Increased expression of genes from growth factor signaling pathways in glioblastoma cell lines

The concept of autocrine stimulation of cell proliferation postulates growth autonomy by acquisition of the ability to produce and respond to growth factors. Overproduction of several growth factors in a variety of human tumors and cell lines derived from these tumors has been reported. We have screened several cell lines derived from glioblastomas for anomalies in the expression of genes encoding transforming growth factor alpha (TGF-alpha), TGF-beta, basic fibroblast growth factor (bFGF) and its high-affinity receptor, flg. Compared with normal human brain tissue, we observed a generalized elevation in the levels of expression of these genes in glioblastoma cell lines and an SV40-transformed human astroglial cell line. Overexpression of these genes does not appear to be merely a reflection of the proliferative state of transformed cells since some other human tumor cell lines, when analysed for the expression of TGF-beta and bFGF, did not show a significant increase in these transcripts. The specificity of the elevated transcription of TGF-alpha, TGF-beta, bFGF and flg in glioblastoma cell lines is further suggested by the fact that the transcription of the proto-oncogene c-erbB2, which is overproduced in breast tumor cell lines, was not elevated in glioblastoma cell lines. Increased expression of growth factors, which are potent mitogens and angiogens, and/or their receptors may have critical roles in autonomous proliferation as well as neovascularization of glioblastomas.

Congenital complete heart block in structurally normal heart--a study of 44 cases

Data of 44 patients with congenital complete heart block and structurally normal heart have been analysed. Thirty one patients were asymptomatic (group I) and 13 patients had symptoms of low cerebral perfusion like syncope, near syncope or convulsions (group II). A ventricular rate on surface ECG was found to be significantly lower in the symptomatic group (56.7 +/- 13.2 beats per minute, bpm, in group I and 46.5 +/- 6.0 bpm in group II). Similarly wide QRS escape rhythm of greater than 0.10 seconds was more often seen in group II (2/13) as compared to group I (2/31) though the difference did not reach statistical significance. Presence of pauses of more than 3.0 seconds on ambulatory ECG monitoring were infrequent in both the groups (group I 1/7, group II 2/7), however more often seen in group II. Electrophysiological studies carried out in 11 patients were not helpful in differentiating the two groups and all the patients including two with a wide QRS escape rhythm on surface ECG showed suprahisian level of block. The corrected junctional recovery time in two groups did not show any statistical difference. A persistently slow ventricular rate of less than 50 bpm during waking hours, wide QRS escape rhythm and pauses of greater than 3 seconds on ambulatory monitoring are suggestive of high risk to the patient and may justify implantation of permanent pacemaker even in asymptomatic patients.

Anomalous origin of the left pulmonary artery from the ascending aorta in a patient with tetralogy of Fallot and "absent pulmonary valve"

The rare association of tetralogy of Fallot, rudimentary formation of the leaflets of the pulmonary valve, and anomalous origin of the left pulmonary artery from the ascending aorta is described in a two-month-old infant. The diagnosis was made by cardiac catheterisation and angiography.

Echocardiographic determinants of outcome after percutaneous transluminal balloon dilatation of discrete subaortic stenosis

Eleven patients (seven females and four males; age 4 to 24 years) with discrete subaortic stenosis (DSS) diagnosed on echocardiography were subjected to balloon dilatation. The site of the obstruction was 1 to 8 mm below the aortic valve. On the basis of echocardiographic appearance, the patients could be divided into three groups. Group I patients had a uniformly thin (1 to 3 mm) obstructing "membrane" (n = 7). Group II patients had a thin obstructing "membrane" present at the tip of a thick bulge from the interventricular septum (n = 2) (intermediate form). Group III patients had an obstruction caused by a thick ridge of tissue (6 to 8 mm thick, n = 2). Maximum inflatable diameter of the balloon used was less than or equal to the aortic valve anulus. After balloon dilatation in group I, the gradients across the obstruction fell from 86.6 +/- 16.9 mm Hg to 24.0 +/- 13.1 mm Hg. Relief of obstruction persisted on follow-up of 3 to 24 months (gradient 28.8 +/- 15.7 mm Hg). In group II patients gradients fell from 116 and 40 mm Hg to 58 and 20 mm Hg, respectively immediately after balloon dilatation. On follow-up of 6 and 9 months the gradients have increased to 76 and 32 mm Hg, respectively. In group III the gradients fell from 64 and 70 mm Hg to 15 and 16 mm Hg, respectively, immediately after balloon dilatation, which increased to 58 and 60 mm Hg, respectively, within 24 hours and persisted around that level at 3 months' follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of stretching the gastrocnemius muscle

