Acquisition of microvascular suturing techniques is feasible using objective measures of performance outside of the operating room.

The aim of this study was to determine the effectiveness of a microsurgical simulation course on a group of novice surgeons. The study also aimed to see whether a device to measure manual dexterity (Imperial College Surgical Assessment Device, ICSAD), a global rating scale and an end product assessment tool could be used to objectively measure performance. Thirty surgeons were recruited to take part and were evenly split into novice, intermediate, and expert groups. The novice group took part in a one-week microsurgical course. The assessment of performance was done with the surgeon anastomosing a harvested rat aorta. They were assessed using ICSAD, which records number of hand movements, distance moved by hands and time. The assessment was also video recorded and later watched by two assessors. The procedure performance was scored using a global rating scale and the final anastomosis was scored using an end product assessment tool. The novice surgeons took the assessment at the beginning and at the end of the course. The intermediate and expert group performed the assessment once to use as a comparison to the novice group. By the end of the course the novices performed significantly better in all parameters in comparison to their pre course assessment. The novice group performed similarly to the expert group in their end of course assessment in four out of the five assessment parameters. Simulation using objective measures of performance can be used to effectively to train a group of novice microsurgeons.

Costochondral grafting for paediatric temporomandibular joint reconstruction: 10-year outcomes in 55 cases.

Costochondral grafting (CCG) can be used for the reconstruction of ankylotic, hypoplastic, and resected temporomandibular joint (TMJ) defects. CCGs have previously been considered the gold standard in children due to their growth potential and autogenous origin, but the disadvantages are unpredictable growth and joint ankylosis. This was a retrospective study of all children who received CCGs for TMJ reconstruction from 1985 to 2004, to allow a 10-year follow-up. Fifty-five patients were included in this study, with 74 grafts being placed; their mean age was 7.9±4.2years. Infection-related ankylosis (18.2%) and craniofacial microsomia (16.4%) were the most common diagnoses. Overall, 58.2% of patients suffered one or more complications over the follow-up period, with ankylosis (32.7%) and overgrowth (16.4%) being most common. There was a significant correlation between those with infection-related ankylosis and subsequent complications (χ2=8.8, df=1, P<0.005), while ankylotic patients in general exhibited greater overall complication rates (χ2=9.0, df=1, P<0.005). Patients with congenital TMJ defects were more likely to be complication-free than those with acquired defects (χ2=4.0, df=1, P<0.05). Caution is advised when placing CCGs in paediatric patients with ankylosed TMJs, especially those with infection-related ankylosis.

Guidelines for management of sodium hypochlorite extrusion injuries.

Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics. It is highly effective at dissolving organic debris and disinfecting the root canal system due to the high pH. Extravasation of NaOCl into intra-oral and extra-oral tissues can lead to devastating outcomes leading to long-term functional and aesthetic deficits. Currently no clear guidelines are available which has caused confusion among the dental and oral and maxillofacial (OMFS) surgical community how best to manage these patients. Following a literature review and considering our own experience we have formulated clear and precise guidelines to manage patients with NaOCl injury.

NICE guideline and current practice of antibiotic prophylaxis for high risk cardiac patients (HRCP) among dental trainers and trainees in the United Kingdom (UK).

OBJECTIVE: The National Institute for Health and Clinical Excellence (NICE) introduced the antibiotic prophylaxis guideline in 2008 for cardiac patients in the UK, which has led to a decrease in national prescription levels for antibiotic prophylaxis. Despite the introduction of the guideline there is still a discrepancy in levels of compliance among the dental community. The aims of this study were to determine the understanding of the NICE clinical guideline on antimicrobial prophylaxis against infective endocarditis (IE) and the difference in antibiotic prescription for high risk cardiac patients (HRCP) between dental trainers and trainees. METHODS: A proforma was designed and distributed among dental trainers and trainees attending a conference at the London deanery. The trainers were GDPs responsible for training dental trainees allocated to them over a 12 month period based in a general dental practice. Dental trainees were recent graduates about to commence their vocational dental training. Eighty-five vocational dental trainees and 70 trainers completed the proforma on a voluntary basis. RESULTS: The results of the study confirm that most trainers (95.7%) and trainees (94.1%) are aware of this guideline but only 62% of trainers and 69.7% of trainees have read the guideline. Compliancy with the guideline was low among trainers (55.7%) and trainees (77.6%). Compliance was high among those who had read the guideline. Trainers were more likely to prescribe prophylaxis antibiotics for HRCP. The majority (74-76%) would prescribe antibiotics on a specialist's request. Some trainers (54.9%) and trainees (48.2%) would want antibiotics themselves if they were HRCP. CONCLUSION: This study concludes that much needs to be done to improve the understanding and practice of NICE guideline among the dental trainers and trainees.

Tale of a human tail: case report of a torted human tail.

A baby was referred with torsion of a sacral appendage. The lesion was excised and the histology confirmed it to be a lipoma. Human tail is a rare presentation and torsion is a complication that has not been documented before.

Not to knot a catheter. Case report of the knotting of a suprapubic catheter.

A 20-month-old boy, who underwent left nephrectomy, had a suprapubic catheter inserted that knotted within the bladder. This case report identifies possible causes for such occurrences and how best to manage them.

The prevention of type 2 diabetes mellitus: recent advances.

Diabetes is a major public health problem that is approaching epidemic proportions globally. There is an urgent need for strategies to curb the rising prevalence of this disease, and prevention appears a logical approach. Lifestyle modifications with weight loss and moderate exercise can reduce the incidence of diabetes by >50% in patients with impaired glucose tolerance (IGT). The use of metformin, acarbose and other agents have been shown in randomized prospective trials to prevent type 2 diabetes in high-risk subjects with IGT. Other pharmacological interventions are currently being examined in large prospective studies. It is likely that one or a combination of these approaches could make diabetes prevention a reality in the near future.

Hyperthermic potentiation of chromosome aberrations by anticancer antibiotics.

In view of the success of hyperthermia as a modality in cancer treatment, we have studied its effect on chromosomes in combination with anticancer antibiotics. Three classes of chemicals, one with a non-delayed type of effect (adriamycin), one with a delayed type of effect (mitomycin C), and one with a truely radio-mimetic effect (bleomycin) were selected for study on human lymphocytes and Chinese hamster K-1 cells. Propane sultone was also included because its effect on plants is suppressed by hyperthermia. The data show increased because its effect on plants is suppressed by hyperthermia. The data show increased potential of these chemicals to induce chromosome aberrations when applied at temperatures higher than 37 degrees C, irrespective of the phase of cell cycle. The potentiation may be due to true synergism (bleomycin) of facilitation of entry of larger quantities of the drug (adriamycin). No potentiating effect was observed on the induction of sister chromatid exchanges (SCEs).