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Sekar T, Sebire NJ. Renal Pathology of Ciliopathies. Pediatr Dev Pathol 2024:10935266241242173. [PMID: 38616607 DOI: 10.1177/10935266241242173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Renal ciliopathies are a group of genetic disorders that affect the function of the primary cilium in the kidney, as well as other organs. Since primary cilia are important for regulation of cell signaling pathways, ciliary dysfunction results in a range of clinical manifestations, including renal failure, cyst formation, and hypertension. We summarize the current understanding of the pathophysiological and pathological features of renal ciliopathies in childhood, including autosomal dominant and recessive polycystic kidney disease, nephronophthisis, and Bardet-Biedl syndrome, as well as skeletal dysplasia associated renal ciliopathies. The genetic basis of these disorders is now well-established in many cases, with mutations in a large number of cilia-related genes such as PKD1, PKD2, BBS, MKS, and NPHP being responsible for the majority of cases. Renal ciliopathies are broadly characterized by development of interstitial fibrosis and formation of multiple renal cysts which gradually enlarge and replace normal renal tissue, with each condition demonstrating subtle differences in the degree, location, and age-related development of cysts and fibrosis. Presentation varies from prenatal diagnosis of congenital multisystem syndromes to an asymptomatic childhood with development of complications in later adulthood and therefore clinicopathological correlation is important, including increasing use of targeted genetic testing or whole genome sequencing, allowing greater understanding of genetic pathophysiological mechanisms.
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Affiliation(s)
- Thivya Sekar
- Histopathology Department, Level 3 CBL Labs, Great Ormond Street Hospital, London, UK
| | - Neil J Sebire
- Histopathology Department, Level 3 CBL Labs, Great Ormond Street Hospital, London, UK
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Inserra A, Zarfati A, Pardi V, Bertocchini A, Accinni A, Aloi IP, Martucci C, Frediani S. Case report: A simple and reliable approach for progressive internal distraction of the sternum for Jeune syndrome (asphyxiating thoracic dystrophy): preliminary experience and literature review of surgical techniques. Front Pediatr 2023; 11:1253383. [PMID: 37822322 PMCID: PMC10562558 DOI: 10.3389/fped.2023.1253383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
Background Described for the first time in 1954, Jeune syndrome (JS), often called asphyxiating thoracic dystrophy, is a congenital musculoskeletal disease characterized by short ribs, a narrow thorax, and small limbs. In this study, we analyzed and presented our preliminary experience with a device for progressive internal distraction of the sternum (PIDS) in patients with symptomatic JS. In addition, we reviewed the contemporary English literature on existing surgical techniques for treating children with congenital JS. Material and methods A retrospective analysis of pediatric patients (<18 years old) treated for symptomatic JS at our tertiary center between 2017 and 2023 was performed. Results We presented two patients with JS who underwent surgery using an internal sternal distractor, a Zurich II Micro Zurich Modular Distractor, placed at the corpus of the sternum among the divided halves. Conclusions We obtained promising results regarding the safety and effectiveness of this less-invasive device for PIDS in patients with symptomatic JS. Further studies on long-term outcomes are needed to validate these findings.
