Control preconcepcional y diabetes gestacional. Revisión sistemática y estado del arte / Preconceptional control and gestational diabetes. Systematic review and state of the art

Introducción: La diabetes mellitus gestacional se manifiesta con una intolerancia a los carbohidratos, ocasionada por una alteración en la secreción de insulina, con descontrol de los niveles de glucosa en sangre, caracterizada por ser una condición temporal y que se desarrolla por primera vez durante el embarazo; suele desaparecer después del parto, pero puede desarrollarse diabetes mellitus en un futuro. Metodología: Se realizó un estudio investigativo tipo documental, sistematizada, descriptiva, prospectiva en un periodo de revisión de cinco años, del 2013 a 2018. Discusión: Entre los trastornos más comunes en el feto esta la macrostomia, posterior al nacimiento se puede desarrollar hipoglu-cemia. Por parte de la madre también se han documentado complicaciones que pueden percutir al momento del parto como la preeclampsia y el síndrome metabólico. Conclusiones: La diabetes gestacional puede cursar asintomática, por lo que se recomienda realizar pruebas de medición de glucosa en sangre durante las semanas 24 y 28 de gestación. Hay factores que pueden incrementar los riesgos de desarrollar diabetes gestacional, como: la edad avanzada de la madre, sobrepeso u obesidad, antecedentes familiares de diabetes mellitus, entre otros. Por lo tanto, someterse a la prueba de tamizaje sigue siendo el método más seguro de detección.

Introduction: Gestational diabetes mellitus manifests itself with a carbohydrate intolerance, caused by an alteration in insulin secretion, with uncontrolled blood glucose levels, characterized by being a temporary condition, which develops for the first time during pregnancy; It usually disappears after childbirth, although diabetes mellitus may develop later. Methodology: A documentary, systematic, descriptive, prospective research study was conducted in a five-year review period, from 2013 to 2018. Discussion: Among the most common disorders in the fetus is macrostomia, hypoglycemia may develop after birth. On the part of the mother complications have also been documented that can affect the moment of delivery such as preeclampsia and metabolic syndrome. Conclusions:Gestational diabetes can be asymptomatic, so it is recommended to perform blood glucose measu-rement tests during weeks 24 and 28 of gestation. There are factors that can increase the risks of developing gestational diabetes, such as: the mother's advanced age, overweight or obesity, family history of diabetes mellitus, among others. Therefore, undergoing the screening test remains the safest method of detection

Histological development of ligamentum teres and its vascularisation in the human fetuses

Background: Ligamentum teres is the ligament of the hip joint. It is flat and triangular in shape. The ligamentum teres starts developing in the fetal life during 10-11 weeks. The present work was undertaken chiefly to gain insight into the pattern of sequential development of ligamentum teres and to compare the findings of other authors with the observations made in the present study and to correlate these findings clinically to find out the function of ligamentum teres.Methods: The present study was undertaken on 40 fetuses of varying gestational periods collected from the operation theatre, labour room and obstetrics wards of department of Gynaecology and Obstetrics, Government Medical College, Jammu and other areas of Jammu, 10% Formalin was used as preservative. The hip joints of both the sides were dissected carefully. 5% solution of Gooding and Stewart’s was used for decalcification. Paraffin wax embedding method was used for preparing the tissue for section cutting. Staining was done by Harri’s Hematoxylin and Eosin stain and Masson’s Trichrome stain. The slides were then examined under microscope for important findings.Results: The ligamentum teres is seen by 10½ weeks. Blood vessels appear in 12½ weeks. Ramification of blood vessels in this ligament is seen by 21½ weeks. Through this ligament, the blood vessels are seen limited up to the fovea capitis femoris by about 16½ weeks and by 18½ weeks they penetrate deep into the head of femur. Ligamentum teres is lined by thin synovial membrane at 19th week.Conclusions: The ligamentum teres develops by 10½ weeks. It arises in-situ as it develops in the same position as it occupies in the adult but as age advances, it shows much differentiation and resembles the adult features.

