According to the New Testament , the Beautiful Gate was one of the gates belonging to the Temple in Jerusalem prior to its destruction by the Romans in AD 70. It was referred to as "beautiful" in chapter 3 of the Acts of the Apostles .
107-507: Acts of the Apostles chapter 3, verses 2 and 10, respectively state: According to the Acts narrative, there was a habitual beggar there with a congenital disability , who sought alms as people entered and left the temple. Peter says to him, "I have no gold and silver but what I do have I give you: In the name of Jesus Christ of Nazareth, rise up and walk". Then taking the man's right hand, he helped
214-539: A nail , and connected to the hand with a small skin pedicle. Mostly one neurovascular bundle can be identified, with no tendons present in the extra digit. In case of a fully developed extra finger, the duplication usually presents itself at the level of the metacarpophalangeal joint. A triplication of the little finger is very rare. Ulnar polydactyly occurs ten times more often in African populations. The incidence in Caucasians
321-434: A syndrome of congenital anomalies. When it occurs by itself, it is associated with autosomal dominant mutations in single genes, i.e. it is not a multifactorial trait . But mutation in a variety of genes can give rise to polydactyly. Typically the mutated gene is involved in developmental patterning, and a syndrome of congenital anomalies results, of which polydactyly is one feature or two. Polydactyly has been linked to
428-409: A 22% chance, while weeks 9–12, a 7% chance exists, followed by 6% if the exposure is during the 13th-16th weeks. Exposure during the first eight weeks of development can also lead to premature birth and fetal death. These numbers are calculated from immediate inspection of the infant after birth. Therefore, mental defects are not accounted for in the percentages because they are not evident until later in
535-458: A 30% higher risk for congenital malformations and a 50% higher risk of neonates being under-sized for their gestational age. Paternal smoking prior to conception has been linked with the increased risk of congenital abnormalities in offspring. Smoking causes DNA mutations in the germline of the father, which can be inherited by the offspring. Cigarette smoke acts as a chemical mutagen on germ cell DNA. The germ cells suffer oxidative damage, and
642-626: A Welsh community also showed an increased incidence of gastroschisis. Another study on 21 European hazardous-waste sites showed that those living within 3 km had an increased risk of giving birth to infants with birth defects and that as distance from the land increased, the risk decreased. These birth defects included neural tube defects, malformations of the cardiac septa, anomalies of arteries and veins, and chromosomal anomalies. Looking at communities that live near landfill sites brings up environmental justice. A vast majority of sites are located near poor, mostly black, communities. For example, between
749-411: A broad or bifid metacarpal or phalanx. Type III is a complete digital duplication, which has a well-formed duplicated metacarpal. Ulnar polydactyly usually does not interfere with hand function, but for social reasons it can be treated operatively. The treatment of Type A ulnar polydactyly is complex as its goal is to remove the accessory digit while maintaining a stable, functional small finger. When
856-440: A fully functional supranumerary digit is preferable to surgical intervention. In contrast, a functional, four-fingered hand achieved via ray amputation may be preferable to a five-fingered hand with a deformed or stiff reconstructed finger. Cases of polysyndactyly are approached through a standard opposing zig-zag incision. The incision is favored toward the accessory digit, preserving extra skin for subsequent closure. Depending on
963-417: A larger whole, with the combined cells attempting to continue to develop in a manner that satisfies the intended growth patterns of both cell masses. The two cellular masses can compete with each other, and may either duplicate or merge various structures. This results in conditions such as conjoined twins , and the resulting merged organism may die at birth when it must leave the life-sustaining environment of
1070-757: A level of 5 ppm. The fetus is even more susceptible to damage from carbon monoxide intake, which can be harmful when inhaled during pregnancy, usually through first- or second-hand tobacco smoke. The concentration of carbon monoxide in the infant born to a nonsmoking mother is around 2%, and this concentration drastically increases to a range of 6%–9% if the mother smoked tobacco. Other possible sources of prenatal carbon monoxide intoxication are exhaust gas from combustion motors, use of dichloromethane (paint thinner, varnish removers) in enclosed areas, defective gas water heaters, indoor barbeques, open flames in poorly ventilated areas, and atmospheric exposure in highly polluted areas. Exposure to carbon monoxide at toxic levels during
1177-441: A mother over the age of 35 years old. Many are believed to involve multiple factors. Birth defects may be visible at birth or diagnosed by screening tests . A number of defects can be detected before birth by different prenatal tests . Treatment varies depending on the defect in question. This may include therapy , medication, surgery, or assistive technology . Birth defects affected about 96 million people as of 2015 . In
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#17328586065371284-448: A normal digit does. Polydactyly can be divided into three major types, which are discussed below, which depend on the location of the additional digit. In 2019 it was found that in cases of polydactyly with a fully functional additional digit, muscles to control the extra digit may be duplicated, resulting in increased motor control that allows the patient to carry out certain tasks with one hand that would normally require two. This
1391-496: A result of a defective development of both the dentine and the enamel of teeth . Several anticonvulsants are known to be highly teratogenic. Phenytoin , also known as diphenylhydantoin, along with carbamazepine , is responsible for the fetal hydantoin syndrome , which may typically include broad nose base, cleft lip and/or palate, microcephalia , nails and fingers hypoplasia , intrauterine growth restriction , and intellectual disability. Trimethadione taken during pregnancy
