1
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Berry-Kravis E, Filipink RA, Frye RE, Golla S, Morris SM, Andrews H, Choo TH, Kaufmann WE. Seizures in Fragile X Syndrome: Associations and Longitudinal Analysis of a Large Clinic-Based Cohort. Front Pediatr 2021; 9:736255. [PMID: 35036394 PMCID: PMC8756611 DOI: 10.3389/fped.2021.736255] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
Fragile X syndrome (FXS), the most common inherited cause of intellectual disability, learning disability, and autism spectrum disorder, is associated with an increased prevalence of certain medical conditions including seizures. The goal of this study was to better understand seizures in individuals with FXS using the Fragile X Online Registry with Accessible Research Database, a multisite observational study initiated in 2012 involving FXS clinics in the Fragile X Clinic and Research Consortium. Seizure data were available for 1,607 participants, mostly male (77%) and white (74.5%). The overall prevalence of at least one seizure was 12%, with this rate being significantly higher in males than females (13.7 vs. 6.2%, p < 0.001). As compared to individuals with FXS without seizures, those with seizures were more likely to have autism spectrum disorder, current sleep apnea, later acquisition of expressive language, more severe intellectual disability, hyperactivity, irritability, and stereotyped movements. The mean age of seizure onset was 6.4 (SD 6.1) years of age with the great majority (>80%) having onset of seizures which was before 10. For those with epilepsy, about half (52%) had seizures for more than 3 years. This group was found to have greater cognitive and language impairment, but not behavioral disruptions, compared with those with seizures for <3 years. Antiepileptic drugs were more often used in males (60.6%) than females (34.8%), and females more often required more than one medication. The most commonly used anticonvulsants were oxcarbazepine, valproic acid, lamotrigine, and levetiracetam. The current study is the largest and first longitudinal study ever conducted to describe seizures in FXS. Overall, this study confirms previous reports of seizures in FXS and extends previous findings by further defining the cognitive and behavioral phenotype of those with epilepsy in FXS. Future studies should further investigate the natural history of seizures in FXS and the characteristics of seizures in FXS in adulthood.
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Affiliation(s)
- Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Robyn A Filipink
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Richard E Frye
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Sailaja Golla
- Division of Neurodevelopmental Medicine, Department of Neurology, Thompson Autism Center, Children's Hospital of California, University of Irvine, Orange, CA, United States
| | - Stephanie M Morris
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, MO, United States
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, United States
| | - Tse-Hwei Choo
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, United States
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2
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James L, Keshwani N, Haffner D, Zahlanie Y, Golla S, Agharokh L. Scratching Past Lymphadenopathy: A Case of Bartonella henselae Encephalitis. Pediatr Ann 2020; 49:e359-e362. [PMID: 32785721 DOI: 10.3928/19382359-20200713-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A previously healthy 6-year-old boy presented with new onset seizure activity and altered mental status. His prehospital course included prolonged fever, vague abdominal complaints, and unusual behavior. Neurological testing was unrevealing, and his symptoms slowly improved without intervention. His primary pediatrician had ordered serum antibody titers to Bartonella henselae for testing of prolonged fever in the setting of exposure to a kitten; these were found to be positive for both immunoglobulin G and immunoglobulin M. Further examination for organ involvement revealed splenic and liver micro-abscesses. After completion of his antibiotic course, the patient returned to his cognitive and neurologic baseline with resolution of his abdominal abscesses. This case emphasizes the importance of obtaining a thorough exposure history when evaluating for infectious causes of encephalitis. [Pediatr Ann. 2020;49(8):e359-e362.].
