DOCSLIB.ORG

Thoracic Cage Deformities in the Early Diagnosis of the Marfan Syndrome and Cardiovascular Disease

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Thoracic Cage Deformities in the Early Diagnosis of the Marfan Syndrome and Cardiovascular Disease CASE RER)R-ES • Thoracic cage deformities in the early diagnosis of the Marfan syndrome and cardiovascular disease TIMOTHY P. OBARSKI, DO WILLIAM A. SCHIAVONE, DO The Marfan syndrome is fre- 1896.2 The genetic pattern is one of autosomal quently complicated by cardiovascular ab- dominant trait with incomplete penetrance, normalities. Of these, aortic dissection and making the phenotypic presentation variable. aortic valve regurgitation are the most life- The prevalence of this disorder is estimated threatening. The most noticeable abnor- to be 4 to 6 persons per 100,000,3 with no ra- malities of the Marfan syndrome—the cial or ethnic predisposition. Diagnostic crite- skeletal abnormalities—may be subtle and ria for the Marfan syndrome are broad and limited. Presented here are five reports of each criterion has degrees of abnormality; there- cases of the Marfan syndrome. All patients fore, if only the more severe cases are included had potentially lethal cardiovascular com- in this estimate, the estimate may be too low. plications. Either the syndrome had not The diagnosis of the Marfan syndrome is been previously diagnosed or the patient based on the presence of two or more charac- had not been adequately monitored de- teristic familial, ocular, cardiovascular, or skele- spite the the presence of thoracic cage de- tal features. The skeletal abnormalities of doli- formities present from youth. The purpose chostenomelia (increased limb length), in- of this report is to heighten recognition of creased joint laxity, increased floor-to-pelvis the association of thoracic cage deformi- measurement, and arachnodactyly are easily ties with the Marfan syndrome to permit recognized signs of the Marfan syndrome. Pec- early diagnosis of the associated cardio- tus excavatum, pectus carinatum, and thoracic vascular complications. Surgical manage- scoliosis may also be present. These manifes- ment of these complications can favorably tations may occur early in life and can be clues alter the natural history of the Marfan syn- to early diagnosis. The case reports of five pa- drome. tients with the Marfan syndrome are presented here. All had thoracic cage abnormalities pre- The Marfan syndrome is a hereditary disor- sent from youth, and all eluded diagnosis or der of the connective tissue first described in careful monitoring until cardiovascular com- plications arose. The cases are presented to heighten recognition of the association of tho- From the Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio. Dr Obarski is a fellow in racic abnormalities with the Marfan syn- cardiology. Dr Schiavone is a staff cardiologist in Ak- drome. ron, Ohio and an assistant professor of medicine at the Northeastern Ohio Universities College of Medicine, Report of cases Rootstown. Case 1 Reprint requests to Timothy P. Obarski, DO, Depart- ment of Cardiology, Riverside Methodist Hospital, 3535 A 36-year-old woman saw her primary physician Olentangy River Rd, Columbus, OH 43214. and complained of shortness of breath and cough- 446 • JAOA • Vol 90 • No 5 • May 1990 Case report • Obarski and Schiavone Figure 1. Left: Chest prominence (arrow). Right: Lateral chest x-ray film shows protrusion of left rib cage (arrow) (case 1). ing. She was known to have had a cardiac murmur patient successfully underwent surgical placement for 11 years. When antibiotic therapy failed to re- of an aortic-valved conduit with reimplantation of lieve her symptoms, she was referred to the Cleve- the left coronary artery. Reimplantation of the land Clinic. Examination revealed pistol-shot right coronary artery was not surgically possible. pulses, a vibrating systolic murmur, and a diastolic murmur of aortic valve regurgitation. Also noted Case 3 was a left parasternal chest prominence (Fig 1). A 26-year-old woman had a strong family history A chest x-ray film and an echocardiogram revealed of the Marfan