MDCT and MR Urogram Spectrum of Congenital Anomalies of the Kidney and Urinary Tract Diagnosed in Adulthood.

Objective: Congenital anomalies of the kidneys and urinary tract (CAKUT) encompass a spectrum of anomalies that result from genetic, epigenetic, environmental, and molecular signal aberrations at key stages of urinary tract development. CAKUT can be seen incidentally on cross-sectional imaging of the abdomen or can be a cause for adult-onset chronic kidney disease, posing new challenges for nephrologists, urologists, and radiologists.

Conclusion: Awareness of CAKUT and familiarity with their imaging findings permit optimal patient management and thorough workup to prevent hypertension and progression from CAKUT to renal failure.

The somatosensory link in fibromyalgia: functional connectivity of the primary somatosensory cortex is altered by sustained pain and is associated with clinical/autonomic dysfunction.

Objective: Fibromyalgia (FM) is a chronic functional pain syndrome characterized by widespread pain, significant pain catastrophizing, sympathovagal dysfunction, and amplified temporal summation for evoked pain. While several studies have demonstrated altered resting brain connectivity in FM, studies have not specifically probed the somatosensory system and its role in both somatic and nonsomatic FM symptoms. Our objective was to evaluate resting primary somatosensory cortex (S1) connectivity and to explore how sustained, evoked deep tissue pain modulates this connectivity.

Increased pressure pain sensitivity in women with chronic pelvic pain.

Objective: To determine whether women with chronic pelvic pain and variable degrees of endometriosis demonstrate altered pain sensitivity relative to pain-free healthy women in a control group and whether such differences are related to the presence or severity of endometriosis or comorbid pain syndromes.

Methods: Four patient subgroups (endometriosis with chronic pelvic pain [n=42], endometriosis with dysmenorrhea [n=15], pain-free endometriosis [n=35], and chronic pelvic pain without endometriosis [n=22]) were each compared with 30 healthy women in a control group in this cross-sectional study. All patients completed validated questionnaires regarding pain symptoms and underwent screening for comorbid pain disorders.

Comparison of 2 minimally invasive routes for hysterectomy of large uteri.

Objective: To compare the perioperative outcomes associated with 2 minimally invasive surgical routes for the hysterectomy of large fibroid uteri.

Methods: Retrospective review of 84 women undergoing hysterectomy via minilaparotomy (n=54) or robot-assisted laparoscopy (n=30) for uteri weighing at least 500g. Outcome measures included hemorrhage (blood loss of 500mL or more) and postoperative length of stay.

An apparent case of undiagnosed donor Kawasaki disease manifesting as coronary artery aneurysm in a pediatric heart transplant recipient.

We present a case of coronary ectasia and LAD coronary artery aneurysm with angiographic characteristics of Kawasaki disease in a three-yr-old girl two-yr status post-orthotopic heart transplant. Coronary anomalies were noted during initial screening coronary angiography two yr after transplant. Subsequent review of the donor echocardiogram revealed that the LMCA had been mildly dilated prior to transplant.

Risk factors for postoperative urinary retention after laparoscopic and robotic hysterectomy for benign indications.

Objective: To estimate the occurrence of postoperative urinary retention after traditional laparoscopic and robotic hysterectomy.

Methods: We performed a chart review of all patients who underwent total or supracervical hysterectomy using a laparoscopic (n=253) or robotic approach (n=281) from March 2001 until June 2010 for benign indications at the division for minimally invasive surgery. Urinary retention was defined as the inability to spontaneously void or as incomplete voiding requiring either self-catheterization or Foley catheter replacement in the first postoperative week.

Diagnosis and management issues in thoracic aortic aneurysm.

Thoracic aortic enlargement is an increasingly recognized condition that is often diagnosed on imaging studies performed for unrelated indications. The risk of unrecognized and untreated aortic enlargement and aneurysm includes aortic rupture and dissection which carry a high burden of morbidity and mortality. The etiologies underlying thoracic aortic enlargement are diverse and can range from degenerative or hypertension associated aortic enlargement to more rare genetic disorders.

Sleep disturbance in hospitalized recipients of stem cell transplantation.

Disrupted sleep is considered a patient outcome sensitive to oncology nursing care and can lead to a variety of physical and psychologic dysfunctions, such as insomnia, chronic pain, respiratory distress, obesity, stress, and anxiety. Although sleep disturbances have been studied in recipients of hematopoietic stem cell transplantations (HSCTs), these studies have not examined the acute phase of transplantation. The current study aimed to identify the level of sleep disturbance in this patient population, identify factors contributing to decreased ability to sleep for hospitalized recipients of HSCT, and compare the differences in sleep disturbance between age, gender, type of transplantation, and initial stem cell transplantation versus readmission for transplantation-associated complications.

Association of pediatric heart transplant coronary vasculopathy with abnormal hemodynamic measures.

Objective: Transplant coronary artery disease (TCAD) is the limiting factor to long-term cardiac allograft survival; however, presymptomatic diagnosis remains challenging. To that concern, we evaluated the association of abnormal catheter-derived filling pressures with TCAD in pediatric heart transplant (HTx) recipients. DESIGN, PATIENTS, OUTCOME MEASURES: Data from 52 presymptomatic pediatric HTx patients were analyzed.

