Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series.

Cerebral venous sinus thrombosis is an uncommon cause of stroke with high morbidity and mortality rates from venous infarction, intracranial hemorrhage, and extensive cerebral edema. Endovascular treatment with various devices has been proposed as a salvage treatment when standard medical treatment with systemic anticoagulation is ineffective, especially in long segment dural sinus thrombosis. We describe our technique of transvenous endovascular aspiration thrombectomy with large bore thrombectomy catheters, followed by placement of microcatheter for local thrombolytic infusion at the site of thrombosis. We report a retrospective study of angiographic and clinical outcome of six consecutive patients treated with this approach. Endovascular aspiration thrombectomy with large bore catheters followed by continuous local thrombolytic infusion appeared to be a safe and effective salvage treatment for selected patients with cerebral dural venous sinus thrombosis refractory to medical treatment.

Dickkopf 4 (DKK4) acts on Wnt/ß-catenin pathway by influencing ß-catenin in hepatocellular carcinoma.

Deregulation of Wnt/ß-catenin pathway is a hallmark of major gastrointestinal cancers including hepatocellular carcinoma (HCC). The oncogenic role of ß-catenin is well defined but reasons for its accumulation in HCC remain unclear. Dickkopf 4 (DKK4) acts as a negative regulator of Wnt/ß-catenin pathway but its functional role in liver carcinogenesis has not been studied. We investigated the role of DKK4 in ß-catenin regulation in HCC. Reduced expression of DKK4 was found in 47% (38/81) of HCC, as measured by quantitative real time PCR. Ectopic expression of DKK4 in two HCC cell lines, PLC/PRF/5 (PLC) and MHCC97L (97L), attenuated ß-catenin responsive luciferase activity, and decreased both ß-catenin and cyclin D1 protein levels. To study the effect of DKK4 on cell growth and tumourigenicity, two stable HCC cell lines were established from PLC and 97L cells. Functional assays demonstrated that overexpression of DKK4 hampered cell proliferation, reduced colony formation and retarded cell migration. When DKK4-expressing 97L stable cells were used to induce tumour xenografts in nude mice (n=8), reduction in tumour sizes was observed (P=0.027). Furthermore, immunohistochemical studies showed that decreased expression of DKK4 was associated with ß-catenin accumulation in HCC tissues. Additionally, inhibition of the proteasome using specific inhibitor in DKK4-expressing 97L stable cells masked the effect of ß-catenin. Our findings suggest a potential tumour suppressive role of DKK4 as well as that of an important regulator of HCC.

Hemangioma of the diaphragm presenting with cardiac tamponade.

We report a rare form of presentation of diaphragmatic hemangioma in a neonate. The patient presented with pericardial effusion and cardiac tamponade, requiring tapping of the pericardial effusion and subsequent en-bloc resection of the hemangioma with diaphragmatic reconstruction.

Pulmonary valve replacement after surgical repair of tetralogy of Fallot.

OBJECTIVE: To evaluate the results of pulmonary valve replacement in patients with severe pulmonary regurgitation after tetralogy of Fallot repair in Hong Kong. DESIGN: Retrospective review. SETTING: University teaching hospital, Hong Kong. PATIENTS: Consecutive patients undergoing pulmonary valve replacement after repair of tetralogy of Fallot between August 2002 and December 2008. MAIN OUTCOME MEASURES: Magnetic resonance imaging of right ventricular volume and cardiopulmonary exercise test data before and after the operation were documented and compared. RESULTS: Over a 6-year period, 16 patients underwent pulmonary valve replacement for severe pulmonary regurgitation after prior complete repair for tetralogy of Fallot. There was no in-hospital mortality. The mean time interval between the initial repair and pulmonary valve replacement was 19 (standard deviation, 9) years. In three patients, the indication for pulmonary valve replacement was symptomatic severe pulmonary regurgitation, and asymptomatic progressive right ventricular dilatation in the remaining 13 patients. After pulmonary valve replacement, there was a significant decrease in the mean indexed right ventricular end-diastolic volume from 173 (standard deviation, 44) mL/m(2) to 103 (19) mL/m(2) (P=0.043). After the operation, there was also a tendency for improvement of the right ventricular ejection fraction and the maximum oxygen consumption: from 42% (standard deviation, 9%) to 47% (6%) [P=0.173], and 27 (4) mL/kg/min to 29 (4) mL/kg/min (P=0.208), respectively. CONCLUSION: Pulmonary valve replacement for severe pulmonary regurgitation after tetralogy of Fallot repair is a safe procedure. However, the indications for such an operation in asymptomatic patients remain controversial. Further studies are required to better delineate the timing of pulmonary valve replacement in this patient group.

