RESUMEN
A 28-year-old male musical student has been presented with visible inability of active abduction and extension of the thumbs in both hands beyond the neutral position. The student has not been previously diagnosed and claimed no history of trauma or surgical procedures in the area of hands and no family history of such disabilities. The student remained capable of playing on keyboard instruments on high level due to compensation by hyperextension of the interphalangeal joint of both thumbs and showed no increased frequency of the injuries or playing-related disorders. The ultrasound and magnetic resonance imaging showed complete bilateral agenesis of extensor pollicis brevis muscles and was classified as isolated congenital clasped thumb syndrome. Due to the age of the student and the agenesis of the muscles the conservative treatment was deemed inadequate and due to high functionality of the student as a musician and unforeseeable results it might have on a musician's career, surgical treatment has been disadvised.
Asunto(s)
Anomalías Múltiples , Músculo Esquelético , Masculino , Humanos , Adulto , Músculo Esquelético/diagnóstico por imagen , Pulgar/anomalías , Pulgar/lesiones , Pulgar/cirugía , Mano , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Multiple renal artery kidneys still represent a special challenge for surgeons, during both nephrectomy for organ donation and transplantation. Recognition of anatomical conditions with advanced imaging methods is one of the most important elements of the preoperative evaluation process. AIM: The purpose of the current study was to assess if anatomical abnormalities affect the outcomes of living kidney donor transplantation procedures. PATIENTS AND METHODS: A retrospective analysis of 60 living kidney donors and their recipients was performed. Patients were assigned to two groups: pairs with a single allograft vessels (group I) and pairs with any anatomical abnormalities of the transplanted organ (group II). The impact of anatomical abnormalities on initial and long-term outcomes of the transplantation were analyzed. RESULTS: The analyzed study group consisted of 60 pairs (35 included in group I and 25 in group II). Immediate graft function was observed in 65.7% vs 64% individuals, recpectively (n.s.). Mean serum creatinine concentration was 1.6, 1.46, and 1.44 mg/mL (group I) vs 1.78, 1.78, and 1.65 mg/mL (group II) at 1, 6, and 12 months posttransplant, respectively (n.s.). Glomerular filtration rate (using the Chronic Kindey Disease Epidemiology Collaboration equation) was estimated at 54.3, 59.9, and 61.0 mL/min/1.73 m2 (group I) vs 59.8, 57.6, and 59.8 mL/min/1.73 m2 (group II) at the same time points, respectively (n.s.). CONCLUSIONS: Presence of single renal vessels was not a predictor of immediate graft function in living-donor kidney transplantation. Transplantation outcomes for kidneys with anatomical anomalies did not differ when compared to organs with typical anatomy. Multiple renal arteries did not impact initial graft function if precise surgical technique and proper preoperative diagnostics were provided.
Asunto(s)
Trasplante de Riñón/métodos , Riñón/anomalías , Donadores Vivos , Nefrectomía/métodos , Recolección de Tejidos y Órganos/métodos , Adulto , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Supervivencia de Injerto , Humanos , Riñón/irrigación sanguínea , Riñón/cirugía , Enfermedades Renales/patología , Enfermedades Renales/cirugía , Masculino , Persona de Mediana Edad , Arteria Renal/anomalías , Arteria Renal/cirugía , Estudios Retrospectivos , Trasplante Homólogo/métodos , Resultado del Tratamiento , Uréter/anomalías , Uréter/cirugíaRESUMEN
Kidney donation should not lead to deterioration of the donor's health condition, both during the perisurgical period and in the long term. Safety of a living kidney donor becomes a prerequisite for his/her qualification. Detailed diagnostic procedures are performed to exclude any abnormalities of his/her health condition. Additionally, a long-term post-donation follow-up system for kidney donors has been set up in Poland besides the restrictive qualification system. Transplantation centers are obligated to provide a diagnostic procedures for living organ donors as a part of the monitoring of their health condition and to ensure them a medical follow-up for 10 years after the donation. A total of 141 cases of unilateral nephroureterectomy performed in 2003-2014 to obtain a kidney for transplantation were considered. Medical files of post-donation diagnostic or therapeutic methods and their outcomes were retrospectively analyzed. The aim of the study was to assess the efficacy of monitoring of donors' health condition within the framework of the long-term follow-up system for kidney donors in the aspect of detection of the donation-independent abnormalities.
Asunto(s)
Cuidados Posteriores/métodos , Trasplante de Riñón , Donadores Vivos , Cuidados a Largo Plazo , Nefrectomía/efectos adversos , Recolección de Tejidos y Órganos/efectos adversos , Adulto , Anciano , Femenino , Humanos , Cuidados a Largo Plazo/métodos , Masculino , Persona de Mediana Edad , Nefrectomía/métodos , Polonia , Estudios Retrospectivos , Recolección de Tejidos y Órganos/métodosRESUMEN
AIM: To establish the normal apparent diffusion coefficient (ADC) values in healthy kidneys, comparing them with the literature, and assessing the correlation between ADC values, creatinine blood level, and glomerular filtration rate (GFR). MATERIALS AND METHODS: Twenty-four healthy volunteers and 26 living kidney donors were examined on a 1.5 T magnetic resonance imaging (MRI) unit. Two diffusion-weighted imaging (DWI) sequences were included in the study protocol (protocol 1 with 16 b-values, protocol 2 with 10 b-values) before the examination blood and urine samples were collected. The GFR was calculated using Cockcroft & Gault and MDRD (Modification of Diet In Renal Disease) formulas and the ADC values were measured separately for the cortex and medulla of each kidney by two independent observers. All statistical analyses were performed using the STATISTICA (version 10.0) software package. Data were analysed using an unpaired t-test; p < 0.05 indicated a statistically significant difference. RESULTS: The average ADC value for protocol 1 for the cortex was 2.26 × 10(-3) mm(2)/s, for the medulla 2.21 × 10(-3) mm(2)/s. In protocol 2, the respective values were 2.13 × 10(-3) mm(2)/s and 2.06 × 10(-3) mm(2)/s. Neither statistically significant interobserver differences nor correlation between ADC values, GFR, and creatinine serum level were observed. CONCLUSION: The reference ADC values were established. The measurements show high interobserver consistency. The differences in ADC values reported in the literature suggest dependence on the equipment and methodology and point to the necessity of obtaining ADC norms for each MRI unit.