Browsing by Author "Eskildsen, Dane"
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Item A Case of Symptomatic Angiomyolipoma(2019-03-05) Young, Todd; Eskildsen, DaneBackground: Renal angiomyolipoma (AML) are benign soft tissue neoplasms classically composed of blood vessels, smooth muscle cells and adipocytes. These masses are found in .3 to 2.1% of the population and can be strongly associated with genetic syndromes such as the Tuberous Sclerosis Complex. While most of these masses are found incidentally, they can, in rare cases, become symptomatic. Patients with symptomatic AML most commonly present with hematuria, flank pain and renal hemorrhage. Case Presentations: A.H. is a 51-year-old obese female who presented 7 months ago to the emergency department with sudden onset left upper quadrant pain, nausea and emesis. On admission, her hemoglobin was found to be 9.1. Due to continued anemia she was transfused with 2 units of blood. CT scan of the abdomen and pelvis showed massive hemorrhage in the retroperitoneum surrounding the left kidney and a focus of fatty tissue likely representing a large AML. After Urological consult, left renal pole artery embolization was performed by interventional radiology. Over the next several months, after resolution of the hemorrhage, subsequent scans found that the symptomatic mass measured 4 cm and another 1.2 cm AML was found in the ipsilateral kidney. 6 months’ post presentation it was determined that, due to size and history of hemorrhage that the patient would undergo a radical left nephrectomy. Upon surgical exploration of the abdomen the tissue around the kidney was found to still be incredibly inflamed and thick. Despite this, the surgery proceeded without complications. Conclusion: Classic AML are the only benign renal masses that can confidently be diagnosed using imaging. As such, confirmed asymptomatic AML are often left untreated and actively observed over time. The consensus in literature indicates a size 4 cm as the cutoff for when AML are suspicious for symptomatic manifestation. Indeed, the risk of significant symptoms directly increases with size of the mass. This same 4cm size cutoff is used as a guideline for when treatment is warranted. Modern first line treatment includes embolization, with partial or radical nephrectomy coming into play when embolization fails to control symptoms or with excessively large masses. In this case, although embolization initially controlled the bleeding, patient comorbidities and tumor size warranted definitive removal of the mass.Item Inline flow sensor for ventriculoperitoneal shunts: Experimental evaluation in swine(2018-03-14) Qin, Chuchu; Williams, Arthur Jr.; Dasgupta, Pernandu; Mallet, Robert T.; Yurvati, Albert; Eskildsen, DaneBackground: Hydrocephalus is a potentially life-threatening disorder in which cerebrospinal fluid (CSF) fails to circulate properly, causing a dangerous buildup of pressure in the cerebral ventricles and the surrounding brain tissue. It is seen most often in infants with congenital abnormalities of the CSF tract, and in patients with traumatic brain injury. The only treatment in most cases is the placement of a tubing to drain the excess CSF from the brain to the abdomen. These shunts are prone to blockage that requires invasive replacement surgery, so a reliable flow sensor is needed to detect shunt failure at its early stages. Currently available flow sensors often fail to detect blockage. Objective: The purpose of this project is to evaluate an advanced in-line electronic flow sensor capable of monitoring CSF flow over time for use in the treatment of hydrocephalus. This project evaluated the performance of this sensor in domestic swine. Methods/Materials: Ventriculo-peritoneal shunts were installed in the third cerebral ventricle of juvenile Yorkshire pigs, and routed to the peritoneal space in the abdomen. The flow sensor was positioned halfway between the cephalic and peritoneal ends of the shunt. Data were acquired on a laptop computer. Shunt flows were obtained at 30 s intervals. The sensor alternately heated the shunt fluid for 5 s and then monitored temperature decline, the rate of which was proportional to flow, for 25 s. The fluid was diverted into pre-weighed vials for 1- or 5-min to determine flow gravimetrically. At regular intervals, 5-20 ml boluses of artificial CSF were injected into the third ventricle. Flows reported by the sensor were compared to concomitant gravimetric flows by linear regression. Results: Over 4300 sensor measurements of flow were obtained in 6 experiments. The flow sensor reliably reports shunt flows up to 35 ml/min, the highest rate produced by 20 ml CSF injections. Four experiments showed strong linear correlations (r2 ³ 0.90) between gravimetric and sensor flows. The slope of the linear regression between the two flows was 1.05 ± 0.14 in the 6 experiments, indicating that the sensor accurately reported flows of up to 35 ml/min. Conclusions: The results of this experiment indicate that the flow sensor can report accurately ventriculo-peritoneal shunt flows over a wide range in a large animal model. Studies are planned to evaluate performance of chronically implanted shunts in ambulatory pigs.Item Screening the ability of BNS-22 against chemotherapy-induced cytotoxicity in Cardiomyocytes(2018-03-14) Basha, Riyaz; Sankpal, Umesh; Hurtado, Myrna; Eskildsen, DaneHypothesis: Cardiac toxicity is one of the leading contraindications to many chemotherapeutic agents including anthracyclines (e.g. Doxorubicin). It has been demonstrated that knocking out the beta isozyme of topoisomerase II in mice results in amelioration of the cardiotoxic effects of Doxorubicin. The purpose of this study is to evaluate whether or not the inhibiton of the Topoisomerase II beta isozyme by the drug BNS-22 in cardiomyocytes can alleviate the cardiotoxic effects of doxorubicin. Methods/Materials: Cardiomyocyte cells (H9C2) were used to evaluate the cytotoxicity of BNS-22. Additionally, these cardiomyocytes were used to determine the rate of cardiac cell death in cells treated with Doxorubicin and BNS-22 concurrently compared to cells treated with Doxorubicin alone. Cell viability was measured by luminescence assay using the CellTiter-Glo kit. Cell viability was measured 72 hours after the administration of Vehicle (control) or BNS-22 or doxorubicin or doxorubicin and BNS-22. Results: Cardiomyocytes (H9C2) were grown following standard cell culture conditions. Cells which were treated with both Doxorubicin and BNS-22 together and the cells treated with only BNS-22 suffered considerably less cell loss than the cells treated with Doxorubicin alone. Conclusions: These preliminary results suggest that BNS-22 helps to alleviate the cardiotoxic effects of Doxorubicin. This experiment provides some evidence for the use of Topoisomerase inhibitors in the treatment of doxorubicin induced cardiotoxicity. Further cell viability assays using this drug will be performed to substantiate current findings.