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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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Kawano O, Saito T, Sumitomo N, Takeshita E, Shimizu-Motohashi Y, Nakagawa E, Mizuma K, Tanifuji S, Itai T, Miyatake S, Matsumoto N, Takahashi Y, Mizusawa H, Sasaki M. Skeletal anomaly and opisthotonus in early-onset epileptic encephalopathy with KCNQ2 abnormality. Brain Dev 2023; 45:231-236. [PMID: 36631315 DOI: 10.1016/j.braindev.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Heterozygous KCNQ2 variants cause benign familial neonatal seizures and early-onset epileptic encephalopathy in an autosomal dominant manner; the latter is called KCNQ2 encephalopathy. No case of KCNQ2 encephalopathy with arthrogryposis multiplex congenita has been reported. Furthermore, early-onset scoliosis and opisthotonus have not been documented as characteristics of KCNQ2 encephalopathy. CASE REPORT A male infant born with scoliosis and arthrogryposis multiplex congenita developed intractable epilepsy on the second day of life. At 4 months of age, he developed opisthotonus. The opisthotonus was refractory to medication in the beginning, and it spontaneously disappeared at 8 months of age. Whole-exome sequencing revealed a novel de novo heterozygous variant in KCNQ2, NM_172107.4:c.839A > C, p.(Tyr280Ser). CONCLUSIONS Early-onset scoliosis, arthrogryposis multiplex congenita, and opisthotonus may be related to KCNQ2 encephalopathy.
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Affiliation(s)
- Osamu Kawano
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Eri Takeshita
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuko Shimizu-Motohashi
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kanako Mizuma
- Department of Pediatrics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Sachiko Tanifuji
- Department of Pediatrics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Toshiyuki Itai
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Clinical Genetics Department, Yokohama City University Hospital, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hidehiro Mizusawa
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masayuki Sasaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
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Tarakci D, Leblebici G, Tarakci E, Bursali A. The effectiveness of three-phase physiotherapy program in children with clubfoot after Ponseti treatment. Foot Ankle Surg 2022; 28:181-185. [PMID: 33722486 DOI: 10.1016/j.fas.2021.03.003] [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: 10/26/2020] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUNDS Clubfoot is a foot disorder frequently seen. Although, there are several studies about the efficiency of physiotherapy in the treatment of clubfoot, physiotherapy programs may be more efficient if the treatment apply step by step similar to the logic of the serial casting progression of the involved foot. Therefore, the aim of this study was to determine the effectiveness of three-phase physiotherapy program in children with clubfoot. METHODS Fifty-seven patients (37 males, 20 females; 7.26 ± 1.27 years) with clubfoot which had Ponseti treatment before were included. The ankle dorsiflexion (DF) and plantar flexion (PF) ranges of motion (ROM), one-leg standing time, sit-to-stand test, The Oxford Ankle Foot Questionnaire (OxAFQ) and treatment satisfaction were evaluated before and after treatment. A three-phase physiotherapy program was applied for 3 months. RESULTS DF, PF, one-leg standing time, sit-to-stand test, treatment satisfaction and all parameters of OxAFQ except 'Emotional' parameter of OxAFQ-Children significantly improved after treatment (p < 0.05). CONCLUSIONS The three-phase physiotherapy program increased the ankle range of motion, improved functional status and treatment satisfaction in children with clubfoot. The three-phase physiotherapy might be a reasonable treatment for clubfoot. Although, there is a need for long-term studies to understand its effects on preventing relapse.
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Affiliation(s)
- Devrim Tarakci
- Istanbul Medipol University, Faculty of Health Science, Division of Occupational Therapy, Istanbul, Turkey.
| | - Gokce Leblebici
- Istanbul Medeniyet University, Faculty of Health Science, Division of Physiotherapy and Rehabilitation, Istanbul, Turkey; Istanbul University-Cerrahpasa, Institute of Graduate Studies, Division of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Ela Tarakci
- Istanbul University-Cerrahpasa, Faculty of Health Science, Division of Physiotherapy and Rehabilitation, Istanbul, Turkey.
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Abstract
Metabolic disorders in a neonate can present with involvement of any organ system and can be challenging to diagnose. A newborn can present with an acute metabolic crisis such as hyperammonemia or seizures needing immediate management, with a more chronic clinical picture such as cholestatic liver disease, or with structural abnormalities such as skeletal manifestations. Early detection of treatable metabolic conditions is important to improve outcomes. Newborn screening has facilitated early detection and initiation of therapy for many metabolic disorders. However, normal testing does not rule out a metabolic disorder and a high index of suspicion should remain when caring for any critically ill neonate without a diagnosis. Whole exome sequencing (WES) or whole genome sequencing (WGS) can be powerful tools in rapid diagnosis of a potentially treatable metabolic condition in a critically ill neonate. This review presents classic clinical presentations of neonatal metabolic disorders and also highlights some uncommon neonatal manifestations of metabolic disorders to improve the recognition and diagnosis of these conditions.
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Affiliation(s)
- Anna-Kaisa Niemi Md
- Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
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5
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Desai D, Stiene D, Song T, Sadayappan S. Distal Arthrogryposis and Lethal Congenital Contracture Syndrome - An Overview. Front Physiol 2020; 11:689. [PMID: 32670090 PMCID: PMC7330016 DOI: 10.3389/fphys.2020.00689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022] Open
Abstract
Distal arthrogryposis (DA) is a skeletal muscle disorder which can be classified under a broader term as Arthrogryposis multiplex contractures. DA is characterized by the presence of joint contractures at various parts of the body, particularly in distal extremities. It is identified as an autosomal dominant and a rare X-linked recessive disorder associated with increased connective tissue formation around joints in such way that immobilizes muscle movement causing deformities. DA is again classified into various types since it manifests as a range of conditions representing different etiologies. Myopathy is one of the most commonly listed etiologies of DA. The mutations in sarcomeric protein-encoding genes lead to decreased sarcomere integrity, which is often associated with this disorder. Also, skeletal disorders are often associated with cardiac disorders. Some studies mention the presence of cardiomyopathy in patients with skeletal dysfunction. Therefore, it is hypothesized that the congenitally mutated protein that causes DA can also lead to cardiomyopathy. In this review, we will summarize the different forms of DA and their clinical features, along with gene mutations responsible for causing DA in its different forms. We will also examine reports that list mutations also known to cause heart disorders in the presence of DA.
