DNA analysis in a paternity case involving a triploid fetus

BACKGROUND

A parentage testing laboratory was asked to perform testing in a case of sexual assault that resulted in the conception of a child. Samples submitted to the laboratory included blood from the mother, the alleged father, and the fetus.

CASE REPORT

DNA typing was used to determine if the suspect in this sexual assault was the father of the expected child. DNA extracted from these samples was subjected to both restriction fragment length polymorphism and polymerase chain reaction/short-tandem repeat analysis at a total of 13 genetic loci. Examination of DNA profiles for selected markers suggested that the fetus was triploid. Triploidy was confirmed through the use of fluorescent in situ hybridization of chromosomes, employing three chromosome-specific alpha satellite probes and fetal trophoblast nuclei. Statistical interpretation of the test results required identifying a method for calculation that would consider two transmitted paternal genes. Attempts to modify the standard method of calculating a paternity index were unsuccessful, because it was not possible to distinguish between dispermy and diandry as the mechanism of conception. Therefore, the likelihood ratio was calculated as the reciprocal of the random men not excluded value or the proportion of the population that possesses all of the paternal markers observed in the triploid fetus.

CONCLUSION

Calculation of a likelihood ratio employing the exclusionary power of a collection of DNA markers appears to be the only method suitable for assigning weight to the significance of DNA matches between an alleged father and a child who is triploid.

Treatment of intractable pain with topical large-dose capsaicin: preliminary report

Complex regional pain syndromes (CRPS) and neuropathic pain are often poorly controlled by conventional pharmacologic interventions. We administered 8-methyl-N-vanillyl-noneamide (capsaicin) at doses of 5%-10% to individuals with such disorders in this trial. Previous limitations to trials with larger-dose, topical concentrations of capsaicin included intense burning sensations experienced after application. To enable patients to tolerate the high concentrations, we first performed regional anesthesia. All patients reported at least some relief. Of 10 patients, 9 obtained substantial analgesia that lasted 1-18 wk. At Week 1 after therapy, the mean verbal analog scale (VAS) scores decreased from 8.0 to 3.0. At Week 4 after therapy, mean VAS score was 4.5. Analgesia lasted from < 1 wk (1 patient) to more than 50 wk (1 patient). Patients received one to eight treatments. With one exception, patients receiving more than one treatment obtained additional relief with subsequent treatment. Pain responsive to opioids was the only side effect of treatment. Large-dose capsaicin administered with regional anesthesia may effectively minimize refractory CRPS and neuropathic pain. A double-blind, placebo-controlled study in patients with bilateral peripheral neuropathy using epidural anesthesia with and without large-dose topical capsaicin is in progress.

IMPLICATIONS

Sensory neuropathies are associated with many diseases. Pain from these disorders can produce greater disability than the primary disease processes themselves. Currently available therapies are limited. However, the intermittent application of large-dose topical capsaicin may provide significant pain relief, decrease chronic analgesic dependence, and decrease aggregate health care expenditures.

Space product development: bringing the benefits of space down to Earth

In fulfilling the National Aeronautics and Space Administration's (NASA) responsibility to encourage the fullest commercial use of space the Space Product Development (SPD) Program, within the Microgravity Research Program Office (MRPO) located at the Marshall Space Flight Center (MSFC) in Huntsville, Alabama, is managing an organization of Commercial Space Centers (CSC's) that have successfully employed methods for encouraging private industries to exploit the benefits of space-based research. Unique research opportunities of the space environment are being made available to private industry in an effort to develop new, competitive products; create jobs; and enhance the country's quality of life. Over 200 commercial research activities have been conducted in space by the CSC's and their industrial partners during the last several years. The success of this research is evidenced by the increasing amount of industrial participation in commercial microgravity research and the potential products nearing marketability.

Prolonged muscle weakness following emergency tonsillectomy in a patient with familial periodic paralysis and infectious mononucleosis

A thirteen-year-old girl with normokalaemic familial periodic paralysis (FPP) suffered life threatening upper airway obstruction secondary to tonsillopharyngitis resulting from infectious mononucleosis (IM). Emergency tonsillectomy was performed, but her postoperative course was complicated by persistent muscle weakness requiring a very prolonged period of artificial ventilation.

Low-cost high-resolution fast spin-echo MR of acoustic schwannoma: an alternative to enhanced conventional spin-echo MR?

PURPOSE

To determine whether unenhanced high-resolution T2-weighted fast spin-echo MR imaging provides an acceptable and less expensive alternative to contrast-enhanced conventional T1-weighted spin-echo MR techniques in the diagnosis of acoustic schwannoma.

