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Al-Redouan A, Benes M, Abbaspour E, Kunc V, Kachlik D. Prevalence and anatomy of the anomalous subclavius posticus muscle and its clinical implications with emphasis in neurogenic thoracic outlet syndrome: Scoping review and meta-analysis. Ann Anat 2023; 247:152046. [PMID: 36690046 DOI: 10.1016/j.aanat.2023.152046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/30/2022] [Accepted: 01/01/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND The subclavius muscle runs underneath the clavicle. However, there have been a few reports of a duplicated subclavius muscle which is commonly referred to as subclavius posticus muscle due to its orientation being posterior to the proper subclavius muscle. Its occurrence seems to potentially create a narrowing interval at the superior thoracic aperture as it crosses over the brachial plexus. It might also have functional influence on the shoulder girdle. PURPOSE To provide comprehensive gross anatomy description of the variant "subclavius posticus muscle" and to investigate its reported clinical implications with emphasis on its involvement in causing brachial plexus compression. BASIC PROCEDURES A scoping review with meta-analysis of the gross anatomy of the subclavius posticus muscle was conducted along with investigating its correlation to the thoracic outlet syndrome. Forty-seven articles were pooled through two rounds of the selection process. The relevant information was extracted and meta-analyzed. MAIN FINDINGS The scoping review and meta-analysis of the 47 articles revealed a total prevalence of 11/2069 (4.9%); 10/1369 (5.1%) in cadaveric studies, and 1/700 (5.0%) in MRI studies. The subclavius posticus muscle is a short triangular muscle with an average length of 12 cm and an average width of 1 cm. It originates from the sternal end of the first rib in most cases with reported variants of one case originating from the costoclavicular ligament and one case where it was fused with the proper subclavius muscle. Its insertion is more variable: on the superior border of the scapula with variable length in 71.35%, on the coracoid process of the scapula in 25.42%, and on the clavicle in 0.90%. The subclavian nerve seems to be the dominant nerve supply with a 57.6% prevalence, while 25.8% are innervated by the suprascapular nerve. Other reported nerves were the nerve to the myolohyoid (4.5%), accessory phrenic nerve (4.5%), and a direct branch from the brachial plexus (2.0%). The blood supply was reported (only once) to be from the suprascapular artery. However, the venous drainage was not established at all. PRINCIPAL CONCLUSIONS The subclavius posticus muscle is a variant muscle occurring with a reported overall prevalence of 4.9%. It can compress the brachial plexus as it runs across at the space of the superior thoracic aperture with exquisite contact, and this can lead to a neurogenic thoracic outlet syndrome. It also can be involved in the vascular thoracic outlet syndrome. Lastly, it is important not to omit its potential influence in shoulder joint instability to some extent.
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Affiliation(s)
- Azzat Al-Redouan
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Michal Benes
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Ehsan Abbaspour
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Vojtech Kunc
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Alallah J, Al Talhi YM. Case 1: A Full-Term Neonate with Trisomy 13 and Pneumoperitoneum. Neoreviews 2020; 21:e571-e573. [PMID: 32737174 DOI: 10.1542/neo.21-8-e571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jubara Alallah
- Neonatology Section, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Yousef M Al Talhi
- Neonatology Section, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Diogo R, Siomava N, Gitton Y. Development of human limb muscles based on whole-mount immunostaining and the links between ontogeny and evolution. Development 2019; 146:146/20/dev180349. [PMID: 31575609 DOI: 10.1242/dev.180349] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 12/28/2022]
Abstract
We provide the first detailed ontogenetic analysis of human limb muscles using whole-mount immunostaining. We compare our observations with the few earlier studies that have focused on the development of these muscles, and with data available on limb evolution, variations and pathologies. Our study confirms the transient presence of several atavistic muscles - present in our ancestors but normally absent from the adult human - during normal embryonic human development, and reveals the existence of others not previously described in human embryos. These atavistic muscles are found both as rare variations in the adult population and as anomalies in human congenital malformations, reinforcing the idea that such variations/anomalies can be related to delayed or arrested development. We further show that there is a striking difference in the developmental order of muscle appearance in the upper versus lower limbs, reinforcing the idea that the similarity between various distal upper versus lower limb muscles of tetrapod adults may be derived.
