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Silvernale C, Garcia-Fischer I, Staller K. Relationship Between Psychological Trauma and Irritable Bowel Syndrome and Functional Dyspepsia in a Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Patient Population. Dig Dis Sci 2024; 69:870-875. [PMID: 38112834 DOI: 10.1007/s10620-023-08201-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND There is frequent overlap between and the connective tissue diseases Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome (JHS/EDS) and disorders of the gut-brain interaction (DGBIs). AIMS Because not all JHS/EDS patients develop DGBIs, we sought to determine whether secondary environmental triggers may lead to development of irritable bowel syndrome (IBS) and functional dyspepsia (FD) in patients with JHS/EDS. METHODS We sent electronic surveys to 253 patients from a JHS/EDS support group, with responses collected over one year. IBS and FD were diagnosed by the Rome IV criteria, with additional validated assessments of adverse childhood experiences (ACEs) and traumatic stressors according to DSM-V criteria. We compared clinical and psychological characteristics of JHS/EDS patients with and without DGBIs using univariable and multivariable analyses. RESULTS We enrolled 193 JHS/EDS patients, of whom 67.9% met Rome IV criteria for IBS. The IBS and JHS/EDS overlap group reported significantly more traumatic exposures (P < 0.001) and were more likely to have experienced greater than 3 ACEs (P < 0.001) than JHS/EDS patients without IBS. FD was found in 35.2% of patients and was associated with significantly more traumatic exposures (P < 0.001) and were more likely to have experienced greater than 3 ACEs (P < 0.001) than JHS/EDS patients without FD. CONCLUSIONS We found that JHS/EDS patients with IBS and FD overlap reported significantly more traumatic exposures and ACEs compared to JHS/EDS patients without overlapping IBS or FD. JHS/EDS patients may have increased susceptibility to DGBIs, with traumatic life experiences and/or ACEs acting a secondary environmental trigger driving the subsequent development of DGBIs.
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Affiliation(s)
- Casey Silvernale
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Sidney Kimmel Medical College, Jefferson University Hospital, 1025 Walnut St #100, Philadelphia, PA, 19107, USA.
| | - Isabelle Garcia-Fischer
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
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Isaacson E, Dowlut-McElroy T. Heavy Menstrual Bleeding in Adolescents with Joint Hypermobility Syndrome/Hypermobile-Type Ehlers-Danlos: A Review. Pediatr Ann 2024; 53:e104-e108. [PMID: 38466333 DOI: 10.3928/19382359-20240109-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heavy menstrual bleeding has a high prevalence and is well documented in adult patients with hypermobile-type Ehlers-Danlos syndrome, but there is limited research surrounding work-up and treatment for the adolescent population. Excessive menstrual blood loss can significantly interfere with emotional and physical quality of life. A provider should acquire a comprehensive medical and menstrual history and focused physical examination, as well as baseline laboratory studies, to determine the presence of anemia or underlying bleeding disorder. Use of a pictorial blood assessment chart may be considered to help quantify the amount of bleeding. Treatment to reduce heavy menstrual flow and referral to specialty care should be initiated swiftly to improve quality of life for this population. [Pediatr Ann. 2024;53(3):e104-e108.].
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Tirado-Caballero J, Moreno-Madueño G, Rivero-Garvia M, Mayorga-Buiza MJ, Valencia-Anguita J, Márquez-Rivas J. Two-Stage Approach for Unstable Pediatric Craniocervical Junction Anomalies with a Halo Vest and Delayed Occipitocervical Fusion: Technical Note, Case Series, and Literature Review. World Neurosurg 2020; 146:e1021-e1030. [PMID: 33227530 DOI: 10.1016/j.wneu.2020.11.079] [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: 10/08/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Malformations in the craniocervical junction (CCJ) are rare in the pediatric population but often need surgical treatment. We present a pediatric case series of patients treated with a 2-stage surgical approach with a halo vest and occipitocervical fusion and review complications and outcomes. METHODS A retrospective analysis of a single-center case series was performed. Pediatric patients affected by congenital craniocervical junction anomalies and treated with a 2-stage approach were included. A halo vest was implanted in the first surgery, and ambulatory progressive reduction was performed. When a favorable anatomic situation was observed, arthrodesis was performed. Safety analysis was undertaken by analyzing the incidence of complications in both procedures. Effectivity analysis was carried out analyzing radiologic and clinical outcome (Goel grade and modified Japanese Orthopaedic Association score). Student t test was used for statistical analysis. RESULTS Sixteen cases were included. Mean age of patients was 9.38 years. Safety analysis showed 2 halo loosenings, 1 pin infection, 2 wound infections, 1 cerebrospinal fluid leak, and 2 delayed broken rods. No major complications were observed. Radiologic analysis showed an improvement in the tip of the odontoid process to the McRae line distance (from -3.26 mm to -6.16 mm), atlantodental interval (from 3.05 mm to 1.88 mm), clival-canal angle (from 134.61° to 144.38°), and cervical kyphosis (from 6.39° to 1.54°). Clinical analysis also showed improvement in mean Goel grade (from 1.75 to 1.44) and modified Japanese Orthopaedic Association score (from 15.12 to 16.41). CONCLUSIONS The 2-stage approach was a suitable and effective treatment for craniocervical junction anomalies in pediatric patients.
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Affiliation(s)
- Jorge Tirado-Caballero
- Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain; Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain; Neurosurgery Service, 12 de Octubre University Hospital, Madrid, Spain.
| | | | - Mónica Rivero-Garvia
- Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain; Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain
| | - María José Mayorga-Buiza
- Pediatric Anesthesia Service, Virgen del Rocío University Hospital, Seville, Spain; Group of Advanced Neurology, Seville, Spain
| | - Julio Valencia-Anguita
- Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain; Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain
| | - Javier Márquez-Rivas
- Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain; Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain; Group of Advanced Neurology, Seville, Spain
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Rolvien T, Kornak U, Linke SJ, Amling M, Oheim R. Whole-Exome Sequencing Identifies Novel Compound Heterozygous ZNF469 Mutations in Two Siblings with Mild Brittle Cornea Syndrome. Calcif Tissue Int 2020; 107:294-299. [PMID: 32671420 PMCID: PMC7415034 DOI: 10.1007/s00223-020-00721-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Abstract
Connective tissue diseases, including osteogenesis imperfecta (OI) and Ehlers-Danlos syndrome (EDS), exhibit a high degree of clinical and genetic heterogeneity. We report two sisters with blue sclerae, joint hypermobility and hearing loss. Whole-exome sequencing identified two compound heterozygous ZNF469 loss-of-function mutations due to a frameshift. Since these findings indicate the presence of brittle cornea syndrome (BCS), we performed ocular optical coherence tomography (OCT) and pachymetry, which revealed a moderate decrease in corneal thickness. While only one traumatic fracture was observed in each of the patients, a detailed skeletal assessment indicated no specific patterns of bone mass and microstructure reduction as well as normal bone turnover markers. Taken together, our findings point to a mild form of brittle cornea syndrome with a phenotype compatible with the extraskeletal features of OI but also with EDS.