Comparison of Postmortem Analysis of Anomalous Fetuses with the Prenatal Ultrasonography Findings

Background: Congenital anomalies cause around 10–15% of perinatal deaths in India. At present, these fetal deaths are onlyevaluated with ultrasonography (USG) findings. With this study, we aimed to do the postmortem analysis of these anomalousfetuses and compare the findings with antenatal ultrasound findings.Materials and Methods: A descriptive study carried out with 43 anomalous fetuses over 1½ years period in a tertiary careinstitute by comparing the postmortem analysis of anomalous fetuses with the prenatal USG findings.Results: Among the 43 cases, 41 had antenatal USG taken. In 11 cases, autopsy confirmed the USG findings and autopsyshowed extra findings in 16 cases. Antenatal USG was normal in 12 cases, but autopsy only identified anomalies. In two cases,autopsy detected no anomalies. Among 41 cases, 12 cases with normal antenatal USG had significant findings and 11 caseswith abnormal USG had new findings after physical examination and X-ray evaluation.Conclusion: Fetal autopsy helps in identifying many external and internal malformations which were undetected by antenatalUSG. Fetal autopsy can be useful in 95% of cases – it can either confirm or add findings. Limited fetal autopsy can benefit in56% of cases. The study shows that in majority of cases, the limited fetal autopsy itself will detect many anomalies undetectedby the USG.

Current trends in bovine abortion in Argentina / Tendências atuais do aborto bovino na Argentina

Bovine abortion is an important cause of significant economic losses in beef and dairy herds. This syndrome is usually difficult to diagnose. The aim of this study was to characterize bovine abortion causes in Argentina by standard diagnosis procedures (histology, bacterial and viral isolation) and other diagnostic tests like direct fluorescent antibody test (DFAT), fetal serology, immunohistochemistry (IHC), and PCR, showing their specific advantages and limitations. Necropsies were performed in 150 aborted bovine fetuses submitted to the diagnostic laboratories of Instituto Nacional de Tecnología Agropecuaria (INTA) Balcarce, Argentina. Etiological diagnosis was confirmed in 78 fetuses (52% of the cases). Most causes of abortion were of infectious origin, being Neospora caninum (14.67%), Campylobacter fetus sp. (9.33%), Leptospira spp. (7.33%) and Brucella abortus (6.65%) the main microorganisms identified. Bovine viral diarrhea virus (BVDV) and bovine herpes virus (BHV) were diagnosed in 2 (1.33%) and 3 (2%) cases, respectively. This study showed a better characterization of bovine abortion compared with previous researches done on this topic.(AU)

O aborto bovino é uma causa importante de perdas econômicas significativas em rebanhos bovinos e leiteiros. Esta síndrome é geralmente difícil de diagnosticar. O objetivo deste estudo foi caracterizar o aborto bovino na Argentina por procedimentos diagnósticos de rotina (histologia, isolamento viral e bacteriana) e outros testes diagnósticos como ensaio directo de anticorpos fluorescentes (DFAT), sorologia fetal, imuno-histoquica (IHC), e PCR; mostrando suas vantagens e limitações específicas. As necropsias foram realizadas em 150 fetos bovinos abortados submetidos aos laboratórios de diagnóstico do Instituto Nacional de Tecnologia Agropecuária (INTA) de Balcarce, na Argentina. O diagnóstico etiológico foi confirmado em 78 fetos (52% dos casos). A maioria das causas de aborto foram de origem infecciosa, sendo Neospora caninum (14,67%), Campylobacter fetus sp. (9,33%), Leptospira spp. (7,33%) e Brucella abortus (6,65%) os principais microrganismos identificados. O vírus da diarréia viral bovina (BVDV) e o herpesvírus bovino (BHV) foram diagnosticados em 2 (1,33%) e 3 (2%) casos, respectivamente. Este estudo mostrou uma melhor caracterização do aborto bovino em comparação com pesquisas anteriores feita sobre este tema.(AU)

A temporary disc-like structure at the median atlanto-axial joint in human fetuses / 대한해부학회지

Topographical anatomy of the greater omentum and transverse mesocolon: a study using human fetuses / 대한해부학회지

The protective influence of vitamin c against different skeletal malformations in prenatal embryos and postnatal newborns of female rats treated with indomethacin during pregnancy / 国际药学研究杂志

