Effect of Alprazolam as a Preoperative Adjuvant Analgesic on Postoperative Pain in Laparoscopic Donor Nephrectomy Patients.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of alprazolam, administered at different doses, for the control of adjuvant analgesia in laparoscopic donor nephrectomy patients preoperatively in the Akdeniz University Organ Transplantation Center, using various pain scales. MATERIALS AND METHODS: Only patients with a body mass index ≤28 kg/m2, aged between 18 and 65 years old, and with an American Society of Anesthesiologists score of 1 to 2 were included in the study. The patients were studied in 3 groups, which were given 0.5 mg alprazolam (group 1), 1 mg alprazolam (group 2), or no alprazolam (group 3) in the preoperative period. Collected data were evaluated for preoperative, intraoperative, and postoperative periods. RESULTS: There were 75 patients (31 men, 44 women). Mean age was 43.1 years. Twenty-five patients were evaluated in all 3 groups. Mean operation time was 137.8 minutes. There was no statistical difference among the groups in the duration of administered alprazolam before the operation, on the Ramsey sedation score, verbal pain score, or numeric pain score, and duration of administered first analgesic in the postoperative period. Additional dose of analgesics were administered in 7, 7, and 11 of the patients in group 1, group 2, and group 3, respectively. We found a significant difference between groups 1 and 2 in blood pressure (P = .017 and P = .014). We found a significant difference in group 1 in heart rate (P = .002). CONCLUSION: More effective analgesia protocols need to be identified for pain control in patients of laparoscopic donor nephrectomy. It is thought that the effectiveness of pain control may increase the number of donors and progress in the treatment of patients with renal failure.

In Vitro Fertilization After Renal Transplantation: A Single-Center Experience.

INTRODUCTION: Although kidney transplantation often increases the chances of fertility, the rate of infertile patients is still high. In vitro fertilization promises successful results for infertile renal transplantation patients. The purpose of this study was to analyze the experience of a single center. METHODS: Patients were invited to complete a survey for their obstetric history. Documentation review included demographic and clinical characteristics of patients, like procedure records, follow-up complications, immunosuppression maintenance protocols, and pregnancy outcomes. RESULTS: Thirteen patients were reached to complete the survey. The mean age of patients was 33 ± 4 years at in vitro fertilization (IVF). The median duration of infertility was 2 years. Twenty-four IVF sessions were applied to these 13 women with renal transplantation. The procedure failed in 13 of these sessions; and 8 women achieved 11 clinical pregnancies. There were 3 miscarriages and 2 stillbirths. Six women had live births with no neonatal deaths. One patient had a graft rejection after the IVF procedure. Serum creatinine level increased more than 30% in 3 patients after the IVF procedure, while 9 patients had a minimal or no change. DISCUSSION: In our study, we evaluated the records of 13 patients with renal transplantation who had IVF procedures. Fortunately, more than half of these patients had live births with no neonatal deaths. In our opinion, our findings show that IVF procedures can be accepted as a promising method in patients with renal transplantation and need a therapy for fertility. Moreover, a 25% live-birth rate per procedure is also a satisfactory result.

Cardiovascular and Neurologic Complications in Kidney Transplant Recipients: A Focused Appraisal of Symptoms.

BACKGROUND AND OBJECTIVE: After a kidney transplantation, all efforts are focused on graft function. However, cardiovascular and neurologic complications might lead to decreased quality of life and shortened life expectancy. Early recognition of related symptoms might be critical to successfully manage these complications. METHODS AND PATIENTS: We retrospectively reviewed the medical records of patients who had undergone kidney transplantation in a tertiary center between January 2014 and December 2017. Demographic data and past medical history were systematically gathered. Symptoms related to cardiac or neurologic disorders and final diagnoses were recorded. RESULTS: One hundred eighty-six patients were evaluated by a cardiologist or a neurologist in the early post-operative period or long-term follow-up. Chest pain (n = 17; 9.1%) and palpitations (n = 13; 7.0%) were the most prevalent symptoms. Coronary artery disease was diagnosed in 70.6% (n = 12) of the patients presenting with chest pain. All of the patients were treated successfully, with either antianginal drugs or percutaneous angioplasty. Atrial fibrillation was diagnosed in 53.9% (n = 7) of the patients presenting with palpitations. Headache was the most prevalent chronic neurologic symptom (n = 16; 8.6%). Transient ischemic attack occured in 7 patients (3.8%) and 5 (2.7%) patients experienced ischemic stroke. CONCLUSION: Kidney transplantation is associated with short- and long-term cardiac and neurologic complications. Our findings underscore the crucial role of questioning symptoms that might be related to severe disorders. Asymptomatic patients with high risk factors must also be under scope. Attending physicians should have a low threshold for referring these patients to cardiologists and neurologists.

Fertility Outcome After Renal Transplantation: A Single-Center Experience.

