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Doğru Ş, Acar A. Fetoscopic surgery for amniotic band syndrome: Case series. Congenit Anom (Kyoto) 2023; 63:4-8. [PMID: 36116114 DOI: 10.1111/cga.12494] [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: 04/14/2022] [Revised: 08/09/2022] [Accepted: 09/03/2022] [Indexed: 01/05/2023]
Abstract
We aimed to evaluate the fetoscopic procedure indications, procedure-related complications, and neonatal outcomes in cases diagnosed with amniotic band syndrome (ABS). Stage II and III cases according to Hüsler classification were included for fetoscopic surgery. Scissors were used to release the amniotic band in six cases, and a diode laser was used in one case. A single entry was made in all cases. The majority of the children acquired a functional limb (71.4%). Fetal morbidity was mainly linked to the consequences of preterm premature rupture of the membranes (57.1%) and preterm birth (28.5%). Excluding complicated cases, fetoscopic band release is encouraging in cases of ABS in the limbs.
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Affiliation(s)
- Şükran Doğru
- Division of Maternal and Fetal Medicine, Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Konya, Turkey
| | - Ali Acar
- Division of Maternal and Fetal Medicine, Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Konya, Turkey
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2
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Congenital Defects in a Patient Carrying a Novel Homozygous AEBP1 Variant: Further Expansion of the Phenotypic Spectrum of Ehlers-Danlos Syndrome Classical-like Type 2? Genes (Basel) 2022; 13:genes13122358. [PMID: 36553625 PMCID: PMC9777638 DOI: 10.3390/genes13122358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
In 2018, a new clinical subtype, caused by biallelic variants in the AEBP1 gene, encoding the ACLP protein, was added to the current nosological classification of the Ehlers-Danlos Syndromes (EDS). This new phenotype, provisionally termed EDS classical-like type 2 (clEDS2), has not yet been fully characterized, as only nine cases have been reported to date. Here we describe a patient, homozygous for a novel AEBP1 pathogenic variant (NM_001129.5 c.2123_2124delTG (p.Val708AlafsTer5)), whose phenotype is reminiscent of classical EDS but also includes previously unreported multiple congenital malformations. Furthermore, we briefly summarize the current principal clinical manifestations of clEDS2 and the molecular evidence surrounding the role of AEBP1 in the context of extracellular matrix homeostasis and connective tissue development. Although a different coexisting etiology for the multiple congenital malformations of our patient cannot be formally excluded, the emerging role of ACLP in TGF-β and WNT pathways may explain their occurrence and the phenotypical variability of clEDS2.
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3
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Schirwani S, van Dijk FS, Cauldwell M, Harrison RE, Kraus A, Brennan P, Ghali N, Lahiri N, Johnson D, Sobey G. Amniotic band sequence in vascular Ehlers-Danlos Syndrome (EDS): Experience of the EDS National Diagnostic Services in the UK. Eur J Med Genet 2022; 65:104592. [PMID: 35964932 DOI: 10.1016/j.ejmg.2022.104592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 06/26/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
The association between vascular Ehlers-Danlos Syndrome (vEDS) and amniotic band sequence (ABS) has been previously reported in the literature, mostly in single patient case reports. Here, we aim to extend the current knowledge of this association through a case series of five unrelated individuals with ABS in association with molecularly confirmed vEDS, in addition to undertaking a comprehensive literature review. All the individuals were recruited through the EDS national diagnostic service in the UK following appropriate history, physical examination and genetic investigations. Clinical presentation ranged from a single constriction ring to complex craniofacial clefts to limb reduction deformities, reflecting the spectrum of ABS presentation. vEDS was inherited paternally (n = 2), maternally (n = 2) and de novo (n = 1). Previously, maternal vEDS was considered the risk factor for ABS, but our findings suggest that it may be the disease status of the fetus which poses the main risk. It is established that amniotic membrane is derived from fetal tissue, which supports our conclusions. Our observations suggest the increased risk of ABS in fetuses with vEDS. Therefore, exploring family history and features that may suggest vEDS diagnosis in patients with ABS might be useful. We also recommend that a collaborative international study would be useful to help gain a better insight into this association.
