Novel patterns for the growing main bronchi in the human fetus: an anatomical, digital and statistical study.

PURPOSE: Intensive progress in prenatal medicine results in performing airway management in the fetus affected by life-threatening congenital malformations. This study aimed to examine age-specific reference intervals and growth dynamics for length, proximal and distal external transverse diameters, and projection surface areas of the two main bronchi at varying gestational ages, including their relative growth in length and projection surface area. MATERIALS AND METHODS: Using anatomical dissection, digital image analysis and statistics, length, proximal and distal external transverse diameters, and projection surface areas of the right and left main bronchi were examined in 73 human fetuses (39 males, 34 females) aged 14-25 weeks, derived from spontaneous abortions and stillbirths. RESULTS: Statistical analysis showed no sex differences. Between the 14 and 25th week of gestation, the lengths of the right and left main bronchi increased from 1.43 ± 0.18 to 3.18 ± 0.39 mm, and from 2.97 ± 0.16 to 7.58 ± 1.95 mm, in accordance with the functions: [Formula: see text], respectively. The proximal external transverse diameters of the right and left main bronchi varied from 2.13 ± 0.41 to 4.24 ± 0.20 mm, and from 1.84 ± 0.06 to 3.67 ± 0.66 mm, following the logarithmic models: [Formula: see text], respectively. The distal external transverse diameter rose from 2.09 ± 0.47 to 4.24 ± 0.20 mm, as [Formula: see text] for the right main bronchus, and from 1.85 ± 0.04 to 3.67 ± 0.66 mm, like [Formula: see text] for the left one. On either side, there were no statistically significant differences between values of the proximal and distal transverse diameters of the main bronchus. The projection surface areas of the right and left main bronchi ranged from 2.95 ± 0.19 to 13.34 ± 2.12 mm(2), and from 5.57 ± 0.21 to 28.52 ± 5.24 mm(2), as [Formula: see text] and [Formula: see text]. The two main bronchi revealed a proportionate increase in both length and projection surface area, since the right-to-left bronchial length ratio and the right-to-left bronchial projection surface area ratio were stable, 0.41 ± 0.07 and 0.47 ± 0.08, respectively, throughout the analyzed period. CONCLUSIONS: The main bronchi show no sex differences. The right and left main bronchi grow logarithmically in length and external transverse diameter, and linearly in projection surface area. The right and left main bronchi evolve proportionately, with the right-to-left bronchial ratios of 0.41 ± 0.07 for length, and 0.47 ± 0.08 for projection surface area.

Volumetric growth of the lungs in human fetuses: an anatomical, hydrostatic and statistical study.

PURPOSE: The prenatal assessment of lung volume is becoming increasingly important in determining survival in both preterm infants and newborns affected by pulmonary hypoplasia. This study aimed to examine the lung volumes in the human fetus at varying gestational ages. MATERIALS AND METHODS: Using anatomical, hydrostatic (water displacement according to Archimedes' patent) and statistical methods (one-way ANOVA test for paired data and post-hoc Bonferroni test, Kolmogorov-Smirnov test, Levene's test, Student's t test, regression analysis), volumes of the right and left lungs were measured in 67 human fetuses of both sexes (35 males, 32 females) aged 16-25 weeks, derived from spontaneous abortions and stillbirths. RESULTS: No male-female differences concerning the right and left pulmonary volumes were found. The mean volume of the right lung increased from 1.43 ± 0.25 to 8.45 ± 2.66 cm(3), according to the cubic function y = -1.592 + 0.0007 × age(3) ± 0.851 (R (2) = 0.84). The volumetric growth of the left lung, from 1.24 ± 0.22 to 6.78 ± 3.03 cm(3), followed the cubic model y = -1.110 + 0.0005 × age(3) ± 0.794 (R (2) = 0.78). The total pulmonary volume increased from 2.67 ± 0.47 to 15.22 ± 5.58 cm(3), in accordance with the cubic model y = -2.729 + 0.0012 × age(3) ± 1.598 (R (2) = 0.83). The mean volumes of the right and left lungs accounted for 54.9 ± 2.0 and 45.1 ± 2.0 %, respectively, of the total lung volume. CONCLUSIONS: No sex differences are found between the lung volumes in the fetus. The growth of fetal lung volume follows a three-degree polynomial function. Throughout the analyzed period the two lungs grow proportionately to each other, with the volumetric predominance of the right lung. The lung volumes in the fetus are of great relevance in the evaluation of the normal pulmonary growth and the diagnosis of pulmonary hypoplasia.

New anatomical data on the growing C4 vertebra and its three ossification centers in human fetuses.

