Fused blastocysts as a consequence of group embryo culture: observations, complications, and potential solutions

How embryos are cultured, in groups or individually, can influence their development and have other unforeseen impacts on subsequent assisted reproductive technologies. Although a group culture of embryos improves the blastocyst formation rates, this can create conditions wherein separate blastocysts may fuse. This fusion of 2 blastocysts can create unique logistic issues for embryo biopsy and genetic analysis. New culture approaches have emerged to facilitate individual embryo culture without losing the benefit of the group culture approach. Unique culture dishes and adjustments of laboratory culture/embryo handling protocols offer possible solutions to minimize or avoid blastocyst fusion.

Crossed Fused Renal Ectopia with Single Ureter and Single Renal Vein: A Rare Case

Crossed fused renal ectopia with a single ureter and single renal vein is a rare congenital anomaly in which both the fused kidneys lie on one side of the body. We present an unusual case of crossed fused renal ectopia with a single ureter, single renal vein, and a calculus in a 22-year-old man who presented with lower abdominal pain, burning micturition, and a right-side abdominal lump present for three months. On abdominal ultrasound and non-contrast computed tomography (CT), the left kidney was not visualized in the left renal fossa. However, we noted it on the right side, fused to the lower pole of the right kidney with a calculus within the pelvis leading to mild hydronephrosis. After intravenous administration of non-ionic contrast medium, we saw a single ureter draining both the moieties into the urinary bladder on the right side. A three-dimensional volume rendering technique revealed a single renal vein draining the renal parenchyma into the inferior vena cava. Cross fused renal ectopia is an uncommon congenital anomaly which remains asymptomatic throughout life and undetected in the absence of renal pathologies. Multi-detector computed tomography (MDCT) is an excellent tool for denoting anatomical details of this anomaly; the information provided by MDCT is crucial for surgeons, nephrologists, and radiologists alike in facilitating proper management of the condition.

Fused cardiac hybrid imaging with coronary computed tomography angiography and positron emission tomography in patients with complex coronary artery anomalies

OBJECTIVE

To provide data on the value of fused cardiac hybrid imaging with coronary computed tomography angiography (CCTA) and positron emission tomography myocardial perfusion imaging (PET-MPI) in patients with complex coronary artery anomalies (CCAA).

DESIGN/SETTING

This is a retrospective, single-center study.

PATIENTS

Seven consecutive patients with CCAA (mean 57 ± 7 y, 86% were male) who underwent clinically indicated hybrid CCTA/PET-MPI between 2005 and 2015 in our clinic were included. The findings from both modalities and fused cardiac hybrid imaging were evaluated in these patients.

RESULTS

Out of the seven patients with CCAA, two patients had Bland-White-Garland anomaly, two patients showed a coronary artery fistula, two patients showed a "single right," and one patient showed a "single left" coronary artery. Semiquantitative fused hybrid CCTA/PET-MPI depicted inferolateral scar matching the territory of a nonanomalous vessel with significant concomitant coronary artery disease (CAD) in one patient only. In contrast, analysis of quantitative myocardial blood flow (MBF) as assessed by fused hybrid CCTA/PET-MPI revealed abnormally reduced flow capacities in the territories subtended by the anomalous vessels in 4 patients.

CONCLUSIONS

In this case series of middle-aged patients with CCAA, perfusion defects as assessed by semiquantitative PET-MPI were rare and attributable to concomitant CAD rather than to the anomalous vessel itself. By contrast, impaired MBF as assessed by quantitative hybrid CCTA/PET-MPI was revealed in the majority of patients in the vessel territories subtended by the anomalous coronary artery itself. Fused hybrid CCTA/PET-MPI incorporating information on morphology and on semiquantitative and quantitative myocardial perfusions may provide added value for the management of patients with CCAA.