BACKGROUND: Women suffering from kidney disease are more prone to fertility problems, due to uremia. Fortunately, their fertility rate increases dramatically after renal transplantation. This study analyzes the predictors/risk factors of successful pregnancy with live birth outcome while presenting an overview of the 7-year experience of a single center. METHODS: This retrospective cohort study includes 239 women of reproductive age (18-40 years) who underwent renal transplantation in a tertiary Turkish clinic between October 1, 2011, and August 24, 2017. The subjects were invited to take part in a survey questioning their obstetric characteristics and they were assessed in 2 groups: fertile and infertile. Multivariable linear regression analysis was conducted to determine the predictors of a successful pregnancy. RESULTS: Thirty-five 35 patients wished to become pregnant: 12 got pregnant spontaneously, while 21 failed to become pregnant (spontaneously). The mean age of the patients at the survey was 34 ± 7. Regular menstrual cycles after renal transplantation, tacrolimus-mycophenolate mofetil maintenance protocol, and age at transplantation were found to be predictors of spontaneous pregnancy. The duration of peritoneal dialysis was significantly longer in the infertile group (48 vs 12 months). CONCLUSION: End-stage renal disease's negative impacts, including menstrual abnormality and fertility problems, can be overcome by successful kidney transplantation with appropriate immunosuppression. Minimizing the duration of peritoneal dialysis, particularly in patients who desire future fertility, may be accepted as a logical management strategy.

Cardiac and Neurologic Complications in the Late Period After Liver Transplantation: A Retrospective Analysis of 4 Years.

BACKGROUND AND OBJECTIVE: The aim of our study was to assess the cardiac and neurologic complications after liver transplantation in the late period. METHOD AND PATIENTS: Medical records of 198 patients who had liver transplantation in the organ transplantation center of our university hospital between between February 2014 and October 2017 were reviewed retrospectively. Patients who were consulted by a physician from either the cardiology or neurology departments during their long-term follow-up after liver transplantation were included in the study. RESULTS: Thirty patients (9 female; 30.0%) were evaluated by a cardiologist (n = 23; 76.7%) or a neurologist (n = 19; 63.3%) during their long-term-follow-up. The mean age was 55.0 ± 13.3. Atherosclerotic risk factors such as hypertension (n = 10; 33.3%), diabetes mellitus (n = 17; 56.7%), hyperlipidemia (n = 7; 23.3%), and coronary artery disease (n = 7; 23.3%) were highly prevalent. Chest pain (n = 5; 16.7%) was the most encountered symptom. Of these patients, 2 (6.7%) underwent coronary bypass surgery, whereas 1 (3.3%) patient was treated medically. Palpitation was the second most frequent cardiac symptom (n = 3; 10.0%). Atrial fibrillation paroxysm occurred in 2 patients. Headache (n = 4; 13.3%) was the most prevalent neurologic symptom. Transient ischemic attack occurred in 1 patient (3.3%), whereas 2 patients (6.7%) experienced stroke (1 ischemic and the other hemorrhagic). Seizures occurred in 2 patients (6.7%). CONCLUSION: Long-term follow-up of liver transplant recipients might be challenging due to the diversity of symptoms and wide spectrum of cardiac and neurologic complications. A multidisciplinary approach involving cardiologists and neurologists would help to improve early preventive measures and medical treatment strategies.

Quantitative assessment of the impacts of stoppa repair and total extraperitoneal repair on the lower extremity muscular functions in cases of unilateral inguinal hernia: a randomized controlled study.

PURPOSE: Choosing the best operative technique for unilateral inguinal hernia is a challenge for surgeons. Therefore, anticipating loss of strength in the lower extremity muscles could be the initial step to make the right decision. To this end, this prospective randomized controlled study compared the physical activity parameters of the lower extremity muscles in patients who underwent total extraperitoneal repair (TEP) and Stoppa repair. METHODS: Fifty patients with unilateral inguinal hernia who were 18-65 years of age were admitted to a single institution in a metropolitan city in Turkey. Patients were randomized in a 1:1 ratio to parallel study arms of TEP and STOPPA repair. They were evaluated in the preoperative period and on the postoperative day 3 for an objective isometric and isokinetic assessment of the pain-related functional changes in the lower extremity muscles. RESULTS: The measurement results obtained with the Cybex device on the postoperative day 3 were presented as numeric parameters in the digital setting, where the Stoppa repair resulted in a higher loss of strength in the lower extremities compared to the TEP repair. With respect to the total workforce loss in isokinetic muscular measurements at 90 °C/s extension, 90 °C/s flexion, 180 °C/s extension and 180 °C/s flexion, the difference between the TEP repair and Stoppa repair was statistically significant in favor of TEP repair (p < 0.05). CONCLUSION: This study is the first comparative study in the literature to demonstrate the favorable impact of the laparoscopic hernia repair on the physical activity on the same anatomic site compared to the open surgical procedure by using quantitative values. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT02813057.

Use of suicidal deaths as kidney donors: a single-center experience.

