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Brambilla M, De Mauri A, Lizio D, Leva L, Carriero A, Carpeggiani C, Picano E. Cumulative radiation dose estimates from medical imaging in paediatric patients with non-oncologic chronic illnesses. A systematic review. Phys Med 2014; 30:403-12. [DOI: 10.1016/j.ejmp.2013.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022] Open
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202
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Gamé X, Moscovici J, Guillotreau J, Roumiguié M, Rischmann P, Malavaud B. Sexual function of young women with myelomeningocele. J Pediatr Urol 2014; 10:418-23. [PMID: 23992838 DOI: 10.1016/j.jpurol.2013.07.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/16/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the sexual function of young women with spina bifida and myelomeningocele and to determine the factors influencing their sexual function. METHODS A postal cross-sectional study using a self-administered questionnaire was performed in 44 women, mean age 27.66 ± 5.89 years, with spina bifida and myelomeningocele. The questionnaire included the Brief Index of Sexual Functioning for Women and questions about voiding mode, urinary symptoms, socioeconomic status, education level, lifestyle, and partnership. In parallel, data were also collected from the paediatric surgery records of patients who returned the questionnaire. RESULTS The response rate was 56.8% (25/44). All domains of female sexual function (thoughts/desires, arousal, frequency of sexual activity, receptivity/initiation, pleasure/orgasm, relationship satisfaction) were altered. Urinary incontinence was likely to be the main factor responsible for altered sexual function and was associated with lower thoughts/desires, arousal, and receptivity/initiation scores. Wearing pads also constituted a limitation to achieving intimacy. CONCLUSIONS Young myelomeningocele women report poor sexual functioning. The presence of urinary incontinence is associated with lower thoughts/desire, arousal, and receptivity/initiation.
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Affiliation(s)
- Xavier Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse Cedex 9, France.
| | - Jacques Moscovici
- Département de Chirurgie Viscérale Infantile, Hôpital des Enfants, Toulouse, France
| | - Julien Guillotreau
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Mathieu Roumiguié
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Pascal Rischmann
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Bernard Malavaud
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse Cedex 9, France
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203
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Osinga R, Mazzone L, Meuli M, Meuli-Simmen C, von Campe A. Assessment of long-term donor-site morbidity after harvesting the latissimus dorsi flap for neonatal myelomeningocele repair. J Plast Reconstr Aesthet Surg 2014; 67:1070-5. [PMID: 24865618 DOI: 10.1016/j.bjps.2014.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/27/2014] [Accepted: 04/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM The latissimus dorsi flap (LDF) has been employed very successfully over decades to cover large soft-tissue defects. Its donor-site morbidity has been extensively investigated in adults - but not in children - and is considered to be nonrestrictive. The aim of this long-term study was to assess donor-site morbidity with the modified Constant score more than 8 years after coverage of large myelomeningocele (MMC) defects with a reverse latissimus dorsi flap. METHODS Within the first days after birth, the reverse latissimus dorsi muscle flap was used uni- or bilaterally in three neonates to cover a large MMC defect. Bilateral shoulder function was tested more than 8 years postoperatively according to the modified Constant score. RESULTS The mean age at follow-up was 11.7 years. None of the patients experienced any pain or shoulder restrictions during normal daily activities. They all managed to position both of their arms comfortably above the head. Forward flexion was normal in all patients as was abduction and external rotation. Dorsal extension was minimally reduced on the operated side. Internal rotation was symmetric in all patients; the extent of active movement varied from excellent to poor. CONCLUSIONS Our long-term data suggest that there is no specific and significant impairment of shoulder function after using the distally pedicled reverse LDF for neonatal MMC repair.
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Affiliation(s)
- R Osinga
- Clinic of Hand, Reconstructive and Plastic Surgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - L Mazzone
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - C Meuli-Simmen
- Clinic of Hand, Reconstructive and Plastic Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - A von Campe
- Clinic of Hand, Reconstructive and Plastic Surgery, Kantonsspital Aarau, Aarau, Switzerland
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204
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Oliveira A, Jácome C, Marques A. Physical fitness and exercise training on individuals with spina bifida: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1119-1136. [PMID: 24612860 DOI: 10.1016/j.ridd.2014.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/01/2014] [Accepted: 02/03/2014] [Indexed: 06/03/2023]
Abstract
Spina Bifida (SB) is characterized by several physical impairments; however, data on physical fitness and on the benefits of exercise training in individuals with SB are dispersed in the literature. Thus, this systematic review aimed to describe (i) physical fitness components (cardiorespiratory endurance, muscle strength, body composition, flexibility and neuromotor) and (ii) exercise training effects on the physical fitness of individuals with SB. CINAHL, MEDLINE and EMBASE were searched from January to March 2013 and updated in December 2013. Twenty-three studies were included. A summary of the results was performed using a best-evidence synthesis. Participants with SB had lower cardiorespiratory endurance (-32 to 54% in VO2 peak) and muscle strength (-58 to 90%) and higher body fat (159%) than their healthy peers. Mobility restrictions were present in 26.3-61% of participants. No data on neuromotor fitness were found. Aerobic and strength training improved participants' cardiorespiratory endurance (effect sizes 0.78-1.4) and muscle strength (effect sizes 0-0.59). Individuals with SB have impaired cardiorespiratory endurance, muscle strength, body composition and flexibility when compared to healthy peers. Exercise training seems to improve two of these fitness components (cardiorespiratory endurance and muscle strength). Nevertheless, the heterogeneity of the studies' designs, methods and instruments used limits the establishment of firm conclusions and highlights the need for further research.
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Affiliation(s)
- Ana Oliveira
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal.
| | - Cristina Jácome
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal.
| | - Alda Marques
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal; Unidade de Investigação e Formação sobre Adultos e Idosos (UniFAI), 4050-313 Porto, Portugal.
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205
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Kondo A, Morota N, Ihara S, Saisu T, Inoue K, Shimokawa S, Fujimaki H, Matsuo K, Shimosuka Y, Watanabe T. Risk factors for the occurrence of spina bifida (a case-control study) and the prevalence rate of spina bifida in Japan. ACTA ACUST UNITED AC 2014; 97:610-5. [PMID: 24078478 DOI: 10.1002/bdra.23179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 07/29/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Japanese government recommended in 2000 that women planning pregnancy should take 400 μg of folic acid daily to decrease the risk of having an infant with spina bifida. We aimed to identify risk factors for the occurrence of spina bifida and to evaluate how the prevalence rate has altered over the past 3 decades. METHODS Subjects comprised 360 women who gave birth to spina bifida-affected offspring and 2333 women who gave birth to offspring without spina bifida between 2001 and 2012. A self-administered questionnaire was used to collect data, which were analyzed by multiple logistic regression models. The prevalence rate of spina bifida was obtained through data provided by international and domestic organizations. RESULTS Four variables were significantly associated with the increased risk of having newborns afflicted with spina bifida: not taking folic acid supplements (odds ratios [OR], 2.50; 95% confidence interval [CI], 1.72-3.64), presence of spina bifida patients within third-degree relatives (OR, 4.26; 95% CI, 1.12-16.19), taking anti-epileptic drugs without folic acid (OR, 20·20; 95% CI, 2.06-198.17), and low birth weight in the newborns ≤ 2500 g (OR, 4.21; 95% CI, 3.18-5.59). The prevalence rate of spina bifida has remained 5 to 6 per 10,000 total births and has not shown any decreasing trend over the past 11 years. CONCLUSION Four risk factors were identified among Japanese women. Because recommendations and information have not decreased the occurrence of spina bifida, the Japanese government should implement mandatory food fortification.
