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Cox S, Duncan JS. Extensive hemicerebral damage after traumatic midterm amniocentesis. Pract Neurol 2021; 21:practneurol-2020-002683. [PMID: 33495282 DOI: 10.1136/practneurol-2020-002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Seth Cox
- Medicine, Bedford Hospital NHS Trust, Bedford, UK
| | - John S Duncan
- National Hospital for Neurology and Neurosurgery, University College London, London, London, UK
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Para commissural cleft of the lower lip: A first case described in the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:288-290. [PMID: 29679736 DOI: 10.1016/j.jormas.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/06/2018] [Indexed: 11/20/2022]
Abstract
We described the first case of para-commissural cleft of the lower lip in a 2 year-old child. He is from a trichorionic triamniotic triplet pregnancy after ovarian stimulation. He has no history except a selective fetal reduction of the mother. We correct this cleft of the lower lip with a double plasty of Malek. The functional and aesthetic result is satisfactory. This particular cleft cannot be explained by the embryological theory. We favor two hypothesis to explain this anomaly: a vascular origin with the stapedial artery and the selective fetal reduction.
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Ghi T, Sotiriadis A, Calda P, Da Silva Costa F, Raine-Fenning N, Alfirevic Z, McGillivray G. ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:256-268. [PMID: 27485589 DOI: 10.1002/uog.15945] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/15/2016] [Indexed: 06/06/2023]
Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A Sotiriadis
- Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Calda
- Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic
| | - F Da Silva Costa
- Monash Ultrasound for Women and Perinatal Services, Monash Medical Centre, Melbourne, Victoria, Australia
| | - N Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK - Nurture Fertility, The Fertility Partnership
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - G McGillivray
- Victorian Clinical Genetics Services, Mercy Hospital for Women, Murdoch Children's Research Institute, Melbourne, Australia
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Abstract
There have been tremendous advances in the ability to screen for the "odds" of having a genetic disorder (both mendelian and chromosomal). With microarray analyses on fetal tissue now showing a minimum risk for any pregnancy being at least 1 in 150 and ultimately greater than 1%, it is thought that all patients, regardless of age, should be offered chorionic villus sampling/amniocentesis and microarray analysis. As sequencing techniques replace other laboratory methods, the only question will be whether these tests are performed on villi, amniotic fluid cells, or maternal blood.
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Abstract
Many specifically human psychiatric and neurological conditions have developmental origins. Rodent models are extremely valuable for the investigation of brain development, but cannot provide insight into aspects that are specifically human. The human brain, and particularly the cerebral cortex, has some unique genetic, molecular, cellular and anatomical features, and these need to be further explored. Cortical expansion in human is not just quantitative; there are some novel types of neurons and cytoarchitectonic areas identified by their gene expression, connectivity and functions that do not exist in rodents. Recent research into human brain development has revealed more elaborated neurogenetic compartments, radial and tangential migration, transient cell layers in the subplate, and a greater diversity of early-generated neurons, including predecessor neurons. Recently there has been a renaissance of the study of human brain development because of these unique differences, made possible by the availability of new techniques. This review gives a flavour of the recent studies stemming from this renewed focus on the developing human brain.
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Affiliation(s)
- Gavin Clowry
- Institute of Neuroscience, Newcastle UniversityNewcastle upon Tyne, UK
| | - Zoltán Molnár
- Department of Physiology, Anatomy and Genetics, University of OxfordOxford, UK
| | - Pasko Rakic
- Department of Neurobiology, Kavli Institute of Neuroscience, Yale University School of MedicineNew Haven, CT, USA
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Abstract
The main focus of this chapter is the comprehensive description of the neuropathology, the imaging correlates and underlying mechanisms of prenatal stroke. We describe established prenatal stroke in subgroups similar to postnatal stroke: arterial (forebrain or hindbrain) infarction, venous thrombosis, primary lobar haemorrhage. This longitudinal classification should facilitate the study of risk factors and mechanisms. Forebrain lesions of arterial type present as porencephaly, (hemi)hydranencephaly, multicystic encephalopathy or schizencephaly. Venous prenatal forebrain stroke presents as simple porencephaly (in some of genetic nature) and sinus thrombosis. A list of rare porencephaly-like conditions is added for differentiation from arterial and venous porencephaly. Hindbrain infarctions (so far the only reported variants seem to be of arterial nature) present as brainstem disconnection, focal brainstem destruction, uni- or bilateral cerebellar destruction and focal spinal cord ischaemia. Prenatal intracranial haemorrhage and congenital brain infection should be considered in the differential diagnosis of prenatal stroke.
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Affiliation(s)
- Paul Govaert
- Sophia Children's Hospital Erasmus MC Rotterdam, dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
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García-Soler P, Martínez Antón J, Bauzano Poley E, Delgado Marqués MP. [Congenital cerebral hemiatrophy]. An Pediatr (Barc) 2008; 68:401-3. [PMID: 18394388 DOI: 10.1157/13117715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Autism is a brain disorder characterized by abnormalities in how a person relates and communicates to others. Both post-mortem and neuroimaging studies indicate the presence of increased brain volume and, in some cases, an altered gray/white matter ratio. Contrary to established gross findings there is no recognized microscopic pathology to autism. Early studies provided multiple leads none of which have been validated. Clinicopathological associations have been difficult to sustain when considering possible variables such as use of medications, seizures, mental retardation and agonal/pre-agonal conditions. Research findings suggest widespread cortical abnormalities, lack of a vascular component and an intact blood-brain barrier. Many of the previously mentioned findings can be explained in terms of a mini-columnopathy. The significance of future controlled studies should be judged based on their explanatory powers; that is, how well do they relate to brain growth abnormalities and/or provide useful clinicopathological correlates.
