Mosaic Trisomy 12: Prenatal Diagnosis at Amniocentesis and Molecular Genetic Analysis on Fetal Tissues

Background: Mosaic trisomy 12 is a genetic condition with few cases diagnosed prenatally and postnatally. Phenotypic variability is wide ranging from normal patients to severe congenital anomalies. Case report: A 35-year-old woman underwent amniocentesis at 17 weeks of gestation because of advanced maternal age. Prenatal ultrasound was negative. Cultured amniocytes revealed a karyotype of 47,XX,+12/46,XX. Parents opted for termination of pregnancy at 22 weeks. Postmortem revealed dysmorphic face; hands with broad thumbs and incomplete transverse palmar creases; partial anomalous pulmonary venous return, intestinal malrotation, and bicornuate uterus. Histologically, no anomalies were identified. Cytogenetic analyses on fetal tissues detected mosaic trisomy 12 in thymus, lung, brain, kidney, placenta, and cord blood. Discussion/Conclusion: We report a new case of mosaic trisomy 12 with non-lethal morphological findings not previously described. Although prenatal ultrasound may be negative, genetic counseling should consider minor abnormalities and widespread presence of trisomic cell lines in various internal organs.

Crystal structure determination of a lifelong biopersistent asbestos fibre using single-crystal synchrotron X-ray micro-diffraction

The six natural silicates known as asbestos may induce fatal lung diseases via inhalation, with a latency period of decades. The five amphibole asbestos species are assumed to be biopersistent in the lungs, and for this reason they are considered much more toxic than serpentine asbestos (chrysotile). Here, we refined the atomic structure of an amosite amphibole asbestos fibre that had remained in a human lung for ∼40 years, in order to verify the stability in vivo. The subject was originally exposed to a blend of chrysotile, amosite and crocidolite, which remained in his parietal pleura for ∼40 years. We found a few relicts of chrysotile fibres that were amorphous and magnesium depleted. Amphibole fibres that were recovered were undamaged and suitable for synchrotron X-ray micro-diffraction experiments. Our crystal structure refinement from a recovered amosite fibre demonstrates that the original atomic distribution in the crystal is intact and, consequently, that the atomic structure of amphibole asbestos fibres remains stable in the lungs for a lifetime; during which time they can cause chronic inflammation and other adverse effects that are responsible for carcinogenesis. The amosite fibres are not iron depleted proving that the iron pool for the formation of the asbestos bodies is biological (haemoglobin/plasma derived) and that it does not come from the asbestos fibres themselves.

TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins: Two Cases Treated with Fetoscopic Laser Surgery

INTRODUCTION

Ablation of the acardiac twin umbilical cord in the TRAP protects the normal donor twin.

MATERIALS AND METHODS

Two case descriptions, one of interstitial laser photocoagulation and one of laser umbilical cord occlusion (L-UCO) of the acardiac twin in monochorionic monoamniotic pregnancies are reported.

RESULTS

L-UCO in two pregnancies with TRAP syndrome in the second trimester resulted in intrauterine fetal death in both cases after 1 month. Case 1 had no detectable cause of fetal death. Case 2 had rupture of the amniotic sac causing anhydramnios and acute chorioamnionitis. A groove on the umbilical cord of the normal twin indicated a cord stricture due to cord entanglement.

CONCLUSION

Our experience confirms that the best timing and optimal treatment of MC/MA twins complicated by TRAP sequence still remains a controversial clinical issue. Cord entanglement may continue be a potential clinical risk factor for adverse perinatal outcome even after ablation therapy.