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Affiliation(s)
- Atsuo Kondo
- Department of Urology, Tsushima Rehabilitation Hospital, Tsushima, Japan
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206
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Ceylan E, Ekinci M, Aksu N, Kartal B, Tanyıldız B, Çinici E, Keleş S, Çağatay HH, Hüseyinoğlu N. Peripapillary Retinal Nerve Fibre Layer Thinning Secondary to Nutritional Folic Acid Deficiency. Neuroophthalmology 2014; 38:135-139. [PMID: 27928289 DOI: 10.3109/01658107.2013.874455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/13/2022] Open
Abstract
Folic acid has a fundamental role in central nervous system (CNS) function at all ages, especially the methionine synthase-mediated conversion of homocysteine to methionine, which is essential for nucleotide synthesis and genomic and non-genomic methylation. Folic acid and vitamin B12 may have roles in the prevention of disorders of CNS development, mood disorders, and dementias, including Alzheimer disease and vascular dementia in elderly people. The authors examined the peripapillary retinal nerve fibre layer thickness (RNFLT) in patients with nutritional folic acid deficiency using optical coherence tomography (OCT). Patients were divided into two groups according to blood folic acid levels: blood folic acid <7 nmol/L as Group 1 and >7 nmol/L as Group 2. Peripapillary RNFL measurements were performed. There were significant positive correlations between serum folate levels and RNFLT in all quadrants (p < 0.05), except for the temportal quadrant (p = 0.41).
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Affiliation(s)
- Erdinç Ceylan
- Erzurum Training and Research Hospital Ophthalmology Clinic Erzurum Turkey
| | - Metin Ekinci
- Department of Ophthalmology, Kafkas University Medical School Merkez, Kars Turkey
| | - Nihan Aksu
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University Istanbul Turkey
| | - Baki Kartal
- Erzurum Training and Research Hospital Ophthalmology Clinic Erzurum Turkey
| | - Burak Tanyıldız
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University Istanbul Turkey
| | - Emine Çinici
- Erzurum Training and Research Hospital Ophthalmology Clinic Erzurum Turkey
| | - Sadullah Keleş
- Department of Ophthalmology, University of Atatürk Erzurum Turkey
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207
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Trudell AS, Odibo AO. Diagnosis of spina bifida on ultrasound: Always termination? Best Pract Res Clin Obstet Gynaecol 2014; 28:367-77. [DOI: 10.1016/j.bpobgyn.2013.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 09/04/2013] [Accepted: 10/03/2013] [Indexed: 10/25/2022]
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208
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Galaly SR, Abdella EM, Mohammed HM, khadrawy SM. Effects of royal jelly on genotoxicity and nephrotoxicity induced by valproic acid in albino mice. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2014. [DOI: 10.1016/j.bjbas.2014.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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209
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Economic burden of neural tube defects in Germany. Public Health 2014; 128:274-81. [DOI: 10.1016/j.puhe.2013.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 10/29/2013] [Accepted: 12/04/2013] [Indexed: 11/20/2022]
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210
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Joyeux L, Chalouhi GE, Ville Y, Sapin E. [Maternal-fetal surgery for spina bifida: future perspectives]. ACTA ACUST UNITED AC 2014; 43:443-54. [PMID: 24582882 DOI: 10.1016/j.jgyn.2014.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/14/2014] [Accepted: 01/21/2014] [Indexed: 12/29/2022]
Abstract
Open spina bifida or myelomeningocele (MMC) is a frequent congenital abnormality (450 cases per year in France) associated with high morbidity. Immediate postnatal surgery is aimed at covering the exposed spinal cord, preventing infection, treating hydrocephalus with a ventricular shunt. MMC surgical techniques haven't achieved any major progress in the past decades. Numerous experimental and clinical studies have demonstrated the MMC "two-hit" hypothetic pathogenesis: a primary embryonic congenital abnormality of the nervous system due to a failure in the closure of the developing neural tube, followed by secondary damages of spinal cord and nerves caused by long-term exposure to amniotic fluid. This malformation frequently develops cranial consequences, i.e. hydrocephalus and Chiari II malformation, due to leakage of cerebrospinal fluid. After 30 years of research, a randomized trial published in February 2011 proved open maternal-fetal surgery (OMFS) for MMC to be a real therapeutic option. Comparing prenatal to postnatal surgery, it confirmed better outcomes of MMC children after a follow up of 2.5 years: enhancement of lower limb motor function, decrease of the degree of hindbrain herniation associated with the Chiari II malformation and the need for shunting. At 5 years of age, MMC children operated prenatally seems to have better neurocognitive, motor and bladder-sphincter outcomes than those operated postnatally. However, risks of OMFS exist: prematurity for the fetus and a double hysterotomy at approximately 3-month interval for the mother. Nowadays, it seems crucial to inform parents of MMC patients about OMFS and to offer it in France. Future research will improve our understanding of MMC pathophysiology and evaluate long-term outcomes of OMFS. Tomorrow's prenatal surgery will be less invasive and more premature using endoscopic, robotic or percutaneous techniques. Beforehand, Achilles' heel of maternal-fetal surgery, i.e. preterm premature rupture of membranes, preterm labor and preterm birth, must be solved.
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Affiliation(s)
- L Joyeux
- Service de chirurgie pédiatrique, hôpital d'enfants, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France.
| | - G E Chalouhi
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - Y Ville
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - E Sapin
- Service de chirurgie pédiatrique, hôpital d'enfants, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France
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211
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Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica 2014; 44:480-8. [PMID: 24494987 DOI: 10.3109/00498254.2013.845705] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
1. Folate, an essential micronutrient, is a critical cofactor in one-carbon metabolism. Mammals cannot synthesize folate and depend on supplementation to maintain normal levels. Low folate status may be caused by low dietary intake, poor absorption of ingested folate and alteration of folate metabolism due to genetic defects or drug interactions. 2. Folate deficiency has been linked with an increased risk of neural tube defects, cardiovascular disease, cancer and cognitive dysfunction. Most countries have established recommended intakes of folate through folic acid supplements or fortified foods. External supplementation of folate may occur as folic acid, folinic acid or 5-methyltetrahydrofolate (5-MTHF). 3. Naturally occurring 5-MTHF has important advantages over synthetic folic acid - it is well absorbed even when gastrointestinal pH is altered and its bioavailability is not affected by metabolic defects. Using 5-MTHF instead of folic acid reduces the potential for masking haematological symptoms of vitamin B12 deficiency, reduces interactions with drugs that inhibit dihydrofolate reductase and overcomes metabolic defects caused by methylenetetrahydrofolate reductase polymorphism. Use of 5-MTHF also prevents the potential negative effects of unconverted folic acid in the peripheral circulation. 4. We review the evidence for the use of 5-MTHF in preventing folate deficiency.
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Affiliation(s)
- Francesco Scaglione
- Department of Medical Biotechnology and Translational Medicine, University of Milan , Milan , Italy
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212
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Khalil A, Caric V, Papageorghiou A, Bhide A, Akolekar R, Thilaganathan B. Prenatal prediction of need for ventriculoperitoneal shunt in open spina bifida. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:159-164. [PMID: 24006252 DOI: 10.1002/uog.13202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/13/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate whether the need for ventriculoperitoneal shunting in neonates with open spina bifida can be predicted prenatally. METHODS This was a retrospective cohort study of all fetuses with open spina bifida identified at a single referral center between 1998 and 2012. Ultrasound records were reviewed and outcomes were ascertained from maternal, neonatal and pediatric records. The performance of screening was determined by receiver-operating characteristics (ROC) curve analysis. RESULTS We identified 124 cases of isolated open spina bifida, of which 48 were liveborn. Detailed postnatal follow-up was available for 39 cases, with an average follow-up time of 3.6 years. A shunt was inserted in 22 (56.4%) cases. The width of the posterior horn of the lateral ventricle (Vp) and the ratio between its width and that of the cerebral hemisphere (Vp/H) at diagnosis were significantly greater in cases that required a shunt compared with those that did not subsequently require a shunt (Vp: median 12.4 mm vs 7.7 mm, P < 0.001, and Vp/H: median 0.54 vs 0.33, P < 0.001, respectively). Similarly, at the last scan before delivery, Vp and Vp/H were significantly higher in those requiring a shunt (Vp: median 23.1 mm vs 8.2 mm, P < 0.001; and Vp/H: 0.54 vs 0.21, P < 0.001, respectively). Using Vp and Vp/H at the initial assessment, the rates of detection of fetuses requiring a shunt postnatally were 68.2% and 86.4% for a false-positive rate of 13%, with positive likelihood ratios of 6 and 7, respectively. All fetuses with a Vp of ≥ 12 mm or a Vp/H of ≥ 0.6 at the time of diagnosis required postnatal shunt insertion (positive predictive value = 100%). CONCLUSIONS In cases with open spina bifida the need for a postnatal shunt can be predicted prenatally. This novel observation should be useful in the prediction of outcome and therefore for accurate prenatal counseling and triaging cases for fetal surgery.
