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Di Rocco F, Rothenbuhler A, Cormier Daire V, Bacchetta J, Adamsbaum C, Baujat G, Rossi M, Lingart A. Craniosynostosis and metabolic bone disorder. A review. Neurochirurgie 2019; 65:258-263. [PMID: 31562881 DOI: 10.1016/j.neuchi.2019.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Some metabolic bone disorders may result in the premature closure of one or more calvarial sutures during childhood, potentially leading to a cranioencephalic disproportion. The aim of this paper is to review the characteristics and consequences of craniosynostosis associated with metabolic disorder. MATERIAL AND METHODS A review of the literature on metabolic forms of craniosynostosis was performed. RESULTS The most common forms of craniosynostosis associated with metabolic bone disorder were isolated sagittal suture fusion with or without scaphocephaly, and sagittal suture fusion associated with coronal suture fusion (oxycephaly) or also with lambdoid suture fusion (pansynostosis). Synostosis may be well-tolerated, but in some subjects results in neurodevelopmental and functional impairment that is sometimes severe. CONCLUSION The impact of metabolic synostosis is very variable, depending on the specific underlying metabolic disease, with a large spectrum of morphological and functional consequences. Diagnosis should be early and management should be carried out by a multidisciplinary team with expertise in both rare skeletal disorders and craniosynostosis. The impact of emergent medical therapies recently developed for some of these diseases will be assessed by systematic coherent follow-up of international registries.
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Affiliation(s)
- F Di Rocco
- Inserm 1033, neurochirurgie pédiatrique, centre de référence pour les craniosténoses, Lyon et université Claude Bernard Lyon 1, hôpital femme-mère-enfant, 69003 Lyon, France.
| | - A Rothenbuhler
- Endocrinologie et diabète de l'enfant, filière OSCAR et plateforme d'expertise Paris Sud maladies rares, centre de référence des maladies rares du calcium et du phosphate, hôpital Bicêtre Paris Sud, AP-HP, 94270 Le Kremlin Bicêtre, France
| | - V Cormier Daire
- Centre de référence maladies osseuses constitutionnelles, institut imagine, 75015 Paris, France
| | - J Bacchetta
- Inserm 1033, centre de référence des maladies rares du calcium et du phosphate, université Claude Bernard Lyon 1, hôpital femme-mère-enfant, 69003 Lyon, France
| | - C Adamsbaum
- Service de radiologie pédiatrique, université Paris-Saclay, hôpital Bicêtre, AP-HP, 94270 Le Kremlin Bicêtre, France
| | - G Baujat
- Centre de référence maladies osseuses constitutionnelles, institut imagine, 75015 Paris, France
| | - M Rossi
- GENDEV Team, CNRS UMR5292, CRNL, UCBL1, Inserm U1028, service de génétique, centre de référence anomalies du développement, centre de compétence maladies osseuses constitutionnelles, hospices civils de Lyon, 69003 Lyon, France
| | - A Lingart
- Endocrinologie et diabète de l'enfant, filière OSCAR et plateforme d'expertise Paris Sud maladies rares, centre de référence des maladies rares du calcium et du phosphate, hôpital Bicêtre Paris Sud, AP-HP, 94270 Le Kremlin Bicêtre, France; Service de radiologie pédiatrique, université Paris-Saclay, hôpital Bicêtre, AP-HP, 94270 Le Kremlin Bicêtre, France; Inserm U1185, université Paris Sud Paris-Saclay, 94270 Le Kremlin Bicêtre, France
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Akhtar Ali S, Mathalikunnel A, Bhardwaj V, Braskett M, Pitukcheewanont P. Nutritional hypophosphatemic rickets secondary to Neocate® use. Osteoporos Int 2019; 30:1887-1891. [PMID: 31143989 DOI: 10.1007/s00198-019-04836-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/02/2019] [Indexed: 01/12/2023]
Abstract
Elemental formula is commonly used in children with feeding intolerance. We describe two, medically complex and feeding tube dependent, patients exclusively fed with Neocate® who subsequently developed hypophosphatemic rickets. Both patients had gross motor decline and pain with physical touch. They were found to have low serum phosphorus, normal calcium, and vitamin D studies, with elevated alkaline phosphatase suggestive of nutritional hypophosphatemia. Both courses were complicated by hypocalcemia following formula change and phosphorus supplementation, highlighting the need for careful management of phosphate repletion in affected individuals. Diligent serial electrolyte monitoring as well as attention to bone health is needed in conjunction with elemental nutrition. Formula change led to restoration of calcium and phosphorus homeostasis and radiographic improvement in these patients.
