Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms / Reparo Ex Vivo de Aneurismas Intraparenquimatosos Múltiplos da Artéria Renal

Abstract A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.

Resumo Uma mulher de 45 anos com hipotireoidismo conhecido e sem outras comorbidades teve achado incidental de múltiplos aneurismas da artéria renal direita. O maior aneurisma media 5 x 4,5 cm e tinha origem no ramo segmentar inferior, juntamente com dois pequenos aneurismas originários do ramo segmentar superior da artéria renal direita. Realizamos o reparo ex vivo com enxerto reverso de veia safena, sob preservação a frio, seguido de autotransplante renal ortotópico. O pós-operatório ocorreu sem intercorrências, e a paciente teve o rim direito preservado no seguimento de 1 ano. Neste artigo, relatamos o tratamento bem-sucedido de múltiplos aneurismas complexos da artéria renal direita e descrevemos a técnica cirúrgica utilizada para o reparo bem-sucedido.

Congenital lobar emphysema: a rare cause of respiratory distress in a neonate

Congenital lobar emphysema (CLE) is a congenital condition characterized by distension and air trapping of the affected lobe of the lung. It is one of the causes of infantile respiratory distress, which may require surgical resection of affected lobe. Case characteristics: 3-day-old neonate with ventilation refractory respiratory distress. Imaging was suggestive of decreased lung tissue on the right side with ipsilateral mediastinal shift. Intervention/ outcome: Early surgical lobectomy was done to improve lung functions and the child improved dur to early intervention. Message: An early diagnosis with high index of suspicion helps patients with this rare congenital anomaly. Early intervention is the key to good long-term outcome. More awareness about the entity and treatment options available would greatly help improving the outcome and disease burden.

A Rapid, Stability Indicating RP-UPLC Method for Determination of Paliperidone Palmitate in a Depot Injectable Formulation.

A rapid, stability-indicating reversed phase ultra-performance liquid chromatographic (RP-UPLC) method was developed for the determination of paliperidone palmitate (PP), in depot injectable dosage form. The chromatographic separation was achieved on an Acquity BEH C18 (50 mm × 2.1 mm, 1.7 μm) column, with a mobile phase consisting of ammonium acetate buffer, and acetonitrile at a ratio of 10:90 (v/v) and a flow rate of 0.6 mL/min. The eluted compound was monitored at a wavelength of 238 nm using a UV detector. The method described herein separated paliperidone palmitate from all other formulation components and two major known degradation products (N-Oxide and paliperidone) within a run time of 2.5 min. The method also generated linear results over a PP concentration range of 156 to 468 μg/mL. The stability indicating capability of the method was established by performing forced degradation experiments. The RP-UPLC method that was developed was validated according to the International Conference on Harmonization (ICH) guidelines. This method was successfully applied in the quantitative determination of PP in a stability study of paliperidone palmitate depot injection. The procedure described herein is simple, selective, and reliable for routine quality control analysis as well as stability testing.

Isolated post-traumatic right-sided diaphragmatic hernia.

A 3-yr-old boy presented with respiratory distress of 2 days duration. There was a history of blunt trauma to the lower chest having occurred 5 days earlier. Although missed initially, serial chest X-rays and a computed tomographic (CT) scan revealed an isolated traumatic right-sided diaphragmatic hernia without any injury to the viscera or the ribcage. Laparotomy with reduction of the herniated right lobe of the liver and the transverse colon was performed. Recovery was uneventful. The presentation, diagnosis and management of this relatively uncommon injury is discussed. The need for a high index of suspicion and critical evaluation of appropriate investigations to prevent diagnostic delay and optimize management in patients with traumatic diaphragmatic injury is emphasized.

Anterior urethral valves and diverticulum.

Anterior urethral valves with associated urethral diverticulum is a rare but important cause of infravesical obstructive uropathy in children. This condition can be a cause of significant morbidity and can even lead to end-stage renal disease. This rare condition should be included in the differential diagnosis while evaluating male infants with infravesical obstructive uropathy.

Hepatobiliary cystadenoma with mesenchymal stroma--a case report.

Hepatobiliary cystadenoma with mesenchymal stroma (HCMS) is a rare lesion characterized by multiloculated cyst lined by columnar epithelium ad mesenchymal stroma. It occurs exclusively in females and is intrahepatic in location with only 17% cases arising in extrahepatic biliary tree. Exact histogenesis is not known, but it is hypothesized the HCMS arises from ectopic embryonic tissue destined to form the adult gall bladder. HCMS has got a malignant potential and requires radical excision.

Subcutaneous angiolipomas: a clinicopathological study of 12 cases.

A total of 12 cases of angiolipomas were received over a period of 2 years and comprised 13% of all lipomatous tumors. There were eleven males and one female. Pain/tenderness was the presenting feature in 11 of the cases and in all the cases, the tumors were located on upper extremities or trunk. Grossly, the tumors were encapsulated and histologic examination revealed fibrin thrombi in many capillaries, in all cases. None of these tumors were infiltrating into the surrounding skeletal muscle or soft tissue.