Phocomelia

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Phocomelia
Thalidomide effects.jpg
Cases of severe thalidomide-induced phocomelia.
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Phocomelia is a congenital condition that involves malformations of human arms and legs which results in a flipper-like appendage. [1] [2] A prominent cause of phocomelia is the mother's use of the drug thalidomide during pregnancy; however, the causes of most cases are to be determined. [2]

Contents

Occurrence in an individual results in various abnormalities to the face, limbs, ears, nose, vessels and many other underdevelopments. Although operations may improve some abnormalities, many are not surgically treatable due to the lack of nerves and other related structures.

The term is from Ancient Greek φώκη phōkē, "seal (animal)" + -o- interfix + μέλος melos, "limb" + ια -ia suffix). Phocomelia is an extremely rare congenital disorder involving malformation of the limbs (dysmelia). Étienne Geoffroy Saint-Hilaire coined the term in 1836. [3]

Signs and symptoms

Phocomelia manifested as aural abnormalities. Ears of phocomelia patients.jpg
Phocomelia manifested as aural abnormalities.
Eyesight limitation from phocomelia. Phocomelia1.jpg
Eyesight limitation from phocomelia.
9-year-old Indian boy with phocomelia affecting all 4 limbs, 1928 Phocomelia.jpg
9-year-old Indian boy with phocomelia affecting all 4 limbs, 1928

The symptoms of phocomelia syndrome are undeveloped limbs and absent pelvic bones; however, various abnormalities can occur to the limbs and bones. [4] Usually the upper limbs are not fully formed and sections of the "hands and arms may be missing". Short arm bones, fused fingers, and missing thumbs will often occur. Sometimes hands or fingers will be present but limp due to having no bones or being loosely attached. Legs and feet are also affected similarly to the arms and hands. Individuals with phocomelia will often lack thigh bones, and the hands or feet may be abnormally small or appear as stumps due to their close "attachment to the body". [5]

According to National Organization for Rare Disorders (NORD), individuals carrying phocomelia syndrome will generally show symptoms of growth retardation previous to and after birth. The syndrome can also cause severe mental deficiencies in infants. Infants born with phocomelia will normally have a petite head with "sparse hair" that may appear "silvery-blonde". Hemangioma, the abnormal buildup of blood vessels, will possibly develop around the facial area at birth and the eyes may be set widely apart, a condition known as orbital hypertelorism. The pigment of the eyes will be a bluish white. [5] Phocomelia can also cause: an undeveloped nose with slender nostrils, disfigured ears, irregularly petite jaws (a condition known as micrognathia), and a cleft lip with cleft palate. [6] According to NORD, severe symptoms of phocomelia include:[ citation needed ]

Thalidomide syndrome symptoms

When an individual is born with phocomelia due to drugs or pharmaceuticals, it is known as thalidomide syndrome. The symptoms of thalidomide syndrome are defined by absent or shortened limbs, causing flipper hands and feet. According to Anthony J Perri III and Sylvia Hsu they can additionally receive: [7]

The infants that were exposed to thalidomide during development phases had a 40% chance of survival. [8] The McMredie–McBride hypothesis explains that the limbs of the infants become malformed as a result of the thalidomide harming the neural tissue—simply because the neural tissue has such a large impact on formation and development of the limbs. [7]

Causes

Thalidomide

Thalidomide was released onto the market in 1958 in West Germany under the name Contergan. Primarily prescribed as a sedative or hypnotic, thalidomide also claimed to cure "anxiety, insomnia, gastritis, and tension". [8] Afterwards it was used against nausea and to alleviate morning sickness in pregnant women. Thalidomide became an over-the-counter drug in Germany around 1960, i.e. it could be bought without a prescription. Shortly after the drug was sold, in Germany between 5,000 and 7,000 infants were born with phocomelia. Only 40% of these children survived. [8]

Research also proves that although phocomelia did exist through the 1940s and 1950s, cases of severe phocomelia multiplied in the 1960s when thalidomide was released in Germany; the direct cause was traced to thalidomide. [9] The statistic was given that "50 percent of the mothers with deformed children had taken thalidomide during the first trimester of pregnancy." Throughout Europe, Australia, and the United States, 10,000 cases were reported of infants with phocomelia; only 50% of the 10,000 survived. Thalidomide became effectively linked to death or severe disabilities among babies. Those subjected to thalidomide while in the womb experienced limb deficiencies in that the long limbs either were not developed or presented themselves as stumps. Other effects included deformed eyes, hearts, alimentary and urinary tracts, blindness and deafness. [10]

Genetic inheritance

According to the National Organization for Rare Disorders (NORD), when phocomelia is transmitted (in its familial genetic form) it is seen as an autosomal recessive trait and the mutation is linked to chromosome 8. [5]

A study of Roberts syndrome, a genetic disorder showing similar symptoms to phocomelia, has shed light on the possible causes. [11] An individual afflicted with Roberts Syndrome will have chromosome copies that do not connect at the centromeres, making them unable to line up accordingly. [12] As a result, the newly made cells contain an excess or reduced number of chromosomes. In both Roberts syndrome and phocomelia the cells cease to develop, or die, preventing proper development of the limbs, eyes, brain, palate, or other structures.[ citation needed ]

