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Microassay for screening newborns for galactosemia with use of a fluorometric microplate reader.

We describe a microassay for measuring galactose (Gal) and galactose 1-phosphate (Gal-1-P) in dried blood spots. After a coupled enzyme reaction involving galactose dehydrogenase (GADH, EC 1.1.1.48) and alkaline phosphatase (AP, EC 3.1.3.1) in a microplate well, NADH fluorescence is measured by a highly sensitive fluorometric microplate reader, capable of rapid measurement of fluorescence (2 min per 96 samples). Within- and between-run CVs for measurements of Gal at 90 mg/L with Gal-1-P at 130 mg/L were both less than 5% (n = 8), and analytical recoveries for Gal at 90 mg/L and Gal-1-P at 130 mg/L were 98% and 92%, respectively. Five hundred dried blood-spot samples can be assayed within 2 h, with full calculation of results by an on-line microcomputer. This rapid and reliable assay system is very useful for the routine screening of newborns for galactosemia.

Female↗

Screening of congenital hypothyroidism, phenylketonuria, galactosemia, homocystinuria, and maple syrup urine disease in moderate to severe mentally retarded Chinese children.

Five-hundred and fifty one mentally retarded children from seven institutes in Northern Taiwan were screened by dried blood spot for the detection of treatable congenital metabolic diseases, including congenital hypothyroidism, phenylketonuria, homocystinuria, maple syrup urine disease and galactosemia. We found 2 children (0.36%) with congenital hypothyroidism, 1 case (0.18%) of classical phenylketonuria and two cases (0.36%) of trisomy 21 associated with autoimmune thyroiditis. The results of our investigation suggest that congenital hypothyroidism and phenylketonuria can be the factors causing mental retardation among children in Taiwan and mass neonatal screening of these treatable inborn metabolic diseases is strongly indicated for efficiently circumventing mental retardation in our community.

Adolescent↗

[Gonadotropin secretion in children with galactosemia].

Basal and stimulated gonadotropin levels were evaluated in 8 children with galactosemia (2 boys, 6 girls). 5 girls demonstrated increased gonadotropin concentrations being in accordance with hypergonadotropic hypogonadism. It appears, that galactose and its metabolites-either dietary or by self-intoxication-exerts a toxic effect on the ovarian parenchyma, whereas the testis seems to be resistant to the damaging agent.

Adolescent↗

Galactosemia detection from phenylketonuria screening.

We describe a case of classical galactosemia in which the diagnosis was first suggested by the finding of a moderately increased blood-spot phenylalanine concentration. The child was clinically unaffected at six days when the initial sample was collected. Prompt institution of dietary management averted a serious metabolic crisis.

Female↗

Increased concentrations of HbAlab in hereditary fructose intolerance and galactosemia.

In patients with diabetes mellitus nonenzymatic glycosylation of hemo-globin is a result of increased blood glucose concentrations. In analogy glycosylated hemo-globin fractions were determined in 23 patients with hereditary fructose intolerance (HFI) and 8 patients with galactosemia (G) by means of hemoglobin chromatography on a column packed with Bio-Rex 70 resin. The concentrations were compared to those of 14 control patients and 43 patients with type 1 diabetes mellitus. Compared to controls, in HFI- and G-patients HbAlab was significantly increased. In contrast diabetic patients presented with a marked and significant increase of the HbAlc fraction. When purified hemoglobin was incubated with different monosaccharides respectively monosaccharide phosphates, an increase of HbAlab resulted mainly after galactose and fructose-1-phosphate. The determination of HbAlab in patients with HFI and G is considered a possible means of metabolic control.

Carbohydrate Metabolism, Inborn Errors↗

Computed tomographic demonstration of cerebral edema in a child with galactosemia.

An eight-day-old male infant with galactosemia presented with signs of increased intracranial pressure and no evidence of intracranial infection or hemorrhage. Computed tomographic scans demonstrated the presence of diffuse cerebral edema. With treatment, the edema gradually resolved, although it persisted longer within the white matter and was associated with transient bilateral pyramidal tract signs.

Brain Edema↗

[Galactosemia of early diagnosis with psychomotor retardation].

