Increased C-MYC oncogene copy number detected with combined modified comparative genomic hybridization and FISH analysis in a Richter syndrome case with complex karyotype

Modified comparative genomic hybridization (mCGH) was performed in a Richter syndrome case with a complex karyotype to identify and map gains of DNA sequences with possible importance in the pathogenesis and progression of the tumor. The mCGH analysis revealed a more intense signal on part of the long arm of one pair of chromosomes belonging to group C. The G-banding study showed that the increased DNA-sequence copy number originated from the 8q22-->qter chromosomal region. This increase was confirmed by performing a fluorescence in situ hybridization analysis on tumor metaphases by first using a chromosome 8-specific library and subsequently a C-MYC probe, which revealed positive staining on six different regions located on six different chromosomes, each one bearing a single copy of the C-MYC oncogene. These results show the existence of C-MYC oncogene copy-number increases and confirm the usefulness of mCGH in the genetic analysis of malignancies.

Sensitization to mite allergens and acute asthma in a tropical environment

The objective of this study was to determine whether sensitization to certain aeroallergens is associated with acute asthma in Cartagena, Colombia. Ninety-nine subjects with acute asthma and 100 controls evaluated for other reasons were studied at a local emergency room. Sensitization was established by specific IgE determinations. Statistically significant differences between asthmatic subjects and controls were found in the prevalence of specific IgE to Dermatophagoides pteronyssinus, 64.6% vs. 28% (p = 0.0001); to Dermatophagoides farinae, 74.7% vs. 40% (p = 0.0001); to Euroglyphus maynei, 68.7% vs. 22% (p = 0.0001); and to Blomia tropicalis, 54.5% vs. 17% (p = 0.0001). The odds ratios were 4.9; 4.4; 7.7 and 5.8, respectively. In contrast, there was no significant difference between subjects with asthma and controls in the prevalence of specific IgE to Alternaria tenuis: 4% vs. 1% (p = 0.35); to Paspalum notatum (Bahia grass): 28% vs. 19% (p = 0.16); to Periplaneta americana (American cockroach): 21% vs. 19% (p = 0.83); to Ambrosia artemisifolia (short ragweed): 12% vs. 23% (p = 0.11); and to cat epithelium: 5% vs. 1% (p = 0.17). The results suggest that sensitization to domestic mites in subjects who reside in this tropical city is associated with acute asthma that requires emergency room treatment.

Molecular analysis of the BRCA2 gene in 16 breast/ovarian cancer Spanish families

The recent isolated gene BRCA2 is responsible for about 45% of familial breast cancer and the majority of male breast cancer families. In order to evaluate the role of inherited BRCA2 mutations in Spanish families, the complete coding sequence of the gene was screened by SSCP/sequencing in 16 high-risk breast/ovarian cancer families. Four mutations were found that cause a premature termination codon. Two of them have been reported elsewhere and one is a novel mutation. In addition we have found seven polymorphisms, two of which have not been previously described. One of the mutations, 936delAAAC was found in two of our high-risk families. Because this mutation is considered as recurrent, we have tried to estimate its frequency in our breast cancer population. A total of 127 moderate- high-risk families were screened for this mutation and it was also found in another high-risk family. All the families carrying the 936delAAAC mutation harboured part of a common haplotype shared by other reported carriers, suggesting a possible founder effect for this mutation.

Hematopoietic cell transplantation using plasma and DMSO without HES, with non-programmed freezing by immersion in a methanol bath: results in 213 cases

A simplified cryopreservation method for bone marrow (BM) and peripheral blood progenitor cells (PBPC) was utilized in hematopoietic cell transplantation of 213 patients with hematological or solid neoplasms after ablative chemotherapy (187 with peripheral blood progenitor cells and 26 with bone marrow). Cells were cryopreserved, after addition of autologous fresh plasma with DMSO, without HES, by freezing to -80 degrees C in a methanol bath and non-programmed freezer. For the patients autotransplanted with PBPC, the median period necessary for recovery of more than 0.5 x 10(9)/l granulocytes was 11 days (range 6-44), and 15 (8-204) days were required to obtain more than 20 x 10(9)/l platelets. For the patients autotransplanted with BM, the median period necessary to recover >0.5 x 10(9)/l granulocytes was 12 days (range 9-33), and 24 (12-57) days to obtain more than 20 x 10(9)/l platelets. These results support this method as being very effective in achieving high-quality cryopreservation. The procedure, which uses a non-programmed freezer, simplifies and reduces enormously the cost of the technical measures currently in use, enabling its adoption in almost any clinical oncological institution.

