Partial splenic artery embolization in portal hypertension patients with hypersplenism: Two interval-spaced sessions’ technique

AbstractPurposeTo evaluate the ability of interval spaced sessions of transcatheter partial splenic artery embolization (PSE) to avoid the potential post procedure major complications, in portal hypertension patients with hypersplenism.Material and methodsThe study included 50 patients (39 male and 11 females). All patients had liver cirrhosis and portal hypertension with hypersplenism and hyperactive bone marrow. All patients underwent PSE in two sessions separated at least by 1month interval. Immediate, short and intermediate term follow-up for 1year were done.ResultsWe had no post procedure mortality. None of the patients developed septic shock, splenic abscess or needed emergency surgery. Ten of our patients developed subcapsular collections which were treated conservatively. All of our patients showed significant increase in the thrombocyte count after the first session which becomes remarkable after the second session and remained at appropriate levels during the follow up period.ConclusionPSE using two (interval-spaced) sessions with careful pre- and post procedure medications and care; is really effective non surgical minimally invasive procedure in avoiding the potential post procedure complications while achieving remarkable hematologic response on controlling hypersplenism in cirrhotic patients with portal hypertension

Cloaca-Like Anomalies in the Male: A Report on Two Cases

“Cloaca” is a term used to describe an anomaly in the female where a single orifice is located in the perineum draining both urogenital and gastrointestinal tracts. Few reports used the same term “cloaca” to describe the counterpart anomaly in the male. We present two “male” cases of anorectal anomalies associated with significant penile deformity (caudally displaced penis) that were managed during the period between January 2010 and September 2021. Characteristically, both cases had a single “central” perineal orifice. The latter was located anterior to the predestined site of the normal anus and just beneath a caudally positioned hypospadiac phallus. The caudal displacement of the penis was strikingly obvious by the presence of severe form of penoscrotal transposition. Both cases were associated with a perineal swelling (hamartoma) just beside the central perineal orifice. The urethra was very short (like that in the female), besides the single perineal orifice, which makes the presentation very similar to cloacal anomalies

The Association between Fibroblast Growth Factor-23 and Vascular Calcification Is Mitigated by Inflammation Markers

Background: Fibroblast growth factor-23 (FGF-23) has been linked to vascular calcification, ventricular hypertrophy and mortality in chronic kidney disease (CKD), although these links may not be direct and independent. Similar grave outcomes are associated with inflammation and oxidative stress in CKD. Recently, accumulating evidence has linked components of phosphate homeostasis to inflammation and oxidative stress. The interaction between the triad of inflammation, FGF-23 and cardiovascular outcomes is underinvestigated. Methods: We studied 65 patients with stage 5 CKD on hemodialysis. Serum levels of FGF-23, high-sensitivity C-reactive protein (hsCRP), endogenous soluble receptor of advanced glycation end products (esRAGE), advanced oxidation protein products (AOPP), parathormone, lipids, calcium and phosphorous were measured. The aortic calcification index (ACI) was determined using non-contrast CT scans of the abdominal aorta. Results: FGF-23 was elevated (mean: 4,681 pg/ml, SD: 3,906) and correlated with hsCRP, esRAGE, AOPP, dialysis vintage and phosphorus in univariate analysis. In multiple regression analysis, hsCRP, AOPP and phosphorus but not esRAGE were all significantly correlated to FGF-23 (R2 = 0.7, p 2 = 0.65, p Conclusion: FGF-23 is strongly correlated to various markers of inflammation and oxidative stress in hemodialysis patients. The association between FGF-23 and vascular calcification was mitigated when corrected for inflammation markers