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Background: Coronavirus (COVID19) appears to be an inflection point that is forcing a disruption in medical education. Objective: The study aims to explore how medical schools in Egypt responded to COVID-19 pandemic regarding teaching and learning/assessment for undergraduate students. Design: A mixed method exploratory 2-phase study was conducted. Data was collected through a questionnaire and focus groups. Results: The responses of the participants were categorized according to main themes; University preparedness, Role of faculty in the transition, Role of ME units/Departments/National/Regional bodies in the transition, Role of Egyptian Knowledge Bank, New teaching methods/strategies, New assessment methods/strategies and Projection into the future. The staff level of preparedness for that unexpected shift was evaluated as optimum to high and a good leadership support was reported by 70% of them. They reported conflicting views about the proper role of medical education units but reinforced the idea of Egyptian Knowledge Bank’s crucial role in this transition. Additionally, 64.1% of the participants identified a clinical skills teaching challenge and 76.3% of them reported absence of alternative methods for summative assessment. Finally, there is a communication problem with the students that leads to their detachment. Conclusions: Individuals moved faster than bodies and relied on support existing outside the universities when catastrophe happened. Many recommendations emerged including the need to integrate online learning into the curriculum at favorable percentages.

Background Ultrasound (US) monitoring of arteriovenous fistulas (AVFs) presents contradictory findings. These differences may be attributed to variances in the chosen surveillance strategy, the specific type of fistula being monitored, and the precise technique used for ultrasound scanning. In this study, we are trying to assess the benefits and cost-effectiveness of US scanning of AVF. Patients and methods This was a descriptive, retrospective, and observational study. The study sample consisted of patients diagnosed with end-stage renal disease (ESRD) on hemodialysis who had AVF for dialysis either by native vein or using prosthetic grafts. We excluded all the patients whose fistula failed to mature, failed to attend the surveillance scan at six weeks, or had absent records or incomplete data. We retrieved the data of the patients who underwent AVF creation at Glan Clwyd Hospital between April 2020 and April 2023. The data was analysed using statistical software (SPSS) version 21 (IBM Corp., Armonk, NY, USA). Results Ninety-eight patients were studied. Stenosis 43.9% (n = 43) was the predominant complication, followed by thrombosis (15.3%; n = 15) while the remaining complications (bleeding, pseudoaneurysm) were less prominent. On the other hand, a total of 37.8% (n = 37) did not experience any complications. Primary patency ranged from 2 to 87 months with a mean of 9 ± 13.2 months SD, and secondary patency ranged from 1 to 24 months with a mean of 1.3 ± 3.9 months SD. The mean cost of a surveillance scan for AVF is 2520 USD, and the mean cost of intervention is 1332 + 1258 USD SD. Out of all the patients, 52 (53%) underwent intervention to salvage the AVF, 2 (2%) received open surgical intervention, and 50 (51%) underwent endovascular intervention. Considering the AVF failure to work, 29.6% (n = 29) had fistulas that failed to work, and 70.4% (n = 69) were still working. Conclusion Routine duplex scanning in six-month periods to diagnose failing AV fistulas is not cost-effective when compared to diagnosing failing or failed AV fistulas based on clinical symptoms., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Elshikhawoda et al.)

Variations in the size and texture of melanoma make the classification procedure more complex in a computer-aided diagnostic (CAD) system. The research proposes an innovative hybrid deep learning-based layer-fusion and neutrosophic-set technique for identifying skin lesions. The off-the-shelf networks are examined to categorize eight types of skin lesions using transfer learning on International Skin Imaging Collaboration (ISIC) 2019 skin lesion datasets. The top two networks, which are GoogleNet and DarkNet, achieved an accuracy of 77.41 and 82.42%, respectively. The proposed method works in two successive stages: first, boosting the classification accuracy of the trained networks individually. A suggested feature fusion methodology is applied to enrich the extracted features' descriptive power, which promotes the accuracy to 79.2 and 84.5%, respectively. The second stage explores how to combine these networks for further improvement. The error-correcting output codes (ECOC) paradigm is utilized for constructing a set of well-trained true and false support vector machine (SVM) classifiers via fused DarkNet and GoogleNet feature maps, respectively. The ECOC's coding matrices are designed to train each true classifier and its opponent in a one-versus-other fashion. Consequently, contradictions between true and false classifiers in terms of their classification scores create an ambiguity zone quantified by the indeterminacy set. Recent neutrosophic techniques resolve this ambiguity to tilt the balance toward the correct skin cancer class. As a result, the classification score is increased to 85.74%, outperforming the recent proposals by an obvious step. The trained models alongside the implementation of the proposed single-valued neutrosophic sets (SVNSs) will be publicly available for aiding relevant research fields., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Abdelhafeez, Mohamed, Maher and Khalil.)

