Magnetic Resonance Imaging in the Diagnosis of Fetal Pathology.

INTRODUCTION: Fetal Magnetic Resonance Imaging (MRI) is an imaging method for displaying anatomical structures of the fetus without ionizing radiation and it has been in use since the MRI has been used for the analysis of the adult human body. AIM: The aim of our paper is the two-year retrospective analysis of fetal MRI examinations for the purpose of presenting various pathological conditions of the fetuses. METHODS: A total of 59 fetal MRI examinations were performed on pregnant women in the time period 2016 to 2018 at the Radiology Clinic at Sarajevo University Clinical Center, on Siemens and Toshiba 1.5 Tesla scanners. All cases were referred by gynecologists who suspected a fetal pathology. The comparison of the fetal age at which the congenital anomalies are usually detected is performed using the univariate analysis of variance and the Student t test, at the 95% level of confidence. RESULTS: Of the total of 59 fetal MRI examinations, 2 fetuses (3,4%) were healthy, while pathology of the head and CNS was found in 26 fetuses (44,2%), thoracic cavity pathology in 5 fetuses (8,5%), abdominal cavity pathology in 18 fetuses (30,6%), pathology of extremities in 2 fetuses (3,4%), spinal cord pathology in one fetus (1,7%), and in 3 fetuses associated anomalies were found (5,1%). The pathology of the uterus and placenta was found in two pregnant women (3,4%). CONCLUSION: Prenatal MRI provides extremely useful information in cases where the ultrasound examination of the fetus is insufficient due to the size and position of the fetus. MRI is a key tool in deciding whether to continue or stop the further development of the fetus.

Frequency of Acccessory Renal Arteries Diagnosed by Computerized Tomography.

INTRODUCTION: Accessory renal arteries play a significant role in kidney and abdominal aorta surgery, and renovascular hypertension. In the published literature, the frequency varies considerably, depending on the size of the sample, the method of examination and the ethnic group. MATERIALS AND METHODS: The aim of this study is to determine the general frequency of accessory renal arteries, their frequency in relation to gender, the origin and the vascularization area, and to determine the differences in left-right and bilateral distribution. RESULTS AND DISCUSSION: CT scans of 1357 patients were retrospectively analyzed. Accessory renal arteries were recorded in 35.5% of patients, with a statistically significant difference in male and female incidence (p<0.05) with a ratio of 1.4 : 1. Accessory arteries occur more commonly unilaterally (p<0.05) than bilaterally with a ratio of 4 : 1. Unilateral accessory renal arteries occur at approximately the same frequency at right and left side 1.1 : 1, without statistically significant differences in frequencies (p>0.05). Of the total number of noticed accessory renal arteries 76.7% was originated from abdominal aorta (AA), 23% from renal artery and 0.3% from CIA, with a ratio of 3.3: 1 : 0.0005. CONCLUSIONS: The study showed a relatively high frequency of accessory arteries and described their anatomy in detail, which can be of great importance in surgical interventions on abdominal aorta, kidneys, and in case of kidney transplantation.

Pulmonary Hypertension - New Trends of Diagnostic and Therapy.

Pulmonary hypertension is a pathophysiological state hemodynamically defined as the increase of the mean pulmonary arterial pressure above 25, or 30 mmHg at rest, measured by catheterization of the right heart. Laboratory findings usually reveals polycythemia, the ECG right ventricle hypertrophy, and x-ray characteristic of diseased branches (echocardiography and biomarkers such as B-type natriuretic peptide (BNP) and N-terminal pro-BNP hormones are potentially helpful tools in identifying PH). Echocardiography can be found the increase of the right atrium and ventricle, right ventricular hypertrophy, abnormal contraction of the interventricular septum, left ventricular diastolic dysfunction and decreased left ventricular size, with reduced volumes of systole and end diastole. Doppler confirming tricuspid regurgitation. Pharmacological therapy would represent a use: Calcium Channel Blockers, Prostacyclin Analogues, Endothelin Receptor Antagonists and Phosphodiesterase-5 Inhibitors. Alpha adrenergic antagonists, endothelial receptor subtype A (Bosentan, Tracller) with treatment of the underlying disease or anticongestive therapy, are recommended. In case of inadequate response to treatment with a specific drug, guidelines recommend the combined use of drugs from the basic three groups, using their synergism.

Chronic Kidney Disease and Lipid Disorders.

