Morphometry and skeletopy of kidneys and renal vessels in marmoset (Callithrix spp.).

BACKGROUND: Marmosets, Callithrix spp, are small New World monkeys that have gained importance as an experimental animal model for human. Despite its use, information on its renal morphometry, vascularization, and location are limited. Therefore, this study will supply basic anatomy for applied studies and for comparative anatomy. METHODS: Fifty cadavers of Callithrix spp were collected on highways from the Atlantic Forest biome, identified and injected with a 10% formaldehyde solution. Later, the specimens were dissected and the measurements and topography of the kidneys and renal vessels were recorded. Both left and right kidneys were significantly larger in females. RESULTS: In the specimens studied, the average body length was 20.00 ± 2.46 cm in males and 20.50 ± 1.98 cm in females (p = .43). The kidneys of the Callithrix spp. were symmetrical in shape and resembled a "bean." They were also pale brown with a smooth surface. In males, the most frequent location of the right kidney was at the L1-L2 level (92%), while the location of the left kidney was between L2 and L3 (76%). In females, the most frequent location of the right kidney was at the L1-L2 level (56%), while the location of the left kidney was between L2 and L3 (32%) (Table 1). However, in seven (28%) males and nine (36%) females, the kidneys were at the same level. CONCLUSIONS: In both sexes, there was a positive and significant linear correlation between body length and kidney length. Regardless of the variable location of the kidneys in both sides and in either sexe, the right kidney was always located more cranially than the left, similar to observations in other non-human primates.

Pedículo Renal: Análisis de sus Variantes / Renal Pedicle: Analysis of their Variants

Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describen las relaciones intrínsecas del pedículo renal (PR) a partir de dos planos coronales, siendo la PER el elemento que limita entre ambos. Trivedi et al. (2011) demostró relaciones entre los elementos del PR que no coinciden con las descripciones aportadas por dichos autores.Conocer las posibles variantes en las relaciones intrínsecas del PR es de suma importancia en prácticas quirúrgicas como el trasplante renal (García de Jalón Martínez et al., 2003; Batista Hernández et al., 2010). Por lo tanto, el objetivo del presente trabajo fue analizar las variables relaciones entre los elementos que conforman el PR en la región yuxtahiliar del riñón. Se estudiaron 23 PR, formolizados al 10 % y provistos por el Equipo de Disección de la Segunda Cátedra de Anatomía de la Universidad de Buenos Aires. Se clasificaron los PR en dos grupos. En el Grupo I, las afluentes de origen de la vena renal (AOVR) se hallaban en el mismo plano coronal. En el grupo II, las AOVR se encontraban en diferentes planos coronales. Cada grupo fue subdividido en distintos patrones. Los patrones I y II, de mayor incidencia, fueron asociados al grupo I y los patrones III, IV y V al grupo II. En el patrón I, las AOVR eran anteriores a la pelvis renal (PER) y posteriores a la arteria prepiélica (APP). En el patrón II, las AOVR eran anteriores a la PER y a la APP. Los patrones I y II conforman el grupo I y presentaron mayor número de incidencia en nuestra investigación. Existen también variantes que inciden con menor frecuencia que dichos patrones, estas comprenden el grupo II de la clasificación planteada en el presente trabajo.

SUMMARY: Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describe the intrinsic relationships of the renal pedicle (PR) from two coronal planes, the renal pelvis (PER) being the element that limits between both. Trivedi et al. (2011) showed relationships between the elements of the RP that do not coincide with the descriptions provided by these authors. Knowing the possible variants in the intrinsic relationships of the RP is of the utmost importance in surgical practices such as renal transplantation (García de Jalón Martínez et al., 2003). Therefore, the objective of this study is to analyze the variable relationships between the elements that make up the RP in the juxtahilar region of the kidney. 23 RP were studied, formalized at 10 % and provided by the Dissection Team of the Second Chair of Anatomy of the University of Buenos Aires. PRs were classified into two groups. In Group I, the tributaries of origin of the renal vein (RVOA) were in the same coronal plane. In group II, the AOVRs were in different coronal planes. Each group was subdivided into different patterns. Patterns I and II, with the highest incidence, were associated with group I and patterns III, IV and V with group II. In pattern I, the VROA were anterior to the renal pelvis (PER) and posterior to the prepelvic artery (PPA). In pattern II, AOVRs were prior to PER and APP. Patterns I and II make up group I and presented a higher number of incidence in our investigation. There are also variants that occur less frequently than these patterns, these comprise group II of the classification proposed in this work.

Anomalous drainage of the right gonadal vein.

The present research aims to present and describe an unusual and rare anatomical variation in relation to the drainage of the right gonadal vein. This anatomical knowledge is crucial as it assists in the work of surgeons and health professionals in general. The dissection occurred in the anterior wall of the abdomen and, through observational analysis, an anatomical variation was found in the drainage of the right gonadal vein in a human cadaver, obtained by anonymous donation, male gender and without predetermined clinical characteristics, ethnicity, and age, belonging to the Padre Albino University Center collection. This research was approved by the Research Ethics Committee under protocol 12923919.8.0000.5430. The drainage of right gonadal vein is this variant occurs anastomosed with an innominate venous trunk that empties into the inferior vena cava. Furthermore, the presence of an accessory right renal vein is also noticed, which anastomoses with the innominate venous trunk and with the right renal vein, through a vein suggestively called interrenal, differing from the anatomical normality described in the literature. This variation is supposed to occur due to flaws in the development of the embryo, which generate venous changes in the origins of the right gonadal vein. Acknowledging the existence of it is relevant when performing surgical procedures in the region, as it differs from the most frequent anatomy found in the human population. The rare drainage of the right gonadal vein through an innominate trunk to the inferior vena cava and its importance is highlighted in this article.

