A Novel Hybrid Surgical Technique for Large Renal Masses—Hybrid Technique of Laparoscopic-Assisted Open Radical Nephrectomy

Urology Research and Practice · 2025-07-29

Objective: The complex patient dynamic in India leads to diverse presentations of renal cell carcinoma, ranging from incidental small renal masses to large palpable renal masses. Minimally invasive surgical approaches pose challenges for patients with large renal masses (≥7 cm), prompting many urologists to opt for open radical nephrectomy. However, open surgery is associated with higher morbidity due to prolonged visceral exposure and increased intraoperative bleeding. Large renal masses often exhibit significant neovascularity, complicating dissection and elevating intraoperative blood loss risk. This problem led the authors to devise a novel hybrid technique of laparoscopic-assisted open radical nephrectomy (HLO-RN), which helps to decrease morbidity. In this article, the authors discuss this novel hybrid technique incorporating the benefits of both open and laparoscopic approaches (HLO-RN). Methods: The authors conducted an observational study to report the authors'. HLO-RN, in 5 patients with large renal masses (≥7 cm) suggestive of renal cell carcinoma. Patients with morbid obesity (BMI ≥40) were excluded. The hybrid technique involves initial laparoscopy, followed by open flank incision after vessel clipping. Conversion-to-open procedure can be adjusted based on intraoperative conditions. In patients with inferior vena cava (IVC) thrombus extension, conversion-to-open procedure is made after sequential clamping of renal vessels and IVC with or without hepatic mobilization. All the patients were followed for 6 months. Various parameters including patient characteristics, renal mass characteristics, staging, mean duration of laparoscopic and open procedures, intraoperative and postoperative complications, and duration of hospitalstay and duration to return to normal activity were recorded. Results: Five patients (mean age: 61.2 years) were included, with 2 presenting with venous tumor thrombus extension. The mean renal mass size was 10.7 cm (range: 7.8-14 cm). One patient with IVC Level I thrombus required open conversion after sequential vessel clamping due to significant neovascularity. Partial laparoscopic mobilization was feasible in the remaining patients. Procedure durations averaged 35.8 minutes (laparoscopic) and 35.6 minutes (open). All procedures were performed by the same senior urologist team. Patients were extubated immediately post-surgery, with one requiring intensive care unit admission for 1 day. No surgical site infections or major postoperative complications occurred. The drop in hemoglobin in this study was 0.84 g/dL. Conclusion: The authors' novel HLO-RN technique is a practical and feasible approach for large renal masses, including those with IVC thrombus extension. By reducing intra-operative blood loss and open procedure duration, this hybrid technique significantly decreases perioperative morbidity.

5.56 Adolescent Overdose Suicide Attempts: Associations With Time of Day, Screen Use, and Medication Type

Journal of the American Academy of Child & Adolescent Psychiatry · 2025-10-01

Multisystem Sequelae of Chronic Diphenhydramine Misuse in an Adolescent: A Case Highlighting the Importance of Comprehensive History-Taking

Psychopharmacology Bulletin · 2025-12-22 · 1 citations

Background: Diphenhydramine, an over-the-counter antihistamine, is increasingly misused by adolescents for its sedative and hallucinogenic effects. Despite its accessibility and perceived safety, chronic misuse poses serious risks, including neurologic, psychiatric, and gastrointestinal complications, especially in vulnerable youth with preexisting trauma or psychiatric illness. Case: We present a case of a teenage female with a history of traumatic brain injury, major depressive disorder, and restrictive eating disorder who was admitted following a diphenhydramine overdose. Her suicide attempt was preceded by a two-year history of undisclosed daily diphenhydramine misuse, initially for mood regulation and later escalating to dependency. Multisystem symptoms including seizures, disordered eating, and behavioral changes were retrospectively linked to her chronic use. Her TBI and initial seizure also coincided with a period of increased diphenhydramine ingestion, raising concern for misattributed or missed diagnoses. Discussion: This case highlights the diagnostic challenges posed by diphenhydramine misuse in adolescents. Chronic use can mimic or exacerbate psychiatric and neurologic conditions, delay appropriate intervention, and contribute to unnecessary polypharmacy or healthcare utilization. Her improvement with structured psychiatric care and medication discontinuation supports the role of early identification and trauma-informed management in preventing further harm. Conclusion: Diphenhydramine misuse should be considered in adolescents with overlapping psychiatric, neurologic, and gastrointestinal complaints. Routine psychosocial screening and awareness of non-traditional substances of abuse are essential for timely diagnosis and intervention.

