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Background: Ischemic heart disease is the leading cause of death worldwide. Mitral regurgitation is one of the common complications associated with acute coronary syndromes leading to high morbidity and mortality. Aims and Objectives: Ischemic mitral regurgitation (IMR) is one of the frequent complications associated with coronary artery disease (CAD); but the optimal management of IMR is controversial. Our aim was to evaluate and compare the impact of medical therapy versus revascularization on the degree of MR. Materials and Methods: We performed observational follow up study on 114 patients admitted to our hospital with AMI and mild to moderate degree of MR. Multiple parameters were used to assess the severity of MR at baseline and after 1 year of follow up to assess the change in MR severity after medial therapy and revascularization. Results: In the medically managed group, MR grade improved in 28.57% of patients while 53.57% patients remained in the same grade as before. The grade of MR deteriorated from moderate to severe in 17.86% patients during follow up. In revascularization group; improvement in MR grade was observed in 60.71% of patients while 32.14% patients remained in the previous grade. Deterioration from moderate to severe occurred in 7.14% of patients. PCI and CABG subgroup analysis showed almost similar impact on degree of MR during follow up. Conclusion: From our study we concluded that revascularization; either in form of PCI or CABG, is associated with improvement in degree of MR when compared to optimal medical therapy alone. [ABSTRACT FROM AUTHOR]

A neck injury that extends deep into the platysma is called a penetrating injury of the neck. It is a diagnostic and a therapeutic challenge to the treating surgeon, because a number of important structures are densely packed in a small area, and the injury to any of these structures may immediately cause a life threatening situation. We are describing an interesting case, where a 40- year old woman presented with a penetrating neck injury which was caused by a heavy knife, which ran transversely from the left to the right side of the neck at zone-I. On presentation, she was found to have stable vitals and no active bleeding from the wounds; but, right ulnar nerve monoplagiea was found on examination. Bilateral exploration of the neck was done. The knife passed between the trachea and the oesophagus from the left side to reach up to the right supraclavicular fossa and it rested over the brachial plexus. The weapon was retrieved under direct vision. Surprisingly, there were no injuries to any vital structures of the neck. The patient made an uneventful recovery. [ABSTRACT FROM AUTHOR]

The arthroscopically assisted posterior cruciate ligament tibial inlay technique, frequently used in athletic individuals and in revision cases, requires a thorough and comprehensive understanding of posterior knee anatomy. Importantly, variations in the posterior vascular anatomy may be encountered. A safe and methodical posteromedial approach in a layered fashion to achieve proper and safe tibial inlay graft placement and fixation is described. The authors advocate use of a double-bundle quadriceps tendon autograft. Graft position of the double strands, fixation, and tensioning issues are presented.