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Lynch H, Dweck E, Nadeem J. The Importance of Primary Care Physicians in the Diagnosis and Exclusion of Rare Syndromes: A Case Study of Ruling Out PHACE Syndrome. Cureus 2024; 16:e51939. [PMID: 38333469 PMCID: PMC10851920 DOI: 10.7759/cureus.51939] [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] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
PHACE (posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta/cardiac defects, and eye abnormalities) syndrome is an extremely uncommon condition that requires a team of physicians to properly diagnose, treat, and follow. Patients are at risk of posterior fossa malformations, hemangiomas, and arterial, cardiac, eye, and sternal cleft abnormalities. These syndrome hallmarks can cause severe functional and developmental issues or, in the worst case, death. The pediatrician's role is even more essential for pediatric patients who present with rare and intricate syndromes. Primary care physicians are the first line of defense for patients. They recognize alarm signs, coordinate patient care, and promote participation. This case report aims to describe the process by which a multisystemic and potentially lethal syndrome was excluded and illustrates the significance of a primary care physician for the diagnosis and management of such conditions.
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Affiliation(s)
- Hannah Lynch
- Graduate Medical Education, New York Institute of Technology College of Osteopathic Medicine (NYITCOM), New York, USA
| | - Ezra Dweck
- Department of Family Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Jehanzeb Nadeem
- Department of Family Medicine, Jamaica Hospital Medical Center, New York, USA
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Lamotte M, Paris C, Euvrard E, Pomero E, Schwartz C, Vené Y, Aubin F, Puzenat E. Long-term follow-up of patients with extensive segmental infantile hemangioma of the cervical or facial region: A French single-center prospective study. Arch Pediatr 2023:S0929-693X(23)00057-X. [PMID: 37188563 DOI: 10.1016/j.arcped.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/29/2023] [Accepted: 03/25/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Infantile hemangiomas (IHs) can be part of PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, eye anomalies) syndrome when they are segmental, extensive, and located on the face or neck. The initial assessment is codified and well known, but there are no recommendations for the follow-up of these patients. The aim of this study was to assess the long-term prevalence of different associated abnormalities. METHODS Patients with a history of large segmental IHs of the face or neck. diagnosed between 2011 and 2016 were included in the study. Each patient underwent an ophthalmological, dental, ENT (ear, nose, and throat), dermatological, neuro-pediatric, and radiological assessment at inclusion. Eight patients including five with PHACE syndrome were prospectively evaluated. RESULTS After a mean follow-up of 8.5 years, three patients presented with an angiomatous aspect of the oral mucosa, two with hearing loss, and two with otoscopic abnormalities. No patients developed ophthalmological abnormalities. The neurological examination was altered in three cases. Brain magnetic resonance imaging follow-up was unchanged in three out four patients and revealed atrophy of the cerebellar vermis in 1 patient. Neurodevelopmental disorders were found in five of the patients and learning difficulties were observed in five patients. The S1 location appears to be associated with a higher risk of neurodevelopmental disorders and cerebellar malformations, while the S3 location was associated with more progressive complications, including neurovascular, cardiovascular, and ENT abnormalities. CONCLUSION Our study reported late complications in patients with a large segmental IH of the face or neck, whether associated with PHACE syndrome or not, and we proposed an algorithm to optimize the long-term follow-up.
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Affiliation(s)
- M Lamotte
- Service de Dermatologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - C Paris
- Service de Pédiatrie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - E Euvrard
- Service de Chirurgie maxillo-faciale, Stomatologie et Odontologie hospitalière, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - E Pomero
- Service de Radiologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - C Schwartz
- Service d'Ophtalmologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - Y Vené
- Service d'ORL, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - F Aubin
- Service de Dermatologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France; Inserm UMR 1098 RIGHT, Besançon, France.
| | - E Puzenat
- Service de Dermatologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
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O TMJ, Ceisler E, Broude C, Chan K, Pacicco L, Fay A, Waner M. Distribution and Clinical Characteristics of Periorbital Infantile Hemangiomas. Facial Plast Surg Aesthet Med 2023; 25:172-178. [PMID: 36473202 DOI: 10.1089/fpsam.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Periorbital infantile hemangiomas (POIHs) are associated with a high incidence of visual complications. Objective(s): To analyze the sites of predilection of POIHs and to determine whether certain sites require earlier intervention due to their higher rate of visual complications. Methods: A retrospective case series study was conducted on patients from two tertiary care centers for 25 years. The location of POIHs was determined from clinical photographs, medical records, and radiological studies. The presence or absence of anisometropic astigmatism (anisoastigmatism) and amblyopia was recorded. Data were analyzed using a chi-square test. Results: There were 486 patients, of which 302 patients had ophthalmology evaluations and 245 patients had refractive error data. At presentation, 10% of patients already had amblyopia and 44% had anisoastigmatism. Medial eyelid lesions had the highest risk of developing anisoastigmatism (anisoastigmatism correlates with eyelid position, p = 0.0001). Segmental and upper medial lesions had the highest risk of amblyopia at initial evaluation. Conclusion: The site of POIH is an important indicator for developing clinically significant anisoastigmatism and amblyopia, underlining the need for early ophthalmologic assessment and management.
