FAMILIAL MOSAICISM OF A CHROMOSOME 16 ABNORMALITY ASSOCIATED WITH MULTIPLE CONGENITAL ANOMALIES.
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Gait abnormalities in minimally impaired multiple sclerosis patients.
Subclinical evidence of gait abnormalities were identified in a group of seven patients with multiple sclerosis, EDSS scored 0 - 2, without functional limitations. A movement analysis technique was used to identify gait parameters indicative of impaired motor function during walking. Abnormalities related primarily to time-distance parameters (reduced speed of progression, shorter strides, prolonged double support phase) and muscular function (premature recruitment of gastrocnemius and late relaxation of tibialis anterior during stance phase) were identified regardless the severity of the clinical score. The gait analysis procedure was able to provide the clinician with evidence of motor abnormalities prior to functional disturbance observable by a trained physician. These minimal dysfunctions may have resulted from reflex mechanisms impaired by delayed transmission through long loop pathways or else as a result of a nonspecific protective gait strategy to improve balance control. The technique described in this study may be useful to identify earlier starting points for follow-up and physiotherapy.
Adult↗
Immunological abnormalities in splenic atrophy.
Multiple immunological abnormalities have been demonstrated in fourteen patients with evidence in the blood-film of hyposplenism due to splenic atrophy. Reduction in spleen size was confirmed radiologically, and impairment of phagocytosis by the spleen was demonstrated by studying the survival and fate of chemically damaged autologous red blood-cells. Eight of the patients had intestinal malabsorption, and there was a high frequency of autoimmune disease in the remainder. Although patients with splenic atrophy showed little evidence of impairment of normal immune responses, there was a high frequency of autoantibody formation. There is thus an association between widespread immunological disturbances, notably autoimmunity, and splenic atrophy.
Adult↗
Bilateral corneal anesthesia associated with diaphragmatic paralysis, ovarian failure, and developmental delay.
PURPOSE: To describe two siblings with bilateral corneal anesthesia associated with multiple systemic abnormalities. DESIGN: Interventional case report. METHODS: A 38-year-old Hispanic woman was seen for bilateral corneal ulcers, exposure keratitis, hemorrhagic retinopathy, and multiple systemic abnormalities. A younger sibling with similar but milder findings was also examined. Medical and genetic evaluation was investigated in these two siblings with bilateral decreased sensation and multiple abnormalities from a consanguineous union. RESULTS: Examination of the patient showed bilateral corneal anesthesia, and multiple systemic abnormalities included diaphragmatic paralysis, ovarian failure, multiple thrombotic cerebrovascular accidents, pedal edema, mandibular hypoplasia, and developmental delay. Milder findings were seen in a sibling. Corneal ulcers were stabilized after treatment that included bandage contact lens, pressure patching, topical antibiotics, and tarsorrhaphy. CONCLUSIONS: The combination of corneal anesthesia and systemic abnormalities, with parental consanguinity, suggests an inherited syndrome.
Abnormalities, Multiple↗
Abnormal processing of multiple proteins in Alzheimer disease.
