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1.
BMJ Case Rep ; 14(11)2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34728503

RESUMO

A primiparous woman in her late 30s at 28+1 weeks' gestation presented with a 3-day history of abdominal pain, loss of appetite, nausea and vomiting and was diagnosed with starvation ketoacidosis. A routine admission swab returned positive for COVID-19. She had been diagnosed with acrorenal syndrome from birth. Three days post admission, she deteriorated rapidly into respiratory failure requiring intubation and ventilation. She was treated with dexamethasone, prophylactic enoxaparin, a course of piperacillin/tazobactam followed by meropenem and fluconazole and 8 cycles of proning. An emergency caesarean section was performed on day 12 of hospital admission at 29+5 weeks' gestation to improve maternal oxygenation and ventilation. The baby had deformities consistent with acrorenal syndrome but no evidence of COVID-19. She spent 23 days in the intensive care unit. Our case describes an unusual presentation of COVID-19, the challenges in managing critically ill pregnant patients along with a rare background history of acrorenal syndrome.


Assuntos
COVID-19 , Cetose , Adulto , COVID-19/complicações , Cesárea , Feminino , Dedos/anormalidades , Deformidades Congênitas da Mão , Humanos , Rim/anormalidades , Gravidez
6.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413033

RESUMO

Solitary fibrous tumours (SFTs) are a rare mesenchymal neoplasm with an incidence of 2.8 per 100 000 of which only 1% occur in the female genital tract. Doege-Potter syndrome is a paraneoplastic phenomenon associated with approximately 5%-10% of SFTs and is characterised by non-islet cell hypoglycaemia due to tumour production of low molecular weight insulin-like growth factor-II. We present the fourth confirmed case of female pelvic SFT with Doege-Potter syndrome and a literature review.


Assuntos
Nefropatias , Síndromes Paraneoplásicas , Tumores Fibrosos Solitários , Anormalidades Congênitas , Feminino , Humanos , Rim/anormalidades , Nefropatias/congênito , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/etiologia , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/cirurgia
7.
J Obstet Gynaecol Res ; 47(10): 3702-3706, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34365700

RESUMO

Anal atresia is the most common malformation occurring in VACTERL association, but it is difficult to diagnose antenatally. We herein present a case of fetal anal atresia in VACTERL association diagnosed by ultrasonography and supported by autopsy. This case emphasizes the clues to ultrasonographic diagnosis of anal atresia at 11-13+6 weeks of gestation, promoting increased awareness of VACTERL association during first-trimester screening.


Assuntos
Anus Imperfurado , Cardiopatias Congênitas , Deformidades Congênitas dos Membros , Canal Anal/anormalidades , Canal Anal/diagnóstico por imagem , Anus Imperfurado/diagnóstico por imagem , Esôfago/anormalidades , Feminino , Humanos , Rim/anormalidades , Deformidades Congênitas dos Membros/diagnóstico por imagem , Gravidez , Primeiro Trimestre da Gravidez , Coluna Vertebral/anormalidades , Traqueia/anormalidades
9.
Fertil Steril ; 116(5): 1360-1369, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34311961

RESUMO

OBJECTIVE: To explore the genetic causes of Herlyn-Werner-Wunderlich syndrome (HWWS) using whole-exome sequencing. DESIGN: Retrospective genetic study. SETTING: Academic medical center. PATIENT(S): Twelve patients with HWWS. INTERVENTION(S): Whole-exome sequencing was performed for each patient. Sanger sequencing was used to confirm the potential causative genetic variants. In silico analysis and American College of Medical Genetics and Genomics guidelines were used to classify the pathogenicity of each variant. MAIN OUTCOME MEASURE(S): Rare sequence variants associated with müllerian duct development and renal agenesis were identified and included in subsequent analyses. RESULT(S): A total of 11 variants were identified in 10 of 12 patients (83.3%) and were considered to constitute a molecular genetic diagnosis of HWWS. These 11 variants were related to 9 genes: CHD1L, TRIM32, TGFBR3, WNT4, RET, FRAS1, FAT1, FOXF1, and PCSK5. All variants were heterozygous and confirmed by Sanger sequencing. The changes included one frameshift variant, one splice-site variant, and eight missense variants. All of the identified variants were absent or rare in Genome Aggregation Database East Asian populations. One of the 11 variants (9.1%) was classified as a pathogenic variant according to the American College of Medical Genetics and Genomics guidelines, and 8 of the 11 variants (72.7%) were classified as variants of uncertain significance. CONCLUSION(S): To our knowledge, this is the first report of the genetic causes of HWWS. Renal agenesis-related genes, such as CHD1L, TRIM32, RET, and WNT4, may be associated with HWWS. Identification of these variants can not only help us understand the etiology of HWWS and the relationship between reproductive tract development and urinary system development, but additionally improve the level of genetic counseling for HWWS.