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Affiliation(s)
- Tim Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Kornak
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
- FG Development and Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Stephan J Linke
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany.
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Demmler JC, Atkinson MD, Reinhold EJ, Choy E, Lyons RA, Brophy ST. Diagnosed prevalence of Ehlers-Danlos syndrome and hypermobility spectrum disorder in Wales, UK: a national electronic cohort study and case-control comparison. BMJ Open 2019; 9:e031365. [PMID: 31685485 PMCID: PMC6858200 DOI: 10.1136/bmjopen-2019-031365] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To describe the epidemiology of diagnosed hypermobility spectrum disorder (HSD) and Ehlers-Danlos syndromes (EDS) using linked electronic medical records. To examine whether these conditions remain rare and primarily affect the musculoskeletal system. DESIGN Nationwide linked electronic cohort and nested case-control study. SETTING Routinely collected data from primary care and hospital admissions in Wales, UK. PARTICIPANTS People within the primary care or hospital data systems with a coded diagnosis of EDS or joint hypermobility syndrome (JHS) between 1 July 1990 and 30 June 2017. MAIN OUTCOME MEASURES Combined prevalence of JHS and EDS in Wales. Additional diagnosis and prescription data in those diagnosed with EDS or JHS compared with matched controls. RESULTS We found 6021 individuals (men: 30%, women: 70%) with a diagnostic code of either EDS or JHS. This gives a diagnosed point prevalence of 194.2 per 100 000 in 2016/2017 or roughly 10 cases in a practice of 5000 patients. There was a pronounced gender difference of 8.5 years (95% CI: 7.70 to 9.22) in the mean age at diagnosis. EDS or JHS was not only associated with high odds for other musculoskeletal diagnoses and drug prescriptions but also with significantly higher odds of a diagnosis in other disease categories (eg, mental health, nervous and digestive systems) and higher odds of a prescription in most disease categories (eg, gastrointestinal and cardiovascular drugs) within the 12 months before and after the first recorded diagnosis. CONCLUSIONS EDS and JHS (since March 2017 classified as EDS or HSD) have historically been considered rare diseases only affecting the musculoskeletal system and soft tissues. These data demonstrate that both these assertions should be reconsidered.
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Affiliation(s)
- Joanne C Demmler
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Mark D Atkinson
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Ernest Choy
- School of Medicine, Cardiff University, Cardiff, UK
| | - Ronan A Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Sinead T Brophy
- Swansea University Medical School, Swansea University, Swansea, UK
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Al Kaissi A, Ryabykh S, Pavlova OM, Ochirova P, Kenis V, Chehida FB, Ganger R, Grill F, Kircher SG. The Managment of cervical spine abnormalities in children with spondyloepiphyseal dysplasia congenita: Observational study. Medicine (Baltimore) 2019; 98:e13780. [PMID: 30608389 PMCID: PMC6344193 DOI: 10.1097/md.0000000000013780] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Spondyloepiphyseal dysplasia congenita (SEDC) is an autosomal dominant disorder, characterized by disproportionate dwarfism with short spine, short neck associated with variable degrees of coxa vara. Cervical cord compression is the most hazardous skeletal deformity in patients with SEDC which requires special attention and management.Ten patients with the clinical and the radiographic phenotypes of spondyloepiphyseal dysplasia congenita have been recognized and the genotype was compatible with single base substitutions, deletions or duplication of part of the COL2A1 gene (6 patients out of ten have been sequenced). Cervical spine radiographs showed apparent atlantoaxial instability in correlation with odontoid hypoplasia or os-odontoideum.Instability of 8 mm or more and or the presence of symptoms of myelopathy were the main indications for surgery. Posterior cervical fusion from the occiput or C1-3, decompression of C1-2 and application of autorib transfer followed by halo vest immobilization have been applied accordingly.Orthopedic management of children with spondyloepiphyseal dysplasia congenita (SEDC) should begin with the cervical spine to avoid serious neurological deficits and or mortality.
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Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and, AUVA TraumaCentre Meidling, First Medical Department, Hanusch Hospital
- Orthopaedic Hospital of Speising- Pediatric Department, Vienna, Austria
| | - Sergey Ryabykh
- Division Spine Pathology and Rare Diseases, Russian Scientific Ilizarov Center, Kurgan, Russia
| | - Olga M. Pavlova
- Division Spine Pathology and Rare Diseases, Russian Scientific Ilizarov Center, Kurgan, Russia
| | - Polina Ochirova
- Division Spine Pathology and Rare Diseases, Russian Scientific Ilizarov Center, Kurgan, Russia
| | - Vladimir Kenis
- Pediatric Orthopedic Institute n.a. H. Turner, Department of Foot and Ankle Surgery, Neuroorthopaedics and Systemic Disorders, Saint-Petersburg, Russia
| | | | - Rudolf Ganger
- Orthopaedic Hospital of Speising- Pediatric Department, Vienna, Austria
| | - Franz Grill
- Orthopaedic Hospital of Speising- Pediatric Department, Vienna, Austria
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Clement BC, Forster C, Logemann N. Focal linear elastosis in a patient with joint hypermobility syndrome. Dermatol Online J 2018; 24:13030/qt6n9456xv. [PMID: 29469764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 06/08/2023] Open
Abstract
Focal linear elastosis (FLE) is a benign skin findingcharacterized by hypertrophic linear plaques withabnormal elastic fibers on histology. We present aunique case in which focal linear elastosis occurredin the setting of joint hypermobility syndrome(JHS). Our patient, a 20-year-old man with a medicalhistory significant for symptoms consistent with JHS,had been followed by the rheumatology clinic formany months. He was referred to the dermatologydepartment for further evaluation of asymptomaticlongitudinal bands on his back that had been presentfor many years. He denied trauma but endorsed ahistory of 'stretch marks.' On examination there werenumerous horizontally oriented, firm, linear, yellowto flesh colored bands, all non-tender to palpation.Punch biopsies were performed of involved anduninvolved skin. Histopathology of normal skinrevealed no significant abnormalities whereasinvolved skin demonstrated broadened collagenbundles in the deep dermis. The elastic fiber stain,Verhoeff-Van Gieson, revealed a gross increase in thenumber of elastic fibers, fragmented fibers, fiberswith "paintbrush" or widened-ends, fibers of varyingthickness, and clumped fibers. This combination ofhistopathologic and clinical features was consistent with FLE.
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Affiliation(s)
- Barak C Clement
- Walter Reed National Military Medical Center, Bethesda, Maryland.
