Coronary artery fistula is an abnormal communication between the coronary artery and the cardiac chambers. In particular, an abnormal connection between the conus branch of the right coronary artery and the proximal left anterior descending coronary artery is defined as Vieussens’ arterial ring. Coronary artery fistulas are usually asymptomatic, but some can cause complications such as infective endocarditis. Here, we report a case of Vieussens’ arterial ring causing infective endocarditis with severe mitral regurgitation.
Conus Snail ; Coronary Vessel Anomalies ; Coronary Vessels ; Endocarditis ; Fistula ; Mitral Valve Insufficiency ; Pulmonary Artery

STUDY DESIGN: Retrospective study (level of evidence: level 3). PURPOSE: To study the anatomy of the conus medullaris in Koreans. OVERVIEW OF LITERATURE: The anatomical position of the conus medullaris is well-documented in anatomy textbooks; however, the shape of the conus in the canal rarely described. Furthermore, to our knowledge, no study in Korea has not yet assessed the shape of the conus as well as its position in the canal via cadavaric dissection and/or magnetic resonance imaging (MRI). METHODS: MRI findings of 189 Korean patients aged 2–94 years (93 men and 94 women) were assessed. No subjects from other ethnicities were included. The method proposed by Arai and colleagues was used to assess the termination point and shape of the conus in the canal. The position of the intervertebral disc trisection of the vertebral body closest to the tip of the conus was recorded at the canal level. RESULTS: The tip of the conus medullaris was positioned from the upper T12 body to the L2–L3 disc, mostly in L1 bodies (52.4%), followed by the L2 bodies (22.5%), the L1–L2 disc, and the L2–L3 disc (1.1%). The shape of the conus was classified as type A in 74 (39.6%), type B in 58 (31%), and type C in 55 patients (29.4%). The conus did not terminate at the L3 body in any patient. In the first decade ones (five children) conus positioned rather lowly from L1 bodies to L2–L3 disc, and no type A conus shape, and mostly type B (80%). CONCLUSIONS: The conus medullaris was positioned mostly in the lower one-third of L1 and it in the first decades terminated lowly. No type A in the first decade one, and type B was mostly frequently formed which was followed by type C.
Asian Continental Ancestry Group ; Conus Snail ; Humans ; Intervertebral Disc ; Korea ; Magnetic Resonance Imaging ; Male ; Methods ; Retrospective Studies ; Spinal Cord

Rapid reduction of postprandial blood glucose is very beneficial to diabetics. In order to shorten the onset time of recombinant insulin, the cone snail insulin G1 (cI G1) of Conus geographus was studied. First, the nucleotide sequence of recombinant cone snail proinsulin G1 (cPI G1) was designed and synthesized according to the genes of human proinsulin (hPI) and cPI G1. The codon was optimized according to Escherichia coli (E. coli) codon usage frequency. Then, the plasmid pET22b(+)-cPI G1 was constructed and the recombinant cPI G1 was expressed in E. coli BL21(DE3) host strain. The recombinant cPI G1 was then purified and cleaved specially by trypsin to generate the recombinant cI G1, and its potency is 25.9 IU/mg. Fasting blood glucose test (FBGT) and oral glucose tolerance test (OGTT) suggested that the recombinant cI G1 could rapidly reduce blood glucose in normal and streptozotocin (STZ)-induced diabetic mice, but only for a short duration. This study provides a technical reference for the development of recombinant fast-acting insulin.
Animals ; Conus Snail ; Diabetes Mellitus, Experimental ; Escherichia coli ; Humans ; Hypoglycemic Agents ; Insulin ; Mice

