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Sato VN, Moriwaki TL, do Amaral E Castro A, da Rocha Correa Fernandes A, Guimaraes JB. Capsular and retinaculum thickening in type II mucopolysaccharidosis: a novel MRI finding. Skeletal Radiol 2024; 53:1211-1217. [PMID: 37930378 DOI: 10.1007/s00256-023-04499-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases caused by a deficiency of glycosaminoglycan (GAG) catalytic enzymes, resulting in an accumulation of unprocessed or partly degraded GAGs in different tissues, including bones and joints. Notably, skeletal and joint abnormalities may be the first complaint that prompts patients to seek medical attention, especially in the milder forms of the disease. To our knowledge, there are no prior imaging reports that have documented capsuloligamentous thickening in patients with MPS on MRI. In this study, we present four cases of patients with clinically and genetically confirmed diagnosis of type II MPS, encompassing seven MRI examination of different joints, including cervical spine, hip, wrist, knee, and shoulder. All of the patients were male, aged between 14 and 35 years, and exhibited varying degrees of joint stiffness in the clinical examination and carpal tunnel syndrome in cases of the wrist joint was affected. None of the patients had a history of surgical procedures on the affected joint, other metabolic or deposit diseases, or sports activity practice. The MRI revealed significant capsuloligamentous and retinaculum thickening, up to eight times greater than the normal capsular thickness reported in the literature.
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Affiliation(s)
- Vitor Neves Sato
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil.
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil.
- Department of Radiology, Hospital Do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.
| | - Tatiane Lumi Moriwaki
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil
| | - Adham do Amaral E Castro
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Artur da Rocha Correa Fernandes
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Radiology Department - Grupo de Radiologia e Diagnóstico por Imagem da Rede D'or, São Paulo, SP, Brazil
| | - Julio Brandao Guimaraes
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, São Paulo, SP, Brazil
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Dehghan B, Rostampour N, Sedighi M, Saryazdi MH, Rizi MJ, Mostofizadeh N, Hashemipour M, Khoshhali M. Evaluation of cardiac findings in mucopolysaccharidosis. Int J Cardiovasc Imaging 2024; 40:73-78. [PMID: 37845409 DOI: 10.1007/s10554-023-02983-y] [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] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE Mucopolysaccharidoses (MPS) are a group of rare genetic diseases and heart involvement is one of the important conflicts in most types, which may cause serious complications. We used M-Mode and two-dimensional speckle tracking echocardiography (2D-STE) to explore cardiovascular involvements in MPS patients. METHOD The present cross-sectional study investigated the frequency of cardiac involvements in MPS patients. Included participants were MPS types I, II, III, IV, and VI who underwent specialized echocardiography exams to assess valvular function, systolic and diastolic function, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS). RESULTS 35 patients were enrolled in this study. The total mean age of patients was 9.58 ± 5.11 years and 71.4% were male. Type IV (40%) and type III (31.4%) were the most frequent MPS. Although LVEF did not differ notably among MPS types, GLS was significantly different (p = 0.029). Mitral regurgitation was observed remarkably more in MPS type III (p = 0.001) while mitral stenosis was more common in type III (p = 0.007). There was a significant association between LVEF and GLS (β= -0.662; p = 0.025) and between LVEF and MPS type (β = 1.82; p = 0.025) when adjusted for GLS. CONCLUSION Cardiac complications are very common and are one of the most important causes of death in MPS patients. 2D-STE seems to be superior to M-Mode for detection of early and subclinical cardiac dysfunction in MPS patients.
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Affiliation(s)
- Bahar Dehghan
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Rostampour
- Metabolic Liver Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohsen Sedighi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Neda Mostofizadeh
- Metabolic Liver Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahin Hashemipour
- Metabolic Liver Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Khoshhali
- Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Altin H, Dorum S, Ture E. Tissue doppler echocardiographic evaluation of cardiac functions in children with mucopolysaccharidosis type III disease. Niger J Clin Pract 2022; 25:1717-1724. [PMID: 36308245 DOI: 10.4103/njcp.njcp_195_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mucopolysaccharidosis type III (MPS III) is an extremely rare group of diseases among all MPS types. In recent years, there are studies about the presence and importance of cardiac involvement in MPS III patients as in other types of MPS. AIM The aim of our study is to evaluate the cardiac functions of MPS III patients in pediatric age by using the M-mode, 2D, and Tissue Doppler echocardiographic measurements. METHODS The study was conducted prospectively between September and December 2020. Fifteen MPS III patients and 15 healthy volunteers were included in the study. RESULTS The mean Tei indexes of all three regions including left ventricle (LV), right ventricle (RV), and interventricular septum (IVS) were higher in MPS III patients compared to the control group (0.43/0.36 for LV and 0.44/0.37 for RV and 0.41/0.35), respectively. Diastolic function parameters of MPS III Patients were worse than the control group. In MPS III patients, eight (53.3%) patients had valvular dysfunction, three (20%) patients asymmetric septal hypertrophy and four (26.7%) patients LV concentric remodeling pattern. We detected an increase of z score above +2 in aortic valve annulus, sinuses of Valsalva, IVS diastole diameter and also in the LV posterior wall diastole diameter measurements in some MPS III patients. CONCLUSION We conclude that cardiac monitoring of MPS III patients is very important in terms of early detection and treatment of cardiac problems that may arise. Cardiac evaluation of larger series of MPS III patients are needed to make a better decision.
