Chromosome 11p15 duplication in Silver-Russell syndrome due to a maternally inherited translocation t(11;15)

The role of 11p15 disturbances in the aetiology of Silver-Russell syndrome (SRS) is well established: in addition to hypomethylation of the H19/IGF2 differentially methylated regions, five patients with a duplication of maternal 11p15 material have been described. We report on a boy with SRS carrying a maternally inherited duplication of chromosome 11p15. The patient showed the typical clinical picture of SRS including severe intrauterine and postnatal growth restriction, relative macrocephaly, a prominent forehead, a triangular face, down-turned corners of the mouth and fifth digit clinodactyly. Body asymmetry was not observed. By molecular genetic analyses, MLPA and microsatellite typing detected a duplication of chromosome 11p15 and cytogenetic analysis showed an unbalanced translocation t(11;15)(p15.5:p12). The size of the duplicated region is approximately 8.8 Mb as determined by SNP-array analysis. The healthy mother carried a balanced reciprocal chromosome translocation t(11;15). Thus, there is an increased risk for further children with SRS due to 11p15 duplication. Additionally, the family is at risk for offspring with an 11p15 deletion and Beckwith-Wiedemann syndrome whereby the phenotype will be influenced by haploinsufficiency of additional genes at 11p15 due to the deletion. The balanced aberrant karyotype was identified in several other family members, but interestingly there was no history of recurrent miscarriages, intrauterine fetal death, or multiple congenital anomaly syndromes in the family.

Randomized trial of Cervene, a kappa receptor-selective opioid antagonist, in acute ischemic stroke

The purpose of this randomized trial was to confirm drug safety and to obtain preliminary efficacy data on Cervene (nalmefene), an opioid antagonist with relative kappa receptor selectivity, for the treatment of acute ischemic stroke. Patients were treated for 24 hours with either intravenous Cervene (0.05 mg/kg as an initial infusion over 15 minutes and 0.01 mg/kg/h maintenance) or placebo within 6 hours of an ischemic stroke. Efficacy was assessed by comparing the change from baseline to day 7 in the National Institutes of Health stroke scale score (NIHSSS) and the Glasgow Outcome Scale and Barthel Index at 3 months. Forty-four evaluable patients were randomized (3:1) to Cervene (n = 34; treated at 5.0 +/- 0.9 hours after onset) and placebo (n = 10; treated at 4.6 +/- 1.5 hours). No deaths or serious adverse events reasonably attributable to Cervene have been reported. A "major improvement" (NHSSS > 4) was seen at day 7: placebo, 33% (three of nine patients) and Cervene, 66% (19 of 29 patients). Only patients with initial NIHSSS >/= 4 were considered evaluable for this primary endpoint. "Good recovery" at 3 months (Glasgow = 5) was as follows: placebo, 50% (5 of 10 patients) and Cervene, 73% (24 of 33 patients). The death rate at 3 months was placebo, 20% (2 of 10 patients) and Cervene, 9.1% (3 of 33 patients). One patient was lost to follow-up. In conclusion, results from this randomized trial suggest that Cervene is safe, tolerable, and may be beneficial in the treatment of acute stroke patients.

[Measuring quality of life in head and neck cancer. Current status and future needs]

This review presents the current knowledge and methods of measuring disease-related quality of life in oncology, with particular emphasis on laryngeal and hypopharyngeal cancer. In addition to the currently popular and well-established instruments, specifics of the initial interview process, collection of psychiatric comorbidities, and the role of social care and its substantial influence on disease-related quality of life are discussed. At the forefront are the results of the central German head and neck oncology social-medical studies.

[Smoking behaviour after laryngectomy]

BACKGROUND

Tobacco smoking is an important risk factor for laryngeal cancer. Aim of this study was to investigate the prevalence of smoking and to identify factors that can promote tobacco abstinence.

PATIENTS AND METHODS

In a multi-centre cross-sectional study, 187 patients after laryngectomy were surveyed regarding their smoking behaviour. Instruments used were the questionnaire "Quality of Life after Laryngectomy" (Ackerstaff & Hilgers) and the "Questionnaire of Health Behaviour" ("Fragebogen zur Erfassung des Gesundheitsverhaltens", Dlugosch & Krieger).

RESULTS

Life time prevalence of tobacco smoking was 89%, whereas current prevalence was only 6%. None of the laryngectomies believed tobacco consumption to be safe. 24% thought that their tumour was caused mainly by smoking, although the current prevalence of smoking was not related to that number. 74% of all ex-smokers had stopped smoking at the time of the laryngectomy.

CONCLUSIONS

Only a small fraction of laryngectomized patients do smoke several years after the operation. Anti-tobacco interventions should therefore be focused on high risk persons, not on the entire patient population.

