Computed Tomography Findings in Vernix Caseosa Peritonitis.

INTRODUCTION: Vernix caseosa peritonitis (VCP) is a rare peripartum complication secondary to the introduction of fetal vernix into the maternal peritoneal cavity. Vernix caseosa peritonitis typically manifests a few hours to days after a cesarian section and is often initially misdiagnosed as a more common disease process resulting in delayed diagnosis. We report the computed tomography (CT) findings in 2 patients with VCP and reviewed the previously reported CT findings of VCP. CASES: Two patients, aged 17 and 24 years, presented with signs and symptoms of peritonitis within days of undergoing a cesarian section. In both cases, CT scans of the abdomen and pelvis demonstrated ascites and multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules which were most prominent around the liver and became larger and more numerous over time. Antibiotic therapy was not effective, subsequent laparoscopic peritoneal biopsy demonstrated VCP, and patients were successfully treated with lavage and the addition of intravenous steroids. CONCLUSIONS: Vernix caseosa peritonitis is an underrecognized disorder that is most often mistaken for other more common causes of peritonitis. In the setting of peripartum peritonitis, the CT findings of ascites with multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules, especially adjacent to the liver, which grow in size and number strongly suggests VCP.

Temperature-induced changes in structural and physicochemical properties of vernix caseosa.

The skin of the third trimester fetus and early newborn exhibits a complex, multifunctional, highly hydrated but viscous skin-surface biofilm called vernix caseosa (VC). During birth, VC undergoes a substantial change from an aqueous and warm surrounding into a gaseous and colder environment postnatally. The aim of this study was to investigate the structural and physicochemical changes in VC, which accompany physiologically relevant variations in environment parameters, such as temperature and humidity. A remarkable difference was observed in water release and uptake properties: dehydration and rehydration processes take place two to four times faster at 37 degrees C than at room temperature (RT). The dehydration was irreversible; rehydration was only possible to a final weight of 55% (37 degrees C) and 46% (RT) of the pre-desiccation weight. Differential scanning calorimetry showed two different overlapping phase transitions within physiological temperature range. Investigation of the lipid organization by Fourier transform infrared spectroscopy and small-angle X-ray diffraction revealed a more disordered state of lipids at 37 degrees C than at RT, which might explain the faster dehydration and rehydration process at 37 degrees C as well as the changes in thermotropic rheological behavior. In conclusion, we demonstrated that VC properties adjust to the fundamental change from the intrauterine to the post-natal environment.

[In vitro isolation, cultivation and identification of sebocytes and eccrine sweat gland cells from human fetal skin].

OBJECTIVE: To explore the preliminary methods of in vitro isolation, culture and identification of sebocytes and eccrine sweat gland cells from human fetal skin. METHODS: Human fetal skin was digested with dispase or type II collagenase, and then by micro - sieving to isolate human sebaceous gland and eccrine sweat gland cells. DMEM/F12 (1: 1) was used as the basic culture medium, supplemented with fetal bovine serum, recombinant human epidermal growth factor, L-glutamine, Hydrocortisone, choleratoxin, penicillin and streptomycin as the medium for sebocytes, or fetal bovine serum, recombinant human epidermal growth factor, triiodothyronine, hydrocortisone, insulin, transferrin, sodium selenite to the medium for eccrine sweat gland duct cells. Primary cultures and subcultures were incubated at 37 degrees C in humidified atmosphere of 5% CO2/95% oxygen. Cell morphology was observed by inverted phase contrast microscopy, and the cultured cells were identified with cell clone efficiency determination. The cultured sebocytes were identified with oil red staining and CK4.62, Epithelia Membrane Antigen (EMA) immunohistochemistry staining. The cultured eccrine sweat gland duct cells were identified with CK7, CK19 immunohistochemistry staining. RESULTS: The isolated sebocytes and eccrine sweat gland cells from human fetal skin could grow by adhering to the wall and proliferate in vitro. The cell clone efficiency of human fetal sebocytes was 2.7%, which was obviously lower than that of human fetal keratinocytes (8.0%, P < 0.01). There was no obvious difference in the cell clone efficiency between human fetal eccrine sweat gland cells (7.3%) and human fetal keratinocytes (7.7%, P > 0.05) . The results of oil red staining indicated that a small quantity of lipid droplets in sebocytes, and immunohistochemistry staining of CK4.62, EMA were positive in subculture sebocytes. The immunohistochemistry staining of CK7, CK19 was positive in subculture eccrine sweat gland duct cells. CONCLUSION: In vitro cultured human fetal sebocytes and eccrine sweat gland duct cells displayed the markers and biological characteristics of epithelial lineage, but human fetal sebocytes proliferated more

Characterization of vernix caseosa: water content, morphology, and elemental analysis.

