The value of magnetic resonance imaging geometric parameters in pre-assessing the surgical approaches of pelvic fracture urethral injury

BackgroundTo investigate the correlation between the magnetic resonance urethrography and the surgical approach and complexity for the patients with pelvic fracture urethral injury (PFUI) by combining the geometry with magnetic resonance imaging (MRI).MethodsForty-three male patients with PFUI (part of the patients complicated with rectal injury) from January 2016 to December 2018 were analyzed in this retrospective research. All the patients underwent a delayed anastomotic urethroplasty and were divided into 2 groups according to the approaches (simple perineal approach or inferior pubectomy). For magnetic resonance urethrography, we measured and calculated the geometric parameters such as the gap distance between two urethral ends, the pubourethral vertical distance (PUVD), and the rectourethral median distance (RUMD).ResultsOf the 43 patients, 16 underwent inferior pubectomy and 27 underwent simple perineal approach. The numbers of patients with and without rectal injury history were 17 and 26, respectively. The operation time and intraoperative blood loss was significantly higher in the inferior pubectomy group. Multivariate logistic analysis revealed that gap distance and PUVD were independent factors of the surgical approaches. The accuracies were 83.7% and 67.4% respectively in the ROC curve analysis. In addition, the RUMD was significantly shorter in the patients with rectal injury history (1.4, 1.8 cm).ConclusionsLonger gap distance and shorter PUVD were the two independent factors of the inferior pubectomy approach. Furthermore, among the patients with rectal injury history, the tissue posterior to the urethra was often weaker and should be carefully handled during the surgery.Trial registrationThis research has been registered on the Chinese Clinical Trial Registry. The registration number is ChiCTR2000030573.     

Detection of diastolic mitral regurgitation using pulsed Doppler and its implications

Diastolic mitral regurgitation has been angiographically demonstratedin some patients with severe aortic regurgitation and/or nonobstructivecardiomyopathy. The purpose of this paper was two-fold: to studythe feasibility of pulsed Doppler noninvasive detection of thisunusually timed regurgitation on the basis of angiographic correlationsin a group of 21 patients with such conditions and sinus rhythmwith normal PR interval in 81% of the cases, and when diastolicmitral regurgitation was present, to study if it had clinicalimplications. Doppler detection was feasible in all cases and there were nofalse positive diagnoses. Comparison of haemodynamic data inpatients without (group A) and with (group B) diastolic mitralregurgitation showed a significant increase in the mean valuesof pressures, particularly for the mean pulmonary artery andcapillary wedge pressures (P<0.001), in group B. This study suggests that the recording of mitral flow velocityshould be routinely performed in patients with such pathologicalconditions, since the finding of diastolic mitral regurgitationmay have clinical significance.     

Renovascular hypertension and coronary heart disease complicating essential thrombocythemia

A 36-year-old male was evalued for treatment-resistant hypertension.A high platelet count 828. 10⁹ l^–1, led to the diagnosisof essential thrombocythemia (ET). Aorto-renal angiography revealedcritical bilateral renal artery stenosis and coronary angiographyshowed three-vessel disease. Percutaneous transluminal renalangioplasty was only partially successful. The patient receiveda 12-week course of busulphan and subsequently the thrombocytecount decreased to 200. 10⁹ l^–1 Renal angiography 12 monthslater showed bilateral regression of the renal artery stenosiswith lowering of the blood pressure to normal levels.     

Thoracic aortic dissection in an 18-year-old woman with no risk factors

Spontaneous aortic dissection is a rare, life-threatening cause of chest pain, and has a higher prevalence when traditional risks such as age, hypertension, dyslipidemia, or connective tissue disorders are present. However, even in the absence of risk factors, non-traumatic rupture of an aortic dissection may occur. Most are found in patients over 40 years of age. Younger victims of this disease often also suffer from other conditions such as cystic medial necrosis, connective tissue disorders such as Marfan's syndrome, or vasculitis. We present the case of an 18-year-old, previously healthy woman who was country line dancing when she began to complain of severe, cramping chest and back pain. She was hemodynamically stable on initial presentation but experienced two seizures while in the emergency department and was intubated. Subsequently, her blood pressure dropped and she developed cardiac arrest, and despite vigorous resuscitation that included blood products and emergency department thoracotomy, she was refractory to all attempts. At autopsy she was found to have a spontaneous, non-traumatic rupture of an aortic dissection. This patient had no discernable risk factors for aortic dissection or discoverable cause on necropsy. We present this case to raise awareness among physicians and review other reported cases in the literature of aortic dissection in patients under age 40 years.