Vírus e fissuras orofaciais: um histórico isolado e de associação / Viruses and orofacial clefts: an isolated and associational history / Virus y fisuras orofaciales: una historia aislada y asociativa

Os vírus são microrganismos comumente associados as doenças e infectam todos os seres vivos. Atuam de forma direta e indireta levando a pressão seletiva, com papel significativo e ainda em exploração no planeta. As fissuras orofaciais são anomalias congênitas de etiologia complexa e multifatorial, sendo as infecções virais durante a gestação um dos possíveis fatores etiológicos. A história da humanidade frente aos vírus e fissuras orofaciais de forma isolada é vasta, remontando a períodos antes de Cristo, seja por meio de leis para o controle de pragas e/ou por lendas de míticas criaturas deificadas e/ou demonizadas, cuja criação está fundamentada na Teoria Alegórica do surgimento das mitologias, demonstrando assim o interesse do ser humano e sua curiosidade em inovação e explicação destes assuntos. Considerando a relevância histórica, bem como a possível relação etiológica destes dois elementos, uma revisão da literatura foi realizada para apresentar a história mitológica e científica dos vírus e fissuras orofaciais, de forma isolada e associadas para fins de comparação. Para isso, foram utilizadas as bases PubMed/Medline, SciElo, LILACS e Portal Periódicos (CAPES) com os descritores: Virus, Anomalias/Anomalies, Virus and Anomalias/Virus and Anomalies, A History of viruses/História dos vírus, Virus and History/História and Virus, Virus and Myth/Virus and Mito, Anomalias and Mitos/Anomalies and Myths, Vampires and Virus/Vampiros and Virus. Enquanto o histórico mitológico é cheio de teorias contraditórias, o histórico cientifico acadêmico se revela coerente, porém resistente as novas áreas de atuação, não ponderando novas possibilidades e limitando a exploração científica, que só pôde ser alcançada nos séculos atuais. Quanto a associação, a linha de pesquisa relacionando vírus e fissuras orofaciais não possui nem meio século de existência, propiciando um grande campo a ser explorado e na mesma medida limitando os benefícios em prevenção que poderiam ser obtidos através destes estudos.

Viruses are microorganisms commonly associated with diseases that infect all living beings, they act directly and indirectly leading to selective pressure, their role on the planet is significant and still under exploration. Orofacial clefts are congenital anomalies that have a complex multifactorial etiology, with viral infections during pregnancy being one of the possible etiological factors. The history of humanity in the face of viruses and orofacial clefts in isolation is vast, dating back to periods before Christ, whether through laws for pest control and/or legends of mythical deified and/or demonized creatures, whose creation is fundamentalized in the Allegorical Theory of the emergence of mythologies, thus demonstrating the interest of human beings and their curiosity in innovation and explanation of these subjects. Considering the historical relevance, as well as the possible etiology relationship of these two elements, we carried out a literature review to present the mythological and scientific history of viruses and orofacial clefts, isolated and associated for comparison purposes. For this intent, the bases PubMed/Medline, SciElo, LILACS and Portal Periódicos (CAPES) were selected with the descriptors: A History of viruses/História dos vírus, Virus and History/História and Virus, Virus and Myth/Virus and Mito, Anomalias and Mitos/Anomalies and Myths, Vampires and Virus/Vampiros and Virus. While the mythological history is full of contradictory theories, the academic, scientific history proves to be consistent, but resistant to new areas of action, not considering new possibilities and limiting scientific exploration, which can only be achieved in the present centuries. As for the association, the line of research relating viruses and orofacial clefts does not even have half a century of existence, providing a large field to be explored and at the same time limiting the benefits of prevention that could be obtained through these studies.

Los virus son microorganismos comúnmente asociados a enfermedades que infectan a todos los seres vivos, actúan directa e indirectamente provocando presión selectiva, su papel en el planeta es significativo y aún en exploración. Las hendiduras orofaciales son anomalías congénitas que tienen una compleja etiología multifactorial, siendo las infecciones virales durante el embarazo uno de los posibles factores etiológicos. La historia de la humanidad frente a los virus y las hendiduras orofaciales de forma aislada es vasta, remontándose a períodos anteriores a Cristo, ya sea a través de leyes para el control de plagas y/o leyendas de criaturas míticas deificadas y/o demonizadas, cuya creación se fundamentaliza en la Teoría Alegórica del surgimiento de las mitologías, demostrando así el interés del ser humano y su curiosidad en la innovación y explicación de estos temas. Considerando la relevancia histórica, así como la posible relación etiológica de estos dos elementos, realizamos una revisión bibliográfica para presentar la historia mitológica y científica de los virus y las hendiduras orofaciales, aislados y asociados para fines de comparación. Para ello, se seleccionaron las bases PubMed/Medline, SciElo, LILACS y Portal Periódicos (CAPES) con los descriptores: A History of viruses/História dos vírus, Virus and History/História and Virus, Virus and Myth/Virus and Mito, Anomalias and Mitos/Anomalías y Mitos, Vampiros and Virus/Vampiros y Virus. Mientras que la historia mitológica está llena de teorías contradictorias, la historia académica, científica, se muestra coherente, pero resistente a nuevos campos de actuación, no considerando nuevas posibilidades y limitando la exploración científica, que sólo puede alcanzarse en los siglos actuales. En cuanto a la asociación, la línea de investigación que relaciona virus y hendiduras orofaciales no tiene ni medio siglo de existencia, proporcionando un gran campo a ser explorado y al mismo tiempo limitando los beneficios de prevención que podrían ser obtenidos a través de estos estudios.

