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Shravya MS, Girisha KM, Nayak SS. Comprehensive phenotyping of fetuses with trisomy 18: a perinatal center experience. Clin Dysmorphol 2024; 33:16-26. [PMID: 38038141 DOI: 10.1097/mcd.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Trisomy 18 is the second most common aneuploidy after trisomy 21. It presents with varying degrees of heterogeneous clinical phenotypes involving multiple organ systems, with a high mortality rate. Clinical assessment of fetal trisomy 18 is always challenging. In this study, we describe the phenotypes of the fetuses with trisomy 18 from a perinatal cohort. We reviewed fetuses with trisomy 18 in referrals for perinatal autopsy over the period of 15 years. A detailed phenotyping of the fetuses with trisomy 18 was executed by perinatal autopsy. Appropriate fetal tissues were obtained to perform genomic testing. We observed trisomy 18 in 16 fetuses (2%) in our cohort of 784 fetal/neonatal losses and a perinatal autopsy was performed on all of them. Abnormal facial profile was the most frequent anomaly (10/16, 62%) followed by anomalies of the extremities (9/16, 56%), and cardiac defects (6/16, 37%). We also observed esophageal atresia, diaphragmatic hernia, and neural tube defect. The study represents one of the largest cohorts of trisomy 18 from a perinatal center from a developing country and highlights the clinical heterogeneity attributed to trisomy 18. We also report a recurrence of trisomy 18 in a family.
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Affiliation(s)
- Mangalore S Shravya
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Shalini S Nayak
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Okamoto M, Fukushima S, Okada S, Tsuruno Y, Fukuzawa H, Ioroi T, Kugo M. Challenging management of a baby with congenital multiple intestinal atresia, trisomy 18 and extremely low birth weight: a case report. Surg Case Rep 2023; 9:177. [PMID: 37831225 PMCID: PMC10575833 DOI: 10.1186/s40792-023-01761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Extremely low birth weight (< 1000 g) still influences postsurgical prognosis in the neonatal and infantile periods. Additionally, the life expectancy of neonates with trisomy 18 is extremely poor owing to various comorbidities. Therefore, it takes courage to perform laparotomy for the purpose of treatment of congenital multiple intestinal atresia in a baby with an unpredictable life prognosis. CASE PRESENTATION Fetal ultrasonography revealed cardiac malformation, intestinal dilation, and physical characteristics suggestive of a chromosomal abnormality in this case. The patient was diagnosed with trisomy 18 after birth, with an extremely low birth weight. An atrial septal defect, ventricular septal defect, dilated jejunum, and a very thin collapsed small intestine were found on ultrasonography. With a diagnosis of congenital small intestinal atresia, a challenging laparotomy was done at 3 days of age, with jejunal atresia and multiple distal small intestinal atresia were observed. The jejunal end and distal small intestinal stump were separated into stomas at the wound edge. Hypertrophic pyloric stenosis developed at the age of 3 months and resolved with medication. The patient gained weight (2 kg) by daily stool injection into anal side of the intestine and decompression against poor peritonitis of dilated jejunum using enteral feeding tube for the long period. Finally, we could perform intestinal reconstruction safely and successfully at the age of 9 months. Tracheotomy was performed due to difficulty in extubation associated with chronic lung disease. The patient was discharged at the age of 1 year and 3 months, and no major problems were noted at the age of 2 years. CONCLUSIONS We treat congenital intestinal atresia in extremely low birth weight infants with severe chromosomal abnormalities and severe cardiac malformations as follows: Stoma creation is performed quickly to avoid deterioration of the patient's hemodynamics. After that, while continuing enteric management, palliative cardiovascular surgery is performed as necessary, and the patient's body weight and intestinal tract status are determined to allow safe intestinal reconstruction.
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Affiliation(s)
- Mitsumasa Okamoto
- Department of Pediatric Surgery, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan.
| | - Sachiyo Fukushima
- Department of Neonatology, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Satoshi Okada
- Department of Neonatology, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Yudai Tsuruno
- Department of Pediatric Surgery, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Hiroaki Fukuzawa
- Department of Pediatric Surgery, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Tomoaki Ioroi
- Department of Neonatology, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Masaaki Kugo
- Department of Neonatology, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
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Teixeira S, Guedes-Martins L. First Trimester Tricuspid Regurgitation: Clinical Significance. Curr Cardiol Rev 2023; 19:e061222211643. [PMID: 36475342 PMCID: PMC10280996 DOI: 10.2174/1573403x19666221206115642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
Tricuspid regurgitation is a cardiac valvular anomaly that consists of the return of blood to the right atrium during systole due to incomplete valve closure. This structure can be visualized on ultrasound between 11 and 14 weeks of gestation in most cases. Despite being a common finding, even in healthy fetuses, the presence of tricuspid regurgitation may be associated with chromosomal and structural abnormalities. The evaluation of tricuspid flow and the presence of regurgitation on first-trimester ultrasound has shown promising results regarding its role in the early detection of aneuploidies, congenital heart defects, and other adverse perinatal outcomes. This review article aims to demonstrate the importance of tricuspid regurgitation as a secondary marker, and consequently, significant benefits of its early detection when added to the combined first-trimester screening. Its value will be discussed, namely its sensitivity and specificity, alone and together with other current markers in the fetal assessment performed in the first-trimester ultrasound.