1.18 Analyzing the Prevalence of OCD in Adolescents With ADHD: Insights From the National Inpatient Sample Dataset

Journal of the American Academy of Child & Adolescent Psychiatry · 2025-10-01

Cannabis Pen-Induced Psychosis in a First-Time Adolescent User

Psychopharmacology Bulletin · 2025-08-12

Cannabis is a widely used illicit substance that is historically consumed via smoking, but alternative methods of cannabis consumption have been growing in popularity over the past several decades. One such modality is vaporization, which can appeal specifically to adolescent consumers given these pen devices’ ease of concealment, lack of characteristic odor, and marketability. Cannabis products designed for vaping often have higher concentrations of the psychoactive component of cannabis, tetrahydrocannabinol (THC), when compared with traditional cannabis leaf smoking. This can increase the intensity of cannabis-related effects such as analgesia, relaxation, appetite stimulation, and reduced nausea and emesis, but also potentially increases the risk for adverse effects such as dysphoria, and more severely, cannabis-induced psychosis (CIP). Here, we present the case of an adolescent female who was brought after school to our emergency department presenting with symptoms of acute psychosis. Her subsequent workup was effectively normal apart from a urine drug screen positive for THC, which the patient confirmed was due to use of a cannabis pen prior to leaving school that day. This prompted the diagnosis of CIP, which was self-limited and resolved without significant intervention. We use this case to provide the symptomatology and treatment of CIP secondary to cannabis pen use, as well as more broadly discuss the potential implications of cannabis vaping on adolescent neurodevelopment, substance use, and psychiatric comorbidities.

Exploring the Interplay of Sleep and Nicotine Vaping in Adolescents: An Evidence-Based Narrative Review

Psychopharmacology Bulletin · 2025-08-12

Introduction: Although adolescent use of combustible cigarettes (CC) has decreased, the rise of nicotine electronic vaping products (EVPs) presents new public health concerns. Nicotine vaping devices, with appealing packaging and flavors, are now the most commonly used nicotine delivery method among adolescents. While the long-term effects remain unclear, short-term effects include tachycardia, coughing, and wheezing. This review explores the relationship between nicotine vaping and sleep disturbances in adolescents. Methods: A PubMed search (2006-2024) using keywords "nicotine sleep adolescents," "vaping sleep adolescents," and "e-cigarette sleep adolescents" identified 159 articles. Filters for "Humans," "English," and "Age-Birth-18 years" narrowed the list to 124. Abstracts were independently screened for cross-sectional studies describing sleep disturbances, yielding nine articles. Outcome measures included insufficient sleep (< 7-8 hours/night) and sleep latency, assessed through self-reported hours and the Pittsburgh Sleep Quality Index (PSQI). Results: Data from 106,628 adolescents (12-18 years; males = females) revealed e-cigarette (most common vaping device used) and dual users (e-cigs + CC) reported significantly more insufficient sleep on school nights than non-users. Dual users exhibited increased sleep latency, particularly in males. Two studies suggested chronic insufficient sleep might lead to initiation or increased use of vaping devices, highlighting a bidirectional relationship. Conclusions: Many survey studies indicate vaping nicotine is associated with sleep disturbances in adolescents. Other studies determined sleep disturbances were associated with an initiation or increase in vaping nicotine indicating a cause-and-effect conundrum. Further investigation through longitudinal studies are needed to determine factors such as the causal relationship, dose-response and product-specific effects.

