Clinical and genetic analysis of two cases of Prader-Willi syndrome / 中国综合临床

Objective:To investigate the clinical and genetic characteristics of Prader-Willi syndrome (PWS).Methods:The clinical data and genetic characteristics of 2 children with PWS diagnosed in Hebei Provincial People's Hospital were retrospectively analyzed, and the relevant literature was reviewed.Results:Case 1, male, aged 6 years and 3 months, was presented to the hospital because of short stature, mild mental retardation, dysarthria, scoliosis, cryptorchidism, micropenis, long skull, narrow face, almond eyes, small mouth, thin upper lip, downward corners of the mouth, fair skin. He had hypotonia and feeding difficulties in infancy, and gradually became hyperappetitive. Bilateral cryptorchidism surgery was performed at 1.5 years old, but the effect was not good. Case 2, male, aged 4 years, presented to the hospital mainly due to obesity, hyperappetite, excessive weight gain, backward language and cognitive function, dysarthria, and scoliosis.The infant had feeding difficulties in the early stage, and bilateral cryptorchidism surgery at the age of 2 was not effective.Methylation specific polymerase chain reaction and methylation specific multilink probe amplification were used to detect the loss of the parent fragment in the key region (15q11-13) of PWS, which confirmed Prader-Willi syndrome.Conclusion:PWS is a rare hereditary disease with complex and diverse clinical manifestations and different characteristics in different age groups. It is highly susceptible to unexplained hypotonia and feeding difficulties in infancy. Children with short stature and obesity should be alert to the disease, which can be clearly diagnosed by molecular genetic techniques.

Prader-Willi syndrome diagnosed in adulthood: A case report / 中华内分泌代谢杂志

This article reports a case of Prader-Willi syndrome(PWS) diagnosed in adulthood. PWS is a rare genetic disease with most of the reported cases being diagnosed in infancy and childhood, and adulthood case is rarely reported. The patient had insidious symptoms in infancy and was diagnosed as PWS using genetic test in adulthood due to diabetes and menstrual disorders. This article focuses on the patient′s clinical manifestations in adulthood, and reviews relevant literature to improve the understanding of the disease.

Prader-Willi syndrome: endocrine manifestations and management

ABSTRACT Prader-Willi syndrome (PWS) is a genetic disorder caused by the absence of gene expression in the 15q11.2-q13 paternal chromosome. Patients with PWS develop hypothalamic dysfunction that can lead to various endocrine changes such as: obesity, growth hormone deficiency, hypogonadism, hypothyroidism, adrenal insufficiency and low bone mineral density. In addition, individuals with PWS have increased risk of developing type 2 diabetes mellitus. This review summarizes and updates the current knowledge about the prevention, diagnosis and treatment of endocrine manifestations associated with Prader Willi syndrome, especially diagnosis of growth hormone deficiency, management and monitoring of adverse effects; diagnosis of central adrenal insufficiency and management in stressful situations; screening for central hypothyroidism; research and treatment of hypogonadism; prevention and treatment of disorders of glucose metabolism. Careful attention to the endocrine aspects of PWS contributes significantly to the health of these individuals. Arch Endocrinol Metab. 2020;64(3):223-34

Manifestaciones clínicas asociadas al síndrome de Prader-Willi / Clinical Manifestations Associated with Prader-Willi Syndrome

RESUMEN El síndrome de Prader-Willi (SPW) es un trastorno genético, que afecta el neurodesarrollo que, a pesar de su baja frecuencia, merece ser considerado como un trastorno de relevancia clínica al ser la causa más frecuente de obesidad de origen genético. Las manifestaciones clínicas que derivan de SPW tienen origen en la desregulación hipotalámica, por lo que al comprender la trascendencia e implicación de ésta se entenderá la amplia gama de manifestaciones que pueden presentarse con severidad variable y cuyas complicaciones a su vez afectan la salud y socialización a largo plazo lo que influye sobre la calidad de vida de los pacientes con SPW. El diagnóstico preciso permite distinguir este síndrome de otros trastornos genéticos y de otras patologías que afectan la función hipotalámica a la vez que posibilita estimar la gravedad de las manifestaciones y el riesgo de repetición en una misma familia. Por ello, esta revisión se presenta con el objetivo de describir las manifestaciones clínicas del síndrome de Prader-Willi que orienten la sospecha clínica, las similitudes que comparte éste con otros trastornos, así como dar a conocer las técnicas de diagnóstico disponibles que favorecen el abordaje de los pacientes y facilitar su manejo integral oportunamente.

