Radiation-related thyroid carcinoma

Of 1,825 subjects with a history of head or neck irradiation, 358 (19.6%) were found to have thyroid abnormalities. One hundred sixty-five (9%) had either single or multiple nodules 153 (8.4%) had diffuse thyromegaly, and 40 (2.2%) had had thyroid surgery. Surgery was performed on 113 subjects with nodules; carcinoma was found in 34 (30.1%). Clinical examination of the neck was the most valuable method of detecting abnormalities. Detection of nodules was not significantly enhanced by routine use of thyroid imaging studies. Measurements of levels of serum thyroid-stimulating hormone, thyroxine, triidothyronine resin uptake, and thyroid antibodies were not useful in screening for nodules or carcinoma.

The influence of hormonal changes of pregnancy on maternal metabolism

Mammalian pregnancy is characterized by progressive hyperinsulinaemia, raised plasma lipids and increased vulnerability to ketosis after food deprivation. The present investigations were performed to assess the role of two placental steroids, oestradiol and progesterone, in the development of these changes, since plasma titres of these hormones progressively increase during human gestation. In both human subjects and adult female rats it was demonstrated that these two steroids, separately or in combination, augment plasma insulin concentration in vivo, cause hypertrophy of pancreatic islets and promote exaggerated secretion of insulin, but not glucagon, by pancreatic islets in vitro. Hypertriglyceridaemia induced by oestrogen alone or combined with progesterone was associated with increased splanchnic production of triglyceride as well as altered tissue lipoprotein lipase (EC 3.1.1.34) and circulating apoproteins that influence activity of this enzyme. The combined regimen also increased hepatic glycogen storage and suppressed gluconeogenesis in vivo in the rat while accelerating the onset of ketosis during starvation in human subjects and in the animal model. Oestradiol and progesterone appear to effect metabolic changes in nonpregnant animals and human subjects that simulate maternal adaptations to advancing gestation, including altered endocrine pancreatic function, triglyceride metabolism and metabolic fuel storage and mobilization.

Prenatal cytogenetic diagnosis: first 1,000 successful cases

From February 1969 to August 1976, we studied 1,048 amniotic fluids. Of these, 958 (91.4%) were primarily for prenatal cytogenetic diagnosis. Cytogenetic studies were attempted in 1,021 cases; the diagnosis was successful in 1,000 of these. The failure rate of obtaining a diagnosis from the amniotic fluid cell culture of the first amniocentesis was 5% (50 cases); 29 cases had a repeat tap and successful diagnosis was achieved in all. In 21 cases, a repeat tap was refused. Thus, the overall failure rate of obtaining a final cytogenetic diagnosis was 2.06% (21/1,021). There were 32 fetal losses after amniocentesis including 16 spontaneous second trimester abortions, 7 fetal deaths in utero and 9 stillbirths. In two additional cases, fetal death had occurred before amniocentesis. This number of fetal losses does not exceed the number that would be expected in the same maternal age group without amniocentesis. In our series, the frequencies of trisomy in maternal age groups 40 years and over, 37-39 years, 35-36 years, and under 35 years were 4.5, 3.14, 0 and 0% respectively. These frequencies are comparable to those reported from other prospective prenatal studies and higher than those of retrospective live born studies. Various problems and pitfalls in prenatal cytogenetic diagnosis are discussed.

Supernumerary small ring chromosome

A supernumerary small ring chromosome was found in 30% of cultured peripheral leucocytes and 50% of skin fibroblasts in a 6-year-old boy with mild mental retardation and midline cleft palate. The extra chromosome appeared to carry a densely staining region on Giemsa banding. The banding patterns of the remaining 46 chromosomes were normal. C banding indicated that the ring chromosome contained mainly centromeric constitutive heterochromatin. Chromosome analysis of both parents showed normal karyotypes by both conventional and banding techniques; thus the origin of the ring chromosome could not be determined.

