We report 17 novel mutations that cause profound biotinidase deficiency. Six of the mutations are due to deletions, whereas the remaining 11 mutations are missense mutations located throughout the gene and encode amino acids that are conserved in mammals. Our results increase the total number of different mutations that cause biotinidase deficiency to 79. These additional mutations will undoubtedly be helpful in identifying structure/function relationships once the three-dimensional structure of biotinidase is determined.

Amidohydrolases↗

PubMedDate not supplied

[Lectin-reactive alpha-fetoprotein in tyrosinaemia type I].

UNLABELLED: Despite the introduction of NTBC into the treatment of tyrosinaemia type I (TT1) and a considerable improvement in the outcome of these patients, the principal risk of developing hepatocellular carcinoma (HCC) in this metabolic disorder remains mainly in those children with late introduction of NBTC after the second year of life. Serial total alpha-Fetoprotein (AFP) levels are used to evaluate the individual risk to develop malignant changes. A failure of AFP to decrease on adaequate treatment or a secondary increase after a period of falling levels have been an indication for liver transplantation. Lectin-reactive alpha-Fetoprotein is a recently described marker to distinguish hepatocellular carcinoma from benign liver disease in adult cirrhotic patients. AIMS: To investigate if the analysis for Lectin-reactive alpha-Fetoprotein would lead to earlier detection of HCC compared to a judgement based on the evolution of standard total AFP alone. PATIENTS: We report the analysis of 12 patients with TTI and histologically proven HCC. There of 5 were diagnosed under one year of age, but NTBC treatment was started between 2 years 3 month and 7 years of age except in one case in which NTBC was introduced when the diagnosis of TTI was made. The remainder of the patients cover up to the age of 15 years. All patients had been treated with NTBC. METHODS: Lectin containing agarose gel for AFP electrophoresis leads to AFP separation according to different affinities of the varying carbohydrate chains of AFP to lectins. RESULTS: AFP subfractions could be identified in all 12 patients. In 6 patients the L3-AFP rose before the total AFP. In 3 patients the rise in L3-AFP was consistent with the rise of the total AFP and in 3 patients the L3-AFP was raised after the total AFP or did not increase at all. DISCUSSION: We were able to identify 6 out of 12 patients who had an early increase of L3-AFP before they developed a change in total AFP levels. The clinical significance of these early changes need to be determined. Lectin-affinity electrophoresis may have a potential role as an additional tool that may help to discriminate benign liver disease from HCC in TTI. CONCLUSIONS: We suggest the further evaluation of lectin-reactive AFP in TTI.

Adolescent↗

PubMedDate not supplied

Primary hyperparathyroidism in infants. Diagnostic and therapeutic difficulties.

On the basis of 3 infants with primary congenital hyperparathyroidism we discuss problems in the early diagnosis and interpretation of the results of laboratory findings. The lack of increased renal echogenicity and hypercalciuria, which is regularly present in idiopathic hypercalcaemia is emphasized. In contrast to secondary hyperparathyroidism caused by prolonged hypocalcaemia, e.g. in patients treated by longterm haemodialysis, the aetiology of primary hyperparathyroidism (pHPT) remained unclear although molecular genetic studies suggest that the development of parathyroid adenoma may be due to gene mutation in a cell. Congenital pHPT is a particularly rare condition usually due to diffuse hyperplasia of all parathyroid glands. Its inheritance is known to be autosomal. Three infants with congenital primary hyperparathyroidism were treated at the Child Health Centre in the years 1987-1988.

Diagnosis, Differential↗

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A case of organic aciduria--suspected 3-hydroxy-3-methylglutaric aciduria.

In a girl from a family with muscular hypotonia, hypoglycaemia, lactic acidosis and delayed development the analysis of organic acids in urine suggested a defect in leucine metabolism--3-hydroxy-3-methylglutaric aciduria. A good therapeutic effect was obtained with low-protein diet.

Amino Acid Metabolism, Inborn Errors↗

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Urinary succinylacetone presence and delta-aminolaevulinic acid excretion in patients with type I tyrosinaemia during treatment.

In a group of 5 patients it was found that the presence of succinylacetone in urine as well as increased urinary excretion of delta-aminolaevulinic acid are a good criterion for the diagnosis of type I tyrosinaemia, and may serve for monitoring of the effectiveness of treatment with low-tyrosine diet. Determination of tyrosine levels in blood and urine by the semiquantitative method may be deceptive.

Amino Acid Metabolism, Inborn Errors↗

PubMedDate not supplied

Congenital lactic acidosis in children--differential diagnosis in 44 cases.

