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Picard JY, Morin G, Devouassoux-Shisheboran M, Van der Smagt J, Klosowski S, Pienkowski C, Pierre-Renoult P, Masson C, Bole C, Josso N. Persistent Müllerian duct syndrome associated with genetic defects in the regulatory subunit of myosin phosphatase. Hum Reprod 2022; 37:2952-2959. [PMID: 36331510 DOI: 10.1093/humrep/deac239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
STUDY QUESTION Can mutations of genes other than AMH or AMHR2, namely PPP1R12A coding myosin phosphatase, lead to persistent Müllerian duct syndrome (PMDS)? SUMMARY ANSWER The detection of PPP1R12A truncation mutations in five cases of PMDS suggests that myosin phosphatase is involved in Müllerian regression, independently of the anti-Müllerian hormone (AMH) signaling cascade. WHAT IS KNOWN ALREADY Mutations of AMH and AMHR2 are detectable in an overwhelming majority of PMDS patients but in 10% of cases, both genes are apparently normal, suggesting that other genes may be involved. STUDY DESIGN, SIZE, DURATION DNA samples from 39 PMDS patients collected from 1990 to present, in which Sanger sequencing had failed to detect biallelic AMH or AMHR2 mutations, were screened by massive parallel sequencing. PARTICIPANTS/MATERIALS, SETTING, METHODS To rule out the possibility that AMH or AMHR2 mutations could have been missed, all DNA samples of good quality were analyzed by targeted next-generation sequencing. Twenty-four samples in which the absence of AMH or AMHR2 biallelic mutations was confirmed were subjected to whole-exome sequencing with the aim of detecting variants of other genes potentially involved in PMDS. MAIN RESULTS AND THE ROLE OF CHANCE Five patients out of 24 (21%) harbored deleterious truncation mutations of PP1R12A, the gene coding for the regulatory subunit of myosin phosphatase, were detected. In addition to PMDS, three of these patients presented with ileal and one with esophageal atresia. The congenital abnormalities associated with PMDS in our patients are consistent with those described in the literature for PPP1R12A variants and have never been described in cases of AMH or AMHR2 mutations. The role of chance is therefore extremely unlikely. LIMITATIONS, REASONS FOR CAUTION The main limitation of the study is the lack of experimental validation of the role of PPP1R12A in Müllerian regression. Only circumstantial evidence is available, myosin phosphatase is required for cell mobility, which plays a major role in Müllerian regression. Alternatively, PPP1R12A mutations could affect the AMH transduction pathway. WIDER IMPLICATIONS OF THE FINDINGS The study supports the conclusion that failure of Müllerian regression in males is not necessarily associated with a defect in AMH signaling. Extending the scope of molecular analysis should shed light upon the mechanism of the initial steps of male sex differentiation. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by la Fondation Maladies Rares, GenOmics 2021_0404 and la Fondation pour la Recherche Médicale, grant EQU201903007868. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Jean-Yves Picard
- Sorbonne Université, INSERM, Centre de Recherches Saint-Antoine, Lipodystrophies, Adaptations Métaboliques et Hormonales et Vieillissement, UMR_S 938, Paris, France
| | - Gilles Morin
- Department of Medical Genetics, Centre Hospitalo-Universitaire d'Amiens, Amiens, France
| | | | | | - Serge Klosowski
- Service de Néonatologie, Centre Universitaire de Lens, Lens, France
| | | | | | - Cécile Masson
- Bioinformatics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UAR3633, Paris Descartes University, Sorbonne Paris Cite University, Paris, France
| | - Christine Bole
- Genomics Core Facility, Institut Imagine, Structure Fédérative de Recherche Necker, INSERM 1163, INSERM US24/CNRS UAR3633, Paris Descartes University, Sorbonne Paris Cité University, Paris, France
| | - Nathalie Josso
- Sorbonne Université, INSERM, Centre de Recherches Saint-Antoine, Lipodystrophies, Adaptations Métaboliques et Hormonales et Vieillissement, UMR_S 938, Paris, France
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AlBassam BN, Al-Shammari AA, AlQahtani SA, Hassan E. Case Report: Jejuno ileal Atresia With Persistent Poor Bowel Function Can Occur After Surgical Correction for Hirschsprung Disease. Front Pediatr 2022; 10:907179. [PMID: 35669397 PMCID: PMC9165582 DOI: 10.3389/fped.2022.907179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Jejunoileal atresia (JIA) is one of the common etiologies of intestinal obtrusion in neonates. However, cases of concomitant ileal atresia and Hirschsprung disease (HD) rarely occur. We report the case of a male infant who had JIA concomitantly with HD that was re-anastomosed. The patient underwent an exploratory laparotomy to resect the dilated terminal ileum. Subsequently, owing to a significantly dilated proximal bowel, he underwent a second exploratory laparotomy. However, he continued to have feeding intolerance postoperatively. He had colonic aganglionosis and was diagnosed with HD. A third laparotomy was then performed. Additionally, he had recurrent episodes of gram-negative bacteremia, especially candida parapsilosis fungemia, despite receiving antibiotics and antifungal, and there were no identifiable underlying genetic or immunological causes. Finally, the patient had recurrent episodes of hypoglycemia, central hypothyroidism, and multiple organ failure and died at the age of 7 months. The concomitant ileal atresia and HD was thought to be due to a common intrauterine vascular accident, together with loss of bowel, thereby acting as a barrier for the caudal migration of neuromeric cells and leading to colonic aganglionosis. In this case, ileal atresia was associated with colonic aganglionosis, central hypothyroidism, and persistent bacteremia, which is a unique finding. In cases of JIA, persistent poor bowel function after surgical correction of concomitant HD should be considered.
