Treatment of Intravenous Leiomyomatosis with Cardiac Extension following Incomplete Resection.

Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign uterine leiomyoma. Incomplete resection has a recurrence rate of over 30%. Different hormonal treatments have been described following incomplete resection; however no standard therapy currently exists. We review the literature for medical treatments options following incomplete resection of IVL with CE. Methods. Electronic databases were searched for all studies reporting IVL with CE. These studies were then searched for reports of patients with inoperable or incomplete resection and any further medical treatments. Our database was searched for patients with medical therapy following incomplete resection of IVL with CE and their results were included. Results. All studies were either case reports or case series. Five literature reviews confirm that surgery is the only treatment to achieve cure. The uses of progesterone, estrogen modulation, gonadotropin-releasing hormone antagonism, and aromatase inhibition have been described following incomplete resection. Currently no studies have reviewed the outcomes of these treatments. Conclusions. Complete surgical resection is the only means of cure for IVL with CE, while multiple hormonal therapies have been used with varying results following incomplete resection. Aromatase inhibitors are the only reported treatment to prevent tumor progression or recurrence in patients with incompletely resected IVL with CE.

Twenty-year experience of transvenous lead extraction at a single centre.

AIMS: Indications for cardiovascular implantable electronic devices continue to evolve, which has led to an increasing requirement for transvenous lead extraction. We explore the indications, complications, and success rates involved in the removal of pacemaker and implantable cardioverter-defibrillator (ICD) leads in a high-volume centre, over 20 years. METHODS AND RESULTS: We performed a retrospective analysis of all consecutive patients undergoing transvenous lead extraction by a single operator at a single centre between 1993 and 2012. Patient characteristics, indications, and outcomes were analysed. A total of 1006 leads were removed from 510 patients. Seventy-two per cent of patients were males. The mean age was 64 years (range 14-96). Indications included systemic infection (25%), pocket infection (40%), lead failure (26%), chronic pain (3%), and other (6%). Ninety-six per cent of leads were completely removed. There was one procedure-related death, and the major complication rate was 0.3%. Infection was the only identified predictor of increased complication (χ² for difference between groups 20, P< 0.0001). CONCLUSION: Pacing and ICD leads can be safely extracted with mechanical techniques. The presence of device infection appears to be the major predictor of procedural complications.

Requirement of Wnt/beta-catenin signaling in pronephric kidney development.

The pronephric kidney controls water and electrolyte balance during early fish and amphibian embryogenesis. Many Wnt signaling components have been implicated in kidney development. Specifically, in Xenopus pronephric development as well as the murine metanephroi, the secreted glycoprotein Wnt-4 has been shown to be essential for renal tubule formation. Despite the importance of Wnt signals in kidney organogenesis, little is known of the definitive downstream signaling pathway(s) that mediate their effects. Here we report that inhibition of Wnt/beta-catenin signaling within the pronephric field of Xenopus results in significant losses to kidney epithelial tubulogenesis with little or no effect on adjoining axis or somite development. We find that the requirement for Wnt/beta-catenin signaling extends throughout the pronephric primordium and is essential for the development of proximal and distal tubules of the pronephros as well as for the development of the duct and glomus. Although less pronounced than effects upon later pronephric tubule differentiation, inhibition of the Wnt/beta-catenin pathway decreased expression of early pronephric mesenchymal markers indicating it is also needed in early pronephric patterning. We find that upstream inhibition of Wnt/beta-catenin signals in zebrafish likewise reduces pronephric epithelial tubulogenesis. We also find that exogenous activation of Wnt/beta-catenin signaling within the Xenopus pronephric field results in significant tubulogenic losses. Together, we propose Wnt/beta-catenin signaling is required for pronephric tubule, duct and glomus formation in Xenopus laevis, and this requirement is conserved in zebrafish pronephric tubule formation.