The purpose of the study was differential diagnosis of lactic acidosis in 44 children aged from 2 weeks to 4 years. In all of them the lactate level in repeated determinations exceeded 27 mg/100 ml. From the point of view of clinical manifestations the children were divided into three groups: 26 with hepatomegaly and hypoglycaemia (I), 6 with ataxia and retardation of somatic development (II), 12 with mental retardation and muscular hypotonia (III). Together with basic biochemical studies other tests were done, if necessary, including glucose and alanine loading, lactate determination in cerebrospinal fluid, analysis of urinary organic acids by the GC-MS method, morphological examinations of muscle biopsy material, enzymatic determinations in liver biopsy material. In group I glycogenosis was suspected and its type was finally established after biochemical and enzymatic tests (types I, Ib, III, VI, VIa, XI). In one case fructose-1,6-diphosphatase deficiency was suspected. In group II the clinical manifestations resembled Leigh's syndrome. The tests demonstrated an inhibition of glucose formation from alanine, and lactate level in the cerebrospinal fluid was evidently raised above that in the serum. Gasometric index showed the presence of respiratory alkalosis with metabolic compensation rather than primary lactate acidosis. In group III, with considerable clinical variety of signs, in only nine out of 12 children the cause of lactate acidosis could have been established (pathological changes of mitochondria in 4 cases, secondary increase of lactate without pathogenetic importance in 4, and 3-hydroxy-3-methylglutaric acidosis in 1 case. In conclusion it is thought that this combination of diagnostic methods is useful in differential diagnosis of congenital lactate acidosis in children.

Acidosis, Lactic↗

PubMedDate not supplied

A case of vitamin B12--independent methylmalonic aciduria.

The reported case was a female infant aged 7 months with severe ketoacidosis associated with vomiting, dehydration and cardiorespiratory disturbances at the time of exacerbation of the disease. The analysis of urinary organic acids by the GC-MS method revealed methylmalonic aciduria. After placing the infant on a low-protein diet (1.5 g of protein per 1 kg of body weight) and initially vitamin B12 parenterally a striking clinical improvement with evident progress in psychomotor development of the child was achieved.

Acidosis↗

PubMedDate not supplied

The surgical approach to hyperinsulinism and hypoglycemia in children.

Authors present 19 children aged from 2 weeks to 16 y with severe hypoglycemia. In 3 oldest children a single nesidioma was found. In other 16 children mainly infants nesidioblastosis has been recognised, and in those cases the subtotal pancreatectomy was performed. In 4 infants the additional resection of the pancreas was done because after the primary procedure hypoglycemia persisted. All patients survived and were euglycemic. Severe hypoglycemia leads to brain damage and therefore should be treated as an urgent state.

Adolescent↗

PubMedDate not supplied

[Idiopathic juvenile osteoporosis with the symptoms suggesting nervous system damage].

10 children with final diagnosis of idiopathic juvenile osteoporosis were admitted to the Department of Neurology because of suspected lesion of nervous system. The main clinical features were gait disturbances and pain. Radiological examination was decisive for diagnosis. The authors discuss the course of disease and effect of the treatment.

Adolescent↗

PubMedDate not supplied

[Suspected pyruvate carboxylase deficiency in 4 children with Leigh disease].

Clinical observations and results of investigations of pyruvic acid metabolism are reported in 4 children in whom subacute necrotizing encephalomyelopathy of Leigh was diagnosed intravitally. Attention is called to the similarity of the clinical manifestations with its onset in the first year of life, deficient body weight and growth, progressing neurological disturbances (weakening of muscle power, tremor, ataxia, nystagmus), course with periods of exacerbations, tachypnoea, skin changes (hirsutism, telangiectasia, perspiration), death at the age of 2-3 years. The biochemical changes in all children included raised serum levels of lactic acid, pyruvic acid and alanine, and acid-base equilibrium disturbances with metabolic acidosis (relatively balanced respiratory alkalosis). The results of the test of intravenous loading with glucose and alanine carried out in all children indicated indirectly reduced activity of pyruvate carboxylase. In one child histological examination of the brain carried out postmortem confirmed the diagnosis of Leigh's disease.

Brain Diseases, Metabolic↗

PubMedDate not supplied

Treatment with D-thyroxine of patients with glycogen storage diseases type VI and VIa.

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Child↗

PubMedDate not supplied

[Role of the parathyroid glands in the pathogenesis of intracerebral calcifications].

Investigations of calcium-phosphate metabolism were carried out in a group of 11 children and adults with intracerebral calcifications. It was possible to isolate three different pathogenetic types of calcifications in the striatum and dentate nuclei in the cerebellum. The authors suggest restriction of the term "Fahr's syndrome" to cases without true of false hypoparathyroidism. The assessment of the calcium-phosphate metabolism, and particularly, the test with parathyroid hormone, seem to be an indispensable element in the differential diagnosis of this type of intracerebral calcifications.

Adolescent↗