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Affiliation(s)
- H Altin
- Department of Pediatric Cardiology, Bursa City Hospital, Bursa, Turkey
| | - S Dorum
- Department of Pediatric Metabolism and Nutrition, Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - E Ture
- Pediatric Emergency, Bursa City Hospital, Bursa, Turkey
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Ayaz E, Bozaci AE. Radiographic Findings of Mucopolysaccharidosis and Comparison with Bone Mineral Density: A Study from Southeastern Turkey. J Clin Densitom 2022; 25:475-484. [PMID: 36100508 DOI: 10.1016/j.jocd.2022.08.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/23/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The first aim of this study is to define the severity of radiologic features according to mucopolysaccharidosis (MPS) type. The second aim is to compare spine radiographs with dual-energy X-ray absorptiometry (DXA) scores. METHODOLOGY A total of 64 MPS children were enrolled between January 2017 and March 2021. Patients with a history of surgery, fracture or improper radiographs were excluded. Finally, 48 cases (20 MPS VI, 12 MPS IVA, 7 MPS IIIA, 4 MPS IIIB, 3 MPS II, 2 MPS I) were yielded. Among them, 38 had DXA performed in the same week with radiographs. Demographic and radiographic features and the hip acetabular index were noted. T12-L5 vertebral body heights were measured from lateral spine radiographs and divided by patient height. DXA measurements, bone mineral density and Z-scores were also recorded. RESULTS Spine and hip findings were most frequently seen in MPS VI and IVA. Oar-shaped ribs were more common in MPS VI, whereas anteromedial beaking of vertebra was predominantly seen in MPS IVA. Femoral head dysplasia is most common in MPS IVA, VI and I. The highest mean acetabular was observed in MPS I. The mean Z-score of L1-L4 vertebrae was low for MPS I (-3.8), IVA (-3.79) and VI (-3.73), but normal for MPS II (0.6) and IIIA (0.23). Correlation between the Z-score and vertebral index was highest in the L1 vertebral body. CONCLUSION Interpreting the characteristic radiographic features of different MPS types is important. In addition to dysostosis multiplex, quantitative measurements from radiographs may be beneficial in evaluating disease progression.
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Affiliation(s)
- Ercan Ayaz
- Department of Radiology, Diyarbakir Children's Hospital, Diyarbakır, Turkey.
| | - Ayse Ergul Bozaci
- Department of Pediatric Nutrition and Metabolism, Diyarbakir Children's Hospital, Diyarbakır, Turkey
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Carneiro NCR, Abreu LG, Milagres RMC, Amaral TMP, Flores-Mir C, Pordeus IA, Borges-Oliveira AC. Dental and maxillomandibular incidental findings in panoramic radiography among individuals with mucopolysaccharidosis: a cross-sectional study. J Appl Oral Sci 2021; 29:e20200978. [PMID: 33886944 PMCID: PMC8054648 DOI: 10.1590/1678-7757-2020-0978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/19/2020] [Accepted: 01/07/2021] [Indexed: 11/22/2022] Open
Abstract
Mucopolysaccharidosis (MPS) is a group of rare and inherited metabolic disorders caused by the accumulation of macromolecule glycosaminoglycans inside lysosomes. Affected individuals may have dental and craniofacial tissue alterations, facilitating the development of several oral diseases. OBJECTIVES To assess, with panoramic radiographic images, the frequency of dental and maxillomandibular incidental findings among MPS individuals and compare them with non-MPS individuals. METHODOLOGY A cross-sectional study evaluating a sample of 14 MPS individuals and 28 non-MPS individuals aged from 5 to 26 years was carried out. They were matched for sex and age on a 2:1 proportion. Panoramic radiographs were assessed for the presence/absence of the following dental and maxillomandibular alterations: dental anomalies of number (hypodontia/dental agenesis, supernumerary teeth); anomalies of form (microdontia, macrodontia, conoid teeth, taurodontism, and root dilaceration); anomalies of position (impacted tooth, inverted tooth, tooth migration, partially bony teeth, complete bony teeth); periapical alterations (furcation lesion, circumscribed bone rarefaction); other alterations (radiolucent bone lesions, radiopaque bone lesions, radiopacity in the maxillary sinus, condylar hypoplasia). Differences between groups were tested by the Fisher's exact test and chi-square test (p<0.05). RESULTS For intrarater agreement, Kappa values were 0.76 to 0.85. The presence of supernumerary teeth (p=0.003); conoid teeth (p=0.009); taurodontism (p<0.001); impacted teeth (p<0.001); partial bony teeth (p=0.040); complete bony teeth (p=0.013); and root dilaceration (p=0.047) were statistically more frequent in MPS individuals compared to non-MPS individuals. Bone rarefaction/furcation lesions (p=0.032), condylar hypoplasia (p<0.001), radiolucent bone lesions (p=0.001), and dentigerous cysts (p=0.002) were also more frequent in MPS individuals. CONCLUSION The presence of specific oral manifestations is more common in MPS individuals than non-MPS individuals.
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Affiliation(s)
- Natália Cristina Ruy Carneiro
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Saúde Bucal da Criança e do Adolescente, Belo Horizonte, Brasil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Saúde Bucal da Criança e do Adolescente, Belo Horizonte, Brasil
| | - Roselaine Moreira Coelho Milagres
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Clínica, Patologia e Cirurgia, Belo Horizonte, Brasil
| | - Tania Mara Pimenta Amaral
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Clínica, Patologia e Cirurgia, Belo Horizonte, Brasil
| | - Carlos Flores-Mir
- University of Alberta, School of Dentistry, Division of Orthodontics, Edmonton, Canada
| | - Isabela Almeida Pordeus
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Saúde Bucal da Criança e do Adolescente, Belo Horizonte, Brasil
| | - Ana Cristina Borges-Oliveira
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Odontologia Social e Preventiva, Belo Horizonte, Brasil
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Labounek R, Mai K, Mueller B, Ellinwood NM, Dickson P, Nestrasil I. In-vivo cortical thickness estimation from high-resolution T 1w MRI scans in healthy and mucopolysaccharidosis affected dogs. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2848-2851. [PMID: 31946486 DOI: 10.1109/embc.2019.8856826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cortical thickness measurement estimated from high-resolution anatomical MRI scans may serve as a marker of cortical atrophy in clinical research applications. Most of the working algorithms and pipelines are optimized for human in-vivo data analyses that offer robust and reproducible measures. As animal-models are widely utilized in many preclinical phases of clinical trials the need for an optimized automated MRI data analysis to yield reliable data is warranted. We present a processing pipeline optimized for cortical thickness estimation of canine brains in native and template spaces. Preliminary results of 5 healthy and 5 mucopolysaccharidosis (MPS) dogs demonstrate single-canine mean/median cortical thickness in range of 2.69-3.58mm in native space and 3.26-4.15mm in template space. Our MRI generated values exceed previous histological measurements (observed mean about 2mm) in limited literature reports. Randomly selected manual measures corroborated the ranges defined by estimated cortical thickness probability density functions. Geometric transformations between native and template spaces change absolute mean/median cortical thickness values, but do not change the data nature and properties since the Pearson correlation coefficients between different space estimates were 0.84 for mean values and 0.89 for median values. No significant difference in total cortical thickness between MPS and age-and gender-matched dogs was observed.
