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Kilawa SI, Nkya GZ, Shoo RR, Mrimba PM, Temu RJ, Shirima OA. Megadactyly with syndactyly of the right toes, a rare case report. Int J Surg Case Rep 2024; 119:109723. [PMID: 38692121 DOI: 10.1016/j.ijscr.2024.109723] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Megadactyly of the foot is uncommon non hereditary congenital anomalies of the extremities and poses a dilemma on treatment however multiple treatment modalities were developed but is not uniform to all patients with megadactyly. The goal of the surgical treatment is to achieve painless and function of the foot. CASE PRESENTATION We report a 14 years old male presented with complaints of progressive enlargement 2nd, 3rd, 4th and 5th toes of the right foot since birth, associated with inability to wear shoes. One month prior to admission he experienced gradual onset painful forefoot and toes that was increasing in severity with time associated with inability to walk normally. He is the first born in a family of four children and his other siblings are healthy with no anomalies. On clinical evaluation, he was health with stable vitals, with enlarged 2nd, 3rd, 4th and 5th toes of the right foot with no tenderness with intact neurovascular status. On clinical and radiological evaluation he was diagnosed with congenital megadactyly of the right foot, a multidisciplinary team including orthopedic surgeons and prosthetics team agreed to do trans-metatarsal, then partial foot prosthesis fabrication. He underwent trans-metatarsal amputation of the affected foot and tissue sample was taken for histopathology. The histological findings revealed bone enlargement with increased proliferation of subcutaneous adipose tissues with increased fibrous septae together with thinning of the epidermis, features suggestive of lipomatosis. The wound site healed very well after 14 days stitches were removed and the child was scheduled for follow-up after six weeks, 12 weeks and 6 month post-surgery. On the last visit he was free from pain on his right forefoot and toes, able to wear fabricated partial foot prosthesis and shoes normally, walk with no incapacitation. DISCUSSION Our case report is unique due to the involvement of the multiple toes of the right foot with syndactyly at third and fourth toes and its management is challenging because there is no uniformity in its surgical treatment, in our case trans-metatarsal amputation was done and the patient progressed well after six months of follow up. CONCLUSION Foot megadactyly is uncommon congenital malformation, most common on the right foot. Regardless of the dilemma on treatment, the trans-metatarsal amputation and a fabricated prosthesis to our patient fulfilled the goals of painless right foot and able to wear shoes and walk normally with no impairment.
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Affiliation(s)
- Shindo Isack Kilawa
- Department of Orthopedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | | | - Reginald R Shoo
- Department of Orthopedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Peter Magembe Mrimba
- Department of Orthopedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rogers J Temu
- Department of Orthopedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Octavian A Shirima
- Department of Orthopedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Zhao C, Gao C, Zhu Y, Zhang Q, Lin P. A novel GLI3 frameshift mutation in a Chinese pedigree with polydactyly: A case report. Heliyon 2024; 10:e28638. [PMID: 38571622 PMCID: PMC10988035 DOI: 10.1016/j.heliyon.2024.e28638] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Background GLI3 gene mutations can result in various forms of polysyndactyly, such as Greig cephalopolysyndactyly syndrome (GCPS, MIM: #175700), Pallister-Hall syndrome (PHS, MIM: #146510), and isolated polydactyly (IPD, MIM: #174200, #174700). Reports on IPD-associated GLI3 mutations are rare. In this study, a novel GLI3 mutation was identified in a Chinese family with IPD. Results We report a family with six members affected by IPD. The family members demonstrated several special phenotypes, including sex differences, abnormal finger joint development, and different polydactyly types. We identified a novel frameshift variant in the GLI3 gene (NM_000168.6: c.1820_1821del, NP_000159.3: p.Tyr607Cysfs*9) by whole-exome sequencing. Further analysis suggested that this mutation was the cause of polydactyly in this family. Conclusions The discovery of this novel frameshift variant in our study further solidifies the relationship between IPD and GLI3 and expands the previously established spectrum of GLI3 mutations and associated phenotypes.
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Affiliation(s)
- Chi Zhao
- Department of Orthopaedic Surgery, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, 321000, China
| | - Chengcheng Gao
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou, Zhejiang Province, 310030, China
| | - Yijun Zhu
- Department of Clinical Laboratory, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, 321000, China
| | - Qi Zhang
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou, Zhejiang Province, 310030, China
| | - Ping Lin
- Department of Orthopaedic Surgery, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, 321000, China
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Mangla M, Kaliappan A, Srirambhatla A, Chandrupatla M, Motwani R, Kumar N, Roy S. Fraser syndrome with limb reduction defect: a rare and unique anatomic variation. Surg Radiol Anat 2024; 46:501-506. [PMID: 38310170 DOI: 10.1007/s00276-024-03299-9] [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: 10/19/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Fraser syndrome, named after George Fraser, is an autosomal recessive disorder showing a highly variable interfamilial phenotypic variation, with malformations ranging from minor symptoms to lethal anomalies like renal agenesis, incompatible with survival. Limb reduction defects have not been reported to be associated with it. CASE PRESENTATION A 21-year-old primigravida presented to the antenatal outpatient department with a level two targeted anomaly scan report suggestive of severe oligohydramnios with suspected renal agenesis. The cranial vault bones were compressed, and orbital globes and lenses could not be visualized. Renal agenesis was confirmed due to sleeping adrenals sign, non-visualization of the urinary bladder, and Doppler of renal arteries. A detailed examination of the fetal head in the sagittal section showed the absence of an eye globe and lens, arousing suspicion of Fraser syndrome. After pregnancy termination, a complete fetal autopsy was done to look for any additional findings. CONCLUSION Patients who have a syndromic mix of acrofacial and urogenital abnormalities with or without cryptophthalmos should be evaluated for Fraser syndrome, which can be diagnosed by clinical examination and perinatal autopsy.
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Affiliation(s)
- Mishu Mangla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Ariyanachi Kaliappan
- Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Annapurna Srirambhatla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, 508126, Hyderabad, India.
| | - Mrudula Chandrupatla
- Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Rohini Motwani
- Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Naina Kumar
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Subhrajyoti Roy
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
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Zhou X, Li T, Kuang H, Zhou Y, Xie D, He J, Xiao J, Chen C, Jiang Y, Fang J, Wang H. Epidemiology of congenital polydactyly and syndactyly in Hunan Province, China. BMC Pregnancy Childbirth 2024; 24:216. [PMID: 38521899 PMCID: PMC10960469 DOI: 10.1186/s12884-024-06417-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE To describe the prevalence and epidemiology of congenital polydactyly and syndactyly in Hunan Province, China, 2016-2020. METHODS Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2016-2020. Prevalence of birth defects (polydactyly or syndactyly) is the number of cases per 1000 births (unit: ‰). Prevalence and 95% confidence intervals (CI) were calculated by the log-binomial method. Chi-square trend tests (χ2trend) were used to determine trends in prevalence by year. Crude odds ratios (ORs) were calculated to examine the association of each demographic characteristic with polydactyly and syndactyly. RESULTS Our study included 847,755 births, and 14,459 birth defects were identified, including 1,888 polydactyly and 626 syndactyly cases, accounting for 13.06% and 4.33% of birth defects, respectively. The prevalences of total birth defects, polydactyly, and syndactyly were 17.06‰ (95%CI: 16.78-17.33), 2.23‰ (95%CI: 2.13-2.33), and 0.74‰ (95%CI: 0.68-0.80), respectively. Most polydactyly (96.77%) and syndactyly (95.69%) were diagnosed postnatally (within 7 days). From 2016 to 2020, the prevalences of polydactyly were 1.94‰, 2.07‰, 2.20‰, 2.54‰, and 2.48‰, respectively, showing an upward trend (χ2trend = 19.48, P < 0.01); The prevalences of syndactyly were 0.62‰, 0.66‰, 0.77‰, 0.81‰, and 0.89‰, respectively, showing an upward trend (χ2trend = 10.81, P = 0.03). Hand polydactyly (2.26‰ vs. 1.33‰, OR = 1.69, 95%CI: 1.52-1.87) and hand syndactyly (0.43‰ vs. 0.28‰, OR = 1.42, 95%CI: 1.14-1.76) were more common in males than females. Polydactyly (2.67‰ vs. 1.93‰, OR = 1.38, 95%CI: 1.26-1.51) and syndactyly (0.91‰ vs. 0.62‰, OR = 1.47, 95%CI: 1.26-1.72) were more common in urban areas than in rural areas. Compared to maternal age 25-29, hand polydactyly was more common in maternal age < 20 (2.48‰ vs. 1.74‰, OR = 1.43, 95%CI: 1.01-2.02) or ≥ 35 (2.25‰ vs. 1.74‰, OR = 1.30, 95%CI: 1.12-1.50). CONCLUSION In summary, we have described the prevalence and epidemiology of polydactyly and syndactyly from hospital-based surveillance in Hunan Province, China, 2016-2020. Our findings make some original contributions to the field, which may be valuable for future research.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Ting Li
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Haiyan Kuang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Ying Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Donghua Xie
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Jian He
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Juan Xiao
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Chanchan Chen
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Yurong Jiang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China.
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China.
| | - Hua Wang
- The Hunan Children's Hospital, Changsha, Hunan Province, 410000, China.
- National Health Commission Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, 410000, China.
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Eksi MA, Ozdemir Sahan Y, Koca S, Ozeke O. An unruly case of functional 2:1 atrioventricular block. Heart Rhythm 2024:S1547-5271(24)00246-7. [PMID: 38461920 DOI: 10.1016/j.hrthm.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Muhammed Ali Eksi
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yasemin Ozdemir Sahan
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Serhat Koca
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey.
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Estanbouli MA, Anadani A, Albobah H, Dakkak T, Mokresh R, Etr A. Late management of amniotic bands syndrome with incomplete syndactyly: A case report of 4-year-old child. Int J Surg Case Rep 2024; 115:109277. [PMID: 38262220 PMCID: PMC10830882 DOI: 10.1016/j.ijscr.2024.109277] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Amniotic band syndrome is a fetal entrapment in strands of amniotic tissue. This condition causes multiple deformities ranging from simple constricting bands to lymphedema, autoamputation, syndactyly and other congenital anomalies. Reconstructive surgery is the main treatment for ABS. PRESENTATION OF CASE A 4-year-old male presented with multiple constricting bands affecting both hands in addition to an incomplete syndactyly between the third and fourth left digits. A two-staged operation was performed to repair the deformities with 6 months interval. Series of Z-plasties were used to release the constricting bands and the syndactyly was separated by a web zigzag incision approach and full-thickness skin grafting. DISCUSSION Management of ABS must be individualized. The urgency of the surgical release depends on the depth of the constricting bands and their influence on circulation and lymphatic drainage. Superficial bands can be released electively for cosmetic appearance while deep bands should be released as soon as possible. The separation of syndactyly should be done at the first year of life to maintain the digits functionality and parallel growth. CONCLUSION This paper emphasizes the importance of early repair of constricting bands associated with syndactyly to avoid the consequences of the delay on digital growth.