The objective of this case report is to alert the cardiologists and radiologists about the possibility of an extremely rare trifurcation of the right coronary artery. During dissection classes, an early trifurcation of the right coronary artery (RCA) was observed in an adult male cadaver aged approximately 65 years. The RCA had a normal origin from the anterior aortic sinus. After a course of just 2 mm, it trifurcated into a conus artery, a huge right ventricular branch and then a main continuation of the RCA. The conus artery entered the myocardium of the conus after a short course. The huge ventricular branch had a downward and left course almost till the apex of the heart. Right marginal artery was absent. No other vascular variations of heart were observed apart from this. Knowledge of this trifurcation could be useful in coronary angioplasty and bypass procedures.
Adult ; Angioplasty ; Arteries ; Cadaver ; Conus Snail ; Coronary Vessels* ; Heart ; Humans ; Male ; Myocardium ; Sinus of Valsalva

OBJECTIVE: Ultrasonography (US) is the most non-invasive, safe, and, especially in the period of infancy, best method for visualizing and examining the spinal cord. Furthermore, US is the primary work-up for development of the spinal canal, and for follow-up on issues relating to subcutaneous tissues, bone development, and the spinal cord. Conus medullaris terminates at the second lumbar vertebra, according to a consensus in the literature.METHODS: Healthy children under the age of 6 months who were admitted to the radiology clinic for routine USG follow-ups between the dates of March 2012 to December 2014 were included in this study.RESULTS: Our study includes data from 1125 lumbosacral ultrasounds. The terminal point of the conus level of the attended infants, superior, middle part, inferior of the vertebrae L1, L2, and L3. Furthermore, the termination of the discal distance ratio did not differ significantly between genders.CONCLUSION: Therefore, according to our results, gender is not an influencing factor in the termination of the spinal cord. Based on the study we performed, as well as the previous literature, in infants without a recognized spinal pathology, the spinal cord is detected below the vertebra L3.
Bone Development ; Child ; Consensus ; Conus Snail ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Methods ; Pathology ; Spinal Canal ; Spinal Cord ; Spine ; Subcutaneous Tissue ; Term Birth ; Ultrasonography

A 77-year-old female with a history of osteoarthritis visited our clinic complaining of lower back pain, paresthesia in both legs, and voiding difficulty. Her pain and temperature sensations were diminished below the L1 dermatome, and proprioception was decreased in both feet. The findings of a routine laboratory workup, echocardiogram, and cerebrospinal fluid studies were normal. Spine magnetic resonance imaging revealed high T2-weighted signal intensities and diffusion restriction in the posterior conus medullaris. The patient was diagnosed and treated for posterior spinal artery infarction.
Aged ; Arteries ; Cerebrospinal Fluid ; Conus Snail ; Diffusion ; Female ; Foot ; Humans ; Infarction ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Osteoarthritis ; Paresthesia ; Proprioception ; Sensation ; Spinal Cord Compression ; Spinal Cord Ischemia ; Spinal Cord Vascular Diseases ; Spinal Cord ; Spine

PURPOSE: The purpose of this study was to analyze the retention force changes and wear behaviours of double-crown systems over long-term use. MATERIALS AND METHODS: Ten groups, each consisting of six samples, were evaluated. Specifically, casting gold alloy primary crown - casting gold alloy secondary crown (AA), laser sintering primary crown - laser sintering secondary crown (LL), casting Cr alloy primary crown - casting Cr alloy secondary crown, (CC) zirconia primary crown - electroformed secondary crown (ZA), and CAD/CAM titanium alloy primary crown - CAD/CAM titanium alloy secondary crown (TT) groups were evaluated at cone angles of 4° and 6°. The samples were subjected to 5,000 insertion-separation cycles in artificial saliva, and the retention forces were measured every 500 cycles. The wear levels were analyzed via SEM at the beginning and end of the 5,000 cycles. RESULTS: In all samples, the retention forces increased when the conus angle decreased. The highest initial and final retention force values were found in the LL-4° group (32.89 N-32.65 N), and the lowest retention force values were found in the ZA6° group (5.41 N-6.27 N). The ZA groups' samples showed the least change in the retention force, and no wear was observed. In the other groups, wear was observed mostly in the primary crowns. CONCLUSION: More predictable, clinically relevant, and less excursive retention forces can be observed in the ZA groups. The retention force values of the LL groups were statically similar to those of the other groups, except the ZA groups.
Alloys ; Conus Snail ; Crowns* ; Methods* ; Saliva, Artificial ; Titanium

