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Introduction Chylothorax is a rare complication after LTx resolving in a minority of cases with non-surgical management, primarily tube drainage, low-fat or parenteral nutrition and somatostatin analogues. In refractory chylothorax, surgical ligation and thoracic duct embolization have been used.1 Thoracic duct embolization has been effectively undertaken with varying combinations of alcohol, coiling, glue or lipiodol (iodinated poppy seed oil).2-3 Lipiodol is theorised to cause intraluminal inflammation and duct closure. Previous cases have reported profound lung injury with pulmonary embolization.2,4-5 Case Report A 67-year-old woman underwent a left single LTx for Chronic Obstructive Pulmonary Disease. Her post-LTx course was complicated by acute kidney injury and pulmonary venous congestion with high chest drain output. 7 days post-LTx, a persistent chyle leak was noted. Failing medical management, methylene guided lymphangiography deployed 30ml lipiodol and alcohol into the cisterna chyli. Unfortunately, on subsequent imaging lipiodol had accumulated in the pleural space and the interstitium of the LTx with spread to the retrocural space and thoracic inlet (Fig. 1A). The patient remained in ICU for 3-weeks, requiring slow wean of invasive ventilation via tracheostomy. Despite initial concerns of permanent lung fibrosis post-lipiodol, there was progressive resorption over the next month. The patient was decannulated and discharged home without supplemental oxygen (Fig. 1B). She achieved her peak lung function 1 year following LTx (FEV1 50%, FVC 42%). Complete radiological clearance of lipiodol was noted at 3 years (Fig. 1C). She remains alive with stable Chronic Lung Allograft Dysfunction (FEV1 20%) 11 years following LTx with no recurrent pleural effusions. Summary This case shows long-term single LTx survival despite lipiodol escape during attempted embolization without development of fibrosis.

Background: Much attention has been paid to radiation exposure with CT coronary angiography (CTCA) but less to the dose associatedwith invasive catheter angiography (CA). Methods: Radiation doses were reviewed from consecutive CTCA and diagnostic CA studies (100 CTCA, 400 CA) from January 2014. CT and CA studies for bypass graft or non-coronary indications were excluded. Effective radiation doses were estimated from the dose-length product and the dose-area product using the respective chest conversion coefficients (0.014 mSv/mGy x cm and 0.20 mSv/Gy x cm2). CTCA was performed on a 128 detector row dual source scanner. Doses were then compared with 2012 when a 1st generation dual source CT scanner was in use. Results: The median effective dose for CTCA was 2.0 mSv (IQR 1.3 to 3.6) vs 9.2 mSv (IQR 6.3 to 12.8) for CA, p < 0.001. The majority of CTCA patients (87/100) underwent calcium scoring with a median additional dose of 0.7 mSv. In patients weighing < 80kg, the median CTCA dose was 1.6 mSv vs 7.0 for CA (p < 0.001). Compared with 2012, CTCA radiation doses have reduced from 5.2mSv to 2.0 mSv (p < 0.001) while there has been no significant change in CA doses (9.1 vs 9.2 mSv, p = NS). Conclusion: At our institution, radiation exposure associated with CTCA is several-fold less than that with CA. With new hardware, CTCA doses have halved since 2012 while there has been no significant change in CA over the same period.

1. 1. An increase in the incidence of oral cancer in women is demonstrated by a study of the records of the Cook County Hospital and the Research and Educational Hospitals of the University of Illinois. 2. 2. Other investigators have found a similar trend. 3. 3. This increased incidence in women is associated with an increasing use of tobacco by women and suggests a causal relationship. 4. 4. A long duration of exposure to the use of tobacco prior to onset of symptoms is a consistent finding. 5. 5. If a degree of prevention of oral cancer is to be achieved, physicians must advocate a program which will: (1) educate their patients to avoid harmful habits such as smoking, to seek early advice and aid if any abnormality is suspected and to practice self-examination of the oral cavity (similar to the self-examination of the breasts which is taught to women); and (2) help to discover and remove or correct noxious influences such as neglected oral hygiene, chronic dental infection and inflammation, mechanical, thermal, actinic and chemical irritants, and early lesions such as leukoplakia and benign growths.

