13q33.2 deletion: a rare cause of ambiguous genitalia in a male newborn with growth restriction

13q deletion is a rare cause of ambiguous genitalia in the male newborn, and can be associated with mental retardation of varying degree, retinoblastoma, and malformations of the brain, eye, genitourinary and gastrointestinal tract, depending on the level of the deletion. We present a male neonate with ambiguous genitalia and IUGR with a 13q33.2 deletion, and a paternal balanced translocation. Microarray analysis found the genes involved to be on chromosome 13 in the region 102989254bp-109214509bp. This deletion encompasses the EFNB2 gene, which has been implicated in genital malformations in 13q deletion cases.

CONCLUSIONS

We find a link between haploinsufficiency of the EFNB2 gene and the presence of ambiguous genitalia and hypospadia in patients with a 13q.33 deletion. This work emphasizes the importance of early diagnosis of this condition due to the link with mental retardation and the need for follow up and management.

Skeletal size and bone mineral content in Turner's syndrome: relation to karyotype, estrogen treatment, physical fitness, and bone turnover

Bone mineral content (BMC), bone mineral density, and metacarpal dimensions were studied in 50 women with Turner's syndrome aged 21-45 years in relation to karyotype, estrogen treatment, physical fitness, and biochemical markers of bone turnover. No differences were found between the 25 women with karyotype 45.X and women with other karyotypes. Forty-six women had received estrogen. Significant partial correlations were found between bone mineral density of the forearm and duration of estrogen treatment and physical fitness. BMC of the lumbar spine corrected for vertebral height (BMC(C)spine) was directly correlated with duration of estrogen treatment and height, marginally correlated with physical fitness, and inversely correlated with age. Outer metacarpal width was positively correlated with duration of estrogen treatment, age at initiation of therapy, and body weight. The diameter of medullary space showed negative correlation with physical fitness and height, and positive correlation with age at initiation of estrogen treatment. Cortical thickness was positively correlated with duration of estrogen treatment, physical fitness, and height. No convincing effects of estrogen could be demonstrated in women below the age of 30. Above the age of 30, all bone mineral measurements were markedly elevated in women treated for longer than the average of this age group. BMC(C)spine was inversely correlated with biochemical markers of bone formation. Our results demonstrate that estrogen treatment and physical fitness are important determinants of bone mineral status in Turner's syndrome and add to the evidence that estrogen treatment increases BMC in Turner's syndrome.

[Percutaneous embolization of vascular abnormalities]

In six male patients, percutaneous embolisation of symptom-producing vascular anomalies was performed with spirals or small particles. After a total of ten treatments, symptom-free states were obtained in half of the patients and definite improvement in the remainder. The results are so promising that this method of treatment will be continued.

[Percutaneous transluminal angioplasty of the brachiocephalic arteries]

The results of eight percutaneous transluminal angioplastic (PTA) interventions in seven patients on the brachiocephalic arteries are presented. The occlusions and stenoses were dilated up to the normal lumen. The subjective symptoms disappeared in all of the patients and, similarly, the pulse and blood pressure in the arm were normalized. No complications were registered.

[Comparison of 2 non-ionic radiographic contrast agents in intravenous subtraction angiography]

A prospective randomised comparison was undertaken of iopromide and iopamidol in intravenous digital subtraction angiography. This revealed that the two contrast agents produced pictures of similar quality. A slightly increased number of side effects in patients with cardio-pulmonary disease was demonstrated in the investigation and a slightly increased number of side effects after injection of iopamidol.

[Bone changes following long-term isotretinoin (Roaccutane) treatment]

The case is presented of a 33-year-old man treated with Roaccutane for two years on account of severe acne conglobata. X-ray examination after two years showed pronounced hyperostoses with bridging in the thoracic spine and hyperostoses and beginning bridging in the cervical spine. Furthermore, small exostoses were found on the hands and feet. X-ray control of patients treated for more than six months with Roaccutane is recommended.

[Preoperative evaluation of arteriosclerotic symptoms in the lower extremities by means of intravenous digital subtraction angiography]

Intravenous DSA was performed in 106 patients with symptoms of arterial insufficiency in the lower extremities, requiring treatment according to preceding clinical examination. The examinations were carried out using a 36.5 cm (14 in.) intensifier and a 5.5 F pigtail catheter located centrally. 71% of the examinations were carried out on out-patients. No complications were observed. In 96% of the cases, the intravenous DSA provided sufficient information to make decisions about treatment.

Renal parenchymal appearance on 123iodine-hippurate renoscintigrams and excretory urograms

In 61 patients with vesicoureteral reflux renal scar formation was diagnosed by excretory urography and 123iodine-hippurate scintigrams. Scar formation on the nephrograms was detected in the upper, middle and lower zones of the kidneys on tomography exposures. Scintigraphic detection of scars was performed on the computerized uptake of the parenchymal phase. Maximal time elapse between the 2 investigations was 1 year. Excretory urography revealed 37 kidneys with a total of 74 regional scars. On scintigraphy 57 kidneys were judged to have 102 scars. There were 281 regions judged to be identical on the scintigram and the nephrogram. A true positive ratio (sensitivity) of 0.46 and a true negative ratio (specificity) of 0.90 were noted for the excretory urogram, compared to a sensitivity of 0.64 and a specificity of 0.81 for renography. The study confirms an over-representation of scars judged from scintigrams, which calls for further investigation of scar formation detection.

