Treatment of lumbar disc herniation with robot combined with unilateral biportal endoscopic technology:A case report

BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment,and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement.The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies,and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients,and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference.CASE SUMMARY A 44-year-old patient presented to our hospital.Combining various clinical data,we diagnosed the patient with lumbar disc herniation with radiculopathy,lumbar spondylolisthesis,and lumbar spinal stenosis.We developed a surgical plan of"UBE decompression+UBE-LIF+orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation".The results were satisfactory.CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results.Therefore,the technique is worthy of clinical promotion.

Symmetry of upper eyelid after unilateral blepharoptosis repair with minimally invasive conjoint fascial sheath suspension technique

AIM:To investigate the symmetry of upper eyelid in patients with unilateral mild and moderate blepharoptosis who underwent unilateral minimally invasive combined fascia sheath(CFS)suspension.METHODS:A retrospective study of patients who underwent unilateral minimally invasive CFS suspension surgery between January 2018 and December 2021.Inclusion criteria included unilateral mild and moderate ptosis,good levator muscle function(>9 mm)and follow-up of at least 6mo.Pre-and post-operative symmetry was graded subjectively for marginal reflex distance 1(MRD1),tarsal platform show(TPS)and eyebrow fat span(BFS).A t-test was used to evaluate MRD1,TPS and BFS asymmetry by calculating delta values.The Bézier curve tool of the Image J software was used to extract the upper eyelid contours,where the symmetry was measured by the percentage of overlapping curvatures(POC).RESULTS:Totally 105 patients(105 eyelids)were included(mild group,n=84;moderate group,n=21).Postoperatively,all patients increased MRD1 and decreased TPS in the ptotic eye while maintaining unchanged BFS.The asymmetric delta value for MRD1 was measured to be 1.48±0.86 preoperatively,and it decreased to 0.58±0.67 postoperatively in all cases(P=0.0004).In patients with mild ptosis,the asymmetry value of TPS fell significantly from 1.15±0.62 to 0.68±0.38(P=0.0187).The symmetry of the upper eyelid contour increased in all subgroups of patients,with a POC of 59.39%±13.45%preoperatively and POC of 78.29%±13.80%postoperatively.CONCLUSION:Minimally invasive CFS suspension is proved to be an effective means of improving the symmetry of unilateral ptosis in terms of MRD1(all subgroups),POC(all subgroups)and TPS(only mild group),whereas BFS is unaffected.

Effects of unilateral superimposed high-frequency jet ventilation on porcine hemodynamics and gas exchange during one-lung flooding

BACKGROUND Superimposed high-frequency jet ventilation(SHFJV)is suitable for respiratory motion reduction and essential for effective lung tumor ablation.Fluid filling of the target lung wing one-lung flooding(OLF)is necessary for therapeutic ultrasound applications.However,whether unilateral SHFJV allows adequate hemodynamics and gas exchange is unclear.AIM To compared SHFJV with pressure-controlled ventilation(PCV)during OLF by assessing hemodynamics and gas exchange in different animal positions.METHODS SHFJV or PCV was used alternatingly to ventilate the non-flooded lungs of the 12 anesthetized pigs during OLF.The animal positions were changed from left lateral position to supine position(SP)to right lateral position(RLP)every 30 min.In each position,ventilation was maintained for 15 min in both modalities.Hemodynamic variables and arterial blood gas levels were repeatedly measured.RESULTS Unilateral SHFJV led to lower carbon dioxide removal than PCV without abnormally elevated carbon dioxide levels.SHFJV slightly decreased oxygenation in SP and RLP compared with PCV;the lowest values of PaO_(2) and PaO_(2)/FiO_(2) ratio were found in SP[13.0;interquartile range(IQR):12.6-5.6 and 32.5(IQR:31.5-38.9)kPa].Conversely,during SHFJV,the shunt fraction was higher in all animal positions(highest in the RLP:0.30).CONCLUSION In porcine model,unilateral SHFJV may provide adequate ventilation in different animal positions during OLF.Lower oxygenation and CO_(2) removal rates compared to PCV did not lead to hypoxia or hypercapnia.SHFJV can be safely used for lung tumor ablation to minimize ventilation-induced lung motion.

Unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection in Stage II non-seminomatous germ cell tumor:A tertiary care experience

Objective Post-chemotherapy retroperitoneal lymph node dissection(PC-RPLND)represents an integral component of the management of patients with non-seminomatous germ cell tumor(NSGCT).Modified templates have been proposed to minimize the surgical morbidity of the procedure.Moreover,the implementation of robotic surgery in this setting has been explored.We report our experience with unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection(PC-rRPLND)for clinical Stages IIA and IIB NSGCTs.Methods A retrospective single institution review was performed including 33 patients undergoing PC-rRPLND for Stages IIA and IIB NSGCTs between January 2015 and February 2019.Following orchiectomy,patients were scheduled for chemotherapy with three cycles of bleomycin-etoposide-cisplatin.Patients with a residual tumor of<5 cm and an ipsilateral metastatic disease on pre-and post-chemotherapy CT scans were eligible for a unilateral template in absence of rising tumor markers.Descriptive statistics were provided for demographics,clinical characteristics,intraoperative and postoperative parameters.Perioperative,oncological,and functional outcomes were recorded.Results Overall,7(21.2%)patients exhibited necrosis or fibrosis;14(42.4%)had mature teratoma;and 12(36.4%)had viable tumor at final histology.The median lymph node size at surgery was 25(interquartile range[IQR]21-36)mm.Median operative time was 180(IQR 165-215)min and no major postoperative complications were observed.Anterograde ejaculation was preserved in 75.8%of patients.Median follow-up was 26(IQR 19-30)months and a total of three recurrences were recorded.Conclusion PC-rRPLND is a reliable and technically reproducible procedure with safe oncological outcomes and acceptable postoperative ejaculatory function in well selected patients with NSGCTs.

Modified unilateral periureteral injection technique in the treatment of patients with high-grade vesicoureteral reflux: A study of primary findings

Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outcomes of unilateral periureteral injection technique(PIT),as well as bilateral PIT in high-grade VUR.Methods:In this prospective study,we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018.Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units,respectively.In the unilateral PIT,the subureteral injection site was only at the 5-or 7-o’clock position.However,in the bilateral PIT,the subureteral injection sites were at 5-and 7-o’clock position.Pre-and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery.Results:Seven patients had bilateral reflux.Overall,75(81.5%)ureters showed Grade IV VUR,while 17(18.5%)had primary Grade V VUR.The mean age of the subjects was 39.2 months.In unilateral PIT ureters,VUR was resolved in 23(92.0%)refluxing units.It was downgraded to Grade III in one ureter(4.0%)and to Grade II in another ureter(4.0%).In addition,in bilateral PIT cases,VUR was resolved in 60(89.6%)ureters;it downgraded to Grades II and III in 3(4.5%)and 4(6.0%)refluxing units,respectively.Conclusion:Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR.However,further studies are needed to confirm our results.

Recurrence of unilateral angioedema of the tongue:A case report

BACKGROUND Angioedema is a disorder characterized by edema of the face,lips,tongue,and extremities due to increased vascular permeability.Angioedema of the tongue usually occurs bilaterally,and the incidence of unilateral angioedema of the tongue is rare.This study reports a rare case of unilateral angioedema of the tongue with no identifiable cause and repeated recurrence even after discontinuation of an angiotensin-converting enzyme inhibitor.CASE SUMMARY The patient was a 65-year-old woman with pre-existing hypertension and hyperlipidemia and had been receiving 20 mg/d of lisinopril.She was diagnosed with angioedema due to unilateral swelling of the tongue.No airway obstruction was observed,and the symptoms improved following the administration of 0.3 mg of epinephrine intramuscularly and 125 mg of methylprednisolone intravenously.Although lisinopril was discontinued,unilateral angioedema of the tongue continued to recur every 2-5 mo,with the symptoms improving following the administration of prednisolone and an antihistamine.Daily oral administration of 500 mg of tranexamic acid after dinner prevented the recurrence of angioedema.CONCLUSION Careful monitoring and identification of the underlying mechanism play a crucial role in the treatment of angioedema.

