The low dopamine hypothesis: A plausible mechanism underpinning residual urine, overactive bladder and nocturia (RON) syndrome in older patients.

INTRODUCTION: Aging is associated with a combination of several lower urinary tract (LUT) signs and symptoms, including residual urine, overactive bladder and nocturia. One of the mechanisms of this LUT dysfunction that has not been discussed in dept so far is the role of dopamine (DA). METHODS: In this narrative review, we explore the dopaminergic hypothesis in the development of this combination of LUT signs and symptoms in older adults. RESULTS: DA is one of the neurotransmitters whose regulation and production is disrupted in aging. In synucleinopathies, altered DAergic activity is associated with the occurrence of LUTS and sleep disorders. Projections of DAergic neurons are involved in the regulation of sleep, diuresis, and bladder activity. The low dopamine hypothesis could explain the genesis of a set of LUT signs and symptoms commonly seen in this population, including elevated residual urine, Overactive bladder syndrome and Nocturia (discussed as the RON syndrome). This presentation is however also common in older patients without synucleinopathies or neurological disorders and therefore we hypothesise that altered DAergic activity because of pathological aging, and selective destruction of DAergic neurons, could underpin the presentation of this triad of LUT dysfunction in the older population. CONCLUSION: The concept of RON syndrome helps to better understand this common phenotypic presentation in clinical practice, and therefore serves as a useful platform to diagnose and treat LUTS in older adults. Besides recognizing the synucleinopathy "red flag" symptoms, this set of multi-causal LUT signs and symptoms highlights the inevitable need for combination therapy, a challenge in older people with their comorbidities and concomitant medications.

Paclitaxel drug-coated balloon angioplasty for the treatment of failing arteriovenous fistulas: a single-center experience.

Objectives: To report our experience of angioplasty with Lutonix (Bard Peripheral Vascular, Inc., Tempe, AZ) drug-coated balloon (DCB) for the treatment of failing arteriovenous fistulas (AVF).Materials and methods: Retrospective, single-center analysis consisting of 14 patients treated with Lutonix paclitaxel DCBs in the period from July 2015 through April 2017. We analyzed technical success, clinical success, primary patency of the target lesion, primary patency of the dialysis circuit, and the rate of complications. Regular follow-up of AVF patency was realized by clinical examination and duplex ultrasonography. The Kaplan-Meier survival method was applied to determine the cumulative primary patency of the target lesion and the dialysis circuit.Results: Technical success was 100% and clinical success 92.9%. There were no major or minor complications. Cumulative target lesion primary patency after DCB was 69.2% at 6 months and 31.6% at 12 months. Cumulative vascular circuit primary patency was 61.5% at 6 months and 31.6% at 12 months.Conclusion: Compared to results reported in literature with plain old balloon angioplasty (POBA), Lutonix paclitaxel DCB angioplasty proved a short-term patency benefit in treatment of dialysis AVF stenosis.

[Neurosyphilis revealed by a multiple cranial neuropathy: magnetic resonance imaging findings]. / Neurosyphilis révélée par une atteinte multiple des nerfs crâniens: apport de l'imagerie par résonance magnétique nucléaire.

INTRODUCTION: We report the magnetic resonance imaging (MRI) findings in a case of neurosyphilis revealed by the involvement of two cranial nerves. CASE REPORT: A 41-year-old man developed a right cochleovestibular and left trigeminal neuropathy, associated with high serum titers of VDRL and TPHA, high titers of TPHA in the cerebrospinal fluid (CSF) and several CSF oligoclonal IgG bands. On MRI, hypertrophy and gadolinium contrast enhancement of these cranial nerves were associated with several supratentorial cortical nodules surrounded by marked cerebral edema, corresponding to syphilitic gummas. One of these cortical nodules was biopsied. Microscopic examination showed lesions of meningoencephalitis with necrosis and granulomatous vasculitis. After penicillin therapy, the serum VDRL titers and the MRI abnormalities disappeared, a partial clinical recovery was observed and a significant reduction of the serum TPHA titers was found. DISCUSSION: Such MRI abnormalities are not specific and can be observed in various tumoral, auto-immune and infectious diseases. They can also mimic neurofibromatosis type II. Cranial nerve involvements in neurosyphilis can result from nerve inflammation in basal meningitis, nerve ischemia in meningovasculitis or from compression by an adjacent gumma. In our case, the cranial neuropathy was related to a mixed meningovascular and parenchymatous form of neurosyphilis.

The whirl sign in caecal volvulus: a decisive diagnostic clue.

The case of a 35-year-old woman with acute right flank pain, right iliac fossa pain, nausea and vomiting for 6 hours is presented. Plain abdominal radiography and CT scan were performed to find the etiology. These exams showed no signs of colonic obstruction but thickened non-enhancing wall of caecum with ascites was suggestive for ischemia. The whirl sign depicted on CT was the decisive feature for the diagnosis of caecal volvulus.

Hepatic portal venous gas as a complication of diverticulitis with a colovenous fistula: a case report.

We report here a case of sigmoid diverticulitis complicated by a colovenous fistula, as a rare but also a nonfatal cause of hepatic portal venous gas. The different radiological examinations and their features will be discussed.

[Selective embolization of an aneurysm in a massive angiomyolipoma of the kidney]. / Selectieve embolisatie van een aneurysma in een massief angiomyolipoom van de nier.

Forty to 80% of patients with tuberous sclerosis exhibit renal angiomyolipomas which are often multiple and bilateral. Renal ultrasonography has a low sensitivity and a low specificity in the diagnosis of renal angiomyolipomas. Some patients have so many angiomyolipomas that ultrasonography indicates a confluence of angiomyolipomatous tissue throughout the kidney, in which case the size of a separate angiomyolipoma is difficult to estimate and the actual size may be underestimated. However it is an important tool in the follow-up of smaller lesions. With CT and magnetic resonance imaging, the diagnosis of these angiomyolipomas can always be confirmed due to the characteristic fat component. In addition, a better visualisation of the extension of the lesions can be obtained. Once the diagnosis of angiomyolipoma has been established a sonographic follow-up every 6 months is mandatory and feasible. Renal angiomyolipomas larger than 3.5 cm in diameter have a substantial risk for severe hemorrhage which should be treated by selective embolization.