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Hendriks S, Althaus J, Atkinson MA, Baschat AA, Berkman BE, Grady C, Wasserman D, Wendler D, Miller JL. Precarious hope: Ethical considerations for offering experimental fetal therapies outside of research after initial studies in humans. Prenat Diagn 2024; 44:180-186. [PMID: 38069681 DOI: 10.1002/pd.6474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Risks and benefits of experimental fetal therapies can remain uncertain after initial clinical studies, especially long-term effects. Nevertheless, pregnant individuals may request them, hoping to benefit their future child. Guidance about offering experimental fetal therapies outside research (as "innovative therapy") is limited, despite their ethical complexity. We propose points for clinicians and reviewers to consider when deciding whether and how to offer experimental fetal therapies as innovative therapies after initial clinical studies. METHOD We used conceptual analysis and a current case to develop points for consideration, grounded in broader debates on innovative therapy and the unique challenges associated with experimental fetal therapies. RESULTS Clinicians should evaluate whether offering experimental fetal therapies as innovative therapy is appropriate for a pregnant individual and their fetus. The anticipated risk-benefit ratio for the fetus should be favorable. For the pregnant individual, risks may outweigh benefits, within reasonable limits. Medical resources should be sufficient to ensure appropriate care. Clinicians should support pregnant individuals in making informed choices. Clinicians offering innovative therapies with more than minimal risk should collect and report data on outcomes. Independent review should take place. CONCLUSION Considering these points may advance the interests of fetuses, future children, and their families.
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Affiliation(s)
- Saskia Hendriks
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Janyne Althaus
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Maryland, USA
| | - Meredith A Atkinson
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin E Berkman
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
- National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Christine Grady
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - David Wasserman
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - David Wendler
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Jena L Miller
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland, USA
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Vardhan H, Verma M. Prenatal management in clefts. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2023. [DOI: 10.4103/jclpca.jclpca_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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3
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Hendriks S, Grady C, Wasserman D, Wendler D, Bianchi DW, Berkman B. A New Ethical Framework for Assessing the Unique Challenges of Fetal Therapy Trials. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:45-61. [PMID: 33455521 PMCID: PMC8530458 DOI: 10.1080/15265161.2020.1867932] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
New fetal therapies offer important prospects for improving health. However, having to consider both the fetus and the pregnant woman makes the risk-benefit analysis of fetal therapy trials challenging. Regulatory guidance is limited, and proposed ethical frameworks are overly restrictive or permissive. We propose a new ethical framework for fetal therapy research. First, we argue that considering only biomedical benefits fails to capture all relevant interests. Thus, we endorse expanding the considered benefits to include evidence-based psychosocial effects of fetal therapies. Second, we reject the commonly proposed categorical risk and/or benefit thresholds for assessing fetal therapy research (e.g., only for life-threatening conditions). Instead, we propose that the individual risks for the pregnant woman and the fetus should be justified by the benefits for them and the study's social value. Studies that meet this overall proportionality criterion but have mildly unfavorable risk-benefit ratios for pregnant women and/or fetuses may be acceptable.
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Affiliation(s)
- Saskia Hendriks
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
| | - Christine Grady
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
| | - David Wasserman
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
| | - David Wendler
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
| | - Diana W. Bianchi
- National Human Genome Research Institute, National
Institutes of Health, 31 Center Dr, Room 2A03, Bethesda, MD 20894, USA
| | - Benjamin Berkman
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
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Tunc TE. Prenatal politics: fetal surgery, abortion and disability rights in the United States. New Bioeth 2021; 27:334-348. [PMID: 34558374 DOI: 10.1080/20502877.2021.1981043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While fetal surgery-and pregnancy termination as a possible therapeutic alternative-have been examined in a number of studies, very few have addressed the issues and tensions that arise when prenatal surgery is considered from the standpoint of Disability Studies. This article will expose these concerns by tracing the medical development of fetal surgery; the arguments for and against prenatal surgery; and the connections between fetal surgery, abortion, and disability rights. Like other dimensions of the life cycle that involve reproduction, prenatal surgery has become highly politicized in the United States which has, to a certain extent, stalled critical discussion. However, the skepticism with which many disability rights advocates and policymakers approach prenatal medical intervention in general has opened a new space for active debate concerning fetal surgery in terms of how it medicalizes pregnancy, pathologizes diversity, contributes to the valuation of life, and emphasizes 'perfect babies' at any cost.