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Affiliation(s)
- Rui Diogo
- Department of Anatomy, Howard University College of Medicine, Washington, DC 20059, USA
| | - Natalia Siomava
- Department of Anatomy, Howard University College of Medicine, Washington, DC 20059, USA
| | - Yorick Gitton
- Sorbonne Universites, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, 17 Rue Moreau, 75012 Paris, France
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Wijerathne BTB, Meier RJ, Salgado SS, Agampodi SB. Dermatoglyphics in kidney diseases: a review. SPRINGERPLUS 2016; 5:290. [PMID: 27066327 PMCID: PMC4781820 DOI: 10.1186/s40064-016-1783-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/12/2016] [Indexed: 01/25/2023]
Abstract
Kidney diseases are becoming a major cause of global burden with high mortality and morbidity. The origins of most kidney diseases are known, but for some the exact aetiology is not yet understood. Dermatoglyphics is the scientific study of epidermal ridge patterns and it has been used as a non-invasive diagnostic tool to detect or predict different medical conditions that have foetal origin. However, there have been a limited number of studies that have evaluated a dermatoglyphic relationship in different kidney diseases. The aim of this review was to systematically identify, review and appraise available literature that evaluated an association of different dermatoglyphic variables with kidney diseases. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The PubMed® (Medline), POPLINE, Cochrane Library and Trip Database and grey literature sources such as OpenGrey, Google Scholar, and Google were searched to earliest date to 17 April 2014. Of the 36 relevant publications, 15 were included in the review. Of these studies, there are five case reports, seven case series and three comparative studies. Possible association of dermatoglyphics with Wilms tumor (WT) had been evaluated in two comparative studies and one case series that found fewer whorls and a lower mean total ridge count (TRC). Another study evaluated adult polycystic kidney disease (APCD) type III that revealed lower TRC means in all cases. All other case series and case reports describe dermatoglyphics in various kidney disease such as acro-renal-ocular syndrome, potter syndrome, kabuki makeup syndrome, neurofaciodigitorenal syndrome, syndactyly type V, ring chromosome 13 syndrome, trisomy 13 syndrome and sirenomelia. It is evident that whorl pattern frequency and TRC have been used widely to investigate the uncertainty related to the origin of several kidney diseases such as WT and APCD type III. However, small sample sizes, possibly methodological issues, and discrepancy in the make up between cases and control groups limits interpretation of any significant findings. Future studies with proper protocol, adequate cases, and control groups may provide stronger evidence to resolve uncertainty related to the aetiology of kidney diseases.
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Affiliation(s)
- Buddhika T B Wijerathne
- Department of Forensic Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
| | - Robert J Meier
- Department of Anthropology, Indiana University, Bloomington, IN USA
| | - Sujatha S Salgado
- Department of Anatomy, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Suneth B Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Diogo R, Walsh S, Smith C, Ziermann JM, Abdala V. Towards the resolution of a long-standing evolutionary question: muscle identity and attachments are mainly related to topological position and not to primordium or homeotic identity of digits. J Anat 2015; 226:523-9. [PMID: 25851747 DOI: 10.1111/joa.12301] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 12/27/2022] Open
Abstract
Signaling for limb bone development usually precedes that for muscle development, such that cartilage is generally present before muscle formation. It remains obscure, however, if: (i) tetrapods share a general, predictable spatial correlation between bones and muscles; and, if that is the case, if (ii) such a correlation would reflect an obligatory association between the signaling involved in skeletal and muscle morphogenesis. We address these issues here by using the results of a multidisciplinary analysis of the appendicular muscles of all major tetrapod groups integrating dissections, muscle antibody stainings, regenerative and ontogenetic analyses of fluorescently-labeled (GFP) animals, and studies of non-pentadactyl human limbs related to birth defects. Our synthesis suggests that there is a consistent, surprising anatomical pattern in both normal and abnormal phenotypes, in which the identity and attachments of distal limb muscles are mainly related to the topological position, and not to the developmental primordium (anlage) or even the homeotic identity, of the digits to which they are attached. This synthesis is therefore a starting point towards the resolution of a centuries-old question raised by authors such as Owen about the specific associations between limb bones and muscles. This question has crucial implications for evolutionary and developmental biology, and for human medicine because non-pentadactyly is the most common birth defect in human limbs. In particular, this synthesis paves the way for future developmental experimental and mechanistic studies, which are needed to clarify the processes that may be involved in the elaboration of the anatomical patterns described here, and to specifically test the hypothesis that distal limb muscle identity/attachment is mainly related to digit topology.