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Affiliation(s)
- Sofia Teixeira
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto 4050-313, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia-Centro Materno Infantil do Norte, Porto 4099-001, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto 4050-313, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia-Centro Materno Infantil do Norte, Porto 4099-001, Portugal
- Departamento da Mulher e da Medicina, Reprodutiva, Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto 4099-001, Portugal
- Unidade de Investigação e Formação-Centro Materno Infantil do Norte, Porto 4099-001, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto 4200-319, Portugal
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Mena Ugarte SC, Rodríguez Funes MV, Viterna J. Maternal morbidity under an absolute abortion ban: insights from a 6-year case series of fatal fetal malformations in El Salvador. AJOG GLOBAL REPORTS 2022; 3:100147. [PMID: 36632427 PMCID: PMC9826817 DOI: 10.1016/j.xagr.2022.100147] [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] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A striking number of national and subnational governments that previously allowed legal abortion in cases of severe fetal anomaly have passed new legislation to explicitly remove these allowances. However, we know little about the maternal health implications of such restrictions. OBJECTIVE This study aimed to examine the health outcomes of pregnant individuals in El Salvador whose fetuses were diagnosed with a fatal congenital malformation and who were legally required to carry these nonviable pregnancies to term under the nation's absolute abortion ban. STUDY DESIGN We reviewed the charts of all 239 pregnancies with fetuses classified as having 1 of 18 congenital malformations typically considered to be incompatible with extrauterine life that were evaluated at the National Women's Hospital in El Salvador between January 1, 2013 and December 31, 2018. Because regional healthcare providers who identify pregnancy complications in El Salvador are instructed to refer those patients to the National Women's Hospital, our analysis captured the total population of lethal fetal malformations treated by the national public health system. We documented pregnant patients' socioeconomic characteristics, pregnancy-related complications, and the medical procedures used to mitigate complications. RESULTS Individuals who were required to carry pregnancies with severe fetal malformations to term (or until preterm labor began naturally) experienced high rates of maternal morbidity. More than half (54.9%) of pregnancies experienced at least 1 serious pregnancy-related health complication, whereas 47.9% underwent a physically-invasive medical procedure to manage complications, including cesarean deliveries, decompression amniocenteses, fetal head decompressions, and, in 1 case, a full hysterectomy. A total of 9% of patients opted to discontinue care after receiving the diagnosis of fatal fetal malformation. We also found striking variation in how physicians managed pregnancies with fatal fetal malformations, suggesting that different interpretations of the law lead to inequities in individual-level patient care. CONCLUSION Laws prohibiting abortions in cases of severe fetal malformation can increase risks to pregnant patients by requiring clinicians to subject healthy patients to a course of treatment that generates morbidity.
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Affiliation(s)
| | | | - Jocelyn Viterna
- Harvard University, Cambridge, MA,Corresponding author: Jocelyn Viterna, PhD
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Gerakova E, Genova S. A rare case report of Edwards syndrome with immature teratoma in submandibular region and literature review. Folia Med (Plovdiv) 2022; 64:348-353. [DOI: 10.3897/folmed.64.e61024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/15/2021] [Indexed: 11/12/2022] Open
Abstract
Trisomy 18 (Edward syndrome) was first described by Edwards et al. in 1960. The condition is the second most common autosomal trisomy syndrome in males. The prevalence in infants is estimated as 1/6000-1/8000. Those affected have a high mortality rate – only 4% may survive their first year.
The study illustrates the first reported case of Edwards syndrome with immature teratoma in submandibular region.
A 33-year-old multigravida had a normal antenatal course until 36 weeks of gestation. Two hours after delivery, the baby was transported to a neonatal ward, where several malformations were described: a tumour formation the size of a walnut in the right submandibular region, ear abnormality, micrognathia with high arched palate, overlapping fingers, and feet deformities. A genetic test was performed which confirmed trisomy 18. After 26 days of assisted ventilation and oxygen therapy, the newborn developed hyaline-membrane disease, dilatation of the pulmonary artery and the right side of the heart, thrombosis of the right atrium and these conditions were determined to be the cause of death.
The autopsy and histological examination confirmed the aforementioned malformations finding also a kidney with duplicated collecting system on the right and ectopic ureter in the left kidney. The submandibular tumour was determined to be immature teratoma.
Conclusion: This is the first presented case in the literature of a newborn with Edwards syndrome combined with immature teratoma.
