Change in prevalence of congenital defects in children with Prader-Willi syndrome.

OBJECTIVE: The aim of this study was to assess the prevalence of congenital defects observed in patients with Prader-Willi syndrome (PWS) and to compare this prevalence with that described in the general population. In addition, these findings were correlated with the different etiologic subtypes. METHODS: A total of 180 children with PWS followed for 13 years were included in this study. Diagnosis was confirmed by the methylation test, and genetic subtypes were established by using fluorescence in situ hybridization or multiplex ligation-dependent probe amplification and microsatellite analyses. The prevalence of congenital defects was compared with national and international registries of congenital defects in the general population (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas, European Surveillance of Congenital Anomalies, and the New York Registry). RESULTS: Twenty-two percent of the patients presented congenital defects with a risk of 5.4 to 18.7 times higher than that of the general population. The most frequent congenital defects were heart defects, renoureteral malformations, vertebral anomalies, hip dysplasia, clubfoot, and agenesis/hypoplasia of the corpus callosum. Each of these congenital defects was significantly more frequent in the children with PWS than in the general population. The congenital heart defects were more frequent in girls than in boys with PWS. No significant differences were found when the defects were correlated with the different etiologic subtypes. CONCLUSIONS: An increased prevalence of congenital defects was found in our PWS patients. This finding suggests the need for further studies in PWS children that allow physicians to detect the congenital defects found in this series and, thus, to anticipate complications, with the ultimate aim of enhancing the management of PWS patients.

Hipotiroidismo central en pacientes con el síndrome de Prader-Willi durante los 2 primeros años de vida / Central hypothyroidism in patients with Prader-Willi syndrome during the first 2 years of life

Introducción. El síndrome de Prader-Willi SPW) es un trastorno genético causado por la pérdida de expresión de genes de origen paterno en la región cromosómica compleja 15q11-q13. El fenotipo clínico ha sido bien caracterizado, especialmente relacionado con la disfunción hipotalámica. Aunque entre 20 a 30% de los pacientes con SPW tienen hipotiroidismo central (HC), no ha sido bien definida la función tiroidea durante los dos primeros años de vida. Objetivo: evaluar la función hipotalámica-pituitaria-tiroidea en lactantes con SPW. Diseño del estudio: 18 pacientes con SPW entre 0,16 y 2 años de edad fueron incluídos en un estudio prospectivo. El diagnóstico de SPW se basó en los hallazgos clínicos y en el análisis molecular. Se calcularon los escores de desviacion estándar (SDS) de la T4 total (T), T4 libre (L), T3 y TSH en suero en todos los pacientes incluídos en el estudio. Resultados: En 14 de los 18 pacientes con SPW, se encontraron niveles de T4T y/o T4L menores a -2 SDS (44,4 y 55,5%, respectivamente), mientras que solamente en 1 paciente con SPW el nivel de T3 estaba por debajo de -2 SDS. Conclusión: Este estudio muestra que la incidencia de HC es alta en lactantes con SPW. Los pediatras deben tener en cuenta el diagnostico de HC en este período crítico de la acción de la hormona tiroidea en el desarrollo neurológico (AU)

Introduction. Prader-Willi syndrome (PWS) is a genetic disorder caused by the loss of expression of paternally transcribed genes in a highly imprinted region of chromosome 15q11- q13. The clinical phenotype has been well characterized, mostly related to hypothalamic dysfunction. Even though central hypothyroidism (CH) has been documented in 20 to 30% of PWS patients, thyroid function has not been well characterized during the first 2 years of life. Objective: to evaluate hypothalamic-pituitary-thyroid function in infant PWS patients. Study design: Eighteen PWS patients, aged 0.16 to 2 years, were included in a prospective study. PWS diagnosis was based on clinical features and molecular analysis. Serum total (T) T4, free (F) T4, T3 and TSH standard deviation scores (SDS) were calculated in all PWS patients included in the study. Results: In 14 out of 18 PWS patients, serum TT4 and/or FT4 levels less than -2 SDS ( 44.4 and 55.5 %, respectively) were found, while in only 1 PWS patient serum T3 levels was below -2 SDS. Conclusion: This study shows that there is a high incidence of CH in infant PWS patients. Pediatricians should be aware of this diagnosis in this critical period of thyroid hormone action on neurological development (AU)

