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Slesnick TC, Ayres NA, Altman CA, Bezold LI, Eidem BW, Fraley JK, Kung GC, McMahon CJ, Pignatelli RH, Kovalchin JP. Characteristics and outcomes of fetuses with pericardial effusions. Am J Cardiol 2005; 96:599-601. [PMID: 16098320 DOI: 10.1016/j.amjcard.2005.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Revised: 04/05/2005] [Accepted: 04/05/2005] [Indexed: 10/25/2022]
Abstract
Little is known about the characteristics and outcomes of fetuses with pericardial effusions (PEs); therefore, this study sought to identify factors associated with fetal PEs and the natural histories and outcomes of fetuses with PEs. Large PEs are associated with a greater likelihood of structural heart disease, impaired cardiac function, and chromosomal abnormalities, and PEs with hydrops or extracardiac malformations are associated with death. Most fetal PEs resolve, and fetuses with isolated PEs have a very good prognosis.
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Affiliation(s)
- Timothy C Slesnick
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, USA
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Coles JG, Boscarino C, Takahashi M, Grant D, Chang A, Ritter J, Dai X, Du C, Musso G, Yamabi H, Goncalves J, Kumar AS, Woodgett J, Lu H, Hannigan G. Cardioprotective stress response in the human fetal heart. J Thorac Cardiovasc Surg 2005; 129:1128-36. [PMID: 15867790 PMCID: PMC5328676 DOI: 10.1016/j.jtcvs.2004.11.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We propose that the fetal heart is highly resilient to hypoxic stress. Our objective was to elucidate the human fetal gene expression profile in response to simulated ischemia and reperfusion to identify molecular targets that account for the innate cardioprotection exhibited by the fetal phenotype. METHODS Primary cultures of human fetal cardiac myocytes (gestational age, 15-20 weeks) were exposed to simulated ischemia and reperfusion in vitro by using a simulated ischemic buffer under anoxic conditions. Total RNA from treated and baseline cells were isolated, reverse transcribed, and labeled with Cy3 or Cy5 and hybridized to a human cDNA microarray for expression analysis. This analysis revealed a highly significant (false discovery rate, <3%) suppression of interleukin 6 transcript levels during the reperfusion phase confirmed by means of quantitative polymerase chain reaction (0.25 +/- 0.11-fold). Interleukin 6 signaling during ischemia and reperfusion was assessed at the protein expression level by means of Western measurements of interleukin 6 receptor, the signaling subunit of the interleukin 6 receptor complex (gp130), and signal transducer of activated transcription 3. Posttranslational changes in the protein kinase B signaling pathway were determined on the basis of the phosphorylation status of protein kinase B, mitogen-activated protein kinase, and glycogen synthase kinase 3beta. The effect of suppression of a prohypertrophic kinase, integrin-linked kinase, with short-interfering RNA was determined in an ischemia and reperfusion-stressed neonatal rat cardiac myocyte model. Endogenous secretion of interleukin 6 protein in culture supernatants was measured by enzyme-linked immunosorbent assay. RESULTS Human fetal cardiac myocytes exhibited a significantly lower rate of apoptosis induction during ischemia and reperfusion and after exposure to staurosporine and recombinant interleukin 6 compared with that observed in neonatal rat cardiac myocytes ( P < .05 for all comparisons, analysis of variance). Exposure to exogenously added recombinant interleukin 6 increased the apoptotic rate in both rat and human fetal cardiac myocytes ( P < .05). Short-interfering RNA-mediated suppression of integrin-linked kinase, a prohypertrophy upstream kinase regulating protein kinase B and glycogen synthase kinase 3beta phosphorylation, was cytoprotective against ischemia and reperfusion-induced apoptosis in neonatal rat cardiac myocytes ( P < .05). CONCLUSIONS Human fetal cardiac myocytes exhibit a uniquely adaptive transcriptional response to ischemia and reperfusion that is associated with an apoptosis-resistant phenotype. The stress-inducible fetal cardiac myocyte gene repertoire is a useful platform for identification of targets relevant to the mitigation of cardiac ischemic injury and highlights a novel avenue involving interleukin 6 modulation for preventing the cardiac myocyte injury associated with ischemia and reperfusion.
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Affiliation(s)
- John G Coles
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
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Bulla M, Kuwertz-Bröking E, Fründ S, Schulze Everding A, Louwen F, Baez E, Steinhard J, Brinkmann O, August C, Harms E, Hertle L, Kiesel L. Fetale Nephro-/Uropathien: Retrospektive Analyse von 124 Fällen, erfasst im Zeitraum von 1996 bis 2002. Z Geburtshilfe Neonatol 2005; 209:100-7. [PMID: 15995942 DOI: 10.1055/s-2005-871219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The embryological development of the kidneys and the urinary tract follows a complex choreography. Disorders are quite common. The incidence of disorders amounts to 0.3 - 0.8 % of live-born infants. In addition, several chromosomal anomalies are combined with renal malformations. The poor prognosis of some of these diseases is reflected in a perinatal mortality of 6.3 %. PATIENTS AND METHODS Retrospectively 124 cases with fetal nephro-/uropathy detected by prenatal ultrasonography between 1996 and 2002 were analyzed. Features of hypo-dysplastic kidneys (uni- or bilateral) were seen in 21 cases. Multicystic kidney disease (uni- or bilateral) existed in 40 fetuses. In some cases of multicystic or dysplastic kidney diseases, extrarenal malformations were combined. 21 fetuses suffered from autosomal recessive polycystic kidney disease. 18 male unborns showed the typical picture of intravesical obstruction due to posterior uretheral valves. The prune belly syndrome was seen 4 times. Hydronephrotic kidneys with more than 5 mm pelvic dilatation were detected in 13 cases. Renal agenesis led to a lethal outcome perinatally in 5 cases. One child died of bilateral thrombosis of renal artery and venous system. RESULTS The high incidence of diseases with a poor prognosis accounts for the high mortality of 50.8 % (intrauterine or postnatal death, induced abortion). Such a fatal outcome was observed in autosomal recessive polycystic kidney disease, bilateral multicystic dysplastic kidney disease, bilateral renal dysplasia combined with severe extrarenal malformations, intravesical obstruction, renal agenesis and bilateral thrombosis of the renal vessels. Only 60 children survived. Of these 26 needed urological surgery. 15 suffered from progressive renal insufficiency. During a follow-up of 8 - 58 months only 44 exhibited a normal renal function. CONCLUSIONS Such complex renal and urological diseases in the fetus require an interdisciplinary management of the pregnancy.
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Affiliation(s)
- M Bulla
- Pädiatrische Nephrologie, Universität Münster, Deutschland.
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Glenn OA, Norton ME, Goldstein RB, Barkovich AJ. Prenatal diagnosis of polymicrogyria by fetal magnetic resonance imaging in monochorionic cotwin death. J Ultrasound Med 2005; 24:711-716. [PMID: 15840804 DOI: 10.7863/jum.2005.24.5.711] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Orit A Glenn
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628, USA.
