Yolk sac count matters

Yolk sac is the first anatomical structure identified within the gestational sac at 5+ weeks and is diagnostic of intrauterine pregnancy. It is attached through the yolk stalk with the intestinal cavity of the embryo and is supplied with blood vessels that transport nutritive yolk products to the developing embryo. It provides nutritive, metabolic, endocrine, immunological and haemopoietic functions. The poor quality and early regression of a yolk sac in presence of embryonic heart beats are more specific than the large size of a yolk sac in predicting pregnancy loss. Number of yolk sac is usually indicative of amnionicity, except in select reported cases of monoamniotic twins when two yolk sacs are present. Singleton pregnancies contain only one yolk sac as a rule. We have come across a case of elderly non-diabetic primi gravida where presence of one extra yolk sac has accelerated growth of single foetus by 8 days in early first trimester. We followed it up to 16 weeks of gestation when both yolk sacs disappeared. It was concluded that two yolk sacs conferred extra mileage of growth to the foetus due to doubled yolk sac functions, and this extra growth persisted throughout

Surgical treatment of congenital biliary duct cyst

<p>Abstract</p> <p>Background</p> <p>It is acknowledged that total cyst excision is a safe and ideal surgical treatment for congenital biliary duct cyst, compared to simple internal drainage. The aim of this study was to determine the optimal operation occasion and the effect of laparoscopy on congenital biliary duct cyst based upon total cyst excision.</p> <p>Methods</p> <p>From January 2002 to January 2011, 217 patients were admitted to Southwest Hospital for congenital biliary duct cyst. To determine the optimal surgery occasion, we divided these subjects into three groups, the infant group (age ≤ 3 years), the immaturity group (3 < age ≤ 18 years), and the maturity group (age > 18 years), and then evaluated the feasibility, risk and long-term outcome after surgery in the three groups. To analyze the effect of laparoscopic technique on congenital biliary duct cyst, we divided the patients into the laparoscopy and the open surgery groups.</p> <p>Results</p> <p>Among the three groups, the morbidity from cholangiolithiasis before surgical treatment had obvious discrepancy (p < 0.05) (lowest in the infant group), and intraoperative blood loss also had apparent diversity (p < 0.05). Furthermore, long-term outcomes (secondary cholangiolithiasis, stoma stenosis and cholangiocarcinoma) showed no significant difference between different groups (p > 0.05).</p> <p>Similarly, no significant discrepancy was observed in the morbidity from postoperative complications or long-term postoperative complications (p > 0.05) between the laparoscopic and the open surgery groups.</p> <p>Conclusions</p> <p>We conclude that total cyst excision should be performed as early as possible. The optimal treatment occasion is the infant period, and laparoscopic resection may be a new safe and feasible minimally invasive surgery for this disease.</p

Susceptibility calculations for alternating antiferromagnetic chains

Earlier work of Duffy and Barr consisting of exact calculations on alternating antiferromagnetic Heisenberg spin‐1/2 chains is extended to longer chains of up to 12 spins, and subsequent extrapolations of thermodynamic properties, particularly the susceptibility, are extended to the weak alternation region close to the uniform limit. This is the region of interest in connection with the recent experimental discovery of spin‐Peierls systems. The extrapolated susceptibility curves are compared with corresponding curves calculated from the model of Bulaevskii, which has been used extensively in approximate theoretical treatments of a variety of phenomena. Qualitative agreement is observed in the uniform limit and persists for all degrees of alternation, but quantitative differences of about 10% are present over the whole range, including the isolated dimer limit. Potential application of the new susceptibility calculations to experiment is discussed

The opposite effects of fluvoxamine and sertraline in the treatment of psychotic major depression: a case report

