Minimally Invasive Selective Neck Dissection: A Prospective Study of Endoscopically Assisted Dissection via a Small Submandibular Approach in cT(1-2)N(0) Oral Squamous Cell Carcinoma

Selective neck dissection (SND) in clinical N-0 (cN(0)) cases of oral squamous cell carcinoma (SCC) has been performed by surgeons using a retroauricular or modified facelift approach with robotic or endoscopic assistance. However, these procedures provide cosmetic satisfaction at the cost of possible maximal invasiveness. In this prospective study, we introduced and evaluated the feasibility as well as surgical invasiveness and cosmetic outcome of endoscopically-assisted SND via a small submandibular approach.Forty-four patients with cT(1-2)N(0) oral SCC (OSCC) were randomly divided into two groups of endoscopically-assisted SND and conventional SND. Perioperative and postoperative outcomes of patients were evaluated, including the length of the incision, operating time for neck dissection, estimated blood loss during the operation, amount and duration of drainage, total hospitalization period, total number of lymph nodes retrieved, satisfaction scores based on the cosmetic results, perioperative local complications, shoulder syndrome, and follow-up information.The mean operation time in the endoscopically-assisted group (126.04 +/- A 12.67 min) was longer than that in the conventional group (75.67 +/- A 16.67 min). However, the mean length of the incision was 4.33 +/- A 0.76 cm in the endoscopically-assisted SND group, and the amount and duration of drainage, total hospital stay, postoperative shoulder pain score, and cosmetic outcomes were superior in the endoscopically-assisted SND group. Additionally, the retrieved lymph nodes and complications were comparable.Endoscopically-assisted SND via a small submandibular approach had a longer operation time than the conventional approach. However, endoscopically-assisted SND was feasible and reliable while providing minimal invasiveness and satisfactory appearance.

Blindness after laryngectomy and bilateral neck dissection in a diabetic patient: case report

CONTEXTO: O esvaziamento cervical que acompanha a ressecção da lesão primária no tratamento dos tumores malignos das vias aerodigestivas superiores possibilita o surgimento de complicações inerentes a ela ou ao prolongamento do tempo cirúrgico, aumentando os riscos para o paciente. Entre as complicações que podem ocorrer está a amaurose, de incidência rara. RELATO do CASO: Um paciente submetido a laringectomia total e esvaziamento cervical seletivo à esquerda e radical modificado à direita, que evoluiu com amaurose, provavelmente decorrente de hipotensão intra-operatória, com contribuição dos Diabetes Mellitus descompensado e trombose da veia jugular interna à direita. Discutem as possíveis causas, os fatores de risco e os cuidados que devem ser tomados para evitar essa rara, mas tão debilitante complicação.

Laser irradiation and thermal treatment inducing selective crystallization in Sb2O3-Sb2S3 glassy films

The influence of both thermal treatment and laser irradiation on the structural and optical properties of films in the Sb 2 O 3 –Sb 2 S 3 system was investigated. The films were prepared by RF-sputtering using glass compositions as raw materials. Irreversible photodarkening effect was observed after exposure the films to a 458nm solid state laser. It is shown, for the first time, the use of holographic technique to measure “in situ”, simultaneously and independently, the phase and amplitude modulations in glassy films. The films were also photo-crystallized and analysed “in situ” using a laser coupled to a micro-Raman equipment. Results showed that Sb 2 S 3 crystalline phase was obtained after irradiation. The effect of thermal annealing on the structure of the films was carried out. Different from the result obtained by irradiation, thermal annealing induces the crystallization of the Sb 2 O 3 phase. Photo and thermal induced effects on films were studied using UV–Vis and Raman spectroscopy, atomic force microscopy (AFM), thermal analysis (DSC), X-ray diffraction, scanning electron microscopy (MEV) and energy-dispersive X-ray spectroscopy (EDX).

