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Wang Z, Man X. An 18-Year-Old Woman With Recurrent Skin, Nail, and Oral Mucosal Abnormalities. JAMA 2022; 328:1100-1101. [PMID: 35980713 DOI: 10.1001/jama.2022.14460] [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] [Indexed: 11/14/2022]
Abstract
An 18-year-old woman had a 14-year history of recurrent skin, nail, and oral mucosal abnormalities, treated with 3- to 6-month courses of itraconazole; the abnormalities typically recurred within 6 to 12 months of discontinuing itraconazole. Skin scrapings from the lower extremities demonstrated fungal elements; fungal culture of the skin scrapings grew Candida albicans. What is the diagnosis and what would you do next?
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Affiliation(s)
- Zhaoyuan Wang
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyong Man
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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2
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Shih MY, Wu MC, Chen YA, Wang JD. Puffy Eyes and Pale Face. J Pediatr 2021; 228:302-303. [PMID: 32828882 DOI: 10.1016/j.jpeds.2020.08.050] [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] [Received: 08/07/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ming-Yang Shih
- Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Meng-Che Wu
- Division of Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-An Chen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiaan-Der Wang
- Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
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3
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Gychka SG, Shults NV, Nikolaienko SI, Marcocci L, Sariipek NE, Rybka V, Malysheva TA, Dibrova VA, Suzuki YJ, Gavrish AS. Vasa Vasorum Lumen Narrowing in Brain Vascular Hyalinosis in Systemic Hypertension Patients Who Died of Ischemic Stroke. Int J Mol Sci 2020; 21:ijms21249611. [PMID: 33348552 PMCID: PMC7767198 DOI: 10.3390/ijms21249611] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
Ischemic stroke is a major cause of death among patients with systemic hypertension. The narrowing of the lumen of the brain vasculature contributes to the increased incidence of stroke. While hyalinosis represents the major pathological lesions contributing to vascular lumen narrowing and stroke, the pathogenic mechanism of brain vascular hyalinosis has not been well characterized. Thus, the present study examined the postmortem brain vasculature of human patients who died of ischemic stroke due to systemic hypertension. Hematoxylin and eosin staining and immunohistochemistry showed the occurrence of brain vascular hyalinosis with infiltrated plasma proteins along with the narrowing of the vasa vasorum and oxidative stress. Transmission electron microscopy revealed endothelial cell bulge protrusion into the vasa vasorum lumen and the occurrence of endocytosis in the vasa vasorum endothelium. The treatment of cultured microvascular endothelial cells with adrenaline also promoted the formation of the bulge as well as endocytic vesicles. The siRNA knockdown of sortin nexin-9 (a mediator of clathrin-mediated endocytosis) inhibited adrenaline-induced endothelial cell bulge formation. Adrenaline promoted protein-protein interactions between sortin nexin-9 and neural Wiskott–Aldrich syndrome protein (a regulator of actin polymerization). Spontaneously hypertensive stroke-prone rats also exhibited lesions indicative of brain vascular hyalinosis, the endothelial cell protrusion into the lumen of the vasa vasorum, and endocytosis in vasa vasorum endothelial cells. We propose that endocytosis-dependent endothelial cell bulge protrusion narrows the vasa vasorum, resulting in ischemic oxidative damage to cerebral vessels, the formation of hyalinosis, the occurrence of ischemic stroke, and death in systemic hypertension patients.
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Affiliation(s)
- Sergiy G. Gychka
- Department of Pathological Anatomy N2, Bogomolets National Medical University, 01601 Kyiv, Ukraine; (S.I.N.); (V.A.D.); (A.S.G.)
- Correspondence: (S.G.G.); (Y.J.S.); Tel.: +1-202-687-8090 (Y.J.S.)
| | - Nataliia V. Shults
- Department of Pharmacology and Physiology, Georgetown University Medical Center, Washington, DC 20007, USA; (N.V.S.); (N.E.S.); (V.R.)
| | - Sofia I. Nikolaienko
- Department of Pathological Anatomy N2, Bogomolets National Medical University, 01601 Kyiv, Ukraine; (S.I.N.); (V.A.D.); (A.S.G.)
| | - Lucia Marcocci
- Department of Biochemical Sciences “A. Rossi Fanelli”, Sapienza University of Rome, 00185 Rome, Italy;
| | - Nurefsan E. Sariipek
- Department of Pharmacology and Physiology, Georgetown University Medical Center, Washington, DC 20007, USA; (N.V.S.); (N.E.S.); (V.R.)
| | - Vladyslava Rybka
- Department of Pharmacology and Physiology, Georgetown University Medical Center, Washington, DC 20007, USA; (N.V.S.); (N.E.S.); (V.R.)
| | - Tatiana A. Malysheva
- Department of Neuropathomorphology, Romodanov Neurosurgery Institute, 04050 Kyiv, Ukraine;
| | - Vyacheslav A. Dibrova
- Department of Pathological Anatomy N2, Bogomolets National Medical University, 01601 Kyiv, Ukraine; (S.I.N.); (V.A.D.); (A.S.G.)
| | - Yuichiro J. Suzuki
- Department of Pharmacology and Physiology, Georgetown University Medical Center, Washington, DC 20007, USA; (N.V.S.); (N.E.S.); (V.R.)