Cerebrovascular amyloid is the main constituent of the perivascular and neuritic plaques typical of Alzheimer disease, whereas neurofilaments and microtubule-associated tau protein have been considered primary contributors to the formation of the characteristic Alzheimer tangles. Plaques and tangles and their constituents have at times been ascribed a role in pathogenesis of the disease. Normally, neurofilaments become phosphorylated only upon axonal entry. In many neurologic disorders, neurofilament phosphorylation, as detected by any of the available monoclonal antibodies (mAbs) to neurofilament phosphorylated epitopes is shifted from an axonal to a cell-body location. An exception is provided by Alzheimer disease, where tangles (which are neuronal cell-body-derived structures) exhibit only one phosphorylated epitope. However, the very presence of neurofilaments in tangles and plaques has been questioned because of a reported cross-reaction of mAbs to phosphorylated neurofilaments with tau protein. On reinvestigating this cross-reactivity we found that four of five mAbs to phosphorylated neurofilaments and four of five mAbs to nonphosphorylated neurofilaments failed to react with tau protein. A fifth mAb (07-5) to phosphorylated neurofilament cross-reacted with partially denatured tau protein at an affinity 1/1700th of that for denatured neurofilaments; nondenatured tau protein in tissue sections did not cross-react. A fifth mAb (02-40) to nonphosphorylated neurofilament also cross-reacted weakly. In Alzheimer disease normal-appearing axons were revealed with all the mAbs to phosphorylated neurofilaments, but tangles were revealed with only one of them (mAb 07-5). mAb to tau protein did not stain or did so indistinctly. Four of five mAbs to nonphosphorylated neurofilaments failed to reveal axons. Upon dephosphorylation of tissue, staining by mAbs to phosphorylated neurofilaments disappeared, and axons were revealed with the mAb to tau protein and all mAbs to the nonphosphorylated neurofilaments. Tangles became stained with tau mAb and one mAb to the nonphosphorylated neurofilaments (mAb 10-1). Quantitative evaluation of immunocytochemical staining intensities and immunoblot cross-reactivity showed that neurofilaments are, indeed, constituents of tangles--apparently exceeding the concentration of tau protein 17-fold. Contribution of both conformation and primary structure to IgG specificity may explain the lack of any cross-reaction of mAbs to neurofilaments with tau protein in intact tissue and the appearance of cross-reaction in immunoblots where conformation specificity may be largely lost. The present data extend earlier findings of abnormal processing of neurofilaments and tau protein in Alzheimer disease and, together with reported abnormal processing of cerebrovascular amyloid beta-protein, suggest that inhibition of the processing of multiple proteins is basic to the pathogenesis of Alzheimer disease, whereas formation of plaques and tangles could be merely the most striking histologic result.
Adult↗
[Anemia and hemostatic abnormalities associated with multiple myeloma].
Anemia and bleeding are commonly observed in patients with multiple myeloma (MM). Anemia in MM is multifactorial in origin. Three common causes are marrow replacement by the malignant cells, thereby reducing the available number of BFU-E, chronic renal failure and shortening of the half life of erythrocytes. Some patients with anemia but without renal failure show a good response to erythropoietin (Epo) with full correction of anemia. This indicates that human Epo is a promising therapeutic tool or treating myeloma-associated anemia. The incidence of severe bleeding complications is low, despite the diversity of abnormal hemostatic tests in patients with MM. These patients frequently show abnormal coagulation tests, including thrombin time, fibrin degeneration products, platelet aggregation tests and bleeding time. The most effective therapeutic approach to bleeding is to treat the underlying malignancy. Supplemental to this, plasma exchange is useful.
Anemia↗
Abnormal glutamic acid metabolism in multiple sclerosis.
We have found extensive amino acid abnormalities in multiple sclerosis sera. The most consistent abnormality is an elevation in serum glutamate, which is most striking during relapses. The increase in glutamate in the patients does not occur sharply during the onset of the relapse. Instead it appears to rise gradually within a month or two prior to the onset of the clinical relapse, to reach a peak during the relapse and then to slowly decline.
Female↗
Fraser syndrome with bladder pseudoexstrophy.
We report a one year old girl with Fraser Syndrome (the association of craniofacial abnormalities, syndactaly and cryptophlamos) and multiple urogenital abnormalities including clitorimegaly, left renal agenesis and a unique urinary bladder exstrophy variant (psuedoexstrophy) with intact bladder which herniates through the lower abdominal wall defect.
Abnormalities, Multiple↗
Multiple unrelated clonal abnormalities in host bone marrow cells after allogeneic stem cell transplantation.
