Objective To discuss the video-urodynamic characteristics and management in infra-sacral cord injured patients. Methods The video-urodynamic finding and managements in 169 patients was reviewed. They were followed up for 2 years. Results Detrusor areflexia was found in 76.33% (129/169) patients, among them there were 27.22% (46/169) patients appeared hyper-compliance, and 7.10% (12/169) patients appeared reflux. The video-urodynamic characteristics showed over activity and low-compliance in 12.43% (21/169) patients, including reflux in 5 cases. Different management was chosen according to the video-urodynamic examination. No special complication was observed after 2 years follow-up. Conclusion The majority patients with infra-sacral cord injury appeared detrusor areflexia and hyper-compliance. Special management according to the video-urodynamic characteristics is important for protecting upper urinary tract and preventing urinary system infection.

Objective To evaluate the effectiveness and safety of Botulinum toxin-A (BTX-A) injection into detrusor to treat neurogenic detrusor overactivity in patients with spinal cord injury (SCI).Methods A total of 78 patients with SCI were treated with transurethral injection of BTX-A (300 IU dissolved in 15 ml of saline) into 30 different points of detrusor with 15 ml in every patients. Urodynamic parameters and voiding diary were assessed at baseline and 3 weeks and 3 months after the injections. Adverse events were recorded after the injection if present.Results After the first injection, 78 patients showed that the mean frequencies of incontinence decreased from 13.5 to 2.7 times per day, the mean volume of intermittent catheterization (IC) increased from 131 ml to 389 ml per time, the mean volume of incontinence decreased from 1 690 ml to 281 ml per day, the mean getting effect time was 7.6 days. 10 patients received second injection at 8.9 months after first injection, the results showed that the mean frequencies of incontinence decreased from 9.7 to 3.7 times per day, the mean IC volume increased from 108 ml to 387 ml. 6 patients received third injection at 5.8 months after second injection, the results showed that the mean frequencies of incontinence decreased from 9.2 to 3.9 times per day, the mean IC volume increased from 116 ml to 364 ml. No side effects were observed during the follow-up.Conclusion BTX-A injection into detrusor to treat neurogenic detrusor overactivity in patients with SCI seems to be an effective, safe and miniinvasive solution.

Objective To explore the technique,efficacy and complications of external sphincterotomy with Holmium laser for the treatment of detrusor external sphincter dyssynergia (DSD). Methods 7 male cases with neurogenic DSD who received the procedure were reported. Results All patients got significant improvement after the operation in symptoms,laboratory,imaging and urodynamic index. No one required transfusion. 1 case lost the erection. There was no need of re-operation during the follow-up. Conclusion External sphincterotomy with Holmium laser for the treatment of DSD shows the advantages of less bleeding,safety and good effectiveness for the well selected patients.

ObjectiveTo observe the effects of intravesical electric stimulation (IVES) on bladder sensation of neurogenic bladder.Methods28 patients with neurogenic bladder was evaluated, which all underwent intravesical bladder stimulation. Their bladder sensation were analyzed before and after the treatment.Results57.1% of the patients increased bladder sensation after treatment, 32.1% appeared the first sensation and urge sensation after treatment, 42.9% remained stable.ConclusionIntravesical bladder stimulation is effective to improve bladder sensation in a majority of the patients with neurogenic bladder.

ObjectiveTo study risk factors of urinary calculus formation in spinal cord injured patients. MethodsThe clinical data of 128 patients with spinal cord injury following urinary calculi were retrospectively reviewed.ResultsAmong the 128 cases, there were 32 cases receiving bladder stoma; 34 cases, regular replacement of indwelling catheter; 12 cases, intermittent catheterization; 19 cases, triggered reflex voiding; 11 cases, voiding by abdominal straining; 20 cases, condom catheters with urine collection devices. 120 cases presented with urinary tract infection, and 11 cases presented serum calcium increase. Video urodynamic suggested detrusor areflexia in 39 cases, detrusor overactivity in 63 cases, detrusor external sphincter dyssynergia in 41 cases, detrusor bladder neck dyssynergia in 11 cases, external urethral sphincter overactivity in 27 cases, and urethral sphincter deficiency in 11 cases. The pathology of several physiological conditions coexisted in some patients.ConclusionBladder management after spinal cord injury have a major impact on urinary stones formation. Low urinary tract infection, detrusor-urethral sphincter dyssynergia and other lower urinary tract dysfunction, long-term indwelling urinary catheter and cystostomy were main risk factors for urinary calculus formation. The abnormal calcium metabolism after spinal cord injury may be a risk factor for calculus formation.

Objective To investigate the effect of Holmium laser urethrotomy under ureteroscopy on urethral stricture.Methods 30 men with urethral stricture who accepted urethrotomy with Holmium laser under ureteroscopy were observed.Results Operation was performed successfully in 21 cases;7 cases underwent 2～3 endoscopic surgical treatments.Endoscopic surgical treatment failed in 2 cases,and open surgery were performed on them.21 cases were followed up for 3～37 months,and 8 of them need urethral dilatation termly.Conclusion Endoscopic surgery with ureteroscopy and Holmium laser may be effective on urethral stricture with slight trauma.

