Anna Szpinda

New patterns of the growing L3 vertebra and its 3 ossification centers in human fetuses – a CT, digital, and statistical study

BACKGROUND This study describes reference data for L3 vertebra and its 3 ossification centers at varying gestational ages. MATERIAL AND METHODS Using CT, digital-image analysis and statistics, the growth of L3 vertebra and its 3 ossification centers in 55 spontaneously aborted human fetuses aged 17-30 weeks was examined. RESULTS Neither sex nor right-left significant differences were found. The height and transverse and sagittal diameters of the L3 vertebral body increased logarithmically. Its cross-sectional area followed linearly, whereas its volume increased parabolically. The transverse and sagittal diameters of the ossification center of the L3 vertebral body varied logarithmically, but its cross-sectional area and volume grew linearly. The ossification center-to-vertebral body volume ratio gradually declined with age. The neural ossification centers increased logarithmically in length and width, and proportionately in cross-sectional area and volume. CONCLUSIONS With no sex differences, the growth dynamics of the L3 vertebral body follow logarithmically in height, sagittal and transverse diameters, linearly (in cross-sectional area), and parabolically (in volume). The growth dynamics of the 3 ossification centers of the L3 vertebra follow logarithmically in transverse and sagittal diameters, and linearly (in cross-sectional area and volume). The age-specific reference intervals of the L3 vertebra and its 3 ossification centers present the normative values of clinical importance in the diagnosis of congenital spinal defects.

Oxidative Stress Markers in Prostate Cancer Patients after HDR Brachytherapy Combined with External Beam Radiation

Assessment of oxidative stress markers was perfomed in prostate cancer (PCa) patients subjected to high-dose brachytherapy (HDR) with external beam radiotherapy (EBRT). Sixty men with PCa were subjected to combined two-fraction treatment with HDR (tot. 20 Gy) and EBRT (46 Gy). Blood samples were taken before treatment, immediately afterwards, after 1.5–3 months, and approx. 2 years. Control group consisted of 30 healthy men. Erythrocyte glutathione peroxidase activity in the patients was lower than in healthy subjects by 34% (P < 0.001), 50% (P < 0.001), 30% (P < 0.05), and 61% (P < 0.001), respectively, at all periods. No significant differences were found by comparing superoxide dismutase and catalase activity in PCa patients with that of the controls. After 2 years of the end of treatment, the activity of studied enzymes demonstrated a decreasing tendency versus before therapy. Blood plasma thiobarbituric acid reactive substances (TBARS) concentration was higher than in the controls at all periods, while erythrocyte TBARS decreased after 2 years to control levels. The results confirm that in the course of PCa, imbalance of oxidant-antioxidant processes occurs. The therapy did not alter the levels of oxidative stress markers, which may prove its applicability. Two years is too short a period to restore the oxidant-antioxidant balance.

The normal growth of the common iliac arteries in human fetuses - an anatomical, digital and statistical study.

Summary Background The present study was carried out to compile normative data for dimensions of the common iliac arteries at varying gestational ages. Material/Methods We used anatomical dissection, digital-image analysis (system of Leica QWin Pro 16) and statistical analysis (Student T test, one-way ANOVA, post-hoc RIR Tukey test, and regression analysis) to examine the increase in length (mm), proximal external diameter (mm), and volume (mm3) of the common iliac arteries in 124 (60 males, 64 females) spontaneously aborted human fetuses aged 15–34 weeks. Results Neither sex nor right-left significant differences were found (P>0.05). The length ranged from 4.76±1.05 to 15.38±1.60 mm on the right, and from 4.92±1.33 to 14.91±1.25 mm on the left, according to the linear functions y=−3.598+0.585×Age ±1.522 (R2=0.83) and y=−3.107+0.554×Age ±1.444 (R2=0.83). The proximal external diameter increased from 0.66±0.19 to 2.30±0.42 mm on the right, and from 0.66±0.14 to 2.16±0.42 mm on the left, according to the quadratic models y=1.392−0.110×Age+0.004×Age2 ±0.285 (R2=0.77) and y=1.283−0.099×Age+0.004×Age2 ±0.238 (R2=0.81). The volumes were increasing from 1.93±1.74 to 66.95±29.31 mm3 on the right, and from 1.91±1.65 to 56.86±25.17 mm3 on the left, given by the quadratic functions: y=99.69−10.60×Age+0.287×Age2 ±14.40 (R2=0.67) and y=82.62−8.86×Age+0.242×Age2 ±11.60 (R2=0.71). Conclusions The common iliac arteries grow linearly in length, and parabolically in both diameter and volume. The right common iliac artery constitutes a predominant vessel in relation to its length, external diameter and volume. The morphometric data on the common iliac arteries may serve as a useful reference in the prenatal diagnosis and monitoring of congenital aorto-iliac abnormalities.

