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Lena F, Piro L, Forlini V, Guerriero V, Salvati P, Stagnaro N, Sacco O, Torre M, Mattioli G. Lateral Thoracic Expansion for Jeune's Syndrome, Surgical Approach, and Technical Details. Eur J Pediatr Surg 2023; 33:85-89. [PMID: 36502808 DOI: 10.1055/s-0042-1758830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Jeune's syndrome, or asphyxiating thoracic dystrophy (ATD), is a rare autosomal recessive disorder characterized by skeletal dysplasia. Ribs are typically short and horizontal resulting-in lethal variant-in severe lung hypoplasia, progressive respiratory failure, and death. Lateral thoracic expansion (LTE) consists in staggered bilateral ribs osteotomy leading to chest expansion and lung development. Studies on LTE in ATD patients report encouraging data, but the rarity of ATD implies the lack of a standardized surgical path. The aim of this report is to present our experience with LTE, the technical modification we adopted, and patients' clinical outcome. MATERIALS AND METHODS We retrospectively reviewed data of 11 LTE performed in 7 ATD patients with lethal variant. Information regarding pre- and postoperative clinical conditions and surgical details was collected. We adopted a single-stage or a two-stage approach based on patient clinical condition. Computed tomography (CT) scan was performed before and after surgery and lung volume was calculated. RESULTS Five patients are alive, while two died in intensive care unit for other than respiratory cause (sepsis). Most patients experienced clinical improvement in terms of decreased respiratory infections rate, need for ventilation, and improved exercise tolerance. Postoperative CT scan demonstrated a median lung volume increase of 88%. CONCLUSION Mortality in ADT patients is high. However, LTE is a feasible and safe surgical approach, which could improve clinical conditions and survival rate. Survived patients showed postoperatively less oxygen requirement and improved clinical conditions.
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Affiliation(s)
- Federica Lena
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa Ringgold Standard Institution, Genova, Italy.,Pediatric Surgery Unit, Giannina Gaslini Children's Hospital Ringgold Standard Institution, Genova, Liguria, Italy
| | - Liliana Piro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa Ringgold Standard Institution, Genova, Italy.,Pediatric Surgery Unit, Giannina Gaslini Children's Hospital Ringgold Standard Institution, Genova, Liguria, Italy
| | - Valentina Forlini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa Ringgold Standard Institution, Genova, Italy.,Pediatric Surgery Unit, Giannina Gaslini Children's Hospital Ringgold Standard Institution, Genova, Liguria, Italy
| | - Vittorio Guerriero
- Pediatric Thoracic and Airway Surgery Unit, Giannina Gaslini Children's Hospital Ringgold Standard Institution, Genova, Liguria, Italy
| | - Pietro Salvati
- Department of Pediatrics, Pulmonary and Allergy Disease Unit, Giannina Gaslini Children's Hospital Ringgold Standard Institution, Genova, Liguria, Italy
| | - Nicola Stagnaro
- Department of Radiology, Giannina Gaslini Children's Hospital Ringgold Standard Institution, Genova, Liguria, Italy
| | - Oliviero Sacco
- Department of Pediatrics, Pulmonary and Allergy Disease Unit, Giannina Gaslini Children's Hospital Ringgold Standard Institution, Genova, Liguria, Italy
| | - Michele Torre
- Pediatric Thoracic and Airway Surgery Unit, Giannina Gaslini Children's Hospital Ringgold Standard Institution, Genova, Liguria, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Unit, Giannina Gaslini Children's Hospital Ringgold Standard Institution, Genova, Liguria, Italy