A 22-year-old man with chronic myeloid leukemia (CML) received fractionated total body irradiation (TBI) (1440cGy) and etoposide (60 mg/kg) followed by infusion of 10 x 10(6) /kg CD34+ selected stem cells from his mother. Donor and recipient were 50% matched at the HLA-A and -B loci and 100% at HLA-DR. Mixed lymphocyte culture reaction was negative. Post-stem cell transplant (SCT) immunosuppression consisted of antithymocyte globulin, cyclosporine, and prednisone, and was discontinued after 7 months. The donor graft was rejected 2 years post-SCT. At 7 years post-SCT, he is clinically well with normal blood counts and no evidence of CML or myelodysplasia despite the presence over 6 years of multiple clones with balanced translocations and deletions in host bone marrow cells. The emergence of clonal hematopoiesis may provide insights into therapy-related leukemogenesis.
Adult↗
Gene abnormalities may lead to multiple system defects for heart patients.
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Abnormalities, Multiple↗
Bortezomib therapy response is independent of cytogenetic abnormalities in relapsed/refractory multiple myeloma.
Myeloma patients with unfavorable molecular cytogenetics have a poor prognosis irrespective of treatment with conventional chemotherapy or autologous stem cell transplant. To investigate whether bortezomib, a new proteasome inhibitor, is active in relapsed/refractory myeloma patients with genetic risk factors, we evaluated the outcome of 65 patients and correlated the clinical response with 13q deletion, translocations t(11;14) and t(4;14) and CKS1B amplification as detected by interphase cytoplasmic fluorescence in situ hybridization (cIg-FISH). Thirty-seven of 61 (61%) evaluable patients had an objective response to bortezomib with median progression free (PFS) and overall survivals (OS) of 9.5 and 15.1 months, respectively. Of 43 cases with evaluable bone marrows, cIg-FISH determination of del(13q), t(4;14), t(11;14) and CKS1B amplification was done on 40, 41, 41 and 37 cases and the frequency of their detection was 35%, 15%, 15%, and 32%, respectively. There was no statistically significant difference in response to bortezomib for patients with or without 13q deletion (77% versus 50%), t(4;14) (67% versus 56%), t(11;4) (33% versus 62%), or CKS1B amplification (67% versus 57%). Furthermore, there was no statistically significant difference in PFS or OS following bortezomib therapy between patients with or without these molecular cytogenetic abnormalities. Our data suggest that, in this pilot study, bortezomib is an effective salvage therapy for refractory/relapsed myeloma, irrespective of genetic risk factors.
Adult↗
Subclinical autoimmunity in recurrent aborters.
Thirty-four women with habitual abortion (HA) were evaluated for the presence of lupus-associated autoantibodies, antisperm antibodies, and evidence of complement abnormalities. A control group of women who had only successful pregnancy outcomes also was studied. Fourteen HA women had anatomic, genetic, or hormonal causes for their pregnancy losses ("explained losses"), and 20 had no apparent causative factors ("unexplained losses"). Fifty percent of HA women with unexplained losses and 34% of women with explained losses had at least one abnormal result, but multiple autoimmune abnormalities were found only in women with unexplained losses. Anticardiolipin antibodies were found most commonly (30% of all HA women and 8% of controls). Two clinically normal HA women had multiple autoantibodies detected. This study suggests that recurrent pregnancy loss may be a marker for subclinical autoimmune disease.
Abortion, Habitual↗
Clonal karyotype abnormalities and clinical progress in the myelodysplastic syndrome.
