Microgenia: an unusual complication of cesarean delivery.
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In 1,015 CD-1 near-term mouse fetuses, removed by cesarean section after cervical dislocation of dams, skin color, motility, crying, and breathing were studied. Three categories of fetuses were considered: living and surviving (92.5%); living but non-surviving (6.9%), and stillborn (0.6%). Particular attention was paid to the following: 24 fetuses, still apneic after routine manipulation, started breathing by specific maneuvers; 5 of these 24 fetuses were apparently dead when apnea recovery was successfully tried, and the living but non-surviving category must be considered in developmental toxicity screening as prenatal injuries may be manifested by an increase in the incidence of the fetuses belonging to this category.
OBJECTIVE: The study was designed to analyse the value of specific dermatoglyphic characters in assessing prenatal injuries in schizophrenic patients. Analysis of pattern frequency in schizophrenics and normal controls, sex related differences in hand-print patterns in schizophrenic patients, and relationship between dermatoglyphic characters and age of onset of the disease was made. METHOD: Hand-prints of 42 schizophrenic inpatients meeting the DSM-IV criteria for schizophrenia and 36 normal controls were obtained using the ink method. To avoid possible confounding, patients with diagnoses of the schizophrenic spectrum, i.e., schizophreniform and schizoaffective, schizotypal and schizoid personality disorder were excluded from the study. RESULTS: Statistically significant differences in the finger-print patterns were found between the schizophrenic patients and controls. In males this was largely attributed to the increase of whorls and in females--to the increase of arches. Patients with early age of onset showed higher frequency of Lr pattern in the hypothenar area. In terms of dermatoglyphic characters and season of birth the differences did not reach statistical significance. CONCLUSION: The results show an association between the frequency of certain dermatoglyphic characters and schizophrenia. The nature of association can be better evaluated by using the schizophrenia types in further analyses.
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A study was made of the clinical picture of congenital cytomegaloviral infection in 40 children of the first year of life. The diagnosis was established on the basis of demonstration in all the patients of IgM antibodies to cytomegalovirus (IgM anti-CMV) by EIA with the aid of the commercial test systems. Besides, 81% of the children were found to have cytomegalic-specific cells in urine, 17.6% in saliva, and 72.5% demonstrated IgG anti-CMV (in accordance with EIA). The majority of the patients (70%) were born premature. The most typical clinical signs of congenital cytomegaloviral infection were adynamia, jaundice, liver and CNS injury, prenatal hypotrophy; 45% of the children had developmental abnormalities and stigmas of dysembryogenesis. In 97.5% of the mothers, the pregnancy ran a pathological course. The disease history often pointed to miscarriages (10%) and death of the children due to intrauterine infection in the early times after birth (15%).
The role of endogenous opioid systems in preweaning development after intrauterine exposure to X-irradiation or ethylnitrosourea (ENU) was explored in rats using naltrexone, a potent antagonist of beta-endorphin. After daily s.c. injections of 50 mg/kg naltrexone only the prenatally untreated controls had body weights increased by 11% from control level on day 28 (weaning). In the X-irradiated as well as the ENU-treated pups no significant effects of naltrexone on body weight gain were observed. However, brain weight increased in all animals under the influence of naltrexone, irrespective of prenatal treatment or the severity of brain lesions: 9.5% above control values in untreated offspring and 14% after X-irradiation (1 Gy) on gestation day 14. The brain weight of ENU-treated rats (50 mg/kg on gest. day 14) was 13% higher after postnatal naltrexone application than that of their postnatally untreated counterparts. ENU (80 mg/kg) effects on the brain when given on gestation day 18 were ameliorated to 9.2% by naltrexone in the weaning period. Naltrexone significantly increased the thymus weight in controls. Prenatally treated animals also showed an increased thymus weight at weaning, presumably due to compensatory growth. In these cases naltrexone revealed a suppressive effect on the thymus, whereas spleen weight was apparently not influenced by naltrexone treatment. These results provide compelling evidence that endogenous opioid systems play a crucial role not only in normal development, but also in reparative growth events of the brain after prenatal injuries. The thymus, predominantly containing T-lymphocytes, seems to represent another sensitive system which is regulated under the influence of opioids.