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Affiliation(s)
- A Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
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213
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High-Throughput Translational Medicine: Challenges and Solutions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 799:39-67. [DOI: 10.1007/978-1-4614-8778-4_3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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214
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Al-Akour NA, Khader YS, Hamlan A. Stress among parents of infants with neural tube defect and its associated factors. Int J Nurs Pract 2013; 19:149-55. [PMID: 23577972 DOI: 10.1111/ijn.12049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to assess the stress among parents (either the mother or the father) of infants with neural tube defects (NTDs) and its associated factors. Using Parenting Stress Index-Short Form (PSI-SF), 100 parents of infants with NTDs were compared with 100 parents as a normative group. The total mean score for parents of infants with NTDs was 104.0 (standard deviation (SD) = 22.9) compared with 84.3 (SD = 18.9) for parents of infants without NTDs. Fifty-three (53.5%) parents of infants with NTDs and 15% of the control group had clinically significant high total stress score. Parents of infants with NTDs had a significantly higher score of distress in all scales of PSI-SF compared with those of infants without NTDs. Multivariate analysis found that mothers of infants with NTDs had a significantly higher average score for parental distress, parent-child dysfunctional interaction and total stress than fathers. Parents' lower education, unemployed parents and lower family income per month were significantly associated with increased parent-child dysfunctional interaction and parental distress. Parents with lower education and lower family income are in need for psychological and emotional support from health-care professionals.
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Affiliation(s)
- Nemeh Ahmad Al-Akour
- Maternal and Child Health Department, School of Nursing, Jordan University of Science and Technology (JUST), Irbid, Jordan.
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215
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Zamłyński J, Olejek A, Koszutski T, Ziomek G, Horzelska E, Gajewska-Kucharek A, Maruniak-Chudek I, Herman-Sucharska I, Kluczewska E, Horak S, Bodzek P, Zamłyński M, Kowalik J, Horzelski T, Bohosiewicz J. Comparison of prenatal and postnatal treatments of spina bifida in Poland--a non-randomized, single-center study. J Matern Fetal Neonatal Med 2013; 27:1409-17. [PMID: 24156622 DOI: 10.3109/14767058.2013.858689] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally. METHODS The study group (SG) comprised 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study. RESULTS High incidence of prelabor rupture of membranes (24 (52.2%), CI: 3.74 (1.69-8.26) (p < 0.001) was noted in the group of prenatal surgeries as compared to controls. The need for ventriculoperitoneal shunt implantation was statistically significantly lower (p < 0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI: 0.35 (0.16-0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the SG (2 (11.1%) CI: 1.86 (1.00-3.48) p < 0.05) are able to walk independently. CONCLUSIONS Prenatal MMC closure significantly lowers further adverse evolution of the II CM. Further studies are needed, especially on preventive measures for preterm labor and iatrogenic preterm prelabor rupture of membranes (iPPRM) in the postoperative course of IUMR.
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Affiliation(s)
- Jacek Zamłyński
- Department of Gynecology, Obstetrics and Gynecologic Oncology in Bytom, Medical University of Silesia , Bytom , Poland
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Imaging the course of a hypoplastic cerebellum in a spina bifida newborn. Childs Nerv Syst 2013; 29:2131-5. [PMID: 23686389 DOI: 10.1007/s00381-013-2156-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We report about a spina bifida patient with myelomeningocele at the lumbar level L5, extensive Chiari malformation type II with vermal herniation reaching to C6 with downward pontine shift, and a severe hypoplastic cerebellum. Chromosomal diagnostic tests showed no abnormalities. CASE REPORT The infant experienced severe central apneas successfully treated with oxygen therapy and caffeine medication; functional motor level was established at L5 with sparse anal sphincter function. DISCUSSION After surgical intervention (myelomeningocele repair and ventriculoperitoneal shunt placement), these abnormalities significantly improved on radiological imaging; the preoperative hypoplastic, almost undetectable, cerebellum developed to a fair sized cerebellum. Apneas disappeared over time and the patient showed further developmental improvement. Herein, we illustrate and discuss the changes of the cerebellar volume before and after neurosurgical intervention.
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217
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Abstract
Until about forty years ago, the womb shielded the fetus from observation and therapy. The rapid changes in the diagnosis and treatment of human fetal anatomical abnormalities are due to improved fetal imaging studies as well as fetal sampling techniques (e.g. amniocentesis, chorionic villus sampling), and a better understanding of fetal pathophysiology derived from laboratory animals. Fetal therapy is the logical culmination of progress in fetal diagnosis. In other words, the fetus is now a patient. The fetal surgical treatment of the most severe form of spina bifida - myelomeningocele (MMC) - will be used as a paradigm to illustrate progress in and future prospects for fetal surgery. This review will focus on the rationale for in utero repair in the context of pathologic observations and animal models of MMC, outcomes from human fetal MMC repair including the recently completed Management of Myelomeningocele Study (MOMS trial), and future research directions.
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218
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Lei Y, Zhu H, Finnell RH. Prevention of neural tube defects by nucleotide precursors in the curly tail mouse. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.13.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of: Leung KY, De Castro SC, Savery D et al. Nucleotide precursors prevent folic acid-resistant neural tube defects in the mouse. Brain 136(Pt 9), 2836–2841 (2013). In this study, the authors examined the effects of treating curly tail mutant mice, a folate-resistant mouse model, with specific combinations of pyrimidine and purine nucleotide precursors in an effort to prevent neural tube defects. These investigators found that the prevalence of neural tube defects in the group treated with combinations of thymidine and purine nucleotide precursors was significantly lower than that observed in the control groups. Before combination of nucleotide precursors can be used as a new neural tube defect intervention strategy, the beneficial effects, the side effects, as well as other physiological consequences have to be carefully evaluated and compared with other folate-resistant mice and, ultimately, investigated in human cohorts.
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Affiliation(s)
- Yunping Lei
- Dell Pediatric Research Institute, Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Huiping Zhu
- Dell Pediatric Research Institute, Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Richard H Finnell
- Department of Chemistry & Biochemistry, The University of Texas at Austin, Austin, TX, USA
- Dell Pediatric Research Institute, Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA
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219
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Stubberud J, Langenbahn D, Levine B, Stanghelle J, Schanke AK. Goal Management Training improves everyday executive functioning for persons with spina bifida: self-and informant reports six months post-training. Neuropsychol Rehabil 2013; 24:26-60. [PMID: 24168074 DOI: 10.1080/09602011.2013.847847] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Executive dysfunction accounts for significant disability for many patients with spina bifida (SB), thus indicating the need for effective interventions aimed at improving executive functioning in this population. Goal Management Training™ (GMT) is a cognitive rehabilitation approach that targets disorganised behaviour resulting from executive dysfunction, and has received empirical support in studies of other patient groups. The purpose of this study was to determine if GMT would lead to perceived improved executive functioning in the daily lives of patients with SB, as evidenced by reduced report of dysexecutive problems in daily life on self- and informant questionnaires. Thirty-eight adults with SB were included in this randomised controlled trial (RCT). Inclusion was based upon the presence of executive functioning complaints. Experimental subjects (n = 24) received 21 hours of GMT, with efficacy of GMT being compared to results of subjects in a wait-list condition (n = 14). All subjects were assessed at baseline, post-intervention, and at six-month follow-up. Self-report measures indicated that the GMT group's everyday executive functioning improved significantly after training, lasting at least 6 months post-treatment. There were no significant effects on informant-report questionnaires. Overall, these findings indicate that executive difficulties in everyday life can be ameliorated for individuals with congenital brain dysfunction.
