Microdeletions in interval 6 of the Y chromosome of males with idiopathic sterility point to disruption of AZF, a human spermatogenesis gene

For males with idiopathic sterility, a molecular screen specific for small lesions (microdeletions) in interval 6 of the Y chromosome was set up using 29 Y-DNA probes. A "de novo" microdeletion in Y interval 6 was detected in 2 out of 19 "chromosomally normal" sterile males. The first microdeletion includes the Y-DNA probes pY6HP35 and 12f3; the second microdeletion includes the Y-DNA probes pY6HP52, 49f, FR15-II and the subinterval "C" of probe 50f2. A probe of the pY6H sequence family is present in both deletions. Sequences of this family cross-hybridize to dhMiF1, a DNA sequence of a fertility gene structure on the Y chromosome of Drosophila hydei. It was possible to map the position of the Y-deletion of one patient to the distal part of Yq11.22 or the proximal part of Yq11.23, and the deletion of the second patient to the distal part of Yq11.23. These microdeletions probably do not overlap. Since AZF, a human spermatogenesis gene, has been mapped to Y interval 6, we postulate that the microdeletions detected in this chromosome region affect the functional DNA structure of the AZF gene. If this holds true, it is possible that the AZF locus, cytogenetically mapped to distal Yq11, contains two spermatogenesis genes (AZFa and AZFb) or a large gene structure comparable to the Y fertility genes of Drosophila.

Long-term clinical and angiographic follow-up of patients treated with the self-expanding coronary stent for acute occlusion during balloon angioplasty of the right coronary artery

A self-expanding coronary stent was implanted in 17 patients to treat acute occlusion of the right coronary artery after percutaneous transluminal angioplasty. There were 2 women and 15 men, with a mean age of 59 +/- 8 years. All patients underwent at least one follow-up angiographic examination 4 to 6 months after implantation and six patients had additional follow-up angiography. During a mean follow-up interval of 32 +/- 10 months no patient died or had a myocardial infarction. Restenosis within the stent did not occur. Two patients had a new stenosis adjacent to the stent. Stent occlusion was found on follow-up angiography in one patient who had not been treated with an antiplatelet agent. The mean intraluminal diameter was 2.77 +/- 0.5 mm after implantation and 2.67 +/- 0.5 mm on follow-up angiography. It is concluded that coronary stenting is effective in treating right coronary artery occlusion after balloon angioplasty. Immediate and long-term outcome suggest that the right coronary artery may be a particularly favorable site for stent implantation.

Differential response of kidney and pancreas rejection to cyclosporine immunosuppression

Immunological interferences between kidney and pancreas transplants were investigated in a genetically defined rat model of combined kidney and pancreas transplantation. Kidney and whole-pancreas grafts were transplanted microsurgically either as individual grafts or in a combined technique. Whole pancreas grafts were grafted into streptozotocin diabetic recipients (55 mg/kg bodyweight i.v.) three days after induction of diabetes. The exocrine secretion was suppressed by duct ligation. Rejection of the grafts was defined by recurrence of diabetes in pancreas-grafted recipients and renal failure after kidney transplantation. There were marked differences in the efficacy of identical short-term cyclosporine immunosuppression (15 mg/kg intramuscularly for 14 days): DA kidneys survived indefinitely in LEW rats (MST greater than 100 days), while DA pancreas allografts underwent prolonged but not permanent survival (P less than 0.01) either as individual grafts (MST 27.3 +/- 1,9 days) or when transplanted simultaneously together with the kidney (44 +/- 16 days) (P less than 0.01). LEW rats carrying a DA kidney for 100 days also rejected a subsequent donor-specific pancreas transplant within 30 days. The histological alterations in the kidney were more pronounced than after cyclosporine-induced DA kidney long-term survival alone. By contrast to the rejecting subsequently transferred pancreas, a metachronous second DA kidney was permanently accepted (greater than 100 days) without further immunosuppression after removal of the first graft, while unrelated LEW. 1U kidneys were acutely rejected. In summary, the results indicate that there are not only quantitative differences of kidney and pancreas allograft survival but also differences concerning the state of immunological unresponsiveness induced by identical cyclosporine immunosuppression. While CsA induces donor-specific immunological unresponsiveness after kidney transplantation, pancreas transplants are all eventually rejected after some differential prolongation of survival. Further investigations on the effects of different MHC and minor alloantigens may provide more insight into the complex immunological situation of individual and combined kidney and pancreas transplantation.