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Affiliation(s)
- Schaida Schirwani
- EDS National Diagnostic Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK; Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK.
| | - Fleur S van Dijk
- National EDS Service London, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Matthew Cauldwell
- Department of Obstetrics, St George's University Hospital, London, UK
| | - Rachel E Harrison
- Department of Clinical Genetics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alison Kraus
- Yorkshire Regional Genetic Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Brennan
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neeti Ghali
- National EDS Service London, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Nayana Lahiri
- Department Clinical Genetics, St George's University Hospital & St. George's University, London, UK
| | - Diana Johnson
- EDS National Diagnostic Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK; Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Glenda Sobey
- EDS National Diagnostic Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK; Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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He T, Xu H, Sui P, Wang X, Sun Y. Amniotic constriction band syndrome resulting in amputation caused by septate uterus: a case report. J Int Med Res 2021; 48:300060520949755. [PMID: 32954908 PMCID: PMC7509729 DOI: 10.1177/0300060520949755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Amniotic band syndrome is an unusual congenital condition characterized by manifestations of disfigurement and disablement. Patients with this condition may experience an array of clinical deformities, including constriction rings, digital defects, and even visceral defects. Although this disease has been identified for centuries, its etiology is still unknown. The present male patient was born by cesarean section at 34 weeks and 4 days of gestation. At birth, an amniotic band that encircled and constricted his right upper limb was observed. Four hours after the amniotic band was cut off, amputation was performed because the right limb remained insensate. The patient suffered from amniotic band syndrome and presented with a gangrenous limb leading to amputation at birth, which is extremely rare. Moreover, the patient’s mother suffered from a uterine septum, which has not been previously reported in this situation. Timely surgical treatment avoided further tissue necrosis threating the patient’s life. This rare case of amniotic band syndrome provides new clinical evidence for the “extrinsic theory”.
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Affiliation(s)
- Tian He
- Department of Orthopedics Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China.,Department of Joint Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinnan, Shandong, P.R. China
| | - Hao Xu
- Department of Neurosurgery Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China
| | - Ping Sui
- Department of Oncology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China
| | - Xin Wang
- Department of Orthopedics Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China
| | - Yujie Sun
- Department of Orthopedics Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China
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Yamada M, Arimitsu T, Osada A, Kosaki K. Direct visualization of the evolution of limb amputation in amnion rupture sequence in an extremely preterm infant born at 22 weeks. Am J Med Genet A 2021; 185:2821-2823. [PMID: 33605525 DOI: 10.1002/ajmg.a.62137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Mamiko Yamada
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Arimitsu
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Asami Osada
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
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6
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Chatterjee S, Rao KSM, Nadkarni A. Amniotic band syndrome associated with limited dorsal myeloschisis: a case report of an unusual case and review of the literature. Childs Nerv Syst 2021; 37:707-713. [PMID: 32519131 DOI: 10.1007/s00381-020-04713-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022]
Abstract
Amniotic band syndrome (ABS) has been known since ancient times. Descriptions in modern medicine have occurred since the mid-nineteenth century. The association of the amniotic band syndrome with tethered cord is rare. It was generally thought to be incompatible with life. Of late, with better imaging, there have been case reports of amniotic bands causing cord tethering in neurosurgical literature, but its association with limited dorsal myeloschisis has hitherto not been described. We report a case of amniotic band syndrome (ABS) associated with a cervical limited dorsal myeloschisis (LDM) in a child of 2 and a half years old. The management of LDM in ABS is essentially the same as in isolated cases.
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Affiliation(s)
- Sandip Chatterjee
- Department of Neurosurgery, Park Neurosciences, Park Clinic, 4 Gorky terrace, Kolkata, 700017, India.
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7
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Gooch C, Wright C, Nelson K, Robin N. Inherited cause of in utero digital malformations. BMJ Case Rep 2020; 13:13/3/e232020. [PMID: 32209574 DOI: 10.1136/bcr-2019-232020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Amniotic band sequence (ABS) is common birth defect of incompletely understood origin. Here we describe a case of ABS in a child with paternally inherited Ehlers-Danlos syndrome, vascular type (vEDS). This is the third reported instance of ABS associated with paternally inherited vEDS in the medical literature. The two main theories of ABS formation are the extrinsic and intrinsic. The extrinsic theory states that placental tears form fibrous cords that wrap around the fetus; the intrinsic states that poor vascularisation in the fetus leads to necrosis of distal extremities. We believe this case supports extrinsic theory as it shows that as an amnion weakened by vEDS in fetal components is associated with ABS.
