Kalideen Jm

Additional renal arteries : incidence and morphometry

Advances in surgical and uro-radiological techniques dictate a re-appraisal and definition of renal arterial variations. This retrospective study aimed at establishing the incidence of additional renal arteries. Two subsets were analysed viz. a) Clinical series-130 renal angiograms performed on renal transplant donors, 32 cadaver kidneys used in renal transplantation b) Cadaveric series - 74 en-bloc morphologically normal kidney pairs. The sex and race distribution was males 140, females 96 African 84, Indian 91, White 43 and “Coloured” 18, respectively. Incidence of first and second additional arteries were respectively, 23.2% (R 18.6% L 27.6%) and 4.5% (R 4.7% L 4.4%). Additional arteries occurred more frequently on the left (L 32.0% R 23.3%). The incidence bilaterally was 10.2% (first additional arteries, only). The sex and race incidence (first and second additional) was males, 28.0%, 5.1% females, 16.4%, 3.8% and African 31.1%, 5.4% Indian 13.5%, 4.5% White 30.9%, 4.4% and “Coloured” 18.5%, 0% respectively. Significant differences in the incidence of first additional arteries were noted between sex and race. The morphometry of additional renal arteries were lengths (cm) of first and second additional renal arteries 4.5 and 3.8 (right), 4.9 and 3.7 (left) diameters 0.4 and 0.3 (right), 0.3 and 0.3 (left). Detailed morphometry of sex and race were also recorded. No statistically significant differences were noted. Our results of the incidence of additional renal arteries of 27.7% compared favourably to that reported in the literature (weighted mean 28.1%). The study is unique in recording detailed morphometry of these vessels. Careful techniques in the identification of this anatomical variation is important since it impacts on renal transplantation surgery, vascular operations for renal artery stenosis, reno-vascular hypertension, Takayasu’s disease, renal trauma and uro-radiological procedures.

Left renal vein variations

The highly complex embryological development of the left renal vein compared to its right counterpart results in greater variations which are clinically significant. The study aimed to identify these variations and to document its incidence. Cadaveric study: 153 kidney pairs were harvested en bloc, dissected, 100 resin casts prepared and 53 plastinated; renal venography performed on further 58 adults and 20 foetal cadavers. Clinical study: (retrospective analysis): a) radiological study, 104 renal venograms; b) live related renal transplantation, 148 donor left kidneys; c) abdominal aortic aneurysm surgery, 525 patients. Total sample size: 1008. Renal collars observed in 0.3%; retro-aortic vein 0.5%; additional veins 0.4%; posterior primary tributary 23.2%, (16.7% Type IB; 6.5% Type IIB, cadaveric series, only). Our results differ significantly in incidence to that reported in the literature: renal collar 0.2-30%; retro-aortic vein 0.8-7.1%; additional renal vein 0.8-6%. Variations are clinically silent and remain unnoticed until discovered during venography, operation or autopsy. To a transplant surgeon, morphology acquires special significance, since variations influence technical feasibility of operation. Prior knowledge of circum-aortic vein is important when blood samples from suprarenal or renal veins are collected. Collar may provide developed collateral pathway immediately after surgery if renal interruption planned without awareness of its presence. Variations restrict availability of vein for mobilisation procedures. In aortic aneurysm repair, retro-aortic vein is important. During retroperitoneal surgery, the surgeon may visualise a pre-aortic vein but be unaware of an additional retroaortic component or a posterior primary tributary, and may avulse it while mobilising the kidney or clamping the aorta.

Bilateral styloid chain ossification: case report.

The styloid chain is defined as the styloid process of the temporal bone, the stylohyoid ligament and the lesser cornua of the hyoid bone. Unusually long, incidental bilateral styloid chain ossification is described. This paper is presented for its unusual incidence, unusual length, the presence of ossification rather than calcification and its embryological correlation. Brief mention is made on the embryology and clinical significance of this condition.

Lithopedion: a case report.

An 80‐year‐old Black, South African woman presented in the outpatient department with severe abdominal pain. Ultrasound examination revealed a large echogenic mass (20 × 20 cm) in the right upper quadrant. An abdominal x‐ray demonstrated the skeleton of a fully developed extrauterine fetus. It is presumed from the patients history that this fetus was present for at least 40 years. Radiography revealed a fetus shrouded in a mantle of calcification. The fetus was hyper‐flexed with other signs of “intrauterine” death. Fetal dentition charts dated the fetus at 34 weeks, the epiphyses being obscured by extensive calcification. In addition to subcutaneous calcification there was extensive visceral and intracranial calcification. Clin. Anat. 14:52–54, 2001.

Fractures of the acromium in tetanus neonatorum

Avulsion fractures of the acromium are described in 10 patients with severe tetanus neonatorum. Typically bilateral and invariably contemporaneous, they result from isometric contraction. Forced abduction of the arm against adductor resistance leads to avulsion of that segment of the acromium where the multipenate fibres of the deltoid muscle originate. To our knowledge this unique and ominous orthopaedic complication of severe neonatal tetanus has not been documented previously.

Pedicular cleft associated with bilateral pars interarticularis defects and transverse process hypoplasia of a fifth lumbar vertebra

The rare anomaly of cleft pedicle co-existing with bilateral pars interarticularis defects and ipsilateral transverse process hypoplasia of a lumbar vertebra is described in a 39-year-old male presenting with chronic low backache. The importance of recognizing pedicular clefts as congenital anomalies and distinguishing them from fractures or destructive processes is emphasized, and the relationship of pedicular clefts to hypoplastic or absent pedicles is discussed.

Absence of renal vein valves in humans and baboons

There is disagreement on the presence of renal vein valves. Cadaveric anatomical and radiological studies were undertaken on renal veins to determine their presence. No valves were demonstrated in the samples studied (56 adult human, 11 fetal and 11 Chacma baboon kidney pairs). The significance and reasons for this disagreement are discussed.

Circumaortic renal collar: Two case reports

The recognition of circumaortic renal venous collar on venography prompted a retrospective review of the incidence of this anomaly from data accessioned from in vivo and cadaveric studies. Our incidence of 0.6% is compared with those in other series that ranged between 0.2% to 30%. Surgical and investigative implications of this abnormality are discussed and emphasized.

Therapeutic intervention in renal arterial injuries

The efficacy of transcatheter vascular occlusion has been proven in many disease states. No doubt, its most productive application is its role in posttraumatic vascular injury. Posttraumatic hematuria refractory to conservative management demands intervention. Irrespective of the interventional technique, maximum conservation of renal parenchyma and preservation of normal renal function are mandatory in the management of renal trauma. This paper describes a 10-year experience with transcatheter embolization of posttraumatic refractory hematuria in 45 patients. The angiographic abnormalities requiring embolization are classified, indications for embolizations discussed, and consideration given to the choice of embolic material. As determined by immediate postembolization angiographic criteria and clinical outcome, the procedure was successful in 43 patients. In addition to two minor complications of unintentional nontarget vessel occlusion, there were two failures. It is concluded that transcatheter vascular occlusion in posttraumatic, intractable, renal hematuria, refractory to conservative management, should be considered. It is a safe, simple, and satisfactory alternative to surgical intervention. Should transcatheter embolization fail, conventional nephrectomy, partial nephrectomy, or segmental dearterialization may be necessary.