Hemangiomas of the Umbilical Cord

Four cases of umbilical cord hemangioma are presented and analyzed with all previously reported cases. Umbilical cord hemangiomas consist of an angiomatous nodule containing and encompassed by edema and myxomatous degeneration of Wharton's jelly, often cystic. The angiomatous nodules range from 0.2 to 7 cm in largest dimension, whereas the associated edema may measure up to 15 cm. The tumors tend to occur at the placental end of the cord and presumably arise from one or more of the major umbilical vessels. The angiomatous nodules tend to be sharply demarcated from the surrounding stroma and are invariably cytologically benign. Although cord hemangiomas are strongly associated with fetal morbidity and mortality, a causal relationship has not been definitely established. There is no apparent association between cord hemangiomas and maternal age, race, or gravidity nor does one sex predominate. Unlike placental hemangiomas, cord hemangiomas are not associated with maternal hydramnios. Ultrastructural differences between umbilical cord and placental amnion explain both this differing clinical effect as well as the presence of marked edema and myxomatous degeneration of Wharton's jelly in cord tumors. Speculation concerning an underlying congenital predisposition to vascular neoplasm in these infants is presented.     

Omphalomesenteric Duct Cysts of the Umbilical Cord

Three cases of omphalomesenteric (OM) duct cyst within the umbilical cord are presented and analyzed together with 6 previously reported cases. The embryology of the OM duct is reviewed, emphasizing those portions of the duct that may persist beyond early fetal life. Omphalomesenteric duct cysts are located at the proximal (fetal) end of the cord and range from 0.4-6.0 cm in diameter. They appear as cystically dilated “miniature” segments of the gastrointestinal tract and are lined by columnar epithelium resembling that of the gastric, small intestinal, or colonic mucosa; islands of pancreatic tissue may be associated with the cyst lining. The cysts have peripheral angiomatoid vascularity and the surface epithelium of the cord at one site tends to be hyperplastic. These lesions occur more often in males than in females and are unrelated to prematurity or to maternal age, race, or gravidity. They only rarely cause fetal morbidity or mortality but evidence is presented to suggest that they may on occasion be associated with potentially dangerous intraabdominal anomalies of the OM duct.     

Thrombosis of the Umbilical Cord: Analysis of 52 Cases and Literature Review

Fifty-two cases of umbilical cord thrombosis from 3 patient populations are analyzed and compared with 68 cases from the literature. The incidence of cord thrombosis is approximately 1/1300 deliveries, 1/1000 perinatal autopsies, and 1/250 high-risk gestations. There is a slight male predominance. Umbilical vein thrombosis occurs more frequently than thrombosis of one or both umbilical arteries, but poor fetal outcome is more likely with arterial thrombosis. The mechanism of fetal death when only one umbilical artery is thrombosed is illustrated and discussed. The strong association between cord thrombosis and perinatal morbidity and mortality is not noted among prospective cases but, when present, is related to additional umbilical cord abnormalities, obstetrical complications, or systemic fetal conditions that are the likely cause of both the thrombosis and the poor fetal outcome. The pathogenetic relationship between cord thrombosis and these associated conditions is discussed, and it is concluded that cord thrombosis is a marker of both the severity of these conditions and the likelihood of poor fetal outcome.     

Transplantation of Umbilical Cord Blood in a Refractory Lymphoma

A successful cord blood transplantation combined with hematopoietic growth factor was performed in a boy presenting with refractory mediastinal T-cell lymphoma. Cord blood cells were collected from an HLA-identical sibling at the time of delivery. A transient and corticosensitive acute grade II graft versus host disease was observed. One year after transplantation, the child is still in remission with complete engraftment. This is the first report of cord blood transplantation in a patient with refractory lymphoma.     