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Wright D, Bradbury I, Benn P, Cuckle H, Ritchie K. Contingent screening for Down syndrome is an efficient alternative to non-disclosure sequential screening. Prenat Diagn 2005; 24:762-6. [PMID: 15503281 DOI: 10.1002/pd.974] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present a first and second trimester Down syndrome screening strategy, whereby second-trimester marker determination is contingent on the first-trimester results. Unlike non-disclosure sequential screening ('the Integrated test'), which requires all women to have markers in both trimesters, this allows a large proportion of the women to complete screening in the first trimester. METHODS Two first-trimester risk cut-offs defined three types of results: positive and referred for early diagnosis; negative with screening complete; and intermediate, needing second-trimester markers. Multivariate Gaussian modelling with Monte Carlo simulation was used to estimate the false-positive rate for a fixed 85% detection rate. The false-positive rate was evaluated for various early detection rates and early test completion rates. Model parameters were taken from the SURUSS trial. RESULTS Completion of screening in the first trimester for 75% of women resulted in a 30% early detection rate and a 55% second trimester detected rate (net 85%) with a false-positive rate only 0.1% above that achievable by the Integrated test. The screen-positive rate was 0.1% in the first trimester and 4.7% for those continuing to be tested in the second trimester. If the early detection rate were to be increased to 45% or the early completion rate were to be increased to 80%, there would be a further 0.1% increase in the false-positive rate. CONCLUSION Contingent screening can achieve results comparable with the Integrated test but with earlier completion of screening for most women. Both strategies need to be evaluated in large-scale prospective studies particularly in relation to psychological impact and practicability.
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Affiliation(s)
- Dave Wright
- Department of Mathematics and Statistics, University of Plymouth, UK.
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Bétrémieux P, Gaillot T, de la Pintière A, Beuchée A, Pasquier L, Habonimana E, Le Bouar G, Branger B, Milon J, Frémond B, Wodey E, Odent S, Poulain P, Pladys P. Congenital diaphragmatic hernia: prenatal diagnosis permits immediate intensive care with high survival rate in isolated cases. A population-based study. Prenat Diagn 2005; 24:487-93. [PMID: 15300735 DOI: 10.1002/pd.909] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To estimate the prognosis of prenatally diagnosed isolated congenital diaphragmatic hernia (PDICDH) treated with 'immediate planned care' (IPC) between 1999 and 2003 in Eastern Brittany. METHODS The prognosis of PDICDH was compared with the prognosis of the other live-born CDH, either prenatally undiagnosed or not having had IPC. IPC consisted in prenatal lung maturation with corticosteroids, elective caesarean section at 37 weeks, immediate intubation, surfactant, high- frequency ventilation or oscillation, nitric oxide, intravenous prostacyclin, anaesthesia and haemodynamic support. Surgical repair was performed in the NICU 34 h after birth. RESULTS The incidence of CDH was 0.8 per thousand with a prenatal diagnosis rate of 27/30 (90%), leading to a termination of pregnancy in nine cases. Ten CDH were associated with other malformations. IPC in PDICDH was performed in 12 cases. The survival rate of PDICDH with IPC was 11/12 versus 1/9 in CDH with no IPC or no prenatal diagnosis (p < 0.01). Logistic regression analysis showed that IPC was determinant for survival (p < 0.01). CONCLUSION Prenatal diagnosis of isolated CDH treated with immediate planned care is associated with a high survival rate. This suggests that prenatal diagnosis associated with specifically adapted postnatal procedure may improve the prognosis of isolated CDH.
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Affiliation(s)
- Pierre Bétrémieux
- Centre Pluridisciplinaire de Diagnostic Prénatal (CPDP) and Réseau Est Bretagne d'Etudes en Médecine Périnatale (REBEMP), Rennes, France.
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Bernasconi A, Delezoide AL, Menez F, Vuillard E, Oury JF, Azancot A. Prenatal rupture of a left ventricular diverticulum: a case report and review of the literature. Prenat Diagn 2005; 24:504-7. [PMID: 15300739 DOI: 10.1002/pd.912] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Congenital left ventricular diverticulum is a rare malformation. We report a case of a ruptured congenital left ventricular diverticulum in a 24-week-old fetus. The fetus was referred for a large and circumferential pericardial effusion confirmed by cross-sectional echocardiography in our tertiary fetal cardiology unit. Pericardiocentesis removed 25 mL of old hematic fluid. The fetus died 5 days later. The pathological examination showed a ruptured submitral fibrous diverticulum of the posterior wall of the left ventricle. There is no previous report in the literature of prenatal rupture of a cardiac diverticulum. The submitral location and the fibrous wall of the diverticulum is uncommon. As regards this case, we reviewed the diagnostic criteria and the outcome of 11 cases of prenatal cardiac diverticulum reported in the literature.
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Affiliation(s)
- A Bernasconi
- Perinatal cardiology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France
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Abstract
Fetal pulse oximetry is a continuous method to exclude the lack of oxygen in cases of non-reassuring fetal heart rate. This study aims at the evaluation of the predictive value of this method concerning the development of fetal acidosis. 136 fetuses with non-reassuring heart rate were monitored by fetal pulse oximetry. In all cases fetal blood pH and base excess were determined repeatedly by fetal blood analysis (FBA). The pH value and base excess in the umbilical artery and scalp blood as well as the changes of pH and base excess were correlated to the duration of low, medium and high fetal oxygen saturation (FSpO (2)). Sensitivity, specificity, positive and negative predictive values were calculated for the assumption that "FSpO (2) < or = 30 % for at least 10 or 15 minutes" predicts a pH or base excess in the umbilical artery and in FBA of < 7.1/7.15/7.2 or < or = -4/8/12 mmol/L and a decline of pH (base excess) by more than 0.05 (0.1) pH units (4 mmol/L). A highly significant negative correlation was found between umbilical artery and FBA pH and base excess as well as the change of both and the duration of low oxygen saturation. Additionally the change of FBA pH depends on the duration of medium FSpO (2). A pH below 7.15 in FBA as well as base excess < or = -12 mmol/L were safely detected by a cut-off of "FSpO (2) < or = 30 % for at least 10 minutes" and pH < 7.1 and base excess < or = -12 mmol/l in FBA in 100 % and 75 %, respectively. A decline of pH by more than 0.1 pH units and of base excess by more than 4 mmol/L were excluded by a negative predictive value of 98 %. In conclusion, medium and progressive acidosis can be reliably excluded by fetal pulse oximetry.
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Affiliation(s)
- B Seelbach-Göbel
- Klinik für Frauenheilkunde und Geburtshilfe, St. Hedwig/ Perinatalzentrum, Krankenhaus der Barmherzigen Brüder, Lehrstuhl der Universität Regensburg, Schwerpunkt Geburtshilfe, Regensburg.
