Detailed clinical and radiological features of the first patient with Elsahy-Waters syndrome in East Asia.

Elsahy-Waters syndrome (EWS; OMIM#211380) is a rare autosomal recessive disorder that is caused by loss-of-function variants in CDH11, which encodes cadherin 11. EWS is characterized by brachycephaly, midface hypoplasia, characteristic craniofacial morphology, cervical fusion, cutaneous syndactyly in 2-3 digits, genitourinary anomalies, and intellectual disability. To the best of our knowledge, there have been only six patients of molecularly confirmed EWS. We report the first patient of EWS in East Asia in a Japanese man with a novel splice site homozygous variant of CDH11. We reviewed the clinical and molecular findings in previously reported individuals and the present patient. In addition to the previously reported clinical features of EWS, the present patient had unreported findings of atlantoaxial instability due to posterior displacement of dens, thoracic fusion, thoracic butterfly vertebra, sacralization of the lumbar vertebra (L5), and multiple perineural cysts. The spinal findings in this patient could represent a new spectrum of skeletal phenotypes of EWS. It remains to be clarified whether the multiple perineural cysts in the patient were associated with EWS or coincidental. The current observation might contribute to an expanded understanding of the clinical consequences of loss-of-function of cadherin 11.

Elsahy-Waters syndrome is caused by biallelic mutations in CDH11.

Elsahy-Waters syndrome (EWS), also known as branchial-skeletal-genital syndrome, is a distinct dysmorphology syndrome characterized by facial asymmetry, broad forehead, marked hypertelorism with proptosis, short and broad nose, midface hypoplasia, intellectual disability, and hypospadias. We have recently published a homozygous potential loss of function variant in CDH11 in a boy with a striking resemblance to EWS. More recently, another homozygous truncating variant in CDH11 was reported in two siblings with suspected EWS. Here, we describe in detail the clinical phenotype of the original CDH11-related patient with EWS as well as a previously unreported EWS-affected girl who was also found to have a novel homozygous truncating variant in CDH11, which confirms that EWS is caused by biallelic CDH11 loss of function mutations. Clinical features in the four CDH11 mutation-positive individuals confirm the established core phenotype of EWS. Additionally, we identify upper eyelid coloboma as a new, though infrequent clinical feature. The pathomechanism underlying EWS remains unclear, although the limited phenotypic data on the Cdh11-/- mouse suggest that this is a potentially helpful model to explore the craniofacial and brain development in EWS-affected individuals.

The Sequential Ultrasonographic, Electrophysiological and MRI Findings in a Patient with the Pharyngeal-cervical-brachial Variant of Guillain-Barré Syndrome from the Acute Phase to the Chronic Phase.

Acute progressive weakness in bulbar, neck and limbs is included in several differential diagnoses, including the pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome (GBS). Patients with the PCB variant of GBS are reported to have localized diagnostic cervical spinal nerve abnormalities that can be examined by nerve ultrasonography (NUS) and magnetic resonance neurography (MRN). We herein report the case of a 77-year-old man with the PCB variant of GBS. Although the nerve conduction study (NCS) findings were indirect indicators for an early diagnosis, the combination of NCS and NUS was a useful complementary measure that facilitated an early diagnosis. MRN did not show any apparent diagnostic abnormalities. After early treatment, the patient was discharged and returned home.

Proximal conduction block in the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome.

INTRODUCTION: Conduction block (CB) has been included in the Rajabally criteria for axonal Guillain-Barré syndrome (GBS). Because the nerve roots may be affected early in GBS, detection of proximal CB by the triple stimulation technique (TST) can be useful. METHODS: We describe TST findings in 2 patients who presented with the pharyngeal-cervical-brachial (PCB) variant of axonal GBS. RESULTS: In the first patient, although conventional nerve conduction studies (NCS) did not fit electrodiagnostic criteria for axonal GBS, the TST detected proximal CB in the median and ulnar nerves. In the second patient, NCS fulfilled criteria for axonal GBS, and the TST detected proximal CB in the median nerve. After plasmapheresis, NCS and TST findings were normalized, suggesting reversible conduction failure rather than demyelinating CB. CONCLUSION: The TST may be useful for diagnosis of PCB when NCS remain inconclusive. The technique provides additional clues for classifying PCB into the acute nodo-paranodopathies.