METHODS

We reviewed in a blinded fashion the records of 25 patients with pathologically documented acoustic schwannoma and of 25 control subjects, all of whom had undergone both enhanced conventional spin-echo MR imaging and unenhanced fast spin-echo MR imaging of the cerebellopontine angle/internal auditory canal region. The patients were imaged with the use of a quadrature head receiver coil for the conventional spin-echo sequences and dual 3-inch phased-array receiver coils for the fast spin-echo sequences.

RESULTS

The size of the acoustic schwannomas ranged from 2 to 40 mm in maximum dimension. The mean maximum diameter was 12 mm, and 12 neoplasms were less than 10 mm in diameter. Acoustic schwannoma was correctly diagnosed on 98% of the fast spin-echo images and on 100% of the enhanced conventional spin-echo images. Statistical analysis of the data using the kappa coefficient demonstrated agreement beyond chance between these two imaging techniques for the diagnosis of acoustic schwannoma.

CONCLUSIONS

There is no statistically significant difference in the sensitivity and specificity of unenhanced high-resolution fast spin-echo imaging and enhance T1-weighted conventional spin-echo imaging in the detection of acoustic schwannoma. We believe that the unenhanced high-resolution fast spin-echo technique provides a cost-effective method for the diagnosis of acoustic schwannoma.

Relief of tension subcutaneous emphysema using a large bore subcutaneous drain

We report a case of subcutaneous emphysema following multiple attempts to cannulate both subclavian veins for pacemaker insertion. Initial bilateral pneumothoraces were complicated by subcutaneous emphysema which became so severe that respiration and cardiac output became seriously impaired. The insertion of a single large bore subcutaneous drain produced a dramatic improvement. The aetiology, complications and management of tension subcutaneous emphysema are discussed.

Religion and children with disabilities

Religion as a personal coping resource used by parents of infants and toddlers with disabilities has received some attention in recent literature. This exploratory study involved indepth interviews of 12 parents who had children with disabilities ranging in age from 15 months to 30 years. The ways in which religion can be used as a coping resource across the life-cycle are exemplified through excerpts from these interviews. Prayer, church attendance, and specific religious beliefs were identified as sources of support which helped some parents feel a growing sense of hope and strength. Suggestions for future research are discussed.

Single-base substitutions give rise to a five-banded DNA profile at the D10S28 locus

BACKGROUND

DNA profiles from variable number of tandem repeat (VNTR) loci typically are composed of two bands, one derived from each member of the homologous pair of chromosomes. DNA profiles composed of more than two bands result from mutations, and the question arises as to the mechanism underlying these unusual multi-banded DNA profiles.

STUDY DESIGN AND METHODS

An alleged father in a paternity test was found to have a five-banded DNA profile at the D10S28 locus when his DNA was subjected to single-locus restriction fragment length polymorphism mapping with the restriction enzyme Pvu II.

RESULTS

Several results suggest that this complex DNA profile is the result of several single-base changes within the VNTR locus. First, there was no evidence of partial digestion of the DNA with Pvu II. Furthermore, the multi-banded allele happened, in this case, to be transmitted to the child, who also showed a five-banded pattern composed of four bands inherited from the alleged father and one band inherited from the mother. Second, digestion of this DNA with Hae III resulted in the visualization of just two bands at the D10S28 locus.

CONCLUSION

The results confirm the notion that mutations at VNTR loci are not always the result of additions or deletions of tandem repeats, but that they can also involve single-base substitutions either within or flanking VNTR loci that give rise to atypical DNA profiles and new alleles at the locus.

Isolation of tumor cell-specific single-chain Fv from immunized mice using phage-antibody libraries and the re-construction of whole antibodies from these antibody fragments

Enhanced expression of epidermal growth factor receptor (EGFR) occurs on a variety of malignant tissues thus making anti-EGFR antibodies possible agents for the diagnosis and therapy of human tumors. Standard hybridoma technology has been used successfully to isolate anti-EGFR antibodies from immunized mice and rats. This report demonstrates that phage-antibody libraries are an alternative, and more versatile, method for isolating antibodies from immunized mice. Anti-EGFR antibodies were isolated from phage-antibody libraries constructed not only from the spleen of an immunized mouse but also from the draining lymph node of an immunized mouse and from in vitro immunized mouse cells. Two of the single-chain Fv isolated from the phage-antibody libraries were engineered to create partially humanized whole antibody molecules.

Metastatic choriocarcinoma: correlation of MRI, CT, and angiography

We have described a 46-year-old woman with metastatic choriocarcinoma, anemia, and a liver mass. She subsequently had widespread metastatic disease and died despite chemotherapy. Without an antecedent history of pregnancy, her clinical presentation posed a diagnostic dilemma. This case emphasizes the importance of including choriocarcinoma in the differential diagnosis of liver masses in women of childbearing age and of correlating CT, MRI, and angiographic findings.

