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Turgut GT, Altunoglu U, Gulec C, Sarac Sivrikoz T, Kalaycı T, Toksoy G, Avcı Ş, Yıldırım BT, Sayın GY, Kalelioglu IH, Karaman B, Has R, Başaran S, Yuksel A, Kayserili H, Uyguner ZO. Clinical and molecular characteristics of 26 fetuses with lethal multiple congenital contractures. Clin Genet 2024; 105:596-610. [PMID: 38278647 DOI: 10.1111/cge.14490] [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: 11/16/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
Multiple congenital contractures (MCC) due to fetal akinesia manifest across a broad spectrum of diseases, ranging from mild distal arthrogryposis to lethal fetal akinesia deformation sequence. We hereby present a series of 26 fetuses displaying severe MCC phenotypes from 18 families and describe detailed prenatal ultrasound findings, postmortem clinical evaluations, and genetic investigations. Most common prenatal findings were abnormal facial profile (65%), central nervous system abnormalities (62%), polyhydramnios (50%), increased nuchal translucency (50%), and fetal hydrops (35%). Postmortem examinations unveiled additional anomalies including facial dysmorphisms, dysplastic skeletal changes, ichthyosis, multiple pterygia, and myopathy, allowing preliminary diagnosis of particular Mendelian disorders in multiple patients. Evaluation of the parents revealed maternal grip myotonia in one family. By exome sequencing and targeted testing, we identified causative variants in ACTC1, CHST14, COG6, DMPK, DOK7, HSPG2, KLHL7, KLHL40, KIAA1109, NEB, PSAT1, RAPSN, USP14, and WASHC5 in 15 families, and one patient with a plausible diagnosis associated with biallelic NEB variants. Three patients received a dual diagnosis. Pathogenic alterations in newly discovered genes or in previously known genes recently linked to new MCC phenotypes were observed in 44% of the cohort. Our results provide new insights into the clinical and molecular landscape of lethal MCC phenotypes.
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Affiliation(s)
- Gozde Tutku Turgut
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Umut Altunoglu
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Medical Genetics, Koç University School of Medicine (KUSoM), Istanbul, Turkey
| | - Cagri Gulec
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugba Sarac Sivrikoz
- Division of Perinatology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuğba Kalaycı
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Guven Toksoy
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Şahin Avcı
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Medical Genetics, Koç University School of Medicine (KUSoM), Istanbul, Turkey
| | - Behiye Tuğçe Yıldırım
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gözde Yeşil Sayın
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ibrahim Halil Kalelioglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Birsen Karaman
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Pediatric Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Recep Has
- Division of Perinatology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seher Başaran
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Atil Yuksel
- Division of Perinatology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hülya Kayserili
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Medical Genetics, Koç University School of Medicine (KUSoM), Istanbul, Turkey
| | - Zehra Oya Uyguner
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Comeau D, Belliveau J, Bouhamdani N, Amor MB. Expanding the phenotypic spectrum for CDK8-related disease: A case report. Am J Med Genet A 2024; 194:e63537. [PMID: 38193604 DOI: 10.1002/ajmg.a.63537] [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: 08/11/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Cyclin-dependent kinase 8 (CDK8) is part of a regulatory kinase module that regulates the activity of the Mediator complex. The Mediator, a large conformationally flexible protein complex, goes on to regulate RNA polymerase II activity, consequently affecting transcriptional regulation. Thus, inactivating mutations of the genes within the kinase module cause aberrant transcriptional regulation and disease, namely, CDK8-related intellectual developmental disorder with hypotonia and behavioral abnormalities (IDDHBA). CASE PRESENTATION We describe, for the first time, a likely pathogenic heterozygous CDK8 variant c.599G>A, p.(Arg200Gln) inherited from the biological mother. The clinical presentation of the child and mother is within the described clinical spectrum for IDDHBA; however, undocumented progressive contractures of the hips and knees as well as scoliosis were also observed in the child. This phenotype was not found in the mother, highlighting a heterogenous presentation for the same variant within the same family. Furthermore, the described clinical presentation may further support the notion of a module- or Mediator-related syndrome with varying clinical presentation. CONCLUSION This case report documents the first inherited case of IDDHBA and expands the phenotypic spectrum for CDK8-related disease to include undocumented progressive contractures of the hips and knees as well as scoliosis, which may support the notion of a module- or Mediator-related syndrome with varying clinical presentation.
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Affiliation(s)
- Dominique Comeau
- Vitalité Health Network, Dr Georges-L.-Dumont University Hospital Center, Moncton, New Brunswick, Canada
| | - Jenna Belliveau
- Centre de formation médicale du New-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada
| | - Nadia Bouhamdani
- Vitalité Health Network, Dr Georges-L.-Dumont University Hospital Center, Moncton, New Brunswick, Canada
- Centre de formation médicale du New-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada
- Medical Genetics Department, Vitalité Health Network, Dr Georges-L.-Dumont University Hospital Center, Moncton, New Brunswick, Canada
| | - Mouna Ben Amor
- Medical Genetics Department, Vitalité Health Network, Dr Georges-L.-Dumont University Hospital Center, Moncton, New Brunswick, Canada
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Tariq H, Collins K, Dunn J, Tait D, Porter S. The Delphi of ORACLE: An Expert Consensus Survey for the Development of the Observational Risk Assessment of Contractures (Longitudinal Evaluation). Clin Rehabil 2024; 38:664-677. [PMID: 38332642 PMCID: PMC11005314 DOI: 10.1177/02692155241229285] [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: 09/06/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Despite rising prevalence rates, no standard tool is available to identify individuals at risk of developing contractures. This study aimed to gain expert consensus on items for the development of the Observational Risk Assessment Tool for Contractures: Longitudinal Evaluation (ORACLE) for care home residents. DESIGN A two-round, online modified Delphi study. PARTICIPANTS Panellists were qualified healthcare professionals with a background in physiotherapy, occupational therapy, nursing, and rehabilitation medicine. MAIN OUTCOME MEASURES In the first round, the experts were asked to rate the predesigned list of items on a Likert scale while in the second round, consensus was sought in the areas of disagreement identified in the previous round. RESULTS The two rounds of the Delphi survey included 30 and 25 panellists, respectively. The average clinical and academic experience of the panellists was 22.2 years and 10.5 years, respectively. The panel demonstrated a high level of consensus regarding the clinical factors (10 out of 15 items); preventive care approaches (9 out of 10 items), and contextual factors (12 out of 13 items) ranging from 70% to 100%. CONCLUSION This Delphi study determined expert consensus on items to be included in a contracture risk assessment tool (ORACLE). The items were related to factors associated with joint contractures, appropriate preventive care interventions, and potentially relevant contextual factors associated with care home settings. The promise of a risk assessment tool that includes these items has the capacity to reduce the risk of contracture development or progression and to trigger timely and appropriate referrals to help prevent further loss of function and independence.
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Affiliation(s)
- Hina Tariq
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Kathryn Collins
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Joel Dunn
- Community Therapy Team (Christchurch, Bournemouth & Poole), Dorset Healthcare University Foundation Trust, Poole, UK
| | - Desiree Tait
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sam Porter
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Marinelli A, Guerra E, Bain G. Classification of elbow stiffness. J ISAKOS 2024; 9:234-239. [PMID: 37923144 DOI: 10.1016/j.jisako.2023.10.011] [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: 09/11/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
Stiffness is a clinical disorder that affects the patient's function of the entire upper limb. Many classifications systems have been developed for elbow stiffness based on the plane of motion, severity, aetiology, prognosis or anatomical location. A new classification, the Stiffness types and Influencing Factors Classification System, is proposed as a treatment algorithm to guide the surgical treatment and the preferred operative approach (open or arthroscopic).
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Affiliation(s)
- Alessandro Marinelli
- Shoulder and Elbow Unit - IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy..
| | - Enrico Guerra
- Shoulder and Elbow Unit - IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Gregory Bain
- Flinders University and Finders Medical Center, Adelaide, South Australia, 5042, Australia.
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Graves BR. The examination and treatment of soft tissue contracture of the elbow. J ISAKOS 2024; 9:98-102. [PMID: 37866511 DOI: 10.1016/j.jisako.2023.10.006] [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: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
Treatment of the stiff elbow can be a challenging task. A thorough understanding of normal elbow anatomy and the potential causes of elbow contracture are essential for the development of effective treatment strategies. This chapter provides a review of key points for the treating surgeon including normal elbow anatomy, etiological factors that commonly contribute to elbow stiffness, physical examination and imaging of the stiff elbow, and treatment options for contracture correction.
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Affiliation(s)
- Benjamin R Graves
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, One Medical Plaza Blvd, 4th Floor Watlington Hall, Winston-Salem, NC 27104, USA.