Malformations fœtales diagnostiquées à l'échographie obstétricale au CHU de Bouaké: à propos de 43 cas (Côte d'Ivoire) / Fetal Malformations diagnosed by Obstetrical Ultrasound at the University Hospital of Bouake : 43 cases reported (Cote d'Ivoire)

L'échographie obstétricale est l'examen de référence dans l'étude et le suivi des malformations fœtales que sont des anomalies morphologiques et fonctionnelles congénitales. L'objectif était de déterminer la fréquence et les types de malformations fœtales diagnostiquées à l'échographie obstétricale à Bouaké. Méthodes. Il s'agissait d'une étude transversale rétrospective descriptive de 2010 à 2019 au centre hospitalier et universitaire (CHU) de Bouaké. Ont été incluses dans l'étude, toutes les femmes enceintes ayant présenté au moins une malformation fœtale au cours de la grossesse. Les variables étudiées étaient : l'âge de la mère, l'âge gestationnel, le sexe du fœtus et les caractéristiques échographiques des malformations fœtales retrouvées. L'analyse statistique s'est faite à l'aide des tests de Khi2 et de Fisher au seuil de signifi cativité situé à 5% (P<005). Résultats : Les malformations fœtales représentaient 43 cas sur 11879 échographies obstétricales soit une prévalence de 0,36%. L'âge moyen des gestantes était de 40,23 ± 6,34 ans avec des extrêmes de 16 et 43 ans. Les malformations fœtales découvertes au troisième trimestre représentaient 67,44% des cas. Les anomalies malformatives prédominaient sur les fœtus de sexe masculin avec 62,8%. Les anomalies du système nerveux central (SNC) étaient les plus représentées avec 51,16 % suivies des anomalies uro-génitales (30,23 %). L'hydrocéphalie était la principale malformation du SNC avec 63,63% des cas. L'hydronéphrose représentait 76,93% des anomalies uro-génitales et l'omphalocèle était la malformation abdominale la plus représentée avec 60% des cas. Conclusion: L'échographie obstétricale occupe une place incontournable dans le dépistage, le suivi et la prise en charge des malformations fœtales

Application value of systematic prenatal ultrasound in prenatal screening of twin pregnancy / 中华医学超声杂志（电子版）

Objective To explore the application value of systematic prenatal ultrasound in prenatal screening of twin pregnancy. Methods Retrospectively analyzed 393 cases of twin pregnancy who underwent systematic prenatal ultrasound examination in our hospital from October 2012 to December 2017, and 27 cases of twin pregnancy malformation were included in the study. By comparing the data of prenatal ultrasound examination with follow-up data and pathological anatomic results, the detection rate and diagnostic coincidence rate of fetal malformation in prenatal screening of twin pregnancy by systematic prenatal ultrasound examination were analyzed. Results Among 27 cases of twin pregnancy malformation, 19 cases were fetal structural malformation and 8 cases were unique malformation of twin pregnancy. Nineteen cases of twin pregnancy fetal structural malformation occurred in one of the two fetuses in twin pregnancies, and all of which were single malformations. Eight cases of unique malformation of twin pregnancy were often involved in double fetuses. Seventeen cases of fetal structural abnormalities and 8 cases of unique malformation of twin pregnancy were diagnosed correctly by systematic prenatal ultrasound examination, and the diagnostic coincidence rate of prenatal ultrasound was 100% (25/25). Two cases of structural malformation were missed, and the detection rate of fetal malformation was 92.6% (25/27). Conclusion The systematic prenatal ultrasound in prenatal screening of twin pregnancy has high detection rate of malformation and diagnostic coincidence rate, which has important clinical application value.

