1
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Dorado-Fernández E, Herrerín-López J, Ramírez-González I, Parro-González L, Isidro-Llorens A. Survival in Mudejar Spain in the Middle Ages (thirteenth-fourteenth centuries): Ancient Rare Diseases-an uncommon diagnosis in archaeological human remains. INTERNATIONAL ORTHOPAEDICS 2023; 47:2869-2875. [PMID: 37294431 DOI: 10.1007/s00264-023-05863-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The finding of severe skeletal alterations in ancient remains could give us useful information not only about the pathologies of the individual per se, as it could infer the state of health of a population. METHODS From the findings of the Mudéjar Cemetery of Uceda (Guadalajara, Central Spain) where a total of 116 burials with almost complete skeleton were recovered, an interesting individual is presented (palaeopathological perspective). The individual 114UC corresponds to a male of 20-25 years old and its age goes back to the thirteenth-fourteenth centuries. RESULTS The first inspection showed the presence of serious alterations especially in the lumbar spine and pelvic girdle. Seven vertebrae (from T11 to L5) showed an unusual posterior fusion only in the postzygapophyseal joints. The pelvis, after being accurately assembled and congruence verified by X-ray and CT scan, showed a noticeable asymmetry of both iliac wings together with a coxa magna protusa (Otto's pelvis), severe anteversion of both cup hips and osteochondritis of the right femoral head. The posterior-slope of both tibias reached about 10°. CONCLUSIONS The differential diagnoses lead us to think of Arthrogryposis Multiplex Congenita as the most probable diagnosis. We analyzed the same biomechanical aspects after taking into account some patterns that give us information about a possible mobility in the first stage of life. We discuss the very few other cases described both from artworks and in the palaeopathological record. To our knowledge, this case could be the oldest published case of AMC worldwide.
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Affiliation(s)
| | - Jesús Herrerín-López
- Departamento de Biología, Unidad de Antropología Física, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Albert Isidro-Llorens
- Hospital Universitari Sagrat Cor, Quironsalud/Universitat de Barcelona, Barcelona, Spain.
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2
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Weissbach T, Hausman-Kedem M, Yanay Z, Meyer R, Bar-Yosef O, Leibovitch L, Berkenstadt M, Chorin O, Shani H, Massarwa A, Achiron R, Weisz B, Sharon R, Mazaki-Tovi S, Kassif E. Congenital hypotonia: systematic approach for prenatal detection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:94-105. [PMID: 36779229 DOI: 10.1002/uog.26178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/07/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Congenital hypotonic conditions are rare and heterogeneous, and some are severely debilitating or lethal. Contrary to its prominent postnatal manifestation, the prenatal presentation of hypotonia is frequently subtle, inhibiting prenatal detection. We aimed to characterize the prenatal sonographic manifestation of congenital hypotonia throughout pregnancy, evaluate the yield of diagnostic tests and propose diagnostic models to increase its prenatal detection. METHODS This was a retrospective observational study of singleton pregnancies with congenital hypotonia, diagnosed either prenatally or immediately after birth, at a single tertiary center between the years 2012 and 2020. Prenatally, hypotonia was diagnosed if a fetus showed sonographic or clinical signs suggestive of hypotonia and had a confirmed underlying genetic condition, or in the absence of a known genetic abnormality if the fetus exhibited multiple prominent signs suggestive of hypotonia. Postnatally, it was diagnosed in neonates displaying reduced muscle tone leading to reduced spontaneous movement, reduced swallowing or feeding difficulty. We reviewed the medical records of pregnant patients carrying fetuses subsequently diagnosed with congenital hypotonia and assessed the yield of ultrasound scans, fetal magnetic resonance imaging, computed tomography and genetic tests. The detection rate of sonographic signs suggesting fetal hypotonia was calculated. The prevalence of non-specific signs, including polyhydramnios, persistent breech presentation, intrauterine growth restriction and maternal perception of reduced fetal movement, were compared between the study group and the local liveborn singleton population. Potential detection rates of different theoretical semiotic diagnostic models, differing in the threshold for referral for a targeted scan, were assessed based on the cohort's data. RESULTS The study group comprised 26 cases of congenital hypotonia, of which 10 (38.5%) were diagnosed prenatally, and the controls included 95 105 singleton live births, giving a prevalence of congenital hypotonia of 1:3658. Nuchal translucency thickness and the early anomaly scan at 13-17 weeks were normal in all 22 and 23 cases, respectively, in which this was performed. The mid-trimester scan performed at 19-25 weeks was abnormal in four of 24 (16.7%) cases. The overall prenatal detection rate of congenital hypotonic conditions in our cohort was 38.5%. Only cases which underwent a targeted scan were detected and, among the 16 cases which underwent this scan, the prenatal detection rate was 62.5% compared with 0% in pregnancies that did not undergo this scan (P = 0.003). An abnormal genetic diagnosis was obtained in 21 (80.8%) cases using the following modalities: chromosomal microarray analysis (CMA) in two (9.5%), whole-exome sequencing (WES) in 14 (66.7%) and methylation analysis in five (23.8%). CMA was abnormal in 8% (2/25) of the cases and WES detected a causative genetic mutation in 87.5% (14/16) of the cases in which these were performed. Comparison of non-specific signs in the study group with those in the local singleton population showed that hypotonic fetuses had significantly more polyhydramnios (64.0% vs 3.0%, P < 0.0001), persistent breech presentation (58.3% vs 4.2%, P < 0.0001), intrauterine growth restriction (30.8% vs 3.0%, P < 0.0001) and maternal perception of reduced fetal movement (32.0% vs 4.7%, P < 0.0001). Prenatally, the most commonly detected signs supporting a diagnosis of hypotonia were structural anomaly (62.5%, 10/16), reduced fetal movement (46.7%, 7/15), joint contractures (46.7%, 7/15) and undescended testes ≥ 30 weeks (42.9%, 3/7 males). Proposed diagnostic strategies that involved performing a targeted scan for a single non-specific ultrasound sign or two such signs, and then carrying out a comprehensive genetic evaluation for any additional sign, offered theoretical detection rates in our cohort of 88.5% and 57.7%, respectively. CONCLUSIONS Congenital hypotonic conditions are rare and infrequently detected prenatally. Sonographic signs are visible from the late second trimester. A targeted scan increases prenatal detection significantly. Comprehensive genetic testing, especially WES, is the cornerstone of diagnosis in congenital hypotonia. Theoretical diagnostic models which may increase prenatal detection are provided. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Weissbach
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Hausman-Kedem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Z Yanay
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Schneider Children's Medical Center, Petach Tikva, Israel
| | - R Meyer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - O Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology, Safra Children's Hospital, Sheba, Tel Hashomer, Israel
| | - L Leibovitch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neonatal Intensive Care Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - M Berkenstadt
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Danek Institute of Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - O Chorin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Danek Institute of Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - H Shani
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Danek Institute of Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - A Massarwa
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Weisz
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Sharon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | - S Mazaki-Tovi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - E Kassif
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Martinez-Lozano E, Beeram I, Yeritsyan D, Grinstaff MW, Snyder BD, Nazarian A, Rodriguez EK. Management of arthrofibrosis in neuromuscular disorders: a review. BMC Musculoskelet Disord 2022; 23:725. [PMID: 35906570 PMCID: PMC9336011 DOI: 10.1186/s12891-022-05677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/20/2022] [Indexed: 11/20/2022] Open
Abstract
Arthrofibrosis, or rigid contracture of major articular joints, is a significant morbidity of many neurodegenerative disorders. The pathogenesis depends on the mechanism and severity of the precipitating neuromuscular disorder. Most neuromuscular disorders, whether spastic or hypotonic, culminate in decreased joint range of motion. Limited range of motion precipitates a cascade of pathophysiological changes in the muscle-tendon unit, the joint capsule, and the articular cartilage. Resulting joint contractures limit functional mobility, posing both physical and psychosocial burdens to patients, economic burdens on the healthcare system, and lost productivity to society. This article reviews the pathophysiology of arthrofibrosis in the setting of neuromuscular disorders. We describe current non-surgical and surgical interventions for treating arthrofibrosis of commonly affected joints. In addition, we preview several promising modalities under development to ameliorate arthrofibrosis non-surgically and discuss limitations in the field of arthrofibrosis secondary to neuromuscular disorders.
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Affiliation(s)
- Edith Martinez-Lozano
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Indeevar Beeram
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Mark W Grinstaff
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
| | - Brian D Snyder
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.,Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, 0025, Armenia
| | - Edward K Rodriguez
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA.