This analysis aims to evaluate the comparative outcomes of gallbladder extraction with a bag versus direct extraction in laparoscopic cholecystectomy (LC). A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov, and Science Direct. Comparative studies comparing bag versus direct extraction of the gallbladder in LC were included. Outcomes were surgical site infection (SSI), the extension of fascial defect to extract the gallbladder, intra-abdominal collection, bile spillage, and port-site hernia. Revman 5.4 (Cochrane, London, United Kingdom) was used for the data analysis. The results show eight studies were eligible to be included in this review with a total number of 1805 patients divided between endo-bag (n=835) and direct extraction (n=970). Four of the included studies were randomized controlled trials (RCTs) while the rest were observational studies. The rate of SSI and bile spillage were significantly higher in the direct extraction group: odds ratio (OR)=2.50, p=0.006 and OR=2.83, p=0.01, respectively. Comparable results were observed regarding intra-abdominal collection between the two groups(OR=0.01, p=0.51). However, the extension of a fascial defect was higher in the endo-bag group (OR=0.22, p=0.00001), and no difference was observed regarding the port-site hernia rate (OR-0.70, p=0.55). In conclusion, extraction of the gallbladder with an endo-bag provides a lower rate of SSI and bile spillage with similar results regarding post-operative intra-abdominal collection. Although with the endo-bag, the fascial defect will more likely need to be increased to extract the gallbladder. However, the port-site hernia rate remains similar between the two groups., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mohamed et al.)

Premature ovarian failure (POF) is described as a loss of oocytes and the absence of folliculogenesis and is considered an adverse effect of chemotherapeutic drugs, which leads to infertility. Subsequently, the existing inquiry was achieved by exploring the potential suspicious influences of lemon peel extract (LPE), and resveratrol (RES) on cyclophosphamide (CPA) induced-POF. The results showed that CPA-induced POF significantly decreased serum estradiol (E2) and progesterone levels, along with a considerable rise in serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. Moreover, CPA administration to rats significantly increased the serum level of Malondialdehyde (MDA) and significantly lowered the levels of reduced glutathione (GSH) and superoxide dismutase (SOD); in addition, it increased nuclear factor kappa B (NF-κB) levels, tumor necrosis factor-α (TNF-α), as well as cyclooxygenase 2 (COX-2) with the spread expression of inducible nitric oxide synthase (iNOS) mRNA levels and caspase-3 (Casp3) levels in ovarian tissues versus the control rats. However, treatment with LPE and RES suppressed the triggering of NF- κB pathways, evidenced by a considerable reduction in Casp3 & iNOS mRNA expression level and significant ameliorative effects in all evaluated parameters, as confirmed by the histological and immunohistochemical investigation when comparing the model group. In overall findings, both lemon peel extract and resveratrol can mitigate the adverse effects of CPA-induced POF. Most crucially, its combination therapy is a promising pharmacological agent for this disease.

This meta-analysis aims to evaluate the comparative outcomes of drain insertion versus no drain after appendicectomy for complicated appendicitis. A systematic search of PubMed, Cochrane Library and Scopus was conducted, and all studies comparing drain versus no drain after appendicectomy for complicated appendicitis were included. Abdominal collection, surgical site infection (SSI), bowel obstruction, faecal fistula, paralytic ileus, length of hospital stay (LOS) and mortality were the evaluated outcome parameters for the meta-analysis. Seventeen studies reporting a total number of 4,255 patients who underwent appendicectomy for complicated appendicitis with (n=1,580) or without (n=2,657) drain were included. There was no significant difference between the two groups regarding abdominal collection (odds ratio (OR)=1.41, P=0.13). No-drain group was superior to the drain group regarding SSI (OR=1.93, P=0.0001), faecal fistula (OR=4.76, P=0.03), intestinal obstruction (OR=2.40, P=0.04) and paralytic ileus (OR=2.07, P=0.01). There was a difference regarding mortality rate between the two groups (3.4% in the drain group vs 0.5% in the no-drain group, risk difference (RD)=0.01, 95% CI (-0.01, 0.04), P=0.36). In conclusion, this meta-analysis has shown that drains have no effect on the development of intra-abdominal collections in complicated appendicitis, but it can significantly increase the risk of postoperative complications such as fistula, surgical site infection (SSI), bowel obstruction, ileus and length of hospital stay., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Abu et al.)