The case history of a baby girl suffering galactosemia is described. This was due to a deficit of galactose-1-phosphate uridyl transferase, with symptoms during the neonatal period consisting in weight loss, vomiting, jaundice and bleeding syndrome. From the twelfth day of life, a strict diet without galactose was imposed and controlled by measuring galactose and Hb A1 in serum. The clinical evolution was satisfactory and a liver biopsy, which was taken after seven months of live, shows minimal histological changes. At present, however, the girl is now two years old and shows a marked backwardness in psychomotor functions. The etiologic treatment which consists in the exclusion of galactose from the diet, even when started at a very early stage, does not prevent the aparition of sequelae.

Female↗

Galactose and galactitol in the urine of children with compound heterozygosity for Duarte variant and classical galactosemia (GtD/gt) after an oral galactose load.

An oral dose of galactose, 1 g/kg of body weight, was administered to 24 children with the Duarte variant/classical galactosemia genetic compound (GtD/gt) and to 16 controls ranging in age from 0.3 to 10.7 years. Urine was then collected for 3h. Excreted amounts of galactose and galactitol increased with age in all subjects, but were consistently greater in the compound heterozygotes. If related to urinary creatinine, galactosuria and galactitoluria were no longer age-dependent, although as compared with the controls, urinary galactose was about three times and urine galactitol twice as high in the patients (p less than 0.01 for both). We found a statistically significant correlation between urinary galactitol and galactose in these patients. Moreover, urinary galactitol and galactose each correlated positively with the area under the plasma galactose curve, as well as with the peak value for plasma galactose after galactose ingestion.

Aging↗

[Ophthalmologic follow-up examination in galactosemia (author's transl)].

In 1966, Thalhammer foundet "The Austrian Newborn Screening Program." Since 1969, we have examined 18 infants with galactosemia at 6 month to 8 year intervals. Even dense lens opacities often disappear with the correct dietary adjustment; progression of the cataract indicates failure to adhere to the prescribed diet.

Cataract↗

[Ovarian insufficiency and galactosemia ].

A primitive gonadal failure was observed in 2, 20 and 18 years old galactosemic female patients. The conditions was clinically suspected because of primary amenorrhea in one case and delayed puberty, followed by spaniomenorrhea in the other case, and confirmed by very low plasma estradiol and very high plasma gonadotropin levels. Galactose-free diet was started at 9 months of age in the first case and soon after birth in the second. Several similar cases have been recently reported. Primitive gonadal failure associated with galactosemia suggests a possible toxic' destruction of the ovaries during the intrauterine life by a galactose metabolite.

Adolescent↗

[Decompensated liver cirrhosis caused by galactosemia in a 52-year-old man].

A 52-year-old oligophrenic man hospitalized for esophageal hemorrhage had histologically proven liver cirrhosis and died from massive rehemorrhage. As a neonate he had survived severe jaundice, had had delayed psychomotor development and remained severely retarded. At age 15 years, bilateral cataracts had been excised and from 18 to 25 years he had had occasional grand mal seizures. The triad oligophrenia, liver cirrhosis and cataracts, prompted suspicion of galactosemia. Deficiency of galactose-1-phosphate uridyltransferase was demonstrated in blood and post mortem tissue. At autopsy, liver cirrhosis and esophageal varices were confirmed and unilateral chronic pyelonephritis, bilateral nephrolithiasis and testicular atrophy were found. There was not brain pathology. The patient appeared to be the oldest nondiagnosed galactosemic and the first male patient in whom hypogonadism was documented.

Galactosemias↗

[Late neurologic complications of galactosemia: study of 3 cases].

Galactosemia is an autosomal recessive, inborn error of galactose metabolism due to the deficiency of galactose-I-phosphate uridyl transferase. Late-onset neurologic complications may develop despite Galactose restriction. Three adult patients are reported. They suffered from mental retardation. Two of them developed progressive cerebellar ataxia, spastic gait and postural tremor. The magnetic resonance imaging revealed moderate cortical atrophy, multifocal areas of increased signal in the periventricular white matter on T2-weighted images, and in one case, abnormal myelination. The Fluoro-2-deoxy-D-glucose position emission tomography showed different patterns of regional hypometabolism.