Seasonal variability of PM2.5 and PM10 composition and sources in an urban background site in Southern Italy

Comparison of fine and coarse fractions in terms of sources and dynamics is scarce in southeast Mediterranean countries; differences are relevant because of the importance of natural sources like sea spray and Saharan dust advection, because most of the monitoring networks are limited to PM₁₀. In this work, the main seasonal variabilities of sources and processes involving fine and coarse PM (particulate matter) were studied at the Environmental-Climate Observatory of Lecce (Southern Italy). Simultaneous PM_2.5 and PM₁₀ samples were collected between July 2013 and July 2014 and chemically analysed to determine concentrations of several species: OC (organic carbon) and EC (elemental carbon) via thermo-optical analysis, 9 major ions via IC, and 23 metals via ICP-MS. Data was processed through mass closure analysis and Positive Matrix Factorization (PMF) receptor model characterizing seasonal variabilities of nine sources contributions. Organic and inorganic secondary aerosol accounts for 43% of PM_2.5 and 12% of PM_2.5-10 with small seasonal changes. SIA (secondary inorganic aerosol) seasonal pattern is opposite to that of SOC (secondary organic carbon). SOC is larger during the cold period, sulphate (the major contributor to SIA) is larger during summer. Two forms of nitrate were identified: NaNO₃, correlated with chloride depletion and aging of sea-spray, mainly present in PM_2.5-10; NH₄NO₃ more abundant in PM_2.5. Biomass burning is a relevant source with larger contribution during autumn and winter because of the influence of domestic heating, however, is not negligible in spring and summer, because of the contributions of fires and agricultural practices. Mass closure analysis and PMF results identify two soil sources: crustal associated to long range transport and carbonates associated to local resuspended dust. Both sources contributes to the coarse fraction and have different dynamics with crustal source contributing mainly in high winds from SE conditions and carbonates during high winds from North direction.

Antenatal Diagnosis of a Large Immature Abdominal Wall Teratoma by 2D-3D Ultrasound Using HDlive and Magnetic Resonance Imaging

We describe the first case of prenatally detected teratoma of the fetal abdomen wall using ultrasound and fetal magnetic resonance imaging (MRI). A heterogeneous mass, partly solid and cystic, originating from the anterior abdominal wall of the fetus close to an omphalocele sac was detected by means of 2D/3D ultrasound and MRI. Amniodrainage was performed and due to sign of impending fetal risk, an emergency Cesarean section was performed. A bulky, crumbly and bleeding tumoral mass was confirmed at delivery. Ligation of the supplying artery to the tumor was complicated by uncontrollable hemorrhage and early neonatal death. Pathology identified the tumor as an immature teratoma of the anterior fetal abdominal wall. 2D/3D ultrasound, especially using HDlive application and MRI demonstrated accurate detection and characterization of this congenital tumor.

The distribution and frequency of pulmonary neuroendocrine cells in Down syndrome fetal lungs

The pulmonary neuroendocrine cells (PNEC) are located in the epithelial lining of the airways and consist of solitary neuroendocrine cells (NEC) and NEC clusters, the neuroepithelial bodies (NEB). During fetal life, PNEC are the first to differentiate within the primitive airway epithelium, and bombesin expression favors branching of the respiratory tree. We investigated PNEC in Down syndrome (DS), where the lungs often show enlarged and reduced number of alveoli. Immunohistochemistry for bombesin and synaptophysin, PNEC markers, was evaluated in fetal lungs from 15 cases of DS and 11 age-matched controls from the 17th to 23rd week of gestation. Morphometric analysis assessed PNEC in the mucosal lining of each lung, expressed as number/mm. Nonparametric Mann-Whitney U test showed no statistical difference in frequency of PNEC in DS and controls. Our findings suggest that, at least in late second trimester, the distribution and frequency of PNEC in DS fetuses is not altered.

The role of diagnostic imaging and liver biopsy in the diagnosis of focal nodular hyperplasia in children

BACKGROUND & AIMS

Focal nodular hyperplasia (FNH), a benign liver tumour, has a characteristic appearance on diagnostic imaging (DI) and histology. The role of liver biopsy in children for the diagnosis of FNH is unclear. This study investigates the diagnostic accuracy of DI for FNH in children without comorbidities, compared to liver biopsy.