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Crostelli M, Mazza O, Mariani M, Mascello D, Iorio C. Spine challenges in mucopolysaccharidosis. Int Orthop 2018; 43:159-167. [PMID: 30218179 DOI: 10.1007/s00264-018-4143-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/07/2018] [Accepted: 09/03/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Mucopolysaccharidosis (MPS) are rare inherited metabolic diseases, causing lysosomal storage of mucopolysaccharides; clinical presentation involves skeletal system and particularly the spine. Anomalies include developing kyphosis at thoracolumbar junction, that can causes nervous symptoms, and dens hypoplasia with associated atlantoaxial subluxation that can cause myelopathy. We present our experience in the treatment of spine pathology in MPS. METHODS Medical treatments of MPS seem to have little impact on spine disease: treatment of cervical instability often includes surgical decompression and stabilization, as in patient MPS1 that we present, while thoracic lumbar kyphosis is treated by bracing and, in severe cases, with surgery. Bracing is more effective in kyphosis under 40° Cobb. Our surgical cases with thoracic lumbar kyphosis over 40° Cobb, treatment include the first one ever described by only posterior approach with vertebrectomy in MPS and a case of lateral costo-transverse approach instrumented correction. RESULTS Surgical patients had no major complications after surgery and CT scan at follow-up showed complete fusion without loss of correction, even if in a cervical case we used an adult rigid instrumentation in a four year-and-six month-old girl (11 years follow-up) and in thoracic lumbar kyphosis case treated by vertebrectomy due to diminutive anatomy we positioned interbody cage in suboptimal position. CONCLUSIONS Bracing is a viable treatment strategy in thoracic lumbar kyphosis and can obtain good clinical results at medium terms follow-up even if kyphosis deformity remains in radiographs. Surgical treatment is effective in severe evolving cases both at cervical and thoracic lumbar level, main difficulties arose from unavailability of dedicated instrumentation in very young patient, as even smallest devices available are often too big.
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Affiliation(s)
- Marco Crostelli
- Spine Surgery Unit, Surgery and Transplantations Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
| | - Osvaldo Mazza
- Spine Surgery Unit, Surgery and Transplantations Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Massimo Mariani
- Spine Surgery Unit, Surgery and Transplantations Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Dario Mascello
- Spine Surgery Unit, Surgery and Transplantations Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Carlo Iorio
- Spine Surgery Unit, Surgery and Transplantations Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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Abstract
The mucopolysaccharidosis (MPS) disorders are rare lysosomal storage disorders caused by mutations in lysosomal enzymes involved in glycosaminoglycan (GAG) degradation. The resulting intracellular accumulation of GAGs leads to widespread tissue and organ dysfunction. In addition to somatic signs and symptoms, patients with MPS can present with neurological manifestations such as cognitive decline, behavioral problems (e.g. hyperactivity and aggressiveness), sleep disturbances, and/or epilepsy. These are associated with significant abnormalities of the central nervous system (CNS), including white and gray matter lesions, brain atrophy, ventriculomegaly, and spinal cord compression. In order to effectively manage and develop therapies for MPS that target neurological disease, it is important to visualize and quantify these CNS abnormalities. This review describes optimal approaches for conducting magnetic resonance imaging assessments in multi-center clinical studies, and summarizes current knowledge from neuroimaging studies in MPS disorders. The content of the review is based on presentations and discussions on these topics that were held during a meeting of an international group of experts.
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Affiliation(s)
- Igor Nestrasil
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
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Shih SL, Lee YJ, Lin SP, Sheu CY, Blickman JG. Airway changes in children with mucopolysaccharidoses: CT evaluation. Acta Radiol 2016; 43:40-3. [PMID: 11972460 DOI: 10.1080/028418502127347628] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess the CT findings of the airway in children with mucopolysaccharidoses (MPS). Material and Methods: The study included 13 patients (9 boys, 4 girls; age range 2-17 years; mean age 9.2 years) with MPS: 6 with Hunter syndrome, 3 with Maroteaux-Lamy syndrome, 2 with Sanfilippo syndrome, 1 with Hurler/Scheie syndrome and 1 with Morquio syndrome. CT of the airways was done in the axial section with 3-mm collimation from the oropharynx at the level of C3 to the base of the lung. The shape of the vocal cords and trachea at the level of T1 was evaluated. The tracheal surface area (TSA) at the level of T1 was measured both in patients and in age-matched subjects. Results: CT showed an abnormality of the vocal cords in 7 of the 13 patients. Six patients had an abnormal shape and 7 had an inhomogenous density. The abnormalities included elliptical (5 of 6) and star-shaped (1 of 6) cords. Eight of 13 tracheas were also abnormal, either U-shaped (6 of 8) or worm-shaped (2 of 8). The TSA was significantly smaller in patients (79.6±28.9 mm2) than in control subjects (138.1±50.1 mm2). The TSA of those ≤⃒9 years was 61.4±15.2 mm2 as compared with 99.9±23.5 mm2 for the control group. The TSA of patients ≥11 years was 107.1±25.3 mm2 as compared with 187.6±32.0 mm2 for the control group. Conclusion: Significant changes in the shape of the vocal cords and trachea in patients with MPS were found. The most common abnormal configuration of trachea was the U-shape. The TSA was smaller in patients with MPS than in controls. The airway changes may be due to abnormal submucosal storage of substances such as keratan or dermatan sulfate.
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Affiliation(s)
- Shin-Lin Shih
- Department of Radiology, Mackay Memorial Hospital, 92 Section 2, Chung San North Road, Taipei, Taiwan
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Morimoto N, Kitamura M, Kosuga M, Okuyama T. CT and endoscopic evaluation of larynx and trachea in mucopolysaccharidoses. Mol Genet Metab 2014; 112:154-9. [PMID: 24767144 DOI: 10.1016/j.ymgme.2014.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 03/27/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mucopolysaccharidoses (MPSs) are lysosomal storage disorders caused by lysosomal enzyme deficiencies that result in systemic accumulation of glycosaminoglycans (GAGs). Accumulation of GAGs in the upper airway can lead to respiratory failure. The aim of this study was to investigate changes of the airway by flexible endoscopy and CT. METHODS Thirty-five patients aging from 2 to 16 years (mean: 9.2±4.4 years) participated in this study. The majority had MPS I (n=5) or MPS II (n=25). The shape of the trachea and the cross-sectional trachea surface area (TSA) was determined at the Th1 and Th2 levels. Airway obstruction was evaluated from endoscopic findings and classified into 3 grades (Grades 0, 1, and 2). Forty-five patients in the control group who underwent tracheal CT for other conditions were retrospectively selected from the database. RESULTS Tracheal morphology was abnormal in 50-60%, which showed a transversely collapsing narrow trachea. Tracheal deformity was severe in MPS II and MPS IV. The mean TSA of the MPS patients was 55.5±29.0 mm(2) at Th1 and 61.4±29.0 mm(2) at Th2, while that of the control group was 90.1±41.9 mm(2) and 87.9±39.3 mm(2), respectively. Respiratory distress was noted in 15 of the 35 patients, among whom 7 patients showed tracheal deformity and 7 patients had laryngeal redundancy. Three patients had no abnormalities of the larynx or trachea, so other factors such as pharyngeal stenosis or lower airway stenosis might have contributed to their respiratory distress. CONCLUSION CT and flexible endoscopy allow quantitative and morphological evaluation of airway narrowing, which is beneficial for airway management in MPS children.
