Síndrome de Hunter

Se realizó una revisión bibliográfica sobre el Síndrome de Hunter. Se abordó el caso de un paciente portador de dicho síndrome a quien se le diagnosticó la enfermedad y mantuvo control y seguimiento hasta su deceso, en el Hospital General Docente Héroes del Baire(AU)

A bibliographical revision on the Syndrome of Hunter was done. An pursuit and control of a patient carrying this syndrome was taken into account to whom the disease was diagnosed and kept control until his death, in the General Hospital Heroes of the Baire(AU)

[Program for diagnosis and prevention of inherited metabolic diseases of cellular organelles]. / Prgramma diagnostiki i profilaktiki nasledstvennykh boleznei obmena kletochnykh organell.

A programme for diagnosis and prevention of lysosomal, peroxisomal, and mitochondrial [respiratory chain diseases (RCD)] diseases was developed on clinical, biochemical, and molecular approaches. The authors made postnatal diagnosis was made in 674 patients from 516 families and prenatal diagnosis in 124 fetuses in 94 families at risk. DNA analysis of mutant alleles in the mucopolysaccharidoses (MPS) I, II, and VI revealed 14, 13, and 4 new mutant alleles in IDS, ASB, IDUA genes, respectively. The pressure of a mutation process played a major role in the distribution of mutant alleles leading to MPS I and VI, but along with this factor genetic drift and migration undoubtedly influenced the observed spectrum of IDUA alleles in Russia. A clinical phenotype of patients with different MPS was analyzed on the basis of uniform registration of 167 symptoms and signs in 249 patients. Special statistical approaches were developed to characterize early manifestations of different MPS and "unique" signs and symptoms for many of them and "phenotypic distances" between them. The similar problems were solved for RCD through uniform registration of 110 symptoms and signs in 54 patients with different syndromes: pathognomonic symptoms for the whole RCD and "unique" symptoms for syndromes were defined.

Early presentation in the mucopolysaccharide disorders.

The findings of an international questionnaire study of 258 children, affected by the four main subtypes of mucopolysaccharidosis, are presented. Questionnaires were completed by a parent or main carer and all subjects were alive at the time of contact and suffering from Hurler, Hunter, Sanfilippo or Morquio syndrome. A significant proportion of parents of Hurler children (24%) were unaware that anything was wrong with their baby before diagnosis but a larger number (45%) had felt concerned about their child's appearance. Similarly, in the case of the Morquio children, in 75% of cases, parents had been worried about some aspect of their child's physical appearance. In contrast, it was frequently delayed or regressing language which alerted parents of Sanfilippo (56%) and Hunter (32%) children, and this was associated with behaviour problems in 43% of Sanfilippo cases. There were many cases of delayed diagnosis, often occurring more than 2 years after concerns were first raised.

[A program of prevention of hereditary lysosomal diseases in the USSR]. / Programma profilaktiki nasledstvennykh lizosomnykh boleznei v SSSR.

The organization of genetic counselling for the families of patients with lysosomal storage diseases (LSD) was based on the interaction of the genetic counselling units of this country with a laboratory of inherited metabolic diseases of the National Research Center of Medical Genetics, USSR AMS. All the patients from 705 families at risk were examined using biochemical techniques and methods of somatic cell genetics. In total the loci differentiation was performed for 309 patients with mucopolysaccharidoses, glycoproteinoses, mucolipidoses, sphingolipidoses and other LSD. 53 families at risk (of 277) were prenatally diagnosed. 66 fetuses were diagnosed for mucopolysaccharidoses, type I, II, III, A and B, VI, Tay-Sachs disease, Sandhoff's disease, GM1-gangliosidosis, metachromatic leukodystrophy, mannosidosis, and multiple sulfatidosis. In total 18 affected fetuses were diagnosed and aborted. All the prenatal diagnoses were verified. The prevalence of mucopolysaccharidoses in two Central Asian republics was evaluated as 1:15,000. An Uneven ethnic distribution of different mucopolysaccharides in the USSR has also been shown.

Selective urinary screening for mucopolysaccharidoses.

Two methods for analysis of urinary glycosaminoglycans (GAGs) have been modified and improved for efficient screening of mucopolysaccharidoses. Urinary excretion of GAGs was estimated by spectrophometric measurement of alcian blue complex formation and was used in conjunction with qualitative analysis by thin layer chromatography. After normal variation in GAG excretion was established using 120 urine samples, these screening methods were applied to a total of 2057 urine samples over 4 years. Six patients with abnormal urinary GAG excretion had a mean of 50.5 +/- 20.6 mg GAG/mmol creatinine compared to 3.4 +/- 2.9 for age-matched controls. Qualitative analysis by thin layer chromatography using alternating solvent systems identified the GAGs excreted in excess and facilitated selection of specific enzyme assays for final confirmation. Six cases were diagnosed prospectively and demonstrate these quantitative and qualitative methods to be economical, efficient, and suitable for clinical use.

[Mass-screening for acid mucopolysaccharidosis using urine samples by modified HCl-albumin turbidity method].

To establish a method for screening acid mucopolysaccharidosis (AMPS), the HCl-albumin turbidity method was reexamined and modified for semiquantitative analysis. Mucopolysaccharide samples and HCl-albumin in buffer solution were incubated at 37 degrees C for 30 minutes, and the optical density at 600 nm (OD 600) of the reaction mixtures were measured. When the same amount of the samples were tested, OD 600 of dermatan sulfate and hyaluronic acid were higher than that of keratan sulfate. When the cut-off point of OD 600 was set at 0.100 based on the values obtained from randomly selected subjects, only 3 of 328 urine samples (0.9%) showed value higher than the cut off value. The values in five patients with AMPS were all above 0.800 without overlapping those of the control subjects. These results suggest that mass-screening for AMPS using urine sample is possible by the partially modified HCl-albumin turbidity method with the cut-off point of OD 600 set at 0.100.

[Problems in the diagnosis of hereditary metabolic defects in pediatric neurology]. / Problemy diagnostiki nasledstvennykh defektov obmena veshchestv v detskoi nevrologii.

The authors have elaborated a program of selective screening of hereditary metabolic defects (HMD) ensuring the identification of over 100 disease entities as well as a program of the biochemical diagnosis and prophylaxis of mucopolysaccharidoses. More than 3000 patients who applied for help to the medical-genetic consultative centre were examined. Data on the incidence and genogeography of HMD were obtained.