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Affiliation(s)
- Jan Stubberud
- a Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway
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220
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Ebid AA, El-Kafy EMA, Alayat MSM. Effect of pulsed Nd:YAG laser in the treatment of neuropathic foot ulcers in children with spina bifida: a randomized controlled study. Photomed Laser Surg 2013; 31:565-70. [PMID: 24160904 DOI: 10.1089/pho.2013.3533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study assessed the effects of pulsed Nd:YAG laser treatment of neuropathic foot ulcers in children with spina bifida. BACKGROUND DATA Children with spina bifida face increased risk for developing neuropathic foot ulcers. METHODS In a randomized controlled trial, 39 children and adolescents (ages 6-15 years) with spina bifida and stage III neuropathic foot ulcers were randomly assigned to the laser group or the placebo laser group. The former received pulsed Nd:YAG laser treatments (i.e., total energy of 300-350 J during three sessions/week) plus standard wound care, and the latter received sham laser treatments plus standard wound care. Wound size and wound appearance were assessed for all patients at the beginning of the treatment, after 5 weeks, and after 10 weeks. RESULTS The decrease in wound surface area at 5 and 10 weeks post- treatment was significantly greater in the laser group (i.e., 2.44 ± 0.33 and 0.29 ± 0.25 cm(2), respectively) than in the placebo group (i.e., 3.81 ± 0.18 and 3.24 ± 0.44 cm(2), respectively). Also, the decrease in the total score for the Pressure Sore Status Tool (PSST) at 5 and 10 weeks post-treatment was significantly different for the laser group (i.e., 32.76 ± 2.30 and 17.52 ± 1.66, respectively) than for the placebo group (i.e., 46.50 ± 2.12 and 38.11 ± 3.17, respectively). CONCLUSIONS Treatment with pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser combined with standard wound care decreases wound size and improves wound appearance for stage III neuropathic foot ulcers in children with spina bifida.
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Affiliation(s)
- Anwar Abdelgayed Ebid
- 1 Department of Surgery, Faculty of Physical Therapy, Cairo University , Giza, Egypt
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221
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Tort J, Lelong N, Prunet C, Khoshnood B, Blondel B. Maternal and health care determinants of preconceptional use of folic acid supplementation in France: results from the 2010 National Perinatal Survey. BJOG 2013; 120:1661-7. [DOI: 10.1111/1471-0528.12414] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J Tort
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - N Lelong
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - C Prunet
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - B Khoshnood
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - B Blondel
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
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222
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Tezcan S, Simsek TT. Comparison of Health-Related Quality of Life between children with cerebral palsy and spina bifida. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2725-2733. [PMID: 23787116 DOI: 10.1016/j.ridd.2013.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/07/2013] [Accepted: 05/07/2013] [Indexed: 06/02/2023]
Abstract
This study has two aims-the first is to compare the Health Related Quality of Life (HRQoL) between children with cerebral palsy (CP) and children with spina bifida (SB); the second is to investigate the relationship between HRQoL and age, sex, body mass index (BMI), level of ambulation, cooperation, family income and the mother's education level in both groups of children. The study included 96 children with CP and 70 children with SB (aged 5-18) who attended a physiotherapy and rehabilitation program at an institute of special training and rehabilitation. Socio-demographic information was obtained within the study. The Child Health Questionnaire (CHQ-PF50) was used to evaluate HRQoL. A significant difference was found in terms of age and BMI between children with CP and SB (p<0.05). HRQoL was lower for children with CP. There was a significant difference between the two groups in terms of role/social limitations - emotional behavioral, behavior, global behavior, parental impact-emotional and parental impact-time (p<0.05). A positive correlation was found between BMI and self-esteem in children with SB, unlike children with CP. The HRQoL of children with CP was lower than children with SB. The parameters of behavior and parental impact were particularly affected in the children with CP. Minimizing behavioral problems (which can improve with advancing age) of the children with CP and reducing parental impact are important for improving the HRQoL of both the child and parents. There is a need for further studies on this issue.
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Affiliation(s)
- Sezen Tezcan
- Special Ilgim Special Education and Rehabilitation Center, Düzce, Turkey
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223
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Lee DH, Phi JH, Kim SK, Cho BK, Kim SU, Wang KC. Enhanced reclosure of surgically induced spinal open neural tube defects in chick embryos by injecting human bone marrow stem cells into the amniotic cavity. Neurosurgery 2013; 67:129-35; discussion 135. [PMID: 20559100 DOI: 10.1227/01.neu.0000371048.76494.0f] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the reclosure-promoting capacity of a neural stem cell line (F3) and a human bone marrow stem cell line (B10) injected into the amniotic cavity of spinal open neural tube defects (ONTDs) of chick embryos of Hamburger and Hamilton stage 18 or 19. METHODS Fifteen chick embryos that survived the procedure were obtained for each of 4 groups: untreated control, F3-, B10-, and HFF-1 (human foreskin fibroblast)-treated groups. Embryos in the control group underwent ONTD surgery but no cell injection. RESULTS Compared with the untreated control and HFF-1 groups, the B10 group showed enhanced reclosure at 3, 5, and 7 days after injection, whereas the F3 group did not. B10 cells were not incorporated into reclosed neural tubes but simply covered ONTDs during the process of reclosure. F3 cells did not cover ONTDs. The cell survival of F3 cells exposed to the chick amniotic fluid in vitro for 48 hours was significantly lower than that of B10 cells. CONCLUSION The results confirmed that B10 cells enhance reclosure of ONTDs by covering and protecting neural tissues, not by direct cell incorporation. The lack of reclosure capacity in the F3 group may be related to the poor survival of F3 cells in the amniotic fluid.
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Affiliation(s)
- Do-Hun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
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224
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Giardini V, Russo FM, Ornaghi S, Todyrenchuk L, Vergani P. Seasonal impact in the frequency of isolated spina bifida. Prenat Diagn 2013; 33:1007-9. [DOI: 10.1002/pd.4175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 04/21/2013] [Accepted: 05/30/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Valentina Giardini
- Department of Obstetrics and Gynecology; University of Milano Bicocca; Monza Italy
| | | | - Sara Ornaghi
- Department of Obstetrics and Gynecology; University of Milano Bicocca; Monza Italy
| | - Lyudmyla Todyrenchuk
- Department of Obstetrics and Gynecology; University of Milano Bicocca; Monza Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology; University of Milano Bicocca; Monza Italy
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225
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An increase in neural tube defect notifications, South Australia, 2009-2010. Western Pac Surveill Response J 2013; 4:30-9. [PMID: 24015369 DOI: 10.5365/wpsar.2012.3.3.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In South Australia, reporting of live births, stillbirths of at least 20 weeks or 400 g birth weight, termination of pregnancies and congenital anomalies is mandated. We describe the investigation of an increase in notifications of neural tube defects (NTDs) in South Australia in 2009 and 2010 using data from several surveillance systems. METHODS NTD trend data from 1966 to 2010 were reviewed. Comparisons of pregnancies affected by an NTD in 2009 and 2010 were made with pregnancies affected by an NTD in the period 2003-2008 and with all pregnancies in 2009 and 2010. Statistical analysis was undertaken using Poisson regression, χ(2) or Fisher's exact tests. RESULTS The prevalence of NTD-affected pregnancies was 1.95 per 1000 births (39 cases) in 2010 and 1.91 per 1000 births in 2009 (38 cases), the highest annual rates since 1991. Case series comparisons indicated women with NTD-affected pregnancies in 2009 and 2010 were less likely to be Caucasian compared with women who had NTD-affected pregnancies in the period 2003-2008. Women born in the Middle East and African region (n = 7) were significantly more likely to have NTD-affected pregnancies in the years 2009 and 2010 (relative risk: 3.03; 95% confidence interval: 1.39-6.62) compared with women born in the Oceania region. DISCUSSION The increased notifications of NTDs can only be partially explained by the increase in numbers of women from the Middle East and African region, with no other contributory causes revealed. This analysis highlighted areas where prevention efforts should be strengthened and surveillance data improved.