ABSTRACT Prader-Willi syndrome (PWS) is a genetic disorder that affects neurodevelopment, which, despite its low frequency, deserves to be consideredaclinically relevant disorder since it is themost frequent cause of genetically derived obesity. The clinical manifestations that derive from SPW correlate to those from a hypothalamic dysregulation, so that, understanding the importance and implication of the hypothalamic involvement, the wide range of manifestations that can present with variable severity and whose complications in turn affect the health can be understood. and long-term socialization affecting the quality of life of patients with PWS. An accurate diagnosis can discriminate this syndrome from other genetic disorders and from non-genetic pathologies that affect hypothalamic function, while also allowing to estimate the severity in a specific patient and the risk of repetition in other family members. Therefore, the present descriptive review is aimed to describe the clinical manifestations of Prader-Willi syndrome to guide the clinical diagnosis; the signs and symptoms that can differentiate this syndrome from other disorders, as well as presenting a description of the actual diagnostic techniques that can allow a prompt and precise diagnosis, and thus, translate in a comprehensive and timely approach of the patients with PWS.

Anestesia locorregional en una paciente adulta con síndrome de Prader-Willi: consideraciones anestésicas / Anesthetic consideration: Regional anesthesia with Prader-Willi

Prader-Willi syndrome (PWS) is a disorder caused by a genetic alteration that causes a multisystem clinic. It can be due mainly to three genetic mechanisms; a paternal deletion of the 15q11-13 region, a maternal uniparental disomy, or an imprinting defect. The paternal deletion is observed in 70% of the patients, the disomy in 25% and the imprinting defect in only 5% of those affected by this syndrome. 1) It is the most common syndromic cause of obesity with an estimated prevalence in the population of 1: 50,000; 2) The clinic is very variable, which is why clinical criteria have been created that, supported by the genetic study, confirm the diagnosis; 3) They have difficulty feeding during lactation, which leads to hyperphagia in childhood that leads to obesity. In the adult stage, in addition to obesity, respiratory pathology, sleep disturbances and psychological disorders stand out; 4) Objective: the aim of the present review was to compile the cases recorded in the scientific literature of patients anesthetized with PWS and the anesthetic options used in said patients.

El síndrome de Prader-Willi (SPW) es un trastorno causado por una alteración genética que provoca una clínica multisistémica. Puede ser debido principalmente a tres mecanismos genéticos; una deleción paterna de la región 15q11-13, una disomía uniparental materna o un defecto de impronta. La deleción paterna se observa en el 70% de los pacientes, la disomía en el 25% y el defecto de impronta en tan solo el 5% de los afectados por este síndrome. 1) Constituye la causa sindrómica más frecuente de obesidad con una prevalencia estimada en la población de 1:50.000; 2) La clínica es muy variable por lo que se han creado unos criterios clínicos que apoyados por el estudio genético confirman el diagnóstico; 3) Presentan dificultad para la alimentación durante la lactancia, que da paso a una hiperfagia en la infancia que deriva en obesidad. En la etapa adulta, además de la obesidad destacan la patología respiratoria, alteraciones del sueño y trastornos psicológicos; 4) Objetivo: el objetivo de la presente revisión fue recopilar los casos registrados en la literatura científica de pacientes anestesiados con SPW y las opciones anestésicas utilizadas en dichos pacientes.

Epilepsy in Prader‐Willi syndrome:clinical characteristics and related analysis / 中国小儿急救医学

Objective To analyze the incidence and clinical characteristics of epilepsy in children with Prader‐Willi syndrome (PWS),and to explore the relationship with genotype. Methods Ninety‐five children with PWS were chosen from Department of Pediatric Neurology in Shengjing Hospital of China Medical University during 2008 to 2018. The general information of all children included in the study were collected and analyzed at the same time. At first,95 children with PWS were divided into two groups accord‐ing to epilepsy or not(epilepsy group 23 cases and non‐epilepsy group 72 cases),the relationship between in‐cidence of epilepsy and genotype or gender was analyzed. Furthermore,23 PWS children with epilepsy were divided into two groups according to genotype:paternal 15q11‐13 region deletion genotype group (20 cases) and maternal uni‐parental disomy(UPD) group (3 cases),then the relationship between clinical characteris‐tics and genotype was analyzed. Results A retrospective analysis of 95 patients with PWS found that the proportion of deletion in 15q11‐13 was significantly higher in the epilepsy group than that in the non‐epilepsy group,and the difference was statistically significant (87. 0% vs. 56. 9%,χ2 ＝6. 832,P＝0. 009),while there was no statistical difference in gender (χ2 ＝0. 603,P＝0. 437). Among the 23 PWS children with epilepsy, 18 cases (78. 2%) were generalized epilepsy,and 5 cases (21. 8%) were focal epilepsy. The proportion of generalized epilepsy of deletion genotype group was higher than UPD group,and there was statistical differ‐ence(85. 0% vs. 33. 3%,P<0. 05). But the differences in seizure onset age and seizure frequency were not statistically significant(P>0. 05). The effective epilepsy control rate was 91. 3% in 23 children with epilep‐ sy. Conclusion PWS children have a higher incidence of epilepsy,which can manifest with generalized fea‐tures. PWS patients with a deletion genotype in paternal 15q11‐13 region show a trend toward developing sei‐zures,especially generalized epilepsy. But the seizure onset age and seizure frequency have no correlation with genotype. There is a good prognosis in most PWS with epilepsy.

