ABSTRACT
PURPOSE: To compare two-dimensional ultrasonography (2DUS) and magnetic resonance imaging (MRI) for assessing brain and spine parameters in fetuses with spina bifida. METHODS: A cross-sectional study was conducted on 15 fetuses with spina bifida (one with encephalocele, four with rachischisis and 10 with myelomeningocele). The size of the atrium of the lateral ventricle, percentage shortening of the cerebellum, degree of compromising of the first vertebra and total number of vertebras affected by herniation were assessed. The MRI examination was performed not more than 7 days after the 2DUS. To compare and correlate the parameters from the two techniques, the paired Student's t test and intraclass correlation coefficient (ICC) were used. To assess the correlations of atrium measurements from 2DUS and MRI with other parameters, Pearson's correlation coefficient (r) was used. RESULTS: No significant difference was observed in any of the means of the parameters assessed using the two techniques (p > 0.05). Both 2DUS and MRI seemed to present satisfactory reliability in measurements on the size of the atrium of the lateral ventricle and the first vertebra affected (ICC = 0.88 and 0.75, respectively). Measurements on the atrium of the lateral ventricle from 2DUS correlated better with the other parameters than did measurements from MRI. CONCLUSIONS: In fetuses with spina bifida, 2DUS and MRI present similar results, but measurements on the atrium of the lateral ventricle from 2DUS correlated better with the other parameters.
Subject(s)
Brain/pathology , Magnetic Resonance Imaging , Spinal Dysraphism/embryology , Spine/pathology , Ultrasonography, Prenatal/methods , Adult , Brain/embryology , Female , Gestational Age , Humans , Meningomyelocele/diagnosis , Meningomyelocele/diagnostic imaging , Pregnancy , Spinal Dysraphism/diagnosis , Spinal Dysraphism/pathology , Spine/embryologyABSTRACT
Neural tube defects (NTDs) are a group of congenital anomalies that affect the central nervious system. Spina Bifida (SB) is the most frecuent NTD in live births andi t is usually associated to disease, disability; and mortality. NTDs are considered as a multifactorial disease. Women who use folic acid periconceptionally are at a 50-70% reduced risk for NTD-affected pregnancies. More than 80 candidates genes to SB are been studied, someones related to folic acid metabolic pathway. MTHFR gene is the gene more studied in NTDs. Its allele 677T is asóciate to higher risk to NTD. It is important to study polymorphisms in MTHFR gene in Chile because Chilean population has dfferent ethnic origen from others previous studied populations.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Spinal Dysraphism/embryology , Spinal Dysraphism/genetics , Chile , Congenital Abnormalities , Neural Tube Defects/embryology , Neural Tube Defects/geneticsABSTRACT
PURPOSE: To develop a simplified technique for antenatal correction of a meningomyelocele -like defect in fetal sheep to allow direct skin closure. METHODS: A spinal defect was surgically created at 75 days of gestation in the fetuses of 36 pregnant sheep, 23 survived the surgery. At 102 days gestation, the defect was corrected in 14 cases (9 were left untreated). Skin surrounding the defect was dissected below the dermis to permit its edges to be approximated and sutured, without interposing any material to its edges. An interface material intended to protect the neural tissue from skin adhesion was used and the skin defect was completely closed over it. Pregnancy was allowed to continue up to 138 days gestation, the fetuses were submitted to macroscopic and microscopic analysis. RESULTS: The defect was successfully corrected in 90.9% in the experimental group, and spontaneous closure occurred in 22.3% in the control group (p < 0.05). The survival rate after the creation and correction of the defect was 63.4% and 78% respectively. CONCLUSION: This simplified technique was successful in the correction a meningomyelocele-like defect, in the fetal sheep.
