CHILD syndrome: successful treatment of skin lesions with topical lovastatin and cholesterol lotion

Abstract: CHILD syndrome (Congenital Hemidysplasia, Ichthyosiform erythroderma, Limb Defects) is a rare X-linked dominant disease. The authors report a 2-month-old patient presenting with typical features of CHILD syndrome that was treated with a topical solution containing cholesterol and lovastatin, with complete clearance of her CHILD nevus. The changes in skin lipid metabolism that explain the CHILD ichthyosiform nevus and their correction through topical application of cholesterol and lovastatin are discussed.

Characterization of a group unrelated patients with arthrogryposis multiplex congenita / Caracterização de um grupo de pacientes não relacionados com artrogripose múltipla congênita

ABSTRACT OBJECTIVE: Arthrogryposis multiplex congenita is a relatively rare neuromuscular syndrome, with a prevalence of 1:3000-5000 newborns. In this study, the authors describe the clinical features of a group of 50 unrelated Mexican patients with arthrogryposis multiplex congenita. METHODS: Patients were diagnosed by physical and radiographic examination and the family history was evaluated. RESULTS: Of the 50 cases, nine presented other features (pectum excavatum, cleft palate, mental retardation, ulnar agenesis, etc.). Environmental factors, as well as prenatal and family history, were analyzed. The chromosomal anomalies and clinical entities associated with arthrogryposis multiplex congenita were reported. No chromosomal aberrations were present in the cases with mental retardation. Three unrelated familial cases with arthrogryposis multiplex congenita were observed in which autosomal recessive, autosomal dominant and X-linked inheritance patterns are possible. A literature review regarding arthrogryposis multiplex congenita was also conducted. CONCLUSIONS: It is important to establish patient-specific physical therapy and rehabilitation programs. A multidisciplinary approach is necessary, with medical, surgical, rehabilitation, social and psychological care, including genetic counseling.

RESUMO OBJETIVO: A artrogripose múltipla congênita é uma síndrome neuromuscular relativamente rara, com prevalência de 1:3000-5000 recém-nascidos. É por isso que, neste estudo, descrevemos as características clínicas de um grupo de 50 casos de pacientes mexicanos não relacionados com artrogripose múltipla congênita. MÉTODOS: Os pacientes foram diagnosticados por exame físico e radiográfico e o histórico familiar foi avaliado. RESULTADOS: Descrevemos 50 pacientes não relacionados com artrogripose múltipla congênita. Nove deles apresentaram outras características (pectus excavatum, fissura palatina, retardo mental, agenesia da ulna etc.). Foram analisados os fatores ambientais, pré-natais e o histórico familiar. Relatamos as anomalias cromossômicas e as entidades clínicas associadas com a artrogripose múltipla congênita. Não havia aberração cromossômica nos casos com retardo mental. Também encontramos três casos familiares não relacionados com artrogripose múltipla congênita, em que são possíveis padrões de herança autossômica recessiva, autossômica dominante e ligada ao cromossomo X. Também analisamos a preocupação da literatura com a artrogripose múltipla congênita. CONCLUSÕES: Reiteramos a ideia de que é importante estabelecer programas de fisioterapia e reabilitação específicos para os pacientes. É necessária uma abordagem multidisciplinar com cuidado médico, cirúrgico, de reabilitação, social e psicológico, incluindo aconselhamento genético.

Fenotipo grave en dos medio hermanas con síndrome de Adams Oliver / Severe phenotype in two half-sibs with Adams Oliver syndrome

El síndrome de Adams Oliver (AOS) es una entidad heterogénea con defecto transverso terminal de extremidades (TTLD) y aplasia cutis congénita (ACC) con un amplio espectro fenotípico. Se han descrito diferentes modos de herencia en esta enfermedad; los defectos más graves se han asociado a un patrón autosómico recesivo (AR). Objetivo. presentar a una familia con dos medio hermanas con un fenotipo grave de Adams Oliver, con una madre sana. Reporte del caso: una mujer de 27 años de edad fue referida al Departamento de Genética. Su hija anterior presentó acránea, anillos de constricción y defectos transversos terminales de extremidades. Su hija actual presentaba encefalocele occipital, defecto amplio en huesos del cráneo, aplasia cutis congénita, defecto terminal transverso de extremidades y labio y paladar hendido bilateral. Sugerimos que algunos casos con fenotipo grave del síndrome de Adams Oliver pueden deberse a herencia autosómico dominante con penetrancia incompleta o a la presencia de mosaicismo gonadal.

