A fourth case of ring chromosome 7.

An 8-year-old child with a ring chromosome 7 is presented, the first female and the fourth such individual to be described. The associated anomalies were rather benign: she presented with short stature, minor skeletal alterations, and normal intelligence. The only truly striking feature was the presence of multiple large, pigmented naevi, suggestive of a hamartomatous origin, but unlike those typical of any particular syndrome. Though other ring 7 patients have had naevus flammeus, and one had café-au-lait spots, our proband is the first with an anomaly of chromosome 7 to have such extensive lesions. These four cases of ring 7, which show great phenotypic variation, are reviewed, and the clinical presentation of the proband is also compared with that of patients suffering from terminal, interstitial and translocation-derived 7p and 7q deletions. The formation and behavior of ring chromosomes are discussed, as are the cytogenetic factors which may influence their phenotypic expression.

Structural anomalies of the X chromosome: personal observation and review of non-mosaic cases.

We describe a new case of partial deletion of the long arm of the X chromosome, found in a 24-year-old female with secondary amenorrhea; the karyotype of the proposita is 46,X,del(X)(q22). We take this opportunity to review the previously published descriptions of non-mosaic structural anomalies of the X chromosome (X isochromosomes excepted) with the goal of "testing" the recent hypothesis formulated about: (a) the existence of an X inactivation center (Therman et al. 1974b); (b) the presence of a "b" segment remaining active on Xp (Therman et al. 1976); (c) the potential importance of a critical area on Xq linked to gonadal function (Sarto et al. 1973); and (d) the presence of normal gonadal function despite and Xp terminal deletion (Fraccaro et al. 1977). We conclude that the above-mentioned theories, as well as those concerning phylogenetic evolution of sex chromosome morphology presented by Lyon (1974) and Hoo (1975), receive support from practically all of the 149 cases we compared. Regarding the features of the Turner syndrome, we propose "mapping" of the X chromosome as follows: the genes involved in gonadal function seem to be located on the proximal part of Xp and on the distal part of Xq, whereas the genes whose absence is responsible for somatic features of the syndrome may be distributed along the length of Xp and the middle section of Xq(q21-q26). Furthermore, we note some interesting analogies between the evolutional model proposed by Hoo (1975) and the map we visualize.

[Multisynostotic osterodysgenesis and the problem of genetic counseling in newly-identified syndromes (author's transl)]. / L'ostéodysgénésie multisynostotique et les problémes de conseil génétuque dans les syndromes nouvellement identifiés.

The authors report two female infants affected with a skeletal malformation syndrome, recently identified and probably genetic in nature, which includes as principal features a craniosynostosis with secondary midfacial hypoplasia and a characteristic facies. More specifically, the skeletal alterations include synostosis of the radius and humerus, congenital bowing of the femurs with fracturing during the neonatal period, and other minor anomalies of the thorax and extremities. The differential diagnosis includes serveral skeletal dysplasias such as the Campomelic syndrome, certain of the Acrocephalosyndactylies, and Osteodysgenesis Imperfecta. However, global comparison of the clinical and radiographic features permits their exclusion, allowing the consideration that we are dealing with a new syndrome, which has been named Multisynostotic Osteodysgenesis. The etiology of this disorder has not been elucidated, the two cases being isolated and without parental consanguinity. The authors, however, favor the theory of autosomal dominant inheritance. The difficulty of providing genetic counseling in the case of such poorly-understood syndromes is emphasized.

Genetic and endocrine findings in a 48,XXYY male.

Characteristics of a 16-yr-old male with a 48,XXYY karyotype are presented; this chromosome constitution was demonstrated consistently in four tissue studied. Basal gonadotropins were elevated, and serum testosterone varied between 3.2-4.0 ng/ml. A pronounced rise was observed in LH after LRH administration with a lesser rise of FSH. The testis displayed hyperplasia of the interstitial cells, tubular atrophy, absent spermatogenesis with preservation of some Sertoli cells, and peritubular fibrosis. The phenotypic, behavioral, endocrine and pathological features of this patient are compared with those found in males with the 47,XXY and 47,XYY syndromes. The 48,XXYY phenotype may result from compounding effects of the additional X and Y chromosomes.

The syndrome of multisynostotic osteodysgenesis with long-bone fractures.

Described here are two patients with a newly recognized syndrome of bone and cartilage maldevelopment which, we believe, results from a single embryonic defect, probably of genetic origin. The cardinal manifestations of this association are craniosynostosis, radiohumeral synostosis (RHS), and femoral bowing. Specific secondary defects include midface hypoplasia with characteristic facial appearance and ears, neonatal femoral fractures, and multiple minor anomalies of the limbs. Though the differential diagnosis includes such disorders as the campomelic syndrome, osteogenesis imperfecta (OI) and certain of acrocephalosyndactyly syndromes, the unique combination of clinical and radiographic abnormalities allows ready differentiation. The cause cannot be determined from these two cases.