- Correspondence: (S.G.G.); (Y.J.S.); Tel.: +1-202-687-8090 (Y.J.S.)
| | - Alexander S. Gavrish
- Department of Pathological Anatomy N2, Bogomolets National Medical University, 01601 Kyiv, Ukraine; (S.I.N.); (V.A.D.); (A.S.G.)
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Choi SJ, Yoon HM, Hwang JS, Suh CH, Jung AY, Cho YA, Lee JS. Incidence of Occult Spinal Dysraphism Among Infants With Cutaneous Stigmata and Proportion Managed With Neurosurgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e207221. [PMID: 32614421 PMCID: PMC7333023 DOI: 10.1001/jamanetworkopen.2020.7221] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Occult spinal dysraphism (OSD) is the most common congenital spinal anomaly. Cutaneous anomalies such as skin dimples or deviated gluteal folds are well known as stigmata of OSD and are indicators for further evaluation; however, the association between cutaneous anomalies and OSD has not been systemically evaluated. OBJECTIVE To evaluate the incidence of OSD and the proportion of OSD cases managed with a neurosurgical intervention among neonates or infants with various cutaneous stigmata. DATA SOURCES PubMed and Embase databases were searched for studies published up to July 25, 2018, that evaluated the proportion of OSD cases in neonates or infants with cutaneous stigmata. Search terms included ultrasound, dysraphism, dimple, and infant or neonate. The search was limited to English-language publications. STUDY SELECTION Two reviewers selected the studies evaluating the incidence of OSD among neonates or infants with cutaneous stigmata. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction were followed. Pooled proportions of OSD cases and OSD cases that were managed with a neurosurgical intervention were obtained using the generalized linear mixed model and maximum likelihood method. MAIN OUTCOME AND MEASURES The pooled incidence of OSD and OSD cases managed with neurological surgery among patients with cutaneous stigmata was the primary outcome. This outcome was also evaluated in each subgroup, and heterogeneity was explored using subgroup analysis. RESULTS A total of 15 studies, involving 6558 neonate or infant patients with various cutaneous stigmata, were included. The pooled proportion of OSD cases among the patients with cutaneous stigmata was 2.8% (95% CI, 2.1%-3.8%; I2 = 51.6%), and the proportion managed with neurological surgery was 0.6% (95% CI, 0.3%-1.3%; I2 = 66.4%). Cases with combined stigmata showed a significantly higher association with OSD than those with a single stigma (10.5% [95% CI, 6.9%-15.8%] vs 2.3% [%, 95% CI, 1.5%-3.5%]; P < .001). The pooled proportion of OSD cases among patients with an atypical dimple was significantly higher than among those with simple dimple (8.8% [95% CI, 4.5%-16.6%] vs 0.6% [95% CI of 1.4%-2.1%]; P = .001). CONCLUSIONS AND RELEVANCE The proportion of OSD in healthy, asymptomatic patients with midline cutaneous stigmata was low, and the proportion of patients who underwent a neurosurgical intervention was even lower. However, a careful evaluation as well as potential spinal magnetic resonance imaging is recommended for neonates or infants with combined stigmata or an atypical dimple for possible high-risk lesions.
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Affiliation(s)
- Se Jin Choi
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Mang Yoon
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Sun Hwang
- Department of Radiology, Hallym University Medical Center, Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Chong Hyun Suh
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ah Young Jung
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Ah Cho
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin Seong Lee
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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5
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Lee YK, Chung YH, Burm JS. A congenital accessory skin appendage of the nasal columella and nostril sill: a rare anatomical variation. Surg Radiol Anat 2018; 40:923-926. [PMID: 29468267 DOI: 10.1007/s00276-018-1992-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/15/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE An accessory skin appendage of the nasal columella and nostril sill is an extremely rare congenital anatomical malformation; only a single case has been reported in the literature. However, no pathophysiology has been proposed. The purpose of this study is to present a review of the anatomical distribution of accessory skin appendages and provide a comprehensive review of their pathophysiology based on embryological development. METHODS We present four cases of a protruding skin appendage of the nasal columella or nostril sill. All lesions were present from birth with no family history of skin appendages. Three patients underwent surgical excision under local anesthesia. RESULTS The lesions were located at the upper and lower lateral borders of the nasal columella and the medial and lateral borders of the nostril sill. There has been no sign of recurrence over a mean follow-up of 11 months. CONCLUSIONS Any obstacle or injury during the migration process of embryonic development may result in maldevelopment. If an obstacle or injury occurs during the medial migration of the medial nasal process, congenital polypoid remnant tissue may remain along the migration route, resulting in an accessory skin appendage of the nasal columella. The location of the accessory columellas ranged from the nostril sill to the soft triangle along the anterior border of the medial crus of the alar cartilage. These anatomical distributions correspond exactly to the migration route of the medial nasal process during embryonic development. We believe that it supports our suggested pathophysiology.
