Ultrastructural localization of glutamate and aspartate immunoreactivities in gerbil inner hair cells

The endogenous neurotransmitter released at the base of cochlear inner hair cells (IHCs) is still not clear. L-Glutamate is the most likely candidate at present. Although it has been demonstrated that IHCs contain high levels of glutamate, the association of glutamate with synaptic release has not yet been established. In this study, presynaptic location of glutamate and aspartate immunoreactivities was examined by using the postembedding immunogold technique. The results show that neither glutamate nor aspartate exhibit immunoreactivities around the synaptic vesicles of IHCs. Although the results do not support the hypothesis that glutamate or aspartate is the endogenous neurotransmitter, the possibility that the real transmitter is a substance with a structure very similar to glutamate or aspartate cannot be excluded.

A diagnostic dilemma in an elderly patient with bone pains

A 61-year-old patient presented with multiple bone pains. Biochemical, haematological and radiological investigations initially suggested a diagnosis of osteomalacia because of the presence of hypocalcaemia and looser zones. There were also multiple lytic bone lesions and bone scan showed multiple hot spots suggesting multiple bone secondaries. The key investigation in this case was examination of the bone marrow.

High dose chemotherapy with peripheral blood stem cells transplantation in patients with relapsed or refractory lymphomas preliminary reports

High dose chemotherapy with peripheral blood stem cells transplantation (PBSCT) has been used worldwide in the treatment of patients with various hematological malignancies and other solid tumors. It has just come into use as a salvage therapy in various malignancies in Taiwan in recent years. We report eight cases with relapsed or refractory lymphoma treated with high dose chemotherapy and PBSCT. Our results showed all cases but one achieved complete remission. The mean days of white cell recovery were 10 days to > 500/microliter (ranges, 8-16 days) and 12 days to > 1,000/microliter (ranges, 9-19 days). The mean days to platelet transfusion independent, i.e. platelet > 20,000/microliters, was 14 days. No specific side effect was noted except death in one case on D+9 during cytopenia state. Four patients relapsed and died during the follow-up after PBSCT. From our preliminary results we suggest that high dose chemotherapy with PBSCT could be used as a salvage therapy in patients with relapsed or refractory lymphomas with favorable and sustained hematological recovery. Most cases were tolerable with myeloablative chemotherapy and re-achieved remission, however, remission duration was still short and relapse remained the main problem to be overcome. The long term effects of high dose chemotherapy with PBSCT still need further study.

Differential effect of age on transforming growth factor-beta 1 inhibition of prolactin gene expression versus secretion in rat anterior pituitary cells

Transforming growth factor-beta 1 (TGF-beta 1) synthesized in the pituitary may act as an autocrine/paracrine regulator of lactotrope function. We examined the effects of TGF-beta 1 on PRL messenger RNA (mRNA), PRL synthesis, and PRL secretion in cultured anterior pituitary (AP) cells from rats at different ages. APs excised from ovariectomized female Sprague-Dawley rats, either young(2-3 months old; average serum PRL: 9 ng/ml), middle-aged (11-12 months old; average serum PRL: 133 ng/ml), or old (24 months old; average serum PRL: 159 ng/ml), were dispersed and cultured for 5 days. Then, cells were washed and challenged with increasing doses of TGF-beta 1 (0-100 ng/ml) for 1-48 h in serum-free medium. Northern blot analysis showed an increase in basal PRL mRNA levels, and a decrease in responsiveness to TGF-beta 1 with age. TGF-beta 1 suppressed PRL mRNA in a dose- and time-dependent manner in cells from young rats. Maximum inhibition was observed at 0.5-1 ng/ml of TGF-beta 1. At 0.5 ng/ml TGF-beta 1, significant reduction in PRL mRNA was detected at 6 h, and maximum inhibition was observed at 12-48 h post TGF-beta 1 incubation. Cells from middle-aged rats were less responsive to TGF-beta 1, whereas cells from old rats did not seem to respond under our experimental conditions. In addition to its effect on PRL mRNA in young AP cells, TGF-beta 1 dose dependently inhibited the rate of PRL synthesis, as indicated by reduced [35S]methionine incorporation into immunoprecipitated PRL. Responsiveness of PRL synthesis to TGF-beta 1 inhibition also decreased with age; however, significant inhibition by TGF-beta 1 on PRL synthesis could still be observed in old AP cells. Analysis by RIA demonstrated that young AP cells produced lower levels (15 micrograms/10(6) cells.24 h) of PRL in culture medium than old AP cells (32 micrograms/10(6) cells.24 h). TGF-beta 1 decreased medium PRL levels in old AP cells as efficaciously as in young AP cells. Significant reduction in medium PRL secreted by young AP cells was observed at 3 h when changes in both PRL mRNA and PRL synthesis were not evident. Taken together, our data suggest that TGF-beta 1 affects PRL production at multiple levels. Moreover, its inhibition on PRL synthesis and mRNA expression, but not on PRL secretion, is age-related. Thus, TGF-beta 1 may play an important role in regulating lactotrope function during aging.