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4
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Lambert LM, Pemberton VL, Trachtenberg FL, Uzark K, Woodard F, Teng JE, Bainton J, Clarke S, Justice L, Meador MR, Riggins J, Suhre M, Sylvester D, Butler S, Miller TA. Design and methods for the training in exercise activities and motion for growth (TEAM 4 growth) trial: A randomized controlled trial. Int J Cardiol 2022; 359:28-34. [PMID: 35447274 DOI: 10.1016/j.ijcard.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/07/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Growth is often impaired in infants with congenital heart disease. Poor growth has been associated with worse neurodevelopment, abnormal behavioral state, and longer time to hospital discharge. Nutritional interventions, drug therapy, and surgical palliation have varying degrees of success enhancing growth. Passive range of motion (PROM) improves somatic growth in preterm infants and is safe and feasible in infants with hypoplastic left heart syndrome (HLHS), after their first palliative surgery (Norwood procedure). METHODS This multicenter, Phase III randomized control trial of a 21-day PROM exercise or standard of care evaluates growth in infants with HLHS after the Norwood procedure. Growth (weight-, height- and head circumference-for-age z-scores) will be compared at 4 months of age or at the pre-superior cavopulmonary connection evaluation visit, whichever comes first. Secondary outcomes include neonatal neurobehavioral patterns, neurodevelopmental assessment, and bone mineral density. Eligibility include diagnosis of HLHS or other single right ventricle anomaly, birth at ≥37 weeks gestation and Norwood procedure at <30 days of age, and family consent. Infants with known chromosomal or recognizable phenotypic syndromes associated with growth failure, listed for transplant, or expected to be discharged within 14 days of screening are excluded. CONCLUSIONS The TEAM 4 Growth trial will make an important contribution to understanding the role of PROM on growth, neurobehavior, neurodevelopment, and BMD in infants with complex cardiac anomalies, who are at high risk for growth failure and developmental concerns.
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Affiliation(s)
- Linda M Lambert
- Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, United States of America.
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, United States of America
| | | | - Karen Uzark
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI, United States of America
| | - Frances Woodard
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, United States of America
| | - Jessica E Teng
- HealthCore Inc., Watertown, MA, United States of America
| | - Jessica Bainton
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shanelle Clarke
- Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Lindsey Justice
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Marcie R Meador
- Division of Cardiology Pediatric Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States of America
| | - Jessica Riggins
- Division of Cardiovascular Surgery, Riley Hospital for Children at IU Health, Indianapolis, IN, United States of America
| | - Mary Suhre
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Donna Sylvester
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Samantha Butler
- Department of Psychiatry, Children's Hospital Boston, Boston, MA, United States of America
| | - Thomas A Miller
- Division of Cardiology, Maine Medical Center, Portland, ME, United States of America
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5
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Computation of Fetal Kicking in Various Fetal Health Examinations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074366. [PMID: 35410056 PMCID: PMC8998667 DOI: 10.3390/ijerph19074366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
Fetal movement has always been considered an essential indicator to evaluate the health of the unborn fetus. Many factors affect fetal movement. The frequency of fetal kicking is an important measurement of whether fetal development is progressing and healthy. Various instruments and methods of detecting fetal movement have been used and each method has its advantages and disadvantages. Although limited by the fetal environment in utero, the finite element method and musculoskeletal model can be used to calculate fetal lower limb movement. This review aims to summarize the current detection techniques for fetal movement, especially in the lower limbs. These will be outlined by describing the different measurements of fetal movement, and the related biomechanical analyses of fetal lower limb skeletogenesis and the associated muscular development to better evaluate and calculate the movements of the fetus in the womb.
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6
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Tjon JK, Tan-Sindhunata MB, Bugiani M, Witbreuk MMEH, van der Sluijs JA, Weiss MM, van Weissenbruch MM, van de Pol LA, Buizer AI, van Doesburg MHM, Bakker PCAM, van der Knoop BJ, Linskens IH, de Vries JIP. Care pathway for fetal joint contractures, Fetal Akinesia Deformation Sequence and Arthrogryposis Multiplex Congenita. Fetal Diagn Ther 2021; 48:829-839. [PMID: 34775380 DOI: 10.1159/000520869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022]
Abstract
Introduction The majority of arthrogryposis multiplex congenita (AMC) and lethal forms of AMC such as fetal akinesia deformation sequence (FADS) cases are missed prenatally. We have demonstrated the additional value of fetal motor assessment and evaluation in a multidisciplinary team for the period 2007-2016. An applied care pathway for fetuses presenting with joint contracture(s) in one anatomic region (e.g. talipes equinovares), more than one body part with non-progressive contractures and motility (AMC) and with deterioration over time (FADS). Methods The multidisciplinary team of Amsterdam University Medical Centre Expertise Centre FADS and AMC developed the care pathway. Additional tools are provided including a motor assessment by ultrasound examination and postmortem assessment form. Results An eight-step care pathway is presented with a proposed timing for prenatal sonographic examination, genetic examinations, multidisciplinary meetings, prenatal and postnatal counselling of the parents by specialist also treating after birth, follow-up of prenatal and postnatal findings with counselling for future pregnancies. Discussion/conclusion The scheduled serial structural and motor sonograpahic assessment together with follow-up examinations and genetic analysis, should be tailored per prenatal centre per available resources. The multidisciplinary care pathway may pave the way to increase detection rate and diagnosis of isolated contracture(s), talipes equinovares with underlying genetic causes and the rare phenotypes AMC/FADS and prompt treatment after birth within expertise teams.
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Affiliation(s)
- Jill K Tjon
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maria B Tan-Sindhunata
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marianna Bugiani
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Melinda M E H Witbreuk
- Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A van der Sluijs
- Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjan M Weiss
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mirjam M van Weissenbruch
- Department of Child Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura A van de Pol
- Department of Paediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine and Emma Children's Hospital, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Petra C A M Bakker
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bloeme J van der Knoop
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ingeborg H Linskens
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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7
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Scott JB, Yanes AF, Vivar KL, Yun D, Wagner A, Kruse L, Mancini AJ. Restrictive dermopathy: Three new patients with ZMPSTE24 mutations and a review of the literature. Pediatr Dermatol 2021; 38:1535-1540. [PMID: 34647350 DOI: 10.1111/pde.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Restrictive dermopathy (RD) is a rare and lethal laminopathy caused by mutations in LMNA or ZMPSTE24. This series reports 3 patients with RD and reviews the literature of the 113 previously reported cases, including highlights of the unique constellation of clinical findings in RD, as well as histologic, radiographic, and genetic features. Early recognition of these characteristic features is vital to establish a prompt diagnosis and provide adequate family counseling for this terminal condition.
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Affiliation(s)
- Jennifer B Scott
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Arianna F Yanes
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Karina L Vivar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Duri Yun
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Annette Wagner
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lacey Kruse
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anthony J Mancini
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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8
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ALGhasab NS, Alshehri B, Altamimi LA, Assiri RA, AlYousef LA, ALMesned S, ALreshidi FS, Kharabsheh SM, Al-Saud SA, Alharbi W. Cardiac anomalies associated with Escobar syndrome: A case report and a review of the literature. Medicine (Baltimore) 2021; 100:e26687. [PMID: 34397695 PMCID: PMC8322495 DOI: 10.1097/md.0000000000026687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Escobar syndrome (ES) is an autosomal recessive disorder. It is highly characterized by facial abnormalities, congenital diaphragmatic muscle weakness, myasthenic-like features, and skin pterygiums on multiple body legions. ES is a rare condition associated with many external and internal abnormalities. The internal malformations described in ES affect many organs including the heart, lungs, esophagus, liver, spleen, and intestine. The purpose of this paper is to explore the cardiac manifestations associated with ES. PATIENT CONCERNS A 3.5-year-old girl, who was born for double first cousins, was admitted to the hospital for neuromuscular evaluation of multiple congenital contractures. DIAGNOSIS The girl was diagnosed with ES and isolated dextrocardia which is a rare cardiac manifestation. However, to the best of our knowledge, no similar cases have been reported to date, and this case is thus believed to be very rare. INTERVENTIONS The patient underwent an operative intervention to correct the bilateral fixed flexion deformity at her knees which was related to the posterior bilateral fibrotic bands/pterygia. OUTCOMES Post-operatively, complete knee extension was obtained, the patient was fitted with a cast and extension night splint. She was discharged alive and had no complications. The patient was followed regularly in the orthopedic clinic and had periodic physiotherapy sessions. CONCLUSIONS ES and isolated dextrocardia concurrence in the presented case resulted from different pathogenic mechanisms. Our findings suggest that ES might be caused by dysfunction in the acetylcholine receptor throughout fetal life, which may have affected muscle strength and movement. Other cardiac conditions include hypoplastic left-sided heart, Hypertrophic cardiomyopathy, patent ductus arteriosus, and heterotaxia.
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Affiliation(s)
- Naif Saad ALGhasab
- Department of Internal Medicine, Medical College, Ha’il University, Ha’il, Saudi Arabia
| | - Bandar Alshehri
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | | | - Raghad Asaad Assiri
- College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Loujain Ahmad AlYousef
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sulaman ALMesned
- Department of Surgery, Medical College, Qassim University, Buraydah, Saudi Arabia
| | - Fayez Saud ALreshidi
- Department of Family and Community Medicine, College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Suleiman M. Kharabsheh
- Department of Cardiovascular Disease, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sara Abou Al-Saud
- Department of Cardiac Science, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Alharbi
- Department of Cardiac Science, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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9
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Pellegrino M, Lombisani A, Lanzone A, Visconti D. Ultrasonographic evidence of persistent hyperextension of the fetal neck: is it a true sign? A diagnostic and prognostic challenge. J Matern Fetal Neonatal Med 2020; 35:3393-3399. [PMID: 32998589 DOI: 10.1080/14767058.2020.1818223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical evolution, structural anomalies associated and neonatal outcomes of fetal neck hyperextension in two cases with prenatal ultrasound diagnosis in two different gestational ages. METHODS In 2019, two cases of fetal hyperextension came to our attention. Follow-up information was obtained from hospital medical records and obstetrical care providers. RESULTS Two woman were investigated in our institution for the presence of fetal abnormalities in the II and III trimester, respectively. In both cases, fetal attitude presented persistent fetal neck hyperextension. One of the two fetuses had a mild ventriculomegaly and suspected for micrognathia. Both had an amniotic fluid increase. One of two had no movement in the lower and upper limbs in ultrasound scans associated with club foot and suspected scoliosis. Both were born by cesarean section with pretty different prognosis: one healthy baby had a retarded psychomotor development and the other one died after 6 months. A precise diagnosis was possible only in one case. CONCLUSION The early identification of a fetus with persistent hyperextension of the fetal head should require a detailed ultrasound exam for structural abnormalities and a careful prenatal counseling due to possible postnatal outcome.
