Tratamiento del pie zambo congénito a lo largo de la historia / Congenital clubfoot treatment throughout history

El tratamiento del pie zambo congénito ha evolucionado a lo largo de la historia. Desde la Antigüedad hasta finales de la Edad Media se utilizaron las manipulaciones e inmovilizaciones seriadas. Del Renacimiento al siglo XVII se crearon las primeras ortesis. En el siglo XVIII comenzó el uso de moldes de yeso y se desarrollaron ortesis y calzados complejos. El período del siglo XIX hasta la tercera década del XX, se caracterizó por la práctica de las tenotomías, siendo la cirugía el principal enfoque terapéutico. En el siglo XX, Joseph Kite e Ignacio Ponseti describieron su eficaz método no quirúrgico, lo que produjo el regreso a las manipulaciones e inmovilizaciones seriadas frente a la cirugía agresiva. Cuando se revisa la historia del tratamiento del pie zambo, sorprende ver que los médicos tratantes cometían los mismos errores una y otra vez, porque ignoraban constantemente lo que ya habían aprendido de sus antecesores y, en su lugar, a menudo se veían confundidos por las nuevas informaciones o tendencias. En el siglo XXI, los avances en biología celular, genética molecular, diagnóstico por la imagen, biomecánica y biomateriales hacen prever que se puedan diseñar tratamientos personalizados para los pacientes con pie zambo(AU)

Congenital clubfoot treatment has evolved throughout history. Serial manipulations and immobilizations were used from antiquity to the end of the Middle Ages. From the Renaissance to the 17th century the first orthotics were created. In the 18th century, the use of plaster casts began and complex orthotics and footwear developed. The period from 19th century until the third decade of the 20th century was characterized by the practice of tenotomies, with surgery being the main therapeutic approach. In the 20th century, Joseph Kite and Ignacio Ponseti described their effective non-surgical method, which led to the return to serial manipulations and immobilizations in the face of aggressive surgery. When reviewing the history of clubfoot treatment, it is surprising to see that the treating doctors made the same mistakes over and over again because they constantly ignored what they had already learned from their predecessors and, instead, were often confused by the new ones information or trends. In the 21st century, advances in cell biology, molecular genetics, diagnostic imaging, biomechanics and biomaterials suggest that personalized treatments can be designed for patients with clubfoot(AU)

Trends in congenital anomalies in Europe from 1980 to 2012.

BACKGROUND: Surveillance of congenital anomalies is important to identify potential teratogens. METHODS: This study analysed the prevalence of 61 congenital anomaly subgroups (excluding chromosomal) in 25 population-based EUROCAT registries (1980-2012). Live births, fetal deaths and terminations of pregnancy for fetal anomaly were analysed with multilevel random-effects Poisson regression models. RESULTS: Seventeen anomaly subgroups had statistically significant trends from 2003-2012; 12 increasing and 5 decreasing. CONCLUSIONS: The annual increasing prevalence of severe congenital heart defects, single ventricle, atrioventricular septal defects and tetralogy of Fallot of 1.4% (95% CI: 0.7% to 2.0%), 4.6% (1.0% to 8.2%), 3.4% (1.3% to 5.5%) and 4.1% (2.4% to 5.7%) respectively may reflect increases in maternal obesity and diabetes (known risk factors). The increased prevalence of cystic adenomatous malformation of the lung [6.5% (3.5% to 9.4%)] and decreased prevalence of limb reduction defects [-2.8% (-4.2% to -1.5%)] are unexplained. For renal dysplasia and maternal infections, increasing trends may be explained by increased screening, and deceases in patent ductus arteriosus at term and increases in craniosynostosis, by improved follow up period after birth and improved diagnosis. For oesophageal atresia, duodenal atresia/stenosis and ano-rectal atresia/stenosis recent changes in prevalence appeared incidental when compared with larger long term fluctuations. For microcephaly and congenital hydronephrosis trends could not be interpreted due to discrepancies in diagnostic criteria. The trends for club foot and syndactyly disappeared once registries with disparate results were excluded. No decrease in neural tube defects was detected, despite efforts at prevention through folic acid supplementation.

