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To evaluate prospectively the accuracy of scrotal ultrasonography (US) in distinguishing obstructive azoospermia from nonobstructive azoospermia in infertile men by using histologic findings as the reference standard.The institutional review board approved the study, and informed consent was obtained from each patient. Twenty infertile men (mean age, 34.7 years; 40 testes) with azoospermia were evaluated at scrotal US, with an emphasis on the course of the proximal genital duct: mediastinum testis, epididymal head, epididymal body, and epididymal tail. Testicular volumes were calculated by using the formula: length x height x width x 0.71. On the basis of histologic results, azoospermia was divided into two groups (obstructive vs nonobstructive) in all cases except one. Scrotal US findings between obstructive and nonobstructive azoospermia were compared. The Fisher exact and Wilcoxon signed rank sum tests were used to assess differences between both groups.Of 20 infertile men with azoospermia, 14 were proved to have obstructive azoospermia; the others had nonobstructive azoospermia. According to US findings, epididymal abnormalities in the head, body, and tail were significantly associated with obstructive azoospermia (17 [61%], 18 [64%], and 20 [71%] of 28 testes, respectively; P.001 for all), while abnormalities of the mediastinum testis between both groups were not significant (P.05). By taking epididymal abnormalities into account, sensitivity, specificity, and accuracy of scrotal US for differentiation of obstructive from nonobstructive azoospermia were 82.1% (23 of 28 scrota), 100% (12 of 12 scrota), and 87.5% (35 of 40 scrota), respectively. The median testicular volume in obstructive azoospermia was 11.6 mL (range, 7.7-25.8 mL) and that in nonobstructive azoospermia was 8.3 mL (range, 1.2-16.4 mL) (P.05).Evaluation of the epididymis and measurement of testicular volume with scrotal US are important in distinguishing obstructive azoospermia from nonobstructive azoospermia in infertile men.

Objectives The aim of this study was to provide reference values for nasal bone length (NBL) scanned at 11–14 weeks' gestation in the Korean population and compare these values with those of the Caucasian and African–American populations. Methods From April 2004 to July 2004, fetal NBLs were measured in well-dated, non-anomalous fetuses at 11–14 weeks' gestation in the Korean population. Regression analysis was used to assess the relationship between NBL and crown-rump length (CRL), and reference values including the 5th, 50th, and 95th percentile were calculated for each gestational age. The reference values in our study were compared with those of the Caucasian and African–American populations. Results A total of 982 cases were prospectively included in the study. NBL increased linearly with advance in CRL and was described by the equation; NBL (mm) = 0.433 + 0.022 × CRL (mm), R2 = 0.37. The median values (5%, 95%) were 1.5 mm (1.2 mm, 1.9 mm), 1.7 mm (1.4 mm, 2.1 mm), 1.9 mm (1.6 mm, 2.3 mm), and 2.1 mm (1.7 mm, 2.6 mm) for 11, 12, 13, and 14 weeks' gestation, respectively. The median values for each gestational age in the Korean population were significantly lower than those in the Caucasian and African–American populations (P < 0.0001). Conclusion There is a difference in NBL scanned at 11–14 weeks' gestation between the Korean and the Caucasian/African–American populations, and so racial adjustment is needed in the evaluation of the fetal nasal bone for current first-trimester screening. Copyright © 2006 John Wiley & Sons, Ltd.

Objective To construct new reference charts and equations for fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FDL) from Korean fetuses at 12–40 weeks. Method Prospective cross-sectional data obtained in one center for 5 years from a population of pregnant women undergoing ultrasound examination between the 12th and 40th week of gestation. Exclusion criteria comprised all maternal and fetal conditions possibly affecting fetal biometry. No fetuses were excluded on the basis of abnormal biometry. For each measurement, regression models were fitted to estimate both the mean and the standard deviation at each menstrual age. Results Biometric measurements were obtained for 10 455 fetuses. New charts and reference equations are reported for BPD, HC, AC and FDL. Reference equations are cubic models. Conclusion We present new Korean reference charts and equations for fetal biometry. They can be easily used in obstetric ultrasound studies for the Korean population. Copyright © 2007 John Wiley & Sons, Ltd.