METHODS

A total of 304 consecutive patients (age <18 years) with a biopsied liver mass were retrospectively ascertained (1990-2010). Individuals with a history of malignancy, liver disease or syndromes with increased malignancy risk were excluded. DI and biopsy data were reviewed.

RESULTS

After excluding 205 cases, 99 liver masses were studied. Based on histology, the most common diagnosis was hepatoblastoma (46/99, 44%) followed by FNH (23/99, 23%). The mean age at FNH diagnosis was 11.1 ± 5.2 years, with female preponderance (78%), and a median follow-up of 1.35 years (interquartile range 0.54, 4.20 years). 19/23 biopsy-proven FNH met standard criteria for FNH on DI. In 4/23 cases of biopsy-proven FNH, imaging did not suggest FNH. Two false positive cases included adenoma and fibrolamellar hepatocellular carcinoma. On review of original reports, DI had 82.6% sensitivity and 97.4% specificity for the diagnosis of FNH. On blind review, the sensitivity of DI for FNH diagnosis was 81.3% for MRI (13/16), and 53.3% for CT (8/15).

CONCLUSIONS

In this cohort of children with liver masses and no comorbidities, a diagnosis of FNH by imaging was highly specific, and MRI was the most sensitive study for its diagnosis. Liver biopsy may be deferred in selected children if the DI, particularly MRI, is indicative of FNH.

Influence of open vegetation fires on black carbon and ozone variability in the southern Himalayas (NCO-P, 5079 m a.s.l.)

We analysed the variability of equivalent black carbon (BC) and ozone (O3) at the global WMO/GAW station Nepal Climate Observatory-Pyramid (NCO-P, 5079 m a.s.l.) in the southern Himalayas, for evaluating the possible contribution of open vegetation fires to the variability of these short-lived climate forcers/pollutants (SLCF/SLCP) in the Himalayan region. We found that 162 days (9% of the data-set) were characterised by acute pollution events with enhanced BC and O3 in respect to the climatological values. By using satellite observations (MODIS fire products and the USGS Land Use Cover Characterization) and air mass back-trajectories, we deduced that 56% of these events were likely to be affected by emissions from open fires along the Himalayas foothills, the Indian Subcontinent and the Northern Indo-Gangetic Plain. These results suggest that open fire emissions are likely to play an important role in modulating seasonal and inter-annual BC and O3 variability over south Himalayas.

High black carbon and ozone concentrations during pollution transport in the Himalayas: five years of continuous observations at NCO-P global GAW station

To study the influence of polluted air-mass transport carrying ozone (O3) and black carbon (BC) in the high Himalayas, since March 2006 the Nepal Climate Observatory at Pyramid (NCO-P) GAW-WMO global station (Nepal, 5079 m a.s.l.) is operative. During the first 5-year measurements, the O3 and BC concentrations have shown a mean value of 48 +/- 12 ppb (+/- standard deviation) and 208 +/- 374 ng/m3, respectively. Both O3 and BC showed well defined seasonal cycles with maxima during pre-monsoon (O3: 61.3 +/- 7.7 ppbV; BC: 444 +/- 433 ng/m3) and minima during the summer monsoon (O3: 40.1 +/- 12.4 ppbV; BC: 64 +/- 101 ng/m3). The analysis of the days characterised by the presence of a significant BC increase with respect to the typical seasonal cycle identified 156 days affected by "acute" pollution events, corresponding to 9.1% of the entire data-set. Such events mostly occur in the pre-monsoon period, when the O3 diurnal variability is strongly related to the transport of polluted air-mass rich on BC. On average, these "acute" pollution events were characterised by dramatic increases of BC (352%) and O3 (29%) levels compared with the remaining days.

