Transient tyrosinemia presenting as lactic acidosis in a term baby: report of one case

Tyrosinemia is one of the disorders of aromatic amino acid metabolism. The report describes a male newborn who presented with tachypnea, lethargy, diarrhea and metabolic acidosis at 12 days old, with an elevated level of lactic acid. Tyrosinemia was impressed according to elevated plasma tyrosine level and specific metabolites of tyrosine detected by gas chromatography/mass spectrometry (GC/MS) study. The symptoms/signs subsided within one month after supportive treatment and protein restriction. Transient tyrosinemia of the newborn is indicative of delayed maturation of the liver enzyme systems (i.e. p-hydroxyphenylpyruvate dioxygenase), and is not a true inborn error of metabolism. Lactic acidosis is a rare associated findings in this condition.

Idiopathic juvenile osteoporosis: five-year case follow-up

Juvenile osteoporosis is a disease of childhood and adolescence exhibiting marked clinical variability in bone change. The disease usually begins in the prepubertal period or even younger. A case of a Chinese boy suffering from back pain and generalized osteoporosis since 9 yr of age who spontaneously recovered at 14 yr of age when entering puberty is reported. The affected patient was clinically normal (as shown by X rays), until he fractured his left humerus. Metabolic studies indicated a negative calcium balance, but serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, calcifediol, calcitriol, cortisol and sex hormones were normal. X ray showed typical generalized osteoporosis with vertebral collapse. The disease markedly improved within 5 yr. No family history of inherited skeletal disorders or presenile osteoporosis was noted. The diagnosis of idiopathic juvenile osteoporosis was made.

Microdeletion of chromosomal region 22q11 in DiGeorge syndrome: report of a case

This is a case of chromosome 22q11 deletion in a female Chinese infant with DiGeorge syndrome. Cardiac anomalies included a type B interrupted aortic arch from the descending aorta with an aberrant right subclavian artery, a large ventricular septal defect, a small atrial septal defect and a large patent ductus arteriosus. This patient was small for her age and showed symptoms of feeding difficulties, chronic diarrhea and facial dysmorphisms (frontal bossing, hypertelorism, posteriorly rotated ears, fish-like mouth and micrognathia). Chest film did not reveal a thymic shadow. Immunological studies showed a low T-cell ratio (20%). Laboratory tests revealed a borderline low serum calcium level. The karyotype, 46, XX, del(22) (q11.21-->q11.23), was observed by high-resolution banding techniques. Cardiac surgery was successfully performed at 1 month of age. Operative findings confirmed aplasia of the thymus and the above complex cardiac anomalies. To our knowledge, this is the first Taiwanese case of DiGeorge syndrome proven immunologically and cytogenetically.

Trisomy 18 in a patient with CHARGE association

CHARGE association is the non-random association of congenital anomalies, including colobomata of the eyes, heart defects, choanal atresia, retardation of growth and development, genital hypoplasia and ear abnormalities. It is usually a sporadic event of unknown cause. We report a neonate with trisomy 18 and apparent CHARGE association. The associated abnormalities made the diagnosis difficult until the chromosomal results became available. Abnormalities such as clenched hands and short palpebral fissures pointed to the possibility of a chromosomal anomaly. The chromosome study revealed trisomy 18. It is important to perform chromosomal studies quickly when diagnosing a patient with apparent CHARGE association who also has other minor anomalies atypical of CHARGE.

Cytogenetic investigations in trisomy 21 with reciprocal 4/9 translocation: report of a case

A 3-month-old male infant with Down's syndrome resulting from de novo trisomy 21 had an additional reciprocal translocation between the long arms of chromosomes 4 and 9: 47,XY,+21,rcp t(4;9)(q35;q22.3). Both C- and Ag-NOR bandings showed that the extra chromosome 21 was maternal in origin, but that the translocated chromosome 9 was from the father. To evaluate the nature of the translocation, fluorescence in situ hybridization (FISH) with whole chromosome painting probes (Coatasomes 4 & 9), followed by an enzymatic precipitation (HRP-DAB) assay was used. Whole chromosome FISH demonstrated the origin of the translocated region and clarified the karyotype. Enzymatic methods achieved the same result and were kept as a permanent record.