Assuntos
Anormalidades Múltiplas , Anormalidades Congênitas/genética , Variação Genética , Nefropatias/congênito , Rim/anormalidades , Anormalidades Urogenitais/genética , Adolescente , Adulto , Criança , Anormalidades Congênitas/diagnóstico , Feminino , Predisposição Genética para Doença , Heterozigoto , Humanos , Nefropatias/diagnóstico , Nefropatias/genética , Fenótipo , Estudos Retrospectivos , Fatores de Risco , Síndrome , Anormalidades Urogenitais/diagnóstico , Sequenciamento Completo do Exoma , Adulto Jovem
10.
J Am Soc Nephrol ; 32(8): 1871-1879, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34049960

RESUMO

BACKGROUND: Bilateral renal agenesis (BRA) is a lethal con genital anomaly caused by the failure of normal development of both kidneys early in embryonic development. Oligohydramnios on fetal ultrasonography reveals BRA. Although the exact causes are not clear, BRA is associated with mutations in many renal development genes. However, molecular diagnostics do not pick up many clinical patients. Nephronectin (NPNT) may be a candidate protein for widening diagnosis. It is essential in kidney development, and knockout of Npnt in mice frequently leads to kidney agenesis or hypoplasia. METHODS: A consanguineous Han family experienced three cases of induced abortion in the second trimester of pregnancy, due to suspected BRA. Whole-exome sequencing (WES)-based homozygosity mapping detected underlying genetic factors, and a knock-in mouse model confirmed the renal agenesis phenotype. RESULTS: WES and evaluation of homozygous regions in II:3 and II:4 revealed a pathologic homozygous frameshift variant in NPNT (NM_001184690:exon8:c.777dup/p.Lys260*), which leads to a premature stop in the next codon. The truncated NPNT protein exhibited decreased expression, as confirmed in vivo by the overexpression of WT and mutated NPNT. A knock-in mouse model homozygous for the detected Npnt mutation replicated the BRA phenotype. CONCLUSIONS: A biallelic loss-of-function NPNT mutation causing an autosomal recessive form of BRA in humans was confirmed by the corresponding phenotype of knock-in mice. Our results identify a novel genetic cause of BRA, revealing a new target for genetic diagnosis, prenatal diagnosis, and preimplantation diagnosis for families with BRA.


Assuntos
Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/genética , Proteínas da Matriz Extracelular/genética , Nefropatias/congênito , Rim/anormalidades , Alelos , Animais , Mapeamento Cromossômico , Anormalidades Congênitas/patologia , Modelos Animais de Doenças , Proteínas da Matriz Extracelular/metabolismo , Feminino , Mutação da Fase de Leitura , Técnicas de Introdução de Genes , Células HEK293 , Homozigoto , Humanos , Rim/patologia , Nefropatias/diagnóstico , Nefropatias/genética , Nefropatias/patologia , Mutação com Perda de Função , Masculino , Linhagem , Fenótipo , Sequenciamento Completo do Exoma
11.
BMJ Case Rep ; 14(4)2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858901