1498-782: A structural basis, organized when possible by primary organ system affected. Several terms are used to describe congenital abnormalities. (Some of these are also used to describe noncongenital conditions, and more than one term may apply in an individual condition.) A limb anomaly is called a dysmelia . These include all forms of limbs anomalies, such as amelia , ectrodactyly , phocomelia , polymelia , polydactyly , syndactyly , polysyndactyly , oligodactyly , brachydactyly , achondroplasia , congenital aplasia or hypoplasia , amniotic band syndrome , and cleidocranial dysostosis . Congenital heart defects include patent ductus arteriosus , atrial septal defect , ventricular septal defect , and tetralogy of Fallot . Congenital anomalies of
1605-477: A study on 21 patients with Type B ulnar polydactyly treated with suture ligation it was found that the duplicated digit was typically amputated at an average of 10 days and no complications of infection or bleeding were reported. In a large study on 105 patients treated with suture ligation an overall complication rate of 23.5% was reported, citing a residual tender or unacceptable bump in 16%, infection in 6%, and bleeding in 1% of patients. In general, suture ligation
1712-521: A teratogenic agent. These exposures include medication or drug exposures, maternal infections and diseases, and environmental and occupational exposures. Paternal smoking has also been linked to an increased risk of birth defects and childhood cancer for the offspring, where the paternal germline undergoes oxidative damage due to cigarette use. Teratogen-caused birth defects are potentially preventable. Nearly 50% of pregnant women have been exposed to at least one medication during gestation. During pregnancy,
1819-417: A woman can also be exposed to teratogens from contaminated clothing or toxins within the seminal fluid of a partner. An additional study found that of 200 individuals referred for genetic counseling for a teratogenic exposure, 52% were exposed to more than one potential teratogen. The United States Environmental Protection Agency studied 1,065 chemical and drug substances in their ToxCast program (part of
1926-403: Is Potter syndrome due to oligohydramnios . This finding is important for future understanding of how genetics may predispose individuals for diseases such as obesity, diabetes, and cancer. For multicellular organisms that develop in a womb , the physical interference or presence of other similarly developing organisms such as twins can result in the two cellular masses being integrated into
2033-499: Is thalidomide . It was developed near the end of the 1950s by Chemie Grünenthal as a sleep-inducing aid and antiemetic . Because of its ability to prevent nausea, it was prescribed for pregnant women in almost 50 countries worldwide between 1956 and 1962. Until William McBride published the study leading to its withdrawal from the market in 1961, about 8,000 to 10,000 severely malformed children were born. The most typical disorders induced by thalidomide were reductional deformities of
2140-425: Is 55 degrees less than the contralateral thumb. MCP flexion averaged 55 degrees in reconstructed thumbs, compared to 75 degrees in the contralateral thumb. Advantages: The reconstructed joints tend to remain flexible. Also, it preserves the nail bed and physis, this increases the prevention of nail deformities over time. Disadvantages: Although surgeons try to obtain a stable thumb of appropriate size, instability of
2247-440: Is a central duplication, not attached to the adjacent finger by osseous or ligamentous attachments; it frequently does not include bones, joints, cartilage, or tendons. Type IIA is a nonsyndactylous duplication of a digit or part of a digit with normal components, and articulates with a broad or bifid metacarpal or phalanx. Type IIB is a syndactylous duplication of a digit or part of a digit with normal components, and articulates with
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#17328586065372354-480: Is a disorder in which the fetus has an atypically small head, cerebral calcifications means certain areas of the brain have atypical calcium deposits, and meningoencephalitis is the enlargement of the brain. All three disorders cause abnormal brain function or intellectual disability. Hepatosplenomegaly is the enlargement of the liver and spleen which causes digestive problems. It can also cause some kernicterus and petechiae . Kernicterus causes yellow pigmentation of
2461-501: Is a less common situation, in which the affectation is on the side of the hand towards the thumb. Radial polydactyly refers to the presence of an extra digit (or extra digits) on the radial side of the hand. It is most frequent in Indian populations and it is the second most common congenital hand disorder. The incidence of radial polydactyly is reported as 1 in every 3,000 live births. The clinical features of radial polydactyly will depend upon
2568-489: Is a phenotypic variation or innovation, as the fingers and toes arise in places where nothing is phenotypically present in the wild type. Although it is initiated by a point mutation, it occurs as a polyphenism with different numbers of toes. The analysis of the additional toe numbers of Maine Coon cats revealed that the number of toes follows a developmental bias : 2 additional toes occur much more frequently than 4, these more frequently than 6 or 8 additional ones. Also, for
2675-447: Is acquired. Furthermore, the IP and MCP joints are very stable as the collateral ligaments are not violated during reconstruction. Disadvantages: Violation during reconstruction can lead to growth arrest or asymmetric growth. Nail deformity could also occur after reconstruction. Although the joints are stable, restriction of flexion may be possible. The average IP flexion in a reconstructed thumb
2782-437: Is an absence of osseous and ligamentous structures. The surgical technique is analogous to radial polydactyly, in which the level of duplication and anatomical components should guide operative treatment. The pedicled ulnar extra digit can be removed by suture ligation to devise the skin bridge of the newborn child. This might be easier than an excision of the extra digit when the child is 6 to 12 months old. Ligation occludes
