array:23 [
  "pii" => "S1578219015000566"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2015.03.006"
  "estado" => "S300"
  "fechaPublicacion" => "2015-05-01"
  "aid" => "1088"
  "copyright" => "Elsevier España, S.L.U. and AEDV"
  "copyrightAnyo" => "2014"
  "documento" => "simple-article"
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2015;106:e19-22"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1129
    "formatos" => array:3 [
      "EPUB" => 47
      "HTML" => 579
      "PDF" => 503
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:18 [
      "pii" => "S0001731014004803"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2014.11.004"
      "estado" => "S300"
      "fechaPublicacion" => "2015-05-01"
      "aid" => "1088"
      "copyright" => "Elsevier España, S.L.U. y AEDV"
      "documento" => "simple-article"
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2015;106:e19-22"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1052
        "formatos" => array:3 [
          "EPUB" => 3
          "HTML" => 636
          "PDF" => 413
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">e-Casos cl&#237;nicos</span>"
        "titulo" => "S&#237;ndrome LEOPARD sin sordera ni estenosis pulmonar&#58; a prop&#243;sito de 2 casos"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "e19"
            "paginaFinal" => "e22"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "LEOPARD Syndrome Without Hearing Loss or Pulmonary Stenosis&#58; A Report of 2 Cases"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 633
                "Ancho" => 1300
                "Tamanyo" => 125198
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Caso 2&#46; A&#46; Pectus excavatum&#44; lesi&#243;n esquel&#233;tica frecuente en pacientes con mutaciones en la v&#237;a RAS-MAPK y lesiones hiperpigmentadas lenticulares en el tronco&#46; B&#46; Lesi&#243;n hiperpigmentada de bordes irregulares junto a m&#250;ltiples lentigos en el lateral izquierdo del cuello&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "T&#46;T&#46; Ramos-Geldres, P&#46; D&#225;vila-Seijo, A&#46; Duat-Rodr&#237;guez, L&#46; Noguera-Morel, B&#46; Ezquieta-Zubicaray, E&#46; Ros&#243;n-L&#243;pez, A&#46; Hern&#225;ndez-Mart&#237;n, A&#46; Torrelo-Fern&#225;ndez"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "T&#46;T&#46;"
                "apellidos" => "Ramos-Geldres"
              ]
              1 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "D&#225;vila-Seijo"
              ]
              2 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Duat-Rodr&#237;guez"
              ]
              3 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Noguera-Morel"
              ]
              4 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "Ezquieta-Zubicaray"
              ]
              5 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Ros&#243;n-L&#243;pez"
              ]
              6 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Hern&#225;ndez-Mart&#237;n"
              ]
              7 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Torrelo-Fern&#225;ndez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219015000566"
          "doi" => "10.1016/j.adengl.2015.03.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000566?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014004803?idApp=UINPBA000044"
      "url" => "/00017310/0000010600000004/v2_201505051016/S0001731014004803/v2_201505051016/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1578219015000578"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2015.03.007"
    "estado" => "S300"
    "fechaPublicacion" => "2015-05-01"
    "aid" => "1043"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "simple-article"
    "subdocumento" => "cor"
    "cita" => "Actas Dermosifiliogr. 2015;106:317-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1002
      "formatos" => array:3 [
        "EPUB" => 52
        "HTML" => 552
        "PDF" => 398
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>"
      "titulo" => "Patchy Facial Hyperpigmentation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "317"
          "paginaFinal" => "318"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hiperpigmentaci&#243;n facial parcheada"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 500
              "Ancho" => 667
              "Tamanyo" => 205298
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin and eosin&#44; original magnification &#215;<span class="elsevierStyleHsp" style=""></span>40&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#46; Kindem, C&#46; Serra-Guill&#233;n, C&#46; Guill&#233;n"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Kindem"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Serra-Guill&#233;n"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Guill&#233;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731014003901"
        "doi" => "10.1016/j.ad.2014.06.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014003901?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000578?idApp=UINPBA000044"
    "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000578/v2_201505051007/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1578219015000554"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2015.03.005"
    "estado" => "S300"
    "fechaPublicacion" => "2015-05-01"
    "aid" => "1105"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "article"
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2015;106:310-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 924
      "formatos" => array:3 [
        "EPUB" => 42
        "HTML" => 595
        "PDF" => 287
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Cutaneous Leishmaniasis&#58; 20 Years&#8217; Experience in a Spanish Tertiary Care Hospital"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "310"
          "paginaFinal" => "316"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Leishmaniasis cut&#225;nea&#46; Experiencia de 20 a&#241;os en un hospital espa&#241;ol de tercer nivel"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 746
              "Ancho" => 996
              "Tamanyo" => 164766
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cutaneous leishmaniasis with multiple lesions&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46; Giavedoni, P&#46; Iranzo, I&#46; Fuertes, T&#46; Estrach, M&#46; Alsina Gibert"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Giavedoni"
            ]
            1 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Iranzo"
            ]
            2 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Fuertes"
            ]
            3 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "Estrach"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Alsina Gibert"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731015000022"
        "doi" => "10.1016/j.ad.2014.12.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015000022?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000554?idApp=UINPBA000044"
    "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000554/v2_201505051007/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">e- Case Report</span>"
    "titulo" => "LEOPARD Syndrome Without Hearing Loss or Pulmonary Stenosis&#58; A Report of 2 Cases"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "e19"
        "paginaFinal" => "e22"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "T&#46;T&#46; Ramos-Geldres, P&#46; D&#225;vila-Seijo, A&#46; Duat-Rodr&#237;guez, L&#46; Noguera-Morel, B&#46; Ezquieta-Zubicaray, E&#46; Ros&#243;n-L&#243;pez, A&#46; Hern&#225;ndez-Mart&#237;n, A&#46; Torrelo-Fern&#225;ndez"
        "autores" => array:8 [
          0 => array:3 [
            "nombre" => "T&#46;T&#46;"
            "apellidos" => "Ramos-Geldres"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "D&#225;vila-Seijo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Duat-Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "L&#46;"
            "apellidos" => "Noguera-Morel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "B&#46;"
            "apellidos" => "Ezquieta-Zubicaray"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Ros&#243;n-L&#243;pez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          6 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Hern&#225;ndez-Mart&#237;n"
            "email" => array:1 [