syndrome. Nevertheless, the condi- a markedly dilated aortic root. The patient under- tion was not so diagnosed until she had an acute went successful repair of the ascending aorta with aortic dissection. She was found to have a systolic an aortic-valved conduit with reimplantation of the ejection murmur, multiple systolic clicks, joint lax- coronary arteries. ity, arachnodactyly, and a prominent pectus cari- natum (Fig 3). Echocardiograms revealed a dilated Case 2 aortic root and an aortic dissection distal to the A 39-year-old man with a diagnosis of the Marfan left subclavian artery. The patient underwent suc- syndrome had had a cardiac murmur since birth. cessful surgical repair of the aneurysm and dissec- The patient had not received regular medical care. tion. At age 29, acute aortic valve regurgitation devel- oped and required aortic valve replacement. Ten Case 4 years later, he presented at our clinic with symp- A 32-year-old man had the Marfan syndrome di- toms of congestive heart failure. He was tall and agnosed at age 12. The diagnosis was based on skele- thin with a markedly straightened dorsal spine sig- tal and ocular abnormalities. There was no family nifying loss of the normal dorsal kyphosis (Fig 2). history of the disorder. The patient was clinically A murmur consistent with aortic valve regurgita- well until age 32 when he was seen at the Cleve- tion was noted. A chest x-ray film revealed marked land Clinic with aortic valve endocarditis and aor- thoracic lordosis, cardiomegaly, and a normal- tic valve regurgitation. An echocardiogram re- appearing aorta. An echocardiogram showed aor- vealed an aortic root measuring 5.8 cm in diame- tic root dilation and aortic valve regurgitation. The ter. The patient had a murmur characteristic of Case report • Obarski and Schiavone JAOA • Vol 90 • No 5 • May 1990 • 447 Figure 3. Left: Prominent pectus carinatum. Right: Posteroanterior chest x-ray film shows widening of the ascending and descending aortas consistent with ascending aortic aneurysm and descending aortic dissection (case 3). aortic valve regurgitation, pectus excavatum (Fig The patient had had three first-trimester sponta- 4), ectopia lentis, and a high arched palate. There neous abortions and chondromalacia patellae. She were no arachnodactyly or dolichostenomelia. He denied chest trauma but was concerned about the underwent successful surgical repair with aortic- pain because her father had had surgery for a tho- valved conduit with reimplantation of the coronary racic aortic aneurysm. The findings of the cardiac arteries. examination were normal; however, skeletal ex- amination revealed dolichostenomelia, arachnodac- Case 5 tyly, torus palatinus, and pectus excavatum. She A 37-year-old woman with intermittent, sharp had seen numerous physicians but had never had chest pain was seen at the Cleveland Clinic. She her condition diagnosed as the Marfan syndrome. had been told as a child that she had a cardiac mur- Despite a chest x-ray film that revealed a normal- mur but there had been no further investigation. appearing heart and aorta, an echocardiogram 448 • JAOA • Vol 90 • No 5 • May 1990 Case report • Obarski and Schiavone Figure 5. Two-dimensional echocardiogram. Anterior and posterior walls of the aortic root (arrows) dilated to 4.1 cm at level of sinuses of Valsalva (case 5). hoor r SS 15:58:35 -ND CLINIC CFL 26-532-3 FALSE Figure 4. Lateral chest x-ray film shows sternal de- pression (arrows) consistent with pectus excavatum (case 4). showed a dilated ascending aorta (Fig 5) at the level of the sinuses of Valsalva. The patient now under- goes a yearly echocardiogram to assess the aortic root size. Discussion Thoracic cage abnormalities can be an early Figure 6. Transesophageal echocardiogram. Note true clue to the diagnosis of the Marfan syndrome. and false lumens of this aortic dissection. Blood flows from true to false lumen. Classic skeletal signs include dolichostenome- lia, arachnodactyly, and increased floor-to- pelvis measurement. Pectus carinatum, includ- Marfan syndrome and are the primary reason ing unilateral pectus carinatum, pectus exca- that these patients life