Skull repair after major crush injury.

Reconstructive surgery after trauma of the head and neck is a wide field in ENT surgery. The repair of bony defects often requires implantation of engineered prostheses. We present the case of a 48-year-old male patient who had suffered a major crush injury to his head resulting in a complex bony defect. A computer-assisted designed (CAD/CAM) Titanium implant was used for reconstruction. Direct prefabrication of the individually designed implant led to an excellent coverage of the bony defect and easy adaptation to the defect margins. Results. Treatment plan and surgery as well as implant design and manufacturing were performed in a multidisciplinary team. Skin expander implantation prior to reconstructive surgery ensured a tension-free closure. This team approach led to a satisfactory outcome for this patient. This case illustrates the necessity of a multidisciplinary approach for the optimum management of complex head and neck injuries.

Vagus nerve stimulation for depression: efficacy and safety in a European study.

BACKGROUND: Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression. METHOD: An open, uncontrolled European multi-centre study (D03) of VNS therapy was conducted, in addition to stable pharmacotherapy, in 74 patients with treatment-resistant depression (TRD). Treatment remained unchanged for the first 3 months; in the subsequent 9 months, medications and VNS dosing parameters were altered as indicated clinically. RESULTS: The baseline 28-item Hamilton Depression Rating Scale (HAMD-28) score averaged 34. After 3 months of VNS, response rates (> or = 50% reduction in baseline scores) reached 37% and remission rates (HAMD-28 score <10) 17%. Response rates increased to 53% after 1 year of VNS, and remission rates reached 33%. Response was defined as sustained if no relapse occurred during the first year of VNS after response onset; 44% of patients met these criteria. Median time to response was 9 months. Most frequent side-effects were voice alteration (63% at 3 months of stimulation) and coughing (23%). CONCLUSIONS: VNS therapy was effective in reducing severity of depression; efficacy increased over time. Efficacy ratings were in the same range as those previously reported from a USA study using a similar protocol; at 12 months, reduction of symptom severity was significantly higher in the European sample. This might be explained by a small but significant difference in the baseline HAMD-28 score and the lower number of treatments in the current episode in the European study.