Evolution of endoscopic management of ectopic ureterocele: a new approach

PURPOSE: We report the evolution of endoscopic treatment of ectopic ureteroceles from the unroofing technique to a novel approach using concomitant ureterocele double puncture and intraureterocele fulguration. We also compare the results of different endoscopic modalities at a single center. MATERIALS AND METHODS: We reviewed the records of 46 children with ectopic ureteroceles who were treated endoscopically between 1995 and 2005. The patients were divided into 2 main groups. Group 1 included 17 patients who underwent common endoscopic treatments, including ureterocele incision (4 patients), single ureterocele puncture (4), and single puncture with insertion of a Double-J stent (9). Group 2 included 29 children who underwent ureterocele double puncture and fulguration of the anterior and posterior walls of the collapsed ureterocele after insertion of a Double-J stent into both punctured sites. We also managed concomitant vesicoureteral reflux by endoscopic injection of tricalcium phosphate ceramic into the subureteral region. RESULTS: Total success rates in group 1 were 0%, 25% and 33% in patients who underwent ureterocele incision, single ureterocele puncture and single puncture with insertion of a stent, respectively. Total success rate in group 2 was 90% (p<0.05). New onset vesicoureteral reflux developed in 8 patients (47%) in group 1, of which 6 were in ureterocele moieties, and in 8 patients (28%) in group 2, with none in a ureterocele moiety (p<0.01). A total of 13 patients (76%) in group 1 required open surgical intervention, compared to 3 (10%) in group 2 (p<0.05). CONCLUSIONS: This new endoscopic approach is highly effective in the treatment of children with ectopic ureteroceles.     

Etiology, pathogenesis, and management of acute intraocular lens opacification: a systematic review

Millions of cataract surgeries with intraocular lens (IOL) implantation are performed worldwide. Although cataract surgery brings many benefits to the patients, the risk of various complications is still a concern. One of the infrequent adverse events but potentially affecting on patients’ visual acuity and contrast sensitivity is losing the transparency of IOL. IOL opacification may lead to IOL removal or exchange, which is unpleasant to both the patient and the surgeon. Several reports of acute IOL clouding are available in the literature describing various etiologies of this phenomenon, however, the exact mechanism remained unclear in some cases. Herein, we aimed to review the causes and outcomes of intraoperative and early postoperative IOL opacification.     

Effect of Nano Silica on Setting Time and Physical Properties of Mineral Trioxide Aggregate

IntroductionMineral trioxide aggregate (MTA) has been widely used in all fields of endodontics. One of the major drawbacks of this material is the long setting time. MTA is primarily composed of type 1 Portland cement and bismuth oxide. In cement, nanoscale SiO₂ behaves as a filler to improve microstructure and to accelerate hydration process. The aforementioned reaction is also expected in MTA because of the same structure. Thus, the aim of this study was to evaluate the effect of addition of nano-SiO₂ to MTA on the setting time and its physical properties.MethodsTwo concentrations (8% and 10%) of nano-SiO₂ were added to the white MTA powder. After mixing with water, the setting time, compressive strength, and flexural strength were investigated and compared with pure MTA.ResultsWith the addition of 8% and 10% of nano-SiO₂ to the MTA, the setting time of both mixtures decreased significantly (P < .05). However, the compressive strength (after 1 day and 1 week) and flexural strength increased; this was not significant (P > .05). There was no significant difference between MTA mixed with 8% and 10% nano-SiO₂ in setting time, compressive strength, and flexural strength (P > .05).ConclusionsThe addition of 8% and 10% of nano-SiO₂ to MTA accelerated the hydration process, reduced the setting time, and had no adverse effect on the compressive and flexural strength of MTA.     

Nephrometry score matched robotic vs. laparoscopic vs. open partial nephrectomy

To compare perioperative outcomes in the three most common partial nephrectomy modalities: robotic (RPN), laparoscopic (LPN), and open (OPN), matched for nephrometry scores. Patients aged 16–85 who underwent RPN, LPN, or OPN from 2007 to 2014 for localized renal carcinoma within our healthcare system were enrolled. Age, sex, body mass index, and Charlson Comorbidity Index (CCI) as well as perioperative outcomes of estimated blood loss (EBL), length of hospital stay (LOS), ischemia time (IT), change in eGFR, positive margin rate, operative time (OT), and emergency room visit rates were compared between RPN, LPN, and OPN using the R.E.N.A.L nephrometry score. A total of 862 patients underwent partial nephrectomy (523 LPN, 176 OPN, and 163 RPN). Patients who underwent OPN were significantly older, and had higher nephrometry scores and CCI. When matched for nephrometry scores, minimally invasive (LPN and RPN) compared to OPN had lower EBL (<?0.0001), shorter LOS (<?0.0001), shorter IT (<?0.001), and less change in eGFR (<?0.001), particularly in nephrometry scores higher than 8 (0.0099). Comparing RPN with LPN, RPN had significantly shorter OT in all nephrometry scores (<?0.001); shorter IT and LOS in nephrometry scores higher than 7. Our study suggests that minimally invasive partial nephrectomy may have superior outcomes to OPN when matched by nephrometry scores, particularly at higher scores and for RPN. This finding may contribute to a surgeon’s decision in the approach to partial nephrectomy.     

Improved diagnostic yield of neuromuscular disorders applying clinical exome sequencing in patients arising from a consanguineous population

Neuromuscular diseases (NMDs) include a broad range of disorders affecting muscles, nerves and neuromuscular junctions. Their overlapping phenotypes and heterogeneous genetic nature have created challenges in diagnosis which calls for the implementation of massive parallel sequencing as a candidate strategy to increase the diagnostic yield. In this study, total of 45 patients, mostly offspring of consanguineous marriages were examined using whole exome sequencing. Data analysis was performed to identify the most probable pathogenic rare variants in known NMD genes which led to identification of causal variants for 33 out of 45 patients (73.3%) in the following known genes: CAPN3, Col6A1, Col6A3, DMD, DYSF, FHL1, GJB1, ISPD, LAMA2, LMNA, PLEC1, RYR1, SGCA, SGCB, SYNE1, TNNT1 and 22 novel pathogenic variants were detected. Today, the advantage of whole exome sequencing in clinical diagnostic strategies of heterogeneous disorders is clear. In this cohort, a diagnostic yield of 73.3% was achieved which is quite high compared to the overall reported diagnostic yield of 25% to 50%. This could be explained by the consanguineous background of these patients and is another strong advantage of offering clinical exome sequencing in diagnostic laboratories, especially in populations with high rate of consanguinity.