              0 => "ahernandez&#95;hnj&#64;yahoo&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Torrelo-Fern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Infantil del Ni&#241;o Jes&#250;s&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Dermatology and Venereology Department&#44; Ume&#229; University Hospital&#44; Ume&#229; &#40;Suecia&#41;"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Neurolog&#237;a&#44; Hospital Infantil del Ni&#241;o Jes&#250;s&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Laboratorio de Diagn&#243;stico Molecular&#44; Hospital Materno Infantil&#44; Hospital Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Complexo Hospitalario Universitario de Santiago de Compostela&#44; Santiago de Compostela&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "S&#237;ndrome LEOPARD sin sordera ni estenosis pulmonar&#58; a prop&#243;sito de 2 casos"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 534
            "Ancho" => 1305
            "Tamanyo" => 110977
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patient 1&#46; A&#44; Facial lentigines&#46; B&#44; Hyperpigmented lesions of various sizes on the lower limbs&#59; the largest was located on the right buttock&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">LEOPARD syndrome&#44; which is currently also called Noonan syndrome with multiple lentigines &#40;NSML&#41; &#40;Online Mendelian Inheritance in Man 151100&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> is an autosomal dominant disease of the <span class="elsevierStyleItalic">RAS</span> &#40;rat sarcoma&#41; gene signaling pathway&#46; The acronym refers to the main manifestations of the syndrome&#44; namely&#44; lentigines&#44; electrocardiographic conduction abnormalities&#44; ocular hypertelorism&#44; pulmonary stenosis&#44; abnormal genitalia&#44; retarded growth&#44; and sensorineural deafness&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;3</span></a> These signs are not constant&#44; however&#44; and none of them are pathognomonic&#46; We report 2 genetically confirmed cases of NSML without hypertrophic cardiopathy&#44; pulmonary stenosis&#44; or deafness&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patient 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 6-year-old boy&#44; the firstborn of healthy nonconsanguineous parents&#44; had been followed by the neurologist since the age of 4&#46;5 years because of developmental delays&#44; including slight speech-language impairment&#46; Physical examination revealed facial dysmorphism with large&#44; prominent&#44; low-set&#44; posteriorly rotated ears&#59; widely spaced eyes&#59; and a flat nasal bridge&#46; On the back of his neck &#40;area of the cervical spine&#41;&#44; right buttock&#44; left axilla&#44; and right knee&#44; the boy also had 4 hyperpigmented macules with irregular borders measuring 5<span class="elsevierStyleHsp" style=""></span>to 15<span class="elsevierStyleHsp" style=""></span>mm in diameter&#46; Multiple lentigines 5<span class="elsevierStyleHsp" style=""></span>mm in diameter were observed on the face&#44; trunk&#44; and extremities &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Cardiac evaluation revealed a right bundle-branch block&#46; A hearing test was normal&#46; Testing for mutations in the <span class="elsevierStyleItalic">PTPN11</span> &#40;protein tyrosine phosphatase nonreceptor 11&#41; gene demonstrated a T468M mutation &#40;p&#46;Thr468Met&#41; in exon 12&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Patient 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 6-year-old boy born to healthy nonconsanguineous parents was being treated by a speech therapist for delayed language acquisition and difficulty with auditory discrimination of some phonemes&#46; Physical examination revealed facial dysmorphism&#44; including an inverted triangular-shaped face&#44; short neck&#44; large low-set ears&#44; orbital hypertelorism&#44; megalocornea&#44; and pectus excavatum&#46; Numerous caf&#233; au lait macules and lentigines were present on the face&#44; neck&#44; and upper trunk &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Hearing and cardiac evaluations were normal&#46; Genetic testing detected the R498W mutation &#40;p&#46;Arg498Trp&#41; in axon 13 of <span class="elsevierStyleItalic">PTPN11</span>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">NSML belongs to a group of neuro-cardio-fascio-cutaneous syndromes in which germline mutations in the <span class="elsevierStyleItalic">RAS-MAPK</span> &#40;mitogen-activated protein kinase&#41; pathway are present&#46; The most characteristic dermatologic findings are pigmented lesions&#44; especially lentigines&#44; which are present in 90&#37; of patients with these syndromes&#46; Manifestations may be present from birth&#44; but they usually appear when the child is around 4<span class="elsevierStyleHsp" style=""></span>or 5<span class="elsevierStyleHsp" style=""></span>years of age and may even first present in puberty&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a> Caf&#233; au lait macules&#44; which are somewhat larger than lentigines&#44; can be seen in 70&#37; to 80&#37; of patients&#46; Lesions that are darker have been called black coffee macules&#46; The most common cardiac finding in NSML is hypertrophic myocardiopathy&#44; which can be fatal&#46; Cardiac valve and coronary abnormalities may also be present&#46; Pulmonary stenosis is less common than mitral valve or aortic abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> Typical electrocardiographic signs are those of left or right ventricular hypertrophy&#44; right atrial enlargement&#44; and gradual development of right bundle-branch block&#46; Deafness&#44; traditionally considered highly specific to NSML&#44; only presents in 25&#37; to 30&#37; of these patients&#59; the deficit is neurosensorial&#44; may be unilateral or bilateral&#44; and is sometimes profound &#40;&#62;<span class="elsevierStyleHsp" style=""></span>95<span class="elsevierStyleHsp" style=""></span>db&#41;&#46; Although deafness is usually diagnosed in childhood&#44; it may develop later&#44; making periodic hearing tests advisable&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Other manifestations include distinctive facial features&#59; skeletal abnormalities such as pectus carinatum or excavatum&#44; which are seen in up to 75&#37; of neonates&#59; delayed puberty and late menarche&#59; and urogenital abnormalities such as horseshoe-shaped kidney and hypospadia&#44; underdeveloped ovaries or testicles&#44; and small penis&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;4</span></a> The slow growth observed in 25&#37; of patients does not appear to be related to endocrine dysregulation or systemic disease&#46; Eighty-five percent of patients will remain in the lower 25th percentile on growth charts&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> Unlike other <span class="elsevierStyleItalic">RAS</span>opathies&#44; NSML seems to confer only minimal predisposition to cancer&#44; but blood tumors<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> and other malignancies&#44; such as melanomas<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8</span></a> have been reported&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Genetic testing is necessary for a definitive diagnosis&#46; Mutations in exons 7&#44; 12&#44; and 13 in the PTP domain of the <span class="elsevierStyleItalic">PTPN11</span> oncogene that encodes the SHP-2 phosphatase have been demonstrated in 85&#37; to 90&#37; of patients with NSML&#46; Functional SHP2 deficiency &#40;not present in Noonan syndrome&#41; is compensated for by hypersensitivity to growth factor stimulus&#44; longer contact time at the C-terminal domain &#40;pTyr ligands&#41;&#44; and the weakening of interactions of the SH2 inhibitor with the catalytic zone&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> The result is functional gain&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> At least 11 different mutations have been described to date&#46; Among them are 2 frequently recurring ones&#8212;Y279C and T468M&#8212;that have been found in over half of patients with NSML&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;9&#44;10</span></a> Of patients who have been found to be negative for <span class="elsevierStyleItalic">PTPN11</span> mutation&#44; a third have <span class="elsevierStyleItalic">RAF1</span> &#40;Raf-1 proto-oncogene&#44; serine&#47;threonine kinase&#41; mutations and fewer than 5&#37; have <span class="elsevierStyleItalic">BRAF</span> &#40;B-Raf&#41; mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> There is a certain correlation between genotype and phenotype&#44; such that patients who are negative for <span class="elsevierStyleItalic">PTPN11</span> mutation tend to have a higher prevalence of cardiac conduction abnormalities&#44; left ventricular or atrial hypertrophy&#44; and a family history of sudden death&#44; whereas patients who are <span class="elsevierStyleItalic">PTPN11</span>-mutation positive &#40;exon 13&#41; have greater risk of hypertrophic myocardiopathy and severe cardiac complications&#59; mutation in exon 7 is more often associated with delayed growth and deafness&#44; and <span class="elsevierStyleItalic">BRAF</span> mutations confer greater risk of cognitive disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleItalic">RAF</span> mutation may cause lentigines&#44; caf&#233; au lait macules&#44; abnormal facial features&#44; hypertrophic myocardiopathy&#44; arrhythmias&#44; and delayed puberty&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The main differential diagnoses are other diseases linked to the <span class="elsevierStyleItalic">RAS-MAPK</span> pathway&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> and the strong genetic-phenotypic overlap of <span class="elsevierStyleItalic">RAS</span>opathies makes clinical diagnosis difficult&#46; NSML can be phenotypically very difficult to distinguish from Noonan syndrome itself &#40;without multiple lentigines&#41; and neurofibromatosis type 1&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> Lentigines and deafness are not present in Noonan syndrome&#44; and caf&#233; au lait macules and hypertrophic myocardiopathy are more typical of NSML than of Noonan syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4&#44;13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; the 2 cases we report show that NSML cannot be ruled out when deafness and cardiopathy are absent&#46; Genetic testing of these patients is highly advisable&#44; because the findings provide a basis for guiding follow-up and establishing prognosis&#46; However&#44; regardless of which exon is mutated&#44; all patients with NSML should receive periodic evaluations to detect late development of neurologic&#44; dermatologic&#44; cardiac&#44; or hearing complications&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Ethical Disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Protection of human and animal subjects</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Data confidentiality</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they followed their hospitals&#8217; regulations regarding the publication of patient information and that written informed consent for voluntary participation was obtained for all patients&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article&#46;</p></span></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres494677"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec515885"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres494678"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec515884"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Patient 1"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Patient 2"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of Interest"
        ]
        9 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Ethical Disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-08-27"
    "fechaAceptado" => "2014-11-06"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec515885"
          "palabras" => array:4 [
            0 => "Rasopathy"
            1 => "Cafe au lait macules"
            2 => "Lentigines"
            3 => "LEOPARD syndrome"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec515884"
          "palabras" => array:4 [
            0 => "Rasopatia"
            1 => "Manchas caf&#233; con leche"
            2 => "Lentigines"
            3 => "Sindrome LEOPARD"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">LEOPARD syndrome is an autosomal dominant disease caused by germline mutations in the <span class="elsevierStyleItalic">RAS</span>-MAPK &#40;rat sarcoma mitogen-activated protein kinase&#41; pathway&#46; LEOPARD is an acronym for the main manifestations of the syndrome&#44; namely&#44; multiple Lentigines&#44; Electrocardiographic conduction abnormalities&#44; Ocular hypertelorism&#44; Pulmonary stenosis&#44; Abnormalities of genitalia&#44; Retardation of growth&#44; and sensorineural Deafness&#46; None of these characteristic features&#44; however&#44; are pathognomonic of LEOPARD syndrome&#44; and since they are highly variable&#44; they are often not present at the time of diagnosis&#46; We describe 2 cases of LEOPARD syndrome without hearing loss or pulmonary stenosis in which diagnosis was confirmed by identification of a mutation in the <span class="elsevierStyleItalic">PTPN11</span> gene&#46; Regular monitoring is important for the early detection of complications&#44; as these can occur at any time during the course of disease&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome LEOPARD es una enfermedad autos&#243;mica dominante producida por mutaciones germinales en la v&#237;a RAS-MAPK&#46; El acr&#243;nimo agrupa las manifestaciones m&#225;s importantes de la enfermedad &#40;L<span class="elsevierStyleItalic">entiginosis</span>&#44; E<span class="elsevierStyleItalic">CG conduction anomalies</span>&#44; O<span class="elsevierStyleItalic">cular hypertelorism&#47;hypertrophic</span> O<span class="elsevierStyleItalic">bstructive cardiomyopathy</span>&#44; P<span class="elsevierStyleItalic">ulmonary stenosis</span>&#44; A<span class="elsevierStyleItalic">bnormalities of genitalia&#44; growth</span> R<span class="elsevierStyleItalic">etardation and</span> D<span class="elsevierStyleItalic">eafness</span>&#41;&#44; pero ninguna de ellas es patognom&#243;nica ni constante&#44; por lo que muchos pacientes no las presentan en el momento del diagn&#243;stico&#46; Presentamos 2 casos de s&#237;ndrome LEOPARD sin sordera ni estenosis pulmonar en los que la detecci&#243;n de la mutaci&#243;n en el gen PTPN11 permiti&#243; confirmar la enfermedad&#44; y se&#241;alamos la importancia del seguimiento continuado para la detecci&#243;n precoz de las complicaciones&#44; ya que las mismas pueden aparecer en el transcurso de la enfermedad&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ramos-Geldres T&#44; D&#225;vila-Seijo P&#44; Duat-Rodr&#237;guez A&#44; Noguera-Morel L&#44; Ezquieta-Zubicaray B&#44; Ros&#243;n-L&#243;pez E&#44; et al&#46; S&#237;ndrome LEOPARD sin sordera ni estenosis pulmonar&#58; a prop&#243;sito de 2 casos&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;e19&#8211;e22&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 534
            "Ancho" => 1305
            "Tamanyo" => 110977
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patient 1&#46; A&#44; Facial lentigines&#46; B&#44; Hyperpigmented lesions of various sizes on the lower limbs&#59; the largest was located on the right buttock&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 633
            "Ancho" => 1300
            "Tamanyo" => 139281
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patient 2&#46; A&#44; Pectus excavatum&#44; a skeletal abnormality that is common in patients with mutations in the <span class="elsevierStyleItalic">RAS-MAPK</span> &#40;rat sarcoma mitogen-activated protein kinase&#41; pathway&#59; hyperpigmented lenticular lesions on the trunk&#46; B&#44; Hyperpigmented macule with irregular borders along with multiple lentigines on the left side of the neck&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:13 [
            0 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The RASopathies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Rauen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1146/annurev-genom-091212-153523"
                      "Revista" => array:6 [
                        "tituloSerie" => "Annu Rev Genomics Hum Genet"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "355"
                        "paginaFinal" => "369"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23875798"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome&#58; Clinical features and gene mutations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Mart&#237;nez-Quintana"