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Affiliation(s)
- Teresa Min-Jung O
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA
| | - Emily Ceisler
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, USA
| | - Caroline Broude
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA
| | - Kimberly Chan
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA.,College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Lauren Pacicco
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA
| | - Aaron Fay
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Milton Waner
- Vascular Birthmark Institute of New York, New York, New York, USA.,Department of Otolaryngology, Lenox Hill Hospital, New York, New York, USA
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Kalambe AS, Sugihara K, Yamamoto K, Kawano S, Oyama C, Taketani T, Hayashida K, Tanito M. PHACE(S) Syndrome with Ocular Involvements and No Periocular Hemangioma. Case Rep Ophthalmol 2023; 14:477-483. [PMID: 37901638 PMCID: PMC10601854 DOI: 10.1159/000533887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/27/2023] [Indexed: 10/31/2023] Open
Abstract
PHACE(S) syndrome is a neurocutaneous disorder with a hallmark finding of an infantile facial hemangioma (IFH) >5 cm. Eye examination of patients with PHACE(S) syndrome with no IFH at periorbital region is reported to be of low yield. We report a unique case of the syndrome with ocular manifestations without periorbital IFH or systemic findings. A 3-week-old female infant with right periauricular IFH >5 cm, extending to the neck and cheek and lower lip IFH was presented. Examination revealed pseudoptosis due to microphthalmia with esotropia and hypertropia. Both corneas were clear with diameters of 5 mm and 10 mm, right eye (RE) and left eye (LE), respectively. There was a posterior polar cataract with a poor view of the fundus RE. Ocular B-scan and magnetic resonance imaging (MRI) findings were suggestive of a dysmorphic globe, vitreous hemorrhage, spherophakia and persistent fetal vasculature RE and normal findings LE. Clinical evaluation, MRI, and MR angiography revealed no other systemic abnormalities. Subsequent follow-up visits revealed progressive clouding of the cornea with neovascularization and the development of phthisis bulbi RE at which point an ocular prosthesis was placed. The IFH was managed with dye laser and with oral propranolol. At 1 year, the patient has remained stable with no development of new local or systemic anomalies, regression of the periauricular and lip IFH, and normal development of the orbital structure RE with an ocular prosthesis in situ. Ocular involvement in patients with PHACE(S) syndrome may be present without periorbital IFH. Regardless of the location of the IFH and the presence or absence of a periocular component, it is recommended that they receive a full initial ophthalmological assessment.
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Affiliation(s)
- Aisha Sheriff Kalambe
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
- Department of Ophthalmology, Asokoro District Hospital, Abuja, Nigeria
- Department of Ophthalmology, College of Medical Sciences, Nile University of Nigeria, Abuja, Nigeria
| | - Kazunobu Sugihara
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kei Yamamoto
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Sakiko Kawano
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Chigusa Oyama
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Takeshi Taketani
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
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The eyes have it: when skin findings prompt referral to ophthalmology. Curr Opin Pediatr 2022; 34:381-389. [PMID: 35836396 DOI: 10.1097/mop.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Co-presentation of ocular and cutaneous conditions is common and prompt recognition of known associations may be imperative to sight-saving intervention. There are currently limited reviews in the pediatric literature addressing comorbid ocular and dermatologic presentations. Recent diagnostic and therapeutic advances have drastically altered the prognostic landscape for several disease states when recognition and referral are timely. The aim of this report is to examine important oculocutaneous disease associations with emphasis on management of ocular complications and appropriate referral practices to ophthalmology specialists. RECENT FINDINGS Oculocutaneous associations can be broadly classified into four etiologic categories: infectious, inflammatory, genetic, and medication/nutrition induced pathology. Several conditions in all four categories have had recent advances in their etiologic understanding, diagnostic evaluation, and therapeutic approach. Thematically, these advances highlight increasing disease prevalence of certain conditions, previously unrecognized pediatric relevance of others, updated diagnostic criteria, and newer categories of iatrogenic illness induced by advances in medical therapy. SUMMARY This review is designed to provide the pediatric practitioner a vignette-based high-level overview of both common and sight threatening associations that should prompt consideration for ophthalmology consultation. Conditions were selected based on relevance, relative urgency, and recent advances in their etiologic/therapeutic understanding.