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Buczyńska A, Sidorkiewicz I, Hameed A, Krętowski AJ, Zbucka-Krętowska M. Future Perspectives in Oxidative Stress in Trisomy 13 and 18 Evaluation. J Clin Med 2022; 11:jcm11071787. [PMID: 35407395 PMCID: PMC8999694 DOI: 10.3390/jcm11071787] [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: 02/07/2022] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023] Open
Abstract
Autosomal aneuploidies are the most frequently occurring congenital abnormalities and are related to many metabolic disorders, hormonal dysfunctions, neurotransmitter abnormalities, and intellectual disabilities. Trisomies are generated by an error of chromosomal segregation during cell division. Accumulating evidence has shown that deregulated gene expression resulting from the triplication of chromosomes 13 and 18 is associated with many disturbed cellular processes. Moreover, a disturbed oxidative stress status may be implicated in the occurrence of fetal malformations. Therefore, a literature review was undertaken to provide novel insights into the evaluation of trisomy 13 (T13) and 18 (T18) pathogeneses, with a particular concern on the oxidative stress. Corresponding to the limited literature data focused on factors leading to T13 and T18 phenotype occurrence, the importance of oxidative stress evaluation in T13 and T18 could enable the determination of subsequent disturbed metabolic pathways, highlighting the related role of mitochondrial dysfunction or epigenetics. This review illustrates up-to-date T13 and T18 research and discusses the strengths, limitations, and possible directions for future studies. The progressive unification of trisomy-related research protocols might provide potential medical targets in the future along with the implementation of the foundation of modern prenatal medicine.
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Affiliation(s)
- Angelika Buczyńska
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland; (I.S.); (A.H.); (A.J.K.)
- Correspondence: (A.B.); (M.Z.-K.); Tel.: +48-85-746-85-13 (A.B.); +48-85-746-83-36 (M.Z.-K.)
| | - Iwona Sidorkiewicz
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland; (I.S.); (A.H.); (A.J.K.)
| | - Ahsan Hameed
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland; (I.S.); (A.H.); (A.J.K.)
| | - Adam Jacek Krętowski
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland; (I.S.); (A.H.); (A.J.K.)
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Monika Zbucka-Krętowska
- Department of Gynecological Endocrinology and Adolescent Gynecology, Medical University of Bialystok, 15-276 Bialystok, Poland
- Correspondence: (A.B.); (M.Z.-K.); Tel.: +48-85-746-85-13 (A.B.); +48-85-746-83-36 (M.Z.-K.)
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Sandal S, Mahay SB, Dimri Gupta N, Saxena R, Lall M, Dua Puri R. Prenatal phenotypic spectrum of full trisomy 18 in an Indian cohort. Am J Med Genet A 2022; 188:1904-1908. [DOI: 10.1002/ajmg.a.62692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/04/2022] [Accepted: 01/22/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Sapna Sandal
- Institute of Medical Genetics and Genomics Sir Ganga Ram Hospital New Delhi India
| | | | | | - Renu Saxena
- Institute of Medical Genetics and Genomics Sir Ganga Ram Hospital New Delhi India
| | - Meena Lall
- Institute of Medical Genetics and Genomics Sir Ganga Ram Hospital New Delhi India
| | - Ratna Dua Puri
- Institute of Medical Genetics and Genomics Sir Ganga Ram Hospital New Delhi India
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Kusano ME, Schmidt A. Teaching motor responses to a child with trisomy 18: A preliminary study. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Maria Elisa Kusano
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (USP—FFCLRP), Departamento de Psicologia Universidade de São Paulo – Brasil São Paulo Brazil
| | - Andréia Schmidt
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (USP—FFCLRP), Departamento de Psicologia Universidade de São Paulo – Brasil São Paulo Brazil
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Clinical and molecular cytogenetic description of a female patient with de novo 18q inversion duplication/deletion. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Xu X, Zhang X, Han J, Adamu Y, Zhang B. Potential Increased Risk of Trisomy 18 Observed After a Fertilizer Warehouse Fire in Brazos County and TX. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072561. [PMID: 32276490 PMCID: PMC7177937 DOI: 10.3390/ijerph17072561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 12/05/2022]
Abstract
Background: In this paper, we aimed to investigate the potential impacts of a fire accident in a fertilizer warehouse on chromosomal anomalies, including Trisomy 21 (T21) and Trisomy (T18) among pregnancies in Brazos County, Texas. We conducted an observational study in Brazos County, TX, with all patients of T18 and T21 cases in the live births in Brazos County between 2005–2014. The prevalence of T18 and T21 before, during, and after the accident in Brazos County were calculated and compared. The Standardized Morbidity Ratio (SMR) was applied to compare the prevalence of T18 and T21 in Brazos County to the statewide prevalence in Texas after adjusting for maternal race and age. Compared with statewide risk, the risk of T18 during the impacted years in Brazos county was found to be significantly higher (SMR = 5.0, 95% Confidence Interval(CI): 2.19–9.89), while there was no significant difference before (SMR = 0.77, 0.13–2.54) and after the accident (SMR = 0.71, 0.12–2.36). However, the prevalence of T21 during the impacted years was not significantly different from those before or after the accident. This study conclusively suggests that this fertilizer fire may be related to the increased prevalence of T18 in Brazos County, though the findings warrant further investigation.