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Affiliation(s)
- Yung Ki Lee
- Department of Plastic Surgery, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Young Hun Chung
- Department of Plastic Surgery, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Jin Sik Burm
- Department of Plastic Surgery, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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6
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van der Weijden CP, Joore IK. [A young man with extensive skin abnormalities]. Ned Tijdschr Geneeskd 2018; 161:D2188. [PMID: 29328015] [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: 06/07/2023]
Abstract
A 26-year-old man who has sex with men visited the STI clinic because of increasing skin abnormalities since four months. The patient had macular skin lesions on his penis and scrotum, condylomata lata in the anal region, cutaneous lesions on the feet, and a widespread papular rash. A secondary stage of syphilis was diagnosed.
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7
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Twigg SRF, Hufnagel RB, Miller KA, Zhou Y, McGowan SJ, Taylor J, Craft J, Taylor JC, Santoro SL, Huang T, Hopkin RJ, Brady AF, Clayton-Smith J, Clericuzio CL, Grange DK, Groesser L, Hafner C, Horn D, Temple IK, Dobyns WB, Curry CJ, Jones MC, Wilkie AOM. A Recurrent Mosaic Mutation in SMO, Encoding the Hedgehog Signal Transducer Smoothened, Is the Major Cause of Curry-Jones Syndrome. Am J Hum Genet 2016; 98:1256-1265. [PMID: 27236920 DOI: 10.1016/j.ajhg.2016.04.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/13/2016] [Indexed: 01/20/2023] Open
Abstract
Curry-Jones syndrome (CJS) is a multisystem disorder characterized by patchy skin lesions, polysyndactyly, diverse cerebral malformations, unicoronal craniosynostosis, iris colobomas, microphthalmia, and intestinal malrotation with myofibromas or hamartomas. Cerebellar medulloblastoma has been described in a single affected individual; in another, biopsy of skin lesions showed features of trichoblastoma. The combination of asymmetric clinical features, patchy skin manifestations, and neoplastic association previously led to the suggestion that this could be a mosaic condition, possibly involving hedgehog (Hh) signaling. Here, we show that CJS is caused by recurrent somatic mosaicism for a nonsynonymous variant in SMO (c.1234C>T [p.Leu412Phe]), encoding smoothened (SMO), a G-protein-coupled receptor that transduces Hh signaling. We identified eight mutation-positive individuals (two of whom had not been reported previously) with highly similar phenotypes and demonstrated varying amounts of the mutant allele in different tissues. We present detailed findings from brain MRI in three mutation-positive individuals. Somatic SMO mutations that result in constitutive activation have been described in several tumors, including medulloblastoma, ameloblastoma, and basal cell carcinoma. Strikingly, the most common of these mutations is the identical nonsynonymous variant encoding p.Leu412Phe. Furthermore, this substitution has been shown to activate SMO in the absence of Hh signaling, providing an explanation for tumor development in CJS. This raises therapeutic possibilities for using recently generated Hh-pathway inhibitors. In summary, our work uncovers the major genetic cause of CJS and illustrates strategies for gene discovery in the context of low-level tissue-specific somatic mosaicism.
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Affiliation(s)
- Stephen R F Twigg
- Clinical Genetics Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DS, UK
| | - Robert B Hufnagel
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, MLC 4006, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Kerry A Miller
- Clinical Genetics Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DS, UK
| | - Yan Zhou
- Clinical Genetics Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DS, UK
| | - Simon J McGowan
- Computational Biology Research Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DS, UK
| | - John Taylor
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, University of Oxford, Oxford OX3 7BN, UK; Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK
| | - Jude Craft
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, University of Oxford, Oxford OX3 7BN, UK
| | - Jenny C Taylor
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, University of Oxford, Oxford OX3 7BN, UK; Oxford Biomedical Research Centre, National Institute for Health Research, Oxford OX3 7BN, UK
| | - Stephanie L Santoro
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, MLC 4006, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Taosheng Huang
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, MLC 4006, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Robert J Hopkin
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, MLC 4006, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Angela F Brady
- North West Thames Regional Genetics Service, Kennedy-Galton Centre, Northwick Park Hospital, Harrow HA1 3UJ, UK
| | - Jill Clayton-Smith
- Manchester Centre for Genomic Medicine, St. Mary's Hospital, University of Manchester, Manchester M13 9WL, UK
| | - Carol L Clericuzio
- Division of Genetics/Dysmorphology, Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USA
| | - Dorothy K Grange
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Leopold Groesser
- Department of Dermatology, University of Regensburg, 93053 Regensburg, Germany
| | - Christian Hafner
- Department of Dermatology, University of Regensburg, 93053 Regensburg, Germany
| | - Denise Horn
- Institute for Medical Genetics and Human Genetics, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - I Karen Temple
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; Wessex Clinical Genetics Service, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - William B Dobyns
- Center for Integrative Brain Research, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Cynthia J Curry
- Genetic Medicine, University of California, San Francisco, Fresno, CA 93701, USA
| | - Marilyn C Jones
- Department of Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, CA 92123, USA
| | - Andrew O M Wilkie
- Clinical Genetics Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DS, UK.
