Ciprofloxacin is a commonly used antibiotic for gastrointestinal and genitourinary tract infections with a considerably good safety profile. However, occasionally it may cause life-threatening complications. Two case reports of bone marrow depression and 1 case of thrombocytopenia due to ciprofloxacin therapy have been reported in literature. We report a case of bone marrow depression due to ciprofloxacin therapy for urinary tract infection in an otherwise healthy woman.

Background Coupling devices have become commonplace in performing venous anastomoses during microvascular free tissue transfer (FTT). However, arterial anastomoses are still most commonly performed using traditional microvascular suture techniques. Objective To describe the safety and feasibility of using microvascular coupling devices for free flap arterial anastomosis. Methods A systematic review of English language literature was performed for studies that investigated the use of an arterial coupler for microvascular FTT in human patients. A comprehensive search of MEDLINE (January 1948 to August 2018), EMBASE (January 1974 to August 2018), and Web of Science was performed. Results Fifteen studies were included. All studies were retrospective case series. A combined total of 395 arterial anastomoses were attempted with a coupling device. All studies except for one used the 3M Unilink/Synovis coupling device. One study used a novel absorbable coupling device. The coupling device was aborted and converted to a suture technique in 8.4% of attempted anastomoses. Rupture of the anastomotic device was reported in only 1 patient (0.3%). Thrombosis was also infrequent at 1.9%. The quality assessment showed a high risk of bias in all studies. Conclusion In selected patients, coupling devices for arterial anastomoses have a good success rate with low rates of thrombosis based on limited quality evidence.

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Background The American Joint Committee on Cancer (AJCC) released a new staging system for human papilloma virus (HPV) positive oropharyngeal cancer (OPC) in their eighth edition. The role of smoking in HPV positive oropharyngeal cancer remains controversial and is not factored into the updated staging system. Methods Single institutional, retrospective chart review of patients with HPV positive OPC from 2009 to 2017 was completed. Dichotomized smoking data were collected into 0–9 and ≥10 pack‐year histories. Kaplan–Meier survival curves compared overall survival (OS) for smokers and nonsmokers. Results Five‐year OS was not statistically different in stage I or stage II HPV positive OPC comparing nonsmokers versus smokers, but worse in stage III smokers (38% vs. 76%, p < 0.05). Conclusion Greater than 10 pack‐year smoking status may negatively affect survival in late stage HPV positive OPC but not in early stage disease. HPV positive smokers may require additional risk stratification.

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