Comparison of intravenous granisetron with metoclopramide plus dexamethasone in the prevention of nausea and vomiting associated with emetogenic cytotoxic chemotherapy

Fifty-one patients who received their first course of chemotherapy were studied to compare the respective efficacy and safety of granisetron and metoclopramide plus dexamethasone in the prevention of nausea and vomiting induced by emetogenic cytotoxic drugs. The results showed the response rate of antiemesis in the first 24 hours was higher in the metoclopramide plus dexamethasone group than in the granisetron group: 95% vs 84%. For the next six days of the study period, the response rate of the granisetron group was shown to be more effective than that of metoclopramide plus dexamethasone group: 77% vs 60%. Furthermore, the granisetron seemed to display enhanced tolerability with less drug-related side effects and no extrapyramidal effects which appeared in 2 cases of the metoclopramide plus dexamethasone group. In conclusion, a single dose of granisetron can be as effective as the gold standard of metoclopramide plus dexamethasone regimen in preventing and treating acute nausea and vomiting. For preventing delayed nausea and vomiting, granisetron is shown to be more effective than metoclopramide plus dexamethasone.

Inward growth of colonic adenomatous polyps

BACKGROUND & AIMS

Most colon cancers arise from polypoid adenomas, but how these benign lesions develop into malignant neoplasms is not understood. This study examined the migration of epithelial cells within human adenomatous polyps by determining the distribution of proliferating and apoptotic cells and immunoreactivity to transforming growth factor beta (TGF-beta).

METHODS

Sections of surgically resected normal (n = 10) and adenomatous (n = 22) formalin-fixed tissue were examined for proliferating cells and TGF-beta isoenzymes 1-3 by immunohistochemistry and apoptotic cells by terminal deoxyuridine nick end-labeling.

RESULTS

The distribution of proliferating, apoptotic, and TGF-beta immunoreactive cells was strikingly reversed in adenomatous polyps compared with normal mucosa. Proliferating cells were located in the base of normal colonic crypts and TGF-beta immunoreactive and apoptotic cells near or at the luminal surface, corresponding to the normal migration of colonocytes. In adenomas, increased numbers of proliferating cells were mainly located at the luminal surface and TGF-beta immunoreactive and apoptotic cells were located principally at the crypt base.

CONCLUSIONS

This distribution suggests that cell migration in adenomas is not toward the lumen but instead inward toward the polyp base.

Tobacco, alcohol, and oral cancer: the patient's perspective

It is well known that smoking, chewing tobacco, and alcohol play a significant role in the etiology of oral cancer. Although this is common knowledge in the medical community, it appears that patients are not aware of this association. We performed a prospective study on all patients newly diagnosed with oral cancer and a control group without any head and neck cancer. Patients completed a questionnaire assessing their awareness of these causative factors. Other parameters measured as possible influences of patient perception included patient age, sex, smoking status, education level, occupation, and place of residence. Patients were also questioned about their knowledge of the causes of lung cancer to allow for comparison. A total of 134 patients were questioned, with 22 of the patients assigned to the oral cancer group and the second group being comprised of 112 patients without head and neck cancer. Only 20 patients (14.9%) were aware of the causative factors of oral cancer. There was no significant difference in the knowledge of causation when comparing the cancer and control group. The patient age, sex, smoking status, or place of residence did not affect their knowledge of the causes of oral cancer. There was a highly significant difference between patients of different education levels and occupations, with the more educated and higher level occupations being better informed about the causes of oral cancer. In contrast, the majority of patients were aware of smoking as a causative factor in the development of lung cancer. The results from this study demonstrate a serious lack of knowledge in the general population of known causes of oral cancer. The relevant issues are discussed and recommendations are made.