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Gaughran F, Howes OD, Chrisman L, Vincent A. Serum glutamic acid decarboxylase 65 antibody levels in people with schizophrenia and their families. Schizophr Res 2005; 73:379-81. [PMID: 15653287 DOI: 10.1016/j.schres.2004.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Indexed: 11/25/2022]
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Donnelly DF, Kim I, Carle C, Carroll JL. Perinatal hyperoxia for 14 days increases nerve conduction time and the acute unitary response to hypoxia of rat carotid body chemoreceptors. J Appl Physiol (1985) 2005; 99:114-9. [PMID: 15731397 DOI: 10.1152/japplphysiol.01009.2004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hyperoxia in the immediate perinatal period, but not in adult life, is associated with a life-long impairment of the ventilatory response to acute hypoxia. This effect is attributed to a functional impairment of peripheral chemoreceptors, including a reduction in the number of chemoreceptor afferent fibers and a reduction in "whole nerve" afferent activity. The purpose of the present study was to assess the activity levels of single chemoreceptor units in the immediate posthyperoxic period to determine whether functional impairment extended to single chemoreceptor units and whether the impairment was only induced by hyperoxia exposure in the immediate postnatal period. Two groups of rat pups were exposed to 60% inspired O2 fraction for 2 wk at ages 0-14 days and 14-28 days, at which time single-unit activities were isolated and recorded in vitro. Compared with control pups, hyperoxia-treated pups had a 10-fold reduction in baseline (normoxia) spiking activity. Peak unit responses to 12, 5, and 0% O2 were reduced and nerve conduction time was significantly slower in both hyperoxia-treated groups compared with control groups. We conclude that 1) hyperoxia greatly reduces single-unit chemoreceptor activities during normoxia and acute hypoxia, 2) the treatment effect is not limited to the immediate newborn period, and 3) at least part of the impairment may be due to changes in the afferent axonal excitability.
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Affiliation(s)
- David F Donnelly
- Dept. of Pediatrics, University of Arkansas for Medical Sciences, College of Medicine, 800 Marshall St., Little Rock, AR 72202-3591, USA
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Affiliation(s)
- Szu-Yuan Chou
- Department of Obstetrics and Gynecology, Taipei Medical University, Wan Fan Hospital, Taipei, Taiwan
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Abstract
Many genetic disorders are reported to cause irreversible damage to the fetus before birth. In utero gene therapy may be an effective tool for correction of genetic disorders by replacing defective gene with normal one. There are many reasons for moving forward with in utero gene therapy. The most important reason is to provide early intervention as to prevent or slow dysfunction and morbidity. This approach may prove to be advantageous in rapidly replicating fetal cells, and less sensitive to immune response to vector or transgene product due to underdeveloped immune system. In addition, the developing fetus may be a better candidate for gene therapy than the adult because gene engraftment may be more feasible in early fetal life, where stem cells or pleuripotent progenitor cells are more accessible to vectors. Some reports are available on successful in utero gene transfer in animal models but many questions remain to be answered before in utero gene therapy can be considered a viable solution to human. The real moral challenge facing in utero gene therapy is finding ways to insure that the review of protocols is adequate, and that those undertaking trials are competent to do so. Present review article analyzes the overall progress of the field, and the research that still needs to be performed before it can be considered to human clinical trials.
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Affiliation(s)
- D P Chauhan
- Department of Medicine, School of Medicine, University of California San Diego, USA.
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Barker DJP, Hanson MA. Altered regional blood flow in the fetus: the origins of cardiovascular disease? Acta Paediatr 2004; 93:1559-60. [PMID: 15841760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
UNLABELLED A fetal response to hypoxia and other adverse influences is to redistribute blood flow in order to "spare" the brain. This, however, is associated with reduced growth of the liver and kidneys. CONCLUSION The long-term consequences of fetal redistribution of blood flow are unknown, but preliminary evidence suggests that there is an increased risk of coronary heart disease and hypertension in later life.
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Affiliation(s)
- D J P Barker
- Division of Developmental Origins of Adult Health and Disease, University of Southampton, Southampton, United Kingdom.
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Abstract
Wolfram syndrome (WS) is an autosomal recessive neurodegenerative disorder characterized by early onset diabetes mellitus and progressive optic atrophy in the first decade of life. Other clinical features such as diabetes insipidus, deafness, renal tract abnormalities or psychiatric illnesses are often present. The sequence of the Wolfram syndrome gene (WFS1) was described in 1998, and mutations in the gene have been reported in many populations. To date, the function of the putative protein remains unknown. Here we report prenatal diagnosis by analysing the WFS1 gene, in a foetus belonging to a family with a child diagnosed for Wolfram syndrome. The parents are carriers of the c.2206G > C (G736R) mutation. To our knowledge this is the first description of prenatal diagnosis for Wolfram syndrome, based on the molecular analysis of the WFS1 gene.
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Affiliation(s)
- Enric Domènech
- Centre de Genètica Mèdica i Molecular, Institut de Recerca Oncològica, L'Hospitalet de Llobregat, Barcelona, Spain
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Abstract
Fetal MR imaging is complementary to obstetric ultrasonography. The additional information provided by in utero MR imaging may alter prenatal, perinatal, or immediate postnatal management. For example, the MR imaging findings may affect the decision to continue the pregnancy, change the mode, timing, or location of delivery, or modify decisions regarding the necessity of immediate postnatal surgery. Finally, the information contributed by MR may permit a better assessment of the risk of recurrent defects in subsequent pregnancies.
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Affiliation(s)
- Anna M Golja
- Department of Radiology, Children's Hospital Boston, MA 02115, USA.
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Wilson RD, Johnson MP, Flake AW, Crombleholme TM, Hedrick HL, Wilson J, Adzick NS. Reproductive outcomes after pregnancy complicated by maternal-fetal surgery. Am J Obstet Gynecol 2004; 191:1430-6. [PMID: 15507978 DOI: 10.1016/j.ajog.2004.05.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The reproductive outcomes for women after the pregnancy complicated by maternal-fetal surgery were evaluated to obtain evidence-based information for prenatal risk counseling. STUDY DESIGN The retrospective review identified 83 women with maternal-fetal surgery from a single institution (1996-2002). These women were sent a consent form and a questionnaire to document postoperative problems, fertility, obstetric outcomes, and psychosocial concerns in pregnancy after the index fetal therapy. Institutional Review Board approval was obtained from Committee for Protection of Human Subjects. RESULTS The total return rate was 55 (66%). The pregnancy rate was 62% (18% spontaneous abortion, 24% preterm delivery, and 58% term delivery). Complications were reported in 12 of 34 pregnancies (35%), including uterine dehiscence/rupture (12%/6%), cesarean hysterectomy (3%), and antepartum hemorrhage requiring transfusion (9%). CONCLUSION The reproductive outcome of uterine dehiscence, rupture, and hysterectomy was 12%, 6%, and 3%, respectively, after a pregnancy complicated by maternal-fetal surgery. The uterine rupture rate is similar to the rupture rate after "classical" cesarean section (4%-9%).
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Affiliation(s)
- R Douglas Wilson
- Pediatric Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Abstract
OBJECTIVES Hypophosphatasia is a rare heritable inborn error of metabolism characterized by a liver/bone/kidney alkaline phosphatase defective bone mineralization due to mutations in the tissue-non-specific alkaline phosphatase (TNS-ALP) gene. To date 128 mutations are described in the TNS-ALP gene located on the short arm of chromosome 1. The clinical presentation of hypophosphatasia is variable ranging from early onset lethal short-limb dwarfism to a late-onset presentation with fractures in childhood or adulthood. METHODS We report a pregnancy with a positive maternal serum triple test screening and a post-mortem pathological and molecular diagnosis of perinatal lethal hypophosphatasia. RESULTS Two heterogeneous missense mutations in the TNS-ALP gene were found, of which one was not previously described. CONCLUSION This case report adds to the list of fetal malformations found after positive maternal serum triple test screening and reports a previously undescribed mutation in the TNS-ALP gene responsible for hypophosphatasia.
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Affiliation(s)
- Ingrid Witters
- Department of Obstetrics and Gynecology, University of Leuven, Leuven, Belgium.
