scholarly journals Imaging evaluation of uterine arteries in potential living donors for uterus transplantation: a comparative study of MRA, CTA, and DSA

2021 ◽  
Author(s):  
Henrik Leonhardt ◽  
Anne Thilander-Klang ◽  
John Båth ◽  
Marit Johannesson ◽  
Niclas Kvarnström ◽  
...  
Keyword(s):  
Graft Survival ◽  
Living Donors ◽  
Radiation Doses ◽  
Digital Subtraction ◽  
Imaging Evaluation ◽  
Pelvic Mri ◽  
Uterus Transplantation ◽  
Uterine Arteries ◽  
Key Points ◽  
Uterine Transplantation

Abstract Objective To evaluate uterine arteries (UA) of potential living donors for uterus transplantation (UTx) by comparison of CT angiography (CTA), digital subtraction angiography (DSA), and MR angiography (MRA) with care taken to minimize radiation doses. Methods Prospective donors for a clinical UTx trial were included. CTA, DSA, and MRA measurements in three predefined segments of the UAs were evaluated. Radiation doses were estimated and 1-year graft survival was recorded. Results Twelve potential donors (age 37–62 years) were investigated. There was no difference in visualized average UA lumen diameter when comparing CTA (mean 2.0 mm, SD 0.4), DSA (mean 2.1 mm, SD 0.6), and MRA (mean 2.0 mm, SD 0.3). MRA was not able to fully evaluate 10 (43%) out of 23 UA that proved to be patent on DSA. One UA was not identified by any of the modalities, and three MRA-absent UAs were identified by both CTA and DSA. The estimated mean effective dose was lower for DSA (5.1 mSv, SD 2.8) than CTA (7.1 mSv, SD 2.0), but not significantly (p value = 0.06). Three potential donors were excluded due to UA pathology and one due to adenomyosis. Eight donors underwent hysterectomy, with 1-year graft survival in six women. Conclusion MRI including MRA should be the initial modality to examine potential UTx donors to acquire valuable details of uterine anatomy, and if UAs are fully visualized, there is no need for further angiographic methods with radiation. If UAs are not visualized by MRA, CTA may be performed and in selective cases with addition of the invasive modality DSA. Key Points • For uterine transplantation, pelvic MRI with MRA provides information of the uterine structure and of the diameters of uterine arteries in living donors. • Failure of MRA to demonstrate uterine arteries could be followed by CTA which will visualize the uterine arteries in a majority of cases. If MRA and additional CTA provide inconclusive results, the uterine arteries should be further evaluated by DSA. • Information of CTA can be used in the angio-system for DSA settings to minimize the radiation and contrast media doses.

scholarly journals Successful desensitization with proteasome inhibition and costimulation blockade in sensitized nonhuman primates

2017 ◽  
Vol 1 (24) ◽  
pp. 2115-2119 ◽  
Author(s):  
Jean Kwun ◽  
Christopher Burghuber ◽  
Miriam Manook ◽  
Brian Ezekian ◽  
Jaeberm Park ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Nonhuman Primates ◽  
Proteasome Inhibition ◽  
Costimulation Blockade ◽  
Specific Antibodies ◽  
Key Points ◽  
Donor Specific Antibodies

Key Points Targeting both PCs and GC response reduces donor-specific antibodies and prolongs graft survival in sensitized NHP kidney transplantation.

scholarly journals Imaging of Bone Sarcomas and Soft-Tissue Sarcomas

2021 ◽  
Author(s):  
Jasminka Igrec ◽  
Michael H. Fuchsjäger
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Bone Cancer ◽  
Bone Sarcoma ◽  
Daily Practice ◽  
Imaging Evaluation ◽  
Key Points ◽  
Bone Sarcomas ◽  
Publication Period ◽  
Ct And Mri

Background In the diagnosis of bone and soft-tissue sarcomas, the continuous advancement of various imaging modalities has improved the detection of small lesions, surgical planning, assessment of chemotherapeutic effects, and, importantly, guidance for surgery or biopsy. Method This review was composed based on a PubMed literature search for the terms “bone sarcoma,” “bone cancer” and “soft tissue sarcoma,” “imaging,” “magnetic resonance imaging”, “computed tomography”, “ultrasound”, “radiography”, and “radiomics” covering the publication period 2005–2020. Results and Conclusion As discussed in this review, radiography, ultrasound, CT, and MRI all play key roles in the imaging evaluation of bone and soft-tissue sarcomas. In daily practice, advanced MRI techniques complement standard MRI but remain underused, as they are considered time-consuming, technically challenging, and not reliable enough to replace biopsy and histology. PET/MRI and radiomics have shown promise regarding the imaging of sarcomas in the future. Key Points:  Citation Format

scholarly journals Ethical and policy issues raised by uterus transplants

2019 ◽  
Vol 131 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Laura O’Donovan ◽  
Nicola Jane Williams ◽  
Stephen Wilkinson
Keyword(s):  
Deceased Donor ◽  
Access To Treatment ◽  
Policy Issues ◽  
Uterus Transplantation ◽  
Academic Literature ◽  
International Registry ◽  
Uterine Transplantation ◽  
Key Issues ◽  
Surgical Teams ◽  
Definition Of