New quantitative patterns of the growing trachea in human fetuses

Summary Background Rapid progress in perinatal medicine has resulted in numerous tracheo-bronchial interventions on fetal and neonatal airways. The present study was performed to compile normative data for tracheal dimensions at varying gestational ages. Material/Methods Using anatomical dissection, digital image analysis (NIS-Elements BR 3.0) and statistical analysis (Wilcoxon signed-rank test, Student’s t test, one-way ANOVA, post-hoc Bonferroni test, linear and nonlinear regression analysis) a range of the 4 variables (length in mm, middle external transverse diameter in mm, proximal internal cross-sectional area in mm2, internal volume in mm3) for the trachea in 73 spontaneously aborted human fetuses (39 male, 34 female) aged 14–25 weeks was examined. Results No significant male-female differences were found (P>0.05). The length ranged from 10.37±2.15 to 26.54±0.26 mm as y=−65.098 + 28.796 × ln (Age) ±1.794 (R2=0.82). The middle external transverse diameter varied from 2.53±0.09 to 5.09±0.42 mm with the model y=−11.020 + 5.049 × ln (Age) ±0.330 (R2=0.81). The trachea indicated a proportional evolution because the middle external transverse diameter-to-length ratio was stable (0.23±0.03). The proximal internal cross-sectional area rose from 1.46±0.04 to 5.76±1.04 mm2 as y=−3.562 + 0.352 × Age ±0.519 (R2=0.76). The internal volumetric growth from 11.89±2.49 to 119.63±4.95 mm3 generated the function y=−135.248 + 9.919 × Age ±10.478 (R2=0.86). Conclusions The growth in both length and middle external transverse diameter of the trachea follows logarithmic functions, whereas growth of both its proximal internal cross-sectional area and internal volume follow linear functions. The length and middle external transverse diameter of the trachea develop proportionally to each other. The tracheal dimensions may be helpful in the prenatal diagnosis and monitoring of tracheal malformations and obstructive anomalies of the upper respiratory tract.

Tracheo-bronchial angles in the human fetus – an anatomical, digital, and statistical study

Background Both the advancement of visual techniques and intensive progress in perinatal medicine result in performing airway management in the fetus and neonate affected by life-threatening malformations. This study aimed to examine the 3 tracheo-bronchial angles, including the right and left bronchial angles, and the interbronchial angle, in the fetus at various gestational ages. Material/Methods Using methods of anatomical dissection, digital image analysis with an adequate program (NIS-Elements BR 3.0, Nikon), and statistics, values of the two bronchial angles and their sum as the interbronchial angle were semi-automatically measured in 73 human fetuses at the age of 14–25 weeks, derived from spontaneous abortions and stillbirths. Results No male-female differences between the parameters studied were found. The 3 fetal tracheo-bronchial angles were found to be independent of age. The right bronchial angle ranged from 11.4° to 41.8°, and averaged 26.9±7.0° for the whole analyzed sample. The values of left bronchial angle varied from 24.8° to 64.8°, with the overall mean of 46.2±8.0°. As a consequence, the interbronchial angle totalled 36.2–96.6°, and averaged 73.1±12.7°. Conclusions The tracheo-bronchial angles change independently of sex and fetal age. The left bronchial angle is wider than the right one. Values of the 3 tracheo-bronchial angles are unpredictable since their regression curves of best fit with relation to fetal age cannot be modelled. Both of the 2 bronchial angles and the interbronchial angle are of great relevance in the location of inhaled foreign bodies, and in the diagnosis cardiac diseases and mediastinal abnormalities.

The normal growth of the tracheal wall in human foetuses.

