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Al Kaissi A, Ryabykh S, Ochirova P, Bouchoucha S, Kenis V, Shboul M, Ganger R, Grill F, Kircher SG. Arthrogryposis is a descriptive term, not a specific disease entity: Escobar Syndrome is an example. Minerva Pediatr (Torino) 2024; 76:30-36. [PMID: 32536119 DOI: 10.23736/s2724-5276.20.05796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Children born with multiple congenital contractures have been almost always given the diagnosis of arthrogryposis multiplex congenita. Arthrogryposis is a descriptive term, not a specific disease entity. A heterogeneous group of conditions associated with multiple congenital joint contractures (mostly syndromic) should be considered. METHODS The records of seven children (four boys and three girls aged 6 months - 11 years) of different ethnic origins have been included in this study. The constellation of specific craniofacial dysmorphic features, spine malformation complex, and appendicular skeletal abnormalities in addition to camptodactyly, talipes equinovarus and rocker-bottom feet were a cluster of malformation complex encountered in our patients. Via comprehensive clinical and imaging study (3D reconstruction CT scan), definite diagnosis of Escobar Syndrome has been approached. RESULTS The clinical and imaging phenotype was the key factor towards etiological understanding, treatment and genotype confirmation. We identified compound heterozygous mutations (c.459dupA [p.Val154Serfs*24] and c.794T>G [p.Leu265Serfs*24] of the CHRNG gene in four patients. Bilateral flexion contractures of the knees have been treated by using Iliazarov external fixator. Simultaneous corrections of scoliosis have been achieved by applying either dual traditional growing rods or single growing rods. CONCLUSIONS The clinical and radiological phenotypic characterizations are the fundamental tool in differentiating Escobar from other forms of multiple contractures. The aim of this study are three folds, firstly to demonstrate the importance of detecting the etiological understanding in children presented with multiple contractures, secondly to refute the general conception among the vast majority of pediatricians and orthopedic surgeons that arthrogryposis multiplex is a diagnostic entity. And thirdly, we were able to detect severe spine deformity via 3D reconstruction CT scan, namely unsegmented posterior spinal bar.
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Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, the Hanusch Hospital of WGKK, Vienna, Austria -
- AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital, Vienna, Austria -
| | - Sergey Ryabykh
- Department of Paediatrics, Orthopedic Hospital of Speising, Vienna, Austria
| | - Polina Ochirova
- Department of Paediatrics, Orthopedic Hospital of Speising, Vienna, Austria
| | - Sami Bouchoucha
- Division Spine Pathology and Rare Diseases, Russian Scientific Ilizarov Center (RISC), Kurgan, Russia
| | - Vladimir Kenis
- Department of Pediatric Orthopedic Surgery, Children Hospital (Becher Hamza), Tunis, Tunisia
| | - Mohammad Shboul
- Department of Foot and Ankle Surgery, Neuro-orthopedics and Systemic Disorders, H. Turner Pediatric Orthopedic Institute, Saint Petersburg, Russia
| | - Rudolf Ganger
- AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital, Vienna, Austria
| | - Franz Grill
- AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital, Vienna, Austria
| | - Susanne G Kircher
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Sandweiss AJ, Patel S, Bader MY, Kylat RI. A Truncating Variant of CHRNG as a Cause of Escobar Syndrome: A Multiple Pterygium Syndrome Subtype. J Pediatr Genet 2020; 11:144-146. [DOI: 10.1055/s-0040-1715640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
AbstractEscobar syndrome is a milder variant of multiple pterygium syndrome characterized by pterygia, scoliosis, and multiple congenital contractures. It is most frequently due to a genetic variant in CHRNG, which encodes the γ-subunit of the nicotinic acetylcholine receptor. Though the subunit is considered a “fetal” form and transitions to the “adult” ε-subunit by 33 weeks' gestation, the pathogenic musculoskeletal effects during fetal development render children with this condition permanently affected. We report a neonate with homozygous CHRNG c.117dupC and discuss some of the downstream clinical effects we observed with this variant.
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Affiliation(s)
- Alexander J. Sandweiss
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States
- Section of Neurology and Developmental Neurosciences, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Shalinkumar Patel
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States
| | - Mohammad Y. Bader
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States
| | - Ranjit I. Kylat
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States
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Marques FBC, de Morais LS, Squeff LR, de Souza MMG, Bolognese AM. Escobar Syndrome-An Multidisciplinary Approach for an Excellent Outcome With 3 Years of Follow-Up. Cleft Palate Craniofac J 2019; 56:970-977. [PMID: 30654650 DOI: 10.1177/1055665618823416] [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: 11/17/2022] Open
Abstract
This case report intends to provide the facial characteristics of Escobar syndrome and to describe the orthodontic treatment of a 12-year-old female patient diagnosed with it. Escobar syndrome, a variant of the multiple pterygium syndrome, is a rare disorder with many systemic, facial, and oral manifestations.The patient presented with mixed dentition, severe dolichofacial pattern, increased lower facial height, convex profile, severe anterior open bite, maxillary hypoplasia, and mandibular retrognatism. The multidisciplinary approach included soft cleft palate repair, orthodontic treatment, orthognathic surgery, restorative cosmetic dentistry, speech therapy, and physiotherapy. Despite the limitations imposed by the syndrome, this report illustrates how the multidisciplinary treatment approach aided in the correction of occlusal function and facial esthetics and improvement in the quality of life of the patient with Escobar syndrome.
