Aspectos ultrassonográficos dos componentes umbilicais de bezerros da raça Holandesa durante o processo de involução fisiológica / Ultrasonographic aspects of umbilical components of Holstein calves during the physiological involution process

Afecções umbilicais são comumente encontradas nos bezerros durante o período neonatal, podendo ocasionar graves complicações. Seu diagnóstico muitas vezes não é preciso pela palpação abdominal, sendo a ultrassonografia um valioso exame complementar, pois permite precisão na localização e na extensão das onfalopatias intra-abdominais. Diante disso e da raridade de pesquisas com estabelecimento de padrões ultrassonográficos do umbigo, o presente estudo propôs padronizar os aspectos das imagens ultrassonográficas dos componentes umbilicais em decorrência de sua involução. Foram avaliados 23 bezerros Holandeses, do nascimento até os 30 dias de vida, em cuja região umbilical se usou como antisséptico tintura de iodo em diferentes concentrações. Os resultados evidenciaram que veia e artérias umbilicais perdem suas características de vasos, assumindo aspecto de ligamento por proliferação de tecido fibroso. Nesse processo, o tecido fibroso, inicialmente presente na região interna da parede do vaso, segue, com a involução, em direção à luz, sendo observado mais precocemente em porções dos vasos mais distantes do umbigo externo, não havendo distinção de comportamento determinada pela antissepsia. Para aproveitamento do exame ultrassonográfico, é importante o conhecimento dos aspectos das imagens durante o processo de involução dos componentes umbilicais, de acordo com cada fase, sendo assim possível o diagnóstico das diferentes alterações nessas estruturas.(AU)

Umbilical diseases of calves happen during neonatal period and may lead to severe complications. The diagnosis is usually through abdominal palpation although it is not very accurate, thus ultrasound provides a valuable complementary exam to establish a precise diagnosis of location and extent of intra-abdominal umbilical diseases. Given those facts and the lack of established standards for umbilical ultrasound imaging the present study proposal was to standardize the physiological aspects of umbilical components during involution. Ultrasound images were obtained for 23 Holstein calves, from birth until 30 days of life. Iodine tincture of different concentrations was used for umbilical region antisepsis. Results show that umbilical vein and arteries lose their vessel characteristics, becoming similar to ligament, due to the proliferation of fibrous tissue. The growth pattern of the fibrous tissue was from the vessel walls growing toward vascular lumen. The involution process begins at the most distant part and did not vary with antiseptic concentrations. To obtain a reliable ultrasound exam it's important to know the aspects of imaging patterns according to each phase of umbilical involution, thus leading to an accurate diagnosis of structural variations and umbilical diseases.(AU)

Diagnóstico prenatal y evolución en fetos con agenesia de ductus venoso / Prenatal diagnosis and evolution in fetuses with ductus venosus agenesis

Antecedentes: El ductus venoso es una derivación vascular (shunt) presente en el feto que permite el paso de sangre oxigenada de la vena umbilical (VU) hacia la circulación coronaria y cerebral. Su agenesia se asocia con defectos cromosómicos, síndromes genéticos, defectos estructurales y complicaciones prenatales como crecimiento intrauterino retardado y muerte fetal. Resultados: Se analizaron 15 agenesias de ductus venoso (ADV) en gestaciones únicas entre enero de 2010 y diciembre de 2013. El 80 por ciento de ellas fueron diagnosticadas en la exploración rutinaria de la semana 12. Se realizó estudio de cariotipo en el 53 por ciento de los casos (8/15), bien por riesgo alto de cromosomopatía en el cribado combinado y/o translucencia nucal aumentada (75 por ciento) o malformaciones asociadas (25 por ciento). Sólo hubo un diagnóstico de trisomía 21 y postnatalmente de una microdelección del cromosoma 7. Realizaron interrupción legal del embarazo un total de 4 pacientes (por trisomía 21 o por alteraciones estructurales). Entre las 11 gestaciones restantes un 27 por ciento se diagnosticó RCIU, hubo una muerte neonatal a las 12 horas de vida por síndrome de aspiración meconial e hipertensión pulmonar. En un 60 por ciento se objetivó la presencia de un drenaje umbilicohepático y entre los 6 restantes con shunt portosistémico, 4 tenían conexión entre la VU y la VCI. Conclusión: La ADV es una anomalía infrecuente del sistema venoso fetal, de difícil diagnóstico y con mal pronóstico en aquellos casos en que se asocia con otros marcadores y/o anomalías estructurales que pueden aparecer tardíamente, por lo que debe realizarse un seguimiento adecuado.

Background: The ductus venosus (DV) is a unique shunt that allows direct passage of oxygenated blood from the umbilical vein (UV) to the coronary and cerebral circulation by a preferential passage through the foramen ovale. DV agenesis (DVA) is associated with chromosomal abnormalities, genetic syndromes, structural defects and prenatal complications such as intrauterine growth retardation (IUGR) or even stillbirth. Results: We report 15 cases of DVA in singleton pregnancies between January 2010 and December 2013. 80 percent of them were diagnosed on routine examination during the 11-14 weeks scan. Karyotyping was performed in 53 percent of cases (8/15) by high risk of chromosomal abnormalities in the first trimester combined screening and/or an increased nuchal translucency thickness in 6/8 (75 percent), or associated malformations 2/8 (25 percent). There was only one fetus diagnosed of trisomy 21 by amniocentesis and another fetus was postnatally diagnosed of a microdeletion of chromosome 7. 4 patients performed legal abortions (the trisomy 21 and in 3 cases for severe structural malformations). Among the remaining 11 pregnancies, 3 (27 percent) were diagnosed with IUGR and there was a neonatal death at 12 hours of life for meconium aspiration syndrome and pulmonary hypertension. 60 percent of the fetus presented an intrahepatic drainage and among the remaining 6 with portosystemic shunt, in 4 a connection between the UV and the inferior vena cava was observed. Conclusion: DVA is a rare anomaly of the fetal venous system, difficult diagnosis and poor prognosis in cases associated with other markers and/or structural abnormalities that may even appear late. A detailed survey of fetal anatomy and follow up of these fetuses is necessary.

Fetal ductus venosus pulsatility index and diameter during 20-30 weeks gestation.

OBJECTIVE: To present normal range of the pulsatility index and the smallest diameter in the ductus venosus in normal fetuses throughout gestation. MATERIAL AND METHOD: This was a prospectively cross-sectional study. Three measurements were made for the ductus venosus diameter and the pulsatility index in each fetus during fetal quiescence. Statistical Package for the Social Sciences 14.0 software was used to create nomograms for the ductus venosus pulsatility index and diameter against gestational age. Four hundred and sixty normal fetuses aged seventeenth to thirty-seventh weeks were evaluated. RESULTS: The median diameter of the ductus venosus was linear across gestation. CONCLUSION: The nomograms for the ductus venosus pulsatility index and diameter are presented. The size of the narrowest portion of the DV grows in a linear relationship through gestation.