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Biomedical subjects

G Moscoso

Publications and source records attributed to G Moscoso.

64 records · Page 4Linked to original sources

[Prenatal diagnosis of molar pathologies coexisting with a fetus. Review of the recent literature and a case report].

A case of twin pregnancy combining a complete mole and a normal pregnancy is reported. A spontaneously aborted partial triploid mole was found in the past medical history of the patient. Prenatal investigations showed an heterogenous mass suggestive of a trophoblastic disorder coexisting with a normal placenta and a morphologically normal fetus on sonography associated with increased levels of hCG and normal levels of AFP in the maternal serum. High-resolution color Doppler imaging showed no blood flow within the suspect mass, excluding a myoma in necrobiosis or a large placental chorioangioma. The patient did not presented the severe complications classically described in classical mole and a passive conservative attitude was adopted. The pregnancy ended prematurely and the patient delivered at 27 weeks of gestation of a phenotypically normal infant. The mother and the baby had an unremarkable post-partum course. The review of the recent literature showed that partial hydatidiform mole could be separated in four categories: triploid partial moles; twin pregnancies combining a complete mole and a normal pregnancy; diploid partial mole; and pseudo-moles. Detailed sonographic examination and evaluation of maternal serum hCG and AFP should allow prenatal differential diagnosis of these pathological entities.

Adult↗

Nonimmune hydrops fetalis associated with genetic abnormalities.

The purpose of this review of the literature on nonimmune hydrops fetalis was to evaluate whether recent clinicopathologic studies have modified the relative incidence of the different associated conditions and the management of these pregnancies. We found 600 cases of nonimmune hydrops fetalis published since 1982. These cases were reviewed with particular attention to genetic causes and were compared with a literature review of 298 cases published before 1982. The mean gestational age at diagnosis varied from 24-29 weeks in the recent series, compared with 31-33 weeks in the earlier series. Genetically transmitted conditions accounted for more than 35% of the fetal and maternal disorders associated with nonimmune hydrops fetalis in the recent series, compared with 21% before 1982. The most frequently identified genetic abnormalities in our review were chromosomal disorders (15.7%), alpha-thalassemia (10.3%), skeletal dysplasia (4%), arthrogryposis multiplex syndromes (1.8%), multiple pterygium syndrome (1.5%), and lysosomal storage disorders (1.0%). These results confirm the need for systematic chromosome analysis in fetuses with nonimmune hydrops. From this review, we conclude that prenatal noninvasive and invasive techniques combined with detailed pathologic studies have improved the accuracy of diagnosis of the underlying causes of nonimmune hydrops fetalis and have influenced the management of these pregnancies.

Bone Diseases, Developmental↗

Ciliogenesis and ciliation of the respiratory epithelium in the human fetal cartilaginous trachea.

Ciliogenesis of the respiratory epithelium in the human cartilaginous trachea start during the 12th week of gestation. Ciliary shafts are first seen under the scanning electron microscope during the 13th week. Unlike its membranous counterpart, ciliary shafts appear all over the epithelial surface at almost the same time. Epithelial cells destined to become ciliated cells first develop numerous long and thin microvilli. A process of individual cell extrusion and proliferation of neuroepithelial bodies around the carinal angle precede ciliation in the respiratory epithelium of the cartilaginous trachea. Epithelial cell differentiation patterns in both the cartilaginous and membranous trachea are different. The mechanisms involved in modulating cell differentiation are currently under investigation.

Cartilage↗

Fetal breathing movements as predictor of favourable pregnancy outcome after oligohydramnios due to membrane rupture in second trimester.

In 11 pregnancies complicated by oligohydramnios due to spontaneous rupture of the membranes in the second trimester of pregnancy fetal breathing movements were assessed regularly by ultrasonographic examinations. In the 6 cases in which fetal breathing movements were detected the babies were liveborn and there was no evidence of pulmonary hypoplasia or the other non-renal features of Potter's syndrome. In the other 5 cases there were no fetal breathing movements. 1 pregnancy was terminated electively, and 1 ended in an intrauterine death; the remaining 3 infants died in the neonatal period. All 5 cases showed necropsy evidence of pulmonary hypoplasia. These findings indicate that premature and prolonged rupture of membranes in the second trimester of pregnancy does not uniformly result in a poor prognosis. They suggest that fetal breathing movements could be used as a predictor of favourable neonatal outcome.

Amniotic Fluid↗

Normal venous circulation of the gastroesophageal junction. A route to understanding varices.

A study into the normal anatomy of the venous circulation of the gastroesophageal junction was undertaken using three complementary techniques (radiology, corrosion casting, and morphometry). Four distinct zones of venous drainage were defined as follows: (a) gastric zone, characterized by a longitudinal venous distribution; (b) palisade zone, composed of parallel vessels arranged in groups, lying mainly within the lamina propria; (c) perforating zone, characterized by "treble clef" shaped veins, which collect and channel blood into extrinsic veins; and (d) truncal zone, composed of four or five deep lying descending veins. This venous system appeared to be mainly distributed within the esophageal mucosal folds. The anatomic pattern suggests that venous flow is bidirectional at the palisade zone, which acts as a high-resistance watershed region between the portal and azygos systems. In patients with portal hypertension this normal vascular system has to accommodate greatly increased venous flow, and the anatomy as demonstrated here offers insight into variceal development.

Aged↗

First trimester diagnosis of hypophosphatasia with a monoclonal antibody to the liver/bone/kidney isoenzyme of alkaline phosphatase.

Prenatal diagnosis of hypophosphatasia was made by alkaline phosphatase (ALP) assay on a chorionic villus sample taken in the first trimester. Monoclonal antibodies against the liver/bone/kidney (LBK) and placental isoenzymes of ALP were used, and the bound isoenzymes were quantified by an amplification system. Very low activities of the LBK isoenzyme indicated an affected fetus. Diagnosis was confirmed by ultrasound scan at 15 weeks' gestation, and by ALP measurement in amniotic fluid supernatant and fetal serum.

Adult↗

Cardiac defects in 1st-trimester fetuses with trisomy 18.

In trisomy 18, echocardiographic studies of affected neonates and pathological studies of stillbirths and infants have demonstrated a high incidence of cardiac defects. Fetal trisomy 18 can now be detected at 11-14 weeks of gestation, providing the opportunity to examine the incidence of cardiac defects at this gestational age. In 19 fetuses with trisomy 18 pathological examination of heart and great vessels was carried out after termination of pregnancy at 11-14 weeks of gestation. The abnormal karyotype was diagnosed by chorion villus sampling in pregnancies with increased fetal nuchal translucency thickness. All 19 fetuses had cardiac defects, and the commonest were ventricular septal defects in 16 (84%) and valvular abnormalities in 16 (84%). In 14 of the 16 cases with valvular abnormalities more than one valve was affected. The great vessels were available for examination in 18 of the 19 cases, and in 10 there was a hypoplastic aortic isthmus or pulmonary trunk. In 6 (32%) cases there was persistence of the left superior vena cava. In 1st-trimester fetuses with trisomy 18, the frequency of perimembranous ventricular septal defects and valvular abnormalities is similar to that in affected neonates. Haemodynamic changes due to the valvular abnormalities, especially imperforate valves, and hypoplasia of the great vessels may be the underlying mechanisms for the increased nuchal translucency of trisomic fetuses. Persistence of the left superior vena cava may result from venous congestion of head and neck.

Chromosomes, Human, Pair 18↗