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PubMed1999

Sotos syndrome and cutis laxa.

Characteristics suggestive of connective tissue dysfunction have been described in Sotos syndrome and include joint hyperextensibility, pes planus, and a high arched palate. A variety of cutis laxa syndromes have also been described, some of them exhibiting mental retardation, but no reports have drawn an association with overgrowth or abnormal facies characteristic of Sotos syndrome. We report three patients with the anthropometric and dysmorphological appearance of classical Sotos syndrome in association with redundant skin folds, joint hypermobility, and, in two of the three, vesicoureteric reflux suggestive of a coexisting connective tissue disorder. All of the patients had a normal bone age suggesting that Sotos syndrome in its classically described form was not present and that this entity possibly reflects a related, perhaps allelic, condition.

Abnormalities, Multiple↗
PubMed2007

Carcinoid tumor of lung with Cushing's syndrome.

Carcinoid tumor of lung with Cushing's syndrome is a rare condition. We report a 38-year-old man, with a 28-month history of Cushing's syndrome presented with hypertension, diabetes mellitus, decreased libido, muscle weakness and fatigability, moon facies, buffalo hump, truncal obesity, cutaneous striae, and easy bruisability. Diagnosis was made by measurements of ACTH (149 pg/mL) and cortisol levels (36 microg/dL) and computerized tomography of the chest.

Adrenocorticotropic Hormone↗
PubMed1980

Porphyria turcica. Twenty years after hexachlorobenzene intoxication.

Porphyria involving more than 4,000 persons occurred in Eastern Turkey from 1956 to 1961 due to ingestion of hexachlorobenzene (HCB), a fungicide added to wheat seedlings. During a site visit in 1977, 32 porphyric Turks (mean age, 29 years) were examined. Porphyrin concentrations were determined with samples of urine and stool from 29 porphyric and 10 control Turks and compared with results from 40 subjects in the United States. Distinctive clinical features were found in porphyric subjects, including hyperpigmentation, hirsutism, severe scarring, short stature, pinched facies, small hands, painless arthritis, weakness, and enlarged thyroids. Porphyrin levels were still substantially elevated in five subjects. Hexachlorobenzene, which is fat soluble, was detected in maternal milk of one porphyric patient and in one other patient's fat. The level of HCB was not considered sufficient to account for persistence of porphyria but may be a clue to the cause of pembe yara (pink sore), in which many children who were breast-fed by affected mothers died with associated weakness, convulsions, and annular erythema.

Adipose Tissue↗
PubMed1981

Haber's syndrome. Report of a new family.

Three Japanese brothers had the rosacea-like facies and multiple intraepidermal epitheliomas that characterize Haber's syndrome. They also had xerosis of the lower extremities. The facial lesions were dry, warm, erythematous, and indurated, with enlarged follicular orifices and telangiectasia. One patient had disturbing "burning" of the face, which was relieved by short courses of steroid therapy that were given for systemic effects.

Adult↗
PubMed1983

Centennial Paper. November 1951 (Arch Dermatol Syphilol: Cortisone acetate administered orally in dermatologic therapy by Marion B. Sulzberger, Victor H. Witten and Stanley N. Yaffe.

Thirty-two patients with various severe or selected dermatoses were chosen for treatment with cortisone acetate by mouth. The criteria for selection included refractoriness to previous therapy and absence of ascertainable contraindications. The initial dose of cortisone acetate varied between 100 and 200 mg. per day. The dose was reduced as quickly as each patient's response permitted, with the object of reaching the lowest effective dose as quickly as possible. Response of most patients to the hormone was dramatic, with abatement of symptoms within 24 hours and substantial improvement of clinical signs within 24 to 48 hours. Details of the results are tabulated. Adverse effects, possibly attributable to the hormone, were noted in five patients. In two instances, moon facies developed, one with hypertrichosis and a 20-lb. (9.1-kg.) gain in weight. However, both of these patients had received corticotropin (ACTH) prior to the cortisone. A third patient showed hyperpigmentation of the areas of skin usually exposed and not covered by clothing. Two additional patients each complained of hyperexcitability and insomnia. All these undesirable effects diminished or disappeared after the dose was reduced or administration of cortisone was discontinued. The effectiveness of this new therapeutic approach in a wide variety of skin diseases is clearly demonstrated by the excellent response noted in this series of selected cases. No other modality known to us has comparable beneficial effects. It is to be stressed, however, that the benefits generally stop soon after cortisone therapy is discontinued, unless the disease or the attack is one with spontaneous remissions. Disagreeable and sometimes dangerous effects still preclude the use of this treatment except in serious diseases and situations, and unless the patient can be kept under sufficiently close and expert surveillance.