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Affiliation(s)
- S Akhtar Ali
- Center For Endocrinology, Diabetes and Metabolism, Division of Pediatrics, Children's Hospital Los Angeles (CHLA), 4650 Sunset Blvd, # 61, Los Angeles, CA, 90027, USA
| | - A Mathalikunnel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - V Bhardwaj
- Division of Gastroenterology, Hepatology and Nutrition, CHLA, Los Angeles, CA, USA
| | - M Braskett
- Division of Clinical Immunology and Allergy, CHLA, Los Angeles, CA, USA
| | - P Pitukcheewanont
- Center For Endocrinology, Diabetes and Metabolism, Division of Pediatrics, Children's Hospital Los Angeles (CHLA), 4650 Sunset Blvd, # 61, Los Angeles, CA, 90027, USA.
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The Use of Distraction Osteogenesis in the Treatment of Rickets-Associated Craniosynostosis. World Neurosurg 2019; 131:200-206. [PMID: 31295604 DOI: 10.1016/j.wneu.2019.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Craniosynostosis has a known association with rickets. Because of abnormal bone development and a tendency for patients with rickets to present at an older age than most patients with craniosynostosis, repair may be complicated by inadequate cranial expansion and greater risk of sutural re-fusion. We present 2 cases of rickets-associated sagittal craniosynostosis and show the effectiveness of distraction osteogenesis in the surgical management of this condition. CASE DESCRIPTION Two 3-year-old boys with rickets presented with sagittal synostosis and marked scaphocephalic deformity. Cranial osteotomies were performed followed by placement of 2 internal distractors. The devices were activated daily for 30 days to achieve a target transverse cranial distraction of 30 mm. A subsequent period of 10-12 weeks allowed for adequate bone consolidation. At the time of device removal, the final breadth of distraction and the quality of new bone formed was assessed. Distraction distance in both cases was verified intraoperatively to be 30 mm. Clinical examination confirmed that the distraction gaps were bridged by solid bone. The treatment protocol resulted in a significant improvement in cranial proportion in both patients, which was maintained at long-term follow-up. Estimated blood loss was high in both cases, presumably related to the hyperemic nature of rickets bone. CONCLUSIONS Distraction osteogenesis promotes bone growth and cranial remodeling in patients with craniosynostosis caused by rickets. The technique allows for continuous incremental expansion of both bone and scalp tissue. We recommend consideration of distraction osteogenesis in the treatment of older children with severe deformity related to craniosynostosis, including those with rickets.
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Di Rocco F, Baujat G, Cormier-Daire V, Rothenbuhler A, Linglart A. Craniosynostosis and hypophosphatasia. Arch Pediatr 2017; 24:5S89-5S92. [DOI: 10.1016/s0929-693x(18)30022-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lattanzi W, Barba M, Di Pietro L, Boyadjiev SA. Genetic advances in craniosynostosis. Am J Med Genet A 2017; 173:1406-1429. [PMID: 28160402 DOI: 10.1002/ajmg.a.38159] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/30/2016] [Accepted: 01/06/2017] [Indexed: 12/22/2022]
Abstract
Craniosynostosis, the premature ossification of one or more skull sutures, is a clinically and genetically heterogeneous congenital anomaly affecting approximately one in 2,500 live births. In most cases, it occurs as an isolated congenital anomaly, that is, nonsyndromic craniosynostosis (NCS), the genetic, and environmental causes of which remain largely unknown. Recent data suggest that, at least some of the midline NCS cases may be explained by two loci inheritance. In approximately 25-30% of patients, craniosynostosis presents as a feature of a genetic syndrome due to chromosomal defects or mutations in genes within interconnected signaling pathways. The aim of this review is to provide a detailed and comprehensive update on the genetic and environmental factors associated with NCS, integrating the scientific findings achieved during the last decade. Focus on the neurodevelopmental, imaging, and treatment aspects of NCS is also provided.
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Affiliation(s)
- Wanda Lattanzi
- Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy.,Latium Musculoskeletal Tıssue Bank, Rome, Italy
| | - Marta Barba
- Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorena Di Pietro
- Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simeon A Boyadjiev
- Division of Genomic Medicine, Department of Pediatrics, Davis Medical Center, University of California, Sacramento, California
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Abstract
Calcium (Ca) and phosphorus (P) are essential for various systemic functions, including bone mineralization. Adequate provision of Ca and P in pediatric parenteral nutrition (PN) solutions is necessary for skeletal growth and for the prevention of metabolic bone disease. The provision of adequate doses of Ca and P in pediatric PN solutions is complicated by the increased needs in preterm and term infants, solubility limitations, and venous access. Clinicians should be aware of the evidence that supports the optimal use of Ca and P in pediatric PN solutions, including studies that have evaluated dosing and solubility. The aim of this article is to review relevant literature and practices for the use of these two minerals in pediatric PN solutions. The vitamin D endocrine system, a critical component for Ca homeostasis and bone mineralization, is discussed, as well as clinical manifestations of metabolic bone disease and methods for its prevention, assessment, and treatment in pediatric patients receiving PN.
