Intrauterine dwarfism, peculiar facies and thin bones with multiple fractures--a new syndrome

Three newborns with thin ribs and thin long bones with multiple fractures are reported. Whereas one patient presents a syndromic association of bone dysplasia and intrauterine dwarfism two other patients cannot be appropriately evaluated due to lack of basic clinical and pathologic data.

Acro-mesomelic dysplasia--a new type. Report of two siblings

Two siblings who represent a new type of acro-mesomelic dysplasia are reported. The unique pattern of the acro-mesomelic hypoplastic/dysplastic changes allows us to designate them as a new syndrome.

Primary bone tumours of the hand. Report of 21 cases

Twenty-one primary bone tumours of the hand in children from 8 paediatric hospitals are reported. Osteochondromas and enchondromas were not included. Our material consisted of 16 patients with common tumours (3 Ewing's sarcoma, 5 aneurysmal bone cyst, 6 osteoid osteoma and 2 epidermoid cyst) and 5 patients with uncommon tumours (osteoma, simple bone cyst, haemangiopericytoma, capillary angiomatous tumour and benign ossifying fibroma or osteoblastoma). The X-ray diagnosis of the common tumours should have high concordance with histology, whereas that of uncommon tumours is much more difficult and uncertain. The characteristic features of Ewing's sarcoma are stressed as all our children with this tumour had a delayed diagnosis and a fatal outcome. Differential diagnosis with other short tubular bone lesions of the hand - specifically osteomyelitis - is discussed and the possibilities of microscopic diagnosis are stressed.

A new type of spondylo-metaphyseal dysplasia--Algerian type. Report of five cases

A new, dominantly inherited, severe form of spondylometaphyseal dysplasia in five members of an Algerian family is reported. Another child, not investigated, was also probably affected. The disease is characterised by a unique clinical and radiological set of features: dwarfism, genu valgum deformity, progressive kypho-scoliosis, wrist deformity, myopia and severe metaphyseal dysplasia, with moderate spinal changes and minimal changes in the hands and feet. In view of the geographical localisation of the disorder and the anatomical distribution we propose the name Algerian type of spondylo-metaphyseal dysplasia.

Polyostotic fibrous dysplasia and chronic osteomyelitis in a 12-year-old boy. Diagnostic difficulties in double bone pathology

A twelve-year-old boy with double bone pathology (polyostotic fibrous dysplasia and chronic monofocal osteomyelitis), causing radiologic diagnostic difficulties is reported. The nuclear scan which was interpreted with disregard of the patient's history and physical examination lead to erroneous conclusions. Basic clinical signs and symptoms should always be taken into account when more sophisticated examinations are performed.

Congenital agastria

Congenital agastria has never before been reported. Congenital microgastria is rare but is well documented. We have cared for a Melanesian child in whom there was no radiological, anatomical, or physiological evidence of either a rudimentary stomach or a pylorus. The esophagus joined the first part of the duodenum directly. At this esophago-duodenal junction there was microscopic evidence of fundic-type gastric mucosa. The intestine was normally rotated and there was a functioning spleen. The child also had a severe micrognathia and a cleft soft palate and required a tracheostomy to relieve upper airway obstruction. The combination of micrognathia and agastria presented a difficult nutritional delivery problem. A jejunal pouch was constructed and placed between the esophagus and duodenum to provide some storage capacity. The child grew and developed well for almost 3 years. He suffered three episodes of severe acute enteritis, probably related to lack of the protective acid-pepsin barrier against ingested microorganisms. Unfortunately, the third episode of acute enteritis caused his death 3 months after returning home to his own country.

Perinatally lethal short rib-polydactyly syndromes. 1. Variability in known syndromes

Thirteen newborns with lethal short rib-polydactyly (SRP) have been reviewed, 11 with SRP type III (Verma-Naumoff) and 2 with SRP type II (Majewski). In the former group there were three sets of siblings. The excess of males with SRP type III (Verma-Naumoff) is confirmed in this present study. A high frequency of phenotypic females including sex-reversed constitutional males with SRP type I (Saldino-Noonan) is in marked contrast to these findings in SRP type III. Possible hypotheses include variable expressivity in non-Majewski short rib-polydactyly syndromes with sex-reversed and constitutional female cases tending to show more severe phenotypic expression both in terms of major anomalies and skeletal dysplastic effects.

Atelosteogenesis: evidence for heterogeneity

Four cases of neonatal death dwarfism resembling atelosteogenesis but with some distinctive radiographic and characteristic histopathologic features are reported. The name atelosteogenesis II is proposed for this entity.

Geleophysic dysplasia--acromicric dysplasia with evidence of glycoprotein storage

"Geleophysic" dysplasia is a rare autosomal recessive disorder, probably of glycoprotein metabolism, which shares some clinical and roentgenological manifestations with acromicric dysplasia. We report the clinical, radiological, and pathological data of a patient with the typical picture of progressive growth delay; mild facial anomalies; small, abnormal hands; hepatosplenomegaly; and progressive cardiac valvular lesions. Electron microscopy of a liver biopsy showed similar and additional changes to those published previously.

Unusual facies, arthrogryposis, advanced skeletal maturation and unique bone changes. A new congenital malformation syndrome

Two strikingly similar infant siblings showed the following pattern of anomalies: unusual cranio-facial appearance, arthrogryposis, advanced bone age of the hips and unique skeletal X-ray abnormalities. They represent a previously unrecognised, fatal malformation syndrome.

Unilateral mid-femoral periosteal newbone of varying aetiology in children. Radiographic analysis of 25 cases

Thigh pain is a serious condition in childhood and should be promptly and thoroughly investigated. Twenty-five cases of thigh pain lasting between 1 day and 7 months with mid-femoral periosteal thickening were analysed. There were 10 patients with Ewing's sarcoma, 7 with eosinophilic granuloma, 1 with osteoid osteoma, 1 with leukaemia, 3 with osteomyelitis, 1 with myositis and 2 with post-traumatic periosteal reaction. It was shown that patients with Ewing's sarcoma and eosinophilic granuloma have certain patterns of X-ray changes of high diagnostic value, which allow a proper diagnosis in most cases.

Osteoid osteoma and osteoblastoma of the spine in children. Report of 22 cases with brief literature review

Thirteen cases of osteoid osteoma and nine cases of osteoblastoma are reported. Diagnostic difficulties of osteoblastoma are illustrated by the versatile radiographic appearances of this tumour. The authors stress the importance of nuclear scan and CT in diagnosis and management.

A new type of achondrogenesis

A new type of neonatal death dwarfism, resembling the achondrogenesis syndromes on clinical examination but presenting distinctive radiographic and microscopic features has been described. It presents another, new form of achondrogenesis.