Administration, Oral↗
PubMed1992

Restrictive dermopathy. Report of two affected siblings and a review of the literature.

BACKGROUND: Restrictive dermopathy is a lethal genetic disorder consisting of abnormally tight skin, generalized joint contractures, distinctive facies, and pulmonary hypoplasia. Autosomal recessive inheritance has been suggested based on multiply affected siblings and some reports of parental consanguinity. This article describes two siblings with the restrictive dermopathy syndrome and reviews previously reported cases. OBSERVATIONS: Eight other cases have been reported in the literature as restrictive dermopathy. These cases have shared striking similarities in their clinical histories and phenotypes. The skin in these infants has been described as rigid and tense, with skin biopsy specimens showing a thick epidermis, thin dermis, abnormally arranged collagen bundles, and poorly developed appendages. Other prominent features are flexion contractures and craniofacial and pulmonary abnormalities. The genetic and/or developmental defects leading to the restrictive dermopathy syndrome are presently not known. CONCLUSIONS: The restrictive dermopathy syndrome is distinct and is easily differentiated from other congenital diseases such as the icthyoses and also from the clinical conditions of sclerema neonatorum and subcutaneous fat necrosis of the newborn. Recognition of this syndrome is important for determining the prognosis of affected infants and for recommending genetic counseling to affected families.

Contracture↗
PubMed1995

Congenital generalized follicular hamartoma associated with alopecia and cystic fibrosis in three siblings.

BACKGROUND: Generalized follicular hamartoma is a rare condition that has been described in association with alopecia, myasthenia gravis, and circulating autoantibodies. To date, all reported cases have appeared in female individuals. We report a kindred in which three siblings were affected by this condition in association with alopecia and cystic fibrosis. OBSERVATIONS: Three children of two consanguineous patients were affected by cystic fibrosis. They also had the same phenotype characterized by senilized facies, partial alopecia, and hypohidrosis, severe retardation of physical growth, and hyperelasticity of the skin. In all three children, skin biopsy specimens revealed the presence of basaloid proliferations at the level of the hair follicles that could not be demonstrated in their healthy parents. Myasthenia gravis did not appear during the clinical course of our patients, and circulating autoantibodies were not detected. All three patients died during childhood due to complications of cystic fibrosis. CONCLUSIONS: Generalized follicular hamartoma is a rare condition previously reported in association with alopecia, myasthenia gravis, and/or circulating autoantibodies (antinuclear and antiacetylcholine receptor antibodies). These are the first congenital cases of generalized follicular hamartoma described, and it is also the first time that an association with cystic fibrosis is reported. The striking association of generalized follicular hamartoma with cystic fibrosis in these three siblings suggests that there may be a genetic linkage between the two conditions.

Alopecia↗
PubMedDate not supplied

Relationship between systemic markers of inflammation and serum beta-carotene levels.

BACKGROUND: Low serum levels of beta-carotene have been associated with increased risk of cancer and cardiovascular disease. However, in clinical trials, supplementation of the diet with beta-carotene either had no benefit or caused harm. This pattern of findings raises the possibility that confounding by other factors might explain the association between serum beta-carotene level and disease risk. METHODS: We used data from 14 470 current smokers, ex-smokers, and never smokers aged 18 years or older who participated in the Third National Health and Nutrition Examination Survey to assess the relationship between serum beta-carotene and markers of inflammation (C-reactive protein and white blood cell count). RESULTS: After adjustment for beta-carotene intake and other factors, geometric mean levels of serum beta-carotene for individuals with undetectable (< 0.22 mg/dL), mildly elevated (0.22-0.99 mg/dL), and clinically elevated (> or =1.0 mg/dL) C-reactive protein levels were 18.0, 16.1, and 13.6 microg/dL, respectively, in never smokers; 18.1, 15.7, and 13.9 microg/dL in ex-smokers; and 11.3, 10.2, and 9.4 microg/dL in current smokers (P< .001 for all). In corresponding analyses, white blood cell count was also inversely related to serum beta-carotene concentration (P< .05 for all). CONCLUSIONS: The strong and inverse association of serum beta-carotene level with C-reactive protein level and white blood cell count suggests that the relationship between serum beta-carotene concentration and disease risk might be confounded by inflammation. More broadly, for beta-carotene and likely other nutrients, it seems unwise to interpret biomarker data as prima facie evidence of dietary intake without a more complete understanding of the physiologic processes that affect nutrient levels.

Adult↗
PubMed1978

Atlantoaxial malformation in a 46,XY, 17q+ child.