The relationship between mediastinal lymph node attenuation with parenchymal lung parameters in silicosis.

OBJECTIVE: Attenuation changes on computed tomography (CT) in mediastinal lymph nodes (LN) may be related to lung alterations and functional impairment in silicosis. DESIGN: CT and clinical data of 41 (64.2 +/- 8.3 years) males with silicosis were retrieved. Attenuation type (calcified, hyperdense, normodense) and calcification pattern (central, eccentric, dense, eggshell, speckled) of mediastinal LN were evaluated; LN attenuation of uncalcified LNs quantified on CT in six LN stations. Nodular profusion (CT-NP) and progressive massive fibrosis (CT-PMF) were graded. Relationships between LN, CT, lung function and clinical parameters were determined. RESULTS: LN sites were paratracheal (n = 39), subcarinal (n = 39), tracheobronchial (n = 37), aortopulmonary (n = 37), hilar (n = 27), and peri-oesophageal (n = 21). LNs were calcified, hyperdense and normodense in 107, 85 and 54 LN stations, respectively. Uniformly calcified LN was most common, followed by speckled calcification. Central, eccentric and eggshell calcification was rare. CT-NP scores > or = 16 were associated with higher LN attenuation and number of calcified LN stations than CT-NP scores < 16. PMF had no influence over LN morphology or calcification pattern. LN attenuation correlated with CT-PMF (r = 0.36, P = 0.01), CT-NP (r = 0.54, P < 0.001) and DLCO/VA (r = -0.33, P = 0.02). CONCLUSION: Uniformly calcified and hyperdense LNs are common in silicosis, and eggshell LN calcification is rare. There are associations between LN attenuation and lung function impairment, and CT grades of nodular profusion and PMF.

Inhibitors of tyrosine kinase signaling cascade attenuated antigen challenge of guinea-pig airways in vitro.

Activation of nontransmembrane protein tyrosine kinases (PTKs), phosphatidylinositol 3-kinase (PI3K), and mitogen-activated protein kinase (MAPK) has been shown to be responsible for high-affinity Fc receptor (Fcepsilon RI)-mediated mast cell degranulation. Effects of inhibitors of the PTK signaling cascade on ovalbumin (OA)-induced anaphylactic contraction of isolated guinea-pig bronchi and release of histamine and peptidoleukotrienes from chopped lung preparations were studied. Genistein (30 microM) and tyrphostin 47 (50 microM), two PTK inhibitors, as well as LY294002 (10 microM), a selective PI3K inhibitor, significantly reduced (p < 0.05) peak anaphylactic bronchial contraction and facilitated relaxation of the contracted bronchi. PD 098059 (30 microM), a selective MAPK kinase inhibitor, failed to suppress OA-induced peak bronchial contraction, but facilitated the relaxation of the contracted bronchi (p < 0.05). At the same concentrations, none of these inhibitors showed any inhibitory effects on histamine-, leukotriene D(4) (LTD(4))- or KCl-induced bronchial contraction. On the other hand, these inhibitors significantly prevented (p < 0.05) OA-induced release of both histamine and peptidoleukotrienes from chopped lung preparations. In addition, combined PD 098059 and LY294002 treatment markedly (p < 0.05) suppressed the peak anaphylactic bronchial contraction and facilitated relaxation of the contracted bronchi. The combination of these two inhibitors further inhibited the release of peptidoleukotrienes from chopped lung preparations. Taken together, our data show that inhibition of tyrosine kinase signaling cascade can markedly attenuate anaphylactic contraction of airways, probably via inhibition of mast cell degranulation, and that inhibitors of this signaling cascade may have therapeutic potential for the treatment of asthma.