Síndrome de prader willi: o que o pediatra geral deve fazer - uma revisão / Prader-willi syndrome: what is the general pediatrician supposed to do? - a review

RESUMO Objetivo: Realizar uma revisão sobre a Síndrome de Prader-Willi (SPW) com base nas publicações mais recentes e fornecer recomendações ao pediatra geral para diagnóstico precoce e seguimento. Fonte de dados: Artigos publicados nas bases Pubmed e SciELO. A pesquisa não foi limitada a um período e incluiu todos os artigos das bases de dados. Síntese dos dados: A SPW é uma síndrome genética rara, resultante da perda do imprinting gênico expresso no cromossomo paterno 15q11-q13, sendo caracterizada por alterações endocrinológicas, como deficiência de hormônio de crescimento, obesidade, insuficiência adrenal central, hipotireoidismo, hipogonadismo, além de alterações comportamentais e déficit intelectual. Há outras comorbidades associadas, como distúrbios de sono, escoliose, constipação, problemas dentários e alterações de coagulação. O protocolo de seguimento da SPW do Instituto da Criança da Universidade de São Paulo se baseia em quarto pilares principais: dieta, exercício físico, terapia com hormônio de crescimento humano recombinante (rhGH) e manejo comportamental e cognitivo. A dieta deve ser restrita a 900 kcal/dia, de acordo com a Pirâmide Alimentar do Prader-Willi, e o exercício físico deve ser diário, aeróbico e postural. A terapia com rhGH é fortemente recomendada pela literatura científica internacional e deve ser iniciada assim que for realizado o diagnóstico da síndrome. O manejo do comportamento é realizado com estratégias para estabelecer rotina e regras. Conclusões: Se a SPW se tornar mais familiar ao pediatra geral, o diagnóstico e o tratamento começarão mais precocemente, o que irá melhorar a qualidade de vida e os cuidados desses pacientes.

ABSTRACT Objective: To carry out a review about Prader-Willi Syndrome based on the most recent data about the subject and to give recommendation for the general pediatricians for early diagnoses and follow-up. Data sources: Scientific articles in the PubMed and SciELO databases. The research was not limited to a specific time period and included all articles in such databases. Data synthesis: The Prader-Willi Syndrome (PWS) is a rare genetic disorder resulting from the loss of imprinted gene expression within the paternal chromosome 15q11-q13. PWS is characterized by endocrine abnormalities, such as growth hormone (GH) deficiency, obesity, central adrenal insufficiency, hypothyroidism, hypogonadism and complex behavioral and intellectual difficulties. PWS individuals also may present other comorbidities, such as sleep disorders, scoliosis, constipation, dental issues and coagulation disorders. The follow-up protocol of the Children's Institute at Universidade de São Paulo is based on four main pillars: diet, exercise, recombinant human growth hormone (rhGH) therapy and behavioral and cognitive issues. The diet must include a caloric restriction of 900 kcal/day, according to the Prader-Willi Eating Pyramid and exercise plan is focused on daily aerobic exercises and postural therapy. The rhGH therapy is highly recommended by the international scientific literature and must be started as soon as the diagnostic is made. The management of behavioral issues is based on strategies to establish routine and rules. Conclusions: If the general pediatrician becomes more familiar with PWS, the diagnosis and treatment will start earlier, which is essential to improve the quality of life and care for these individuals.

