Asymmetry and anomalies of the circle of Willis in fetal brain. Microsurgical study and functional remarks

The arteries of the circle of Willis in fetal brains of 20-40 weeks of gestational age were studied with the operating microscope. The majority of fetuses were between 24-32 weeks of age. Our findings were as follows: 1) the average diameters of all segments were 4-5 times narrower than the average diameters in adults, and the average lengths of the same segments were 2-2.5 times shorter than the same lengths in adults; 2) the number of perforators corresponded with the perforating arteries in adults; 3) hypoplastic segments, as well as anomalies and variations, were identified; 4) calibers almost equal in size between the right and left corresponding segments were found in a high proportion of cases; 5) in the majority of cases a polygon, much like the "precarious" circle in adults, was dissected. The "fetal" or the "ideal" circles were found in a low proportion of cases.     

Anaesthesia for fetal surgery

A variety of fetal disorders are now accessible to treatment in utero due to the rapid advances in diagnostic and therapeutic possibilities. Different surgical techniques, such as open or endoscopic fetal procedures, require special anaesthesiological management because the anaesthesiologist has to care for two patients—the mother and the fetus. This chapter describes currently performed fetal interventions and outlines anaesthesiological features. We describe the pros and cons of regional and general anaesthesia for this highly specialized surgical field, as well as different treatment modalities in post-operative pain and tocolytic therapy. Ethical issues arise because fetal surgery is a relatively new sector and deals with unborn life. Although, currently, only a few centres carry out fetal surgical interventions, this medical field is expanding. This chapter offers some support to the anaesthesiologists who have to care for these patients in the future.     

Ultrasonic prediction of fetal mass

A clinically accurate method for estimating fetal mass from fetal body parameters is reviewed. The abdominal circumference is first calculated from the anteroposterior and transverse diameters. This is used as an extra indicator of fetal age. By adding the biparietal diameter, these measurements are converted into fetal mass. From percentile tables the fetal mass at different stages of pregnancy and at term can then be predicted. This method was used on 101 private patients and the average error between actual and predicted mass was 210 g (6.5% of the birth mass).     

MRI测量正常中晚孕胎儿大脑主要径线的价值

目的探讨3.0T MRI测量正常胎儿头颅主要径线的可重复性及其与孕周的相关性;建立MRI对正常胎儿大脑发育的量化评价方法。方法收集219胎超声检查初步提示胎脑解剖结构正常的胎儿。采用3.0T MR仪扫描胎儿颅脑。由2名MRI医师测量胎儿脑双顶径、脑额枕径、骨双顶径、骨额枕径、头围、胼胝体长度及小脑横径,评价观察者间的可重复性,并对胎儿颅脑主要径线与孕周相关性进行分析。结果 2名医师应用MRI测量胎儿颅脑主要径线的可重复性好(组内相关系数均0.7);胎儿脑双顶径、脑额枕径、骨双顶径、骨额枕径、头围、胼胝体长度、小脑横径与孕周均呈正相关(r=0.957、0.974、0.949、0.959、0.971、0.887、0.985,P均0.001)。结论 3.0T MR用于测量正常中晚孕胎儿大脑主要径线具有较好的可重复性;孕中晚期胎儿脑生物测量参数随孕龄呈二次多项式函数变化趋势。     

孕晚期胎羊作为供肝来源的解剖可行性实验研究

目的探讨孕晚期胎羊的肝脏作为肝移植供肝来源的外科解剖可行性。方法从9只孕晚期胎羊中取出其肝脏,修肝,测量其重量、各管道外径等,并与16只新生羊的肝脏相比较。结果孕125～135 d胎羊的体重较小(1 000 g),血管较细、较脆,在修肝过程中缝线牵引时,肝上和肝下下腔静脉极易撕脱。孕142～145 d的胎羊体重达1 050～1 560 g,在修肝过程中肝上和肝下下腔静脉无牵引线撕脱现象,与出生9 d内新生羊的肝脏在管径上相差不大,可以直接进行外科吻合;其门静脉较小,可用其脐静脉与新生羊的门静脉进行外科吻合;动脉吻合宜将胎羊腹主动脉上开口处修剪成袢与受体的相应动脉吻合;胆道重建则选择胎羊胆囊与新生羊的小肠或总胆管吻合。结论体重小于1 000 g的胎羊(孕135 d以内)不宜作为肝移植的供体;而孕142～145 d胎羊的胎肝可作为1周内新生羊原位肝移植和较大新生羊辅助肝移植的供肝,在外科解剖上是可行的。     