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Affiliation(s)
- Marcella Pellegrino
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica - UOC Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Lombisani
- Centro Studi per la Tutela della Salute della Madre e del Concepito, Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica - UOC Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centro Studi per la Tutela della Salute della Madre e del Concepito, Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Visconti
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica - UOC Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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11
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Niles KM, Blaser S, Shannon P, Chitayat D. Fetal arthrogryposis multiplex congenita/fetal akinesia deformation sequence (FADS)-Aetiology, diagnosis, and management. Prenat Diagn 2019; 39:720-731. [PMID: 31218730 DOI: 10.1002/pd.5505] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 01/01/2023]
Abstract
Arthrogryposis multiplex congenita (AMC) refers to an aetiologically heterogenous condition, which consists of joint contractures affecting two or more joints starting prenatally. The incidence is approximately one in 3000 live births; however, the prenatal incidence is higher, indicating a high intrauterine mortality. Over 320 genes have been implicated showing the genetic heterogeneity of the condition. AMC can be of extrinsic aetiology resulting from intrauterine crowding secondary to congenital structural uterine abnormalities (eg, bicornuate or septate uterus), uterine tumors (eg, fibroid), or multifetal pregnancy or intrinsic/primary/fetal aetiology, due to functional abnormalities in the brain, spinal cord, peripheral nerves, neuromuscular junction, muscles, bones, restrictive dermopathies, tendons and joints. Unlike many of the intrinsic/primary/fetal causes which are difficult to treat, secondary AMC can be treated by physiotherapy with good response. Primary cases may present prenatally with fetal akinesia associated with joint contractures and occasionally brain abnormalities, decreased muscle bulk, polyhydramnios, and nonvertex presentation while the secondary cases usually present with isolated contractures. Complete prenatal and postnatal investigations are needed to identify an underlying aetiology and provide information regarding its prognosis and inheritance, which is critical for the obstetrical care providers and families to optimize the pregnancy management and address future reproductive plans.
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Affiliation(s)
- Kirsten M Niles
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Susan Blaser
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - David Chitayat
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Division of Clinical and Metabolic Genetics, University of Toronto, Toronto, ON, Canada
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12
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Tjon JK, Tan-Sindhunata GM, Bugiani M, Witbreuk MM, van der Sluijs JA, Weiss MM, van de Pol LA, van Weissenbruch MM, van der Knoop BJ, de Vries JI. Fetal akinesia deformation sequence, arthrogryposis multiplex congenita, and bilateral clubfeet: Is motor assessment of additional value for in utero diagnosis? A 10-year cohort study. Prenat Diagn 2019; 39:219-231. [PMID: 30578734 PMCID: PMC6593723 DOI: 10.1002/pd.5411] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 12/30/2022]
Abstract
Objective The diagnosis of fetal akinesia deformation sequence (FADS) is a challenge. Motor assessment is of additional value to advanced ultrasound examinations (AUE) for in utero FADS diagnosis before 24 weeks of gestation. Methods All consecutive fetuses with greater than or equal to two contractures on the 20 week structural anomaly scan (2007–2016) were included. Findings at AUE, including motor assessment were analysed and related to outcome. Results Sixty‐six fetuses fulfilled the inclusion criteria. On the basis of the first AUE, FADS was suspected in 13 of 66, arthrogryposis multiplex congenita (AMC) in 12 of 66, bilateral pes equinovares (BPEV) in 40 of 66, and Holt‐Oram syndrome in one of 66. On the basis of the first motor assessment, the suspected diagnosis changed in 19 of 66, in 13 of 66 worsening to FADS, six of 66 amelioration from FADS, and confirmed FADS in seven of 13. The result was 20 FADS, seven AMC, and 38 BPEV. Second AUE in 44 fetuses showed additional contractures in two of eight FADS, and one intrauterine fetal death (IUFD). The second motor assessment changed the diagnosis in three of 43, one worsening from BPEV into FADS, two ameliorations from FADS, and confirmed FADS in seven by deterioration of motility. The result was nine FADS, six AMC, and 29 BPEV. Conclusion The results suggest that motor assessment has additional value to distinguish between FADS, AMC, and BPEV. Systematic motor assessment for differentiation, quality, and quantity of the movements has been performed in a high risk population for FADS.1 This analysis revealed abnormal quality in all fetuses with deterioration in a 2‐week period, reduced differentiation in the majority and only half showed abnormal quantity. This study evaluates whether motor assessment in addition to advanced ultrasound examination in case of multiple contractures, supports the timely diagnosis of FADS.
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Affiliation(s)
- Jill K Tjon
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam University Medical Centre, VUmc, Amsterdam, the Netherlands
| | - Gita M Tan-Sindhunata
- Department of Genetics, Amsterdam University Medical Centre, VUmc, Amsterdam, the Netherlands
| | - Marianna Bugiani
- Department of Pathology, Amsterdam University Medical Centre, VUmc, Amsterdam, the Netherlands
| | - Melinda M Witbreuk
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, VUmc, Amsterdam, the Netherlands
| | - Johannes A van der Sluijs
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, VUmc, Amsterdam, the Netherlands
| | - Marjan M Weiss
- Department of Genetics, Amsterdam University Medical Centre, VUmc, Amsterdam, the Netherlands
| | - Laura A van de Pol
- Department of Child Neurology, Amsterdam University Medical Centre, VUmc, Amsterdam, the Netherlands
| | | | - Bloeme J van der Knoop
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam University Medical Centre, VUmc, Amsterdam, the Netherlands
| | - Johanna I de Vries
- Department of Obstetrics and Gynaecology, Amsterdam Movement Sciences, Amsterdam University Medical Centre, VUmc, Amsterdam, the Netherlands
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13
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Alkhunaizi E, Shuster S, Shannon P, Siu VM, Darilek S, Mohila CA, Boissel S, Ellezam B, Fallet-Bianco C, Laberge AM, Zandberg J, Injeyan M, Hazrati LN, Hamdan F, Chitayat D. Homozygous/compound heterozygote RYR1 gene variants: Expanding the clinical spectrum. Am J Med Genet A 2019; 179:386-396. [PMID: 30652412 DOI: 10.1002/ajmg.a.61025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023]
Abstract
The ryanodine receptor 1 (RYR1) is a calcium release channel essential for excitation-contraction coupling in the sarcoplasmic reticulum of skeletal muscles. Dominant variants in the RYR1 have been well associated with the known pharmacogenetic ryanodinopathy and malignant hyperthermia. With the era of next-generation gene sequencing and growing number of causative variants, the spectrum of ryanodinopathies has been evolving with dominant and recessive variants presenting with RYR1-related congenital myopathies such as central core disease, minicore myopathy with external ophthalmoplegia, core-rod myopathy, and congenital neuromuscular disease. Lately, the spectrum was broadened to include fetal manifestations, causing a rare recessive and lethal form of fetal akinesia deformation sequence syndrome (FADS)/arthrogryposis multiplex congenita (AMC) and lethal multiple pterygium syndrome. Here we broaden the spectrum of clinical manifestations associated with homozygous/compound heterozygous RYR1 gene variants to include a wide range of manifestations from FADS through neonatal hypotonia to a 35-year-old male with AMC and PhD degree. We report five unrelated families in which three presented with FADS. One of these families was consanguineous and had three affected fetuses with FADS, one patient with neonatal hypotonia who is alive, and one individual with AMC who is 35 years old with normal intellectual development and uses a wheelchair. Muscle biopsies on these cases demonstrated a variety of histopathological abnormalities, which did not assist with the diagnostic process. Neither the affected living individuals nor the parents who are obligate heterozygotes had history of malignant hyperthermia.