A child with 46,XY, 17q+ chromosome aberration and unusual skeletal abnormalities had the presenting symptom of respiratory arrest after a fall and minor head trauma. He exhibited proportionate short stature, peculiar facies with antimongoloid slant, simian creases, postaxial hexadactyly, metatarsus adductus deformity, and anomalous penoscrotal configuration. Delayed speech and mild mental retardation were also present. Atlantoaxial dislocation secondary to odontoid process hypoplasia was demonstrated. Additional skeletal abnormalities included dysplastic changes in the first and fourth metacarpals, the middle phalanx of the second finger, and hypoplasia of the first metatarsal, with medial insertion of the great toe. Treatment consisted of halo jacket cast and fusion of the occiput to C1, C2, and C3. Early detection and preventive surgery for atlantoaxial dislocation is necessary to prevent neurological deficit and possibly death by respiratory failure.

Axis, Cervical Vertebra↗
PubMed1978

Familial juvenile neuronal storage disease. New disease or variant of juvenile lipidosis?

Two patients had an illness characterized by a positive family history, juvenile onset, macular cherry-red spots, myoclonus, generalized convulsions, and cerebellar ataxia. Neither had dementia, gargoyle facies, bone or joint deformities, or visceromegaly. Vacuolated lymphocytes were not seen in the peripheral blood or bone marrow. Specimens from the rectum and vermiform appendix showed Sudan black B-, Sudan III-, and PAS-positive granules within the neurons of the myenteric plexus. On electron microscopic examination, lysosome-like bodies, membranous cytoplasmic bodies, pleomorphic lamellated bodies, dense bodies, and lipofuscin-like bodies in the neurons were seen, with a suggestion of morphological transitional forms among them. Sialoglycopeptides, especially sialic acid, were increased in the urine, but excretion of acid mucopolysaccharides was normal. Assays of lysosomal enzymes in leucocytes showed normal enzymatic activity. On the basis of the clinical, biochemical, and histological results, we suggest that these two cases and four similar cases reported in the literature be classified differently from the previously described lipidoses, although it is not known whether these cases represent a new entity or merely a clinical variant of juvenile lipidosis.

Adolescent↗
PubMed1985

Possible valproate teratogenicity.

The teratogenic risk of maternal valproic acid therapy and the prenatal effects on growth and morphogenesis have been difficult to determine, in part, because of the small number of epileptic women who receive valproic acid as the sole anticonvulsant therapy. An increased incidence of open neural tube defects has been suggested and other isolated case reports have noted the presence of certain dysmorphic features. We present a patient whose defects in morphogenesis appear to be associated with valproic acid exposure only, and suggest a clinical phenotype that our patient shares with other children exposed to prenatal valproic acid therapy. Features described previously include dysmorphic facies with hypertelorism, prominent forehead, low flat nasal bridge, low-set or odd-shaped ears, and micrognathia with growth deficiency of prenatal or postnatal onset. A striking and perhaps unique feature in our patient consists of hypoplasia of the lateral margins of the zygomatic arches. We discuss the pharmacokinetics of valproic acid in pregnancy and in the neonatal period.

Abnormalities, Multiple↗
PubMed1981

Blepharospasm surgery. An anatomical approach.

Essential blepharospasm is an idiopathic, progressively debilitating disease leading to blindness. Years of forceful spasms result in brow ptosis, dermatochalasis, and, frequently, levator aponeurosis and lateral canthal tendon defects. Following standard neurectomy procedures, the facies droop, brow ptosis and dermatochalasis worsen, and ptosis and canthal tendon laxity suddenly become more evident. We describe a procedure involving meticulous extirpation of all accessible orbicularis oculi, procerus, corrugator superciliaris, and facial nerves in postorbicular fascia. This extirpation of eyelid protractors is combined with browplasty with fixation to frontalis and reinforcement of the levator aponeurosis to strengthen the retractors. Our technique opens the eye just as effectively as standard facial neurectomy procedures, simultaneously corrects associated anatomical deformities, and avoids facial paralysis. Gratifying results were obtained in 15 patients followed up for six to 38 months.

Aged↗
PubMed1981

Zellweger syndrome. Lenticular opacities indicating carrier status and lens abnormalities characteristic of homozygotes.

Cataracts were found in four patients with pathologically confirmed Zellweger syndrome. By careful slitlamp examination with the pupil completely dilated, there is a denser cortex that produces a cortical-nuclear interface. These opacities have ultrastructural analogues, which are inclusion bodies restricted to the cortical lens fibers. The lens epithelium shows abnormal mitochondrial proliferation that is age dependent. The parents of these four infants with Zellweger syndrome have lenticular opacities that are seen only biomicroscopically after maximal pupillary dilation. These changes consist of curvilinear condensations in the cortical region corresponding to the locus of the cataractous changes in the homozygous state. In the clinical setting of an infant who is failing to thrive, has the Zellweger facies, and demonstrates an absent electroretinogram, these heterozygote lens opacities are useful in making the diagnosis of Zellweger syndrome before pathologic substantiation.

