Extensive porto-mesenteric thrombosis presents a significant challenge in liver transplantation and was previously considered a contraindication. However, advancements in surgical techniques have made liver transplantation feasible. For optimal allograft function, adequate portal flow is crucial, as it generates shear stress that stimulates regeneration. In such cases, portal inflow options include the left renal vein (reno-portal anastomosis; RPA), the inferior vena cava (cavo-portal hemi-transposition; CPHT), any patent splanchnic territory, portal vein arterialization, or multi-visceral transplantation. Among these, CPHT and RPA are the most commonly performed. Generally, CPHT is used in pediatric liver transplantation; however, it is rarely reported in adult living donor liver transplantation (LDLT) due to technical challenges. In this report, we describe our technical modifications to CPHT and present the results in two patients with extensive porto-mesenteric thrombosis who underwent LDLT.

Background: s/Aims: Early liver graft regeneration after living donor liver transplantation (LDLT) is critical for patient outcomes, yet prospective volumetric data from Indian recipients remain limited. This study quantifies early graft regeneration and identifies predictors using computed tomography (CT) volumetry. Methods: In this prospective single-center study, 34 consecutive adult LDLT recipients underwent CT volumetry on postoperative days 7 and 30. Results: Mean baseline graft volume was 607.9 ± 137.9 cm3 , increasing to 957.3 ± 175.7 cm3 at day 7 (+62%, p < 0.001) and 1,293.4 ± 247.0 cm3 at day 30 (+111%, p < 0.001), achieving 93% ± 22.7% of predicted standard liver volume (SLV). Multivariate analysis identified recipient body mass index (BMI) (β = 29.4 cm3 /kg/m2 , 95% CI 14.4–44.4, p < 0.001) and graft-to-recipient-weight ratio (GRWR) (β= 435.9 cm3 per unit, 95% CI 95–777, p = 0.015) as independent predictors of day-30 graft volume (adjusted R2 = 0.349). Left-lobe grafts showed higher proportional growth than right-lobe grafts (174% ± 41% vs. 103% ± 34%, p < 0.001) with comparable absolute volumes (p = 0.56). Younger recipients (19–41 years) demonstrated greater regeneration than older recipients (56–64 years; 160% ± 32% vs. 109% ± 38%, p = 0.01). Mild macrosteatosis (< 30%) did not impair regeneration. Conclusions Liver graft regeneration in this Indian LDLT cohort was rapid, with near-complete SLV restoration by 30 days. BMI and GRWR independently predicted volumetric recovery, supporting personalized graft selection and the expanded use of left-lobe grafts.

Purpose: Reports remain sparse on the outcomes of quadratus femoris muscle pedicle bone grafting (QF-MPBG) for osteonecrosis of the femoral head (ONFH) in the existing literature. This study reports on the clinico-radiological outcomes of this procedure in early-stage non-traumatic ONFH using a quadriceps-coxae sparing (QCS) modified posterior approach. Materials and Methods: This prospective study included 22 symptomatic patients suffering from early-stage, non-traumatic ONFH. These patients underwent QF-MPBG surgery using a QCS modified posterior approach and were followed up for a minimum duration of 24 months. Results: The mean age of patients was 29 years (range, 20-47 years). As per the modified Kerboul’s combined necrotic angle, the distribution of patients was as follows: grade 1 (n=5); grade 2 (n=9); grade 3 (n=4); and grade 4 (n=4). All four patients belonging to grade 4 and two belonging to grade 3 required total hip arthroplasty (THA) within 24 months. As per the modified Ficat’s classification, 18 cases were in stage II and four in stage I. Six cases (out of the preoperative 18 cases classified as stage II) deteriorated to stage IV, and two deteriorated to stage III. The mean Harris hip score improved from 63 (range, 57-67) to 75 (range, 50-93) after surgery (P<0.05). Four out of six patients necessitating THA had steroid-induced ONFH. Conclusion The QCS modified posterior approach provides sufficient exposure required for QF-MPBG. Steroid-induced ONFH and a modified Kerboul’s combined necrotic angle of >250° may be considered as potential risk factors for progression of this disease.

Foreign body aspiration is frequently encountered in children but can also occur in adults, where it often remains undiagnosed for years. Forgotten foreign bodies within the bronchial tree may later manifest with either vague symptoms or life-threatening complications, such as massive hemoptysis. Contrast-enhanced computed tomography of the thorax is the preferred initial diagnostic modality and can suggest the presence of a foreign body. We present a case involving an adult who remained undiagnosed until adulthood, when he was ultimately found to have a foreign body embedded in the lung parenchyma.

Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.

BACKGROUND: Transcatheter left atrial appendage occlusion (LAAO) has become a suitable alternative to anticoagulation in patients with atrial fibrillation (AF). However, outcomes among patients age > 75 years undergoing LAAO are lacking. METHODS: We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020. Patient data including clinical, laboratory, procedural characteristics, medications and outcomes were collected. The primary composite outcome was major adverse cardiac events (MACE) including mortality, stroke, bleeding and readmissions at 60-days. RESULTS: Mean age was 75 ± 8 years and 434 (60%) were males. Median CHA₂DS₂-VASc score was 4 (IQR: 4, 5) points and median HASBLED score was 4 (IQR: 3, 4) points. Composite MACE outcome was significantly higher among patients age > 75 years in both unadjusted (17.1% vs. 11.5%, P = 0.03) and adjusted (Odds Ratio = 1.59, 95% CI: 1.02 - 2.46, P = 0.04) analysis. Composite MACE was primarily driven by higher all-cause mortality (1.3% vs. 0, P = 0.04) among patients age > 75 years. The secondary outcome of procedural success was also lower among patients age > 75 years (92.2% vs. 96.2%, P = 0.02). The occurrence of stroke (P = 0.38), major bleeding (P = 0.29) and readmissions (P = 0.15) did not differ between patients age > 75 years and less than 75 years. CONCLUSION Patients age >75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success. Future prospective studies evaluating these findings are warranted.

Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.