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Vansenne F, Goddijn M, Redeker B, Snijder S, Gerssen-Schoorl K, Lemmink H, Leschot NJ, van der Veen F, Bossuyt PMM, de Borgie CAJM. Knowledge and perceived risks in couples undergoing genetic testing after recurrent miscarriage or for poor semen quality. Reprod Biomed Online 2011; 23:525-33. [PMID: 21855412 DOI: 10.1016/j.rbmo.2011.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 04/22/2011] [Accepted: 07/04/2011] [Indexed: 11/19/2022]
Abstract
Couples with recurrent miscarriage (RM) and men with poor semen quality may undergo genetic testing as part of the diagnostic work-up. This study explored their knowledge and perception of genetic testing, evaluated psychological wellbeing and identified associated variables. A prospective questionnaire study was conducted in seven clinical genetics centres and referring gynaecological departments in couples with RM or poor semen quality. Questionnaires were completed before disclosure of genetic test results. Main outcome measures were knowledge, perceived risk, anxiety and depression. Of 439 participants, 256 were not aware genetic testing was part of the diagnostic work-up. One-third (36% RM, 33% poor semen quality) indicated they had not received information about the genetic test from their doctor. Perceived risk of receiving an abnormal genetic test result was higher than objective risk. Anxiety was highly correlated with perceived risk. Women with RM were more anxious than women in the poor semen quality group or men (P<0.01). These couples undergoing genetic testing have a suboptimal understanding of the nature of testing, overestimate the risks of receiving an abnormal result and some show high levels of anxiety. The results of this study can be used to improve patient counselling before genetic testing.
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Affiliation(s)
- F Vansenne
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, The Netherlands.
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van Westrum SMS, Hoogerwaard EM, Dekker L, Standaar TS, Bakker E, Ippel PF, Oosterwijk JC, Majoor-Krakauer DF, van Essen AJ, Leschot NJ, Wilde AAM, de Haan RJ, de Visser M, van der Kooi AJ. Cardiac abnormalities in a follow-up study on carriers of Duchenne and Becker muscular dystrophy. Neurology 2011; 77:62-6. [DOI: 10.1212/wnl.0b013e318221ad14] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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3
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Franssen MTM, Musters AM, van der Veen F, Repping S, Leschot NJ, Bossuyt PMM, Goddijn M, Korevaar JC. Reproductive outcome after PGD in couples with recurrent miscarriage carrying a structural chromosome abnormality: a systematic review. Hum Reprod Update 2011; 17:467-75. [PMID: 21504961 DOI: 10.1093/humupd/dmr011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Preimplantation genetic diagnosis (PGD) has been stated to improve live birth rates compared with natural conception in couples with recurrent miscarriage (RM) carrying a structural chromosome abnormality. It is unclear to what extent this claim can be substantiated by evidence. A systematic review of the literature was performed on the reproductive outcome of these couples after natural conception or after PGD. METHODS MEDLINE, EMBASE and the Cochrane database were searched until April 2009. Trials, patient series and case reports describing reproductive outcome in couples with RM carrying a structural chromosome abnormality after natural conception and/or after PGD were included. Since no randomized controlled trials or non-randomized comparative studies were found, separate searches for both groups were conducted. Primary outcome measure was live birth rate per couple. Secondary outcome measure was miscarriage rate per couple. RESULTS Four observational studies reporting on the reproductive outcome of 469 couples after natural conception and 21 studies reporting on the reproductive outcome of 126 couples after PGD were found. After natural conception, live birth rate per couple varied between 33 and 60% (median 55.5%) after parental chromosome analysis; miscarriage rate ranged from 21 to 40% (median 34%). After PGD, live birth rate per couple varied between 0 and 100% (median 31%) after parental chromosome analysis; miscarriage rate ranged from 0 to 50% (median 0%). CONCLUSIONS Currently, there are insufficient data indicating that PGD improves the live birth rate in couples with RM carrying a structural chromosome abnormality.
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Affiliation(s)
- M T M Franssen
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
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Ocal P, Sahmay S, Irez T, Senol H, Cepni I, Purisa S, Lin W, Liu X, Donjacour A, Maltepe E, Rinaudo P, Baumgarten MN, Stoop D, Haentjes P, Verheyen G, De Schrijver F, Liebaers I, Camus M, Bonduelle M, Devroey P, Nelissen ECM, Van Montfoort APA, Coonen E, Derhaag JG, Evers JLH, Dumoulin JCM, Costa Lopes JR, Mendes dos Santos J, Portugal Silva Lima S, Portugal Silva Souza S, Rodrigues Pereira T, Barguil Brasileiro JP, Pina H, Lessa ML, Genovese Soares M, Medina Lopes V, Ribeiro CG, Adami K, Hughes C, Emerson G, Grundy K, Kelly P, Mocanu E, Rodrigues Pereira T, Medina Lopes V, Barguil Brasileiro JP, Coelho Cafe T, de Souza Costa JBM, Zavattiero Tierno NI, Portugal Silva Lima S, Portugal Silva Souza S, Mendes dos Santos J, Costa Lopes JR, Rinaudo P, Lin W, Liu X, Donjacour A, Singh S, Vitthala S, Zosmer A, Sabatini L, Tozer A, Davis C, Al-Shawaf T, Neri QV, Monahan D, Rosenwaks Z, Palermo GD, Kalu E, Thum MY, Abdalla HA, Sazonova A, Bergh C, Kallen K, Thurin-Kjellberg A, Wennerholm UB, Griesinger G, Doody K, Witjes H, Mannaerts B, Tarlatzis B, Witjes H, Mannaerts B, Rombauts L, Heijnen E, Marintcheva-Petrova M, Elbers J, Koning A, Mutsaerts MAQ, Hoek A, Mol BW, Fadini R, Guarnieri T, Mignini Renzini M, Comi R, Mastrolilli M, Villa A, Colpi E, Coticchio G, Dal Canto M, Dolleman M, Broer SL, Opmeer BC, Fauser BC, Mol BW, Broekmans FJM, Alama P, Requena A, Crespo J, Munoz M, Ballesteros A, Munoz E, Fernandez M, Meseguer M, Garcia-Velasco JA, Pellicer A, Munk M, Smidt-Jensen S, Blaabjerg J, Christoffersen C, Lenz S, Lindenberg S, Bosch E, Labarta E, Cruz F, Simon C, Remohi J, Pellicer A, Esler J, Osborn J, Boissonnas Chalas C, Marszalek A, Fauque P, Wolf JP, De Ziegler D, Cabanes L, Jouannet P, Han AR, Park CW, Cha SW, Kim HO, Yang KM, Kim JY, Song IO, Koong MK, Kang IS, Roszaman R, Omar MH, Nazri Y, Azantee YW, Murad AZ, Zainulrashid MR, Wang N, Le F, Wang LY, Ding GL, Sheng JZ, Huang HF, Jin F, Reinblatt S, Holzer H, Son WY, Shalom-Paz E, Chian RC, Buckett W, Dahan M, Demirtas E, Tan SL, Revel A, Schejter-Dinur Y, Revel-Vilk S, Hermens RPMG, van den Boogaard E, Leschot NJ, Vollebergh JHA, Bernardus R, Kremer JAM, van der Veen F, Goddijn M, Nahuis MJ, Kose N, Bayram N, Hompes PGA, Mol BWJ, van der veen F, van Wely M, Van Disseldorp J, Broer SL, Dolleman MD, Broeze K, Opmeer BC, Mol BW, Broekmans FJM, De Rycke M, Petrussa L, Liebaers I, Van de Velde H, Cerrillo M, Pacheco A, Rodriguez S, Gomez R, Delagado F, Pellicer A, Garcia Velasco JA, Desmyttere S, Verpoest W, De Rycke M, Staessen C, De Vos A, Liebaers I, Bonduelle M, Kohls G, Ruiz FJ, De la Fuente G, Toribio M, Martinez M, Pellicer A, Garcia-Velasco JA, Soderstrom - Anttila V, Salevaara M, Suikkari AM, Clua E, Tur R, Alcaniz N, Boada M, Rodriguez I, Barri PN, Veiga A, Nelen WLDM, Van Empel IWH, Cohlen BJ, Laven JS, Aarts JWM, Kremer JAM, Ricciarelli E, Gomez-Palomares JL, Andres-Criado L, Hernandez ER, Courbiere B, Aye M, Perrin J, Di Giorgio C, De Meo M, Botta A, Castilla Alcala J, Luceno Maestre F, Cabello Y, Gomez-Palomares JL, Hernandez J, Marqueta J, Pareja A, Hernandez E, Coroleu B, Helmgaard L, Klein BM, Arce JC, Aarts JWM, van Empel IWH, Boivin J, Kremer JAM, Verhaak CM, Ding G, Yin R, Wang N, Sheng J, Huang H, Mancini F, Tur R, Gomez MJ, Rodriguez I, Coroleu B, Barri PN, van den Boogaard NM, van der Steeg JW, van der Veen F, Hompes P, Mol BW, Boyer P, Gervoise-Boyer M, Meddeb L, Rossin B, Audibert F, Sakian S, Chan Wong E, Ma S, Pathak R, Mustafa MD, Ahmed RS, Tripathi AK, Guleria K, Banerjee BD, Vela G, Luna M, Flisser ED, Sandler B, Brodman M, Grunfeld L, Copperman AB, Baronio M, Carrascosa P, Capunay C, Vallejos J, Papier S, Borghi M, Sueldo C, Carrascosa J, Martin Lopez E, Marcucci A, Marcucci I, Salacone P, Sebastianelli A, Caponecchia L, Pacini N, Rago R, Alvarez M, Carreras O, Gomez MJ, Tur R, Coroleu B, Barri PN, Arnoldi M, Diaferia D, Corbucci MG, De Lauretis L, Kook MJ, Jung JY, Lee JH, Jung YJ, Hwang HK, Kang A, An SJ, Kim HM, Kwon HC, Lee SJ, Satoh M, Imada J, Ito K, Migishima F, Inoue T, Ohnishi Y, Kawato H, Nakaoka Y, Fukuda A, Morimoto Y, Mourad S, Hermens RPMG, Nelen WLDM, Grol RPTM, Kremer JAM, Polyzos NP, Valachis A, Patavoukas E, Papanikolaou EG, Messinis IE, Tarlatzis BC, Kang H, Kim CH, Park E, Kim S, Chae HD, Kang BM, Jung KS, Song HJ, Ahn YS, Petkova L, Canov I, Milachich T, Shterev A, Patrat C, Fauque P, Pocate K, Juillard JC, Gayet V, Blanchet V, de Ziegler D, Wolf JP, van der JW, Leushuis E, Steures P, Koks C, Oosterhuis J, Bourdrez P, Bossuyt PM, van der Veen F, Mol BWJ, Hompes PGA. Posters * Safety & Quality (I.E. Guidelines, Multiple Pregnancy, Outcome, Follow-Up etc.). Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Emery M, Wirthner D, Germond M, Van Rij MC, Lulofs R, Muntjewerff N, Evers JLH, Geraedts JPM, de Die CEM, Vansenne F, Goddijn M, Redeker B, Snijder S, Gerssen-Schoorl K, Lemmink HH, Leschot NJ, Van der Veen F, Bossuyt PMM, De Borgie CAJM, Nekkebroeck J, Stoop D, Devroey P, Provoost V, Pennings G, De Sutter P, Gerris J, Vandevelde A, Dhont M, Verhaak CM, Aarts JWM, Boivin J, Kremer JAM, van Empel IWH. Session 07: Psychology & Counselling 1. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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van den Boogaard E, Kaandorp SP, Franssen MTM, Mol BWJ, Leschot NJ, Wouters CH, van der Veen F, Korevaar JC, Goddijn M. Consecutive or non-consecutive recurrent miscarriage: is there any difference in carrier status? Hum Reprod 2010; 25:1411-4. [DOI: 10.1093/humrep/deq089] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van den Boogaard E, Goddijn M, Leschot NJ, Veen FVD, Kremer JAM, Hermens RPMG. Development of guideline-based quality indicators for recurrent miscarriage. Reprod Biomed Online 2009; 20:267-73. [PMID: 20113965 DOI: 10.1016/j.rbmo.2009.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 05/21/2009] [Accepted: 11/05/2009] [Indexed: 11/24/2022]
Abstract
Recurrent miscarriage (RM) is a multifactorial clinical problem. Guidelines have been published to guide evidence-based clinical practice in RM. To measure adherence to these guidelines in daily practice and to monitor quality of care delivered in RM patients, indicators are necessary. This study aimed to develop a set of valid quality indicators for RM and to explore the relationship between evidence level of guideline recommendations and their acceptance rate as quality indicators. Expert opinions of 11 gynaecologists were used to appraise all guideline recommendations. The systematic RAND-modified Delphi method was used to develop the indicator set from the Dutch guideline on RM. The acceptance rate as indicator of the initial recommendations was assessed per evidence level. A representative set of 23 key recommendations was selected out of 39 guideline recommendations, covering diagnostic tests, lifestyle, therapy and counselling. All recommendations of evidence level A (high) and D (consensus based) were accepted as indicators, while 64% of level B and 22% of level C was accepted. In conclusion, this study generated a set of 23 quality indicators for care in couples with RM. The selection of all consensus-based recommendations subscribes the general importance of these recommendations for gynaecologists.
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Affiliation(s)
- E van den Boogaard
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Mollema ED, Smets EMA, Richard ME, Schiphorst AM, Leschot NJ. Psycho-social counselling in predictive genetic testing for cancer: the association between number of supportive sessions and client characteristics as assessed by psycho-social workers. J Genet Couns 2008; 17:480-8. [PMID: 18751878 DOI: 10.1007/s10897-008-9166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2007] [Accepted: 04/09/2008] [Indexed: 11/30/2022]
Abstract
Given the increased demand on genetic services, it is important to identify clients who may require relatively more extensive psychosocial support. This paper describes which client characteristics, as assessed in the first psycho-social counselling session, were associated with requiring relatively more psycho-social support (> or = 3 sessions) in the process of predictive testing for cancer. The study population consisted of 244 counselees for hereditary cancer. Data were derived from an electronic data-base, used by psycho-social workers for the systematic registration of relevant details of each counselling session. Data were analysed for two respective groups: (A) patients who had a known mutation in the family and (B) patients with an as yet unknown mutation in the family. Results show that two or more psychosocial sessions were given if the information derived from the first session indicated the client to have childhood experiences with cancer (in group A), to experience the family role and/or the psychological impact as burdensome (in both groups) or to experience the social impact as burdensome (in group B). We conclude that the first assessment by a psychosocial worker already provides valuable information on the psychological support needs of patients. These findings provide insight into possible problem areas for clients dealing with predictive genetic testing.
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Affiliation(s)
- E D Mollema
- Departments of Clinical Genetics and Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
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Goddijn M, Repping SR, van der Veen F, Leschot NJ. [Examples of preimplantation genetic diagnosis versus prenatal diagnosis in carriers of genetic abnormalities: advantages and disadvantages]. Ned Tijdschr Geneeskd 2008; 152:1545-1546. [PMID: 18683319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Franssen MTM, Korevaar JC, Tjoa WM, Leschot NJ, Bossuyt PMM, Knegt AC, Suykerbuyk RF, Hochstenbach R, van der Veen F, Goddijn M. Inherited unbalanced structural chromosome abnormalities at prenatal chromosome analysis are rarely ascertained through recurrent miscarriage. Prenat Diagn 2008; 28:408-11. [DOI: 10.1002/pd.1960] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Important insights in the process of genetic counseling can be provided by establishing levels of satisfaction. The aim of our study was to compare counselees' and counselors' satisfaction with the initial consultation in reproductive genetic counseling and to gain insight into the factors associated with their contentment. One hundred and fifty-one women and 11 counselors participated in this study. Pre-test questionnaires included counselees' socio-demographic, physical and psychological characteristics, i.e. their degree of worry, expectations, preferred participation in decision making and experienced degree of control. Post-visit questionnaires asked for counselees' and counselors' satisfaction, counselees' participation in decision making and counselees' Perceived Personal Control (PPC). Little difference was found between counselees' and counselors' overall visit-specific satisfaction (mean 79 vs 74, respectively, on a visual analogue scale from 0 to 100). The correlation between counselees' and counselors' satisfaction was medium sized (r = 0.26, p < 0.01). Counselees' satisfaction was positively associated with being pregnant and with their post-visit PPC. Counselors' satisfaction was positively associated with counselees' post-visit PPC. No other counselee and counselor related variables appeared to be associated with satisfaction, nor was the duration of the consultation. Our findings suggest that, although both groups were satisfied with the consultation, counselees and counselors do not always have equal perceptions of the consultation process and may form their evaluation in different ways. In the assessment of quality of care, evaluation of both counselees' and counselors' satisfaction deserves more attention.