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Mohan AS, Sullivan J, Tenenbaum MM, Broderick KB, Myckatyn TM. Toward a Consensus Aproach for Assessing Capsular Contracture Severity and Progression: A Systematic Review. Plast Reconstr Surg 2024; 153:7-22. [PMID: 37075286 PMCID: PMC10729898 DOI: 10.1097/prs.0000000000010573] [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] [Received: 07/25/2022] [Accepted: 11/11/2022] [Indexed: 04/21/2023]
Abstract
BACKGROUND Breast implants are the most commonly used medical devices in plastic surgery, and capsular contracture (CC) is one of the most common complications. However, our assessment of CC is based largely on Baker grade, which is problematically subjective and affords only four possible values. METHODS The authors performed a systematic review concluding in September of 2021 in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. It identified 19 articles that propose approaches to measuring CC. RESULTS In addition to Baker grade, the authors identified several modalities reported to measure CC. These included magnetic resonance imaging, ultrasonography, sonoelastography, mammacompliance measuring devices, applanation tonometry, histologic evaluation, and serology. Capsule thickness and other measures of CC inconsistently correlated with Baker grade, whereas the presence of synovial metaplasia was consistently associated with Baker grade I and II, but not III and IV capsules. CONCLUSIONS There remains no particular method to reliably and specifically measure the contracture of capsules that form around breast implants. As such, we would recommend that research investigators use more than one modality to measure CC. Other variables that can impact breast implant stiffness and associated discomfort beyond CC need to be considered when evaluating patient outcomes. Given the value placed on CC outcomes in assessing breast implant safety, and the prevalence of breast implants overall, the need for a more reliable approach to measuring this outcome persists.
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Affiliation(s)
- Abee S. Mohan
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine
| | - Janessa Sullivan
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Marissa M. Tenenbaum
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Kristen B. Broderick
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
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Liu DS, Miller P, Rothenberg A, Vuillermin C, Waters PM, Bauer AS. Early Elbow Flexion Contracture Predicts Shoulder Contracture in Infants with Brachial Plexus Birth Injury. J Pediatr 2024; 264:113739. [PMID: 37717907 DOI: 10.1016/j.jpeds.2023.113739] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/19/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To determine if children who present with an elbow flexion contracture (EFC) from brachial plexus birth injury (BPBI) are more likely to develop shoulder contracture and undergo surgical treatment. STUDY DESIGN Retrospective review of children <2 years of age with BPBI who presented to a single children's hospital from 1993 to 2020. Age, elbow and shoulder range of motion (ROM), imaging measurements, and surgical treatment and outcome were analyzed. Patients with an EFC of ≥10° were included in the study sample. Data from 2445 clinical evaluations (1190 patients) were assessed. The final study cohort included 72 EFC cases matched with 230 non-EFC controls. Three patients lacked sufficient follow-up data. RESULTS There were 299 included patients who showed no differences between study and control groups with respect to age, sex, race, ethnicity, or functional score. Patients with EFC had 12° less shoulder range of motion (95% CI, 5°-20°; P < .001) and had 2.5 times the odds of shoulder contracture (OR, 2.5; 95% CI, 1.3-4.7; P = .006). For each additional 5° of EFC, the odds of shoulder contracture increased by 50% (OR, 1.5; 95% CI, 1.2-1.8; P < .001) and odds of shoulder procedure increased by 62% (OR, 1.62; 95% CI, 1.04-2.53; P = .03). Sensitivity of EFC for predicting shoulder contracture was 49% and specificity was 82%. CONCLUSIONS In patients with BPBI <2 years of age, presence of EFC can be used as a screening tool in identifying shoulder contractures that may otherwise be difficult to assess. Prompt referral should be arranged for evaluation at a BPBI specialty clinic, because delayed presentation risks worsening shoulder contracture and potentially more complicated surgery.
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Affiliation(s)
- David S Liu
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Patricia Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Anna Rothenberg
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Carley Vuillermin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Peter M Waters
- Department of Orthopaedic Surgery, Atrium Health, Charlotte, NC
| | - Andrea S Bauer
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
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Sarygin PV, Gushchina NV. [Surgical treatment of combined injuries of the neck and shoulder joints]. Khirurgiia (Mosk) 2023:19-24. [PMID: 37850890 DOI: 10.17116/hirurgia202304119] [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] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To develop the algorithm for effective surgical restoration of shoulder joint and neck functions and acceleration of social and labor rehabilitation. MATERIAL AND METHODS There were 116 patients with combined consequences of burns of the neck and shoulder joints between 2012 and 2021. These ones amounted to 29.4% of all patients with lesions of the neck or shoulder joints. Simultaneous surgeries with correction of post-burn cicatricial deformities and contractures were performed in 66 patients (56.9%). Age of patients ranged from 18 to 72 years, and 96% of them were employable. There were 89 (76.7%) women and 27 (23.3%) men. We assessed spread and localization of cicatricial process, as well as restriction of mobility of the neck and shoulder joint to select optimal surgical approach. Classification of neck deformities and contractures of shoulder joints considering severity of cicatricial lesion and functional impairment made it possible to systematize the approach to reconstructive procedures. Reconstructive surgery included repair with local tissues including skin-fatty flap, non-perforated split or full-thickness skin autograft, rotated flaps including those based on perforator vessels, as well as preliminary skin stretching. RESULTS In general, 116 patients with combined lesions of the neck and shoulder joints underwent 314 surgeries. To accelerate rehabilitation, we performed simultaneous surgeries with correction of deformities and contractures in 66 patients (56.9%). Staged reconstructive surgeries were carried out in 50 patients. Acute dermotension and skin-fatty neck flap grafting were the most common for deformities and contractures of the neck. Skin-fatty axillary flap was used in most patients with contractures of shoulder joints. CONCLUSION Simultaneous surgeries can accelerate rehabilitation. Correct algorithm of staged surgical treatment reduces rehabilitation period and eliminates functional disorders.
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Affiliation(s)
- P V Sarygin
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - N V Gushchina
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Gentile D, Toriello F, Santangelo G, Bursi F, Carugo S. Spontaneous coronary dissection in a patient with Beals syndrome. J Cardiovasc Med (Hagerstown) 2021; 22:e18-e20. [PMID: 33927143 DOI: 10.2459/jcm.0000000000001200] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Domitilla Gentile
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Cardiology, Department of Internal Medicine
| | - Filippo Toriello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Cardiology, Department of Internal Medicine
| | - Gloria Santangelo
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca Bursi
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Cardiology, Department of Internal Medicine
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Morris FM, Bain SC. Clumsy hands in a woman with long-standing diabetes. Diabet Med 2020; 37:1770-1771. [PMID: 31127641 DOI: 10.1111/dme.14041] [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] [Accepted: 05/23/2019] [Indexed: 12/01/2022]
Affiliation(s)
- F M Morris
- Swansea Bay University Health Board, Singleton Hospital, Swansea, UK
| | - S C Bain
- Swansea Bay University Health Board, Singleton Hospital, Swansea, UK
- Diabetes Research Unit Cymru, Swansea University Medical School, Swansea, UK
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Abstract
RATIONALE Wiedemann-Steiner syndrome (WDSTS, online mendelian inheritance in man 605130) is a rare autosomal dominant disorder characterized by hypertrichosis cubiti. Here, we report a Chinese boy who do not show the characteristic of hypertrichosis cubiti, and was misdiagnosed as blepharophimosis-ptosis-epicanthus inversus syndrome at first. We found a de novo frameshift mutation (p.Glu390Lysfs*10) in the KMT2A gene, which was not reported before. Our study increases the cohort of Chinese WDSTS patients, and expand the WDSTS phenotypic and variation spectrum. PATIENT CONCERNS The patient demonstrated typical craniofacial features of blepharophimosis-ptosis-epicanthus inversus syndrome, including small palpebral fissures, ptosis, telecanthus, and epicanthus inversus, besides he had congenital heart disease (ventricular septal defects), strabismus, hypotonia, amblyopia, delayed speech and language development, delayed psychomotor development, and amblyopia (HP:0000646) which was not reported before. DIAGNOSIS FOXL2 gene was cloned and sequenced, however, there was no mutation detected in this patient. The result of Chromosomal microarray analysis was normal. The patient was diagnosed as WDSTS by whole exome sequencing. INTERVENTIONS The patient received cardiac surgery, frontalis suspension and regular speech and occupational therapy. He also treated with growth hormone (GH). OUTCOMES The patient's symptoms are improved after cardiac surgery and frontalis suspension, he can express himself well now and had a 10 cm gain in height. LESSONS As the relationship between genotype and phenotype becomes more and more clear, WES is incredibly powerful tool to diagnose the disease of WDSTS.