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3
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Bhaskar S, Bradley S, Israeli-Korn S, Menon B, Chattu VK, Thomas P, Chawla J, Kumar R, Prandi P, Ray D, Golla S, Surya N, Yang H, Martinez S, Ozgen MH, Codrington J, González EMJ, Toosi M, Hariya Mohan N, Menon KV, Chahidi A, Mederer Hengstl S. Chronic Neurology in COVID-19 Era: Clinical Considerations and Recommendations From the REPROGRAM Consortium. Front Neurol 2020; 11:664. [PMID: 32695066 PMCID: PMC7339863 DOI: 10.3389/fneur.2020.00664] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 01/10/2023] Open
Abstract
With the rapid pace and scale of the emerging coronavirus 2019 (COVID-19) pandemic, a growing body of evidence has shown a strong association of COVID-19 with pre- and post- neurological complications. This has necessitated the need to incorporate targeted neurological care for this subgroup of patients which warrants further reorganization of services, healthcare workforce, and ongoing management of chronic neurological cases. The social distancing and the shutdown imposed by several nations in the midst of COVID-19 have severely impacted the ongoing care, access and support of patients with chronic neurological conditions such as Multiple Sclerosis, Epilepsy, Neuromuscular Disorders, Migraine, Dementia, and Parkinson disease. There is a pressing need for governing bodies including national and international professional associations, health ministries and health institutions to harmonize policies, guidelines, and recommendations relating to the management of chronic neurological conditions. These harmonized guidelines should ensure patient continuity across the spectrum of hospital and community care including the well-being, safety, and mental health of the patients, their care partners and the health professionals involved. This article provides an in-depth analysis of the impact of COVID-19 on chronic neurological conditions and specific recommendations to minimize the potential harm to those at high risk.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
- Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research and South West Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Simon Israeli-Korn
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan and Sackler School of Medicine, Movement Disorders Institute, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Bindu Menon
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Apollo Hospitals, Nellore, India
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Pravin Thomas
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, University Hospitals NHS Foundation Trust, Birmingham, United Kingdom
| | - Jasvinder Chawla
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Loyola University Medical Center & Hines VA Hospital, Chicago, IL, United States
| | - Rajeev Kumar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Psychiatry, Hamad Medical Center, Qatar & Australian National University, Canberra, ACT, Australia
| | - Paolo Prandi
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
| | - Sailaja Golla
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Texas Institute for Neurological Disorders, Dallas, TX, United States
| | - Nirmal Surya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Bombay Hospital & Medical Research Centre, and Epilepsy Foundation India, Mumbai, India
| | - Harvey Yang
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Academic Hospital Paramaribo & Anton de Kom Universiteit van Suriname Faculteit der Medische Wetenschappen, Paramaribo, Suriname
| | - Sandra Martinez
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Hospital da Restauração, Recife, Brazil
| | - Mihriban Heval Ozgen
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Psychiatry, Parnassia Psychiatric Institute, The Hague, Netherlands
- Curium-Leiden University Medical Centre, Oegstgeest, Netherlands
| | - John Codrington
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Laboratory Medicine, Academic Hospital Paramaribo and Anton de Kom Universiteit van Suriname Faculteit der Medische Wetenschappen, Paramaribo, Suriname
| | - Eva María Jiménez González
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Forensic Psychology, Forensic Psychology and Forensic Sciences Institute, Ministry of Justice, Granada, Spain
| | - Mandana Toosi
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- LodeStone Center for Behavioral Health and Eastern Illinois University, Chicago, IL, United States
| | - Nithya Hariya Mohan
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Chengalpattu Medical College and Hospital, Chengalpattu, India
| | - Koravangattu Valsraj Menon
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Psychiatry, South London and Maudsley NHS Foundation Trust, Kings Health Partners, London, United Kingdom
| | - Abderrahmane Chahidi
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- ED 268, DR 178, Sorbonne Nouvelle University, Paris, France
- Moroccan Society of Neurophysiology, Marrakech, Morocco
- Morocco and Basic and Clinical Neurosciences Research Laboratory, University Medical School of Marrakech, Marrakech, Morocco
| | - Susana Mederer Hengstl
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
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Abstract
Pitt-Hopkins syndrome (PTHS) is a rare, genetic disorder caused by a molecular variant of TCF4 which is involved in embryologic neuronal differentiation. PTHS is characterized by syndromic facies, psychomotor delay, and intellectual disability. Other associated features include early-onset myopia, seizures, constipation, and hyperventilation-apneic spells. Many also meet criteria for autism spectrum disorder. Here the authors present a series of 23 PTHS patients with molecularly confirmed TCF4 variants and describe 3 unique individuals. The first carries a small deletion but does not exhibit the typical facial features nor the typical pattern of developmental delay. The second exhibits typical facial features, but has attained more advanced motor and verbal skills than other reported cases to date. The third displays typical features of PTHS, however inherited a large chromosomal duplication involving TCF4 from his unaffected father with somatic mosaicism. To the authors' knowledge, this is the first chromosomal duplication case reported to date.
