Nephron sparing surgery as the treatment of choice in renal cell carcinoma

Wprowadzenie. Rozwój technik obrazowych układu moczowego sprawił, iż coraz częściej rozpoznajemy guzy nerek mniejszych rozmiarów, we wczesnym etapie rozwoju oraz o mniejszym stopniu złośliwości. Wprawdzie nadal standardowym leczeniem chorych z RCC pozostaje radykalna nefrektomia, obserwujemy jednak wzrost liczby zabiegów oszczędzających miąższ nerki (NSS – Nephron Sparing Surgery). Cel pracy. Celem pracy była retrospektywna ocena onkologiczna stanu 108 chorych poddanych NSS. Materiał i metodyka. Pacjenci zostali podzieleni na dwie podgrupy w zależności od wielkości guza: T1a (≤ 4 cm) i T1b (≥ 4 ≤ 7 cm). Czas obserwacji wynosił nie mniej niż 24 miesiące. Rak jasnokomórkowy nerki stanowił 83,9% wszystkich guzów. Wyniki. Najczęściej (51,7%) występowały guzy o typie złośliwości G2. Skumulowany odsetek chorych przeżywających bez wznowy procesu nowotworowego w operowanej nerce i/lub okolicznych węzłach chłonnych lub przerzutów odległych po 2- i 3-latach wynosił odpowiednio 99% i 93%. Nasze wyniki wskazują, iż NSS guzów nerek w stopniu zaawansowania pT1a i pT1b jest zabiegiem bezpiecznym i skutecznym. Wielkość guza w stopniu pT1 nie ma wpływu na 2- i 3- letnie przeżycie bez wznowy procesu nowotworowego w nerce operowanej. Wnioski. Badanie ultrasonograficzne w trakcie operacji pozwala na identyfikację dodatkowych ognisk nowotworowych i optymalny dobór cięcia operacyjnego. Jest również niezwykle przydatne w ocenie guzów zlokalizowanych w centralnej części nerki.Introduction. Advances in imaging diagnostics have contributed to the frequent detection of small kidney tumours both at an early stage and of low grade. Although radical nephrectomy is still the gold standard in Renal Cell Carcinoma (RCC) treatment, yet it slowly ceases to be the standard approach and open or laparoscopic Nephron Sparing Surgery (NSS) is becoming more and more common. A i m. The purpose of the study was to determine the functional and oncological outcomes of NSS for RCC basing on an analysis of 108 patients. Material and methods. The patients were divided into two groups: T1a (≤4 cm) and T1b (≥4 ≤ 7 cm). We performed an analysis of all patients with a minimal follow-up time of 24 months. In the majority of patients the diagnosis was clearcell carcinoma(83.9%). Results. G2 tumours were the most common (51.7%). The cumulative proportion of survivors without local relapse within the operated kidney and/or in the local lymph nodes and without distant metastases after 2 and 3 years was 99% and 93%, respectively. Our results support the fact that in pT1a and pT1b patients NSS is a safe and effective procedure. The size of pT1 tumours has no bearing on 2-year and 3-year recurrence-free survivals. Conclusion. Intraoperative ultrasound allows for further identification of additional neoplasmatic foci and for the use of the best surgical approach. Intraoperative ultrasound is useful in NSS, and especially in those cases, where the tumor lies in the central part of the kidney

Methodology and evaluation of the renal arterial system

INTRODUCTION: The broad range of medical images and image processing technologies are applied in urology. The aim was to propose methodology to assess three–dimensional (3D) arrangement of renal arterial tree and to build a statistical model for analyzing the layout of arteries in the sections of the kidney. METHODS: The series of kidney CT slices are analyzed using image processing procedures and further the 3D model of arterial systems is converted to a graph tree which includes information about features of the renal arterial system. RESULTS: The selected endocast was transformed to the form of the 3D connected tubes, further to the tree data structure and next analyzed. The information about 3D coordinates of the nodes, also branch length and diameter were stored. Renal arterial system of the considered kidney possessed 181 branches with 14 bifurcation levels. The number of branches was highest at the 9th bifurcation level. The mean length of the arterial branch on each bifurcation level was constant (6 mm). The branch diameters rapidly decreased after each bifurcation. The number of terminal branches increases up to 9th level where there are 19 terminal branches. The mean length of terminal arteries was 7.17 mm while the mean radius 0.46 mm. A statistically significant correlation between parameters that described sub–trees was noticed. It was observed that the individual artery segments occupy a separate space in the kidney volume. CONCLUSIONS: The methodology has the potential to assist in presurgical planning based on branching patterns of the renal arterial system and corresponding pathology

Case Report of Cerebral Sinus Thrombosis Related to Immune Thrombotic Thrombocytopenia Following Administration of ChAdOx1 nCoV-19 for Vaccination against COVID-19

Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous sinus thrombosis (CVST) has been recently reported after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a case of a patient with fulminant CVST and thrombocytopenia after receiving the ChAdOx1 nCoV-19 vaccine. Although the patient received immediate anticoagulant and intravenous immune globulin treatment, he died within 24 h after hospital admission. VITT and CVST are rare conditions; however, the course may be fatal. Therefore, clinicians should be familiarized with the clinical and laboratory features of VITT

Antimicrobial prophylaxis in adults and children undergoing hematopoietic cell transplantation: 2021 Polish recommendations

Infections are still a major reason of morbidity and one of the most common causes of death after hematopoietic cell transplantation (HCT). Antimicrobial prophylaxis plays a crucial role in decreasing non-relapse mortality after HCT. The objective of this guideline paper is presentation of current recommendations of antimicrobial prophylaxis for children and adults after hematopoietic cell transplantation, prepared in cooperation of Polish scientific hematological societies. Recommendations were prepared by the working group and finally approved by all 23 Polish transplant centers for children and adults. Existing ECIL (European Conference on Infections in Leukemia) and EBMT (European Society of Blood and Marrow Transplantation) guidelines, as well as results of survey performed among all Polish transplant centers, were the background material for working group. Recommendations are presented in sections dedicated to antibacterial prophylaxis, antifungal prophylaxis, antiviral prophylaxis, as well as prophylaxis of toxoplasmosis and infections with Pneumocystis jiroveci. Recommendations on principles of vaccination against COVID-19 are provided based on the state of knowledge in September 2021. A section on guidelines of environmental prophylaxis is also presented