In one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity.

ObjectivesVentricular septal rupture (VSR) is a rare but feared complication after myocardial infarction (MI). The objective of this study was to investigate the effects of thrombolytic therapy on the patterns of VSR following MI.Methods30 consecutive patients admitted to a single tertiary level cardiac hospital with a diagnosis of acute MI and developed VSR in the hospital were included. The effect on thrombolytic therapy on the formation of VSR and its clinical outcome was studied.ResultsOut of 30 patients, 15 patients received thrombolytic therapy.10 received early (<12 h) and 5 received late (>12 h). The median time to post MI VSR formation was significantly shorter in thrombolysis group compared to non thrombolysis group at 1 vs 3 days(p = 0.026). The median time for VSR formation was shorter in early thrombolysis group compared to late thrombolysis group at 1 vs 3 days (p = 0.022). There was no difference between late and no thrombolytic therapy (3 vs 3 days, p = 0.672). There was no significant difference in the mortality between thrombolytic and no thrombolytic therapy (p = 0.690). Patients treated medically had a significant higher mortality compared to patients treated surgically (p = 0.005).ConclusionThrombolytic therapy results in an earlier presentation of VSR after MI. This earlier presentation may be due to reduction in the number of patients developing late VSR after thrombolytic therapy, while the number of patients developing an early VSR remaining unaffected. Despite improvements in medical therapy and percutaneous and surgical techniques, mortality with this complication remains extremely high.

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We present a case of dislocation of the fourth carpometacarpal joint without associated fractures. This is the first case to be reported in the literature. Carpal injuries are uncommon; it is even rare for isolated carpometacarpal dislocation to occur without associated fractures. The injury is difficult to diagnose because of the swelling of the hand and may be missed on several occasions. A lateral radiograph of the wrist has been found to be mandatory to its precise diagnosis if suspected. Early recognition and anatomical reduction are essential in achieving good long-term outcomes.

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