Impact of Vascular Variations on Living Donor Kidney Transplantation

Background: Kidney transplantation is the best treatment for end-stage chronic kidney disease. However, its realization is confronted by several difficulties among which are anatomical variations. Objective: The objective of our work was to describe the impact of renal pedicle variations on the operative procedure as well as the complications. Method: We conducted a retrospective study on living kidney donors and their recipients in the period from 2012 to 2017. Several variables were studied, in particular socio-demographic, operative and progression. Results: We identified 49 living donors whose mean age was 37.59 years with a male-to-female ratio of 3.9 and 45 ± 10.75 years in the recipients. The prevalence of renal vascular abnormalities was higher with a proportion of 46.94% in recipients. The left kidney was most frequently removed (75.51%) and then kept mainly in HTK (95.92%). These vascular anomalies were associated with a longer operating time but this difference was not statistically significant (p = 0.5804). They had no effect on hot and cold ischemia times (p = 0.9838, p = 0.8389). Complications were observed in 11 patients, all recipients, i.e. 11.22%, and were not related to the presence of vascular abnormalities (p = 0.086). We observed that 4.08% of deaths were all recipients. Conclusion: It seems that kidney transplantation with multiple renal arteries and/or veins does not significantly lengthen the operating time and does not promote the onset of complications.

Anomalous retinal artery associated with branch retinal artery occlusion and neovascular glaucoma: A case report

BACKGROUND Congenital anomalous retinal artery is rare and does not typically affect visual acuity.However,an abnormal artery that passes through and supplies blood to the macular area complicated with branch retinal artery occlusion may negatively impact visual acuity.This study reports an unusual case of anomalous retinal artery combined with retinal artery occlusion.CASE SUMMARY A 52-year-old male presented with severely reduced vision in the right eye.The fundus examination revealed an anomalous artery,extending from the superior temporal arcade and crossing the macula into the inferior temporal quadrant.The anomalous artery was partially occluded,with a narrowed lumen.A cherry-red spot was observed with whitening of the macular area,suggesting macular edema.Fundus fluorescein angiography revealed disc leakage and a delayed filling time.Optical coherence tomography revealed increased thickness of the neuroretina and underlying layers.The patient was treated with vessel dilation,hyperbaric oxygen,ocular massage,and thrombolytics.Visual acuity of the right eye subsequently improved to 20/200 from hand motion at 4 cm.This improvement in visual acuity persisted when the patient was examined at the 1-mo follow-up visit.The patient was subsequently followed via telephone interview.The information provided via interview indicated that visual acuity in the affected eye was stable up to 6 years from the time of the initial presentation.However,after 3 additional years,the patient was diagnosed with neovascular glaucoma in the right eye,which was subsequently enucleated.CONCLUSION Although congenital retinal vascular anomaly,including anomalous retinal artery,rarely affects vision,when complicated with branch retinal artery occlusion,the abnormal artery that supplies the macula may severely reduce visual acuity.

Identification of Mucilage Cavity as a Significant Microscopic Characteristic Existing in Phloem Instead of Pith of Radix et Rhizoma Rhei

The morphologic and microscopic features of Radix et Rhizoma Rhei were studied. The study verified that the mucilage cavities did exist in phloem of rhizomes and roots or abnormal vascular bundles. Also, they were in similar distribution in three species of Radix et Rhizoma Rhei. The diagnostic characteristic for microscopic identification was found to be the similar distribution of abnormal vascular bundles in pith of rhizomes in all three species. And the appearance of the crude drug varied more depending on the plants＇ geographical origin and different preliminary treatment on the spot of collection than on the species differences. Our findings, having not been delineated clearly so far in the previous reports, are helpful for clarifying current descriptions in different literatures or standards and make a full understanding on microscopic and macroscopic identification of Radix et Rhizoma Rhei.