Laparoscopy-assisted liver transplantation: A single-center case series

IntroductionIntracranial arterial stenting is a technique for treatment of symptomatic stenosis causing acute and/or recurrent ischemic stroke. In this single-center retrospective case series we evaluated a novel low profile laser-cut...

Simple SummaryFocal radiation necrosis of the brain (fRNB) is a late side effect that can occur after treatment of brain lesions with focal radiation therapy (stereotactic radiosurgery [SRS] or stereotactic radiation therapy [SRT]). This is becoming more common as more cancer patients are receiving effective systemic therapy for brain metastases, extending survival, and putting them at risk for fRNB. Currently, treatment options are limited to long-term corticosteroid therapy, which has significant side effects, or surgery with its inherent risks. Bevacizumab, a monoclonal antibody that targets the vascular endothelial growth (VEGF), is effective in treating fRNB but its use has remained limited due to its cost. In this single-center case series, a fixed low dose of bevacizumab (400 mg loading dose followed by 100 mg every 4 weeks) was shown to be a safe and cost-effective alternative treatment option for fRNB.Focal radiation necrosis of the brain (fRNB) is a late adverse event that can occur following the treatment of benign or malignant brain lesions with stereotactic radiation therapy (SRT) or stereotactic radiosurgery (SRS). Recent studies have shown that the incidence of fRNB is higher in cancer patients who received immune checkpoint inhibitors. The use of bevacizumab (BEV), a monoclonal antibody that targets the vascular endothelial growth factor (VEGF), is an effective treatment for fRNB when given at a dose of 5–7.5 mg/kg every two weeks. In this single-center retrospective case series, we investigated the effectiveness of a low-dose regimen of BEV (400 mg loading dose followed by 100 mg every 4 weeks) in patients diagnosed with fRNB. A total of 13 patients were included in the study; twelve of them experienced improvement in their existing clinical symptoms, and all patients had a decrease in the volume of edema on MRI scans. No clinically significant treatment-related adverse effects were observed. Our preliminary findings suggest that this fixed low-dose regimen of BEV can be a well-tolerated and cost-effective alternative treatment option for patients diagnosed with fRNB, and it is deserving of further investigation.

Background and study aims Endoscopic management of colonic diverticular bleeding remains challenging. Endoscopic coagulation with clipping (ECC) has been performed at our institution, but real-world outcome data remain limited. We aimed to describe the clinical outcomes and safety of ECC. Patients and methods We conducted a single-center retrospective case series of consecutive patients with colonic diverticular bleeding who underwent ECC for endoscopically confirmed diverticular bleeding between January 2017 and December 2025. Rebleeding was defined as clinically significant recurrent hematochezia within 30 days after initial hemostasis. Rebleeding rates and procedure-related adverse events were evaluated. Results Among 256 patients presenting with hematochezia and clinically suspected diverticular bleeding, 238 underwent colonoscopy. Of these, 83 patients who underwent ECC for endoscopically confirmed diverticular bleeding were included in the analysis. Rebleeding within 30 days occurred in 7 patients (8.4%), including 6 cases within 7 days. Among the 83 patients treated with ECC, stigmata of recent hemorrhage were identified in 81 patients. Among these, rebleeding occurred in 3 of 54 patients (5.6%) with active bleeding and in 4 of 27 patients (14.8%) with nonbleeding visible vessels or adherent clots. Procedure-related adverse events were observed in 3 patients (3.6%), all managed conservatively. Conclusions In this single-center case series, ECC was associated with a low rebleeding rate in this cohort. ECC may represent a practical hemostatic option when the bleeding diverticulum is clearly identified.

Graft ureteral stricture is an uncommon but important complication after renal transplantation that may compromise graft function. Endoscopic balloon dilatation offers a minimally invasive treatment, though regional data are limited. The study aimed to determine the number of endoscopic balloon dilatation procedures required to manage graft ureteral strictures and to evaluate their success rate as a bridge to or alternative to surgical revision. A single-center retrospective case series included 10 recipients treated between May 2018 to August 2025 conducted at the Department of Kidney Transplant Surgery, Pakistan Kidney and Liver Institute & Research Center (PKLI & RC), Lahore, Pakistan, with outcomes assessed based on the number and success of dilatation procedures. Among 1,070 living-donor renal transplants, graft ureteral strictures occurred in 10 patients, yielding an incidence of 0.93% (95% CI:0.45-1.71%). No ureteral stricture has occurred in our pediatric patients. Recipients were predominantly male (80%) with a median age of 28.50 (IQR:9) years. Most strictures developed within two months post-transplant, presenting as a rise in serum creatinine (median 2.51 (IQR:2.06) mg/dL at diagnosis). The median number of balloon dilatations per patient was 3.50 (IQR: 2). Outcomes included successful resolution in four patients (40%), surgical revision in four patients (40%), and periodic double J stent replacement in two patients (20%). All patients and graft were stable at one year with stable renal function (median serum creatinine 1.60 (IQR:0.44 mg/dL); median eGFR 44.9 (IQR:13.42) mL/min/1.73 m2). Balloon dilatation demonstrated limited long-term success, with only 40% achieving sustained resolution. A majority required surgical revision or ongoing stenting, suggesting its role as a bridging rather than definitive therapy.