Introduction Tracheal wall thickness is a substantial indicator in various pathological changes. The present study was performed to compile normative data and formulae for the tracheal wall thickness and volume at varying gestational age. Material and methods Using anatomical dissection, digital image analysis and statistics a range of the wall thickness, proximal internal-to-external cross-sectional area ratio, and wall volume for the trachea in 73 spontaneously aborted human fetuses aged 14-25 weeks was examined. Results No significant male-female differences were found. The values of tracheal wall thickness ranged from 0.36 ±0.01 mm for the 14-week group to 1.23 ±0.17 mm for the 25-week group of gestation, according to the linear function y = –0.823 + 0.083 × age ± 0.087. The tracheal lumen rate, expressed as the proximal internal-to-external cross-sectional area ratio, decreased from 42.61 ±1.11% to 26.78 ±4.95%, according to the function y = 62.239 – 1.487 × age ±3.119. The tracheal wall volume rose from 16.28 ±4.18 mm3 in fetuses aged 14 weeks to 269.22 ±29.26 mm3 in fetuses aged 25 weeks, according to the quintic function y = 0.000052 × age4.894. Conclusions The tracheal wall parameters show no sexual dimorphism. The tracheal wall grows linearly in its length, and according to a quintic function in its volume. A relative decrease in the tracheal lumen at the expense of an increase in both the wall thickness and wall volume of the trachea is found during gestation.

Cross-sectional study of C1-S5 vertebral bodies in human fetuses.

Introduction Knowledge on the normative spinal growth is relevant in the prenatal detection of its abnormalities. The present study determines the height, transverse and sagittal diameters, cross sectional area, and volume of individual C1–S5 vertebral bodies. Material and methods Using the methods of computed tomography (CT), digital image analysis, and statistics, the size of C1–S5 vertebral bodies in 55 spontaneously aborted human fetuses aged 17–30 weeks was examined. Results All the 5 examined parameters changed significantly with gestational age (p < 0.01). The mean height of vertebral bodies revealed an increase from the atlas (2.39 ±0.54 mm) to L2 (4.62 ±0.97 mm), stabilized through L3–L4 (4.58 ±0.92 mm, 4.61 ±0.84 mm), and then was decreasing to S5 (0.43 ±1.06 mm). The mean transverse diameter of vertebral bodies was increasing from the atlas (1.20 ±1.96 mm) to L1 (6.24 ±1.46 mm), so as to stabilize through L2–L3 (6.12 ±1.65, 6.12 ±1.61 mm), and finally was decreasing to S5 (0.26 ±0.96 mm). There was an increase in sagittal diameter of vertebral bodies from the atlas (0.82 ±1.34 mm) to T7 (4.76 ±0.85 mm), its stabilization for T8–L4 (4.73 ±0.86 mm, 4.71 ±1.02 mm), and then a decrease in values to S5 (0.21 ±0.75 mm) was observed. The values for cross-sectional area of vertebral bodies were increasing from the atlas (2.95 ±5.25 mm2) to L3 (24.92 ±11.07 mm2), and then started decreasing to S5 (0.48 ±2.09 mm2). The volumetric growth of vertebral bodies was increasing from the atlas (8.60 ±16.40 mm3) to L3 (122.16 ±74.73 mm3), and then was decreasing to S5 (1.60 ±7.00 mm3). Conclusions There is a sharp increase in size of fetal vertebral bodies between the atlas and the axis, and a sharp decrease in size within the sacral spine. In human fetuses the vertebral body growth is characterized by maximum values in sagittal diameter for T7, in transverse diameter for L1, in height for L2, and in both cross-sectional area and volume for L3.

Quantitative anatomy of the growing abdominal aorta in human fetuses: An anatomical, digital and statistical study

Summary Background Advances in perinatal medicine have required an extensive knowledge of fetal aorto-iliac measurements. The present study was performed to compile reference data for dimensions of the abdominal aorta at varying gestational ages. Material/Methods Using the methods of anatomical dissection, digital-image analysis (Leica QWin Pro 16 system), and statistical analysis (Student’s t-test, one-way ANOVA, post-hoc RIR Tukey test, regression analysis, and Wilcoxon signed-rank test), the growth of length (mm), proximal and distal external diameters (mm), and volume (mm3) of the abdominal aorta in 124 (60 male, 64 female) spontaneously aborted human fetuses aged 15–34 weeks was examined. Results No significant male-female differences were found. The length ranged from 9.35±1.24 to 36.29±4.98 mm, according to the linear function y=−14.596+1.519 × Age ±2.639 (R2=0.92; p<0.0001). The proximal external diameter varied from 1.18±0.25 to 5.19±0.49 mm, according to the linear pattern y=−2.065+0.212 × Age ±0.348 (R2=0.92; p<0.0001). The distal external diameter increased from 1.03±0.23 to 4.92±0.46 mm, in accordance with the linear model y=−2.097+0.203 × Age ±0.351 (R2=0.92; p<0.0001). Both length and proximal external diameter of the abdominal aorta indicated a proportionate evolution, because the length-to-proximal external diameter ratio was stable, following the linear function y=7.724–0.017 × Age ±0.925. The abdominal aorta volume ranged from 9.6±4.5 to 740.5±201.8 mm3, given by the quadratic function y=911–101 × Age +2.838 × Age2 ±78 (R2=0.89; p<0.0001). Conclusions There are no significant differences between males and females for morphometric parameters of the abdominal aorta. The abdominal aorta grows linearly in both length and diameters, and parabolically in volume. These detailed morphometric data of the abdominal aorta provide a database for intra-uterine echographic examinations in the early diagnosis, monitoring and management of aorto-iliac malformations.

