A comparative study of filicidal and abusive mothers

It is generally believed that some abusive parents if untreated eventually kill their children and "the murder of a child is the final chapter in his history of maltreatment." Yet only few authors have investigated the homicide of abused children. In this paper the authors report on a study of 8 filicidal and 52 abusive mothers referred to them by courts for pre-trial psychiatric evaluation. They found that there were significant differences between the two groups in that all (100%) of the filicidal women suffered from a major psychiatric illness before and at the time of committing the murder of their child while only 4 (7.7%) abusive mothers had a major psychiatric illness (x2 = 24.41, df = 1, p less than .001). They conclude from this study that the filicidal mothers are different from abusive mothers and that the risk of fatality as a complication of child abuse increases significantly when the mental illness is present in the mother. They point to the implications of their findings for child protection and intervention procedures and suggest that one should act very vigorously and take the child into protective custody when the mother is found to have a major psychiatric illness.

Experimentally induced inflammation of the guinea pig palatal mucosa by injection of a microcrystalline suspension of monosodium urate

The injection of microcrystals has been frequently used to induce inflammatory reactions in various sites (i.e., joints, skin, pleural cavity). The aim of this study was to create a reproducible experimental animal model of buccal inflammatory reaction. The monosodium urate (MSU) crystals were obtained following the technique described by Denko and Whitehouse (1976). After injection in the palatal mucosa, biopsies were sampled and analyzed using the stereologic technique described by Weibel et al. (1966). This analysis shows 1) a decrease of the collagen volume fraction in the hours after the injection; 2) the presence of vasculitis and edema during the 12 hours after the injection; and 3) an increase in the volume fractions of the inflammatory cells, especially monocytes and polymorphonuclear leukocytes, during the same period.

Interstitial deletion of chromosome 3p: report of a patient and delineation of a proximal 3p deletion syndrome

We report on a patient with a de novo interstitial deletion of the proximal portion of the short arm of chromosome 3 (p12----14.2). The deleted portion excludes the constitutive fragile site assigned to band 3p14. The phenotype of the patient, together with that of three previously reported cases, seems to be sufficiently characteristic to allow the delineation of a proximal 3p deletion syndrome.

Constitutive fragile sites 1p31, 3p14, 6q26, and 16q23 and their use as controls for false-negative results with the fragile(X)

Fragile(X) estimations in fragile(X)-mental retardation hemizygotes or heterozygotes can become falsely negative in stored blood (lymphocytes). This was shown in blood stored (before culture) at 4 degrees C, room temperature (25 degrees C), 37 degrees C, and 39 degrees C for 1-4 days. After storage, blood was cultured in Ham's F10-5% FC serum with 0.1 microM FUdR and scored for fra(X) and the constitutive fragile sites at 3p14 and 6q26. It was found that the proportion of cells expressing the fragile(X) and the 3p14 site varied inversely with the temperature and time of storage. In addition, 50 patients and controls were scored for the three latter sites after routine 72-96-hr culture in F10-0.05 or 0.1 microM FUdR. The 3p14 site was detected in every individual tested in a mean +/- S.D. of 11.3 +/- 3.2% of cells (0.1 microM FUdR). It was found that this site was FUdR dose dependent whereas the 6q26 site was not. The 3p14 (but not the 6q26) site is therefore suitable as a control site for the FUdR effect. It is proposed that repeat studies are necessary when less then 4% 3p14 sites are present in specimens from males referred for fra(X) estimation. Other constitutive fragile sites (eg, 1p31 and 16q23) can also be used.

Discovery of a connective tissue dysplasia in the Martin-Bell syndrome

The fact that a connective tissue dysplasia is a component of the Martin-Bell syndrome was a fortuitous discovery. A 26-month-old developmentally delayed boy had many signs of a connective tissue dysplasia for which he was referred to a University center where he was found to be fragile (X)-positive without confirmation of a connective tissue problem. Sensitized by these events and observations, we were able to predict at a glance in an unrelated family the fragile (X)-positive status of 2 subsequently referred brothers with mental retardation and prominent manifestations of connective tissue dysplasia. Thus, the Martin-Bell syndrome is an incompletely recessive, pleiotropic trait involving CNS, testes and connective tissues. The characteristic facial appearance of affected males largely represents interaction of mental retardation, congenital CNS based muscle hypotonia and connective tissue dysplasia. At the 1983 NIH workshop on XLMR there was a general consensus that a connective tissue dysplasia is a component of the Martin-Bell syndrome, a fact since confirmed by others on the basis of objective measurements of finger joint hypermobility and frequent presence of mitral valve prolapse.