This study was carried out in the animal house laboratories of the Department of biology in the Faculty of Education for Girls/University of Kufa from 1/6/2018 until 1/8/2018, for the purpose of demonstrating the possible preventive effects of vitamin C against skeletal malformations in embryos in pregnancy for 20 days (prenatal) and postnatal newborns respectively for pregnant female rats that treated with indomethacin with a concentration of 8.40 mg/kg. In the current study, 40 female rats (aged 12 weeks) with a mean weight of (135.5 g) were employed and 40 fertile males with age (12 weeks). The females were placed with males for matting, and after obtaining the required number of pregnant female rats, which were divided into (4) main groups, each group contained 10 pregnant female rats. The first group was treated with normal saline that was represented the control group, while the second group was administrated indomethacin drug with a concentration of 8.40 mg/kg only, whereas the third group was subjected to vitamin C with concentration of 85 mg/kg only, and the fourth group was submitted to vitamin C with concentration of 85 mg/kg + indomethacin drug with a concentration of 8.40 mg/kg. Moreover, all the females in the four groups were orally administrated with a special administration tube(gavage) from the first day of pregnancy until delivery and by a dose every day, (5) female rats were explained during pregnancy for 20 days(prenatal), while the remaining (5) female rats were left in each major group to postpartum, the weights of prenatal fetuses and neonatal were measured, as well as skeletal structures(bone skeletons) of prenatal fetuses and postnatal were cleared for studying the structural skeletal changes and abnormalities. The results of this study showed that there was a significant decrease (P 0.05) between these two groups. Also, the findings of present study pointed to a significant decrease (p 0.05)were revealed when the groups that treated with vitamin C with a concentration of 85 mg/kg and the groups of vitamin C with a concentration of 85 mg/kg + indomethacin drug with a concentration of 8.40 mg/kg were compared with each other. Furthermore, the data did not show any skeletal malformations of the fetuses during pregnancy for (20) days (prenatal)and postpartum births in the control groups and groups that orally given vitamin C with a concentration of 85 mg/kg, as well as the groups of vitamin C with a concentration of 85 mg/kg + indomethacin drug with a concentration of 8.40 mg/kg respectively in comparison to the other experimental groups submitted to indomethacin drug with a concentration of 8.40.1 mg/kg which showed various skeletal abnormalities were observed in the fetuses during pregnancy for (20) days (prenatal)and postpartum births in these groups when compared with the control groups and the other study groups.

Ganglion cardiacum or juxtaductal body of human fetuses / 대한해부학회지

The ganglion cardiacum or juxtaductal body is situated along the left recurrent laryngeal nerve in the aortic window and is an extremely large component of the cardiac nerve plexus. This study was performed to describe the morphologies of the ganglion cardiacum or juxtaductal body in human fetuses and to compare characteristics with intracardiac ganglion. Ganglia were immunostained in specimens from five fetuses of gestational age 12–16 weeks and seven fetuses of gestational age 28–34 weeks. Many ganglion cells in the ganglia were positive for tyrosine hydroxylase (TH; sympathetic nerve marker) and chromogranin A, while a few neurons were positive for neuronal nitric oxide synthase (NOS; parasympathetic nerve marker) or calretinin. Another ganglion at the base of the ascending aorta carried almost the same neuronal populations, whereas a ganglion along the left common cardinal vein contained neurons positive for chromogranin A and NOS but no or few TH-positive neurons, suggesting a site-dependent difference in composite neurons. Mixtures of sympathetic and parasympathetic neurons within a single ganglion are consistent with the morphology of the cranial base and pelvic ganglia. Most of the intracardiac neurons are likely to have a non-adrenergic non-cholinergic phenotype, whereas fewer neurons have a dual cholinergic/noradrenergic phenotype. However, there was no evidence showing that chromogranin A- and/or calretinin-positive cardiac neurons corresponded to these specific phenotypes. The present study suggested that the ganglion cardiacum was composed of a mixture of sympathetic and parasympathetic neurons, which were characterized the site-dependent differences in and near the heart.

Alizarin Red-S Protocol for Skeletal Staining during Fetal Period in Rabbit

Background: The main purpose of this study was to give detailed information on the staining protocol of Alizarin Red-S to detect the normal and abnormal skeleton of rabbit fetus. Methods: Eleven (9 females and 2 males) of adult rabbit weighing 3-3.5 kg were used. The female rabbits were left with buck to become pregnant then were classified into a treatment and a control group. The former group received oral doses of 400mg/kg of sodium valproate for 15 days starting from the 6th day after mating until 20th day of pregnancy, while the second received water in the same period. The pregnant rabbit was slaughtered at the 29th day of pregnancy. The live rabbit fetuses were collected. The staining protocol included fixation, dehydration, clearing, staining and preservation. The fetuses were examined under dissecting microscope and photos were taken for documentation. Results: The staining protocol made the rabbit fetuses to be clear enough to see their skeleton through the surrounding tissue. The axial skeleton including skull with mandible, vertebral column, ribs and sternum and the appendicular skeleton including the bones of the fore-and hindlimbs took the stain and became red in color. The macroscopic skeletal disorders of the fetuses of the treatment group were observed. The ossification centres were assessed. Conclusion: This protocol which depended on fixation by 95% ethanol, clearing by 1% potassium hydroxide and staining by 0.001 % Alizarin Red-S was effective in detecting normal and abnormal fetal skeletal morphology