Abstract Introduction In 2014, Brännström and colleagues reported the first human live birth following uterine transplantation (UTx). Research into this treatment for absolute uterine factor infertility has since grown with clinical trials currently taking place across centers in at least thirteen countries worldwide. Sources of data This review summarizes and critiques the academic literature on ethical and policy issues raised by UTx. Areas of agreement There is general agreement on the importance of risk reduction and, in principle, to the sharing and maintenance of patient data on an international registry. Areas of controversy There are numerous areas of controversy ranging from whether it is ethically justified to carry out uterus transplants at all (considering the associated health risks) to how deceased donor organs for transplant should be allocated. This review focuses on three key issues: the choice between deceased and living donors, ensuring valid consent to the procedure and access to treatment. Growing points UTx is presently a novel and rare procedure but is likely to become more commonplace in the foreseeable future, given the large number of surgical teams working on it worldwide. Areas timely for developing research Uterus transplantation requires us to re-examine fundamental questions about the ethical and social value of gestation. If eventually extended to transgender women or even to men, it may also require us to reconceptualize what it is to be a ‘father’ or to be a ‘mother’, and the definition of these terms in law.

scholarly journals DUETS (Dallas UtErus Transplant Study): The role of imaging in uterus transplantation

2019 ◽  
Vol 7 ◽  
pp. 205031211987560 ◽  
Author(s):  
Soran Mahmood ◽  
Liza Johannesson ◽  
Giuliano Testa ◽  
Gregory de Prisco
Keyword(s):  
Imaging Techniques ◽  
Vascular Anatomy ◽  
Evaluation Process ◽  
Living Donors ◽  
Important Variable ◽  
Donor Selection ◽  
Preoperative Imaging ◽  
Uterus Transplantation ◽  
Contrast Enhanced Ct

Objective: Uterus transplantation is rapidly becoming a viable clinical option for women with uterine-factor infertility and a desire for parenthood. Radiological imaging plays a central role in selecting the optimal living donors for uterus transplantation and serves to exclude any pathology and evaluate the uterine vasculature. The latter is the most important variable in the ultimate technical success of the uterus transplant. In this first report of imaging in the setting of uterus transplantation, we report our experience with living-donor selection, and the evolution of the imaging techniques that ultimately allowed a significant improvement in donor selection and transplant outcome. We also suggest a framework for preoperative imaging in uterus transplantation. Methods: Between 2016 and 2018, 27 potential living donors were evaluated by imaging prior to uterine donation for uterus transplantation. Predonation imaging included a screening chest radiograph, dual-phase computed tomography (CT) angiograms of the abdomen and pelvis in the arterial and venous phases and pelvic sonography with Doppler. Seventeen potential donors additionally underwent multiphasic pelvic MR angiograms. The imaging performed was meant to display features of the vascular anatomy relevant for uterus transplantation. Results: Out of the 27 potential live donors who were evaluated by imaging, 9 eventually donated their uterus for transplantation. The most frequent reason for exclusion was suboptimal quality of the vessels (33%), including small uterine arteries, the presence of atherosclerosis or small size/poor quality of the uterine or utero-ovarian veins, or both. The next most common reason was voluntary patient withdrawal or failure to complete the evaluation process (28%). Three potential donors (16.6%) were rejected for uterine factors, fibroids, and/or adenomyosis. Other reasons for donor rejection included ABO incompatibility and unfavorable psychological evaluation. Conclusion: Diagnostic imaging plays a crucial role in selecting appropriate potential donors, screening prospective recipients, planning the graft procedure, and following up on any graft or nongraft-related complications in both the donor and recipient after the transplantation procedure is performed. Contrast-enhanced CT and MR angiographies have complementary roles, especially when evaluating the donor for adequacy of the arterial and venous supply to the uterine graft and the experience gained from our series indicates that the inclusion of both modalities contributed directly to successful uterus transplant graft survival by selecting patients with favorable arterial and venous vasculature.