Understanding the basis of auriculocondylar syndrome: Insights from human, mouse and zebrafish genetic studies.

Among human birth defect syndromes, malformations affecting the face are perhaps the most striking due to cultural and psychological expectations of facial shape. One such syndrome is auriculocondylar syndrome (ACS), in which patients present with defects in ear and mandible development. Affected structures arise from cranial neural crest cells, a population of cells in the embryo that reside in the pharyngeal arches and give rise to most of the bone, cartilage and connective tissue of the face. Recent studies have found that most cases of ACS arise from defects in signaling molecules associated with the endothelin signaling pathway. Disruption of this signaling pathway in both mouse and zebrafish results in loss of identity of neural crest cells of the mandibular portion of the first pharyngeal arch and the subsequent repatterning of these cells, leading to homeosis of lower jaw structures into more maxillary-like structures. These findings illustrate the importance of endothelin signaling in normal human craniofacial development and illustrate how clinical and basic science approaches can coalesce to improve our understanding of the genetic basis of human birth defect syndromes. Further, understanding the genetic basis for ACS that lies outside of known endothelin signaling components may help elucidate unknown aspects critical to the establishment of neural crest cell patterning during facial morphogenesis.

Manifestaciones clínicas de 149 pacientes con espectro facio-aurículo-vertebral / Clinical features of 149 patients with facio-auriculo-vertebral spectrum

El espectro facio-aurículo-vertebral, también denominado síndrome de Goldenhar, o síndrome del primer y segundo arcos branquiales, es un complejo de anomalías craneofaciales y vertebrales principalmente. La malformación eje de este complejo es la microtia, uni o bilateral. Se realizó una investigación clínica observacional, retrospectiva trasversal y descriptiva, revisando 149 expedientes de pacientes con diagnóstico de microtia. No hubo diferencia significativa en cuanto al sexo de los afectados. La edad promedio fue de 6,97 años, con un rango de 1 a 52 años. Endogamia positiva en 14 pacientes y consanguinidad en un caso. Antecedentes familiares de microtia en 37 casos. Además de la microtia, las malformaciones más frecuentes fueron: faciales, costo-vertebrales, de extremidades, cardíacas, de genitales, oftalmológicas y otras. Los pacientes tuvieron un porcentaje elevado de antecedentes heredo familiares, lo que podría evidenciar un tipo de herencia autosómica dominante con penetrancia reducida (AU)

Facio-auriculo-vertebral (FAV) spectrum, also known as Goldenhar syndrome or first and second branchial arch syndrome, is a complex of mainly craniofacial and vertebral anomalies. Microtia is a principal malformation in this complex; it can be unilateral or bilateral. We performed an observational, retrospective, transverse descriptive clinical study, reviewing 149 records of patients with a diagnosis of microtia treated in the Genetics Department. There was no significant difference in the sex of the individuals involved. The mean age was 6.97 years, with a range of 1–52 years. We founded a positive inbreeding in 14 patients and consanguinity in 1 case. There was a family history of microtia in 37 cases. The most frequent malformations, besides microtia, were facial, costo-vertebral, limb, cardiac, genital, eye and other defects. Patients had a high percentage of family history, which could suggest an autosomal dominant inheritance with reduced penetrance (AU)

Branchial O(2) chemoreceptors in Nile tilapia Oreochromis niloticus: Control of cardiorespiratory function in response to hypoxia.