Adult↗

Galactosemia: a strategy to identify new biochemical phenotypes and molecular genotypes.

We describe a stratagem for identifying new mutations in the galactose-1-phosphate uridyl transferase (GALT) gene. GALT enzyme activity and isoforms were defined in erythrocytes from probands and their first-degree relatives. If the biochemical phenotypes segregated in an autosomal recessive pattern, we screened for common mutations by using multiplex PCR and restriction endonuclease digestions. If common mutant alleles were not present, the 11 exons of the GALT gene were amplified by PCR, and variations from the normal nucleotide sequences were identified by SSCP. The suspected region(s) was then analyzed by direct DNA sequencing. We identified 86 mutant GALT alleles that reduced erythrocyte GALT activity. Seventy-five of these GALT genomes had abnormal SSCP patterns, of which 41 were sequenced, yielding 12 new and 21 previously reported, rare mutations. Among the novel group of 12 new mutations, an unusual biochemical phenotype was found in a family whose newborn proband has classical galactosemia. He had inherited two mutations in cis (N314D-E203K) from his father, whose GALT activity was near normal, and an additional GALT mutation in the splice-acceptor site of intron C (IVSC) from his mother. The substitution of a positively charged E203K mutation created a unique isoform-banding pattern. An asymptomatic sister's GALT genes carries three mutations (E203K-N314D/N314D) with eight distinct isoform bands. Surprisingly, her erythrocytes have normal GALT activity. We conclude that the synergism of pedigree, biochemical, SSCP, and direct GALT gene analyses is an efficient protocol for identifying new mutations and speculate that E203K and N314D codon changes produce intraallelic complementation when in cis.

Base Sequence↗

Identification and functional analysis of three distinct mutations in the human galactose-1-phosphate uridyltransferase gene associated with galactosemia in a single family.

We have identified three mutations associated with transferase-deficiency galactosemia in a three-generation family including affected members in two generations and have modeled all three mutations in a yeast-expression system. A sequence of pedigree, biochemical, and molecular analyses of the galactose-1-phosphate uridyltransferase (GALT) enzyme and genetic locus in both affected and carrier individuals revealed three distinct base substitutions in this family, two (Q188R and S135L) that had been reported previously and one (V151A) that was novel. Biochemical analyses of red-blood-cell lysates from the relevant family members suggested that each of these mutations was associated with dramatic impairment of GALT activity in these cells. While this observation was consistent with our previous findings concerning the Q188R mutation expressed both in humans and in a yeast-model system, it was at odds with a report by Reichardt and colleagues, indicating that in their COS cell-expression system the S135L substitution behaved as a neural polymorphism. To address this apparent paradox, as well as to investigate the functional significance of the newly identified V151A substitution, all three mutations were recreated by site-directed mutagenesis of the otherwise wild-type human GALT sequence and were expressed both individually and in the appropriate allelic combinations in a GALT-deficient strain of the yeast Saccharomyces cerevisiae.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

[Problem solving of the clinical case-method type for the development of clinical thinking. The illustrative problem of galactosemia].

Problem-solving case approach is an effective method for teaching clinical concepts. This method makes medical students be aware of the significance of Biochemistry for the clinical practice. The students are stimulated to study basic biochemical principles. The complete text of a problem case on galactosemia is presented. This case, usually given to the students during the final seminar on carbohydrate metabolism reflects a real situation, in which the student feels responsible to make decisions. He has to make the diagnosis and prescribe a treatment. The student's actions are assessed and commented. The students took a great interest in that problem case and that shows that it is possible and necessary even in the second preclinical year to joint the theoretical principles with the future clinical practice.

Bulgaria↗

Galactosemia with endogenous production of galactose-1-phosphate and with cystic fibrosis-like appearance at autopsy.

In an infant with galactosemia high levels of galactose-1-phosphate in red blood cells and of blood galactose were observed under a "galactose-free'' diet. The child did not thrive and developed a liver cirrhosis. At the age of 5 months he died unexpectedly. Post mortem examination revealed in the pancreas and the small intestine changes suggestive of a cystic fibrosis. Since the exogenous administration of galactose by diet could be excluded the endogenous production of significant amounts of galactose-1-phosphate has to be considered.

Autopsy↗