Analysis of radiation doses incurred during diagnostic cerebral angiography after the implementation of dose reduction strategies

2016 ◽  
Vol 9 (4) ◽  
pp. 384-388 ◽  
Author(s):  
Tanja Schneider ◽  
Emily Wyse ◽  
Monica S Pearl
Keyword(s):  
Radiation Dose ◽  
Dose Reduction ◽  
Cerebral Angiography ◽  
Pediatric Patients ◽  
Radiation Doses ◽  
Digital Subtraction ◽  
Air Kerma ◽  
Reduction Strategies ◽  
Technical Modifications ◽  
Area Product

BackgroundOne goal of increasing awareness of radiation dose is to encourage personal and technical modifications in order to reduce the radiation exposure of patients and staff.ObjectiveTo analyze the radiation doses incurred during diagnostic cerebral angiography and the angiographic techniques practiced over a 4-year period, in order to demonstrate the effectiveness of implementing radiation dose reduction strategies.MethodsA retrospective review of the first 50 consecutive adult and pediatric patients undergoing diagnostic cerebral angiography each year from 2010 to 2013 was performed. Angiograms and procedure examination protocols were reviewed for patient age, gender, diagnosis, angiography techniques, fluoroscopy time, reference point air kerma (Ka,r in mGy), and kerma-area product (PKA in μGym2).ResultsFrom January 2010 to June 2013, a total of 231 diagnostic cerebral angiograms were reviewed (200 adults, 31 children). Adult patients were aged from 19 to 94 years and included 77 men and 123 women. Pediatric patients were aged from 2 to 18 years and comprised 11 boys and 20 girls. Median Ka,r and PKA significantly decreased from 2010 to 2013 in adults (1867 mGy; 21 231 µGym2 vs 653 mGy; 7860 µGym2) and children (644 mGy; 6495 µGym2 vs138 mGy; 1465 µGym2), (p<0.001).ConclusionsIncreased awareness and implementation of dose reduction strategies resulted in decreased radiation doses for diagnostic cerebral angiography both in adult and pediatric patients. The use of lower and variable digital subtraction angiography frame rates and tailored examinations contributed significantly to the reduced radiation doses observed during diagnostic cerebral angiography.

scholarly journals Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines

Blood ◽  
2017 ◽  
Vol 129 (16) ◽  
pp. 2257-2265 ◽  
Author(s):  
Frederika A. van Nimwegen ◽  
Georgios Ntentas ◽  
Sarah C. Darby ◽  
Michael Schaapveld ◽  
Michael Hauptmann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hodgkin Lymphoma ◽  
Radiation Doses ◽  
Key Points

Key Points Risk of HF increases following cardiac radiation doses above 20 Gy. Anthracyclines increase HF rate by threefold independently of radiation.

Radiation doses to patients from digital subtraction angiography

2005 ◽  
Vol 117 (1-3) ◽  
pp. 251-255 ◽  
Author(s):  
H. Goni ◽  
I. A. Tsalafoutas ◽  
G. Tzortzis ◽  
P. Pappas ◽  
N. Bouzas ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Radiation Doses ◽  
Digital Subtraction

scholarly journals Uterine transplantation: Legal and regulatory implications in the UK

2021 ◽  
Author(s):  
Saaliha Vali ◽  
Benjamin Jones ◽  
Srdjan Saso ◽  
Michael Fertleman ◽  
Amel Alghrani ◽  
...  
Keyword(s):  
Public Funding ◽  
Solid Organ Transplantation ◽  
Reproductive Technology ◽  
Fertility Treatment ◽  
Solid Organ ◽  
Uterus Transplantation ◽  
Regulatory Aspects ◽  
Fertility Treatments ◽  
Uterine Transplantation ◽  
The Uk

Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the UK leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications on fertility treatment and the birth of the resultant child. As the world’s first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein. Public funding of fertility treatments pertaining to UTx remains variable and warrants review.

scholarly journals Ovary and uterus transplantation

Reproduction ◽  
2008 ◽  
Vol 136 (6) ◽  
pp. 671-680 ◽  
Author(s):  
Roger G Gosden
Keyword(s):  
Conservation Biology ◽  
Reproductive Medicine ◽  
Ovarian Tissue ◽  
Tissue Slices ◽  
Uterus Transplantation ◽  
Laboratory Rodents ◽  
Uterine Transplantation ◽  
Potential Applications ◽  
New Applications ◽  
Practicable Method

Ovarian and uterine transplantation are procedures gaining more attention again because of potential applications in respectively fertility preservation for cancer and other patients and, more tentatively, women with uterine agenesis or hysterectomy. Cryopreservation of tissue slices, and possibly whole organs, is providing opportunities for banking ovaries for indefinite periods before transplanting them back to restore fertility. The natural plasticity of this organ facilitates grafting to different sites where they can be revascularized and rapidly restore the normal physiology of secretion and ovulation. Ischemic damage is a chief limitation because many follicles are lost, at least in avascular grafts, and functional longevity is reduced. Nevertheless, grafts of young ovarian tissue, even after cryopreservation, can be highly fertile in laboratory rodents and, in humans, autografts have functioned for up to 3 years before needing replacement. Transplantation by vascular anastomosis provides potentially longer function but it is technically much more demanding and riskier for the recipient. It is the only practicable method with the uterus, and has enabled successful pregnancies in several species, but not yet in humans. Contrary to claims made many years ago, neither organ is privileged immunologically, and allografts become rapidly rejected except in hosts whose immune system is deficient or suppressed pharmacologically. All in all, transplantation of these organs, especially the ovary, provides a broad platform of opportunities for research and new applications in reproductive medicine and conservation biology.

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