guidelines and actual clinical practice. We studied the effect of high potency statin on the percentage of patients who achieve the target low density lipoprotein (LDL) cholesterol level, and we determined the changes of lipid profiles with using 10 mg of rosuvastatin and 20 mg of atorvastatin. MATERIALS AND METHODS: 222 consecutive patients with acute coronary syndrome or acute ischemic stroke were randomly assigned to either the group treated with rosuvastatin 10 mg (Group I) or atorvastatin 20 mg (Group II). We compared the percentage of patients who achieved the target LDL cholesterol level, and the percent change of the serum lipid profile from baseline to the 40th week between the two groups. RESULTS: 117 (52.7%) patients completed this study. When the target LDL cholesterol level was <100 mg/dL, there was no significant difference in the target attainment rate between the two groups (86.7% vs. 77.2%; respectively, p=0.182). When the target LDL cholesterol level was <70 mg/dL, 48.3% of Group I and 29.8% of Group II reached the goal (p=0.040). The LDL cholesterol level was reduced by 46.8% in Group I (p<0.001), and by 40.1% in Group II (p<0.001). However, the final level showed a trend to be lower in the rosuvastatin group (p=0.077). There were no serious side effects in both groups. The study drug was discontinued due to adverse events in 2 patients (2.6%) of Group I, and in 3 patients (3.8%) of Group II (p=0.523). CONCLUSION: This study showed that the reduction of LDL cholesterol was not statistically different between rosuvastatin 10 mg and atorvastatin 20 mg. However, fewer than half of the patients achieved the goal in both groups despite of high potency statin therapy. This suggests that more aggressive statin therapy is preferred for high risk patients.

Effect of Thyroid Stimulating Hormone on Prognosis of Elderly Angina Patients

BACKGROUND: It was not established whether a normal range of thyroid stimulating hormone (TSH) influences the presence and outcome of coronary atherosclerosis. We evaluated that the effect of TSH level on prognosis of elderly angina patients who have normal thyroid function. METHODS: We studied 166 angina patients (70.8+/-4.02 years, male 43.4%) who underwent elective coronary angiography. TSH, free thyroxine, serum lipid levels and high-sensitivity C-reactive protein levels were measured before coronary angiography. According to TSH level, the patients divided into two groups; patients with high level of TSH (> or =2.5 microIU/mL) and low level of TSH (<2.5 microIU/mL). Laboratory findings and 1 year major adverse cardiac events (MACE) were compared between the two groups. RESULTS: Serum creatinine levels were significantly higher in patients with high TSH level (p=0.048). A significant correlation was observed between the levels of TSH and triglyceride level and creatinine level (r=0.704 and 0.512, respectively, p<0.05). MACE occurred in 5.1% of patients with higher TSH and 16.7% of patients with lower TSH (p=0.034). The multivariate analysis revealed that creatinine (OR 5.33, p=0.012) and TSH (OR 1.46, p=0.042) were independent predictors for MACE. CONCLUSIONS: The high level of serum TSH is associated with poor outcome in elderly angina patients with normal range of thyroid function.

Papillary Muscle Rupture Complicating a Papillary Muscle Abscess

Spontaneous rupture of a papillary muscle from a papillary abscess is extremely rare. Most cases of papillary muscle ruptures are due to myocardial infarction or trauma. We describe the clinical course of a 68-year-old man who died from a papillary muscle rupture as a complication of a papillary muscle abscess due to Streptococcal pyogenes septicemia.

Prenatal Sonographic Diagnosis of Acardiac Twins

PURPOSE: This study was performed to present the prenatal sonographic findings and the associated abnormalities of acardiac twins. MATERIALS AND METHODS: Seven cases of acardiac twins were reviewed retrospectively. Prenatal ultrasonography was performed in all patients at a gestational age between 12 and 27 weeks (mean 17.6 weeks). Autopsy was performed in four cases. The sonographic and autopsy findings were reviewed to report the associated abnormalities of the acardiac and donor fetuses. RESULTS: The diagnosis of acardiac twins was made on the basis of ultrasonography (n=6) or autopsy (n=1). The associated abnormalities of the acardiac fetuses were single umbilical artery (SUA) (n=5), abdominal wall defect (n=4), club feet (n=4), scoliosis (n=1), cleft lip and palate (n=1), digital anomaly (n=1), and umbilical cord cyst (n=1). In four of the donor fetuses, sonographic abnormalities were found. Autopsy was performed in three of the four cases to reveal hydropic change (n=2), diaphragmatic hernia (n=1) and multiple structural abnormalities of interventricular septal defect, polydactyly, club feet and SUA (n=1). Intrauterine fetal death occurred in five donors and follow-up was lost in the remaining two. CONCLUSION: Meticulous sonography enables the diagnosis of acardiac twins at an early gestational age and can reveal the associated abnormalities of the donor fetus as well as the acardiac fetus.