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Affiliation(s)
- Catherine Gooch
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin Wright
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katherine Nelson
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nathaniel Robin
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA .,Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lies S, Beckwith T, Mills J, Butler L, Ezaki M, Oishi S. Case series: Amniotic band sequence with craniofacial abnormalities. Birth Defects Res 2019; 111:1494-1500. [PMID: 31407870 DOI: 10.1002/bdr2.1576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 07/18/2019] [Accepted: 07/30/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND To objectively describe craniofacial, visual, and neurological features associated with amniotic band syndrome (ABS) and discuss likely associated multifactorial etiology. METHODS A retrospective review of patients identified with ABS and concomitant limb involvement and craniofacial features was conducted. The following data were collected from the patients' medical records: demographic information, past medical history including birth history, surgical history, previous clinic visits/physical exams, description of craniofacial features and ABS, family history, any noted obstetric complications, visceral features, visual features, craniofacial features, intracranial features, neurological symptoms, developmental features, diagnostic tests (including radiographs, IQ testing, EEG findings, chromosomes), photographs, and treatment history. RESULTS Seven patients were included in the final cohort, all of whom had a cleft lip with six having both cleft lip and palate. Other craniofacial abnormalities seen were facial clefts which were vertical oblique in nature, tear duct involvement, cranial deformities that required surgical correction with cranial reconstruction, recorded hypertelorism with vision and gaze abnormalities, coloboma, lagopthalmos and optic never dysplasia. CONCLUSIONS This case series presents seven children with craniofacial involvement associated with amniotic band sequence and attempts to categorize the salient dysmorphology and neurocognitive development. Major craniofacial anomalies in patients with ABS is a rare clinical finding that cannot be completely explained on the basis of premature amniotic layer disruption alone. This study supports that the dysmorphology seen in cases of ABS with craniofacial involvement is complex and most likely multifactorial. LEVEL OF EVIDENCE IV Case Series.
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Affiliation(s)
- Shelby Lies
- Department of Hand and Upper Extremity, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Terri Beckwith
- Department of Hand and Upper Extremity, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Janith Mills
- Department of Hand and Upper Extremity, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Lesley Butler
- Department of Hand and Upper Extremity, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Marybeth Ezaki
- Department of Hand and Upper Extremity, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Scott Oishi
- Department of Hand and Upper Extremity, Texas Scottish Rite Hospital for Children, Dallas, Texas
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Digital-Facial Translocation in Amniotic Band Sequence: Evidence of the Intrinsic Theory. J Craniofac Surg 2018; 29:1890-1892. [PMID: 30106805 DOI: 10.1097/scs.0000000000004817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Amniotic band sequence is a complex congenital anomaly in which infants with typically no known genetic mutation have bands of maternal amniotic tissue wrapped around body parts, most commonly the limbs and digits. The authors report a novel variation on this presentation in 3 patients from 2 centers with complex craniofacial clefting and amniotic band sequence. They presented with hypertelorism, different forms of complex craniofacial clefting, and bands connecting ipsilateral hands to facial clefts, with digital-facial translocation in 2 cases. These findings support a model in which complex craniofacial clefts result in areas of exposed, sticky, and temporally and spatially coincident mesenchyme within the embryo that are susceptible to adherence of ipsilateral fetal hands. This strongly supports the intrinsic and adhesion theories of the etiology of amniotic band syndrome.
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Ananthan A, Athalye Jape G, Du Plessis J, Annear P, Page R, Rao S. Amniotic Band Syndrome With Pseudoarthrosis of Tibia and Fibula: A Case Report. J Foot Ankle Surg 2017. [PMID: 28623060 DOI: 10.1053/j.jfas.2017.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Constriction of the lower limb by a congenital amniotic band has been proposed to explain the development of pseudoarthrosis of the tibia and fibula. We report a case of amniotic band syndrome in a preterm female infant with pseudoarthrosis of the tibia and fibula. She was born at 29 weeks of gestation with congenital amniotic bands and was noted to have a severely edematous left foot distal to the constricting band with rudimentary digits. The skin was pink and well perfused with palpable pulses. Radiography demonstrated pseudoarthrosis of the tibia and fibula. The limb deformities were managed with splints, positioning, and physiotherapy. She underwent Z-plasty with soft tissue release on the left lower leg on day 7 of life. At 36 weeks of postmenstrual age, a repeat radiograph showed markedly improved growth of the tibia and fibula with mature new bone formation, which avoided the need for further surgical intervention. During the follow-up period, she underwent left Syme's amputation at 18 months. At 29 months of age, the child was able to walk and run without support. The findings from our case confirm the potential for bone growth in patients with amniotic band syndrome, once the constricting band has been released. Simple release of the constriction band with Z-plasty resulted in growth of mature bone, replacing the pseudoarthrosis and, hence, the patient did not require surgical amputation. Thus, one should be cautious when deciding on surgical amputation, even in the presence of pseudoarthrosis, especially in preterm infants. Early limb-preserving surgery with release of the constricting band with an intention to salvage the limb appears appropriate.