                            1 => "F&#46; Rodr&#237;guez-Gonz&#225;lez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000342251"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mol Syndromol"
                        "fecha" => "2012"
                        "volumen" => "3"
                        "paginaInicial" => "145"
                        "paginaFinal" => "157"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23239957"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Qiu W&#44; Wang X&#44; Romanov V&#44; Hutchinson A&#44; Lin A&#44; Ruzanov M&#44; et al&#46; Structural insights into Noonan&#47;LEOPARD syndrome-related mutants of protein-tyrosine phosphatase SHP2 &#40;PTPN11&#41;&#46; BMC Struct Biol&#46; 2014&#59;14&#58;10&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Two cases of LEOPARD syndrome-RAF1 mutations firstly described in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Kuburovi&#263;"
                            1 => "V&#46; Vukomanovi&#263;"
                            2 => "A&#46; Carcavilla"
                            3 => "B&#46; Ezquieta-Zubicaray"
                            4 => "N&#46; Kuburovi&#263;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Turk J Pediatr"
                        "fecha" => "2011"
                        "volumen" => "53"
                        "paginaInicial" => "687"
                        "paginaFinal" => "691"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22389993"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome &#40;PTPN11&#44; T468<span class="elsevierStyleHsp" style=""></span>M&#41; in three boys fulfilling neurofibromatosis type 1 clinical criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Carcavilla"
                            1 => "I&#46; Pinto"
                            2 => "R&#46; Mu&#241;oz-Pacheco"
                            3 => "R&#46; Barrio"
                            4 => "M&#46; Martin-Fr&#237;as"
                            5 => "B&#46; Ezquieta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00431-011-1418-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2011"
                        "volumen" => "170"
                        "paginaInicial" => "1069"
                        "paginaFinal" => "1074"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21365175"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Common acute lymphoblastic leukemia in a girl with genetically confirmed LEOPARD syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Laux"
                            1 => "C&#46; Kratz"
                            2 => "A&#46; Sauerbrey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPH.0b013e31817588fb"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Hematol Oncol"
                        "fecha" => "2008"
                        "volumen" => "30"
                        "paginaInicial" => "602"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18799937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatologic manifestations of the LEOPARD syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Cao"
                            1 => "A&#46;F&#46; Nikkels"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Open Dermatol J"
                        "fecha" => "2013"
                        "volumen" => "7"
                        "paginaInicial" => "11"
                        "paginaFinal" => "14"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome with a new association of congenital corneal tumor&#44; choristoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;W&#46; Choi"
                            1 => "J&#46;Y&#46; Yoo"
                            2 => "K&#46;C&#46; Park"
                            3 => "K&#46;H&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Derm"
                        "fecha" => "2003"
                        "volumen" => "20"
                        "paginaInicial" => "158"
                        "paginaFinal" => "160"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Structural and mechanistic insights into LEOPARD syndrome-associated SHP2 mutations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46;H&#46; Yu"
                            1 => "J&#46; Xu"
                            2 => "C&#46;D&#46; Walls"
                            3 => "L&#46; Chen"
                            4 => "S&#46; Zhang"
                            5 => "R&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1074/jbc.M113.450023"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Biol Chem"
                        "fecha" => "2013"
                        "volumen" => "288"
                        "paginaInicial" => "10472"
                        "paginaFinal" => "10482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23457302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leopard syndrome&#58; A report of five cases from one family in two generations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; Begi&#263;"
                            1 => "H&#46; Tahirovi&#263;"
                            2 => "M&#46; Karda&#353;evi&#263;"
                            3 => "I&#46; Kalev"
                            4 => "K&#46; Muru"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00431-013-2243-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2014"
                        "volumen" => "173"
                        "paginaInicial" => "819"
                        "paginaFinal" => "822"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24401936"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Rasopathies&#58; Developmental disorders that predispose to cancer and skin manifestations&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Hernandez Martin"
                            1 => "A&#46; Torrelo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2011.02.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2011"
                        "volumen" => "102"
                        "paginaInicial" => "402"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21536246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome&#58; Clinical diagnosis in the first year of life"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;C&#46; Digilio"
                            1 => "A&#46; Sarkozy"
                            2 => "A&#46; de Zorzi"
                            3 => "G&#46; Pacileo"
                            4 => "G&#46; Limongelli"
                            5 => "R&#46; Mingarelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ajmg.a.31156"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Genet A"
                        "fecha" => "2006"
                        "volumen" => "140"
                        "paginaInicial" => "740"
                        "paginaFinal" => "746"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16523510"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome&#58; Clinical dilemmas in differential diagnosis of RASopathies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Santoro"
                            1 => "G&#46; Pacileo"
                            2 => "G&#46; Limongelli"
                            3 => "S&#46; Scianguetta"
                            4 => "T&#46; Giugliano"
                            5 => "G&#46; Piluso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2350-15-44"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Med Genet"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24767283"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000566/v2_201505051007/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "34944"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "e- Case Report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000004/v2_201505051007/S1578219015000566/v2_201505051007/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000566?idApp=UINPBA000044"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

e- Case Report
LEOPARD Syndrome Without Hearing Loss or Pulmonary Stenosis: A Report of 2 Cases
Síndrome LEOPARD sin sordera ni estenosis pulmonar: a propósito de 2 casos
T.T. Ramos-Geldresa, P. Dávila-Seijob, A. Duat-Rodríguezc, L. Noguera-Morela, B. Ezquieta-Zubicarayd, E. Rosón-Lópeze, A. Hernández-Martína,
Autor para correspondencia
ahernandez_hnj@yahoo.es

Corresponding author.
