The significance of cobalt as a cause of symptoms after McKee hip arthroplasty is discussed. Seven patients are described in whom such arthroplasties became unsatisfactory after periods varying from nine months to four years. Six of these patients were cobalt-positive but nickel-and chrome-negative on patch testing. Macroscopic and histological necrosis of bone, muscle and joint capsule around the prostheses was found in five patients whose hips were explored. The symptoms were progressive pain, a feeling of instability, and in two cases spontaneous dislocation. Radiological features included acetabular fracture, bone resorption, loosening and dislocation of the prosthesis. Increased cobalt concentrations (determined by atomic absorption spectrophotometry) in the urine of four patients and in a variety of tissues in one patient are presented. Patch testing is recommended in the investigation of patients with troublesome McKee hip arthroplasties.

Background: Angiographic guidance for percutaneous coronary intervention (PCI) has substantial limitations. The superior spatial resolution of optical coherence tomography (OCT) could translate into meaningful clinical benefits, although limited data exist to date about their effect on clinical end points. We aimed to determine the effect on long-term survival of using OCT during percutaneous coronary intervention (PCI). Methods and results:This was a cohort study based on the Pan-London (United Kingdom) PCI registry. In total, 123,764 patients are included in this registry covering London, England, which includes all patients who underwent PCI in National Health Service hospitals in London between January 1, 2005, and May 31, 2015. Patients undergoing primary PCI or pressure wire use were excluded. The primary end point was all-cause mortality at a median of 4.1 years. OCT was used in 1149 patients (1.4%), IVUS was used in 19,971 patients (19.7%) and angiography alone in the remaining 66,149. Overall OCT rates increased over time (p<0.0001) with variation in rates between centres (p=0.002). The mean stent length was shortest in the angiography-guided group, longer in the IVUS guided group and longest in the OCT-guided group. OCT guided procedures were associated with greater procedural success rates and reduced inhospital MACE rates. A significant difference in mortality was observed between patients who underwent OCT-guided PCI (7.7%) compared with patients who underwent either IVUS (12.2%) or angiography guided PCI (15.7%, p<0.0001) (Figure 1), with differences seen for both elective (P<0.0001) and ACS subgroups (p=0.0024). Overall this difference persisted after multivariate cox analysis (HR 0.37 (95% CI 0.25-0.62) and propensity matching (HR=0.36, 95% CI: 0.18-0.73, p=0.0005) (OCT versus anigo alone cohort) with no difference in matched OCT and IVUS cohorts (HR 0.86 CI: 0.57-1.34). Conclusion:In this large observational study, OCT-guided PCI was associated with improved procedural outcomes and long-term survival compared with standard angiography-guided PCI. Background: Non-vitamin K antagonist oral anticoagulants (NOACs) have changed the landscape of stroke prevention in patients with atrial fibrillation (AF), but comparative outcome data for standard or reduced dose NOAC-use are limited. Purpose: To compare effectiveness and safety of standard and reduced dose dabigatran, rivaroxaban, and apixaban in a nationwide cohort. YOUNG INVESTIGATOR AWARDS SESSION THROMBOSIS

Patients with limited T1aN0 cancers may be treated with either transoral laser excision or RT. Those with more advanced T1-T2N0 cancers are treated with definitive RT. We do not advocate elective nodal irradiation, even for those with bulky T2B malignancies. The addition of concomitant weekly cisplatin 30 mg/M² is considered for patients with T2B cancers. Open parotid laryngectomy is reserved for salvage of suitable patients with a local recurrence.

Optimal management for unplanned excision of soft-tissue sarcoma is unknown. Our institution has adopted the approach of preoperative radiotherapy, followed by definitive surgery. In our series of 44 patients, local control was excellent at 95%, with perioperative complications seen only in patients with lower extremity sarcomas, suggesting that this is a reasonable approach to manage inadvertently resected sarcoma.

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