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James O, Adekunle AA, Adeyemo WL. How Does Octyl-2-Cyanoacrylate Tissue Adhesive Compare With Prolene Sutures in Cleft Lip Repair? J Oral Maxillofac Surg 2021; 79:1540-1548. [PMID: 33621479 DOI: 10.1016/j.joms.2021.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Comparative evidence of the usefulness of octyl-2-cyanoacrylate tissue adhesive in cleft lip epidermal skin closure especially in Africans is still lacking. This study aimed to compare the outcome of wound healing after the use of Dermabond tissue adhesive and 5/0 Prolene sutures in cleft lip repair. METHODS This was a prospective randomized controlled clinical study. The sampled population was patients undergoing cleft lip repair at a tertiary health facility in Lagos, Nigeria. Study patients were randomly allocated to either group A (Dermabond) or group B (suture). The predictor variable was the type of material used in skin closure; the primary outcome variable was the esthetics of the resulting scar, and secondary outcome variables were wound healing complications. Assessment of the 3-month postoperative wound scar was performed using the cosmetic visual analog scale (CVAS) and the Hollander Wound Evaluation scale (HWES). Calculated sample size was 14 participants per group. Descriptive and comparative statistics were computed, and the P value was set at <0.05. RESULTS Analysis of result included 38 participants. Median age was 4 months and 52.6% were women. Two cases (5.3%) of wound healing complications were recorded (1 in each group). Blinded evaluation of the 3-month postoperative photographs yielded a mean CVAS score of 86.0 (±11.2) and HWES score of 5.0 (±0.9) for group A and a mean CVAS score of 76.5 (±14.5) and HWES score of 4.5 (±1.1) for group B. There was no statistically significant difference between these 2 groups based on the CVAS (P = .052) and HWES (P = .152). CONCLUSIONS The results of this study suggest Dermabond offers a comparable cosmetic outcome as 5/0 Prolene suture in epidermal closure of cleft lip. There was no statistically significant difference in wound complications and wound cosmetic scores between the 2 groups.
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Affiliation(s)
- Olutayo James
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi - Araba, Lagos, Nigeria
| | - Adegbayi Adeola Adekunle
- Senior Resident, Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi - Araba, Lagos, Nigeria.
| | - Wasiu Lanre Adeyemo
- Professor, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi - Araba, Lagos, Nigeria
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Gimenez A, Kopkin R, Chang DK, Belfort M, Reece EM. Advances in Fetal Surgery: Current and Future Relevance in Plastic Surgery. Semin Plast Surg 2019; 33:204-212. [PMID: 31384237 DOI: 10.1055/s-0039-1693431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Scarless healing has long been the holy grail for plastic surgery. While historically fetal surgery has tempted plastic surgeons with the allure of scarless correction of congenital abnormalities, the risks far outweighed the benefits and these interventions never materialized. Current advances in fetal surgery with minimally invasive fetoscopic surgery have made these early fetal interventions safer, leading to expanding applications. While the plastic surgeon's role is limited as of yet, this article provides a review of the history of fetal surgery and the advances that may become relevant to the future plastic surgeon.
