This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Recurrent cancers present some of the most challenging management issues in head and neck surgical and oncological practice. This is rendered even more complex by the poor evidence base to support management options, the substantial implications that treatments can have on the function and quality of life, and the difficult decision-making considerations for supportive care alone. This paper provides consensus recommendations on the management of recurrent head and neck cancer.Recommendations• Consider baseline and serial scanning with computed tomography and/or magnetic resonance (CT and/or MR) to detect recurrence in high-risk patients. (R)• Patients with head and neck cancer recurrence being considered for active curative treatment should undergo assessment by positron emission tomography combined with computed tomography (PET–CT) scan. (R)• Patients with recurrence should be assessed systematically by a team experienced in the range of management options available for recurrence including surgical salvage, re-irradiation, chemotherapy and palliative care. (R)• Management of patients with laryngeal recurrence should include input from surgeons with experience in transoral surgery and partial laryngectomy for recurrence. (G)• Expertise in transoral surgery and partial laryngectomy for recurrence should be concentrated to a few surgeons within each multidisciplinary teams. (G)• Transoral or open partial laryngectomy should be offered as definitive treatment modality for highly-selected patients with recurrent laryngeal cancer. (R)• Patients with OPC recurrence should have p16 human papilloma virus status assessed. (R)• Patients with OPC recurrence should be considered for salvage surgical treatment by an experienced team, with reconstructive expertise input. (G)• Transoral surgery appears to be an effective alternative to open surgery for the management of OPC recurrence in carefully selected patients. (R)• Consider elective selective neck dissections in patients with recurrent primaries with N0 necks, especially in advanced cases. (R)• Selective neck dissection (with preservation of nodal levels, especially level V, that are not involved by disease) in patients with nodal (N+) recurrence appears to be as effective as modified or radical neck dissections. (R)• Use salivary bypass tubes following salvage laryngectomy. (R)• Use interposition muscle-only pectoralis major or free flap for suture line reinforcement if performing primary closure following salvage laryngectomy. (R)• Use inlaid pedicled or free flap to close wound if there is tension at the anastomosis following laryngectomy. (R)• Perform secondary puncture in post chemoradiotherapy laryngectomy patients. (R)• Triple therapy with platinum, cetuximab and 5-fluorouracil (5-FU) appears to provide the best outcomes for the management of patients with recurrence who have a good performance status and are fit to receive it. If...

Our study is the largest to date examining the role of tamoxifen in idiopathic gynecomastia, and our results show approximately nine in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. We support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits.

This paper proposes a simplified structure of microcontroller based mechanical ventilator integrated with a Bag-Valve-Musk (BVM) ventilation mechanism. Here, an Ambu bag is operated with computer-aided manufacturing (CAM) arm that is commanded via a microcontroller and manual switches by sending a control signal to the mechanical system and according to this control signal, the mechanical computer-aided manufacturing (CAM) arm simultaneously compresses and decompresses the Ambu bag. It is a selfinflating bag and like a one-way valve around its inlet and outlet corner. By compressing the Ambu bag it delivers air and by relaxing, it takes air from the environment through a mechanical scavenger. The control signals are designed with three modes named adult mode, pediatric mode, and child mode based on the respiratory rate. The device is in assist controlled mode by dint of fixing the tidal volume for all unique control signals. The control signal is visualized by a platform known as the BIOPAC student's lab system. The proposed device is portable, compact, low weight, and efficient performable. It can be supplied around the rural area hospitals for immediate medication with cost efficiency and risk avoidance. Anyone can operate it as no need to study or training of ventilation rules like ICU ventilator. The proposed system is safe, riskless, and repairable. The angle, volume, and respiratory measurement have found 95%, 92%, and 90% accuracy respectively. By applying this portable ventilator system immediate attention can be taken up in rural or general hospitals and in ambulances.

Bang Med J (Khulna) 2012; 45 : 3-5

Male breast cancer (MBC) is rare and accounts for 1% all breast cancers. 1 Approximately, 350 men are diagnosed with the condition each year within the UK and its incidence is increasing. 2 However, due to the rare nature of the disease, MBC has been poorly studied in relation to female breast cancer (FBC). 3 We aimed to investigate the prognosis of MBC in our center's past 10-year experience, and to compare the patient, tumor, and treatment differences between men who were treated successfully and those who suffered breast cancer recurrence or all-cause mortality.We undertook a prospective cohort study of all patients diagnosed with MBC over a 10-year period from 1 January 2005 until 31 December 2014. The identifiers of all men were prospectively recorded over the study period and at the end of this study, the clinical notes were retrieved and reviewed. Outcome and treatment-related information was extracted from the clinical notes. The primary outcome measure of interest was adverse outcome, defined as ipsilateral disease recurrence, contralateral breast cancer occurrence, metastatic disease, or all-cause mortality.A total of 30 primary cases of MBC were identified; 27 unilateral and 3 bilateral cases. All patients were treated with mastectomy and either sentinel lymph node biopsy or axillary clearance, followed by adjuvant endocrine therapy. Radiotherapy and chemotherapy were reserved for cases of metastatic disease or high risk of recurrence.Of these, 24 patients adhered to adjuvant endocrine therapy, six had adjuvant chemotherapy, and 16 patients had adjuvant radiotherapy.No patients were lost to follow-up.The mean age was 68.3 years (SD 11.8) and patient characteristics are shown in Table 1. All patients were followed up annually with surveillance contralateral imaging and clinical examination. Five patients had an adverse outcome, of which three patients had a subsequent recurrence (10%) and two died from their disease (7%). Of the five patients with adverse outcome, three patients had invasive ductal carcinoma and two had invasive cribiform carcinoma. Tumor size and nodal status did not reach statistical significance (P = 0.13 and 0.14, respectively) for adverse outcome (Table 2).There is limited evidence on the prognosis of MBC; however, it is generally worse than for FBC. 4 MBC is predominantly ER-positive, 5 suggesting that underlying endocrine factors may play an important role in pathogenesis. In more recent years, a number of other receptors have also been identified with MBC such as glucocorticoid, androgen, HER2, and EGF receptors although the prognostic value of these receptors is still poorly understood. 6While not identified in our cohort, axillary nodal involvement and tumor size have previously been identified as key prognostic determinants for MBC. Although there is heterogeneous evidence on the prognosis of men with breast cancer, their prognosis is generally worse than their female counterparts. The reason for this is unclear, but since this difference in prognosis appears to be independe...