Sonographic appearance of an advanced invasive mole and associated metastatic thrombus in the inferior vena cava.

We present a case of an advanced invasive mole with a metastatic thrombus in the inferior vena cava in which sonography clearly showed vesicles in the myometrium, ovaries, and metastatic thrombus leading to a diagnosis of invasive mole rather than choriocarcinoma.

An evaluation of auditory exostoses in 621 prehistoric human skulls from coastal Brazil.

Auditory exostoses are bone anomalies located on the floor of the external auditory canal. They frequently develop in individuals who participate in water sports and other aquatic activities. Their etiology is probably multifactorial; development seems to be triggered by regular exposure to cold water as well as to low air temperatures and/or cold winds. The presence ofauditory exostoses has been recorded in human skull fossils that date back approximately 250,000 years. We conducted a study of auditory exostoses in 621 skulls of adult humans who had been part of a marine-dependent population that lived on the Brazilian coast between 5400 and 800 years ago. The overall frequency of exostoses was 22%, but there was a great variance among different subgroups (0 to 56%). In this article, we propose some possible explanations for this variance. We also hope that our study will stimulate multidisciplinary research aimed at deciphering the intricate bony messages contained in cryptic archaeologic remains.

Triploid twin gestation with single fetal demise associated with partial mole and pre-eclampsia.

Both partial mole and twin gestation are conditions associated with the risk of the early onset of pre-eclampsia. In cases of twin gestation, the death or selective termination of a severely growth-restricted fetus may lead to the reversal of maternal pre-eclampsia because of the involution or death of the pathological placenta, as has been reported by some authors. This case demonstrates that in a twin triploid gestation, in spite of the demise of one of the fetuses, the respective partial molar placenta can continue to grow and may contribute to the development or to the worsening of the pre-eclampsia.

Prenatal detection and postnatal management of an intranasal glioma.

Nasal gliomas are rare benign congenital midline tumors composed of heterotopic neuroglial tissue. They have potential for intracranial extension through a bony defect in the skull base. Neuroimaging is essential for identifying nasal lesions and for determining their exact location and any possible intracranial extension. Computed tomography is often the initial imaging study obtained because it provides good visualization of the bony landmarks of the skull base; it is not, however, well suited for soft tissue imaging. Magnetic resonance imaging has better soft tissue resolution and may be the best initial study in patients seen early in life because the anterior skull base consists of an unossified cartilage and may falsely appear as if there is a bony dehiscence on computed tomography. A frontal craniotomy approach is recommended if intracranial extension is identified, followed by a transnasal endoscopic approach for intranasal glioma. A case is presented of a huge fetal facial mass that was shown by ultrasound that protruded through the left nostril at 33 weeks of gestation. Computed tomography of the neonate suggested a transethmoidal encephalocele. Magnetic resonance imaging showed a huge mass occupying the nasopharynx and the nasal cavity and protruding externally to the face but ruled out bony discontinuity in the skull base and, therefore, any intracranial connection. The infant underwent an endoscopic resection of the mass via oral and nasal routes and pathologic examination revealed intranasal glioma.

Auditory exostoses as an aquatic activity marker: a comparison of coastal and inland skeletal remains from tropical and subtropical regions of Brazil.

Auditory exostoses are bone masses located in the external auditory canal. Currently, most researchers agree that the environment (especially water temperature, but also atmospheric temperature and wind action) plays a pivotal role in the development of this trait. This article discusses whether the presence of auditory exostoses can be used as an aquatic activity marker in bioarchaeological studies, especially in groups that inhabited tropical and subtropical regions. We analyzed 676 skeletons (5,000 years BP to historical times) from 27 coastal and inland native Brazilian groups. Very low frequencies of auditory exostoses were found in the inland groups (0.00-0.03), but the expected high frequency of auditory exostoses in the coastal groups was not always observed (0.00-0.56). These differences might be explained by the combination of water and atmospheric temperatures in conjunction with wind effects. In areas with mild atmospheric temperatures and wind chill factors, the coastal populations analyzed do not show high frequencies of auditory exostoses. However, high frequencies of auditory exostoses develop where cold atmospheric temperatures are further lowered by strong wind chill. Therefore, the association between aquatic activities, low atmospheric temperature, and wind chill is strongly correlated with the presence of auditory exostoses, but where these environmental factors are mild, the frequencies of auditory exostoses are not necessarily high. Concluding, auditory exostoses should be cautiously used as a marker of aquatic activity in bioarchaeological studies in tropical and subtropical regions, since these activities do not always result in the presence of this trait.