Frequent allelic losses of 9p21 markers and low incidence of mutations at p16(CDKN2) gene in non-Hodgkin lymphomas of B-cell lineage

We present an allelotype analysis of 35 cases of non-Hodgkin lymphomas and normal pairs using four microsatellite markers that flank the region occupied by the CDKN2 gene locus at 9p21. Frequent allelic losses (LOH) were detected in B-cell lineage NHLs, including Burkitt lymphoma (33.3% of total, if we only consider high grade tumors). In five of these tumors LOH did not include the CDKN2 gene. Mutational analysis of exon 1 and 2 of CDKN2 (SSGP and sequencing of abnormal bands) revealed a nonsense mutation (Arg72Ter) in one tumor (case 10), where the second hit of the Knudson's model consisted of the elimination of the wild type allele. In view of these results, the hypothesis of two different candidate tumor suppressor gene regions around the CDKN2 locus remains an intriguing possibility.

[Value of protein 53 expression in lymphoma. Its correlation with genetic mutations]

PURPOSE

p53 is a tumour suppressor gene encoding a nuclear phosphoprotein that plays an important role in the control of normal cell proliferation. We have tried to establish the value of expression of the p53 protein in malignant lymphomas and its correlation with the presence of structural gene abnormalities.

MATERIAL AND METHODS

230 cases of lymphomas (11 Hodgkin's disease and 219 non-Hodgkin's) were studied by immunohistochemistry using an anti-p53 monoclonal antibody (DO-7, DAKO). Sections were heated by pressure cooker in 0.01 M sodium citrate buffer pH 6 as a method for antigen unmasking. The quantification of levels of nuclear p53 protein were measured with an Image Analyzer (CAS-200, Becton-Dickinson S.A.). We have also searched for mutations in a series of 94 lymphomas using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis in exons 5 to 9 of the p53 gene and the sample showing abnormal pattern were sequenced.

RESULTS

p53 immunoreactivity has been detected in 82.6% of cases. The percentage of positive cells varies in a wide range which was divided into 0% (17.39%), less than 5% (57.39%), between 5-10% (13.91%) and more than 10% (11.30%). In all lymphoma subtypes, we have found the majority of cases show levels less than 10% and few more than 10%. We found abnormal bands in 9 of 94 lymphomas with different diagnosis (1 ALCL, 1 T-LNH, 2 B-LNH, 2 centroblastic, 1 lymphoblastic and 2 MALT). Two cases resulted to be a silent base change which not alter the function of the p53 protein and represent a common polymorphism. Seven cases showed single base pair missense mutations in all of them. Mutations in codons 179, 248 and 273 correspond to some of the typical hotspots described in p53 gene.

CONCLUSIONS

p53 expression, is a frequent finding in malignant lymphomas, is variable and relates to histological subtype. The results suggest that positive immunocytochemistry cannot be used to determine which tumours have mutations of p53 because the existence of cases with discrepancies between overexpression of the protein and presence of mutations.

[Type 1 Gaucher disease in a pediatric patient: 12 year's evolution]

A 14 years old patient, diagnosed in early childhood of type 1 Gaucher's disease is reported to show his unusual genotype and clinical course. The patient is heterozygous for mutation D409H, that in the homozygous patient determines an aggressive disease accompanied by neurological signs, and for a new mutation, which must be considered of mild effects. Early detection of bone involvement is emphasized as a factor to consider when indicating of enzyme replacement therapy.

