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Filges I, Jünemann S, Viehweger E, Tercanli S. Fetal arthrogryposis-what do we tell the prospective parents? Prenat Diagn 2023; 43:798-805. [PMID: 36588183 DOI: 10.1002/pd.6299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/11/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Arthrogryposis, also termed arthrogryposis multiplex congenita, is a descriptive term for conditions with multiple congenital contractures (MCC). The etiology is extremely heterogeneous. More than 400 specific disorders have been identified so far, which may lead to or are associated with MCC and/or fetal hypo- and akinesia as a clinical sign. With improved sensitivity of prenatal ultrasound and expanding prenatal diagnostic options, clinicians are tasked with providing early detection in order to counsel the prospective parents regarding further prenatal diagnostic as well as management options. We summarize the most important knowledge to raise awareness for early detection in pregnancy. We review essential points for counseling when MCC is detected in order to provide answers to common questions, which, however, cannot replace interdisciplinary expert opinion in the individual case.
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Affiliation(s)
- Isabel Filges
- Medical Genetics, Institute of Medical Genetics and Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stephanie Jünemann
- Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel UKBB and University of Basel, Basel, Switzerland
| | - Elke Viehweger
- Pediatric Orthopedics, Neuro-Orthopedics and Movement Analysis Center, University Children's Hospital Basel UKBB and University of Basel, Basel, Switzerland
| | - Sevgi Tercanli
- Center for Prenatal Ultrasound, Basel and University of Basel, Basel, Switzerland
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2
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Hall JG. The mystery of monozygotic twinning I: What can Amyoplasia tell us about monozygotic twinning and the possible role of twin-twin transfusion? Am J Med Genet A 2021; 185:1816-1821. [PMID: 33760374 DOI: 10.1002/ajmg.a.62172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 01/13/2023]
Abstract
Amyoplasia is a very specific, nongenetic clinically recognizable form of arthrogryposis, representing about one-third of individuals with arthrogryposis surviving the newborn period. There is a markedly increased number of individuals with Amyoplasia who are one of monozygotic (MZ) twins, with the other twin being normal. Thus, it would appear that Amyoplasia is definitely associated with and may be caused by an MZ twinning event. The twin-twin transfusion seen in MZ twins could play an etiologic role in producing Amyoplasia. In this article, Amyoplasia twinning is compared to twinning in other forms of arthrogryposis. The accompanying paper examines various types of MZ twinning (Hall, 2021). Amyoplasia is primarily associated with spontaneous MZ twinning.
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Affiliation(s)
- Judith G Hall
- Department of Pediatrics and Medical Genetics, British Columbia Children's Hospital, University of British Columbia and Children's and Women's Health Centre of British Columbia, Vancouver, Canada
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3
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Park KB, Chapman T, Aldinger KA, Mirzaa GM, Zeiger J, Beck A, Glass IA, Hevner RF, Jansen AC, Marshall DA, Oegema R, Parrini E, Saneto RP, Curry CJ, Hall JG, Guerrini R, Leventer RJ, Dobyns WB. The spectrum of brain malformations and disruptions in twins. Am J Med Genet A 2020; 185:2690-2718. [PMID: 33205886 DOI: 10.1002/ajmg.a.61972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/27/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022]
Abstract
Twins have an increased risk for congenital malformations and disruptions, including defects in brain morphogenesis. We analyzed data on brain imaging, zygosity, sex, and fetal demise in 56 proband twins and 7 less affected co-twins with abnormal brain imaging and compared them to population-based data and to a literature series. We separated our series into malformations of cortical development (MCD, N = 39), cerebellar malformations without MCD (N = 13), and brain disruptions (N = 11). The MCD group included 37/39 (95%) with polymicrogyria (PMG), 8/39 (21%) with pia-ependymal clefts (schizencephaly), and 15/39 (38%) with periventricular nodular heterotopia (PNH) including 2 with PNH but not PMG. Cerebellar malformations were found in 19 individuals including 13 with a cerebellar malformation only and another 6 with cerebellar malformation and MCD. The pattern varied from diffuse cerebellar hypoplasia to classic Dandy-Walker malformation. Brain disruptions were seen in 11 individuals with hydranencephaly, porencephaly, or white matter loss without cysts. Our series included an expected statistically significant excess of monozygotic (MZ) twin pairs (22/41 MZ, 54%) compared to population data (482/1448 MZ, 33.3%; p = .0110), and an unexpected statistically significant excess of dizygotic (DZ) twins (19/41, 46%) compared to the literature cohort (1/46 DZ, 2%; p < .0001. Recurrent association with twin-twin transfusion syndrome, intrauterine growth retardation, and other prenatal factors support disruption of vascular perfusion as the most likely unifying cause.