Objectives The purpose of our study is to provide reference values for the great vessels obtained from images of the three-vessel view of the fetal heart, with an emphasis on the size discrepancy of the great vessels. Methods From February 2003 to May 2003, the main pulmonary artery (MPA), ascending aorta (AA), and SVC were measured in well-dated, nonanomalous fetuses scanned at 14–38 weeks of gestation. Results The size of each great vessel had a significant positive relationship with advance in gestation (P < 0.001); MPA (mm) = − 2.76 + 0.34 × GA, ascending aorta (AA) (mm) = − 1.73 + 0.26 × GA − 1.18E − 05 × GA3, and SVC (mm) = 0.33 + 0.01 × GA2 − 4.12E − 05 × GA3. The AA/MPA ratio was significantly decreased with advance in gestation, while the SVC/AA ratio was significantly increased; AA/MPA ratio = − 1.24 − 0.03 × GA + 3.88E − 04 × GA2; P < 0.001, SVC/AA ratio = 0.63 − 5.43E − 03 × GA + 1.96E − 04 × GA2; P < 0.001. Conclusion On the three-vessel view of the fetal heart, the interpretation of the size discrepancy of the great vessels needs to be adjusted according to fetal growth. Copyright © 2006 John Wiley & Sons, Ltd.

Objective: We sought to investigate the feasibility of 3-dimenstional ultrasound (3D US)-based virtual cystoscopy in experimentally designed bladder phantoms using pig bladders. Materials and Methods: Ten bladder phantoms with simulated polypoid tumors of different sizes were constructed to provide 3D US-based virtual cystoscopic images. The simulated polypoid tumors were divided by their location into 2 groups: group 1 included the polyps on the anterior and posterior walls, and group 2 included those on the remaining 4 walls. Two genitourinary radiologists independently interpreted the virtual cystoscopic images, with a consensus reached for cases with discrepant results. Results: In a consensus reading, 3D US-based virtual cystoscopy detected 44 (91.7%) of 48 polypoid lesions. All lesions (n = 4) with false-negative results were 5 mm or smaller in diameter, and so the detection rate was 81.8% (18/22) for lesions 5 mm or smaller whereas it was 100% (26/26) for lesions larger than 5 mm. The detection rate for group 1 (93.8%) was not significantly different from that for group 2 (90.6%; P = 1.000). There were 7 false-positive lesions. Of these, 5 lesions were seen in group 1, and reverberation artifacts were the most common source of these errors (n = 4). Blind areas were present in 19 (31.7%) of 60 virtual cystoscopic images and were seen only in group 2. The differences in the false-positive rate and the incidence of blind area were statistically significant between both groups (P = 0.036, P = 0.00008, respectively). Conclusion: 3D US-based virtual cystoscopy may have diagnostic potential in the detection of polypoid bladder tumors.

Retroperitoneal fibrosis is characteristic plaques of dense fibrous tissue, typically extending from the level of the kidney down to the sacral promontory. Involvement of the presacral space is extremely rare in retroperitoneal fibrosis. We report two cases of idiopathic retroperitoneal fibrosis manifested by a presacral mass.

Ovarian carcinoma is the most common cause of death from a gynecologic malignancy. The most important prognostic factors are the presence and magnitude of residual or recurrent disease after therapy. Recurrent ovarian malignancy usually manifests as pelvic masses in the surgical bed, peritoneal seeding, nodal recurrence and pleuropulmonary lesions, and liver metastasis. Pelvic recurrence involves the vaginal stump, parametria, urinary bladder, and/or bowel adjacent to the surgical bed. Peritoneal seeding presents as nodules on the peritoneal surface, most commonly around the liver or cul-de-sac, and mesenteric infiltration. Pseudomyxoma peritonei is the other form of peritoneal seeding. Nodal recurrence appears as enlarged paraaortic nodes, especially at the renal hilar level. Unusual manifestations include metastasis in the extrahepatic abdominal solid organs, bone metastasis, and abdominal wall lesion involving subcutaneous fat or muscle. Familiarity with the patterns and spectrum of imaging findings of recurrent ovarian malignancy will facilitate accurate diagnosis and prompt treatment.