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8
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Castori M, Colombi M. Generalized joint hypermobility, joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet C Semin Med Genet 2015; 169C:1-5. [PMID: 25821089 DOI: 10.1002/ajmg.c.31432] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 12/31/2014] [Indexed: 11/10/2022]
Abstract
This issue of the American Journal of Medical Genetics Seminar Series Part C is dedicated to generalized joint hypermobility (gJHM), joint hypermobility syndrome (JHS), and Ehlers-Danlos syndrome, hypermobility type (EDS-HT). gJHM is the best known clinical manifestation of inherited defects of the connective tissue. On the other side, JHS and EDS-HT are actually considered one and the same from a clinical perspective by most practitioners and researchers (i.e., JHS/EDS-HT), and their molecular basis remains unknown. For decades, "non-syndromic" gJHM and JHS/EDS-HT have been thought to be simple clinical curiosities or an asset for the "affected" individual. In recent years, the attention on these partially overlapping phenotypes has increased, as they are now recognized risk factors for a series of non-communicable diseases and long-term disabilities. This series consists of 10 papers focused on three main topics, namely (i) assessment and differential diagnosis of children and adults with gJHM, (ii) systematic presentation of selected key non-articular manifestations of JHS/EDS-HT and actual perception of physiotherapy as the best therapeutic resource for this condition, and (iii) exploration of the available knowledge relating "congenital laxity of tissues" to various dysfunctions of the nervous system during development and adulthood. The contributors hope that this collection raises attention to this fascinating field of knowledge, which seems to have ramifications in virtually all medical disciplines.
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Castori M, Morlino S, Pascolini G, Blundo C, Grammatico P. Gastrointestinal and nutritional issues in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet C Semin Med Genet 2015; 169C:54-75. [PMID: 25821092 DOI: 10.1002/ajmg.c.31431] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/22/2014] [Indexed: 12/31/2022]
Abstract
Gastrointestinal involvement is a well known complication of Ehlers-Danlos syndromes (EDSs), mainly in form of abdominal emergencies due to intestinal/abdominal vessels rupture in vascular EDS. In the last decade, a growing number of works investigated the relationship between a wide spectrum of chronic gastrointestinal complaints and various EDS forms, among which the hypermobility type (a.k.a. joint hypermobility syndrome; JHS/EDS-HT) was the most studied. The emerging findings depict a major role for gastrointestinal involvement in the health status and, consequently, management of JHS/EDS-HT patients. Nevertheless, fragmentation of knowledge limits its impact on practice within the boundaries of highly specialized clinics. In this paper, literature review on gastrointestinal manifestations in JHS/EDS-HT was carried out and identified papers categorized as (i) case-control/cohort studies associating (apparently non-syndromic) joint hypermobility and gastrointestinal involvement, (ii) case-control/cohort studies associating JHS/EDS-HT and gastrointestinal involvement, (iii) case reports/series on various gastrointestinal complications in (presumed) JHS/EDS-HT, and (iv) studies reporting gastrointestinal features in heterogeneous EDS patients' cohorts. Gastrointestinal manifestations of JHS/EDS-HT were organized and discussed in two categories, including structural anomalies (i.e., abdominal/diaphragmatic hernias, internal organ/pelvic prolapses, intestinal intussusceptions) and functional features (i.e., dysphagia, gastro-esophageal reflux, dyspepsia, recurrent abdominal pain, constipation/diarrhea), with emphasis on practice and future implications. In the second part of this paper, a summary of possible nutritional interventions in JHS/EDS-HT was presented. Supplementation strategies were borrowed from data available for general population with minor modifications in the light of recent discoveries in the pathogenesis of selected JHS/EDS-HT features.
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Murali J, Monchik K, Fadale P. Congenital Absence of the Anterior Cruciate Ligament. Am J Orthop (Belle Mead NJ) 2015; 44:E283-E285. [PMID: 26251945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The incidence of congenital absence of the anterior cruciate ligament (ACL) is extremely low. Congenital ACL absence has most often been found in association with conditions such as knee dislocation, knee dysplasia, proximal focal femoral deficiency, and fibular hemimelia. We report on the incidental finding of ACL aplasia in a patient with a medial meniscal tear and history of leg-length discrepancy. As has been found in prior case studies, this patient had hypertrophy of the meniscofemoral ligament of Humphrey, which likely lent her stability. This case highlights the importance of differentiating between a stable and an unstable knee in congenital absence of the ACL.
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Jacobs JW, da Silva JA. Hypermobility syndromes from the clinician's perspective: an overview. Acta Reumatol Port 2014; 39:124-136. [PMID: 24861097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Symptomatic generalized hypermobility is a frequent occurring condition among patients referred to the rheumatologist or other medical specialist. In a subset of patients, a further classifying diagnosis of a specific syndrome can (and should) be made, based on pattern recognition and knowledge of the spectrum of hypermobility syndromes. Diagnostic clues are the patient's and family history and signs at physical examination, including skin abnormalities. It is especially important to recognize hypermobility syndromes with potentially life threatening complications. Genetic testing is only available for some syndromes; is only indicated if there is a reasonable pretest probability regarding a specific syndrome, especially if this syndrome can have life-threatening complications. The therapy is for the major part of syndromes only symptomatic; key features of management are education and physical exercises; joint surgery is to be avoided.
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Mirzatolooei F. Patellofemoral ligament reconstruction in a patient with Rubinstein-Taybi syndrome. Acta Med Iran 2014; 52:228-230. [PMID: 24901727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 04/30/2013] [Indexed: 06/03/2023] Open
Abstract
Recurrent dislocation of patella may occur in patients with ligament laxity. Method of treatment in this condition is controversial but patellofemoral ligament reconstruction is the most accepted method. We present a patient with Rubinstein-Taybi syndrome and recurrent patellar dislocation who managed successfully by patellofemoral ligament reconstruction.
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Affiliation(s)
- Fardin Mirzatolooei
- Department of Orthopedic Surgery, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
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13
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Uzak AS, Fryns JP, Dundar M. Syndromes presenting adducted thumb with/without clubfoot and Dundar syndrome. Genet Couns 2014; 25:159-169. [PMID: 25059014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Congenital adducted thumb has been called variously as congenital clasped thumb, thumb in palm deformity or flexion adduction deformity of the thumb. This condition can be an isolated anomaly or associated with several genetic disorders. The syndromes that include adducted thumb as a cardinal feature such as Dundar Syndrome are few in the literature. This syndrome is an autosomal-recessive very rare disorder characterized by typical facial appearance with dysmorphic features that includes wasted build, hyperextensible, thin and translucent skin with atrophic scarring, severe congenital contractures of fingers and thumbs, club feet, severe kyphoscoliosis, joint instability, muscular hypotonia, and ocular involvement. Heart, kidney, and/or intestinal defects can also be observed. Up to date the syndrome is described in few families in the literature. Here we discuss the syndromes that include adducted thumb as a cardinal feature and also the differential diagnosis of the Dundar Syndrome according to the literature.
