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Saadi A, Navarro C, Ozalp O, Lourenco CM, Fayek R, Da Silva N, Chaouch A, Benahmed M, Kubisch C, Munnich A, Lévy N, Roll P, Pacha LA, Chaouch M, Lessel D, De Sandre-Giovannoli A. A recurrent homozygous LMNA missense variant p.Thr528Met causes atypical progeroid syndrome characterized by mandibuloacral dysostosis, severe muscular dystrophy, and skeletal deformities. Am J Med Genet A 2023; 191:2274-2289. [PMID: 37387251 DOI: 10.1002/ajmg.a.63335] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
Atypical progeroid syndromes (APS) are premature aging syndromes caused by pathogenic LMNA missense variants, associated with unaltered expression levels of lamins A and C, without accumulation of wild-type or deleted prelamin A isoforms, as observed in Hutchinson-Gilford progeria syndrome (HGPS) or HGPS-like syndromes. A specific LMNA missense variant, (p.Thr528Met), was previously identified in a compound heterozygous state in patients affected by APS and severe familial partial lipodystrophy, whereas heterozygosity was recently identified in patients affected by Type 2 familial partial lipodystrophy. Here, we report four unrelated boys harboring homozygosity for the p.Thr528Met, variant who presented with strikingly homogeneous APS clinical features, including osteolysis of mandibles, distal clavicles and phalanges, congenital muscular dystrophy with elevated creatine kinase levels, and major skeletal deformities. Immunofluorescence analyses of patient-derived primary fibroblasts showed a high percentage of dysmorphic nuclei with nuclear blebs and typical honeycomb patterns devoid of lamin B1. Interestingly, in some protrusions emerin or LAP2α formed aberrant aggregates, suggesting pathophysiology-associated clues. These four cases further confirm that a specific LMNA variant can lead to the development of strikingly homogeneous clinical phenotypes, in these particular cases a premature aging phenotype with major musculoskeletal involvement linked to the homozygous p.Thr528Met variant.
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Affiliation(s)
- Abdelkrim Saadi
- Service de neurologie, Etablissement Hospitalier Specialisé de Ben Aknoun, Université Benyoucef Benkhedda, Algiers, Algeria
- Laboratoire de Neurosciences, Service de neurologie, Centre Hospitalo Universitaire Mustapha Bacha, Université Benyoucef Benkhedda Alger, Algiers, Algeria
| | - Claire Navarro
- INSERM, MMG, Aix Marseille University, Marseille, France
- Neoflow Therapeutics, 61 boulevard des Dames, 13002, Marseille, France
| | - Ozge Ozalp
- Genetic Diagnosis Center, Adana City Training and Research Hospital University of Health Sciences, Adana, Turkey
| | - Charles Marques Lourenco
- Neurogenetics Unit-Inborn Errors of Metabolism Clinics, National Reference Center for Rare Diseases, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil
- Department of Specialized Education, Personalized Medicine Area, DLE/Grupo Pardini, Rio de Janeiro, Brazil
| | - Racha Fayek
- INSERM, MMG, Aix Marseille University, Marseille, France
| | | | - Athmane Chaouch
- Service de neurophysiologie, Etablissement Hospitalier Specialisé, Algiers, Algeria
| | - Meryem Benahmed
- Service d'anatomo-pathologie, Centre Pierre Marie Curie, Algiers, Algeria
| | - Christian Kubisch
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arnold Munnich
- Department of Clinical Genetics, Institut de Recherche Necker Enfants Malades, Paris, France
| | - Nicolas Lévy
- INSERM, MMG, Aix Marseille University, Marseille, France
- Department of Medical Genetics, La Timone Hospital, APHM, Marseille, France
| | - Patrice Roll
- INSERM, MMG, Aix Marseille University, Marseille, France
- Cell Biology Laboratory, La Timone Hospital, APHM, Marseille, France
| | - Lamia Ali Pacha
- Laboratoire de Neurosciences, Service de neurologie, Centre Hospitalo Universitaire Mustapha Bacha, Université Benyoucef Benkhedda Alger, Algiers, Algeria
| | - Malika Chaouch
- Service de neurologie, Etablissement Hospitalier Specialisé de Ben Aknoun, Université Benyoucef Benkhedda, Algiers, Algeria
| | - Davor Lessel
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Human Genetics, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Annachiara De Sandre-Giovannoli
- INSERM, MMG, Aix Marseille University, Marseille, France
- Department of Medical Genetics, La Timone Hospital, APHM, Marseille, France
- Biological Resource Center (CRB-TAC), La Timone Hospital, APHM, Marseille, France
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Velasco HM, Ullah E, Martin AM, Hufnagel RB, Prada CE. Novel progressive acrodysostosis-like skeletal dysplasia, cerebellar atrophy, and ichthyosis. Am J Med Genet A 2020; 182:2214-2221. [PMID: 32783359 DOI: 10.1002/ajmg.a.61782] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022]
Abstract
Acrodysostosis refers to a rare heterogeneous group of bone dysplasias that share skeletal features, hormone resistance, and intellectual disability. Two genes have been associated with acrodysostosis with or without hormone resistance (PRKAR1A and PDE4D). Severe intellectual disability has been reported with acrodysostosis but brain malformations and ichthyosis have not been reported in these syndromes. Here we describe a female patient with acrodysostosis, intellectual disability, cerebellar hypoplasia, and lamellar ichthyosis. The patient has an evolving distinctive facial phenotype and childhood onset ataxia. X-rays showed generalized osteopenia, shortening of middle and distal phalanges, and abnormal distal epiphysis of the ulna and radius. Brain magnetic resonance imaging showed cerebellar atrophy without other brainstem abnormalities. Genetic workup included nondiagnostic chromosomal microarray and skeletal dysplasia molecular panels. These clinical findings are different from any recognized form of acrodysostosis syndrome. Whole exome sequencing did not identify rare or predicted pathogenic variants in genes associated with known acrodysostosis, lamellar ichthyosis, and other overlapping disorders. A broader search for rare alleles absent in healthy population databases and controls identified two heterozygous truncating alleles in FBNL7 and PPM1M genes, and one missense allele in the NPEPPS gene. Identification of additional patients is required to delineate the mechanism of this unique disorder.