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Swinkels DW, De Kok JB, Steegers EAP. [Fetal DNA in maternal blood]. Ned Tijdschr Geneeskd 2004; 148:1466-7; author reply 1467. [PMID: 15310033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Walmsley R, Hishitani T, Sandor GGS, Lim K, Duncan W, Tessier F, Farquharson DF, Potts JE. Diagnosis and outcome of dextrocardia diagnosed in the fetus. Am J Cardiol 2004; 94:141-3. [PMID: 15219529 DOI: 10.1016/j.amjcard.2004.03.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 03/15/2004] [Accepted: 03/15/2004] [Indexed: 11/28/2022]
Abstract
A retrospective review of 5,539 fetal echocardiograms over a 22-year period revealed 85 cases of dextrocardia. In primary dextrocardia (46 cases), the incidence of situs solitus, inversus, and ambiguous, was similar and associated with a high incidence of complex cardiac malformations in situs solitus and situs ambiguous. Secondary dextrocardia (39 cases) was due to intrathoracic displacement and, when caused by diaphragmatic hernia, was associated with cardiac malformations in 31% of cases. Even in complex cases, fetal echocardiography was highly accurate; therefore, specific counseling can be given to parents.
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Affiliation(s)
- Rebecca Walmsley
- Division of Cardiology, British Columbia's Children's and Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Chen CP, Chern SR, Chang TY, Tzen CY, Lee CC, Chen WL, Chen LF, Wang W. Prenatal diagnosis of the distal 11q deletion and review of the literature. Prenat Diagn 2004; 24:130-6. [PMID: 14974122 DOI: 10.1002/pd.802] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To present the prenatal diagnosis of de novo distal 11q deletions and a review of the literature. CLINICAL SUBJECTS AND METHODS: A 31-year-old primigravid woman underwent amniocentesis at 20 weeks' gestation because of a maternal serum alpha-fetoprotein (MSAFP) level of 2.63 multiples of the median. Amniocentesis demonstrated a karyotype of 46,XY,del(11)(q24.2). The parental karyotypes were normal. Level II ultrasound revealed short femurs and humeri, and overlapping of the toes. Postnatally, the proband manifested additional findings of the characteristic facial dysmorphism and camptodactyly. A 38-year-old gravida 2, para 1, woman underwent amniocentesis at 18 weeks' gestation because of advanced maternal age. Amniocentesis revealed a karyotype of 46,XX,del(11)(q24.1). The parental karyotypes were normal. Level II ultrasound did not show fetal structural abnormalities. Postnatally, the proband manifested characteristic facial dysmorphism and camptodactyly. RESULTS Of these two cases, genetic marker analysis determined the paternally derived distal deletions of chromosome 11q and the deletion breakpoints. A comparison of the present cases with the reported cases of prenatally diagnosed distal 11q deletion is made. CONCLUSION The distal 11q deletion can be identified prenatally because of parental balanced translocations involving chromosome 11, previous-term infants with an unbalanced rearrangement, advanced parental age, sonographically detected fetal abnormalities and abnormal maternal serum screening. Fetuses with de novo distal 11q deletions may be associated with elevated MSAFP and abnormal sonographic findings of the digits and limbs in the second trimester.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
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Rousseau T, Couvreur S, Senet-Lacombe E, Durand C, Justrabo E, Malka G, Sagot P. Prenatal diagnosis of enteric duplication cyst of the tongue. Prenat Diagn 2004; 24:98-100. [PMID: 14974114 DOI: 10.1002/pd.748] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cysts located on the tongue are rare and usually diagnosed in childhood. Here we report on the prenatal diagnosis of an unusual cystic malformation of the tongue with heterotopic intestinal tissue explored by prenatal ultrasound, magnetic resonance imaging and on its surgical treatment and histological examination. The prenatal differential diagnoses as well as perinatal management of cystic lesions of the tongue are reviewed.
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Affiliation(s)
- Thierry Rousseau
- Clinique Gynécologique et Obstétricale, Centre Hospitalier Universitaire, Dijon, France.
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23
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Persona-Sliwińska A, Brazert K, Wender-Ozegowska E, Pietryga M, Błaszczyński M, Brazert J. [Lymphangioma--prenatal and perinatal aspects--Part one]. Ginekol Pol 2004; 75:425-30. [PMID: 15524417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Lymphangioma or cystic hygroma is a congenital malformation of the lymphatic system which has been commonly associated with fetal aneuploidy, hydrops, structural malformations and intrauterine death. In this paper we would like to report two cases of lymphangioma diagnosed prenatally in the third trimester in the fetuses with normal karyotype, normal NT in the first trimester and without other structural anomalies and with good perinatal outcome.
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Abstract
The characteristic of fetal wound healing is scarless wound repair in early gestation. During the last two decades, intensive research efforts have focused on unraveling the molecular regulations underlying the phenomenon of scarless wound healing. Better understanding of synthesis and degradation will enable us to develop important therapeutic options for the prevention and reduction of scarring. The aim of this article is to present an overview, discuss the most important research works of the last two decades on the field of fetal wound healing, and report current therapeutic developments for the modulation of adult wound repair. Recent experimental results using these new therapeutic approaches are very promising and present great possibilities and chances for future surgery.
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Affiliation(s)
- E A Huhn
- Abteilung für Plastische and Wiederherstellungschirurgie, Klinikum rechts der Isar, Technische Universität München
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Abstract
Cardiac embyogenesis occurs in the first 6 to 7 weeks of human development. Although it is during this time that many of the major cardiovascular defects develop, many of these lesions continue to evolve and others develop in the latter half of gestation. There may be development or progression of ventricular inflow or outflow tract and arch obstruction, and ventricular or great artery hypoplasia. There may be progressive antrioventricular or semi-lunar valve regurgitation which can compromise the fetal circulation. There may be development of dysrhythmias, primary myocardial disease and heart failure. The fetal shunts, the foramen ovale and ductus arteriosus, may change in form and function. Finally, cardiac tumors may develop, grow, or regress. Knowledge of the mechanisms of and potential for progression in fetal heart disease is critical for counseling regarding prognosis and for planning of prenatal and neonatal management.
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Affiliation(s)
- J Trines
- Fetal Cardiac Program, Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto
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26
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Erickson JA, Ashwood ER, Gin CA. Evaluation of a Dimeric Inhibin-A Assay for Assessing Fetal Down Syndrome: Establishment, Comparison, and Monitoring of Median Concentrations for Normal Pregnancies. Arch Pathol Lab Med 2004; 128:415-20. [PMID: 15043467 DOI: 10.5858/2004-128-415-eoadia] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Several studies report the role of dimeric inhibin-A in assessing risk for fetal Down syndrome. The majority, however, use the Serotec inhibin-A assay and not the newer Diagnostic Systems Laboratories inhibin-A enzyme-linked immunosorbent assay (ELISA).
Objectives.—To establish normal gestational age day-specific medians, to compare our results against previous studies pertaining to the inhibin-A ELISA, and to evaluate long-term assay performance.
Design.—Using the inhibin-A ELISA, 100 specimens were assayed for each completed week of gestation for weeks 15 to 20, 50 specimens for 14 weeks, and 54 specimens for 21 weeks or older. Regressed inhibin-A medians were calculated employing a second-degree polynomial fit of the arithmetic medians. Thereafter, inhibin-A ELISA lot comparisons were performed to evaluate consistency.