This study examined the distribution and orientation of gill O(2) chemoreceptors in Oreochromis niloticus and their role in cardiorespiratory responses to graded hypoxia. Intact fish, and a group with the first gill arch excised (operated), were submitted to graded hypoxia and their cardiorespiratory responses (oxygen uptake - V˙O(2) , breathing frequency - fR, ventilatory stroke volume - VT, gill ventilation - V˙G, O(2) extraction from the ventilatory current - EO(2) , and heart rate - fH) were compared. Their responses to bolus injections of NaCN into the bloodstream (internal) or ventilatory water stream (external) were also determined. The V˙O(2) of operated fish was significantly lower at the deepest levels of hypoxia. Neither reflex bradycardia nor ventilatory responses were completely abolished by bilateral excision of the first gill arch. EO(2) of the operated group was consistently lower than the intact group. The responses to internal and external NaCN included transient decreases in fH and increases in fR and Vamp (ventilation amplitude). These cardiorespiratory responses were attenuated but not abolished in the operated group, indicating that chemoreceptors are not restricted to the first gill arch, and are sensitive to oxygen levels in both blood and water.

Caracterización epidemiológica y clínica de pacientes operados con diagnóstico de quiste branquial / Epidemiological and clinical characterization of operated patients diagnosed with branchial cyst

Branchial Cysts are uncommon anomalies in regular clinical practice. However, among congenital cervical cysts, they represent about 30% from total. Objective: Characterize patients diagnosed with operated branquial cyst in our clinical center, and correlate clinic, imaging and final diagnose. Material and methods: Retrospective descriptive study of discharged patients diagnosed as cervical cysts, between January 2005 and July 2011, at Hospital Clinico Universidad de Chile. Selection of Clinical records with final diagnose of branchial cyst were selected. Age, sex, clinical story, imaging exams, pre-operative and post-operative diagnoses, and biopsy report were registered. Results: from a total of 149 cervical cysts, 31 (20,8%) were branchial cysts. Man 45% and women 55%. By age, 9 (29%) were < 15 years old (average: 6,69 years) and 22 (70,9%) > 15 years (average: 33,7 years). Lateral cervical mass was the most common clinical manifestation. Regarding Imaging study, 15 cervical ultrasounds (sensibility 0,86 and specificity 0,98) and 13 cervical CTA scans (sensibility 0,92 and specificity 0,94) were conducted. In 9 patients, imaging studies weren't conducted for the clinical diagnose (sensibility 0,77 and specificity 0,98). Correlation of pre-operative and post-operative diagnose was 87%. Discussion: According to literature, presentation age is generally during childhood; however, in our statistics it presented during adult age, which could be explained due to the main focus our medical center has for adult population. Most common clinical presentation was lateral neck mass, which had a good clinical correlation, however improves with imaging studies. (AU)

Onset and early development of hypoxic ventilatory responses and branchial neuroepithelial cells in Xenopus laevis.

Onset and ontogeny of the O2 chemoreceptive control of ventilation was investigated in Xenopus laevis. The density and size of branchial serotonin-immunoreactive neuroepithelial cells (5-HT-IR NECs) were also determined using confocal immunofluorescent microscopy. Larvae started gill ventilation at 3 days post-fertilization (dpf), and, at this early stage, acute hypoxic exposure produced an increase in frequency from 28 ± 4 to 60 ± 2 beats x min⁻¹. Concurrent with the onset of ventilatory responses, 5-HT-IR NECs appeared in the gill filament bud. Lung ventilation began at 5 dpf and exhibited a 3-fold increase in frequency during acute hypoxia. At 10 dpf, gill ventilatory sensitivity to hypoxia increased, as did NEC density, from 15 ± 1 (5 dpf) to 29 ± 2 (10 dpf) cells x mm of filament⁻¹. Unlike ventilation frequency, gill ventilation amplitude and lung expired volume were unaltered by acute hypoxia. Chronic exposure to moderate hypoxia, at a P(O2) of 110 mmHg, attenuated acute responses to moderate hypoxia at 10 and 14 dpf but had no effect at more severe hypoxia or at other stages. Chronic hypoxia also stimulated 5-HT-IR NECs growth at 21 dpf. Collectively, larvae at 5 dpf exhibited strong O2-driven gill and lung ventilatory responses, and between 10 and 21 dpf, the early hypoxic responses can be shaped by the ambient P(O2).