Molecular karyotyping of patients with unexplained mental retardation by SNP arrays: a multicenter study

Genomic microarrays have been implemented in the diagnosis of patients with unexplained mental retardation. This method, although revolutionizing cytogenetics, is still limited to the detection of rare de novo copy number variants (CNVs). Genome-wide single nucleotide polymorphism (SNP) microarrays provide high-resolution genotype as well as CNV information in a single experiment. We hypothesize that the widespread use of these microarray platforms can be exploited to greatly improve our understanding of the genetic causes of mental retardation and many other common disorders, while already providing a robust platform for routine diagnostics. Here we report a detailed validation of Affymetrix 500k SNP microarrays for the detection of CNVs associated to mental retardation. After this validation we applied the same platform in a multicenter study to test a total of 120 patients with unexplained mental retardation and their parents. Rare de novo CNVs were identified in 15% of cases, showing the importance of this approach in daily clinical practice. In addition, much more genomic variation was observed in these patients as well as their parents. We provide all of these data for the scientific community to jointly enhance our understanding of these genomic variants and their potential role in this common disorder.

Mosaic trisomy 21/monosomy 21 in a living female infant

Many autosomal monosomies are presumed to end in arrested growth in the first few mitoses, prior even to the time of implantation, with possibly some proceeding to the stage of occult abortion. The single exception may be monosomy 21, although this has been questioned, with most earlier reports of monosomy 21 recently re-interpreted as being due to an unbalanced translocation involving chromosome 21. Here we report a female infant with a mosaic trisomy 21/monosomy 21 karyotype. While the karyotype 46,XX,i(21)(q10) is detected in all metaphases investigated in lymphocytes, mosaicism with the karyotype 46,XX,i(21)(q10)[31]/45,XX, -21[12] is seen in fibroblasts from a skin biopsy. Dysmorphic facial features and multiple malformations remarkably resemble cases of monosomy 21 that have been described in the literature. This suggests a dominant phenotypic effect of loss of one chromosome 21. Detailed clinical description, results of gene dosage studies, and cytogenetic analysis will be presented.

Association of Notch signaling pathway expression in liposarcomas with outcome, and targeting with gamma-secretase inhibitors

10526

Background: The Notch pathway directs normal fat cell development, but its aberrant activation may promote the development of sarcomas. The expression of the Notch pathway in liposarcoma (LPS), however, is unknown. We examined Notch signaling components in LPS's and suppressed Notch activation with drug targeting in LPS cell lines. Methods: RNA was isolated from 18 normal fat and 140 LPS tissue samples from five LPS subtypes: well-differentiated (33%), de-differentiated DD (25%), myxoid (12%), round cell (6%), and pleomorphic (13%), and were hybridized to Affymetrix U133A arrays. Microarray data were normalized with the RMA method. Correlation analysis identified genes expressed between sample classes, using Empirical Bayes t-test, and genes associated with survival, using Cox regression. The Notch pathway in two LPS lines, DDLS and LS141, was suppressed with a novel gamma-secretase inhibitor (GSI) or with siRNA to Notch receptors. Viability was assessed by colony formation, apoptosis by DAPI staining, and Notch expression by immunoblotting. Results: Expression of Notch-3 and its targets, Hes-1, Hey-1, and survivin, was increased in LPS subtypes, compared to fat tissue (p<0.001). Inhibition of Notch signaling with GSI's or siRNA to Notch-1 suppressed the viability of both DD LPS lines (p<0.05), inducing a G1/S arrest followed by apoptosis. Transfection of siRNA to each Notch receptor, especially Notch-3, also suppressed the viability of DD LPS's (p<0.05). Expression of Notch-3 (p=0.027, HR=2.64), Notch-4 (p=0.026, HR=2.70), the ligand JAG-2 (p=0.049, HR=2.32), and Hey-1 (p=0.001, HR=4.25) was associated with reduced distant recurrence free survival in patients with DD LPS's. Expression of the negative Notch regulator Fbxw7 was associated with improved overall survival in patients with LPS (p=0.008, HR=-1.42). Conclusions: Elements of the Notch pathway (receptors, ligands, targets, and modifiers) are overexpressed in LPS's compared to normal fat tissue and associate with outcome. Suppression of Notch signaling decreased DD LPS cell line viability and induced apoptosis. Notch inhibition may represent a new therapeutic strategy for patients with LPS's and deserves further validation in a clinical trial.

No significant financial relationships to disclose.

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care

The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of ⩾13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of ⩾6 (specificity 0.21). With scores of ⩾16 and ⩾22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.

[Quality of life in elderly cancer patients--need for and benefit of inpatient rehabilitation]

BACKGROUND AND AIMS

Elderly cancer patients are often excluded from research studies and in turn do not end up receiving treatment according to standard guidelines. While frequent co-morbidity or non-compliance of the patients provides a partial explanation for this the chronological age of the patients also plays a significant role. This presents the question of whether elderly patients have either less or no need for comprehensive treatment such as, for instance, oncological inpatient rehabilitation, and/or whether or not they are able to benefit from it.