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Affiliation(s)
| | - Cassandra Newsom
- University of Texas Southwestern Medical School
- Children’s Health Dallas
| | | | | | - Patricia Evans
- University of Texas Southwestern Medical School
- Children’s Health Dallas
| | - Sailaja Golla
- University of Texas Southwestern Medical School
- Children’s Health Dallas
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5
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Gambin T, Yuan B, Bi W, Liu P, Rosenfeld JA, Coban-Akdemir Z, Pursley AN, Nagamani SCS, Marom R, Golla S, Dengle L, Petrie HG, Matalon R, Emrick L, Proud MB, Treadwell-Deering D, Chao HT, Koillinen H, Brown C, Urraca N, Mostafavi R, Bernes S, Roeder ER, Nugent KM, Bader PI, Bellus G, Cummings M, Northrup H, Ashfaq M, Westman R, Wildin R, Beck AE, Immken L, Elton L, Varghese S, Buchanan E, Faivre L, Lefebvre M, Schaaf CP, Walkiewicz M, Yang Y, Kang SHL, Lalani SR, Bacino CA, Beaudet AL, Breman AM, Smith JL, Cheung SW, Lupski JR, Patel A, Shaw CA, Stankiewicz P. Identification of novel candidate disease genes from de novo exonic copy number variants. Genome Med 2017; 9:83. [PMID: 28934986 PMCID: PMC5607840 DOI: 10.1186/s13073-017-0472-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/01/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Exon-targeted microarrays can detect small (<1000 bp) intragenic copy number variants (CNVs), including those that affect only a single exon. This genome-wide high-sensitivity approach increases the molecular diagnosis for conditions with known disease-associated genes, enables better genotype-phenotype correlations, and facilitates variant allele detection allowing novel disease gene discovery. METHODS We retrospectively analyzed data from 63,127 patients referred for clinical chromosomal microarray analysis (CMA) at Baylor Genetics laboratories, including 46,755 individuals tested using exon-targeted arrays, from 2007 to 2017. Small CNVs harboring a single gene or two to five non-disease-associated genes were identified; the genes involved were evaluated for a potential disease association. RESULTS In this clinical population, among rare CNVs involving any single gene reported in 7200 patients (11%), we identified 145 de novo autosomal CNVs (117 losses and 28 intragenic gains), 257 X-linked deletion CNVs in males, and 1049 inherited autosomal CNVs (878 losses and 171 intragenic gains); 111 known disease genes were potentially disrupted by de novo autosomal or X-linked (in males) single-gene CNVs. Ninety-one genes, either recently proposed as candidate disease genes or not yet associated with diseases, were disrupted by 147 single-gene CNVs, including 37 de novo deletions and ten de novo intragenic duplications on autosomes and 100 X-linked CNVs in males. Clinical features in individuals with de novo or X-linked CNVs encompassing at most five genes (224 bp to 1.6 Mb in size) were compared to those in individuals with larger-sized deletions (up to 5 Mb in size) in the internal CMA database or loss-of-function single nucleotide variants (SNVs) detected by clinical or research whole-exome sequencing (WES). This enabled the identification of recently published genes (BPTF, NONO, PSMD12, TANGO2, and TRIP12), novel candidate disease genes (ARGLU1 and STK3), and further confirmation of disease association for two recently proposed disease genes (MEIS2 and PTCHD1). Notably, exon-targeted CMA detected several pathogenic single-exon CNVs missed by clinical WES analyses. CONCLUSIONS Together, these data document the efficacy of exon-targeted CMA for detection of genic and exonic CNVs, complementing and extending WES in clinical diagnostics, and the potential for discovery of novel disease genes by genome-wide assay.