Clonal karyotype abnormalities in 124 patients with myelodysplastic syndrome are reviewed. 36% of patients had abnormalities at referral, the most common being 5q-, +8 and lesions of chromosomes 7 and 20. Reduced survival was associated with the presence of either single or multiple clonal abnormalities at referral, abnormalities of chromosome 7 or 8 (either alone or with other lesions) and exclusively abnormal metaphases. The presence of 5q- alone did not appear to affect survival. Sequential studies were carried out in 77 patients of whom 12 showed karyotypic evolution. Reduced survival was observed in patients with an evolving karyotype but appeared to be due almost entirely to evolution in those patients whose initial karyotype was normal. Leukaemic transformation occurred more commonly in patients with an abnormal karyotype, particularly those with multiple abnormalities, and in patients with an evolving karyotype. Although the first appearance of an abnormal karyotype or an apparent evolution are important phenomena, it is probable that in some cases they merely represent expansion of a previously existing clone that has escaped detection. The distinction between true karyotypic evolution or clonal expansion and statistical variations due to small sample size and variability of samples may be difficult but needs to be taken into account in considering clinical significance.
Adult↗
Correlation between cytogenetic abnormalities and disease characteristics in multiple myeloma: monosomy of chromosome 13 and structural abnormalities of 11q are associated with a high percentage of S-phase plasma cells.
BACKGROUND AND OBJECTIVES: Cytogenetic studies in multiple myleoma (MM) are limited by the difficulties in obtaining metaphases that can be investigated and few studies have analyzed the relationship between cytogenetics and clinical disease characteristics. The aim of our study was to analyze the recurrent cytogenetic changes in MM and to correlate them with clinical and biological characteristics including the percentage of S-phase plasma cells (PCs). DESIGN AND METHODS: Chromosomal abnormalities were analyzed in 86 patients with MM. In all patients, two types of cultures (5 d culture with interleukin-4 and unstimulated 72 h culture) were used for cytogenetic analysis. DNA content analysis (ploidy and cell cycle analysis) together with the most relevant clinical and biological disease features were studied. RESULTS: Cytogenetic analysis was successful in 72 of the 86 patients (84%). Forty-seven patients (65%) had an abnormal karyotype. The most frequent trisomies involved chromosomes 3, 5, 9, 11, 15, 19, 22, 1, 7, 17, 18, and 21, and monosomies affected chromosomes 13 and 8, while structural changes involved chromosomes 1, 11, 14q32, 4p16 and 16q22-23. Patients with abnormal karyotype displayed a poor performance status, advanced stage, anemia and a high percentage of bone marrow plasma cells. In addition, MM patients with -13/13q- and 11q abnormalities showed a significantly higher proportion of S-phase PCs (p=0.02). INTERPRETATION AND CONCLUSIONS: In summary, our study shows a relationship between unfavorable cytogenetics (-13/13q-/11q abnormalities) and a high percentage of S-phase PCs, a well-known adverse prognostic factor.
Aged↗
Fanconi anemia: a pleotropic mutation with multiple cellular and developmental abnormalities.
Fanconi anemia (FA), an autosomal recessive disorder of children, is characterized by congenital or childhood aplastic anemia, multiple developmental anomalies, increased incidence of myeloid leukemia, increased spontaneous chromosome breakage, and cellular and chromosomal hypersensitivity to DNA bifunctional crosslinking and alkylating agents. Attempts to understand the biochemical basis of the disorder over the past two and a half decades have resulted in a number of descriptive studies pertaining to cytogenetic and biochemical abnormalities, especially of DNA repair proficiency following treatment with DNA bifunctional crosslinking agents. More recent approaches such as DNA transfection offer the potential for isolation and molecular characterization of the gene. The FA gene is postulated to belong to the family of genes that regulate the development of hematopoietic and other cell types.
Abnormalities, Multiple↗
Multiple serotonergic brainstem abnormalities in sudden infant death syndrome.