RESUMO

Hypoglycaemia due to insulin-like growth factor (IGF)-2 secretion is a paraneoplastic complication of malignancy with significant morbidity that can often go unrecognised due to its uncommon presentation. We report on a case of a 51-year-old man with metastatic haemangiopericytoma presenting with refractory hypoglycaemia, requiring continuous dextrose 10% infusion while in hospital. IGF-2 levels were significantly elevated, in keeping with a rare entity associated with solitary fibrous tumours, known as Doege-Potter syndrome. The patient was managed using uncooked cornstarch in conjunction with debulking of the hepatic tumour burden with bland IR-guided transarterial embolisation, and eventual surgical resection to treat his non-islet cell tumour hypoglycaemia (NICTH). The case highlights this rare paraneoplastic phenomenon that should be included in the differential for hypoglycaemia, especially if a history of a solitary fibrous tumour is elicited. Our case is the first to document a successful approach to treating the hypoglycaemia using preoperative transarterial bland embolisation.


Assuntos
Hemangiopericitoma , Hipoglicemia , Síndromes Paraneoplásicas , Anormalidades Congênitas , Hemangiopericitoma/complicações , Hemangiopericitoma/terapia , Humanos , Hipoglicemia/etiologia , Hipoglicemia/terapia , Fator de Crescimento Insulin-Like II , Rim/anormalidades , Nefropatias/congênito , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/terapia
12.
Transplant Proc ; 53(4): 1257-1261, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33892929

RESUMO

BACKGROUND: In living-donor kidney transplantation, laparoscopic nephrectomy from a donor has become widespread. However, more careful treatment is required for nephrectomy from a donor with horseshoe kidney. This report presents an interesting surgical case of laparoscopic nephrectomy from a donor with horseshoe kidney. CASE PRESENTATION: A woman aged 53 years was a donor candidate for living-donor kidney transplantation for her husband. She had no medical history and had no problems on preoperative examination, but contrast-enhanced computed tomography revealed that she had horseshoe kidney. As the isthmus was thin and the contrast effect was poor, the isthmus was considered to have poor kidney parenchyma and consisted almost exclusively of fibrous tissue. Therefore, laparoscopic nephrectomy was performed for the donor. On the basis of the 99m Tc-dimercaptosuccinic acid renal scintigraphy results, the right kidney was collected. A laparoscopic nephrectomy with a retroperitoneal approach was performed using GelPort access platforms in a right abdominal incision with an accessory port. We firmly expanded the isthmus and then dissected it just above the aorta using a linear stapling device. Subsequently, we sutured a renal artery and vein with linear stapling devices. The recipient's surgery was also performed without any problems, and the postoperative course of both donor and recipient was good. CONCLUSIONS: We suggest that even if the donor has horseshoe kidney, laparoscopic donor nephrectomy should be actively considered depending on the thickness of the isthmus of the horseshoe kidney.


Assuntos
Rim Fundido/cirurgia , Laparoscopia/métodos , Doadores Vivos , Nefrectomia/métodos , Coleta de Tecidos e Órgãos/métodos , Feminino , Humanos , Rim/anormalidades , Rim/cirurgia , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Artéria Renal/cirurgia
13.
Clin Nephrol ; 95(6): 332-337, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33704056

RESUMO

AIMS: Severe reduction in nephron numbers that are characteristic of renal hypodysplasia (RHD) are one of the cause of childhood chronic kidney disease (CKD). Glomerular hyperfiltration, glomerular hypertrophy, progressive glomerular scarring, and interstitial fibrosis due to reduced nephron number are risk factors for CKD. In recent years, studies on specific markers for early diagnosis of renal failure and mortality have been carried out. The objectives of this study were to identify serum and urinary endocan levels that are expressed in glomerular endothelial cells and tubular epithelial cells in RHD. MATERIALS AND METHODS: 29 children with RHD were compared to 26 healthy controls in terms of serum and urinary endocan levels. RESULTS: The mean serum endocan level in the RHD group and the control group was 700.72 ± 323.19 and 426.86 ± 233.14 pg/mL, respectively. The mean serum endocan level was significantly higher (p = 0.003) in the RHD group. The mean urinary endocan level in the RHD group was 63.62 ± 92.46 pg/mL, and in the control group it was 80.26 ± 142.49 pg/mL. The mean urinary endocan level did not change between groups (p = 0.95). There was also a significant correlation between serum endocan level and uric acid level in the study group (r = 0.325, p = 0.028). CONCLUSION: To our knowledge, this was the first study that evaluated serum and urinary endocan levels in children with RHD. Although serum endocan level was found to be significantly higher in patients with RHD, further studies are needed to validate whether endocan could serve as a marker of poor renal prognosis in RHD.