Artéria renal tripla em porco-espinho (Sphiggurus villosus): relato de caso / Triple renal artery in porcupine (Sphiggurus villosus): case report

O interesse pelo estudo de animais silvestres vem crescendo consideravelmente nos últimos anos, seja em decorrência do risco de extinção ou visando o controle de doenças, especialmente as zoonoses. A ordem Rodentia apresenta o maior número de espécies da classe Mammalia. Apesar de ampla distribuição e importância, dados sobre sua anatomia vascular renal são escassos na literatura. O objetivo deste artigo é relatar o aparecimento de variação numérica na artéria renal esquerda em Sphiggurusvillosus com enfoque nas possibilidades de implicações clínico-cirúrgicas, como, anastomoses cirúrgicas, estudos imaginológicos, nefrectomias e planejamento pré-operatório para redução de riscos e complicações como hemorragia. O cadáver foi devidamente formolizado no Laboratório de Ensino e Pesquisa em Morfologia de Animais Domésticos e Selvagens e posteriormente dissecado. O rim esquerdo apresentou três artérias renais, uma cranial, uma intermediaria e outra caudal, ambas posicionadas em nível de L2 emergindo de forma impar lateralmente da aorta abdominal. A primeira artéria, mais cranial, apresentou 10,52 mm de comprimento e se dirigiu diretamente para o hilo renal, emitindo ramo para adrenal, diafragma e musculatura sublombar. A segunda artéria, intermediária, mediu 7,77 mm, emitiu ramo cranial e caudal para o hilo renal e ramo ureteral. A terceira artéria, caudal, mediu 10,11 mm e se dirigiu para o hilo renal. A veia renal esquerda era única e apresentou 9,25 mm de comprimento, posicionada em nível de L1. Este é o primeiro relato de artéria renal tripla em mamífero silvestre.

Interest in the study of wild animals has grown considerably in recent years, either due to the risk of extinction or to control diseases, especially zoonoses. The order Rodentia has the largest number of species in the Mammalia class. Despite its wide distribution and importance, data on its renal vascular anatomy are scarce in the literature. The aim of this paper is to report the appearance of numerical variation in the left renal artery in porcupine focusing on the possibilities of clinical and surgical implications, such as surgical anastomoses, imaging studies, nephrectomies and preoperative planning to reduce risks and complications such as bleeding. The animal was duly formalized in the Laboratory of Teaching and Research in Morphology of Domestic and Wild Animals and subsequently dissected. The left kidney had three renal arteries, one cranial, one intermediate, and one caudal, both positioned at L2 level, emerging unevenly laterally from the abdominal aorta. The first more cranial artery was 10.52 mm long and directed directly into the renal hilum, emitting a branch to the adrenal, diaphragm and sub lumbar muscles. The second intermediate artery measured 7.77 mm, emitting a cranial and caudal branch to the renal hilum and ureteral branch. The third caudal artery measured 10.11 mm and headed straight for the renal hilum. The left renal vein was unique, measured 9.25 mm long, and positioned at L1 level. This is the first report of triple renal artery in wild mammals.

Compressões das veias renal e ilíaca comum esquerdas em tomografias computadorizadas: com que frequência são detectadas? / Compression of left renal vein and left common iliac vein on CT scans: how often are they detected?

Resumo Contexto As síndromes de nutcracker e May-Thurner são raras e, apesar de muitas vezes subdiagnosticadas, podem causar sintomas limitantes de gravidade variável. Frequentemente são consideradas diagnóstico de exclusão e não há consenso na literatura quanto a prevalência, incidência e critérios diagnósticos. Objetivos Estimar a frequência da compressão das veias ilíaca comum e renal esquerdas em tomografias computadorizadas de abdome e pelve. Métodos Estudo descritivo, quantitativo e transversal. Para veia renal esquerda, foram considerados como critérios de compressão a relação diâmetro hilar/aortomesentérico > 4 e o ângulo aortomesentérico < 39° e, para veia ilíaca comum esquerda, o diâmetro < 4 mm. Resultados Foram analisadas tomografias computadorizadas de 95 pacientes; destes, 61% eram mulheres e 39% eram homens. A compressão da veia renal esquerda foi encontrada em 24,2% da amostra, com idade média de 48,8 anos, ocorrendo em 27,6% das mulheres e 18,9% dos homens (p = 0,3366). A compressão da veia ilíaca comum esquerda foi detectada em 15,7% da amostra, com idade média de 45,9 anos, ocorrendo em 24,10% das mulheres e 2,7% dos homens (p = 0,0024). Em 7,4% dos pacientes, ambas compressões venosas foram detectadas. Conclusões A compressão da veia renal esquerda ocorreu em mulheres e homens com frequência semelhante, enquanto a compressão da veia ilíaca comum esquerda foi mais frequente em mulheres. Ambas as compressões venosas foram mais frequentemente encontradas em pacientes com idade entre 41 e 50 anos.

