Ullrich-Turner phenotype with unusual manifestation in a patient with mosaicism 45,X/47,XX,+18

We report on a girl with Ullrich-Turner phenotype and 45,X/47,XX,+18 chromosomal mosaicism. Only two other patients with similar mosaicism have been reported, both girls with XY sex chromosome constitution. The face of the patient was highly asymmetric, the right side being almost normal, the left showing a typical Ullrich-Turner syndrome appearance. This clinical impression was strengthened by photographic doubling of both hemifaces. The patient had normal intelligence and did not show any stigmata of trisomy 18. © 1996 Wiley-Liss, Inc.     

肾病综合征患儿治疗前后血浆leptin、血清IL-6和IL-18水平的变化及临床意义

目的:探讨了肾病综合征患儿治疗前后血浆leptin和血清IL-6、IL-18水平的变化及临床意义.方法:应用放射免疫分析和酶联法对31例肾病综合征患儿进行了治疗前后血浆leptin和血清IL-6、IL-18的检测,并与30名正常健康儿作比较.结果:肾病综合征患儿在治疗前血浆leptin和血清IL-6、IL-18水平均非...     

Syndromes associated with deletion of the long arm of chromosome 18[del(18q)]

We studied eight persons whose karyotypes demonstrated deletion of a portion of the long arm of chromosome 18. Seven of these persons who showed the typical del(18q) syndrome had a common deletion in band 18q21, most likely band q21.3, and in at least two persons the deletion was interstitial. Another mentally retarded child, dissimilar in appearance, had a more proximal deletion within band 18q12. Two different clinical syndromes resulted from deletions of these different segments of the long arm of chromosome 18.     

Duplication 18q syndrome

Some variation in the phenotype of patients with dup(18q) is recognized. Our patient has the phenotype described for dup(18qter).     

Monosomy 18q 12.1→21.1: A recognizable aneuploidy syndrome? Report of a patient and review of the literature

This report of a patient with an interstitial deletion 18q and review of previously described cases suggest a clinically recognizable syndrome. The phenotype appears to result from a microdeletion of part of 18q12.2 or q12.3, or a deletion of parts of both bands. © 1992 Wiley-Liss, Inc.     

Preferential loss of the paternal alleles in the 18q- syndrome

Individuals with the 18q- syndrome have variable deletions from the long arm of chromosome 18. They also exhibit a highly variable phenotype. To correlate genotype with phenotype accurately, extensive molecular and phenotypic analyses are needed on each affected individual. As a part of this analysis, we have determined the parental origin of the deleted chromosome in 34 individuals with the 18q- syndrome. We have found that 85% of the de novo deletions are paternal in origin. The percentage of fathers of individuals with paternally derived deletions who were >30 years old was (not significantly) greater than that of the general population. The mothers of individuals with maternally derived deletions were near an average age for childbearing compared to the general population. Individuals with maternally derived terminal deletions had breakpoints as varied as those with paternally derived deletions. These results are consistent with the hypothesis that the reduced incidence of maternally derived deletions is not due to reduced viability, since individuals with large maternally derived deletions of chromosome 18q were found. We hypothesize that the prevalence of paternally derived deletions is due to an increased frequency of chromosome breakage in male germ cells. These results are consistent with results observed in other segmental aneusomies in which there is a high incidence of paternally derived deletions. Am. J. Med. Genet. 69:280–286, 1997. © 1997 Wiley-Liss, Inc.     

Contribution to the 18q- syndrome. A patient with del (18) (q22.3qter)

A patient with the typical features of the 18q- syndrome, but with the deletion restricted to the most distal part, bands q22.3----qter is reported. The cytogenetic finding is supported by a decrease in activity of the enzyme peptidase A.     

Growth hormone deficiency associated in the 18q deletion syndrome

The 18q- syndrome is one of the commonest deletion syndromes. Clinical characteristics are variable but may include: hypotonia, tapered digits, “carp-like” mouth, mental retardation, and hearing impairment. Growth failure (GF; both weight and height <3%) was reported in 80% of affected individuals. We evaluated growth hormone (GH) sufficiency in 5 18q- syndrome patients, 3 of whom had growth failure (<3% weight and height); the remaining 2 had normal growth parameters. Laboratory evaluation of growth included measurement of IGF-1, IGFBP-3, bone ages and GH response to pituitary provocative agents. Three patients failed to produced adequate GH following stimulation testing. Of 3 patients with inadequate GH production, 1 had normal growth (above 3%). Only 1 of 5 patients had normal GH production and normal growth parameters. Our findings to date suggest that GH deficiency is common in individuals with the 18q- syndrome. The pathogenesis of this finding is unknown. We postulate that a gene(s) on 18q is involved in GH production. Am. J. Med. Genet. 69:7–12, 1997. © 1997 Wiley-Liss, Inc.     