PURPOSE: Detailed knowledge on the normative growth of the spine is of great relevance in the prenatal diagnosis of its abnormalities. The present study was conducted to compile age-specific reference data for vertebra C4 and its three ossification centers in human fetuses. MATERIALS AND METHODS: With the use of CT (Biograph mCT), digital image analysis (Osirix 3.9) and statistical analysis (Wilcoxon signed-rank test, Kolmogorov-Smirnov test, Levene's test, Student's t test, one-way ANOVA, post hoc RIR Tukey test, linear and nonlinear regression analysis), the normative growth of vertebra C4 and its three ossification centers in 55 spontaneously aborted human fetuses (27 males, 28 females) aged 17-30 weeks was examined. RESULTS: Significant differences in neither sex nor laterality were found. The height and transverse and sagittal diameters of the C4 vertebral body increased logarithmically as: y = -3.866 + 2.225 × ln(Age) ± 0.238 (R(2) = 0.69), y = -7.077 + 3.547 × ln(Age) ± 0.356 (R(2) = 0.72) and y = -3.886 + 2.272 × ln(Age) ± 0.222 (R(2) = 0.73), respectively. The C4 vertebral body grew linearly in cross-sectional area as y = -7.205 + 0.812 × Age ± 1.668 (R(2) = 0.76) and four-degree polynomially in volume as y = 14.108 + 0.00007 × Age(4) ± 6.289 (R(2) = 0.83). The transverse and sagittal diameters, cross-sectional area and volume of the ossification center of the C4 vertebral body generated the following functions: y = -8.836 + 3.708 × ln(Age) ± 0.334 (R(2) = 0.76), y = -7.748 + 3.240 × ln(Age) ± 0.237 (R(2) = 0.83), y = -4.690 + 0.437 × Age ± 1.172 (R(2) = 0.63) and y = -5.917 + 0.582 × Age ± 1.157 (R(2) = 0.77), respectively. The ossification center-to-vertebral body volume ratio gradually declined with age. On the right and left, the neural ossification centers showed the following growth: y = -19.601 + 8.018 × ln(Age) ± 0.369 (R(2) = 0.92) and y = -15.804 + 6.912 × ln(Age) ± 0.471 (R (2) = 0.85) for length, y = -5.806 + 2.587 × ln(Age) ± 0.146 (R(2) = 0.88) and y = -5.621 + 2.519 × ln(Age) ± 0.146 (R(2) = 0.88) for width, y = -9.188 + 0.856 × Age ± 2.174 (R(2) = 0.67) and y = -7.570 + 0.768 × Age ± 2.200 (R(2) = 0.60) for cross-sectional area, and y = -13.802 + 1.222 × Age ± 1.872 (R(2) = 0.84) and y = -11.038 + 1.061 × Age ± 1.964 (R(2) = 0.80) for volume, respectively. CONCLUSIONS: The morphometric parameters of vertebra C4 and its three ossification centers show no sex differences. The C4 vertebral body increases logarithmically in height and both sagittal and transverse diameters, linearly in cross-sectional area, and four-degree polynomially in volume. The three ossification centers of vertebra C4 grow logarithmically in both transverse and sagittal diameters, and linearly in both cross-sectional area and volume. The age-specific reference intervals for evolving vertebra C4 may be useful in the prenatal diagnosis of congenital spinal defects.

Cross-sectional study of the neural ossification centers of vertebrae C1-S5 in the human fetus.

PURPOSE: An understanding of the normal evolution of the spine is of great relevance in the prenatal detection of spinal abnormalities. This study was carried out to estimate the length, width, cross-sectional area and volume of the neural ossification centers of vertebrae C1-S5 in the human fetus. MATERIALS AND METHODS: Using the methods of CT (Biograph mCT), digital-image analysis (Osirix 3.9) and statistics (the one-way ANOVA test for paired data, the Kolmogorov-Smirnov test, Levene's test, Student's t test, the one-way ANOVA test for unpaired data with post hoc RIR Tukey comparisons) the size for the neural ossification centers throughout the spine in 55 spontaneously aborted human fetuses (27 males, 28 females) at ages of 17-30 weeks was studied. RESULTS: The neural ossification centers were visualized in the whole pre-sacral spine, in 74.5 % for S1, in 61.8 % for S2, in 52.7 % for S3, and in 12.7 % for S4. Neither male-female nor right-left significant differences in the size of neural ossification centers were found. The neural ossification centers were the longest within the cervical spine. The maximum values referred to the axis on the right, and to C5 vertebra on the left. There was a gradual decrease in length for the neural ossification centers of T1-S4 vertebrae. The neural ossification centers were the widest within the proximal thoracic spine and narrowed bi-directionally. The growth dynamics for CSA of neural ossification centers were found to parallel that of volume. The largest CSAs and volumes of neural ossification centers were found in the C3 vertebra, and decreased in the distal direction. CONCLUSIONS: The neural ossification centers show neither male-female nor right-left differences. The neural ossification centers are characterized by the maximum length for C2-C6 vertebrae, the maximum width for the proximal thoracic spine, and both the maximum cross-sectional area and volume for C3 vertebra. There is a sharp decrease in size of the neural ossification centers along the sacral spine. A decreasing sequence of values for neural ossification centers along the spine from cervical to sacral appears to parallel the same direction of the timing of ossification. The quantitative growth of the neural ossification centers is of potential relevance in the prenatal diagnosis and monitoring of achondrogenesis, caudal regression syndrome, diastematomyelia and spina bifida.

Cross-sectional study of the ossification center of the C1-S5 vertebral bodies.