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Affiliation(s)
- Fernanda Blaudt C Marques
- 1 Department of Pedodontics and Orthodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Liliane Siqueira de Morais
- 2 Department of Pediatric Dentistry and Orthodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciana Rougemont Squeff
- 2 Department of Pediatric Dentistry and Orthodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Margareth Maria Gomes de Souza
- 2 Department of Pediatric Dentistry and Orthodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Maria Bolognese
- 2 Department of Pediatric Dentistry and Orthodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Kariminejad A, Almadani N, Khoshaeen A, Olsson B, Moslemi AR, Tajsharghi H. Truncating CHRNG mutations associated with interfamilial variability of the severity of the Escobar variant of multiple pterygium syndrome. BMC Genet 2016; 17:71. [PMID: 27245440 PMCID: PMC4886457 DOI: 10.1186/s12863-016-0382-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 05/25/2016] [Indexed: 12/29/2022] Open
Abstract
Background In humans, muscle-specific nicotinergic acetylcholine receptor (AChR) is a transmembrane protein with five different subunits, coded by CHRNA1, CHRNB, CHRND and CHRNG/CHRNE. The gamma subunit of AChR encoded by CHRNG is expressed during early foetal development, whereas in the adult, the γ subunit is replaced by a ε subunit. Mutations in the CHRNG encoding the embryonal acetylcholine receptor may cause the non-lethal Escobar variant (EVMPS) and lethal form (LMPS) of multiple pterygium syndrome. The MPS is a condition characterised by prenatal growth failure with pterygium and akinesia leading to muscle weakness and severe congenital contractures, as well as scoliosis. Results Our whole exome sequencing studies have identified one novel and two previously reported homozygous mutations in CHRNG in three families affected by non-lethal EVMPS. The mutations consist of deletion of two nucleotides, cause a frameshift predicted to result in premature termination of the foetally expressed gamma subunit of the AChR. Conclusions Our data suggest that severity of the phenotype varies significantly both within and between families with MPS and that there is no apparent correlation between mutation position and clinical phenotype. Although individuals with CHRNG mutations can survive, there is an increased frequency of abortions and stillbirth in their families. Furthermore, genetic background and environmental modifiers might be of significance for decisiveness of the lethal spectrum, rather than the state of the mutation per se. Detailed clinical examination of our patients further indicates the changing phenotype from infancy to childhood.
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Affiliation(s)
| | - Navid Almadani
- Kariminejad-Najmabadi Pathology & Genetics Centre, Tehran, Iran
| | | | - Bjorn Olsson
- Systems Biology Research Centre, School of Bioscience, University of Skovde, SE-541 28, Skovde, Sweden
| | - Ali-Reza Moslemi
- Department of Pathology, University of Gothenburg, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden
| | - Homa Tajsharghi
- Systems Biology Research Centre, School of Bioscience, University of Skovde, SE-541 28, Skovde, Sweden. .,Department of Pathology, University of Gothenburg, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden.
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Bildner A. Prenatal Sonographic Detection of Skeletal Dysplasias. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479314528754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Skeletal dysplasias are a genetically heterogeneous group of disorders that can be diagnosed prenatally by sonography. Differentiating these disorders in the prenatal period can be difficult. However, differentiating known lethal disorders from nonlethal disorders can improve patient care and plan of action. This case study presents multiple pterygia, flexion contractures, and skeletal abnormalities, which are consistent with multiple pterygium syndrome, or Escobar syndrome.
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Deodhar A. An uncommon case of upper limb pterygia. Indian J Plast Surg 2012; 45:128-9. [PMID: 22754168 PMCID: PMC3385377 DOI: 10.4103/0970-0358.96610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Reporting images in a case of a 9-year-old boy who presented with bilateral congenital webbing (pterygium) of axillae and elbows. This deformity was restricting his axilla and elbow movements. This was successfully treated on one side with multiple Z-plasty. An outline of multiple pterygium syndrome is given herewith.
