Red-cell alloimmunization

Morbidity and mortality due to Rhesus antibodies in pregnant women's serum have steadily declined because of various factors which include, implementation of routine antenatal anti-D prophylaxis and development of non-invasive investigations for monitoring Rhesus affected pregnancies. Because at present this condition is so rare, any case of red-cell alloimmunization should be managed in liaison with a specialist in foetal medicine. Unlike the first immunized pregnancy, maternal antibody titres are not predictive of foetal risk in any subsequent pregnancies. Serial peak middle cerebral artery velocities using Doppler can be used in these pregnancies to detect foetal anaemia. Foetal blood type can now be determined by new techniques to detect free foetal DNA in maternal plasma. In selected cases depending on the gestational age of foetus intrauterine transfusion is necessary through ultrasound directed puncture of the umbilical cord with the direct intravascular infusion of red blood cells. Perinatal survival rates of more than 90% have been reported.     

Acute pyelonephritis with renal vein and inferior vena cava thrombosis in a case of hyperhomocysteinemia

Acute pyelonephritis is not considered a common cause of renal vein (RVT) and inferior vena caval thrombosis (IVCT). Apart from malignancy, RVT is not an uncommon condition amongst patients with nephrotic syndrome, most commonly seen in patients with membranous glomerulonephritis. However, RVT occurring in association to acute pyelonephritis is rare. Clinically, it is difficult to distinguish between acute pyelonephritis and RVT because both present with fever, flank pain, and hematuria. We report a case of acute pyelonephritis with RVT and IVCT with underlying hyperhomocysteinemia. The patient was treated with systemic anticoagulation, antibiotics, and B complex therapy. At 3 months follow-up, there was complete resolution of thrombus but the left kidney was nonfunctioning.     

Simultaneous robotic-assisted adrenalectomy and partial nephrectomy: technical aspects

Robot-assisted partial nephrectomy has become a safe and feasible procedure for small renal masses (SRM). Similarly, robot-assisted adrenalectomy has also been well established. Robotic surgery has provided the possibility to manage complex cases that are considered technically challenging for traditional laparoscopy. We describe in this video the details of performing simultaneous robotic adrenalectomy with partial nephrectomy highlighting the technical aspects of the same. A 62-year-old gentleman presented to us with incidentally detected left renal complex cyst (Bosniak IIF) and a concomitant left adrenal mass. Hormonal evaluation of adrenal tumor revealed raised levels of serum estrogen and DHEAS. A robotic-assisted simultaneous procedure was planned. Patient was positioned in right lateral position. After port placement, robot was brought from the shoulder of the patient and docked. We first excised the adrenal tumor followed by the renal cyst. Total operative time was 180 min with warm ischemia time of 20 min for renal cyst excision. Drain was removed on post-operative day 2. Patient was discharged on post-operative day 3. Histopathology revealed adrenocortical adenoma and benign hemorrhagic renal cyst. We found simultaneous ipsilateral adrenalectomy with partial nephrectomy using robotic assistance is feasible and safe with minimal morbidity. Port placement in such cases should be individualized according to the location of the SRM. The robot provides the ergonomic advantage and 3D vision for better anatomic definition as compared to laparoscopy.