OBJECTIVE: Although the number of end-stage renal disease patients on the waiting list has increased, the number of deceased kidney donors has not increased proportionately. Therefore, the use of kidney donors defined as "marginal" has become an issue. Since the acceptance of deaths due to poisoning or suicide as donors has been proposed, we evaluated the clinical courses of kidney transplantations from suicidal death donors. PATIENTS AND METHODS: We analyzed retrospectively the outcomes of nine deceased donor kidneys (8 males) from suicide victims between 2001 and 2012. Demographic and clinical characteristics of donors and recipients were collected from medical files. RESULTS: The mean donor age was 27.8 ± 11.9 years. Causes of death were: gunshot wounds to the head (n:4), pesticide intoxication (n:2), methanol intoxication (n:1), hanging (n:1), or carotid artery laceration (n:1). Mean donor creatinine level, urine output per hour, and 24-hour urine volume were 0.94 ± 0.53 mg/dL, 270 ± 113 mL, and 5496 ± 832 mL, respectively. Mean cold ischemia time was 12.3 ± 5.7 hours. Primary allograft nonfunction occurred in one recipient requiring nephrectomy. The average posttransplantation creatinine level at 1 year was 1.19 ± 0.62 mg/dL. The mean follow-up was 55 ± 49 months. Allograft loss occurred due to chronic rejection in three patients at 10, 37, and 40 months. Five patients are still undergoing follow-up with functioning grafts. CONCLUSION: Brain death cases caused by the suicide should be considered for organ donation.

Effect of inter-breed embryo transfer on lamb growing performance and survival.

The roles of recipient and embryo genotype in determining the growth performance and survivability of offspring based on specific behavioural differences were investigated using inter-breed embryo transfer. This study was carried out using three recipient genotypes (Awassi, Redkaraman and Tuj) and two embryo genotypes (Charollais and Romanov) to obtain the six possible combinations of ewe and lamb genotypes. Data were collected from 71 recipient ewes (10 Redkaraman with Charollais and 15 Redkaraman with Romanov embryos; 10 Tuj with Charollais and 12 Tuj with Romanov embryos, and 12 Awassi with Charollais lambs and 12 Awassi with Romanov embryos); all ewes received two frozen-thawed embryos. Awassi ewes had a significantly longer duration of the licking/grooming event (25.5 min, p < 0.05) than Tuj ewes. Charollais lambs were significantly (p < 0.05) more likely to require birth assistance compared to Romanov lambs. Romanov lambs were significantly more (p < 0.01) active than Charollais lambs in the first 2 h after birth; ewe breed had no effect on lamb behaviour. There was no recipient breed effect on either birth or weaning weights of lambs. Charollais lambs were recorded with higher birth (5.5 ± 0.3 kg vs 3.9 ± 0.2 kg; p < 0.001) and weaning (29.4 ± 1.2 kg vs 22.4 ± 1.9 kg; p < 0.001) weights compared to Romanov lambs. At weaning Romanov lambs had significantly higher (95% vs 75%; p < 0.05) survival rates, however, this was not significantly affected by recipient breed. It was concluded that recipient breed was not an important factor in survival and weaning performance of embryo transferred lambs from a prolific breed (Romanov) while these traits recorded for lambs from meat type (Charollais) embryos were influenced by dam breed.

Paw preference in cats: distribution and sex differences.

Paw preference assessed by a food-reaching test was studied in male and female cats. Of the total sample (N = 66), 34 (51.5%) were right-preferent, 24 (36.4%) left-preferent, and 8 (12.1%) ambilateral. In the total sample, there was evidence for an overall paw preference, general paw preference, right-, and left-paw preference. The distribution of the right- minus left-paw reaches was neither normal, nor U or J shaped. Of the males (N = 24), 10 (41.7%) were right-pawed, 12 (50.5%) left-pawed, and 2 (8.3%) ambilateral. In males, there was evidence for an overall, general, and right-, left-paw preference relative to no preference. The right- minus left-paw reaches fitted to guassian data with two prominent peaks due to the right- and left-preferents. In females (N = 42), 22 (52.4%) were right-preferent, 14 (33.3%) left-preferent, and 6 (14.3%) ambilateral. There was an overall, general, and right-preference but not a left-preference relative to no preference. The distribution of the right- minus left-paw reaches was neither normal nor U or J shaped. The female right-preferents showed a right-bias compared to males. The left-preferent males were more left-preferent than the right-preferent males are right preferent. The mean right- minus left- paw reaches for the female right-preferents were significantly higher than those for the male right-preferents. There was no significant difference between the right- minus left-paw reaches of the male and female left-preferents. The paw preferences exhibited consistency over time; no learning tendencies were established during testing periods for at least 10 days. Considering the mean right-paw reaches for each successive day (N = 10), the mean right-paw uses in the right-preferents was higher in females than males. The mean left-paw uses in left-preferents was about the same for males and females. In males, the mean left-paw uses for the left-pawed males were higher than the right-paw reaches for the male right-preferents. In females, there was no difference between the right paw reaches of the right-preferents and the left-paw reaches of the left-preferents. It was concluded that there is a right-bias in paw preference of cats, which is caused by the female right-preferents under the influence of a biological factor.(ABSTRACT TRUNCATED AT 400 WORDS)