Umbilical Cord Stricture and Intrauterine Fetal Death

Umbilical cord stricture is an uncommon but distinctive condition associated with intrauterine fetal death. Although cases have been reported periodically since the last century, there has been considerable speculation as to whether the condition is real or a postmortem artifact. In the present study, 25 cases reported since 1925 are reviewed and 8 new cases are described. Clinically, a decrease in fetal movements is usually the only symptom during the second or third trimester of pregnancy and fetal death occurs soon after. The women's age, health, and previous history have shown no link with this condition, but a higher incidence is noted in twin pregnancies. Morphologically, most infants are macerated and an extremely narrow segment of umbilical cord is usually seen at the fetal end and rarely at the placental end or in multiple sites along the cord. Absence of Wharton's jelly, stenosis, or obliteration of cord vessels at the narrow segment and intravascular cord thrombosis are the major pathological features. The findings of this study support the view that the condition can cause fetal death and alerts both pathologists and clinicians to the important features identifying this cause of perinatal wastage.     

Prediction of the Development of Neonatal Jaundice by Increased Umbilical Cord Blood Bilirubin

ABSTRACT. Umbilical cord serum bilirubin concentration as a predictor of subsequent jaundice was studied in 291 newborns. It was possible to define subgroups of infants with significantly higher or lower risks of developing jaundice. If cord bilirubin was below 20 |imol/l, 2.9% became jaundiced as opposed to 85% if cord bilirubin was above 40 μmol/l. Furthermore, 57% of jaundiced infants with cord bilirubin above 40 nmol/1 required phototherapy, but only 9% if cord bilirubin was 40 μmol/1 or lower ( p <0.003). Knowledge of infants at risk of developing jaundice allows simple bilirubin reducing methods to be implemented before jaundice is present and could influence a decision regarding early discharge from hospital. Since the ability of plasma to bind bilirubin in cord blood from jaundiced and non-jaundiced infants showed no significant differences, the increased cord bilirubin among infants who later became jaundiced is presumably caused by increased fetal bilirubin production or decreased removal of bilirubin from the fetal circulation.     

人脐带血间充质干细胞在缺氧缺血性脑病新生鼠脑内的定植

目的探讨脐带血间充质干细胞(MSCs)培养及其在缺氧缺血性脑病(HIE)新生鼠脑内的定植。方法用出生7 d的新生SD大鼠制作HIE模型,同时在当天分别用2种方法(定向注射和尾静脉注射方式)接受经Hoechst 33258标记24 h的MSCs移植,15~30 d观察MSCs存活情况。结果用改良Rice法可制备7日龄新生鼠单侧脑损伤为主的HIE模型;经定向注射和尾静脉注射移植的MSCs能在HIE脑内定植,分布在患侧大脑皮层、海马等部位,并主要以额叶为多,和宿主脑组织融合在一起。结论在体外培养条件下,人脐血MSCs可以生长,当MSCs移植到HIE模型鼠后,细胞能和脑实质融合在一起,并更多地向脑损伤部位迁移聚集。     

Abnormal Umbilical Cord Coiling Is Associated with Adverse Perinatal Outcomes

The normal umbilical cord coil index is one coil/5 cm, i.e., 0.2 ± 0.1 coils completed per cm. We report the frequency and clinical correlations of abnormally coiled cords among 1329 cases referred to our placental pathology services. Twenty-one percent of cords were overcoiled and 13% were undercoiled. Abnormal cord coiling was seen at all gestational ages. Principal clinical correlations found in overcoiled cords were fetal demise (37%), fetal intolerance to labor (14%), intrauterine growth retardation (10%), and chorioamnionitis (10%). For undercoiled cords, the frequencies of these adverse outcomes were 29%, 21%, 15%, and 29%, respectively. Abnormal cord coiling was associated with thrombosis of chorionic plate vessels, umbilical venous thrombosis, and cord stenosis. Thus, abnormal cord coiling is a chronic state, established in early gestation, that may have chronic (growth retardation) and acute (fetal intolerance to labor and fetal demise) effects on fetal well-being. The cause of abnormal cord coiling is not known. Its effects on neurological status of survivors are also unknown. Antenatal detection of abnormal cord coil index by ultrasound could lead to elective delivery of fetuses at risk, thereby reducing the fetal death rate by about one-half. We recommend that the cord coil index become part of the routine placental pathology examination. Received December 1, 1999; accepted February 15, 2000.     

