RESUMO
OBJECTIVES: To report the feasibility of early fetal cystoscopy for the prenatal diagnosis and therapy of severe first-trimester megacystis. METHODS: Between January 2008 and February 2010, early fetal cystoscopy at 16 weeks of gestation was offered to 15 patients whose fetuses presented with severe first-trimester megacystis. All infants were followed up for 6-12 months after birth. Autopsy was always performed whenever fetal or neonatal deaths occurred. RESULTS: Seven patients decided to undergo fetal therapy, and eight elected to continue with expectant observation. One fetus died before early fetal cystoscopy was performed. Therefore, six fetuses underwent early fetal cystoscopy. Urethral atresia was diagnosed in three fetuses during fetal cystoscopy and confirmed at autopsy following termination of pregnancy at 19-20 weeks in all cases. Posterior urethral valves were diagnosed and successfully fulgurated by laser during early cystoscopy in three fetuses, two of which survived with normal renal and bladder function after birth; the remaining fetus had a postnatal diagnosis of megacystis-microcolon intestinal hypoperistalsis syndrome and died neonatally. In the expectantly managed group, no survivals were observed, even among cases with 'isolated' posterior urethral valves. CONCLUSIONS: Percutaneous early fetal cystoscopy is feasible for prenatal diagnosis and therapy of severe megacystis.
Assuntos
Cistoscopia/métodos , Ultrassonografia Pré-Natal/métodos , Bexiga Urinária/cirurgia , Duodeno/anormalidades , Duodeno/diagnóstico por imagem , Duodeno/embriologia , Duodeno/cirurgia , Estudos de Viabilidade , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/cirurgia , Humanos , Lactente , Recém-Nascido , Terapia a Laser/métodos , Masculino , Gravidez , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Diagnóstico Pré-Natal , Estudos Prospectivos , Uretra/anormalidades , Uretra/diagnóstico por imagem , Uretra/cirurgia , Bexiga Urinária/anormalidades , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/embriologiaRESUMO
To date, intrinsic obstructions of the duodenum have been explained by the "solid core" theory, described by Tandler in 1902 (Morphol Jahrb 29:187-216, 1902). This study aimed to evaluate the epithelial occlusion of rat duodenum during embryonic development, through optical microscopy and computerized three-dimensional reconstruction. The Wistar rat embryos used in this study had 13, 14, 15, and 16 days of gestation. This corresponds to human embryos with 33, 40, 44, and 52 days of development, which is between the fifth and eighth week. The study included 12 embryos studied by optical microscopy, and four by three-dimensional reconstruction (those with 13, 14, 15, and 16 days). Through optical microscopy, an intense epithelial proliferation was observed in the gestation embryo of 13 days, with no occlusion of the opening of the duodenum. In the embryos with 14, 15, and 16 days of gestation, an increase in diameter of the duodenum was observed along with intestinal development. Through three-dimensional reconstruction, it was observed that the opening of the digestive tube of rat embryos with 13-16 days of gestation is never obstructed by epithelial proliferation, although it may follow a sinuous path. This study concludes that the "solid core" phase described by Tandler does not occur in the embryonic development of rat duodenum.
Assuntos
Duodeno/embriologia , Imageamento Tridimensional/métodos , Animais , Modelos Animais de Doenças , Duodeno/citologia , Feminino , Seguimentos , Masculino , Gravidez , Ratos , Ratos WistarRESUMO
El presente estudio informa el caso de una paciente de 30 años, en la que se le diagnóstico malrotación intestinal, que se atendió en un diseño en el Hospital de tercer nivel de atención, se trata de una mujer de 30 años; con un cuadro clínico de ocho años de evolución con dolor epigástrico, acompañado con vómito gastrobiliar, postprandial mediato aparición esporádica. Tres meses antes de su ingreso, dolor diario de mismas características y pérdida de peso de 11 kilogramos. A la exploración: paciente ectomórfica. Estudio de laboratorio normales. Estudio baritado de tubo digestivo con dilatación de duodeno, paso de medio de contraste adecuado pero retardado. Pandedoscopia: dilatación de las primeras dos porciones. Peritoneoscopia: dilatación del duodeno por banda adherencial. Una semana posterior a su ingreso se realizó laparotomía media supraumbilical con diagnóstico de probable de pinza mesentérica. Se encontró dilatación duodenal completa, con banda adherencial en la cuarta porción, intestino grueso en su totalidad en el lado izquierdo y libre. Se realizó procedimiento de Ladd. Postoperatorio adecuado, sin complicaciones y alta estando asintomática. Se concluye que la malrotación intestinal en el adulto es rara, se presenta como cuadro de pseudobstrucción intestinal. El procedimiento quirúrgico de Ladd es el indicado
Assuntos
Humanos , Feminino , Adulto , Dilatação Patológica , Duodenopatias/cirurgia , Duodeno/anormalidades , Duodeno/embriologia , Intestinos/embriologia , Obstrução Duodenal/etiologia , RotaçãoRESUMO
Intestinal closure is the blocking of biopolymers transferred across the small intestine epithelium that coincides with gut maturation. Sixty-one fetuses of D. albiventris, 45 to 55 mm in Crown-Rump length, were studied. Forty-one fetuses were injected subcutaneously with hydrocortisone hemisuccinate (0.4 mg/15.0 g of body weight) daily for 7 days in order to produce intestinal closure (TA). The control group (CA), consisted of twenty fetuses. Seven days after injection several fragments from the duodenum and ileum were prepared for transmission electron microscopic examination. Microvillus lengths and widths were determined from micrographs (final magnification: 100,000 x). The volume of the microvillus was calculated as the volume of the cylinder. Quantitative differences of the microvilli between the treated and control groups taken from duodenum and ileum material were noted. The distribution of the microvilli in the apical part of the enterocytes was more irregular in controls than in the TA group. Quantitatively, microvillus length in the duodenum was more than 50 per cent greater in TA than in CA and more than 30 per cent greater in TA than in CA in the ileum. Consequently, microvilli volume in the duodenum in TA was about 65 per cent greater than in CA and about 33 per cent greater than in CA in the ileum. Microvilli width presented little change and no statistically significant differences were found between TA and CA in either the duodenum or the ileum. These changes in the microvilli of the treated animals most probably indicate improvement in the absorptive function of the epithelium.