Caracterización de las alteraciones del metabolismo de los hidratos de carbono en una población de nIños con Sindrome de Prader Willi / Characterization of carbohydrate metabolism disturbances in a children population with Prader Willi Syndrome

Estudiar el metabolismo de los hidratos de carbono y la sensibilidad y secreción de insulina en niños y adolescentes con sindrome de Prader Willi (SPW) comparados con niños con obesidad multifactorial (OM) como grupo control. Material y métodos: fueron evaluados 75 niños con SPW y 395 con OM con test de tolerancia a la glucosa oral. La resistencia a la insulina y función de celula fueron medidos por el modelo homeostático (HOMA IR Y HOMA beta cell), índice insulina /glucosa, insulina en ayunas e índice de sensibilidad a la insulina. Resultados: La prevalencia de diabetes fue 0% en SPW y 1.5% en OM mientras que la intolerancia a la glucosa fue de 9,3% en el primer gurpo y 7,6%en los obesos controles (p no significativa) El valor de la insulina basal (12 más menos 8,2 vs 22.3 más menos 25 mU/ml) ay el HOMA- IR (2.47 más menos 1.6 vs 4.18 más menos 5.05) fue más bajo en los pacientes con S PW (p 0.004 y 0.04, respectivamente), mientras el índice HOMA fue más bajo en el SPW que en los OM (59 más menos 42 vs 102 más menos 119, p 0.03). El índice ISI composite fue más alto en el SPW comparado al grupo de OM (6 más menos 5.7 vs 4.18 más menos 5.05, p 0.04). Conclusión: los niños con Sindrome de Prader Willi mostraron a igual nivel de obesidad menor resistencia a la insulina pero mayor alteración en la secreción que la obesidad multifactorial. Esto sugiere mecanismos diferentes en la alteración del metabolismo de los H de C de la población con el sindrome

A combination of five short tandem repeats of chromosome 15 significantly improves the identification of Prader-Willi syndrome etiology in the Argentinean population

Prader-Willi syndrome (PWS) is a multisystemic disorder caused by the loss of expression of paternally transcribed genes in the PWS critical region of chromosome 15. Various molecular mechanisms are known to lead to PWS: deletion 15q11-q13 (75% of cases), maternal uniparental disomy (matUPD15) (23%) and imprinting defects (2%). FISH and microsatellite analysis are required to establish the molecular etiology, which is essential for appropriate genetic counseling and care management. We characterized an Argentinean population, using five microsatellite markers (D15S1035, D15S11, D15S113, GABRB3, D15S211) chosen to develop an appropriate cost-effective method to establish the parental origin of chromosome 15 in nondeleted PWS patients. The range of heterozygosity for these five microsatellites was 0.59 to 0.94. The average heterozygosity obtained for joint loci was 0.81. The parental origin of chromosome 15 was established by microsatellite analysis in 19 of 21 non-deleted PWS children. We also examined the origin of the matUPD15; as expected, most of disomies were due to a maternal meiosis I error. The molecular characterization of this set of five microsatellites with high heterozygosity and polymorphism information content improves the diagnostic algorithm of Argentinean PWS children, contributing significantly to adequate genetic counseling of such families.

Frog lim-1-like protein is expressed predominantly in the nervous tissue, gonads, and early embryos of the bivalve mollusc Mytilus galloprovincialis.

In a few well-known cases, the biological consequences of the disruption of lim-1 homeodomain (HD) genes have demonstrated the important roles of these genes in vertebrate development, especially in the nervous tissue, kidney, and gonads. Functional assay approaches require information not only about lim-1 gene organization, but also about properties and tissue localization of Lim-1 proteins. Although lim-1 genes have been identified in certain phyla of invertebrates, no information is available on Lim-1 proteins and genes in bivalve molluscs. Our study represents the beginning stage of identification of the Lim-1-related proteins in marine bivalves. Using antibodies against the C-terminal region of the Xenopus laevis Lim-1 protein, we describe cross-reactive antigen patterns in adults and early embryos of the mussel Mytilus galloprovincialis, as well as in sea urchin and chick embryos. In adult mussels, nervous ganglia and gonads display the most prominent Lim-1 immunoreactivity. Further, the antibodies verified the prediction that mussel Lim-1 antigens, like Lim-1 HD proteins in general, can be localized in the nucleus. Moreover, antibody detection allowed us to identify the Lim-1-like antigens in unfertilized mature eggs, as well as in very early embryos of bivalve molluscs and sea urchins (Strongylocentrotus purpuratus). In mussel eggs and embryos, Lim-1 antigens are expressed in multiple forms (40, 45, and 65 kDa), as detected by SDS-PAGE followed by Western blot. Taken together, the observations emphasize the conservation of the Lim-1 protein expression pattern in the nervous tissue and gonads of different animal groups, and demonstrate that Lim-1-like polypeptides can be maternally accumulated in eggs and, therefore, are present in very early embryos before zygotic expression of the genes begins.