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Affiliation(s)
- Alejandro Gimenez
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rachel Kopkin
- School of Medicine, Health Sciences Center, Louisiana State University, New Orleans, Louisiana.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Daniel K Chang
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Michael Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Edward M Reece
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Gonçalves LF. Three-dimensional ultrasound of the fetus: how does it help? Pediatr Radiol 2016; 46:177-89. [PMID: 26829949 DOI: 10.1007/s00247-015-3441-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/30/2015] [Accepted: 07/13/2015] [Indexed: 01/20/2023]
Abstract
Three-dimensional ultrasonography (3-D US) was introduced to the field of fetal imaging in the early 1990s. Since then several publications have described potential applications for the diagnosis of congenital malformations as well as organ volumetry. This article reviews basic principles of 3-D US as well as its clinical applicability to prenatal diagnosis of abnormalities involving the face, spine and skeletal system, as well as potential applications of 3-D US for fetal cardiovascular and neuroimaging. Limitations related to motion artifacts, acoustic shadowing and barriers to clinical implementation of 3-D US in clinical practice are addressed.
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Affiliation(s)
- Luis F Gonçalves
- Department of Radiology and Department of Obstetrics & Gynecology, Beaumont Health System,, Divisions of Pediatric Radiology and Fetal Imaging,, 360 W. 13 Mile Road, Royal Oak, MI, 48073, USA.
- Department of Radiology and Department of Obstetrics & Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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Abramson ZR, Peacock ZS, Cohen HL, Choudhri AF. Radiology of Cleft Lip and Palate: Imaging for the Prenatal Period and throughout Life. Radiographics 2015; 35:2053-63. [DOI: 10.1148/rg.2015150050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Nicholls W, Jennings R, Yeung Y, Walters M, Hewitt B. Antenatal Ultrasound Detection of Cleft in Western Australia from 2003 to 2012: A Follow-Up Study. Cleft Palate Craniofac J 2015; 54:321-326. [PMID: 26506047 DOI: 10.1597/15-127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
AIM To investigate trends in the rate of antenatal detection of cleft lip and palate (CLP) patients referred to the CLP Unit at Princess Margaret Hospital for Children in Perth, Western Australia during the period 2003-2012 and compare data with a previously published report covering the years 1996-2003. METHODS This is a single-center, retrospective survey of antenatal transabdominal ultrasound screenings of mothers of infants born between July 1, 2003 and June 30, 2012 that were referred to the CLP Unit at Princess Margaret Hospital. RESULTS Detection rates of oral clefts increased significantly when compared with outcomes reported in the same population between 1996 and 2003 (P < .05). An overall detection rate of 71.7% (165/230) was achieved for clefts involving lip and palate. Detection of isolated cleft palate (1/99) and microform (0/8) remained elusive. Most detections (76.5%) were achieved at 15 to 20 weeks of gestational age, corresponding with routine anatomical screening. A further 16.8% were detected post-20 weeks of gestation. Scans were performed by specialist obstetricians, and sonography clinics reported a detection rate of 84.6% (55/65), whereas nonspecialist clinics reported a detection rate of only 67.1% (110/164). CONCLUSION The antenatal detection rates of oral clefts involving the lip have improved to the extent that the majority of mothers are now being referred to a cleft unit in Western Australia prior to the births of their children. As a result of this improvement, antenatal counseling is now a common facet of cleft management.