Results.—Regressed values of 182, 174, 175, 184, 201, and 226 pg/mL resulted for weeks 15 to 20, respectively [pg/mL inhibin-A = 4.1528(gestational age)2 − 136.49(gestational age) + 1294.9]. A comparison with 2 other studies shows our values to be lower overall by 15 ± 11.4% and 16 ± 2.6%. However, variability between kit lots was as high as 30%.
Conclusions.—The equation derived provides for the calculation of gestational age day-specific inhibin-A medians for integration into maternal serum screening programs with a subsequent decrease in false-positives expected and observed. Our medians differ considerably from those of other studies, with limited data, using the Diagnostic Systems assay. However, lot changes since the initial analysis have exhibited similar inconsistencies. Therefore, we recommend that others incorporating the assay into their screening programs carefully establish, monitor, and adjust their medians accordingly as a result of potential variations.
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Affiliation(s)
- J Alan Erickson
- ARUP Institute for Clinical and Experimental Pathology, LLC, Salt Lake City, Utah 84108, USA.
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27
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Baba K. [Obstetrics and gynecology]. Nihon Rinsho 2004; 62:807-14. [PMID: 15106353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Three-dimensional(3D) ultrasound is getting popular rapidly in obstetrics and gynecology, especially for fetal diagnosis. Three-dimensional ultrasound provide with not only various kinds of 3D images but also any arbitrary sections that cannot be obtained by conventional two-dimensional ultrasound. Fetal biometry can be performed easily and accurately on a 3-orthogonal-plane image by 3D ultrasound. Morphological abnormalities of the fetus and their severities, especially on the face, ears, extremities and skeleton, can be depicted clearly by 3D images. Realistic surface images of a normal fetus may work well on the parents-fetus bonding. Congenital uterine abnormalities are depicted easily and clearly on coronal sections of the uterus by transvaginal 3D ultrasound.
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Affiliation(s)
- Kazunori Baba
- Center for Maternal and Fetal and Neonatal Medicine, Saitama Medical School
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28
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Bahado-Singh RO, Cheng CSC. First trimester prenatal diagnosis. Curr Opin Obstet Gynecol 2004; 16:177-81. [PMID: 15017349 DOI: 10.1097/00001703-200404000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The recent developments in first trimester sonography promise to greatly enhance our diagnostic capabilities for detection of aneuploidies. Collateral benefits of nuchal translucency measurements include the prediction of non-chromosomal adverse outcomes. These advances will fundamentally change clinical practices. All obstetricians must therefore have a working knowledge of the expanding literature in this field. RECENT FINDINGS The review covers developments in nuchal translucency based first trimester detection of chromosomal anomalies and discusses the recent literature on the use of fetal nasal bone measurements to further improve diagnostic accuracy. Emerging data on the relationship between nuchal fluid measurement and the risk of cardiac anomaly will also be presented. SUMMARY It is likely that the emphasis in obstetric clinical care will shift substantially towards the first trimester. With the enhanced diagnostic capabilities, greater research emphasis will inevitably need to be placed on the first trimester treatment of fetal disorders.
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Affiliation(s)
- Ray O Bahado-Singh
- University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0526, USA.
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29
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Strenge S, Froster UG, Wanders RJA, Gartner J, Maier EM, Muntau AC, Faber R. First-trimester increased nuchal translucency as a prenatal sign of Zellweger syndrome. Prenat Diagn 2004; 24:151-3. [PMID: 14974126 DOI: 10.1002/pd.805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Waldo Sepulveda
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London, UK.
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31
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Akgür FM, Olguner M. Amniotic fluid beta-endorphin: a prognostic marker for gastroschisis. J Pediatr Surg 2004; 39:248-9. [PMID: 14966756 DOI: 10.1016/j.jpedsurg.2003.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aite L, Trucchi A, Nahom A, Casaccia G, Zaccara A, Giorlandino C, Bagolan P. Antenatal diagnosis of diaphragmatic hernia: parents' emotional and cognitive reactions. J Pediatr Surg 2004; 39:174-8; discussion 174-8. [PMID: 14966735 DOI: 10.1016/j.jpedsurg.2003.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to assess parent's emotional and cognitive reactions to the prenatal diagnosis of diaphragmatic hernia in their prospective children. METHODS A survey was conducted by means of a questionnaire. In the period ranging from 1997 to 2002, 40 couples in whom an established diagnosis of diaphragmatic hernia was made in their fetus were seen for prenatal consultation at a tertiary referral center. RESULTS Overall response rate was 93% (37 couples). Mean period since diagnosis for compilation of the questionnaire was 2 weeks. Mean gestational age at diagnosis was 25 weeks (range, 16 to 35 weeks). All parents lacked prediagnostic knowledge of diaphragmatic hernia and consider a single consultation with the paediatric surgeon inadequate to have a clear understanding of the anomaly. Only 1 mother and 1 father reported they understood all the information given by the surgeon. The most frequent (75%) feeling during and after the consultation was fear. Most parents (70%) referred to the intense emotions as the factor that made it difficult to follow the surgeon's explanations as well as to ask questions. CONCLUSIONS Because of the incompatibility of emotional distress and optimum learning, impairment of early comprehension of information about diaphragmatic hernia is unavoidable. Therefore, we believe that follow-up antenatal consultations and provision of written and visual illustration are extremely important to facilitate informed choices.
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Affiliation(s)
- Lucia Aite
- Neonatal Surgery Unit, Bambino Gesú Children's Hospital, Rome, Italy
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Abstract
Ethmocephaly is a rare anomaly associated with partial failure of cleavage of the prosencephalon. Morphologically, it is closely related to cyclopia. We present an extremely rare case of ethmocephaly diagnosed in utero and caused by an unbalanced de novo translocation 18;21.
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Affiliation(s)
- Israel Goldstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
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34
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Affiliation(s)
- A R Aslan
- Division of Urology, Albany Medical College, Albany NY 12208, USA
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35
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Cohen O, Pinhas-Hamiel O, Sivan E, Dolitski M, Lipitz S, Achiron R. Serial in utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy. Prenat Diagn 2003; 23:740-2. [PMID: 12975785 DOI: 10.1002/pd.685] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Treatment of maternal hyperthyroidism during pregnancy is complicated by the lack of readily available measures of the thyroid status of the fetus. The aim of this study is to describe the use of serial in utero ultrasound measurements of fetal thyroid in patients being treated for Graves' disease in pregnancy. METHODS Over a 24-month period, all pregnant women with Graves' disease attending our special Fetal Thyroid Unit were followed. Maternal thyroid status was assessed by thyroid function tests. Fetal thyroid size was measured serially by transvaginal ultrasonography between 14 and 17 weeks of gestation and by abdominal ultrasonography between 18 and 37 weeks of gestation in 20 women with Grave's disease. RESULTS In 15 fetuses, thyroid width and circumference were within the 95% confidence interval of the normal population. In five fetuses, thyroid size was above the 95th percentile for gestational age. In three of them, thyroid size decreased concurrently with a decrease in maternal thionamide dosage, reaching normal range. These three fetuses were born euthyroid. In two fetuses, thyroid size was unaffected by a decrement in maternal drug dosage. Both had neonatal thyrotoxicosis at birth. CONCLUSIONS Serial in utero ultrasonography measuring fetal thyroid size in mothers with Graves' disease can serve as an effective noninvasive tool for the early detection of enlarged fetal thyroid. These findings can be used to monitor the maternal antithyroid drug dosage, thereby preventing intrauterine hypothyroidism in some cases. When a dosage reduction does not cause a decrease in fetal thyroid size, transplacental passage of thyroid-stimulating antibodies causing fetal thyrotoxicosis should be suspected.