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Affiliation(s)
- C M Aalfs
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands.
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Aalfs CM, Smets EMA, Leschot NJ. Genetic counselling for familial conditions during pregnancy: a review of the literature published during the years 1989-2004. Public Health Genomics 2007; 10:159-68. [PMID: 17575460 DOI: 10.1159/000101757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genetic counselling for familial conditions during pregnancy may have some disadvantages, such as time pressure and induced worry. However, little is known about the reasons for and consequences of this timing of genetic counselling. OBJECTIVE The objective of this study was to provide an overview of research aimed at the counselee's reasons for seeking genetic counselling during pregnancy and the medical-technical and procedural consequences thereof. METHODS We searched the databases Medline and PsycINFO for primary research papers, reviews and case reports, published from 1989 to June 2004. RESULTS No papers could be retrieved which explicitly addressed our research questions. However, 34 papers, out of a total of 399 papers, covered issues with some relevance to our research questions. Limited knowledge and alertness towards genetics and a greater apparent relevance of genetic issues during pregnancy seemed to explain, at least partly, the timing of referral during pregnancy. Literature on the consequences of this timing for the quality of the genetic counselling process appeared to be scarce. These consequences, therefore, remain unclear. CONCLUSION In the literature, little attention is paid to the various aspects of the timing of genetic counselling for familial conditions during pregnancy. More research on this issue is important, with a view to improving the care of pregnant women and their children.
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Affiliation(s)
- C M Aalfs
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands.
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Leschot NJ, Wilde AAM. [The optimal treatment of chronic heart failure with beta-blockers may be dependent upon the genetic background of the patient]. Ned Tijdschr Geneeskd 2007; 151:1610-1. [PMID: 17727180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Pharmacogenetics, which aims at the development of'personal pills', is an attractive field in modern medicine. However, the results obtained in the last few years are somewhat disappointing. Recently, a genetic polymorphism was discovered in the treatment of chronic heart failure with beta-blockers. An in-vitro study revealed a hypersensitivity of the Arg389 variant in the beta1-adrenergic receptor to the beta-blocker carvedilol. Interestingly, this polymorphism also has ethnic aspects: the allele frequency of the Arg389 variant is 20% lower in Negroes than in Caucasians. If this result can be confirmed in other studies, one should consider testing for this polymorphism before carvedilol is prescribed. The manufacturer of carvedilol might well consider offering to test the patient's DNA for this polymorphism.
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Affiliation(s)
- N J Leschot
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Klinische Genetica, Postbus 22.660, 1100 DB Amsterdam.
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Franssen MTM, Korevaar JC, Leschot NJ, Bossuyt PMM, Knegt AC, Gerssen-Schoorl KBJ, Wouters CH, Hansson KBM, Hochstenbach PFR, Madan K, van der Veen F, Goddijn M. [Risk factors for structural chromosomal abnormality in > or = 2 miscarriages, as an instrument for selective karyotyping]. Ned Tijdschr Geneeskd 2007; 151:863-7. [PMID: 17472118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To identify additional risk factors and the corresponding probability of carrying a chromosome abnormality in couples with two or more miscarriages. DESIGN Nested case-control study. METHOD In 6 centres for clinical genetics in the Netherlands, data were collected from couples referred for karyotyping after 2 2 miscarriages from 1992-2000. Factors influencing the probability of carrier status were examined. The corresponding probability of carrier status was calculated for the various combinations of these factors. RESULTS In total 279 carrier couples and 428 non-carrier couples were included. 4 independent factors influencing the probability of carrier status were identified: a younger maternal age at the time of second miscarriage, a history of > or = 3 miscarriages, a history of > 2 miscarriages in a brother or sister of either partner, and a history of> 2 miscarriages in parents of either partner. The calculated probability of carrier status in couples referred for chromosome analysis after two or more miscarriages, varied between 0.5-10.2%. In 18% of couples included, the risk was found to be so low (< 2.2%), that in couples with comparable risk factors, it may not be necessary to perform karyotyping. CONCLUSION This study demonstrated that the probability of carrier status in couples with > or = 2 miscarriages is modified by additional factors. Selective chromosome analysis would result in a more effective referral policy and therefore decrease the number of chromosome analyses and lower the costs.
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Affiliation(s)
- M T M Franssen
- Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.660, II00 DD Amsterdam.
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Franssen MTM, Korevaar JC, van der Veen F, Boer K, Leschot NJ, Goddijn M. Management of recurrent miscarriage: evaluating the impact of a guideline. Hum Reprod 2007; 22:1298-303. [PMID: 17317720 DOI: 10.1093/humrep/dem014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known on the actual diagnostic and therapeutic management of recurrent miscarriage and the impact of introducing guidelines on this topic. The objective of this study was to evaluate any changes in the management of recurrent miscarriage among Dutch gynaecologists after the introduction of the Dutch guideline 'Recurrent Miscarriage' in 1999. METHODS Questionnaires were sent to all practices for obstetrics and gynaecology in the Netherlands. Data concerned definition, diagnosis and treatment of recurrent miscarriage. Results were compared with a similar study conducted before the introduction of the guideline and with the recommendations in the guideline. RESULTS The response rate was 83%. Regarding gestational age, only 3% of the respondents used the definition as advised in the guideline. After the introduction of the guideline, thrombophilia factors were tested more frequently, anticoagulants were prescribed more frequently and more respondents reported to correct uterine malformations. Therapies not described in the guideline, e.g. donor insemination and oocyte donation, were still applied. CONCLUSIONS The adherence to the Dutch guideline 'Recurrent Miscarriage' was rather poor, presumably due to guideline-related as well as physician-related barriers. Too many diagnostic tests and ineffective therapeutic interventions were performed. This study demonstrates the importance of appropriate implementation and revision.
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Affiliation(s)
- M T M Franssen
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Nagel HTC, Knegt AC, Kloosterman MD, Wildschut HIJ, Leschot NJ, Vandenbussche FPHA. Prenatal diagnosis in the Netherlands, 1991–2000: number of invasive procedures, indications, abnormal results and terminations of pregnancy. Prenat Diagn 2007. [DOI: 10.1002/pd.1659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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van Zwieten MCB, Leschot NJ, Willems DL. [Rapid prenatal diagnosis of chromosomal abnormalities; limitations and possibilities]. Ned Tijdschr Geneeskd 2006; 150:2454; author reply 2454. [PMID: 17131706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Leschot NJ. ['Multifactorial disorders in the genomics era'; notes on a recent report from The Royal Netherlands Academy of Arts and Sciences]. Ned Tijdschr Geneeskd 2006; 150:2350-2. [PMID: 17100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The Royal Netherlands Academy of Arts and Sciences (KNAW) has issued a report entitled 'Multifactorial diseases in the genomics era'. It makes two major recommendations. The ministers of Science, Health and Economic Affairs are advised to (a) to take steps to ensure the development, evaluation and implementation of advanced high-throughput technologies in order to improve the international position of the Netherlands, and (b) to actively promote the setting up of one or more general biobanks in the Netherlands that should contain biological samples and data from parts of the population and that are not restricted to a single disorder. The report fails to address some important aspects of biobanks, such as the registration of the ethnicity of patients and controls. In addition monogenetic subvariants in multifactorial disease are not mentioned.
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Affiliation(s)
- N J Leschot
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Klinische Genetica, Postbus 22.660, 1100 DD Amsterdam.