Prospective study of patients' subjective responses to botulinum toxin injection for spasmodic dysphonia

Adductor spasmodic dysphonia (SD) is a speech disorder resulting from involuntary contractions of the laryngeal muscles. Botulinum toxin (BT) injection of the thyroarytenoid muscle is an effective, though temporary, treatment for most SD patients. Though there are reports of objective improvements in voice quality, there are no large studies of patients' subjective responses to treatment over time. In the present study, patients were given voice diaries to rate vocal spasms, hoarseness, breathiness, volume problems, and dysphagia before and the after treatment. Analysis of these diaries revealed that: (1) most side effects had resolved 4 to 6 weeks after injection, whereas vocal spasm relief persisted; (2) vocal spasm relief and severity of side effects peaked within 1 week; and (3) unilateral injections, though as effective in relieving vocal spasms, caused less volume and swallowing problems than did bilateral injections.

The role of discriminant functions in screening for beta-thalassaemia traits during pregnancy

INTRODUCTION

The mean red cell volume (MCV) has been shown to be useful in a 2-stage screening process for beta-thalassaemia traits among pregnant women though associated with a large number of false positive results. We tested prospectively the ability of 5 discriminant functions (DF), (England & Fraser, Shine & Lal, Mentzer, Srivistava and Klee et al) to reduce the number of false positives when used as additional screening determinants for beta-thalassaemia in antenatal patients with red cell microcytosis.

METHODS

The diagnostic performance of each DF was compared in 493 patients with microcytosis and known beta-thalassaemia status. Truth table analysis and Receiver Operation Characteristic curves for each function were determined.

RESULTS

11.4% of the patients with microcytosis were diagnosed to have beta-thalassaemia traits. DFs incorporating the red cell indices: haemoglobin or total red cell count are unsuitable during pregnancy. Shine & Lal's index [(0.01 x MCH x (< MCV)2] reduced the number of people recalled for confirmatory testing by 31.1% and increased the diagnostic yield to 38.7% while maintaining a negative predictive value for the test of 0.993.

CONCLUSION

We conclude that a 3-stage screening process for beta-thalassaemia among pregnant women in Singapore involving the MCV, Shine & Lal's index and a confirmatory test to be both valid and cost-effective.

Application of ABO genotyping using polymerase chain reaction method to assess engraftment in bone marrow transplantation--a case report

We described a case of acute promyelocytic leukemia with O blood type who received bone marrow transplantation during a second remission from his HLA identical, B blood type sibling. Using PCR genotyping of the ABO group and analysis of the variable number of tandem repeats of the D1S80 locus, we could quickly document the successful early engraftment in this patient. We emphasize that the use of PCR ABO genotyping is a quick and valuable method which could be applied to assess the engraftment and its follow up in those transplant cases with donors of mismatched blood groups.

Spectroscopic studies of the characterization of recombinant human dihydrolipoamide dehydrogenase and its site-directed mutants

In this paper, we report the overexpression and single-step purification of recombinant wild-type and site-directed mutants of human dihydrolipoamide dehydrogenase in Escherichia coli and detailed spectroscopic studies aimed at understanding the catalytic mechanism of this enzyme. One mutation (K37E) has been identified in a patient lacking dihydrolipoamide dehydrogenase activity and has been reported previously (Liu, T.-C., Kim, H., Arizmendi, C., Kitano, A., and Patel, M. S. (1993) Proc. Natl. Acad. Sci. USA. 90, 5186-5190), while the other two mutations were previously generated specifically to address the role of the active-site base (His-452) and its ion pair (Glu-457). Circular dichroic and fluorescence spectroscopic data illustrate the role of these amino acids in maintaining the structure and function of human dihydrolipoamide dehydrogenase. While mutant H452Q is severely crippled in catalysis of the physiological reaction, the reverse reaction is affected in the E457Q mutant. The K37E mutant shows very little deviation from the wild-type enzyme.

