Development and regulations of testicular functions in the human foetus

Two major functions are assumed by the testis: the production of male gametes (that is, spermatozoa) and the production of steroid hormones. Both two functions are established during fetal life and are essential to the adult fertility and the masculinization of the internal tract and genitalia. For many years, our laboratory has been interested in the ontogeny of those two functions in rodents and, since 2003, in collaboration with gynecology and obstetrics service of professor R. Frydman in Antoine-Béclère hospital, we have studied them in human. The first aim of this work was to improve the global knowledge of the human fetal testis development by using both our experimental data and the literature. Then, we focused on the different defects that can occur during the fetal testis development. Indeed, male reproductive abnormalities have been steadily increasing since the last decades and are thought to be related to the concomitant increase of the concentration of contaminants and particularly of endocrine disruptors in the environment. Thus, we decided to study the effect of endocrine disruptors on human fetal testis and, more particularly, the effect of phthalates, by using an organ culture system developed for human. In contrast to the data obtained in rat, mono (ethylhexyl)-phthalate (MEHP), an active metabolite of the most widespread phthalate in the environment, does not disturb the steroidogenic function. On the other hand, it has a negative effect on the male germ cells number. This study is the first experimental demonstration of a negative effect of phthalates directly on human fetal testis.     

Contribution of 3D-ultrasound in the heterotaxy syndromes: about four cases and review of the literature

The position or location of the organs and vessels is usually classified into three types: situs solitus, situs inversus, and situs ambigus. Situs solitus is the usual arrangement of organs and vessels within the body. Only 0.6 to 0.8% of patients with situs solitus and levocardia have associated congenital heart diseases. Situs inversus refers to an anatomic arrangement that is the mirror image of situs solitus. The incidence of congenital heart disease is increased to 3 to 5% in the patients with situs inversus. The patients with heterotaxy have congenital heart disease in high incidence, ranging from 50 to nearly 100%. We present four cases diagnosed in our department in a period of 18 months. With these four cases and a review in the literature, we explore the definitions and characteristics of heterotaxy syndromes and we study the role of 3D ultrasound.     

Evaluation of the coronary arteries in the foetus and newborn and their physiologic significance

Abstract

Objective: To review the current literature addressing the visualisation and clinical applicability of coronary artery blood flow in various foetal and neonatal settings.

Method: We reviewed original research papers, commentaries and review articles which studied the usefulness of coronary flow assessments in the growth restricted foetus, healthy neonates and neonates with clinical conditions such as asphyxia, congenital heart disease and post-surgical duct ligation myocardial failure.

Results: Relevant literature showed that visualisation of coronary blood flow in growth restricted foetuses is considered an ominous sign and identifies a subgroup of foetuses with a poorer foetal and neonatal outcome. A direct relationship between coronary blood flow and echocardiographic parameters in healthy term infants was noted. These assessments also provided useful information in infants with heart disease and perinatal asphyxia. Coronary perfusion has been noted as an important haemodynamic marker in the peri-operative evaluation of preterm infants undergoing surgical duct ligation.

Conclusions: The available literature suggests that these assessments play an important role in improving the understanding of the underlying clinical physiology of the disease process in both the foetus and the newborn. Future research should focus on the evolution of coronary blood flow in clinical situations such as hypotension and inotropic support.     

Histologic subtypes and laterality of primary epithelial ovarian tumors

OBJECTIVES: To determine if the likelihood of bilateral primary ovarian tumors differs by histologic subtype. METHODS: Using data collected by the Surveillance Epidemiology and End Results (SEER) program, the analysis included 22,328 women 25-84 years of age who were diagnosed with a borderline or malignant epithelial ovarian tumor during 1992-2000, categorized as to laterality and histologic subtype. RESULTS: Malignant serous tumors were bilateral in 57.5% of cases. Corresponding figures for mucinous, clear cell, endometrioid and other epithelial tumors were 21.3%, 13.3%, 26.8%, and 35.6%, respectively. Borderline serous tumors were bilateral in 29.8% of the cases compared to only 7.0% of mucinous tumors. The tendency for serous tumors to present as bilateral was consistent across all categories of race, age, and stage. CONCLUSIONS: Serous tumors of the ovary are more commonly bilateral than ovarian tumors of other histologic subtypes. The reasons for this tendency remain to be determined.     