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Affiliation(s)
- Kaylee B Park
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Teresa Chapman
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kimberly A Aldinger
- Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, Washington, USA
| | - Ghayda M Mirzaa
- Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Jordan Zeiger
- Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, Washington, USA
| | - Anita Beck
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ian A Glass
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Robert F Hevner
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Anna C Jansen
- Neurogenetics Research Group, Reproduction Genetics and Regenerative Medicine Research Cluster, Vrije Universiteit Brussel, Brussels, Belgium.,Pediatric Neurology Unit, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Desiree A Marshall
- Department of Anatomic Pathology and Neuropathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Renske Oegema
- University Medical Center Utrecht, Department of Genetics, Utrecht, The Netherlands
| | - Elena Parrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Russell P Saneto
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Cynthia J Curry
- Genetic Medicine, Department of Pediatrics, University of California San Francisco, Fresno, California, USA
| | - Judith G Hall
- Departments of Medical Genetics and Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, Canada
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Richard J Leventer
- Department of Neurology, Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne Department of Pediatrics, Melbourne, Australia
| | - William B Dobyns
- Department of Pediatrics, Division of Genetics and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
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Salinas-Torres VM, Salinas-Torres RA, Cerda-Flores RM, Gallardo-Blanco HL, Martínez-de-Villarreal LE. A clinical-pathogenetic approach on associated anomalies and chromosomal defects supports novel candidate critical regions and genes for gastroschisis. Pediatr Surg Int 2018; 34:931-943. [PMID: 30094464 DOI: 10.1007/s00383-018-4331-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gastroschisis has been assumed to have a low rate of syndromic and primary malformations. We aimed to systematically review and explore the frequency and type of malformations/chromosomal syndromes and to identify significant biological/genetic roles in gastroschisis. METHODS Population-based, gastroschisis-associated anomalies/chromosomal defects published 1950-2018 (PubMed/MEDLINE) were independently searched by two reviewers. Associated anomalies/chromosomal defects and selected clinical characteristics were subdivided and pooled by race, system/region, isolated, and associated cases (descriptive analysis and chi-square test were performed). Critical regions/genes from representative chromosomal syndromes including an enrichment analysis using Gene Ontology Consortium/Panther Classification System databases were explored. Fisher's exact test with False Discovery Rate multiple test correction was performed. RESULTS Sixty-eight articles and 18525 cases as a base were identified (prevalence of 17.9 and 3% for associated anomalies/chromosomal defects, respectively). There were 3596 associated anomalies, prevailing those cardiovascular (23.3%) and digestive (20.3%). Co-occurring anomalies were associated with male, female, American Indian, Caucasian, prenatally diagnosed, chromosomal defects, and mortality (P < 0.00001). Gene clusters on 21q22.11 and 21q22.3 (KRTAP), 18q21.33 (SERPINB), 18q22.1 (CDH7, CDH19), 13q12.3 (FLT1), 13q22.1 (KLF5), 13q22.3 (EDNRB), and 13q34 (COL4A1, COL4A2, F7, F10) were significantly related to biological processes: blood pressure regulation and/or vessel integrity, angiogenesis, coagulation, cell-cell and/or cell-matrix adhesion, dermis integrity, and wound healing (P < 0.05). CONCLUSIONS Our findings suggest that gastroschisis may result from the interaction of several chromosomal regions in an additive manner as a pool of candidate genes were identified from critical regions supporting a role for vascular disruption, thrombosis, and mesodermal deficiency in the pathogenesis of gastroschisis.
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Affiliation(s)
- Victor M Salinas-Torres
- Departamento de Genética, Facultad de Medicina y Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos S/N Col. Mitras Centro, CP 64460, Monterrey, Nuevo León, México.
| | - Rafael A Salinas-Torres
- Departamento de Sistemas y Computación, Instituto Tecnológico de Tijuana, Calzada del Tecnológico S/N Fracc. Tomas Aquino, CP 22414, Tijuana, Baja California, México
| | - Ricardo M Cerda-Flores
- Universidad Autónoma de Nuevo León, Facultad de Enfermería, Dr. José Eleuterio González 1500, Mitras Centro, CP 64460, Monterrey, Nuevo León, México
| | - Hugo L Gallardo-Blanco
- Departamento de Genética, Facultad de Medicina y Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos S/N Col. Mitras Centro, CP 64460, Monterrey, Nuevo León, México
| | - Laura E Martínez-de-Villarreal
- Departamento de Genética, Facultad de Medicina y Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos S/N Col. Mitras Centro, CP 64460, Monterrey, Nuevo León, México
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5
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Congenital lateral abdominal wall defect in two Congolese children. Clin Dysmorphol 2018; 28:50-52. [PMID: 30138140 DOI: 10.1097/mcd.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Arthrogryposis multiplex congenital (AMC) is a descriptive term for a group of conditions that all share the characteristic of congenital contractures. There are an estimated 400 discrete diagnoses that can lead to a child being born with arthrogryposis. The 2 biggest categories of conditions are amyoplasia and distal arthrogryposis, which combined make up ∼50% to 65% of all diagnoses within the AMC subset. Amyoplasia, the most common AMC condition, seems to be a nongenetic syndrome, leading to very characteristic upper and lower limb contractures. The distal arthrogryposes, in contrast, have an underlying genetic abnormality, which in many cases seems to target the fast twitch muscles of the developing fetus. Classifying AMC is a difficult task, given the broad range of conditions represented. Four different classification schemes are presented.
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Affiliation(s)
- Judith G Hall
- *Departments of Medical Genetics and Pediatrics, University of British Columbia †British Columbia Children's Hospital, Child and Family Research Institute, Vancouver, BC, Canada ‡Department of Pediatrics, University of Gothenburg, The Queen Silvia Children's Hospital, Gothenburg, Sweden §Department of Orthopaedic Surgery, Shriners Hospital for Children, Philadelphia, PA
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7
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Abstract
Clinical genetics is the application of advances in genetics and medicine to real human families. It involves diagnosis, care, and counseling concerning options available to affected individuals and their family members. Advances in medicine and genetics have led to dramatic changes in the scope and responsibilities of clinical genetics. This reflection on the last 50+ years of clinical genetics comes from personal experience, with an emphasis on the important contributions that clinical geneticists have made to the understanding of disease/disorder processes and mechanisms. The genetics clinic is a research laboratory where major advances in knowledge can and have been made.
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Affiliation(s)
- Judith G. Hall
- Department of Medical Genetics and Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver V6H 3N1, Canada
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8
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Abstract
Arthrogryposis multiplex congenita (AMC) is a heterogeneous condition defined as multiple congenital joint contractures in two or more body areas. The common pathogenesis is impaired fetal movements. Amyoplasia, the most frequent form, is a sporadically occurring condition with hypoplastic muscles and joint contractures. Distal arthrogryposis (DA) syndromes are often hereditary, and joint involvement is predominantly in the hands and feet. In a Swedish study, 131 patients with arthrogryposis were investigated. The most frequent diagnoses were amyoplasia and DA. In amyoplasia, muscle strength was found to be more important than joint range of motion (ROM) for motor function. In DA, muscle weakness was present in 44 % of investigated patients. The clinical findings were found to be highly variable between families and also within families with DA. Fetal myopathy due to sarcomeric protein dysfunction can cause DA. An early multidisciplinary team evaluation of the child with arthrogryposis for specific diagnosis and planning of treatment is recommended. Attention should be directed at the development of muscle strength with early stimulation of active movements. Immobilization should be minimized.
