Prenatal magnetic resonance imaging within the 26th week of gestation may predict the fate of isolated upward rotation of the cerebellar vermis: insights from a multicentre study.

OBJECTIVES: We investigated whether prenatal magnetic resonance imaging (MRI) within 26 weeks of gestation (GW) may predict the fate of isolated upward rotation of the cerebellar vermis (URCV). METHODS: This retrospective multicentre observational study included foetuses diagnosed with isolated URCV in prenatal MRI performed within 26 GW. Isolated URCV was defined by a brainstem-vermis angle (BVA) ≥ 12° in the MR midline sagittal view without abnormalities of the supratentorial structures, brainstem, or cerebellum hemispheres. The assessments included the BVA, clival-supraoccipital angle, transverse diameter of the posterior cranial fossa, tentorial angle, width of the cisterna magna (WCM), ventricular width, vermian diameters, hypointense stripes, and cerebellar tail sign. Late prenatal or postnatal MRI was used as a reference standard to assess the final vermian fate (rotated/de-rotated). RESULTS: Forty-five foetuses (mean GW at prenatal MRI = 21.5 ± 1.4 weeks) were included. In the reference standard, the vermis was de-rotated in 26 cases (57.7%). At least two of the following criteria were used to predict the persistence of URCV at imaging follow-up: BVA ≥ 23°, WCM ≥ 9 mm, and the cerebellar tail sign. The results were a sensitivity of 84.21% (95% CI, 60.4-96.6%), specificity of 80.8% (95% CI, 60.6-93.4%), positive predictive value of 76% (95% CI, 58.7-87.8%), and negative predictive value of 87.5% (95% CI, 70.9-95.2%). CONCLUSIONS: MRI within 26 GW on foetuses diagnosed with isolated URCV may predict delayed cerebellar vermis de-rotation, which is associated with good neurodevelopmental outcome in most cases. KEY POINTS: • Foetal MRI is a valuable tool in predicting the fate of isolated upward-rotated cerebellar vermis. • A wider angle between the brainstem and vermis is associated with higher risk of persistence of vermian rotation. • The presence of ≥ 2 factors among a brainstem-to-vermis angle ≥ 23°, width of the cisterna magna ≥ 9 mm, and the presence of the "cerebellar tail sign" has a sensitivity of 84.21% (95% CI, 60.4-96.6%) and specificity of 80.8% (95% CI, 60.6-93.4%) in predicting the persistence of the vermian rotation at imaging follow-up.

A systematic review and meta-analysis on fetal ovarian cysts: impact of size, appearance and prenatal aspiration.

OBJECTIVE: The objective of the study is to compare outcomes of ultrasound-guided aspiration of fetal ovarian cysts with conservative management. METHOD: A systematic review of MEDLINE and Web of Science included studies reporting outcomes (prenatal and postnatal torsion, spontaneous resolution and surgery) of fetuses with ovarian cysts. Subgroup analysis was performed according to cyst diameter at diagnosis and cysts ≥40 mm. RESULTS: Ninety-two non-randomised studies reported on 380 cysts (324 observed and 56 aspirated in utero) in 365 fetuses. All studies were case reports or series with high heterogeneity and risk of bias. The overall spontaneous resolution rate of conservatively managed cysts was 46%, yet decreased with increasing cyst size. Risk of prenatal ovarian torsion in conservatively managed cases depended on cyst size and was particularly important in the range 30 to 59 mm (15-34%). The rate of prenatal torsion in simple cysts ≥40 mm was lower in aspirated than conservatively managed cysts (0% vs 10%, p = 0.03). Aspirated cysts had lower rates of postnatal surgery (7%) compared with conservatively managed cysts (49%, p < 0.001). CONCLUSION: Cysts 30 to 59 mm were at highest risk of torsion. Simple cysts >40 mm had lower rates of torsion when aspirated prenatally. Randomised studies and safety data are needed prior to routine prenatal ovarian cyst aspiration. © 2017 John Wiley & Sons, Ltd.