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Affiliation(s)
- Anitha Ananthan
- Senior Resident, Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
| | - Gayatri Athalye Jape
- Assistant Professor, Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Jean Du Plessis
- Assistant Professor, Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Peter Annear
- Orthopaedic Surgeon, Department of Orthopaedics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Rohan Page
- Plastic Surgeon, Department of Plastic Surgery, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Shripada Rao
- Associate Professor, Centre for Neonatal Research and Education, University of Western Australia, Crawley, Western Australia, Australia
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11
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Xu Y, Mu Y, Chen R, Zheng Z, Zhang W. Two rare cases of simultaneous Tessier number 3 cleft, contralateral cleft lip, and signs of amniotic band syndrome. J Craniomaxillofac Surg 2016; 44:672-5. [PMID: 27052637 DOI: 10.1016/j.jcms.2015.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/10/2015] [Accepted: 11/17/2015] [Indexed: 11/29/2022] Open
Abstract
The Tessier number 3 cleft is rare. In this paper, we report two extremely rare cases of simultaneous Tessier number 3 cleft, contralateral cleft lip, and signs of amniotic band syndrome. In the two cases, we confirmed that amniotic bands were the probable cause of the Tessier number 3 cleft, where swallowed fibrous strands of amniotic bands entangle a typical cleft lip and cause the more severe Tessier number 3 cleft. In this study, Z-plasty was performed for one case, and a straight-line method was used for the other. Postoperatively, the appearance of both patients was satisfactory, as expected. Consequently, treatment for the Tessier number 3 cleft should be designed individually based on the severity of deformity.
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Affiliation(s)
- Yi Xu
- Department of Plastic and Traumatic Surgery, School of Stomatology, Capital Medical University, No.4, Tiantan West, East District, Beijing, 100050, China
| | - Yue Mu
- Department of Plastic and Traumatic Surgery, School of Stomatology, Capital Medical University, No.4, Tiantan West, East District, Beijing, 100050, China
| | - Renji Chen
- Department of Plastic and Traumatic Surgery, School of Stomatology, Capital Medical University, No.4, Tiantan West, East District, Beijing, 100050, China.
| | - Zongmei Zheng
- Department of Plastic and Traumatic Surgery, School of Stomatology, Capital Medical University, No.4, Tiantan West, East District, Beijing, 100050, China
| | - Wenjing Zhang
- Department of Plastic and Traumatic Surgery, School of Stomatology, Capital Medical University, No.4, Tiantan West, East District, Beijing, 100050, China
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Valdés-Flores M, Casas-Avila L, Hernández-Zamora E, Kofman S, Hidalgo-Bravo A. Characterization of a group unrelated patients with arthrogryposis multiplex congenita. J Pediatr (Rio J) 2016; 92:58-64. [PMID: 26453511 DOI: 10.1016/j.jped.2015.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Arthrogryposis multiplex congenita is a relatively rare neuromuscular syndrome, with a prevalence of 1:3000-5000 newborns. In this study, the authors describe the clinical features of a group of 50 unrelated Mexican patients with arthrogryposis multiplex congenita. METHODS Patients were diagnosed by physical and radiographic examination and the family history was evaluated. RESULTS Of the 50 cases, nine presented other features (pectum excavatum, cleft palate, mental retardation, ulnar agenesis, etc.). Environmental factors, as well as prenatal and family history, were analyzed. The chromosomal anomalies and clinical entities associated with arthrogryposis multiplex congenita were reported. No chromosomal aberrations were present in the cases with mental retardation. Three unrelated familial cases with arthrogryposis multiplex congenita were observed in which autosomal recessive, autosomal dominant and X-linked inheritance patterns are possible. A literature review regarding arthrogryposis multiplex congenita was also conducted. CONCLUSIONS It is important to establish patient-specific physical therapy and rehabilitation programs. A multidisciplinary approach is necessary, with medical, surgical, rehabilitation, social and psychological care, including genetic counseling.
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Affiliation(s)
| | - Leonora Casas-Avila
- Genetics Department, Instituto Nacional de Rehabilitación (INR), Mexico City, Mexico
| | | | - Susana Kofman
- Genetics Department, Hospital General de México, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Alberto Hidalgo-Bravo
- Genetics Department, Instituto Nacional de Rehabilitación (INR), Mexico City, Mexico
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13
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Characterization of a group unrelated patients with arthrogryposis multiplex congenita. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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14
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Romero-Valdovinos M, Galván-Montaño A, Olivo-Díaz A, Maravilla P, Bobadilla NA, Vadillo-Ortega F, Flisser A. The Amniotic Band Syndrome in the Rat Is Associated with the Activation of Transforming Growth Factor-β. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 185:2076-82. [DOI: 10.1016/j.ajpath.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 12/11/2022]
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15
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Kruszka P, Uwineza A, Mutesa L, Martinez AF, Abe Y, Zackai EH, Ganetzky R, Chung B, Stevenson RE, Adelstein RS, Ma X, Mullikin JC, Hong SK, Muenke M. Limb body wall complex, amniotic band sequence, or new syndrome caused by mutation in IQ Motif containing K (IQCK)? Mol Genet Genomic Med 2015; 3:424-32. [PMID: 26436108 PMCID: PMC4585450 DOI: 10.1002/mgg3.153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/30/2015] [Accepted: 04/07/2015] [Indexed: 12/31/2022] Open
Abstract
Limb body wall complex (LBWC) and amniotic band sequence (ABS) are multiple congenital anomaly conditions with craniofacial, limb, and ventral wall defects. LBWC and ABS are considered separate entities by some, and a continuum of severity of the same condition by others. The etiology of LBWC/ABS remains unknown and multiple hypotheses have been proposed. One individual with features of LBWC and his unaffected parents were whole exome sequenced and Sanger sequenced as confirmation of the mutation. Functional studies were conducted using morpholino knockdown studies followed by human mRNA rescue experiments. Using whole exome sequencing, a de novo heterozygous mutation was found in the gene IQCK: c.667C>G; p.Q223E and confirmed by Sanger sequencing in an individual with LBWC. Morpholino knockdown of iqck mRNA in the zebrafish showed ventral defects including failure of ventral fin to develop and cardiac edema. Human wild-type IQCK mRNA rescued the zebrafish phenotype, whereas human p.Q223E IQCK mRNA did not, but worsened the phenotype of the morpholino knockdown zebrafish. This study supports a genetic etiology for LBWC/ABS, or potentially a new syndrome.
