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Fluorescent in situ hybridization (FISH) is a rapid, sensitive and reliable method for the identification of complete chromosomes, or segments of them, during metaphase or nuclear interphase. The present study shows the results of the analysis of 32 bone marrow aspirates from patients with malignant hematological diseases (11 AML, 7 ALL, 12 CML and 2 CLL), referred to the Medical Genetics Unit of the Faculty of Medicine, Zulia University, Maracaibo, Venezuela between 1994 and 1996. All samples were studied by conventional and molecular techniques (FISH), using probes of total chromosomes, alpha-satellites and locus specific. In patients with AML and ALL and FISH technique detected clonal chromosomal abnormalities, that were not found by the conventional cytogenetic technique. Furthermore, the PML-alpha RARA complex was identified in the promyelocytic acute leukemias. The presence of the molecular complex ABL-BCR was also demonstrated in CML. The present study demonstrates the usefulness of the FISH technique in the detection of clonal chromosomal abnormalities, which are important when considering the clinical care of patients with these pathologies.

The Prenatal Diagnosis Program of the Medical Genetic Unit of University of Zulia has the following objectives: Identification of Genetic Risk Factors (GRF) in those couples who attend to the Prenatal Genetic Clinic, application of different prenatal diagnostic procedures (PDP), and providing adequate genetic counseling. The goal of this paper is to show preliminary results obtained between January 1993 and December 1996. Three hundred and twenty one pregnant women were analyzed by determining the GRF and taking into account the genetic clinical history. The GRF analyzed were: Advanced maternal age (AMA), congenital malformation history (CMH), previous child with chromosomic anomalies (PCCA), defects of neural tube history (DNTH), congenital heart disease history (CHDH), any parent carrier of chromosomic anomaly (PCA), habitual abortion (HA), abnormal fetal echography (AFE), altered maternal serum levels of alpha-feto-protein (AMSAFP) and OTHERS: exposure to teratogenic agents, history of Mendelian diseases, maternal systemic diseases and anxiety in the mother or in her partner. The PDP was designed according to the GRF, which included fetal echography (FE), fetal echocardiography (FEc), amniocentesis (AMN), chordocentesis (CCT) and AMSAFP. Results showed that 58.4% of the expectant mothers asked for counseling during the 2nd trimester, 70% of the total showed only one GRF, and AMA was the most frequent GRF found (40.3%), followed by PCCA, AFE, CHDH, HA, DNTH, PCA, and OTHERS in that order. The specific PDP applied to the identified GRF allowed a health evaluation of the fetus. The GRF identification gave the opportunity of establishing a Prenatal Diagnostic Program producing a response to the couple's needs and showed the utility of an integral and multidisciplinary management directed to any expecting mother in order to identify any high GRF.

An estimated 20% of all breast cancer or ovarian and breast cancer cases have familial aggregation. Today it is known that approximately 10% of these cases are attributable to inherited mutations of a predisposition gene that confers a high risk of developing the disease. Several genes have been identified that differ in the risks which they determine, the proportion of cases they explain and the other cancers they may cause. Out of all the genes reported so far, BRCA1 and BRCA2 are the most important ones. The mutations in the remaining genes are rare or involve moderate or low risks. The possibility to detect breast and/or ovarian cancer susceptibility genes in high risk families poses serious challenges that must be faced by health professionals related with this field.

Cystic Fibrosis (CF) is a severe and relatively common autosomic recessive disease caused by a variety of mutations in the CFTR gene. The most frequent mutation worldwide, consists of the deletion of the phenylalanine codon at position 508 (delta F508). Here we report the first cases of prenatal diagnosis of CF by DNA analysis in couples at risk in Venezuela. The study focused on the detection of delta F508 alleles analyzing DNA recovered directly from amniocytes or from their cultures, using the polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis. Two of three fetuses resulted homozygotic for the delta F508 allele and the third one turned out to be a delta F508 carrier. This information sustained the genetic counseling of the couples and allowed them to take objective reproductive decisions, a direct consequence of the availability of gene analysis at the DNA level.

