Publications by authors named "Simon Holmes"

30 Publications

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Primary Orbital Fracture Repair.

Authors:
Simon Holmes

Atlas Oral Maxillofac Surg Clin North Am 2021 Mar 8;29(1):51-77. Epub 2021 Jan 8.

Department of Oral and Maxillofacial Surgery, Royal London Hospital, London, UK. Electronic address:

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http://dx.doi.org/10.1016/j.cxom.2020.11.004DOI Listing
March 2021

Orbital Bone Fractures in a Central London Trauma Center: A Retrospective Study of 582 Patients.

J Craniofac Surg 2021 Jan 5;Publish Ahead of Print. Epub 2021 Jan 5.

Department of Oral and Maxillofacial Surgery, Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, United Kingdom.

Abstract: The aim of the present study was to evaluate the injury patterns and etiology of orbital bone fractures treated at a busy level one trauma center.Between 2015 and 2019, patients with orbital bone fractures from the Department of Oral and Maxillofacial Surgery at the Royal London Hospital, were evaluated in a retrospective analysis. A pro-forma was used to collect data from electronic patient records. Parameters included age, gender, maxillofacial fracture, mechanism of injury, and length of hospital admission.Of 582 patients, 82% (n = 476) were male and 18% (n = 106) were female, with those in the age group 20 to 29 years most affected (36%; n = 212). The most common etiology was interpersonal violence (55%; n = 320), followed by falls (20%; n = 118) and road traffic accidents (12%, n = 68). The most common isolated orbital bone fracture site was the orbital floor (40%; n = 234). Of the impure orbital fractures, the zygoma was the most commonly involved structure adjacent to the orbit (19%, n = 110).In our department, the authors see high numbers of complex orbital bone requiring surgical treatment. Interpersonal violence is a significant cause of orbital bone fractures with young males most affected. This study provides an insight into the current trends in etiology, demographics, and clinical findings of orbital fractures that will help guide prevention and treatment strategies.
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http://dx.doi.org/10.1097/SCS.0000000000007384DOI Listing
January 2021

Acquired Brown Syndrome in Head Trauma: Does Fixation of Associated Nasal and Frontal Bone Fractures Provide a Cure?

Br Ir Orthopt J 2020 Jan 30;16(1):1-3. Epub 2020 Jan 30.

Royal Devon and Exeter NHS Foundation Trust, GB.

A 43-year-old gentleman presented with vertical double vision following nasal and frontal bone fractures resulting from blunt trauma to the glabella. Orthoptic assessment revealed a diagnosis of traumatic Brown syndrome affecting the right eye. The fractures were fixed with open reduction internal fixation via a coronal flap nine days after the injury was sustained. Evidence of resolution of the syndrome became apparent clinically within 15 days following surgery, which was confirmed with a later orthoptic evaluation. This case demonstrates that prompt surgical intervention of fractures associated with traumatic Brown syndrome may lead to resolution without the need to resort to extraocular muscle surgery.
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http://dx.doi.org/10.22599/bioj.144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510388PMC
January 2020

Elite and Professional sports facial injuries management - a consensus report.

Br J Oral Maxillofac Surg 2020 12 26;58(10):e254-e259. Epub 2020 Aug 26.

Consultant in Oral and Maxillofacial Surgery, University Hospitals Bristol NHS Trust, Bristol. Electronic address:

Whilst there have been great improvements in the management of elite and professional athletes with the formalisation of the clinical specialty of Sports and Exercise medicine, the management of facial injuries has perhaps lagged in this group. Professional athletic careers can be put in jeopardy due to unnecessarily long absences from training and competition after facial injuries. Professional and elite sports athletes can benefit from different approaches to the management of their facial injuries to reduce time away from competing but maximise their safety. On 6 December 2018, a consensus meeting of interested clinicians involved in the management of facial injuries of elite and professional athletes was held at the Royal Society of Medicine, London, UK to provide a contemporary review of the approaches to conservative, operative and recovery management of facial injuries. National experts with specialist experience of facial injuries presentation and athlete needs from a range of elite and professional sports led the day's programme and the discussions so that guidelines could be formulated. These are presented in this review paper.
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http://dx.doi.org/10.1016/j.bjoms.2020.08.046DOI Listing
December 2020

Toward a consensus view in the management of acute facial injuries during the Covid-19 pandemic.

Br J Oral Maxillofac Surg 2020 06 11;58(5):571-576. Epub 2020 Apr 11.

Barts Health NHS Trust.

