Objective: Carotid artery stenosis is a complication of neck irradiation. We describe the immediate and long-term results of surgical treatment.Methods: This was a retrospective single centre study. From 1996 to 2009, 24 consecutive patients who had in the past received neck radiation therapy (mean 12 years, 1-41 years) underwent 27 primary carotid artery revascularisation procedures. Six patients (23%) had previous radical neck dissection, three permanent tracheostomies and one cervicoplasty with pectoral muscle flap. Indications for surgery included symptomatic (five transient ischaemic attacks (TIAs), four strokes; 34%) and asymptomatic (18 patients, 66%) stenosis. Four patients had occlusion of the contralateral carotid. General anaesthesia without shunting was used with measurement of stump pressure. Carotid interposition bypass grafting included 23 vein grafts and three Polytetrafluoroethylene (PTFE) grafts.Results: No perioperative deaths or central neurological events occurred. Three patients suffered transient cranial nerve injuries. Eleven patients died during follow-up, mean interval of 28 months (range 6 -120 months), of causes unrelated to surgery. Five patients had recurrent bypass stenosis with one TIA and one stroke. All other surviving patients remained asymptomatic.Conclusion: Despite no comparative study as evidence, we think that the perioperative risk of stroke is at least comparable with the risk encountered for angioplasty procedures. Evaluation of Radiation during EVAR Performed on a Mobile C-armMaurel B., Sobocinski J., Perini P., Guillou M., Midulla M., Azzaoui R., Haulon S. Eur J Vasc Endovasc Surg 2012;43:17-22.

This paper describes a blind cross-over study on the gastrointestinal uptake of soluble and insoluble cobalt compounds (8.5 mumol/day) in 12 male and 11 female volunteers. In a controlled study it was found that the gastrointestinal uptake of the soluble cobalt compound cobalt chloride was considerably higher than the uptake of the insoluble cobalt compound cobalt oxide (urine ranges: < 0.17-4373 and < 0.17-14.6 nmol/mmol creatinine, respectively). Surprisingly, it was shown that ingestion of controlled amounts of soluble cobalt compound resulted in significantly higher urinary cobalt levels (P < 0.01) in females (median: 109.7 nmol/mmol creatinine) than in males (median: 38.4 nmol/mmol creatinine). The results suggest that the gastrointestinal uptake of cobalt is higher for females than males. The present study shows that the normal levels of cobalt in blood and urine in a non-random-selected group of Danes are low. As the fraction of values below the detection limit of the analytical method was 0.19 and 0.33 for urinary cobalt in females and males, respectively, distribution-free one-sided tolerance intervals were chosen to describe the values. The precision of the estimate of the tolerance intervals was expressed as coverage intervals. In females the 95% one-sided tolerance limit calculated for cobalt in blood and urine was 8.48 and 55.10 nmol/l with coverage intervals of 90% +/- 6.5% and 95% +/- 4.2% at a probability of 0.95, respectively. Even though the studied groups of males and females were not representative for the general population, the study indicates that oral exposure may be important in occupational settings.(ABSTRACT TRUNCATED AT 250 WORDS)

A review of classifications of zygomatic fractures demonstrates an increasing complexity in the choice of proper treatment. To facilitate the choice of treatment a proposal is made of a simplified classification with prediction of post-reductive fracture stability. The author's material, comprising 137 patients, has been accordingly divided and the proposed classification justified by the peroperative findings and by the follow-up results.

Out of a total of 137 patients with zygomatic fractures, 87 with post-reductively stable fractures were treated solely with Gillies' procedure. Twenty-eight patients with unstable fractures were treated with transosseous wiring. In 22 patients, in whom the fracture was considered undisplaced, no fracture treatment was given. At the follow-up only 2 of the patients treated by Gillies' procedure presented malunited fractures, and these only minor ones,this reductive method thus being satisfactory in 64% of all cases. Malunion was seen in one-third of the patients treated with transosseous wiring, this treatment thus appearing frequently insufficient. Consequently, accomplishment with Kirschner-pin fixation is proposed. Finally, a schedule for treatment of zygomatic fractures is given.

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