[Value of physiological cardiac stimulation in the treatment of hypertrophic obstructive cardiomyopathy]

Subaortic pressure gradient in hypertrophic obstructive cardiomyopathy (HOCM) is the consequence of a dynamic obstruction of the left ventricular outflow tract linked to the presence of a hypertrophied septum. We tried to induce an altered septal motion electrically by physiologic pacing. We studied 8 patients (6 men, 2 women, mean age 60 +/- 13 years) with symptomatic HOCM, resistant to optimal drug treatment. During a hemodynamic study, dual chamber pacing significantly reduced the preexistent subaortic pressure gradient, from 69 +/- 39 to 34 +/- 26 mm Hg (p less than 0.004), without concomitant reduction of aortic pressure or cardiac output. This reduction was dependent upon a optimized AV interval. A dual chamber pacemaker (PM) was then implanted and programmed to VDD mode and optimized AV delay interval (50-90 ms), warranting full ventricular capture. The follow-up of 3 to 30 months showed a significant reduction of both angina (from NYHA class 3 to 1: p less than 0.009) and dyspnea (from 3 to 2: p less than 0.03). An echo-doppler study in 6 patients proved the persistence of the beneficial effect of the stimulation by showing a significant reappearance of the subaortic pressure gradient after switching off the PM, from 44 +/- 29 in VDD pacing mode to 77 +/- 44 mm Hg (p less than 0.02). We conclude that atrial synchronized ventricular pacing, together with an optimized AV interval, significantly reduces the outflow gradient and improves symptoms in patients with HOCM. An altered ventricular activation sequence with late septal activation is suspected to be the mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

Towards the molecular localisation of the AZF locus: mapping of microdeletions in azoospermic men within 14 subintervals of interval 6 of the human Y chromosome

We have used a series of 30 DNA probes previously mapped to the long arm of the human Y chromosome, to screen a panel of 21 patients with structural abnormalities in Yq, by genomic blot hybridisation. The results have allowed us to construct a detailed map of interval 6 of the Y chromosome, in which 28 of the probes could be assigned to 14 sub-intervals within interval 6. Some probes detect two or more loci within this region, each of which has been localised. The same set of probes has been used to screen a panel of 19 chromosomally normal azoospermic men, two of whom have been found to carry microdeletions within this region. With the completion of this map we have been able accurately to localise these microdeletions within interval 6 and show that they do not overlap. We believe these microdeletions may disrupt the azoospermia factor (AZF) involved in spermatogenesis, and which is known to lie in this region. These results are an important step towards the localisation of the AZF locus.

[Interleukin-6 (IL-6), soluble interleukin-2-receptor (sIL-2R) and microheterogeneity of alpha-! acid glycoprotein (AGP): new markers of the acute-phase reaction?]

Cytokines and the different glycosylation profiles of some acute phase proteins appear to be of great value in investigating the activity of inflammatory rheumatic diseases. Using an ELISA to measure the serum concentration of sIL-2R and IL-6 and an affinity electrophoresis with Concanavalin A as a lectin to determine the microheterogenity of the alpha-1-acid-glycoprotein (AGP), we tested the sera of 63 patients with various rheumatic and infectious diseases and 17 healthy persons and compared the results with the usual markers of inflammation, e.g. erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and with the clinical activity of the disease. ESR, CRP and sIL-2R were significantly elevated (p less than 0.001) in seropositive rheumatoid arthritis (RA) and in acute bacterial infection. ESR and CRP showed a better correlation with the clinical activity of RA than sIL-2R. Marked elevation of IL-6 was found only in 30% of RA patients in the early stage of the acute phase reaction (APR). The AGP reactivity coefficient (AGP-RC) was significantly decreased in RA (p less than 0.01) but increased in bacterial infections (p less than 0.001). Our results show that there is no advantage in measuring sIL-2R in the routine diagnosis of rheumatic diseases. Raised IL-6 levels seem to indicate an early stage of APR. If ESR and CRP are elevated, the AGP-RC helps to differentiate between infection and chronic inflammatory rheumatic diseases.