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Affiliation(s)
- Eva Kimber
- Department of Pediatrics, Institute of Clinical Sciences at Sahlgrenska Academy, The Queen Silvia Children´s Hospital, Gothenburg, Sweden
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Wertelecki W, Yevtushok L, Zymak-Zakutnia N, Wang B, Sosyniuk Z, Lapchenko S, Hobart HH. Blastopathies and microcephaly in a Chornobyl impacted region of Ukraine. Congenit Anom (Kyoto) 2014; 54:125-49. [PMID: 24666273 PMCID: PMC4233949 DOI: 10.1111/cga.12051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/05/2014] [Indexed: 12/17/2022]
Abstract
This population-based descriptive epidemiology study demonstrates that rates of conjoined twins, teratomas, neural tube defects, microcephaly, and microphthalmia in the Rivne province of Ukraine are among the highest in Europe. The province is 200 km distant from the Chornobyl site and its northern half, a region known as Polissia, is significantly polluted by ionizing radiation. The rates of neural tube defects, microcephaly and microphthalmia in Polissia are statistically significantly higher than in the rest of the province. A survey of at-birth head size showed that values were statistically smaller in males and females born in one Polissia county than among neonates born in the capital city. These observations provide clues for confirmatory and cause-effect prospective investigations. The strength of this study stems from a reliance on international standards prevalent in Europe and a decade-long population-based surveillance of congenital malformations in two distinct large populations. The limitations of this study, as those of other descriptive epidemiology investigations, is that identified cause-effect associations require further assessment by specific prospective investigations designed to address specific teratogenic factors.
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Affiliation(s)
- Wladimir Wertelecki
- Department of Medical Genetics, College of Medicine, University of South AlabamaMobile, Alabama, USA
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
| | - Lyubov Yevtushok
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
- Rivne Regional Medical Diagnostic CenterRivne, Rivne Province, Ukraine
| | - Natalia Zymak-Zakutnia
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
- Khmelnytsky Perinatal CenterKhmelnytsky, Khmelnytsky Province, Ukraine
| | - Bin Wang
- Department of Mathematics and Statisitcs, University of South AlabamaMobile, Alabama, USA
| | - Zoriana Sosyniuk
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
- Rivne Regional Medical Diagnostic CenterRivne, Rivne Province, Ukraine
| | - Serhiy Lapchenko
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
| | - Holly H Hobart
- Cyto-Genetics Laboratory, Department of Pathology, University of Mississippi Medical CenterJackson, Mississippi, USA
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Borja Andueza L, Apilanez Urquiola M, Cortajarena Altuna M, Martí Carrera I. Amioplasia congénita. An Pediatr (Barc) 2014; 81:63-5. [DOI: 10.1016/j.anpedi.2013.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022] Open
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Lubinsky M. A vascular and thrombotic model of gastroschisis. Am J Med Genet A 2014; 164A:915-7. [PMID: 24458365 DOI: 10.1002/ajmg.a.36370] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/17/2013] [Indexed: 01/09/2023]
Abstract
A binary vascular/thrombotic pathogenesis for gastroschisis, a form of congenital bowel herniation, is proposed, where normal right umbilical vein involution creates a possible site for thrombosis adjacent to the umbilical ring. If thrombosis occurs, it weakens the area, explaining overwhelmingly right-sided lesions. The model arises from the existence of two groups of risk factors with different maternal age associations. Older mothers show a greater association with vascular factors (although this may actually represent a lack of any significant maternal age effect), consistent with associations of gastroschisis with congenital heart lesions and with amyoplasia. Alternatively, other predispositions, and especially decreased maternal age, the greatest known risk factor, associate with factors raising maternal estrogen, with evidence that estrogen in turn acts here as a predisposition to thrombosis. Absorption of thrombotic by-products from the amniotic fluid can explain the unusual amniocyte inclusions that are common with gastroschisis, while a role for estrogens suggests a connection between rising gastroschisis prevalence and increasing environmental contamination with estrogen disruptors. This model explains a variety of structural and epidemiological findings, and suggests that stratification of data based on binary effects may clarify associated risks and mechanisms. The model also shows that what is often referred to as vascular disruption may actually reflect alternative or additional factors instead, including thrombosis as a primary mechanism.
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Hall JG, Aldinger KA, Tanaka KI. Amyoplasia revisited. Am J Med Genet A 2014; 164A:700-30. [DOI: 10.1002/ajmg.a.36395] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 11/14/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Judith G. Hall
- Departments of Medical Genetics and Pediatrics; University of British Columbia and BC Children's Hospital; Vancouver Canada
| | - Kimberly A. Aldinger
- Center for Integrative Brain Research; Seattle Children's Research Institute; Seattle Washington
| | - Kimi I. Tanaka
- Departments of Medical Genetics and Pediatrics; University of British Columbia and BC Children's Hospital; Vancouver Canada
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Filges I, Hall JG. Failure to identify antenatal multiple congenital contractures and fetal akinesia - proposal of guidelines to improve diagnosis. Prenat Diagn 2013; 33:61-74. [DOI: 10.1002/pd.4011] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Isabel Filges
- Department of Medical Genetics, BC Children's and Women's Hospital, Child and Family Research Institute; University of British Columbia; Vancouver Canada
- Division of Medical Genetics, University Children's Hospital and Department of Biomedicine; University of Basel; Basel Switzerland
| | - Judith G. Hall
- Department of Medical Genetics, BC Children's and Women's Hospital, Child and Family Research Institute; University of British Columbia; Vancouver Canada
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Haliloglu G, Topaloglu H. Arthrogryposis and fetal hypomobility syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2013; 113:1311-9. [PMID: 23622356 DOI: 10.1016/b978-0-444-59565-2.00003-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Arthrogryposis is a heterogeneous condition, evident from birth, which can be defined as multiple contractures of the joints. The etiology is multifold: genetic disorders of the central or peripheral nervous system, or of the connective tissue leading to decreased fetal movements, and vascular and environmental causes. The problem begins in utero. There may be overlapping conditions between sporadic, syndromic, neurogenic, myopathic and metabolic types. The workup should include a family tree. Systemic involvement, for example of the renal and pulmonary systems, may be encountered in associated syndromes. Motor neuron disorders leading to the condition are the most commonly seen type. Fetal or neonatal akinesia/hypokinesia is at the severe end of the spectrum, in which there is literally intrauterine limitation of movement. Children with amyplasia are born with little or diminished muscle bulk of the extremities. Distal arthrogryposis is almost always a dominantly inherited condition. A multidisciplinary care approach is required in order to provide optimum healthcare. The management team should include a nutritionist and a physiotherapist. Genetic counseling is possible in most instances. A truly genetic cause can be identified in more than 50% of cases. Survivors, though handicapped, can lead near normal lives.
