We report on a child with Duane anomaly, deafness, cervical spine, and radial ray abnormalities. A sister of the proposita had hemifacial microsomia, cervical abnormalities, and hypoplasia of the thenar eminence. Four relatives had hypoplasia of the thenar eminence. A fifth had preaxial polydactyly. Duane anomaly was present in two sixth-degree relatives. This appears to be an autosomal dominant trait. Singly or in combination the abnormalities seen in this family have all been described in association with Duane anomaly. Their occurrence in the same family suggests that they are not independent entities but represent pleiotropic effects of the same gene.
We describe an attempt to measure efficacy of treatment in the Mendelian diseases of man. We used the McKusick Catalogs to identify 351 single gene diseases. We scored the impact of each disease in seven phenotypic categories: lifespan, reproductive capability, somatic growth, intellectual development, learning ability, capacity to work, and cosmetic effect. We then scored the success of treatment in ameliorating each of these component manifestations separately and together. The response to treatment was slight in the whole sample (n = 351): lifespan was increased in 15%, reproductive capability in 11%, and social adaptation in 6%. We observed that the mutant gene product was known in only 15% of the conditions comprising our sample. Since the mutant polypeptide is known in most inborn errors of metabolism, the diseases of this type (n = 65) in our sample of Mendelian traits were studied separately. In each of the seven categories of phenotypic impact, only a few of the hereditary metabolic diseases responded in any degree to specific treatment: the treatment gave complete relief in 12%, there was a partial response in 40%, and none in the remaining 48%. These findings have implications for prognosis, genetic counseling, and medical care of patients with Mendelian disease.
An infant was born with osteogenesis imperfecta (OI) and died after 7 days. In addition, there were amniotic constriction bands and amputations of several digits of the upper and lower limbs. The radiologic picture was suggestive of type III OI. Histomorphometric analysis of the bone showed a trabecular bone volume of 15.1% compared to 26.9% for age-matched controls. This was due to a decreased apposition of matrix by the osteoblasts. Because abnormal collagen synthesis has been suggested as the underlying defect in most forms of OI, collagen studies were undertaken using intact tissues. Bone and skin collagen solubilities were strikingly reduced. Shortened type I collagen molecules, representing 25% of the total type I collagen, were produced by pepsin digestion of the demineralized bone matrix. The molecular weight of the shortened collagen, was 10 kd lower than normal for both the alpha 1 and alpha 2 chains as determined by gel electrophoresis. The bone acetic acid-soluble collagen showed few shortened alpha-chains. Twenty-five percent of the acid-soluble bone collagen was cleaved into shortened molecules by a pepsin digestion. The shortened alpha 1 chain was purified by high-performance liquid chromatography (HPLC) and digested with CNBr. The analysis of the resulting fragments by HPLC and by gel electrophoresis unequivocally demonstrated that the shortened alpha 1 chain was derived from the alpha 1(I) chains and that the pepsin sensitivity extends from the amino terminal end of the chain to the alpha 1(I) CB5 peptide, approximately 120 residues inside the triple helix. These studies show a distinct structural abnormality of type I collagen in the bone matrix of this patient resulting in an increased sensitivity of the collagen to general enzymatic proteolysis. The importance of correlating clinical and biochemical information in OI is emphasized; classification and genetic counseling based only on clinical observations are inaccurate.
Equine gastric ulcer syndrome (EGUS) has been reported to occur in 40% to over 90% of horses across multiple equestrian disciplines. The objective of this study was to evaluate the effect of trace mineral supplementation on gastric ulcers in exercising yearling horses. Twenty-one Quarter Horse yearlings, 15 to 18 mo of age, were randomly assigned to 1 of 3 treatment groups. The control group received no supplemental trace minerals, the inorganic group received supplemental sulfated trace minerals, and the organic treatment received supplemental amino acid complexed trace minerals. The trial consisted of 3 consecutive 28-d periods, separated by 5 d of diet acclimation. The basal ration included a 14% CP textured concentrate, with coastal Bermudagrass hay fed in Periods 1 and 3 and alfalfa consumed in Period 2. In Periods 1 and 2, horses were exercised on a mechanical horse-exerciser, but were lunged or underwent training in an undergraduate course in Period 3. At the end of each period, horses were transported for 6 h, 5 d before being endoscopically examined to assign ulcer scores. Data were analyzed as repeated measures using the mixed procedure of iv SAS, with the model including fixed effects of treatment, period, and their interaction (SAS 9.2). All P-values < 0.05 were considered significantly different.
A girl with adrenogenital syndrome (21-hydroxylase deficiency) and Hirschsprung's disease is described She also had skeletal anomalies. It seems likely that the occurrence of these diseasec in the same patient is coincidental.
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