RESUMO
This study reports three patients with Cat-eye Syndrome (CES), two of which present a previous clinical diagnosis of Craniofacial microsomia (CFM). Chromosomal microarray analysis (CMA) revealed a tetrasomy of 1,7 Mb at the 22q11.2q11.21 region, which is the typical region triplicated in the CES, in all patients. The most frequent craniofacial features found in individuals with CFM and CES are preauricular tags and/or pits and mandibular hypoplasia. We reinforce that the candidate genes for CFM features, particularly ear malformation, preauricular tags/pits, and facial asymmetry, can be in the proximal region of the 22q11.2 region.
RESUMO
Cat eye syndrome (CES) is a rare chromosomal disorder that may be evident at birth. A small supernumerary chromosome is present, frequently has 2 centromeres, is bisatellited, and represents an inv dup(22)(q11) in those affected. It's known that the 22q11 region is associated with disorders involving higher and lower gene dosages. Conditions such as CES, 22q11 microduplication syndrome (Dup22q11) and oculoauriculovertebral spectrum phenotype (OAVS) may share genes belonging to this same region, which is known to have a predisposition to chromosomal rearrangements. The conditions, besides being related to chromosome 22, also share similar phenotypes. Here we have added a molecular evaluation update and results found of the first patient described with CES and OAVS phenotype, trying to explain the potential mechanism involved in the occurrence of this association.
Assuntos
Transtornos Cromossômicos/genética , Duplicação Cromossômica , Anormalidades do Olho/genética , Síndrome de Goldenhar/genética , Aneuploidia , Criança , Transtornos Cromossômicos/patologia , Cromossomos Humanos Par 22/genética , Hibridização Genômica Comparativa , Anormalidades do Olho/patologia , Feminino , Dosagem de Genes , Síndrome de Goldenhar/patologia , HumanosRESUMO
BACKGROUND: Cat eye syndrome (CES) is a rare chromosomal disorder with a known incidence of 1 per 50,000-150,000 live newborns. The classic triad of iris coloboma, anorectal malformations, and auricular abnormalities is present in 40% of patients. In addition, other ocular malformations and systemic defects can be present. The aim of this report is to present a patient with unilateral iris coloboma related to a mosaicism of cat eye syndrome. METHODS: A complete ophthalmological and systemic evaluation was performed in a three-year-old male. He also underwent a standard karyotype and FISH analysis with a probe against the 22q11.2 locus. RESULTS: The ophthalmological and systemic evaluation revealed a unilateral iris coloboma and ipsilateral auricular malformations. Karyotype analysis of blood leukocytes indicated the presence of a marker chromosome in 6% of the analyzed cells. FISH analysis showed three positive signals in 5.5% of the analyzed nucleus. CONCLUSION: This patient presented two of the three classic manifestations of CES; interestingly, they were unilateral. The 22q11 duplication was identified by standard karyotype and confirmed with FISH. The present case demonstrates the importance of conducting a multidisciplinary approach in patients with congenital malformations associated with known syndromes.
Assuntos
Transtornos Cromossômicos/patologia , Cromossomos Humanos Par 22/genética , Coloboma/complicações , Anormalidades do Olho/patologia , Doenças da Íris/complicações , Mosaicismo , Fenótipo , Aneuploidia , Pré-Escolar , Transtornos Cromossômicos/etiologia , Anormalidades do Olho/etiologia , Marcadores Genéticos , Humanos , Cariotipagem , MasculinoRESUMO
Introdução. A via aérea de difícil intubação é um achado incomum na rotina em emergências, unidades de terapia intensiva e centros cirúrgicos. Apesar de corresponderem a uma minoria das intubações traqueais, podem determinar complicações graves.Relato do caso. Paciente de 29 anos, com diagnóstico de síndrome de Schmid-Fraccaro, submetida a colecistectomia videolaparoscópica, apresentou dificuldade para intubação orotraqueal durante procedimento anestésico,apesar do reconhecimento prévio de sinais preditivos de via aérea de difícil intubação. Conclusão. A identificação da via aérea difícil previamente a intubações traqueais eletivas é ajudada pelo reconhecimento de antecedentes pessoais relevantes e utilização de índices preditivos, mas a utilização desses últimos é discutível.
Introduction. Difficult airway is an uncommon finding in emergency rooms, Intensive Care Units and operation rooms. Although occurring in a minority of the endotracheal intubations, it can cause serious complications.Case report. A 29 year-old woman, with diagnosed Schimid-Fraccaro syndrome, underwent laparoscopic cholecystectomy and presented a difficult intubation during anesthesia, despite the early recognition of predictive signs. Conclusion. Identification of difficult airway prior to elective tracheal is aided by the recognition of relevant individualhistory and predictive indexes, but of questionable value.
RESUMO
Relatamos um caso de paciente com Síndrome do Olho de Gato (Cat Eye Syndrome-CES) e interrupção do arco aórtico tipo B, um achado típico na síndrome da deleção 22q11.2. A análise cromossômica e a técnica de hibridização fluorescente in situ (FISH) mostraram um cromossomo marcador isodicêntrico supranumerário com bi-satélite derivado do cromossomo 22. O segmento de 22pter a 22q11.2 no cromossomo supranumerário encontrado em nosso paciente não estava em sobreposição com a região deletada em pacientes com a síndrome da deleção 22q11.2. Entretanto, o achado de interrupção do arco aórtico tipo B não é usual na CES, mas é um defeito cardíaco freqüente na síndrome da deleção 22q11.
We report a patient with cat eye syndrome and interrupted aortic arch type B, a typical finding in the 22q11.2 deletion syndrome. Chromosomal analysis and fluorescent in situ hybridization (FISH) showed a supernumerary bisatellited isodicentric marker chromosome derived from chromosome 22. The segment from 22pter to 22q11.2 in the supernumerary chromosome found in our patient does not overlap with the region deleted in patients with the 22q11.2 deletion syndrome. However, the finding of an interrupted aortic arch type B is unusual in CES, although it is a frequent heart defect in the 22q11 deletion syndrome.
Informamos un caso de paciente con Síndrome de Ojo de Gato (Cat Eye Syndrome-CES) e Interrupción del Arco Aórtico tipo B, un hallazgo típico en el síndrome de la deleción 22q11.2. El análisis cromosómico y la técnica de hibridación in situ fluorescente (FISH) mostraron un cromosoma marcador isodicéntrico supernumerario bisatelitado derivado del cromosoma 22. El segmento de 22pter a 22q11.2 en el cromosoma supernumerario encontrado en nuestro paciente no estaba en sobreposición con la región deletada en pacientes con el síndrome de la deleción 22q11.2. Con todo, el hallazgo de interrupción del arco aórtico tipo B no es usual en el CES, sino que es un defecto cardíaco frecuente en el síndrome de deleción 22q11.