2889-451: Is an anomaly in humans and non-human animals resulting in supernumerary fingers and/or toes. Polydactyly is the opposite of oligodactyly (fewer fingers or toes). As of 1977, the incidence of congenital deformities in newborns was approximately 2%, and 10% of these deformities involve the upper extremity. In 1961, Frantz and O’Rahilly proposed that congenital anomalies of the limb could be classified in seven categories, based on
2996-483: Is an extra little finger at the metacarpophalangeal joint, or more proximal including the carpometacarpal joint. The little finger can be hypoplastic or fully developed. Type B varies from a nubbin to an extra, non-functional little finger part on a pedicle. According to the three-type classification, type I includes nubbins or floating little fingers, type II includes duplications at the MCPJ, and type III includes duplications of
3103-521: Is associated with several syndromes: Holt–Oram syndrome , Fanconi anemia (aplastic anemia by the age of 6), Townes–Brocks syndrome , and Greig cephalopolysyndactyly (also known to occur with ulnar polydactyly). The syndromes associated with central polydactyly are: Bardet–Biedl syndrome , Meckel syndrome , Pallister–Hall syndrome , Legius syndrome , Holt–Oram syndrome . Central polydactyly can also be associated with syndactyly and cleft hand . From an evo-devo point of view, polydactyly
3210-426: Is considered harmless for the embryo. Peterka and Novotná do, however, state that synthetic progestins used to prevent miscarriage in the past frequently caused masculinization of the outer reproductive organs of female newborns due to their androgenic activity. Diethylstilbestrol is a synthetic estrogen used from the 1940s to 1971, when the prenatal exposition has been linked to the clear-cell adenocarcinoma of
3317-424: Is currently known about how paternal smoking damages the fetus, and what window of time in which the father smokes is most harmful to offspring. A vertically transmitted infection is an infection caused by bacteria , viruses , or in rare cases, parasites transmitted directly from the mother to an embryo , fetus , or baby during pregnancy or childbirth. Congenital disorders were initially believed to be
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3424-578: Is estimated at least 1% in U.S. as well in Canada. Very few studies have investigated the links between paternal alcohol use and offspring health. However, recent animal research has shown a correlation between paternal alcohol exposure and decreased offspring birth weight. Behavioral and cognitive disorders, including difficulties with learning and memory, hyperactivity, and lowered stress tolerance have been linked to paternal alcohol ingestion. The compromised stress management skills of animals whose male parent
3531-483: Is expressed in an organiser region, called the zone of polarizing activity (ZPA) on the posterior limb side. From there it diffuses anteriorly, laterally to the growth direction of the limb. In the mutant, smaller ectopic expression in a new organiser region is seen on the anterior side of the limb. This ectopic expression causes cell proliferation delivering the raw material for one or more new digits. Polydactyly can occur by itself, or more commonly, as one feature of
3638-477: Is fertilized with sperm that has damaged DNA, a possibility exists that the fetus could develop abnormally. Genetic disorders are all congenital (present at birth), though they may not be expressed or recognized until later in life. Genetic disorders may be grouped into single-gene defects, multiple-gene disorders, or chromosomal defects . Single-gene defects may arise from abnormalities of both copies of an autosomal gene (a recessive disorder) or of only one of
3745-520: Is found mostly in drinking water from ground sources, is a powerful teratogen. A case-control study in rural Australia that was conducted following frequent reports of prenatal mortality and congenital malformations found that those who drank the nitrate-containing groundwater, as opposed to rain water, ran the risk of giving birth to children with central nervous system disorders, muscoskeletal defects, and cardiac defects. Chlorinated and aromatic solvents such as benzene and trichloroethylene sometimes enter
3852-427: Is initially described as a way to lengthen amputated digits.) The goal is to create a functional thumb by combining less-hypoplastic components. On top plasty procedure is rarely employed in the treatment of congenital thumb duplication. It might be necessary for Wassel types 4, 5, 6. At the level of the mid-proximal phalanx or mid-metacarpal, the distal component is transferred to the proximal component. The tendons of
3959-435: Is known to cause abnormalities of the eye, internal ear, heart, and sometimes the teeth. More specifically, fetal exposure to rubella during weeks five to ten of development (the sixth week particularly) can cause cataracts and microphthalmia in the eyes. If the mother is infected with rubella during the ninth week, a crucial week for internal ear development, destruction of the organ of Corti can occur, causing deafness. In
4066-415: Is made. This incision may be extended proximally in order to adequately expose the abductor digiti minimi . The ulnar collateral ligament and the insertions of the abductor digiti minimi are then elevated with a periosteal sleeve. The duplicated extensor and flexor tendons to the ulnar digit are transected and after that the digit is amputated at its articulation with the metacarpal. If the articular surface
4173-412: Is mainly caused by the fact that there is a generally normal function of these patients’ hands following ablation with collateral ligament reconstruction. In a study on 27 patients undergoing surgical excision for Type A ulnar polydactyly, only one complication was noted in the form of an infection. However, no investigators have objectively reviewed functional range of motion or articular stability. In
4280-402: Is most common on the ulnar (little finger) side of the hand, less common on the radial ( thumb ) side, and very rarely within the middle three digits. These are respectively known as postaxial (little finger), preaxial (thumb), and central (ring, middle, index fingers) polydactyly. The extra digit is most commonly an abnormal fork in an existing digit, or it may rarely originate at the wrist as