Partial trisomy 18 with minimal anomalies: Lack of correspondence between phenotypic manifestations and triplicated loci along chromosome 18

A 2-year-old boy with microcephaly, developmental delay, and minimal anomalies was found to have an extra submetacentric chromosome equivalent to 18pter-→q12. Review of the phenotypes produced by various triplicated 18 regions supports the hypothesis that no one chromosome 18 region is sufficient to produce the phenotype of trisomy 18. The mild phenotype of trisomy 18p, the variable phenotype of trisomy 18pter-→q12, and the discontinuous phenotype of triplication for band 18q12 alone emphasizes that the contribution of triplicated loci to the phenotype is neither additive nor invariant.     

Identification of iso(18p) marker chromosome by fluorescencein situ hybridization with single-copy DNA probe

Summary The patient displayed the clinical features consistent with tetrasomy (18p) syndrome, who had an extra small metacentric iso(18p) chromosome in otherwise normal karyotype. Identification of the marker chromosome used the chromosome 18 band-specific fluorescencein situ hybridization strategy.     

18q-mosaicism associated with Rett syndrome phenotype

Rett syndrome consists of a characteristic progressive encephalopthy in females. The cause of this syndrome is unknown. We present a patient with 18q-mosaicism who, along with the characteristics of this autosomal deletion, also fulfills the clinical criteria for Rett syndrome. This may demonstrate heterogeneity within this as yet cinically defined syndrome. A thorough chromosomal analysis should be performed in suspected cases of Rett syndrome. © 1993 Wiley-Liss, Inc.     

Rates and survival of individuals with trisomy 13 and 18 Data from a 10-year period in Denmark

Rates and survival figures for trisomy 13 and trisomy 18 have been calculated for Denmark (DK) based on a 10-year period (1977-86). The data have been ascertained through The Danish Central Cytogenetic Register, all cytogenetic laboratories in DK, paediatric departments throughout the country. The Medical Birth Register and The Register of Causes of Death in DK. Nineteen liveborn probands with trisomy 13 and 76 liveborn probands with trisomy 18 were found. No stillborn cases with trisomy 13 but 6 with trisomy 18 were found. By prenatal diagnosis 19 probands with trisomy 13 and 46 with trisomy 18 were found. Based on liveborn and stillborn probands, the prevalence at birth was 1 per 29,374 for trisomy 13 and 1 per 6806 for trisomy 18. The median survival for trisomy 13 was 2.5 days, while the same figure for trisomy 18 was 6.0 days. The rates calculated seem rather low compared to earlier studies.     

Features of trisomy 18 and 18p-syndromes in an infant with 46, XY, i(18q)

An isochromosome for the long arm of chromosome number 18 - 46,XY,i(18q) - was found in an infant who had features of both trisomy 18 and 18p- syndromes. Findings compatible with trisomy 18 included postmature delivery, prominent occiput, severe congenital heart disease, overlapping fingers, and rocker-bottom feet. Those of 18p- syndrome, which frequently resembles Turner syndrome, were downward obliquity to the palpebral fissures, short, webbed neck, low posterior hairline, and widely-spaced nipples. The infant died of heart failure at 3.5 months of age. Parental karyotypes were normal.     

Isolated skeletal malformations in a child with a small mosaic ring microduplication of 18 p11.21q11.2: genotype-phenotype correlations

We describe a developmentally normal Amish child who has a karyotype with 47 chromosomes, including a supernumerary ring-shaped chromosome 18 in each metaphase studied. The only phenotypic findings in the patient were hemivertebrae and rib anomalies. Further analysis of interphase cells revealed an additional, less frequent mosaic, apparently normal cell population. Genes in the triplicated region that possibly are contributing to her skeletal phenotype include GATA6, MC2R, MC5R, RBBP8, ESCO1, and ROCK1, among others. By studying such patients with abnormal genetic dosage, genotype-phenotype correlations can be used to refine gene function.     

