Carotid artery rupture is fortunately an uncommon complication of head and neck cancer treatment. Eleven episodes of carotid artery rupture following irradiation and major head and neck resection were identified over a 6-year period. We review our experience and discuss the predisposing factors that can cause this complication, important aspects of management and outcome. During this 6-year period, 11 episodes of carotid artery rupture were treated in our unit. All patients had received prior irradiation (more than 60 Gy) and undergone a major surgical resection or resections. The average age was 59 years; all patients had a salivary fistula, local infection and a manifest 'herald bleed' just before their major carotid artery rupture. These patients were resuscitated, taken to theatre and the neck explored, with control of the vessel and debridement of necrotic tissue. Soft tissue coverage was in the form of a flap. Many of the factors predisposing to carotid artery rupture can be ameliorated or treated early in order to avoid this complication. Early and aggressive nutritional support together with correction of haematological abnormalities promote wound healing and prevent tissue breakdown. The detection and treatment of infection also reduces fistula formation and wound compromise. We present our protocol for the early, aggressive management of these patients with carotid artery rupture.

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1.  A spatial depletion model of the responses of grazing wildfowl to the availability of intertidal vegetation at Lindisfarne National Nature reserve, north‐east England, was used to investigate the capacity of the site’s beds of Zostera and other intertidal vegetation to support brent geese Branta bernicla hrota and wigeon Anas penelope. 2.  Recent total winter counts of brent geese and wigeon were both only 40% of the maximum that the food supply at the site could theoretically support. Other factors must have been restricting their numbers. Earlier arrival of brent geese at the site could increase the number of brent goose‐days which could be supported, but would have only a slight negative effect on the wigeon‐days. 3.  The model was used to examine three conservation issues: encroachment of Spartina anglica, sea level rise and loss of food plants from the whole site (which could result from increased autumn storms or plant disease). Loss from the top of the shore through encroachment by Spartina anglica had the greatest effect on the site’s capacity to sustain geese and wigeon. Loss from the bottom of the shore, as would occur through sea level rise, had less impact. Increased loss of vegetation over the whole site would have an intermediate effect. 4.  This work has important implications for the management of the site. Factors such as hunting, that may be restricting current numbers below those that could be supported by the food supply, require urgent investigation. Model predictions indicate that encroachment of Spartina is likely to depress local populations of brent geese and wigeon under current conditions only if it results in the complete loss of Zostera from the top 500 m of the shore.

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CONTENTS I. Introduction. 2. Factors which increase the daily energy requirements 3. Factors which reduceihe rate offood intake. .. 4. Factors which reduce the availability of prey 5. Factors which reduce potential feeding time '.'. . 6. The influence of physical factors on energy balance. 7. Optimal foraging strategies in shorebirds-some energetic considerations 8. The distribution of shorebirds inthe non-breeding season 9. Summary. .. . 10. Acknowledgements II. References .