胎盘绒毛组织及脐血中造血细胞生长因子对人胎盘造血功能的影响

目的检测胎盘绒毛组织多种造血细胞生长因子(HGF)含量,探讨其对胎盘造血的意义。方法分别取早孕(6- 8周)、中孕(16-22周)、足月妊娠(37-42周)胎盘绒毛组织2 g各30份、脐血清30份,测定上清液中各种HGF含量。结果早期妊娠各种HGF均已产生;FL-13、IL-3在胎盘绒毛组织中含量随着胎龄增加,各胎龄组间比较,均有显著差异(P均< 0.01)。7种HGF在胎盘和脐血中含量,均有显著差异(P均<0.01)。结论F-T3配体(FL)、干细胞因子(SCF)、G-CSF等7 种HGF均参与胚胎期造血,尤以FL、IL-3、SCF最为重要。     

三种不同方法分离脐血造血干细胞的效果比较

目的探讨一种较好的脐血造血干细胞(HSCs)的分离方法,以最大限度地分离出脐血中的HSCs,使其以高纯度、最佳生长状态用于治疗和研究。方法取本院足月妊娠健康产妇的脐血20份,每份均采用羟乙基淀粉沉淀(HES)法、淋巴细胞分离液(Ficoll)密度梯度离心法、免疫磁珠(MACS)法处理。比较3种方法分离后的单个核细胞(MNCs)回收率、锥虫蓝拒染率及CD34细胞阳性率;将以上3种方法所得细胞用完全培养基培养,不同时间点计数细胞,绘制生长曲线,并观察原代细胞的生长情况及其形态特征;并采用半固体琼脂培养法,计数其粒-巨噬细胞集落形成单位数。结果 HES法得到的MNCs回收率高于Ficoll密度梯度离心法和MACS法(Pa<0.05);锥虫蓝拒染率三者比较差异无统计学意义(P>0.05);MACS法所得细胞CD34阳性率明显高于另2种方法(Pa<0.05),并且其所得细胞生长状态好,集落数最多;HES法和Ficoll法所得细胞,部分呈贴壁生长,与贴壁细胞共培养的细胞生长状态好;Ficoll密度梯度离心法得到细胞生长状态最差,集落数最少。结论 HES法可作为一种首选常规分离脐血造血干细胞的方法;MACS法分离得到造血干细胞纯度高,适于实验及临床研究。     

丹参诱导人脐血间充质干细胞分化为神经样细胞

目的探讨丹参注射液对人脐血单个核细胞来源的间充质干细胞(MSCs)向神经细胞分化的诱导作用。方法利用FACScan流式细胞仪检测MSCs表面抗原CD29、CD44、CD59、CD33,用丹参注射液诱导人脐血原代细胞和脐血来源的间充质干细胞向神经细胞方向分化,并与神经生长因子(NGF)和神经常苷脂(GM1)的诱导作用比较,用免疫细胞化学方法对分化和未分化细胞进行鉴定。结果人脐血原代细胞中MSCs的表耐标记CD29、CD44、CD59阳性率分别为10.7%、37.27%和66.67%,而造血细胞的表面标记CD33阳性率仅为0.33%。人脐血传代细胞(第5代)MSCs的表面标记CD29、CD44、CD59的阳性率分别为40.2%、70.5%和95.4%。原代培养的贴壁细胞形态呈大小不等圆形和条形,用丹参诱导可表达神经细胞的标记。传代培养的间充质干细胞,可维持在未分化状态稳定增殖。用丹参可诱导这种细胞向神经样细胞分化,表达神经干细胞标记nestin,神经元的标记β-Ⅲ类神经微管(β-TubulinⅢ)、神经微丝(NF)和神经胶质细胞的标记胶质纤维酸性蛋白(GFAP)。与NGF和GMI的诱导作用比较,细胞形态类似,表达相同的神经细胞标记,丹参的诱导速度较快,诱导后细胞表达神经元标记的比例较高。结论人脐血是MSCs的来源之一,丹参可诱导人脐血干细胞分化为神经样细胞,丹参可作为神经诱导剂,人脐血干细胞可作为神经干细胞的来源。     

Fetus in Fetu: A Case with Complete Umbilical Cord and Fetal Sac

The authors present a retroperitoneal fetus in fetu in a 3-month-old girl. A 15-cm cystic mass with a monstrous fetuslike structure surrounded by a complete sac containing serous fluid was removed from the left retroperitoneal space. The draining vessel of the cystic mass was connected to the right renal vein of the host. The included fetus weighed 380 g. It had a well-developed umbilical cord, four extremities, head, buttock, and vertebral bodies with a meningomyelocele. The thoracic cavity of the included fetus had only a saclike foregut structure, but the abdominal cavity revealed a full length of intestine with a Meckel diverticulum, bilateral ovaries, urinary bladder, and cloaca with external opening. The cephalic end was composed of well-developed tooth germs, tongue and buccopharynx, mandible, maxilla, sphenoid bone, and salivary glands. Chromosomal study showed 46,XX with a normal G banding pattern. We report this case as an example of fetus in fetu with a complete umbilical cord and fetal membrane.     

