Postextinction Geographies: Audiovisual Afterlives of the Bucardo and the Ivory-Billed Woodpecker.

How do technologies animate more-than-human geographies after extinction? How can geographical scholarship evoke, or bring presence to, extinct biota? In an epoch simultaneously characterized by biotic loss at an unthinkable scale and the increased presence of representations depicting nonhuman life through mass media and digitization, we examine the epistemic, affective, and ethical possibilities of extinct animal traces to shape more-than-human geographies. We show how technological apparatuses inaugurate afterlives of extinction troubling binaries of extinct-extant and absence-presence. Specifically, we consider audio and visual remains of two taxa producing awkward and unsettling postextinction geographies: the ivory-billed woodpecker and the bucardo. Sound recordings and other historical traces continue to forge contemporary connections between human searchers and the ivory-billed woodpecker, although no sighting of the ghost bird has been universally accepted since 1944. The bucardo was declared extinct in 2000, but it was tentatively reanimated through a failed 2003 cloning project; in this milieu, visual technologies and representations conjure alternative presence and speculative futures beyond technoscientific spectacle. Through conversing our own situated, speculative, and technologically mediated relations with these taxa-and situating the technological assemblages themselves-we present some of the lively, contested, and dispersed ways technological apparatuses affect and inaugurate animated geographies after extinction.

¿Cómo animan las tecnologías a las geografías más-que-humanas después de la extinción? ¿Cómo puede la erudición geográfica evocar o darle existencia a la biota extinta? En una época que simultáneamente se caracteriza por la pérdida biótica a una escala impensable, y la creciente presencia de representaciones que muestran la vida no humana a través de los medios masivos y la digitalización, examinamos las posibilidades epistémicas, afectivas y éticas de las huellas de animales extintos para configurar las geografías más-que-humanas. Mostramos cómo los aparatos tecnológicos inauguran las posvidas de la extinción cuestionando los binarios de lo extinto­existente y de la ausencia­presencia. Específicamente, tomamos en consideración los restos sonoros y visuales de dos taxones que producen geografías postextincionales hoscas e inquietantes: el pájaro carpintero pico de marfil y el bucardo. Las grabaciones de sonidos y otros relictos históricos siguen forjando conexiones contemporáneas entre las búsquedas humanas y el pájaro carpintero pico de marfil, así desde 1944 no haya sido universalmente aceptado avistamiento alguno de esta ave fantasmal. El bucardo se declaró extinto en 2000, pero fue tentativamente revivido por medio de un fallido proyecto de clonación en 2003; en este entorno ambiental las tecnologías y representaciones visuales conjuran una presencia alternativa y unos futuros especulativos más allá del espectáculo tecnocientífico. A través de nuestras propias relaciones situadas, especulativas y tecnológicamente mediadas con aquellos taxones ­y situando los propios ensamblajes tecnológicos­ presentamos algunas de las formas vivas, controvertidas y dispersas en que los aparatos tecnológicos afectan e inauguran geografías animadas después de la extinción.

Manually after-loaded 192Ir low-dose rate brachytherapy after subtotal excision and flap reconstruction of recurrent cervical lymphadenopathy from head and neck cancer.

BACKGROUND: Treatment of extensive recurrent cervical lymph node metastases from previously irradiated head and neck cancer represents a difficult clinical challenge. We report the results of an approach of maximal surgical debulking and manually after-loaded intra-operative brachytherapy. PATIENTS AND METHODS: Seventy-four procedures were carried out at the Royal Marsden Hospital between 1979 and 2003. All patients had previously been treated with radical radiotherapy or chemoradiation. Patients underwent maximal surgical debulking, followed by brachytherapy to the tumour bed with low-dose rate (192)Ir to a dose of 60 Gy to the reference isodose using the Paris system. RESULTS: Overall and disease specific survival rates were 31% and 28% at two years and 23% and 17% at five years. Corresponding Loco-regional control rates were 37% and 23%, respectively. Fifty per cent of patients developed metastatic disease within 5 years of treatment. Best results were obtained with surgical excision, brachytherapy and reconstruction of the skin defect using a vascularised myo-cutaneous flap with in-field control rates of 72% at two years and 66% at 5 years. Nine per cent of patients developed fistulae, 4% had haemorrhage and 8% wound breakdown/infection. CONCLUSIONS: Maximal surgical debulking, including removal of overlying skin, and brachytherapy to the surgical tumour bed provides high levels of local control, and can be achieved with acceptable morbidity. Only a minority of patients achieve long-term survival because of the high risk of systemic relapse.

Direct microvascular monitoring of a free autologous jejunal flap using microendoscopy: a case report.

