We report a case of heart failure and pulmonary edema in patient with Graves disease during recovery from general anesthesia for cesarean section. A 34-year-old multigrivida, at 35 weeks gestation underwent emergency cesarian section for preterm labor, twin pregnancy and polyhydramnios. She has been treated with Graves' disease for 5 years. After premedication with propranolol and glycopyrrolate, anesthesia was induced with thiopenthal and maintained with O2 -N2 O-enflurane. At the end of skin closure, heart failure and pulmonary edema were developed. On auscultation, systolic murmur was audible at the left sternal border and immediate echocardiography revealed mitral valve prolapse accompanied with mitral regurgitation. After proper treatment, she was discharged without complication at 14 days after surgery.
Adult ; Anesthesia ; Anesthesia, General ; Auscultation ; Cesarean Section ; Echocardiography ; Emergencies ; Female ; Glycopyrrolate ; Graves Disease ; Heart Failure* ; Heart* ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Obstetric Labor, Premature ; Polyhydramnios ; Pregnancy ; Pregnancy, Twin ; Premedication ; Propranolol ; Pulmonary Edema* ; Skin ; Systolic Murmurs

We report a case of heart failure and pulmonary edema in patient with Graves disease during recovery from general anesthesia for cesarean section. A 34-year-old multigrivida, at 35 weeks gestation underwent emergency cesarian section for preterm labor, twin pregnancy and polyhydramnios. She has been treated with Graves' disease for 5 years. After premedication with propranolol and glycopyrrolate, anesthesia was induced with thiopenthal and maintained with O2 -N2 O-enflurane. At the end of skin closure, heart failure and pulmonary edema were developed. On auscultation, systolic murmur was audible at the left sternal border and immediate echocardiography revealed mitral valve prolapse accompanied with mitral regurgitation. After proper treatment, she was discharged without complication at 14 days after surgery.
Adult ; Anesthesia ; Anesthesia, General ; Auscultation ; Cesarean Section ; Echocardiography ; Emergencies ; Female ; Glycopyrrolate ; Graves Disease ; Heart Failure* ; Heart* ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Obstetric Labor, Premature ; Polyhydramnios ; Pregnancy ; Pregnancy, Twin ; Premedication ; Propranolol ; Pulmonary Edema* ; Skin ; Systolic Murmurs

Acardiac fetus in triplet pregnancy is a very rare, fatal congenital anomaly that had not been reported in Korea. It only occurs in multiple gestations associated with placental vascular anastomoses between the affected fetus and its co-twin. The major complications associated with acardiac fetus in triplet pregnancy are congestive heart failure in normal pumping fetus, maternal polyhydramnios, preterm labor, intrauterine fetal death, etc, and perinatal diagnosis can be made with the perinatal ultrasonographic examination. We report a case of acardiac fetus in a spontaneous triplet pregnancy at 23 weeks of gestational age with a brief review of the literature.
Diagnosis ; Female ; Fetal Death ; Fetus* ; Gestational Age ; Heart Failure ; Humans ; Korea ; Obstetric Labor, Premature ; Polyhydramnios ; Pregnancy ; Pregnancy, Triplet* ; Triplets*

Focal nodular hyperplasia (FNH) is a benign hepatic tumor that likely represents a local hyperplastic response of hepatocytes to a congenital vascular anomaly. The histological feature of focal nodular hyperplasia is dominated by a progressive fibrotic process. Focal lesions of the liver represent a significant diagnostic problem for various imaging modalities. Because of that, in some cases, the distinction between focal nodular hyperplasia and other primary hepatic neoplasms is not possible. In the present report, we describe focal nodular hyperplasia observed in three patients with and without chronic liver disease. These patients were disclosed by various imaging procedures. Under the clinical impression of a hepatocellular carcinoma, operations were performed. The results were consistent with the typical observation in focal nodular hyperplasia. We report three cases of focal nodular hyperplasia of the liver mimicking hepatocellular carcinomas in patients with and without chronic liver disease.
Carcinoma, Hepatocellular ; Focal Nodular Hyperplasia* ; Hepatocytes ; Humans ; Liver Diseases ; Liver Neoplasms ; Liver*

PURPOSE: To present a diagnostic sign on MRI and US in patients with ovarian torsion. MATERIALS AND METHODS: We present characteristic imaging findings in eight patients with surgically-proven ovarian torsion. MRI was performed in four patients, CT in six and US in all patients; the procedures including eight transabdominal US(TAS) and three transvaginal US(TVS). In each study, imaging findings were analyzed for the appearance of twisted pedicle and the presence of a "whirling sign". RESULTS: The pedicle which indicates ovarian torsion was detected on MRI in all 4 patients, on TAS in 4/7, on TVS in 3/3, and on CT in 4/6. A specific "whirling sign" was detected on MRI in 2/4 patients, on TAS in 2/4, and on TVS in all three. On CT a "whirling sign" was not detected. CONCLUSION: The "whirling sign" on both MRI & US is a characteristic finding of ovarian torsion; in a patient with adnexal mass and complaining of lower abdominal pain, the presence of this sign is very useful for the diagnosis of ovarian torsion.
Abdominal Pain ; Diagnosis ; Humans ; Magnetic Resonance Imaging

PURPOSE: To present a diagnostic sign on MRI and US in patients with ovarian torsion. MATERIALS AND METHODS: We present characteristic imaging findings in eight patients with surgically-proven ovarian torsion. MRI was performed in four patients, CT in six and US in all patients; the procedures including eight transabdominal US(TAS) and three transvaginal US(TVS). In each study, imaging findings were analyzed for the appearance of twisted pedicle and the presence of a "whirling sign". RESULTS: The pedicle which indicates ovarian torsion was detected on MRI in all 4 patients, on TAS in 4/7, on TVS in 3/3, and on CT in 4/6. A specific "whirling sign" was detected on MRI in 2/4 patients, on TAS in 2/4, and on TVS in all three. On CT a "whirling sign" was not detected. CONCLUSION: The "whirling sign" on both MRI & US is a characteristic finding of ovarian torsion; in a patient with adnexal mass and complaining of lower abdominal pain, the presence of this sign is very useful for the diagnosis of ovarian torsion.
Abdominal Pain ; Diagnosis ; Humans ; Magnetic Resonance Imaging

Objective:To investigate epidemiological characteristics of a viral rash caused by enterovirus.Methods:Retrospective epidemiological analysis was carried out on the cases who had infections in a company. Throat swab samples were collected to detect 22 kinds of respiratory pathogenic agents’ nucleic acids. Enterovirus VP1 gene was amplified and sequenced.Results:A total of 14 adult cases with skin rash, fever, conjunctival hyperemia and sore throat were reported from February 14 to February 21, 2019 from different departments of the company. The peak of incidence occurred on February 18. There were 4 cases. The clinical features were. Of the 14 cases, 6 were male and 8 were female, male: female ration was 0.75∶1. The average age was 35 years.VP1 sequencing showed that 6 cases had coxsackievirus A6 (CV-A6) infection.Conclusions:Combined with the result of epidemiological investigation and laboratory tests, it can be concluded that the viral rash was caused by enterovirus coxsackievirus A6.