Pediatric pulmonary resections are performed for a wide spectrum of congenital, infectious, and neoplastic diseases; however, clinical outcomes and surgical approaches remain subjects of ongoing evaluation. To evaluate the indications, surgical techniques, and clinical outcomes of pediatric pulmonary resections. A retrospective, single-center case series. Medical records of 41 pulmonary resection procedures performed in pediatric patients were reviewed retrospectively. Data on demographic characteristics, type of resection, laterality, pathological diagnoses, and postoperative outcomes were analyzed. Wedge resection was the most frequently performed procedure (75.6%), while bullous emphysema was the most common pathological diagnosis (51.2%). Of all resection procedures, 86.1% were associated with benign and 13.9% with malignant conditions. No major postoperative complications and no 90-day mortality were documented in the reviewed records. During follow-up, three patients died, all of whom had malignant diagnoses. In this retrospective single-center mixed-pathology case series, pediatric pulmonary resections were associated with favorable observed perioperative outcomes, with no documented major postoperative complications or 90-day mortality. Operative strategy was individualized according to lesion type, extent, and surgical feasibility, while follow-up deaths were confined to patients with malignant diagnoses.

In children, chylothorax post cardiac surgery can be difficult to treat, may run a protracted course, and remains a source of morbidity and mortality. To analyze the experience with percutaneous image-guided chest-tube drainage in the management of post-cardiac-surgery chylothoraces in children. We conducted a single-center retrospective case series of 37 post-cardiac-surgery chylothoraces in 34 children (20 boys; 59%), requiring 48 drainage procedures with placement of 53 image-guided chest tubes over the time period 2004 to 2015. We analyzed clinical and procedural details, adverse events and outcomes. Median age was 0.6years, median weight 7.2kg. Attempted treatments of chylothoraces prior to image-guided chest tubes included dietary restrictions (32/37, 86%), octreotide (12/37, 32%), steroids (7/37, 19%) and thoracic duct ligation (5/37, 14%). Image-guided chest tubes (n=43/53, 81%) were single unilateral in 29 children, bilateral in 4 (n=8/53, 15%), and there were two ipsilateral tubes in one (2/53, 4%). Effusions were isolated, walled-off, in 33/53 (62%). In 20/48 procedures (42%) effusions were septated/complex. The mean drainage through image-guided chest tubes was 17.3mL/kg in the first 24h, and 13.4mL/kg/day from diagnosis to chest tube removal; total mean drainage from all chest tubes was 19.6mL/kg/day. Nine major and 27 minor maintenance procedures were required during 1,207 tube-days (rate: 30 maintenance/1,000 tube-days). Median tube dwell time was 21days (range 4-57days). There were eight mild adverse events, three moderate adverse events and no severe adverse events related to image-guided chest tubes. Radiologic resolution was achieved in 26/37 (70%). Twenty-three children (68%) survived to discharge; 11 children (32%) died from underlying cardiac disease. Management of chylothorax post-cardiac-surgery in children is multidisciplinary, requiring concomitant multipronged approaches, often through a protracted course. Multiple image-guided chest tube drainages can help achieve resolution with few complications. Interventional radiology involvement in tube care and maintenance is required. Overall, mortality remains high.

Prolonged SARS-CoV-2 shedding and mild course of COVID-19 in a patient after recent heart transplantation.