In these unprecedented times, OMFS surgeons are faced with dilemmas over the priority of treatment, safety of staff, safety of patients and the most appropriate use of available resources. Efforts should be made to provide the best evidence-based care, which will mean revisiting old techniques, and risk stratifying patients on a case by case basis. Recent experience from colleagues internationally has shown that even the wealthiest health care infrastructure is at best fragile. We hope this paper will add to the debate and hopefully provide a framework for decision making in OMFS trauma care during this difficult time.
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http://dx.doi.org/10.1016/j.bjoms.2020.03.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151269PMC
June 2020

Motor vehicle accidents-related maxillofacial injuries: a multicentre and prospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Sep 13;128(3):199-204. Epub 2018 Dec 13.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objectives: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures.

Study Design: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1.

Results: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures.

Conclusions: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.
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http://dx.doi.org/10.1016/j.oooo.2018.12.009DOI Listing
September 2019

Prevalence and predictive factors of psychological morbidity following facial injury: a prospective study of patients attending a maxillofacial outpatient clinic within a major UK city.

Dialogues Clin Neurosci 2018 12;20(4):327-339

Oral and Maxillofacial Surgery Department, the Royal London Hospital, Barts Health NHS Trust, London, UK.

Adults presenting to maxillofacial surgery services are at high risk of psychological morbidity. This study examined the prevalence of depression, post-traumatic stress disorder (PTSD), anxiety, drug and alcohol use, and appearance-related distress among maxillofacial trauma outpatients over medium-term follow-up. It also explored socio-demographic and injury-related variables associated with psychological distress to inform targeted psychological screening protocols for maxillofacial trauma services. Significant associations were found between level of distress at time of injury and number of traumatic life events with levels of depression at 3 months. No significant associations were found between predictor variables and PTSD at 3 months, or with any psychiatric diagnosis at 6 months. The lack of evidence for an identifiable subgroup of patients who were at higher risk of psychological distress indicated that routine screening of all maxillofacial trauma outpatients should be offered in order to best respond to their mental health needs. The feasibility of the medical team facilitating this is challenging and should ideally be undertaken by psychologists integrated within the MDT. This study led to the funding of a clinical psychologist to provide collaborative care with the maxillofacial surgeons, resulting in brief assessment and treatment to over 600 patients in the first year of the service.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436951PMC
December 2018

The "European zygomatic fracture" research project: The epidemiological results from a multicenter European collaboration.

J Craniomaxillofac Surg 2019 Apr 30;47(4):616-621. Epub 2019 Jan 30.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

Purpose: Fractures of the zygomaticomaxillary complex (ZMC) are common injuries that may lead to loss of an aesthetically pleasing appearance and functional impairment. The aim of this study was to analyze the demographics, causes, characteristics, and outcomes of zygomatic fractures managed at several European departments of oral and maxillofacial surgery.

Materials And Methods: This study is based on a multicenter systematic database that allowed the recording of all patients with ZMC fractures between 1 January 2013 and 31 December 2017. The following data were recorded: gender, age, personal medical history, etiology, side of zygomatic fracture, classification of ZMC fracture, associated maxillofacial fractures, symptoms at diagnosis, type of performed treatment, and sequelae/complications.

Results: A total of 1406 patients (1172 males, 234 females) were included in the study. Statistically significant correlations were found between assault-related ZMC fractures and the A3 class (p < .0000005) and between Infraorbital Nerve (ION) anesthesia and B class (p < .00000005).

Conclusion: The most frequent cause of ZMC fractures was assault, followed by falls. The most frequently involved decade of age was between 20 and 29 years. The decision and type of surgical treatment of ZMC fractures depends on several issues that need to be considered on a case by case basis.
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http://dx.doi.org/10.1016/j.jcms.2019.01.026DOI Listing
April 2019

The 100 Most Cited Articles in Facial Trauma: A Bibliometric Analysis.

J Oral Maxillofac Surg 2016 Nov 23;74(11):2240.e1-2240.e14. Epub 2016 Jun 23.

Professor in Craniofacial Traumatology, Department of Oral and Maxillofacial Surgery, The Royal London Hospital, Whitechapel, London, UK.

Purpose: The number of citations an article receives has been used as a marker of its influence within a surgical specialty. Currently, there is limited citation analysis in oral and maxillofacial trauma surgery. The purpose of this study was to determine the 100 most cited articles in facial trauma surgery and their characteristics.