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Shanmugapriya V, Subashini B, Brindha K, Shobhana S. A 'benign' condition masquerading as arthritis. BMJ Case Rep 2013; 2013:bcr2013010518. [PMID: 23917365 PMCID: PMC3761653 DOI: 10.1136/bcr-2013-010518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 9 year-old boy presented with a 3-week history of low-grade fever, on and off, and additive arthritis of the lower limb joints with no overt antecedent trauma. Investigations for juvenile idiopathic arthritis (JIA), reactive and tuberculous arthritis were normal. He was started on anti-inflammatory drugs as for seronegative oligoarticular JIA. Since arthritis persisted despite treatment, MRI of the left knee joint was planned prior to an aspiration/synovial biopsy. MRI revealed a partial tear of the anterior cruciate ligament with a significant effusion. On careful re-examination, at this point, he was found to have generalised hypermobility with a Beighton score of 9/9. This had been missed initially, leading to a delay in diagnosis and management. He was managed with careful physiotherapy and lifestyle modification. The left knee effusion resolved within a month. This case is being reported in order to highlight the fact that joint hypermobility syndrome can be misdiagnosed as arthritis.
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Affiliation(s)
- V Shanmugapriya
- Department of Pediatrics, ESI-PGIMSR, Chennai, Tamil Nadu, India
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15
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Rohrbach M, Spencer HL, Porter LF, Burkitt-Wright EM, Bürer C, Janecke A, Bakshi M, Sillence D, Al-Hussain H, Baumgartner M, Steinmann B, Black GC, Manson FD, Giunta C. ZNF469 frequently mutated in the brittle cornea syndrome (BCS) is a single exon gene possibly regulating the expression of several extracellular matrix components. Mol Genet Metab 2013; 109:289-95. [PMID: 23680354 PMCID: PMC3925994 DOI: 10.1016/j.ymgme.2013.04.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 01/17/2023]
Abstract
Brittle cornea syndrome (BCS; MIM 229200) is an autosomal recessive generalized connective tissue disorder caused by mutations in ZNF469 and PRDM5. It is characterized by extreme thinning and fragility of the cornea that may rupture in the absence of significant trauma leading to blindness. Keratoconus or keratoglobus, high myopia, blue sclerae, hyperelasticity of the skin without excessive fragility, and hypermobility of the small joints are additional features of BCS. Transcriptional regulation of extracellular matrix components, particularly of fibrillar collagens, by PRDM5 and ZNF469 suggests that they might be part of the same pathway, the disruption of which is likely to cause the features of BCS. In the present study, we have performed molecular analysis of a cohort of 23 BCS affected patients on both ZNF469 and PRDM5, including those who were clinically reported previously [1]; the clinical description of three additional patients is reported in detail. We identified either homozygous or compound heterozygous mutations in ZNF469 in 18 patients while, 4 were found to be homozygous for PRDM5 mutations. In one single patient a mutation in neither ZNF469 nor PRDM5 was identified. Furthermore, we report the 12 novel ZNF469 variants identified in our patient cohort, and show evidence that ZNF469 is a single exon rather than a two exon gene.
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Affiliation(s)
- Marianne Rohrbach
- Division of Metabolism, Connective Tissue Unit and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Helen L. Spencer
- Genetic Medicine Research Centre, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, UK
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Louise F. Porter
- Genetic Medicine Research Centre, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, UK
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma M.M. Burkitt-Wright
- Genetic Medicine Research Centre, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, UK
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Céline Bürer
- Division of Metabolism, Connective Tissue Unit and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Andreas Janecke
- Division of Human Genetics, Innsbruck Medical University, Innsbruck, Austria
| | - Madhura Bakshi
- Department of Clinical Genetics, Children's Hospital at Westmead, Westmead NSW, Sydney, Australia
| | - David Sillence
- Department of Clinical Genetics, Children's Hospital at Westmead, Westmead NSW, Sydney, Australia
| | - Hailah Al-Hussain
- King Khaled Eye Specialist Hospital, Division of Oculoplastics and Orbit, Saudi Arabia
| | - Matthias Baumgartner
- Division of Metabolism, Connective Tissue Unit and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Beat Steinmann
- Division of Metabolism, Connective Tissue Unit and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Graeme C.M. Black
- Genetic Medicine Research Centre, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, UK
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Forbes D.C. Manson
- Genetic Medicine Research Centre, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, UK
- St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Cecilia Giunta
- Division of Metabolism, Connective Tissue Unit and Children's Research Center, University Children's Hospital, Zurich, Switzerland
- Corresponding author at: Division of Metabolism, University Children's Hospital Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
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Düppe H. [Congenital instability and dislocation of the hip--management today]. Lakartidningen 2013; 110:740-743. [PMID: 23662531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Charlton S, Muir L, Skinner TC, Walters L. Pilot evaluation of anterior dynamic ultrasound screening for developmental dysplasia of the hip in an Australian regional hospital. Rural Remote Health 2012; 12:2091. [PMID: 22985098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Developmental Dysplasia of the Hip (DDH) is the most common notifiable musculoskeletal birth defect in South Australia (SA). Despite routine screening by physical examination of the hips in the neonatal period and at 6 weeks of age, the risk of late diagnosis is increased in rural areas. It is assumed this is due to the examining doctors' reduced clinical expertise. Introducing Anterior Dynamic Ultrasound (ADUS) has reduced the late detection rates in Sweden to almost zero, and may benefit Australian infants in rural areas if routine screening was introduced. This study reports on a small implementation pilot in a SA regional hospital where volunteer postnatal mothers consented to their babies having ADUS examinations. METHODS The pilot was evaluated by collecting results of physical examination, ADUS, and surveying parental impressions of the screening test. RESULTS Hips of 86 infants underwent ADUS during the implementation pilot. Parents' perceptions were mainly very positive and indicated ADUS was an accessible and acceptable screening test. Of the hips scanned, three were found to have maximum movement of the femoral head of >3 mm and were deemed to demonstrate increased laxity. Four hips described as loose or mobile on clinical examination were found to be within normal limits of maximum mobility on ADUS. CONCLUSIONS This study has demonstrated that a larger scale implementation project would be feasible in regional Australia, and would enable researchers to better understand how to reduce the late diagnosis rate of DDH in rural areas.
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Affiliation(s)
- S Charlton
- 1 Stop Paediatric Services, Mount Gambier, South Australia, Australia.
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Gharbiya M, Moramarco A, Castori M, Parisi F, Celletti C, Marenco M, Mariani I, Grammatico P, Camerota F. Ocular features in joint hypermobility syndrome/ehlers-danlos syndrome hypermobility type: a clinical and in vivo confocal microscopy study. Am J Ophthalmol 2012; 154:593-600.e1. [PMID: 22633352 DOI: 10.1016/j.ajo.2012.03.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/13/2012] [Accepted: 03/13/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate ocular anomalies in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT). DESIGN Prospective, cross-sectional study. METHODS Forty-four eyes of 22 consecutive patients with an established diagnosis of JHS/EDS-HT and 44 eyes of 22 age- and gender-matched control subjects. Administration of a standardized questionnaire (Ocular Surface Disease Index) and a complete ophthalmologic examination, including assessment of best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, indirect ophthalmoscopy, tear-film break-up time, Schirmer I testing, axial length and anterior chamber depth measurement, corneal topography, corneal pachymetry, and confocal microscopy. Main outcome measures included comparing ocular anomalies in JHS/EDS-HT and control eyes. RESULTS JHS/EDS-HT patients reported dry eye symptoms more commonly than controls (P < .0001). Scores of tear-film break-up time and Schirmer I test were significantly lower in JHS/EDS-HT eyes (P < .0001). Minor lens opacities were significantly more common in the JHS/EDS-HT group (13.6%; P < .05). Pathologic myopia with abnormal vitreous was found in 7 JHS/EDS-HT eyes (15.9%) and 0 controls (P = .01). Corneas were significantly steeper and the best-fit sphere index was significantly higher in JHS/EDS-HT group (P < .01). By confocal microscopy, the JHS/EDS-HT group showed lower density of cells in the superficial epithelium (P < .001) and higher density of stromal keratocytes in anterior and posterior stroma (P < .0001). CONCLUSIONS The most consistent association of eye anomalies in the JHS/EDS-HT group included xerophthalmia, steeper corneas, pathologic myopia, and vitreous abnormalities, as well as a higher rate of minor lens opacities. These findings indicate the need for ophthalmologic survey in the assessment and management of patients with JHS/EDS-HT.