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Affiliation(s)
- Darshini Desai
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Danielle Stiene
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Taejeong Song
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Sakthivel Sadayappan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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6
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Rodriguez LM, Bickley C, Russo S, Barnes D, Gagnon M, Hamdy R, Veilleux LN. Perspectives on gait and motion analysis in the management of youth with arthrogryposis multiplex congenita. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:404-409. [PMID: 31359604 DOI: 10.1002/ajmg.c.31728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Luisa M Rodriguez
- Motion Analysis Center, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania, United-States
| | - Christina Bickley
- Motion Analysis Center, Shriners Hospitals for Children-Houston, Houston, Texas, United-States.,Texas Woman's University, School of Physical Therapy, Houston, Texas, United-States
| | - Stephanie Russo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center-Hamot, Erie, Pennsylvania, United-States
| | - Douglas Barnes
- Motion Analysis Center, Shriners Hospitals for Children-Houston, Houston, Texas, United-States
| | - Marianne Gagnon
- Motion Analysis Center, Shriners Hospitals for Children-Canada, Montréal, Quebec, Canada.,Department of Surgery, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Reggie Hamdy
- Motion Analysis Center, Shriners Hospitals for Children-Canada, Montréal, Quebec, Canada.,Department of Surgery, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Louis-Nicolas Veilleux
- Motion Analysis Center, Shriners Hospitals for Children-Canada, Montréal, Quebec, Canada.,Department of Surgery, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
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7
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Ahmed AA, Skaria P, Safina NP, Thiffault I, Kats A, Taboada E, Habeebu S, Saunders C. Arthrogryposis and pterygia as lethal end manifestations of genetically defined congenital myopathies. Am J Med Genet A 2017; 176:359-367. [DOI: 10.1002/ajmg.a.38577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Atif A. Ahmed
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Priya Skaria
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Nicole P. Safina
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
- Center for Pediatric Genomic MedicineChildren's Mercy HospitalKansas CityMissouri
- Division of Clinical GeneticsChildren's Mercy HospitalKansas CityMissouri
| | - Isabelle Thiffault
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
- Center for Pediatric Genomic MedicineChildren's Mercy HospitalKansas CityMissouri
| | - Alex Kats
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Eugenio Taboada
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Sultan Habeebu
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Carol Saunders
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
- Center for Pediatric Genomic MedicineChildren's Mercy HospitalKansas CityMissouri
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8
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Abstract
During embryogenesis, the musculoskeletal system develops while containing within itself a force generator in the form of the musculature. This generator becomes functional relatively early in development, exerting an increasing mechanical load on neighboring tissues as development proceeds. A growing body of evidence indicates that such mechanical forces can be translated into signals that combine with the genetic program of organogenesis. This unique situation presents both a major challenge and an opportunity to the other tissues of the musculoskeletal system, namely bones, joints, tendons, ligaments and the tissues connecting them. Here, we summarize the involvement of muscle-induced mechanical forces in the development of various vertebrate musculoskeletal components and their integration into one functional unit.
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Affiliation(s)
- Neta Felsenthal
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Elazar Zelzer
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
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9
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Vergara-Amador E, Erazo Acosta LM. Artrogriposis múltiple congénita: espectro de deformidades en el miembro superior, a propósito de una serie de casos. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n4.59446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La artrogriposis múltiple comprende un grupo complejo de patologías que producen disminución de la movilidad articular. Su tratamiento está enfocado en mejorar la movilidad con rehabilitación y cirugía en algunos casos.Objetivo. Mostrar las deformidades por artrogriposis en el miembro superior, los tipos de tratamiento y sus resultados.Materiales y métodos. Se estudiaron 27 casos (19 operados) que fueron agrupados de acuerdo a compromiso distal en dedos o muñeca o proximal en codo y hombroResultados. El compromiso principal fue de muñecas y dedos, solo se presentaron dos casos con afectación única del codo. Las cirugías comprendieron z-plastias, liberación de placa palmar y fijación de articulaciones; en la muñeca se realizó liberación de partes blandas, fijación provisional y artrodesis. Se dio un caso de liberación del tríceps, otro de liberación de un pterigio y otro de transferencia muscular para flexión de codo.Conclusión. En miembros superiores hay disminución o ausencia de pliegues en zonas de flexión, rotación interna del hombro, limitación marcada de flexión de codo y de la muñeca en flexión y desviación cubital. En los dedos se encontró camptodactilia y aducción del pulgar. Las cirugías mejoraron la función para las actividades diarias. El tratamiento es individualizado y de acuerdo al grado de afectación.
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10
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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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11
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Aragao MFVV, Brainer-Lima AM, Holanda AC, van der Linden V, Vasco Aragão L, Silva Júnior MLM, Sarteschi C, Petribu NCL, Valença MM. Spectrum of Spinal Cord, Spinal Root, and Brain MRI Abnormalities in Congenital Zika Syndrome with and without Arthrogryposis. AJNR Am J Neuroradiol 2017; 38:1045-1053. [PMID: 28364011 DOI: 10.3174/ajnr.a5125] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Arthrogryposis is among the malformations of congenital Zika syndrome. Similar to the brain, there might exist a spectrum of spinal cord abnormalities. The purpose of this study was to explore and describe in detail the MR imaging features found in the spinal cords, nerve roots, and brains of children with congenital Zika syndrome with and without arthrogryposis. MATERIALS AND METHODS Twelve infants with congenital Zika syndrome (4 with arthrogryposis and 8 without) who had undergone brain and spinal cord MR imaging were retrospectively selected. Qualitative and quantitative analyses were performed and compared between groups. RESULTS At visual inspection, both groups showed reduced thoracic spinal cord thickness: 75% (6/8) of the group without arthrogryposis and 100% (4/4) of the arthrogryposis group. However, the latter had the entire spinal cord reduced and more severely reduced conus medullaris anterior roots (respectively, P = .002 and .007). Quantitative differences were found for conus medullaris base and cervical and lumbar intumescences diameters (respectively, P = .008, .048, .008), with more prominent reduction in arthrogryposis. Periventricular calcifications were more frequent in infants with arthrogryposis (P = .018). CONCLUSIONS Most infants had some degree of spinal cord thickness reduction, predominant in the thoracic segment (without arthrogryposis) or in the entire spinal cord (with arthrogryposis). The conus medullaris anterior roots were reduced in both groups (thinner in arthrogryposis). A prominent anterior median fissure of the spinal cord was absent in infants without arthrogryposis. Brain stem hypoplasia was present in all infants with arthrogryposis, periventricular calcifications, in the majority, and polymicrogyria was absent.
