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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">14-Year-old patient with a hypoplastic breast &#40;the small right breast&#41; &#40;B&#44; C&#41;&#44; the small left nipple &#40;B&#44; C&#41;&#44; facial paralysis &#40;A&#41;&#44; small hands &#40;D&#41;&#44; missing teeth &#40;E&#41;&#44; and mother&#39;s teeth &#40;F&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ectodermal dysplasias are rare major inherited disorder characterized by changes in structures of ectodermal origin&#46; The syndrome is characterized by ectrodactyly&#44; hypoplasia of the mammary glands and nipples&#44; cleft palate&#44; tear duct stenosis&#44; hearing loss&#44; urogenital abnormalities&#44; nasal dysplasia&#44; hypohidrosis&#44; hypodontia&#44; gonadaldysplasia&#44; and absence of skin or hair abnormalities&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a> Possible causes of congenital breast asymmetry&#59; it may be due to a developmental or hormonal problem&#44; a syndrome&#44; to familial or a genetic disorder&#46; In this manuscript&#44; we describe a family with different clinical findings over four generations&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 14-year-old girl presented complaining about the underdevelopment of the right breast &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#44; C&#41;&#46; The clinical examination showed a normal nipple but with no normal left breast tissue &#40;E-5&#41; and no areola in the width of the nipple&#46; The right pectoralis major muscle was normal&#46; She also had facial palsy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; extensively depigmented skin areas&#44; hyperpigmentation&#44; irregular and missing teeth &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#44; hearing loss&#44; pubic hair P4-5&#44; and slightly elongated axillary hair &#40;A-2&#41;&#46; External genitalia&#44; uterus&#44; and ovaries were normal&#44; but there was no cliteromegaly&#46; She also had small hands &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#44; closed epiphysis&#44; atrophic left kidney&#44; and endocrinological problems&#46; Hormones such as FSH&#44; LH&#44; E2&#44; prolactin&#44; progesterone&#44; testosterone&#44; TSH&#44; FT4&#44; mental and motor development were normal&#46; Father and mother were diagnosed with obsessive compulsive disorder and mild mental retardation&#46; Physical dental problems &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41; and speech disorders were observed in the parents&#46; It was also reported that the sweat glands of the mother lost their function during childhood&#44; that she had goiter&#44; allergic problems and learning difficulties&#44; and that the father&#39;s hair did not grow and was abnormal&#46; Consanguinity &#40;I-3&#44;4&#41;&#44; learning&#44; mild mental retardation&#44; nervous disorders and biliary disorders were recorded in the first generation grandparents&#46; However&#44; congenital hearing loss was also found in two other members of the third generation &#40;Cousins&#44; III-5&#44;6&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">It was determined that 9 permanent teeth of the patient were still in the growth process and 4 primary teeth were still in place&#46; It was recorded that the permanent teeth of the patient were left upper anterior central incisors&#44; right upper and left upper canines&#44; right upper and left upper 1st molars&#44; lower right and lower left 1st molars and upper left 2nd molars&#46; The canines had dysmorphological features such as the morphology of the nail-shaped incisors tapering toward the edges&#44; and the other permanent teeth had normal morphological features&#46; Retained teeth and teeth losses in patient were not detected&#46; One deciduous molar for each half jaw and bone loss in the lower anterior part due to edentulism were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The cytogenetic results of our patient showed a normal chromosomal complement&#46; However&#44; structural and numerical chromosome changes were detected in 22&#46;5&#37; of the mother cells&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical and phenotypic findings of the patient&#39;s parents were also consistent with EDs&#46; In addition&#44; it was reported that the mother and father of the mother &#40;Grandparents&#44; I-3&#44;4&#41; were consanguineous and both had similar clinical findings&#46; As a matter of fact&#44; it was recorded that both daughters of the uncle of the proband were congenitally deafness &#40;Cousins&#44; III-5&#44;6&#41;&#46; The familial history shows us that the clinical findings in the proband are hereditary&#46; Cases of asymmetrical breasts have been reported in some families before&#46; In one of these families&#44; bilateral breast absence was reported in 1 boy&#44; 3 out of 4 girls and 3 grandchildren over three generations&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> On the other hand&#44; in a family where the mother and father were not affected&#44; male and female cousins did not have bilateral breasts in another family&#44; 7 individuals in 4 generations were reported to have no breasts or hypoplastic breasts&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#44;5</span></a> Our findings suggest that the presence of asymmetric breasts is a serious and rare pathology of