Clinical Study on Treatment of Type II/III Lumbar Brucellar Spondylitis by Unilateral Biportal Endoscopy

Objective: Explore the feasibility and clinical efficacy of using unilateral biportal endoscopy for the treatment of Type II/III lumbar brucellar spondylitis. Methods: A retrospective study of the clinical data of 20 patients with Type II/III lumbar brucellar spondylitis admitted to the First Affiliated Hospital of Hebei North University from January 2020 to May 2022, including 15 males and 5 females, aged 41 - 60 years old, average age (48.11 ± 7.28) years old. After admission, the patient can isolate brucella through metagenomic Next-Generation Sequencing (mNGS), meeting the tertiary diagnostic criteria. Preoperative conventional drug treatment, unilateral biportal endoscopic minimally invasive surgery was performed when nutrition was improved, perioperative control of various indexes was stable, and erythrocyte sedimentation was declining. It was completed under an endoscope. The lesion was cleared, spinal nerve compression was relieved, interbody fusion was performed, and the spine was fixed by a percutaneous pedicle screw. Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were analyzed at 1 month, 3 months, 6 months and the last follow-up. At the final follow-up of all patients, the clinical efficacy criteria and the Bridwell grading criteria were used to evaluate the recovery and intervertebral bone graft fusion, respectively. Results: All patients’ lower back and leg pain was relieved the next day after surgery. At a follow-up of one month after surgery, both systemic and local symptoms significantly improved. At the last follow-up, clinical symptoms disappeared and there was no tenderness or percussion pain in the local area. With the passage of time, 1 month, 3 months, 6 months after the operation, and the last follow-up are all evaluation indicators compared with those before the operation. No matter VAS, JOA, ODI score, or ESR, CRP is significantly improved compared with preoperative (P All 20 cases in this group reached the BS clinical cure standard, and the excellent rate of intervertebral bone graft fusion was 95%. Conclusion: On the basis of .

Symmetry and Hojman Conserved Quantity of Tznoff Equations for Unilateral Holonomic System

Symmetry of Tzénoff equations for unilateral holonomic system under the infinitesimal transformationsof groups is investigated.Its definitions and discriminant equations of Mei symmetry and Lie symmetry of Tzénoffequations are given.Sufficient and necessary condition of Lie symmetry deduced by the Mei symmetry is also given.Hojman conserved quantity of Tzénoff equations for the system above through special Lie symmetry and Lie symmetryin the condition of special Mei symmetry respectively is obtained.

Mei symmetry and Mei conserved quantity of nonholonomic systems with unilateral Chetaev type in Nielsen style

This paper studies the Mei symmetry and Mei conserved quantity for nonholonomic systems of unilateral Chetaev type in Nielsen style. The differential equations of motion of the system above are established. The definition and the criteria of Mei symmetry, loosely Mei symmetry, strictly Mei symmetry for the system are given in this paper. The existence condition and the expression of Mei conserved quantity are deduced directly by using Mei symmetry. An example is given to illustrate the application of the results.

Contrast-free air cholangiography-assisted unilateral plastic stenting in malignant hilar biliary obstruction

