Kidney Transplant Loss Due to May-Thurner Syndrome: Case Report and Review of the Literature.

BACKGROUND: May-Thurner syndrome (MTS) is an extrinsic venous compression by the arterial system against bony structures in the iliocaval territory. The most common variant of MTS is due to compression of the left iliac vein between the overlying right common iliac artery and the fifth lumbar vertebrae. The prevalence of MTS is unknown; therefore, there are only a few publications about MTS in kidney transplant recipients. Risk factors that may progress from usually asymptomatic to symptomatic MTS are female sex, scoliosis, dehydration, coagulation disorders, and radiation. Clinical presentations include acute extremity pain and swelling, venous claudication, and chronic signs of venous insufficiency. METHODS: We describe a 63-year-old man who underwent kidney transplantation (left iliac fossa). Four days after transplantation, a graftectomy was done due to graft rupture caused by renal vein thrombosis. After imaging studies, a diagnosis of MTS was established. The patient had no typical symptoms of MTS. However, an incidence of right lower limb thrombosis was observed, and due to vertebral discopathy, the patient underwent surgery with implantation of a vertebral implant. RESULT: After a successful second transplantation on the right side, incidents of thrombosis were observed: superficial thrombosis of the upper limbs and massive deep vein thrombosis of the right lower limb. Thrombophilia was recognized, the graft function is stable, and anticoagulation therapy is being continued. CONCLUSION: Asymptomatic MTS in the case of coincidence of other risk factors, such as coagulation disorders, history of vertebral operation, and additional pressure of the graft, can result in graft failure.

Assessment of the Carotid Bodies in Magnetic Resonance-A Head-to-Head Comparison with Computed Tomography.

OBJECTIVES: To evaluate carotid body visibility in contrast-enhanced magnetic resonance (MR) studies and to compare the results to contrast-enhanced computed tomography (CT). METHODS: Two observers separately evaluated MR and CT examinations of 58 patients. MR scans were acquired with contrast-enhanced isometric T1-weighted water-only Dixon sequence. CT examinations were performed 90 s after contrast agent administration. Carotid bodies' dimensions were noted and their volumes calculated. To quantify the agreement between both methods, Bland-Altman plots were computed. Receiver operating characteristic (ROC) and its localization-oriented variant (LROC) curves were plotted. RESULTS: Of the 116 expected carotid bodies, 105 were found on CT and 103 on MR at least by a single observer. Significantly more findings were concordant in CT (92.2%) than in MR (83.6%). The mean carotid body volume was smaller in CT (19.4 mm3) than in MR (20.8 mm3). The inter-observer agreement on volumes was moderately good (ICC (2,k) 0.42, p < 0.001), but with significant systematic error. The diagnostic performance of the MR method added up to 88.4% of the ROC's area under the curve and 78.0% in the LROC algorithm. CONCLUSIONS: Carotid bodies can be visualized on contrast-enhanced MR with good accuracy and inter-observer agreement. Carotid bodies assessed on MR had similar morphology as described in anatomical studies.

ALK-rearranged renal cell carcinomas in Polish population.

Anaplastic lymphoma kinase (ALK) is a receptor tyrosine kinase, the activation of which is considered an important event in the pathogenesis of several neoplasms and a predictive factor for the targeted therapy with ALK inhibitors. Thus far, ALK rearrangements have been identified in 22 renal cell carcinomas in both pediatric and adult patients. We evaluated the incidence of ALK rearrangement-associated RCC in adult Central European population. An immunohistochemical evaluation of 1019 kidney tumors was performed with use of three different clones of anti-ALK antibodies. None of the tested samples showed positive staining, which suggests that the incidence of ALK rearrangement-associated renal cell carcinomas is significantly lower in the Polish population, and indicates a potential association between ethnicity and occurrence of these rare neoplasms.

The challenges of hypervolemic therapy in patients after subarachnoid haemorrhage.

PURPOSE: The triple-H therapy is widely used for cerebral vasospasm (CV) prevention and treatment in patients after subarachnoid haemorrhage (SAH). However, this practice is based on low level evidence. Aim of this study was to evaluate errors in fluid administration, fluid balance monitoring and bedside charts completeness during a trial of triple-H therapy. MATERIALS AND METHODS: An audit of the SAH patient charts was performed. A total of 508 fluid measurements were performed in 41 patients (6 with delayed cerebral ischaemia; DCI) during 14 days of observation. RESULTS: Underestimating for intravenous drugs was the most frequent error (80.6%; 112), resulting in a false positive fluid balance in 2.4% of estimations. In 38.6% of the negative fluid balance cases, the physicians did not order additional fluids for the next 24h. In spite of that, the fluid intake was significantly increased after DCI diagnosis. The mean and median intake values were 3.5 and 3.8l/24h respectively, although 40% of the fluid balances were negative. The positive to negative fluid balance ratio was decreasing in the course of the 14 day observation. CONCLUSIONS: This study revealed inconsistencies in the fluid orders as well as mistakes in the fluid monitoring, which illustrates the difficulties of fluid therapy and reinforces the need for strong evidence-based guidelines for hypervolemic therapy in SAH.