Novel method of primary endoscopic realignment for high-grade posterior urethral injuries:A case report

BACKGROUND A male urethral disruption injury is a urological emergency.Primary endoscopic realignment(PER)refers to reestablishment of urethral alignment via indwelling urethral catheter by cystoscope,which is recommended as the optimal emergent treatment approach for reducing the likelihood of complications following injury.However,the prior literature suggests the success rate of PER to be relatively low due to complicated urethral disruption.We report a modified PER approach that serves to improve both the success rate and safety of the treatment.CASE SUMMARY A 19-year-old male patient presented with multiple pelvic fractures and complete urethral disruption following a high-velocity traffic accident.The patient’s abdominal computed tomography and retrograde urethrography results revealed complete urethral disruption at the bulbar urethra,with hematoma and contrast medium extravasation that extended into the extraperitoneal space.The conventional retrograde PER by cystoscope failed due to severe disruption and considerable hematoma.Modified simultaneous antegrade and retrograde PER was performed by means of semi-rigid ureteroscopy via a suprapubic Foley catheter and cystoscopy via the external urethra.An antegrade guidewire was passed through the bladder neck and then pulled out through the external urethral meatus with a cystoscope.Urethral continuity was achieved after a 16-Fr silicone Foley catheter was indwelled into the bladder along the guidewire.The patient recovered well,achieving voiding continence and avoiding further operation for urethral stricture.CONCLUSION Modified PER via suprapubic Foley catheter represents a promising and safe treatment approach in patients with posterior urethral injuries.

Outcomes of Early Primary Endoscopic Realignment and Delayed Reconstruction in the Management of Posterior Urethral Injury in Male

Background: Posterior urethral injury usually occurs in male patients with pelvic fractures. Posterior urethral injuries are associated with considerable morbidity including urinary incontinence, erectile dysfunction and urethral stricture. Objective: To compare the outcomes between early primary endoscopic realignment and delayed reconstruction in the management of male patients of posterior urethral injury. Methodology: This prospective study was conducted in the department of urology and department of casualty, Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2015 to June 2017 among 50 male patients with posterior urethral injury. Fifty patients were randomly allocated into two groups;the group A consisted of 24 patients underwent early primary endoscopic realignment within 10 days after posterior urethral injury and the group B consisted of 26 patients underwent delayed reconstruction in form of anastomotic urethroplasty after 3 months. All patients were followed up at 3rd, 6th and 9th month after the procedure. Outcome variables were post-operative urethral stricture, urinary incontinence and erectile dysfunction. Data were analyzed and compared by statistical tests. Results: The mean (±SD) age of the study patients was almost similar between the groups (28.8 ± 8.4 vs. 27.4 ± 7.2 years, p = 0.486). In group A, 83.33% patients developed postoperative urethral stricture, none of them developed urinary incontinence and 20.83% developed erectile dysfunction;On the other hand, in group B, these rates were 38.46%, 23.07% and 38.46% respectively. Postoperative urethral stricture formation was significantly higher in Group A (p = 0.0012) but urinary incontinence and erectile dysfunction rates were significantly higher in Group B (p = 0.018 and p = 0.042 respectively). Conclusion: Early primary endoscopic realignment is better than delayed reconstruction in the management of male patients with posterior urethral injury. It provides less postoperative complications like urinary incontinence and erectile dysfunction, though postoperative urethral stricture formation is higher but amenable to be corrected endoscopically.

Realignment of Great Power Relations

Wang: Speaking of Sino-U. S. relations, actually it touches upon great power relationship. The current Iraqi crisis became a focus in UN. There is a clear demarcation line between those countries supporting a war and those countries in favor of weapons inspections within

A decade of job realignment movement at large Chinese and American academic libraries from 1998 to 2007

Based on a questionnaire survey,the paper made a comparative study on the changes of traditional library positions within the context of the emerging professional positions and functional units at some large academic libraries in China and in the United States from 1998 to 2007.It describes how some of the library professional positions and functional units have gone through a time period of intensified and proactive position allocation realignment in terms of their rise,decline,fission and/or fusion within the administrative context of their library's evolving changes in missions,objectives and service delivery structure under the impact of the rapid development of information technologies.Such changes are graphically demonstrated in several charts in this paper to highlight the evolutionary development of academic librarianship in general and the waves of changes for library position reallocations in specific in the ten-year period under study.It is believed that such a study can be useful for discerning the overall developing trend of academic librarianship,especially in the area of the rising professional and social status of academic librarianship during this period.The movement of library position allocation realignment was a corresponding response at the time to the influx of applicable information technologies to the library scene.It not only made the library operation to become'leaner and meaner,' but also gave added impetus to the rise of the professional and social status of their practitioners in the society due to the latter's enhanced service delivery innovations and capabilities for meeting their constituencies' timely information needs more satisfactorily.

Treatment of posterior urethral distractions defects following pelvic fracture

Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected.Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first.Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected.Early diagnosis and proper acute management decrease the associated complications,such as strictures,urinary incontinence and erectile dysfunction.The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury.Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3e6 months continues to be the gold standard of treatment.In this paper,we provide a comprehensive review of the literature with a special emphasis on the various treatments available:Open or endoscopic primary realignment,immediate or delayed urethroplasty after suprapubic cystostomy,and delayed optical urethrotomy.