Prenatal ultrasonic diagnosis of fetal isolated levocardia / 中华超声影像学杂志

Objective To investigate the clinical application valve of prenatal ultrasound in diagnosis of fetal isolated levocardia ( IL ) . Methods Thirty-eight IL fetuses diagnosed in three prenatal diagnosis centers from 2000 to 2016 were reviewed with their prenatal ultrasound features and cardiac and extracardiac malformations . Results Thirty-eight IL cases included 19 cases of left isomerism ( LI) ,14 cases of right isomerism( RI) and 5 non-classified cases . The overall incidence of malformations in IL patients was 97 .4％with 94 .7％ in LI patients and 100％ in RI patients . The incidence of cardiac malformations was 92 .1％with 84 .2％ in LI patients and 100％ in RI patients . The most common congenital heart diseases were:right ventricle outlet obstruction , univentricular physiology and atrioventricular septal defect . Anomalous pulmonary venous connection was more commonly seen in LI patients than in RI patients . The most common extracardiac malformation was duodenal obstruction( 86 .9％ ) . Inferior vena cava interruption and polysplenia were more commonly seen in LI patients .Juxtaposition of aorta and inferior vena cava and asplenia were more commonly seen in RI patients . Conclusions IL is very rarely seen in population with high incidence of congenital heart diseases and extracardiac malformations .

Administration mode of cyclophosphamide for the embryo-fetal developmental toxicity test in rabbits / 中国比较医学杂志

Objective To explore the effects of cyclophosphamide administered by different routes or in different doses on the embryo-fetal development in pregnant rabbits, and to determine the optimal mode of cyclophosphamide administration to induce fetal malformation.Methods Pregnant rabbits were divided into control group C (saline), group Y1 (intravenous injection of 15 mg/kg cyclophosphamide,), group Y2 (subcutaneous injection of low dose cyclophosphamide, 20 mg/kg), and group Y3 (subcutaneous injection of high dose cyclophosphamide, 30 mg/kg).Each rat was administrated according to the corresponding mode once daily on GD10~13.The day of conception was designated as GD0.The pregnant rabbits were sacrificed and dissected on GD28.Then, the number of corpora lutea and implantation, the weight of uterus with contained fetus, and fetal resorption rate were detected, the fetuses were removed and the fetal sex, body length, tail length, the number of live births and stillbirths were recorded, and the appearance of deformities, visceral deformities and skeletal malformations were detected.Results Pregnant rabbit fetuses in the cyclophosphamide intravenous injection group and subcutaneous injection of low dose cyclophosphamide group showed deformities.The appearance malformation rates in the two groups were 30.77% and 95.65%, the skeletal deformity rates were 7.69% and 73.91%, and the visceral abnormality rates were 20.51% and 47.83%, respectively.The fetal resorption rate in the high dose cyclophosphamide subcutaneous injection group was 100%.Conclusions Subcutaneous injection of 20 mg/kg cyclophosphamide to pregnant rabbits at GD10~13 can be used as a positive administrationmethod for rabbit embryo-fetal developmental toxicity test.Thismethod has the advantages of short administration period, easy operation, few fetus resorption, and high rate of fetal malformation, thus, providing the evidence for selection of appropriate model of rabbit embryo-fetal developmental toxicity.

Prenatal ultrasonographic diagnosis and differential diagnosis of fetal penoscrotal transposition / 中华医学超声杂志（电子版）

Objective To study the ultrasonographic features and differential diagnosis of fetal penoscrotal transposition.Two dimensional and three dimensional ultrasound were applied in the diagnosis of fetal penoscrotal transpositionto improve the detection rate. Methods Twenty cases of suspected penile scrotal transposition of the fetus in Shengjing Hospital affiliated to China Medical University fromJanuary 2015 to February 2017were included in present study. The ultrasound findings, fetal chromosome examination and clinical follow-up outcome were retrospectively summarized. Results Among the 20 suspected cases of penile scrotal transposition, 17 cases were diagnosed correctly. All the 17 cases were partial type of penile scrotal transposition. In the remaining 3 cases, 2 caseswere hermaphroditism with the karyotype of 46-XX, and the other 1 case was confirmed as normal female fetusesby clinical follow-up after birth. The ″tulip″signwas the typical ultrasonographic features offetal penoscrotal transposition. Conclusion 2D combined with 3D ultraosound is useful in diagnosis and differential diagnosis of fetal penile scrotal transposition.

Diagnosis judgment values of trimester ultrasound screening for simple single umbilical artery fetal malformation / 中国综合临床

Objective To investigate the diagnosis judgment values of trimester ultrasound screening for simple single umbilical artery fetal malformation.Methods From January 2011 to January 2015,selected the 15-28 weeks pregnant singleton pregnancies in Shunyi Hospital of Beijing Chinese Medicine Hospital for system fetal ultrasound,in which the single umbilical artery group of 50 patients,50 cases of healthy pregnant women (control group),the two groups were carried ultrasound screening with single umbilical artery flow spectrum analysis,and observed the prognosis.Results The single umbilical artery fetal bladder after abdominal oblique horizontal cross-section of the umbilical artery bypass saw one side of the bladder,and there were 24 patients the malformations with the incidence rate was 48.0％.In the two groups can be clearly demonstrated umbilical artery condition,but the umbilical artery pulsation index(PI),arterial resistance index (RI) and peak valley ratio of umbilical artery blood flow velocity (S/D) value in the single umbilical artery group were 1.02±0.17,0.66±0.06 and 3.08 ±0.57,significantly higher than those of the control group (0.75 ± 0.21,0.53 ± 0.08,2.11±0.27;t=7.298,11.874,15.983,P＜ 0.05).In the single umbilical artery group,there were 32 patients of abortion,10 patients of birth were,8 patients ogpregnancy.Perinatal death in 8 cases,the mortality rate was 16.0％,the single umbilical artery fetal malformations of perinatal mortality was significantly higher than that of children with simple single fetal umbilical artery (x2 =9.333,P ＜ 0.05).Conclusion Trimester ultrasound screening for single umbilical artery combined with simple two-dimensional ultrasound and umbilical arteryblood flow velocity conditions can improve fetal malformations value judgment,provide a reliable detection method to reduce oerinatal mortality.

