- Email: [email protected]
Journal oracle
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery 49 (2011) 332–333
Journal Oracle to changes in the routine use of the pneumatic tourniquet in some selected cases. New automatic tourniquet systems might also be advantageous in such cases.
Barts and the London NHS Trust. Department of Oral and Maxillofacial Surgery. MK Alibhai, S Stagnell, M Millwaters We report an unusual mandibular fracture involving an ectopic tooth in the ramus. Radiographs showed fractures of the symphysis and right ramus through an ectopic tooth. The ramus fracture was not mobile and did not communicate with the oral cavity. The ectopic tooth had previously been asymptomatic. Therefore, following open reduction and internal fixation of the symphysis, the ramus fracture was conservatively managed and the tooth left in-situ. Four weeks postoperatively, the occlusion was stable with no fracture mobility. This case highlights that a rare fracture involving an ectopic tooth should be managed with the same basic fracture fixation principles. Figure 1. Pre-op panoramic radiograph Post-op PA mandible. of Cranio-Maxillofacial 2011;39(April (3)):206–8 0266-4356/$ – see front matter
doi:10.1016/j.bjoms.2011.04.070
Journal Surgery
This article caught my eye, as I was taught one treatment for acute compartment syndrome in the leg can include removal of the mid third of fibula which will open all the tissue spaces as the authors say ‘ACS is an unexpected complication after fibula flap harvest since the three compartments of the leg are opened during surgery‘.
The patient measured 183 cm and weighed 76 kg, and had no significant medical history. Computed tomography (CT) angiogram showed normal vascular anatomy in both legs. A pneumatic tourniquet was placed around the proximal thigh and inflated to 400 mmHg to create a bloodless field. Fibula harvest was done through a lateral approach, the skin paddle being raised on the posterior crural intermuscular septum with some part of the soleus muscle because of intramuscular perforator vascular branches. The skin defect was covered with a loose dressing maintained with stitches to avoid a circular bandage while waiting for secondary grafting. A catheter was placed into the wound for continuous Naropeine infusion. The patient was then transferred to the intensive care unit (ICU) for postoperative surveillance.View Within Article
This group report on a case of acute compartment syndrome (ACS) in a 22-year-old male, following fibula flap harvest for mandibular reconstruction. Dissection during this patient’s surgery was unusually difficult due to muscle volume, which explains the unusually long ischemia time of 3 h and 10 min. Only four cases of ACS have been reported in the literature. Analysis of this serious complication might lead
Five hours post-operatively, significant swelling in the patient’s foot and leg was noticed. Stopping local analgesia resulted in intense pain in the right leg. Physical examination showed a tense and oedematous swollen right leg, good capillary return and good distal pulses, but an altered sensitivity and toe mobility. Deep vein thrombosis was excluded by ultrasound examination performed immediately.
Acute compartment syndrome following fibula flap harvest for mandibular reconstruction. Siham Kerrary, Thomas Schouman, Amanda Cox, Chloe Bertolus, Guillaume Febrer and Jacques Charles Bertrand
Journal Oracle / British Journal of Oral and Maxillofacial Surgery 49 (2011) 332–333
Creatine phosphokinase (CPK) value was 43450 IU/L and serum potassium level was 6.6 mEq/L. Forced alkaline diuresis was started to prevent renal failure. In addition to the post-ischemic reperfusion syndrome a compressive haematoma was feared and the wound immediately explored to release the internal pressure. No such complication was found, the wound was washed and all muscular adhesions released.
alone in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck after failure of platinum-based chemotherapy: an open-label, randomised phase 3 trial. Prof Jean-Pascal Machiels, Somasundaram Subramanian, Agnes Ruzsa, Prof Gabor Repassy, Igor Lifirenko, Annika Flygare, Per Sørensen, Tina Nielsen, Steen Lisby and Paul MJ Clement
After complete recovery from anaesthesia the symptoms were unchanged and intracompartmental pressures measured by the Wick catheter technique were 30 mmHg in the thigh, 45 mmHg in the medial side of the leg and 60 mmHg in the lateral side left opened. A second exploration was decided and an extensive three-compartment fasciotomy was performed through a medial incision and an extension of the lateral wound. When opening the muscular compartments, the medial gastrocnemius showed early signs of ischemia but recovered a satisfactory appearance by the end of the surgery. After fasciotomy, compartment pressures were all under 20 mmHg.
No treatments are presently available to increase survival in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck after failure of platinum-based chemotherapy. This group aimed to assess efficacy and safety of zalutumumab, a human IgG1 monoclonal antibody targeting the epidermal growth factor receptor, for overall survival in such patients.
