Hemoglobinopathies in Italy.
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Biomedical subjects
Publications and source records attributed to G Russo.
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Haemoglobin synthesis was studied in bone marrow erythroblasts and in reticulocytes of 4 children with beta O-thalassaemia major and of 7 children with beta +-thalassaemia major. In patients with beta O-thalassaemia the gamma/a ratio was found to be lower in bone marrow than in peripheral blood. On the contrary, in patients with beta + thalassaemia the beta + gamma/a ratio was more balanced in bone marrow, where the beta-chain synthesis was higher, than in reticulocytes. This last result could be explained by the presence of an abnormal m-RNA for beta-chains in beta +-thalassaemia.
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The authors correlate echocardiographic and haemodynamic reports of a 12 year old patient with congestive heart failure and enlarged heart, secondary to fibrotic cardiomyopathy which effected the right ventricle (RV) and left ventricle (LV) apex. The echocardiographic M-mode examination showed: dilatation of the RV; ectasis and akinesis of the apex of the LV; the left auricle small for hypoafflux; tricuspid valve very noticeable with defective end-diastolic closure, delayed 0,80 msec as regards to the mitral valve, and in which it was not possible to identify the proto-diastolic opening; typical movement of the pulmonary valve, according to French's description, with synchronous opening to the atrial systole; paradoxical movement of septum, with the peculiarity of showing the maximum posterior movement relating to the atrial systole. Catheterism indicated same pressures in the right auricle, RV and pulmonary artery, as is typical of right ventricle ipoplastic. Angiography confirmed echocardiographic reports revealing an enlarged right auricle and an ectasic and akinetic RV; the tricuspid valve was normally established and it remained almost constantly open; the apex of the LV was ectasic and akinetic. In conclusion, for the akinesis of the RV, the blood flow in the pulmonary artery was secured by atrial systole; such a haemodynamic situation had already been indicated by the echocardiographic examination for the absence of the real systolic closure of the tricuspid valve that the authors indicate as the most characteristic sign of such a table, together with the opening of the pulmonary valve with atrial systole.
The presence of the nervous system-specific S-100 antigen has been tested by microcomplement fixation assay with a monospecific anti-S-100 antiserum in cerebrospinal fluid (CSF) of subjects suffering from psychiatric disorders or various neurological diseases. The antigen was detectable in the CSF of most of the patients with neurological diseases characterized by an appreciable lesion in the nervous parenchyma, whereas it was generally absent from CSF of subjects presumably free from an extensive neurological lesion in the active phase. It is possible that the presence of S-100 IN CSF might be an index of active cell injury in the nervous parenchyma.
Haemoglobin F (HbF) levels were significantly increased in 40 children with kala-azar in comparison with controls (3.36 +/- 2.32 versus 0.90 +/- 1.8; P < 0.01). The HbF was heterogeneously distributed among the red blood cells. The glycine residue of peptides gamma CN3 were within the normal umbilical cord blood range, and the haemoglobin synthesis in vitro was balanced. After recovery from kala-azar the HbF fell within the normal range. These results suggest that increased production of HbF is associated with accelerated erythropoiesis due to temporary marrow stress.
The red cells of a patient heterozygous for beta-thalassaemia contained 19% fetal Hb. Study of his family suggested that the proband had inherited the Swiss type of hereditary persistence of fetal Hb (HPFH) from his mother who is not thalassaemic and possessed 1.37% of Hb and 11% F-cells. Studies of globin synthesis showed a similar imbalance in the heterocellular HPFH-beta-thalassaemia compound heterozygotes and in the heterozygous beta-thalassaemic members of the family. Age stratification of the red cells showed a slight enrichment in Hb F and a decreased Hb A2 level in the older cell populations. Hb F production in the BFU-E colonies of the proband was higher than that found in vivo and in other beta-thalassaemic heterozygotes in culture. Study of single erythroid burst colonies showed a marked heterogeneity in Hb F synthesis from one colony to another, while the pool of free alpha-chains remained of similar magnitude. It is suggested that in the proband, the HPFH gene, which is in trans with respect to the beta-thal-gene, increases the size of the F-cell population and its activity is carried on at the expense of the normal beta A gene.
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In the south-east of Sicily 23 children from 14 unrelated families have been diagnosed as suffering from haemoglobin Lepore. Such a high incidence shows that Sicily is an important focus of haemoglobin Lepore. The results of haematological and biosynthetic studies in 18 carriers of Hb Lepore and in five double heterozygotes for Hb Lepore and beta-thalassaemia are presented. In the carriers the haematological and biosynthetic data are compared with carriers of beta-thalassaemia, while the five double heterozygotes are compared with beta o- and beta +-thalassaemia major subjects. In the carriers of Hb Lepore no synthesis of delta beta-chains was observed in peripheral blood cells; in fact we found a peak in the bone marrow. Double heterozygotes with circulating nucleated red cells showed delta beta-chain synthesis in peripheral blood.