Heart Failure and Cardiorenal Syndrome: A Narrative Review on Pathophysiology, Diagnostic and Therapeutic Regimens-From a Cardiologist's View.

In cardiorenal syndrome (CRS), heart failure and renal failure are pathophysiologically closely intertwined by the reciprocal relationship between cardiac and renal injury. Type 1 CRS is most common and associated with acute heart failure. A preexistent chronic kidney disease (CKD) is common and contributes to acute kidney injury (AKI) in CRS type 1 patients (acute cardiorenal syndrome). The remaining CRS types are found in patients with chronic heart failure (type 2), acute and chronic kidney diseases (types 3 and 4), and systemic diseases that affect both the heart and the kidney (type 5). Establishing the diagnosis of CRS requires various tools based on the type of CRS, including non-invasive imaging modalities such as TTE, CT, and MRI, adjuvant volume measurement techniques, invasive hemodynamic monitoring, and biomarkers. Albuminuria and Cystatin C (CysC) are biomarkers of glomerular filtration and integrity in CRS and have a prognostic impact. Comprehensive "all-in-one" magnetic resonance imaging (MRI) approaches, including cardiac magnetic resonance imaging (CMR) combined with functional MRI of the kidneys and with brain MRI are proposed for CRS. Hospitalizations due to CRS and mortality are high. Timely diagnosis and initiation of effective adequate therapy, as well as multidisciplinary care, are pertinent for the improvement of quality of life and survival. In addition to the standard pharmacological heart failure medication, including SGLT2 inhibitors (SGLT2i), renal aspects must be strongly considered in the context of CRS, including control of the volume overload (diuretics) with special caution on diuretic resistance. Devices involved in the improvement of myocardial function (e.g., cardiac resynchronization treatment in left bundle branch block, mechanical circulatory support in advanced heart failure) have also shown beneficial effects on renal function.

Eight-Year Experience With 3-T Intraoperative MRI Integration in Focal Pediatric Epilepsy Surgery: Impact on Extent of Resection, Residual Volumes, and Seizure Outcomes.

OBJECTIVE. The purpose of this study was to investigate the influence of 3-T intraoperative MRI (ioMRI) on the extent of resection of pediatric focal epileptogenic lesions, residual lesion volumes, and postoperative seizure outcomes. MATERIALS AND METHODS. All surgical procedures for focal epilepsy from 2003 to 2017 were retrospectively reviewed. Patients were divided into two groups: those who underwent ioMRI and those who did not. Each group was subdivided into two subcategories according to preoperative MRI visualization of the lesion: those with well-defined and those with poorly defined lesions. The volumes of preoperative lesions and postoperative residual lesions were delineated. Outcome data and patient characteristics were reviewed. The results were compared between the two groups and the two subcategories. RESULTS. Eighty patients were included: 45 in the ioMRI group (24 with well-defined lesions, 21 with poorly defined lesions) and 35 in the non-ioMRI group (18 with well-defined lesions, 17 with poorly defined lesions). The well-defined lesions included tumors and vascular lesions. The poorly defined lesions included malformations of cortical development, hippocampal sclerosis, and tuberous sclerosis. The mean follow-up duration was 5.1 ± 3.3 years. The rate of gross total resection was not significantly different between the ioMRI and non-ioMRI groups (p = 0.46). However, ioMRI findings facilitated further resection during surgery, increasing gross total resection by an additional 11.1%. The ioMRI group had a significant reduction in percentage of residual volume (p < 0.001). Outcome data suggested that ioMRI is protective against poor Engel score (p = 0.048). Although ioMRI prolonged the mean operative time by 1.2 hours (p = 0.002), the additional time was not associated with additional complications. CONCLUSION. Integration of ioMRI into focal epilepsy surgery was associated with smaller residual lesions and was protective against poor Engel score. It prolonged the operative time but without increasing the number of complications.

A rare case of extensive spinal epidural abscess in a diabetic patient.

STUDY DESIGN: Case report. OBJECTIVE: We report a rare case of extensive spinal epidural abscess in a patient with diabetes. SUMMARY OF BACKGROUND DATA: Spinal epidural abscess is a very uncommon infection that requires prompt recognition and proper management to avoid potentially disastrous complications. This lesion can expand to compress the spinal cord causing severe symptoms and complications. METHODS: Combination of the patient clinical history, physical examination, laboratory results, radiologic and intraoperative findings along with brief related literature review. RESULTS: We present a rare case of spinal epidural abscess extending to the entire length of the spinal cord in a previously undiagnosed patient with diabetes. CONCLUSION: Diabetes is an important condition that can predispose an individual to the development of localized or extensive spinal epidural abscess.

Multiple bilateral renal oncocytoms in a known case of tuberous sclerosis: a case report.

One of the rare patterns of renal involvement by tuberous sclerosis is oncocytoma. This is a report of a known male patient diagnosed with tuberous sclerosis. He was asymptomatic, but his periodic abdominal ultrasound examination revealed bilateral renal masses. CT and MRI confirmed the presence of these masses which were proven histopathologically to be multiple oncocytomas.

Increasing accuracy of detection of breast cancer with 3-T MRI.

OBJECTIVE: The purposes of this study were to assess the sensitivity and specificity of 3-T MRI compared with those of mammography and sonography in the evaluation of breast cancer and to evaluate the results in light of previously published data obtained with 1-T and 1.5-T systems. MATERIALS AND METHODS: A retrospective review was conducted with data on 434 women (mean age, 53 years) who underwent MRI evaluation of the breasts (n = 868). Results obtained from 3-T MRI, mammographic, and sonographic examinations of all patients were compared. Sensitivity, specificity, and predictive values were calculated, and statistics were analyzed with the chi-square test. RESULTS: The sensitivities of MRI, mammography, and sonography in the detection of malignancy were 100%, 81.8%, and 86.4%, and the specificities were 93.9%, 99%, and 98.1%. The specificity of MRI increased from 92.8% to 94.5% over the course of the study (2006-2007). Compared with mammography (p < 0.001) and sonography (p = 0.001), MRI depicted a significantly higher number of malignant tumors of the breast. There was no significant difference between mammography and sonography (p = 0.095). Results were compared with those in earlier reports in the literature. CONCLUSION: MRI at 3 T is more sensitive than mammography and sonography in the detection of breast cancer and the characterization of small lesions (reaching 4 mm) but has lower specificity. Compared with the results of 1-T and 1.5-T MRI in the literature, 3-T MRI has higher sensitivity in the detection of breast cancer with no significant difference in specificity.