[Arterial involvements in hereditary dysplasia of the connective tissue]

[Ocular manifestations of pseudoxanthoma elasticum]

BACKGROUND

Pseudoxanthoma elasticum (PXE) is a hereditary disease characterized by skin, ocular, and cardiovascular lesions. Its prognosis depends mainly on the ocular and vascular lesions.

METHODS

This study included 11 patients with PXE. All patients had an ophthalmologic examination.

RESULTS

All patients had ocular lesions. Seven (63%) had angioid streaks and two, macular lesions. One patient had bilateral intrapapillary drusen (of the optic nerve head).

CONCLUSION

Ocular lesions in PXE had substantial diagnostic value. Ocular complications affect functional prognosis. These patients must undergo routine ophthalmologic examinations to look for ocular manifestations and their complications.

Pseudoxanthome élastique de survenue précoce avec atteinte cardiovasculaire sévère

INTRODUCTION

Pseudoxanthoma elasticum is a rare inherited connective disorder, characterized by elastic tIssue degeneration. The onset of the symptoms usually occurs within the second decade of life.

CASE REPORT

We describe the case of a 15 year-old boy, born to consanguin parents, who presented characteristic cutaneous signs of pseudoxanthoma elasticum. The patient had also presented with severe cardiovascular involvement of early onset, at the age of 6 months. The latter included episodes of ischemic stroke, arterial hypertension, thrombosis of the left iliac and carotid arteries and cardiomegaly. His sister suffered from isolated cutaneous involvement. Diagnosis of pseudoxanthoma elasticum was confirmed on the histology of the skin and molecular analysis in our patient and in his sister revealed the same homozygote mutation.

DISCUSSION

The organs most commonly affected by pseudoxanthoma elasticum are the skin, eyes and vascular system. The cutaneous lesions are characteristic and usually appear around the age of 13. Ophthalmological involvement is frequent. Angioid bands are the most typical lesions; the occur between the ages of 14 and 25. Survival depends on the vascular damage. Conversely to our case report, it usually appears later in life, during the third decade. Arterial hypertension and intestinal bleeding have also been described. The cardiac involvement in our patient is rare. This boy and his sister presented with the same homozygote mutation. Such a major intra-familial clinical variability emphasizes the hypothesis of the absence of any genotype-phenotype relationship in pseudoxanthoma elasticum.

[Cardiovascular manifestations of systemic elastorrhexis]

INTRODUCTION

Systemic elastorrhexis or Grönblad-Strandberg-Touraine syndrome is a rare inherited disease characterized by a generalized elastic tissue dysplasia and polymorphic clinical features, with the main tissues affected being cutaneous, ocular and arterial.

CURRENT KNOWLEDGE AND KEY POINTS

Usual cardiovascular complications of this entity include ischemic heart disease, renovascular hypertension and atherosclerotic peripheral vascular disease. Some cases of restrictive cardiomyopathies and valvular disease have been reported. Coronary artery disease, often with early onset, is seen in approximately 20% of cases.

FUTURE PROSPECTS AND PROJECTS

This review of the literature concerning a rare cause of cardiopathy underlines the need to search for underlying elastorrhexis in the clinical setting of early onset and severe coronary artery disease or arteriopathy, especially in the absence of vascular risk factors. This hereditary disease has been traced to chromosome 16p13.1 and may in the future be easily diagnosed, bypassing the need for cutaneous biopsy.

Congenital aneurysm of the descending aorta in a neonate

A large aneurysm of the descending aorta of unknown etiology was diagnosed in utero. Medical treatment with propranolol was continued after surgery which was performed at the age of 2 months.

A patient with Werner's syndrome and erythroleukemia: just coincidence?

Werner's syndrome is a rare clinical entity and approximately 150 cases have been reported in the medical literature. Werner's syndrome, inherited by autosomal recessive transmission, is characterized primarily by a short stature, premature greying and balding, trophic ulceration of the legs, diabetes mellitus and hypogonadism. These features combine to present a picture of adult progeria. In this brief report we describe a 51-year-old Bedouin male with Werner's syndrome, diagnosed as erythroleukemia (AML-6), and presenting as acute pancytopenia. The patient died two months after diagnosis. This is a rare case of erythroleukemia in a patient with Werner's syndrome. We survey current knowledge of the cytogenetic pathogenesis of Werner's syndrome and erythroleukemia, and attempt to explain the possible link between these two rare syndromes.

Genetic and environmental factors in the function and structure of the arterial wall

In large arteries the structure of the arterial wall determines pulsatile hemodynamics of pressure and flow. Mechanical wall stiffness, wall thickness, and elastin and collagen content vary along the arterial tree. The contribution of genetic and environmental factors to such structural properties is not yet known, but some data are available on possible functional correlates. In hypertensive rats diastolic and pulse pressure have been shown to be linked to two different genes on separate chromosomes. Although a genetic component contributes to intimal calcification, medial hypertrophy is not associated with genetic factors. A study of French West Indies families showed a preferential genetic determinant for pulse pressure in contrast to systolic or diastolic pressure. Environmental and geographic factors are associated with markedly different prevalences of hypertension and age-related increases in arterial stiffening in urban and rural communities in China. Salt consumption has also been implicated in modifications of pulse wave velocity. Recent data on structural parameters of the aortic trunk in oriental (Chinese) and occidental (American and Australian) subjects have shown that the ascending aorta in oriental subjects is of a relatively large diameter and thinner media. This suggests that in this population a relatively higher primary pressure pulse would be generated because of increased stiffness of the proximal aorta. This suggests that factors other than arterial pressure are responsible for structural differences in the aortic wall and that oriental populations may have a predisposition to increased arterial pressure based on structural factors that affect the interaction between ventricular ejection and arterial load.