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Affiliation(s)
| | | | - Hala Albobah
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Tala Dakkak
- Faculty of Medicine, Hama University, Hama, Syrian Arab Republic
| | - Raneem Mokresh
- Department of Plastic Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Aladdin Etr
- Department of Plastic Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
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Matthews A, Timothy K, Golden A, Gonzalez Corcia MC. International Cohort of Neonatal Timothy Syndrome. Neonatology 2024:1-8. [PMID: 38211567 DOI: 10.1159/000535221] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/06/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Timothy syndrome (TS) is an extremely rare, multisystem disorder classically associated with long QT, syndactyly, ventricular arrhythmias, and hypoglycaemia. A neonatal diagnosis allows maximal medical and device therapy to be implemented to avoid malignant arrhythmias and sudden cardiac death. METHODS This was a retrospective case series study of type I TS (TS1) patients using data from the Timothy Syndrome Foundation's international registry, encompassing patients with a genetic diagnosis (CACNA1C variant G406R in exon 8A) recruited over a 28-year period. RESULTS Forty-four cases of TS1 were included (26 male; 60%). Mean gestational age (GA) was 35.6 weeks (range 28 weeks - term), with 43% of patients born less than 37 weeks GA. In TS1 patients presenting with foetal bradycardia, mean GA was significantly lower (34.2 weeks, p < 0.05). Foetal bradycardia secondary to atrioventricular block was present in 20 patients (45%), resulting in premature delivery in 14 patients (32%). Fifteen patients (34%) were diagnosed with TS1 as neonates. Long QT at birth helped secure a diagnosis in 25 patients (57%). Syndactyly was seen in most patients (n = 40, 91%). Twenty patients died, with an average age of death of 2.3 years (range 1 month-6 years). Of the 7 patients who died before the first year of life (16%), the average age of death was 2.5 months. CONCLUSION TS is associated with high early mortality. TS should be considered in paediatric patients presenting with long QT and syndactyly. Recognition of TS in the neonatal period allows for early intervention to prevent life-threatening arrhythmias.
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Affiliation(s)
- Alexandra Matthews
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, London, UK
| | - Katherine Timothy
- The Timothy Syndrome Foundation, Charitable Organization, Ellicott City, Maryland, USA
| | - Andy Golden
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, Maryland, USA
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Sánchez Godoy L, Hernández Barceló JE. [About a case of Fraser syndrome. Autopsy of a 37 weeks gestation fetus with multiple malformations]. Rev Esp Patol 2024; 57:64-66. [PMID: 38246713 DOI: 10.1016/j.patol.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/13/2023] [Accepted: 07/09/2023] [Indexed: 01/23/2024]
Abstract
Fraser syndrome or cryptophthalmos-syndactyly syndrome is a rare genetic disease, the diagnosis of which is based on a series of major and minor clinical criteria and that can be supported by genetic tests. This article presents the case of a fetal autopsy at 37 weeks of gestation with suspicion of CHAOS syndrome (congenital obstructive syndrome of the upper airways).
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Affiliation(s)
- Laura Sánchez Godoy
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
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Tonkin M, Donaldson M, Graham D, Marshall T, Yang OO. Utilization of the web index in the measurement of web creep after syndactyly surgery. J Hand Surg Eur Vol 2023; 48:1184-1190. [PMID: 37395396 DOI: 10.1177/17531934231184134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The aim of this study was to explore the feasibility of using a web index to measure web creep after syndactyly surgery. A total of 19 hands in nine children (six preoperatively and 13 immediately postoperatively) underwent measurement of their web position. A preliminary study confirmed that the web index measured on the child's hand at the time of surgery was similar to that measured on photographs taken at the same time. Subsequently, an intra- and inter-observer error rate found excellent agreement among four observers measuring the web index using photographs. Of 13 postoperative webs using a winged central rectangular web flap without skin grafting, 12 were re-measured using photographs at an average of 88 months (range 78 to 96) after surgery. There was evidence of minor web creep in one web only. Our study demonstrates the efficacy of web index calculation on photographs to measure web position in children after syndactyly surgery. The study also demonstrates the effectiveness of the graftless winged central rectangular web flap technique in avoiding web creep.Level of evidence: IV.
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Affiliation(s)
- Michael Tonkin
- University of Sydney Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Matthew Donaldson
- Royal North Shore Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - David Graham
- Gold Coast University Hospital Department of Musculoskeletal Services, Southport, QLD, Australia
- Queensland Children's Hospital. Department of Orthopaedic Surgery, South Brisbane, QLD, Australia
| | - Timothy Marshall
- Department of Orthopaedics. Launceston General Hospital, Launceston, TAS, Australia
| | - Owen Ou Yang
- South Western Sydney Hand Centre, Fairfield Hospital, Prairiewood, NSW, Australia
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Bartsch A, Nikkhah D, Miller R, Mende K, Hovius SER, Kaempfen A. Correction of symbrachydactyly: a systematic review of surgical options. Syst Rev 2023; 12:218. [PMID: 37974291 PMCID: PMC10652478 DOI: 10.1186/s13643-023-02362-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
Symbrachydactyly is a rare congenital malformation of the hand characterized by short or even absent fingers with or without syndactyly, mostly unilaterally present. The hand condition can vary from a small hand to only nubbins on the distal forearm. This study aims to systematically review the surgical management options for symbrachydactyly and compare functional and aesthetic outcomes.The review was performed according to the PRISMA guidelines. Literature was systematically assessed searching the Cochrane Library, PubMed, Embase, and PROSPERO databases up to January 1, 2023. Studies were identified using synonyms for 'symbrachydactyly' and 'treatment'. Inclusion criteria were the report of outcomes after surgical treatment of symbrachydactyly in humans. Studies were excluded if they were written in another language than English, German, or French. Case reports, letters to the editor, studies on animals, cadaveric, in vitro studies, biomechanical reports, surgical technique description, and papers discussing traumatic or oncologic cases were excluded.Twenty-four studies published were included with 539 patients (1037 digit corrections). Only one study included and compared two surgical techniques. The quality of the included studies was assessed using the Modified Coleman Methodology Score and ranged from 25 to 47. The range of motion was the main reported outcome and demonstrated modest results in all surgical techniques. The report on aesthetics of the hand was limited in non-vascularized transfers to 2/8 studies and in vascularized transfers to 5/8 studies, both reporting satisfactory results. On average, there was a foot donor site complication rate of 22% in non-vascularized transfers, compared to 2% in vascularized transfers. The hand-related complication rate of 54% was much higher in the vascularized group than in the non-vascularized transfer with 16%.No uniform strategy to surgically improve symbrachydactyly exists. All discussed techniques show limited functional improvement with considerable complication rates, with the vascularized transfer showing relative high hand-related complications and the non-vascularized transfer showing relative high foot-related complications.There were no high-quality studies, and due to a lack of comparing studies, the data could only be analysed qualitatively. Systematic assessment of studies showed insufficient evidence to determine superiority of any procedure to treat symbrachydactyly due to inadequate study designs and comparative studies. This systematic review was registered at the National Institute for Health Research PROSPERO International Prospective Register of Systematic Reviews number: CRD42020153590 and received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Level of evidenceI.Systematic review registrationPROSPERO CRD42020153590.
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Affiliation(s)
- A Bartsch
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland
- Orthopaedic Surgery and Traumatology, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland
| | - D Nikkhah
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust, London, UK
| | - R Miller
- Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT5, UK
| | - K Mende
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland
| | - S E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - A Kaempfen
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland.
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland.
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Iba K, Yotsuyanagi T, Yamashita K, Onuma M, Kitada A, Ueda N. Two-stage surgical treatment for medially angulated great toes in Apert feet by wedged corrective osteotomy with distraction of the inter-metatarsal space: A case report. J Orthop Sci 2023:S0949-2658(23)00207-5. [PMID: 37567836 DOI: 10.1016/j.jos.2023.07.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/05/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND One of most severe clinical problems related to Apert foot anomalies is medial angulation deformities of the great toe as the foot grows. CASE PRESENTATION The patient was a 22-month-old Japanese child with Apert syndrome, who had broad bilateral great toe showing medially angulated deformity. We performed two-stage surgical treatment including distraction of the remarkable narrowing the first inter-metatarsal space using an external distractor device, and the corrective wedge-osteotomy of the first metatarsal with a graft of wedged bone in the reverse direction and inter-positioning of the resected local bone between the first and second metatarsal to preserve the space. At 3 years after surgery, the patient did not have any disturbance of gait and could wear normal shoes without weight-bearing pain, and was satisfied with the appearance of the great toes. CONCLUSION The two-stage surgical method could be an option for surgical treatment of Apert feet.
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Affiliation(s)
- Kousuke Iba
- Department of Musculoskeletal Anti-aging Medicine (KI), Sapporo Medical University, Sapporo, Japan
| | - Takatoshi Yotsuyanagi
- Department of Plastic and Reconstructive Surgery (TY, KY, MO, AK, NU), Sapporo Medical University, Sapporo, Japan.
| | - Ken Yamashita
- Department of Plastic and Reconstructive Surgery (TY, KY, MO, AK, NU), Sapporo Medical University, Sapporo, Japan
| | - Masahiro Onuma
- Department of Plastic and Reconstructive Surgery (TY, KY, MO, AK, NU), Sapporo Medical University, Sapporo, Japan
| | - Ayaka Kitada
- Department of Plastic and Reconstructive Surgery (TY, KY, MO, AK, NU), Sapporo Medical University, Sapporo, Japan
| | - Naohiro Ueda
- Department of Plastic and Reconstructive Surgery (TY, KY, MO, AK, NU), Sapporo Medical University, Sapporo, Japan
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Sobana M, Halim D, Faried A, Riestiano BE, Pajan HF, Islam AA, Dariansyah AD, Parenrengi MA. Amniotic band syndrome with CNS involvement: a pediatric neurosurgeon's dilemma-a case series and literature review. Childs Nerv Syst 2023; 39:2003-2017. [PMID: 37266681 DOI: 10.1007/s00381-023-06008-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Amniotic band syndrome (ABS) is a rare congenital disease characterized by a broad spectrum of congenital anomalies resulting from the strangulated developing organ(s) by the detached fibrous amniotic band. The prevalence of CNS involvement in ABS is rare, but the mortality rate in these cases is high, while morbidity among the surviving patients is inevitable. CASE REPORT Three-month-old male, 9-month-old female, and newborn female babies were presented with head lump(s), severe facial cleft, syndactyly, and finger amputation. The patient's head imaging confirmed meningoencephalocele as the cause of the head lump in 2 patients; meanwhile, a porencephalic cyst was identified as the origin of head lumps in the other patient. VP shunt placement surgery was performed as the initial management in 2 patients, while one patient directly underwent meningoencephalocele resection surgery. Craniofacial and limb reconstructions were planned as the follow-up management in all cases. Unfortunately, one patient died of complications from suspected aspiration, while another never returned for follow-up treatment. CONCLUSION Here, we report 3 ABS cases with CNS involvement. Despite the severe disfigurement and disability, the inexistence of fatal malformation might lead to long-term survival. The treatment of malformation(s) that might predispose to another fatal condition and surgery(-ies) to improve functional outcomes and patient's social acceptability should be prioritized in managing the surviving ABS patients.