Unusual sonographic features of ARPKD.

The classic sonographic appearance of the kidneys in fetuses with autosomal recessive polycystic kidney disease (ARPKD) has been well described. We report a case of enlarged kidneys with pyramidal hyperechogenicity quite similar to medullary nephrocalcinosis found in a fetus at 34 weeks' gestation. At 39 weeks, a female neonate was delivered and died after 22 h due to pulmonary insufficiency secondary to severe oligohydramnios. On pathological analysis, the gross and microscopic findings were typical of ARPKD with diffuse dilatation of tubules throughout. The fetal renal lobulation was prominent and on section, the pyramids were delineated within each lobule, accounting for the clear image of the pyramids observed on sonography.

A new early Holocene human skeleton from Brazil: implications for the settlement of the New World.

Increasing skeletal evidence from the U.S.A., Mexico, Colombia, and Brazil strongly suggests that the first settlers in the Americas had a cranial morphology distinct from that displayed by most late and modern Native Americans. The Paleoamerican morphological pattern is more generalized and can be seen today among Africans, Australians, and Melanesians. Here, we present the results of a comparative morphological assessment of a late Paleoindian/early archaic specimen from Capelinha Burial II, southern Brazil. The Capelinha skull was compared with samples of four Paleoindian groups from South and Central America and worldwide modern groups from W.W. Howells' studies. In both analyses performed (classical morphometrics and geometric morphometrics), the results show a clear association between Capelinha Burial II and the Paleoindians, as well as Australians, Melanesians, and Africans, confirming its Paleoamerican status.

Prenatal diagnosis of congenital Chagas' disease (American trypanosomiasis).

The prenatal diagnosis of congenital transmission of Chagas' disease in a pregnant woman with the indeterminate form of the disease is reported. Sonography revealed fetal hydrops at 31 weeks' gestation. Anti-Trypanosoma cruzi IgM and IgG antibodies were negative in the fetal blood sampled by cordocentesis, but T. cruzi trypomastigotes were found in its buffy coat. Owing to anemia, in utero exchange transfusion was undertaken, but fetal demise ensued. Labor was induced and a stillborn infant weighing 2030 g was delivered. The pathological examination revealed placentitis and meningoencephalitis, myocarditis and splenitis in the stillborn fetus. Amastigotes were found in the myocardium, brain and placenta.

Aspectos parasitológicos do pescado comercializado na costa da Mata Atlântica / Parasitological aspects of the fish commercialized on Costa da Mata Atlantica

O objetivo deste trabalho foi relatar a ocorrência de nematóides da família Anisakidae e trematódeos da espécie Ascocotyle (Phagicola) longa em pescado marinho comercializado na costa da Mata Atlântica. Foram examinadas 257 amostras de peixes colhidas pelos Serviços de Inspeção Federal, Estadual e Municipal em oito municípios, oriundas de toda cadeia produtiva, desde as unidades de captura até os pontos de comercialização. As análises parasitológicas foram conduzidas no Instituto de Pesca de Santos (URLTP), constituídas de peixes refrigerados inteiros, eviscerados, em postas ou filés. O pescado foi considerado infectado quando apresentava ao menos a presença de uma larva na cavidade abdominal e/ou no tecido muscular, após análise macroscópica e em mesa de inspeção (candling-table). Do total de 257 amostras de peixes, 63 estavam parasitadas por nematóides anisaquídeos e trematódeos digenéticos, representando 25,29% da amostragem. Este trabalho permitiu concluir que o consumidor pode infectar-se por esses parasitos ao se alimentar de produtos elaborados com carne de pescado crua, insuficientemente cozida ou defumada a frio.