Subject(s)
Fetus/surgery , Meningomyelocele/surgery , Spinal Cord/surgery , Spinal Dysraphism/surgery , Animals , Disease Models, Animal , Female , Pregnancy , Sheep , Spinal Dysraphism/embryologyABSTRACT
PURPOSE: To develop a simplified technique for antenatal correction of a meningomyelocele -like defect in fetal sheep to allow direct skin closure. METHODS: A spinal defect was surgically created at 75 days of gestation in the fetuses of 36 pregnant sheep, 23 survived the surgery. At 102 days gestation, the defect was corrected in 14 cases (9 were left untreated). Skin surrounding the defect was dissected below the dermis to permit its edges to be approximated and sutured, without interposing any material to its edges. An interface material intended to protect the neural tissue from skin adhesion was used and the skin defect was completely closed over it. Pregnancy was allowed to continue up to 138 days gestation, the fetuses were submitted to macroscopic and microscopic analysis. RESULTS: The defect was successfully corrected in 90.9 percent in the experimental group, and spontaneous closure occurred in 22.3 percent in the control group (p < 0.05). The survival rate after the creation and correction of the defect was 63.4 percent and 78 percent respectively. CONCLUSION: This simplified technique was successful in the correction a meningomyelocele-like defect, in the fetal sheep.
OBJETIVO: Desenvolver uma técnica simplificada de correção pré-natal de defeito semelhante à mielomeningocele em fetos de ovelha permitindo um fechamento direto da pele. MÉTODOS: Um defeito espinhal foi cirurgicamente criado com 75 dias de gestação, em 36 fetos de ovelha, 23 sobreviveram à cirurgia. Após 102 dias de gestação, o defeito foi corrigido em 14 casos (9 não foram tratados). A pele em volta do defeito foi dissecada abaixo da derme para permitir a aproximação direta das bordas através de sutura, sem a interposição de nenhum material entre a pele. Um material de interface foi colocado entre o tecido neural exposto e a pele, com o objetivo de evitar a adesão da medula à pele, que foi completamente fechada sobre o defeito. A gravidez foi mantida até 138 dias, os fetos foram submetidos a análises macroscópicas e microscópicas. RESULTADOS: O defeito foi corrigido em 90.9 por cento no grupo experimental, e o fechamento espontâneo ocorreu em 22.3 por cento no grupo controle (p < 0.05). A taxa de sobrevivência após a criação do defeito e posteriormente a sua correção foi de 63,4 por cento e 78 por cento, respectivamente. CONCLUSÃO: Esta técnica simplificada teve sucesso na correção do defeito semelhante à mielomeningocele em feto de ovelha.
Subject(s)
Animals , Female , Pregnancy , Fetus/surgery , Meningomyelocele/surgery , Spinal Cord/surgery , Spinal Dysraphism/surgery , Disease Models, Animal , Sheep , Spinal Dysraphism/embryologyABSTRACT
Se llevó acabo una revisión bibliográfica sobre la importancia del ácido fólico en el desarrollo del embrión humano. Se realizó un estudio a 387 pacientes, de las diferentes áreas de salud del Municipio Especial, con patologías en la columna vertebral. Al analizar las radiografías se comprobó que 81 pacientes (21.6 porciento) tenían anomalías congénitas en su raquis y el defecto más frecuente fue la espina bífida oculta con 46 casos, que representan el 56.7 porciento del total de la muestra. Por su implicación en la síntesis de ADN, ARN y el metabolismo de algunos aminoácidos, la deficiencia de ácido fólico en el embarazo, antes del cierre del tubo neural, puede ocasionar daños en la formación de la médula espinal y el cerebro(AU)
It was carried out a study from of a social problem of the science that refers to the rejection from the Christian believers to the treatments that are applied in the Chinese Traditional Medicine (CTM). We didn't know why the believers rejected this therapy because we didnt get any explanation from them about it. Therefore, we intended to settle down the causes. In our study, we checked that philosophical theoretical contradictions were existed, because the Tao's philosophy is based on a primitive Dialectical Materialism instead of the religious philosophy, which is Idealist. The consulted specialists said that the theoretical foundations of the Traditional Medicine, are based on the Tao's philosophy and they are not related with any religion. However, we found in the investigation that the Tao's philosophy, which began like a pure philosophical school, became a Religion where they use magic symbols, as the Ying Yang symbol. In the Asian countries, the Traditional Medicine is related with the Taoist religion. We also verify that many believers ignore about the Taoist religion and their relationship with the CTM(AU)