<p>Abstract</p> <p>Background</p> <p>Psychotic major depression is a clinical subtype of major depressive disorder. A number of clinical studies have demonstrated the efficacy of the combination of an antidepressant (for example, a tricyclic antidepressant or selective serotonin reuptake inhibitor (SSRI)) and an atypical antipsychotic or electroconvulsive therapy (ECT) in treating psychotic major depression. In several studies, monotherapy of SSRIs such as fluvoxamine has been shown to be effective in the treatment of psychotic major depression.</p> <p>Methods</p> <p>We report on a 36-year-old Japanese woman in whom fluvoxamine (a SSRI with sigma-1 receptor agonist) and sertraline (a SSRI with sigma-1 receptor antagonist) showed the opposite effects on psychotic symptoms in the treatment of psychotic major depression.</p> <p>Results</p> <p>Symptoms of depression and psychosis in the patient who was non-respondent to antipsychotic drugs improved after fluvoxamine monotherapy. At 3 years later, a switch to sertraline from fluvoxamine dramatically worsened the psychotic symptoms in the patient. Then, a switch back to fluvoxamine from sertraline improved these symptoms 1 week after fluvoxamine treatment.</p> <p>Conclusion</p> <p>Doctors should consider the monotherapy of sigma-1 receptor agonist fluvoxamine as an alternative approach to treating psychotic major depression.</p

Choledochocele: an unusual form of choledochal cyst

Choledochocele, or type III choledochal cyst, is a rare anomaly. Two children with choledochocele, both younger than any previously reported patient, were recently cared for at the University of Michigan Medical Center and prompted a literature review of this subject. Since 1974, 40 cases of choledochocele have been reported with enough clinical information for critical review. Ten of these patients were 21 years of age or younger. Presenting symptoms were not specific for choledochocele; they were generally interpreted to result from other biliary or gastrointestinal disorders that are more common for each age group. In pediatric patients the most frequent signs and symptoms of choledochocele were abdominal pain (70%), nausea and/or vomiting (60%), jaundice (30%), and acute pancreatitis (30%). While two-thirds of adult patients with choledochocele had undergone prior cholecystectomy (with stones rarely found), this was observed only once in children. Obstructive symptoms led to evaluation of the stomach and duodenum with either barium upper GI series or endoscopy in all children. These demonstrated an extrinsic mass effect in 90% of the patients. Endoscopic retrograde cholangiopancreatography identified a choledochocele in all cases in which the study was successfully executed. Intravenous cholangiography was sensitive in children, but less so in the adult patients reviewed. Other imaging efforts (computerized tomography, ultrasound, radionuclide scanning) were less dependable. Transduodenal marsupialization is the treatment of choice for patients of all ages and was provided in both of these newly reported children.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47183/1/383_2004_Article_BF00179633.pd

Part 2: CT characterisation of pancreatic neoplasm: tumour mimics

There are numerous pancreatic and peripancreatic conditions that can mimic pancreatic neoplasms. Many of these can be confidently diagnosed on computed tomography (CT), while others will require further imaging. Knowledge of these tumour mimics is important to avoid misclassification of benign conditions as malignant and to avoid unnecessary surgery. Mimics can be grouped as parenchymal, vascular, biliary and peripancreatic. These are discussed and illustrated in this review

One-Dimensional Model Systems: Theoretical Survey

In the early 1960’s one-dimensional model systems were regarded as amusing toys with the advantage of being far more easily solvable than their ’’real’’ three-dimensional counterparts. Now essentially 1-D (quasi-1-D) magnets can be ’’tailor-made’’ in the laboratory. Even more popular is the field of organic conductors like TTF⋅TCNQ, which are naturally quasi-1-D. Currently solitons and related solutions of non-linear, dispersive 1-D differential equations are ubiquitous in physics, including the area of 1-D magnetism. These developments are discussed in the Introduction. The rest of this paper is concerned with model Hamiltonians, model comparisons, critical singularities in 1-D (quasi-1-D) systems, accuracy of numerical techniques in comparison with exact solutions, brief accounts of dilute and disordered 1-D systems, and 1-D spin dynamics. Finally, a comment is made on a variety of interesting isomorphisms between 1-D magnets and phenomena in several other areas of physics, for example 2-D ferroelectrics, field-theoretic models, and realistic fluids. Comparison of theory and experiment has been the subject of several excellent reviews and is therefore not discussed here

Hepatobiliary and pancreatic imaging in children—techniques and an overview of non-neoplastic disease entities

Imaging plays a major role in the diagnostic work-up of children with hepatobiliary or pancreatic diseases. It consists mainly of US, CT and MRI, with US and MRI being the preferred imaging modalities because of the lack of ionizing radiation. In this review the technique of US, CT and MRI in children will be addressed, followed by a comprehensive overview of the imaging characteristics of several hepatobiliary and pancreatic disease entities most common in the paediatric age group