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Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Annette Uwineza
- Center for Medical Genetics, College of Medicine and Health Sciences, University of Rwanda Huye, Rwanda
| | - Leon Mutesa
- Center for Medical Genetics, College of Medicine and Health Sciences, University of Rwanda Huye, Rwanda
| | - Ariel F Martinez
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Yu Abe
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Elaine H Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Clinical Genetics Center, Perelman School of Medicine of the University of Pennsylvania Philadelphia, Pennsylvania
| | - Rebecca Ganetzky
- Division of Human Genetics, The Children's Hospital of Philadelphia, Clinical Genetics Center, Perelman School of Medicine of the University of Pennsylvania Philadelphia, Pennsylvania
| | - Brian Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong Pokfulam, Hong Kong
| | | | - Robert S Adelstein
- Laboratory of Molecular Cardiology, National Heart Lung and Blood Institute, National Institutes of Health Bethesda, Maryland
| | - Xuefei Ma
- Laboratory of Molecular Cardiology, National Heart Lung and Blood Institute, National Institutes of Health Bethesda, Maryland
| | - James C Mullikin
- Comparative Genomics Analysis Unit, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Sung-Kook Hong
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
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Abstract
BACKGROUND The purpose of this study was to clarify the spectrum of congenital constriction band syndrome (CBS) and associated anomalies and mortality in Finland. METHODS Register-based data were analyzed for children with congenital constriction bands in upper and lower extremities as a part of an ongoing study on 419 upper limb defects and 171 lower limb defects occurring among 753,342 births in Finland during 1993 to 2005. RESULTS A total of 71 cases with limb CBS were identified during the 13-year study period. The birth prevalence was 0.9 per 10 000 births (1:10 600). Infant mortality was 4.6% (3/65) and perinatal mortality 12.7% (9/71). In 35 cases (49%) only upper limbs were affected and in 13 cases (18%) there were constriction defects only in lower limbs. In 23 cases (32%) both upper and lower limbs were involved. None of the cases associated with a known syndrome. However, in 21 cases (30%) the child had other anomalies associated with constriction rings: pes equinovarus in 8/21, cleft palate in 5/21, congenital heart defect in 6/21, and other anomalies in 14/21. Eighteen (25%) had low birth weight, 22 (31%) were born preterm, and 8 children (11%) were small for gestational age. Children with associated anomalies showed higher mortality, shorter duration of gestation, and lower birth weight. CONCLUSIONS CBS is rare and comprises approximately 12% of all congenital upper limb defects and 14% of lower limb defects. Other skeletal and nonskeletal anomalies are present in 30% of the affected children, suggesting a possible genetic etiology. More detailed characterization of the children with associated anomalies may shed light to the pathogenetic mechanisms of this syndrome. LEVEL OF EVIDENCE Population-based register study/II.
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Abstract
As the information obtained from previable fetal and stillbirth autopsies is used not only to explain the loss to the parents, but for future pregnancy planning, general pathologists need to be comfortable in dealing with these autopsies. The importance of an adequate fetal examination has been emphasized in a recent policy on the subject by the American Board of Pathology http://www.abpath.org/FetalAutopsyPolicy.pdf. This review paper covers the approach to the fetal and stillbirth autopsy. This first article covers the approach to the nonanomalous and anomalous autopsy. Hydrops fetalis will be covered in the second part of this series to be published subsequently.