Many authors currently disagree on the amount of time necessary to provide an adequate stretch flexibility. Since gastrocnemius equinus has been recognized as a cause of athletic injury, the authors performed a study to test what may be an adequate amount of stretching a gastrocnemius to improve flexibility. This study could not be conducted blind, and it was hoped that the contralateral leg could offer some control. The results of this study are presented here and should be kept in mind when evaluating and treating patients with ankle equinus, especially when considering surgical intervention.

Non-specific aorto-arteritis (Takayasu's disease) in children

Digital subtraction panaorto-arteriography was performed in 32 consecutive children (21 females, mean age 10.8 years) with non-specific aorto-arteritis to assess digital subtraction angiography (DSA) in imaging these children and to study the patterns of involvement in the Indian sub-continent. Diagnostic quality DSA images were obtained in 21 out of 27 intravenous and nine out of 11 intra-arterial studies. Obstructive lesions were present in all the patients and commonly involved the abdominal aorta (24 patients) and renal arteries (20 patients). Aneurysms were seen in five patients and predominantly involved the descending thoracic aorta. Pulmonary artery involvement was uncommon (five out of 20 patients) and clinically silent. Based on clinical and angiographic features, percutaneous transluminal angioplasty was performed for the management of uncontrolled hypertension in eight patients (10 lesions). Initial success was obtained in eight procedures (80%). Re-stenosis occurred after 5.5 months in one patient, but was successfully re-dilated. The follow-up period ranged between 5 and 16 months (mean 9 months). Long-term efficacy of transluminal angioplasty in the management of these children is awaited.

Identity of BCA200 and c-erbB-2 indicated by reactivity of monoclonal antibodies with recombinant c-erbB-2

BCA200 has been described as a 200,000 Mr monomeric cell surface glycoprotein associated with human breast cancer. Since the physical properties and cellular distribution of BCA200 resemble those of c-erbB-2, antibodies to BCA200 were tested for the ability to bind a recombinant protein containing the c-erbB-2 extracellular domain (erbB-2 ECD). Three antibodies to distinct epitopes of BCA200 reacted with erbB-2 ECD but not with a control protein expressed in a similar baculovirus lysate. Control myeloma proteins and antibodies to four other antigens did not react with erbB-2 ECD. A protein with the expected molecular weight for erbB-2 ECD was also immunoprecipitated by anti-BCA200 antibody 520C9. We conclude that BCA200 is another synonym for c-erbB-2.

Identification of anomalous origin of one pulmonary artery from ascending aorta by two-dimensional and colour Doppler echocardiography

The anomalous origin of the right pulmonary artery from the ascending aorta in a neonate was diagnosed by two-dimensional and colour directed Doppler echocardiography. An anomalous arterial vessel coursing towards the right lung originated from the posterolateral aspect of the ascending aorta. It could be visualized in parasternal and suprasternal views. The normal bifurcation of the pulmonary trunk was absent. Colour Doppler examination aided in clearer delineation and consequent correct identification of the anomalous vessel as the right pulmonary artery.

