Enteric neuronal development in canine small intestine - an immunohistochemical study.

The development of the enteric nervous system (ENS) is still a valid and intensely studied issue. However, literature in the field has no data on this topic in the dog. The present investigations were performed in three groups of fetuses from mongrel dogs - from the third, sixth- -seventh, and ninth week of pregnancy - and in 3-5-day-old puppies (3 specimens for each age group). The tissues (the medial parts of the duodenum, jejunum, and ileum with the cecum and a small portion of the adjacent ascending colon) were cut using a cryostat and the sections were processed for single- and double-labeling immunohistochemistry using antisera against acetylated tubulin (AcTub), vesicular acetylcholine transporter (VAChT), nitric oxide synthase (NOS), vasoactive intestinal polypeptide (VIP), galanin (GAL), neuropeptide Y (NPY), substance P (SP), and calcitonin gene-related peptide (CGRP). In the 3-week-old fetuses, some oval cells invading the gut wall were found. From the seventh week of pregnancy onwards, two different enteric ganglia were present: submucosal and myenteric. The estimated number of nerve elements in the 9-week-old fetuses was much higher than that observed in the 6-7-week-old individuals. There was no significant difference in the estimated number of nerve structures between the 9-week-old fetuses and the 3-5-day-old puppies. The colonization pattern and the development of the ENS in the canine small intestine are very similar to those observed in other mam- mals. However, a few exceptions have been confirmed, regarding the time of appearance of the VIP-, GAL-, and CGRP-immunoreactive neurons, and their distribution in different portions of the canine bowel during development.

The course and branching patterns of the superficial branch of radial nerve in foetuses and clinical significance / Curso y patrones de ramificación del ramo superficial del nervio radial en fetos y su importancia clínica

Knowing the anatomical, topographic and morphometric properties of the superficial branch of the radial nerve (SBRN) in the forearm and the dorsum of the hand is important for minimizing nerve damage. The purpose of this study is to evaluate the anatomical and morphometric properties of SBRN in foetuses. Forty forearms of twenty-one foetuses (n=21) were dissected. The anatomical variations of SBRN in the dorsal forearm were assessed in three types (Type-1, Type-2 and Type-3). The innervation areas in dorsum of hand were assessed in four types (Type-1, Type-2, Type-3 and Type-4). The forearm length was divided to three part and emerging point of SBRN was determined as topographically. The relation of the SBRN with lateral antebrachial cutaneous nerve (LACN), anatomic snuffbox and cephalic vein was also evaluated. In forearm, Type-1 variation rate of SBRN was 87.5 %. In the dorsum of hand, Type-3 innervation pattern was 32.5 %. The emerging rate of SBRN in the middle third of the forearm was 74.4 %. There were nerve branches between LACN and SBRN or its terminal branches in 32.5 % of the forearms. The branches of SBRN passed within the margins of anatomic snuffbox in 50 % of the forearms. The most frequently branching type of SBRN was Type-1 in the forearm and Type-3 in the dorsum of hand in foetuses. These results may aid to minimize nerve injuries performed in clinical applications.

Conocer las propiedades anatómicas, topográficas y morfométricas del ramo superficial del nervio radial (RSNR) en el antebrazo y el dorso de la mano es importante para minimizar el daño a los nervios. El propósito de este estudio fue evaluar las propiedades anatómicas y morfométricas de RSNR en fetos. Fueron disecados 40 antebrazos de veintiún fetos. Las variaciones anatómicas de RSNR en el dorso del antebrazo se clasificaron en tres tipos (Tipo-1, Tipo-2 y Tipo-3). Las áreas de inervación en el dorso de la mano se evaluaron en cuatro tipos (Tipo 1, Tipo 2, Tipo 3 y Tipo 4). La longitud del antebrazo se dividió en tres partes y el punto emergente de RSNR se determinó topográficamente. Se evaluó la relación del RSRN con el nervio cutáneo antebraquial lateral (NCAL), la tabaquera anatómica y la vena cefálica. En el antebrazo, la tasa de variación de Tipo 1 de RSNR fue de 87,5 %. En el dorso de la mano, el patrón de inervación tipo 3 fue del 32,5 %. La emergencia del RSNR en el tercio medio del antebrazo fue de 74,4 %. En el 32,5 % de los antebrazos se observaron ramos nerviosos entre NCAL y RSNR. Los ramos de RSNR pasaron dentro de los límites de la tabaquera anatómica en 50 % de los antebrazos. El tipo de RSNS con ramificación más frecuente fue el Tipo 1 en el antebrazo y el Tipo 3 en el dorso de la mano en los fetos. Conocer las variaciones anatómicas de RSNS puede ayudar a minimizar las lesiones nerviosas durante los procedimientos clínicos.