Familial translocation with partial trisomy of 13 and 22: evidence that specific regions of chromosomes 13 and 22 are responsible for the phenotype of each trisomy

A newborn infant with clinical and pathological findings typical trisomy 13 and 22 syndromes had an extra chromosome which was a derivative chromosome from maternal balanced translocation affecting Nos. 13 and 22; 47,XY,+der(22),t(13:22)(q22:q12)Mat. The presence of extra specific euchromatic regions of No. 13(13q22 and/or 13q34) and No. 22 (22q11) seem to be responsible for the trisomy 13 and 22 syndromes.

Prenatal diagnosis of 45,X/46,XY mosaicism with postnatal confirmation in a phenotypically normal male infant

Prenatal detection of chromosome mosaicism has always been a diagnostic dilemma. In 21 reported cases of chromosomal mosaicism in cultured amniotic fluid cells, only two cases had cytogenetic confirmation of the mosaicism. All 21 pregnancies resulted in either phenotypically normal liveborns or grossly normal abortuses. We report a case of XO/XY mosaicism detected prenatally and confirmed postnatally in a grossly normal male infant. The indication for prenatal cytogenetic diagnosis was advanced maternal age (38 years). A diagnosis of XO/XY mosaicism was made from two separate culture flasks of amniotic fluid cells, with 45,X cells predominating (86.4%). The Y chromosome was of normal size but carried no fluorescent band. The parents were counseled and were advised that the phenotype of XO/XY mosaicism can range from relative normality to sexual maldevelopment. They decided to continue this pregnancy. The infant was born at term and was a grossly normal male with normal penis and descended, normal-sized testes. Leukocyte culture from the cord blood and a skin fibroblast culture confirmed the mosaicism of XO/XY. The father's Y chromosome was of identical size and carried a small fluorescent band. It appears that an altered Y chromosome may be predisposed to anaphase lag leading to mosaicism.

Karyology of primary human fetal cell cultures

Cell cultures were established from the biopsies of lung, skin and kidney from each of nine human fetuses, and chromosome analyses were performed on material through the fifth subculture. Kidney cell cultures generally showed a higher level of polyploidy than lung or skin. The frequencies of hyperdiploid cells and those with structural abnormalities were consistent with the low levels found in cultures of human lymphocytes. The data provide a normal cytogenetic baseline for human fetal material which may be useful in a variety of studies.

The state of lysosomes and protein turnover in rat liver. Effect of excess vitamin A

Administration of excess vitamin A to rats induces labilization of liver lysosomal membranes, as shown by the release of lysosomal cathepsins upon tissue homogenization. The effect of lysosomal labilization on liver protein turnover was investigated. The apparent turnover rate of liver proteins in the hypervitaminotic animals, as measured by a double isotope-labeling technique (Glass and Doyle (1972) J, Biol. Chem, 247, 5234-5242), was found to be the same as that in control animals. Neutral and alkaline fructose-1, 6-biphosphatase [EC 3.3.3.11] activities in the liver were also found to be unchanged in hypervitaminosis A. These data indicate that the rate of intracellular protein degradation is not determined by the level of "free cathepsins. Protein synthesis in the livers of the hypervitaminotic animals was partially imparied, as shown by the shift of polysomal profiles toward lighter aggregates.

Kniest syndrome with dominant inheritance and mucopolysacchariduria

A mother and daughter with clinical and radiographic findings typical of the Kniest syndrome are reported. It is apparent that this syndrome is dominantly inherited and that sporadic cases may represent fresh mutations. Abnormally high keratan sulfate excretion was found, indicating that the Kniest syndrome is a mucopolysacchariduria.

Skeletal abnormalities in the Kniest syndrome with mucopolysacchariduria

The roentgenographic and clinical findings are described in a mother and daughter with the Kniest syndrome associated with urinary keratan sulfate excretion. Osteoporosis, kyphoscoliosis, vertebral irregularity, pelvic deformity, flat femoral heads and enlargement of the ends of the long bones were the main roentgen findings. Irregularity of ossification on both sides of the growth plate was observed in the daughter, and marked degenerative changes were superimposed on several of the mother's abnormal joints. Abnormal mucopolysacchariduria, observed in both patients, and cataracts, fusion of the symphysis pubis, and deficiency of carpal bones, seen in the mother, have not been described previously.

