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OBJECTIVES: Studies on nontechnical risk factors for ureterovesical leak after renal transplant are scarce. This study aimed to report the possible pre- and postoperative risk factors and the role of acute rejection and antirejection therapies for urine leak after transplant and its effect on graft and patient survival. MATERIALS AND METHODS: We conducted a retrospective analysis of 13 patients (1.17%) with urine leak (case group) and 52 patients without leak (control group) (case-to-control ratio of 1:4) from 1102 living related (first degree) renal transplant recipients seen between January 2012 and December 2021. We analyzed demographic and clinical details and biochemical and outcome parameters using a nested case-control design. RESULTS: Cases were olderthan controls (P = .018), were more ABO incompatible (P = .009), and had more 6/6 HLA mismatch transplants (P = .047). Donors of cases were older than donors of controls (P = .049). The rate of postoperative hypoalbuminemia was greaterin the case group (P = .050). Rates of acute rejection (P = .012) and plasmapheresis (P = .003) were greaterin the case group than in the control group. On multivariate logistic regression analysis, recipient age, 6/6 HLA mismatch, and plasmapheresis were found to independently associated with urine leak. None ofthe patient required surgical repair, as all responded to conservative therapy. Urine leak did not affect graft outcomes (P = .324), but overall survival was less in cases than in controls. CONCLUSIONS: Nontechnical risk factors that cause posttransplant ureteric leak include older donor and recipient age and ABO incompatible and 6/6 HLA mismatch transplants. Acute rejection and plasmapheresis predispose leak, and an indwelling double J stent can allow adequate healing of the anastomosis. High index of suspicion and prompt management are imperative to preserve graft and patient outcome.

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BACKGROUND: Patient presenting with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) have extremely high mortality rates. OBJECTIVES: We sought to assess the impact of prior revascularization by either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) on the in-hospital and 12-month outcomes and compare them with revascularization-naïve patients. METHODS AND RESULTS: Between 1/2010 and 5/2017, a total of 241 consecutive patients were admitted to our institution with STEMI and CS as defined by New York State Percutaneous Coronary Interventions Reporting System (PCIRS) and underwent primary PCI. Baseline clinical, angiographic and procedural characteristics, as well as in-hospital outcomes were prospectively collected among all patients undergoing primary PCI as part of the New York State PCIRS data collection. Patients with a history of prior bypass graft surgery were older and had a history of heart failure, hypertension, dyslipidemia, and diabetes. The left anterior descending coronary artery was usually the culprit vessel in post PCI and revascularization naïve patients, whereas it was a vein graft in patients with a prior history of surgical bypass. In-hospital mortality rates were different in the three groups and there was no significant difference in major adverse cardiac and cerebrovascular events rates among the three groups (p = 0.87). Notably, revascularization-naïve patients had higher rates of major bleeding complications (p = 0.006). By multivariable analysis, only age (OR 1.03; CI = 1.0-1.06), a prior history of congestive heart failure (OR 4.36, CI = 1.04-18.38) and dyslipidemia (OR 0.32 CI = 0.15-0.64) were independent predictors of 12-month mortality. Prior revascularization had no impact on rates of stroke, death or MACCE. CONCLUSIONS: Patients with acute STEMI and CS had similar in-hospital and one year mortality, stroke or major adverse cardiac and cerebrovascular events rates irrespective of their prior revascularization status.

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Organ transplantation has improved the lives of hundreds of thousands of patients all the world. The total organ donation shortage of the country can be met with if even 5 to 10% of the victims involved in fatal accidents serve as organ donors. The challenges include an interplay of sociocultural factors, beliefs and superstitions, lack of communication and organizational support, and negative views by the media. Several initiatives to encourage deceased organ donation include the Indian Network for Organ Sharing, a subdivision of the National Organ and Tissue Transplant Organization, the Transplantation of Human Organ Act (THOA), as well as the Transplantation of Human Organs and Tissue Rules. There are stringent criteria instituted for the retrieval, preservation and transportation of donor organs. This article reviews the ongoing efforts being implemented to encourage organ transplantation.

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Renal cell carcinoma accounts for 3% of all adult malignancies. Usual sites of metastasis are lymph nodes, lungs, bone, liver and brain. We describe a patient who presented with complaints of holocranial headache and diplopia. MRI of the head showed a clival-based lesion with associated bony erosion. With suspicion of a metastatic lesion, an ultrasonogram of the abdomen was done which showed a left renal mass that enhanced on contrast-enhanced CT. There were no other metastatic foci. Patient underwent radiotherapy for the clival lesion. This case report emphasises on the evaluation of clival lesion with cranial neuropathies for a possibility of a renal primary tumour.

