Introduction Recurrent HCV infection after transplantation is aggressive, and progression to cirrhosis is more rapid than in non-transplant settings. As pegylated interferon (Peg-IFN) based therapies for HCV treatment after transplantation have poor tolerance, poor efficacy, and significant interactions with immunosuppression medications, this developed the need for a new safe and effective oral regimen. Aim To evaluate the efficacy, safety and tolerability of sofosbuvir (SOF) in combination with ribavirin (RBV) in treating recurrent hepatitis C after transplantation and also to detect any significant interaction with immunosuppressive therapy Patients and methods Between August 2014 and January 2016, a single center, prospective, non-randomized, open labeled study was conducted, in which the patients with post-transplant recurrent HCV infection were enrolled. All patients received 400 mg once-daily SOF for 24 weeks with variable dose of RBV. After treatment, patients underwent follow up for 12 weeks. Results Sixty patients were enrolled, mean age was 57.67 years with 78.3% were male. 70% had genotype 1 and 61.7% received previous HCV treatment. At baseline, 21 patients had severe fibrosis. Median time interval from LT was 51 months, immunosuppressive therapy was tacrolimus based in 78.3%. Median baseline HCV-RNA was 2.341.172 IU/ml. 12-week SVR was achieved in 43 patients (71.7%). There was no significant difference in dose and level of tacrolimus during course of therapy. Absence of HE, treatment-naive patients, non-severe fibrosis and low pre-therapy LS values were predictors for SVR. Conclusion IFN free regimen containing SOF and RBV is generally safe, well tolerated and reasonably effective in post-transplantation settings

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Management of recurrent radial deviation after centralization for radial longitudinal deficiency patients usually involves some form of wrist fusion. We report on a child with recurrence after centralization, where correction and successful maintenance of a good functional and cosmetic position were obtained by vascularized second metatarsophalangeal joint transfer.

Background: This study aimed to delineate and compare the hot spots and three-dimensional vascular territories of dominant profunda artery perforators in the posterior thigh region, and modifications in flap design are discussed. Methods: Twenty-nine posterior thigh flaps were raised in fresh cadaveric specimens, and profunda artery perforators were documented. Dominant perforators were injected with iodinated contrast to assess perforasomes using computed tomographic angiography. Analysis with three-dimensional rendering and volume calculations of perfusion patterns was performed. Results: In total, 316 perforators were mapped and 33 perforators were injected for analysis. The hot spot for dominant perforators was the proximal medial quadrant, 5 to 10 cm from the inferior gluteal crease, with two smaller hot spots in the upper lateral and distal posterior midline. Although 69 percent were musculocutaneous, distal perforators were predominantly septocutaneous in the posterior midline, 5 to 8 cm from the popliteal crease. Proximal perforators were classified into first (most proximal) and second perforators, and their median perforasome was 233 and 286.4 cm2, respectively (p = 0.86). There were no significant differences between proximal and distal perforators in perforasome surface areas, percentage areas perfused, and perforasome volumes. Large linking vessel networks were attributed to a broader perforasome and greater overlap between adjacent or distal perforators. Conclusions: Dominant linking vessels and recurrent flow through the subdermal plexus contribute to the robust vascular supply of profunda artery perforator flaps. Posterior thigh region perforator hot spots and their perfusion characteristics can inform the potential limits, orientation, and modifications of flap or skin paddle designs.

Purpose To study the intraosseous 3-dimensional microvasculature of the capitate bone using a novel high-resolution micro-computed tomography (μCT) imaging technology, and to examine the blood supply as it relates to the most common fracture types. Methods Ten cadaveric wrists were injected with a lead-based contrast agent. The capitates were harvested and imaged using a μCT scanner. The intraosseous vascularity was incorporated into a 3-dimensional image. We measured the vascular pattern as well as the vessels’ cross-sectional area, number, and distribution. An average capitate fracture line was calculated using clinical data from 22 patients with capitate fractures. The fracture line was projected on the representative capitate to assess its relation with the nutrient vessels’ entry points. Results The capitate is a well-vascularized carpal supplied by dorsal and volar vascular systems that anastomose in 30% of cases. There was no predominance of one vascular system over the other. Most vessels enter the capitate at the distal half and supply the proximal pole in a retrograde fashion. In addition, most specimens (70%) also had at least one vessel entering the proximal pole through the volar capitate ligaments and supplying the proximal pole directly. The average fracture line had an oblique orientation, and 90% of the specimens had a blood vessel entering proximal to that line. Conclusions This μCT vascular study further verifies that the capitate receives most of its vasculature in a retrograde fashion, but the study also shows that most capitates have vessels supplying the proximal pole directly. These findings might explain why most capitate waist fractures do not progress to proximal pole avascular necrosis. Clinical relevance This study characterizes the microvasculature of the capitate and might shed light on processes involved in bone healing and the etiology of capitate avascular necrosis.

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Objective: Presentation of a case of isolated renal hydatid cyst with novel findings and unusual surgical scenario. Clinical Presentation and Intervention: A 54-year-old female patient presented with left loin pain and a palpable left renal mass. Imaging described a welldemarcated left renal cystic lesion with a two-layer wall. Radical nephrectomy was done due to the possibility of malignancy. On retrograde revision, the two-layer wall represented the detached germinative membrane of a hydatid cyst that was confirmed by histopathology. Conclusion: Isolated renal hydatid cyst could be misinterpreted as a renal tumor. It should be considered in the differential diagnosis of renal cystic lesions.

Objective: Presentation of a case of isolated renal hydatid cyst with novel findings and unusual surgical scenario. Clinical Presentation and Intervention: A 54-year-old female patient presented with left loin pain and a palpable left renal mass. Imaging described a welldemarcated left renal cystic lesion with a two-layer wall. Radical nephrectomy was done due to the possibility of malignancy. On retrograde revision, the two-layer wall represented the detached germinative membrane of a hydatid cyst that was confirmed by histopathology. Conclusion: Isolated renal hydatid cyst could be misinterpreted as a renal tumor. It should be considered in the differential diagnosis of renal cystic lesions.

Objective: Presentation of a case of isolated renal hydatid cyst with novel findings and unusual surgical scenario. Clinical Presentation and Intervention: A 54-year-old female patient presented with left loin pain and a palpable left renal mass. Imaging described a welldemarcated left renal cystic lesion with a two-layer wall. Radical nephrectomy was done due to the possibility of malignancy. On retrograde revision, the two-layer wall represented the detached germinative membrane of a hydatid cyst that was confirmed by histopathology. Conclusion: Isolated renal hydatid cyst could be misinterpreted as a renal tumor. It should be considered in the differential diagnosis of renal cystic lesions.