Detection of trisomy 8 using conventional cytogenetic techniques and interphase FISH analysis in 34 myeloid disorders: a comparative study

Trisomy for chromosome 8 is one of the most common chromosome abnormalities detected in myeloid disorders. However, and despite its great incidence, its biologic significance remains poorly understood. Recently, some reports have shown the existence of masked trisomy 8 in myeloid disorders. To try to detect occult trisomy 8, we performed a study in which 34 myeloid disorders with apparent normal karyotypes using conventional cytogenetic techniques were analyzed using fluorescence in situ hybridization (FISH) analysis. Masked trisomy 8 was not detected in any of the 34 cases studied. This suggests that trisomy 8 may be a rare event in myeloid disorders in which an optimal conventional cytogenetic analysis has been performed. The acquisition of trisomy 8 either in early neoplastic stages in some cases or in late neoplastic stages in others and the absence of masked trisomy 8 suggest that this chromosome alteration may not be essential to the development of myeloid disorders.

[Detection of t(15;17) using cytogenetic, fluorescent in situ hybridization, and molecular techniques. Comparative study of 11 patients with acute promyelocytic leukemia]

OBJECTIVES

Analysis and comparison of the sensitivity for the detection of t(15; 17) with conventional cytogenetic (CC), Southern blotting (SB), metaphase fluorescence in situ hybridization (M-FISH), interphase fluorescence in situ hybridization (I-FISH) and polymerase chain reaction (PCR) techniques.

PATIENTS AND METHODS

11 acute promyelocytic leukaemia (APL) patients (9 M3 and 2 M3v) were studied at diagnosis and partial remission and analyzed with CC (11 cases), SB (7 cases), I-FISH (2 cases) and PCR (3 cases) techniques.

RESULTS

The percentages of detection of t(15;17) were: 90.9% (CC), 71.4% (SB), 85.7% (M-FISH) and 100% (I-FISH and PCR). Additional chromosomal abnormalities were detected in 2 cases with CC techniques.

CONCLUSIONS

1.- There is a very good correlation in the detection of t(15; 17) between the techniques analyzed. 2.- At diagnosis, partial remission and relapse, M-FISH and PCR provide a reliable diagnosis of t(15; 17). Nevertheless, it is important to perform a CC analysis because it enables the recognition of additional chromosome abnormalities with putative prognostic importance. 3.- At complete remission, I-FISH and PCR provide a rapid and safe screening of putative residual cells. 4.- The great sensibility of the techniques available for the detection of t(15; 17) translocation allows the use in each laboratory of the most appropriate techniques according to their substructure and the patients' clinical stage.

[A long-term pharmacoepidemiological study on drug dispensing by the pharmacy office in rural primary care. The influence of age and sex]

OBJECTIVES

To obtain data on the use of medicaments dispensed through pharmacies in primary rural care.

DESIGN

Long-term descriptive observational study.

SETTING

Nivar and Güevejar municipalities, Sanitary Health District in north Granada (Spain). There were 2.7% losses.

PATIENTS

A randomised sample of 589 inhabitants, 18 years o more, included in the census of two villages.

MEASUREMENTS AND MAIN RESULTS

The number of visits to the pharmacy, number of medicaments dispensed, prescribing physician and adverse effects to medicaments were recorded and compared between age groups, and between men and women. Prescriptions accounted for 75% of all medicaments, and 67.4% of the prescriptions were written by the primary care physician. Greater numbers of prescriptions were written for elderly persons and women than for younger person and men. Adverse reactions occurred in 3.3% of all subjects. Most reactions were mild (93.6%), and the greatest number of reactions were caused by nonsteroid antiinflammatory agents.

CONCLUSIONS

Age and female sex influence the consumption of medicaments. Long-term studies of dispensation patterns in pharmacies can represent a useful method.