Chronic Myeloid Leukemia (CML) is a clonal disease of bone marrow, citogenetically characterized by the presence of the Philadelphia chromosome (Ph). Additional anomalies in the Ph cromosome have been found during the evolution of CML. This paper will show evidence of cytogenetic abnormalities during the evolution of CML in this region, and its correlation with clinical evolution. 55 samples of bone marrow, 81.3% (45/55) in chronic phase (CP), 12.7% (7/55) in an accelerated phase (AP), and 5.4% (3/55) in blastic phase (BP) were received. In 12/45 patients in CP the karyotype was repeated at least once a year during the evolution of their illness. 9/12 presented the Ph chromosome as a single anomaly at the moment of diagnosis; the other 3 presented a distinct anomaly. 4/9 presented additional abnormalities moving to the stages AP or BP between 4-8 months after initial discovery. 7/10 patients referred in AP or BP presented additional abnormalities in the Ph chromosome. It is evident that the chromosome study of each patient with CML must be carried out at least once a year in order to detect chromosomal abnormalities in addition to the Ph chromosome. Thus, a greater therapeutic control of the disease is possible.

The Medical Genetics Unit at Universidad del Zulia (UGM-LUZ) gives counsel to patients with partial and total genetic diseases. Counseling is available for patients of both sexes and all ages, from public and private health centers and several medical specialities. In the present study an analysis of 4617 clinical records from families referred for genetic counseling to the UGM-LUZ is given. The study spans from January 1983 to December 1992. Fifty four (1.2%) of these histories correspond to pre-nuptial counseling, 773 (16.7%) pre-conceptional, 316 (6.8%) pre-natal and 3474 (75.3%) for diagnosis. A computerized system was developed, based on relational data base manager, that permits access with interactive Dbase type applications. A total of 5433 diagnoses were made. The most frequent causes of genetic diseases were chromosomal abnormalities (12.32%), mainly Down and Turner syndromes. Mendelian diseases occupied 14.45% of all cases, with Marfan and Noonan syndrome, Osteogenesis imperfecta. Duchenne-Becker muscular dystrophy and Incontinentia Pigmenti as the most frequent syndromes. Diseases that involve multifactorial inheritance, such as neural tube defects, accounted for 7.36% of all diagnosis. Effects of teratogenic agents such as german measles, radiations and others were detected in 3.96% of all cases. In 8.5% of the patients a hereditary factor was suspected. No definitive diagnosis was reached in 32.45% of all cases and 20.96% of the patients were normal. The need for data from other medical genetic centers is stressed. In this way the regional and national genetic diseases on morbidity can be known.

Duchenne and Becker muscular dystrophy (DMD/BMD) are recessive X-linked neuromuscular diseases produced by allelic mutations in the human dystrophin gen. In the present study we determined the 14-deletion prone exons by multiplex PCR in 24 no related venezuelan patients with clinical diagnosis of DMD/BMD. We found 37% of intragenic deletions of which 77% were located at the "hot spot" deletion region that includes exons 44 to 55. The present study show that deletion frequency observed in venezuelan patients resembles some Asian populations and is lower than that observed in Europe and North America. The explanation of the low frequency detected in our patients is beyond the present study, but it is likely that different mutations, ocurring at other regions of the gene is determining a molecular heterogeneity of the DMD/BMD disease in Venezuela.

