Can Transplantation of Kidney from Living Related Donor with Both-sided Double Renal Arteries to Adpkd Patient Allergic to Muscle Relaxant Succeed? – A Case Study

Abstract: 55-year old man (BMI = 32) with ESRD caused by ADPKD was qualified to kidney transplantation. His 63 years old sister (BMI = 24, GFR = 97 ml/min/1.73 m2 and both-sided double renal arteries) volunteered to be an organ donor. In the half of March 2014, open nephroureterectomy procedure was performed. Left kidney was prepared and ureter was cut out. Then, transplant recipient revealed anaphylactic shock during induction of his general anaesthesia. Donors ureter was reconstructed by end-to-end repair. The diagnosis of recipient’s allergy to the antibiotic was suspected. A month later, second try of transplantation was performed. At those time, ciprofloxacin instead of ceftriaxone was administered for the recipient, however symptoms of the anaphylactic shock occurred again. Further diagnostic tests for anaesthetic agents showed positive intradermic allergy tests with cisatracurium. Next month, third try of kidney transplantation was organized and pancuronium was administered for skeletal muscles relaxation. Recipient anaelgesia underwent without any complications. Read full text »

Vascular Complications After Kidney Transplantation

Abstract: Vascular complications remain the major surgical concern after kidney transplantation. They particularly include renal artery thrombosis, transplant renal artery stenosis, renal vein thrombosis, transplant renal artery kinking and arterial injury. Although being uncommon, they may lead to serious consequences including renal transplant dysfunction and allograft loss. Precise diagnosis and treatment of such conditions are crucial for graft and patient survival. Therapeutic options include both surgical and interventional radiologic methods. The risk of vascular complications in renal transplant recipient can be minimized with careful transplantation technique. Understanding of etiological factors of may lead to their elimination in the future, resulting in better outcomes of kidney transplantation procedures. Read full text »

Kidney Retransplantation – Are The Good Results Attainable? – Review

Abstract: Kidney transplantation is the best-known method of treatment for patients with end-stage renal disease. Thanks to the development of effective immunosuppressive regimens in kidney transplantation, graft and patient survival during last decades has lengthened. However, chronic allograft dysfunction remains the main problem as long as kidney transplantation is concerned and is one of the main reasons for patients return to the dialyses program. 25% of the patients on the waiting list are patients qualified for retransplantation. The aim of this study was to analyze literature from PubMed database regarding kidney retransplantation results. Kidney retransplantation is considered the preferred treatment for patients with renal allograft failure, not only because the good results are attainable but also because of the significant improvement of quality of life in the retransplanted patients and the costs are comparable.
Read full text »

High Risk Pregnancy of a Woman With Liver Transplant Failure – Case Report

Abstract: Along with the progress of transplantation medicine, the number of liver transplant recipients has gradually increased in the last decade. Among different indications and clinical run, also some young females have been given a chance to live, become pregnant and give birth to a healthy child. However, pregnancy in liver recipients is associated with increased risk in the post transplant run, both in respect of graft failure and the fetus. A 22-year-old woman after two liver transplantations: first due to the secondary biliary cirrhosis induced by biliary atresia, and second for multiple complications (acute rejections, recurrent cholangitis and the development of AIH), was considered for the third liver transplantation. Read full text »

Pregnancy Associated Atypical Hemolytic Uremic Syndrome: Clinical Case and Literature Review

Abstract: Pregnancy associated atypical hemolytic uremic syndrome (pa-aHUS) is a rare thrombotic microangiopathy (TMA), fatal in 50-60% of cases. It‘s typical clinical presentation is a triad of microangiopathic hemolytic anaemia, thrombocytopenia and acute progressive renal failure. Plasmapheresis therapy is recommended as a specific treatment. Retrospective analysis of medical documentation of a patient, who was treated for the pa-aHUS in Vilnius University Hospital Santaros Klinikos, was carried out. 44-year old 34th-week pregnant woman was admitted to Vilnius University Hospital Santaros Klinikos with signs of preeclampsia. As preeclampsia progressed, caesarian section was performed. The classical triad of aHUS was observed. Read full text »

Results of The Usage of Biological Mesh in the Repair of Complex Abdominal Wall Defects in Patients Post Transplantation and General Surgery. The Feasibility of Using MRI in Follow up

Abstract: Immunosuppressive therapy, inflammation, and surgical site or general infection make the use of traditional methods for abdominal wall closure ineffective and preclude the application of synthetic mesh. In such difficult cases, the utilization of the biological material, such as PermacolTM, a porcine acellular dermal collagen implant, may be a solution. The purpose of this study was to analyse the use of biological mesh in patients in whom the closure of abdominal wall defect with other methods was not possible and to compare outcomes in patients after transplantation and general surgery. The study group consisted of 14 patients, including 6 patients after transplantation. The evaluation of wound healing was based on a clinical examination and in selected patients on magnetic resonance imaging (MRI) that is an excellent examination however it should not be considered as an examination of choice in such cases. Only 3 uneventful outcomes were observed. Biological meshes may be used in patients in whom other ways of treatment had failed; still a prolonged time of wound healing should be expected. It seems, that it is safe to use PermacolTM in post transplantational patients. Implanting PermacolTM and negative pressure wound therapy can be combined. Read full text »

