Renal pedicle control in laparoscopic donor nephrectomy: Evaluation of a single-center experience.

Introduction and Study Purpose: Renal pedicle control is a crucial period in laparoscopic donor nephrectomy (LDN). Till now, there is no standardized technique for renal pedicle control. Proper evaluation and investigation of the different ways of renal vessel control have to be done to avoid any calamitous event. We aim to prove the safety and reliability of the Hem-o-Lok clips for the renal vascular control in transperitoneal LDN. Methods: All LDNs or hand-assisted LDNs done between January 2016 and December 2018 were collected. The primary outcome was the safety of the Hem-o-Lok clips. The secondary outcomes were blood loss, ischemia time, hospital stay, cost, and operative time. The data were analyzed using SPSS 20, and a statistical package was conducted. Results: The data showed that 238 laparoscopic donor nephrectomies were done. The renal pedicle control during the 1st year was done using a vascular stapler for the artery (63 cases) and two polymer self-locking clips extra-large (XL) for the vein. Two events were reported in the form of mechanical failure. In the following 2 years, the artery was controlled using polymer self-locking clips large (L) few millimeters distal to the aorta and two metallic clips distal to it to increase the safety and stability of the vascular stump (175 cases). However, the vein was controlled by the two polymer self-locking clips XL. There was no reported intraoperative complications or events related to this way of pedicle control; there was no open conversion or blood transfusion required. There was no postoperative complication or collection in ultrasound. Conclusion: Using a combined polymer self-locking clip few millimeters distal to the aorta and two metallic clips distal to it for renal artery control in laparoscopic donor nephrectomies is cost-effective and safe. However, further and broader evidenced base studies are still needed to establish a standard technique for renal pedicle control.

Renal cystic oncocytoma, malignant presentation for a benign disease.

Renal cysts can be identified using standard medical imaging and, a histological diagnosis is not required. However, lesions that are more complex require a detailed characterization to allow for determination of differential diagnosis and subsequent management approach. Oncocytoma is a benign epithelial tumor of the kidney, which usually presents as a solid tumor with a central stellate scar. But rarely, it can have central cystic degeneration or can present as a multilocular cyst. We are presenting a case of incidental renal complex renal cyst managed by laparascopic partial nephrectomy which came to be rare cystic presentation of this benign tumor.

Impact of type 1 diabetes mellitus on academic performance.

OBJECTIVE: To examine the effect of type 1 diabetes on academic performance. METHODS: Ethnically Saudi students with type 1 diabetes, and age, sex, ethnicity and socio-economic status-matched nondiabetic control students were recruited from eight schools. Overall academic grades were recorded, based on the scores obtained in written examinations in English, mathematics, physics, chemistry, biology and humanities. RESULTS: Students with type 1 diabetes (n = 36) obtained significantly lower academic grades compared with their nondiabetic control classmates (n = 36) (86.58 ± 1.48 vs 90.62 ± 1.36). CONCLUSIONS: Overall academic performance is significantly lower in students with type 1 diabetes compared with their nondiabetic classmates. This decline in academic performance may be explained by an association between diabetes and cognitive function.