As pediatric head and neck cancer (pHNC) incidence increases, the development of new surgical oncology techniques to reduce morbidity are essential. Intraoperative navigation (iNav) represents the most translatable technology among both the model-comparative and integrative surgical navigation technologies to optimize surgical outcomes. A scoping review of the literature was performed according to PRISMA guidelines from 1970 to present (February 2025), investigating the use of iNav in cases of pHNC. Patient case details and authors' perception of iNav's utility were analyzed. A single-center retrospective case series review (September 2022 to September 2025) of the senior authors' experience employing iNav in pHNC cases was also performed. The scoping review identified twenty-seven cases of pHNC from sixteen studies that both utilized iNav and met the inclusion criteria. Many of the authors commented favorably on the utility of iNav technology, while concurrently agreeing upon its limitations. The case series review identified five cases of pHNC that met the inclusion criteria. This small case series revealed a 100% R0 resection rate with the use of iNav in four pHNC resections. The fifth case used iNav for biopsy site selection. The results of our scoping review as well as our institutional experience with this technology demonstrate its utility in guiding surgical approach, confirming depth of resection, and navigating marginal assessment. This study was limited by incidental and incomplete reporting of iNav's clinical application to pHNC; several extensive institutional reports had to be excluded due to insufficiently detailed data linkage. Our review builds upon the existing pediatric surgical literature, anchoring the evidentiary justification for the application of iNav to pediatric head and neck surgery.

Eccrine porocarcinoma (EPC) is a rare sweat gland malignancy. Recognition of histologic features is challenging, and specific pathologic features correlate with risk of poor outcome. This single-center retrospective review and case series of 58 EPC cases from 2000 to 2016 elucidates epidemiologic and pathologic characteristics of EPC. Pathology slides from 52 cases were analyzed by a dermatopathologist for standardized variable characteristics, including previously determined high-risk features (HRF) associated with poor prognosis. The incidence of EPC increased over the study period with 3 times more cases diagnosed in the last 4 years than in the first 4 years. Most cases were in the elderly males (mean age 75 years), and 50% were located in the head and neck region. Although 38% of tumors exhibited one histologic HRF, only 10% exhibited more than one. Of the HRF, a greater tumor depth was associated with both increased age (P = 0.04) and clear cell differentiation (P = 0.02). This study elucidates epidemiologic and pathologic features of EPC and highlights how age and clear cell differentiation can be associated with greater tumor depth, although further research is needed to determine whether clear cell differentiation is associated with poor clinical outcome.

Clinical outcomes and serologic response in solid organ transplant recipients with COVID-19: A case series from the United States.

Objective: This study aims to investigate whether advanced age is an absolute contraindication for radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) through a single-center case series and a systematic review with meta-analysis. Materials and methods: In the single-center case series, 588 UTUC patients who underwent RNU between May 2003 and June 2019 in West China Hospital were enrolled, and cancer-specific survival (CSS) was the primary outcome of interest. In the systematic review with meta-analysis, PubMed, Scopus, Embase, and Cochrane databases were systematically searched for related articles for further analysis. The endpoints for meta-analyses were overall survival (OS) and CSS. Results: The single-center case series included 57 (9.7%) octogenarians. The CSS of octogenarians after RNU was comparable to that of younger people. Advanced age (≥80) was not an independent risk factor for poor CSS (HR, 1.08; 95% CI, 0.48, 2.40). In a systematic review with meta-analysis, the cut-off value of advanced age is 70, and the results showed that advanced age was associated with inferior OS (pooled HR, 1.55; 95% CI, 1.29, 2.01) and CSS (pooled HR, 1.37; 95% CI, 1.08, 1.65). However, the subgroup analysis of countries found no positive correlation between advanced age and CSS (pooled HR, 1.33; 95% CI 0.92, 1.74) in Chinese. Conclusions: Advanced age may no longer be an absolute contraindication for RNU. RNU can be safely and effectively performed on UTUC patients of advanced age after a comprehensive presurgical evaluation.

(1) Background: Non-stenotic complicated plaques are a neglected cause of stroke, in particular in young patients. Atherosclerosis has some preferential sites in extracranial arteries and the prepetrous segment of the internal carotid artery has been rarely described as site of atheroma in general and of complicated atheroma in stroke patients. The aim of this study is to describe the rate of the prepetrous internal carotid artery's (ICA) involvement in a single-center case series of young stroke patients. (2) Methods: All patients < 50 years old with acute ischemic stroke admitted to a single-center Stroke Unit during two time periods (the first one from 1 January 2018 to 31 December 2019, and the second one from 1 January 2021 to 30 June 2022), were prospectively investigated as part of a screening protocol of the Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO) study [ClinicalTrials.gov ID NCT01934725], including extracranial vascular examination by using computed tomography (CT) or magnetic resonance imaging (MRI). (3) Results: Two out of ninety-three consecutive patients (2.15%) had a complicated atheroma in the prepetrous ICA as the cause of stroke and both CT angiography and high-resolution vessel wall MRI were applied to document the main features of positive remodeling, cap rupture, ulceration, intraplaque hemorrhage, and a transient thrombus superimposed on the atheroma. The two patients had a different evolution of healing in the first case and a persisting ulceration at 12 months in the second case. (4) Conclusions: The prepetrous ICA is a rarely described location of complicated atheroma in stroke patients at all ages and it represents roughly 2% of causes of acute stroke in this single-center case series in young people.