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Affiliation(s)
- Ohad Cohen
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv, Israel
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36
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Abstract
Chromosome translocations are often early or initiating events in leukaemogenesis, occurring prenatally in most cases of childhood leukaemia. Although these genetic changes are necessary, they are usually not sufficient to cause leukaemia. How, when and where do translocations arise? And can these insights aid our understanding of the natural history, pathogenesis and causes of leukaemia?
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Affiliation(s)
- Mel F Greaves
- LRF Centre for Cell and Molecular Biology, Institute of Cancer Research, Chester Beatty Laboratories, 237 Fulham Road, London SW3 6JB, UK.
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37
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Guibaud L, Garel C, Annie B, Pascal G, François V, Vavasseur C, Oury JF, Pracros JP. Prenatal diagnosis of capillary telangiectasia of the cerebellum-ultrasound and MRI features. Prenat Diagn 2003; 23:791-6. [PMID: 14558021 DOI: 10.1002/pd.695] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report three cases of capillary telangiectasia (CT) of the cerebellum revealed as focal cerebellar lesions. METHODS Ultrasound and magnetic resonance imaging (MRI) were performed in all cases in the prenatal period. Prenatal imaging findings were compared with either post-mortem examination (case 1) or post-natal MRI (cases 2 & 3). RESULTS A discrepancy between a hyperechoic lesion without any mass effect on sonogram and normal T1 and T2 spin-echo fetal magnetic resonance images was found in all cases. The diagnosis of CT was made on post-mortem examination in case 1. Prenatal ultrasound and magnetic resonance imaging findings were suggestive of the diagnosis in cases 2 and 3. In both cases, the pregnancy was managed conservatively and the diagnosis of CT was documented on post-natal MRI after gadolinium injection. CONCLUSION The diagnosis of CT of the cerebellum was strongly suggested in these three cases in the prenatal period by the combination of ultrasound and fetal MRI findings. In the vast majority of cases, CT has a benign clinical course and complication with haemorrhage appears to be exceedingly rare. This fact should be taken into account in the prenatal counselling.
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Affiliation(s)
- Laurent Guibaud
- Department of Pediatric and Fetal Imaging, Hôpital Debrousse, Lyon.
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38
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Abstract
INTRODUCTION It has been recognized that the morphological fetal CNS findings detected in early development are not always the final features: occasionally they may not be determined in diagnosis and may change developmentally or chronologically during the fetal life in utero. DISCUSSION Certain factors of the fetal chronology of CNS anomalies can cause irreversible changes during fetal life. These include: significant delay in the neuronal maturation process in fetal hydrocephalus developed in clinico-embryological stage II of the Perspective Classification of Congenital Hydrocephalus (PCCH), secondary neural injury in the intactly developing spinal cord above the neural placode in fetuses with spina bifida aperta (myeloschisis), histological "evolution" of tumors or dysgenetic CNS, and deformity of the normally developed intracranial or intraspinal CNS structures. Considering the current status of fetal surgery in general and technical advances promising improved outcomes, fetal neurosurgery can also be applied to the above-mentioned progressive pathology or pathophysiology in the fetal CNS. However, since the failure of the first trial of fetal neurosurgery in the 1980s, the prerequisites have still not been clarified. In order to use advanced neurosurgery techniques in the management of fetal CNS anomalies, these prerequisites have to be established.
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Affiliation(s)
- Shizuo Oi
- Division of Pediatric Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi Shinbashi, Minato-ku, 105-6451 Tokyo, Japan.
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Sonigo-Cohen P, Schmit P, Zerah M, Chat L, Simon I, Aubry MC, Gonzales M, Pierre-Kahn A, Brunelle F. Prenatal diagnosis of diastematomyelia. Childs Nerv Syst 2003; 19:555-60. [PMID: 12845458 DOI: 10.1007/s00381-003-0771-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2003] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Diastematomyelia, also termed split cord malformation, is a form of occult spinal dysraphism characterized by a cleft in the spinal cord. Prenatal diagnosis of this anomaly is possible by ultrasonography (US), and fetal MRI can be used to diagnose the type of diastematomyelia precisely. Diastematomyelia can be isolated or associated with other dysraphisms, segmental anomalies of the vertebral bodies, or visceral malformations (horseshoe or ectopic kidney, utero-ovarian malformation, and anorectal malformation). We present three cases of fetal diastematomyelia investigated using a multimodal prenatal work-up (US, MRI, 3D-CT). CASES The first case, detected at 20 weeks' gestation, had a lumbar meningocele. At 30 weeks' gestation, direct US visualization revealed the division of the spinal cord into two hemicords. This patient illustrates an isolated type II diastematomyelia with a favorable prognosis. The second case, detected at 22 weeks' gestation, presented with disorganization of bony process of the vertebral column with a midline echogenic bony spur, asymmetrical hemicords, and a foot malposition. Fetal MRI at 26 weeks' gestation and CT/3D reconstructed at 32 weeks' gestation confirmed a type I diastematomyelia with orthopedic malposition. The third case, detected at 22 weeks' gestation, presented with widening of the lumbar canal and scoliosis. Prenatal work-up (US, MRI) disclosed other visceral malformations (pelvic kidney), which led to the assumption of a complex polymalformative syndrome. The pregnancy was terminated. Fetopathologic examination disclosed even more visceral malformations (anal atresia and unicorn uterus).
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Affiliation(s)
- Pascale Sonigo-Cohen
- Pediatric Radiology Department, Hôpital Necker-Enfants Malades, 149 rue de Sevres, 75743 Paris Cedex 15, France.
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Stec AAJ, Wakim A, Barbet P, McCarthy EF, Lakshmanan Y, Sponseller PD, Gearhart JP. Fetal bony pelvis in the bladder exstrophy complex: normal potential for growth? Urology 2003; 62:337-41. [PMID: 12893348 DOI: 10.1016/s0090-4295(03)00474-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To provide the first look at the bony histologic features of fetuses with the exstrophy complex, specifically evaluating the endochondral ossification, stage of development, and microscopic potential for normal growth. METHODS Three fetuses between 28 and 30 weeks of gestation, one with classic bladder exstrophy, one with cloacal exstrophy, and one control, were obtained from France. The bony pelves were dissected and preserved in formalin, and multiple representative sections were sliced from all pelvic areas: pubis, ischium, ilium, and sacrum. These slices were sequentially processed as slides, stained with hematoxylin-eosin, and evaluated microscopically for histologic changes, developmental stage, and degree of endochondral ossification. RESULTS All slides from the three specimens showed cartilage analogue with endochondral ossification. Histologically the exstrophy specimens were identical to the control and appeared completely normal; bone development was occurring at an expected rate with the potential for continued normal growth. CONCLUSIONS These new findings illustrate that fetal bone in the exstrophy complex displays normal microscopic growth patterns and unhindered endochondral ossification at 28 weeks of gestation, well beyond the embryologic period. With no evident microscopic bony defect, the gross bony anomalies in exstrophy should be surgically correctable, leading us to conclude that early reapproximation of the physiologic shape of the pelvis could lead to more normal gross bone growth, decreased shortage of bone, and a more appropriate distribution of the mechanical and developmental forces on a closed, normally functioning pelvic ring.