Serie de casos: síndrome de Prader-Willi con diagnóstico molecular y citogenético en la Unidad de Especialidades Médicas / Case series: Prader-Willi syndrome with molecular and cytogenetic diagnosis in the Medical Specialities Unit

Resumen El síndrome de Prader-Willi en un trastorno multisistémico; se caracteriza en la infancia por hipotonía, dificultades para la alimentación, retraso en el desarrollo e hipoplasia genital. En la adolescencia y edad adulta, la problemática se centra en las alteraciones del comportamiento, la ausencia de saciedad y el retraso mental leve o moderado. Su diagnóstico temprano requiere una alta sospecha clínica y estudios especiales (estudios de metilación e hibridación fluorescente in situ). La detección temprana se realiza con el fin de disminuir la morbilidad y mortalidad de los pacientes. Existe una clara necesidad de un enfoque multidisciplinario para facilitar el diagnóstico temprano y optimizar el manejo y tratamiento para mejorar la calidad de vida. Se presentan seis casos de SPW que tienen seguimiento en la Unidad de Especialidades Médicas a fin de conocer la prevalencia del SPW, ya que en la actualidad no se cuenta con ningún registro que la documente.

Abstract Prader-Willi syndrome in a multisystem disorder; it is characterized in childhood by hypotonia, feeding difficulties, developmental delay and genital hypoplasia. In adolescence and adulthood, the problem focuses on behavioral changes, the absence of satiety and mild or moderate mental retardation. Its early diagnosis requires a high clinical suspicion and special studies (methylation studies and fluorescent in situ hybridization). An early detection reduces the morbidity and mortality of patients. There is a clear need for a multidisciplinary approach to facilitate early diagnosis and optimize management and treatment to improve quality of life. There are six cases of SPW that are followed in the Medical Specialties Unit; we report them in order to know the prevalence of PWS, since at present there is no record documenting it.

Bariatric surgery in individuals with severe cognitive impairment: report of two cases / Cirurgia bariátrica em indivíduos com déficits cognitivos graves: relato de dois casos

ABSTRACT CONTEXT: Bariatric surgery has become the gold-standard treatment for refractory morbid obesity. Obesity is frequently associated with certain syndromes that include coexisting cognitive deficits. However, the outcomes from bariatric surgery in this group of individuals remain incompletely determined. CASE REPORT: A 25-year-old male with Prader-Willi syndrome, whose intelligence quotient (IQ) was 54, was admitted with a body mass index (BMI) of 55 kg/m2, associated with glucose intolerance. He underwent the Scopinaro procedure for biliopancreatic diversion, with uneventful postoperative evolution, and presented a 55% loss of excess weight one year after the surgery, with resolution of glucose intolerance, and without any manifestation of protein-calorie malnutrition. A 28-year-old male with Down syndrome, whose IQ was 68, was admitted with BMI of 41.5 kg/m2, associated with hypertension. He underwent Roux-en-Y gastric bypass, with uneventful postoperative evolution. He presented a 90% loss of excess weight one year after the surgery, with resolution of the hypertension. CONCLUSION: Bariatric surgery among individuals with intellectual impairment is a controversial topic. There is a tendency among these individuals to present significant weight loss and comorbidity control, but less than what is observed in the general obese population. The severity of the intellectual impairment may be taken into consideration in the decision-making process regarding the most appropriate surgical technique. Bariatric surgery is feasible and safe among these individuals, but further research is necessary to deepen these observations.

RESUMO CONTEXTO: A cirurgia bariátrica tornou-se o tratamento padrão ouro para a obesidade mórbida refratária. A obesidade está frequentemente associada a certas síndromes nas quais também coexistem déficits cognitivos, entretanto, os resultados da cirurgia bariátrica nesse grupo de indivíduos ainda não foram completamente determinados. RELATO DE CASO: Um homem de 25 anos com síndrome de Prader-Willi, cujo quociente de inteligência (QI) era estimado em 54, foi admitido com índice de massa corporal (IMC) de 55 kg/m2, associado com intolerância à glicose. Foi submetido a uma derivação biliopancreática à Scopinaro, com evolução pós-operatória sem complicações significativas. Apresentou perda de 55% do excesso de peso um ano após a cirurgia, com resolução da intolerância à glicose, sem manifestação de desnutrição proteico-calórica. Outro paciente, homem de 28 anos com syndrome de Down, cujo QI era de 68, foi admitido com IMC de 41,5 kg/m2, associado a hipertensão arterial. Foi submetido ao bypass gástrico em Y de Roux, com evolução pós-operatória sem complicações. Apresentou perda de 90% do excesso de peso após um ano e resolução da hipertensão. CONCLUSÃO: A cirurgia bariátrica em indivíduos com déficits intelectuais é um tópico controverso. Existe uma tendência entre esses indivíduos de apresentar perda de peso e controle de comorbidades significativos, porém menores que os observados na população obesa geral. A gravidade do déficit intelectual pode ser considerada no processo de decisão sobre a técnica cirúrgica mais adequada. A cirurgia bariátrica é factível e segura nesse grupo de indivíduos. Porém, mais estudos são necessários para aprofundar estas observações.