[Behavior of creatine in red blood cells and in plasma of children with chronic kidney insufficiency]

The creatine concentration of red blood cells and plasma in 44 children with chronic renal failure was studied and found to be significantly higher than in healthy children of comparable age. The creatine concentrations of the 31 hemodialyzed children surpassed those of the 13 conservatively treated patients by 30%. A statistically significant correlation was demonstrated between the serum creatinine level and the creatine concentrations in red blood cells. During hemodialysis the plasma creatine concentration decreases by half and reaches the predialysis values within 42 h after the end of dialysis, whereas the creatine concentration of the red cells does not change during a 4-5-h hemodialysis. With increasing number of hemodialyses the creatine concentration of red cells rises, suggesting an improvement of erythropoiesis.

Dipalmitoylphosphatidylcholine in amniotic fluid quantified by fast-atom-bombardment mass spectrometry

Dipalmitoylphosphatidylcholine (DPC) is quantified by taking advantage of stable-isotope-labeled d9-DPC as internal standard. Use of a mass spectrometer to measure the ratio of d9/d0 makes this procedure a quantitative one. d9-DPC was synthesized by refluxing dipalmitoylethanolamine with d3-methyl iodide in methanol in the presence of sodium bicarbonate for 26 h. The yield of d9-phosphatidylcholine (d9-lecithin) was 89% after column-chromatographic purification. Fast atom bombardment was used to desorb the preformed phosphatidylcholine ions in a mass spectrometer of Nier-Johnson geometry. In our assessment of accuracy and precision of this technique, we found a correlation coefficient of 0.9994 between signal and sample concentration. The method was less precise when the total d0- plus d9-DPC was less than 0.2 micrograms or when the ratio of d0- to d9-lecithin exceeded 100. The within-run CV was about 1.0%. The amount of DPC in amniotic fluid samples assessed by mass spectrometry was compared with results for total phosphatidylcholine quantified by thin-layer chromatography. The fate of DPC in various laboratory manipulations was also studied.

Dipalmitoylphosphatidylcholine in amniotic fluid quantified by fast-atom-bombardment mass spectrometry

Dipalmitoylphosphatidylcholine (DPC) is quantified by taking advantage of stable-isotope-labeled d9-DPC as internal standard. Use of a mass spectrometer to measure the ratio of d9/d0 makes this procedure a quantitative one. d9-DPC was synthesized by refluxing dipalmitoylethanolamine with d3-methyl iodide in methanol in the presence of sodium bicarbonate for 26 h. The yield of d9-phosphatidylcholine (d9-lecithin) was 89% after column-chromatographic purification. Fast atom bombardment was used to desorb the preformed phosphatidylcholine ions in a mass spectrometer of Nier-Johnson geometry. In our assessment of accuracy and precision of this technique, we found a correlation coefficient of 0.9994 between signal and sample concentration. The method was less precise when the total d0- plus d9-DPC was less than 0.2 micrograms or when the ratio of d0- to d9-lecithin exceeded 100. The within-run CV was about 1.0%. The amount of DPC in amniotic fluid samples assessed by mass spectrometry was compared with results for total phosphatidylcholine quantified by thin-layer chromatography. The fate of DPC in various laboratory manipulations was also studied.

The diagnosis and frequency of X-linked conditions in a cohort of moderately retarded males with affected brothers

An epidemiological study was carried out on the group of moderately retarded brothers (IQ, 30-55) identified by Turner and Turner [1974]. Of the original 58 sets of brothers, 54 sets (now 17 to 32 years old) were traced; another four sets (missed in the earlier survey) were added. Forty-five of the 58 pairs were diagnosed as having nonspecific X-linked mental retardation (MR) giving an overall frequency of 5.57 moderately retarded males/10,000 male births. In 12 of the 45 families, affected males had the fragile(X) and macroorchidism; six had macroorchidism alone, giving a frequency of 2.8 moderately retarded males with X-linked MR and macroorchidism +/- the fragile(X) per 10,000 males. Corresponding heterozygote frequencies are 7.34 and 3.65/10,000 females respectively. A new subgrouping of nonspecific X-linked mental retardation is described in six families: X-linked MR, macroorchidism without the fragile(X). Three other X-linked conditions were identified: in one family, the Coffin-Lowry syndrome, in another, Duchenne muscular dystrophy, and in two families X-linked MR and muscle atrophy. Half (56%) of the obligatory carriers of fra(X)-MR in this study were dull to mildly retarded. The mildly retarded heterozygotes had a significantly higher percentage of fra(X) expressing lymphocytes as compared to the intellectually normal heterozygotes. When the three types of nonspecific X-linked MR for which population frequencies were calculated were considered together, half of the obligatory carriers (46%) were dull or mildly retarded, thus confirming that this condition is a significant cause of mild intellectual handicap in females.

