Surgical Treatment of Symptomatic Congenital Type I Lunotriquetral Coalition: Technique and a Report of 4 Cases.

Lunotriquetral (LT) synchondrosis is an uncommon variant of congenital LT coalition. Unlike complete LT fusions, this incomplete pseudoarthrosis-like coalition can become symptomatic. Surgical LT arthrodesis is a described treatment for this variant of LT coalition (Minnaar type I). We report 4 patients who underwent LT fusion with a second-generation headless compression screw and distal radius cancellous autograft. Fusion was achieved in all cases at an average of 2.5 months postoperatively. All the patients were satisfied with complete pain relief in 2 patients and minimal pain in 2 patients, and all improved their range of motion. We recommend this procedure, and report the techniques for this limited wrist arthrodesis as treatment for the symptomatic LT synchondrosis.

Altered protein metabolism following coronary artery bypass graft (CABG) surgery.

The aim of the present study was to investigate the acute effect of CABG (coronary artery bypass graft) surgery on the rates of synthesis of muscle protein, the positive acute-phase protein fibrinogen and the negative acute-phase protein albumin. Synthesis rates of muscle protein, fibrinogen and albumin were measured simultaneously before and 4 h after the end of surgery from the incorporation of L-[(2)H(5)]phenylalanine (given at 43 mg/kg of body weight) in 12 patients undergoing CABG surgery. Surgery was performed either with the use of extracorporeal circulation with cardiopulmonary bypass (on-pump; n=5) or with the beating heart procedure without cardiopulmonary bypass (off-pump; n=7). Post-surgical muscle protein fractional synthesis rates were decreased by 36+/-6.5% compared with pre-surgical values (1.59+/-0.10 compared with 0.97+/-0.08%/day respectively; P<0.001). In contrast, the synthesis rates of both fibrinogen (36+/-4 compared with 100+/-11 mg.day(-1).kg(-1) of body weight; P<0.0001) and albumin (123+/-12 compared with 178+/-19 mg.day(-1).kg(-1) of body weight; P<0.001) were both significantly increased after surgery. No significant differences were found between surgery performed with or without cardiopulmonary bypass. In conclusion, the results demonstrate that CABG surgery has a profound effect on protein metabolism, with a differential response of protein synthesis in muscle and liver.