Anomalias congênitas e suas principais causas evitáveis: uma revisão / Congenital anomalies and its main avoidable causes: a review

As anomalias congênitas (AC) podem ser definidas como todas as alterações funcionais ou estruturais do desenvolvimento fetal, cuja origem ocorre antes do nascimento. Elas possuem causas genéticas, ambientais ou desconhecidas. As principais causas das anomalias são os transtornos congênitos e perinatais, muitas vezes associados a agentes infecciosos deletérios à organogênese fetal, tais como os vírus da rubéola, da imunodeficiência humana (HIV), o vírus Zika, o citomegalovírus; o Treponema pallidum e o Toxoplasma gondii. O uso de drogas lícitas e ilícitas, de medicações teratogênicas, endocrinopatias maternas também podem ser citados como causa de AC. Estima-se que 15 a 25% ocorram devido às alterações genéticas, 8 a 12% são causadas por fatores ambientais e 20 a 25% podem ser causadas tanto por alterações genéticas quanto por fatores ambientais. Neste artigo, serão abordadas as principais causas das AC, com foco naquelas que podem ser evitadas. (AU)

Congenital anomalies (CA) can be defined as all functional or structural changes of fetal development that originate before birth. They have genetic, environmental or unknown causes. The main causes of anomalies are congenital and perinatal disorders, often associated with infectious agents deleterious to fetal organogenesis, such as rubella virus, human immunodeficiency virus (HIV), Zika virus, cytomegalovirus; the Treponema pallidum and the Toxoplasma gondii. The use of licit and illicit drugs, teratogenic medications, and maternal endocrinopathies can also be cited as causes of CA. It is estimated that 15 to 25% occur due to genetic alterations, 8 to 12% are caused by environmental factors and 20 to 25% can be caused by both genetic and environmental changes. In this article, the main causes of CA will be addressed, focusing on those that can be avoided. (AU)

[The advent of a newborn specialty: 19th century pediatrics]. / Naissance de la pédiatrie au 19e siècle.

Pediatrics began under the most unfavorable conditions that are difficult to imagine nowadays. Children at the start of the 19th century were considered as negligible. The death rate was tremendous, increased by the work of children in factories as soon as 6 years of age in textile industries. In upper classes, infants were fed by a wet nurse, far from their parents and death rate was high as well. The emergence of pediatrics was the result of work carried out in adult medicine in the first half of the 19th century: clinical anatomic method, knowledge of contagious diseases even before the discovery of bacteria, birth of bacteriology. During the whole century, infectious diseases contributed in a large part to children mortality, as that of adults, by cholera, typhus, variola, diphtheria, measles and tuberculosis. Progresses noted during the 2nd part of the century resulted from beginning of hygiene, antisepsis, nutrition improvement, taking consideration of children as human being asking for protection. In contrast, therapeutics as serotherapy, vaccinations at the break of the 20th century played a secondary role.

Frederik Ruysch (1638-1731): Historical perspective and contemporary analysis of his teratological legacy.

The Peter the Great Museum of Anthropology and Ethnography (Kunstkamera) in Saint Petersburg is the oldest museum in Russia. It keeps the remains of the anatomical collection of the world-famous 17th century Dutch anatomist Frederik Ruysch. This unique collection was bought and shipped in 1717 by Czar Peter the Great, and presently still comprises more than 900 specimens, a modest number of which concerns specimens with congenital anomalies. We searched for teratological clues in the existing collection and in all his descriptions and correspondence regarding specimens and cases he encountered during his career as doctor anatomiae and chief instructor of the surgeons and midwives in Amsterdam. A total of 63 teratological specimens and case descriptions were identified in this legacy, including some exceedingly rare anomalies. As it turns out, Ruysch was the first to describe several of the conditions we encountered, including intracranial teratoma, enchondromatosis, and Majewski syndrome. Although his comments pose an interesting view on how congenital anomalies were scientifically perceived in early 18th century Europe, Ruysch mostly refrained from explaining the causes of the conditions he encountered. Instead, he dedicated himself to careful descriptions of his specimens. Almost 300 years after his demise, Ruysch's legacy still impresses and inspires both scientists and lay men. © 2016 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.