PURPOSE: Knowledge on the normative growth of the spine is relevant in the prenatal detection of its abnormalities. This study describes the size of the ossification center of C1-S5 vertebral bodies. MATERIALS AND METHODS: Using CT, digital-image analysis, and statistics, the size of the ossification center of C1-S5 vertebral bodies in 55 spontaneously aborted human fetuses aged 17-30 weeks was examined. RESULTS: No sex significant differences were found. The body ossification centers were found within the entire presacral spine and in 85.5 % of S1, in 76.4 % of S2, in 67.3 % of S3, in 40.0 % of S4, and in 14.5 % of S5. All the values for the atlas were sharply smaller than for the axis. The mean transverse diameter of the body ossification center gradually increased from the axis to T12 vertebra, so as to stabilize through L1-L3 vertebrae, and finally was intensively decreasing to S5 vertebra. There was a gradual increase in sagittal diameter of the body ossification center from the axis to T5 vertebra and its stabilization for T6-T9 vertebrae. Afterward, an alternate progression was observed: a decrease in values for T10-T12 vertebrae, an increase in values for L1-L2 vertebrae, and finally a decrease in values for L3-S5 vertebrae. The values of cross-sectional area of ossification centers were gradually increasing from the axis to L2 vertebra and then started decreasing to S5 vertebra. The following cross-sectional areas were approximately equivalent to each other: for L5 and T3-T5, and for S4 and C1. The volumetric growth of the body ossification center gradually increased from the axis to L3 vertebra and then sharply decreased from L4 to S5. CONCLUSIONS: No male-female differences are found in the size of the body ossification centers of the spine. The growth dynamics for morphometric parameters of the body ossification centers of the spine follow similarly with gestational age.

Morphometric study of the T6 vertebra and its three ossification centers in the human fetus.

PURPOSE: Knowledge on the normative growth of the spine is critical in the prenatal detection of its abnormalities. We aimed to study the size of T6 vertebra in human fetuses with the crown-rump length of 115-265 mm. MATERIALS AND METHODS: Using the methods of computed tomography (Biograph mCT), digital image analysis (Osirix 3.9) and statistics, the normative growth of the T6 vertebral body and the three ossification centers of T6 vertebra in 55 spontaneously aborted human fetuses (27 males, 28 females) aged 17-30 weeks were studied. RESULTS: Neither male-female nor right-left significant differences were found. The height, transverse, and sagittal diameters of the T6 vertebral body followed natural logarithmic functions as y = -4.972 + 2.732 × ln(age) ± 0.253 (R (2) = 0.72), y = -14.862 + 6.426 × ln(age) ± 0.456 (R (2) = 0.82), and y = -10.990 + 4.982 × ln(age) ± 0.278 (R (2) = 0.89), respectively. Its cross-sectional area (CSA) rose proportionately as y = -19.909 + 1.664 × age ± 2.033 (R (2) = 0.89), whereas its volumetric growth followed the four-degree polynomial function y = 19.158 + 0.0002 × age(4) ± 7.942 (R (2) = 0.93). The T6 body ossification center grew logarithmically in both transverse and sagittal diameters as y = -14.784 + 6.115 × ln(age) ± 0.458 (R (2) = 0.81) and y = -12.065 + 5.019 × ln(age) ± 0.315 (R (2) = 0.87), and proportionately in both CSA and volume like y = -15.591 + 1.200 × age ± 1.470 (R (2) = 0.90) and y = -22.120 + 1.663 × age ± 1.869 (R (2) = 0.91), respectively. The ossification center-to-vertebral body volume ratio was gradually decreasing with age. On the right and left, the neural ossification centers revealed the following models: y = -15.188 + 6.332 × ln(age) ± 0.629 (R (2) = 0.72) and y = -15.991 + 6.600 × ln(age) ± 0.629 (R (2) = 0.74) for length, y = -6.716 + 2.814 × ln(age) ± 0.362 (R (2) = 0.61) and y = -7.058 + 2.976 × ln(age) ± 0.323 (R (2) = 0.67) for width, y = -5.665 + 0.591 × age ± 1.251 (R (2) = 0.86) and y = -11.281 + 0.853 × age ± 1.653 (R (2) = 0.78) for CSA, and y = -9.279 + 0.849 × age ± 2.302 (R (2) = 0.65) and y = -16.117 + 1.155 × age ± 1.832 (R (2) = 0.84) for volume, respectively. CONCLUSIONS: Neither sex nor laterality differences are found in the morphometric parameters of evolving T6 vertebra and its three ossification centers. The growth dynamics of the T6 vertebral body follow logarithmically for its height, and both sagittal and transverse diameters, linearly for its CSA, and four-degree polynomially for its volume. The three ossification centers of T6 vertebra increase logarithmically in both transverse and sagittal diameters, and linearly in both CSA and volume. The age-specific reference intervals for evolving T6 vertebra present the normative values of potential relevance in the diagnosis of congenital spinal defects.

The normal growth of the common iliac arteries in human fetuses - an anatomical, digital and statistical study.