Gemelos unidos (siameses): descripción de hallazgos anatomopatológicos / Conjoined twins (siamese): description of anatomopathological findings

Resumen OBJETIVO: Describir los hallazgos anatomopatológicos y placentarios en una serie de autopsias de 5 siameses. CASOS CLÍNICOS: Serie de casos de autopsias efectuadas entre 2013 y 2018 de pacientes entre 14 y 30 semanas de embarazo, con diagnóstico de gemelos unidos. RESULTADOS: Se encontraron 5 casos de gemelos unidos, hijos de madres multíparas, 3 tuvieron muerte intrauterina y 2 fallecimiento a los pocos minutos de vida. Tres casos correspondieron a uniones ventrales (2 toracoonfalópagos y 1 cefalópago) y dos a uniones laterales de tipo parápagos, dicéfalos. Hubo corazón único en los gemelos toracoonfalópagos y sistemas cardiacos separados en los tres restantes, donde hubo fusión aórtica distal. En 4 casos el hígado se encontró fusionado, con dos vías biliares independientes. Los cordones umbilicales de los casos de unión ventral tenían 5 vasos sanguíneos. Los de unión lateral tenían cordón umbilical trivascular. Los discos placentarios mostraron grados variables de hipoxia preplacentaria y cambios de malperfusión vascular materna. CONCLUSIONES: Las fusiones ventrales tienen grados variables de estructuras compartidas; entre mayor sea la fusión de los órganos internos, menor es el número de vasos umbilicales. De las teorías etiológicas propuestas, la esférica es la que mejor soporta los grados variables de fusión.

Abstract OBJECTIVE: Description of the anatomopathological and placental findings in a series of autopsies of 5 conjoined twins. MATERIALS AND METHODS: Series of cases of autopsies performed between 2013-2018 of patients between 14-30 weeks of gestation, with diagnosis of conjoined twins. RESULTS: Five cases of conjoined twins, product of multiparous mothers, 3 of these presented intrauterine death and 2 deaths within a few minutes of life. Three cases corresponded to ventral junctions (2 thoracoomphalopagus and 1 cephalopagus) and two to lateral junctions of parapagus type. A single heart was observed in the thoracoomphalopagus twins and separated cardiac systems in the remaining three where there was distal aortic fusion. In 4 cases the liver was found fused with two independent bile ducts. The umbilical cords of the cases of ventral union presented 5 blood vessels; those with lateral junction presented a trivascular umbilical cord. The placentas showed varying degrees of preuterine hypoxic pattern and changes of Maternal Vascular malperfusion of the Placental Bed. CONCLUSIONS: Ventral fusions have varying degrees of shared structures; the greater the fusion of the internal organs, the smaller the number of umbilical vessels will be. Of the proposed etiological theories, it is the so-called spherical theory, which best supports the variable degrees of fusion and how it can be saltatory on the vertical axis.

Occurrence of abortions induced by Neospora caninum in dairy cattle from Santa Catarina, southern Brazil / Ocorrência de abortamentos induzidos por Neospora caninum em vacas de leite de Santa Catarina, sul do Brasil

Abstract The aim of the present study was to investigate the occurrence of N. caninum associated with abortions of dairy cattle from Santa Catarina state, southern Brazil by using enzyme-linked immunosorbent assay (ELISA), immunohistochemistry (IHC), and polymerase chain reaction (PCR). Blood from dairy cows that aborted along with intrathoracic fluid and tissue samples (brain, heart, liver, and lung) from their fetuses were collected and used for serology; PCR, histopathological, and immunohistochemistry (IHC) evaluations were also conducted. Twenty-one cows (51.2%) out of 41, and eight fetuses (26.7%) out of 30 were ELISA (HerdCheck, IDEXX) positive for N. caninum. Dams > 36 months of age had a higher risk of being serum positive than younger animals. PCR and IHC revealed that 38.8% (14/36) and 25.0% (9/36) of the fetuses were positive for N. caninum, respectively for each of the tests. Seropositive cows had a higher frequency of fetuses that were also positive by either intrathoracic fluid, PCR, or IHC. In summary, the present study observed a high frequency of N. caninum in abortions from dairy cows from southern Brazil, with a higher N. caninum prevalence found in cows that were older than 36 months. In addition, serology, PCR, and IHC should be used all together for better diagnosis of neosporosis in cattle.

