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An increased risk of different types of malignancy has been reported in patients with Noonan syndrome (NS). We describe a patient with short stature, dysmorphic features, developmental delay, and congenital cardiomyopathy. At 5 years old, he presented with abdominal pain, constipation, and evaluation with ultrasound and computed tomography scan demonstrated the presence of an abdominal mass. Total resection of the mass and consequent histology revealed an embryonal rhabdomyosarcoma. Rhabdomyosarcoma is a rare tumor in NS patients and to the best of our knowledge only 2 cases have been reported so far. The presentation underlines the importance of frequent follow-up of patients with NS, since the incidence of malignancy is low but existing.

The 4q deletion syndrome, comprising all microscopically visible deletions (interstitial and terminal) is a well-recognized distinctive malformation entity, with an estimated incidence of 1:10,000. Here we present the clinical and molecular findings in a 3-year-old male with a de novo distal deletion of 4q33 [46,XY,del(4) (q33)]. Clinical findings of the patient include: hypertelorism, broad nasal bridge, short nose with anteverted nares, long philtrum, thin upper lip, micro-retrognathia, low-set and protruding ears, pre-auricular tag unilaterally, low posterior hairline, clinodactyly of the 5th fingers, tapering fingers, hypospadias, and severe psychomotor retardation. Soon after birth he developed severe hypotonia and feeding difficulties. Echocardiography at 15 months documented aortic supravalvular membrane resulting in mild aortic stenosis and dysplasia of the pulmonary valve. Genome-wide screening using 1 Mb resolution array-CGH and subsequent FISH analyses defined a 18.9-22.9 Mb deletion located at the beginning of 4q33 and extending to the telomere. The description of additional cases with similar distal deletions of 4q33 will allow a more precise prognosis and is therefore of great value for genetic counsellors, while detailed molecular characterization in any well clinically characterized patient is expected to track down individual candidate genes for the specific features of the syndrome.

A case of an adult patient with CHARGE association complicated with infective endocarditis is presented.

Saethre-Chotzen syndrome represents one of the most common types of craniosynostosis inherited as an autosomal dominant disorder while sporadic cases have also been reported. It is characterized by high penetrance and variable expressivity, leading to difficulties in clinical diagnosis. Some patients, who exhibit most of the diagnostic criteria of Saethre-Chotzen syndrome, have structural abnormalities of chromosome 7. The case of a 4 year old boy with notable dysmorphic features compatible with Saethre-Chotzen syndrome and severe developmental delay is described. Conventional and molecular cytogenetic analysis of peripheral blood samples from the patient and his parents revealed partial monosomy of chromosomal region 7p15 --pter de novo. The TWIST gene, located on chromosome 7p21.1, is thought to be a negative transcriptional regulator involved in osteoblast differentiation and maturation and it is thought that haploinsufficiency of the gene can cause the disorder. The diagnosis of Saethre-Chotzen syndrome and the identification of the chromosomal abnormality in the patient facilitated genetic counseling of the family.

Goldenhar (GS) syndrome is a well-recognised developmental disorder involving first and second branchial arches and characterized by considerable phenotypic variability. The present study presents clinical data on the morphologic features, hearing, ophthalmologic, orthopaedic, neurological, cardiovascular, genitourinary and gastrointestinal evaluation of 17 Greek patients (one pair of monozygotic twins) aged 20 days to 23 years with the clinical diagnosis of GS and with a normal karyotype. The most consistent findings were auricular defects (94%), followed by facial (76%) and ocular anomalies (65%), 70% unilateral, mainly right-sided. In the majority of our patients (90%) mandibular hypoplasia was ipsilateral to the dysplastic ear or the most severely affected ear in bilateral cases. Hearing loss, mainly conductive, was noted in 76% of our patients. Skeletal defects were evident in 23%, while cardiovascular, genitourinary and gastrointestinal in 18%, 23% and 12% respectively. The most frequent neurological manifestation was facial nerve paralysis (12%), while the incidence of mental retardation was higher (23%) than reported in the literature, presumably attributed to the severe hearing and vision loss. In a pair of monozygotic twins of our study discordance of clinical findings was noted. Precise evaluation of GS patients and multidisciplinary care management is necessary to avoid possible complications of many systems and to offer appropriate genetic counselling to the family.

Accurate detection of the abnormal clone in children with persistent cytopenia (PC) may confirm the diagnosis of myelodysplastic syndrome (MDS) and determine prognosis and evolution of the disease. Bone marrow (BM) samples were obtained from 65 children, 11 of which were finally diagnosed as primary or secondary MDS. Ten to 20 G-banded metaphases were analyzed and FISH was performed using a-satellite probes for chromosomes 7 and 8. Conventional cytogenetic analysis (CCA) was successful in 40/65 samples, revealing clonal aberrations in 3 patients with MDS. FISH was successful in all cases, detecting monosomy 7 and trisomy 8 abnormal clones in 5 patients. Abnormalities were identified in 3/6 children with primary MDS and 3/5 with secondary MDS. None of the patients with PC of etiology other than MDS had a clonal abnormality in the BM. The results confirm the high incidence of chromosome abnormalities in childhood MDS and the sensitivity of FISH in detecting minor abnormal clones.

The metabolic effects of honey - alone or combined with other foods - were investigated in type II diabetics using 2 protocols: A) 33 g honey and 50 g bread (same amounts of carbohydrate) were given on alternate days to 12 patients. Blood levels of glucose, insulin and triglycerides were determined in venous samples before and every 30 min after meal ingestion (for a total of 3h). Areas under glucose curves were equal, although honey - compared to bread - resulted in higher blood sugar concentrations at 30 min (p less than 0.01) and lower at 90 min (p less than 0.05). B) Another 19 type II diabetics consumed on separate days 3 different meals: H (30 g honey), HA (30 g honey, 100 g almonds), HB (30 g honey, 125 g cheese, 10 g bread, 10 g butter). HA and HB contained the same amount of fat, but were different in fiber. No significant differences in the areas under glucose curves were observed. However, meal H produced earlier hyperglycemia than HA and HB (30 min: p less than 0.01). Insulin levels were higher after HB compared to H (p less than 0.05). Meals HA and HB were followed by higher triglyceride levels than H (p less than 0.05). It is concluded that: 1) honey and bread produce similar degrees of hyperglycemia in type II diabetics. 2) Fat-rich foods added to honey do not alter the total hyperglycemic effect but result in higher triglyceride and insulin serum concentrations.