BACKGROUND:Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP),whereas contrast injection leads to cholangitis.Contrast-free metal stenting with or without magnetic resonance cholangiopancreatography (MRCP) has shown encouraging results,but MRCP and metal stents are costly.There have been no reports on the use of air cholangiography.METHODS:We prospectively evaluated the role of air cholangiography-assisted unilateral plastic stenting in 10 patients with type Ⅱ malignant hilar biliary obstruction.A retrospectively analysed group of 10 patients treated with contrast-free unilateral metal stenting served as historical controls.RESULTS:Ten patients with unresectable type Ⅱ malignant hilar biliary obstruction were studied.Air cholangiography detected type Ⅱ obstruction in all patients,similar to MRCP.The patients underwent unilateral stenting.Successful endoscopic drainage was achieved in all patients.The mean patency of the stent was 95.8±17.5 days in the study group and 143.9±115.1 days in the control group (P=0.20).The mean survival was 121.8±41.6 days in the study group and 154.9±122.5 days in the control group (P=0.42).KaplanMeier analysis showed an estimated median survival of 100:95% CI (65.9,134.1) days in the study group and 98:95% CI (84.1,111.9) days in the control group (P=0.62).Cholangitis occurred in none of the patients and there were no 30-day deaths nor major complications.Air cholangiographyassisted unilateral plastic stenting was cheaper than contrastfree unilateral metal stenting.CONCLUSION:Air cholangiography-assisted unilateral plastic stenting is as safe and effective as contrast-free unilateral metal stenting in type Ⅱ malignant hilar biliary obstruction for palliating patients,but it is cheaper.

Lie-form invariance of non-holonomic systems with unilateral constraints

In this paper the Lie-form invariance of the non-holonomic systems with unilateral constraints is studied. The definition and the criterion of the Lie-form invariance of the system are given. The generalized Hojman conserved quantity and a new type of conserved quantity deduced from the Lie-form invariance are obtained. Finally, an example is presented to illustrate the application of the results.

Heavy oil component characterization with multi-dimensional unilateral NMR

Heavy oil is a complicated mixture and a potential resource and has attracted much attention since the end of last century. It is important to characterize the composition of heavy oil to enhance its recovery efficiency. A designed unilateral Nuclear Magnetic Resonance （NMR） sensor with a Larmor frequency of 20 MHz and a well-defined constant gradient of 23.25 T/m was employed to acquire three- dimensional （3D） data for three heavy oil samples. The highly-constant gradient is advantageous for diffusion coefficient measurement of heavy oil. A fast data-implementation procedure including specially designed 3D pulse sequence and Inversion Laplace Transform （ILT） algorithm was adopted to process the data and extract 3D T1-D-T2 probability function. It indicates that NMR relaxometry and diffusometry are useful to characterize the components of heavy oil samples. NMR results were compared with independent measurements of fractionation and gas chromatography analysis.

A DIFFERENTIAL GEOMETRIC DESCRIPTION FOR TIME-INDEPENDENT CHETAEV'S NONHOLONOMIC MECHANICAL SYSTEM WITH UNILATERAL CONSTRAINTS

By applying the framework of the tangent bundle geometry to the method of Lagrange multi- pliers,a geometric description of Chetaev's nonholonomic systems subjected to unilateral nonholonomic con- straints trod unilateral holonomic constraints respectively in time-independent circumstances is presented.

A type of new conserved quantity deduced from Mei symmetry for Appell equations in a holonomic system with unilateral constraints

A type of new conserved quantity deduced from Mei symmetry of Appell equations for a holonomic system with unilateral constraints is investigated. The expressions of new structural equation and new conserved quantity deduced from Mei symmetry of Appell equations for a holonomic system with unilateral constraints expressed by Appell functions are obtained. An example is given to illustrate the application of the results.

Combined intra-arterial chemotherapy and intravitreal melphalan for the treatment of advanced unilateral retinoblastoma

●AIM:To evaluate the efficacy and safety of combined intraarterial chemotherapy(IAC)and intravitreal melphalan(IVM)for the treatment of advanced unilateral retinoblastoma.●METHODS:This retrospective study involved 30 consecutive eyes from 30 Chinese patients with advanced unilateral retinoblastoma.All patients were initially treated with IAC combined with IVM.The clinical status and complications were recorded at each visit.●RESULTS:The International Intraocular Retinoblastoma Classification groups were D in 23 eyes and E in 7 eyes.All eyes showed severe cloud vitreous seeds at the first visit.The mean number of IAC cycles and intravitreal injections was 3.2(range,3-4)and 6(range,1-14),respectively.The median follow-up time was 29 mo(range,7-36 mo).Treatment success with regression of the retinal tumor and vitreous seeds was achieved in 29 of 30 eyes(96.7%).Globe salvage was attained in 93.3%(28/30)eyes,and enucleation(n=2)was per formed due to neovascular glaucoma and persistent vitreous hemorrhage.Complications included retinal pigment epithelium(RPE)atrophy(n=13;43%),mild lens opacity(n=7;23%),vitreous hemorrhage(n=5;17%)and rhegmatogenous retinal detachment(n=1;3%).No extraocular tumor extension or metastasis occurred.●CONCLUSION:Combined IAC and IVM is effective and safe for the treatment of advanced unilateral retinoblastoma.