Objective To assess the incidence of urinary tract infection after urodynamic studies for spinal cord injury patients. Methods 86 patients with spinal cord injury were underwent urodynamic studies,all paients were undertaken uronoscopy and urine culture before and after urodynamic studies. Group A applied no special treatment after urodynamic studies, group B applied preventive antibiotic treatment. Results The incidence rate of urinary tract infection after urodynamic studies in group A was 8.81%, 7.32 % in group B. There was no significant difference between two groups. Conclusion Urodynamic studies are safe, well-tolerated procedures, need not use prophylactic antibiotic after urodynamic studies.

Objective To explore the technique, efficacy and complications of transurethral sphincterotomy with Holmium laser for the treatment of male patients with neurogenic bladder and examine its long-term outcome. Methods 20 male cases who received transurethral sphincterotomy with Holmium laser were included in this retrospective analysis, in which 7 cases injuried at cervical spinal cord, 6 at thoracic spinal cord, 3 at cauda equine; 1 was spinal meningocele, 1 was sacral crack, 1 was ependymoma, and 1 was myelitis sequel. The age was 20~64 years, averaged 45.1 years. They were followed up for 3~95 months (averaged 43.6 months) since the last sphincterotomy. Results The 20 patients significantly improved in symptoms, laboratory examination, imaging demonstration and urodynamic index after the operation.There were 3 patients who required repeated laser surgery during the follow- up. 17 patients were stable. Conclusion Transurethral sphincterotomy with Holmium laser is effective on neurogenic bladder with less bleeding for the appropriately selected patients.

OBJECTIVETo investigate the administration of far lateral craniocervical approach in the jugular foramen (JF) tumors.

METHODSA retrospective analysis was performed in 14 cases of JF tumors (9 neurilemmomas, 3 meningiomas, 1 glomus jugulare tumor, and 1 adenoid cystic carcinoma) surgically treated between January 2009 and January 2012, with focus on the surgical approach. Six patients (6/14) showed hydrocephalus. The tumor type was composed of 5 intracranial and intraforamen tumors with patent or occluded jugular bulb, 1 intracranial tumor with extension into the upper cervical canal, 4 extracranial and intra foramen tumors, 4 intra- and extracranial dumbbell-shaped communicating tumors involving the parapharyngeal space above C2 or extending caudally below C3. Far lateral postcondylar approach (FLPC) was carried out in 2 cases, far lateral tansjugular process approach (FLTJP) in 3 cases, combined FLPC + C1-2 semi-laminectomy approach in 1 case, combined FLTJP + trans-C1 transverse process approach in 7 cases, and combined FLTJP + neck approach with dissection of carotid sheath to the skull base in 1 case. Endovascular embolotherapy prior to surgical resection was performed in 1 glomus jugulare tumor.

RESULTSTotal tumor removal was achieved in 12 patients and subtotal removal in 2 patients, with no cerebrospinal fluid leakage or operative mortality. New cranial nerve paresis occurred after surgery in 1 case of facial nerve and 1 case of lower cranial nerve. Transient worsening of preoperative lower cranial nerve deficits was noted in 3 patients. Long-term follow-up study ranging from 5 to 32 months (average 13.7 months) showed 7 patients with lower cranial nerve deficits (6 preexisting and 1 new), with exception of one preoperative lower cranial nerve dysfunction due to the infiltration of an adenoid cystic carcinoma, experienced favorable improvement with recovery of adequate swallowing function, but voice disturbance remained in 4 cases. One patient with new facial nerve deficit presented with partial improvement and the hydrocephalus in 6 patients all spontaneously regressed. There was no tumor recurrence in patients receiving total removal and no tumor progression in patients undergoing subtotal removal.

CONCLUSIONSFLTJP is a basic approach for JF tumors. The combined cranial and cervical approach should be considered in those tumors extending into the upper cervical canal and parapharyngeal space. The associated hydrocephalus seldom requires additional surgical management.

Adult ; Aged ; Brain Neoplasms ; surgery ; Female ; Follow-Up Studies ; Glomus Jugulare Tumor ; surgery ; Humans ; Male ; Microsurgery ; Middle Aged ; Retrospective Studies ; Skull Base ; surgery

The chemical constituents of 95% ethanol extract of Melastoma dodecandrum were isolated and purified by chromatography on silica gel, Sephadex LH-20, and HPLC, to obtain thirteen compounds eventually. On the basis of their physico-chemical properties and spectroscopic data, these compounds were identified as quercetin (1), quercetin-3-O-β-D-glucopyranoside (2), quercetin-3-O-(6"-O-p-coumaroyl) -β-D-glucopyranoside (3), kaempferol (4), kaempferol-3-O-β-D-glucopyranoside (5), kaempferol-3-O- [2",6"-di-O-(E)-coumaroyl]-β-D-glucopyra-noside (6), luteolin (7), luteolin-7-O-(6"-p-coumaroyl) -β-D-glucopyranoside (8), apigenin (9), apigenin-7-(6"-acetyl-glucopyranoside) (10) , naringenin (11), isovitexin (12), and epicatechin-[8,7-e] -4β-(4-hydroxyphenyl)-3,4-dyhydroxyl-2(3H)-pyranone (13). Eight compounds(3,5,6,8-11 and 13) were obtained from M. dodecandrum for the first time.
Apigenin ; analysis ; Chromatography ; methods ; Chromatography, High Pressure Liquid ; Dextrans ; Flavanones ; analysis ; Flavonoids ; analysis ; chemistry ; Glycosides ; analysis ; chemistry ; Kaempferols ; analysis ; Luteolin ; analysis ; Magnoliopsida ; chemistry ; Plants, Medicinal ; chemistry ; Quercetin ; analysis ; Silica Gel