Diagnóstico ecográfico prenatal de displasia tanatofórica: a propósito de un caso / Prenatal diagnosis ultrasonographic thanatophoric dysplasia: report of a case

La Displasia tanatofórica es probablemente la displasia letal más común. Ocurre en aproximadamente en 0,69 por cada 10.000 nacimientos. Su etiología es posiblemente autosómica dominante y resulta de mutaciones nuevas del factor de crecimiento del receptor de los fibroblastos. La patogenia es debida a desorganización del cartílago de crecimiento con persistencia de tejido símil parenquimatoso. Es una condrodisplasia congénita letal caracterizada por el acortamiento de los miembros, hipoplasia torácica, cráneo en hoja de trébol, pliegue simiesco, fémur acortado, estrechamiento torácico, frente prominente, polo cefálico con dimensiones aumentadas aún sin ventriculomegalia y redundancia de las partes blandas.Ademásestá asociado a polihidramnios en un 70 %. Las anomalías asociadas son hidrocefalia, anomalías renales, defecto del tabique auricular, válvula tricúspide anómala, ano imperforado y sinóstosis radio cubital. Se presenta la experiencia de un caso de displasia tanatofórica que se ha podido diagnosticar con la ecografía prenatal.

Thanatophoric dysplasia is probably the most common lethal dysplasia. It occurs in about 0.69 of 10,000 births. Its etiologyis dominantand autosomal probabilly dueto new mutations from growth factor receptor fibroblasts. The pathogenesis is dueto disorganization of the growth cartilage with persistente of parenchymal like tissue. It´s a lethal congenital chondrodysplasia characterized by short limbs, thoracichypoplasia, skull cloverleaf, simiancrease, shortened femur, thoracic narrowing, prominent forehead, cephalic pole with increased dimension seven without ventriculomegaly, redundancy of the soft tissues. Also polyhydramniosis associated with in 70% of cases. The associated anomalies are hydrocephalus, kidney abnormalities, atrial septal defect, abnormal tricuspidvalve, imperforateanus which radioulnarsynostosis. The present a case with thanatophoric dysplasia which has been diagnosed with prenatal ultrasound.

Diagnóstico ecográfico prenatal de sirenomelia: a propósito de un caso / Prenatal ultrasound diagnosis of Sirenomelia: about a case

RESUMEN La sirenomelia constituye una anomalía congénita rara. Su incidencia es de 1:60.000 nacidos vivos. Es causada por un defecto vascular disruptivo y caracterizado por la fusión de las extremidades inferiores, asociados a anomalías cardiacas, renales, de pared abdominal y torácica, vértebras inferiores, tubo digestivo inferiores, genitales y de las arterias umbilicales. Se presenta la experiencia de un caso de sirenomelia que se ha podido diagnosticar con la ecografia prenatal.

ABSTRACT Sirenomelia is a very rare congenic anomaly. Being its incidence of approximately 1:60.000 live born, caused by a vascular disruptive defect, characterized by the fusion of lower limbs, associated to cardiac, renal, abdominal wall, and thoracic anomalies; also characterized by inferior vertebrae, inferior digestive tract, genital and umbilical artery anomalies A case of sirenomelia has been diagnosed thanks to prenatal echography.

The clinical significance of ultrasonography in the diagnosis of simple polyhydramnios / 重庆医学

Objective To investigate the clinical significance of ultrasonography in the diagnosis of simple polyhydramnios . Methods 186 singleton pregnancies cases of inpatient and outpatient diagnosed with simple polyhydramnios were divided into three groups with a two-dimensional semi-quantitative method ,separate amniotic fluid index (AFI)> 20cm (A group) ,separate maxi-mum amnionic fluid volume(AFV)>8 cm(B group) ,AFI≥20 cm and AFV≥8 cm(C group) ,and the changes were dynamically monitored .Results Occurrence rates of persistent polyhydramnios and fetal malformations in C group was higher than in the other two groups ,and the difference showed no statistical significance(P0 .05);Among the 84 .4% of simple polyhydramnios ,no fetal malfor-mation was found .Conclusion Ultrasound diagnosis of simple polyhydramnios shows clinical value in assessment of fetal malfor-mation ,fetal outcome ,perinatal morbidity and prognosis ,and is good for prenatal counseling and treatment .

