No abstract available.
Dysautonomia, Familial*

Riley Day Syndrome, also known as familial dysautonomia, is a rare reported entity characterised by disturbance of pain and temperature perceptions, inability to produce tears, labile blood pressure and poor growth due to disorder of the autonomic and sensory nervous system. It is an autosomal recessive condition with the genetic locus mapped to chromosome 9q31-q33. Traumatic fractures are common and due to lack of pain, may go unrecognised for prolonged periods of time, resulting in nonunion or pseudoarthrosis. Scoliosis is seen in up to 90% of the patients. Complications of are common in these patients and range from infection to wound breakdown to failure of fixation. We report a case (nineyear-old girl) of Riley Day Syndrome with general absence of pain and damage to the extremities to highlight this rare syndrome
Pseudoarthrosis ; Dysautonomia, Familial

The generation of induced pluripotent stem cells (iPSCs) from somatic cells demonstrated that adult mammalian cells can be reprogrammed into a pluripotent state by introducing defined transcription factors. iPSCs show almost identical properties in self-renewal and pluripotency, and can circumvent ethical concerns because they do not use embryonic materials. Therefore, iPSCs from a patient's somatic cells have great potential in studying drug development and regenerative medicine. Several human disease models have already been established using patient-specific iPSCs from Parkinson's disease and familial dysautonomia. Moreover, the correction of genetic defects by homologous recombination has already been accomplished with Fanconi anemia patient-specific iPSCs. However, the generation of patient-specific iPSCs for clinical application requires alternative strategies, because genome-integrating viral vectors may raise tumorigenic risk after transplantation. Moreover, the use of iPSCs for eventual clinical application is limited by the low efficiency of current methods for reprogramming. Studies on the mechanism underlying the reprogramming and on establishment of non-integration methods contribute evidence toward resolving the safety concerns associated with iPSCs. Small molecules involved in the epigenetic modification and signaling pathway not only improve reprogramming efficiencies, but also bypass the addition of certain reprogramming factors. However, reprogramming somatic cells purely by small molecule treatment still remains a challenge. Here, we review recent progress made by the use of transcription factors and small molecules that can either replace reprogramming factors or enhance reprogramming efficiency. We also discuss the progress that has been made in the rapidly moving iPSC field, with an emphasis on understanding the mechanisms of cellular reprogramming and its potential application to cell therapy.
Adult ; Dysautonomia, Familial ; Epigenomics ; Fanconi Anemia ; Homologous Recombination ; Humans ; Induced Pluripotent Stem Cells ; Parkinson Disease ; Regenerative Medicine ; Tissue Therapy ; Transcription Factors ; Transplants

Familial dysautonomia, first described by Riley and co-workers in 1949, is a congenital, heritable syndrome. It is transmitted by a recessive autosomal gene which is generally limited to persons of Jewish extraction; however, rare occurrences among non-Jewish Caucasians and in a black girl have been reported. An eight-year old Korean boy was admitted to Severance Hospital with bulbar conjunctival injection OU for 1 month and visual disturbance OS for 10 days. Examination revealed exfoliated epithelium in an area of about 3mm in diameter in the center of the left cornea, multiple punctate erosions and edema of the corneal epithelium. Yet, he experienced no discomfort, blepharospasm, nor photophobia. He had decreased corneal sensation, decreased lacrimation by Schirmer test and miosis was induced biJaterally by 0.25% pilocarpine (equivalent to 2.5% methacholine). The patient had decreased deep tendon reflexes and postural hypotension, and showed emotional lability, indifference to pain, and abnormal temperature control. He also had marked anorexia, swallowing difficulty, cyclic vomiting, abdominal pain, headache, intermittent vascular hypertension and one episode of convulsive seizure. He was positive to histamine intradermal injection test and had abnormal EEG. EMG was suggestive of some form of neuropathy. He was treated with toplca 0.5% chloramphenicol solution and 10% dextran solution alternatively q.2 hrs., terramycin ophthalmic ointment q.h.s. and bilateral patching; he also received 50,000 units of vitamin A for 10 days. He showed marked improvement of his ocular symptoms in 6 days. The above patient shows many of the essential features of the familial dysautonomia syndrome as outlined by Riley; however, he also lacks some of the most important features. Therefore, we feel that the patient has a case of some other type of autonomic dysfunction simulating Riley-Day svndrome.
Abdominal Pain ; Anorexia ; Blepharospasm ; Chloramphenicol ; Cornea ; Deglutition ; Dextrans ; Dysautonomia, Familial* ; Edema ; Electroencephalography ; Epithelium ; Epithelium, Corneal ; Female ; Headache ; Histamine ; Humans ; Hypertension ; Hypotension, Orthostatic ; Injections ; Injections, Intradermal ; Male ; Miosis ; Oxytetracycline ; Photophobia ; Pilocarpine ; Primary Dysautonomias* ; Reflex, Stretch ; Seizures ; Sensation ; Vitamin A ; Vomiting