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Affiliation(s)
- M F V V Aragao
- From the Centro Diagnostico Multimagem (M.F.V.V.A.), Recife, Brazil
- Mauricio de Nassau University (M.F.V.V.A., A.M.B.-L.), Recife, Brazil
| | - A M Brainer-Lima
- PROCAPE (A.M.B.-L.), University of Pernambuco, Recife, Brazil
- Mauricio de Nassau University (M.F.V.V.A., A.M.B.-L.), Recife, Brazil
| | - A C Holanda
- Federal University of Pernambuco (A.C.H., M.L.M.S.J., M.M.V.), Recife, Brazil
| | - V van der Linden
- Association for Assistance of Disabled Children (V.v.d.L.), Recife, Brazil
- Barão de Lucena Hospital (V.v.d.L., N.C.L.P.), Recife, Brazil
| | - L Vasco Aragão
- Prof Fernando Figueira Integral Medicine Institute (L.V.A.), Recife, Brazil
| | - M L M Silva Júnior
- Federal University of Pernambuco (A.C.H., M.L.M.S.J., M.M.V.), Recife, Brazil
| | - C Sarteschi
- Fundação Oswaldo Cruz-Fiocruz/PE (C.S.), Recife, Brazil
| | - N C L Petribu
- Barão de Lucena Hospital (V.v.d.L., N.C.L.P.), Recife, Brazil
| | - M M Valença
- Federal University of Pernambuco (A.C.H., M.L.M.S.J., M.M.V.), Recife, Brazil
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12
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Balasankar G, Luximon A, Al-Jumaily A. Current conservative management and classification of club foot: A review. J Pediatr Rehabil Med 2016; 9:257-264. [PMID: 27935562 DOI: 10.3233/prm-160394] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Clubfoot, known as congenital talipes equinovarus, is one of the complex paediatric foot deformity with the incidence of 1 in every 1000 live births. It consists of four complex foot abnormalities such as forefoot adductus, midfoot cavus, and hindfoot varus and ankle equinus. There are a number of surgical techniques (soft tissue releases, arthrodesis) used to correct clubfoot. However currently the conservative management (manipulation, serial casting, and braces) of clubfoot is considered as the best choice and it is widely accepted among orthopaedists. Clubfoot treated with surgical techniques might suffer various complications such as soft tissues contractures, neurovascular complications, infections, and shortening of the limbs. Although conservative method is generally considered as an effective method, it is still challenging to cure clubfoot in advance stages. Also, the classification of the initial severity of clubfoot is essential to evaluate the outcome of the treatment. In this review, the aim is to review the different types of conservative method and the assessment of clubfoot severity.
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Affiliation(s)
| | | | - Adel Al-Jumaily
- Department of FEIT, University of Technology Sydney, NSW, Australia
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13
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Dueppers P, Grabitz K, Li Y, Schelzig H, Wagenhäuser MU, Duran M. Surgical management of iliofemoral vein thrombosis during pregnancy and the puerperium. J Vasc Surg Venous Lymphat Disord 2016; 4:392-9. [PMID: 27638991 DOI: 10.1016/j.jvsv.2016.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk of deep venous thrombosis is elevated during pregnancy and the puerperium. Therapy is usually limited to conservative measures as invasive thrombus removal is feared because of possible complications. However, leg- or life-threatening situations require fast thrombus removal, and the long-term rate of post-thrombotic syndrome (PTS) may be reduced by venous recanalization. Our center's experience may give support to surgical venous thrombectomy (VT). METHODS Between 1996 and 2016, all women who received VT for pregnancy-related deep venous thrombosis in our department were included. Retrospective data were combined with a current follow-up. RESULTS The study included 82 women with a mean age of 29 years (17-38 years). An additional arteriovenous fistula was performed in 79 and planned simultaneous cesarean section in 13 patients. Neither pulmonary emboli nor fetal complications occurred during surgery, and perioperative and postoperative mortality was 0%. Operative revision was required in 38% mainly for rethrombosis (24%) and bleeding (12%). One fetus died 2 months after VT of unrelated causes. After a mean of 83 months, complete venous recanalization was seen in 88%, venous valve sufficiency in 90%, and PTS in 31% without any ulcers. At 10 years, PTS incidence rose to reach 50% with limited statistical significance because of the number of patients reaching long-term follow-up. CONCLUSIONS Iliofemoral venous recanalization during pregnancy can be performed safely in a specialized center, with lower PTS rates than in historical controls.
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Affiliation(s)
- Philip Dueppers
- Department of Vascular and Endovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Klaus Grabitz
- Department of Vascular and Endovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - You Li
- Department of Vascular and Endovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Hubert Schelzig
- Department of Vascular and Endovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Markus Udo Wagenhäuser
- Department of Vascular and Endovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Mansur Duran
- Department of Vascular and Endovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany.
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14
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Agerholm JS, McEvoy FJ, Menzi F, Jagannathan V, Drögemüller C. A CHRNB1 frameshift mutation is associated with familial arthrogryposis multiplex congenita in Red dairy cattle. BMC Genomics 2016; 17:479. [PMID: 27364156 PMCID: PMC4929742 DOI: 10.1186/s12864-016-2832-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bovine arthrogryposis multiplex congenita (AMC) is a syndromic term for a congenital condition characterized by multiple joint contractures. Rare inherited forms of bovine AMC have been reported in different breeds. For AMC in Angus cattle a causative genomic deletion encompassing the agrin (AGRN) gene, encoding an essential neural regulator that induces the aggregation of acetylcholine receptors (AChRs), is known. In 2015, three genetically related cases of generalized AMC affecting Red dairy calves were diagnosed in Denmark. RESULTS The family history of three affected calves suggested an autosomal recessive inheritance. Single nucleotide polymorphism (SNP) genotyping showed a single genomic region of extended homozygosity of 21.5 Mb on chromosome 19. Linkage analysis revealed a maximal parametric LOD score of 1.8 at this region. By whole genome re-sequencing of the three cases, two private homozygous non-synonymous variants were detected in the critical interval. Both variants, located in the myosin phosphatase Rho interacting protein (MPRIP) and the cholinergic receptor nicotinic beta 1 subunit gene (CHRNB1), were perfectly associated with the AMC phenotype. Previously described CHRNB1 variants in humans lead to a congenital myasthenic syndrome with impaired neuromuscular transmission. The cattle variant represents a single base deletion in the first exon of CHRNB1 (c.55delG) introducing a premature stop codon (p.Ala19Profs47*) in the second exon, truncating 96 % of the protein. CONCLUSIONS This study provides the first phenotypically and genetically characterized example of a bovine AMC phenotype that represents an inherited neuromuscular disorder corresponding to human congenital myasthenic syndrome. The identified CHRNB1 loss of function variant is predicted to have a deleterious effect on fetal AChR function, which could explain the lethal phenotype reported in this study. The identification of this candidate causative mutation thus widens the known phenotypic spectrum of CHRNB1 mutations and enables selection against this pathogenic variant in Red dairy cattle.
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Affiliation(s)
- Jørgen S Agerholm
- Department of Large Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 68, Frederiksberg C, DK-1870, Denmark.
| | - Fintan J McEvoy
- Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, Frederiksberg C, DK-1870, Denmark
| | - Fiona Menzi
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Bremgartenstrasse 109a, Bern, 3001, Switzerland
| | - Vidhya Jagannathan
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Bremgartenstrasse 109a, Bern, 3001, Switzerland
| | - Cord Drögemüller
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Bremgartenstrasse 109a, Bern, 3001, Switzerland
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Midelfart Hoff J, Midelfart A. Maternal myasthenia gravis: a cause for arthrogryposis multiplex congenita. J Child Orthop 2015; 9:433-5. [PMID: 26482518 PMCID: PMC4661156 DOI: 10.1007/s11832-015-0690-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/07/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Arthrogryposis multiplex congenita (AMC) is a condition defined as contractures in more than two joints and in multiple body areas. The principal mechanism leading to the development of AMC in utero is decreased fetal movement. OBJECTIVE Both fetal and maternal factors can lead to this condition, including maternal myasthenia gravis (MG) which is the topic of this review. MG is an autoimmune disease in which antibodies (immunoglobulin G) are formed against acetylcholine receptors. The disease can affect both genders, but women are more prone to develop the disease in early adulthood, a phase of life when the focus of many women is often directed towards founding a family. During pregnancy, maternal antibodies are transmitted to the fetus. RESULTS Although the child is unaffected in most cases, the constant transmission of antibodies in utero can lead to neonatal myasthenia post-partum, a transient condition characterized by hypotonia and swallowing/respiratory difficulties as well as AMC. CONCLUSION The maternal antibody profile in mothers with MG seems to play a key role in whether the child develops AMC or not. There are also indications that there may be a relation between neonatal MG and AMC, as well as a high recurrence rate in siblings.