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Affiliation(s)
- Avinash Deodhar
- Department of Plastic Surgery, King Edward Memorial Hospital, Rasta Peth, Pune, Maharashtra, India
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Abstract
BACKGROUND Although scoliosis is a predominant feature of multiple pterygium syndrome (MPS), the pattern of deformity and the progression of the curvature have not been well described. The purpose of this study was to assess the prevalence of scoliosis among patients with MPS, and to characterize the abnormalities of the vertebrae and to assess the progression of the scoliosis. METHODS From 1969 to 2008, we identified 19 patients with MPS but only 16 patients (8 boys and 8 girls) had complete data. Medical records and radiographs of these 16 patients were reviewed. Magnetic resonance imaging was performed in 8 patients to evaluate intraspinal anomalies. Functional mobility score was used to assess the ambulatory ability. RESULTS Of 16 patients, 13 patients (81.3%) had scoliosis. The mean age when the scoliosis was first noticed was 3.3±2.6 years (range, 1 mo to 8.2 y). The mean Cobb angle at first visit was 37.4±18.1 degrees (range, 14.0 to 75.0 degrees). With a mean follow-up of 4.0±4.9 years, the Cobb angle at the last visit was 43.3±19.1 degrees (range, 20.0 to 72.0 degrees). Congenital scoliosis was observed in 7 patients (3 unilateral unsegmented bar, 3 fusion of the cervical spine, 1 block vertebrae), whereas neuromuscular scoliosis was observed in 1 patient. A common radiographic finding was narrowing of the intervertebral disc space with decreased height of vertebrae in the thoracic area. Intraspinal anomalies were seen in 4 patients (3 tethered spinal cords, 1 syrinx). At the last follow-up, 5 of 13 patients who had scoliosis were able to walk at school without assistance (Functional mobility scale-500 ≥5). CONCLUSIONS Scoliosis is common among children with MPS. It is frequently accompanied by fusion of the cervical area. Intraspinal anomalies such as tethered cord syndrome and syringomyelia are common associated anomalies. Therefore, it is important to look for intraspinal anomalies. Closed monitoring of the patient's ambulatory ability and bowel and bladder continence is also needed. LEVEL OF EVIDENCE Level IV, Diagnostic Study.
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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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Shawky RM, Elsayed S, Gaboon N. Multiple pterygium syndrome with marked pterygia of the fingers and MRI changes in the spine. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2012. [DOI: 10.1016/j.ejmhg.2011.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Anesthesic management for escobar syndrome: case report. Case Rep Med 2011; 2011:515719. [PMID: 21541234 PMCID: PMC3085429 DOI: 10.1155/2011/515719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 01/31/2011] [Accepted: 02/04/2011] [Indexed: 11/17/2022] Open
Abstract
Escobar syndrome is a rare autosomal recessive disorder which is characterized by growth retardation, axillary, antecubital, popliteal digital, and intercrural joint flexion contracture, pterygium in the eyes, cleft palate, decreased lung capacity, genital abnormalities, and spinal deformity. In this case, we presented the anesthesic management of a 2-year-old child undergoing frontal sling operation for ptosis and amblyopia etiology exploration.
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Güven A, Kırmızıbekmez H. Multiple pterygium syndrome: mimicking the findings of Turner syndrome. ACTA ACUST UNITED AC 2011. [DOI: 10.1515/jpem.2011.367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Eguiluz I, Barber MA, Martín A, Plasencia W, Arencibia O. Fetal akinesia deformation sequence. Pena-Shokeir type I syndrome: new features of an un-uncommon condition. J OBSTET GYNAECOL 2007; 26:818-20. [PMID: 17130047 DOI: 10.1080/01443610600987183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- I Eguiluz
- Obstetric and Gynaecology Department, University Hospital Materno-Infantil of the Canaries, Las Palmas de Gran Canaria, Spain
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Bellamy SG, Gibbs K, Lazaro R. Physical therapy intervention for an adolescent with a knee flexion contracture and diagnosis of multiple pterygium syndrome. Pediatr Phys Ther 2007; 19:140-7. [PMID: 17505291 DOI: 10.1097/pep.0b013e318036a29c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this case report is to describe a course of physical therapy for a client with a rare genetic condition, multiple pterygium syndrome (MPS). SUMMARY OF KEY POINTS MPS is a rare genetic disorder characterized by connective tissue webbing across multiple joints, dysmorphic facies, and various visceral and skeletal deformities. Before the patient commenced physical therapy, surgical amputation was recommended for the client's knee flexion contracture. The client's treatment plan included stretching, manual therapy, and resisted exercise. Long-term outcomes were decreased back and knee pain and improved range of motion, strength, and ambulation. CLINICAL RECOMMENDATIONS Therapists using techniques to improve joint range of motion in clients with MPS should be aware that pterygia may include contractile tissue, nerves, and blood vessels and there may be underlying skeletal deformity or weakness in these areas. Children with MPS are at high risk of developing scoliosis and should be appropriately assessed in early childhood.
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Affiliation(s)
- Sandra Gail Bellamy
- Physical Therapy Department, University of the Pacific, Stockton, California 95211, USA.
