DiGeorge phenotype in the absence of 22q11 deletion - a case report

DiGeorge syndrome is polytopic developmental field defect which is usually associated with 22q11.2 microdeletion. However, this phenotype may be caused by other conditions. We report such a case and briefly review these alternative causes for this particular phenotype.

Knowledge, attitudes and intended behaviours towards HIV testing and self-protection: a survey of Omani pregnant women

Routine HIV testing of all pregnant women in Oman has been introduced without prior knowledge of women's attitudes towards testing or their behaviour in the event of a positive test. This study recruited 1000 Omani pregnant women from antenatal clinics to explore their knowledge of HIV/AIDS, attitudes towards HIV testing and intended behaviours in the event of a positive test. Mother-to-child transmission was recognized by 86.6% of the women but only 21.0% knew that it was preventable and a few acknowledged the important role of antiviral drugs. Half of the women (51.9%) reported having been tested for HIV and 75.8% agreed about routine HIV testing for all pregnant women. A higher level of knowledge was significantly associated with a favourable intended behaviour related to voluntary testing, disclosure and seeking professional assistance in the event of a positive HIV test. The results are discussed in relation to opt-in and opt-out approaches to voluntary testing during pregnancy.

Electrostatic potential and double layer force in a semiconductor-electrolyte-semiconductor heterojunction

This paper reports a theoretical study of the electrostatic potential within a so-called pen-heterojunction made up of two semi-infinite, doped semiconductor media separated by an electrolyte region. An external potential is then applied across the entire system. Both the electrostatic potentials and double layer surface forces are studied as functions of the usual double layer system properties, semiconductor properties such as doping concentrations of acceptor and donator atoms, as well as applied potential. We find that both attractive and repulsive forces are possible depending on the surface charges on the electrolyte-semiconductor interfaces, and that these forces can be significantly modified by the applied potential and by the doping levels in the semiconductors.

Periventricular heterotopia: phenotypic heterogeneity and correlation with Filamin A mutations

Periventricular heterotopia (PH) occurs when collections of neurons lay along the lateral ventricles or just beneath. Human Filamin A gene (FLNA) mutations are associated with classical X-linked bilateral periventricular nodular heterotopia (PNH), featuring contiguous heterotopic nodules, mega cisterna magna, cardiovascular malformations and epilepsy. FLNA encodes an F-actin-binding cytoplasmic phosphoprotein and is involved in early brain neurogenesis and neuronal migration. A rare, recessive form of bilateral PNH with microcephaly and severe delay is associated with mutations of the ADP-ribosylation factor guanine nucleotide-exchange factor-2 (ARFGEF2) gene, required for vesicle and membrane trafficking from the trans-Golgi. However, PH is a heterogeneous disorder. We studied clinical and brain MRI of 182 patients with PH and, based on its anatomic distribution and associated birth defects, identified 15 subtypes. Classical bilateral PNH represented the largest group (98 patients: 54%). The 14 additional phenotypes (84 patients: 46%) included PNH with Ehlers-Danlos syndrome (EDS), temporo-occipital PNH with hippocampal malformation and cerebellar hypoplasia, PNH with fronto-perisylvian or temporo-occipital polymicrogyria, posterior PNH with hydrocephalus, PNH with microcephaly, PNH with frontonasal dysplasia, PNH with limb abnormalities, PNH with fragile-X syndrome, PNH with ambiguous genitalia, micronodular PH, unilateral PNH, laminar ribbon-like and linear PH. We performed mutation analysis of FLNA in 120 patients, of whom 72 (60%) had classical bilateral PNH and 48 (40%) other PH phenotypes, and identified 25 mutations in 40 individuals. Sixteen mutations had not been reported previously. Mutations were found in 35 patients with classical bilateral PNH, in three with PNH with EDS and in two with unilateral PNH. Twenty one mutations were nonsense and frame-shift and four missense. The high prevalence of mutations causing protein truncations confirms that loss of function is the major cause of the disorder. FLNA mutations were found in 100% of familial cases with X-linked PNH (10 families: 8 with classical bilateral PNH, 1 with EDS and 1 with unilateral PH) and in 26% of sporadic patients with classical bilateral PNH. Overall, mutations occurred in 49% of individuals with classical bilateral PNH irrespective of their being familial or sporadic. However, the chances of finding a mutation were exceedingly gender biased with 93% of mutations occurring in females and 7% in males. The probability of finding FLNA mutations in other phenotypes was 4% but was limited to the minor variants of PNH with EDS and unilateral PNH. Statistical analysis considering all 42 mutations described so far identifies a hotspot region for PNH in the actin-binding domain (P < 0.05).