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Affiliation(s)
- Goknur Haliloglu
- Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey
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Hall JG. Arthrogryposis (multiple congenital contractures) associated with failed termination of pregnancy. Am J Med Genet A 2012; 158A:2214-20. [DOI: 10.1002/ajmg.a.35531] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/21/2012] [Indexed: 11/06/2022]
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16
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Filges I, Hall JG. We are failing to identify disorders of fetal movement - why? Prenat Diagn 2012; 32:919-20. [DOI: 10.1002/pd.3944] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/01/2012] [Indexed: 12/21/2022]
Affiliation(s)
- Isabel Filges
- Department of Medical Genetics, BC Children's and Women's Hospital, Child and Family Research Institute; University of British Columbia; Vancouver Canada
| | - Judith G. Hall
- Department of Medical Genetics, BC Children's and Women's Hospital, Child and Family Research Institute; University of British Columbia; Vancouver Canada
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Liewluck T, Sacharow SJ, Fan Y, Lopez-Alberola R. A novel sporadic 614-Kb duplication of the 22q11.2 chromosome in a child with amyoplasia. J Child Neurol 2011; 26:1005-8. [PMID: 21572057 DOI: 10.1177/0883073810394846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Arthrogryposis is a rare congenital disorder characterized by multiple fixed joint contractures. Decreased fetal movement, regardless of etiology, causes an immobilization of the affected joints and subsequent contractures. Amyoplasia refers to the most common variant of arthrogryposis in which patients develop symmetrical limb contractures because of muscle underdevelopment. It is a sporadic condition with no known genetic abnormality being linked to this syndrome. The authors report a 4-month-old boy with amyoplasia carrying a novel de novo 614-Kb duplication of the 22q11.2 region. Amyoplasia has not been reported in patients with 22q11.2 microduplication syndrome. This particular 614-Kb duplicated segment contains 7 genes located within the typical 22q11.2 duplication region and 2 genes, TUBA8 and USP18, mapping outside of the typical region. This patient broadens the phenotypic spectrum of the 22q11.2 microduplication syndrome and raises the possibility that TUBA8 and USP18 may play an important role in the pathogenesis of amyoplasia.
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Affiliation(s)
- Teerin Liewluck
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136, USA
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Ruano R, Picone O, Bernardes L, Martinovic J, Dumez Y, Benachi A. The association of gastroschisis with other congenital anomalies: how important is it? Prenat Diagn 2011; 31:347-50. [DOI: 10.1002/pd.2689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/02/2010] [Accepted: 11/02/2010] [Indexed: 11/07/2022]
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Kamien B, Zankl A, Gabbett M. Septo-optic dysplasia and associations with amyoplasia and gastroschisis. ACTA ACUST UNITED AC 2010; 88:497-501. [DOI: 10.1002/bdra.20663] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Werler MM, Mitchell AA, Moore CA, Honein MA. Is there epidemiologic evidence to support vascular disruption as a pathogenesis of gastroschisis? Am J Med Genet A 2009; 149A:1399-406. [PMID: 19533769 DOI: 10.1002/ajmg.a.32897] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Gastroschisis is a congenital defect of the abdominal wall that occurs most commonly in the offspring of young women. The defect is often hypothesized to result from vascular disruption in the early embryo. We measured the associations between maternal vasoactive exposures in pregnancy, as possible markers of vascular disruption, and gastroschisis risk, using data collected as part of the National Birth Defects Prevention Study. Study participants included mothers of births from October 1997 to December 2003 in 10 states. The mothers of 514 gastroschisis cases were matched by age at delivery and state to 3,277 non-malformed controls and compared for periconceptional smoking and use of vasoconstrictors, non-steroidal anti-inflammatory drugs (NSAIDs), and vasodilators. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CI) were estimated from conditional logistic regression. Case mothers were more likely than control mothers to smoke (OR = 1.5, 95% CI = 1.2-1.9) and report use of non-aspirin NSAIDs (1.4, 1.1-1.7) and anti-hypertensive vasodilators (2.6, 0.9-8.0), but not vasoconstrictive decongestants (1.0, 0.7-1.4). Cigarette smoking had little effect on gastroschisis risk in mothers <25 years of age, but the OR was 3.0 (1.8-5.0) for those >or=25 years. Likewise, ORs were greatest in the older women for use of non-aspirin NSAIDs (1.6, 1.0-2.6) and bronchodilators (3.0, 1.8-5.0). These findings suggest that, overall, vasoactive risk factors play a minor role in the etiology of gastroschisis, and do not support the vascular disruption hypothesis. However, the observation that increased ORs for some vasoactive exposures were confined to older women raises the question of whether inherent maternal factors might influence risk.
