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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conocer la prevalencia y forma de presentaci&#243;n cl&#237;nicade los defectos por reducci&#243;n de extremidades en la poblaci&#243;nasturiana&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de ni&#241;os con defectos de reducci&#243;n de extremidadesentre los 91&#46;300 nacidos vivos&#44; nacidos muertosmayores de 500 g y abortos inducidos por defectos cong&#233;nitos&#44; de mujeres residentes en Asturias&#44; controladospor el Registro de Defectos Cong&#233;nitos de Asturias &#40;registrode base poblacional&#41; en el per&#237;odo 1986-1997&#46; La frecuenciase expresa como prevalencia total por 10&#46;000 nacidos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Durante el per&#237;odo estudiado&#44; se registraron 73 casos&#44; siendo la prevalencia total de 8 por 10&#46;000 &#40;intervalo deconfianza del 95&#37;&#44; 6&#44;2-9&#44;8&#41;&#46; El 65&#44;7&#37; de las anomal&#237;asobservadas afectaban a las extremidades superiores&#44; el23&#44;3&#37; a las inferiores y el 11&#37; a ambas&#46; El 49&#44;3&#37; presentabaun defecto terminal transverso&#44; el 16&#44;4&#37; un defectointercalar&#44; el 8&#44;2&#37; longitudinal preaxial&#44; el 9&#44;6&#37;longitudinal postaxial&#44; el 9&#44;6&#37; mano o pie hendido&#44; y enel 6&#44;8&#37; el defecto era m&#250;ltiple&#46; El 52&#37; eran formas aisladasy el 48&#37; se manifestaron como defecto asociado aotras malformaciones&#46; En 4 exist&#237;a alteraci&#243;n cromos&#243;mica&#44; y en 20 la reducci&#243;n de extremidades formabaparte de un s&#237;ndrome&#44; asociaci&#243;n o secuencia definida&#46; El 31&#44;5&#37; presentaba bajo peso para la edad de gestaci&#243;n&#46; En tres madres se constat&#243; ingesti&#243;n importante de alcohol&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El estudio detallado de los defectos cong&#233;nitos por reducci&#243;nde extremidades permite un mejor conocimientode sus formas cl&#237;nicas de presentaci&#243;n&#44; adem&#225;s de acercarnos a un diagn&#243;stico etiopatog&#233;nico&#44; con posibilidadde actuar sobre los factores de riesgo&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence and clinical presentationof limb reduction defects in Asturias &#40;Spain&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Among the 92300 newborns&#44; stillbirths and inducedabortions for congenital defects surveyed by the Registryof Congenital Defects in Asturias &#40;population-based registry&#41;during 1986-1997&#44; we studied the children withlimb reduction defects&#46; Frequency is expressed as totalprevalence per 10000 births&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Seventy-three children with limb reduction defects wereidentified&#44; with a total prevalence of 8 per 10000 births &#40;CI6&#46;2-9&#46;8&#41;&#58; upper limbs were affected in 65&#46;7&#37;&#44; lower limbs in23&#46;3&#37; and both upper and lower limbs were affected in 11&#37;&#46;Transverse terminal defects were present in 49&#46;3&#37;&#44; andwere intercalcar&#47;intercalary in 16&#46;4&#37;&#44; preaxial longitudinalin 8&#46;2&#37;&#44; postaxial longitudinal in 9&#46;6&#37;&#44; split hand&#47;footin 9&#46;6&#37; and multiple in 6&#46;8&#37;&#46; Limb deficiencies werefound in 52&#37;&#59; of these&#44; 48&#37; were associated with othercongenital defects&#46; Four had chromosomal anomaliesand 20 were syndromes&#46; 31&#37; had low birth weight fortheir gestational age&#46; Alcohol exposure during pregnancywas recorded in three mothers&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A detailed study of limb reduction defects could lead toa better understanding of clinical presentation and to anetio-pathogenic diagnosis to control risk factors&#46;</p>"
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                        "link" => array:1 [
                          0 => array:2 [
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                            2 => "M&#46; Dutra"
                            3 => "J&#46; L&#243;pez-Camelo"
                            4 => "J&#46; Paz"
                            5 => "E&#46; Gadow"
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                    0 => array:1 [
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                        "paginaFinal" => "400"
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                        "paginaInicial" => "127"
                        "paginaFinal" => "135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8446926"
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                        "paginaFinal" => "781"
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                      "titulo" => "Congenital defects of lower limbs and associated malformations&#58; a population based study"
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                          "autores" => array:2 [
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                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8418662"
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                      "titulo" => "Congenital defects of the limbs in stillbirths&#58;data from a population-based study"
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                          "etal" => false
                          "autores" => array:2 [
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                        "volumen" => "46"
                        "paginaInicial" => "479"
                        "paginaFinal" => "482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8322803"
                            "web" => "Medline"
                          ]
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                      "titulo" => "Limb reduction defects in Emilia Romagna&#44; Italy&#58; epidemiological and genetic study in 173&#46;109 consecutive births"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Calzolari"
                            1 => "D&#46; Manservigi"
                            2 => "JP&#46; Garani"
                            3 => "G&#46; Cocchi"
                            4 => "C&#46; Magnani"
                            5 => "M&#46; Milan"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Genet"
                        "fecha" => "1990"
                        "volumen" => "27"
                        "paginaInicial" => "353"
                        "paginaFinal" => "357"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2359096"
                            "web" => "Medline"
                          ]
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            7 => array:3 [
              "identificador" => "bib0040"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Registros poblacionales de defectos cong&#233;nitos en Espa&#241;a"
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                          "etal" => false
                          "autores" => array:6 [
