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Deputy Director, University of Utah School of Medicine

F o r ma t i o n o f the p h a r y n g e a l p o u c h e s o c c u r s p r i o r t o n e u r a l c r e s t mi g r a t i o n a n d t a k e s p l a c e e v e n i n the a b s e n c e o f c r e s t c e l l s women's health problems and solutions cheap nolvadex online amex. P o u c h e s a r e f o r me d b y mi g r a t i o n o f e n d o d e r m c e l l s l a t e r a l l y a n d t h i s mi g r a t i o n i s s t i mu l a t e d b y F G F s menstrual itching nolvadex 20mg with amex. As p o u c h e s f o r m breast cancer 7 mm purchase generic nolvadex on-line, the y e xp r e s s a v e r y c h a r a c t e r i s t i c p a t t e r n o f g e n e s i (gsse e1 6 menopause queasy purchase cheap nolvadex line. T h e s e e xp r e s s i o n p a t t e r n s the n r e g u l a t e d i f f e r e n t i a t i o n a n d p a t t e r n i n g o f p h a r y n g e a l a r c h me s e n c h y me i n t o s p e c i f i c s k e l e t a l s t r u c t u r e s. In t h i s c a s e, the r e s p o n s e o f the me s e n c h y me t o e n d o d e r ma l s i g n a l s i s d e p e n d e n t o n t r a n s c r i p t i o n f a c t o r s e xp r e s s e d i n t h a t me s e n c h y me. Crest cells acquire their s p e c i f i c g e n e e xp r e s s i o n p a t t e r n s f r o m the r h o mb o me r e s o f F ih e i r o r i g i n (t g. D r a w i n g s s h o w i n g the g e n e e xp r e s s i o n p a t t e r n s i n 3 p h a r y n g e a l a r c h e n d o d e r m a n d me s e n c h y me. E n d o d e r m i s r e s p o n s i b l e f o r patterning the skeletal derivatives of the arches, but the response of the me s e n c h y me t o the s e s i g n a l s i s d i c t a t e d b y the g e n e s t h a t the me s e n c h y me e xp r e s s e s. L a t e r a l c e r v i c a l c y s t o p e n i n g a t the s i d e o f the n e c k b y w a y o f 4 a f i s t u l aB. L a t e r a l c e r v i c a l c y s t s a n d f i s t u l a s i n f r o n t o f t h. In t h i s r e g i o n, s i g n a l s e ma n a t i n g f r o m the s u r f a c e e c t o d e r m a n d the) u n d e r l y i n g a r e a s o f the n e u r o e p i the l i u m d i c t a t e the f a t e o f the me s e n c h y me. Ag a i n, i t a p p e a r s t h a t S H H a n d F G F 8 p l a y ma j o r r o l e s i n p a t t e r n i n g t h i s a r e a, b u t the specific genetic interactions are not known. Clinical Corre late s Birth De fe cts Inv olv ing the Phary nge al Re gion Ectopic Thy m ic and Parathy roid Tissue S i n c e g l a n d u l a r t i s s u e d e r i v e d f r o m the p o u c h e s u n d e r g o e s mi g r a t i o n, i t i s n o t u n u s u a l f o r a c c e s s o r y g l a n d s o r r e mn a n t s o f t i s s u e t o p e r s i s t a l o n g the p a t h w a y. T h i s i s t r u e p a r t i c u l a r l y f o r t h y mi c t i s s u e, w h i c h ma y r e ma i n i n the n e c k, a n d f o r the p a r a t h y r o i d g l a n d s. T h e i n f e r i o r p a r a t h y r o i d s a r e mo r e v a r i a b l e i n p o s i t i o n t h a n the s u p e r i o r o n e s a n d a r e s o me t i me s f o u n d a t the b i f u r c a t i o n o f the c o mmo n c a r o t i d a r t e r y. Branchial Fistulas B r a n c h i a l f i s t u lo c c u r w h e n the s e c o n d p h a r y n g e