Prognostic significance of left ventricular diastolic indexes in beta-thalassemia major

OBJECTIVE

To define the prognostic significance of left ventricular diastolic function in patients with beta-thalassemia major by noninvasive M-mode echocardiography and Doppler measurements.

DESIGN

Cohort analytic study.

SETTING

A university hospital in Taipei, Taiwan.

PATIENTS

Forty-five patients (age range, 4 to 25 years) with transfusion-dependent beta-thalassemia major followed up for 5 years.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

M-mode and Doppler echocardiography were used to determine the left systolic time interval; ejection fraction; left atrium emptying index; isovolumetric relaxation period; diastolic total period; the duration, slope, and height of the early diastolic flow-velocity peak; and the ratio between the heights of early and atrial diastolic flow-velocity peaks. All patients had normal systolic ventricular function initially, but impaired diastolic function developed, especially in the older age group who had more evidence of iron loading. In nine of those with abnormal diastolic total period (n = 10) and duration of the early diastolic flow-velocity peak (n = 12) values, regardless of age, congestive heart failure developed during the period of follow-up. Of these nine, four died within 2 years after the advent of heart failure and five remained compensated after anticongestive treatment and use of deferoxamine mesylate. The presence of an abnormal diastolic total period and duration of the early diastolic flow-velocity peak values correlated well with the prognosis.

CONCLUSIONS

Left ventricular diastolic filling variables by echocardiography are important predictors of the outcome of patients with transfusion-dependent beta-thalassemia major and could provide useful measures in determining the effects of medication during long-term follow-up.

MR imaging in patients with strabismus

The patients with strabismus, including 8 with superior oblique paresis, 1 with inferior rectus paresis, and 1 with congenital constant exotropia, were examined with MR imaging at 1.5 tesla (T) or 0.5T with a surface coil. Abnormal findings of extraocular muscles were identified in 8 of the 10 patients and most of them were consistent with the clinical findings. Deviation of the optic nerves was noted in 5 patients. Coronal short repetition time (RT) and echo time (ET) images were used to measure the concerned extraocular muscles and the optic nerves. The differences in diameters between the concerned extraocular muscles of both the diseased and normal eyes were calculated. MR imaging is considered to be advantageous and can be favorably used to observe and measure the extraocular muscles and other intraorbital structures in patients with strabismus.

[Mechanism of scavenging effects of (-)-epigallocatechin gallate on active oxygen free radicals]

The concentration of 50% scavenging ratio (SC50) and the scavenging rate constants (k) and stiochiometric factor (n) were determined when (-)-epigallocatechin gallate [(-)-EGCG] scavenging superoxide anion free radical (O2.-) and hydroxyl radical (.OH). The mechanism of scavenging active free radicals of (-)-EGCG and the promotion of (-)-EGCG free radical and its structure were analyzed in vitro. Our results suggest that the centers of scavenging reaction of (-)-EGCG are B, D, and A cycles, and each (-)-EGCG traps six O2.- or .OH. It is in accord with the value of stiochiometric factor n = 6.

Scavenging effects of tetramethylpyrazine on active oxygen free radicals

The scavenging effects of tetramethylpyrazine (ligustrazine, Lig) isolated from Ligusticum wallichii Franch on active oxygen free radicals were studied using spin trapping technic and chemiluminescence methods. The scavenging rate of superoxide anion (O2-.) by Lig (25 mg.ml-1) was 100% in xanthine/xanthine oxidase (Xan/XO) system, and that of hydroxyl radical (OH-.) was 44% in Fenton's reaction. The scavenging rate of lipid peroxyl radical (LOO-.) by Lig (25 mg.ml-1) was 80% in peroxidizing microsome system. It is possible that Lig scavenged O2-. by catalyzing its spontaneous dismutation. The results showed that Lig had strong effects of scavenging cyotoxic oxygen free radicals (O2-., LOO-., OH-.).