expectancy is halved.4 vatum, loss of the normal dorsal kyphotic Cardiovascular abnormalities in patients curve, and scoliosis, can also indicate this syn- with the Marfan syndrome are many, 3,5-9 but drome. A high index of suspicion of the Mar- the most life-threatening—and the cause of fan syndrome in patients with skeletal abnor- death in 29% to 43% of these patients°"1—is malities can lead to early detection of its dissection of the ascending aorta. Dilation of cardiovascular complications. These complica- the aorta or annulo-aortic ectasia2 progresses tions are responsible for more than 95% of the gradually over years, but dissection with aor- discernible causes of death in patients with the tic valve regurgitation seldom occurs with an Case report • Obarski and Schiavone JAOA • Vol 90 • No 5 • May 1990 • 449 aorta smaller than 6 cm in diameter. Medical longement des os avec un certain degre damincissement. Bul- letin de la Societe Medicale des Hopitaux de Paris 1896;13:220- and surgical intervention can favorably alter 227. the natural history of this syndrome.13 3. Pyeritz RE, McKusick VA: The Marfan syndrome: Diagnosis Physical examination is often not sufficient and management. N Engl J Med 1979;300:772-777. to detect cardiovascular abnormalities. A chest 4. Murdoch JL, Walker BA, Halpren BL, et al: Life expectancy and causes of death in the Marfan syndrome. N Engl J Med x-ray film is helpful in assessing heart size and 1972;286:804-808. aortic diameter, but an echocardiogram is 5. Salle V: Uebereinen fall von angeborener abnormei Grosse more precise.6 The addition of color flow Dop- du Extermitaten mit einem an akromegalie erinnernden symp- tomen komplex. Jahrb Kinderheilkd 1912;75:540-550. pler and transesophageal echocardiography 6. Come PC, Fortuin NJ, White RI Jr, et al: Echocardiographic (Fig 6) to conventional echocardiography fur- assessment of cardiovascular abnormalities in the Marfan syn- ther improves the specificity for the diagnosis drome: Comparison with clinical findings and roentgenogra- of aortic dissection.14 phic estimation of aortic root size.
Load more

Recommended publications
  • Global Journal of Medical Research: F Diseases Cancer, Ophthalmology & Pediatric
    OnlineISSN:2249-4618 PrintISSN:0975-5888 DOI:10.17406/GJMRA CoronaryArteryBypassGrafting RelationshipofClinicalManifestations SynapticPruninginAlzheimerʼsDisease TreatmentofUpperandLowerRespiratory VOLUME20ISSUE6VERSION1.0 Global Journal of Medical Research: F Diseases Cancer, Ophthalmology & Pediatric Global Journal of Medical Research: F Diseases Cancer, Ophthalmology & Pediatric Volume 2 0 Issue 6 (Ver. 1.0) Open Association of Research Society Global Journals Inc. © Global Journal of Medical (A Delaware USA Incorporation with “Good Standing”; Reg. Number: 0423089) Sponsors:Open Association of Research Society Research. 2020. Open Scientific Standards All rights reserved. Publisher’s Headquarters office This is a special issue published in version 1.0 of “Global Journal of Medical Research.” By ® Global Journals Inc. Global Journals Headquarters 945th Concord Streets, All articles are open access articles distributed under “Global Journal of Medical Research” Framingham Massachusetts Pin: 01701, United States of America Reading License, which permits restricted use. Entire contents are copyright by of “Global USA Toll Free: +001-888-839-7392 Journal of Medical Research” unless USA Toll Free Fax: +001-888-839-7392 otherwise noted on specific articles. Offset Typesetting No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including Global Journals Incorporated photocopy, recording, or any information 2nd, Lansdowne, Lansdowne Rd., Croydon-Surrey, storage and retrieval system, without written permission. Pin: CR9 2ER, United Kingdom The opinions and statements made in this Packaging & Continental Dispatching book are those of the authors concerned. Ultraculture has not verified and neither confirms nor denies any of the foregoing and Global Journals Pvt Ltd no warranty or fitness is implied. E-3130 Sudama Nagar, Near Gopur Square, Engage with the contents herein at your own Indore, M.P., Pin:452009, India risk.
