[Tracheal agenesis, a rare cause of respiratory insufficiency in newborn infants]

Tracheal agenesis is a rare congenital anomaly which presents immediately after birth an absolute respiratory insufficency. This report describes a new-born infant with a tracheal agenesis Typ II which was combined with an esophageal atresia and distal esophagotracheal fistula. In addition, costal synostosis was found. These malformations can be added to the VATER-association. Resuscitation of our patient (orotracheal and esophageal intubation, emergency coniotomy) was unsuccessful. However, in most cases of tracheal agenesis with esophagotracheal communication primary resuscitation is possible by esophageal intubation and by application of continuous positive pressure ventilation. Diagnosis must be confirmed by immediate contrast roentgenography or endoscopy. The results of surgery are disappointing until now.

Fraser syndrome (cryptophthalmos with syndactyly) in the fetus and newborn

Clinical and autopsy findings in two fetuses and one newborn infant with Fraser syndrome are presented. Discussion focuses on the range of phenotypic expression within this autosomal-recessive disorder, the resulting difficulties in prenatal and postnatal diagnosis, and on the concept of a neurocristopathy as underlying disturbance.

Chromosome mosaicism of the placenta--a cause of developmental failure of the fetus?

Fourteen (2.5 per cent) of 568 chromosome preparations after CVS showed discrepancies between the placental and fetal karyotype, mainly due to placental mosaicism. The presence of a second cell line within the placenta was confirmed in all but one case, in which cytogenetic reinvestigations were carried out. Our clinical data indicate that severe developmental retardation in the newborn is not to be expected if only the placenta carries the chromosomally abnormal cell line.

Is there a correlation between morphological and cytogenetic findings in placental tissue from early missed abortions?

A retrospective study of 200 missed abortions was performed to determine whether morphological criteria alone are sufficient to ascertain a chromosomal aetiology. Placental changes were classified into five morphological and four morphometric groups, according to the severity of alterations, and were then correlated with the cytogenetic data. The rate of chromosome anomalies was approximately 50% and was thus not significantly different within the groups II-V, but it was 80% in group I, which covered the most severe placental alterations, namely the partial hydatidiform moles. There was a high incidence of triploidies in group I, trisomies with obligatory early lethality in groups II and III, and X-monosomies in group III. Our findings do not support previous evidence regarding the specificity of certain villous alterations in association with chromosome aberrations. Indeed, they indicate that the placental villi may react similarly to chromosomal and non-chromosomal disturbances and that placental morphology depends on the severity and the temporal onset of the underlying disorder rather than on its type. With respect to chorionic villus samplings (CVS), this would mean that an abnormal villous structure may be suggestive for a chromosome anomaly but does not exclude a normal karyotype.

[Animal welfare and disease control regulations for killing cattle, swine and sheep with the help of a transportable electric stunning facility (SCHERMER, type EC)]

Stamping-out of animals in case of infections diseases has to meet the requirements resulting from animal welfare, disease prevention, and practicability under conditions in practice. This is well qualified by application of electrical shock stunning with subsequent generation of ventricular fibrillation in cattle, swine and sheep. The scientific elements of the method, the procedure, and experiences in application of the method during the stamping-out of 340 cattle, 980 swine, 152 sheep and 18 goats are discussed in the paper.

Cardiac defects in chromosomally abnormal human embryos of 10-14 weeks' gestation

Cardiac defects were studied in five chromosomally abnormal embryos of 10-14 weeks' gestation by free-hand microdissection of hearts measuring 2.5-6 mm in diameter. The type of cardiac malformation alone or in association with other anomalies helped to confirm the chromosome diagnosis established prenatally by chorionic villus sampling or after spontaneous abortion. It was suggestive of a chromosomal disorder in one case in which cytogenetic investigation had failed.

Skeletal anomalies in trisomy 21 as an example of amplified developmental instability in chromosome disorders: a histological study of the feet of 21 mid-trimester fetuses with trisomy 21

In a previous radiographic study on the feet of 71 adults with trisomy 21 we found, in comparison to control individuals, an increased prevalence of biphalangeal toes and metatarsophalangeal sesamoid bones. The present histological study on the feet of 21 mid-trimester fetuses with prenatally diagnosed trisomy 21 confirms results of the earlier study. At both stages of development these minor bone anomalies have about the same frequency, thus suggesting 1) that they are selectively neutral, and 2) that they reflect a basic (innate) failure of ordered morphogenesis. Our observation that the normal spatial pattern of skeletal variants is reproduced in trisomy 21 simply on a quantitatively higher level lends sound support to the hypothesis of amplified developmental instability in chromosome trisomies.

Tetrasomy for the short arm of chromosome 12 with accessory isochromosome (+i(12p)) and a marked LDH-B gene dosage effect

A fetus with tetrasomy for the short arm of chromosome 12 due to a de novo accessory isochromosome i(12p) is described. Involvement of the 12p in this chromosome aberration was suggested by banding analysis and substantiated by detection of a marked increase of LDH-B in the fetal fibroblasts. The syndrome shown by this fetus includes many of the minor anomalies described for live-born patients with partial trisomy 12p, and in addition malformations including brachymelia, anal atresia and double kidneys.