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Affiliation(s)
- Andrew A J Stec
- Division of Pediatric Urology, Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Abstract
Renal function in utero deals chiefly with urine production rather than the excretion of metabolites, which are cleared by the placenta. Fetal renal impairment (FRI) in bilateral renal disease thus presents as oligohydramnios or anhydramnios; this can lead to lung hypoplasia and early neonatal death. As in the adult, FRI can be divided into prerenal, renal and postrenal causes. Causes of prerenal FRI include intrauterine growth restriction, unbalanced intertwin transfusion in monochorionic twins and maternal drug ingestion. Bilateral renal agenesis, multicystic dysplasia and both the autosomal dominant and recessive forms of polycystic kidney disease are examples of renal causes, whereas postrenal etiologies are usually caused by lower urinary tract obstruction (LUTO). When both kidneys are affected and there is severe mid-trimester oligohydramnios, the prognosis is poor. Although animal studies have shown that prolonged LUTO leads to lung hypoplasia and renal damage, and that decompression of the fetal kidney in early pregnancy restores fetal pulmonary and renal function, the value of fetal therapy such as vesico-amniotic shunting remains controversial, with a high procedure-related complication rate and a high incidence of end-stage renal failure in childhood. Fetal cystoscopic treatment of posterior urethral valves in utero may obviate some of these difficulties but remains an investigational procedure.
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Affiliation(s)
- Tina Vanderheyden
- Institute of Reproductive and Developmental Biology, Queen Charlotte's and Chelsea Hospital,Imperial College, Hammersmith Campus, Du Cane Road, London W12OSH, UK.
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Kayani SI, Walkinshaw SA, Preston C. Pregnancy outcome in severe placental abruption. BJOG 2003; 110:679-83. [PMID: 12842059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To determine the relationship between decision to delivery interval and perinatal outcome in severe placental abruption. DESIGN A case-control study. SETTING Large inner city teaching hospital. METHODS Retrospective case note review of pregnancies terminated following severe placental aburption and fetal bradycardia. One year paediatric follow up by case note review or postal questionnaire. The differences in outcome (death or cerebral palsy) were examined using non-parametric and univariate analysis for the following time periods--times from onset of symptoms to delivery, onset of symptoms to admission, admission to delivery, onset bradycardia to delivery and decision to delivery interval. MAIN OUTCOME MEASURES Prenatal death or survival with cerebral palsy. RESULTS Thirty-three women with singleton pregnancies over 28 weeks of gestation, admitted with clinically overt placental abruption, where delivery was effected for fetal bradycardia. Eleven of the pregnancies had a poor outcome (cases), eight infants died and three surviving infants have cerebral palsy. Twenty-two pregnancies had a good outcome (controls): survival with no developmental delay. No statistically significant relationship was found between maternal age, parity, gestation, or birthweight and a poor outcome. A statistically significant relationship between time from decision to delivery was identified (P = 0.02, Mann-Whitney U test). The results of a univariate logistic regression for this variable suggest that the odds ratio of a poor outcome for delivery at 20 minutes compared with 30 minutes is 0.44 (95% CI 0.22-0.86). Fifty-five percent of infants were delivered within 20 minutes of the decision to deliver. Serious maternal morbidity was rare. CONCLUSION In this small study of severe placental abruption complicated by fetal bradycardia, a decision to delivery interval of 20 minutes or less was associated with substantially reduced neonatal morbidity and mortality.
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Adamsbaum C, Merzoug V, André C, Ferey S, Kalifa G. [Imaging of the pediatric cerebellum]. J Neuroradiol 2003; 30:158-71. [PMID: 12843872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
After a brief overview of embryology, histogenesis, anatomy, as well as terminology, the authors will review the main acquired (neoplastic and non-neoplastic) and congenital (malformative and non-malformative) cerebellar pathologies through a pictorial essay. Even though there is some overlap, malformations are classified into agenesis, hypoplasia, and dysplasia, either cystic or non-cystic. Their embryological origin will be discussed. The main known syndromes associated with vermian agenesis will be reviewed. Non-neoplastic acquired cerebellar lesions, including atrophy and isolated signal anomalies, will be briefly reviewed. A classification of the main cerebellar malformations will be proposed.
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Affiliation(s)
- C Adamsbaum
- Service de Radiologie, Hôpital St Vincent de Paul, 82 avenue Denfert Rochereau, 75674 Paris Cedex 14
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Ware CB, Nelson AM, Liggitt D. Late gestation modulation of fetal glucocorticoid effects requires the receptor for leukemia inhibitory factor: an observational study. Reprod Biol Endocrinol 2003; 1:43. [PMID: 12823859 PMCID: PMC165445 DOI: 10.1186/1477-7827-1-43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2003] [Accepted: 05/16/2003] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Ablation of the low-affinity receptor subunit for leukemia inhibitory factor (LIFR) causes multi-systemic defects in the late gestation fetus. Because corticosterone is known to have a broad range of effects and LIF function has been associated with the hypothalamo-pituitary-adrenal axis, this study was designed to determine the role for LIFR in the fetus when exposed to the elevated maternal glucocorticoid levels of late gestation. Uncovering a requirement for LIFR in appropriate glucocorticoid response will further understanding of control of glucocorticoid function. METHODS Maternal adrenalectomy or RU486 administration were used to determine the impact of the maternal glucocorticoid surge on fetal development in the absence of LIFR. The mice were analyzed by a variety of histological techniques including immunolabeling and staining techniques (hematoxylin and eosin, Alizarin red S and alcian blue). Plasma corticosterone was assayed using radioimmunoassay. RESULTS Maternal adrenalectomy does not improve the prognosis for LIFR null pups and exacerbates the effects of LIFR loss. RU486 noticeably improves many of the tissues affected by LIFR loss: bone density, skeletal muscle integrity and glial cell formation. LIFR null pups exposed during late gestation to RU486 in utero survive natural delivery, unlike LIFR null pups from untreated litters. But RU486 treated LIFR null pups succumb within the first day after birth, presumably due to neural deficit resulting in an inability to suckle. CONCLUSION LIFR plays an integral role in modulating the fetal response to elevated maternal glucocorticoids during late gestation. This role is likely to be mediated through the glucocorticoid receptor and has implications for adult homeostasis as a direct tie between immune, neural and hormone function.