Assuntos
Rim/anormalidades , Proteoglicanas/análise , Adolescente , Biomarcadores/sangue , Criança , Feminino , Humanos , Masculino , Proteoglicanas/sangue , Proteoglicanas/urina , Insuficiência Renal Crônica/etiologia
14.
Fertil Steril ; 116(2): 558-565, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33745726

RESUMO

OBJECTIVE: To reveal the proportion of concomitant extragenital malformations in a large cohort of Chinese patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. STUDY DESIGN: Retrospective study. SETTING: Tertiary teaching hospitals in China. PATIENT(S): A total of 1,055 Chinese Han women with MRKH syndrome diagnosed and treated at 11 Chinese tertiary teaching hospitals from January 2015 to January 2020. INTERVENTION(S): Karyotype analysis, hormone profiling, pelvic ultrasonography, spinal roentgenograms, urologic ultrasonography, and Chinese female reproductive tract malformation registry platform (https://ecrf.linklab.com/). MAIN OUTCOME MEASURE(S): Patients' demographic and clinical characteristics, concurrent malformations, and family histories. RESULT(S): Of the 1,055 Chinese Han patients with MRKH, 69.6% had type I MRKH syndrome and the remaining 30.4% had type II MRKH syndrome. Among the type II patients, 12.6% had müllerian duct aplasia, unilateral renal aplasia/ectopic kidney, and cervicothoracic somite dysplasia association. Skeletal malformations were the most common associated extragenital malformations in the study (22.0%, 232/1,055), of which idiopathic scoliosis and congenital vertebral malformations were the 2 main skeletal malformations (80.6% and 14.2%, respectively). Renal malformations were the second-highest associated extragenital malformations (9.7%, 102/1,055), with unilateral renal agenesis and ectopic kidney being the most common renal malformations (48.0% and 22.5%, respectively). CONCLUSION(S): Type II disease was less common among Chinese patients with MRKH syndrome compared with European patients. Skeletal malformations were more common extragenital malformations than renal malformations in our cohort.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/complicações , Ductos Paramesonéfricos/anormalidades , Transtornos 46, XX do Desenvolvimento Sexual/genética , Adolescente , Adulto , Osso e Ossos/anormalidades , Criança , Anormalidades Congênitas/genética , Feminino , Humanos , Rim/anormalidades , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Medicine (Baltimore) ; 100(12): e25187, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761700

RESUMO

INTRODUCTION: Duplicate kidneys are the most common congenital abnormality of the urinary system. The location of duplicate kidneys varies. We report a case of an adolescent with upper and lower kidneys that are arranged vertically and approximately T-shaped. PATIENT CONCERNS: A 16-year-old male teenager was examined for pain in the left side of the waist. The Computed Tomography scan revealed that the left kidney was incompletely duplicated and fused; the left upper urinary tract was incompletely obstructed. DIAGNOSIS: The abdominal tomography confirmed the diagnosis of incomplete duplicate kidney. INTERVENTIONS: The patient underwent laparoscopic surgery. The failure to ligate the renal pedicle resulted in increased bleeding during the operation and an open ureteral stump. OUTCOMES: No urine leakage occurred after the operation. Doppler ultrasound of the urinary system showed no hydronephrosis, and the patient was asymptomatic. CONCLUSION: Through this case report, we found that the duplicate kidneys could be arranged in a T-shape under laparoscopy. Although only the supply of the duplicate renal arteries can be ligated during surgical resection, the renal pedicle must also be ligated during the operation if there is a lot of bleeding.