A apropriação da monstruosidade pelo saber médico / The appropriation of monstrosity by medical knowledge

O trabalho tem por objetivo descrever como o discurso em torno das deformidades é resultante de um processo, iniciado no século XIX, que deslocou o fenômeno da monstruosidade dos registros das aberrações descritas moral ou religiosamente para o campo da Biologia. A hipótese é a de que houve uma apropriação médica da monstruosidade guiada principalmente por três vetores: desenvolvimento da Teratologia como ciência; mudança das sensibilidades e o surgimento do sentimento de compaixão, estimulado em grande parte pela literatura do século XIX; e o aumento do número de pessoas deficientes, em decorrência da Primeira e da Segunda Guerras Mundiais, que levou a uma mudança na forma como as sociedades lidavam com um corpo marcado pela deformidade. Tanto a Teratologia, como a literatura foram operadores importantes no processo de conscientização sobre a humanidade dos monstros. É justamente essa transição de uma categoria social de "monstro" para a categoria social de "portador de deformidade", construída pelo saber médico, que o trabalho pretende investigar

The study aims to describe how the discourse around deformities is the result of a process that began in the nineteenth century, which shifted the phenomenon of monstrosity of records on moral aberrations morally or religiously described to the field of Biology. The hypothesis is that there was a medical appropriation of monstrosity guided by three vectors mainly: the development of Teratology as science; change of sensibilities and the emergence of the feeling of compassion, largely stimulated by the nineteenth-century literature; and increasing number of disabled people as a result of the First and Second World Wars, which led to a change in the way societies dealt with a body marked by deformity. Both Teratology, as literature were important players in the process of awareness about the humanity of monsters. It is precisely this transition from one social category of "monster" for the social category of "deformity bearer", built by the medical knowledge, this study aims to investigate

Palaeopathology of human remains from the Roman Imperial Age.

The increasing attention of archaeological and anthropological research towards palaeopathological studies has allowed to focus the examination of many skeletal samples on this aspect and to evaluate the presence of many diseases afflicting ancient populations. This paper describes the most interesting diseases observed in skeletal samples from five necropolises found in urban and suburban areas of Rome during archaeological excavations in the last decades, and dating back to the Imperial Age. The diseases observed were grouped into the following categories: articular diseases, traumas, infections, metabolic or nutritional diseases, congenital diseases and tumors, and some examples are reported for each group. Although extensive epidemiological investigation in ancient skeletal records is impossible, palaeopathology allowed highlighting the spread of numerous illnesses, many of which can be related to the life and health conditions of the Roman population.

Nos domínios do corpo o saber médico luso-brasileiro no século XVIII / In the areas of the body: medical knowledge Luso-Brazilian in the XVIII century

O corpo, sua anatomia e funções não são algo ‘natural’, mas uma construção do saber médico; e as concepções médicas, por sua vez, estão atreladas ao universo cultural. É a partir desta constatação inicial que o autor desenvolve suas análises. Ele se debruçou sobre antigos tratados de medicina e manuais de prática médica escritos por médicos luso-brasileiros e estrangeiros. A pesquisa revela, entre outros aspectos, as diferentes vertentes do saber médico luso-brasileiro do período: o livro mostra como uma medicina recheada de aspectos mágicos e religiosos passou, sobretudo nas últimas décadas do século XVIII, a ser confrontada por conhecimentos fundamentados no experimentalismo e no racionalismo.

A history of fetal surgery.

Over the past 3 decades, fetal surgery for congenital disease has evolved from merely a fanciful concept to a medical field in its own right. Techniques for open hysterotomy, minimal-access hysteroscopy, and image-guided percutaneous fetal access have become well established, first in animal models and subsequently in humans. At the same time, major advances in fetal imaging and diagnosis, anesthesia, and tocolysis have allowed fetal intervention to become a vital tool for subsets of patients who would otherwise endure significant morbidity and mortality. This article offers a concise overview of the history of fetal surgery, from its tumultuous early days to its current status as an important means for the early treatment of potentially devastating congenital anomalies.

Hyphenated history: the Sever-L'Episcopo procedure.

This article offers historical highlights regarding the 2 men from whom the Sever-L'Episcopo procedure takes its name. James W. Sever and Joseph B. L'Episcopo were both orthopaedic surgeons who were dedicated to improving the care of patients experiencing the ill effects of neonatal brachial plexus palsy. They developed techniques aimed at enhancing shoulder function compromised by paralytic contracture and, as a consequence, became linked in orthopaedic hyphenated history. The Sever-L'Episcopo procedure (along with its variations) has been an important part of the treatment of children with neonatal brachial plexus palsy for nearly 90 years.

Accessory breasts: a historical and current perspective.