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Affiliation(s)
- Mirna Sobana
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Danny Halim
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
- Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ahmad Faried
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Betha Egih Riestiano
- Department of Plastic Surgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Hendra Fajar Pajan
- Department of Neurosurgery, Faculty of Medicine, Universitas Hasanuddin - Dr. Wahidin Sudirohusodo General Hospital, Makassar, South Sulawesi, Indonesia
| | - Andi Asadul Islam
- Department of Neurosurgery, Faculty of Medicine, Universitas Hasanuddin - Dr. Wahidin Sudirohusodo General Hospital, Makassar, South Sulawesi, Indonesia
| | - Ahmad Data Dariansyah
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Muhammad Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia.
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Bilal M, Haack TB, Buchert R, Peralta S, Uddin N, Ali RH, Liaqat K, Ahmad W. Sequence Variants in MEGF8 and GJA1 Underlying Syndactyly. Mol Syndromol 2023; 14:201-207. [PMID: 37323198 PMCID: PMC10267519 DOI: 10.1159/000528651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/08/2022] [Indexed: 12/03/2023] Open
Abstract
Introduction Syndactyly is a common congenital limb malformation. It occurs due to embryological failure of digit separation during limb development. Syndactyly often runs in families with an incidence of about one out of every 2,500-3,000 live births. Methods Here, we have reported two families presenting features of severe forms of syndactyly. The disorder segregated in autosomal recessive in one and in autosomal dominant manner in the second family. Search for the causative variants was carried out using whole-exome sequencing in family A and candidate gene sequencing in family B. Results Analysis of the sequencing data revealed two novel missense variants, including p.(Cys1925Arg) in MEGF8 in family A and p.(Thr89Ile) in GJA1 in family B. Conclusion In conclusion, the novel findings, presented here, not only expand the mutation spectrum in the genes MEGF8 and GJA1, but this will also facilitate screening other families carrying similar clinical features in the Pakistani population.
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Affiliation(s)
- Muhammad Bilal
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Tobias B. Haack
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Rebecca Buchert
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Susana Peralta
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Najum Uddin
- National Centre for Bioinformatics, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Raja Hussain Ali
- Department of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Khurram Liaqat
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - Wasim Ahmad
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
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Chen ZY, Li WY, Xu WL, Gao YY, Liu Z, Li Q, Yu B, Dai L. The changing epidemiology of syndactyly in Chinese newborns: a nationwide surveillance-based study. BMC Pregnancy Childbirth 2023; 23:334. [PMID: 37165329 PMCID: PMC10170702 DOI: 10.1186/s12884-023-05660-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/28/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Little is known about the epidemiologic features of syndactyly (SD) in Chinese newborns. METHODS Using 2007-2019 data from the Chinese Birth Defects Monitoring Network, we conducted a prevalence analysis on overall, isolated and associated syndactyly according to birth year, maternal age, maternal residence, geographic region and infant sex, with special interests in time trends, perinatal outcomes and clinical phenotypes. RESULTS A total of 13,611 SD cases were identified among 24,157,719 births in the study period, yielding the prevalence of 5.63, 4.66 and 0.97 per 10,000 for overall, isolated, and associated SD, respectively. The prevalence of each type of SD exhibited an upward trend over the period. The prevalence of overall SD varied significantly by maternal residence (urban vs. rural, 6.69/10,000 vs. 4.35/10,000), maternal age (< 20 years, 5.43/10,000; 20-24 years, 5.03/10,000; 25-29 year, 5.65/10,000; 30-34 years, 6.07/10,000; ≥ 35 years, 5.76/10,000), geographic region (central, 5.07/10,000; east, 6.75/10,000; west, 5.12/10,000), and infant sex (male vs. female, 6.28/10,000 vs. 4.86/10,000). Newborns with associated SD were more likely to be born prematurely (29.2% vs. 10.6%) or with low birthweight (30.5% vs.9.8%) than those with isolated SD. The bilaterally, and unilaterally affected cases accounted for 18.4% and 76.7%, respectively. The feet were more frequently involved (64.3%) in those bilaterally affected cases, while right side preference (right vs left: 53.8% vs 46.2%) and upper limbs preference (hand vs foot: 50.8% vs 48.0%) were found in unilateral cases. CONCLUSIONS The prevalence of syndactyly in China is on the rise and notably higher than that in other Asian and European countries, highlighting the importance of investigating the etiology, epidemiology, and clinical implications of this condition in the Chinese population.
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Affiliation(s)
- Zhi-Yu Chen
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, Sichuan, 610041, China
| | - Wen-Yan Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, Sichuan, 610041, China
| | - Wen-Li Xu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, Sichuan, 610041, China
| | - Yu-Yang Gao
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, Sichuan, 610041, China
| | - Zhen Liu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, Sichuan, 610041, China
| | - Qi Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, Sichuan, 610041, China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, Sichuan, China
| | - Li Dai
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, Sichuan, 610041, China.
- The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
- NHC Key Laboratory of Chronobology, Sichuan University, Chengdu, Sichuan, 610041, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
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Samhitha CS, Subramanyam C. Apert syndrome: a rare clinical image. Pan Afr Med J 2023; 45:24. [PMID: 37521759 PMCID: PMC10386522 DOI: 10.11604/pamj.2023.45.24.38946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Chundi Sai Samhitha
- Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Chiruvella Subramanyam
- Department of Paediatrics, Christian Medical College, Dr. M.G.R Medical University, Chennai, Tamil Nadu, India
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Husile H, Wu Z, Yang L, Cao Y, Wu Q. Identification of a HOXD13 variant in a Mongolian family with incomplete penetrance syndactyly by exon sequencing. BMC Med Genomics 2022; 15:210. [PMID: 36195906 PMCID: PMC9533607 DOI: 10.1186/s12920-022-01360-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Syndactyly (SD) refers to a deformity caused by the fusion and limb differentiation disorder of soft tissues and/or skeletons to varying extents between adjacent fingers (toes). The main features of this disease are phenotypic heterogeneity and genetic heterogeneity. In this study, we examined four generations of a Chinese Mongolian with different phenotypes of syndactylia and analysed and identified the pathogenic genetic variants of SD by exon sequencing. Methods The clinical phenotypes of patients were analysed, and the hands and feet were examined by X-ray. The pedigree was drawn, and the family data were analysed. Peripheral blood was collected from the family members, and genomic DNA was extracted. The candidate genes of SD were identified by exon sequencing, and the mutation sites of the captured candidate genes were amplified by PCR and verified by Sanger sequencing. Results The family has congenital syndactyly, which is an autosomal dominant disease. At present, this condition has been passed down for 4 generations and was identified in 9 patients, including 4 males and 5 females. Five patients, I2, II4, III5, III,7 and III10, had unilateral syndactyly, and four patients, III16, IV3, IV6 and IV7, had bilateral finger syndactyly. All of their toes were unaffected. The proband and the other patients in this family had a c.917G > A (p.R306Q) mutation, which is located at position 917 of the second exon of the HOXD13 gene. This mutation results in a change in the amino acid at position 306, in which arginine is changed to glutamine. This mutation cosegregates in unaffected individuals and affected patients in this family. Moreover, 201 Mongolian genome databases and a thousand human genome databases were referenced to further confirm that the pathogenic genetic variant that causes syndactyly in this family is found in HOXD13. Conclusion This study found that the mutation site of the pathogenic gene in this family was HOXD13, c.917G > A (p.R306Q). The phenotype of the family member III12 was normal, but this member was also a carrier of the pathogenic genetic variant. This indicates that the disease of this family has incomplete penetrance characteristics. Our results further enrich the expression profile of the HOXD13 gene. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01360-3.
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Affiliation(s)
- Husile Husile
- Affiliated Hospital of Inner Mongolia Minzu University, 028000, Tongliao, China.,Inner Mongolia Engineneering and Technical Research Center for personalized Medicine, 028000, Tongliao, China
| | - Zhifeng Wu
- Inner Mongolia Engineneering and Technical Research Center for personalized Medicine, 028000, Tongliao, China.,College of Life Sciences and Food Engineering, Inner Mongolia Minzu University, 028000, Tongliao, China
| | - Liqing Yang
- Affiliated Hospital of Inner Mongolia Minzu University, 028000, Tongliao, China.,Inner Mongolia Engineneering and Technical Research Center for personalized Medicine, 028000, Tongliao, China
| | - Yaning Cao
- School Of Life Sciences, Inner Mongolia University, 010000, Hohhot, China
| | - Qizhu Wu
- Affiliated Hospital of Inner Mongolia Minzu University, 028000, Tongliao, China. .,Inner Mongolia Engineneering and Technical Research Center for personalized Medicine, 028000, Tongliao, China.
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Dailey C, Oshodi RB, Boull C, Aggarwal A. Expanding the clinical spectrum of SOX18-related Hypotrichosis-lymphedema-telangiectasia-renal defect syndrome. Eur J Med Genet 2022; 65:104607. [PMID: 36096470 DOI: 10.1016/j.ejmg.2022.104607] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/18/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
Abstract
Pathogenic variants in SOX18 are associated with hypotrichosis-lymphedema-telangiectasia-renal defects syndrome (HLTRS) and hypotrichosis-lymphedema-telangiectasia syndrome (HLTS). Eleven patients with SOX18 related HLTRS/HLTS have been previously described. Cardinal features include varying degrees of hypotrichosis, lymphedema and telangiectasias. We report a 15-year-old female patient with a likely de novo SOX18 pathogenic variant identified on duo exome sequencing. In addition to the classic features, the currently reported patient presented with novel clinical features including musculoskeletal abnormalities and strikingly poor wound healing. Chronic skin ulcers have been a major cause of morbidity for the patient and have led to significant functional limitation. Further, our experience with wound management has been detailed. We hope to improve understanding of the clinical spectrum of this ultra-rare disorder by reviewing the phenotypic features in all reported patients including our patient.
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Affiliation(s)
- Christina Dailey
- M-Health Fairview Masonic Children's Hospital, Minneapolis, MN, USA
| | - Rashedat B Oshodi
- Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Christina Boull
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Anjali Aggarwal
- Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
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Schierz IAM, Amoroso S, Antona V, Giuffrè M, Piro E, Serra G, Corsello G. Novel de novo missense mutation in the interferon regulatory factor 6 gene in an Italian infant with IRF6-related disorder. Ital J Pediatr 2022; 48:132. [PMID: 35906647 PMCID: PMC9338470 DOI: 10.1186/s13052-022-01330-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Congenital maxillomandibular syngnathia is a rare craniofacial anomaly leading to difficulties in feeding, breathing and ability to thrive. The fusion may consist of soft tissue union (synechiae) to hard tissue union. Isolated cases of maxillomandibular fusion are extremely rare, it is most often syndromic in etiology. Case presentation Clinical management of a female newborn with oromaxillofacial abnormities (synechiae, cleft palate, craniofacial dysmorphisms, dental anomaly) and extraoral malformations (skinfold overlying the nails of both halluces, syndactyly, abnormal external genitalia) is presented. The associated malformations addressed to molecular genetic investigations revealing an interferon regulatory factor 6 (IRF6)-related disorder (van der Woude syndrome/popliteal pterygium syndrome). A novel de novo heterozygous mutation in exon 4 of IRF6 gene on chromosome 1q32.2, precisely c.262A > G (p.Asn88Asp), was found. Similarities are discussed with known asparagine missense mutations in the same codon, which may alter IRF6 gene function by reduced DNA-binding ability. A concomitant maternal Xp11.22 duplication involving two microRNA genes could contribute to possible epigenetic effects. Conclusions Our reported case carrying a novel mutation can contribute to expand understandings of molecular mechanisms underlying synechiae and orofacial clefting and to correct diagnosing of incomplete or overlapping features in IRF6-related disorders. Additional multidisciplinary evaluations to establish the phenotypical extent of the IRF6-related disorder and to address family counseling should not only be focused on the surgical corrections of syngnathia and cleft palate, but also involve comprehensive otolaryngologic, audiologic, logopedic, dental, orthopedic, urological and psychological evaluations.