Experience with a third-generation implantable cardioverter-defibrillator

A Medtronic 7216A pacemaker cardioverter-defibrillator was implanted in 16 patients (mean age 56 years) with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and organic heart disease with a mean left ventricular ejection fraction of 33%. Endocardial and epicardial defibrillation shock efficacy was evaluated before or at implant using 1 to 3 shock patterns, i.e., monophasic single, sequential or simultaneous shocks with dual and triple electrode configurations. Endocardial leads used a common right ventricular cathode and dual anodes, whereas epicardial leads used 2 or 3 helical coil patches. VT termination was evaluated using pacing or shock therapy, or both, whereas only shocks were used in VF. Programmable bradycardia pacing, individual zones for VT and VF detection and individualized pacing and shock therapy for VT and VF were used. Monophasic shocks had epicardial defibrillation thresholds ranging from 3 to 18 (mean 10) J and were comparable for sequential and simultaneous shocks (p greater than 0.2). VT detection rates ranged from 340 to 470 ms and VF detection rates from 270 to 330 ms. VT or VF induction, or both, was performed noninvasively in 13 patients after implant and was reproducibly terminated by rapid pacing alone (5 patients), low-energy shocks (2 patients), high-energy shocks (3 patients) and combined therapy (3 patients). Intermediate or high-energy shocks terminated all induced VF episodes. During follow-up (2 to 12 months), there have been 2 noncardiac deaths. Electrical therapy was delivered in 7 patients, for VT (3 patients), VT and VF (3 patients) and indeterminate tachyarrhythmia (1 patient). All VT/VF episodes were successfully terminated, with 78 of 96 (81%) spontaneous VT episodes terminated by pacing. Follow-up reprogramming was required in 5 patients. It is concluded that successful application of individualized electrical therapy prescriptions in patients with VT/VF is feasible. Pacing therapies, which are effective for induced VT, can be reliably used for effective long-term spontaneous VT termination in conjunction with shock therapy and can permit reduced patient exposure to shock therapy. Thus, a programmable hybrid pacemaker cardioverter-defibrillator system provides nonthoracotomy implantation, effective VT/VF termination, demand ventricular pacing and noninvasive modes for arrhythmia induction, event monitoring and clinical trouble-shooting.

Echocardiographic identification of infradiaphragmatic total anomalous pulmonary venous drainage--a report of 2 cases

Two neonates with infradiaphragmatic type of total anomalous pulmonary venous drainage are reported in whom complete diagnosis was obtained by cross sectional (2D) echocardiography with Doppler and color flow mapping. Visualisation of a dilated venous channel draining into the portal venous system and separate from inferior vena cava and descending aorta in the subcostal view indicates infradiaphragmatic site of drainage of pulmonary veins in a patient with total anomalous pulmonary venous drainage. Doppler and color flow imaging help in defining the direction of blood flow and presence of turbulence in the common venous channel.

Cardiac arrhythmias after surgical correction of total anomalous pulmonary venous connection: late follow-up

Sixteen patients (10 males and six females) aged 7 months to 20 years, who had undergone surgical repair in the first year of life for total anomalous pulmonary venous connection (TAPVC), underwent assessment of cardiac rhythm by 24-h electrocardiogram (ECG) monitoring, nine of them also had maximal exercise treadmill tests, 3 months to 19.5 years after surgical repair. No patient had symptoms of an arrhythmia and the resting ECG was normal in all except one who had occasional single supraventricular ectopic beats. But on 24-h ECG monitoring significant arrhythmias were recorded in six of the 16 patients, including supraventricular tachycardia (three patients), bradyarrhythmia (two patients), sick sinus syndrome (two patients), and multiform supraventricular and ventricular ectopic beats (two patients). Five of these six patients were assessed more than 6 years after surgery. An inappropriate chronotropic response was seen on maximal exercise treadmill testing in four patients; three of them had arrhythmias previously recorded by 24-h ECG monitoring. Our observations show that significant arrhythmias may occur in asymptomatic patients long after TAPVC correction, and we therefore recommend long-term follow-up of these patients, even if they are asymptomatic.

Lone atrial fibrillation with complete heart block in a child

An asymptomatic 9-year-old boy presented with a slow heart rate and a structurally normal heart. He was detected to have complete atrioventricular block and fine atrial fibrillation that was not evident on the surface electrocardiogram. This case appears to be an unusual example of a disease of the cardiac conduction system presenting in childhood.

Factors affecting alkaline nature of rain water in Agra (India)

Rain water was collected and analysed from a reference site, Dayalbagh and Taj Ganj, near the Taj Mahal in Agra. The ionic components Ca, Mg, Na, K, NH(4), Pb, Fe, Zn, SO(4), HCO(3), Cl and F were analysed along with pH, alkalinity and conductance. The average pH of rain water at both sites is 7.05. There is a dominance of alkaline components, particularly Ca. The rain water chemistry shows the importance of calcareous soil-derived materials in controlling the pH of rain water.

