Laparoendoscopic single‐site (LESS) vs laparoscopic living‐donor nephrectomy: a systematic review and meta‐analysis

The aim of this study was to provide a systematic review and meta‐analysis of reports comparing laparoendoscopic single‐site (LESS) living‐donor nephrectomy (LDN) vs standard laparoscopic LDN (LLDN). A systematic review of the literature was performed in September 2013 using PubMed, Scopus, Ovid and The Cochrane library databases. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta‐analyses criteria. Weighted mean differences (WMDs) were used to measure continuous variables and odds ratios (ORs) to measure categorical ones. Nine publications meeting eligibility criteria were identified, including 461 LESS LDN and 1006 LLDN cases. There were more left‐side cases in the LESS LDN group (96.5% vs 88.6%, P < 0.001). Meta‐analysis of extractable data showed that LLDN had a shorter operative time (WMD 15.06 min, 95% confidence interval [CI] 4.9–25.1; P = 0.003), without a significant difference in warm ischaemia time (WMD 0.41 min, 95% CI –0.02 to 0.84; P = 0.06). Estimated blood loss was lower for LESS LDN (WMD ?22.09 mL, 95% CI –29.5 to –14.6; P < 0.001); however, this difference was not clinically significant. There was a greater likelihood of conversion for LESS LDN (OR 13.21, 95% CI 4.65–37.53; P < 0.001). Hospital stay was similar (WMD –0.11 days, 95% CI –0.33 to 0.12; P = 0.35), as well as the visual analogue pain score at discharge (WMD –0.31, 95% CI –0.96 to 0.35; P = 0.36), but the analgesic requirement was lower for LESS LDN (WMD –2.58 mg, 95% CI –5.01 to –0.15; P = 0.04). Moreover, there was no difference in the postoperative complication rate (OR 1.00, 95% CI 0.65–1.54; P = 0.99). Renal function of the recipient, as based on creatinine levels at 1 month, showed similar outcomes between groups (WMD 0.10 mg/dL, –0.09 to 0.29; P = 0.29). In conclusion, LESS LDN represents an emerging option for living kidney donation. This procedure offers comparable surgical and early functional outcomes to the conventional LLDN, with a lower analgesic requirement. However, it is more technically challenging than LLDN, as shown by a greater likelihood of conversion. The role of LESS LDN remains to be defined.     

Evaluation of some oral postradiotherapy sequelae in patients treated for head and neck tumors

The aim of this study was to evaluate the oral sequelae of radiotherapy in patients treated between 1999 and 2003 for head and neck tumors. One-hundred patients (24 women, 76 men) ranging in age from 30 to 83 years (mean 59.2 years) were examined. Time since radiotherapy ranged from 1 to 72 months (mean 28 months). The total mean radiation dose received by the patients was 5,955 cGy. The evaluation protocol included anamnesis, intraoral and extraoral examination, measurement of stimulated salivary flow and salivary pH. Symptoms reported by the patients included dry mouth (68%), dysphagia (38%), and dysgeusia (30%). In 64% of the patients, the mean stimulated salivary flow rate was less than 0.7 ml/min. The mean salivary pH was 6.97 (+/- 0.714). Stimulated salivary flow increased with increasing postradiotherapy time (p < 0.05). The prevalence of mucositis was associated with higher radiation doses (p < 0.05), and the prevalence of atrophic candidiasis was related to a longer post-treatment period (p < 0.05). Two cases of recurrence of the primary tumor were detected during the study. The main effect of radiotheraphy in the head and neck region was a reduction of the salivary flow rate, even though our study demonstrated that there was a modest late improvement of the salivary flow.     

Histologic evaluation of the effect of nicotine administration on bone regeneration. A study in dogs

The objective of this study was to investigate the histometric impact of nicotine on bone regeneration of surgically created alveolar ridge defects in dogs. Sixteen mongrel dogs were used. One defect was surgically created unilaterally in the mandible, and left to heal spontaneously. The animals were randomly assigned to one of the following groups: Group 1--control (n = 8) and Group 2--subcutaneous nicotine administration (2 mg/kg) twice a day (n = 8). After 4 months, the animals were sacrificed and the specimens routinely processed for semi-serial decalcified sections. Bone height (BH), bone width (BW), bone density (BD), and bone area (BA) of the newly-formed bone were evaluated. Intergroup analysis (Mann-Whitney rank sum test) showed that regardless of the presence of nicotine, no significant differences were observed regarding bone width (BW), bone area (BA) and bone height (BH) (p > 0.05). On the other hand, it was demonstrated that nicotine administration significantly influenced the proportion of mineralized tissue within the limits of the newly-formed bone (BD) (p < 0.001). Within the limits of the present study, it can be concluded that nicotine might affect but not prevent bone healing in defects left to heal spontaneously.     