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                            1 => "S&#46; Garc&#237;a-Mi&#241;aur"
                            2 => "M&#46;R&#46; Caball&#237;n"
                            3 => "C&#46; Mosquera"
                            4 => "N&#46; Baena"
                            5 => "E&#46; Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "1998"
                        "volumen" => "48"
                        "paginaInicial" => "575"
                        "paginaFinal" => "582"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9662839"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            8 => array:3 [
              "identificador" => "bib0045"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Registry of congenital defects in Asturias &#40;Spain&#41;"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Mosquera"
                            1 => "C&#46; Moro"
                            2 => "J&#46;L&#46; Bad&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Epidemiol"
                        "fecha" => "1991"
                        "volumen" => "7"
                        "paginaInicial" => "72"
                        "paginaFinal" => "724"
                      ]
                    ]
                  ]
                ]
              ]
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            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10&#46;"
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                0 => array:1 [
                  "referenciaCompleta" => "Grupo de Trabajo del RDCA&#46; Manual Operacional&#46; Registrode Defectos Cong&#233;nitos de Asturias&#46; Consejer&#237;a de Sanidad yServicios Sociales&#46; Asturias&#44; 1990 &#40;2&#46; revisi&#243;n&#44; 1994&#41;"
                ]
              ]
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            10 => array:3 [
              "identificador" => "bib0055"
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                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1977"
                        "editorial" => "World Health Organization"
                        "editorialLocalizacion" => "Ginebra"
                      ]
                    ]
                  ]
                ]
              ]
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            11 => array:3 [
              "identificador" => "bib0060"
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                  "referenciaCompleta" => "Stoll C&#44; Mastroiacovo P&#44; De Wals P&#44; Weatherall J&#46; EUROCATguide for the description and classification of congenital limbdefects&#46; Bruselas&#44; 1986"
                ]
              ]
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            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1989"
                        "editorial" => "INE"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
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            13 => array:3 [
              "identificador" => "bib0070"
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            14 => array:3 [
              "identificador" => "bib0075"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Vigilancia epidemiol&#243;gica de anomal&#237;as cong&#233;nitas"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bol ECEMC&#58; Rev Dismor Epidemiol"
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                        "volumen" => "IV"
                        "paginaInicial" => "37"
                        "paginaFinal" => "116"
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                  ]
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            15 => array:3 [
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              "identificador" => "bib0085"
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                    0 => array:2 [
                      "titulo" => "Ni&#241;os con reducci&#243;n de extremidades en una en unapoblaci&#243;n de 25&#46;193 reci&#233;n nacidos malformados&#58; causas reconocidas"
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                            3 => "M&#46; Blanco"
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                            5 => "J&#46; Eg&#252;&#233;s"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "1998"
                        "volumen" => "48"
                        "paginaInicial" => "49"
                        "paginaFinal" => "53"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9542226"
                            "web" => "Medline"
                          ]
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            17 => array:3 [
              "identificador" => "bib0090"
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                0 => array:2 [
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                      "titulo" => "S&#237;ndrome de Adams-Oliver en nuestro medio&#58; aspectos epidemiol&#243;gicos"
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                            4 => "E&#46; Rodr&#237;guez-Pinilla"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "1996"
                        "volumen" => "45"
                        "paginaInicial" => "57"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8849132"
                            "web" => "Medline"
                          ]
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                  ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Die thalidomid-embriopathie"
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                            0 => "W&#46; Lenz"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Dtsch Med Wochenschr"
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                        "volumen" => "24"
                        "paginaInicial" => "1232"
                        "paginaFinal" => "1242"
                      ]
                    ]
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                  "contribucion" => array:1 [
                    0 => array:1 [
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                            1 => "A&#46; Garber"
                            2 => "D&#46; Viskochil"
                            3 => "R&#46; Schseck"
                            4 => "L&#46;D&#46; Platt"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Prenat Diagn"
                        "fecha" => "1993"
                        "volumen" => "13"
                        "paginaInicial" => "909"
                        "paginaFinal" => "918"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8309898"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0105"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Congenital defects of the limbs and alcohol exposure in pregnancy&#58; data from a population based study"
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                          "etal" => false
                          "autores" => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Genet"
                        "fecha" => "1992"