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Prontera P, Sensi A, Merlo L, Garani G, Cocchi G, Calzolari E. Familial occurrence of multiple pterygium syndrome: Expression in a heterozygote of the recessive form or variability of the dominant form? Am J Med Genet A 2006; 140:2227-30. [PMID: 16964621 DOI: 10.1002/ajmg.a.31428] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report on a case with apparently familial multiple pterygium syndrome (MPS). The proposita was a 3-year-old girl with classical symptoms of MPS. A careful clinical examination of the father disclosed the presence of few minor signs of the syndrome, including difficulty in opening the mouth widely, scoliosis, pectus excavatum, hands with slight cutaneous syndactyly, and bilateral single palmar creases. The radiograph of the hands disclosed malformed carpal bones and an altered metacarpal-phalangeal pattern. The father shows limited symptoms, which has been reported before in the autosomal dominant form of MPS. However, it is also possible that he is showing a heterozygous state of the autosomal recessive form of MPS. In conclusion, we emphasize the importance of examining accurately the parents of a child who has classical MPS phenotype, even those with normal stature and an absence of facial anomalies.
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Affiliation(s)
- Paolo Prontera
- Università di Ferrara, Genetica Medica, 44100 Ferrara, Italy.
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Rajab A, Hoffmann K, Ganesh A, Sethu AU, Mundlos S. Escobar variant with pursed mouth, creased tongue, ophthalmologic features, and scoliosis in 6 children from Oman. Am J Med Genet A 2005; 134A:151-7. [PMID: 15704180 DOI: 10.1002/ajmg.a.30583] [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: 11/10/2022]
Abstract
We report on six Omani children from two consanguineous families, with a multiple congenital anomaly syndrome defined by arthrogryposis multiplex congenita, typical facial appearance, ophthalmologic anomalies, atrophic calf muscles, and interdigital, neck and axillar pterygia. In addition, the patients present unique features as a furrowed tongue and enlarged corneal nerves, undescribed previously in association with other distal arhtrogryposis syndromes (DA). The patients can be classified as multiple pterygium syndrome (Escobar syndrome) but display overlapping features with Freeman-Sheldon syndrome and arthrogryposis with ophthalmologic abnormalities. We excluded two known arthrogryposis loci on chromosome 9p13 (TPM2) and 11p15 (TNNI2, TNNT3). We conclude that our patients display a subtype of multiple pterygium syndrome with overlapping features to other DAs.
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Affiliation(s)
- Anna Rajab
- Genetic Unit, DGHA, Ministry of Health, Muscat, Sultanate of Oman.
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Aslan Y, Erduran E, Kutlu N. Autosomal recessive multiple pterygium syndrome: a new variant? AMERICAN JOURNAL OF MEDICAL GENETICS 2000; 93:194-7. [PMID: 10925380 DOI: 10.1002/1096-8628(20000731)93:3<194::aid-ajmg6>3.0.co;2-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple pterygium syndromes include at least 15 different entities characterized by multiple pterygia or webs of the skin and multiple congenital anomalies. We describe a female infant who presented with a distinct constellation of multiple anomalies consisting of pterygia of the inguinal, intercrural and popliteal areas, flexion contractures and arthrogryposis of some joints, craniofacial anomalies including ectropion, medial canthal web, blepharophimosis, hypoplasia of nose, oral and nasopharyngeal cavities, vocal cords and tongue, micrognathia, orolabial synechiae secondary to pterygia, low set ears, alopecia, sad and expressionless face, short neck, asymmetric nipples, anal stenosis, rectal polyp, hypoplastic labia majora, complete syndactyly of all fingers and toes, pes equinovarus, bandlike web between feet, and absence of the nails and phalangeal-palmar creases. Radiological examination showed synostosis, absence or hypoplasia of metacarpal, metatarsal and phalangeal bones on feet and hands, and hypoplasia of pelvic bones and scapulae. This pattern of anomalies does not fit entirely any of the known multiple pterygium syndromes. Autosomal recessive inheritance is most likely due to the presence of three similarly affected siblings and normal parents.
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Affiliation(s)
- Y Aslan
- Department of Pediatrics, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
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Abstract
Severely involved female child with Multiple Pterygium Syndrome (Escobar) is described. She had the typical findings of the syndrome such as multiple pterygiums, characteristic facial appearance, genital anomalies. She also had bilateral optic atrophy. This is the first case described so far with optic atrophy in Multiple Pterygium Syndrome (Escobar).