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Affiliation(s)
- Xiaohui Xu
- Correspondence: ; Tel.: +979-436-9500; Fax: 979-458-1877
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El-Dessouky SH, Aboulghar MM, Gaafar HM, Abdella RM, Sharaf MF, Ateya MI, Elarab AE, Zidan WH, Helal RM, Aboelsaud SM, Eid MM, Abdel-Salam GMH. Prenatal ultrasound findings of holoprosencephaly spectrum: Unusual associations. Prenat Diagn 2020; 40:565-576. [PMID: 31955448 DOI: 10.1002/pd.5649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/28/2019] [Accepted: 12/29/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the prenatal diagnosis, postnatal characteristics, and the spectrum of associated findings in fetuses with holoprosencephaly (HPE). METHODS Fetal neurosonograms, postnatal assessment, and chromosomal analysis were performed in a cohort of 25 fetuses with HPE. RESULTS The prevalence of HPE in high-risk pregnancies was 4.4:10 000. The alobar subtype was the most frequently encountered, with 17 cases (68%). Interestingly, among them, four cases (16%) presented with the rare agnathia-otocephaly complex. Chromosomal abnormalities were detected in 11 cases (44%), the most frequent being trisomy 13 in seven cases (five alobar, one semilobar, and one lobar HPE), followed by trisomy 18 in two cases with semilobar HPE. One case of alobar HPE had 45, XX, t(18;22) (q10;q10), -18p karyotyping, and one case of semilobar HPE was associated with triploidy. Facial malformations in HPE spectrum ranged from cyclopia, proboscis, and arrhinia that were associated with the alobar subtype to hypotelorism and median cleft that were frequent among the semilobar and lobar subtypes. Associated neural tube defects were identified in 12% of cases. CONCLUSION Our study illustrates the clinical and genetic heterogeneity of HPE and describes different chromosomal abnormalities associated with HPE.
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Affiliation(s)
- Sara H El-Dessouky
- Prenatal Diagnosis & Fetal Medicine Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | | | | | | | | | | | | | | | | | | | - Maha M Eid
- Human Cytogenetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Ghada M H Abdel-Salam
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
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Dieterich K, Kimber E, Hall JG. Central nervous system involvement in arthrogryposis multiplex congenita: Overview of causes, diagnosis, and care. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:345-353. [PMID: 31410997 DOI: 10.1002/ajmg.c.31732] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/13/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022]
Abstract
Arthrogryposis or AMC, arthrogryposis multiplex congenita, is defined as multiple congenital joint contractures in more than two joints and in different body areas. The common cause of all AMC is lack of movement in utero, which in turn can have different causes, one of which is CNS involvement. Intellectual disability/CNS involvement is found in approximately 25% of all AMC. AMC with CNS involvement includes a large number of genetic syndromes. So far, more than 400 genes have been identified as linked to AMC, with and without CNS involvement. A number of neonatally lethal syndromes and syndromes resulting in severe disability due to CNS malfunction belong to this group of syndromes. There are several X-linked disorders with AMC, which are primarily related to intellectual disability. A number of neuromuscular disorders may include AMC and CNS/brain involvement. Careful clinical evaluation by a geneticist and a pediatrician/pediatric neurologist is the first step in making a specific diagnosis. Further investigations may include MRI of the brain and spinal cord, electroencephalogram, blood chemistry for muscle enzymes, other organ investigations (ophtalmology, cardiology, gastrointestinal, and genitourinary systems). Nerve conduction studies, electromyogram, and muscle pathology may be of help when there is associated peripheral nervous system involvement. But most importantly, genetic investigations with targeted or rather whole exome or genome sequencing should be performed. A correct diagnosis is important in planning adequate treatment, in genetic counselling and also for future understanding of pathogenic mechanisms and possible new treatments. A multidiciplinary team is needed both in investigation and treatment.
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Affiliation(s)
- Klaus Dieterich
- Univ. Grenoble Alpes, Inserm, U1216, GIN, Grenoble, France.,CHU Grenoble Alpes, Génétique Médicale, Grenoble, France
| | - Eva Kimber
- Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden.,Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Judith G Hall
- Professor Emerita, Department of Pediatrics and Medical Genetics, University of British Columbia, Vancouver, Canada
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Ferreira de Souza LM, Galvão E Brito Medeiros A, Júnior JPR, de Melo AN, Dias SAMM. Long Survival of a Patient with Trisomy 18 and Dandy-Walker Syndrome. ACTA ACUST UNITED AC 2019; 55:medicina55070352. [PMID: 31288482 PMCID: PMC6681329 DOI: 10.3390/medicina55070352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/16/2022]
Abstract
Trisomy 18 is a genetic disease resulting from an extra chromosome 18, characterized by a broad clinical spectrum, poor prognosis and low rates of survival. This is the case of a 12 year-old girl diagnosed with full trisomy 18, and multiple malformations, including Dandy-Walker Syndrome and congenital heart defects on long term survival. At nine months, a new echocardiogram showed a double outlet right ventricle, significant pulmonary stenosis, patent ductus arteriosus and ventricular septal defect. Cardiac surgery was performed at one year and seven months. Early surgical intervention and multidisciplinary follow-up may change the clinical outcome of the disease. Further studies are required to evaluate the benefit of invasive procedures such as cardiac surgery on survival of patients with trisomy 18.
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Affiliation(s)
| | | | | | - Aurea Nogueira de Melo
- Department of Pediatric of Federal, University of Rio Grande do Norte, Natal 58051-900, Brazil.