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Affiliation(s)
- Rui Diogo
- Department of Anatomy, Howard University College of Medicine, Washington, DC, USA
| | - Sean Walsh
- Department of Anatomy, Howard University College of Medicine, Washington, DC, USA
| | - Christopher Smith
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janine M Ziermann
- Department of Anatomy, Howard University College of Medicine, Washington, DC, USA
| | - Virginia Abdala
- Fundación Miguel Lillo-CONICET, Fac. de Cs. Naturales (UNT), Instituto de Herpetología, Tucumán, Argentina
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Coburn KL, Campbell KCM, Kuhn MJ, Moreno MA. Electrophysiological and Structural Abnormalities in a Long-Term Survivor of Trisomy 13 (Patau’s Syndrome). Am J Audiol 1996. [DOI: 10.1044/1059-0889.0501.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Urban B, Bersu ET. Chromosome 18 aneuploidy: anatomical variations observed in cases of full and mosaic trisomy 18 and a case of deletion of the short arm of chromosome 18. AMERICAN JOURNAL OF MEDICAL GENETICS 1987; 27:425-34. [PMID: 3605225 DOI: 10.1002/ajmg.1320270221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cases of full and mosaic trisomy 18 and a body of an infant with the 18p-syndrome were dissected in detail to compare the anatomical variations associated with these 3 chromosome imbalances involving autosome 18. The types and numbers of morphologic variations present in both the full and mosaic trisomy 18 bodies were similar to the types and numbers of variations seen in all other cases of full trisomy 18 that have been studied by gross dissection. Apart from an atrial septal defect, the body of the infant with the 18p- imbalance showed only 2 striking defects: 1) deficiencies of the levator palpebrae superioris muscle of the upper eyelid, and 2) absence of the ligament of the head of the femur. The first variation provides a morphologic basis to explain the ptosis which is observed frequently in affected individuals. Absence of the ligament of the head of the femur may be a factor contributing to congenital dislocation of the hip, which is reported occasionally in affected individuals. In addition to providing more detailed information about the phenotype of individual aneuploidy syndromes, studies of cases of different imbalances of single autosomes may provide additional insights about the genotype/phenotype relationships of specific chromosome segments.
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Tharapel SA, Lewandowski RC, Tharapel AT, Wilroy RS. Phenotype-karyotype correlation in patients trisomic for various segments of chromosome 13. J Med Genet 1986; 23:310-5. [PMID: 3746829 PMCID: PMC1049695 DOI: 10.1136/jmg.23.4.310] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Analysis of clinical and cytogenetic findings taken from 62 published cases of partial trisomies of chromosome 13 showed that 15 had partial trisomy for the proximal long arm and 47 had trisomy for the distal long arm. Persistence of fetal haemoglobin (Hb F), increased projections of polymorphonuclear leucocytes (PMN), depressed nasal bridge, cleft lip/palate, and clinodactyly were more frequent in patients with proximal trisomy 13. In the distal trisomy group, the common features included haemangioma, bushy eyebrows, long curled eyelashes, prominent nasal bridge, long philtrum, thin upper lip, highly arched palate, and hexadactyly. In addition, several other features were common to both the groups, often showing inconsistency even when the same segment was in trisomy. The influence of the second aneusomy as the most likely cause for such inconsistent and overlapping phenotypes is discussed in view of the fact that 42 of 62 cases were derived from a balanced translocation carrier parent.