Double mosaic aneuploidy: 45, X/47,XY,+8 in a male infant

We report on a 13-month-old boy with abnormalities consistent with mosaic trisomy 8 syndrome and male genitalia with partial peno-scrotal transposition without hypospadias, a retractile left testis in inguinal canal, and an absent right testis. A voiding cystourethrogram showed an outpouching close to the lower right side of the bladder (utriculum) and bilateral hydronephrosis secondary to vesicoureteral reflux. Peripheral blood karyotype was 45,X/47,XY,+8. The karyotype of cultured skin fibroblasts was 47,XY,+8 with no 45,X cells detected among 20 cells counted. Tissues removed during surgery documented a 45,X/47,XY,+8 complement in the left testicle and utriculum, but only a 45,X line among 20 cells counted from vas deferens tissue. A possible mechanism for the origin of this previously unreported mosaicism might be an abnormal zygote with a 47,XY,+8 complement with subsequent simultaneous loss of chromosome Y and 8 in a cell at a very early embryonic stage. © 1992 Wiley-Liss, Inc.     

Congenital heart defects associated with aneuploidy syndromes: New insights into familiar associations

The frequent occurrence of congenital heart defects (CHDs) in chromosome abnormality syndromes is well‐known, and among aneuploidy syndromes, distinctive patterns have been delineated. We update the type and frequency of CHDs in the aneuploidy syndromes involving trisomy 13, 18, 21, and 22, and in several sex chromosome abnormalities (Turner syndrome, trisomy X, Klinefelter syndrome, 47,XYY, and 48,XXYY). We also discuss the impact of noninvasive prenatal screening (mainly, cell‐free DNA analysis), critical CHD screening, and the growth of parental advocacy on their surgical management and natural history. We encourage clinicians to view the cardiac diagnosis as a “phenotype” which supplements the external dysmorphology examination. When detected prenatally, severe CHDs may influence decision‐making, and postnatally, they are often the major determinants of survival. This review should be useful to geneticists, cardiologists, neonatologists, perinatal specialists, other pediatric specialists, and general pediatricians. As patients survive (and thrive) into adulthood, internists and related adult specialists will also need to be informed about their natural history and management.     

Imbalance of interleukin 18 and interleukin 18 binding protein in patients with lupus nephritis

To evaluate the balance status of interleukin 18 （IL-18） and interleukin 18 binding protein （IL-18BP） in circulation in patients with lupus nephritis （LN） and primary nephrotic syndrome （PNS）, plasma levels as well as mRNA expression in peripheral blood mononuclear cells （PBMCs） of IL-18 and IL-18BP were measured by ELISA and RT-PCR respectively. The ratio of IL-18/IL-18BP was also calculated. Both plasma IL-18 and IL-18BP increased significantly in LN patients while only IL-18BP increased in PNS, which resulted in an elevated ratio of IL-18/IL-18BP in LN but not in PNS patients when compared with normal controls. In contrast, increased level of IL-18 mRNA was only detected in LN but not in PNS group, although IL-18BP mRNA expressions in PBMCs in both groups were higher than that in control. The imbalance of IL-18 and IL-18BP might be involved in the pathogenesis of LN, based on which a therapeutic approach is valuable to be developed for LN.     

A retrospective CISS hybridization analysis of a case with de novo translocation t(18;22) resulting in an 18p—syndrome*

Voiculescu I, Toder R, Back E, Osswald P, Schempp W. A retrospective CISS hybridization analysis of a case with de novo translocation t(18;22) resulting in an 18p—syndrome. Clin Genet 1993: 43: 318–320. © Munksgaard, 1993 An unbalanced de novo translocation t(18;22) leading to a severely malformed liveborn girl with 18p—syndrome is described. Using the chromosomal in situ suppression (CISS) hybridization technique on 4-year-old G-banded chromosome preparations, it could be demonstrated that the translocation chromosome is composed of the long arm including the centromere of a chromosome 22 and the long arm of a chromosome 18. Consequently, the patient described here has lost the short arm including the centromere of chromosome 18. The possibility of restudying cytogen-etically unsolved cases in clinical cytogenetics using older G-banded chromosome preparations with the fluorescence in situ hybridization techniques is pointed out.