1
|
Vielsmeier V. [Management of pediatric vascular malformations]. HNO 2024:10.1007/s00106-024-01447-6. [PMID: 38563894 DOI: 10.1007/s00106-024-01447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Vascular malformations belong to the group of vascular anomalies. They are rare congenital diseases resulting from abnormal development of vessels and can arise in any location, often in the head and neck region. Clinical symptoms are variable, functional handicaps and esthetic problems may result. MATERIALS AND METHODS One differentiates between arteriovenous, lymphatic, venous, and capillary malformations and combinations thereof. Their classification, symptoms, diagnostics, and treatment options are discussed. RESULTS The different types of vascular malformations as well as their clinical presentation, diagnostic workup, and therapeutic options are presented, supported by clinical examples. CONCLUSION Interdisciplinary care of pediatric patients with vascular malformations is essential in order to generate a treatment concept after correct diagnosis and improve symptoms and quality of life.
Collapse
Affiliation(s)
- Veronika Vielsmeier
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
| |
Collapse
|
2
|
Dorschel KB, Wanebo JE. Physiological and pathophysiological mechanisms of the molecular and cellular biology of angiogenesis and inflammation in moyamoya angiopathy and related vascular diseases. Front Neurol 2023; 14:661611. [PMID: 37273690 PMCID: PMC10236939 DOI: 10.3389/fneur.2023.661611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 01/16/2023] [Indexed: 06/06/2023] Open
Abstract
Rationale The etiology and pathophysiological mechanisms of moyamoya angiopathy (MMA) remain largely unknown. MMA is a progressive, occlusive cerebrovascular disorder characterized by recurrent ischemic and hemorrhagic strokes; with compensatory formation of an abnormal network of perforating blood vessels that creates a collateral circulation; and by aberrant angiogenesis at the base of the brain. Imbalance of angiogenic and vasculogenic mechanisms has been proposed as a potential cause of MMA. Moyamoya vessels suggest that aberrant angiogenic, arteriogenic, and vasculogenic processes may be involved in the pathophysiology of MMA. Circulating endothelial progenitor cells have been hypothesized to contribute to vascular remodeling in MMA. MMA is associated with increased expression of angiogenic factors and proinflammatory molecules. Systemic inflammation may be related to MMA pathogenesis. Objective This literature review describes the molecular mechanisms associated with cerebrovascular dysfunction, aberrant angiogenesis, and inflammation in MMA and related cerebrovascular diseases along with treatment strategies and future research perspectives. Methods and results References were identified through a systematic computerized search of the medical literature from January 1, 1983, through July 29, 2022, using the PubMed, EMBASE, BIOSIS Previews, CNKI, ISI web of science, and Medline databases and various combinations of the keywords "moyamoya," "angiogenesis," "anastomotic network," "molecular mechanism," "physiology," "pathophysiology," "pathogenesis," "biomarker," "genetics," "signaling pathway," "blood-brain barrier," "endothelial progenitor cells," "endothelial function," "inflammation," "intracranial hemorrhage," and "stroke." Relevant articles and supplemental basic science articles almost exclusively published in English were included. Review of the reference lists of relevant publications for additional sources resulted in 350 publications which met the study inclusion criteria. Detection of growth factors, chemokines, and cytokines in MMA patients suggests the hypothesis of aberrant angiogenesis being involved in MMA pathogenesis. It remains to be ascertained whether these findings are consequences of MMA or are etiological factors of MMA. Conclusions MMA is a heterogeneous disorder, comprising various genotypes and phenotypes, with a complex pathophysiology. Additional research may advance our understanding of the pathophysiology involved in aberrant angiogenesis, arterial stenosis, and the formation of moyamoya collaterals and anastomotic networks. Future research will benefit from researching molecular pathophysiologic mechanisms and the correlation of clinical and basic research results.
Collapse
Affiliation(s)
- Kirsten B. Dorschel
- Medical Faculty, Heidelberg University Medical School, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - John E. Wanebo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
- Department of Neuroscience, HonorHealth Research Institute, Scottsdale, AZ, United States
| |
Collapse
|
3
|
Portugal MFC, Tachibana A, Rocha MA, Naves ÉA, Amaral LTW, Camilo LP, Hallage B, Wolosker N, Teivelis MP. Radiological Profile of 18,430 Vascular Anomalies: Incidence and Demographic Distribution in an Adult Population. Ann Vasc Surg 2023:S0890-5096(23)00103-6. [PMID: 36805426 DOI: 10.1016/j.avsg.2023.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Most studies on focusing on the prevalence of vascular anomalies are either aimed to determine the individual occurrence of a specific type among known bearers of abnormalities or propose an estimation of prevalence for the general population by extrapolating from the paediatric population. In this scenario, we intended to assess the profile of vascular anomalies in a group of patients subjected to imaging studies, throughout a long period of time, to evaluate the frequency of abnormal findings in a consecutive, nonselected population. METHODS This is a retrospective review of 996,569 computed tomography and magnetic resonance studies between 2009 and 2019. Findings were grouped as vascular tumours (hemangiomas; vascular tumours), cavernomas, and vascular malformations. Positive findings were evaluated with regard to patients' demographic characteristics and anatomic distribution and the subset of vascular malformations was also evaluated with regard to size, classification in accordance to flow pattern, and Hamburg Classification. RESULTS Eighteen thousand four hundred thirty positive examinations were evaluated (mean age, 55.82 ± 15.43 years; 8,188 men). Vascular anomalies were present in 18.49 per 1,000 examinations (17.41 hemangiomas; 0.69 cavernomas and 0.39 vascular malformations per 1,000 examinations). Hemangiomas and cavernomas were homogeneous in anatomic location between sexes throughout the age groups. Complex malformations were heterogeneous in anatomic distribution between the sexes in each age group, with intracranial findings decreasing for female patients in older groups. CONCLUSIONS Vascular anomalies were found in 18.49 per 1,000 examinations. Hemangiomas and cavernomas were homogenously distributed, whereas complex malformations displayed a heterogeneous anatomic distribution pattern between sexes in each age group.
Collapse
Affiliation(s)
| | | | | | - Érica A Naves
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Luana Perrone Camilo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil
| | - Bianca Hallage
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil
| |
Collapse
|
4
|
Strübing F, Laurich A, Weiss C, Schönberg S, Kneser U, Sadick M. Performance of a vascular anomaly center: a retrospective analysis of 461 cases over seven years. Acta Radiol 2022; 64:1712-1717. [PMID: 36226366 DOI: 10.1177/02841851221130869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular malformations are rare diseases that are best managed in multidisciplinary vascular anomaly centers (VAC). So far, there are few published data on the logistic structure, patient allotment, and internal workflow in an interdisciplinary VAC. PURPOSE To demonstrate the referral structure and patient allotment in a European VAC. MATERIAL AND METHODS A retrospective cohort study was conducted. All patients treated in the VAC since its establishment in April 2014 until June 2020 were identified. A total of 461 patients were included in this study. RESULTS Most often, a venous malformation was diagnosed (49.9%), followed by arteriovenous malformations (8.7%) and syndromal vascular malformations (8.2%). Only 45.1% of referral diagnoses were correct. Of referrals, 35.1% were internal on-campus references, 28.0% were external references through physicians in private practice, and 19.7% came via external cooperating hospitals. Of the patients, 17.1% were self-admissions without a referral. CONCLUSION The most important referring clinics are internal medicine, pediatric, and vascular surgery. A substantial proportion of referrals came from private practices. Recruiting these cooperation partners should be considered a high priority when establishing a new VAC. The rate of misdiagnosis is high, and more education of fellow clinicians is urgently needed. Therefore, patients with vascular malformations should be referred to and treated in dedicated centers for vascular anomalies.