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Affiliation(s)
- F F Ozkinay
- Ege University, Faculty of Medicine, Department of Pediatrics, Bornova, Izmir, Turkey
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Abstract
Escobar Syndrome, or Multiple Pterygium Syndrome (MPS), is a rare syndrome with multiple congenital anomalies involving the head and neck area and limbs. Affected individuals have multiple pterygia, camptodactyly and/or syndactyly as the main features of this syndrome. Patients with MPS have a characteristic facies, including ptosis, antimongoloid slant of the palpebral fissures, hypertelorism, micrognathia, neck pterygia, and a sad flat, emotionless look to the face. We present a case of MPS recently treated at our institution for the purpose of further describing the clinical features of this syndrome, emphasizing the otolaryngologic manifestations. Increased awareness of MPS will facilitate appropriate management of this syndrome.
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Affiliation(s)
- C J MacArthur
- Department of Otolaryngology, University of California, Irvine, Orange 92668, USA
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22
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Spranger S, Spranger M, Meinck HM, Tariverdian G. Two sisters with Escobar syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1995; 57:425-8. [PMID: 7677145 DOI: 10.1002/ajmg.1320570312] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report on 2 sisters with an autosomal-recessive multiple pterygium syndrome, type Escobar, consisting of multiple pterygia with severe contractures, short stature, and minor facial and external genital anomalies. The striking finding was severe muscular atrophy. We speculate that a neuromuscular disorder is the underlying pathogenesis of Escobar syndrome.
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Affiliation(s)
- S Spranger
- Institute of Human Genetics and Anthropology, University of Heidelberg, Germany
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Hennekam RC. Lingua cochlearis in multiple pterygium syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1993; 47:761. [PMID: 8267008 DOI: 10.1002/ajmg.1320470532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Willems PJ, Colpaert C, Vaerenbergh M, Van Thienen MN, Parizel PM, Van Marck E, Schuerwegh WH, Martin JJ. Multiple pterygium syndrome with body asymmetry. AMERICAN JOURNAL OF MEDICAL GENETICS 1993; 47:106-11. [PMID: 8368239 DOI: 10.1002/ajmg.1320470122] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We report on a fetus with multiple pterygia in the popliteal, antecubital, intercrural, axillary, and nuchal region, arthrogryposis, camptodactyly, anal atresia, hypospadias, ambiguous genitalia, and neonatal death. Arthrogryposis was much more pronounced at the left than at the right side. Moreover, there was gross body asymmetry with hypoplasia of the left arm, leg, pelvis, and kidney. As this spectrum of anomalies does not fit any of the known multiple pterygium syndromes, this patient adds another clinical entity to the already wide spectrum of multiple pterygium syndromes.
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Affiliation(s)
- P J Willems
- Department of Medical Genetics, University of Antwerp-U.I.A., Belgium
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Abstract
Multiple pterygium syndrome is a rare, inherited disorder manifested by growth retardation, facial or genital anomalies, and widespread musculoskeletal deformities. Pterygia are the predominant hallmark of the syndrome. Five children with multiple pterygium syndrome were treated from 1978 to 1987. Treatment involved both upper and lower pterygia and contractures. The results of treatment and modalities used are discussed and a protocol suggested.
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Affiliation(s)
- R E McCall
- Shriners Hospital for Crippled Children, Shreveport, LA 71103
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Gabrielli O, Catassi C, Carlucci A, Coppa GV, Giorgi P. Intestinal lymphangiectasia, lymphedema, mental retardation, and typical face: confirmation of the Hennekam syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1991; 40:244-7. [PMID: 1897580 DOI: 10.1002/ajmg.1320400223] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report on a male with intestinal lymphangiectasia, mild mental retardation, seizures, and a typical face; the syndrome was first delineated by Hennekam et al., Am. J. Med. Genet. 34:593-600 [1989]. His parents are consanguineous. This case seems to confirm the existence of the Hennekam syndrome.
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Affiliation(s)
- O Gabrielli
- Department of Pediatrics, University of Ancona, Italy
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Hunter A. The popliteal pterygium syndrome: report of a new family and review of the literature. AMERICAN JOURNAL OF MEDICAL GENETICS 1990; 36:196-208. [PMID: 2164325 DOI: 10.1002/ajmg.1320360213] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This paper reports on a family with popliteal pterygium syndrome (PPS), which was ascertained through a baby with most of the major signs of the syndrome. The mother, who had a repaired cleft palate and toe syndactyly, had been aware that her syndactyly was familial, but her unpreparedness for the birth of a child with PPS led to interest in, and a subsequent review of, the differnetial diagnosis and the variable expression of the clinical manifestations of this syndrome. Upon review, some earlier reported cases were excluded as PPS, and certain ascertainment and reporting biases that could affect such an analysis were considered.
