[Transperitoneal laparoscopic ureterolithotomy for upper ureteral calculi: a report of 1171 cases].

OBJECTIVE: To evaluate clinical outcomes and values of transperitoneal laparoscopic ureterolithotomy. METHODS: A total of 1171 patients with upper ureteral calculi were recruited during September 1999 to February 2012. The etiologies included impacted calculi (n = 1100), non-impacted calculi (n = 71), multiple ureteral calculi (n = 51) and combined small calculi in unilateral kidney (n = 139). Maximum diameter of calculi was 1.5 (0.8-2.6) cm. All patients underwent transperitoneal laparoscopic ureterolithotomy and double J stent was implanted intraoperatively. RESULTS: Two cases were converted into open operation. Calculi moving up into pelvis occurred in 27 cases. And 25 cases converted into laparoscopic pyelolithotomy and stones were removed successfully. Two cases received extra extracorporeal shock wave lithotripsy postoperatively. The remaining 1142 cases were treated successfully with an operative duration of 56.1 (26-160) min and an estimated volume of blood loss at 45.2 (10-250) ml. The period of drainage tube was 3.1 (1-7) days. Postoperative hospitalization stay was 4.8 (3-9) days. One patient suffered urine leakage and healed at Day 6 days post-operation. Ten cases suffered D-J stent bladder non-arrival or retraction and double J stents were extracted by ureteroscopy. One case suffered paralytic ileus and recovered 7 days later. Another case suffered severe hematuria. No intestine or adjacent viscera injury was observed. The follow-up period of 827 cases was 7.3 (24-108) months. Among 12 cases of ureteral stricture, ureteral dilation (n = 7) and ureteral anastomosis (n = 3) were performed. For 5 cases of renal atrophy, 3 underwent nephrectomy because of recurrent lumbago or persistent urinary infection. CONCLUSIONS: Transperitoneal laparoscopic ureterolithotomy has the advantages of minimal morbidity, little postoperative discomfort and high stone clearance rate over open surgery. It should be widely adopted for the patients with upper ureteral impacted calculi.

[Jingjin needling improves facial nerve function and psychosomatic function in Hunt facial para-lysis patients].

OBJECTIVE: To observe the clinical effectiveness of Jingjin (muscle region) needling in the treatment of Hunt facial paralysis (HFP). METHODS: A total of 80 HFP patients were randomly divided into acupuncture and medication groups (n＝40 cases/group). Jingjin needling was applied to Yangbai(GB14) to Shangxing (GV23), Touwei (ST8), Cuanzhu (BL2), Sizhukong (TE23，penetrative needling), Dicang (ST4) to Jiache (ST6, penetrative needling), Yingxiang(LI20) and Xiaguan(ST7), Hegu(LI4), Yifeng (TE17), Yuyao (EX-HN 4), and Shenmai (BL62), with the needles retained for 30 min. The treatment was conducted once daily, with 10 consecutive days being a therapeutic course, and 3 courses altogether. Patients of the medication group received oral administration of Prednisone acetate (12 days), Acyclovir (7 days), intramuscular injection of Vitamin B12 and Vitamin B1(10 days), then, oral administration of Vitamin B1, successively. The therapeutic effect was assessed by using House-Brackman (H-B) facial function grading system (grade I to VI), traditional Chinese medicine (TCM) sign and symptom score, and facial disability index (FDI) scale including FDI physical function (FDIP, food and water swallowing, speaking-pronouncing, dryness or tearing, and mouth-opening) and FDI social function (FDIS, self-rating anxiety/depression scales), separately. RESULTS: After the treatment, the TCM symptom and sign scores for depth of nasolabial groove, nose shrugging, lower lip asymmetry, food retention and post-auricular pain were significantly lower in the medication group (P<0.05)．After the treatment, the TCM symptom and sign scores for frontal muscle movement, eyelid opening and closing, depth of nasolabial groove, nose shrugging, lower lip asymmetry, cheek blowing, food retention, latissimus cervicalis contraction, taste disorder, hearing hypersensitivity, tears and discomfort and post-auricular pain were significantly lower in the acupuncture group (P<0.05)．Comparison between two groups showed that the TCM symptom and sign scores for frontal muscle movement, eyelid opening and closing, depth of nasolabial groove, nose shrugging, lower lip asymmetry, cheek blowing, food retention, latissimus cervicalis contraction, taste disorder, hearing hypersensitivity, tears and discomfort and post-auricular pain were significantly lower in the acupuncture group than in the medication group(P<0.05)．The scores of FDIP and FDIS were significantly increased in both groups (P<0.01) and notably higher in the acupuncture group than in the medication group (P<0.01) after the treatment. The total effective rate of acupuncture group was 97.5% (39/40), and that of medication group was 72.5% (29/40). The therapeutic effect of the acupuncture group was significantly superior to that of the medication group (P<0.01)．. CONCLUSION: Jingjin needling has a good therapeutic effect in improving facial nerve function, psychosomatic function and clinical signs and symptoms in HFP patients, evidently being better than medication.