Soluble interleukin-2 receptors in children with juvenile chronic arthritis

Concentrations of interleukin-2 receptors were studied in sera of 81 patients with pauciarticular-, polyarticular-, and systemic-onset juvenile chronic arthritis using a double antibody "sandwich" enzyme-linked immunosorbent technique. Serum concentrations were significantly increased in all subgroups when compared with the healthy controls. Higher concentrations were found in systemic onset disease than in pauci- or polyarticular onset disease. Serum levels were found to be increased in both inactive and active disease, showing maximal values in patients with systemic features. A correlation to C-reactive protein, alpha 1-acid glycoprotein, and erythrocyte sedimentation was observed. Increased sIL-2R values suggest disease activity despite the absence of clinical symptoms.

Chromosomal in situ hybridization with double-labeled DNA: signal amplification at the probe level

A double-labeling approach was applied to nonisotopic in situ hybridization with individual cosmid and plasmid clones, using digoxigenin or biotin as label and a combination of two separate enzymatic labeling methods. Probe labeling was achieved by nick translation, followed by tailing of the probe by terminal deoxynucleotidyl transferase. The double-labeling method, in conjunction with an improved detection protocol, provides for a higher signal intensity than that obtainable with single-labeled probes.

[Heart contusion as an unusual cause of shock in severe polytrauma]

The reported incidence of myocardial contusion after blunt chest trauma is 7-17%. Only one third of these patients present with significant morbidity. The polytrauma is generally dominated by hypovolemic and traumatic shock. Other causes of hypotension are less common, and may thus be ignored. The standard algorithm of care in multiple trauma care, however, leads to the diagnosis even in these cases, as illustrated by a case of prolonged shock induced by blunt myocardial trauma.

[Pulmonary venous occlusive disease. Case report and literature review]

We present the case of a 64-year-old female patient who died of pulmonary veno-occlusive disease. The patient had suffered for several months from increasing dyspnea and right heart failure. Chest x-ray showed signs of pulmonary hypertension as well as Kerley A- and B-lines and pre-edema and a moderately enlarged heart. The diagnosis of pulmonary veno-occlusive disease was confirmed by open lung biopsy. We compare our case with the other cases of pulmonary veno-occlusive disease (PVOD) published in the literature.

Evidence that LS-2616 (linomide) causes acute rejection of rat allografts protected by cyclosporine but not of long-term surviving allografts

The immunomodulator LS-2616 (Linomide) induces rejection of cyclosporine-protected rat cardiac allografts. The aim of this study was to characterize this rejection in the presence of CsA and to test LS-2616 in other models of permanent graft acceptance in the rat. PVG rat hearts were transplanted heterotopically to Wistar/Kyoto (Wi/Ky) rat recipients on day 0. The recipients were treated orally on days 0-9 with CsA (10-40 mg/kg) and/or with LS-2616 (2.5-160 mg/kg) starting at different times (day -7 -+5) until the day of complete rejection. The addition of LS-2616 (day -1--stop) to CsA (10 mg/kg) resulted in a dose-dependent antagonism of the immunosuppressive effect of CsA with daily doses of 2.5-160 mg/kg. Furthermore, the results were similar, irrespective of whether LS-2616 treatment (160 mg/kg) was started on day -7, -1, +1, +3, or +5. LS-2616 (160 mg/kg) pretreatment of the recipient for 7 days before transplantation was considerably less effective. CsA (20 mg/kg) for 14 days after a PVG to DA transplantation resulted in permanent graft survival. This was not abrogated by LS-2616. Neither was rejection induced in long-term surviving grafts of RT1.C incompatible Lewis recipients. Our data suggest that LS-2616 activates already stimulated and sensitized T cells that are otherwise controlled by CsA.