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Affiliation(s)
- Martha M Werler
- Slone Epidemiology Center at Boston University, Boston, Massachusetts 02215, USA
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Hunter AG, Stevenson RE. Gastroschisis: Clinical presentation and associations. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2008; 148C:219-30. [DOI: 10.1002/ajmg.c.30178] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hurst J, Firth HV, Chitty LS. Syndromic associations with congenital anomalies of the fetal thorax and abdomen. Prenat Diagn 2008; 28:676-84. [DOI: 10.1002/pd.2023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Digilio MC, Capolino R, Dallapiccola B. Autosomal dominant transmission of nonsyndromic diastasis recti and weakness of the linea alba. Am J Med Genet A 2008; 146A:254-6. [PMID: 18076103 DOI: 10.1002/ajmg.a.32044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Feldkamp ML, Carey JC, Sadler TW. Development of gastroschisis: review of hypotheses, a novel hypothesis, and implications for research. Am J Med Genet A 2007; 143A:639-52. [PMID: 17230493 DOI: 10.1002/ajmg.a.31578] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gastroschisis, a ventral body wall defect, is a continuing challenge and concern to researchers, clinicians, and epidemiologists seeking to identify its cause(s) and pathogenesis. Concern has been renewed in recent years because, unlike most other birth defects, rates of gastroschisis are reportedly increasing in many developed and developing countries. No tenable explanation or specific causes have been identified for this trend. Rates of gastroschisis are particularly high among pregnancies of very young women. Such an intriguing association, not observed to this degree with other birth defects, may afford clues to the defect's cause. Understanding the causes of gastroschisis may provide insight to the defect's origin. In pursuing such causal studies, it would be helpful to understand the embryogenesis of gastroschisis. To date, four main embryologic hypotheses have been proposed: (1) Failure of mesoderm to form in the body wall; (2) Rupture of the amnion around the umbilical ring with subsequent herniation of bowel; (3) Abnormal involution of the right umbilical vein leading to weakening of the body wall and gut herniation; and (4) Disruption of the right vitelline (yolk sac) artery with subsequent body wall damage and gut herniation. Although based on embryological phenomena, these hypotheses do not provide an adequate explanation for how gastroschisis would occur. Therefore, we propose an alternative hypothesis, based on well described embryonic events. Specifically, we propose that abnormal folding of the body wall results in a ventral body wall defect through which the gut herniates, leading to the clinical presentation of gastroschisis. This hypothesis potentially explains the origin of gastroschisis as well as that of other developmental defects of the ventral wall.
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Affiliation(s)
- Marcia L Feldkamp
- Department of Pediatrics, Division of Medical Genetics, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA.
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Mastroiacovo P, Lisi A, Castilla EE, Martínez-Frías ML, Bermejo E, Marengo L, Kucik J, Siffel C, Halliday J, Gatt M, Annerèn G, Bianchi F, Canessa MA, Danderfer R, de Walle H, Harris J, Li Z, Lowry RB, McDonell R, Merlob P, Metneki J, Mutchinick O, Robert-Gnansia E, Scarano G, Sipek A, Pötzsch S, Szabova E, Yevtushok L. Gastroschisis and associated defects: An international study. Am J Med Genet A 2007; 143A:660-71. [PMID: 17357116 DOI: 10.1002/ajmg.a.31607] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Our objective was to evaluate the frequency and type of malformations associated with gastroschisis in a large pool of international data, to identify malformation patterns, and to evaluate the role of maternal age in non-isolated cases. Case-by-case information from 24 registries, all members of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), were evaluated. After the exclusion of other abdominal wall defects cases were classified as: (a) isolated; (b) recognizable syndrome, chromosomal or not; (c) multiple congenital anomalies (MCA). Our results showed that out of 3,322 total cases 469 non-isolated cases were registered (14.1%): 41 chromosomal syndromes, 24 other syndromes, and 404 MCA. Among MCA four groups of anomalies were most frequent: CNS (4.5%), cardio-vascular (2.5%), limb (2.2%), and kidney anomalies (1.9%). No similar patterns emerged except two patterns resembling limb-body wall complex and OEIS. In both of them the gastroschisis could be however misclassified. Chromosomal trisomies and possibly non-syndromic MCA are associated with an older maternal age more than isolated cases. On consideration of our data and the most valid studies published in the literature, the best estimate of the proportion of gastroschisis associated with major unrelated defects is about 10%, with a few cases associated to recognizable syndromes. Recognized syndromes with gastroschisis seem to be so exceptional that the well documented and validated cases are worth being published as interesting case report. An appropriate case definition in etiological studies should include only isolated gastroschisis after an appropriate definition of isolated and non-isolated cases and a thorough case-by-case review.
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Affiliation(s)
- Pierpaolo Mastroiacovo
- Centre of the International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy.
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Abstract
Gastroschisis is increasing in frequency and is becoming a common condition. It is now invariably detected antenatally and although the long-term outcome in the majority of cases is excellent, the existence of both fetal and postnatal complications has led to variations in practice to try to optimise outcome. This article reviews the evidence for some of these variations where such evidence exists and provides a contemporary view of best practice where it does not.
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Affiliation(s)
- Melanie Drewett
- Neonatal Surgical Service, Department of Neonatal Medicine and Surgery, Princess Anne Hospital, Coxford Road, Southampton S0 16 5YA, United Kingdom.
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Kroksmark AK, Kimber E, Jerre R, Beckung E, Tulinius M. Muscle involvement and motor function in amyoplasia. Am J Med Genet A 2006; 140:1757-67. [PMID: 16835916 DOI: 10.1002/ajmg.a.31387] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The most common form of arthrogryposis multiplex congenita (AMC) is amyoplasia. Diagnostic criteria are highly specific, with decreased muscle mass, typical contractures and limb positioning at birth. Intellectual development is normal. The aims of this study were to investigate how muscle strength and contractures affect motor function in amyoplasia, and to relate current functional status to joint positions at birth. Medical records were reviewed and a clinical examination was performed, with investigation of muscle strength, range of motion, and motor function. Thirty-five patients with amyoplasia participated and were divided into three functional groups: 11 community ambulators, 11 household ambulators, and 7 non-ambulators. Six children less than 2 years old were not categorized. Community ambulators had the best muscle strength and none had knee flexion contractures extending 20 degrees. Household ambulators had severe contractures in the lower limbs, but good muscle strength in the upper limbs. Non-ambulators had most severe contractures and most severely reduced muscle strength. Most of the non-ambulators were born with hips in severe abduction, flexion and external rotation. Good and very good correlations were found between muscle strength and motor function, and only moderate correlations between range of motion and motor function. We conclude that more attention should be paid to developing muscle strength, with early stimulation of active movement, and that periods of immobilization should be minimized. Further, ultrasound or MRI of muscle tissue in the newborn period would be useful to evaluate prerequisites for future development of muscle strength and thereby anticipate response to therapy.
