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Ikpe MOMS

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Moms Trial bu clinical trial na mbu nke guru igwo Oria nke omumu ana akpo myelomeningocele, nke bu Oria kachasi nu na Spina bifida. Ihe ogugua lebara Anya na prenatal (tupu omumu), na postnatal(mgbe amuchara NWA) surgery iji mezie Oria. Phase mbu kachasi kwuru na prenatal surgery do Ike, biakwa nwe uru di ogologo nakwa Ihe mgbado Anya..[1]

Aha ikpe ahụ na-anọchite anya M M">o Myelomeningocele S. Ọ bụ Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) kwadoro ya ma Ụlọ Ọgwụ Ụmụaka nke Philadelphia, Mahadum California, San Francisco, Vanderbilt University Medical Center na Nashville na Mahadum George Washington na Washington, D.C.

Akụkọ ihe mere eme

[dezie | dezie ebe o si]

1980 - Dr. Michael R. Harrison, Dr. N. Scott Adzick na ndị ọrụ ibe ya mepụtara usoro ịwa ahụ nwa ọhụrụ site na iji ụdị anụmanụ.

1994 - Ihe nlereanya ịwa ahụ nke yiri nke a na-ahụkarị maka ọrịa mmadụ bụ ihe nlereanya nwa atụrụ nke myelomeningocele (MMC) nke Meuli na Adzick gosipụtara na 1994. A na-emepụta nkwarụ yiri MMC n'ụbọchị 75 nke ime ime (ụbọchị 145 ruo 150) site na lumbo-sacral laminectomy. N'ihe dị ka izu 3 mgbe e mepụtara ntụpọ ahụ, a na-eji flap latissimus dorsi a tụgharịrị atụgharị kpuchie placode akwara a kpughere ma na-enye ụmụ anụmanụ site na ngalaba cesarean n'oge na-adịbeghị anya. A chọtara mmerụ ahụ yiri MMC nke mmadụ nwere nsogbu akwara yiri nke ahụ na njikwa ụmụ atụrụ a mụrụ ọhụrụ. N'ụzọ dị iche, ụmụ anụmanụ ndị mechiri emechi nwere ọrụ akwara dị mma na cytoarchitecture echekwara nke ọma nke ọkpụkpụ azụ kpuchiri na nyocha histopathological. N'agbanyeghị obere paraparesis, ha nwere ike iguzo, na-eje ije, na-eme nnwale motor siri ike ma gosipụta ihe ịrịba ama nke enweghị ike. Ọzọkwa, ọrụ mmetụta nke aka azụ dị na ahụike ma kwado ya na electrophysiology. Nnyocha ndị ọzọ gosipụtara na ihe nlereanya a mgbe ejikọtara ya na myelotomy nke ọkpụkpụ azụ na-eduga na herniation hindbrain nke Chiari II malformation na na ịwa ahụ akpa nwa na-eweghachi anatomy hindbrain dị mma.[2] [3][4][5]

Ndị dọkịta na-awa ahụ na Mahadum Vanderbilt, nke Dr. Joseph Bruner duziri, gbalịrị imechi spina bifida n'ime ụmụ mmadụ anọ na-eto eto site na iji akpụkpọ anụ sitere n'aka nne site na iji onyokomita pụrụ iche a na-akpọ laparoscope. E mere ikpe anọ tupu ịkwụsị usoro ahụ - abụọ n'ime ụmụ anọ nwụrụ.[6]

1998 - Dr. N. Scott Adzick na ndị otu na The Children's Hospital of Philadelphia mere ịwa ahụ n'ime nwa maka spina bifida n'oge ime ime (izu iri abụọ na abụọ) na nsonaazụ gara nke ọma.[7]

Ndị dọkịta na-awa ahụ na Mahadum Vanderbilt, nke Dr. Noel Tulipan duziri, mere oghere n'ime akpa nne iji nweta ohere ka mma maka ụmụ ọhụrụ nke izu 28 ruo 30 nke ime. A mụrụ ụmụ anọ ahụ n'afọ n'oge ma nwee ihe akaebe nke mgbanwe nke chiari II ha. Naanị 2 n'ime 4 chọrọ ventricular shunts mgbe amuchara. Ịwa ahụ nwa e bu n'afọ mgbe izu 25 gasịrị egosighi uru na nyocha ndị sochirinụ [8]

N'ikpeazụ, ụlọ ọgwụ 4 mere mgbakwunye 253 na-emeghe spina bifida tupu nnwale MOMs. Nsonaazụ ndị ahụ dị mgbagwoju anya ma naanị ìgwè ntụnyere bụ ụmụaka ndị ọzọ na-enweghị nrụzi mgbe amụrụ n'oge gara aga.[9]

Na Febụwarị 2003, National Institutes of Health malitere Management of Myelomeningocele Study (MOMS). A họọrọ ebe atọ (Mahadum Vanderbilt, Ụlọ Ọgwụ Ụmụaka nke Philadelphia na Mahadum California na San Francisco) ka ha sonye na nyocha nke ụmụ ọhụrụ 183 nke a na-eme na mberede, 91 maka mmezi nwa ọhụrụ na 92 maka mmezi mgbe amuchara. Nnyocha ahụ were afọ 8 iji mezue na ọnụahịa nke $ 22.5 nde.[10] N'ime ụmụ ọhụrụ 1,087 na ndị nne mbụ nyochara maka nyocha ahụ, 183 mezuru ụkpụrụ ntinye niile. Ụlọ Ọgwụ Ụmụaka nke Philadelphia gwọrọ ndị ọrịa 77, Mahadum California dị na San Francisco gwọrọ 54 na Mahadum Vanderbilt gwọrọ 52.

