Combined Fluoroscopy and Ultrasound-Guided Transjugular Kidney Biopsy in Cirrhotic Patients.

PURPOSE: To evaluate the safety and diagnostic yield of combined fluoroscopy and ultrasound-guided transjugular kidney biopsy (TJKB) in cirrhotic patients with suspected renal parenchymal disease. MATERIALS AND METHODS: A retrospective review was made of 27 patients (21 men; overall mean age 44.7 y) who underwent TJKB from June 2013 to June 2016; 21 patients had coagulopathy and/or thrombocytopenia, 4 underwent simultaneous TJKB with transjugular liver biopsy, and 1 patient each had severe obesity and gross ascites. All procedures were performed with the use of fluoroscopy and simultaneous transabdominal ultrasound guidance. The data were analyzed for number of passes taken, number of glomeruli in the tissue cores, adequacy of tissue core for histopathologic diagnosis, and incidence and severity of complications. RESULTS: The average number of passes per case was 3.6 (range 2-6). The total length of tissue cores ranged from 0.4 cm to 2.5 cm. The mean numbers of glomeruli per procedure on light microscopy were 6.7 (range 0-17). Diagnostic biopsy specimens were obtained in 23 out of 27 patients (85%). Eleven patients had minor complications. One patient had major complication in the form of hemoglobin drop of 2.1 mg/dL which required embolization and blood transfusion. CONCLUSIONS: Combined use of fluoroscopy and ultrasound guidance for TJKB yielded adequate tissue samples with fewer passes and a low rate of complications in high-risk patients with cirrhosis.

Successful Embolization of Spleen through Gastroepiploic Artery in a Liver Transplant Recipient with Splenic Artery Ligation.

Partial splenic embolization (PSE) is a minimally invasive endovascular procedure for the treatment of hypersplenism. This procedure is normally done by catheterization of the splenic artery, which if ligated during surgery, makes the procedure very challenging. We present a case where the splenic artery had been ligated during liver transplant surgery, and the only major endovascular route to reach the spleen was through the hypertrophied tortuous gastroepiploic artery. Successful PSE in these patients suggests the feasibility of this procedure after splenic artery ligation and can thus help to spare a patient from the otherwise more invasive surgical splenectomy.

Isolated left side superior vena cava in a dialysis patient: Right direction, wrong turn!

Tunneled catheter insertion is a routine procedure undertaken by nephrologists world over. However, the presence of a venous anomaly can always test one's skills and can give them anxious moments. Persistent left superior vena cava (SVC) is the most common venous anomaly. We share our experience of successfully placing a hemodialysis central venous catheter in a very rare congenital anomaly wherein patient had persistent left SVC with agenesis of the right SVC.

Profile of Dermatological Disorders Among Workers Involved in Fruit Growing Industry of Kashmir Valley in North India.

Introduction: Skin disorders represent a major proportion of occupational disorders. Dermatoses are becoming a source of concern in various population groups. In Kashmir valley, a large number of people are associated directly or indirectly with horticulture. Fruit cultivation is the main occupation of around 33 lakh people in the Union Territory. Aim: To study the profile of dermatological disorders in workers involved in fruit growing industry of Kashmir valley. Materials and Methods: This study was a cross-sectional observational study, carried out over a period of 2 years, in which 701 workers of fruit growing industry of Kashmir valley were screened. Results: 276 (39.37%) of these workers were found to have skin lesions while the rest, that is, 425 (60.63%) were not found to have any dermatoses. Out of the total dermatological lesions observed, occupational dermatoses contributed to 94 cases (34.05%), while non-occupational dermatoses accounted for 182 cases (65.94%). Among the occupational dermatoses, friction-related disorders (callosities and cuts) were predominant (15.9%) followed by allergic (12%) and irritant contact dermatitis (6.2%). Out of the non-occupational dermatoses group, the major portion was comprised by polymorphic light eruption (6.2%) in non-infectious type while in infectious type, onychomycoses predominated (3.3%). Conclusion: Dermatological conditions form a major group of occupational dermatoses among workers involved in fruit cultivation.

Carbon Dioxide Laser Plus Topical 5% Luliconazole: A Better Combination Therapeutic Modality for Onychomycosis.

BACKGROUND: Onychomycosis has always been a therapeutic challenge because of longer treatment duration, potential adverse effects of oral antifungals, and limited efficacy of topical agents. During the past few years, the emergence of laser therapy has been the topic of discussion as a newer, safe, minimally invasive modality of treatment. AIM: The aim of this study was to evaluate the role of fractional CO2 laser and topical luliconazole 5% lotion in the treatment of onychomycosis, as a combined treatment and as independent modalities. MATERIALS AND METHODS: This was a prospective, randomized, triple-limb comparative observational study in which 106 patients with KOH and culture-proven onychomycosis were randomly assigned to three groups. Group A received fractional CO2 laser (10,600nm) triweekly for four sessions (0, 3, 9, and 12 weeks) plus topical luliconazole 5.0% lotion applied twice daily on the affected nail plates and nail folds for 12 weeks. Group B received only fractional CO2 with the same frequency of sessions and laser parameters as in group A. Group C received only topical luliconazole 5.0% solution twice daily for 12 weeks. Treatment outcome was evaluated using onychomycosis severity index (OSI) score, mycological parameters, and level of satisfaction of patients. RESULTS: The degree of clinical improvement, mycological cure, and patient's satisfaction was significantly better in the combined group than individual modalities. There were no severe adverse effects that warranted the discontinuation of the treatment in any of these patients. CONCLUSION: Fractional CO2 laser combined with topical luliconazole 5% lotion is a safe and effective treatment for onychomycosis especially in those who have contraindications to oral antifungals.