Ten years of continuous observations of stratospheric ozone depleting gases at Monte Cimone (Italy)--comments on the effectiveness of the Montreal Protocol from a regional perspective

Halogenated gases potentially harmful to the stratospheric ozone layer are monitored worldwide in order to assess compliance with the Montreal Protocol requiring a phase out of these compounds on a global scale. We present the results of long term (2002-2011) continuous observation conducted at the Mt. Cimone GAW Global Station located on the highest peak of the Italian Northern Apennines, at the border of two important regions: the Po Valley (and the Alps) to the North and the Mediterranean Basin to the South. Bi-hourly air samples of CFC-12, CFC-11, CFC-114, CFC-115, H-1211, H-1301, methyl chloroform, carbon tetrachloride, HCFC-22, HCFC-142b, HCFC-124 and methyl bromide are collected and analysed using a gas chromatograph-mass spectrometer, providing multi annual time series. In order to appreciate the effectiveness of the Montreal Protocol from a regional perspective, trends and annual growth rates of halogenated species have been calculated after identification of their baseline values. A comparison with results from other international observation programmes is also presented. Our data show that the peak in the atmospheric mixing ratios of four chlorofluorocarbons, two halons and two chlorocarbons has been reached and all these species now show a negative atmospheric trend. Pollution episodes are still occurring for species like halon-1211, methyl chloroform and carbon tetrachloride, indicating fresh emissions from the site domain which could be ascribed both to fugitive un-reported uses of the compounds and/or emissions from banks. For the hydrofluorocarbons changes in the baseline are affected by emissions from fast developing Countries in East Asia. Fresh emissions from the site domain are clearly declining. Methyl bromide, for which the Mediterranean area is an important source region, shows, in a generally decreasing trend, an emission pattern that is not consistent with the phase-out schedule of this compound, with a renewed increase in the last two years of pollution episodes.

Widespread proliferation impairment and hypocellularity in the cerebellum of fetuses with down syndrome

Evidence in mouse models for Down syndrome (DS) and human fetuses with DS clearly shows severe neurogenesis impairment in various telencephalic regions, suggesting that this defect may underlie the cognitive abnormalities of DS. As cerebellar hypotrophy and motor disturbances are part of the clinical features of DS, the goal of our study was to establish whether these defects may be related to neurogenesis impairment during cerebellar development. We found that in fetuses with DS (17-21 weeks of gestation) the cerebellum had an immature pattern, a reduced volume and notably fewer cells (-25%/-50%) in all cerebellar layers. Immunohistochemistry for Ki-67, a marker of cycling cells, showed impaired proliferation (-17%/-50%) of precursors from both cerebellar neurogenic regions (external granular layer and ventricular zone). No differences in apoptotic cell death were found in DS vs. control fetuses. The current study provides novel evidence that in the cerebellum of DS fetuses there is a generalized hypocellularity and that this defect is due to proliferation impairment, rather than to an increased cell death. The reduced proliferation potency found in the DS fetal cerebellum, in conjunction with previous evidence, strengthens the idea that the trisomic brain is characterized by widespread neurogenesis disruption.

Fetal cerebral periventricular halo at midgestation: an ultrasound finding suggestive of fetal cytomegalovirus infection

OBJECTIVE

The objective of the study was to identify a cerebral ultrasound finding indicative of fetal cytomegalovirus (CMV) infection at midgestation.

STUDY DESIGN

All fetuses of 218 patients with primary CMV infection underwent prospective transvaginal neurosonographic examination at 20-22 weeks' gestation.

RESULTS

Transvaginal sonography identified a periventricular echogenic halo with well-defined borders in 6 infected fetuses at a mean gestational age of 20.5 weeks. Transabdominal axial views of the fetal head were normal in all cases. All patients opted for termination of pregnancy. Autopsy in 2 fetuses showed changes compatible with subacute white matter injury resembling telencephalic leukomalacia.

CONCLUSION

A fetal cerebral periventricular halo disclosed by transvaginal sonography at midgestation in pregnant patients with recent CMV infection is suggestive of fetal infection and may be associated with white matter lesions.

Prenatal diagnosis and outcome of partial agenesis and hypoplasia of the corpus callosum

OBJECTIVE

To present antenatal sonographic findings and outcome of fetuses with hypoplasia or partial agenesis of the corpus callosum.