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Affiliation(s)
- Harvy M Velasco
- Master of Science in Human Genetics Program, Department of Morphology, Universidad Nacional de Colombia, Cundinamarca, Colombia
| | - Ehsan Ullah
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Angela M Martin
- Master of Science in Human Genetics Program, Department of Morphology, Universidad Nacional de Colombia, Cundinamarca, Colombia
| | - Robert B Hufnagel
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Carlos E Prada
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Abstract
The mucopolysaccharidoses (MPS), a group of rare genetic disorders caused by defects in glycosaminoglycan (GAG) catabolism, are progressive, multi-systemic diseases with a high burden of morbidity. Enzyme replacement therapy (ERT) is available for MPS I, II, and VI, and may improve walking ability, endurance, and pulmonary function as evidenced by data from pivotal trials and extension studies. Despite these demonstrable benefits, cardiac valve disease, joint disease, and skeletal disease, all of which cause significant morbidity, do not generally improve with ERT if pathological changes are already established. Airway disease improves, but usually does not normalize. These limitations can be well understood by considering the varied functions of GAG in the body. Disruption of GAG catabolism has far-reaching effects due to the triggering of secondary pathogenic cascades. It appears that many of the consequences of these secondary pathogenic events, while they may improve on treatment, cannot be fully corrected even with long-term exposure to enzyme, thereby supporting the treatment of patients with MPS before the onset of clinical disease. This review examines the data from clinical trials and other studies in human patients to explore the limits of ERT as currently used, then discusses the pathophysiology, fetal tissue studies, animal studies, and sibling reports to explore the question of how early to treat an MPS patient with a firm diagnosis. The review is followed by an expert opinion on the rationale for and the benefits of early treatment.
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Affiliation(s)
- Joseph Muenzer
- Division of Genetics and Metabolism, Department of Pediatrics, CB 7487, Medical School Wing E Room 117, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7487, USA.
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Abstract
An 18-year-old man was admitted to the clinic complaining of deterioration in the function of his hands and feet. The clinical examination revealed that his movements were clumsy and that he had disproportionally short limbs. In addition, he also had facial abnormalities of frontal bossing, hypertelorism, maxillary hypoplasia, broad low nasal bridge, short upturned nose with anteverted nostrils and triangular mouth. All extremities appeared short with stubby fingers and toes and with broad hands and wrinkling of the dorsal skin. Chromosomal analysis showed a normal (46, XY) karyotype. X-ray studies revealed broad, short metacarpals and phalanges with cone-shaped epiphyses and brachycdactyly and a diagnosis of peripheral dysostosis was confirmed by the characteristic radiographic appearance of the hands. Serum calcium and alkaline phosphatase levels were high, parathormone (PTH) was low, but 25 (OH) Vitamin D, albumin, and 24 hour urine calcium levels were in the normal range. Based on these findings, a diagnosis of acrodysostosis associated with hypercalcemia was made. To the best of our knowledge, this represents the first description of this syndrome.
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Affiliation(s)
- Mehmet Kirnap
- Department of Physical Medicine and Rehabilitation, Erciyes University Medical School, Kayseri, Turkey
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Simsek-Kiper PO, Topaloglu R, Sahin Y, Utine GE, Boduroglu K. Mucolipidosis type III in an adolescent presenting with atypical facial features and skeletal deformities. Genet Couns 2013; 24:7-12. [PMID: 23610860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Mucolipidosis type III (MLIII) (MIM# 252600) is an uncommon autosomal recessive disorder that results from deficiency of the multimeric enzyme, UDP-N-acetylglucosamine-1-phosphotransferase. The enzymatic defect results in deficiencies of lysosomal degradative enzymes with concomitant intracellular accumulation of both partly degraded glycosaminoglycans and sphingolipids leading to clinical manifestations such as short stature, developmental delay and other structural abnormalities. The diagnosis is challenging since musculoskeletal presentation may mimic some of the rheumatic and metabolic disorders. We herein report on a 13-year-old adolescent who was admitted to our rheumatology clinic because of progressive joint stiffness and deformities of her hands. The clinical and radiological findings led us to the diagnosis of MLIII despite negative urinary aminoglycosyaminoglycans. Therefore we decided to check for the presence of elevated activities of alpha-mannosidase and beta-hexosaminidase A+B in the plasma which was actually the case and confirmed the clinical diagnosis ofMLIII.
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Affiliation(s)
- P O Simsek-Kiper
- Pediatric Genetics Unit, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey.