    [Show full text]
  • Two Novel Pathogenic FBN1 Variations and Their Phenotypic Relationship of Marfan Syndrome
    Published online: 2020-08-20 THIEME 68 Case Report Two Novel Pathogenic FBN1 Variations and Their Phenotypic Relationship of Marfan Syndrome Sinem Yalcintepe1 Selma Demir1 Emine Ikbal Atli1 Murat Deveci2 Engin Atli1 Hakan Gurkan1 1 Department of Medical Genetics, Faculty of Medicine, Trakya Address for correspondence Sinem Yalcıntepe, MD, Department of University, Edirne, Turkey Medical Genetics, Trakya University, Faculty of Medicine, Edirne 2 Department of Pediatric Cardiology, Faculty of Medicine, Trakya 22030, Turkey (e-mail: [email protected]). University, Edirne, Turkey Global Med Genet 2020;7:68–71. Abstract Marfan syndrome is an autosomal dominant disease affecting connective tissue involving the ocular, skeletal systems with a prevalence of 1/5,000 to 1/10,000 cases. Especially cardiovascular system disorders (aortic root dilatation and enlargement of the pulmonary artery) may be life-threatening. We report here the genetic analysis results of three unrelated cases clinically diagnosed as Marfan syndrome. Deoxyribonucleic acid (DNA) was isolated from EDTA (ethylenediaminetetraacetic acid)-blood samples of the patients. A next-generation sequencing panel containing 15 genes including FBN1 was used to determine the underlying pathogenic variants of Marfan syndrome. Three different variations, NM_000138.4(FBN1):c.229G > A(p.Gly77Arg), NM_000138.4(FBN1):c.165– Keywords 2A > G (novel), NM_000138.4(FBN1):c.399delC (p.Cys134ValfsTer8) (novel) were deter- ► Marfan syndrome mined in our three cases referred with a prediagnosis of Marfan syndrome. Our study has ► novel variation confirmed the utility of molecular testing in Marfan syndrome to support clinical diagnosis. ► next-generation With an accurate diagnosis and genetic counseling for prognosis of patients and family sequencing testing, the prenatal diagnosis will be possible.
    [Show full text]
  • Abstracts from the 51St European Society of Human Genetics Conference: Electronic Posters
    European Journal of Human Genetics (2019) 27:870–1041 https://doi.org/10.1038/s41431-019-0408-3 MEETING ABSTRACTS Abstracts from the 51st European Society of Human Genetics Conference: Electronic Posters © European Society of Human Genetics 2019 June 16–19, 2018, Fiera Milano Congressi, Milan Italy Sponsorship: Publication of this supplement was sponsored by the European Society of Human Genetics. All content was reviewed and approved by the ESHG Scientific Programme Committee, which held full responsibility for the abstract selections. Disclosure Information: In order to help readers form their own judgments of potential bias in published abstracts, authors are asked to declare any competing financial interests. Contributions of up to EUR 10 000.- (Ten thousand Euros, or equivalent value in kind) per year per company are considered "Modest". Contributions above EUR 10 000.- per year are considered "Significant". 1234567890();,: 1234567890();,: E-P01 Reproductive Genetics/Prenatal Genetics then compared this data to de novo cases where research based PO studies were completed (N=57) in NY. E-P01.01 Results: MFSIQ (66.4) for familial deletions was Parent of origin in familial 22q11.2 deletions impacts full statistically lower (p = .01) than for de novo deletions scale intelligence quotient scores (N=399, MFSIQ=76.2). MFSIQ for children with mater- nally inherited deletions (63.7) was statistically lower D. E. McGinn1,2, M. Unolt3,4, T. B. Crowley1, B. S. Emanuel1,5, (p = .03) than for paternally inherited deletions (72.0). As E. H. Zackai1,5, E. Moss1, B. Morrow6, B. Nowakowska7,J. compared with the NY cohort where the MFSIQ for Vermeesch8, A.
    [Show full text]
  • A Mutation in FBN1 Disrupts Profibrillin Processing and Results in Isolated Skeletal Features of the Marfan Syndrome Dianna M
    Rapid Publication A Mutation in FBN1 Disrupts Profibrillin Processing and Results in Isolated Skeletal Features of the Marfan Syndrome Dianna M. Milewicz,* Jami Grossfield,* Shi-Nian Cao,* Cay Kielty,* Wesley Covitz, and Tamison Jewett* *Department of Internal Medicine, University of Texas-Houston Medical School, Houston, Texas 77030; tSchool of Biological Sciences, University of Manchester, UK, M 13 9PT; and §Department of Pediatrics, Bowman-Gray School of Medicine, Winston-Salem, North Carolina, 27157 Abstract if left untreated (3). The major ocular manifestations are ectopia lentis and myopia. The skeletal features are readily apparent Dermal fibroblasts from a 13-yr-old boy with isolated skele- when examining affected individuals and include tall stature tal features of the Marfan syndrome were used to study secondary to dolichostenomelia, arachnodactyly, scoliosis, and fibrillin synthesis and processing. Only one half of the se- pectus deformities. Although any of the manifestations of the creted profibrillin was proteolytically processed to fibrillin Marfan syndrome can occur as an isolated finding in an individ- outside the cell and deposited into the extracellular matrix. ual, it is the constellation of findings involving these systems Electron microscopic examination of rotary shadowed mi- and the autosomal dominant inheritance of these findings that crofibrils made by the proband's fibroblasts were indistin- characterize the Marfan syndrome (4). guishable from control cells. Sequencing of the FBN1 gene Extensive research has established that mutations in the revealed a heterozygous C to T transition at nucleotide 8176 FBNJ gene result in the Marfan syndrome (5-8). FBNI en- resulting in the substitution of a tryptophan for an arginine codes a large glycoprotein, fibrillin, that is a component of (R2726W), at a site immediately adjacent to a consensus microfibrils found in the extracellular matrix (9).
