Objective:The goal of this study was to evaluate pediatric post transplant vesicoureteral reflux (VUR) in terms of graft's Urinary Tract Infections (UTIs) episodes, graft outcome and survival in comparison to grafts that don't have reflux. Subjects and Methods: A total of 145 pediatric patients who underwent kidney transplantation at our transplantation unit between 2008 and January 2019 and suited our inclusion criteria were included in this retrospective cohort study and a voiding cystourethrography (VCUG) was done to them and categorized into main groups; group (A) refluxing graft group (n=66) and group (B) non refluxing graft group (n=79). Baseline donor and recipient demographic characteristics, post transplant serum creatinine level at different points, graft outcome, and UTIs were listed. Post transplantation (Tx) UTIs and graft outcome were compared between both groups. Glomerular Filtration Rate (GFR) was measured using Shwartz formula. Frequency-Volume Chart (FVC) and UroDynamic Study (UDS) were used to identify Lower urinary Tract (LUT) condition and helped us regarding decision making in management of graft VUR. Results: Mean ±SD age at time of Tx was 8.7±3.4y in group A versus 8.9±2.8y in group B, P value=0.667. Regarding sex, 46 patients (69.7%) were male in group A, while 56(70.9%) were male in group B, p value = 0.876. UTI occurrence was similar between groups {40(60.6%) patients in group A versus 49 (62%) patients in group B, P value=0.861 but UTIs episodes (more than 3 episode per year) was 20 (30.3%) patients in group A versus 1(1.3%) patient, P value =0.001. Both groups were similar in terms of 5-year (100% versus 98.5%), and 10-year (76.2% versus 84.7%) graft survival. Conclusions: There was no difference between refluxing and non refluxing graft in terms of UTIs occurrence, graft function and survival. Frequency of UTI episodes was more in the refluxing graft like any native kidney primary VUR.

Transcatheter arterial chemoembolization (TACE) is a well-accepted method for Treatment of unresectable hepatocellular carcinoma (HCC). Determining the success of treatment by imaging studies would help to guide subsequent therapeutic planning. Diffusion-weighted imaging (DWI) with calculation of corresponding apparent diffusion coefficient (ADC) maps can give us an impression about the extent of the tumor necrosis after TACE. Also rapid image acquisition and dispensing of contrast are considered superior pros. Objective: To investigate changes in apparent diffusion coefficient (ADC) levels pre and post TACE to monitor early therapeutic response of hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization (TACE). Patients and methods: 20 patients with 22 lesions included in the study, underwent TACE for HCC lesions, All patients had MR-DWI pre TACE and 1 month after TACE with calculation of ADC values and comparing the percentage of change in ADC level pre and post TACE in 1 month after TACE with the results of contrast enhanced Dynamic MRI 3 or 6 month after TACE based on MRECIST criteria. Results: Of about 20 patients, 22 lesions was treated, ADC levels 1 month post-operative showed 75% sensitivity, 80% specificity and about 77.27% accuracy. It was found that the specificity of degree of ADC change is maximized by gaining at least 22% increase in ADC value, and the sensitivity is maximized by gaining less than 15% increase in ADC. At these points sensitivity increased to 91.67% and specificity up to 90%. Conclusion: the calculation of percentage of change in ADC levels 1 month after TACE with addition of specific Cut off values can improve the accuracy of assessment of early response to TACE and create proper planning for achievement of treatment goals. Although larger, more definitive and quantitative studies with clinical end points are needed.