Growth hormone improves height in patients with juvenile idiopathic arthritis: 4-year data of a controlled study

OBJECTIVE

To evaluate the efficacy and safety of growth hormone treatment in severely growth retarded children with juvenile idiopathic arthritis (JIA) receiving glucocorticoids.

STUDY DESIGN

Children with systemic and polyarticular idiopathic arthritis (22 F, 16 M) with a mean age of 10.1 years were enrolled in this controlled study. Eighteen patients (9 F, 9M; mean age, 10.5 years) received growth hormone in a dose of 0.20 to 0.33 mg/kg body weight per week for 4 years. Twenty patients (13 F, 7 M; mean age, 9.6 years) served as an untreated control group.

RESULTS

Mean improvement in height in the treated group was 1 SD, whereas the patients of the control group lost 0.7 SD. Disease activity markers correlated significantly with the mean growth velocity standard deviation score. In general, children with mild or moderate disease and lower comedication grew and responded better to growth hormone therapy than those with active disease. No adverse events were noted.

CONCLUSION

Our data suggest that long-term growth hormone therapy has a beneficial effect in children with severe forms of JIA. Further data are needed to confirm the efficacy and safety of growth hormone and its effect on final height.

Adult height after GH therapy in 188 Ullrich-Turner syndrome patients: results of the German IGLU Follow-up Study 2001

OBJECTIVES

We aimed to evaluate the factors influencing true adult height (HT) after long-term (from 1987 to 2000) GH treatment in Ullrich-Turner syndrome (UTS) based on modalities conceived in the 1980s.

DESIGN

Out of 347 near-adult (>16 Years) patients from 96 German centres, whose longitudinal growth was documented within KIGS (Pharmacia International Growth Database), 188 (45, X=59%; bone age >15 Years) were available for further anthropometric measurements.

RESULTS

At a median GH dose of 0.88 (10th/90th percentiles: 0.47/1.06) IU/kg per week, a gain of 6.0 (-1.3/+13) cm above the projected adult height was recorded. Variables were recorded at GH start, after 1 Year GH, puberty onset, and last visit on GH therapy. At these visits, the median ages were 11.7, 12.7, 14.2, 16.6 and 18.7 Years; and median heights, 0.4, 1.1, 1.7, 1.7 and 1.3 SDS (UTS) respectively. Height gain (DeltaHT) after GH discontinuation was 1.5 cm. Total DeltaHT correlated (P<0.001) negatively with bone age and HT SDS at GH start, but positively with DeltaHT after the first Year, DeltaHT at puberty onset, and GH duration. Final HT correlated (P<0.001) positively with HT at GH start, first-Year DeltaHT, and HT at puberty onset. Body mass index increased slightly (P<0.05), with values at start and adult follow-up correlating highly (R=0.70, P<0.001). No major side effects of GH occurred.

CONCLUSIONS

GH dosages conceived in the 1980s are safe but too low for most UTS patients. HT gain and height are determined by age and HT at GH start. Height gain during the first Year on GH is indicative of overall height gain. After spontaneous or induced puberty, little gain in height occurs.