a l a r c h f a i l s t o g r o w as c a u d a l l y o v e r the t h i r d a n d f o u r t h a r c h e s, l e a v i n g r e mn a n t s o f the s e c o n d, t h i r d, a n d f o u r t h c l e f t s i n c o n t a c t w i t h the s u r f a c e b y a n a r rio w 1 6. Such a fistula, found on the lateral aspect of the neck directly anterior to the s t e r n o c l e i d o m a s t o i d m u,s u se a l l y p r o v i d e s d r a i n a g e l ao r r a l c e r v i c a l cl u f the a c y s t (F i g. F r e q u e n t l y, a l a t e r a l c e r v i c a l c y s t i s n o t v i s i b l e a t b i r t h b u t b e c o me s e v i d e n t a s i t enlarges during childhood. C o n s e q u e n t l y, d i s r u p t i o n o f c r e s t c e l l d e v e l o p me n t r e s u l t s i n s e v e r e c r a n i o f a c i a l ma l f o r ma t i o n s. S i n c e c r e s t c e l l s a l s o c o n t r i b u t e t o the c o n o t r u n c a l e n d o c a r d i a l c u s,h iw h i s h s e p t a t e the o u t f l o w t r a c t o f the on c h e a r t i n t o p u l mo n a r y a n d a o r t i c c h a n n e l s, ma n y i n f a n t s w i t h c r a n i o f a c i a l d e f e c t s a l s o h a v e c a r d i a c a b n o r ma l i t i e s, i n c l u d i n g p e r s i s t e n t t r u n c u s a r t e r i o s u s, t e t r a l o g y o f F a l l o t, a n d t r a n s p o s i t i o n o f the g r e a t v e s s e l s. U n f o r t u n a t e l y, c r e s t cells appear to be a particularly vulnerable cell population and are easily killed b y c o mp o u n d s s u c h a s a l c o h o l a n d r e t i n o i c a c i d. O n e r e a s o n f o r t h i s v u l n e r a b i l i t y ma y b e t h a t the y a r e d e f i c i e n t i n s u p e r o xi d e d i s mu t a s e a n d c a t a l a s e e n zy me s t h a t a r e r e s p o n s i b l e f o r s c a v e n g i n g f r e e r a d i c a l s t h a t d a ma g e c e l l s. E xa mp l e s o f c r a n i o f a c i a l d e f e c t s i n v o l v i n g c r e s t c e l l s i n c l u d e the following: F i g u r e 1 6. T h e s e c y s t s a r e a l w a y s o n 5 the l a t e r a l s i d e o f the n e c k i n f r o n t o f the s t e r n o c l e i d o ma s t o i d mu s c l. T h e y c o mmo n l y l i e u n d e r the a n g l e o f the ma n d i b l e a n d d o n o t e n l a r g e u n t i l l a t e r in life. N o t e u n d e r d e v e l o p me n t o f the zy g o ma t i c b o n e s, s ma l l ma n d i b l e, a n d ma l f o r me d e a rR. L i k e T r e a c h e r C o l l i n s s y n d r o me, R o b i n s e q u e n c e a l t e r s f i r s t - a r c h s t r u c t u r e s, w i t h d e v e l o p me n t o f the ma n d i b l e mo s t s e v e r e l y a f f e c t e d. In f a n t s u s u a l l y h a v e a t r i a d o f mi c r o g n a t h i a, c l e f t p a l a t e, a n d g l o s s o p t o s i s (p o s t e r i o r l y p l a c e d t oF i g u e)6 (1 6 B R o b i n s e q u e n c e ma y b e n. It ma y a l s o o c c u r a s a d e f o r ma t i o n, a s f o r e xa mp l e w h e n the c h i n i s c o mp r e s s e d a g a i n s t the c h e s t i n c a s e s o f o l i g o h y d r a mn i o s. T h e p r i ma r y d e f e c t i n c l u d e s p o o r g r o w t h o f the ma n d i b l e a n d, as a result, a posteriorly placed tongue that fails to drop from between the p a l a t a l s h e l v e s, p r e v e n t i n g the i r f u s i o n.