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Affiliation(s)
- Ebba Alkhunaizi
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shirley Shuster
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Mok Siu
- Division of Medical Genetics, Department of Pediatrics, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sandra Darilek
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Carrie A Mohila
- Department of Pathology, Texas Children's Hospital, Houston, Texas.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Sarah Boissel
- Department of Medical Genetics, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Benjamin Ellezam
- Department of Medical Genetics, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | | | - Anne-Marie Laberge
- Department of Medical Genetics, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Julianne Zandberg
- Division of Medical Genetics, Department of Pediatrics, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Marie Injeyan
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lili-Naz Hazrati
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Fadi Hamdan
- Department of Medical Genetics, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - David Chitayat
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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14
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Levillain A, Rolfe R, Huang Y, Iatridis J, Nowlan N. Short-term foetal immobility temporally and progressively affects chick spinal curvature and anatomy and rib development. Eur Cell Mater 2019; 37:23-41. [PMID: 30644077 PMCID: PMC6505690 DOI: 10.22203/ecm.v037a03] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Congenital spine deformities may be influenced by movements in utero, but the effects of foetal immobility on spine and rib development remain unclear. The purpose of the present study was to determine (1) critical time-periods when rigid paralysis caused the most severe disruption in spine and rib development and (2) how the effects of an early, short-term immobilisation were propagated to the different features of spine and rib development. Chick embryos were immobilised once per single embryonic day (E) between E3 and E6 and harvested at E9. To assess the ontogenetic effects following single-day immobilisation, other embryos were immobilised at E4 and harvested daily between E5 and E9. Spinal curvature, vertebral shape and segmentation and rib development were analysed by optical projection tomography and histology. The results demonstrated that periods critical for movement varied for different aspects of spine and rib development. Single-day immobilisation at E3 or E4 resulted in the most pronounced spinal curvature abnormalities, multiple wedged vertebrae and segmentation defects, while single-day immobilisation at E5 led to the most severe rib abnormalities. Assessment of ontogenetic effects following single-day immobilisation at E4 revealed that vertebral segmentation defects were subsequent to earlier vertebral body shape and spinal curvature abnormalities, while rib formation (although delayed) was independent from thoracic vertebral shape or curvature changes. A day-long immobilisation in chicks severely affected spine and rib development, highlighting the importance of abnormal foetal movements at specific time-points and motivating targeted prenatal monitoring for early diagnosis of congenital scoliosis.
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Affiliation(s)
- A. Levillain
- Department of Bioengineering, Imperial College London, London, UK
| | - R.A. Rolfe
- Department of Bioengineering, Imperial College London, London, UK,Department of Zoology, Trinity College Dublin, Dublin, Ireland
| | - Y. Huang
- Department of Bioengineering, Imperial College London, London, UK
| | - J.C. Iatridis
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N.C. Nowlan
- Department of Bioengineering, Imperial College London, London, UK,Address for correspondence: Niamh C. Nowlan, Department of Bioengineering, Imperial College London, London SW72AZ, UK. Telephone number: +44 2075945189
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15
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Elmas M, Yıldız H, Erdoğan M, Gogus B, Avcı K, Solak M. Comparison of clinical parameters with whole exome sequencing analysis results of autosomal recessive patients; a center experience. Mol Biol Rep 2018; 46:287-299. [PMID: 30426380 DOI: 10.1007/s11033-018-4470-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/02/2018] [Indexed: 11/24/2022]
Abstract
Whole-exome sequencing (WES) is an ideal method for the diagnosis of autosomal recessive diseases. The aim of this study was to evaluate the diagnostic power of WES in patients with autosomal recessive inheritance and to determine the relationship between genotype and phenotype. Retrospective screenings of 24 patients analysed with WES were performed and clinical and genetic data were evaluated. Any pathogenic mutation that could explain the suspected disease in 4 patients was not identified. A homozygous pathogenic mutation was detected in 18 patients. 2 patients had heterozygous mutations. According to this study results, WES is a successful technique to be used at the stage of diagnosis in patients who are accompanied by various degrees of intellectual disability matching the inheritance of the autosomal recessive.
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Affiliation(s)
- M Elmas
- Medical Genetics Department, Afyon Kocatepe University, Afyonkarahisar, Turkey.
| | - H Yıldız
- Medical Genetics Department, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - M Erdoğan
- Medical Biology and Genetics Department, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - B Gogus
- Medical Genetics Department, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - K Avcı
- Medical Genetics Department, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - M Solak
- Medical Genetics Department, Afyon Kocatepe University, Afyonkarahisar, Turkey
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16
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Skaria P, Dahl A, Ahmed A. Arthrogryposis multiplex congenita in utero: radiologic and pathologic findings. J Matern Fetal Neonatal Med 2017; 32:502-511. [PMID: 28954562 DOI: 10.1080/14767058.2017.1381683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) refers to the development of multiple joint contractures affecting two or more areas of the body prior to birth. It affects approximately 1 in 3000 individuals, mostly reported in individuals of Asian, African and European descent with equal incidence in males and females. Arthrogryposis is associated with over 400 medical conditions and 350 known genes with considerable variability in phenotypic expression. The primary underlying mechanism is decreased fetal movement during development. Prenatal imaging is crucial in early diagnosis by identifying fetal movement limitations and the presence of club foot or joint contractures. Postnatal autopsy confirms the diagnosis and extent of associated congenital anomalies and provides a valuable source of DNA material. Molecular methods are particularly useful in delineating novel gene mutations, locus heterogeneity and phenotype genotype correlation. Prenatal evaluation with early diagnosis via image scanning and further genetic surveillance give the opportunity for family counseling concerning future pregnancy management and expected neonatal morbidity and mortality.
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Affiliation(s)
- Priya Skaria
- a Department of Pathology , University of Missouri , Kansas City , MO , USA.,b Department of Pathology , Children's Mercy Hospital , Kansas City , MO , USA
| | - Amy Dahl
- c Department of Radiology , Children's Mercy Hospital , Kansas City , MO , USA
| | - Atif Ahmed
- a Department of Pathology , University of Missouri , Kansas City , MO , USA.,b Department of Pathology , Children's Mercy Hospital , Kansas City , MO , USA
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17
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Grotto S, Cuisset JM, Marret S, Drunat S, Faure P, Audebert-Bellanger S, Desguerre I, Flurin V, Grebille AG, Guerrot AM, Journel H, Morin G, Plessis G, Renolleau S, Roume J, Simon-Bouy B, Touraine R, Willems M, Frébourg T, Verspyck E, Saugier-Veber P. Type 0 Spinal Muscular Atrophy: Further Delineation of Prenatal and Postnatal Features in 16 Patients. J Neuromuscul Dis 2016; 3:487-495. [DOI: 10.3233/jnd-160177] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Sarah Grotto
- Department of Genetics, Normandy Center for Medical Genomics and Personalized Medicine, Rouen University Hospital, Rouen, France
| | - Jean-Marie Cuisset
- Department of Pediatric Neurology, Roger Salengro Hospital, Lille Regional University Hospital, Lille, France
| | - Stéphane Marret
- Department of Pediatric Intensive Care, Rouen University Hospital, Rouen, France
- Inserm ERI 28, Institute for Research and Innovation in Biomedicine, Rouen University, France
| | - Séverine Drunat
- Department of Genetics, Robert Debre University Hospital, APHP, Paris, France
| | - Patricia Faure
- Inserm U1079, Institute for Research and Innovation in Biomedicine, Rouen University, Rouen, France
| | | | - Isabelle Desguerre
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Vincent Flurin
- Department of Pediatric Intensive Care, Le Mans Hospital, Le Mans, France
| | - Anne-Gaëlle Grebille
- Department of Obstetrics and Gynecology, Saint-Brieuc Hospital, Saint-Brieuc, France
| | - Anne-Marie Guerrot
- Department of Genetics, Normandy Center for Medical Genomics and Personalized Medicine, Rouen University Hospital, Rouen, France
| | - Hubert Journel
- Department of Genetics, Vannes Bretagne-Atlantique Hospital, Vannes, France
| | - Gilles Morin
- Department of Genetics, Amiens University Hospital, Amiens, France
| | | | - Sylvain Renolleau
- Department of Pediatric Intensive Care, Armand-Trousseau Children’s Hospital, APHP, Paris, France
| | - Joëlle Roume
- Department of Genetics, Poissy-Saint-Germain-en-Laye Hospital, Poissy, France
| | | | - Renaud Touraine
- Department of Genetics, Saint-Etienne University Hospital, Saint-Priest-en-Jarez, France
| | - Marjolaine Willems
- Department of Genetics, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Thierry Frébourg
- Department of Genetics, Normandy Center for Medical Genomics and Personalized Medicine, Rouen University Hospital, Rouen, France
- Inserm U1079, Institute for Research and Innovation in Biomedicine, Rouen University, Rouen, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - Pascale Saugier-Veber
- Department of Genetics, Normandy Center for Medical Genomics and Personalized Medicine, Rouen University Hospital, Rouen, France
- Inserm U1079, Institute for Research and Innovation in Biomedicine, Rouen University, Rouen, France
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18
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Chen TH, Tian X, Kuo PL, Pan HP, Wong LJC, Jong YJ. Identification ofKLHL40mutations by targeted next-generation sequencing facilitated a prenatal diagnosis in a family with three consecutive affected fetuses with fetal akinesia deformation sequence. Prenat Diagn 2016; 36:1135-1138. [PMID: 27762439 DOI: 10.1002/pd.4949] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Tai-Heng Chen
- Division of Pediatric Emergency, Department of Emergency; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
| | | | - Pao-Lin Kuo
- Departments of Obstetrics and Gynecology; National Cheng Kung University Hospital; Tainan Taiwan
| | - Hui-Ping Pan
- Center for Medical Genetics; National Cheng Kung University Hospital; Tainan Taiwan
| | - Lee-Jun C. Wong
- Baylor Genetics; Houston TX USA
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston TX USA
| | - Yuh-Jyh Jong
- Departments of Pediatrics and Laboratory Medicine; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Biological Science and Technology, Institute of Molecular Medicine and Bioengineering, College of Biological Science and Technology; National Chiao Tung University; Hsinchu Taiwan
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19
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Schwartz DA. Autopsy and Postmortem Studies Are Concordant: Pathology of Zika Virus Infection Is Neurotropic in Fetuses and Infants With Microcephaly Following Transplacental Transmission. Arch Pathol Lab Med 2016; 141:68-72. [PMID: 27557413 DOI: 10.5858/arpa.2016-0343-oa] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Pathology studies have been important in concluding that Zika virus infection occurring in pregnant women can result in vertical transmission of the agent from mother to fetus. Fetal and infant autopsies have provided crucial direct evidence that Zika virus can infect an unborn child, resulting in microcephaly, other malformations, and, in some cases, death. OBJECTIVE -To better understand the etiologic role and mechanism(s) of Zika virus in causing birth defects such as microcephaly, this communication analyzes the spectrum of clinical and autopsy studies reported from fetuses and infants who developed intrauterine Zika virus infection, and compares these findings with experimental data related to Zika virus infection. DESIGN -Retrospective analysis of reported clinical, autopsy, pathology, and related postmortem studies from 9 fetuses and infants with intrauterine Zika virus infection and microcephaly. RESULTS -All fetuses and infants examined demonstrated an overlapping spectrum of gross and microscopic neuropathologic abnormalities. Direct cytopathic effects of infection by the Zika virus were confined to the brain; in cases where other organs were evaluated, no direct viral effects were identified. CONCLUSIONS -There is concordance of the spectrum of brain damage, reinforcing previous data indicating that the Zika virus has a strong predilection for cells of the fetal central nervous system following vertical transmission. The occurrence of additional congenital abnormalities suggests that intrauterine brain damage from Zika virus interferes with normal fetal development, resulting in fetal akinesia. Experimental in vitro and in vivo studies of Zika virus infection corroborate the human autopsy findings of neural specificity.
