Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke

Introduction  

Quicker recanalization results in better clinical outcomes in patients with acute ischemic strokes. We describe our experience with the use of a self-expanding, fully retrievable stent in acute intracranial occlusions.     

Pentoxifylline protects against loss of function and renal interstitial fibrosis in chronic experimental partial ureteral obstruction

Tubulointerstitial fibrosis (TIF) is a hallmark of chronic kidney disease resulting from diverse etiologies and predicts severity and progression of the kidney disease. To investigate the pathogenesis of TIF, complete unilateral ureteral obstruction (UUO) is the most widely used animal model. However, UUO precludes evaluation of renal function. In the present study, we created a rat model of chronic partial ureteral obstruction (PUO), which allowed assessment of renal function at different intervals after obstruction. We examined the effects of pentoxifylline (PTF), a phosphodiesterase inhibitor used clinically to treat peripheral artery disease, on renal function and TIF. Studies were performed in sham-PUO rats and rats with 14-day PUO or 30-day PUO receiving vehicle in drinking water or PTF (400?mg/liter in drinking water). At day-14 PUO, glomerular filtration rate (GFR) was markedly and similarly depressed in rats receiving vehicle or PTF as compared with sham-operated rats. However, at day-30 PUO, GFR in rats receiving PTF was significantly higher than that in rats receiving vehicle, approaching the level seen in the sham-operated rats. At day-30 PUO, histologic studies also revealed a marked reduction of TIF in rats treated with PTF as compared with the rats receiving vehicle in drinking water. Western blot analysis demonstrated that at day-30 the expression of α-smooth muscle actin (an indicator of renal fibrosis) in the medulla was significantly reduced in PUO rats treated with PTF. In conclusion, PTF treatment ameliorated renal fibrosis and helped preserve renal function in a rodent model of PUO.     

Conjoint bicondylar Hoffa fracture in an adult

Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed.     

Magnetic resonance spectroscopy findings in non-enhancing desmoplastic medulloblastoma

Medulloblasoma is a common posterior fossa tumor seen in children and presents with some typical features like midline vermian location and fairly homogeneous enhancment. Desmoplastic variety of medulloblastoma is usually seen in the adults and is known to show some atypical features like lateral cerebellar location, variable enhancement, and early meningeal infilteration. Therefore medulloblastoma should always be considered in differential diagnosis of posterior fossa mass in adults even when typical imaging findings are not that of medulloblastoma. Enhancement pattern can be variable in these tumors varying from mild to striking. Occasionally, totally non-enhancing tumors are encountered, which can cause further diagnostic confusion. We describe the magnetic resonance (MR) and MR spectroscopy findings in a case of midline vermian mass, which did not show any enhancement on post-contrast images, and was subsequently proven to be desmoplastic medulloblastoma. On MR spectroscopy, the mass showed elevated choline peak consistent with mitotic lesion. No significant lipid lactate leak was seen, which is also consistent with the ususally homogeneous nature of these tumors. Moreover, it displayed taurine peak at 3.4 ppm which is considered fairly specific for medulloblastoma. Therefore, MR spectroscopy findings can be helpful in the diagnosis of medulloblastoma in adults when MR imaging findings can be nonspecific.     

Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke

Journal of Thrombosis and Thrombolysis - Complications following thrombolysis for stroke are well documented, and mostly concentrated on haemorrhage. However, the consequences of patients who...