In-utero Diagnosis of Double Encephalocele - Imaging Features and Review of Literature

Encephalocele is protrusion of brain parenchyma through a defect in the cranium. It is classified into various types based on the defect location: sincipital (fronto-ethmoidal), basal (trans-sphenoidal, spheno-ethmoidal, trans-ethmoidal, and spheno-orbital), occipital and parietal. Double encephaloceles are very rare with only a handful of cases reported in the literature and most of these cases involved either occipital or sub-occipital region. All, except one, cases of double encephaloceles were diagnosed postnatally. We present a case of double encephalocele with parietal and occipital components diagnosed in utero. To the best of our knowledge, this is the first case of double encephalocele involving the parietal and occipital skull bones diagnosed in-utero.     

Auditory ossicles: a potential biomarker for maternal and infant health in utero

Abstract

Background: Carbon (δ¹³C) and nitrogen (δ¹⁵N) isotope ratios of collagen from teeth and bone are used to study human nutrition and health. As bones are constantly remodelling throughout life, isotopic values of bone collagen represent an average of several years. In contrast, human teeth do not remodel and their primary dentine contains only the isotopic data from the time of formation. In contrast to all other bones, human auditory ossicles also appear not to remodel. As they develop in utero and finish formation in the first 2 years of life, their collagen should also represent isotopic values of these two relatively short periods.

Aim: By comparing δ¹³C and δ¹⁵N data from ossicles and incremental dentine, this study aims to investigate how two developmental periods of the ossicles, in utero and the first 2 years of life, reflect in collagen obtained from the ossicles.

Subject and methods: Ossicle and tooth samples of 12 individuals aged 0.5?±?0.4 years to 13?±?1 years from the nineteenth century St. Peter’s burial ground in Blackburn were collected and processed to obtain bulk bone and incremental dentine collagen which was measured for δ¹³C and δ¹⁵N.

Results: Averaged δ¹³C and δ¹⁵N of ossicles are lower when compared to every age group except after 3 years of age. Average offset between ossicles and dentine of different groups ranges from 0.4–0.9‰ for δ¹³C and from 0.3–0.9‰ for δ¹⁵N, with highest counterbalance at birth and after the first 5 months after birth.

Conclusions: There appears to be a systematic offset between the dentine and ossicle data. It seems that the second phase of development does not influence the isotopic values of collagen significantly and the data we are obtaining from ossicles represents the in utero period.     

Different Alcohol Types-Different Models of Drinking:

A classroom survey among 3061 secondary school students in four provinces in Zimbabwe aimed at enabling analysis of social and cultural predictors for use of alcohol and other drugs. The present paper focuses on the relationship between choice of different alcohol types and two indicators for regular drinking. A two-stage sampling strategy distinguished between four different sociocultural subgroups. Measures on experience with different alcohol types were subject to a principal component analysis, revealing one imported (or western) alcohol component and one traditional (or indigenous) alcohol component with the industrially produced opaque beer Chibuku loading on both. Multiple logistic regression revealed experience with western alcohol types to be associated with indicators for frequent drinking as well as experience with being drunk. Experience with use of the traditional alcohol types was not associated with self-reported experience with being drunk. Use of Chibuku was, however, associated with such experience for boys. It is suggested that an integration of traditional and western drinking culture represents reduced danger for socially disruptive modes of drinking among adolescents as compared to a one-sided adoption of western patterns.     

Exposure to female hormone drugs during pregnancy: effect on malformations and cancer.

This study aimed to investigate whether the use of female sex hormone drugs during pregnancy is a risk factor for subsequent breast and other oestrogen-dependent cancers among mothers and their children and for genital malformations in the children. A retrospective cohort of 2052 hormone-drug exposed mothers, 2038 control mothers and their 4130 infants was collected from maternity centres in Helsinki from 1954 to 1963. Cancer cases were searched for in national registers through record linkage. Exposures were examined by the type of the drug (oestrogen, progestin only) and by timing (early in pregnancy, only late in pregnancy). There were no statistically significant differences between the groups with regard to mothers' cancer, either in total or in specified hormone-dependent cancers. The total number of malformations recorded, as well as malformations of the genitals in male infants, were higher among exposed children. The number of cancers among the offspring was small and none of the differences between groups were statistically significant. The study supports the hypothesis that oestrogen or progestin drug therapy during pregnancy causes malformations among children who were exposed in utero but does not support the hypothesis that it causes cancer later in life in the mother; the power to study cancers in offspring, however, was very low. Non-existence of the risk, negative confounding, weak exposure or low study-power may explain the negative findings.     

In-utero transplantation of fetal liver stem cells into human fetuses.

Three human fetuses were treated by transplantation of human fetal liver stem cells. Two of them had severe immunodeficiency disease and the third had thalassaemia major. All three in-utero transplants were followed by engraftment. No adverse effect was seen. The three patients have now been born: the first is very healthy thanks to the reconstitution of cell-mediated immunity associated with this transplant, and he lives normally at home; the other two, who were treated more recently, have not yet shown a complete effect. The feasibility and efficacy of this procedure, used for the first time in humans, has therefore been demonstrated: during early fetal development, foreign cells engraft readily and may result in significant improvement of a large variety of inherited diseases.     

Haematopoietic stem cell transplantation and gene therapy in the fetus: ready for clinical use?

Allogeneic haematopoietic stem cell transplantation in utero has been successfully used for the prenatal treatment of severe combined immunodefiency syndrome. However, this treatment has not been successful in the therapy of other conditions in which the fetus is immunologically competent. The main obstacles to success are lack of competitive advantage of donor versus host stem cells, preventing stable engraftment and graft rejection. Several strategies are being explored to overcome these problems, and some of them have been successful in animal studies. Prenatal gene therapy, using ex-vivo transduced autologous haematopoietic cells or direct gene targeting in utero, is another potential approach in the treatment of immunocompetent fetal recipients. Although this has been shown to be feasible in animal models, safety concerns regarding transduction of fetal germ cells or maternal cells should be addressed in preclinical experiments prior to initiation of clinical trials.     

Evidence for infection of the human embryo with adeno-associated virus in pregnancy.

Previous reports have demonstrated the presence of DNA of the human helper virus-dependent adeno-associated parvovirus (AAV) in uterine tissue and curettage material from early miscarriage. To examine infection of embryonic tissue during pregnancy, amnion fluids were analysed for the presence of AAV. Using polymerase chain reaction, AAV DNA was detected in 64 out of 238 DNA samples extracted from amnion cells. DNA of helper viruses were found in 12% (papillomavirus) and 18% (cytomegalovirus) of the samples (double infections with AAV in eight and nine cases, respectively). Furthermore, infectious AAV virions were found in 13 out of 43 AAV DNA-containing samples. In mothers with AAV DNA-positive amnion fluids, premature amniorrhexis and premature labour occurred significantly more frequently (P < 0.001). Using an immunofluorescence assay, 24% of newborn sera (unrelated to the amnion fluid samples) were found to contain IgM antibodies to AAV, in most cases paralleled by IgM antibodies in the mother's sera. The data demonstrate that AAV infection can occur in utero at early and at late stages of pregnancy. The observed complications at delivery should encourage studies to clarify possible pathological consequences of AAV infection in pregnancy and a possible latent infection of the fetus.