Perda e luto: vivências de mulheres que interromperam a gestação por malformação fetal letal / Loss and grieving: the experiences of women who terminate a pregnancy due to lethal fetal malformations

O presente estudo teve por objetivo conhecer as vivências de luto de mulheres que interromperam a gestação sob autorização judicial, devido à malformação fetal incompatível com a vida. Participaram do estudo dez mulheres atendidas no Setor de Medicina Fetal do Hospital das Clínicas de Botucatu. Para coleta dos dados foi realizada entrevista semiestruturada quarenta dias após a interrupção. As entrevistas foram audiogravadas, transcritas na íntegra e tiveram os dados analisados na perspectiva da análise temática de conteúdo. Os resultados revelaram que as mães buscaram explicações e significados para a perda, sendo muito frequentes respostas religiosas e autoculpabilizantes. Os relatos marcaram sentimentos de tristeza, saudade e sensação de vazio pela perda do filho, revelando também a necessidade das mães de manterem-se ligadas a ele. As mães estavam e continuaram vinculadas aos seus filhos e a interrupção da gestação, embora tenha sido uma escolha para minimizar a dor de uma perda inevitável, não as poupou de vivências de grande sofrimento. O estudo traz subsídios para a discussão e planejamento de abordagens e cuidados com a saúde de mulheres que interrompem a gestação por malformação fetal letal, mediante autorização judicial.

The scope of this study was to investigate the grieving experiences of women who terminated pregnancies under judicial authorization, due to life-incompatible fetal malformation. Ten women attended in the Fetal Medicine Department of Botucatu Clinical Hospital participated in the study. Data collection was conducted by means of semi-structured interviews forty days after termination. The interviews were recorded and transcribed in full, with the data analyzed from the thematic content analysis perspective. The results revealed that the mothers sought explanations and meanings for the loss, with religious responses and self-blame being very frequent. The reports were marked by feelings of sadness, longing and sensations of emptiness due to the loss of the child, revealing the need of the mothers to dwell on the issue. The mothers were and continued to be linked to their children; the termination of the pregnancy, although being a choice to minimize the pain of an inevitable loss, did not spare the women from experiences of great suffering.>The study includes input for the discussion and planning of health approaches and care for women who terminate their pregnancy due to lethal fetal malformation, by means of judicial authorization.

Avaliação da toxicidade das favas de Stryphnodendron fissuratum (Mimosoideae) em vacas gestantes / Evaluation of the toxicity of Stryphnodendron fissuratum (Mimosoideae) pods in pregnant cows

Com o objetivo de avaliar a toxicidade de diferentes concentrações das favas de Stryphnodendron fissuratum em vacas prenhes, as favas desta árvore foram moídas, misturadas à ração comercial e fornecidas a oito vacas nas doses totais de 6,5g/kg, 7,5g/kg, 9g/kg e 10g/kg. Os animais que receberam doses de 6,5g/kg pariram bezerros normais e aqueles que receberam 7,5g/kg pariram bezerros fracos que não sobreviveram. Doses de 9g/kg resultaram no nascimento de um bezerro imaturo e de outro bezerro com distiquíase, opacidade congênita das córneas e microftalmia. Ambas as vacas que ingeriram 10g/kg morreram, porém uma vaca abortou antes de morrer. Nas vacas que morreram, as lesões macroscópicas e histológicas do sistema digestivo e fígado foram semelhantes às descritas anteriormente na intoxicação por S. fissuratum. Nos bezerros e no feto abortado não foram observadas lesões macroscópicas ou histológicas significantes. A análise fitoquímica dos extratos metanólicos das favas de S. fissuratum revelou a presença de taninos hidrossolúveis, proantocianidinas, leucoantocianidinas e da saponina triterpénica β-amirina. Saponinas triterpénicas têm sido associadas com a toxicidade das favas de Stryphnodendron spp. e Enterolobium spp., que causam sinais clínicos semelhantes aos observados na intoxicação por S. fissuratum. Esta pesquisa confirmou a toxicidade das favas de S. fissuratum para bovinos, no entanto não foram confirmados os efeitos abortivos das mesmas, pois o aborto e as mortes neonatais observadas podem ser decorrentes dos efeitos tóxicos da planta nas mães. Novas pesquisas são necessárias para pesquisar se as favas da planta causam malformações semelhantes às observas em um dos bezerros nascidos vivos.