4387-471: Is often bilateral and associated with syndactyly and polydactyly of the feet. This can be a simple or complex polydactyly. Ulnar polydactyly occurs as an isolated congenital condition, but can also be part of a syndrome, such as: Trisomy 13 , Greig cephalopolysyndactyly syndrome , Meckel syndrome , Ellis–van Creveld syndrome , McKusick–Kaufman syndrome , Down syndrome , Bardet–Biedl syndrome , Smith–Lemli–Opitz syndrome . Type VII of radial polydactyly
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4494-418: Is recommended for Wassel types 1 and 2 (in which both thumbs are severely hypoplastic) by some congenital hand surgeons. The technique contains a composite wedge resection of the central bone and soft-tissue. This will be achieved with approach of the lateral tissue of each thumb. The goal is to achieve a normal thumb, what concerns the size, which is possible. If the width of the nail bed is greater than 70% of
4601-455: Is reported as 1 in 1,339 live births, compared with 1 in 143 live births in Africans. Ulnar polydactyly is also often part of a syndrome. In patients with African ancestry ulnar polydactyly mostly occurs isolated, whereas the presentation in Caucasians is often associated with a syndrome, though in a retrospective review, only 4 of 37 cases of ulnar polydactyly in Caucasians were syndromic. This
4708-429: Is responsible for the fetal trimethadione syndrome , characterized by craniofacial, cardiovascular, renal, and spine malformations, along with a delay in mental and physical development. Valproate has antifolate effects, leading to neural tube closure-related defects such as spina bifida. Lower IQ and autism have recently also been reported as a result of intrauterine valproate exposure. Hormonal contraception
4815-412: Is safe and effective when applied to appropriate cases of Type B polydactyly in which no substantial ligamentous or osseous structures are present within the pedicle. Parents should be educated as to the progression of necrosis, and that revision of residual tissue or scar may be necessary when the child is six months of age or older. Advantages: By combining two hypoplastic thumbs a sufficient thumb size
4922-604: Is suspected, or if more than two or three generations of the family are affected. As of 2009, 97 genetic syndromes have been associated with different kinds of polydactyly. Examples of syndromes include Diamond–Blackfan anemia , and the VACTERL association , acrocallosal syndrome , basal cell nevus syndrome , Biemond syndrome , ectrodactyly-ectodermal dysplasias-cleft lip/palate syndrome , mirror hand deformity , Mohr syndrome , oral-facial-digital syndrome , Rubinstein–Taybi syndrome , short rib polydactyly . Ulnar polydactyly
5029-410: Is the most common situation, in which the extra digit is on the ulnar side of the hand, thus the side of the little finger. This can also be called postaxial polydactyly. It can manifest itself very subtly, for instance only as a nubbin on the ulnar side of the little finger, or very distinctly, as a fully developed finger. Most commonly, the extra finger is rudimentary, consisting of an end phalanx with
5136-440: Is used to avoid any angular deformity in the preserved thumb. Tendon centralization is also often used for correction. Still, cases with osseous deformities may happen. To provide alignment, osteotomies are necessary to be done. This operation may need bone grafting, which is obtained from the amputated thumb. This type is indicated when one thumb is larger proximally and the other thumb has a larger distal component. (The procedure
5243-421: Is wide the metacarpal may be shaved. At last the collateral ligament and abductor digiti minimi are reinserted at the base of the preserved proximal phalanx and a wire is then placed across the reconstructed joint. In patients with a duplicated metacarpal, the accessory digit is amputated in a standard ray fashion with transfer of the abductor digiti minimi to the retained small finger. In this situation there
5350-476: The CompTox Chemicals Dashboard ) using in silico modeling and a human pluripotent stem cell -based assay to predict in vivo developmental intoxicants based on changes in cellular metabolism following chemical exposure. Findings of the study published in 2020 were that 19% of the 1065 chemicals yielded a prediction of developmental toxicity . Probably, the most well-known teratogenic drug
5457-889: The Love Canal site near Niagara Falls and the Lipari Landfill in New Jersey have shown a higher proportion of low birth-weight babies than communities farther away from landfills. A study done in California showed a positive correlation between time and quantity of dumping and low birth weights and neonatal deaths. A study in the United Kingdom showed a correlation between pregnant women living near landfill sites and an increased risk of congenital disorders, such as neural tube defects, hypospadias , epispadia , and abdominal wall defects , such as gastroschisis and exomphalos. A study conducted on
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#17328586065375564-512: The gastrointestinal system include numerous forms of stenosis and atresia , and perforation, such as gastroschisis . Congenital anomalies of the kidney and urinary tract include renal parenchyma, kidneys, and urinary collecting system. Defects can be bilateral or unilateral, and different defects often coexist in an individual child. A congenital metabolic disease is also referred to as an inborn error of metabolism . Most of these are single-gene defects , usually heritable. Many affect
5671-406: The 4-week embryologic period of rapid limb development. As of 2002, polydactyly has been associated with 39 genetic mutations. In humans/animals this condition can present itself on one or both hands or feet. The extra digit is usually a small piece of soft tissue that can be removed. Occasionally it contains bone without joints; rarely it may be a complete functioning digit. The extra digit
5778-413: The IP and MCP joint may occur, as well as a size mismatch. Thumbs are defined as unacceptable if IP joint deviation exceeds 15 degrees, MCP joint deviation exceeds 30 degrees, and thumb size is inappropriate based on the examiner's assessment. Also, thumb size one-third greater or less than the contralateral thumb is defined as unacceptable. No surgical outcomes studies exist for evaluating the function of
