Effect of impaction on third molar development and age estimation-A study in a Lebanese population.

BACKGROUND: The effect of impaction on third molar development is disputable as the scientific literature is not uniform. In parallel, population-specific studies have been encouraged in dental age estimation. This study aimed to investigate the effect of impaction on third molar formation in a sample of Lebanese individuals. MATERIALS AND METHODS: The sample consisted of 518 panoramic radiographs of females (n=229) and males (n=289) between 15 and 23.9 years. Mandibular third molars were classified based on their position as non-impacted and impacted (with horizontal, vertical, mesioangular, and distoangular impaction). Dental development was classified according to Demirjian's 8-level staging system. RESULTS: Most teeth presented mesioangular impaction (#38=29.7%, #48=33%). Developing third molars were predominantly distributed between stages D and G. The mean age of most developmental stages was higher among impacted teeth, meaning that third molar mineralization could be slower in the presence of impaction. In general, the delayed dental development did not have statistically significant effects (P<0.05). However, descriptive data pointed out differences between (impacted and non-impacted) mean ages of >12 months-suggesting a potential clinical significance (despite the lack of a statistical one). Furthermore, differences changed based on sex and side (#38/#48). CONCLUSION: Therefore, dental age estimation from third molars in the selected Lebanese population should preferably be performed in non-impacted third molars whenever available.

Comparison of the third molar maturity index (I3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample.

The diagnostic accuracy of the I3M to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (I3ML and I3MR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for I3ML and I3MR, respectively. In addition, all these quantities were high when only the I3MR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both I3ML and I3MR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority.

Comparing laparoscopic and percutaneous renal biopsy for diagnosing native kidney disease: A matched pair analysis.

BACKGROUND: Percutaneous renal biopsy is a well-established diagnostic procedure in patients with underlying medical renal disease. Aim of this study is to compare the adequacy of the biopsy material, the diagnostic yield, and the complication rates of the trans-peritoneal laparoscopic approach and the image-guided percutaneous approach to renal biopsy in the diagnosis of native kidney disease. METHODS: We performed a matched-pair analysis matching 1:3 40 patients who underwent trans-peritoneal laparoscopic renal biopsy to 120 patients who underwent percutaneous renal biopsy in the same years. Patients were retrospectively analyzed. Differences in adequacy of biopsy material (i.e. number of glomeruli, continuous), diagnostic yield (categorical) and postoperative complications across the two groups were assessed using Wilcoxon Rank sum or χ2 test. RESULTS: Laparoscopic biopsy was associated with a higher number of harbored glomeruli (median 50, IQR 20-77) compared to the percutaneous approach (median 10, IQR 7-15), P<0.001. Adequate biopsies containing at least ten glomeruli were obtained in a significantly higher percentage of patients in the laparoscopic group versus the percutaneous group (92.5% vs. 57.1%, P<0.001). The laparoscopic approach was also associated with a significantly higher diagnostic yield than the percutaneous approach (82.5% vs. 63.5%, P=0.027). Patients who underwent laparoscopic biopsy had no perioperative or postoperative complications, resulting in a significantly lower complication rate than percutaneous biopsy (0% vs. 4%, P<0.001), particularly in the need for transfusion for post-procedure bleeding (0% vs. 1.8%, P<0.001). CONCLUSIONS: In this retrospective matched-pair analysis comparing patients undergoing renal biopsy for medical kidney disease, trans-peritoneal laparoscopic renal biopsy was safer and more effective for the diagnosis of medical renal diseases compared to percutaneous renal biopsy. Prospective trials with a good follow-up are needed to define the best candidate for each approach. LEVEL OF EVIDENCE: 4.

[Kidney transplantation in the child. Experiences of l'Hôtel-Dieu de France]. / La transplantation rénale chez l'enfant. Expérience de l'Hôtel-Dieu de France.

A retrospective study was conducted on all kidney transplantations performed between January 1993 and June 1996 in our multidisciplinary pediatric department. Thirteen children with a mean age of 6 years (3.5-12) were transplanted during the study period after an average waiting time of 2 years on dialysis for cadaveric transplants and 3.5 months for living related ones. No urologic complication was noted; however, intra-abdominal approach was decided to be performed only in children less than 9 kg. This decision was taken after the occurrence of one intestinal intussusception and two ileal obstructions. During these 3.5 years, five rejection episodes were treated: three were steroid responsive, two were resistant but responded respectively to plasmapheresis and to OKT3. The actuarial survival of the grafts and recipients were 100% for an average mean time of follow-up of 18 months. The latest serum creatinine and creatinine clearance averages were respectively 66 mumol/l and 105 ml/min/1.73 m2. In seven transplanted children for more than 18 months growth was satisfactory. Eleven children returned to school. Kidney transplantation is the optimal treatment for children and infants with chronic renal failure; however, this technique needs a highly experienced team and a permanent close follow-up. Some children with end stage renal disease can directly have preemptive transplantation which is becoming our recent choice to avoid the hemodialysis strain.