To evaluate the toxicity of different concentrations of pods of Stryphnodendron fissuratum to pregnant cows, the pods of this tree were grounded, mixed in a commercial food and given to eight pregnant cows in total doses of 6.5g/kg, 7.5g/kg, 9g/kg and 10g/kg. The animals that received doses of 6.5g/kg delivered normal calves and those that received 7.5g/kg delivered weak calves that did not survive. Doses of 9g/kg resulted in the birth of an immature calf and another with congenital bilateral distichiasis, corneal opacity, and microphthalmia. Both cows that ingested 10g/kg died, and one of these aborted before death. In the dead cows, the gross and histological lesions of the digestive system and liver were similar to those previously described in S. fissuratum poisoning. No significant lesions were observed in the calves and in the aborted fetus. The phytochemical analysis of methanol extracts from pods of S. fissuratum revealed the presence of soluble tannins, proanthocyanidins, leucoanthocyanidins and the triterpenoid saponin β-amyrin. Triterpenoid saponins had been associated with the toxicity of Stryphnodendron spp. and Enterolobium spp., which cause clinical signs similar to those observed in the poisoning by S. fissuratum. The results presented herein confirmed the toxicity of S. fissuratum to bovines. However, the abortive effects of this plant was not confirmed; thus because the abortion and neonatal deaths could be due to the toxicity of the pods to the cows. New research should be done to demonstrate if S. fissuratum is a cause of malformations similar to those observed in one of the calves born from the treated cows.

Psychological analysis of odinopoeia patients with stillbirth or fetal malformation / 中国实用护理杂志

Objective The aim of the study was to analyze the psychological problems and psychological needs of the odinopoeia patients with stillbirth or fetal malformation.Methods From May to August 2012,25 patients with stillbirth or fetal malformation were collected and 40 normal patients were selected as control in the targeted hospital,their psychological conditions were compared.The socio-demographics of patients were survey,the Symptom Check List 90(SCL-90) was applied to assess the two groups' psychological conditions,and Impact of Event Scale Revised (IES-R) was applied to assess the post traumatic stress disorder (PTSD),moreover,the associated factors with PTSD was also analyzed.Results The symptom factor scores of the cases were significantly higher in odinopoeia patients than the controls.The age,education levels,having or no offsprings and the support of spouse were greatly associated with PTSD of patients with stillbirth or fetal malformation.The patients with stillbirth or fetal malformation demanded to understand some prenatal care knowledge and the reasons for stillbirth or fetal malformation.Conclusions The patients with stillbirth or fetal malformation had low levels of psychological health,so the medical workers and family members must pay much attention to the psychological conditions of patients with stillbirth or fetal malformation,and provide them the psychological counseling in order to eliminate the patients' suffering from stillbirth or fetal malformation and improve their mental health.

Ultrassonografia obstétrica entre a 11ª e a 14ª semanas: além do rastreamento de anomalias cromossômicas / Obstetric ultrasound between the 11th and 14th weeks: beyond the screening for chromosomal abnormalities

Esta é uma revisão tradicional (narrativa) que teve como objetivo salientar a contribuição da ultrassonografia (USG) obstétrica entre a 11ª e a 14ª semana de gravidez, comumente denominada ultrassonografia morfológica de primeiro trimestre. Além do rastreamento de anomalias cromossômicas, a USG pode ser empregada neste período para: confirmação ou determinação da idade gestacional; avaliação da anatomia fetal; diagnóstico de malformações; rastreamento de anormalidades estruturais maiores e de síndromes gênicas; definição do prognóstico da gravidez; diagnóstico e caracterização das gestações múltiplas; e rastreamento da pré-eclampsia e da restrição de crescimento intrauterino. Foram incluídos os principais estudos sobre o tema publicados entre 1990 e 2010, pesquisados nas bibliotecas eletrônicas Cochrane e PubMed, e que podem ser incorporados nos níveis de evidência científica I a III.

This is a traditional (narrative) review with the objective of highlighting the contribution of obstetric ultrasonography (US) between the 11th and 14th week of pregnancy, commonly called first trimester anomaly scan. In addition to being used for the screening of chromosomal anomalies, US can be employed during this period to confirm or determine gestational age, evaluate fetal anatomy, diagnose malformations, screen major structural abnormalities and genetic syndromes, define the prognosis of pregnancy, diagnose and characterize multiple pregnancies, and screen preeclampsia and intrauterine growth restriction. The most important studies about this subject published between 1990 and 2010 in the Cochrane and PubMed libraries were included. The selected studies can be classified with scientific levels I to III.