Adams Oliver syndrome (AOS) is a highly variable entity with terminal transverse limb defects (TTLD) and aplasia cutis congenita (ACC) with a wide phenotypic spectrum. Several inheritance models have been observed; the most severe phenotype has been related to an autosomal recessive (AR) pattern of inheritance. Objective. To present a family with two half siblings with a severe phenotype of Adams Oliver syndrome in which the mother was healthy. Case report: A 27 year-old woman was referred to the Genetics Department. Her previous girl presented acrania, constriction rings and terminal transverse limb defects. The present girl had occipital encephalocele, large scalp defects, aplasia cutis congenita, terminal transverse limb defects and bilateral cleft lip and palate. Autosomal dominant inheritance with reduced penetrance or gonadal mosaicism has to be considered in Adams Oliver syndrome with severe intracranial anomalies.

Split-hand/feet malformation in three tamilian families and review of the reports from India.

Split‑hand/foot malformation (SHFM) is a rare condition which can be either syndromic or nonsyndromic. We report three unrelated pedigrees, one with autosomal dominant (AD) inheritance and the other two with autosomal recessive (AR) pattern. We also briefly review the published reports from India.

Anormalidades de membros na trissomia do cromossomo 18: evidência para o diagnóstico precoce / Limb abnormalities on trisomy 18: evidence for early diagnosis

OBJETIVO: Verificar a frequência e os tipos de anormalidades de membros observadas entre pacientes com trissomia do cromossomo 18, ou síndrome de Edwards (SE). MÉTODO: A amostra foi constituída de pacientes consecutivos avaliados por um serviço de genética clínica no período entre 1975 e 2008. O resultado da análise citogenética, bem como os dados clínicos, foram coletados a partir dos prontuários médicos, dando-se ênfase aos seus achados de membros. Todos foram submetidos ao exame de cariótipo no mesmo laboratório. RESULTADOS: No período de avaliação, foram identificados 50 pacientes, 33 deles (66%) do sexo feminino, com idade na primeira avaliação variando de 1 dia a 16 anos (mediana de 14 dias). A linhagem única com trissomia livre do cromossomo 18 foi a alteração cromossômica predominante (90%). Mosaicismo foi verificado em 10% dos casos. A anormalidade predominante de membros superiores observada na amostra (n = 50) foi o punho cerrado com sobreposição dos dedos (70%). Outras alterações frequentes incluíram a prega palmar única (42%) e a hipoplasia das unhas (36%). Anormalidades radiais foram observadas em 11 pacientes (22%). Quanto aos membros inferiores, a hipoplasia de unhas foi a alteração mais comum (58%), seguida do pé em mata-borrão com calcâneo proeminente (50%). Um dos pacientes possuía ainda ectrodactilia unilateral. CONCLUSÕES: Apesar da descrição clássica, as anormalidades de membros podem ser bastante variáveis na SE. Alguns pacientes podem ainda apresentar alterações não usuais, como defeitos radiais e ectrodactilia. Esses achados são de extrema importância para a suspeita e a identificação clínica precoce dos pacientes com a SE.