Strangulation of the Umbilical Cord by Amniotic Bands: Report of 6 Cases and Literature Review

The amniotic band syndrome is the triad of amnion-denuded placenta; fetal attachment to or entanglement by amniotic remnants; and fetal deformation, malformation, or disruption. Theories of pathogenesis and etiology of the syndrome are discussed.

Amniotic bands occur in 1 of every 5000-15,000 births and are demonstrable in 1-2% of malformed infants. Nearly 10% of cases include umbilical cord strangulation. Six cases of umbilical cord strangulation by amniotic bands are presented, and 57 previously reported cases are reviewed. Two of the 63 were liveborn and 61 were stillborn, 3 of whom died intrapartum. Thirty had associated fetal abnormalities. Five were from multiple gestations. Outcome of the co-twin was determined by its presence within the same amniotic sac. Four fetuses beyond 28 weeks had short cords and were the only malformed fetuses in this age group. The earlier in gestation that amniotic bands form, the greater the likelihood of associated fetal abnormalities. All but 2 of 28 less than 32 weeks and only 4 of 35 greater than 32 weeks were malformed. A marked male predominance was noted in the former group, perhaps because the larger size and/or more vigorous movements of male fetuses promote early amnion rupture.     

早产儿脐血造血干/祖细胞特点

目的对12例早产儿和18例足月儿脐血采集量、有核细胞数量、CD34+细胞比例、体外形成造血细胞克隆的能力进行比较研究。方法采用密闭式脐血采集袋,经脐静脉穿刺收集脐带血,按体积比5:1与60 g.L-1羟乙基淀粉(HES)混合、浓缩有核细胞,流式细胞仪检测CD34+细胞比例,甲基纤维素半固体培养基检测其脐血形成造血细胞克隆能力。结果早产儿脐血采集量及分离前后有核细胞数量均低于足月儿脐血[脐血采集量分别为(76.52±22.48)mLvs(94.21±20.32)mL,P<0.05;分离前有核细胞数量分别为(4.78±2.30)×108vs(8.36±2.51)×108,P<0.01;分离后有核细胞数量分别为(3.72±1.71)×108vs(6.54±1.94)×108,P<0.01)]。早产儿CD34+细胞比例高于足月儿脐血[(0.49±0.16)%vs(0.32±0.13)%,P<0.01],早产儿脐血体外生成红系爆式集落形成单位和粒-单系集落形成单位的能力也高于足月儿脐血[分别为(29.58±10.54)/2×105MNCvs(19.27±7.26)/2×105MNC,P<0.01和(45.28±16.2...     

人脐带间充质干细胞向胰岛素分泌细胞分化过程免疫特性的研究

目的研究人脐带间充质干细胞(huMSCs)向胰岛素分泌细胞(IPCs)分化过程中的免疫学特性,为huMSCs作为胰岛细胞移植治疗1型糖尿病的细胞来源提供依据。方法以流式细胞术检测huMSCs及huMSCs源性IPCs的免疫表型;RT-PCR法检测huMSCs及huMSCs源性IPCs的HLA-A、HLA-DR基因的表达;CCK8法测定细胞增殖率,观察huMSCs及huMSCs源性IPCs对外周血单个核细胞增殖的影响。结果 huMSCs在体外培养条件诱导下,具有向胰岛素分泌细胞分化的潜能;huMSCs及huMSCs源性IPCs均不表达CD80、CD86、CD40、CD40L、HLA-DR,均表达HLA-A;huMSCs能够抑制PHA刺激的外周血单个核细胞的增殖,但huMSCs源性IPCs未见该作用。结论 huMSCs及huMSCs源性IPCs均具有低免疫原性,可作为胰岛细胞移植的细胞来源,huMSCs对免疫反应具有负调节作用,但huMSCs源性IPCs不具有该作用。     