BACKGROUND: Early identification of flap failure is an indispensable prerequisite for flap salvage. Although many technical developments of free flap monitoring have now reached clinical application, very few are considered to be reliable and non-invasive for early recognition of flap failure. CASE PRESENTATION: We used microendoscopic technique for microvascular monitoring of free autologous jejunal flap by the direct visualisation of the flow of erythrocytes through the capillary vasculature on both the mucosal and serosal surfaces. Blood flow was seen to be pulsatile, with individual erythrocytes visible in the capillaries. The best view was obtained when the scope was focussed directly on the capillary rather than the graft surface. The view of the unstained mucosal surface was bland apart from the fine capillary loops which were seen to fill with each pulsatile event. The microendoscopic examination of the serosal surface revealed much larger calibre vessels with obvious blood flow. CONCLUSION: The microendoscopic monitoring technique is simple and safe with direct visualisation of blood flow. The technique may also be useful for the monitoring of other free bowel transplants.

Surgical management of radiation-induced angiosarcoma after breast conservation therapy.

BACKGROUND: Radiation-induced angiosarcoma (RA) is a well-recognized complication of breast conservation therapy (BCT). METHODS: Over a 12-year period, 14 patients with a median age of 68 years were identified retrospectively. The median latency from BCT to onset of RA was 81 months. The incomplete excision rate (complete histologic margin taken to be > 10 mm) was 46%. There was a significant difference in the size of the cutaneous defect between the complete and incomplete excision groups (412 vs 592 cm(2), respectively; P < .05), indicating more extensive disease in the latter group. RESULTS: The tumor recurred locally in 12 patients (92%). The median time to local recurrence (LR) in patients with incomplete excision was 3 versus 23 months in patients who had a complete excision. The median survival time for patients who underwent complete versus incomplete excision was 42 and 6 months, respectively. CONCLUSIONS: RA is a challenging condition, with a prolonged latency period and variable clinical progression. Incomplete excision of RA is a surrogate marker of aggressive disease and is associated with rapid LR and poor survival.

Limb salvage surgery in the excision of a massive fibromatosis.

Fibromatosis is a rare fibroproliferative disorder with a tendency for local infiltrative and destructive growth. Local recurrence is frequent, despite apparent complete resection after radical excision. We present a case of a 22-year-old woman with massive recurrent thoracic fibromatosis extending into the neck and impairing the function of her right upper limb. This required a multidisciplinary approach to surgery to salvage the limb. The case highlights the fact that while every attempt should be made to achieve negative histologic margins, local recurrence is not uncommon. Therefore, if fibromatosis occurs adjacent to or involves vital structures, these should not be sacrificed to achieve negative margins. Function and structure preserving procedures are important as the primary goal, if not even more important.

Flap reconstruction following gynaecological tumour resection for advanced and recurrent disease--a 12 year experience.

We have reviewed all the cases of flap reconstruction following resection of a gynaecological malignancy at the Royal Marsden Hospital over 12 years from 1993 until 2005. Forty-six patients were identified who required 53 flaps. The predominant site of the primary tumour was vulva, accounting for 83% of the cases, with cervix, ovary, vagina and endometrium making up the remainder. Squamous cell carcinoma was the most common histological type, accounting for 71% of cases, with adenocarcinoma, Paget disease, leiomyosarcoma, melanoma and basosquamous carcinoma making up the remainder. Most patients (73%) had recurrent disease at the time of reconstruction and most patients (80%) had been treated with radiotherapy either before and/or after surgery. Local flaps accounted for 49% of the reconstructions performed, with 16 rhomboid flaps, five lotus petal flaps and five advancement flaps. Of the pedicled myocutaneous flaps, there were 21 rectus abdominis flaps, four gracilis flaps and one tensor fascia lata flap. There was one free flap. The complication rate was 53%, with wound breakdown predominating. The 5 year survival was 14%, with 67% of patients surviving 1 year. This group of patients often have advanced disease and a limited life span. The complications associated with performing a major reconstructive procedure need to be balanced against the potential wound problems associated with leaving these advanced tumours untreated surgically.

Recent technological developments: in situ histopathological interrogation of surgical tissues and resection margins.

OBJECTIVES: The tumour margin is an important surgical concept significantly affecting patient morbidity and mortality. We aimed in this prospective study to apply the microendoscope on tissue margins from patients undergoing surgery for oral cancer in vivo and ex vivo and compare it to the gold standard "paraffin wax", inter-observer agreement was measured; also to present the surgical pathologist with a practical guide to the every day use of the microendoscope both in the clinical and surgical fields. MATERIALS AND METHODS: Forty patients undergoing resection of oral squamous cell carcinoma were recruited. The surgical margin was first marked by the operator followed by microendoscopic assessment. Biopsies were taken from areas suggestive of close or positive margins after microendoscopic examination. These histological samples were later scrutinized formally and the resection margins revisited accordingly when necessary. RESULTS: Using the microendoscope we report our experience in the determination of surgical margins at operation and later comparison with frozen section and paraffin section margins "gold standard". We were able to obtain a sensitivity of 95% and a specificity of 90%. Inter-observer Kappa scores comparing the microendoscope with formal histological analysis of normal and abnormal mucosa were 0.85. CONCLUSION: The advantage of this technique is that a large area of mucosa can be sampled and any histomorphological changes can be visualized in real time allowing the operator to make important informed decisions with regards the intra-operative resection margin at the time of the surgery.

The management of carotid artery rupture.

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.