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Affiliation(s)
- Ingrid Anne Mandy Schierz
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy.
| | - Salvatore Amoroso
- Pediatric Surgery Unit, Children's Hospital, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Vincenzo Antona
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
| | - Ettore Piro
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
| | - Gregorio Serra
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
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Tekin E. Bone deformities in patients with neurofibromatosis type 1: Single-center experience. Arch Pediatr 2022; 29:434-438. [PMID: 35705383 DOI: 10.1016/j.arcped.2022.05.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/22/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF-1) is the most common neurocutaneous syndrome with an autosomal dominant inheritance. However, half of the cases are de novo mutations. Involvement of bone, skin (cafe au lait macules), as well as ocular and tumoral formations is also associated with NF-1. Here, we present our case series of patients with bone deformities. METHODS The medical files of patients with NF-1 who were followed up by the same doctor in the pediatric neurology outpatient clinic over 2 years were retrospectively analyzed. RESULTS Overall, 19 girls and 13 boys were diagnosed with NF-1. Of these 32 patients, 12 (nine girls, three boys) were found to have bone pathologies. The average age was of these patients with bone pathology was 7.5 and 9.5 years. Scoliosis, bowing, short stature, and long bone cysts were found in descending order of frequency. Severe adhesions in the hands and feet as well as phalangeal hypoplasia were noted in one patient. CONCLUSION NF-1 requires a multidisciplinary approach. Routine follow-up is very important as it is known that deformities that affect different systems may appear or increase with age. Severe hand and foot anomalies seen in one of our patients did not seem to be associated with NF-1.
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Affiliation(s)
- E Tekin
- Division of Pediatric Neurology, Giresun Maternity and Children Hospital, Faculty of Medicine, Giresun University, Teyyaredüzü mh. Atatürk Bulvarı No: 335 Merkez, Giresun, Turkey.
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Shen XF, Yin F, Gasteratos K, Wang J, Chim H, Rui YJ. Thumb and first webspace reconstruction in nonsyndromic congenital mitten hand with symbrachydactyly. J Plast Reconstr Aesthet Surg 2022; 75:1902-6. [PMID: 34972652 DOI: 10.1016/j.bjps.2021.11.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nonsyndromic congenital mitten hand with thumb and index finger syndactyly is rare. Reconstruction of this condition is challenging, requiring repositioning of the thumb and creation of a wide and deep first webspace. The aim of this paper is to describe the characteristics of patients with this condition and also to describe our surgical technique. METHODS We describe our technique in 16 consecutive children utilizing complete mobilization of the first metacarpal and thumb as an island flap on the neurovascular bundle, with a rotational osteotomy to reposition the thumb in pronation. In addition, a dorsal M flap was used to reconstruct the first webspace. Patients in this series also had varying degrees of symbrachydactyly with hypoplastic or aplastic phalanges of the central digits. RESULTS There were 9 male and 7 female patients, with a mean age of 24.4 ± 22.4 months at the time of surgery. Mean follow-up was 19.1 ± 18.3 months. All reconstructions healed well. The mean thumb web distance in the affected hands was 4.2 cm (range 3.5 to 5). All reconstructed thumbs had a good opposition. Two children initially had mild hypertrophic scarring, which resolved with pressure gloves. No other complications were observed. CONCLUSION One-stage reconstruction of the thumb and first webspace can be effectively achieved with our technique of complete mobilization of the thumb unit, rotational osteotomy, and a dorsal interdigitating M flap.
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Cassim A, Hettiarachchi D, Dissanayake VHW. Genetic determinants of syndactyly: perspectives on pathogenesis and diagnosis. Orphanet J Rare Dis 2022; 17:198. [PMID: 35549993 PMCID: PMC9097448 DOI: 10.1186/s13023-022-02339-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
The formation of the digits is a tightly regulated process. During embryogenesis, disturbance of genetic pathways in limb development could result in syndactyly; a common congenital malformation consisting of webbing in adjacent digits. Currently, there is a paucity of knowledge regarding the exact developmental mechanism leading to this condition. The best studied canonical interactions of Wingless‐type–Bone Morphogenic Protein–Fibroblast Growth Factor (WNT–BMP–FGF8), plays a role in the interdigital cell death (ICD) which is thought to be repressed in human syndactyly. Animal studies have displayed other pathways such as the Notch signaling, metalloprotease and non-canonical WNT-Planar cell polarity (PCP), to also contribute to failure of ICD, although less prominence has been given. The current diagnosis is based on a clinical evaluation followed by radiography when indicated, and surgical release of digits at 6 months of age is recommended. This review discusses the interactions repressing ICD in syndactyly, and characterizes genes associated with non-syndromic and selected syndromes involving syndactyly, according to the best studied canonical WNT-BMP-FGF interactions in humans. Additionally, the controversies regarding the current syndactyly classification and the effect of non-coding elements are evaluated, which to our knowledge has not been previously highlighted. The aim of the review is to better understand the developmental process leading to this condition.
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Affiliation(s)
- Afraah Cassim
- Human Genetics Unit, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, Sri Lanka.
| | - Dineshani Hettiarachchi
- Human Genetics Unit, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, Sri Lanka
| | - Vajira H W Dissanayake
- Human Genetics Unit, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, Sri Lanka
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22
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Afshar S, Abbasinazari M, Darvishi B, Ziaie S, Esmaily H. Case report: Bilateral simple Syndactyly in a toddler with maternal exposure to cabergoline. Clin Case Rep 2022; 10:e05795. [PMID: 35521048 PMCID: PMC9066742 DOI: 10.1002/ccr3.5795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/13/2022] [Accepted: 03/09/2022] [Indexed: 11/08/2022] Open
Abstract
Cabergoline is routinely prescribed in the management of prolactin excreting adenomas and is associated with low risk of congenital malformations and teratogenicity. Here, we reported the case of a bilateral simple syndactyly in a toddler with maternal exposure to cabergoline during the pregnancy. This association has not been previously described before.
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Affiliation(s)
- Shima Afshar
- Department of Clinical Pharmacy School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mohammad Abbasinazari
- Department of Clinical Pharmacy School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Behnam Darvishi
- Department of Orthopedics Rasoul Akram Hospital Iran University of Medical Sciences Tehran Iran
| | - Shadi Ziaie
- Department of Clinical Pharmacy School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Hadi Esmaily
- Department of Clinical Pharmacy School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran
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Slevin O, Beutel BG, Ohana N, Marascalchi B, Melamed E. Factors Associated with Timing of Syndactyly Release in the United States. J Hand Surg Asian Pac Vol 2022; 27:294-299. [PMID: 35404201 DOI: 10.1142/s2424835522500229] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Syndactyly is one of the commonly encountered congenital hand anomalies. However, there are no strict guidelines regarding the timing of surgical release. The aim of this study was to investigate the age and factors associated with syndactyly release in the United States. Methods: A retrospective analysis of the California and Florida State Ambulatory Surgery and Services Databases for patients aged 18 years or younger who underwent syndactyly release surgery between 2005 and 2011 was performed. Demographic data that included the age at release, gender, race and primary payor (insurance) was collected. A sub-analysis was performed to compare the demographic characteristics between those patients undergoing syndactyly release before 5 years of age ('Early Release') and at (of after) 5 years ('Late Release'). Results: A total of 2,280 children (68% male, 43% Caucasian) were identified. The mean age of syndactyly release was 3.6 years, and 72.9% of patients underwent release before the age of 5 years. A significantly larger proportion of females (p = 0.002), and Hispanics and African Americans (p = 0.024), underwent late release compared to early release. Additionally, a significantly higher percentage of patients undergoing late release utilised private insurance (p = 0.005). However, the actual differences in gender, race and primary payor were small. Conclusion: The majority of syndactyly releases were performed before school age, which is the primary goal in the management of syndactyly. While gender and racial disparities in the surgical treatment of syndactyly may exist, the differences in the present study were relatively small. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Omer Slevin
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Bryan G Beutel
- Department of Orthopaedics and Sports Medicine, The Christ Hospital, Cincinnati, OH, USA
| | - Nissim Ohana
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Bryan Marascalchi
- Department of Anesthesiology and Critical Care, Division of Pain Medicine and Pain Research, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eitan Melamed
- The Center for Hand Surgery, NYC Health + Hospitals/Elmhurst, Elmhurst, NY, USA
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24
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Li AL, Borooah S, Nudleman E. Multimodal imaging of retinal findings in syndactyly, telecanthus, anogenital, and renal malformations (STAR) syndrome. Am J Ophthalmol Case Rep 2022; 25:101284. [PMID: 35128153 PMCID: PMC8810370 DOI: 10.1016/j.ajoc.2022.101284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 12/21/2022] Open
Abstract
Purpose To report multimodal imaging of novel retinal findings in a case of syndactyly, telecanthus, anogenital, and renal malformations (STAR) syndrome. Observations A 5-year old patient with STAR syndrome, an ultra-rare developmental disorder composed of syndactyly, telecanthus, anogenital, and renal malformations, was found to have bilateral macular yellow pigmentary changes and peripheral retinal pigment epithelial changes in a radial pattern highlighted by fundus autofluorescence (FAF) imaging. Optical coherence tomography (OCT) of the macula revealed foveal hypoplasia, ellipsoid zone disruption, and outer retinal atrophy suggestive of a retinal degeneration. OCT angiography found no significant abnormalities, and oral fluorescein angiography revealed staining in areas of atrophy in both eyes. Conclusions and Importance This case displays the first report of multimodal imaging of retinal manifestations in STAR syndrome, revealing bilateral foveal hypoplasia, outer retinal macular atrophy, and peripheral retinal pigment epithelial changes. Further studies and long-term follow-up are warranted to determine if patients with STAR syndrome have an underlying progressive retinal degeneration.
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Affiliation(s)
- Alexa L Li
- Shiley Eye Institute, Department of Ophthalmology, University of California at San Diego, La Jolla, CA, USA
| | - Shyamanga Borooah
- Shiley Eye Institute, Department of Ophthalmology, University of California at San Diego, La Jolla, CA, USA
| | - Eric Nudleman
- Shiley Eye Institute, Department of Ophthalmology, University of California at San Diego, La Jolla, CA, USA
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Waknin R, Evens AL, Phillips LG, Kucera JN. Fibrolipomatous hamartoma of the foot with associated macro syndactyly: a case report. Radiol Case Rep 2022; 17:638-640. [PMID: 35027987 PMCID: PMC8715131 DOI: 10.1016/j.radcr.2021.11.058] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/20/2021] [Accepted: 11/21/2021] [Indexed: 11/07/2022] Open
Abstract
Fibrolipomatous hamartoma is a rare benign congenital overgrowth of fibroadipose tissue in the nerve sheath. While usually affecting the median nerve, the digits of the hands and feet are sometimes affected and may result in macrodactyly, which is referred to as macrodystrophia lipomatosa. We present a rare case of fibrolipomatous hamartoma in a 6-week-old female's foot with macrodactyly and syndactyly and discuss its presentation and radiologic features.