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Affiliation(s)
- Tomasz Gambin
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Institute of Computer Science, Warsaw University of Technology, Warsaw, 00-665, Poland.,Department of Medical Genetics, Institute of Mother and Child, Warsaw, 01-211, Poland
| | - Bo Yuan
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Weimin Bi
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Pengfei Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA
| | - Zeynep Coban-Akdemir
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA
| | - Amber N Pursley
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA
| | - Sandesh C S Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA
| | - Ronit Marom
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA
| | - Sailaja Golla
- Division of Pediatric Neurology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Lauren Dengle
- Division of Pediatric Neurology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | | | - Reuben Matalon
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, 77555, USA.,Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Lisa Emrick
- Department of Pediatric, Section of Child Neurology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Monica B Proud
- Department of Pediatric, Section of Child Neurology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Diane Treadwell-Deering
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry Division, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Hsiao-Tuan Chao
- Department of Pediatric, Section of Child Neurology, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Hannele Koillinen
- Department of Clinical Genetics, Helsinki University Hospital, Helsinki, 00029, Finland
| | - Chester Brown
- Genetics Division, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, 38105, USA.,Le Bonheur Children's Hospital, Memphis, TN, 38103, USA
| | - Nora Urraca
- Le Bonheur Children's Hospital, Memphis, TN, 38103, USA
| | | | | | - Elizabeth R Roeder
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, 78207, USA
| | - Kimberly M Nugent
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, 78207, USA
| | - Patricia I Bader
- Northeast Indiana Genetic Counseling Center, Wayne, IN, 46804, USA
| | - Gary Bellus
- Section of Clinical Genetics & Metabolism, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Michael Cummings
- Department of Psychiatry Erie County Medical Center, Buffalo, NY, 14215, USA
| | - Hope Northrup
- Division of Medical Genetics, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Myla Ashfaq
- Division of Medical Genetics, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | | | - Robert Wildin
- St. Luke's Children's Hospital, Boise, ID, 83702, USA.,The National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Anita E Beck
- Seattle Children's Hospital, Seattle, WA, 98105, USA.,Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA, 98195, USA
| | | | - Lindsay Elton
- Child Neurology Consultants of Austin, Austin, TX, 78731, USA
| | - Shaun Varghese
- THINK Neurology for Kids/Children's Memorial Hermann Hospital, The Woodlands, TX, 77380, USA
| | - Edward Buchanan
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Laurence Faivre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, Dijon, France
| | - Mathilde Lefebvre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Est, FHU-TRANSLAD, CHU Dijon, Dijon, France
| | - Christian P Schaaf
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Magdalena Walkiewicz
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Yaping Yang
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Sung-Hae L Kang
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Carlos A Bacino
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Arthur L Beaudet
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Amy M Breman
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Janice L Smith
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Sau Wai Cheung
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA.,Texas Children's Hospital, Houston, TX, 77030, USA
| | - Ankita Patel
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Chad A Shaw
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA.,Baylor Genetics, Houston, TX, 77021, USA
| | - Paweł Stankiewicz
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030-3411, USA. .,Baylor Genetics, Houston, TX, 77021, USA.
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6
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Golla S, Ren J, Malloy CR, Pascual JM. Intramyocellular lipid excess in the mitochondrial disorder MELAS: MRS determination at 7T. Neurol Genet 2017; 3:e160. [PMID: 28589178 PMCID: PMC5444911 DOI: 10.1212/nxg.0000000000000160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/07/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE There is a paucity of objective, quantifiable indicators of mitochondrial disease available for clinical and scientific investigation. METHODS To this end, we explore intramyocellular lipid (IMCL) accumulation noninvasively by 7T magnetic resonance spectroscopy (MRS) as a reporter of metabolic dysfunction in MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes). We reasoned that mitochondrial dysfunction may impair muscle fat metabolism, resulting in lipid deposition (as is sometimes observed in biopsies), and that MRS is well suited to quantify these lipids. RESULTS In 10 MELAS participants and relatives, IMCL abundance correlates with percent mitochondrial DNA mutation abundance and with disease severity. CONCLUSIONS These results indicate that IMCL accumulation is a novel potential disease hallmark in MELAS.