METHODS

The database of our ultrasound laboratory was searched retrospectively for cases of hypoplasia or partial agenesis of the corpus callosum suspected at antenatal neurosonography between 1998 and 2008 and confirmed by pathology or postnatal neuroimaging. In surviving infants, clinical follow-up had been arranged to assess neurodevelopmental outcome.

RESULTS

Nineteen fetuses with callosal underdevelopment were identified at a median gestational age of 22 (range, 21-33) weeks and confirmed at follow-up, including 14 with partial agenesis and five with hypoplasia. Among the 14 fetuses with partial agenesis, there were additional brain findings in 10, including two with absent cavum septi pellucidi, four with mild isolated ventriculomegaly and four with cerebellar abnormalities, two of which also had ventriculomegaly. Pregnancy was terminated electively in seven of the cases with partial agenesis and there was one neonatal death. Among the six surviving infants, neurodevelopmental outcome was appropriate for age in three at follow up, including two cases with isolated partial agenesis of the corpus callosum. Among the five fetuses with prenatally diagnosed callosal hypoplasia, additional anomalies were present in four. Two cases were terminated electively and three were alive at the time of writing, with a median age of 3 years. Among them, apparently normal neurological development was observed in only one case.

CONCLUSIONS

An antenatal diagnosis of callosal underdevelopment is possible by expert sonography. There is often association with other major anomalies. However, even in fetuses with apparently isolated findings, the prognosis is uncertain.

Bilateral cleft lip and palate without premaxillary protrusion is associated with lethal aneuploidies

OBJECTIVE

To investigate the clinical implications of two categories of fetal bilateral cleft lip and palate (BCLP): with premaxillary protrusion and with a flattened profile.

METHODS

This was a retrospective study of fetuses with a prenatal diagnosis of BCLP at the Department of Obstetrics and Gynecology of the University of Bologna in the period 1991-2005.

RESULTS

BCLP was diagnosed prenatally in 14 cases (mean gestational age at diagnosis, 21 (range, 12-36) weeks). In nine of these, there was a premaxillary pseudomass; in the remaining five, the profile was flat. Associated structural and/or chromosomal anomalies were found in two of the nine with a premaxillary pseudomass and in all five of those with a flat profile (P = 0.02). All fetuses with a flat profile had aneuploidies (three trisomy 18, one trisomy 13, one trisomy 8 mosaic), as did one of the nine with a premaxillary pseudomass. Eight of the pregnancies were terminated, including three of those with a premaxillary pseudomass and all five of those without. All continuing pregnancies resulted in live births, although one neonate affected by Krabbe's disease died shortly after birth.

CONCLUSIONS

Our findings suggest that a third of cases of BCLP diagnosed in utero have a flat profile and these are at high risk of lethal aneuploidies.

Continuous measurements of aerosol physical parameters at the Mt. Cimone GAW Station (2165 m asl, Italy)

Particle size distribution in the range 0.3<D(p)<or=20 microm, has been analysed from August 2002 to July 2006 at the GAW Station of Mt. Cimone (44.10 N, 10.42 E; 2165 m asl) in the northern Italian Apennines. The seasonal aerosol number size distribution, characterized by a bimodal shape, showed a behaviour typical for background conditions, characterized by highest values in summer and lowest in winter. The seasonal and diurnal variations of the larger accumulation mode (0.3<D(p)<or=1 microm average values: 26.15 cm(-3)) and the coarse mode (1<Dp<or=20 microm, average value: 0.17 cm(-3)) particle number concentrations (N 0.3-1 and N 1-20, respectively) exhibited a seasonal cycle with the highest values in spring-summer and the lowest value in autumn-winter. Except in winter, N 0.3-1 showed a clear diurnal variation with high values during day-time. N 1-20 showed a less marked diurnal variation (but with higher variability), suggesting the influence of non-continuous sources of coarse particle (i.e. Saharan dust events). Since July 2005, continuous measurement of black carbon (BC) concentrations was also available at the measurement site. On average low BC concentrations were recorded (average value: 0.28 microg m(-3)) even if a few events of high concentrations were recorded both in warm and cold season. Apart from wet scavenging processes which strongly affected aerosol concentrations, combined analysis of N 0.3-1, BC, meteorological parameters and air mass back-trajectories, suggests that the transport of polluted air masses from the lower troposphere (by local, regional or long-range transport) represents an important mechanism favouring N 0.3-1 and BC increases at Mt. Cimone. In particular, a trajectory statistical analysis for the period July 2005-July 2006 allowed the identification of the main source regions of BC and N 0.3-1 for Mt. Cimone: north Italy, west Europe and east Europe.