Treatment

Prosthesis is a synthetic alternative for missing limbs, teeth, and various other body parts. Advances in prosthetic limbs have increased greatly during the twentieth century. The use of new materials such as modern plastics, complex procedures and better pigments have created lighter in weight and more realistic looking artificial limbs. With the advancement of myoelectric prosthetic limbs, patients are able to move their limbs without the use of cords or other devices. The myoelectric limbs can detect electric signals from the nervous system and muscles. They were first used on adults, but now they are being fitted to children. [13]

Patients that receive a loss of limbs due to phocomelia are typically treated with prosthetics. Infants at the age of six months are recommended to have a prosthetic mitten fitted, enabling them to get used to the prosthesis. A hook will be added when the child reaches the age of two years. Eventually the patient may receive a myoelectric prosthetic limb. Patients are treated in this way due to the lack of understanding at a young age and the absence of necessary tissues and bones to hold the prosthetic limb.[ citation needed ]

Notable cases

Related Research Articles

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References

  1. Hooper, G.; Tytherleigh-Strong, G. (2003). "The Classification of Phocomelia". Journal of Hand Surgery (British and European Volume). 28B (3): 215–217.
  2. 1 2 Amar, Emmanuelle (2011). "Phocomelia: A Worldwide Descriptive Epidemiologic Study in a Large Series of Cases From the International Clearinghouse for Birth Defects Surveillance and Research, and Overview of the Literature". American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 15 (4): 305–320. doi:10.1002/ajmg.c.30320. PMC   4427055 . PMID   22002800.
  3. Zimmer, Carl (15 March 2010). "Answers Begin to Emerge on How Thalidomide Caused Defects". New York Times . Retrieved 26 February 2012. The word "phocomelia" means seal limb. It describes an extremely rare condition in which babies are born with limbs that look like flippers.
  4. Olney, Richard S.; Hoyme, H. Eugene; Roche, Frances; Ferguson, Kevin; Hintz, Susan; Madan, Ashima (2001). "Limb/pelvis hypoplasia/aplasia with skull defect (Schinzel phocomelia): Distinctive features and prenatal detection". American Journal of Medical Genetics. 103 (4): 295–301. doi:10.1002/ajmg.1560. PMID   11746009.
  5. 1 2 3 "Phocomelia Syndrome". National Organization for Rare Disorders. 11 October 2007.
  6. Hunt, Katherine Susan (2002). "Roberts SC phocomelia". Gale Encyclopedia of Genetic Disorders, Part I. Detroit: The Gale Group.
  7. 1 2 Perri, Anthony J.; Hsu, Sylvia (2003). "A review of thalidomide's history and current dermatological applications". Dermatology Online Journal. 9 (3): 5. doi:10.5070/D35FK5W0QV. PMID   12952752.
  8. 1 2 3 Miller, Marylin T. (1991). "Thalidomide embryopathy: a model for the study of congenital incomitant horizontal strabismus". Transactions of the American Ophthalmological Society. 89: 623–74. PMC   1298636 . PMID   1808819.
  9. "Pharmaceutical Teratogens". Teratology Society—Birth Defects Research. 8 December 2007. Archived May 7, 2010, at the Wayback Machine
  10. Cuthbert, Alan (2001–2003). The Oxford Companion to the Body. Oxford University Press. Retrieved 26 February 2012.
  11. Vega, Hugo; et al. (11 April 2005). "Fifteen-Year Hunt Uncovers Gene Behind 'Pseudothalidomide' Syndrome". Johns Hopkins Medicine. Retrieved 10 December 2007.
  12. Horsburgh, Sheri; Kasai, Yumi; Kolomeitz, Elena; Morel, Chantal France; Li, Chumei; Suk-King Goh, Elaine (2009). "The Roberts Syndrome/SC Phocomelia Spectrum - A Case Report of an Adult With Review of the Literature" (PDF). American Journal of Medical Genetics . 152: 472=478. Retrieved 2023-04-25.
  13. Hunter, James (1976). "An Externally Powered Prothesis for Unilateral Congenital Amelia". ICIB. 15 (7): 1–4. Retrieved 20 May 2013.
  14. 1 2 Barnbrook, Ame (2011). "Ame Barnbrook: 2011 Aim for the Stars Scholarship winner". aimforthestars.com.au. Aim for the Stars Foundation. Retrieved June 26, 2017.
  15. SKUD18 at skud.org
  16. Photo of Eli Bowen and Family at 19thcenturyphotos.com
  17. Kupfer, Lindsey (October 15, 2014). "Which 'AHS: Freak Show' "Freaks" Are Real And Which Ones Are Modified For TV?". Bustle.com. Retrieved June 26, 2017.
  18. Limbless teen who lived in plastic bowl died on Christmas Day at Telegraph.co.uk
  19. 1 2 Walker, Stephen (24 November 2007). "Alison Lapper: The Woman with the Remarkable Body". Multiple Sclerosis - A Personal Account. Retrieved 10 December 2007.
  20. Tynan, Ronan (2002). Halfway Home: My Life 'til Now. New York, New York: Schribner UK. p. 16. ISBN   0-7432-2291-1.
  21. "Ronan Tynan". paralympic.org. International Paralympic Committee . Retrieved 2023-03-22.
  22. "Sheetal Devi | World Archery". www.worldarchery.sport. Archived from the original on 7 December 2023. Retrieved 2023-12-07.