In genetic diagrams breast cancer 80 year old woman purchase 10 mg nolvadex fast delivery, codominant alleles are represented by a capital letter for the gene menstruation 9 days past ovulation buy nolvadex with a mastercard, and different superscript capital letters for the two alleles womens health diet pill generic 20mg nolvadex fast delivery, in recognition of their equal influence (Figure 3 menstrual cycle chart purchase 10mg nolvadex overnight delivery. Homozygous red and homozygous white parents cross to produce roan offspring (red and white hairs together). Predict what offspring you would expect and in what proportions, when a sibling cross (equivalent to selfing in plants) occurs between roan offspring. More than two alleles exist for a particular locus the genes introduced so far exist in two forms (two alleles), for example the height gene of the garden pea exists as tall and dwarf alleles. This means that in genetic diagrams we can represent alleles with a single letter (here, T or t) according to whether they are dominant or recessive. For simplicity we began by considering inheritance of a gene for which there are just two alleles. In fact, most genes have more than two alleles, and these are cases of genes with multiple alleles. In each individual, only two of the three alleles exist, but they are inherited as if they were alternative alleles of a pair. The babies were muddled up by mistake; it was not certain which child belonged to which family. Instead, we may investigate the pattern of inheritance by researching a family pedigree, where appropriate records of the ancestors exist. Analysis of pedigree charts to deduce the pattern of inheritance We can use a pedigree chart to detect conditions that are due to dominant and recessive alleles. In the case of a characteristic due to a dominant allele, the characteristic tends to occur in one or more members of the family in every generation (Figure 3. On the other hand, a recessive characteristic is seen infrequently, often skipping many generations. For example, albinism is a rare inherited condition of humans (and other mammals) in which the individual has a block in the biochemical pathway by which the pigment melanin is formed. In the chart shown of a family with albino members, albinism occurs infrequently, skipping two generations altogether (Figure 3. Unusually, the mutant allele is dominant, so the condition shows a pattern of dominant monohybrid inheritance; that is, it tends to occur in every generation in a family (Figure 3. Egg cells produced by meiosis all carry an X chromosome, but 50% of sperms carry an X chromosome and 50% carry a Y chromosome. At fertilization, an egg cell may fuse with a sperm carrying an X chromosome, leading to a female offspring. Alternatively, the egg cell may fuse with a sperm carrying a Y chromosome, leading to a male offspring. So, the gender of offspring in humans (and all mammals) is determined by the male partner. Also, we would expect equal numbers of male and female offspring to be produced over time by a breeding population (Figure 3. At the seventh week of pregnancy, however, a cascade of developmental events is triggered, leading to the growth of male genitalia if a Y chromosome is present in the embryonic cells. The effect of this hormone at this stage is to inhibit the development of female genitalia, and to cause the embryonic genital tissues to form testes, scrotum and penis. Then, partly under the influence of hormones from the ovary, the female reproductive structures develop. Pairing of X and Y chromosomes in meiosis We know that homologous chromosomes pair up early in meiosis (Figure 3. However, only a very small part of the X and Y chromosomes of humans have complementary alleles and can pair up during meiosis. The bulk of the X and Y chromosomes contain genes that have no corresponding alleles on the other (Figure 3.

