Gender differences in anxiety and depressive symptoms in patients with primary hyperaldosteronism: A cross-sectional study

Objective. The renin-angiotensin-aldosterone-system (RAAS) has gained increasing attention in the investigation of the pathogenesis of depression. Primary hyperaldosteronism (PA) is associated with a marked aldosterone excess. Prior studies on PA describe an increased prevalence of anxiety and sub-threshold depressive symptoms in these patients. Methods. In a cross-sectional exploratory study we investigated 132 patients with PA. Twenty-seven patients were studied before initiation of specific treatment (U = untreated), 56 were studied 5.4 years after initiation of mineralocorticoid antagonist treatment (MRA) and 49 patients were studied 4.3 years after unilateral adrenalectomy (ADX). GAD-7 and PHQD self-rating questionnaires were used to assess symptoms for anxiety and depression. Results. No significant difference was found between the three investigated groups. A higher prevalence for depression and anxiety compared to the normal population was found. Women of all groups had higher mean values compared to men, for depression in untreated patients this difference was found to be significant. Correlations between the psychopathology and hormones were only found for renin. Plasma renin concentration correlated significantly with anxious symptoms of untreated females. Conclusions. This study supports the RAAS to be involved in the pathogenesis of depression as patients with PA seem to be more depressive and anxious compared to the normal population. Gender differences in the regulation of the RAAS seem to be apparent, as females were more affected by the dysregulation than males.     

Decompression of the anterior thoracic spinal canal using a novel full‐endoscopic uniportal transthoracic retropleural technique—an anatomical feasibility study in human cadavers

Surgery for thoracic disc herniation and spinal stenosis is comparatively rare and often demanding. The goal is to achieve sufficient decompression without manipulating the spinal cord. Individual planning and various surgical techniques and approaches are required. This anatomical study examines the feasibility of a novel full‐endoscopic uniportal technique with a transthoracic retropleural approach for decompression of the anterior thoracic spinal canal. Operations were performed on three fresh adult cadavers. The endoscope used, from RIWOspine, Germany, has a shaft cross‐section of 6.9 × 5.9 mm and a 25° view angle. It contains an eccentric intraendoscopic working channel with a diameter of 4.1 mm. A transthoracic retropleural approach was used. The anatomical structures were dissected and the anterior thoracic epidural space was decompressed. The planned steps of the operation were performed on all cadavers. The transthoracic retropleural approach allowed the target region to be accessed easily. The anatomical structures could be identified and dissected. The anterior thoracic epidural space could be decompressed sufficiently. Using the uniportal full‐endoscopic operation technique with a transthoracic retropleural approach, the anterior thoracic epidural space can be adequately reached. This is a minimally invasive method with the known advantages of an endoscopic technique under continuous irrigation. The retropleural approach allows direct access. The instruments are available for clinical use and have been established for years in other operations on the entire spine. Clin. Anat. 31:716–723, 2018. © 2018 Wiley Periodicals, Inc.     

Detection of acute pulmonary embolism: feasibility of diagnostic accuracy of MRI using a stepwise protocol

Multidetector computed tomography (MDCT) has become the imaging method of choice in patients suspected of having pulmonary embolism (PE) but has the inherent limitation of radiation dose and the side effects of contrast agents. The purpose of the study was to assess the feasibility of a stepwise MRI protocol in the clinical setting of acute PE. The stepwise approach should make it possible to diagnose acute PE in critically ill patients using fast MR sequences and included the option to add comprehensive sequences when patients were stable. Forty-five patients with acute PE (26 men, 19 women; 41?±?16 years) were included in this prospective study. The diagnosis was initially confirmed by MDCT as gold standard. MRI at 1.5 T was subsequently performed without any delay in medical treatment. The MRI protocol proceeded stepwise from robust to detailed imaging techniques (i.e., from TrueFISP and single shot HASTE sequence to MR perfusion and 3D-MR angiography) if the patient was able to tolerate additional imaging time. Diagnostic accuracy was evaluated on the central (lobar) and peripheral (segmental) levels. The complete MR protocol was applied in 40 of the 45 patients (88 %). In the remaining five patients with severe dyspnea the diagnosis of acute PE was established by using fast TrueFISP sequences that were insensitive to respiratory movement. All five patients suffered from a major central PE. Highest sensitivity was achieved by MR perfusion (lobar, 98 %; segmental, 95 %). Real-time TrueFISP and MR angiography showed the highest specificity (lobar, 90–100 %; segmental, 95–97 %). The combination of all MR sequences matched closely the results of MDCT (lobar: sensitivity 98 %, specificity 100 %; segmental: sensitivity 95 %, specificity 97 %). MRI using a stepwise protocol is a promising approach for diagnosing acute PE. The protocol can be tailored for dyspneic patients with central PE using real-time MRI sequences. The diagnostic accuracy for peripheral PE can be improved by using combined MR techniques, achieving comparable results to MDCT.     

The red connection: a review of aortic and arterial fistulae with an emphasis on CT findings

Fistulae between the aorta and adjacent structures are a rare, emergent, and potentially life-threatening process. Most commonly, aortic fistulae arise secondarily as a complication of prior aortic surgery with fistulization to adjacent structures. Rarely, a primary fistula may arise from the aorta in the setting of a pre-existing aneurysm or from a mass, inflammation, or infection. Although the incidence of aortic fistulae remains low, the frequency continues to increase as aortic surgical interventions and post-surgical follow-up with imaging become more common. Computed tomography (CT) is the modality of choice in evaluating the patient with suspected aortic fistula because of its accessibility and short scan time. In addition, CT allows for more clear depiction of para-aortic or intra-aortic gas than ultrasound or magnetic resonance (MR). This gas may be the first clue of a fistula. Given the high mortality associated with aortic fistulae, familiarity with the imaging findings of the spectrum of aortic fistulae is essential knowledge in the emergency setting. This review will discuss the imaging appearance of aortic and arterial fistulae to the bronchi, esophagus, gastrointestinal tract, ureters, and veins on CT.