Tuberous sclerosis in children

Tuberous sclerosis (TS) is a multiple-system disease involving the brain, skin, kidneys, heart and other visceral organs. There were 18 children with TS at our clinic, and complete studies of these patients and their families were performed. Male to female ratio was 11:7. Age at diagnosis was from 1 month to 18 years. Seizures (infantile spasm, generalized and partial epilepsy), skin lesions and intracranial calcifications were the most common clinical manifestations. Mental retardation was closely correlated with seizure attacks. Neoplasms of the brain, retina, heart, lung and kidneys were all encountered. Hypopigmented macules, intracardiac tumors and infantile spasms were usually the first signs in younger ages and can give hints of early diagnosis of TS. In total, six patients had positive family histories and one of them had non-penetrating parents. Detailed family studies are mandatory prior to genetic counseling.

Molecular cytogenetic studies of children with marker chromosomes

The molecular cytogenetic characterization and clinical description of 15 children with marker chromosomes of unknown nature are presented. By combining both conventional cytogenetic methods (G-, C-, Ag-NOR- and Distamycin-A/DAPI bandings) and molecular techniques (fluorescence in situ hybridization), the chromosomal origin of these markers was successfully determined. The marker chromosomes were first characterized by cytogenetic techniques and later identified by fluorescence in situ hybridization, using a procedure involving stepwise hybridization of chromosome-specific DNA probes (alpha and classical satellites) at various conditions of stringency. There were four cases with bisatellited markers (of chromosome 15 origin), one with acrocentric satellited marker (of chromosome 13 or 21 origin), and two carrying markers that appeared to be autosomal rings (of chromosomes 13 and 18, respectively). The other eight cases belonged to mosaic (n = 5) or nonsupernumerary (n = 3) sex-chromosomal anomalies. Six were of Y and two of X chromosomal origin. Because no familial cases were found, these markers probably developed de novo. In cases of supernumerary marker with satellites, the origin was from acrocentric groups and had common features such as mild to moderate psychomotor retardation and mild facial dysmorphism. In the cases of autosomal ring, multiple anomalies and moderate to severe retardation occurred. For the category of sex-chromosomal origin, stigmata of Turner's syndrome and/or ambiguous genitalia were noted. Mentality was normal.

Y-specific polymerase chain reaction for the interpretation of a chromosome marker

Chromosome marker is a very special type of chromosomal aberration. In addition to their normal chromosomes, patients with this type of disease own one (or more) small, unrecognizable chromosome. The extra chromosome markers may originate from the products of breakage and translocation of other chromosomes. Interpretation of the chromosome marker is usually very difficult, but its presence is an important prognosis factor for patients if the marker originated from a Y chromosome, or its components. This study explores the possibility of interpreting the chromosome marker by Y-specific polymerase chain reaction. A pair of primers designed from one Y-specific DNA sequence was employed. By studying normal controls, the most specific conditions for the chain reaction were established. Comparison of normal males and females showed that this reaction is specific to males (that is, to the Y chromosome). Also one patient with a karyotype 46,X,+marker was studied. The external genitalia of this patient were female type except for an enlarged clitoris. Y-specific polymerase chain reaction showed that the patient did have the Y-specific sequence. The chromosome marker did originate from the Y chromosome. This work proposes that Y-specific polymerase chain reaction is an effective and necessary diagnostic procedure for patients with chromosome marker.

Fragile-X mental retardation--a combination of cytogenetic and molecular approaches, with greater emphasis on DNA analysis

Fragile X syndrome is one of the most frequent causes of hereditary mental retardation. In the past, its diagnosis depended primarily on cytogenetic demonstration of chromosome fragile site Xq27.3. Recently, the gene FMR-1 has been found responsible for this disease. Here a combined method was used to study fragile X syndrome. A fragment (pP1fr) of DNA was subcloned from pE5.1 by polymerase chain reaction. With this probe, DNA samples from two cytogenetically proved families were analyzed by restriction fragment length polymorphisms. It was demonstrated that EcoRI polymorphism was an easy and accurate method for diagnosis of the fragile X syndrome. To study methylation status of patients, another methylation-sensitive enzyme, BssHII, could be used together with EcoRI. The PstI polymorphism of one family was also studied and showed one kb fragment as normal, and detected more precise changes in length. Prominent mosaicism necessary was characteristic in PstI polymorphism. The DNA diagnosis of fragile X syndrome was a reliable method.

