SUMMARY The morphology of the atrial appendages was examined in 1842 specimen hearts from patients with congenital lesions. The extemal and internal features that permitted the identification of the right and left appendages were studied in detail in one tenth of the hearts. These results were compared with a similar analysis of 25 normal hearts. This study showed that criteria for identification of right and left appendages were reliable. Application of these criteria to the overall collection identified the usual arrangement in 1776 (97%) hearts, a mirror image arrangement in eight (0O4o/o); left atrial isomerism in 22 (1-2%); and right atrial isomerism in 36 (1-9%). Fourteen (081 %) had juxtaposed atrial appendages (13 with usual arrangement and one with left isomerism). This did not interfere with identification of the left and right atria on the basis of appendage morphology. In only two cases did the determination by atrial morphology produce a result that was inconsistent with the arrangement of the other thoracoabdominal organs. Further examination of the atria in these showed a mistake had been made in the initial assessment. The atrial arrangement can be accurately determined by the morphology of the atrial appendages.

BackgroundStudies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS), though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India.Methods and ResultsThe Detection and Management of Coronary Heart Disease (DEMAT) Registry collected data from 1,565 suspected ACS patients (334 women; 1,231 men) from ten tertiary care centers throughout India between 2007–2008. We evaluated gender differences in presentation, in-hospital and discharge management, and 30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest) rates. Women were less likely to present with STEMI than men (38% vs. 55%, p<0.001). Overall inpatient diagnostics and treatment patterns were similar between men and women after adjustment for potential confounders. Optimal discharge management with aspirin, clopidogrel, beta-blockers, and statin therapy was lower for women than men, (58% vs. 65%, p = 0.03), but these differences were attenuated after adjustment (OR = 0.86 (0.62, 1.19)). Neither the outcome of 30-day mortality (OR = 1.40 (0.62, 3.16)) nor MACE (OR = 1.00 (0.67, 1.48)) differed significantly between men and women after adjustment.ConclusionsACS in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen. These findings underscore the importance of further investigation of gender differences in cardiovascular care in India.

In carefully selected children and young adults, the Amplatzer asymmetric ventricular septal defect occluder is a promising device for transcatheter closure of perimembranous ventricular septal defect with encouraging results on short term follow up.

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Fractures of the distal femur typically occur in the axial and sagittal planes. A Hoffa fracture is a coronal plane fracture of the femoral condyle, which accounts for 8.7% to 13% of distal femoral fractures. It is usually associated with other injuries around the knee joint and hence is often missed. We conducted a comprehensive systematic review of papers published in the English language using PubMed, Web of Science, Scopus, and the Cochrane Database, which reported Hoffa's fracture associated with other injuries around the knee joint. We selected 11 eligible papers for final analysis and review. These papers had 12 patients with Hoffa's fracture, with associated injuries around the knee joint. The associated injuries with Hoffa's fracture were in the ipsilateral distal femur, proximal tibia fractures, patellar dislocation, patella fracture, and patellar tendon incarceration. The management principles for Hoffa's fracture with associated injuries around the knee joint are: having a high clinical index of suspicion for these injuries, obtaining all trauma series radiographs and computed tomography of the knee, achieving complete articular incongruity, and restoring the functions of the knee joint.