5885-420: The IP joint level. However, several primary factors contribute to the complexity of central polydactyly reconstruction. Hypoplastic joints and soft tissues that predispose the reconstructed finger to joint contracture, and angular deformities as well as complex tendon anomalies, are often difficult to address. Therefore, treatment is wholly dependent on the anatomic components present, the degree of syndactyly, and
5992-688: The United States, they occur in about 3% of newborns. They resulted in about 628,000 deaths in 2015, down from 751,000 in 1990. The types with the greatest numbers of deaths are congenital heart disease (303,000), followed by neural tube defects (65,000). Much of the language used for describing congenital conditions antedates genome mapping , and structural conditions are often considered separately from other congenital conditions. Many metabolic conditions are now known to have subtle structural expression, and structural conditions often have genetic links. Still, congenital conditions are often classified on
6099-425: The abortion did not happen, but the newborns had a fetal aminopterin syndrome consisting of growth retardation, craniosynostosis , hydrocephalus, facial dismorphities, intellectual disability, or leg deformities Drinking water is often a medium through which harmful toxins travel. Heavy metals, elements, nitrates, nitrites, and fluoride can be carried through water and cause congenital disorders. Nitrate, which
6206-404: The child's life, precise incidence of birth defects due to rubella are not entirely known. The timing of the mother's infection during fetal development determines the risk and type of birth defect. As the embryo develops, the risk of abnormalities decreases. If exposed to the rubella virus during the first four weeks, the risk of malformations is 47%. Exposure during weeks five through eight creates
6313-431: The child's life. If they were to be included, these numbers would be much higher. Other infectious agents include cytomegalovirus , the herpes simplex virus , hyperthermia , toxoplasmosis , and syphilis . Maternal exposure to cytomegalovirus can cause microcephaly , cerebral calcifications, blindness, chorioretinitis (which can cause blindness), hepatosplenomegaly , and meningoencephalitis in fetuses. Microcephaly
6420-460: The contralateral thumb, it may be split. This type of procedure is used for all Wassel types of polydactyly and is the most commonly used technique. It is recommended in all cases of thumb duplication with a hypoplastic, less-functional thumb. Otherwise, one could consider the Bilhaut-Cloquet. The ulnar thumb is preferably preserved as it is the more developed one in most cases. By detaching
6527-468: The development of the foetal nervous system. Studies with mice have found that food deprivation of the male mouse prior to conception leads to the offspring displaying significantly lower blood glucose levels. External physical shocks or constraints due to growth in a restricted space may result in unintended deformation or separation of cellular structures resulting in an abnormal final shape or damaged structures unable to function as expected. An example
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#17328586065376634-577: The distal component are preserved as the rest of the distal component is amputated. The neurovascular bundle which supplies the distal component is reserved and transferred proximally. Early osteotomy and ligament reconstructions should be done to prevent deformities, such as angular growth deformities. The surgical treatment of central polydactyly is highly variable. After the surgery the hand must be functional and stable, but also aesthetically pleasing. This requires intraoperative creativity and flexibility. The surgeon must also consider whether retention of
6741-412: The duplicated proximal phalanx articulates with a common, broad metacarpal head, the ulnar collateral ligament must be considered. In those cases with a common articulation or with a sixth metacarpal the muscle executing the abduction of the little finger ( abductor digiti minimi ) must be preserved. In patients with a common metacarpal articulation an elliptical incision at the base of the post-axial digit
6848-413: The dust containing lead, leading to lead exposure in the fetus. When lead pipes are used for drinking water and cooking water, this water is ingested, along with the lead, exposing the fetus to this toxin. This issue is more prevalent in poorer communities because more well-off families are able to afford to have their homes repainted and pipes renovated. Endometriosis can impact a woman's fetus , causing
6955-465: The early 1920s and 1978, about 25% of Houston's population was black. However, over 80% of landfills and incinerators during this time were located in these black communities. Another issue regarding environmental justice is lead poisoning . A fetus exposed to lead during the pregnancy can result in learning difficulties and slowed growth. Some paints (before 1978) and pipes contain lead. Therefore, pregnant women who live in homes with lead paint inhale
7062-552: The effects can be seen in altered mRNA production, infertility issues, and side effects in the embryonic and fetal stages of development. This oxidative damage may result in epigenetic or genetic modifications of the father's germline. Fetal lymphocytes have been damaged as a result of a father's smoking habits prior to conception. Correlations between paternal smoking and the increased risk of offspring developing childhood cancers (including acute leukemia , brain tumors , and lymphoma ) before age five have been established. Little
7169-400: The elevation is performed proximally too to potentially rebalance the ulnar thumb. After the radial thumb is amputated, the ulnar elements are centralized and fixed with a Kirschner wire . In most cases, a longitudinal and sagittal osteotomy is needed to centralize the bony parts of the ulnar thumb. While the soft-tissue of the radial thumb was preserved, it is now attached to the radial side of
7276-434: The embryonic failure causing the clinical presentation. These categories are failure of formation of parts, failure of differentiation, duplication, overgrowth, undergrowth, congenital constriction band syndrome, and generalized skeletal abnormalities. In 1976 this was modified by Swanson. Polydactyly belongs to the category of duplication. As of 2009, research has shown that the majority of congenital anomalies occur during