Recent studies have prompted interest in the use of epidermal barrier creams as protective biofilms for very low birthweight preterm infants. The key to understanding the role of epidermal barrier films is an elucidation of their interaction with water and a basic knowledge of their composition. In this study, we investigated the morphologic properties and elemental composition of the naturally occurring biofilm, vernix caseosa. This biofilm is typically lacking in preterm infants and its production coincides in utero with terminal differentiation of the epidermis and formation of the stratum corneum. Significantly, vernix (80.5+/-1.0% H2O) had a much higher water content than other barrier creams (Eucerin: 17.1+/-0.6%, Aquaphor: 0.33+/-0.03%, Ilex: 0.19+/-0.02%, petrolatum: 0.03+/-0.01%; all p<0.05). Phase contrast microscopy of vernix showed multiple cellular elements with nucleic "ghosts" embedded in a putative lipid matrix. Transmission electron microscopy revealed flattened structures approximately 1-2 microm in thickness with distinct cellular envelopes indicative of differentiated corneocytes. Compared with mature corneocytes in adult stratum corneum, vernix corneocytes appeared swollen, the density of the keratin filaments was less, and there was a relative lack of tonofilament orientation. Cryofractured specimens were examined by cryoscanning electron microscopy with subsequent elemental localization by X-ray beam analysis. The findings indicate the high water content of vernix is largely compartmentalized within fetal corneocytes. These results are consistent with the novel view of vernix as a "fluid phase" stratum corneum consisting of a hydrophobic lipid matrix with embedded fetal corneocytes possessing unique biomechanical and water-binding properties.

Subamnionic vernix caseosa.

Vernix caseosa occasionally dissects underneath the amnion, presumably following rupture of the amnion prior to rupture of the chorion laeve. We describe the clinicopathological features of 18 cases in which large quantities of vernix caseosa were present beneath the amnion of the parietal membranes or the chorionic plate. The subamnionic vernix caseosa was an unexpected microscopic finding in each case and was not associated with any inflammation, giant cell reaction, or other chronic change in the adjacent membranes. The gestational age ranged from 29 to 42 weeks (mean, 37). Five (28%) of the 18 were twin pregnancies. Five (28%) were delivered by cesarean section. In no case was there a history of amniocentesis, prolonged rupture of membranes, or amnionic fluid leakage. None of the mothers had signs of amnionic fluid embolism. The absence of tissue response around the vernix caseosa suggests rupture of the amnion close to the time of delivery.

Features of vernix caseosa cells.

In an attempt to collect more information about the features of the vernix caseosa (VC), a relatively unstudied material, some of the histochemical, ultrastructural, and immunological characteristics of VC cells have been investigated. Histochemistry and light microscopy was used to demonstrate the activity of acid and alkaline phosphatase in VC cells, enzymes with a marked increase in activity in the amniotic fluid toward term. Acid phosphatase activity was strongly present either as intracytoplasmic granules or as amorphous material between the cells; alkaline phosphatase activity was absolutely nonexistent. The ultrastructural morphology of the VC cells was analyzed by scanning and transmission electron microscopy (TEM). Significant differences can be demonstrated in the individual surface patterns of the VC keratinocytes. TEM showed irregularly flattened cells in various stages of keratinization. The ultrastructural findings confirm the dissimilarity, which exists between the individual VC cells. Finally, immunofluorescent staining tests of frozen VC smears showed that only immunoglobulin G conjugate gives strong positive reaction at the antigen sites of the VC cells. The special finding in this study is the polymorph appearance of the surface pattern and the cytoplasma structure of the VC cells, as well as the lack of uniform appearance of the acid phosphatase activity in and between the cells. All these suggest that the status of the individual VC cell is not similar in regard to their keratinization and desquamation activities.

Ultrasonographic demonstration of floating particles in amniotic fluid.

This prospective study of 131 pregnant women was designed to determine the incidence and significance of floating particles in amniotic fluid. Floating particles ranging in size from 1 to 5 mm were seen in the amniotic fluid of pregnant women at 15 to 40 weeks' gestation. Since vernix is rarely present before 35 weeks' gestation, a source other than flakes of vernix must be sought to explain the floating particles in amniotic fluid in early gestations. There was no significant difference in the sizes or numbers of particles at different gestational ages (from 15 to 40 weeks). Therefore, it is concluded that ultrasonographic demonstration of floating particles in amniotic fluid cannot be considered an indicator of fetal maturity.