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Maternal Body Mass Index and Risk of Congenital Heart Defects in Infants: A Dose-Response Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1315796. [PMID: 31360700 PMCID: PMC6642764 DOI: 10.1155/2019/1315796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 01/19/2023]
Abstract
Objective The exact shape of the dose-response relationship between maternal body mass index (BMI) and the risk of congenital heart defects (CHDs) in infants has not been clearly defined yet. This study aims to further clarify the relationship between maternal obesity and the risk of CHDs in infants by an overall and dose-response meta-analysis. Methods PubMed, Embase, and Web of Science databases were searched to identify all related studies. The studies were limited to human cohort or case-control studies in English language. Random-effect models and dose-response meta-analysis were used to synthesize the results. Heterogeneity, subgroup analysis, sensitivity analysis, and publication bias were also assessed. Results Nineteen studies with 2,416,546 participants were included in our meta-analysis. Compared with the mothers with normal weight, the pooled relative risks (RRs) of infants with CHDs were 1.08 (95% CI=1.03-1.13) in overweight and 1.23 (95% CI=1.17-1.29) in obese mothers. According to the findings from the linear meta-analysis, we observed an increased risk of infants with CHDs (RR=1.07, 95% CI=1.06-1.08) for each 5 kg/m2 increase in maternal BMI. A nonlinear relationship between maternal BMI and risk of infants with CHDs was also found (p=0.012). Conclusion The results from our meta-analysis indicate that increased maternal BMI is related to increased risk of CHDs in infants.
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Mužinić V, Ramić S, Želježić D. Chromosome Missegregation and Aneuploidy Induction in Human Peripheral Blood Lymphocytes In vitro by Low Concentrations of Chlorpyrifos, Imidacloprid and α-Cypermethrin. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2019; 60:72-84. [PMID: 30264469 DOI: 10.1002/em.22235] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
Chlorpyrifos, imidacloprid, and α-cypermethrin are some of the most widely used insecticides in contemporary agriculture. However, their low-dose, nontarget genotoxic effects have not been extensively assayed. As one of the most relevant cancer biomarkers, we aimed to assess the aneuploidy due to chromosome missegregation during mitosis. To aim it we treated human lymphocytes in vitro with three concentrations of insecticides equivalents relevant for real scenario exposure assessed by regulatory agencies. We focused on chlorpyrifos as conventional and imidacloprid and α-cypermethrin as sustainable use insecticides. Cytokinesis-blocked micronucleus assay was performed coupled with fluorescence in situ hybridization (FISH) with directly labeled pancentromeric probes for chromosomes 9, 18, X and Y. None of the insecticides induced significant secondary DNA damage in terms of micronuclei (MN), nuclear buds (NB), or nucleoplasmic bridges (NPB). However, significant disbalances in chromosomes 9, 18, X and Y, and in insecticide-treated cells has been observed. According to recent studies, these disbalances in chromosome numbers may be atributted to defect sister chromatid cohesion which contribute to the increase of chromosome missegregation but not to micronuclei incidence. We conclude that tested insecticidal active substances exert chromosome missegregation effects at low concentrations, possibly by mechanism of sister chromatid cohesion. These findings may contribute to future risk assesments and understanding of insecticide mode of action on human genome. Environ. Mol. Mutagen. 60:72-84, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Vedran Mužinić
- Unit of Mutagenesis, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Snježana Ramić
- Department of Oncological Pathology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Davor Želježić
- Unit of Mutagenesis, Institute for Medical Research and Occupational Health, Zagreb, Croatia
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Thorvilson MJ, Copeland AJ. Incompatible with Care: Examining Trisomy 18 Medical Discourse and Families' Counter-discourse for Recuperative Ethos. THE JOURNAL OF MEDICAL HUMANITIES 2018; 39:349-360. [PMID: 28185147 DOI: 10.1007/s10912-017-9436-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Parents whose child is diagnosed with a serious disease such as trisomy 18 first rely on the medical community for an accurate description and prognosis. In the case of trisomy 18, however, many families are told the disease is "incompatible with life" even though some children with the condition live for several years. This paper considers parents' response to current medical discourse concerning trisomy 18 by examining blogs written by the parents of those diagnosed. Using interpretive humanistic reading and foregrounding Cathryn Molloy's recuperative ethos theory (2015), we find that parents demonstrate recuperative ethos in response to physicians' descriptions of trisomy 18, particularly in rhetoric addressing survival, medicalized language, and religious and/or spiritual rhetoric. We argue that, by using language such as "incompatible with life," physicians distance themselves from families, creating not care, but the very gulf that requires recuperation. We conclude that medical professionals would do well to engage with the trisomy 18 community-including learning from blogs and online forums- employ palliative care practices, and seek more accurate, descriptive language that is compatible with care.