Analysis of collagen content in the fetal wound

The absence of apparent scar formation following the creation of surgical wounds in utero appears to be a phenomenon peculiarly privileged as a sequela of fetal wound healing. Little information exists to explain this disparity from our knowledge of adult wound healing. Therefore, following creation of surgical wounds in fetal rats, at different intervals the healing wounds were harvested and analyzed for collagen content and types. The average proportion of type III collagen was elevated in normal (26.5%) as well as wounded fetal skin (33.8%) when compared with normal levels for the adult (15%). The total collagen content was markedly diminished in the fetal wound. Although embryonal collagen synthesis apparently does exist in fetal reparative processes, the relationship to the lack of gross scarring remains undetermined.     

Shadow photogrammetric apparatus for the quantitative evaluation of corneal buttons

We have developed a technique for the accurate, quantitative, geometric evaluation of trephined and punched corneal buttons. A magnified shadow of the frontal and edge views of a corneal button mounted on the rotary stage of a modified optical comparator is projected onto the screen of the comparator and photographed. This process takes approximately three minutes. The diameters and edge profile at any meridian photographed can subsequently be analyzed from the film. The precision in measuring the diameters of well cut corneal buttons is +/- 23 microns, and in measuring the angle of the edge profile is +/- 1 degree. Statistical analysis of inter observer variability indicated excellent reproducibility of measurements. Shadow photogrammetry offers a standardized, accurate, and reproducible method for analysis of corneal trephination.     

Rat tail: A useful model for microvascular training

The rat femoral vessel model is widely used as the basic model for microvascular training; however, it offers only a limited number of anastomoses and vessel sizes. Rat tail vessels provide long length, almost as long as the tail; adequate diameters, from about 1 mm to 0.2 mm; as well as the economy and a convenient location for practicing microvascular anastomoses. It is also the best choice for anastomosing vessels smaller than 0.5 mm diameter. Using stored, frozen tails harvested from sacrificed rats of other projects makes it even more frugal and convenient. Hence, it is an ideal model for microvascular training. The related anatomy and dissecting method are described and discussed. © 1995 Wiley-Liss, Inc.     

Increase in fetal pulmonary artery diameters during late gestation is a predictor of outcome in congenital diaphragmatic hernia with liver herniation

Aim

Liver herniation (LH) in congenital diaphragmatic hernia (CDH) may not be a reliable prognostic indicator. We measured pulmonary artery (PA) diameters in CDH + LH as an alternative.

Methods

Of 41 consecutive cases of prenatally diagnosed left-sided CDH treated from 2002 to 2010, 19 had CDH + LH and 22 had CDH − LH. Ultrasonography and magnetic resonance imaging were used to assess LH and echocardiography to measure PA diameters during the third trimester (fetal; 32-34 weeks), at birth, and on day 2 of life.

Results

In CDH + LH survivors (9/19; 47%), fetal right PA (RPA) diameters were significantly larger than in nonsurvivors (2.58 ± 0.56 vs 1.82 ± 0.35 mm; P < .01), but left PA (LPA) diameters were not (1.73 ± 0.38 vs 1.59 ± 0.22). In survivors, fetal RPA was greater than 2 mm in all but one case, and both PA diameters increased significantly by birth (RPA, 2.58 ± 0.56 vs 3.52 ± 0.54; LPA, 1.73 ± 0.38 vs 2.60 ± 0.40; both P < .01). Final diameters at birth in survivors were at least 2.5 and 2.0 mm, respectively. In nonsurvivors, both PAs were significantly smaller (RPA, 3.52 ± 0.54 vs 2.04 ± 0.31; LPA, 2.60 ± 0.40 vs 1.68 ± 0.18; P < .01), with no observed increase by birth. Survival in CDH − LH was 82% (18/22).

Conclusion

PA diameter appears to be correlated with prognosis in infants with CDH + LH.     

