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Natural history and results of therapy in 50 patients with histologically confirmed cerebral radiation necrosis [Meeting Abstract]
Rogers, Lisa R.; Scarpace, Lisa; Honsowetz, Jodie; Lord, Bryce; Gutierrez, Jorge; Shultz, Lonni; Movsas, Benjamin; Ryu, Samuel; Rosenblum, Mark; Jain, Rajan; Ellika, Shehanaz
ISI:000240877301375
ISSN: 1522-8517
CID: 542162
Kruppel-like factor 2 inhibits protease activated receptor-1 expression and thrombin-mediated endothelial activation
Lin, Zhiyong; Hamik, Anne; Jain, Rajan; Kumar, Ajay; Jain, Mukesh K
OBJECTIVE:The serine protease thrombin can dramatically alter endothelial gene expression in a manner that confers a proinflammatory phenotype. Recent studies have identified the Kruppel-like factor 2 (KLF2) as a critical regulator of endothelial gene expression. Herein, we provide evidence that KLF2 inhibits thrombin-mediated endothelial activation via alterations in expression of its principal receptor protease-activated receptor-1 (PAR-1). METHODS AND RESULTS/RESULTS:Forced expression of KLF2 in human umbilical vein endothelial cells potently inhibited the ability of thrombin to induce multiple prothrombotic factors (tissue factor, CD40L, plasminogen activator inhibitor-1), cytokines/chemokines (eg, monocyte chemotactic protein-1, interleukin-6 [IL-6], IL-8), and matrix degrading enzymes (eg, matrix metalloproteinases 1, 2, and 9). Mechanistically, KLF2 inhibits PAR-1 expression and, as a consequence, thrombin-mediated nuclear factor kappaB (NF-kappaB) nuclear accumulation and DNA binding. Conversely, small interfering RNA-mediated knockdown of KLF2 increases PAR-1 expression and thrombin-mediated induction of NF-kappaB activation. CONCLUSIONS:These studies identify KLF2 as a novel regulator of PAR-1 expression and thrombin action in endothelial cells.
PMID: 16514085
ISSN: 1524-4636
CID: 5877172
Magnetic resonance Imaging features of histologically documented cerebral radiation necrosis [Meeting Abstract]
Rogers, LR; Scarpace, L; Gutierrez, J; Ryu, S; Rosenblum, ML; Lord, B; Jain, R
ISI:000236068104060
ISSN: 0028-3878
CID: 542182
Magnetic resonance imaging features of histologically documented cerebral radiation necrosis [Meeting Abstract]
Rogers, LR; Scarpace, L; Gutierrez, J; Ryu, S; Rosenblum, ML; Lord, B; Jain, R
ISI:000236068104324
ISSN: 0028-3878
CID: 542172
Radiation-induced cavernomas of the brain
Jain, Rajan; Robertson, Patricia L; Gandhi, Dheeraj; Gujar, Sachin K; Muraszko, Karin M; Gebarski, Stephen
The purpose of this report is to add support to the growing literature that there is a correlation between radiation and cavernomas of the brain, particularly if the radiation is received in childhood, as well as to increase awareness of this correlation in the radiology community. Retrospective review of our experience returned five patients who received radiation therapy while they were children and developed cavernomas in the irradiated tissues 3-41 years later. Cavernomas should be considered in the differential diagnosis of a hemorrhagic lesion in any patient who has received previous CNS radiation, particularly if he or she underwent radiation therapy in childhood.
PMID: 15891176
ISSN: 0195-6108
CID: 455522
Direct infiltration of brainstem glioma along the cranial nerves [Case Report]
Ree, Alexander; Jain, Rajan; Rock, Jack; Rosenblum, Mark; Patel, Suresh C
The authors describe a case of a low-grade brainstem glioma extending along the cranial nerves without any evidence of leptomeningeal spread. The tumor extended directly along the VII-VIIIth cranial nerve complex and also along the trigeminal nerve, which is quite an unusual characteristic of the glial tumors.