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Romero-Valdovinos M, Bobadilla-Sandoval N, Flisser A, Vadillo-Ortega F. The epithelial mesenchymal transition process may contribute to the pathogenesis of amniotic band syndrome. Med Hypotheses 2014; 83:306-11. [PMID: 24998668 DOI: 10.1016/j.mehy.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 05/13/2014] [Accepted: 06/04/2014] [Indexed: 11/30/2022]
Abstract
The etiology of the amniotic band syndrome is unknown, and has been subject of debate since the time of Hippocrates. The most accepted theories fail to cover all the abnomalities found in affected children. During organogenesis the epithelial-mesenchymal transition process (EMTP) participates in adequate formation of different organs from three embryo layers. Altered activation of EMTP occurs when the epithelial homeostasis is disturbed, the resulting myofibroblasts are able to secrete extracellular matrix proteins and deposit them on the tissues contributing to a fibrotic phenotype. If injury occurs during organogenesis, wound healing could be exaggerated and fibrotic response could be triggered. The molecule that regulates both of these processes (EMTP and fibrosis) is the transforming growth factor β (TGFβ); indeed null animals for TGFβ isoforms show similar defects than those seen in the amniotic band syndrome. Based on documented evidence this review intends to explain how the epithelial mesenchymal transition process may contribute to the pathogenesis of amniotic band syndrome.
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Affiliation(s)
- M Romero-Valdovinos
- Departamento de Biología Molecular e Histocompatibilidad, Hospital General "Dr. Manuel Gea González", Secretaría de Salud, Mexico
| | - N Bobadilla-Sandoval
- Unidad de Fisiología Molecular, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México and Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico
| | - A Flisser
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
| | - F Vadillo-Ortega
- Unidad de Vinculación de la Facultad de Medicina, Universidad Nacional Autónoma de México en el Instituto Nacional de Medicina Genómica, Mexico.
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Doi Y, Kawamata H, Asano K, Imai Y. A case of amniotic band syndrome with cleft lip and palate. J Maxillofac Oral Surg 2012. [PMID: 23204754 DOI: 10.1007/s12663-011-0174-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The patient was a 5-day-old boy born at 37 weeks and 4 days. At birth, an amniotic band encircling and constricting his left middle finger was noted, in addition to multiple anomalies including a right-side cleft lip and palate, a club foot, and syndactyly on the left hand. We performed cheiloplasty at 5 months, and palatoplasty at 18 months.
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Affiliation(s)
- Yutaka Doi
- Department of Oral and Maxillofacial Surgery, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimo-tsuga, Tochigi, 321-0293 Japan
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Addona T, Friedman A, Post A, Weiss N, Silver L, Taub PJ. Complete calvarial agenesis in conjunction with a Tessier 1-13 facial cleft. Cleft Palate Craniofac J 2012; 49:484-7. [PMID: 22839097 DOI: 10.1597/08-232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Amniotic band sequence (ABS) is a condition in which rupture of the amniotic sac leads to the development of a broad spectrum of fetal anomalies. A newborn male presented at term with multiple craniofacial and skeletal anomalies, including attachment of the placenta to the head, a paramedian facial cleft, and multiple skeletal anomalies. The patient has undergone several operations to date. The initial operation was performed to remove the attached placenta off the underlying dura, which was with a collagen matrix bound to a silicone membrane. The patient subsequently underwent split-thickness skin grafting with complete survival of the graft.
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Affiliation(s)
- Tommaso Addona
- Division of Plastic Surgery, Mount Sinai Medical Center, One Gustave L Levy Pl, New York, NY 10029, USA
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Hung NN. Congenital constriction ring in children: sine plasty combined with removal of fibrous groove and fasciotomy. J Child Orthop 2012; 6:189-97. [PMID: 23814619 PMCID: PMC3399999 DOI: 10.1007/s11832-012-0420-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 06/14/2012] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To evaluate the clinical and functional results of a technical procedure used in the surgical treatment of congenital constriction ring (CCR) in children. MATERIALS AND METHODS This was a retrospective study undertaken to evaluate the results of surgical techniques performed from January 1995 to December 2005 on 95 patients with 134 congenital constriction bands. Due to the drop-out of nine patients during follow-up, data on 86 patients (121 congenital constriction rings; average age at surgery 1 year 2 months) were analyzed. The extent of the constrictions was classified by according to the Patterson criteria. All patients were treated by two-stage sine plasty combined with removal of the fibrous groove and fasciotomy, with one-half of the ring removed during the first stage and the other half removed 1 week later during the second state. The surgical outcomes were assess according to the Moses criteria. RESULTS Three types of CCR (Patterson criteria) were identified among the 86 patients (121 constriction rings): types I (5 patients, 4.1 %), II (107, 88.5 %), III (9, 7.4 %). Of the 121 constriction rings, good results were attained in 73.6 % and fair results in 26.4 %. Sensory deficits were seen in six patients immediately after the surgery but all six had improved to a normal condition at the final follow-up examination. There were no skin necrosis or wound healing problems. CONCLUSION The combined sine plasty/removal of fibrous groove and fasciotomy method reported here is a simple and safe surgical technique for treating CCR in children.