, A. Torrelo-Fernándeza
a Servicio de Dermatología, Hospital Infantil del Niño Jesús, Madrid, Spain
b Dermatology and Venereology Department, Umeå University Hospital, Umeå (Suecia)
c Servicio de Neurología, Hospital Infantil del Niño Jesús, Madrid, Spain
d Laboratorio de Diagnóstico Molecular, Hospital Materno Infantil, Hospital Universitario Gregorio Marañón, Madrid, Spain
e Servicio de Dermatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
Leído
6566
Veces
se ha leído el artículo
2399
Total PDF
4167
Total HTML
Compartir estadísticas
 array:23 [
  "pii" => "S1578219015000566"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2015.03.006"
  "estado" => "S300"
  "fechaPublicacion" => "2015-05-01"
  "aid" => "1088"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
  "copyrightAnyo" => "2014"
  "documento" => "simple-article"
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2015;106:e19-22"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1129
    "formatos" => array:3 [
      "EPUB" => 47
      "HTML" => 579
      "PDF" => 503
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:18 [
      "pii" => "S0001731014004803"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2014.11.004"
      "estado" => "S300"
      "fechaPublicacion" => "2015-05-01"
      "aid" => "1088"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y AEDV"
      "documento" => "simple-article"
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2015;106:e19-22"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1052
        "formatos" => array:3 [
          "EPUB" => 3
          "HTML" => 636
          "PDF" => 413
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">e-Casos cl&#237;nicos</span>"
        "titulo" => "S&#237;ndrome LEOPARD sin sordera ni estenosis pulmonar&#58; a prop&#243;sito de 2 casos"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "e19"
            "paginaFinal" => "e22"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "LEOPARD Syndrome Without Hearing Loss or Pulmonary Stenosis&#58; A Report of 2 Cases"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 633
                "Ancho" => 1300
                "Tamanyo" => 125198
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Caso 2&#46; A&#46; Pectus excavatum&#44; lesi&#243;n esquel&#233;tica frecuente en pacientes con mutaciones en la v&#237;a RAS-MAPK y lesiones hiperpigmentadas lenticulares en el tronco&#46; B&#46; Lesi&#243;n hiperpigmentada de bordes irregulares junto a m&#250;ltiples lentigos en el lateral izquierdo del cuello&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "T&#46;T&#46; Ramos-Geldres, P&#46; D&#225;vila-Seijo, A&#46; Duat-Rodr&#237;guez, L&#46; Noguera-Morel, B&#46; Ezquieta-Zubicaray, E&#46; Ros&#243;n-L&#243;pez, A&#46; Hern&#225;ndez-Mart&#237;n, A&#46; Torrelo-Fern&#225;ndez"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "T&#46;T&#46;"
                "apellidos" => "Ramos-Geldres"
              ]
              1 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "D&#225;vila-Seijo"
              ]
              2 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Duat-Rodr&#237;guez"
              ]
              3 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Noguera-Morel"
              ]
              4 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "Ezquieta-Zubicaray"
              ]
              5 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Ros&#243;n-L&#243;pez"
              ]
              6 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Hern&#225;ndez-Mart&#237;n"
              ]
              7 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Torrelo-Fern&#225;ndez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219015000566"
          "doi" => "10.1016/j.adengl.2015.03.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000566?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014004803?idApp=UINPBA000044"
      "url" => "/00017310/0000010600000004/v2_201505051016/S0001731014004803/v2_201505051016/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1578219015000578"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2015.03.007"
    "estado" => "S300"
    "fechaPublicacion" => "2015-05-01"
    "aid" => "1043"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "simple-article"
    "subdocumento" => "cor"
    "cita" => "Actas Dermosifiliogr. 2015;106:317-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1002
      "formatos" => array:3 [
        "EPUB" => 52
        "HTML" => 552
        "PDF" => 398
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>"
      "titulo" => "Patchy Facial Hyperpigmentation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "317"
          "paginaFinal" => "318"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hiperpigmentaci&#243;n facial parcheada"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 500
              "Ancho" => 667
              "Tamanyo" => 205298
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin and eosin&#44; original magnification &#215;<span class="elsevierStyleHsp" style=""></span>40&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#46; Kindem, C&#46; Serra-Guill&#233;n, C&#46; Guill&#233;n"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Kindem"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Serra-Guill&#233;n"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Guill&#233;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731014003901"
        "doi" => "10.1016/j.ad.2014.06.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014003901?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000578?idApp=UINPBA000044"
    "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000578/v2_201505051007/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1578219015000554"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2015.03.005"
    "estado" => "S300"
    "fechaPublicacion" => "2015-05-01"
    "aid" => "1105"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "article"
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2015;106:310-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 924
      "formatos" => array:3 [
        "EPUB" => 42
        "HTML" => 595
        "PDF" => 287
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Cutaneous Leishmaniasis&#58; 20 Years&#8217; Experience in a Spanish Tertiary Care Hospital"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "310"
          "paginaFinal" => "316"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Leishmaniasis cut&#225;nea&#46; Experiencia de 20 a&#241;os en un hospital espa&#241;ol de tercer nivel"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 746
              "Ancho" => 996
              "Tamanyo" => 164766
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cutaneous leishmaniasis with multiple lesions&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46; Giavedoni, P&#46; Iranzo, I&#46; Fuertes, T&#46; Estrach, M&#46; Alsina Gibert"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Giavedoni"
            ]
            1 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Iranzo"
            ]
            2 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Fuertes"
            ]
            3 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "Estrach"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Alsina Gibert"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731015000022"
        "doi" => "10.1016/j.ad.2014.12.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015000022?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000554?idApp=UINPBA000044"
    "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000554/v2_201505051007/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">e- Case Report</span>"
    "titulo" => "LEOPARD Syndrome Without Hearing Loss or Pulmonary Stenosis&#58; A Report of 2 Cases"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "e19"
        "paginaFinal" => "e22"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "T&#46;T&#46; Ramos-Geldres, P&#46; D&#225;vila-Seijo, A&#46; Duat-Rodr&#237;guez, L&#46; Noguera-Morel, B&#46; Ezquieta-Zubicaray, E&#46; Ros&#243;n-L&#243;pez, A&#46; Hern&#225;ndez-Mart&#237;n, A&#46; Torrelo-Fern&#225;ndez"
        "autores" => array:8 [
          0 => array:3 [
            "nombre" => "T&#46;T&#46;"
            "apellidos" => "Ramos-Geldres"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "D&#225;vila-Seijo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Duat-Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "L&#46;"
            "apellidos" => "Noguera-Morel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "B&#46;"
            "apellidos" => "Ezquieta-Zubicaray"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Ros&#243;n-L&#243;pez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          6 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Hern&#225;ndez-Mart&#237;n"
            "email" => array:1 [