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Rosa RFM, Correia EPE, Bastos CS, da Silva GS, Correia JD, da Rosa EB, Silveira DB, Targa LV, da Cunha AC, Zen PRG. Trisomy 18 and holoprosencephaly. Am J Med Genet A 2017; 173:1985-1987. [DOI: 10.1002/ajmg.a.38129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/07/2016] [Accepted: 12/24/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Rafael F. M. Rosa
- Clinical Genetics; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA); Porto Alegre RS Brazil
- Graduate Program in Pathology; UFCSPA; Porto Alegre RS Brazil
- Graduate Program in Biosciences; UFCSPA; Porto Alegre RS Brazil
| | | | | | | | | | | | | | - Luciano V. Targa
- Pediatric Radiology; Hospital Materno Infantil Presidente Vargas (HMIPV); Porto Alegre RS Brazil
| | | | - Paulo R. G. Zen
- Clinical Genetics; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA); Porto Alegre RS Brazil
- Graduate Program in Pathology; UFCSPA; Porto Alegre RS Brazil
- Graduate Program in Biosciences; UFCSPA; Porto Alegre RS Brazil
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18
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Trevisan P, Rosa RFM, Koshiyama DB, Zen TD, Paskulin GA, Zen PRG. Congenital heart disease and chromossomopathies detected by the karyotype. ACTA ACUST UNITED AC 2016; 32:262-71. [PMID: 25119760 PMCID: PMC4183026 DOI: 10.1590/0103-0582201432213213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/17/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE: To review the relationship between congenital heart defects and chromosomal
abnormalities detected by the karyotype. DATA SOURCES: Scientific articles were searched in MEDLINE database, using the descriptors
"karyotype" OR "chromosomal" OR "chromosome" AND "heart defects, congenital". The
research was limited to articles published in English from 1980 on. DATA SYNTHESIS: Congenital heart disease is characterized by an etiologically heterogeneous and
not well understood group of lesions. Several researchers have evaluated the
presence of chromosomal abnormalities detected by the karyotype in patients with
congenital heart disease. However, most of the articles were retrospective studies
developed in Europe and only some of the studied patients had a karyotype exam. In
this review, only one study was conducted in Latin America, in Brazil. It is known
that chromosomal abnormalities are frequent, being present in about one in every
ten patients with congenital heart disease. Among the karyotype alterations in
these patients, the most important is the trisomy 21 (Down syndrome). These
patients often have associated extra-cardiac malformations, with a higher risk of
morbidity and mortality, which makes heart surgery even more risky. CONCLUSIONS: Despite all the progress made in recent decades in the field of cytogenetic, the
karyotype remains an essential tool in order to evaluate patients with congenital
heart disease. The detailed dysmorphological physical examination is of great
importance to indicate the need of a karyotype.
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Identification of candidate genes for congenital heart defects on proximal chromosome 8p. Sci Rep 2016; 6:36133. [PMID: 27808268 PMCID: PMC5093561 DOI: 10.1038/srep36133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/10/2016] [Indexed: 12/21/2022] Open
Abstract
With the application of advanced molecular cytogenetic techniques, the number of patients identified as having abnormal chromosome 8p has increased progressively. Individuals with terminal 8p deletion have been extensively described in previous studies. The manifestations usually include cardiac anomalies, developmental delay/mental retardation, craniofacial abnormalities, and multiple other minor anomalies. However, some patients with proximal deletion also presented with similar phenotypic features. Here we describe a female child with an 18.5-Mb deletion at 8p11.23–p22 that include the cardiac-associated loci NKX2-6 and NRG1. Further mutation screening of these two candidate genes in 143 atrial septal defect patients, two heterozygous mutations NKX2-6 (c.1A > T) and NRG1 (c.1652G > A) were identified. The mutations were described for the first time in patients with congenital heart disease (CHD). The c.1A > T NKX2-6 generated a protein truncated by 45 amino acids with a decreased level of mRNA expression, whereas the NRG1 mutation had no significant effect on protein functions. Our findings suggest that 8p21-8p12 may be another critical region for 8p-associated CHD, and some cardiac malformations might be due to NKX2-6 haploinsufficiency. This study also links the NKX2-6 mutation to ASD for the first time, providing novel insight into the molecular underpinning of this common form of CHD.
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20
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Correia JD, da Rosa EB, Silveira DB, Correia EPE, Lorenzen MB, Travi GM, Rosa RCM, Zen PRG, Zen TD, Rosa RFM. Trisomy 18 and eye anomalies. Am J Med Genet A 2016; 173:553-555. [PMID: 27792864 DOI: 10.1002/ajmg.a.38036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/07/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Jamile D Correia
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ernani B da Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Daniélle B Silveira
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | | | - Giovanni M Travi
- Pediatric Ophthalmology, Hospital da Criança Santo Antônio (HCSA)/Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, RS, Brazil
| | - Rosana C M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Paulo R G Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Graduate Program in Biosciences, UFCSPA, Porto Alegre, RS, Brazil.,Clinical Genetics, UFCSPA and CHSCPA, Porto Alegre, RS, Brazil
| | - Tatiana D Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Pharmacy, Faculdade de Ciências da Saúde, Centro Universitário Ritter dos Reis-UniRitter, Porto Alegre, RS, Brazil
| | - Rafael F M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Graduate Program in Biosciences, UFCSPA, Porto Alegre, RS, Brazil.,Clinical Genetics, UFCSPA and CHSCPA, Porto Alegre, RS, Brazil
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21
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Management Considerations for Ongoing Pregnancies Complicated by Trisomy 13 and 18. Obstet Gynecol Surv 2016; 71:295-300. [DOI: 10.1097/ogx.0000000000000304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Rittinger O, Krabichler B, Kronberger G, Kotzot D. Clinical, cytogenetic, and molecular findings in a patient with a 46,XX,del(18)(q22)/46,XX,idic(18)(q22) karyotype. Eur J Med Genet 2015; 58:603-7. [PMID: 26417856 DOI: 10.1016/j.ejmg.2015.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/16/2015] [Accepted: 09/23/2015] [Indexed: 11/30/2022]
Abstract
Pseudoisodicentric or asymmetrical dicentric chromosomes 18 are rare findings in clinical cytogenetics. So far, only 8 patients with breakpoints in 18q have been reported and in none of them breakpoints were narrowed down to the molecular level. Here, we describe a 17 months old girl with a perimembranous ventricular septal defect, cleft palate, and minor dysmorphism including hypertelorism, flat nose, frontal bossing and low set ears as well as mosaicism for a cell line with a pseudoisodicentric chromosome 18q and a second cell line with a terminal deletion of 11 Mb in 18q22.2→qter. SNP-array investigation revealed a symmetric breakpoint in 18q22.2 and most likely postzygotic formation from the maternal chromosome 18. Clinical findings in all patients reported so far as well as in the patient presented here were in part overlapping with the clinical phenotypes of trisomy 18 and partial monosomy 18q.
