In reading about for more information on Bingley's post regarding diaetetic, I came across this largely unrelated term:

atretic

"Having an abnormal closure or absence of a body opening or tubular organ (for example, a child born without an oesophagus would have an atretic birthdefect). "

*Note the spelling of oesophagus; I would spell it 'esophagus,' but perhaps this is a regional difference.

Dear WW: atresia is not a rare condition. I still remember being told in embryology that every newborn baby should have little finger of obstetrician very cautiously inserted into its rectum to detect imperforate anus. An excess of caution. Little girls may have imperforate hymen,but that is seldom troublesome and easily corrected. Embryology is fascinating. There are so many changes made so rapidly that it is amazing that there are not far more congenital defects.

What is an imperforate anus, wwh? Is it one through which that which would be expelled cannot be?

Exactly. Embryology is fascinating in the way many structures are formed. It has been so long since I studied it that I can't describe the steps in which the tube that is the intestinal tract which is I guess endoderm,with a bind end, meets the skin, which is ectoderm, and for quite a while the opening is closed by a layer of both, then a rim forms, and the opening is formed. We are strangely and wonderfully made. I'd be surprised if there were any pictures of this on the Internet, but I'll look.

Here's some picture about spina bifida, a potentially tragic failure of developing lower end of spine with spinal cord inside to become separate from the skin. You can get some ideas of the layers forming. There are so many such events it is a marvel that congenital anomalies are not far commoner than they are.

You forgot to post the link, wwh. Thanks for doing so if you can find it again.

Dear WW: I came back and edited it in.Can't understand what happened. I'll try to find the site again, Think I can.
Actually, I blocked on name of the problem, and had to
search for approximations of the problem before I found it.
Spina bifida. It's been a long time since I saw a patient with it.Anyhow here's the URL:
http://www.pediatric-orthopedics.com/Topics/Embryo_S_Bifida/embryo_s_bifida.html

"Select" it, press Control,C, then put insertion point into Location Box, and press Contro, V That should do it.

Has spina bifida got less common over the years? I remember back in the 1970s one of our neighbour's kids had had surgery for this problem, and spina bifida used to feature quite regularly in the medical sections of newspapers and on TV, but I haven't heard anybody mention it for years.

Bingley

Thanks, wwh.

Bingley, I haven't heard anything regarding spina bifida's having become less common. I'd be interested in knowing whether there has been a decrease.

Dear WW: I would doubt that there would be any likelihood
of a change in incidence of spina bifida. A lot of congenital anomalies may be associated with mother having virus infection such as rubella during third month of pregnancy. I don't recall reading that spina bifida is in that group. Nor have I read that it is familial. But I haven't read much about it.
Remember that many "changes" in incident of any disease
may be just a change in recognition and reporting of diseases.

That is what I am asking. Spina bifida seems, to me at any rate, to be much less reported on or discussed than it used to be. Is that because it's less common or just because people want to talk about something else?

Bingley

Dear Bingley and WW: I searched for "incidence spina bifida"
and got a link to a big bungh of links about the problem.
It also says CDC collects data, but I couldn't find a tidy
easy to comprehend graph. I can't read well enough to wade through these. Perhaps you can find something useful at:
http://www.noah-health.org/english/illness/neuro/spinabif.html

spina bifida, is one of those genetic defects that seems to have an "an affinity" for certain ethnic/racial groups, and it is much more common in Northern europeans, specifically, irish, english, german, dutch, and scandinavian heritage.

there is some evidence that the same virus that caused the potato failure, can cause genetic damage in humans, that leads to increased spina bifida (but i don't think was proven)-- and certainly the groups most effected tend to be 'potato eaters'- both in europe & US

there is now an inutero test for SB, and two things happen, one, when SB is detected, the pregnancy is terminated, or there is also a inutrero operation that can graft skin into the area, and reduce the major problems associated with spina bifida.

One problems that SB causes, is beacuse of the open end of the spinal cord, there is a causes lose of spinal fluid, and presure, which results in the brain slidding too far back in the skull, (and moving into spinal cord space in effect, not remaining fully in the skull)this movement of the brain causes other problems.

the surgery prevents this, and reduces some the other nerve damage that occurs (by providing at least a covering of skin for spinal cord). later surgeries can further reduce the damage, so that many children born with the defect today, don't have mis-shaped skulls, don't need shunts (the brain moving into the spinal space collapes ducts for spinal fluid, so external shunts were needed) have much less brain damage(often none), and less spinal cord damage, so the few children that are born with the condition are pretty normal looking, and often have 80 to 95% fuction of the their lower limbs. in the "worst cases" with the in utero surgeries, they kids usually still end up being able to walk, (with braces and crutches) their life expectancy is also improved.