    [Show full text]
  • Prognosis Factors in Probands with an FBN1 Mutation Diagnosed Before the Age of 1 Year
    0031-3998/11/6903-0265 Vol. 69, No. 3, 2011 PEDIATRIC RESEARCH Printed in U.S.A. Copyright © 2011 International Pediatric Research Foundation, Inc. Prognosis Factors in Probands With an FBN1 Mutation Diagnosed Before the Age of 1 Year CHANTAL STHENEUR, LAURENCE FAIVRE, GWENAE¨ LLE COLLOD-BE´ ROUD, ELODIE GAUTIER, CHRISTINE BINQUET, CLAIRE BONITHON-KOPP, MIREILLE CLAUSTRES, ANNE H. CHILD, ELOISA ARBUSTINI, LESLEY C. ADE` S, UTA FRANCKE, KARIN MAYER, MINE ARSLAN-KIRCHNER, ANNE DE PAEPE, BERTRAND CHEVALLIER, DAMIEN BONNET, GUILLAUME JONDEAU, AND CATHERINE BOILEAU Service de Pe´diatrie [C.S., B.C.], Hoˆpital Ambroise Pare´, Boulogne, 92100 France; Consultation multidisciplinaire Marfan [G.J.], Hoˆpital Bichat, Paris, 75018 France; Centre de Ge´ne´tique [L.F.], CHUDijon, Dijon, 21000 France; Centre d’Investigation Clinique– Epide´miologie-Clinique/essais cliniques [L.F., E.G., C.B., C.B.-K.], CHU Dijon, Dijon, 21000 France; INSERM, U827 [G.C.-B., M.C.], Universite´ Montpellier, Montpellier, 34000 France; Department of Cardiological Sciences [A.H.C.], St Georges Hospital, London SW17 0RE, United Kingdom; Molecular Diagnostic Division [E.A.], IRCCS Foundation San Matteo Hospital, Pavia, 27100 Italy; Marfan Research Group and Department of Clinical Genetics [L.C.A.], Children’s Hospital at Westmead, New South Wales 2145, Australia; Department of Genetics and Pediatrics [U.F.], Stanford University Medical Center, Stanford, California 94305; Center for Human Genetics and Laboratory Medicine [K.M.], Martinsried, 82152 Germany; Institut fu¨r Humangenetik [M.A.-K.], Hannover Medical School, Hannover, 30625 Germany; Center for Medical Genetics [A.D.P.], Ghent University Hospital, Ghent, 9000 Belgium; Service de Cardiologie Pediatrique [D.B.], Hoˆpital Necker-Enfants-Malades, Paris, 75015 France ABSTRACT: Marfan syndrome (MFS) is an autosomal dominant along the entire FBN1 gene.