Cataract↗
PubMed1979

The Campomelic syndrome. Temporal bone histopathologic features and otolaryngologic manifestations.

The campomelic syndrome is characterized by dwarfism, craniofacial anomalies, bowing of the tibiae and femora, cutaneous dimpling overlying the tibial bend, respiratory distress, and early death. Otolaryngologic manifestations include flat facies with a broad nasal bridge, low-set ears, cleft palate, mandibular hypoplasia, and tracheobronchial malacia. The underlying pathologic feature appears to be disturbance in cartilage growth involving the affected bones and the respiratory tract cartilage. The cause is unknown. We report clinical and histopathologic features in two cases of this syndrome. The endochondral layer of the otic capsule contained no cartilage cells. The cochlea was short and flattened, presenting a scala communis. The vestibule and the canals were deformed by bone invasion. Defective endochondral ossification of the petrooccipital synchondroses possibly explains the shortened skull base seen in this syndrome. The tracheobronchial malacia significantly contributes to respiratory distress and neonatal death.

Abnormalities, Multiple↗
PubMed1986

Nasal respiratory function and craniofacial growth.

Nasal respiratory function and its relationship to growth development of the craniofacial structure has been a subject of interest and controversy for over 100 years. The otolaryngologist as the primary physician with responsibility of managing the upper respiratory tract is obviously most intimately involved with diagnosis and treatment of upper respiratory tract problems. To further evaluate the evidence regarding causes of craniofacial growth, a study was done involving pretreatment orthodontic subjects and their manifestation of classic signs of adenoid facies ("long-face syndrome"). Randomly selected were 106 subjects, ranging in age from 6 to 13 years, for evaluation of the facial features and medical history associated with long-face syndrome. No conclusive proof was found that nasal respiratory obstruction alters facial growth development. Studies of the nasal respiratory function need to be done utilizing clear definitions of respiratory mode and objective; reproducible techniques of measuring respiratory modes must be employed. Highly selected orthodontic patients can benefit from adenoidectomy and/or tonsillectomy.

Adolescent↗
PubMed1975

Further identification of a D/E translocation.

An infant previously reported to have psychomotor retardation and multiple congenital anomalies including hypotonia, failure to thrive, peculiar facies, low-set ears, micrognathia, and cryptorchidism in association with monosomy due to a D/E (13-15/17-18) translocation has been reexamined. Further cytogenetic studies, using fluorescent techniques, indicate the translocation involves chromosomes 15 and 17. Only two other patients with partial monosomy due to grossly similar D/E translocations have been reported. On reexamination, the translocation in one has recently been found to involve chromosomes 15 and 18 and that in the other has not been further defined.

Abnormalities, Multiple↗
PubMed1975

Pseudohypoparathyroidism with normal serum calcium level.

A mildly obese 15-year-old boy had short stature with rounded facies and short, stubby hands and toes. He had the fully expressed syndrome of pseudohypoparathyroidism but was the only member of his family who had all the somatic characteristics of this disease. The serum parathyroid hormone level was substantially elevated. Urinary excretion of cyclic adenosine monophosphate and phosphate failed to increase following intravenous infusion of parathyroid hormone. However, he did not have hypocalcemia. The present entity is probably a transient form of pseudohypoparathyroidism with partial responsiveness of skeletal adenyl cyclase to parathyroid hormone.

Adolescent↗
PubMed1976

Frontometaphyseal Dysplasia. Evidence for dominant inheritance.

A 10-year-old boy with mixed bilateral hearing loss and unusual facies was found to have frontometaphyseal dysplasia. He has prominent supraorbital ridges, height-span disproportion, dental abnormalities, thick clavicles, pectus excavatum, winged scapulae, joint contractures, and generalized muscular underdevelopment. Roentgenograms show supraorbital hyperostosis, antegonial notching of the mandible, flared ilia, contraction of the midpelvis, flattened vertebrae, deformities of the ribs posteriorly, flared metaphyses of the long tubular bones, and greatly widened and elongated metacarpals, metatarsals, and phalanges. His mother has prominent supraorbital ridges, distinct scoliosis, contractures of the fifth fingers, and conductive hearing loss. She also has many of the roentgenographic features of frontometaphyseal dysplasia. Frontometaphyseal dysplasia in a mother and son strongly suggests a dominant mode of inheritance.

Adult↗