Resumo O objetivo deste estudo foi avaliar a ocorrência de N. caninum associado a abortamentos em vacas de leite do estado de Santa Catarina, sul do Brasil pelo uso das técnicas de ELISA (HerdCheck, IDEXX), reação em cadeia pela polimerase (PCR) e imunohistoquímica (IHC). O sangue das vacas leiteiras que abortaram, bem como, o líquido intratorácico e amostras de tecidos (cérebro, coração, fígado e pulmão) de seus fetos foram coletados e usados para sorologia, PCR (Np21+ e Np6+), e IHC. Vinte e uma vacas (51,2%) de um total de 41, bem como, oito fetos (26,7%) de um total de 30 foram positivos no ELISA (IDEXX) para N. caninum. As vacas > 36 meses de idade tiveram um maior risco de serem soropositivas do que os animais mais jovens. PCR e IHC revelaram que 38,8% e 25,0% dos fetos foram positivos para N. caninum, respectivamente para cada um dos testes. As vacas soropositivas tiveram uma maior frequência de fetos que também foram positivos no fluído intratorácico, na PCR ou na IHC. Em resumo, o presente estudo observou uma alta frequência de N. caninum em abortos de vacas leiteiras na região estudada, com maior prevalência de N. caninum em vacas com mais de 36 meses de idade. Além disso, sorologia, PCR e IHC deveriam ser utilizadas ​​conjuntamente para melhor diagnóstico de neosporose em bovinos.

Effects of the hydro-ethanolic extract of Marrubium vulgare in female rats

Objective To evaluate the effects of ethanol–water (80:20) extract of Marrubium vulgare (M. vulgare) on the hematological parameters, macroscopic and histological aspects of the uterus and fetus in non-pregnant and pregnant rats. Methods Female rats were divided into 4 equal groups (n = 9), group N (normal rats) and group G (pregnant rats) considered as control groups, group NE (normal rats treated with the ethanol–water (80:20, v/v) extract of M. vulgare) and group GE (pregnant rats treated with the extract). The ethanol–water (80:20) plant extract was administered in a single daily dose 1 g/kg at the morning, during 19 d. On the 19 day of the experiment, animals were sacrificed, the uterus and fetuses were removed for the morphological and histological studies and the blood was collected in EDTA tubes for the measurement of hematological parameters with the use of an automate ‘HORIBA ABX Micros 60 Hematology Analyzer’. Results Our results showed, in group NE and GE, a significant decrease on hematological parameters: red blood cells (NE: 18.6%; GE: 38.4%), hematocrit (NE: 13.8%; GE: 20.4%), hemoglobin (NE: 12.1%; GE: 8.3%) and mean corpuscular volume (NE: 6.4%; GE: 2%) with P more less a 0.05. Indeed, the extract of M. vulgare caused a significant decrease on the mean implantations of fetuses (82.5%, P < 0.001) and their size (47.2%, P < 0.01). As for the macroscopic and histological appearance of uterus, our data showed no change in normal treated rats. In contrast, the treated pregnant rats showed a severe histological change characterized by the existence of location of stopped gestation. Furthermore, it was also found in the uterus of these rat lyses placental and embryo tissue. Conclusions All these results support the hypothesis of an abortifacient effect of M. vulgare.

Effects of the hydro-ethanolic extract of Marrubium vulgare in female rats

OBJECTIVE@#To evaluate the effects of ethanol-water (80:20) extract of Marrubium vulgare (M. vulgare) on the hematological parameters, macroscopic and histological aspects of the uterus and fetus in non-pregnant and pregnant rats.@*METHODS@#Female rats were divided into 4 equal groups (n = 9), group N (normal rats) and group G (pregnant rats) considered as control groups, group NE (normal rats treated with the ethanol-water (80:20, v/v) extract of M. vulgare) and group GE (pregnant rats treated with the extract). The ethanol-water (80:20) plant extract was administered in a single daily dose 1 g/kg at the morning, during 19 d. On the 19 day of the experiment, animals were sacrificed, the uterus and fetuses were removed for the morphological and histological studies and the blood was collected in EDTA tubes for the measurement of hematological parameters with the use of an automate 'HORIBA ABX Micros 60 Hematology Analyzer'.@*RESULTS@#Our results showed, in group NE and GE, a significant decrease on hematological parameters: red blood cells (NE: 18.6%; GE: 38.4%), hematocrit (NE: 13.8%; GE: 20.4%), hemoglobin (NE: 12.1%; GE: 8.3%) and mean corpuscular volume (NE: 6.4%; GE: 2%) with P more less a 0.05. Indeed, the extract of M. vulgare caused a significant decrease on the mean implantations of fetuses (82.5%, P < 0.001) and their size (47.2%, P < 0.01). As for the macroscopic and histological appearance of uterus, our data showed no change in normal treated rats. In contrast, the treated pregnant rats showed a severe histological change characterized by the existence of location of stopped gestation. Furthermore, it was also found in the uterus of these rat lyses placental and embryo tissue.@*CONCLUSIONS@#All these results support the hypothesis of an abortifacient effect of M. vulgare.