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Affiliation(s)
- Noriko Morimoto
- Department of Otolaryngology, National Center for Child Health and Development, Japan.
| | - Masayuki Kitamura
- Department of Radiology, National Center for Child Health and Development, Japan
| | - Motomichi Kosuga
- Center for Lysosomal storage diseases, National Center for Child Health and Development, Japan
| | - Torayuki Okuyama
- Center for Lysosomal storage diseases, National Center for Child Health and Development, Japan
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Lin SM, Lin HY, Chuang CK, Lin SP, Chen MR. Cardiovascular abnormalities in Taiwanese patients with mucopolysaccharidosis. Mol Genet Metab 2014; 111:493-8. [PMID: 24598247 DOI: 10.1016/j.ymgme.2014.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND The mucopolysaccharidoses (MPS) are a group of rare inherited metabolic diseases that can cause damages in various organs including the heart. This study aimed to review the medical records of Taiwanese patients with MPS in order to evaluate the cardiovascular involvement in those patients. METHODS From 2000 to 2012, the medical records of 60 patients with MPS in a tertiary medical center in Taiwan were retrospectively reviewed. Data on cardiac measurements and functions were obtained from previously performed echocardiograms and electrocardiograms. Cardiac parameters were analyzed according to MPS types and patients' age. RESULTS The most frequent MPS type was type II (43%). Overall, heart conditions such as thick interventricular septum (55%), asymmetric septal hypertrophy (42%) and mitral valve prolapse (33%) were common, while cardiac enlargement was infrequently seen. Valvular stenosis/regurgitation and cardiac hypertrophy were more common in patients with MPS I, II, and VI when compared with other MPS types. Cardiovascular abnormalities including valvular deformation and thickening, thick interventricular septum and diastolic dysfunction were found to progress with age. CONCLUSIONS The anatomical changes of cardiovascular systems were common in all types of MPS patients, especially in MPS I, II, and VI. Echocardiography and electrocardiography can provide us good tools for early detection and long-term follow-up for these patients.
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Affiliation(s)
- Shan-Miao Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Hsiang-Yu Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chih-Kuang Chuang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Medical College, Fu-Jen Catholic University, Taipei, Taiwan
| | - Shuan-Pei Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Infant and Child Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Ming-Ren Chen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
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Scaramuzzo L, Perisano C, Leone A, Graci C, Spinelli MS, Di Giacomo G, Venanzi E, Schiavone Panni A, Maccauro G. Skeletal modifications in mucopolysaccharidoses: an overview. J BIOL REG HOMEOS AG 2012; 26:139-144. [PMID: 22475106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The mucopolysaccharidoses (MPS) are a group of rare diseases characterized by deficiencies in different enzymes required for degradation of complex carbohydrates. The enzymatic deficiencies lead to lysosomal accumulation of dermatan sulphate, heparan sulphate, and keratan sulphate in different tissue resulting in multi-system complications. Six different principal types are described. Most MPS types, with the exception of MPS III, are associated with widespread skeletal abnormalities and joint disease. Authors analyzed clinical pathological and radiographical features of mucopolysaccharidoses focusing on pelvic and spine pathologies that generally limit activity and normal life so they have to be treated at the beginning of their manifestations in order to avoid major complication and improve quality of life.
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13
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Wang RY, Covault KK, Halcrow EM, Gardner AJ, Cao X, Newcomb RL, Dauben RD, Chang AC. Carotid intima-media thickness is increased in patients with mucopolysaccharidoses. Mol Genet Metab 2011; 104:592-6. [PMID: 21963080 PMCID: PMC3924772 DOI: 10.1016/j.ymgme.2011.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 09/03/2011] [Accepted: 09/03/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND The feasibility of carotid artery intima-media thickness (C-IMT), an established cardiovascular disease marker, as a cardiac risk marker in mucopolysaccharidosis (MPS) patients was explored. OBJECTIVES To determine if C-IMT is abnormal in MPS versus unaffected controls, and if C-IMT correlates with coronary artery diameter in MPS. MATERIAL AND METHODS Measurements of C-IMT via neck ultrasound and echocardiographic parameters, including coronary artery diameters, were obtained from MPS and control patients, and compared. RESULTS Sixteen MPS subjects (6 MPS I, 6 MPS II, 2 MPS III, 1 MPS VI, 1 MPS VII) and sixteen age, ethnicity, and gender-matched controls were enrolled. Median MPS and control subject ages were 8.3±4.5 and 8.6±4.3 years, respectively (p=0.73). Mean MPS and control C-IMTs were 0.54±0.070 and 0.48±0.034 mm (p=0.0029). No differences in left main, left anterior descending, or right coronary artery diameters were seen between MPS and controls. A significant proportion of MPS subjects had mitral insufficiency (14/16; p=0.0002), aortic insufficiency (10/16; p=0.0021), and left ventricular dilatation (7/16, p=0.037) versus controls. C-IMT did not correlate significantly with age, height, weight, coronary measurements, or duration of treatment. CONCLUSION C-IMT in MPS patients is increased compared to matched controls, likely reflective of arterial intima-medial glycosaminoglycan accumulation. MPS subjects demonstrated a high percentage of left-sided valvular insufficiency and ventricular dilatation. Additional studies should be performed in MPS patients to determine if C-IMT correlates with arterial elasticity, biomarkers of vascular dysfunction, and higher risk of cardiovascular events.