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Affiliation(s)
- Liu Jinxiu
- Yinfeng Medical Laboratory, Jinan Shandong
| | | | - Xue Ming
- Genetics Diagnostic Lab, Tai’an Maternity and Child Care Hospital, Tai’an, China
| | - Liu CS. Jonathan
- SoftGenetics LLC, 100 Oakwood Ave, State College, Pennsylvania 16803, USA
| | - Liu Xiangju
- Genetics Diagnostic Lab, Tai’an Maternity and Child Care Hospital, Tai’an, China
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Abstract
A fundamental etiologic component of metatarsalgia is the repetitive loading of a locally concentrated force in the forefoot during gait. In the setting of an isolated gastrocnemius contracture, weight-bearing pressure is shifted toward the forefoot. If metatarsalgia is considered an entity more than a symptom, evaluation of gastrocnemius contracture must be a part of the physical examination, and gastrocnemius recession via the Baumann procedure alone, or in combination with other procedures, considered as an alternative treatment in an attempt to restore normal foot biomechanics.
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Affiliation(s)
- Gastón Slullitel
- Department of Foot and Ankle Surgery, J Slullitel Institute of Orthopedics, San Luis 2534, Rosario 2000, Santa Fe, Argentina.
| | - Juan Pablo Calvi
- Department of Foot and Ankle Surgery, J Slullitel Institute of Orthopedics, San Luis 2534, Rosario 2000, Santa Fe, Argentina
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Hirakawa A, Komura S, Hirose H, Akiyama H. Heterotopic Ossification Requiring Revision Surgery for Elbow Contracture After Tension Band Wiring for an Isolated Olecranon Fracture A Case Report. Bull Hosp Jt Dis (2013) 2019; 77:217-220. [PMID: 31487489] [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: 06/10/2023]
Abstract
Olecranon fractures are common trauma presentations, and generally good or excellent functional outcomes are expected after surgical treatment. The development of heterotopic ossification (HO) is a well-known complication, leading to restricted motion, subsequent joint contractures, and marked functional limitation of the upper extremity. Whereas most olecranon fractures complicated by HO have less extensive ossification and limited clinical implications, we report a rare case of HO that required revision surgery for elbow contracture after tension band wiring for an isolated olecranon fracture. Our findings indicate that even patients with isolated olecranon fractures should be notified about the potential risk of HO development, which could result in restricted motion and subsequent joint contractures. The risk factors associated with the development of HO after elbow trauma should be recognized during surgical treatment for olecranon fracture. Fractures of the olecranon are common trauma presentations. 1 Most olecranon fractures are treated surgically, and good or excellent functional outcomes are expected after surgical treatment.1 The development of heterotopic ossification (HO) is a well-known complication after elbow trauma that causes restricted motion, subsequent joint contractures, and marked functional limitation of the affected upper extremity.2 The severity of HO is related to the nature of the injury. Most olecranon fractures complicated by HO have less extensive ossification, and the clinical implications of this type of injury are limited.3 We report a rare case of HO in which revision surgery for the treatment of elbow contracture was required after an isolated olecranon fracture.
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Abstract
RATIONALE Severe limitation of motion (LOM) in the spine occasionally occurs in patients with diffuse idiopathic skeletal hyperostosis (DISH). However, in extraspinal areas, significant LOM has rarely been reported. In this study, we report a patient with DISH who had severe motion restriction within both hip joints. PATIENT CONCERNS A 57-year-old man presented with a 10-year history of LOM of bilateral hip joints. He had gait difficulty due to shortened stride length induced by LOM. Also, he had mild bilateral hip pain [numeric rating scale (NRS): 2]. DIAGNOSES Hip joint range of motion was 60.3% of normal. The patient had bridging ossification along the anterolateral borders of 7 contiguous vertebrae (T10 to L4) without the findings of ankylosing spondylitis or degenerative disc disease. In addition, severe hyperostosis was diffusely formed around bilateral hip joints. He was diagnosed with DISH. INTERVENTIONS No specific treatment was performed for controlling LOM of bilateral hip joints. Meloxicam 15 mg was administered to the patient for the management of mild bilateral hip pain. OUTCOMES At 2-month follow-up visit, the degree of LOM in the bilateral hip joints was not changed. However, the patient's pain severity was reduced from NRS 2 to 1. LESSONS We showed that DISH can cause significant motion restriction due to severe hyperostosis in the bilateral hip joints.
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Affiliation(s)
- Wonho Lee
- Department of Radiology, Neul Yeolin Seongmo Hospital
| | - Wook Ro Kim
- Deungpyeonhan Rehabilitation Medicine Clinic
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea
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Cohen Aubart F, Haroche J, Emile JF, Charlotte F, Barete S, Schleinitz N, Donadieu J, Amoura Z. [Rosai-Dorfman disease: Diagnosis and therapeutic challenges]. Rev Med Interne 2018; 39:635-640. [PMID: 29501513 DOI: 10.1016/j.revmed.2018.02.011] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/28/2018] [Accepted: 02/04/2018] [Indexed: 12/24/2022]
Abstract
Rosai-Dorfman disease (RDD) was first described by the French pathologist Paul Destombes in 1965. It frequently affects children or young adults and is characterized by the presence of large histiocytes with emperipolesis. More than 50 years after this first description, the pathogenesis of this rare disease is still poorly understood. The revised classification of histiocytoses published in 2016 identified various forms of RDD, from familial RDD to IgG4-associated RDD. Almost 90% of the patients with RDD have cervical lymph nodes involvement although all the organs may virtually be involved. Outcomes are typically favorable. Treatments may be necessary in case of compression or obstruction, and are not well codified. The main therapeutic strategies rely on surgery, radiotherapy, steroids, immunosuppressive drugs or interferon-alpha and cladribine.
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Affiliation(s)
- F Cohen Aubart
- Service de médecine interne 2, centre national de référence maladies systémiques rares et histiocytoses, institut e3M, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Université Paris-VI, Sorbonnes-Universités, 75013 Paris, France.
| | - J Haroche
- Service de médecine interne 2, centre national de référence maladies systémiques rares et histiocytoses, institut e3M, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Université Paris-VI, Sorbonnes-Universités, 75013 Paris, France
| | - J-F Emile
- Département d'anatomo-pathologie, EA4340, hôpital Ambroise-Paré, université de Versailles, AP-HP, 92104 Boulogne, France
| | - F Charlotte
- Université Paris-VI, Sorbonnes-Universités, 75013 Paris, France; Service d'anatomo-pathologie, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - S Barete
- UF de dermatologie, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - N Schleinitz
- Service de médecine interne, hôpital de la Timone et Aix-Marseille université, AP-HM, 13385 Marseille, France
| | - J Donadieu
- Service d'hématologie, hôpital Trousseau, AP-HP, 75012 Paris, France
| | - Z Amoura
- Service de médecine interne 2, centre national de référence maladies systémiques rares et histiocytoses, institut e3M, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Université Paris-VI, Sorbonnes-Universités, 75013 Paris, France
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Butterfield RJ, Dunn DM, Hu Y, Johnson K, Bönnemann CG, Weiss RB. Transcriptome profiling identifies regulators of pathogenesis in collagen VI related muscular dystrophy. PLoS One 2017; 12:e0189664. [PMID: 29244830 PMCID: PMC5731705 DOI: 10.1371/journal.pone.0189664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives The collagen VI related muscular dystrophies (COL6-RD), Ullrich congenital muscular dystrophy (UCMD) and Bethlem myopathy (BM) are among the most common congenital muscular dystrophies and are characterized by distal joint laxity and a combination of distal and proximal joint contractures. Inheritance can be dominant negative (DN) or recessive depending on the type and location of the mutation. DN mutations allow incorporation of abnormal chains into secreted tetramers and are the most commonly identified mutation type in COL6-RD. Null alleles (nonsense, frameshift, and large deletions) do not allow incorporation of abnormal chains and act recessively. To better define the pathways disrupted by mutations in collagen VI, we have used a transcriptional profiling approach with RNA-Seq to identify differentially expressed genes in COL6-RD individuals from controls. Methods RNA-Seq allows precise detection of all expressed transcripts in a sample and provides a tool for quantification of expression data on a genomic scale. We have used RNA-Seq to identify differentially expressed genes in cultured dermal fibroblasts from 13 COL6-RD individuals (8 dominant negative and 5 null) and 6 controls. To better assess the transcriptional changes induced by abnormal collagen VI in the extracellular matrix (ECM); we compared transcriptional profiles from subjects with DN mutations and subjects with null mutations to transcriptional profiles from controls. Results Differentially expressed transcripts between COL6-RD and control fibroblasts include upregulation of ECM components and downregulation of factors controlling matrix remodeling and repair. DN and null samples are differentiated by downregulation of genes involved with DNA replication and repair in null samples. Conclusions Differentially expressed genes identified here may help identify new targets for development of therapies and biomarkers to assess the efficacy of treatments.
