Cases reported "DiGeorge Syndrome"

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1/3. tetralogy of fallot with aortic valvular stenosis: surgical correction in one case.

    We report a case of an infant presenting with the rare association of tetralogy of fallot, hypoplasia of the pulmonary arteries, and stenotic bicuspid aortic valve. Surgical correction, performed at 16 months of age, included aortic valvular commissurotomy, opening the right ventricular outflow tract (transannular patch), and ventricular septal defect closure. The postoperative course was favorable, and the child was discharged from the hospital. Three months after the procedure, the patient is in excellent condition, without cardiac medication.
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2/3. Case report of 5 siblings: malnutrition? rickets? digeorge syndrome? Developmental delay?

    BACKGROUND: parents of six children are facing a trial on charges of aggravated manslaughter in the care a 5 1/2 month old infant who died suddenly and neglect of their four older children for causing them to be malnourished by feeding them all an exclusively raw foods vegan diet. Both parents declined plea bargains and plan to defend themselves in court. CASE PRESENTATION: The fifth child born to a married couple was breast-fed until 2 1/2 months. Subsequently, the parents fed the baby an exclusively raw foods diet prepared in a blender at home. The four older children, ages 18 months-6 1/2 years also ate an exclusively raw foods vegan diet. None of the four older children had significant previous injuries or serious illnesses. At autopsy, the infant weighed 3180 mg (6.99 pounds) and appeared emaciated. The thymus gland was absent and parathyroid glands were not located. The lungs were "congested." DiGeorge anomaly cannot be ruled out from these findings. Although, the coroner ruled that "malnutrition" was the sole cause of death, malnutrition, according to the world health organization definition, cannot be diagnosed in this infant. Compared with standard growth charts, the older children fell 2.1-4.1 standard deviations below the mean for North American children in height and weight. Labs were normal except for a low cholesterol level in all and a low prealbumin in one of three children tested. Therefore, malnutrition cannot be diagnosed in these children. The pediatrician diagnosed rickets in the four-year-old. However, chest x-rays were normal in all and long bone x-rays showed minimal changes in one child--no sign of rickets. The clinical diagnosis of rickets was not confirmed by the Center for disease Control's criteria. A psychologist diagnosed the 18-month-old as developmentally delayed to the level of a 15-month-old, but this diagnosis is questionable. CONCLUSION: The raw foods vegan diet and possibly inherited small stature from the father's side account for their relatively low heights and weights. Catch-up growth will probably occur on the standard American diet but would have also been expected if they had remained on a vegan diet.
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3/3. Partial DiGeorge anomaly associated with 10p deletion.

    We report a girl with partial DiGeorge anomaly associated with a distal chromosome 10p deletion. The initial manifestation was hypocalcemia convulsion at the age of 14 days. The patient was small for her gestational age and showed symptoms of poor feeding and inspiratory stridor. Facial dysmorphisms included a cupped ear, hypertelorism downslanted and short palpebral fissures frontal bossing, anteverted nostrils, a flat nasal bridge, and micrognathia. Developmental delay was also noted. Hypoplasia of the thymus was detected by ultrasound examination, but results of immunologic studies were all normal at 6 weeks of age. The echocardiogram, brain ultrasound, electroencephalogram, and magnetic resonance images of the brain were normal, but brainstem auditory evoked potentials showed bilateral sensorineural hearing loss. Chromosomal analysis showed 16, XX, del(10)(p12.3); the parents had normal karyotypes. After treatment with vitamin d, calcium gluconate, and magnesium sulfate, the patient's serum calcium and magnesium levels were within normal limits. She was discharged and received regular follow-up at our clinic for physical therapy and to ensure adequate supply of divalent cations. Complex partial seizure was noted at the age of 1 year and was controlled with carbamazepine. To our knowledge, this is the first Taiwanese reported to have partial DiGeorge anomaly associated with 10p deletion. We recommend that standard karyotyping should be performed in children suspected to have this anomaly.
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