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Objectives: To assess the frequency of anterolateral ligament (ALL) tears and ramp lesions (RL) detected with MRI in patients with anterior cruciate ligament (ACL) tears and to describe associated injuries indicative for these lesions., Methods: In this retrospective study, 164 patients with surgically verified ACL tears were included. Preoperative MRI scans were reviewed for ALL tears and different types of RL. All coexisting meniscal tears, tears of the medial (MCL) and lateral collateral band (LCL), and posterior-medial tibial bone marrow edema (BME) were recorded. The frequency of ALL tears and RL was assessed and coexisting injuries were correlated using Pearson's chi-square test. A p < 0.05 was defined as statistically significant. In cases of multiple testing, Bonferroni's correction was applied., Results: ALL tears and RL combined were detected in 28 patients (17.1%), ALL tears in 48 patients (29.3%), and RL in 54 patients (32.9%) which were significantly associated to each other. ALL tears were significantly associated with tears of the posterior horn of the lateral meniscus (PHLM), BME, and with tears of the LCL and MCL. RL were significantly associated with tears of the posterior horn of the medial (PHMM) and PHLM, with BME, and with tears of the LCL., Conclusions: ACL tears are associated with RL or ALL tears in about one-third of cases and with both lesions combined in about one-fifth of cases. ALL tears and RL are significantly associated with additional posttraumatic injuries, which can thus be indicative of these lesions., Key Points: • ACL tears were associated with ramp lesions or ALL tears in about one-third of the cases. • Ramp lesions and ALL tears were significantly associated with each other, tear in the PHLM, tear in the LCL, and BME. • ALL tears were more frequently associated with instable classified ramp lesion type 4b and type 5., (© 2023. The Author(s).)

Background: Sodium glucose cotransporter 2 (SGLT2) inhibitors are established antidiabetic drugs with proven cardiovascular benefit. Although growing evidence suggests beneficial effects on myocardial remodeling, fluid balance and cardiac function, the impact of empagliflozin initiated early after acute myocardial infarction (AMI) has not been investigated yet. Therefore, the impact of EMpagliflozin on cardiac function and biomarkers of heart failure in patients with acute MYocardial infarction (EMMY) trial was designed to investigate the efficacy and safety of empagliflozin in diabetic and non-diabetic patients after severe AMI., Methods: Within a multicenter, randomized, double-blind, placebo-controlled, phase 3b trial we will enroll patients with AMI and characteristics suggestive of severe myocardial necrosis are randomized in a 1:1 ratio to empagliflozin (10 mg once daily) or matching placebo. The primary endpoint is the impact of empagliflozin on changes in NT-proBNP within 6 months after AMI. Secondary endpoints include changes in echocardiographic parameters, levels of ketone body concentrations, HbA1c levels and body weight, respectively. Hospitalization rate due to heart failure or other causes, the duration of hospital stay and all-cause mortality will be assessed as exploratory secondary endpoints., Discussion: The EMMY trial will test empagliflozin in patients with AMI regardless of their diabetic status. The EMMY trial may therefore underpin the concept of SGLT2 inhibition to improve cardiac remodeling, pre-and afterload reduction and cardiac metabolism regardless of its antidiabetic effects. Results will provide the rationale for the conduct of a cardiovascular outcome trial to test the effect of empagliflozin in patients with AMI., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The aim of this investigation was to provide a detailed analysis of accidents on ski slopes of Styrian resorts comparing two winter seasons., Methods: Accident data requiring the presence of the ski patrol of the seasons 2007/08 (10 skiing resorts with 1029 injuries) and 2014/15 (8 resorts with 1844 injuries) were recorded. Accidents were normalized to 1000 skier days and 10000 lift transports. Patients were followed to hospitals to obtain information about injured body region, final diagnosis and type of treatment., Results: A slight increase of injuries from 0.5 to 0.7 per 1000 skier-days was found (P=0.046). Overall, the knee was most commonly affected followed by shoulder, lower leg, head and forearm. While the shoulder was most often affected in men the knee was most commonly affected in women. Patients <15 years had a higher prevalence of forearm injuries. Comparing the two seasons the use of helmets and spine protectors increased, associated with decreased injuries of these body regions. The hospitalization rate was 26% in both seasons; patients <15 years required less inpatient treatment than older ones., Conclusions: Different injury patterns between gender and age-groups have to be taken into account for future preventive measures. The increased acceptance of safety equipment was associated with reduced injury rates of the respective body regions. Results of the present study can facilitate to develop future injury prevention strategies in order to further decrease the number of casualties on ski slopes.

A patient was admitted reporting tingling pain and numbness in the right hand. Neurological examination--including nerve conduction studies--diagnosed carpal tunnel syndrome. Operative carpal tunnel release was performed without complications. Four months postoperatively the otherwise healthy patient presented again due to persistent complaints, although preoperative symptoms had improved. On this occasion, the patient reported loss of strength accompanied by rigidity in the wrist. Clinical examination showed some swelling adjacent to the operation wound. A postoperative ganglion cyst was suspected and a conservative treatment option--splinting the wrist--was chosen. Four weeks later the patient presented again with further swelling and increasing rigidity of the wrist. Surgical intervention was planned. Preoperative plain radiographs of the wrist revealed chronic palmar dislocation of the lunate to be the cause of the symptoms in our patient. Radiological signs of scapholunate advanced collapse arthritis (SLAC wrist) were also observed.

Aims: Immediate surgical repair of ventricular septal defect (VSD) complicating acute myocardial infarction is associated with high mortality. Percutaneous device closure appears to be safe and effective in patients treated for a residual shunt after initial surgical closure, as well as in patients with a chronic post-infarct VSD. Primary transcatheter VSD closure in the acute setting may also offer advantages over surgery., Methods and Results: Between September 2003 and February 2008, 29 consecutive patients underwent primary transcatheter VSD closure. Clinical, procedural, and outcome data were collected. Patients were divided into those with and those without cardiogenic shock at presentation for risk stratification. The median follow-up time of surviving patients was 730 days. The median time between VSD occurrence and closure was 1 day [interquartile range (IQR) 1-3] and the initial procedural success rate was 86%. The shunt (Qp:Qs) could be reduced from 3.3 (IQR 2.3-3.8) to 1.4 (IQR 1.2-1.7; P < 0.001). Procedure-related complications such as major residual shunting, left ventricular rupture, and device embolization occurred in 41%. The overall 30-day survival rate was 35%. Mortality was higher for cardiogenic shock in comparison to non-shock patients (88 vs. 38%, P < 0.001)., Conclusion: Interventional acute VSD closure is a promising technique that can be performed with a high procedural success rate and may offer an alternative to surgery. Despite the less invasive technique, mortality of postinfarction VSD remains high, particularly in patients with cardiogenic shock. Further developments in devices and delivery techniques are required.

Postinfarction ventricular septal defect (VSD) is a rare but fatal complication after myocardial infarction. Surgery for postinfarction VSD is considered the gold standard. However, it is associated with high morbidity and mortality, patient discomfort, need of cardiopulmonary bypass, sternotomy, and skin scarring. As a consequence, less invasive interventional techniques have been developed for postinfarction VSD closure. The current review focuses on patient selection, techniques, results, potential complications and outcome of percutaneous postinfarction closure.