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Linglart A, Fryssira H, Hiort O, Holterhus PM, Perez de Nanclares G, Argente J, Heinrichs C, Kuechler A, Mantovani G, Leheup B, Wicart P, Chassot V, Schmidt D, Rubio-Cabezas Ó, Richter-Unruh A, Berrade S, Pereda A, Boros E, Muñoz-Calvo MT, Castori M, Gunes Y, Bertrand G, Bougnères P, Clauser E, Silve C. PRKAR1A and PDE4D mutations cause acrodysostosis but two distinct syndromes with or without GPCR-signaling hormone resistance. J Clin Endocrinol Metab 2012; 97:E2328-38. [PMID: 23043190 DOI: 10.1210/jc.2012-2326] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Acrodysostosis is a rare skeletal dysplasia that is associated with multiple resistance to G protein-coupled receptor (GPCR) signaling hormones in a subset of patients. Acrodysostosis is genetically heterogeneous because it results from heterozygous mutations in PRKAR1A or PDE4D, two key actors in the GPCR-cAMP-protein kinase A pathway. OBJECTIVE Our objective was to identify the phenotypic features that distinguish the two genotypes causing acrodysostosis. PATIENTS AND METHODS Sixteen unrelated patients with acrodysostosis underwent a candidate-gene approach and were investigated for phenotypic features. RESULTS All patients had heterozygous de novo mutations. Fourteen patients carried a PRKAR1A mutation (PRKAR1A patients), five each a novel PRKAR1A mutation (p.Q285R, p.G289E, p.A328V, p.R335L, or p.Q372X), nine the reported PRKAR1A p.R368X mutation; two patients harbored a mutation in PDE4D (PDE4D patients) (one novel mutation, p.A227S; one reported, p.E590A). All PRKAR1A, but none of the PDE4D mutated patients were resistant to PTH and TSH. Two PRKAR1A patients each with a novel mutation presented a specific pattern of brachydactyly. One PDE4D patient presented with acroskyphodysplasia. Additional phenotypic differences included mental retardation in PDE4D patients. In addition, we report the presence of pigmented skin lesions in PRKAR1A and PDE4D patients, a feature not yet described in the acrodysostosis entity. CONCLUSIONS All PRKAR1A and PDE4D patients present similar bone dysplasia characterizing acrodysostosis. Phenotypic differences, including the presence of resistance to GPCR-cAMP signaling hormones in PRKAR1A but not PDE4D patients, indicate phenotype-genotype correlations and highlight the specific contributions of PRKAR1A and PDE4D in cAMP signaling in different tissues.
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Affiliation(s)
- Agnès Linglart
- Institut National de la Santé et de la Recherche Médicale Unité 986 et Centre de Reference des Maladies Rares du Phosphate et du Calcium, Hôpital de Bicêtre, 94276 Le Kremlin Bicêtre Cedex, France
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Assié G. One single signaling pathway for so many different biological functions: lessons from the cyclic adenosine monophosphate/protein kinase A pathway-related diseases. J Clin Endocrinol Metab 2012; 97:4355-7. [PMID: 23223481 DOI: 10.1210/jc.2012-3659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Yang L, Liang QH, Luo XH. [Asphyxiating thoracic dysplasia: a case report]. Zhonghua Er Ke Za Zhi 2009; 47:473-474. [PMID: 19951482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Ornetti P, Prati C, Fery-Blanco C, Streit G, Toussirot E, Wendling D. Pedicle stress fracture: an unusual complication of pycnodysostosis. Clin Rheumatol 2007; 27:385-7. [PMID: 17891524 DOI: 10.1007/s10067-007-0740-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 08/20/2007] [Accepted: 08/30/2007] [Indexed: 11/26/2022]
Abstract
Pycnodysostosis is a rare dysplasia characterised by high bone density and susceptibility to long bone fractures caused by cathepsin K deficiency. Spinal abnormalities have rarely been described in this uncommon inherited bone dysplasia. A 28-year-old female, with a past history of pycnodysostosis and spontaneous leg fractures was hospitalized for a 2-month history of spontaneous low back pain. Physical examination revealed the typical facial and hand features of pycnodysostosis and local lumbar stiffness. No abnormalities were found in laboratory tests, particularly with regard to bone turnover markers. Fracture of the left pedicle of the third lumbar vertebra was suspected on lumbar radiographs and later confirmed by a computed tomography (CT) scan. A dramatic improvement in symptoms was achieved, thanks to a course of injectable calcitonin therapy and rest. To our knowledge, it is the first-ever reported case of pedicle stress fracture in a patient with pycnodysostosis, suggesting that spontaneous fractures resulting from this bone dysplasia do not only affect diaphysis of brittle long bones but could also affect the lumbar spine. Furthermore, the present case confirms previous observations in such patients of frequent spondylolysis, which could lead to abnormal lumbar pedicle stress. The dramatic improvement achieved by calcitonin therapy might be related to osteoclastic dysfunction in pycnodysostosis caused by a deficiency of cathepsin K, a cystein protease involved in bone matrix remodelling.
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Affiliation(s)
- Paul Ornetti
- Department of Rheumatology, University Teaching Hospital, Franche-Comté University, 25030, Besançon, France
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Fonteles CSR, Chaves CM, Da Silveira A, Soares ECS, Couto JLP, de Azevedo MDFV. Cephalometric characteristics and dentofacial abnormalities of pycnodysostosis: report of four cases from Brazil. ACTA ACUST UNITED AC 2007; 104:e83-90. [PMID: 17703963 DOI: 10.1016/j.tripleo.2007.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 04/09/2007] [Accepted: 05/07/2007] [Indexed: 10/22/2022]
Abstract
Pycnodysostosis (PKND) is a human autosomal recessive genetic disorder characterized mainly by osteosclerosis of the skeleton, severe bone fragility, and short stature. This syndrome usually presents very typical craniofacial deformities, such as beaked nose, micrognathia, hypoplastic midface, open mouth posture, grooved palate, anterior cross-bite, dental crowding, and over-retained deciduous teeth. Early diagnosis and intervention are of the utmost importance. Four cases from the northeast of Brazil are reported including 2 siblings. Features included maxillary retrusion, reduced facial height, open bite, and bone fracture history. Very poor oral hygiene, severe dental caries, and periodontal disease were also present.
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Abstract
Acrodysostosis is an extremely rare disorder characterized by short stature and peripheral dysostosis. The co-existence of metabolic syndrome and acrodysostosis in adolescence has not been previously reported in the pediatric endocrinology literature. We report a 17 year-old boy with acrodysostosis who developed metabolic syndrome, with insulin resistance and impaired glucose tolerance exhibited by an oral glucose tolerance test as well as other features of metabolic syndrome including hyperlipidemia and hypertension.
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Affiliation(s)
- Mehmet Emre Atabek
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Selcuk University, Konya, Turkey.
