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Folson AA, Agyapong KO, Dey D, Eghan P, Quaye B. Marfan syndrome in a Ghanaian male: The diagnostic challenges. Clin Case Rep 2024; 12:e8494. [PMID: 38380377 PMCID: PMC10876919 DOI: 10.1002/ccr3.8494] [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: 10/28/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
Marfan syndrome (MFS) is an autosomal dominantly inherited condition that has varying phenotypic expressions. This case report describes one such African patient, from Ghana, who had typical clinical and imaging traits of MFS but was first diagnosed incidentally at the age of 23 years. In this report, we explore the challenges of early diagnosis in this population.
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Affiliation(s)
- Aba A. Folson
- Department of Internal Medicine and Therapeutics, School of MedicineUniversity of Health and Allied SciencesHoGhana
| | | | - Dzifa Dey
- Department of Medicine and TherapeuticsUniversity of Ghana Medical School, College of Health Sciences, University of GhanaAccraGhana
| | - Philip Eghan
- Department of RadiologyUniversity of Ghana Medical CentreAccraGhana
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Pollock L, Ridout A, Teh J, Nnadi C, Stavroulias D, Pitcher A, Blair E, Wordsworth P, Vincent TL. The Musculoskeletal Manifestations of Marfan Syndrome: Diagnosis, Impact, and Management. Curr Rheumatol Rep 2021; 23:81. [PMID: 34825999 PMCID: PMC8626407 DOI: 10.1007/s11926-021-01045-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
Purpose of Review
Marfan syndrome (MFS) is an autosomal dominant heritable disorder of fibrillin-1 (FBN1) with predominantly ocular, cardiovascular, and musculoskeletal manifestations that has a population prevalence of approximately 1 in 5–10,000 (Chiu et al. Mayo Clin Proc. 89(1):34–42, 146, Dietz 3, Loeys et al. J Med Genet. 47(7):476–85, 4). Recent Findings The vascular complications of MFS still pose the greatest threat, but effective management options, such as regular cardiac monitoring and elective surgical intervention, have reduced the risk of life-threatening cardiovascular events, such as aortic dissection. Although cardiovascular morbidity and mortality remains high, these improvements in cardiovascular management have extended the life expectancy of those with MFS by perhaps 30–50 years from an estimated mean of 32 years in 1972 (Dietz 3, Gott et al. Eur J Cardio-thoracic Surg. 10(3):149–58, 147, Murdoch et al. N Engl J Med. 286(15):804–8, 148). The musculoskeletal manifestations of MFS, which to date have received less attention, can also have a significant impact on the quality of life and are likely to become more important as the age of the Marfan syndrome population increases (Hasan et al. Int J Clin Pract. 61(8):1308–1320, 127). In addition, musculoskeletal manifestations are often critically important in the diagnosis of MFS. Summary Here, we review the main clinically relevant and diagnostically useful musculoskeletal features of MFS, which together contribute to the “systemic features score” (referred to hereafter as systemic score), part of the revised Ghent nosology for MFS. We discuss current treatment strategies and highlight the need for a multidisciplinary approach to diagnosis and management. Finally, we review new pharmacological approaches that may be disease modifying and could help to improve the outcome for individuals with this syndrome.