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226
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Abstract
Recently published results suggest that prenatal repair of fetal myelomeningocele is a potentially preferable alternative when compared to postnatal repair. In this article, the pathology of myelomeningocele, unique physiologic considerations, perioperative anesthetic management, and ethical considerations of open fetal surgery for prenatal myelomeningocele repair are discussed. Open fetal surgeries have many unique anesthetic issues such as inducing profound uterine relaxation, vigilance for maternal or fetal blood loss, fetal monitoring, and possible fetal resuscitation. Postoperative management, including the requirement for postoperative tocolysis and maternal analgesia, are also reviewed. The success of intrauterine myelomeningocele repair relies on a well-coordinated multidisciplinary approach. Fetal surgery is an important topic for anesthesiologists to understand, as the number of fetal procedures is likely to increase as new fetal treatment centers are opened across the United States.
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227
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Vidal CHF, Silva JCD, Lins CJP, Brainer-Lima AM, Valenca MM. Craniovertebral junction malformation in Northeastern Brazil: the myth of the Dutch colonization. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:405-7. [DOI: 10.1590/0004-282x20130047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 11/14/2012] [Indexed: 11/22/2022]
Abstract
The high prevalence of craniovertebral junction malformation in Northeastern Brazil is historically associated with brachycephalic biotype (flat head), also common in this region. It has been postulated that this trait was introduced to this region by the Dutch during the colonial period in Brazil's history. Based on the confrontation of this paradigm against some historical facts, the authors concluded that the brachycephalic phenotype was inherited from prehistoric ancestors (Amerindians) who were already living in this region when white European men arrived.
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228
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Joó JG, Csaba Á, Szigeti Z, Rigó J. Isolated and ventriculomegaly-associated cases of spina bifida in genetic counseling: focus on fetal pathology. Pathol Res Pract 2013; 209:409-12. [PMID: 23706941 DOI: 10.1016/j.prp.2013.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/12/2012] [Accepted: 04/11/2013] [Indexed: 11/16/2022]
Abstract
Cases of spina bifida alone and in association with ventriculomegaly represent important but different malformations according to clinical characteristics. In our study, we analyzed the data on pregancies terminated because of isolated cases (n=307) and ventriculomegaly-associated cases (n=372) of spina bifida. In spina bifida cases in association with hydrocephalus, positive obstetric history was found approximately 1.5 times more frequently than in the isolated ones. The incidence of positive genetic history was nearly two-fold in the latter cases. In isolated cases of spina bifida, associated malformations were more common than in cases of spina bifida and ventriculomegaly together. The most frequent associated malformations were those of the urogenital system (in cases of spina bifida: 11.1%; in cases of SB+V: 9.14%). The risk of recurrence of SB+V is significantly higher than that of isolated SB (8.9% vs. 2.1%). It can be concluded that positive genetic history is more common in cases of isolated spina bifida. Malformations out of the nervous system are more commonly observed in cases of isolated spina bifida. During the prenatal diagnostics of spina bifida, sonography must focus on malformations of the urogenital system.
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Affiliation(s)
- József Gábor Joó
- 1st Department of Obstetrics and Gynaecology, Faculty of General Medicine, Semmelweis University, Hungary.
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229
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McPherson AC, Swift JA, Yung E, Lyons J, Church P. The assessment of weight status in children and young people attending a spina bifida outpatient clinic: a retrospective medical record review. Disabil Rehabil 2013; 35:2123-31. [PMID: 23510013 PMCID: PMC3857675 DOI: 10.3109/09638288.2013.771705] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 01/21/2013] [Accepted: 01/28/2013] [Indexed: 01/21/2023]
Abstract
PURPOSE Children with disabilities are two to three times more likely to become overweight or obese than typically developing children. Children with spina bifida (SB) are at particular risk, yet obesity prevalence and weight management with this population are under-researched. This retrospective chart review explored how weight is assessed and discussed in a children's SB outpatient clinic. METHOD Height/weight data were extracted from records of children aged 2-18 with a diagnosis of SB attending an outpatient clinic at least once between June 2009-2011. Body mass index was calculated and classified using Centers for Disease Control and Prevention cut-offs. Notes around weight, diet and physical/sedentary activities were transcribed verbatim and analysed using descriptive thematic analysis. RESULTS Of 180 eligible patients identified, only 63 records had sufficient data to calculate BMI; 15 patients were overweight (23.81%) and 11 obese (17.46%). Weight and physical activity discussions were typically related to function (e.g. mobility, pain). Diet discussions focused on bowel and bladder function and dietary challenges. CONCLUSIONS Anthropometrics were infrequently recorded, leaving an incomplete picture of weight status in children with SB and suggesting that weight is not prioritised. Bowel/bladder function was highlighted over other benefits of a healthy body weight, indicating that health promotion opportunities are being missed. Implications for Rehabilitation It is important to assess, categorise and record anthropometric data for children and youth with spina bifida as they may be at particular risk of excess weight. Information around weight categorisation should be discussed openly and non-judgmentally with children and their families. Health promotion opportunities may be missed by focusing solely on symptom management or function. Healthcare professionals should emphasise the broad benefits of healthy eating and physical activity, offering strategies to enable the child to incorporate healthy lifestyle behaviours appropriate to their level of ability.
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Affiliation(s)
- Amy C. McPherson
- Bloorview Research Institute, Dalla Lana School of Public
HealthToronto, ONCanada
| | - Judy Anne Swift
- Division of Nutritional Sciences, University of
NottinghamNottinghamUK
| | - Emily Yung
- Bloorview Research InstituteToronto, ONCanada
| | - Julia Lyons
- Holland Bloorview Kids Rehabilitation HospitalToronto, ONCanada
| | - Paige Church
- Holland Bloorview Kids Rehabilitation HospitalToronto, ONCanada
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230
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Ulus Y, Tander B, Akyol Y, Ulus A, Tander B, Bilgici A, Kuru O, Akbas S. Functional disability of children with spina bifida: its impact on parents' psychological status and family functioning. Dev Neurorehabil 2013; 15:322-8. [PMID: 22712551 DOI: 10.3109/17518423.2012.691119] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the impact of functional disability of Turkish children with spina bifida (SB) on parents' psychological status and family functioning. METHODS Fifty-four children with SB and parents were included. The Functional Measure for Children (WeeFIM), Beck Depression Inventory (BDI), and Family Assessment Device (FAD) were used. RESULTS Mothers' BDI scores were significantly higher than fathers' (p < 0.001). No significant effects of the knowledge of having children with SB before birth and the number of children in families on BDI scores and FAD sub-scores were found (p > 0.05). According to multiple regression analysis; significant correlations with fathers' BDI were problem-solving (p = 0.012) and general functioning (p = 0.037) and with mothers' BDI was roles (p = 0.018). Only childrens age was found to be an influential variable on WeeFIM scores (p < 0.001). CONCLUSION Spina bifida healthcare should include psychological support to parents of these children and this support should be independent from disability level of children.
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Affiliation(s)
- Yasemin Ulus
- Department of Physical Medicine and Rehabilitation, Ondokuz Mayis University, Samsun, Turkey.