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Westerveld GH, Korver CM, van Pelt AMM, Leschot NJ, van der Veen F, Repping S, Lombardi MP. Mutations in the testis-specific NALP14 gene in men suffering from spermatogenic failure. Hum Reprod 2006; 21:3178-84. [PMID: 16931801 DOI: 10.1093/humrep/del293] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Because of the common use of ICSI and the potential genetic aetiology of spermatogenic failure, concern has been raised about transmitting genetic disorders to ICSI offspring. However, to date, in only approximately 15% of all cases of spermatogenic failure, an underlying genetic cause can be identified. We have previously established an association between spermatogenic failure and chromosomal region 11p15. In this study, we set out to explore whether NALP14, a gene recently mapped to 11p15, has a function in spermatogenesis and whether mutations in NALP14 can cause spermatogenic failure. METHODS We applied two different multiple tissue northern (MTN) blots to determine tissue specificity of NALP14 and performed immunohistochemistry on human testis with anti-NALP14 antiserum. To determine imprinting status of NALP14, we tested the expression pattern of two single-nucleotide polymorphisms (SNPs) in human testis. Finally, we performed a mutation screen of the NALP14 gene in 157 men with azoospermia or severe oligozoospermia by direct sequencing; 158 normospermic men served as controls. RESULTS NALP14 was, as are the three other genes in 11p15, exclusively expressed in testis. Within the testis, the NALP14 protein was mainly expressed in A dark spermatogonia, mid and late spermatocytes and spermatids. The mutation screen revealed five mutations that occurred only in the patient group. One of these unique mutations introduced an early stop codon in the NALP14 sequence, predicted to result in a severely truncated protein. CONCLUSION Our data suggest that NALP14 has a function in spermatogenesis and that mutations in this gene might cause spermatogenic failure.
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Affiliation(s)
- G H Westerveld
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam, The Netherlands.
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20
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Kapma S, Leschot NJ, Aalfs CM. [DNA-analysis in hereditary cancer: the importance of a reliable family history]. Ned Tijdschr Geneeskd 2005; 149:57-60. [PMID: 15688834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Three patients, a 45-year-old man, a 51-year-old woman and a 43-year-old woman, wanted to know whether they had a hereditary predisposition for cancer. The family of patient A fulfilled the clinical diagnostic criteria for hereditary non-polyposis colorectal carcinoma (HNPCC). The family of patient B fulfilled the clinical diagnostic criteria for hereditary breast/ovarian cancer (HBOC). The family of patient C did not completely fulfil the criteria for HBOC since only two family members had a confirmed diagnosis of breast cancer. In all three families, DNA-mutation analysis was performed. In families A and B no mutation was found. However, based on the family history, the diagnosis of hereditary cancer was made and recommendations for surveillance were given. After extensive counselling, one member of family B eventually decided to have prophylactic surgery performed. A few years later, a pathogenic mutation in BRCA2 was found in family B. In family C, an unclassified variant was found in BRCA1. Further investigations in the family were not possible, due to a lack of co-operation from family members. It is important to obtain a thorough and complete family history. When DNA-analysis remains inconclusive or if an unclassified variant is found, recommendations for surveillance will be based on this family history.
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Affiliation(s)
- S Kapma
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Klinische Genetica, Meibergdreef 15, 1105 AZ Amsterdam.
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21
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Leschot NJ, Mannens MMAM. [The disquieting consequences of granting patents on human genes for healthcare and scientific research in The Netherlands]. Ned Tijdschr Geneeskd 2004; 148:1712-5. [PMID: 15468898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The granting of a patent by the European Patent Office to Myriad Genetics on the sequence of the BRCA-1 gene in 2001 prompted the Dutch Minister of Healthcare and the Minister of Education, Culture and Science to ask for advice. The Royal Netherlands Academy of Arts and Science (KNAW) prepared a report in 2003 entitled: 'The consequences of granting patents on human genes for scientific research in The Netherlands'. Another recommendation (by Van de Bunt) entitled: 'A code of gene patenting' was also published in 2003. The KNAW report recommends, among others: a redefinition of the 'research exemption' and renewed discussion on a 'grace period'. The Van de Bunt report concludes, among other things, that some holders of gene patents cause unwanted side effects, but that the patent system itself provides sufficient possibilities to prevent these side effects. In a comment on both reports, the Dutch Ministry of Healthcare concluded: 'There is no reason to change the current patent system'. One should be more critical, however, and favour the possibility of a 'diagnostic exemption' in which DNA-diagnostics would be excluded from patenting.
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Affiliation(s)
- N J Leschot
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Klinische Genetica, Meibergdreef 9-15, 1105 AZ Amsterdam.
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22
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Nagel HTC, Knegt AC, Kloosterman MD, Wildschut HIJ, Leschot NJ, Vandenbussche FPHA. [Invasive prenatal diagnosis in the Netherlands, 1991-2000: number of procedures, indications and abnormal results detected]. Ned Tijdschr Geneeskd 2004; 148:1538-43. [PMID: 15366724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To provide an overview of invasive prenatal diagnosis in the Netherlands during the period 1991-2000 and to analyse potential trends. DESIGN Retrospective. METHOD The annual results from all 13 Dutch centres for invasive prenatal diagnosis over the period 1991-2000 were combined and described, with particular emphasis on indications, number and type of invasive procedures, and number and type of abnormal results. RESULTS The percentage of pregnancies in which invasive prenatal diagnostics were carried out increased from 5% in 1991 to 6% in 1996 and remained at the same level until 2000. 'Maternal age' was the main reason for prenatal testing (69.2-73.3% of procedures). However, the number of pregnant women aged 36 or over increased by 69.9%. An abnormal result was found in an average of 4.7% of procedures, rising from 3.6% in 1991 to 5.4% in 2000. In 70.8% of cases with abnormal results, the pregnancy was terminated. Important trends were the relative decrease of cordocentesis (-82%) and chorionic villi biopsy (-18%) in favour of amniocentesis (+48%), and a strong decrease in the number of amniocentesis procedures on indication of increased risk of neural tube defect. CONCLUSION The total number of invasive prenatal diagnostic procedures remained stable. However, there was an important decrease in the percentage of pregnant women aged 36 or over who underwent invasive prenatal diagnosis without previous prenatal screening.
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Affiliation(s)
- H T C Nagel
- Ziekenhuis Bronovo, afd. Gynaecologie en Obstetrie, Den Haag
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23
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Aalfs CM, Mollema ED, Oort FJ, de Haes JCJM, Leschot NJ, Smets EMA. Genetic counseling for familial conditions during pregnancy: an analysis of patient characteristics. Clin Genet 2004; 66:112-21. [PMID: 15253761 DOI: 10.1111/j.0009-9163.2004.00279.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Reproductive genetic counseling for a familial genetic risk factor preferably takes place before conception. However, of the women with a family history of genetic conditions who attend our department of clinical genetics, about 10-20% attend for the first time during a pregnancy. The current study aims to explore patient-related factors that may affect this late timing of reproductive genetic counseling. Consecutive pregnant (n = 100) and non-pregnant (n = 84) women visiting the department of clinical genetics for a genetic risk factor which was not age related completed a questionnaire immediately prior to the consultation. The questionnaire asked for (a) background characteristics, i.e. socio-demographic, obstetric, and disease characteristics (b) cognitive factors, i.e. initiative of referral, knowledge of the risk factor involved, risk perception, worry, child wish, attitudes toward abortion, and preferred participation in decision making, and (c) reasons for the timing of the consultation and for seeking genetic counseling. Pregnant women appeared to be higher educated, considered their children more often as healthy and were less often affected themselves, as compared to non-pregnant women. They also estimated their chance of having an affected child as lower, and they worried less. Furthermore, the initiative for referral was taken less often by the pregnant woman herself and more often by a medical worker. There were no major differences between the two study groups in knowledge, perceived severity of the risk factor, child wish, attitudes toward abortion, desired participation in decision making, and reasons to seek genetic counseling. Women indicated no specific reasons for their timing of referral for reproductive genetic counseling, e.g. during vs before pregnancy. Our data suggest that this timing of referral is not influenced predominantly by the women's level of knowledge. Rather, women's estimation of genetic risks and their degree of worry, which may be in accordance with the actual risk figures, seem to play a role in seeking genetic counseling. Although further studies are required, a more active role of health care providers seems warranted if we want to prevent genetic counseling for familial genetic conditions during pregnancy as much as possible.
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Affiliation(s)
- C M Aalfs
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands.
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24
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Bergen AAB, Leschot NJ, Hulsman CAA, De Smet MD, De Jong PTVM. [From gene to disease; primary open-angle glaucoma and three known genes: MYOC, CYP1B1 and OPTN]. Ned Tijdschr Geneeskd 2004; 148:1343-4. [PMID: 15283026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Primary open-angle glaucoma (POAG) is a group of multifactorial diseases that affects 1.5% of the population. If untreated, the disease leads to irreversible damage to the visual system. The clinical features of POAG are excavation of the optic disc and visual field defects, probably due to degeneration of retinal ganglion cells. Important risk factors for POAG are older age, elevated intraocular pressure, the presence of POAG in relatives, and still largely unknown molecular genetic factors. The clinical, genetic and pathological heterogeneity most likely reflects the complex heterogeneous situation at the molecular level. The three genes known to be involved in POAG (MYOC, CYP1B1 and OPTN) account for up to 18% of the POAG cases. These findings result in new possibilities for the presymptomatic molecular diagnosis of POAG.
