The trigemino-cardiac reflex (TCR) is clinically defined as the sudden onset of parasympathetic activity, sympathetic hypotension, apnea, or gastric hypermotility during central or peripheral stimulation of any of the sensory branches of the trigeminal nerve. Clinically, the TCR has been reported to occur during craniofacial surgery, manipulation of the trigeminal nerve/ganglion and during surgery for lesion in the cerebellopontine angle, cavernous sinus, and the pituitary fossa. Apart from the few clinical reports, the physiologic function of this brainstem reflex has not yet been fully explored. The manifestation of the TCR can vary from bradycardia and hypotension to asystole. From the experimental findings, the TCR represents an expression of a central reflex leading to rapid cerebrovascular vasodilatation generated from excitation of oxygen-sensitive neurons in the rostral ventro-lateral medulla oblongata. By this physiologic response, the systemic and cerebral circulations may be adjusted in a way that augments cerebral perfusion. This review summarizes the current state of knowledge about TCR.

Background: Traditionally, physicians have believed that limb‐salvage surgery has functional and cosmetic advantages over amputation, yet the literature is equivocal. Therefore, we sought to compare the psychosocial and functional outcomes in osteosarcoma survivors after limb‐salvage surgery and amputation. We hypothesized there to be neither psychosocial nor functional outcome differences between groups.Procedure: Participants received treatment of extremity osteosarcoma, had received their cancer diagnosis at least 2 years prior, and were at least 16 years old. A comprehensive set of validated psychosocial and functional measures was used to assess outcome.Results: Fifty‐seven patients participated in this study (33 who underwent limb‐salvage surgery and 24 who underwent amputation). Participants had gone 12–24 years since diagnosis and were 16–52 years old at study participation. We used multiple linear regression models to examine differences in quality of life, body image, self‐esteem, and social support between the two groups and found no differences. Lower limb function was a significant predictor of quality of life (P < 0.001), whereas surgery type did not impact this relationship. Body image was rated significantly worse by those who underwent late amputation, amputation after failed limb salvage, than by those who did not.Conclusions: Participants with more functional lower limbs had better quality of life than did those with less functional lower limbs regardless of whether they underwent amputation or limb‐salvage surgery. Pediatr Blood Cancer 2010;54:990–999

We intended to evaluate the technique of treatment of complex fractures of the tibial plateau using external circular fixation combined with limited internal fixation, and to evaluate the treatment outcomes. From 1992 to 2002, we treated 59 patients (40 men, 19 women) ranging in age from 23 to 63 years with the external circular fixation. All the cases were classified preoperatively as Schatzker types V, VI/Orthopedic Trauma Association 41-C1.3, C2.3, C3.1, C3.3. Five fractures were open. Three different strategies of treatment were used: (1) the frame is confined to the tibia when the external fixation is stable enough to allow knee bending; (2) the frame is extended onto the distal femur, with the proximal tibial ring located at the level of the tibial plateau when the joint surface is severely unstable; and (3) the frame is extended onto the distal femur, with the proximal tibial ring located more distally, bypassing the fracture, when the skin and soft tissue are compromised and within the fracture there is no bone suitable to place wires and pins for the external fixation construct. The results were evaluated as excellent in 30 patients (50.85%), good in 27 patients (45.76%), fair in 1 patient (1.695%), and poor in another 1 (1.695%). The patients' satisfaction was significantly related with the functional results. Our hybrid Ilizarov method combined with minimal internal fixation enables excellent to good results in most cases of complex tibial plateau fractures.