Spontaneous spinal epidural hematomas: One case report and rehabilitation outcome.

RATIONALE: Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but potentially disabling disease, and the classical presentation of it includes an acute onset of severe, sometimes radiating back or neck pain, followed by signs and symptoms of rapidly evolving nerve root or spinal cord compression. PATIENT CONCERNS: Here, we report a 26-year-old female patient presented with weakness in bilateral lower extremities, progressing to intense paraplegia and anesthesia without recent medical history of trauma, infection, surgery, or drug use. DIAGNOSIS: A magnetic resonance imaging (MRI) scan of spinal cord was planned and a posterior epidural hematoma of the thoracic spine was observed. INTERVENTIONS: A posterior decompression and hematoma evacuation was performed after diagnosis immediately. Early rehabilitation program of the specific kind spinal cord injury was formulated and implemented. OUTCOMES: The patient finally can handle basic living activities, such as completing wheelchair locomotion, transferring from bed to wheelchair independently after 3 months of rehabilitation. LESSONS: SSEH is a rarely occurring case in emergency. Acute chest pain and paraplegia could be the initial presentation of acute spinal epidural hemorrhage, but the diagnosis of patient without classical manifestations is still a challenge for doctors. Early diagnosis, prompt decompression, and individualized rehabilitation program can improve the prognosis and outcome.

Pure transperitoneal laparoscopic correction of retrocaval ureter.

BACKGROUND: Retrocaval ureter is a rare congenital abnormality. Operative repair is always suggested in cases of significant functional obstruction. Laparoscopic procedures have been employed as the minimally invasive therapeutic option for retrocaval ureter. However, the laparoscopic techniques for retrocaval ureter might be technically challenging to some surgeons. The aim of this article was to present our experience and surgical techniques of pure transperitoneal laparoscopic pyelopyelostomy and ureteroureterostomy in nine patients with retrocaval ureter. METHODS: A total of nine patients of retrocaval ureter underwent pure laparoscopic pyelopyelostomy or ureteroureterostomy. The operation was performed with the patients placed in the 70-degree lateral decubitus position via a three port transperitoneal approach with two 10-mm and one 5-mm ports. The distal part of the dilated renal pelvis was transected at the ureteropelvic junction and the ureter was relocated anterior to the inferior vena cava. The tension-free pyeloureteral or ureteroureteral anastomosis was completed with the intracorporal freehand suturing and in situ knot-tying techniques combined with interrupted and continuous fashion. A double J ureteral stent was inserted in an antegrade manner during laparoscopy. Intravenous urography or computerized tomography and renal ultrasonography were performed after 3 months postoperatively. RESULTS: All operations were completed laparoscopically, and no open conversion was required. The mean operative time was 135 minutes (range, 70 - 250 minutes), with minimal blood loss (less than 60 ml). No intra-operative complications or significant bleeding occurred. All patients presented mild postoperative pain and quick convalescence. The symptoms disappeared and hydronephrosis decreased substantially after surgery. CONCLUSIONS: Pure transperitoneal laparoscopic correction for retrocaval ureter was associated with an excellent outcome, minimal invasiveness and short hospital stay. It is technically feasible and reliable for retrocaval ureter treatment. Laparoscopic surgery could be the standard treatment for retrocaval ureter.