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Affiliation(s)
- Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of “Tor Vergata”, Rome, Italy
| | - Angelo Zarfati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of “Tor Vergata”, Rome, Italy
| | - Valerio Pardi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Accinni
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ivan Pietro Aloi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina Martucci
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Duncan Phillips J, Hoover JD. Chest Wall Deformities and Congenital Lung Lesions. Surg Clin North Am 2022; 102:883-911. [DOI: 10.1016/j.suc.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Prenatal Diagnosis of Jeune Syndrome Caused by Compound Heterozygous Variants in DYNC2H1 Gene-Case Report with Rapid WES Procedure and Differential Diagnosis of Lethal Skeletal Dysplasias. Genes (Basel) 2022; 13:genes13081339. [PMID: 35893076 PMCID: PMC9332837 DOI: 10.3390/genes13081339] [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: 07/11/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Skeletal dysplasias (SDs) are a large, heterogeneous group of mostly genetic disorders that affect the bones and cartilage, resulting in abnormal growth and development of skeletal structures. The high clinical and genetic diversity in SDs cause difficulties in prenatal diagnosis. To establish a correct prognosis and better management, it is very important to distinguish SDs with poor life-limiting prognosis or lethal SDs from other ones. Bad prognosis in foetuses is assessed on the basis of the size of the thorax, lung volumes, long bones’ length, bones’ echogenicity, bones’ angulation or presented fractures, and the concomitant presence of non-immune hydrops or visceral abnormalities. To confirm SD diagnosis and perform family genetic consultation, rapid molecular diagnostics are needed; therefore, the NGS method using a panel of genes corresponding to SD or whole-exome sequencing (WES) is commonly used. We report a case of a foetus showing long bones’ shortening and a narrow chest with short ribs, diagnosed prenatally with asphyxiating thoracic dystrophy, also known as Jeune syndrome (ATD; OMIM 208500), caused by compound heterozygous variants in the DYNC2H1 gene, identified by prenatally performed rapid-WES analysis. The missense variants in the DYNC2H1 gene were inherited from the mother (c.7289T>C; p.Ile2430Thr) and from the father (c.12716T>G; p.Leu4239Arg). The DYNC2H1 gene is one of at least 17 ATD-associated genes. This disorder belongs to the ninth group of SD, ciliopathies with major skeletal involvement. An extremely narrow, bell-shaped chest, and abnormalities of the kidneys, liver, and retinas were observed in most cases of ATD. Next to lethal and severe forms, clinically mild forms have also been reported. A diagnosis of ATD is important to establish the prognosis and management for the patient, as well as the recurrence risk for the family.
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Mira PCDS, Arid J, Paula‐Silva FWG, Queiroz AM, Carvalho FK, Pagnano VO. Oral rehabilitation in a patient with Jeune syndrome presenting with multiple teeth agenesis. SPECIAL CARE IN DENTISTRY 2020; 40:493-497. [DOI: 10.1111/scd.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/25/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Paôla Caroline da Silva Mira
- Department of Pediatric Clinics, School of Dentistry of Ribeirão Preto University of São Paulo (USP) Ribeirão Preto São Paulo Brazil
| | - Juliana Arid
- Department of Pediatric Clinics, School of Dentistry of Ribeirão Preto University of São Paulo (USP) Ribeirão Preto São Paulo Brazil
| | | | - Alexandra Mussolino Queiroz
- Department of Pediatric Clinics, School of Dentistry of Ribeirão Preto University of São Paulo (USP) Ribeirão Preto São Paulo Brazil
| | - Fabricio Kitazono Carvalho
- Department of Pediatric Clinics, School of Dentistry of Ribeirão Preto University of São Paulo (USP) Ribeirão Preto São Paulo Brazil
| | - Valéria Oliveira Pagnano
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto University of São Paulo (USP) Ribeirão Preto São Paulo Brazil
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Page J, Bodart E, Hennecker JL. [Infant respiratory distress revealing Jeune syndrome]. Arch Pediatr 2016; 24:41-44. [PMID: 27889373 DOI: 10.1016/j.arcped.2016.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
Abstract
Jeune syndrome (asphyxiating thoracic dystrophy) is a rare autosomal recessive osteochondrodysplasia with a variable degree of severity, clinically characterized by respiratory distress with a narrow chest and limb shortness. The reported incidence is one to five in 500,000 live births. Most patients develop severe respiratory failure during the first 2 years of life, leading to death in 60-80 % of cases. Survivors may suffer from renal, hepatic, or pancreatic complications. Expanding thoracic surgery can be used for severe cases. We describe the case of an 18-month-old boy who developed mild respiratory distress. The patient showed typical radiological features of Jeune syndrome: narrow thorax with short ribs and trident appearance of the pelvis. This case underscores the value of the right interpretation of the chest radiograph of the infant with a respiratory distress syndrome.