Diffusion weighted imaging research in fetus with mild ventriculomegaly / 中国医学影像技术

Objective To explore the diagnostic value of ADC values in fetus with mild ventriculomegaly.Methods Fifteen fetuses with mild ventriculomegaly (mild ventriculomegaly group) and fifteen healthy controls (control group) were scanned with DWI.The ADC values in bilateral frontal lobes,parietal lobes,temporal lobes,occipital lobes,basal ganglia,thalamus and cerebella were measured.The ADC values of mild ventriculomegaly group were compared with those of control group.And the ADC values in left regions were compared with those in right regions of fetuses with mild ventriculomegaly.The correlation between ADC values of all fetuses and gestational age,as well as the correlation between the diameters of ventriculomegaly in feutes with mild ventriculomegaly and gestational age were analyzed.Results Compared with control group,ADC values were lower in bilateral frontal lobes and parictal lobes in mild ventriculomegaly group (all P＜ 0.05).There were no significant differences of ADC values between left regions and right regions (all P＞0.05).Correlation analysis showed that ADC values of all fetuses in bilateral occipital lobes,basal ganglia,thalamus,cerebella and left temporal lobe were negatively correlated with gestational age.The diameters of ventriculomegaly were positively correlated with gestational age (r=0.635,P=0.011).Conclusion The ADC values decrease in frontal lobes and parietal lobes in fetuses with mild ventriculomegaly.The ADC value may be more sensitive for detecting potential damage of brain,which is helpful for the diagnosis of fetus ventriculomegaly.

Ultrasound assessment of abnormal fetal ductus arteriosus / 中国医学影像技术

Objective To analyze the abnormal fetal ductus arteriosus (DA) by echocardiography.Methods Seventy fetuses of abnormal DA diagnosed prenatally were retrospectively reviewed.Transverse scans combined with color Doppler were used to acquire four chamber view,left and right ventricular outflow tract views,three vessel view,and three-vesseltrachea view.In addition,sagittal scans with color Doppler were used to get vena cava long axis view,aortic arch view,and ductal arch view.The spatial relationship of the great arteries and trend of DA were observed.Results Abnormal fetal DA is mainly composed of DA absence,DA abnormal function and DA morphological abnormality.Among 70 cases of fetal DA,9 cases were diagnosed with DA absence,8 cases were DA atresia,11 cases were DA completed closure nearly,9 cases were shown with reverse DA blood perfusion,33 cases were shown with DA curvature and dilatation.Conclusion Prenatal diagnosis of DA absence and DA abnormal function is of great significance.Three-vessel-trachea view and ductal arch view combined with CDFI can make a definitive diagnosis.

Is there a trans-abdominal testicular descent during the second gestational trimester? Study in human fetuses between 13 and 23 weeks post conception

ABSTRACT Objectives To confirm if a real inner descend of testis occurs, correlating the testicular position with fetal parameters and analyzing the position of the testes relative to the internal ring. Material and Methods Twenty nine human fetuses between 13 and 23 weeks post conception (WPC) were studied. The fetuses were carefully dissected with the aid of a stereoscopic lens with 16/25X magnification and testicular position observed. With the aid of a digital pachymeter the distance between the lower pole of the kidney and the upper extremity of the testis (DK-T) was measured to show the position of the testis. During the dissection we also indicated the position of the testes relative to the internal ring. Means were statistically compared using simple linear regression and the paired T-test. Results The 58 testes had abdominal position. The DK-T in the right side measured between 0.17 and 1.82cm (mean=0.79cm) and in the left side it was between 0.12 and 1.84cm (mean=0.87cm), without statistically differences (p=0.0557). The linear regression analysis indicated that DK-T in both sides correlated significantly and positively with fetal age. All fetuses with more than 20 WPC, heavier than 350g and with CRL over 22cm had a greater distance than the average DK-T. We xobserved that the 58 testis remains adjacent to the internal ring throughout the period studied. Conclusions The testes remains adjacent to the internal ring throughout the period studied, indicating that there is no real trans-abdominal testicular descent during the second gestational trimester.