Collapse
Affiliation(s)
- Felix Strübing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Annette Laurich
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics and Data Processing, University Medical Center Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Mannheim, Germany
| | - Stefan Schönberg
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Mannheim, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
5
|
Mortality and morbidity of infants with trisomy 21, weighing 1500 grams or less, in Japan. J Hum Genet 2022; 67:623-628. [PMID: 35787654 DOI: 10.1038/s10038-022-01061-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/26/2022] [Accepted: 06/22/2022] [Indexed: 11/09/2022]
Abstract
Although very low birth weight (VLBW) is well studied in neonatology and the perinatal prognosis of VLBW infants has improved over time, little is known about the prognosis of VLBW infants with trisomy 21 (T21). We aimed to investigate the mortality and morbidity of VLBW infants with T21 during NICU admission in Japan, in comparison to those of infants without birth defects (BD-). Maternal and neonatal data of infants weighing 1500 grams or less admitted to the centers of the Neonatal Research Network of Japan from 2003 to 2016 were collected prospectively. Of 60,136 infants, 328 (0.55%) had T21. Although maternal age in the case of T21 infants was higher, maternal complications tended to be less frequent than in those with BD-. Multivariable analysis revealed that morbidities were higher in infants with T21 than in those with BD- but respiratory distress syndrome and retinopathy of prematurity were less frequent in those with T21 (p < 0.001, and p = 0.014, respectively), and no significant difference was observed between the two groups in the proportion of late-onset circulatory collapse of prematurity as well as cystic periventricular leukomalacia (p = 0.739 and p = 0.733, respectively). The survival rate at discharge from the NICU was 77% and 94% for T21 and BD-, respectively. This was the first nationwide survey of VLBW infants with T21 in Japan. Although there were no data regarding the timing of diagnosis, these data will aid prenatal genetic counseling and perinatal management of T21 infants.
Collapse
|
6
|
Azis KA, Koh KL, Wan Sulaiman WA, Al-Chalabi MMM. Extracranial Arteriovenous Malformations Rupture in Pregnancy. Cureus 2022; 14:e22798. [PMID: 35399437 PMCID: PMC8980199 DOI: 10.7759/cureus.22798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/05/2022] Open
|
7
|
Wall shear stress on vascular smooth muscle cells exerts angiogenic effects on extracranial arteriovenous malformations. Arch Plast Surg 2022; 49:115-120. [PMID: 35086320 PMCID: PMC8795650 DOI: 10.5999/aps.2021.00626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background In addition to vascular endothelial cells, vascular smooth muscle cells (VSMCs) are subject to continuous shear stress because of blood circulation. The angiogenic properties of VSMCs in extracranial arteriovenous malformations (AVMs) may exceed those of normal blood vessels if the body responds more sensitively to mechanical stimuli. This study was performed to investigate the hypothesis that rapid angiogenesis may be achieved by mechanical shear stress. Methods VSMCs were obtained from six patients who had AVMs and six normal controls. The target genes were set to angiopoietin-2 (AGP2), aquaporin-1 (AQP1), and transforming growth factor-beta receptor 1 (TGFBR1). Reverse-transcriptase polymerase chain reaction (RT-PCR) and real-time PCR were implemented to identify the expression levels for target genes. Immunofluorescence was also conducted. Results Under the shear stress condition, mean relative quantity values of AGP2, AQP1, and TGFBR1 in AVM tissues were 1.927±0.528, 1.291±0.031, and 2.284±1.461 when compared with neutral conditions. The expression levels of all three genes in AVMs were higher than those in normal tissue except for AQP1 under shear stress conditions. Immunofluorescence also revealed increased staining of shear stress-induced genes in the normal tissue and in AVM tissue. Conclusions Shear stress made the VSMCs of AVMs more sensitive. Although the pathogenesis of AVMs remains unclear, our study showed that biomechanical stimulation imposed by shear stress may aggravate angiogenesis in AVMs.
Collapse
|
8
|
Abstract
Down syndrome (DS) is the most common chromosomal condition and affects many organs including the skin. Dermatologists are an integral part of the DS care team. This is a review of both common and rare dermatologic conditions in DS. We provide practical strategies for a successful dermatology interview and examination. We explore the downstream effects of trisomy of chromosome 21, in particular on the immune system, and how these insights may enhance our pathophysiologic understanding of their cutaneous conditions.
Collapse
Affiliation(s)
- Chenin Ryan
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Kishore Vellody
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Leah Belazarian
- Departments of Pediatrics and Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jillian F Rork
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.,Department of Dermatology, Dartmouth-Hitchcock Medical Center, Manchester, New Hampshire, USA
| |
Collapse
|
9
|
Abstract
A 56-year-old woman with Down syndrome presented with right-sided weakness and dysarthria, and was found on CT/CTA to have a left middle cerebral artery infarct secondary to moyamoya disease. Her left posterior inferior cerebellar artery (PICA) was fed both by the left vertebral artery, and the left ascending pharyngeal artery (APA), with a variant origin from the internal carotid artery (ICA), then passing through the jugular foramen (Figure 1). Her right PICA originated exclusively from her right occipital artery, also via the jugular foramen (Figure 2). The left vertebral artery originated directly from the aortic arch, whereas the right vertebral artery originated from the brachiocephalic trunk. In addition, she had a trifurcated anterior cerebral artery (ACA), and just prior to this trifurcation, her left ACA was partially supplied by the left ICA, via a superior hypophyseal artery. This case is noteworthy for several reasons. First, though it is exceedingly rare to have the PICA supplied by the jugular branch of the APA, this is the first reported case with an ICA origin of that APA.1,2 The fact that both PICAs in this patient originate from the anterior circulation should remind clinicians that in unexplained posterior circulation infarctions, vascular anatomy should be explored, as carotid-vertebrobasilar anastomoses such as these are rare, but possible. Lastly, the conjunction of moyamoya disease and anomalies of the vertebrobasilar system in a patient with Down syndrome raises interesting questions about the influence of trisomy 21 on the developing vasculature. Connections from the APA to the vertebrobasilar system are hypothesized to result from a lack of regression of an embryological anastomosis, in line with the more common persistent trigeminal and persistent hypoglossal arteries.1 Patients with moyamoya disease have a significantly higher rate of persistent carotid-vertebrobasilar anastomoses than the general population,3 and are also 26 times more likely to have Down syndrome.4 Correspondingly, patients with Down syndrome have significantly higher levels of moyamoya disease, and are more than 10 times as likely as the general population to have abnormalities of the Circle of Willis5 and vertebral arteries.6 Several genes on chromosome 21 are known to affect angiogenesis, namely collagen XIII/endostatin (COL18A1), DYRK1A, and Down syndrome candidate region 1 (DSCR1), possibly through inhibition of VEGF activity.7 Whether additional copies of these genes are responsible for the anomalous vascular development seen in Down syndrome, in turn predisposing to the development of moyamoya disease, could benefit from further exploration.
Collapse
|
10
|
Abstract
Background: Tessellated fundus refers to a specific change in the appearance of the internal layers of the eye in which the choroidal large vessels became visible through polygonal hypopigmented areas. Such hypopigmented areas alternate with hyperpigmented zones in a tigroid pattern. Fundus tessellation is often associated with myopia and choroidal thinning.Materials and Methods: We analyzed fundus images from 50 children with Down syndrome and 52 controls.Results: Tessellation was present in 64% of children with Down syndrome, compared with only 13.5% of controls (p < .0001). In most cases, tessellation was located peripapillary, and no difference was observed in tessellation localization between children with Down syndrome and controls (p = .60). Although more prevalent in myopic children with and without Down syndrome, tessellation was present in almost half (48%) of children with Down syndrome with hyperopia versus only 5% of controls with the same refractive status.Conclusions: Mechanical stretching of the choroid could explain the high rate of tessellation in myopes. Other factors must contribute to the higher prevalence of tessellated fundus in children with Down syndrome without myopia. We discuss potentially relevant factors and propose vascular involvement as a contributor to tessellation in our population with Down syndrome. Further studies assessing choroidal vasculature in individuals with Down syndrome are needed to confirm this theory.