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Affiliation(s)
- Magda Gharbiya
- Department of Ophthalmology, Sapienza University, Umberto I Hospital, Rome, Italy.
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Khan AO, Aldahmesh MA, Alkuraya FS. Brittle cornea without clinically-evident extraocular findings in an adult harboring a novel homozygous ZNF469 mutation. Ophthalmic Genet 2012; 33:257-9. [PMID: 22486320 DOI: 10.3109/13816810.2012.670362] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Affiliation(s)
- Malid Molloholli
- Horton General Hospital, Oxford Radcliffe Hospitals NHS Trust, Banbury, Oxfordshire OX16 9AL, UK
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Ioscovich A, Grisaru-Granovsky S, Halpern S, Shapiro Y. Peripartum anesthetic management of a patient with brittle cornea syndrome. Arch Gynecol Obstet 2011; 283 Suppl 1:49-52. [PMID: 21258811 DOI: 10.1007/s00404-011-1838-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Accepted: 01/07/2011] [Indexed: 12/19/2022]
Abstract
Brittle cornea syndrome (BCS) is a rare autosomal recessive disease that affects the connective tissue. The syndrome is caused by genetic changes in the 4.7-Mb interval between the D16S3423 and D16S3425 markers on the 16q24 chromosome and mutations in the Zinc-Finger 469 gene (ZNF469). BCS is characterized by thin and fragile cornea that tends to perforate spontaneously or as a result of minor trauma to the eye. In addition, the patient usually suffers from hearing loss, mental retardation, hyperextensibility of skin and joints, as well as varying degrees of scoliosis. This phenotypical expression presents an interesting challenge to anesthetic care. We briefly present the perioperative management of a patient with BCS who underwent three cesarean sections.
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Affiliation(s)
- A Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Centre, Hebrew University, POB 3235, 91031, Jerusalem, Israel.
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Bravo JF. [Ehlers-Danlos syndrome, with special emphasis in the joint hypermobility syndrome]. Rev Med Chil 2009; 137:1488-1497. [PMID: 20098810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There is an urgent need to increase the awareness on the Joint Hyper mobility Syndrome QHS). This is a congenital and prevalent emergent condition that is frequently undiagnosed and that causes significant health problems. Besides recurrent muscular-skeletal problems and signs and symptoms derived from tissue fragility, adolescents and young adults may develop osteoporosis, early osteoarthritis or dysautonomia, that are common in the disease, and deteriorate quality of life. Many JHS patients have signs and symptoms suggestive of fibromyalgia and are usually misdiagnosed. Physicians should be able to differentiate the less severe form of JHS from the Vascular Ehlers-Danlos Syndrome, to diagnose it before the appearance of serious complications and even death. The study of these diseases is a promising area for genomic and rheumatologic research.
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Affiliation(s)
- Jaime F Bravo
- Departamento de Reumatología, Departamento de Medicina Occidente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Thiryayi WA, Alakandy LM, Leach PA, Cowie RA. Craniocervical instability in an infant with partial sacral agenesis. Acta Neurochir (Wien) 2007; 149:623-7. [PMID: 17508125 DOI: 10.1007/s00701-007-1147-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 03/13/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED Sacral agenesis is an uncommon condition characterised by total or partial absence of the sacrum. The association of this condition with craniocervical junction abnormalities is extremely rare. CASE REPORT We describe a 3-year-old girl who, at the age of 8 months, while being investigated for short stature, was found to have significant craniocervical instability associated with anomalies of the odontoid peg. In addition to this she had partial sacral agenesis but genetic tests showed a normal karyotype. Due to the inherent difficulty of surgical fixation and immobilisation in an infant of her age, she was managed conservatively in a soft cervical orthosis. At the age of three years, surgery for decompression and stabilisation was deemed necessary due to the onset of neurological morbidity. CONCLUSION The authors describe this extremely rare association and discuss the difficulties faced while deciding the optimum surgical strategy for managing such young children with craniocervical instability.
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Affiliation(s)
- W A Thiryayi
- Department of Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
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Abstract
We report a rare case of major trapezometacarpal instability observed in a 31-year-old woman with congenital hyperlaxity. The patient presented major functional impotency of both thumbs, closure of the first commissure, and absence of effective opposition except between the lateral borders of the long fingers due to severe pain in the trapezometacarpal joint attributed to osteoarthritis. The patient underwent bilateral trapezectomy with ligamentoplasty. The gross examination of the trapezeal specimens revealed major cartilage destruction on the medial portion of the trapezeal joint surface. Three months after surgery, the patient was able to resume occupational and recreational activities. At one year, she was pain free with normal function. No other similar case could be identified in the literature and search for a pathological condition which could have contributed to the altered collagen was negative. It was observed that since stabilization was achieved by ligamentoplasty, recurrence should not be expected in congenital hyperlaxity if the tendons are unaffected.
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Affiliation(s)
- J-M Cognet
- Département de Chirurgie Orthopédique et Traumatologique, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, avenue Molière, 67098 Strasbourg.
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Browd S, Healy LJ, Dobie G, Johnson JT, Jones GM, Rodriguez LF, Brockmeyer DL. Morphometric and qualitative analysis of congenital occipitocervical instability in children: implications for patients with Down syndrome. J Neurosurg Pediatr 2006; 105:50-4. [PMID: 16871870 DOI: 10.3171/ped.2006.105.1.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Congenital occipitocervical (OC) instability is uncommon in healthy children but can occur in many children with Down syndrome. A simple morphometric method of evaluating the OC joint in children with OC instability is presented, supported by a qualitative image analysis based on computed tomography (CT). METHODS Thin-cut CT scans of the OC joint were obtained in eight patients with Down syndrome and one patient with congenital OC instability. These patients' CT scans were compared with those of 15 healthy age-matched control individuals. Morphometric analysis was performed by measuring the depth and length of the superior articular surface (SAS) of C-1, and these values were normalized for a comparison between groups. Qualitative data were acquired using a surface-rendering technique for a visual comparison of the C-1 SAS. Morphometric analysis demonstrated an absence of the concave C-1 SAS anatomy in patients with congenital OC instability compared with age-matched control individuals (0.083 compared with 0.202, p < 0.001). Three-dimensional (3D) image analysis of the C-l SAS supported this finding. CONCLUSIONS Congenital differences in the shape of the OC joint are highly associated with atraumatic OC instability in children with Down syndrome. High-resolution CT imaging combined with 3D rendering techniques and surface mapping provides support for this assessment. It appears that abnormal OC joint shape is a contributing factor to congenital OC instability, especially in patients with Down syndrome.