Functional Connectome of the Fetal Brain.

Large-scale functional connectome formation and reorganization is apparent in the second trimester of pregnancy, making it a crucial and vulnerable time window in connectome development. Here we identified which architectural principles of functional connectome organization are initiated before birth, and contrast those with topological characteristics observed in the mature adult brain. A sample of 105 pregnant women participated in human fetal resting-state fMRI studies (fetal gestational age between 20 and 40 weeks). Connectome analysis was used to analyze weighted network characteristics of fetal macroscale brain wiring. We identified efficient network attributes, common functional modules, and high overlap between the fetal and adult brain network. Our results indicate that key features of the functional connectome are present in the second and third trimesters of pregnancy. Understanding the organizational principles of fetal connectome organization may bring opportunities to develop markers for early detection of alterations of brain function.SIGNIFICANCE STATEMENT The fetal to neonatal period is well known as a critical stage in brain development. Rapid neurodevelopmental processes establish key functional neural circuits of the human brain. Prenatal risk factors may interfere with early trajectories of connectome formation and thereby shape future health outcomes. Recent advances in MRI have made it possible to examine fetal brain functional connectivity. In this study, we evaluate the network topography of normative functional network development during connectome genesis in utero Understanding the developmental trajectory of brain connectivity provides a basis for understanding how the prenatal period shapes future brain function and disease dysfunction.

New insights into fetal pain.

Fetal pain is difficult to assess, because the main feature needed to spot pain, is the subject's capability of declaring it. Nonetheless, much can be affirmed about this issue. In this review we first report the epochs of the development of human nociceptive pathways; then we review since when they are functioning. We also review the latest data about the new topic of analgesia and prenatal surgery and about the scarce effect on fetal pain sentience of the natural sedatives fetuses produce. It appears that pain is a neuroadaptive phenomenon that emerges in the middle of pregnancy, at about 20-22 weeks of gestation, and becomes more and more evident for bystanders and significant for the fetus, throughout the rest of the pregnancy.

Is fetal analgesia necessary during prenatal surgery?

Fetal pain and fetal anesthesia are still matter of debate: some authors hypothesize that several intrauterine endocrine neuroinhibitors (ENIn) anesthetize the fetus, keeping it in a constant state of sleep, and making pharmacological fetal anesthesia useless for fetal surgery, while others argue fetal pain is possible and shoud be prevented with fetal anesthesy. AIM: To retrieve evidences about fetal pain, fetal arousability and about the level of sedation induced by the ENIn, in order to assess the necessity of direct fetal anesthesia during prenatal fetal surgery. METHODS: We performed a careful literature review (1990-2016) on fetal arousability, and on the possibility that ENIn at the average fetal blood levels induce actual anesthesia. We retrieved the papers that fulfilled the research criteria, with particular attention to the second half of pregnancy, the period when most fetal surgery is performed. RESULTS: Fetuses are awake about 10% of the total time in the last gestational weeks, and they can be aroused by external stimuli. ENIn have not an anesthetic effect at normal fetal values, but only when they areartificialy injected at high doses; their blood levels in the last trimester of average pregnancies are not dissimilar either in the fetus or in the mother. CONCLUSIONS: During the second half of the pregnancy, external stimuli can awake the fetuses, although they spend most of the time in sleeping state; the presence of ENIn is absolutely not enough to guarantee an effective anesthesia during surgery. Thus, direct fetal analgesia/anesthesia is mandatory, though further studies on its possible drawbacks are necessary.

Midline sensory nerve supply to the anoscrotal junction: a study using human male fetuses.