Denture disinfection by microwave irradiation: A randomized clinical study

Processo FAPESP: 05/02384-4

Methylation profile of genes CDKN2A (p14 and p16), DAPK1, CDH1, and ADAM23 in head and neck cancer

Hypermethylation in the promoter region has been associated with a loss of gene function that may give a selective advantage to neoplastic cells. In this study, the methylation pattern of genes CDKN2A (alias p14, p14(ARF), p16, p16(INK4a)), DAPK1, CDH1, and ADAM23 was analyzed in 43 samples of head and neck tumors using methylation-specific polymerase chain reaction. In the oropharynx, there was a statistically significant association between hypermethylation of the DAPK1 gene and the occurrence of lymph node metastases, and in the larynx there was statistically significant evidence of an association between hypermethylation of the ADAM23 gene and advanced stages of the tumors. Thus, a correlation was observed between hypermethylation of the promoter region of genes DAPK1 and ADAM23 and the progression of head and neck cancer. (c) 2007 Elsevier B.V. All rights reserved.

Study of the effects of exposure to ionizing irradiation on the materials used for dental restoration

A quantitative study was made about the effects caused by ionizing irradiation on materials used for dental restoration (amalgams, compound resins and compomere), aiming to alleviate in bearers of head and neck cancer, the possible harmful effects of radiotherapy perceived when the repaired teething is within the radiation field. Research also encourages further studies for new alternative materials to be used in dental repair of patients submitted to radiotherapy for head and neck cancer. Test samples were submitted to a gamma radiation beam coming from a cobalt-therapy source and analyzed according to the X-ray fluorescence technique, comparing the chemical composition of the samples before and after irradiation. Radiation detectors such as an ionization chamber and a Geiger-Muller were used to measure the rate of residual dose. Gamma spectrometry with Nal detectors was also performed on the same samples. Results showed that there was no significant change in the chemical composition and that at post-irradiation, samples did not exhibit radiation emission, that is to say they had not become radioactive.

Effectiveness of microwave irradiation on the disinfection of complete dentures

Purpose: The purpose of this study was to evaluate the effectiveness of microwave irradiation on the disinfection of simulated complete dentures. Materials and Methods: Eighty dentures were fabricated in a standardized procedure and subjected to ethylene oxide sterilization. The dentures were individually inoculated (10 7 cfu/mL) with tryptic soy broth (TSB) media containing one of the tested microorganisms (Candida albicans, Streptoccus aureus, Bacillus subtilis, and Pseudomonas aeruginosa). After 48 hours of incubation at 37°C, 40 dentures were individually immersed in 200 mL of water and submitted to microwave irradiation at 650 W for 6 minutes. Forty nonirradiated dentures were used as positive controls. Replicate aliquots (25 μL) of suspensions were plated at dilutions of 10 -3 to 10 -6 on plates of selective media appropriate for each organism. All plates were incubated at 37°C for 48 hours. TSB beakers with the microwaved dentures were incubated at 37°C for 7 more days. After incubation, the number of colony-forming units was counted and the data were statistically analyzed by Kruskal-Wallis test (α = .05). Results: No evidence of growth was observed at 48 hours for S aureus, B subtilis, and C albicans. Dentures contaminated with P aeruginosa showed small growth on 2 plates. After 7 days incubation at 37°C, no growth was visible in the TSB beakers of S aureus and C albicans. Turbidity was observed in 3 broth beakers, 2 from P aeruginosa and 1 from B subtilis. Conclusion: Microwave irradiation for 6 minutes at 650 W produced sterilization of complete dentures contaminated with S aureus and C albicans and disinfection of those contaminated with P aeruginosa and B subtilis.

Candida albicans inactivation and cell membrane integrity damage by microwave irradiation

In indicating the microwave irradiation for disinfecting dentures it is necessary to see how this procedure influences Candida albicans integrity and viability. The aim of this study was to evaluate the ability of microwaves to inactivate C. albicans and damage cell membrane integrity. Two 200-ml C. albicans (ATCC 10231) suspensions were obtained. A sterile denture was placed in a beaker containing the Experimental (ES) or the Control suspension (CS). ES was microwaved at 650 W for 6 min. Suspensions were optically counted using methylene blue dye uptake as indicative of membrane-damaged cells; spread on Agar Sabouraud dextrose (ASD) for viability assay; or spectrophotometrically measured at 550 nm. Cell-free solutions were submitted to content analyses of protein (Bradford and Pyrogallol red methods); Ca++ (Cresolftaleine complexone method); DNA (spectrophotometer measurements at 260 nm) and K + (selective electrode technique). Data were analysed by Student's t- or Wilcoxon z-tests (α = 0.05). All ES cells demonstrated cell membrane damage. Viable cells were non-existent in the ES ASD plates. No significant difference in optical density between ES and CS was observed (P = 0.272). ES cells released significantly high protein (P < 0.001, Bradford; P = 0.005, Pyrogallol red), K+ (P < 0.001), Ca++ (P = 0.012) and DNA (P = 0.046) contents. Microwaves inactivated C. albicans and damaged cell membrane integrity. © 2007 The Authors.