OBJECTIVE: To assess the frequency and types of limb abnormalities observed among patients with trisomy 18, or Edwards syndrome (ES). METHOD: The sample consisted of consecutive patients evaluated by a clinical genetics service in the period from 1975 to 2008. The results of the cytogenetic analysis, as well as the clinical data were retrieved from the medical records, with special attention to limb abnormalities findings. All the karyotype analysis was performed at the same laboratory. RESULTS: During the study period, 50 patients were identified, 33 (66%) of them females, with ages at the first evaluation ranging from 1 day to 16 years (median 14 days). The single lineage with free trisomy 18 was the most frequent chromosomal disorder (90%). Mosaicism was observed in 10% of the cases. Clenched fist with overlapping fingers was the predominant anomaly of the upper limbs (70%). Other common disorders included the single palmar crease (42%) and hypoplastic nails (36%). Radial abnormalities were found in 11 patients (22%). As for the lower limbs, hypoplastic nails were the most common abnormality (58%), followed by the rocker bottom foot with prominent calcaneus (50%). One patient had unilateral ectrodactyly as well. CONCLUSIONS: Despite the classical description, limb anomalies can be much variable in ES. Some patients may show unusual abnormalities, such as radial defects and ectrodactyly. These findings are extremely important for the clinical suspicion and early identification of patients with ES.

Síndrome de ectrodactilia, displasia ectodérmica y fisura de labio/paladar, informe de un caso con expresividad variable / Ectrodactyly, ectodermal dysplasia and cleft lip/palate syndrome, report of a case with variable expressivity

El síndrome ectrodactilia, displasia ectodérmica y fisura de labio/paladar es una entidad poco frecuente, asociada a la mutación de genes que codifican la proteína p63. Presentamos un caso de un paciente con ectrodactilia en el pie derecho asociada a labio y paladar fisurados, sin otras alteraciones evidentes, con antecedente familiar de labio con paladar fisurado y muerte en el período perinatal. El manejo de cada caso de este síndrome debe ser específico y multidisciplinario.

The ectrodactyly-ectodermal dysplasia-cleft lip/palate syndrome is a rare entity associated with mutations in the genes that express the protein p63. We present a case of a patient with right foot ectrodactyly associated with cleft lip and palate, without other evident anomalies. The patient has a positive familiar history for cleft lift and palate and mortality during the perinatal period. The management of each case must be specific and multidisciplinary.

Ectrodactyly/split hand feet malformation.

Split-hand/split-foot malformation is a rare limb malformation with median clefts of the hands and feet and aplasia/hypoplasia of the phalanges, metacarpals and metatarsals. When present as an isolated anomaly, it is usually inherited as an autosomal dominant form. We report a case of autosomal recessive inheritance and discuss the antenatal diagnosis, genetic counseling and treatment for the malformation.

Point Mutation of Hoxd12 in Mice

PURPOSE: Genes of the HoxD cluster play a major role in vertebrate limb development, and changes that modify the Hoxd12 locus affect other genes also, suggesting that HoxD function is coordinated by a control mechanism involving multiple genes during limb morphogenesis. In this study, mutant phenotypes were produced by treatment of mice with a chemical mutagen, N-ethyl-N-nitrosourea (ENU). We analyzed mutant mice exhibiting the specific microdactyly phenotype and examined the genes affected. MATERIALS AND METHODS: We focused on phenotype characteristics including size, bone formation, and digit morphology of ENU-induced microdactyly mice. The expressions of several molecules were analyzed by genome-wide screening and quantitative real-time PCR to define the affected genes. RESULTS: We report on limb phenotypes of an ENU-induced A-to-C mutation in the Hoxd12 gene, resulting in alanine-to-serine conversion. Microdactyly mice exhibited growth defects in the zeugopod and autopod, shortening of digits, a missing tip of digit I, limb growth affected, and dramatic increases in the expressions of Fgf4 and Lmx1b. However, the expression level of Shh was not changed in Hoxd12 point mutated mice. CONCLUSION: These results suggest that point mutation rather than the entire deletion of Hoxd12, such as in knockout and transgenic mice, causes the abnormal limb phenotype in microdactyly mice. The precise nature of the spectrum of differences requires further investigation.

Complex genetic interactions govern the temporal effects of Antennapedia on antenna-to-leg transformations in Drosophila melanogaster.