Abstract Background The nutcracker and May-Thurner syndromes are rare and, although often underdiagnosed, they can cause limiting symptoms. They are frequently considered only after exclusion of other diagnoses and there is no consensus in the literature on prevalence, incidence, or diagnostic criteria. Objectives To estimate the frequency of compression of the left common iliac vein and left renal vein in CT scans of the abdomen and pelvis. Methods Descriptive, quantitative, cross-sectional study. The criteria used to define compression of the left renal vein were a hilar/aortomesenteric diameter ratio > 4 and aortomesenteric angle < 39° and the criterion for compression of the left common iliac vein was a diameter < 4mm. Results CT scans of 95 patients were analyzed; 61% were women and 39% were men. Left renal vein compression was observed in 24.2% of the sample, with a mean age of 48.8 years, occurring in 27.6% of the women and 18.9% of the men (p = 0.3366). Compression of the left common iliac vein was detected in 15.7% of the sample, with a mean age of 45.9 years, occurring in 24.1% of the women and 2.7% of the men (p = 0.0024). Both veins were compressed in 7.4% of the patients. Conclusions Left renal vein compression was detected in women and men at similar frequencies, whereas left common iliac vein compression was more frequent in women. Both venous compressions were most frequently found in patients aged 41 to 50 years.

Duplicidad de la vena renal derecha en Didelphis aurita (Didelphimorphia: Didelphidae): reporte de un caso / Double right renal vein in Didelphis aurita (Didelphimorphia: Didelphidae): case report

El Didelphis aurita, conocido como comadreja de orejas negras, es un marsupial con amplia distribución en la América del Sur, frecuente tanto en los ambientes silvestres como antrópicos debido a su gran plasticidad ecológica. Animales de esta especie son comúnmente atendidos en la medicina de animales silvestres y vienen siendo empleados como modelos experimentales alternativos a especies tradicionales. El objetivo de ese trabajo fue relatar la ocurrencia de un caso de vena renal doble en un espécimen adulto, macho, de D. aurita. Para eso, se ha disecado un cadáver fijado y conservado en solución de formaldehído 10%, previamente inyectado con látex de color azul por la porción torácica de la arteria aorta para facilitar la disección. El espécimen poseía dos venas renales derechas, una vena craneal (11,3 mm) y otra caudal (10,0 mm) que drenaban distintamente para una vena cava caudal. La vena renal izquierda y las arterias renales eran únicas. Aunque la duplicidad de la vena renal es reportada en otras especies como perros, gatos y felideos silvestres, este es el primer relato en el género Didelphis. El conocimiento de las variaciones anatómicas vasculares es relevante para la correcta ejecución de procedimientos veterinarios y en la interpretación de hallazgos experimentales en relación con el sistema urogenital.(AU)

Didelphis aurita, known as black eared oposum, is a marsupial widely distributed in South America, frequently seen in both wild and anthropogenic environments due to its great ecological plasticity. This species is commonly treated in wildlife veterinary services and has been used as alternative experimental models instead of conventional species. The aim of this report was to describe a case of double renal vein in a male, adult, specimen of D. aurita. In order to make the dissection easier, the cadaver was fixed and preserved in 10 % formaldehyde solution, and previously injected with latex in blue color by the thoracic aorta to facilitate dissection. The specimen had two right renal veins, one cranial (11.3 mm) and other caudal (10.0 mm) that drained distinctly for caudal vena cava. The left renal vein and the renal arteries were single. Although double renal vein has been reported in other species, such as dogs, cats and wild felids, this is the first mention in the genus Didelphis. The knowledge of the vascular anatomical variations is relevant for the correct execution of veterinary procedures and the interpretation of experimental findings in urogenital system research.(AU)

Terminal bifurcation and unusual communication of left testicular vein with the left suprarenal vein / Bifurcação terminal e comunicação atípica de veia testicular esquerda com veia suprarrenal esquerda

Abstract Variations of the testicular veins are relevant in clinical cases of varicocele and in other therapeutic and diagnostic procedures. We report herein on a unique variation of the left testicular vein observed in an adult male cadaver. The left testicular vein bifurcated to give rise to left and right branches which terminated by joining the left renal vein. There was also an oblique communication between the two branches of the left testicular vein. A slender communicating vein arose from the left branch of the left testicular vein and ascended upwards in front of the left renal vein and terminated into the left suprarenal vein. The right branch of the testicular vein received an unnamed adipose tributary from the side of the abdominal aorta. Awareness of these venous anomalies can help surgeons accurately ligate abnormal venous communications and avoid iatrogenic injuries and it is important for proper surgical management.