The effect of ionic strength and pH of carrier solutions on the separation of liposomes by flow field-flow fractionation (flow FFF) has been studied for the determination of accurate vesicle size distribution of liposomes. Retention behaviors of liposomes (PC/PG/cholesterol) are observed in typical buffer solutions (PBS and Tris-HCl) of various ionic strengths as carrier liquids in flow FFF. The average diameters of collected fractions at each flow FFF run are measured by photon correlation spectroscopy (PCS) for the comparison with FFF calculations at corresponding time interval of collected fractions. A reasonable separation of liposomes is observed at I = 0.016 M for both buffer solutions. Retention of liposomes is found to be elongated at ionic strengths higher than an optimum condition found experimentally, but it is shortened at a lower ionic strength due to the electrostatic interaction between the channel wall and the liposomes. Finally, size distributions of liposomes are provided comparing the liposome preparations by flow FFF.

Objectives: To examine the outcome of fetuses with short femur length (FL) at the time of the routine anomaly scan. Methods: This was a retrospective review of antenatal, pediatric and genetics records of pregnancies where ultrasound measurement of FL at 18–24 weeks of gestation was found to be below the 5th centile. All pregnancies had an ultrasound at 11–13 + 6 weeks to confirm pregnancy dating and also had nuchal translucency (NT) risk assessment. Results: There were 129 fetuses over a 6-year period. In 46 (35.7%) cases short FL was associated with other structural abnormalities. In this group skeletal dysplasias (n = 16), chromosomal abnormalities (n = 10) and genetic syndromes (n = 4) were the most common associations. Short FL was classified as isolated in the remaining 83 (64.3%) cases. There were no cases of chromosomal abnormalities in this group. Eleven (13%) were false positives with FL at subsequent scans within the normal range; all of these had a normal outcome. In the remaining 72 (87%) FL measurements were consistently below the fifth centile. Early severe fetal growth restriction (FGR) with abnormal umbilical artery Doppler requiring delivery before 37 weeks of gestation occurred in 33/83 (40%); 90% of these had abnormal uterine artery Doppler at the time of presentation. This cohort was complicated by pre-eclampsia in 12/33 (36%) cases, intauterine fetal death in 11/33 (30%), while a further two suffered a neonatal death. In 39/83 cases umbilical artery Doppler remained normal; five of these patients delivered before 37 weeks owing to pre-eclampsia or placental abruption (n = 3) or spontaneous preterm labour (n = 2), while in 34 delivery occurred after 37 weeks of gestation. Conclusions: In a population previously screened by NT, isolated short FL at the time of the routine anomaly scan is not associated with chromosomal abnormalities. Severe FGR associated with high mortality occurs in 40%, making uterine artery Doppler evaluation more useful than amniocentesis in these pregnancies.

Objective: To evaluate the sonographic characteristics of the cloacal anomaly on prenatal ultrasound and to correlate with pathologic findings. Methods: From March 1991 to December 2002, eight cases with the persistent cloaca (4 cases in female 1 case in male) and cloacal exstrophy (3 cases) diagnosed by prenatal ultrasound examination were included, and all of them were pathologically confirmed by autopsy. One radiologist retrospectively analyzed the prenatal sonographic findings, including the urinary bladder, kidney, pelvic cyst, abdominal wall defect and amount of amniotic fluid. Results: The ultrasonographic diagnosis was established at 21.8 ± 7.8 weeks of gestation. The prenatal sonographic findings of the persistent cloaca were absent bladder (n = 2), distended bladder (n = 2), and small thick bladder (n = 1). Sonography of kidney showed normal (n = 2), hydronephrosis (n = 1), dysplasia (n = 1), and unilateral hydronephrosis with absent contralateral kidney (n = 1). Four fetuses showed septated pelvic cyst; three fetuses, oligohydramnios. The prenatal sonographic findings of cloacal exstrophy included absent bladder (n = 3), normal kidney (n = 1), hydronephrosis (n = 1), and absent kidney (n = 1). All fetuses with cloacal exstrophy had abdominal wall defect while two of them had ligohydramnios. Conclusions: A prenatal diagnosis of persistent cloaca can be confidently made when there is septated pelvic cyst combined oligohydramnios, sediments within the cyst and intraluminal calcifications. Cloacal exstrophy should be included in diagnosis if there is a low abdominal wall defect with absent urinary bladder.