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Nakase T, Yasui N, Hiroshima K, Ohzono K, Higuchi C, Shimizu N, Yoshikawa H. Surgical outcomes after treatment of fractures in femur and tibia in pycnodysostosis. Arch Orthop Trauma Surg 2007; 127:161-5. [PMID: 17195933 DOI: 10.1007/s00402-006-0270-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Indexed: 11/25/2022]
Abstract
Pycnodysostosis is a rare hereditary disease, characterized by systemic bone sclerosis. The most important orthopedic problem in this condition is the recurrent pathological fracture of long bones. In this paper, the surgical results for fractures of six limbs (three femurs and three tibias) in five cases of pycnodysostosis are reported. Five limbs achieved fracture union and union is developing in one tibia after intramedullary nail (IM) nailing or Ilizarov external fixation (IEF), although fracture line tends to persist for longer periods of time. One femoral fracture was treated by IM nailing, and one femoral and one tibial fracture were treated by IEF leading to final bone union. One femoral and one tibial fracture were initially treated by IEF, and were treated by IM nailing after re-fracture. One tibial fracture was initially treated by IEF leading to a failure of union, and was converted to IM nailing. All cases are able to walk; one case requires a single crutch. Infection was noted in two limbs after IM nailing following IEF. Fixation with IM nail was effective in preventing re-fracture as well as in alignment correction. Although the surgical technique is more difficult, IM nailing in the initial surgery may be a better choice for achieving successful union while reducing the risk of re-fracture or infection.
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Affiliation(s)
- T Nakase
- Department of Orthopedic Surgery, Hoshigaokakouseinenkin Hospital, 4-8-1, Hoshigaoka, Hirakata, 573-8511, Osaka, Japan.
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Dimitrakopoulos I, Magopoulos C, Katopodi T. Mandibular Osteomyelitis in a Patient With Pyknodysostosis: A Case Report of a 50-Year Misdiagnosis. J Oral Maxillofac Surg 2007; 65:580-5. [PMID: 17307614 DOI: 10.1016/j.joms.2005.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 08/19/2005] [Indexed: 10/23/2022]
Affiliation(s)
- Ioannis Dimitrakopoulos
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Moniz N, Queiroz EA, Freitas RR, Felix VB. Mandibular Reconstruction With Autogenous Graft in Patient Presenting Pyknodysostosis: Case Report. J Oral Maxillofac Surg 2006; 64:1292-5. [PMID: 16860227 DOI: 10.1016/j.joms.2006.04.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Indexed: 10/24/2022]
Affiliation(s)
- Nilesh Moniz
- Oral and Maxillofacial Surgery Service, Irmandade de Santa Casa de Misericórdia de São Paulo, Santa Casa São Paulo-Fac, São Paulo, Brazil.
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Abstract
STUDY DESIGN A retrospective study of radiographic and clinical findings of spondylocostal dysostosis. OBJECTIVE To determine the features of spondylocostal dysostosis diagnosed using consistent diagnostic criteria. SUMMARY OF BACKGROUND DATA To our knowledge, no clear definition of spondylocostal dysostosis exists, and little information is available regarding its clinical or radiographic features. METHODS We defined spondylocostal dysostosis as a congenital spinal disorder consisting of >or=2 vertebral anomalies associated with rib anomalies, without crab-like chest. For 30 patients, including 12 males and 18 females, who met these criteria, we evaluated vertebral and rib anomalies, birth and present body height, and associated anomalies. There were only 2 familial cases. RESULTS Features of spondylocostal dysostosis were: (1) anomalies involved the thoracic region in all cases; many also involved the cervical spine; (2) most patients had >or=4 vertebral anomalies; (3) frequent vertebral anomalies were butterfly vertebra, hemivertebra, complete block, and unilateral bar, which were associated with both rib absence and fusion; (4) short stature was not always present at birth; and (5) complete block was 1 factor identified as being related to short stature after 12 years of age. CONCLUSION Several features of sporadic spondylocostal dysostosis disorder were determined, including new findings related to body height.
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Affiliation(s)
- Kazuharu Takikawa
- Department of Pediatric Orthopedics, Shizuoka Children's Hospital, Shizuoka-City, Japan.
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Abstract
Spondylocostal dysostosis is a rare congenital segmental costovertebral malformation. Neural tube defects associated with it have been reported several times, and a genetic cause has been proposed. The authors report on the first patient with both spondylocostal dysostosis and an intrathoracic myelomeningocele in whom surgical treatment was successful.
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Affiliation(s)
- Seong Yi
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
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Abstract
Shwachman-Diamond syndrome (SDS) is an inherited marrow failure disorder with varying cytopenia, pancreatic dysfunction, and metaphyseal dysostosis. SDS is also characterized by a risk of myelodysplasia and leukemia in up to one third of the patients. Over the last 5 years, major advances have been made in understanding the bone marrow phenotype. The gene associated with the disease, SBDS, has recently been identified. Herein we provide an update on the clinical features, the hematopoietic defects, and the genetics of the disease as they are currently understood. We also review the diagnostic and therapeutic approaches to the hematological complications in the syndrome.
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Affiliation(s)
- Yigal Dror
- Marrow Failure and Myelodysplasia Program, Division of Haematology and Oncology, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
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18
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Nadkarni TD, Menon RK, Desai KI, Goel A. Segmental costovertebral malformation associated with lipomyelomeningocoele. J Clin Neurosci 2005; 12:599-601. [PMID: 15936198 DOI: 10.1016/j.jocn.2004.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Accepted: 08/10/2004] [Indexed: 11/23/2022]
Abstract
We describe 2 patients with segmental costovertebral malformation, a form of spondylocostal dysostosis, associated with tethering of the conus to a lipomyelomeningocoele. Such an association is rare. In both these patients the defects occurred sporadically. The relevant literature is reviewed.