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Vega RA, Opalak C, Harshbarger RJ, Fearon JA, Ritter AM, Collins JJ, Rhodes JL. Hypophosphatemic rickets and craniosynostosis: a multicenter case series. J Neurosurg Pediatr 2016; 17:694-700. [PMID: 26824597 DOI: 10.3171/2015.10.peds15273] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examines a series of patients with hypophosphatemic rickets and craniosynostosis to characterize the clinical course and associated craniofacial anomalies. METHODS A 20-year retrospective review identified patients with hypophosphatemic rickets and secondary craniosynostosis at 3 major craniofacial centers. Parameters examined included sex, age at diagnosis of head shape anomaly, affected sutures, etiology of rickets, presenting symptoms, number and type of surgical interventions, and associated diagnoses. A review of the literature was performed to optimize treatment recommendations. RESULTS Ten patients were identified (8 males, 2 females). Age at presentation ranged from 1 to 9 years. The most commonly affected suture was the sagittal (6/10 patients). Etiologies included antacid-induced rickets, autosomal dominant hypophosphatemic rickets, and X-linked hypophosphatemic (XLH) rickets. Nine patients had undergone at least 1 cranial vault remodeling (CVR) surgery. Three patients underwent subsequent surgeries in later years. Four patients underwent formal intracranial pressure (ICP) monitoring, 3 of which revealed elevated ICP. Three patients were diagnosed with a Chiari Type I malformation. CONCLUSIONS Secondary craniosynostosis develops postnatally due to metabolic or mechanical factors. The most common metabolic cause is hypophosphatemic rickets, which has a variety of etiologies. Head shape changes occur later and with a more heterogeneous presentation compared with that of primary craniosynostosis. CVR may be required to prevent or relieve elevated ICP and abnormalities of the cranial vault. Children with hypophosphatemic rickets who develop head shape abnormalities should be promptly referred to a craniofacial specialist.
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Affiliation(s)
| | | | - Raymond J Harshbarger
- Craniofacial and Pediatric Plastic Surgery, Dell Children's Medical Center of Central Texas, Austin, Texas; and
| | - Jeffrey A Fearon
- The Craniofacial Center, Medical City Children's Hospital, Dallas, Texas
| | | | | | - Jennifer L Rhodes
- Surgery, Division of Plastic and Reconstructive Surgery, Children's Hospital of Richmond, Virginia Commonwealth University Health System, Richmond, Virginia
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Jaszczuk P, Rogers GF, Guzman R, Proctor MR. X-linked hypophosphatemic rickets and sagittal craniosynostosis: three patients requiring operative cranial expansion: case series and literature review. Childs Nerv Syst 2016; 32:887-91. [PMID: 26510652 DOI: 10.1007/s00381-015-2934-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/14/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE A defect in a phosphate-regulating gene leads to the most common form of rickets: X-linked hypophosphatemic rickets (XLH) or vitamin D-resistant rickets (VDDR). XLH has been associated with craniosynostosis, the sagittal suture being the most commonly involved. METHODS We present three patients with rickets and symptomatic sagittal suture craniosynostosis all of whom presented late (>2 years of age). Two had a severe phenotype and papilledema, while the third presented with an osseous bulging near the anterior fontanel and experienced chronic headaches. RESULTS All underwent successful cranial vault expansion. CONCLUSIONS Rachitic patients with scaphocephaly should be screened for craniosynostosis.