Objective: This study was undertaken to evaluate the feasibility of using free-hand three-dimensional (3D) ultrasonography to evaluate the volume of the fetal stomach. Material and methods: We studied a total of 108 normal singleton fetuses from 13 to 42 gestational weeks. During 2D ultrasonographic examination three-dimensional upper abdomen data were collected prospectively. The stomach was scanned with a fanning motion of the transducer in the axial plane, nearly parallel to the conventional abdominal circumference plane. 3D volume segmentation processing of the stomach was performed and saved in different files. Stomach volume was calculated. Results: In almost all cases in which the stomach was visualized it was possible to calculate structure volume. There was considerable volume variation during the range of gestational ages studied. This preliminary study would have to be expanded to construct nomograms of stomach dimensions. Conclusion: 3D echocardiography can provide estimates of fluid filled fetal organs’ volumes and can be used for nomogram construction.

Physiotherapists use electromyographic (EMG) techniques to look at muscle strength, and can also examine muscle behaviour. This paper examines the manner in which pain appears to result from the sustained muscle contraction that expresses unresolved emotion that may, indeed, be reactive to pain, thus forming a pain-perpetuating factor. This theory of pain perpetuation by the muscle activity of emotion is presented, and is illustrated by case examples. A discussion follows in which the literature pertaining to the muscle activity of emotion, and pain philosophy relevant to this situation, are introduced.

Summary Objective The present study was performed to elucidate the possible role of SIRT1 signaling in joint inflammation in human articular chondrocytes. Design Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blotting were performed to detect gene products and proteins involved in tumor necrosis factor α (TNF-α)-induced inflammation and cartilage degradation in human primary chondrocytes. Matrix metalloproteinase (MMP)-2 and MMP-9 activity was evaluated by gelatin zymography. Overexpression and knockdown of SIRT1 were also performed to investigate whether SIRT1 is associated with the anti-inflammatory activity of resveratrol in chondrocytes. Results Resveratrol dose-dependently inhibited TNF-α-induced cyclooxygenase-2 (COX-2), MMP-1, MMP-3, MMP-13 and PGE 2 production in human chondrocytes. Moreover, MMP-2 and MMP-9 activity was increased by treatment with TNF-α; however, SIRT1 activation decreased the proinflammatory effects induced by TNF-α. In addition, treatment of SIRT1 activator and overexpression of SIRT1 inhibited the expression and activation of the main proinflammatory regulator NF-κB, which was increased by TNF-α. When SIRT1 was overexpressed in chondrocytes, the anti-inflammatory action of SIRT1 was similar to that exerted by resveratrol. Conclusions SIRT1 activation deacetylates and inactivates NF-κB, and thereby, exerts an anti-inflammatory effect on chondrocytes, suggesting that SIRT1 activators could be explored as potential treatments for arthritis.

Forty-six patients with rheumatoid arthritis affecting their hands were questioned to establish whether or not they complied with the medical specialist's instructions about wearing splints. Only one-third of the patients appeared to comply. A high extraversion score (measured on the EPI questionnnaire) identified half of the patients who did not comply. All patients scored significantly lower then the population norm on the introversion-extraversion dimension, indicating that this dimension may be involved in the psychosomatic aspect of rheumatoid arthritis.

Electromyographic (EMG) measurements from the forehead and rectus abdominis areas were undertaken in a group of patients presenting for elective hysterectomy. The efficacy of EMG auditory feedback as a means of inducing relaxation so as to modify the dose of postoperative analgesia was examined and compared with the dose in subjects having EMG measurements without audiofeedback. Comparison was also made with a group of subjects who did not have EMG measurements. Subjects in those groups who were given relaxation instruction received less postoperative analgesia than subjects not receiving this treatment. A reduction in EMG activity was demonstrated with auditory feedback, but this did not relate directly to reduced analgesic administration after surgery.