The human vomeronasal organ. Part II: prenatal development

During the 20th century, the human vomeronasal organ (VNO) has been controversial regarding its structure, function, and even identity. Despite reports that provide evidence for its presence throughout prenatal and postnatal ontogeny, some studies and numerous textbooks declare its absence in late fetal and postnatal humans. To that end, the present study was designed to establish firmly whether the human VNO is homologous with that of other mammals and whether it degenerates (partially or completely) or persists throughout prenatal development. Fifty human embryos and fetuses (33 d to 32 wk fertilisation age) and 2 neonates were examined by light microscopy. Four embryonic primates (mouse lemurs) were examined for a comparison of VNO embryogenesis. The presence or absence and structural characteristics of the VNO and supporting tissues are described. The first appearance of the VNO was in the form of bilateral epithelial thickenings of the nasal septum, the vomeronasal primordium. The primordia invaginated between 37 and 43 d of age and formed the tubular VNO. The tubular VNO was located dorsally at a variable distance from, but was always spatially separated from the paraseptal cartilages. The mouse lemurs examined in this study and other reports from the literature indicate that the human VNO resembles that of primates having functional VNOs until just after a tubular VNO is formed. Examination of the VNO and adjacent tissues suggested that the VNO may lose receptor cells and corresponding vomeronasal nerves and become a ciliated, pseudostratified epithelium between ～ 12 and 14 wk of age. Our findings indicate the prenatal human VNO goes through 3 successive stages: early morphogenesis, transformation (of the epithelium), and growth. These observations indicated that (1) all embryonic humans develop a vomeronasal organ which is homologous with the VNOs of other mammals, but which has become displaced and highly variable in relative location during embryogenesis; (2) the human vomeronasal organ does not degenerate prenatally, but very likely loses the functional components of the vomeronasal complex of other mammals; and (3) the remnant of the human VNO persists until birth and beyond.     

Effect of low-dose cyclosporin on plasma lipoproteins and markers of cholestasis in patients with psoriasis

The benefits of using cyclosporin in organ transplantation toprevent graft rejection outweigh its potential disadvantages,but with the use of lowdose cyclosporin in relatively healthyindividuals, such as those with psoriasis, the risk:benefitratio is altered. The effects of low-dose cyclosporin (<5mg/kg body weight) on liver function and serum lipids and lipoproteinswere examined in 40 normolipidaemic, normotensive psoriasispatients with normal renal function. After 3 months of treatment,serum cholesterol and bilirubin concentrations and alkalinephosphatase activity increased significantly (p = 0.001), andglomerular filtration rate (GFR) declined from 107 to 96 ml/min/1.73m² (p = 0.05). All these values returned to pretreatment levels3 months after cessation of cyclosporin. In 15 patients in whomlipoproteins were isolated by ultracentrifugation, there wasan increase in plasma low-density lipoprotein (LDL) cholesterol(p=0.05), but very-low-density lipoprotein cholesterol, high-densitylipoprotein (HDL) and HDL₂ and HDL₃ cholesterol concentrationsdid not change. The increases in serum bilirubin, alkaline phosphataseactivity and LDL cholesterol, seen in individuals with normalbaseline liver and renal function, which reverted to baselinefollowing cessation of cyclosporin, suggest that cyclosporininducedhypercholesterolaemia may be due to either decreased biliaryexcretion of cholesterol or impaired catabolism of LDL.     

Significance of a mitral regurgitation systolic murmur complicating a first acute myocardial infarction in the coronary care unit -- assessment by colour Doppler flow imaging

To determine the prevalence and significance of a systolic mitralmurmur heard after a first acute myocardial infarction (MI),we studied 186 consecutive patients in the coronary care unit(CCU) during a one-year period. Fifteen patients had a murmuras a result of mitral regurgitation (MR) (prevalence 8%) documentedby colour Doppler flow imaging. It was heard before the thirdday of hospitalization in 10 (67%) patients, and on the thirdday itself in the remainder. The severity of MR was graded semi-quantitatively:moderate in 12 (80%) patients, and mild, moderate to severeand severe in three respectivety. The direction of the MR jet,determined by colour flow imaging, improved the informationobtained by two-dimensional echocardiography (2D echo) thatcould only diagnose mitral leaflet abnormality in seven (47%)patients. in 10 of 15 (67%) patients, the 2D echo ejection fractionwas 40% and in eight (53%) the wall motion score obtained byanalysing 11 left ventricular (LV) segments was $$$8. Two (13%)patients died in tile CCU, four (27%) had LV failure, one anginaand eight (53%) remained asymptomaric in the hospital. Of 171patients without a systolic murmur, 22 (13%) had LV failure,13 (8%) angina and 25 (15%) died during the in-hospital stay(P-NS for these complications between patients with and withoutMR murmur). During a follow-up of 12–24 months, one MRpatient died, and seven (47%) remained asymptomatic. We conclude that the prevalence of MR systolic murmurs in acuteMI patients is low. The LV function and the prognosis of a majorityof these patients is rather good.     

Hydrometrocolpos: Diagnosis and Follow-up by Ultrasound — A Case Report

Hydrometrocolpos is accumulation of secretions in the vagina and uterus, caused by excessive intrauterine stimulation of the infant's cervical mucous glands by maternal oestrogen in the presence of an intact hymen (Wilson et al 1978). Hydrocolpos is dilatation of the vagina proximal to a congenital obstruction. If the uterus is also dilated, the condition is called hydrometrocolpos. Most cases of hydrocolpos are associated with an imperforate hymen that forms a thin bulging membrane between the labia. Though many cases of hydrometrocolpos have been reported in literature, there is no case report which shows classical ultrasound findings and follow up ultrasound scans to show the involuted uterus. We are presenting a case report whose diagnosis was established on ultrasound. This case highlights the value of ultrasound in diagnosing this condition and excluding other associated renal anomalies.     

STUDY OF LOW BIRTH WEIGHT NEONATES

Low birth weight neonates with 2000g or less birth weight constitute about 10% of live births with perinatal mortality as high as 32.4%. Perinatal morbidity is 19.3% with asphyxia neonatorum and neonatal jaundice heading the list. Epidemiological maternal factors include extremes of age and parity, lack of antenatal care, low socioeconomic status, illiteracy and underweight short women. Etiologic factors are obstetric complications, hypertensive disorders, systemic diseases or idiopathic. The scope of preventive measures include improvement of economic status and education about health and safe pregnancy. Proper antenatal care for early detection of high risk cases, adequate and timely management of complications and adequate facilities for neonatal care can reduce the perinatal morbidity and mortality.KEY WORDS: Low birth weight neonates, Perinatal mortality