    [Show full text]
  • A Case of Marfan Syndrome with Ascending and Arch of Aorta Aneurysm Presenting with Type A- Dissection of Aorta
    A Case Of Marfan Syndrome With Ascending And Arch Of Aorta Aneurysm Presenting With Type A- Dissection Of Aorta. Dr E Srikanth , Dr Ravi Srinivas MD.DM , Dr O Adikesava Naidu MD.DM, FACC,FESC. Dr Y V Subba Reddy MD.DM, Professor & Head Dept. of Cardiology Osmania General Hospital, Hyderabad. Introduction: • First described by Antoine – Bernard Marfan in an 1896 case report of a young girl with unusual musculoskeletal features . • Hereditary disease which has AD inheritance because of mutation in the fibrillin-1 gene-chromosome 15. • It affects connective tissue of the body- dolichostenomelia, mainly involves • CARDIOVASCULAR SYSTEM : Ascending aorta aneurysm -annuloaortic ectasia with high risk of dissection ( root diameter of > 4.5cm) , mitral valve prolapse , aortic regurgitation secondary to root dilatation. • OCULAR : Bilateral ectopia lentis (40 – 56 %), myopia (28%) and retinal detachment (0.78%). • SKELETAL SYSTEM: Scoliosis, pectus excavatum, pectus carinatum, positive thumb & wrist sign. • It is usually diagnosed with 2010 Revised Ghent Nosology with a score of more than 7. • Marfan syndrome incidence of acute aortic dissection is 1/10,000(0.01%). • When the aortic root is dilated more than 5cm, it is usually managed surgically by Bentall procedure /David valve sparing reimplantation operation depending on involvement of aortic valve. CASE REPORT: • Female / 40 yr came with tearing type retrosternal chest pain radiating to neck and back of chest, and breathlessness of NYHA class 3 . • On examination: conscious and coherent HR = 78/min, regular, all peripheral pulse felt , BP = 150/60 mm of Hg both upper limb, 180/50mm of Hg , lower limbs Lumbar scoliosis, pectus carinatum, upper segment to lower segment ratio 0.71 , Increased arm span to height ratio with positive thumb sign.
    [Show full text]
  • 00464 Genetic Testing for Marfan Syndrome
    Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders Policy # 00464 Original Effective Date: 10/21/2015 Current Effective Date: 11/09/2020 Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the “Company”), unless otherwise provided in the applicable contract. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically. When Services Are Eligible for Coverage Coverage for eligible medical treatments or procedures, drugs, devices or biological products may be provided only if: • Benefits are available in the member’s contract/certificate, and • Medical necessity criteria and guidelines are met. Based on review of available data, the Company may consider individual genetic testing for the diagnosis of Marfan syndrome (MFS), other syndromes associated with thoracic aortic aneurysms and dissections, and related disorders, and panels comprised entirely of focused genetic testing limited to the following genes: FBN1 and MYH11 (CPT code 81408) and ACTA2, TGFBR1, and TGFBR2 (CPT code 81405), when signs and symptoms of a connective tissue disorder are present, but a definitive diagnosis cannot be made using established clinical diagnostic criteria to be eligible for coverage.** Based on review of available data, the Company may consider individual, targeted familial variant testing for Marfan syndrome (MFS), other syndromes associated with thoracic aortic aneurysms and dissections, and related disorders, for assessing future risk of disease in an asymptomatic individual, when there is a known pathogenic variant in the family to be eligible for coverage.** When Services Are Considered Investigational Coverage is not available for investigational medical treatments or procedures, drugs, devices or biological products.
    [Show full text]
  • Proceedings Allergy, Asthma, Copd, Immunophysiology & Norehabilitology: Innovative Technologies
    PROCEEDINGS ALLERGY, ASTHMA, COPD, IMMUNOPHYSIOLOGY & NOREHABILITOLOGY: INNOVATIVE TECHNOLOGIES Editor Professor REVAZ SEPIASHVILI FILODIRITTO INTERNATIONAL PROCEEDINGS INDEX Foreword 13 Immunorehabilitology: Sources, Present and Perspectives. From Immunotherapy to Personalized Targeted Immunorehabilitation 17 SEPIASHVILI Revaz Log in to find out all the titles of our catalog Follow Filodiritto Publisher on Facebook to learn about our new products Omalizumab Therapy for Asthma and Urticaria 33 KAPLAN Allen P. ISBN 978-88-95922-83-6 Clinical and Laboratory Biomarkers in Patients with Chronic Urticaria 41 First Edition April 2017 SÁNCHEZ-BORGES Mario © Copyright 2015 Filodiritto Publisher filodirittoeditore.com Atopic Dermatitis in Children: Differential Approach to the Choic inFOROmatica srl, Via Castiglione, 81, 40124 Bologna (Italy) inforomatica.it of Treatment Strategy 53 tel. 051 9843125 - Fax 051 9843529 - [email protected] SLAVYANSKAYA Tatiana Chemically Modified Allergens - Allergoids in Specific Immunotherapy Printed by Rabbi S.r.l., Via del Chiù, 74, Bologna (Italy) of Respiratory Allergy 61 PETRUNOV Bogdan, NIKOLOV Georgi, HRISTOVA Mariela, Translation, total or partial adaptation, reproduction by any means (including films, microfilms, photocopies), as well HRISTOVA Rumyana, KANDOVA Yana as electronic storage, are reserved for all the countries. Photocopies for personal use of the reader can be made in the 15% limits for each volume upon payment to SIAE of the expected compensation as per the Art. 68, commi 4 and 5, of the law 22 April 1941 n. 633. Photocopies used for purposes of professional, economic or commercial nature, or Interleukin-8 and RANTES at Early Stages of Allergen-Specific however for different needs from personal ones, can be carried out only after express authorization issued by CLEA Immunotherapy in Polyvalent Sensitized Patients 71 Redi, Centro Licenze e Autorizzazione per le Riproduzioni Editoriali, Corso di Porta Romana, 108 - 20122 Milano.