INTRODUCTION: Chronic kidney disease (CKD) represents a serious public health problem due to the increase in incidence and prevalence of this disease worldwide. Given the significant morbidity and mortality from cardiovascular disease (CVD) in the population of patients with CKD, and the fact that dyslipidemia itself is a risk factor for CVD, increases the importance of lipid metabolism study in patients with CKD. GOAL: Evaluate the lipid status of patients with chronic kidney disease. MATERIAL AND METHODS: A one-year prospective study included 150 adult patients who were in various stages of chronic renal failure (stage I to IV). Estimate of creatinine clearance was performed using Cockroft-Goult formula. The classification of patients according to stages of chronic renal insufficiency was performed in accordance with the criteria of Kidney Disease Outcomes Quality Initiative (K/DOQI). RESULTS: Of the total number of patients (N=150) there was 71 males and 79 females. The mean age of patients was 55.43 years. Average values of serum cholesterol were highest in patients with stage II renal disease and the lowest in patients classified as stage IV (5.76±1.60 mmol/L vs. 5.07±1.88 mmol/L). Analysis of the average value of triglycerides in blood show a slight increase through the stages of CKD in a manner that patients classified into stage I have low serum triglyceride levels (1.73±1.17 mmol/L (range 0.61 to 5.5 mmol/L), and patients classified in stage III the highest value 2.13±1.11 mmol/L (range 0.62 to 4.66 mmol/L). CONCLUSION: Average cholesterol levels does not statistically significantly change with progression of chronic renal disease. There is an almost linear increase in average triglyceride levels in chronic renal disease. Triglyceride levels in serum begins to increase in the early stage of chronic renal disease and reach the peak in stage IV.

Modified Algorithm for the Risk of Coronary Heart Disease Estimation.

INTRODUCTION: Determination of the overall risk of coronary disease, enables the health professionals for planning the intensity of preventive action. AIM: The aim of this study is that by the results obtained using a modified algorithm with tables adopted by the European Society of Cardiology demonstrate the possibilities for assessment of the risk of coronary heart disease degree, for application to the targeted individual or risk factors groups. MATERIAL AND METHODS: The study was conducted as a retrospective, prospective and controlled (included two groups of 200 respondents). RESULTS: By comparing the presence of risk factors according to the representation of groups of diseases, or myocardial infarction, results showed that the European and SCORE table have significantly lower levels of risk factors, or those with sustained myocardial infarction are ranked in groups of low and present risk in relation to our algorithm which patients with myocardial infarction ranked as high and pronounced degree of risk. Results showed that the European and SCORE table significantly reduce the levels of risk or the persons with heart failure have been ranked in the group of low and present risks in relation to our algorithm which patients with coronary insufficiency ranked as pronounced degree of risk. CONCLUSION: Determination of the overall risk of coronary disease, enables the health professionals for planning the intensity of preventive action. The activities of primary prevention of risk factors, or already resulting disease, may be helpful in assessing the reduction in economic costs in healthcare, both due to lower morbidity, and reducing the total cost of treatment of patients with coronary disease.

Renal artery aneurism.

BACKGROUND: Renal artery aneurysm is very rare and most often incidental finding and we will present it in our case report. CASE REPORT: We report a case of 65 years old women who was sent to our hospital Clinic of Radiology. We detected a renal artery aneurysm on the left side on the ultrasound and later we confirmed it on the CTA of the abdominal aorta and its visceral branches. DISCUSSION: Renal artery aneurysms can be classified in true anaurysm and pseudoaneurysm. They are more often find at females. They can be fusiform or saccular in appearance and are extraparenchymal in 90% of cases. Most are saccular and noncalcified. CONCLUSION: In the case of renal artery aneurysm that we founded we recommended regular Color Doppler ultrasound examinations, consultation from the urologist and CTA control if there is a need.

[Angiographic imaging of supernumerary kidney arteries by nonselective angiography]. / Angiografski prikaz prekobrojnih arterija bubrega metodom neselektivne angiografije.

In this paper was examined the occurrence frequently more of one kidney artery of the aortic origin. The examinations were performed on the 213 angiograms of the kidney artery by the method of the unselective renal angiography per Seldinger, in both sexes, of the various life ages. On the analyzed angiograms was the presence of these arteries in 25.82% of cases. They were more often at the right side in 49.09%, than on the left side in 36.36%, while their both side presence was found in 14.55%. Although are these arteries more frequently in male persons, a though the sex cannot be statistically significant the parameter for the determination the frequency of their occurrence. In the relation to the backbone column the level of the exit of this arteries from the aorta is the greatest number of cases between the trunk of the first and third loins vertebra (L1-L3) and all were directed according to the medial edge of the corresponding kidney. According the place of the entrance in the kidney can be differed three types of these arteries: the artery, and upper and low polar artery. On the analyzed angiograms most often were found the hilar and lower polar artery, while the upper polar artery was present in only seven cases of the total number of the analyzed angiograms. We consider that the recognition of the supernumerary arteries of the kidney there is both anatomically and the significance in the surgical and radiological practice and their best identification achieves by the application of the angiographic radiology methods.

[Retroperitoneal ganglioneurinoma]. / Ganglioneurinom retroperitoneuma.

We present a case of 20-years-old female with nonspecific symptoms (intermittent abdominal pains) and blood and urine tests showed the changes connected with infection of the urinal tract. The patient was sent to further diagnostic imaging methods, because the repeated attacks of uroinfection after the applied antibiotic therapy. After the US we performed CT and MRI that indicated the existence of retroperitoneal mass which dislocated the surrounding structures (left kidney and the urether) but was not infiltrated them. US were initial method and CT and MRI have done as complementary methods providing the exact picture of the mass. After surgical treatment, ganglioneurinoma was histological diagnosed.