BACKGROUND: The present study was carried out to compile normative data for dimensions of the common iliac arteries at varying gestational ages. MATERIAL/METHODS: We used anatomical dissection, digital-image analysis (system of Leica QWin Pro 16) and statistical analysis (Student T test, one-way ANOVA, post-hoc RIR Tukey test, and regression analysis) to examine the increase in length (mm), proximal external diameter (mm), and volume (mm³) of the common iliac arteries in 124 (60 males, 64 females) spontaneously aborted human fetuses aged 15-34 weeks. RESULTS: Neither sex nor right-left significant differences were found (P>0.05). The length ranged from 4.76 ± 1.05 to 15.38 ± 1.60 mm on the right, and from 4.92 ± 1.33 to 14.91 ± 1.25 mm on the left, according to the linear functions y=-3.598+0.585 × Age ± 1.522 (R²=0.83) and y=-3.107+0.554 × Age ± 1.444 (R²=0.83). The proximal external diameter increased from 0.66 ± 0.19 to 2.30 ± 0.42 mm on the right, and from 0.66 ± 0.14 to 2.16 ± 0.42 mm on the left, according to the quadratic models y=1.392-0.110 × Age + 0.004 × Age² ± 0.285 (R²=0.77) and y=1.283-0.099 × Age + 0.004 × Age² ± 0.238 (R²=0.81). The volumes were increasing from 1.93 ± 1.74 to 66.95 ± 29.31 mm³ on the right, and from 1.91 ± 1.65 to 56.86 ± 25.17 mm³ on the left, given by the quadratic functions: y=99.69-10.60 × Age+0.28 7 × Age² ± 14.40 (R²=0.67) and y=82.62-8.86 × Age + 0.242 × Age² ± 11.60 (R²=0.71). CONCLUSIONS: The common iliac arteries grow linearly in length, and parabolically in both diameter and volume. The right common iliac artery constitutes a predominant vessel in relation to its length, external diameter and volume. The morphometric data on the common iliac arteries may serve as a useful reference in the prenatal diagnosis and monitoring of congenital aorto-iliac abnormalities.

Quantitative anatomy of the growing abdominal aorta in human fetuses: an anatomical, digital and statistical study.

BACKGROUND: Advances in perinatal medicine have required an extensive knowledge of fetal aorto-iliac measurements. The present study was performed to compile reference data for dimensions of the abdominal aorta at varying gestational ages. MATERIAL/METHODS: Using the methods of anatomical dissection, digital-image analysis (Leica QWin Pro 16 system), and statistical analysis (Student's t-test, one-way ANOVA, post-hoc RIR Tukey test, regression analysis, and Wilcoxon signed-rank test), the growth of length (mm), proximal and distal external diameters (mm), and volume (mm3) of the abdominal aorta in 124 (60 male, 64 female) spontaneously aborted human fetuses aged 15-34 weeks was examined. RESULTS: No significant male-female differences were found. The length ranged from 9.35±1.24 to 36.29±4.98 mm, according to the linear function y=-14.596+1.519 × Age ±2.639 (R2=0.92; p<0.0001). The proximal external diameter varied from 1.18±0.25 to 5.19±0.49 mm, according to the linear pattern y=-2.065+0.212 × Age ±0.348 (R2=0.92; p<0.0001). The distal external diameter increased from 1.03±0.23 to 4.92±0.46 mm, in accordance with the linear model y=-2.097+0.203 × Age ±0.351 (R2=0.92; p<0.0001). Both length and proximal external diameter of the abdominal aorta indicated a proportionate evolution, because the length-to-proximal external diameter ratio was stable, following the linear function y=7.724-0.017 × Age ±0.925. The abdominal aorta volume ranged from 9.6±4.5 to 740.5±201.8 mm3, given by the quadratic function y=911-101 × Age +2.838 × Age2 ±78 (R2=0.89; p<0.0001). CONCLUSIONS: There are no significant differences between males and females for morphometric parameters of the abdominal aorta. The abdominal aorta grows linearly in both length and diameters, and parabolically in volume. These detailed morphometric data of the abdominal aorta provide a database for intra-uterine echographic examinations in the early diagnosis, monitoring and management of aorto-iliac malformations.

New quantitative patterns of the growing trachea in human fetuses.

BACKGROUND: Rapid progress in perinatal medicine has resulted in numerous tracheo-bronchial interventions on fetal and neonatal airways. The present study was performed to compile normative data for tracheal dimensions at varying gestational ages. MATERIAL/METHODS: Using anatomical dissection, digital image analysis (NIS-Elements BR 3.0) and statistical analysis (Wilcoxon signed-rank test, Student's t test, one-way ANOVA, post-hoc Bonferroni test, linear and nonlinear regression analysis) a range of the 4 variables (length in mm, middle external transverse diameter in mm, proximal internal cross-sectional area in mm², internal volume in mm³) for the trachea in 73 spontaneously aborted human fetuses (39 male, 34 female) aged 14-25 weeks was examined. RESULTS: No significant male-female differences were found (P>0.05). The length ranged from 10.37±2.15 to 26.54±0.26 mm as y=-65.098 + 28.796 × ln (Age) ±1.794 (R²=0.82). The middle external transverse diameter varied from 2.53±0.09 to 5.09±0.42 mm with the model y=-11.020 + 5.049 × ln (Age) ±0.330 (R²=0.81). The trachea indicated a proportional evolution because the middle external transverse diameter-to-length ratio was stable (0.23±0.03). The proximal internal cross-sectional area rose from 1.46±0.04 to 5.76±1.04 mm² as y=-3.562 + 0.352 × Age ±0.519 (R²=0.76). The internal volumetric growth from 11.89±2.49 to 119.63±4.95 mm³ generated the function y=-135.248 + 9.919 × Age ±10.478 (R²=0.86). CONCLUSIONS: The growth in both length and middle external transverse diameter of the trachea follows logarithmic functions, whereas growth of both its proximal internal cross-sectional area and internal volume follow linear functions. The length and middle external transverse diameter of the trachea develop proportionally to each other. The tracheal dimensions may be helpful in the prenatal diagnosis and monitoring of tracheal malformations and obstructive anomalies of the upper respiratory tract.

