Neonatal progeroid variant of Marfan syndrome with congenital lipodystrophy results from mutations at the 3' end of FBN1 gene

We report a 16-year-old girl with neonatal progeroid features and congenital lipodystrophy who was considered at birth as a possible variant of Wiedemann-Rautenstrauch syndrome. The emergence of additional clinical signs (marfanoid habitus, severe myopia and dilatation of the aortic bulb) lead to consider the diagnosis of the progeroid variant of Marfan syndrome. A de novo donor splice-site mutation (c.8226+1G>A) was identified in FBN1. We show that this mutation leads to exon 64 skipping and to the production of a stable mRNA that should allow synthesis of a truncated profibrillin-1, in which the C-terminal furin cleavage site is altered. FBN1 mutations associated with a similar phenotype have only been reported in four other patients. We confirm the correlation between marfanoid phenotype with congenital lipodystrophy and neonatal progeroid features (marfanoid-progeroid-lipodystrophy syndrome) and frameshift mutations at the 3' end of FBN1. This syndrome should be considered in differential diagnosis of neonatal progeroid syndromes.

Syncope in pediatric patients presenting to an emergency department

OBJECTIVE

To assess the epidemiology of syncope coming to medical attention among unselected children referred to an emergency department in Western Europe.

STUDY DESIGN

We analyzed the cause of syncope and diagnostic workup of 226 consecutive pediatric patients seen in our emergency department because of a syncopal event.

RESULTS

Neurocardiogenic syncope and neurologic disorders were the most common diagnoses (80% and 9%, respectively). Other causes included psychologic, cardiac, respiratory, toxicologic, and metabolic problems. The neurocardiogenic and disease-related syncopes were easily identified or suspected by history and physical examination. Electrocardiography was not performed in 132 cases (58%). Most patients with suspected neurocardiogenic syncope had an electroencephalogram, and 29% were admitted to the hospital. Cardiac disorders represented 5 cases (2%); 2 had been previously misdiagnosed.

CONCLUSIONS

Syncope in children can result from a wide variety of causes. Consequently, an evaluation that fails to approach this problem in a goal-directed fashion proves to be very expensive, time-consuming, and frustrating to all concerned. Thorough history and physical examination are usually all that are necessary to guide practitioners in choosing the diagnostic tests that apply to a given patient.

[Paroxysmal tachyarrhythmias in pediatrics]

The purpose of this retrospective study was to investigate the clinical characteristics in pediatric patients with supraventricular or ventricular tachycardia. Sixty-nine pediatric patients were included. Age distribution at first episode of tachyarrythmia, most indicative symptoms and signs, associated conditions and long-term prognosis were determined for the different mechanisms of tachyarrythmia. 78% of the children had supraventricular tachycardia and 22% ventricular tachycardia. At diagnosis, 57% of the children with supraventricular tachycardia were younger than 1 year. The majority of infants were detected during routine investigation without having any complaints whereas the majority of children presented with symptoms. Recurrence was rare in cases diagnosed during infancy, but was usual in cases diagnosed beyond infancy.

Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic

The aim of this study was to assess the epidemiology of chest pain among unselected Belgian children referred to an emergency department or to a cardiology clinic.

MATERIAL AND METHODS

We analyzed the etiology to chest pain and the diagnostic workup of 168 consecutive pediatric patients, seen in our emergency department with the primary diagnosis of chest pain over a 5-year period (group A). Simultaneously a sample of 69 consecutive pediatric patients referred to the cardiology clinic by primary care physicians with the same chief complaint was prospectively included in the study (group B).

RESULTS

Chest wall pain was the most common diagnosis in the group A (64%). Other causes included pulmonary (13%), psychological (9%), cardiac (5%), traumatic (5%), and gastrointestinal problems (4%). The organic causes were easily identified or suspected by history and physical examination. Chest radiography, electrocardiography, and blood analysis were performed in most patients with suspected nonorganic chest pain but in no case were organic diseases diagnosed by those ancillary studies. In group B, chest wall pain was also the most common diagnosis (89%). Supraventricular tachyarrhythmia and exercise-induced asthma were demonstrated in 5 (7%) and 3 patients (4%), respectively. The most important tools in assessing a child with acute chest pain in an emergency department are thorough history and physical examination. Assessment of recurrent chest pain is more difficult; arrhythmia, and allergic and exercise-induced asthma may be underestimated when investigations are not performed.

[Prevention of bacterial endocarditis]

Because of its severity, it is agreed that infectious endocarditis should be prevented whenever possible. Certain patient populations at risk for endocarditis have been identified. Antibiotic prophylaxis is therefore recommended when these individuals undergo procedures likely to cause bacteremia with organisms that cause endocarditis. In this article we attempt to provide a comprehensive approach to infectious endocarditis prophylaxis based both on the pathophysiology of the disease and on the mechanisms of action of prophylactic drugs. Approaches to the prevention of endocarditis have been recently modified and are reviewed in this paper, especially important issues for the primary care physician.

[Preventive cardiology: strategies in children]

The importance of preventive cardiology in youth has been established by several critical observations: there is evidence that the atherogenic process begins in childhood, and that the degree of atherogenesis is related to measurable risk factors present during childhood. The literature indicated that long-range prevention of atheroselerosis and its sequelae by control of those risk factors should begin in childhood. This article reviews the established risk factors, the identification of high-risk individuals, public health strategies for the promotion of health in the French Community of Belgium and treatment of high-risk individuals.

[Chronic heart failure in children: recent contributions of physiopathology and therapeutic implications]

The treatment of chronic heart failure has made remarkable progress over the past ten years. Recent advances in our understanding of the pathophysiologic mechanisms involved in heart failure syndrome have led to changes in our approach to the treatment of children. The goals of the therapy have shifted from purely hemodynamic manipulation to a combination of hemodynamic and neurohumoral modulation. As for adults, three therapeutic classes have recently emerged: conversion enzyme inhibitors, spironolactone and beta-blockers. Pediatricians know that a child is not a small adult and we have to think about heart failure on the basis of etiology, the age of the patient, and circulatory physiology and maturation.

Pubertal growth as a determinant of adult height in boys with constitutional delay of growth and puberty

In boys with constitutional delay of growth and puberty, adult height may be inconsistent with parental (target) height. We aimed at studying which period of growth was important to account for adult height being above or below target height. In this retrospective study, adult height measured after 20 years in 39 patients was compared with target height and height data obtained at about 6 and 12 years of age and at diagnosis of delayed puberty (mean 14.6 years). Twenty-eight patients were untreated while 11 received testosterone enanthate (50 or 100 mg/month for 6 months). The growth data from both groups were pooled since they were not different. On average, the adult height standard deviation score (-0. 6 +/- 0.8, mean +/- SD) was similar to target height (-0.5 +/- 0.6). There were, however, marked individual differences since adult height varied between 1.7 SD (11 cm) below target height and 1.4 SD (9.5 cm) above target height. Multiple regression analysis showed that the most significant determinant of the difference between adult height and target height was height catch up during puberty (p < 0.002). We conclude that the magnitude of height catch up during puberty is a significant determinant of adult height in boys with constitutional delay of growth and puberty. Thus, optimizing pubertal growth may be a relevant therapeutic aim for adult height in boys with short stature and delayed puberty. Copyrightz1999S. KargerAG,Basel