7383-403: The embryonic stage, such as hand and foot malformations, hip dysplasia , hip subluxation, agenesis of a limb, and inferior maxillary atresia with glossoptosis . Also, carbon monoxide exposure between days 35 and 40 of embryonic development can lead to an increased risk of the child developing a cleft palate. Exposure to carbon monoxide or polluted ozone exposure can also lead to cardiac defects of
7490-412: The entire ray. The Wassel classification is the most widely used classification of radial polydactyly, based upon the most proximal level of skeletal duplication. The most common type is Wassel 4 (about 50% of such duplications) followed by Wassel 2 (20%) and Wassel 6 (12%). The classification of central polydactyly is based on the extent of duplication and involves the following three types: Type I
7597-551: The evo-devo theory, polydactyly cannot be adequately explained by genetic mutation alone, but only by constructive development , i.e. the ability of development to produce a complex phenotypic output. The corresponding symbolic generation of toes can now be shown in computer models. Classification is performed by using x-ray imaging to see the bone structures. The classification of ulnar polydactyly exists of either two or three types. The two-stage classification, according to Temtamy and McKusick, involves type A and B. In type A there
7704-563: The expression of a specific gene. Mutations in Hoxa- or Hoxd clusters are reported leading to polydactyly. Interactions of Hoxd13 and GLI3 induce synpolydactyly , a combination of extra and consolidated digits. Other signal transduction pathways in this context are the Wnt signaling pathway or Notch . In the specific case of preaxial polydactyly (Hemingway mutant), a cis-acting mutation approximately 1Mb upstream of SHH gene has been implicated. Normally SHH
7811-445: The extent of duplication. Radial polydactyly varies from a barely visible radial skin tag to complete duplication. Thumb polydactyly varies from barely visible broadening of the distal phalanx to full duplication of the thumb including the first metacarpal. Radial polydactyly is frequently associated with several syndromes. This is a very rare situation, in which the extra digit is on the ring, middle or index finger. Of these fingers,
7918-583: The first two trimesters of pregnancy can lead to intrauterine growth restriction, leading to a baby who has stunted growth and is born smaller than 90% of other babies at the same gestational age. The effect of chronic exposure to carbon monoxide can depend on the stage of pregnancy in which the mother is exposed. Exposure during the embryonic stage can have neurological consequences, such as telencephalic dysgenesis, behavioral difficulties during infancy, and reduction of cerebellum volume. Also, possible skeletal defects could result from exposure to carbon monoxide during
8025-774: The gate by one of its recognized names have met with little success although both the upper inner gate, the Nicanor , and the lower outer gate, the Shushan , have been suggested as candidates. This Christianity -related article is a stub . You can help Misplaced Pages by expanding it . Congenital disorder A birth defect is an abnormal condition that is present at birth , regardless of its cause. Birth defects may result in disabilities that may be physical , intellectual , or developmental . The disabilities can range from mild to severe. Birth defects are divided into two main types: structural disorders in which problems are seen with
8132-431: The heart, the ductus arteriosus can remain after birth, leading to hypertension. Rubella can also lead to atrial and ventricular septal defects in the heart. If exposed to rubella in the second trimester, the fetus can develop central nervous system malformations. However, because infections of rubella may remain undetected, misdiagnosed, or unrecognized in the mother, and/or some abnormalities are not evident until later in
8239-411: The index finger is most often affected, whereas the ring finger is rarely affected. This type of polydactyly can be associated with syndactyly , cleft hand and several syndromes. Polysyndactyly presents various degrees of syndactyly affecting fingers three and four. Polydactyly is associated with different mutations, either mutations in a gene itself or in a cis-regulatory element responsible for
8346-412: The level and extent of duplication, the flexor and extensor tendons may require centralization or rebalancing. Also, the collateral ligaments must be preserved or reconstructed. Wide articular surfaces should be narrowed and phalangeal wedge osteotomies may be required to provide an axial alignment. Attention must also be given to reconstruct the intermetacarpal ligament. Furthermore, one should take in mind
8453-417: The liver and lungs, if the embryo is exposed. For example, a lack of folic acid , a B vitamin, in the diet of a mother can cause cellular neural tube deformities that result in spina bifida. Congenital disorders such as a neural tube deformity can be prevented by 72% if the mother consumes 4 mg of folic acid before the conception and after twelve weeks of pregnancy. Folic acid, or vitamin B 9 , aids
8560-437: The liver stores lipophilic vitamins, including retinol. Isotretinoin (13-cis-retinoic-acid; brand name Roaccutane), vitamin A analog, which is often used to treat severe acne , is such a strong teratogen that just a single dose taken by a pregnant woman (even transdermally ) may result in serious birth defects. Because of this effect, most countries have systems in place to ensure that it is not given to pregnant women and that
8667-737: The local water supply. This led many people in the area to develop what became known as the " Minamata disease ". Because methylmercury is a teratogen, the mercury poisoning of those residing by the bay resulted in neurological defects in the offspring. Infants exposed to mercury poisoning in utero showed predispositions to cerebral palsy , ataxia , inhibited psychomotor development, and intellectual disability. Landfill sites have been shown to have adverse effects on fetal development. Extensive research has shown that landfills have several negative effects on babies born to mothers living near landfill sites: low birth weight, birth defects, spontaneous abortion, and fetal and infant mortality. Studies done around
