We randomized prospectively 144 patients, undergoing elective coronary artery bypass surgery, to either early or to routine extubation [mechanical ventilatory support for 4-7 h (Group A), or 8-14 h (Group B)]. Anaesthesia was modified for both groups. The groups were well matched in terms of sex, age, NYHA class, preoperative left ventricular ejection fraction, bypass time and aortic cross-clamp time, number of grafts used, and blood units transfused. All patients had normal preoperative respiratory, renal, hepatic and cerebral functions. Mechanical ventilatory support (mean +/- SD) was 6.3 +/- 0.7 h for Group A and 11.6 +/- 1.3 h for Group B. Mean ICU stay was 17 +/- 1.3 h for Group A and 22 +/- 1.2 h for Group B, while the mean hospital stay was 7.3 +/- 0.8 days and 8.4 +/- 0.9, respectively. There were no statistically significant differences in the frequency of all postoperative complications among the two groups. There were no reintubation, readmission to the ICU or death in either group. We concluded that change in anaesthesia practice and early postoperative sedation in patients undergoing elective coronary artery bypass graft (CABG) surgery resulted in earlier tracheal extubation, shorter ICU and hospital length of stay without organ dysfunction or postoperative complications. Early extubation was only possible due to the modification of anaesthesia and ICU sedation regime.

The measured resection and the gap balancing techniques achieved comparable correction of femoral rotational alignment.

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Dislocation of the proximal tibiofibular joint is an unusual injury. We report a patient, who developed inferior proximal tibiofibular dislocation after a severe motorcycle accident. The dislocation was associated with avulsion of the leg, fractures of the fibula and the ankle and neurovascular lesions. The patient was surgically treated and had a good final outcome. Classifications of proximal tibiofibular dislocations did not include inferior dislocation. This type is always associated with avulsion mechanism and has the poorest prognosis.

We present the clinical results of total knee replacement (TKR) in 133 patients who had two or more major joints of the lower limbs replaced, and compare them to the outcome in 406 patients with an isolated TKR. 383 patients had osteoarthritis (OA) and 136 had rheumatoid arthritis (RA) and these were assessed separately. A meniscal bearing prosthesis was used. The functional score was high and there was no statistically significant difference in the incidence of complications between the two groups.Résumé On présente les résultats cliniques de l'arthroplastie totale du genou sur 133 patients qui ont dû se faire remplacer deux ou trois articulations des membres inféri-eurs, en comparaison aux résultats de 406 patients qui ont subi une simple arthroplastie du genou. 383 patients souffraient d'arthrose et 136 de rhumatisme et ont été examinés séparemment. La prothèse du genou était du type menisceal bearing. Le score fonctionnel était élevé dans tous les groupes. Il n'y avait pas de différence statistiquement importante du pourcentage des complications post-opératoires entre les deux groupes.

Background: Acute carpal tunnel syndrome is a common complication following injuries of the wrist and hand. There are however a few reported cases in the literature where spontaneous intraneural bleeding following anticoagulation treatment with various agents. Case presentation:We present the case of a 53-year-old female patient with a past medical history of aortic valve replacement and rheumatoid arthritis treated with warfarin and methotrexate, who presented to our emergency department with symptoms of Acute Carpal Tunnel Syndrome (ACTS). Due to the escalating severity of the median nerve neuropathy, she underwent an ACTS decompression, which revealed a median intraneural hematoma. The hemorrhage restricted carpal tunnel space causing acute pressure on the median nerve. There was no diffuse bleeding inside the carpal tunnel or subcutaneously. Four weeks post operatively there was no sign of median nerve neuropathy. Conclusion:Acute carpal tunnel decompression can safely be performed in rheumatoid patients on warfarin and raised INR with ACTS due to spontaneous intraneural bleeding

Introduction:The Monteggia fracture is a fracture to the proximal third of ulna associated with a radial head dislocation. Although this is well described and classified in adults, it is uncommon in children. Identifying growth plate trauma and subsequent surgical management are of critical importance. This report identifies a unique variant of Monteggia fracture with a Salter-Harris Type I injury of the radial head instead of a dislocation, and how it was successfully stabilised with a closed reduction. Case Rport: We present a case of a nine 9 year-old female admitted to our unit with a deformed upper extremity following a fall from height. This was a closed and isolated injury without neurovascular compromise. Radiographs revealed a displaced fracture to the proximal ulna shaft. Unlike a true Monteggia, the radial fracture went through the proximal physis with anterior divergence of the distal fragment. The radiocapitellar joint remained congruent. The ulna fracture was stabilized with open reduction and plate osteosynthesis whilst the radial injury underwent closed reduction and intramedullary pinning with excellent outcomes and maintenance of full range of motion. Conclusion: This case highlights a new variant and successful outcome following a closed reduction intramedullary fixation technique in this emergent pattern of injury. We highlight the need for a classification of these fractures in children. Keywords: Case report, Monteggia, growth plate, pediatric, fracture, trauma, variant.