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Affiliation(s)
- Roy Waknin
- Department of Radiology, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, STC 6102, Tampa, FL, USA
| | - Ashley Lynn Evens
- Department of Radiology, Mayo Clinic Hospital in Florida, 4500 San Pablo Rd, Jacksonville, FL, USA
| | - Lee Garritt Phillips
- Department of Orthopedics, Johns Hopkins All Children's Hospital, 501 6th Ave S St, Saint Petersburg, FL, USA
| | - Jennifer Neville Kucera
- Department of Radiology, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, STC 6102, Tampa, FL, USA.,Department of Radiology, Johns Hopkins All Children's Hospital, 501 6th Ave S St, Saint Petersburg, FL, USA
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26
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Abstract
This article explores different pediatric forefoot deformities including syndactyly, polydactyly, macrodactyly, curly toe, and congenital hallux varus. The epidemiology and genetic background are reviewed for each condition. Preferred treatment options and recommended surgical techniques are discussed with review of the current literature.
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Affiliation(s)
- Maryellen P Brucato
- Brucato Foot and Ankle Surgery, LLC, 1011 Clifton Avenue, Suite 1G, Clifton, NJ 07013, USA.
| | - David Y Lin
- The Pediatric Orthopedic Center, 218 Ridgedale Avenue, Suite 101, Cedar Knolls, NJ 07927, USA
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Langlais T, Rougereau G, Marty-Diloy T, Bachy M, Barret H, Vialle R, Fitoussi F. Surgical treatment in child's congenital toe syndactyly: Risk factor of recurrence, complication and poor clinical outcomes. Foot Ankle Surg 2022; 28:107-113. [PMID: 33642221 DOI: 10.1016/j.fas.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/31/2020] [Accepted: 02/11/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Surgical treatment of toe syndactyly remains controversial. The strong demand from parents for a cosmetic release is increasing in our societies. But is it worth it? The objective was to assess medium-long term outcomes and to identify the risk factors of recurrence, complication and poor clinical outcomes. METHODS Sixty-eight toe syndactylies (38 patients) undergoing surgery between 2008 and 2017 with a follow-up higher than two years were included consecutively and retrospectively. Four children (four syndactylies) were lost to follow-up and excluded. The mean age of the first surgery was 3.9 years old (0.8-16.7) and cohort mean follow-up was 6.9 years (2.8-11.2). In all patients, web release with a commissural dorsal flap was performed and associated a cutaneous resurfacing (spontaneous epithelialization, full-thickness skin graft taken from the popliteal crease, or a hyaluronic acid ester matrix). RESULTS Eighteen syndactylies (28.1%) in 14 patients recurred and one syndactyly required revision surgery. An age of surgery above two years was the only risk factor for recurrence found in univariate (OD = 0.27[0.08;0.85];p = 0.02) and multivariate studies (IC 95% = 0.05-0.68;p = 0.02). Seven complications (11.7%) in seven syndactylies (6 patients) were reported with six keloids (9.4%) and one scar retraction (1.6%). Each complication underwent an additional procedure. African ethnicity (N = 15) represents a risk factor (N = 4/15; OD = 0.12[0.009;0.97];p = 0.02) for keloids formation. Withey's average score is 4.9 (1-11), mean OxAFQ-C score was 52/60 (30-60), 67% would repeat the surgery and 69% felt satisfied at last follow-up. The simple syndactyly would appear less satisfied than complex or complicated (p = 0.02). CONCLUSIONS Surgical treatment of child's congenital syndactyly involves a risk of recurrence (28%) and potential complications (11,7%). Performed surgical procedure over two years old increase the risk of recurrence. African ethnicity is a risk factor in scarring complication. Only half of simple syndactylies are satisfied and prone to repeat the surgery.
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Affiliation(s)
- Tristan Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; Children's Hospital, Purpan, Toulouse University, Toulouse, France.
| | - Gregoire Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Manon Bachy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Hugo Barret
- Orthopedics Department, Purpan, Toulouse University, Toulouse, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
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Facioli FL, da Silva AN, Dos Santos ED, de Camargo J, Warpechowski MB, da Oliveira Cruz J, Lof LM, Zanella R. From Mendel laws to whole genetic association study to decipher the swine mulefoot phenotype. Res Vet Sci 2021; 143:58-65. [PMID: 34974356 DOI: 10.1016/j.rvsc.2021.12.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/24/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
The swine mulefoot (SM) is a rare condition characterized by a non-cloven hoof due to the partial or total fusion of the phalanges. No comprehensive study has been conducted to identify associated markers with this phenotype until now. We aimed to characterize the association between SNP and the mulefoot phenotype using a Genome-Wide Association Study (GWAS). An experimental population was produced using a half-sib mating where the male had the mulefoot phenotype and the females (n = 6) had cloven hoofs. The cross resulted in 27 (47%) animals with the mulefoot characteristic and 30 (53%) normal animals, indicating the possible dominant gene action. Animals were further genotyped using the Illumina PorcineSNP50k BeadChip, and SNPs were tested for associations. Twenty-nine SNPs located on the SSC15, SSC4, and SSCX were associated with the mulefoot phenotype (p-value <5 × 10-5). Six markers were found in the intronic regions of VWC2L, CATIP, PDK3, PCYT1B, and POLA1 genes. The marker rs81277626, on SSC15:116,886,110 bp, is located in the Von Willebrand Factor C Domain (VWC2L), a possible functional candidate gene. The VWC2L is part of a biological process involved with the bone morphogenetic protein (BMP) signaling pathway, previously associated with syndactyly in other species. In conclusion, the identified markers suggest the involvement of the VWC2L gene in the SM phenotype in this population.
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Affiliation(s)
- Fernanda Luiza Facioli
- Faculdade de Agronomia e Medicina Veterinária, Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Arthur Nery da Silva
- Faculdade de Agronomia e Medicina Veterinária, Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Ezequiel Davi Dos Santos
- Faculdade de Agronomia e Medicina Veterinária, Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Janine de Camargo
- Programa de Pós Graduação em Bioexperimentação, Faculdade de Agronomia e Medicina Veterinária,Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Marson Bruck Warpechowski
- Departamento de Zootecnia, Setor de Ciências Agrárias, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Juliano da Oliveira Cruz
- Faculdade de Agronomia e Medicina Veterinária, Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Lucas Mallmann Lof
- Faculdade de Agronomia e Medicina Veterinária, Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Ricardo Zanella
- Faculdade de Agronomia e Medicina Veterinária, Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil; Programa de Pós Graduação em Bioexperimentação, Faculdade de Agronomia e Medicina Veterinária,Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.
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Caivio-Nasner S, López-Herrera A, González-Herrera LG, Rincón JC. Frequency of genotypic markers for genetic disorders, colour, polledness, and major genes in Blanco Orejinegro cattle. Trop Anim Health Prod 2021; 53:546. [PMID: 34779908 DOI: 10.1007/s11250-021-02990-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this work was to establish DNA marker frequencies for genetic disorders, colour, horned/polled trait, and major genes of importance for productive and reproductive traits in Blanco Orejinegro (BON) cattle. The Blanco Orejinegro breed is a Colombian creole breed characterized by a white hair coat on black skin with black ears, black hair on the middle part of the legs, and absence of horns. We genotyped 420 animals of Colombia, 70 with the GGP-Bovine 150 K chip and 350 with the GGP-Bovine 50 K chip. The markers were associated with 50 genetic diseases, 52 major gene variants related to productive traits, and 12 variants related to coat coloration, presence of horns, and adaptation, selected from the information contained in the chips. Genotype frequencies were estimated using the R statistical program. Genetic disorder annotations were derived using the Online Mendelian Inheritance in Animals tool (OMIA) and the average inbreeding coefficient (F) (n = 7799) using the MTDFNRM program. Carriers were found for 16 of the genetic disorders evaluated but with low frequencies (0.24 to 2.46%); no homozygous animals were found for the disorders. Carriers were associated with disorders such as bovine leukocyte adhesion deficiency (BLAD), deficiency of uridine monophosphate synthase (DUMPS), syndactyly, and epidermolysis bullosa (EB). The F was 4.41%. Concerning the genes associated with colour (TYR, MC1R, and PMEL), alleles related to black pigmentation, the absence of horns (polledness), and slick coat (an adaptive trait) were highly frequent (> 81.90%). Markers associated with milk production and quality, yellow fat, and fertility showed variable frequencies, indicating selection potential. Allele frequency of genetic disorders in BON cattle was low, suggesting few genetic disorder problems, with syndactyly being the most frequent condition. The markers associated with colour and polledness were almost fixed, with a frequency at or near 100%. Production and reproduction markers showed variability for selection.
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Zhang SJ, Lin HB, Jiang QX, He SZ, Lyu GR. Prenatal diagnosis of triphalangeal thumb-poly syndactyly syndrome by ultrasonography combined with genetic testing: A case report. World J Clin Cases 2021; 9:6832-6838. [PMID: 34447832 PMCID: PMC8362503 DOI: 10.12998/wjcc.v9.i23.6832] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Triphalangeal thumb-polysyndactyly syndrome (TPT-PS) is a rare type of congenital limb deformity, and most studies focus on the genetics. Case reports of the sonographic characteristics of TPT-PS during pregnancy are rare.
CASE SUMMARY A 30-year-old woman (G3P1) who had pregnancies with TPT-PS fetuses is presented. The possibility of TPT-PS was shown by ultrasound performed at the 19th wk of pregnancy, featuring hands with six metacarpals, an extra digit at the 5th finger side, and an abnormally widened thumb. Whole-exome sequencing was subsequently conducted. The results showed that exons 1-17 of the LMBR1 gene had a heterozygous duplication, with a length of approximately 253 kb.
CONCLUSION We suggest prenatal ultrasound examination combined with genetic testing to diagnose TPT-PS accurately and to help clinicians and patients make decisions.