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Soliman SE, Wan MJ, Pennal A, Pope E, Mireskandari K. Ophthalmic involvement in PHACES syndrome: prevalence, spectrum of anomalies, and outcomes. J AAPOS 2022; 26:129.e1-129.e7. [PMID: 35550864 DOI: 10.1016/j.jaapos.2022.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/13/2021] [Accepted: 01/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To highlight prevalence, spectrum of anomalies, and outcome of ophthalmic involvement in PHACES syndrome (posterior fossa malformations, infantile hemangiomas, arterial, cardiac, eye, and sternal anomalies). METHODS A retrospective, noncomparative, single-institution observational case series of children with PHACES was conducted from 2000 to 2019. Data on ocular presentations, interventions and visual outcomes were collected. Primary outcome measures were the frequency and spectrum of ocular involvement. Secondary outcomes were final visual acuity, long-term ocular sequelae, and frequency of surgical interventions. RESULTS A total of 43 infants had PHACES, of whom 29 (67%) had periocular infantile facial hemangiomas (IFH) and 6 (14%) had primary ocular anomalies that were always ipsilateral to the IFH. Five patients (12%) met ocular PHACES-specific diagnostic criteria, including optic nerve (3), retinal vascular (1) and lenticular (2) anomalies. Non-PHACES-specific abnormalities were Peters anomaly (1), persistent pupillary membranes (2), dysmorphic optic nerves (1), and iris/choroidal hemangiomas (2). IFH-related periocular abnormalities were frequent: ptosis (29), proptosis (9), strabismus (6). Surgery was required in 8 of the 29 children: (strabismus [6], entropion [2], ptosis [2], and optical iridectomy [1]), all of whom had orbital/conjunctival hemangioma (P = 0.03). Final visual acuity (follow-up, 8.7 years) ranged between 20/20 and 20/80 in 26 of 29 patients. All patients with visual acuity worse than 20/200 (3/29 [10%]) had structural anomalies. CONCLUSIONS Two-thirds of infants with PHACES have periocular IFH causing vision compromising complications of amblyopia and strabismus. Structural ocular anomalies exist in 1 of 7 patients and are always ipsilateral to the IFH. Long-term ophthalmic monitoring and management is required, and the majority of patients obtain good visual outcomes.
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Affiliation(s)
- Sameh E Soliman
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Michael J Wan
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Alexandra Pennal
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Elena Pope
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Kamiar Mireskandari
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
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Saikia SJ, Nirmala SR. Identification of disease genes and assessment of eye-related diseases caused by disease genes using JMFC and GDLNN. Comput Methods Biomech Biomed Engin 2021; 25:359-370. [PMID: 34384296 DOI: 10.1080/10255842.2021.1955358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Early detection of disease genes helps humans to recover from certain gene-related diseases, like genetic eye diseases. This work identifies the possibility of eye diseasesfor the disease genes utilizing a Gaussian-activation function (G)-centric deeplearning neural network (GDLNN) model. In this work, human genes are selected by computing structural similarity and genes are clustered as disease genesand normal genes by using the JMFC clustering algorithm. Levy flight and Crossover and Mutation (LCM) centric Chicken Swarm Optimization (LCM-CSO) is employed for feature selection and GDLNN classifies the eye-related diseases for the input genes using the selected features.
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Affiliation(s)
- Samar Jyoti Saikia
- Department of Electronics and Communication Engineering, Gauhati University, Guwahati, Assam, India.,Department of Electronics and Communication Engineering, Assam Don Bosco University, Guwahati, Assam, India
| | - S R Nirmala
- Department of Electronics and Communication Engineering, Gauhati University, Guwahati, Assam, India.,School of Electronics and Communication Engineering, KLE Technological University, Hubli, Karnataka, India
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Ali MJ. Updates on congenital lacrimal drainage anomalies and their association with syndromes and systemic disorders: A major review. Ann Anat 2020; 233:151613. [PMID: 33098980 DOI: 10.1016/j.aanat.2020.151613] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To review and update the syndromic and non-syndromic systemic associations of congenital lacrimal drainage anomalies. METHODS The authors performed a PubMed search of all articles published in English on congenital lacrimal drainage anomalies (CLDA). The current review provides an update from January 2017 to August 2020 on all CLDA associated with clinical syndromes or non-syndromic systemic disorders. The update intends to appraise the readers on all papers that were published in the interim 3-year period since the publication of the previous major review by authors (1933-2016). Patients with specific syndromes or systemic disorders were then reviewed. Pertinent cross-references from each of the short-listed articles were also included. Data reviewed include syndromic descriptions, systemic details, demographics, lacrimal presentations, management, and outcomes. RESULTS There have been significant new updates. Eleven new syndromes have been added to the list of syndromic associations, of which three were suspects. Among the new syndromic associations, three (PHACE, Williams-Beuren, and Peter's plus syndromes) described CLDA details in depth. Several new non-syndromic systemic conditions with associated CLDA also came to light, the foremost amongst them being proboscis lateralis, diprosopus dirrhinus, cerebral palsy, and NGLY-1 related disorders. Although familial presentations have been reported, the inheritance patterns are unclear for most anomalies. Surgical challenges in these patients are distinct, and a thorough pre-operative assessment, including detailed imaging when indicated, may facilitate good outcomes. Two updated tables reflecting the summary of syndromic and non-syndromic systemic associations are provided to capture the details at a glance. CONCLUSION It is not very uncommon to find CLDA in syndromic or non-syndromic systemic disorders. Diagnosis of a craniofacial syndrome should prompt the physician to look out for CLDA. Similarly, a diagnosis of multiple CLDA should alert the examiner for the possible presence of associated systemic anomalies.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, India.
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