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Crabtree S, Lowry D, Tiwari A, Gittoes N. Difficult access in the anaesthetic room leads to a difficult diagnosis. BMJ 2015; 351:h3430. [PMID: 26156143 DOI: 10.1136/bmj.h3430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sarah Crabtree
- Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK
| | - Danielle Lowry
- Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK
| | - Alok Tiwari
- Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK
| | - Neil Gittoes
- Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK
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9
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Sandoval ARH, Flores-Robles BJ, Llanos JC, Porres S, Dardón JDP, Harrison RM. Cutis verticis gyrata as a clinical manifestation of Touraine-Solente-Gole' syndrome (pachydermoperiostosis). BMJ Case Rep 2013; 2013:bcr2013010047. [PMID: 23853021 PMCID: PMC3736327 DOI: 10.1136/bcr-2013-010047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/03/2022] Open
Abstract
Cutis verticis gyrata is a descriptive term for a condition of the scalp consisting of deep grooves and convolutions that resemble the surface of the brain. We present a case of a 22-year-old man who presented with pain and swelling of both knees and hands. Enlarged wrists, ankles and feet were also noted, along with facial seborrhoea, thickening of the skin and deformity of the fingers. Physical examination of the scalp showed a cerebriform appearance with accentuating folds and deep furrows (cutis verticis gyrata), thickening in the face, frontal and parietal regions. Bone enlargement of the hands, knees, ankles and feet was also found. Secondary causes of pachydermoperiostosis were negative.
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10
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Valdés Rodríguez R, Moncada González B, Rivera Rodríguez SP, Aradillas García C, Hernández-Rodríguez H, Torres Álvarez B. [Skin tags and Acanthosis nigricans: association with insulin resistance and overweight in Mexican children]. GAC MED MEX 2011; 147:297-302. [PMID: 21894227] [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: 05/31/2023] Open
Abstract
BACKGROUND Childhood overweight and obesity are a notorious health problem around the world that may lead to an increase in insulin resistance and metabolic syndrome. Acanthosis nigricans (AC) and skin tags (ST) are skin markers that can help to obtain an early diagnose of these metabolic disorders. OBJECTIVE To determine whether such skinmarkers (ST and AN), correlate with insulin resistance based on the assessment of the homeostasis model of insulin resistance (HOMA-IR), and also with overweight and obesity. METHODS Weight, height and body mass index were obtained and accordingly to CDC based on percentiles, and classification was made as follows: underweight, healthy weight, overweight and obesity. Beside insulin, glucose, and HOMA-IR were assessed. RESULTS We included 186 patients age range 6-14 yr, 89 female, 97 male, 10 with underweight, 148 healthy weight, 18 overweight, 10 obese; 18 children presented ST and 29 AN. We found a relationship between the presence of ST and AN with higher BMI and insulin resistance. CONCLUSIONS The presence of skin tags and Acanthosis nigricans correlates with the presence of insulin resistance in children even in healthy weight patients and higher BMI.
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Affiliation(s)
- Rodrigo Valdés Rodríguez
- Departamento de Dermatología, Hospital Central, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
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11
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van Ruth S, Preesman AH. [Diagnostic image (363). A basketball player with skin abnormalities]. Ned Tijdschr Geneeskd 2008; 152:501. [PMID: 18389882] [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: 05/26/2023]
Abstract
A 14-year-old male fanatic basketball player with a good skill of dunking presented with skin abnormalities on the right side of his back due to sports-related striae, stretch marks.