                        "volumen" => "44"
                        "paginaInicial" => "782"
                        "paginaFinal" => "785"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1481846"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0110"
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                      "titulo" => "Embriofetopat&#237;a alcoh&#243;lica&#46; Casu&#237;stica neonatal propia en los &#250;ltimos doce a&#241;os"
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                            1 => "A&#46; Fern&#225;ndez"
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                            4 => "J&#46;M&#46; Rodr&#237;guez"
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                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
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                        "paginaInicial" => "405"
                        "paginaFinal" => "409"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9499311"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "sverse limb reduction defects"
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                        "tituloSerie" => "J Pediatr"
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                        "paginaInicial" => "839"
                        "paginaFinal" => "843"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7131173"
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                      "titulo" => "Terminal transverse limb defects and early chorionic villus sampling&#58; evaluation of 4300 cases with completed follow-up"
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                          "etal" => false
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                        "paginaFinal" => "485"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                            4 => "C&#46;C&#46; Lan"
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                        "paginaInicial" => "445"
                        "paginaFinal" => "447"
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                          "etal" => false
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                        "paginaInicial" => "1022"
                        "paginaFinal" => "1026"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                        "fecha" => "1996"
                        "volumen" => "174"
                        "paginaInicial" => "807"
                        "paginaFinal" => "811"
                      ]
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                  "contribucion" => array:1 [
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46;J&#46; Wald"
                            1 => "A&#46;K&#46; Hackshaw"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "volumen" => "52"
                        "paginaInicial" => "3"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8746292"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            2 => "E&#46; Rodr&#237;guez-Pinilla"
                            3 => "S&#46; Mart&#237;nez"
                            4 => "J&#46; Eg&#252;&#233;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "fecha" => "1998"
                        "volumen" => "48"
                        "paginaInicial" => "159"
                        "paginaFinal" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9577024"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral contraception and congenital malformations in offspring&#58; a review and meta-analysis of the prospective studies"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;B&#46; Bracken"
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                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "1990"
                        "volumen" => "76"
                        "paginaInicial" => "552"
                        "paginaFinal" => "557"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2143279"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#46; Limb reduction defects in the northern region of England 1985-92"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Wright"
                            1 => "J&#46;N&#46; Newell"
                            2 => "ME&#46; Charlton"
                            3 => "E&#46;N&#46; Hey"
                            4 => "L&#46;J&#46; Donaldson"
                            5 => "J&#46; Burn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Epidemiol Community Health"
                        "fecha" => "1995"
                        "volumen" => "49"
                        "paginaInicial" => "305"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7629469"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Limb reduction defects after prenatal inhibition of nitric oxide synthase in rats"
                      "autores" => array:1 [
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                          "autores" => array:5 [
                            0 => "R&#46;L&#46; Pierce"
                            1 => "M&#46;R&#46; Pierce"
                            2 => "H&#46; Liu"
                            3 => "P&#46;J&#46; Kadowitz"
                            4 => "M&#46;J&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1203/00006450-199512000-00013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Res"
                        "fecha" => "1995"
                        "volumen" => "38"
                        "paginaInicial" => "905"
                        "paginaFinal" => "911"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8618792"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
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                      "titulo" => "Physical mapping of the split hand&#47; split foot locus on chromosome 7 and implication in syndromic ectrodactyly"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;W&#46; Scherer"
                            1 => "P&#46; Poorkaj"
                            2 => "H&#46; Massa"
                            3 => "S&#46; Soder"
                            4 => "T&#46; Allen"
                            5 => "M&#46; Numes"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
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                        "tituloSerie" => "Hum Mol Genet"
                        "fecha" => "1994"
                        "volumen" => "8"
                        "paginaInicial" => "1345"
                        "paginaFinal" => "1354"
                      ]
                    ]
                  ]
                ]
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Vol. 52. Núm. 4.
Páginas 362-368 (abril 2000)
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Vol. 52. Núm. 4.
Páginas 362-368 (abril 2000)
Acceso a texto completo
Defectos de reducción de extremidades en Asturias, 1986–1997: prevalencia y presentación clínica
Limb reduction defects in asturias (1986–1997): prevalence and clinical presentation
Visitas
7933
I. Riaño Galán
Autor para correspondencia
isogalan@teleline.es