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Affiliation(s)
- Russell J. Butterfield
- University of Utah, Departments of Pediatrics and Neurology, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Diane M. Dunn
- University of Utah, Department of Human Genetics, Salt Lake City, Utah, United States of America
| | - Ying Hu
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States of America
| | - Kory Johnson
- Bioinformatics section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States of America
| | - Carsten G. Bönnemann
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States of America
| | - Robert B. Weiss
- University of Utah, Department of Human Genetics, Salt Lake City, Utah, United States of America
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Baltz RG, Wang H, Garg A. Cordlike dermal plaques and nodules on the neck and hands. Cutis 2017; 100:354-357. [PMID: 29360895] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Rebekah G Baltz
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Hongbei Wang
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
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Bloom JL, Lin C, Imundo L, Guthery S, Stepenaskie S, Galambos C, Lowichik A, Bohnsack JF. H syndrome: 5 new cases from the United States with novel features and responses to therapy. Pediatr Rheumatol Online J 2017; 15:76. [PMID: 29041934 PMCID: PMC5645937 DOI: 10.1186/s12969-017-0204-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND H Syndrome is an autosomal recessive disorder characterized by cutaneous hyperpigmentation, hypertrichosis, and induration with numerous systemic manifestations. The syndrome is caused by mutations in SLC29A3, a gene located on chromosome 10q23, which encodes the human equilibrative transporter 3 (hENT3). Less than 100 patients with H syndrome have been described in the literature, with the majority being of Arab descent, and only a few from North America. CASE PRESENTATION Here we report five pediatric patients from three medical centers in the United States who were identified to have H syndrome by whole exome sequencing. These five patients, all of whom presented to pediatric rheumatologists prior to diagnosis, include two of Northern European descent, bringing the total number of Caucasian patients described to three. The patients share many of the characteristics previously reported with H syndrome, including hyperpigmentation, hypertrichosis, short stature, insulin-dependent diabetes, arthritis and systemic inflammation, as well as some novel features, including selective IgG subclass deficiency and autoimmune hepatitis. They share genetic mutations previously described in patients of the same ethnic background, as well as a novel mutation. In two patients, treatment with prednisone improved inflammation, however both patients flared once prednisone was tapered. In one of these patients, treatment with tocilizumab alone resulted in marked improvement in systemic inflammation and growth. The other had partial response to prednisone, azathioprine, and TNF inhibition; thus, his anti-TNF biologic was recently switched to tocilizumab due to persistent polyarthritis. Another patient improved on Methotrexate, with further improvement after the addition of tocilizumab. CONCLUSION H syndrome is a rare autoinflammatory syndrome with pleiotropic manifestations that affect multiple organ systems and is often mistaken for other conditions. Rheumatologists should be aware of this syndrome and its association with arthritis. It should be considered in patients with short stature and systemic inflammation, particularly with cutaneous findings. Some patients respond to treatment with biologics alone or in combination with other immune suppressants; in particular, treatment of systemic inflammation with IL-6 blockade appears to be promising. Overall, better identification and understanding of the pathophysiology may help devise earlier diagnosis and better treatment strategies.
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Affiliation(s)
- Jessica L. Bloom
- 0000 0001 0703 675Xgrid.430503.1Department of Pediatrics, University of Colorado, Aurora, CO 80045 USA
| | - Clara Lin
- 0000 0001 0703 675Xgrid.430503.1Department of Pediatrics, University of Colorado, Aurora, CO 80045 USA
| | - Lisa Imundo
- 0000000419368729grid.21729.3fDepartment of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032 USA
| | - Stephen Guthery
- 0000 0001 2193 0096grid.223827.eDepartment of Pediatrics, University of Utah, Salt Lake City, UT 84113 USA
| | - Shelly Stepenaskie
- 0000 0001 2188 8502grid.266832.bDepartment of Pathology and Dermatology, University of New Mexico, Albuquerque, NM 87102 USA
| | - Csaba Galambos
- 0000 0001 0703 675Xgrid.430503.1Department of Pathology, University of Colorado, Aurora, CO 80045 USA
| | - Amy Lowichik
- 0000 0001 2193 0096grid.223827.eDepartment of Pathology, University of Utah, Salt Lake City, UT 84113 USA
| | - John F. Bohnsack
- 0000 0001 2193 0096grid.223827.eDepartment of Pediatrics, University of Utah, Salt Lake City, UT 84113 USA
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MARTINS ANAINÊS, MAARQUE CRISTIN, PINTO-BASTO JORGE, NEGRÃO LUIS. Bethlem myopathy in a Portuguese patient - case report. Acta Myol 2017; 36:178-181. [PMID: 29774307 PMCID: PMC5953228] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mutations of the encoding genes of collagen VI (COL6A1, COL6A2 and COL6A3), are responsible for two classical phenotypes (with a wide range of severity), the Ullrich congenital muscular dystrophy (UCMD) and the Bethlem myopathy (BM). We present a male patient of 49 years old, with symptoms of muscle weakness beginning in childhood and of very slowly progression. At the age of 42, the neurological examination revealed proximal lower limb muscle weakness and contractures of fingers flexors muscles, positive Gowers manoeuvre and a waddling gait. Serum creatine kinase (CK) values were slightly elevated, electromyographic study revealed myopathic changes and muscle MRI of the lower limbs showed a specific pattern of muscle involvement, with peripheral fat infiltration in vastus lateralis and intermedius and anterocentral infiltration in rectus femoris. Respiratory and cardiac functions were unremarkable. Whole exome sequencing identified the homozygous mutation c.1970-9G>A in COL6A2 gene.
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Affiliation(s)
- ANA INÊS MARTINS
- Neuromuscular Disease Unit, Neurology Department, Coimbra University and Hospital Center, Coimbra, Portugal
| | - CRISTIN MAARQUE
- Neuromuscular Disease Unit, Neurology Department, Coimbra University and Hospital Center, Coimbra, Portugal
| | - JORGE PINTO-BASTO
- Neuromuscular Disease Unit, Neurology Department, Coimbra University and Hospital Center, Coimbra, Portugal
| | - LUIS NEGRÃO
- Neuromuscular Disease Unit, Neurology Department, Coimbra University and Hospital Center, Coimbra, Portugal
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Abstract
Objective The aim of this retrospective study was to find out whether a cut off value existed for elbow flexion and extension after open surgical release of elbow contracture that would correlate with subjective patient satisfaction. Methods The study enrolled 77 patients (53 males and 24 females with a mean age of 35.1 (18–77) years at the time of operation) with elbow contracture who attended regular follow-up appointments for more than 12 months. The mean follow up period was 44.2 months (12–186). The preoperative and postoperative modified MAYO elbow scores, objective parameters of increase in both flexion and extension end point measurements and improvement in total ROM were compared in order to determine the cut off degree of ROM in both flexion and extension that significantly correlated with patient satisfaction. Results Of the 77 participating patients, 26 patients had an extrinsic (33.8%) and 51 patients had an intrinsic elbow contracture (66.2%). Surgeries performed involved 40 cases of lateral release and 37 cases of both lateral and medial (progressive) release. The median preoperative total flexion-extension arch (ROM) was 45° (20°–65°). The median postoperative total flexion-extension arch (ROM) was 110° (97.5°–125°). The modified MAYO elbow score improved from 60 to 85 points postoperatively. The postoperative flexion cut off value was 115° for an excellent or good postoperative modified MAYO elbow score. Conclusion Post-operative flexion cut off value was 115° and had a positive effect on the postoperative patient satisfaction. The cut off value for postoperative extension was 20° but it was not a significant variable on patient satisfaction as was the total increase in ROM. Level of significance Level IV Therapeutic Study.