Cardiovascular disorders in Turner's syndrome and its correlation to karyotype

Forty-nine out of 66 patients with Turner's syndrome and different karyotypes underwent full cardiological evaluations (physical examination, electrocardiography, chest X-ray and echocardiography). Congenital cardiovascular anomalies were found in 11 patients (22.4%). Among the cardiac anomalies in patients with Turner's syndrome, aortic malformations (aortic coarctation [27%], aortic stenosis [18%] and bicuspid aortic valve [18%]) were the most frequent. We observed that the most severe malformations were found in those with karyotype 45,X or 45,X/46,XX. No anomalies were detected in patients with the X isochromosome or those mosaic with the Y component.

Mosaic ring chromosome 13 analyzed by fluorescence in situ hybridization: report of a case

A five-year-old boy with psychomotor retardation, microcephaly, bilateral cataracts, hearing impairment and hypospadia with microphallus was found to have multiple cell lines from peripheral blood: 46,XY/46,XY, -13,+r(13)/46, Xy, -13, +dic r(13) in the ratio of 35%/61%/4% by trypsin-Giemsa, and C-bandings. Using fluorescence in situ hybridization (FISH) with biotin-labeled alpha-satellite probe (D21Z1/D13Z1) and fluorescence staining (FITC), we confirmed that the ring originated from chromosome 13. To elucidate changes in the chromosome ends in the ring originated from chromosome 13. To elucidate changes in the chromosome ends in the ring formation, we used human telomere-specific probes for FISH study; it showed an absence of telomeres on the ring chromosome, although Ag-NOR staining was positive. These findings yielded different breaking points on the ends of both the short and long arms of chromosome 13 from those reported in the literature.

Atlantoaxial subluxation and syringomyelia in Down syndrome: report of one case

Atlantoaxial instability is a relatively frequent finding in Down syndrome, but syringomyelia is a rare symptom. A four-year-old girl with Down syndrome was noted to have one year history of torticollis and progressive motor deterioration presenting with abnormal gait, ataxia or quadriparesis for the past three months. She was admitted because of acute urinary retention. Physical examination showed distended urinary bladder, hyperreflexia, bilateral ankle clonus and the existence of Babinski's signs. The x-ray films of the cervical spine showed widening between the joint space of atlas and odontoid processes. Magnetic resonance imaging revealed C1-C2 subluxation with syringomyelia. After bladder training and cervical orthosis, the symptoms improved.

Identification of sex chromosomal abnormalities by fluorescence in situ hybridization

Chromosomes can be specifically stained in metaphase spreads and interphase nuclei by fluorescence in situ hybridization (FISH). Case 1 was a 20 year-old female patient who had chromosomal analysis six years ago because of primary amenorrhea and short stature. Three cell lines were identified: 45, X (20%); 46, X plus an unidentifiable fragment (50%) and 46, X plus an isodicentric X chromosome of short arm fusion (30%). Case 2 was a 6 year-old girl with the problems of clitoromegaly and growth retardation. By use of in situ hybridization with biotinylated X and Y centromere-specific alpha repetitive sequence probes, we were able to identify the marker chromosomes to be X and Y-chromosome originated, respectively. The use of FISH can facilitate clinical cytogenetic diagnosis, and allows fast screening of a large number of metaphases. This technique is applicable to the screening of other types of chromosomal mosaicism as well.