Collapse
Affiliation(s)
- Lavinia Postolache
- Ophthalmology Department, Queen Fabiola University Children's Hospital, Université Libre De Bruxelles, Brussels, Belgium
| | - Casper De Jong
- Ophthalmology Department, Queen Fabiola University Children's Hospital, Université Libre De Bruxelles, Brussels, Belgium
| | - Georges Casimir
- Pediatric Department, Queen Fabiola University Children's Hospital, Université Libre De Bruxelles, Brussels, Belgium
| |
Collapse
|
11
|
Gao X, Li Y, Meng L, Tong Z, Guo L, Zhang J, Gu Y. A Vascular Malformation in the Carotid Sheath at the Carotid Bifurcation Mimicking Carotid Body Tumor. Vasc Endovascular Surg 2019; 54:195-197. [PMID: 31597540 DOI: 10.1177/1538574419879849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The carotid sheath contains clinically important and vital anatomical neurogenic, vascular, and lymphatic structures that allow for a great variety of lesions. Vascular anomalies found in the carotid sheath are rarely reported and may be easily misdiagnosed as arterial aneurysms, neurogenic tumors, paragangliomas, or lymphatic masses. METHOD We present a 60-year-old woman with a vascular malformation arising within the carotid sheath at the right carotid bifurcation, which mimics carotid body tumor. RESULT The mass was excised successfully with an uneventful postoperative course, and histological analysis suggested a vascular malformation with thin-walled blood vessels, lined by endothelial cells and separated by fibrous tissue. The patient was in good clinical condition without signs of relapse of the mass at 6-month follow-up. CONCLUSION Vascular malformation is a rare but existing possibility of pathology in the carotid sheath, which can be effectively removed by meticulous surgery.
Collapse
Affiliation(s)
- Xixiang Gao
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Li
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang Meng
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhu Tong
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Zhang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
12
|
Samadi K, Salazar GM. Role of imaging in the diagnosis of vascular malformations vascular malformations. Cardiovasc Diagn Ther 2019; 9:S143-S151. [PMID: 31559160 DOI: 10.21037/cdt.2018.08.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Imaging evaluation of vascular malformations (VM) is paramount for proper diagnosis and treatment planning. These lesions often present as complex vascular masses with arterial, venous and lymphatic components, requiring the use of advanced imaging modalities for full anatomical characterization. Symptoms also depend of the location and flow characteristic of such lesions and range from: asymptomatic to severe forms of cardiac arteriovenous shunting. We present an overview of the diagnostic work-up of VM per most recent classification systems and describe imaging characteristics of such lesions at ultrasonography (US) and magnetic resonance imaging (MRI) as a diagnostic tool for work-up of such patients.
Collapse
Affiliation(s)
- Katayoun Samadi
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Gloria Maria Salazar
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
13
|
Lee JW, Chung HY. Vascular anomalies of the head and neck: current overview. Arch Craniofac Surg 2018; 19:243-247. [PMID: 30613084 PMCID: PMC6325330 DOI: 10.7181/acfs.2018.02383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022] Open
Abstract
Vascular anomalies are disorders of the endothelium and surrounding cells that can affect the vasculature and involve any anatomical structure. The most common problem associated with vascular anomalies is psychological distress related to disfigurement as well as functional defects, as many lesions affect the head and neck. This article provides an overview of the current clinical features that distinguish the major types of vascular anomalies that affect the head and neck.
Collapse
Affiliation(s)
- Jeong Woo Lee
- Department of Plastic and Reconstructive Surgery, Vascular Anomalies Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, Vascular Anomalies Center, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
14
|
Kaya H, Gokce IK, Gungor S, Turgut H, Ozdemir R. A Newborn with Gastric Hemangioma Treated Using Propranolol. Pediatr Gastroenterol Hepatol Nutr 2018; 21:341-346. [PMID: 30345249 PMCID: PMC6182481 DOI: 10.5223/pghn.2018.21.4.341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 12/22/2022] Open
Abstract
Gastric hemangiomas are rare benign vascular tumors that can cause severe gastrointestinal system bleeding. We presented the case of a neonate with fresh bleeding and melena from the orogastric tube and detected gastric hemangioma in esophagogastroduodenoscopic examination. Propranolol is widely used in treatment of cutaneous hemangiomas and non-gastric gastrointestinal system hemangiomas. However, the surgical approach is preferred for treating gastric hemangiomas, and there are few reports of gastric hemangiomas associated with non-surgical treatment. Gastric hemorrhage decreased with antacid and somatostatin treatment. Propranolol treatment was initiated before the surgery decision. After three weeks of treatment, we observed regression in the hemangioma with endoscopic evaluation. During the course of treatment, the patient's gastrointestinal system bleeding did not recur, and there were no side effects associated with propranolol.
Collapse
Affiliation(s)
- Huseyin Kaya
- Division of Neonatology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
| | - Ismail Kursad Gokce
- Division of Neonatology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
| | - Sukru Gungor
- Division of Pediatric Gastroenterology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
| | - Hatice Turgut
- Division of Neonatology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
| | - Ramazan Ozdemir
- Division of Neonatology, Department of Pediatrics, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey
| |
Collapse
|
15
|
Abstract
Hemangioma is a congenital vascular soft tissue tumor, defined as a vascular lesion present in the newborn, with a progressive developmental pattern related to age. It has a progressive and regressive periodic growth mode, in comparison with arteriovenous malformation (AVM). Although there are many treatment approaches for curing this lesion such as; surgery, cryotherapy, sclerosant agents, laser therapy has more advantages in comparison to the other methods. Such as, hemostasis and clean operating field, decreased amount of pain and edema. There are many types of lasers manufactured that could be used for therapeutic purposes. This article focuses on different types of laser applications in the treatment of these lesions.
Collapse
Affiliation(s)
- Ehsan Azma
- Oral and Maxillofacial Medicine of Dental Faculty of Guilan Medical University, Guilan, Iran
| | - Melika Razaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Ranieri M, Wohlgemuth W, Müller-Wille R, Prantl L, Kehrer A, Geis S, Klein S, Lamby P, Schiltz D, Uller W, Aung T, Dolderer JH. Vascular malformations of upper and lower extremity - from radiological interventional therapy to surgical soft tissue reconstruction - an interdisciplinary treatment. Clin Hemorheol Microcirc 2018; 67:355-372. [PMID: 28885203 DOI: 10.3233/ch-179216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations.The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration.The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification.Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up.Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.
Collapse
Affiliation(s)
- M Ranieri
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - W Wohlgemuth
- Department of Radiology, University Hospital Regensburg, Germany.,Institute of Radiology, University Hospital Halle, Germany
| | - R Müller-Wille
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Germany
| | - L Prantl
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - A Kehrer
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - S Geis
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - S Klein
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - P Lamby
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - D Schiltz
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - W Uller
- Department of Radiology, University Hospital Regensburg, Germany
| | - T Aung
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| | - J H Dolderer
- Center of Plastic, Hand and reconstructive Surgery, University Hospital Regensburg, Germany
| |
Collapse
|
17
|
Schicchi N, Tagliati C, Agliata G, Esposto Pirani P, Spadari R, Giovagnoni A. MRI evaluation of peripheral vascular anomalies using time-resolved imaging of contrast kinetics (TRICKS) sequence. Radiol Med 2018; 123:563-571. [DOI: 10.1007/s11547-018-0875-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
|
18
|
Yazici MU, Cil B, Bayrakci B, Sasmaz N, Baysoy G, Gurakan F. Transarterial and Transhepatic Endovascular Intervention to Alleviate Portal Hypertension Secondary to Arterioportal Fistula in a Trisomy 21 Infant. J Pediatr Intensive Care 2017; 7:54-58. [PMID: 31073469 DOI: 10.1055/s-0037-1603822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/10/2017] [Indexed: 12/15/2022] Open
Abstract
Individuals with trisomy 21 have an 80% risk reduction of vascular anomalies compared with general population. However, an association of trisomy 21 and portal vascular and arteriovenous anomalies has been defined in the literature. The primary hemodynamic abnormality in portal hypertension is increased resistance to portal blood flow. In various case reports in adults and pediatric age group patients, transarterial coil embolization of hepatoportal fistula was described. One of the authors of this article has previously reported successful treatment of congenital arterioportal fistula (APF) with percutaneous transhepatic liquid embolization in a patient who previously had transarterial coil embolization. To date, eight patients with trisomy 21 (Down syndrome) and congenital portosystemic shunts were reported of which four were treated with embolization. Here, we describe a 3-month-old infant with trisomy 21 and intrahepatic APF associated with extrahepatic portal hypertension and massive ascites. In the current report, a rare case of a patient with a diagnosis of trisomy 21 is discussed who was attempted to be treated with transarterial coil embolization and percutaneous transhepatic liquid embolization of the congenital APF in a single session.