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Affiliation(s)
- Shi-Jie Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Hai-Bin Lin
- Department of Ultrasound, Jinjiang Municipal Hospital, Quanzhou 362000, Fujian Province, China
| | - Qiu-Xia Jiang
- Department of Ultrasound, Quanzhou Women’s and Children’s Hospital, Quanzhou 362000, Fujian Province, China
- Collaborative Innovation Center for Maternal and Infant Health Service, Application Technology of Education Ministry, Quanzhou Medical College, Quanzhou 362000, Fujian Province, China
| | - Shao-Zheng He
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Guo-Rong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
- Department of Ultrasound, Jinjiang Municipal Hospital, Quanzhou 362000, Fujian Province, China
- Department of Ultrasound, Quanzhou Women’s and Children’s Hospital, Quanzhou 362000, Fujian Province, China
- Collaborative Innovation Center for Maternal and Infant Health Service, Application Technology of Education Ministry, Quanzhou Medical College, Quanzhou 362000, Fujian Province, China
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Sasaki K, Sasaki M, Oshima J, Aihara Y, Sekido M. Aesthetic reconstruction for syndactyly using the "gradation skin graft" from the plantar instep area. J Plast Reconstr Aesthet Surg 2021; 74:3371-3376. [PMID: 34226133 DOI: 10.1016/j.bjps.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 03/22/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
In syndactyly, the donor site of the skin graft should have the characteristics of both the dorsal and the plantar or palmar skin because the skin defects after the dividing procedure are at the lateral sides of the digits. The plantar instep region has a color and texture border between the dorsal and plantar skin as a gradational boundary belt. We performed "gradation skin grafting" including the belt for syndactyly. We retrospectively analyzed 110 skin graft sites in 56 patients, aged ≤ 2 years, with syndactyly of the hand or foot. The follow-up durations were ≥ 6 months. The skin graft sites were divided into the gradation skin graft (G[+]) and the traditional skin graft (G[-]) groups. They were examined for matching of the skin graft with the circumferential skin, the causes of mismatching, the closing method of the donor site, and the complications. Regarding skin graft matching, the excellent rate of achievement was greater in the G(+) than in the G(-) group (P < 0.01). The causes of mismatching were misalignment of the gradational boundary belt in the G(+) group and postoperative pigmentation in the G(-) group. All the donor sites were closed directly without complications. The gradation skin graft for syndactyly was cosmetically superior to the traditional one from the submalleolar area. The design's hazard is that the gradational boundary belt of the skin graft should match the alignment with the gradational boundary belt around the skin defect of the digits.
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Affiliation(s)
- Kaoru Sasaki
- Department of Plastic and Reconstructive Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8577, Japan.
| | - Masahiro Sasaki
- Department of Plastic and Reconstructive Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8577, Japan
| | - Junya Oshima
- Department of Plastic and Reconstructive Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8577, Japan
| | - Yukiko Aihara
- Department of Plastic and Reconstructive Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8577, Japan
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8577, Japan
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Nandadasa S, Burin des Roziers C, Koch C, Tran-Lundmark K, Dours-Zimmermann MT, Zimmermann DR, Valleix S, Apte SS. A new mouse mutant with cleavage-resistant versican and isoform-specific versican mutants demonstrate that proteolysis at the Glu 441-Ala 442 peptide bond in the V1 isoform is essential for interdigital web regression. Matrix Biol Plus 2021; 10:100064. [PMID: 34195596 PMCID: PMC8233476 DOI: 10.1016/j.mbplus.2021.100064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/31/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
• A novel Vcan mouse allele, VcanAA, has ADAMTS protease-resistant versican. • VcanAA/AA mice are viable and develop soft tissue-syndactyly (STS) • VcanAA/AA STS is rendered more severe in combination with Adamts20Bt/Bt. • Mice lacking the versican GAGβ domain, but not the GAGα domain, also have STS. • The versican GAGβ proteolytic fragment versikine is necessary for web regression.
Two inherent challenges in the mechanistic interpretation of protease-deficient phenotypes are defining the specific substrate cleavages whose reduction generates the phenotypes and determining whether the phenotypes result from loss of substrate function, substrate accumulation, or loss of a function(s) embodied in the substrate fragments. Hence, recapitulation of a protease-deficient phenotype by a cleavage-resistant substrate would stringently validate the importance of a proteolytic event and clarify the underlying mechanisms. Versican is a large proteoglycan required for development of the circulatory system and proper limb development, and is cleaved by ADAMTS proteases at the Glu441-Ala442 peptide bond located in its alternatively spliced GAGβ domain. Specific ADAMTS protease mutants have impaired interdigit web regression leading to soft tissue syndactyly that is associated with reduced versican proteolysis. Versikine, the N-terminal proteolytic fragment generated by this cleavage, restores interdigit apoptosis in ADAMTS mutant webs. Here, we report a new mouse transgene, VcanAA, with validated mutations in the GAGβ domain that specifically abolish this proteolytic event. VcanAA/AA mice have partially penetrant hindlimb soft tissue syndactyly. However, Adamts20 inactivation in VcanAA/AA mice leads to fully penetrant, more severe syndactyly affecting all limbs, suggesting that ADAMTS20 cleavage of versican at other sites or of other substrates is an additional requirement for web regression. Indeed, immunostaining with a neoepitope antibody against a cleavage site in the versican GAGα domain demonstrated reduced staining in the absence of ADAMTS20. Significantly, mice with deletion of Vcan exon 8, encoding the GAGβ domain, consistently developed soft tissue syndactyly, whereas mice unable to include exon 7, encoding the GAGα domain in Vcan transcripts, consistently had fully separated digits. These findings suggest that versican is cleaved within each GAG-bearing domain during web regression, and affirms that proteolysis in the GAGβ domain, via generation of versikine, has an essential role in interdigital web regression.
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Affiliation(s)
- Sumeda Nandadasa
- Department of Biomedical Engineering-ND20, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Cyril Burin des Roziers
- Institut Cochin, Inserm U1016 - CNRS UMR8104 - Paris Descartes University Medical School, 24, Rue du faubourg Saint Jacques, 75014 Paris, France
| | - Christopher Koch
- Department of Biomedical Engineering-ND20, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Karin Tran-Lundmark
- Department of Experimental Medical Science and Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - María T Dours-Zimmermann
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Dieter R Zimmermann
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Valleix
- Institut Cochin, Inserm U1016 - CNRS UMR8104 - Paris Descartes University Medical School, 24, Rue du faubourg Saint Jacques, 75014 Paris, France
| | - Suneel S Apte
- Department of Biomedical Engineering-ND20, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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Jiang YT, Gong TT, Zhang JY, Huang YH, Li J, Liu S, Chen YL, Li LL, Jiang CZ, Chen ZJ, Zhao YH, Wu QJ. Maternal exposure to ambient SO 2 and risk of polydactyly and syndactyly: a population-based case-control study in Liaoning Province, China. Environ Sci Pollut Res Int 2021; 28:11289-11301. [PMID: 33118065 DOI: 10.1007/s11356-020-11351-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/20/2020] [Indexed: 05/26/2023]
Abstract
Evidence links exposure to maternal sulfur dioxide (SO2) and the risk of limb defects have been inconsistent. To investigate associations between SO2 exposure during preconception and the first trimester and risks of polydactyly and syndactyly. The study population was acquired from the Maternal and Child Health Certificate Registry of Liaoning Province between 2010 to 2015, and consisted of 2605 polydactyly, 595 syndactyly cases, and 7950 controls. Ambient air pollutants levels were retrieved from air quality monitoring stations. We used multivariable logistic regression model to assess the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). We found that exposure to increased SO2 concentrations was associated with polydactyly during both the 3 months preconception (ORQ4 vs. Q1 = 3.76; 95% CI 2.61, 5.42; per 10 μg/m3 increment: OR = 1.07; 95% CI 1.04, 1.10) and the first trimester (ORQ4 vs. Q1 = 2.03; 95% CI 1.41, 2.92; per 10 μg/m3 increment: OR = 1.07; 95% CI 1.03, 1.11). However, we only observed increased risk for syndactyly in the analysis of high vs. low quartiles (three months preconception: ORQ4 vs. Q1 = 3.72; 95% CI 2.05, 6.75; first trimester: ORQ4 vs. Q1 = 1.98; 95% CI 1.11, 3.51). Most results of analyses based on single-month exposure window generally showed similar positive associations. Additionally, these findings were broadly consistent across subgroups and sensitivity analyses. Maternal SO2 exposure increase the risk of polydactyly and syndactyly.
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Affiliation(s)
- Yu-Ting Jiang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No.36, San Hao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jia-Yu Zhang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No.36, San Hao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Yan-Hong Huang
- Department of Ophthalmology, Shenyang Women's and Children's Hospital, Shenyang, Liaoning, People's Republic of China.
| | - Jing Li
- Department of Science and Education, Shenyang Maternity and Child Health Hospital, Shenyang, China
| | - Shu Liu
- Department of Atmospheric Environment Monitoring, Liaoning Eco-environmental Monitoring Center, Shenyang, China
| | - Yan-Ling Chen
- Liaoning Women and Children's Health Hospital, Shenyang, China
| | - Li-Li Li
- Department of Children's Health Prevention, Shenyang Maternity and Child Health Hospital, Shenyang, China
| | - Cheng-Zhi Jiang
- School of Environmental and Chemical Engineering, Shenyang Ligong University, Shenyang, China
| | - Zong-Jiao Chen
- Department of Atmospheric Environment Monitoring, Liaoning Eco-environmental Monitoring Center, Shenyang, China
| | - Yu-Hong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No.36, San Hao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No.36, San Hao Street, Shenyang, 110004, Liaoning, People's Republic of China.
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Greene AK, Sudduth CL, Taghinia AH. Lower Extremity Reconstruction in the Pediatric Population. Clin Plast Surg 2021; 48:341-347. [PMID: 33674055 DOI: 10.1016/j.cps.2020.12.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Indications for lower extremity reconstruction in children are unique because most result from congenital conditions (eg, constriction ring, lymphedema, syndactyly, nevi, vascular anomalies). Like adults, pediatric patients also suffer from effects following extirpation and trauma. Principles of reconstruction are based on the condition and type of deformity. The pediatric population typically has fewer comorbidities than adults that can negatively affect outcomes (eg, diabetes, peripheral vascular disease), although children can be less compliant with postoperative care. Growth, development, appearance, and postoperative compliance are variables that especially influence operative management of children.
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Affiliation(s)
- Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Christopher L Sudduth
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Amir H Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Abstract
BACKGROUND Amniotic band syndrome (ABS) is a rare condition of controversial etiology that is associated with varying degrees of anomalies. This study reports a case of a newborn with ABS associated with double encephalocele in the frontal region. CASE DESCRIPTION A 29-year-old primiparous woman with no history of prenatal infection or consanguineous marriage had a cesarean section at gestational week 38, giving birth to a newborn who was well but had limb anomalies (constriction rings, amputations, and syndactyly) and craniofacial anomalies, mainly double frontal encephalocele. The patient underwent surgical repair and subsequent placement of a ventriculoperitoneal shunt. CONCLUSION Studies clarifying this uncommon association with double encephalocele are limited. ABS associated with double encephalocele is rare and even more complex when associated with other anomalies. Thus, the conditions in such children are severe and require multidisciplinary monitoring.
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Affiliation(s)
- Aldo Jose Ferreira da Silva
- Department of Pediatric Neurosurgery, Santa Monica Maternity School - Alagoas State University of Health Sciences, Maceio, Alagoas, Brazil
| | | | - Sonaly C. R. Mariano
- Department of Pediatrics, Neonatal Intensive Care Unit, Santa Monica Maternity School, Maceio, Alagoas, Brazil
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Hettiarachchi D, Panchal H, Lai PS, Dissanayake VHW. Novel variant in NSDHL gene associated with CHILD syndrome and syndactyly- a case report. BMC Med Genet 2020; 21:164. [PMID: 32819291 PMCID: PMC7439548 DOI: 10.1186/s12881-020-01094-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022]
Abstract
Background Congenital hemidysplasia with ichthyosiform erythroderma and limb defects also known as CHILD syndrome is an X-linked dominant, male lethal genodermatosis with a prevalence of 1 in 100,000 live births. Mutations in NSDHL gene located at Xq28 potentially impair the function of NAD(P) H steroid dehydrogenase-like protein and is responsible for its pathogenesis. Case presentation The proband was a 9-month-old twin (T2) girl with a healthy twin sister (T1) of Sri Lankan origin born to non-consanguineous parents. She presented with right sided continuous icthyosiform erythroderma and ipsilateral limb defects and congenital hemidysplasia since birth. Notably the child had ipsilateral hand hypoplasia and syndactyly. There were other visceral abnormalities. We performed whole exome sequencing and found a novel heterozygous variant (NSDHL, c.713C > A, p.Thr238Asn). Conclusion We report a novel missense variant in the NSDHL gene that resides in a highly-conserved region. This variant affects the NAD(P) H steroid dehydrogenase-like protein function via reduction in the number of active sites resulting in the CHILD syndrome phenotype and syndactyly.