Dilemma of oxalosis in end stage renal failure: isolated kidney allograft or hemodialysis.

We report the case of a 10-year-old girl who received a cadaveric kidney transplant for oxalosis after a period of 12 months on hemodialysis. The donor was a 6-year-old child. Cold ischemia was four hours. Diuresis occurred immediately in the operating room. Mean daily diuresis was maintained at 8 liters: first by i.v. perfusion, then by nocturnal continuous nasogastric hydration. In addition to the usual immunosuppressive drugs, she received pyridoxine, sodium citrate, phosphate, hydrochlorothiazide and magnesium. Daily hemodialysis was performed from Day 1 to Day 9 and four additional sessions every other day. The postoperative course was satisfactory. Oxaluria was elevated initially at 1074 mg/24 h (normal < 50 mg/24 h). One year later, mean daily diuresis is still 8 liters, renal function is normal and oxaluria is at 296 mg/24 h. Repeated graft sonography showed no nephrocalcinosis, but mild oxalate deposits are noted on renal biopsy. Isolated renal transplantation was successful in our patient. It allowed us to stop hemodialysis and to avoid extra-renal accumulation of oxalate. Despite this success, we are convinced that long term prognosis is uncertain and liver transplantation should be realized to correct definitely the biochemical defect.

Treatment of staghorn calculi by percutaneous nephrolithotomy and SWL: the Hotel Dieu de France experience.

To evaluate the combined approach of percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (SWL) in the treatment of staghorn calculi, we carried out a retrospective review of 101 patients. The stone surface area ranged from 654 to 3042 mm2 (1535 mm2 on average). During PCNL, a single access tract was used in 22 patients, a double tract in 65 patients, and a triple tract in 14 patients. A double-J stent was placed percutaneously in 62 patients. Extracorporeal lithotripsy was scheduled at the patient's convenience on an outpatient basis approximately 2 weeks after PCNL. The mean hospital stay was 4.4 days. The combined approach showed a stone-free rate of 67% on the initial evaluation, an insignificant residual fragment rate of 26%, and a residual stone rate of 7%. With a follow-up of 52 months on average, the global stone growth rate was 17%, being 4.4% only among the stone-free group and 27% among the group with insignificant residual fragments. The global transfusion rate was 10%. Percutaneous stone debulking combined with SWL on an outpatient basis is an efficient, minimally invasive treatment for staghorn renal calculi. Reducing the number of access tracts, using the flexible nephroscope liberally, and placing a double-J stent frequently after PCNL increases the stone-free rate while reducing the morbidity and hospital stay.

Kidney transplantation after a severe form of pseudotumor cerebri.

Pseudotumor cerebri is a syndrome characterized by intracranial hypertension (intracranial pressure >200 mmH2O) and a normal ventricular system. The diagnosis should be made as early as possible to prevent impairment of vision. Several diseases have been reported in association with pseudotumor cerebri in pediatric patients, and have been occasionally also noted with chronic renal failure, heart and renal transplantation. We report a 7-year-old boy who complained of severe headaches and visual impairment 2 years after hemodialysis for renal hypoplasia. Pseudotumor cerebri was suspected and, despite treatment with corticosteroids, acetazolamide, and lumboperitoneal diversion, visual impairment worsened. Bilateral optic nerve sheath decompression (ONSD) was performed without success and the child completely lost his vision within 2 weeks. He was successfully transplanted 2 months later. Two years post transplantation, the blind child has a normal renal function and school performance. Pseudotumor cerebri must be rapidly suspected in a child with renal failure suffering from headaches and papilledema. Visual loss may progress rapidly and ONSD seems to be the best surgical treatment when medical treatment fails. In this patient renal transplantation was well tolerated, with no deterioration in the neurological status over 2 years of follow-up.

Vein grafting of tunical incisions in the treatment of Peyronie's disease.