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BACKGROUND: Prenatal diagnosis of fetal intracranial hemorrhage has important etiologic, management, and prognostic implications. Ultrasonography and magnetic resonance imaging (MRI) have been used to identify and evaluate this condition. We present the first reported case of epidural hematoma diagnosed prenatally. CASE: A 25-year-old para 3 was referred for evaluation of a suspected fetal intracranial abnormality following an alleged assault. Ultrasonography and MRI were used to diagnose an epidural hematoma prenatally. The fetus subsequently died in utero. Autopsy confirmed the presence of an epidural hematoma. CONCLUSION: Ultrasonography and MRI were useful in diagnosing a fetal epidural hematoma. Unfortunately, no known effective in utero therapy exists for this rare problem.
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INTRODUCTION: Prenatal intracranial anomalies of a cystic nature are mainly either malformations (arachnoid cysts) or disruptive (porencephaly). They are usually incidental findings and, unless they undergo a progressive increase in size and become expansile or offer clinical features, they are usually managed 'expectantly'. Disruptive defects are more frequent in twin pregnancies. CASE REPORT: A one and a half-month-old male patient, fruit of a bichorial twin pregnancy, with bouts of paleness, cyanosis around the mouth and movements of the mouth that initially responded to treatment with valproate. Physical exploration was normal except for a significant increase in the cephalic perimeter. A notable anaemia was observed and neuroimaging revealed a left temporal intraparenchymatous cystic lesion; in addition, magnetic resonance imaging showed alterations in the linear and symmetrical signals in the parasagittal region. At three months the seizures reappeared and the cyst had increased in size, which led to the implantation of a cyst peritoneal shunt. The seizures ceased and the size of the cyst became stable, without full re expansion of the brain tissue. DISCUSSION: It is necessary to carry out a differential diagnosis of an arachnoid cyst and porencephaly. Given the history of being a twin, the notable degree of anaemia at the age of one month and the image suggesting parasagittal cerebral injury (a pattern of hypoxic ischemic encephalopathy in the full term neonate), we think that our patient was suffering from antenatal or perinatal cerebrovascular damage, which conditioned the development of an expansile porencephalic cyst and cortical damage that accounted for the symptoms of epilepsy.
Neuropathological examinations were carried out at necropsy on 274 cases of intrauterine death or neonatal death at or before three days after birth. Fifty six (20.4%) subjects had evidence of prenatal ischaemic brain damage. On review of the maternal case notes to ascertain antenatal clinical associations there was an increased incidence of intrauterine growth retardation, either based on birth weight for gestational age (odds ratio (OR) 2.0; 95% confidence interval (CI) 1.1 to 3.7) or diagnosed antenatally (OR 2.7; 95% CI 1.3 to 5.6). Oligohydramnios was also more common (OR 2.9; 95% CI 1.2 to 7.0). The association of intrauterine growth retardation and white matter damage remained after excluding fetuses with a major congenital anomaly (OR 2.4; 95% CI 1.1 to 5.1). The findings suggest that chronic intrauterine hypoxia may be associated with damage to cerebral white matter among fetuses and infants who die. The relation between ischaemic white matter damage and cerebral palsy among survivors remains speculative.
Experimental data indicate a particular vulnerability of striatal neurons in the developing brain, and together with the idea that the striatum is important for context recognition and behavior, these data have led the author to search for subtle striatal lesions, in the form of biochemical changes, in children who have suffered perinatal adverse events. Evidence is presented to demonstrate that the composition of metabolites in the striatum is altered, primarily in the form of an elevated level of lactate, in human neonates who have suffered various perinatal disorders, such as germinal matrix hemorrhage, intrauterine growth retardation, and asphyxia. An elevated level of lactate suggests tissue hypoxia, which may interfere with the formation of frontostriatal circuits and may play a role in the pathogenesis of the behavioral disturbances observed in a proportion of children with a history of perinatal adverse events.
Virtually every part of the body can be injured by electric current. The extent of injury to any given tissue will depend on many factors, including the nature of the tissue and the amount and duration of the electric current. In addition, cardiac and respiratory arrest can be induced by a number of mechanisms with little or no immediate tissue damage. Burns can be caused by the heating of tissue by electric current and by other mechanisms. Secondary trauma may result from falls, explosions, and other events initiated by electric forces. Nervous tissue has the least resistance to current flow and is thus more easily damaged. Part II in this 3-part series will discuss nervous tissue damage first, followed by discussions of damage to tissues of increasingly greater electric resistance. These are blood vessels, muscle, skin, and bone. Less common injuries are discussed last.
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