ABSTRACT
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy(CADASIL)is a common hereditary disease caused by NOTCH3 gene. The major clinical manifestations includerecurrent small-vessel ischaemic events, migraine, dementia and mood disturbance. Herein, wereport a 32-years-old male presented with right leg weakness and persistent migraine. We carried outneurological exams, genetic testing, blood and cerebrospinal fluid analysis (CSF) as well as magneticresonance imaging (MRI) for the brain and spinal cord. There were no anti-aquaporin-4 antibodiesand oligoclonal bands in the CSF and blood investigations were within the normal range. MRI scansrevealed multiple hyperintense regions in the brain and longitudinally hyperintense signal in spinal cord.Further, we identified a c.383G>A(p.Cys128Tyr) mutation in NOTCH3 gene. Therefore, the patientwas diagnosed with CADASIL concurrent with spinal cord lesion. The patient’s condition slightlyimproved after two weeks treatment with daily dosage of 0.5 g citicoline and 75 mg clopidogrel.
ABSTRACT
Objective To evaluate the methods and efficacy of retroperitoneal laparoscopic nephron-sparing surgery for the treatment of renal tumor. Methods A total of 6 patients with renal tumors underwent retroperitoueal laparoscopie nephron-sparing surgery during warm ischacmia. Among the 6 eases, 2 had malignant tumor with the diameter of 2.5 cm and 2.2 cm,and 4 had renal angiomyolipoma with the diameter from 2.5 cm to 3.5 cm.The renal yes,Is were secured by a self-made equipment. Tumors were excised with a cold Endo-shear. Parenehymal edges were approximated using a absorbable hemostatic gauze. Results All procedures were successfully completed without open conversion. Mean surgical time was 150 minutes (range 120-210 minutes). Mean ischaemia time was 22 minutes (range 18-33 minutes) and the mean blood loss was 170 ml (range 150-200 ml). Surgical margins were negative in all patients.During a follow-up for 6-12 months, no patient had local or port site recurrence. Conclusions Betroperitoneal laparoscopic nephron-sparing surgery for renal tumor by using serf-made equipment is safe and effective. This procedure has the advantages of minimal invasion, less blood loss, good vision, and rapid convalescence and so on.
ABSTRACT
Objective To evaluate the safety and efficacy of transurethral resection of the prostate(TURP)for high-risk benign prostatic hyperplasia(BPH).Methods Form January 2001 to July 2007,we performed TURP on 303 patients with high-risk BPH.The patients aged form 65 to 89 years with a mean of 76.3.Among them,151 were complicated with cardiovascular diseases,67 had pulmonary diseases,37 had diabetes mellitus,26 had brain disease,16 showed renal inadequacy,and 6 showed abnormal liver function.Results The procedure was completed successfully in all of the 303 cases without death,dysuria,or severe complications.Compared to the examinations carried out before the procedure,the IPSS and QOL scores,and RU decreased significantly,while the Qmax increased 3 months after the prosedure[IPSS:(19.6?7.9)points vs.(6.4?3.3)points,t=26.838,P=0.000;QOL:(4.7?1.5)points vs.(2.3?1.1)points,t=22.459,P=0.000;Qmax:(4.1?2.6)ml/s vs.(13.9?7.1)ml/s,t=-22.561,P=0.000;and RU:(139.0?32.5)ml vs(13.5?8.6)ml,t=55.143,P=0.000].ConclusionsTURP is a safet and effective procedure for high-risk BPH with a low rate of postoperative complications.Proper peri-operative individual management and operation skills are important for the success of the procedure.
ABSTRACT
Objective To evaluate the clinical effectiveness of ureteroscopic pneumatic ballistic lithotripsy for the treatment of ureteral stones.Methods A total of 185 patients with ureteral stones(accompanying renal colic in 96 patients) were treated with ureteroscopic pneumatic ballistic lithotripsy from February 2004 to March 2005 in this hospital. Results The procedure failed in 12 patients,including conversions to open surgery in 6 patients and to extracorporeal shock wave lithotripsy 3 days later in 6 patients.The single-session success rate was 93.5%(173/185),and was 75.0%(24/32) in the upper segment,95.8%(46/48) in the middle segment,and 98.1%(103/105) in the lower segment.The success rate in patients with renal colic was 100%(96/96).The rate of intraoperative ureteral injury was 2.9%(5/173),with conversions to open surgery required in 3 patients(1.7%).Postoperative renal colic occurred in 1 patient.Follow-up checkups in all the patients for 6~12 months(mean,10.2 months) showed no recurrence. Conclusions Ureteroscopic pneumatic ballistic lithotripsy is safe and effective,being the first choice for patients with middle or lower ureteral stones,especially accompanying renal colic.