The patient was monitored postoperatively in the ICU, where serum chemistries were carefully monitored. CPK rapidly declined Secondary closure by skin grafting was done a week later and the patient was discharged home 12 days after the initial surgery. Six months post-operatively, the patient still suffers from significant neurogenic pain and a near complete anaesthesia of the whole foot; very weak extrinsic foot muscles, both anterior and posterior, with 5◦ dorsiflexion at best. Gait is altered but no walking aid is needed. The Lancet Oncology 2011;12(April (4)):333–43 Zalutumumab plus best supportive care versus best supportive care
In this open-label, parallel-group, phase 3, randomised trial, they randomly allocated patients with squamous-cell carcinoma of the head and neck who were regarded as incurable with standard therapy, a WHO performance status of 0–2, and progressive disease within 6 months of platinum-based therapy in a 2:1 ratio to receive zalutumumab plus best supportive care (zalutumumab group) or best supportive care with optional methotrexate (control group) at medical centres in Europe, Brazil, and Canada. Randomisation was done via a centralised interactive voice-response system, stratified by performance status. Data were analysed when the randomisation code was broken, after the completion of the accrual and cleaning of the relevant data. An independent review committee, masked to treatment assignment, assessed tumour response and disease progression according to response evaluation criteria in solid tumours. Zalutumumab was given weekly by individual dose titration on the basis of skin rash. After a prespecified 231
333
deaths, we included all randomised patients in the survival analyses and all patients receiving at least one session of therapy in the safety analysis. The primary endpoint was overall survival, although progression-free survival was also assessed. This trial is registered with ClinicalTrials.gov, NCT00382031. They randomly allocated 191 (67%) of 286 eligible patients to the zalutumumab group and 95 (33%) to the control group. Median overall survival was 6·7 months (95% CI 5·8–7·0) in the zalutumumab group and 5·2 months (4·1–6·4) in the control group (hazard ratio [HR] for death, stratified by WHO performance status, was 0·77, 97·06% CI 0·57–1·05; unadjusted p = 0·0648). Progression-free survival was longer in the zalutumumab group than in the control group (HR for progression or death, stratified by WHO performance status, was 0·63, 95% CI 0·47–0·84; p = 0·0012). 189 patients given zalutumumab and 94 controls were included in the safety analysis. The most common grade 3–4 adverse events were rash (39 [21%] patients in the zalutumumab group vs none in the control group), anaemia (11 [6%] vs five [5%]), and pneumonia (nine [5%] vs two [2%]). 28 (15%) patients in the zalutumumab group had grade 3/4 infections compared with eight (9%) in the control group. The most common serious adverse events were tumour haemorrhage (28 [15%] patients given zalutumumab vs 13 [14%] controls), pneumonia (13 [7%] vs three [3%]), and dysphagia (11 [6%] vs two [2%]). Although zalutumumab did not increase overall survival, progressionfree survival was extended in patients with recurrent squamous-cell carcinoma of the head and neck who had failed platinum-based chemotherapy. Zalutumumab dose titration on the basis of rash is safe.
British Journal of Oral and Maxillofacial Surgery 49 (2011) 332–333
Journal Oracle to changes in the routine use of the pneumatic tourniquet in some selected cases. New automatic tourniquet systems might also be advantageous in such cases.
Barts and the London NHS Trust. Department of Oral and Maxillofacial Surgery. MK Alibhai, S Stagnell, M Millwaters We report an unusual mandibular fracture involving an ectopic tooth in the ramus. Radiographs showed fractures of the symphysis and right ramus through an ectopic tooth. The ramus fracture was not mobile and did not communicate with the oral cavity. The ectopic tooth had previously been asymptomatic. Therefore, following open reduction and internal fixation of the symphysis, the ramus fracture was conservatively managed and the tooth left in-situ. Four weeks postoperatively, the occlusion was stable with no fracture mobility. This case highlights that a rare fracture involving an ectopic tooth should be managed with the same basic fracture fixation principles. Figure 1. Pre-op panoramic radiograph Post-op PA mandible. of Cranio-Maxillofacial 2011;39(April (3)):206–8 0266-4356/$ – see front matter
doi:10.1016/j.bjoms.2011.04.070
Journal Surgery
This article caught my eye, as I was taught one treatment for acute compartment syndrome in the leg can include removal of the mid third of fibula which will open all the tissue spaces as the authors say ‘ACS is an unexpected complication after fibula flap harvest since the three compartments of the leg are opened during surgery‘.
The patient measured 183 cm and weighed 76 kg, and had no significant medical history. Computed tomography (CT) angiogram showed normal vascular anatomy in both legs. A pneumatic tourniquet was placed around the proximal thigh and inflated to 400 mmHg to create a bloodless field. Fibula harvest was done through a lateral approach, the skin paddle being raised on the posterior crural intermuscular septum with some part of the soleus muscle because of intramuscular perforator vascular branches. The skin defect was covered with a loose dressing maintained with stitches to avoid a circular bandage while waiting for secondary grafting. A catheter was placed into the wound for continuous Naropeine infusion. The patient was then transferred to the intensive care unit (ICU) for postoperative surveillance.View Within Article
This group report on a case of acute compartment syndrome (ACS) in a 22-year-old male, following fibula flap harvest for mandibular reconstruction. Dissection during this patient’s surgery was unusually difficult due to muscle volume, which explains the unusually long ischemia time of 3 h and 10 min. Only four cases of ACS have been reported in the literature. Analysis of this serious complication might lead
Five hours post-operatively, significant swelling in the patient’s foot and leg was noticed. Stopping local analgesia resulted in intense pain in the right leg. Physical examination showed a tense and oedematous swollen right leg, good capillary return and good distal pulses, but an altered sensitivity and toe mobility. Deep vein thrombosis was excluded by ultrasound examination performed immediately.