Infrared venography of the hand in Apert syndrome

As well as craniofacial synostosis, complex syndactyly of hands is a distinctive feature of Apert syndrome. Consideration of blood flow to the digits is very important in separation surgery. Several reports offer information about arterial distribution in Apert''s hands. Though, venous pattern has not been well discussed. Infrared venography offers a real-time image with minimal invasion. An Apert syndrome patient underwent a series of finger splitting surgeries. Infrared venography was carried out to assess veins. There was a palmar venous arch, placing distally to the metacarpophalangeal joint. The arch had to be cut to divide fused fingers sufficiently. As well as arterial abnormality, venous uniqueness should be noted in Apert syndactyly surgeries. Infrared venography, which can be carried out easily, offers good information that surgeon require.KEY WORDS: Anomaly, Apert syndrome, hand, infrared, syndactyly, vein     

时间-空间相关成像技术的反转模式在胎儿心血管成像中的应用进展

随着三维及四维超声技术的迅速发展,时间-空间相关成像技术(STIC)已成为研究胎儿心脏的一种相对成熟的技术,其多种成像模式可提供更多结构及血流的相关信息,为临床诊断提供依据。STIC技术的反转模式可更清晰、准确地呈现心室腔和血管腔的立体结构。本文就其在胎儿心血管系统中的研究进展进行综述。     

Longitudinal and thickness measurement of the normal distal and intravesical ureter in human fetuses

PURPOSE: We define reference data concerning the development of the ureterovesical junction in fetuses and newborns by measuring the diameters of the distal mesenchymal and muscular ureteral walls as well as intravesical ureteral length. MATERIALS AND METHODS: A total of 90 normal fetal and newborn ureters were investigated. Our histological studies were based on "plastinated" sections of whole pelves which allow study of the sectional anatomy of the distal and intravesical ureter. The development of the mesenchymal and smooth muscle growth of the distal and intravesical ureter was examined. The ureteral measurements were correlated with age of gestation. RESULTS: The length of the intravesical ureter and mesenchymal as well as smooth muscle walls increased in a linear mode. Significant correlations (p <0.0001) were found between gestational age and the growth of the mesenchymal as well as smooth muscle walls in the distal intravesical ureter as well as the length of the intravesical ureter. CONCLUSIONS: Significant positive linear relationships exist between gestational week, and distal and intravesical ureteral wall thickness of the mesenchymal and smooth muscle growth to the length of the intravesical ureter in fetuses and newborns. The ratio of the intravesical ureteral length-to-ureteral diameter is obviously lower than assumed previously. Data from this study can be used for a more accurate assessment of cases with abnormal lower urinary tract development.     

Value of magnetic resonance imaging in cancer of the endometrium. Apropos of 3 cases

Magnetic nuclear resonance imaging offers a new approach for assessing the spread of endometrial cancer. Clinical and histopathological data correlated well in two cases; in the third patient, the degree of vesicovaginal wall involvement was more difficult to appreciate. RMN accurately characterizes the tumor and provides information on how deeply the myometrial lesion extends, as well as on isthmic and cervical involvement. Such evaluation is conducive to more precise prognostic conclusions and may be strategically influencial on therapeutic behavior.     

采用基因芯片筛选与汗腺发育相关基因的初步研究

目的：探讨人胚胎皮肤汗腺在不同发育胎龄时的基因表达变化特征及其可能的生物学意义。方法：收集12周（H1）、16周（H2）、24周（H3）等3组不同胎龄胎儿皮肤,组织常规切片,显微镜下观察胚胎皮肤不同发育阶段的汗腺结构特征,提取不同胎龄的胚胎表皮组织总RNA,用逆转录-聚合酶链反应（RT-PCR）方法和基因芯片技术检测胚胎皮肤汗腺在不同发育阶段的基因表达变化规律。结果：光镜下可见不同发育阶段的胎儿皮肤具有典型的组织学结构,胎龄24周时汗腺结构初步形成,数量稳定。在95%的可信区间内,H2与H1样本相比较（H2/H1）,差异表达基因有113个,其中下调的基因有45个,上调的基因有68个;H3与H2样本相比较（H3/H2）,差异表达基因有91个,其中下调的基因有66个,上调的基因有25个;差异表达的基因包括生长因子、细胞外基质分子和外胚层发育因子等,与汗腺发育进程密切相关。结论：将基因芯片运用于汗腺发生机制的研究,可以较全面地反映汗腺发育及成熟过程中基因表达变化规律,寻找特异性调控基因。通过对汗腺不同发育阶段的基因表达及功能研究,可以筛选关键步骤调控基因,指导实现分子基因水平调控皮肤创面修复和汗腺组织再生。     