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12
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Abstract
Anhidrotic ectodermal dysplasia is a congenital, generally X-linked dermatosis that associates facial dysmorphy, short stature, and severe blepharitis. The anomalies of the skin are epidermic abnormalities; reduction of the glands of the derm, particularly the sweat glands, explaining the hypohidrosis; onychodysplasia; trichodysplasia; and abnormal dentition. The ophthalmologic manifestations are palpebral anomalies with a reduction in or an absence of Meibomian glands, dysfunction of the Moll and Zeis glands, leading to chronic squamous blepharitis and lacrimal punctal atresia. These anomalies result in severe attacks of the ocular surface, developing during the second decade, which are often invalidating and require a rigorous follow-up to avoid corneal complications.
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Affiliation(s)
- J Allali
- Service d'Ophtalmologie Groupe Hospitalier Necker-Enfants Malades, Paris.
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13
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Abstract
Seven patients with bi-acromial dimples are reported, with a family history in only one. This skin condition presented as an anatomic peculiarity without associated abnormalities. Although it has been previously documented as a finding in malformation syndromes such as the 18q syndrome, we point out that it may be found quite frequently in isolation and without morbidity. Therefore, it should be mainly considered as an anatomic variation without pathologic significance.
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14
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Scheithauer MO, Rettinger G. Gestörte Schutzfunktion der GesichtshautOperative Behandlung bei Funktionsstörungen der Gesichtshaut. Laryngorhinootologie 2005; 84 Suppl 1:S233-47. [PMID: 15846556 DOI: 10.1055/s-2005-861148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M O Scheithauer
- HNO-Klinik und Poliklinik des Universitätsklinikums Ulm, Prittwitzstrasse 45, 89075 Ulm.
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15
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Abstract
We describe two cases of oculocerebrocutaneous syndrome (OCCS) or Delleman syndrome, characterized by congenital anomalies that involve the skin, orbit, and central nervous system (CNS). Complete MRI studies of the orbit, CNS and the entire spinal region must be performed in these cases. New MRI techniques can show cortical malformations, such as polymicrogyria, lissencephaly, or abnormal disposition of cortical sulci and gyri. Lesions can be bilateral or unilateral, as occurred in our patients. In one case, the ocular, skin, cerebral, and cerebellar lesions involved mainly the same side, whereas in the second case, all anomalies were generalized and the patient also showed skin hypopigmented lesions distributed bilaterally. Both patients show severe encephalopathy and Dandy-Walker malformation. One case is blind and shows generalized hydrocephalus, and the other one has vision through an eye, and has complete agenesis of the corpus callosum and severe disorder of neuronal migration and cortical organization with polymicrogyria and abnormal cortical sulci and gyri in a cerebral hemisphere. Our second case shows arachnoid cysts in both temporal, retrocerebellar, and spinal (D(8)-D(11)) regions, and lipoma in the pontomedullary and spinal (D(4)-D(7)) regions. The latter features correspond more to ECCL than to OCCS. The overlap between the two syndromes is unquestionable and it is possible that they constitute different manifestations of the same disorder.
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16
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Adolphe C, Narang M, Ellis T, Wicking C, Kaur P, Wainwright B. An in vivo comparative study of sonic, desert and Indian hedgehog reveals that hedgehog pathway activity regulates epidermal stem cell homeostasis. Development 2004; 131:5009-19. [PMID: 15371305 DOI: 10.1242/dev.01367] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Despite the well-characterised role of sonic hedgehog (Shh) in promoting interfollicular basal cell proliferation and hair follicle downgrowth, the role of hedgehog signalling during epidermal stem cell fate remains largely uncharacterised. In order to determine whether the three vertebrate hedgehog molecules play a role in regulating epidermal renewal we overexpressed sonic(Shh), desert (Dhh) and Indian (Ihh) hedgehog in the basal cells of mouse skin under the control of the human keratin 14 promoter. We observed no overt epidermal morphogenesis phenotype in response to Ihh overexpression, however Dhh overexpression resulted in a range of embryonic and adult skin manifestations indistinguishable from Shh overexpression. Two distinct novel phenotypes were observed amongst Shh and Dhh transgenics, one exhibiting epidermal progenitor cell hyperplasia with the other displaying a complete loss of epidermal tissue renewal indicating deregulation of stem cell activity. These data suggest that correct temporal regulation of hedgehog activity is a key factor in ensuring epidermal stem cell maintenance. In addition, we observed Shh and Dhh transgenic skin from both phenotypes developed lesions reminiscent of human basal cell carcinoma (BCC), indicating that BCCs can be generated despite the loss of much of the proliferative (basal) compartment. These data suggest the intriguing possibility that BCC can arise outside the stem cell population. Thus the elucidation of Shh (and Dhh)target gene activation in the skin will likely identify those genes responsible for increasing the proliferative potential of epidermal basal cells and the mechanisms involved in regulating epidermal stem cell fate.
