Familial congenital esophageal atresia

Summary Esophageal atresia with or without tracheoesophageal fistula (EA±TEF) usually occurs sporadically either as an isolated malformation or in conjunction with other congenital anomalies. Seventy-six familial cases are recorded in the literature. Two personal cases are additionally reported. An overview of the 33 pedigrees with familial occurence of EA is presented. All available data of relevance for genetic analysis are compiled in eight tables. Attention is given to possible heterogeneity between sporadic and familial and between isolated and associated EA. Guidelines for genetic counseling are presented. With exception of the cases where EA is part of a chromosomal or of a known monogenic or teratogenic syndrome, the recurrence risks fit into a multifactorial scheme.     

Etiological study of omphalocele

Summary The epidemiological, teratological and genetic data on 134 index patients with omphalocele (79 isolated and 55 multiple ones) and on 134 matched controls born in Hungary 1970–1976 were studied from medical records and by retrospective interview. The stillbirth rate and infant mortality are significantly higher, and there is intrauterine weight retardation and more frequent preterm delivery. The distribution of maternal age-groups shows a U-shaped trend in isolated omphalocele. Spontaneous abortions were significantly higher, particularly in previous pregnancies of mothers of index patients. A strikingly higher incidence of early and late toxaemia was found in the pregnancies of mothers of the isolated omphalocele group. Sib occurrence was not found in 161 brothers and sisters. Thus amniotic fluid AFP examination is not recommended in subsequent pregnancies. The occurrence of other congenital abnormalities corresponds to random risk.     

Familial syndromic esophageal atresia maps to 2p23-p24

Esophageal atresia (EA) is a common life-threatening congenital anomaly that occurs in 1/3,000 newborns. Little is known of the genetic factors that underlie EA. Oculodigitoesophageoduodenal (ODED) syndrome (also known as "Feingold syndrome") is a rare autosomal dominant disorder with digital abnormalities, microcephaly, short palpebral fissures, mild learning disability, and esophageal/duodenal atresia. We studied four pedigrees, including a three-generation Dutch family with 11 affected members. Linkage analysis was initially aimed at chromosomal regions harboring candidate genes for this disorder. Twelve different genomic regions covering 15 candidate genes (approximately 15% of the genome) were excluded from involvement in the ODED syndrome. A subsequent nondirective mapping approach revealed evidence for linkage between the syndrome and marker D2S390 (maximum LOD score 4.51 at recombination fraction 0). A submicroscopic deletion in a fourth family with ODED provided independent confirmation of this genetic localization and narrowed the critical region to 7.3 cM in the 2p23-p24 region. These results show that haploinsufficiency for a gene or genes in 2p23-p24 is associated with syndromic EA.     

Prevalence of esophageal atresia among 18 international birth defects surveillance programs

BACKGROUND: The prevalence of esophageal atresia (EA) has been shown to vary across different geographical settings. Investigation of geographical differences may provide an insight into the underlying etiology of EA. METHODS: The study population comprised infants diagnosed with EA during 1998 to 2007 from 18 of the 46 birth defects surveillance programs, members of the International Clearinghouse for Birth Defects Surveillance and Research. Total prevalence per 10,000 births for EA was defined as the total number of cases in live births, stillbirths, and elective termination of pregnancy for fetal anomaly (ETOPFA) divided by the total number of all births in the population. RESULTS: Among the participating programs, a total of 2943 cases of EA were diagnosed with an average prevalence of 2.44 (95% confidence interval [CI], 2.35–2.53) per 10,000 births, ranging between 1.77 and 3.68 per 10,000 births. Of all infants diagnosed with EA, 2761 (93.8%) were live births, 82 (2.8%) stillbirths, 89 (3.0%) ETOPFA, and 11 (0.4%) had unknown outcomes. The majority of cases (2020, 68.6%), had a reported EA with fistula, 749 (25.5%) were without fistula, and 174 (5.9%) were registered with an unspecified code. CONCLUSIONS: On average, EA affected 1 in 4099 births (95% CI, 1 in 3954–4251 births) with prevalence varying across different geographical settings, but relatively consistent over time and comparable between surveillance programs. Findings suggest that differences in the prevalence observed among programs are likely to be attributable to variability in population ethnic compositions or issues in reporting or registration procedures of EA, rather than a real risk occurrence difference. Birth Defects Research (Part A), 2012. © 2012 Wiley Periodicals, Inc.     

Etiological study of uveitis in young children

The etiology of acute infectious diseases accompanied by uveitis in young children has been studied. In these investigations a high degree of contamination with virus ECHO 19 in patients with acute diseases accompanied by uveitis has been revealed and the ophthal motropic properties of the virus have been experimentally established, which indicates that certain variants of virus ECHO 19 play, probably, some role in the etiology of uveitis in young children.     