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Affiliation(s)
- J Page
- Service de pédiatrie, clinique Notre-Dame de Grâce, 212, chaussée de Nivelles, 6041 Gosselies, Belgique
| | - E Bodart
- Service de pédiatrie, CHU UCL Namur site Godinne, 1, avenue du Docteur-Gaston-Therasse, 5530 Yvoir, Belgique
| | - J-L Hennecker
- Service de pédiatrie, clinique Notre-Dame de Grâce, 212, chaussée de Nivelles, 6041 Gosselies, Belgique.
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Krupnick AS. What are the indications for pectus excavatum repair at the time of congenital cardiac surgery: Separating theory from reality. J Thorac Cardiovasc Surg 2016; 151:e69-70. [DOI: 10.1016/j.jtcvs.2015.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
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Reversed autogenous sternal plate flaps for treatment of sternal clefts: A novel technique. J Pediatr Surg 2015; 50:1991-4. [PMID: 26316301 DOI: 10.1016/j.jpedsurg.2015.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A sternal cleft is an extremely rare congenital anomaly resulting from a failure of the fusion of the sternal bars. The condition can be classified as complete or incomplete, where there is an inferior or less commonly a superior attachment. We report our experience with a modified surgical technique using a reverse autogenous sternal plate flap to treat complete sternal clefts in children beyond the neonatal period without the need for any prosthetic material or disruption of the chest wall structure. PATIENTS AND METHODS The technique was performed on three patients beyond the neonatal period at the age of 2, 4 and 12years. Two patients were female and one was a male. All cases were performed by a single surgeon. Parents were consented for the new technique. Institutional review board (IRB) approval was obtained. RESULTS Recovery in all children was uncomplicated, and they were discharged home after 4, 4 and 5days respectively. There were no morbidities among all 3 patients. Review at 4 and 12weeks revealed complete wound healing and a well-united sternum. All remain asymptomatic on a median follow-up period of 22months. CONCLUSIONS Our new technique in repairing complete sternal clefts was easy, reproducible and generated satisfactory results on a reasonable follow up period. Most importantly we avoided the use of prosthetic material and any disruption to the chest wall structure in a subgroup of older patients.
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Mistry KA, Suthar PP, Bhesania SR, Patel A. Antenatal Diagnosis of Jeune Syndrome (Asphyxiating Thoracic Dysplasia) with Micromelia and Facial Dysmorphism on Second-Trimester Ultrasound. Pol J Radiol 2015; 80:296-9. [PMID: 26124900 PMCID: PMC4463774 DOI: 10.12659/pjr.894188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/02/2015] [Indexed: 12/12/2022] Open
Abstract
Background Jeune syndrome is a rare congenital malformation with a reported incidence of 1 in 100,000–130,000 live births. Thoracic hypoplasia is the most striking abnormality of this disorder. Here we report a case of Jeune syndrome with marked thoracic hypoplasia, micromelia and facial dysmorphism, which was diagnosed on a second-trimester antenatal real-time three-dimensional ultrasound. Case Report A 24-year-old primigravida came for routine anomaly scan at 19 weeks of gestation. Transabdominal grey scale and real time 3D ultrasound (US) was done with GE Logiq P5 with curvilinear array transducers (4C and 4D3C-L). US findings were consistent with the diagnosis of Jeune syndrome (Asphyxiating thoracic dysplasia). Conclusions Jeune syndrome is an extremely rare congenital disorder with a spectrum of abnormalities of which thoracic hypoplasia is the most striking. It can be diagnosed on early antenatal US by its characteristic skeletal and morphological features which can guide further management of pregnancy in form of termination or preparation for surgical correction of the deformity.