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Affiliation(s)
- Raymond Y Wang
- Division of Metabolic Disorders, Pediatric Subspecialty Faculty, CHOC Children's, Orange, CA, USA.
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14
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Herati RS, Knox VW, O’Donnell P, D’Angelo M, Haskins ME, Ponder KP. Radiographic evaluation of bones and joints in mucopolysaccharidosis I and VII dogs after neonatal gene therapy. Mol Genet Metab 2008; 95:142-51. [PMID: 18707908 PMCID: PMC2803678 DOI: 10.1016/j.ymgme.2008.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 07/01/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Abstract
Mucopolysaccharidosis I (MPS I) and MPS VII are due to deficient activity of the glycosaminoglycan-degrading lysosomal enzymes alpha-L-iduronidase and beta-glucuronidase, respectively, and result in abnormal bones and joints. Here, the severity of skeletal disease in MPS I and MPS VII dogs and the effects of neonatal gene therapy were evaluated. For untreated MPS VII dogs, the lengths of the second cervical vertebrae (C2) and the femur were only 56% and 84% of normal, respectively, and bone dysplasia and articular erosions, and joint subluxation were severe. Previously, we reported that neonatal intravenous injection of a retroviral vector (RV) with the appropriate gene resulted in expression in liver and blood cells, and high serum enzyme activity. In this study, we demonstrate that C2 and femurs of RV-treated MPS VII dogs were longer at 82% and 101% of normal, respectively, and there were partial improvements of qualitative abnormalities. For untreated MPS I dogs, the lengths of C2 and femurs (91% and 96% of normal, respectively) were not significantly different from normal dogs. Qualitative changes in MPS I bones and joints were generally modest and were partially improved with RV treatment, although cervical spine disease was severe and was difficult to correct with gene therapy in both models. The greater severity of skeletal disease in MPS VII than in MPS I dogs may reflect accumulation of chondroitin sulfate in cartilage in MPS VII, or could relate to the specific mutations. Neonatal RV-mediated gene therapy ameliorates, but does not prevent, skeletal disease in MPS I and MPS VII dogs.
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Affiliation(s)
- Ramin Sedaghat Herati
- Department of Internal Medicine, Washington University School of Medicine, St. Louis MO
| | - Van W. Knox
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA
| | - Patricia O’Donnell
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA
| | - Marina D’Angelo
- Center for Chronic Disorders of Aging, Philadelphia College of Osteopathic Medicine, Philadelphia PA
| | - Mark E. Haskins
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA
| | - Katherine P. Ponder
- Department of Internal Medicine, Washington University School of Medicine, St. Louis MO
- Department of Biochemistry and Molecular Biophysics Washington University School of Medicine, St. Louis MO
- Corresponding author Katherine P. Ponder, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, (314)-362-5188 (Phone), (314)-362-8813 (FAX),
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16
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Abstract
AIM Children complaining of hip pain most likely suffer from Perthes' disease. Similar morphological changes are seen in the hereditary diseases of the epiphyseal dysplasias which have a prevalence of about 40 of 100 000 inhabitants. We now show the differentiation between bilateral Perthes' disease, epiphyseal dysplasia and skeletal disorders like mucopolysaccharidosis and pseudoachondroplasia. METHOD We describe the diseases of multiple epiphyseal dysplasia and spondyloepiphyseal dysplasia on the basis of two case reports. Furthermore, we discuss differential diagnostic aspects, therapeutic options and prognosis. RESULTS Epiphyseal dysplasias are classified as osteochondral dysplasia. The characteristic feature of these heredopathies is short statue due to skeletal dysplasias at various sites. Multiple epiphyseal dysplasia is caused by an abnormality of enchondral ossification. A distinction is made between the severe Fairbank form, the milder Ribbing form and a mild but rather localised Meyer form. In addition to the femoral head, the spinal bodies can also be affected by the same enchondral ossification disorders and this is defined as spondyloepiphyseal dysplasia. CONCLUSION The diagnosis of a Perthes' disease can be made from an X-ray of the hip, showing either an advanced necrosis of the femoral head or early signs of it. Typical radiological findings allow the differentiation to other skeletal dysplasias like epiphyseal dysplasia and metabolic disorders.
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Affiliation(s)
- G Kohler
- Klinik für Orthopädische Chirurgie, Kantonsspital Frauenfeld, Schweiz.
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17
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Abstract
We present case reports of five patients with severe forms of mucopolysaccharidoses who developed postobstructive pulmonary oedema during anaesthesia. The difficulties of anaesthesia in these patients and the particular predisposition that these patients exhibit for the development of postobstructive pulmonary oedema is discussed.
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Affiliation(s)
- R W M Walker
- Department of Anaesthetisia, Royal Manchester Children's Hospital, Pendlebury, Manchester, UK
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18
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Sato S, Maeda N, Watanabe H, Tano Y, Inoue Y, Shimomura Y, Tanaka A. Multiple iridociliary cysts in patients with mucopolysaccharidoses. Br J Ophthalmol 2002; 86:933-4. [PMID: 12140222 PMCID: PMC1771251 DOI: 10.1136/bjo.86.8.933] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Allan GS. Radiographic features of feline joint diseases. Vet Clin North Am Small Anim Pract 2000; 30:281-302, vi. [PMID: 10768235] [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: 02/16/2023]
Abstract
Feline joint disorders are often overlooked, possibly because cats are extremely agile and appear to cope with pathologic changes within their joints better than their canine counterparts. There is a growing awareness that osteoarthritis occurs more frequently than previously anticipated in cats, and recently we have seen the emergence of hip dysplasia as an entity of concern in some purebred cats. There are also several poorly understood conditions that affect the joints of cats, such as synovial osteochondromatosis, that invite further study. In recent years we have seen an expansion in the knowledge of immune-mediated and infectious arthropathies and their inter-relationship with infective agents. This article describes the radiographic changes seen in many of the currently recognized joint disorders of domestic cats.