Effect of epicardial fat on electroanatomical mapping and epicardial catheter ablation.

Objectives: The purpose of this study was to correlate 3-dimensional distribution of epicardial fat on computed tomography (CT) with electroanatomical (EA) voltage maps obtained during percutaneous epicardial mapping in order to determine the fat thickness cut-off that results in voltage attenuation and to establish normal ventricular epicardial voltage criteria in the absence of fat.

Background: Epicardial fat can mimic scar tissue when epicardial voltage mapping is performed, as both result in low epicardial voltage. Cardiac CT can differentiate epicardial fat from scar or muscle on the basis of their distinct attenuations.

Imaging of acute pancreatitis: prognostic value of computed tomographic findings.

Although most cases of acute pancreatitis are uncomplicated and resolve spontaneously, the presence of complications has significant prognostic importance. Necrosis, hemorrhage, and infection convey up to 25%, 52%, and 80% mortality, respectively. Other complications such as pseudocyst formation, pseudoaneurysm formation, or venous thrombosis increase morbidity and mortality to a lesser degree.

Neonatal diabetes mellitus with pancreatic agenesis in an infant with homozygous IPF-1 Pro63fsX60 mutation.

Permanent neonatal diabetes mellitus is a rare disorder known to be caused by activating mutations in KCNJ11 or ABCC8, inactivating mutations in INS, or very rarely in GCK or insulin promotor factor-1 (IPF-1) genes. We report a patient with permanent neonatal diabetes mellitus and severe exocrine pancreatic insufficiency. Ultrasound examination revealed pancreatic agenesis with a suggestion of a small amount of tissue in the head of the pancreas.

Adrenocortical response in infants undergoing cardiac surgery with cardiopulmonary bypass and circulatory arrest.

Objective: To detail changes in adrenocorticotropic hormone (ACTH), cortisol, and aldosterone levels following cardiac surgery and to test the hypothesis that postcardiotomy infants requiring excessively high-dose vasopressor support will demonstrate adrenal insufficiency which will be proportional to cardiopulmonary bypass (CPB)/circulatory arrest times and vasopressor requirements.

Design: Prospective observational pilot study.

Setting: A tertiary care pediatric cardiac intensive care unit.

Ultraperformance liquid chromatography-tandem mass spectrometry assay for iohexol in human serum.

Background: Iohexol is an iodinated contrast dye that has been shown to be useful in the estimation of glomerular filtration rate (GFR) in patients with suspected renal insufficiency. We developed and validated an ultraperformance liquid chromatography (UPLC)-triple quadrupole mass spectrometry (MS/MS) assay for quantifying iohexol in human serum.

Methods: Sample preparation involved dilution of 50 microL serum with 400 microL water, followed by protein precipitation with zinc sulfate and methanol containing the structural analog ioversol as the internal standard.

Technique and diagnostic utility of saline infusion sonohysterography.

The introduction of saline infusion sonohysterography has significantly improved sonographic diagnosis of various endometrial pathologies. This procedure entails instillation of warm saline into the uterine cavity transcervically to provide enhanced visualization of the endometrium during transvaginal ultrasound examination. This article reviews the sonohysterography technique and current utility, as well as the spectrum of imaging features of various endometrial pathologies.

Gastrointestinal manifestations of diabetes mellitus: spectrum of imaging findings.

Diabetes mellitus is the most common multisystemic endocrine disorder. It can be complicated by several serious gastrointestinal manifestations that can be depicted by a variety of imaging methods. This article reviews the most commonly depicted gastrointestinal and hepatobiliary findings in patients with diabetes mellitus.

Computed tomography and magnetic resonance features of renal Ewing sarcoma.

Ewing sarcoma (ES) is a rare malignant tumor that primarily involves long and flat bones but can develop in almost any bone or soft tissue. ES accounts for 2.3-3.

MRI characterization of 124 CT-indeterminate focal hepatic lesions: evaluation of clinical utility.

Objective: To evaluate the diagnostic yield of MRI performed for characterization of focal hepatic lesions that are interpreted as indeterminate on CT.

Patients And Methods: In a retrospective investigation, 124 indeterminate focal hepatic lesions in 96 patients were identified on CT examinations over 5 years from 1997 to 2001. All patients had MRI performed for the liver within 6 weeks of their CT examination.

The central scar: pathophysiology and imaging features.

The central scar is a relatively uncommon radiologic finding. However, when present, it is a highly useful imaging feature which may suggest a specific diagnosis in patients with renal, hepatic, or pancreatic masses of unknown etiology. This pictorial review will serve to illustrate the computed tomography, magnetic resonance, and ultrasonographic imaging features of abdominal neoplasms associated with a central scar.

Closed-loop small-bowel obstruction: diagnostic patterns by multidetector computed tomography.

Multidetector computed tomography is a highly accurate method in evaluating high-grade intestinal obstruction. Closed-loop obstruction is a relatively uncommon subcategory of small-bowel obstruction; however, it is associated with a high risk of vascular impairment and is, therefore, important to diagnose accurately. Closed-loop obstruction is often caused by conditions such as internal hernias, congenital bands, postoperative adhesions, and malrotation.