Uncooled Infrared Camera for the Noninvasive Visualization of the Vascular Flow in an Anastomotic Vessel during Neurological Surgery: Technical Note

We herein present our experience to assess intraoperative confirmation of vascular patency with an uncooled infrared camera in extracranial–intracranial (EC-IC) bypass surgery. This camera had distinguishing characteristics, including its small size, light weight, and adequate temperature resolution (< 0.022 degrees). We used a simplified zoom germanium lens as a preliminary study to verify the potential of using this camera to assess the vascular flow of the end-to-side anastomosis model in rats. In addition, we evaluated the vascular flow in continuous clinical series using this infrared camera during EC-IC bypass in 14 patients (17 sides). This infrared camera offers real-time information on the vascular patency of end-to-side anastomosis vessels of all relevant diameters. The spatial resolution and image quality are satisfactory, and the procedure can be safely repeatable. We have shown that the infrared camera could be a new and feasible technology for intraoperative imaging of the vascular flow and is considered to be clinically useful during cerebrovascular surgery.     

Evaluation of lower-limb arteries with multidetector computed tomography angiography prior to free flap surgery: a radioanatomic study

In this study, we aimed to evaluate the vascular structures of the lower limb with multidetector computed tomography (CT) angiography and to reveal the importance of this method in preoperative planning of microsurgical transplantation. In 24 patients, lower-limb arteries were bilaterally evaluated with 16-detector spiral CT scanner in terms of patency, stenosis, or occlusion; maximal and minimal external diameters through their traces; and variations as well as length of the peroneal artery. The peroneal artery was absent unilaterally in two patients (4.3%). The mean maximal and minimal diameters were as 2.77 and 1.63, 2.92 and 1.75, and 2.72 and 1.50 mm for anterior and posterior tibial and peroneal arteries, respectively. The ranges of lengths of peroneal arteries were 50 to 117 mm. This valuable tool can provide detailed information about vascular and the remaining anatomic structures by means of its high-resolution characteristics before planning free flap surgery.     

Proteomics: clinical applications for head and neck squamous cell carcinoma

The emerging field of proteomics offers great promise for unraveling the complex molecular events of tumorigenesis, as well as those that control clinically important tumor behaviors such as metastases, invasion, and resistance to therapy. Understanding the molecular basis of these tumor characteristics will usher in a new age of individualized cancer therapy. Advances in genomics, the study of genes and gene expression, as well as technologic advances have made possible study of all expressed proteins or the proteome (proteomics). Whereas genomics offers the opportunity to examine gene expression or variation in gene sequence, proteomics encompasses evaluation of protein expression, activation, modification, and degradation and ambitiously targets protein function. Although the present age has already been referred to as the post-genomic era, it is our opinion that both proteomics and genomics will provide clinically useful and complementary information that will speed scientific understanding of cancer. Ultimately, these new technologies will positively impact care of patients with head and neck squamous cell carcinoma.     

Marking of the stereotactic target point by a radiopaque silicone sphere

Summary We present a simple but efficient technique for marking the site of a stereotactic biopsy. This is done by a radiopaque Barium impregnated silicone sphere, which is introduced through the stereotactic cannula and placed at the target point. This allows a postoperative check of the target point by computer tomography or Magnetic Resonance Imaging and offers a landmark for further stereotactic intervention as well as for planning of high precision radiotherapy. Moreover it gives information about the growing direction of a tumour. The silicone spheres are well tolerated; no complications have occured so far.     

Hyperparathyroidism in pregnancy.

Primary hyperparathyroidism in pregnancy is uncommon and easily overlooked. It is associated with a complication rate of up to 80 per cent--mainly stillbirths, abortions and neonatal tetany. Surgical treatment during pregnancy offers the best chance for fetal and neonatal survival.