Sonographic Measurement of Liver, Spleen and Kidneys and its Correlation With the Parameters ff the Body in 203 Volunteers

Abstract: Ultrasound examination has recently become widely popular and now it constitutes an examination of choice in the majority of cases. One of the basic features assessed during the ultrasound procedure is the size of the particular organ. To find correlation between the size and the age, weight, height and BMI (Body Mass Index) and also to check if already established normal values can be modified accordingly to these body parameters. 206 healthy volunteers without any known chronic disease and under no chronic treatment were examined in this study. In the analysis the following factors were taken under consideration: the size of the liver in the midclavicular line, the size of left kidney in midaxillary line, the size of right kidney in anterior axillary line and the size of spleen in posterior axillary line in correlation with age, weight, high and BMI. Read full text »

Wound Healing Complications After Radical Vulvectomy-treatment With the Use of Vacuum-assisted Closure (VAC)

Abstract: Cancer of the vulva accounts 3-5% of gynaecologic malignancies. In 90% it is a squamous cell carcinoma. The most common location is labia majora. Surgical treatment of vulvar cancer is often followed by complications in wound healing process. The aim of this work is to present advantages of negative-pressure drainage used in postoperative therapy of the wound. A patient diagnosed with a cancer of the vulva underwent radical vulvectomy with bilateral lymphadenectomy. Postoperatively, complex wound failure was observed and the patient was treated with vacuum-assisted closure therapy (VAC). After 10 days, the use of VAC resulted in amelioration of the wound state. Vacuum-assisted closure aims to reduce total time of wound healing, hospitalization and nursing work. Additionally, it enables to ameliorate patient’s general state. It is a safe and successful method used worldwide and it should be considered to be introduced in gynaecologic patients after. Read full text »

Accuracy of Sonographic Fetal Weight Prediction – Evaluation of Sex-specific Formulas

Abstract: Traditional evaluation of fetal weight is performed by means of ultrasonography and mathematical formulas using combinations of biometric parameters, like abdominal circumference (AC), head circumference (HC), biparietal diameter (BPD), femur length (FL). It was recently shown that mentioned parameters and intrauterine growth patterns demonstrate gender-related differences. These reports were used to develop new formulas which take into account the influence of fetal sex. The aim of this paper was to determine the accuracy of ultrasound fetal weight estimations with use of many different formulas, test sex-specific formulas against established methods and to compare their precision in different weight groups. This retrospective study included 97 singleton fetuses with birth weight (BW) between 1040 g and 4740 g and ultrasound examination within 7 days before delivery. Estimated fetal weight (EFW) was calculated by Hadlock, Shepard, Campbell and Merz formulas and sex-specific models of Schild and Melamed. EFW was confronted with actual BW. Achieved results were compared in a few groups considering gender and BW. The accuracy of fetal weight estimations turned out to be higher for males regardless of the used formula. For the whole study population, the best accuracy was proved for Melamed formulas and the worst for models of Shepard and Merz. The highest precision of predictions was revealed in the group of newborns with BW 2500 – 3999 g. Estimated errors for low birth weight (LBW) infants and macrosomic fetuses were more significant. In most cases, new sex-specific formulas provide smaller mean errors than established methods. Read full text »

Unexpected Cause of Chronic Cough in a Pregnant Woman

Abstract: Cough is an interdisciplinary symptom. Chronic cough in pregnant women requires precise diagnosis, especially when it appears for the first time during pregnancy. Case report. A 32-year old woman was seen by her obstetrician at 13th week of gestation. She had a history of miscarriage and premature birth. She did not report any medical problems and had no aberrations in a physical examination aside from abdominal wall scars caused by trauma during an assault with a knife. At 15th week of gestation the patient reported a severe, dry cough with no symptoms of infection. During the previous pregnancy the cough also appeared and ceased after delivery. She was diagnosed with asthma and gastro-oesopharyngeal reflux and received adequate treatment. A chest X-ray performed before the pregnancy showed elevation of the diaphragm. MRI during pregnancy revealed cavity in the diaphragm and a hernia. She was referred for surgery. Meanwhile, the cough became milder and the operation was postponed. Several weeks later the cough returned. Current treatment was modified, with improvement. As there was a risk of premature birth, the patient received full cycle of steroid therapy at 27th week. The elective caesarean section was performed at 39th weeks. She gave birth to a healthy newborn. The cough regressed during puerperium. Conclusions. The cough can be caused by a wide spectrum of factors. Carefully obtained medical history is crucial in establishing diagnosis. We should bear in mind anatomical changes in the body of pregnant women, which can potentially modify symptoms of certain diseases. Read full text »