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Vesicoureteral reflux (VUR) is a common urological complication in renal transplant patients., The Aim: of this study is to evaluate the performance of contrast-enhanced voiding urosonography (CEvUS) in the diagnosis and classification of reflux into the renal allograft, to evaluate and classify VUR into the allograft using voiding cystourethrography (VCUG) and CEvUS, to compare the two methods, and to propose a new classification of reflux into the allograft based on CEvUS and VCUG assessment, in line with the international reflux grading system., Materials and Methods:  From January 2017 to July 2019, 84 kidney transplant patients were enrolled. All patients underwent VCUG and CEvUS., Results:  In 76 cases there was agreement between VCUG and CEvUS (90 %) (Kappa = 0.7). The sensitivity of CEvUS using VCUG as the gold standard was 90 %, and the specificity was 92 %. Of the 7 cases diagnosed by VCUG and not by CEvUS, 6 were grade 1 and 1 was grade 2., Conclusion:  Transplant patients with reflux symptoms should undergo CEvUS. If the outcome is negative, VCUG should be performed. The classification that we propose is better suited to describe VUR in transplant patients, because it is simpler and takes into account whether reflux occurs not only during urination but also when the bladder is relaxed., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tomography determining the malignant potential of cystic renal lesions. Ultrasound has not been incorporated into this pathway. However, the development of ultrasound contrast agents coupled with the superior resolution of ultrasound makes it possible to redefine the imaging of cystic renal lesions. In this position statement, an EFSUMB Expert Task Force reviews, analyzes, and describes the accumulated knowledge and limitations and presents the current position on the use of ultrasound contrast agents in the evaluation of cystic renal lesions., Competing Interests: Vito Cantisani: lecturer fees from Bracco, Samsung, Toshiba.Paul Sidhu: lecture fees from Bracco.Adrian Saftoiu: lecture fees from Bracco.Dirk-André Clevert: speaker bureau Bracco, Siemens, Esaote, Samsung, Philips., (Thieme. All rights reserved.)

The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications., Competing Interests: Fabrizio Calliada: Congress participation support, Toshiba, Guerbet, Bayer, Hitachi, MindrayVito Cantisani: Congress participation support, Toshiba, Guerbet, Bayer, Hitachi, MindrayDirk Clevert: Speaker honoraria for Siemens, Philips, Samsung Falk, Bracco; Advisory Board Member Siemens, Philips, Samsung, Bracco; Research grants, Siemens, Philips, Samsung, BraccoDavid Cosgrove: Speaker honoraria, Bracco, Toshiba, SuperSonic, BK Medical, Carestream; Advisory Board Member, Toshiba, Carestream; Research grant, Carestream; Congress participation support, Bracco, ToshibaAnnamarie Dagenello: Speaker honoraria, BraccoChristoph F Dietrich: Speaker honoraria, Bracco, Hitachi, GE, Mindray, Supersonic, Pentax, Olympus, Fuji, Covidien, Boston Scientific, AbbVie, MSD, Falk Foundation, Novartis, Roche; Advisory Board Member, Hitachi and Mindray; Research grant, Bracco, Hitachi, GE, Siemens, Mindray, SuperSonic; Congress participation support, IPSENOdd Helge Gilja: Speaker honoraria, GE Healthcare Takeda AS and Meda ASChristian Jenssen: Speaker honoraria, Bracco, Hitachi, Toshiba, Falk Foundation, Covidien; Research grant, NovartisNathalie Lassau: Speaker honoraria, Bracco, Toshiba; Congress participation support, Bracco, ToshibaEdward Leen: Research equipment support, Philips Healthcare & SuperSonic ImagingMaria Franca Meloni: Speaker honoraria, BraccoChristian Pállson Nolsøe: Speaker honoraria and congress participation support, GE Healthcare and NeovitalisMirko D’Onofrio: Speaker honoraria, Bracco, Siemens; Advisor Board Member, Bracco, Siemens, Congress participation support, BraccoFabio Piscaglia: Speaker honoraria Bracco, Bayer; Advisory Board Member, Bayer; Research support, EsaoteMaija Radzina: Speaker honoaria, Bayer, Covidien; Congress participation support, BayerAdrian Saftiou: Speaker honoraria, Pentax Medical Singapore Ltd; Consulting/Advisory board, Mediglobe Corporation Gmbh; Congress participation support, Hitachi Medical Systems UKPaul Sidhu: Speaker honoraria, Siemens, Bracco, Hitachi, Philips and GEHans-Peter Weskott: Speaker honoraria for Bracco, Samsung and GEThe following members declared no conflicts of interest: Eva Bartels, Michele Bertolotto, Francesca Drudi, Simon Freeman, Christopher Harvey, Ernst Michael Jung, Andrea Klauser, Carlos Nicolau, Francesco Prada, Luca Savelli, Hessel Wijkstra, (© Georg Thieme Verlag KG Stuttgart · New York.)

