Retrospective study on the predictive factors in chronic trismus.

Trismus is one of the most debilitating and treatment-resistant complications resulting from head and neck oncological treatments. The objective of this study was to assess how primary tumour variables could assist in predicting chronic trismus. From a (retrospective) oncological database (Department of Oral and Maxillofacial Surgery, University Hospitals Leuven), tumour-related, surgical, and oral functional variables were reviewed. Contributing factors for chronic trismus, defined as a mouth opening of less than 35 mm, at least one year after treatment for oral squamous cell cancer, were assessed via logistic regression. A mediational analysis was conducted on the significant predictive variables. Thirteen out of 52 patients were observed to have chronic trismus. A significantly higher prevalence of trismus was found for increasing clinical T classification (p < 0.01), tumours based in the maxilla or the retromolar trigone (p = 0.04), after adjuvant radiotherapy (p = 0.04), and/or with masticatory muscle tumour invasion (p ≤ 0.02). Furthermore, radiotherapy significantly impacted T classification in chronic trismus, while T classification was significantly related to masticatory muscle invasion. Although radiotherapy and clinical T classification are well-established risk factors for postoperative trismus, masticatory muscle invasion should be considered as one of the main predictive factors.

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis.

Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75-33.49; p<0.01), and of 4.57% for overall surgical complications (95% CI: 1.97-7.15; p<0.01). No significant difference in risk was found for flap failure (95% CI: -4.33-9.90; p=0.44), surgical site infection (95% CI: -0.88-2.60; p=0.33) and fistula formation (95% CI: -3.81-3.71; p=0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I2=63.02%; p=0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.

[Ultrasonography in carpal tunnel syndrome. A case report]. / Sonografie u syndromu karpálního tunelu - kazuistika.

Ultrasonography is an excellent tool for diagnosing pathologies of peripheral nerves. It quickly provides reliable information about possible nerve entrapment, even in post-operative conditions. We present a case of failed surgery for carpal tunnel syndrome in which ultrasonography gave us immediately all the information needed for quick therapeutic decision-making. Some basic principles of ultrasonography of peripheral nerves are also mentioned.

AIDS in Africa : a manual for physicians / Peter Piot ... [et al.] / Le SIDA en Afrique : manuel du practicien

A comprehensive guide to the diagnosis and clinical management of HIV infection and AIDS in Africa. Addressed to hospital-based physicians, the manual includes abundant practical information and advice that is specific to both the distinctive clinical presentation of HIV infection in Africa and the reality of conditions where drugs, resources, and laboratory facilities are limited. Distinctive clinical features, as seen in African patients, are illustrated in 37 colour plates. The book opens with a summary of what is known about the etiology and pathogenesis of HIV infection, including information on the structure and properties of the virus, characteristic and consistently observed immunological abnormalities, and the natural history of infection. The second chapter, devoted to epidemiology, explains the patterns of transmission and risk factors documented in Africa and gives figures indicating incidence and prevalence in different groups and areas. Against this background, clinical chapters describe each of the main signs and symptoms of HIV infection in detail and discuss the most commonly seen opportunistic infections and tumours. Other chapters offer guidance in the diagnosis of HIV infection and AIDS and the management of patients. Throughout, an effort is made to facilitate clinical decisions based on signs and symptoms rather than on the results of sophisticated laboratory investigations. Advice on treatment includes the examinations to be performed according to specific signs and symptoms, first-choice and alternative drugs, recommended doses, duration of treatment, and response rates. The concluding chapters outline what physicians should know about counselling, psychological support, and measures for prevention and control

AIDS in Africa : A manual for physicians / AIDS in Africa : A manual for physicians

In many parts of Africa, infection with human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS), is a major public health problem. The infection is now endemic in several African countries, and estimates of the number of infected people range in the millions. Because of the dramatic rise in the number of cases, many physicians and other health workers are having to cope daily with a disease for which they have had little or no training. Furthermore, most published information on the features of HIV infection relates to patients in Europe and North America, whose symptoms are often different from those of African patients

This books brings together a wealth of information that had previously been available only in specialist journals, providing a comprehensive description of the clinical manifestations of HIV infection in Africa, as well as guidelines on the management of patients. It it intended primarily for physicians working in hospitals, but other health workers will also find much relevant information on such topics as prevention of transmission, nursing care, and special features of the disease in children. Drawing on their own experience, as well as published reports, the authors have produced a guide that will be an invaluable tood in the fight agains AIDS in Africa