Tracheal dimensions in human fetuses: an anatomical, digital and statistical study.

PURPOSE: Rapid advances in perinatal medicine have resulted in increased number of various tracheo-bronchial interventions on fetal and neonatal airways. The present study was performed to compile normative data for external dimensions of the trachea at varying gestational age. MATERIALS AND METHODS: Using anatomical dissection, digital image analysis (NIS-Elements BR 3.0) and statistical analysis (ANOVA, regression analysis), a range of measurements (prebifurcation and bifurcation lengths, proximal and distal external transverse diameters, proximal external cross-sectional area, and external volume) for the trachea in 73 spontaneously aborted fetuses (39 male, 34 female) aged 14-25 weeks was examined. RESULTS: No significant male-female differences were found (P > 0.05). The prebifurcation and bifurcation lengths ranged from 8.14 ± 1.90 to 20.77 ± 0.50 mm and from 2.23 ± 0.25 to 5.77 ± 0.76 mm, according to the functions y = -54.291 + 23.940 × ln (Age) ± 1.681 (R (2) = 0.78) and y = -10.756 + 4.860 × ln (Age) ± 0.731 (R (2) = 0.44), respectively. Their relative growth, expressed as the bifurcation-to-prebifurcation length ratio, was stable from the age of 16 weeks and attained the value 0.22 ± 0.05. The proximal external transverse diameter of the trachea was greater (36 fetuses, 49.3%), smaller (34 fetuses, 46.6%) or similar (3 fetuses, 4.1%), when compared to the distal external transverse diameter. The values for proximal and distal transverse diameters ranged from 2.39 ± 0.04 to 5.20 ± 0.17 mm and from 2.42 ± 0.20 to 4.93 ± 0.08 mm, expressed by the functions: y = -9.659 + 4.574 × ln (Age) ± 0.313 (R (2) = 0.79) and y = -10.897 + 4.984 × ln (Age) ± 0.327 (R (2) = 0.81). The values of proximal external cross-sectional area ranged from 3.38 ± 0.12 to 15.98 ± 1.04 mm(2), according to the linear function y = -11.798 + 1.077 × Age ± 1.463 (R (2) = 0.78). The values of external volume of the trachea ranged from 34.3 ± 11.6 to 370.6 ± 94.1 mm(3) and generated the quadratic function y = -154.589 + 0.858 × Age(2) ± 34.196 (R (2) = 0.87). CONCLUSIONS: The tracheal parameters do not show male-female differences. The developmental dynamics of prebifurcation and bifurcation lengths and proximal and distal external transverse diameters of the trachea follow linear functions dependent on the natural logarithm of fetal age, its external cross-sectional area-according to a linear function, and its external volume-according to a quadratic function.

Cross-sectional study of C1-S5 vertebral bodies in human fetuses.

INTRODUCTION: Knowledge on the normative spinal growth is relevant in the prenatal detection of its abnormalities. The present study determines the height, transverse and sagittal diameters, cross sectional area, and volume of individual C1-S5 vertebral bodies. MATERIAL AND METHODS: Using the methods of computed tomography (CT), digital image analysis, and statistics, the size of C1-S5 vertebral bodies in 55 spontaneously aborted human fetuses aged 17-30 weeks was examined. RESULTS: All the 5 examined parameters changed significantly with gestational age (p < 0.01). The mean height of vertebral bodies revealed an increase from the atlas (2.39 ±0.54 mm) to L2 (4.62 ±0.97 mm), stabilized through L3-L4 (4.58 ±0.92 mm, 4.61 ±0.84 mm), and then was decreasing to S5 (0.43 ±1.06 mm). The mean transverse diameter of vertebral bodies was increasing from the atlas (1.20 ±1.96 mm) to L1 (6.24 ±1.46 mm), so as to stabilize through L2-L3 (6.12 ±1.65, 6.12 ±1.61 mm), and finally was decreasing to S5 (0.26 ±0.96 mm). There was an increase in sagittal diameter of vertebral bodies from the atlas (0.82 ±1.34 mm) to T7 (4.76 ±0.85 mm), its stabilization for T8-L4 (4.73 ±0.86 mm, 4.71 ±1.02 mm), and then a decrease in values to S5 (0.21 ±0.75 mm) was observed. The values for cross-sectional area of vertebral bodies were increasing from the atlas (2.95 ±5.25 mm(2)) to L3 (24.92 ±11.07 mm(2)), and then started decreasing to S5 (0.48 ±2.09 mm(2)). The volumetric growth of vertebral bodies was increasing from the atlas (8.60 ±16.40 mm(3)) to L3 (122.16 ±74.73 mm(3)), and then was decreasing to S5 (1.60 ±7.00 mm(3)). CONCLUSIONS: There is a sharp increase in size of fetal vertebral bodies between the atlas and the axis, and a sharp decrease in size within the sacral spine. In human fetuses the vertebral body growth is characterized by maximum values in sagittal diameter for T7, in transverse diameter for L1, in height for L2, and in both cross-sectional area and volume for L3.

