Familial cavernous angiomas of the brain in an Hispanic family.

We found cavernous angiomas (CA) in 10 of 22 members of a large Hispanic family. The proband had seizures, and a CA was found at surgery. He and two sisters with seizures had normal angiograms, but CT or MRI showed lesions compatible with CA. Similar abnormalities were found in two cousins with seizures and 5 of 17 asymptomatic relatives studied. MRI proved to be more sensitive than CT for identifying CA. Hispanic families appear to have a predisposition for dominantly inherited CA of the brain.

FG syndrome update 1988: note of 5 new patients and bibliography.

At the eve of its mapping, the pre-molecular picture of the FG syndrome is heavily biased towards the severe end of the phenotypic spectrum because present knowledge is largely based on propositi. It is an X-linked, incompletely recessive, complexly pleiotropic syndrome with considerably variable expressivity. Though a true multiple congenital anomalies/mental retardation (MCA/MR) syndrome, severe malformations are uncommon and involve mostly the anus (60%) and non-colonic GI defects (33%), hypospadias (25%), cleft palate (6%), rarely a congenital heart defect. The complex CNS dysfunctions of congenital hypotonia and all of its sequelae, MR, and occasional seizures, must be attributed to a developmental CNS defect which is rarely demonstrated at pre-mortem, and which is known to involve agenesis of the corpus callosum in some 25% of appropriately studied patients (mostly propositi). Thus, the diagnosis is largely made on a specific constellation of minor anomalies and mild malformations in a hypotonic boy with severe constipation and a very characteristic facial appearance and behavioral phenotype. In about 1/3 of cases, carrier manifestations may be detected physically. New hemizygote manifestations seen in this review of 5 new patients include abnormal eruption of teeth, diastasis between upper central incisors, apparent gynecomastia, cleft lip, and nasolacrimal and helicine fistulae. Only a half hundred or so FG syndrome patients are known, but we suspect the syndrome is much more common than realized, and because of the unfortunate recurrence risk potential, deserves careful consideration in every appropriate case. RFLP mapping studies are urged in order to aid diagnosis of "mild" cases, and prenatal and carrier detection.

Structural defects as consequence of late intrauterine constraint: craniotabes, loose skin, and asymmetric ear size.

Those fetal structures that are normally marked by passive growth in response to neighboring tissues show the effects of extrinsic deforming forces in distinctive ways. An appreciation for the mechanisms of deformation in these structures allows for more accurate clinical diagnosis, provides guidance for prognostic counseling and treatment, and may help eliminate unnecessary testing in the newborn period.

Dysmorphologic diagnosis for the pediatric practitioner.

Attaining an accurate diagnosis in children with congenital abnormalities is an important and sometimes vital part of their care. With a basic knowledge of the types and causes of birth defects, the pediatric clinician often can arrive at a correct diagnosis, even in children with rare syndromes or multiple anomalies. This article reviews the four major mechanisms that produce congenital defects, discusses the various types and subtypes of structural anomalies, and provides an algorithmic approach to their diagnosis.

The fetal alcohol syndrome in American Indians: a high risk group.

There are several factors which might increase the risk for Fetal Alcohol Syndrome in Native American groups. Culture influences, fertility, patterns of alcohol consumption and abuse, and perhaps dietary and metabolic differences may be involved. The suspicion of increased occurrence of Fetal Alcohol Syndrome in the Indian population is presently based upon incomplete or anecdotal evidence, but studies are now underway to define actual prevalence rates in some of these groups.

Genetic risks and environmental surveillance: epidemiological aspects of monitoring industrial populations for environmental mutagens.

As industrial populations are exposed to new chemicals and other agents in their work environment, it becomes increasingly important to be able to ascertain any associated genetic risks. The characteristics of a desirable surveillance system for deleterious genetic effects are outlined and the existing or proposed surveillance systems for industrial populations are reviewed against these criteria. At present, monitoring for reproductive loss and infertility seems to be the technique best suited for surveillance of industrial populations. However, monitoring techniques based on these events do not directly assess mutagenicity. Since fetal death and infertility are strongly, but not exclusively, correlated with mutation, these methods can be considered as an early-warning system to indicate when and where more definitive studies are needed.

The craniofacial team and the Navajo patient.

The craniofacial team at the University of New Mexico Medical Center in Albuquerque, New Mexico has treated a large population of Navajo Indians. Team awareness of the Navajo concept of health as man in balance with his environment has resulted in more expedient treatment of the Navajo children. An understanding of Navajo concerns with ghosts, skinwalkers, and rules for orderly living has allowed team members to integrate the family and the Navajo medicine man in caring for the children with craniofacial disease. Special concerns for informed surgical consent and genetic counseling of the Navajo are reviewed. Respect for the traditional Navajo healing ceremonies and special handling of disposed body parts in surgery are required of the health professionals caring for these people.

Fetal alcohol syndrome in adolescents and adults.

Fetal alcohol syndrome is a specific recognizable pattern of malformation. Manifestations in 61 adolescents and adults suffering from alcohol teratogenesis are presented. After puberty, the faces of patients with fetal alcohol syndrome or fetal alcohol effects were not as distinctive. Patients tended to remain short and microcephalic, although their weight was somewhat closer to the mean. The average IQ was 68, but the range of IQ scores widely varied. Average academic functioning was at the second- to fourth-grade levels, with arithmetic deficits most characteristic. Maladaptive behaviors such as poor judgment, distractibility, and difficulty perceiving social cues were common. Family environments were remarkably unstable. Fetal alcohol syndrome is not just a childhood disorder; there is a predictable long-term progression of the disorder into adulthood, in which maladaptive behaviors present the greatest challenge to management.

Immunologic significance of the mumps virus skin test in infants, children and adults.

The biologic validity of cell-mediated immunity to mumps virus was evaluated in 395 children, adolescents and adults. The study protocol included the determination of cutaneous delayed hypersensitivity to viral and avian control antigens and in 79% of the subjects an essential double bleeding was performed before and after mumps virus skin test for assay of neutralizing antibody. Seven per cent of subjects expressed sufficient delayed hypersentitivity to the control antigen to erase an apparently positive mumps virus skin test. Anamnestic conversions from seronegativity to seropositivity, elicited by the mumps virus skin test, increased from 4% in children to 25% in adults, which suggests waning B-cell recognition of prior mumps virus infection in adults. Although pregnancy diminished the difference (p smaller than .001), adults showed greater cutaneous delayed hypersensitivity to mumps virus antigen than did children (p smaller than .001), suggesting that mumps virus reinfection or persistence induced the escalation of more sensitive T-cell recognition with increasing age. Humoral immunity, assessed by the double bleeding technique in the vast majority of individuals, rose form 16% (1-4 years), 45% (5-9 years) and 80% (10-14 years) to 94% in adolescents and adults. Ordinarily 75-95% in other age groups, the decline of correlation between mumps virus cellular and humoral immunity to 60% in school children may result from prior parainfluenza virus infection, inconsistent potency of the skin test antigen, concurrent immunosuppressive infection, and lagging induction of mumps virus cellular immunity in recently infected individuals. Immunologic study of a large colony of subhuman primates failed to establish an hierarchial antigenic interrelationship among mumps virus and two additional paramyxoviruses.