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Affiliation(s)
- D Hettiarachchi
- Human Genetics Unit, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 08, Sri Lanka.
| | - Hetalkumar Panchal
- Department of Bioscience, Sardar Patel University, Vallabh Vidyanagar, Gujarat, India
| | - P S Lai
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - V H W Dissanayake
- Human Genetics Unit, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 08, Sri Lanka
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Romeus L, Liu C, Stanton R, Ellsworth P. Routine circumcision? The role of prepuce in syndactyly repair. J Pediatr Urol 2020; 16:497-499. [PMID: 32631672 DOI: 10.1016/j.jpurol.2020.06.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022]
Abstract
Circumcisions are among the most commonly performed procedures in the pediatric population, but the value of the preputial skin often goes unrecognized as a potential graft (Ehrlichman et al., 2018). We highlight three patients who underwent coordinated circumcision and use of the excised preputial skin as a graft for syndactyly repair. Syndactyly, a condition where fingers are fused together, is often repaired utilizing skin from the groin region, which can result in unwanted hair growth and subcutaneous fat growth. The utilization of the prepuce is a convenient alternative that may have fewer undesirable qualities.
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Affiliation(s)
- Laniel Romeus
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | - Cherry Liu
- University of Central Florida, College of Medicine, Orlando, FL, USA.
| | - Robert Stanton
- Department of Orthopedics, Nemours Children's Hospital, Orlando, FL, USA
| | - Pamela Ellsworth
- Division of Pediatric Urology, Nemours Children's Hospital, Orlando, FL, USA.
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Zhang JY, Gong TT, Huang YH, Li J, Liu S, Chen YL, Li LL, Jiang CZ, Chen ZJ, Wu QJ. Association between maternal exposure to PM 10 and polydactyly and syndactyly: A population-based case-control study in Liaoning province, China. Environ Res 2020; 187:109643. [PMID: 32416360 DOI: 10.1016/j.envres.2020.109643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND The number of studies on air pollution with birth defects as the primary outcome has increased dramatically over the past two decades, but the potential role of specific air pollutants in congenital limb anomalies remains unclear. OBJECTIVES To evaluate associations between preconception and first-trimester PM10 exposure and polydactyly and syndactyly in a population-based case-control study. METHODS Polydactyly cases (n = 2605), syndactyly cases (n = 595), and controls without any birth defects (n = 7950) born between 2010 and 2015 were selected from the Maternal and Child Health Certificate Registry of Liaoning Province. The monthly mean PM10 concentrations were obtained from 75 air monitoring stations, and the exposure assessment was based on the mean concentration of all stations in mother's residential city. A multivariable logistic regression model was constructed to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS PM10 exposure was positively associated with the risks of polydactyly (preconception: aORT3 vs. T1 = 1.95, 95% CI 1.56-2.45, aOR = 1.06, 95% CI 1.01-1.10 [per 10-μg/m3 increment]; first-trimester: aORT3 vs. T1 = 2.51, 95% CI 2.00-3.15) and syndactyly (preconception: aORT3 vs. T1 = 2.86, 95% CI 1.98-4.13, aOR = 1.11, 95% CI 1.03-1.20 [per 10-μg/m3 increment]; first-trimester: aORT3 vs. T1 = 3.10, 95% CI 2.11-4.56). Analyses based on single month exposure windows basically showed similar positive associations. Additionally, these findings were robust in sensitivity analyses and broadly consistent across subgroups. CONCLUSION Our study suggest that preconception and first-trimester PM10 exposures are related to increased risks of polydactyly and syndactyly.
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Affiliation(s)
- Jia-Yu Zhang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Yan-Hong Huang
- Department of Ophthalmology, Shenyang Women's and Children's Hospital, Shenyang, China.
| | - Jing Li
- Department of Science and Education, Shenyang Maternity and Child Health Hospital, Shenyang, China.
| | - Shu Liu
- Department of Atmospheric Environment Monitoring, Liaoning Eco-environmental Monitoring Center, China.
| | - Yan-Ling Chen
- Liaoning Women and Children's Health Hospital, Shenyang, China.
| | - Li-Li Li
- Department of Children's Health Prevention, Shenyang Maternity and Child Health Hospital, Shenyang, China.
| | - Cheng-Zhi Jiang
- School of Environmental and Chemical Engineering, Shenyang Ligong University, Shenyang, China.
| | - Zong-Jiao Chen
- Department of Atmospheric Environment Monitoring, Liaoning Eco-environmental Monitoring Center, China.
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
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Garcia-Rodriguez R, Rodriguez-Rodriguez R, Garcia-Delgado R, Romero-Requejo A, Medina-Castellano M, Garcia Cruz L, Santana Rodriguez A, Garcia-Hernandez JA. Prenatal diagnosis of Greig Cephalopolysyndactyly Syndrome. When to suspect it. J Matern Fetal Neonatal Med 2020; 35:2162-2165. [PMID: 32495660 DOI: 10.1080/14767058.2020.1774541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Greig Cephalopolysyndactyly Syndrome (GCPS) is a very rare multiple congenital anomaly with an estimated incidence of 1-9:1,000,000 in newborns with principal findings of macrocephaly, ocular hypertelorism, and polysyndactyly (preaxial or mixed preaxial and postaxial). Very few cases of prenatal diagnoses have been reported. The postnatal diagnosis is based on clinical findings and family background. GLI3, the only gene associated with this anomaly, is altered in more than 75% of cases. Deletions over 1 Mb and involving other genes yield severe clinical cases, which are known collectively as Greig Cephalopolysyndactyly-contiguous gene Syndrome. We report a case in which, despite early polydactyly findings on week 16, the diagnosis was established during the third trimester of pregnancy due to the late presentation of other anomalies corresponding to this syndrome.
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Affiliation(s)
- Raquel Garcia-Rodriguez
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Raul Rodriguez-Rodriguez
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Raquel Garcia-Delgado
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Azahar Romero-Requejo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Margarita Medina-Castellano
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Loida Garcia Cruz
- Clinical Genetics Unit, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alfredo Santana Rodriguez
- Clinical Genetics Unit, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Jose Angel Garcia-Hernandez
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
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Ngoc NT, Duong NT, Quynh DH, Ton ND, Duc HH, Huong LTM, Anh LTL, Hai NV. Identification of novel missense mutations associated with non-syndromic syndactyly in two vietnamese trios by whole exome sequencing. Clin Chim Acta 2020; 506:16-21. [PMID: 32165123 DOI: 10.1016/j.cca.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/26/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND METHODS Syndactyly is a congenital disorder caused by an irregularity in limb formation during the embryonic development. Many studies have demonstrated the critical effect of genetic factor in controlling the outcome of non-syndromic syndactyly. However the signaling pathway causing this disease has not been fully understood. The aim of this study was to identify the genetic mutations that related to syndactyly type I-c and I-d by exome sequencing. RESULTS The exome sequence from two patients revealed two novel heterozygous missense mutations: GLI3: cG1622A pT541M and GJA1: cT274C p.Y92H. Sanger sequencing result confirmed that these mutations were present under heterozygous form in the affected mothers, but not in the unaffected fathers. In-silico analyses by SIFT, Polyphen-2, PredictSNP, PhD-SNP, and PROVEAN did confirm the damaging effect of these mutations in the structure and function of the proteins. CONCLUSIONS The result suggested that the two novel mutations may be pathogenic for the disease in these families under the dominant model, provided the initial data for further functional studies to investigate whether those mutations play a disturbing role in the molecular network of syndactyly.
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Affiliation(s)
- Nguyen Thy Ngoc
- Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Viet Nam; University of Science and Technology of Hanoi, Vietnam Academy of Science and Technology, Viet Nam.
| | - Nguyen Thuy Duong
- Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Viet Nam; Institute of Genome Research, Vietnam Academy of Science and Technology, Viet Nam
| | - Do Hai Quynh
- Institute of Genome Research, Vietnam Academy of Science and Technology, Viet Nam
| | - Nguyen Dang Ton
- Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Viet Nam; Institute of Genome Research, Vietnam Academy of Science and Technology, Viet Nam
| | | | | | - Luong Thi Lan Anh
- Genetic Counseling Center, Hanoi Medical University Hospital, Hanoi Medical University, Viet Nam
| | - Nong Van Hai
- Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Viet Nam; Institute of Genome Research, Vietnam Academy of Science and Technology, Viet Nam
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Le Hanneur M, Cambon-Binder A, Bachy M, Fitoussi F. Treatment of congenital syndactyly. Hand Surg Rehabil 2020; 39:143-153. [PMID: 32142954 DOI: 10.1016/j.hansur.2019.12.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 10/24/2022]
Abstract
Defined as the union of two adjacent digits, syndactyly is one of the most common congenital deformities. The severity of the malformation depends on the fusion level, the tissues involved in the union, and whether it is isolated or syndromic. In order to improve the hand's appearance and function, surgery is recommended in the great majority of cases, ideally during early childhood (i.e., before entering school). Web space reconstruction is done using local flaps. Depending on the flap design, digital resurfacing can be done with or without skin grafts. While graftless techniques have shorter operating times and no morbidity associated with skin harvesting, their cosmetic outcomes seem to be worse than those of traditional grafting techniques, with more postoperative complications; furthermore, such techniques cannot be used in all cases, especially those with osteoarticular fusions. When the fingertip is involved, paronychial reconstruction is carried out with pulp flaps. The prognosis for these deformities directly depends on their severity, with excellent outcomes in cases of cutaneous fusion, and much less predictable ones when osteoarticular and/or tendinous tissues are involved.
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Affiliation(s)
- M Le Hanneur
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - A Cambon-Binder
- Service of Hand Surgery, Department of Orthopedics and Traumatology, Saint-Antoine Hospital, Sorbonne University, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - M Bachy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
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Kracoff SL. Radiographic Characteristics of the Hand in Apert Syndrome. J Hand Surg Asian Pac Vol 2020; 25:82-86. [PMID: 32000596 DOI: 10.1142/s2424835520500113] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: In a small series, it has been postulated that delayed release of complex syndactyly of the 3rd web in Apert syndrome patients causes compression on epiphyses, with early epiphyseal closure, leading to symphalangism and reduced capitate ossification. We wished to see whether this remains true in a larger series. Methods: We reviewed radiographs of 48 patients (86 hands) with Apert syndrome seen in the department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, between the years 2001-2012. Patients underwent surgical release of syndactyly in a staged fashion with the 3rd web release left until last. We measured the size of the capitate ossification center relative to that of the hamate and determined the relative position of the middle finger metacarpal relative to the ring finger metacarpal. Results: We found agreement with many findings, however we weren't able to demonstrate the catch-up growth of the capitate after release of the third web. The failure of normal distal migration of the 3rd metacarpal appeared to occur until the 3rd web release is performed. Conclusions: Consistent findings of delayed ossification of the capitate and failure of normal distal migration of the third metacarpal add support to the initial hypothesis, however, we cannot fully conclude that an earlier release of the third web is recommended, further research is still needed.