Since the beginning of cytogenetics, there has been a constant improvement of chromosomal culture and banding techniques. In 1976, Yunis described a high chromosomal resolution technique (HRC), that permits the detection of subtle chromosomal abnormalities. The present work, reports the results obtained when HRC was applied to the study of chromosomal abnormalities in patients with high risk of such. The study comprised 434 specimens of venous blood and 182 bone marrow aspirates. The samples were classified according to the presuntive diagnoses. The highest frequency of chromosomal abnormalities, was found in blood samples from patients with physical deformities with or without mental retardation (22.22%), followed by mental retardation autism and/or fragile X chromosome (13.66%), and in couples with reproductive disorders (5.8%). In bone marrow, the most frequent abnormalities corresponded to patients with chronic myeloid leukemia (78.43%), acute lymphocytic leukemia (62.10%), acute myeloide leukemia (61.9%), myelodisplastic syndromes (43.7%) and chronic lymphocytic leukemia (14.2%). The present results stress the need to apply the HRC technique when the probability of minute chromosomal abnormalities is high.

Results from an epidemiological study of congenital malformations (CM) realized at Pedro Garcia Clara Hospital from march 1989 to december 1992 are presented. Malformation was defined as all external or internal morphological defects that could be clinically diagnosed at birth. In all births, incidence and type of CM, birth condition, sex, weight, number of pregnancies and maternal ages were analyzed. Moreover, in live births from march 1989 to august 1991, were analyzed: the type of childbirth presentation, maternal residence place, paternal age, maternal and paternal occupation and school education, parental consaguinity, previous spontaneous abortions, other malformed in the family and exposition to physical agents, medicaments, vaccines, acute and chronical diseases and vaginal bleeding in the first trimester of pregnancy. The control group were children born during the same day and sex matched as the malformed children. The incidence of CM was 23.4 per 1000 total births. Most frequent malformations were principally minor or feasible of satisfactory treatment. Major malformations were Central Nervous System anomalies, specially, neural tube deffects and Down syndrome. Only maternal age, type of childbirth, other malformed members in the family and medicaments exposition were statistically significant. Our results confirm the importance and utility of CM epidemiology monitoring.

The results of a retrospective analysis of newborn population with neural tube defects (NTD) occurred in the Hospital Pedro Garcia Clara at Zulia State for the period 1982-1988, sex, birth condition, maternal age, number of pregnancies and mother's mean permanency of time in the zone, were studied. The control sample were children who were born the same day and of the same sex as the malformed children. By that period, the NTDs occupied the first place as morbidity caused for congenital malformations. NTDs had an incidence rate of 2.28 out of thousand total of births and can be considered one of the highest reported in the country. The major rate, 5.5 per 1000 was observed in 1986. The frequency of NTDs was higher in stillbirths and females. There were no differences between NTDs and controls in relation with maternal age and number of pregnancies in the mother. There was a heterogeneous geographical distribution with high concentration of cases of NTDs in Bachaquero and Mene Grande. The permanency of the NTDs's mothers was greater than that the controls' mothers. According to this investigation, it is suggested a necessity for more profound studies in order to identify and clarify some possible environmental conditions that could explain the present findings.

Chronic myelocytic leukemia is a particular subtype of leukemia characterized by increased myeloid precursor cells. It has been associated with the presence of the Philadelphia chromosome, described by Nowel and Hungerford in 1960, as a deletion of part of the long arm of a G group chromosome, the 22 chromosome. The present work reports the chromosomal abnormalities observed in 39 patients with chronic myelocytic leukemia, studied at the Genetic Unit, in the Faculty of Medicine of Zulia University, during the period from 1987 to 1991. Sixty per cent of the patients showed different abnormalities, such as 8 trisomy, t (8;22), and in the remaining 15%, no chromosomal changes were detected. The patients with t (9;22) as the only abnormality, had less relapses and longer survival. The clinical course of 50% of the patients with normal karyotype was similar to those with t (9;22) as the only abnormality; the other 50% had an accelerated course with frequent relapses and early death. The present findings confirm that the presence of the Philadelphia chromosome as the only karyotypical abnormality, is indicative of better prognosis, and its association with other chromosomal changes predicts a more accelerated course that will probably require a more aggressive treatment.