A preliminary assessment of epidural chloroprocaine for day procedures

Twenty-five patients underwent epidural anaesthesia with a new formulation of chloroprocaine 3% (1.0-1.5 ml x 10 cm body height-1) for a variety of day procedures. The mean (range) duration of surgery was 17 (5-35) min. The mean (range) time taken to establish maximal block was 16 (15-21) min and the mean (range) time to ambulation was 78 (55-95) min after administration of chloroprocaine. Twenty-three patients experienced a decrease in systolic arterial blood pressure of up to 15% of baseline values with another two decreasing by up to 25%. Two patients complained of severe backache immediately after operation and a further 16 and four patients reported mild or moderate backache respectively. Operating conditions were excellent in all but one patient and 23 patients said they would be happy to have the same anaesthetic again.

Genetic differences at four DNA typing loci in Finnish, Italian, and mixed Caucasian populations

Highly polymorphic segments of the human genome containing variable numbers of tandem repeats (VNTRs) have been widely used to establish DNA profiles of individuals for use in forensics. Methods of estimating the probability of occurrence of matching DNA profiles between two randomly selected individuals have been subject to extensive debate regarding the possibility of significant substructure occurring within the major races. We have sampled two Caucasian subpopulations, Finns and Italians, at four commonly used VNTR loci to determine the extent to which the subgroups differ from each other and from a mixed Caucasian database. The data were also analyzed for the occurrence of linkage disequilibrium among the loci. The allele frequency distributions of some loci were found to differ significantly among the subpopulations in a manner consistent with population substructure. Major differences were also found in the probability of occurrence of matching DNA profiles between two individuals chosen at random from the same subpopulation. With respect to the Finnish and Italian subpopulations, the conventional product rule for estimating the probability of a multilocus VNTR match using a mixed Caucasian database consistently yields estimates that are artificially small. Systematic errors of this type were not found using the interim ceiling principle recently advocated in the National Research Council's report [National Research Council (1992) DNA Technology in Forensic Science (Natl. Acad. Sci., Washington)]. The interim ceiling principle is based on currently available racial or ethnic databases and sets an arbitrary lower limit on each VNTR allele frequency. In the future the ceiling frequencies are expected to be established from more adequate data acquired for relevant VNTR loci from multiple subpopulations.

Partial attenuation of the pressor response to endotracheal intubation. A comparison of the effects of intravenous clonidine and fentanyl

In a randomized, double-blind placebo controlled study, intravenous clonidine, fentanyl and saline were compared for both their effect on the cardiovascular response to intubation, and early post-operative pain. The patients treated with fentanyl and clonidine were more sedated and the requirements for induction agents were lower compared to the control group. On intubation, both the active treatments resulted in a smaller increase in both heart rate and mean arterial pressure compared to the control group. There was no significant difference in recovery times in the three groups. Although the time to first request for analgesia was longer in the clonidine group compared to both the fentanyl and saline groups, the difference in morphine requirements between the groups was not significant. The differences between the two active treatments were not significant, and clonidine offered no additional benefits over fentanyl for this purpose.

Gastric emptying during lumbar extradural analgesia in labour: effect of fentanyl supplementation

We measured gastric emptying (by paracetamol absorption) and duration of analgesia in 30 women in labour after extradural injection of 0.375% bupivacaine 10 ml either alone or combined with fentanyl 100 micrograms. Treatment was administered double blind by random allocation after the first request for analgesia. The median (range) times to maximal serum concentration of paracetamol were 60 (15-90) min and 75 (30-180) min after administration in the control and fentanyl groups, respectively (P = 0.026), and corresponding mean (95% confidence interval) maximal concentrations of paracetamol were 27.3 (18.8-35.8) micrograms ml-1 and 18.0 (15.1-20.9) micrograms ml-1 (P = 0.020). Mean duration of analgesia, from the first extradural bolus until return of pain in those given bupivacaine alone was 113 (87-139) min and 154 (131-176) min when fentanyl was added to the local anaesthetic (P = 0.016). These results confirm the prolongation of analgesia after fentanyl supplementation of lumbar extradural analgesia, but indicate that it results in delayed gastric emptying.

Attenuation of the pressor response to tracheal intubation in hypertensive proteinuric pregnant patients by lignocaine, alfentanil and magnesium sulphate

The pressor response to intubation is known to be exaggerated in patients with gestational proteinuric hypertension (GPH). The effect of pretreatment with lignocaine 1.5 mg kg-1, magnesium sulphate 40 mg kg-1 or alfentanil 10 micrograms kg-1 on this pressor response was studied in 69 patients with moderate to severe GPH. Systolic arterial pressure exceeded baseline values for the first 5 min after tracheal intubation in the lignocaine group, with a peak increase of 31.6 (SEM 3.6) mm Hg at 2 min after intubation, but no mean increase in pressure occurred in the two other groups. Following intubation, six of 24 mothers in the alfentanil group, six of 21 in the lignocaine group and one of 24 in the magnesium group (P less than 0.05) exhibited a systolic arterial pressure (SAP) greater than 180 mm Hg sustained for 2 min or more. Alfentanil caused the least change in heart rate, but resulted in significant fetal depression.

