Mini-incision for strictly retroperitoneal nephrectomy in living kidney donation vs flank incision
NEPHROLOGY DIALYSIS TRANSPLANTATION
Authors: Schnitzbauer, A. A.; Loss, M.; Hornung, M.; Glockzin, G.; Mantouvalou, L.; Krueger, B.; Kraemer, B. K.; Schlitt, H. J.; Obed, A.
Abstract
Background. Mini-incision donor nephrectomies (MIDNs) were established during the last decade, as an alternative to traditional open donor nephrectomy (ODN) via flank incision. In this study, we investigated intra-operative and post-operative data on outcome following MIDN in comparison with ODN data. Methods. Data of 70 living kidney donations, performed at the University of Regensburg Medical Center since 1996, were evaluated. Donor operation was performed as either strictly retroperitoneal MIDN (n = 34) or as traditional ODN (n = 36) via flank incision. Total operation time, warm ischaemia time (WIT), perioperative pain-medication usage and creatinine levels as well as length of hospital stay, return to complete enteral nutrition and regular digestion were evaluated retrospectively. Results. Total operation times were similar in MIDN, n = 34 (132 +/- 26 min) and in ODN, n = 36 (140 +/- 37 min) (P = 0.424). WIT was also similar in both: MIDN (0.9 +/- 0.4 min) and ODN (0.9 +/- 0.4 min) (P = 0.568). The requirement for post-operative opioids in morphine equivalent doses was significantly lower in MIDN (8.4 +/- 16 mg) compared with ODN (44 +/- 57 mg) (P = 0.001). Additional application of non-opioids (metamizole) (MIDN: 4.8 +/- 6.3 g, ODN: 3.4 +/- 3.9 g) and non-steroidal antirheumatic (NSAR) (diclofenac) (MIDN: 322 +/- 361 mg, ODN: 247 +/- 474 mg) revealed no significant differences between the groups. The hospital stay was 4.9 +/- 1.4 days in MIDN which was significantly shorter than that in ODN (9.3 +/- 3.3 days) (P = 0.001). Patients achieved fully independent mobility earlier in MIDN than in ODN (P = 0.934). Start of enteral nutrition with fluids was significantly quicker in MIDN (1.9 +/- 7 h) compared with ODN (12 +/- 13 h) (P = 0.05). Full enteral nutrition was accomplished significantly earlier in MIDN (1.6 +/- 0.8 days) (P = 0.023). Return to normal digestion revealed no significant differences between groups. Serum creatinine levels of all kidney donors were in the normal range (66 +/- 18 mu mol/l) one day before nephrectomy, increased on day 1 after surgery (119 mu mol/l +/- 31 mu mol/l) and were stable on day 3 (115 mu mol/l +/- 30 mu mol/l) without significant differences. Conclusion. Strictly, retroperitoneal MIDN in living kidney donation is a fast and safe method for the procurement of a living donor graft, giving the patient a significantly shorter period of recovery, and thus is an attractive and recommendable alternative to traditional ODN procedures.
Corn yield, nitrogen use, and corn rootworm infestation of rotations in the northern corn
AGRONOMY JOURNAL
Authors: Pikul, JL; Hammack, L; Riedell, WE
Abstract
Crop rotation may improve production efficiency and reduce fertilizer N requirements for corn (Zea mays L.). Objectives were to determine effect of rotation and N on corn yield, efficiency of water use (WUE) and N use (NUE), and corn rootworm (Coleoptera: Chrysomelidae) beetle populations (CR). Rotations (started in 1990) were continuous corn (CC), corn-soybean [Glycine mar (L.) Merr.] (CS), and a 4-yr rotation of corn-soybean-spring wheat (Triticum aestivum L.) companion-seeded with alfalfa (Medicago sativa L.)-alfalfa hay (CSWA). Nitrogen treatments for corn were corn fertilized for a grain yield of 8.5 Mg ha(-1) (highN), 5.3 Mg ha(-1) (midN), and no N fertilizer (noN). Average yield (1992-2003) was greatest (p = 0.003) under CS and highN (7.0 Mg ha(-1)). Yield differences (p = 0.001) among rotations increased with decreased fertilizer N. Average (1992-2003) yield with noN fertilizer was 5.8 Mg ha(-1) under CSWA, 4.5 Mg ha(-1) under CS, and 2.8 Mg ha(-1) under CC. Nitrogen use efficiency differed (p = 0.096) only under midN with CSWA = CS > CC. Soil water (upper 1.8 m) for corn measured on 1 June (average of N treatments) was 55, 54, and 45 cm for CC, CS, and CSWA, respectively. For CSWA under highN, available water limited yield in 3 of 6 yr. At highN, CR adult populations were greater under CS compared with CC and greater at higher N fertilizer levels within CC. Rotations have potential to improve production efficiency; however, there is potential for reduced corn yield after alfalfa due to less available soil water.