[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.

[Application of magnetic materials in analysis on Chinese herb medicines].

China is the cradle of Chinese herb medicines,with rich plant resources. However, traditional processing methods have many disadvantages, such as high comsumption of organic solvent, long extraction time and high loss of effective constituents. For the purpose of rational use of Chinese herb medicines and accurate analysis on their constituents,the sample pre-treatment method with magnetic nanoparticles as the carrier brought new opportunities in recent years. after consulting literatures,the essay summarizes traditional extraction methods of Chinese herb medicines, characteristics of magnetic materials and their application in the analysis on Chinese herb medicines.

Beware of the Potential Risks for Polygoni Multiflori Caulis-Induced Liver Injury.

Background: Reynoutria multiflora (Thunb.) Moldenke (PM) is a widely-used medicinal plant in China, whose root and stem are included in the Chinese Pharmacopoeia as Polygoni Multiflori Radix (RPM), Polygoni Multiflori Radix Preparata (PMP), and Polygoni Multiflori Caulis (PMC). The hepatotoxicity of RPM and PMP is concerned by the public, while the risk of PMC is ignored. Purpose: Here, we investigate the potential risks for PMC-induced liver injury from clinical, chemical, and animal features. Study design: First, we analyzed the 12-month usage of RPM, PMP, and PMC in Longhua Hospital. Second, we determined the contents of gallic acid, cis-2,3,5,4'-tetrahydroxy-stilbene-2-O-ß-D-glucoside (cis-SG), trans-2,3,5,4'-tetrahydroxy-stilbene-2-O-ß-D-glucoside (trans-SG), emodin-8-O-ß-D-glucoside (EG), physcion-8-O-ß-D-glucoside (PG), emodin, and physcion in the water extracts from 15 batches of RPM, PMP, and PMC. Third, we probed the hepatotoxic effect of RPM, PMP, and PMC in mice and explored the mechanism of cis-SG and trans-SG causing the liver injury at the dosages based on our results from the first and second parts. Results: PMC had nearly five times the amount of usage in both outpatient prescriptions and inpatient orders than RPM and PMP. Overall, 68% dosage of PMC was 30 g. The contents of cis-SG, trans-SG, and emodin in PMC water extracts were significantly lower than those in RPM and PMP water extracts. PMC induced milder idiosyncratic liver injury for its lower content of cis-SG and trans-SG than its root counterparts. Conclusion: The potential risks for PMC-induced liver injury should be fully aware of.

Sesquiterpenoids from Inula racemosa.

Phytochemical research on the roots of Inula racemosa yielded nine sesquiterpenoids including a new nor-eudesmane-type sesquiterpenoid, 11,12,13-trinoreudesm-5-en-7ß,8α-diol (1). The structures of isolated compounds were elucidated by extensive spectroscopic methods including 1D and 2D NMR. The structure of compound 2 was confirmed by single-crystal X-ray diffraction analysis.

[Influence on orbicularis oculi muscle in the patients with facial neuritis treated with the penetra-ting needling at Cuanzhu (BL2) and Yuyao (EX-HN4) combined with the perpendicular needling at Shenmai (BL62)].