Spermatogenesis in two patients with the fragile X syndrome. I. Histology: light and electron microscopy

Light and electron microscopic studies on testicular biopsies were carried out in two men, 40 and 44 year old, with the fra(X) form of mental retardation and macroorchidism. Distinct interstitial edema, an increased amount of lysosomal inclusions in Sertoli cells, and disturbance of spermatid differentiation were found in both probands. Additionally, some extent of tubular atrophy was demonstrated in one patient. The impairment of spermatogenesis is discussed with respect to pressure effects on the germinal epithelium due to the edema.

Roberts syndrome and SC phocomelia. A single genetic entity

A family with three siblings showing different manifestations of Roberts syndrome or SC phocomelia is described. With regard to previously published cases of familial Roberts syndrome and SC phocomelia we conclude that these two syndromes are one and the same genetic entity.

Molecular approaches to developmental genetics and pathology

New insights into gene structure and expression and the observation that homeobox-containing genes, the t-complex, and oncogenes are expressed also in humans contribute to the understanding of normal and pathobiological mechanisms of embryonal and fetal development.

The fetal pathology of the XXXXY-syndrome

A second case of fetal XXXXY-syndrome detected by prenatal chromosome analysis is presented. The pathological findings include a facial aspect featuring fetal Down's syndrome, hypogenitalism and hypogonadism with excessive reduction of germ cells and also skeletal abnormalities that may be interpreted as early changes, preceding phalangeal shortening V and radioulnar synostosis.

Triploid embryo after in vitro fertilization

A case of a triploid embryo (69,XXX) resulting from in vitro fertilization is reported. The pregnancy ended in spontaneous abortion 44 days after embryo transfer. The embryo showed anomalies considered typical of triploidy but molar changes were not noted. The origin of extra chromosomes was apparently maternal.

Anencephaly in one monoamniotic-monochorionic twin and encephalocele in the other

This is a report of monoamniotic-monochorionic (ie, probably MZ) twins, one of which had anencephaly, whereas the co-twin died of complications of prematurity. Autopsy in this seemingly nonmalformed twin showed a small encephalocele. The literature on MZ twins with discordant anencephaly is often contradictory. It is suggested that this might be due to the difficulty of determining zygosity on the one hand and identifying discordance or concordance on the other. This case is presented as an example of this difficulty; it is discordant with respect to anencephaly, but concordant in the sense of "dysraphic" disturbances.

Quantitative histology of human fetal testes in chromosomal disease

Morphometric studies on male gonads were performed in 35 midterm fetuses aborted after prenatal diagnosis of a chromosome anomaly and in 11 chromosomally normal controls. A significant reduction of the number and volume percentage of premeiotic germ cells was observed in the chromosomally abnormal cases. Germ cell depletion was correlated with the severity of the chromosomal disease. It was least expressed in the XYY condition. In trisomy 13 and 18, depletion lead to values of less than a half or even a fourth the values of controls. Complex anomalies with XXY or XYY in addition to an autosomal disorder showed a moderate effect on germ cell reduction. No morphological differences were observed in germ cells or in Sertoli cells in a comparative electron microscopic study. Paucity of fetal germ cells can result from impaired colonization of the gonadal ridge, from low mitotic activity, or from increased premeiotic cell loss. All three factors seem to contribute to the above findings.

Isochromosome 18q with karyotype 46,XX,i(18q). Cytogenetics and pathology

Cytogenetic and morphological findings of a 20-gestational-week-old female fetus with karyotype 46,XX,i(18q) are reported. The fetus displayed clinical features resembling Edward's syndrome. No characteristic symptoms of monosomy 18p could be observed.

Prenatal diagnosis of a probable hereditary syndrome with holoprosencephaly, hydrocephaly, octodactyly, and cardiac malformations

Following genetic counselling of a consanguineous couple because of a daughter born with peripheral hypoplasia of the left arm, ultrasonographic examination during the second pregnancy revealed marked hydrocephalus of the fetus in the 17th week of pregnancy. Pathologic examination of the female fetus disclosed severe cerebral, cardiac, and skeletal malformations including holoprosencephaly, absent corpus callosum, microphthalmia, facial clefts, tetramelic octodactyly, and cardiac defects. These findings indicate a possible genetically determined syndrome that appears to be distinct in spite of some overlap with other malformation syndromes.

[Psychological aspects of spinal anesthesia. Vasovagal syncope and anxiolytic medication]

In 61 male and female patients, the influence of the preoperative emotional state on vasovagal syncopes and anxiolytic medication during spinal anaesthesia for elective orthopaedic surgery was investigated. Male patients pretended to feel emotionally better than female patients, but had higher rates of anxiolytic medication and vasovagal syncopes. Patients in a bad (n = 8) and in a good emotional state (n = 3) received more anxiolytic medication than those with a mean emotional state. Vasovagal syncopes were registered in patients who pretended to feel good (n = 6), in those who felt bad (n = 4) and only in one patient of the mean group. The factors anxiety and depression were the most responsible for this result. The importance of coping-mechanisms for the development of psychological and psychophysiological reactions is discussed. Vasovagal syncope is interpreted as a psychophysiological reaction. In consequence it needs psychoprophylaxis.

Prenatal diagnosis of a 46,XX/47,XX, + 12 mosaic

A case of true mosaicism 46,XX/47,XX,+ 12 was diagnosed prenatally. The pregnancy was terminated in the 21st week of gestation and the aberrant cell line was rediscovered in cultured fetal tissue. However, a detailed examination of the fetus did not disclose any significant physical malformation.