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Affiliation(s)
| | | | - Umit Gok
- Kocaeli University, Kocaeli, Turkey
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21
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Saal S, Beutner K, Bogunski J, Obermüller K, Müller M, Grill E, Meyer G. Interventions for the prevention and treatment of disability due to acquired joint contractures in older people: a systematic review. Age Ageing 2017; 46:373-382. [PMID: 28338811 DOI: 10.1093/ageing/afx026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 04/02/2016] [Indexed: 11/14/2022] Open
Abstract
Background acquired joint contractures have significant effects on quality of life and functioning. Objective to determine the effects of interventions to prevent and treat disabilities in older people with acquired joint contractures. Methods systematic search (last 8/2016) via Cochrane Library, PubMed, EMBASE, PEDro, CINAHL, trial registries, reference lists of retrieved articles and scientific congress pamphlets. Controlled and randomised controlled trials in English or German comparing an intervention with another intervention or standard care were included. Two independent researchers performed the selection of publications, data extraction and critical appraisal. Results seventeen studies with 992 participants met the inclusion criteria: 16 randomised controlled trials and 1 controlled trial (nursing homes = 4, community settings = 13). The methodological quality of the studies varied. Splints were examined in four studies, stretching exercises in nine studies, and ultrasound, passive movement therapy, bed-positioning and group exercise were each examined in one study. Studies on splints revealed inconclusive results regarding joint mobility or spasticity. Five of seven studies that assessed active stretching programmes for healthy older people reported statistically significant effects on joint mobility in favour of the intervention. Pain, quality of life, activity limitations and participation restrictions were rarely assessed. Conclusion the evidence for the effectiveness of interventions to prevent and treat disability due to joint contractures is weak, particularly for established nursing interventions such as positioning and passive movement. Better understanding is required regarding the delivery of interventions, such as their intensity and duration. In addition to functional issues, activities and social participation should also be studied as outcomes.
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Affiliation(s)
- Susanne Saal
- Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Katrin Beutner
- Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Julia Bogunski
- Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Kathrin Obermüller
- Ludwig-Maximilians-Universität München, Medical Faculty, Institute for Medical Information Processing, Biometrics and Epidemiology, München, Germany
| | - Martin Müller
- Ludwig-Maximilians-Universität München, Medical Faculty, Institute for Medical Information Processing, Biometrics and Epidemiology, München, Germany
- Hochschule Rosenheim, Faculty of Applied Health and Social Sciences, Rosenheim, Germany
| | - Eva Grill
- Ludwig-Maximilians-Universität München, Medical Faculty, Institute for Medical Information Processing, Biometrics and Epidemiology, München, Germany
- Ludwig-Maximilians-Universität München, German Center for Vertigo and Balance Disorders, München, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
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Bruschetta D, Milardi D, Trimarchi F, DI Mauro D, Valenti A, Arrigo A, Valenti B, Santoro G, Cascio F, Vaccarino G, Cacciola A. Muscle contracture diagnosis: the role of sonoelastography. J Sports Med Phys Fitness 2016; 56:1518-1525. [PMID: 26990421] [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: 06/05/2023]
Abstract
BACKGROUND Sonoelastography plays today a major role in musculoskeletal disease, showing minor muscle injuries not well appreciable in conventional B-mode ultrasonography and integrating it in major muscle injuries diagnosis. The aim of this study was to demonstrate the ability of elastosonography in the diagnosis of muscular contracture in football players presenting negative basic echography. METHODS We examined twenty-two football players using basic echography and elastosonography approximately 24-48 hours after the traumatic event and we subsequently re-evaluated them after two weeks. RESULTS Conventional echography showed, in the early stage, no muscle injuries; in twenty-two out of twenty-two patients, sonoelastography had instead underlined a heterogeneous colorimetric map, related to decreased elasticity in the area of the muscle contracture. An evaluation effected 1-2 weeks later showed a clear improvement of the sonoelastographic appearance. CONCLUSIONS This information will be useful for prognostication, post-traumatic monitoring and to detect subclinical changes in MIs even before there are changes on the routine B-mode ultrasound.
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Affiliation(s)
- Daniele Bruschetta
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy -
| | - Demetrio Milardi
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Fabio Trimarchi
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Debora DI Mauro
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Andrea Valenti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessandro Arrigo
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Barbara Valenti
- Diagnostics Fiumara Centre, Santa Teresa Riva, Messina, Italy
| | - Giuseppe Santoro
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Filippo Cascio
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gianluigi Vaccarino
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alberto Cacciola
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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Chohan O, Daugherty RJ, Bartoshesky L. Restrictive Dermopathy: A Rare Disease with Unusual Radiographic Findings. Del Med J 2016; 88:308-310. [PMID: 29894032] [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: 06/08/2023]
Abstract
The patient is a unique case presenting with presumed Restrictive Dermopathy (RD) and intracranial and adrenal calcifications, an association not previously described in the literature. This case postulates the possibility of additional radiographic features that can be included in the spectrum of RD or as secondary events from the underlying pathophysiology of RD.
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Papa R, Nozza P, Granata C, Caorsi R, Gattorno M, Martini A, Picco P. Juvenile eosinophilic fasciitis: three case reports with review of the literature. Clin Exp Rheumatol 2016; 34:527-530. [PMID: 27268780] [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] [Received: 06/13/2015] [Accepted: 10/26/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Eosinophilic fasciitis is an uncommon scleroderma-like disorder characterised by induration and thickening of skin and soft tissue, usually associated with peripheral eosinophilia, poorly characterised in childhood. METHODS We report 3 paediatric cases of eosinophilic fasciitis showing unusual clinical and histopathological features with a review of the literature. RESULTS All cases presented progressive motility impairment started from upper limbs with no skin abnormalities. All cases showed systemic inflammatory involvement and 2 patients had acute complications. Two patients developed disabling outcomes despite appropriate treatments. CONCLUSIONS Eosinophilic fasciitis may present unusual clinical and histopathological features during childhood and requires early recognition in order to prevent acute complications and disabling outcomes.
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Affiliation(s)
- Riccardo Papa
- UOC Pediatria II, Reumatologia, Istituto Giannina Gaslini, Genoa, Italy.
| | - Paolo Nozza
- UOC Anatomia patologica, Istituto Giannina Gaslini, Genoa, Italy
| | | | - Roberta Caorsi
- UOC Pediatria II, Reumatologia, Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Gattorno
- UOC Pediatria II, Reumatologia, Istituto Giannina Gaslini, Genoa, Italy
| | | | - Paolo Picco
- UOC Pediatria II, Reumatologia, Istituto Giannina Gaslini, Genoa, Italy
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Bao JM, Tan WL, Wang BW, Qiu XF, Liu BC, Zhong RL, Li GY, Yang GS. Transurethral front-firing Greenlight bladder autoaugmentation for bladder contracture: technique and clinical outcomes. Int Urol Nephrol 2016; 48:475-80. [PMID: 26803485 DOI: 10.1007/s11255-015-1209-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/29/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a novel transurethral front-firing Greenlight bladder autoaugmentation for the treatment of bladder contracture and report initial clinical outcomes. METHODS Between April 2014 and August 2015, five patients diagnosed with contracted bladder were all refractory to conservative treatment and received novel transurethral autoaugmentation. CT scan and urodynamics examination were conducted before operation for disease assessment. Mucosal and muscular layers of bladder wall in fundus were incised vertically and horizontally with front-firing Greenlight laser to enlarge bladder capacity in the operation. Imaging examination and periodical urodynamics study were performed to evaluate the clinical outcomes of the procedure in postoperative follow-up. RESULTS Transurethral front-firing Greenlight bladder autoaugmentation was performed successfully on all the patients. The mean operative time was 59 min (range 52-65 min) with no significant blood loss. Urodynamic parameters of these patients after operation improved significantly compared with those before operation. Average maximum cystometric capacity (Vmax) increased from 91.2 to 333 ml (p < 0.01), average maximum flow rate (Qmax) ascended from 12.6 to 18.62 ml/min (p < 0.01), and average flow rate (Q(ave)) also increased from 5.74 to 13.18 ml/min (p < 0.01). At the last follow-up, all the patients could void spontaneously with good bladder emptying and their symptoms improved significantly. CONCLUSION Our novel transurethral front-firing Greenlight bladder autoaugmentation is a safe and effective treatment for contracted bladders. Future studies with larger sample size and long-term follow-up are needed to confirm our findings.
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Affiliation(s)
- Ji-Ming Bao
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Wan-Long Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Bing-Wei Wang
- Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China
| | - Xiao-Fu Qiu
- Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China
| | - Bai-Chuan Liu
- Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China
| | - Rui-Lun Zhong
- Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China
| | - Gao-Yuan Li
- Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China
| | - Guo-Sheng Yang
- Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China.
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Turan E, Yesilova Y, Surucu HA, Tanrikulu O, Eroglu N, Kocarslan S. Juvenile dermatomyositis with joint contractures and calcinosis cutis. Dermatol Online J 2015; 21:13030/qt1cg4c5pn. [PMID: 26632806] [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] [Received: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 06/05/2023] Open
Abstract
A 12-year-old boy presented to our department with firm papules on the fingers of both hands, erythematous scaly plaques on the dorsum of the hands and elbow, and deformities and limitation of motion in the joints of the hands and feet. His parents reported that the eruption started 6 years prior to presentation. He was previously diagnosed with psoriasis by physicians and acitretin treatment was given. However, he did not benefit from the treatment.
