Hungarian Radiology

[Pancreas transplantation: Indication, surgery, complications, diagnostic imaging and outcome]

NÉMETH Andrea, DOROS Attila, HARTMANN Erika, WESZELITS Viola, DABASI Gabriella, LANGER Róbert, MÁTHÉ Zoltán, JÁRAY Jenő

OCTOBER 20, 2007

Hungarian Radiology - 2007;81(05-06)

[Diabetes mellitus is often leading to chronic microvascular and macrovascular complications. At present time, wholepancreas transplantation is the only option to achieve long-term insulin independence. Therefore, simultaneous kidney-pancreas transplantation has become the preferred treatment option for selected patients with type I diabetes mellitus and renal failure. In this review authors describe the indications and main types of pancreas transplantation: simultaneous pancreaskidney transplantation, renal transplantation first then pancreas transplantation, pancreas transplantation alone, islet-cell transplantation, and deal with surgical technical aspects. The immunological, metabolic, inflammatory, technical and late complications are also datailed as well as the outcome of the operations. The importance of the various imaging techniques is emphasized. The rate of mortality and complications are significantly higher after simultaneous kidney-pancreas transplantation than those after kidney transplantation alone. The role of the radiologist is to promote a successful outcome by early detection of the complications.]

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[Intravenous urography has been the gold standard in diagnostic radiology studying the urogeintal system. However, ultrasound and other cross-sectional imaging methods have brought major change in this area. Beside modern (multislice) CT examinations the methods of MR urography are more frequently applied making possible both static and dynamic examinations beyond the wellknown advantages of MR imaging. The authors describe two complemetary methods of MR urography which provide a complete evaluation of the urinary system. The first method is aimed to image stationary fluid by using heavily T2 weighted turbo spin echo pulse sequences. This measurement well depicts the dilations of the excretory system even with little or no excretion of urine. The second method is analogous with the traditional IVU, as the excretion of a less nephrotoxic gadolinium based contrast medium followed by a T1 weighted gradient echo pulse sequence (possibly dynamic) helps to visualise the renal cavities and the urinary pathways. Normal renal function is a prerequisite when using this technique in order to visualise normal and obstructed urinary pathway disorders. The use of MR urography together with traditional MR methods may significantly reduce the number of invasive examinations and methods based on X-ray radiation exposure. MR urography may be exceptionally important in the uroradiological study of distensions of renal cavities in pediatric cases, pregnant women and renal transplant patients or in case of contrast material allergy.]

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[Tarsal coalitions in our adult patients]

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[INTRODUCTION - Tarsal coalition is an abnormal bony, cartilaginous or fibrous union between two or three bones of the mid and hindfoot. It occurs mostly (90%) in the calcaneonavicular and talocalcaneal joints. Coalitions are usually detected in the second decade of life, but several cases are noted in children and in later adulthood. Estimated incidence is 1-2% of the total population. CASE REPORTS - Cases of unilateral tarsal coalitions (five calcaneonavicular, three talocalcaneal) in four male and three female patients are presented. The average age of the patients is 30 years. The radiologic diagnosis was based on the secondary signs seen on the lateral plain films of the feet. These signs are parallel with clinical symptoms, in contrary to the primary radiologic signs. The two types of the anomaly coexisted in a female patient. CONCLUSION - Routine lateral not-magnified pedal radiographs are valuable screening tool for tarsal coalitions.]

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