Translucencia nucal aumentada y cariotipo normal / Increased nuchal translucency and normal kariotype

Antecedentes: La exploración ecográfica entre las semanas 11 y 14 tiene un papel fundamental en el cribado de anomalías cromosómicas, siendo la medida de la translucencia nucal un método bien establecido y ampliamente aceptado para este fin. Objetivo: Evaluar retrospectivamente la evolución de los fetos con translucencia nucal aumentada y cariotipo normal. Método: Se recogieron los datos de 104 fetos con TN >percentil 95 (p95) entre las semanas 11 y 14, evaluados en nuestro centro. En los 61 que resultaron eu-ploides, se estudió la incidencia de anomalías estructurales diagnosticadas tanto prenatalmente como tras el nacimiento, así como las pérdidas fetales anteparto. De estos fetos, nacieron sanos el 80 por ciento cuando la TN estaba entre p95 y 3,4 mm, el 50 por ciento con TN entre 3,5 y 4,4 mm, el 30 por ciento con TN entre 4,5 y 5,4 mm, y el 18 por ciento con TN > 5,5 mm. Entre los 4 recién nacidos euploides con patología, hubo 3 con cardiopatía. Conclusión: La presencia de TN aumentada entre las 11 -14 semanas en fetos euploides se asocia a un incremento del riesgo de anomalías estructurales mayores, principalmente cardiacas. La prevalencia de malformaciones aumenta significativamente con TN >3,5 mm, y el pronóstico gestacional adverso empeora conforme aumenta la medida de la TN.

Background: Ultrasound scan has a main role at the 11-14 weeks screening for chromosomal abnormalities. The measurement of nuchal translucency (NT) thickness is a widespread stablished method to achieve this target. Objective: To assess retrospectively the outcome of fetuses with increased nuchal translucency and normal karyotype. Method: Data were collected from 104 fetuses with NT > 95th percentile at 11 to 14 weeks of gestation, followed in our institution. The sixty one euploid fetuses were studied in order to determine the incidence of structural abnormalities, diagnosed either before or after delivery, as well as antenatal fetal loss. Among these fetuses, there were no malformations at birth in 80 percent for NT between the 95th percentile and 3.4 mm; 50 percent for NT between 3.5 and 4.4 mm; 30 percent for NT of 4.5-5.4 mm; and 18 percent for NT > 5.5 mm. There were 4 euploid newborns with some kind of structural defect at birth, 3 of them presented a cardiac malformation. Conclusion: The presence of increased NT at 11-14 weeks scan in euploid fetuses it's associated with a higher risk of major structural abnormalities, mainly cardiac ones. The prevalence of malformations is significantly increased for NT > 3.5 mm, and the adverse perinatal outcome is directly associated with the thickness of NT.

Anesthetic management of the ex utero intrapartum treatment (EXIT) procedure: A case report / 대한마취과학회지

The ex utero intrapartum treatment (EXIT) procedure is a very rare technique performed in cases of fetal congenital malformations. The EXIT procedure increases the rate of survival at delivery by maintaining the uteroplacental circulation until the airway of the fetus is secured. To maintain the uteroplacental circulation, a higher dose of inhalational anesthetics and/or intravenous nitroglycerin can be used as compared to conventional Cesarean section. The aim of this report is to share our anesthetic experience during the EXIT procedure with members of the Korean society of anesthesiology for the first time, and to highlight the maternal implications of the use of inhalational anesthetics and nitroglycerin during Cesarean section for the EXIT procedure.

Recent Trends in Prenatal Diagnosis of Fetal Malformations

The frequency of fetal malformations accounts for around 3~5% and evaluation of the health of the fetus and screening for fetal malformations has become an important part of prenatal care. Fetal malformations can be classified into structural and chromosomal abnormalities. Improvements in prenatal diagnosis have allowed identification of malformations in fetuses during the first and second trimesters of pregnancy. In prenatal diagnosis, both screening and diagnostic procedures are included. Screening tests include maternal serum aneuploidy screening tests, which are double marker test, triple test, and quadruple test. Recently, first trimester combined ultrasound-biochemical screening and integrated screening were introduced and provided higher detection rates of chromosomal anomalies (ex. Down syndrome). Diagnostic tests are usually performed when screening results are positive and they include chorionic villus sampling, amniocentesis, and percutaneous fetal blood sampling. With highresolution ultrasound equipment, it is now possible to diagnose most structural abnormalities prenatally. On top of that, recent advances in 3D/4D ultrasound have allowed better understanding of fetal anatomy. However, when ultrasound is equivocal, fetal MRI also can be a useful adjuvant in evaluating fetal structural anomalies. Advances in prenatal diagnostic testing have resulted in tremendous benefits to patients and challenges to healthcare providers and new approaches to education and counseling are needed to assure that all patients receive a complete and balanced review of their prenatal diagnostic testing options. This article provides an overview of various screening and diagnostic methods for prenatal diagnosis of fetal malformations.

Monocephalus dipygus EN CACHARROS: REPORTE DE DOS CASOS / Monocephalus dipygus IN PUPPIES: REPORT OF TWO CASES

Se describen dos casos de duplicación posterior congénita en cachorros. Esta malformación también conocida como Monocephalus dipygus, hace referencia a individuos dobles, caracterizados por tener cabeza y tórax fusionados en uno solo, duplicidad simétrica de pelvis y miembros posteriores. El primer caso, presentó cuatro miembros anteriores, cuatro miembros posteriores y palatosquisis. El segundo caso, presentó dos miembros anteriores y cuatro miembros posteriores. En general, ambos casos pueden ser relacionados como gemelos fusionados simétricos.

