Injury of the corticobulbar tract in patients with dysarthria following cerebral infarct: diffusion tensor tractography study

Objectives: Little is known about injury of the corticobulbar tract (CBT) in stroke patients. We attempted to investigate injury of the CBT in patients with dysarthria following cerebral infarct, using diffusion tensor tractography (DTT). Methods: Eight patients with dysarthria following a corona radiata infarct and 12 control subjects were recruited for this study. Diffusion tensor imaging was performed at 14.3 days after onset and reconstruction of the CBT was performed using the probabilistic tractography method. Fractional anisotropy, mean diffusivity, and tract volume of the CBT were measured. Results: Reconstructed CBTs in the affected hemisphere of the patient group were thinner than those of the unaffected hemisphere of the patient group and the control group. Regarding the DTT parameters of the CBTs, fractional anisotropy and tract volume were significantly lower in the affected hemisphere of the patient group than in the unaffected hemisphere of the patient group and the control group (p < 0.05). However, we did not observe any difference in the mean diffusivity value (p > 0.05). Conclusions: We demonstrated injury of the CBT in patients with dysarthria following cerebral infarct in the corona radiata using DTT. This result indicates the importance of CBT evaluation for dysarthria in patients with cerebral infarct. Therefore, we suggest that evaluations of the CBT using DTT would be useful for patients with dysarthria following cerebral infarct.     

Reproduction of Female Lower Urinary Tract Symptoms on Urodynamics

Objectives: Urodynamic testing (UDS) can be a valuable tool in the assessment of urinary incontinence and voiding dysfunction. The success of UDS in reproducing patients' symptoms has not been well defined. We sought to determine the ability of UDS to reliably reproduce various lower urinary tract symptoms and secondarily the ability of UDS to produce disparate findings not associated with patients presenting symptoms. Methods: Following Institutional Review Board approval, patient data was accumulated prospectively over 10 months. Notation was made of primary and secondary symptoms as well as if these stated symptoms were reproduced during the urodynamic procedure. Presenting lower urinary tract symptoms included for analysis were stress, mixed and urge incontinence, urgency, and obstructive symptoms. We also reviewed the number of disparate urodynamic observations that did not correlate with patient history. Results: Over a 10‐month period, 127 women had interpretable data with respect to whether their presenting symptoms were reproduced during UDS. Presenting symptoms were successfully reproduced on 83% of UDS studies. Disparate urodynamic observations were noted in 60% of patients. Conclusions: Reproduction of patient symptoms during UDS occurred in the majority of cases if the patient was queried regarding this association. Additional disparate urodynamic observations were also noted in a majority of patients undergoing UDS. It remains unclear whether reproduction of symptoms during UDS in females ultimately results in improved interventional outcomes. The implications of new or unexpected UDS findings during UDS are unknown.     

Male Lower Urinary Tract Symptoms: Hypertension as a Risk Factor for Storage Symptoms,but Not Voiding Symptoms

Objective: Both the presence of lower urinary tract symptom (LUTS) and that of hypertension (HT) increase with age. We investigated the associations between male LUTS and HT, and also whether α1‐blockers could allow for the alteration of symptoms. Methods: The subjects comprised 10 744 men with LUTS in a multicenter Japan‐Tamsulosin International Prostate Symptom Score (IPSS) Survey to assess the long‐term effects of α1‐blockers. A total of 4828 men (mean age, 68.5 years) who received a 12‐week administration of tamsulosin (0.2 mg/day) were assessed using IPSS and quality of life (QOL) surveys before and after tamsulosin administration. Data were collected by self‐administered questionnaires including age, complete history and IPSS at the initial visit. Results: HT was a more common comorbidity (25.9%) than diabetes mellitus (9.9%) or cardiac disease (7.2%). The presence of HT increased significantly with the degree of frequency (mild, 21%; severe, 29%) and nocturia (mild, 23%; severe, 28%), but did not increase with the degree of urgency. Tamsulosin significantly improved all storage and voiding symptoms in every age group above 40 years. The effect of tamsulosin on storage symptoms was more prominent in patients with HT than in patients without it. Concerning voiding symptoms, however, tamsulosin was as effective in patients with HT as it was in patients without HT. Conclusion: HT represents a risk factor for the increased frequency and severity of storage symptoms and it also influences the efficacy of α1‐blockers.     