The origin of the posterior scrotal nerve is considered to be the bilateral pudendal nerves but the course to the midline is still obscure. Using 5 late-stage human male fetuses, we identified the single nerve through the intramuscular midline septum of the bulbospongiosus and the bilateral nerves along the left and right sides of the septum. Thus, the posterior scrotal nerve showed a variation: a single midline trunk or bilateral nerves. Branches of the bilateral pudendal nerves ran medially between the muscle and Cowper's gland and, at the midline area, they joined or associated closely. During the proximal course, much or less, the nerve penetrated the superior part of the muscle. The nerve entered the subcutaneous tissue at and near the perineal raphe. The communication with intrapelvic autonomic nerves were suggested behind Cowper's gland. Notably, the midline skin immediately anterior to the anus carried a considerable dense supply of thin sensory nerves. However, these nerves seemed to come from a space between the rectal smooth muscle and the external anal sphincter, not from the posterior scrotal nerve. Therefore, surgical treatment of the intersphincteric layer was likely to injure the original sensory nerve supply to the anterior anal skin.

The Relationship of the Temporal Branch of the Facial Nerve to the Fascial Planes of Temporal Region in Human Fetuses.

The aim of this study was to obtain information by assessing the relationship between temporal region fascial structures, fat pads, and temporal branches of facial nerve in human fetuses to use the knowledge on treatment of early childhood period surgeries. This anatomic dissection study was conducted on 40 hemifaces with no visible external abnormalities on their faces. Fascial layers and related fat pads of temporal region were dissected layer by layer beginning from superficial to deep. The relations of temporal branches of facial nerve and temporoparietal fascia and the structures of these fascial layers were evaluated. Temporoparietal fascia showed continuity below zygomatic arc with superficial musculoaponeurotic system. Temporal branches of facial nerve showed a multiple branching. Parotid-masseteric fascia became very thin on the superficial of zygomatic arch and ran with superficial layer of temporal fascia above without attaching to periosteum. Temporal branches of facial nerve entered between multilayered layers of temporoparietal fascia. Temporoparietal fascia became thicker on anterior and middle parts because of the localization of superficial temporal fat pad. Temporal fascia was a 2-layered thick and fibrous tissue enveloping intermediate fat pad. Deep layer connected to periosteum of zygomatic arch and superficial layer continued passing superficial of zygomatic arch and connected to the parotid-masseteric fascia. Deep temporal fat pad was found on the deep to deep layer of temporal fascia and surface of temporal muscle. The findings of this study may contribute to the knowledge of the topographical localization of temporal branches of facial nerve with temporal region fascial structures and fat pads in fetuses.

Fetal growth restriction: current knowledge.

BACKGROUND: Fetal growth restriction (FGR) is a condition that affects 5-10% of pregnancies and is the second most common cause of perinatal mortality. This review presents the most recent knowledge on FGR and focuses on the etiology, classification, prediction, diagnosis, and management of the condition, as well as on its neurological complications. METHODS: The Pubmed, SCOPUS, and Embase databases were searched using the term "fetal growth restriction". RESULTS: Fetal growth restriction (FGR) may be classified as early or late depending on the time of diagnosis. Early FGR (<32 weeks) is associated with substantial alterations in placental implantation with elevated hypoxia, which requires cardiovascular adaptation. Perinatal morbidity and mortality rates are high. Late FGR (≥32 weeks) presents with slight deficiencies in placentation, which leads to mild hypoxia and requires little cardiovascular adaptation. Perinatal morbidity and mortality rates are lower. The diagnosis of FGR may be clinical; however, an arterial and venous Doppler ultrasound examination is essential for diagnosis and follow-up. There are currently no treatments to control FGR; the time at which pregnancy is interrupted is of vital importance for protecting both the mother and fetus. CONCLUSION: Early diagnosis of FGR is very important, because it enables the identification of the etiology of the condition and adequate monitoring of the fetal status, thereby minimizing risks of premature birth and intrauterine hypoxia.

Morphometric characteristics of caudal cranial nerves at petroclival region in fetuses.