Materials And Methods: Articles were identified from the Science Citation Index of the Institute for Scientific Information using the Thomson Reuters Web of Science search engine. All articles until 2015 were included. Then, the 100 most cited articles were assessed for title, author, journal, country of origin, and number of citations. A citation index (number of citations received per year) also was calculated.

Results: The 100 most cited articles in facial trauma received 9,933 citations (range, 66 to 297). They were published from 1942 through 2008, with 1990 through 1999 being the commonest decade. Articles were cited on average 4.6 times per year. Articles were published in 28 different journals, with impact factors ranging from 0.94 to 35.3. Most articles were observational research studies.

Conclusion: These findings reflect the attention that articles have received during the past half century in oral and maxillofacial trauma research, shedding light on often-read articles in this field. In addition to current bibliometric indices, it could provide a useful evidence base for facial surgeons, represent key educational material for aspiring trainees, and be used to help guide future research efforts.
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http://dx.doi.org/10.1016/j.joms.2016.06.175DOI Listing
November 2016

Good people who try their best can have problems: recognition of human factors and how to minimise error.

Br J Oral Maxillofac Surg 2016 Jan 2;54(1):3-7. Epub 2015 Nov 2.

Department of Anatomy, Guy's Campus, London, UK.

Human error is as old as humanity itself and is an appreciable cause of mistakes by both organisations and people. Much of the work related to human factors in causing error has originated from aviation where mistakes can be catastrophic not only for those who contribute to the error, but for passengers as well. The role of human error in medical and surgical incidents, which are often multifactorial, is becoming better understood, and includes both organisational issues (by the employer) and potential human factors (at a personal level). Mistakes as a result of individual human factors and surgical teams should be better recognised and emphasised. Attitudes and acceptance of preoperative briefing has improved since the introduction of the World Health Organization (WHO) surgical checklist. However, this does not address limitations or other safety concerns that are related to performance, such as stress and fatigue, emotional state, hunger, awareness of what is going on situational awareness, and other factors that could potentially lead to error. Here we attempt to raise awareness of these human factors, and highlight how they can lead to error, and how they can be minimised in our day-to-day practice. Can hospitals move from being "high risk industries" to "high reliability organisations"?
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http://dx.doi.org/10.1016/j.bjoms.2015.09.023DOI Listing
January 2016

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 May 24;119(5):499-504. Epub 2014 Dec 24.

Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia.

Objective: The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year.

Study Design: The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years.

Results: The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures.

Conclusions: Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.
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http://dx.doi.org/10.1016/j.oooo.2014.12.012DOI Listing
May 2015

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 Apr 11;119(4):385-91. Epub 2014 Dec 11.

Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia.

Objective: The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study.

Study Design: Demographic and injury data were recorded for each patient who was a victim of an assault.

Results: Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures.

Conclusions: Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.
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http://dx.doi.org/10.1016/j.oooo.2014.12.004DOI Listing
April 2015

European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study.

J Craniomaxillofac Surg 2015 Jan 22;43(1):62-70. Epub 2014 Oct 22.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.
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http://dx.doi.org/10.1016/j.jcms.2014.10.011DOI Listing
January 2015

Towards a classification system for complex craniofacial fractures.

Br J Oral Maxillofac Surg 2012 Sep 14;50(6):490-4. Epub 2011 Oct 14.

Barts and the London NHS Trust, United Kingdom.

The complexity of facial fractures has changed considerably in recent years together with more commonly observed high velocity trauma. Traditional classification systems describe fractures in an isolated manner but fail to recognise those that affect more than one region. We applied four conceptual scoring systems for craniofacial trauma to a cohort of patients in east London. We exposed the limitations of the systems and developed a new scoring system that encompasses elements of all of the models and is capable of overcoming previous limitations.
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http://dx.doi.org/10.1016/j.bjoms.2011.09.018DOI Listing
September 2012

Reoperative orbital trauma: management of posttraumatic enophthalmos and aberrant eye position.

Authors:
Simon Holmes

Oral Maxillofac Surg Clin North Am 2011 Feb 17;23(1):17-29, v. Epub 2010 Dec 17.

Barts and the London NHS Trust, The Royal London Hospital, London, UK.