Cytogenetics of fetal wastage

A consecutive series of 50 couples with a histroy of fetal wastage were studied cytogenetically with current banding technics. Fetal wastage was defined as occurring in couples who had more than two early abortions, stillbirth(s) or livebirths(s) or both of infants with multiple congenital anomalies. Three women were found to be balanced reciprocal translocation carriers; all translocations were not detectable by the conventional method but were demonstrable by current banding technics. In addition to the translocation carriers, one woman was found to be a mosaic for 45,X/46,XX/47,XXX. Four of the parents showed increased mitotic instability or chromosome breakage and rearrangement, or both. Parental chromosome abnormalities may therefore account for fetal wastage in between 6 and 16 per cent (or about one in 10) of couples having such a history. Such couples, if identified, can potentially benefit by prenatal monitoring of future pregnancies.

Sex steroid influence on triglyceride metabolism

Triglyceride metabolism was investigated in groups of fed and fasted rats after 21 days of parenteral estradiol (5 mug daily), progesterone (5 mg daily), or the two steroids in combination. Results were compared with control groups receiving an oil solvent alone. In rats given estradiol separately or combined with progesterone, hypertriglyceridemia was uniformly associated with increased plasma triglyceride entry, estimated with the i.v. Triton WR1339 technique. Progesterone alone had no effect on these parameters. Plasma postheparin lipolytic activity (PHLA), adipose, mammary gland, and protamine-resistant liporotein lipases (LPL) were significantly increased in progesterone-treated rats and significantly decreased in rats receiving estradiol with the exception of mammary gland LPL, which was also increased to a slight extent. The combined regimen reduced plasma PHLA and increased protamine-resistant adipose, and mammary gland LPL activity. Sex steroid treatments had minimal effects on plasma glucose and free fatty acid concentrations, but all increased plasma insulin significantly. Hyperinsulinemia did not parallel changes in body weight or other measured parameters. Linear regression analyses revealed that plasma triglyceride concentrations in all fed, treated rats correlated significantly with triglyceride entry but not very uniformly with plasma or tissue LPL activity. We conclude that estradiol, unlike progesterone, has substantial lipemic effects in the rat which relate best to triglyceride entry. Hyperinsulinemia, changes in body weight, plasma PHLA, and tissue LPL activities did not consistently predict the influence of sex steroid treatment on plasma triglyceride concentrations.

Balanced translocation in fetal wastage

A balanced reciprocal translocation involving the long arms of a No. 4 and a No. 11 chromosome, t(4;11) (q25;q13), was found in a mother who had one spontaneous first trimester abortion and 2 abnormal infants, as well as in her 2 phenotypically normal children. This translocation was not detectable by conventional karotyping since the two exchanged chromosome segments are almost identical in size; it was demonstrated by the new banding technic which allow us to recognize and to identify each chromosome and its segments accurately.

Familial x/x translocation: t(x;x)(p22;q13)

We have studied a family with an X/X translocation which was found in a 16-year-old daughter and in her 34-year-old mother. The daughter had short stature, secondary amenorrhea, and many Turner’s stigmata. The mother, 5-ft tall, had a few Turner’s stigmata and had developed secondary amenorrhea at age 24. Both peripheral leukocyte and skin fibroblast cultures of the daughter revealed, by conventional karyotype analysis, 46 chromosomes with one C-group chromosome missing and with an extra No. 2-like chromosome in all metaphase cells examined. By both Q- and G-banding techniques, this abnormal karyotype was identified as 46,X, + t(X;X)(p22;ql3). An identical translocation chromosome was demonstrated in the mother’s cells, but 50 % of the cells had a 45,X chromosomal constitution. Autoradiographic studies showed that the X/X translocation chromosome was the late-replicating X in all cells examined from both the daughter and the mother. The difference in the phenotypic manifestations of the daughter and of her mother can be explained perhaps by the different contents of the other active X chromosomes. When the same X chromosome is inactivated in all cells, mutations present in the active X chromosome are not compensated and therefore are expressed.