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Affiliation(s)
- Anna-Karin Kroksmark
- Department of Pediatrics, Institute for the Health of Women and Children, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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Komuro H, Amagai T, Hori T, Hirai M, Matoba K, Watanabe M, Kaneko M. Placental vascular compromise in jejunoileal atresia. J Pediatr Surg 2004; 39:1701-5. [PMID: 15547837 DOI: 10.1016/j.jpedsurg.2004.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE The mechanisms of intrauterine vascular disruptions that result in the development of jejunoileal atresia (JIA) are not fully understood. Monochorionic twinning with fetal death of a cotwin is known to be correlated with the development of JIA in the survivor through placental communication. The aim of this study was to evaluate whether other placental vascular compromises might contribute to the development of JIA. METHODS Forty-five newborns (23 boys and 22 girls) who were treated for JIA at Tsukuba University Hospital from 1978 to 2003 were reviewed. Placental findings were informative in 23 cases. RESULTS No or slight abnormality of the placenta was found in 19 cases. Significant placental abnormalities were found in 4 patients who also had a low birth weight. One patient with apple peel atresia (APA) had excessive torsion of the umbilical cord (UC), which was inserted at the margin of the placenta, and there was an adjacent area of infarction. One patent with multiple atresia (MA) was a surviving monochorionic twin with intrauterine fetal death of the other. Another case of MA showed marginal insertion of the UC. Severe placental abnormalities including wide infarction, cyst formation, and marginal insertion of the UC were found in 1 case of MA. These 3 cases of MA were complicated with other anomalies including brain anomaly. CONCLUSIONS Placental vascular compromises were involved infrequently in JIA but might possibly be responsible for the development of JIA as well as associated anomalies and a low birth weight as chronic insults since an early stage of gestation in some cases.
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Affiliation(s)
- Hiroaki Komuro
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, Japan
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31
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Celli J, van Bokhoven H, Brunner HG. Feingold syndrome: clinical review and genetic mapping. Am J Med Genet A 2004; 122A:294-300. [PMID: 14518066 DOI: 10.1002/ajmg.a.20471] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Feingold syndrome is characterized by autosomal dominant inheritance of microcephaly and limb malformations, notably hypoplastic thumbs, and clinodactyly of second and fifth fingers. Syndactyly frequently involves the second and third, as well as the fourth and fifth toes. Approximately one in three Feingold syndrome patients have esophageal or duodenal atresia or both. Anal atresia has been reported in a single case. At least 79 patients in 25 families have been reported. The syndrome has autosomal dominant inheritance with full penetrance, and variable expressivity. Vertebral anomalies, cardiac malformations, and deafness have been noted in a minority of patients. Here, we report a patient with hydronephrosis of one kidney and cystic dysplasia of the other, necessitating nephrectomy. The overall pattern of malformations in Feingold syndrome shows considerable overlap with the VATER/VACTERL association. The gene for Feingold syndrome maps to 2p23-p24, but remains to be identified. Comparison of the pattern of anomalies that occurs in the Feingold syndrome in humans and malformations that are present in mice with mutations of genes in the sonic hedgehog signaling pathway suggest, that the elusive Feingold syndrome gene may involve this signaling pathway as well.
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Affiliation(s)
- Jacopo Celli
- University Medical Center Nijmegen, Department of Human Genetics, Nijmegen, The Netherlands
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Kammoun F, Tanguy A, Boesplug-Tanguy O, Bensahel H, Khouri N, Landrieu P. Club feet with congenital perisylvian polymicrogyria possibly due to bifocal ischemic damage of the neuraxis in utero. ACTA ACUST UNITED AC 2004; 126A:191-6. [PMID: 15057985 DOI: 10.1002/ajmg.a.20562] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Club foot is a common congenital deformity, for which a neurogenic process in utero has been proposed in some severe forms, but in most cases its cause remain uncertain. We report on four patients with an unilateral (three cases) or bilateral (one case) clubfoot and a bilateral perisylvian cortical dysplasia. All had severe dysarthria with mild mental retardation, epilepsy occurred in three cases. Direct evidence of fetal lesions of the spinal cord was occasionally present, such as signs of motor axonopathy in two cases analyzed by electrophysiological methods and syringomyelic cavitation at the thoracic level in one case. Even though the sensitivity of the investigations to demonstrate microcopic scars in the spinal cord remains weak, the presence of polymicrogyric rearrangements in the perisylvian cortex, known to proceed from a transient ischemic process occurring in the carotid territory during mid-gestation, strongly suggests that a similar mechanism occurred in the spinal cord. In fact, the foot deformity cannot be viewed as the consequence of lesions to brain regions that do not control the foot motility in the fetus. Extraneurological lesions such as jejunal atresia, possibly proceeding from localized vascular compromise, were also encountered. In one sibship, one sister was found to have a severe developmental anomaly of one foot, suggesting that genetic factors may be involved.