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Prenatal Diagnosis of Jeune Syndrome Caused by Compound Heterozygous Variants in DYNC2H1 Gene-Case Report with Rapid WES Procedure and Differential Diagnosis of Lethal Skeletal Dysplasias. Genes (Basel) 2022; 13:genes13081339. [PMID: 35893076 PMCID: PMC9332837 DOI: 10.3390/genes13081339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Skeletal dysplasias (SDs) are a large, heterogeneous group of mostly genetic disorders that affect the bones and cartilage, resulting in abnormal growth and development of skeletal structures. The high clinical and genetic diversity in SDs cause difficulties in prenatal diagnosis. To establish a correct prognosis and better management, it is very important to distinguish SDs with poor life-limiting prognosis or lethal SDs from other ones. Bad prognosis in foetuses is assessed on the basis of the size of the thorax, lung volumes, long bones’ length, bones’ echogenicity, bones’ angulation or presented fractures, and the concomitant presence of non-immune hydrops or visceral abnormalities. To confirm SD diagnosis and perform family genetic consultation, rapid molecular diagnostics are needed; therefore, the NGS method using a panel of genes corresponding to SD or whole-exome sequencing (WES) is commonly used. We report a case of a foetus showing long bones’ shortening and a narrow chest with short ribs, diagnosed prenatally with asphyxiating thoracic dystrophy, also known as Jeune syndrome (ATD; OMIM 208500), caused by compound heterozygous variants in the DYNC2H1 gene, identified by prenatally performed rapid-WES analysis. The missense variants in the DYNC2H1 gene were inherited from the mother (c.7289T>C; p.Ile2430Thr) and from the father (c.12716T>G; p.Leu4239Arg). The DYNC2H1 gene is one of at least 17 ATD-associated genes. This disorder belongs to the ninth group of SD, ciliopathies with major skeletal involvement. An extremely narrow, bell-shaped chest, and abnormalities of the kidneys, liver, and retinas were observed in most cases of ATD. Next to lethal and severe forms, clinically mild forms have also been reported. A diagnosis of ATD is important to establish the prognosis and management for the patient, as well as the recurrence risk for the family.
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Genetic Interaction of Thm2 and Thm1 Shapes Postnatal Craniofacial Bone. J Dev Biol 2022; 10:jdb10020017. [PMID: 35645293 PMCID: PMC9149932 DOI: 10.3390/jdb10020017] [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: 04/14/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Ciliopathies are genetic syndromes that link skeletal dysplasias to the dysfunction of primary cilia. Primary cilia are sensory organelles synthesized by intraflagellar transport (IFT)—A and B complexes, which traffic protein cargo along a microtubular core. We have reported that the deletion of the IFT-A gene, Thm2, together with a null allele of its paralog, Thm1, causes a small skeleton with a small mandible or micrognathia in juvenile mice. Using micro-computed tomography, here we quantify the craniofacial defects of Thm2−/−; Thm1aln/+ triple allele mutant mice. At postnatal day 14, triple allele mutant mice exhibited micrognathia, midface hypoplasia, and a decreased facial angle due to shortened upper jaw length, premaxilla, and nasal bones, reflecting altered development of facial anterior-posterior elements. Mutant mice also showed increased palatal width, while other aspects of the facial transverse, as well as vertical dimensions, remained intact. As such, other ciliopathy-related craniofacial defects, such as cleft lip and/or palate, hypo-/hypertelorism, broad nasal bridge, craniosynostosis, and facial asymmetry, were not observed. Calvarial-derived osteoblasts of triple allele mutant mice showed reduced bone formation in vitro that was ameliorated by Hedgehog agonist, SAG. Together, these data indicate that Thm2 and Thm1 genetically interact to regulate bone formation and sculpting of the postnatal face. The triple allele mutant mice present a novel model to study craniofacial bone development.