    [Show full text]
  • Skeletogenic Phenotype of Human Marfan Embryonic Stem Cells Faithfully Phenocopied by Patient-Specific Induced-Pluripotent Stem Cells
    Skeletogenic phenotype of human Marfan embryonic stem cells faithfully phenocopied by patient-specific induced-pluripotent stem cells Natalina Quartoa,b,1, Brian Leonardc,d,2,3, Shuli Lia,2, Melanie Marchandc, Erica Andersonc, Barry Behrd, Uta Franckee, Renee Reijo-Perac,d, Eric Chiaoc,d,1,3, and Michael T. Longakera,c,1 aDepartment of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, dDepartment of Obstetrics and Department of Gynecology, and eDepartment of Genetics and Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305; bDipartimento di Scienze Chirurgiche, Anestesiologiche-Rianimatorie e dell’Emergenza “Giuseppe Zannini,” Universita’ degli Studi di Napoli Federico II, 80131 Naples, Italy; and cInstitute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305 Edited by Clifford J. Tabin, Harvard Medical School, Boston, MA, and approved November 17, 2011 (received for review August 18, 2011) Marfan syndrome (MFS) is a heritable connective tissue disorder and Loeys-Dietz syndrome, and myosin heavy chain (MYH)11 caused by mutations in the gene coding for FIBRILLIN-1 (FBN1), an and actin/alpha2 smooth muscle/aorta (ACTA2) in familial tho- extracellular matrix protein. MFS is inherited as an autosomal racic aortianeurysms and dissections (21, 22). dominant trait and displays major manifestations in the ocular, To date, by necessity most knowledge of MFS has been skeletal, and cardiovascular systems. Here we report molecular obtained by extrapolation of studies in the mouse Fbn1 null/ and phenotypic profiles of skeletogenesis in tissues differentiated transgenic models (2, 23–27). However, with the derivation of from human embryonic stem cells and induced pluripotent stem human embryonic stem cells carrying a common FBN1 mutation, cells that carry a heritable mutation in FBN1.
