The role of carnitine supplementation during valproic acid therapy.

Objective: To review the pathophysiology and significance of valproic acid-induced carnitine deficiency; to present and evaluate the literature pertaining to carnitine supplementation in pediatric patients receiving valproic acid; and to present the consensus guidelines for carnitine supplementation during valproic acid therapy.

Data Sources: A MEDLINE search (1966-December 1998) restricted to English-language literature, using MeSH headings of carnitine and valproic acid, was conducted to identify clinically relevant articles. Selected articles and references focusing on the pediatric population were included for review.

Gabapentin and lamotrigine in bipolar disorder.

The utility of gabapentin and lamotrigine for the treatment of bipolar disorder is reviewed. Bipolar disorder is characterized by extreme mood fluctuations, including mania, hypomania, depression, and mixed episodes. Extrapolation of postulated mechanisms of anticonvulsant activity in bipolar disorder has led to the use of the newer anticonvulsants gabapentin and lamotrigine for therapy.

Arthroscopic versus open debridement of penetrating knee joint injuries.

Arthroscopic debridement of penetrating knee joint injuries has become a common treatment method. A comparative study was undertaken to compare this method with open joint debridement. Fourteen penetrating knee joint injuries (fourteen patients) were treated by arthroscopic examination and debridement and were compared to sixteen penetrating knee joint injuries (fifteen patients) treated by open debridement.

Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons.

Eighty consecutive patients with chronic laxity due to a torn ACL underwent arthroscopically assisted reconstruction with either autogenous patellar tendon or doubled semitendinosus and gracilis tendons. Reconstructions were performed on a one-to-one alternating basis. Preoperatively, no significant differences between the two groups were noted with respect to age, sex, level of activity, and degree of laxity (chi square analysis).

Allograft replacement with distal radioulnar joint fusion and ulnar osteotomy for treatment of giant cell tumors of the distal radius.

Three patients with advanced giant cell tumors of the distal radius received a frozen allograft replacement of the distal radius, accompanied by a distal radioulnar arthrodesis with ulnar osteotomy proximal to the wrist. Follow-up ranged from 2 to 4 years. During this time this combined procedure provided the following advantages: complete tumor resection, no donor site morbidity, retention of pronation-supination, and avoidance of pain or subluxation at the distal radial ulnar joint.