Prenatal depression effects on the foetus and neonate in different ethnic and socio-economic status groups

The questions addressed in this study were whether prenatal depression effects on the foetus and neonate varied by ethnicity and socio-economic status. Eighty-six depressed pregnant women were compared by ethnic group, Hispanic and African-American, and by socio-economic status (upper/lower) on prenatal and neonatal outcome variables. The Hispanic mothers were older, had a higher SES and had higher prenatal norepinephrine levels. Their foetuses were also more active. At the neonatal period they had higher anger scores, but also higher serotonin levels, and their infants had higher dopamine and lower cortisol levels and they spent less time in deep and indeterminate sleep. The comparison by middle/lower socio-economic status revealed that the middle SES group was older, had more social support and showed less depressed affect but had higher norepinephrine levels prenatally. At the postnatal period the middle SES mothers had lower depression, anxiety and anger scores and lower norepinephrine levels.Their infants also had lower norepinephrine levels, fewer postnatal complications and were less excitable on the Neonatal Behaviour Assessment Scale.     

Ultrasound and hormonology in the diagnosis of hydatiform mole with coexistent foetus. A case report

The Authors report a case of hydatiform mole coexistent with a 12 week old foetus. They suggest that a diagnosis of hydatiform mole cannot always be based on the results of ultrasound examination and that combined ultrasound/hormone assay investigation is a valid obstetric tool for formulating the diagnosis and prognosis of hydatiform mole.     

Trisomy 16 in a mid-trimester IVF foetus with multiple abnormalities

An 18 week foetus with multiple system abnormalities was found to have full trisomy 16. This appears to be only the third reported case surviving into mid-gestation; typically, this common aneuploidy dies post-implantation. Similarities exist in the abnormalities found in the three cases suggesting that there is a 'surviving' trisomy 16 phenotype. It is characterised by: absent hemidiaphragm, pulmonary hypoplasia/aplasia, major cardiac defect, small chest, vertebral and rib defects, cystic kidneys, absent gall bladder, multiple spleens and imperforate anus, together with cleft palate, nuchal webbing/cystic hygroma, microcephaly, marked dysmorphic facial features and dorsiflexed great toe.     

The Diagnosis of Disorders in the Newborn

IN Victoria about 1,600 children die each year. Of these, at least 53 per cent die in the first month of life, and 46 per cent in the first week. There is an undeniable challenge to the medical profession in these figures. In the first year of life the number of deaths per 1,000 live births, i.e. the infant mortality rate, has fallen continuously and dramatically throughout this century. However, although the infant mortality rate has fallen to less than one-fifth of the rate in 1900, the fall in the neonatal mortality rate has been much less gratifying (Fig. 1). Thus, in this State the infant mortality rate has fallen from 100 in 1900 to 19.2 in 1958, while the neonatal mortality rate has only fallen from 34 in 1900 to 13.5 in 1958. Half a century ago the neonatal period provided 30 per cent of all deaths in the first year of life; today it provides 75 per cent. These figures surely speak for themselves and we must ask ourselves: how often is this loss of neonatal life preventable?     

Obesity and the Hypertensive Disorders of Pregnancy

Overweight and obesity have a strong association with the development of hypertensive disorders of pregnancy. However, the mechanisms underpinning this relationship are not clear. Obesity is associated with insulin resistance, endothelial dysfunction, hypertension dyslipidaemia, inflammatory upregulation, alteration in immune function and prothrombotic changes. These changes may contribute to the development of hypertensive disorders of pregnancy, by influencing placentation, endothelial function, and inflammation. The genetic predisposition for hypertensive disorders of pregnancy needs to be examined in the context of obesity. Common antecedents such as dietary factors and inadequate physical activity might also explain the relationship between hypertensive disorders of pregnancy and obesity. This review is concluded with a synopsis and recommendations for further research.