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Affiliation(s)
- G S Allan
- Veterinary Imaging Associates, Newtown, Australia
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20
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Dangel JH. Cardiovascular changes in children with mucopolysaccharide storage diseases and related disorders--clinical and echocardiographic findings in 64 patients. Eur J Pediatr 1998; 157:534-8. [PMID: 9686810 DOI: 10.1007/s004310050872] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.8] [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: 02/08/2023]
Abstract
Cardiovascular abnormalities were evaluated in 64 children aged between 1 year 9 months and 25 years with mucopolysaccharidoses (MPS) and related disorders. A heart murmur was heard in 18 patients, but in only 6 was it characteristic for specific valvular lesions. Echocardiography was performed in 63 children. In one girl cardiac lesions were diagnosed on autopsy. In 46 patients (72%), valvular lesions and/or different types of cardiomyopathy were detected. There were no characteristic changes for different types of MPS. In the majority of children in whom dermatan sulphate accumulated, cardiac involvement was the most frequent (88%) and severe. The most common lesion, regardless of MPS type, was thickening of the mitral valve (66%), with regurgitation or stenosis in 28 (44%). Aortic valve thickening was detected in 17 patients (27%), asymmetric septal hypertrophy or hypertrophic cardiomyopathy in 18, congestive cardiomyopathy in 1 and endocardial thickening in 13 patients. Cardiac involvement was less frequent in children with Sanfilippo disease. Two or more echocardiographic examinations were performed in 23 patients. In 19 of them (83%) cardiac changes were more severe during the second examination. One 7-year-old boy with Hunter disease underwent successful mitral valve replacement. CONCLUSIONS; Cardiac involvement is present in most patients with MPS although there are few clinical signs and symptoms. The most common and severe changes are in Hurler, Hunter, Maroteaux-Lamy and I-cell disease, rarely in Sanfilippo disease. Mitral valve deformation is most frequent in all patients. The cardiac lesions are progressive.
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Affiliation(s)
- J H Dangel
- The Children Memorial Health Institute, Department of Cardiology, Warsaw, Poland.
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21
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Chen SJ, Li YW, Wang TR, Hsu JC. Bony changes in common mucopolysaccharidoses. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1996; 37:178-84. [PMID: 8755171] [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
To evaluate the radiological features of mucopolysaccharidoses (MPS), 15 cases were collected for review in this hospital, retrospectively (1985-1995). Eight cases of Hurler syndrome, two cases of Hunter syndrome, two cases of Sanfilippo syndrome and three cases of Morquio syndrome were classified. Varying severity of dysostosis multiplex is the general bony manifestation of MPS, but special appearance may occur in particular types. Hurler syndrome is the prototype of MPS. The main findings were as follows: "J" shaped sella turcica, paddle-like ribs, anterior inferior beaking (hook-like) of lower thoracic-upper lumbar hypoplastic vertebral bodies, flared iliac wings, constrictive iliac bodies, diaphyseal expansion of long bones, distal ulna and radius tilt toward each other, bullet-like proximal phalanges and central pointing of proximal metacarpals. Hunter and Sanfilippo syndromes had the appearance of moderate to mild dysostosis multiplex. Morquio syndrome had distinctive bony changes as vertebral plana and tongue-like protrusion in the anterior part of the lower thoracic-upper lumbar vertebral bodies, particularly short of the distal deformed ulna and poor ossification of the proximal lateral tibial epiphyses. Although clinical presentations and the hallmarks of bony changes helped possible classification of MPS, definite diagnosis depends on enzyme analysis.
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Affiliation(s)
- S J Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, R.O.C
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22
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Abstract
This study was planned to determine the presence and extent of cardiac involvement in metabolic storage diseases, including types I and II glycogenoses, Gaucher and Neimann-Pick diseases, galactosialidosis and mucopolysaccharidosis. M-mode, 2-dimensional and Doppler echocardiographic studies were used for the determination of left ventricular wall thickness, systolic function, anatomic derangement, valvular dysfunction and left ventricular diastolic function in the patient and control groups. In 19.35% of the cases valvular involvement, and in 59.26% thickening of the left ventricular wall due to metabolic storage, was found. Left ventricular systolic function was in the normal range. The diastolic mitral flow patterns of the cases showed obstructive type changes. It can be concluded that in this study, besides previously described cardiovascular changes, some new findings have been detected by means of echocardiography in patients with metabolic storage diseases.
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Affiliation(s)
- F Senocak
- Department of Pediatric Cardiology, Hacettepe University, Ankara, Turkey
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23
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Gupta AK, Sandhyamani S, Ravimandalam K, Rao VR, Neelakandhan KS, Joseph S, Unni M, Rao AS. Multiple pulmonary-artery aneurysms due to mucoid vasculopathy--angiographic and histological observations. Thorac Cardiovasc Surg 1993; 41:189-92. [PMID: 8367874 DOI: 10.1055/s-2007-1013852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 01/30/2023]
Abstract
Multiple peripheral pulmonary artery aneurysms were diagnosed by computed tomography and confirmed angiographically in a 7-year-old boy. On histological examination unusual mucoid vasculopathic changes were noted in the pulmonary artery aneurysms and pulmonary vasculature as a part of systemic vascular involvement. This case demonstrates a new association between mucoid vasculopathic changes and pulmonary aneurysms. Mucoid vasculopathy could represent one more disorder having a causative role in the etiology of intrapulmonary arterial aneurysms.
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Affiliation(s)
- A K Gupta
- Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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24
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Affiliation(s)
- V Farina
- Department of Paediatrics, University of Naples, Italy
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25
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Nakamura T, Miwa K, Kanda S, Nonaka K, Anan H, Higash S, Beppu K. Rosette formation of impacted molar teeth in mucopolysaccharidoses and related disorders. Dentomaxillofac Radiol 1992; 21:45-9. [PMID: 1397452 DOI: 10.1259/dmfr.21.1.1397452] [Citation(s) in RCA: 29] [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] [Indexed: 12/26/2022] Open
Abstract
The radiographic features of the jaws in the mucopolysaccharidoses and related disorders (MPS) have been reviewed and three further cases are reported here, with particular reference to a novel dental anomaly, not previously described in detail, in two of them. The dental changes appear to be fully developed by the third decade and are characterized by bilateral multiple impacted molar teeth, which conglomerate in a single follicle to form a characteristic rosette of teeth. Rosetting was present only in relatively mature cases of MPS. However, it was also seen in the fourth patient, where we could not detect any other abnormal clinical or radiographic features. We therefore propose that since multiple rosetting of molar teeth can also occur in an isolated form, it is only suggestive of MPS.
