Perfusão arterial reversa gemelar: revisão da literatura / Twin reverse arterial perfusion: literature review

A perfusão arterial reversa gemelar é uma anormalidade rara que pode ocorrer em gestações gemelares monocoriônicas. Consiste em uma alteração na circulação fetoplacentária, com desvio de sangue de um dos gemelares para o outro, por meio de anastomoses arterioarteriais e venovenosas na superfície placentária e anastomoses arteriovenosas em áreas de circulação placentária compartilhada. O feto bombeador pode desenvolver insuficiência cardíaca devido ao aumento do débito cardíaco, e o feto receptor, perfundido por sangue pobre em oxigênio por meio do fluxo reverso, é severamente malformado, incompatível com a vida extrauterina. Este artigo apresenta o caso de uma gestação gemelar monocoriônica diamniótica, com manejo clínico conservador. O objetivo é relatar um caso de complicação rara de gestações monozigóticas e revisar condutas para diagnóstico e manejo adequado.(AU)

Twin reverse arterial perfusion is a rare abnormality that can occur in monochorionic twin pregnancies. It consists of an alteration in the fetal-placental circulation, with blood diversion from one of the twins to the other, through arterio-arterial and veno- venous anastomosis on the placental surface and arterio-venous anastomosis in areas of shared placental circulation. The pumping fetus may develop heart failure due to increased cardiac output, and the recipient fetus, perfused by oxygen-poor blood through reverse flow, is severely malformed, incompatible with extrauterine life. This article presents the case of a monochorionic diamniotic twin pregnancy, with conservative clinical management. The objective is to report a case of rare complication of monozygotic pregnancies and review procedures for diagnosis and adequate management.(AU)

A rare variation of the testicular blood supply by the deferential artery / Rara variación del suministro de sangre testicular por la arteria del conducto deferente

Any compression of testicular arteries may lead to loss of spermatogenesis and gonadal hormone production, existence of the variational arteries is accountable in cases of vasoligation, orchidopexy and other surgical approach on them. Anomalies of the testicular blood arteries were observed during dissection of the pelvic cavity in a 68-year-old male cadaver. This report describes a very rare case of lack of testicular arteries. For the blood supply to the testis, thick deferential arteries form some vascular winding and loops and course accompanied by deferent duct to the testis. This case report would serve as ray of light for knowledge of the possible variations of the testicular arteries during surgical procedures.

Cualquier compresión de las arterias testiculares puede conducir a la pérdida de la espermatogénesis y la producción de hormonas gonadales. La existencia de variaciones en las arterias testiculares es relevante en los casos de vasectomía, orquidopexia y otros tipos de abordaje quirúrgico. Se observaron anomalías de las arterias testiculares durante la disección de la cavidad pélvica de un cadáver de sexo masculino de 68 años de edad. En este trabajo se describe un caso muy poco frecuente de ausencia de arterias testiculares. Para el suministro sanguíneo del testículo, se encontraron arterias deferentes gruesas que producen sinuosidad y tortuosidad vascular junto al conducto deferente en los testículos. Este caso podría ser útil para el conocimiento de las posibles variaciones de las arterias testiculares durante los procedimientos quirúrgicos.

Ocular Findings in Children with Single Umbilical Artery: A Case Series of 14 Children

PURPOSE: Single umbilical artery (SUA) is the most common malformation of the umbilical cord. However, there have been no studies on the ocular findings in SUA, except for one case report. This study aimed to investigate the ocular findings in children with SUA. METHODS: Fourteen children (eight boys and six girls) with SUA were evaluated retrospectively. All children underwent a complete ophthalmologic examination. RESULTS: The prevalence of abnormal ocular findings in children was up to 42.9%. Refractive errors are detected in four eyes (14.3%): myopia > or =-1.50 diopters (D) in one eye (3.6%) and hyperopia > or =+2.00 D in three eyes (10.7%). Epiblepharon was found in three children (21.4%), and strabismus was detected in one child (7.1%). CONCLUSIONS: Approximately half of the children with SUA showed abnormal ocular findings, therefore, our case series highlight the need for a comprehensive ocular examination and larger prospective research studies in young patients with SUA.