Effect of different exposure times on microwave irradiation on the disinfection of a hard chairside reline resin

Purpose: This study evaluated the effectiveness of different exposure times of microwave irradiation on the disinfection of a hard chairside reline resin. Materials and Methods: Sterile specimens were individually inoculated with one of the tested microorganisms (Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans, and Bacillus subtilis) and incubated for 24 hours at 37°C. For each microorganism, 10 specimens were not microwaved (control), and 50 specimens were microwaved. Control specimens were individually immersed in sterile saline, and replicate aliquots of serial dilutions were plated on selective media appropriate for each organism. Irradiated specimens were immersed in water and microwaved at 650 W for 1, 2, 3, 4, or 5 minutes before serial dilutions and platings. After 48 hours of incubation, colonies on plates were counted. Irradiated specimens were also incubated for 7 days. Some specimens were prepared for scanning electron microscopic (SEM) analysis. Results: Specimens irradiated for 3, 4, and 5 minutes showed sterilization. After 2 minutes of irradiation, specimens inoculated with C. albicans were sterilized, whereas those inoculated with bacteria were disinfected. One minute of irradiation resulted in growth of all microorganisms. SEM examination indicated alteration in cell morphology of sterilized specimens. The effectiveness of microwave irradiation was improved as the exposure time increased. Conclusion: This study suggests that 3 minutes of microwave irradiation can be used for acrylic resin sterilization, thus preventing cross-contamination. © 2008 by The American College of Prosthodontists.

Influence of preventive dental treatment on mutans streptococci counts in patients undergoing head and neck radiotherapy

The aim of this study was to evaluate the influence of chlorhexidine gluconate, sodium fluoride and sodium iodine on mutans streptococci counts in saliva of irradiated patients. Forty-five patients were separated into three experimental groups and received chlorhexidine (0.12%), sodium fluoride (0.5%) or sodium iodine (2%), which were used daily during radiotherapy and for 6 months after the conclusion of the treatment. In addition, a fourth group, composed by 15 additional oncologic patients, who did not receive the mouthwash or initial dental treatment, constituted the control group. Clinical evaluations were performed in the first visit to dental clinic, after initial dental treatment, immediately before radiotherapy, after radiotherapy and 30, 60, 90 days and 6 months after the conclusion of radiotherapy. After clinical examinations, samples of saliva were inoculated on SB20 selective agar and incubated under anaerobiosis, at 37oC for 48 h. Total mutans streptococci counts were also evaluated by using real-time PCR, through TaqMan system, with specific primers and probes for S. mutans and S. sobrinus. All preventive protocols were able to reduce significantly mutans streptococci counts, but chlorhexidine gluconate was the most effective, and induced a significant amelioration of radiotherapy side effects, such as mucositis and candidosis. These results highlights the importance of the initial dental treatment for patients who will be subjected to radiotherapy for head and neck cancer treatment.

Annual and monthly mean global, direct and diffuse solar irradiation in Botucatu/SP/Brazil

