Sanjay Sharma

Mediastinal haematoma is a rare complication following insertion of central venous catheter, with few cases reported in the literature. We report a case of mediastinal haematoma in a 33-year-old male patient with end-stage renal disease. In this patient central venous catheter insertion through the right subclavian vein was attempted on the operation table for renal transplantation but the procedure was abandoned as the attempt was unsuccessful. Post-procedure chest radiograph showed a large mediastinal haematoma occupying right hemithorax that developed as a result of injury to the subclavian vein. Patient was managed conservatively and haematoma completely resolved in four weeks time. This case is being reported to signify the importance of routine obtaining a post-procedure chest radiograph and to state that even large mediastinal haematoma can be managed conservatively in asymptomatic patients.

Objective: To study correlation between Cerebral Venous Sinus Thrombosis and Serum Homocysteine levels. Patients and Methods: 76 patients having Cerebral Venous Thrombosis were admitted to our hospital from September 2017 to September 2019. In each patient fasting serum homocysteine levels and serum B12 levels were taken and analyzed. Every patient was subjected to a detailed clinical history and neurological examination. In each patient fasting serum homocysteine levels and serum B12 levels were done. The serum homocysteine levels were done by kinetic biochemistry using R1 and R 2 reagents. The serum B12 levels were done by using ELISA Technique. On the basis of serum homocysteine levels, the patients were divided into 4 categories: Normal Level, Mild Hyperhomocysteinrmia, Moderate Hyperhomocysteinemia and Severe Hyperhomocysteinemia. On the basis of serum B12 levels, the patients were again divided into 4 categories: Severe Deficiency, Mild Deficiency, Normal range and High levels. Conclusion: Hyperhomocysteinemia could be a risk factor accounting forCerebral Venous Sinus Thrombosis. The results of this study have shown that homocysteine levels were significantly higher in CVST patients and serum hyperhomocysteinemia is one of the risk factor in the etiology of Cerebral Venous Sinus Thrombosis patients. Though, Serum B12 levels showed no correlation in patients of CVST. Thus, Serum homocysteine estimation needs to be sent from emergency department of all patients with diagnosis of Cerebral Venous Sinus Thrombosis.

The number of patients who could benefit from liver transplantation markedly exceeds the number of available donors. This increasing gap has fuelled efforts to maximize existing donor pool and identify new avenues. To compare the outcome in deceased donor liver transplant (DDLT) based on extended donor selection criteria. Donor and recipients' data were analyzed following DDLT from Mar 2007 to Feb 2013. Donors were grouped into either ideal donor (ID) or extended criteria donor (ECD) based on donor and graft related characteristics. Primary nonfunction (PNF) and patient survival were the primary endpoints while early graft dysfunction (EGD) and incidence of major postoperative complications were the secondary endpoints of the study. We had a total of 6 mortalities (13%) at the end of 1 year. The Kaplan Meier survival analysis at 7 days, 3, 6 and 12 months were not statistically different (p > 0.05). PNF occurred in three (6.5%) patients and was not significantly different nor influenced by cumulative number of risk factors in the subgroup analysis (p < 0.3). However, the incidence of EGD was significantly influenced by the cumulative number of risk factors (p < 0.005). A total of 12 (26.1%) patients were graded with 3 or more complications according to the 'Clavien Dindo Grade' for major post operative complications, although it did not reach a statistical significance in the various subgroups. Univariate analysis of the donor risk factors showed that none of these factors were predictive for PNF and mortality in deceased donor liver transplant recipients. Although the incidence of early graft dysfunction is statistically more with increase in number of donor risk factors, the overall survival and outcome in extended criteria liver donors are similar to that of an ideal donor. With the supply demand gap widening, extended criteria for selection of deceased donors will definitely expand the donor pool without adversely affecting the outcome of liver transplantation.

Introduction Orthotopic liver transplantation has become a routinely applied therapy for an expanding group of patients with end-stage liver disease. Shortage of organs has led centers to expand their criteria for the acceptance of marginal donors. There is current debate about the regulation and results of liver transplantation using marginal grafts. Methods The study included data of all patients who received deceased donor liver grafts between March 2007 to December 2011. Patients with acute liver failure, living donor transplantation, split liver transplantation, and retransplantation were excluded. Early allograft dysfunction, primary nonfunction, patient survival, and incidence of surgical complications were measured. Results A total of 33 patients were enrolled in this study. There were 20 marginal and 13 nonmarginal grafts. The two groups were well matched regarding age, sex and indication of liver transplantation, model for end-stage liver disease score, technique of transplant, requirement of vascular reconstruction, warm ischemia time, blood loss, mean operative time, etc. In our study, posttransplant peak level of liver enzymes, international normalization ratio, and bilirubin were not statistically significant in the marginal and nonmarginal group. Wound infection occurred in 10 % of marginal compared with 7.7 % of nonmarginal graft recipients (p > 0.05). In the marginal group, the incidences of vascular complications, hepatic artery thrombosis (four), and portal vein thrombosis (one) were not statistically significant compared to the nonmarginal group. Acute rejection was observed in a total of seven patients (21.2 %)—five (25 %) in the marginal group and two (15.4 %) in the nonmarginal graft recipients. Primary nonfunction occurred in three (9.1 %) patients—two (10 %) in the marginal and one (7.7 %) in the nonmarginal group. Average patient survival for the whole group was 91 % at 1 week, 87.8 % at 3 months, and 84.8 % at 6 months. Conclusion Because organ scarcity persists, additional pressure will build to use a greater proportion of the existing donor pool. The study, although small, clearly indicates that marginal livers can assure a normal early functional recovery after transplantation.