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Affiliation(s)
- Kewal A Mistry
- Department of Radiology, Dr. Rajendra Prasad Government Medical College, Kangra, India
| | - Pokhraj P Suthar
- Department of Radiology, Baroda Medical College, Vadodara, India
| | - Siddharth R Bhesania
- Department of Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
| | - Ankitkumar Patel
- Department of Physiology, Baroda Medical College, Vadodara, India
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Kanani M, Elliott MJ, Withey S, Pearl R. Chest wall reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sacco Casamassima MG, Goldstein SD, Salazar JH, Papandria D, McIltrot KH, O'Neill DE, Abdullah F, Colombani PM. Operative management of acquired Jeune's syndrome. J Pediatr Surg 2014; 49:55-60; discussion 60. [PMID: 24439581 DOI: 10.1016/j.jpedsurg.2013.09.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 09/30/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acquired Jeune's syndrome is a severe iatrogenic deformity of the thoracic wall following a premature and aggressive open pectus excavatum repair. We report herein our technique and experience with this rare condition. METHODS From 1996 to 2011, nineteen patients with acquired Jeune's syndrome were retrospectively identified in a tertiary referral center. The technique used to expand and reconstruct the thoracic wall consisted of 1) release of the sternum from fibrous scar tissue, 2) multiple osteotomies along the lateral aspect of the ribs with anterior advancement of costal-cartilages to protect the heart, 3) stabilization of the thorax by placing a curved bar for retrosternal support and, 4) restoration of the sterno-costal junction by wiring the lower cartilages to the edge of the sternum. RESULTS Major complications observed in this series were: bar displacement (seven cases), postoperative death from cardiac arrest following bronchoscopy (one case), late cardiac tamponade from migration of wire suture fragment (one case), and need for multiple reoperations (one case). Long-term cosmetic results and improvement in daily quality of life were reported as positive in the majority of cases. CONCLUSIONS Anterior chest wall reconstruction successfully treated our series of patients with acquired Jeune's syndrome. This multifaceted technique is an effective procedure that allows expansion of the thoracic cavity and improvement of aerobic activity.
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Affiliation(s)
- Maria Grazia Sacco Casamassima
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth D Goldstein
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jose H Salazar
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dominic Papandria
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kimberly H McIltrot
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David E O'Neill
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fizan Abdullah
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Colombani
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Poyner SE, Bradshaw WT. Jeune syndrome: considerations for management of asphyxiating thoracic dystrophy. Neonatal Netw 2013; 32:342-352. [PMID: 23985472 DOI: 10.1891/0730-0832.32.5.342] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Jeune syndrome (JS), or asphyxiating thoracic dystrophy, is a rare genetic disorder characterized by a small, narrow thorax, with associated shortening of limbs. Children with JS present with variable degrees of respiratory distress, frequently lethal in the neonatal period. Other associated complications include renal, hepatic, gastrointestinal, and retinal dysfunction. Management focuses on stabilization and support of respiratory function. Treatment may be palliative in nature or corrective. In recent years, the advance in surgical treatment of the thoracic hypoplasia in JS offers hope to those families with a child suffering from the syndrome. Even with increased research into treatment of this disorder, prognosis is usually poor. Comorbidities associated with JS lead to serious organ dysfunction in later years. Families who have a child with JS need genetic counseling and education focusing on the seriousness of the disorder, the risks and benefits of treatment, and the lifelong needs of those with JS.
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Affiliation(s)
- Sabrina E Poyner
- Rady Children's Specialists of San Diego, 3020 Children’s Way, MC 5008, San Diego, CA 92123, USA.