The rapid development of technology has brought about a revolution in healthcare stimulating a wide range of smart and autonomous applications in homes, clinics, surgeries and hospitals. Smart healthcare opens the opportunity for a qualitative advance in the relations between healthcare providers and end-users for the provision of healthcare such as enabling doctors to diagnose remotely while optimizing the accuracy of the diagnosis and maximizing the benefits of treatment by enabling close patient monitoring. This paper presents a comprehensive review of non-invasive vital data acquisition and the Internet of Things in healthcare informatics and thus reports the challenges in healthcare informatics and suggests future work that would lead to solutions to address the open challenges in IoT and non-invasive vital data acquisition. In particular, the conducted review has revealed that there has been a daunting challenge in the development of multi-frequency vital IoT systems, and addressing this issue will help enable the vital IoT node to be reachable by the broker in multiple area ranges. Furthermore, the utilization of multi-camera systems has proven its high potential to increase the accuracy of vital data acquisition, but the implementation of such systems has not been fully developed with unfilled gaps to be bridged. Moreover, the application of deep learning to the real-time analysis of vital data on the node/edge side will enable optimal, instant offline decision making. Finally, the synergistic integration of reliable power management and energy harvesting systems into non-invasive data acquisition has been omitted so far, and the successful implementation of such systems will lead to a smart, robust, sustainable and self-powered healthcare system.

Breast cancer is a gigantic burden on humanity, causing the loss of enormous numbers of lives and amounts of money. It is the world's leading type of cancer among women and a leading cause of mortality and morbidity. The histopathological examination of breast tissue biopsies is the gold standard for diagnosis. In this paper, a computer-aided diagnosis (CAD) system based on deep learning is developed to ease the pathologist's mission. For this target, five pre-trained convolutional neural network (CNN) models are analyzed and tested-Xception, DenseNet201, InceptionResNetV2, VGG19, and ResNet152-with the help of data augmentation techniques, and a new approach is introduced for transfer learning. These models are trained and tested with histopathological images obtained from the BreakHis dataset. Multiple experiments are performed to analyze the performance of these models through carrying out magnification-dependent and magnification-independent binary and eight-class classifications. The Xception model has shown promising performance through achieving the highest classification accuracies for all the experiments. It has achieved a range of classification accuracies from 93.32% to 98.99% for magnification-independent experiments and from 90.22% to 100% for magnification-dependent experiments.

In recent years, we have witnessed the fast growth of deep learning, which involves deep neural networks, and the development of the computing capability of computer devices following the advance of graphics processing units (GPUs). Deep learning can prototypically and successfully categorize histopathological images, which involves imaging classification. Various research teams apply deep learning to medical diagnoses, especially cancer diseases. Convolutional neural networks (CNNs) detect the conventional visual features of disease diagnoses, e.g., lung, skin, brain, prostate, and breast cancer. A CNN has a procedure for perfectly investigating medicinal science images. This study assesses the main deep learning concepts relevant to medicinal image investigation and surveys several charities in the field. In addition, it covers the main categories of imaging procedures in medication. The survey comprises the usage of deep learning for object detection, classification, and human cancer categorization. In addition, the most popular cancer types have also been introduced. This article discusses the Vision-Based Deep Learning System among the dissimilar sorts of data mining techniques and networks. It then introduces the most extensively used DL network category, which is convolutional neural networks (CNNs) and investigates how CNN architectures have evolved. Starting with Alex Net and progressing with the Google and VGG networks, finally, a discussion of the revealed challenges and trends for upcoming research is held., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ibrahim, Mohamed, Maher and Zhang.)

