Initial experience with laparoscopic donor nephrectomies

BACKGROUND: Laparoscopic donor nephrectomy (LDN) is being adopted rapidly by transplant centres around the world as it offers less postoperative pain, quicker convalescence, and better cosmetic result when compared with the open approach. There may, however, be a steep learning curve with this technique. METHOD: A retrospective review was performed to evaluate the donor morbidity and graft outcome of 21 consecutive LDN performed at one centre between May 2002 and August 2003. RESULTS: Eighteen LDN were performed on the left and three on the right side. All left and one right LDN were done transperitoneally while the remaining two right side kidneys were removed by a retroperitoneal approach. The mean (+/-SD) operating time and warm ischemic time were, respectively, 236 minutes (+/- 46) and 4 minutes (+/- 1). The mean time for resuming oral intake was 23 hours (SD +/- 22.7). The median length of hospital stay was 5 days (range 3 to 18). One patient was reoperated for bleeding and required four units of packed cell transfusion. One recipient displayed delayed graft function requiring dialysis for 14 days. There were no graft losses. The mean creatinine of the recipients at the time of discharge was 1.15 mg/dL (+/- 0.21). CONCLUSIONS: There is undoubtedly a learning curve with LDN. Nevertheless, with prior skills in similar procedures such as laparoscopic radical nephrectomies, it is feasible to diminish the learning curve and morbidity of LDN to yield results consistent with those in the published literature.     

Experimental and Theoretical Investigations of Three-Ring Ester/Azomethine Materials

New three-ring ester/azomethine homologues series, (E)-4-((4-hydroxybenzylidene)amino)phenyl 4-(alkoxy)benzoate In, were prepared and their properties were investigated experimentally and theoretically. FT-IR, NMR, and elemental analyses were used to confirm the chemical structures of the synthesized compounds. The mesomorphic activities of the planned homologues were evaluated using differential scanning calorimetry (DSC) and polarized optical microscopy. All of the homologous examined were found to have non-mesomorphic properties. Theoretical calculations using the density functional theory (DFT) were used to validate the experimental data and determine the most stable conformation of the synthesized compounds. All calculated conformers’ thermal properties, dipole moments, and polarizability were discussed. The results show that the terminal alkoxy chain length affects the thermal parameters of the conformers. The correlations between these parameters’ values and the conformer type were demonstrated. The base component was expected to be in two conformers according to the orientation of the N atom of imine-linkage. DFT calculations revealed the more probable of the two possible conformers, and the incorporation of the alkoxy terminal chain in one position affect its geometrical and mesomerphic characteristics.     

Advanced liver fibrosis and care continuum in emergency department patients with chronic hepatitis C

Background

FIB-4, a non-invasive serum fibrosis index (which includes age, ALT, AST, and platelet count), is frequently available during ED visits. Our objective was to define 1-year HCV-related care outcomes of ED patients with known HCV, for the overall group, and both those with and without advanced fibrosis.

School performance of Nigerian adolescents with epilepsy

PURPOSE: The study assessed the school performance of Nigerian adolescents with epilepsy compared with healthy controls and examined the variables correlating with their academic difficulties. METHODS: The school grades of adolescents with epilepsy aged 12 to 18 years (n = 73) over the past academic year were compared with the grades of their classmates of the same age and gender. Risk factors possibly associated with school performance, such as adolescent variables (age, gender, perceived stigma, attitude toward epilepsy, and psychopathology), seizure variables (age at onset of illness, years of illness, types of seizures, and frequency of seizures per month), drug variables [types of antiepileptic drugs (AEDs), number of AEDs and side effects of AEDs], and family variables (family's socioeconomic status, family functioning, caretakers' psychopathology, and caretakers' perceived stigma) were assessed. RESULTS: The mean school grades of adolescents with epilepsy are significantly lower than are those of their healthy controls (p < 0.001) in all the subjects. The variables that significantly predict poor school performance in adolescents with epilepsy include psychopathology in the caretaker (p < 0.001), adolescents' perceived poor family functioning (p = 0.002), adolescents' attitude toward the illness (p = 0.001), adolescents' felt stigma (p = 0.002), externalizing symptoms in the adolescents (p = 0.004), and duration of illness (p = 0.024). CONCLUSIONS: The determinants of poor school performance in adolescents with epilepsy in Nigeria are multivariate, with psychosocial factors most important. These should be noted for early identification and screening of those children at greatest risk for academic failure and the greatest need for appropriate educational remediation services.     

Bilateral nephron sparing surgeries for multiple renal angiomyolipomas in Bourneville’s disease

Introduction Angiomyolipomas are the most common renal lesions in tuberous sclerosis complex. When symptomatic, the treatment includes nephron sparing surgery. This is especially challenging when the lesions are bilateral, large and multiple. Case-History A 22-year-old lady with bilateral multiple large symptomatic renal angiomyolipomas associated with other manifestations of tuberous sclerosis was managed with partial nephrectomies on either side. At 30 months of follow-up, the patient has normal renal functions and no evidence of recurrence. Discussion Intervention for renal angiomyolipomas is indicated in symptomatic tumors larger than four centimetres. Selective arterial embolisation is the therapeutic modality of choice in such cases. However, in bilateral cases when angioembolisation may not always be feasible, nephron sparing surgery maybe considered. Nephron sparing surgery of both kidneys for angiomyolipomas in association with tuberous sclerosis has only been sparingly reported in literature.