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Wu C, Endo M, Yang BH, Radecki MA, Davis PF, Zoltick PW, Spivak RM, Flake AW, Kirschner RE, Nah HD. Intra-amniotic transient transduction of the periderm with a viral vector encoding TGFβ3 prevents cleft palate in Tgfβ3(-/-) mouse embryos. Mol Ther 2012; 21:8-17. [PMID: 23089732 DOI: 10.1038/mt.2012.135] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cleft palate is a developmental defect resulting from the failure of embryonic palatal shelves to fuse with each other at a critical time. Immediately before and during palatal fusion (E13-E15 in mice), transforming growth factor β3 (TGFβ3) is expressed in the palatal shelf medial edge epithelium (MEE) and plays a pivotal role in palatal fusion. Using Tgfβ3(-/-) mice, which display complete penetrance of the cleft palate phenotype, we tested the hypothesis that intra-amniotic gene transfer could be used to prevent cleft palate formation by restoring palatal midline epithelial function. An adenoviral vector encoding Tgfβ3 was microinjected into the amniotic sacs of mouse embryos at successive developmental stages. Transduced Tgfβ3(-/-) fetuses showed efficient recovery of palatal fusion with mesenchymal confluence following injection at E12.5 (100%), E13.5 (100%), E14.5 (82%), and E15.5 (75%). Viral vectors injected into the amniotic sac transduced the most superficial and transient peridermal cell layer but not underlying basal epithelial cells. TGFβ3 transduction of the peridermdal cell layer was sufficient to induce adhesion, fusion, and disappearance of the palatal shelf MEE in a cell nonautonomous manner. We propose that intra-amniotic gene transfer approaches have therapeutic potential to prevent cleft palate in utero, especially those resulting from palatal midline epithelial dysfunction.
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Affiliation(s)
- Chadwick Wu
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
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Usefulness of magnetic resonance imaging in the prenatal study of malformations of the face and neck. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zugazaga Cortazar A, Martín Martínez C. Utilidad de la resonancia magnética en el estudio prenatal de las malformaciones de la cara y el cuello. RADIOLOGIA 2012; 54:387-400. [DOI: 10.1016/j.rx.2011.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 05/17/2011] [Accepted: 05/19/2011] [Indexed: 10/28/2022]
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Robinson AN, Scully C. Re: Kontopoulos EV, Gualtieri M, Quintero RA. Successful in utero treatment of an oral teratoma via operative fetoscopy: case report and review of literature [Am. J. Obstet. Gynecol. 207 (2012) e12-e15]. Br J Oral Maxillofac Surg 2012; 51:83. [PMID: 22846886 DOI: 10.1016/j.bjoms.2012.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
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Abstract
Background Fetal surgery, also referred to as in utero, prenatal or intrauterine surgery, consists of treatment of congenital malformations during the fetal period. The idea of treating malformations diagnosed in the course of intrauterine life dates back to 1963, when Lilly performed the first blood transfusion in a fetus. Since then it has been introduced as a treatment option in a series of lethal malformations. Efforts are being made to treat nonlethal malformations by means of fetal surgery. Material/Methods A comprehensive search of the literature using MEDLINE and PubMed between 1925 and February 2009 was performed. Search terms for MEDLINE and PubMed were: fetal surgery, foetal surgery, in utero surgery, prenatal surgery, and in utero treatment. In addition, information was obtained at Web sites of the International Medicine and Surgery Society and the University of California Fetal Treatment Centre. Results Authors’ attention focused on the survey of indications to intrauterine operations. We outline potential directions of its development, quoting the groundwork of the most experienced researchers and clinicians. Moreover, owing to the authors’ interest in plastic surgery, some remarks on the role of intrauterine medicine and surgery in this branch of medicine are made. Conclusions In utero surgery may be regarded as an efficient tool of preventive medicine. It offers some advantages that no other branch of medicine may offer. However, its implementation is more troublesome than in the past, therefore only selected cases may benefit from its advantages. Nevertheless, current tendencies are to include, after thorough evaluation of benefit-risk ratio, some new indications for fetal surgery.