Collapse
Affiliation(s)
- Mutlu Uysal Yazici
- Department of Pediatric Intensive Care, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Barbaros Cil
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Intensive Care, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Necati Sasmaz
- Department of Pediatric Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Gokhan Baysoy
- Department of Pediatric Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Figen Gurakan
- Department of Pediatric Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey
| |
Collapse
|
19
|
Drachman DA, Smith TW, Alkamachi B, Kane K. Microvascular changes in Down syndrome with Alzheimer's‐type pathology: Insights into a potential vascular mechanism for Down syndrome and Alzheimer's disease. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- David A. Drachman
- Department of Neurology University of Massachusetts Medical School Worcester MA USA
| | - Thomas W. Smith
- Department of Neurology University of Massachusetts Medical School Worcester MA USA
- Department of Pathology University of Massachusetts Medical School USA
| | | | - Kevin Kane
- Health Statistics and Geography Lab, Division of Preventive and Behavioral Medicine University of Massachusetts Medical School USA
| |
Collapse
|
20
|
Kato Y, Furusyo N, Tanaka Y, Ueyama T, Yamasaki S, Murata M, Hayashi J. The Relation between Serum Endostatin Level and Carotid Atherosclerosis in Healthy Residents of Japan: Results from the Kyushu and Okinawa Population Study (KOPS). J Atheroscler Thromb 2017; 24:1023-1030. [PMID: 28428451 PMCID: PMC5656764 DOI: 10.5551/jat.39735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM To examine the association between the serum endostatin levels and subclinical atherosclerosis independent of traditional risk factors in a healthy Japanese population. METHODS Among 1,057 residents who attended free public physical examinations between 2010 and 2011, we evaluated the data of 648 healthy residents for whom the serum endostatin level and common carotid intima-media thickness (IMT) were successfully measured. RESULTS The median endostatin level was 63.7 ng/mL (interquartile ranges: 49.7-93.2 ng/mL), and the mean carotid IMT was 0.68±0.12 mm. Residents with above median endostatin had significantly higher carotid IMT than did those with below median endostatin (0.71±0.14 vs. 0.65±0.09 mm, P<0.001). Multiple linear regression analysis demonstrated that increased serum endostatin is significantly associated with carotid IMT (above vs. below median endostatin level; beta=0.11, P=0.03), independent of the known covariates of age, sex, body mass index, drinking and smoking status, systolic blood pressure, diastolic blood pressure, hemoglobin A1c, low density lipoprotein cholesterol, estimated glomerular filtration rate, and log-transformed high sensitive C-reactive protein. CONCLUSIONS A higher serum endostatin level reflected subclinical atherosclerosis in this Japanese population.
Collapse
Affiliation(s)
- Yoshifumi Kato
- Department of Environmental Medicine and Infectious Disease, Graduate School of Medical Sciences, Kyushu University.,Department of General Internal Medicine, Kyushu University Hospital
| | - Norihiro Furusyo
- Department of Environmental Medicine and Infectious Disease, Graduate School of Medical Sciences, Kyushu University.,Department of General Internal Medicine, Kyushu University Hospital
| | - Yuuki Tanaka
- Department of Environmental Medicine and Infectious Disease, Graduate School of Medical Sciences, Kyushu University.,Department of General Internal Medicine, Kyushu University Hospital
| | - Takatsugu Ueyama
- Department of Environmental Medicine and Infectious Disease, Graduate School of Medical Sciences, Kyushu University.,Department of General Internal Medicine, Kyushu University Hospital
| | - Sho Yamasaki
- Department of Environmental Medicine and Infectious Disease, Graduate School of Medical Sciences, Kyushu University.,Department of General Internal Medicine, Kyushu University Hospital
| | - Masayuki Murata
- Department of General Internal Medicine, Kyushu University Hospital
| | - Jun Hayashi
- Kyushu General Internal Medicine Center, Haradoi Hospital
| |
Collapse
|
21
|
Galambos C, Minic AD, Bush D, Nguyen D, Dodson B, Seedorf G, Abman SH. Increased Lung Expression of Anti-Angiogenic Factors in Down Syndrome: Potential Role in Abnormal Lung Vascular Growth and the Risk for Pulmonary Hypertension. PLoS One 2016; 11:e0159005. [PMID: 27487163 PMCID: PMC4972384 DOI: 10.1371/journal.pone.0159005] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/24/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND AIMS Infants with Down syndrome (DS) or Trisomy 21, are at high risk for developing pulmonary arterial hypertension (PAH), but mechanisms that increase susceptibility are poorly understood. Laboratory studies have shown that early disruption of angiogenesis during development impairs vascular and alveolar growth and causes PAH. Human chromosome 21 encodes known anti-angiogenic factors, including collagen18a1 (endostatin, ES), ß-amyloid peptide (BAP) and Down Syndrome Critical Region 1 (DSCR-1). Therefore, we hypothesized that fetal lungs from subjects with DS are characterized by early over-expression of anti-angiogenic factors and have abnormal lung vascular growth in utero. METHODS Human fetal lung tissue from DS and non-DS subjects were obtained from a biorepository. Quantitative reverse transcriptase PCR (qRT-PCR) was performed to assay 84 angiogenesis-associated genes and individual qRT-PCR was performed for ES, amyloid protein precursor (APP) and DSCR1. Western blot analysis (WBA) was used to assay lung ES, APP and DSCR-1 protein contents. Lung vessel density and wall thickness were determined by morphometric analysis. RESULTS The angiogenesis array identified up-regulation of three anti-angiogenic genes: COL18A1 (ES), COL4A3 (tumstatin) and TIMP3 (tissue inhibitor of metallopeptidase 3) in DS lungs. Single qRT-PCR and WBA showed striking elevations of ES and APP mRNA (p = 0.022 and p = 0.001) and protein (p = 0.040 and p = 0.002; respectively). Vessel density was reduced (p = 0.041) and vessel wall thickness was increased in DS lung tissue (p = 0.033) when compared to non-DS subjects. CONCLUSIONS We conclude that lung anti-angiogenic factors, including COL18A1 (ES), COL4A3, TIMP3 and APP are over-expressed and fetal lung vessel growth is decreased in subjects with DS. We speculate that increased fetal lung anti-angiogenic factor expression due to trisomy 21 impairs lung vascular growth and signaling, which impairs alveolarization and contributes to high risk for PAH during infancy.