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Affiliation(s)
- Bassam N AlBassam
- Department of Pediatrics, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.,Department of Paediatrics, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Ahmad A Al-Shammari
- Department of Pediatrics, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.,Department of Paediatrics, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Saleh A AlQahtani
- Department of Pediatrics, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.,Department of Paediatrics, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Elham Hassan
- Department of Paediatrics, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
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Anık A, Akcan AB, Çulcuoğlu İ, Erdem AO, Özkısacık SK, Türkmen MK. Ileal atresia and severe cerebral injury after fetoscopic laser photocoagulation treatment for twin-to-twin transfusion syndrome. Turk J Pediatr 2021; 63:927-931. [PMID: 34738377 DOI: 10.24953/turkjped.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Twin-to-twin transfusion syndrome (TTTS) is a significant cause of perinatal morbidity and mortality. Fetoscopic laser photocoagulation (FLP) is the optimal treatment option for twin-to-twin transfusion syndrome; but can cause central nervous system, extremity and intestinal system injury. CASE We report the case report of ileal atresia and severe cerebral infarction co-occurrence after fetoscopic laser photocoagulation treatment. It is uncertain as to whether ileal atresia occurred due to ischemia associated with TTTS, the treatment with FLP, or a combination of both. CONCLUSIONS Cases with prenatal ultrasonographic abnormalities after FLP should have a close assessment to detect bowel complications. Despite many developments in its management, TTTS remains an important risk factor for cerebral injury.
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Affiliation(s)
- Ayşe Anık
- Departments of Neonatology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Abdullah Barış Akcan
- Departments of Neonatology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - İrem Çulcuoğlu
- Departments of Pediatrics,Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ali Onur Erdem
- Departments of Pediatric Surgery, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Sezen Karaca Özkısacık
- Departments of Pediatric Surgery, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Münevver Kaynak Türkmen
- Departments of Neonatology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
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Chen D, Tam KH, Xiao Y, Geng J, Tan Y, Zhu X, Ge W, Zhou J, Xiao S, Chen J. New sonographic feature (C-sign) to improve the prenatal accuracy of jejunal atresia. J Obstet Gynaecol Res 2021; 47:4196-4202. [PMID: 34545663 PMCID: PMC9292541 DOI: 10.1111/jog.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/24/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe a new sonographic feature of the C-sign for prenatal diagnosis of jejunal atresia and evaluate its role in prenatal jejunal atresia, particularly preceding bowel dilatation and polyhydramnios. METHODS This was a retrospective study from a tertiary maternal hospital. Patients with prenatal sonographic examination and confirmed small bowel atresia postdelivery were included. All sonographic images were reviewed by two senior sonographers. Comparison of sonographic images between prenatal jejunal and ileal atresia using the C-sign resembles the shape of the entire duodenum and other traditional sonographic features. The control group without bowel atresia was assessed for the presence of the C-sign. RESULTS The C-sign and combined bowel dilatation with polyhydramnios were more frequent in jejunal atresia than ileal atresia, but the C-sign can be used to detect jejunal atresia earlier. The C-sign can be more likely to diagnose jejunal atresia in persisting bowel dilatation and polyhydramnios. The C-sign was not reported in any of the control fetuses. CONCLUSION The C-sign is a new sonographic feature that can be used to improve the prenatal accuracy and early detection of jejunal atresia. However, further prospective validation is needed.