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Affiliation(s)
- Olaf Rittinger
- Department of Pediatrics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Birgit Krabichler
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriela Kronberger
- Department of Pediatrics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Dieter Kotzot
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
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23
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Denardin D, Savaris FE, da Cunha AC, Betat RDS, Telles JAB, Targa LV, Weiss A, Zen PRG, Rosa RFM. Retrospective cohort of trisomy 18 (Edwards syndrome) in southern Brazil. SAO PAULO MED J 2015; 133:320-5. [PMID: 25388684 PMCID: PMC10876362 DOI: 10.1590/1516-3180.2013.79900715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 11/20/2013] [Accepted: 07/11/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Trisomy 18 (T18), or Edwards syndrome, is a chromosomal disease characterized by a broad clinical picture and a poor prognosis. Our aim was to describe clinical, radiological and survival data of a cohort of patients prenatally diagnosed with T18. DESIGN AND SETTING Retrospective single cohort in the Fetal Medicine Service of Hospital Materno Infantil Presidente Vargas (HMIPV). METHODS All sequential patients with T18 registered at the Fetal Medicine Service of HMIPV between January 2005 and September 2013 were considered. We gathered their clinical, radiological and survival data and used the Kaplan-Meier test for survival analysis. RESULTS Ten patients were diagnosed with T18, of whom seven (70%) were female. The majority (90%) were referred due to malformations seen on ultrasound. The mean gestational age at the first evaluation was 25.5 weeks. At karyotyping, the defects were considered multiple in only four patients (40%). All the fetuses presented full trisomy of chromosome 18. The main abnormality observed was congenital heart disease (n = 7). Intrauterine death occurred in half of the patients (50%). All live patients (n = 5) were born through cesarean section presenting low weight and low Apgar scores. The median length of survival after birth was 18 days. CONCLUSIONS T18 is associated with a high risk of fetal and neonatal death. The majority of the patients present major malformations identified through ultrasound, such as congenital heart defects, which could help in identifying such cases prenatally.
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Affiliation(s)
- Daniela Denardin
- MD. Physician, Residency Program on Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Fabíola Elizabete Savaris
- MD. Physician, Residency Program on Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - André Campos da Cunha
- MD. Obstetrician, Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Rosilene da Silveira Betat
- MD. Obstetrician, Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Jorge Alberto Bianchi Telles
- MD. Fetologist, Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Luciano Vieira Targa
- MD. Pediatric Radiologist, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Aline Weiss
- MD. Neonatologist, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Paulo Ricardo Gazzola Zen
- PhD. Adjunct Professor of Clinical Genetics and of the Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Rafael Fabiano Machado Rosa
- PhD. Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA) and Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
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24
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Reid SN, Ziermann JM, Gondré-Lewis MC. Genetically induced abnormal cranial development in human trisomy 18 with holoprosencephaly: comparisons with the normal tempo of osteogenic-neural development. J Anat 2015; 227:21-33. [PMID: 26018729 PMCID: PMC4475356 DOI: 10.1111/joa.12326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/21/2022] Open
Abstract
Craniofacial malformations are common congenital defects caused by failed midline inductive signals. These midline defects are associated with exposure of the fetus to exogenous teratogens and with inborn genetic errors such as those found in Down, Patau, Edwards' and Smith-Lemli-Opitz syndromes. Yet, there are no studies that analyze contributions of synchronous neurocranial and neural development in these disorders. Here we present the first in-depth analysis of malformations of the basicranium of a holoprosencephalic (HPE) trisomy 18 (T18; Edwards' syndrome) fetus with synophthalmic cyclopia and alobar HPE. With a combination of traditional gross dissection and state-of-the-art computed tomography, we demonstrate the deleterious effects of T18 caused by a translocation at 18p11.31. Bony features included a single developmentally unseparated frontal bone, and complete dual absence of the anterior cranial fossa and ethmoid bone. From a superior view with the calvarium plates removed, there was direct visual access to the orbital foramen and hard palate. Both the eyes and the pituitary gland, normally protected by bony structures, were exposed in the cranial cavity and in direct contact with the brain. The middle cranial fossa was shifted anteriorly, and foramina were either missing or displaced to an abnormal location due to the absence or misplacement of its respective cranial nerve (CN). When CN development was conserved in its induction and placement, the respective foramen developed in its normal location albeit with abnormal gross anatomical features, as seen in the facial nerve (CNVII) and the internal acoustic meatus. More anteriorly localized CNs and their foramina were absent or heavily disrupted compared with posterior ones. The severe malformations exhibited in the cranial fossae, orbital region, pituitary gland and sella turcica highlight the crucial involvement of transcription factors such as TGIF, which is located on chromosome 18 and contributes to neural patterning, in the proper development of neural and cranial structures. Our study of a T18 specimen emphasizes the intricate interplay between bone and brain development in midline craniofacial abnormalities in general.
