One bone forearm with vascularized fibular graft. Clinical experience and literature review.

One-Bone-Forearm (OBF) is a procedure in which the proximal stump of the ulna is fixed to the distal stump of the radius. Historically, the indications for OBF have been represented by forearm instability due to trauma, infection, tumor resection, and congenital deformities with severe radius and ulna bone loss. When major bone loss prevents direct fixation between ulna and radius a Vascularized Fibular Bone Graft (VFBG) may allow forearm bone reconstruction and fixation. In this study we report our clinical experience in 4 cases of OBF with VFBG performed in 3 patients. Compared to standard OBF technique with direct osteodesis, OBF with VFBG showed similar clinical results and high rate of healing even in case of bone infection. Moreover, composite osteocutaneous VFBG might concurrently allow to treat local soft tissue defects.

100% survival: a cardiac surgery centre experience inTrinidad and Tobago

OBJECTIVE: To report the 2012 results of a cardiac surgerycentre in Trinidad and Tobago. METHODS: Data was reviewed on 245 consecutive patients who underwent cardiac surgery in 2012 at Eric Williams MedicalScience Complex (E.W.M.S.C) Mount Hope, Trinidad. RESULTS: Mean patient age was 58.5 ±9.5 years; 147 patients(60%) were male and the mean calculated EUROSCORE IIwas 1.7. Coronary artery bypass surgery was the most commonprocedure, performed on 190 patients, 98% were done on the beating heart and 3.15% (6 patients) were redo-CABG. Thirteen patients (5.3%) underwent CABG plus other procedures, 9patients (3.7%) had aortic valve replacement, 21 patients (8.6%)had mitral valve repair/replacement, 2 patients (0.8%) had double valve replacement and 10 patients (4.1%) a variety ofother procedures including atrial or ventricular septal defect closure, fibro-elastoma removal, type A Aortic dissection.The operative mortality in the study period was 0%, and at 6months follow-up all patients were alive. CONCLUSION: Excellent results similar to the best institutions in the world can be obtained even in a medium volume centre in a developing country.

Methylphenidate in children with seizures and attention-deficit disorder.

This study assessed the safety and efficacy of methylphenidate in children with seizures and attention-deficit disorder. Ten children, aged 6 years 10 months to 10 years 10 months, without seizures while receiving a single antiepileptic drug, were evaluated in a double-blind medication-placebo crossover study with methylphenidate hydrochloride was administered at 0.3 mg/kg per dose and given at 8 AM and 12 PM on school days only. The use of methylphenidate was associated with statistically significant improvements on the Conners' Teacher Rating Scale and on the Finger Tapping Task and with trends toward improvement on the Matching Familiar Figures Test and Discriminant Reaction Time tests. No child had seizures during the study period nor subsequently for those who continued receiving psychostimulants. There were no significant changes of epileptiform features or back-ground activity on electroencephalograms and no alterations in antiepileptic drug levels. Methylphenidate may be a safe and effective treatment for certain children with seizures and concurrent attention-deficit disorder.

Basilar impression in children.

Ataxia is a common neurologic sign in childhood. Basilar impression due to bony abnormalities of the craniovertebral junction is an uncommon but readily treatable cause of ataxia in children. Two children who had neck stiffness, ataxia, nystagmus, and corticospinal tract signs are described. Basilar impression was recognized only after specific radiologic studies were performed. Both children were treated surgically with good results.