Correspondencia: Fuertes Acevedo, 96, 6.° A. 33006 Oviedo.
Servicio de Pediatría de Hospital Narcea. Cangas del Narcea. Grupo de trabajo del Registro de DefectosCongénitos de Asturias
J. Fernández Torala, E. García Lópeza, C. Moro Bayóna, C. Mosquera Tenreirob, A. Rodríguez Fernándeza, E. Suárez Menéndeza, F. Ariza Heviaa, A. Franganillo Fernándeza
a INSALUD y Sanidad del Principado de Asturias. Oviedo.
b Consejería de Servicios Sociales y Sanidad del Principado de Asturias. Oviedo.
Este artículo ha recibido
Información del artículo
Objetivo

Conocer la prevalencia y forma de presentación clínicade los defectos por reducción de extremidades en la poblaciónasturiana.

Pacientes y métodos

Estudio de niños con defectos de reducción de extremidadesentre los 91.300 nacidos vivos, nacidos muertosmayores de 500 g y abortos inducidos por defectos congénitos, de mujeres residentes en Asturias, controladospor el Registro de Defectos Congénitos de Asturias (registrode base poblacional) en el período 1986-1997. La frecuenciase expresa como prevalencia total por 10.000 nacidos.

Resultados

Durante el período estudiado, se registraron 73 casos, siendo la prevalencia total de 8 por 10.000 (intervalo deconfianza del 95%, 6,2-9,8). El 65,7% de las anomalíasobservadas afectaban a las extremidades superiores, el23,3% a las inferiores y el 11% a ambas. El 49,3% presentabaun defecto terminal transverso, el 16,4% un defectointercalar, el 8,2% longitudinal preaxial, el 9,6%longitudinal postaxial, el 9,6% mano o pie hendido, y enel 6,8% el defecto era múltiple. El 52% eran formas aisladasy el 48% se manifestaron como defecto asociado aotras malformaciones. En 4 existía alteración cromosómica, y en 20 la reducción de extremidades formabaparte de un síndrome, asociación o secuencia definida. El 31,5% presentaba bajo peso para la edad de gestación. En tres madres se constató ingestión importante de alcohol.

Conclusiones

El estudio detallado de los defectos congénitos por reducciónde extremidades permite un mejor conocimientode sus formas clínicas de presentación, además de acercarnos a un diagnóstico etiopatogénico, con posibilidadde actuar sobre los factores de riesgo.

Palabras clave:
Defectos congénitos
Reducción de extremidades
Registros de base poblacional
Objective

To determine the prevalence and clinical presentationof limb reduction defects in Asturias (Spain).