Análisis de variación del número de copias y de patrones de metilación en la región 15q11-q13 / Variation analysis of the number of copies and methylene patterns in region 15q11-q13

La región q11-q13 del cromosoma 15 humano es proclive a sufrir alteraciones genéticas. Algunos genes de la región presentan expresión parental diferencial monoalélica, regulada por imprinting (EI). Errores en la regulación del EI, disomías uniparentales (DSU), así como también el cambio en el número de copias genómicas (CNV) producidos por sitios susceptibles de quiebre cromosómico (BP), producen alteraciones en esta región. Las enfermedades más frecuentes asociadas son el síndrome de Prader-Willi, el síndrome de Angelman y el síndrome de microduplicación 15q11-q13. En el presente trabajo analizamos la región 15q11-q13 por Methyl specific-multiplex ligation-dependent probe amplification (MS-MLPA) en 181 muestras de ADN derivadas a nuestro servicio de análisis genético molecular. En este trabajo mostramos que, de las 181 muestras, 39 presentaron alteraciones detectables por MS-MLPA. El 61.5% (24/39) de esas alteraciones detectadas fueron deleciones, el 5.1% (2/39) duplicaciones y el 33.3%(13/39) DSU/EI. Los CNV fueron 4 veces más frecuentes que las DSU/EI (OR = 4; IC 95%: 1.56-10.25) consistente con la literatura. Entre los CNV, dos casos atípicos permiten postular posibles sitios BP que no han sido informados en la literatura previamente.

Human chromosome 15q11-q13 region is prone to suffer genetic alterations. Some genes of this region have a differential monoallelic imprinting-regulated expression pattern. Defects in imprinting regulation (IE), uniparental disomy (UPD) or copy number variation (CNV) due to chromosomal breakpoints (BP) in 15q11-q13 region, are associated with several diseases. The most frequent are Prader-Willi syndrome, Angelman syndrome and 15q11-q13 microduplication syndrome. In this work, we analyzed DNA samples from 181 patients with phenotypes which were compatible with the above-mentioned diseases, using Methyl specific-multiplex ligation-dependent probe amplification (MS-MLPA). We show that, of the 181 samples, 39 presented alterations detectable by MS-MLPA. Of those alterations, 61.5% (24/39) were deletions, 5.1% (2/39) duplications and 33.3% (13/39) UPD/IE. The CNV cases were 4 times more frequent than UPD/IE (OR= 4; IC 95%: 1.56-10.25), consistent with the literature. Among the CNVs, two atypical cases allow to postulate new possible BP sites that have not been reported previously in the literature.

Clinical Usefulness of Aripiprazole Treatment in a Girl with Prader-Willi Syndrome and Psychosis

Prader-Willi syndrome (PWS) is a quite rare multi-systemic genetic disorder strongly associated with psychiatric illness in adults, especially psychosis. This report presents a 16-year-old female with PWS and symptoms of brief psychotic disorder with a complete resolution of symptoms under aripiprazole medication. However, an exacerbation occurred after aripiprazole reduction. Apart from a weight gain of about 2 kg over the course of two years, no adverse effects could be found. This first report on the use of aripiprazole in a subject with PWS and psychosis suggests that aripiprazole might be a promising treatment approach in this distinct group of patients.

Etiological Classification and Developmental Outcomes in Floppy Infants: A Single Tertiary Center Experience / 대한소아신경학회지