OBJECTIVE: To explore the therapeutic effect on incomplete eyelid in the patients with facial neuritis treated with the penetrating needling at Cuanzhu (BL2) and Yuyao (EX-HN4) combined with the perpendicular needling at Shenmai (BL62). METHODS: A total of 64 patients with facial neuritis, in compliance with the inclusion criteria, were randomized into a treatment group and a control group, with 32 cases in each. In the treatment group, the penetrating needling was applied to BL2 and EX-HN4 on the affected side, combined with the perpendicular needling at bilateral BL62. Besides, on the affected side, the penetrating needling was applied from Yangbai (GB14) toward four directions, named Shangxing (GV23), Touwei (ST8), Cuanzu (BL2) and Sizukong (TE23), the mutual penetrating needling was adopted between Dicang (ST4) and Jiache (ST6). Between Yingxiang (LI20) and Xiaguan (ST7), a row-arranged needling technique was applied. All of the needles were retained for 10 to 30 min in each treatment. The treatment was given once daily and the treatment for 10 days was as 1 course. A total of 2 courses of treatment were required. In the control group, prednisone acetate （30 mg/d）, was administered consecutively for 5 days. Afterward, the dose was reduced to be 10 mg/d and the medication stopped after taking consecutively for 1 week. Muscular injection with vitamin B12 （0.5 mg） and B1 （0.1 mg） was given, once daily. 10 days later, vitamin B1 was taken for oral administration, 10 mg each time, three times a day, for 10 days totally. Before and after the treatment, the clinical effect was compared between the two groups in terms of the analysis on the Hourse-Brackman (H-B) grade of facial nerve function, the distance between the upper and the lower eyelids, muscle strength, degree of eyelid closure and electromyogram (EMG). RESULTS: The total effective rate of treatment group was 96.9 % (31/32), better than 84.4%（27/32） in the control group (P<0.05). After treatment, in the treatment group, the distance between the upper and lower eyelids, the muscle strength, the degree of eyelid closure, the wave amplitude of motor nerve conduction and the latent period, as well as the blink reflex were all improved as compared with those before the treatment (P<0.01, P<0.05). In the control group, the distance between the upper and lower eyelids, the muscle strength, the degree of eyelid closure, the latent period of motor nerve conduction and the blink reflex were all improved as compared with those before the treatment (P<0.01, P<0.05). After the treatment, the results of the distance between the upper and lower eyelids, the muscle strength, the degree of eyelid closure, the wave amplitude of motor nerve conduction and the latent period, as well as the blink reflex in the treatment group were all better than those in the control group (P<0.05，P<0.01). CONCLUSION: The treatment with the penetrating needling at Cuanzhu (BL2) and Yuyao (EX-HN4) combined with the perpendicular needling at Shenmai (BL62) greatly promotes the recovery of orbicularis oculi muscle in the patients with facial neuritis, reduces the complications and presents the satisfactory clinical effect.

Clinical analysis of 132 cases COVID-19 from Wuhan.

Numerous cases of pneumonia from a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China during December 2019.We determined the correlations of patient parameters with disease severity in patients with COVID-19.A total of 132 patients from Wuhan Fourth Hospital who had COVID-19 from February 1 to February 29 in 2020 were retrospectively analyzed.Ninety patients had mild disease, 32 had severe disease, and 10 had critical disease. The severe/critical group was older (P < .05), had a higher proportion of males (P < .05), and had a greater mortality rate (0% vs 61.9%, P < .05). The main symptoms were fever (n = 112, 84.8%) and cough (n = 96, 72.7%). Patients were treated with antiviral agents (n = 94, 71.2%), antibiotics (n = 92, 69.7%), glucocorticoids (n = 46, 34.8%), intravenous immunoglobulin (n = 38, 27.3%), and/or traditional Chinese medicine (n = 40, 30.3%). Patients in the severe/critical group received mechanical ventilation (n = 22, 16.7%) or high-flow nasal can-nula oxygen therapy (n = 6, 4.5%). Chest computed tomography (CT) indicated bilateral pneumonia in all patients. Relative to the mild group, the severe/critical group had higher levels of leukocytes, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, B-type natriuretic peptide (BNP), liver enzymes, and myocardial enzymes (P < .05), and decreased levels of lymphocytes and blood oxygen partial pressure (P < .05).The main clinical symptoms of patients from Wuhan who had COVID-19 were fever and cough. Patients with severe/critical disease were more likely to be male and elderly. Disease severity correlated with increased leukocytes, CRP, PCT, BNP, D-dimer, liver enzymes, and myocardial enzymes, and with decreased lymphocytes and blood oxygen partial pressure.

[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.

The RNA-binding protein RBM47 inhibits non-small cell lung carcinoma metastasis through modulation of AXIN1 mRNA stability and Wnt/ß-catentin signaling.