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Affiliation(s)
- Manuel F Casanova
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY 40292, USA.
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ten Donkelaar HJ, Lammens M, Wesseling P, Hori A, Keyser A, Rotteveel J. Development and malformations of the human pyramidal tract. J Neurol 2004; 251:1429-42. [PMID: 15645341 DOI: 10.1007/s00415-004-0653-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Accepted: 09/07/2004] [Indexed: 11/28/2022]
Abstract
The corticospinal tract develops over a rather long period of time, during which malformations involving this main central motor pathway may occur. In rodents, the spinal outgrowth of the corticospinal tract occurs entirely postnatally, but in primates largely prenatally. In mice, an increasing number of genes have been found to play a role during the development of the pyramidal tract. In experimentally studied mammals, initially a much larger part of the cerebral cortex sends axons to the spinal cord, and the site of termination of corticospinal fibers in the spinal grey matter is much more extensive than in adult animals. Selective elimination of the transient corticospinal projections yields the mature projections functionally appropriate for the pyramidal tract. Direct corticomotoneuronal projections arise as the latest components of the corticospinal system. The subsequent myelination of the pyramidal tract is a slow process, taking place over a considerable period of time. Available data suggest that in man the pyramidal tract develops in a similar way. Several variations in the funicular trajectory of the human pyramidal tract have been described in otherwise normally developed cases, the most obvious being those with uncrossed pyramidal tracts. A survey of the neuropathological and clinical literature, illustrated with autopsy cases, reveals that the pyramidal tract may be involved in a large number of developmental disorders. Most of these malformations form part of a broad spectrum, ranging from disorders of patterning, neurogenesis and neuronal migration of the cerebral cortex to hypoxic-ischemic injury of the white matter. In some cases, pyramidal tract malformations may be due to abnormal axon guidance mechanisms. The molecular nature of such disorders is only beginning to be revealed.
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Affiliation(s)
- H J ten Donkelaar
- Department of Neurology, University Medical Centre Nijmegen, P. O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Abstract
Genetic testing comes in many shapes and sizes. The decision to undergo genetic testing must involve consideration of the medical, psychosocial, and reproductive benefits and risks of testing. The evaluation of risks and benefits varies significantly both between and within families. Pediatricians should keep up with the rapid advances in genetic medicine and the myriad of tests that are being developed and marketed. They also need to be familiar with the psychosocial risks and benefits that these new tests generate for individuals, families and communities. In some situations, genetic testing is merely another diagnostic tool; in other situations, genetic testing offers information about the risks for future diseases. Pediatricians need to be knowledgeable about tests that are indicated clinically and their potential psychosocial implications to best serve children, adolescents, and their families.
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Affiliation(s)
- Lainie Friedman Ross
- University of Chicago Department of Pediatrics, 5841 S. Maryland Ave, MC 6082, Chicago, IL 60637, USA
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Abstract
This article describes the current techniques of foetal sampling. All of them are actually ultrasound guided, and therefore generally very safe. Nevertheless, an elaborate learning process remains indispensable, in addition to a particular attention to the quality of the physician-patient dialogue. The choice of a technique depends on the indication and on the term of the pregnancy. The most frequently used technique is amniocentesis which presents a low risk of foetal loss, estimated between 0.2 and 0.5 percent. The interest of chorionic villus sampling is the possibility to obtain results at an earlier stage of pregnancy, with a lower risk taking when compared to early amniocentesis. We prefer the transabdominal chorionic villus sampling to the transvaginal. Foetal blood sampling is still required in some cases, but the risk of complications is higher--around 1 percent.
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Affiliation(s)
- R Levy
- Service de médecine foetale, institut de puériculture et de périnatalogie, 26, boulevard Brune, 75014 Paris, France.
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Raymond GV. Rare neurologic injury from amniocentesis. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2003; 67:205-6. [PMID: 12797464 DOI: 10.1002/bdra.10013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Nizard J, Duyme M, Ville Y. Teaching ultrasound-guided invasive procedures in fetal medicine: learning curves with and without an electronic guidance system. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:274-277. [PMID: 11896950 DOI: 10.1046/j.1469-0705.2002.00647.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To compare the learning curves of inexperienced junior obstetrics/gynecology registrars for ultrasound-guided invasive procedures on a training model, with and without an electronic guidance system. STUDY DESIGN Four junior registrars performed their first 100 procedures on a training model with a new electronic guidance system, and four other junior registrars performed their first 100 procedures on the same training model without using the guidance system. All procedures were performed using a free-hand technique. We evaluated the quality of the procedure, which we defined as the time spent with the entire needle clearly visualized on the screen over the total duration of the procedure. We constructed learning curves for the eight junior registrars for comparative analysis. RESULTS Quality of the procedure increased over time for all trainees. The learning curves were significantly steeper for trainees using the electronic guidance system. Trainees using the electronic guidance system performed better in the middle of their learning curve (procedures 25-75). All trainees reached the same level of quality by the end of their 100 procedures. CONCLUSIONS The automated electronic guidance system helps faster learning but, after 100 procedures on a training model, both groups reached the same level of quality.
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Affiliation(s)
- J Nizard
- Fetal Medicine Unit, Paris-Ouest University, CHI, Poissy, France
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