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At least 253 records · Page 14Linked to original sources

Alagille syndrome: case report with bilateral radio-ulnar synostosis and a literature review.

We report a case of Alagille syndrome (arteriohepatic dysplasia) with the unusual radiological abnormality of synostosis of the proximal portions of the radius and ulna bilaterally, a manifestation which, to our knowledge, has not previously been described in a specific patient in the English language literature. We also describe additional features of the syndrome in the same patient and review the published literature on radiological manifestations of this condition.

Adult↗

Spondylocarpotarsal synostosis syndrome (with a posterior midline unsegmented bar).

Spondylocarpotarsal synostosis syndrome (SSS) is characterised by malsegmentation of the thoracic spine and carpal/tarsal fusions. A unilateral or bilateral unsegmented bar may be present in the thoracic spine. Presenting clinical signs are congenital scoliosis early in life, and shortening of the trunk with scoliosis and/or lordosis in older children. We report a 13-year-old girl with SSS and a midline unsegmented bar running along the spinal processes of T3 to L2 and extending into the posterior vertebral elements.

Abnormalities, Multiple↗

The relationship of rapid maxillary expansion to surgery with special reference to midpalatal synostosis.

This study is a multi-disciplinary approach to the regulation of the maxillary width in adults, based on published histological evidence of midpalatal synostosis and the analysis of nine cases. The treatment involves the maximal use of rapid expansion for movement with the minimal surgical intervention to free maxillae. The results provide a modus operandi for oral surgeon/orthodontist association with a three-stage series of age-related incremental surgical procedures to meet the resistance to maxillary separation and a tie-up with orthognathic surgery. It seems unnecessary to intervene surgically to free the maxillae under 25 years of age. Stage 1 applies between 25 and 30 years, Stage 2 between 30 and 40 years, and Stage 3 between 40 and 50 years. Attention is drawn to the respiratory improvement following these technics.

Adolescent↗

HOXA11 mutation in amegakaryocytic thrombocytopenia with radio-ulnar synostosis syndrome inhibits megakaryocytic differentiation in vitro.

Homeobox genes encode for regulatory proteins central to hematopoietic differentiation and proliferation. Previously, we identified an inherited syndrome of congenital amegakaryocytic thrombocytopenia and radio-ulnar synostosis that is associated with a point mutation in the third helix of HOXA11 homeodomain (HOXA11-DeltaH3). Here, we demonstrate that this mutation results in a significantly truncated protein with impaired DNA-binding efficiency. Electrophoretic mobility shift assays (EMSA) confirm that wild-type HOXA11 (HOXA11-WT) interacts in vitro with the DNA-binding consensus sequence for HOXA11, and that this interaction is most efficient when the TALE transcription factor, Meis1b, is also present. However, the binding between HOXA11-DeltaH3 and DNA is abrogated even in the presence of Meis1b, suggesting the point mutant causes a disruption in the DNA-binding capacity. We investigated whether the point mutation also affected the physical protein-protein interaction between HoxA11 and Meis1b. Using GST pulldown assays, we find Meis1b interactions with both HOXA11-WT and HOXA11-DeltaH3 in the presence of DNA. DNAse treatment decreased these interactions, suggesting that the interaction is a protein-protein association, and DNA may serve to stabilize this interaction. Stable expression of FLAG-HOXA11-WT or -DeltaH3 in K562 cells significantly impacts megakaryocytic differentiation. Staurosporine (STSP) induced K562 cells to differentiate into a megakaryocytic phenotype. Treatment leads to an increase in surface expression of the megakaryocytic/platelet-specific antigen, CD61, and causes morphological changes consistent with megakaryocytic differentiation. CD61 surface expression on STSP treated HOXA11-WT and -DeltaH3 expressing cells was significantly reduced as compared to untransfected K562 cells. Interestingly, we found only a slight difference in CD61 expression between wild-type and mutant HOXA11 K562. These data suggest that HoxA11 inhibition of differentiation may involve nonhomeodomain sequences. Finally, our laboratory has detected a small amount of HoxA11 mRNA in cells isolated from unfractionated human cord blood and murine ES cell culture cocultured on OP9 for 6 days in the absence of leukemia inhibitory factor (LIF). This finding suggests HoxA11 may be endogenously expressed in very early hematopoietic precursor cells. Taken together, these data begin to give us insight into the molecular mechanisms by which HoxA11 may be involved in regulating megakaryocytic differentiation.

Animals↗

Congenital proximal radioulnar synostosis associated with bilateral hypoplasia of the scaphoid bone, bilateral os lunatotriquetrum, and anomalies of the carpometacarpal complex.

We describe a unique case of bilateral os lunatotriquetrum associated with bilateral hypoplasia of the scaphoid bone. On both sides, the medial carpi were in a single row. The capitate bone occupied the lunate position, whereas the lunatotriquetral bone was displaced ulnarly and tilted. The capitate thus articulated with the radius and metacarpal bones, consistent with carpal collapse. In addition, there was congenital proximal radioulnar synostosis on the left side.