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Affiliation(s)
- David A Schwartz
- From the Department of Pathology, Medical College of Georgia, Augusta University, Augusta
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20
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AKINESIA/HIPOKINESIA FETAL: UNA VENTANA AL MOVIMIENTO FETAL DURANTE EL DESARROLLO. ORIENTACIÓN CLÍNICA, ETIOLOGÍA Y DIAGNÓSTICO. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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21
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Kowalczyk B, Feluś J. Arthrogryposis: an update on clinical aspects, etiology, and treatment strategies. Arch Med Sci 2016; 12:10-24. [PMID: 26925114 PMCID: PMC4754365 DOI: 10.5114/aoms.2016.57578] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/04/2014] [Indexed: 11/20/2022] Open
Abstract
Arthrogryposes - multiple joint contractures - are a clinically and etiologically heterogeneous class of diseases, where accurate diagnosis, recognition of the underlying pathology and classification are of key importance for the prognosis as well as for selection of appropriate management. This treatment remains challenging and optimally in arthrogrypotic patients should be carried out by a team of specialists familiar with all aspects of arthrogryposis pathology and treatment modalities: rehabilitation, orthotics and surgery. In this comprehensive review article, based on literature and clinical experience, the authors present an update on current knowledge on etiology, classifications and treatment options for skeletal deformations possible in arthrogryposis.
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Affiliation(s)
| | - Jarosław Feluś
- Department of Orthopedics, University Children's Hospital, Krakow, Poland
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22
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Prenatal diagnosis of fetal akinesia deformation sequence (FADS): a study of 79 consecutive cases. Arch Gynecol Obstet 2016; 294:697-707. [DOI: 10.1007/s00404-016-4017-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
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23
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Laquerriere A, Gonzales M, Saillour Y, Cavallin M, Joyē N, Quēlin C, Bidat L, Dommergues M, Plessis G, Encha-Razavi F, Chelly J, Bahi-Buisson N, Poirier K. De novo TUBB2B mutation causes fetal akinesia deformation sequence with microlissencephaly: An unusual presentation of tubulinopathy. Eur J Med Genet 2015; 59:249-56. [PMID: 26732629 DOI: 10.1016/j.ejmg.2015.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/26/2015] [Accepted: 12/20/2015] [Indexed: 11/19/2022]
Abstract
Tubulinopathies are increasingly emerging major causes underlying complex cerebral malformations, particularly in case of microlissencephaly often associated with hypoplastic or absent corticospinal tracts. Fetal akinesia deformation sequence (FADS) refers to a clinically and genetically heterogeneous group of disorders with congenital malformations related to impaired fetal movement. We report on an early foetal case with FADS and microlissencephaly due to TUBB2B mutation. Neuropathological examination disclosed virtually absent cortical lamination, foci of neuronal overmigration into the leptomeningeal spaces, corpus callosum agenesis, cerebellar and brainstem hypoplasia and extremely severe hypoplasia of the spinal cord with no anterior and posterior horns and almost no motoneurons. At the cellular level, the p.Cys239Phe TUBB2B mutant leads to tubulin heterodimerization impairment, decreased ability to incorporate into the cytoskeleton, microtubule dynamics alteration, with an accelerated rate of depolymerization. To our knowledge, this is the first case of microlissencephaly to be reported presenting with a so severe and early form of FADS, highlighting the importance of tubulin mutation screening in the context of FADS with microlissencephaly.
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Affiliation(s)
- Annie Laquerriere
- Pathology Laboratory, Rouen University Hospital, France; Region-Inserm Team NeoVasc ERI28, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute of Research Innovation in Biomedecine, Normandy University, Rouen, France
| | - Marie Gonzales
- Department of Medical Genetics, Armand Trousseau Hospital, APHP, Paris, France; Sorbonne Universities, UPMC, Paris, France
| | - Yoann Saillour
- Inserm, U1016, Institut Cochin, Paris, France; CNRS, UMR8104, Paris, France; Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Mara Cavallin
- Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Neurology, Necker Enfants Malades University Hospital, Paris, France; INSERM UMR-1163, Embryology and Genetics of Congenital Malformation Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Université Paris Descartes-Sorbonne Paris Cité, France
| | - Nicole Joyē
- Department of Medical Genetics, Armand Trousseau Hospital, APHP, Paris, France; Sorbonne Universities, UPMC, Paris, France
| | - Chloé Quēlin
- Department of Clinical Genetics, South University Hospital, Rennes, France
| | - Laurent Bidat
- Department of Prenatal Diagnosis, Department of Obstetrics and Gynecology, René Dubos Hospital, Pontoise, France
| | - Marc Dommergues
- Sorbonne Universities, UPMC, Paris, France; Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié Salpêtrière, APHP, Paris, France
| | - Ghislaine Plessis
- Department of Genetics, Clinical Genetics, Caen University Hospital, Caen, France
| | - Ferechte Encha-Razavi
- Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Neurology, Necker Enfants Malades University Hospital, Paris, France; Département de Génétique, Necker-Enfants Malades University Hospital, Paris, France
| | - Jamel Chelly
- Pôle de biologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Institut de Génétique et Biologie Moléculaire et Cellulaire - IGBMC, INSERM, CNRS, Université de Strasbourg, Strasbourg, France
| | - Nadia Bahi-Buisson
- Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Neurology, Necker Enfants Malades University Hospital, Paris, France; INSERM UMR-1163, Embryology and Genetics of Congenital Malformation Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Université Paris Descartes-Sorbonne Paris Cité, France.
| | - Karine Poirier
- Inserm, U1016, Institut Cochin, Paris, France; CNRS, UMR8104, Paris, France; Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France
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Dohrn N, Le VQ, Petersen A, Skovbo P, Pedersen IS, Ernst A, Krarup H, Petersen MB. ECEL1 mutation causes fetal arthrogryposis multiplex congenita. Am J Med Genet A 2015; 167A:731-43. [PMID: 25708584 DOI: 10.1002/ajmg.a.37018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 01/28/2015] [Indexed: 12/14/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) is a descriptor for the clinical finding of congenital fixation of multiple joints. We present a consanguineous healthy couple with two pregnancies described with AMC due to characteristic findings on ultrasonography of fixated knee extension and reduced fetal movement at the gestational age of 13 weeks + 2 days and 12 weeks + 4 days. Both pregnancies were terminated and postmortem examinations were performed. The postmortem examinations confirmed AMC and suggested a diagnosis of centronuclear myopathy (CNM) due to characteristic histological findings in muscle biopsies. Whole exome sequencing (WES) was performed on all four individuals and the outcome was filtered by application of multiple filtration parameters satisfying a recessive inheritance pattern. Only one gene, ECEL1, was predicted damaging and had previously been associated with neuromuscular disease or AMC. The variant found ECEL1 is a missense mutation in a highly conserved residue and was predicted pathogenic by prediction software. The finding expands the molecular basis of congenital contractures and the phenotypic spectrum of ECEL1 mutations. The histological pattern suggestive of CNM in the fetuses can expand the spectrum of genes causing CNM, as we propose that mutations in ECEL1 can cause CNM or a condition similar to this. Further investigation of this is needed and we advocate that future patients with similar clinical presentation or proven ECEL1 mutations are examined with muscle biopsy. Secondly, this study illustrates the great potential of the clinical application of WES in couples with recurrent abortions or stillborn neonates.