Resumo Variações nas veias testiculares têm relevância em casos clínicos de varicocele e em outros procedimentos terapêuticos e diagnósticos. Relatamos aqui uma variação peculiar de veia testicular esquerda observada em um cadáver adulto do sexo masculino. A veia testicular esquerda bifurcava para dar origem aos ramos esquerdo e direito, os quais terminavam juntando-se à veia renal esquerda. Foi observada também comunicação oblíqua entre os dois ramos da veia testicular esquerda. Uma fina veia comunicante originava-se do ramo esquerdo da veia testicular esquerda e ascendia até a frente da veia renal esquerda, terminando na veia suprarrenal esquerda. O ramo direito da veia testicular recebia um tecido adiposo tributário não especificado da lateral da aorta abdominal. Conhecimento dessas anomalias venosas pode ajudar os cirurgiões a ligar corretamente comunicações venosas anormais e evitar danos iatrogênicos e é importante para um manejo cirúrgico apropriado.

Variantes anatómicas de las venas renales / Anatomical variants of the renal veins

Introducción: el drenaje venoso de los riñones se produce a partir de las venas renales que clásicamente se describen como troncos únicos que drenan en las paredes laterales de la vena cava inferior. Objetivo: determinar las características morfológicas de las venas renales. Materiales y métodos: se realizó un estudio cuantitativo, longitudinal, prospectivo, observacional y descriptivo, en 47 bloques, provenientes de cadáveres sin cirugías arteriovenosas aortorenales, enfermedad aórtica aneurismática, ni malformaciones congénitas renoureterales demostrables, en el Hospital Provincial Clínico Quirúrgico Docente Celia Sánchez Manduley, de Manzanillo, provincia Granma. Los bloques fueron lavados, fijados y disecados por el método macroscópico directo. Resultados: Las venas renales fueron únicas en el 61,70 % (18 bloques) de los bloques, siendo más constantes en el lado izquierdo (87,23 %). El recorrido fue prearterial en el 88,18 % de las venas, siendo este recorrido más frecuente en el lado izquierdo (66,03 %). La unión a la vena cava inferior fue en la cara lateral en el 95,46 % de las venas, siendo esta unión más constante en el lado izquierdo (98,11 %). Conclusiones: las venas renales presentan un patrón de variabilidad anatómica bajo. Las variantes a la norma anatómica fueron más frecuentes en el lado derecho, siendo su conocimiento importante en el planeamiento de la cirugía exerética y reconstructiva nefrourológica.

Introduction: the venous drainage of the kidneys is produced beginning from the renal veins that are classically described as unique trunks draining in the lateral walls of the inferior vena cava. The objective of the research was determining the morphological characteristics of the renal veins. Objective: determining the morphological characteristics of the renal veins. Materials and Methods: a quantitative, longitudinal, prospective, observational and descriptive study was carried out in 47 blocks, coming from dead bodies without aorta-renal arterial-venous surgeries, aortic aneurismal disease nor demonstrable reno-ureteral congenital malformations, in the Teaching Surgical-Clinical Provincial Hospital Celia Sanchez Manduley, of Manzanillo, province of Granma. The blocks were washed, fixed and dissected using the direct macroscopic method. Results: the renal veins were unique in 61.7 % (18 blocks) of the blocks, being more constants in the left side (87.23 %). The course was pre-arterial in 88.18 % of the veins, being this course more frequent in the left side (66.03 %). The union to the inferior vena cava was in the lateral side in 95.46 % of the veins, being this union more constant in the left side (98.11 %). Conclusions: the renal veins have a low pattern of anatomical variability. The variants of the anatomical norm were more frequent in the right side, being its knowledge important in the process of planning the exeretic and nephro-urologic reconstructive surgery.

Conventional and doppler abdominal ultrasonography in pacas (Cuniculus paca)

Background: The first report of ultrasound evaluation in pacas was for gestational diagnosis and monitoring. However,there are no reports of the use of this technique for the evaluation of abdominal structure in pacas. Elucidating the biologyof wild species is important for preservation and potential use as experimental models for human and animal research. Assuch, this study aimed to describe an ultrasonographic view of major abdominal organs and determine the vascular indicesof abdominal aorta and renal arteries in pacas (Cuniculus paca) by Doppler mode.Materials, Methods & Results: Fifteen adult females with a mean weight of nine kilograms were positioned into dorsal orlateral recumbency. A specific gel was applied, and transabdominal ultrasound examination was performed by a single experienced evaluator using MyLab 30 VET ultrasound equipment (ESAOTE, Italy) with 7.5 and 10.0 MHz linear transducers.Anatomy, biometry and ultrasonographic findings, such as ecogenicity, echotexture and wall thickness of main abdominalorgans (bladder, kidneys, adrenals, spleen, liver, digestive system and ovaries), were assessed during the ultrasound scan.Doppler ultrasound was used to determine the peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI = [PSV - EDV]/PSV) and pulsatility index (PI = [PSV - EDV]/mean velocity) of the abdominal aorta and renalarteries. The animals were healthy based on physical examination, hemogram and biochemical profile. Furthermore, wedetermined that the ultrasound technique for abdominal evaluation of these animals was feasible. Major abdominal organswere accessed using conventional ultrasonography biometric values and sonographic characteristics. Doppler examinationwas used to determine mean vascular indices of the abdominal aorta and the left and right renal arteries...