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Affiliation(s)
- Samuel Browd
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Medical Center, University of Utah, Salt Lake City, 84113, USA
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Abstract
Sternoclavicular joint subluxation/dislocation injuries in the athlete are uncommon. They can be organised by degree (subluxation, dislocation), timing (acute, chronic, recurrent, congenital), direction (anterior, posterior), and cause (traumatic, atraumatic). The unusual case reported is an adolescent butterfly swimmer with recurrent bilateral sternoclavicular subluxation associated with pain and discomfort. The condition was treated and resolved with conservative management. The diagnosis, investigations, and treatment options are discussed.
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Affiliation(s)
- P S Echlin
- Providence Athletic Medicine, Providence Hospital and Medical Centers, Novi, MI 48374, USA.
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Steckel H, Klinger HM, Baums MH, Schultz W. [Cruciate ligament reconstruction in knees with congenital cruciate ligament aplasia]. Sportverletz Sportschaden 2005; 19:130-3. [PMID: 16167265 DOI: 10.1055/s-2005-858474] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The absence of the cruciate ligament is a rare pathology which is described as a congenital entity often being bilateral and in combination with other malformations. Patients mostly deny symptoms of instability but demonstrate signs of laxity. There is not a standardized treatment yet. METHODS We report a case of congenital cruciate ligament aplasia which was treated with an ACL reconstruction. RESULTS In the described case, the patient had a bad clinical result after ACL reconstruction with a fixed posterior subluxation of the tibia. Resection of the ACL reconstruction and physical therapy led to a better clinical result. DISCUSSION While some authors report favourable results with cruciate ligament reconstruction, others report good results with a conservative regime of symptomatic treatment. When patients do not complain of instability conservative treatment might be one option, since the knee joint is adjusted to this abnormality. Surgical treatment should be considered when conservative therapy is frustrane. If however reconstructive surgery is done in cruciate ligament aplasia both cruciate ligaments need to be reconstructed. After isolated ACL reconstruction the tibia might be fixed posteriorly, leading to extension problems and severe patellofemoral pain as seen in our case.
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Affiliation(s)
- H Steckel
- Orthopädische Klinik, Universitätsklinikum Göttingen.
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Ozturk S, Zor F, Sengezer M, Isik S. Correction of bilateral congenital swan-neck deformity by use of Mitek mini anchor: a new technique. ACTA ACUST UNITED AC 2005; 58:822-5. [PMID: 15950958 DOI: 10.1016/j.bjps.2005.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 01/13/2005] [Indexed: 10/25/2022]
Abstract
Congenital swan neck deformity is a rare condition, secondary to congenital laxity of the palmar plate of the proximal interphalangeal joint. Here, we describe a new surgical method which is based on the palmar plate reinforcement using the Mitek mini anchor system (Mitek Surgical Products Inc., Norwood, MA, USA). Four fingers of a patient with congenital swan neck deformities were corrected with this technique at two stages. First, the anchor was inserted into the volar surface of the proximal phalanx. The two sutures of the anchor system were then crossed the PIP joint in a V fashion. Two holes, 5mm apart from each other, were created through the middle phalanx distal to both insertion points of superficial flexor tendon. The suture ends of the anchor were passed through these holes from the volar to the dorsal side of the middle phalanx and then turned around the edges of the bone to the volar surface. They were tied to each other as the PIP joint was stabilised at 20 degrees flexion by use of a K-wire. The K-wire was removed 21 days later and a rehabilitation program was then initiated. A second operation for the two fingers of the opposite hand was performed 2 months after the first operation. No postoperative complications were encountered. At 2 years follow-up, the active range of motion was within normal limits at PIP and DIP joints of all four fingers without any recurrence of hyperextension or hyperflexion. The final result was satisfactory regarding both the functional and cosmetic aspects. The Mitek mini anchor offers a practical, reliable and functional reconstruction of the volar plate in the management of congenital swan neck deformities. We believe that it may also be used for the acquired deformities.
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Affiliation(s)
- Serdar Ozturk
- Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Ankara, Turkey
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Ochs BG, Schmelzer-Schmied N, Carstens C, Thomsen M. [Fixed posterior subluxation with lateral rotation of the knee joint caused by congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. Case report and review of the literature]. Orthopade 2005; 34:356-61. [PMID: 15726323 DOI: 10.1007/s00132-005-0767-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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Congenital dislocation of the patella is very rare. In this anomaly, the patella is dislocated to the side of the lateral femoral condylus and cannot be repositioned manually. Diagnosis is often made by clinical examination and observation of an abnormal gait. We describe the long-term course of treatment in a young girl with fixed posterior subluxation with lateral rotation of the knee joint caused by congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. These anomalies of the knee joint were corrected incrementally. First, recentralization of the patella was performed by open surgery. Subsequently, distraction of the shortened ischiocrural muscles and the posterior capsules and ligaments was conducted. This is the first case to be described, to the best of our knowledge, of a patient with congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. We describe the successful treatment of such a fixed posterior subluxation and lateral rotation of the knee joint.
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Affiliation(s)
- B G Ochs
- Orthopädische Klinik, Universität, Heidelberg
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Fagan AB, Askin GN, Earwaker JWS. The jigsaw sign. A reliable indicator of congenital aetiology in os odontoideum. Eur Spine J 2004; 13:295-300. [PMID: 15232724 PMCID: PMC3468053 DOI: 10.1007/s00586-004-0732-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Revised: 04/06/2004] [Accepted: 04/10/2004] [Indexed: 11/29/2022]
Abstract
There is evidence in the literature for both a congenital and a post-traumatic aetiology for os odontoideum. In no series published to date has CT been used to aid in the diagnosis. This is a prospective study of the history of trauma and presence of diagnostic features on CT of 18 consecutive cases with os odontoideum. Our objective was to derive clinically useful radiological features enabling accurate differentiation between congenital and post-traumatic aetiologies. A mid-sagittal CT reconstruction of the atlanto-dens joint was obtained. Hypertrophy of the anterior arch of the atlas was quantified by measurement of the arch-peg-area ratio. The presence of dysplastic features (a positive "jigsaw" sign) of the atlanto-axial joint were noted. These included narrowing of the cartilage space and interdigitation of the two joint surfaces. A history of a potential traumatic aetiology was only obtained in one of the 18 (6%) in our series. A significant elevation of the arch-peg ratio was found when comparing this series to 85 controls. And a positive jigsaw sign was observed in 75% of cases. These features were not seen in paediatric cases of atlanto-axial instability, including odontoid non-union. In conclusion, an elevated arch-peg ratio and the presence of a jigsaw sign are sensitive and specific diagnostic criteria for os odontoideum. This series supports a congenital aetiology for this condition.