Study of neuromyopathy in amyloid kidney transplant patients

Neuromuscular status of amyloid and control groups of kidney transplant recipients was assessed through complete neurological examination, assay for serum levels of muscle enzymes (CPK and LDH), electromyography and nerve conduction velocity studies. Neuromyopathic findings were detected in both groups but without severe disabling clinical manifestations. These findings were more prominent in the amyloid group, evidenced by a more significant increase in polyphasicity detected by electromyography and longer prolongation of terminal latency measured in the median nerve. From this study, we concluded that amyloid kidney transplant recipients are more prone to neuromyopathy than the general kidney transplant population, which is mostly due to the amyloidosis itself and/or the colchicine therapy.

Intravenous regional anesthesia in the treatment of forearm and wrist fractures and dislocations in children

OBJECTIVE

To evaluate the efficacy and safety of intravenous regional anesthesia in the treatment of unilateral closed fractures and dislocations of forearm or wrist in children.

DESIGN

A prospective study over 6 years.

SETTING

The study was undertaken in the well-equipped emergency department of a community general hospital for ambulatory patients.

PATIENTS

One hundred and thirty-nine children between the ages of 4 and 18 years with unilateral closed fractures and dislocations of forearm or wrist.

INTERVENTION

All children received premedication with a combination of meperidine and promethazine (0.5 mg/kg intramuscularly) and regional upper limb anesthesia with 0.5% lidocaine solution (3 mg/kg intravenously) after inflation of an arm tourniquet.

MAIN OUTCOME MEASURES

The relief of pain, allowing closed reduction with intravenous regional anesthesia, and the incidence of complications.

RESULTS

All patients had complete relief of pain allowing successful closed reduction in 133 patients (96%); tourniquet pain occurred in 10 patients (7%). There were no symptoms of lidocaine toxicity. There were no neurovascular or compartment syndrome complications.

CONCLUSIONS

Intravenous regional anesthesia for the treatment of fractures and dislocations of forearm and wrist in children was found to be simple, safe and effective.

Effect of treatment of anaemia with erythropoietin on neuromuscular function in patients on long term haemodialysis

To study the effect of treatment of anaemia with recombinant human erythropoietin (r-HUEPO) on neuromuscular function in patients undergoing haemodialysis for chronic renal failure, six patients were given r-HUEPO in an initial dose of 50 u/kg three times a week and their haemoglobin concentration was measured. The dose was increased by 25 u/kg every four weeks if the response was not satisfactory. In five patients anaemia had been corrected within 12 weeks of initiation of treatment. Neuromuscular function was evaluated before treatment, half way through, and after correction of anaemia by clinical examination and neurophysiological studies including motor nerve conduction velocity, distal latency, electromyography and test for neuromuscular fatigue. After correction of anaemia there was a significant increase in motor nerve conduction velocity, a decrease in the duration of motor unit action potential, and a lessening of neuromuscular fatigue. We conclude that treatment of anaemia with r-HUEPO in patients with chronic renal failure undergoing haemodialysis may improve neuromuscular function.

Acute intermittent porphyria--an unusual cause of "surgical" abdomen. Response to propranolol therapy

We report a case of Acute Intermittent Porphyria which presented with acute abdominal distress, autonomic dysfunction and laboratory abnormalities. The treatment is discussed with special emphasis on the effect of large doses of Propranolol.

Exercise-induced asthma in schoolchildren. A pilot study in two Haifa districts

The prevalence of exercise-induced asthma was studied in 313 Haifa schoolchildren, 160 living in an unpolluted urban area close to the sea and 153 living in a rural kibbutz (communal agricultural settlement) in the proximity of polluting industries. The overall prevalence was 8.6%; it was higher in the kibbutz group, but the difference was not significant. The prevalence tended to fall with increasing age and did not change with sex.

Where ankle fusion stands today

A retrospective study involving thirty-six patients with thirty-seven ankle fusions was undertaken to assess the rate of fusion, the subjective and objective results, the residual subtalar and midtarsal movement, and the functional disability. Fusion occurred in thirty-one ankles (84 per cent). Twenty-four patients were reviewed, on average 7.5 years after fusion, and eighteen had good or excellent results; only four had been unable to return to their previous employment. The conclusion is that fusion is still a good treatment for the painful post-traumatic arthritis ankle, the resulting functional disability being minimal.