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Affiliation(s)
- Sharon Leigh Kracoff
- Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel
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Abstract
Evaluation of the pediatric musculoskeletal system may be difficult because of differences between children and adults. As children mature, their physical structure approaches that of an adult. However, in the meantime, varying stages of ossification and developmental timelines may confuse the average clinician. Congenital abnormalities of the upper extremity are extremely numerous, but here we present 10 that often are seen in clinical practice. The article discusses the diagnosis, evaluation, treatment, and outcomes of each condition.
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Abstract
BACKGROUND There is paucity of literature focusing on the incidence and surgical management of syndactyly. In this study, we describe the incidence and rates of surgical management of patients with syndactyly in New York State.
AIM To describe the incidence and surgical management of patients with syndactyly using an America's population-based database.
METHODS We conducted a retrospective study using the New York State Statewide Planning and Research Cooperative System. All patients with a diagnosis of syndactyly at birth were identified and followed longitudinally to determine yearly incidence as well as demographic and surgical factors. Descriptive statistics and univariate analyses were used.
RESULTS There were 3306 newborns with a syndactyly diagnosis between 1997 and 2014 in New York State. The overall incidence was 0.074% or 7 cases per 10000 live births. A small number of patients underwent surgical correction in New York State (178 patients, 5.4%). Among the surgical patients, most of the operations were performed before the age of two (79%). Approximately 87% of surgeries were performed at teaching hospitals, and 52% of procedures were performed by plastic surgeons. Skin grafting was performed in 15% of cases. Patients having surgery in New York State were more likely to have Medicaid insurance compared to patients not having surgery (P = 0.02).
CONCLUSION Syndactyly occurs in approximately 7 per 10000 live births, and the majority of patients undergo surgical correction before age two. There may be several barriers to care including the availability of specialized hand surgeons, access to teaching hospitals, and insurance status.
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Affiliation(s)
- Ishaan Swarup
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Yi Zhang
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY 10021, United States
| | - Huong Do
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY 10021, United States
| | - Aaron Daluiski
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
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Abstract
Background: Eruption of first primary tooth starts on an average at around six to seven months of age. Presence of teeth at birth or within a month after birth is considered rare. Natal teeth are those present in the oral cavity at the time of birth. These teeth can cause ulcers on the ventral surface of the tongue, lip, and the mother's breast characterizing the Riga Fede Disease. Exact aetiology of natal and neonatal teeth is still unclear. The treatment depends on its mobility of teeth as it is associated with the risk of aspiration or swallowing, whether the natal tooth is supernumerary or primary, causing any problems in breast feeding, presence of soft tissue injuries on tongue of the child or mother's breast and overall health of child. Case presentation: A fifteen day old girl reported with large ulceration on ventral surface of tongue due to sharp natal teeth present at mandibular anterior region which was also associated with feeding difficulties. Along with Riga Fede disease Syndactyly and Oligodactyly in left and right legs respectively was also observed. Extraction of the teeth has been carried out and complete healing of ulceration has been achieved within 30 days. Conclusion: The present case report describes a rare occurrence of Riga Fede disease with Syndactyly and Oligodactyly and highlights its symptomatology and therapeutic approach.
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Abstract
Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7-166). The mean follow-up was 52 months (range 6-111). The mean tourniquet time was 97 minutes (range 66-135) for graft and 84 minutes (55-120) for graftless. The mean finger abduction was 57° (32°-80°) for graft and 54° (38°-80°) for graftless. The mean web creep score was 1.2 (0-3) for graft and 2.1 (0-3) for graftless. The mean scar score was 1.9 (1-3) bilaterally. The mean parents' visual analogue scale for graft cosmesis was 7.1 (5-9) and 6.2 (4.3-8) for graftless. The surgeon's visual analogue scale for graft was 7.9 (6.4-9.5) and 6.2 (4-8.7) for graftless. The therapist's visual analogue scale was 7.9 (6.5-10) and 6.4 (4.7-8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II.
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Affiliation(s)
- Angela A Wang
- Orthopedics, University of Utah, Salt Lake City, UT, USA
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Mbonda A, Endomba FT, Kanmounye US, Nkeck JR, Tochie JN. Diagnosis of Fraser syndrome missed out until the age of six months old in a low-resource setting: a case report. BMC Pediatr 2019; 19:292. [PMID: 31438902 PMCID: PMC6704688 DOI: 10.1186/s12887-019-1673-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022] Open
Abstract
Background Fraser syndrome is a rare genetic disorder that often presents with ocular, renal, genital and limb’s congenital anomalies. The prognosis of this genetic disorder depends on the severity of the combination of congenital malformations, some of which may be fatal. The diagnosis of Fraser syndrome is based on established clinical criteria and genetic tests. The criteria enabling clinical diagnosis are visible dysmorphic features present at birth, hence, Fraser syndrome can easily diagnosed at birth, except when health professionals are inexperienced in clinical recognition. Herein, we report a case of Fraser syndrome missed out at birth and fortuitously diagnosed at the age of six months in a bid to raise clinicians’ awareness, particularly in resource-limited settings. Case presentation We report a case of a six-month-old Cameroonian female infant, born at home and taken the following day to a primary healthcare facility for neonatal care. Her mother had no antenatal care until birth. She presented at our health center with respiratory distress and fever. She had a temperature of 38.8 °C and signs of left lung basal consolidation, suggestive of a left lower lober pneumonia, confirmed on chest x-ray. Other incidental clinical findings were several dysmorphic features like bilateral cryptophthalmos, nasal malformation, anal imperforation (with a perianal fistula), an external genital anomaly and syndactyly characteristic of Fraser syndrome associated with pneumonia. The patient responded well to intravenous antibiotics for the treatment of her pneumonia. Thereafter, she was referred to a pediatric surgeaon for surgical corrections of her bilateral cryptophthalmos, anal imperforation, external genital defect and syndactyly. Conclusion Here we presented a case of Fraser syndrome in a Cameroonian infant whose diagnosis was missed out at birth and fortuitously made at six months of age. In view of the serious and potentially fatal complications of this genetic disorder, we draw clinicians’ attention, especially obstetricians, midwives and pediatricians for a high index of clinical suspicion geared at a timely diagnosis and management. Also, for a timely diagnosis, health education on regular antenatal and postnatal follow ups of the mother-infant couple respectively, cannot be overemphasized.
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Affiliation(s)
- Aimé Mbonda
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Cameroon.,District Hospital Djohong, Adamawa, Cameroon
| | - Francky Teddy Endomba
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Cameroon
| | - Ulrick S Kanmounye
- International Team, InciSioN, Adamawa, Cameroon.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA.,Faculty of Medicine, Université Technologique Bel Campus, Kinshasa, DR, Congo
| | - Jan René Nkeck
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Cameroon
| | - Joel Noutakdie Tochie
- Department of Surgery and Anaesthesiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon.
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Chen HY, Zheng JQ, Zhang HP. A case report of Turner syndrome associated with fetal nuchal cystic hygroma and bilateral syndactyly of the hands and feet. Ital J Pediatr 2019; 45:85. [PMID: 31319890 PMCID: PMC6639934 DOI: 10.1186/s13052-019-0680-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background Turner syndrome (45,X), accounts for 1–2% of conceptions which typically miscarry early in the first trimester. Cases detected prenatally often present with cystic hygroma, which is an ultrasound marker for aneuploidy generally, but Turner syndrome particularly. In this study, we report a second trimester intrauterine fetal demise (IUFD), complicated by a marked cystic hygroma and bilateral syndactyly of the fingers and toes. Case presentation A 25-year-old woman presented for her first prenatal visit at 22-week gestation with IUFD. Color Doppler ultrasound revealed a septated nuchal lymphatic hygroma and hydrops fetalis, characterized by edema of the whole body, substantial pleural effusion and abdominal fluid. Pregnancy was further complicated by oligohydramnios. Following labor induction, a stillborn female baby was delivered at 22 weeks gestation. Autopsy confirmed the presence of huge nuchal cystic hygroma (10 cm × 10 cm × 6 cm) and generalized edema. Bilateral, partial syndactyly involving digits 2–5 of the fingers and toes were also observed. Chromosomal analysis revealed a 45,X karyotype. Conclusions We investigated an unusual case of severe septated nuchal cystic hygroma associated with bilateral syndactyly of the fingers and toes in a stillborn infant with Turner syndrome. Although cystic hygroma has been frequently reported in 45,X the severity is marked in this case. In addition, syndactyly is not a typical complication of Turner syndrome. This case emphasizes the importance of early ultrasound in pregnancy.
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Affiliation(s)
- Hai-Ying Chen
- Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, The Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou, 325000, China
| | - Jian-Qiong Zheng
- Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, The Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou, 325000, China
| | - Hong-Ping Zhang
- Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, The Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou, 325000, China.
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Abstract
Syndactyly correction without skin grafting is advocated because it prevents graft-related complications and donor site morbidity. In this cross-sectional study, we compared satisfaction among patients who underwent correction with and without skin grafting to determine preference based on subjective and objective parameters. Retrospective chart analysis was performed among 27 patients (49 webs) who were seen at follow-up after a median follow-up period of 7.4 years, at which the Patient and Observer Scar Assessment Scale, the Withey score and a satisfaction survey were used. Notably, there were no significant differences in complication rates or observer rated scar scores. Although the need for an additional surgical procedure was higher after skin grafting, patient-rated satisfaction scores were similar irrespective of the use of grafting. Our data suggest that corrections can best be performed without skin grafts if seeking to minimize the need for an additional procedure, but that the use of skin grafts does not appear to affect patient satisfaction. Level of evidence: IV.
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Affiliation(s)
- Bien R. Ferrari
- Bien R. Ferrari, Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, HPC BB81 P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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Abstract
INTRODUCTION This study reports the use of a dorsal pentagonal island flap for post-burn webbing contracture, in which the islanded flap is harvested from the burn scar tissue. METHODS Fourteen dorsal pentagonal island flaps were harvested in seven patients with post-burn webbing. Each flap was selected by examining the scar tissue donor using a modified Vancouver scar scale. Modification from the basic design was made according to the density of the donor scar tissue and the metacarpophalangeal joint movement. RESULTS All the flaps survived with normal abduction of the affected fingers. Modification of the flap design needed adjustment by assessing it through flexion and extension of the metacarpophalangeal joints. There was no incidence of web creep after two months to one year of follow-up. CONCLUSION Dorsal pentagonal island flap shows promising results as an alternative for reconstructing post-burn webbing.
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Affiliation(s)
- Toh Prasetyono
- Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia.,Indonesian Clinical Training and Education Centre, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia
| | - C R Andrian
- Indonesian Clinical Training and Education Centre, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia
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