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Affiliation(s)
- Trimurti D Nadkarni
- Department of Neurosurgery, King Edward Memorial Hospital, Seth GS Medical College, Parel, Mumbai, India.
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Tamay Z, Guler N, Ones U, Leman OD, Akcay A. Thoracic three-dimensional spiral CT findings of an infant with spondylothoracic dysostosis. Indian J Pediatr 2005; 72:367. [PMID: 15876776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Spondylocostal dysostoses are a group of rare inherited disease with a heterogeneous disorder of vertebral segmentation defects and rib anomalies, which lead to respiratory problems predicting the clinical outcome. Spiral CT with three-dimensional (3D) imaging provides exact measurement of the bony rib cage. We report a case of an infant with spondylothoracic dysostosis, a phenotype of spondylocostal dysostoses, and 3D spiral CT findings of his rib cage since it may contribute to the surgical planning.
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Affiliation(s)
- Zeynep Tamay
- Department of Pediatrics, Division of Allergy and Chest Diseases, Istanbul University, Medical Faculty, Istanbul, Turkey.
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Menghsol SC, Harris RD, Ornvold K. Thrombocytopenia and absent radii, TAR syndrome: report of cerebellar dysgenesis and newly identified cardiac and renal anomalies. Am J Med Genet A 2004; 123A:193-6. [PMID: 14598347 DOI: 10.1002/ajmg.a.20251] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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21
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Abstract
STUDY DESIGN Prospective assessment of a cohort of patients affected by spondylocostal dysostosis. OBJECTIVE To report on the results of conservative and operative management of spondylocostal dysostosis and, based on this, to propose an assessment and treatment protocol for the condition. SUMMARY OF BACKGROUND DATA Spondylocostal dysostosis and spondylothoracic dysostosis are subtypes of Jarcho-Levin syndrome, a hereditary condition manifested by vertebral body and related rib malformations. Mortality prevails in spondylothoracic dysostosis because of more severe respiratory compromise. METHODS Details of prenatal and postnatal diagnosis, history, and management of 13 patients with spondylocostal dysostosis are presented. All patients were treated postnatally with repeated chest physiotherapy. Two patients refractory to conservative treatment underwent surgical intervention: the first had a chest wall reconstruction via a latissimus dorsi flap, the second a posterior spinal instrumented fusion for progressive scoliosis. RESULTS Prenatal ultrasound in 4 of 13 cases showed full details of vertebral and rib anomalies. Thoracic and lumbar hemivertebrae were most common, leading to congenital scoliosis in 10 of 13 cases. A number of extraskeletal abnormalities were also identified. At an average follow-up of 4.5 years, the survival rate was 100% with a remarkable decrease of the rate of respiratory complications. Surgical treatment in selected cases led to satisfactory results. CONCLUSIONS Prenatal diagnosis of spondylocostal dysostosis allows exclusion of spondylothoracic dysostosis and aids genetic counseling in quantifying the risk to siblings. Postnatally, prompt management of these patients with physiotherapy leads to prolonged survival. Surgical intervention may then be indicated to stabilize chest wall or spine deformities, with promising results.
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Affiliation(s)
- Marco Teli
- Great Ormond Street Hospital for Sick Children, London, UK.
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22
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Nishikawa H, Pearman K, Dover S. Multidisciplinary management of children with craniofacial syndromes with particular reference to the airway. Int J Pediatr Otorhinolaryngol 2003; 67 Suppl 1:S91-3. [PMID: 14662175 DOI: 10.1016/j.ijporl.2003.08.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- H Nishikawa
- Children's Hospital Birmingham, Steelhouse Lane, Birmingham B4 6NH, UK.
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23
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Abstract
In reports on children with congenital segmental costovertebral malformations who showed neural tube defects, cases with type I split cord malformation are quite rare. Up to now such association has been reported only in two cases with Jarcho-Levin syndrome. Here, a 7-year-old girl presenting with spondylocostal dysostosis and type I split cord malformation is reported. To the best of our knowledge, this is the first case documented in the literature. The association of segmental costovertebral malformations and neural tube defects is discussed. Genetic and embryological studies are also briefly reviewed.
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Affiliation(s)
- V Etus
- Department of Neurosurgery, Kocaeli University School of Medicine, Sopaliçiftligi, 41900 Derince, Kocaeli, Turkey
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24
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Tubbs RS, Wellons JC, Blount JP, Oakes WJ. Jarcho-Levin syndrome. Pediatr Neurosurg 2002; 36:279. [PMID: 12053050 DOI: 10.1159/000058435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, USA.
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25
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Isono M, Goda M, Kamida T, Ishii K, Kobayashi H, Maeda T, Imai K, Izumi T. Limited dorsal myeloschisis associated with multiple vertebral segmentation disorder. Pediatr Neurosurg 2002; 36:44-7. [PMID: 11818747 DOI: 10.1159/000048349] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 3-year-old girl was admitted to our department with spina bifida occulta. At birth, thoracic dysplasia with severe respiratory dysfunction and a soft pedunculated mass connecting with an intradural mass were noted. The patient did not start to walk and partial removal of the intradural mass was performed via a laminectomy of the fused vertebrae. There was no boundary between the spinal cord and the mass and the histological diagnosis of this mass was connective tissue. The anomalies in this case were considered to be multiple vertebral segmentation disorder (MVSD) and limited dorsal myeloschisis. The coincidence of these anomalies might suggest the causal genesis of MVSD.
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Affiliation(s)
- Mitsuo Isono
- Department of Neurosurgery, Oita Medical University, Hasama-machi, Oita, Japan.
