Intrauterine growth restriction and fetal body composition

Objective: To assess the differences in fetal body compartments between fetuses with normal growth and those with reduced intrauterine growth, during the third trimester, through ultrasonographic determination of subcutaneous tissue thickness (SCTT). Methods: Twenty-eight patients were enrolled into this case control study carried out at 30-31 weeks' gestation. Two study groups were matched for maternal age and pregestational body mass index: controls (n = 14) and intrauterine growth-restricted (IUGR) fetuses (n = 14). Routine ultrasound-derived biometric parameters (head circumference, abdominal circumference, femur length and humerus length) were measured. Additionally, the mid-arm fat mass and lean mass (MAFM and MALM), the mid-thigh fat mass and lean mass (MTFM and MTLM), the abdominal fat mass (AFM) and the subscapular fat mass (SSFM) were measured. The Mann-Whitney U-test and Student's t-test were used to compare the two groups. Results: The abdominal circumference and the humerus were significantly smaller in IUGR fetuses than in controls. Most of the SCTT values were different in the two groups. The SSFM (3.6 ± 1.1 vs. 2.6 ± 0.7 mm; P = 0.011), the AFM (5.1 ± 0.7 vs. 4 ± 1 mm; P = 0.01), the MAFM (3.5 ± 0.9 vs. 2.2 ± 0.8 cm2; P < 0.01) and MALM (2.1 ± 0.4 vs. 1.7 ± 0.5 cm2; P = 0.029) were all significantly greater in fetuses with normal development compared to those with growth restriction. Conclusions: During the third trimester, SCTT (with the exception of MTFM and MTLM) is reduced in fetuses with IUGR. Furthermore, MALM is lower in growth-restricted fetuses, confirming that the parameters measured in this study are affected in IUGR fetuses. Our findings indicate that specific changes in fetal body compartments occur as a result of chronic metabolic impairment. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd

A conformação dos ecomuseus: elementos para compreensão e análise

Apresenta uma história dos ecomuseus enraizado nos movimentos de folclore e etnografia regional, do final do século XIX até os dias de hoje, examinando o caso francês. Explora aspectos em geral menos enfatizados neste campo, tal como a natureza e o papel atribuído aos acervos e ao patrimônio cultural e padrões museográticos

et al - Primo accesso in chirurgia laparoscopica Primo accesso in chirurgia laParoscoPica

The peritoneal access remains the gravest concern for the laparoscopic surgeon and continues to be a leading cause of complication during laparoscopic surgery. Choosing the best method of peritoneal access depends on the patient’s phenotype and clinical history. Since no single methods is completely adaptable for all patients, the surgeon must be knowledgeable about alternative methods and be able to execute them technically. The aim of the manuscript is to provide clinical direction on laparoscopic entry techniques and technologies and their associated complications. The laparoscopic surgeon must be mindful that most life-threatening surgical accidents to the bowel as well as to retroperitoneal vessels occur during insertion of the Veress needle and primary cannula. We analize the different laparoscopic entry techniques and technologies including the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars, and visual entry systems. Key words

et al - Primo accesso in chirurgia laparoscopica Primo accesso in chirurgia laParoscoPica

The peritoneal access remains the gravest concern for the laparoscopic surgeon and continues to be a leading cause of complication during laparoscopic surgery. Choosing the best method of peritoneal access depends on the patient’s phenotype and clinical history. Since no single methods is completely adaptable for all patients, the surgeon must be knowledgeable about alternative methods and be able to execute them technically. The aim of the manuscript is to provide clinical direction on laparoscopic entry techniques and technologies and their associated complications. The laparoscopic surgeon must be mindful that most life-threatening surgical accidents to the bowel as well as to retroperitoneal vessels occur during insertion of the Veress needle and primary cannula. We analize the different laparoscopic entry techniques and technologies including the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars, and visual entry systems. Key words

Umbilical cord segmental hemorrhage and fetal distress

We describe an unexplained case of umbilical cord segmental hemorrhage linked with meconium-stained amniotic fluid. A severely asphyxiated infant was delivered at term by Caesarean section. There were poor prognostic signs on fetal cardiotocography with rupture of membranes with meconium-stained amniotic fluid. The pathophysiologic mechanism in this case is still unknown, even if we argued a possible role of the umbilical cord shortness

Ultrasound detection of the "sliding viscera" sign promotes safer laparoscopy.

To estimate the feasibility of preoperative ultrasound evaluation of the umbilical region in patients undergoing laparoscopy with a previous history of abdominal surgery.Prospective study (Canadian Task Force Classification II-1).Department of Obstetrics and Gynecology Fatebenefratelli Isola Tiberina Hospital.Twenty-five women with a previous history of open abdominal surgery (group A) and a group of 22 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the umbilical field.Ultrasound Slide-By test.Patients were asked to take a deep inspiratory breath, which accentuated respiratory excursion. The movement of the intraabdominal contents in a vertical fashion in relation to the abdominal wall, referred to as the "viscera slide," between the bowel and peritoneum was evaluated. Abdominal wall tissue thickness, Uracus to peritoneum thickness (UTP, mm) were also evaluated. Non parametric Mann-Whitney testing was used. No major demographic differences between the 2 study groups was noted. The abdominal wall tissue thickness was not significantly different between the 2 groups. The UTP was shorter in A group than in B group (1.5 +/- 0.3 mm vs 3.5 +/- 0.9 mm, p = .002). Absence of the "sliding viscera" sign was observed in 16 patients in group A and in 1 patient in group B. Patients with an absence of the sliding viscera sign were found to have subumbilical fibrous adhesions during laparoscopy.Evaluation of trocar insertion sites may be difficult and remains a challenge for peritoneal endosurgical access. We have shown that absence of the "sliding viscera" sign is more likely to be linked to subumbilical adhesions and represents a quick method for preoperative assessment. The UTP may also be a useful measurement, which requires further validation

Umbilical cord segmental hemorrhage and fetal distress

We describe an unexplained case of umbilical cord segmental hemorrhage linked with meconium-stained amniotic fluid. A severely asphyxiated infant was delivered at term by Caesarean section. There were poor prognostic signs on fetal cardiotocography with rupture of membranes with meconium-stained amniotic fluid. The pathophysiologic mechanism in this case is still unknown, even if we argued a possible role of the umbilical cord shortness