PATIENTS AND METHODS

In a rehabilitation centre in Germany, 339 tumour patients (> or = 70 years) were assessed at the beginning of inpatient rehabilitation regarding quality of life via the EORTC QLQ-C30. Need for rehabilitation was defined as being a clinically relevant difference on the EORTC scales (> or = 10 points) as compared with an age-matched sample of the German general population (n = 276). Four months after completing inpatient rehabilitation patients were asked to fill in the questionnaire again.

RESULTS

On 13 out of 15 EORTC scales, patients reported having more problems than the general population (adjusted for age and sex), whereby 8 domains were also clinically relevant (physical, emotional, social and role functioning, global quality of life, fatigue, appetite loss, constipation and diarrhoea). Low quality of life was associated with higher age (> or = 80 years), as well as gastro-intestinal and urological tumours (not prostate cancer). Significant improvements were achieved in 13 domains and clinically relevant improvements in 8 (physical, emotional, social and role functioning, global quality of life, fatigue, appetite loss, and pain), adjusted for age, sex, and tumour site.

CONCLUSIONS

Tumour patients should not be excluded from rehabilitation only because of their chronological age.

[Use of adaptive devices by laryngectomees]

AIMS

This study is directed at the following questions: How many laryngectomees are using which adaptive devices how often? Which devices are they lacking? Which alaryngeal voice has the best results in terms of intelligibility?

METHODS

218 patients operated on in 6 ENT-clinics in Eastern Germany over the last 25 years were interviewed in person. Items from a German questionnaire for psychosocial adjustment after laryngectomy (FPAL) and from the quality of life questionnaire EORTC QLQ-H&N35 were used. Voice intelligibility was measured by an objective test, the Postlaryngectomy-Telephone-Intelligibility-Test (PLTT).

RESULTS

The most common communication method in this group is the esophageal voice, only 20% use voice prostheses regularly, and 15% of the patients use electronic devices. 87% of the laryngectomees wear scarves to protect their stoma, and 82% use inhalers. Several patients lack tools for communication, some for protection of the tracheostoma and others devices for showering and swimming. The best speech results are gained with voice prostheses. Health related Quality of Life shows only poor correlation with the use of adaptive devices.

CONCLUSION

In general the health care for laryngectomees in terms of device use can be seen as relatively good but not as optimal. Problematic is the fact that 15.5% of the patients could not acquire an adequate voice, that some devices are missed by patients despite the fact that they are available for purchase, and that some patients do not care for their tracheostoma. It could be useful to consider these findings within medical consultations.

Häufigkeit psychischer Begleiterkrankungen und der Wunsch nach psychosozialer Unterstützung bei Tumorpatienten im Akutkrankenhaus

BACKGROUND AND OBJECTIVE

A diagnosis of cancer can overpower a patient's ability to cope and thus can increase the prevalence of psychiatric disorders in this group of patients. It was the aim of this study to estimate that prevalence in tumor patients during their acute treatment.

PATIENTS AND METHODS

689 patients with malignancies were interviewed using the structure clinical interview connected with the Diagnostic and Statistical Manual of Mental Disorders IV [SCID]) DSM-IV during their first days of inpatient treatment. The patients' wishes for psychosocial support by the oncological team were assessed.

RESULTS

32 % of the patients were diagnosed having a psychiatric disorder, e. g. depression. Prevalence was greater among female and/or young patients, those who had little money, were receiving chemotherapy and those who had not yet been diagnosed with cancer but in whom it was suspected. Some types of tumor were more likely to be associated with a mental disorder, for instance gynecological and head-and-neck malignancies. 83 % of the patients asked for psychosocial help from the treating physician, 44 % from the social worker, 30 % from the clinical psychologist, and 8 % from a spiritual adviser. Support was especially needed by patients who felt sad or depressed, and in those who lacked social support: these needs were unrelated to tumor stage and time since diagnosis.

CONCLUSIONS

Inpatient cancer patients frequently suffer from a psychiatric disorder. The majority of them would like to get psychosocial support, especially from their treating physician. It should be recognized that it is not only palliative care patients with advanced disease who need psychosocial treatment and support.

[Quality of life and voice intelligibility in laryngeal cancer patients--relevance of the "satisfaction paradox"]

BACKGROUND

Aim of this study was to compare postoperative quality of life and voice intelligibility of laryngeal cancer patients.

PATIENTS AND METHODS

Two studies assessed the quality of life (by EORTC QLQ-C30 and EORTC QLQ-H&N35) and the voice intelligibility (by PLTT and FPAL) of 218 laryngectomized and 151 partially resected patients. The data of 86 patients was analysed on the basis of matched pairs (matching criteria: sex and tumour stage).

RESULTS

The smelling and tasting of the laryngectomized patients were more affected. Other domains of quality of life did not differ significantly between the groups. The subjective assessment of voice intelligibility led to worse results among the patients with partial laryngectomy, although the objective test proved the contrary.

CONCLUSIONS

Subjective and objective assessment of quality of life can differ, which led to paradox results in this study, especially for voice intelligibility. This might be due to the fact that partially resected patients have higher expectations of their operation.