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Affiliation(s)
- Andrew B Fagan
- Spinal Unit Department of Orthopaedics and Trauma, Royal Adelaide Hospital and the University of Adelaide, North Tce, 5000 Adelaide, Australia.
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Abstract
The atlantoaxial region has been extensively described as a spinal segment especially prone to injury in children. In this clinical review, the authors evaluate and summarize the management of 23 pediatric cases of atlantoaxial instability treated between March 1990 and October 2002. Four broad categories of atlantoaxial problems were observed-atlantoaxial rotatory subluxation in six patients, anterior-posterior atlantoaxial instability caused by ligamentous injury or congenital ligamentous laxity (10 patients), atlantoaxial fracture with or without dislocation (five patients), and atlantooccipital dislocation (two patients). Most cases (60.9%) were treated without surgical intervention, resulting in excellent outcomes; however, 21.7% of cases were treated with a cervical halo (mean patient age 72.6 months) alone for 3 months. Various techniques of surgical stabilization including transarticular screws with sublaminar wiring, transoral decompression with posterior plating, and laminectomy with Steinmann pin occipital-cervical fusion were used with good results. Both patients with atlantooccipital dislocation underwent immediate Locksley occipital-cervical fusion, with marked neurological improvement. Individualized case management must be based on clinical presentation, with internal fixation being the last resort.
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Affiliation(s)
- Scott Y Rahimi
- Department of Neurosurgery, Medical College of Georgia, Augusta 30912, USA.
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Affiliation(s)
- Christopher S Ahmad
- New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, NY, USA
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Abstract
On 14 March 2001, an 8 mo old, male white-tailed deer (Odocoileus virginianus) was found in lateral recumbency exhibiting neurologic signs including inability to rise, opisthotonus, paddling, and respiratory distress. There was evidence of minor cranial trauma. Postmortem examination revealed atlantoaxial instability with ventral deviation of the axis due to malformation of the caudal atlas and cranial axis. Given the age of the fawn, the instability was assumed to be congenital with minor trauma inducing severe, acute neurologic signs.
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Affiliation(s)
- Mitchell V Palmer
- Bacterial Diseases of Livestock Research Unit, National Animal Disease Center, Agricultural Research Service, USDA, 2300 Dayton Road, Ames, Iowa 50010, USA.
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Düppe H, Danielsson LG. Screening of neonatal instability and of developmental dislocation of the hip. A survey of 132,601 living newborn infants between 1956 and 1999. J Bone Joint Surg Br 2002; 84:878-85. [PMID: 12211683 DOI: 10.1302/0301-620x.84b6.12326] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Between 1956 and 1999, 132,601 living children were born in Malmö, and screened for neonatal instability of the hip. All late diagnosed patients have been followed and re-examined clinically and radiologically. During the first years of screening, less than five per 1,000 living newborn infants were treated. This figure increased to 35 per 1000 in 1980, but later diminished again to about six per 1,000 annually after 1990. The number of referred cases decreased from 45 per 1,000 in 1980 to between 10 to 15 per 1,000 from 1990. During the period of high rates of referral and treatment a larger number of paediatricians were involved in the screening procedure than during the periods with low rates of ferral and treatment. Altogether 21 patients (0.16 per 1,000) with developmental dislocation of the hip were diagnosed late, after one week. At follow-up, 18 were free from symptoms and 15 considered to be diologically normal.
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Affiliation(s)
- H Düppe
- Department of Orthopaedics, Malmö University Hospital, Sweden
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Perçin EF, Gedik R, Develioğlu H, Kunt T. Larsen's syndrome with dental anomalies: report of a case. ASDC J Dent Child 2002; 69:172-4, 125. [PMID: 12515061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Dental anomalies and mixed-type hearing loss are extremely rare symptoms of Larsen's syndrome that is characterized by multiple joint dislocation and flat face. A 15-year-old Turkish girl affected with Larsen's syndrome exhibiting many characteristic facial and skeletal features plus hitherto unreported oral and oral-facial anomalies including, maxillary prognathi, malocclusion, supernumerary teeth, macroglossia and microdontia is reported.
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Affiliation(s)
- E Ferda Perçin
- Cumhuriyet University, Faculty of Medicine, Department of Medical Biology and Genetics, Sivas, Turkey
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Nishimura G. [Spondyloepimetaphyseal dysplasia-joint laxity]. Ryoikibetsu Shokogun Shirizu 2002:686-7. [PMID: 11528965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Wild A, Jäger M, Fuss M, Werner A, Krauspe R. [Medical-insurance aspects of atlantoaxial instability in children]. Z Orthop Ihre Grenzgeb 2001; 139:481-4. [PMID: 11753766 DOI: 10.1055/s-2001-19227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION An os odontoideum is mostly diagnosed coincidentally on the basis of neurological symptoms or painful movement of the cervical spine. Diagnostic work-up and therapy are currently subjects of controversial discussion in the literature. CASE Our report is about an eleven-year-old boy with an unknown os odontoideum, who developed neurological symptoms with tetraparesis after a fall from 1.5 m height. Conventional X-ray examination resulted in the diagnosis of a suspected dens fracture, MRI showed atlanto-axial instability and an os odontoideum with significant dural sack compression but no signs of acute bony or ligamentous lesion. CONCLUSION Because of the importance concerning not only medical but also legal/insurance aspects, a possible coincidental finding of an os odontoideum versus a dens fracture must be included in the differential diagnosis. In the case of an os odontoideum without instability in children, conservative therapy is justified after due enlightenment regarding possible risks. In the event of neurological symptoms and/or persistent instability the authors advocate early surgical stabilization even in patients with little infirmity, particularly in view of the possible consequences.
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Affiliation(s)
- A Wild
- Orthopädische Universitätsklinik Düsseldorf, Germany.
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Weiss M, Hartmann K, Fischer JE, Gerber AC. Use of angulated video-intubation laryngoscope in children undergoing manual in-line neck stabilization. Br J Anaesth 2001; 87:453-8. [PMID: 11517131 DOI: 10.1093/bja/87.3.453] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Laryngeal views obtained during direct laryngoscopy with and without manual in-line neck stabilization (MILNS) and during video-assisted intubation with MILNS using the angulated video-intubation laryngoscope were assessed in 100 paediatric patients (aged 0.25-17.3 yr). Visualization of the larynx (Cormack and Lehane score) as well as time taken for video-assisted tracheal intubation by six nurses and four resident anaesthetists not experienced in the technique were recorded. Cormack and Lehane scores were significantly worse during direct laryngoscopy when MILNS was applied. Video-assisted visualization of the larynx during MILNS produced scores, which were as good or better than those observed during direct laryngoscopy alone. Intubation times ranged from 19-75 s (mean 35 (SD 13.4); median 32).
