Use of autogenous internal iliac artery for bridging the external iliac artery after excision of Aspergillus mycotic aneurysm in renal transplant recipients

Repair of vascular defects in the presence of infection remains a challenging task in immunocompromised patients. We report two patients with postrenal transplant Aspergillus mycotic aneurysms of the allograft renal artery involving the external iliac artery which were excised along with the allograft. The defect in the external iliac artery was repaired successfully with interposition of autogenous internal iliac artery graft. Use of an internal iliac artery graft in such settings has been rarely reported in English literature. Autogenous internal iliac artery grafts provide a useful method to bridge the vascular defects created by radical debridement in the presence of fungal infections

<span style="font-size: 21.5pt;mso-bidi-font-size:14.5pt;font-family:"Times New Roman","serif"">Orientational ordering and binding in alkali doped C_{<span style="font-size:17.0pt; mso-bidi-font-size:10.0pt;font-family:"Times New Roman","serif"">60</span>}<span style="font-size:17.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman","serif""> <span style="font-size:21.5pt;mso-bidi-font-size:14.5pt;font-family: "Times New Roman","serif"">solids </span></span></span>

320-324<span style="font-size: 15.5pt;mso-bidi-font-size:8.5pt;font-family:" times="" new="" roman","serif""="">The binding energy of K3C<span style="font-size:13.0pt; mso-bidi-font-size:6.0pt;font-family:" times="" new="" roman","serif""="">60, a conductor, is described well by an ionic solid type calculation. This succeeds because there is little overlap between molecular wave functions on neighbouring sites, so that electrons are practically localized onshell. This leads one to believe that even in K3C60 <span style="font-size:15.5pt;mso-bidi-font-size:8.5pt;font-family: " times="" new="" roman","serif""="">and K<span style="font-size:13.0pt; mso-bidi-font-size:6.0pt;font-family:" times="" new="" roman","serif""="">6C60 systems, such calculation may suffice. However, the on shell <span style="font-size: 15.5pt;mso-bidi-font-size:8.5pt;font-family:" times="" new="" roman","serif""="">Coulomb repulsion is large for the C<span style="font-size:13.0pt;mso-bidi-font-size: 6.0pt;font-family:" times="" new="" roman","serif""="">60 molecule. So, for large charge on the anion, there is a possibility for some electrons to delocalize and go into the s-band. In the calculation of binding energy, we keep these delocalised electrons <span style="font-size:16.0pt; mso-bidi-font-size:9.0pt;font-family:" times="" new="" roman","serif""="">x, as a parameter and minimize the energy w.r.t. it. We take the intermolecular interaction to be arising out of a C-C potential of <span style="font-size: 15.5pt;mso-bidi-font-size:8.5pt;font-family:" times="" new="" roman","serif""="">6-exp form (Kitaigorodsky) and a screened Coulomb interaction between the anions and cations and among themselves. The screening is provided by the electrons delocalised from the anion which supposedly go into the s-band of the cations, and are modeled by a free electron fermi gas. The energy of the anion (to be added to the lattice sum) takes into account the onsite Coulomb energy, and is thus a quadratic function of anion charge. The delocalised electrons go into s-band whose position is estimated and corresponding energy added. Model calculations are presented for K<span style="font-size:13.0pt; mso-bidi-font-size:6.0pt;font-family:" times="" new="" roman","serif""="">1C60, K3C60, K4C60 and K<span style="font-size:13.0pt;mso-bidi-font-size:6.0pt;font-family: " times="" new="" roman","serif""="">6<span style="font-size:15.5pt; mso-bidi-font-size:8.5pt;font-family:" times="" new="" roman","serif""="">C60 <span style="font-size:15.5pt;mso-bidi-font-size:8.5pt;font-family: " times="" new="" roman","serif""="">for which the minimum energy state shows no delocalisation. Cohesive Energy dependence on Lattice constant is used to <span style="font-size: 15.5pt;mso-bidi-font-size:8.5pt;font-family:" times="" new="" roman","serif""="">calculate Bulk Modulus for all systems. We have got a reasonably good resemblance with experimental values. Further, we observe that the cohesive energy shows poor resemblance with experimental values. This can be explained by invoking orientation in these calculations. Further, delocalisation of a fraction of electron at the centre of double bond show <span style="font-size:15.5pt;mso-bidi-font-size:8.5pt; line-height:115%;font-family:" times="" new="" roman","serif""="">considerable increase in cohesive energy. </span

Multiple cephalic vein aneurysms with calcification in a patient undergoing hemodialysis: An unusual entity

Peripheral venous aneurysms are a known complication following autogenous arteriovenous fistula (AVF) for hemodialysis. We present a case of aneurysms involving the cephalic vein associated with calcification, a condition that, to the best of our knowledge, has not been reported earlier in the literature

Salvage of renal allograft in mycotic pseudoaneurysm of the transplant renal artery

Mycotic pseudoaneurysm of transplant renal artery is a rare complication and warrants allograft nephrectomy. We report a 54-year-old renal allograft recipient who presented with 9.2 cm × 5.9 cm × 5.7 cm sized pseudoaneurysm of transplant renal artery. Blood culture grew Pseudomonas aeruginosa. The allograft was explanted, aneurysm was excised, and the allograft was reimplanted to right internal iliac artery with interposition of autogenous arterial graft. Microbiological examination of the aneurysm wall did not reveal active infection. The patient did well and at four years maintains normal renal function. Salvage of renal allograft is possible in selected patients with mycotic pseudoaneurysm of transplant renal artery

Cytomegalovirus Infection in Postrenal Transplant Recipients: 18 Years' Experience From a Tertiary Referral Center

Cytomegalovirus (CMV) reactivation or infection is one of the most important infectious complications in transplant recipient leading to significant morbidity and mortality. Its early detection and prompt treatment is imperative to improve transplant outcome. The present study estimated the frequency of CMV in renal transplant recipients (RTR). Various aspects of pp65Ag assay and quantitative real-time polymerase chain reaction (qRT-PCR) were evaluated in relation to the recent guidelines for CMV detection and treatment. Retrospectively, data of clinically suspected cases of CMV (1610 out of total 2681 renal transplants) were analyzed along with a comparison of pp65Ag assay and qRT-PCR. The overall incidence of CMV syndrome was 14.25%; however, the incidence of CMV viremia in the clinically suspected group was 23.73%. The proportion of positive cases with pp65Ag assay and qRT-PCR were 13.6% (95% CI; 7.9-22.3) and 19.3% (95% CI; 12.4-28.8) with a substantial agreement (Cohen's kappa = 0.632) between the 2 techniques. CMV positive recipients were treated with ganciclovir until their viral count was negative or up to 3 weeks, followed by 3 months of prophylaxis with valganciclovir. No graft failure or mortality was reported secondary to CMV infection until 3 to 5 years of follow-up. CMV infection is quite prevalent in RTR, and early detection and immediate treatment or prophylaxis is of utmost importance. qRT-PCR is the gold standard and preferred over other methods; however pp65Ag assay still holds its importance in low-economic countries and populations where CMV infection is more prevalent and financial constraints are a major limitation

Immediate Recurrence of Genetic Focal Segmental Glomerulosclerosis PostKidney Transplant

Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation is a serious concern with poor allograft outcomes. Possible circulating permeability factors are postulated as pathogenetic factors leading to recurrence. Genetic FSGS is said to have a negligible risk of posttransplant recurrence. Here, we describe an unfortunate patient of genetic FSGS (pathogenic genetic variant) who had a recurrence within hours after transplant and presented with a sudden onset of anuria. The patient did not respond to plasma exchange and subsequently underwent allograft nephrectomy