Collapse
Affiliation(s)
- Csaba Galambos
- Departments of Pathology and Laboratory Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
- The Pediatric Heart Lung Center, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
- * E-mail:
| | - Angela D. Minic
- Departments of Pathology and Laboratory Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
- The Pediatric Heart Lung Center, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Douglas Bush
- Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
- The Pediatric Heart Lung Center, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Dominique Nguyen
- University of Notre Dame, South Bend, Indiana, United States of America
| | - Blair Dodson
- Pediatric Surgery, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
- The Pediatric Heart Lung Center, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Gregory Seedorf
- The Pediatric Heart Lung Center, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Steven H. Abman
- Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
- The Pediatric Heart Lung Center, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| |
Collapse
|
22
|
Low risk of solid tumors in persons with Down syndrome. Genet Med 2016; 18:1151-1157. [DOI: 10.1038/gim.2016.23] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/22/2016] [Indexed: 02/07/2023] Open
|
23
|
Yamaguchi H, Kosugiyama K, Honda S, Tadao O, Taketomi A, Iwata S. Down Syndrome with Patent Ductus Venosus and Hepato-Biliary-Pancreatic Abnormalities. Indian J Pediatr 2016; 83:78-80. [PMID: 26096864 DOI: 10.1007/s12098-015-1797-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 05/18/2015] [Indexed: 11/27/2022]
Abstract
The association between Down syndrome and congenital portosystemic shunts, most commonly caused by patent ductus venosus, remains relatively unknown. The authors present a girl with Down syndrome with patent ductus venosus, pancreaticobiliary maljunction and paucity of interlobular bile ducts, presenting with neonatal cholestasis and transient abnormal myeloproliferative disorder. To the best of authors' knowledge, no report of the concurrent presence of the above in Down syndrome has been published.
Collapse
Affiliation(s)
- Hiroshi Yamaguchi
- Department of Pediatrics, Teine Keijinkai Hospital, 1 Jo 12-1-40, Maeda, Teine-ku, Sapporo, Japan.
| | - Kiyotaka Kosugiyama
- Department of Pediatrics, Teine Keijinkai Hospital, 1 Jo 12-1-40, Maeda, Teine-ku, Sapporo, Japan
| | - Shohei Honda
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan
| | - Okada Tadao
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan
| | - Seido Iwata
- Department of Pediatrics, Teine Keijinkai Hospital, 1 Jo 12-1-40, Maeda, Teine-ku, Sapporo, Japan
| |
Collapse
|
24
|
Mattila KA, Kervinen K, Kalajoki-Helmiö T, Lappalainen K, Vuola P, Lohi J, Rintala RJ, Pitkäranta A, Salminen P. An interdisciplinary specialist team leads to improved diagnostics and treatment for paediatric patients with vascular anomalies. Acta Paediatr 2015; 104:1109-16. [PMID: 26096329 DOI: 10.1111/apa.13076] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 11/28/2022]
Abstract
AIM Patients with vascular anomalies are often misdiagnosed, leading to delayed or improper treatment. The aim of this study was to evaluate the impact of an interdisciplinary team on the diagnosis and treatment of paediatric patients with vascular anomalies. METHODS We reviewed the paediatric patients evaluated by our interdisciplinary team between 2002 and 2012, analysing the referral diagnosis, final diagnosis, patient age, sex, clinical history, laboratory tests, imaging studies and treatments. RESULTS Of the 480 patients who were evaluated, 435 (90.6%) had a vascular anomaly: 30.7% of all patients had a tumour and 55.2% had a malformation. Haemangiomas comprised 93.2% of all tumours, while malformations included capillary (9.8%), lymphatic (30.1%), venous (36.8%), arteriovenous (3.8%) and combined slow-flow (7.9%) malformations. Tumours were initially diagnosed correctly in 89.2% of the patients, but only 38.0% of the malformations were diagnosed correctly. Improper treatment was given to 1.4%, due to incorrect diagnoses. CONCLUSION This study showed that haemangiomas were likely to be diagnosed correctly, but other tumours and vascular malformations were likely to be misdiagnosed. Misdiagnosis seldom led to improper treatment, but probably led to delayed treatment in many cases. The interdisciplinary approach led to improved diagnostics and treatment.
Collapse
Affiliation(s)
- Katariina A. Mattila
- Department of Paediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Kaisa Kervinen
- Department of Paediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Teija Kalajoki-Helmiö
- Department of Radiology; HUS Medical Imaging Centre; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Kimmo Lappalainen
- Department of Radiology; HUS Medical Imaging Centre; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Pia Vuola
- Department of Plastic Surgery; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - Jouko Lohi
- Department of Pathology; HUSLAB; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Risto J. Rintala
- Department of Paediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Anne Pitkäranta
- Department of Otorhinolaryngology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- The College of Medicine; Qatar University; Doha Qatar
| | - Päivi Salminen
- Department of Paediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| |
Collapse
|
25
|
Abstract
BACKGROUND AND OBJECTIVES Trisomy 21 is known to decrease the risk of several (nonocular) angiogenic-mediated diseases. The objective of this study was to determine whether trisomy 21 can also be shown to be significantly protective against ocular angiogenic-mediated disorders such as retinopathy of prematurity (ROP). METHODS A retrospective analysis of deidentified data from the Pediatrix BabySteps Clinical Warehouse. This large repository of neonatal data is approved for use in research studies by the Western Institutional Review Board. The study population consisted of 99,080 infants with very low birth weights (BWs; BW <1500 g), born between 1996 and 2013, cared for at >300 US NICUs, and who had been discharged alive from hospital. Statistical significance for unadjusted comparisons between groups was determined with Pearson's χ(2) test or Student's t test. Logistic regression models were used to calculate the odds of ROP (of any stage) and advanced ROP (stage 3 or greater) for infants with trisomy 21 compared with all other infants. RESULTS The prevalence of trisomy 21 was 0.3% in the study population (321 of 99,080). After adjustment for BW, gestational age, oxygen exposure, and other potential confounders, there was an odds ratio of 0.6 (95% confidence interval: 0.5-0.8) for ROP in infants with trisomy 21compared with other infants and an odds ratio of 0.4 (95% confidence interval: 0.1-0.9) for advanced-stage ROP. CONCLUSIONS Trisomy 21 significantly decreases the odds for ROP in very low BW infant survivors. This study unmasks a potentially identifiable genetic component to ROP risk, paving the way for the development of a laboratory-based ROP screening tool.
Collapse
Affiliation(s)
- Tammy Z Movsas
- Midland County Department of Public Health, Midland, Michigan;
| | - Alan R Spitzer
- MEDNAX Services-Pediatrix Medical Group, Sunrise, Florida; and
| | - Ira H Gewolb
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, Michigan
| |
Collapse
|
26
|
Makary AT, Testa R, Tonge BJ, Einfeld SL, Mohr C, Gray KM. Association between adaptive behaviour and age in adults with Down syndrome without dementia: examining the range and severity of adaptive behaviour problems. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:689-702. [PMID: 25414060 DOI: 10.1111/jir.12172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Studies on adaptive behaviour and ageing in adults with Down syndrome (DS) (without dementia) have typically analysed age-related change in terms of the total item scores on questionnaires. This research extends the literature by investigating whether the age-related changes in adaptive abilities could be differentially attributed to changes in the number or severity (intensity) of behavioural questionnaire items endorsed. METHODS The Adaptive Behaviour Assessment System-II Adult (ABAS-II Adult) was completed by parents and caregivers of 53 adults with DS aged between 16 and 56 years. Twenty adults with DS and their parents/caregivers were a part of a longitudinal study, which provided two time points of data. In addition 33 adults with DS and their parents/caregivers from a cross-sectional study were included. Random effects regression analyses were used to examine the patterns in item scores associated with ageing. RESULTS Increasing age was found to be significantly associated with lower adaptive behaviour abilities for all the adaptive behaviour composite scores, expect for the practical composite. These associations were entirely related to fewer ABAS-II Adult items being selected as present for the older participants, as opposed to the scores being attributable to lower item severity. CONCLUSIONS This study provides evidence for a differential pattern of age-related change for various adaptive behaviour skills in terms of range, but not severity. Possible reasons for this pattern will be discussed. Overall, these findings suggest that adults with DS may benefit from additional support in terms of their social and conceptual abilities as they age.
