Nd:YAG laser as an adjunctive treatment to nonsurgical periodontal therapy

A meta-analysis was conducted to investigate whether the use of Nd:YAG laser adjunctive to scaling root planing (SRP) could provide additional benefits compared to SRP alone in patients with chronic periodontitis. The meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement and the recommendations of the Cochrane Collaboration. A literature search was performed on seven databases, followed by a manual search. Weighted mean differences and 95 % confidence intervals were calculated for the clinical attachment level (CAL), probing depth (PD), and changes in plaque index (PI) and gingival crevicular fluid (GCF). Inter-study heterogeneity was assessed by the I ² test, and publication bias was analyzed by the visual inspection of the funnel plot for asymmetry, Egger’s regression test, and trim-and-fill method. All outcomes were evaluated from baseline to the end of follow-up. Significant differences in PD and GCF reduction were observed in favor of SRP?+?Nd:YAG; no significant differences were observed in CAL gain or PI change. The findings of this meta-analysis suggest that use of the Nd:YAG laser as an adjunctive therapy to conventional nonsurgical periodontal therapy could potentially provide additional benefits. However, all included studies were not at low risk of bias, and only three studies were included in the meta-analysis. As a result, the evidence is insufficient to support the effectiveness of adjunctive Nd:YAG to SRP. Future long-term well-designed parallel randomized clinical trials are required to assess the effectiveness of the adjunctive use of Nd:YAG laser. These trials should also include microbiological and adverse events analyses.     

Attention‐network specific alterations of structural connectivity in the undamaged white matter in acute neglect

Visual neglect results from dysfunction within the spatial attention network. The structural connectivity in undamaged brain tissue in neglect has barely been investigated until now. In the present study, we explored the microstructural white matter characteristics of the contralesional hemisphere in relation to neglect severity and recovery in acute stroke patients. We compared age‐matched healthy subjects and three groups of acute stroke patients (9 ± 0.5 days after stroke): (i) patients with nonrecovered neglect (n = 12); (ii) patients with rapid recovery from initial neglect (within the first week post‐stroke, n = 7), (iii) stroke patients without neglect (n = 17). We analyzed the differences between groups in grey and white matter density and fractional anisotropy (FA) and used fiber tracking to identify the affected fibers. Patients with nonrecovered neglect differed from those with rapid recovery by FA‐reduction in the left inferior parietal lobe. Fibers passing through this region connect the left‐hemispheric analogues of the ventral attention system. Compared with healthy subjects, neglect patients with persisting neglect had FA‐reduction in the left superior parietal lobe, optic radiation, and left corpus callosum/cingulum. Fibers passing through these regions connect centers of the left dorsal attention system. FA‐reduction in the identified regions correlated with neglect severity. The study shows for the first time white matter changes within the spatial attention system remote from the lesion and correlating with the extent and persistence of neglect. The data support the concept of neglect as disintegration within the whole attention system and illustrate the dynamics of structural‐functional correlates in acute stroke. Hum Brain Mapp 35:4678–4692, 2014. © 2014 Wiley Periodicals, Inc .     

Lymphom am Auge

Die Ophthalmologie - Die personalisierte Medizin ist mittlerweile Standard in der onkologischen Betreuung von Patienten. Ein Paradebeispiel stellt das Lymphom dar, das durch den intra- und...     

Synchronous Bilateral Adrenalectomy for Cushing’s Syndrome: Laparoscopic Versus Posterior Retroperitoneoscopic Versus Robotic Approach

Background

Synchronous endoscopic bilateral adrenalectomy (BilA) can effectively provide definitive cure of hypercortisolism in ACTH-dependent Cushing’s syndrome and in primary adrenal bilateral disease. We compared three different approaches for BilA: transabdominal laparoscopic BilA (TL-BilA), simultaneous posterior retroperitoneoscopic BilA (PR-BilA), and robot-assisted BilA (RA-BilA).

Methods

All patients who underwent BilA between January 1999 and December 2012 at two referral centers (one performing TL-BilA and PR-BilA and one performing RA-BilA) were included. A comparative analysis was performed.

Results

Twenty-nine patients were included: 5 underwent TL-BilA, 11 underwent PR-BilA, and 13 underwent RA-BilA. No significant difference was found concerning age, gender, diagnosis, and previous abdominal surgery. No conversion to open approach was registered. Operative time was significantly shorter for the PR-BilA group than for the TL-BilA and RA-BilA groups (157.4 ± 54.6 vs 256.0 ± 43.4 vs 221.5 ± 42.2 min, respectively) (P < 0.001). No significant difference was found concerning intraoperative and postoperative complications rate and time to first flatus. Drains were used routinely after PR-BilA and TL-BilA and electively in four RA-BilA patients (P < 0.001). Hospital stay was longer in the TL-BilA and PR-BilA groups than in the RA-BilA group (12.0 ± 5.7 vs 10.8 ± 3.7 vs 4.4 ± 1.7 days, respectively) (P < 0.001). No recurrence or disease-related death was registered.

Conclusions

Operative time was significantly shorter in the PR-BilA group, because it eliminates the need to reposition the patient. The number of drains and the length of hospital stay were reduced after RA-BilA, but this was likely related to different management protocols in different settings. Because no significant difference was found in terms of postoperative outcome, none of the three operative approaches can be considered the preferable one.