A chịkọtara ozi ahụike banyere ndị nne na ụmụ ọhụrụ n'oge ọmụmụ ihe ahụ ma soro ọganihu ha gaa n'ihu ruo mgbe nwatakịrị ahụ ruru ọ dịkarịa ala afọ abụọ na ọkara. A tụlere nsonaazụ abụọ. Nke mbụ, mgbe ọ dị ọnwa iri na abụọ, bụ ọnwụ ma ọ bụ mkpa maka ventricular shunt. Nke abụọ, nke a tụrụ na ọnwa 30, bụ akara nke ule maka mmepe uche na nke mmegharị ahụ.

Nsonaazụ nke Ikpe ahụ

[dezie | dezie ebe o si]

Nnyocha nwa oge e mere na Disemba 2010, nke e mere n'ihu ọha na Febụwarị 2011, ma wepụta ya na New England Journal of Medicine na Machị 2011, gosipụtara uru dị ịrịba ama maka ịwa ahụ ma mechie ikpe ahụ.[1] Ule ahụ gosipụtara na nsonaazụ mgbe ọgwụgwọ spina bifida tupu a mụọ nwa ka mma ruo n'ókè nke na uru nke ịwa ahụ na-akarị ihe ize ndụ nne.

Dabere na nsonaazụ ndị a, a na-ewere mmezi nke spina bifida ugbu a dị ka ụkpụrụ nlekọta na ụfọdụ ebe a na-elekọta nwa. Otú ọ dị, mmezi tupu amụọ bụ usoro dị mgbagwoju anya ma bụrụ ihe ịma aka, na-achọ nlekọta kachasị mma maka nne na nwa e bu n'afọ.[11] Ọnọdụ ahụmịhe nke ndị ọrụ ịwa ahụ n'akụkụ niile nke nlekọta gbara ịwa ahụ gburugburu dị oke mkpa. Ọgwụgwọ nke na-adabere nke ukwuu na onye na-eweta ya bara uru dị nta nye ndị mmadụ ka ukwuu.[12]

  1. ↑ 1.0 1.1 Adzick (2011-03-17). "A randomized trial of prenatal versus postnatal repair of myelomeningocele". The New England Journal of Medicine 364 (11): 993–1004. DOI:10.1056/NEJMoa1014379. ISSN 1533-4406. PMID 21306277. Adzick, N. Scott; Thom, Elizabeth A.; Spong, Catherine Y.; Brock, John W.; Burrows, Pamela K.; Johnson, Mark P.; Howell, Lori J.; Farrell, Jody A.; Dabrowiak, Mary E. (2011-03-17). "A randomized trial of prenatal versus postnatal repair of myelomeningocele". The New England Journal of Medicine. 364 (11): 993–1004. doi:10.1056/NEJMoa1014379. ISSN 1533-4406. PMC 3770179. PMID 21306277.
  2. ↑ Meuli. "In utero repair of experimental myelomeningocele spares neurologic function at birth". J Pediatr Surg 196 (31): 397–402. 
  3. ↑ Bouchard (2003). "Correction of hindbrain herniation and anatomy of the vermis following in utero repair of myelomeningocele in sheep". J Pediatr Surg 38 (3): 451–58. DOI:10.1053/jpsu.2003.50078. PMID 12632366. 
  4. ↑ Pack (2000). "Hindbrain herniation develops in surgically created myelomeningocele but is absent after repair in fetal lambs". Obstet Gynecol 183 (5): 1119–23. DOI:10.1067/mob.2000.108867. PMID 11084552. 
  5. ↑ Meuli (1995). "In utero surgery rescues neurologic function at birth in sheep with spina bifida.". Nat Med 1 (4): 342–47. DOI:10.1038/nm0495-342. PMID 7585064. 
  6. ↑ Bruner (1997). "Endoscopic coverage of fetal open myelomeningocele in utero.". Am J Obstet Gynecol 176 (1 Pt 1): 256–57. DOI:10.1016/s0002-9378(97)80050-6. PMID 9024126. 
  7. ↑ Adzick (21 November 1998). "Successful fetal surgery for spina bifida". The Lancet 352 (9141): 1675–1676. DOI:10.1016/S0140-6736(98)00070-1. PMID 9853442. 
  8. ↑ Tubbs (March 2003). "Late gestational intrauterine myelomeningocele repair does not improve lower extremity function.". Pediatric Neurosurgery 38 (3): 128–32. DOI:10.1159/000068818. PMID 12601237. 
  9. ↑ "Fetal Surgery for Spina Bifida Video". Retrieved on 7 December 2011.
  10. ↑ Belluck, Pam. "Success of Spina Bifida Study Opens Fetal Surgery Door", "The New York Times", 9 February 2011. Retrieved on 7 December 2011.
  11. ↑ Fetal Surgery for Spina Bifida (2014-03-31).
  12. ↑ Facts about Surgery for Myelomeningocele Repair (2021-04-08). Archived from the original on 2024-05-19. Retrieved on 2024-05-19.
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