Reconstructive options after temporal bone resection for squamous cell carcinoma.

Squamous cell carcinoma (SCC) of the temporal bone is a rare, aggressive and highly malignant tumour that requires specialised, multidisciplinary surgery for its treatment. Reconstruction of the defect is as crucial as the tumour ablation in terms of mortality and postoperative morbidity. METHODS: The experience of the East Anglian Skull Base Surgery Service from 1982 to 2004 in managing 42 consecutive patients (22 females; age range 37-80 years) undergoing extended and lateral temporal bone resection for SCC is presented. RESULTS: The overall 5-year survival was 31.0% (median follow up: 97 months) when both curative and palliative procedures were included. On multivariate analysis, the favourable prognostic factors were male sex, well-differentiated tumours and stage N(0) neck. The reconstructions in 38 patients were analysed. The majority (24/38) had free tissue transfer reconstructions and most of these were radial forearm free flaps. Later in the series, other free flap types such as anterolateral thigh flaps and lateral arm flaps were employed. Pedicled myocutaneous flaps and local flaps were also used. CONCLUSIONS: This paper analyses the outcomes of the various reconstructions and discusses the evolution of their care in our unit. The information obtained from the review of our data is extrapolated to offer guidance on the choice of reconstructive option in these patients.     

Estimation methods for Maximum Residue Limits for pesticides

Maximum Residue Limits (MRLs) are standards that represent the maximum residue concentration expected to be found if a pesticide is applied according to good agricultural practice (GAP). MRLs are established only where the residues in food resulting from particular use patterns of the pesticide pass the public health risk assessment. Foodstuffs are monitored for MRL compliance and MRL exceedance can have economic and trade consequences. There is a trade-off when deciding on values for MRLs. The aim is to establish MRLs at levels that are high enough to prevent chance exceedance but not so high that misuse will not be detected. Small data sets typically available for estimating MRLs present problems for establishing consistent values. A review of MRL estimation methods is presented together with an assessment of the various methods.     

The -Omes are coming! The -Omes are coming! Research on the epididymis in the 21st century

Looking at the history of epididymal research provides a level of confidence in predictions of cause and effect that looking at the future cannot achieve. Thus, when one of us （Hamilton, 2002） wrote a short essay on the history of the testicular excurrent ducts it became fairly obvious that advances in understanding the epididymis followed advances in other fields, particularly those that provided new instrumentation to probe at ever finer levels of detail. Can this same theme lead to predictions about what will happen in epididymis research over the next century？     

Recent insights into platinum drug resistance in cancer.

Cisplatin and its analogs have become important components of chemotherapeutic regimens for the treatment of solid tumors, however, their overall effectiveness is limited by the emergence of drug-resistant tumor cells. Resistance to the platinum drugs is multifactorial consisting of mechanisms that prevent the formation of lethal platinum-DNA adducts and mechanisms that operate downstream of the drug/target interaction to promote cell survival. Continued progress in the study of the drug resistance phenotype as well as the development of new platinum analogs may eventually lead to improved therapies and increased survival rates.     

A SAFE,NEW APPROACH TO ESTABLISHING A PNEUMOPERITONEUM AT LAPAROSCOPY

The traditional method of establishing a pneumoperitoneum before laparoscopic surgery is via a Verres needle inserted in the midline below the umbilicus while tenting the abdominal wall with the hand. A new approach is described in which preliminary surgical exposure and tenting of the linea alba immediately above the umbilicus is achieved before needle insertion through the superior margin of the umbilical ring. The advantages of this new technique over the conventional method are discussed. Further technical features important in the safe formation of the pneumoperitoneum are emphasized.