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Biomedical subjects

J V Higgins

Publications and source records attributed to J V Higgins.

At least 19 recordsLinked to original sources

Craniodigital syndromes: report of a child with Filippi syndrome and discussion of differential diagnosis.

We describe a boy with low birth weight, congenital microcephaly, multiple minor facial anomalies, cleft palate, soft tissue syndactyly of fingers and toes, and moderate to severe mental retardation. Literature review suggested 6 possible diagnoses, including Scott craniodigital syndrome, Chitayat syndrome, Filippi syndrome, Zerres syndrome, Kelly syndrome, and Woods syndrome. Each has as part of the phenotype craniofacial anomalies and soft tissue syndactyly of fingers and toes; and superficially, distinction among the 6 may be difficult. However, based on the phenotype analysis we performed, we conclude that our patient has Filippi syndrome, and thus is the first reported case from the United States.

Abnormalities, Multiple

Prenatal diagnosis of Smith-Lemli-Opitz syndrome, type II.

Smith-Lemli-Opitz syndrome, type II (SLOS-II) is a severe autosomal recessive disorder characterized by a distinctive face, unusual cleft palate, postaxial polydactyly, congenital heart defects, renal anomalies, and male pseudohermaphroditism. We present the first report of prenatal diagnosis of SLOS-II, as well as an additional report of prenatal detection of multiple anomalies, in which a positive diagnosis of SLOS II was made postnatally. In neither case was the pregnancy known prospectively to be at risk for SLOS-II. In the former case, targeted sonographic examination at 31 weeks of gestation showed intrauterine growth retardation, atrioventricular septal defect, mesomelic shortening of the arms, small kidneys, overlapping fingers, and female external genitalia; a 46,XY chromosome constitution had been ascertained previously. A provisional diagnosis of SLOS-II was made prenatally. In the latter case, targeted sonographic examination at 18 weeks of gestation showed severe oligohydramnios, atrioventricular septal defect, and Dandy-Walker malformation. The kidneys and bladder were not visualized. The chromosome constitution was 46,XX. The diagnosis of SLOS-II was made postnatally. In both cases, additional findings compatible with SLOS-II were noted postnatally. Prenatal detection of congenital heart defects and renal abnormalities, in combination with certain additional findings (most notably, female external genitalia in the presence of a 46,XY karyotype, polydactyly, disproportionately short limbs, or intrauterine growth retardation) and a normal karyotype, suggests the diagnosis of SLOS-II, and warrants further investigation.

Abnormalities, Multiple

Fine mapping of X-linked clasped thumb and mental retardation (MASA syndrome) in Xq28.

The MASA syndrome is an X-linked disorder with mental retardation, spastic paraparesis, and adducted thumbs as the most characteristic features. We performed linkage analysis, using Xq28 markers, on a large MASA syndrome family. The maximum lodscore was 6.37 at 0 recombination for DXS52 and 5.99 at 0 recombination for DXS305. Crossovers were demonstrated between the disorder and DXS455. Clinical and linkage data from this family further support the hypothesis that the MASA syndrome and X-linked hydrocephalus are allelic disorders.

Chromosome Mapping

Downregulation of taurocholate transport by ileal BBM and liver BLM in biliary-diverted rats.

The enterohepatic circulation of bile salts may be substrate dependent. We hypothesize that decreased intestinal delivery of bile salts results in downregulation of ileal and hepatocyte bile salt transport in the biliary-diverted rat. Maximal velocity (Vmax) of taurocholate transport by ileal brush-border membrane (BBM) vesicles was downregulated in the bile-diverted animals by 45.5% (559.9 +/- 57.8 pmol.mg protein-1.min-1 in bile-diverted rats vs. 1,026.6 +/- 170.9 pmol.mg protein-1.min-1 in shams). Similarly, taurocholate transport Vmax by hepatocyte basolateral membrane (BLM) was downregulated by 37.8% (2.62 +/- 0.18 pmol.mg protein-1.min-1 in bile-diverted rats vs. 6.93 +/- 0.41 pmol.mg protein-1.min-1 in shams). Cholesterol content (mumol/mg protein) of the membranes was increased in both BBM (0.478 +/- 0.055 vs. 0.272 +/- 0.029) and BLM (0.410 +/- 0.052 vs. 0.294 +/- 0.044) in diverted rats compared with shams. Fluorescence anisotropy was significantly higher in diverted animals compared with shams for both BBM (0.2333 +/- 0.001 vs. 0.2120 +/- 0.004) and BLM (0.1524 +/- 0.002 vs. 0.1426 +/- 0.005). We conclude that biliary diversion in the rat leads to downregulation of both ileal BBM and hepatocyte BLM taurocholate transport. Alterations in transporter expression caused by diversion may, in part, be mediated by changes in membrane lipid composition or fluidity.