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231
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Garabedian C, Di Rocco F, Fallet-Bianco C, Zerah M, Jouannic JM. [Prenatal repair of myelomeningocele: State of the art]. ACTA ACUST UNITED AC 2013; 42:227-31. [PMID: 23453920 DOI: 10.1016/j.jgyn.2012.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 12/20/2022]
Abstract
Myelomeningocele is characterized by the extrusion of the spinal cord into a sac filled with cerebrospinal fluid. One part of the postnatal disabilities could be related to the spinal damage and to the cerebral repercussion of the leak of cerebrospinal fluid from the defect. Several experimental studies in animals have demonstrated that a surgical repair of the lesion at middle gestation reduced the postnatal disabilities. These results were confirmed in humans by the Management of Myelomeningocele (MOM) Trial. However, the prenatal surgical repair is associated with maternal and fetal morbidity.
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Affiliation(s)
- C Garabedian
- Pôle de périnatalité, centre pluridisciplinaire de diagnostic prénatal de l'Est parisien, université Paris 6, hôpital Trousseau, AP-HP, 26, avenue Arnold-Netter, 75012 Paris, France
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232
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Di Rocco C, Trevisi G, Massimi L. Myelomeningocele: an overview. World Neurosurg 2013; 81:294-5. [PMID: 23454181 DOI: 10.1016/j.wneu.2013.02.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 02/08/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Concezio Di Rocco
- Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy.
| | - Gianluca Trevisi
- Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy
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233
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Turner CG, Klein JD, Wang J, Thakor D, Benedict D, Ahmed A, Teng YD, Fauza DO. The Amniotic Fluid As a Source of Neural Stem Cells in the Setting of Experimental Neural Tube Defects. Stem Cells Dev 2013; 22:548-53. [DOI: 10.1089/scd.2012.0215] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Christopher G. Turner
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - Justin D. Klein
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - Junmei Wang
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Division of SCI Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Devang Thakor
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Division of SCI Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Darcy Benedict
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Division of SCI Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Azra Ahmed
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - Yang D. Teng
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Division of SCI Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dario O. Fauza
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
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234
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Abstract
Open spina bifida or myelomeningocele (MMC) is a common birth defect that is associated with significant lifelong morbidity. Little progress has been made in the postnatal surgical management of the child with spina bifida. Postnatal surgery is aimed at covering the exposed spinal cord, preventing infection, and treating hydrocephalus with a ventricular shunt. Experimental and clinical evidence suggest that the primary cause of the neurologic defects associated with MMC is not simply incomplete neurulation, but rather chronic, mechanical and amniotic-fluid induced chemical trauma that progressively damages the exposed neural tissue during gestation. The cerebrospinal fluid leak through the MMC leads to hindbrain herniation and hydrocephalus. In utero repair of open spina bifida is now performed in selected patients and presents an additional therapeutic alternative for expectant mothers carrying a fetus with MMC. In the past, studies in animal models and clinical case series laid the groundwork for a clinical trial to test the safety and efficacy of fetal MMC repair. In the present, a prospective, randomized study (the MOMS trial) has shown that fetal surgery for MMC before 26 weeks' gestation may preserve neurologic function, reverse the hindbrain herniation of the Chiari II malformation, and obviate the need for postnatal placement of a ventriculoperitoneal shunt. However, this study also demonstrates that fetal surgery is associated with significant risks related to the uterine scar and premature birth. In the future, research will expand our understanding of the pathophysiology of MMC, evaluate the long-term impact of in-utero intervention, and to refine timing and technique of fetal MMC surgery using tissue engineering technology.
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Affiliation(s)
- N Scott Adzick
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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235
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Turner CG, Pennington EC, Gray FL, Ahmed A, Teng YD, Fauza DO. Intra-Amniotic Delivery of Amniotic-Derived Neural Stem Cells in a Syngeneic Model of Spina Bifida. Fetal Diagn Ther 2013; 34:38-43. [DOI: 10.1159/000350267] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/26/2013] [Indexed: 11/19/2022]
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236
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Welle-Strand GK, Skurtveit S, Jones HE, Waal H, Bakstad B, Bjarkø L, Ravndal E. Neonatal outcomes following in utero exposure to methadone or buprenorphine: a National Cohort Study of opioid-agonist treatment of Pregnant Women in Norway from 1996 to 2009. Drug Alcohol Depend 2013; 127:200-6. [PMID: 22841456 DOI: 10.1016/j.drugalcdep.2012.07.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/27/2012] [Accepted: 07/04/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND In Norway, most opioid-dependent women are in opioid maintenance treatment (OMT) with either methadone or buprenorphine throughout pregnancy. The inclusion criteria for both medications are the same and both medications are provided by the same health professionals in any part of the country. International studies comparing methadone and buprenorphine in pregnancy have shown differing neonatal outcomes for the two medications. METHOD This study compared the neonatal outcomes following prenatal exposure to either methadone or buprenorphine in a national clinical cohort of 139 women/neonates from 1996 to 2009. RESULTS After adjusting for relevant covariates, buprenorphine-exposed newborns had larger head circumferences and tended to be heavier and longer than methadone-exposed newborns. The incidence of neonatal abstinence syndrome (NAS) and length of treatment of NAS did not differ between methadone- and buprenorphine-exposed newborns. There was little use of illegal drugs and benzodiazepines during the pregnancies. However, the use of any drugs or benzodiazepines during pregnancy was associated with longer lasting NAS-treatment of the neonates. CONCLUSIONS The clinical relevance of these findings is that both methadone and buprenorphine are acceptable medications for the use in pregnancy, in line with previous studies. If starting OMT in pregnancy, buprenorphine should be considered as the drug of choice, due to more favorable neonatal growth parameters. Early confirmation of the pregnancy and systematic follow-up throughout the pregnancy are of importance to encourage the women in OMT to abstain from the use of tobacco, alcohol, illegal drugs or misuse of prescribed drugs.
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Abstract
About three-fourths of the total world population live in the tropics but consume only 6% of worldwide food production and contribute 15% of the world's net revenue explaining the short life expectancy, high infantile mortality, and poor daily caloric intake; moreover, lack of clean drinking water and deficient sanitation promote water-borne infections, diarrhea, and risk of malabsorption that contribute to the prevalence of malnutrition in the tropics. One-third of the world's population consumes insufficient iodine increasing the risk for mental retardation and deafness due to maternal hypothyroidism. The main nutritional syndromes comprise protein-energy malnutrition (marasmus and kwashiorkor); nutritional neuropathies, myelopathies and neuromyelopathies, as well as specific deficiencies of vitamins and micronutrients including iodine, iron, zinc, and selenium.
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Affiliation(s)
- Gustavo C Román
- Department of Neurology, Weill Cornell Medical College and Nantz National Alzheimer Center, Methodist Neurological Institute, Houston, TX, USA.
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238
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Chiari II malformation and syntelencephaly in a young woman: coincidence or pathogenetic association? Clin Neuroradiol 2012; 23:319-21. [PMID: 23263291 DOI: 10.1007/s00062-012-0191-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
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239
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Herrera SRF, Leme RJDA, Valente PR, Caldini ÉG, Saldiva PHN, Pedreira DAL. Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep. EINSTEIN-SAO PAULO 2012; 10:455-61. [DOI: 10.1590/s1679-45082012000400011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 09/27/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. METHODS: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was corrected using the classic neurosurgical technique of three-layer suture (dura mater, muscle and skin closure) performed by a neurosurgeon. In Group 2, a fetal medicine specialist used a biosynthetic cellulose patch to protect the spinal cord and only the skin was sutured above it. Near term (day 132 of gestation) fetuses were sacrificed for pathological analysis. RESULTS: There were two miscarriages and one maternal death. In total, six cases were available for pathological analysis, three in each group. In Group 1, there were adherence of the spinal cord to the scar (meningo-neural adhesion) and spinal cord architecture loss with posterior funiculus destruction and no visualization of grey matter. In Group 2, we observed in all cases formation of a neo-dura mater, separating the nervous tissue from adjacent muscles, and preserving the posterior funiculus and grey matter. CONCLUSION: The new simplified technique was better than the classic neurosurgical technique. It preserved the nervous tissue and prevented the adherence of the spinal cord to the scar. This suggests the current technique used for the correction of spina bifida in humans may need to be reassessed.
