Bladder cancer is the fourth most common cancer in men and the most common malignancy of the urinary tract. Bladder cancers detected at an early stage have a very high five-year survival rate, but when detected after local metastasis the rate is only about 50%. Our group recently reported a positive correlation between the expression of Wnt5a, a member of the Wnt proteins family, and histopathological grade and stage of urothelial carcinoma (UC). The objective of this study was to analyze UC cases reported in Athens, Ohio and investigate the major components of Wnt5a / planar cell polarity (PCP) signaling pathway in UC human tissue samples and UC cell lines.Formalin fixed and paraffin embedded transurethral resection tissues were immunostained for Wnt5a, Ror-2, CTHRC1 and E-cadherin. In addition, in vitro studies using UC cell lines were investigated for Wnt5a/PCP signaling and epithelial mesenchymal transition (EMT) gene expression. The IHC results showed a correlation between the expression of Wnt5a, Ror2 and CTHRC1 with high histological grade of the tumor, while E-cadherin showed an opposite trend of expression. Real time RT-PCR results showed that RNA expression of the Wnt5a/ PCP pathway genes vary in low and high grade UC cell lines and that the high grade cell lines exhibited signs of EMT.These findings support that Wnt5a-Ror2 signaling plays a role in UC, support the potential use of Wnt5a as a prognostic marker and provide evidence that Wnt5a signaling may be used as an effective molecular target for novel therapeutic tools.
Infective endocarditis (IE) is a life-threatening infection, which has had a notable increase in incidence in recent years. Although Staphylococci or Streptococci are the most common culprit organisms, rarer organisms have also been implicated and associated with a more aggressive disease course. We present a case of Enterobacter cloacae IE affecting the aortic valve in an 82-year-old male with an implantable permanent pacemaker. Our case demonstrates that a prolonged-course of beta-lactam therapy may be an effective, non-invasive management option for IE caused by multidrug-resistant gram-negative organisms.
Large thoracic aortic pseudoaneurysms are a life-threatening complication that typically occur as a complication of aortic prior surgery in less than 0.5% of cardiac surgical cases. Thoracic aortic pseudoaneurysms are typically asymptomatic and found incidentally. The gold standard for treatment remains surgical, but novel repairs have been suggested. We will describe a case of a large thoracic ascending aortic pseudoaneurysm treated by amplatzer plug.
CASE PRESENTATION:The patient is a 70-year-old man with a past medical history of thoracic aortic aneurysm status post aortic root replacement with aortic valve replacement, reduced ejection heart failure, persistent atrial fibrillation who presented to the hospital for a heart failure exacerbation. Patient had a transthoracic echocardiogram that was concerned for a large pseudoaneurysm with aortic collapse. CT angiography of the chest was obtained that was concerning for a 7.3 cm thoracic aortic pseudoaneurysm. Transesophageal echocardiogram confirms a large pseudoaneurysm with a discrete neck for possible amplatzer plug closure. Left heart catheterization showed moderate coronary artery disease and a large pseudoaneurysm. Patient was evaluated by cardiothoracic surgery but was deemed too high risk and transferred to outside hospital for successful amplatzer plug closure of pseudoaneurysm.DISCUSSION: A thoracic aortic pseudoaneurysm is a false aneurysm caused by the transmural disruption of the aortic sometimes caused by infection or trauma, but most often caused by previous surgery. Outside of case reports, there is little evidence regarding aortic pseudoaneurysm including mortality rates. The gold standard for treatment remains aortic graft replacement, but many patients are poor surgical candidates. Novel treatments have been proposed including amplatzer plugs.CONCLUSIONS: Thoracic aortic pseudoaneurysm are a rare complication of cardiac surgery that requires further study to determine the ideal treatment in non-surgical candidates.
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