The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications., Competing Interests: Fabrizio Calliada: Congress participation support, Toshiba, Guerbet, Bayer, Hitachi, MindrayVito Cantisani: Congress participation support, Toshiba, Guerbet, Bayer, Hitachi, MindrayDirk Clevert: Speaker honoraria for Siemens, Philips, Samsung Falk, Bracco; Advisory Board Member Siemens, Philips, Samsung, Bracco; Research grants, Siemens, Philips, Samsung, BraccoDavid Cosgrove: Speaker honoraria, Bracco, Toshiba, SuperSonic, BK Medical, Carestream; Advisory Board Member, Toshiba, Carestream; Research grant, Carestream; Congress participation support, Bracco, ToshibaAnnamarie Dagenello: Speaker honoraria, BraccoChristoph F Dietrich: Speaker honoraria, Bracco, Hitachi, GE, Mindray, Supersonic, Pentax, Olympus, Fuji, Covidien, Boston Scientific, AbbVie, MSD, Falk Foundation, Novartis, Roche; Advisory Board Member, Hitachi and Mindray; Research grant, Bracco, Hitachi, GE, Siemens, Mindray, SuperSonic; Congress participation support, IPSENOdd Helge Gilja: Speaker honoraria, GE Healthcare Takeda AS and Meda ASChristian Jenssen: Speaker honoraria, Bracco, Hitachi, Toshiba, Falk Foundation, Covidien; Research grant, NovartisNathalie Lassau: Speaker honoraria, Bracco, Toshiba; Congress participation support, Bracco, ToshibaEdward Leen: Research equipment support, Philips Healthcare & SuperSonic ImagingMaria Franca Meloni: Speaker honoraria, BraccoChristian Pállson Nolsøe: Speaker honoraria and congress participation support, GE Healthcare and NeovitalisMirko D’Onofrio: Speaker honoraria, Bracco, Siemens; Advisor Board Member, Bracco, Siemens, Congress participation support, BraccoFabio Piscaglia: Speaker honoraria Bracco, Bayer; Advisory Board Member, Bayer; Research support, EsaoteMaija Radzina: Speaker honoaria, Bayer, Covidien; Congress participation support, BayerAdrian Saftiou: Speaker honoraria, Pentax Medical Singapore Ltd; Consulting/Advisory board, Mediglobe Corporation Gmbh; Congress participation support, Hitachi Medical Systems UKPaul Sidhu: Speaker honoraria, Siemens, Bracco, Hitachi, Philips and GEHans-Peter Weskott: Speaker honoraria for Bracco, Samsung and GEThe following members declared no conflicts of interest: Eva Bartels, Michele Bertolotto, Francesca Drudi, Simon Freeman, Christopher Harvey, Ernst Michael Jung, Andrea Klauser, Carlos Nicolau, Francesco Prada, Luca Savelli, Hessel Wijkstra, (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: The aim of the present prospective study was to evaluate the usefulness of labeled leukocyte scan as a guide to open biopsy for the management of hip and knee prosthesis infection in patients without loosening of orthopedic device., Methods: Twenty-six patients with suspected hip (24) and knee (2) prosthesis infection underwent routine analysis of blood, plain radiography and 99mTc-HMPAO labelled leukocyte scan (WBCS). On these basis, patients were subdivided in the following groups: bone infection without loosening (n°=14), septic loosening (n°=8), superficial infection (n°=2), no infection (n°=2). Patients with septic loosening underwent empirical antibiotic therapy in order to avoid two-stage reimplantation. When the medical treatment was effective patients were submitted to one-stage operation. Patients without loosening of prosthesis but positive WBCS results underwent open biopsy: bone samples and periprosthetic tissues were taken from the regions showing pathological leukocyte uptake at the scan. Samples were submitted to microbiological examination and antibiotic treatments were undertaken in cases of bacterial growth. A 24-months clinical and instrumental follow-up was carried out in all patients., Results: WBCS showed 22 patients affected by bone infection, 2 by superficial infection and 2 not