ABSTRACT
Living kidney donation is the most common type of living-donor transplant. Italian guidelines allow the living donations from emotionally related donors only after clear and voluntary consent expressed by both the donor and the recipient involved. Living donation raises ethical and legal issues because donors voluntarily undergo a surgical procedure to remove a healthy kidney in order to help another person. According to the Italian standards, the assessment of living donor-recipient pair has to be conducted by a medical "third party", completely independent from both the patients involved and the medical team treating the recipient. Starting from the Hospital "Città della Salute e della Scienza" of Turin (Italy) experience, including 116 living kidney donations, the Authors divided the evaluation process performed by the "Third-Party" Commission into four stages, with a particular attention to the potential donor. Living donation procedures should reflect fiduciary duties that healthcare providers have toward their patients, originating from the relationship of trust between physician and patient. In addition to that, the social implications are enormous if one considers the worldwide campaigns to promote public awareness about organ donation and transplantation, and to encourage people to register their organ donation decisions. The systematic process proposed here can be a tool that proactively reduces and controls the risks of coercion, organ trafficking, vitiated consent, insufficient weighting of donative choice, that could arise especially in donors involved in living kidney donation.
Subject(s)
Kidney Transplantation , Living Donors , Tissue and Organ Procurement , Humans , Italy , Kidney Transplantation/methods , Kidney Transplantation/psychology , Living Donors/psychology , Risk Assessment , Tissue and Organ Procurement/ethicsABSTRACT
Internal carotid artery dissection (ICAD) after motorcycle accidents is unusual but life threatening if not promptly diagnosed and treated. We report the case of a motorcyclist involved in a frontal collision with a car, suffering injuries due to direct blunt trauma and indirect trauma by sudden deceleration force. Bilateral ICAD was diagnosed by computed tomography angiogram 5 days after the accident. Here in, starting from a medicolegal case, we emphasized some clinical criteria to make a prompt diagnosis to prevent permanent neurological deficit in this pathology whose best management is still under the debate. An unusual case of ICAD is described with regard to both forensic and promptly diagnostic therapeutic management.
Subject(s)
Accidents, Traffic , Carotid Artery, Internal, Dissection/diagnostic imaging , Cerebral Angiography , Computed Tomography Angiography , Motorcycles , Wounds, Nonpenetrating/diagnostic imaging , Adult , Carotid Artery, Internal, Dissection/etiology , Carotid Artery, Internal, Dissection/physiopathology , Carotid Artery, Internal, Dissection/therapy , Delayed Diagnosis , Disability Evaluation , Humans , Magnetic Resonance Imaging , Male , Predictive Value of Tests , Recovery of Function , Time Factors , Time-to-Treatment , Treatment Outcome , Wounds, Nonpenetrating/etiology , Wounds, Nonpenetrating/physiopathology , Wounds, Nonpenetrating/therapyABSTRACT
Percutaneous closure of an atrial septal defect has been increasingly used, and complications have been rare. We report the case of a 63-year-old man who had undergone endovascular closure of a secundum atrial septal defect months earlier. The occluder was later found in the abdominal aorta.
Subject(s)
Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/therapy , Heart Septal Defects, Atrial/surgery , Leg/blood supply , Septal Occluder Device/adverse effects , Cardiac Catheterization , Device Removal , Echocardiography , Heart Septal Defects, Atrial/diagnostic imaging , Humans , Male , Middle AgedABSTRACT
This report describes the case of a 60-year-old woman with a history of hysterectomy for myomas, totally asymptomatic, with incidental evidence of a pelvic intracaval mass extending to the right atrium. She underwent a staged procedure (sternothomic and abdominal) through a thoracolaparotomic approach in circulatory arrest and deep hypothermia. Using a one-stage surgical approach, we were able to withdraw one portion of the mass from the right atrium and another from the abdominal inferior vena cava, thus minimizing the risk of unexpected venous or atrial wall injury during surgical manipulation.
Subject(s)
Iliac Vein/surgery , Leiomyomatosis/surgery , Thoracic Surgical Procedures , Uterine Neoplasms/surgery , Vena Cava, Inferior/surgery , Biopsy , Cardiopulmonary Bypass , Circulatory Arrest, Deep Hypothermia Induced , Female , Heart Atria/pathology , Heart Atria/surgery , Humans , Iliac Vein/diagnostic imaging , Iliac Vein/pathology , Incidental Findings , Leiomyomatosis/diagnostic imaging , Leiomyomatosis/pathology , Middle Aged , Neoplasm Invasiveness , Sternotomy , Tomography, X-Ray Computed , Treatment Outcome , Uterine Neoplasms/pathology , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/pathologyABSTRACT
After the incidental intraoperative discovery of a paraganglioma of cranial nerve XII, we searched our hospital database and literature for similar cases to determine whether evidence exists to support the existence of paraganglioma of the hypoglossal nerve. We describe a case of cranial nerve XII paraganglioma, recognized only during surgery, without any indicative preoperative sign or symptom nor diagnostic imaging studies. In light of published findings, only four cases described since 1966, and our experience, the report discusses diagnostic criteria that could aid in establishing a diagnosis of hypoglossal nerve paraganglioma based on a reasonable degree of medical certainty.
