Novel ERCC2 mutation in two siblings with trichothiodystrophy

Trichothiodystrophy describes a group of recessively inherited multisystem neuroectodermal disorders that takes its name from the characteristic feature of brittle, sulfur-deficient hair. We describe two siblings with trichothiodystrophy due to a novel genotype. The maternal mutation (p.Arg722Trp) is a previously described pathogenic mutation in ERCC2 that has been shown to result in a severe phenotype, while the paternal mutation (c.1480-1G > C) has not been previously reported. Our cases confirm the severe phenotype associated with the p.Arg722Trp mutation and expand the known genetic mutations associated with trichothiodystrophy by demonstrating a novel pathogenic mutation in ERCC2.

Utility of routine electrocardiographic screening before initiation of propranolol for infantile hemangiomas

Screening electrocardiography (ECG) before initiation of propranolol for treatment of infantile hemangiomas (IH) is controversial. A retrospective chart review was conducted to assess the utility of pretreatment ECG in infants with IH starting propranolol. Although nearly half of the ECGs were abnormal, no contraindications to treatment were identified from screening ECG, and no association was found between any of the reported side effects and abnormal ECG. These results support previously published data, and in a larger cohort, providing further confirmation that pretreatment ECG is not necessary in most infants with IH.

Neurodevelopmental outcome in full-term infants with symptomatic intracranial haemorrhage of unknown aetiology

During a seven-year period symptomatic intracranial haemorrhage was diagnosed in ten full-term infants from the County of North Jutland, Denmark. The source of the haemorrhage was unknown in six of these patients. These infants were followed for a mean period of 50 months. The haemorrhages were located in the germinal matrix in two, the choroid plexus in one, the thalamus in one and the occipital region in two infants. Onset of symptoms, of which the most common was seizures, ranged from one to 35 days of age. All infants survived. Five infants developed hydrocephalus and were shunt operated. Three had a normal neurodevelopmental outcome. Three had an abnormal neurodevelopmental outcome: one had a mild hemiparesis and epilepsy and two were considered to have psychomotor retardation. The incidence of symptomatic intracranial haemorrhage of unknown aetiology was 1.6 cases per 10,000 live term births. We conclude that the neurodevelopmental outcome was fairly favourable although five out of six infants had to be shunted.

[Incidence of juvenile-onset diabetes in Denmark. A prospective registration in the counties of Fyn, Ribe, Sønderjylland and Vejle]

To provide contemporary figures of the incidence of childhood onset diabetes mellitus in Denmark, a prospective routine registration system has been established. The present study covered the population of children aged 0-14 years in four Danish counties, observed during the calendar years 1989 through 1993 concerning new cases of the disease. A total of 201 cases (113 boys and 88 girls) were registered, corresponding with a sex- and age-adjusted incidence rate of 17.4 per 100,000 person-years. Based on a validation analysis the study material is considered virtually complete. Overall, the incidence among boys was slightly higher than among girls, but not statistically significantly so. The incidence rate increased with age for both boys and girls. The results confirm that the incidence of childhood onset diabetes in Denmark is relatively high. Compared with previous Danish studies there has been an increase of about 20-25% in the incidence during the last 20 years. Our study stresses the importance of a continuous registration of new cases of childhood diabetes in Denmark, thereby providing clues for further aetiological studies as well as providing reference values for the planning of the diabetes health care. Our results indicate that at least two independent ascertainment sources must be employed to ensure complete registration in studies that rely upon voluntary registration as the primary reporting source.

[Clinical criteria for acute maxillary sinusitis in general practice]

The purpose of the investigation was to examine the diagnostic value of various symptoms, clinical findings, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) in acute maxillary sinusitis using the aspiration of purulent or mucopurulent from the sinus of a patient with a pathological CT-scanning as the golden standard. Of 174 patients with suspected acute maxillary sinusitis seen in general practice we found 70% to have a pathological CT-scanning and 53% to have pus or mucous pus in the sinus aspirate. Only the ESR and CRP level were found to be significantly and independently associated with a positive diagnosis as defined by the golden standard. A clinical criterion based on either an elevated ESR and/or CRP level in a patient with pain related to the maxillary sinus region had sensitivity of 0.82, a specificity of 0.57, a positive predictive value of 0.68 and a negative predictive value of 0.75, and was diagnostically superior to the clinical examination. The investigation also confirms that this disease is most likely overdiagnosed in general practice.

Arteriographic findings in EDTA chelation therapy on peripheral arteriosclerosis

In a randomized, double-blind, controlled study, 153 patients with claudication were each given either 20 infusions of Na2EDTA or 20 infusions of saline. Walking distances and ankle/brachial indices were measured before, during, and after treatment. In 30 patients, angiograms and transcutaneous oxygen tensions were obtained before, during, and after treatment. The patients' subjective evaluations of the effect of treatment were also recorded. It is concluded that EDTA chelation therapy has no effect in patients with intermittent claudication in the legs caused by arteriosclerosis.