Effects of oxygen radicals on the conformation of sulfhydryl groups on human polymorphonuclear leukocyte membranes

The healthy intact polymorphonuclear leukocytes (PMNs) were labeled with 4-maleimide-TEMPO spin labeling compound (MAL) to study the effects of oxygen radicals produced by phorbol myristate acetate (PMA)-stimulated PMNs on the conformation of sulfhydryl (SH) groups of PMN membrane proteins. The lipid peroxidation induced by PMA-stimulated PMNs was detected by evaluating the formation of malonaldehyde (MDA) with the thiobarbituric acid (TBA) test. From the experiments of luminol-dependent chemiluminescence (CL) and fluorometry, it was found that Chinese herbs schizandrin B (Sin B) and quercetin (Q) possessed scavenging properties for oxygen radicals produced during the PMN respiratory burst. These two herbs can also inhibit the conformation changes in SH binding sites on the PMN membrane proteins caused by oxygen radicals produced by the PMNs themselves. They also decreased the amount of MDA, which was a final product formed during lipid peroxidation.

ESR spin trapping studies on the free radicals in gasphase of cigarette smoking

Free radicals in the gasphase of cigarette smoke were determined by spin trapping agent PBN (N-tert-butyl-2-phenyl nitrone) and DMPO (5,5-dimethyl-1-pyrroline-oxide) on electron spin resonance spectrometer. They were identified according to the spectrum parameters calculated from the spectra. The free radicals mainly consist of alkoxyl and alkyl free radicals, of which alkoxyl free radicals make up 60-70% of the total spectral components. These free radicals are very active and reactive. They can damage cells and lead to some diseases. This work points out the importance of scavenging the free radicals of cigarette smoke to prevent diseases caused by them.

Active oxygen radicals produced by leukocytes of malignant lymphoma

The electron spin resonance (ESR) spectra of active oxygen radicals produced during the respiratory burst of PMA-stimulated leukocytes and oxygen consumption are studied by ESR spin trapping and spin probe oxymetry for 31 times in 17 cases of malignant lymphoma. The results showed that the spectra produced from PMA-stimulated patients' leukocytes were predominantly spin adducts of DMPO-hydroxyl radicals (DMPO-OH). The decrease in oxygen consumption during respiratory burst suggested that respiratory burst function was inhibited. Kinetic observations of patient condition showed that respiratory burst and oxygen consumption were improved and even approached normal, when the patient was in remission or the condition was ameliorated. This paper is the first of its type and helps clarify the mechanism of malignant proliferation and metastasis.

Sources of cholesterol for testosterone biosynthesis in murine Leydig cells

The sources of cholesterol for testosterone production were investigated in freshly isolated murine Leydig cells. In vitro stimulation with human CG (hCG) (0.2 IU/ml) caused a 75-fold increase in testosterone production. Leydig cells contained approximately equal amounts of free and esterified cholesterol (7.8 vs. 8.7 micrograms/mg protein). The total cholesterol content of cells stimulated for 4 h with hCG was significantly decreased compared with unstimulated cells (8.4 vs. 17.6 micrograms/mg protein); both free and esterified cholesterol decreased by about 50%. In unstimulated Leydig cells incubated with [14C]acetate for 12 h, the majority of incorporated [14C] was found in free and esterified cholesterol, whereas, in the hCG-stimulated cells, 80% of incorporated 14C was in testosterone. The activity of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase after 4 h in hCG-stimulated cells was 20% higher than in unstimulated cells (115.5 vs. 84.4 pmol/mg protein.min). However, by 6 h, HMG-CoA reductase activity doubled in the hCG-stimulated compared with unstimulated cells. By 12 h, HMG-CoA reductase activity in hCG-stimulated cells was 4 times the preincubation level and 8 times the 12-h level in unstimulated cells. HMG-CoA reductase activity induced by hCG was blocked by aminoglutethimide, an inhibitor of the cholesterol side-chain cleavage enzyme. Lovastatin, a potent inhibitor of HMG-CoA reductase, had no effect on unstimulated or hCG-stimulated testosterone production during a 12-h incubation. Murine high density lipoproteins (mHDL) increased HMG-CoA reductase activity in both unstimulated (29%) and hCG-stimulated (20%) cells. During a 6 h incubation, mHDL increased hCG-stimulated testosterone production by 20%, but had no effect on unstimulated testosterone production. These results suggest that murine Leydig cells store enough cholesterol and cholesteryl esters to support testosterone production for at least 12 h in vitro. Although mHDL does not have a major stimulatory effect on testosterone biosynthesis, it may be involved in the regulation of de novo cholesterol synthesis.