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Affiliation(s)
- Dan Chen
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Kwong Ho Tam
- Ocean Gardens Health Centre, Health Bureau, Macau SAR, China
| | - Yiwei Xiao
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Juan Geng
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yu Tan
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiaochun Zhu
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Wuping Ge
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jialiang Zhou
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shangjie Xiao
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jiaxin Chen
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
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Yokoyama S, Nakaoka T, Nukada T, Ikeda Y, Hara S. Meconium-related ileus mimicking ileal atresia in a full-term neonate. Pediatr Int 2021; 63:229-231. [PMID: 33529482 DOI: 10.1111/ped.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/27/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Satoshi Yokoyama
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Tatsuo Nakaoka
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Takayuki Nukada
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Yuka Ikeda
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Shigeto Hara
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
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Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: A Critically Appraised Topic. Acad Radiol 2016; 23:559-68. [PMID: 26857524 DOI: 10.1016/j.acra.2015.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/09/2015] [Accepted: 12/27/2015] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of upper and lower gastrointestinal (GI) tract obstruction in neonates and infants. METHODS A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome method comparing radiography, upper GI contrast study, and ultrasound in the detection of upper GI tract obstruction such as duodenal atresia and stenosis, jejunal and ileal atresia, and malrotation and volvulus. The same methods were used to compare radiography and contrast enema in the detection of lower GI tract obstruction such as meconium plug syndrome, meconium ileus, Hirschsprung disease, and imperforate anus. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies. RESULTS There were no sensitivities/specificities available for the imaging diagnosis of duodenal atresia or stenosis, jejunal or ileal atresias, meconium plug, and meconium ileus or for the use of cross-table lateral radiography for the diagnosis of rectal pouch distance from skin in imperforate anus. The retrieved sensitivity for the detection of malrotation on upper GI contrast study is 96%, and the sensitivity for the diagnosis of midgut volvulus on upper GI contrast study is 79%. The retrieved sensitivity and specificity for the detection of malrotation with volvulus on ultrasound were 89% and 92%, respectively. The retrieved sensitivity and specificity for the detection of Hirschsprung disease on contrast enema were 70% and 83%, respectively. The retrieved sensitivity of invertogram for the diagnosis of rectal pouch distance from skin in imperforate anus is 27%. The retrieved sensitivities of perineal ultrasound and colostography for the diagnosis of rectal pouch distance from skin in imperforate anus were 86% and 100%, respectively. CONCLUSIONS There is limited evidence for the imaging diagnosis of duodenal atresia and stenosis, jejunal and ileal atresias, meconium plug, meconium ileus, and imperforate anus, with recommended practice based mainly on low-quality evidence or expert opinion. The available evidence supports the use of upper GI contrast study for the diagnosis of malrotation and volvulus, with ultrasound as an adjunct to diagnosis. Contrast enema is useful in the investigation of suspected Hirschsprung disease, but a negative study does not outrule the condition. Colostography is the investigation of choice for the work-up of infants with complex anorectal malformations before definitive surgical repair.
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Affiliation(s)
- A G Carroll
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - R G Kavanagh
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - C Ni Leidhin
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - N M Cullinan
- Department of Pediatrics, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - L P Lavelle
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - D E Malone
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
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Virgone C, D'antonio F, Khalil A, Jonh R, Manzoli L, Giuliani S. Accuracy of prenatal ultrasound in detecting jejunal and ileal atresia: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2015; 45:523-529. [PMID: 25157626 DOI: 10.1002/uog.14651] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/02/2014] [Accepted: 08/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The accuracy of prenatal ultrasound examination in detecting jejunal and ileal atresia has been reported in the literature to be highly variable, at 25-90%. The aim of this systematic review was to evaluate the accuracy of prenatal ultrasound in detecting non-duodenal small bowel atresia (ND-SBA). METHODS MEDLINE, EMBASE and The Cochrane Library, including The Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE) and The Cochrane Central Register of Controlled Trials (CENTRAL), were searched electronically. The overall detection rate of jejunal or ileal atresia using ultrasound was reported. The accuracy of using polyhydramnios and dilated loops of bowel as diagnostic signs was also explored. RESULTS Sixteen studies involving 640 fetuses were included in this review. The detection rate of ND-SBA by prenatal ultrasound was highly variable, with values ranging from 10 to 100%, with an overall prediction of 50.6% (95% CI, 38.0-63.2%). When analyzed separately, the detection rates of jejunal and ileal atresia were 66.3%, (95% CI, 33.9-91.8%) and 25.9% (95% CI, 4.0-58.0%), respectively. Both dilated loops of bowel and polyhydramnios as diagnostic signs for ND-SBA provided a low overall detection rate. CONCLUSIONS The diagnostic performance of prenatal ultrasound in identifying ND-SBA is extremely variable. Large studies are needed in order to identify objective and combined criteria for the diagnosis of these anomalies.
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Affiliation(s)
- C Virgone
- Department of Paediatric and Neonatal Surgery, St. George's Healthcare NHS Trust and University of London, London, UK
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Sinha S, Sarin Y, Ramji S. Ileal atresia with duplication cyst of terminal ileum: a rare association. J Neonatal Surg 2012; 1:27. [PMID: 26023386 PMCID: PMC4420390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 02/11/2012] [Indexed: 11/11/2022] Open
Abstract
A case of ileal atresia in association with duplication of terminal ileum is being reported here.
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