Left Ventricular Rotational and Twist Mechanics in the Human Fetal Heart.

BACKGROUND: The authors investigated left ventricular (LV) rotational indices, twist, and torsion in a large cohort of fetuses using two-dimensional speckle-tracking echocardiography. METHODS: Pregnant women (N = 102) were prospectively recruited for fetal two-dimensional speckle-tracking echocardiography. Because of variable fetal position, ventricular orientation was established using the location of the liver and LV position in relation to the right ventricle. Twist measurements required correction to account for fetal position, reconciling directionality across all fetal orientations. Peak apical and basal rotations, global longitudinal strain, global circumferential strain (GCS), longitudinal strain rate, circumferential strain rate (CSR), twist, and torsion were reported and tested for associations with gestational age (GA) and estimated fetal weight (EFW). RESULTS: Measurement of rotational indices was feasible in 175 examinations (73%). The mean maternal age was 31 ± 6 years, the mean GA 24 ± 6 weeks, and the EFW 1.0 ± 1.0 kg. Mean peak apical rotation, basal rotation, twist, and torsion were 9.5 ± 2.0°, -4.4 ± 1.1°, 13.1 ± 2.3°, and 7.9 ± 3.4°/cm, respectively. Mean global longitudinal strain, GCS, longitudinal strain rate, and CSR were -22.3 ± 4.3%, -25.0 ± 6.1%, -1.4 ± 0.5 sec-1, and -1.6 ± 0.5 sec-1, respectively. Absolute GCS, CSR, apical rotation, and twist declined moderately with GA and EFW (P < .05). There were strong negative nonlinear correlations of torsion with GA and EFW: torsion = 1,104 × GA-1.591 (r2 = 0.760, P < .001); torsion = 115.88 × EFW-0.427 (r2 = 0.772, P < .001). CONCLUSIONS: Determination of fetal LV rotational mechanics is feasible and reproducible using two-dimensional speckle-tracking echocardiography. Basal rotation, longitudinal strain, and strain rate vary little with EFW and GA. Interpretation of LV apical rotation, twist, torsion, GCS, and CSR, however, must take GA or EFW into account. These data form the basis for comparison with findings in fetuses with abnormal cardiac anatomy and function.

Evaluación de las variaciones del ángulo de torsión del fémur en fémures aislados de individuos brasileños / Evaluation of changes of femoral torsion angle in brazilian individuals isolated femur

En corte axial del fémur, generalmente la orientación del eje del cuello femoral se ubica en diferente plano del eje de los cóndilos. La formación angular que el eje del cuello hace, en relación a la de los cóndilos, es conocida como ángulo de torsión femoral. Los autores realizaron mediciones de los ángulos de torsión (o antetorsión) en 56 fémures humanos adultos, de ambos sexos, siendo 26 derechos y 30 izquierdos. La literatura investigada presenta varios valores que varían de 8 a 25. Los valores obtenidos en las mediciones buscaron determinar el valor del ángulo de torsión en ese material y compararlo con los datos de la literatura. También se determinaron los valores que, permitieran conocer si el miembro inferior tenía rotación lateral o medial patológicas. Los valores obtenidos de los ángulos en las mediciones variaron entre 0 y 35. En el lado derecho, el promedio del ángulo de torsión fue de 20,8 y el del lado izquierdo de 14,86, lo que indica una mayor tendencia del lado derecho a tener anteversión.

In axial section of the fêmur, typically the axis direction of the femoral neck is located in different plane of the axis of the condoyle. The angle that the axis of the neck makes, when compared to the condoyle, is known as angle of femoral torsion. The authors carried out measurements of torsion angles or anteversion femurs in 56 human adults of both sexes, bein 26 right and 30 left. The literature shows several values ranging from 8-25 degrees. The values obtained in measurements seek to determine the value of the torsion angle in this material and compare with literature data. Also we determine values that, in tum, determine, from which, if the leg will feature lateral rotation, medial rotation or pathological. The values obtained in measurements of the angles between zero and thirty-five degrees. On the obtained in measurements of the angles zero and thirty-five degrees. On the right side, the average torsion angle was 20.8 and the left side of 14.86, indication a greater tendency to have the right anteversion.