Metabolic responses to fasting and ethanol infusion in obese, diabetic subjects. Relationship to insulin deficiency

During total fasting, insulin regulates plasma glucose concentrations primarily by controlling hepatic glucose production rather than by influencing peripheral tissue glucose utilization. Administration of ethanol to individuals deprived of food lowers plasma glucose principally by suppressing hepatic gluconeogenesis. With these two observations in mind, an indirect study was made of insulin deficiency and disturbed hepatic carbohydrate metabolism with persistent hyperglycemia during total fasting in six severely diabetic obese women, matched in age and weight with six nondiabetic and six moderately diabetic, obese female subjects. The degree of abnormal hyperglycemia that distinguished the two diabetic groups from each other and from control patients during a seven day total fast were related to the degree of hypoinsulinemia. Plasma glucogenic amino acids, including alanine were significantly depressed in the severely diabetic patients throughout the fasting interval. Four hour intravenous infusions of ethanol after fasting lowered plasma glucose to the greatest extent in patients with severe diabetes and least in the nondiabetic obese. In all instances, ethanol infusion decreased plasma glucogenic amino acids. Differential sensitivities of plasma glucose responses to fasting and to ethanol administration in these patients suggest that hepatic glucose production is inappropriate in severely diabetic, obese subjects. The defect correlates with subnormal plasma glucogenic substrate concentrations, suggesting increased hepatic extraction and conversion to glucose. Hypoglycemic effects of ethanol may be induced, in part, by altered availability of plasma amino acid precursors.

Reciprocal translocation versus centric fusion between two No. 13 chromosomes. A case of 46,XX,-13,+t(13;13)(p12;q13) and a case of 46,XY,-13,+t(13;13)(p12;p12)

The centric fusion, or Robertsonian, type of translocation has been considered as a fusion of the entire long arms of two acrocentric chromosomes preceded by breakage of the centric heterochromatin. Reunion of the long arms is considered to include the centromeres, only one of which is visible by conventional staining methods. Prior to the development of the current banding techniques in human chromosome identification, the possibility that a centric fusion-like translocation might be the result of a reciprocal translocation was merely speculative. With the various banding techniques, we have identified two different types of 13/13 “centric fusion”-like translocation chromosomes with trisomy 13, i.e., one case of reciprocal translocation, 46,XX,–13,+t(13;13)(p12;q13), and one true case of centric fusion translocation, 46,XY,–13,+t(13;13)(p12;p12). In the first case, the unequal translocation of two No. 13 chromosomes was evident with the Q-and G-banding patterns; this patient also had a milder clinical manifestation of trisomy 13, since she was only partially trisomic for the long arm of No. 13. In the second case, the Q- and G-banding patterns revealed a symmetrical involvement of two No. 13 chromosomes in the translocation, and the C- and Q-banding techniques showed two distinct centromeres in the translocation chromosome. The latter patient demonstrated the typical trisomy 13 syndrome. The example of these two cases indicates that, with the current banding techniques, the true incidence of reciprocal translocations among so-called centric fusion types of translocations can be more accurately estimated.

Metabolic effects of weight loss in obese subjects. Changes in plasma substrate levels, insulin and growth hormone responses

Oral glucose tolerance and intravenous tolbutamide, glucagon and insulin tolerance were assessed in six obese patients before and after an average weight loss of eighty-five pounds and a reduction from 83 to 27 per cent above ideal body weight. Results were compared to ten nonobese subjects of similar age.

Before treatment fasting plasma glucose, free fatty acids and immunoreactive insulin exceeded normal levels. Total plasma alpha-amino acid nitrogen levels were unaffected by obesity. Post-challenge insulin responses during the first three tolerance tests were two to four-fold above control responses, and increments of immunoreactive growth hormone during insulin tolerance were subnormal in the obese. After weight reduction only minor differences in mean yjilues existed between obese and control groups.

These findings indicate that disturbances in fasting plasma substrate levels as well as plasma insulin and growth hormone responses fii obese individuals are reversible after substantial weight reduction.