Conventional and doppler abdominal ultrasonography in pacas (Cuniculus paca)

Background: The first report of ultrasound evaluation in pacas was for gestational diagnosis and monitoring. However,there are no reports of the use of this technique for the evaluation of abdominal structure in pacas. Elucidating the biologyof wild species is important for preservation and potential use as experimental models for human and animal research. Assuch, this study aimed to describe an ultrasonographic view of major abdominal organs and determine the vascular indicesof abdominal aorta and renal arteries in pacas (Cuniculus paca) by Doppler mode.Materials, Methods & Results: Fifteen adult females with a mean weight of nine kilograms were positioned into dorsal orlateral recumbency. A specific gel was applied, and transabdominal ultrasound examination was performed by a single experienced evaluator using MyLab 30 VET ultrasound equipment (ESAOTE, Italy) with 7.5 and 10.0 MHz linear transducers.Anatomy, biometry and ultrasonographic findings, such as ecogenicity, echotexture and wall thickness of main abdominalorgans (bladder, kidneys, adrenals, spleen, liver, digestive system and ovaries), were assessed during the ultrasound scan.Doppler ultrasound was used to determine the peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI = [PSV - EDV]/PSV) and pulsatility index (PI = [PSV - EDV]/mean velocity) of the abdominal aorta and renalarteries. The animals were healthy based on physical examination, hemogram and biochemical profile. Furthermore, wedetermined that the ultrasound technique for abdominal evaluation of these animals was feasible. Major abdominal organswere accessed using conventional ultrasonography biometric values and sonographic characteristics. Doppler examinationwas used to determine mean vascular indices of the abdominal aorta and the left and right renal arteries...(AU)

Morphologic evaluation of the renal veins: a study with autopsy material from Colombian subjects.

Renal venous drainage presents a large degree of variability. The purpose of this study was to determine the morphological expression of the renal veins. Renal vein formation patterns, their morphometry, and frequency of additional veins were studied in a sample of 156 pairs of kidneys, the vascular beds of which were subjected to an injection-corrosion technique, taken from cadaver specimens autopsied at National Institute of Legal Medicine and Forensics Sciences in Bucaramanga, Colombia. A single renal vein (RV) was found bilaterally in 122 (78.2%) samples, whereas 34 (21.8%) kidneys had additional RVs (left side 33 cases, right side one case). Of the specimens with multiple right renal veins (RRV), 28 (17.9%) had two RVs and five (3.2%) had three RVs. Of the left kidneys, 99.4% had one LRV and 0.6% had two LRVs. The lengths of the left and right renal veins were 56.5±12.7 mm and 23.6±8.21 mm, respectively; the caliber of the left renal vein (LRV) was 12.3±1.41 mm, whereas the caliber of the RRV was 10.9±1.56 mm, a statistically non-significant difference (p=0.262). 82.7% of the LRVs and the 73.1% of the RRVs (p=0.768) originated at the extra-hilum level. Renal vein formation pattern characterized by the confluence of upper and lower tributaries was found in 61.6% of the cases, whereas 16.3% of the specimens had upper, medium, and lower tributaries. Variation patterns found in this study point towards a wide morphological expression of these vessels that needs to be taken into account for both imaging and surgical procedures.

Study and clinical application of the anatomy of renal pedicles in retroperitoneoscopic nephrectomy / Estudio y aplicación clínica de la anatomía de los pedículos renales en la nefrectomía retroperitoneoscópica

This work aims to investigate the anatomical basis and clinical application value of renal pedicle locating in retroperitoneoscopic nephrectomy. To summarize the anatomical basis of renal pedicle locating through retrospective analysis of 278 cases of retroperitoneoscopic nephrectomy from July 2007 to September 2009, during which renal pedicle was located at about 2-4 cm below the medial arcuate ligament of the diaphragm in the space between the psoas major muscle and inferior vena cava (abdominal aorta) in the anatomical level of space before psoas. The operation of 278 patients was all successfully completed, where renal pedicle was quickly found. It took 3.5+/-1.3 min to locate the renal pedicle, and 95.6+/-23.8 min to operate. In retroperitoneoscopic nephrectomy, it is most preferable to locate renal pedicle in the space before psoas. The renal pedicle is located exactly at about 2-4 cm below the medial arcuate ligament of the diaphragm in the space between the psoas major muscle and inferior vena cava (abdominal aorta). The time for locating the renal pedicle can be shortened if the surgeon is familiar with the anatomic features of renal pedicle in retroperitoneoscopy, thereby saving the operation time.

El objetivo del estudio fue investigar las bases anatómicas y el valor de la aplicación clínica de la localización del pedículo renal en la nefrectomía retroperitoneoscópica. Para resumir las bases anatómicas de la localizacion del pedículo renal se realizó el análisis retrospectivo de 278 casos de nefrectomía retroperitoneoscópica desde Julio del 2007 a Septiembre del 2009. El pedículo renal se encontró a unos 2-4 cm por debajo del ligamento arqueado medial del diafragma en el espacio entre el músculo psoas mayor y vena cava inferior (o parte abdominal de la aorta) en el nivel anatómico del espacio anterior al músculo psoas mayor. La cirugía de los 278 pacientes fue completada exitosamente, encontrándose rápidamente el pedículo renal. El procedimiento para localizar el pedículo renal tomó 3,5+/-1,3 minutos y la cirugía completa 95.6+/-23.8 minutos. En la nefrectomía retroperitoneoscópica, es preferible localizar el pedículo renal en el espacio anterior al músculo psoas mayor. El pedículo renal se encuentra alrededor de 2-4 cm por debajo del ligamento arqueado medial de la membrana en el espacio entre el músculo psoas mayor y vena cava inferior (parte abdominal de la aorta). El tiempo para localizar el pedículo renal se puede disminuir si el cirujano está familiarizado con las características anatómicas del pedículo renal en la retroperitoneoscopía, ahorrando así el tiempo total de la cirugía.