Suboclusión intestinal secundaria a endometriosis en paciente con Síndrome de V. A. T. E. R. L. S. / Intestinal sub-occlusion secundary to endometriosis in a patient with

We report a case of acute small bowel obstruction occurring secondary to endometriosis of the terminal ileum. Ileal endometriosis is a rare condition that can cause acute small bowel obstruction. As this cse and others in the literture highlight, establishing a preoperative diagnosis is very difficult due to the vagueness of symptoms and similarity in presentation to other causes of obstruction, and is based on a high index of suspicion. However, this disorder should be considered in the differential diagnosis of women of child-bearing age who present with symptoms of obstruction. The definiteve treatment includes resection of the involved segment with primary anastomosis, and adjuvant hormonal therapy may prevent recurrence. VATER association is an acronym for the fllowing non-random association of defects: Vertebral defects, Anal atresia, tracheoesophageal fistula with Esophageal atresia, and Renal or Radial defects. VACTERL association is an expanded acronym to include Cardiac defects and Limb defects. Diagnosis of VACTERL association is made if theree out of seven above defects are present in an infant. The incidence is estimated to be 1.6 cases in 10,000 live births.

predictive value of studying the uterine and umbilical artery resistance indices in cases of pre term labour

To assess the value of uterine artery and umbilical artery resistance indices changes in predicting cases of PTD. The study was carried on gravid women attending Al zahraa University Hospital between February 2009 to September 2010. A prospective study on gravid women picked up at 24 week gestation during ANC. They were subjected to Doppler velocimetry study of the Umbalical and Uterine artery blood flow to measure the resistive indices changes on going GA. Participants were 24 weeks pregnant with a singleton pregnancy, Participants were seen at three study visits: at recruitment, at, 28 weeks gestation; and finally at 34 weeks gestation. Patients who later developed PTL formed the study group n=28. The control group were the women who completed 40 weeks gestation at the time of delivery. For each patient seen at the three visits Doppler velocimetry ultrasound study of the umbilical and uterine were performed to assess the RI indices changes. The current study revealed a high significant difference in the RI value of the umblical artery starting from 28 weeks visit to be [0.74], [0.61] in the study group and control group respectively with p-value [0.001] also a highly significant diff. were noticed at the 34 weeks visit to be [0.65],[0.49] in the study group and control group respectively with p-value [0.0001]. As regard the uterine artery RI the study group showed a highly significant difference at 28 weeks visit when compared to the value of the control group with p-value [0.001] in the same manner the RI value at 34 weeks visit showed a highly significant difference between both groups with p-value [0.0001].In the current study the mean RI for both uterine and umbilical arteries decreased steadily across all study visits from 24 weeks to 34 weeks gestation. In linear regression models, the relationships of both uterine and umbilical artery RI with gestational age were significantly different between study group and control group. The mean umbilical artery RI and uterine artery RI indices decreased significantly more slowly across gestation for study group than for control group. In univariate analyses, a 2.9 fold increase in risk for PTD was associated with a 0.1 unit increase in uterine artery RI across gestation; while a 3.4 fold increase in risk for PTD was associated with a 0.1 unit increase in umbilical artery RI across gestation. The RI indices values in the umblical artery and uterine artery showed a significant slowly decrease along gestational age among gravid patients developed preterm labour so that they could be predictive for PTL

Arteria umbilical única y malformaciones asociadas en una serie de 5500 autopsias: implicancia en conductas perinatales / Single umbilical artery and associated malformations in a series of 5500 autopsies: implication in perinatal conducts

Con una incidencia del 1% de nacimientos, la arteria umbilical única (AUU) es, de todos los defectos congénitos, el más frecuente. Se asocia reconocidamente a una variedad de malformaciones pero existen controversias acerca de su condición de predictora de un resultado perinatal adverso y de constituir una indicación para descartar otras malformaciones. Objetivos: establecer las frecuencias de malformaciones asociadas a AUU, determinar si existen asociaciones preferenciales y cuantificar el riesgo de otras malformaciones en presencia de AUU en una serie de autopsias perinatales. Material y métodos: en 5.539 autopsias del Hospital Materno Infantil Ramón Sardá y del Laboratorio Privado de Patología Perinatal se calculó la frecuencia de cada malformación (agrupadas por aparato) asociada a la AUU y los riesgos de malformaciones asociadas. Se estableció el riesgo para anomalías cromosómicas en casos con AUU sin otras malformaciones asociadas. Resultados: la AUU fue 10 veces más frecuente en presencia de otras malformaciones. El riesgo para malformaciones se incrementó significativamente entre tres y nueve veces en presencia de AUU. Las anomalías renales y digestivas mostraron una asociación preferencial con la AUU. En ausencia de otras malformaciones agregadas, la AUU presentó un bajo riesgo para anomalías cromosómicas. Conclusiones: el diagnóstico de AUU es indicación para realizar un exhaustivo monitoreo fetal y para descartar anomalías renales y cardiovasculares. No sería indicación para realizar un estudio cromosómico fetal si no se detectan otras malformaciones.

