Search

We present the case of a 32-year-old pregnant woman in the 32 + 3 weeks of pregnancy who presented to the hospital with an exacerbation of pain in the right flank. The diagnostic evaluation revealed the presence of severe anemia and a spontaneous adrenal hemorrhage (SAH) in the right adrenal gland. The patient was transferred to the Perinatology, Obstetrics and Gynecology Clinic with the intention of undergoing preterm childbirth. However, the doctors made a risky decision to wait until week 37 and to terminate the pregnancy at that point. The decision was right, as a cesarean section was performed without complications, and the patient gave birth to a healthy child. Spontaneous adrenal hemorrhage (SAH) is a rare condition, defined as spontaneous hemorrhage without trauma or anticoagulant therapy. Due to bleeding and damage to the adrenal cortex, SAH can lead to adrenal insufficiency. Because of its non-specific symptoms and potentially fatal outcomes for the patient and fetus, it should be considered during diagnostics. [ABSTRACT FROM AUTHOR]

Tailgut cysts are rare lesions which are found in the rectorectal space. They develop in the final section of the intestine from which the rectum and anus extend and vary from being asymptomatic to symptomatic due to pressure on organs or nerves. Tailgut cysts are more common in females, usually between 30 and 60 years of age. They are thought to be benign, with variable malignancy risks. Surgical excision followed by histological examination is the gold standard of treatment, but access and approach to tailgut cysts depend on the location and morphology of the lesion. We present two symptomatic cases of this very rare pathology. In both cases, the cyst and coccyx bone were successfully excised using different approaches. The first patient was a 40-year-old woman with a large cyst which caused morning tenesmus, urinary outflow disorders and painful ovulation. Due to the cyst size, laparotomy was performed, and a combined approach was used. The second patient is a 36-year-old woman with co-existing endometriosis and a cyst causing pain in the sacral spine, constipation and tenesmus. The tumor was excised using a Kraske approach, and due to the infiltration of the coccyx bone it was removed using an osteotome. In this patient, perforation of the cyst was also observed. Both patients completed follow-ups involving regular surgical check-ups and MRI scans. Descriptions of different symptoms and surgical approaches make our study an important source of knowledge for diagnosing and treating these very rare tumors. [ABSTRACT FROM AUTHOR]

The presence of an oval-shaped lesion in the liver is mainly associated with either primary liver cancer or metastatic disease from another malignancy. However, we present the case of a 62-year-old patient diagnosed with plasma cell myeloma, which reveals that these kinds of lesions can also be found during the course of this disease. Rarity and non-specificity make this a very challenging diagnosis for radiologists. It involves a special alert from the doctors taking care of the patient. Biopsy may sometimes be necessary to make a correct diagnosis. It is significant to ensure that the correct treatment is implemented and that the patient is not exposed to the unnecessary diagnosis of another neoplastic disease. [ABSTRACT FROM AUTHOR]

Strangulation of the vermiform appendix into the femoral hernia sac (de Garengeot hernia) is very rare. This article presents a case of a 63-year-old woman with this kind of hernia which contained a strangulated tumour of the appendix. The patient presented to the hospital with a 3-day-long history of a palpable lump in the right groin. She had no other significant complaints, but USG imaging showed suspicion of the strangulated femoral hernia containing a bowel. The patient was operated on. As the tumour was not suitable to remove via groin incision, laparotomy was performed, followed by a release of the appendix with the tumour and their resection together with a fragment of the caecum. The postoperative course was uneventful, and histological examination showed appendiceal mucinous neoplasm with high-grade dysplasia. After oncological consultation, the patient underwent prophylactic right hemicolectomy. [ABSTRACT FROM AUTHOR]

Heavy metals, including cadmium (Cd), lead (Pb) and mercury (Hg) act as nephrotoxic agents, particularly in the renal cortex. The aim of the study was to determine the concentrations of Cd, Pb and Hg in kidneys removed from patients due to lesions of various etiologies and from patients after the rejection of transplanted kidneys. Additionally, we determined the influence of selected biological and environmental factors on the concentrations of toxic metals. The study material consisted of kidneys with tumor lesions ( n = 27), without tumors ( n = 7) and its extracted grafts ( n = 10) obtained from patients belongs to the north-western areas of Poland. The determined metal concentrations in the renal cortex and medulla may be arranged in the following descending order: Cd > Pb > Hg. The highest concentrations of Cd and Hg were found in the cortex, while the maximum content Pb was observed in the medulla. Significant correlations were found in the concentrations of the same metals between cortex and medulla and between Pb and Hg in the renal medulla. Pb content was higher in the renal medulla of men than in the cortex of the elderly (above 60 years of age). The highest concentrations of Pb and Hg were found in the cortex and medulla, of the kidneys had not neoplastic changes, and lower content of these metals were found in the extracted kidney grafts. In summary, renal grafts accumulate less heavy metals than cancerous kidneys, what could have been caused by immunosuppressors taken by the graft recipients. Moreover, sex, age and smoking are key factors responsible for xenobiotics concentrations. [ABSTRACT FROM AUTHOR]