              0 => "ahernandez&#95;hnj&#64;yahoo&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Torrelo-Fern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Infantil del Ni&#241;o Jes&#250;s&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Dermatology and Venereology Department&#44; Ume&#229; University Hospital&#44; Ume&#229; &#40;Suecia&#41;"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Neurolog&#237;a&#44; Hospital Infantil del Ni&#241;o Jes&#250;s&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Laboratorio de Diagn&#243;stico Molecular&#44; Hospital Materno Infantil&#44; Hospital Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Complexo Hospitalario Universitario de Santiago de Compostela&#44; Santiago de Compostela&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "S&#237;ndrome LEOPARD sin sordera ni estenosis pulmonar&#58; a prop&#243;sito de 2 casos"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 534
            "Ancho" => 1305
            "Tamanyo" => 110977
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patient 1&#46; A&#44; Facial lentigines&#46; B&#44; Hyperpigmented lesions of various sizes on the lower limbs&#59; the largest was located on the right buttock&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">LEOPARD syndrome&#44; which is currently also called Noonan syndrome with multiple lentigines &#40;NSML&#41; &#40;Online Mendelian Inheritance in Man 151100&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> is an autosomal dominant disease of the <span class="elsevierStyleItalic">RAS</span> &#40;rat sarcoma&#41; gene signaling pathway&#46; The acronym refers to the main manifestations of the syndrome&#44; namely&#44; lentigines&#44; electrocardiographic conduction abnormalities&#44; ocular hypertelorism&#44; pulmonary stenosis&#44; abnormal genitalia&#44; retarded growth&#44; and sensorineural deafness&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;3</span></a> These signs are not constant&#44; however&#44; and none of them are pathognomonic&#46; We report 2 genetically confirmed cases of NSML without hypertrophic cardiopathy&#44; pulmonary stenosis&#44; or deafness&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patient 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 6-year-old boy&#44; the firstborn of healthy nonconsanguineous parents&#44; had been followed by the neurologist since the age of 4&#46;5 years because of developmental delays&#44; including slight speech-language impairment&#46; Physical examination revealed facial dysmorphism with large&#44; prominent&#44; low-set&#44; posteriorly rotated ears&#59; widely spaced eyes&#59; and a flat nasal bridge&#46; On the back of his neck &#40;area of the cervical spine&#41;&#44; right buttock&#44; left axilla&#44; and right knee&#44; the boy also had 4 hyperpigmented macules with irregular borders measuring 5<span class="elsevierStyleHsp" style=""></span>to 15<span class="elsevierStyleHsp" style=""></span>mm in diameter&#46; Multiple lentigines 5<span class="elsevierStyleHsp" style=""></span>mm in diameter were observed on the face&#44; trunk&#44; and extremities &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Cardiac evaluation revealed a right bundle-branch block&#46; A hearing test was normal&#46; Testing for mutations in the <span class="elsevierStyleItalic">PTPN11</span> &#40;protein tyrosine phosphatase nonreceptor 11&#41; gene demonstrated a T468M mutation &#40;p&#46;Thr468Met&#41; in exon 12&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Patient 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 6-year-old boy born to healthy nonconsanguineous parents was being treated by a speech therapist for delayed language acquisition and difficulty with auditory discrimination of some phonemes&#46; Physical examination revealed facial dysmorphism&#44; including an inverted triangular-shaped face&#44; short neck&#44; large low-set ears&#44; orbital hypertelorism&#44; megalocornea&#44; and pectus excavatum&#46; Numerous caf&#233; au lait macules and lentigines were present on the face&#44; neck&#44; and upper trunk &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Hearing and cardiac evaluations were normal&#46; Genetic testing detected the R498W mutation &#40;p&#46;Arg498Trp&#41; in axon 13 of <span class="elsevierStyleItalic">PTPN11</span>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">NSML belongs to a group of neuro-cardio-fascio-cutaneous syndromes in which germline mutations in the <span class="elsevierStyleItalic">RAS-MAPK</span> &#40;mitogen-activated protein kinase&#41; pathway are present&#46; The most characteristic dermatologic findings are pigmented lesions&#44; especially lentigines&#44; which are present in 90&#37; of patients with these syndromes&#46; Manifestations may be present from birth&#44; but they usually appear when the child is around 4<span class="elsevierStyleHsp" style=""></span>or 5<span class="elsevierStyleHsp" style=""></span>years of age and may even first present in puberty&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a> Caf&#233; au lait macules&#44; which are somewhat larger than lentigines&#44; can be seen in 70&#37; to 80&#37; of patients&#46; Lesions that are darker have been called black coffee macules&#46; The most common cardiac finding in NSML is hypertrophic myocardiopathy&#44; which can be fatal&#46; Cardiac valve and coronary abnormalities may also be present&#46; Pulmonary stenosis is less common than mitral valve or aortic abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> Typical electrocardiographic signs are those of left or right ventricular hypertrophy&#44; right atrial enlargement&#44; and gradual development of right bundle-branch block&#46; Deafness&#44; traditionally considered highly specific to NSML&#44; only presents in 25&#37; to 30&#37; of these patients&#59; the deficit is neurosensorial&#44; may be unilateral or bilateral&#44; and is sometimes profound &#40;&#62;<span class="elsevierStyleHsp" style=""></span>95<span class="elsevierStyleHsp" style=""></span>db&#41;&#46; Although deafness is usually diagnosed in childhood&#44; it may develop later&#44; making periodic hearing tests advisable&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Other manifestations include distinctive facial features&#59; skeletal abnormalities such as pectus carinatum or excavatum&#44; which are seen in up to 75&#37; of neonates&#59; delayed puberty and late menarche&#59; and urogenital abnormalities such as horseshoe-shaped kidney and hypospadia&#44; underdeveloped ovaries or testicles&#44; and small penis&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;4</span></a> The slow growth observed in 25&#37; of patients does not appear to be related to endocrine dysregulation or systemic disease&#46; Eighty-five percent of patients will remain in the lower 25th percentile on growth charts&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> Unlike other <span class="elsevierStyleItalic">RAS</span>opathies&#44; NSML seems to confer only minimal predisposition to cancer&#44; but blood tumors<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> and other malignancies&#44; such as melanomas<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;8</span></a> have been reported&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Genetic testing is necessary for a definitive diagnosis&#46; Mutations in exons 7&#44; 12&#44; and 13 in the PTP domain of the <span class="elsevierStyleItalic">PTPN11</span> oncogene that encodes the SHP-2 phosphatase have been demonstrated in 85&#37; to 90&#37; of patients with NSML&#46; Functional SHP2 deficiency &#40;not present in Noonan syndrome&#41; is compensated for by hypersensitivity to growth factor stimulus&#44; longer contact time at the C-terminal domain &#40;pTyr ligands&#41;&#44; and the weakening of interactions of the SH2 inhibitor with the catalytic zone&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> The result is functional gain&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> At least 11 different mutations have been described to date&#46; Among them are 2 frequently recurring ones&#8212;Y279C and T468M&#8212;that have been found in over half of patients with NSML&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;9&#44;10</span></a> Of patients who have been found to be negative for <span class="elsevierStyleItalic">PTPN11</span> mutation&#44; a third have <span class="elsevierStyleItalic">RAF1</span> &#40;Raf-1 proto-oncogene&#44; serine&#47;threonine kinase&#41; mutations and fewer than 5&#37; have <span class="elsevierStyleItalic">BRAF</span> &#40;B-Raf&#41; mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> There is a certain correlation between genotype and phenotype&#44; such that patients who are negative for <span class="elsevierStyleItalic">PTPN11</span> mutation tend to have a higher prevalence of cardiac conduction abnormalities&#44; left ventricular or atrial hypertrophy&#44; and a family history of sudden death&#44; whereas patients who are <span class="elsevierStyleItalic">PTPN11</span>-mutation positive &#40;exon 13&#41; have greater risk of hypertrophic myocardiopathy and severe cardiac complications&#59; mutation in exon 7 is more often