Use of Living Donors for Renal Homotransplantation

The procedure is described which is followed at the University of Colorado Medical Center for the selection and evaluation of living donors for renal homotransplantation. Priority is given to volunteers who have a close genetic relationship to the recipient. The aortogram is the single most useful test for determining which kidney to be used. If either organhas a single artery, it can be employed for homografting without fear of encountering anatomic difficulties at the time of its subsequent insertion into the recipient. Twenty-two left and 18 right kidneys have been excised. The donor operation has been a safe one. The only complications have been two pneumothoraces, one atelectasis, one transient peroneal nerve palsy, and two subcutaneous wound infections. Renal hyperplasia of the remaining kidney apparently occurs promptly since the creatinine clearance returns to or toward normal within a few weeks after operation. Interestingly, the same phenomenon is also observed in the homograft in those recipients who have a successful result. The steps in the donor operation are described for both right and left sides. Wide exposure, block removal of the specimen, and meticulous technique are required both to protect the donor from surgical accidents and to insure a homograft of high quality. Homograft cooling is provided eitherby total body hypothermia of the donor or by a method in which intra-arterial infusion of a chilled electrolyte solution isused. The relative future roles of living and cadaveric donors are discussed. The results with parental or sibling donations have been good enough to justify further employment of these sources. In cases in which a genetically unrelated donor must be used, a sounder policy may be to seek cadaveric organs, especially if the recipient falls in an older age group. © 1964 American Medical Association All rights reserved

Renal homografts in patients with major donor-recipient blood group incompatibilities

Three documented cases of clinical renal transplantation in which the donor and recipient patients had different major blood types have been presented. The relationship of the donor-recipient pairs ranged from that of sister-to-brother to that of totally unrelated patients of different races. The renal homografts were obtained from living donors in 2 cases and from a recently dead cadaver in the third. Renal function was prompt and excellent when living donors were used, and more indolent when a cadaver kidney subjected to a long period of ischemia was employed. Two of the patients have normal renal function after 74 and 49 days. The third patient died with rejection and sepsis 24 days after transplantation. This study demonstrates the feasibility of obtaining both immediate and prolonged renal function despite the presence of major blood group incompatibilities between donor and recipient patients. This knowledge should expand the donor pool, making it possible to transfer renal homografts under much less stringent requirements than has been the case in the past. © 1964

The Use of Elastic Resistance Bands to Reduce Dynamic Knee Valgus in Squat-Based Movements: A Narrative Review

An elastic band wrapped around the distal thighs has recently been proposed as a method for reducing dynamic knee valgus (medial movement of the knee joint in the frontal/coronal plane) while performing squats. The rationale behind this technique is that, by using an external force to pull the knees into further knee valgus, the band both exaggerates the pre-existing movement and provides additional local proprioceptive input, cueing individuals to adjust their knee alignment. If these mechanisms are true, then elastic bands might indeed reduce dynamic knee valgus, which could be promising for use in injury prevention as excessive knee valgus may be associated with a greater risk of sustaining an ACL rupture and/or other knee injuries. Due to this possibility, certain athletic populations have already adopted the use of elastic bands for training and/or rehab, despite a limited number of studies showing beneficial findings. The purpose of this narrative review is to examine current literature that has assessed lower limb muscle activity and/or lower limb kinematics performance on squat-based movements with or without an elastic band(s). Importantly, this paper will also discuss the key limitations that exist in this area, propose suggestions for future research directions, and provide recommendations for training implementations. # Level of Evidence

Examining Muscle Activity Differences During Single and Dual Vector Elastic Resistance Exercises

# Background Elastic resistance exercise is a common part of rehabilitation programs. While these exercises are highly prevalent, little information exists on how adding an additional resistance vector with a different direction from the primary vector alters muscle activity of the upper extremity. # Purpose The purpose of this study was to examine the effects of dual vector exercises on torso and upper extremity muscle activity in comparison to traditional single vector techniques. # Study Design Repeated measures design. # Methods Sixteen healthy university-aged males completed four common shoulder exercises against elastic resistance (abduction, flexion, internal rotation, external rotation) while using a single or dual elastic vector at a fixed cadence and standardized elastic elongation. Surface electromyography was collected from 16 muscles of the right upper extremity. Mean, peak and integrated activity were extracted from linear enveloped and normalized data and a 2-way repeated measures ANOVA examined differences between conditions. # Results All independent variables differentially influenced activation. Interactions between single/dual vectors and exercise type affected mean activation in 11/16 muscles, while interactions in peak activation existed in 7/16 muscles. Adding a secondary vector increased activation predominantly in flexion or abduction exercises; little changes existed when adding a second vector in internal and external rotation exercises. The dual vector exercise in abduction significantly increased mean activation in lower trapezius by 25.6 ± 8.11 %MVC and peak activation in supraspinatus by 29.4 ± 5.94 %MVC (p<0.01). Interactions between single/dual vectors and exercise type affected integrated electromyography for most muscles; the majority of these muscles had the highest integrated electromyography in the dual vector abduction condition. # Conclusion Muscle activity often increased with a second resistance vector added; however, the magnitude was exercise-dependent. The majority of these changes existed in the flexion and abduction exercises, with little differences in the internal or external rotation exercises. # Level of Evidence 3