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Affiliation(s)
- N Dohrn
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
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Inbar-Feigenberg M, Meirowitz N, Nanda D, Toi A, Okun N, Chitayat D. Beals syndrome (congenital contractural arachnodactyly): prenatal ultrasound findings and molecular analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:486-490. [PMID: 24585410 DOI: 10.1002/uog.13350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/24/2014] [Accepted: 02/11/2014] [Indexed: 06/03/2023]
Abstract
We report the prenatal findings in two cases of Beals syndrome. Both pregnancies presented with clinical features of arthrogryposis multiplex congenita/fetal akinesia syndrome (AMC/FAS), including clenched fists and multiple joint contractures on repeat prenatal ultrasound examinations. The first case was diagnosed as having Beals syndrome on physical examination shortly after birth and the diagnosis was confirmed by DNA analysis, shown as a point mutation in the fibrillin 2 (FBN2) gene. The second case was diagnosed with Beals syndrome following microarray analysis on amniocytes, which showed a deletion of the FBN2 gene. Although most cases with AMC/FAS carry a poor prognosis, Beals syndrome is consistent with normal cognitive development and a better prognosis. Thus, making the correct diagnosis is crucial, both pre- and postnatally, for accurate counseling and management.
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Affiliation(s)
- M Inbar-Feigenberg
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Tamblyn JA, Morris RK, Cox P, Hargitai B, Kilby MD. The role of ultrasound in fetal congenital myopathy detection: a novel case of fetal-onset cap myopathy. Prenat Diagn 2013; 33:1102-4. [DOI: 10.1002/pd.4184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/23/2013] [Accepted: 06/20/2013] [Indexed: 11/09/2022]
Affiliation(s)
- J. A. Tamblyn
- Division of Reproduction, Genes and Development, School of Clinical and Experimental Medicine; University of Birmingham; Birmingham UK
| | - R. K. Morris
- Division of Reproduction, Genes and Development, School of Clinical and Experimental Medicine; University of Birmingham; Birmingham UK
- Fetal Medicine Centre; Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - P. Cox
- Department of Perinatal Pathology; Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - B. Hargitai
- Department of Perinatal Pathology; Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - M. D. Kilby
- Division of Reproduction, Genes and Development, School of Clinical and Experimental Medicine; University of Birmingham; Birmingham UK
- Fetal Medicine Centre; Birmingham Women's NHS Foundation Trust; Birmingham UK
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Hagen MA, Stuurman KE, de Vries JI. Abnormal motor behavior at 23 weeks in a fetus with Smith-Lemli-Opitz syndrome (SLOS). Prenat Diagn 2013; 33:807-9. [DOI: 10.1002/pd.4133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/14/2013] [Accepted: 04/09/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Marleen A. Hagen
- Department of Obstetrics and Gynecology, Research Institute MOVE; VU University Medical Center; Amsterdam The Netherlands
| | - Kyra E. Stuurman
- Department of Clinical Genetics; VU University Medical Center; Amsterdam The Netherlands
| | - Johanna I. de Vries
- Department of Obstetrics and Gynecology, Research Institute MOVE; VU University Medical Center; Amsterdam The Netherlands
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Haliloglu G, Topaloglu H. Arthrogryposis and fetal hypomobility syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2013; 113:1311-9. [PMID: 23622356 DOI: 10.1016/b978-0-444-59565-2.00003-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Arthrogryposis is a heterogeneous condition, evident from birth, which can be defined as multiple contractures of the joints. The etiology is multifold: genetic disorders of the central or peripheral nervous system, or of the connective tissue leading to decreased fetal movements, and vascular and environmental causes. The problem begins in utero. There may be overlapping conditions between sporadic, syndromic, neurogenic, myopathic and metabolic types. The workup should include a family tree. Systemic involvement, for example of the renal and pulmonary systems, may be encountered in associated syndromes. Motor neuron disorders leading to the condition are the most commonly seen type. Fetal or neonatal akinesia/hypokinesia is at the severe end of the spectrum, in which there is literally intrauterine limitation of movement. Children with amyplasia are born with little or diminished muscle bulk of the extremities. Distal arthrogryposis is almost always a dominantly inherited condition. A multidisciplinary care approach is required in order to provide optimum healthcare. The management team should include a nutritionist and a physiotherapist. Genetic counseling is possible in most instances. A truly genetic cause can be identified in more than 50% of cases. Survivors, though handicapped, can lead near normal lives.
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Affiliation(s)
- Goknur Haliloglu
- Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey
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Kalampokas E, Kalampokas T, Sofoudis C, Deligeoroglou E, Botsis D. Diagnosing arthrogryposis multiplex congenita: a review. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:264918. [PMID: 23050160 PMCID: PMC3461621 DOI: 10.5402/2012/264918] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 08/26/2012] [Indexed: 11/23/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) refers either to a syndromic or to a nonsyndromic group of conditions with varied etiology and complex clinical features, including multiple congenital contractures in different body areas. Its etiology still remains unclear but generally any cause that leads to reduced fetal movement may lead to congenital contractures and in severe cases to fetal akinesia deformation sequence (FADS).
It affects approximately 1 in 2-3000 live births with an approximately equal gender ratio. There are many known subgroups of AMC differing in signs, symptoms, and causes. The primary diagnosis is made when a lack of mobility and an abnormal position is noted in routine ultrasound scanning. Early diagnosis, prenatal evaluation, and further surveillance via image scanning (ultrasound and MRI) give the opportunity for family counseling concerning neonatal morbidity and mortality and labor or delivery planning. Better understanding of the ultrasound findings and the etiology of this clinical situation offers the opportunity for careful prenatal assessment.
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Affiliation(s)
- Emmanouil Kalampokas
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, University of Athens, 76 Vas. Sofias Avenue, 11528 Athens, Greece
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Prenatal diagnosis and genetic analysis of fetal akinesia deformation sequence and multiple pterygium syndrome associated with neuromuscular junction disorders: A review. Taiwan J Obstet Gynecol 2012; 51:12-7. [DOI: 10.1016/j.tjog.2012.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2012] [Indexed: 12/30/2022] Open
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Harms CA, Cooper D, Tanaka H. Exercise Physiology of Normal Development, Sex Differences, and Aging. Compr Physiol 2011; 1:1649-78. [DOI: 10.1002/cphy.c100065] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Dimauro S, Garone C. Metabolic disorders of fetal life: glycogenoses and mitochondrial defects of the mitochondrial respiratory chain. Semin Fetal Neonatal Med 2011; 16:181-9. [PMID: 21620786 DOI: 10.1016/j.siny.2011.04.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Two major groups of inborn errors of energy metabolism are reviewed -glycogenoses and defects of the mitochondrial respiratory chain - to see how often these disorders present in fetal life or neonatally. After some general considerations on energy metabolism in the pre- and postnatal development of the human infant, different glycogen storage diseases and mitochondrial encephalomyopathies are surveyed. General conclusions are that: (i) disorders of glycogen metabolism are more likely to cause 'fetal disease' than defects of the respiratory chain; (ii) mitochondrial encephalomyopathies, especially those due to defects of the nuclear genome, are frequent causes of neonatal or infantile diseases, typically Leigh syndrome, but usually do not cause fetal distress; (iii) notable exceptions include mutations in the complex III assembly gene BCS1L resulting in the GRACILE syndrome (growth retardation, aminoaciduria, cholestasis, iron overload, lactic acidosis, and early death), and defects of mitochondrial protein synthesis, which are the 'new frontier' in mitochondrial translational research.
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Affiliation(s)
- S Dimauro
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.
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Nemec SF, Höftberger R, Nemec U, Bettelheim D, Brugger PC, Kasprian G, Amann G, Rotmensch S, Graham JM, Rimoin DL, Prayer D. Fetal akinesia and associated abnormalities on prenatal MRI. Prenat Diagn 2011; 31:484-90. [PMID: 21374641 DOI: 10.1002/pd.2724] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 01/04/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE In view of the increasing role of magnetic resonance imaging (MRI) as an adjunct to prenatal ultrasonography (US), this study sought to demonstrate the visualization of fetal akinesia and associated abnormalities on MRI. METHODS This retrospective study included six fetuses with akinesia and associated abnormalities, depicted on fetal MRI after suspicious prenatal US. The whole fetus was assessed for musculoskeletal abnormalities and associated pathological conditions elsewhere. Fetal outcome data were compared with prenatal imaging. US and MRI findings were also compared. RESULTS Akinesia resulting in arthrogryposis was seen in 6/6 fetuses, with abnormal musculature in 5/6 fetuses. Associated brain abnormalities were found in 2/6 fetuses; facial abnormalities in 3/6; lung hypoplasia in 3/6; and polyhydramnios in 2/6. There were 5/6 pregnancies that were terminated and one individual died neonatally. MRI and brain autopsy were concordant in 4/6 cases. MRI and body autopsy were concordant in 1/6 cases and in 5/6 cases, autopsy revealed additional abnormalities. In addition to US, MRI correctly identified central nervous system findings in four cases and lung hypoplasia in three cases. CONCLUSION Our MRI results demonstrate fetal akinesia and associated abnormalities, which may have an impact on perinatal management, as an adjunct to prenatal US.
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Affiliation(s)
- Stefan F Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Vienna, Austria.