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Affiliation(s)
- Sailaja Golla
- Rare Brain Disorders Program (S.G., J.M.P.), Department of Neurology and Neurotherapeutics, Department of Pediatrics (S.G., J.M.P.), Advanced Imaging Research Center (J.R., C.R.M.), Department of Radiology (J.R., C.R.M.), Department of Internal Medicine (C.R.M.), Department of Physiology (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.M.P.), The University of Texas Southwestern Medical Center, Dallas
| | - Jimin Ren
- Rare Brain Disorders Program (S.G., J.M.P.), Department of Neurology and Neurotherapeutics, Department of Pediatrics (S.G., J.M.P.), Advanced Imaging Research Center (J.R., C.R.M.), Department of Radiology (J.R., C.R.M.), Department of Internal Medicine (C.R.M.), Department of Physiology (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.M.P.), The University of Texas Southwestern Medical Center, Dallas
| | - Craig R Malloy
- Rare Brain Disorders Program (S.G., J.M.P.), Department of Neurology and Neurotherapeutics, Department of Pediatrics (S.G., J.M.P.), Advanced Imaging Research Center (J.R., C.R.M.), Department of Radiology (J.R., C.R.M.), Department of Internal Medicine (C.R.M.), Department of Physiology (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.M.P.), The University of Texas Southwestern Medical Center, Dallas
| | - Juan M Pascual
- Rare Brain Disorders Program (S.G., J.M.P.), Department of Neurology and Neurotherapeutics, Department of Pediatrics (S.G., J.M.P.), Advanced Imaging Research Center (J.R., C.R.M.), Department of Radiology (J.R., C.R.M.), Department of Internal Medicine (C.R.M.), Department of Physiology (J.M.P.), and Eugene McDermott Center for Human Growth & Development/Center for Human Genetics (J.M.P.), The University of Texas Southwestern Medical Center, Dallas
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Anandh U, Golla S, Balasubramaniam A. Mixed acid-base disorder secondary to topiramate use in traumatic brain injury. Indian J Nephrol 2016; 26:452-454. [PMID: 27942179 PMCID: PMC5131386 DOI: 10.4103/0971-4065.177136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dharmadhikari AV, Gambin T, Szafranski P, Cao W, Probst FJ, Jin W, Fang P, Gogolewski K, Gambin A, George-Abraham JK, Golla S, Boidein F, Duban-Bedu B, Delobel B, Andrieux J, Becker K, Holinski-Feder E, Cheung SW, Stankiewicz P. Molecular and clinical analyses of 16q24.1 duplications involving FOXF1 identify an evolutionarily unstable large minisatellite. BMC Med Genet 2014; 15:128. [PMID: 25472632 PMCID: PMC4411736 DOI: 10.1186/s12881-014-0128-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 11/18/2014] [Indexed: 11/10/2022]
Abstract
Background Point mutations or genomic deletions of FOXF1 result in a lethal developmental lung disease Alveolar Capillary Dysplasia with Misalignment of Pulmonary Veins. However, the clinical consequences of the constitutively increased dosage of FOXF1 are unknown. Methods Copy-number variations and their parental origin were identified using a combination of array CGH, long-range PCR, DNA sequencing, and microsatellite analyses. Minisatellite sequences across different species were compared using a gready clustering algorithm and genome-wide analysis of the distribution of minisatellite sequences was performed using R statistical software. Results We report four unrelated families with 16q24.1 duplications encompassing entire FOXF1. In a 4-year-old boy with speech delay and a café-au-lait macule, we identified an ~15 kb 16q24.1 duplication inherited from the reportedly healthy father, in addition to a de novo ~1.09 Mb mosaic 17q11.2 NF1 deletion. In a 13-year-old patient with autism and mood disorder, we found an ~0.3 Mb duplication harboring FOXF1 and an ~0.5 Mb 16q23.3 duplication, both inherited from the father with bipolar disorder. In a 47-year old patient with pyloric stenosis, mesenterium commune, and aplasia of the appendix, we identified an ~0.4 Mb duplication in 16q24.1 encompassing 16 genes including FOXF1. The patient transmitted the duplication to her daughter, who presented with similar symptoms. In a fourth patient with speech and motor delay, and borderline intellectual disability, we identified an ~1.7 Mb FOXF1 duplication adjacent to a large minisatellite. This duplication has a complex structure and arose