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Affiliation(s)
- A A B Bergen
- Interuniversitair Oogheelkundig Instituut, Meibergdreef 47, 1105 BA Amsterdam.
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25
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Westerveld GH, Gianotten J, Leschot NJ, van der Veen F, Repping S, Lombardi MP. Heterogeneous nuclear ribonucleoprotein G-T (HNRNP G-T) mutations in men with impaired spermatogenesis. Mol Hum Reprod 2004; 10:265-9. [PMID: 14996998 DOI: 10.1093/molehr/gah042] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The genetic cause of male subfertility due to impaired spermatogenesis is unknown in the majority of cases, but the general assumption is that it is a complex disorder. The aim of this study was to determine whether mutations occur in the HNRNP G-T gene in men with idiopathic impaired spermatogenesis. The heterogeneous nuclear ribonucleoprotein G-T (HNRNP G-T) gene is located in chromosomal region 11p15 that has been shown to be associated with impaired spermatogenesis. It is a member of the hnRNP gene family and is predominantly expressed in pachytene spermatocytes and round spermatids, where it is thought to affect splicing and signal transduction. We identified eight single nucleotide variants in our patient group of 153 subfertile men by sequencing the HNRNP G-T gene. Two of the mutations, R100H and G388del, did not occur in a control group of 143 normozoospermic men. The R100H mutation causes loss of a conserved arginine, thereby affecting a putative site of methylation possibly required for RNA-binding. Interestingly, this mutation was inherited from the mother. The G388del mutation causes loss of one non-conserved glycine located in a glycine stretch at the end of the protein that is not a known functional motif or domain. Our data show that HNRNP G -T mutations are not a frequent cause of impaired spermatogenesis. Nevertheless, the R100H mutation detected suggests that in some men mutations in the HNRNP G-T gene can cause impaired spermatogenesis.
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Affiliation(s)
- G H Westerveld
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, Meibergdreef 9, H4-205, 1105 AZ Amsterdam, The Netherlands.
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26
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Goddijn M, Joosten JHK, Knegt AC, van derVeen F, Franssen MTM, Bonsel GJ, Leschot NJ. Clinical relevance of diagnosing structural chromosome abnormalities in couples with repeated miscarriage. Hum Reprod 2004; 19:1013-7. [PMID: 14990541 DOI: 10.1093/humrep/deh172] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The annual number of parental karyotypes in cases of repeated miscarriage is increasing gradually in The Netherlands. The efficiency of offering parental karyotyping in couples with repeated miscarriage has not been evaluated before, especially not for the group with miscarriages at advanced maternal age. METHODS A historical cohort study and nested case-control study were conducted, including couples with at least two miscarriages. Data were retrieved from medical records and telephone interviews. The obstetric follow-up was recorded for > or =2 years after the parental chromosome analysis. Data were analysed to compare ratios of carrier/non-carrier couples in whom maternal age was > or =36 or <36 years at the second, third or fourth and more miscarriage. A projected prevalence of carrier status of a structural chromosome abnormality was calculated by extrapolating the number of included patients to the original level of the total screening population. RESULTS Forty-one couples with carrier status of a structural chromosome abnormality and 74 couples without carrier status were included. No unbalanced offspring arose after the detection of a structural chromosome abnormality. The risk of being a carrier was not significantly lower (as might be expected) when women were > or =36 years. Ascertainment after two, three, or four and more miscarriages did not change these findings. CONCLUSIONS Karyotyping of 1324 couples ascertained for repeated miscarriage did not yield an unbalanced fetal chromosome pattern after the ascertainment of parental carrier status. In women with advanced maternal age, the frequency of carrier status was not lower than in younger women.
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Affiliation(s)
- M Goddijn
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, University of Amsterdam, Amsterdam, The Netherlands.
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Abstract
AIMS Genetic scientific knowledge is growing rapidly but how this affects clinical practice is unclear. We investigated the levels of knowledge, practical skills and clinical genetic practices of Dutch cardiologists. METHODS AND RESULTS A survey was designed to assess cardiologists' experience with genetic aspects of hypertrophic cardiomyopathy, self-reported genetic knowledge, and genetic skills in general and aimed at this disease. In addition, cardiologists' opinions on five possible measures for improvement were obtained. STUDY POPULATION all Dutch cardiologists (n=643). Median number of patients suffering from hypertrophic cardiomyopathy per cardiologist is five. Forty-one percent of respondents do not give information about genetics to all their patients. Cardiologists rarely initiate DNA tests for hypertrophic cardiomyopathy. Only 38% refer patients to clinical geneticists. Self-reported knowledge levels are low (average score 3.3-5.1, 0-10 scale). Cardiologists with an established working relationship with a clinical geneticist report significantly higher levels of knowledge. Clinical guidelines, education and improved collaboration with clinical geneticists are preferred. CONCLUSION Dutch cardiologists' genetic knowledge and clinical genetic practice levels are insufficient. As a result, clinical genetic care for patients with hypertrophic cardiomyopathy is poor. Improvements proposed include advancement of knowledge (education, professional guidelines) and structural measures (working relationships, multidisciplinary outpatient clinics). Collaboration of cardiologists and clinical geneticists is urgently needed to optimise cardiogenetic patient care.
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Affiliation(s)
- I M van Langen
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands.
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28
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Cobben JM, Bröcker-Vriends AHJT, Leschot NJ. [Prenatal diagnosis for hereditary predisposition to mammary and ovarian carcinoma--defining a position]. Ned Tijdschr Geneeskd 2002; 146:1461-5. [PMID: 12190015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Prenatal testing for a BRCA mutation, the hereditary trait for mammary and ovarian carcinoma, with the intention of selective termination of pregnancy in case of a female carrier is a controversial ethical issue. Based on a review of the (limited) medical literature as well as of Dutch policy statements relating to this subject, the following conclusions and recommendations are proposed: (a) the decision to opt for prenatal BRCA testing and selective termination of pregnancy in case of a BRCA mutation in the foetus cannot immediately be judged unacceptable from an ethical point of view; (b) prenatal BRCA testing is morally defensible only in case of a female foetus and if the parents at least have the intention to terminate the pregnancy if the foetus is a carrier, although the final decision is in any case up to the parents only; (c) prental testing for a BRCA mutation should only be done after extensive counselling of the parents, during which not only the medical genetic aspects but also the ethical aspects of prenatal BRCA testing are discussed.
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Affiliation(s)
- J M Cobben
- VU Medisch Centrum, polikliniek Klinische Genetica, De Boelelaan 1117, 1081 HV Amsterdam.
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29
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Schuring-Blom GH, Hoovers JM, van Lith JM, Knegt AC, Leschot NJ. FISH analysis of fetal nucleated red blood cells from CVS washings in cases of aneuploidy. Prenat Diagn 2001; 21:864-7. [PMID: 11746131 DOI: 10.1002/pd.160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In chorionic villus sampling (CVS) the chromosome analysis is inconclusive in 1-2% of the samples. In many cases follow-up amniocentesis is performed. Fetal nucleated red blood cells (FNRBCs) are present in washings of chorionic villus samples. We wanted to establish whether analysis of these true fetal cells, using fluorescence in situ hybridization (FISH), could support the CVS karyotype. METHODS We analysed washings of first trimester chorionic villi from non-mosaic 45,X (n=6) and full trisomy 18 cases (n=7). FNRBCs were identified by immunostaining and FISH was performed with chromosome-specific probes for X, Y and 18. RESULTS In all 13 samples FNRBCs were present (between 4 and 30 cells per sample). Five cases of monosomy X showed one X signal in 89-100% of the nuclei; in the other case 50% of the nuclei displayed one signal. In the trisomy 18 cases three spots were seen in 60-100% of the cells. CONCLUSION The CVS aneuploidy was confirmed in FNRBCs in all samples, so FISH on FNRBCs can be used in cases of non-mosaic numerical chromosomal abnormalities. This test can confirm a CVS diagnosis of monosomy X or trisomy 18 and thus minimize the risk for false-positive diagnoses. An additional invasive test may be prevented.
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Affiliation(s)
- G H Schuring-Blom
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands.