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Affiliation(s)
- Jana Midelfart Hoff
- />Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Anna Midelfart
- />Faculty of Medicine, Norwegian University of Science and Technology (NTNU), 7000 Trondheim, Norway
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Abstract
Arthrogryposis multiplex congenita (AMC) is a heterogeneous condition defined as multiple congenital joint contractures in two or more body areas. The common pathogenesis is impaired fetal movements. Amyoplasia, the most frequent form, is a sporadically occurring condition with hypoplastic muscles and joint contractures. Distal arthrogryposis (DA) syndromes are often hereditary, and joint involvement is predominantly in the hands and feet. In a Swedish study, 131 patients with arthrogryposis were investigated. The most frequent diagnoses were amyoplasia and DA. In amyoplasia, muscle strength was found to be more important than joint range of motion (ROM) for motor function. In DA, muscle weakness was present in 44 % of investigated patients. The clinical findings were found to be highly variable between families and also within families with DA. Fetal myopathy due to sarcomeric protein dysfunction can cause DA. An early multidisciplinary team evaluation of the child with arthrogryposis for specific diagnosis and planning of treatment is recommended. Attention should be directed at the development of muscle strength with early stimulation of active movements. Immobilization should be minimized.
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Affiliation(s)
- Eva Kimber
- Department of Pediatrics, Institute of Clinical Sciences at Sahlgrenska Academy, The Queen Silvia Children´s Hospital, Gothenburg, Sweden
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Does the Ponseti technique affect the vascular development in patients with congenital talipes equinovarus? J Pediatr Orthop B 2015; 24:6-10. [PMID: 25229798 DOI: 10.1097/bpb.0000000000000105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In this study, we have evaluated the changes observed in the main arteries of the foot before and after the Ponseti technique. Arterial structures of seven patients were examined using Doppler ultrasound and the parameters studied included the course of the arteries, lumen filling, flow direction, pattern, and velocity. Before the treatment, the side with congenital talipes equinovarus deformity showed decreased blood flow in all arteries, except for the posterior tibial artery. At the second examination, the increase in the flow velocity of both arteries except tibialis anterior arteries was statistically significant. The Ponseti method results in normalization of the arterial structures in extremities with congenital talipes equinovarus.
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Borja Andueza L, Apilanez Urquiola M, Cortajarena Altuna M, Martí Carrera I. Amioplasia congénita. An Pediatr (Barc) 2014; 81:63-5. [DOI: 10.1016/j.anpedi.2013.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022] Open
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Ellis-Hutchings RG, Rasoulpour RJ, Terry C, Carney EW, Billington R. Human relevance framework evaluation of a novel rat developmental toxicity mode of action induced by sulfoxaflor. Crit Rev Toxicol 2014; 44 Suppl 2:45-62. [DOI: 10.3109/10408444.2014.910752] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Pollard AS, McGonnell IM, Pitsillides AA. Mechanoadaptation of developing limbs: shaking a leg. J Anat 2014; 224:615-23. [PMID: 24635640 DOI: 10.1111/joa.12171] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 02/06/2023] Open
Abstract
The proportion of total limb length taken up by the individual skeletal elements (limb proportionality), varies widely between species. These diverse skeletal forms have evolved to allow for a range of limb uses and they first emerge as the embryo develops, to achieve the characteristic skeletal architecture of each species. During this time, the developing skeleton experiences mechanical loading as a result of embryonic muscle contraction. The possibility that adaptation to such mechanical input may allow embryos to coordinate the appearance of skeletal design with their expanding range of movements has so far received little attention. This is surprising, given the critical role exerted by embryo movement in normal skeletal development; stage-specific in ovo immobilisation of embryonic chicks results in joint contractures and a reduction in longitudinal bone growth in the limbs. Epigenetic mechanisms allow for selective activation of genes in response to environmental signals, resulting in the production of phenotypic complexity in morphogenesis; mechanical loading of bone during movement appears to be one such signal. It may be that 'mechanosensitive' genes under regulation of mechanical input adjust proportionality along the bone's proximo-distal axis, introducing a level of phenotypic plasticity. If this hypothesis is upheld, species with more elongated distal limb elements will have a greater dependence on mechanical input for the differences in their growth, and mechanosensitive bone growth in the embryo may have evolved as an additional source of phenotypic diversity during skeletal development.
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Affiliation(s)
- A S Pollard
- Comparative Biomedical Sciences, Royal Veterinary College, London, UK
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Gain-of-function mutations in the mechanically activated ion channel PIEZO2 cause a subtype of Distal Arthrogryposis. Proc Natl Acad Sci U S A 2013; 110:4667-72. [PMID: 23487782 DOI: 10.1073/pnas.1221400110] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Mechanotransduction, the pathway by which mechanical forces are translated to biological signals, plays important but poorly characterized roles in physiology. PIEZOs are recently identified, widely expressed, mechanically activated ion channels that are hypothesized to play a role in mechanotransduction in mammals. Here, we describe two distinct PIEZO2 mutations in patients with a subtype of Distal Arthrogryposis Type 5 characterized by generalized autosomal dominant contractures with limited eye movements, restrictive lung disease, and variable absence of cruciate knee ligaments. Electrophysiological studies reveal that the two PIEZO2 mutations affect biophysical properties related to channel inactivation: both E2727del and I802F mutations cause the PIEZO2-dependent, mechanically activated currents to recover faster from inactivation, while E2727del also causes a slowing of inactivation. Both types of changes in kinetics result in increased channel activity in response to a given mechanical stimulus, suggesting that Distal Arthrogryposis Type 5 can be caused by gain-of-function mutations in PIEZO2. We further show that overexpression of mutated PIEZO2 cDNAs does not cause constitutive activity or toxicity to cells, indicating that the observed phenotype is likely due to a mechanotransduction defect. Our studies identify a type of channelopathy and link the dysfunction of mechanically activated ion channels to developmental malformations and joint contractures.
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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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Abstract
Arthrogryposis multiplex congenital is a rare condition defined as contractures in multiple joints at birth due to disorders starting in fetal life. Its etiology is associated with many different conditions and in many instances remains unknown. The final common pathway to all of them is decreased fetal movement (fetal akinesia) due to an abnormal intrauterine environment. Causes of decreased fetal movements may be neuropathic abnormalities, abnormalities of connective tissue or muscle, intrauterine vascular compromise, maternal diseases, and space limitations within the uterus. When the cause of arthrogryposis is space limitations in uterus, the most common etiology is oligohydramnios. The same can result from intrauterine tumours as fibroids, although to our knowledge there are only two papers reporting cases of fetal deformities related to uterine leiomyomas. We describe a well-documented exceptional case of arthrogryposis associated with the presence of a large uterine fibroid. It could illustrate the importance of a careful and appropriate assessment of uterine fibroids before and in the course of a pregnancy considering that they can cause both serious maternal and fetal complications.