Labial Adhesion with Acute Urinary Retention Secondary to Bartholin's Abscess

Labial adhesions are usually seen in early childhood or in the postmenopausal years, but this clinical entity is rarely seen in the reproductive years. We report a case of labial adhesion with acute urinary retention secondary to Bartholin's abscess in a reproductive‐aged woman with normal menstrual periods. We emphasize the possible occurrence of labial adhesion following Bartholin's abscess in the reproductive years with normal estrogen levels.     

Effects of Diesel Vehicle Emissions of Polycyclic Aromatic Hydrocarbons on the Surrounding Environment and Residents

Ten stations alongside major thoroughfares were selected as exposure sites, while a small village located about 3 kilometers away from a main traffic route was selected as the control site. The concentrations of particulate matters with aerodynamic less than 2.5 μm (PM_2.5) and elemental carbon (EC) at exposure sites were both higher than those at the control site. Daytime mean concentrations of total polycyclic aromatic hydrocarbons (t-PAHs), carcinogenic PAHs (car-PAHs), and Benzo(a)pyrene-equivalent dose (BaP_eq) at exposure sites were all about twice as high as those at the control site. A significant relationship between t-PAHs and EC was found, suggesting that most of the t-PAHs at exposure sites were contributed by diesel exhaust. Furthermore, the diagnostic ratios also show that diesel emissions were the dominant sources of PAHs at exposure sites. A multiple linear regression was applied to urinary 1-hydroxyprene (1-OHP) using four variables (exposure status, sex, smoker status, and incense burning) as independent variables. The results showed that the concentrations of 1-OHP in exposure groups were significantly (p < 0.001) higher than those in the control group. The explainable percentage for exposure status was 91.1%, indicating that the exposure factor, in comparison with other factors, has a dominant contribution to the concentration of 1-OHP. After subtracting the background levels of 1-OHP, the levels of urinary 1-OHP for residents exposed to the exhaust of 100 vehicles were about 0.062 μg/g creatinine.     

Montelukast in the treatment of asthma as a systemic disease

Asthma affects 300 million people worldwide. The common association of asthma with allergic rhinitis and the presence of proinflammatory mediators in the circulation of patients provide strong evidence for the need to treat asthma as a systemic disease. The leukotriene receptor antagonist montelukast is a disease-specific oral medication that has dual effects on airway smooth muscle cells and inflammatory processes. This review describes recent randomized, controlled studies of montelukast in asthma and allergic rhinitis in adults and children as young as 3 months old. Montelukast treatment consistently produced significant reductions in asthma exacerbations. While many patients may benefit from montelukast as monotheray, combination treatment for chronic asthma with inhaled corticosteroids is advocated as being rational. Significant improvements in symptoms and quality of life were observed in allergic rhinitis patients. Montelukast is well tolerated in patients of all ages. Long-term studies are underway to determine its effects on airway remodeling.     

Gall Stone Ileus with Acute Kidney Injury—A Case Report

Abstract

Gall stone ileus is a rare serious complication of cholelithiasis. We report a case of cholecystoduodenal fistula presenting as gall stone ileus with acute kidney injury which was managed successfully.     

蔡妙珊治疗泌尿系结石经验

蔡妙珊教授认为泌尿系结石病机多为脾肾气虚为本,湿热气滞血瘀为标,治疗常用清热利湿、通络、补虚三法,自拟金石芍苓汤,融三法于一方,疗效较好。同时结合针刺、穴位注射、总攻疗法及综合疗法等,缩短治疗周期,加快排石,促进中、大型结石的排出,疗效显著。     

Antenatal screening and fetal intervention

Congenital malformations are a common cause of reduced life expectancy and disability and can affect all body systems. Therefore, they are relevant to all surgeons. One in fifty children will have a major or significant congenital anomaly at birth. Since the advent of antenatal ultrasound (US) there has been the potential to diagnose many congenital anomalies before birth. This can forewarn parents and clinicians, so that treatment can be started promptly following birth rather than waiting for the baby to become symptomatic. It has also raised the possibility of treatment in-utero with the goal of stopping or reversing the pathological effects of the anomaly on the developing tissues, which will, hopefully, reduce morbidity and mortality once the baby is born and thus improve outcomes. This article focuses on congenital anomalies relevant to surgeons, initially looking at screening and diagnosis and how this may affect treatment and surgery following delivery. The second part will look at some of the interventions that have been attempted to treat ‘surgical’ congenital anomalies in-utero.