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Hiraki Y, Nishimura A, Hayashidani M, Terada Y, Nishimura G, Okamoto N, Nishina S, Tsurusaki Y, Doi H, Saitsu H, Miyake N, Matsumoto N. A de novo deletion of 20q11.2-q12 in a boy presenting with abnormal hands and feet, retinal dysplasia, and intractable feeding difficulty. Am J Med Genet A 2011; 155A:409-14. [PMID: 21271663 DOI: 10.1002/ajmg.a.33818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 10/23/2010] [Indexed: 11/11/2022]
Abstract
Proximal interstitial deletions involving 20q11-q12 are very rare. Only two cases have been reported. We describe another patient with 20q11.21-q12 deletion. We precisely mapped the 6.5-Mb deletion and successfully determined the deletion landmarks at the nucleotide level. Common clinical features among the three cases include developmental delay, intractable feeding difficulties with gastroesophageal reflux, and facial dysmorphism including triangular face, hypertelorism, and hypoplastic alae nasi, indicating that the 20q11.2-q12 deletion can be a clinically recognizable syndrome. This is also supported by the fact that the three deletions overlap significantly. In addition, unique features such as arthrogryposis/fetal akinesia (hypokinesia) deformation and retinal dysplasia are recognized in the patient reported herein.
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Affiliation(s)
- Yoko Hiraki
- Hiroshima Municipal Center for Child Health and Development, Hiroshima, Japan
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Rudzinski ER, Kapur RP, Hevner RF. Fetal akinesia deformation sequence with delayed skeletal muscle maturation and polymicrogyria: evidence for a hypoxic/ischemic pathogenesis. Pediatr Dev Pathol 2010; 13:192-201. [PMID: 19968489 DOI: 10.2350/09-08-0693-oa.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple congenital contractures, also known as fetal akinesia deformation sequence (FADS) and related terms, result from decreased fetal movement. The underlying etiologies are diverse and include central nervous system (CNS) dysgeneses and primary myopathies. Persistent central nuclei or the presence of myotubes is often regarded as evidence of a primary myopathic etiology; however, these findings are also associated with impaired fetal innervation. We report 7 fetuses, estimated gestational age 20 to 23 weeks, with persistent myotubular morphology, a change that could be (mis)interpreted as a primary myopathy. In 4 of the patients, CNS histology showed hypoxic/ischemic injury, polymicrogyria, mineralized neurons, and microinfarcts with or without loss of anterior horn neurons. FADS cases with polymicrogyria have frequently been interpreted as a consequence of a primary brain malformation. Only a few descriptions of FADS associate polymicrogyria with CNS hypoxic/ischemic injury, however, and do not describe skeletal muscle maturation delay. We hypothesize that this combination of neural and muscular pathology is an under-recognized pattern in FADS, which results from diffuse hypoxic/ischemic injury involving the brain and spinal cord during early to middle gestation.
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Affiliation(s)
- Erin R Rudzinski
- Department of Laboratories, Seattle Children's Hospital and Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA.
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Meyer E, Ricketts C, Morgan NV, Morris MR, Pasha S, Tee LJ, Rahman F, Bazin A, Bessières B, Déchelotte P, Yacoubi MT, Al-Adnani M, Marton T, Tannahill D, Trembath RC, Fallet-Bianco C, Cox P, Williams D, Maher ER. Mutations in FLVCR2 are associated with proliferative vasculopathy and hydranencephaly-hydrocephaly syndrome (Fowler syndrome). Am J Hum Genet 2010; 86:471-8. [PMID: 20206334 DOI: 10.1016/j.ajhg.2010.02.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 02/03/2010] [Accepted: 02/04/2010] [Indexed: 11/28/2022] Open
Abstract
Proliferative vasculopathy and hydranencephaly-hydrocephaly syndrome (PVHH), also known as Fowler syndrome, is an autosomal-recessively inherited prenatal lethal disorder characterized by hydranencephaly; brain stem, basal ganglia, and spinal cord diffuse clastic ischemic lesions with calcifications; glomeruloid vasculopathy of the central nervous system and retinal vessels; and a fetal akinesia deformation sequence (FADS) with muscular neurogenic atrophy. To identify the molecular basis for Fowler syndrome, we performed autozygosity mapping studies in three consanguineous families. The results of SNP microarrays and microsatellite marker genotyping demonstrated linkage to chromosome 14q24.3. Direct sequencing of candidate genes within the target interval revealed five different germline mutations in FLVCR2 in five families with Fowler syndrome. FLVCR2 encodes a transmembrane transporter of the major facilitator superfamily (MFS) hypothesized to be involved in regulation of growth, calcium exchange, and homeostasis. This is the first gene to be associated with Fowler syndrome, and this finding provides a basis for further studies to elucidate the pathogenetic mechanisms and phenotypic spectrum of associated disorders.
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Affiliation(s)
- Esther Meyer
- Department of Medical and Molecular Genetics, Institute of Biomedical Research, University of Birmingham, Birmingham, B15 2TT, UK
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Abstract
Abstract
Diagnostic ultrasound in the field of obstetrics is used to evaluate fetal anomalies and well-being. These images are used to develop a differential diagnosis that can later be correlated with postnatal outcomes. The following cases are a small sample of recent challenging fetal anomalies at our institution that were detected on prenatal ultrasound.
Objectives
Interpret ultrasound images of fetal anomalies
Assimilate the interpretation of images into a differential diagnosis
Correlate prenatal imaging with postnatal outcomes
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Donker ME, Eijckelhof BHW, Tan GMB, de Vries JIP. Serial postural and motor assessment of Fetal Akinesia Deformation Sequence (FADS). Early Hum Dev 2009; 85:785-90. [PMID: 19944545 DOI: 10.1016/j.earlhumdev.2009.10.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 10/22/2009] [Accepted: 10/27/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fetal Akinesia Deformation Sequence (FADS) is a rare, in most cases autosomal recessive, disorder. Its heterogeneous origin results in variable onset and expression of motor and postural anomalies. DNA-diagnostic possibilities are limited, thus prenatal diagnosis is chiefly dependent on sonographic examinations. AIM To explore postural and motor development from a systematic sonographic protocol for fetuses at high risk for FADS. Specific questions are: which motor (i.e., specific movement patterns, quality and quantity of general movements) and postural aspects are most informative about emerging FADS and is the gestational age of onset range of FADS more limited for siblings? METHODS Ten families underwent 45, 15-minute sonographic assessments for motility and posture for ten index fetuses with FADS and nine subsequent pregnancies from five families. RESULTS FADS was diagnosed between 18 and 33 weeks gestation in ten index pregnancies and between 11 and 18 weeks gestation in 4/9 subsequent pregnancies, 1-12 weeks earlier than their index pregnancies. From the four assessment aspects, posture and movement quality were always abnormal, movement quantity in 7/14 and differentiation into specific movement patterns were reduced in comparison with healthy siblings (p<0.01). Deterioration occurred in a 2 week period. CONCLUSIONS Serial postural and qualitative assessments were most informative diagnosing FADS. Quantity and differentiation into specific movement patterns contributed substantially. Onset range of FADS within siblings was suggested to be more limited than between families.
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Affiliation(s)
- Mariëlle E Donker
- Department of Obstetrics and Gynecology, Research Institute MOVE, VU university medical center, 1007 MB Amsterdam, The Netherlands
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Rehabilitation of an Adult Patient with Arthrogryposis Multiplex Congenita Treated with an External Fixator. Am J Phys Med Rehabil 2009; 88:431-4. [DOI: 10.1097/phm.0b013e3181a0e249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bayat A, Petersen A, Møller M, Andersen G, Ebbesen F. Incidence of fetal akinesia-hypokinesia deformation sequence: a population-based study. Acta Paediatr 2009; 98:3-4. [PMID: 19086936 DOI: 10.1111/j.1651-2227.2008.01102.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thill M, Nguyen TD, Wehnert M, Fischer D, Hausser I, Braun S, Jackisch C. Restrictive dermopathy: a rare laminopathy. Arch Gynecol Obstet 2008; 278:201-8. [PMID: 18470519 DOI: 10.1007/s00404-008-0676-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 04/22/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Restrictive dermopathy (RD) belongs to the laminopathies and mostly shows an autosomal recessive heredity pattern. This rare genetic disorder is lethal for the newborn in the neonatal period. Clinical and pathological findings are distinctive and allow for a specific diagnosis in most cases. Furthermore, polyhydramnios, decreased foetal movement, facial dysmorphisms and arthrogryposis are characteristic of RD. Respiratory insufficiency leads to an early neonatal death. METHODS We present the case of an affected infant and a review of the previously reported cases in the literature. RESULTS The infant showed thin, shiny skin with exfoliating desquamation, a small, round and open mouth, low-set ears, a small pinched nose, joint contractures at all four extremities and distinctive pulmonic atelectasis. It died 3 h and 20 min post-partum. Histologically, the skin showed the typical pattern of an RD with the epidermis covered by an exfoliated, hyperkeratotic horn layer, clearly hypoplastic hair follicles and a considerably reduced dermis thickness, although it had a massive subcutaneous adipose tissue. Electron microscopically, the diagnosis was confirmed. CONCLUSIONS It is important to know about this disease and to distinguish it from others like keratinization malfunctions such as ichtyosis, congenital, developmental and akinesia disturbance, etc., to know the prognosis for the affected newborn and to provide sufficient (genetic) counselling to the families. This disorder is caused by dominant mutations of the LMNA (primary laminopathy) or recessive mutations of the ZMPSTE24 (FACE1) (secondary laminopathy) genes.