Morphometric measurements of cranial nerves in posterior cranial fossa of fetus cadavers were carried out in an attempt to identify any asymmetry in their openings into the cranium. Twenty-two fetus cadavers (8 females, 14 males) with gestational age ranging between 22 and 38 weeks (mean 30 weeks) were included in this study. The calvaria were removed, the brains were lifted, and the cranial nerves were identified. The distance of each cranial nerve opening to midline and the distances between different cranial nerve openings were measured on the left and right side and compared. The mean clivus length and width were 21.2 ± 4.4 and 13.2 ± 1.5 mm, respectively. The distance of the twelfth cranial nerve opening from midline was shorter on the right side when compared with the left side (6.6 ± 1.1 versus 7.1 ± 0.8 mm, p = 0.038). Openings of other cranial nerves did not show such asymmetry with regard to their distance from midline, and the distances between different cranial nerves were similar on the left and right side. Cranial nerves at petroclival region seem to show minimal asymmetry in fetuses.

Nerve innervations in the human adult and fetal parotid duct

The human adult parotid duct is the longest of all major salivary gland ducts, approximately 6-8 cm in length. Its unique structure extends over the masseter muscle, penetrates through the buccinator muscle and opens into the oral cavity. Salivary secretion is under basic control of the sympathetic and parasympathetic divisions of the autonomic nervous system. Scarce reporting on the parotid duct nerve distribution led us to this study; to investigate the nervous distribution in the human adult and fetal parotid ducts using an antibody against protein gene product 9.5 (PGP9.5), a molecular marker for nerve cells and fibers. In order to identify the nerve fibers distributed throughout the parotid duct and confirm them to be part of the autonomic nervous system, we stained adult parotid ducts with tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT) for observation. PGP9.5 staining of the parotid duct’s inside wall where it traverses over the masseter prior to penetrating the buccinator revealed a dense concentration of nerve fibers in the area. Staining revealed both sympathetic and parasympathetic nerve fibers in the same area, with the majority of the sympathetic nerve fibers surrounding blood vessels. However, the section of the duct penetrating the buccinator showed less concentration of nerve fibers in both adult and fetal specimens. The difference in the nerve distribution of the parotid duct suggests its direct association with the salivary transport function of the duct. PGP9.5 expression in fetuses over five months of age further suggests that the nerve distribution in the human parotid duct is fully established at six months of gestation

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Estudo morfométrico do músculo latíssimo do dorso em fetos humanos / Morphometric study of the latissimus dorsi muscle in human fetuses

Introdução: O músculo latíssimo do dorso (MLD) é largo, triangular e realiza extensão, adução e rotação medial do braço. É vascularizado pelos vasos toracodorsais e ramos perfurantes das artérias intercostais posteriores e lombares, configurando retalho tipo V de Mathes e Nahai, de grande aplicabilidade em cirurgia plástica. O objetivo é analisar a morfometria e a vascularização do MLD em fetos humanos. Método: Dissecou-se a região axilar e o MLD de oito fetos humanos formolizados (três do sexo feminino e cinco do sexo masculino), entre 20 e 32 semanas gestacionais, em decúbito dorsal e abdução completa do braço. Mensuraram-se os comprimentos dos vasos subescapulares e toracodorsais, e foi realizada a morfometria do músculo. Resultados: Em todos os fetos, os vasos toracodorsais conferiram a vascularização primária do MLD. Em 25%, a veia subescapular era tributária direta da veia axilar; 25% dos casos apresentaram veia circunflexa da escápula dupla. O ramo para o músculo serrátil anterior foi único em todos os casos. Em 50% dos casos, o ramo angular da artéria toracodorsal foi visualizado e, em 25% deles, era proveniente do ramo para o músculo serrátil anterior. A distância entre a inserção do músculo e a entrada do pedículo neurovascular variou entre 1,1 e 1,9 cm em fetos de 21 e 26 semanas, respectivamente. Todos os fetos apresentaram a margem anterior do músculo na linha axilar média. Conclusão: A morfometria constante e a reduzida variação anatômica do pedículo vascular encontradas possibilitam a realização de pesquisas envolvendo o uso do MLD em reconstruções cirúrgicas intraútero.