The ABC-Pyramid Atmospheric Research Observatory in Himalaya for aerosol, ozone and halocarbon measurements

In this work we present the new ABC-Pyramid Atmospheric Research Observatory (Nepal, 27.95 N, 86.82 E) located in the Himalayas, specifically in the Khumbu valley at 5079 m a.s.l. This measurement station has been set-up with the aim of investigating natural and human-induced environmental changes at different scales (local, regional and global). After an accurate instrumental set-up at ISAC-CNR in Bologna (Italy) in autumn 2005, the ABC-Pyramid Observatory for aerosol (physical, chemical and optical properties) and trace gas measurements (ozone and climate altering halocarbons) was installed in the high Khumbu valley in February 2006. Since March 2006, continuous measurements of aerosol particles (optical and physical properties), ozone (O3) and meteorological parameters as well as weekly samplings of particulate matter (for chemical analyses) and grab air samples for the determination of 27 halocarbons, have been carried out. These measurements provide data on the typical atmospheric composition of the Himalayan area between India and China and make investigations of the principal differences and similarities between the monsoon and pre-monsoon seasons possible. The study is carried out within the framework of the Ev-K2-CNR "SHARE-Asia" (Stations at High Altitude for Research on the Environment in Asia) and UNEP-"ABC" (Atmospheric Brown Clouds) projects. With the name of "Nepal Climate Observatory-Pyramid" the station is now part of the Observatory program of the ABC project.

Neurogenesis impairment and increased cell death reduce total neuron number in the hippocampal region of fetuses with Down syndrome

We previously obtained evidence for reduced cell proliferation in the dentate gyrus (DG) of fetuses with Down syndrome (DS), suggesting that the hippocampal hypoplasia seen in adulthood may be caused by defective early neuron production. The goal of this study was to establish whether DS fetuses (17-21 weeks of gestation) exhibit reduction in total cell number in the DG, hippocampus and parahippocampal gyrus (PHG). Volumes of the cellular layers and cell number were estimated with Cavalieri's principle and the optical fractionator method, respectively. We found that in DS fetuses all investigated structures had a reduced volume and cell number. Analysis of cell phenotype showed that DS fetuses had a higher percentage of cells with astrocytic phenotype but a smaller percentage of cells with neuronal phenotype. Immunohistochemistry for Ki-67, a marker of cycling cells, showed that DS fetuses had less proliferating cells in the germinal zones of the hippocampus and PHG. We additionally found that in the hippocampal region of DS fetuses there was a higher incidence of apoptotic cell death. Results show reduced neuron number in the DS hippocampal region and suggest that this defect is caused by disruption of neurogenesis and apoptosis, two fundamental processes underlying brain building.

Cell cycle alteration and decreased cell proliferation in the hippocampal dentate gyrus and in the neocortical germinal matrix of fetuses with Down syndrome and in Ts65Dn mice