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Ogunmakin K, Vangipuram R, Sturgeon A, Shimizu I. A 7-year-old with indurated skin and unilateral progressive joint immobility: A case of stiff skin syndrome. Dermatol Online J 2015; 21:13030/qt116291c1. [PMID: 26437281] [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] [Received: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 06/05/2023] Open
Abstract
Stiff skin syndrome is a rare sclerotic condition that presents during infancy or early childhood. It has an insidious chronic course and may lead to significant co-morbidity and reduced quality of life. Often, affected individuals experience impaired ambulation and immobilization related to joint involvement. Clinically, it may resemble other sclerotic diseases, so histopathological evaluation is necessary to establish a diagnosis. As it is a condition with limited treatment options, prompt diagnosis and early initiation of physical therapy is crucial to prevent joint restriction and maintain quality of life. We describe a case of a 7-year-old with stiff skin syndrome, and review the literature to discuss the clinical presentation, histological findings, and management of this condition.
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Kvirkvelia N, Shakarishvili R, Gugutsidze D, Khizanishvili N. [DIAGNOSTIC VARIATIONS OF X-LINKED MUSCULAR DYSTROPHY WITH CONTRACTURES]. Georgian Med News 2015:40-44. [PMID: 26177134] [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: 06/04/2023]
Abstract
Case report with review describes X-linked muscular dystrophy with contractures in 28 years old man and his cousin. The disease revealed itself in an early stage (age 5-10), the process was progressing with apparent tendons retraction and contraction, limited movement in the areas of the neck and back of spine, atrophy of shoulder and pelvic yard and back muscles. Intellect was intact. Cardyomyopathy was exhibited. CK was normal. EMG showed classic myopathic features. Muscle biopsy showed different caliber groups of muscle fibers, growth of endo-perimesial connective tissue. Clinical manifestations together with electrophysiological and histological data suggest consistency with Rotthauwe-Mortier-Bayer X-linked muscular dystrophy.
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Affiliation(s)
- N Kvirkvelia
- P. Sarajishvili Institute of Neurology; Iv. Javakhishvili Tbilisi State University, Georgia
| | | | | | - N Khizanishvili
- P. Sarajishvili Institute of Neurology; Iv. Javakhishvili Tbilisi State University, Georgia
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Abstract
Spastic hemiplegia and cerebral palsy often lead to typical deformities of the upper extremity. Muscle- and joint-contractures may be painful and aesthetically unappealing and may interfere with function and hygiene. Within the first weeks after the cerebral incidence the vital threat is dominating and the exact amount of neurologic impairment is not assessable. During this period, conservative treatment should counteract the development of contractures. After spontaneous neurologic recovery, surgical options should be taken into account. When choosing surgical procedures, factors as volitional motor control, sensibility and cognition must be taken into account besides the morphologic changes. This is best achieved in a multidisciplinary setting of neurologists, rehabilitation specialists, physiotherapists and surgeons.
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Affiliation(s)
- Mathias Haefeli
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich
| | - Maurizio Calcagni
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich
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Kotha VK, Reddy R, Reddy MV, Moorthy RS, Kishan TV. Congenital gluteus maximus contracture syndrome--a case report with review of imaging findings. J Radiol Case Rep 2014; 8:32-7. [PMID: 24967033 DOI: 10.3941/jrcr.v8i4.1646] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Indexed: 11/15/2022] Open
Abstract
Although the clinical features of gluteus maximus contracture syndrome have been frequently described, imaging features have been seldom described. Most commonly reported cases are those following intramuscular injection in the gluteal region although congenital contracture is an uncommon but important occurrence. This condition has most often been reported in children of school going age. These patients often present with difficulty in squatting, limitation of hip motion or specific deformities and often require surgical correction. We describe the plain radiography, ultrasonography (USG) and magnetic resonance imaging (MRI) features of this condition in a patient with no previous known history of intramuscular injections.
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Affiliation(s)
- Vamshi Krishna Kotha
- Department of Radiology, Kamineni Institue of Medical Sciences, Andhra Pradesh, India
| | - Rajasekhar Reddy
- Department of Radiology, Kamineni Institue of Medical Sciences, Andhra Pradesh, India
| | - M Venkateshwar Reddy
- Department of Orthopaedics, Kamineni Institue of Medical Sciences, Andhra Pradesh, India
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Mestiri S, Labaied N, Mama N, Ayadi A, Ladib M, Sriha B, Krifa H, Mokni M. Juvenile hyaline fibromatosis: a case report. Pathologica 2014; 106:70-2. [PMID: 25291871] [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: 06/03/2023] Open
Abstract
Juvenile hyaline fibromatosis is a rare, hereditary disease with distinct clinical and histopathological features. Clinically, it presents with gingival hypertrophy, pappulonodular skin lesions and joint contractures. Bone involvement is usually an uncommon finding. We report a case of a 2-year-old patient, daughter of consanguineous parents, who presented since the age of 2 months with impairment of mental development, multiple joint contractures, motion limitation and nodules on the scalp. The calvarian lesions were surgically removed, and histopathological examination concluded to juvenile hyaline fibromatosis.
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Abstract
BACKGROUND Camptodactyly is usually painless, not caused by trauma, often appearing bilaterally, gradually progressive flexion contracture of the proximal interphalangeal joint mainly on the 5th fingers. OBJECTIVES The aim of the study was to analyze the efficacy injecting botulinum neurotoxin in short muscles of the hand responsible for the contraction of the proximal interphalangeal joint. MATERIAL AND METHODS The clinical material consisted of 12 patients (8 women, 4 men) treated with injections of botulinum neurotoxin in 2009-2012. Patients were monitored respectively for 2 weeks, 3 and 6 months and then every six months after the procedure. The observation period after injection of toxin ranged from 18 to 36 months. Our proposed method of treatment is inducing a temporary paralysis of muscles (lumbrical, interosseous) by means of botulinum neurotoxin (Botox). RESULTS In the majority (10) of patients an improvement and stabilization was achieved just after one injection and there were no disease progression in subsequent controlled studies. These patients continued treatment with usage of redressing extensive splints. In case of the other two patients it was required to repeat the injections. CONCLUSIONS The preliminary results obtained are promising. This method of treatment requires further studies and long-term follow-ups every six months until release of symptoms of the disease will be achieved. The operative treatment is reserved for severe deformities.
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Affiliation(s)
- Maciej Urban
- Department of Traumatology, Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland
| | - Roman Rutowski
- Department of Traumatology, Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland
| | - Józef Urban
- Clinic of Traumatology and Hand Surgery, Wroclaw University Hospital, Poland
| | - Piotr Mazurek
- Clinic of Traumatology and Hand Surgery, Wroclaw University Hospital, Poland
| | - Sebastian Kuliński
- Clinic of Traumatology and Hand Surgery, Wroclaw University Hospital, Poland
| | - Jerzy Gosk
- Department of Traumatology, Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland
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Fei X, Feng S, Gao S. [Microsurgery for severe flexion contracture of proximal interphalangeal joint]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2012; 26:803-805. [PMID: 22905614] [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: 06/01/2023]
Abstract
OBJECTIVE To investigate the clinical results of cross-finger flap combined with laterodigital pedicled skin flap for repair of severe flexion contracture of the proximal interphalangeal joint. METHODS Between October 2008 and February 2011, 11 patients (11 fingers) with severe flexion contracture of the proximal interphalangeal joint were treated with cross-finger flap combined with laterodigital pedicled skin flap. There were 7 males and 4 females, aged 20-63 years (mean, 32.6 years). The causes of injury were crush or electric-saw injury in 7 cases, burn or explosive injury in 3 cases, and electrical injury in 1 case. The locations were the index finger in 4 cases, the middle finger in 2 cases, the ring finger in 2 cases, and the little finger in 3 cases. The mean disease duration was 12.4 months (range, 6-24 months). All cases were rated as type III according to Stern classification standard. The volar tissue defect ranged from 3.0 cm x 1.5 cm to 5.0 cm x 2.5 cm, with exposed tendons, nerves, vessels, or bone after scar relaxation. The defects were repaired with cross-finger flaps (2.2 cm x 1.8 cm to 3.8 cm x 2.5 cm) combined with laterodigital pedicled skin flaps (1.5 cm x 1.2 cm to 2.5 cm x 2.0 cm). Double laterodigital pedicled skin flaps were used in 3 cases. The flap donor site was sutured directly or repaired with the skin graft. RESULTS All flaps survived completely and wound healed by first intention. The donor skin graft survived. All the patients were followed up 6-18 months (mean, 11.3 months). The finger appearance was satisfactory. The flaps had soft texture and good color in all cases. No obvious pigmentation or contraction was observed. The contracted fingers could extend completely with good active flexion and extension motion. At last follow-up, the extension of the proximal interphalangeal joint was 10-150. Based on proximal interphalangeal joint motion standard of Chinese Medical Association for hand surgery, the results were excellent in 6 cases, good in 4 cases, and fair in 1 case; the excellent and good rate was 90.9%. CONCLUSION It is an easy and simple therapy t o cover wound area of severe flexion contracture of the proximal interphalangeal joint after scar relaxation using cross-finger flap combined with laterodigital pedicled skin flap, which can repair large defect and achieve good results in finger appearance and function.