Persistencia del collar venoso renal / Persistence of renal venous collar

El desarrollo del sistema venoso cava es bastante complejo, pudiendo producirse innumerables variaciones de los padrones anatómicos ya conocidos, siendo algunos más frecuentes y otros de rara incidencia. De estas variaciones, puede ocurrir una en que se forma un anillo vascular en torno de la aorta, constituído por una vena renal pre-aórtica y otra retro-aórtica, desembocando a un nivel más bajo en la vena cava inferior (VCI), una disposición llamada "collar venoso renal", que consiste en la persistencia de las anastomosis intersupracardinales e intersubcardinales embrionarias. En la variación presentada en este artículo, la disposición de los vasos corresponde a un tipo de la clasificación mencionada en la literatura, con excepción de la emergencia independiente de los componentes pre y retroaórtico del collar referido, a partir del hilio renal y del calibre distal de la vena renal retroaórtica. La vena renal preaórtica tenía 90 mm de longitud y 20 mm de calibre en su parte terminal, desembocando en la VCI a nivel del tercio inferior de la vértebra L1. La vena renal retroaórtica tenía 125 mm de longitud, cruzando las vértebras L1 y L2 para desembocar en la VCI a nivel del tercio superior de L3, donde se registró un diámetro terminal de 14 mm. La disposición presentada, es una variación potencialmente peligrosa de la vena renal izquierda, importante de recalcar su presencia, ya que ha sido relatado que en cirugías retroperitoneales no se ha identificado el componente dorsal, produciendo hemorragia profusa, nefrectomía innecesaria y hasta la muerte.

The development of the cava venous system is very complex, taking place to the raising of innumerous variations of the anatomical patterns already known, which could be more or less common and others, still, of rare incidence. One of these anomalies may occur in a low frequency on the left side, forming a vascular ring around the aorta constituted by a preaortic renal vein and other retro-aortic renal vein, entering in a lower level of the VCI, in a condition called as " Renal Collar" consisted of persistence of the Intersupracardial embrionary anastomoses. In this case report, the vascular disposition corresponds to a type of the classification as related in literature, with exception of the independent emergency of the preaortic and retro-aortic components of the circum-aortic collar from the renal hilum and the distal diameter of the retroaortic renal vein. The preaortic vein had 90 mm of length, diameter of 20 mm in its end and led into the VCI on the lower level of L1. The retroaortic vein measured 125 mm of length, crossing L1 and L2 to discharge in the VCI, to the upper level of L3, where it had diameter of 14 mm. The importance of the study and description of the circumaortic renal collar is due to it representing a potentially hazardous anomaly of the left renal vein, occurring case reports where failure to recognize the dorsal component during retroperitoneal surgery may lead to abundant hemorrhage after inadvertent injury, unnecessary nephrectomy or, even death.

Bilateral Duplication of Gonadal Veins: a Case Report / Duplicación Bilateral de las Venas Gonadales: Reporte de Caso

The duplication of gonadal vessels is mainly found on the left side, with less numbers of bilateral cases. The objective of this work is describing a case of bilateral duplication of gonadal veins, where two veins were draining to inferior vena cava, being that the closest vein of kidney medial margin had a thickness of 2.68mm and was distant 64.41 mm of the organ. The second vessel had a thickness of 1.43mm and was distant 73.76mm. Two veins follow to left renal vein, being that the first vessel had a thickness of 2.7mm and was distant 21.8mm of the kidney medial margin; the other had a thickness of 1.64mm and was distant 35.13mm of the organ. The presence of variations on the local of drainage of gonadal vessels has clinical importance for comprehension of origin of varicocele cases, as well as the recurrence of them after surgical procedures.

La duplicación de las venas gonadales es más común en el lado izquierdo, con pocos casos bilaterales. El propósito de este reporte fue describir el caso de una duplicación bilateral de las venas gonadales, dos de las cuales desembocaban en la vena cava inferior. El vaso próximo del margen medial del riñon tenía un diámetro de 2,68mm y una longitud de 64,41 mm. La segunda vena tenía un diámetro de 1,43 mm y una longitud de 73,76 mm. Los dos vasos desembocaban en la vena renal izquierda. La primera vena tenía un diámetro de 2,7 mm y estaba a 21,8 mm del margen medial del riñon. La otra tenía un diámetro de 1,64 mm y se se localizaba a 35,13 mm del margen medial del riñon. La presencia de variaciones donde se produce el drenaje de los vasos gonadales tiene importancia clínica para la comprensión del origen del varicocele y la recurrencia del mismo, después de procedimientos quirúrgicos.