Patients and methods

Among the 92300 newborns, stillbirths and inducedabortions for congenital defects surveyed by the Registryof Congenital Defects in Asturias (population-based registry)during 1986-1997, we studied the children withlimb reduction defects. Frequency is expressed as totalprevalence per 10000 births.

Results

Seventy-three children with limb reduction defects wereidentified, with a total prevalence of 8 per 10000 births (CI6.2-9.8): upper limbs were affected in 65.7%, lower limbs in23.3% and both upper and lower limbs were affected in 11%.Transverse terminal defects were present in 49.3%, andwere intercalcar/intercalary in 16.4%, preaxial longitudinalin 8.2%, postaxial longitudinal in 9.6%, split hand/footin 9.6% and multiple in 6.8%. Limb deficiencies werefound in 52%; of these, 48% were associated with othercongenital defects. Four had chromosomal anomaliesand 20 were syndromes. 31% had low birth weight fortheir gestational age. Alcohol exposure during pregnancywas recorded in three mothers.

Conclusions

A detailed study of limb reduction defects could lead toa better understanding of clinical presentation and to anetio-pathogenic diagnosis to control risk factors.

Key words:
Congenital defects
Limb reduction
Population-based
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Bibliografía
[1.]
C. Stoll, E. Calzolari, M. Cornel, S. García-Minaur, E. Garne, N. Nevin.
A study on limb reduction defects in six European regions.
Ann Genet, 39 (1996), pp. 99-104
[2.]
E. Castilla, D. Cavalcanti, M. Dutra, J. López-Camelo, J. Paz, E. Gadow.
Limb reduction defects in South America. Br J Obst.
Gyn, 102 (1995), pp. 393-400
[3.]
S. Lin, EG. Marshall, G.K. Davidson, G.B. Roth, C.M. Druschel.
Evaluation of congenital limb reduction defects in upstate New York.
Teratology, 47 (1993), pp. 127-135
[4.]
U. Froster, P. Baird.
Upper limbs deficiencies and associated malformations: a population based study.
Am J Med Genet, 44 (1992), pp. 767-781
[5.]
U. Froster, P. Baird.
Congenital defects of lower limbs and associated malformations: a population based study.
Am J Med Genet, 45 (1993), pp. 60-64
[6.]
U. Froster, P. Baird.
Congenital defects of the limbs in stillbirths:data from a population-based study.
Am J Med Genet, 46 (1993), pp. 479-482
[7.]
E. Calzolari, D. Manservigi, JP. Garani, G. Cocchi, C. Magnani, M. Milan.
Limb reduction defects in Emilia Romagna, Italy: epidemiological and genetic study in 173.109 consecutive births.
J Med Genet, 27 (1990), pp. 353-357
[8.]
J. Salvador, S. García-Miñaur, M.R. Caballín, C. Mosquera, N. Baena, E. García.
Registros poblacionales de defectos congénitos en España.
An Esp Pediatr, 48 (1998), pp. 575-582
[9.]
C. Mosquera, C. Moro, J.L. Badía.
Registry of congenital defects in Asturias (Spain).
Eur J Epidemiol, 7 (1991), pp. 72-724
[10.]
Grupo de Trabajo del RDCA. Manual Operacional. Registrode Defectos Congénitos de Asturias. Consejería de Sanidad yServicios Sociales. Asturias, 1990 (2. revisión, 1994)
[11.]
World Health Organization, (1977),
[12.]
Stoll C, Mastroiacovo P, De Wals P, Weatherall J. EUROCATguide for the description and classification of congenital limbdefects. Bruselas, 1986
[13.]
INE, (1989),
[14.]
Sociedad Asturiana de Estudios Económicos e Industriales. Movimiento natural de la población de Asturias, 1987-97. Ed. Servicio de Publicaciones del Principado de Asturias, 1988-98
[15.]