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BACKGROUND: Transplant renal artery stenosis (TRAS) is a common vascular complication after kidney transplantation and is associated with refractory hypertension, volume overload, and graft injury or loss. This article describes 5-year outcomes of endovascular intervention for TRAS with bare metal and drug eluting stents (DES). METHODS: We investigated, as a prospective cohort study, patient and graft outcomes after the targeted use of DES for vessel diameter less than 5 mm and bare metal stents (BMS) for vessel diameter greater than 5 mm as the primary management for TRAS. RESULTS: From March 2008 to November 2014, 57 patients were stented for hemodynamically significant TRAS; 29 received DES, 26 received BMS, and 2 patients received both stent types. They were followed up for a mean of 35.1 ± 22.8 months; a subset of these patients who all received DES were followed up for 61.7 ± 17.5 months. Mean serum creatinine declined from 2.87 ± 1.5 mg/dL at the time of intervention to 1.98 ± 0.76 mg/dL (P < 0.001) at one month follow-up and was 1.96 ±0.92 mg/dL (P < 0.001) at 35.1 ± 22.8 months. Mean systolic blood pressure declined from 159.05 ± 19.68 mm Hg at time of intervention to 135.65 ± 15.10 mm Hg (P < 0.001) at most recent visit. Clinically driven restenosis requiring repeat revascularization occurred in 15.7% of patients. CONCLUSIONS: Primary stenting with DES and BMS is both successful in the initial treatment of TRAS and also produced an immediate and long-term reduction in serum creatinine and systolic blood pressure.

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BACKGROUND: The use of adjunctive thrombectomy during primary percutaneous coronary intervention (PCI) has steadily increased with recent trials demonstrating an improved clinical and mortality benefit for manual aspiration thrombectomy. The use of an in-dwelling guide extension mother-and-child catheter allows direct aspiration of thrombus from the vessel with its larger extraction area. METHODS: Between December 2011 and September 2013, a total of 17 patients who presented with acute coronary syndromes (ACS) in whom a guide extension catheter was utilized specifically for manual thrombus aspiration were identified and studied. RESULTS: The guide extension catheter was utilized specifically for thrombus aspiration in 18 vessels involving 17 patients presenting with ACS where severe thrombus burden was noted. The cases involved 4 saphenous vein grafts and 14 native coronary arteries, with 4 cases involving vessels with late stent thrombosis. Successful outcomes with thrombus aspiration and TIMI-3 flow were achieved in 17/18 vessels treated, with no adverse outcomes of vessel trauma or strokes noted. CONCLUSIONS: Adjunctive manual aspiration thrombectomy utilizing a guide extension mother-and-child catheter affords a novel method of thrombus aspiration, offering a larger extraction area within the conventional 6 Fr system, with demonstrated efficacy for vessel lesions with a large thrombus burden.

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UNLABELLED: To date there has been no reliable noninvasive real time monitoring available to determine cerebral perfusion during cardiac arrest. OBJECTIVES: To investigate the feasibility of using a commercially available cerebral oximeter during in-hospital cardiac arrest, and determine whether this parameter predicts return of spontaneous circulation (ROSC). METHODS: Cerebral oximetry was incorporated in cardiac arrest management in 19 in-hospital cardiac arrest cases, five of whom had ROSC. The primary outcome measure was the relationship between rSO(2) and ROSC. RESULTS: The use of cerebral oximetry was found to be feasible during in hospital cardiac arrest and did not interfere with management. Patients with ROSC had a significantly higher overall mean ± SE rSO(2) (35 ± 5 vs. 18 ± 0.4, p<0.001). The difference in mean rSO(2) between survivors and non-survivors was most pronounced in the final 5 min of cardiac arrest (48 ± 1 vs. 15 ± 0.2, p<0.0001) and appeared to herald imminent ROSC. Although spending a significantly higher portion of time with an rSO(2)>40% was found in survivors (p<0.0001), patients with ROSC had an rSO(2) above 30% for >50% of the duration of cardiac arrest, whereas non-survivors had an rSO(2) that was below 30%>50% of their cardiac arrest. Patients with ROSC also had a significantly higher change in rSO(2) from baseline compared to non-survivors (310% ± 60% vs. 150% ± 27%, p<0.05). CONCLUSION: Cerebral oximetry may have a role in predicting ROSC and the optimization of cerebral perfusion during cardiac arrest.

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