Pattern of Skin Diseases and Occupational Dermatoses among Paddy Field Workers in Kashmir Valley: A Cross-Sectional Study from North India.

INTRODUCTION: Paddy farming is one of the main occupations in Kashmir valley. The workers associated with paddy are exposed to variety of irritants such as manures, fertilizers, and pesticides, besides getting exposed to intense sunlight for long hours due to the nature of their work. All these factors can potentially either trigger skin diseases or can worsen them. AIM: The aim of this study was to find out the prevalence and pattern of various skin disorders among paddy field workers in Kashmir valley. MATERIALS AND METHODS: This was a cross-sectional descriptive study in which 600 workers engaged in paddy farming in different areas of Kashmir valley were screened. The diagnosis was made on clinical grounds and wherever deemed necessary, relevant investigations were carried out to establish the nature of the disease. RESULTS: A total of 600 workers were evaluated for the presence of skin disorders. Two hundred thirty workers (38.3%) were found to have skin lesions, while the rest, i.e. 370 (61.7%) were free from any skin problem. Out of the total skin lesions, infectious ones were seen in 40.4%, while non-infectious accounted for 59.6% cases. The main non-infectious disorders included melasma, followed by hand and foot eczemas, hyperkeratosis of palms and soles and callosities/cuts, while among the infectious group the major chunk was formed by bacterial infections followed by fungal, viral, and parasitic. Pitted keratolysis and intertrigo were the most common bacterial and fungal infections respectively. CONCLUSION: A large number of skin diseases were seen in paddy field workers, with some diseases showing an occupational nature.

Living Donor Liver Transplant for Budd-Chiari Syndrome Without Caval Replacement: A Single-Center Study.

OBJECTIVES: Adequate venous outflow is one of the most important factors responsible for optimal graft function in liver transplantation. Thrombosis of the inferior vena cava in cases of Budd-Chiari syndrome poses a major challenge to a transplant surgeon in establishing proper graft outflow. In deceased donor liver transplant, this problem can be dealt with relative ease as the liver graft includes donor inferior vena cava. However, this is not the case in living donor liver transplant. We present our findings of living donor liver transplant for Budd-Chiari syndrome and discuss techniques that have helped overcome this unique problem without the need for complete inferior vena cava replacement. MATERIALS AND METHODS: Our retrospective analysis included living donor liver transplant recipients from November 2006 to March 2020 at our center and selected patients who underwent this transplant for Budd-Chiari syndrome. We studied the extent and severity of inferior vena cava involvement in these cases. We developed a classification that not only helped to stratify patterns of venacaval disease but also helped to plan the surgical technique. The role of interventional radiology combined with surgery in management of extensive inferior vena cava stenosis was studied. RESULTS: Among 2952 cases of liver transplant in our unit from November 2006 to March 2020, 36 patients had Budd-Chiari syndrome; 21 had significant level of inferior vena cava thrombosis, which was managed with inferior vena cava thrombectomy with either patchplasty (n = 20) or segmental replacement (n = 1). None of our patients showed recurrence of primary disease during the median follow-up of 36 months (range, 8-158 mo). CONCLUSIONS: Establishment of adequate venous ouflow in thrombosed inferior vena cava is possible with proper planning of surgical technique and timely involvement of interventional radiology-guided interventions in patients with Budd-Chiari syndrome.

Prevalence of Cold Dermatoses in Kashmir Valley: A Cross-Sectional Study from North India.

BACKGROUND: Often quoted as "heaven on earth," Kashmir forms one of the two divisions of the Union territory of Jammu and Kashmir. A high-altitude region with abundant precipitation and snowfall, the people of Kashmir experience peculiar dermatoses not commonly seen in the majorly tropical subcontinent of India. In this study, we focussed on cold dermatoses as a comprehensive cluster and attempted to study them as a group. AIMS: To determine the prevalence of cold dermatoses in Kashmir valley and study their epidemiological characteristics. METHODS: This observational, cross-sectional community-based study was conducted on native Kashmiri population in three districts of the valley, exclusively during the winter season of the year 2016-17 and 2017-18. The data were tabulated and analyzed with Chi-square test for discrete variables and t-test for continuous variables, using OpenEpi. A P value of less than 0.05 was taken as significant. RESULTS: The study included a total of 1200 cases with 602 males and 598 females. Perniosis was most commonly encountered dermatoses in our study with a prevalence of 12.2%. Frostbite had a prevalence of 0.83%. Raynaud's phenomenon and asteatotic eczema were seen in 1.5% and 1.67% of the population, respectively. Cold panniculitis, cold urticaria, and livedo reticularis were each seen in 0.08% of the population. CONCLUSIONS: Cold dermatoses form an important source of morbidity among the native population of Kashmir. These can be easily prevented by ensuring adequate protection against cold. Creating awareness regarding these disorders and probable association with connective tissue disorders is also imperative.

Portal vein thrombosis after donor liver biopsy: Case report.

Percutaneous plugged liver biopsy is a safe procedure with a low complication rate. Portal vein thrombosis has not been reported after percutaneous liver biopsy in the literature. We present a case of portal vein thrombosis after percutaneous plugged liver biopsy in a voluntary liver donor, which was subsequently treated with catheter-directed percutaneous transhepatic thrombolysis. In future, healthy patients undergoing liver biopsies are expected to increase for donor evaluation. More refinements of technique and hardware in the future may further decrease the rate of complications. However, if they occur, they need to be recognized and managed at the earliest.