Asymmetric distribution of enlarged perivascular spaces in centrum semiovale may be associated with epilepsy after acute ischemic stroke.

OBJECTIVE: To investigate the factors influencing enlarged perivascular space (EPVS) characteristics at the onset of acute ischemic stroke (AIS), and whether the PVS characteristics can predict later post-stroke epilepsy (PSE). METHODS: A total of 312 patients with AIS were identified, of whom 58/312 (18.6%) developed PSE. Twenty healthy participants were included as the control group. The number of PVS in the basal ganglia (BG), centrum semiovale (CS), and midbrain (MB) was manually calculated on T2 -weighted MRI. The scores and asymmetry index (AI) of EPVS in each region were compared among the enrolled participants. Other potential risk factors for PSE were also analyzed, including NIHSS at admission and stroke etiologies. RESULTS: The EPVS scores were significantly higher in the bilateral BG and CS of AIS patients compared to those of the control group (both p < 0.01). No statistical differences in EPVS scores in BG, CS, and MB were obtained between the PSE group and the nonepilepsy AIS group (all p > 0.01). However, markedly different AI scores in CS were found between the PSE group and the nonepilepsy AIS group (p = 0.004). Multivariable analysis showed that high asymmetry index of EPVS (AI≥0.2) in CS was an independent predictor for PSE (OR = 3.7, 95% confidence interval 1.5-9.1, p = 0.004). CONCLUSIONS: Asymmetric distribution of EPVS in CS may be an independent risk factor and a novel imaging biomarker for the development of PSE. Further studies to understand the mechanisms of this association and confirmation with larger patient populations are warranted.

The Consequences of Inadvertent Radical Nephrectomy in the Treatment of Upper Tract Urothelial Carcinoma.

OBJECTIVE: To determine factors associated with performing inadvertent radical nephrectomy (RN) for upper tract urothelial carcinoma (UTUC), and to assess the impact of radical nephrectomy on overall survival (OS) compared to radical nephroureterectomy (NU). METHODS: Using the National Cancer Database (NCDB), patients with UTUC of the renal pelvis who were diagnosed with renal cortical tumors and underwent RN (n = 820) with subsequent surgical pathology demonstrating urothelial carcinoma were identified. These patients were compared to those diagnosed with renal pelvis tumors who appropriately underwent NU (n = 16,464) between 2005 and 2015. Multivariable logistic regression was used to determine patient, facility and tumor-related factors associated with undergoing RN. The impact of surgery (RN vs NU) on OS was determined by Cox-regression after propensity score matching. RESULTS: A total of 4.7% patients with UTUC underwent inadvertent RN. Black race (adjusted odds ratio [aOR] 1.62, 95%CI 1.23-2.13), larger tumors, advanced tumor stage, and high-grade tumors (P < 0.0001) were associated with RN. However, surgery at a facility performing a higher volume of NU/year was associated with lower odds of having RN performed (aOR 0.85, 95%CI 0.75-0.97). After propensity score matching, the 5-year OS was 39.9% for those undergoing RN vs 49.9% for those undergoing NU (hazard ratio 1.45, 95%CI 1.30-1.62). CONCLUSION: Inadvertent RN is not uncommon, occurring in almost 5% of patients with UTUC in the NCDB. Patients who underwent RN had significantly worse OS as compared to those treated with NU. These data highlight that accurate diagnosis of UTUC is paramount and clinicians should not hesitate to perform further workup when imaging findings are equivocal.

Association of Smoking and Death from Genitourinary Malignancies: Analysis of the National Longitudinal Mortality Study.

