Pregnancies in Women After Liver Transplant due to Wilson's Disease-Case Series.

Wilson's disease is a rare autosomal recessive disorder. Due to a defect in membrane copper transporter, copper is not excreted in the bile and accumulates in the tissues. The only treatment for acute liver failure in Wilson's disease is a liver transplant. AIM: Assessment of the course of pregnancies and comparison of obstetric outcomes in female liver transplant recipients in the course of Wilson's disease. METHODOLOGY: Retrospective analysis of data of women, who were pregnant and gave birth in the years: 2017 to 2023. Evaluation of their liver function used pharmacotherapy and obstetric outcomes. RESULTS: We recorded 11 pregnancies in liver transplantation recipients due to Wilson's disease. Ten single pregnancies and 1 twin (DCDA) were observed. In all pregnancies, graft functions and immunosuppressive drug concentrations were monitored. Three women suffered from epilepsy, one was diagnosed with psychiatric disorder. Two were diagnosed with cholestasis, and another 2 with gestational diabetes. Two of them were treated for pregnancy-induced hypertension and 2 developed preeclampsia. Deterioration of liver function parameters in pregnancy was observed in 2 cases. In total, 8 full-term babies were born and 4 late-preterm, including twins at 35 weeks of gestation. Seven pregnancies were delivered by caesarean section and 4 delivered vaginally. No complications in early postpartum period have been reported. CONCLUSIONS: Women with Wilson's disease treated with organ transplantation have a chance of successful pregnancies and deliveries.

Pregnancy in Liver and Kidney Female Recipient: A Case Report.

Deterioration of kidney function after orthotopic liver transplantation is a common complication that may occur after perioperative acute kidney injury (AKI) and preexisting or developing chronic kidney disease (CKD). AKI is described in the early postoperative period in more than half of recipients, whereas the main cause of CKD is pharmacotherapy. When end-stage renal failure occurs, patients may be qualified for additional transplantations. We present a rare case of a 27-year-old woman who, as a teenager, underwent 2 liver transplantations due to Wilson's disease. Surgeries were complicated by systemic infection and multiple organ failure. The kidneys did not regain their function, and therefore, after 6 months of dialysis, the organ was transplanted. Three organ transplantations were performed. Due to the patient's willingness and good graft functions, the patient started trying to conceive. Three months before successful conception, immunosuppressive therapy was changed to tacrolimus and azathioprine. Pregnancy was complicated by pregnancy-induced hypertension, and its course was closely monitored. Organ functions and immunosuppressive therapy were regularly assessed. Due to the pre-eclampsia developed in the 35th week of gestation, a Cesarean delivery was performed, and she gave birth to a daughter weighing 2350 g (Apgar 7-7-8). The patient decided to breastfeed. There were no obstetric complications or graft function deterioration in the early postpartum period. Mother and daughter left home after 7 days of hospitalization. The presented clinical situation proves that multiorgan transplantation recipients can have a successful pregnancy without impairing graft functions. Therefore, the pregnancy requires adequate preparation and increased care.

HOW DO HOSPITAL STERILISATION PROCEDURES AFFECT THE RESPONSE OF PERSONAL EXTREMITY RINGS AND OF EYE LENS TL DOSEMETERS?

Stringent standards of hygiene must be applied in medical institutions, especially at operating blocks or during interventional radiology procedures. Medical equipment, including personal dosemeters that have to be worn by medical staff during such procedures, needs therefore to be sterilised. In this study, the effect of various sterilisation procedures has been tested on the dose response of extremity rings and of eye lens dosemeters in which thermoluminescent (TL) detectors (of types MTS-N and MCP-N, respectively) are used. The effects of medical sterilisation procedures were studied: by chemicals, by steam or by ultraviolet (UV), on the dose assessment by extremity rings and by eye lens dosemeters. Since it often happens that a dosemeter is accidentally machine-washed together with protective clothing, the effect of laundering on dose assessment by these dosemeters was also tested. The sterilisation by chemicals is mostly safe for TL detectors assuming that the dosemeters are waterproofed. Following sterilisation by water vapour, the response of these dosemeters diminished by some 30 %, irrespectively of the period of sterilisation; therefore, this method is not recommended. UV sterilisation can be applied to EYE-D™ eye lens dosemeters if their encapsulation is in black. The accidental dosemeter laundry in a washing machine has no impact on measured dose.

EYE LENS DOSES IN NUCLEAR MEDICINE: A MULTICENTRIC STUDY IN BELGIUM AND POLAND.

This study aimed to investigate the level of the eye lens (EL) doses in nuclear medicine in the light of the new International Commission on Radiological Protection limit. In 7 Belgian and 1 Polish hospitals, 45 staff members were monitored for EL (Hp(3)) and whole-body (WB) (Hp(10)) doses using dedicated dosemeters. Weekly measurements were carried out and used to estimate annual doses. Mostly diagnostic procedures involving radionuclides such as (99m)Tc and (18)F were monitored; measurements were also performed for therapeutic procedures. The cumulative doses showed important variation across the participants. The weekly EL and WB doses ranged from 0.02 to 0.27 and 0.03 to 0.17 mSv, respectively; the annual EL and WB doses ranged from 0.6 to 9.3 and 0.9 to 8.0 mSv, respectively. Some correlation was found between the EL and the WB doses. No significant correlation with the manipulated activities was found.

Distribution of the radiation dose in multislice computer tomography of the chest - phantom study.

BACKGROUND: The most commonly used form of reporting doses in multislice computed tomography involves a CT dose index per slice and dose-length product for the whole series. The purpose of this study was to analyze the actual dose distribution in routine chest CT examination protocols using an antropomorphic phantom. MATERIAL/METHODS: We included in the analysis readings from a phantom filled with thermoluminescent detectors (Art Phantom Canberra) during routine chest CT examinations (64 MDCT TK LIGHT SPEED GE Medical System) performed using three protocols: low-dose, helical and angio-CT. RESULTS: Mean dose values (mSv) reported from anterior parts of the phantom sections in low-dose/helical/angio-CT protocols were as follows: 3.74; 16.95; 30.17; from central parts: 3.18; 14.15; 26.71; from posterior parts: 3.01; 12.47; 24.98 respectively. Correlation coefficients for mean doses registered in anterior parts of the phantom between low-dose/helical, low-dose/angio-CT and helical/angio-CT protocols were 0.49; 0.63; 0.36; from central parts: 0.73; 0.66; 0.83, while in posterior parts values were as follows: 0.06; 0.21; 0.57. CONCLUSIONS: The greatest doses were recorded in anterior parts of all phantom sections in all protocols in reference to largest doses absorbed in the anterior part of the chest during CT examination. The doses were decreasing from anterior to posterior parts of all sections. In the long axis of the phantom, in all protocols, lower doses were measured in the upper part of the phantom and at the very lowest part.