PURPOSE: Floppy infants or congenital hypotonia indicates decreased muscle tone in infants secondary to abnormalities of the central or the peripheral nervous system, or both. Previous literature classified its causes as those attributable to a central vs. peripheral origin; however, recent studies have introduced a newer classification describing a combined origin. We invenstigated floppy infants by applying the new etiological classification and reviewed the most common etiologies based on the age of presentation. We additionally reviewed the clinical characteristics, diagnoses, and the developmental outcomes in these infants. METHODS: We retrospectively reviewed the electronic medical charts and recruited 116 infants diagnosed with floppy infant syndrome between January 2005 and December 2016 at Severance Children's Hospital. Among these infants, 66 with a confirmed diagnosis were reviewed for the etiological classification. Information regarding developmental outcomes was obtained via phone interviews with the infants' families. RESULTS: Based on the new etiological classification, among 69 infants with a confirmed diagnosis, in 40 (34.5%) this syndrome was of central origin, in 19 (16.4%) of peripheral origin, and in 10 (8.6%) of combined origin. Prader-Willi syndrome, myotonic dystrophy, and spinal muscular atrophy were the most common disorders observed and combined hypotonia showed the poorest developmental outcome. CONCLUSION: The study states the importance of proper evaluation of etiological diagnosis and optimal intervention for developmental prognosis. The introduction of a new etiological group of combined hypotonia especially emphasizes regular monitoring and timely rehabilitative intervention in patients for the better quality of life in them as well as their caregivers.

Clinical features and follow－up of 11 newborns with Prader－Willi syndrome / 中国新生儿科杂志

Objective To study the clinical features of the Prader－Willi syndrome ( PWS) in neonatal period, and to explore intervention methods to improve their intelligence development.Method From September 2012 to September 2017, clinical data of infants with PWS in our hospital were retrospectively analyzed.Methylation－specific multiplex ligation－dependent probe amplification (MS－MLPA) were used for genetic testing.The patients received rehabilitation training and drug treatment , and followed－up every 6 months after the diagnosis.Result A total of 11 infants with PWS (6/11 male) were included. 8 cases had fetal bradycardia before delivery , 11 cases had hypomyotonia, lethargy, feeding difficulty, no or weak crying and nasogastric tube feeding.Among them, 9 cases had facial anomalies , 8 cases whitish skin and 7 cases genital dysplasia.2 infants died shortly after discharge , 2 infants received no intervention , 3 infants were regularly trained in our rehabilitation division with oral treatment of docosahexaenoic acid (DHA), and 4 infants were trained at home with intermittent oral DHA treatment.Among 11 cases, 3 cases received growth hormone treatment at the age of 6 months and 1 case received at the age of 59 months.The survivors received intelligence test every 6 months using children′s mental behavior scale (0－6 years old). They had severe mental retardation with the scores between 20 and 70 points.5 cases had gene deletion of q11 related area in chromosome 15, 4 cases had gene deletion of q11－13 related area in chromosome 15. 1 case had abnormal demethylation of q 11－13 in chromosome 15, and 1 case had loss of heterozygosity with methylation abnormality in chromosome 15 q11－13 areas.Conclusion Children with PWS can exhibit certain characteristics during both fetal and neonatal periods.Deletion of related genes are more frequently seen than abnormal methylation in these patients.During infantile period with rapid development of nervous system, the growth and development of infants with PWS can not be obviously improved using conventional rehabilitation training and drug treatment.

Experience with reversal of a neuromuscular block with sugammadex in a child with Prader-Willi syndrome: A case report

We treated a 4-year-old patient with a genetic disorder, Prader-Willi syndrome, that was accompanied by pulmonary hypertension due to upper airway obstruction. Prader-Willi syndrome is a complex genetic condition characterized by hypotonia, feeding difficulties, poor growth, and delayed development. Hypotonia was the main concern in the anesthetic management of this patient, including the choice of a neuromuscular blocking agent. We report successful induction of anesthesia in this patient with sevoflurane inhalation, remifentanil infusion, and a non-depolarizing muscle relaxant, rocuronium, while following up the status of the neuromuscular block by train-of-four monitoring and reversing the neuromuscular block with sugammadex.

Experience with reversal of a neuromuscular block with sugammadex in a child with Prader-Willi syndrome: A case report

We treated a 4-year-old patient with a genetic disorder, Prader-Willi syndrome, that was accompanied by pulmonary hypertension due to upper airway obstruction. Prader-Willi syndrome is a complex genetic condition characterized by hypotonia, feeding difficulties, poor growth, and delayed development. Hypotonia was the main concern in the anesthetic management of this patient, including the choice of a neuromuscular blocking agent. We report successful induction of anesthesia in this patient with sevoflurane inhalation, remifentanil infusion, and a non-depolarizing muscle relaxant, rocuronium, while following up the status of the neuromuscular block by train-of-four monitoring and reversing the neuromuscular block with sugammadex.