Curva de crescimento do diâmetro biparietal e da circunferência cefálica na gestação gemelar / Growth curve of the biparietal diameter and head circunference in twin gestation

Objetivo: determinar curvas a tabelas de crescimento do diâmetro biparietal médio a da circunferência cefálica média em relação à idade gestacional de gestações gemelares e analisar eventuais diferenças com as existentes para fetos únicos e gêmeos. Métodos: por meio de exames ultra?sonográficos realizados a cada duas ou três semanas por um único observador em 34 pacientes com gestação gemelar sem patologias feto-maternas foi possível estabelecer curvas e tabelas do diâmetro biparietal médio e da circunferência cefálica média em relação a idade gestacional. Os valores destes parâmetros biométricos foram comparados aos descritos pela literatura para fetos únicos e gêmeos. Resultados: foram obtidas curvas e tabelas do diâmetro biparietal e da circunferência cefálica em relação a idade gestacional. O crescimento do diâmetro biparietal e da circunferência cefálica se revelou menor no terceiro trimestre em relação aos observados por Hadiock et al. para gestação única. A diferença entre os valores médios foi 6 mm (diâmetro biparietal) e 2,0 cm (circunferência cefálica) na 39ª semana de gestação. Foram observadas também algumas diferenças em relação a outros estudos de gestações gemelares. Conclusão: este estudo sugeriu que as curvas e tabelas de crescimento do diâmetro biparietal médio e da circunferência cefálica média de gestações únicas não são apropriadas para avaliação de gestações gemelares da população analisada principalmente no terceiro trimestre

Onfalocele: prognóstico fetal em 51 casos com diagnóstico pré-natal / Omphalocele: fetal prognosis in 51 cases with prenatal diagnosis

Objetivo: avaliar o prognóstico fetal dos casos de onfalocele com diagnóstico pré-natal. Métodos: foram analisados 51 casos de onfalocele com diagnóstico pré-natal e divididos em 3 grupos: Grupo 1, onfalocele isolada; Grupo 2, onfalocele com malformações estruturais associadas e cariótipo normal; Grupo 3, onfalocele associada à cromossomopatia. As análises foram realizadas em relação à sobrevida geral e pós-correção cirúrgica, considerando as malformações associadas, idade gestacional no parto, peso no nascimento e tamanho da onfalocele. Resultados: o Grupo 1 correspondeu a 21 por cento (n=11), o Grupo 2 a 55 por cento (n=28) e o Grupo 3 a 24 por cento (n=12). Todos os casos do grupo 3 evoluíram para óbito, e a cromossomopatia mais freqüente foi a trissomia do 18. A sobrevida foi de 80 por cento no Grupo 1 e de 25 por cento no Grupo 2. Dezesseis casos foram submetidos à correção cirúrgica (10 isoladas e 6 associadas) e 81 por cento sobreviveram (8 isoladas e 5 associadas). A mediana do peso no nascimento dos sobreviventes pós-correção cirúrgica foi 3.140 g e dos que morreram foi de 2.000 g (p=0,148) e a idade gestacional do parto foi de 37 e de 36 semanas (p=0,836), respectivamente. A relação das circunferências onfalocele/abdominal diminuiu com a idade gestacional, 0,88 entre 25-29 semanas e 0,65 entre 30-35 semanas (p=0,043). Não foi observada diferença significativa no tamanho da onfalocele nos 3 grupos (p=0,988) e influência deste prognóstico pós-correção cirúrgica (p=0,553). Conclusão: a sobrevida geral e pós-correção cirúrgica foi de 25 e 81 por cento, respectivamente. As malformações associadas representam o principal fator prognóstico das onfaloceles com diagnóstico pré-natal, visto que se associam com prematuridade e baixo peso.

Diagnóstico ultra-sonográfico pré-natal de osteogenesis imperfecta / Prenatal ultrasonic diagnosis in osteogenesis imperfecta

Os autores descrevem aspectos ultra-sonográficos de um caso de forma letal perinatal, tipo II, de OI, na 30ª semana de gestaçäo e comparam com os achados de literatura. As estruturas intra-cranianas estavam mais evidentes do que o habitual, havia desproporçäo entre a cabeça e o tronco e os membros eram curtos e exibiam fraturas. Diante da possibilidade de diagnóstico desta e de outras displasias esqueléticas pela ultra-sonografia, recomenda-se a sua realizaçäo em todas as gestantes com risco genético em relaçäo a estas anomalias

Transfusao intravascular por cordocentese na terapeutica da doenca hemolitica perinatal / Intravascular intrauterine transfusion by cordocentesis in Rh alloimmunization

Os autores relatam a experiencia com 65 transfusoes intravasculares no tratamento da Doenca Hemolitica Perinatal realizada em 25 gestacoes complicadas por aloimunizacao Rh no periodo de janeiro a dezembro de 1991. As transfusoes comecaram entre 20-34 semanas e foram repetidas ate 6 vezes, com intervalos de 3-28 dias...