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Haubitz M, Neuenschwander S, Vögeli P. Porcine arthrogryposis multiplex congenita (AMC): New diagnostic test and narrowed candidate region. Mol Cell Probes 2012; 26:248-52. [DOI: 10.1016/j.mcp.2012.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/27/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
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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: 53] [Impact Index Per Article: 4.4] [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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Wilnai Y, Seaver LH, Enns GM. Atypical amyoplasia congenita in an infant with Leigh syndrome: A mitochondrial cause of severe contractures? Am J Med Genet A 2012; 158A:2353-7. [DOI: 10.1002/ajmg.a.35533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 05/21/2012] [Indexed: 11/11/2022]
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Fassier A, Wicart P, Dubousset J, Seringe R. Arthrogryposis multiplex congenita. Long-term follow-up from birth until skeletal maturity. J Child Orthop 2009; 3:383-90. [PMID: 19669823 PMCID: PMC2758174 DOI: 10.1007/s11832-009-0187-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 06/12/2009] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this retrospective long-term study was to review and present the effects of treatment for 11 children with arthrogryposis multiplex congenital, or amyoplasia, followed from birth until skeletal maturity. METHODS We evaluated walking ability, age of beginning to walk, required ambulatory devices, age of independent walking and muscle strength. RESULTS Our series showed babies with severe limb involvements without spine abnormalities. Despite the initial severity of involvement, nine patients finally became ambulators with flexion contracture of less than 20 degrees on hips and 15 degrees on knees, and six were independent walkers before the age of 2.5 years. The two non-ambulators presented severe scoliosis at skeletal maturity, which needed spinal fusion. CONCLUSION We conclude that long-term ambulatory status at skeletal maturity is not correlated with the severity of condition at birth. A prognosis for ambulation at skeletal maturity will be done before 2.5 years of age. We believe that early aggressive management of children with severe arthrogryposis is warranted and justified.
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Affiliation(s)
- Alice Fassier
- />Université de Lyon, Faculté Laennec, Hôpital Femme-Mère-Enfant, 59, Boulevard Pinel, 69677 Bron Cedex, France
| | - Philippe Wicart
- />Hôpital Saint Vincent de Paul, Université René Descartes, 74–82, Avenue Denfert-Rochereau, 75674 Paris Cedex 14, France
| | - Jean Dubousset
- />Hôpital Saint Vincent de Paul, Université René Descartes, 74–82, Avenue Denfert-Rochereau, 75674 Paris Cedex 14, France
| | - Raphaël Seringe
- />Hôpital Saint Vincent de Paul, Université René Descartes, 74–82, Avenue Denfert-Rochereau, 75674 Paris Cedex 14, France
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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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Abstract
UNLABELLED Although clubfoot is one of the most common congenital abnormalities affecting the lower limb, it remains a challenge not only to understand its genetic origins but also to provide effective long-term treatment. This review provides an update on the etiology of clubfoot as well as current treatment strategies. Understanding the exact genetic etiology of clubfoot may eventually be helpful in determining both prognosis and the selection of appropriate treatment methods in individual patients. The primary treatment goal is to provide long-term correction with a foot that is fully functional and pain-free. To achieve this, a combination of approaches that applies the strengths of several methods (Ponseti method and French method) may be needed. Avoidance of extensive soft-tissue release operations in the primary treatment should be a priority, and the use of surgery for clubfoot correction should be limited to an "a la carte" mode and only after failed conservative methods. LEVEL OF EVIDENCE Level V, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Dobbs MB, Gurnett CA. Clubfoot: etiology and treatment: editorial comment. Clin Orthop Relat Res 2009; 467:1119-20. [PMID: 19241114 PMCID: PMC2664446 DOI: 10.1007/s11999-009-0761-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 02/10/2009] [Indexed: 02/06/2023]
Affiliation(s)
- Matthew B. Dobbs
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Children’s Place, St. Louis, MO 63110 USA
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Gurnett CA, Boehm S, Connolly A, Reimschisel T, Dobbs MB. Impact of congenital talipes equinovarus etiology on treatment outcomes. Dev Med Child Neurol 2008; 50:498-502. [PMID: 18611198 DOI: 10.1111/j.1469-8749.2008.03016.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although congenital talipes equinovarus (CTEV) is often idiopathic, additional birth defects occur in some patients that may have an impact on the treatment of this disorder. The purpose of this study was to determine the prevalence of associated malformations, chromosomal abnormalities, or known genetic syndromes, and to compare treatment outcomes of children with idiopathic CTEV with children with non-idiopathic CTEV. Of 357 children evaluated, 273 (76%) had idiopathic CTEV (179 males, 94 females; mean age 2 y 1 mo [SD 1 y 2 mo], range 0-18 y) and 84 (24%) had non-idiopathic CETV (51 males, 33 females; mean age 2 y 5 mo [SD 2 y], range 0-16 y). Disorders affecting the nervous system were found in 46 (54%) children with non-idiopathic CTEV. In a subgroup of patients treated entirely at our institution (n=196), children with non-idiopathic CTEV (n=47) required more casts for correction than those with idiopathic CTEV (n=149; 5.3 vs 4.6; p=0.016). There was also a greater risk of recurrence in non-idiopathic CTEV (14.9% vs 4%; p=0.009), but no significant difference in the need for extensive surgery (2.7% vs 8.5%; p=0.096). Treatment was initiated at a mean age of 13 weeks (range 1 wk to 2 y 6 mo) for both idiopathic and non-idiopathic patients, and treatment was assessed during a minimum 2-year follow-up. Non-idiopathic CTEV can be successfully treated with the Ponseti method of serial casting, with low recurrence rates or need for surgery.
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Affiliation(s)
- Christina A Gurnett
- Department of Orthopedic Surgery, Washington University School of Medicine, One Children's Place, St Louis, MO 63110, U.S.A.
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Netscher DT, Aliu O, Samra S, Lewis E. A case of congenital bilateral absence of elbow flexor muscles: review of differential diagnosis and treatment. Hand (N Y) 2008; 3:4-12. [PMID: 18780113 PMCID: PMC2528969 DOI: 10.1007/s11552-007-9056-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 05/25/2007] [Indexed: 10/22/2022]
Abstract
A 1-year-old boy presented to us with congenital inability to flex his elbow. He had bilaterally absent biceps brachii and brachialis muscles, a rare condition. We performed pedicle latissimus dorsi musculocutaneous flaps to the left and right volar upper arm at 21 and 24 months of age, respectively, to create elbow flexors. By 4 years of age, he had excellent elbow flexion bilaterally with strength grade in excess of 4.5. In addition to discussing our patient's treatment options, we discuss other potential causes of weak elbow flexion when faced with this clinical dilemma.