With a birth prevalence rate of about 1%, single umbilical artery (SUA) is the most frequent congenital anomaly. It recognizably associates with a variety of birth defects but its ability to predict an adverse perinatal outcome is unclear, as well as if other malformations should be ruled out when a SUA is diagnosed. Aims: to estimate the association between SUA and other birth defects in a series of perinatal autopsies, to establish if preferential associations between SUA and certain birth defects exist, and to quantify the risks for other birth defects when a SUA is diagnosed. Material and methods: in a series of 5.539 perinatal autopsies, from the Hospital Materno Infantil Ramón Sardá and the Private Laboratory of Perinatal Pathology, Buenos Aires, the rate of each malformation (grouped by organ/system) associated with SUA and the risks of associated malformations were estimated. Results: the rate of SUA showed a 10-fold increase when other malformations were present. The risk for other malformations increased significantly, from 3 to 9-fold, when a SUA was present. Urinary and gut anomalies showed a preferential association with SUA. The absence of other birth defects lowered the risk of SUA for chromosome anomalies in almost 60 per cent. Conclusions: prenatal diagnosis of SUA should lead to an exhaustive fetal monitoring, and urinary and cardiovascular defects should be ruled out. The diagnosis of a SUA is not an indication for a fetal chromosome analysis, if no other malformations are present.

Assessment of foetal umbilical artery acid base and blood gases in high risk pregnancies

To evaluate the foetal condition by assessment of foetal umbilical artery acid base balance and blood gases in high risk pregnancies compared to normal pregnancy. Forty female patients were included in this study, twenty served as normal controls, ten preeclamptic patients and ten diabetic patients. Post delivery umbilical artery blood sampling was withdrawn to measure pH, PaO[2], PaCO[2]. There was a significant difference in umbilical artery blood acid base parameters [pH, PaO[2], PaCO[2]] between normal pregnancies and high risk pregnancies [Diabetes mellitus and hypertension]. In addition the acid-base showed a good condition with mode of delivery. It appears that umbilical artery acid-base is an accurate assessment of foetal metabolic status and much more accurate than APGAR scoring system in diagnosis of asphyxia

Absence of Wharton's jelly around the umbilical arteries.

Wharton's jelly is a specialized tissue which acts as supportive and protective structure substituting for the adventitia of the umbilical vessels. Absence of Wharton's jelly around the umbilical arteries is very rare and an unusual cause of perinatal mortality. We report a case of absent Wharton's jelly around the umbilical arteries with patent vitellointestinal duct--a rare association.

A cicatriz umbilical e a neurologia / The umbilical scar and neurology

Em algumas situações específicas a cicatriz umbilical deve ser objeto de observação atenta por parte do neurologista: nas doenças geneticamente adquiridas; quando se desloca em resposta a dois reflexos -cutâneo abdominal superficial e cutâneo abdominal profundo - e na pesquisa do Sinal de Beevor. O movimento do umbigo também deve ser observado em doenças que cursam com dirtúrbios do movimento e como parte do exame do paciente em morte cerebral. Este artigo trata de como um pequeno acidente anatômico e cicatricial, situado no epicentro da parede abdominal, pode contribuir para o diagnóstico neurológico.

The umbilical scar must be an object of attentive observation by the neurologist in some specific situation: in the genetically trasmitted diseases, in the neurologic examination (when we valorize its displacement in the response to two reflexes - superficial abdominal cutaneous and deep abdominal cutaneous), and by the observation of the Beevor Sign. The navel's shift can also be seen in some diseases with movement disorder and in-patients with cerebral death. This article deals with how a small scar, a little anatomic accident situated in the middle of the abdominal wall, may contribute to the neurologic diagnosis.

Arteria umbilical única y malformaciones asociadas: experiencia en el Hospital Clínico de la Universidad de Chile / Single umbilical artery and associated malformations: experience at Hospital Clínico, Universidad de Chile

La arteria umbilical única (AUU) es una malformación centinela que debe orientar a la búsqueda más exhaustiva de malformaciones asociadas que pueden no ser siempre evidentes, ya sea que estas se presenten en forma de síndromes o bien con un patrón desconocido. Este estudio incluye a los casos registrados de AUU en la Unidad de Neonatología del Hospital Clínico de la Universidad de Chile desde enero de 1978 hasta abril de 1998. Observamos, como se ha reportado en la literatura, que la AUU aislada o asociada a malformaciones menores tiene buen pronóstico en contraposición a lo que ocurre cuando se acompaña de una o más malformaciones mayores. Se encontró a la AUU como parte de un síndrome en un 36,4 por ciento de los casos y se detectaron causas cromosómicas en 10,9 por ciento de ellos. Es importante intentar realizar un diagnóstico preciso, de manera de estimar el riesgo de recurrencia que puedan tener los padres en futuros embarazos