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30
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Aalfs CM, Smets EM, de Haes JC, Leschot NJ. [Prenatal genetic counseling in pregnancy: the importance of (early) timely referral ]. Ned Tijdschr Geneeskd 2001; 145:1577-81. [PMID: 11534373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Three women aged 34, 23 and 39 years, who were respectively, 14, 12 and 8 weeks pregnant, requested genetic counselling due to grave genetic diseases in their families. The first woman chiefly wanted to be prepared; an investigation revealed no abnormalities and a healthy child was born. The second needed time to assimilate the information provided and terminated the pregnancy. For the third woman genetic screening was not possible in the short term and furthermore acceptation of the pregnancy was the biggest problem; she gave birth to a healthy child. In the Netherlands, about 800 to 1600 women every year request prenatal genetic counselling when they are already pregnant. The disadvantages of this late timing are the disquiet and uneasiness, the lost options and the time pressure under which difficult decisions have to be taken. Causes of this are a lack of genetic knowledge and psychosocial aspects. Ideally, genetic counselling that deals with reproductive issues should take place prior to conception.
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Affiliation(s)
- C M Aalfs
- Afd. Klinische Genetica, Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam.
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31
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Leschot NJ. [Use of genetics in the Dutch health care system; a memorandum from the Dutch Minister of Health, Welfare and Sports to the Dutch Parliament]. Ned Tijdschr Geneeskd 2001; 145:1233-5. [PMID: 11455687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
In the memorandum entitled 'The application of genetics in health care', which was sent to the Dutch Parliament in December 2000, the Minister of Health, Welfare and Sport responded to four proposals she had received from the Health Council of the Netherlands during the previous three years. These proposals included reports on in vitro fertilisation, DNA diagnostics, clinical genetic testing and genetic counselling, and pharmacogenetics. Legal aspects dominate the section on the consumer's/patient's position: detailed legal guidelines are provided for difficult family-related issues in genetic counselling. For genetic counselling and clinical genetic testing, permission from the Minister of Health is still required. Criteria have been provided for the public funding of these activities in the shorter term. Clinical geneticists have been asked to develop guidelines for a number of clinical situations, which include predictive genetic testing and genetic testing in children. Moreover both medical and laboratory professionals have already initiated a number of self-regulatory measures. The Minister has adopted most of the proposals received, which means that for the foreseeable future, there is a clearly regulated framework for the responsible use of genetics within the Dutch healthcare system.
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Affiliation(s)
- N J Leschot
- Academisch Medisch Centrum, afd. Klinische Genetica, Meibergdreef 15, 1105 AZ Amsterdam.
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Schuring-Blom GH, Boer K, Leschot NJ. A placental diploid cell line is not essential for ongoing trisomy 13 or 18 pregnancies. Eur J Hum Genet 2001; 9:286-90. [PMID: 11313773 DOI: 10.1038/sj.ejhg.5200631] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2000] [Revised: 11/21/2000] [Accepted: 12/20/2000] [Indexed: 11/09/2022] Open
Abstract
Viable trisomy 13 or 18 pregnancies may be supported by the presence of a diploid cell line, confined to the outer layer of the placenta (cytotrophoblast). To establish the presence of diploid cells we investigated five random biopsies from placentas of trisomy 13 (n = 8) and trisomy 18 cases (n = 6) of newborn infants and terminated pregnancies by means of fluorescence in situ hybridisation on interphase nuclei (n = 100). In 12 of these 14 placentas (including all five liveborns) 80% or more of the analysed nuclei showed three spots, suggestive of the presence of a full trisomy. In the other two placentas (both cases of trisomy 18) mosaicism was detected at most investigated sites. Thus, in contrast with earlier studies, these results show that a significant diploid cell line present in the placenta, confined to the trophoblast, is not a pre-requisite for intrauterine survival in the investigated cases.
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Affiliation(s)
- G H Schuring-Blom
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands.
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33
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de Vries JW, Repping S, Oates R, Carson R, Leschot NJ, van der Veen F. Absence of deleted in azoospermia (DAZ) genes in spermatozoa of infertile men with somatic DAZ deletions. Fertil Steril 2001; 75:476-9. [PMID: 11239526 DOI: 10.1016/s0015-0282(00)01758-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the presence or absence of the deleted in azoospermia (DAZ) gene clusters in the Y-bearing spermatozoa in semen of severely oligozoospermic men or in testicular biopsy samples of azoospermic men with somatic DAZ deletions. DESIGN Prospective study. SETTING Academic hospital. PATIENT(S) Nineteen patients attending our clinics for therapeutic intracytoplasmic injection of sperm. INTERVENTION(S) Peripheral blood lymphocytes were used to obtain somatic DNA for analysis using the polymerase chain reaction. Analysis of chromosomes X and Y and the detection of the DAZ gene clusters were carried out with the fluorescence in situ hybridization technique in spermatozoa remaining after intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S) Presence or absence of the DAZ gene clusters in matched somatic DNA and Y-bearing spermatozoa. RESULT(S) Seven patients appeared to have a somatic DAZ deletion. Three-color fluorescence in situ hybridization showed that all Y-bearing spermatozoa examined from these men carried the same deletion. CONCLUSION(S) The DAZ deletions present in the seven men would all have been transmitted if they had fathered sons through artificial fertilization techniques using the sperm cells examined in this study.
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Affiliation(s)
- J W de Vries
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
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Hoogerwaard EM, Ginjaar HB, Wilde AA, Leschot NJ, de Voogt WG, de Visser M. [The heartache of muscular dystrophy]. Ned Tijdschr Geneeskd 2000; 144:2181-4. [PMID: 11103252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Duchenne and Becker muscular dystrophy are caused by a mutation in the dystrophin gene, located on the short arm of the X chromosome. Three so called dystrophinopathy patients, a women aged 54 and two men aged 23 and 21 years, suffered from a severe dilated cardiomyopathy. Such a cardiomyopathy can develop in both carriers and patients. In addition, it is often more important for prognosis than muscle weakness. For these two reasons it is important to screen both groups for (early) cardiological abnormalities. If these are present, regular follow-up is necessary to start timely therapy. When cardiological investigations yield normal results, it is advised to screen carriers with a five-year interval. Dystrophinopathy patients should be checked every year, because the cardiomyopathy sometimes develops and deteriorates over a short period of time. Patients with dilated cardiomyopathy and with a positive family history for dilated cardiomyopathy, muscle weakness or high serum creatine kinase activity should be screened for a mutation in the dystrophin gene.
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Affiliation(s)
- E M Hoogerwaard
- Afd. Neurologie, Academisch Medisch Centrum/Universiteit van Amsterdam.
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35
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Abstract
Fetal chromosome abnormalities account for about 50% of first-trimester pregnancy losses. Most of these abnormalities are numerical abnormalities (86%) and a low percentage is caused by structural abnormalities (6%) or other genetic mechanisms, including chromosome mosaicism (8%). The recurrence risk of numerical abnormalities is low, so karyotyping of fetal material in case of a miscarriage does not seem worthwhile in daily practice. Half of the structural abnormalities may be inherited from a parent carrying a balanced chromosome translocation or inversion. Parental carriership is found in 4-6% of the couples with recurrent miscarriage. In case of parental carriership of a balanced structural chromosome abnormality, a next pregnancy may result in a child with an unbalanced structural chromosome abnormality. This child can have multiple congenital malformations and/or a mental handicap. Prenatal diagnosis is therefore recommended. Conventional laboratory techniques, such as tissue culturing and karyotyping, or (semi-)direct chromosome technique of chorionic villi, and the recently developed laboratory techniques such as fluorescence in situ hybridization (FISH) and comparative genomic hybridization (CGH), are described successively. Until now, not enough evidence has been available about the role of other genetic mechanisms, such as single-gene abnormalities, uniparental disomy, genomic imprinting, multifactorial disorders and skewed X chromosome, in the occurrence of miscarriages.
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Affiliation(s)
- M Goddijn
- Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, 1100 DE, TheNetherlands
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Leschot NJ. Qigong: a personal experience. Altern Ther Health Med 2000; 6:98-9. [PMID: 11012283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Leschot NJ, Mannens MM. [Decoding of the human genome: a milestone, but not the end of the road]. Ned Tijdschr Geneeskd 2000; 144:1093-6. [PMID: 10876702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The base sequence of the entire human DNA will be known within only a few years. So far, 16,000 of an expected total of 100,000 genes have been identified. Nowadays there are different stages of molecular unraveling: from fully sequenced genes, including mutations responsible for diseases, down to 'predicted' genes for which no corresponding protein is yet known. Moreover, the genes responsible for many monogenetic conditions have not yet been identified. The revolutionary approach of at random cloning and sequencing was shown to be successful in the recently published genome sequence of the fruit fly. The next landmark will be an overview of the characteristics and activity of every protein that this organism can synthesize. However, protein technology has developed less far than DNA-technology and will be subject of the next project.
