Transcutaneous electrical nerve stimulation and placental vascularization in cases of uterine blood flow restriction.

Studies report transcutaneous electrical nerve stimulation (TENS) as a treatment for placental insufficiency. To induce utero-placental insufficiency in rats, the uterine artery was ligated. Transcutaneous electrical nerve stimulation was applied with a frequency of 80 Hz, pulse duration of 200 µs, and low intensity. Placental blood vessels were analyzed after immunohistochemistry. The number, caliber and area occupied by placental vessels, fetal weight and length, and placental volume were lower in cases stimulated by TENS. The interaction between ligation and stimulation by TENS was associated with reduction of all these measurements, suggesting that TENS use during pregnancy may have harmful effects on intra-uterine development.

Kocher-Debré-Sémélaigne syndrome diagnosed by autopsy associated with disseminated intravascular coagulation.

Kocher-Debré-Sémélaigne syndrome is a rare disease with little literature, which develops with myopathy in infancy associated with neuromuscular alterations, polymyositis with symmetrical proximal muscle weakness, pseudohypertrophy, muscular rigidity and spasms, exercise intolerance, myxoedema, short stature, and cretinism. Male patient aged 18 years old, 1.52 m in height, admitted in the General Hospital of Triângulo Mineiro Federal University on November 11, 2003, complaining of intense diffuse abdominal pain like severe cramps, without triggering factors, associated with asthenia and hyporexia. This seems to be one of the few reports of KDS syndrome diagnoses by autopsy, where alterations in the thyroid gland connected with hypotrophy and probable congenital hypothyroidism were described and resulted in complications such as disseminated intravascular coagulation and hemophagocytic syndrome with fast progression to death of an 18-year-old patient.

Abnormalities of placenta implantation.

Implantation abnormalities are a group of disorders encompassing several entities with different degree of severity. This section will cover the etiopathogenesis, imaging findings, definition, risk factors, and pathology of the abnormally located and morbidly adherent placenta.

Osteochondral junction lesions in stillborn fetuses and their relationship to autopsy diagnoses.

BACKGROUND: In the perinatal period, microscopic abnormalities of the costochondral junction in fetuses were described but little is known about the perinatal intercurrences that were associated with them. AIMS: The aim of this study was to correlate the findings of the osteochondral junction (OCJ) of stillborn with the autopsy findings. STUDY DESIGN: We studied 50 longitudinal sections of OCJ of the 5th and 6th ribs collected from stillborn fetuses, after decalcification and staining with Hematoxilyn and Eosin (HE). The gestational age ranged between 22 and 41 weeks. RESULTS: The incidence of abnormal OCJ in the ribs was 62%. Intrauterine growth restriction was associated most often with banding. In 12% of our cases, we found one pattern of OCJ alteration that did not fit into the previous described categories. This pattern was the presence of a bone in the middle of the cartilage column associated with disorganization of the OCJ. The other pattern that has rarely been mentioned in the literature, we called "bizarre" and all the fetuses were less than 37 weeks of gestational age. The incidence of the "bizarre" or the "funny bone" patterns was less frequent than the other patterns of OCJ alteration, although they seem to be associated with the cases that had the most severe placental abnormalities (massive perivillous fibrinoid, decreased placenta blood flow) or congenital malformations (complex congenital heart defect, hydrocolpos). CONCLUSION: In conclusion, OCJ alterations were more commonly associated with congenital malformation or placental abnormalities. Histologic examination of the OCJ is an easy and reproducible method of determining in utero growth disturbance even before there is a lag in fetal growth and is an important component of the perinatal autopsy.

Assessment of renal maturity by assisted morphometry in autopsied fetuses.