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240
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Shin M, Kucik JE, Siffel C, Lu C, Shaw GM, Canfield MA, Correa A. Improved survival among children with spina bifida in the United States. J Pediatr 2012; 161:1132-7. [PMID: 22727874 PMCID: PMC4547557 DOI: 10.1016/j.jpeds.2012.05.040] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/24/2012] [Accepted: 05/17/2012] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate trends in survival among children with spina bifida by race/ethnicity and possible prognostic factors in 10 regions of the United States. STUDY DESIGN A retrospective cohort study was conducted of 5165 infants with spina bifida born during 1979-2003, identified by 10 birth defects registries in the United States. Survival probabilities and adjusted hazard ratios were estimated for race/ethnicity and other characteristics using the Cox proportional hazard model. RESULTS During the study period, the 1-year survival probability among infants with spina bifida showed improvements for whites (from 88% to 96%), blacks (from 79% to 88%), and Hispanics (from 88% to 93%). The impact of race/ethnicity on survival varied by birth weight, which was the strongest predictor of survival through age 8. There was little racial/ethnic variation in survival among children born of very low birth weight. Among children born of low birth weight, the increased risk of mortality to Hispanics was approximately 4-6 times that of whites. The black-white disparity was greatest among children born of normal birth weight. Congenital heart defects did not affect the risk of mortality among very low birth weight children but increased the risk of mortality 4-fold among children born of normal birth weight. CONCLUSIONS The survival of infants born with spina bifida has improved; however, improvements in survival varied by race/ethnicity, and blacks and Hispanics continued to have poorer survival than whites in the most recent birth cohort from 1998-2002. Further studies are warranted to elucidate possible reasons for the observed differences in survival.
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Affiliation(s)
- Mikyong Shin
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and, Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- RTI International, Atlanta, GA
| | - James E. Kucik
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and, Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Csaba Siffel
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and, Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chengxing Lu
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and, Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA
| | | | - Adolfo Correa
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and, Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
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241
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Rofail D, Maguire L, Heelis R, Colligs A, Lindemann M, Abetz L. The impact of spina bifida on caregivers. Neurol Ther 2012; 1:4. [PMID: 26000210 PMCID: PMC4389037 DOI: 10.1007/s40120-012-0004-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Neural tube defects (NTDs) are the second most common birth defects. Spina bifida (SB) and anencephaly make up approximately 90% of total NTDs. Given the number of infants born with an NTD each year, anyone who provides unpaid care for the child (especially caregivers) is affected. This literature review explores the humanistic burden on caregivers of people with SB, specifically myelomeningocele. METHODS A search using PubMed, PsycINFO, and Embase was performed to find studies from 1976 to 2010. Interpretative phenomenological analysis was performed on qualitative data and relevant extracts from the data were collated to form master themes. RESULTS A total of 168 abstracts met the inclusion and exclusion criteria. Of these, 25 articles related to caregivers of individuals with SB. Four master themes emerged: initial diagnosis, living with an individual with SB, social support, and coping. Different aspects of caregivers' lives were found to be affected by caring for a child with SB, including activities of daily living, work impact, time consumption, parental responsibilities, confidence, feelings and emotions, mental health, stress, social impact, psychological adjustment, and relationships. CONCLUSION NTDs, such as SB, present a multitude of issues to caregivers. Issues that affect caregivers of individuals with SB must be addressed in order to reduce the considerable burden that SB places on the caregiver. Continued and enhanced support from health services and patient advocacy groups is needed. For example, providing additional information, support, and empathy can help parents prepare themselves for dealing with the needs of a child with SB over their lifetime.
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Affiliation(s)
- Diana Rofail
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB UK
| | - Laura Maguire
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB UK
| | - Rebecca Heelis
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB UK
| | | | | | - Linda Abetz
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB UK
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242
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Koral K, Blackburn T, Bailey AA, Koral KM, Anderson J. Strengthening the argument for rapid brain MR imaging: estimation of reduction in lifetime attributable risk of developing fatal cancer in children with shunted hydrocephalus by instituting a rapid brain MR imaging protocol in lieu of Head CT. AJNR Am J Neuroradiol 2012; 33:1851-4. [PMID: 22555583 PMCID: PMC7964620 DOI: 10.3174/ajnr.a3076] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 01/26/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Children with shunted hydrocephalus have been undergoing surveillance neuroimaging, generally in the form of head CT, for evaluation of ventricular size. As the life expectancy of these children has improved due to better shunt technology and medical care, risks related to the ionizing radiation incurred during multiple head CT examinations that they are expected to undergo throughout their lifetime have become a concern. The purpose of this study is to estimate the LAR of developing fatal cancer due to head CT for ventricular size assessment in children with shunted hydrocephalus and to assess the impact of instituting a rapid brain MR imaging protocol in reducing radiation exposure. MATERIALS AND METHODS Retrospective review of medical records yielded 182 patients who underwent neuroimaging for assessment of ventricular size. Available neuroimaging studies (head CT and rapid brain MR) were counted and annual neuroimaging frequency was calculated. It was assumed that these patients undergo a similar number of neuroimaging studies annually through 20 years of age. A risk estimate was calculated based on the BEIR VII report and effective doses obtained using the International Commission on Radiologic Protection Report 103 organ weighting factors. RESULTS The mean annual neuroimaging study frequency was 2.1. Based on the average age of 1.89 years, it was assumed neuroimaging surveillance commences in the second year of life. LAR was calculated assuming that a patient undergoes neuroimaging in the form of head CT at this frequency (2/year) through 20 years of age. Assuming 2 scans are performed per year and the low-dose head CT protocol is used, approximately 1 excess lifetime fatal cancer would be generated per 230 patients; with standard head CT, there would be 1 excess lifetime fatal cancer per 97 patients. CONCLUSIONS Children with shunted hydrocephalus are at increased risk of developing fatal cancer if they are to undergo surveillance using head CT. Implementation of a rapid brain MR imaging protocol with no radiation detriment will reduce this risk.
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Affiliation(s)
- K Koral
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75235, USA.
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243
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Johnson CY, Honein MA, Dana Flanders W, Howards PP, Oakley GP, Rasmussen SA. Pregnancy termination following prenatal diagnosis of anencephaly or spina bifida: a systematic review of the literature. ACTA ACUST UNITED AC 2012; 94:857-63. [PMID: 23097374 DOI: 10.1002/bdra.23086] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/28/2012] [Accepted: 09/04/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND In regions where prenatal screening for anencephaly and spina bifida is widespread, many cases of these defects are diagnosed prenatally. The purpose of this study was to estimate the frequency of termination of pregnancy (TOP) following prenatal diagnosis of anencephaly or spina bifida and to investigate factors associated with TOP that might lead to selection bias in epidemiologic studies. METHODS We included articles indexed in Medline or Embase between 1990 and May 2012 reporting the frequency of TOP following prenatal diagnosis of anencephaly or spina bifida with English-language abstracts, 20 or more prenatally diagnosed cases, and at least half of the study years in 1990 or later. We summarized the frequency of TOP across studies using random-effects metaanalysis and stratified results by fetal and study characteristics. RESULTS Among the 17 studies identified, 9 included anencephaly and 15 included spina bifida. Nine were from Europe, six were from North America, and one each was from South America and Asia. The overall frequency of TOP following prenatal diagnosis was 83% for anencephaly (range, 59-100%) and 63% for spina bifida (range, 31-97%). There were insufficient data to stratify the results for anencephaly; TOP for spina bifida was more common when the prenatal diagnosis occurred at less than 24 weeks' gestation, with defects of greater severity, and in Europe versus North America. CONCLUSIONS Because underascertainment of birth defects might be more likely when the pregnancy ends in TOP and TOP is associated with fetal characteristics, selection bias is possible in epidemiologic studies of anencephaly or spina bifida.