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Affiliation(s)
- N J Leschot
- Afd. Klinische Genetica, Academisch Medisch Centrum/Universiteit van Amsterdam.
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de Pater JM, Schuring-Blom GH, Nieste-Otter MA, van Nesselrooij B, Kapitein B, Christiaens GC, Leschot NJ. Trisomy 8 in chorionic villi-unpredictable results in follow-up. Prenat Diagn 2000; 20:435-7. [PMID: 10820417 DOI: 10.1002/(sici)1097-0223(200005)20:5<435::aid-pd823>3.0.co;2-q] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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39
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de Graaf IM, Cuckle HS, Pajkrt E, Leschot NJ, Bleker OP, van Lith JM. Co-variables in first trimester maternal serum screening. Prenat Diagn 2000; 20:186-9. [PMID: 10719318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The objective of this study was to determined the influence of maternal weight, maternal smoking habits, gravidity, parity and fetal gender on the level of maternal serum marker used in first trimester screening for Down syndrome. A total of 2449 singleton unaffected pregnancies from two centres were studied. Maternal serum free beta-human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP) concentrations had been measured in all pregnancies, and pregnancy associated plasma protein (PAPP)-A levels had been measured in 924. All results were expressed as multiples of the gestation specific median (MoM) values after regression, using each centre's own medians. Information on maternal weight was available in 2259 pregnancies, on self-reported current cigarette smoking in 1364 (of whom 117 (8.6%) were smokers), on gravidity in 1371, parity in 1303 and fetal gender in 253. All three markers showed a statistically significant negative association with maternal weight (p<0.0005) and in the subsequent analyses MoM values were weight adjusted using standard methods. The median PAPP-A level in smokers was 0.81 MoM, a significant reduction (p<0.005); free beta-hCG was also reduced (median 0.89 MoM) but not significantly (p=0.17), and AFP was unaltered. The median AFP level in primagravidas was highly significantly greater than that in gravid women (p<0.0005). In PAPP-A the reverse effect was seen but it did not reach statistical significance (p=0.15) and there was no effect for free beta-hCG. Results of a similar magnitude and direction were found for parity. The median level of free beta-hCG was higher (p=0.0005), and the median AFP lower in female pregnancies. Maternal weight and, for PAPP-A, maternal smoking are important first trimester screening co-variables. Gravidity, parity and fetal gender also seem to influence one or more first trimester markers.
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Affiliation(s)
- I M de Graaf
- Department of Obstetrics and Gynaecology, Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands.
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40
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Hoovers JM, Mellink CH, Leschot NJ. [Fluorescence in situ hybridization in the study of chromosomal abnormalities]. Ned Tijdschr Geneeskd 1999; 143:2265-8. [PMID: 10578427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Classical cytogenetics has a low resolving power and allows analysis of dividing cells only. In fluorescence in situ hybridization (FISH), a DNA fragment is stained with a fluorescent marker, after which this fragment is brought into contact with a patient's DNA. The stained fragment can bind to a corresponding fragment, revealing its presence or absence. Using FISH, every desired DNA sequence (from a whole chromosome to one gene) can be stained. In this way it is also possible to diagnose microdeletion syndromes, such as the Williams syndrome, the DiGeorge syndrome and submicroscopic chromosome anomalies that play a part in mental handicaps. FISH also allows analysis of non-dividing cells. In this way it is possible for instance rapidly to examine uncultured amniotic fluid cells for the commoner trisomies or to find foetal erythrocytes in a pregnant woman's blood. It is also possible to demonstrate tumour-specific breaking points. By application of FISH to microarrays it is possible to study a large number of genes simultaneously for the presence of a particular number of DNA sequences linked to a clinical abnormality.
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Affiliation(s)
- J M Hoovers
- Academisch Medisch Centrum, afd. Klinische Genetica, Amsterdam
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41
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de Graaf IM, Jakobs ME, Leschot NJ, Ravkin I, Goldbard S, Hoovers JM. Enrichment, identification and analysis of fetal cells from maternal blood: evaluation of a prenatal diagnosis system. Prenat Diagn 1999; 19:648-52. [PMID: 10419613 DOI: 10.1002/(sici)1097-0223(199907)19:7<648::aid-pd600>3.0.co;2-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this study we evaluated the performance of a system for the enrichment, identification and analysis of fetal cells in maternal peripheral blood. Blood samples were collected from women after chorionic villus sampling and enriched for the presence of nucleated erythrocytes using a three-step procedure, namely: (a) centrifugation to separate nucleated red blood cells (NRBCs) from the majority of red blood cells (RBCs) and white blood cells (WBCs); (b) selective lysis of the remaining maternal RBCs; (c) separating the NRBCs from the remaining WBCs in a three-layer density gradient. Fetal cells were identified by using a monoclonal antibody against the gamma-chain of fetal haemoglobin (anti-HbF) and a nuclear stain (DAPI). Additionally, to further increase the specificity of the identification, and to eliminate some of the undesired staining by maternal leukocytes, a fluorescent antibody (CD45) was added. The sex chromosome complement of the cells was determined by fluorescence in situ hybridization (FISH) with X and Y-specific probes and the results were compared with the karyotypes obtained after analysis of chorionic villi. Using the described method, in all cases where the woman was carrying a male fetus (n=18) at least one XY cell was found, while no male cells were found in women carrying a female fetus. However, in the majority of cases with a male fetus (n=11) female HbF positive cells were found indicating the presence of maternal nucleated erythrocytes. The study demonstrates that the combination of anti-HbF and CD45 is a useful, but not fully specific, marker for fetal NRBCs and that additional markers are needed.
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Affiliation(s)
- I M de Graaf
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands.
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Hoogerwaard EM, van der Wouw PA, Wilde AA, Bakker E, Ippel PF, Oosterwijk JC, Majoor-Krakauer DF, van Essen AJ, Leschot NJ, de Visser M. Cardiac involvement in carriers of Duchenne and Becker muscular dystrophy. Neuromuscul Disord 1999; 9:347-51. [PMID: 10407858 DOI: 10.1016/s0960-8966(99)00018-8] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A cross-sectional study in a cohort of DNA proven carriers of Duchenne (DMD) and Becker (BMD) muscular dystrophy was undertaken with the following objectives: (1) to estimate the frequency of electrocardiographic (ECG) and echocardiographic abnormalities; (2) to establish the proportion of carriers with dilated cardiomyopathy and (3) to assess possible associations between dilated cardiomyopathy and genotype. One hundred and twenty nine DMD and BMD carriers, aged 18-60 years, were traced through the files of the central register kept at the department of Human Genetics in Leiden. Investigations included full medical history, physical examination, ECG and two-dimensional and M-mode echocardiographic examination. Forty-seven percent had ECG changes. Thirty-six percent (DMD 41%, BMD 27%) had at least one abnormality as is usually found in the male patients. Echocardiographic examination was abnormal in 36% (DMD 38%, BMD 34%). Dilated cardiomyopathy was found in seven DMD carriers (8%), and in none of BMD carriers. In addition, 18% had left ventricle dilatation (DMD 19%, BMD 16%). Only 38% had a completely normal investigation of the heart. We found no association between genotype and cardiac manifestations. Our study underlines that cardiac involvement is part of the dystrophinopathies. Carriers should be told about the increased risk of this complication when asking genetic advice. It also implicates that a complete cardiological evaluation should be performed at least once in all carriers. If left ventricle dilatation or dilated cardiomyopathy is present a yearly follow up is needed, in order to start timely therapy.
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Affiliation(s)
- E M Hoogerwaard
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Mohrschladt MF, Bijlsma EK, Sluijter S, De Coo RF, Hoovers JM, Leschot NJ. A patient with a de novo t (6;9) and an interstitial duplication of (9)(q21.2q22.1). Clin Dysmorphol 1999; 8:211-4. [PMID: 10457857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
We report on a 4-year-old child with psychomotor retardation, general hypotonia and only mild dysmorphic features. Her chromosome constitution was 46,XX, t (6;9) (q27;q22.1), dup (9) (q21.2q22.1). This de novo interstitial duplication was confirmed using fluorescence in situ hybridisation (FISH) with band-specific probes. This is the second report of a patient with an interstitial duplication of this region of the long arm of chromosome 9. It is concluded that in a child with an abnormal phenotype and a de novo (apparently) balanced translocation, the possibility of a small duplication or deletion should be considered.
