Klippel-Trenaunay-Weber syndrome with hydrocephalus: an unusual association

Macrocephaly is an associated finding with Klippel-Trenaunay-Weber syndrome, the cause of which remains to be determined. Association of this syndrome with hydrocephalus due to aqueductal stenosis has not been reported previously in world literature and is presented in this clinical brief.

Evaluation of short neck: new neck length percentiles and linear correlations with height and sitting height

Qualitative impressions of neck length are often used as aids to dysmorphology in syndromes like Turner, Noonan, Klippel-Feil and in craniovertebral anomalies, some of which have serious neurological implications. There are no national or international standards for neck length. The present study attempted to create standards and percentile charts for Indian children and compute age-independent correlations of neck length with linear measurements such as standing and sitting height. A total of 2724 children of both sexes between 3 and 15 years, whose heights and weights conformed to ICMR standards were inducted. Neck length was measured by a modified two-point discriminator between two fixed bony points-inion and spinous process of C7 with the head held in neutral position. Percentiles (5th-95th) were constructed for both sexes. Growth was rapid from 3 to 6 years. Neck length formed a mean of 12.7 +/- 4.58% of height and 20.1 +/- 6.73% of sitting height. Age independent linear regression equations: Neck length = 10 + (0.035 x height) and Neck length = 9.65 + (0.07 x sitting height) were highly significant (p < 0.001). Neck length relationships of 30 randomly selected normal children clustered around the regression lines and 16 with genetic syndromes fell below the regression lines.

Storage disorders presenting like mucopolysaccharidosis

The term dysostosis multiplex is specifically applied to the group of radiological features collectively found in a number of specific metabolic disorders including the mucopolysaccharidoses, mucolipidosis, mannosidosis, fucosidosis and several other rarer conditions. We report eight cases of mannosidosis, fucosidosis and mucolipidosis with special emphasis on the differentiation from the more common mucopolysaccharidoses.

Massive haemoptysis controlled by bronchial artery embolisation: a case report

Massive haemoptysis results in a high rate of mortality and morbidity. It is infrequently seen in children. Medical and surgical interventions are not very effective in controlling torrential bleeding. Therefore, newer modalities like bronchial artery embolisation are found to be promising in life threatening situations in both adults and children.

Spondylocostal dysostosis

Spondylocostal dysostosis is a rare condition characterized by short stature due to a short trunk, multiple morphological abnormalities of the vertebrae and ribs due to malsegmentation of the axial skeleton. Radiological features include reduced number of vertebrae and ribs, hemivertebrae, fused or sagitally cleft vertebrae or multiple rib fusions. Three distinct clinical entities are described. We report nine cases of this syndrome, seven were infants and presented with an abnormal shape of the thorax. Two of them had a meningocoele, and one succumbed to the CNS anomalies on the third day of life. The other two cases were two and eight years of age. Cardiac lesion was detected in one case and renal malformations in three cases. Reduction in the rib number was present in all cases, and rib fusion in seven cases. Thoracic vertebral dysegmentation was noted in all, lumbar in three and cervical in one case. This is the first large series from India. No clear single etiology was established.

The Proteus syndrome

A race case of Proteus syndrome is presented. The main features of this hamartomatous condition are partial gigantism of hands and feet, hemihypertrophy, subcutaneous masses, epidermal nevi and bony abnormalities. The condition is extremely rare. Though the child had severe cosmetic disability, motor intellectual and language development was found to be normal.

Fraser syndrome

Fraser Syndrome is a rare disorder with only a few cases having been described in Indian literature. We report here a case of a patient aged 16 yr present with primary amenorrhea which is a very unusual mode of presentation. Multiple associated anomalies were present including those of eyelids, eyebrow, face, fingers and genitalia. Chromosome analysis revealed a normal female karyotype. Pituitary gonadotropins were within normal range.

Pseudoachondroplastic dysplasia

Pseudoachondroplasia is a heterogeneous inherited skeletal dysplasia in which dwarfism is a major feature. We report here a case of a 7 year old girl misdiagnosed as rickets, who presented with short stature, lordosis, genu varum and flexion deformities at both the elbows. Skeletal survey revealed epiphyseal and metaphyseal irregularities. A review of literature is also presented.

Wildervanck syndrome (cervico-oculo-acoustic syndrome)

Wildervanck syndrome i.e. cervico (Klippel-Feil anomalad) -oculo (Duane-Stilling-Turk phenomenon with bilateral abducens palsy)-acoustic (deafness) is a rare syndrome. We report here 4 cases diagnosed as Wildervanck syndrome and analyse their findings. One patient had an an atrial septal defect. Such association of congenital heart disease with Wildervanck syndrome has not been reported previously.

Asymmetric crying facies: the cardiofacial syndrome

A 5 1/2 month old female child presented with cyanosis and recurrent respiratory infection. Asymmetric facies was noticed on crying. On investigation an ostium secundum atrial septal defect with right partial anomalous pulmonary venous connection and severe pulmonary hypertension was detected. The association of asymmetric crying facies with congenital cardiac anomalies, known as cardiofacial syndrome, is presented here to highlight the use of this clinical sign as a marker to congenital anomalies.

MURCS association--a review of 7 cases

MURCS association (Mullerian hypoplasia/aplasia, renal agenesis and cervicothoracic somite dysplasia) is emerging as the second most frequent cause of primary amenorrhoea after Turner syndrome. Seven cases have been described and analysed. All cases had absence of uterus and tubes 85% had cervical spine abnormalities such as vertebral fusion, hypoplasia of vertebrae or butterfly vertebrae and short stature and 28% had renal agenesis or ectopy. The latter finding is in contrast to the reports in world literature where the frequency of renal agenesis is higher. There was no familial incidence in these seven cases lending credence to the belief that the association is essentially sporadic.

Efficacy of three doses of oral polio immunization beginning within the first four days of life

A study was carried out to test the efficacy of oral polio immunization commencing in the newborn period. In Group A, 47 term newborn infants were given trivalent oral polio vaccine (TOPV) within the first four days, at one month and at two months. In Group B, 21 infants were given TOPV at 3, 4 and 5 months. The seroconversion rates for types 1, 2 and 3 were 87.2, 95.7 and 72.3%, respectively in Group A and 85.7, 95.2 and 66.7%, respectively in Group B after 3 doses of TOPV, the differences being insignificant. Oral polio immunization beginning in the newborn period was as effective as when commenced at 3 months of age. Before immunization, the number of babies with protective titers against polioviruses were significantly more in Group A as compared to Group B. Thus, the later onset of immunization schedule leaves more children susceptible to poliomyelitis during the first 3 months of life.