The putative regulatory relationships between Antennapedia (Antp), spalt major (salm) and homothorax (hth) are tested with regard to the sensitive period of antenna-to-leg transformations. Although Antp expression repressed hth as predicted, contrary to expectations, hth did not show increased repression at higher Antp doses, whereas salm, a gene downstream of hth, did show such a dose response. Loss of hth allowed antenna-to-leg transformations but the relative timing of proximal-distal transformations was reversed, relative to transformations induced by ectopic Antp. Finally, overexpression of Hth was only partially able to rescue transformations induced by ectopic Antp. These results indicate that there may be additional molecules involved in antenna/leg identity and that spatial, temporal and dosage relationships are more subtle than suspected and must be part of a robust understanding of molecular network behaviour involved in determining appendage identity in Drosophila melanogaster.

Características clinicogenética y epidemiológica de los defectos por reducción de extremidades informados al Registro de Malformaciones Congénitas / Clinical, genetic and epidemiologic characteristics of defects due to reduction of extremities informed to the congenital malformations registration

Se revisaron los expedientes de todos los niños con defectos congénitos por reducción de extremidades, notificados al Registro de Malformaciones Congénitas de Santiago de Cuba en el período comprendido de 1997 al 2004, así como los protocolos de las muertes fetales o abortos inducidos terapéuticamente, de donde se extrajeron los datos primarios de interés. La frecuencia de dichas anomalías fue de 0,43 por cada 1 000 nacidos vivos, con predominio de los defectos terminales transversos y de la afectación unilateral de los miembros superiores. No se obtuvo información relevante sobre la exposición a algún agente teratogénico conocido. Las formas aisladas primaron sobre las asociadas

Manifestaciones maxilofaciales del raquitismo hipofosfatémico: reporte de un caso clínico / Maxillofacial manifestations of hypophosphatemic rickets: report of a clinical case

El raquitismo hipofosfatémico es una alteración metabólica transmitida genéticamente (ligada al cromosoma X) en donde disminuye la reabsorción de fosfato en el túbulo proximal. Esta enfermedad se manifiesta con defectos en la mineralización de los tejidos esquelético y dentario. El caso clínico presentado en este artículo corresponde a un niño de 8 años de edad con eta alteración en la que se observan deformidades en las extremidades inferiores (piernas arqueadas), disminución de su talla y bucalmente en los tejidos blandos, se aprecia gingivitis generalizada y sondajes periodontales no mayores de 2 mm. En el aspecto dentario existe una relación molar en clase II de Angle, con pérdida prematura de los molares temporales y por consecuencia, erupción prematura de los premolares permanentes. Debido a la asociación con la deficiente formación dentaria y la historia familiar, podríamos suponer una asociación entre raquitismo hipofosfatémico y las periodontitis de inicio precoz

Síndrome de Jackson Weiss: ¿entidad nosológica o parte de un espectro? / Jackson-Weiss syndrome: a single entity or a part of a spectrum of disorders?

Introducción. El síndrome de Jackson Weiss es una craneosinostosis sindromática asociada a otras alteraciones esqueléticas, siendo característica la afección de las extremidades inferiores. Entre las craneosinostosis sindromáticas también se encuentran los síndromes de Apert, de Crouzon y de Pfeiffer, los cuales además de presentar un fenotipo similar al síndrome de Jackson Weiss, comparten la mutación en FGFR2 (receptor de factor de crecimiento de fibroblastos tipo 2), mapeada en 10q. Casos clínicos. Se presentan 3 casos de pacientes mexicanos no emparentados entre sí, con el síndrome de Jackson Weiss, diagnosticados clínicamente y confirmados con estudios de imagen. Conclusiones. Dada la heterogeneidad fenotípica observada en estos pacientes, donde las características clínicas se sobreponen a las de otros síndromes, como la facies similar al síndrome de Crouzon, la afección articular presente en el síndrome de Apert y los ortejos anchos como en el síndrome de Pfeiffer, se postula que el síndrome de Jackson Weiss no es una entidad nosológica separada, sino parte del espectro de craneosinostosis sindromáticas.