Our study demonstrates that survival has improved within the same period that intraoperative ultrasound and neuronavigation was introduced and established in our department. The demonstrated association is a necessity for causation, but given the nature of this study, one must be cautious to claim causality. The improvement was, however, significant after adjustment for known major prognostic factors.
M agnetic resonance imaging has clearly revolutionized many fields of medicine, not least neurology, neuro-oncology, and neurosurgery. Today, diagnosing or ruling out intracranial disease without a cerebral MRI scan is exceedingly rare, and perhaps even no longer recommended. However, the toll for patients can be incidental findings. In asymptomatic volunteers, incidental abnormalities were seen in 18% of cerebral MRI scans, and 2.9% required further referral.7 In another study, 1.6% of healthy volunteers who underwent 1.5-T cerebral MRI scans were diagnosed with primary, most often benign tu- mors.18 It is often speculated that the increase in brain tumor incidence observed over recent decades may at least partially be explained by increased use of MRI. 2,3,5,6,[14][15][16] However, a direct population-based comparison of MRI use and brain tumor incidence rates is lacking.In a population-based study we aimed to investigate whether regional cerebral MRI use correlates to regional incidence of intracranial tumors as reported to the Cancer Registry of Norway. We also sought to study whether a possible effect of MRI on observed brain tumor incidence has affected treatment rates or observed patient survival.Effects of cerebral magnetic resonance imaging in outpatients on observed incidence of intracranial tumors and patient survival: a national observational study Object. It is assumed that the observed increase in brain tumor incidence may at least partially be explained by increased use of MRI. However, to date no direct estimate of this effect is available. The authors undertook this registry-based study to examine whether regional frequencies of cerebral MRI use correlate to regional incidence rates of intracranial tumors and survival of patients with these lesions.Methods. The authors used Norwegian national population registries from January 2002 through December 2007 to conduct this observational study. They obtained information on outpatient MRI scans in Norwegian counties and examined whether the annual regional rates of cerebral MRI scans correlated to regional age-and sex-adjusted brain tumor incidence rates. They also explored whether differences in cerebral MRI use were associated with survival and examined time trends in the study period.Results. Approximately 50,000 cerebral MRI scans are carried out annually in outpatient settings in Norway, and 6363 primary intracranial tumors were diagnosed in Norway during the study period. There was an overall positive correlation between the annual number of cerebral MRI scans per 100,000 capita and age-and sex-adjusted incidence rates of intracranial tumors in the various Norwegian counties (Spearman's rho = 0.35, p < 0.001). In a linear model, an increase in 1 MRI per 100,000 capita per year results in a 0.004 (95% CI 0.002-0.006) increase in diagnosed intracranial tumors per 100,000 capita per year (p < 0.001). Subgroup analysis showed a correlation between MRI use and the annual age-and sex-adjusted incidence rates of extraaxial tumors (p = 0.04, Spearman's ...
Background Inflammatory aneurysms and mycotic aneurysms make up a minority of abdominal aortic aneurysms. Mainly autoimmune mechanisms are proposed in the pathogenesis of inflammatory aneurysms, and it is not routine to check for infectious agents as disease culprits. Case presentation A 58-year-old European male with complaints of abdominal and back pain for 8 weeks was admitted after a semi-urgent computed tomography scan revealed an 85 mm inflammatory abdominal aortic aneurysm. The patient had normal vital signs, slightly elevated inflammatory markers, and mild anemia on admission. Clinical examination revealed a tender pulsating mass in his abdomen. His clinical condition was interpreted as impending rupture and urgent repair of the aneurysm was deemed necessary. Due to the patient’s relatively young age and aneurysm neck morphology, open aortic repair was preferred. Preoperatively, the aneurysm appeared inflamed, with fibrous wall thickening and perianeurysmal adhesions. Aneurysm wall biopsies were sent to histopathological and microbiological diagnostics. Routine cultures were negative, but 16S rRNA gene real-time polymerase chain reaction was positive and Borrelia afzelii was identified by DNA sequencing of the polymerase chain reaction product. B. afzelii was also identified by sequencing the polymerase chain reaction product of a Borrelia-specific groEL target. Immunoglobulin G and M anti-Borrelia antibodies were present on serological analysis. Histopathological analysis displayed loss of normal aortic wall structure and diffuse infiltration of lymphocytes and plasma cells. The patient had an uneventful recovery and was discharged after 1 week to a regional rehabilitation facility. Though the patient fares clinically well and inflammatory markers had normalized, antimicrobial treatment with doxycycline continues at 3 months follow-up due to remaining radiologic signs of inflammation. Conclusions Borrelia infection in the setting of acute aortic pathology is a rare entity. To our knowledge, this is the first case report to demonstrate a mycotic abdominal aortic aneurysm as a rare manifestation of Lyme disease. Aortic wall biopsies and real-time polymerase chain reaction analysis of the specimen were essential for accurate diagnosis. This finding may contribute to the understanding of the etiology of inflammatory aneurysmal disease and abdominal aneurysms in general.
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