It is described two cases of congenital posterior duplication in puppies. This malformation also known as Monocephalus dipygus refers to individuals doubles, characterized by having the head and thorax fused into a single and symmetrical duplication of pelvis and hind limbs. The first case, showed four former members, four posterior members and palatosquisis. The second case, showed only two former members and four posterior members. In general, both cases can be related as twins symmetric fused.

Hernia diafragmática congénita: revisión de casos en el Hospital Guillermo Grant Benavente 2001-2007 / Congenital diaphragmatic hernia

The congenital diaphragmatic hernia is one of the most common severe malformations, with a high mortality that has been maintained for the time. There have been numerous markers that predict postnatal survival, of which the LHR and the presence of intrathoracic liver are the most reliable. Materials and methods: A review of the tabs of patients carrying fetuses with diagnosed CHD in the HGGB’s Department of Echography, as well as records of entry, exit and neonatal mortality in the same hospital. Results: We found 20 cases of CHD with an incidence of 1:1.647 births. Two patients were discarded by incomplete data. The 77,7 percent were diagnosed leftists. A 50 percent presenting deformities partners, among which one was diagnosed as Sd. Pallister Killian. The presence of intrathoracic liver was found in 38,8 percent. The mortality was 66,6 percent. Patients with LHR <1 were 100 percent mortality. Patients with liver Intrathoracic had 71,4 percent of mortality. Conclusion: The HDC is a malformation of high perinatal mortality. The indicators used as predictors of survival were very effectively. Our results are comparable to current publications.

La hernia diafragmática congénita constituye una de las malformaciones severas más comunes, con una alta mortalidad que se ha mantenido durante el tiempo. Se han formulado numerosos marcadores predictores de sobrevida postnatal, de los cuales el LHR y la presencia de hígado intratorácico son los más confiables. Material y método: Se realizó una revisión de las fichas de pacientes portadoras de fetos con hernia diafragmática congénita diagnosticadas en el Departamento de Ecografía del HGGB, además de registros de ingreso, egreso y mortalidad de neonatología del mismo hospital. Resultado: Se encontraron 20 casos de hernia diafragmática congénita con una incidencia de 1:1.647 partos. Se descartaron 2 pacientes por data incompleta. El 77,7 por ciento fueron diagnosticadas izquierdas. Un 50 por ciento presentó malformaciones asociadas, entre las cuales una fue diagnosticada como síndrome Pallister Killian. La presencia de hígado intratorácico se encontró en el 38,8 por ciento. La mortalidad fue de 66,6 por ciento. Las pacientes con LHR<1 tuvieron 100 por ciento mortalidad. Las pacientes con hígado intratorácico tuvieron 71,4 por ciento de mortalidad. Conclusión: La hernia diafragmática congénita constituye una malformación de alta mortalidad perinatal. Los indicadores utilizados como predictores de sobrevida tuvieron una alta efectividad. Nuestros resultados son comparables a las publicaciones actuales.

Síndrome de Meckel-Gruber: relato de caso / Meckel-Gruber syndrome: a case report

Os autores relatam um caso de diagnóstico pré-natal de síndrome de Meckel-Gruber em gestante de 12 anos de idade. A primeira ultra-sonografia, realizada na 32ª semana, identificou feto único portador de microcefalia, volumosa encefalocele na linha média da região occipital, lábio leporino completo bilateral e fenda palatina. Os rins encontravam-se de dimensões e ecotextura aumentadas, medindo cerca de 12 cm de comprimento, levando a importante aumento do volume abdominal. A genitália fetal não foi identificada, sendo visualizada pequena imagem cística na sua topografia.Em função da presença de oligodramnia, foi realizada ressonância magnética na 33ª semana, que confirmou os achados ultra-sonográficos e demonstrou uma lisencefalia. Na 34ª semana, a gestação evoluiu com amniorrexe prematura, sendo realizada cesariana, com retirada de natimorto, posteriormente encaminhado à necropsia. Polidactilia foi a única alteração presente não-identificada pelos métodos de imagem.

The authors report a case of antenatal ultrasound diagnosis of Meckel-Gruber syndrome in a 12-year-old pregnant girl. The first scan done at 32 weeks of gestation revealed a single fetus withmicrocephaly, large encephalocele in the occipital mid-line region, bilateral complete cleft lip, and cleft palate. The kidneys and their ecotexture were found to be enlarged, measuring about 12 cm in length, causing an important enlargement of the abdomen. The fetus' genitals were not identified, but a small cystic image was visualized in their topography. Due to the presence of oligohydramnios, a magnetic resonance was performed at 33 weeks of gestation,which confirmed the sonographic findings and demonstrated a lisencephaly. A premature rupture of membranes occurred at 34 weeks of gestation, upon which a caeserian section was performed, the stillborn baby removed and subsequently taken for a necropsy. Polydactyly was the only anomaly present which was not identified by the imaging methods used.