Collapse
Affiliation(s)
- A T Makary
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - R Testa
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | - B J Tonge
- Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia
| | - S L Einfeld
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - C Mohr
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - K M Gray
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| |
Collapse
|
27
|
Abstract
A standardized classification system allows improvements in diagnostic accuracy. Multidisciplinary vascular anomaly centers combine medical, surgical, radiologic, and pathologic expertise. This collaborative approach tailors treatment and management of vascular anomalies for affected individuals.
Collapse
Affiliation(s)
- Lisa S Foley
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA.
| |
Collapse
|
28
|
Long-segment thoracoabdominal aortic coarctation in a child with Down syndrome. J Vasc Surg Cases 2015; 1:171-173. [PMID: 31724602 PMCID: PMC6849921 DOI: 10.1016/j.jvsc.2015.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/16/2015] [Indexed: 11/20/2022] Open
Abstract
Midaortic syndrome is a rare vascular anomaly characterized by coarctation of the descending thoracic and abdominal aorta. Down syndrome is associated with multiple congenital cardiac malformations but is rarely associated with developmental vascular anomalies. Midaortic syndrome may result in severe renovascular hypertension that requires early intervention to prevent life-threatening complications. We report a child with Down syndrome who presented with occlusion of the aorta and was treated with aortic bypass. More than 4 years after the procedure, the patient's renal function remains normal, and there is no evidence of recurrent hypertension. Long-term follow-up is important to assess the benefits of surgical repair.
Collapse
|
29
|
|
30
|
Multimodal therapy in the treatment of a venolymphatic malformation of the axilla and chest wall in an infant. J Vasc Surg Venous Lymphat Disord 2014; 2:451-4. [DOI: 10.1016/j.jvsv.2013.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/18/2013] [Accepted: 11/25/2013] [Indexed: 11/22/2022]
|
31
|
Makary AT, Testa R, Einfeld SL, Tonge BJ, Mohr C, Gray KM. The association between behavioural and emotional problems and age in adults with Down syndrome without dementia: Examining a wide spectrum of behavioural and emotional problems. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1868-1877. [PMID: 24794290 DOI: 10.1016/j.ridd.2014.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 06/03/2023]
Abstract
The literature on the association between behavioural and emotional problems and ageing in adults with Down syndrome (DS) without dementia is limited and has generally not reported on a wide range of behavioural and emotional problems. This research aimed to extend the field by examining the associations between age and a wide spectrum of behavioural and emotional problems in adults with DS without dementia. A preliminary analysis of the association between potential covariates and behavioural and emotional problems was also undertaken. Parents and caregivers completed a questionnaire on behavioural and emotional problems for 53 adults with DS aged between 16 and 56 years. Twenty-eight adults with DS and their caregivers were part of a longitudinal sample, which provided two time points of data approximately four years apart. Additionally, 25 participants with DS and their caregivers were from a cross sectional sample, which provided one time point of data. Random effects regression analyses were used to examine the patterns in item scores for behavioural and emotional problems associated with age. No significant associations between age and the range or severity of any behavioural and emotional items were found. This suggested a more positive pattern for ageing adults with DS than has been previously described. Given that behavioural and emotional problems were not associated with age, investigation into other factors that may be associated with the behavioural and emotional difficulties for adults with DS is discussed.
Collapse
Affiliation(s)
- Anna T Makary
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Southern Clinical School, Monash University, Early in Life Mental Health Service, Monash Medical Centre.
| | - Renee Testa
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Southern Clinical School, Monash University, Early in Life Mental Health Service, Monash Medical Centre; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Parkville, P.O Box 294, St Albans, VIC, 3021, Australia.
| | - Stewart L Einfeld
- Faculty of Health Sciences and Brain and Mind Research Institute, University of Sydney, 100 Mallet Street, Camperdown, NSW 2006, Australia.
| | - Bruce J Tonge
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Southern Clinical School, Monash University, Early in Life Mental Health Service, Monash Medical Centre.
| | - Caroline Mohr
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Southern Clinical School, Monash University, Early in Life Mental Health Service, Monash Medical Centre.
| | - Kylie M Gray
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Southern Clinical School, Monash University, Early in Life Mental Health Service, Monash Medical Centre.
| |
Collapse
|
32
|
Abstract
A neonate with a double aneuploidy associated with congenital heart defect (CHD) suffered from cyanosis after birth. He had typical features of Down syndrome (DS) including hypertelorism, slightly lowset ears with protruding pinna. Doppler echocardiography indicated complex congenital heart disease with an ostium secundum atrial septal defect, enlarged right ventricle, and mild tricuspid valve regurgitation. Further chromosomal analysis showed a karyotype of 48,XXY,+21: a double aneuploidy of DS and Klinefelter syndrome (KS). Until now, only seven cases of double aneuploidy associated with CHD defect have been reported.
Collapse
|
33
|
Elsayed SM. The blessing effect of an extra copy of chromosome 21. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2014. [DOI: 10.1016/j.ejmhg.2014.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
34
|
Percutaneous embolization of congenital portosystemic venous fistula in an infant with down syndrome. Case Rep Vasc Med 2013; 2013:127023. [PMID: 24171135 PMCID: PMC3792513 DOI: 10.1155/2013/127023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/16/2013] [Indexed: 11/17/2022] Open
Abstract
Congenital intrahepatic portosystemic venous shunts are rare vascular malformations often associated with severe complications. We describe a term male infant with Down syndrome with high output heart failure secondary to a congenital arterial to portal venous fistula that was diagnosed by Doppler ultrasound. Percutaneous embolizations of the left hepatic vein, portal vein, and communicating fistulas were performed without complications, resulting in clinical improvement. A subsequent hepatic ultrasound demonstrated resolution of the pathologic fistulous communication and shunting effects.
Collapse
|
35
|
Elton TS, Selemon H, Elton SM, Parinandi NL. Regulation of the MIR155 host gene in physiological and pathological processes. Gene 2012; 532:1-12. [PMID: 23246696 DOI: 10.1016/j.gene.2012.12.009] [Citation(s) in RCA: 350] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/29/2012] [Accepted: 12/05/2012] [Indexed: 02/06/2023]
Abstract
MicroRNAs (miRNAs), a family of small nonprotein-coding RNAs, play a critical role in posttranscriptional gene regulation by acting as adaptors for the miRNA-induced silencing complex to inhibit gene expression by targeting mRNAs for translational repression and/or cleavage. miR-155-5p and miR-155-3p are processed from the B-cell Integration Cluster (BIC) gene (now designated, MIR155 host gene or MIR155HG). MiR-155-5p is highly expressed in both activated B- and T-cells and in monocytes/macrophages. MiR-155-5p is one of the best characterized miRNAs and recent data indicate that miR-155-5p plays a critical role in various physiological and pathological processes such as hematopoietic lineage differentiation, immunity, inflammation, viral infections, cancer, cardiovascular disease, and Down syndrome. In this review we summarize the mechanisms by which MIR155HG expression can be regulated. Given that the pathologies mediated by miR-155-5p result from the over-expression of this miRNA it may be possible to therapeutically attenuate miR-155-5p levels in the treatment of several pathological processes.