[Thoracic pain, dyspnea]

A 54-year old patient was admitted to the hospital with chest pain, dyspnea and left-sided pleural effusion, which was confirmed by a radiograph of the chest. In view of an exposure to asbestosis a CT scan of the chest was performed, which showed pleural thickening. The suspected diagnosis of a malignant mesothelioma was confirmed by needle biopsy of a paraaortic lymph node. Because of the existence of metastases a palliative pleurectomy was performed. Histologically a malignant mesothelioma of the biphasic type was found. The patient died less than half a year later from local progression of the tumor.

Long-term follow-up of the first 56 patients treated with intracoronary self-expanding stents (the Lausanne experience)

Fifty-six patients treated with the self-expanding intracoronary stent for acute occlusion during percutaneous transluminal coronary angioplasty (PTCA) or restenosis were followed for 24 to 43 months (mean 34). Successful deployment and positioning were achieved in 55 of 56 patients. Occlusion of the stent was documented in 8 patients, the earliest occurring 30 minutes and the latest 8 months after implantation. Three of the occluded stents were recanalized by PTCA. Coronary artery bypass grafts (CABG) were required in 4 patients: 1 for symptomatic restenosis, 1 for left main stenosis adjacent to the stent and 2 for acute ischemia during the in-hospital stay (less than 7 days). Myocardial infarction occurred in the territory of the stented vessel in 8 patients. Seven patients died between 1 day and 19 months after implantation. Local bleeding complications occurred in 10 patients, with 5 requiring blood transfusion. Restenosis within the stent was angiographically documented in 5 patients (9%). A new lesion in the treated vessel was found in 10 patients, followed by implantation of a second stent in 5 and a third stent in 1 patient. Medical treatment was instituted in the remaining 4 patients. Forty-nine patients (88%) are alive. Twenty-nine patients (51%) remained asymptomatic, and 44 (78%) are in a better functional class than before the implantation. Eleven of 15 (79%) major complications (acute occlusions or deaths) occurred in patients who received a stent in the left anterior descending coronary artery. In conclusion, implantation of the self-expanding intracoronary stent appears to be a new therapeutic option for treating acute occlusion or restenosis after PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Selection of DNA sequences from interval 6 of the human Y chromosome with homology to a Y chromosomal fertility gene sequence of Drosophila hydei

An experimental approach towards the molecular analysis of the male fertility function, located in interval 6 of the human Y chromosome, is presented. This approach is not based on the knowledge of any gene product but on the assumption that the functional DNA structure of male fertility genes, evolutionary conserved with their position on the Y chromosome, may contain an evolutionary conserved frame structure or at least conserved sequence elements. We tested this hypothesis by using dhMiF1, a fertility gene sequence of the Y chromosome of Drosophila hydei, as a screening probe on a pool of cloned human Y-DNA sequences. We were able to select 10 human Y-DNA sequences of which 7 could be mapped to Y interval 6 (the pY6H sequence family). Since the only fertility gene of the human Y chromosome is mapped to the same Y interval, our working hypothesis seems to be strongly supported. Most interesting in this respect is the isolation of the Y-specific repetitive pY6H65 sequence. The pY6H65 locus extends to a length of at least 300 kb in Y interval 6 and has a locus-specific repetitive sequence organization, reminiscent of the functional DNA structure of Y chromosomal fertility genes of Drosophila. We identified the simple sequence family (CA)n as one sequence element conserved between the Drosophila dhMiFi fertility gene sequence and the homologous human Y-DNA sequences.

Angiographic follow-up after placement of a self-expanding coronary-artery stent

BACKGROUND

The placement of stents in coronary arteries after coronary angioplasty has been investigated as a way of treating abrupt coronary-artery occlusion related to the angioplasty and of reducing the late intimal hyperplasia responsible for gradual restenosis of the dilated lesion.