Major Depressive Disorder Following Dermatomyositis: A Case Linking Depression with Inflammation

Psychopharmacology Bulletin · 2025-08-12 · 8 citations

Major depressive disorder (MDD) is one of the most common psychiatric disorders. Recent studies have shown a strong association between MDD and peripheral inflammation, shown by a higher incidence of depression in patients with inflammatory diseases including rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis and systemic lupus erythematosus. Dermatomyositis (DM), an idiopathic inflammatory connective tissue disease that is associated with inflammation, predominantly affects the skin and skeletal muscle. The association between DM and MDD in the context of inflammation has seldom been reported. Here we report a 30- year- old Caucasian female with symptoms of depression dating back to 2 years. These symptoms started after cutaneous manifestations of DM. In the past two years, her DM symptoms have worsened that paralleled an increase of depressive symptoms. Also, during the course of the patient's DM, we tracked elevated inflammatory markers including creatine kinase and aldolase, whereas C-reactive protein, C3, and C4 were in a high normal range which correlated with worsening of depression. Hence, a temporal relationship between the onset of MDD and DM symptoms suggests that inflammation may be a common mechanism linking these two conditions.

Thoracoscopic Ligation of the Thoracic Duct for Persistent Chylothorax After Pediatric Cardiac Surgery—Outcomes of a Standardized Technique

World Journal for Pediatric and Congenital Heart Surgery · 2025-09-09

BackgroundChylothorax, the accumulation of triglyceride-rich fluid in the pleural cavity, is a well-recognized complication after surgery for congenital heart disease in children. Treatment protocols and role of surgery are not standardized.ObjectiveThis study aims to evaluate the outcomes of a standardized technique of thoracoscopic ligation of the thoracic duct (TLTD), for the management of persistent chylothorax following pediatric cardiac surgery.MethodsA longitudinal study was conducted on children diagnosed with postoperative chylothorax at a single center from 2018 to 2024. Children who required surgery were included in the study. Data on demographics, treatment timelines, and outcomes were collected and analyzed.ResultsOut of 11,429 children who underwent cardiac surgery, 24 children (median age of 33.5 months) required surgery for persistent chylothorax. Thoracoscopic ligation of the thoracic duct was typically performed on day 7 after diagnosis. Chylothorax resolved in 23 out of 24 cases by a median of 10 days following TLTD. The procedure caused minimal morbidity, and no significant procedure-related complications. There were two deaths due to poor cardiac function despite resolution of chylothorax.ConclusionThoracoscopic ligation of the thoracic duct is a safe and effective technique for persistent chylothorax in children following cardiac surgery. This standardized technique is reproducible and its timely application enhances recovery and reduces hospital stay. Further research will define the role of this technique in overall management of chylothorax postcardiac surgery.

First Episode Psychosis in a Teen with Narcolepsy and Cataplexy

Psychopharmacology Bulletin · 2025-08-12

Narcolepsy with cataplexy (NT1) is a sleep disorder very rarely associated with early-onset psychosis. The incidence of this association is unknown but appears to be more common in children and adolescents. This combination of diagnoses presents a diagnostic and therapeutic challenge. This case report discusses an adolescent female with first-episode psychosis who was being treated for NT1 and had no prior psychiatric history. After ruling out other possible medical causes, she was given an initial diagnosis of a brief psychotic episode and treated with Risperidone while continuing treatment for NT1 with Modafinil and Venlafaxine. Following partial response to Risperidone, her psychosis improved with Chlorpromazine, one of the first documented cases of successful use of this medication for first-episode psychosis with NT1.

95.1 Digital Media and Sleep: Effects on Children and Adolescents and Strategies for Intervention

Journal of the American Academy of Child & Adolescent Psychiatry · 2025-10-01