New insights into HIV-1-primary skin disorders

Since the first reports of AIDS, skin involvement has become a burdensome stigma for seropositive patients and a challenging task for dermatologist and infectious disease specialists due to the severe and recalcitrant nature of the conditions. Dermatologic manifestations in AIDS patients act as markers of disease progression, a fact that enhances the importance of understanding their pathogenesis

Pickering syndrome in a patient with a single kidney: role of renal artery stenting

Renal artery stenosis (RAS) is associated with hypertension and high mortality rates. With its prevalence and associated risk of death, it is important to screen for patients displaying symptoms of RAS. RAS has a wide spectrum of clinical manifestations and is usually resistant to medical therapy. Of these clinical manifestations is Pickering syndrome which is characterized by bilateral renal arterial occlusion inflow lesions, flash pulmonary edema, acute kidney injury, and hypertensive emergencies in the setting of a preserved left ventricle function. Stenting techniques have been used extensively to treat symptomatic renal artery stenosis with excellent primary patency rate, however have failed to demonstrate a long-term benefit over the optimal medical management alone in randomized trials. However, accumulating evidence suggests that stenting is justified in specific patient subgroups that have severe occlusive renal artery stenoses with significant clinical sequelae, including flash pulmonary edema, acute ischemic kidney injury, and uncontrolled hypertension. In this report we discuss the case of a 32-year-old male who presented to our center with recurrent flash pulmonary edema and hypertensive emergency and was found to have RAS, which responded well to renal artery stenting. In conclusion, correcting the renal arterial inflow stenosis is beneficial and warranted in selective clinical scenarios

Urgent-Start Peritoneal Dialysis Catheter Placement: Comparative Study between Percutaneous Image-Guided versus Laparoscopic Techniques

Objective: The objective of this study was to compare the outcomes and complications of percutaneous image-guided versus laparoscopic peritoneal dialysis (PD) catheter placement techniques in the urgent-start setting. Materials and Methods: The medical records of 273 patients who had their first PD catheter between November 2012 and May 2017 were retrospectively reviewed. Patients were divided into radiologic group (n = 26) and laparoscopic group (n = 16). Descriptive and Kaplan–Meier (KM) analysis were used to compare time to first complication, time to catheter removal, and patient survival between the two groups. Complication-free and catheter removal rates at 1, 3, and 12 months were estimated from KM analysis. Results: A total of 42 patients were included in the study. The baseline demographics were similar between the two groups. In the radiologic group, the estimated 1, 3, and 12 months' complication-free rate were 100%, 94%, and 67%, respectively, which was not significantly different from 93%, 85%, and 45%, respectively, in the laparoscopic group (P = 0.543). The rate of catheter complications was not significantly different between the radiologic group (50%) and the laparoscopic group (31%) (P = 0.3382). The catheter removal rate in the radiologic group was 8, 18%, and 38% at 1, 3, and 12 months, respectively, versus 0%, 8%, and 20%, respectively, in the laparoscopic group (P = 0.298). The overall patient survival between two groups was not significantly different (P = 0.116) with estimated patient mortality of 15.4% at 12 months in the radiologic group and no deaths in the laparoscopic group. Conclusion: Image-guided percutaneously placed PD catheters have a similar complication and removal rates compared to laparoscopically placed catheters in the urgent-start setting