Enophthalmos is a complex and unpredictable condition to treat secondarily, and this is likely to remain a difficult challenge. Modern imaging technology and the aggressive stance taken on appropriate primary repair make it likely that surgeons will see fewer minor cases and increased numbers of major cases. The choice of reconstructive material should be evidence-based rather than based on surgical preference. Of crucial importance to the management of all traumas, particularly in revisional surgery, is attention to the soft tissue envelope, which adds to the postoperative result, and may camouflage minor degrees of enophthalmos.
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http://dx.doi.org/10.1016/j.coms.2010.10.010DOI Listing
February 2011

Diver's harpoon gun: facial injury caused by an unusual weapon.

Br J Oral Maxillofac Surg 2010 Sep 26;48(6):482-3. Epub 2010 May 26.

Oral and Maxillofacial Surgery Centre, The Royal London Hospital, First Floor, John Harrison House, Philpot Street, Whitechapel, London E1 1BB, United Kingdom.

This unusual case of a facial injury caused by being shot with a diver's harpoon gun highlights the importance of good radiological assessment and careful planning before removal of the harpoon, and emphasises the need to control the barb.
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http://dx.doi.org/10.1016/j.bjoms.2009.06.234DOI Listing
September 2010

Infraorbital orbitotomy: modification of the Weber-Ferguson approach.

Br J Oral Maxillofac Surg 2010 Jan 24;48(1):44-5. Epub 2009 Jul 24.

Department of Oral & Maxillofacial Surgery, The Royal London Hospital, Whitechapel, London, United Kingdom.

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http://dx.doi.org/10.1016/j.bjoms.2009.02.017DOI Listing
January 2010

Facial trauma--who should provide care?

Authors:
Simon Holmes

Br J Oral Maxillofac Surg 2009 Apr;47(3):179-81

Department of Oral and Maxillofacial Surgery, Barts and the London NHS Trust, London, United Kingdom.

The management of facial trauma is key to the development and longevity of the specialty of Oral and Maxillofacial Surgery. Advances in material technology and surgical evolution have kept pace with increasingly complex fracture configurations. Soft tissue components of major craniofacial injuries are best managed in a multidisciplinary environment. This may be facilitated by a nominated team within specific trauma centres. Trauma management of the face is a continuum with both training implications and clinical governance issues. There is no uniformly accepted staging of severity, and no accepted quantifiable outcome measures. Until there are, craniofacial trauma management will remain anecdotal.
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http://dx.doi.org/10.1016/j.bjoms.2008.08.013DOI Listing
April 2009

Orbital emphysema - the need for surgical intervention.

J Craniomaxillofac Surg 2008 Dec 23;36(8):473-6. Epub 2008 Aug 23.

Department of Oral and Maxillofacial Surgery, St. Georges Hospital, Tooting, London, UK.

Introduction: Orbital emphysema is a recognised complication of fractures of the orbit and only rarely poses a threat to vision.

Patients And Methods: We present three patients with threatened vision secondary to orbital emphysema that required an immediate surgical decompression.

Results: Visual function was preserved in all three patients.

Conclusion: Clinical awareness of pneumo-orbitism is vital as immediate orbital decompression may be necessary to preserve visual function.
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http://dx.doi.org/10.1016/j.jcms.2008.04.004DOI Listing
December 2008

CMT3 alters mitochondrial function in murine osteoclast lineage cells.

Biochem Biophys Res Commun 2008 Jan 26;365(4):840-5. Epub 2007 Nov 26.

Section of Musculoskeletal Science, School of Medicine, University of Sheffield, UK.

Chemically modified tetracyclines (CMTs 1-10) were developed as non-antibiotic inhibitors of matrix metalloproteinases (MMPs). We previously demonstrated that MMP inhibition alone is insufficient to explain the pro-apoptotic action of CMTs in osteoclast lineage cells and we have explored additional mechanisms of action. We compared the characteristics of apoptosis in RAW264.7 murine monocyte and osteoclast cultures treated with pharmacologically relevant concentrations of CMT3 or the bisphosphonate alendronate, which induces osteoclast apoptosis through inhibition of farnesyl diphosphate synthase. CMT3 induced apoptosis rapidly (2-3h), whereas alendronate-induced apoptosis was delayed (>12h). CMT3-treated cells did not accumulate unprenylated Rap1A in contrast to cells treated with alendronate. Importantly, CMT3 induced a rapid loss of mitochondrial stability in RAW264.7 cells measured by loss of Mitotracker((R)) Red fluorescence, while bongkrekic acid protected polykaryons from CMT3-induced apoptosis. Modulation of mitochondrial function is therefore a significant early action of CMT3 that promotes apoptosis in osteoclast lineage cells.
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http://dx.doi.org/10.1016/j.bbrc.2007.11.054DOI Listing
January 2008

Predictors of tadalafil efficacy in men with erectile dysfunction: the SURE study comparing two dosing regimens.