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Affiliation(s)
- Shaina N Reid
- Laboratory for Neurodevelopment, Department of Anatomy, Howard University College of MedicineWashington, DC, USA
| | - Janine M Ziermann
- Laboratory for Neurodevelopment, Department of Anatomy, Howard University College of MedicineWashington, DC, USA
| | - Marjorie C Gondré-Lewis
- Laboratory for Neurodevelopment, Department of Anatomy, Howard University College of MedicineWashington, DC, USA
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Huntingford K, Montalto SA, Choudhry M. A 3-year-old girl with Trisomy 18 and intussusception with Meckel's diverticulum. Am J Med Genet A 2015; 167A:2226-8. [PMID: 26108702 DOI: 10.1002/ajmg.a.37109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/19/2015] [Indexed: 11/10/2022]
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26
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Pelizzari E, Valdez CM, Picetti JDS, da Cunha AC, Dietrich C, Fell PRK, Targa LV, Zen PRG, Rosa RFM. Characteristics of fetuses evaluated due to suspected anencephaly: a population-based cohort study in southern Brazil. SAO PAULO MED J 2015; 133:101-8. [PMID: 25789781 PMCID: PMC10496632 DOI: 10.1590/1516-3180.2013.8012608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 11/22/2013] [Accepted: 08/26/2014] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Anencephaly is considered to be the most common type of neural tube defect. Our aim was to assess the clinical and gestational features of a cohort of fetuses with suspected anencephaly. DESIGN AND SETTING Population-based retrospective cohort study in a referral hospital in southern Brazil. METHODS The sample consisted of fetuses referred due to suspected anencephaly, to the Fetal Medicine Service of Hospital Materno Infantil Presidente Vargas, between January 2005 and September 2013. Clinical, radiological, pathological and survival data were gathered. RESULTS Our sample was composed of 29 fetuses. The diagnosis of suspected anencephaly was made on average at 21.3 weeks of gestation. Seven fetuses had malformations that affected other organs, and these included oral clefts (n = 4) and congenital heart defects (n = 2). In 16 cases, there was termination of pregnancy (n = 12) or intrauterine death (n = 4). Regarding those who were born alive (n = 13), all of them died in the first week of life. After postnatal evaluation, the diagnosis of anencephaly was confirmed in 22 cases (75.9%). Other conditions included amniotic band disruption complex (6.9%), microhydranencephaly (6.9%), merocrania (3.4%) and holoprosencephaly (3.4%). CONCLUSIONS Different conditions involving the cranial vault may be confused with anencephaly, as seen in our sample. However, these conditions also seem to have a poor prognosis. It seems that folic acid supplementation is not being properly performed.
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Affiliation(s)
- Emanuele Pelizzari
- MD. Physician, Residency Program in Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Carolina Melendez Valdez
- MD. Physician, Residency Program in Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Jamile dos Santos Picetti
- MD. Physician, Residency Program in Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - André Campos da Cunha
- MD. Obstetrician, Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Cristine Dietrich
- MD. Obstetrician, Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Paulo Renato Krahl Fell
- MD. Obstetrician, Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Luciano Vieira Targa
- MD. Pediatric Radiologist, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Paulo Ricardo Gazzola Zen
- PhD. Adjunct Professor of Clinical Genetics and of the Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Rafael Fabiano Machado Rosa
- PhD. Clinical Geneticist, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA) and Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Rio Grande do Sul, Brazil.
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Abstract
AIM To present an infant of trisomy 18 (Edwards Syndrome) with unilateral microphthalmia. METHODS A female infant who was born at 41 weeks of gestation had been diagnosed with Edwards Syndrome (ES). On ophthalmic examination, microphthalmia, microcornea, optic disc coloboma, and persistent hyaloid artery were determined in the left eye. In addition, abnormalities in the ears, hands, feet, and cardiovascular system were present. DISCUSSION With this case report, we aimed to highlight the relationship between ocular disgenesis and chromosomal disorders and the importance of prenatal testing and genetic counseling for parents.
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Affiliation(s)
- D Erginturk Acar
- Ministry of Health, Zekai Tahir Burak Women's Health Research and Education Hospital , Ankara , Turkey and
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