Background: We present the design of an open randomized multi-centre study on surgical versus conservative treatment of acute Achilles tendon ruptures. The study is designed to evaluate the effectiveness of conservative treatment in reducing complications when treating acute Achilles tendon rupture.

Long-term outcome after minimally invasive Achilles tendon rupture repair is excellent. Rerupture and severe wound infection are the most important complications with lasting negative effect on outcome. It justifies the use of rerupture as a relevant outcome measure in treatment evaluation.

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Nitrous oxide is a recreational drug gaining in popularity for its deemed innocence. However, side effects have recently been reported. In this case, a patient suffered major aortic arch thrombus resulting in arterial occlusion of his arm and temporary cerebral infarction and later deep venous thrombosis and pulmonary embolism. No common causes for thrombus in this high-flow vessel were identified. The authors state that the patient's chronic nitrous oxide abuse might have led to this thrombus, although it has never been described previously. This hypothesis is supported with laboratory tests at several presentations.

Despite being a less invasive alternative to conversion and open repair, the long-term outcome of sac fenestration is unpredictable and additional major procedures were often necessary to arrest sac growth.