Abnormalities, Multiple↗

Congenital radioulnar synostosis. Surgical correction by derotational osteotomy.

We have evaluated 4 cases of congenital proximal radioulnar synostosis corrected by proximal derotational osteotomy. Surgery was only indicated in cases with more than 60 degrees of pronation. Mean age at the time of surgery was 7 years and 4 months and mean postoperative follow-up time was 8 years. Forearm position after surgery ranged from 15 to 0 degrees of pronation. Aesthetic and functional improvement was achieved in all cases. No complications were observed the Surgical technique is reviewed.

Child↗

Management of radioulnar synostosis with mobilization, anconeus interposition, and a forearm rotation assist splint.

Three cases of post-traumatic proximal radioulnar synostosis are presented. Each was treated with surgery with excision of the heterotrophic new bone and mobilization of the proximal radius. The anconeus muscle was mobilized as a vascularized pedicle graft and then interposed between the proximal radius and ulna. Two patients had postoperative radiotherapy. A forearm rotation assist splint was used to augment rehabilitation after surgery. This device consists of an inner sleeve that attaches to the hand and then rotates within a standard turnbuckle flexion/extension assist splint. The overall improvement in forearm rotation in each case was 100 degrees, 140 degrees, and 150 degrees, respectively.

Adult↗

Molecular and clinical characterization of a patient with duplication of 1p36.3 and metopic synostosis.

Chromosome 1p duplications are rare. There have been only 11 reported cases of isolated 1p duplication, all of which were proximal, interstitial duplications. We present a patient with a terminal duplication of 1p (1p36.3). To our knowledge, this is the first such reported case. Our patient presented with metopic synostosis, rectal stenosis, atrial septal defect, and mildly delayed gross motor development. Molecular characterization using microsatellite marker analysis and fluorescence in situ hybridization (FISH) revealed an area of duplication between p58 and D1S2893, approximately 13 cM in size. We compare our patient's clinical findings with the clinical phenotype found in patients with the corresponding deletion of 1p36.3 and discuss the role of gene dosage in other deletion/duplication syndromes.

Child, Preschool↗

Mutations of the NOG gene in individuals with proximal symphalangism and multiple synostosis syndrome.

Proximal symphalangism is an autosomal-dominant disorder with ankylosis of the proximal interphalangeal joints, carpal and tarsal bone fusion, and conductive deafness. These symptoms are shared by another disorder of joint morphogenesis, multiple synostoses syndrome. Recently, it was reported that both disorders were caused by heterozygous mutations of the human noggin gene (NOG). To date, seven mutations of NOG have been identified from unrelated families affected with joint morphogenesis. To characterize the molecular lesions of proximal symphalangism, we performed analyses of NOG in three Japanese individuals with proximal symphalangism. We found three novel mutations: g.551G>A (C184Y) in a sporadic case of symphalangism, g.386T>A (L129X) in a familial case of symphalangism, and a g.58delC (frameshift) in a family with multiple synostosis syndrome. Characteristic genotype-phenotype correlations have not been recognized from the mutations in the NOG gene.

Abnormalities, Multiple↗

Congenital thrombocytopenia and radio-ulnar synostosis: a new familial syndrome.

The association of bone marrow failure and skeletal defects has been frequently noted, however, the genetic basis for most of these syndromes remains unclear. We describe a previously uncharacterized autosomal dominant syndrome of amegakaryocytic thrombocytopenia associated with radial-ulnar synostosis. The clinical features of this syndrome appear to be distinct from other similar conditions, including Fanconi's anaemia and thrombocytopenia-absent radii (TAR). The physical findings at diagnosis and clinical management of each case are detailed, as well as a discussion of this disorder in the context of other syndromes in which marrow failure and skeletal defects are prominent features. We also review recent developments in molecular genetics that may provide important clues to the underlying aetiology of this condition.

Bone Marrow Cells↗

[A case of bilateral isolated talonavicular synostosis in childhood--observations of tarsal joint function and functional adaptation of the proximal ankle joint].

A rare case of bilateral isolated coalition of the talonavicular joint with ball and socket ankle joint is presented. Range of motion of the subtalar joint and hindfoot mobility were measured intraoperatively. The following conclusions may be drawn on development and function of the ankle joint complex: Isolated talonavicular synostosis in the growing foot results in marked impairment of subtalar range of motion. The development of a ball and socket ankle joint may be caused thereby, if tarsal hypomobility becomes effective at an early stage of growth.

Ankle Joint↗

Congenital synostosis of the fourth and fifth metacarpals treated by free bone grafting from the fusion site.

Simultaneous correction of the alignment and the shortening of the deformed little finger in congenital synostosis of the fourth and fifth metacarpals was accomplished by insertion of a wedge-shaped bone block harvested from the fusion site following transverse osteotomy of the fifth metacarpal. Correction can be performed simply and successfully without morbidity of the donor site when this technique is applied to suitable patients.

Bone Transplantation↗