Treino parental para manejo comportamental de crianças com Síndrome de Prader-Willi: impacto sobre a saúde mental e práticas educativas do cuidador / Parental training for the behavioral management of children with Prader-Willi Syndrome: impact on the mental health and parenting practices of the caregiver

RESUMO Objetivo: verificamos os indicadores de impacto na saúde mental de cuidadores de um programa de treinamento parental para manejo de crianças e adolescentes com Síndrome de Prader-Willi. Métodos: a amostra foi composta por 5 mães de crianças/adolescentes com Síndrome de Prader-Willi entre 6 a 18 anos. Os instrumentos de coleta de dados foram: a) Questionário para verificação de conhecimentos das mães sobre a síndrome, b) Inventário de Auto-avaliação para Adultos de 18 a 59 anos, c) Inventário de Estilos Parentais/Práticas educativas maternas e paternas; d) Levantamento de dificuldades e preocupações sobre os filhos. O estudo foi realizado em quatro fases: pré-intervenção, intervenção, pós-intervenção e seguimento. Resultados: as mães passaram a adotar práticas parentais educativas baseadas na monitoria positiva, diminuíram as práticas de risco. Conclusão: houve melhora em indicadores de dificuldades emocionais das mães, apreenderam a identificar e manejar fatores que prejudicavam a saúde física, o comportamento e a aprendizagem escolar dos filhos e a necessidade do envolvimento de outros familiares no cuidado do filho.

ABSTRACT Purpose: we verified the impact of the parent training program for management of children and adolescents with Prader-Willi Syndrome on the mental health caregivers. Methods: the sample was composed by five mothers of children / adolescents with Prader-Willi Syndrome between 6-18 years. The data collection instruments were: a) Questionnaire for verification Mothers' knowledge about the syndrome, b) Inventory Self-Assessment for Adults 18-59 years c) Inventory of Parental Styles / maternal and paternal educational practices; d) Survey of difficulties and concerns about their children. The study was conducted in four phases: pre-intervention, intervention, post-intervention and follow-up. Results: as a result we find that mothers have adopted parental educational practices based on positive monitoring, decreased risk practices. Conclusion: we conclude that there was an improvement in indicators of emotional difficulties of mothers, seized identify and manage factors that harmed the physical health, behavior and school learning of the children and the need to involve other family members in child care.

Relato de caso: Síndrome de Prader-Willi / Case report: Prader-Willi Syndrome

A Síndrome de Prader-Willi (SPW), descrita em 1956, é uma doença genética devido à deleção da porção proximal do braço longo do cromossomo 15 paterno (15q11-q13) ou, mais raramente, translocações, dissomia materna do cromossomo 15 ou anormalidades do imprinting cromossômico. A incidência é de cerca de 1:15.000 nascidos vivos. As principais características da SPW sugerem uma deficiência orgânica do hipotálamo, sendo a causa principal de hiperfagia, secreção deficiente do hormônio do crescimento (GH) e hipogonadismo. Outras características importantes são hipotonia na infância, baixa estatura, anormalidades de comportamento e obesidade mórbida. A história natural da SPW pode ser dividida em dois períodos distintos. O primeiro é caracterizado por vários graus de hipotonia neonatal e da primeira infância, choro fraco, instabilidade de temperatura por disfunção hipotalâmica, um reflexo de sucção fraco e hipoplasia genital. Assim que o tono muscular melhora, a criança se torna mais alerta, há aumento de apetite e ganho de peso. A segunda fase, que começa por volta de 1 a 2 anos de idade, é caracterizada por retardo psicomotor. A obesidade, principal consequência da hiperfagia, é uma das maiores consequências a longo prazo dessa síndrome, estando relacionada a eventos cardiovasculares prematuros e prejuízos na qualidade de vida. Uma análise definitiva para diagnóstico da SPW é a análise da metilação do DNA, que detecta o modelo de metilação no cromossomo 15. O presente trabalho é um relato de caso sobre as características da Síndrome de Prader-Willi na infância e suas principais consequências(AU)

The Prader-Willi syndrome (PWS), described in 1956, is a genetic disease due to the deletion of the proximal portion of the long arm of parental chromosome 15 (15q11-q13) or, more rarely, to translocations, maternal disomy of chromosome 15, or abnormalities of the chromosomal imprinting. The incidence is about 1: 15,000 live births. The main features of PWS suggest a dysfunction of the hypothalamus, the main cause of hyperphagia, poor secretion of growth hormone (GH) and hypogonadism. Other important features are hypotonia in infancy, short stature, behavioral abnormalities and morbid obesity. The natural history of PWS can be divided into two distinct periods. The first is characterized by varying degrees of neonatal and early childhood hypotonia, weak cry, temperature instability due to hypothalamic dysfunction, weak suction reflex and genital hypoplasia. Once the muscle tone improves the child becomes more alert, the appetite increases and there is weight gain. The second phase, which begins around 1 to 2 years of age, is characterized by psychomotor delay. Obesity, the main consequence of hyperphagia, is one of the major long-term consequences of this syndrome, and is related to premature cardiovascular events and impaired quality of life. A definitive analysis for the diagnosis of PWS is the analysis of DNA methylation, which detects the methylation pattern on chromosome 15. This is a case report on the characteristics of Prader-Willi syndrome in childhood and its main consequences(AU)

