Akihiko Kikuchi

Neurodevelopmental outcomes of very low birth weight and extremely low birth weight infants at 18 months of corrected age associated with prenatal risk factors.

BACKGROUNDnVery premature infants occasionally have neurodevelopmental disabilities. However, there have been quite limited data on prenatal risk factors associated with their neurodevelopmental outcomes.nnnAIMnTo clarify the relationship between prenatal risk factors and neurodevelopmental outcomes of very premature infants.nnnSTUDY DESIGNnThe study design is a retrospective review.nnnSUBJECTSnOne hundred seventy Japanese women with a singleton pregnancy and their infants whose birth weight being less than 1500 g were included. We classified those infants into 118 appropriate for gestational age (AGA) and 52 small for gestational age (SGA) infants.nnnOUTCOME MEASURESnInfants neurodevelopmental outcomes at 18 months of corrected age were evaluated by the Kyoto Scale of Psychological Development 2001 (KSPD). We analyzed and compared the infants outcomes and prenatal risk factors between two groups.nnnRESULTSnMortality and rate of infants unevaluable by KSPD because of severe impairment were not significantly different between those groups. However, the developmental quotient score of the cognitive-adaptive area in SGA infants born between 25 and 31 weeks of gestation was significantly lower than that in AGA infants randomly selected as gestation-matched controls. More advanced gestational age and heavier birth weight protected against adverse neurodevelopmental outcomes in both groups. Moreover, male infants were related to the excess risk of adverse neurodevelopmental outcomes in the SGA group.nnnCONCLUSIONnIn view of the neurodevelopment of the infants, it seems that the most efficient obstetric strategy for improving prognosis of premature infants should be targeted to prolong the pregnancy period as long as the reassuring fetal status and maternal stable health condition are being confirmed.

Comparison of biochemical markers and cervical length for predicting preterm delivery

Aim:u2002 To examine the clinical utility of several prognostic factors for predicting preterm delivery.

Detrended Fluctuation Analysis of Heart Rate Variability in Normal and Growth-Restricted Fetuses

Background: Detrended fluctuation analysis (DFA) has recently been validated as an excellent method by which to analyze heart rate variability and distinguish healthy subjects from patients with various types of the cardiac nervous system dysfunction. Methods: One hundred and nineteen fetal heart rate (FHR) recordings obtained from healthy normal fetuses and 68 recordings obtained from small-for-gestational-age (SGA) fetuses were analyzed by DFA to examine gestational and pathologic changes of the scaling exponent, α. Results: In normal fetuses, a significant increase was observed in both the short-term (≤30 s) α1 and long-term (>30 s) α2 scaling exponents according to gestational age. The α1 values of SGA fetuses were not significantly different from those of healthy normal fetuses; however, the α2 values of the former group (0.955 ± 0.152) were significantly higher than those of normal subjects (0.887 ± 0.128; p = 0.001). Conclusion: The α2 exponent appears to be a sensitive probe for detecting subtle, and possibly important, changes that occur in fetuses with intrauterine growth restriction, and may be helpful in the early and noninvasive detection of placental insufficiency or incipient intrauterine growth restriction. The use of DFA techniques offers great promise for understanding FHR behavior.

Prenatal ultrasound and magnetic resonance imaging depiction of a small sublingual ranula.

Prenatal diagnosis of a congenital ranula has rarely been reported. We describe the case of a small ranula depicted on prenatal sonogram and magnetic resonance imaging, in which we could confirm the intact airway. Although the size of the ranula noted in our fetus was the smallest among the cases reported in the English literature, both of these imaging modalities clearly presented typical diagnostic features present on both ultrasound and magnetic resonance imaging.

Fractal Analysis of Surface Growth Patterns in Endometrioid Endometrial Adenocarcinoma

Objective: A fractal is a shape made of parts similar to the whole in some way. The objective of this study was to determine whether surface growth patterns in endometrioid endometrial adenocarcinoma are fractal, and the mean fractal dimension differs according to histologic grades and depth of myometrial invasion. Methods: After the images of photographs of 120 resected uteri with endometrial cancers were digitized, the fractal dimensions of surface of tumors were measured using a fractal analysis software. Results: The mean fractal dimensions of surface growth patterns in G1, G2, and G3 adenocarcinoma were 2.318, 2.303, and 2.383, respectively. These values were significantly greater than the topological dimension of a surface (= 2). The value was significantly higher in G3 than in G2 (p = 0.03). And although not statistically significant, the value of G3 was greater than G1 (p = 0.10) and than (G1 and G2) group (p = 0.06). No significant difference nor tendency was found in the fractal dimension of the surface of the tumor according to depth of invasion. Conclusion: This study shows that the surface of endometrioid endometrial adenocarcinoma has a fractal structure, and the mean fractal dimension may differ according to histologic grades. Our report proposes a new way of looking at endometrial cancer pathology. We believe that fractal geometry gives insights into tumor morphology and becomes a useful tool for analyzing complex and irregular tumor growth patterns mathematically.