Clonal analysis in acute myeloid leukemia by polymerase chain reaction

We have used PCR to amplify a polymorphic portion of the X-chromosome linked phosphoglycerate kinase gene (PGK) combined with a methylation-sensitive restriction enzyme digestion of the active X chromosome to examine the frequency of heterozygosity in Taiwanese females and analyze clonality in 18 female patients with acute myeloid leukemia (AML). We used hair follicles as normal tissue control. We found that the incidence of heterozygosity of the PGK gene in 102 hematological normal females and 18 patients tested was 35% (42/120). In five AML patients, a monoclonal X-inactivation pattern of leukemic blasts was found at presentation, which then returned to polyclonal at remission. In two of these five cases, a monoclonal pattern recurred at relapse. We also found that the hair follicles were readily accessible normal tissue for control, were easy to obtain, and were non-invasive.

MDR1 gene expression in acute myeloid leukemia: clinical correlation

Acute myeloid leukemia (AML) has a poor long-term prognosis, with a disease-free survival rate of only 20%. Drug resistance remains the major obstacle in this disease, although relatively little data are available on the correlation of multi-drug resistance (MDR) and clinical outcome. We examined 28 bone marrow samples from 24 patients with AML. The MDR1 RNA levels were determined by slot blot analysis. The incidence of positive expression of MDR1 mRNA in patients was 64.7% in samples from newly-diagnosed patients and 85.7% in relapse samples. The overall complete remission rate was 45%. However, the complete remission rate was lower for patients in the MDR1 RNA positive group than in the negative group. In three cases, the MDR1 RNA expression steadily rose during the period of disease progression and after several courses of chemotherapy. We suggest that a high frequency of MDR1 gene expression in patients with AML and higher MDR1 RNA levels are associated with a lower incidence of complete remission as well as a shorter disease-free time. The expression of MDR1 is a poor prognostic factor for AML treatment and it may play an important role in resistance to chemotherapy.

Chronic neutrophilic leukemia--a case report

We describe a 77-year-old patient with chronic neutrophilic leukemia (CNL). Diagnosis of CNL was made by marked increase of mature neutrophils without increased immature granulocytes, splenomegaly and elevated serum vitamin B12 level and by ruling out any infection or occult malignancy. The chromosome analysis showed one abnormal karyotype out of 14 metaphases. The neutrophilic function with nitroblue tetrazolium test revealed impaired phagocytic function in this patient. The neutrophil count became normal gradually after hydroxyurea treatment. However, it still maintained a high percentage of mature neutrophils. Background literature and the prognosis of CNL are discussed.

Dihydrolipoamide dehydrogenase: activity assays

We have described the most commonly used assay procedures determination of the DHLipDH activities from prokaryotic and eukaryotic cells. We have also described the procedures for the preparation of tissue extracts to determine the enzymatic activity. We have briefly alluded to the problems inherent in these assay procedures and suggested some precautions for using the assays to determine DHLipDH activity. We have also included a statement about the purification procedures and described some of the properties of this enzyme, which might help the reader in planning studies. We have, by no means, attempted to be comprehensive in this regard; therefore, the reader should consult the appropriate references (and references therein).

[Rhinocerebral mucormycosis in a case of malignant lymphoma]

Mucormycosis, an uncommon opportunistic fungal infection, usually occurs in immunocompromised patients. It is rapidly progressive and almost always fatal. Patients with lymphoma are susceptible to pulmonary or disseminated mucormycosis, whereas rhinocerebral mucormycosis in such patients, as far as we know, is rarely reported. We present a patient with malignant lymphoma who exhibited such an acute rhinocerebral infection after chemotherapy which manifested initially as a stuffy nose and intractable headache. Then ptosis, proptosis, chemosis and multiple cranial nerve palsies appeared. Eschar was found in the nasal cavity. Direct KOH smear and tissue biopsy revealed mucormycotic infection. He survived because of early diagnosis and prompt treatment.

Primary amino acid sequence and structure of human pyruvate carboxylase

Pyruvate carboxylase (PC) (pyruvate:carbon dioxide ligase (ADP-forming), EC 6.4.1.1.), a nuclear-encoded mitochondrial enzyme, catalyzes the conversion of pyruvate to oxaloacetate. We have isolated and characterized cDNAs spanning the entire coding region of human PC. The sequence of human PC has an open reading frame of 3537 nucleotides which encodes for a polypeptide with a length of 1178 amino acids. The identity of the cDNA as PC is confirmed by comparison to PC cDNAs of other species and sequenced peptide fragments of mammalian PC. The M(r) of the full length precursor protein is 129,576 and that of the mature apoprotein is 127,370. RNA blot analysis from a variety of human tissues demonstrates that the highest level of PC mRNA is found in liver corresponding to this tissue's high level of PC activity. Based on homology with other biotin-containing proteins, the ATP, pyruvate, and biotin-binding sites can be identified. One of two patients with documented PC deficiency was found to be missing PC mRNA, further confirming the identity of this cDNA.