BACKGROUND: The kidney is one organ which presents distinct morphology depending on GA; the classic references for kidney measurements were established several years ago and it is not certain if they are still accurate. AIM: To evaluate the renal maturity using a computer-assisted morphometry in autopsied fetuses within 20 to 40 weeks of GA. STUDY DESIGN: Microscopic hematoxylin and eosin stained renal sections from 67 stillborns were utilized for the morphometric analyses. RESULTS: It was possible to promote an adjustment in the formula used to calculate the number of mature glomeruli layers to the GA (GLN = 0.212GA + 0.0169) in autopsy material and it was different from the literature (Sr = 0.709; p < 0.001). Regarding the nephrogenic zone, it decreases with the GA as confirmed by the regression equation NZ = 490.7-(11.9 x GA) (p < 0.001; Sr = -0.685). CONCLUSION: In conclusion, our data contribute to the evaluation of renal maturity and GA in autopsied fetuses, showing particular importance in autolyzed fetuses, in which the parameters used in the present study can still be applied. The correction of the formula for counting mature glomeruli layers for each GA and the addition of new morphometric parameters for the evaluation of renal maturity increase the precision for the analysis of spontaneous abortion and autopsy material, improving the correlation with pathological processes in clinical findings and in the other organs.

Histochemical and immunohistochemical study of the glomerular development in human fetuses.

Few studies exist that establish the normal morphological patterns of glomerular development, though this is one of the organs that continues to evolve morphologically during the postnatal period up to 4 weeks after birth. In our study one kidney from each autopsy of a total of 86 autopsies was analyzed [15 weeks to 40 weeks of gestational age (GA)]. We examined the variation in the nephrogenic zone thickness, the area and diameter of the glomerular tuft, the area and diameter of the glomerular capsule, and the immunohistochemical markers, anti-CD31 and anti-CD34 antibodies, which accompany the development of the glomerular microvasculature. Periodic acid-methenamine silver (PAMS) stain was used for the morphological and morphometrical analyses, and it was particularly useful in fetuses in which autolysis had occurred. The length of the nephrogenic zone (NZ) decreased with the increase of the GA (P < 0.001) according to the formula: GA = 36.5 - (0.05 x length of NZ). The areas of the Bowman capsule (P < 0.0001), the capillary tuft (P < 0.0001), and the capillary tuft diameter (P = 0.00393) of the intermediary glomeruli increased with the advance of GA, with a positive significant correlation. The same parameters of the juxtamedullary and superficial glomeruli had no correlation with the advance of GA. The cells of the primary structures in the "S" shape of the primitive nephrons were negative for CD31 and CD34. Staining for both antibodies was found, for all GAs, in the endothelial cells of the mature glomeruli tuft and in the renal interstitial vessels. The data obtained in this work contribute to the evaluation of renal maturity in autopsied fetuses and are particularly important in fetuses when autolysis has occurred, to which the parameters used in this study can also be applied. The establishment of normal morphometric and immunohistochemical parameters for the evaluation of renal maturity increases the diagnostic precision of renal pathological alterations in aborted material and perinatal autopsy.

Inflammation and glandular duct dilatation of the tongue from patients with chronic Chagas disease.

The purpose of this study was to evaluate morphologically the tongue of individuals with chronic Chagas disease (CD) in comparison to the non-chagasic ones. Twenty-four protocol cases of autopsies were selected. They were subdivided into CD patients (10 cases) and non-chagasic ones (14 cases). The morphometric analysis was accomplished for the tongue muscle and salivary glands duct lumen area. In three CD patients, perineuritis was found, and two of them showed megaesophagus and megacolon. The intensity of the inflammation in the von Ebner's glands, the tongue muscles, and the salivary glands duct lumen area was significantly higher in the CD patients. We concluded that the CD patients show salivary glands duct dilatation, which probably would have a relation with alterations in the autonomic nervous system. The inflammation found in CD patients is in accordance with that described in comparative studies on the digestive tract and heart. These morphological findings suggest that the histopathological analysis of the tongue associated with other organs, or even in an isolated manner, can add in the diagnosis and pathogenesis of the CD chronic phase.