associated with delayed growth and deafness&#44; and <span class="elsevierStyleItalic">BRAF</span> mutations confer greater risk of cognitive disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleItalic">RAF</span> mutation may cause lentigines&#44; caf&#233; au lait macules&#44; abnormal facial features&#44; hypertrophic myocardiopathy&#44; arrhythmias&#44; and delayed puberty&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2&#44;4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The main differential diagnoses are other diseases linked to the <span class="elsevierStyleItalic">RAS-MAPK</span> pathway&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> and the strong genetic-phenotypic overlap of <span class="elsevierStyleItalic">RAS</span>opathies makes clinical diagnosis difficult&#46; NSML can be phenotypically very difficult to distinguish from Noonan syndrome itself &#40;without multiple lentigines&#41; and neurofibromatosis type 1&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> Lentigines and deafness are not present in Noonan syndrome&#44; and caf&#233; au lait macules and hypertrophic myocardiopathy are more typical of NSML than of Noonan syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4&#44;13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; the 2 cases we report show that NSML cannot be ruled out when deafness and cardiopathy are absent&#46; Genetic testing of these patients is highly advisable&#44; because the findings provide a basis for guiding follow-up and establishing prognosis&#46; However&#44; regardless of which exon is mutated&#44; all patients with NSML should receive periodic evaluations to detect late development of neurologic&#44; dermatologic&#44; cardiac&#44; or hearing complications&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Ethical Disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Protection of human and animal subjects</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Data confidentiality</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they followed their hospitals&#8217; regulations regarding the publication of patient information and that written informed consent for voluntary participation was obtained for all patients&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article&#46;</p></span></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres494677"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec515885"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres494678"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec515884"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Patient 1"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Patient 2"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of Interest"
        ]
        9 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Ethical Disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-08-27"
    "fechaAceptado" => "2014-11-06"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec515885"
          "palabras" => array:4 [
            0 => "Rasopathy"
            1 => "Cafe au lait macules"
            2 => "Lentigines"
            3 => "LEOPARD syndrome"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec515884"
          "palabras" => array:4 [
            0 => "Rasopatia"
            1 => "Manchas caf&#233; con leche"
            2 => "Lentigines"
            3 => "Sindrome LEOPARD"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">LEOPARD syndrome is an autosomal dominant disease caused by germline mutations in the <span class="elsevierStyleItalic">RAS</span>-MAPK &#40;rat sarcoma mitogen-activated protein kinase&#41; pathway&#46; LEOPARD is an acronym for the main manifestations of the syndrome&#44; namely&#44; multiple Lentigines&#44; Electrocardiographic conduction abnormalities&#44; Ocular hypertelorism&#44; Pulmonary stenosis&#44; Abnormalities of genitalia&#44; Retardation of growth&#44; and sensorineural Deafness&#46; None of these characteristic features&#44; however&#44; are pathognomonic of LEOPARD syndrome&#44; and since they are highly variable&#44; they are often not present at the time of diagnosis&#46; We describe 2 cases of LEOPARD syndrome without hearing loss or pulmonary stenosis in which diagnosis was confirmed by identification of a mutation in the <span class="elsevierStyleItalic">PTPN11</span> gene&#46; Regular monitoring is important for the early detection of complications&#44; as these can occur at any time during the course of disease&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome LEOPARD es una enfermedad autos&#243;mica dominante producida por mutaciones germinales en la v&#237;a RAS-MAPK&#46; El acr&#243;nimo agrupa las manifestaciones m&#225;s importantes de la enfermedad &#40;L<span class="elsevierStyleItalic">entiginosis</span>&#44; E<span class="elsevierStyleItalic">CG conduction anomalies</span>&#44; O<span class="elsevierStyleItalic">cular hypertelorism&#47;hypertrophic</span> O<span class="elsevierStyleItalic">bstructive cardiomyopathy</span>&#44; P<span class="elsevierStyleItalic">ulmonary stenosis</span>&#44; A<span class="elsevierStyleItalic">bnormalities of genitalia&#44; growth</span> R<span class="elsevierStyleItalic">etardation and</span> D<span class="elsevierStyleItalic">eafness</span>&#41;&#44; pero ninguna de ellas es patognom&#243;nica ni constante&#44; por lo que muchos pacientes no las presentan en el momento del diagn&#243;stico&#46; Presentamos 2 casos de s&#237;ndrome LEOPARD sin sordera ni estenosis pulmonar en los que la detecci&#243;n de la mutaci&#243;n en el gen PTPN11 permiti&#243; confirmar la enfermedad&#44; y se&#241;alamos la importancia del seguimiento continuado para la detecci&#243;n precoz de las complicaciones&#44; ya que las mismas pueden aparecer en el transcurso de la enfermedad&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ramos-Geldres T&#44; D&#225;vila-Seijo P&#44; Duat-Rodr&#237;guez A&#44; Noguera-Morel L&#44; Ezquieta-Zubicaray B&#44; Ros&#243;n-L&#243;pez E&#44; et al&#46; S&#237;ndrome LEOPARD sin sordera ni estenosis pulmonar&#58; a prop&#243;sito de 2 casos&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;e19&#8211;e22&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 534
            "Ancho" => 1305
            "Tamanyo" => 110977
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patient 1&#46; A&#44; Facial lentigines&#46; B&#44; Hyperpigmented lesions of various sizes on the lower limbs&#59; the largest was located on the right buttock&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 633
            "Ancho" => 1300
            "Tamanyo" => 139281
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patient 2&#46; A&#44; Pectus excavatum&#44; a skeletal abnormality that is common in patients with mutations in the <span class="elsevierStyleItalic">RAS-MAPK</span> &#40;rat sarcoma mitogen-activated protein kinase&#41; pathway&#59; hyperpigmented lenticular lesions on the trunk&#46; B&#44; Hyperpigmented macule with irregular borders along with multiple lentigines on the left side of the neck&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:13 [
            0 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The RASopathies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Rauen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1146/annurev-genom-091212-153523"
                      "Revista" => array:6 [
                        "tituloSerie" => "Annu Rev Genomics Hum Genet"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "355"
                        "paginaFinal" => "369"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23875798"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome&#58; Clinical features and gene mutations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Mart&#237;nez-Quintana"
                            1 => "F&#46; Rodr&#237;guez-Gonz&#225;lez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000342251"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mol Syndromol"
                        "fecha" => "2012"
                        "volumen" => "3"
                        "paginaInicial" => "145"
                        "paginaFinal" => "157"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23239957"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Qiu W&#44; Wang X&#44; Romanov V&#44; Hutchinson A&#44; Lin A&#44; Ruzanov M&#44; et al&#46; Structural insights into Noonan&#47;LEOPARD syndrome-related mutants of protein-tyrosine phosphatase SHP2 &#40;PTPN11&#41;&#46; BMC Struct Biol&#46; 2014&#59;14&#58;10&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Two cases of LEOPARD syndrome-RAF1 mutations firstly described in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Kuburovi&#263;"
                            1 => "V&#46; Vukomanovi&#263;"
                            2 => "A&#46; Carcavilla"
                            3 => "B&#46; Ezquieta-Zubicaray"
                            4 => "N&#46; Kuburovi&#263;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Turk J Pediatr"
                        "fecha" => "2011"