Rapid detection of -alpha 4.2 deletion of alpha-thalassemia-2 by polymerase chain reaction

We sequenced part of the X boxes of alpha-thalassemia-1 of Southeast Asia type (- -SEA) with -alpha 4.2, -alpha 3.7, -alpha G-Taichung, and alpha CS alpha. We found the X box of -alpha 3.7 belonged to the X box of alpha 2 globin gene and the X box of alpha CS alpha contained X boxes of both alpha 1 and alpha 2 globin gene, whereas the X box of -alpha 4.2 and -alpha G-Taichung was a hybrid of X boxes of alpha 2 and alpha 1 globin gene. We also found there are two types of -alpha 4.2 deletion; type 1 is a common type of -alpha 4.2 deletion and type 2 is linkage to -alpha G-Taichung. We used a combination of two methods, the amplification refractory mutation system (ARMS) and the amplified created restriction sites (ACRS), to amplify the hybrids of X boxes specifically. The upstream primer for X box of alpha 2 globin gene was designed following the standard ARMS procedure to amplify the X segment of the alpha-globin gene. The downstream primer was designed according to the ACRS method to check the specificity of PCR products. Using this approach, we can diagnose the different types of -alpha 4.2 deletion. This kind of approach can also be used to amplify the specific region from the cluster of highly homologous genes.

Differential actions of phospholipase C on gonadotropin-releasing-hormone-stimulated release and glycosylation of luteinizing hormone in rat anterior pituitary cells

Receptor-mediated activation of phospholipase C (PLC) which releases diacylglycerol and inositol trisphosphate has been implicated in the action of gonadotropin-releasing hormone (GnRH) on gonadotrophs. Previously we demonstrated that the synthetic diacylglycerol, phorbol 12-myristate 13-acetate (PMA) and PLC mimic the stimulatory effects of GnRH on both luteinizing hormone (LH) glycosylation and release. In this study we further investigated how PMA or PLC interact with GnRH to control LH release versus glycosylation. Cultured pituitary cells were incubated in the presence of radiolabeled precursors and GnRH (0, 1, or 100 nM), with or without PMA (10 nM) or PLC (0.24 U/ml) for 4 h. LH translation and glycosylation were monitored by measuring incorporation of [14C]alanine and [3H]glucosamine, respectively, into total (cell and medium) immunoprecipitable LH. Immunoreactive LH (IRLH) was measured by radioimmunoassay. Both PMA and PLC increased (p < 0.01) basal IRLH release, and IRLH release stimulated by 1 nM GnRH. Neither PMA nor PLC exerted an additive effect on IRLH release stimulated by 100 nM GnRH. The interactions between PMA or PLC and GnRH on IRLH release were significant (p < 0.01). Both PMA and PLC elevated (p < 0.01) total [3H]glucosamine-LH, but had no additive effect with 1 nM GnRH; PLC depressed (p < 0.05) the stimulatory effect of 100 nM GnRH, whereas PMA had no effect. The interactions between PMA or PLC and GnRH on LH glycosylation were significant (p < 0.01). PMA, PLC or GnRH alone did not affect total [14C]alanine-LH. In the presence of 1 or 100 nM GnRH, PLC, but not PMA, decreased (p < 0.05) total [14C]alanine-LH.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular basis of beta-thalassemia minor in Taiwan

The mutations producing beta-thalassemia minor in 227 Taiwanese were studied using the method of naturally and amplified created restriction sites. beta-Thalassemia minor was caused by one beta-globin gene mutation in most of the cases (225/227); only a few cases were caused by two gene mutation (2/227). The most common type of mutation was frameshift codon 41/42 (-TCTT) (93/227), followed in descending order by the C-->T substitution at nucleotide 654 of IVS-2 (83/227), the nonsense mutation A--T at codon 17 (22/227), the A-->T mutation at position -28 of the promotor region (12/227), the frameshift codon 27/28 (+C) (6/227), the initial codon mutation (ATG-->AGG) (5/227), and one each of the codon 71/72 (+A), IVS-1 nt 1 (G-->T), IVS-1 3' end (TAG-->GAG), and nonsense codon 43. In the two cases of the two-gene mutation, one was the nt 654 mutation with Hb Kaohsiung and another one was frameshift codon 41/42 with Hb Meinung. The first four mutations accounted for more than 90% of the mutations. The C-->T substitution at the nt 654 of IVS-2 and initial codon mutation in our study had a higher incidence than in other Southeast Asia areas. Comparison of clinical data in different types of beta-thalassemia showed that there were higher MCV and MCH levels in beta (+)-thalassemia.