PMID: 15746234
ISSN: 1051-2284
CID: 455532
Carotid perfusion CT with balloon occlusion and acetazolamide challenge test: feasibility
Jain, Rajan; Hoeffner, Ellen G; Deveikis, John P; Harrigan, Mark R; Thompson, B Gregory; Mukherji, Suresh K
Carotid balloon test occlusion (BTO) is used to assess the collateral circulation and cerebrovascular reserve in patients in whom carotid artery occlusion is contemplated. Eight patients in whom the test was successful were evaluated with perfusion computed tomography (CT) in the resting state and after acetazolamide challenge. Three of the patients showed symmetric blood flow and normal response to acetazolamide. One of them underwent permanent carotid occlusion and did not develop any delayed ischemic stroke. The remaining five patients showed asymmetric blood flow. One of them had markedly low blood flow and abnormal response to acetazolamide. The patient developed ipsilateral hemispheric stroke following permanent carotid occlusion after the superficial temporal artery to middle cerebral artery bypass graft occluded. In the other four patients, the steal phenomenon was seen in ipsilateral and contralateral hemispheres. Although definitive quantitative values for perfusion CT are not yet standardized, it may be feasible to predict that the patients with symmetric blood flow and normal acetazolamide-enhanced challenge test results will do well after permanent carotid occlusion. Patients with asymmetric blood flow and abnormal response to the acetazolamide challenge test may require a revascularization procedure to protect them from delayed ischemic stroke.
PMID: 15118119
ISSN: 0033-8419
CID: 455542
Cerebral perfusion CT: technique and clinical applications
Hoeffner, Ellen G; Case, Ian; Jain, Rajan; Gujar, Sachin K; Shah, Gaurang V; Deveikis, John P; Carlos, Ruth C; Thompson, B Gregory; Harrigan, Mark R; Mukherji, Suresh K
Perfusion computed tomography (CT) is a relatively new technique that allows rapid qualitative and quantitative evaluation of cerebral perfusion by generating maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). The technique is based on the central volume principle (CBF = CBV/MTT) and requires the use of commercially available software employing complex deconvolution algorithms to produce the perfusion maps. Some controversies exist regarding this technique, including which artery to use as input vessel, the accuracy of quantitative results, and the reproducibility of results. Despite these controversies, perfusion CT has been found to be useful for noninvasive diagnosis of cerebral ischemia and infarction and for evaluation of vasospasm after subarachnoid hemorrhage. Perfusion CT has also been used for assessment of cerebrovascular reserve by using acetazolamide challenge in patients with intracranial vascular stenoses who are potential candidates for bypass surgery or neuroendovascular treatment, for the evaluation of patients undergoing temporary balloon occlusion to assess collateral flow and cerebrovascular reserve, and for the assessment of microvascular permeability in patients with intracranial neoplasms. This article is a review of the technique, clinical applications, and controversies surrounding perfusion CT.
PMID: 15118110
ISSN: 0033-8419
CID: 455552
Endovascular management of poor-grade aneurysmal subarachnoid hemorrhage in the geriatric population
Jain, Rajan; Deveikis, John; Thompson, Byron Gregory
BACKGROUND AND PURPOSE: The incidence of poor-grade (Hunt and Hess grade IV and V) subarachnoid hemorrhage (SAH) is higher in elderly patients (>70 years) than in younger groups. The aim of this retrospective study was to analyze the outcome of these poor grade elderly patients after endovascular treatment. METHODS: We retrospectively reviewed the clinical records of 27 patients older than 70 years who underwent endovascular treatment for aneurysmal SAH between January 1996 and July 2002. Thirteen patients with SAH and a poor Hunt and Hess grade at initial presentation had been treated by endovascular means. Their outcomes were assessed by the using the Glasgow Outcome Scale (GOS). RESULTS: Two patients (15%) had a good outcome according to the GOS. Three patients (23%) were moderately disabled, two (15%) were severely disabled at the time of discharge from the hospital, and six (47%) died. Five patients (38%) developed clinical vasospasm and underwent balloon angioplasty. Three procedure-related deaths occurred (23%). CONCLUSION: Endovascular treatment has modified the management of poor-grade SAH in elderly patients, most of whom are high-risk surgical candidates. Endovascular treatment can be administered early after the initial ictus, reducing the risk of rebleeding and providing an option to pursue aggressive triple-H therapy. Symptomatic vasospasm can also be treated by endovascular means in the initial setting.
PMID: 15090348
ISSN: 0195-6108
CID: 455562
Case 68: Hirayama disease [Case Report]
Gandhi, Dheeraj; Goyal, Mayank; Bourque, Pierre R; Jain, Rajan
PMID: 14990837
ISSN: 0033-8419
CID: 455572