Rearrangement of one RAR-alpha gene in an acute promyelocytic leukemia case with t(15;17) and t(6;17) involving chromosomes 17 band q21

Acute promyelocytic leukemia (APL) is a specific type of acute myelogenous leukemia characterized by a typical morphology and by a translocation between chromosomes 15 and 17, t(15;17)(q22;q21). Because this translocation is not found in other subtypes of acute myelogenous leukemias, it has become an important marker in the diagnosis and treatment of APL. Here we report a case with apparent absence of t(15;17) cells by cytogenetic techniques at diagnosis. At relapse, a metaphase FISH analysis (not dependent on chromosomal quality), followed by G-banding, was performed. t(15;17) was detected in 60% of the metaphases. In 30% of metaphases, an additional t(6;17) was detected involving the other chromosome 17 at band q21. In parallel, a molecular study (using the Southern blotting technique) was carried out and a single molecular rearrangement of the RAR-alpha gene was detected implying that RAR-alpha was not rearranged in the t(6;17) translocation.

Incidence of homogeneously staining regions in non-Hodgkin lymphomas

We report a series of 86 non-Hodgkin's lymphomas (NHL) studied cytogenetically in which two cases with a homogeneously staining region (HSR) located on chromosome 19 and on chromosome 1, respectively, were observed. The low incidence detected (2.3%) suggests that HSR are rare events in NHL. An oncogenetic amplification study was performed with probes for genes that are currently known to undergo amplification and with probes for two genes located on chromosome 19q (AKT2 and BCL-3). We detected no amplification except for AKT2 putative oncogene in the lymphoma in which the HSR was located on chromosome 19. Because amplification of AKT2 putative oncogene has been detected in ovarian carcinomas bearing HSR and in this case NHL, we believe that this gene may be implicated in the pathogenesis of other neoplasias in cooperation with other genes. Further investigation is needed to confirm the low incidence of HSR in NHL and the origin of the amplified material.

[Morbid obesity. Reflections on a surgical protocol (II). The experience accumulated over 5 years]

Bariatric surgery is done on a selected, ill patient (morbid obesity), with a surgical risk which is intrinsic to his condition and morbidity. The results on any program are more a function of the adequate selection, information and control, than of the surgical model itself. The first 125 patients of the present surgical series have been reviewed, with a minimum of 18 months of follow up, and the complications are detailed, with emphasis on the compulsory and necessary radiological evaluation in the immediate post-operative period, during the follow up, and in the face of any complication. The effectiveness criteria of the technique and the real value of the weight loss are reevaluated, as well as defining the criteria of failure of surgical treatment. Finally, we end with an up dating of the psychological results observed, as well justifying the need for a bariatric surgery protocol, with its ethical-legal implications. The final conclusion is that bariatric surgery shall only be clinically and ethically accepted if it complies with the principles for which it was designed.

[Large-cell anaplastic lymphomas: a genetic and immunophenotypic study]

PURPOSE

To characterize from a genetic point of view a group of non-Hodgkin's anaplastic large-cell lymphomas (ALCL) by Southern blot and PCR methods with different probes (molecular study) and with direct or post 24-78 hours cultures with GTC banding techniques (cytogenetic). To correlate the results to the immunophenotype performed with a complete panel of monoclonal antibodies (MoAb) according to avidin-biotine and alkaline phosphatase (APAAP) methods.

MATERIAL AND METHODS

Sixty cases of ALCL were reviewed and only 19 selected (with frozen or fresh material) because a complete immunohistologic and genotypic correlation had been done. According to CD15 expression two groups were considered, CD15+ (the so-called Hodgkin's related or Hodgkin's like) and CD15- or classical type.

RESULTS

Only 26.5% of cases showed immuno -genotypic correlation. Immunohistochemistry is an accurate method for activation, proliferation and B-cell nature, but T-cell cases were not stained because T-cell paraffin markers are not completely specific. CD15 group had only 30% rearranged cases with scarce cytogenetic abnormalities, as it occurs in Hodgkin's disease (HD). ALCL classical type showed 66% rearranged cases, and one of the T-cell cases showed an incomplete t (2:5) translocation or polyploid cell lines.

CONCLUSIONS

Both groups have different genetic and immunophenotypic behaviour which resembles HD or NHL. CD15 positive cases or ALCL HD-related constitute a borderline entity which has to be recognized because of the different therapy and clinical behaviour.