Characterization of mesenchymal cells beneath cornification of the fetal epithelium and epidermis at the face: an immunohistochemical study using human fetal specimens / 대한해부학회지

Fetal development of the face involves a specific type of cornification in which keratinocytes provide a mass or plug to fill a cavity. The epithelial-mesenchymal interaction was likely to be different from that in the usual skin. We examined expression of intermediate filaments and other mesenchymal markers beneath cornification in the fetal face. Using sections from 5 mid-term human fetuses at 14–16 weeks, immunohistochemistry was conducted for cytokeratins (CK), vimentin, nestin, glial fibrilary acidic protein, desmin, CD34, CD68 and proliferating cell nuclear antigen (PCNA). Fetal zygomatic skin was composed of a thin stratum corneum and a stratum basale (CK5/6+, CK14+, and CK19+) and, as the intermediate layer, 2–3 layered large keratinocytes with nucleus. The basal layer was lined by mono-layered mesenchymal cells (CD34+ and nestin+). Some of basal cells were PCNA-positive. In the keratinocyte plug at the external ear and nose, most cell nuclei expressed PCNA, CK5/6, CK14, and CK19. Vimentin-positive mesenchymal cells migrated into the plug. The PCNA-positive nucleus as well as mesenchymal cell migration was not seen in the lip margin in spite of the thick keratinocyte layer. The lingual epithelium were characterized by the CK7-positive stratum corneum as well as the thick mesenchymal papilla. CD68-positive macrophages were absent in the epidermis/epithelium. Being different from usual cornification of the skin, loss of a mesenchymal monolayer as well as superficial migration of mesenchymal cells might connect with a specific differentiation of keratinocyte to provide a plug at the fetal nose and ear.

End-of-life decisions in perinatal care: A view from health-care providers in Mexico / Decisiones sobre el final de la vida en la atención perinatal: Una visión del equipo de salud en México

Objective. To examine the opinions of a perinatal health team regarding decisions related to late termination of pregnancy and severely ill newborns. Materials and Methods. An anonymous questionnaire was administered to physicians, social workers, and nurses in perinatal care. Differences were evaluated using the chi square and Student's t tests. Results. When considering severely ill fetuses and newborns, 82% and 93% of participants, respectively, opted for providing palliative care, whereas 18% considered feticide as an alternative. Those who opted for palliative care aimed to diminish suffering and those who opted for intensive care intended to protect life or sanctity of life. There was poor knowledge about the laws that regulate these decisions. Conclusions. Although there is no consensus on what decisions should be taken with severely ill fetuses or neonates, most participants considered palliative care as the first option, but feticide or induced neonatal death was not ruled out.

Objetivo. Explorar la opinión del equipo de salud sobre las decisiones relacionadas con la atención de fetos y neonatos gravemente enfermos. Material y métodos. Se aplicó un cuestionario anónimo a médicos, trabajadoras sociales y enfermeras perinatales. Las diferencias se evaluaron con las pruebas chi cuadrada y t de Student. Resultados. Al tratar fetos y neonatos gravemente enfermos, 82 y 93% de los participantes optaron, respectivamente, por atención paliativa. El 18% consideró el feticidio como alternativa. Quienes optaron por atención paliativa, lo hicieron para disminuir el sufrimiento, mientras que los que eligieron cuidados intensivos lo hicieron para proteger la vida o la sacralidad de la vida. Nuestro estudio mostró un pobre conocimiento de las leyes que regulan estas decisiones. Conclusiones. Aun cuando no existe un consenso sobre las decisiones que deben tomarse con fetos o neonatos gravemente enfermos, la mayoría consideró como primera opción los cuidados paliativos, aunque el feticidio y la muerte neonatal inducida no se descartaron.

Comparative Study of Efficacy of Extra-amniotic Ethacridine Lactate with Oxytocin Versus Extra-amniotic Ethacridine Lactate with Intravaginal Misoprostol for Termination of Pregnancy with IUD Anamolous Fetuses in Second and Third Trimesters