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Dunlap SS, Aziz MA, Rosenbaum KN. Comparative anatomical analysis of human trisomies 13, 18, and 21: I. The forelimb. TERATOLOGY 1986; 33:159-86. [PMID: 2943045 DOI: 10.1002/tera.1420330204] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Human trisomies 13, 18, and 21 exhibit specific neuromuscular phenotypes (Pettersen and Bersu, '82) which include a high proportion of neuromuscular forelimb variations, many of which are atavistic in nature (de Beer, '58; Barash et al., '79; Aziz, '81a). In order to test the neuromuscular phenotype, examine the atavistic nature, and analyze the developmental delay of the trisomy forearm musculature, we dissected the forelimbs of five trisomy 13, ten trisomy 18, and two trisomy 21 cases. Our dissections compare favorably with the existing published trisomy cases (Opitz et al., '79; Pettersen and Bersu, '82). Additionally, we found significant differences in the stage at which developmental arrest occurred in trisomies 13 and 18 for the pectoral complex, extensor digitorum profundus, and intrinsic hand musculature. Some of these muscles, which occur normally in nonhuman primates (Cihak, '67, '69; Dunlap et al., '85), also appear briefly in normal human ontogeny (Cihak, '72), constituting further evidence for developmental delay in aneuploids. The disproportionately effected limb tissues also lend support to the evidence for some degree of autonomy in their development in normal individuals. Our observations are consistent with Shapiro's amplified developmental instability model ('83). Aneuploids may be viewed as genetic variants from which much may be learned about normal limb development, how aneuploidy affects dysmorphogenesis, and the kind of information which exists on the duplicated (or monosomic) chromosome.
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Reed SD, Hall JG, Riccardi VM, Aylsworth A, Timmons C. Chromosomal abnormalities associated with congenital contractures (arthrogryposis). Clin Genet 1985; 27:353-72. [PMID: 3995785 DOI: 10.1111/j.1399-0004.1985.tb02278.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In a study of 350 patients with multiple congenital contractures (arthrogryposis), 80 (23%) patients had mental retardation or were developmentally delayed. Out of that group of 80 patients, 13 (16%) were found to have abnormal karyotypes. Two of the thirteen had a family history of chromosomal abnormalities without congenital contractures, therefore, 11 patients had chromosomal anomalies which appeared to be associated with the congenital contractures. Five of the eleven (45%) had chromosome mosaicism, three of those had tissue mosaicism. Two had abnormal skin fibroblast cell lines and normal peripheral leukocyte chromosome studies and one had a normal bone marrow karyotype with abnormal peripheral leukocyte chromosome studies. Chromosome studies were done in these patients with congenital contractures because of developmental delay and multisystem involvement, or recognition of clinical features typical of a chromosomal syndrome. We recommend first lymphocyte; and if those are normal, then fibroblast studies be done on all patients with multiple joint contractures and developmental delay, particularly if unusual facial features or multisystem abnormalities are present.
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Pettersen JC. Gross anatomical studies of a newborn infant with the Meckel syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1984; 18:649-59. [PMID: 6486165 DOI: 10.1002/ajmg.1320180412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A male infant with the Meckel syndrome was studied anatomically. The findings were compared to those from eight trisomy 13 cases to determine whether or not the superficial similarities between the two syndromes were matched by similarities in the internal variations. Emphasis was on the head and limbs. In the head, major differences were found in the nasal bones, mandible, and tongue. In the limbs, the skeletal variations were more severe in the Meckel syndrome infant, but he lacked the muscle variations diagnostic of trisomy 13.
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Rivas F, Rivera H, Plascencia ML, Ibarra B, Cantú JM. The phenotype in partial 13q trisomies, apropos of a familial (13;15)(q22;q26) translocation. Hum Genet 1984; 67:86-93. [PMID: 6745930 DOI: 10.1007/bf00270563] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A 12 month-old male patient with a karyotype 46,XY,-15,+der(15),t(13;15)(q22;q26)pat is presented. His stillborn sib showed malformations compatible with the 13q deletion syndrome, probably due to a 46,XY,der(13) karyotype. Phenotypic analysis of 41 cases from the literature with partial distal 13q (D13q) trisomies indicate that the segment 13q22----qter in trisomy with or without another concomitant aneusomy is sufficient to produce the majority of the trisomy 13 syndrome features, some of which (cleft palate, increased HbF and projections in PMN) are present in different non-overlapping partial 13q trisomies. About 82% of the D13q trisomies are inherited, more frequently from the mother.