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Affiliation(s)
- Fatma Kammoun
- Service de Neurologie Pédiatrique, CHU Paris sud-Bicêtre, 94275 Paris Cedex, France
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Brantberg A, Blaas HGK, Salvesen KA, Haugen SE, Eik-Nes SH. Surveillance and outcome of fetuses with gastroschisis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:4-13. [PMID: 14970991 DOI: 10.1002/uog.950] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Infants with gastroschisis have a high survival rate. However, the rate (10-15%) of intrauterine fetal death (IUFD) is considerable, and the association with fetal distress is well known. The aim of this study was to describe the outcome of fetuses with a prenatal diagnosis of gastroschisis. The impact of correct prenatal diagnosis, surveillance and signs of complicating risk factors were evaluated. METHODS All fetuses with prenatally diagnosed gastroschisis at the National Center for Fetal Medicine from January 1988 to August 2002 were registered and prospectively evaluated with regular ultrasound examinations. From 34-36 completed gestational weeks the fetuses were monitored daily to every second day with cardiotocography (CTG). RESULTS Gastroschisis was diagnosed in 64 fetuses at a mean gestational age of 19 + 2 weeks. All had normal karyotype. Associated anomalies were found in four cases (6.3%). Three pregnancies (4.7%) were terminated, all for reasons other than gastroschisis. One fetus (1.6%) died in utero. Thirteen fetuses (22%) had abnormal CTG leading to subsequent Cesarean sections. Mean gestational age at delivery was 36 + 1 weeks. Mean birth weight was 2586 g. Thirteen infants (22%) were small for gestational age (SGA). In 15 cases (25%) meconium-stained amniotic fluid was found; 14 of these had abnormal CTG and/or were SGA. Small bowel atresia was found in four infants (6.7%). Four infants died postnatally at the age of 0-9 months. CONCLUSIONS CTG surveillance of fetuses with gastroschisis may improve the outcome through detection of fetal distress thereby reducing the risk of IUFD. Other clinical situations of importance that are associated with gastroschisis are described and discussed.
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Affiliation(s)
- A Brantberg
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway.
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Abstract
The incidence of monozygotic twinning appears to be increasing within the field of assisted human reproduction. Many theories have been put forward as to how and when this occurs. Whatever the cause, the normal events of embryo development, which necessarily involve axis formation, patterning and polarization, need to be adhered to in order to obtain a viable offspring. This paper describes the course of development in terms of axis formation and polarity and offers suggestions as to how either a disruption of this or duplication events in the course of the formation of these parameters could prevent or contribute to a twinning event. The likelihood of twinning occurring at any point is discussed in terms of the establishment of polarity and axes.
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Affiliation(s)
- Lynette Scott
- University of Washington Medical School, Department of Obstetrics and Gynaecology, 4225 Roosevelt Way, Seattle, WA 98105, USA.
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Graham JM, Edwards MJ, Edwards MJ. Teratogen update: gestational effects of maternal hyperthermia due to febrile illnesses and resultant patterns of defects in humans. TERATOLOGY 1998; 58:209-21. [PMID: 9839360 DOI: 10.1002/(sici)1096-9926(199811)58:5<209::aid-tera8>3.0.co;2-q] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This review has covered the pertinent literature concerning the teratogenic effects of hyperthermia in man and experimental animals. This is the first teratogen that was initially discovered in animals and then subsequently found to be a cause for concern in humans when similar patterns of defects were observed. Hyperthermia is a physical agent with a dose-response curve for abortions and malformations, but these effects can be mitigated in some circumstances by the heat shock response (HSR). We have reviewed the known functions of HSR and provided some insight into why embryos have some protection following an initial dose of heat, if it is sufficient to initiate the response. Thus, by reviewing the effects of hyperthermia in experimental animals, as well as malformative and protective mechanisms of teratogenesis, we have attempted to understand the effects of human hyperthermia teratogenesis.
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Affiliation(s)
- J M Graham
- Medical Genetics Birth Defects Center, UCLA School of Medicine, Cedars-Sinai Medical Center, USA.
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Malinowski W, Biskup I. The sonographic prenatal diagnosis of congenital defects of the anterior abdominal wall based on our own study of twin pregnancies--gastroschisis. ACTA GENETICAE MEDICAE ET GEMELLOLOGIAE 1998; 46:101-4. [PMID: 9492892 DOI: 10.1017/s0001566000000659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The authors present gastroschisis which occurred in a surviving fetus after the co-twin demise in a monochorionic pregnancy. They analyze the problems of prenatal ultrasound diagnosis of gastroschisis stressing the adequate planning of delivery with necessary additional diagnostic and therapeutic efforts.
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Affiliation(s)
- W Malinowski
- Department of Obstetrics and Gynaecology, Kutno Hospital, Poland
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Abstract
We report a patient with Möbius syndrome. The birth defect in this child is probably the result of both vasoconstriction and uterine contractions brought on by ergotamine taken during the sixth week of pregnancy. We propose that vasoconstrictive or mechanical effects, or both, of abortifacient drugs such as ergotamine and misoprostol may account for other cases of Möbius syndrome, and we suggest that uterine contraction from any cause, at about the sixth or seventh week of pregnancy, may cause this birth defect. Further observational studies are needed to verify this hypothesis.
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Affiliation(s)
- W D Graf
- Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
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Lipson AH, Gillerot Y, Tannenberg AE, Giurgea S. Two cases of maternal antenatal splenic rupture and hypotension associated with Moebius syndrome and cerebral palsy in offspring. Further evidence for a utero placental vascular aetiology for the Moebius syndrome and some cases of cerebral palsy. Eur J Pediatr 1996; 155:800-4. [PMID: 8874116 DOI: 10.1007/bf02002911] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED We wish to report two cases of congenital abnormality after antenatal car accidents resulting in ruptured spleen and severe hypotension in the mothers at 8 and 14 weeks gestation. The first case had the classical Moebius syndrome with 6th and 7th cranial nerve palsy with abnormal brain stem evoked responses, presumably due to hypoxic/ischaemic brain stem damage and the second case had severe retardation and hypertonic cerebral palsy which at post mortem was found to be due to old hypoxic/ischaemic lesions to the caudate nucleus putamen and striatum. CONCLUSION The cases described provide evidence that severe maternal hypotension during pregnancy can be associated with lesions to the midbrain and brain stem of offspring. The mechanism is probably utero-placental insufficiency, and extrapolation from these two unusual cases would support utero-placental insufficiency as a cause of Moebius syndrome and limb deficiency after chorionic villus sampling.
