Re: =?us-ascii?Q?RE:_Informal_Case:_Exencephaly_-_Anencephaly_Sequence_and_it?= =?us-ascii?Q?s_Sonographic_Features?
From: Terry J DuBose (tjdubose@juno.com)
Thu Oct 9 19:16:14 2003
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Philippe, thanks for discussing this. I have a bit of confusion myself
concerning the definitions of "Acrania" and "Exencephaly" and the terms
you point out of the definition of acrania and anencephaly. The Case
Series -- First-Trimester Echogenic Amniotic Fluid in the
Acrania-Anencephaly Sequence by Daniel Cafici and Waldo Sepulveda (J
Ultrasound Med 22:1075-1079 . 0278-4297
http://www.jultrasoundmed.org/cgi/content/full/22/10/1075 ) looks
convincing for a progression from acrania to anencephaly, as does Martin
Necas's article/images posted here:
http://www.obgyn.net/us/us.asp?page=/us/cotm/0006/Exencephaly-Anencephaly
Could Martin's observation, "High degree of fetal activity is often
observed" be an answer to your question: "(how little brain should you
have to be considered anencephaly and how much to be called acrania ?)."
Do you have examples of both types to share... TheFetus URL perhaps?
--
Terry J DuBose, M.S., RDMS
Little Rock Arkansas USA
----------------------------------------
On Thu, 9 Oct 2003 12:22:29 -0500 "Philippe Jeanty, MD, PhD"
----------------------------------------
<jeanty@TheFetus.net> writes:
----------------------------------------
> I very disagree with the hypothesis that anencephaly is the end
> result of
> acrania. Why would acrania be visible in older fetuses then those
> with
> anencephaly ? The paper of Dani and Waldo is very interesting and I
> would
> agree that it is quite suggestive that in some case this could be
> the
> pathway in a specific subset. However the problem is that there are
> no good
> definition of acrania and anencephaly (how little brain should you
> have to
> be considered anencephaly and how much to be called acrania ?).
>
> The embryological mechanism for the 2 conditions is also different
> (failure
> of closure of the anterior neuropore in anencephaly versus lack of
> migration
> of the mesoderm over the neural tube in acrania.
>
> Finally the recurrence rate of neural tube defect in anencephaly is
> well
> known, while recurrence of acrania is exceedingly rare
> (notwithstanding the
> case in their series).
>
> -----Original Message-----
> From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf
> Of Terry
> J. DuBose
> Sent: Thursday, October 09, 2003 10:12 AM
> To: Multiple recipients of list ULTRASOUND
> Subject: Informal Case: Exencephaly - Anencephaly Sequence and its
> Sonographic Features
>
> Re:
>
http://www.obgyn.net/us/us.asp?page=/us/cotm/0006/Exencephaly-Anencephaly
>
> There is an excellent article that also documents the change from
> Exencephaly to Anencephaly with images in the current JUM. See:
> http://www.jultrasoundmed.org/cgi/content/full/22/10/1075
> Unfortunately, this article did not reference our earlier
> publication of the
> same type of series with images... I guess electronic peer-review
> and
> publication just doesn't count. If it isn't in Medline it doesn't
> count.
> :-(
>
> However the article title raises an academic question for me.
> According to
> my handy-dandy Stedman's Electronic Medical Dictionary "Acrania" and
> "Exencephaly" are very similar if not the same... so is there a
> difference
> in the two terms and how they should be used? Thanks, Terry
>
> J Ultrasound Med 22:1075-1079 . 0278-4297
> http://www.jultrasoundmed.org/cgi/content/full/22/10/1075
> Case Series
>
> First-Trimester Echogenic Amniotic Fluid in the Acrania-Anencephaly
> Sequence
>
> By Daniel Cafici, MD and Waldo Sepulveda, MD
> Ultrasound and Prenatal Diagnosis Unit, Ecodiagnostico Alem, Buenos
> Aires,
> Argentina (D.C.); and Fetal Medicine Center, Department of
> Obstetrics and
> Gynecology, Clinica Las Condes, Santiago, Chile (W.S.).
>
> Abstract
>
> Objective. To describe the association between echogenic amniotic
> fluid and
> first-trimester fetal acrania. Methods. Nine fetuses with acrania
> were
> examined between 11 weeks' and 13 weeks 6 days' menstrual age for
> the
> presence of echogenic free-floating particles in the amniotic fluid.
> Cases
> were classified into 3 types according to the echogenicity of the
> amniotic
> fluid: similar to (type 0), slightly greater than (type 1), and
> clearly more
> echogenic than (type 2) that of the extracelomic fluid.
> Results. In 1 pregnancy, no free-floating particles were identified
> (type
> 0). In 6 cases, small free-floating particles scattered within the
> amniotic
> cavity were identified, making the amniotic fluid slightly more
> echogenic
> than the extracelomic fluid (type 1). In the remaining 2 cases, the
> amniotic
> fluid was homogeneously and clearly more echogenic than the
> extracelomic
> fluid (type 2). Conclusions. A high percentage (89%) of fetuses with
> acrania
> had echogenic amniotic fluid, suggesting that this
> finding could potentially be used as a marker of fetal acrania in
> the first
> trimester. This finding also supports the hypothesis of the
> transition from
> acrania to anencephaly, with the unprotected brain undergoing
> progressive
> destruction from the first trimester, leading to the classic finding
> of
> anencephaly in the second trimester.
>
> Key Words: acrania . anencephaly . fetal sonography . first
> trimester .