The effectiveness of vein grafting of tunical incisions of Peyronie's plaques in straightening the penis, with preservation of normal erectile function is evaluated. Eighteen patients with Peyronie's disease were surgically treated with a vein patch graft technique to correct their penile curvature. Transverse relaxing incisions were made on the tunica albuginea where a curvature was identified by an artificial erection. A vein graft from the saphenous vein was sewn into the defect created by relaxing incisions. If there was evidence of a residual curvature after the vein grafts were sewn in, a plication of the contralateral surface of the tunica albuginea was performed. The saphenous vein grafting alone was sufficient to straighten the penis 90 to 100% in 50% of patients. Of twelve patients who were potent preoperatively, one required postoperatively an occasional intracorporeal injection to maintain erection. Two of the impotent men regained their potency postoperatively. None of the patients lost sensation in the glans or shaft of the penis. Penile shortening was reported in three patients. No decrease in the penis rigidity was noted. Patients were discharged within 5 days of the procedure. There were no immediate complications. Fifteen of our sixteen followed patients resumed intercourse in eight weeks. We found that plaque incision in the venous grafting is much easier than the other incisional and excisional procedures described in the literature, and may lead to successful correction of penile deformity without compromising potency, penile length and sensitivity.

Management of posttraumatic posterior urethral disruption.

We reviewed our experience with 17 cases of posterior urethral disruption due to traumatic pelvic injuries. In all cases, a suprapubic cystostomy was performed at first. For blunt injuries, urethroplasty was delayed for 6 months in average. For most of the penetrating injuries (3/4), we performed immediate debridement and primary repair. Resulting bulbous or membranous strictures less than 3 cm long were treated with one-stage perineal excision-reanastomosis urethroplasty. Membranous strictures longer than 3 cm were managed with a combined transpubic-perineal repair, while bulbous defects longer than 3 cm were treated with a scrotal pedicled island flap. The overall restricture rate was 25%. Those having had initial repeated urethrotomies displayed a 100% restenosis rate. Incontinence rate was 12.5% Erectile dysfunction occurring in 42% of our patients is a sequela of the pelvic injury and was found to be directly related postoperatively to its presence at the time of surgery.

[Implantation of the Ultrex type inflatable penile prosthesis. Four years experience]. / Implantation de prothese pénienne gonflable type Ultrex. L'experiencede 4 ans.

During the last 4 years, 12 patients had an implantation of the AMS Ultrex2 penile prosthesis : 4 of these patients were impotent after a cystoprostatectomy, 4 patients had vascular insufficiency, 2 patients had psychogenic impotency, one patient was diabetic and one patient had a spinal cord injury. The complication rate was low (16%): one patient necessitated a surgical revision of the prosthesis after disconnection of the tubulure. A second patient had a urethral stenosis treated by dilation. The degree of satisfaction of both patient and partner was satisfactory.

Incidence of vascular complications in kidney transplantation: is there any interference with the nature of the perfusion solution?

Two non-randomized groups of 100 kidney transplants each were compared in relation to the flush-out solution used. The two groups were similar with the exceptions of the number of multiple artery kidneys and the proportion of kidneys procured in our center. The rate of vascular complications such as arterial venous thrombosis and renal artery stenosis was higher in the Eurocollins (19) group than in the UW group (4) p < 0.01, even if the multiple artery kidneys are excluded. These results need to be confirmed by a randomized study but it is clear that the use of the UW solution leads to a better arterial flow with fewer vascular complications.

Piezolith extracorporeal shockwave lithotripsy: the Hotel-Dieu de France experience.

A total of 1500 patients underwent treatment with the Wolf Piezolith 2300 extracorporeal shockwave lithotripter for renal, ureteral, and bladder stones. Follow-up data were available at 3 months for 1435 patients. At that time, the overall stone-free rate was 82.7%: 82.4% for patients with renal stones, 81.0% for those with ureteral stones, and 100% for those with bladder stones. The overall success rate was 92.3%: 93.8% for patients with renal stones, 87.1% for those with ureteral stones, and 100% for those with bladder stones. The auxiliary treatment rate was 14.9%, and the retreatment rate was 53%. The effectiveness quotient was 49.2%. The Wolf Piezolith 2300 is an effective treatment for most stones smaller than 30 mm.

Anatomy of the prostatic nerves.

The entire prostate of a 10 year old boy was cut with a microtome in to 4300 serial slices. The nerves were stained using a monoclonal antibody called anti PS 100. All information was recorded using a computer reconstruction programme. The prostatic nerve supply is very abundant. The nerve fibers of the cranial prostate (central zone) follow a pathway parallel to the anterior surface of the seminal vesicles going towards the caudal prostate. The periurethral zone is widely innervated by nerves arising from the periphery. The caudal prostate also contains many nerve fibers of variable size. We identified many nerve fibers along the anterior surface of the seminal vesicles and surrounding the lateral aspect of the prostatic capsule. They penetrate the capsule and the whole circumference of the caudal prostate. The prostatic capsule is covered by numerous nerve fibers and ganglia, which form a true periprostatic nerve network. The urethra is supplied by numerous thick fibers of more than 30 microns in diameter.