    [Show full text]
  • The Top 10 Dysmorphic Syndromes: Keys to Diagnosis/What's
    The Top 10 Dysmorphic Syndromes: Keys to Diagnosis/What’s Hot Kenneth N. Rosenbaum, MD Children’s National Health System Washington, DC Conflict of Interest Disclosure Dr. Rosenbaum has no financial interests, arrangements, affiliations, or any bias with any of the corporate organizations offering financial support or educational grants for this program. Top 10 Dysmorphic Syndromes • Keys to diagnosis/important clues – Expect variability in presentation – Be aware of heterogeneity – Low threshold for diagnosis • Management of expected issues • New advances/what’s hot Down Syndrome • Incidence 1/650 births; 1/270 mid-trimester • Diagnosis based on number of minor variations; use available systems (Hall) • Important to be comfortable with clinical diagnosis prior to cytogenetics Down Syndrome-Management • Chromosomes (rapid FISH) • ECHO • CBC, thyroid function • Auditory screening • Specialty involvement • Intervention referral, support groups • AAP Health Supervision for Children with Down Syndrome, 2011 Down Syndrome-Advances • Rapid diagnosis • Improved outcomes? • Pharmaceutical trials? • Silent issues (thyroid, celiac, OSA) • Significant risk for dyspraxia, attention deficit, autistic spectrum disorder Down Syndrome-Advances • Maryland Senate bill 654: authorizing provision of information • Non-invasive prenatal testing – Maternal cell-free DNA;1st trimester – Aneuploidy screen – ~99% detection rate for Down syndrome • Digital remote diagnosis Digital Dysmorphology Digital Down Face Machine Analysis Learning Healthy Automatic Facial
    [Show full text]
  • ED368492.Pdf
    DOCUMENT RESUME ED 368 492 PS 6-2 243 AUTHOR Markel, Howard; And Others TITLE The Portable Pediatrician. REPORT NO ISBN-1-56053-007-3 PUB DATE 92 NOTE 407p. AVAILABLE FROMMosby-Year Book, Inc., 11830 Westline Industt.ial Drive, St. Louis, MO 63146 ($35). PUB TYPE Guides Non-Classroom Use (055) Reference Materials Vocabularies/Classifications/Dictionaries (134) Books (010) EDRS PRICE MF01/PC17 Plus Postage. DESCRIPTORS *Adolescents; Child Caregivers; *Child Development; *Child Health; *Children; *Clinical Diagnosis; Health Materials; Health Personnel; *Medical Evaluation; Pediatrics; Reference Materials; Symptoms (Individual Disorders) ABSTRACT This ready reference health guide features 240 major topics that occur regularly in clinical work with children nnd adolescents. It sorts out the information vital to successful management of common health problems and concerns by presentation of tables, charts, lists, criteria for diagnosis, and other useful tips. References on which the entries are based are provided so that the reader can perform a more extensive search on the topic. The entries are arranged in alphabetical order, and include: (1) abdominal pain; (2) anemias;(3) breathholding;(4) bugs;(5) cholesterol, (6) crying,(7) day care,(8) diabetes, (9) ears,(10) eyes; (11) fatigue;(12) fever;(13) genetics;(14) growth;(15) human bites; (16) hypersensitivity; (17) injuries;(18) intoeing; (19) jaundice; (20) joint pain;(21) kidneys; (22) Lyme disease;(23) meningitis; (24) milestones of development;(25) nutrition; (26) parasites; (27) poisoning; (28) quality time;(29) respiratory distress; (30) seizures; (31) sleeping patterns;(32) teeth; (33) urinary tract; (34) vision; (35) wheezing; (36) x-rays;(37) yellow nails; and (38) zoonoses, diseases transmitted by animals.
    [Show full text]
  • 2.04.129 Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders Page 2 of 19
    Medical Policy Genetic Testing for Marfan Syndrome, Thoracic Aortic 2.04.129 Aneurysms and Dissections, and Related Disorders Original Policy Date: May 29, 2015 Effective Date: April 1, 2019 Section: 2.0 Medicine Page: Page 1 of 19 Policy Statement Individual genetic testing for the diagnosis of Marfan syndrome, other syndromes associated with thoracic aortic aneurysms and dissections, and related disorders, and panels comprised entirely of focused genetic testing limited to the following genes−FBN1 and MYH11 (CPT code 81408) and ACTA2, TGFBR1, and TGFBR2 (CPT code 81405)−may be considered medically necessary, when signs and symptoms of a connective tissue disorder are present, but a definitive diagnosis cannot be made using established clinical diagnostic criteria. Individual, targeted familial variant testing for Marfan syndrome, other syndromes associated with thoracic aortic aneurysms and dissections, and related disorders, for assessing future risk of disease in an asymptomatic individual, may be considered medically necessary when there is a known pathogenic variant in the family. Genetic testing panels for Marfan syndrome, other syndromes associated with thoracic aortic aneurysms and dissections, and related disorders that are not limited to focused genetic testing as defined by CPT codes 81405 and 81408 are considered investigational. Policy Guidelines Syndromes associated with thoracic aortic aneurysms may have established clinical criteria with major and minor criteria (e.g., Marfan syndrome [Ghent criteria] and Ehlers-Danlos syndrome type IV), or may be associated with characteristic clinical findings. While most of these syndromes can be diagnosed based on clinical findings, these syndromes may be associated with variability in clinical presentation and may show overlapping features with each other, and with other disorders.
    [Show full text]