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Affiliation(s)
- M Weiss
- Department of Anaesthesia , University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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Andersson JE, Odén A. The breech presentation and the vertex presentation following an external version represent risk factors for neonatal hip instability. Acta Paediatr 2001; 90:895-8. [PMID: 11529538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
UNLABELLED The aim of this study was to evaluate the frequency and type of hip-joint instability and the frequency of hip dislocation requiring treatment in neonates who had been lying in the breech presentation and were delivered vaginally after an external version or by caesarean section, and to compare them with neonates who were naturally in the vertex presentation. Breech presentations without ongoing labour were subjected to an attempted external version and, in cases where this proved unsuccessful or where labour had started, to deliver by caesarean section. None of the breech presentations was vaginally delivered. The anterior-dynamic ultrasound method was used to assess the hip-joint status of the neonates. Out of 6,571 foetuses, 257 were in breech presentation after 36 wk of pregnancy. Sixty-two were vaginally delivered following an external version to vertex presentation and 195 were delivered by caesarean section, 75 of these following unsuccessful attempts to perform a version. Treatment for congenital hip-joint dislocation was performed on 0.2%. Out of the breech presentations, 1.0% of those delivered by caesarean section were treated, while in those with vaginal delivery following an external version the treatment frequency was 3.2%. No case of late diagnosed hip dislocation was recorded. Significant differences in frequency of hip-joint instability and treatment were found between (i) neonates delivered in breech presentation and those delivered with vertex presentation, (ii) infants delivered in vertex presentation, naturally or after successful version, and (iii) those delivered by caesarean section with or without attempted external version and those delivered with vortex presentation. CONCLUSION Breech presentation predisposes to increased hip instability. The instability is present prior to delivery and is certainly not a primary result of delivery forces. Both breech and vertex presentations following an external or spontaneous version should be considered as risk factors for neonatal hip instability.
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Affiliation(s)
- J E Andersson
- Department of Paediatrics, Blekingesjukhuset, Karlskrona, University of Gothenberg, Sweden.
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Gunn G, Caldow G, Lowman B. Congenital joint laxity and dwarfism in calves. Vet Rec 2000; 147:199-200. [PMID: 10985469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Davies S. Congenital joint laxity and dwarfism in calves. Vet Rec 2000; 147:144. [PMID: 10958544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Holen KJ, Tegnander A, Eik-Nes SH, Terjesen T. The use of ultrasound in determining the initiation of treatment in instability of the hip in neonates. J Bone Joint Surg Br 1999; 81:846-51. [PMID: 10530848 DOI: 10.1302/0301-620x.81b5.9502] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have evaluated the effect of the use of ultrasound in determining the initiation of treatment in neonatal instability of the hip. A total of 99 newborn infants (1.5% of all live births) with neonatal hip instability did not have treatment from birth, but were re-examined at eight to 15 days. In the 31 who had persisting clinical instability and ultrasound abnormality, treatment was then started with a Frejka pillow. The hips in the remaining 68 infants showed spontaneous clinical stabilisation and improvement of the ultrasound findings. Treatment was therefore withheld. There was a marked trend towards normal development in mildly unstable hips, whereas no hips with severe instability did so spontaneously. Further follow-up showed normal development in all the hips which had been treated, and in all except five of the 68 untreated infants. These five infants showed persistent hip dysplasia on both ultrasound and radiological examination at four to five months of age. Treatment with an abduction splint was then started and their hips developed normally. Ultrasound is very useful in deciding on treatment if the examiners have adequate experience with the method. Its use substantially reduces the rate of treatment. Spontaneous resolution occurred in more than half of the unstable hips. Since five of the untreated infants developed hip dysplasia a strict follow-up is essential to identify and treat these cases.
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Affiliation(s)
- K J Holen
- Department of Obstetrics and Gynaecology, Trondheim University Hospital, Norway
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Cebra CK, Cebra ML, Ikede BO. Congenital joint laxity and disproportionate dwarfism in a herd of beef cattle. J Am Vet Med Assoc 1999; 215:519-21, 483. [PMID: 10461638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Three calves from a herd of beef cattle were examined because of disproportionate dwarfism and excessive extension of metacarpophalangeal and metatarsophalangeal joints. Abnormalities had been noticed at birth, 1 to 6 days earlier. A thorough herd investigation revealed that 16 calves born to 70 multiparous cows were affected during the calving season. The condition did not adversely affect calf survival. Affected calves had limbs that were disproportionally short, compared with their trunk size, and wide epiphyses of the femurs and humeri. Radiographic evaluation revealed incomplete maturation of carpal and tarsal bones and incomplete maturation and abnormal flaring of epiphyses of the short humeri and femurs. Histologic findings were consistent with chondrodystrophy. This disorder had not been seen in the herd in previous years and was traced to feeding of dry, spoiled silage to the dams during midgestation. Covering the silage prevented problems in the subsequent year.
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Affiliation(s)
- C K Cebra
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Canada
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Abstract
Dislocation of the fibular head is rare. In most of the cases a trauma caused by sports activity, sometimes associated with a tibia fracture, is described. Only a few publications exist about habitual dislocation of the fibular head without history of trauma. This article reports a case of bilateral habitual anterolateral dislocation of the fibular head in a 17-year-old female. There was no information about a neurological or other disease and no sign of generalized ligamentous laxity. Because of marked symptoms with severe pain after each sensation of dislocation which appeared several times a day, the patient was treated by using a part of the biceps tendon for fixation of the reduced fibular head.
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Affiliation(s)
- J Franke
- Orthopädische Klinik, Medizinische Hochschule Hannover
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Abstract
The authors report the case of a patient with rotatory posterior subluxation of the occiput on the atlas associated with tropism of the O-C1 articulations. Lateral flexion-extension plain films demonstrated 5 mm of posterior translation of the occiput on the atlas. Tomographs revealed tropism of the O-C1 articulations, and CT scans on extension demonstrated posterior rotatory subluxation of the occiput on the atlas. The patient had no osseous abnormality caudally below the atlantoaxial joint, and underwent posterior occipitoatlantal fusion by wiring. At the 4-year follow-up, the grafted bone had been incorporated, and the patient was completely free from preoperative symptoms. In the present patient, occipitoatlantal instability is presumed to have derived from articular tropism.
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Affiliation(s)
- K Abumi
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan
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Chien M, Punwani I, Watanabe K. Advanced periodontitis associated with Larsen's syndrome: case report. Pediatr Dent 1995; 17:62-4. [PMID: 7899108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Larsen's syndrome is a genetic disorder of connective tissue characterized by multiple large-joint dislocations, abnormalities of hands and feet, and anomalous facial features. Although findings involving multiple systems have been added to its clinical and pathological entity, oral pathology besides cleft palate has not been reported. We report here advanced periodontitis with severe gingival inflammation in a 29-year-old Larsen's syndrome patient. Bacterial culture of subgingival plaque identified the periodontal pathogens that were present in numbers above the normal range. We speculate that the underlying defect in connective tissue may predispose Larsen's syndrome patients to periodontal destruction provoked by microbiological factors.
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Affiliation(s)
- M Chien
- Department of Pediatric Dentistry, University of Illinois at Chicago, USA
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