Achondrogenesis type II (Langer-Saldino)--a case report

Achondrogenesis is a lethal form of congenital chondrodystophy characterised by extreme micromelia. Definitive clinical and radiographic criteria have been established to differentiate Type II Achondrogenesis (Langer-Saldino) from type I Achondrogenesis (Parenti-Fraccaro). The mode of inheritance is autosomal recessive for both types. We are presenting a case of Type II Achondrogenesis, a still born male to consanguinous parents. The clinical features included an enlarged head, protuberant abdomen and short stubby limbs. The mother had earlier delivered two still born males presumably with similar features. Radiographic characteristics of absence of rib fractures and well ossified iliac bones with concave medial margins and absent or deficient ossification of the sacrum, ischiae, and pubic bones differentiated Type II Achondrogenesis from Type I Achondrogenesis.

Lung hypoplasia and severe pulmonary hypertension in an infant with double heterozygosity for spondyloepiphyseal dysplasia congenita and achondroplasia

A rare instance of double heterozygosity for spondyloepiphyseal dysplasia congenita and achondroplasia is presented. Despite midface hypoplasia, thorax deformity and lung hypoplasia, the child survived the neonatal period. Severe pulmonary hypertension, already present at birth, led to right heart failure and death at the age of 1 year.

A radiographic, morphologic, biochemical and molecular analysis of a case of achondrogenesis type II resulting from substitution for a glycine residue (Gly691-->Arg) in the type II collagen trimer

The type II collagenopathies form a continuous spectrum of clinical severity, ranging from lethal achondrogenesis type II and hypochondrogenesis, through spondyloepiphyseal dysplasia, spondyloepimetaphyseal dysplasia and Kniest dysplasia to the Stickler syndrome and familial precocious osteoarthropathy at the mildest end of the spectrum. We have carried out a radiographic, morphologic, biochemical and molecular study in a case of achondrogenesis type II. Electron micrographs showed inclusion bodies of dilated rough endoplasmic reticulum in the chondrocytes and the presence of sparse collagen fibers in the cartilage matrix. Protein analysis of collagen from cartilage indicated posttranslational overmodification of the major cyanogen bromide peptides, and suggested a mutation near the carboxyl terminus of the type II collagen molecule. Analysis at the DNA level demonstrated that the phenotype was produced by a single base change (G-->C) that resulted in the substitution of glycine691 by arginine in the type II collagen triple helical domain. We confirm previous observations in three cases of hypochondrogenesis that glycine substitutions in the alpha 1(II) chain can result in a phenotype at the most severe end of the type II collagenopathy spectrum.

Lethal skeletal dysplasia owing to double heterozygosity for achondroplasia and spondyloepiphyseal dysplasia congenita

A male infant with lethal short limbed dwarfism is described. His father had spondyloepiphyseal dysplasia congenita and his mother had achondroplasia. It is believed that the infant inherited both of these disorders and that their combined effects resulted in early death owing primarily to severe pulmonary hypoplasia.

Surgical treatment of Kirner's deformity

In 1927 Kirner described a congenital deformity of the fifth finger. Since then only 68 cases have been reported and to date many different views in the pathogenesis and treatment exist. The authors report a case of a 13 years-old girl. By a dorso-lateral approach, the distal phalanx was exposed and bone resection performed; alignment was maintained by Kirschner longitudinal wires, parosteal for the left digit and intramedullary for the right. The cosmetic and functional results were good.

New forms of neonatal death dwarfism. Report of 3 cases

The term Lethal Neonatal Dwarfism (Death Dwarfism) denotes bone dysplasias which always have a fatal outcome. Three different cases of "new" forms of death dwarfism are reported. A babygram should be a routine examination in all the cases of stillborn babies or those who die soon after the birth. If then the diagnosis cannot be established microscopic investigations of the growth cartilage should be performed.

A new estimate of the achondroplasia mutation rate

An estimate is derived of the mutation of achondroplasia based upon the accumulated data of recent newborn studies in four cities. In a total of 242,257 births, seven infants had mutant achondroplasia, the diagnosis being confirmed radiologically in all but one. From this, the rate of mutation of the normal to the achondroplasia allele is calculated to be 1.4 x 10(-5) +/- standard error 0.5 x 10(-5). Certain shortcomings of this estimate are discussed.

[The so-called chondrodystrophia of the newborn (author's transl)]

Chondrodystrophia (now: Achondroplasia) formerly believed to be a uniform disease rather is an entity comprising up till now at least ten radiologically differing types. Definite diagnosis of these types can only be made radiologically although certain clinical features are of additional help. For practical purpose a schematic representation of these types is given, based upon the classification of congenital osteochondrodysplasias by the ESPR (European Society of Pediatric Radiology, Rome, 1969). It emphasizes the characteristic radiological signs and describes the typical changes in body proportions. In a second part the single diseases are discussed according to the scheme with their radiological differential diagnosis and their prominent changes in the skeletal system. Some examples are given for possibly associated malformations and final prognosis.