Acute compartment syndrome following fibula flap harvest for mandibular reconstruction. Siham Kerrary, Thomas Schouman, Amanda Cox, Chloe Bertolus, Guillaume Febrer and Jacques Charles Bertrand
Journal Oracle / British Journal of Oral and Maxillofacial Surgery 49 (2011) 332–333
Creatine phosphokinase (CPK) value was 43450 IU/L and serum potassium level was 6.6 mEq/L. Forced alkaline diuresis was started to prevent renal failure. In addition to the post-ischemic reperfusion syndrome a compressive haematoma was feared and the wound immediately explored to release the internal pressure. No such complication was found, the wound was washed and all muscular adhesions released.
alone in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck after failure of platinum-based chemotherapy: an open-label, randomised phase 3 trial. Prof Jean-Pascal Machiels, Somasundaram Subramanian, Agnes Ruzsa, Prof Gabor Repassy, Igor Lifirenko, Annika Flygare, Per Sørensen, Tina Nielsen, Steen Lisby and Paul MJ Clement
After complete recovery from anaesthesia the symptoms were unchanged and intracompartmental pressures measured by the Wick catheter technique were 30 mmHg in the thigh, 45 mmHg in the medial side of the leg and 60 mmHg in the lateral side left opened. A second exploration was decided and an extensive three-compartment fasciotomy was performed through a medial incision and an extension of the lateral wound. When opening the muscular compartments, the medial gastrocnemius showed early signs of ischemia but recovered a satisfactory appearance by the end of the surgery. After fasciotomy, compartment pressures were all under 20 mmHg.
No treatments are presently available to increase survival in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck after failure of platinum-based chemotherapy. This group aimed to assess efficacy and safety of zalutumumab, a human IgG1 monoclonal antibody targeting the epidermal growth factor receptor, for overall survival in such patients.
The patient was monitored postoperatively in the ICU, where serum chemistries were carefully monitored. CPK rapidly declined Secondary closure by skin grafting was done a week later and the patient was discharged home 12 days after the initial surgery. Six months post-operatively, the patient still suffers from significant neurogenic pain and a near complete anaesthesia of the whole foot; very weak extrinsic foot muscles, both anterior and posterior, with 5◦ dorsiflexion at best. Gait is altered but no walking aid is needed. The Lancet Oncology 2011;12(April (4)):333–43 Zalutumumab plus best supportive care versus best supportive care
In this open-label, parallel-group, phase 3, randomised trial, they randomly allocated patients with squamous-cell carcinoma of the head and neck who were regarded as incurable with standard therapy, a WHO performance status of 0–2, and progressive disease within 6 months of platinum-based therapy in a 2:1 ratio to receive zalutumumab plus best supportive care (zalutumumab group) or best supportive care with optional methotrexate (control group) at medical centres in Europe, Brazil, and Canada. Randomisation was done via a centralised interactive voice-response system, stratified by performance status. Data were analysed when the randomisation code was broken, after the completion of the accrual and cleaning of the relevant data. An independent review committee, masked to treatment assignment, assessed tumour response and disease progression according to response evaluation criteria in solid tumours. Zalutumumab was given weekly by individual dose titration on the basis of skin rash. After a prespecified 231
333
deaths, we included all randomised patients in the survival analyses and all patients receiving at least one session of therapy in the safety analysis. The primary endpoint was overall survival, although progression-free survival was also assessed. This trial is registered with ClinicalTrials.gov, NCT00382031. They randomly allocated 191 (67%) of 286 eligible patients to the zalutumumab group and 95 (33%) to the control group. Median overall survival was 6·7 months (95% CI 5·8–7·0) in the zalutumumab group and 5·2 months (4·1–6·4) in the control group (hazard ratio [HR] for death, stratified by WHO performance status, was 0·77, 97·06% CI 0·57–1·05; unadjusted p = 0·0648). Progression-free survival was longer in the zalutumumab group than in the control group (HR for progression or death, stratified by WHO performance status, was 0·63, 95% CI 0·47–0·84; p = 0·0012). 189 patients given zalutumumab and 94 controls were included in the safety analysis. The most common grade 3–4 adverse events were rash (39 [21%] patients in the zalutumumab group vs none in the control group), anaemia (11 [6%] vs five [5%]), and pneumonia (nine [5%] vs two [2%]). 28 (15%) patients in the zalutumumab group had grade 3/4 infections compared with eight (9%) in the control group. The most common serious adverse events were tumour haemorrhage (28 [15%] patients given zalutumumab vs 13 [14%] controls), pneumonia (13 [7%] vs three [3%]), and dysphagia (11 [6%] vs two [2%]). Although zalutumumab did not increase overall survival, progressionfree survival was extended in patients with recurrent squamous-cell carcinoma of the head and neck who had failed platinum-based chemotherapy. Zalutumumab dose titration on the basis of rash is safe.