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26
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Ata J, Brigui M, Jerad T, Belkhiria N, Yacoub M, Harbi A, Essoussi AS. [Cardiac involvement in mucopolysaccharidosis. Apropos of an echocardiographic study in 8 cases]. Ann Pediatr (Paris) 1991; 38:614-7. [PMID: 1750743] [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: 12/28/2022]
Abstract
Of all the storage diseases, mucopolysaccharidosis is the one whose cardiac manifestations are probably the least well known. Clinical and above all echocardiographic findings of heart involvement were studied in 8 patients with mucopolysaccharidosis, including four with Hunter disease. The paucity of clinical manifestations was in sharp contrast with the highly informative echocardiographic results. Valvular dystrophy, usually of the left side of the heart, was the most common anomaly, with five patients affected. Whereas some valvular lesions had no consequences, others led to stenosis or incompetence. Asymmetrical hypertrophy of the septum was found in one patient. No patient had evidence suggestive of vascular involvement, in particular of the coronary arteries.
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Affiliation(s)
- J Ata
- Service de Cardiologie, CHU de Sousse
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27
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Bharatmoorthy, Prasad N, Hamide A, Swaminathan RP, Das AK. Dysostosis multiplex. J Assoc Physicians India 1990; 38:805-6. [PMID: 2128085] [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: 12/30/2022]
Affiliation(s)
- Bharatmoorthy
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry
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28
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Gerhardt R, Stichel W. [Visual diagnosis: diastrophic dwarfism (Lamy-Maroteaux syndrome)]. Beitr Orthop Traumatol 1989; 36:575-80. [PMID: 2514681] [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: 01/01/2023]
Abstract
It is reported about the finding of a very typical case of the Lamy-Maroteaux-Syndrome. This girl is four years old.
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29
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Chapman S, Gray RG, Constable TJ, Bundey S. Atypical radiological features of beta-glucuronidase deficiency (mucopolysaccharidosis VII) occurring in an elderly patient from an inbred kindred. Br J Radiol 1989; 62:491-4. [PMID: 2496886 DOI: 10.1259/0007-1285-62-737-491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- S Chapman
- Department of Radiology, Children's Hospital, Birmingham
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30
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Murata R, Nakajima S, Tanaka A, Miyagi N, Matsuoka O, Kogame S, Inoue Y. MR imaging of the brain in patients with mucopolysaccharidosis. AJNR Am J Neuroradiol 1989; 10:1165-70. [PMID: 2556907 PMCID: PMC8332423] [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: 01/01/2023]
Abstract
MR imaging of the brain was performed in eight patients with mucopolysaccharidosis (MPS). Two had MPS I S, one had MPS IIA, two had MPS IIB, two had MPS IIIB, and one had MPS VI. In the patients with MPS IIA and MPS VI, T1 and T2 were prolonged in various areas of the cerebral white matter. These findings seemed to correspond with the development of pathologic changes in MPS, such as perivascular pits in the white matter observed on slices of the fixed brain. In the patients with MPS IIA and MPS IIIB, the white matter did not show the proper signal intensity, which suggested that myelination was insufficient and that infiltration or deposition of glycosaminoglycan had occurred; this was consistent with the association of these two types with mental retardation. In the patients with MPS I S, no intracranial abnormalities were detected on MR images. MR imaging of the brain may be used to obtain a differential diagnosis of the various types of MPS, to estimate the extent of mental retardation, and to monitor the progress of this disease.
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Affiliation(s)
- R Murata
- Department of Pediatrics, Osaka City University Medical School, Japan
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31
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Dutton RV. A practical radiologic approach to skeletal dysplasias in infancy. Radiol Clin North Am 1987; 25:1211-33. [PMID: 3118409] [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: 01/04/2023]
Abstract
Although skeletal dysplasias occur infrequently, the recognition of these disorders is important both for the patient and for genetic counseling. Our present understanding of these diseases has come about largely as a result of continued study by a small group of individuals who have become authoritative experts. This accumulated knowledge, as well as newer methods of antenatal detection, has significantly heightened the general interest in these disorders.
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Affiliation(s)
- R V Dutton
- Baylor College of Medicine, Houston, Texas
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32
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Abstract
In conclusion, this short communication has emphasized that the well known radiographic features of juvenile chronic arthritis are by no means pathognomonic of this entity. A large differential diagnosis must be considered, including haemophilia, idiopathic multicentric osteolysis, the mucopolysaccharidoses, a variety of skeletal dysplasias, infection, and synovial haemangioma. Correlation of radiographic observations with clinical findings will permit the establishment of an accurate and specific diagnosis in most instances, underscoring the need for close communication between the paediatric radiologist and practising paediatrician.
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Affiliation(s)
- D J Sartoris
- Department of Radiology, University of California Medical Center, San Diego 92103
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33
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Sfar MT, Hamza H, Chadanian D, Pousse H, Farrouj M. [Constitutional bone diseases detected in the neonatal period. Apropos of a series of 11 cases]. Tunis Med 1987; 65:401-10. [PMID: 3145632] [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: 01/04/2023]
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Schmidt H, Ullrich K, von Lengerke HJ, Kleine M, Brämswig J. Radiological findings in patients with mucopolysaccharidosis I H/S (Hurler-Scheie syndrome). Pediatr Radiol 1987; 17:409-14. [PMID: 3114705 DOI: 10.1007/bf02396619] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [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: 01/04/2023]
Abstract
The development of radiological changes in two patients with mucopolysaccharidosis (MPS) Type I H/S is described. Radiological findings reveal enlargement of the sella in one patient, impression of the basilar skull in the other patient. Sclerosis and thickening of the base of skull was observed in both patients. The mandibular necks were short with striking flattening of the superior surfaces of the condyles, when the patients reached adult age. At the age of 12, hypertelorism and spaced teeth were already present in both patients. In addition, they showed early costal, clavicular and scapular changes, irregularities of the acromial joints and acetabulae, hypoplasia of the inferior portion of the iliac bones and flared iliac wings. The flat femurs had short metaphyses and were held in valgus position. Development of dentigerous cysts as well as mandibular changes seem to be rather specific for this variant of alpha-L-iduronidase deficiency. In contrast to the classical form of MPS I, skeletal changes of the spine and hands are minimal.