Morbidity, Mortality, and Placental Pathology in Excessively Long Umbilical Cords: Retrospective Study

The purpose of this study was to compare specific fetal, maternal, and placental factors, including neonatal morbidity and mortality, in infants with umbilical cords (UCs) of normal length to the same factors in infants with excessively long umbilical cords (ELUCs). We performed an 18-year retrospective chart review of the medical records of mothers and infants with ELUCs (926 cases) and normal-length UCs (200 cases) and recorded maternal factors, fetal factors, and neonatal outcomes. Corresponding placental pathologic reports and slides were reviewed. Statistical analysis comparing the two groups included univariate and multivariate analyses. ELUCs were significantly associated with certain maternal factors (systemic diseases, delivery complications, increased maternal age), fetal factors (non-reassuring fetal status, respiratory distress, vertex presentation, cord entanglement, fetal anomalies, male sex, increased birth weight), gross placental features (increased placental weight, right-twisted cords, markedly twisted cords, true knots, congestion), and microscopic placental features (nucleated red blood cells, chorangiosis, vascular thrombi, vascular cushions, meconium, increased syncytial knots, single umbilical artery). Some of these histopathologic features have previously been associated with fetal hypoxia and/or altered blood flow in the placenta. Infants with ELUCs were found to be at a significantly increased risk of brain imaging abnormalities and/or abnormal neurological follow-up. In addition, mothers with a history of an ELUC are at increased risk of a second long cord. Received February 4, 2000; accepted April 24, 2000.     

Heterotopic Glial Nodule in the Lung of Anencephaly

Abstract Heterotopic glial nodule in the lung is a rare abnormality. Most reported cases are associated with major cranial malformations including anencephaly. The pathogenesis of this condition has not been established. The hypotheses are (1) embolization of glial tissue after head trauma during fetal development, (2) aspiration/implantation of fragments of brain tissue from the amniotic fluid, and (3) aberrant migration of neural crest elements to the lung. This report documents the presence of an intravascular embolus of a glial nodule, which offers support to the embolization theory for the pathogenesis of this peculiar abnormality.     

PCR-Based Allelic Discrimination for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency in Ugandan Umbilical Cord Blood

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common X-linked disorder in the world. G6PD deficiency puts children at risk for hyperbilirubinemia and kernicterus during the newborn period and an increased risk of severe hemolysis after exposure to many antimalarial medications. A laboratory diagnosis of G6PD deficiency is rare in the developing world due to limited resources. We developed a TaqMan-based allele-specific assay to rapidly determine rates of G6PD deficiency contributing alleles (G202A and A376G) in East Africa. We tested umbilical cord blood from 100 Ugandan newborns and found that the overall allele frequency of G202A was .13 and A376G was .32. The overall incidence of G6PD A? (G202A/A376G) was 6%; all A? variants were males. There was no correlation between G6PD deficiency and umbilical cord blood hemoglobin, white blood count, platelet count, or other hematologic parameters. Allele-specific PCR can serve as a rapid method to determine specific G6PD deficiency allele frequencies in a given population and as a diagnostic tool in a hospital setting in which laboratory resources are present.     

窒息后缺氧缺血性脑病新生儿脐血S-100B蛋白变化的意义

目的研究脐血S-100B蛋白在窒息新生儿中的变化,探讨其对新生儿窒息后缺氧缺血性脑病(HIE)的早期诊断价值。方法同期分娩足月正常新生儿43例为对照组(1组)。Apgar评分<7分未发生HIE 44例,为窒息组(2组);发生HIE 16例,为HIE组(3组)。用ELISA方法分别检测3组脐静脉血S-100B水平。结果1~3组S-100B蛋白水平分别为(1.055±0.356)(、1.572±0.533)(、2.394±0.943)μg/L。2、3组脐血S-100B较1组显著增高(t=2.306,7.991 P均<0.01)。3组脐血S-100B较2组显著增高(t=4.242 P<0.01)。结论窒息新生儿脐血S-100B蛋白较正常升高,其可作为窒息后HIE早期诊断指标之一。