de novo on the maternal chromosome, likely as a result of a DNA replication error initiated by the adjacent large tandem repeat. Using bioinformatic and array CGH analyses of the minisatellite, we found a large variation of its size in several different species and individuals, demonstrating both its evolutionarily instability and population polymorphism. Conclusions Our data indicate that constitutional duplication of FOXF1 in humans is not associated with any pediatric lung abnormalities. We propose that patients with gut malrotation, pyloric or duodenal stenosis, and gall bladder agenesis should be tested for FOXF1 alterations. We suggest that instability of minisatellites greater than 1 kb can lead to structural variation due to DNA replication errors. Electronic supplementary material The online version of this article (doi:10.1186/s12881-014-0128-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Avinash V Dharmadhikari
- Interdepartmental Program in Translational Biology & Molecular Medicine, Baylor College of Medicine, Houston, TX, USA. .,Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Tomasz Gambin
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Przemyslaw Szafranski
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Wenjian Cao
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Frank J Probst
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Weihong Jin
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Ping Fang
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | | | - Anna Gambin
- Institute of Informatics, University of Warsaw, Warsaw, Poland. .,Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
| | | | - Sailaja Golla
- Departments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Francoise Boidein
- Neuropediatrics Service, Saint Vincent de Paul Catholic Hospitals Association of Lille, Free Faculty of Medicine, Lille, France.
| | - Benedicte Duban-Bedu
- Cytogenetics Service, Saint Vincent de Paul Catholic Hospitals Association of Lille, Free Faculty of Medicine, Lille, France.
| | - Bruno Delobel
- Cytogenetics Service, Saint Vincent de Paul Catholic Hospitals Association of Lille, Free Faculty of Medicine, Lille, France.
| | - Joris Andrieux
- Laboratory of Medical Genetics, University Hospital, Lille, France.
| | | | | | - Sau Wai Cheung
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Pawel Stankiewicz
- Interdepartmental Program in Translational Biology & Molecular Medicine, Baylor College of Medicine, Houston, TX, USA. .,Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
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Szafranski P, Golla S, Jin W, Fang P, Hixson P, Matalon R, Kinney D, Bock HG, Craigen W, Smith JL, Bi W, Patel A, Wai Cheung S, Bacino CA, Stankiewicz P. Neurodevelopmental and neurobehavioral characteristics in males and females with CDKL5 duplications. Eur J Hum Genet 2014; 23:915-21. [PMID: 25315662 DOI: 10.1038/ejhg.2014.217] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/21/2014] [Accepted: 09/05/2014] [Indexed: 12/21/2022] Open
Abstract
Point mutations and genomic deletions of the CDKL5 (STK9) gene on chromosome Xp22 have been reported in patients with severe neurodevelopmental abnormalities, including Rett-like disorders. To date, only larger-sized (8-21 Mb) duplications harboring CDKL5 have been described. We report seven females and four males from seven unrelated families with CDKL5 duplications 540-935 kb in size. Three families of different ethnicities had identical 667kb duplications containing only the shorter CDKL5 isoform. Four affected boys, 8-14 years of age, and three affected girls, 6-8 years of age, manifested autistic behavior, developmental delay, language impairment, and hyperactivity. Of note, two boys and one girl had macrocephaly. Two carrier mothers of the affected boys reported a history of problems with learning and mathematics while at school. None of the patients had epilepsy. Similarly to CDKL5 mutations and deletions, the X-inactivation pattern in all six studied females was random. We hypothesize that the increased dosage of CDKL5 might have affected interactions of this kinase with its substrates, leading to perturbation of synaptic plasticity and learning, and resulting in autistic behavior, developmental and speech delay, hyperactivity, and macrocephaly.