Male-associated polypeptide (MAP) expression in different compartments of the reproductive system of the mussel Mytilus galloprovincialis: immunocytochemical and western blot study.

Mytilus mussels are characterized by annually repeated reproduction which is associated with subsequent growth, morphogenesis, breakdown and redevelopment of the gonad and reproductive tract into mantle mesenchyme. We present a description of the expression of the male-associated polypeptide (MAP; see Mikhailov et al. 1995) in different compartments of the male reproductive system as well as in mantle gonad-supporting tissue. MAP is expressed in both gonad and mantle structures in dynamic patterns that show a substantial overlap in terms of dependence on the stage of gonad development/involution. In general, the total MAP concentration directly correlates with the volume of gonad tubule/duct structures but inversely correlates with mantle connective tissue cell fraction. A maximum of MAP expression is reached in the fully ripe male gonad. MAP is localized around gonad tubules/ducts, in the gonoduct epithelium, membranes of follicle-like structures as well as in the extracellular fiber-like structures of the mantle. However, we also demonstrate unique sites of MAP accumulation in the lumen of gonad follicle-like tubules and in ductal fluid. The latter is characterized by a very high MAP concentration. MAP is also detected in sperm-containing cell suspension obtained by gonad biopsy which we interpret as a result of the adsorption of MAP on mature spermatozoa. The results obtained should be taken into consideration in the interpretation of possible MAP functions since they seem to point to MAP as a major component of ductal (seminal) fluid of the male reproductive tract. It is likely that MAP is able to complement the processes of sperm terminal differentiation and maturation. In addition, we demonstrate that the male-predominant character of MAP expression is restricted by gonad-containing tissues (i.e., mantle and visceral mass) only, although the polypeptide is also detected in other somatic organs in both males and females.

Lymphedema as a postulated cause of cutis verticis gyrata in Turner syndrome.

Unusual skin lesions were present at birth in four infants with Turner syndrome. The skin changes in these patients appear to have resulted either from in utero entrapment or pinching of edematous skin or from redundant skin remaining after in utero resolution of lymphedema. Distention by lymphedema is thought to cause several of the phenotypic characteristics seen in patients with Turner syndrome, including nuchal webbing and nail changes. In three of these patients the clinical appearance of the skin changes was similar to cutis verticis gyrata, marked by fixed thickened plaques in folds.

Male-predominant carboxylesterase expression in the reproductive system of molluscs and insects: immunochemical and biochemical similarity between Mytilus male associated polypeptide (MAP) and Drosophila sex-specific esterase S.

We suggested that sexual differentiation of the reproductive system in gonochoric species of invertebrates can be characterized by common molecular mechanisms in spite of high morphological divergences of reproductive tract organs in different animal groups. The present study focused on this problem and report our observations on biochemical characteristics of male-associated polypeptide (MAP) identified in the gonad tissue of bivalve molluscs, Mytilus galloprovincialis, in comparison to those of male-specific carboxylesterase (esterase S) of Drosophila virilis ejaculatory bulbs. We provide evidences for the immunochemical similarity of Mytilus MAP and Drosophila esterase S. We also show that MAP is characterized by esterase activity toward both, alpha- and beta-naphthyl acetates. Using immunofluorescence, we found MAP in the gonad (mantle) connective tissue, membranes of follicles and around gonad ducts but not in sperm cells. Nevertheless, the levels of MAP expression depend on presence or absence of ripe spermatozoa in the gonad follicles. In mature gonads before spawning, MAP is expressed at high level, while in the spent gonads only traces of this polypeptide could be detected. Using Western immunoblot, MAP was not observed in spermatozoa obtained by biopsy of gonad follicles. In contrast, we found this protein in spawned sperm cells. Thus, we suggest that spawning may be required to establish the trafficking mechanisms that control whether MAP is retained or excreted by the gonad. Taken together, the results indicate that MAP of M. galloprovincialis is structurally and functionally related to esterase S of D. virilis ejaculatory bulbs.