Subject(s)
Humans , Pregnancy , Folic Acid , Anencephaly , Spinal Dysraphism/embryology , Meningomyelocele , Embryonic Development , Review Literature as TopicABSTRACT
OBJECTIVES: To determine the prevalence of chromosomal abnormalities in fetuses with open neural tube defects (NTD) undergoing prenatal chromosome analysis. The role of prenatal ultrasound in detecting those with an underlying chromosomal abnormality was also investigated. METHODS: Over a 6-year period, 144 fetuses with open NTD underwent prenatal chromosome analysis between 12 and 37 weeks of gestation, as part of a prospective, multicenter prenatal diagnosis and counseling program in Chile. This population included 66 fetuses with spina bifida, 46 with acrania/anencephaly, 21 with cephalocele and 11 with iniencephaly. A confident prenatal diagnosis was made in 143 fetuses (99%) and confirmed postnatally in all cases. RESULTS: An underlying chromosomal abnormality was diagnosed in 10 fetuses (7%), six with spina bifida, three with cephalocele and one with craniorachischisis. The prevalence of chromosomal abnormality varied according to the defect present in the fetus, with a 14% (3/21) prevalence among those with cephalocele, 9% (6/66) among those with spina bifida and 2% (1/57) among those with lethal defects such as acrania, anencephaly or iniencephaly. Karyotype results revealed trisomy 18 in seven cases, trisomy 13 in two and mosaicism for a marker chromosome in one. Prenatal ultrasound before the procedure showed that all chromosomally abnormal fetuses had additional findings. The prevalence of chromosomal abnormality in fetuses with spina bifida and cephalocele was higher when chromosome analysis was performed at or before 24 weeks of gestation in comparison to those performed after 24 weeks (5/31 (16%) vs. 4/56 (7%), respectively). However, this difference did not reach statistical significance, probably due to the small number of cases. CONCLUSIONS: A significant number of fetuses with open NTD are chromosomally abnormal. Although prenatal chromosome analysis should be considered in all cases, prenatal ultrasound seems effective in identifying those fetuses with an underlying chromosomal abnormality.
Subject(s)
Chromosome Aberrations/embryology , Neural Tube Defects/embryology , Ultrasonography, Prenatal/methods , Adult , Anencephaly/diagnostic imaging , Anencephaly/embryology , Anencephaly/epidemiology , Chile/epidemiology , Chromosomes, Human, Pair 13/genetics , Chromosomes, Human, Pair 18/genetics , Female , Gestational Age , Humans , Middle Aged , Mosaicism/genetics , Neural Tube Defects/diagnostic imaging , Neural Tube Defects/epidemiology , Pregnancy , Prevalence , Prospective Studies , Spinal Dysraphism/diagnostic imaging , Spinal Dysraphism/embryology , Spinal Dysraphism/epidemiology , Trisomy/geneticsABSTRACT
Basándonos en la casuística de la policlínica de Malformaciones del Sistema Nervioso Central que comprende 38 mielomeningoceles, 2 meningoceles y 2 encefaloceles se analiza la embriogénesis; etiología e incidencia de estas malformaciones. Un capítulo aparte merece el enfoque terapéutico que se ha dado al mielomeningocele durante varias décadas, el cual ha sido un punto controversial. La asociación de mielomeningocele e hidrocefalia que en nuestra casuística fue de 92 por ciento es también analizada. La etiología más frecuente fue el Arnold-Chiari (89 por ciento) y el tratamiento instituido la derivación ventrículo-peritoneal. Se concluye que una política de selección, no es el método más adecuado de tratamiento en el mielomeningocele(AU)
Subject(s)
Humans , Male , Female , INFORME DE CASO , Spinal Dysraphism/surgery , Meningomyelocele/surgery , Spinal Dysraphism/embryology , Spinal Dysraphism/etiology , Hydrocephalus/surgeryABSTRACT
Basándonos en la casuística de la policlínica de Malformaciones del Sistema Nervioso Central que comprende 38 mielomeningoceles, 2 meningoceles y 2 encefaloceles se analiza la embriogénesis; etiología e incidencia de estas malformaciones. Un capítulo aparte merece el enfoque terapéutico que se ha dado al mielomeningocele durante varias décadas, el cual ha sido un punto controversial. La asociación de mielomeningocele e hidrocefalia que en nuestra casuística fue de 92 por ciento es también analizada. La etiología más frecuente fue el Arnold-Chiari (89 por ciento) y el tratamiento instituido la derivación ventrículo-peritoneal. Se concluye que una política de selección, no es el método más adecuado de tratamiento en el mielomeningocele