Normal and abnormal appearance of fetal ganglionic eminence on second-trimester three-dimensional ultrasound.

OBJECTIVES: To describe the appearance and size of the ganglionic eminence (GE) in normal fetuses on midtrimester three-dimensional (3D) neurosonography and to report on the association between GE alterations (cavitation or enlargement) and malformation of cortical development (MCD). METHODS: This was a prospective multicenter cohort study of normal fetuses and a retrospective analysis of pathological cases with MCD. From January 2022 to June 2022, patients attending our tertiary centers for an expert fetal brain scan were recruited for the purpose of the study. A 3D volume of the fetal head, starting from the sagittal plane, was acquired in apparently normal fetuses using a transabdominal or transvaginal approach. Stored volume datasets were then evaluated independently by two expert operators. Two measurements (longitudinal diameter and transverse diameter) of the GE in the coronal view were obtained twice by each operator. Intra- and interobserver measurement variation was calculated. Reference ranges for GE measurements were calculated in the normal population. A previously stored volume dataset of 60 cases with MCD was also analyzed independently by the two operators using the same method in order to assess if GE abnormalities (cavitation or enlargement) were present. Postnatal follow-up was obtained in all cases. RESULTS: In the study period, 160 normal fetuses between 19 and 22 weeks of gestation were included in the study. The GE was visible in the coronal plane on 3D neurosonography in 144 (90%) cases and was not clearly visible in the remaining 16 (10%) cases. The intra- and interobserver agreement was almost perfect for the longitudinal diameter, with an intraclass correlation coefficient (ICC) of 0.90 (95% CI, 0.83-0.93) and 0.90 (95% CI, 0.86-0.92), respectively, and substantial for the transverse diameter, with an ICC of 0.80 (95% CI, 0.70-0.87) and 0.64 (95% CI, 0.53-0.72), respectively. A retrospective analysis of 50 cases with MCD in the second trimester showed that GE enlargement was present in 12 cases and GE cavitation was present in four cases. CONCLUSIONS: Systematic assessment of the GE in fetuses at 19-22 weeks of gestation is feasible on 3D neurosonography, with good reproducibility in normal cases. Cavitation or enlargement of the GE can be demonstrated in fetuses with MCD. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A case of late orthostatic headache secondary to lumbar hidden dural fistula 20 months after epidural anesthesia.

The clinical recognition of CSF fistula is a clinical challenge. We report the case of a young woman, who presented with a late orthostatic headache 20 months after epidural anesthesia. She developed a lumbar dural fistula of CSF confirmed in myelography CT scanning and treated successfully with epidural blood patch.

Successful incorporation of short-interfering RNA into islet cells by in situ perfusion.

UNLABELLED: Islet transplantation offers a potential cure for type I diabetes, although its success has been limited, due to loss of cells by apoptosis stimulated by the procurement, ischemia, and the isolation process itself. RNA interference (RNAi) as mediated by short interfering RNAs (siRNAs) has become a potent tool to manipulate gene expression in mammalian cells. We describe the first successful introduction of siRNA directly into pancreatic islet cells both during in situ perfusion and from intravenous tail vein injection (in vivo). METHODS: siRNA was targeted to the pancreatic islets of BALB/c mice by retrograde portal vein perfusion or tail vein injection. Cy3-labeled siRNA was dissolved in University of Wisconsin (UW) solution at 2 microg/mL. After delivery pancreata were placed in cold storage at 4 degrees C in UW solution for 24 hours, followed by processing for immunofluorescent staining for insulin. Fluorescent imaging was obtained using a Nikon DIAPHOT 300 Inverted Micoscope with a Zeiss AxioCam and OpenLab image capturing software. RESULTS: In situ delivery of siRNA was demonstrated by fluorescent imaging composites of (red) siRNA in and along (green) insulin stained islets from pancreas sections as compared with untreated control sections. The siRNA was detected mainly in and along venous structures throughout the pancreatic tissue. In vivo delivery of siRNA into islets was observed by fluorescent images taken of isolated islets in culture. CONCLUSIONS: We have described the successful delivery of siRNA to pancreatic islets via a novel in situ pancreas perfusion technique and in vivo delivery via tail vein injection.

Acute cholecystitis secondary to hemobilia after percutaneous liver biopsy.

A case of obstructive acute cholecystitis following percutaneous liver biopsy is presented. The patient complained of intense and continuous pain in the right upper quadrant of the abdomen 2 days after the liver biopsy. On abdominal examination, Murphy's sign was present. Hemogram revealed a fall in the hematocrit level from 44 to 38 because of hemobilia. Ultrasonography showed a dilated gallbladder with moderate thickness of the wall and a blood clot of 20 x 9 mm inside. The patient was subjected to laparoscopic cholecystectomy. The acute inflammation of the gallbladder was secondary to obstruction of the cystic duct by the blood clot. The postoperative period was uneventful.

[Laparoscopic cholecystectomy in the third trimester of pregnancy]. / Colecistectomia laparoscópica no terceiro trimestre da gravidez.

Two patients in the third trimester of pregnancy were subjected to laparoscopic cholecystectomy for the treatment of symptomatic gallstone disease. Indications for the procedure were acute cholecystitis in the first case and biliary pancreatitis associated to recurrent biliary pain in the second one. The operations were done without hemodinamic or anesthetic complications to the pregnants and fetus. The mean operative time was 22 minutes. Although suggested that visualization of the anatomic structures of the superior abdomen could be difficult in the third trimester, we did not find problems for dissection and visualization of structures including cystic duct and cystic artery. Both patients were discharged 24 hours after the procedures and until the present description, remain with no related complications. Laparoscopic cholecystectomy, when strictly necessary, can be safely done and is of proven effectiveness in surgical management of symptomatic gallstone disease during third trimester of pregnancy. It is related to a very low index of complications and does not present difficulties concerning access and exposure of intrabdominal structures.