E. Bermejo, M.L. Martínez-Frías.
Vigilancia epidemiológica de anomalías congénitas.
Bol ECEMC: Rev Dismor Epidemiol, IV (1998), pp. 37-116
[16.]
EUROCAT. Report 6: surveillance of congenital anomalies1980-1992. Bruselas, 1995
[17.]
M.L. Martínez-Frías, E. Bermejo, L. Paisán, M. Blanco, V. Félix, J. Egüés.
Niños con reducción de extremidades en una en unapoblación de 25.193 recién nacidos malformados: causas reconocidas.
An Esp Pediatr, 48 (1998), pp. 49-53
[18.]
M.L. Martínez-Frías, I. Arroyo, N.J. Jiménez, C. Nieto, E. Rodríguez-Pinilla, M. Urioste.
Síndrome de Adams-Oliver en nuestro medio: aspectos epidemiológicos.
An Esp Pediatr, 45 (1996), pp. 57-61
[19.]
W. Lenz, K. Knapp.
Die thalidomid-embriopathie.
Dtsch Med Wochenschr, 24 (1962), pp. 1232-1242
[20.]
R. Sharony, A. Garber, D. Viskochil, R. Schseck, L.D. Platt.
Prenat Diagn, 13 (1993), pp. 909-918
[21.]
U. Froster, P. Baird.
Congenital defects of the limbs and alcohol exposure in pregnancy: data from a population based study.
Am J Med Genet, 44 (1992), pp. 782-785
[22.]
G. Romera, A. Fernández, Y. Jordán, A. Pastor, J.M. Rodríguez, F. Botet.
Embriofetopatía alcohólica. Casuística neonatal propia en los últimos doce años.
An Esp Pediatr, 47 (1997), pp. 405-409
[23.]
HE. Hoyme, K.L. Jones, M.I. Van Allen, B.S. Saunders Q, K. Benirschke.
sverse limb reduction defects.
J Pediatr, 101 (1982), pp. 839-843
[24.]
M. Jahoda, H. Brandenburg, T. Cohen-Overbeek, F. Los, E. Sachs, J. Wladimiroff.
Terminal transverse limb defects and early chorionic villus sampling: evaluation of 4300 cases with completed follow-up.
Am J Med Genet, 46 (1993), pp. 483-485
[25.]
C.P. Chen, F.F. Liu, S.W. Jan, S.P. Lin, C.C. Lan.
CVS-exposed limb deficiency defects with or without other birth defects: presentation of six cases born during a period of nine years.
Am J Med Genet, 63 (1996), pp. 445-447
[26.]
K. Blakemore, K. Filkins, D.A. Luthy, L.D. Platt, A.L. Meclearis, D. Carlson.
Cook obstetrics and gynecology catheter multicenter chorionic villus sampling trial: comparison of birth defects with expected rates.
Am J Obstet Gynecol, 169 (1993), pp. 1022-1026
[27.]
A. Kuliev, L. Jackson, U. Froster, B. Bambati, J.L. Simson, Y. Verlinsky.
Chorionic villus sampling safety. Report of World Health Organitation.
Am J Obst Gynecol, 174 (1996), pp. 807-811
[28.]
N.J. Wald, A.K. Hackshaw.
Cigarette smoking: an epidemiological overview.
Br Med Bull, 52 (1996), pp. 3-11
[29.]
M.L. Martínez-Frías, E. Bermejo, E. Rodríguez-Pinilla, S. Martínez, J. Egüés.
Aspectos epidemiológicos de los hijos de mujeres con útero bicorne.
An Esp Pediatr, 48 (1998), pp. 159-162
[30.]
M.B. Bracken.
Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies.
Obstet Gynecol, 76 (1990), pp. 552-557
[31.]
M.J. Wright, J.N. Newell, ME. Charlton, E.N. Hey, L.J. Donaldson, J. Burn.
. Limb reduction defects in the northern region of England 1985-92.
J Epidemiol Community Health, 49 (1995), pp. 305-308
[32.]
R.L. Pierce, M.R. Pierce, H. Liu, P.J. Kadowitz, M.J. Miller.
Limb reduction defects after prenatal inhibition of nitric oxide synthase in rats.
Pediatr Res, 38 (1995), pp. 905-911
[33.]
S.W. Scherer, P. Poorkaj, H. Massa, S. Soder, T. Allen, M. Numes.
Physical mapping of the split hand/ split foot locus on chromosome 7 and implication in syndromic ectrodactyly.
Hum Mol Genet, 8 (1994), pp. 1345-1354
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