Introduction: The latissimus dorsi muscle (LDM) is a flat triangular muscle which extends, adducts and draws the arm medially. Its blood supply is from the thoracodorsal vessels and the perforating branches of the posterior intercostal and lumbar arteries, therefore, it is a type V flap variety, which has great applicability in plastic surgery. This study aims to analyze the morphometry and the vascularization of MLD in human fetuses. Methods: The axillary region and LDM of eight human fetuses (3 females, 5 males), between 20 and 32 weeks of gestational ages, were dissected in supine position with complete abduction of the arm. The subscapular and thoracodorsal vessels lengths were measured and the morphology of the muscle was studied. Results: In all fetuses, the dominant vascular pedicle of LDM was the thoracodorsal vessels. In 25% of cases the subscapular vein was tributary of the axillary vein. Double circumflex scapular vein were found in 25% of the cases. In all fetuses, the serratus anterior branch was unique. In 50% of the cases the angular branch of the thoracodorsal artery was found, 25% of them were from the serratus anterior branch. The length between its insertion and the entry of the neurovascular pedicle was 1.1 to 1.9 cm in fetuses of 21 and 26 weeks, respectively. In all fetuses, the anterior border of the muscle was at the mid-axillary line. Conclusion: The constant morphometry and reduced anatomical variation of the vascular pedicle enables new studies regarding the use of LDM in surgical reconstructions in utero.

Morphologic evaluation of the fetal recurrent laryngeal nerve and motor units in the thyroarytenoid muscle.

This study is a morphologic description of the recurrent laryngeal nerve (RLN) and of the number and size of motor units (MUs) in the thyroarytenoid (TA) muscle bilaterally of a human fetus aged 25 weeks. A quantitative analysis of RLN and MUs is presented to investigate similarities with equivalent structures in adults. In the fetus used in our study, the morphologic organization of the RLN was similar to that commonly described in the adult RLN. Moreover, as is observed in adult TA, the TA of the analyzed fetus, particularly the right TA, showed MUs typical of muscles with great motor accuracy. These results may be used to increase our knowledge of the features of the voice in adults and newborns.

Identification of the origin of adrenergic and cholinergic nerve fibers within the superior hypogastric plexus of the human fetus.

Nerve fibers contributing to the superior hypogastric plexus (SHP) and the hypogastric nerves (HN) are currently considered to comprise an adrenergic part of the autonomic nervous system located between vertebrae (T1 and L2), with cholinergic aspects originating from the second to fourth sacral spinal segments (S2, S3 and S4). The aim of this study was to identify the origin and the nature of the nerve fibers within the SHP and the HN, especially the cholinergic fibers, using computer-assisted anatomic dissection (CAAD). Serial histological sections were performed at the level of the lumbar spine and pelvis in five human fetuses between 14 and 30 weeks of gestation. Sections were treated with histological staining [hematoxylin-eosin (HE) and Masson's trichrome (TriM)] and with immunohistochemical methods to detect nerve fibers (anti-S100), adrenergic fibers (anti-TH), cholinergic fibers (anti-VAChT) and nitrergic fibers (anti-nNOS). The sections were then digitalized using a high-resolution scanner and the 3D images were reconstructed using winsurf software. These experiments revealed the coexistence of adrenergic and cholinergic fibers within the SHP and the HNs. One-third of these cholinergic fibers were nitrergic fibers [anti-VACHT (+)/anti-NOS (+)] and potentially pro-erectile, while the others were non-nitrergic [anti-VACHT (+)/anti-NOS (-)]. We found these cholinergic fibers arose from the lumbar nerve roots. This study described the nature of the SHP nerve fibers which gives a better understanding of the urinary and sexual dysfunctions after surgical injuries.

Internal anal sphincter parasympathetic-nitrergic and sympathetic-adrenergic innervation: a 3-dimensional morphological and functional analysis.