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Affiliation(s)
- M F Mohrschladt
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, The Netherlands
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Hoogerwaard EM, Bakker E, Ippel PF, Oosterwijk JC, Majoor-Krakauer DF, Leschot NJ, Van Essen AJ, Brunner HG, van der Wouw PA, Wilde AA, de Visser M. Signs and symptoms of Duchenne muscular dystrophy and Becker muscular dystrophy among carriers in The Netherlands: a cohort study. Lancet 1999; 353:2116-9. [PMID: 10382696 DOI: 10.1016/s0140-6736(98)10028-4] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Carriers of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) may show muscle weakness or dilated cardiomyopathy. Studies focusing on skeletal-muscle involvement were done before DNA analysis was possible. We undertook a cross-sectional study in a population of definite carriers to estimate the proportion and to assess the clinical profile of carriers with symptoms. We also assessed a possible correlation between genotype and phenotype. METHODS Carriers of DMD and BMD, aged 18-60 years, were traced through the files of the central register kept at the Department of Human Genetics in Leiden, Netherlands. For each carrier who agreed to participate a medical history was taken, and muscle-strength assessment by hand-held dynamometry and manual muscle testing and cardiological assessment were done. FINDINGS 129 carriers of muscular dystrophy (85 DMD, 44 BMD) participated in the study. In 90 women from 52 (70%) families, 37 different mutations were found. 28 (22%) women had symptoms. 22 (17%) had muscle weakness, varying from mild to moderately severe. Muscle weakness was found in carriers of DMD and BMD, but dilated cardiomyopathy was found only in seven (8%) carriers of DMD, of whom one had concomitant muscle weakness. There was an unexpectedly high proportion of left-ventricle dilation (18%). No genotype-phenotype correlation was found. INTERPRETATION Clinical manifestation of muscle weakness, dilated cardiomyopathy, or both can be found in about a fifth of carriers of DMD and BMD. If left-ventricle dilation is taken into account, the proportion of carriers with symptoms is even higher, amounting to 40%.
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Affiliation(s)
- E M Hoogerwaard
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
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Abstract
We determined the aneuploidy detection rate achievable by early pregnancy screening with pregnancy associated plasma protein (PAPP)-A, free beta human chorionic gonadotrophin (hCG) and ultrasound nuchal translucency (NT) measurement. Women having prenatal diagnosis were scanned, and a blood sample was taken and stored. Stored samples were tested and a total of 37 were found to have Down syndrome, 8 to have Edwards syndrome and 255 were controls. Results were expressed in multiples of the gestation-specific median (MOM) value in the controls after regression and, for the serum markers, maternal weight adjustment. In Down syndrome the medians were for PAPP-A 0.63 MOM (95 per cent confidence interval (CI) 0.45-0.87); free beta-hCG 1.88 MOM (1.33-2.66); and NT 2.34 MOM (1.70-3.22). Using these parameters the expected detection rate for a 5 per cent false-positive rate for different marker combinations were: 55.3 per cent for PAPP-A and free beta-hCG; 68.4 per cent for NT alone; and 84.6 per cent for PAPP-A, free beta-hCG and NT. The median values for Edwards syndrome were: 0.17 MOM for PAPP-A; 0.18 MOM for free beta-hCG; and 2.64 MOM for NT. Early pregnancy screening with the combined measurement of maternal serum PAPP-A and free beta-hCG and fetal nuchal translucency could achieve a high Down syndrome detection rate.
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Affiliation(s)
- I M de Graaf
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
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Goddijn M, van der Veen F, Ankum WM, Bonsel GJ, Leschot NJ, Boer K. [No consensus on the definition, diagnosis and treatment of habitual abortion in the Netherlands]. Ned Tijdschr Geneeskd 1999; 143:897-902. [PMID: 10347665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE To review the current policy in diagnosis and treatment of recurrent miscarriage in the Netherlands. DESIGN Cross-sectional survey. METHOD A printed questionnaire was sent in 1996 to all 125 departments of gynaecology in the Netherlands with questions about definition, investigation and therapy of recurrent miscarriage. RESULTS The response rate was 90% (n = 112). Twenty-nine per cent of the respondents defined recurrent miscarriage as having two or more abortions and 71% as three or more abortions. In 42% of the departments a diagnostic protocol for recurrent miscarriage was present. Diagnostic investigations most frequently performed were vaginal ultrasound (79%), parental chromosome analysis (78%), thyroid-stimulating hormone (72%), lupus anticoagulant (69%), blood glucose (65%), hysterosalpingography (56%) and anticardiolipin antibodies (IgG, IgM) (56%). Therapy most frequently applied was prescription of folic acid (53%). CONCLUSION The definition of recurrent miscarriage differed. Uncertainty about a rational diagnostic approach was evident from the large number of tests requested by 20-50% of the respondents. Some diagnostic tests like immunological investigation and search for infectious factors were not followed by a therapeutical intervention.
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Affiliation(s)
- M Goddijn
- Afd. Verloskunde en Gynaecologie, Academisch Medisch Centrum, Amsterdam
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de Graaf IM, Pajkrt E, Keessen M, Leschot NJ, Bilardo CM. Enlarged nuchal translucency and low serum protein concentrations as possible markers for Zellweger syndrome. Ultrasound Obstet Gynecol 1999; 13:268-270. [PMID: 10341407 DOI: 10.1046/j.1469-0705.1999.13040268.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We present a case of a fetus in which an enlarged nuchal translucency was detected at 12 weeks' gestation. The karyotype was normal. Subsequent ultrasound examination showed no obvious fetal abnormalities apart from a mild pericardial effusion. Serum screening revealed very low concentrations of estriol and human chorionic gonadotropin. After birth the diagnosis of Zellweger syndrome was made. Nuchal translucency screening, estriol level identification and detailed ultrasound scanning may help to identify fetuses affected by this syndrome.
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Affiliation(s)
- I M de Graaf
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
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de Graaf IM, van Bezouw SM, Jakobs ME, Leschot NJ, Zondervan HA, Bilardo CM, Hoovers JM. First-trimester non-invasive prenatal diagnosis of triploidy. Prenat Diagn 1999; 19:175-7. [PMID: 10215078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
We report a case of fetal triploidy in which fetal nucleated red blood cells were isolated from the maternal peripheral circulation at 12 weeks' gestation. FISH analysis with X and Y specific probes revealed three hybridization signals for the X chromosomes in 14 cells. The karyotype as established after CVS was shown to be 69,XXX. Two other non-invasive first-trimester screening methods were also evaluated. The serum markers pregnancy-associated plasma protein A (PAPP-A) and the free beta-chain of chorionic gonadotrophin (free beta-hCG) were both shown to be decreased in the same blood sample. An enlarged nuchal translucency (5 mm > or =95th centile) was seen at 13+2 weeks of gestation.
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Affiliation(s)
- I M de Graaf
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands.
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Hansson K, Poelma WM, Zondervan HA, Leschot NJ. Low-level mosaicism for both trisomy 15 and monosomy-X in amniotic fluid cells confirmed in fetal tissues. Prenat Diagn 1998; 18:975-8. [PMID: 9793985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We report here a case of true fetal mosaicism for both trisomy 15 and monosomy-X; the aberrant cell lines were initially detected at amniocentesis as low-level mosaicism (trisomy 15) and multiple-cell pseudo-mosaicism (monosomy-X). In the fetal lymphocytes, only metaphases with a normal chromosome complement were observed. After termination of the pregnancy, various fetal biopsies revealed both trisomy 15 and monosomy-X mosaicism, whereas, at autopsy, no external or internal abnormalities could be detected in the fetus. The karyotype can be described as 45,X[15]/47,XY,+15[3]/46,XY[27]. Our results implicate that an additional amniocentesis could be more helpful than fetal blood sampling in predicting the fetal karyotype after diagnosis of chromosome mosaicism at amniocentesis.
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Affiliation(s)
- K Hansson
- Academic Medical Centre, University of Amsterdam, Department of Human Genetics, The Netherlands.
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