D Ramesh

Transplant renal artery stenosis: The impact of endovascular management and their outcomes

Introduction: Transplant renal artery stenosis (TRAS) is a well-known vascular complication of renal transplantation. The aim of this analysis was to assess the short and midterm outcomes of endovascular therapy to salvage transplant kidney. Methods: We retrospectively analyzed our transplant database from 2000 to 2015. Percutaneous transluminal angioplasty/stenting was done in 24 patients (22 men and two women) with significant TRAS. The mean age was 59 ± 12 years. The parameters analyzed were: Technical success, pre- and post-treatment serum creatinine and number of antihypertensive drugs before and after treatment and vessel patency on Doppler ultrasonography at 3 and 6 months. Results: Overall incidence of TRAS in this study was 5.06%. Incidence of TRAS following live donor transplantation was 4.68% while that in deceased donors was 11.5%. Technical success was 100%. There were no periprocedural deaths. Renal function was improved from 2.32 ± 0.5 mg/dL to 1.72 ± 0.3 mg/dL (P < 0.001) and number of antihypertensive medications after the procedure was reduced from 2.9 ± 0.7 to 2 ± 0.6 (P < 0.001) at 6 months follow-up. One patient developed restenosis within 5 months (4.2%). Clinical success at 6 months follow-up was 79.2%. Conclusions: Endovascular treatment of TRAS has high technical success with minimal complications. It also provides satisfactory clinical success with improvement in overall transplant renal function and renovascular hypertension in early follow-up.

Virilizing lipoadenoma of the adrenal gland in a pre-pubertal girl: A rare case.

We report a case of a 12-year-old girl who presented with the history of hirsutism. On evaluation, she was found to have testosterone secreting adrenal gland tumor. Histopathological examination of the adrenalectomy specimen revealed a lipoadenoma.

Acute pancreatitis and development of pancreatic pseudo cyst after extra corporeal shock wave lithotripsy to a left renal calculus: A rare case with review of literature.

Extracorporeal shock wave lithotripsy (SWL) is considered the standard of care for the treatment of small upper ureteric and renal calculi. A few centers have extended its use to the treatment of bile duct calculi and pancreatic calculi. The complication rates with SWL are low, resulting in its wide spread acceptance and usage. However, some of the serious complications reported in 1% of patients include acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, rupture of aortic aneurysm and intracranial hemorrhage. To our knowledge, only six cases of acute pancreatitis or necrotizing pancreatitis following SWL have been documented in the literature. Herein, we report a rare case of acute pancreatitis and formation of a pseudo cyst following SWL for left renal pelvic calculus.

Evaluation and outcome of M plasty for the management of doughnut scrotum

Introduction: Penoscrotal transposition is a rare anomaly of the external genitalia. They can be classified as complete or incomplete based on degrees of positional exchange between the penis and the scrotum. Both forms are known to be associated with hypospadias and multiple surgeries are required for complete correction. Most surgeries performed for the correction of penoscrotal transposition involve making a complete circular incision around the root of the scrotum, which often results in massive penile lymphoedema and often delays the correction of hypospadias. The M plasty technique can prevent the incidence of lymphoedema by preserving the dorsal penile skin. Objective: To evaluate the effectiveness of M plasty for the correction of penoscrotal transposition. Materials and methods: Sixteen patients underwent M plasty for incomplete penoscrotal transposition. An ‘M’-shaped incision was made at the base of the scrotum and the scrotal halves were dissected and brought down posterior and caudal to the penis and sutured primarily. Results: All patients showed excellent cosmetic results. There was minimal postoperative oedema with no vascular compromise to penile or scrotal skin. Conclusion: M plasty is an excellent technique for the correction of penoscrotal transposition. The low incidence of penile lymphoedema could be attributed to the preservation of the dorsal penile skin. This procedure provides an excellent cosmetic appearance and also allows for early correction of hypospadias.

Psuedo-aneurysm following Renal Transplantation Presenting as Extensive Ileofemoral Thrombosis

Pseudo Aneurysm of the arterial anastomosis is a rare complication seen in less than 1% of recipients and pseudo aneurysm of ileofemoral thrombosis is even rarer. Herein, we report a case of pseudo aneurysm of the anastomotic site following renal transplantation with extensive ileofemoral thrombosis with literature review. The intension of this paper is to provide an update on the varied clinical presentation, early diagnosis and management of this rare case presentation.

Pleomorphic undifferentiated sarcoma of urinary bladder with calcified pulmonary metastasis: A rare entity.

We report the case of a 29-year-old male who presented to us with hematuria, dysuria and bilateral flank pain. On evaluation, the patient was found to have primary pleomorphic undifferentiated sarcoma of bladder with calcified pulmonary metastasis, confirmed with computerized tomography scan and immunohistochemistry.