Micro-magnetic resonance imaging and embryological analysis of wild-type and pma mutant mice with clubfoot.

Gross similarities between the external appearance of the hind limbs of the peroneal muscle atrophy (pma) mouse mutant and congenital talipes equinovarus (CTEV), a human disorder historically referred to as 'clubfoot', suggested that this mutant could be a useful model. We used micro-magnetic resonance imaging to visualize the detailed anatomy of the hind limb defect in mutant pma mice and performed 3D comparisons between mutant and wild-type hind limbs. We found that the pma foot demonstrates supination (i.e. adduction and inversion of the mid foot and fore foot together with plantar flexion of the ankle and toes) and that the tibiale and distal tarsals display 3D abnormalities in positioning. The size and shape of the tibia, fibula, tarsal and metatarsal bones are similar to the wild-type. Hypoplasia of the muscles in the antero-lateral (peroneal) compartment was also demonstrated. The resemblance of these features to those seen in CTEV suggests that the pma mouse is a possibly useful model for the human condition. To understand how the observed deformities in the pma mouse hind foot arise during embryonic development, we followed the process of foot rotation in both wild-type and pma mutant mice. Rotation of the hind foot in mouse embryos of wild-type strains (CD-1 and C57/Black) occurs from embryonic day 14.5 onwards with rotation in C57/Black taking longer. In embryos from both strains, rotation of the right hind foot more commonly precedes rotation of the left. In pma mutants, the initiation of rotation is often delayed and rotation is slower and does not reach completion. If the usefulness of the pma mutant as a model is confirmed, then these findings on pma mouse embryos, when extrapolated to humans, would support a long-standing hypothesis that CTEV is due to the failure of completion of the normal process of rotation and angulation, historically known as the 'arrested development hypothesis'.

Bazo ectópico torsionado / Wandering spleen torsion

El bazo ectópico se caracteriza por ausencia de sus ligamentos suspensorios y un pedículo largo, que le predisponen a complicarse por una torsión, con compromiso del drenaje venoso en un principio y posteriormente arterial, produciendo aumento de su volumen e infarto. Esta situación anómala puede ser debida a una malformación congénita del desarrollo de sus elementos suspensorios y caída hacia el abdomen inferior, o bien a un crecimiento inferior de la yema mesodérmica de la que se origina este órgano. El tratamiento idóneo es la esplenopexia vía laparoscópica, pero cuando existe infarto no podemos evitar la esplenectomía (AU)

The ectopic spleen characterizes for absence of its suspensory ligaments and a long pedicle that are predisposed to complicate it for a torsion with commitment of the venous drainage at first and arterial at a later time himself, producing increase of its volume and infarct. This anomalous situation, it can be had to a congenital malformation of the development of its suspensory elements and fall toward the inferior abdomen or else to an inferior growth of the mesodermic yolk of that this organ originates itself. The suitable treatment is the laparoscopic splenopexy, but when it exists infarction, it is no possible avoid the splenectomy (AU)

Gastropod ontogenetic torsion: developmental remnants of an ancient evolutionary change in body plan.