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Affiliation(s)
- A Hunter
- Division of Genetics, Children's Hospital, Eastern Ontario, Canada
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Moerman P, Fryns JP, Cornelis A, Bergmans G, Vandenberghe K, Lauweryns JM. Pathogenesis of the lethal multiple pterygium syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1990; 35:415-21. [PMID: 2309791 DOI: 10.1002/ajmg.1320350319] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We present autopsy studies in 4 unrelated fetuses with the lethal multiple pterygium syndrome (LMPS) with special emphasis on the neuromuscular system. The data suggest that LMPS combines the manifestations of a jugular lymphatic obstruction sequence with those of an early severe fetal akinesia sequence. The jugular lymphatic obstruction sequence with resultant edema and cystic hygroma colli causes fetal lethality usually in the second trimester of pregnancy. Generalized amyoplasia appears to be an important mechanism in the pathogenesis of fetal akinesia as part of LMPS and is not associated with dysgenesis or degeneration of the central nervous system (CNS) but is apparently the result of an early fetal muscular "dystrophy." We propose a genetically determined insult affecting the early embryonic development of both lymph vessels and muscles as the basic defect in LMPS. Placental structure, studied in all 4 cases, demonstrated that triploidy-like placental lesions are specific to LMPS. The present findings suggest that LMPS may be a less heterogeneous entity than previously proposed.
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Affiliation(s)
- P Moerman
- Department of Pathology, Katholieke Universiteit Leuven, Belgium
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Cunningham LN, Keating MA, Snyder HM, Duckett JW. Urological manifestations of the popliteal pterygium syndrome. J Urol 1989; 141:910-2. [PMID: 2926888 DOI: 10.1016/s0022-5347(17)41049-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report a case of the popliteal pterygium syndrome resulting in abnormalities of the external genitalia and testicular ectopia. Management included bilateral orchiopexy and complex genitoplasty. Pterygia represent errors in development that manifest as webs across joints and can result in anomalies of the external genitalia. The genitourinary aspects of the popliteal pterygium syndrome and their management are discussed.
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Affiliation(s)
- L N Cunningham
- Division of Urology, Children's Hospital of Philadelphia, Pennsylvania
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Fryns JP, Volcke P, van den Berghe H. Multiple pterygium syndrome type Escobar in two brothers. Follow-up data from childhood to adulthood. Eur J Pediatr 1988; 147:550-2. [PMID: 3409934 DOI: 10.1007/bf00441989] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We present two brothers with Multiple Pterygium Syndrome type Escobar. Characteristic findings in this autosomal recessively inherited pterygium syndrome are, in addition to multiple pterygia, short stature, cleft palate, vertebral fusion defects and minor facial anomalies. The adult height in the two male siblings was below the third centile. Secondary sexual development and testicular size were normal, in contrast with the cryptorchidism and pubertal delay documented in most young patients.
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Affiliation(s)
- J P Fryns
- Centre for Human Genetics, University of Leuven, Belgium
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Zeitune M, Fejgin MD, Abramowicz J, Ben Aderet N, Goodman RM. Prenatal diagnosis of the pterygium syndrome. Prenat Diagn 1988; 8:145-9. [PMID: 3283718 DOI: 10.1002/pd.1970080208] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report two second trimester pregnancy terminations in the same woman following intrauterine ultrasonic findings of hydrops fetalis, polyhydramnios, lack of fetal movements, and short, fixed malformed limbs. One fetus also showed a cystic mass at the back of the head. Radiographic and anatomic studies of the fetuses demonstrated multiple pterygia, flexion contracture of multiple joints, abnormal facial appearance, cleft palate, pulmonary hypoplasia, and gracile bones. The cystic mass of the back of the head was found to be a cystic hygroma. These findings are consistent with the lethal variant of multiple pterygium syndrome. Early prenatal diagnosis of this condition is possible using ultrasonography.
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Affiliation(s)
- M Zeitune
- Department of Obstetrics and Gynecology, A Meir Hospital, Kfar Saba, Israel
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Thompson EM, Donnai D, Baraitser M, Hall CM, Pembrey ME, Fixsen J. Multiple pterygium syndrome: evolution of the phenotype. J Med Genet 1987; 24:733-49. [PMID: 3430553 PMCID: PMC1050402 DOI: 10.1136/jmg.24.12.733] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The clinical features of the multiple pterygium syndrome are multiple congenital joint contractures, multiple skin webs, camptodactyly, vertebral anomalies, short stature, ptosis, and antimongoloid eye slant. We present 11 new cases to show the evolution of the full phenotype from birth and to confirm autosomal recessive inheritance. We emphasise morbidity secondary to respiratory impairment and that conductive deafness may be part of the syndrome.
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Bisceglia M, Zelante L, Bosman C, Cera R, Dallapiccola B. Pathologic features in two siblings with the Pena-Shokeir I syndrome. Eur J Pediatr 1987; 146:283-7. [PMID: 3595647 DOI: 10.1007/bf00716474] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Two siblings whose clinical and pathologic features were consistent with the "Syndrome of camptodactyly, multiple ankyloses and pulmonary hypoplasia" originally described by Pena and Shokeir were examined at autopsy. Additional features were intrauterine growth retardation, immaturity of the central nervous system (CNS) and atrophy of skeletal muscles. Our data suggest that CNS damage may cause the complicated phenotypic abnormalities of the syndrome.