Quantitative Anatomy of the Growing Lungs in the Human Fetus.

Using anatomical, digital, and statistical methods we examined the three-dimensional growth of the lungs in 67 human fetuses aged 16-25 weeks. The lung dimensions revealed no sex differences. The transverse and sagittal diameters and the base circumference were greater in the right lungs while the lengths of anterior and posterior margins and the lung height were greater in the left lungs. The best-fit curves for all the lung parameters were natural logarithmic models. The transverse-to-sagittal diameter ratio remained stable and averaged 0.56 ± 0.08 and 0.52 ± 0.08 for the right and left lungs, respectively. For the right and left lungs, the transverse diameter-to-height ratio significantly increased from 0.74 ± 0.09 to 0.92 ± 0.08 and from 0.56 ± 0.07 to 0.79 ± 0.09, respectively. The sagittal diameter-to-height ratio significantly increased from 1.41 ± 0.23 to 1.66 ± 0.18 in the right lung, and from 1.27 ± 0.17 to 1.48 ± 0.22 in the left lung. In the fetal lungs, their proportionate increase in transverse and sagittal diameters considerably accelerates with relation to the lung height. The lung dimensions in the fetus are relevant in the evaluation of the normative pulmonary growth and the diagnosis of pulmonary hypoplasia.

Volumetric Growth of the Liver in the Human Fetus: An Anatomical, Hydrostatic, and Statistical Study.

Using anatomical, hydrostatic, and statistical methods, liver volumes were assessed in 69 human fetuses of both sexes aged 18-30 weeks. No sex differences were found. The median of liver volume achieved by hydrostatic measurements increased from 6.57 cm(3) at 18-21 weeks through 14.36 cm(3) at 22-25 weeks to 20.77 cm(3) at 26-30 weeks, according to the following regression: y = -26.95 + 1.74 × age ± Z × (-3.15 + 0.27 × age). The median of liver volume calculated indirectly according to the formula liver volume = 0.55 × liver length × liver transverse diameter × liver sagittal diameter increased from 12.41 cm(3) at 18-21 weeks through 28.21 cm(3) at 22-25 weeks to 49.69 cm(3) at 26-30 weeks. There was a strong relationship (r = 0.91, p < 0.001) between the liver volumes achieved by hydrostatic (x) and indirect (y) methods, expressed by y = -0.05 + 2.16x ± 7.26. The liver volume should be calculated as follows liver volume = 0.26 × liver length × liver transverse diameter × liver sagittal diameter. The age-specific liver volumes are of great relevance in the evaluation of the normal hepatic growth and the early diagnosis of fetal micro- and macrosomias.

The normal growth of cross-sectional areas of the aorto-iliac segment in human fetuses - an anatomical, digital, and statistical study.

BACKGROUND: The intraluminal size of the aorto-iliac segment is relevant in both the clinical and echographic settings. The aim of this study was to compile both the absolute and relative age-specific reference intervals for cross-sectional areas (CSAs) of the aorto-iliac segment. MATERIAL/METHODS: Using the methods of anatomical dissection, digital-image analysis (Leica QWin Pro 16) and statistical analysis (Student's t test, one-way ANOVA, post-hoc RIR Tukey test, linear regression), the growth in CSA (in mm2) of the abdominal aorta, the common, external, and internal iliac arteries in 124 (60 males, 64 females) spontaneously aborted human fetuses aged 15-34 weeks was examined. RESULTS: No significant sex differences were found. In the age range of 4-9 months, the distal CSA of the abdominal aorta ranged from 0.87±0.34 to 19.18±3.36 mm2. The CSA of the common iliac artery varied from 0.37±0.22 to 4.30±1.54 mm2 on the right, and from 0.36±0.16 to 3.80±1.44 mm2 on the left. The sum of the CSAs of the right and left common iliac arteries grew proportionately to the distal CSA of the abdominal aorta; the latter being significantly larger than the former. On both sides, however, the CSA of the internal iliac artery was approximately twice that of the external iliac artery. Between the ages of 4 and 9 months, the CSA of the external iliac artery ranged from 0.10±0.06 to 1.32±0.52 mm2 on the right, and from 0.08±0.03 to 1.19±0.42 mm2 on the left. The CSA of the internal iliac artery increased from 0.23±0.14 to 2.59±1.22 mm2 on the right, and from 0.21±0.14 to 2.27±1.11 mm2 on the left. Bilaterally, the sum of the CSAs of the internal and external iliac arteries was significantly smaller than the CSA of the common iliac artery. The relative CSA of each artery decreased until the age of 6 months, after which their values were gradually increasing until the age of 9 months. CONCLUSIONS: The aorto-iliac segment does not reveal sex differences in its cross-sectional area. The cross-sectional area of the internal iliac artery is approximately twice the size of the external iliac artery. The aorto-iliac segment observed proximally to distally reduces its cross-sectional area, thereby resulting in an increase in blood velocity.