BACKGROUND: Little detailed information is available concerning morphological and functional autonomic nerve supply to the internal anal sphincter. However, denervation of the sphincter potentially affects anal function after rectal surgery for cancer. OBJECTIVE: The aim of this study was to identify the location and type (nitrergic, adrenergic, and cholinergic) of nerve fibers in the internal anal sphincter and to provide a 3-dimensional representation of their structural relationship in the human fetus. MATERIALS AND METHODS: serial transverse sections were obtained from 14 human fetuses (7 male, 7 female, 15-31 weeks of gestation) and were studied histologically and immunohistochemically; digitized serial sections were used to construct a 3-dimensional representation of the pelvis. MAIN OUTCOMES MEASURES: The location and type of internal anal sphincter nerves were assessed qualitatively. RESULTS: Posteroinferior fibers originating from the inferior hypogastric plexus posteroinferior angle projected to the posterolateral and posterior rectal wall and internal anal sphincter, forming the inferior rectal plexus. The inferior rectal plexus contained vesicular acetylcholine transporter-positive (cholinergic), tyrosine hydroxylase-positive (adrenergic/sympathetic), and neural nitric oxide synthase-positive (nitrergic) fibers. The intrasphincteric vesicular acetylcholine transporter-positive fibers included both neural nitric oxide synthase-negative fibers and neural nitric oxide synthase-positive fibers (nitrergic-parasympathetic). LIMITATIONS: The study focused on topographic and functional anatomy, so that quantitative data were not obtained. A small number of fetal specimens were available. CONCLUSIONS: We report the precise location and distribution of the autonomic neural supply to the internal anal sphincter. This description contributes to the understanding of neurogenic postoperative sphincteric dysfunction. Three-dimensional cartography of pelvic-perineal neurotransmitters provides an anatomical and physiological basis for the selection and development of pharmacological agents to be used in the treatment of primary or postoperative continence and evacuation disorders.

The lesser occipital nerve in fetuses / El nervio occipital menor en fetos

The lesser occipital nerve (LON) is an ascending superficial branch of the cervical plexus that has a variable origin either from the ventral ramus of the second cervical nerve or second and third cervical nerves and is purely sensory. Forty fetuses (right side: 40/80; left: 40/80) with gestational ages between 15 to 28 weeks were microdissected to document the anatomy of the LON. Results: a) Incidence and Morphometry: LON present in 100 percent specimens, with average length on the right and left sides of 23.59 +/- 2.32 mm and 23.45 +/- 2.27 mm, respectively; b) Course: In its ascent towards the occipital region, the LON was located on the splenius capitus muscle in 85 percent of specimens and in 15 percent of the specimens, it ascended vertically on the sternocleidomastoid muscle towards the ear, innervating its superior third; c) Branching pattern: LON displayed (i) single: 70 percent; (ii) duplicate: 26 percent and (iii) triplicate: 4 percent patterns; d) Variation in the course of LON was observed in 6 percent of the specimens. Knowledge of the anatomy and variations of the LON may assist in the understanding of cervicogenic headaches and may be of assistance to anesthetists performing regional anesthesia for surgical procedures in the neck.

El nervio occipital menor (NOM) es una rama ascendente superficial del plexo cervical que tiene un origen variable ya sea del ramo ventral del segundo nervio cervical o de los nervios cervicales segundo y tercero, y es solamente sensitivo. Cuarenta fetos (lado derecho: 40/80; izquierdo: 40/80), con edades gestacionales de 15 a 28 semanas fueron microdisecados para documentar la anatomía del NOM. a) Incidencia y morfometría: el NOM estuvo presente en el 100 por ciento de los especímenes, con una longitud media de los lados derecho e izquierdo de 23,59 +/- 2,32 mm y 23,45 +/- 2,27 mm, respectivamente; b) Curso: en su ascenso hacia la región occipital, el NOM se localiza en el músculo esplenio de la cabeza en el 85 por ciento de las muestras y en el 15 por ciento de las muestras, ascendió verticalmente sobre el músculo esternocleidomastoideo hacia el oído, inervando el tercio superior, c) Patrón de ramificación: el NOM se observa (i) individual: 70 por ciento, (ii) duplicado: 26 por ciento y (iii) triplicado: 4 por ciento de los patrones; d) Variación en el curso de NOM se observó en el 6 por ciento de las muestras. El conocimiento de la anatomía y las variaciones del NOM puede ayudar en la comprensión de los dolores de cabeza cervical y puede ser de ayuda a los anestesiólogos a realizar la anestesia regional para procedimientos quirúrgicos en el cuello.

Back to the debate: sternalis muscle / Volver al debate: músculo esternal

The sternalis muscle (SM) is an anatomical variant found in the anterior thoracic wall. While the attachment sites of SM are generally agreed upon, the innervation and function of this muscle are not well established. Cadaveric and surgical explorations to date report that SM is innervated by either the pectoral nerves or the anterior branches of the intercostal nerves, or a combination of both. Knowledge of SM is relevant to health care providers specialising in imaging and/or surgery of the anterior thoracic wall. This paper aims to raise awareness in the medical community of the clinical relevance of SM through two case reports and a brief literature review.