8774-489: The long bones of the extremities. Phocomelia , otherwise a rare deformity, therefore helped to recognise the teratogenic effect of the new drug. Among other malformations caused by thalidomide were those of ears, eyes, brain, kidney, heart, and digestive and respiratory tracts; 40% of the prenatally affected children died soon after birth. As thalidomide is used today as a treatment for multiple myeloma and leprosy , several births of affected children were described in spite of
8881-409: The man up and immediately the man's feet and ankles were strengthened and he was able to walk and move instead of laying there begging. The Greek adjective used to name the gate ( hōraios ) can be defined as '1. happening or coming at the right time —2. beautiful, fair, lovely'. Some scholars believe the word may refer more to ripeness than to beauty. Attempts by scholars to agree on the identity of
8988-589: The most common symptom in infants is an inflammatory response that develops during the first three weeks of life. Hyperthermia causes anencephaly , which is when part of the brain and skull are absent in the infant. Mother exposure to toxoplasmosis can cause cerebral calcification, hydrocephalus (causes mental disabilities), and intellectual disability in infants. Other birth abnormalities have been reported as well, such as chorioretinitis, microphthalmus, and ocular defects. Syphilis causes congenital deafness, intellectual disability, and diffuse fibrosis in organs, such as
9095-514: The nervous system include neural tube defects such as spina bifida , encephalocele , and anencephaly . Other congenital anomalies of the nervous system include the Arnold–Chiari malformation , the Dandy–Walker malformation , hydrocephalus , microencephaly , megalencephaly , lissencephaly , polymicrogyria , holoprosencephaly , and agenesis of the corpus callosum . Congenital anomalies of
9202-635: The offspring displaying ventricular septal defects at birth. Substances whose toxicity can cause congenital disorders are called teratogens , and include certain pharmaceutical and recreational drugs in pregnancy , as well as many environmental toxins in pregnancy . A review published in 2010 identified six main teratogenic mechanisms associated with medication use: folate antagonism , neural crest cell disruption, endocrine disruption , oxidative stress , vascular disruption, and specific receptor- or enzyme-mediated teratogenesis. An estimated 10% of all birth defects are caused by prenatal exposure to
9309-792: The patient is aware of how important it is to prevent pregnancy during and at least one month after treatment. Medical guidelines also suggest that pregnant women should limit vitamin A intake to about 700 μg /day, as it has teratogenic potential when consumed in excess. Vitamin A and similar substances can induce spontaneous abortions, premature births, defects of eyes ( microphthalmia ), ears, thymus, face deformities, and neurological ( hydrocephalus , microcephalia ) and cardiovascular defects, as well as intellectual disability . Tetracycline , an antibiotic , should never be prescribed to women of reproductive age or to children, because of its negative impact on bone mineralization and teeth mineralization . The "tetracycline teeth" have brown or grey colour as
9416-454: The prenatal environment in a 2020 study showing a relationship to maternal PM10 pollution exposure in China. Types include: Because polydactyly can be part of a syndrome (known genetic defect) or association (genetic defect not known), children with a congenital upper extremity deformity should be examined by a geneticist for other congenital anomalies. This should also be done if a syndrome
9523-431: The provision for adequate web-space soft tissue. Complications include: painful scarring, infection, joint instability, residual deformity, angulated growth, growth arrest, joint stiffness, and nail bed deformities. A 2014 study reported a 19% revision rate for preaxial polydactyly for pain or instability. There are no substantive outcome studies regarding the function of these hands following surgical intervention. This
9630-501: The radial collateral ligament from distal to proximal, a periosteal sleeve can be preserved. In this way, the radial collateral band of the radial digit will function as the absent radial collateral ligament of the preserved ulnar thumb. Elevation of the APB and FPB is performed in Wassel type 4 duplication; this can be accomplished via the periosteum or separately. As the tendons insert proximally,
9737-683: The result of only hereditary factors. However, in the early 1940s, Australian pediatric ophthalmologist Norman Gregg began recognizing a pattern in which the infants arriving at his surgery were developing congenital cataracts at a higher rate than those who developed it from hereditary factors. On October 15, 1941, Gregg delivered a paper that explained his findings-68 out of the 78 children with congenital cataracts had been exposed in utero to rubella due to an outbreak in Australian army camps. These findings confirmed, to Gregg, that, in fact, environmental causes for congenital disorders could exist. Rubella
9844-548: The sensitivity due to a neuroma. For infants with ulnar type B polydactyly the recommended treatment is ligation in the neonatal nursery. A 2011 study opined that excision of an extra digit in the neonatal nursery was a safe and simple procedure with a good clinical and cosmetic outcome. As of 2022, for infants with ulnar type B polydactyly the recommended treatment is surgical excision or suture ligation, when no bony structures exist. Complications of ligation include infection, neuroma or cyst formation. Because neither of
9951-531: The shape of a body part and functional disorders in which problems exist with how a body part works. Functional disorders include metabolic and degenerative disorders . Some birth defects include both structural and functional disorders. Birth defects may result from genetic or chromosomal disorders , exposure to certain medications or chemicals, or certain infections during pregnancy . Risk factors include folate deficiency , drinking alcohol or smoking during pregnancy, poorly controlled diabetes , and
10058-520: The skin, brain damage, and deafness. Petechaie is when the capillaries bleed resulting in red/purple spots on the skin. However, cytomegalovirus is often fatal in the embryo. The Zika virus can also be transmitted from the pregnant mother to her baby and cause microcephaly. The herpes simplex virus can cause microcephaly , microphthalmus (abnormally small eyeballs), retinal dysplasia, hepatosplenomegaly , and intellectual disability. Both microphthalmus and retinal dysplasia can cause blindness. However,