Interaction of aromatic donor molecules with manganese(III) reconstituted horseradish peroxidase: proton nuclear magnetic resonance and optical difference spectroscopic studies

The interaction of aromatic donor molecules with manganese(III) protoporphyrin-apohorseradish peroxidase complex [Mn(III)HRP] was investigated by optical difference spectroscopy and relaxation rate measurements of 1H resonances of aromatic donor molecules (at 500 MHz). pH dependence of substrate proton resonance line-widths indicated that the binding was facilitated by protonation of an amino acid residue (with a pKa of 6.1), which is presumably distal histidine. Dissociation constants were evaluated from both optical difference spectroscopy and 1H-NMR relaxation measurements (pH 6.1). The dissociation constants of aromatic donor molecules were not affected by the presence of excess of I-, CN- and SCN-. From competitive binding studies it was shown that all these aromatic donor molecules bind to Mn(III)HRP at the same site, which is different from the binding site of I-, CN- and SCN-. Comparison of the dissociation constants between the different substrates suggests that hydrogen bonding of the donors with distal histidyl amino acid and hydrophobic interaction between the donors and active site contribute significantly towards the associating forces. Free energy, entropy and enthalpy changes associated with the Mn(III)HRP-substrate equilibrium have been evaluated. These thermodynamic parameters were found to be all negative. Distances of the substrate protons from the paramagnetic manganese ion of Mn(III)HRP were found to be in the range of 7.7 to 9.4 A. The Kd values, the thermodynamic parameters and the distances of the bound aromatic donor protons from metal center in the case of Mn(III)HRP were found to be very similar as in the case of native Fe(III)HRP.

Doppler assessment of interventricular pressure gradient across isolated ventricular septal defect

Continuous wave Doppler ultrasound was used to estimate the pressure gradient between the right and left ventricle for assessment of pulmonary arterial systolic pressure in 30 patients with isolated ventricular septal defect and for subsequent comparison with similar data obtained on cardiac catheterization. The age of the patients ranged from 8 months to 45 years (6.8 +/- 8.6 years). No patient had right or left ventricular outflow tract obstruction. Doppler measurements were done within 24 h of cardiac catheterization. Pressure gradient across ventricular septal defect on cardiac catheterization ranged from 7 to 95 mmHg (48 +/- 24 mmHg) and that on Doppler assessment ranged from 8 to 78 mmHg (42 +/- 20 mmHg). Doppler measurements of interventricular pressure gradient correlated well with those obtained on cardiac catheterization (r = 0.90, p less than 0.001). Correlation was better in patients with pressure gradient across ventricular septal defect less than 75 mmHg (r = 0.96). Correlation was poor in three of five patients with very small ventricular septal defects (interventricular pressure gradient greater than 75 mmHg) because the jet used was not ideal. Thus continuous wave Doppler ultrasound is an accurate noninvasive means of measuring pressure gradient across ventricular septal defect, which is a useful parameter for assessment of pulmonary artery systolic pressure in patients with isolated ventricular septal defect without right and left ventricular outflow tract obstruction.

Coronary arteriovenous fistula in tetralogy of Fallot: an unusual association

A congenital coronary arteriovenous fistula is a rare anomaly, and only two cases have been previously reported in association with tetralogy of Fallot. We report one more patient with tetralogy of Fallot who had an associated fistulous communication between the left circumflex coronary artery and the coronary sinus. It is important to localize these left to right shunts preoperatively in order to plan optimal surgical management.

Use of balloon dilatation to treat supravalvar pulmonary stenosis developing after anatomical correction for complete transposition

Eight balloon dilatations were performed in five patients (aged from 10 to 37 months) in whom supravalvar pulmonary stenosis developed after anatomical correction for complete transposition. The ratio of the maximum diameter of the inflated balloon to the narrowest pulmonary arterial diameter varied from 1.6 to 3.3. In three patients with an initial ratio of less than or equal to 2 dilatation was repeated with a larger balloon. The right ventricular systolic pressure ranged from 0.70 to 1.25 of the simultaneously measured femoral arterial systolic pressure. The major stenosis was in the main pulmonary artery in four patients and at the pulmonary arterial bifurcation in one. After balloon angioplasty in the four patients there was no significant improvement in the ratio of right ventricular to femoral arterial systolic pressure or in the angiographic appearance. There was no change in the pressure ratio after angioplasty in the patient who had a major stenosis of the pulmonary arterial bifurcation and mild main pulmonary artery narrowing. There seemed to be a slight angiographic improvement in the bifurcation stenosis but at restudy two months later the angiographic improvement had disappeared. Balloon angioplasty of supravalvar pulmonary stenosis developing after anatomical correction for complete transposition was not successful in eight procedures. This lack of success may be attributable to a small pulmonary annulus with consequent multiple levels of stenosis and distortion of the main pulmonary artery.