CONTEXT: The serotonergic (5-hydroxytryptamine [5-HT]) neurons in the medulla oblongata project extensively to autonomic and respiratory nuclei in the brainstem and spinal cord and help regulate homeostatic function. Previously, abnormalities in 5-HT receptor binding in the medullae of infants dying from sudden infant death syndrome (SIDS) were identified, suggesting that medullary 5-HT dysfunction may be responsible for a subset of SIDS cases. OBJECTIVE: To investigate cellular defects associated with altered 5-HT receptor binding in the 5-HT pathways of the medulla in SIDS cases. DESIGN, SETTING, AND PARTICIPANTS: Frozen medullae from infants dying from SIDS (cases) or from causes other than SIDS (controls) were obtained from the San Diego Medical Examiner's office between 1997 and 2005. Markers of 5-HT function were compared between SIDS cases and controls, adjusted for postconceptional age and postmortem interval. The number of samples available for each analysis ranged from 16 to 31 for SIDS cases and 6 to 10 for controls. An exploratory analysis of the correlation between markers and 6 recognized risk factors for SIDS was performed. MAIN OUTCOME MEASURES: 5-HT neuron count and density, 5-HT(1A) receptor binding density, and 5-HT transporter (5-HTT) binding density in the medullary 5-HT system; correlation between these markers and 6 recognized risk factors for SIDS. RESULTS: Compared with controls, SIDS cases had a significantly higher 5-HT neuron count (mean [SD], 148.04 [51.96] vs 72.56 [52.36] cells, respectively; P<.001) and 5-HT neuron density (P<.001), as well as a significantly lower density of 5-HT(1A) receptor binding sites (P<or=.01 for all 9 nuclei) in regions of the medulla involved in homeostatic function. The ratio of 5-HTT binding density to 5-HT neuron count in the medulla was significantly lower in SIDS cases compared with controls (mean [SD], 0.70 [0.33] vs 1.93 [1.25] fmol/mg, respectively; P = .001). Male SIDS cases had significantly lower 5-HT(1A) binding density in the raphé obscurus compared with female cases (mean [SD], 16.2 [2.0] vs 29.6 [16.5] fmol/mg, respectively; P = .04) or with male and female controls combined (mean [SD], 53.9 [19.8] fmol/mg; P = .005). No association was found between 5-HT neuron count or density, 5-HT(1A) receptor binding density, or 5-HTT receptor binding density and other risk factors. CONCLUSIONS: Medullary 5-HT pathology in SIDS is more extensive than previously delineated, potentially including abnormal 5-HT neuron firing, synthesis, release, and clearance. This study also provides preliminary neurochemical evidence that may help explain the increased vulnerability of boys to SIDS.
Binding Sites↗
Tibial/femoral hypoplasia with "hook" pelvis: a potentially unique dysostosis.
We report a 2-year-5-month-old girl with malformed lower limbs. The radiographic skeletal survey revealed agenesis of the ilio-pubic rami with pubic dehiscence, right hip dislocation, bilateral coxa vara, short femurs, femoro-tibial synchondrosis, bilateral hypoplastic tibiae more severe on the left side, and hypoplastic left calcaneus and talus. To the best of our knowledge, this combination of multiple congenital skeletal abnormalities has not been reported before.
Abnormalities, Multiple↗
Identification of multiple chromosome 12 abnormalities in human testicular germ cell tumors by two-color fluorescence in situ hybridization (FISH).
The distribution of segments of the short and long arms of chromosome 12 was distinguished by two-color fluorescence in situ hybridization (FISH) in 27 cytogenetically abnormal testicular germ cell tumors (TGCTs). A 12p-specific probe was developed by chromosomal microdissection and sequence-independent polymerase chain reaction (PCR) amplification and was combined with a commercially available whole-chromosome 12 painting probe. The TGCTs included both i(12p)-positive and i(12p)-negative primary tumors and lymph node metastases from patients in clinical stage I or stage II who were not previously treated with chemotherapy. Rearrangements of the short arm of chromosome 12 and overrepresentation of 12p DNA sequences were found in all cases. In addition, cryptic rearrangements of 12p were found in 39% (7/18) of the i(12p)-positive tumors and in 78% (7/9) of the i(12p)-negative tumors. Only 7% (2/27) of all tumors had cryptic rearrangements of 12q.
Chromosome Aberrations↗