BACKGROUND: Non-small-cell lung cancer (NSCLC) remains a highly prevalent and deadly form of cancer, with efforts to better understand the molecular basis of the progression of this disease being essential to its effective treatment. Several recent studies have highlighted the ability of RNA-binding proteins (RBPs) to regulate a wide range of cellular processes in both healthy and pathogenic contexts. Among these RBPs, RNA binding motif protein 47 (RBM47) has recently been identified as a tumor suppressor in both breast and colon cancers, whereas its role in NSCLC is poorly understood. METHODS: RBM47 expression in NSCLC samples was evaluated by RT-PCR, western blotting and immunohistochemistry analysis. Molecular and cellular techniques including lentiviral vector-mediated knockdown were used to elucidate the functions and mechanisms of RBM47. RESULTS: This study sought to analyze the expression and role of RBM47 in NSCLC. In the present study, we observed reduced levels of RBM47 expression in NSCLC, with these reductions corresponding to a poorer prognosis and more advanced disease including a higher TNM stage (p = 0.022), a higher likelihood of tumor thrombus (p = 0.001), and pleural invasion (p = 0.033). Through functional analyses in vitro and in vivo, we further demonstrated that these RBP was able to disrupt the proliferation, migration, and invasion of NSCLC cells. At a molecular level, we determined that RBM47 was able to bind the AXIN1 mRNA, stabilizing it and thereby enhancing the consequent suppression of Wnt/ß-catentin signaling. CONCLUSION: Together our findings reveal that RBM47 targets AXIN1 in order to disrupt Wnt/ß-catenin signaling in NSCLC and thereby disrupting tumor progression. These results thus offer new insights into the molecular biology of NSCLC, and suggest that RBM47 may also have value as a prognostic biomarker and/or therapeutic target in NSCLC patients.

The prognostic value of miRNA-18a-5p in clear cell renal cell carcinoma and its function via the miRNA-18a-5p/HIF1A/PVT1 pathway.

Purpose Clear cell renal cell carcinoma(ccRCC) is the most common type of renal cell carcinoma. While it is curable when detected at an early stage, some patients presented with advanced disease have poor prognosis. We aimed to identify key genes and miRNAs associated with clinical prognosis in ccRCC. Methods The microarray datasets were obtained from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) and differentially expressed miRNAs (DEMs) were analyzed by using GEO2R. Then, Functional enrichment analysis was performed using the DAVID. A retrospective series of 254 ccRCC patients with complete clinical information was included in this study. Kaplan-Meier analysis and multivariate cox regression analysis were used for prognostic analysis. Wound healing assay and transwell assay were designed to evaluate the migration and invasion ability of ccRCC cell lines. Results miRNA-18a was identified to be related with prognosis of ccRCC by using Kaplan-Meier analysis and multivariate cox regression analysis demonstrated that the prognostic value of miRNA-18a was independent of clinical features. Further studies showed that up-regulation of miRNA-18a had a positive effect on migration and invasion of ccRCC cells. The target gene (HIF1A) of the miRNA-18a was predicted by using the miRPathDB database. The transcription factors of DEGs were identified by using the i-cisTarget. Luckily, HIF1A was found to be one of the transcription factors of DEGs. Among these DEGs, PVT1 may be regulated by HIF1A and be related with prognosis of ccRCC. Finally, validation of miRNA18a/HIF1A/PVT1 pathway was checked via reverse transcription-polymerase chain reaction (RT-PCR) assay in both cell lines and clinical tumor samples. Conclusion Our research revealed that miRNA18a/HIF1A/PVT1 pathway might play a crucial role in ccRCC progression, providing novel insights into understanding of ccRCC molecular mechanisms. Importantly, miRNA-18a could serve as a potential diagnostic biomarker and therapeutic targets for ccRCC patients.

[Transvesical removal of seminal vesicle mass: a report of 5 cases].

OBJECTIVE: To investigate the transvesical approach to the surgical treatment of seminal vesicle mass. METHODS: Transvesical removal of seminal vesicle mass was performed for 5 patients aged 45-69 (mean 51) years. The clinical symptoms included those involving the lower urinary tract such as frequent micturition and urgency in 3 cases (1 accompanied with dyschezia), hematospermia in 1, and lower abdominal and perineal malaise in the other. Two masses were in the left side and the other 3 in the right, ranging from 3 to 10 cm (mean 5 cm) in size, detected by transrectal ultrasonography, CT, MRI or digital rectal examination. The mean course of disease was 9 (2-18) months. RESULTS: All the 5 patients were treated successfully and uneventfully, with a mean operation time of 75 minutes, a mean blood loss of 140 ml and a mean hospital stay of 10 days. Pathological examinations revealed 2 cases of seminal vesicle cyst with infection, 1 cystadenoma, 1 phyllode tumor and 1 prostatic hyperplasia. A 3-72 months follow-up showed that all the patients were free of symptoms and had normal sexual function. CONCLUSION: Transvesical removal of seminal vesicle mass, with small incisal opening, good visual field and easy operation, is an effective surgical procedure for seminal vesicle disease.