J Sex Med 2006 Nov;3(6):1050-1058

Eli Lilly, Erl Wood Research Center, UK.

Introduction: The efficacy of phosphodiesterase-5 inhibitors in the treatment of erectile dysfunction may depend on patient characteristics.

Aim: To determine whether patient characteristics influence the efficacy of two tadalafil dosage regimens and to identify prognostic factors predictive of tadalafil efficacy.

Methods: This was a multicenter, open-label study in which men with erectile dysfunction were randomized to tadalafil 20 mg either on demand or three times per week for a period of 5-6 weeks. After a 1-week washout period, patients were crossed over to the alternate regimen for another 5-6 weeks.

Main Outcome Measures: Score of the Erectile Function (EF) domain of the International Index of Erectile Function Questionnaire (IIEF) and percentage of positive responses to questions 3 and 5 of the Sexual Encounter Profile (SEP) diary.

Results: A total of 4,262 patients were randomized. A normal EF domain score (> or =26) at the end of on-demand and three-times-per-week treatment was reported by 60.2% and 62.3% of patients, respectively. The percentage of patients who achieved a normal EF domain score and the percentages reporting positive responses to SEP3 and SEP5 depended on the severity of erectile dysfunction and the presence of certain comorbidities, irrespective of the tadalafil dosage regimen. On regression analysis, the two best predictors of tadalafil efficacy were the baseline score of the IIEF-EF domain and the baseline percentage of "Yes" responses to SEP2.

Conclusions: On-demand and three-times-per-week dosage regimens of tadalafil 20 mg were equally efficacious in men with erectile dysfunction. Among the possible prognostic factors tested in this study, baseline disease severity scores were the strongest predictors of efficacy endpoint scores.
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http://dx.doi.org/10.1111/j.1743-6109.2006.00330.xDOI Listing
November 2006

Evaluation of complex craniomaxillofacial fractures by a new three-dimensional planning system.

Br J Oral Maxillofac Surg 2006 Oct 18;44(5):416-7. Epub 2005 Oct 18.

Department of Oral and Maxillofacial Surgery, Barts and the London NHS Trust, 3rd Floor Alexandra House, Royal London Hospital, Whitechapel, UK.

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http://dx.doi.org/10.1016/j.bjoms.2005.05.021DOI Listing
October 2006

The role of the maxillofacial surgeon in the initial 48 h following a terrorist attack.

Br J Oral Maxillofac Surg 2005 Oct;43(5):375-82

Department of Oral and Maxillofacial Surgery, First Floor John Harrison House, Phillpott St, Royal London Hospital, Whitechapel E1 1BB, UK.

On 7 July 2005 there were four explosions in central London, three almost synchronously and a fourth within an hour. The Royal London Hospital received 208 casualties and the Hospital Major Incident Plan was put into action. We report on the events of that day and the role of the maxillofacial surgeons immediately and in the subsequent 48 h.
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http://dx.doi.org/10.1016/j.bjoms.2005.08.001DOI Listing
October 2005

Trauma--pertinent papers 2002-2003. A personal view.

Authors:
Simon Holmes

Br J Oral Maxillofac Surg 2005 Oct;43(5):435-7

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http://dx.doi.org/10.1016/j.bjoms.2005.03.002DOI Listing
October 2005

An evaluation of an alternative dosing regimen with tadalafil, 3 times/week, for men with erectile dysfunction: SURE study in 14 European countries.

Eur Urol 2005 Jun 9;47(6):846-54; discussion 854. Epub 2005 Mar 9.

University of Naples Federico II, A.O.U. Federico II, Via S. Pansini 5, Ed. 5-80131, Napoli, Italy.

Objective: To examine the preference for 2 dosing regimens (on demand or 3 times/week) for tadalafil, a phosphodiesterase 5 inhibitor with a duration of effectiveness up to 36 hours in men with erectile dysfunction (ED).

Design And Methods: SURE is a 14 European country, multicenter, crossover, and open-label study. Men with ED (N=4262) were randomized to tadalafil 20mg treatment on demand (maximum one dose per day and before sexual activity) or 3 times/week for 5-6 weeks. After a 1-week washout period, patients were crossed over to the alternate regimen for 5-6 weeks. The patient's response to a treatment preference question (TPQ) was used to determine the preferred treatment regimen.

