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THE PLACENTA IN THE ANDEAN dolichomegacolon TALL

The placenta seen by fetal face umbilical cord

The Placenta:

The term placenta comes from the Latin word "circular cake" and was introduced in 1559 by a doctor named Realdus Columbus. The placenta is a round structure on a disk cake or about 25 cm. in diameter and about 2.5 cm. thick towards the end of pregnancy.
The placenta attached to the inside of the uterus allows the baby nourished by removing the elements from maternal blood.


Structure of the placenta:

By the beginning of the fourth month of pregnancy, and placenta has two components:
• Portion fetal formed by the leafy chorion, the placenta is surrounded by the chorionic plate . Here are noticed arteries and veins of large caliber, chorionic vessels, which converge into the umbilical cord.
• Lot feeding: formed by the deciduous baseline from which the compact layer, call or decidual basal plate is the portion most closely incorporated into the placenta. During the fourth and fifth months the decidua forms several partitions dividing the placenta in compartments called cotyledons. Among

chorionic and basal plates are filled intervillous spaces maternal blood. From gaps in the syncytiotrophoblast and are always covered with syncytium of fetal origin. Arborescent villi are developed within the intervillous blood lakes.



The placental weight is higher in Height:

Since 1963 several authors (in Cerro de Pasco: R. Sanchez, Fuentes, K. Kadar, R. Herrera and many more) found that placental weight is greater in height.

placental morphology on the most significant histological finding concerns the relative volume of fetal capillaries is significantly greater in height, which is associated with a decrease in the relative volume of the chorionic villi stroma. The more surface area and capillary villous placenta in height would be in the phenomena of gas exchange and metabolism of the placenta which would be a structural adaptive mechanism of great efficiency against hypoxia at high altitudes. Similarly
defined
the hairy surface area determined by the microscope light increases due to the presence of microvilli, by a factor of 5.23 in Cerro de Pasco (4330 m asl.) 3.50 in Puno (3800 masl.) and 3.03 in Lima (sea level). The actual area of \u200b\u200bmaternal-fetal exchange is 60.72 m in Cerro de Pasco, 38.92 m. Puno and 26.60 m in Lima.

S. Recavarren in 1979 found structural changes in placentas from high altitude at the level of syncytial microvilli with an increase in the area of \u200b\u200bgas exchange.

placental circulation showing the level of communication from the placenta between maternal and fetal vessels

The weight of the placenta is related to the birth weight on height and regulates fetal erythropoiesis:

Tulio Ramírez in 1987 on a detailed work by studying 224 placentas in Cerro de Pasco (4340 m) showed statistically that the weight of the placenta does not change with sex of the newborn, with the number of previous pregnancies, or the weight or maternal height.

placental weight in relation to birth weight, is greater as the level of altitude. Placental weight increases with birth weight as opposed to what happens at sea level, where at the end of pregnancy the fetal weight increases faster than the placenta. One

adaptive adaptive mechanisms that play major placenta to the fetus would be the regulation of erythropoiesis in the newborn at high altitude compared to sea level is statistically similar. These data suggest that fetal erythropoiesis and newborns are independent of maternal factors and hypoxic environment and could be due to the barrier holding the placenta. We will review the issue in some detail in another installment.





Summary Since 1963 Several authors (R. Sanchez, Fuentes, K. Kadar, R. Herrera) Found That placental weight is great at high altitude. The Most Significant

Histological finding in the placental morphology concerns the relative volume of fetal capillaries is significantly greater at high altitude than at sea level. It is associated to a decrease in the relative volume of the stroma of the chorionic villi. The bigger surface area would be an important gas exchange and metabolism phenomena of the placenta which would be a structural adaptive mechanism of great efficiency in the hypoxia at altitude.

S. Recavarren in 1979 found structural changes in placentas from high altitude in syncytial microvilli with an increase in the area of gas exchange.

Mean placental weigth is not different between sexes gravity weigth or maternal height at high altitude. When newborn body weight is similar at any altitudes the placental weigth is increased according altitude is INCREASED. Placental weigth is when to newborn weigth is INCREASED INCREASED. Placental growth rate is similar Than weigth body growth rate at high altitude last weeks of Pregnancies Through Different To That Observed at sea level (T. Ramírez 1987).