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Affiliation(s)
- Xiaoxuan Fei
- No.2 Department of Hand Surgery, the Second Hospital of Tangshan, Affiliated Orthopedic Hospital of Hebei United University, Tangshan Hebei, 063000, PR China
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Lu Y, Li X, Wang M, Li X, Zhang F, Li Y, Zhang M, Da Y, Yu J, Jia J. A novel autosomal dominant inclusion body myopathy linked to 7q22.1-31.1. PLoS One 2012; 7:e39288. [PMID: 22723986 PMCID: PMC3377676 DOI: 10.1371/journal.pone.0039288] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 05/21/2012] [Indexed: 11/18/2022] Open
Abstract
We describe a novel autosomal dominant hereditary inclusion body myopathy (HIBM) that clinically mimics limb girdle muscular dystrophy in a Chinese family. We performed a detailed clinical assessment of 36 individuals spanning four generations. The age of onset ranged from the 30s to the 50s. Hip girdle, neck flexion and axial muscle weakness were involved at an early stage. This disease progressed slowly, and a shoulder girdle weakness appeared later in the disease course. Muscle biopsies showed necrotic, regenerating, and rimmed vacuolated fibers as well as congophilic inclusions in some of the fibers. Electron micrograph revealed cytoplasmic inclusions of 15–21 nm filaments. A genomewide scan and haplotype analyses were performed using an Illumina Linkage-12 DNA Analysis Kit (average spacing 0.58 cM), which traced the disease to a new locus on chromosome 7q22.1–31.1 with a maximum multi-point LOD score of 3.65. The critical locus for this unique disorder, which is currently referred to as hereditary inclusion body myopathy 4 (HIBM4), spans 8.78 Mb and contains 65 genes. This localization raises the possibility that one of the genes clustered within this region may be involved in this disorder.
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Affiliation(s)
- Yan Lu
- Department of Neurology, Capital Medical University, Xuan Wu Hospital, Beijing, People’s Republic of China
| | - Xingang Li
- Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing,People’s Republic of China
- Graduate School of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Min Wang
- Department of Neurology, Capital Medical University, Xuan Wu Hospital, Beijing, People’s Republic of China
| | - Xin Li
- Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing,People’s Republic of China
| | - Feng Zhang
- Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing,People’s Republic of China
| | - Yun Li
- Department of Neurology, Capital Medical University, Xuan Wu Hospital, Beijing, People’s Republic of China
| | - Meng Zhang
- Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing,People’s Republic of China
| | - Yuwei Da
- Department of Neurology, Capital Medical University, Xuan Wu Hospital, Beijing, People’s Republic of China
- * E-mail: (YD); (JY)
| | - Jun Yu
- Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing,People’s Republic of China
- * E-mail: (YD); (JY)
| | - Jianping Jia
- Department of Neurology, Capital Medical University, Xuan Wu Hospital, Beijing, People’s Republic of China
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Lustig S, Scholes CJ, Stegeman TJ, Oussedik S, Coolican MRJ, Parker DA. Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up. Int Orthop 2012; 36:1835-9. [PMID: 22638608 DOI: 10.1007/s00264-012-1580-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/09/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Flexion contracture has been shown to impair function and reduce satisfaction following total knee arthroplasty (TKA). The aim of this study was to identify modifiable intra-operative variables that predict post-TKA knee extension. METHODS Data was collected prospectively on 95 patients undergoing total knee arthroplasty, including pre-operative assessment, intra-operative computer assisted surgery (CAS) measurements and functional outcome including range of motion at one year. Patients were divided into two groups: those with mild flexion contracture (> 5°) at the one-year follow-up and those achieving full extension. RESULTS The sagittal orientation of the distal femoral cut differed significantly between groups at the one-year follow-up (p = 0.014). Sagittal alignment of greater than 3.5° from the mechanical axis was shown to increase the relative risk of a mild flexion contracture at one-year follow-up by 2.9 times, independent of other variables. CONCLUSION Increasing the sagittal alignment of the distal femoral cut more than 3.5° from the mechanical axis is an independent risk factor for clinically detectable flexion contracture one year from index procedure.
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Affiliation(s)
- Sebastien Lustig
- Sydney Orthopaedic Research Institute, Suite 12, Level 1, 445 Victoria Avenue, Chatswood, NSW, Australia.
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37
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Schüssler N, Lassen B, Palm R, Dunger C, Giessen-Scheidel M, Haut A, Bartoszek G. [Experiences of nurses in assessment of contractures in the nursing home. "Something is going on!"]. Pflege Z 2012; 65:166-169. [PMID: 22509712] [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: 05/31/2023]
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38
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Abstract
Contractures of the intrinsic muscles of the fingers disrupt the delicate and complex balance of intrinsic and extrinsic muscles, which allows the hand to be so versatile and functional. The loss of muscle function primarily affects the interphalangeal joints but also may affect etacarpophalangeal joints. The resulting clinical picture is often termed, intrinsic contracture or intrinsic-plus hand. Disruption of the balance between intrinsic and extrinsic muscles has many causes and may be secondary to changes within the intrinsic musculature or the tendon unit. This article reviews diagnosis, etiology, and treatment algorithms in the management of intrinsic contractures of the fingers.
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Affiliation(s)
- Nader Paksima
- New York University Hospital for Joint Diseases, New York, NY, USA.
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39
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Bloch SB, Bedda A, Abdel Hadi AM, Larsen M. Contraction of occult choroidal neovascular membrane and rupture of the retinal pigment following verteporfin and bevacizumab treatment. Acta Ophthalmol 2011; 89:e665-6. [PMID: 21091938 DOI: 10.1111/j.1755-3768.2010.02023.x] [Citation(s) in RCA: 6] [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: 11/28/2022]
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40
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Chen X, Tang X, Jiang X, Wang D, Peng M, Liu L. [Diagnosis and treatment of unilateral gluteal muscle contracture]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2011; 25:530-532. [PMID: 21675106] [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: 05/30/2023]
Abstract
OBJECTIVE To investigate the pathogenesis, diagnosis, and treatment of unilateral gluteal muscle contracture. METHODS Between January 1990 and September 2009, 41 patients with unilateral gluteal muscle contracture were treated and the clinical data were retrospectively analysed. Among them, 24 were male and 17 were female with an age range from 6 to 29 years (mean, 12 years). Thirty-nine patients had a definite history of repeat intragluteal injection. The locations were the left side in 9 cases and the right side in 32 cases. The main clinical manifestations included lameness and abnormal gait. The medical examination showed pelvic oblique and relative inequality of lower limbs with a mean difference of 2.1 cm (range, 1.2-3.8 cm) in the distance form navel to malleolus medials. The X-ray films of pelvis showed outpouching trochanter of femur and pelvic oblique. The CT scans showed no abnormal finding except pelvic oblique and gluteal muscle contracture. The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of the gluteal muscles was performed, followed by the skin traction of both legs and rehabilitation exercise. RESULTS All incisions healed by first intention. Forty-one patients were followed up 1-20 years (mean, 5 years), and the signs of gluteal muscle contracture disappeared. After 1 year of operation, 34 patients had equal leg length, 5 patients had mild pelvic oblique, and 2 patients had obvious pelvic oblique. According to LIU Guohui et al. evaluation standard, the results were excellent in 33 cases, good in 6 cases, and poor in 2 cases with an excellent and good rate of 95.12% at 1 year after operation. CONCLUSION Unilateral gluteal muscle contracture leads to pelvic oblique and inequality of lower limbs, and it can be cured with the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter, combined with postoperative skin traction and rehabilitation exercises.
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Affiliation(s)
- Xiaoliang Chen
- Department of Pediatrics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China
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41
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Shaĭdaev EZ, Kol'tsov AA. [The up-to-date data on congenital contracture of the elbow joint]. Vestn Khir Im I I Grek 2011; 170:95-98. [PMID: 21674946] [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: 05/30/2023]
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42
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Jain S, Anwar MU, Majumder S. Improved, atraumatic access to digits with severe flexor contractures: surgical tape and suture modification of the lead hand. J Hand Surg Am 2010; 35:1885-6. [PMID: 20961699 DOI: 10.1016/j.jhsa.2010.08.023] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 03/08/2010] [Accepted: 08/26/2010] [Indexed: 02/02/2023]
Abstract
We present a modification to the widely used lead hand retraction system that allows for improved surgical access to a digit with a severe flexor contracture. A simple construct using surgical adhesive tape and a silk suture can be made and applied to the digit and lead hand. Our technique is simple and inexpensive to use, and we recommend its use to improve surgical access without causing unnecessary trauma to the digit.
