Paul S. Sidhu

Ultrasound of the urogenital system

1.1 Introduction Medical Overview 1.2 The Normal Kidney 1.3 Parenchymal diseases 1.4 Chronic Renal Failure 1.5 Transplantation 1.6 Radiological Intervention in the GU tract (including Trauma & Emergencies) 2 Urology 2.1 The Genito-urinary Tract Surgical Overview 2.2 Focal Lesions of the Kidney 2.3 Diseases of Collecting System and Ureters 2.4 Diseases of the Bladder and Prostate 2.5 Diseases of the Testis and Epididymis 2.6 Diseases of the penis with functional evaluation 2.7 Oncological Management of Genito-urinary tract tumours 3 The Genito-Urinary Tract in the Child 4 Other Imaging Modalities in the Genito-Urinary Tract 5 New Developments: US Contrast agents 5.1 Native Kidney 5.2 Transplant Kidney THE KIDNEY Anatomy: normal and ultrasonic (cortex, medulla, humps, column of Bertin, etc.) technique renal size and thickness vascular and Doppler findings variants, e.g., congenital (ectopic, absent, duplex, pelvic, horseshoe, etc.) PARENCHYMAL DISEASE General ultrasound features Medical diseases and features, including vascular occlusions, ATN, GN, nephritides, infection, XGP, general conditions affecting kidney, end stage renovascular disease FOCAL DISEASE Cysts (simple, complex, diffuse) VHL Benign - AML etc Malignant - primary, secondary, lymphoma, metastasis Trauma and infection COLLECTING SYSTEM Obstruction, duplex systems, tumors, calculi, and ureters etc. RENAL FAILURE Vascular access, complications of therapy, role of ultrasound pre-treatment and complications. TRANSPLANTATION Background, imaging of acute and chronic complications following transplantation. CONTRAST AGENTS IN THE KIDNEY Background info on contrast agents, potential role with examples LOWER GU TRACT DISEASES OF THE BLADDER AND PROSTATE: Introduction, technique, anatomy. Carcinoma: diagnosis and staging, BPH, prostatitis, etc. Other uses of trans-rectal US, i.e., seminal vesical pathology, drainage, etc. TESTES AND PENIS Anatomy, technique, conditions TREATMENT OF TUMOURS OF THE GU TRACT Oncologist GU INTERVENTIONAL US PAEDIATRIC IMAGING General ante-post natal renal problems, cyst, medical, infection, tumors. OTHER IMAGING MODALITIES Cross-sectional, value in diagnostic process, etc

Pediatric Renal Transplantation

In contrast to vascularized organs, xenotransplantation of pancreas islets are predominantely rejected by T-cell mediated rejection. Inhibition of the B7/CD28 co-stimulatory pathway of T-cell activation by systemic administration of LEA29Y (belatacept®) has been successfully tested in several studies using islet xenografts. However, the high dosis of the drug might comopromise the recipients immune system. Rather, the usage of LEA29Y transgenic donor pigs and the local expression of the drug might be superior to systemic administration. Pigs transgenic for the coding sequence of the co-stimulation blocking agent LEA29Y under the control of the 1.3kb core promoter from the porcine insulin gene were generated. The gene construct was transfected into porcine fetal fibroblasts and stable, pooled clones were subsequently used for nuclear transfer into enucleated oocytes. Embryos gained after electrofusion and activation were transferred into synchronised gilts. By this, two litters with a total of seven unique transgenic founder piglets could be generated. Genomic analysis by Southern blotting revealed the distinct transgenic properties of each individual. Immunohistochemical analysis of organ spectra of four animals sacrificed at an age of three months illustrated strong pancreas islet specific expression of the transgene product in two piglets which were therefore chosen for recloning to generate animals for functional analysis and breeding. Isolated islet-like clusters of re-cloned neonatal INS-LEA transgenic pigs and wild-type controls were transplanted under the kidney capsule of streptozotocin induced NOD-SCID mice. After mice had re-gaining normoglycaemia, human peripheral blood mononuclear cells were administered to restore their immune system in a humanised way. Mice transplanted with wild-type control islets subsequently became hyperglycaemic, while recipients with LEA29Y transgenic islets retained their normoglycaemia for 30 days but became hyperglycaemic after removal of the transplant. Thus, the functionality of this INS-LEA pig model could be demonstrated. Pediatric Renal Transplantation