Assuntos
Rim/anormalidades , Rim/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Adolescente , Perda Sanguínea Cirúrgica , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Pelve Renal/anormalidades , Pelve Renal/cirurgia , Laparoscopia/efeitos adversos , Dor Lombar/etiologia , Masculino , Nefrectomia/efeitos adversos , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Ureter/anormalidades , Ureter/cirurgia
16.
Taiwan J Obstet Gynecol ; 60(2): 232-237, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33678321

RESUMO

OBJECTIVE: To present the experience on prenatal features of 17q12 microdeletion and microduplication syndromes. MATERIALS AND METHODS: Prenatal chromosomal microarray analysis (CMA) were conducted between January 2015 and December 2018 at a single Chinese tertiary medical centre. Information of cases identified with 17q12 microdeletion or microduplication syndromes were retrospectively collected. Foetal ultrasonographic findings were reviewed, and other information about the gestation week at diagnosis, inheritance and pregnancy outcomes were also included. RESULTS: Ten pregnancies with 17q12 microdeletion and 4 with 17q12 microduplication were identified. The copy number variation (CNV) sizes were 1.39-1.94 Mb in the deleted cases and 1.42-1.48 Mb in the duplicated cases, respectively. All the duplicated and deleted regions included HNF1B and LHX1 genes. Most individuals with 17q12 deletion presented kidney anomalies (9/10), with renal hyperechogenicity being the most common finding (7/10). Fetuses with 17q12 duplication presented a wide phenotypic spectrum, including "double bubble" sign, structural anomalies of the heart and growth anomalies. CONCLUSIONS: Our experience further demonstrated the high correlation between 17q12 microdeletion and renal anomalies especially hyperechogenic kidneys. Structural anomalies of the heart were newly identified phenotypes of 17q12 duplication during prenatal period. Besides, growth anomalies and duodenal atresia might be associated with the duplication.


Assuntos
Deleção Cromossômica , Duplicação Cromossômica , Cromossomos Humanos Par 17/genética , Anormalidades Congênitas/embriologia , Anormalidades Congênitas/genética , Adulto , Anormalidades Congênitas/diagnóstico , Variações do Número de Cópias de DNA , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/embriologia , Fator 1-beta Nuclear de Hepatócito/genética , Humanos , Rim/anormalidades , Rim/embriologia , Proteínas com Homeodomínio LIM/genética , Análise em Microsséries , Fenótipo , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Síndrome , Fatores de Transcrição/genética
17.
Taiwan J Obstet Gynecol ; 60(2): 355-358, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33678342

RESUMO

OBJECTIVE: We reported a fetus that presenting with persistent left superior vena cava (PLSVC), polyhydramnios, and a small gastric bubble during prenatal examination and identified VACTERL association after birth. CASE REPORT: A 34-year-old woman underwent amniocentesis at 18 weeks of gestation because of advanced maternal age and the result was normal. Subsequently, an ultrasound revealed single umbilical artery (SUA) at 21 weeks of gestation. She received a detailed fetal anatomy survey that presented the same findings and PLSVC. A small visible gastric bubble was noted at that time, and the other organs were unremarkable. Polyhydramnios was identified at 30 weeks of gestation and amnioreduction was subsequently performed at 32 weeks of gestation. However, polyhydramnios was persisted despite amnioreduction and intrauterine growth restriction was also detected. A cesarean section was performed because of fetal distress at 36 + 2 weeks, and a 1832-g female baby was delivered. Pre-axial polydactyly at left thumb, SUA and esophageal atresia with distal tracheoesophageal fistula (TEF) were identified after birth. The neonate died at age of 4 days because of surgical complication following esophageal anastomosis. CONCLUSION: Prenatal diagnosis of PLSVC associated with polyhydramnios and a small gastric bubble may indicate esophageal atresia with TEF, and further examination for associated syndromes such as VACTERL association is warranted.