Animals

Provisionally unique autosomal recessive chondrodysplasia punctata syndrome.

Stippled epiphyses occur in several monogenic, teratogenic, or aneuploidy syndromes. We describe two sibs with a provisionally unique chondrodysplasia punctata syndrome, who have, in addition to stippled epiphyses, minor facial anomalies, short stature, and ocular colobomata. Inheritance of this condition is likely autosomal recessive.

Abnormalities, Multiple

DiGeorge anomaly in an infant with deletion of chromosome 22 and dup(9p) due to adjacent type II disjunction.

A term white girl presented with low birth weight, minor anomalies, and congenital heart defects. The infant had microcephaly, upslanting palpebral fissures, prominent nasal bridge, short philtrum, thin upper lip vermilion, down-turned corners of the mouth, receding mandible, and short broad neck. The hands showed proximal placement of the thumbs, bilateral clinodactyly of the index finger, and bilateral transverse crease. Both hands were clenched, with the index finger overlapping the third finger and the fifth finger overlapping the fourth. There was also talipes calcaneo-valgus, bilateral dorsiflexion of the metatarsophalangeal joints, flexion of the interphalangeal joints, and hypoplasia of all nails. The patient's karyotype was 46,XX,-22, + der(9)t(9;22)(q21.13;q12.1)mat; the mother had the balanced translocation 46,XX,t(9;22)(9pter----9q21.13::22q12.1----22qter++ +;22pter---- 22q12.1::9q21.3----9qter). The infant died at age 10 days, and the autopsy showed absent thyroid isthmus and rudimentary thymus, with one small ectopic parathyroid attached to it. The lungs were hypoplastic, with abnormal lobation. The cardiac anomalies included truncus arteriosus, truncal valve stenosis, single carotid trunk, subclavian arteries arising from the distal part of the aortic arch, atrial and ventricular septal defects, right ventricular hypertrophy, and a hypoplastic left pulmonary artery. Also, multiple small accessory spleens were present in addition to a normal-sized spleen. This case combines features associated with DiGeorge anomaly and dup(9p). The chromosome abnormality in this patient appears to have arisen in a maternal germ cell due to adjacent type II disjunction.

Chromosome Deletion

Localization of the translocation breakpoint in a female with Menkes syndrome to Xq13.2-q13.3 proximal to PGK-1.

Menkes syndrome is a rare X-linked recessive disorder characterized by an inability to metabolize copper. A female patient with both this disease and an X; autosome translocation with karyotype 46,X,t(X;2)(q13;q32.2) has previously been described. The translocation breakpoint in Xq13 coincides with a previous assignment of the Menkes gene at Xq13 by linkage data in humans and by analogy to the mottled mutations which are models for Menkes disease in the mouse. Therefore, this translocation probably interrupts the gene for Menkes syndrome in band Xq13. We describe here experiments to precisely map the translocation breakpoint within this chromosomal band. We have established a lymphoblastoid cell line from this patient and have used it to isolate the der(2) translocation chromosome (2pter----2q32::Xq13----Xqter) in human/hamster somatic cell hybrids. Southern blot analyses using a number of probes specific for chromosomes X and 2 have been studied to define precisely the location of the translocation breakpoint. Our results show that the breakpoint in this patient--and, therefore, likely the Menkes gene--maps to a small subregion of band Xq13.2-q13.3 proximal to the PGK1 locus and distal to all other Xq13 loci tested.

Animals

Two siblings with Tel Hashomer camptodactyly and mitral valve prolapse.

A brother and sister with Tel Hashomer camptodactyly and mitral valve prolapse are described. Mitral valve prolapse is heterogenous, but appears to occur more frequently in individuals with connective tissue disorders. The presence of mitral valve prolapse as a component manifestation of Tel Hashomer camptodactyly suggests that abnormal connective tissue is a pleiotropic effect of the mutant allele.

Abnormalities, Multiple

Renal tubular dysgenesis: delayed onset of oligohydramnios.