Restriction fragment length polymorphisms at the methylmalonyl CoA mutase locus in normal Chinese

L-methylmalonyl-CoA mutase (MCM; E.C. 5,4,99,2) is the apoenzyme for catalyzing the isomerization of L-methylmalonyl-CoA to succinyl-CoA. Genetic deficiency of MCM leads to the accumulation of precursors and abnormal metabolites of L-methylmalonyl-CoA. This can be associated with fulminant metabolic acidosis, widespread secondary aberrations in systemic metabolic homeostasis, mental retardation, or even neonatal death. This disorder is termed methylmalonic acidemia (MMA). This report, describes the use of an authentic, full-length cloned human cDNA probe, MCM26, kindly provided by Dr. Fred Ledley, for Southern blot analysis of genomic DNA. The pattern of EcoRI, Sac I and Hind III restriction endonuclease sites is reported from 14 unrelated control individuals of Chinese background. A Southern blot by EcoRI to the MCM26b probe reveals invariant bands of 4.1, 3.8, and 2.2 kb respectively. By EcoRI to the MCM26c probe, 7.2 kb is invariant. By HindIII to the MCM26c probe, invariant bands are 4.8 and 2.7 kb respectively. By SacI to the MCMb probe, invariant bands are 17, 8.0, 6.0, 3.6 and 1.8 kb respectively, while the polymorphic band is at 5.6kb. When combined with more diverse samples and additional polymorphisms, this restriction fragment length polymorphism may be useful for genetic diagnostic and linkage studies of MCM in MMA.

[Scavenging effects of sodium ferulate and 18 beta-glycyrrhetic acid on oxygen free radicals]

The scavenging effects of sodium ferulate (SF) and glycyrrhetic acid (GA) on oxygen free radicals were studied by using spin trapping technique and chemiluminescence (CL) methods. SF 0.3 mmol/L and GA 0.3 mmol/L effectively scavenged oxygen free radicals produced by phorbol myristate acetate (PMA)-stimulated polymorphonuclear leukocytes (PMN), but had no effect on the oxygen consumption by PMN, measured with spin probe oxymetry. In 3 cell-free oxygen free radical generating systems, both SF and GA showed a remarkably scavenging effects on O2- and OH.. SF 30 mumol/L and GA 30 mumol/L prominently inhibited the CL response of PMA-stimulated PMN. The results demonstrated that SF and GA are oxygen free radical scavengers.

Clinical observation of Wilms' tumor

Forty-two cases with Wilms' tumor encountered in the National Taiwan University Hospital from 1978 through 1989 were retrospectively reviewed. Included were 19 boys and 23 girls, with an age range at diagnosis from 7 days to 10 years; a majority were in the first 6 years of life. The presenting symptoms and signs included: abdominal mass (89.2%), hypertension (57.9%), hematuria (28.2%), gastrointestinal symptoms (26.3%), fever (24.3%), and body weight loss (21.6%). The initial laterality of tumor was 28 right and 14 left, with one contralateral and one ipsilateral relapse. One extrarenal Wilms' tumor (right inguinal lymph nodes) was encountered. Every case was confirmed by pathology. Histologic findings included typical Wilms' tumor (35/42), rhabdoid (3/42), anaplastic (3/42), and clear cell (1/42) types. The common sites of metastasis were lung, liver and bone. Major complications during or following therapy were severe pancytopenia, ileus, sepsis or pneumonia, delayed wound healing and tumor rupture with hemorrhage. Rare complications included irradiation hepatitis (venooclusive disease) and colitis. There were 20 deaths. The causes of death were respiratory or hepatic failure due to tumor metastasis, sepsis and internal hemorrhage. Mortality (19/20) usually occurred within two years after diagnosis and therapy. The two-year's relapse-free survival and two-year's survival rates were 51.2% and 53.7%, respectively.