[Wilms' tumor and neuroblastoma--diagnosis and differential diagnosis]

The radiological results of the urographic findings of 39 children with Wilms' tumours and 20 children with neuroblastomas were analysed respectively. In most cases an exact diagnosis could be achieved by means of the intravenous pyelography with differentiation between the two malignant tumours. Only in a few cases the investigation had to be supplemented with a retrograde pyelography or an angiography. Of great value was the detection of calcifications, the evaluation of the outline and size of the kidneys, decreased function of the affected kidney and filling defects of the calyceal groups and displacement of the renal pelvis.

[Extraskeletal calcification in chronic renal failure during hemodialysis and after renal transplantation (author's transl)]

The frequency of calcifications in vessels and soft tissue was 39% in 184 patients with chronic renal failure. Non-dialyzed patients and dialyzed patients at the start of dialysis treatment had most frequently calcifications of the aorta and larger vessels. Renal transplant recipients, who developed osteonecrosis or spontaneous fractures after transplantation, showed at the time of transplantation a higher frequency of calcifications compared to renal transplant recipients, who did not develop these complications. The frequency of calcifications increased with increasing age not only in the aorta, but also in the other vessels. In nondialyzed patients and in dialyzed patients at the start of dialysis treatment the calcifications were more commonly found in women and in renal transplant recipients in men. In all groups of patients a significant, higher frequency of calcifications was found in patients with radiologic evidence of bone resorption compared to patients without resorptive bone changes. Before and during chronic hemodialysis and following renal transplantation the frequency of calcifications increased. Calcification was most pronounced in the larger vessels in nondialyzed and dialyzed patients and in small vessels in renal transplant recipients. Increase in frequency of calcifications occurred slowly in nondialyzed patients and in renal transplant recipients, whereas an accelerated increase occurred in the first 15 months of the dialysis period in hemodialyzed patients.

[Significance of parasitic blood supply in malignant retroperitoneal tumours (author's transl)]

Twenty-one neoplastic retroperitoneal tumours- in particular Wilm's tumours and neuroblastomas of the suprarenal glands in children - are analyzed angiographically and the significance of the parasitic blood supply evaluated. More than half of the tumours had penetrating or perforating vessels, but in only 50% there were operative and histologic signs of tumour spread into neighbouring structures. The remaining tumours had vascular adhesions. A hint may be the demarcation and the slight vascularity of the tumours. The value of the presence of penetrating or perforating vessels must not be overestimated regarding the spread of the tumour and inoperability.

[Normal position and malposition of the heart (author's transl)]

The main types of heart positions and the malpositions are described as demonstrated on plain films of the thorax. Special attention is drawn to the situs ambi -- guous with the poly -- or asplenia which may be recognized from hypoarterial or epiarterial position of the main bronchi and their equal lengths and courses. This diagnosis is important because of the frequent accompanying congenital cardiac malformations and in respect to the planning of angiocardiography.

[Urographic and angiographic diagnosis of Wilm's tumor (author's transl)]

Twelve cases of Wilm's tumor were examined: By intravenous pyelography alone in eight children and by pyelography and angiography in four adults. Intravenous pyelography showed characteristic displacement of the calyceal structures and displacement of the renal pelvis. Angiography gave detailed information regarding the vascular supply to the mass, the degree of vascularity, presence and number of tumor vessels and degree of pooling of contrast material in the tumor. Vascular penetration through the capsule of the kidney was not always consistent to perirenal tumor infiltration. By angiography one case of bilateral Wilm's tumor and two cases with metastases were discovered.

Scanning and radiology of the carpal scaphoid bone

The value of isotope scanning in patients with suspected fracture of the scaphoid bone of the wrist was examined. For this purpose comparable examinations were made of 50 patients using both radiography and isotope scanning. With a normal scan, the suspicion of fracture or other bone diseases can be excluded. Increased focal activity corresponding to the region of the scaphoid bone indicates the possibility of a fracture, even if a fracture cannot be seen in the initial X-rays.

[The value of the chest radiograph in thoracic aortic dissection and traumatic rupture (author's transl)]

The plain chest radiographs of 40 patients with angiographically proven thoracic aortic dissection or traumatic rupture are analyzed retrospectively with regard to their value. Only in two cases completely normal findings were observed. In all other cases characteristic changes could be observed leading to an immediate aortography. The plain chest radiograph is very important in the decision whether and when an aortography has to be performed on clinical suspected patients.

[Situs ambiguus of the bronchial tree (author's transl)]

The heterotaxy syndrome is a rare condition and very often combined with congenital abnormalities or malformations. Studying the bronchial tree on the chest x-ray it is possible to indicate the visceral situs with asplenia or with polysplenia.

[The periarteritis nodosa--diagnosted by angiography. A case with multiple aneurysms (author's transl)]

Periarteritis nodosa is a severe systemic disease which is characterized by an inflammation of the vessel walls and a high incidence of renal involvement. Angiography should be performed immediately when clinical suspicion is aroused. Angiography is superior to the results of skin and muscles biopsy and gives information about the extension of the disease.