Two premature sibs had Potter sequence and died of respiratory failure within the first day. Ultrasonography at 26 weeks during the earlier of the two pregnancies showed complete absence of amniotic fluid, and the urinary bladder was not visualized. Ultrasound examinations during the second pregnancy showed adequate amniotic fluid at 16 and 20 weeks, with a subsequent reduction in fluid volume. Two older sibs had also died of respiratory failure shortly after birth. Postmortem histopathologic studies showed all four sibs to have severely deficient renal tubular development. However, the presence of numerous glomeruli indicated prolific nephrogenesis. Most of the tubules in sections of cortex had the lectin-binding and immunohistochemical characteristics of collecting ducts; proximal tubules were not identified by lectin-binding. Electron-microscopic examination showed a general absence of differentiated characteristics in cortical tubular epithelium, except that rare tubules contained rudimentary proximal tubular brush borders. Three of the sibs were boys, one a girl. The three children that were studied had normal chromosomes. Two unaffected sibs are alive and well. Neither parent has any clinical evidence of renal disease. These studies support the interpretation that renal tubular dysgenesis is autosomal recessive with pleiotropy. However, the relatively late appearance of oligohydramnios makes early diagnosis difficult, even when the condition is suspected.

Amniotic Fluid

Acute lymphoblastic leukemia with a unique rearrangement between chromosomes 4 and 11.

A case of pre-B cell acute lymphoblastic leukemia (pre-B ALL) with a dir ins(11;4)(q23;q21q31) chromosome rearrangement is presented. The patient's clinical findings and history were similar to those described for the t(4;11)(q21;q23) subgroup of childhood ALL. These findings suggest that the interfacing of the distal breakpoint at band 4q21 to the proximal breakpoint of band 11q23 represents the primary cytogenetic change observed in this subgroup of ALL.

B-Lymphocytes

Menkes syndrome in a girl with X-autosome translocation.

We report on a girl with Menkes syndrome (M.S.) and X-2 reciprocal translocation. We conclude that the probable locus for M.S. gene is at band Xq13. This case and other previous case reports of X-linked disorders in females suggest that chromosome analysis is indicated in all females who present with manifestations of a known X-linked lethal condition in order to detect a possible associated balanced X-autosome translocation.

Brain Diseases, Metabolic

Double minute chromosomes. A bone marrow indicator of neuroblastoma metastasis and relapse: two case reports.

Two cases of childhood neuroblastoma are presented. Case 1 was diagnosed as Stage IV with metastasis to the bone marrow. During remission, histologic studies of bone marrow aspirate and biopsy showed a normocellular marrow with no evidence of malignant cells. Concurrent cytogenetic studies of the bone marrow showed the majority of the cells to contain double minute chromosomes (DM). The chromosome findings indicated the presence of neuroblastoma cells in the marrow prior to histologic evidence of relapse. Case 2 was diagnosed as Stage I neuroblastoma with no metastasis to the bone marrow. Subsequent cytogenetic studies showed DM present in a small number of cells and a deletion of chromosome 1 (1p-) in a single cell. The chromosome findings indicated an advanced stage of malignancy which was not evident with histologic techniques. These findings suggest that cytogenetic analysis of bone marrow can be a valuable aid to the early diagnosis, prognosis, and treatment of neuroblastoma.

Bone Marrow

Sibs with the polyasplenia developmental field defect.

We report on two brothers each with absent spleen, multiple cardiac defects, and varying degrees of situs inversus. One brother also had omphalocele; the other also had annular pancreas. These findings are consistent with a diagnosis of polyasplenia, a complex developmental field defect affecting visceral and cardiac situs, with associated spleen and heart defects. We also discuss familial cases from a developmental field perspective.

Abnormalities, Multiple

Isolated diaphragmatic defect in three sibs.

We describe three sisters with unilateral agenesis of the diaphragm. No other anomalies were present. As a developmental field defect, diaphragmatic defect is, by definition, causally heterogeneous, and may be seen in several syndromes. Whereas most isolated diaphragmatic defects are likely multifactorially determined, monogenic forms seem to exist.

Congenital Abnormalities

A practical metaphase marker of the inactive X chromosome.

It is paradoxical that the inactivated X is the only chromosome that can be identified in the interphase nucleus, yet in metaphase, it is indistinguishable from its genetically active homolog unless special culture and staining procedures are employed. A specific inactivation-associated fold in proximal Xq resolves that paradox. We describe here how the fold in the proximal long arm can be used as a simple and reliable marker to identify the inactivated X in G-, Q-, or R-banded preparations. Several examples are given, including localization of the inactivation center to band Xq13 or q21.1, identification of nonrandom inactivation in X-chromosome rearrangements, identification of multiple active X chromosomes in tumor cell lines, analysis of X-inactivation patterns in female carriers of the fragile site at Xq27, and comparison of X-inactivation patterns among primate species.

Chromosome Banding