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Affiliation(s)
- Przemyslaw Szafranski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Sailaja Golla
- Departments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Weihong Jin
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Ping Fang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Patricia Hixson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Reuben Matalon
- Division of General Academic Pediatrics, Department of Pediatrics, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Daniel Kinney
- Memorial Children's Hospital Navarre Pediatrics South Bend, South Bend, IN, USA
| | - Hans-Georg Bock
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - William Craigen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Janice L Smith
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Weimin Bi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Ankita Patel
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Sau Wai Cheung
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Carlos A Bacino
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Paweł Stankiewicz
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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Abstract
Some children with autism spectrum disorders (ASD; 15% to 30% of patients) show a significant and persistent regression in speech and social function during early childhood. There are no established treatments for the regressive symptoms. However, there are some known causes of this type of regression, such as Rett syndrome and Landau-Kleffner syndrome (LKS). In LKS, steroids have been used as a treatment. Some evidence suggests an autoimmune contribution to the pathophysiology of autism (Chez MG, Guido-Estrada N: Immune therapy in autism: historical experience and future directions with immunomodulatory therapy. Neurotherapeutics 2010, 7:293-301, Wasilewska J, Kaczmarski M, Stasiak-Barmuta A, Tobolczyk J, Kowalewska E: Low serum IgA and increased expression of CD23 on B lymphocytes in peripheral blood in children with regressive autism aged 3-6 years old. Arch Med Sci 2012, 8:324-331, Stefanatos G: Changing perspectives on Landau-Kleffner syndrome. Clin Neuropsychol 2011, 25:963-988), raising the possibility that steroids might be a useful therapy for regression in ASD. A retrospective study published in BMC Neurology by Duffy et al. (Duffy, et al: Corticosteroid therapy in regressive autism: A retrospective study of effects on the Frequency Modulated Auditory Evoked Response (FMAER), language, and behavior. BMC Neurol 2014, 14:70) reviewed 20 steroid treated R-ASD (STAR) patients and 24 ASD control patients not treated with steroids (NSA). Improvements in clinical function and in a neurophysiological biomarker were seen in the steroid-treated children pre- to post-prednisolone treatment. This research provides a rationale for a randomized trial with steroid therapy to determine the longer term benefits and complications of steroids in this population.
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Affiliation(s)
- Sailaja Golla
- Division of Pediatric Neurology, Neurodevelopmental Pediatrics, UT Southwestern and Children's Medical Center at Dallas, Dallas, USA.
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Golla S, Agadi S, Burns DK, Marks W, Dev Batish S, del Gaudio D, Iannaccone ST. Dystrophinopathy in girls with limb girdle muscular dystrophy phenotype. J Clin Neuromuscul Dis 2010; 11:203-208. [PMID: 20516809 DOI: 10.1097/cnd.0b013e3181c7f18f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Limb girdle muscular dystrophy (LGMD) is a diverse group of myopathic disorders characterized by proximal muscle weakness and hyperCKemia. Mutations encoding sarcoglycans and numerous other proteins have been shown to be responsible for most cases. We report a series of girls with a negative family history for boys with Duchenne muscular dystrophy, demonstrating an LGMD phenotype associated with dystrophinopathy. METHODS A retrospective chart review of all girls presenting with the LGMD phenotype to our clinic between January 2001 and September 2007 was conducted. Patients 18 years old or younger with dystrophinopathy proven by muscle biopsy and/or gene mutations and a negative family history for affected boys were included in the review. RESULTS Five patients, 4 to 10 years of age at presentation, were included in the series. Four had an LGMD phenotype at presentation. All five patients had hyperCKemia, all five patients had gene mutations, and four patients had muscle biopsy consistent with dystrophinopathy. CONCLUSION Dystrophinopathy is an important cause of LGMD phenotype in girls and should be considered in the differential diagnosis.
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Affiliation(s)
- Sailaja Golla
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA.