Dithiocarbamate as a Valuable Scaffold for the Inhibition of Metallo-ß-Lactmases.

The 'superbug' infection caused by metallo-ß-lactamases (MßLs) has grown into an emergent health threat. Given the clinical importance of MßLs, a novel scaffold, dithiocarbamate, was constructed. The obtained molecules, DC1, DC8 and DC10, inhibited MßLs NDM-1, VIM-2, IMP-1, ImiS and L1 from all three subclasses, exhibiting an IC50 < 26 µM. DC1 was found to be the best inhibitor of ImiS (IC50 < 0.22 µM). DC1-2, DC4, DC8 and DC10 restored antimicrobial effects of cefazolin and imipenem against E. coli-BL21, producing NDM-1, ImiS or L1, and DC1 showed the best inhibition of E. coli cells, expressing the three MßLs, resulting in a 2-16-fold reduction in the minimum inhibitory concentrations (MICs) of both antibiotics. Kinetics and isothermal titration calorimetry (ITC) assays showed that DC1 exhibited a reversible, and partially mixed inhibition, of NDM-1, ImiS and L1, with Ki values of 0.29, 0.14 and 5.06 µM, respectively. Docking studies suggest that the hydroxyl and carbonyl groups of DC1 form coordinate bonds with the Zn (II) ions, in the active center of NDM-1, ImiS and L1, thereby inhibiting the activity of the enzymes. Cytotoxicity assays showed that DC1, DC3, DC7 and DC9 have low toxicity in L929 mouse fibroblastic cells, at a dose of up to 250 µM. These studies revealed that the dithiocarbamate is a valuable scaffold for the development of MßLs inhibitors.

Construction, mechanism, and antibacterial resistance insight into polypeptide-based nanoparticles.

The emergence of drug-resistant bacteria poses a serious threat to public health. The traditional antibiotics have specific intracellular targets and disinfect via chemical ways, which easily lead to the development of drug resistance, therefore, cationic peptides as promising antibiotic agents have attracted extensive attention due to their unique properties. Herein, we report a class of amphiphilic peptide-based pectinate polymers with primary amino groups. The polymers spontaneously self-assembled into the positively charged nanoparticles, which were evaluated and confirmed by scanning electron microscopy (SEM) and dynamic light scattering (DLS). Biological assays revealed that the nanoparticles showed broad-spectrum antibacterial efficacy against both Gram-positive and Gram-negative bacteria, exhibiting a MIC of 16 µg mL-1 against six clinical bacteria, namely, E. faecalis, S. aureus, MRSA, VRE, P. aeruginosa, and K. pneumonia, and three bacterial strains E. coli and E. coli producing NDM-1 and ImiS, and showed a sterilization rate of 95.6% and 94.7% on S. aureus and E. coli, respectively. Importantly, the nanoparticles did not result in drug-resistance for both the normal and drug-resistant bacteria tested after 14 passages and showed low toxicity on the mouse fibroblast cells (L929). The fluorescence staining, electrical conductivity, SEM, and surface plasmon resonance (SPR) characterization suggested that the nanoparticles initially bound to the surface of the bacteria, then pierced into the membranes of the bacteria with their phenyl groups, and finally disrupted the membranes, resulting in ions leaking out and thus exhibiting broad-spectrum antibacterial efficacy. This bactericidal mechanism that the nanoparticles employed does not lead the bacteria susceptible to developing drug resistance. This study provides a promising pathway for the development of the efficient antibacterial materials.

[Analysis of principal composition of ethyl acetate part in Huangqi Danggui decoction by HPLC-ESI-TOF-MS].