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Affiliation(s)
- David T Netscher
- Division of Plastic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
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Lin IW, Chueh HY, Chang SD, Cheng PJ. The Application of Three-dimensional Ultrasonography in the Prenatal Diagnosis of Arthrogryposis. Taiwan J Obstet Gynecol 2008; 47:75-8. [DOI: 10.1016/s1028-4559(08)60058-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Murphy AM, MacHugh DE, Park SDE, Scraggs E, Haley CS, Lynn DJ, Boland MP, Doherty ML. Linkage mapping of the locus for inherited ovine arthrogryposis (IOA) to sheep chromosome 5. Mamm Genome 2007; 18:43-52. [PMID: 17242863 DOI: 10.1007/s00335-006-0016-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 09/21/2006] [Indexed: 11/30/2022]
Abstract
Arthrogryposis is a congenital malformation affecting the limbs of newborn animals and infants. Previous work has demonstrated that inherited ovine arthrogryposis (IOA) has an autosomal recessive mode of inheritance. Two affected homozygous recessive (art/art) Suffolk rams were used as founders for a backcross pedigree of half-sib families segregating the IOA trait. A genome scan was performed using 187 microsatellite genetic markers and all backcross animals were phenotyped at birth for the presence and severity of arthrogryposis. Pairwise LOD scores of 1.86, 1.35, and 1.32 were detected for three microsatellites, BM741, JAZ, and RM006, that are located on sheep Chr 5 (OAR5). Additional markers in the region were identified from the genetic linkage map of BTA7 and by in silico analyses of the draft bovine genome sequence, three of which were informative. Interval mapping of all autosomes produced an F value of 21.97 (p < 0.01) for a causative locus in the region of OAR5 previously flagged by pairwise linkage analysis. Inspection of the orthologous region of HSA5 highlighted a previously fine-mapped locus for human arthrogryposis multiplex congenita neurogenic type (AMCN). A survey of the HSA5 genome sequence identified plausible candidate genes for both IOA and human AMCN.
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Affiliation(s)
- Angela M Murphy
- Animal Genomics Laboratory, School of Agriculture, Food Science and Veterinary Medicine, College of Life Sciences, University College Dublin, Belfield, Dublin 4, Ireland
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Robinson P, Lipscomb S, Preston LC, Altin E, Watkins H, Ashley CC, Redwood CS. Mutations in fast skeletal troponin I, troponin T, and β‐tropomyosin that cause distal arthrogryposis all increase contractile function. FASEB J 2006; 21:896-905. [PMID: 17194691 DOI: 10.1096/fj.06-6899com] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Distal arthrogryposes (DAs) are a group of disorders characterized by congenital contractures of distal limbs without overt neurological or muscle disease. Unexpectedly, mutations in genes encoding the fast skeletal muscle regulatory proteins troponin T (TnT), troponin I (TnI), and beta-tropomyosin (beta-TM) have been shown to cause autosomal dominant DA. We tested how these mutations affect contractile function by comparing wild-type (WT) and mutant proteins in actomyosin ATPase assays and in troponin-replaced rabbit psoas fibers. We have analyzed all four reported mutants: Arg63His TnT, Arg91Gly beta-TM, Arg174Gln TnI, and a TnI truncation mutant (Arg156ter). Thin filaments, reconstituted using actin and WT troponin and beta-TM, activated myosin subfragment-1 ATPase in a calcium-dependent, cooperative manner. Thin filaments containing either a troponin or beta-TM DA mutant produced significantly enhanced ATPase rates at all calcium concentrations without alternating calcium-sensitivity or cooperativity. In troponin-exchanged skinned fibers, each mutant caused a significant increase in Ca2+ sensitivity, and Arg156ter TnI generated significantly higher maximum force. Arg91Gly beta-TM was found to have a lower actin affinity than WT and form a less stable coiled coil. We propose the mutations cause increased contractility of developing fast-twitch skeletal muscles, thus causing muscle contractures and the development of the observed limb deformities.
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Affiliation(s)
- Paul Robinson
- Department of Cardiovascular Medicine, University of Oxford, Oxford OX3 7BN, UK
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Kim ES, Jung KE, Kim SD, Kim EK, Chae JH, Kim HS, Park JD, Kim KJ, Kim BI, Hwang YS, Choi JH. Diagnostic classification and clinical aspects of floppy infants in the neonatal and pediatric intensive care units. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.11.1158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eun Sun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Eun Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Duk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Eo Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Hee Chae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Seung Hwang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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38
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Abstract
Amyoplasia congenita is a diagnostic subgroup of children with arthrogryposis multiplex congenita (AMC). AMC is a relatively rare syndrome characterized by multiple joint contractures at birth. Amyoplasia congenita is the most common type of this syndrome with an occurrence rate of 1 in 10,000 live births, and mainly refers to the disorders with limb involvement. In this report, the author presents a premature baby with amyoplasia congenita, whose hips showed flexion, abduction, and external rotation contractures. The knees showed fixed extension contractures, so that his lower extremities were cylindrical with absent skin creases at birth.
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Affiliation(s)
- Hyeon Soo Lee
- Department of Pediatrics, Kangwon National University College of Medicine, 17-1 Hyoja 3-dong, Chuncheon, Kangwon 200-947, Korea.
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39
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Obarski TP, Fardal PM, Bush CR, Leier CV. Stenotic aortic and mitral valves in three adult brothers with arthrogryposis multiplex congenita. Am J Cardiol 2005; 96:464-6. [PMID: 16054484 DOI: 10.1016/j.amjcard.2005.03.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Revised: 03/24/2005] [Accepted: 03/24/2005] [Indexed: 11/22/2022]
Abstract
Three brothers with arthrogryposis multiplex congenita survived into adulthood. In their fourth decade, the clinical course for each brother became complicated by severe stenoses of their aortic and mitral valves. One brother died suddenly, and the remaining 2 developed heart failure. requiring valvular replacement.
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40
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Shibasaki H, Hitomi T, Mezaki T, Kihara T, Tomimoto H, Ikeda A, Shimohama S, Ito M, Oka N. A new form of congenital proprioceptive sensory neuropathy associated with arthrogryposis multiplex. J Neurol 2005; 251:1340-4. [PMID: 15592729 DOI: 10.1007/s00415-004-0539-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Revised: 05/07/2004] [Accepted: 05/17/2004] [Indexed: 10/26/2022]
Abstract
We report two siblings who presented with non-progressive marked sensory ataxia associated with arthrogryposis multiplex congenita (AMC). Deep tendon reflexes and H reflex were completely absent, but F waves were preserved. The sensory nerve conduction studies indicated the presence of relatively mild sensory polyneuropathy. The conventional somatosensory evoked potentials (SEPs) showed mildly prolonged latency for both the peripheral and cortical responses, suggesting a slowed conduction through the peripheral as well as central pathway. However, the 'proprioceptive SEPs' were absent, in conformity with complete loss of joint sense. Sural nerve biopsy revealed only mild thinning of myelin in the younger sister but was entirely normal in her brother. Taken together with the characteristic electrophysiological findings, the symptoms were considered to be due to predominant involvement of a selective population of somatosensory ganglions. The present cases showed no progression of the neurological deficit what-so-ever since birth, which strongly suggests a developmental anomaly or aplasia of a limited population of peripheral sensory neurons.