Cytotoxic T-Lymphocyte Antigen 4 (CTLA4) downregulates the immune system. Lymphoid tyrosine phosphatase (Lyp)-PTPN22 protein-is suggested to be negative regulator of T-cell reaction. There are several polymorphisms in the CTLA4 and PTPN22 genes, which can influence the immune response and allograft function after kidney transplantation. The aim of this study was to examine the impact of CTLA4 and PTPN22 genes polymorphisms on the long-term renal transplant function and recipients' outcomes during a 5-year follow-up observation. The study enrolled 268 Caucasian renal transplant recipients. Genotyping of the rs231775 (+49AG) CTLA4 gene polymorphism was performed using real-time PCR and rs2476601 (C1858T) PTPN22 gene polymorphism using PCR-RFLP method. The 5-year graft survival rate was 81.7%. Dialysis was necessary in 22 (8%) patients, 7 (2.6%) patients died and 20 (7.4%) switched to another transplantation center. We found no association between studied polymorphisms and graft loss/dialysis. Comparison of the distribution of the +49AG CTLA4 and C1858T PTPN22 genes polymorphisms genotypes among dead and living patients showed no statistically significant differences. Above results suggest that the rs231775 (+49AG) CTLA4 and rs2476601 (C1858T) PTPN22 genes polymorphisms are not associated with long-term allograft failure, graft loss and mortality after transplantation. [ABSTRACT FROM AUTHOR]

Not required for Clinical Vignettes.

Background: Creatinine is a standard marker for estimation of the transplanted kidney function. Concentration values are used in mathematical equations for GFR (glomerular filtration rate) calculation, with MDRD (modification diet in renal disease) being most commonly used. Cystatin C is an alternative marker for changes in glomerular filtration, which is also used in eGFR (estimated GFR) formulas. The aim of this study was to reveal eGFR <60 ml/min/1.72 m(2) in a population of patients after renal transplant, with stable graft function, using different formulas. MatERIAL AND METHODS: A group of 100 patients (56 females and 44 males) aged 20-78 years, took part in this study. Renal transplantation was conducted from 10 years to 10 months prior to the study. Estimated GFR was calculated with 4 formulas: MDRD, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration), CKD-EPI cys (using cystatin C), and CKD-EPI mix (using creatinine and cystatin C). We used electronic calculators available on the National Kidney Foundation and the Nephron Information Center websites., Results: The occurrence of eGFR values <60 ml/min/1.73 m(2) was 28% according to MDRD formula, 23% according to CKD-EPI, 25% according to CDK-EPI cys, and 26%according to CDK-EPI mix., Conclusions: Occurrence of GFR <60 ml/min/0.73 m(2) was the highest when calculated by MDRD formula, and the lowest when calculation was done with CDK-EPI. The significant discrepancy with different eGFR formula testing suggests the need for further research to find the best marker and/or formula for graft function estimation.

Background: In peritoneal dialysis (PD) approximately 40% of ultrafiltration (UF) during hypertonic dwell (mini-PET test) occurs as free water transport (FWT) through water channels, mainly aquaporin-1. Experimental studies have shown that aquaporin-1 plays a role in cell migration and inflammatory response., Objectives: The purpose of the study was to evaluate if FWT is associated with the incidence of PD-related peritonitis., Material and Methods: Standard PET and mini-PET tests were performed on 27 patients at the onset of PD. Clinical data was reviewed and PET transport parameters calculated. The peritonitis rate was assessed and the group of patients was divided into the subgroups of peritonitis-free patients (n = 18) and patients with peritonitis episode (n = 9)., Results: Solute transport, measured as D/P creatinine during the PET test was significantly higher in the group of patients with peritonitis episode than in the group of peritonitis-free patients (0.77 ± 0.12 vs. 0.66 ± 0.11, p = 0.02). In the mini-PET test, there was a tendency to have higher solute transport in the group of patients with peritonitis episode compared to the group of peritonitis-free patients (0.61 ± 0.13 vs. 0.51 ± 0.1, p = 0.07). Ultrafiltration (mL) in the mini-PET test was slightly higher in the group of peritonitis-free patients (642 ± 178 vs. 488.9 ± 161.6, p = 0.06). FWT was not different between the two groups., Conclusions: Higher solute transport at the start of PD may be associated with the risk of peritonitis.