A dramatic morphogenetic movement ('ontogenetic torsion') during the development of gastropods has been proposed as a recapitulation of the original developmental departure that established the novel gastropod body plan. Nevertheless, speculative literature about ontogenetic torsion and its evolutionary significance has far outstripped empirical observations and recent results suggest that the developmental process may be somewhat different than the traditional description. I used scanning electron microscopy, immunohistochemistry, phalloidin labeling, and histological sections to monitor displacements of five components of the visceropallium with respect to axial coordinates of the cephalopodium in developing embryos of the caenogastropod, Trichotropis cancellata. Embryos of this species achieve a transient stage of anatomical organization that also arises during development of a vetigastropod (Haliotis kamtschatkana), although morphogenetic processes that generate this stage are different in these two species. At the stage of similarity, the embryonic shell has achieved its definitive orientation with respect to the cephalopodium, but the developing mantle cavity, sensory osphradium, and anus are confined to the right side. I also show that this stage of anatomical organization is recognizable during the development of other gastropods, which collectively represent three major gastropod clades. I propose that ontogenetic torsion should be viewed as a conserved stage of anatomical organization during development, rather than a conserved process of 180 degrees rotation between the visceropallium and cephalopodium. The results lead to the suggestion that the mantle cavity of extant gastropods evolved by enlargement of the right side of the mantle cavity in a monoplacophoran-like ancestor. Under this interpretation, there is no need for a hypothetical pre-gastropod with a mantle cavity that was restricted to the posterior end.

Hydatid of morgagni with torsion diagnosed during cesarean delivery. A case report.

BACKGROUND: Hydatids of Morgagni are benign, pedunculated, cystic structures arising from müllerian vestiges below the fallopian tube near the fimbria. They usually are of no clinical significance unless the pedicle becomes twisted and infarction occurs. CASE: A 39-year-old primigravida at 41 weeks and 5 days' gestation underwent primary cesarean delivery for macrosomia and failure to descend during labor. A 4 x 3-cm hydatid of Morgagni with torsion of the pedicle was found on the left fallopian tube. Ligation of the pedicle and excision of the infarcted cyst were performed. Histology of the specimen demonstrated cuboidal epithelium with extensive hemorrhage and necrosis, consistent with an infarcted hydatid of Morgagni. All pain and symptoms experienced by the patient during the previous day were associated with the onset of labor. No specific left lower quadrant pain was reported. CONCLUSION: Hydatids of Morgagni are common findings at pelvic surgery and usually of no clinical significance. Torsion of a hydatid of Morgagni is rarely reported and most likely is a rare occurrence. In this patient, torsion of the hydatid of Morgagni was possibly pregnancy related, and symptoms associated with torsion were probably masked by labor pain.

[Rotation of the intestine--an illusion or reality?]. / Rotation des Darmes--Schein oder Wirklichkeit?

Disorders of intestinal rotation present with a wide spectrum of abnormalities. This variety is attributed to the puzzling embryology of the midgut. Clinicians, as well as embryologists, believe that normally a process of rotation of the midgut takes place which can be hampered at any stage resulting in the different types of "malrotations". However, a "malrotated" gut has never been observed in normal embryos. Therefore all theories on the normal and abnormal development of the gut are still highly hypothetical. In an attempt to elucidate more clearly which events occur during the development of the gut, we studied its embryology in 58 normal rat embryos between the 13th and 20th day of gestation using scanning electron microscopy. In 13 day old rat embryos, the midgut already forms a loop. It can be subdivided into three parts: the central part (with its connections to rectum and stomach), the straight part (with the colorectum on the left and the "small bowel" on the right) and the tip of the loop (inside the umbilical cord). Obviously, these three parts show no signs of developmental synchronization. Each part develops according to its own developmental blue print: the duodenal and umbilical parts of the midgut show much developmental activity, while gross changes of the straight part of the midgut are missing. This finding is surprising because a process of rotation, if occurring, should result in notable morphological changes especially in this region. Further more, the coecum never achieved a position in the upper left abdomen, as it is often outlined by schematic drawings.(ABSTRACT TRUNCATED AT 250 WORDS)

The embryology of lower-extremity torsion.

The presence of torsional deformities in the lower extremities of otherwise normal children is based on a variety of developmental processes. With intrauterine maturation, both rotation and external compression of the extremities take place. These forces result in the normal molding and final position of the limbs. Torsion of the extremities is, thus, a normal embryological process. It is imperative for the treating physician to understand these factors in human development to decide which cases are significant deviations from normal torsion. Knowledge of the embryology and natural history of these conditions is a key to appropriate treatment of patients with torsional or angular malalignments.