Effect of urinary proteins on in vitro immunological tests for pregnancy

A study of the possible interference of urinary proteins with all the commercial in vitro pregnancy products on the market in the United States today was carried out by our group. Six of these tests were of the tube type and seven were slide tests. Radioimmunoassays and receptor assays for beta human chorionic gonadotropin (beta-HCG) were not tested. The products examined showed interferences by urinary proteins presented at various levels. Interference by human serum albumin (HSA) (in five tube tests) occurred only at a physiologically improbable, high concentration of HSA (5 g/dL). However, in certain cases interferences by serum proteins (false positive type) occurred at concentrations lower than 0.06 g/dL which are physiologically probable. The four tests formulated to work with both serum and urine did not show any urinary protein interference with HCG measurements. There was no clear difference in urinary protein interferences between the tube and the slide tests; the tube tests were slightly more sensitive to the presence of HSA. Those tests employing latex beads, as opposed to erythrocytes, showed greater sensitivity to protein interferences.

Red cell creatine in steady state and stimulated erythropoiesis

Intra- and interindividual variances as well es the age dependency of red cell creatine were studied. Following a single erythropoietic stimulation creatine can stay elevated for many months. A rise of creatine may not only reflect a shift towards a younger cell population but also different erythropoietic sites. The creatine concentration of red blood cells (rbc) has been shown to be an excellent indicator of cell age (1,2,3) and of dynamics of erythropoiesis (3). Intra- and interindividual variances were determined. Fig. 1 (designed according to 4) shows the variance of the method (3)-both for serial determinations and for repeated analyses of the same sample after storing up to 19 days--as well as the variances for the individual person and for a group. It is shown, that the values for one individual are remarkably constant. Fig. 2 illustrates values obtained from presumably healthy persons without evidence of hematological pathology--from newborn to old age. The fat bar represents the values for adults with a mean of 6,64 mg/dl cells and a rather small standard deviation. The mean creatine concentration for very old persons (bar to the utmost right) appears to be higher with a larger standard deviation. However, these values probably should be taken with caution, since some of the persons might have had some minor cardiac or pulmonary difficulty or occult blood loss from the gastrointestinal tract--even though they were declared healthy by the physician of the seniority home. From the age of 6 months on there appears to be no age dependency of rbc creatine concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

The fragile X(q27) form of X-linked mental retardation: FUdR as an inducing agent for fra(X)(q27) expression in lymphocytes, fibroblasts, and amniocytes

The effect of FUdR on the expression of fra(X)(q27) was examined in lymphocytes and/or fibroblasts from 16 affected males and 5 carriers from 10 families; six different culture media were used: F10, 5% serum, pH 7.3(37 degrees C); medium 199, 5% serum, pH 7.6(37 degrees C); folate-free 199, 5% serum, pH 7.6(37 degrees C), and these three media with FUdR (0.05 micron). In lymphocytes there was no significant difference in the percentage of fra(X) expressing cells between any of the FUdR-containing media. The highest percentage of expressing cells seen in lymphocytes with FUdR was 56%. The average enhancement in males with FUdR in the 199 and folate-free 199 media was 30%. This relative enhancement with FUdR was very much higher in a few blood specimens delayed in transit and FUdR may prevent some of the false-negative results obtained from mailed specimens. FUdR did not induce the marker in four obligate carriers with previously negative results. The fibroblasts from affected males were grown in the six specific media for the last 48 hr. Two of the six media yielded reproducibly positive results. These were 199-FUdR and folate-free 199-FUdR with mean percentages of expressing cells of 12.8 +/- 7.1% and 11.3 +/- 6.1%, respectively. F10-FUdR, which contains thymidine, did not permit expression of the marker in fibroblasts and there was no difference in the percentage of fra(X) expression in 199-FUdR media with or without folate. It was concluded that FUdR shows promise as an agent to permit prenatal diagnosis of the condition and to enhance the detection of the marker in lymphocyte cultures.

[Erythrocyte creatine concentration in infants and children with congenital heart disease and left-to-right shunts (author's transl)]