Expression of cell adhesion molecules in the adriamycin-induced esophageal atresia rat model

Cell adhesion molecules are well-known membrane glycoproteins widely expressed during embryonic development that play a crucial role in cell division, migration and differentiation. We investigated the cell-matrix relationship using N-CAM and pan-cadherin adhesion molecules in the adriamycin-induced esophageal atresia (EA) rat model in the hope of finding a clue to the mechanisms of this unique anomaly.Time-mated pregnant Sprague-Dawley rats were given either saline or adriamycin on days 8 and 9 of gestation. Embryos were harvested on the 18th day of gestation. Esophageal specimens obtained from adriamycin-exposed embryos with (EA+) or without esophageal atresia (EA-) and from saline-exposed embryos were immunostained with N-CAM and pan-cadherin primary antisera.The esophageal specimens from control and EA- groups revealed similar immunostaining properties: weak N-CAM and pan-cadherin immunoreactivity. In contrast, the EA+ group showed intense immunoreactivity.Our study demonstrated an increased synthesis of N-CAM and pan-cadherin in the epithelial cells of the atretic esophagus and trachea. These results suggest that embryonic cell-cell and cell-matrix interactions may play a crucial role in the development of adriamycin-induced EA.     

Maternal factors in the origin of isolated oesophageal atresia: A population‐based case–control study

Background: In most patients affected by isolated oesophageal atresia (IOA) the etiology is largely unknown. Thus, the aim of this study was to analyze potential risk factors in mothers. Methods: The study samples included 221 cases with IOA, 356 matched and 38,151 population controls without any defect in the population‐based dataset of the Hungarian Case–Control Surveillance of Congenital Abnormalities, 1980 to 1996. Only those exposures were evaluated that were medically recorded in prenatal maternity logbooks during the critical period of IOA. Results: The findings of this case–control study suggested that the mothers of cases with IOA had a higher proportion of first delivery and lower socioeconomic status. Acute respiratory diseases (odds ratio [OR] 95% confidence interval [CI], 3.8, 1.8–8.1) and essential hypertension treated with nifedipine (OR 95% CI, 3.8, 1.7–8.7) in the mothers of cases associated with a higher risk for IOA in their children. Conclusion: First delivery, lower socioeconomic status, acute respiratory diseases and essential hypertension treated with nifedipine in the mothers may associate with a higher risk for IOA in their children. Birth Defects Research (Part A) 103:804–813, 2015. © 2015 Wiley Periodicals, Inc.     

A comparison of incidence trends for esophageal atresia and tracheoesophageal fistula, and infectious disease

There has been a suggestion that esophageal atresia with tracheoesophageal fistula (EA/TEF) may be related to the occurrence of infectious disease in the population during the time of early gestation. There is therefore a need for further data on trends in incidence related to infectious diseases. Data on the occurrence of EA/TEF with and without additional congenital malformations may also be relevant. The British Columbia Health Surveillance Registry is population-based with excellent case ascertainment of birth defects, and data are available on the incidence of infectious diseases for B.C., allowing comparison of trends to be made. One hundred forty-nine cases of EA/TEF occurred among 534,834 consecutive livebirths during the period 1966-1980 for an incidence rate of 1/3,590. No significant (p less than 0.05) annual, seasonal or monthly incidence trends were observed. In addition, the occurrence of EA/TEF could not be correlated with the prior incidence of infectious hepatitis, rubella, salmonella, or rubeola. Fifty-five percent of individuals with EA/TEF had congenital malformations in other systems, most frequently cardiovascular, gastrointestinal, and genitourinary. Most individuals with additional congenital malformations had multiple system involvement.     

The co-occurrence of congenital diaphragmatic hernia, esophageal atresia/tracheoesophageal fistula, and lung hypoplasia

BACKGROUND: Two severe birth defects, congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) with or without tracheoesophageal fistula (TEF), have traditionally been analyzed separately in epidemiological studies. Lung hypoplasia (LH), part of the CDH spectrum, is not usually associated with EA/TEF, yet both are foregut malformations. METHODS: We conducted an epidemiological study of two combinations of the defects in the population of 3,318,966 live births and stillbirths monitored from 1983 to 1996 by the California Birth Defects Monitoring Program (CBDMP). RESULTS: A total of 433 cases had a Bochdalek type CDH/LH (0.13 per 1000 births), 893 had EA/TEF (0.27 per 1000 births), and 646 had LH (0.19 per 1000 births). Among them, 18 cases had CDH/LH with EA/TEF (0.005 per 1000 births), and 53 had EA/TEF and LH (0.02 per 1000 births); both prevalences are significantly higher than expected. Sixteen of 17 cases of CDH/LH with EA/TEF, and 34 of 40 cases of EA/TEF with LH were stillborn or died; 72% and 74%, respectively, had an autopsy. The male to female sex ratios were 1.43 and 1.13, respectively. In both groups, infants had similar proportions of additional severe defects, except for genitourinary and anal defects and syndromes/associations, which were more prevalent in the EA/TEF with LH group. We reviewed human studies and experimental animal models for factors reported to cause any combination of the defects. CONCLUSIONS: Several genetic and environmental factors could affect the significant co-occurrence of the defects. Future studies should include storage of patients' biological materials for DNA analysis, karyotyping, and environmental exposure evaluation.     

microRNA与食管癌关系的研究进展

肿瘤的发生、发展是多基因共同参与的多步骤的复杂过程,包括癌基因的异常激活和抑癌基因的失活。MicroRNAs(miRNAs)是一组真核细胞内源性产生的单链小RNA分子,研究发现miRNAs的表达异常与人类肿瘤发生有着密切的关系。食管癌是我国常见的恶性肿瘤之一,近来miRNA与食管癌的相关研究也日渐报道,因此本文就此作一综述。