ED&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Since the otic capsule is of ectodermal origin&#44; it is natural to see sensorineural hearing loss in ED&#46; In the current family&#44; three members of the third generation &#40;probant&#44; cousins&#44; III-1&#44;5&#44;6&#41; had congenital hearing loss&#46; It is noteworthy that all three of these cousins were female&#46; The hearing loss in our patients was consistent with the previous case series&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Intelligence&#44; motor and cognitive development were found to be affected in some other members of the family&#46; Some studies have reported abnormal motor&#47;mental development in 15&#8211;25&#37; of patients affected by HED&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Various renal problems have been identified in individuals affected by ED&#46; We have reported atrophic kidney structure in the patient&#46; The mother of the patient had many structural and numerical irregularities in different chromosomes&#46; It should be kept in mind that structural damages in the 2nd chromosome &#40;q11-ter&#44; q14&#44; q21&#44; q23 and p23 regions&#41; and 19&#44; 21 and other chromosome losses detected in the mother may be associated with ecdodermal tissue development&#46; A gene responsible for autosomal HED has recently been mapped to chromosome 2q11-q13 in human and mouse&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> This gene has also been shown to be expressed in the epithelium and in adjacent or partially overlapping layers of developing human skin&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> All this information shows that chromosome 2 plays a role in the etiology of ED&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare they have no conflict of interest&#46;</p></span></span>"
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        "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">We gratefully thank the Department of Pediatrics for referring the family to our department&#46; I would like to express my gratitude to the aunt&#44; who took close care of the index patient and her mother&#44; contributed to the acquisition of information&#44; and filled out the consent form in line with their approval&#46;</p>"
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Case and Research Letter
Different Clinical Effects of Ectodermal Dysplasias in Four Generations
Efectos clínicos diferentes de las displasias ectodérmicas en cuatro generaciones
O. Demirhana,
Autor para correspondencia
osdemir@cu.edu.tr

Corresponding author.
, B. Yükselb, S. Yilmazc, N. Cetinela
a Department of Medical Biology and Genetics, Faculty of Medicine, University of Çukurova, Adana, Turkey
b Department of Pediatrics, Faculty of Medicine, University of Çukurova, Adana, Turkey
c Department of Endodontics, Faculty of Dentistry, Cukurova University, Adana, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ectodermal dysplasias are rare major inherited disorder characterized by changes in structures of ectodermal origin&#46; The syndrome is characterized by ectrodactyly&#44; hypoplasia of the mammary glands and nipples&#44; cleft palate&#44; tear duct stenosis&#44; hearing loss&#44; urogenital abnormalities&#44; nasal dysplasia&#44; hypohidrosis&#44; hypodontia&#44; gonadaldysplasia&#44; and absence of skin or hair abnormalities&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a> Possible causes of congenital breast asymmetry&#59; it may be due to a developmental or hormonal problem&#44; a syndrome&#44; to familial or a genetic disorder&#46; In this manuscript&#44; we describe a family with different clinical findings over four generations&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 14-year-old girl presented complaining about the underdevelopment of the right breast &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#44; C&#41;&#46; The clinical examination showed a normal nipple but with no normal left breast tissue &#40;E-5&#41; and no areola in the width of the nipple&#46; The right pectoralis major muscle was normal&#46; She also had facial palsy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; extensively depigmented skin areas&#44; hyperpigmentation&#44; irregular and missing teeth &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#44; hearing loss&#44; pubic hair P4-5&#44; and slightly elongated axillary hair &#40;A-2&#41;&#46; External genitalia&#44; uterus&#44; and ovaries were normal&#44; but there was no cliteromegaly&#46; She also had small hands &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#44; closed epiphysis&#44; atrophic left kidney&#44; and endocrinological problems&#46; Hormones such as FSH&#44; LH&#44; E2&#44; prolactin&#44; progesterone&#44; testosterone&#44; TSH&#44; FT4&#44; mental and motor development were normal&#46; Father and mother were diagnosed with obsessive compulsive disorder and mild mental retardation&#46; Physical dental problems &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41; and speech disorders were observed in the parents&#46; It was also reported that the sweat glands of the mother lost their function during childhood&#44; that she had goiter&#44; allergic problems and learning difficulties&#44; and that the father&#39;s hair did not grow and was abnormal&#46; Consanguinity &#40;I-3&#44;4&#41;&#44; learning&#44; mild mental retardation&#44; nervous disorders and biliary disorders were recorded