Assuntos
Canal Anal/anormalidades , Esôfago/anormalidades , Cardiopatias Congênitas/diagnóstico , Rim/anormalidades , Deformidades Congênitas dos Membros/diagnóstico , Veia Cava Superior Esquerda Persistente/diagnóstico , Poli-Hidrâmnios/diagnóstico , Diagnóstico Pré-Natal/métodos , Coluna Vertebral/anormalidades , Gastropatias/diagnóstico , Traqueia/anormalidades , Adulto , Canal Anal/embriologia , Esôfago/embriologia , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/genética , Cardiopatias Congênitas/embriologia , Cardiopatias Congênitas/genética , Humanos , Recém-Nascido , Rim/embriologia , Deformidades Congênitas dos Membros/embriologia , Deformidades Congênitas dos Membros/genética , Morte Perinatal/etiologia , Veia Cava Superior Esquerda Persistente/embriologia , Veia Cava Superior Esquerda Persistente/genética , Poli-Hidrâmnios/genética , Gravidez , Coluna Vertebral/embriologia , Gastropatias/congênito , Gastropatias/embriologia , Traqueia/embriologia
20.
Am J Med Genet A ; 185(5): 1379-1387, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33522143

RESUMO

Decades of clinical, pathological, and epidemiological study and the recent application of advanced microarray and gene sequencing technologies have led to an understanding of the causes and pathogenesis of most recognized patterns of malformation. Still, there remain a number of patterns of malformation whose pathogenesis has not been established. Six such patterns of malformation are sirenomelia, VACTERL association, OEIS complex, limb-body wall defect (LBWD), urorectal septum malformation (URSM) sequence, and MURCS association, all of which predominantly affect caudal structures. On the basis of the overlap of the component malformations, the co-occurrence in individual fetuses, and the findings on fetal examination, a common pathogenesis is proposed for these patterns of malformation. The presence of a single artery in the umbilical cord provides a visible clue to the pathogenesis of all cases of sirenomelia and 30%-50% of cases of VACTERL association, OEIS complex, URSM sequence, and LBWD. The single artery is formed by a coalescence of arteries that supply the yolk sac, arises from the descending aorta high in the abdominal cavity, and redirects blood flow from the developing caudal structures of the embryo to the placenta. This phenomenon during embryogenesis is termed vitelline vascular steal.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico , Anormalidades Múltiplas/diagnóstico , Canal Anal/anormalidades , Anormalidades Congênitas/diagnóstico , Ectromelia/diagnóstico , Esôfago/anormalidades , Cardiopatias Congênitas/fisiopatologia , Rim/anormalidades , Deformidades Congênitas dos Membros/fisiopatologia , Ductos Paramesonéfricos/anormalidades , Coluna Vertebral/anormalidades , Traqueia/anormalidades , Transtornos 46, XX do Desenvolvimento Sexual/fisiopatologia , Anormalidades Múltiplas/fisiopatologia , Canal Anal/irrigação sanguínea , Canal Anal/fisiopatologia , Anus Imperfurado/fisiopatologia , Aorta/patologia , Artérias/patologia , Anormalidades Congênitas/fisiopatologia , Ectromelia/fisiopatologia , Embrião de Mamíferos , Esôfago/irrigação sanguínea , Esôfago/fisiopatologia , Extremidades/irrigação sanguínea , Extremidades/embriologia , Extremidades/crescimento & desenvolvimento , Feminino , Feto , Hérnia Umbilical/fisiopatologia , Humanos , Rim/irrigação sanguínea , Rim/fisiopatologia , Ductos Paramesonéfricos/irrigação sanguínea , Ductos Paramesonéfricos/fisiopatologia , Gravidez , Escoliose/fisiopatologia , Coluna Vertebral/irrigação sanguínea , Coluna Vertebral/fisiopatologia , Tronco/irrigação sanguínea , Tronco/fisiopatologia , Traqueia/irrigação sanguínea , Traqueia/fisiopatologia , Cordão Umbilical/irrigação sanguínea , Cordão Umbilical/fisiopatologia , Anormalidades Urogenitais/fisiopatologia
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