Fístula del primer arco branquial / Fistula of the first branchial arch

La complejidad del desarrollo embriológico del cuello y las posibles del cuello y las posibles anomalías en este proceso, con las consiguientes manifestaciones posteriores hacen necesario el conocimiento de la anatomía embriológica del cuello. Dentro de las posibles manifestaciones que pueden darse de las anomlías del desarrollo de los arcos branquiales se encuentran las anomalías del primer arco branquial. Son dentro de las anomalías del desarrollo de los arcos branquiales, infrecuentes y están íntimamente relacionadas con el nervio facial. Presentamos el caso clínico correspondiente a un niño de 7 años con esta patología y repasamos los aspectos más importantes de la misma

The complexity of the embryologic development of the neck and the possible abnormalies in thi process, with the consequent posterior manifestations make necessary the knowledge of the embryologic anatomy of the neck. In the possible manifestations that can be of the abnormalies of the development of the branchial archs are the abnormalies of the first branchial archs. The are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects

Fístula de segundo arco branquial

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Neurochemical mechanisms behind gill microcirculatory responses to hypoxia in trout: in vivo microscopy study.

In vivo microscopy combined with systemic blood flow and pressure measurements were used to examine the hemodynamic and microcirculatory responses to hypoxia in gills of rainbow trout and to clarify if the underlying mechanisms are adrenergic, cholinergic, serotonergic, or adenosinergic. Hypoxia (P(O2) 1.07-1.33 kPa) reduced, halted, or reversed the blood flow in the distal portion of the efferent filamental artery (EFA). Simultaneously, a large overflow to the central venous system appeared, allowing a continuous flow through many of the secondary lamellae. No vasoconstriction could be observed in this portion of the filament, showing that a vasoconstriction occurred elsewhere, possibly at the EFA sphincter, because the gill resistance (R(G)) increased. These effects were mimicked by prebranchial injection of acetylcholine, a treatment that also strongly constricted the distal efferent filamental vasculature. Atropine blocked most of the hypoxia-induced hemodynamic changes, although a minor increase in R(G) remained. The latter appeared to be of a nonadrenergic noncholinergic origin, being unaffected by additional treatment with an alpha-adrenoreceptor antagonist. It was also unaffected by blockers of serotonin and adenosine-A1 receptors. Other responses seen included a cholinergic maintenance of the systemic resistance during hypoxia and an alpha-adrenoceptor-mediated posthypoxic hypertension. This study demonstrates that hypoxia evoked a cholinergic reflex vasoconstriction located at proximal parts of the efferent filamental vasculature.

Síndrome branquio-oto-renal / Branchio-oto-renal syndrome

El Síndrome Branquio-Oto-Renal es una entidad clínica heredada en forma autosómica dominante, caracterizada por la presencia de hipoacusia, malformaciones del oído, remanentes branquiales y displasia renal. Presentamos una familia afectada por el síndrome y una revisión de sus aspectos clínicos y genéticos

Role of electromyography in the diagnosis of motor neuron disorders.

Programming of electromyographic examination in motor neuron diseases is discussed taking into account application of appropriate techniques. The difficulties of correct interpretation of results are stressed. The stages of disintegration and reintegration of affected motor units are described as well as compensatory changes of surviving motor units. A detailed description of EMG dynamics of amyotrophic lateral sclerosis, late post-polio syndrome and of childhood spinal muscular atrophy is given.

General body growth in children with clefts of the lip, palate, and craniofacial structure.

This paper discusses general body growth in children with craniofacial clefts. Body growth is important in such patients because morphology reflects the cumulation of metabolism over time. The same hormones that direct general body growth also govern the ontogeny of the head and face. Body growth varies in children with different types of clefts. We found no average differences from US norms for those with isolated clefts of the lip alone or those with bilateral clefts of the lip and palate. Children with unilateral clefts of the lip and palate and with isolated cleft palate were significantly shorter than their unaffected peers. Males with these defects were also thinner than normal based on average standard deviation scores for body mass indices. Both unilateral and bilateral clefts of the lip and palate predominated in males, while isolated cleft lip was more frequent in females. Our results indicate that congenital metabolic variation contributes to the development of orofacial clefting and influences postnatal development in certain types of cleft. Accordingly, cleft type is important to growth prognosis, and growth status is relevant to optimization of therapy in orofacial cleft patients.