OBJECTIVE: To analyze and identify the principal composition of ethyl acetate part of Huangqi Danggui decoction by high performance liquid chromatography-electrospray ionization-mass spectrometry (HPLC-ESI-MS). METHOD: The analysis conditions are as follows: Zorbax SB C18 (4.6 mm x 250 mm, 5 microm) column; mobile phase (A) water mobile phase (B) acetonitrile, gradient elution; UV detection wavelength 254 nm; ESI source and data acquisition in positive and negative mode. RESULT: The accurate molecular weights of 20 compounds were measured and identified in ethyl acetate part of Huangqi Danggui decoction. Furthermore, the types of them are as below: flavonoids and flavonoid glycosides, saponins, oligosaccharides, amino acids and phthalides. CONCLUSION: It is a rapid and accurate method that the compositions of compound prescription of traditional Chinese medicine can be identified in terms of the separation of high performance liquid chromatography, the accurate molecular weights measured by MS and other information, which can clarify the potential effective compounds of Huangqi Danggui decoction.

Rhodanine as a Potent Scaffold for the Development of Broad-Spectrum Metallo-ß-lactamase Inhibitors.

A series of rhodanines was constructed, their Z-configuration was confirmed by small molecule X-ray crystal structures, and their activity against metallo-ß-lactamases (MßLs) was measured. The obtained 26 molecules and a thioenolate specifically inhibited the MßL L1 with an IC50 range of 0.02-1.7 µM, and compounds 2h-m exhibited broad-spectrum inhibition of the MßLs NDM-1, VIM-2, ImiS, and L1 with IC50 values <16 µM. All inhibitors increased the antimicrobial effect of cefazolin against E. coli cells expressing L1, resulting in a 2-8-fold reduction in MIC. Docking studies suggested that the nitro (NDM-1, CphA, and L1) or carboxyl group (VIM-2) of 2l coordinates one or two Zn(II) ions, while the N-phenyl group of the inhibitor enhances its hydrophobic interaction with MßLs. These studies demonstrate that the diaryl-substituted rhodanines are good scaffolds for the design of future broad-spectrum inhibitors of MßLs.

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.

High-pressure balloon dilation for male anterior urethral stricture: single-center experience.

OBJECTIVES: We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation (HPBD) technique for anterior urethral stricture. METHODS: From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy (DVIU). Patient demographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. RESULTS: The operation time was much shorter for the HPBD procedure than for the DVIU ((13.19±2.68) min vs. (18.44±3.29) min, P<0.01). For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection (UTI) were less frequently encountered than those in DVIU (urethral bleeding: 2/31 vs. 8/25, P=0.017; UTI: 1/31 vs. 6/25 P=0.037). The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups (P=0.21, hazard ratio (HR)=0.65, 95% confidence interval (CI): 0.34 to 1.26). However, there was a significantly higher stricture-free survival in the HPBD group at 12 months (P=0.02, HR=0.35, 95% CI: 0.14 to 0.87), which indicated that the stricture recurrence could be delayed by using the HPBD technique. CONCLUSIONS: HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.

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.

Transperitoneal laparoscopic adrenalectomy for adrenal metastasis.

AIM: The treatment of adrenal metastasis using laparoscopic surgery is evolving. The aim of this study was to evaluate the feasibility of laparoscopic adrenalectomy (LA) in patients who have adrenal metastases. METHODS: From September 1998 to November 2010, 12 patients underwent LA for adrenal metastatic tumors. Three cases were bilateral and 9 were unilateral. We retrospectively reviewed the clinical and histopathologic data of all 12 patients. RESULTS: The operations of all the 12 cases were successful. There were no intraoperative complications. The mean follow-up time was 17.2 months (range, 2 to 56 mo). We found no intraperitoneal and/or port-site recurrence. One patient had died from metastatic disease. CONCLUSIONS: Our experience leads us to feel that LA is feasible when the primary tumor is well controlled, there are no other metastases clinically and radiologically, when the adrenal metastasis is confined to the adrenal gland, and there is no radiologic evidence of local extension into tissue around the adrenal gland.