I exect you hear less, because there are fewer ethinic groups with a history of potato eating members in your area, and testing and early treatment has resulted in few births with the defect, or noticable effects of the defect.

Very interesting informatiion, of troy.

So, from what you've written, I gather that termination of pregnancies is a factor in why we may hear less about the incidence of spina bifida--and that does make sense.

The potato-eating theory--heavens! Here in my neck of the woods potato-eating is as common as water-drinking.

I am very skeptical about those reports of diseases being associated with diet. I don't see how they exclude the post hoc ergo propter hoc fallacy.

Ergo, wwh, my "heavens!"

When my daughter in law was pregnant, CA requires a host of genetic test, and she came back positive for one.. but it was a test know to have a high percentage of false positives- she waited and worried till the sonigram in her seventh month made it clear the baby didn't have any problems.. for some time we discussed different test, and options.. and i learned a good deal about her test, and others.. SB can be detected and if it is, a percentage of pregnancies get terminated.

i have second cousin's who have phenyleketonuria-- the disease that is always being warned about on Equal and other 'blue' artifical sweeteners. it too is genetic, but it is only test for post birth.

If I'm not mistaken (and I could be; I'm a cardiologist, not a _____ologist) spina bifida is one of a class of developmental problems called "neural tube defects" and can be prevented, or at least minimized, if mother-to-be gets enough folic acid; this could well be the connection to diet. People who are malnourished, or who take too much alcohol, or who eat fad diets, are more susceptible than the general population to folate deficiency, and pregnant women need enough for two, which is the reason folic acid is an obligatory component of pre-natal vitamins.

See http://www.spinabifida.org/genetics.htm, from Dr. Bill's site/citation above; start a couple of paragraphs down.

Later on in life folate can be important for preventing nutritional anemia, and it's also prescribed with the hope of bringing down a high "homocysteine" level, thereby (maybe) giving a modicum of protection against coronary artery disease.

Here's a URL with a lot of information about folic acid.
http://www.marchofdimes.com/professionals/681_1151.asp

So, back to potatoes. It could be that people whose diets were largely potato diets--without the benefit of other food sources--would be those potato diet victims of whom of troy was writing. Perhaps it wasn't the potatoes per se, but the limited diet itself. That would make sense here.

Dear WW: here is an excerpt from an NIH publication:
"How can you make sure you're getting enough folic acid? In 1998, the Food and Drug Administration mandated that folic acid be added to enriched grain products - so you can increase your intake by looking for breakfast cereals, breads, pastas, and rice containing 100% of the recommended daily folic acid allowance. But for most women, eating fortified foods isn't enough. To reach the recommended daily level, you'll probably need a vitamin supplement. Talk to your doctor about whether he or she recommends a prescription supplement or an over-the-counter brand."

Apologies for any inadvertant mantling.

Spina bifida and other neural tube defects are decreasing in incidence for a couple of reasons. Firstly, as mentioned above, the understanding of the preventative role of folic acid. Secondly, the increase in (nay, introduction of) pre-natal detection and hence an increase in elective termination of the pregnancy.

There are a number of different atresias (oesophageal - the spelling IS regional, if the Commonwealth nations are a region, biliary, duodenal, any part of the gut really) and they are quite common, lethal if untreated, but easily corrected in most cases.

An interesting discussion to read. Thank you all.

Edit: just remembered that when I was a boy we were told that if a potato had been cooked with 'eyes' still in it we should cut them away and never eat them. Wonder what was behind that old wives' tale?

I don't think it is an OWT, dixby - potatoes can be a source of a poison called solanine in some circumstances.

http://www.exploratorium.edu/cooking/icooks/ask_8-5-02.html

So is there owt in it?

Bingley

Nah, there's nowt in't.

One of potato lore that surprised me. My daughter on Prince Edward Island told me that after the potato harvest there,
the small potatoes left in the fields were not safe to eat after the first frost. I do not know the basis for that,
but have no reason to disbelieve it. The islanders are too frugal to waste anything without good reason.