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Affiliation(s)
- Lily Pollock
- Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
| | - Ashley Ridout
- Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - James Teh
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, England, UK
| | - Colin Nnadi
- Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Alex Pitcher
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Edward Blair
- Department of Clinical Genetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paul Wordsworth
- Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tonia L Vincent
- Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK. .,Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Bachmann KR, Yaszay B, Bartley CE, Bastrom TP, Reighard FG, Upasani VV, Newton PO. A three-dimensional analysis of scoliosis progression in non-idiopathic scoliosis: is it similar to adolescent idiopathic scoliosis? Childs Nerv Syst 2019; 35:1585-1590. [PMID: 31183529 DOI: 10.1007/s00381-019-04239-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the three-dimensional (3D) characteristics of spine deformity in patients with non-idiopathic scoliosis compared with those observed in patients with adolescent idiopathic scoliosis (AIS). METHODS A retrospective chart review was conducted to identify patients with non-idiopathic scoliosis. Twenty-eight patients with neural axis (NA) abnormalities (Chiari 1, syrinx) and 20 patients with connective tissue disorder (CTD) (Marfan's, Beal's, Ehlers-Danlos syndrome, mixed) were identified. The 3D parameters of the coronal, sagittal, and axial plane were compared with 284 AIS patients with a similar range of coronal deformity. RESULTS The average coronal curve was similar between all three groups (AIS 48 ± 15°, CTD 43 ± 22°, and NA 49 ± 18°; p = 0.4). The NA patients had significantly greater 3D thoracic kyphosis (20 ± 18° vs 10 ± 15°, p = 0.001) and less thoracic apical vertebral rotation (- 5 ± 18° vs - 12 ± 10°, p = 0.003) when compared with AIS. The CTD group's 3D thoracic kyphosis (p = 0.7) and apical vertebral rotation (p = 0.09) did not significantly differ from AIS. Significant negative correlations were found in all three groups between thoracic kyphosis and coronal curve magnitude (AIS r = - 0.49, CTD r = - 0.772, NA r = -0.677, all p < 0.001). CONCLUSIONS Scoliotic patients with NA abnormalities have a more kyphotic, less-rotated 3D profile than patients with AIS, while scoliosis patients with CTD have 3D features similar to AIS. Irrespective of the underlying diagnosis, however, greater scoliotic curves were associated with a greater loss of intersegmental kyphosis, suggesting a similar biomechanical pathophysiology for curve progression.
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Affiliation(s)
- Keith R Bachmann
- Department of Orthopedics, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Burt Yaszay
- Department of Orthopedics, Rady Children's Hospital, 3030 Children's Way, MC5062, San Diego, CA, 92123, USA. .,Department of Orthopedics, University of California, San Diego, CA, USA.
| | - Carrie E Bartley
- Department of Orthopedics, Rady Children's Hospital, 3030 Children's Way, MC5062, San Diego, CA, 92123, USA
| | - Tracey P Bastrom
- Department of Orthopedics, Rady Children's Hospital, 3030 Children's Way, MC5062, San Diego, CA, 92123, USA
| | - Fredrick G Reighard
- Department of Orthopedics, Rady Children's Hospital, 3030 Children's Way, MC5062, San Diego, CA, 92123, USA
| | - Vidyadhar V Upasani
- Department of Orthopedics, Rady Children's Hospital, 3030 Children's Way, MC5062, San Diego, CA, 92123, USA.,Department of Orthopedics, University of California, San Diego, CA, USA
| | - Peter O Newton
- Department of Orthopedics, Rady Children's Hospital, 3030 Children's Way, MC5062, San Diego, CA, 92123, USA.,Department of Orthopedics, University of California, San Diego, CA, USA
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Sato H, Kondo M, Ojima I, Fukasawa H, Higuchi S. Trunk deformity evaluation based on 3D measurements of front body surface landmarks in people with severe physical disabilities. Dev Neurorehabil 2017; 20:280-286. [PMID: 27715377 DOI: 10.1080/17518423.2016.1211188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess reliability and validity of a trunk deformity evaluation method expressed as rotational and lateral lean angles between the upper and the lower trunk and between the lower trunk and the pelvis using 3D positions of six front body surface landmarks. METHODS Inter- and intra-rater reliabilities of the proposed method in adults with typical development (n = 22) were assessed, and its validity was also assessed through correlations between the Cobb angle and the analyzed trunk deformity parameters in adults with severe physical disabilities (n = 22). RESULTS The mean differences between two raters and between the initial and second measures were within 2°. Moderate correlations were found between the Cobb angle and both the upper and the lower trunk lateral lean angle and the upper trunk rotation angle. CONCLUSIONS The proposed trunk deformity evaluation appears to be a reliable and valid approach for bedridden people with physical disabilities.
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Affiliation(s)
- Haruhiko Sato
- a School of Allied Health Sciences , Kitasato University , Sagamihara , Japan
| | - Mika Kondo
- b Department of Physical Therapy , Shin-Yurigaoka General Hospital , Kawasaki , Japan
| | - Itaru Ojima
- a School of Allied Health Sciences , Kitasato University , Sagamihara , Japan
| | - Hiroaki Fukasawa
- c Institute for People with Disabilities , Sagamihara Ryoikuen, Sagamihara , Japan
| | - Shigeru Higuchi
- c Institute for People with Disabilities , Sagamihara Ryoikuen, Sagamihara , Japan
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