Emergency treatment of male blunt urethral trauma in China: Outcome of different methods in comparison with other countries

Treatment of male urethral trauma is always a challenging problem.In China,as the incidence of urethral trauma keeps rising,more and more studies relating to this are being published.To compare the outcome of different emergency treatments in China and other countries,we searched Chinese and English literature about this topic in the past 16 years.A total of 167 studies involving 5314 patients were included,with 144 in Chinese and 23 in English.All studies were retrospective in nature.Based on the analyses,surgical methods include open realignment,endoscopic realignment and primary repair,and we summarized and compared the success rate and complications(mainly erectile dysfunction and incontinence)of each method.We found that realignment of posterior urethra has similar success rate in China and other countries,but the outcome of realignment of anterior urethra is variable.The reason remains unknown.While long abandoned in Western countries,primary repair of anterior urethra is still an option in China and has high success rate.

Controversies in management of slipped capital femoral epiphysis

The traditional treatment of the hip with a slip of the capital femoral epiphysis has been an in situ fixation using a single screw.This has the sanctity of a long term result.Recent literature stresses the outcomes of failure to restore the upper femoral alignment and on the basis of the poor results makes a plea for capital realignment.This being a recent development,it lacks the support of long term follow up and it remains to be seen if this is a better alternative of managing displaced and unstable slipped capital femoral epiphysis.The authors look at some of the available literature on the subject to highlight these controversies and their implications for orthopedic surgeons.Other controversies pertain to contralateral fixation,duration of immobilization and amount of weight bearing after an in situ fixation.

Distillability sudden death in a two qutrit systems under a thermal reservoir

The dynamics of distillability entanglement between qutrit-qutrit systems interacting with a thermal reservoir is investigated in this paper. We discovered an interesting phenomenon that under a thermal reservoir certain initially prepared free=entangled states become bound-entangled states in a finite time, which is called distillability sudden death （DSD）. We use a realignment criterion to measure the nine-dimensional density matrix of the entanglement. Moreover, we analyze some other parameters to investigate the effects to the systems. Explanations are then given.

Patellar dislocation following distal femoral replacement after extraarticular knee resection for bone sarcoma:A case report

BACKGROUND For the treatment of bone sarcoma in the distal femur,wide-margin resection and knee reconstruction with tumor endoprosthesis are standard therapies.Extraarticular knee resection is required in cases of tumor invasion of the knee joint;however,the incidence of complications,such as aseptic loosening,prosthesis infection,and implant failure,is higher than that following intra-articular knee resection.To the best of our knowledge,there are three reports of patellar dislocations after replacement of a tumor endoprosthesis.CASE SUMMARY A 36-year-old man with no significant past medical history was admitted to our institution with continuous pain in his left knee for 4 mo.An open biopsy was performed,and the patient was diagnosed with a left distal femoral malignant bone tumor.Extra-articular knee resection and knee reconstruction with a tumor endoprosthesis were performed.Although the alignment of the tumor prosthesis was acceptable,knee instability was noticed postoperatively.The axial radiographic view of the patellar and computed tomography showed lateral patellar dislocation at 4 wk postoperatively.The patient had to undergo a lateral release and proximal realignment.He could perform his daily activities at 9 mo postoperatively.Radiography revealed no patellar re-dislocation.CONCLUSION Proximal realignment may be considered during primary surgery if there is an imbalance in the forces controlling the patellar tracking.

Are There Prognostic Factors for Failure of Surgical Treatment of Post-Traumatic Posterior Ureteral Stenosis? About 30 Cases and Review of the Literature

Introduction: The management of post-traumatic stenosis of the posterior urethra is divided between early endoscopic realignment and delayed surgery. In the latter case, several techniques are used taking into account several factors. Our objective was therefore to investigate the possible prognostic factors of failure of this surgical management. Material and Methods: We conducted a retrospective study from January 2006 to December 2017 on patients admitted to the Urology Department of the Mohammed 6 University Hospital of Marrakech for management of post-traumatic posterior urethral stenosis. The parameters studied were age, medical and surgical history, causes, characteristics of the stenosis (location, number, length), associated lesions, surgical technique used, and evolution. The descriptive analysis consisted of calculation of absolute and relative frequencies for the qualitative variables, and of position and dispersion parameters for the quantitative variables (mean, standard deviation). In bivariate analysis, the comparison of categorical variables used Pearson’s Chi-square statistical test and Fisher’s test if necessary. The significance threshold was set at p Results: A total of 30 cases were selected. The age of our patients varied between 18 and 68 years, with an average of 38.33 years (16 - 80 years);the most affected age group was between 20 and 39 years. The mode of revelation of urethral damage was dominated by acute retention of urine present in 76% of patients, followed by dysuria (33%). The stenosis extended over 21.91 mm on average (14 - 40 mm). It was accompanied by bone involvement in 15 patients (53.3%). Erectile dysfunction was present in 23 patients (23%). Terminal urethrogram was the main surgical technique used, followed by internal urethrotomy (60% and 30% respectively). 15 patients had a recurrence, with an average of 1-second operation. Statistical analysis of the different factors studied showed no correlation with the occurrence of recurrence after surgical treatment. Conclusion: The medium and long term results of anastomotic repair of the posterior urethra do not seem to depend on the lesion parameters of the stenosis (site, number, extent, presence of associated bony lesions or erectile disorders).

Distillability sudden death for two-qutrit states under an XY quantum environment

distillability sudden death;;bound entangled states;;negativity;;realignment criterion;;entanglement