Vanishing prenatal sub-hepatic cyst associated with biliary atresia: A case report

Introduction: Biliary atresia (BA) is the result of a progressive obliterative cholangiopathy that begins in the perinatal period. Cystic BA (CBA) is a subtype of BA that can be misdiagnosed easily as a choledochal cyst (CC) during the prenatal period. These two diseases, however, differ widely in their prognosis so differentiating them soon after birth if critical. Case presentation: A fetus was initially suspected to have a CC after a sub-hepatic cyst was detected by prenatal ultrasonography (US) at 16 weeks of gestation. Follow-up serial US showed a gradual decrease in the size of the cyst. The cyst disappeared towards the end of the pregnancy. A CC was excluded because it is an irreversible bile duct dilatation. BA was suspected and confirmed after birth. The patient underwent a Kasai portoenterostomy was 15 days after birth. We believe that a sub-hepatic cyst was formed during bile duct obliteration in the early fetal period, but the cyst involuted progressively and disappeared in the later fetal period. Conclusion: Fetuses who have sub-hepatic cysts that decrease in size over time and disappear towards the end of the gestation should be monitored for cholestasis because it appears that such imaging findings can be associated with biliary atresia

Immune enhancement effect of an herb complex extract through the activation of natural killer cells and the regulation of cytokine levels in a cyclophosphamide-induced immunosuppression rat model

Objective: To investigate the effects of a herb complex extract (HCE) prepared from Cornus officinalis Sieb. Et Zucc., Eriobotrya japonica Lindley, and olive leaves on immune response of mouse spleen NK cells in vitro and in vivo analysis. Methods: The activity of natural killer (NK) cells was measured in splenocytes and YAC-1 cells. Mice were immunosuppressed using cyclophosphamide (5 mg/kg body weight). Three different doses of HCE (200, 400, and 800 mg/kg body weight) and red ginseng extract (800 mg/kg body weight) which was used as standard immunomodulatory herb were administered orally for 4 weeks. The body weight, dietary, water intake, organs (liver, thymus, and spleen) weight, completed blood count, and cytokines (tumor necrosis factor alpha, interferon gamma, and interleukin-2) production was measured. Results: At the maximum concentration of HCE, the activity of NK cells was increased by 48.5%. HCE increased liver, spleen, and thymus weights without altering numbers of white blood cells, lymphocytes, and neutrophils in a cyclophosphamide-induced immunosuppression rat model. However, HCE recovered the inhibited cytokine expression; HCE (800 mg/kg) increased cytokines levels. The results indicate the immune enhancement potential of this HCE. Conclusion: The HCE enhances immunity by increasing NK cell activity, regulating cytokine levels, and maintaining spleen weight. Therefore, it may be used as a potential immunity enhancer