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Affiliation(s)
- Sameer Jain
- Department of Plastic Surgery, Pinderfields General Hospital, Wakefield, United Kingdom.
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43
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Schuh A, Hönle W, Manolikakis G. [17-year-old patient can neither walk nor stand. Now she can hardly sit]. MMW Fortschr Med 2010; 152:5. [PMID: 20464869 DOI: 10.1007/bf03366436] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Alexander Schuh
- Research Unit, Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Strasse 12, D-92318 Neumarkt i.d.OPf
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Edsander-Nord A, Björklund T, Jurell G, Wickman M. Objective evaluation of two differently-shaped permanent expander prostheses used for breast reconstruction. ACTA ACUST UNITED AC 2009; 38:204-8. [PMID: 15370801 DOI: 10.1080/02844310410027220] [Citation(s) in RCA: 6] [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] [Indexed: 10/26/2022]
Abstract
When a breast is being reconstructed with an implant, a capsule of connective tissue always forms around the implant and a capsular contracture can develop. Radiotherapy increases the incidence of capsular contracture. To evaluate the results after breast reconstruction with differently-shaped textured implants, and the effect of radiotherapy on the softness of the reconstruction, 140 patients given permanent breast expander prostheses between 1994 and 2000 were studied. In 99 patients a round implant and in 41 an anatomically-shaped implant was used. Radiotherapy was given to 24 patients. For objective assessment, applanation tonometry was recorded when the desired breast volume was achieved, and 6 and 12 months later. This study showed that, regardless of the shape of the implant, the softness of the breast reconstruction was similar, as shown by the contact area of the applanation tonometry disc. Radiotherapy transiently reduced the softness of the breast.
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Affiliation(s)
- Asa Edsander-Nord
- Department of Reconstructive Plastic Surgery, Karolinska Hospital, Stockholm, Sweden.
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45
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Abstract
BACKGROUND AND PURPOSE The purpose of this study was to document the outcome of non-surgical management of equinovarus ankle contracture in a cohort of patients with acquired brain injury admitted to a specialist Neurosurgical Rehabilitation Unit. METHODS This prospective descriptive study examined all patients with a new diagnosis of moderate to severe acquired brain injury (Glasgow Coma Scale score </=12) admitted for rehabilitation over a 1 year period. Ankle dorsiflexion range and plantarflexor/invertor muscle activity were evaluated weekly during the period of hospitalization. Contracture was defined as maximal passive range of motion </= 0 degrees dorsiflexion, with the knee extended, on a minimum of two measurement occasions. Patients were retrospectively allocated to one of four treatment outcome categories according to ankle dorsiflexion range, type of intervention required and response to treatment. RESULTS Ankle contracture was identified in 40 of the 105 patients studied. Contracture resolved with a standard physiotherapy treatment programme, including prolonged weight-bearing stretches and motor re-education, in 23 patients. Contracture persisted or worsened in 17 of 40 cases, all of whom exhibited dystonic muscle overactivity producing sustained equinovarus posturing. Ten of 17 cases required serial plaster casting (+/- injection of botulinum toxin type A) in order to achieve a functional range of ankle motion. Remediation of ankle contracture was not considered a priority in the remaining seven patients due to the severity of their overall disability. CONCLUSION The incidence of ankle contracture identified in this population was considerably less than previously reported. Reduced dorsiflexion range was remediated with standard physiotherapy treatment in over half of the cases. Additional treatment with serial casting +/- botulinum toxin type-A injection was required to correct persistent or worsening contracture in one quarter of cases. Dystonic extensor muscle overactivity was a major contributor to persistent or progressive ankle contracture.
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Affiliation(s)
- B J Singer
- The Centre for Musculoskeletal Studies, School of Surgery & Pathology, University of Western Australia, Perth, Australia.
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46
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Abstract
The term "failure of differentiation" describes the phenotypes of a large number of otherwise unrelated conditions. The six conditions described here (arthrogryposis, camptodactyly, clinodactyly, Madelung deformity, trigger finger, and trigger thumb) are believed to occur because various structures failed to differentiate normally; however, they have neither common features nor a common cause. We have included information about the history and diagnosis of these conditions, the cause (if known), and the current concepts of treatment and expected outcomes.
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Affiliation(s)
- Jennifer M Ty
- Department of Orthopaedic Surgery, Alfred I. duPont Hospital for Children, Nemours, Wilmington, DE 19803, USA
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47
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Jagadeesh S, Bhat L, Suresh I, Muralidhar SL. Prenatal diagnosis of restrictive dermopathy. Indian Pediatr 2009; 46:349-351. [PMID: 19383993] [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: 05/27/2023]
Abstract
We report three cases of Restrictive dermopathy from unrelated families. All were small for gestational age with small eyes and open mouth. Taut, stretched skin caused restriction of movements. Clavicular hypoplasia was a consistent radiological feature. Molecular diagnosis in the parents facilitated prenatal diagnosis from chorionic villous sample (CVS) in the subsequent pregnancy.
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Ranjbar SH, Amiri P, Amoli MM, Soltani A. A new mitochondrial mutation in a patient with diabetes mellitus, deafness, hydronephrosis and joint contractures. J Pediatr Endocrinol Metab 2008; 21:1185-9. [PMID: 19189693 DOI: 10.1515/jpem.2008.21.12.1185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/15/2022]
Abstract
A 28-year-old man presented with multiple flexion contractures of hands and feet, deafness, diabetes mellitus and obstructive nephropathy because of bilateral ureterovesicular stricture. Other prominent clinical findings were short stature, bilateral proptosis, multiple freckles and sacralisation of LS. In order to investigate the role of mitochondrial mutations in various clinical manifestations observed in this patient, we performed mutation screening of 1.6 kb mtDNA around the tRNA (Leu(UUR)) part of 16SrRNA and the ND1 gene. No mutation was present at position 3243 which is associated with diabetes mellitus and deafness. A new point mutation (A/G) at position 4093 of the ND1 gene was found. In conclusion, we found a novel mitochondrial mutation in a patient with diabetes and deafness. This mutation has not been reported before and is the first mutation described in the ND1 gene which is related to insulin dependent diabetes mellitus and deafness and could be specific to the Iranian population. All other unusual clinical findings in this patient can be attributed to the presence of this new mutation.
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Affiliation(s)
- Shirin Hasani Ranjbar
- Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
We present a 73-year-old man with isolated adrenocorticotropic hormone deficiency and "flexion contractures" syndrome along with a review of the relevant literature. The patient initially presented anorexia, vomiting, arthralgias, malaise, and weight loss, which progressively deteriorated during the subsequent 6 months. He was admitted to the hospital with fever, confusion, severe cachexia, sinus tachycardia, low blood pressure, hyponatremia, and inability to stand or walk due to severe flexion contractures of the lower extremities (from hips to knees). The flexion contractures were not resolved by physiotherapy or diazepam administration. Due to his life-threatening condition the patient was empirically submitted to glucocorticoid replacement therapy and a remarkable relief from all the above symptoms was observed. A subsequent thorough endocrine investigation suggested the diagnosis of isolated ACTH deficiency (IAD) of unknown pathogenetic mechanism. Hence, in patients with "flexion contractures" syndrome, the pituitary adrenal axis should be evaluated.
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Affiliation(s)
- Vassiliki Syriou
- Department of Pathophysiology, Division of Endocrinology, Athens University Medical School, Laiko Hospital, Athens, Greece.
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Hokken JWE, van den Wall Bake AWL, de Nijs RNJ, Westgeest AAA, Kroot EJ, van Lijnschoten G. [Eosinophilic fasciitis; the importance of early detection for optimal outcomes]. Ned Tijdschr Geneeskd 2008; 152:657-662. [PMID: 18438058] [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: 05/26/2023]
Abstract
Eosinophilic fasciitis (EF) is a disease with unknown aetiology, although an immunologic pathogenesis is suspected. The characteristic features of this inflammatory disease include scleroderma-like skin indurations, predominantly on the extremities, and peripheral blood eosinophilia. Internal organs are generally not affected. Initiation of systemic glucocorticoid therapy at an early stage results in a good response and remission of symptoms. This is illustrated in 3 cases of EF to demonstrate the importance of early detection in this disease.
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Affiliation(s)
- J W E Hokken
- Afd. Interne Geneeskunde, Máxima Medisch Centrum, Veldhoven.
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