Collapse
Affiliation(s)
- Terry S Elton
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA; College of Pharmacy, Division of Pharmacology, The Ohio State University, Columbus, OH, USA; Department of Medicine, Division of Cardiology, The Ohio State University, Columbus, OH, USA.
| | | | | | | |
Collapse
|
36
|
Greene AK, Liu AS, Mulliken JB, Chalache K, Fishman SJ. Vascular anomalies in 5,621 patients: guidelines for referral. J Pediatr Surg 2011; 46:1784-9. [PMID: 21929990 DOI: 10.1016/j.jpedsurg.2011.05.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/08/2011] [Accepted: 05/09/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize referrals to a vascular anomalies center to determine which lesions should be treated by specialists. STUDY DESIGN Patients sent to our center between 1999 and 2010 were reviewed. Type of anomaly, anatomical location, sex, accuracy of referral diagnosis, and the geographic origin of the referred patient were analyzed. RESULTS Five thousand six hundred twenty-one patients had a confirmed diagnosis: 35.2% had a tumor and 64.8% had a malformation. Types of tumors included infantile hemangioma (85.9%), hemangioendothelioma (7.8%), congenital hemangioma (5.4%), and pyogenic granuloma (0.9%). Malformations consisted of venous (36.8%), lymphatic (28.3%), arteriovenous (14.3%), capillary (11.0%), and combined slow-flow (9.6%) lesions. Forty-three percent of the cohort resided outside of our region; these patients were most likely to have a malformation (51.9%) or rare vascular tumor (74.5%). Only 53.0% of patients had a correct referral diagnosis: 77.8% for infantile hemangioma and pyogenic granuloma, compared with 45.6% and 34.7% for malformations and rare tumors, respectively. CONCLUSIONS Two thirds of lesions sent to a vascular anomalies center are vascular malformations. Malformations and rare tumors are most likely to be misdiagnosed and referred from outside of the region. Vascular malformations (except for simple capillary lesions), rare tumors, and problematic infantile hemangiomas should be managed by specialists in this field.
Collapse
Affiliation(s)
- Arin K Greene
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | | | |
Collapse
|
37
|
Hassanein AH, Gellis SE, Schmidt BA, Greene AK. Agminated atypical Spitz tumor: large nasal lesion in a child with Down syndrome. J Pediatr Surg 2011; 46:1435-7. [PMID: 21763848 DOI: 10.1016/j.jpedsurg.2011.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/21/2011] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
Abstract
We present a 5-year-old girl with Down syndrome and a 2.5-cm agminated atypical Spitz tumor of the nose. Although atypical Spitz tumor has uncertain malignant potential, trisomy 21 is protective against melanoma. This is the first description of an atypical Spitz tumor in a patient with Down syndrome and the largest nasal lesion reported.
Collapse
Affiliation(s)
- Aladdin H Hassanein
- Department of Plastic and Oral Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | |
Collapse
|
38
|
An evolutionary explanation for the perturbation of the dynamics of metastatic tumors induced by surgery and acute inflammation. Cancers (Basel) 2011; 3:945-70. [PMID: 24212648 PMCID: PMC3756398 DOI: 10.3390/cancers3010945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/17/2011] [Accepted: 02/22/2011] [Indexed: 12/22/2022] Open
Abstract
Surgery has contributed to unveil a tumor behavior that is difficult to reconcile with the models of tumorigenesis based on gradualism. The postsurgical patterns of progression include unexpected features such as distant interactions and variable rhythms. The underlying evidence can be summarized as follows: (1) the resection of the primary tumor is able to accelerate the evolution of micrometastasis in early stages, and (2) the outcome is transiently opposed in advanced tumors. The objective of this paper is to give some insight into tumorigenesis and surgery-related effects, by applying the concepts of the evolutionary theory in those tumor behaviors that gompertzian and tissular-centered models are unable to explain. According to this view, tumors are the consequence of natural selection operating at the somatic level, which is the basic mechanism of tumorigenesis, notwithstanding the complementary role of the intrinsic constrictions of complex networks. A tumor is a complicated phenomenon that entails growth, evolution and development simultaneously. So, an evo-devo perspective can explain how and why tumor subclones are able to translate competition from a metabolic level into neoangiogenesis and the immune response. The paper proposes that distant interactions are an extension of the ecological events at the local level. This notion explains the evolutionary basis for tumor dormancy, and warns against the teleological view of tumorigenesis as a process directed towards the maximization of a concrete trait such as aggressiveness.
Collapse
|
39
|
|
40
|
An unusual presentation of a congenital intrahepatic arterioportal fistula in an infant with Down syndrome. J Pediatr Surg 2011; 46:252-5. [PMID: 21238680 DOI: 10.1016/j.jpedsurg.2010.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 08/10/2010] [Accepted: 08/11/2010] [Indexed: 12/11/2022]
Abstract
Congenital intrahepatic arterioportal fistula is a rare entity that most often presents with symptoms of portal hypertension and malabsorption. We discuss a patient who presented with distributive shock, congestive heart failure, pulmonary hypertension, ascites, and a history of severe constipation.
Collapse
|
41
|
Boghossian NS, Hansen NI, Bell EF, Stoll BJ, Murray JC, Laptook AR, Shankaran S, Walsh MC, Das A, Higgins RD. Survival and morbidity outcomes for very low birth weight infants with Down syndrome. Pediatrics 2010; 126:1132-40. [PMID: 21098157 PMCID: PMC3059605 DOI: 10.1542/peds.2010-1824] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our objective was to compare survival and neonatal morbidity rates between very low birth weight (VLBW) infants with Down syndrome (DS) and VLBW infants with non-DS chromosomal anomalies, nonchromosomal birth defects (BDs), and no chromosomal anomaly or major BD. METHODS Data were collected prospectively for infants weighing 401 to 1500 g who were born and/or cared for at one of the study centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network in 1994-2008. Risk of death and morbidities, including patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), late-onset sepsis (LOS), retinopathy of prematurity, and bronchopulmonary dysplasia (BPD), were compared between VLBW infants with DS and infants in the other groups. RESULTS Infants with DS were at increased risk of death (adjusted relative risk: 2.47 [95% confidence interval: 2.00-3.07]), PDA, NEC, LOS, and BPD, relative to infants with no BDs. Decreased risk of death (relative risk: 0.40 [95% confidence interval: 0.31-0.52]) and increased risks of NEC and LOS were observed when infants with DS were compared with infants with other non-DS chromosomal anomalies. Relative to infants with nonchromosomal BDs, infants with DS were at increased risk of PDA and NEC. CONCLUSION The increased risk of morbidities among VLBW infants with DS provides useful information for counseling parents and for anticipating the need for enhanced surveillance for prevention of these morbidities.
Collapse
Affiliation(s)
| | | | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Abbot R. Laptook
- Department of Pediatrics, Brown University, Providence, Rhode Island
| | | | - Michele C. Walsh
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Abhik Das
- RTI International, Rockville, Maryland
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | |
Collapse
|
42
|
Elton TS, Sansom SE, Martin MM. Trisomy-21 gene dosage over-expression of miRNAs results in the haploinsufficiency of specific target proteins. RNA Biol 2010; 7:540-7. [PMID: 21081842 PMCID: PMC3073250 DOI: 10.4161/rna.7.5.12685] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 05/26/2010] [Accepted: 06/10/2010] [Indexed: 12/13/2022] Open
Abstract
Down syndrome (DS) or Trisomy 21 (Ts21) is caused by the presence of an extra copy of all or part of human chromosome 21 (Hsa21) and is the most frequent survivable congenital chromosomal abnormality. Bioinformatic annotation has established that Hsa21 harbors more than 400 genes, including five microRNA (miRNA) genes (miR-99a, let-7c, miR-125b-2, miR-155, and miR-802). MiRNAs are endogenous, single-stranded, small non-coding RNA molecules that regulate gene expression by interacting with specific recognition elements harbored within the 3'-untranslated region (3'-UTR) of mRNAs and subsequently target these mRNAs for translational repression or destabilization. MiRNA expression profiling, miRNA RT-PCR, and miRNA in situ hybridization experiments have demonstrated that Hsa21-derived miRNAs were over-expressed in fetal brain and heart specimens isolated from individuals with DS. We now propose that Ts21 gene dosage over-expression of Hsa21-derived miRNAs in DS individuals result in the decreased expression of specific target proteins (i.e. haploinsufficiency) that contribute, in part, to the DS phenotype.