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Azevedo IG, Holanda NSO, Arrais NMR, Santos RTG, Araujo AGF, Pereira SA. Chest circumference in full-term newborns: how can it be predicted? BMC Pediatr 2019; 19:341. [PMID: 31554507 PMCID: PMC6761712 DOI: 10.1186/s12887-019-1712-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although over the years a number of studies have used chest circumference (CC) as a sensitive tool to identify the health status of infants, a particularly important aspect for this population is the lack of data on normal values and prediction equations. In order to facilitate and validate the interpretation of CC data in newborn (NB), the aim was to study the relation between CC and other anthropometric variables and develop a predictive equation for CC in a population of full-term newborns. Methods Cross-sectional study, carried out with full-term infants. The anthropometric (CC, head circumference - HC, length, age and weight) and hemodynamic variables were evaluated during the first 24 h of life. Bivariate analysis was performed between CC and HC, weight, length and type of delivery, followed by multiple linear regression analysis, including variables that were significant in the bivariate analysis. For data analysis, we used the SPSS program, considering p < 0.05 and 95% CI. Results The birth weight of the 120 NB varied between 2580 and 4225 g (mean 3360 g) and the gestational age between 37 and 42 weeks (mean 39 weeks). Approximately 61% of the sample were delivered vaginally and 67 (56%) were boys. The variables that remained statistically associated with CC after multivariate analysis were weight (β 0.003, CI: 0.002: 0.003, p = 0.001) and HC (β 0.287, CI: 0.156: 0.417, p = 0.001). For the linear regression model, the predictive equation of CC was 14.87+ (0.003 x weight) + (0.287 x HC), with a prediction of 76%. Conclusion The results show a positive correlation between CC and weight, length and HC, and based on the linear regression model, the predictive equation for CC is based only on weight and HC.
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Affiliation(s)
- Ingrid G Azevedo
- Ana Bezerra University Hospital - Empresa Brasileira de Serviços Hospitalares, Federal University of Rio Grande do Norte (UFRN), Praca Tequinha Farias, 13, Santa Cruz, RN, 59200-000, Brazil
| | - Norrara S O Holanda
- Faculty of Health Sciences, Federal University of Rio Grande do Norte (FACISA - UFRN), Rua Teodorico Bezerra, Santa Cruz, RN, 59200-000, Brazil
| | - Nivia M R Arrais
- Department of Pediatrics, Federal University of Rio Grande do Norte (UFRN), Campus Universitário Lagoa Nova, Natal, RN, 59078-970, Brazil.,Graduate Pediatrics and Applied Sciences in Pediatrics Program, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Raweny T G Santos
- Faculty of Health Sciences, Federal University of Rio Grande do Norte (FACISA - UFRN), Rua Teodorico Bezerra, Santa Cruz, RN, 59200-000, Brazil
| | - Ana G F Araujo
- Postgraduated Program in Rehabilitation Science - FACISA - UFRN, Santa Cruz, Brazil
| | - Silvana A Pereira
- Postgraduated Program in Rehabilitation Science - FACISA - UFRN, Santa Cruz, Brazil. .,Department of Physical therapy and Postgraduated Program in Rehabilitation Science - FACISA, Federal University of Rio Grande do Norte UFRN, Campus Universitário Lagoa Nova - CEP 59078-970, Natal, RN, Caixa Postal 1524, Brazil.
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Wagner MW, Poretti A, Benson JE, Huisman TAGM. Neuroimaging Findings in Pediatric Genetic Skeletal Disorders: A Review. J Neuroimaging 2016; 27:162-209. [PMID: 28000960 DOI: 10.1111/jon.12413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022] Open
Abstract
Genetic skeletal disorders (GSDs) are a heterogeneous group characterized by an intrinsic abnormality in growth and (re-)modeling of cartilage and bone. A large subgroup of GSDs has additional involvement of other structures/organs beside the skeleton, such as the central nervous system (CNS). CNS abnormalities have an important role in long-term prognosis of children with GSDs and should consequently not be missed. Sensitive and specific identification of CNS lesions while evaluating a child with a GSD requires a detailed knowledge of the possible associated CNS abnormalities. Here, we provide a pattern-recognition approach for neuroimaging findings in GSDs guided by the obvious skeletal manifestations of GSD. In particular, we summarize which CNS findings should be ruled out with each GSD. The diseases (n = 180) are classified based on the skeletal involvement (1. abnormal metaphysis or epiphysis, 2. abnormal size/number of bones, 3. abnormal shape of bones and joints, and 4. abnormal dynamic or structural changes). For each disease, skeletal involvement was defined in accordance with Online Mendelian Inheritance in Man. Morphological CNS involvement has been described based on extensive literature search. Selected examples will be shown based on prevalence of the diseases and significance of the CNS involvement. CNS involvement is common in GSDs. A wide spectrum of morphological abnormalities is associated with GSDs. Early diagnosis of CNS involvement is important in the management of children with GSDs. This pattern-recognition approach aims to assist and guide physicians in the diagnostic work-up of CNS involvement in children with GSDs and their management.