Screening for beta thalassaemia and HbE traits with the mean red cell volume in pregnant women

Both beta thalassaemia and HbE disease are microcytic red cell disorders. Pregnancy however induces macrocytosis which makes screening with the mean cell volume (MCV) difficult in antenatal patients. In addition, population screening for HbE has not been widely reported in the literature and the screening criteria for beta thalassaemia may not necessarily apply. A study of the value of the MCV for routine screening for both beta thalassaemia and HbE traits in 3696 antenatal patients of different gestational ages was carried out. All patients with an MCV < or = 80 fL received confirmatory tests for haemoglobinopathies. The MCV rose by only 2.0% in pregnancy. A total of 494 patients (13.4% of the general population) had an MCV < or = 80 fL. Of these microcytic patients, 11.3% (56) and 4.7% (23) were eventually confirmed to have beta thalassaemia and HbE traits respectively. The mean MCV for the 3696 antenatal patients was 87.8 fL (SD 7.5) compared to patients with beta thalassaemia and HbE traits, which were 67.5 fL (SD 4.5) and 75.7 fL (SD 4.1). HbE traits were less microcytic than beta thalassaemia traits and overlapped significantly with the general population. Beta thalassaemia trait and HbE trait detected by this screening method constituted 1.52% and 0.62% respectively of the total antenatal population screened. The MCV remains a valid screening parameter in pregnancy for beta thalassaemia trait. As for HbE trait, applying a discriminant value of 80 fL to the MCV in the population screening would miss a significant proportion of the HbE traits.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of thalassaemia by non-isotope detection of alpha/beta and zeta/alpha mRNA ratios

The alpha/beta and zeta/alpha messenger RNA (mRNA) ratios in the thalassaemia syndromes were investigated by polymerase chain reaction (PCR) with silver staining of the PCR products. In this study we used the PCR to amplify cDNA copies of circulating erythroid cell mRNA in order to measure the relative amounts of alpha-, beta- and zeta-globin contained within. Quantitation was performed by scanning the silver stain of specific globin cDNA bands. We found that there were significant differences of alpha/beta-mRNA and zeta/alpha-mRNA in patients with Hb H disease and alpha-thalassaemia-1 compared to normal subjects. There was a marked increase in the alpha/beta-mRNA ratio but not in the zeta/alpha-mRNA ratio in patients with beta-thalassaemia. In two beta-thalassaemia cases abnormal increases of zeta-globin bands were noted and they were confirmed through DNA analysis to be combined with alpha-thalassaemia-1. This method provides a simple, rapid and non-radioactive approach to detect thalassaemia syndromes, and can help to screen cases of beta-thalassaemia with alpha-thalassaemia-1.

Molecular basis and hematological characterization of Hb H disease in southeast Asia

We molecularly characterized sixty-seven cases of Hb H disease by the polymerase chain reaction. The strategy depends on amplifying the alpha-thalassemia-1 (alpha-thal-1) gene by primers flanking the breakpoint and sequence differences of the 3' end of the alpha-globin gene and the nonhomologous elements I, II, and III among different types of alpha-thala-2. In the 67 cases studied, all involved alpha-thal-1 of the Southeast Asia type (SEA) in combination with deletional or nondeletional alpha-thal-2. Thirty-two cases were of the deletion form and 35 cases were of the nondeletion form. In 32 cases of the deletion form, 29 cases were rightward deletion (-alpha 3.7), and three cases were leftward deletion (-alpha 4.2). We found that all of the nondeletion forms were alpha-thal-1 of SEA type with Hb CS. After the subtyping of Hb H with -alpha 3.7, 26 out of 29 were type I deletion and 3 out of 29 were type II deletion. Comparisons of clinical data of deletion forms and the nondeletion form showed that there were earlier occurrence of anemic symptoms and a larger erythrocyte volume in the nondeletion form group (P < 0.005).