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35
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36
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Winnicki S, Dawydzik B. [The roentgenological image of the skeleton in children with mucopolysaccharidosis type I, II, III and IV]. Pol Przegl Radiol 1985; 49:309-14. [PMID: 3939380] [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: 01/08/2023]
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37
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Riggio S, Felici L, Leone L, Freddara R, Coppa GV. [Radiologic aspects of a severe form of Maroteaux-Lamy syndrome]. Radiol Med 1984; 70:629-30. [PMID: 6443031] [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: 01/20/2023]
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38
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Dunbar JS. Nonpulmonary abnormalities recognizable in pediatric chest radiographs. Radiol Clin North Am 1984; 22:723-40. [PMID: 6433400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Systemic disorders can often be recognized or suspected from chest radiographs. This is often true in pediatric radiology. In this article, the author presents a sampling of metabolic, hematologic, and endocrine diseases as well as malformations that are recognizable on pediatric chest radiographs.
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39
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Wende S, Ludwig B, Kishikawa T, Rochel M, Gehler J. The value of CT in diagnosis and prognosis of different inborn neurodegenerative disorders in childhood. J Neurol 1984; 231:57-70. [PMID: 6429290 DOI: 10.1007/bf00313718] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Inborn errors of metabolism in 40 children have been investigated by computed tomography to obtain data on the degree of cerebral involvement in neurodegenerative and storage disorders: 20 children had various mucopolysaccharidoses, 8 sphingolipidoses , 3 mucolipidoses, 2 oligosaccharidoses , 3 ceroidlipofuscinoses and 4 had various leucodystrophies . Diagnosis in all patients except Alexander's disease was established by biochemical or histological means. The main findings on CT were cerebral atrophy with enlargement of the ventricles and the subarachnoid spaces and hypodensity of the white matter. The degree of cerebral atrophy seemed to develop according to the age of the patients, as could be seen from the patients with mucopolysaccharidosis III, metachromatic leucodystrophy and GM1-gangliosidosis. Hypodensity of the white matter was found in mucopolysaccharidosis I-H, II-B, VI, in mucolipidosis II and in patients with leucodystrophies . On the other hand, there was great variability in these CT findings even in siblings, as seen in four patients with mucopolysaccharidosis VI. Among the series there were several patients who did not show any abnormalities in CT, so that a negative CT did not exclude these disorders, even the leucodystrophies . CT features such as cerebral atrophy or hypodensity were helpful in the evaluation of these disorders, though a diagnosis could not be made by CT alone.
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Xie DZ. [Mucopolysaccharide metabolism and mucopolysaccharidosis]. Zhonghua Fang She Xue Za Zhi 1983; 17:129-34. [PMID: 6226505] [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: 01/19/2023]
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41
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Ludwig B, Kishikawa T, Wende S, Rochel M, Gehler J. Cranial computed tomography in disorders of complex carbohydrate metabolism and related storage diseases. AJNR Am J Neuroradiol 1983; 4:431-3. [PMID: 6410763 PMCID: PMC8335042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Computed tomography (CT) was performed on 34 children with different disorders of complex carbohydrate metabolism and related storage diseases to obtain data on the degree of cerebral involvement. The main findings on CT were cerebral atrophy and hypodensity of the white matter. There was a great variability in these CT findings, even in siblings. Among the patients there were several in whom CT was normal, so a negative study does not exclude one of these disorders. These findings show that CT features such as cerebral atrophy or hypodensity are helpful in the evaluation of these disorders, though a diagnosis cannot be made on the basis of CT alone.
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Abstract
Mucopolysaccharidosis VI (Maroteaux-Lamy Syndrome) form B is a rare disease occurring in siblings. It may present with radiological features like Perthes' disease or hypothyroidism. We report two such cases, and discuss the differential diagnosis of the spondylo-epiphyseal dysplasias. We stress the importance of final diagnosis by identifying a particular glycosaminoglycan excess in the urine and an enzyme deficiency in the fibroblasts aryl sulphatase B and N-acetylgalactosamine-4-sulphatase.
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43
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Xia RG. [Clinical and roentgenographic diagnosis of mucopolysaccharidosis. II. Mucopolysaccharidosis type IV and VI---a report of 8 cases (author's transl)]. Zhonghua Fang She Xue Za Zhi 1981; 15:146-8. [PMID: 6458477] [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: 01/20/2023]
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44
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45
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Pais MJ. Disease states affecting both liver and bone. Radiol Clin North Am 1980; 18:253-67. [PMID: 6782618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The skeletal system may be profoundly affected by chronic liver disease, resulting in a variety of conditions that may include osteomalacia, osteoporosis, hypertrophic osteoarthropathy, and osteonecrosis. Additionally, many diseases, including glycogen storage disease, Gaucher's disease, and hypervitaminosis A, cause concomitant changes in both liver and bone.
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46
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Gatti R, Borrone C, Torreblanca J, Cavalieri S, de Martini I, Filocamo M, Antelo MC. [Mucolipidosis. biologic characteristics (author's transl)]. An Esp Pediatr 1979; 12:563-74. [PMID: 115347] [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: 12/13/2022]
Abstract
Mucolipidosis II is a severe inherited lysosomal storage disease characterized by profound psychomotor retardation, severe Hurler-like skeletal changes and normal urinary mucopolysaccharide excretion. Mucolipidosis II is a related disorder distinguished by its milder course, milder to absent mental retardation and survival to adult life. Cultivated fibroblasts from patients with both of these disorders display large inclusions on phase microscopy and reduced levels of many acid hydrolases. However, culture medium fibroblasts out the body fluids of affected patients show enormously elevated levels of these hydrolases. The lysosomal enzyme activities in serum, leukocytes, fibroblasts extracts and culture medium from seven patients with mucolipidosis II are similar to those found in four cases of mucolipidosis III. The findings of excessive excretion of sialyl-oligosaccharide in urine and of increased level of sialic acid compounds in cultured fibroblasts associated with a sialidase deficiency in leukocytes, fibroblasts and serum are discussed.
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47
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Orii T. [Skeletal abnormalities in storage diseases (author's transl)]. No To Shinkei 1979; 31:455-70. [PMID: 114200] [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: 12/13/2022]
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48
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49
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Slomic AM, Bernier JP, Morissette J. [Basal angle in pathological cases (author's transl)]. J Radiol Electrol Med Nucl 1978; 59:711-4. [PMID: 106110] [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: 12/13/2022]
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50
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Srivastava KK, Bhattacharya AK, Galatius-Jensen F, Tamaela LA, Borgstein A, Kozlowski K. Pycnodysostosis: (report of four cases). Australas Radiol 1978; 22:70-8. [PMID: 103531 DOI: 10.1111/j.1440-1673.1978.tb02050.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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