El músculo esternal (ME) es una variante anatómica en la pared torácica anterior. Mientras que los sitios de fijación del ME estan acordados, la inervación y la función de este músculo no están bien establecida. Exploraciones cadavéricas y quirúrgicas han informado que el ME está inervado por los nervios pectorales o ramos anteriores de los nervios intercostales, o una combinación de ambos. El conocimiento del SE es relevante para los proveedores de atención de salud especializada de imágenes y/o cirugía de la pared torácica anterior. Este documento tiene como objetivo crear conciencia en la comunidad médica de la relevancia clínica de ME a través de dos reportes de caso y una breve revisión bibliográfica.

Postnatal neuro-development of fetuses with absent end-diastolic flow in the umbilical artery and/or fetal descending aorta.

OBJECTIVE: To determine whether absence of end-diastolic flow in the umbilical artery and/or fetal aorta impacts postnatal neuro-development in preterm-born children. METHODS: The study group, consisting of 43 fetuses with absent end-diastolic flow in the umbilical artery and/or fetal aorta, was compared with a control group, consisting of 30 fetuses, matching for gestational age but with normal doppler-flow results. The children's neuro-developmental status was assessed using the 'Munich functional developmental diagnostics' (MFDD), between the 2nd and 3rd year of life. RESULTS: Gestational age at birth was 33 + 6 weeks in the study group and 34 + 4 weeks in the control group. A brain-sparing effect was observed in 37.3% of fetuses in the study group compared with 10.0% in the control group (p = 0.014). For all seven MFDD domains, the number of children with deficiencies was higher in the study group. For the domains perception, active speech and comprehension this effect was statistically significant (p < 0.05). Overall, 30.2% of children in the study group and 16.7% of the control group had pathologic test results (p < 0.013). CONCLUSION: Pathological doppler-flow in the umbilical artery and/or fetal descending aorta in preterm born children is associated with neuro-developmental deficiencies. Intensive pediatric care is recommended to mitigate these deficiencies during early childhood.

Anatomical survey of terminal branching patterns of superficial branch of radial nerve in fetuses.

BACKGROUND: Regional anesthesia plays a key role in elective as well as emergency orthopedic and other surgeries in children. However, peripheral nerve blocks are quite challenging in children due to lack of precise anatomical knowledge of the course and distribution of these nerves. The purpose of this study was to explore the terminal branches of the superficial branch of the radial nerve in fetuses. The relationship of the superficial branch of the radial nerve with cephalic vein and surrounding tendons was also observed. METHODS: A total of 60 upper extremities (42 males and 18 females) of 30 spontaneously aborted fetuses (32-40 weeks) were dissected to expose the superficial branch of the radial nerve in the distal forearm and hand. RESULTS: Three patterns of distribution based on the total area of the dorsum of the hand innervated were observed. Type 1 (66.7%): superficial branch of radial nerve (SBRN) innervated lateral two-and-a-half digits; Type 2 (23.3%): SBRN innervated lateral three digits; Type 3 (10%): SBRN innervated lateral three-and-a-half digits. The cephalic vein was seen to intersect the nerve more than twice along its course. CONCLUSIONS: Detailed knowledge of the distribution patterns of terminal branches of superficial branch of radial nerve in hand will enhance the success rate of regional blocks or hand surgeries and minimize the postoperative complications due to injury to nerve or vascular structures.

Gunshot wound of the fetus.

We report here a fetus, who was delivered via cesarean section in 32th gestational week from a 37-year-old mother and sustained multiple gunshots. Post-natal evaluation revealed eight entry-exit holes and the baby was transferred to our clinic.Upon admission, peripheral pulses were nonpalpable, appropriate fluid administration and blood transfusion were conducted and further examinations revealed bladder perforation. Bladder was repaired over a suprapubic catheter and bullet holes were primarily sutured. Left foot drop was observed on follow up and the patient was discharged with no further complication. Although the maternal and the fetal morbidity and mortality rates are high in intrauterine gunshot wounds, appropriate management may provide survival as seen in our case.