“You can’t get there from here”: Critical obstacles to current estimates of the ESRD risks of young living kidney donors

Short studies that generate lifetime end‐stage renal disease (ESRD) risks for young living kidney donors have conflicted with the knowledge and practice of nontransplant specialists. A widely accepted online risk calculator (OLRC) is no exception. It uses 6.4 year observations and an ostensibly empiric methodology to predict low lifetime risks for normal young candidates. But the nonspecific ESRD risk factors identified in this study are likely features of kidney diseases that were already underway at study entry. No practicing nephrologist would use their absence to predict any specific kidney disease that had yet to begin, which is essential for excluding high‐risk individuals. The OLRC's risk estimates are particularly low because it also does not assign to young adults about 70% of the lifetime ESRD that they will experience as they age, which is part of their risk. It reinforces traditional concepts of low donor risk, minimizing the potential relevance of recent, sometimes concerning, long‐term outcome data. These data suggest many similarities between postdonation ESRD and ESRD in the general population, about which much is already known. Despite our best efforts, the heterogeneity and exponential accumulation of end‐stage kidney diseases over time prevent long‐term predictions of risk for young kidney donors.     

Épaule aiguë hyperalgique atypique : intérêt de l’échographie

A patient presented with an atypical pattern of acute severe shoulder pain. Sonography elucidated the mechanism of the pain and allowed effective treatment. The patient was unable not only to move her shoulder but also to flex and to extend her elbow. Sonography showed a calcific deposit in the subscapularis tendon with local edema displacing the long head of the biceps tendon out of the bicipital groove. Local injection of a glucocorticoid under ultrasonographic control was followed within seven days by subsidence of the subscapularis tendon edema and by a return of the long head of the biceps tendon to its normal position in the bicipital groove.     

‘Ganglions’

The ganglion cyst is the commonest soft-tissue swelling in the hand and wrist. It is a fibrous swelling that arises near a joint or tendon sheath, and contains clear mucinous fluid. The exact pathogenesis of the ganglion is unknown, although various theories quote anatomical and physiological evidence to support them. Ganglia can occur near any joint in the body, although they are encountered most commonly in the wrist and hand. They can present in a diverse number of ways. In cases of diagnostic uncertainty, they can be investigated by imaging techniques. If a ganglion is symptomatic, it should be treated by conservative means initially including aspiration. Steroids have no place in their management. If this strategy fails, then excision is required, it should be radical to minimise the risk of recurrence. Further research into the pathophysiology may allow improvement in treatment.     

Die Rolle des Arginingehaltes und der Arginase-Aktivität in der Fertilität

Experimental studies have shown that in men with pathospermia the arginine content of sperm plasma is lower than in normal men. In order to find out the reason of this divergency the authors analysed the content of arginine, urea, citrulline, GAA and arginase activity in serum and in sperm plasma of 40 patients with normo-, oligo- or azoospermia. For the first time our results show that the low arginine content in pathological sperm is not due to disorder of the precursor metabolism, but to the increased arginase activity and to the increased conversion of arginine to GAA. In order to find out the mechanism of action and to develop an adequate andrological therapy detailed studies on molecular level have to be done.     

‘STAB AND SPLIT’: A ‘BLOODLESS’ AND ‘SCARLESS’ SKIN INCISION TECHNIQUE FOR MINOR SURGERY

The ‘stab and split’ skin incision technique was applied to children requiring minor surgery. A small stab incision was made on a skin crease and split open with mosquito forceps. After the surgical procedure was completed, the wound was closed in layers with a subcuticular suture to the skin. In all cases, splitting caused virtually no blood loss because subcutaneous veins were left intact, and the wounds healed well, especially in infants. ‘Stab and split’ is an effective alternative incision technique for minor surgery in younger children.