Nephrotoxicity is one of the limiting factors for using doxorubicin (DOX). Honey, propolis, and royal jelly were evaluated for their ability to protect against nephrotoxicity caused by DOX. Forty-two adult albino rats were divided into control groups. The DOX group was injected i.p. with a weekly dose of 3 mg/kg of DOX for six weeks. The DOX plus honey treated group was injected with DOX and on the next day, received 500 mg/kg/day of honey orally for 21 days. The DOX plus royal jelly treated group was injected with DOX and on the following day, received 100 mg/kg/day of royal jelly orally for 21 days. The DOX plus propolis treated group received DOX and on the following day, was treated orally with 50 mg/kg/day of propolis for 21 days. The DOX plus combined treatment group received DOX and on the following day, was treated with a mix of honey, royal jelly, and propolis orally for 21 days. Results confirmed that DOX raised creatinine, urea, MDA, and TNF-α while decreasing GPX and SOD. Damages and elevated caspase-3 expression were discovered during renal tissue's histopathological and immunohistochemical studies. Combined treatment with honey, royal jelly, and propolis improved biochemical, histological, and immunohistochemical studies in the renal tissue. qRT-PCR revealed increased expression of poly (ADP-Ribose) polymerase-1 (PARP-1) and a decline of Bcl-2 in the DOX group. However, combined treatment induced a significant decrease in the PARP-1 gene and increased Bcl-2 expression levels. In addition, the combined treatment led to significant improvement in the expression of both PARP-1 and Bcl-2 genes. In conclusion, the combined treatment effectively inhibited nephrotoxicity induced by DOX.

Cisplatin (Cis) a drug commonly used as a chemotherapeutic agent to treat various types of cancer, inducing testicular damage. The present study aimed to investigate the inhibitory potential of bone marrow-derived mesenchymal stem cells (BM-MSCs) and beetroot extract (BRE) in albino rats after testicular toxicity induced by cisplatin. Thirty adult male albino rats were grouped into: the control group, Cis group receiving a single dose of 7 mg/kg i.p. (intraperitoneal) to induce testicular toxicity, Cis plus BM-MSCs injected Cis followed by 2 × 10 6 of BM-MSCs; Cis plus BRE group receiving Cis followed by 300 mg/kg body weight/day of BRE, and Cis plus BM-MSCs and BRE group. In the current study, Cis reduced sperm count, serum testosterone level, and testicular activity of alkaline phosphatase (AKP), besides a marked inhibition of succinate dehydrogenase (SDH) activity. In addition, it significantly increased malondialdehyde (MDA) and along with a marked decrease in testis reduced glutathione content and total antioxidant capacity (TAC). At the same time, Cis administration resulted in a marked elevation in interleukine-6 and the iNOS and caspase-3 genes; however, it decreased the expression of steroidogenic acute regulatory protein (StAR). Combined treatment with BM-MSCs and BRE resulted in great improvement of all previous parameters. These results were also confirmed by histopathological and immunohistochemical examination. In conclusion, both MSCs and BRE were found to have potent potentials to inhibit testicular damage induced by cisplatin.

Epilepsy is one of the most common neurological disorders, its prevalence approximately from 0.5% to 2% of the general population. Generalized seizures could lead to several morphological changes in the brain. This study aimed to investigate the morphological effects of a single convulsive dose of pentylenetetrazol (PTZ) on rat dentate gyrus at different postnatal ages. Thirty-six male Wistar rats were used at the following postnatal ages: P10, P21, and P90 (12 rats per each age). The animals in each age were equally divided into two groups: group I, control and group II, treated with a single intraperitoneal injection of PTZ (55 mg/kg). After confirmation of generalized tonic-clonic seizures, specimens from the right dentate gyrus were processed for light and electron microscopy. In PTZ-treated groups, the number of granule cells significantly decreased. Dark granule cells appeared in the deep layers of the granule cells in P10 and with the progress of age, they significantly increased in number and extended into the superficial layers of the granule cells. The dendritic spines diminished. Glial fibrillary acidic protein and caspase-3 expression increased. Ultrastructurally, granule cells showed irregular shaped nucleus, dilated rough endoplasmic reticulum (RER) cisternae, mitochondria with damaged cristae, large vacuoles, lysosomes, and lipofuscin granules. Dark granule cells characterized by electron-dense nucleus and cytoplasm containing disorganized Golgi bodies, swollen mitochondria with damaged cristae, numerous free ribosomes and few long strands of RER. Astrocytes had hypertrophied cell body. Acute treatment with PTZ-induced epileptic seizures caused toxic effect on the structure of rat dentate gyrus at different postnatal ages., Competing Interests: Conflicts of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2020. Anatomy & Cell Biology.)

Awareness around glycemic control was very low among women in Sudan who were pregnant and had diabetes.