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Schulze H, Golla S, Nagel-Reuper C, Nauck MA. Evaluierung eines modularen Schulungskonzeptes für schulungserfahrene Patienten mit insulinbehandeltem Typ 2 Diabetes. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wit J, Flegel A, Golla S, Mau H. Chirurgische Behandlung großer Milzzysten im Kindesalter. Visc Med 2004. [DOI: 10.1159/000049612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
We report on a 15-month-old boy presenting a juvenile active ossifying fibroma in the right nasal cavity and the sibling, a 9-month-old girl with a mesenchymal hamartoma of the chest wall. The two lesions showed many similarities. Both lesions are present at the time of birth or in early life with local obstructive or compressive effects. The lesions have a similar mixture of mature and immature mesenchymal tissue with areas of ossification. The entities present a tumor-like development with an abnormal mixture of tissue indigenous to the specific area of the body without notable atypical cytologic features. These features are typical criteria for hamartoma lesions.
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Affiliation(s)
- M Guschmann
- Abteilung Paidopathologie und Placentologie, Institut für Pathologie, Charité, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität, Berlin.
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Abstract
Mesenchymal hamartomas of the thorax are known as rare dysontogenetic tumorous non-neoplastic lesions. The juvenile active ossifying fibroma (JAOF) also is considered as a benign tumor like lesion of the mesenchymal connective tissue. The authors report the cases of 2 siblings-a 2-year-old girl with a hamartoma of the chest wall and her 4-year-old brother with a JAOF. The girl had bilocular mesenchymal hamartoma in the area of the 8(th) rib diagnosed in the first year of life, which was surgically removed completely. Her brother had been treated for JAOF of the right nasal sinus area diagnosed at the age of 15 months. Both lesions are extremely rare mutations of the local tissue, which occur typically in early childhood and continue benignly after surgical resection, but such a familial occurrence in siblings has not yet been reported. Furthermore, according to the histologic findings, the JAOF also could be seen as a hamartomatous lesion.
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Affiliation(s)
- S Golla
- Departments of Pediatric Surgery, Charité Medical Center, Virchow Hospital, Humboldt University, Berlin, Germany
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Abstract
BACKGROUND/PURPOSE Patients with spina bifida represent the highest risk group for hypersensitivity to latex. Recognized risk factors for these patients are repeated surgery and an atopic disposition. Little is known about children operated on in the first year of life for reasons other than spina bifida. METHODS Eighty-six patients (mean age, 10.2 years) with gastrointestinal or urologic surgery were investigated for the number, type, and date of surgical interventions. Additionally, skin prick tests and provocation tests were performed to classify sensitized and symptomatic latex-allergic individuals. RESULTS Twenty-seven patients were regarded as sensitized to latex (31.4%). Twenty patients were classified as being atopic (25.6%). Atopic patients were significantly more often sensitized and provocation positive compared with nonsensitized and provocation-negative ones (P <.01). Children already operated on in the first year of life (n = 44) with a positive provocation showed significantly higher latex-specific IgE-values than individuals with a negative outcome (P <.0001). The total number of operations and degree of sensitization showed a significant correlation; more than 8 surgical interventions during the first year of life significantly increased the risk of clinically relevant allergy to latex. CONCLUSION This study emphasizes that individuals undergoing surgical interventions during infancy should be handled latex free from the very beginning of life.
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Affiliation(s)
- P Degenhardt
- Department of Pediatric Surgery, Children's Hospital Charité of Humboldt University, Berlin, Germany
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Abstract
OBJECTIVE To develop a new method of magnetic resonance arthrography (MRA) of the knee using an anterior approach analogous to the portals used for knee arthroscopy. DESIGN An anterior approach to the knee joint was devised mimicking anterior portals used for knee arthroscopy. Seven patients scheduled for routine knee MRA were placed in a decubitus position and under fluoroscopic guidance a needle was advanced from a position adjacent to the patellar tendon into the knee joint. After confirmation of the needle tip location, a dilute gadolinium solution was injected. RESULTS AND CONCLUSION All the arthrograms were technically successful. The anterior approach to knee MRA has greater technical ease than the traditional approach with little patient discomfort.
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Affiliation(s)
- J V Zurlo
- Department of Radiology, Pittsburgh, PA 15213, USA
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