Results: The mean age of the randomized patients was 55 years and 85.2% reported a history of ED for one year or greater. Overall, the responses of 3861 men to the TPQ assessment showed that 57.8% preferred the on-demand regimen and 42.2% preferred the 3 times/week dosing. Both regimens were efficacious and well tolerated.

Conclusions: In this study, while 57.8% of men preferred the on-demand regimen of tadalafil 20mg, a substantial number (42.2%) preferred the 3 times/week treatment. The two regimens provide additional treatment options by giving men with erectile dysfunction unique flexibility in dosing with tadalafil.
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http://dx.doi.org/10.1016/j.eururo.2005.02.019DOI Listing
June 2005

Skin edge debridement made easy.

Injury 2005 Jun 31;36(6):805; author reply 806. Epub 2005 Mar 31.

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http://dx.doi.org/10.1016/j.injury.2004.12.038DOI Listing
June 2005

Simplified transfer of intraoral bone grafts in ridge-augmentation procedures.

Implant Dent 2003 ;12(2):113-5

Department of Prosthodontics, Temple University School of Dentistry, Philadelphia, Pennsylvania, USA.

The use of mandibular symphyseal bone in bony reconstruction of limited anterior defects is common. This communication suggests the use of a template to ensure accurate sizing of the graft. A technique is also suggested where the screw hole in the grafted bone is made prior to the removal from the donor site. These modifications greatly simplify the transfer of bone grafts in these cases.
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http://dx.doi.org/10.1097/01.id.0000055823.61744.87DOI Listing
September 2003

UK department of health guidance on prescribing for impotence following the introduction of sildenafil: potential to contain costs in the average health authority district.

Pharmacoeconomics 2002 ;20(12):839-46

Brighton and Hove City Primary Care Trust, Vantage Point, Brighton, England.

Objectives: To evaluate the effectiveness at containing service costs of the UK's Department of Health (DoH) guidance on prescribing for impotence implemented after the introduction of sildenafil and taking effect from 1 July 1999.

Design: A pragmatic economic analysis of the impact of the DoH guidance on specialist-care activity and costs and primary-care prescribing costs from the perspective of the UK National Health Service. Primary-care prescribing costs and specialist-care activity and cost data were collected for 12-month periods before and after the introduction of the guidance.

Setting: Portsmouth and South East Hampshire Health Authority.

Results: Specialist-care activity and associated costs fell by 70% in the first year following the introduction of the DoH guidance while primary-care prescribing costs doubled. The overall cost for providing impotence services in Portsmouth and South East Hampshire in 1999-2000 was pound 232,619, and is similar to the cost incurred in 1998-1999 of pound 225,108 (uplifted to 1999-2000 values).

Conclusions: The DoH guidance on prescribing for impotence has effectively reduced specialist-care activity and costs in Portsmouth and South East Hampshire. It offers the potential to allow the overall costs of impotence services in the district to be contained even with the use of higher cost drugs, such as sildenafil.
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http://dx.doi.org/10.2165/00019053-200220120-00004DOI Listing
November 2002

Prospective randomised trial comparing diethylstilboestrol and flutamide in the treatment of hormone relapsed prostate cancer.

Int J Urol 2002 Aug;9(8):431-4

Department of Urology, St Mary's Hospital, England.

Background: Patients with hormone relapsed prostate cancer (HRPC) are often treated with flutamide or diethylstilboestrol. However, which of these two options is the best treatment for HRPC remains unclear.

Methods: We carried out a prospective study to determine and compare the prostate-specific antigen (PSA) response and survival in patients with hormone relapsed prostate cancer (HRPC), all of whom had previously shown a good response to medical or surgical castration. The patients were randomised to treatment with diethylstilboestrol (DES) and aspirin, or the antiandrogen flutamide. In addition, quality of life was determined by interview and questionnaire.

Results: Twenty-eight patients were randomised for treatment options. There was a significantly greater fall in the PSA (65% vs 35%; P = 0.034) after treatment with diethylstilboestrol compared to treatment with flutamide. Median survival also rose after treatment with diethylstilboestrol (18 months) compared to flutamide (11 months), but this difference did not reach statistical significance. There was no difference in the quality of life parameters between the two groups. There were no cardiovascular complications in the stilboestrol group.

Conclusions: In HRPC, treatment with stilboestrol is associated with a greater PSA fall and an increase in median survival when compared to flutamide treatment.
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http://dx.doi.org/10.1046/j.1442-2042.2002.00495.xDOI Listing
August 2002