in the first generation grandparents&#46; However&#44; congenital hearing loss was also found in two other members of the third generation &#40;Cousins&#44; III-5&#44;6&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">It was determined that 9 permanent teeth of the patient were still in the growth process and 4 primary teeth were still in place&#46; It was recorded that the permanent teeth of the patient were left upper anterior central incisors&#44; right upper and left upper canines&#44; right upper and left upper 1st molars&#44; lower right and lower left 1st molars and upper left 2nd molars&#46; The canines had dysmorphological features such as the morphology of the nail-shaped incisors tapering toward the edges&#44; and the other permanent teeth had normal morphological features&#46; Retained teeth and teeth losses in patient were not detected&#46; One deciduous molar for each half jaw and bone loss in the lower anterior part due to edentulism were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The cytogenetic results of our patient showed a normal chromosomal complement&#46; However&#44; structural and numerical chromosome changes were detected in 22&#46;5&#37; of the mother cells&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical and phenotypic findings of the patient&#39;s parents were also consistent with EDs&#46; In addition&#44; it was reported that the mother and father of the mother &#40;Grandparents&#44; I-3&#44;4&#41; were consanguineous and both had similar clinical findings&#46; As a matter of fact&#44; it was recorded that both daughters of the uncle of the proband were congenitally deafness &#40;Cousins&#44; III-5&#44;6&#41;&#46; The familial history shows us that the clinical findings in the proband are hereditary&#46; Cases of asymmetrical breasts have been reported in some families before&#46; In one of these families&#44; bilateral breast absence was reported in 1 boy&#44; 3 out of 4 girls and 3 grandchildren over three generations&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> On the other hand&#44; in a family where the mother and father were not affected&#44; male and female cousins did not have bilateral breasts in another family&#44; 7 individuals in 4 generations were reported to have no breasts or hypoplastic breasts&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#44;5</span></a> Our findings suggest that the presence of asymmetric breasts is a serious and rare pathology of ED&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Since the otic capsule is of ectodermal origin&#44; it is natural to see sensorineural hearing loss in ED&#46; In the current family&#44; three members of the third generation &#40;probant&#44; cousins&#44; III-1&#44;5&#44;6&#41; had congenital hearing loss&#46; It is noteworthy that all three of these cousins were female&#46; The hearing loss in our patients was consistent with the previous case series&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Intelligence&#44; motor and cognitive development were found to be affected in some other members of the family&#46; Some studies have reported abnormal motor&#47;mental development in 15&#8211;25&#37; of patients affected by HED&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Various renal problems have been identified in individuals affected by ED&#46; We have reported atrophic kidney structure in the patient&#46; The mother of the patient had many structural and numerical irregularities in different chromosomes&#46; It should be kept in mind that structural damages in the 2nd chromosome &#40;q11-ter&#44; q14&#44; q21&#44; q23 and p23 regions&#41; and 19&#44; 21 and other chromosome losses detected in the mother may be associated with ecdodermal tissue development&#46; A gene responsible for autosomal HED has recently been mapped to chromosome 2q11-q13 in human and mouse&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> This gene has also been shown to be expressed in the epithelium and in adjacent or partially overlapping layers of developing human skin&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> All this information shows that chromosome 2 plays a role in the etiology of ED&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare they have no conflict of interest&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">14-Year-old patient with a hypoplastic breast &#40;the small right breast&#41; &#40;B&#44; C&#41;&#44; the small left nipple &#40;B&#44; C&#41;&#44; facial paralysis &#40;A&#41;&#44; small hands &#40;D&#41;&#44; missing teeth &#40;E&#41;&#44; and mother&#39;s teeth &#40;F&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p>"
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                      "titulo" => "Odonto-onycho-dermal dysplasia syndrome"
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                        0 => array:2 [
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                            0 => "H&#46; M&#233;garban&#233;"
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">We gratefully thank the Department of Pediatrics for referring the family to our department&#46; I would like to express my gratitude to the aunt&#44; who took close care of the index patient and her mother&#44; contributed to the acquisition of information&#44; and filled out the consent form in line with their approval&#46;</p>"
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