Background: Despite the global efforts to control schistosomiasis, still prevalence in endemic regions unchanged. The present study was conducted to investigate the possible role of artesunate (AS) and praziquantel (PZQ) combination in enhancing cure in pre-patent and patent Schistosoma mansoni infection, and study the role of apoptosis in evaluation of the drugs efficacy., Methods: Eighty laboratory-bred Swiss albino male mice were classified into four groups (20 mice each); control, PZQ treated (500 mg/kg), AS treated (400 mg/kg) and combined AS (400 mg/kg) + PZQ (500 mg/g) groups. Efficacy of the drugs was assessed by parasitological (egg count/gram stool, worm burden, tissue egg load, oogram pattern), histopathological (haematoxylin and eosin -for detection of type of hepatic granulomas, number & diameter) and immunohistochemical studies (P53 and Bcl-2 markers for determination of inflammatory cells and the degree of apoptosis)., Results: Significant reduction was recorded in stool egg count, tissue egg count (liver and intestine), worm burden, granuloma number and size and changed oogram patterns in artesunate -praziquantel combined group followed by artesunate monotherapy group. There was a significant increase in the apoptotic proteins P53 and slight increase in anti-apoptotic proteins Bcl-2 in the infected group compared to the control healthy group. A significant decrease and increase in P53 & Bcl-2 expressions respectively were observed in artesunate - praziquantel combined group compared to control infected group., Conclusion: artesunate-praziquantel combination is a potential upcoming chemotherapy for schistosomiasis mansoni . Both Bcl-2 and P53 are good markers assessing S. mansoni apoptosis, morbidity and chemotherapy efficacy., Competing Interests: Conflicts of Interest Authors declare that there is no conflict of interests.

To our knowledge, this is the first study which investigates the induction of neuroinflammation in rats using an acidic-saline model of fibromyalgia. It is well known that the hippocampus has a fundamental role in pain perception, and astrocytes play a crucial role in pain signaling. Our aim is to evaluate the ability of dexmedetomidine to attenuate the inflammatory responses induced in astrocytes. In a group of healthy rats, induction of chronic muscle pain by intramuscular injection of 100 µL of acidic saline on days 0 and 5 resulted in peripheral sensitization (measured using the von Frey test) and significant (p < 0.05) increases in IL-1β (160.2 ± 1.1 to 335.2 ± 1.8), IL-6 (100.1 ± 1.4 to 202.4 ± 1.1), and TNF-α (60.0 ± 0.7 to 115.5 ± 1). Light and electron microscopy revealed degenerative changes in the hippocampus and reactive astrogliosis. Immunohistochemistry showed increased expression of glial fibrillary acid protein and inducible nitric oxide synthase. Surprisingly, treatment with a single dose of an α2-adrenergic agonist, dexmedetomidine (5 µg/kg i.p.), attenuated these changes. This trial suggests that dexmedetomidine possibly directly acts on astrocytes, and a peripheral action is also suggested., (© 2018 S. Karger AG, Basel.)

Aluminum sulphate has a significant toxic effects for humans. Aluminum is one of the most abundant metal on the Earth crust. The purpose of this study is to evaluate the effects of short term exposure to aluminum sulphate on the bone development of the fetuses in rats, and if folic acid has a protective role upon that effects or not. Forty female rats were used, ten per group, GI served as negative control (receive nothing except normal feeding and water), GII served as positive control (receive water by gastric gavage), GIII treated with aluminum sulphate orally by gastric gavage and GIV treated with aluminum sulphate with folic acid. Mating occurred and known by presence of vaginal plug in the female rats. Rats were killed on day 18 of gestation., Results: The female rats weight were significantly reduced in the treated group if compared with the control group (p>0.001), all parameters of the fetuses, fetal weight, malformation and the crown rump length reduced significantly p value were <0.000, <0.001, and <0.000 respectively. In histopathological results the aluminum treated group showed severe limited area of preossfication in fetuses vertebrae. Folic acid gave a protective role for all the hazardous effects of aluminum sulphate and prove the diameters measured and also the histopathological effects., Conclusion: Aluminum sulphate can produce hazardous effects on bone of the fetuses, which may affect the life style of these fetuses later on. Folic acid might give a protective role and so should be given to females who tried to conceive., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Lymphangiomas are congenital lesions of the lymphatic system which are most commonly found in the head and neck, with over 90 % of lesions manifesting in children who are less than 2 years of age. Haemolymphangiomas are rare variant of lymphangioma, with the presence of red blood cells within the lymphatic channels. Laryngeal sites are usually in continuity with foci of disease in the neck. In general, symptoms are non-specific and they vary with the site and size of the mass. Usually, they occur before 2 years of age. Isolated cases of lymphangiomas with involvement of epiglottis are rare and only a few cases have been reported so far. We are reporting the case of a six-year-old girl who presented with a mass in the epiglottis.

