Follicular dendritic cell sarcoma of the soft palate.

Follicular dendritic cell (FDC) sarcomas are extremely rare, with only 2 reported cases involving the palate. These tumors have typical oval to spindle cells with fine chromatin, obvious nucleoli and indistinct cell borders. They are usually arranged as sheets, whorls, or in a storiform pattern. Although FDC sarcoma has a characteristic morphologic picture, due to its rarity it may be mistaken for other types of sarcoma, carcinoma or melanoma. Immunohistochemical and ultrastructural studies are useful for confirmation of the diagnosis. We report a case of FDC sarcoma developing in the soft palate. The patient suffered from an oral cavity mass with dysphagia in the previous 2 months as well as body weight loss of 8 kg during the previous 6 months. He was well previously and denied any other systemic problems. Wide excision of the tumor was performed and no recurrence or metastasis was noted for 5 years. The success of the procedure may have been due to a well-defined tumor margin and less aggressive histological features. The ability to recognize and differentiate extranodal FDC tumors based on knowledge of their full morphologic spectrum is important as they have an intermediate malignant potential.     

Three- and four-dimensional HDlive rendering images of normal and abnormal fetuses: pictorial essay

Background

Our objective is to present our experience of normal embryonic development and fetal anatomy and fetal anomalies reconstructed employing the three-dimensional (3D) and four-dimensional (4D) HDlive rendering mode.

Methods

A total of 18 normal embryos and fetuses and 21 abnormal fetuses (one case each of thoracic meningocele, thickened nuchal translucency, multicystic dysplastic kidney, gastroschisis, omphalocele, and ovarian cyst, five of hydrops fetalis, three of skeletal abnormality, three of chromosome abnormality, two of cystic hygroma, and two of amniotic band syndrome) at 7–36?weeks’ gestation were studied using the 3D/4D HDlive rendering mode.

Results

In normal fetuses, marked embryonic development with advancing gestation was clearly shown in the first trimester of pregnancy, and various realistic facial expressions were noted in the second and third trimesters. In abnormal fetuses, anatomically realistic features such as gross specimens were obtained. In particular, 3D/4D HDlive provides new, realistic sensations for the diagnosis of amniotic band syndrome, skeletal abnormalities, and facial abnormalities.

Conclusion

3D/4D HDlive rendering images seem to be more readily discernible than those obtained by conventional 3D/4D sonography. 3D/4D HDlive may be an important modality in future embryonic research, fetal neurobehavioral assessment, and the evaluation of fetal anomalies.     

脑室扩张胎儿的MRI诊断及预后

目的 探讨超声发现的脑室扩张胎儿行MRI检查的临床价值,并观察脑室扩张胎儿的预后.方法 选择2006年3月至2008年7月在中国医科大学附属盛京医院行超声检查发现有胎儿脑室扩张的孕妇135例,产前检查孕周平均为32周.为进一步明确诊断行MRI检查.MRI检查发现胎儿单侧或双侧侧脑室三角区宽度为10～15 mm者诊断为轻度脑室扩张,16～20 mm者诊断为中度脑室扩张,>20 mm者诊断为重度脑室扩张.采用病例对照研究方法,对MRI诊断为单纯轻度脑室扩张胎儿和无异常胎儿,在出生后半年至1年进行丹佛智能发育筛查量表(DDST)检测,以判断单纯轻度脑室扩张胎儿在婴幼儿期的智力及生长发育状况.结果 (1)MRI诊断胎儿脑室扩张的准确率:135例超声诊断的脑室扩张胎儿中,MRI检查无明显异常56例(41.5%,56/135),单纯脑室扩张60例(60/135,44.4%),脑室扩张合并脑出血5例(3.7%,5/135),脑室扩张合并胼胝体异常12例(8.9%,12/135),脑室扩张合并小脑发育不良2例(1.5%,2/135).MRI诊断胎儿脑室扩张共79例,其中合并胼胝体异常率为15.2%(12/79).(2)MRI检查胎儿脑室扩张的分度:MRI诊断胎儿单纯脑室扩张60例,其中55例(91.7%,55/60)为轻度脑室扩张,5例为中度脑室扩张(8.3%,5/60);脑室扩张合并脑出血的5例胎儿中,1例为轻度脑室扩张、4例为中、重度脑室扩张;脑室扩张合并胼胝体异常的12例胎儿中,8例(66.7%,8/12)为中度脑室扩张,4例为重度脑室扩张(33.3%,4/12);脑室扩张合并小脑发育不良的2例胎儿均为中度脑室扩张.(3)DDST检测结果:55例单纯轻度脑室扩张胎儿中,符合随访条件的30例为病例组.无异常的56例中随访到38例,同期因其他原因行MRI检查无异常的胎儿42例,共计80例为对照组.病例组婴儿中DDST检测结果为可疑或异常4例(13.3%,4/30),正常26例(86.7%,26/30);对照组婴儿中DDST检测结果为可疑或异常10例(12.5%,10/80),正常70例(87.5%,70/80).两组分别比较,差异均无统计学意义(P>0.05).(4)MRI检查确诊的79例单纯脑窜扩张胎儿的临床结局:79例脑室扩张胎儿中,30例轻度脑室扩张胎儿及5例中度脑室扩张胎儿均妊娠至足月,出生后随访未发现婴儿异常;另有7例拒绝合作,6例孕妇坚决要求引产,失访12例.合并胼胝体发育异常的12例胎儿中,3例继续妊娠,胎儿出生后复查MRI,其诊断结果与胎儿期的MRI检查结果相同;8例孕妇坚决要求引产,失访1例.合并脑出血的5例胎儿均按孕妇意愿选择引产,尸体检查结果均证实MRI诊断正确.合并小脑发育不良的2例胎儿,1例要求继续妊娠,足月分娩,生后半年婴儿确诊为脑瘫,另有1例引产.结论 对超声发现的脑室扩张胎儿进一步行MRI检查有重要的临床验证和补充诊断价值;胎儿单纯轻度脑室扩张在出生后6～12个月期间,智力及生长发育与同龄儿无异.     