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Affiliation(s)
- Marc Thill
- Department of Gynecology and Obstetrics, Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
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Prayer D, Brugger PC. Investigation of normal organ development with fetal MRI. Eur Radiol 2007; 17:2458-71. [PMID: 17342486 DOI: 10.1007/s00330-007-0604-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 12/15/2006] [Accepted: 01/22/2007] [Indexed: 01/28/2023]
Abstract
The understanding of the presentation of normal organ development on fetal MRI forms the basis for recognition of pathological states. During the second and third trimesters, maturational processes include changes in size, shape and signal intensities of organs. Visualization of these developmental processes requires tailored MR protocols. Further prerequisites for recognition of normal maturational states are unequivocal intrauterine orientation with respect to left and right body halves, fetal proportions, and knowledge about the MR presentation of extrafetal/intrauterine organs. Emphasis is laid on the demonstration of normal MR appearance of organs that are frequently involved in malformation syndromes. In addition, examples of time-dependent contrast enhancement of intrauterine structures are given.
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Affiliation(s)
- Daniela Prayer
- Department of Radiology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
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Dalton P, Clover L, Wallerstein R, Stewart H, Genzel-Boroviczeny O, Dean A, Vincent A. Fetal arthrogryposis and maternal serum antibodies. Neuromuscul Disord 2006; 16:481-91. [PMID: 16919948 DOI: 10.1016/j.nmd.2006.05.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 05/09/2006] [Accepted: 05/25/2006] [Indexed: 11/21/2022]
Abstract
Arthrogryposis multiplex congenital (AMC) describes multiple joint contractures resulting from lack of movement in utero. Antibodies directed at the fetal isoform of the muscle acetylcholine receptor (AChR) have been reported in a small number of asymptomatic mothers of AMC babies. We examined sera from 179 mothers of AMC babies and 20 parous and non-parous controls to look for antibodies to AChR or undefined muscle or neuronal proteins. We found positive AChR antibodies in only three sera (1.5%) from asymptomatic AMC mothers. However, there was reactivity with muscle or with neuronal antigens in 33% of the sera, and reactivity to undefined neuronal antigens was more common in sera from mothers of AMC babies with CNS involvement (p=0.001) than those without. The offspring of mothers with AChR antibodies may benefit from treatment during pregnancy. Other maternal antibodies require further study, but these observations add to the emerging literature on maternal antibodies associated with developmental intrauterine disorders.
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Affiliation(s)
- Paola Dalton
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, OX3 9DS, UK
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Bruno C, van Diggelen OP, Cassandrini D, Gimpelev M, Giuffrè B, Donati MA, Introvini P, Alegria A, Assereto S, Morandi L, Mora M, Tonoli E, Mascelli S, Traverso M, Pasquini E, Bado M, Vilarinho L, van Noort G, Mosca F, DiMauro S, Zara F, Minetti C. Clinical and genetic heterogeneity of branching enzyme deficiency (glycogenosis type IV). Neurology 2005; 63:1053-8. [PMID: 15452297 DOI: 10.1212/01.wnl.0000138429.11433.0d] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Glycogen storage disease type IV (GSD-IV) is a clinically heterogeneous autosomal recessive disorder due to glycogen branching enzyme (GBE) deficiency and resulting in the accumulation of an amylopectin-like polysaccharide. The typical presentation is liver disease of childhood, progressing to lethal cirrhosis. The neuromuscular form of GSD-IV varies in onset (perinatal, congenital, juvenile, or adult) and severity. OBJECTIVE To identify the molecular bases of different neuromuscular forms of GSD-IV and to establish possible genotype/phenotype correlations. METHODS Eight patients with GBE deficiency had different neuromuscular presentations: three had fetal akinesia deformation sequence (FADS), three had congenital myopathy, one had juvenile myopathy, and one had combined myopathic and hepatic features. In all patients, the promoter and the entire coding region of the GBE gene at the RNA and genomic level were sequenced. RESULTS Nine novel mutations were identified, including nonsense, missense, deletion, insertion, and splice-junction mutations. The three cases with FADS were homozygous, whereas all other cases were compound heterozygotes. CONCLUSIONS This study expands the spectrum of mutations in the GBE gene and confirms that the neuromuscular presentation of GSD-IV is clinically and genetically heterogeneous.
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Affiliation(s)
- C Bruno
- Neuromuscular Disease Unit, Department of Pediatrics, University of Genova, Istituto Giannina Gaslini, Largo G. Gaslini 5, I-16147 Genova, Italy.
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Abstract
One of the major medical concerns in neonates is their vulnerability to life-threatening complications. Early diagnosis of potentially serious medical conditions is essential in prevention of such complication by prompt administration of appropriate treatments. Recognition of cutaneous manifestations of potentially fatal diseases may assist a clinician in management of newborns. To overview the full spectrum of this category of conditions, Medline search was performed for cases of cutaneous manifestations associated with mortality during the first month of live that were published in the English language literature since 1977. This is a concise review of the clinical aspects of most of the potentially life-threatening disorders in neonates divided by basic morphology of their cutaneous manifestations.
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Affiliation(s)
- Alex Zvulunov
- Department of Pediatrics, Joseftal Hospital, Eilat 88000, Israel.
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Grati FR, Lalatta F, Turolla L, Cavallari U, Gentilin B, Rossella F, Cetin I, Antonazzo P, Bellotti M, Dulcetti F, Baldo D, Tenconi R, Simoni G, Miozzo M. Three cases with de novo 6q imbalance and variable prenatal phenotype. Am J Med Genet A 2005; 136:254-8. [PMID: 15957159 DOI: 10.1002/ajmg.a.30837] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We describe two families in which three fetuses had a de novo 6q imbalance and abnormal phenotypes. We determined the boundaries and the parental origin of the chromosomal alterations by segregation analysis using a panel of short tandem repeats (STRs) located on 6q. Cases 1 and 2 (family A) were two sibs with 6q imbalance involving different regions. Case 1 was a female fetus with arthrogryposis, who had a complex rearrangement resulting in two deleted regions (6q22 and 6q25.1-q25.2) and a duplication of 6q23-q25.1. This latter imbalance was reported previously and is associated with joint contractures and short neck, also present in this fetus. The sib (case 2) had intrauterine growth restriction (IUGR) and agenesis of the ductus venosus. This male died shortly after birth; postnatal karyotype and molecular investigations showed a 6q21 de novo deletion. Case 3 (family B) had a prenatally detected deletion of 6q14-q16. Autopsy of the fetus documented minor facial anomalies and contractures of the limbs. All rearrangements were de novo and of paternal origin. Our data and the consistent number of cases of de novo 6q alterations previously reported suggest that chromosome arm 6q could be prone to rearrangements resulting in heterogeneous phenotypes. In family A, chromosome 6q imbalances involving different chromosomal regions were present in two consecutive pregnancies. In such cases counseling should suggest the impossibility of excluding recurrence of a chromosomal imbalance, and should discuss the option of early prenatal diagnosis in subsequent pregnancies.
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Affiliation(s)
- Francesca R Grati
- Dipartimento di Medicina, Chirurgia ed Odontoiatria, Genetica Medica, Università degli Studi di Milano, Milano, Italia
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Usta IM, AbuMusa AA, Khoury NG, Nassar AH. Early ultrasonographic changes in Fowler syndrome features and review of the literature. Prenat Diagn 2005; 25:1019-23. [PMID: 16231307 DOI: 10.1002/pd.1240] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fowler syndrome is characterized by hydranencephaly, brain stem and basal ganglion calcifications, a glomeruloid vasculopathy of the brain vessels, and a fetal akinesia deformation sequence with muscular hypoplasia. The natural progression of the ultrasonographic features of Fowler syndrome has never been described. METHODS Case report and review of the literature. RESULTS A primiparous woman with a negative ultrasound at 11 weeks of pregnancy was noted at 15 weeks to have fetal nuchal thickening, generalized skin edema, prominent lateral ventricles, akinesia with arthrogryposis, and pterygia. At 18 weeks, a cystic hygroma with facial edema, hypertelorism, and hydrocephaly were noted; the limb deformity was still evident. Within 1 week, the cystic hygroma regressed partially, but the hydrocephaly deteriorated. CONCLUSION The multiple ultrasonographic features of Fowler syndrome may not occur simultaneously and their severity may vary with gestational age.
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Affiliation(s)
- Ihab M Usta
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Ruano R, Dumez Y, Dommergues M. Three-dimensional ultrasonographic appearance of the fetal akinesia deformation sequence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:593-599. [PMID: 12795555 DOI: 10.7863/jum.2003.22.6.593] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To present the appearance of the fetal akinesia deformation sequence by three-dimensional ultrasonography after four-dimensional ultrasonographic scanning. METHODS Three-dimensional surface-rendering images were used to show the fixed postural abnormalities of the fetal extremities and body. Four-dimensional ultrasonography was used to show that the postural abnormalities were fixed and to confirm the absence of fetal movements. These images were compared with the postmortem examination findings. RESULTS Three-dimensional ultrasonographic images of 3 cases of fetal akinesia deformation sequence are presented. Surface-rendering imaging and imaging in the skeletal mode were performed to show the postural abnormalities and the arthrogryposis. CONCLUSIONS Facilitated by polyhydramnios, three- and four-dimensional ultrasonography provided clear images of the fixed postural abnormalities, which were confirmed by postmortem examination. Although prenatal diagnosis can be easily made by conventional ultrasonography, three-dimensional ultrasonography might be used as a confirmatory approach. In addition, the quality of recent three-dimensional imaging might help prenatal counseling by providing images more readily understandable to the parents than those obtained by two-dimensional ultrasonography.
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Affiliation(s)
- Rodrigo Ruano
- Maternité, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris V, Paris, France.
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