Helicobacter pylori in the oral mucosa of patients submitted to allogeneic haematopoietic stem cell transplantation

This study was designed to investigate the impact of haematopoietic stem cell transplantation (HSCT) on Helicobacter pylori colonization of the oral mucosa by nested polymerase chain reaction (nested-PCR). Forty six consecutive patients submitted to HSCT and 46 healthy volunteers were included in the study. Oral swabs were taken from the oral mucosa of the patients and control group. The medical records of the patients were reviewed and the following information was retrieved: gender and age of the patient, donor gender, primary disease, stem cell source (bone marrow or blood stem cells), leukocyte, neutrophil and platelet counts, and chronic graft versus host disease (cGVHD) of salivary glands. The results demonstrated an increased frequency of H. pylori in the oral mucosa of HSCT patients compared to controls (rho = 0.002). The presence of H. pylori in the oral mucosa was not related to the severity of cGVHD. The median counts of platelet/mm3, leukocytes/mm3 and neutrophils/mm3 in the group of HSCT patients positive for H. pylori were not statistically different from those of the patients negative for it. In conclusion, the present study shows increased frequency of H. pylori in the oral mucosa of HSCT patients compared to non-transplanted healthy volunteers.     

Age-related changes in human sublingual glands: a post mortem study

OBJECTIVES: To analyse age- and gender-related microscopic changes in sublingual glands obtained from human cadavers. STUDY DESIGN: One hundred eighty six human sublingual glands were obtained from 93 autopsies. Approximately five individuals of each gender per decade of life were allocated to three age groups: group I (0-30 years, n=26); group II (31-60 years, n=32) and group III (61-90 years, n=35). The specimens were fixed in 10% formalin and submitted to routine histological processing, and sections were stained with hematoxylin and eosin. RESULTS: Significant differences with increasing age were observed for the following microscopic aspects: acinar atrophy (r=0.26, p=0.0115); replacement of parenchyma by fibrous tissue (r=0.79, p<0.0001) and/or adipose tissue (r=0.63, p<0.0001); oncocytosis (r=0.61, p<0.0001); duct-like structures (chi(2)=14.68, p=0.0006) and congested blood vessels (chi(2)=7.18, p=0.0276). The mononuclear infiltrate changed from focal to diffuse with age (H=8.47, p=0.0144). No significant differences were observed between genders. CONCLUSIONS: The aging process starts with acinar atrophy, followed by the presence of duct-like structures and ends with the replacement of the parenchyma by fibrous and/or adipose tissue. The mononuclear infiltrate changes from focal to diffuse. No difference in the aging of the sublingual glands is observed between men and women.     

Intermittent cigarette smoke inhalation may affect bone volume around titanium implants in rats

BACKGROUND: A negative influence of smoking on implant outcomes has been reported. This animal study investigated the influence of cigarette smoke on osseointegration and newly formed bone within implant threads. METHODS: Male Wistar rats were included in the study. After anesthesia, the tibiae surface was exposed and a screw-shaped titanium implant (4.0 mm in length; 2.2 mm in diameter) was placed bilaterally. The animals were randomly assigned to group 1, control, or group 2, intermittent cigarette smoke inhalation. The animals were sacrificed after 60 days and undecalcified sections obtained. The degree of bone-to-implant contact (BIC) and the bone area (BA) within the implant threads were measured in the cortical (zone A) and cancellous bone (zone B) areas. RESULTS: A slight difference in the BIC was noted between the groups, but this was not statistically significant either in zone A or in zone B (Mann-Whitney test, P > 0.05). In contrast, the BA close to the implant significantly decreased in both zones for group 2 (84.73% +/- 4.77 versus 79.85% +/- 6.17, zone A in groups 1 and 2, respectively, and 32.01% +/- 6.62 versus 20.71% +/- 8.57, zone B in groups 1 and 2, respectively, P < 0.05). CONCLUSION: Within the limits of the present study, intermittent cigarette smoke inhalation may result in a poor bone quality around titanium implants inserted in rats.