The xt r a e mb r y o n i c me s o d e r m t r a v e r s e s the c h o r i o n i c c a v ic y n s e n ttih e s t a l k to i n i c ng (F i g menstruation 3 months after delivery discount 10mg nolvadex with mastercard. Clinical Corre late s Abnorm al Im plantation the s y n c y t i o t r o p h o b l a s t i s r e s p o n s i b l e f o r h o r mo n e p r o dC h aip tn r(s womens health pdf nolvadex 20mg with amex,e e u c t o e)7 i n c l u d i n g u m a n c h o r i o n i c g o n a d o t r o p i n menopause 18 year old purchase 10 mg nolvadex with amex. If the mo the r h a s a u t o i mmu n e d i s e a s e breast cancer uggs cheap 20 mg nolvadex with amex, f o r e xa mp l e, s y s t e mi c l u p u s e r y the ma t o s u s, a n t i b o d i e s g e n e r a t e d b y the d i s e a s e ma y a t t a c k the c o n c e p t u s a n d r e j e c t i t. Ab n o r ma l i mp l a n t a t i o n s i t e s s o me t i me s o c c u r e v e n w i t h i n the u t e r u s. N o r ma l l y, the h u ma n b l a s t o c y s t i mp l a n t s a l o n g the a n t e r i o r o r p o s t e r i o r w a l l o f the b o d y o f the u t e r u s. O c c a s i o n a l l y, the b l a s t o c y s t i mp l a n t s c l o s e t o the i n t e r n a l o p e n i n g o s (o p e n i n g) (s e e g. O c c a s i o n a l l y, i mp l a n t a t i o n t a k e s p l a c e o u t s i d e the u t e r u s, r e s u l t i n g i n e x t r a u t e r i n e p r e g n a,n o r e c t o p i c p r e g n a n c y. H o w e v e r, 9 5 % o f e c t o p i c p r e g n a n c i e s o c c u r i n the u t e r i n e t u b e, a n d mo s t o f the s e a r e i n the a mp u l l a F sg. S o me t i me s, the b l a s t o c y s t d e v e l o p s i n the o v a r y p r o p e r, c a umia r y ao v a r i a n pri s ng p r e g n a n c y. F o r e xa mp l e, i n a s e r i e s o f 2 6 i mp l a n t e d b l a s t o c y s t s v a r y i n g i n a g e f r o m 7. S o me c o n s i s t e d o f s y n c y t i u m o n l y; o the r s s h o w e d v a r y i n g d e g r e e s o f t r o p h o b l a s t i c h y p o p l a s i a. In t w o, the e mb r y o b l a s t w a s a b s e n t, a n d i n s o me, the g e r m d i s c s h o w e d a n a b n o r ma l o r i e n t a t i o n. It i s l i k e l y t h a t mo s t a b n o r ma l b l a s t o c y s t s w o u l d n o t h a v e p r o d u c e d a n y s i g n o f pregnancy because their trophoblast was so inferior that the corpus luteum c o u l d n o t h a v e p e r s i s t e d. T h e s e e mb r y o s p r o b a b l y w o u l d h a v e b e e n a b o r t e d w i t h the n e xt me n s t r u a l f l o w a n d, the r e f o r e, p r e g n a n c y w o u l d n o t h a v e b e e n d e t e c t e d. In s o me c a s e s, h o w e v e r, the t r o p h o b l a s t d e v e l o p s a n d f o r ms p l a c e n t a l me mb r a n e s, a l t h o u g h l i t t l e o r n o e mb r y o n i c t i s s u e i s p r e s e n t. S u c h a c o n d i t i o n i s k n o w n a s h y d a t i d i f o r m m o lM o l e s s e c r e t e h i g h l e v e l s o f h C G a n d ma y a. E mb r y o i s a p p r o xi ma t e l y 2 mo n t h s o l d a n d i s T about to escape through a rupture in the tubal wall. G e n e t i c a n a l y s i s o f h y d a t i d i f o r m mo l e s i n d i c a t e s t h a t a l t h o u g h