Fetal bilateral renal agenesis is a lethal congenital anomaly. An early and reliable prenatal diagnosis is extremely important as it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossa. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present two cases of bilateral renal agenesis, one is diagnosed by ultrasonography after amnioinfusion at 24 weeks gestation, the other is diagnosed postnatally after term delivery.
Diagnosis ; Female ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography ; Urinary Bladder

Acardiac twinning affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 pregnancies overall. This condition is characterized by the absence or rudimentary development of fetal heart, and associated with various anomaly. The presence of an acardiac twin requires the normal (or "pump") twin to provide circulation for itself, as well as the acardiac sibling. The acardiac malformations are uniformly fatal in the affected twin, and mortality in the co-twin is as high as 55%. The principal perinatal problems associated with acardiac twinning are pump-twin congestive heart failure, maternal hydramnios, and preterm delivery. We recently experienced a case of acardius anceps associated with a normal male infant, so present with a brief review of the literature.
Fetal Heart ; Heart Failure ; Humans ; Infant ; Male ; Mortality ; Polyhydramnios ; Pregnancy ; Siblings ; Twins, Monozygotic

The postnatal development of somatostatin [SOM]- and neuropeptide Y[NPY]- immunoreactive[ir] neurons were examined in rat cerebral cortex considering their coexistence in cortical neurons. Using double immunohistochemical staining for SOM and NPY with diaminobenzidine and benzidine dihydrochloride as chromogens, we subdivided immunoreactive cells into double-labeled SOM/NPY-, SOM only-, and NPY only-ir neurons. Interestingly, SOM/NPY- and SOM only-ir neurons were detectable even at the day of birth, in contrast to NPY only-ir cells which first appeared in most cortices from two weeks of age. The morphological features of double-labeled SOM/NPY neurons were not identical to those SOM only- and NPY only-ir neurons. No apparent changes in the shape and size of single-labeled neurone occurred with age ; throughout their postnatal life they were round and ovoid, had a thin rim of perinuclear cytoplasm, and short processes. In contrast, the features of SOM/NPY-ir neurons were not consistent during postnatal life. By day P7, these neurons showed immature features ; they began to show more advanced neuronal characteristics by week P2, when they had a larger and more intensely-stained cytoplasm. In addition, their processes were longer, thicker and more complex than at earlier ages. At this age, SOM/NPY-ir somata were close to their maximum size. From week P4, they became smaller and were lightly labeled. SOM/NPY-ir somata were larger than SOM only- and NPY only-ir somata at and after two weeks of age. The present results showing different postnatal maturation patterns such as time of appearance and morphological features suggest that double-labeled SOM/NPY and single-labeled neurons might be different populations regulated by different mechanisms in their development, and with different functional properties during development.
Animals ; Cerebral Cortex* ; Cytoplasm ; Neurons* ; Neuropeptide Y* ; Neuropeptides* ; Parturition ; Rats* ; Somatostatin*

Decreased number of the Neuropeptide-Y[NPY] immunoreactive neurons in the corpus striatum and primary motor cortex of aged rat was detected by the immunohistochemical method. The animals were categorized into control and aged group and we used 10 Sprague-Dawley rat weighing 250-300gm for control group. 10 Sprague-Dawley rat weighing over 600gm for aged group. The number of NPY-immunoreactive neurons in corpus striatum and primary motor cortex were counted under the light microscope and the following results were obtained. 1. The NPY-immunoreactive neurons were evenly distributed in corpus striatum and in the primaty motor cortex, the NPY-immunoreactive neurons were concentrated within the layer II, III and layer V, VI. The typical NPY-immunoreactive perikarya was multipolar shape. 2. Decreased number of NPY-immunoreactive neurons were detected in some areas of corpus striatum and primary mortor cortex of the aged rat. 3. Decrease of NPY-immunoreactive neurons were most prominent in the caudate-putamen and there were moderate decrease of NPY-immunoreactive neurons in the primary motor cortex, mild decrease of NPY-immunoreactive neurons in the nucleus accumbens but the NPY-immunoreactive neurons were not observed in the globus pallidus in both control and aged rat. NPY is supposed to act as a neurotransmitter of local circuit neurons in the striatum and may exert its potent vasoconstrictor effects on cerebral vessels which influences on the microcirculation of cerebral cortex and striatum. So our results seems to provide an important data on change of the function in the striatum and primary motor cortex of aged rat brain.
Aging ; Animals ; Brain ; Cerebral Cortex ; Corpus Striatum* ; Globus Pallidus ; Microcirculation ; Motor Cortex ; Neurons* ; Neuropeptide Y* ; Neuropeptides* ; Neurotransmitter Agents ; Nucleus Accumbens ; Rats* ; Rats, Sprague-Dawley