                        "volumen" => "53"
                        "paginaInicial" => "687"
                        "paginaFinal" => "691"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22389993"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome &#40;PTPN11&#44; T468<span class="elsevierStyleHsp" style=""></span>M&#41; in three boys fulfilling neurofibromatosis type 1 clinical criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Carcavilla"
                            1 => "I&#46; Pinto"
                            2 => "R&#46; Mu&#241;oz-Pacheco"
                            3 => "R&#46; Barrio"
                            4 => "M&#46; Martin-Fr&#237;as"
                            5 => "B&#46; Ezquieta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00431-011-1418-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2011"
                        "volumen" => "170"
                        "paginaInicial" => "1069"
                        "paginaFinal" => "1074"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21365175"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Common acute lymphoblastic leukemia in a girl with genetically confirmed LEOPARD syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Laux"
                            1 => "C&#46; Kratz"
                            2 => "A&#46; Sauerbrey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPH.0b013e31817588fb"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Hematol Oncol"
                        "fecha" => "2008"
                        "volumen" => "30"
                        "paginaInicial" => "602"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18799937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatologic manifestations of the LEOPARD syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Cao"
                            1 => "A&#46;F&#46; Nikkels"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Open Dermatol J"
                        "fecha" => "2013"
                        "volumen" => "7"
                        "paginaInicial" => "11"
                        "paginaFinal" => "14"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome with a new association of congenital corneal tumor&#44; choristoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;W&#46; Choi"
                            1 => "J&#46;Y&#46; Yoo"
                            2 => "K&#46;C&#46; Park"
                            3 => "K&#46;H&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Derm"
                        "fecha" => "2003"
                        "volumen" => "20"
                        "paginaInicial" => "158"
                        "paginaFinal" => "160"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Structural and mechanistic insights into LEOPARD syndrome-associated SHP2 mutations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46;H&#46; Yu"
                            1 => "J&#46; Xu"
                            2 => "C&#46;D&#46; Walls"
                            3 => "L&#46; Chen"
                            4 => "S&#46; Zhang"
                            5 => "R&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1074/jbc.M113.450023"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Biol Chem"
                        "fecha" => "2013"
                        "volumen" => "288"
                        "paginaInicial" => "10472"
                        "paginaFinal" => "10482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23457302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leopard syndrome&#58; A report of five cases from one family in two generations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; Begi&#263;"
                            1 => "H&#46; Tahirovi&#263;"
                            2 => "M&#46; Karda&#353;evi&#263;"
                            3 => "I&#46; Kalev"
                            4 => "K&#46; Muru"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00431-013-2243-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2014"
                        "volumen" => "173"
                        "paginaInicial" => "819"
                        "paginaFinal" => "822"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24401936"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Rasopathies&#58; Developmental disorders that predispose to cancer and skin manifestations&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Hernandez Martin"
                            1 => "A&#46; Torrelo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2011.02.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2011"
                        "volumen" => "102"
                        "paginaInicial" => "402"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21536246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome&#58; Clinical diagnosis in the first year of life"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;C&#46; Digilio"
                            1 => "A&#46; Sarkozy"
                            2 => "A&#46; de Zorzi"
                            3 => "G&#46; Pacileo"
                            4 => "G&#46; Limongelli"
                            5 => "R&#46; Mingarelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ajmg.a.31156"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Genet A"
                        "fecha" => "2006"
                        "volumen" => "140"
                        "paginaInicial" => "740"
                        "paginaFinal" => "746"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16523510"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "LEOPARD syndrome&#58; Clinical dilemmas in differential diagnosis of RASopathies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Santoro"
                            1 => "G&#46; Pacileo"
                            2 => "G&#46; Limongelli"
                            3 => "S&#46; Scianguetta"
                            4 => "T&#46; Giugliano"
                            5 => "G&#46; Piluso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2350-15-44"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Med Genet"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24767283"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000566/v2_201505051007/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "34944"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "e- Case Report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000004/v2_201505051007/S1578219015000566/v2_201505051007/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000566?idApp=UINPBA000044"
]
Información del artículo
ISSN: 15782190
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 8 5 13
2024 Octubre 72 46 118
2024 Septiembre 107 24 131
2024 Agosto 134 59 193
2024 Julio 89 40 129
2024 Junio 96 33 129
2024 Mayo 100 48 148
2024 Abril 89 33 122
2024 Marzo 93 31 124
2024 Febrero 71 29 100
2024 Enero 68 32 100
2023 Diciembre 64 26 90
2023 Noviembre 60 30 90
2023 Octubre 72 20 92
2023 Septiembre 73 33 106
2023 Agosto 50 21 71
2023 Julio 72 98 170
2023 Junio 50 24 74
2023 Mayo 62 23 85
2023 Abril 67 31 98
2023 Marzo 65 25 90
2023 Febrero 51 27 78
2023 Enero 46 27 73
2022 Diciembre 55 34 89
2022 Noviembre 42 39 81
2022 Octubre 32 23 55
2022 Septiembre 34 41 75
2022 Agosto 47 37 84
2022 Julio 25 44 69
2022 Junio 45 27 72
2022 Mayo 59 50 109
2022 Abril 98 45 143
2022 Marzo 85 59 144
2022 Febrero 71 55 126
2022 Enero 97 33 130
2021 Diciembre 77 46 123
2021 Noviembre 57 54 111
2021 Octubre 55 47 102
2021 Septiembre 43 40 83
2021 Agosto 89 25 114
2021 Julio 53 35 88
2021 Junio 60 34 94
2021 Mayo 48 29 77
2021 Abril 135 72 207
2021 Marzo 84 25 109
2021 Febrero 102 39 141
2021 Enero 63 18 81
2020 Diciembre 57 14 71
2020 Noviembre 40 20 60
2020 Octubre 34 11 45
2020 Septiembre 56 13 69
2020 Agosto 29 15 44
2020 Julio 28 18 46
2020 Junio 35 27 62
2020 Mayo 32 20 52
2020 Abril 28 27 55
2020 Marzo 30 15 45
2020 Febrero 5 2 7
2020 Enero 5 2 7
2019 Diciembre 4 4 8
2019 Noviembre 4 2 6
2019 Octubre 0 6 6
2019 Septiembre 0 10 10
2019 Agosto 4 6 10
2019 Julio 4 12 16
2019 Junio 4 18 22
2019 Mayo 5 11 16
2019 Abril 5 11 16
2019 Marzo 2 10 12
2019 Febrero 0 3 3
2019 Enero 2 2 4
2018 Diciembre 2 6 8
2018 Noviembre 2 0 2
2018 Octubre 2 0 2
2018 Septiembre 7 0 7
2018 Mayo 0 4 4
2018 Abril 0 1 1
2018 Marzo 2 5 7
2018 Febrero 21 2 23
2018 Enero 37 6 43
2017 Diciembre 28 10 38
2017 Noviembre 22 5 27
2017 Octubre 28 13 41
2017 Septiembre 19 14 33
2017 Agosto 27 3 30
2017 Julio 13 15 28
2017 Junio 25 48 73
2017 Mayo 21 27 48
2017 Abril 33 45 78
2017 Marzo 17 30 47
2017 Febrero 17 19 36
2017 Enero 17 17 34
2016 Diciembre 28 17 45
2016 Noviembre 47 17 64
2016 Octubre 32 26 58
2016 Septiembre 0 5 5
2016 Agosto 0 6 6
2016 Julio 10 5 15
2016 Junio 8 4 12
2016 Mayo 13 2 15
2016 Abril 8 7 15
2016 Marzo 8 1 9
2016 Febrero 8 14 22
2016 Enero 7 2 9
2015 Diciembre 13 2 15
2015 Noviembre 4 8 12
2015 Octubre 1 0 1
2015 Septiembre 0 1 1
2015 Agosto 0 2 2
2015 Julio 3 5 8
2015 Junio 2 6 8
2015 Mayo 7 4 11
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Actas Dermo-Sifiliográficas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?