Background: CTLA4 is expressed on the surface of T helper cells and has a suppressive role in the lymphocytes' activation process. It transmits an inhibitory signal to T cells. Studies suggest that the rate of CTLA4 synthesis has a genetic background. There are several polymorphisms of the CTLA4 gene that can influence the expression of this molecule and may therefore affect immune response and allograft function after kidney transplantation. The aim of this study was to examine the impact of the rs231775 (+49AG) CTLA4 gene polymorphism on transplanted kidney function., Material/methods: The study enrolled 269 Caucasian renal transplant recipients (166 males, 103 females, mean age 47.63±12.96 years). Genotyping of the rs231775 (+49AG) CTLA4 gene polymorphism was performed using real-time PCR., Results: The frequency of DGF was higher in the individuals with the G allele of the rs231775 (+49AG) CTLA4 gene polymorphism compared with the carriers of the A allele (GG+AG vs. AA, OR 1.80; 95% CI 1.02-3.18, p=0.05). In multivariate analysis, rs231775 CTLA4 gene polymorphism G allele was an independent factor associated with increased risk of DGF (p=0.03)., Conclusions: Rs231775 (+49AG) CTLA4 gene polymorphism may be associated with increased risk of delayed graft function after kidney transplantation.

Introduction: The impairment of organ function derived from ischemia-reperfusion injury is still an important problem in solid organ transplantation. Cell alterations induced by ischemia prime the tissue for the subsequent damage that occurs during the reperfusion phase. Despite recent advances in immunosuppressive therapy, delayed graft function (DGF) remains an important problem after kidney transplantation. Different studies have related various clinical factors to DGF, such as donor age, recipient age, cold ischemia time, initial immunosuppressive regimens. The aim of present study was to examine the changes in cytokine concentrations in graft renal vein during the reperfusion in relation to the development of delayed graft function., Material and Methods: The study included 17 recipients of cadaveric renal grafts (10 males, 7 females, mean age 49 +/- 7 years, cold ischemia time 25 +/- 3 h)--8 with DGF and 9 without DGF. Levels of IL-lbeta, IL-2, IL-4, IL-6, IL-8, IL-10, IFN-gamma, TNF-beta and TNF-alpha in renal graft vein plasma during 5 first min. of reperfusion were quantified by flow-cytometry., Results: The increased concentrations ofIL-6, TNF-alpha and IL-1beta were observed during reperfusion. However there were no statistically significant differences between patients with and without DGF.

Introduction: Ischemia/reperfusion injury in organ transplantation is a multifactor process that may lead to organ damage and primary graft dysfunction. Perfusion is a process which creates a possibility of graft injury. Preservation solutions are thought to diminish the ischemic injury and an appropriate choice of the solution should guarantee a better graft function and good prognosis for graft survival. The aim of the study was to examine the effect of preservation solutions University of Wisconsin (UW) and Euro-Collins (EC) on purine concentration in rat kidney., Material and Methods: The study was carried out on Wistar rat kidneys divided into 3 groups: kidneys perfused with 0.9% NaCl (control group), kidneys perfused with UW preservation solution, kidneys perfused with EC preservation solution. After bilateral nephrectomy the right kidney was immediately frozen in liquid nitrogen and the left kidney was placed in 4 degrees C UW, EC or 0.9% NaCl solution for 24 hours. The concentrations of purine nucleotides were determined using high-performance liquid chromatography (HPLC) method., Results: The concentrations ofpurine nucleotides in renal tissue without cold ischemia did not differ significantly between rats perfused with 0.9% NaCl, UW and EC solutions. The tissue concentrations of adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), total adenine nucleotides (TAN), guanosine monophosphate (GMP) and inosine monophosphate (IMP) were significantly increased, whereas the concentrations of adenosine (Ado), inosine (Ino), guanosine (Guo), hypoxanthine (Hyp) and xanthine (Xan) were significantly lower in rats perfused with EC solution in comparison to rats perfused with 0.9% NaCl., Conclusions: Purine concentration profile in rat kidney reflects a protective influence of EC and UW solutions on high-energy nucleotides in conditions when their depletion might be harmful to graft function.