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Papadia F, Longo N, Serlenga L, Porzio G. Progressive form of multiple pterygium syndrome in association with nemalin-myopathy: report of a female followed for twelve years. AMERICAN JOURNAL OF MEDICAL GENETICS 1987; 26:73-83. [PMID: 3812582 DOI: 10.1002/ajmg.1320260114] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We report on a girl with progressive multiple pterygium syndrome in association with gluteal muscle fibrosis and nemalin-myopathy. This girl has been followed for 12 years. Clinical findings, natural history, and the presence of nemalin myopathy suggest the possibility of a distinct form of multiple pterygium syndrome in this patient.
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Haspeslagh M, Fryns JP, de Mûelenaere A, Schautteet L, van Eeckhoutte I, van den Berghe H. Mental retardation with pterygia, shortness and distinct facial appearance. A new MCA/MR syndrome. Clin Genet 1985; 28:550-5. [PMID: 4075567 DOI: 10.1111/j.1399-0004.1985.tb00425.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
During a systematic survey of the mentally retarded, 3 related females were seen with a similar syndrome of shortness, unusual combination of craniofacial anomalies (trigonocephaly; bulging forehead; flat face; posteriorly angulated, lowset ears and microretrognathia), and genital hypoplasia in all 3 cases, and multiple pterygia in one. The facial changes were also noted in 2 grandmothers and may indicate autosomal dominant inheritance of this presently "private" MCA/MR syndrome.
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Abstract
We report on a mother and her dizygotic twin fetuses who were affected with distal arthrogryposis. In addition the mother has cervical vertebral anomalies, scoliosis, short stature, nuchal and axillary pterygia, and unusual facial appearance. The fetuses had a short neck, pterygium colli, retrognathia, and mild apparent scoliosis. We think that these three individuals have a previously undescribed type of distal arthrogryposis.
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Abstract
In addition to the clinical characteristics of Escobar syndrome, including an anomalous facial expression, multiple joint contractures, multiple pterygia and a short stature, two female siblings developed proximal dominant muscle weakness from birth and slowly progressive scoliosis. Biopsied specimens obtained from the paravertebral and gluteus maximums muscles at the time of spinal surgery showed variation in fiber size, increased numbers of fibers with central nuclei, interstitial fibrosis and disorganized intermyofibrillar networks with occasional core/targetoid formations. The most outstanding histochemical abnormality in both cases was an abnormal fiber type distribution (type 2 fiber deficiency) which might be the result of an abnormal or deficient neural supply to the developing muscles. The defective neural influence on the muscle is assumed to produce the above-mentioned muscle changes, inducing multiple joint contractures and scoliosis.
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Isaacson G, Gargus JJ, Mahoney MJ. Brief clinical report: lethal multiple pterygium syndrome in an 18-week fetus with hydrops. AMERICAN JOURNAL OF MEDICAL GENETICS 1984; 17:835-9. [PMID: 6720748 DOI: 10.1002/ajmg.1320170413] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We present the case of an 18-week abortus with lethal multiple pterygium syndrome and hydrops. Radiographic and anatomic study showed none of the bony abnormalities reported in live-born children with multiple pterygium syndrome. The pathogenesis of the hydrops was not apparent. The findings of cleft palate, pulmonary hypoplasia, muscular atrophy, gracile thoracic bones, and fetal death are typical of the lethal variant.
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Papadia F, Zimbalatti F, La Rosa CG. The Bartsocas-Papas syndrome: autosomal recessive form of popliteal pterygium syndrome in a male infant. AMERICAN JOURNAL OF MEDICAL GENETICS 1984; 17:841-7. [PMID: 6720749 DOI: 10.1002/ajmg.1320170414] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We report on an additional patient with the severe autosomal recessive form of the popliteal pterygium syndrome. The patient was diagnosed at birth and had all of the phenotypic manifestations of this rare syndrome. Clinical findings and natural history suggest this is a distinct genetic entity.