Diagnóstico prenatal de arteria umbilical única / Prenatal diagnosis of single umbilical artery

Se presentan 20 pacientes en control maternal en las cuales se realizó dignóstico ultrasonográfico antenatal de arteria umbilical única (AUU) que se confirmaron mediante el examen pediátrico y/o la anatomía patológica. Se analiza el resultado perinatal, malformaciones estructurales y cromosómicas presentes, destacando la pesquisa de seis casos de AUU como único hallazgo patológico, encontrándose en el resto una alta asociación con anomalías fetales múltiples, siendo en trece casos incompatibles con la vida

Marcadores sutiles de anomalías cromosómicas en el feto: detección ultrasonográfica, significado clínico y manejo / Soft markers of cromosomal anomalies in the fetus: ultrasonographic detection, clinical meaning and management

Se analiza el manejo clínico, en la detección de anomalías cromosómicas mínimas, diagnosticadas por ecografía y su relación con diferentes aneuploidias

Arteria umbilical única: revisión de 12 casos / Single umbilical artery: review of 12 cases

El cordón umbilical normalmente está formado por tres vasos, dos de arterias y una vena. La ausencia congénita de una arteria umbilical oarteria umbilical única (AUU) se ha relacionado con una serie de eventos perinatales desfavorables, tales como recién nacidos de bajo peso, prematuridad, malformaciones fetales y muerte perinatal. Se revisan retrospectivamente 12 casos de AUU con comprobación histológica y se analizan las principales características tanto maternas como perinatales. Se encontró un 58% de prematuridad, un 66% de bajo peso de nacimiento y una letalidad perinatal de 580/1000 RN (cuatro mortinatos y tres mortineonatos). En cinco casos se encontró asociación con malformaciones mayores (42%). Se preconiza una búsqueda dirigida de esta anomalía vascular en el momento del parto, debido a que es un importante índice para detectar malformaciones congénitas asociadas

Diagnóstico prenatal ultrasonográfico de arteria umbilical única: presentación de dos casos clínicos / Ultrasonographic prenatal diagnosis of the umbilical artery: presentation of 2 cases

La ausencia congénita de una arteria umbilical o arteria umbilical única (AUU) se ha relacionado con una alta incidencia de otras malformaciones fetales, así como con mortalidad perinatal, prematuridad y bajo peso al nacer. La detección prenatal de una AUU debe obligar al médico ultrasonografista a examinar cuidadosamente al feto en busca de otras malformaciones, así como a considerar dicho embarazo de alto riesgo por la mayor posibilidad de muerte perinatal o retardo de crecimiento intrauterino. Se presentan dos casos clínicos de AUU en los cuales el diagnóstico fue realizado prenatalmente mediante ultrasonografía. En el primer caso no se detectaron malformaciones, pero se asoció con retardo de crecimiento intrauterino. En el segundo caso, el feto presentaba malformaciones múltiples incompatibles con la vida. Se recomienda el examen sistemático del cordón umbilical en toda exploración ultrasonográfica en busca de esta malformación vascular ya que el hallazgo de una AUU favorece el hallazgo de otras malformaciones y permite un control más cuidadoso de la gestación con el objeto de favorecer la sobrevida fetal

Flujo ausente o reverso al final del diástole en aorta descendente o arteria umbilical / Ausent flow or reversal at the end of descendent aorta diastole or umbilical artery

Se presenta el resultado perinatal de 15 embarazos de alto riesgo que mostraron flujo ausente o reverso al final del diástole en arteria umbilical o aorta descendente. Este hallazgo representa una situación fetal muy comprometida. Todos fueron retardos de crecimiento intrauterino severos y la mortalidad perinatal fue de 47%. El parámetro más importante para predecir el resultado perinatal fue el peso del recién nacido; 900 g o más se asoció con buen resultado. En menor medida lo fue la edad gestacional al nacimiento

Arteria umbilical única: incidencias y relaciones con otras anomalías / Single umbilical artery: incidences and relations to other anomalies

Se realizó el examen del cordón umbilical en 10 074 nacimientos consecutivos y se encontró una incidencia de arteria umbilical única (AUU) de 0,27 % del total de nacimientos. Esta anomalía fue 4 veces más frecuente en niños de bajo peso al nacer. La AUU predominó en el sexo femenino. Se expresa que el 42,85 % de los niños con AUU tenía otra anomalía congénita asociada, mientras que los niños con vasos umbilicales normales representaban el 1,8 %. Se destaca que las malformaciones congénitas asociadas con AUU fueron las cardiovasculares, seguidas de las genitourinarias, del sistema nervioso central y las óseas. Se detectó un recién nacido con 5 vasos umbilicales