T HE ameIobIastoma is a benign, radioresistant neopIasm of odontogenic origin. The clinicat and roentgenographic features and histopathoIogy of the tumor are weII known [r3]. Management remains a moot question, however, primariIy because the tumor through systemic spread has never been reported in the literature and when metastasis is present in the Iung, it may be explained by inhalation of fragments of the tumor into the bronchial tree, in other words, impIantation of tumor ceIIs in the tissues. TotaI enucIeation can result in compIete cure. However, the architectura1 pattern of the tumor is such that compIete remova is seldom, if ever, achieved by enucIeation. BIock or radica1 resection, therefore, has become the most wideIy used form of therapy. Even after radical resection, however, there is recurrence in 13 per cent of the cases [rr], and recurrence may occur even twenty-five years after the orrgmal surgery [ 121. This article iIIustrates the problems encountered in the cIinica1 management of recurrent amelobIastoma and reports preIiminary findings on a new method of treatment of the aforementioned neopIasm.

A case of unilateral hyperplasia and exostosis of the mandibular condyle is presented. This benign lesion produced marked facial asymmetry and speech impediment in a 26-year-old woman. The etiological factors responsible for enlargement of the mandibular condyle are discussed briefly. A detailed histologic study of the resected condyle is presented, and a definitive clinical syndrome is described.

Summary Causes of scar formation following incision and drainage of an abscess have been discussed and a new surgical technique which has been illustrated by diagrams and documented by clinical case reports has been recommended. It is suggested that whenever the skin changes are noted at the most dependent part of the abscess, an incision at the centre should be avoided and drainage should be accomplished by approaching the abscess through the periphery via normal skin. Evacuation of the purulent material through the proper surgical approach, with prompt removal of the cause, leads to complete recovery without loss of time and without tissue deformity at the site of incision and resulting in minimisation of scar formation at the site.

Case reports of three members of the same family with multiple neurofibromatosis (von Recklinghausen's disease) have been presented. The mandible is affected in one of the daughters. This is a rare location. 1 A fatal termination occurred from metastatic involvement in another daughter, in whom the leg was first involved. The mother was afflicted with the cutaneous (fibrosum molluscum) form of the disease. Adequate management of the daughter with the mandibular lesion is a difficult surgical problem.

A case is presented which illustrates the problems encountered in the clinical management of ameloblastoma recurring twenty years after surgery (Fig. 8). The fact that even radical surgical procedures do not assure complete cure of ameloblastoma is emphasized.

The management of various types of oroantral perforation has been discussed in detail. Oroantral perforation often occurs in spite of adequate precautions in the surgical extraction of a tooth opening into the floor of the sinus. Failure to heal is generally due to infection or to a drain, plug, or gauze pack that has been inserted in the extraction wound after the perforation during removal of a root or during curettage. Plastic closure following such an accident may not be successful, either for technical reasons or because the sinus becomes infected. An alveolar opening often can be repaired by direct transposition of a fullthickness pedicle palatal flap. With this single-stage operation, a fistula may be adequately closed even though several attempts have been made with other techniques.

A case in which a most unusual sequence of events occurred over a seven-year period has been reported. The diagnoses have included osteomyelitis, epidermoid carcinoma, cystic ameloblastoma, and epidermoid cyst. Up to the present date (November, 1957), the patient is free of disease and is under observation.

Causes of scar formation following incision and drainage of an abscess have been discussed and a new modified surgical technique which has been illustrated by diagrams and documented by clinical case reports has been recommended. It is suggested that whenever the skin changes are noted at the most dependent part of the abscess, an incision at the center should be avoided (Fig. 2) and drainage should be accomplished by approaching the abscess through the periphery via normal skin (Fig. 5). Evacuation of the purulent material through the proper surgical approach, with prompt removal of the cause, leads to complete recovery without loss of time and without tissue deformity at the site of incision (Fig. 10).

A case involving a large odontogenic cyst of the mandible has been presented (Fig. 8). This was successfully treated by intraoral surgery through a conservative approach. The final result was filling-in of the bone defect.