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Abstract
A male infant with the Meckel syndrome was studied anatomically. The findings were compared with those from eight trisomy-13 cases to determine whether or not the superficial similarities between the two syndromes were matched by similarities in the internal variations. Emphasis was on the head and limbs. In the head, major differences were found in the nasal bones, mandible, and tongue. In the limbs, the skeletal variations were more severe in the Meckel syndrome infant, but he lacked the muscle variations diagnostic of trisomy 13.
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Aziz MA. Possible "atavistic" structures in human aneuploids. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1981; 54:347-53. [PMID: 7234983 DOI: 10.1002/ajpa.1330540308] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Comprehensive dissections of aneuploid (trisomy 18 and 13) neonates have revealed numerous supernumerary muscles that, although present in rare individuals, do not regularly occur in the human. These supernumerary muscles include: "platysma occipitalis," "rhomboideus occipitalis, "deltopectoral" complex, "latissimocondyloideus," "pectorodorsalis," "chondrohumeralis," and "peroneus digiti quinti"; a few muscles, e.g., palmaris longus and brevis are lacking altogether. One specimen exhibited a "linguofacial trunk" arising from the external carotid artery. The supernumerary muscles found in these aneuploid specimens are regularly found in monkeys and sometimes in the great apes. It is suggested that these supernumerary muscles may be "atavistic" structures. Problems in establishing homologies between these muscles among primates are discussed, and mechanisms leading to the development of these muscles in human aneuploids are proposed.
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Abstract
Comprehensive dissections of three infants with trisomy-13 and three with trisomy-18 have revealed several muscles which appear to be "abnormal" at the time of birth and shortly thereafter. Careful observations show that the peculiar morphology of these muscles results from delayed development rather than from anatomical malformation. The observations are compared with physiological, pathological and in vitro experimental studies of delayed embryonic development in human aneuploidy.
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Wenger SL, Steele MW. Meiotic consequences of pericentric inversions of chromosome 13. AMERICAN JOURNAL OF MEDICAL GENETICS 1981; 9:275-83. [PMID: 7294066 DOI: 10.1002/ajmg.1320090403] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A case is presented demonstrating meiotic consequences of inheritance of a pericentric inversion, inv(13)(p13q21), and suggesting, together with other similar reports reviewed, that certain manifestations (highly arched palate, long philtrum, polydactyly, microphthalmia, and capillary hemangiomata) result from duplication of the distal 13q while others (cleft lip/palate, scalp defects, congenital heart disease) result from duplication of the proximal 13q.
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Abstract
Gross morphological defects and variations in a cytogenetically confirmed case of trisomy 13 with t (D/D) are described comprehensively for the first time. The subject, a female neonate, exhibited the following clinical features: microcephaly, sloping forehead, coloboma of the iris, bilateral cleft lip and palate, short neck, and postaxial extra digits on hands and feet. Visceral anomalies included: dextrocardia; hypertrophied right ventricle; common atrium; hypertrophied sinus venosus; persistent left superior vena cava; a large, patent ductus arteriosus interventricular septal defect; Meckel diverticulum; common mesentary; omphalocele; accessory renal arteries and veins; bicornuate uterus; bilateral agenesis of the olfactory bulb; partial holoprosencephaly; and the ulnar nerve passed anterior to the medial epicondyle, bilaterally. Supernumerary muscles included: pectorodorsalis ("achselbogen"); chondroepitrochlearis; sternochondroscapularis; accessory heads of biceps brachii; and radiocarpus. The following muscles were absent: stylohyoideus; pectoralis minor (left); subclavius; palmaris longus and brevis; plantaris; and peroneus tertius. The following muscles exhibited unusual variations: digastricus; mylohyoideus; pectoralis major; and extensor indicis. These findings are compared and contrasted with those recently reported in primary trisomy 13 and 18 and with a case of trisomy 13 with a D/G translocation.
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