The normal growth of cross-sectional areas of the aorto-iliac segment in human fetuses – an anatomical, digital, and statistical study

Background The intraluminal size of the aorto-iliac segment is relevant in both the clinical and echographic settings. The aim of this study was to compile both the absolute and relative age-specific reference intervals for cross-sectional areas (CSAs) of the aorto-iliac segment. Material/Methods Using the methods of anatomical dissection, digital-image analysis (Leica QWin Pro 16) and statistical analysis (Student’s t test, one-way ANOVA, post-hoc RIR Tukey test, linear regression), the growth in CSA (in mm2) of the abdominal aorta, the common, external, and internal iliac arteries in 124 (60 males, 64 females) spontaneously aborted human fetuses aged 15–34 weeks was examined. Results No significant sex differences were found. In the age range of 4–9 months, the distal CSA of the abdominal aorta ranged from 0.87±0.34 to 19.18±3.36 mm2. The CSA of the common iliac artery varied from 0.37±0.22 to 4.30±1.54 mm2 on the right, and from 0.36±0.16 to 3.80±1.44 mm2 on the left. The sum of the CSAs of the right and left common iliac arteries grew proportionately to the distal CSA of the abdominal aorta; the latter being significantly larger than the former. On both sides, however, the CSA of the internal iliac artery was approximately twice that of the external iliac artery. Between the ages of 4 and 9 months, the CSA of the external iliac artery ranged from 0.10±0.06 to 1.32±0.52 mm2 on the right, and from 0.08±0.03 to 1.19±0.42 mm2 on the left. The CSA of the internal iliac artery increased from 0.23±0.14 to 2.59±1.22 mm2 on the right, and from 0.21±0.14 to 2.27±1.11 mm2 on the left. Bilaterally, the sum of the CSAs of the internal and external iliac arteries was significantly smaller than the CSA of the common iliac artery. The relative CSA of each artery decreased until the age of 6 months, after which their values were gradually increasing until the age of 9 months. Conclusions The aorto-iliac segment does not reveal sex differences in its cross-sectional area. The cross-sectional area of the internal iliac artery is approximately twice the size of the external iliac artery. The aorto-iliac segment observed proximally to distally reduces its cross-sectional area, thereby resulting in an increase in blood velocity.

Volumetric Growth of the Liver in the Human Fetus: An Anatomical, Hydrostatic, and Statistical Study.

Using anatomical, hydrostatic, and statistical methods, liver volumes were assessed in 69 human fetuses of both sexes aged 18–30 weeks. No sex differences were found. The median of liver volume achieved by hydrostatic measurements increased from 6.57 cm3 at 18–21 weeks through 14.36 cm3 at 22–25 weeks to 20.77 cm3 at 26–30 weeks, according to the following regression: y = −26.95 + 1.74 × age ± Z  × (−3.15 + 0.27 × age). The median of liver volume calculated indirectly according to the formula liver volume = 0.55 × liver length × liver transverse diameter × liver sagittal diameter increased from 12.41 cm3 at 18–21 weeks through 28.21 cm3 at 22–25 weeks to 49.69 cm3 at 26–30 weeks. There was a strong relationship (r = 0.91, p < 0.001) between the liver volumes achieved by hydrostatic (x) and indirect (y) methods, expressed by y = −0.05 + 2.16x  ± 7.26. The liver volume should be calculated as follows liver volume = 0.26 × liver length × liver transverse diameter × liver sagittal diameter. The age-specific liver volumes are of great relevance in the evaluation of the normal hepatic growth and the early diagnosis of fetal micro- and macrosomias.