Somatostatin analogue octreotide is commonly used for the treatment of carcinoid syndrome. Octreotide also has an antiproliferative effect in neuroendocrine tumors and has demonstrated tumor reduction in patients having advanced carcinoid tumor. This is a case report of a patient who had metastatic liver carcinoid tumor and showed marked regression of liver metastasis after octreotide therapy.
Carcinoid Tumor* ; Humans ; Liver ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Octreotide* ; Somatostatin

PURPOSE: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. METHODS: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. RESULTS: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). CONCLUSION: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.
Amylases ; Creatine Kinase ; Critical Care ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Length of Stay ; Logistic Models ; Multivariate Analysis ; Poisoning ; Retrospective Studies ; Snake Bites* ; Snake Venoms ; Snakes*

The management guideline for traumatic brain injury (TBI) recommends high-dose barbiturate therapy to control increased intracranial pressure refractory to other therapeutic options. High-dose barbiturate therapy, however, may cause many severe side effects; the commonly recognized ones include hypotension, immunosuppression, hepatic dysfunction, renal dysfunction, and prolonged decrease of cortical activity. Meanwhile, dyskalemia remains relatively uncommon. In this study, we report the case of a hypokalemic patient with severe rebound hyperkalemia, which occurred as a result of barbiturate coma therapy administered for TBI treatment.
Brain Injuries ; Coma* ; Humans ; Hyperkalemia ; Hypokalemia ; Hypotension ; Immunosuppression ; Intracranial Pressure

OBJECTIVE: We analyzed the gene status of p16INK4A, p18INK4C, the expression of cell cycle associated proteins (p16INK4A, p18INK4C, cyclin D1, CDK4, pRb, and p53), and human papillomavirus (HPV) infection to investigate whether the inactivation of these genes participated in carcinogenesis, and to evaluated the expression of cell cycle associated proteins and HPV infections. METHODS: We examined forty-one primary cervical carcinomas (17 adenocarcinomas, 13 keratinizing squamous cell carcinomas, and 11 nonkeratinizing squamous cell carcinomas) using PCR, comparative multiplex PCR, PCR-SSCP, methylation-specific PCR, and immunohistochemistry. RESULTS: Ninety percent of cervical carcinomas showed HPV infection. HPV type 16 was detected in 41% and HPV type 18 was found in 44%. Homozygous deletions at p16INK4A gene were observed in 2 cases, but the mutation of p16INK4A and alterations of p18INK4C gene were not detected. The promoter hypermethylation for p16INK4A in nine cases (31%) of 29 cervical carcinomas was found. Expression of p16INK4A protein was observed in 93% and p18INK4C protein expression was noted in 78%. Positive immunostaining for cyclin D1 was only identified in 5%, whereas positive immunostaining for CDK4 was observed in 95%. Expression of pRb protein was found in 93% and p53 protein in 24% of cervical carcinomas. CONCLUSION: These results suggest that high risk HPV infections and methylation of the p16INK4A promoter region seem to play an important role in the pathogenesis of cervical carcinomas. Alterations of p18INK4C gene and cyclin D1-CDK4 pathway does not contribute significantly in the cervical carcinogenesis.
Adenocarcinoma ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Cycle* ; Cyclin D1 ; Cyclin-Dependent Kinase Inhibitor p16 ; Cyclin-Dependent Kinase Inhibitor p18 ; Cyclins ; Genes, p16 ; Humans* ; Immunohistochemistry ; Methylation ; Multiplex Polymerase Chain Reaction ; Papillomavirus Infections* ; Polymerase Chain Reaction ; Promoter Regions, Genetic