Leukocyte chemotactic factor 2 (ALECT2) amyloidosis is an emerging but under-recognized cause of CKD, typically presenting with slowly progressive renal dysfunction and no specific treatment modality. Unlike amyloid light chain (AL) or amyloid A (AA) amyloidosis, ALECT2 primarily exhibits interstitial amyloid deposition without systemic involvement. We report a case series patients with ALECT2 amyloidosis, with some of whom demonstrate rare and previously unreported associations. These cases highlight the heterogeneity in clinical presentation, ranging from nephrotic syndrome to AKI and even possible graft dysfunction. Diagnosis was confirmed in all cases through renal biopsy. Disease progression varied depending upon associated disease. This series expands the ALECT2 amyloidosis spectrum and underscores the need for increased awareness
High-volume public radiology departments face multifactorial workflow challenges driven by fragmented digital infrastructure and high imaging demand under state-sponsored health coverage programmes. We aimed to evaluate a multi-phase quality improvement initiative targeting pre-scan, scan and post-scan bottlenecks in CT and MRI services at a publicly funded, PPP-operated tertiary academic centre. A pre–post study using the Plan–Do–Study–Act framework was conducted per SQUIRE 2.0. A multidisciplinary team implemented 13 targeted interventions across three workflow phases. Outcomes were compared by independent-samples t-tests, Wilcoxon rank-sum tests, and chi-square or Fisher exact tests; process stability was assessed with Shewhart X-bar control charts (α = 0.05). CT registration-to-scan time decreased from 2.1 to 1.2 h (−43
Introduction: Morgagni-Larrey hernia, a left-sided anterior congenital diaphragmatic defect, accounts for only 2–8% of all Morgagni hernias and frequently remains clinically silent into adulthood. Diaphragmatic injuries are misdiagnosed in up to 33% of cases, with untreated cases carrying mortality rates between 25% and 80%. Trauma-induced unmasking of such latent defects poses significant diagnostic and surgical challenges. Case Report: A 35-year-old female presented with shortness of breath and left-sided chest pain three days following a fall from 10 feet. She was haemodynamically unstable on arrival. Chest X-ray and contrast-enhanced computed tomography confirmed herniation of the greater omentum, transverse colon, and gastric fundus through a left-sided diaphragmatic defect measuring 10×7 cm (American Association for the Surgery of Trauma Grade IV), with collapse of the left lower lobe of the lung — representing a latent Larrey hernia unmasked by blunt trauma. Following resuscitation and multidisciplinary consultation, laparoscopic repair was performed using primary suture closure with non-absorbable suture, reinforced with a composite polypropylene-oxidised cellulose mesh. Tack fixation was avoided near the pericardium ; vicryl sutures were used instead to prevent iatrogenic cardiac tamponade. An intraoperative intercostal drain ensured complete lung re-expansion. The patient was discharged uneventfully on postoperative day 4. Conclusion Latent congenital diaphragmatic hernias can be unmasked by blunt trauma and must be considered in any patient with cardiorespiratory compromise following thoracoabdominal injury. Laparoscopic repair with mesh reinforcement is safe and effective for large defects, provided careful attention is given to anatomical danger zones like mediastinum during fixation.
Heteropagus twins is a rare congenital anomaly which is usually characterized by a malformed parasitic twin attached to a relatively healthy twin. Here we report a case of a 4-month-old male child which had external accessory limbs with rudimentary phallus attached to the left side of pelvis, a reducible inguinal hernia and undescended testes. On imaging we also found a retroperitoneal mass with intestinal elements. We thus performed a diagnostic laparoscopy where we found that the herniated bowel originated from the parasitic twin. Thus, in our case, laparoscopy helped us in planning definitive surgical management and also to locate undescended testes in the abdomen. We excised both the external and internal parasitic components and also performed orchidopexy and excision of anterior lumbosacral lipomyelomeningocele with dura closure. Postoperative follow up was uneventful, and is on regular follow-up. Based on our review, this appears to be the first reported case of ischiopagus twins with an internal parasitic intestinal component with rudimentary testes in autosite which is presenting as an inguinal hernia in the autosite, and also associated with anterior lipomyelomenigocele, accessory vertebra and ribs, and an undescended testis in the autosite. Our current study also highlights the diagnostic and therapeutic role of laparoscopy in such complex congenital anomalies and its importance in better surgical planning.
Anastomotic leak (AL) is a major complication in colorectal surgery, significantly contributing to perioperative morbidity and mortality. Among strategies to prevent AL, Indocyanine Green Fluorescence Angiography (ICG-FA) has emerged as a promising method for assessing bowel perfusion intraoperatively. This systematic review evaluates the impact of ICG-FA on AL rates and other postoperative outcomes following colorectal anastomoses. A systematic search was conducted in PubMed, PubMed Central, MEDLINE, and Google Scholar, following PRISMA guidelines. Eligible studies included randomized controlled trials (RCTs), prospective cohort studies, and retrospective cohort studies comparing ICG-FA to controls in adult patients undergoing colorectal resections and anastomoses. Data on AL rates, intraoperative characteristics, and postoperative outcomes were extracted. Quality assessment was performed using the Newcastle–Ottawa Scale and the Revised Cochrane Risk-of-Bias Tool. Sixteen studies (12 retrospective, 1 prospective, and 3 RCTs) involving 3231 patients (1562 ICG-FA and 1669 controls) were included. AL rates were significantly lower in the ICG-FA group (5.18