The presence of accessory breast tissue such as extra nipples (polythelia) and extra breast (polymastia) is relatively common, with a high incidence of being misdiagnosed in clinical medicine. Although polythelia is congenital in origin and is identifiable at childhood, polymastia may not be evident until the influence of sex hormones during puberty. In this article, we present a review of the literature concerning the historical background of accessory breasts, their incidence, their misdiagnoses, and their association with other syndromes and diseases. Finally, we present the common treatment options available today for such conditions.

Separation of pyopagus conjoined twins: a New Zealand neurosurgical experience.

Conjoined twins represent a rare form of incomplete embryonic separation. They are classified into eight different subtypes, with 18% representing pyopagus conjoints. History is scattered with accounts of the various types of conjoints and it is only recently that strategies have been devised to enable surgical separation of such twins. It is estimated that approximately 20 cases of separation of pyopagus twins have been performed. We provide a historical look at pyopagus conjoint twins and report our neurosurgical experience of Australasia's first separation of pyopagus twin girls.

History of surgery for cerebrovascular disease in children. Part II. Vein of Galen malformations.

Vein of Galen aneurysmal malformations are a mixed group of lesions characterized by an abnormal fistula between abnormal distal branches of the choroidal and/or posterior cerebral arteries and the great vein of Galen. In this paper the authors trace the historical evolution of the current approach to diagnosis and treatment, and the literature is reviewed comprehensively. During the historical era, vein of Galen malformations were described in individual case reports and an early classification system was developed. In the early era of treatment, open surgery was the preferred approach, although morbidity and mortality rates were high. The development of neurointerventional techniques allowed the introduction of occlusive materials into the fistula, with pronounced improvements in clinical outcome.

Sir Denis Browne (1892-1967) and congenital deformities of mechanical origin.

Sir Denis Browne of the Hospital for Sick Children, Great Ormond Street, London, is regarded as the father of paediatric surgery in the United Kingdom. He made many important scientific and operative contributions, prominent among which were his studies on the origin and management of congenital deformities.

Regenerative medicine: stem cells and the science of monstrosity.

The nineteenth century science of teratology concerned itself with the study of malformations or "monstrosities", as they were then called. The first major contribution to the field was the work of Isidore Geoffrey Saint-Hilaire, Historie Generale et Particuliere des Anomalies de l'Organisation chez l'Homme et les Animaux, published in 1832, whose classifications formed the basis for the later experimental science of teratogeny, the art of reproducing monstrosities in animal embryos. In this article, I will argue that recent developments in the field of regenerative medicine can be situated in the tradition of teratological and teratogenic studies dating back to the nineteenth century. In particular, I will be interested in the historical link between studies in teratogenesis (the artificial production of teratomas) and stem cell research. Recent advances in stem cell research, I will suggest, return us to the questions that animated nineteenth century investigations into the nature of the monstrous or the anomalous. In the process, our most intuitive conceptions of "life itself" are undergoing a profound transformation.

Environmental pediatrics and its impact on government health policy.

Recent public recognition that children are different from adults in their exposures and susceptibilities to environmental contaminants has its roots in work that began >46 years ago, when the American Academy of Pediatrics (APA) established a standing committee to focus on children's radiation exposures. We summarize the history of that important committee, now the AAP Committee on Environmental Health, including its statements and the 1999 publication of the AAP Handbook of Pediatric Environmental Health, and describe the recent emergence of federal and state legislative and executive actions to evaluate explicitly environmental health risks to children. As a result in large part of these efforts, numerous knowledge gaps about children's health and the environment are currently being addressed. Government efforts began in the 1970s to reduce childhood lead poisoning and to monitor birth defects and cancer. In the 1990s, federal efforts accelerated with the Food Quality Protection Act, an executive order on children's environmental health, the Agency for Toxic Substances and Disease Registry/Environmental Protection Agency Pediatric Environmental Health Specialty Units, and National Institute of Environmental Health Sciences/Environmental Protection Agency Centers of Excellence in Research in Children's Environmental Health. In this decade, the Children's Environmental Health Act authorized the National Children's Study, which has the potential to address a number of critical questions about children's exposure and health. The federal government has expanded efforts in control and prevention of childhood asthma and in tracking of asthma, birth defects, and other diseases that are linked to the environment. Efforts continue on familiar problems such as the eradication of lead poisoning, but new issues, such as prevention of childhood exposure to carcinogens and neurotoxins other than lead, and emerging issues, such as endocrine disruptors and pediatric drug evaluations, are in the forefront. More recently, these issues have been taken up by states and in the international arena.