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Affiliation(s)
- Christelle Adolphe
- Institute for Molecular Bioscience, and Special Research Centre for Functional and Applied Genomics, University of Queensland, Victoria, Australia
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17
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Affiliation(s)
- Angela Lin
- Genetics and Teratology Unit, Pediatric Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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18
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Abstract
BACKGROUND Reconstruction of nasal alar defects is difficult because of the complex anatomy of the region. A frequent challenge in this area is repair of small cutaneous defects involving the lateral nasal supratip and the superior alar groove. OBSERVATIONS An oblique advancement flap that uses laxity from the nasal sidewall is described. Its benefits and limitations are compared with those of alternative closures. Overall, the oblique advancement flap preserves the superior alar groove, while minimizing tissue contortion. It is technically similar to a primary closure but functionally and aesthetically superior. CONCLUSIONS For selected small lateral nasal supratip defects impinging on the superior alar groove, the oblique advancement flap offers a simple, visually pleasing repair that preserves the alar architecture.
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Affiliation(s)
- Murad Alam
- Division of Cutaneous and Aesthetic Surgery, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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19
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Smith H, Elliot T, Vinciullo C. Repair of nasal tip and alar defects using cheek-based 2-stage flaps: an alternative to the median forehead flap. Arch Dermatol 2003; 139:1033-6. [PMID: 12925392 DOI: 10.1001/archderm.139.8.1033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe our use of cheek-based 2-stage transposition flaps for repairing Mohs surgery defects of the lower third of the nose. DESIGN Retrospective case series. SETTING Private dermatologic day surgery facility. Patients Twenty-eight patients with defects of the lower third of the nose after Mohs surgery. Intervention Ten alar and 18 nasal tip defects repaired using cheek-based 2-stage transposition flaps. MAIN OUTCOME MEASURES Acceptability of procedure to patient, complications, and appearance from photographic records. RESULTS The procedures were well tolerated and achieved good cosmetic results without major complications. CONCLUSIONS These flaps allow repair of extensive defects of the nasal tip and ala with the patient under local anesthesia. This approach provides an alternative to the median forehead flap for nasal tip repairs.
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Affiliation(s)
- Harvey Smith
- Dermatology, Surgery, and Laser Center, Perth Surgicenter, South Perth, Australia
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20
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Abstract
We report a child with Costello syndrome and Chiari I malformation. The medical literature has several case reports of findings peculiar for each of these two clinical entities that, when investigated, can actually be found in both processes. Recent reports have shown additional medical coincidences for the Chiari I malformation, which, unlike the Chiari II malformation, was once thought not to have many additional associations. We propose that both Costello syndrome and other clinical entities that have potential mesodermal or ectodermal deficiencies (eg, Chiari I malformation and phakomatoses, respectively) could have common dysgeneses. Further case reports from other institutions regarding Costello syndrome and Chiari I malformation are now necessary to confirm our findings. Our hope is that these data will potentially add to our knowledge of the etiology of both Costello syndrome and Chiari I malformation and potentially aid in the definition of a genetic locus for both entities.
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Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, USA.
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21
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Gosselin TK, Pavilonis H. Head and neck cancer: managing xerostomia and other treatment induced side effects. ORL Head Neck Nurs 2003; 20:15-22. [PMID: 12476597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Patients diagnosed with head and neck cancer face a myriad of treatment options. Each treatment is accompanied by acute and chronic side effects. Xerostomia is a side effect of radiation therapy and, if not managed properly, can disrupt the patient's quality of life and lead to other health related issues. This article provides a broad overview of head and neck cancer and examines the current modalities utilized in the treatment and prevention of xerostomia.
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Affiliation(s)
- Tracy K Gosselin
- Department of Radiation Oncology, Duke University Medical Center in Durham, North Carolina, USA
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22
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Abstract
Skin dimples are seldom observed in sites other than the face. We report on a male premature child who was seen at the age of 2 months for the evaluation of cutaneous depressions symmetrically located on the shoulders, elbows and in the sacral region. Skin dimples have sometimes been considered a benign autosomal dominant trait. However, several authors have reported these cutaneous defects in a variety of conditions like congenital syndromes, infections, inborn errors of metabolism and mechanical trauma. In our case, the aetiology is unknown, even though maternal drug or infective exposure can reasonably be excluded as well as traumatic events. At a 3-year follow-up, the patient shows a normal psychophysical development. This appears to be the first case of a child presenting congenital, symmetric dimples in three different areas.
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Affiliation(s)
- Annarosa Virgili
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Ferrara, Italy.