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Chen H, Immken L, Lachman R, Yang S, Rimoin DL, Rightmire D, Eteson D, Stewart F, Beemer FA, Opitz JM. Syndrome of multiple pterygia, camptodactyly, facial anomalies, hypoplastic lungs and heart, cystic hygroma, and skeletal anomalies: delineation of a new entity and review of lethal forms of multiple pterygium syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1984; 17:809-26. [PMID: 6720746 DOI: 10.1002/ajmg.1320170411] [Citation(s) in RCA: 74] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Three unrelated stillborn infants (cases 1-3) are presented here with a distinct constellation of multiple anomalies: namely, multiple pterygia involving chin-to-sternum, cervical, axillary, antecubital, crural and/or popliteal areas, flexion contractures of multiple joints, small chest, hydrops, characteristic abnormal facial appearance with hypertelorism, markedly flattened nasal bridge with hypoplastic nasal alae, cleft palate, micrognathia, apparently low-set malformed ears, short neck with a cystic hygroma at the back of the neck and head, and pulmonary and cardiac hypoplasia. Radiographic studies, in addition, showed scalp edema, microbrachycephaly, flattened mandibular angle, lack of normal curvature at the cervico-thoracic junction, marked bony fusion of posterior spinous processes of older fetuses (cases 1, 2), thin crowded ribs, markedly hypoplastic scapulae, hypoplastic iliac wings, ischia and pubic bones, undermodeling of tubular bones, and radio-ulnar synostosis. Histologic studies of the skeletal system showed cartilaginous and bony fusion of the spinous processes (cases 1, 2), fusion of epiphyseal cartilages of distal humerus and proximal ulna, a poorly developed joint space, an abnormal growth plate, and weak safranin staining of the resting cartilages (cases 1, 2). To the best of our knowledge, this pattern of anomalies constitutes a previously undescribed syndrome. Prenatal diagnosis of this entity is possible by ultrasonographic studies on the basis of nonimmune fetal hydrops, a cystic hygroma at the back of the head and neck, diminished fetal activity, short and fixed limbs, and/or maternal hydramnios. Three additional cases (cases 4-6) are also presented to show a possible heterogeneity of this syndrome.
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Kok JG, Gabreëls FJ, Renier WO, ter Laak HJ, Slot GH, Bouwsma G. Multiple pterygium syndrome. A report of two unrelated cases. Clin Neurol Neurosurg 1984; 86:101-5. [PMID: 6329574 DOI: 10.1016/0303-8467(84)90073-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Clinical description as well as differential diagnosis are presented of two unrelated patients with the so-called Multiple Pterygium Syndrome. In literature pathological alterations of muscle structures in some patients have been described. In our two patients no evidence was found for a neuromuscular disease, nor for a disease state of the central nervous system.
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Chen H, Blumberg B, Immken L, Lachman R, Rightmire D, Fowler M, Bachman R, Beemer FA. The Pena-Shokeir syndrome: report of five cases and further delineation of the syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1983; 16:213-24. [PMID: 6650566 DOI: 10.1002/ajmg.1320160211] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We report on five cases of lethal Pena-Shokeir syndrome from three families with affected sibs. In addition to multiple anklyoses, camptodactyly, facial anomalies, and pulmonary hypoplasia, one fetus had pterygia of the neck and axillae and cardiac hypoplasia. Radiographic changes are nonspecific and probably are related to a lack of intrauterine movement. Our data and review of the literature suggest that pterygium formation is one of the manifestations of the Pena-Shokeir syndrome. A recently described lethal form of the recessively inherited multiple pterygium syndrome may represent a severe form of the Pena-Shokeir syndrome.
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Hall JG, Reed SD, Rosenbaum KN, Gershanik J, Chen H, Wilson KM. Limb pterygium syndromes: a review and report of eleven patients. AMERICAN JOURNAL OF MEDICAL GENETICS 1982; 12:377-409. [PMID: 7124793 DOI: 10.1002/ajmg.1320120404] [Citation(s) in RCA: 138] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Conditions with limb pterygia and congenital contractures were reviewed as part of a study of over 350 infants with arthrogryposis. Emphasis was placed on inheritance and variability of distinct pterygium conditions. Eleven patients with limb pterygia were recognized in our study and are described here. Seven of the 350 patients with congenital contractures had the autosomal recessively inherited multiple pterygium syndrome (Patients 1-7). Three of the seven are sibs, a fourth was born to consanguineous parents, and three were chance isolated cases. These seven had multiple joint webs, unusual finger contractures, syndactyly, rocker bottom feet, ptosis, antimongoloid slant of palpebral fissures, epicanthal folds, highly arched palate, scoliosis, and short stature. There is intrafamilial variability. Three patients from one family had a lethal multiple pterygium syndrome. Two were monozygotic twins. They had webbing and contractures of the elbows, knees, neck, and fingers, calcaneovalgus deformity of the feet, and an unusual facial appearance: hypertelorism, flat nose, antimongoloid slant of palpebral fissures, apparently low-set ears. One had a cleft palate. Internal malformations included: bilateral pulmonary hypoplasia, small heart, absence of the appendix, and attenuation of the ascending and transverse colon. One sporadic case of lethal popliteal pterygium with facial clefts was studied. Multiple anomalies included: ankyloblepharon filiforme adnatum, upslanting palpebral fissures, hypoplasia of nasal cartilages, frenula, clefts into the oropharynx lateral to the mouth, apparently low-set ears with slit-like canals, large popliteal pterygia, syndactyly with fusion of all digits in hands and feet, and hypoplastic labia.
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