Dr. Achilles MONROY

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The Colon and parts

THE HEIGHT IN dolichomegacolon

The Colon The final part of the digestive system:

The colon begins at the ileocecal valve and ends at the junction rectal sigmoid. The classic anatomy books Rouvière and Testud, considered average for a length of 153 colon and 155 cms., A width of 3 to 5 cm. and a sigmoid of 48 cms. Their portions are retroperitoneal ascending and descending, vertical and fixed on both sides of the peritoneal cavity. The transverse and sigmoid colon, due to the presence of the corresponding meso is more mobile.

dolichocolon the colon is called very elongated committed almost exclusively to the Megacolon Sigmoid and chronic dilatation of the colon, when the transverse diameter is greater than 6.5 cm.

can be congenital megacolon (Hirschsprung disease or aganglionic megacolon) and is caused by agenesis or hypogenesis parasympathetic ganglion cells of the myenteric (Auerbach) and submucosal (Meissner) in the large intestine. It was acquired in Latin America for Chagas Disease (by Trypanosoma cruzi) that leads to destruction of myenteric ganglion cells, following the same pathophysiology of Hirschsprung's disease and is associated with pathology of other organs such as myocarditis, megaesophagus, etc. . There are also other cases of anoxia, chemicals and avitaminosis B.



dolichomegacolon Andino:

Residents living above 3000 feet have the longest colon and diameter as the inhabitants of sea level, it is called acquired anatomical modification dolichomegacolon Andino. According to Oscar Frisancho the high fiber diet may inhibit the histological phenomenon known elastogenesis, "to over the years, the megacolon. Another important factor would be the lower atmospheric pressure at altitude, and the expansion of intraluminal gas could affect the growth of intestinal dimensions.

has several anatomical features, clinical, radiological, histological and serological features that differentiate it from chagasic megacolon.



CXR scheme, which is displayed dolichomegacolon gastric zone (below), known as mark-Frisancho Bouroncle



Since the 1950 Peruvian had reports of this disease as those of Delafield, Kurt Hellriegel and Maccagno (Chulec Hospital, La Oroya), David Frisancho (Puno), Fernando Delgado (Tarma), Rigoberto Zuniga (Huancayo), Darwin Salas, and José Serapio Martiarena Somocursio (Cusco).



plain abdominal radiograph demonstrating the Andean dolichomegacolon


Andean dolichomegacolon Alvarez Ruiz found in 50% of 208 X-rays reviewed and David Frisancho colon in 65.13% of 3000 workers examined. David and Oscar Frisancho found in populations of Puno to 3800 meters. a colon with 191 cms. long and 5 to 6 cms. in diameter, with a sigmoid of 68 cms. In Bolivia at the same altitude Oviedo found a colon of 191 cms. long by 6 to 8 cm. wide and 71 cms. for the sigmoid, while the Peruvian Andean groups Escudero found an average of 190 cms. for colon and 84 cms. for the sigmoid.


contrast colon radiography showed a large sigmoid dolichomegacolon Andean


This condition can be asymptomatic, or produce some manifestations clínicas como distensión abdominal, meteorismo, estreñimiento, o síntomas leves digestivos. Nuestros cirujanos en La Oroya como Krüger, Noli, Gonzales siempre repetían ese aforismo ante sus alumnos que “las tres principales causas de dolor abdominal en la altura son la úlcera péptica, la colecistopatía y el dolicomegacolon andino”. En la mayoría de los pacientes la patología se pone de manifiesto cuando se presenta el vólvulo de sigmoides, que es una de las emergencias quirúrgicas más frecuentes en los hospitales del área andina, donde representa más del 50% de todas las obstrucciones intestinales.

El Dolicomegacolon Andino y la Mesocolonitis Retráctil son the main predisposing factors for volvulus as Oscar Frisancho, the principal investigator of this subject. Mesocolonitis approximates the proximal and distal segment of the sigmoid loop, favoring torque. Copious intake of fermented foods is the precipitating factor for volvulus most patients are seen during times of harvest and planting periods in which increases consumption. In the Central Highlands after the famous pachamancas .

For the treatment of sigmoid volvulus can be tried not invasive emergency procedures such as endoscopic volvulus: the replacement of rotation is useful to decrease colonic la compresión abdominal y restaurar la circulación sanguínea enteral. El tratamiento quirúrgico de urgencia debe guiarse por la condición general del paciente y el estado del asa colónica en el acto quirúrgico.



SUMMARY

People, who live at altitudes above 3000 meters sea level, have a larger and thicker colon than coastal residents. Professor David Frisancho calls this acquired pathology the Andean dolichomegacolon DMCA A fiber-rich diet may inhibit the histological phenomenon known as elastogenesis, developing - over the years - the megacolon. Another important factor may be the lower atmospheric pressure in the altitude, the expansion of intraluminal gas may have an influence on intestinal enlargement.

The alteration in the colon can not be symptomatic or can only generate abdominal distension or a long period of time without defecation.

However sigmoid volvulus is a frequent cause of emergencies in hospitals in the Andean area, representing more than 50 per cent of all intestinal obstructions. Andean dolichomegacolon and retractile mesocolonitis are the main contribuiting factors for volvulus. Copious intake of fermentable food is the precipitating factor for volvulus. The patients are seen during sowing and harvest periods, in which the consumption of this type of food increases. DCMA has many special anatomic, clinical, radiological, histological and serological features which make it different from the chagasic megacolon.

Dr. Achilles MONROY