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26
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Savtsova TV, Brusova LA, Nabiev FK. [Maxillonasal dysostosis: Binder's syndrome]. Stomatologiia (Mosk) 2001; 80:66-71. [PMID: 11548297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
It is known that the septum of the nose participates in sagittal growth of medial face. Teratogenic deficiency of vitamin K promotes premature ossification of the septum cartilage. It results in hypoplasia of maxillonasal complex, development of characteristic concave profile with the impressed and short nose with half the moon naries, infringement of an occlusion. The orthodontic treatment should be carried out from younger children's age. The surgical treatment is directed on elimination of bone-skeletal infringements of an occlusion, reconstruction of normal contours of middle face and lengthening of a nose. In our clinic for the last 13 years 11 patients with Binder's syndrome were examined and operated.
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27
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Bathi RJ, Masur VN. Pyknodysostosis--a report of two cases with a brief review of the literature. Int J Oral Maxillofac Surg 2000; 29:439-42. [PMID: 11202325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Pyknodysostosis is a rare sclerosing bone disorder that has an autosomal dominant trait. It is characterized by short stature, brachycephaly, short and stubby fingers, open cranial sutures and fontanelle, and diffuse osteosclerosis, where multiple fractures of long bones and osteomyelitis of the jaw are frequent complications. We present a report of two cases of pyknodysostosis with evidence of long bone fractures and chronic suppurative osteomyelitis of the jaws in one of the cases. Some of the specific oral and radiological findings that are consistent with pyknodysostosis are reported, along with a brief review of the literature.
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Affiliation(s)
- R J Bathi
- Department of Oral Medicine and Radiology, S.D.M. College of Dental Sciences, Dharwad, Kamataka, India.
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28
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Thomas N, Seshadri MS, Thomas G, Chacko R, Samraj T, Nair S, Ponnaiya J, Cherian T. Association of central giant-cell granuloma of the maxilla with pyknodysostosis. Br J Oral Maxillofac Surg 2000; 38:159-60. [PMID: 10864715 DOI: 10.1054/bjom.1998.0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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29
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Dror Y, Freedman MH. Shwachman-Diamond syndrome: An inherited preleukemic bone marrow failure disorder with aberrant hematopoietic progenitors and faulty marrow microenvironment. Blood 1999; 94:3048-54. [PMID: 10556188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Shwachman-Diamond syndrome (SD), an inherited disorder with varying cytopenias and a marked tendency for malignant myeloid transformation, is an important model for understanding genetic determinants in hematopoiesis. To define the basis for the faulty hematopoietic function, 13 patients with SD (2 of whom had myelodysplasia with a clonal cytogenetic abnormality) and 11 healthy marrow donors were studied. Patients with SD had significantly lower numbers of CD34(+) cells on bone marrow aspirates. SD CD34(+) cells plated directly in standard clonogenic assays showed markedly impaired colony production potential, underscoring an intrinsically aberrant progenitor population. To assess marrow stromal function, long-term marrow stromal cell cultures (LTCs) were established. Normal marrow CD34(+) cells were plated over either SD stroma (N/SD) or normal stroma (N/N); SD CD34(+) cells were plated over either SD stroma (SD/SD) or normal stroma (SD/N). Nonadherent cells harvested weekly from N/SD LTCs were strikingly reduced compared with N/N LTCs; numbers of granulocyte-monocyte colony-forming units (CFU-GM) derived from N/SD nonadherent cells were also lower. SD/N showed improved production of nonadherent cells and CFU-GM colonies compared with SD/SD, but much less than N/N. Stem-cell and stromal properties from the 2 patients with SD and myelodysplasia did not differ discernibly from SD patients without myelodysplasia. We conclude that in addition to a stem-cell defect, patients with SD have also a serious, generalized marrow dysfunction with an abnormal bone marrow stroma in terms of its ability to support and maintain hematopoiesis. This dual defect exists in SD with and without myelodysplasia.
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Affiliation(s)
- Y Dror
- Division of Hematology and Oncology and the Research Institute, The Hospital for Sick Children, and the University of Toronto, Toronto, Ontario, Canada
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30
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Abstract
We report pyknodysostosis presenting as extramedullary haematopoiesis in one of two siblings and as obstructive airway disease in the other. Visceral manifestations are rare and have been reported in only two cases in the Indian literature. They have often been mistaken for osteopetrosis, haemolytic anaemia and other osteochondrodystrophies. The cases we report illustrate that, though the physical characteristics may be similar, it is the radiological features that are typical and help establish the diagnosis.
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Affiliation(s)
- I Agarwal
- Department of Child Health, Christian Medical College and Hospital, Vellore, India
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31
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Abstract
BACKGROUND Shwachman's syndrome is the second most common cause of inherited/congenital pancreatic insufficiency after cystic fibrosis. The main associated features are usually cyclic neutropenia, metaphyseal dysostosis, and growth retardation. Other organs or functions may be involved in this syndrome, showing a wide range of abnormalities and symptoms. There are reports of Shwachman's syndrome in childhood, but little is known about the long-term clinical course of these patients. This article reports on the pathomorphosis and long-term follow-up of 13 patients with Shwachman's syndrome diagnosed in infancy focusing, in particular, on modifications of the exocrine pancreatic function over time. METHODS Exocrine pancreatic function was evaluated by duodenal intubation followed by a pancreatic stimulation test. Nutritional, biochemical, hematologic, radiologic, and psychological evaluations were performed at various intervals. Six patients were included in long-term follow-up evaluation. RESULTS At diagnosis, growth retardation was present in all patients, and all subjects showed pancreatic insufficiency. Hematologic features (intermittent neutropenia, anemia and thrombocytopenia), respiratory infection during the first years of life, and skeletal abnormalities were also frequently observed. Other associated features at diagnosis included hepatic involvement and occasional renal dysfunction. In the six patients followed up, a significant growth improvement was observed. In five of them the pancreatic stimulation test showed values of lipase within reference range outputs, whereas fat balance or fecal fat losses were normal in all but one subject. Of seven subjects assessed by psychological evaluation, IQ test results were markedly abnormal in one and bordered on abnormality in the others. CONCLUSIONS The present data on Shwachman's syndrome diagnosed in infancy underline the possibility of improvement or normalization of exocrine pancreatic function with age, suggesting the need for periodic checks on pancreatic activity in these subjects. It also indicates the possibility of diagnosis of this syndrome in the absence of pancreatic insufficiency; decreasing frequency of infections over time; and the usefulness of early neuropsychological evaluation.