A case of pyruvate dehydrogenase E1α subunit deficiency with antenatal brain dysgenesis demonstrated by prenatal sonography and magnetic resonance imaging

Prenatal depiction of brain dysgenesis in patients with pyruvate dehydrogenase complex (PDHc) deficiencies has been infrequently reported. As PDHc plays a critical role in the brain that obtains all of the energy from the aerobic oxidation of glucose, its deficiency is a severe inborn disorder of metabolism, which predominantly affects the nervous system. This report describes a case of PDHc deficiency with antenatal brain dysgenesis depicted in detail by fetal ultrasound and magnetic resonance imaging. This is the first case report clearly demonstrating the developing mechanism and time course of antenatal brain lesions in a patient with PDHc deficiency.

Multifractal Description of the Maternal Surface of the Placenta

Background: Recently, multifractal analysis based on generalized concepts of fractals has been applied to biological tissues composed of complex structures. Methods: Using digitized images of the maternal surface of 278 placentas, multifractal parameters were measured with a fractal analysis software. Results: The values of αmin, α(0), αmax and the degree of multifractality given by the αmax – αmin difference calculated from 278 placentas were 1.840 ± 0.068, 2.089 ± 0.034, 2.856 ± 0.128 and 1.017 ± 0.136, respectively. A significant decrease of αmin and as a consequence a significant increase in the degree of multifractality were observed according to gestational age. The α(0) value of the placenta complicated by pregnancy-induced hypertension (PIH) was significantly higher than that without PIH. The αmin and α(0) values of the placenta having intrauterine growth restriction (IUGR) were significantly higher than those without IUGR. On the other hand, the presence of chorioamnionitis did not change multifractal properties of the maternal surface of the placenta. Conclusion: The multifractal parameters may be objective indices of the heterogeneity or complexity of the macroscopic morphology of the maternal surface of the placenta. Multifractal analysis holds a promise for quantitatively evaluating physiological and pathological development of the placenta.

Clinical features of polyhydramnios associated with fetal anomalies

ABSTRACTu2003 The purpose of this study was to examine the clinical features of pregnancy complicated by polyhydramnios associated with fetal anomalies. Sixty‐nine patients with a singleton pregnancy complicated by polyhydramnios were retrospectively analyzed. Based on prenatal ultrasonographic findings, 13u2003cases were considered to have idiopathic polyhydramnios and the remaining 56u2003cases were associated with fetal anomalies. Between these two groups, no significant difference was found in the gestational weeks when polyhydramnios developed. However, significant difference was noted in the maximum amniotic fluid index (AFI) values during the pregnancy period; 25.4u2003±u20032.7u2003cm in the former, and 30.6u2003±u20038.9u2003cm in the latter (Pu2003=u20030.0004). In all of 13 cases with idiopathic polyhydramnios, AFI values remained less than 30u2003cm until delivery. Twenty‐two patients (39%) with fetal anomalies required a prenatal treatment such as amnioreduction and tocolysis, whereas only one patient (7.7%) with idiopathic polyhydramnios needed tocolysis therapy (Pu2003=u20030.03). There was a significant risk of premature delivery with fetal anomalies (35.6u2003±u20033.9u2003weeks’ gestation vs. 38.8u2003±u20031.5u2003weeks’ gestation, Pu2003=u20030.004) because of refractory polyhydramnios, rupture of membranes, non‐reassuring fetal status, and intrauterine fetal death, and although most infants with idiopathic polyhydramnios were appropriate‐for‐dates, many of the infants with congenital anomalies were small‐for‐dates. Significant risk of fetal anomalies should be considered in pregnant women with severe polyhydramnios (AFIu2003≥u200330u2003cm), an increased trend of amniotic fluid during the pregnancy period, polyhydramnios requiring a prenatal treatment, or fetal growth restriction. On the other hand, based on our experience, a fetus without these conditions seems to have a low risk of congenital anomalies even if polyhydramnios is noted.

Prenatal diagnosis and management of congenital chloride diarrhea: A case report of 2 siblings.

Congenital chloride diarrhea (CLD) is a rare hereditary disease. The basic defect of CLD is massive loss of Cl− and fluid into the ileum and colon. Prenatal diagnosis of this disease is quite important because the infant requires electrolyte supplementation from the early postnatal period. Two cases in which prenatal diagnoses of CLD were made in siblings are reported. Extreme electrolyte imbalance may cause fetal cardiac dysfunction or a poor general condition leading to a non‐reassuring fetal status in cases with CLD. Therefore, frequent fetal monitoring using cardiotocograms and ultrasound may be beneficial to some fetuses with CLD to detect fetal deterioration. In addition, repeated amnioreduction may be required to treat severe polyhydramnios and threatened preterm delivery.

Case of chronic ectopic pregnancy diagnosed in which the complete shape of the fetus was visible by ultrasonography

Preoperative diagnosis of chronic ectopic pregnancy is often difficult because of the high incidence of negative results on pregnancy tests as a consequence of the very small amount of live villi, subtle symptoms, and the poor specificity of ultrasonographic patterns. A 45‐year‐old woman was referred to our department for evaluation of a mass 8 cm in diameter with solid parts in the right adnexal area. Transvaginal ultrasonography showed a mass consisting of a cystic part with an irregular thick capsule distinct from the right ovary. In the center of the cystic part, a fetus‐like image, 20u2003mm in length was seen. Preoperative diagnosis was confirmed by the laparoscopy, which revealed a swollen right tube containing a fetus with highly necrotic changes. This case was unique because chronic ectopic pregnancy was detected at an early stage before absorption of the conceptus occurred, which coincidentally is an appropriate time for morphological diagnosis.