Down syndrome (DS), the leading genetic cause of mental retardation, is characterized by reduced number of cortical neurons and brain size. The occurrence of these defects starting from early life stages points at altered developmental neurogenesis as their major determinant. The goal of our study was to obtain comparative evidence for impaired neurogenesis in the hippocampal dentate gyrus (DG) of DS fetuses and Ts65Dn mice, an animal model for DS. Cell proliferation in human fetuses was evaluated with Ki-67 (a marker of cells in S + G(2) + M phases of cell cycle) and cyclin A (a marker of cells in S phase) immunohistochemistry. We found that in the DG of DS fetuses the number of proliferating cells was notably reduced when compared with controls. A similar reduction was observed in the germinal matrix of the lateral ventricle. In both structures, DS fetuses showed a reduced ratio between cyclin A- and Ki-67-positive cells when compared with controls, indicating that they had a reduced number of cycling cells in S phase. In the DG of P2 Ts65Dn mice cell proliferation, assessed 2 h after an injection of bromodeoxyuridine (BrdU), was notably reduced, similarly to DS fetuses. After 28 days, Ts65Dn mice had still less BrdU-positive cells than controls. Phenotypic analysis of the surviving cells showed that Ts65Dn mice had a percent number of cells with astrocytic phenotype larger than controls. Using phospho-histone H3 immunohistochemistry we found that both DS fetuses and P2 Ts65Dn mice had a higher number of proliferating cells in G(2) and a smaller number of cells in M phase of cell cycle. Results provide novel evidence for proliferation impairment in the hippocampal DG of the DS fetal brain, comparable to that of the P2 mouse model, and suggest that cell cycle alterations may be critical determinants of the reduced proliferation potency.

Prenatal diagnosis of open and closed spina bifida

OBJECTIVE

To identify criteria useful for differentiating closed from open spina bifida antenatally.

PATIENTS AND METHODS

A retrospective study of cases of spina bifida diagnosed in a referral center between 1997 and 2004.

RESULTS

Of 66 cases of fetal spina bifida diagnosed at a median gestational age of 21 (range, 16-34) weeks, detailed follow-up was available for 57. Of these, open defects were found in 53 (93.0%) and closed defects in four (7.0%). Closed spina bifida was associated in two cases with a posterior cystic mass with thick walls and a complex appearance, while in two cases the spinal lesion could not be clearly differentiated from an open defect, particularly at mid-gestation. Open spina bifida was always associated with typical alterations of cranial anatomy, including the so-called 'banana' and 'lemon' signs, while in closed spina bifida the cranium was unremarkable. When the data were available, levels of amniotic fluid alpha-fetoprotein were always abnormally elevated with open spina bifida and within normal limits with closed forms.

CONCLUSION

In this study 7% of cases of spina bifida diagnosed in utero were closed. The differentiation between open and closed forms is best shown by the sonographic demonstration of abnormal or normal cranial anatomy.

Experimental evaluation of Surgisis as scaffold for neointestine regeneration in a rat model

The aim of the study was to evaluate the use of Surgisis (Cook Biotech Inc.), a porcine derived extracellular matrix already used in tissue engineering, as a scaffold for neointestinal regeneration in a rat model. A 3-cm length of tubular Surgisis graft was interposed with bilateral anastomoses in the middle of an isolated ileal loop of Sprague Dawley rats with an ileostomy. The grafts were harvested and analyzed using histology and immunohistochemistry at 24 weeks after operation. Macroscopic examination revealed neither stenosis nor adhesions in the area surrounding the neointestine. The regenerated small bowel showed a mean shrinkage of 30.7% (range 20%-40%). Histologic and immunohistochemical evaluation showed a well-developed three layers of mucosa and smooth muscle and serosa in the regenerated bowel wall that were similar to those of the normal bowel with evident neovascularization. Also, the regeneration of smooth muscle fibers and innervation were evident. The preliminary results of this study showed that Surgisis allowed rapid regeneration of mucosa and smooth muscle and therefore may be a promising material for the creation of a neointestine.

Accurate neurosonographic prediction of brain injury in the surviving fetus after the death of a monochorionic cotwin

OBJECTIVE

To assess the feasibility of the prenatal diagnosis using fetal neurosonography of brain injuries in the surviving fetus after the demise of a monochorionic cotwin.