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Affiliation(s)
- Matthias W Wagner
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jane E Benson
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Page J, Bodart E, Hennecker JL. [Infant respiratory distress revealing Jeune syndrome]. Arch Pediatr 2016; 24:41-44. [PMID: 27889373 DOI: 10.1016/j.arcped.2016.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
Abstract
Jeune syndrome (asphyxiating thoracic dystrophy) is a rare autosomal recessive osteochondrodysplasia with a variable degree of severity, clinically characterized by respiratory distress with a narrow chest and limb shortness. The reported incidence is one to five in 500,000 live births. Most patients develop severe respiratory failure during the first 2 years of life, leading to death in 60-80 % of cases. Survivors may suffer from renal, hepatic, or pancreatic complications. Expanding thoracic surgery can be used for severe cases. We describe the case of an 18-month-old boy who developed mild respiratory distress. The patient showed typical radiological features of Jeune syndrome: narrow thorax with short ribs and trident appearance of the pelvis. This case underscores the value of the right interpretation of the chest radiograph of the infant with a respiratory distress syndrome.
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Affiliation(s)
- J Page
- Service de pédiatrie, clinique Notre-Dame de Grâce, 212, chaussée de Nivelles, 6041 Gosselies, Belgique
| | - E Bodart
- Service de pédiatrie, CHU UCL Namur site Godinne, 1, avenue du Docteur-Gaston-Therasse, 5530 Yvoir, Belgique
| | - J-L Hennecker
- Service de pédiatrie, clinique Notre-Dame de Grâce, 212, chaussée de Nivelles, 6041 Gosselies, Belgique.
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Cramer MT, Guay-Woodford LM. Cystic kidney disease: a primer. Adv Chronic Kidney Dis 2015; 22:297-305. [PMID: 26088074 DOI: 10.1053/j.ackd.2015.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/05/2015] [Accepted: 04/06/2015] [Indexed: 02/07/2023]
Abstract
Renal cystic diseases encompass a broad group of disorders with variable phenotypic expression. Cystic disorders can present during infancy, childhood, or adulthood. Often, but not always, they can be distinguished by the clinical features including age at presentation, renal imaging characteristics, including cyst distribution, and the presence/distribution of extrarenal manifestations. It is important to take the clinical context into consideration when assessing renal cystic disease in children and adults. For example, solitary kidney cysts may be completely benign when they develop during adulthood but may represent early polycystic kidney disease when observed during childhood. In this review, we have categorized renal cystic disease according to inherited single-gene disorders, for example, autosomal recessive polycystic kidney disease; syndromic disorders associated with kidney cysts, for example, tuberous sclerosis complex; and nongenetic forms of renal cystic disease, for example, simple kidney cysts. We present an overview of the clinical characteristics, genetics (when appropriate), and molecular pathogenesis and the diagnostic evaluation and management of each renal cystic disease. We also provide an algorithm that distinguishes kidney cysts based on their clinical features and may serve as a helpful diagnostic tool for practitioners. A review of Autosomal Dominant Polycystic Disease was excluded as this disorder was reviewed in this journal in March 2010, volume 17, issue 2.
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Kanani M, Elliott MJ, Withey S, Pearl R. Chest wall reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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