A previously unrecognised phenotype characterised by obesity, muscular hypotonia, and ability to speak in patients with Angelman syndrome caused by an imprinting defect.

The clinical features of Angelman syndrome (AS) comprise severe mental retardation, postnatal microcephaly, macrostomia and prognathia, absence of speech, ataxia, and a happy disposition. We report on seven patients who lack most of these features, but presented with obesity, muscular hypotonia and mild mental retardation. Based on the latter findings, the patients were initially suspected of having Prader-Willi syndrome. DNA methylation analysis of SNRPN and D15S63, however, revealed an AS pattern, ie the maternal band was faint or absent. Cytogenetic studies and microsatellite analysis demonstrated apparently normal chromosomes 15 of biparental inheritance. We conclude that these patients have an imprinting defect and a previously unrecognised form of AS. The mild phenotype may be explained by an incomplete imprinting defect or by cellular mosaicism.

Syndrome of autosomal recessive polycystic kidneys with skeletal and facial anomalies is not linked to the ARPKD gene locus on chromosome 6p.

We report on two sibs, both males, one born at 37 the other at 24 weeks of gestation, both with a syndrome similar to that seen in three sets of sibs by Gillessen-Kaesbach et al. [1993: Am J Med Genet 45:511-518]. Both propositi had polycystic kidneys and hepatic fibrosis indistinguishable from that seen in autosomal recessive polycystic kidney disease (ARPKD), and skeletal and facial anomalies. Skeletal abnormalities included "butterfly" vertebrae, square shape of pelvis, and brachymelia. The facial anomalies included hypertelorism, epicanthic folds, and anteverted nares. Additional external findings were apparently low-set ears and a short neck. Histopathological examination of the kidneys showed radial orientation and cystic dilatation of the cortical and medullar tubules. The liver showed "congenital hepatic fibrosis." The hepatic findings in the second infant were less severe. Renal abnormalities were limited to focal tubular cystic changes. Linkage analysis with polymorphic markers of the region 6p21.1-p12, flanking the gene locus of ARPKD, showed different haplotypes in the sibs, thus excluding the ARPKD gene locus in this family and indicating genetic heterogeneity.

Patchy dermal hypoplasia as a characteristic feature of Proteus syndrome.

BACKGROUND: The diagnostic criteria of Proteus syndrome include various lesions of localized overgrowth such as digital gigantism, hemihyperplasia with unilateral macrocephaly, epidermal nevus, and mesodermal hamartomas such as lipoma, lymphangioma, hemangioma, or fibroma. Hyperplasia of the plantar dermal tissue may result in a characteristic cerebriform appearance. However, hypoplastic lesions involving various tissues such as subcutaneous fat or muscles also may be observed in this syndrome. This paradoxical phenomenon has so far been underestimated, and the presence of circumscribed lesions of dermal hypoplasia has been entirely ignored. OBSERVATIONS: We report 4 cases of Proteus syndrome associated with large patches of dermal hypoplasia, resulting in a more prominent appearance of venous vasculature. CONCLUSIONS: Patchy dermal hypoplasia appears to be a characteristic feature within the spectrum of Proteus syndrome. The anomaly should not be confused with partial lipohypoplasia that may likewise be associated with this multisystem birth defect. From a review of the literature, we conclude that patchy dermal hypoplasia may have occurred in several previous cases. In the future, recognition of this cutaneous anomaly may help to establish the diagnosis in otherwise doubtful cases. To explain the coexistence of lesions of dermal hyperplasia and hypoplasia, we propose the genetic concept of "twin spotting." At the gene locus of Proteus syndrome the embryo would carry 1 allele giving rise to dermal overgrowth, whereas the corresponding allele would be responsible for a diminished proliferation of cutaneous fibroblasts. Somatic recombination may result in 2 different populations of cells homozygous for either allele.

[Effect of heredity and environment in immune diseases. Presentation of twin data]. / Der Einfluss von Erbe und Umwelt bei Immunerkrankungen. Darstellung anhand von Zwillingsdaten.

BACKGROUND: The study of twins is an important and informative tool in the investigation of the influence of genetic and environmental factors on the pathogenesis of familial traits. MATERIAL: Seven diseases were analysed by carrying out an intensive study of the literature to search for concordance of monozygotic and dizygotic twins. Apart from single case studies, large unselected series have been reported, some of which show considerable differences in concordance rates. Data from twins were collected for myasthenia gravis, systemic lupus erythematosus, rheumatoid arthritis and type 1 diabetes mellitus, Crohn's disease and, for comparative purposes, also type 2 diabetes mellitus. RESULTS: On the basis of the above-mentioned calculated concordance rates, differences in the influence of genetic factors were established, which may be of importance for the genetic counselling of affected families. These findings based on twins also confirm the multifactorial inheritance model.