Sexual differentiation of reproductive tissue in bivalve molluscs: identification of male associated polypeptide in the mantle of Mytilus galloprovincialis Lmk.

We have addressed the question of sexual reproductive tissue dimorphism in bivalve molluscs, Mytilus galloprovincialis Lmk, which is a stable gonochoric species although with no apparent differences in gonad morphology of both sexes. At all periods of the annual cycle the proteins specific of male/female gonads were identified. One of these proteins, "male-associated polypeptide" with apparent MW 39 kDa (MAP-39), has been biochemically and immunochemically characterized. MAP-39 concentration in male mature gonads achieved up to 10% of the total soluble protein while in female ones only traces of this protein could be detected. In male mantle, MAP-39 expression was associated with the process of gonad development and maturation as well as gamete spawning, although this polypeptide has been localized in fibroblast-like cells, membrane of follicles and connective tissue matrix of the mantle but not in germinal cells.

A continuous spectrum of hypercoagulability exists in acute nonlymphoblastic leukemia.

A consumption coagulopathy syndrome has frequently been reported in association with some cases of acute nonlymphoblastic leukemia (ANLL) and mainly in acute promyelocytic leukemia (M3). Eighteen cases of ANLL have been studied on admission, before chemotherapy was started. Levels of antithrombin III (AT-III), protein C (PC), protein S (PS), thrombin-antithrombin complex (T-AT-III), tissue plasminogen activator, plasminogen (Pg), alpha-2-antiplasmin (alpha-2-AP), D-dimer (DD) and fibrinogen (Fg) were determined. The results showed normal levels of AT-III and PS, decreased levels of PC, alpha-2-AP, Pg and Fg in some cases, and an elevation of DD and T-AT III complex in almost all patients. There was a continuous evolution of data from M1 cases in which only slight alterations were seen up to M3 cases where all those pathologic data were observed.

High plasma urokinase-type plasminogen activator levels are present in patients with acute nonlymphoblastic leukemia.

An exaggerated hemorrhagic syndrome is a characteristic in acute non-lymphoblastic leukemia (ANLL) and it determines the patient's outcome. Disseminated intravascular coagulation as a result of a procoagulant factor release and primary hyperfibrinolysis due to plasminogen activators also released by leukemic cells have been implicated in the development of this syndrome. The aim of this work was to evaluate urokinase-type plasminogen activator (u-PA) and related parameters of the fibrinolytic system in 14 ANLL patients. Our results showed an increased u-PA concentration in ANLL patients compared to controls [2.63 (1.61-4.62) vs. 0.95 (0.77-1.48) ng/ml, p < 0.01]. u-PA levels correlated positively with tissue-type plasminogen activator. The relevance of the enhancement of u-PA in this clinical setting was supported by the fact that it was the only analytical parameter positively correlated with patient mortality (p < 0.05). Though u-PA levels do not seem to be the determining factor in the development of the hemorrhagic syndrome of ANLL patients, a contributory role of this plasminogen activator is suggested from our results.

Progeria infantil / Child progeria

Hemos podido estudiar un paciente que por los caracteres clínicos, morfológicos, genéticos creemos corresponde a una progeria. Destacamos los detalles en que basamos nuestro diagnóstico y aquellos elementos negativos que permiten separarlo del síndrome de Hallermann-Streiff

Sindrome de Meckel. / Meckel syndrome

Se presentam 3 casos de sindrome de Meckel Este se hereda como autosomico recesivo e implica, por lo tanto, que luego de tener un hijo afectado el reisgo de otro afectado es del 25% en cada embarazo siguiente.Los signos tipicos del sindrome son: encefalocele, poliquistosis renal,polidactilia postaxial, aunque no necesariamente deban estar los tres presentes. Otras anomalias menos frecuentes que pueden asociarse son: onfalocele, microcefalia, microftalmia,labio leporino y paladar hendido, cardiopatia congenita y genitales ambiguos. Se recalca la importancia del diagnostico clinico y anatomopatologico de los afectados, para poder asesorar geneticamente a los padres, antes de un nuevo embarazo