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23
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Prigent F. [Transverse nasal line in childhood]. Ann Dermatol Venereol 2001; 128:260. [PMID: 11319396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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24
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Brakebusch C, Grose R, Quondamatteo F, Ramirez A, Jorcano JL, Pirro A, Svensson M, Herken R, Sasaki T, Timpl R, Werner S, Fässler R. Skin and hair follicle integrity is crucially dependent on beta 1 integrin expression on keratinocytes. EMBO J 2000; 19:3990-4003. [PMID: 10921880 PMCID: PMC306586 DOI: 10.1093/emboj/19.15.3990] [Citation(s) in RCA: 286] [Impact Index Per Article: 11.9] [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: 11/13/2022] Open
Abstract
beta 1 integrins are ubiquitously expressed receptors that mediate cell-cell and cell-extracellular matrix interactions. To analyze the function of beta1 integrin in skin we generated mice with a keratinocyte-restricted deletion of the beta 1 integrin gene using the cre-loxP system. Mutant mice developed severe hair loss due to a reduced proliferation of hair matrix cells and severe hair follicle abnormalities. Eventually, the malformed hair follicles were removed by infiltrating macrophages. The epidermis of the back skin became hyperthickened, the basal keratinocytes showed reduced expression of alpha 6 beta 4 integrin, and the number of hemidesmosomes decreased. Basement membrane components were atypically deposited and, at least in the case of laminin-5, improperly processed, leading to disruption of the basement membrane and blister formation at the dermal-epidermal junction. In contrast, the integrity of the basement membrane surrounding the beta 1-deficient hair follicle was not affected. Finally, the dermis became fibrotic. These results demonstrate an important role of beta 1 integrins in hair follicle morphogenesis, in the processing of basement membrane components, in the maintenance of some, but not all basement membranes, in keratinocyte differentiation and proliferation, and in the formation and/or maintenance of hemidesmosomes.
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Affiliation(s)
- C Brakebusch
- Department of Experimental Pathology, Lund University, S-221 85 Lund, Sweden
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25
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Abstract
We report on a newborn black male twin with a distinctive circumferential abdominal skin defect who was identified through the Active Malformation Surveillance Program at the Brigham and Women's Hospital. There were no other malformations, and amniotic disruption was not present. Although it cannot be proven, we believe that this skin defect may have been caused by in utero encirclement of the abdomen by an umbilical cord.
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Affiliation(s)
- A E Lin
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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26
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27
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Reichert S, Cocciale MP, Lemelle JL, Barbaud A, Schmitt M, Weber M, Schmutz JL. [Congenital skin defect and fetus papyraceus. A case]. Ann Dermatol Venereol 1998; 124:470-3. [PMID: 9739913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Congenital skin defect is an uncommon condition. The term of "congenital skin aplasia" should be avoided since the origin may not necessarily be congenital malformation. The scalp is involved in 80 p. 100 of the cases. CASE REPORT We observed a congenital skin defect located exclusively on the trunk. The infant lacked wide areas of skin in symmetrical star-like configurations. DISCUSSION The notion of a twin expulsed after 4 months gestation suggested the diagnosis of congenital skin defect and fetus papyraceus or group V congenital skin aplasia in the Frieden classification as recalled. This diagnosis must not be overlooked as the prognosis is good. Closure with atrophic skin usually occurs within a few weeks. The etiopathogenesis remains obscure.
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Affiliation(s)
- S Reichert
- Service de Dermatologie, Hôpital Fournier, Nancy
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28
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Toribio RE, Bain FT, Mrad DR, Messer NT, Sellers RS, Hinchcliff KW. Congenital defects in newborn foals of mares treated for equine protozoal myeloencephalitis during pregnancy. J Am Vet Med Assoc 1998; 212:697-701. [PMID: 9524643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Three weak, recumbent neonatal foals with skin lesions, including a thin wooly coat, were born to mares being treated for equine protozoal myeloencephalitis. Mares received sulfadiazine or sulfamethoxazole-trimethoprim, pyrimethamine, folic acid, and vitamin E orally. Foals were anemic, leukopenic, azotemic, hyponatremic, and hyperkalemic. Serum folate concentrations in the 3 foals and 2 mares were lower than those reported in the literature for clinically normal brood mares. Treatment was unsuccessful. For each foal, necropsy revealed lobulated kidneys with thin cortices and a pale medulla, and the spleen and thymus were small. Histologic examination revealed marked epidermal necrosis without inflammatory cells, thin renal cortices, renal tubular nephrosis, lymphoid aplasia, and bone marrow aplasia and hypoplasia. These observations indicate that oral administration of sulfonamides, 2,4-diaminopyrimidines (pyrimethamine with or without trimethoprim), and folic acid to mares during pregnancy is related to congenital defects in newborn foals.