Termination of a pregnancy in second and third trimesters involving a dead foetus or one with a lethal anomaly is a challenge for health-care professionals in any setting. In addition to the theoretical concern of the dead foetus inutero causing disseminated intravascular coagulation, continuation of such a pregnancy may not be psychologically and socially acceptable to many women, and both the woman and the caretaker are keen to terminate the pregnancy, preferably without an incision on the uterus. Mid-trimester termination of pregnancy is one of the most controversial areas of gynaecological practice. It has moral, emotional, social and technical issues. There is continuous need for termination of pregnancy in second trimester, more recently due to increase in the use of antenatal diagnostic procedures. Nowadays, majority of mid-trimester abortions are carried out medically. The development of prostaglandin analogues has been a major breakthrough in abortion technology. Natural prostaglandins such as PGE1, PGF2a, PGE2, PG analogues like 15-methyl PGF2a have been used by various routes such as intravenous, intramuscular, intra/extra amniotic, oral and vaginal. Ethacridine lactate works by producing prostaglandin from deciduas, whereas misoprostol being synthetic analogue of misoprostol is supposed to act directly. This study aims to evaluate the effectiveness and safety of the extra-amniotic instillation of ethacridine with vaginal misoprostol in comparison to extra-amniotic instillation of ethacridine lactate with oxytocin IV infusion in terminations of second and third trimester pregnanciesin a tertiary referral hospital catering for both rural and urban population. This study concludes that ethacridine lactate with misoprostol is as efficacious as ethacridineplus oxytocinin termination of second and third trimesters anamolus/IUD foetuses. Though there is no significant difference in efficacy between the two. The ethacridineplus misoprostol is slightly effective in reducing the I-A interval. The efficacy of ethacridine plus misoprostol is slightly higher in early second trimester and ethacridine plus oxytocin is effective in the third trimester.

Estudo morfométrico do músculo latíssimo do dorso em fetos humanos / Morphometric study of the latissimus dorsi muscle in human fetuses

Introdução: O músculo latíssimo do dorso (MLD) é largo, triangular e realiza extensão, adução e rotação medial do braço. É vascularizado pelos vasos toracodorsais e ramos perfurantes das artérias intercostais posteriores e lombares, configurando retalho tipo V de Mathes e Nahai, de grande aplicabilidade em cirurgia plástica. O objetivo é analisar a morfometria e a vascularização do MLD em fetos humanos. Método: Dissecou-se a região axilar e o MLD de oito fetos humanos formolizados (três do sexo feminino e cinco do sexo masculino), entre 20 e 32 semanas gestacionais, em decúbito dorsal e abdução completa do braço. Mensuraram-se os comprimentos dos vasos subescapulares e toracodorsais, e foi realizada a morfometria do músculo. Resultados: Em todos os fetos, os vasos toracodorsais conferiram a vascularização primária do MLD. Em 25%, a veia subescapular era tributária direta da veia axilar; 25% dos casos apresentaram veia circunflexa da escápula dupla. O ramo para o músculo serrátil anterior foi único em todos os casos. Em 50% dos casos, o ramo angular da artéria toracodorsal foi visualizado e, em 25% deles, era proveniente do ramo para o músculo serrátil anterior. A distância entre a inserção do músculo e a entrada do pedículo neurovascular variou entre 1,1 e 1,9 cm em fetos de 21 e 26 semanas, respectivamente. Todos os fetos apresentaram a margem anterior do músculo na linha axilar média. Conclusão: A morfometria constante e a reduzida variação anatômica do pedículo vascular encontradas possibilitam a realização de pesquisas envolvendo o uso do MLD em reconstruções cirúrgicas intraútero.

Introduction: The latissimus dorsi muscle (LDM) is a flat triangular muscle which extends, adducts and draws the arm medially. Its blood supply is from the thoracodorsal vessels and the perforating branches of the posterior intercostal and lumbar arteries, therefore, it is a type V flap variety, which has great applicability in plastic surgery. This study aims to analyze the morphometry and the vascularization of MLD in human fetuses. Methods: The axillary region and LDM of eight human fetuses (3 females, 5 males), between 20 and 32 weeks of gestational ages, were dissected in supine position with complete abduction of the arm. The subscapular and thoracodorsal vessels lengths were measured and the morphology of the muscle was studied. Results: In all fetuses, the dominant vascular pedicle of LDM was the thoracodorsal vessels. In 25% of cases the subscapular vein was tributary of the axillary vein. Double circumflex scapular vein were found in 25% of the cases. In all fetuses, the serratus anterior branch was unique. In 50% of the cases the angular branch of the thoracodorsal artery was found, 25% of them were from the serratus anterior branch. The length between its insertion and the entry of the neurovascular pedicle was 1.1 to 1.9 cm in fetuses of 21 and 26 weeks, respectively. In all fetuses, the anterior border of the muscle was at the mid-axillary line. Conclusion: The constant morphometry and reduced anatomical variation of the vascular pedicle enables new studies regarding the use of LDM in surgical reconstructions in utero.