> prenatal diagnosis
>
> Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
> Assistant Professor & Director, Diagnostic Medical Sonography
> Program
> University of Arkansas for Medical Sciences, CHRP
> 4301 West Markham St. Mail Slot #563
> Little Rock, Arkansas, 72205 USA
> 501-686-6510
> DuBoseTerryJ@UAMS.edu
> http://www.io.com/~dubose/
> http://www.uams.edu/chrp/dms/default.asp
> http://www.obgyn.net/us/panel/panel.htm
>
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Could Martin's observation, "High degree of fetal
activity is often observed" be an answer to your question: "(how little brain should you have to be considered
anencephaly and how much to be called acrania ?)." Do you have
examples of both types to share... TheFetus URL perhaps?
Terry J DuBose, M.S., RDMS
Little Rock Arkansas USA
----------------------------------------
size=2>----------------------------------------
On Thu, 9 Oct 2003 12:22:29 -0500 "Philippe Jeanty, MD, PhD" <
----------------------------------------
> I
very disagree with the hypothesis that anencephaly is the end
> result
of
> acrania. Why would acrania be visible in older fetuses then those
> with
> anencephaly ? The paper of Dani and Waldo is very
interesting and I
> would
> agree that it is quite suggestive that
in some case this could be
> the
> pathway in a specific subset.
However the problem is that there are
> no good
> definition of
acrania and anencephaly (how little brain should you
> have to
> be
considered anencephaly and how much to be called acrania ?).
>
>
The embryological mechanism for the 2 conditions is also different
>
(failure
> of closure of the anterior neuropore in anencephaly versus lack
of
> migration
> of the mesoderm over the neural tube in
acrania.
>
> Finally the recurrence rate of neural tube defect in
anencephaly is
> well
> known, while recurrence of acrania is
exceedingly rare
> (notwithstanding the
> case in their
series).
>
> -----Original Message-----
> From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf
> Of Terry
> J. DuBose
> Sent: Thursday, October 09, 2003
10:12 AM
> To: Multiple recipients of list ULTRASOUND
> Subject:
Informal Case: Exencephaly - Anencephaly Sequence and its
> Sonographic
Features
>
> Re:
> http://www.obgyn.net/us/us.asp?page=/us/cotm/0006/Exencephaly-Anencephaly
>
> There is an excellent article that also documents the change
from
> Exencephaly to Anencephaly with images in the current JUM.
See:
> http://http://www.jultrasoundmed.org/cgi/content/full/22/10/1075
>
Unfortunately, this article did not reference our earlier
> publication
of the
> same type of series with images... I guess electronic peer-review
> and
> publication just doesn't count. If it isn't in
Medline it doesn't
> count.
> :-(
>
> However
the article title raises an academic question for me.
>
According to
> my handy-dandy Stedman's Electronic Medical Dictionary
"Acrania" and
> "Exencephaly" are very similar if not the same... so is
there a
> difference
> in the two terms and how they should be
used? Thanks, Terry
>
> J Ultrasound Med 22:1075-1079 .
0278-4297
> http://http://www.jultrasoundmed.org/cgi/content/full/22/10/1075
>
Case Series
>
> First-Trimester Echogenic Amniotic Fluid in the
Acrania-Anencephaly
> Sequence
>
> By Daniel Cafici, MD and
Waldo Sepulveda, MD
> Ultrasound and Prenatal Diagnosis Unit,
Ecodiagnostico Alem, Buenos
> Aires,
> Argentina (D.C.); and Fetal
Medicine Center, Department of
> Obstetrics and
> Gynecology,
Clinica Las Condes, Santiago, Chile (W.S.).
>
> Abstract
>
>
Objective. To describe the association between echogenic amniotic
> fluid
and
> first-trimester fetal acrania. Methods. Nine fetuses with acrania
> were
> examined between 11 weeks' and 13 weeks 6 days' menstrual
age for
> the
> presence of echogenic free-floating particles in
the amniotic fluid.
> Cases
> were classified into 3 types
according to the echogenicity of the
> amniotic
> fluid: similar to
(type 0), slightly greater than (type 1), and
> clearly more
>
echogenic than (type 2) that of the extracelomic fluid.
> Results. In 1
pregnancy, no free-floating particles were identified
> (type
> 0).
In 6 cases, small free-floating particles scattered within the
>
amniotic
> cavity were identified, making the amniotic fluid slightly more
> echogenic
> than the extracelomic fluid (type 1). In the
remaining 2 cases, the
> amniotic
> fluid was homogeneously and
clearly more echogenic than the
> extracelomic
> fluid (type 2).
Conclusions. A high percentage (89%) of fetuses with
> acrania
>
had echogenic amniotic fluid, suggesting that this
> finding could
potentially be used as a marker of fetal acrania in
> the first
>
trimester. This finding also supports the hypothesis of the
> transition
from
> acrania to anencephaly, with the unprotected brain undergoing
> progressive
> destruction from the first trimester, leading to
the classic finding
> of
> anencephaly in the second trimester.
>
>
> Key Words: acrania . anencephaly . fetal sonography .
first
> trimester .
> prenatal diagnosis
>
>
>
>
>
> Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
>
Assistant Professor & Director, Diagnostic Medical Sonography
>
Program
> University of Arkansas for Medical Sciences, CHRP
> 4301
West Markham St. Mail Slot #563
> Little Rock, Arkansas, 72205 USA
> 501-686-6510
> DuBoseTerryJ@UAMS.edu
> http://www.io.com/~dubose/
> http://www.uams.edu/chrp/dms/default.asp
>
http://www.obgyn.net/us/panel/panel.htm
>
>
>
>
>
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