The creatine concentration of red blood cells was determined in 58 children with congenital acyanotic malformations of the heart at the age of 3 weeks to 3 1/2 years. It was correlated to the severity of the hemodynamic changes, the physical development of the children and number of reticulocytes. The average creatine concentration in the red cells of all patients was 12.8 +/- 4.80 mg/100 ml cells, i.e. twice as high as that of the control group (6.61 +/- 1.19 mg/100 ml cells). Particularly high creatine values were found in children, who died in consequence of their heart disease without previous operation (18.49 +/- 4.25 mg/100 ml cells, n = 11) and those children who had to be operated on as a life-saving measure (17.88 +/- 3.43 mg/100 ml cells, n = 10). The highest creatine concentration was found in a 4 weeks-old infant with hypoplastic left heart syndrome (25.3 mg/100 ml cells). In children with a systolic pressure in the pulmonary artery of greater than 50 torr the creatine concentration was significantly higher than in those with pressures less than 50 torr. Increased creatine values correlated well with the poor physical development and increased reticulocyte numbers of the children. There was no correlation found between capillary pO2 and creatine concentration. It is concluded that the determination of erythrocyte creatine in children with congenital heart disease of the left-right shunt type furnishes additional objective information on the general condition of the organism and its adaptation capacities to hypoxia. It may serve as a valuable diagnostic and prognostic measure.

Prenatal diagnosis in 3,000 women for chromosome, X-linked, and metabolic disorders

In 3,000 women referred for prenatal diagnosis, 110(3.7%) abnormal fetuses were detected and 85 therapeutic terminations were performed. These were five main reasons for referral. Among the 2,227 women referred because of maternal age 35 years and older, there were 51 (2.3%) who had aneuploid fetuses. In the 297 women referred because of a previous child with Down syndrome, 3 aneuploid fetuses (1.0%) were detected. Of the 55 couples where one spouse was a carrier of a balanced chromosome rearrangement, 6 chromosomally abnormal fetuses were found (10.9%) (all the offspring of maternal carriers). In the latter group, five of the six heterozygotes with abnormal findings were carriers of tdic (13;21) translocations. In the 82 cases with a history of X-linked disorders, there were 40 males (49%). Thirty-five women were referred because of inborn errors of metabolism: 10 affected fetuses were found (28%). There was a greater proportion of sex-chromosome aneuploids as compared to trisomy 21 fetuses in the 35 to 39 year maternal age group. This was reversed in the group of women 40 years old and older. Of the 25 abnormal fetuses not terminated, 6 were sex chromosome aneuploids and 10 involved X-linked conditions where the progeny could be further prenatally monitored (eg, X-linked hydrocephalus) or treated (eg, hemophilia). In the remaining 9 the parents expressed divers reasons for their choice. Repeat amniocentesis was required in 2.9% of cases. One case of maternal cell contamination and one case of unconfirmed mosaicism were the only diagnostic errors found in the study. In the last 1,000 specimens referred, the average time necessary for a karyotypic result was 15.6 +/- 5.6 days after amniocentesis.

Prenatal diagnosis for adenosine deaminase deficiency

Amniocentesis was performed in two successive pregnancies of the mother of a child with adenosine deaminase (ADA) deficient severe combined immunodeficiency. Assay of ADA in amniotic fluid fibroblasts showed the pregnancies to be normal and homozygous deficient, respectively. These findings were confirmed by the demonstration of a normal level of erythrocyte ADA in the cord blood of the healthy male born of the first pregnancy and by the demonstration of undetectable ADA activity in cord erythrocytes, spleen, liver, and kidney of the abortus of the second pregnancy. Prenatal diagnosis of ADA deficiency appears to be a reliable procedure.

Quantitative nephelometric determination of Haemophilus influenzae antigen in body fluids

Nephelometry, an immunological technique widely used for the quantification of blood proteins, was adapted to provide a quantitative method of detecting Haemophilus influenzae capsular antigen in body fluids. Using specific antiserum directed against H. influenzae capsular antigen, samples of serum, cerebrospinal fluid, urine, and joint fluid from 38 cases of H. influenzae infections were analyzed. The results were compared for reliability to counterimmunoelectrophoresis, a widely used diagnostic tool. The nephelometric technique has the same advantages of speed and specificity as counterimmunoelectrophoresis and provides the clinician and researcher with a quantitative method that is as reliable as the qualitative counterimmunoelectrophoresis procedure. The method allowed directly quantitative readouts on patient specimens, with no necessity for serial dilutions or densitometric readings.

Growth induction in cystic fibrosis fibroblasts with low dexamethasone concentrations. Experience with application to genotyping

Dexamethasone (DM) resistance was evaluated in fibroblasts from a pool of five patients with cystic fibrosis (CF) homozygotes, ten of their parental obligate heterozygotes, and seventeen age-matched controls of both sexes. The CF heterozygotes showed a mean DM resistance greater than homozygotes and both groups exhibited a higher mean DM resistance at every DM concentration than controls. However, substantial interassay variability rendered these differences in the total pooled data to non-significance. One control showed a consistently increased resistance and was possibly a covert heterozygote. It was concluded that the phenomenon of DM resistance was exhibited by CF heterozygotes and homozygotes but was not discrete enough for genotyping in the prenatal diagnosis of CF.