10165-455: The strictly required use of contraception among female patients treated by it. Vitamin A is the sole vitamin that is embryotoxic even in a therapeutic dose, for example in multivitamins , because its metabolite, retinoic acid , plays an important role as a signal molecule in the development of several tissues and organs. Its natural precursor, β-carotene , is considered safe, whereas the consumption of animal liver can lead to malformation, as
10272-494: The structure of body parts, but some simply affect the function. Other well-defined genetic conditions may affect the production of hormones, receptors, structural proteins, and ion channels. The mother's consumption of alcohol during pregnancy can cause a continuum of various permanent birth defects: craniofacial abnormalities, brain damage, intellectual disability, heart disease, kidney abnormality, skeletal anomalies, ocular abnormalities. The prevalence of children affected
10379-436: The thumbs after an on-top plasty reconstruction. Few clinical outcome studies exist regarding the treatment of central polydactyly. Tada and colleagues note that satisfactory surgical correction of central polydactyly is difficult to achieve and that outcomes are generally poor. In Tada's study, 12 patients were reviewed. All patients required secondary surgical procedures to address flexion contractures and angular deviation at
10486-590: The two copies (a dominant disorder). Some conditions result from deletions or abnormalities of a few genes located contiguously on a chromosome. Chromosomal disorders involve the loss or duplication of larger portions of a chromosome (or an entire chromosome) containing hundreds of genes. Large chromosomal abnormalities always produce effects on many different body parts and organ systems. Polydactyly Polydactyly or polydactylism (from Greek πολύς (polys) 'many' and δάκτυλος (daktylos) 'finger'), also known as hyperdactyly ,
10593-455: The two thumb components is normal, a decision should be taken on combining which elements to create the best possible composite digit. Instead of amputating the most hypoplastic thumb, preservation of skin, nail, collateral ligaments and tendons is needed to augment the residual thumb. Surgery is recommended in the first year of life, generally between 9 and 15 months of age. Surgical options depend on type of polydactyly. This type of procedure
10700-420: The ulnar thumb together with the periosteal sleeve. The APB and FPB of the ablated radial thumb are attached to the distal phalanx for more stability. If necessary, the extensor pollicis longus and the flexor pollicis longus are reattached to centralize their course. In Wassel type 5 and 6 the opponens pollicis muscle must be transferred to the ulnar metacarpal. Soft tissue with collateral ligament reconstruction
10807-414: The vagina . Following studies showed elevated risks for other tumors and congenital malformations of the sex organs for both sexes. All cytostatics are strong teratogens; abortion is usually recommended when pregnancy is discovered during or before chemotherapy. Aminopterin , a cytostatic drug with anti folate effect, was used during the 1950s and 1960s to induce therapeutic abortions . In some cases,
10914-408: The vascular supply to the duplicated digit, resulting in dry gangrene and subsequent autoamputation. This must be done with consideration of the presence of a neurovascular bundle, even in very small skin bridges. When the ligation is done inappropriately it can give a residual nubbin. Also, a neuroma can develop in the area of the scar. An excision can prevent the development of a residual nubbin and
11021-532: The ventrical septal, pulmonary artery, and heart valves. The effects of carbon monoxide exposure are decreased later in fetal development during the fetal stage, but they may still lead to anoxic encephalopathy . Industrial pollution can also lead to congenital defects. Over a period of 37 years, the Chisso Corporation, a petrochemical and plastics company, contaminated the waters of Minamata Bay with an estimated 27 tons of methylmercury , contaminating
11128-506: The water supply due to oversights in waste disposal. A case-control study on the area found that by 1986, leukemia was occurring in the children of Woburn, Massachusetts, at a rate that was four times the expected rate of incidence. Further investigation revealed a connection between the high occurrence of leukemia and an error in water distribution that delivered water to the town with significant contamination with manufacturing waste containing trichloroethylene. As an endocrine disruptor , DDT
11235-460: The womb and must attempt to sustain its biological processes independently. Genetic causes of birth defects include inheritance of abnormal genes from the mother or the father, as well as new mutations in one of the germ cells that gave rise to the fetus. Male germ cells mutate at a much faster rate than female germ cells, and as the father ages, the DNA of the germ cells mutates quickly. If an egg
11342-419: Was exposed to alcohol are similar to the exaggerated responses to stress that children with fetal alcohol syndrome display because of maternal alcohol use. These birth defects and behavioral disorders were found in cases of both long- and short-term paternal alcohol ingestion. In the same animal study, paternal alcohol exposure was correlated with a significant difference in organ size and the increased risk of
11449-799: Was shown to induce miscarriages , interfere with the development of the female reproductive system , cause the congenital hypothyroidism , and suspectably childhood obesity . Fluoride, when transmitted through water at high levels, can also act as a teratogen. Two reports on fluoride exposure from China, which were controlled to account for the education level of parents, found that children born to parents who were exposed to 4.12 ppm fluoride grew to have IQs that were, on average, seven points lower than their counterparts whose parents consumed water that contained 0.91 ppm fluoride. In studies conducted on rats, higher fluoride in drinking water led to increased acetylcholinesterase levels, which can alter prenatal brain development. The most significant effects were noted at
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