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Affiliation(s)
- M Cipolli
- Cystic Fibrosis Center, Ospedale Civile Maggiore, Verona, Italy
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32
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Abstract
Shwachman's syndrome is a rare disease characterized by the association of chronic diarrhea due to exocrine pancreatic insufficiency, metaphyseal dysostosis, and neutropenia. The diagnosis requires demonstration of lipomatosis, or fatty replacement of the pancreas, which is the typical pathological feature of the disease. Magnetic resonance imaging (MRI) was performed in 13 patients with exocrine pancreatic insufficiency, 7 with Shwachman's syndrome, 2 with Pearson's syndrome, 1 with normal sweat test later diagnosed as cystic fibrosis, and 3 without identified syndrome, and in 7 control children. Ultrasonography in the patients did not differentiate between atrophy and lipomatosis and could not be performed in 3. MRI visualized the pancreas in all. The same image was noted in all patients with Shwachman's syndrome with a normal-sized or enlarged pancreas, a hyperintense signal on T1- and T2-weighted image, and a null signal on short time inversion recovery (STIR)-weighted image, characteristic of fat. In all other patients, the findings were very different: The pancreas was a small structure surrounded with fat. In 1 patient without identified syndrome, the pancreas appeared to be partially replaced with fat. MRI is an excellent imaging technique to correlate the nature of a tissue and its radiological representation, especially fat, which gives a very typical signal. In our brief series of patients with Shwachman's syndrome, MRI had 100% positive predictive value in demonstrating lipomatosis. In atypical cases of pancreatic insufficiency in which some of the clinical features of Shwachman's syndrome are absent. MRI is an invaluable aid in the diagnostic procedure.
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Affiliation(s)
- F Lacaille
- Department of Paediatrics, Hôpital des Enfants-Malades, Paris, France
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33
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Valentino G, David G, Previtero G, Troisi S. [Diagnosis and logopedic rehabilitation in mandibulofacial dysostosis: a case report]. Acta Otorhinolaryngol Ital 1996; 16:136-9. [PMID: 8766078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
TCS is hereditary condition transmitted as an autosomal dominant with a high penetrance rate and variable expressivity. Over half the cases derives from new mutations. A pathological gene has been located on the chromosome 5, between locus 31 and 34 of the long arm. The clinical picture is dominated by mandible-facial impairment and by numerous associated deficits, among which a hearing deficit. Therapy requires plurispecialistic intervention, personalized according to each patients condition. The Authors report the case of a three-year-old girl with transmissive deafness and serious language retardation. The child successfully underwent logopedical therapy for three years. The Authors conclude affirming that very young patients with S. Treacher Collins-Franceschetti have a very good chance of being inserted into society furthermore improved by the absence lack of mental deficiency and by spontaneous improvement in physical appearance.
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34
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Adegboyega PA, Adesokan AA, Sample TG, Nichols MM. Pathological case of the month. Spondylothoracic dysplasia with multiple congenital cardiac anomalies. Arch Pediatr Adolesc Med 1996; 150:221-2. [PMID: 8556131 DOI: 10.1001/archpedi.1996.02170270103017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- P A Adegboyega
- Department of Pathology, University of Texas Medical Branch at Galveston, USA
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35
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Smith OP, Chan MY, Evans J, Veys P. Shwachman-Diamond syndrome and matched unrelated donor BMT. Bone Marrow Transplant 1995; 16:717-8. [PMID: 8547872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 5 year old with Shwachman-Diamond syndrome (SDS) developed acute monoblastic leukaemia following a period of myelodysplasia associated with a clonal cytogenetic abnormality involving chromosome 7. Matched unrelated BMT was carried out using standard CY/TBI conditioning and GVHD prophylaxis protocols. The patient experienced no toxicity, had temporary committed progenitor cell engraftment but eventually died from bone marrow failure 1 year post-transplant. This report, to our knowledge, documents the first reported case of matched unrelated donor BMT for SDS/AML and we speculate that standard conditioning regimens are probably safe in this group of patients.
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Affiliation(s)
- O P Smith
- Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London, UK
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36
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Abstract
Two familial cases of spondylothoracic dysostosis are reported. Both cases had severe congenital heart disease in addition to the skeletal malformations which are characteristic of the condition.
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Affiliation(s)
- J M Simpson
- Department of Fetal Cardiology, Guy's Hospital, London, UK
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37
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Cantrell SB, Trott JA, Moore MH, David DJ. Craniofrontonasal dysostosis and the Poland anomaly. Am J Med Genet 1994; 52:498. [PMID: 7747768 DOI: 10.1002/ajmg.1320520422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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38
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Affiliation(s)
- G L Gupte
- Department of Pediatrics, Seth G.S. Medical College & K.E.M. Hospital, Parel, Bombay
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39
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Turra S, Gigante C, Taglialavoro G, Iacobellis C. Spondylocostal dysplasia (Jarcho-Levin syndrome). Chir Organi Mov 1993; 78:167-172. [PMID: 8243136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The authors report 3 cases of rare spondylocostal dysplasia (Jarcho-Levin syndrome) associated with multiple visceral anomalies (V.A.C.TE.R.L. syndrome). The difficulty encountered in treating the disease because of the complexity and multiplicity of the visceral anomalies, and the extent and type of associated vertebral deformities is emphasized. The cases described revealed a moderate amount of progression, and were able to be treated non-surgically. It is also emphasized that even when there is moderate scoliosis associated costal deformities may cause anti-cosmetic thoracic gibbosity.