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Affiliation(s)
- Hiroshi Shibasaki
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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41
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Maheshwari A, Calhoun DA, Lacson A, Pereda L, Nelson RM, Saste MD, Kousseff B, Gieron-Korthals M. Pontine hypoplasia in Carey-Fineman-Ziter (CFZ) syndrome. Am J Med Genet A 2005; 127A:288-90. [PMID: 15150780 DOI: 10.1002/ajmg.a.20688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe an infant with multiple congenital anomalies including cleft palate and micrognathia, Möbius sequence, developmental delay, myopathy, hydronephrosis, and bilateral clubfeet. These features are consistent with Carey-Fineman-Ziter (CFZ) syndrome (MIM 254940), which has been previously reported in six children (including two sibling pairs). Cranial magnetic resonance imaging (MRI) revealed an unusually small pons, a finding not previously described in CFZ syndrome.
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Affiliation(s)
- Akhil Maheshwari
- University of South Florida College of Medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Tampa, Florida, USA
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42
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Felderhoff-Mueser U, Uhl J, Penzel R, Van Landeghem F, Vogel M, Obladen M, Kopitz J. Intrauterine onset of acute neuropathic type 2 Gaucher disease: identification of a novel insertion sequence. Am J Med Genet A 2005; 128A:138-43. [PMID: 15214004 DOI: 10.1002/ajmg.a.20445] [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: 11/08/2022]
Abstract
A subset of patients with type 2 Gaucher disease is characterized by intrauterine onset of rapidly progressive neuropathic disease, arthrogryposis, hydrops fetalis and in some cases restrictive dermopathy. beta-Glucocerebrosidase (beta-glucosidase) activity is usually low or undetectable. In most cases death ensues either in-utero or within hours or days after birth. We report on an infant born to non-consanguineous parents of Caucasian origin presenting at birth with hydrops, arthrogryposis, severe respiratory distress, hepatosplenomegaly, and liver failure. Death occurred within several hours after delivery and autopsy revealed typical Gaucher cells in multiple organs in combination with severe apoptotic neurodegeneration throughout the brain. beta-Glucocerebrosidase activity was 1% of the norm in fibroblasts and a novel heterozygous insertion c.1515_1516insAGTGAGGGCAAT was identified by genomic sequencing and an insertion-specific seminested PCR. In addition, molecular studies revealed a previously described in type 1 Gaucher disease missense mutation c.476G --> A which results in a heterozygous substitution of R120Q. Our observations confirm considerable genotypic heterogeneity in patients with type 2 Gaucher disease. The transheterozygous combination of a mutation, previously described in type 1 Gaucher disease, together with a newly identified insertion may result in this severe phenotype.
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43
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Castro-Gago M, Iglesias-Meleiro JM, Blanco-Barca MO, Grande-Seijo M, Barros-Angueira F, Eirís-Puñal J. Neurogenic arthrogryposis multiplex congenita and velopharyngeal incompetence associated with chromosome 22q11.2 deletion. J Child Neurol 2005; 20:76-8. [PMID: 15791927 DOI: 10.1177/08830738050200011301] [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: 11/17/2022]
Abstract
We report a case of neurogenic arthrogryposis multiplex congenita and velopharyngeal incompetence in association with a chromosome 22q11.2 deletion in a 5-month-old boy, the only child of a non-consanguineous couple without relevant antecedents. Specifically, polymerase chain reaction amplification of microsatellite markers revealed a noninherited microdeletion in position D22S306. This phenotype has not been reported previously in association with chromosome 22q11.2 deletions, and these findings raise the possibility that at least some cases of neurogenic arthrogryposis multiplex congenita might be due to genetic defects of this type.
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Affiliation(s)
- Manuel Castro-Gago
- Departamento de Pediatría, Servicio de Neuropediatría, Hospital Clínico Universitario, Universidad de Santiago de Compostela, Spain.
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44
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Burke G, Cossins J, Maxwell S, Robb S, Nicolle M, Vincent A, Newsom-Davis J, Palace J, Beeson D. Distinct phenotypes of congenital acetylcholine receptor deficiency. Neuromuscul Disord 2004; 14:356-64. [PMID: 15145336 DOI: 10.1016/j.nmd.2004.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Revised: 03/23/2004] [Accepted: 03/23/2004] [Indexed: 10/26/2022]
Abstract
We contrast the phenotypes associated with hereditary acetylcholine receptor deficiency arising from mutations in either the acetylcholine receptor epsilon subunit or the endplate acetylcholine receptor clustering protein rapsyn. Mutational screening was performed by amplification of promoter and coding regions by PCR and direct DNA sequencing. We identified mutations in 37 acetylcholine receptor deficiency patients; 18 had acetylcholine receptor-epsilon mutations, 19 had rapsyn mutations. Mutated acetylcholine receptor-epsilon associated with bulbar symptoms, ptosis and ophthalmoplegia at birth, and generalized weakness. Mutated rapsyn caused either an early onset (rapsyn-EO) or late onset (rapsyn-LO) phenotype. Rapsyn-EO associated with arthrogryposis and life-threatening exacerbations during early childhood. Rapsyn-LO presented with limb weakness in adolescence or adulthood resembling seronegative myasthenia gravis. Awareness of distinct phenotypic features of acetylcholine receptor deficiency resulting from acetylcholine receptor-epsilon or rapsyn mutations should facilitate targeted genetic diagnosis, avoid inappropriate immunological therapy and, in some infants, prompt the rapid introduction of treatment that could be life saving.