Isovaleric acidemia: report of one case

A case of isovaleric acidemia appearing as diabetic ketoacidosis with acute encephalopathy and pancytopenia was reported. A three-year-old male patient, with mild psychomotor retardation, had recurrent bouts of acute encephalopathy and pancytopenia after episodes of upper respiratory infection. At admission, he had vomiting associated with dehydration, acidosis, ketonuria, coma and a pungent, rather unpleasant odor. Laboratory features included hyperglycemia, hyperammonemia, hyperamylasemia, hypocalcemia, neutropenia, thrombocytopenia and subsequent anemia. Urine organic acid profiles showed profuse amount of 3-beta-hydroxyisovaleric acid (295 mg/ml) and isovalerylglycine (616 mg/ml) by gas chromatography-mass spectrometry. Levels of amino acids in the serum and urine were normal. The patient received treatment with rehydration and insulin, with rapid improvement. After the acute illness, blood glucose levels returned to normal. The patient was doing well on a low-protein diet in recent 3 months.

Restriction fragment length polymorphisms at the ornithine transcarbamylase locus in normal Chinese

Ornithine transcarbamylase (OTC) (EC 2.1.3.3) is an hepatic mitochondrial enzyme involved in the detoxication of ammonia; it catalyzes the second step of the urea cycle, and is X-linked in human beings. Deficiency of OTC results in ammonia intoxication and, often, in early infant death, especially in males. This report describes the use of a nearly full-length cloned human cDNA for OTC for Southern blot analysis of genomic DNA. The pattern of MspI, TaqI, HindIII and EcoRI restriction endonuclease sites from 28 control individuals of Chinese backgrounds is reported. A Southern blot by Msp I reveals invariant bands of 19.5, 5.2 and 1.9 kb respectively, as well as one set of polymorphic bands 6.6/6.2 kb. By TaqI, invariant bands are 4.8, 2.7, 1.9, 1.7 and 1.4 kb respectively, while polymorphic bands are found at 4.1/3.9 kb. By HindIII, 3.2 kb is invariant but 4.0/2.9 kb polymorphic. By EcoR I, invariant bands are 9.0, 3.6, 3.4 and 1.45 kb respectively, but 2.5 kb is polymorphic. Combined with study of the alteration of restriction sites in the informative pedigrees, this information is expected to allow accurate heterozygote detection and prenatal diagnosis of OTC deficiency.

Salmonella meningitis complicated with subdural empyema, brain abscess and purpura fulminans: report of one case

There exists high incidence of bacteremia, sepsis and meningitis in young infants with Salmonella infection. However, focal intracranial abscesses due to Salmonella infections are rare. We reported a 2-month-old male baby presenting salmonella infection with brain abscess and purpura fulminans. The patient's clinical course was fulminant. He was admitted due to fever, irritability, anemia and leukopenia. He developed cardiac arrest, shock and skin diathesis on his second hospitalization day. After resuscitation he became comatous and showed acrocyanosis and gangrenous skin over the hands, feet and left ear lobe. Both blood and cerebrospinal fluid cultures were Salmonella Group B. The patient got worse rapidly in spite of vigorous treatment. Subdural empyema, ventriculitis and later brain abscess were detected by serial brain sonograms. He died of central nervous system failure, gastrointestinal bleeding and renal failure on the eighteenth hospitalization day.

Spontaneous focal intestinal perforation in prematurity: report of three cases

Three premature neonates with a localized perforation of the intestine, but not associated with necrotizing enterocolitis (NEC) or gastrointestinal anomaly are reported. The birth weight of these babies was around 1500 g and they exhibited striking similarities in the clinical course. Before laparotomy, NEC was firstly impressed. Abdominal distension, refusal of feedings, poor activity and respiratory distress were the major manifestations. Pneumoperitoneum was all detected before operation. The perforate site was terminal ileum in one and anterior cecum in the other two babies. The gastrointestinal tract was otherwise normal. The first case received segmental resection of the perforation with end to end anastomosis and the other two underwent ileostomy. Bacteria was discovered from the peritoneal fluid in the second and third cases, including E. coli, Enterobacter cloacae and Klebsiella pneumoniae respectively. The postoperative course was complicated with wound infection and adhesion ileus in two patients. Rectal suction biopsy in the second and third cases showed normal histology. Until present all three patients were uneventful. We concluded that premature or very low birth weight infants with spontaneous, localized gastrointestinal perforation and peritonitis had milder course than NEC, and if promptly diagnosed and treated, the prognosis is excellent.

