Magnetic resonance imaging of female prostate pathology.

INTRODUCTION: The female prostate (paraurethral glands) is a well-known, yet poorly understood, anatomic structure. Imaging studies of the female prostate, its physiology, and pathologies are still highly controversial. AIM: To study the anatomy of the female prostate with contemporary magnetic resonance imaging (MRI) techniques and correlate these findings to clinical features. MAIN OUTCOME MEASURES: Female prostate pathologic anatomy on MRI. METHODS: Women with clinical signs of function (or dysfunction) of paraurethral glands have been examined with 1.5 or 3 Tesla MRI and urethroscopy. RESULTS: Seven women aged 17 to 62 years (median 40 years) have been prospectively included into the study. Clinically, one of the seven women reported ejaculation at orgasm, whereas three women presented with occasional secretions independent of sexual stimulation. In two women, paraurethral glands have been randomly found on MRI that has been performed in the diagnostic workup of other diseases. One woman presented with swelling of the external urethral meatus at puberty. In this woman, a paraurethral gland has been found, besides the erectile tissue at the external meatus. Two women reported lower urinary tract symptoms (LUTS) with mainly urethral symptoms (recurrent infections in one and paraurethral stones in the other). On MRI, paraurethral glands could be visualized in six of the seven patients. There was no relation between glandular volume and ejaculation status. In cases where glands or related pathologies could be found on physical examination, there was a clear correlation with MRI anatomy. CONCLUSIONS: MRI has the potential to become the standard imaging modality for female prostate pathology. Exact visualization of this highly variable structure is possible by tailored MRI protocols. This tool can aid in understanding an individual woman's symptoms related to paraurethral glands with an impact on her sexual life.

Recurrent posterior reversible encephalopathy syndrome in mitochondrial disorder.

OBJECTIVES: Recurrent posterior reversible encephalopathy syndrome (PRES) has not been reported in association with multi-system mitochondrial disorder (MID). CASE REPORT: In a 60-year-old HIV-negative, Caucasian female with short stature, double vision, struma, memory impairment, chronic renal failure requiring hemodialysis, seizures, intermittent atrial fibrillation, arterial hypertension, hyperlipidemia, anemia, hypacusis, tinnitus, and a daughter with multiple sclerosis, short stature and hypothyroidism; another daughter with schizophrenia, and a son who died from encephalopathy at age 3 months, an MID was suspected. At age 53 years, she experienced sudden, transient blindness for 2 days bilaterally during an episode of high blood pressure with complete recovery within 2 weeks. At age 60 years, a similar episode occurred. Four weeks later, she experienced a third PRES episode with high blood pressure, seizures, impaired consciousness and reversible blindness for 2 days. MRI at the second episode was indicative of a PRES, and MRI at the third episode additionally revealed occipital bleedings, acute embolic stroke and features indicating PRES. CONCLUSIONS: This case indicates that MID may be associated with recurrent PRES, triggered by recurrent episodes of high blood pressure. Whether high blood pressure was a manifestation of the MID or related to other causes remains speculative. PRES does not seem to be a primary but is rather a secondary manifestation of an MID.

Recovery from acute paraplegia due to spontaneous spinal, epidural hematoma under minimal-dose acetyl-salicylic acid.

OBJECTIVE: Spontaneous spinal epidural hematoma (SEH) has not been reported under anti-thrombotic therapy with acetyl-salicylic acid (ASA) in a dosage of 50 mg/d. METHODS: Spinal MRI, emergency laminectomy. RESULTS: A 77-yo, HIV-negative female under longterm treatment over three years with ASA 50 mg/d for varicositas, prescribed by her general practitioner, experienced sudden onset back pain with radiation towards both knees after getting up in the morning. One-and-a-half hours later she also developed ascending hypesthesia and weakness originating from both distal lower limbs. Three hours after onset, hypesthesia had reached the T10-level bilaterally and she had become paraplegic. There was reduced intestinal motility, stool incontinence, and urinary hesitancy. MRI of the thoraco-lumbar spine demonstrated a SEH T9-L1 indenting the dural sack and compressing the myelon. Immediately after emergency laminectomy T10-12 with micro-surgical evacuation of the clot, 12 h after onset, she could move both legs again and was able to walk with support 7 days after surgery. CONCLUSIONS: This case shows that SEH occurs under a minimal dose of ASA and that such patients rapidly recover upon immediate surgical decompression and evacuation of the hematoma.

Diagnosing left ventricular noncompaction by echocardiography and cardiac magnetic resonance imaging and its dependency on neuromuscular disorders.

BACKGROUND: Left ventricular hypertrabeculation (LVHT), also termed noncompaction LVHT, is diagnosed by echocardiography or cardiac magnetic resonance imaging (CMRI), and associated with neuromuscular disorders (NMD). The aim of this study was to assess if LVHT can be diagnosed by CMRI applying echocardiographic definitions. METHODS AND RESULTS: The CMRI images of 19 echocardiographically diagnosed LVHT patients were re-evaluated (10 female, 14-67 y of age). Left ventricular hypertrabeculation was diagnosed by CMRI in 9 cases. Patients with CMRI-diagnosed LVHT were more often females (67% versus 40%), experienced heart failure more often (100% versus 50%), had an LV end diastolic diameter > 57 mm (67% versus 40%), had an LV fractional shortening < 25% (89% versus 40%), and had a larger extension of LVHT than patients without CMRI-diagnosed LVHT. The prevalence of NMD (87%) did not differ between both groups. CONCLUSIONS: Echocardiographic definition for CMRI yielded the diagnosis of LVHT in only 47%. When looking for LVHT by CMRI, LV size, function, and extension of LVHT have to be considered.

Treatment of gastro-jejunal leakage and fistulization after gastric bypass with coated self-expanding stents.

Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gastric bypass (RYGBP) surgery. Most authors agree that operative treatment is the mainstay of therapy in patients with signs of sepsis. However, intestinal contents causing localized infection may impede healing of sutured leaks in some patients, and fistulas develop. Because the anastomosis cannot be disconnected or exteriorized for anatomical reasons, other forms of treatment have to be applied. The following case-reports describe a technique with implantation of coated self-expanding stents. Leakage of the gastro-jejunostomy occurred in one patient 3 days after RYGBP and resulted in formation of a fistula. A fistula developed in a second patient 63 days after RYGBP. Coated self-extending stents were implanted endoscopically in both patients on postoperative days 19 and 67. Enteral nutrition could be started 6 days later. Stents were removed 2 months after implantation without problems. Weight loss and quality of life 7 and 21 months after stent removal have been excellent in both patients. Implantation of coated self-expanding stents was an effective and minimally invasive option for gastro-jejunal anastomotic fistulas after RYGBP where surgical repair was not possible. In these cases, application of stents allows septic source control without any other intervention.