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Affiliation(s)
- Nguyen Ngoc Hung
- Viet Nam National Hospital for Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, Vietnam
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Kahramaner Z, Cosar H, Turkoglu E, Erdemir A, Kanik A, Sutcuoglu S, Ozer EA. Amniotic band sequence: an extreme case. Congenit Anom (Kyoto) 2012; 52:59-61. [PMID: 21039912 DOI: 10.1111/j.1741-4520.2010.00301.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Amniotic band sequence (ABS) is a rare cause of fetal disruptions associated with fibrous bands that entrap various fetal parts in utero and lead to abnormalities. Fetal disruptions of ABS are influenced by the timing of the amnion rupture and the site of amnion adherence. Herein we report an extreme case of ABS presented with dysmorphic face, amputation of four extremities and fusion of legs and genitalia with a fibrotic band. This is an extreme case of ABS characterized by an unusual combination of multiple fetal anomalies.
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Affiliation(s)
- Zelal Kahramaner
- Neonatology Clinic, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey
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Knight JB, Pritsch T, Ezaki M, Oishi SN. Unilateral congenital terminal finger absences: a condition that differs from symbrachydactyly. J Hand Surg Am 2012; 37:124-9. [PMID: 22051235 DOI: 10.1016/j.jhsa.2011.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 09/16/2011] [Accepted: 09/16/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe a type of nonhereditary unilateral transverse deficiency, which we have named hypodactyly, that is distinct from symbrachydactyly or amniotic disruption sequence. METHODS We identified 19 patients with unilateral congenital anomalies consisting of absent or short bulbous fingers that lack terminal ectodermal elements. Medical records and radiographs were retrospectively reviewed and contrasted with the typical findings of symbrachydactyly and amniotic disruption sequence. RESULTS No associated syndromes or potentially causative diagnoses were identified in the hypodactyly patients. The digital absences were of a truncated pattern with thickened, tubular soft tissue coverage. Radiographs revealed a pattern of severity progression that is different from that of symbrachydactyly. Distal phalanges were the bony elements absent most frequently, followed sequentially by the middle phalanx and proximal phalanx. In all cases, metacarpals were present. Unlike symbrachydactyly, the ulnar 2 digits were more involved than the index and long fingers, and the thumb was the least involved digit. CONCLUSIONS Hypodactyly appears to be a congenital hand anomaly that is clinically and radiographically different from symbrachydactyly or amniotic disruption sequence and is presumed to be caused by a distinct pathomechanism. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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de Wit MCY, de Coo IFM, Schot R, Hoogeboom AJM, Lequin MH, Verkerk AJMH, Mancini GMS. Periventricular nodular heterotopia and distal limb deficiency: a recurrent association. Am J Med Genet A 2010; 152A:954-9. [PMID: 20358608 DOI: 10.1002/ajmg.a.33258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Malformations of cerebral cortical development, in particular periventricular nodular heterotopia (PNH), and distal transverse limb deficiency have been reported as associated congenital anomalies. Patients with PNH and transverse limb deficiency can be classified as having amniotic band sequence or Adams-Oliver syndrome (AOS). Controversy exists whether these should be considered separate entities. In some AOS patients, autosomal recessive inheritance has been shown, but in most patients causes are unknown, and both environmental and genetic factors have been implicated. We present three patients with PNH and distal transverse limb deficiency to support the hypothesis that these should be considered part of one group of disorders, and highlight the variable severity of the clinical and neuroradiological phenotype. Chromosome abnormalities were excluded by copy number analysis on 250K SNP microarray data.Research done on limb deficiency as on PNH caused by mutations in known genes, suggests the involvement of vascular developmental pathways. The combination of limb deficiency and PNH may have a common causative mechanism. Recognition and grouping of patients with this combination of abnormalities will help elucidating the cause.