PURPOSE: We explored the association between tobacco use and genitourinary cancer specific survival in a contemporary, nationally representative sample of the United States civilian population. MATERIALS AND METHODS: A total of 493,282 participants in the National Longitudinal Mortality Study who provided detailed tobacco information from 1993 to 2005 were included in study. Our primary outcome was death from bladder, kidney or prostate cancer. Cause of death was determined from death certificates. Analyzed smoking parameters included smoking status at the time of the survey, age at the start of smoking and home smoking rules. Multivariable Cox regression models were used to assess associations of different smoking parameters with bladder, kidney and prostate cancer specific mortality. RESULTS: During a 5-year followup 5.6% of participants who had ever smoked died compared to 3.1% of those who had never smoked (p <0.0001). Of those who died of bladder, kidney and prostate cancer 62%, 58% and 62%, respectively, were ever smokers. On multivariable analysis ever smoking was associated with bladder and kidney cancer mortality (HR 1.92, 95% CI 1.25-2.97, and HR 1.54, 95% CI 1.01-2.34, respectively). Additionally, starting to smoke during teenage years and smoking at home were associated with bladder cancer specific mortality (HR 2.14, 95% CI 1.28-3.56 and HR 2.99, 95% CI 1.34-6.65) and kidney cancer specific mortality (HR 1.65, 95% CI 1.03-2.66 and HR 2.84, 95% CI 1.54-5.23, respectively). However, only everyday smoking was associated with an increased risk of prostate cancer mortality (HR 1.81, 95% CI 1.30-2.53). CONCLUSIONS: In a nationally representative study we confirmed the association between smoking intensity and mortality from genitourinary malignancies. Starting to smoke at a younger age and smoking at home conferred a significantly higher risk of death from bladder and kidney cancers.

Kidney Stones and Risk of Narcotic Use.

PURPOSE: The rise in opioid related deaths and addiction has been linked to physician prescribing. Opioids are commonly prescribed to patients with renal colic due to nephrolithiasis. The aim of this study was to describe the relationship between nephrolithiasis and opioid use in the United States. MATERIALS AND METHODS: Using the NHANES (National Health and Nutrition Examination Survey) we analyzed the relationship between a self-reported history of kidney stones and current opioid use in a nationally representative sample. RESULTS: Current opioid use was significantly greater among those who did vs did not report a history of kidney stones (10.9%, 95% CI 9.1-12.9 vs 6.1%, 95% CI 5.4-6.8). The prevalence of opioid use increased with the number of kidney stones passed, reaching 13.7% (95% CI 11.1-16.9) in subjects who had passed 2 or more stones (p <0.001). On multivariable logistic regression analysis adjusting for age, gender, smoking status, number of health care visits in the last year and comorbid conditions nephrolithiasis was independently associated with opioid based medication use (OR 1.27, 95% CI 1.07-1.49, p = 0.006). CONCLUSIONS: The association between a history of kidney stones and current narcotic use suggests that nephrolithiasis may be a risk factor for long-term opioid use. While this study is limited by the cross-sectional design and the absence of detailed stone histories, it adds to the evidence that altering pain management strategies may be beneficial in this population.

Enfoque diagnóstico de las mielopatías / Diagnostic approach to myelopathies

Mielopatía es un término general que hace referencia a la afectación medular por múltiples etiologías. Las enfermedades de la médula espinal tienen con frecuencia consecuencias devastadoras: pueden producir cuadriplejía, paraplejía y déficits sensitivos graves debido a que la médula espinal está contenida en un canal de área pequeña. Muchas de estas enfermedades de la médula espinal son reversibles si se reconocen con oportunidad, por ello los radiólogos deben sensibilizarse sobre la importancia de las imágenes por resonancia magnética en el enfoque de una patología multifactorial en la cual el pronóstico depende del diagnóstico precoz y preciso, y por ello constituyen una de las urgencias neurológicas más importantes.

Hallazgos tomográficos del melanoma metastásico CT Findings of Metastatic Melanoma / CT findings of metastatic melanoma

El melanoma es un tumor poco frecuente de la piel; sin embargo, es la neoplasia que causa mayor mortalidad dentro de estos tumores y su incidencia aumenta progresivamente. El melanoma maligno puede dar metástasis a cualquier parte del cuerpo, y los sitios más afectados son los ganglios linfáticos y los pulmones. Los hallazgos por imagen de algunas de sus metástasis y de los órganos afectados son bastante característicos de esta neoplasia. En este artículo se presentan algunas de metástasis de melanoma maligno a múltiples órganos que por sus características de imagen o su localización las hacen típicas de esta patología.