Fetal distress evaluation using and analyzing the variables of antepartum computerized cardiotocography

Objective  

In this study, we tried to establish cut-off values for more than one parameters of computerized cardiotocography (c CTG) in the prediction of fetal distress during labor, using a group of pregnant women with low-risk pregnancies.     

Fetal echocardiography using transvaginal and transabdominal probes during the first period of pregnancy: a comparative study

The authors compare the diagnostic possibilities of fetal transabdominal echocardiography versus transvaginal echocardiography. A larger diagnostic capacity is verified in different gestation ages with transvaginal probe between the 11th and 14th week of gestation. The results are emphasized by colour Doppler.     

Fetal growth restriction: the etiology

Fetal growth restriction (FGR) is etiologically associated with various maternal, fetal and placental factors, although such an association may not be present in many cases. Maternal factors include hypertensive diseases, autoimmune disorders, certain medications, severe malnutrition, and maternal lifestyle including smoking, alcohol and cocaine use. Fetal etiologies include aneuploidy, malformations, syndromes related to abnormal genomic imprinting, perinatal viral or protozoan infections, preterm birth, and multiple gestation. Placental factors may involve many conditions including anatomical, vascular, chromosomal and morphological abnormalities. Better understanding of these etiologic conditions may lead to improved prediction, prevention and management of FGR.     

Pseudosinusoidal Fetal Heart Rate Pattern and Fetal Anaemia: Case Report and Review

Summary: The association of a pseudosinusoidal fetal heart rate pattern with fetal anaemia is reported. A system of classifying this cardiotocographic feature as minor, intermediate or major is discussed. The clinical correlates of each of these gradings and the differentiation from a true sinusoidal fetal heart rate pattern are presented.     

Fetal anaemia: diagnosis and management

Fetal anaemia can by treated by in-utero therapy, which results in a significant improvement in perinatal outcome. The important causes of fetal anaemia are rhesus alloimmunisation, kell alloimmunisation and parvovirus infection. At-risk pregnancies require serial monitoring to ensure timely intervention with intrauterine transfusion. Non-invasive testing with middle cerebral artery Doppler is becoming the monitoring modality of choice.     

Fetal death: diagnosis and management

Death of the fetus after 20 weeks of gestation complicates about 1% of pregnancies. Of various means of diagnosing fetal life and death, real-time ultrasound visualization of the fetal heart is the most accurate. Delivery of the dead fetus can be effected by various means, but in most instances, at least before 28 weeks and perhaps thereafter as well, the simplest and most effective method is with prostaglandin vaginal tablets. A variety of conditions are known to cause fetal death or increase the risk that it will happen, but these account for only about 50% of cases. Four special tests may identify a cause of the "unexplained stillbirth" in the other 50% of cases. These tests include karyotype, listerial culture, fetomaternal hemorrhage, and lupus anticoagulant.     

Fetal distress and the condition of the newborn using cardiotocography and fetal blood analysis during labour

The efficacy of electronic fetal monitoring combined with fetal blood analysis during labour in identifying fetal distress was investigated in a retrospective study. Operative delivery for fetal distress diagnosed during labour was performed in 9% of 2659 deliveries. All had continuous fetal heart rate monitoring and 22% had a fetal scalp blood analysis. Operative delivery had been performed in 53% of the infants who were acidotic at birth (umbilical artery pH less than 7.20) and in 46% of those with a low modified Apgar score (less than 7). These results show that the use of continuous fetal heart rate monitoring and fetal scalp blood sampling detects fetal distress without resulting in a high rate of operative delivery.     

Fetal Surveillance: Issues and Implications

In the past, the fetus was considered healthy until evidence was presented to the contrary. With the acceptance of fetal surveillance as part of the pregnancy experience, diagnostic testing and data are thought to be necessary to prove the healthiness of the fetus. The availability of fetal surveillance techniques has transformed the pregnancy experience from a developmental process and a miracle of nature to a risk-dominated and technology-guided event. The implications of this trend significantly affect the care of pregnant women and the role of nurses as providers of comprehensive, individualized nursing care.     

Fetal bradyarrhythmia: diagnosis and outcome

Seventeen patients were referred to out ultrasound unit because of fetal bradyarrhythmia (less than 100 bpm). Duration of pregnancy varied between 21 and 40 weeks. Bradyarrhythmia was diagnosed as atrioventricular block (n = 12), mild sinus bradycardia (n = 3), and irregular bradycardia (n = 2). The association with maternal collagen disease was 29 per cent and with cardiac structural defects 59 per cent. The overall mortality was 41 per cent. There were three abnormal karyotypes (17 per cent) and four cases of cardiac compromise (23 per cent). Prognosis depends on the nature of the bradyarrhythmia and recognition of associated pathology such as cardiac structural defects, abnormal karyotype and degree of cardiac compromise.