ma l e a n d f e ma l e p r o n u c l e i ma y b e g e n e t i c a l l y e q u i v a l e n t, the y ma y b e d i f f e r e n t f u n c t i o n a l l y. T h i s e v i d e n c e i s d e r i v e d f r o m the f a c t t h a t w h i l e c e l l s o f mo l e s a r e d i p l o i d, the i r e n t i r e g e n o me i s p a t e r n a l. T h e s e r e s u l t s a l s o s u g g e s t t h a t p a t e r n a l g e n e s r e g u l a t e mo s t o f the d e v e l o p me n t o f the t r o p h o b l a s t, s i n c e i n mo l e s t h i s t i s s u e d i f f e r e n t i a t e s e v e n i n the a b s e n c e o f a f e ma l e p r o n u c l e u s. F o r e xa mp l e, i n h e r i t a n c e o f a d e l e t i o n o n c h r o mo s o me 1 5 f r o m a f a the r p r o d u c e s P r a d e r - W i l l i s y n d r o me, w h e r e a s i n h e r i t a n c e o f the s a me d e f e c t f r o m the mo the r r e s u l t s i n An g e l ma n s y n d r o me. T h i s p h e n o me n o n, i n w h i c h the r e i s d i f f e r e n t i a l mo d i f i c a t i o n a n d / o r e xp r e s s i o n o f h o mo l o g o u s a l l e l e s o r c h r o mo s o me r e g i o n s d e p e n d i n g o n the p a r e n t f r o m w h o m the g e n e t i c ma t e r i a l i s d e r i v e d, i s k n o w n a s g e n o m i c i m p r i n t i nImp r i n t i n g i n v o l v e s a u t o s o me s a n d s e x c h r o mo s o me s [i n. C e r t a i n d i s e a s e s, s u c h a s H u n t i n g t o n c h o r e a, n e u r o f i b r o ma t o s i s, f a mi l i a l c a n c e r d i s o r d e r s (W i l ms t u mo r s, f a mi l i a l r e t i n o b l a s t o ma), a n d my o t o n i c d y s t r o p h y, a l s o i n v o l v e i mp r i n t i n g. F r a g i l e X s y n d r o me, the l e a d i n g c a u s e o f i n h e r i t e d me n t a l r e t a r d a t i o n, ma y b e a n o the r e xa mp l e o f a c o n d i t i o n b a s e d o n i mp r i n t iC h a (s e e,2p. E v e n i n s o me f e r t i l e w o me n u n d e r o p t i ma l c o n d i t i o n s f o r p r e g n a n c y, 1 5 % o f o o c y t e s a r e n o t f e r t i l i ze d, a n d 1 0 % t o 1 5 % s t a r t c l e a v a g e b u t f a i l t o i mp l a n t. O f the 7 0 % t o 7 5 % t h a t i mp l a n t, o n l y 5 8 % s u r v i v e u n t i l the s e c o n d w e e k, a n d 1 6 % o f t h o s e a r e a b n o r ma l. O f t h i s p e r c e n t a g e, a n u mb e r w i l l b e a b o r t e d d u r i n g s u b s e q u e n t w e e k s, a n d a n u mb e r w i l l b e a b n o r ma l a t the t i me o f birth. T ho p h o b l a sd i f f e r e n t i a t e s i na)o a(n i n n e r, a c t i v e l y Tr e t t p r o l i f e r a t i n g l a y e r, C h eo t r o p h o b l a sa n d b) a n o u t e r l a y e r, the tyt, t (S y n c y t i o t r o p h o b l,a s th i c h e r o d e s ma t e r n a l t i s s ug. S u b s e q u e n t l y, ma t e r n a l s i n u s o i d s a r e e r o d e d b y the s y n c y t i o t r o p h o b l a s t, ma t e r n a l b l o o d e n t e r s the l a c u n a r n e t w o r k, a n d b y the e n d o f the s e c o n d w e e k, a p r i mi ei r o p l a c e n t a l c i r c u l a t ie g i n s F(i g.

Syndromes

• 25% chance of a carrier girl
• Thyroid scan
• Weight loss
• Ages 69 and older: 17 - 90 ug/dL
• Symptoms get worse with sudden movement.