METHODS

This was a retrospective observational study in the period 1990-2004 of monochorionic twin pregnancies with a single fetal demise. A detailed sonographic evaluation of the intracranial anatomy of the surviving twin had been performed whenever possible using a multiplanar approach and from 1999, fetal magnetic resonance imaging was offered as well. Postnatal follow-up was obtained in all cases.

RESULTS

In six of nine cases, abnormal neurosonographic findings were identified including intracranial hemorrhage, brain atrophy, porencephaly and periventricular echogenicities evolving into polymicrogyria. Prenatal diagnosis of brain lesions was confirmed postnatally and all affected infants who survived had severe neurological sequelae. Two fetuses had normal cerebral structures both on the prenatal neurosonogram and on postnatal imaging and were following normal developmental milestones, one at 1 and the other at 5 years of age. In one case the neurosonographic examination was suboptimal and the infant was found at birth to have a porencephalic cyst. Fetal magnetic resonance imaging was performed in two cases and confirmed the ultrasound diagnosis.

CONCLUSIONS

Prenatal neurosonography is a valuable tool for the prediction of neurological outcome in fetuses surviving after the intrauterine death of a monochorionic cotwin. Although our experience is limited, we suggest that magnetic resonance imaging should also be offered.

Diagnosis of midline anomalies of the fetal brain with the three-dimensional median view

OBJECTIVE

To investigate the effectiveness of a simplified approach to the evaluation of the midline structures of the fetal brain using three-dimensional (3D) ultrasound.

METHODS

Sonographic examinations were performed in normal fetuses and in cases with anomalies involving the midline cerebral structures. Two-dimensional (2D) median planes were obtained by aligning the transducer with the anterior fontanelle and midline sutures by either transabdominal or transvaginal scans. Median planes were also reconstructed using 3D ultrasonography from volumes acquired from transabdominal axial planes of the fetal head (3D median planes), by either multiplanar analysis of static volumes or volume contrast imaging in the coronal plane (VCI-C). 2D and 3D median planes were compared qualitatively and quantitatively by measuring the corpus callosum and cerebellar vermis.

RESULTS

2D median planes could be visualized in 54/56 normal fetuses. 3D median planes were obtained in all, usually more easily and rapidly. There was a good correlation between 2D and 3D images. Measurements of the corpus callosum and cerebellar vermis were highly correlated, with mean variations of 6% and 14%, respectively. The abnormal group included 13 fetuses (five with partial or complete agenesis of the corpus callosum, six with posterior fossa malformations, two with a combination of these two anomalies). In all cases the diagnosis could be made by both 2D and 3D views and was always confirmed by postnatal investigation. Although 2D median views were of better quality, 3D images were always adequate for diagnosis, both in normal and abnormal fetuses.

CONCLUSIONS

3D median planes are obtained more easily than 2D ones, and allow an accurate diagnosis of normal cerebral anatomy and anomalies. The 3D approach may be valuable particularly for rapid assessment of fetal cerebral anatomy in standard examinations.

Mt. Cimone Observatory: baseline station for the measurement of gaseous substances and radioactive tracers in the atmosphere

An extensive research program to record atmospheric physicochemical parameters and to track climatological trends was established at a remote Alpine station at Mt. Cimone Observatory in Italy. The main features of the study are outlined briefly and the results thus far collected, including surface ozone, carbon dioxide, stratospheric NO2 and O3, and airborne radioactivity are provided.

Differential optical absorption spectrometer for measurement of tropospheric pollutants

Our institute has recently developed a differential optical absorption spectrometry system called the gas analyzer spectrometer correlating optical absorption differences (GASCOAD), which features as a detector a linear image sensor that uses an artificial light source for long-path tropospheric-pollution monitoring. The GASCOAD, its method of eliminating interference from background sky light, and subsequent spectral analysis are reported and discussed. The spectrometer was used from 7 to 22 February 1993 in Milan, a heavily polluted metropolitan area, to measure the concentrations of SO(2), NO(2), O(3), and HNO(2) averaged over a 1.7-km horizontal light path. The findings are reported and briefly discussed.