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Affiliation(s)
- Phillip Jaszczuk
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Childrens Hospital Basel, Basel, Switzerland
| | - Gary F Rogers
- Division of Plastic and Reconstructive Surgery, Children's National Medical Center, Washington, DC, USA
| | - Raphael Guzman
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Childrens Hospital Basel, Basel, Switzerland.
| | - Mark R Proctor
- Department of Neurosurgery, Children's Hospital Boston, Boston, MA, USA
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Wolff K, Hadadi E, Vas Z. A novel multidisciplinary approach toward a better understanding of cranial suture closure: The first evidence of genetic effects in adulthood. Am J Hum Biol 2013; 25:835-43. [DOI: 10.1002/ajhb.22459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Katalin Wolff
- Department of Forensic and Insurance Medicine; Semmelweis University; Budapest H-1091 Hungary
| | - E. Hadadi
- Department of Genetics, Cell- and Immunobiology; Semmelweis University; Budapest H-1089 Hungary
| | - Z. Vas
- Department of Biomathematics and Informatics; Faculty of Veterinary Sciences; Szent István University; Budapest H-1078 Hungary
- Department of Zoology; Hungarian Natural History Museum; Budapest H-1083 Hungary
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Craniosynostosis-associated Fgfr2(C342Y) mutant bone marrow stromal cells exhibit cell autonomous abnormalities in osteoblast differentiation and bone formation. BIOMED RESEARCH INTERNATIONAL 2013; 2013:292506. [PMID: 23762837 PMCID: PMC3665166 DOI: 10.1155/2013/292506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/18/2013] [Accepted: 03/29/2013] [Indexed: 11/22/2022]
Abstract
We recently reported that cranial bones of Fgfr2C342Y/+ craniosynostotic mice are diminished in density when compared to those of wild type mice, and that cranial bone cells isolated from the mutant mice exhibit inhibited late stage osteoblast differentiation. To provide further support for the idea that craniosynostosis-associated Fgfr mutations lead to cell autonomous defects in osteoblast differentiation and mineralized tissue formation, here we tested bone marrow stromal cells isolated from Fgfr2C342Y/+ mice for their ability to differentiate into osteoblasts. Additionally, to determine if the low bone mass phenotype of Crouzon syndrome includes the appendicular skeleton, long bones were assessed by micro CT. Fgfr2C342Y/+ cells showed increased osteoblastic gene expression during early osteoblastic differentiation but decreased expression of alkaline phosphatase mRNA and enzyme activity, and decreased mineralization during later stages of differentiation, when cultured under 2D in vitro conditions. Cells isolated from Fgfr2C342Y/+ mice also formed less bone when allowed to differentiate in a 3D matrix in vivo. Cortical bone parameters were diminished in long bones of Fgfr2C342Y/+ mice. These results demonstrate that marrow stromal cells of Fgfr2C342Y/+ mice have an autonomous defect in osteoblast differentiation and bone mineralization, and that the Fgfr2C342Y mutation influences both the axial and appendicular skeletons.
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Frost P. Vitamin D deficiency among northern Native Peoples: a real or apparent problem? Int J Circumpolar Health 2012; 71:18001. [PMID: 22456053 PMCID: PMC3417586 DOI: 10.3402/ijch.v71i0.18001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 04/26/2011] [Accepted: 09/16/2011] [Indexed: 01/03/2023] Open
Abstract
Vitamin D deficiency seems to be common among northern Native peoples, notably Inuit and Amerindians. It has usually been attributed to: (1) higher latitudes that prevent vitamin D synthesis most of the year; (2) darker skin that blocks solar UVB; and (3) fewer dietary sources of vitamin D. Although vitamin D levels are clearly lower among northern Natives, it is less clear that these lower levels indicate a deficiency. The above factors predate European contact, yet pre-Columbian skeletons show few signs of rickets-the most visible sign of vitamin D deficiency. Furthermore, because northern Natives have long inhabited high latitudes, natural selection should have progressively reduced their vitamin D requirements. There is in fact evidence that the Inuit have compensated for decreased production of vitamin D through increased conversion to its most active form and through receptors that bind more effectively. Thus, when diagnosing vitamin D deficiency in these populations, we should not use norms that were originally developed for European-descended populations who produce this vitamin more easily and have adapted accordingly.
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Affiliation(s)
- Peter Frost
- Department of Anthropology, Laval University, Quebec, QC G1K 7P4, Canada.
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New thoughts concerning the epidemic of rickets: was the role of alum overlooked? Pediatr Nephrol 2012; 27:3-6. [PMID: 21928131 DOI: 10.1007/s00467-011-2004-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 08/29/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
Abstract
Recent emphasis on the re-emergence of nutritional rickets has renewed interest in the etiology and therapy of this devastating disorder. At its peak in the 19th and 20th century, rickets was a major area of study for countless experts in childhood disorders and numerous theories abounded as to its cause. These included, among others, infections, confinement or intestinal disturbances, and were largely discarded after the discovery of the role of vitamin D and the importance of ultraviolet irradiation. Once a good explanation had been found for the cause of the disorder and the curative power of vitamin D proven, whether it was obtained from the diet or through exposure to sunlight, there was no apparent need to look any further into the etiology of rickets. But in fact there may have been other contributory factors, recognition of which might have lessened the severity of the disease or hastened recovery. One of these theories might be of particular interest to pediatric nephrologists because it relates to insoluble aluminum-based phosphate binders. Namely, alum used as an adulterant in bread in certain locations may have contributed to metabolic bone disease during the great epidemic of rickets.
