Sequence (medicine)
A sequence in medicine refers to a series of events or abnormalities that occur as a result of a single initiating factor.
Overview
In medicine, a sequence is a pattern of multiple anomalies derived from a single known or presumed prior anomaly or mechanical factor. This concept is crucial in understanding how a single defect can lead to a cascade of secondary effects, resulting in a complex presentation of symptoms or conditions.
Pathogenesis
The pathogenesis of a sequence involves an initial event that disrupts normal development, leading to a series of secondary anomalies. This initial event can be genetic, environmental, or mechanical in nature. For example, a genetic mutation might lead to a primary defect in a developmental pathway, which then causes a series of downstream effects.
Examples of Sequences
Several well-known sequences are recognized in medical practice:
Potter Sequence
The Potter sequence is a classic example, characterized by a specific set of physical features resulting from oligohydramnios, a condition where there is too little amniotic fluid surrounding the fetus. The lack of amniotic fluid leads to compression of the developing fetus, resulting in characteristic facial features, limb deformities, and pulmonary hypoplasia.
Pierre Robin Sequence
The Pierre Robin sequence involves a triad of anomalies: micrognathia (small jaw), glossoptosis (downward displacement of the tongue), and airway obstruction. The sequence begins with the underdevelopment of the mandible, which then causes the tongue to be positioned further back in the mouth, leading to breathing difficulties.
Amniotic Band Sequence
The amniotic band sequence occurs when strands of the amniotic sac detach and wrap around parts of the fetus, restricting growth and leading to deformities. This can result in limb amputations, constriction rings, and other abnormalities.
Diagnosis
Diagnosing a sequence involves identifying the primary defect and understanding the cascade of secondary anomalies. This often requires a multidisciplinary approach, including genetic testing, imaging studies, and clinical evaluation by specialists.
Management
Management of sequences depends on the specific anomalies present and their severity. Treatment may involve surgical interventions, supportive care, and addressing any functional impairments. Early diagnosis and intervention can improve outcomes for individuals affected by sequences.
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Contributors: Prab R. Tumpati, MD