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Affiliation(s)
- A H Lipson
- Department of Clinical Genetics, New Children's Hospital, Parramatta, Sydney, NSW, Australia
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Lipson T. Clinical teratology counseling and consultation case report. TERATOLOGY 1995; 52:126-7. [PMID: 8638251 DOI: 10.1002/tera.1420520303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Sepulveda W, Stagiannis KD, Cox PM, Wigglesworth JS, Fisk NM. Prenatal findings in generalized amyoplasia. Prenat Diagn 1995; 15:660-4. [PMID: 8532627 DOI: 10.1002/pd.1970150712] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Amyoplasia is a rare, sporadic condition characterized by different degrees of maldevelopment of the skeletal muscles, which are replaced by fibrous and fatty tissue. In this report, we present a case of generalized amyoplasia presenting at 19 weeks' gestation. The most striking finding was the absence of fetal movements, resulting in severe multiple congenital contractures, hydrops, and polyhydramnios. At autopsy, histological examination of the skeletal muscle showed small groups of poorly developed fibres within areas of fat. This report suggests that generalized amyoplasia could be a common cause of severe forms of multiple congenital contractures, but is probably underdiagnosed at post-mortem because of inadequate examination of muscles. Definitive diagnosis is important in determining the risks of recurrence in these cases.
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Affiliation(s)
- W Sepulveda
- Royal Postgraduate Medical School, Queen Charlotte's and Chelsea Hospital, London, U.K
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41
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Abstract
We report five infants with restricted lateral gaze, facial diplegia, feeding difficulty, and/or respiratory disorders without significant pulmonary disease. Viral studies were negative in all patients. Two children had radiologic findings that included brain-stem hypoplasia and symmetric calcification in the dorsal tectum at the junction of the midbrain and pons. Autopsy of one of these two children demonstrated capillary telangiectasia in the mesencephalon and pons. The other three children had normal computed tomographic (CT) scans. However, their autopsies revealed focal brain-stem necrosis with calcifications but without vascular malformation. We suggest that the capillary malformations in one of our patients directly resulted in a vascular-induced necrosis and the manifestation of Möbius sequence. The similarity of symmetric neuropathologic findings in the three other patients and the CT scan in the one surviving patient suggest focal hemodynamic changes restricted to the posterior circulation, indirectly supporting a vascular theory of embryopathogenesis.
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Affiliation(s)
- O F D'Cruz
- Department of Neurology, University of North Carolina, Chapel Hill 27599-7025
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42
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Robertson WL, Glinski LP, Kirkpatrick SJ, Pauli RM. Further evidence that arthrogryposis multiplex congenita in the human sometimes is caused by an intrauterine vascular accident. TERATOLOGY 1992; 45:345-51. [PMID: 1533956 DOI: 10.1002/tera.1420450405] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 7 1/2-year-old girl with arthrogryposis multiplex congenita of the amyoplasia type in association with intestinal atresias, gastroschisis, Möbius anomaly, and hypoplasia of the pectoral, biceps, and deltoid muscles is described. Several combinations of these birth defects have been previously described. There is considerable evidence that gastroschisis, intestinal atresia, Poland sequence, and Möbius anomaly each has a vascular pathogenesis. Based on the associations seen in this child and past reports of more limited, similar cooccurrences, we suggest that arthrogryposis multiplex congenita may sometimes be caused by an intrauterine vascular catastrophe.
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Affiliation(s)
- W L Robertson
- Department of Medical Genetics, University of Wisconsin-Madison 53705
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Martinez-Frías ML, Frías JL, Salvador J. Clinical/epidemiological analysis of malformations. AMERICAN JOURNAL OF MEDICAL GENETICS 1990; 35:121-5. [PMID: 2301461 DOI: 10.1002/ajmg.1320350123] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To investigate the heterogeneity of congenital malformations, we analyzed the distribution of 14 selected anomalies among 11,421 children with isolated defects and with different patterns of multiple congenital anomalies (MCA). Our study showed a marked variability in the distribution of each of these malformations. For example, although anophthalmia/microphthalmia, cleft palate, and limb deficiency were observed in all etiological categories of syndromes, no case with anencephaly was identified among the 1,244 children with different syndromes. Diaphragmatic hernia, esophageal atresia +/- tracheoesophageal fistula, and gastroschisis were not found in any monogenic syndrome in this sample. These observations may be of help to the clinician in the evaluation of individual children with MCA.
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Affiliation(s)
- M L Martinez-Frías
- Estudio Colaborativo Español de Malformaciones Congénitas, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Froster-Iskenius UG, Curry C, Philp M, Hall JG. Brief clinical report: an unusual bandlike web in an infant with lethal multiple pterygium syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1988; 30:763-9. [PMID: 3189397 DOI: 10.1002/ajmg.1320300310] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We report on a patient with a lethal multiple pterygium syndrome who also had an unusual, bandlike web across one axilla and partial intestinal atresia. Umbilical cord wrapping with subsequent vascular compromise appears to be the most likely pathogenetic mechanism for the additional anomalies.
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Affiliation(s)
- U G Froster-Iskenius
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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Agapitos M, Georgiou-Theodoropoulou M, Koutselinis A, Papacharalambus N. Arthrogryposis multiplex congenita, Pena-Shokeir phenotype, with gastroschisis and agenesis of the leg. PEDIATRIC PATHOLOGY 1988; 8:409-13. [PMID: 2974953 DOI: 10.3109/15513818809041576] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A young mother had a stillborn infant at 33 weeks' gestation, the pregnancy complicated by polyhydramnios. The parents were unrelated, healthy, and both had a normal karyotype. The infant had multiple malformations such as ankylosis, facial anomalies, and pulmonary hypoplasia. A severe gastroschisis and agenesis of the right leg were also present. The neuropathologic findings were those of marked atrophy of anterior horn motor cells in the spinal cord and neurogenic muscle atrophy. This is a case of Pena-Shokeir syndrome with two additional features: gastroschisis and agenesis of the right leg. This syndrome represents a lethal form of arthrogryposis multiplex congenita, and the essential neuropathologic findings are marked reduction in the number of spinal motor cells and neurogenic muscle atrophy.
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Affiliation(s)
- M Agapitos
- Department of Pathology, University of Athens Medical School, Goudi, Greece
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