[Blood relationship]. / Blutsverwandtschaft.

In every-day medical practice, blood relationship of spouses hardly ever play an important part. Mainly for genetic counselors and pediatricians the question of consanguinity of a child's parents arises when either a rare, often hereditary, disorder is diagnosed for the first time in a family, or potential parents want information on the risk for hereditary diseases. A probability calculus based on the corresponding hereditary factors of the joint ancestors establishes how likely homozygotes for hereditary diseases among the offspring of [blood]-related spouses - often cousins of the first or second degree - is. Furthermore, proof of the parents' consanguinity may explain a child's unexpected hereditary disease [especially autosomal recessive disorders] and, at the same time, it means a higher risk of repetition for the affected child's desired siblings. Incest represents a special form of genetic risk; this question arises either in connection with the adoption of a child, which was conceived by an incestuous couple, or with such a child's own family planning later on. Even the parents' descent from an ethnically, politically, religiously or linguistically isolated background may gave a similar impact on the appearance of hereditary disorders: an accumulation of rare genes has to be taken into account; factors causing disorders have to be expected among these genes, too. In the following, all major aspects of the situations described above will be given in detail.

[Genetic counseling in Sjögren-Larsson syndrome (author's transl)]. / Genetische Beratung bei Sjögren-Larsson-Syndrom.

Oligophrenia, ichthyosis, and spastic di- or tetraplegia are the main symptoms of Sjögren-Larsson syndrome. Additional findings in some cases are speech defects, seizures, small stature, and changes of the eye. In 1957 the Swedish authors first described this syndrome, untill now there are some 125 cases, on which the diagnosis can be made certainly. Sjögren-Larsson syndrom follows the autosomal recessive mode of inheritance. Therefore genetic counseling seems to be of great value in families with this syndrome.

[Genetic counseling, a contribution to family planning]. / Genetische Beratung ein Beitrag zur Familienplanung

Since introduction of oral contraceptives "family planning" is mostly understood as birth control. In contrast the gynecologist and the genetic counselor are often confronted with the desire of proconceptive methods. The counselor has different possibilities in family planning: reduction of the age of reproduction; consideration of "safety interval" between the birth of children: a. in families affected with a hereditary disease with late manifestation, b. after exposition to x-rays, cytotoxic or immunosupressant agents; warning against reproduction in case of high genetic risk and missing of prenatal diagnostic procedures; application of modern diagnostic procedures, i.e. detection of carrier in affected families, i.e. prenatal diagnostics. Genetic counseling is a way to help to plan his family, specially in families affected with hereditary diseases and other risks.

[Cardiac involvement in urticaria]. / Kardiale Mitbeteiligung bei Urtikaria.

Cardiac involvement in patients with urticaria is rare, but repeatedly assured in publications. Subjective complaints concern chest pain, which extends to the left shoulder and the left arm. Transient electrocardiographic changes can be observed more frequently and they often persist longer than the ches pain. In these patients the most frequent electrocardiographic changes consist in flattening or inversion of the T-wave and depression of the ST-distance. Such a patient is described who additionally showed monotopic extrasystoles.

[Children of diabetic parents--on the question of developmental disorders in pregnancy with special reference to the so-called risk child]. / Kinder diabetischer Eltern--Zur Frage von Entwicklungsstörungen während der Schwangerschaft mit besonderer Berücksichtigung des sogenannten Riesenkindes.

On the basis of 3 different patient collectives the question of the birthweight of infants with one diabetic parent is considered, and in particular whether paternal diabetes is a causative factor in the birth of macrosomatic children. Diabetes in more distant relatives is also discussed. It is confirmed that there is a relationship between diabetic metabolism of the mother and macrosomatia of the newborn; however, no influence of paternal diabetes on the birthweight of the children can be found. According to this study, miscarriages and stillbirths are more frequent in women with diabetes mellitus than in the general population. The need for intensive monitoring of the metabolism of (pre)diabetic women during pregnancy is pointed out.

[The Rubinstein-Taybi syndrome (author's transl)]. / Das Rubinstein-Taybi-Syndrom.

The clinical picture of the Rubinstein-Taybi syndrome is characterized by mental retardation, broad thumb and large toe, beaky nose, antimongloid lid axis and numerous morphological signs. The patients resemble one another so that in many instances the diagnosis can be made on sight. Three cases are described. The exact differentiation from other abnormalities with mental retardation is important, especially in genetic counselling of the affected families.