Anestesia para cirugía bariátrica en paciente con síndrome de Prader-Willy: reporte de un caso / Anesthesia for bariatric surgery in a patient with Prader-Willi syndrome: Case report

Prader-Willi syndrome is a genetic disorder characterized by hypotonia, obesity, short stature, mental retardation, hyperphagia, hypogonadism and low life expectancy. We describe the case of a 31-year-old female patient with Prader-Willi syndrome scheduled forbariatric surgery. Anesthetic considerations are reviewed highlighting perioperative complications associated with this syndrome.

El síndrome de Prader-Willi es un desorden genético caracterizado por hipotonía, obesidad, baja estatura, retraso mental, hiperfagia, hipogonadismo y expectativa de vida reducida. Describimos el caso de una paciente de 31 años con antecedente de síndrome de Prader -Willi, programada para realización de cirugía bariátrica. Se revisan las consideraciones anestésicas, haciendo énfasis en las complicaciones perioperatorias secundarias a este síndrome.

Relationship between Prader-Willi syndrome and sleep related breathing disorders / 国际儿科学杂志

Prader-Willi syndrome( PWS) is a type of genetic disease,which is associated with low mus-cle tone,growth and development,progressive fatal obesity and sleep related respiratory disorders(SRBD). Ob-structive sleep apnea hypopnea syndrome( OSAHS) is the most common type of SRBD. The cause,influencing factors and treatment of OSAHS in patients with PWS are described in this paper. To understand the degree of OSAHS in children with PWS,the polysomnography is recommended.

Clinical and molecular characteristics of 27 children with Prader-Willi syndrome in South China / 中华实用儿科临床杂志

Objective To understand the clinical and molecular characteristics of children with Prader-Willi syndrome (PWS) in South China.Methods Clinical and molecular data of children diagnosed as PWS by Methylation-specific PCR(MS-PCR) and/or Array Comparative Genomic Hybridization(Array-CGH)in Guangzhou Women and Children's Medical Center from November 2012 to November 2014 were analyzed.Results A total of 27 children diagnosed as PWS were included in this study,including 21 cases diagnosed by Array Comparative Genomic Hybridization (Array-CGH) and 13 cases diagnosed by methylation-specific PC R (MS-PCR).Within the 27 cases,13 cases were male(48.1％) and 14 cases were female(51.9％).The age on diagnosis was from 16 days to 16 years old.MS-PCR was performed in 13 cases,7 cases of them also performed Array-CGH,both of them showed a 174 bp fragment from the methylated allele and a 100 bp fragment from the unmethylated allele.Array-CGH analysis was performed in 21 cases,paternal deletion in 18 cases and mean interstitial deletions measure (5.48 ± 0.51) Mb in size,paternal duplication in 2 cases,loss of heterozygosity measure approximately 79.58 Mb in 1 case.Eighteen simple chromosome deletion cases were divided into 6 Del Ⅰ and 12 Del Ⅱ according to the location of Array-CGH and query the database to DECIPHER(Database of Chromosomal Imbalance and Phenotype in Humans Using Ensembl Resources).The major phenotype included central hypotonia and feeding difficulty in all cases (100.0％),hypogonadism in 25 cases (92.6％),weak crying in 22 cases(81.5％),and hypopigmentation in 22 cases(81.5％).Fourteen cases beyond 1 year old had varied degrees of development disability and behavioral and psychiatric disturbance:speech articulation defects in 13 cases(92.9％),hyperphagia and weight gain too fast in 13 cases(92.9％) when they were between 1 to 6 years old[(2.80 ± 1.32) years old],and obesity in 12 cases (85.7％).Conclusions For PWS children in South China,there is no statistically significant difference in the clinical manifestation between Del Ⅰ and Del Ⅱ.PWS children in South China have typical clinical characteristics,which can be used as a further screening indication to implement molecular diagnostics.