The normal growth of the tracheal wall in human foetuses.

INTRODUCTION: Tracheal wall thickness is a substantial indicator in various pathological changes. The present study was performed to compile normative data and formulae for the tracheal wall thickness and volume at varying gestational age. MATERIAL AND METHODS: Using anatomical dissection, digital image analysis and statistics a range of the wall thickness, proximal internal-to-external cross-sectional area ratio, and wall volume for the trachea in 73 spontaneously aborted human fetuses aged 14-25 weeks was examined. RESULTS: No significant male-female differences were found. The values of tracheal wall thickness ranged from 0.36 ±0.01 mm for the 14-week group to 1.23 ±0.17 mm for the 25-week group of gestation, according to the linear function y = -0.823 + 0.083 × age ± 0.087. The tracheal lumen rate, expressed as the proximal internal-to-external cross-sectional area ratio, decreased from 42.61 ±1.11% to 26.78 ±4.95%, according to the function y = 62.239 - 1.487 × age ±3.119. The tracheal wall volume rose from 16.28 ±4.18 mm(3) in fetuses aged 14 weeks to 269.22 ±29.26 mm(3) in fetuses aged 25 weeks, according to the quintic function y = 0.000052 × age(4.894). CONCLUSIONS: The tracheal wall parameters show no sexual dimorphism. The tracheal wall grows linearly in its length, and according to a quintic function in its volume. A relative decrease in the tracheal lumen at the expense of an increase in both the wall thickness and wall volume of the trachea is found during gestation.

New patterns of the growing L3 vertebra and its 3 ossification centers in human fetuses - a CT, digital, and statistical study.

BACKGROUND: This study describes reference data for L3 vertebra and its 3 ossification centers at varying gestational ages. MATERIAL AND METHODS: Using CT, digital-image analysis and statistics, the growth of L3 vertebra and its 3 ossification centers in 55 spontaneously aborted human fetuses aged 17-30 weeks was examined. RESULTS: Neither sex nor right-left significant differences were found. The height and transverse and sagittal diameters of the L3 vertebral body increased logarithmically. Its cross-sectional area followed linearly, whereas its volume increased parabolically. The transverse and sagittal diameters of the ossification center of the L3 vertebral body varied logarithmically, but its cross-sectional area and volume grew linearly. The ossification center-to-vertebral body volume ratio gradually declined with age. The neural ossification centers increased logarithmically in length and width, and proportionately in cross-sectional area and volume. CONCLUSIONS: With no sex differences, the growth dynamics of the L3 vertebral body follow logarithmically in height, sagittal and transverse diameters, linearly (in cross-sectional area), and parabolically (in volume). The growth dynamics of the 3 ossification centers of the L3 vertebra follow logarithmically in transverse and sagittal diameters, and linearly (in cross-sectional area and volume). The age-specific reference intervals of the L3 vertebra and its 3 ossification centers present the normative values of clinical importance in the diagnosis of congenital spinal defects.

Tracheo-bronchial angles in the human fetus -- an anatomical, digital, and statistical study.

BACKGROUND: Both the advancement of visual techniques and intensive progress in perinatal medicine result in performing airway management in the fetus and neonate affected by life-threatening malformations. This study aimed to examine the 3 tracheo-bronchial angles, including the right and left bronchial angles, and the interbronchial angle, in the fetus at various gestational ages. MATERIAL AND METHODS: Using methods of anatomical dissection, digital image analysis with an adequate program (NIS-Elements BR 3.0, Nikon), and statistics, values of the two bronchial angles and their sum as the interbronchial angle were semi-automatically measured in 73 human fetuses at the age of 14-25 weeks, derived from spontaneous abortions and stillbirths. RESULTS: No male-female differences between the parameters studied were found. The 3 fetal tracheo-bronchial angles were found to be independent of age. The right bronchial angle ranged from 11.4° to 41.8°, and averaged 26.9±7.0° for the whole analyzed sample. The values of left bronchial angle varied from 24.8° to 64.8°, with the overall mean of 46.2±8.0°. As a consequence, the interbronchial angle totalled 36.2-96.6°, and averaged 73.1±12.7°. CONCLUSIONS: The tracheo-bronchial angles change independently of sex and fetal age. The left bronchial angle is wider than the right one. Values of the 3 tracheo-bronchial angles are unpredictable since their regression curves of best fit with relation to fetal age cannot be modelled. Both of the 2 bronchial angles and the interbronchial angle are of great relevance in the location of inhaled foreign bodies, and in the diagnosis cardiac diseases and mediastinal abnormalities.

The normal growth of the biceps brachii muscle in human fetuses.