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Affiliation(s)
- Candice Y Johnson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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244
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Vinck A, Maassen BAM, Hulstijn W, Diender MG, Mullaart RA, Rotteveel JJ, Nijhuis-van der Sanden MWG. Motor sequence learning in children with spina bifida. Dev Neuropsychol 2012; 37:601-16. [PMID: 23066938 DOI: 10.1080/87565641.2012.697502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cognitive and motor problems are common in children with spina bifida (SB), particularly in those children with cerebral malformations (SBM). Little is known about how these conditions affect motor learning. This study examines motor sequence learning in children with SB, SBM, and healthy controls. Assessment consisted of neuropsychological tests, a simple drawing task, and a spatial motor sequence learning task. Implicit motor learning was unaffected in children with SB(M), and their sequence learning ability was also similar to that of controls. However, both groups (SB and SBM) showed impaired motor performance. The role of cerebellar malformation with SB(M) is discussed.
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Affiliation(s)
- Anja Vinck
- Department of Medical Psychology/Pediatric Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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245
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Bower C. Mandatory fortification of flour with folic acid to prevent neural-tube defects. ACTA ACUST UNITED AC 2012; 3:309-14. [PMID: 19803989 DOI: 10.2217/17455057.3.3.309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Firm evidence from randomized, controlled trials that maternal periconceptional folic acid reduced the risk of neural-tube defects was published in the early 1990s. Despite promotion of periconceptional folic acid supplement use, no more than 50% of women take them and so mandatory fortification of a staple food has been considered by many countries as an important adjunct to any public-health approach for the prevention of neural-tube defects. Even 15 years after the confirming evidence, some countries have yet to commit to mandatory fortification and, in those that have, there is limited and poorly coordinated monitoring and evaluation of its effectiveness and safety.
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Affiliation(s)
- Carol Bower
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia 6874, Australia.
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246
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Reamon-Buettner S, Borlak J. Genetic analysis of cardiac-specific transcription factors reveals novel insights into molecular causes of congenital heart disease. Future Cardiol 2012; 1:355-61. [PMID: 19804118 DOI: 10.1517/14796678.1.3.355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Heart development is complex and requires the sequential and timely interplay of regulatory master proteins, notably several transcription factors. Germline mutations in the human transcription factor genes have been associated with congenital heart disease (CHD), but familial cases studied so far have different mutations. There is no strict genotype-phenotype correlation and mutations in transcription factor genes are rare in unrelated patients. Most cases of CHD come from unaffected family members. The study of archived, but morphologically well-characterized malformed hearts for DNA alterations provides important clues regarding cardiogenic transcription factor genes that would lead to loss-of-function of the protein. Identification of tissue-restricted multiple mutations and multiple haplotypes suggests that somatic mutation and mosaicism are linked to cardiac anomalies. Altogether, somatic mutations and genomic instability in the diseased cardiac tissues of patients with CHD provide a novel mechanism of disease.
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Affiliation(s)
- Sm Reamon-Buettner
- Fraunhofer Institute of Toxicology and Experimental Medicine, Drug Research and Medical Biotechnology, Nikolai-Fuchs-Strasse 1, D-30625 Hannover, Germany
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Lee NG, Gomez P, Uberoi V, Kokorowski PJ, Khoshbin S, Bauer SB, Estrada CR. In Utero Closure of Myelomeningocele Does Not Improve Lower Urinary Tract Function. J Urol 2012; 188:1567-71. [DOI: 10.1016/j.juro.2012.06.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Nora G. Lee
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Pablo Gomez
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Vikrant Uberoi
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Paul J. Kokorowski
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Shahram Khoshbin
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart B. Bauer
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Carlos R. Estrada
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
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248
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Diemert A, Diehl W, Glosemeyer P, Deprest J, Hecher K. Intrauterine surgery--choices and limitations. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:603-38. [PMID: 23093990 DOI: 10.3238/arztebl.2012.0603] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 04/25/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND The past decade has seen much progress in intrauterine surgery. Randomized trials have documented the benefit of some procedures of this type for the unborn child. METHOD Selective literature review RESULTS Randomized trials have demonstrated the benefit of fetoscopic laser coagulation of placental anastomoses in twin-to-twin transfusion syndrome (TTTS) and of intrauterine surgery via hysterotomy for the repair of spina bifida. Other fetoscopic procedures have yielded promising initial results but are not yet supported by findings from randomized trials. Some intrauterine surgical procedures must still be considered experimental in view of the lack of randomized trials and the rarity of the conditions they are designed to treat. Fetoscopic laser coagulation for TTTS is by far the most common procedure in fetal surgery; TTTS arises in roughly 1 in 2500 pregnancies. The other procedures discussed in this article are performed much less often and for rarer indications. In general, intrauterine surgery is indicated only to treat conditions that would otherwise lead to intrauterine death or irreversible prenatal damage. CONCLUSION Intrauterine surgery is a rapidly developing field. Prenatal intervention by laser coagulation is indicated to treat severe TTTS, as its benefit has been shown in a randomized trial. Not enough evidence is yet available for the possible benefit of intrauterine surgery to treat myelomeningocele and congenital diaphragmatic hernia. Other indications are experimental. When an indication for intrauterine surgery exists, the parents should be informed and, depending on their wishes, referred to a center where it can be performed.
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Affiliation(s)
- Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Germany
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249
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Periconceptional folate deficiency and implications in neural tube defects. J Pregnancy 2012; 2012:295083. [PMID: 22900183 PMCID: PMC3415073 DOI: 10.1155/2012/295083] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/03/2012] [Accepted: 06/04/2012] [Indexed: 12/28/2022] Open
Abstract
Nutritional deficiencies are preventable etiological and epigenetic factors causing congenital abnormalities, first cause of infant mortality. Folate deficiency has a well-established teratogenic effect, leading to an increasing risk of neural tube defects. This paper highlights the most recent medical literature about folate deficiency, be it maternal or paternal. It then focuses on associated deficiencies as nutritional deficiencies are multiple and interrelated. Observational and interventional studies have all been consistent with a 50–70% protective effect of adequate women consumption of folates on neural tube defects. Since strategies to modify women's dietary habits and vitamin use have achieved little progress, scientific as well as political effort is mandatory in order to implement global preventive public health strategies aimed at improving the alimentation of women in reproductive age, especially folic acid supplementation. Even with the recent breakthrough of fetal surgery for myelomeningocele, the emphasis should still be on prevention as the best practice rather than treatment of neural tube defects.
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250
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Abstract
The prevalence of neural tube defects (NTD) in Europe is around 9 per 10,000 births making it one of the most frequent congential anomalies affecting the central nervous system. NTD encompass all anomalies that are secondary to failure of closure of the neural tube. In this review, we will first summarize the embryology and some epidemiologic aspects related to NTDs. The review focuses on myelomeningocele (MMC), which is the most common distal closure defect. We will describe the secondary pathologic changes in the central and peripheral nervous system that appear later on in pregnancy and contribute to the condition's morbidity. The postnatal impact of MMC mainly depends on the upper level of the lesion. In Europe, the vast majority of parents with a fetus with prenatally diagnosed NTDs, including MMC, opt for termination of pregnancy, as they are apparently perceived as very debilitating conditions. Animal experiments have shown that prenatal surgery can reverse this sequence. This paved the way for clinical fetal surgery resulting in an apparent improvement in outcome. The results of a recent randomized trial confirmed better outcomes after fetal repair compared to postnatal repair; with follow up for 30 months. This should prompt fetal medicine specialists to reconsider their position towards this condition as well as its prenatal repair. The fetal surgery centre in Leuven did not have a clinical programme for fetal NTD repair until the publication of the MOMS trial. In order to offer this procedure safely and effectively, we allied to a high volume centre willing to share its expertise and assist us in the first procedures. Given the maternal side effects of current open fetal surgical techniques, we have intensified our research programmes to explore minimally invasive alternatives. Below we will describe how we are implementing this.
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