Duodenal lipomas are relatively uncommon and are rarely a source of severe upper gastrointestinal haemorrhage. We report the case of a 70-year-old woman who presented with significant upper GI bleed due to a large bleeding duodenal lipoma that was successfully treated by endoscopic polypectomy.

We report a case of combined colon cancer and Clostridium septicum aortitis involving the suprarenal abdominal aorta with rupture. An 82-year-old male presented with fever, abdominal pain, and back pain associated with constipation. He was successfully treated by in situ aortic graft placement with polytetrafluroethylene and concomitant colon resection. Only 20 other cases of C. septicum mycotic aneurysm, aortitis, or aortic dissection have been reported. Concomitant surgical treatment for Clostridium aortitis or mycotic abdominal aortic aneurysm and colon cancer can be accomplished successfully in selected cases when the diagnosis of both conditions is made preoperatively.

We present a case of inadvertent decapsulation and grade IV renal parenchyma laceration during laparoscopic donor nephrectomy. The kidney was repaired, used and functioned immediately. There were no complications in the donor. To our knowledge, this type of injury has not been reported previously and the purpose of this report is to focus attention on the potential for this unusual injury, which can occur during delivery of the kidney using the endocatch bag.

Hepatic artery thrombosis (HAT) is the most common vascular complication after orthotopic liver transplantation (OLT) and has traditionally been managed with re-OLT. However, several reports have shown that urgent revascularization is frequently an effective means of graft salvage. This most often involves hepatic artery (HA) thrombectomy and thrombolysis, with reestablishment of arterial inflow through a donor iliac artery conduit based on the supraceliac or infrarenal aorta. We report a 46-year-old man who developed HAT 13 days after OLT after angiographic splenic artery embolization to reduce splenic artery steal. A suitable donor iliac artery was not available for arterial reconstruction and could not be obtained from neighboring transplant centers. The patient underwent urgent HA thrombectomy, intrahepatic arterial thrombolysis, and revascularization using an autologous radial artery (RA) conduit based on the supraceliac aorta. The patient is alive more than 1 year after revascularization, with normal liver function and documented flow in the arterial conduit by Doppler ultrasound and arteriography. He has not developed late biliary complications or adverse sequelae of RA harvest. Autologous RA can be safely and successfully used as an aortic-based arterial conduit in urgent revascularization of HAT after OLT. RA should be considered for use in HA revascularization if an adequate donor iliac artery is not available and other potential conduits are not usable or desirable. The availability of autologous RA expands the armamentarium of vascular conduits that can be used in HA revascularization and may help minimize re-OLT for otherwise potentially salvageable liver allografts.

Fear of postoperative pain is a disincentive to living donor kidney transplantation. Laparoscopic donor nephrectomy (LDN) was developed in part to dispel this disincentive. The dramatic increase in the number of laparoscopic donor nephrectomies performed at our institution has been in part due to the reduction in postoperative pain as compared to traditional, open donor nephrectomy. We sought to further diminish the pain associated with this surgical technique. The purpose of this study was to compare the efficacy of three different postoperative pain management regimens after LDN. All living kidney donors performed laparoscopically (n=43) between September 1998 and April 2000 were included for analysis. Primary endpoints included postoperative narcotic requirements and length of stay. Narcotic usage was converted to morphine equivalents (ME) for comparison purposes. Patients received one of three pain control regimens (group 1: oral and intravenous narcotics; group II: oral and intravenous narcotics and the On-Q pump delivering a continuous infusion of subfascial bupivicaine 0.5%; and group III: oral and intravenous narcotics and subfascial bupivicaine 0.5% injection). Postoperative intravenous and oral narcotic use as measured in morphine equivalents was significantly less in group III versus groups I and II (group III: 28.7 ME versus group I: 40.2 ME, group II: 44.8 ME; P<0.05). Postoperative length of stay was also shorter for group III (1.8 days) versus group I (2.5 days) and group II (2.9 days). LDN has been shown to be a viable alternative to traditional open donor nephrectomy for living kidney donation. We observed that the use of combined oral and intravenous narcotics alone is associated with greater postoperative narcotic use and increased length of stay compared to either a combined oral and intravenous narcotics plus continuous or single injection subfascial administration of bupivicaine. The progressive modification of our analgesic regimen has resulted in decreased postoperative oral and intravenous narcotic use and a reduction in the length of stay. We recommend subfascial infiltration with bupivicaine to the three laparoscopic sites and the pfannenstiel incision at the conclusion of the procedure to reduce postoperative pain. We believe this improvement in postoperative pain management will continue to make LDN even more appealing to the potential living kidney donor.