METHODS

From March 1986 to January 1988, we implanted 117 self-expanding, stainless-steel endovascular stents (Wallstent) in the native coronary arteries (94 stents) or saphenous-vein bypass grafts (23 stents) of 105 patients. Angiograms were obtained immediately before and after placement of the stent and at follow-up at least one month later (unless symptoms required angiography sooner). The mortality after one year was 7.6 percent (8 patients). Follow-up angiograms (after a mean [+/- SD] of 5.7 +/- 4.4 months) were obtained in 95 patients with 105 stents and were analyzed quantitatively by a computer-assisted system of cardiovascular angiographic analysis. The 10 patients without follow-up angiograms included 4 who died.

RESULTS

Complete occlusion occurred in 27 stents in 25 patients (24 percent); 21 occlusions were documented within the first 14 days after implantation. Overall, immediately after placement of the stent there was a significant increase in the minimal luminal diameter and a significant decrease in the percentage of the diameter with stenosis (changing from a mean [+/- SD] of 1.88 +/- 0.43 to 2.48 +/- 0.51 mm and from 37 +/- 12 to 21 +/- 10 percent, respectively; P less than 0.0001). Later, however, there was a significant decrease in the minimal luminal diameter and a significant increase in the stenosis of the segment with the stent (1.68 +/- 1.78 mm and 48 +/- 34 percent at follow-up). Significant restenosis, as indicated by a reduction of 0.72 mm in the minimal luminal diameter or by an increase in the percentage of stenosis to greater than or equal to 50 percent, occurred in 32 percent and 14 percent of patent stents, respectively.

CONCLUSIONS

Early occlusion remains an important limitation of this coronary-artery stent. Even when the early effects are beneficial, there are frequently late occlusions or restenosis. The place of this form of treatment for coronary artery disease remains to be determined.

Resection of synchronous liver metastases from colorectal cancer

Whereas resection for metachronous liver metastases from colorectal cancer is considered to be a potentially curative approach, little is known about the prognosis after resection of synchronous liver metastases. In the past, these patients usually underwent only palliative therapy. Therefore, we have analyzed the data of 36 patients who underwent curative hepatic resection of synchronous liver metastases from colorectal carcinomas from 1977 to 1987 at the Department of Surgery, Hannover Medical School. In 19 patients, liver resection was combined with colonic resection; in the other 17 patients, hepatic resection was performed after a median interval of 2 months following resection of the primary tumor. No operative mortality was observed in either of the approaches. The median survival time was 28 months for all patients with a median recurrence-free interval of 13.5 months. Overall 5-year survival probability for all patients was 20%. There were no significant differences observed between immediate or delayed liver resection (median survival 18 months versus 31 months). Survival rates were not different after resection of solitary versus multiple liver metastases (26 versus 28 months). Twenty-one of the 36 patients had a recurrence of their liver metastases. In 7 of them, curative liver resection could be performed again. These 7 patients had a significantly improved survival (p less than 0.05) compared to the residual 14 patients. It is concluded that patients with synchronous liver metastases from colorectal cancer may profit from resection of the primary tumor and liver metastases. Timing of liver resection--immediate versus delayed--obviously has no impact on survival rates.

Direct carrier detection by in situ suppression hybridization with cosmid clones of the Duchenne/Becker muscular dystrophy locus

A basic problem in genetic counseling of families with Duchenne/Becker muscular dystrophy (DMD/BMD) concerns the carrier status of female relatives of an affected male. In about 60% of these patients, deletions of one or more exons of the dystrophin gene can be identified. These deletions preferentially include exon 45, which can be detected by multiplex polymerase chain reaction (PCR) and Southern blot analysis of genomic cosmid clones that map to this critical region. As a new approach for definitive carrier detection, we have performed chromosomal in situ suppression (CISS) hybridization with these cosmid clones in female relatives of four unrelated patients. In normal females, most metaphases showed signals on both X chromosomes, whereas only one X chromosome was labeled in carriers. Our results demonstrate that CISS hybridization can define the carrier status in female relatives of DMD patients exhibiting a deletion in the dystrophin gene.