Clinical, anthropometric, radiological and molecular characteristics of Egyptian achondroplasia patients

Achondroplasia is the most common form of non lethal skeletal dysphasia. It is a fully penetrant autosomal dominant disorder and the majority of cases are sporadic resulting from de novo mutations associated with advanced paternal age. The phenotype of achondroplasia is related to disturbance in endochondral bone formation due to mutations in the fibroblast growth factor receptor-3 [FGFR3] gene. Evaluation of the cardinal phenotypic features in achondroplasia, the body physique using anthropometric measurements, the characteristic radiological signs in the patients as a main tool for diagnosis and detection of the most common mutations in achondroplasia patients in the studied sample. From 42 cases referred to us as achondroplasia, we selected 20 cases where clinical manifestations were consistent with achondroplasia. Cases were subjected to full clinical examination, detailed anthropometric measurements, whole body skeletal survey and molecular studies of the most common mutations of the FGFR3 gene using PCR amplification technique. Nineteen cases were sporadic [95%] and one case had an affected father [5%]. A paternal age above 35 years at the time of child's birth was present in 7 cases [35%]. Paternal exposure to occupational heat was noted in 6 cases [30%] and parental exposure to chemicals in 3 cases [15%]. All cases showed typical clinical and radiological manifestations of achondroplasia. Anthropometric measurements quantitatively confirmed the body physique in the studied eases. G380R common mutations of the FGFR3 gene were detected in 15/18 cases [83%] with the G to A transition at nucleotide 1138 in 14 cases [77%]. Agenesis of corpus callosum, not previously reported in association with achondroplasia, was present in the only case with the G-C transversion mutation at nucleotide 1138 [5%]. Awareness of the cardinal features of achondroplasia, proper anthropometric measurements and detailed skeletal survey are the key for accurate diagnosis, genetic counseling and avoidance of over diagnosis. The majority of studied Egyptian achondroplasia patients have the same common mutation that has been most often defined in patients with achondroplasia from other countries

Developmental abnormalities of mid and hindbrain: a study of 23 Egyptian patients

With the advent of neuroimaging modalities specifically, magnetic resonance imaging [MRI], recognition of developmental defects of posterior fossa has greatly improved. Is to delineate the clinical, cytogenetics and radiological features of patients with midhindbrain anomalies. Twenty-three patients with mid-hind brain malformations were included in this study. Complete clinical evaluation, cytogenetic analysis and neuroradiological study were done for each patient. Patients' sex ratio was [M: F/ 0.9:1] and the mean age was 2.17 years. Parental consanguinity was 86.9% and positive family history was recorded in 7 families. Based on clinico-radiological findings, patients were categorized as Joubert syndrome and related cerebellar disorders [34.8%], pontocerebellar hypoplasia [26.1%], lissencephaly cerebellar hypoplasia [13%], isolated cobblestone lissencephaly with normal muscle and eye [8.7%], isolated vermian hypoplasia [13%] and retrocerebellar cyst [4.4%]. Cytogenetic analysis revealed abnormalities in 3 patients [13%]; pericentric inversion of chromosome 8 in a patient with lissencephaly cerebellar hypoplasia, del 5p14.3-pter delineating Cri du chat syndrome and associated with vermian hypoplasia and del 18q21.1-qter in a patient with retrocerebellar cyst due to paternal balanced translocation t [4;18]. FISH for specific locus and whole chromosomal painting were used to document the assigned aberrations. Although most of the cerebellar malformations are of Mendelian inheritance, this study emphasizes the importance of chromosomal analysis for patients with posterior fossa anomalies. With more researches describing clinico-radiological characterization of hind brain dysgenesis will allow better understanding of these disorders, further delineation of relevant syndromes and new genes identification

Efficacy of bronchial wash cytology and its correlation with biopsy in lung tumours

Objective: To evaluate bronchial wash cytology with histology in our set up

Material and Methods: Seventy three specimens were obtained by flexible fiberoptic bronchoscope at pulmonology department of Military Hospital Rawalpindi. All the preserved samples were processed under standard conditions. The slides were stained with Papanicolaou and Haematoxylin and Eosin stains

Results: A total of 73 patients were studied. The age range was 21 to 80 years . Male to female ratio was 8:1. Complete cytological and biopsy consensus was found in 55 [77.4%] cases. Cytology revealed 24 cases as malignant and nine as atypical/suspicious. Benign and inadequate were 29 and 2 respectively. Histopathology of these cases confirmed 24 [32.9%] as malignant and 29 [39.8%] as benign. True positive alongwith suspicious/atypical were 33 and true negative cases were 29. False positive was one case only whereas false negative cases were eight. The bronchial wash cytology showed sensitivity [80.5%], specificity [96.6%] and accuracy [87.3%]. Positive predictive value and negative predictive value were 97% and 78.4% respectively. The commonest types of tumours were squamous cell carcinoma and small cell carcinoma

Conclusion: It is concluded that bronchial wash cytology is a valuable tool and yields almost same information as biopsy. It is useful in patients with evidence of obstruction or risk of haemorrhage

Neuronal migration disorders: clinical, neuroimaging and neurophysiologic studies

Impaired neuronal migration is the basis of many cerebral malformations presenting with mental retardation, epilepsy and motor impairment. We aimed at correlating clinico-radiological presentations and findings of neuro-physiological studies in neuronal migration disorders. This study included 13 child, with mean age 22.6 months, from 12 families presented mainly with developmental delay and diagnosed by CT and MRI as neuronal migration disorders. Neurophysiologic studies including EEG and multi-modality evoked potentials, namely VEP and BAEP were performed. According to neuroimaging findings, lissencephaly was the commonest diagnosis [n=9], followed by unilateral open lip schizencephaly [n=2], periventricular heterotopia [n=1] and hemimegalencephaly [n=1]. Positive family history of similar cases was recorded in 3 families, all had lissencephaly. Abnormal EEG changes were observed in 12 patients [92.3%]; only 10 patients had epilepsy. EEG records were normal in a single patient with periventricular heterotopia. VEP was abnormal in 10 patients [76%] and BAEP was abnormal in 12 patients [92.3%]. Both VEP and BAEP were in the form of ill defined waves in patients with microlissencephaly. Asymmetry of BAEP between right and left side was detected in 3 cases; two of them had' unilateral disorders: hemimegalencephaly [n=1], and unilateral open lip schizencephaly [n=1] and the third had bilateral asymmetric periventricular nodular heterotopia. In conclusion, this study documented the frequent association of cortical and brain stem dysfunction with neuronal migration disorders. It also implied that the type of neuronal migration defect might influence the severity or symmetry of neurophysiologic studies results. Proper assessment of these cases clinically and by neuroimaging and neurophysiologic studies, advances our understanding thus genetic counseling of neuronal migration disorders