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Affiliation(s)
- Piotr Wójcicki
- Department of Plastic Surgery, Wrocław Medical University, Polanica-Zdroj, Poland
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Peiró JL, Carreras E, Guillén G, Arévalo S, Sánchez-Durán MA, Higueras T, Castillo F, Marhuenda C, Lloret J, Martínez-Ibáñez V. Therapeutic Indications of Fetoscopy: A 5-Year Institutional Experience. J Laparoendosc Adv Surg Tech A 2009; 19:229-36. [DOI: 10.1089/lap.2007.0149] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jose L. Peiró
- Fetal Surgery Program, Hospital Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
| | - Elena Carreras
- Fetal Surgery Program, Hospital Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
| | - Gabriela Guillén
- Fetal Surgery Program, Hospital Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
| | - Silvia Arévalo
- Fetal Surgery Program, Hospital Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
| | | | - Teresa Higueras
- Fetal Surgery Program, Hospital Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
| | - Felix Castillo
- Fetal Surgery Program, Hospital Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
| | - Claudia Marhuenda
- Fetal Surgery Program, Hospital Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
| | - Josep Lloret
- Fetal Surgery Program, Hospital Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
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Tollefson TT, Senders CW, Sykes JM. Changing Perspectives in Cleft Lip and Palate. ACTA ACUST UNITED AC 2008; 10:395-400. [DOI: 10.1001/archfaci.10.6.395] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Travis T. Tollefson
- Cleft and Craniofacial Program, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center
| | - Craig W. Senders
- Cleft and Craniofacial Program, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center
| | - Jonathan M. Sykes
- Cleft and Craniofacial Program, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center
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Prenatal Cleft Lip and Maxillary Alveolar Defect Repair in a 2-Step Fetal Lamb Model. J Oral Maxillofac Surg 2007; 65:2479-86. [DOI: 10.1016/j.joms.2007.06.642] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Revised: 05/29/2007] [Accepted: 06/23/2007] [Indexed: 11/18/2022]
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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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Papadopulos NA, Klotz S, Raith A, Foehn M, Schillinger U, Henke J, Kovacs L, Horch RE, Biemer E. Amnion cells engineering: a new perspective in fetal membrane healing after intrauterine surgery? Fetal Diagn Ther 2006; 21:494-500. [PMID: 16969002 DOI: 10.1159/000095660] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Accepted: 11/22/2005] [Indexed: 11/19/2022]
Abstract
In this study we aimed to set up an in vitro culture of the rabbit amnion in order to support in vivo fetal membrane healing capacity following fetoscopy. Fetal membranes were collected from a mid-gestational rabbit, and cultured on collagen support material for 14 days. 34 rabbits at 22-23 days gestational age (GA) underwent fetoscopy. The entry site was randomly allocated to 4 closure technique study groups: group I, human amnion membrane (n = 23); group II, collagen foil (n = 16); group III, collagen plug (n = 19), and group IV, collagen plug with cultured amnion cells (n = 19). In all groups membrane access sites were additionally sealed with fibrin sealant, and the myometrium was closed with sutures. Fetal survival, amnion membrane integrity, and the presence of amniotic fluid were evaluated at 30 days GA. Cultures showed good survival in the collagen support material. Increased cellularity, survival and proliferations were observed. The amnion at the access site resealed in 58-64% of cases in groups II-IV, but none of the tested techniques was significantly better than the other. Histological examination indirectly revealed the anatomic repair of the membranes, since no entrapment of the membranes could be demonstrated in the myometrial wound.
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Affiliation(s)
- Nikolaos A Papadopulos
- Department of Plastic and Reconstructive Surgery, Technical University of Munich, Munich, Germany.
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2006; 14:289-91. [PMID: 16832188 DOI: 10.1097/01.moo.0000233602.37541.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Indications to perform fetal magnetic resonance imaging (MRI) are composed of common ones related to methodological problems of ultrasound (US) assessment (such as for instance hydramnios) and special ones. The latter are related to MR capability of high-resolution soft tissue contrast and an extended field of view that allows visualization of the whole fetus, even in later stages of pregnancy. The most important indications include confirmation of US findings, work-up of malformations with respect to individual prognosis and genetic background, differentiation between acquired conditions and malformations, visualization of pathologies that have to be treated surgically immediately after birth, and morphological changes of the placenta.
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Affiliation(s)
- D Prayer
- Klinik für Radiodiagnostik, Medizinische Universität Wien.
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Abstract
Keloid and hypertrophic scars are the result of abnormal processes in scar formation. This paper reviews the literature and the many debates concerning the processes that cause abnormal scarring.
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Affiliation(s)
- S Pellard
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
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