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MESH Headings
- Abnormalities, Multiple/chemically induced
- Abnormalities, Multiple/etiology
- Abnormalities, Multiple/veterinary
- Administration, Oral
- Animals
- Animals, Newborn/abnormalities
- Anti-Infective Agents/adverse effects
- Anti-Infective Agents/therapeutic use
- Bone Marrow/abnormalities
- Encephalomyelitis/drug therapy
- Encephalomyelitis/embryology
- Encephalomyelitis/veterinary
- Female
- Folic Acid/administration & dosage
- Folic Acid/adverse effects
- Folic Acid/therapeutic use
- Folic Acid Antagonists/adverse effects
- Folic Acid Antagonists/therapeutic use
- Horses/abnormalities
- Kidney/abnormalities
- Pregnancy
- Pregnancy Complications, Parasitic/drug therapy
- Pregnancy Complications, Parasitic/veterinary
- Protozoan Infections, Animal/drug therapy
- Protozoan Infections, Animal/embryology
- Pyrimethamine/adverse effects
- Pyrimethamine/therapeutic use
- Skin Abnormalities/chemically induced
- Skin Abnormalities/etiology
- Skin Abnormalities/veterinary
- Sulfadiazine/adverse effects
- Sulfadiazine/therapeutic use
- Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects
- Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
- Vitamin E/adverse effects
- Vitamin E/therapeutic use
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Affiliation(s)
- R E Toribio
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus 43210, USA
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29
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Andrä K, Lassmann H, Bittner R, Shorny S, Fässler R, Propst F, Wiche G. Targeted inactivation of plectin reveals essential function in maintaining the integrity of skin, muscle, and heart cytoarchitecture. Genes Dev 1997; 11:3143-56. [PMID: 9389647 PMCID: PMC316746 DOI: 10.1101/gad.11.23.3143] [Citation(s) in RCA: 241] [Impact Index Per Article: 8.9] [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: 02/05/2023]
Abstract
Previous studies suggest that plectin, a versatile cytoskeletal linker protein, has an important role in maintaining the structural integrity of diverse cells and tissues. To establish plectin's function in a living organism, we have disrupted its gene in mice. Plectin (-/-) mice died 2-3 days after birth exhibiting skin blistering caused by degeneration of keratinocytes. Ultrastructurally, hemidesmosomes and desmosomes appeared unaffected. In plectin-deficient mice, however, hemidesmosomes were found to be significantly reduced in number and apparently their mechanical stability was altered. The skin phenotype of these mice was similar to that of patients suffering from epidermolysis bullosa simplex (EBS)-MD, a hereditary skin blistering disease with muscular dystrophy, caused by defects in the plectin gene. In addition, plectin (-/-) mice revealed abnormalities reminiscent of minicore myopathies in skeletal muscle and disintegration of intercalated discs in heart. Our results clearly demonstrate a general role of plectin in the reinforcement of mechanically stressed cells. Plectin (-/-) mice will provide a useful tool for the study of EBS-MD, and possibly other types of plectin-related myopathies involving skeletal and cardiac muscle, in an organism amenable to genetic manipulation.
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MESH Headings
- Animals
- Animals, Newborn
- Cell Line
- Desmosomes
- Disease Models, Animal
- Epidermolysis Bullosa Simplex/etiology
- Epidermolysis Bullosa Simplex/genetics
- Female
- Gene Deletion
- Heart/physiology
- Heart Defects, Congenital/etiology
- Heart Defects, Congenital/genetics
- Humans
- Intermediate Filament Proteins/deficiency
- Intermediate Filament Proteins/genetics
- Intermediate Filament Proteins/physiology
- Keratinocytes/cytology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Inbred DBA
- Mice, Knockout
- Muscle, Skeletal/abnormalities
- Muscle, Skeletal/physiology
- Muscle, Skeletal/ultrastructure
- Myocardium/ultrastructure
- Plectin
- RNA, Messenger
- Skin Abnormalities/etiology
- Skin Abnormalities/genetics
- Skin Abnormalities/pathology
- Skin Physiological Phenomena
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Affiliation(s)
- K Andrä
- Institute of Biochemistry and Molecular Cell Biology, Vienna Biocenter, 1030 Vienna, Austria
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30
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Abstract
The oculocerebrocutaneous (OCC) syndrome is characterized by the presence of orbital cysts and microphthalmia/anophthalmia, focal hypo- and aplastic skin defects, skin appendages and cerebral malformations. Most of the patients suffer from psychomotor retardation and seizures. To date, 23 patients in total have been reported. We report on three additional cases which illustrate the broad clinical spectrum of this disorder. In one case, the differentiation between OCC syndrome and encephalocraniocutaneous lipomatosis was difficult. A brief review of the clinical features of OCC syndrome is given. Possible aetiological hypotheses are discussed, namely survival of a lethal mutation by mosaicism, an autosomal dominant mutation and external causal factors. Disruption of the anterior neuroectodermal plate seems to be the most probable pathogenic mechanism.
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Affiliation(s)
- U Moog
- Department of Molecular Cell Biology and Genetics, Maastricht University, The Netherlands
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