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Keppler-Noreuil KM, Adam MP, Welch J, Muilenburg A, Willing MC. Clinical insights gained from eight new cases and review of reported cases with Jeune syndrome (asphyxiating thoracic dystrophy). Am J Med Genet A 2011; 155A:1021-32. [PMID: 21465651 DOI: 10.1002/ajmg.a.33892] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 12/22/2010] [Indexed: 11/09/2022]
Abstract
Jeune syndrome, originally described as asphyxiating thoracic dystrophy by Jeune et al. [Jeune et al. (1955); Arch Fr Pediatr 12:886-891], is an autosomal recessive osteochondrodysplasia with characteristic skeletal abnormalities, and variable renal, hepatic, pancreatic, and retinal complications. We present eight patients, including two brothers with Jeune syndrome, and an extensive review of 118 cases in the published literature with the purposes of: (1) defining the clinical and radiological diagnostic criteria for Jeune syndrome; (2) comparing our cases to those in the literature meeting the documented clinical and radiological findings of Jeune syndrome, in order to: (3) provide an accurate clinical characterization of Jeune syndrome with frequency of associated complications and outcome data. In order to estimate the frequency of phenotypic abnormalities in Jeune syndrome as precisely as possible, we did not include reports in the literature with incomplete descriptions of the radiologic and clinical findings, nor those reports having additional findings overlapping with other syndromes. We found that the occurrence of renal, hepatic, and ophthalmologic complications is variable; does not correlate with severity of the skeletal phenotype; nor is it predictable even with the presence of a well-defined skeletal phenotype, as in this study. Based upon these cases with Jeune syndrome, renal and hepatic abnormalities occur in approximately 30% of cases, with renal failure occurring in 38% of those with kidney involvement. Eye abnormalities are reported in 15%, but it is unclear whether this represents under-ascertainment. There is a 1.2:1 ratio between living and deceased patients; a respiratory cause of death is most common, occurring almost exclusively in those less than 2 years of age, and a renal etiology accounts for all deaths between the ages of 3-10 years of age. There is a paucity of affected individuals reported in the literature greater than age 20 years, and a lack of longitudinal data to obtain accurate data on morbidity and mortality of Jeune syndrome at older ages. This study provides a well-defined group of patients with Jeune syndrome with delineation of the frequency of associated findings, which may form a basis for current and future genotype-phenotype studies.
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Affiliation(s)
- Kim M Keppler-Noreuil
- Division of Medical Genetics, Department of Pediatrics, University of Iowa Hospitals & Clinics, Iowa City, USA.
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Calloway EH, Chhotani AN, Lee YZ, Phillips JD. Three-dimensional computed tomography for evaluation and management of children with complex chest wall anomalies: useful information or just pretty pictures? J Pediatr Surg 2011; 46:640-647. [PMID: 21496531 PMCID: PMC3838878 DOI: 10.1016/j.jpedsurg.2010.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 09/27/2010] [Accepted: 10/14/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Shaded surface display (SSD) technology, with 3-dimensional computed tomography reconstruction, has been reported in a few small series of patients with congenital or acquired chest wall deformities. Shaded surface display images are visually attractive and educational, but many institutions are hesitant to use these secondary to cost and image data storage concerns. This study was designed to assess the true value of SSD to the patient, family, and operating surgeon, in the evaluation and management of these children. METHODS After institutional review board approval, we performed a retrospective review of records of 82 patients with chest wall deformities, evaluated with SSD, from 2002 to 2009. Shaded surface display usefulness, when compared to routine 2-dimensional computed tomography, was graded on a strict numerical scale from 0 (added no value besides education for the patient/family) to 3 (critical for surgical planning and patient management). RESULTS There were 56 males and 26 females. Median age was 15.3 years (range, 0.6-41.1 years). Deformities included 56 pectus excavatum, 19 pectus carinatum, and 8 other/mixed deformities. Six patients also had acquired asphyxiating thoracic dystrophy (AATD). Eleven (13%) had previous chest wall reconstructive surgery. In 25 (30%) patients, SSD was useful or critical. Findings underappreciated on 2-dimensional images included sternal abnormalities (29), rib abnormalities (28), and heterotopic calcifications (7). Shaded surface display changed or influenced operation choice (4), clarified bone vs soft tissue (3), helped clarify AATD (3), and aided in rib graft evaluation (2). Point biserial correlation coefficient analysis (R(pb)) displayed significance for SSD usefulness in patients with previous chest repair surgery (R(pb) = 0.48, P ≤ .001), AATD (R(pb) = 0.34, P = .001), pectus carinatum (R(pb) = 0.27, P = .008), and females (R(pb) = 0.19, P = .044). CONCLUSIONS Shaded surface display, when used to evaluate children and young adults with congenital or acquired chest wall deformities, provides useful or critical information for surgical planning and patient management in almost one third of patients, especially in those requiring a second operation, with acquired asphyxiating thoracic dystrophy, pectus carinatum, and females.
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Affiliation(s)
- E. Hollin Calloway
- Department of Surgery, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ali N. Chhotani
- Department of Surgery, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yueh Z. Lee
- Department of Radiology, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J. Duncan Phillips
- Department of Surgery, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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