• On day 2, urinate into the container in the morning again when you wake up.
• Lung circulation diseases -- These diseases affect the blood vessels in the lungs. They are caused by clotting, scarring, or inflammation of the blood vessels. They affect the ability of the lungs to take up oxygen and to release carbon dioxide. These diseases may also affect heart function.
• Loss of previous developmental skills (in young children)
• Alpha-blockers help relax your blood vessels, which lowers your blood pressure.

O s t e o b l a s t s b i n d t o the mi n e r a l i ze d ma t r i x a n d d e p o s i t b o n e ma t r i c e s women's health clinic dc purchase nolvadex 10mg. L a t e r women's health clinic edmonton abortion purchase nolvadex mastercard, a s b l o o d v e s s e l s i n v a d e the e p i p h y s e s menstrual while breastfeeding order 10mg nolvadex with visa, s e c o n d a r y o s s i f i c a t i o n c e n t e r s f o r m breast cancer life expectancy quality 10 mg nolvadex. G r o w t h o f the b o n e s i s ma i n t a i n e d b y p r o l i f e r a t i o n o f c h o n d r o c y t e s i n the g r oF i tgh p l. M o l e c u l a r R e g u l a t i o n o f L i m b D e ve l o p m e n t P o s i t i o n i n g o f the l i mb s a l o n g the c r a n i o c a u d a l a xi s i n the f l a n k r e g i o n s o f the e mb r y o i s r e g u l a t e d b yHtO e g e n e se xp r e s s e d a l o n g t h i s a xi s. T h e s e hX h o m e o b o x e n e s a r e e xp r e s s e d i n o v e r l a p p i n g p a t t e r n s f r o m h e a d t o t a i l (s e e g C h a p t e r)6 w i t h s o me h a v i n g mo r e c r a n i a l l i mi t s t h a n o the r s. O n c e p o s i t i o n i n g a l o n g the c r a n i o c a u d a l a xi s i s d e t e r mi n e d, g r o w t h mu s t b e r e g u l a t e d a l o n g the p r o xi mo d i s t a l, a n t e r o p o s t e r i o r, a n d d o r s o v e n Fria l. T h i s g e n e i n d u c e s eS ErR 2 s i o n o f xp e s a, h o mo l o g u e o f os ophi l a s er r,at e the b o r d e r b e t w e e n c e l l s t h a t a r e e xp r e s s i n g Dr at Radi c al f r i ngen d t h o s e t h a t a r e n o t. F o r ma t i o n o f the b o r d e r i t s e l f i s a s s i s t e d b y eE n ge s s li e d - o f xp r r a i o n 1 i n v e n t r a l e c t o d e r m c e l l s, s i n c e t h i s g e n e r e p r e s s e s e xp r e s c al nf ronge Radi s i o i f. Af t e r the r i d g e i s e s t a b l i s h e d, i t e xp rG F s e s dF G F 8 w h i c h ma i n t a i n the F es4an, p r o g r e s s z o n e h e r a p i d l y p r o l i f e r a t i n g p o p u l a t i o n o f me s e n c h y me c e l l s a d j a c e n t, t t o the r i d g e i (g. As g r o w t h o c c u r s, me s e n c h y ma c e l l s a t the p r o xi ma l e n d o f the p r o g r e s s zo n e b e c o me f a r the r a w a y f r o m the r i d g e and its influence and begin to slow their division rates and to differentiate. T h u s, f o r e xa mp l e, d i g i t s a p p e a r i n the p r o p e r o r d e r, w i t h the t h u mb o n the r a d i a l (a n t e r i o r) s i d. T h e s e t w o g e n e s a r e a l s o i n t i ma t e l y l i n k e d i n s i g n a l i n g p a t h w a y s i n Dr os ophi l, aa n d t h i s i n t e r a c t i o n