BACKGROUND: The biceps brachii muscle, the strongest flexor and supinator at the elbow joint, and an accessory flexor of the glenohumeral joint is characterized by the two heads, long and short. OBJECTIVES: The purpose of this study was to examine the linear parameters (length and width) of the biceps brachii in human fetuses and to provide their mathematical growth models. MATERIAL AND METHODS: Using methods of anatomical dissection, digital analysis (Multiscan v.14.02), and statistics (Student's t-test and regression analysis) the authors bilaterally measured the length (mm) and width (mm) of the biceps brachii muscle in 30 fetuses of both sexes (14♂,16♀), aged 17-30 weeks. RESULTS: Neither sex nor laterality differences were found. All the parameters studied increased proportionally with age. Both the mean length (5.68 mm) and widths, measured at its mid-length (0.60 mm) and at the widest level (0.65 mm) of the long head's belly, were found to be statistically shorter (5.93 mm, 0.65 mm and 0.72 mm, respectively) when compared to its short head's belly. For these parameters, the following linear models were generated in relation to the long head's belly: y = -0.801 + 0.276 x Age (R2 = 0.591), y = -0.254 + 0.036 x Age (R2 = 0.201) and y = -0.238 + 0.038 x Age (R2 = 0.226), and in relation to the short head's belly: y = -0.134 + 0.258 x Age (R2 = 0.551), y = -0.227 + 0.038 x Age (R2 = 0.241) and y = -0.316 + 0.044 x Age (R2 = 0.333). The tendon length turned out to be the only significantly greater value for the long head (1.89 mm vs. 1.09 mm). The following linear models y = 1.024 + 0.037 x Age (R2 = 0.084) for the long and y = 0.177 + 0.039 x Age (R2 = 0.157) for the short heads were computed. CONCLUSIONS: Neither sex differences nor laterality differences are observed in morphometric parameters of the biceps brachii muscle. The long head's belly is shorter and thinner than that of the short head's belly. The long head's tendon is longer than that of the short head. The developmental dynamics of the biceps brachii muscle follow proportionately.

Normative growth data for the external diameters of the external and internal iliac arteries in human fetuses--an anatomical, digital and statistical study.

BACKGROUND: Normative data on the diameters of the aorto-iliac segment are extremely useful in the diagnosis and monitoring of prenatal arterial variants and pathologies. OBJECTIVES: The present study describes age-specific reference intervals and normal growth curves for the external diameters of the external and internal iliac arteries. MATERIAL AND METHODS: Using anatomical dissection and digital-image analysis, the normal growth of the external diameters of the external and internal iliac arteries was studied in 124 spontaneously aborted human fetuses, aged 15-34 weeks. RESULTS: Neither sex differences nor laterality differences were found. The external diameters of the external iliac arteries increased from 0.31 +/- 0.06 to 1.41 +/- 0.31 mm on the right, and from 0.29 +/- 0.04 to 1.37 +/- 0.24 mm on the left, and generated the following growth curves of best fit: y = 0.665 - 0.056 x Age + 0.002 x Age2 +/- 0.143 (R2 = 0.82) and y = 0.612 - 0.052 x Age + 0.002 x Age2 +/- 0.118 (R2 = 0.86), respectively. The external diameters of the internal iliac arteries were found to be statistically larger than those of the external iliac arteries (p = 0.0000). The external diameters of the internal iliac arteries ranged from 0.44 +/- 0.07 to 2.04 +/- 0.43 mm on the right, and from 0.44 +/- 0.06 to 1.83 +/- 0.43 mm on the left, and modeled the following quadratic functions: y = 1.524 - 0.127 x Age + 0.004 x Age2 +/- 0.242 (R2 = 0.74), and y = 1.391 - 0.117 x Age + 0.004 x Age2 +/- 0.220 (R2 = 0.76), respectively. The right external iliac arteries (in 71% of the cases) and the right internal iliac arteries (in 65.3% of cases) were larger in external diameter. CONCLUSIONS: The values of the external diameters of the external and internal iliac arteries are independent of sex. A strong trend towards higher values for the right external and internal iliac arteries is noted. The external diameter of the internal iliac artery is nearly 1.5 times greater than that of the external iliac artery. Surprisingly, normal growth of the external diameters of the external and internal iliac arteries follows quadratic functions.

Oxidative stress markers in prostate cancer patients after HDR brachytherapy combined with external beam radiation.

Assessment of oxidative stress markers was perfomed in prostate cancer (PCa) patients subjected to high-dose brachytherapy (HDR) with external beam radiotherapy (EBRT). Sixty men with PCa were subjected to combined two-fraction treatment with HDR (tot. 20 Gy) and EBRT (46 Gy). Blood samples were taken before treatment, immediately afterwards, after 1.5-3 months, and approx. 2 years. Control group consisted of 30 healthy men. Erythrocyte glutathione peroxidase activity in the patients was lower than in healthy subjects by 34% (P < 0.001), 50% (P < 0.001), 30% (P < 0.05), and 61% (P < 0.001), respectively, at all periods. No significant differences were found by comparing superoxide dismutase and catalase activity in PCa patients with that of the controls. After 2 years of the end of treatment, the activity of studied enzymes demonstrated a decreasing tendency versus before therapy. Blood plasma thiobarbituric acid reactive substances (TBARS) concentration was higher than in the controls at all periods, while erythrocyte TBARS decreased after 2 years to control levels. The results confirm that in the course of PCa, imbalance of oxidant-antioxidant processes occurs. The therapy did not alter the levels of oxidative stress markers, which may prove its applicability. Two years is too short a period to restore the oxidant-antioxidant balance.