Collapse
Affiliation(s)
- Terry S Elton
- Division of Pharmacology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA.
| | | | | |
Collapse
|
43
|
Elton TS, Sansom SE, Martin MM. Cardiovascular Disease, Single Nucleotide Polymorphisms; and the Renin Angiotensin System: Is There a MicroRNA Connection? Int J Hypertens 2010; 2010. [PMID: 20948563 PMCID: PMC2949081 DOI: 10.4061/2010/281692] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 06/25/2010] [Indexed: 12/12/2022] Open
Abstract
Essential hypertension is a complex disorder, caused by the interplay between many genetic variants, gene-gene interactions, and environmental factors. Given that the renin-angiotensin system (RAS) plays an important role in blood pressure (BP) control, cardiovascular regulation, and cardiovascular remodeling, special attention has been devoted to the investigation of single-nucleotide polymorphisms (SNP) harbored in RAS genes that may be associated with hypertension and cardiovascular disease. MicroRNAs (miRNAs) are a family of small, ∼21-nucleotide long, and nonprotein-coding RNAs that recognize target mRNAs through partial complementary elements in the 3′-untranslated region (3′-UTR) of mRNAs and inhibit gene expression by targeting mRNAs for translational repression or destabilization. Since miRNA SNPs (miRSNPs) can create, destroy, or modify miRNA binding sites, this review focuses on the hypothesis that transcribed target SNPs harbored in RAS mRNAs, that alter miRNA gene regulation and consequently protein expression, may contribute to cardiovascular disease susceptibility.
Collapse
Affiliation(s)
- Terry S Elton
- Davis Heart and Lung Research Institute, The Ohio State University, DHLRI 515, Columbus, OH 43210, USA
| | | | | |
Collapse
|
44
|
Buckmiller LM, Richter GT, Suen JY. Diagnosis and management of hemangiomas and vascular malformations of the head and neck. Oral Dis 2010; 16:405-18. [DOI: 10.1111/j.1601-0825.2010.01661.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
45
|
Miller TW, Isenberg JS, Roberts DD. Molecular regulation of tumor angiogenesis and perfusion via redox signaling. Chem Rev 2009; 109:3099-124. [PMID: 19374334 PMCID: PMC2801866 DOI: 10.1021/cr8005125] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | | | - David D. Roberts
- To whom correspondence should be addressed: NIH, Building 10, Room 2A33, 10 Center Dr, MSC1500, Bethesda, Maryland 20892,
| |
Collapse
|
46
|
|
47
|
Basu S, Pooniya V, Kumar A, Das BK. Down syndrome with cerebral arteriovenous malformation. ANNALS OF TROPICAL PAEDIATRICS 2009; 29:61-5. [PMID: 19222937 DOI: 10.1179/146532809x402051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Down syndrome (DS) or trisomy 21 is one of the most common and best known of all chromosomal disorders. Although major congenital malformations such as those of the heart and gastro-intestinal tract are commonly associated with DS, cerebral arteriovenous malformation with motor neurodeficits is rarely reported. A 2-year-old girl with DS presenting with right-sided hemiparesis and right partial seizures is reported. Computerised tomographic scan of the brain demonstrated features of cerebral arteriovenous malformation.
Collapse
Affiliation(s)
- S Basu
- Department of Paediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | | | | | | |
Collapse
|
48
|
Retsky MW, Hrushesky WJM, Gukas ID. Hypothesis: primary antiangiogenic method proposed to treat early stage breast cancer. BMC Cancer 2009; 9:7. [PMID: 19133151 PMCID: PMC2633344 DOI: 10.1186/1471-2407-9-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 01/08/2009] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Women with Down syndrome very rarely develop breast cancer even though they now live to an age when it normally occurs. This may be related to the fact that Down syndrome persons have an additional copy of chromosome 21 where the gene that codes for the antiangiogenic protein Endostatin is located. Can this information lead to a primary antiangiogenic therapy for early stage breast cancer that indefinitely prolongs remission? A key question that arises is when is the initial angiogenic switch thrown in micrometastases? We have conjectured that avascular micrometastases are dormant and relatively stable if undisturbed but that for some patients angiogenesis is precipitated by surgery. We also proposed that angiogenesis of micrometastases very rarely occurs before surgical removal of the primary tumor. If that is so, it seems possible that we could suggest a primary antiangiogenic therapy but the problem then arises that starting a therapy before surgery would interfere with wound healing. RESULTS The therapy must be initiated at least one day prior to surgical removal of the primary tumor and kept at a Down syndrome level perhaps indefinitely. That means the drug must have virtually no toxicity and not interfere meaningfully with wound healing. This specifically excludes drugs that significantly inhibit the VEGF pathway since that is important for wound healing and because these agents have some toxicity. Endostatin is apparently non-toxic and does not significantly interfere with wound healing since Down syndrome patients have no abnormal wound healing problems. CONCLUSION We propose a therapy for early stage breast cancer consisting of Endostatin at or above Down syndrome levels starting at least one day before surgery and continuing at that level. This should prevent micrometastatic angiogenesis resulting from surgery or at any time later. Adjuvant chemotherapy or hormone therapy should not be necessary. This can be continued indefinitely since there is no acquired resistance that develops, as happens in most cancer therapies.
Collapse
Affiliation(s)
- Michael W Retsky
- Department of Vascular Biology, Children's Hospital and Harvard Medical School, Boston 02115, MA, USA.
| | | | | |
Collapse
|
49
|
Gerretsen MF, Peelen W, Rammeloo LAJ, Koolbergen DR, Hruda J. Double aortic arch with double aneuploidy--rare anomaly in combined Down and Klinefelter syndrome. Eur J Pediatr 2009; 168:1479-81. [PMID: 19263078 PMCID: PMC2772960 DOI: 10.1007/s00431-009-0958-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 02/13/2009] [Indexed: 12/01/2022]
Abstract
A 14-month-old boy with double aneuploidy and a double aortic arch suffered from frequently recurrent severe feeding and respiratory problems. Chromosomal analysis showed a 48,XXY + 21 karyotype: a double aneuploidy of Down syndrome (DS) and Klinefelter syndrome (KS). Only four cases of double aneuploidy (DS + KS) associated with congenital heart defects have been published of which none had a double aortic arch. Our case report should draw attention to the possibility of a double aortic arch in patients with severe feeding and respiratory problems and a double aneuploidy.
Collapse
Affiliation(s)
- Maaike F. Gerretsen
- Department of Pediatric Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem Peelen
- Department of Pediatrics, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Lukas A. J. Rammeloo
- Department of Pediatric Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - David R. Koolbergen
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaroslav Hruda
- Department of Pediatric Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
50
|
Vabres P. [What's new in pediatric dermatology?]. Ann Dermatol Venereol 2008; 135 Suppl 7:S343-53. [PMID: 19264210 DOI: 10.1016/s0151-9638(08)75487-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The main selected articles in pediatric dermatology covered the following topics: development and maturation of the epidermal barrier in the neonate, iatrogenic events in the neonatal ICU, diagnostic value of minor birthmarks, complications, risk factors and treatment of hemangiomas, coagulopathy in venous malformations, epidemiology and dermoscopy of congenital and acquired melanocytic nevi in childhood, growth of the body surface area, new pathogenic concepts and treatment in atopic dermatitis, the impact of filaggrin deficiency, hereditary factors in Kawasaki disease, severe and drug resistant cases, management of juvenile dermatomyositis, treatment of childhood psoriasis with biologics, the new classification of epidermolysis bullosa and therapeutic approach with cell therapy, neurological impairment in xeroderma pigmentosum, behavioural anomalies in X-linked ichthyosis, guidelines for neurofibromatosis type I, the genetics of an hereditary hypotrichosis, infantile acne, rosacea in childhood, mast cell disease management and, last but not least, treatment of hair lice with silicone.
Collapse
Affiliation(s)
- P Vabres
- Service de dermatologie, Hôpital du Bocage, Centre Hospitalier Universitaire et Faculté de Médecine de Dijon, Université de Bourgogne, Dijon, France.
| |
Collapse
|