Objective
To explore the availability and safety of ileal ureter replacement combined with ileal augmentation cystoplasty in treating ureteral stenosis with contracted bladder.
Methods
From August 2015 to November 2018, three patients who underwent ileal ureter replacement combined with augmentation cystoplasty were treated with ileal ureter replacement combined with augmentation cystoplasty. There were 1 male and 2 females with the age ranging from 34 to 55 years (mean 39 years). Two patients suffered from left ureter stenosis, and one patient had stenosis on the both sides. The length of the ureter stenosis ranged from 6 to 18 cm (mean 9.8 cm). The preoperative bladder capacity ranged from 60 to 150 ml (mean 103.3 ml). In the surgery, part of ileum was used to replace the ureter, and the distal intestine was made into U-shape to enlarge the bladder.
Results
All operation were completed successfully. The operation time ranged from 220 to 400 min (mean 303.0 min), and the blood loss ranged from 150 to 500 ml (mean 283.3 ml). Laparoscopic surgery was performed in 1 case and open surgery in 2 cases. Three weeks after the surgery, the bladder volume underwent cystography ranged from 300 to 400 ml (mean 360.0 ml). Three months after the surgery, the postvoid residual urine volume ranged from 20 to 50 ml (mean 33.3 ml). Postoperative frequency and urgency of urine were completely relieved in 1 case, alleviated in 2 cases. Flank pain was completely relieved in 1 case, and alleviated in 2 cases postoperatively. The serum creatinine of 2 patients mildly increased after the surgery, while 1 patient remained stable. For complications, 1 patient had urinary infection, and 1 patient suffered from metabolic acidosis.
Conclusions
Ileal ureteral replacement combined with augmentation cystoplasty can be the choice of treatment for long segment ureteral stenosis and enlarge the bladder simultaneously. The postoperative complications and the kidney functions should be regularly followed up.
Key words:
Augmentation cystoplasty; Ileal ureter replacement; Ureteral obstruction; Urinary tuberculosis
Abstract Hydrogen–disproportionation–desorption–recombination (HDDR) Nd–Fe–B magnetic powders are promising to prepare bulk anisotropic magnets, but high magnetic performance has not been achieved due to the absence of an Nd-rich phase in the powder and the low degree of orientation of the bulk magnets. In this study, an alternative process of pre-orientation sintering via magnetic alignment followed by spark plasma sintering was proposed to prepare the precursor of hot-deformation (HD) magnets, and a high maximum energy product of 294 kJ m −3 was achieved in the HD magnet with a relatively low height reduction of 35%, then an improved coercivity of 1107 kA m −1 could be obtained followed by a grain boundary diffusion of Pr 40 Tb 30 Al 20 Cu 10 . Microstructure analysis indicates that pre-orientation of HDDR powders facilitates grain rotation and alignment during the HD process, thereby reducing the minimum deformation ratio. It helps to obtain the deformed grains with lower shape anisotropy and smaller grain size, enabling a good compatibility of magnetic and mechanical behaviors. In-situ Lorentzian transmission electron microscopy results show that the magnetic domains have been strongly fixed by the thick intergranular RE-rich phase and the fully Tb-diffused grains, which contributes to the improved coercivity after grain boundary diffusion. This study provides a guiding significance for the preparation of the anisotropic Nd–Fe–B HDDR magnets with optimized performance.
Abstract Continuous cutaneous urinary diversion is challenging when the appendix is physically unavailable. The Yang–Monti channel is an alternative to the tunneled appendix for urinary diversion. We present a case involving a 49-year-old man who underwent total urethrectomy and cystostomy 10 months previously. No tumor recurrence was observed; however, the patient experienced severe catheter-related bladder irritation after the procedure. The patient was readmitted to the authors’ hospital and underwent laparoscopic continent cutaneous urinary diversion using extracorporeal construction of a modified Yang–Monti channel. The operation lasted 232 minutes, with an estimated blood loss of 10 mL. The patient was discharged from hospital 6 days after surgery and removal of the cystostomy tube. After this, clean intermittent catheterization was performed every 3 hours for 4 weeks. Five years after the procedure, the modified Yang–Monti channel was still used for clean intermittent catheterization without any stomal stenosis being observed. The patient was satisfied with his postoperative quality of life.
It is desired that spatial audio for virtual reality is able to reproduce various auditory localization information so as to recreate virtual source at different directions and distances. Distance-dependent binaural cue (binaural level difference (ILD), loudness, as well as environmental reflections are considered as auditory distance localization cues. In the case of free and near-field within about 1.0 m, the binaural cue which is encoded in near-field head-related transfer function (HRTFs) is an absolute and dominant distance localization cue [D. S. Brungart, JASA, 1999]. However, HRTFs depending on individualized and non-individualized HRTFs are usually used in spatial audio synthesis. In the present work, the perceptual influence of individualized HRTFs distance localization is evaluated by a psychoacoustic experiment. The binaural signals with various bandwidths are synthesized by filtering the input stimuli with individualized and non-individualized near-field HRTFs and then reproduced by headphone. Preliminary results of virtual source localization experiment indicate that individualized HRTFs influences little on distance localization at low frequencies but have some influence at mid and high frequency. [This work was supported by the Natural Science Foundation of China, Grant No. 11574090.]
Our study aimed to investigate the clinical features, management, and maternal-infant prognosis in patients with complete uterine rupture in the second and third trimester of pregnancy.A total of 15 patients with complete uterine rupture in their second and third trimester of pregnancy who were admitted to our hospital between January 2012 and December 2020 were included in our study. The patients enrolled were divided into the scar group (11 patients) and the non-scar group (4 patients) according to the existence or absence of a uterine scar. The general data, clinical characteristics and follow-up results in the 2 groups were compared.There was no significant difference in age, pregnancy duration or delivery cycle between the 2 groups (P > .05). The incidence of original scar rupture in the scar group was significantly higher than in the non-scar group (P > .05). No significant difference was found in clinical characteristics between the scar and the non-scar groups (P > .05). The most common clinical features included abdominal pain, inability to lie flat, hemorrhagic shock, prenatal vaginal bleeding and uterine rupture, mostly occurring in the lower segments of the uterus and cervix. A total of 3 patients were misdiagnosed as having surgical disease. After completing relevant examinations, the uterine rupture was repaired surgically; the patients were discharged after blood transfusion, and their condition resolved. In all, 3 patients in the non-scar group and 1 patient in the scar group were transferred to the intensive care unit (ICU). All 15 patients were discharged after treatment. Follow-up was completed by all patients for 12 to 36 months, with an average follow-up time of 23.09 ± 2.19 months. Of the 15 patients, 2 underwent induced abortion after 24 months due to unplanned pregnancy. A 5-minute Apgar score of ≤7 in the scar group was higher than that in the non-scar group, but the difference was not statistically significant (P > .05). Perinatal mortality in the 15 patients was 40.00% (6/15).The most common clinical features in patients with complete uterine rupture in the second and third trimester of pregnancy included abdominal pain, inability to lie flat, hemorrhagic shock, prenatal vaginal bleeding and uterine rupture, mostly occurring in the lower segments of the uterus and cervix. In addition, a remarkably worse maternal-infant prognosis was seen in patients with complete uterine rupture in the second and third trimester of scarless pregnancy compared with patients with complete uterine rupture in the second and third trimester of scarred pregnancy.
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