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Affiliation(s)
- S Turra
- 1 Clinica Ortopedica, Università, Padova
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40
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de Agustín JC, Jover P, León M, Oliver A, Izal E, Utrilla JG. [Pyknodysostosis: extreme cause of sleep apnea]. Cir Pediatr 1992; 5:105-8. [PMID: 1503855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a twentieth month old infant who had a pycnodysostosis syndrome. This malformation shows a loss of the normal mandible angle with generalized bone hyperdensification. The first produced and airway obstruction, with special relevance during sleeping hours. A polysomnography revealed an obstructive sleep apnea syndrome. The respiratory picture deteriorated with worsening of the airway obstruction, hypoxemia and finally pulmonary hypertension and cor pulmonale. A tracheostomy was performed, with resolution of the sleep apnea and pulmonary hypertension. The etiology, pathophysiologic consequences and surgical treatment of obstructive sleep apnea syndrome is reviewed.
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Affiliation(s)
- J C de Agustín
- Departamento de Cirugía Pediátrica, Hospital Infantil La Paz, Madrid
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41
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Muenke M, Ruchelli ED, Rorke LB, McDonald-McGinn DM, Orlow MK, Isaacs A, Craparo FJ, Dunn LK, Zackai EH. On lumping and splitting: a fetus with clinical findings of the oral-facial-digital syndrome type VI, the hydrolethalus syndrome, and the Pallister-Hall syndrome. Am J Med Genet 1991; 41:548-56. [PMID: 1776653 DOI: 10.1002/ajmg.1320410436] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The three midline malformation complexes, the oral-facial-digital syndrome type VI (OFDS VI) or Váradi syndrome, the hydrolethalus syndrome (HS), and the Pallister-Hall syndrome (PHS) have been described as distinct genetic entities. Here, we report a fetus with a combination of clinical findings of all 3 syndromes similar to the twin fetuses described in the accompanying paper (Hingorani et al., 1991). The phenotypic overlap in these fetuses with the OFDS VI, HS, and PHS raises the question as to whether or not they indeed represent separate genetic entities as previously assumed.
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Affiliation(s)
- M Muenke
- Children's Hospital of Philadelphia, Division of Human Genetics and Molecular Biology, PA 19104
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42
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Muto T, Michiya H, Okumura K, Yachi K, Matsuzaki H, Egami F, Nakagawa T, Akiyama Y, Yamada T, Konishi R. [Treatment of a refractory chronic osteomyelitis of the jaw]. Higashi Nihon Shigaku Zasshi 1990; 9:29-36. [PMID: 2131291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Two cases of refractory chronic osteomyelitis of the jaw were presented, the first in a patient with pycnodysostosis, the second that had been receiving radiotherapy. Both cases were primary chronic osteomyelitis with a markedly protracted course of recovery, in spite of the antibiotic and local irrigation therapy. However the lesion was cured by the removal of sequesters and granulation tissues without radical treatment such as a decorticotomy. Radical surgery, decortication, is an effective procedure in the treatment of chronic osteomyelitis of the jaw, but treatment with the surgical procedures which remove only the necrotic bones and granulation tissues followed by antibiotic therapy is also possible.
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Affiliation(s)
- T Muto
- First Department of Oral Surgery, Higashi-Nippon-Gakuen University
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43
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Floman Y, Gomori JM, Fast A. Isthmic spondylolisthesis in pycnodysostosis. J Spinal Disord 1989; 2:268-71. [PMID: 2520085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pycnodysostosis is an inborn skeletal syndrome manifested by short stature with a concomitant spinal deformity and by dense sclerotic fragile bones. We report a 35-year-old woman with pycnodysostosis and isthmic spondylolisthesis. Pycnodysostosis should be added to the differential diagnosis of spondylolisthesis.
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Affiliation(s)
- Y Floman
- Spinal Surgery Unit, Hadassah University Hospital Jerusalem, Israel
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44
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Pascual-Castroviejo I, Rodríguez Balo A, Ramos Linaza J, Martínez de Azagra Garde A. [Rhinoliquorrhea in a case of dysosteosclerosis with sclerosis of the aqueduct of Sylvius]. An Esp Pediatr 1989; 30:419-21. [PMID: 2667417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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45
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Abstract
A 6 year old boy with clinical and radiological features of pycnodysostosis is described. In addition to pycnodysostosis he had a myelophthisic type of anaemia suggesting an overlap with osteopetrosis.
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Affiliation(s)
- R Kumar
- Department of Paediatrics, King George's Medical College, Lucknow, India
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46
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Abstract
Progressive protrusio acetabuli in a patient with acrodysostosis (peripheral dysostosis Type 12) has not, as far as we know, been reported previously. It is recognised that epiphyseal dysplasias may lead to disturbances of acetabular growth, but generally this results in a shallow socket with associated changes in the proximal femoral epiphysis.
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Affiliation(s)
- M F Macnicol
- Princess Margaret Rose Orthopaedic Hospital, Fairmilehead, Edinburgh, Scotland
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47
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Williams CA, Cantú ES, Frías JL. Metaphyseal dysostosis and congenital nystagmus in a male infant with the fragile X syndrome. Am J Med Genet 1986; 23:207-11. [PMID: 2420177 DOI: 10.1002/ajmg.1320230115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 14-month-old male with congenital nystagmus, sparse scalp hair, protuberant ears, developmental delay, and radiologic manifestations of mild metaphyseal dysostosis was coincidentally found to have the fra(X) chromosome in 67% of analyzed metaphases. This observation underscores the need for fra(X) analyses in children with developmental deficit of unknown cause.
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48
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Pirnar T, Bakkaloğlu A, Müftü Y. Pycnodysostosis. Turk J Pediatr 1972; 14:161-8. [PMID: 16295086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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