The spinal cord is part of the central nervous system, and its caudal end is named as the conus medullaris. Many researchers have reported the tip level of the conus medullaris by magnetic resonance imaging studies; others by cadaver dissection. The tip level of magnetic resonance imaging studies seemed to be higher than that of cadaver studies. We evaluated the tip level the conus medullaris with magnetic resonance imaging and cadaver dissection in Korean adult population. MR data were scanned with T1-weighted, mid-sagittal magnetic resonance imaging of 248 living persons (mean age, 42.3±16.0 years; range, 12-85 years) and cadaver data were collected by dissections of 118 cadavers (mean age, 56.0±14.9 years; range, 16-94 years). The mean level of conus tip was found to be at the middle third of 1st lumbar vertebra (range, lower third T12 - lower third L2) from magnetic resonance imaging study and the upper third of 2nd lumbar vertebra (range, lower third T12 - lower third L3) from cadaver dissection study. The tip level of conus medullaris from magnetic resonance imaging study was higher than that from cadaver dissection study (p<0.05).
Adult* ; Cadaver* ; Central Nervous System ; Conus Snail* ; Humans ; Magnetic Resonance Imaging* ; Spinal Cord* ; Spine

The purpose of this study was to provide basic biometric data on Korean adults through magnetic resonance imaging (MRI)-based measurements of the distances between the apex of sacral hiatus (SH) and the termination of dural sac (DS), and between SH and conus medullaris (CM) because they are critical to the performance of epidural neuroplasty. A total of 200 patients (88 males and 112 females) with back pain, who had no spine fracture, significant spinal deformity, and spondyloisthesis were selected for this study. The subjects were of mean age 54.3 (20~84) years and mean height 161.3 cm (135~187). T2-weighted MRI images were used for correlation analysis to evaluate the relationships between the distances, and variables such as sex and height. In all patients, the mean distance between SH and DS was 62.8±9.4 mm and the mean distance between SH and CM was 232.2±21.8 mm. The minimum distance and the maximum distance between SH and DS were 34.8 mm and 93.9 mm respectively, and the minimum distance and the maximum distance between SH and CM were 155.0 mm and 284.0 mm respectively. In female patients, both the distances between the SH and DS, and between SH and CM were shorter when compared to those of the male patients (p<0.05). Both the distances between SH and DS and between SH and CM showed a significant correlation with height (p<0.01). The results of this study will provide a useful biometric data on the distances between SH and DS and between SH and CM in Korean in ensuring clinical safety and in the development of more effective catheterization techniques for epidural neuroplasty in Korean.
Adult* ; Back Pain ; Catheterization ; Catheters ; Congenital Abnormalities ; Conus Snail* ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Spinal Cord* ; Spine

A 19-year-old man presented with long lasting significant back and bilateral leg pain, and hypoesthesia on the lateral side of both his thighs for which he had undergone several courses of medication and bouts of physical therapy treatment. His urodynamic parameters were normal and lumbar magnetic resonance imaging (MRI) revealed a low-lying conus at the L2-3 level with a thickened fatty filum, and he was diagnosed as having tethered cord syndrome (TCS). The patient underwent a fully endoscopic detethering through an interlaminar approach with intraoperative neurophysiological monitoring. The thickened filum terminale was located and then the filum was coagulated and cut. The patient showed a significant improvement in his preoperative symptoms, and reported no problems at 2-year follow-up. Detethering of the spinal cord in tethered cord syndrome using a fully endoscopic interlaminar approach provides the advantages of minimal damage to tissues, less postoperative discomfort, early postoperative recovery, and a shorter hospitalization.
Cauda Equina ; Conus Snail ; Follow-Up Studies ; Hospitalization ; Humans ; Hypesthesia ; Intraoperative Neurophysiological Monitoring ; Leg ; Magnetic Resonance Imaging ; Neural Tube Defects* ; Spinal Cord* ; Thigh ; Urodynamics ; Young Adult