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Limb malformations with associated congenital constriction rings in two unrelated Egyptian males, one with a disorganization-like spectrum and the other with a probable distinct type of septo-optic dysplasia. Clin Dysmorphol 2010; 19:14-22. [DOI: 10.1097/mcd.0b013e3283337d92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Purandare SM, Ernst L, Medne L, Huff D, Zackai EH. Developmental anomalies with features of disorganization (Ds) and amniotic band sequence (ABS): A report of four cases. Am J Med Genet A 2009; 149A:1740-8. [DOI: 10.1002/ajmg.a.32716] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Isidor B, Baujat G, Le Caignec C, Pichon O, Martin-Coignard D, Toutain A, David A. Congenital skin pedicles with or without amniotic band sequence: Extending the human phenotype resembling mouse disorganization. Am J Med Genet A 2009; 149A:1734-9. [DOI: 10.1002/ajmg.a.32796] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Jamsheer A, Materna-Kiryluk A, Badura-Stronka M, Wiśniewska K, Wieckowska B, Mejnartowicz J, Balcar-Boroń A, Borszewska-Kornacka M, Czerwionka-Szaflarska M, Gajewska E, Godula-Stuglik U, Krawczynski M, Limon J, Rusin J, Sawulicka-Oleszczuk H, Szwałkiewicz-Warowicka E, Swietliński J, Walczak M, Latos-Bieleńska A. Comparative study of clinical characteristics of amniotic rupture sequence with and without body wall defect: further evidence for separation. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2009; 85:211-5. [PMID: 19180633 DOI: 10.1002/bdra.20555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Amniotic rupture sequence (ARS) is a disruption sequence presenting with fibrous bands, possibly emerging as a result of amniotic tear in the first trimester of gestation. Our comparative study aims to assess whether there is a difference in the clinical pattern of congenital limb and internal organ anomalies between ARS with body wall defect (ARS-BWD) and ARS without BWD (ARS-L). METHODS Among 1,706,639 births recorded between 1998 and 2006, 50 infants with a diagnosis of ARS were reported to the Polish Registry of Congenital Malformations. The information on 3 infants was incomplete, thus only 47 cases were analyzed. These infants were classified into groups of ARS-L (38 infants) and ARS-BWD (9 infants). RESULTS The ARS-BWD cases were more frequently affected by various congenital defects (overall p < 0.0001), and in particular by urogenital malformations (p = 0.003). In both groups, limb reduction defects occurred in approximately 80% of cases; however, minor and distal limb defects (phalangeal or digital amputation, pseudosyndactyly, constriction rings) predominated in the ARS-L group (p = 0.0008). The ARS-L group also had a higher frequency of hand and upper limb involvement. CONCLUSIONS This observation suggests that amniotic band adhesion in ARS-L takes place at a later development stage. Although limited by a small sample size, our study contributes to the growing evidence that both ARS entities represent two nosologically distinct conditions.
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Affiliation(s)
- Aleksander Jamsheer
- Center for Medical Genetics, Department of Medical Genetics, University of Medical Sciences in Poznań, ul. Grunwaldzka 55, Poznań, Poland.
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Four limb syndactyly, constriction rings and skin tags; amniotic bands or disorganization-like syndrome. Clin Dysmorphol 2008; 17:255-8. [DOI: 10.1097/mcd.0b013e328310e07d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choulakian MY, Williams HB. Surgical correction of congenital constriction band syndrome in children: Replacing Z-plasty with direct closure. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2008; 16:221-3. [PMID: 19949501 PMCID: PMC2691027 DOI: 10.1177/229255030801600409] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital constriction band syndrome is a sporadic condition that may also be present in association with other congenital anomalies. It has an incidence varying from one in 1200 to one in 15,000 live births. There is a significant predilection for the upper extremities and distal limbs. The two main objectives for the treatment of congenital constriction band syndrome are improvement of function and improvement of cosmetic appearance. Different surgical techniques, such as Z-plasty, have been described and used for decades; however, direct closure after the excision of the constricting band seems to be the simplest and most appropriate, allowing the fatty tissue to naturally reposition itself under the skin. This technique is used in a two-stage approach to avoid affecting distal circulation to the limb.
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Affiliation(s)
| | - H Bruce Williams
- Division of Pediatric Plastic Surgery, Montreal Children’s Hospital, McGill University, Montreal, Quebec
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Abstract
Patients who have cleft lip or palate face significant lifelong communicative and aesthetic challenges and difficulties with deglutition. Management of patients who have orofacial clefting requires an understanding of the anatomy and pathophysiology associated with clefting and the developmental difficulties encountered by these patients. This article describes current surgical concepts and principles of cleft care. Advances in the embryology and genetics of orofacial clefting are also discussed. It is expected that the care of patients who have clefts will continue to evolve because of advances in the fields of tissue engineering, genetics, and fetal surgery.
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Affiliation(s)
- Oneida A Arosarena
- Department of Otolaryngology, Temple University School of Medicine, 3400 North Broad Street, Kresge First Floor, Suite 102, Philadelphia, PA 19140, USA.
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Levy R, Lacombe D, Rougier Y, Camus E. Limb body wall complex and amniotic band sequence in sibs. Am J Med Genet A 2007; 143A:2682-7. [DOI: 10.1002/ajmg.a.32018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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