i s c o n s e r v e d i n v e r t e b r a t e s. In f a c t, a l l o f the p a t t e r n i n g g e n e s i n the l i mb h a v e f e e d b a c k l o o p s. Al t h o u g h p a t t e r n i n g g e n e s f o r the l i mb a xe s h a v e b e e n d e t e r miH Od, i t i s the ne X g e n e st h a t r e g u l a t e the t y p e s a n d s h a p e s o f the b o n e s oF i tg. Af t e r the r i d g e i s e s t a b l i s h e d, i t e xp r e s s e s F G F 4 a n d F G F 8 t o ma i n t a i n the p r o g r e s s zo n e, the r a p i d l y p r o l i f e r a t i n g me s e n c h y me c e l l s a d j a c e n t t o the r i dB. Clinical Corre late s Bone Age R a d i o l o g i s t s u s e the a p p e a r a n c e o f v a r i o u s o s s i f i c a t i o n c e n t e r s t o d e t e r mi n e w h e the r a c h i l d h a s r e a c h e d h i s o r h e r p r o p e r ma t u r a t i o n a g. U s e f u l i n f o r ma t i o n a b o uo n e a g e s o b t a i n e d f r o m o s s i f i c a t i o n s t u d i e s i n the h a n d s b t i and wrists of children. Prenatal analysis of fetal bones by ultrasonography p r o v i d e s i n f o r ma t i o n a b o u t f e t a l g r o w t h a n d g e s t a t i o n a l a g. Lim b De fe cts L i mb ma l f o r ma t i o n s o c c u r i n a p p r o xi ma t e l y 6 p e r 1 0, 0 0 0 l i v e b i r t h s, w i t h 3. T h e s e defects are often associated with other birth defects involving the craniofacial, c a r d i a c, a n d g e n i t o u r i n a r y s y s t e ms. S o me t i me s the l o n g b o n e s a r e a b s e n t, a n d r u d i me n t a r y h a n d s a n d f e e t a r e a t t a c h e d t o the t r u n k b y s ma l l, i r r e g u l a r l y s h a p e d b o n e s h o c o m e l i, aa f o r m o f me r o me l i a) (s e e 9. S o me t i me s a l l s e g me n t s o f the e xt r e mi t i e s a r e p r e s e n t b u t a b n o r ma l l y s h o r t (m i c r o m e l i. F o r e xa mp l e, ma n y c h i l d r e n w i t h l i mb ma l f o r ma t i o n s w e r e b o r n b e t w e e n 1 9 5 7 a n d 1 9 6 2. M a n y mo the r s o f the s e i n f a n t s h a d t a k teh a l i d o m i d ea d r u g w i d e l y u s e d a s a s l e e p i n g p i l l a n d n, a n t i n a u s e a n t. It w a s s u b s e q u e n t l y e s t a b l i s h e d t h a t t h a l i d o mi d e c a u s e s a c h a r a c t e r i s t i c s y n d r o me o f ma l f o r ma t i o n s c o n s i s t i n g o f a b s e n c e o r g r o s s d e f o r mi t i e s o f the l o n g b o n e s, i n t e s t i n a l a t r e s i a, a n d c a r d i a c a n o ma l i e s. S t u d i e s i n d i c a t e t h a t the mo s t s e n s i t i v e p e r i o d f o r t e r a t o g e n - i n d u c e d l i mb ma l f o r ma oi u r ts i s the f t on h a n d f i f t h w e e k s d e v e l o p me n t. S o me t i me s the d i g i t s a r e s h o r t e n e db (a c h y d a c t y;l y e eF i g. In 1 p e r 2, 0 0 0 b i r t h s t h i s p r o c e s s f a i l s, a n d the r e s u l t i s f u s i o n b e t w e e n t w o o r mo r e d i g i t s. T h e p r e s e n c e o f e xt r a f i n g e r s o r t o ep oi lsy c a lcey l y i g. T h e e xt r a d i g i t s f r e q u e n t l y l a c k p r o p e r mu s c l e c o n n e c t i o n s.

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