Effects of inhibitors of the tyrosine kinase signaling cascade on an in vitro model of allergic airways.

It has been shown that activation of protein tyrosine kinases (PTKs) is the earliest detectable signaling response to FcepsilonRI cross-linking on mast cells. Following tyrosine kinase activation, a family of mitogen-activated protein kinases (MAPKs) was found to be activated as well. Activation of this PTK signaling cascade will lead to mast cell degranulation. This review summarizes our recent studies on the role of PTK signaling cascade in an in vitro guinea pig model of allergic asthma using PTK inhibitors, genistein and tyrphostin 47, and MAPK kinase inhibitor, PD098059. Inhibitors of the PTK and MAPK signaling pathways significantly attenuated the ovalbumin (OVA)-induced bronchial anaphylactic contraction and enhanced relaxation of constricted airways, respectively, and substantially blocked the release of histamine and peptidoleukotrienes from chopped lung preparations induced by OVA. Based upon their substantial inhibitory effects on the Schultz-Dale reaction, further examination on the potential anti-asthmatic effects of PTK cascade inhibitors in an in vivo model of allergic asthma is recommended.

Effects of mitogen-activated protein kinase kinase inhibitor PD 098059 on antigen challenge of guinea-pig airways in vitro.

1. It has been shown that activation of protein tyrosine kinases is the earliest detectable signalling response to FcepsilonRI cross-linking on mast cell. Following tyrosine kinase activation, a family of mitogen-activated protein kinases (MAPKs) was found to be activated as well. The present study examined the role of MAPK signalling cascade in in vitro model of allergic asthma using a specific MAPK kinase inhibitor PD 098059. 2. Guinea-pigs were passively sensitized with IgG antibody raised against ovalbumin (OA). Effects of PD 098059 on OA-induced anaphylactic contraction of isolated bronchi and release of histamine and peptidoleukotrienes from chopped lung preparations were studied. 3. PD 098059 (10-50 microM) produced only minor reduction of maximal OA-induced bronchial contraction. In contrast, the rate of relaxation of OA-induced bronchial contraction was markedly faster in the presence of PD 098059 than the vehicle control in a concentration-dependent manner. 4. These observations corroborate well with the inability of PD 098059 (5-50 microM) to substantially block the OA-induced release of histamine and with marked inhibition of OA-induced release of peptidoleukotrienes from lung fragments in the presence of PD 098059. Exogenous arachidonic acid-induced release of peptidoleukotrienes from lung fragments was not blocked by PD 098059. 5. In immunoblotting study, we found that p42MAPK was constitutively expressed in guinea-pig bronchi. However, treatment with OA, histamine or LTD4 did not cause activation of p42MAPK. These findings together with the lack of inhibitory effects of PD 098059 on bronchial contraction induced by histamine or LTD4 suggest that histamine- and LTD4-induced bronchial contractions are not mediated by p42MAPK activation. 6. Taken together, our findings show that inhibition of MAPK signalling cascade by PD 098059 significantly reduced the OA-triggered release of peptidoleukotrienes leading to rapid relaxation of anaphylactic bronchial contraction. On the other hand, p42MAPK did not play a role in histamine- or LTD4-induced bronchial smooth muscle contraction suggesting that PD 098059 exerts its inhibitory effects on OA-induced bronchial contraction primarily through inhibition of peptidoleukotrienes release from mast cells.