Computed tomographic evaluation of mouth breathers among paediatric patients.

OBJECTIVES: Mouth breathing causes many serious problems in the paediatric population. It has been maintained that enlarged adenoids are principally responsible for mouth breathing. This study was designed to evaluate whether other mechanical obstacles might predispose the child to mouth breathing. METHODS: 67 children with ages ranging from 10 to 15 years were studied and grouped into mouth-breathers and nose-breathers. The children first underwent axial CT scans of the brain for which they were originally referred. In addition, they were subjected to a limited coronal CT examination of the paranasal sinuses. Congenital anatomical variations as well as inflammatory changes were assessed. RESULTS: 87% of mouth-breathing children had hypertrophied adenoids, 77% had maxillary sinusitis, 74% had pneumatized middle concha, 55% had a deviated nasal septum, 55% had hypertrophied inferior conchae, 45% had ethmoidal sinusitis and 23% showed frontal sinusitis. Such changes were significantly less prevalent in nose-breathers. 12.9% of mouth-breathing children did not have adenoids. Of these children, only 3.3% had one or more congenital or inflammatory change whereas the other 9.6% showed a completely normal CT scan signifying the incidence of habitual non-obstructive mouth breathing. CONCLUSIONS: It is clear that adenoids have a dominant role in causing mouth breathing. Yet, we recommend that paediatricians should assess other mechanical obstacles if mouth breathing was not corrected after adenoidectomy. Further research should be performed to test the validity of correction of such factors in improving the quality of life of mouth-breathing children.

Evaluation of the oral health situation of a group of Egyptian haemophilic children and their re-evaluation following an oral hygiene and diet education programme.

Haemophilic children in Egypt have received minimal dental intervention and their dental needs required assessment. The purpose of this study was to assess the oral health needs of a sample (n = 60) of Egyptian haemophilic children (6-12 years), so as to develop, implement and evaluate an oral hygiene education programme over an 8-month period on the experimental group (n = 30) vs. the control group (n = 30). The oral hygiene index simplified (OHI-S) index was used for baseline data and at the end of the study, while DMFS and defs were used to collect caries experience baseline data on each subject. The results showed that the DMFT and deft were significantly higher than those of the non-haemophilic population in Egypt and also higher than those of haemophilic children in developed countries and that the decayed component represented most of the index values. At phase I, the mean value of the OHI-S of experimental and the control groups was 2.67 +/- 0.45 and 2.53 +/- 0.53, respectively, but the difference was not significant (P > 0.05), both values were in the 'fair' category (1.3-3.0). At phase II, the end of the 8 months follow-up period and after the application of a strict oral care programme in the experimental group, there was a significant decrease from 2.67 to 1.20 (P < 0.001), a shift of values occurred from the 'fair' category to the 'good' category (0.1-1.2) while there was no significant difference in the control group. It can be concluded that professional plaque control, education and access to oral hygiene aids is paramount to improve oral health of these children.

Glutathione S-transferase M1, T1 and P1 polymorphisms and bladder cancer risk in Egyptians.

Previous studies suggest that bladder cancer risk may vary with GST genotype but these results are inconsistent. The aim of this study was to explore whether GSTM1, GSTT1 and GSTP polymorphisms were associated with increased bladder cancer risk in an Egyptian population. GSTM1, GSTT1 and GSTP1 genotype frequencies were determined in bladder cancer cases (n=72) and healthy controls with no history of malignancies (n=82) using PCR-based techniques. The GSTT1*2 genotype was particularly associated with increased risk (OR 2.71, 95%CI 1.27-5.73) and the GSTM1*2 genotype to a lesser extent (OR 1.63, 95%CI 0.85-3.10). 18.1% of cases but only 7.3% of controls were GSTP1*B*B homozygotes (OR 2.38, 95%CI 0.83-6.87). The presence of two or more a priori at-risk genotypes was associated with increased bladder cancer risk (OR 2.42; 95%CI 1.47-3.97). These results suggest that polymorphisms in the GST genes are associated with increased risk of bladder cancer among Egyptians.

Changing age incidence and pathological types of schistosoma-associated bladder carcinoma.

PURPOSE: The changes in certain characteristic features of schistosoma-associated bladder carcinoma are determined. MATERIALS AND METHODS: A retrospective study was done of patients with schistosoma-associated bladder carcinoma treated between 1962 and 1967, and between 1987 and 1992. RESULTS: Mean patient age increased from 47 +/- 13.6 to 53 +/- 12.2 years and the male-to-female ratio changed from 7.8:1 to 4.9:1. Tumors showed a decreased incidence of nodular (58.7% versus 83.4%) and squamous (54% versus 65.8%) cell types, and an increased incidence of papillary (34.8% versus 4.3%) and transitional (42% versus 31%) cell types. All changes were statistically significant (p < 0.05) and paralleled by an increased incidence of low degree schistosomal infestation from 18.6 to 47.8% (p < 0.05). CONCLUSIONS: The shift in age incidence and pathological findings towards those of nonschistosomal cases could conceivably be attributed to the increased incidence of low infestation in recent years. The change in male-to-female ratio is probably due to more exposure of women to schistosomal infestation than has occurred previously.

Transurethral ultrasonographic assessment of bladder carcinoma: its value and limitation.

PURPOSE: We assess the value and limitation of transurethral ultrasonography in the diagnostic evaluation of bladder carcinoma. MATERIALS AND METHODS: A total of 115 patients underwent the procedure, either at the same setting as transurethral resection (76) or 2 weeks before radical cystectomy (39). The results were compared with the pathological findings of transurethral and cystectomy specimens. RESULTS: The correlation between transurethral ultrasonography and pathological staging was 100% in tumors without muscle invasion (stages Ta and T1), 95.7% and 96.8% in muscle invasive tumors (stages T2 and T3a, respectively), and 70% in tumors with extravesical spread. CONCLUSIONS: Transurethral ultrasonography is most valuable in determining the stage of tumor confined to the bladder wall. Also, it is of value in detecting tumors in a diverticulum, and monitoring the distensibility of the bladder wall and transurethral resection of disease. The main limitations are the inabilities to discriminate between stages Ta and T1 tumors, and to detect involvement of the pelvic lymph nodes.