Strategies for liver transplantation during the SARS-CoV-2 outbreak: Preliminary experience from a single center in France.

The optimal treatment approach for hemorrhagic moyamoya disease (HMMD) remains a topic of debate, particularly regarding the comparative efficacy of revascularization versus conservative treatment. Our study, which included a single-center case series and a systematic review with meta-analysis, aimed to determine whether surgical revascularization is associated with a significant reduction in postoperative rebleeding, ischemic events, and mortality compared to conservative treatment among East Asian HMMD patients. We conducted a systematic literature review by searching PubMed, Google Scholar, Wanfang Med Online (WMO), and the China National Knowledge Infrastructure (CNKI). The outcomes of surgical revascularization and conservative treatment, including rebleeding, ischemic events and mortality, were compared. The authors' institutional series of 24 patients were also included and reviewed in the analysis. A total of 19 East Asian studies involving 1,571 patients as well as our institution's retrospective study of 24 patients were included in the study. In the adult patients-only studies, those who underwent revascularization had significantly lower rates of rebleeding, ischemic events, and mortality compared to those who received conservative treatment (13.1% (46/352) vs. 32.4% (82/253), P < 0.00001; 4.0% (5/124) vs. 14.9% (18/121), P = 0.007; and 3.3% (5/153) vs. 12.6% (12/95), P = 0.01, respectively). In the adult/pediatric patients' studies, similar statistical results of rebleeding, ischemic events, and mortality have been obtained (70/588 (11.9%) vs. 103/402 (25.6%), P = 0.003 or <0.0001 in a random or fixed-effects model, respectively; 14/296 (4.7%) vs. 26/183 (14.2%), P = 0.001; and 4.6% (15/328) vs. 18.7% (23/123), P = 0.0001, respectively). The current single-center case series and systematic review with meta-analysis of studies demonstrated that surgical revascularization, including direct, indirect, and a combination of both, significantly reduces rebleeding, ischemic events, and mortality in HMMD patients in the East Asia region. More well-designed studies are warranted to further confirm these findings.

e14553 Background: Anti-PD-1 monoclonal antibodies (PD1) have clinical activity in several solid tumors. However, experience treating dialysis pts with PD1 is limited. Dosage adjustments are not recommended for renal impairment but PK studies did not include pts with ESRD on dialysis. Two case reports have described objective responses and a tolerable AE profile. We sought to explore the safety and efficacy of PD1 in such pts. Methods: In this single-center case series, we identified 4 pts with ESRD on dialysis who were treated with PD1 between 10/2014 to 11/2016. Data regarding clinical history, PD1 dosing, dialysis regimen, treatment (tx) response, and toxicity were collected. Results: Four pts were evaluable for data collection. Two pts had metastatic renal cell carcinoma (mRCC) and 2 others had unresectable cutaneous squamous cell carcinoma (cuSCC). Age at tx ranged from 66 to 71; all 4 pts were male. Number of doses ranged from 4 to 8. Two pts with mRCC received nivo 3 mg/kg q2wk after dialysis. Two pts with cuSCC received pembro 2 mg/kg q3wk after dialysis; dosing was extended to q4wk for 1 pt due to persistent grade (G) 2 fatigue. Three pts were on hemodialysis 3 times a wk and 1 pt was on peritoneal dialysis. Time to progression was 3 months for 1 mRCC pt and could not be determined for the other mRCC pt who had a PR but died from possible tx-related causes. Two cuSCC pts are still receiving pembro with PR at time of analysis. Immune-related AEs were seen in all 4 pts, including 2 incidences of G2 fatigue and 1 incidence each of G2 rash and G3 pneumonitis.One pt developed acute encephalitis after 4 doses of nivo that improved with steroids but was ultimately fatal. Conclusions: This single-center case series highlights the efficacy and AE profile of PD1 for pts with ESRD on dialysis. While this is a small series, there was significant anti-tumor activity in this group of pts. Despite the reported favorable AE profile of PD1, one pt had a serious and mortal AE that may have been related to tx. This should be considered in future studies. High molecular weight of PD1 suggests these agents are not removed by dialysis but we were limited by lack of PK data. Our experience adds to the 2 cases in the literature. Further studies are warranted in larger cohorts.