GFAP expression in the optic nerve and increased Н2S generation in the integration centers of the rainbow trout（Oncorhynchus mykiss） brain after unilateral eye injury

Hydrogen sulfide(H2S)is considered as a protective factor against cardiovascular disorders.However,there are few reports on the effects of H2S in the central nervous system during stress or injury.Previous studies on goldfish have shown that astrocytic response occurs in the damaged and contralateral optic nerves.Glial fibrillary acidic protein(GFAP)concentration in the optic nerves of rainbow trout has not been measured previously.This study further characterized the astrocytic response in the optic nerve and the brain of a rainbow trout(Oncorhynchus mykiss)after unilateral eye injury and estimated the amount of H2S-producing enzyme cystathionineβ-synthase(CBS)in the brain of the rainbow trout.Within 1 week after unilateral eye injury,a protein band corresponding to a molecular weight of 50 kDa was identified in the ipsi-and contralateral optic nerves of the rainbow trout.The concentration of GFAP in the injured optic nerve increased compared to the protein concentration on the contralateral side.The results of a quantitative analysis of GFAP+cell distribution in the contralateral optic nerve showed the largest number of GFAP+cells and fibers in the optic nerve head.In the damaged optic nerve,patterns of GFAP+cell migration and large GFAP+bipolar activated astrocytes were detected at 1 week after unilateral eye injury.The study of H2S-producing system after unilateral eye injury in the rainbow trout was conducted using enzyme-linked immunosorbent assay,western blot analysis,and immunohistochemistry of polyclonal antibodies again st CBS in the integrative centers of the brain:telencephalon,optic tectum,and cerebellum.Enzyme-linked immunosorbent assay results showed a 1.7-fold increase in CBS expression in the rainbow trout brain at 1 week after unilateral eye injury compared with that in intact animals.In the ventricular and subventricular regions of the rainbow trout telencephalon,CBS+radial glia and neuroepithelial cells were identified.After unilateral eye injury,the number of CBS+neuroepithelial cells in the pallial and subpallial periventricular regions of the telencephalon increased.In the optic tectum,unilateral eye injury led to an increase in CBS expression in radial glial cells;simultaneously,the number of CBS+neuroepithelial cells decreased in intact animals.In the cerebellum of the rainbow trout,neuroglial interrelationships were revealed,where H2S was released,apparently,from astrocyte-like cells.The organization of H2S-producing cell complexes suggests that,the amount of glutamate produced in the rainbow trout cerebellum and its reuptake was controlled by astrocyte-like cells,reducing its excitotoxicity.In the dorsal matrix zone and granular eminences of the rainbow trout cerebellum,CBS was expressed in neuroepithelial cells.After unilateral eye injury,the level of CBS activity increased in all parts of the cerebellum.An increase in the number of H2S-producing cells was a response to oxidative stress after unilateral eye injury,and the overproduction of H2S in the cerebellum occurred to neutralize reactive oxygen species,providing the cells of the rainbow trout cerebellum with a protective effect.A structural reorganization in the dorsal matrix zone,associated with the appearance of an additional CBS+apical zone,and a decrease in the enzyme activity in the dorsal matrix zone,was revealed in the zones of constitutive neurogenesis.All experiments were approved by the Commission on Biomedical Ethics,A.V.Zhirmunsky National Scientific Center of Marine Biology(NSCMB),Far Eastern Branch,Russian Academy of Science(FEB RAS)(approval No.1)on July 31,2019.