Complex partial status epilepticus: report of one case

Complex partial status epilepticus (CPSE) has rarely been reported in children. We experienced a 5-year-old girl having had an abrupt onset of complex partial seizure with a fluctuating state of consciousness and aphasia. Electroencephalogram revealed repetitive epileptiform discharges originating from bilateral temporal and parieto-occipital regions over the background of diffuse continuous slow activity. Computerized tomography of the brain showed mild atrophy without focal lesions. All the other studies including bacteriology, virology, toxicology and metabolic screening were unremarkable. Intravenous administration of diazepam was ineffective for recovery of consciousness level and cease of seizure activity. A lasting control of the status was not achieved until intravenous phenytoin and oral carbamazepine were added for one more weeks. Paroxysmal attacks of periodic apnea with subsequent hyperpneic movements occurred the fourth month after the onset of illness. She regained language on rehabilitation program. Unfortunately, the patient had recurrence four months later despite medication. Finally, she died of aspiration pneumonia and status epilepticus eleven months after the onset of the disease. Compared with the other previously documented cases of prolonged complex partial status epilepticus, this case is notable for its unusual, complicated and severe symptomatology and long duration (three more months) with poor prognosis.

Mortality and survival in Down syndrome in Taiwan

In order to investigate the morbidity and mortality in individuals with Down syndrome(DS), we reviewed 237 cases of DS visiting our hospital in a ten-year period. There were 150 males and 87 females with age range from newborn to 25 years. The major illnesses included: 1) congenital heart disease (CHD), 42.6%; with endocardial cushion defect, ventricular septal defect, atrial septal defect and patent ductus arteriosus as the common types; 2) frequent or major respiratory tract infections, 34.2%; 3) summer fever, 5.5%; 4) major infective episodes other than pneumonia, 5.0%. Other diseases such as seizure disorder, gastrointestinal tract anomalies and thyroid dysfunction were also noted. There were 28 deaths of them and the causes of mortality were 1) CHD with congestive heart failure (CHD with CHF) and pneumonia (46.9%); 2) CHD with CHF and sepsis (10.7%); 3) CHD with CHF (14.3%) and 4) acute leukemia with infection (10.7%) respectively. Most of the mortality occurred during the first year of life, especially in patients with CHD. In our series, the one year survival rate was 93.6%; the result indicates that life expectancy in DS is much better than generally believed.

Kawasaki disease complicated by gallbladder hydrops mimicking acute abdomen: a report of three cases

Three cases of gallbladder hydrops associated with Kawasaki disease are presented. The initial manifestations were high fever, jaundice and distended abdomen with guarding. The first two cases received laparotomy under the impression of suppurative cholecystitis with peritonitis. A markedly distended acalculous, nongangrenous gallbladder was noted. A cholecystostomy for drainage was performed. Diagnosis of Kawasaki disease was made only when the clinical manifestations became full-blown postoperatively. Both patients led an uneventful postoperative course. The third case had apparent features of Kawasaki disease at admission though the abdominal symptoms were rather prominent. With supportive care, the patient stabilized by the sixth hospital day without complication and did not require surgical intervention. We suggest that the preferred treatment of abdominal symptoms in Kawasaki disease is medical, and surgical intervention is deserved only for the complications of the hydrops. Simple cholecystostomy seems to be safe and sufficient for such occasion. Ultrasonography is helpful for the correct diagnosis of gallbladder hydrops and can exclude dilatation of the intrahepatic biliary trees and cholelithiasis.