This paper presents a climatic and statistical analysis of global, direct horizontal and diffuse radiation from a database of solar radiation measured from 1996 to 2006 in the city of Botucatu, SP, Brazil. Variation intervals of hourly and daily irradiation, annual mean 〈H̄G〉, 〈H̄bh〉 and 〈H̄d〉 irradiation, monthly mean 〈H̄G〉, 〈H̄ bh〉 and 〈H̄d〉 irradiation and monthly mean 〈K̄t〉, 〈K̄bh〉 and 〈K̄d〉 fractions were determined. Results showed that values of hourly and daily annual mean irradiation were as follows: 〈H̄G〉=1.49MJ/m2 and 〈H̄ G〉=17.74MJ/m2; 〈H̄bh〉=0. 90MJ/m2 and 〈H̄bh〉=10.33MJ/m2 and 〈H̄d〉=0.57 MJ/m2 and 〈H̄d〉=7.09MJ/m2, respectively. Variation intervals of hourly monthly mean irradiation were as follows: 〈H̄G〉 ranged from 1.65MJ/m2 in March to 1.16MJ/m2 in June; 〈H̄bh〉 ranged from 1.06MJ/m2 in April to 0.79MJ/m2 in June, and 〈H̄d〉 ranged from 0.70MJ/m2 in January to 0.37MJ/m2 in June and July. Similarly, daily 〈H̄ G〉 irradiation ranged from 21.35MJ/m2 in November to 12.94MJ/m2 in June; 〈H̄bh〉 ranged from 11.83MJ/m2 in April to 8.49MJ/m2 in June, and 〈H̄d〉 ranged from 10.29MJ/m2 in December to 4.38MJ/m2 in June. Variation intervals of hourly monthly mean fractions were as follows: 〈K̄t〉 ranged from 43.5% in January to 54.2% in April; 〈K̄bh〉 ranged from 33.6% in January to 58.0% in April and 〈K̄d〉 ranged from 66.4% in January to 42.0% in April. In the same way, daily 〈K̄ t〉 fractions ranged from 45.5% in January to 59.8% in August; 〈K̄bh〉 ranged from 38.9% in January to 62.0% in August and 〈K̄d〉 ranged from 61.1% in January to 37.7% in July.

Selective photoinactivation of Candida albicans in the non-vertebrate host infection model Galleria mellonella

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Cell membrane integrity of candida albicans after different protocols of microwave irradiation

To evaluate the ability of low time microwaveexposureto inactivate and damage cell membrane integrity of C. albicans. Materials and Methods: Two 200ml C. albicans suspensions were obtained. Sterile dentures were placed in a beaker containing Experimental (ES) or Control suspensions (CS). ES was microwaved at 650 W for 1, 2, 3, 4 or 5 min. Suspensions were optically counted using Methylene blue dye as indicative of membrane-damaged cells; spread on Agar Sabouraud dextrose (ASD) for viability assay; or spectrophotometrically measured at 550nm. Cell-free solutions were submitted to content analyses of protein (Bradford and Pyrogallol red methods); Ca++ (Cresolphthalein Complexone method); DNA (spectrophotometer measurements at 260nm) and K+ (selective electrode technique). Data were analyzed by Student-t test and linear regression (α=0.05). In addition, flowcytometry analysis of Candida cells in suspensionwas performed using propidium iodide. Results: All ES cells demonstrated cell membrane damage at 3, 4 and 5 min,viable cells were nonexistent at 3, 4 and 5 min ES ASD plates and optical density of ES and CS was not significantly differentfor all exposition times. ES cells released highcontents of protein, K+ , Ca++ and DNA after 2 min exposition when compared to that of the CSs. Similar results were observed with flow cytometry analysiswith regard to the periodsof microwave exposure. Conclusions: Microwave irradiation inactivated C. albicansafter 3min and damaged cell membrane integrity after 2 min exposition.

Opportunistic microorganisms in patients with head and neck trauma

The use of antimicrobial agents has facilitated the dissemination of multi-resistant microorganisms, compromising dental and medical treatment. The aim of this study was to evaluate the distribution of different opportunistic microbial species in patients who suffered head and neck trauma, under temporary maintenance in nosocomial environment, particularly intensive care units, on the occurrence of such microorganisms in the oral cavity of the patients. It was selected 38 patients subjected to head and neck traumas. After emergency surgical procedures, clinical samples of saliva, sub and supragingival biofilms and mucosal surfaces were collected at two different moments: just after stabilization of the patient and soon after patients’ release from medical units. The presence of opportunistic and superinfecting microorganisms was evaluated by culture on selective and non-selective media, and the presence of the family Enterobacteriaceae, as well as genera Enterococcus, Pseudomonas, and Staphylococcus was assessed by PCR. It was found that the use of antimicrobials, even for short periods of time was sufficient to facilitate colonization by microorganisms of the families Enterobacteriaceae and Pseudomonadaceae, as well as yeasts and enterococci. These results support the concept that medical and dental teams should make a periodically change of antimicrobials used in treatment protocols in hospital for head and neck trauma patients, in order to minimize dissemination of opportunistic or superinfecting microorganisms.

Comparison of DNA-extraction methods and Selective Enrichment broths on the detection of Salmonella Typhimurium in swine feces by polymerase chain reaction (PCR)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)