A type of new conserved quantity deduced from Mei symmetry for Nielsen equations in a holonomic system with unilateral constraints

A type of new conserved quantity deduced from Mei symmetry for Nielsen equations in a holonomic system with unilateral constraints is investigated. Nielsen equations and differential equations of motion for the holonomic mechanical system with unilateral constraints are established. The definition and the criterion of Mei symmetry for Nielsen equations in the holonomic systems with unilateral constraints under the infinitesimal transformations of Lie group are also given. The expressions of the structural equation and a type of new conserved quantity of Mei symmetry for Nielsen equations in the holonomic system with unilateral constraints are obtained. An example is given to illustrate the application of the results.

Reduction in interhemispheric functional connectivity in the dorsal visual pathway in unilateral acute open globe injury patients: a resting-state fMRI study

This study investigated the changes in interhemispheric functional connectivity （FC） of the whole brain in open globe injury （OGI） patients, using voxel-mirrored homotopic connectivity （VMHC）, and their relationships with clinical features. Totally, 16 male and 2 female acute OGI patients and 18 sex, age, and education-matched healthy volunteers were enrolled in the study. All subjects were scanned through functional magnetic resonance imaging （fMRI）. Receiver operating characteristic （ROC） curves analyses had been used to identify the VMHC in these brain areas could be used as biomarkers to distinguish OGI and from healthy control （HC）. The mean VMHC values in multiple brain areas and clinical OGI manifestations were evaluated with a Pearson correlation analysis. OGI patients had significantly decreased VMHC in the bilateral calcarine/lingual/cuneus （BA18, 19, 30） and middle occipital gyrus （BA18, 19）. The OGI patients had abnormal interhemispheric FC in the dorsal visual pathway, which may represent the pathophysiological mechanism that underlies acute vision loss after OGI.

Does crossover innervation really affect the clinical outcome？ A comparison of outcome between unilateral and bilateral digital nerve repair

Digital nerve injuries are the mostly detected nerve injury in the upper extremity. However, since the clinical phenomenon of crossover innervation at some degree from uninjured digital nerve to the in- jured side occurs after digital nerve injuries is sustained, one could argue that this concept might even result in the overestimation of the outcome of the digital nerve repair. With this knowledge in mind, this study aimed to present novel, pure, focused and valuable clinical data by comparing the outcomes of bilateral and unilateral digital nerve repair. A retrospective review of 28 fingers with unilateral or bilateral digital nerve repair using end-to-end technique in 19 patients within 2 years was performed. Weber＇s two-point discrimination, sharp/dull discrimination, warm/cold sensation and Visual Analog Scale scoring were measured at final 12-month follow ups in all patients. There was no significant difference in recovery of sensibility after unilateral and bilateral digital nerve repairs. Though there is crossover innervation microscopically, it is not important in the clinical evaluation period. According to clinical findings from this study, crossover innervations appear to be negligible in the estimation of outcomes of digital neurorrhaphy.

Trabecular bone deterioration at the greater trochanter ol mice with unilateral obstructive nephropathy

Our previous study showed the early molecular responses of bone in response to obstructive nephropathy in a unilateral ureteral obstruction （UUO） mouse model. Here, we addressed the changes in trabecular bone properties at greater trochanter, the proximal and the distal metaphysis of femur in UUO mice. The male mice were subjected to UUO （n= 10） or sham operation （n= 10）. All mice were killed on day 7 after the surgical operation. The micro-computed tomography （micro-CT） analysis for different femoral trabecular bone sites demonstrated pathological alterations of trabecular bone mass and micro-networks at greater trochanter as shown by decreases in bone mineral density/bone volume （P〈O.05） and trabecular number （P〈O.05） and increases in trabecular separation （P〈O.01） and bone surface/bone volume （P〈O.05） in UUO mice. The present study demonstrates that UUO-induced unilateral obstructivenephropathy has markedly detrimental effects on the trabecular trochanter of the femur.