Surgical repair with a fibular strut, cortico-cancellous bone graft and Ilizarov ring fixation appears a suitable treatment option for C3 distal femoral fractures.

The uptake of secondary prevention medication is high following PPCI in the UK, even in the elderly and in those with renal dysfunction. A focus on strategies to improve up-titration and continuation of drugs following discharge is required.

In children with cleft lip and palate, it is essential to maintain harmony among several aspects of treatment such as growth, esthetics, function and psychosocial development since birth. Treatment of infants with cleft lip and palate has been associated with many marked advances in recent years. To obtain the best possible results, these can and should be incorporated into the cleft team treatment protocols. Deformities in cleft lip and palate exhibit diversities in severity and form, as the wider and complete clefts show significant nasolabial deformity. This article reviews the literature on background of early maxillary orthopedics, various appliances, which have been proposed to reduce the initial alveolar cleft defect and molding of the deformed nasal cartilages, benefits, longterm effects of the same.

Methods:We examined all patients In the NHLBI Dynamic Registry presenting with ACAD and SA to understand difference in clinical characteristics and 1-year adverse events. Results: Of all patients in the NHLBI Dynamic Registry, 2174 underwent PCI for SA, and 742 for ACAD. Patients receiving revascularization for ACAD compared to SA were more likely to have a history of congestive heart failure (14% vs 9%, pϽ0.0001) and HTN (75% vs 71%, pϽ0.05). In addition, Patients with ACAD had an increased prevalence of non-cardiac comorbidites compared to SA patients (43% vs 31%, pϽ0.0001) which included a significant increase in renal disease (10% vs 6% pϽ0.001), peripheral vascular disease (10% vs 7%, pϽ0.05), pulmonary disease (10% vs 6%, pϽ0.01), and cancer (15% vs 11%, p Ͻ0.01). The prevalence of hyperlipidemia (72% vs 75%) and diabetes (33% vs 30%) were similar in both groups. There were no differences between the extent of coronary artery disease or prior myocardial infarction in patient revascularized for ACAD and SA. The combined adjusted 1-year mortality and reinfaction incidence (hazard ratio 0.95; 95% CI; 0.69-1.3) were similar between ACAD and SA patients. Conclusions: Our analysis shows that patients with ACAD have similar 1-year outcomes to SA patients after undergoing PCI while having increased co-morbid conditions. Given these findings, further study is needed on the outcomes of patients with ACAD so that they can be more appropriately represented in the AUC guidelines. Background:The utilization of the 'appropriate use criteria' (AUC) has been controversial and suggested inappropriate and uncertain PCIs may not be uncommon. The issues raised are unlikely to be confined to the US. We therefore applied the AUC to patients with stable angina undergoing PCI at our tertiary centre in order to gain a UK perspective. Methods: We performed a restospective analysis of 200 consecutive patients with known stable angina referred from the chest pain clinic for PCI. The appropriateness of PCI was adjudicated using the published AUC and patients were grouped into those apparently undergoing appropriate, inappropriate or uncertain PCI.We determined the proportion of patients in the uncertain group who had either significant symptoms, intermediate risk or optimal medical therapy (OMT) in order to determine those in whom PCI is known to be beneficial and those where the evidence is less clear. Results: One hundred and twenty nine (64.5%) of PCIs were classified as appropriate, while 64 (32%) could be classified as uncertain indications and 7 (3.5%) were deemed inappropriate (Table 1). Inappropriate procedures were more common in patients with CCS I/II, those with low risk stress testing and in those not receiving OMT. Of the uncertain PCIs, 55 (85.9%) patients had either CCS III/IV, intermediate risk stress tests or were on OMT, with 9 (14.1%) having either CCS I/II, low risk stress tests or no OMT.

ABSTRCAT: INTRODUCTION: Congenital anomalies affecting the craniovertebral or cervical region are common. Among these congenital anomalies the important ones are the fused cervical vertebrae which can be due to either congenital or acquired causes. Fused cervical vertebrae can be asymptomatic or it can produce a myriad of clinical symptoms from mild to severe. Hence a knowledge of the prevalence of these variations are essential. METHOD: 147 dry adult human skulls with 280 adult, dried cervical vertebrae were observed in this study for evidence of fusion. The morphologic details of the fusion were also noted. RESULTS: The total prevalence of fusion of cervical vertebrae was 1.4% which included fusion between occiput and atlas, atlas and axis vertebra, axis and third cervical vertebra and fusion between the typical cervical vertebrae. CONCLUSION AND SUMMARY: Fused cervical vertebrae limit neck movements and cause signs of nerve or spinal cord compression. Evaluation of patients who need surgeries of the head and neck region should involve radiographic examination of the cervical region to prevent accidental intra-operative and post-operative complications.