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Abstract
INTRODUCTION Although rare, pansynostoses are seen and treated by the craniofacial surgeon. To date, a single source that reviews these more severe forms of craniosynostosis is lacking in the literature. MATERIALS AND METHODS The present paper outlines and reviews the associations of both syndromic and nonsyndromic cases, potential mechanisms, and the anatomy involved with such forms of premature fusion of the cranial sutures. RESULTS Pansynostosis is seen in a myriad of syndromes but can also be identified in nonsyndromic cases. Raised intracranial pressure is a concern in these patients. CONCLUSIONS Early recognition and treatment of patients with pansynostosis of the cranial sutures is important.
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Affiliation(s)
- Jeffrey P Blount
- Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
Craniosynostosis is a congenital developmental disorder involving premature fusion of cranial sutures, often associated with multiple neurological manifestations. The perspective of this group of disorders has changed dramatically in the new era of molecular genetics. In the last decade a large literature with new concepts in craniosynostosis has appeared. More than 100 syndromes associated with craniosynostosis have been described, and in about a dozen, the molecular defect has been identified. Pediatric neurologists are less aware than geneticists, neurosurgeons, and craniofacial surgeons of these changes. General concepts about craniosynostosis are here presented with updates of clinical and genetic aspects of well-defined syndromes such as Apert, Crouzon, Pfeiffer, Saethre-Chotzen. Evidence of their relationship with fibroblast growth factor receptors (FGFRs) 1, 2, and 3, and with causative genes such as TWIST has been documented. New and other less common syndromes also are discussed. The differences between positional and synostotic plagiocephaly are important, as well as the cause of nonsyndromic craniosynostosis. The prognosis and neurological outcome of patients, including "benign" forms of craniosynostosis, are other important aspects. Major advances have occurred in understanding pathogenesis, diagnosis, and treatment of craniosynostosis. The role of local dura mater and apoptosis; modalities of imaging such as prenatal ultrasound and three-dimensional and spiral CT have improved the accuracy in diagnosis, and the new approaches in surgical treatment involving efficient and less invasive methods, are evidence of these advances.
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Affiliation(s)
- Laura Flores-Sarnat
- Department of Pediatrics (Neurology), Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Abstract
A 3-month-old premature infant presented with a "soft skull." Clinical and radiologic findings confirmed the diagnosis of rickets. Biochemistry revealed normal serum parathyroid hormone (PTH) and undetectable urine phosphate. These findings combined with a history of 5-6 weeks' treatment with high-dose aluminum-rich antacid established the diagnosis of antacid-induced rickets. Discontinuation of the medicine combined with phosphate and vitamin D supplementation resulted in quick resolution of all clinical, radiologic, and biochemical abnormalities. Our patient demonstrates that in premature infants antacid-induced rickets can develop within a few weeks; normal serum PTH concentration and hypophosphaturia are highly indicative of the diagnosis, and contrary to the situation in adults in whom hypercalciuria has been often described, in infants hypocalciuria is more commonly observed. Pediatricians should avoid or minimize the use of aluminum-containing antacids, and when used, carefully monitor mineral metabolism.
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Affiliation(s)
- A Pattaragarn
- Section of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City, USA
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Abstract
Ongoing research in several areas of pediatric nutrition has new practical applications for community-based pediatricians. For example, a fresh understanding of risk factors for rickets persuades pediatricians to recognize and treat this disease, which was thought to be nearly extinct in the modern industrialized world. Similarly, an expanded awareness of the antibacterial components of breast milk encourages a more complete dialogue between pediatricians and new mothers about the potential benefits of breast-feeding. For those infants with feeding intolerance, new data help to refine the indications for hypoallergenic formulas, which are increasingly recommended for children with a variety of symptoms. The past year also has seen breakthroughs in our understanding of supplemental nutrition for children. Vitamin A may provide direct benefits for the most vulnerable of children, namely premature infants at high risk for lung disease. At the other end of the pediatric spectrum, adolescent athletes seeking to enhance their performance are consuming poorly studied sports supplements that may not be beneficial and may even be toxic. Finally, a greater appreciation for the epidemic of obesity that is sweeping the United States and other countries suggests that children at high risk may represent a far more diverse population than had been recognized previously.
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Affiliation(s)
- E Oken
- Women's Health Center, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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