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MESH Headings
- 4-Aminopyridine/analogs & derivatives
- 4-Aminopyridine/therapeutic use
- Adolescent
- Adult
- Aged
- Amifampridine
- Cell Line
- Child
- Child, Preschool
- Cholinesterase Inhibitors/therapeutic use
- DNA Mutational Analysis/methods
- Drug Therapy, Combination
- Electric Stimulation
- Electromyography/methods
- Electrophysiology/methods
- Embryo, Mammalian
- Ephedrine/therapeutic use
- Evoked Potentials, Motor/drug effects
- Evoked Potentials, Motor/radiation effects
- Female
- Fluorescent Antibody Technique/methods
- Humans
- Kidney
- Male
- Middle Aged
- Muscle Proteins/genetics
- Muscles
- Mutation/genetics
- Myasthenic Syndromes, Congenital/classification
- Myasthenic Syndromes, Congenital/drug therapy
- Myasthenic Syndromes, Congenital/genetics
- Myasthenic Syndromes, Congenital/physiopathology
- Phenotype
- Potassium Channel Blockers/therapeutic use
- Protein Subunits/deficiency
- Protein Subunits/genetics
- Pyridostigmine Bromide/therapeutic use
- RNA, Messenger/biosynthesis
- Receptors, Cholinergic/deficiency
- Receptors, Cholinergic/genetics
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Sequence Analysis, DNA/methods
- Severity of Illness Index
- Sympathomimetics/therapeutic use
- Transfection/methods
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Affiliation(s)
- G Burke
- Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK
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45
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Akagi S, Adachi N, Matsukawa K, Kubo M, Takahashi S. Developmental potential of bovine nuclear transfer embryos and postnatal survival rate of cloned calves produced by two different timings of fusion and activation. Mol Reprod Dev 2003; 66:264-72. [PMID: 14502605 DOI: 10.1002/mrd.10352] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We compared developmental potential of somatic cell nuclear transfer (NT) embryos and postnatal survivability of cloned calves produced by two different fusion and activation protocols. As donor cells for NT, bovine cumulus cell-derived cultured cells of passage 5 were used following culture in serum-starved medium for 5-7 days. Enucleated oocytes were fused with donor cells at 21 or 24 hr post maturation. NT embryos fused at 21 hr were activated chemically 3 hr after fusion (DA group) and embryos fused at 24 hr were activated chemically immediately after fusion (FA group). Chemical activation was accomplished by calcium ionophore for 5 min and cytochalasin D + cycloheximide for 1 hr then cycloheximide alone for 4 hr. After in vitro culture in IVD101 medium for 7 days, embryo transfer was performed. Fusion rates were 86 and 84% in the DA and FA groups, respectively. Developmental rate to the blastocyst stage of NT embryos in the DA group was higher than in the FA group (42% vs. 28%). Pregnancy rate did not differ significantly between the DA and FA groups (11/13 and 5/7 at day 35), and 13 cloned calves (including 1 set of twins from a single embryo transfer) were born. High rates of postnatal mortality were observed in both groups. These results suggest that the DA method improves in vitro developmental potential of NT embryos, but the timing of fusion and chemical activation does not affect the pregnancy rate and the survivability of cloned calves.
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Affiliation(s)
- Satoshi Akagi
- Department of Animal Breeding and Reproduction, National Institute of Livestock and Grassland Science, Tsukuba, Ibaraki, Japan.
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46
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Ogino S, Leonard DGB, Rennert H, Wilson RB. Spinal muscular atrophy genetic testing experience at an academic medical center. J Mol Diagn 2002; 4:53-8. [PMID: 11826188 PMCID: PMC1906969 DOI: 10.1016/s1525-1578(10)60680-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Approximately 94% of spinal muscular atrophy (SMA) patients lack both copies of SMN1 exon 7. We report our SMA genetic testing experience (total 1281 cases), using SMA linkage analysis (32 families), SMA diagnostic testing by PCR-RFLP (restriction fragment length polymorphism) to detect the homozygous absence of SMN1 exon 7 (and exon 8) (533 cases), and an assay to determine copy number of SMN1 exon 7 (SMN1 gene dosage analysis) (716 cases). SMN1 gene dosage analysis is used for SMA carrier testing as well as for the confirmation of a heterozygous SMN1 deletion in symptomatic individuals who do not lack both copies of SMN1. We conclude that comprehensive SMA testing, including SMN1 deletion analysis, SMN1 gene dosage analysis, and linkage analysis, offers the most complete evaluation of SMA patients and their families.
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Affiliation(s)
- Shuji Ogino
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA
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47
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Puri P, Gupta M, Chan J. Progressive ophthalmoplegia in arthrogryposis multiplex congentia. Eye (Lond) 2002; 16:86-8. [PMID: 11913897 DOI: 10.1038/sj.eye.6700014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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48
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Weber A, Maier RF, Felderhoff-Mueser U, Lehmann R, Stöver B, Obladen M. Neonate with spinal hypoplasia on T12 and a localized vertebral malformation on L4. J Child Neurol 2001; 16:619-21. [PMID: 11510940 DOI: 10.1177/088307380101600819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of a neonate with sectional narrowing of the spinal cord on the level of T12 to L2 and a deformed vertebral body on a different level, L4. In previously described cases of sectional spinal dysgenesis, the vertebral and spinal cord malformations are usually found on the same level. Our case may represent a new variant of spinal dysgenesis.
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Affiliation(s)
- A Weber
- Department of Neonatology, Campus Virchow Klinikum, University Hospital Charité, Humboldt University, Berlin, Germany.
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49
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Abstract
Arthrogryposis multiplex congenita (AMC) is a term that is used to describe the presence of multiple joint contractures at birth. AMC can be seen singularly or in conjunction with other abnormalities. Historically, the term arthrogryposis was used as a disease diagnosis, but it is now clear that AMC is not a disease entity but a syndrome, involving a manifestation of many fetal and neonatal disorders of the neuromuscular system. Its etiology is multifocal, and there is a wide variation in the degree to which muscles and joints are affected. Early identification and implementation of a plan of therapy are essential. The purpose of this article is to provide an overview of the AMC 'syndrome, specifically, clinical features, etiology, diagnosis, therapeutic interventions, family support, and outcomes.
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50
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Orti R, Rachidi M, Vialard F, Toyama K, Lopes C, Taudien S, Rosenthal A, Yaspo ML, Sinet PM, Delabar JM. Characterization of a novel gene, C21orf6, mapping to a critical region of chromosome 21q22.1 involved in the monosomy 21 phenotype and of its murine ortholog, orf5. Genomics 2000; 64:203-10. [PMID: 10729227 DOI: 10.1006/geno.1999.6109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Phenotypic and molecular analyses of patients with partial chromosome 21 monosomy enabled us to define a region, spanning 2.4 Mb between D21S190 and D21S226, associated with arthrogryposis, mental retardation, hypertonia, and several facial anomalies. The markers of the region were used to screen a total human PAC library (Ioannou, RZPD). We isolated 57 PACs, which formed primary contigs. EST clusters (UNIGENE collection) located in a 6-Mb interval, between D21S260 and D21S263, were mapped in individual bacterial clones. We mapped the WI-17843 cluster to the PAC clone J12100, which contains the two anchor markers LB10T and LA329. The open reading frame extends over 960 bp, with three putative start codons. The 1695-bp cDNA containing a polyadenylation signal should correspond to the full-length cDNA. From the genomic sequence, we deduced that the gene contained five exons and that there was a putative promoter sequence upstream from exon 1. In silico screening of DNA databases revealed similarity with a murine EST. The corresponding cDNA (1757 bp) sequence was very similar (>85%) to the human cDNA and had an open reading frame of 876 nucleotides. Somatic hybrid mapping localized the cDNA to mouse chromosome 16. EST analyses and RT-PCR indicated that the third exon in the human gene (exon 2 in the mouse) undergoes alternative splicing. Northern blot hybridization showed that the gene was ubiquitously expressed in humans and mice. The longest mouse clone was used to generate riboprobes, which were hybridized to murine embryos at stages E-9.5, E-10.5, E-12.5, E-13.5, and E-14.5-15, to study the pattern of expression during development. Ubiquitous labeling was observed, with strong signals restricted to limited areas of the telencephalon, the mesencephalon, and the interrhombomeric regions in the central nervous system, and other regions of the body such as the limb buds, branchial arches, and somites.
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Affiliation(s)
- R Orti
- UMR 8602 CNRS, UFR Necker Enfants-Malades, 156 rue de Vaugirard, Paris, 75730, France
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