Normal and variant anatomy of renal hilar structures and its clinical significance / Anatomía normal y variante de las estructuras hiliares renales y su significancia clínica

Advanced imaging techniques have resulted in increasing use of minimally invasive approaches for nephron sparing surgeries of kidney. Need for precise knowledge of normal and variant anatomy of vascular pedicle of kidney is thus justified. Ample literature is available on the variations in the intrarenal vascular pattern of the kidney, which are seen frequently. But the variation in arrangement of structures at the renal hilum has not gained much interest up till now. One hundred (51 right and 49 left) embalmed kidneys were utilized for the present study. Careful dissection of renal hilar structures was carried out to observe antero-posterior relationship of structures at the hilum of the kidney. In majority (73 percent), the arrangement was not according to the normal textbook description i.e. renal vein, renal artery and pelvis arranged antero-posteriorly. In 31 percent anterior division of renal artery was seen in front of renal vein at the hilum, whereas, in 50 percent cases the pelvis was not the posterior most relation. The variable patterns observed were classified into five types. In cases of renal hilar tumors laparoscopic partial nephrectomy is being done with a limited field of vision. Knowledge of these variations is useful for operating surgeons to identify and individually clamp the hilar structures, which is advantageous over en-bloc clamping.

Las técnicas avanzadas de imagen han permitido aumentar el uso de abordajes mínimamente invasivos para la cirugía conservadora del nefrón. Por esto, se justifica la necesidad de un conocimiento preciso de la anatomía normal y las variaciones anatómicas del pedículo vascular del riñón. Es amplia la literatura disponible sobre variaciones en el patrón vascular intrarrenal, lo que se observa con frecuencia. Sin embargo, hasta ahora, la variación en la disposición de las estructuras en el hilio renal no ha generado mucho interés. Se utilizaron 100 riñones fijados (51 derechos y 49 izquierdos) para el estudio. Una cuidadosa disección de las estructuras hiliares renales se llevó a cabo para observar la relación antero-posterior de las estructuras en el hilio del riñón. En la mayoría de los casos (73 por ciento), las características no estaba de acuerdo con la descripción normal de la vena renal, es decir, con la arteria renal y la pelvis renal dispuestos en sentido anteroposterior. Los patrones de las variables observadas fueron clasificadas en cinco tipos. En el 31 por ciento de los casos la división anterior de la arteria renal estaba anterior a la vena renal en el hilio, mientras que, en el 50 por ciento de los casos, la pelvis no estaba posterior. En los casos de tumores renales hiliares la nefrectomía parcial laparoscópica se realiza con un limitado campo de visión. El conocimiento de estas variaciones es útil para un adecuado desempeño de los cirujanos al identificar y separar individualmente las estructuras hiliares, que es una ventaja sobre la separación en bloque.

Uncommon drainage of the gonadal vein: case report

The gonadal veins are anatomically asymmetric and there are several anatomical variations involving them. During a renal vascular anatomy study through cadaver dissection, students of the School of Medical Science of Santa Casa of Sao Paulo, Brazil, found an anomalous drainage of the left spermatic vein. In the case presented here the right spermatic vein drains normally to the inferior vena cava, but the left spermatic vein penetrates in the inferior pole of the left kidney and there it tributes in a branch of the renal vein. According to the reviewed literature a case like this had never been reported. There was not any other abnormality in the renal vascular anatomy in this case. The gonadal vein, renal vein and the segments of inferior vena cava into which the gonadal vein drains have a common origin in the fetal subcardinal vein and or in its anastomosis with the supracardinal veins, which would justify the finding.

Vena Renal Izquierda Recurrente Retroaórtica: Reporte de una Rara Variación / Recurrent Retroaortic Left Renal Vein: Report of an Uncommon Anomaly

Este trabajo describe el trayecto aberrante de la vena renal izquierda detectado en un cadáver de sexo masculino, utilizado con fines docentes en nuestro Departamento de Anatomía, cuya causa de muerte fue un cuadro de neumonía intrahospitalaria. En este caso, la vena renal izquierda tiene un trayecto descendente de 89 mm, dispuesta a la izquierda de la aorta abdominal, entre los niveles vertebrales L II-L V. A la altura de la V vértebra lumbar la vena recurrente se curva hacia medial, pasando por dorsal de la aorta abdominal, para abocarse a la vena ilíaca común izquierda justo en el punto donde esta forma, junto con la vena homónima de la antímera derecha, la vena cava inferior. La vena renal izquierda recurrente tiene un calibre final de 14,86 mm y recibe como afluentes a la vena adrenal, la vena gonadal y finas ramas parietales de la región lumbar izquierda. La vena renal derecha, de situación normal, tiene un diámetro de 12,10 mm y desemboca en la vena cava inferior a 101,85 mm del punto de formación de esta. En relación con las tributarias de la vena cava inferior, la vena ilíaca común derecha presenta un calibre de 18,44 mm mientras que su homóloga izquierda, que recibe como afluente a la vena renal recurrente, presenta un diámetro de 23,74 mm. La causa de esta rara anomalía, cuya incidencia es del orden del 0,16 por ciento y que aparece escasamente descrita en la literatura, radica en la persistencia del segmento posrrenal de la vena supracardinal izquierda y el cierre de las anastomosis supracardinal y subcardinal. Este hallazgo, que es especialmente atractivo para los alumnos durante la disección, representa un problema en la clínica debido a que más del 40 por ciento de estas venas de trayecto aberrante son interesadas en la cirugía de la aorta abdominal.