infected. Height out of the 22 patients affected by deep infection had a septic loosening. In these cases, the medical treatment was inadequate in 6 patients and effective in 2. Fourteen patients with bone infection without loosening were submitted to open biopsy: in 9 cases a complete remission of the disease was found. Two patients, without infection, underwent single-stage surgery for mechanical problems. Superficial infection was assessed and successfully treated in 2 patients., Conclusion: The obtained results indicate that a multidisciplinary approach to infection of orthopedic prostheses, characterized by the combined use of open biopsy, WBC, and microbiological examination, produced positive outcome in 9 out of 14 patients., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Objective: Human beta-defensin-3 (HBD-3) is an antimicrobial peptide which is up-regulated during inflammation. Based on the previously demonstrated capacity of technetium-99m ((99m)Tc) labelled HBD-3 of distinguishing infection from inflammation in rats, we have decided to collect information on the potential toxicity of the tracer in view of its possible use for imaging in humans., Materials and Methods: Recombinant HBD-3 underwent labeling with (99m)Tc. The CD1 mice were selected as standard rodent species. Ten mice, 5 male and 5 female, were subjected to physical examination and housed in a dedicated room in 5 per cage. After 9 days pre-test period, all mice were weighted for dose adjustment and received intravenously 6mcg/mouse of (99m)Tc-HBD-3. Mortality was recorded daily, while body weight was registered once a week. Clinical observation of animals was performed daily for sickness symptoms due to the drug treatment. At day 19 a second dose of 6mcg/mouse (99m)Tc-HBD-3, was administered. Twenty-four hours after the second dose (day 20) the animals were euthanized. A piece of liver, kidneys, heart and lungs was collected for histopathological analysis., Results: Our results showed that the labelled-HBD-3 dose did not induce significant toxicity in mice. Of course these parameters were not sufficient to authorize use in humans. This non-toxic dose of HBD-3 when translated from animals to humans resulted in an equivalent dose of approximately 25 times higher than that needed for imaging., Conclusion: Our non toxicity data of using (99m)Tc-beta-defensin-3 in mice offer a further indication in favour of the clinical use of this radiopharmaceutical in all cases where discrimination between infection and inflammation is needed.

The natural history of urolithiasis includes the risk of recurrence and of the development of chronic kidney and/or bone disease, which is why a thorough clinical and metabolic evaluation of these patients is of the utmost importance at disease onset. This paper is aimed at identifying the type of urolithiasis, the related risk factors, and the corresponding treatment options. The diagnostic and therapeutic approach described here includes 1) accurate history taking to detect secondary nephrolithiasis and screen for the main risk factors for kidney and bone disease; 2) metabolic evaluation graded according to different complexity levels based on the severity of the disease and the presence of risk factors; 3) carrying out appropriate imaging procedures. The resulting information allows to plan treatment based either on general rules of lifestyle and diet, or on selected medical intervention, if necessary. This report, which is based on current guidelines, was produced by the Gruppo Italiano di Studio Multidisciplinare per la Calcolosi Renale. It is addressed to all professionals involved in the management of patients suffering from nephrolithiasis, first of all general practitioners, who often become involved immediately at the onset of the disease.