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MESH Headings
- Abnormalities, Multiple/embryology
- Abnormalities, Multiple/genetics
- Adrenalectomy
- Adrenocorticotropic Hormone/analysis
- Animals
- Bone Diseases, Metabolic/embryology
- Bone Diseases, Metabolic/genetics
- Bone Diseases, Metabolic/prevention & control
- Corticosterone/blood
- Female
- Fetal Diseases/embryology
- Fetal Diseases/genetics
- Fetal Diseases/prevention & control
- Fetus/physiology
- Genes, Lethal
- Gestational Age
- Homeostasis
- Hormone Antagonists/pharmacology
- Hypothalamo-Hypophyseal System/physiology
- Interleukin-6
- Leukemia Inhibitory Factor
- Leukemia Inhibitory Factor Receptor alpha Subunit
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Mifepristone/pharmacology
- Muscle, Skeletal/embryology
- Muscle, Skeletal/pathology
- Neuroglia/drug effects
- Neuroimmunomodulation/physiology
- Pituitary-Adrenal System/physiology
- Pregnancy
- Proteins/physiology
- Receptors, Cytokine/deficiency
- Receptors, Cytokine/genetics
- Receptors, Cytokine/physiology
- Receptors, Glucocorticoid/physiology
- Receptors, OSM-LIF
- Specific Pathogen-Free Organisms
- Spinal Cord/embryology
- Spinal Cord/pathology
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Affiliation(s)
- Carol B Ware
- Department of Comparative Medicine, University of Washington, Seattle, WA 98195-7190
| | - Angelique M Nelson
- Department of Comparative Medicine, University of Washington, Seattle, WA 98195-7190
| | - Denny Liggitt
- Department of Comparative Medicine, University of Washington, Seattle, WA 98195-7190
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45
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Amsalem H, Valsky DV, Yagel S, Celnikier DH, Anteby EY. Effect of indomethacin on amniotic fluid prostaglandin and aldosterone levels in a fetus with Bartter syndrome. Prenat Diagn 2003; 23:431-3. [PMID: 12749044 DOI: 10.1002/pd.583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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46
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Jouannic JM, Hyett JA, Pandya PP, Gulbis B, Rodeck CH, Jauniaux E. Perinatal outcome in fetuses with megacystis in the first half of pregnancy. Prenat Diagn 2003; 23:340-4. [PMID: 12673643 DOI: 10.1002/pd.593] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To present the outcome of a consecutive series of 19 fetuses referred to our center for megacystis in the first half of the pregnancy. STUDY DESIGN Retrospective analysis. METHODS 19 cases of early fetal megacystis were reviewed. Inclusion criteria were the visualization of an enlarged bladder with a maximum longitudinal diameter >10 mm and a gestational age of no more than 19 weeks. RESULTS The median gestational age at diagnosis was 16 weeks (range 12-19 weeks). The median maximum longitudinal diameter of the fetal bladder at the time of diagnosis was 21 mm (range 11-35 mm). The fetal megacystis was associated with another extra renal anomaly in six cases (30%). There was no fetus with abnormal karyotype. Termination of pregnancy was performed in 11 cases because of the severity of the renal disease. One spontaneous intrauterine death occurred. A vesicoamniotic shunt was inserted in three cases, two of which died in utero. The surviving fetus that was shunted died in the neonatal period from acute renal failure. In the remaining four fetuses, resolution of the megacystis occurred spontaneously (n = 2) or following serial single-needle aspiration (n = 2). One of these had renal insufficiency requiring kidney transplantation. CONCLUSION The outcome of fetuses with early obstructive uropathy is poor, with or without in utero therapy. Pathophysiology, clinical presentation and outcome of fetuses with early uropathy may differ from those previously described in the latter part of pregnancy.
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Affiliation(s)
- Jean-Marie Jouannic
- Academic Department of Obstetrics and Gynaecology, University College London, London, UK.
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47
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Grover TR, Parker TA, Zenge JP, Markham NE, Kinsella JP, Abman SH. Intrauterine hypertension decreases lung VEGF expression and VEGF inhibition causes pulmonary hypertension in the ovine fetus. Am J Physiol Lung Cell Mol Physiol 2003; 284:L508-17. [PMID: 12573989 DOI: 10.1152/ajplung.00135.2002] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although vascular endothelial growth factor (VEGF) plays a vital role in lung vascular growth in the embryo, its role in maintaining endothelial function and modulating vascular structure during late fetal life has not been studied. We hypothesized that impaired lung VEGF signaling causes pulmonary hypertension, endothelial dysfunction, and structural remodeling before birth. To determine whether lung VEGF expression is decreased in an experimental model of persistent pulmonary hypertension of the newborn (PPHN), we measured lung VEGF and VEGF receptor protein content from fetal lambs 7-10 days after ductus arteriosus ligation (132-140 days gestation; term = 147 days). In contrast with the surge in lung VEGF expression during late gestation in controls, chronic intrauterine pulmonary hypertension reduced lung VEGF expression by 78%. To determine whether VEGF inhibition during late gestation causes pulmonary hypertension, we treated fetal lambs with EYE001, an aptamer that specifically inhibits VEGF(165). Compared with vehicle controls, EYE001 treatment elevated pulmonary artery pressure and pulmonary vascular resistance by 22 and 50%, respectively, caused right ventricular hypertrophy, and increased wall thickness of small pulmonary arteries. EYE001 treatment reduced lung endothelial nitric oxide synthase protein content by 50% and preferentially impaired the pulmonary vasodilator response to ACh, an endothelium-dependent agent. We conclude that chronic intrauterine pulmonary hypertension markedly decreases lung VEGF expression and that selective inhibition of VEGF(165) mimics the structural and physiological changes of experimental PPHN. We speculate that hypertension downregulates VEGF expression in the developing lung and that impaired VEGF signaling may contribute to the pathogenesis of PPHN.
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Affiliation(s)
- Theresa R Grover
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado 80262, USA.
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48
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Kocakoç E, Kiriş A, Kazez A. [Duodenal atresia: prenatal ultrasonic evidence]. Tani Girisim Radyol 2003; 9:111-2. [PMID: 14661309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Ercan Kocakoç
- Firat Universitesi Tip Fakültesi, Radyoloji Anabilim Dali, Elaziğ
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49
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Unlübay D, Kacar M, Koşar U, Uysal S. [Antenatal ovarian cysts]. Tani Girisim Radyol 2003; 9:126-7. [PMID: 14661318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- D Unlübay
- S.B. Ankara Eğitim ve Araştirma Hastanesi, Radyoloji Kliniği, Ankara
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50
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Chen JJ, Pugach J, West D, Naseer S, Steinhardt GF. Infant vesicoureteral reflux: a comparison between patients presenting with a prenatal diagnosis and those presenting with a urinary tract infection. Urology 2003; 61:442-6; discussion 446-7. [PMID: 12597964 DOI: 10.1016/s0090-4295(02)02275-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the severity, laterality, and gender distribution of infant vesicoureteral reflux (VUR) and its potential impact on renal outcome, we compared patients presenting fetally (FDR group) and those presenting with a urinary tract infection (INF group). METHODS A retrospective review of 202 patients with the diagnosis of VUR before 6 months of age was performed. The grade of VUR, gender, laterality, initial renal scarring, breakthrough urinary tract infections, new renal scarring, and surgical intervention were compared between the INF group (n = 146) and FDR group (n = 56). RESULTS The male/female ratio in the FDR group was 1.67:1 compared with 0.60:1 in the INF group. The FDR group had more unilateral VUR than the INF group (P <0.001), and no significant difference was found between the two groups in terms of VUR grade distribution (P = 0.13), percentage of initial damage (28% of FDR patients versus 23% of INF patients), or clinical course. In either group, boys and girls exhibited a very similar distribution of grade and renal damage. CONCLUSIONS Our findings do not support the commonly held belief that fetally diagnosed reflux is an overwhelmingly male, bilateral, and high-grade phenomenon. Few differences were observed between infants diagnosed fetally and those diagnosed subsequent to urinary tract infection. Once diagnosed, from either group, infant reflux has neither great morbidity nor a frequent need for surgery.
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Affiliation(s)
- John J Chen
- Department of Preventive Medicine, State University of New York at Stony Brook School of Medicine, Stony Brook, New York 11794-8036, USA
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