Anaesthetic hazards of the 'passion gap'. A case report

Dental abnormalities cause problems for both dentist and anaesthetist. The anaesthetic hazards associated with the 'passion gap'--a term used in the western Cape Province for removal of the top four incisor teeth, a practice widespread among members of the Cape Coloured community--are discussed. Recommendations are made to assist the anaesthetist when dealing with such a patient.

Characteristics of a DNA probe (pa3'HVR) when used for paternity testing

DNA probes that detect polymorphic loci in the human genome are finding widespread application in many areas of genetic testing. Paternity testing represents one area for the application of probe technology; this report presents data obtained in a paternity testing program with a probe (pa3'HVR) derived from a locus (D16S85) approximately 8 kilobases (kb) downstream from the alpha globin gene complex on chromosome 16. The pa3'HVR probe used under stringent conditions of hybridization detects a highly polymorphic locus in chromosomal DNA digested with Pvu 2 restriction endonuclease. Alleles at the D16S85 locus were grouped into 58 size bins differing from one another by 100 base pairs in the black and white populations. The most common alleles detected in whites fell into the 2.3-kb group with a collective frequency of 0.1849. In blacks, the most common allele group is 2.0 kb with a collective frequency of 0.1333. The probe was used for restriction fragment length polymorphism mapping in conjunction with standard paternity testing techniques in 100 paternity cases. Thirty direct exclusions were encountered in the 100 cases with standard testing methods, versus 27 exclusions with the pa3'HVR probe alone. Four exclusions detected with standard methods were not detected with the probe and one exclusion detected with the probe was missed by standard testing. The probability of excluding a falsely accused man by use of the pa3'HVR probe was approximately 90 percent. In cases where exclusions were not encountered, the data obtained with the pa3'HVR probe increased the paternity index calculated from standard testing by about 16-fold.2+ informative for paternity testing.

Identification of the 37-kDa protein displaying a variable interaction with the erythroid cell membrane as glyceraldehyde-3-phosphate dehydrogenase

In previous studies from this laboratory we isolated and characterized a 37-kDa protein that was associated with the membrane of erythroid cells. The polypeptide appeared to undergo a lineage-specific alteration in its interaction with the membrane during erythroid development and migrated as a family of isoelectric focusing variants during analyses on two-dimensional gels. We report here that the 37-kDa protein is homologous to the enzyme glyceraldehyde-3-phosphate dehydrogenase (EC 1.2.1.12). This conclusion was reached from the results of several experimental approaches comparing the biochemical and genetic properties of the 37-kDa protein (p37) with authentic glyceraldehyde-3-phosphate dehydrogenase. Peptide maps of highly purified p37 and glyceraldehyde-3-phosphate dehydrogenase, generated with Staphylococcus V8 protease, were identical. The nucleotide sequence of a cDNA clone encoding p37 was nearly identical to the published sequence for genes encoding glyceraldehyde-3-phosphate dehydrogenase. These results suggest that the interaction of the enzyme with the red cell membrane is more complex than previously envisioned. The existence of subpopulations of glyceraldehyde-3-phosphate dehydrogenase molecules is envisioned that exhibit different levels of enzyme activity and bind to the red cell membrane with varying affinities.

Isolation and characterization of a 37,000-dalton protein associated with the erythrocyte membrane

We have purified a 37,000-dalton polypeptide (p37) from the red cell membrane that was found in previous studies to undergo a lineage-specific alteration in its membrane association. Our data suggest that p37 associates with the red cell membrane through electrostatic interactions that are resistant to 0.5 M NaCl or 10 mM EDTA. Conditions found to elute p37 from red cell ghosts include H2O at pH 12, 0.1 N NaOH + 1 mM ethanol and 1.0% Triton X-100. p37 was purified substantially from ghosts by Triton X-100 solubilization followed by sequential DEAE-Sephadex and CM-Sephadex chromatography. When p37 was analyzed by two-dimensional gel electrophoresis, a family of isoelectric focusing variants was detected ranging in pI from 7.0 to 7.8. All of the isoelectric focusing variants showed homology to one another when compared serologically with anti-p37 antibodies or by limited peptide mapping using Staphylococcus aureus V8 protease. The isoelectric focusing variants appear to represent distinct, yet related polypeptides rather than degrees of post-translational modifications to a single species, inasmuch as all of the variants are present in anti-p37 immunoprecipitates prepared from in vitro translations programmed with p37 mRNA.