This paper describes the aberrant trajectory of the left renal vein. The present study describes the aberrant trajectory of the left renal vein detected in a cadaver used for teaching purposes in the Department of Anatomy, School of Medicine, Pontificia Universidad Católica de Chile. In this case, the left renal vein has a recurrent, retro aortic downward path, between vertebrae levels L II to L V. At level of L V, the vein curves medially, passing dorsal to the abdominal aorta and joins the left common iliac vein. The recurrent left renal vein has a final diameter of 14.86 mm and receives as tributaries to the adrenal vein, the testicular vein and fine parietal branches of the left lumbar region. The normal right renal vein has diameter of 12.10 mm and converges in the inferior vena cava at 101.85 mm above the point of union of both common iliac veins. At this point, the right common iliac vein has an 18.44 mm caliber while its left counterpart which receives the recurrent left renal vein, has a diameter of 23.74 mm. The cause of this rare anomaly which incidence is around 0.16 percent and is only scarcely described in the literature, is based in the persistence of the postrenal segment of the left supracardinal vein and closure of the supracardinal and subcardinal anastomosis. This finding, particularly attractive for students during dissection, as they represent a clinical problem since over 40 percent of these aberrant veins are of interest during surgical procedures of the abdominal aorta.

Variation in the Origin of the Testicular Arteries and Drainage of the Right Testicular Vein / Variación en el Origen de las Arterias Testiculares y el Drenaje de la Vena Testicular Derecha

During routine dissection of a 42 year old male Indian cadaver posterior abdominal wall, variations in the testicular vessels were observed. The right testicular artery arose from the right accessory renal artery, which originated from the ventral aspect of the abdominal aorta. The left testicular artery originated from the ventral aspect of the aorta in almost the same horizontal line as the right accessory renal artery, just below the superior mesenteric artery and 1.79 cm, above the origin of the renal arteries. The right vein drained into the right accessory renal vein instead of the inferior vena cava, while the left testicular vein drained into the left renal vein. The presence of variation of both the testicular arteries as well as the testicular vein is seldom seen together.

Durante una disección de rutina de un cadáver, perteneciente a un hombre indio de 42 años, se observaron variaciones en los vasos testiculares en la pared abdominal posterior. La arteria testicular derecha se originó desde la arteria renal accesoria, proveniente de la cara ventral de la parte abdominal de la aorta. La arteria testicular izquierda se originó en la cara ventral de la parte abdominal de la aorta, casi en la misma línea horizontal de la arteria renal accesoria derecha, justo distal a la arteria mesentérica superior y 1,79 cm sobre el origen de las arterias renales. La vena renal derecha drenaba en la vena renal accesoria en lugar de la vena cava inferior, mientras que la vena testicular izquierda drenaba en la vena renal izquierda. En muy pocas ocasiones es posible observar de manera conjunta, variaciones tanto de las arterias como de las venas testiculares.

Three rare variations in the course of the gonadal artery / Tres raras variaciones en el trayecto de la arteria gonadal

The gonadal arteries, lateral branches of the abdominal aorta, usually arise distal to the renal vessels. Knowledge of the origin and course of them, particularly their relationships with renal vessels, are important for uncomplicated surgical procedures on the posterior abdominal wall. So the relationship of the testicular artery and renal vessels were studied in 80 cadavers in Calcutta National Medical College, India and detected three rare variations. We have discussed the possible clinical implications and embryological explanation with review of literature of those variations.

Las arterias gonadales, ramas laterales de la aorta abdominal, usualmente surgen distales a los vasos renales. El conocimiento del origen y trayecto de estas, particularmente sus relaciones con los vasos renales, son importantes para procedimientos quirúrgicos sin complicaciones en la pared posterior del abdomen. La relación de la arteria testicular y los vasos renales fueron estudiados en 80 cadáveres en la Escuela Nacional de Medicina de Calcuta, India y se detectaron tres variaciones raras. Se discuten las posibles implicancias clínicas y explicaciones embriológicas, con la revisión de la literatura de estas variaciones.

The superficial femoral vein: a valuable conduit for a short renal vein in kidney transplantation.

A variety of techniques have been developed to improve the problem with a short renal vein in kidney transplantation. Those techniques range from thorough mobilization of the recipient common and external iliac veins (iliac vein transposition) to donor vein elongation with a saphenous or gonadal vein or a polytetrafluoroethylene graft. Right renal vein extension using the inferior vena cava represents an excellent option for cadaveric kidney transplantation; however, for kidneys from living donors, that is not a suitable alternative. We present two cases where the superficial femoral vein was used as a conduit with good results; there was no additional morbidity for the patient. Although uncommon, renal vein extensions are sometimes needed in kidney transplantation. The superficial femoral vein comes close to representing the ideal conduit for a short renal vein when compared with a synthetic or an autologous graft due to its diameter and harvesting technique.