Beak Sign:A New Sign of Prenatal Ultrasound in the Diagnosis of Annular Pancreas / 中国医学影像学杂志

Purpose To explore the diagnostic value of beak sign in fetal annular pancreas by analyzing the ultrasonographic features of fetal annular pancreas.Materials and Methods The ultrasound images and clinical data of 13 cases of fetal annular pancreas diagnosed by prenatal ultrasound in Shandong Provincial Maternal and Child Health Hospital from September 2019 to December 2021 and confirmed by surgery after birth were retrospectively analyzed.The degree of duodenal stenosis at the obstruction site was observed,especially whether the angle formed by the intestinal wall could identify the fetal annular pancreas,and the ultrasonic characteristics were summarized and analyzed.Results A total of 13 fetuses with annular pancreas showed double bubble sign,3 cases showed clamp sign,and 7 cases showed beak sign at the end of duodenal dilatation.All the 13 cases underwent surgical treatment after birth,including 2 cases with duodenal atresia and 1 case with atypical intestinal malrotation.All the children had good prognosis after operation.Conclusion By observing the dilated end of duodenum and the relationship with pancreatic head,prenatal ultrasound combined with beak sign and double bubble sign could improve the diagnostic accuracy of fetal annular pancreas,which has significant value in prenatal diagnosis of fetal annular pancreas.

Hammock-shaped capsular flaps in repair of the bottoming-out and double-bubble deformity of augmentation mammaplasty / 中华医学美学美容杂志

Objective:To introduce a novel method to repair bottoming-out and double-bubble deformity after augmentation mammaplasty with a hammock-shaped capsular flap, and to evaluate its clinical effect of the related complications.Methods:From 2015 to 2019, a total of 16 patients (aged range from 23 to years, with average age of 33.4 years) were treated in the Department of Plastic Surgery, Shanghai Mylike Cosmetic Hospital. We performed a novel hammock-shaped capsular flap with periareolar incision. First of all, the periprosthetic capsule was widely separated from the lower pole of the breasts. Then the inframammary folds were anchored to the chest wall to eliminate the excess the cavity. Finally, the capsular flaps were raised up from both anterior and posterior leaf and resutured by fold tile shaped suture, in order to elevate the inframammary folds in aesthetic revision.Results:Only one case showed mild hematoma and healed after treatment. After 6 months follow-up, all the inframammary folds were elevated to the ideal position, and the double-bubble deformity was corrected with concealed scars and satisfactory shape and symmetry. Meanwhile, recurrent cases and capsule contraction were not observed.Conclusions:For patients with bottoming-out and double-bubble complications after augmentation mammaplasty, the use of hammock-shaped capsular flap can effectively revise the deformation. This technical refinement seems to afford stable outcomes with convenient operation and minor injury and produce satisfactorily clinical effects with fewer complications.

Signo de la doble burbuja: marcador ecográfico asociado a aneuploidías / Double bubble sign. sonographic marker associated with aneuploidy

Introducción: Las anomalías cromosómicas ocurren en 0,1 a 0,2% de los recién nacidos (RN). En el ultrasonido se pueden observar marcadores ecográficos sugestivos de aneuploidia. El signo de la doble burbuja representa una anomalía estructural de la porción proximal del duodeno, generalmente debido atresia duodenal, que se asocia en un 30 – 40% a trisomía 21.Objetivos: Presentación de caso clínico y revisión de marcadores ecográficos que permiten detectar defectos estructurales que representen anomalías cromosómicas. Presentación de caso: Paciente de 38 años cursando embarazo de 32,3 semanas. Biometría fetal informó retardo de crecimiento intrauterino leve, con diámetro biparietal y circunferencia cefálica de 31 semanas, circunferencia abdominal y longitud femoral de 28 semanas. Scan fetal morfológico detallado visualiza cámara gástrica presente con dilatación de duodeno superior. Signo de la doble burbuja. Discusión: El signo de la doble burbuja suele reconocerse luego de la semana 24 de gestación. La detección lleva a la sospecha de un número de anomalías estructurales, las cuales causan obstrucción duodenal. La atresia duodenal es el tipo más común de atresia fetal del intestino delgado.

Introduction: Chromosomal abnormalities occur in 0.1 to 0.2% of newborns. By using ultrasound we can observe suggestive sonographic markers of aneuploidy. The double bubble sign represents a structural abnormality of the proximal duodenum, usually due to duodenal atresia, associated in a 30 to 40% with trisomy 21. Objectives: Presentation of a case and review of sonographic markers to detect structural defects that represent chromosomal abnormalities. Case presentation: 38 year old female patient, with a 32.3 weeks pregnancy. Fetal biometrics reported mild intrauterine growth retardation biparietal diameter and head circumference of 31 weeks, abdominal circumference and femur length of 28 weeks. Morphological fetal Scan shows gastric chamber with dilatation of the upper duodenum. Double bubble sign.Discussion: The double bubble sign is usually recognized after 24th week of pregnancy. Detecting this sign leads to suspicion of a number of structural abnormalities, which cause duodenal obstruction. Duodenal atresia is the most common type of fetal small bowel atresia.