Platelet count/spleen volume ratio has a good predictive value for esophageal varices in patients with hepatitis B liver cirrhosis

Background & aims Platelet count/spleen longest diameter ratio (PSDR) is widely used in clinical practice due to its good performance in predicting esophageal varices (EV). We obtained spleen volume (SV) by magnetic resonance examination, the purpose of this study was to evaluate the clinical value of platelet count/spleen volume ratio (PSVR) and spleen volume in predicting EV in patients with hepatitis B cirrhosis. Methods: This study was a diagnostic accuracy experiment and retrospective, 199 patients with hepatitis B cirrhosis who met the criteria were selected as the research subjects. All patients were collected blood samples in the morning on an empty stomach within 2 days, and related indicators were tested. Within 10 days, they received electronic gastroscopy and abdominal magnetic resonance examination. According to the Child-Pugh score, the patients were divided into groups with or without EV and with or without high-risk esophageal varices (HRV), then statistical analysis of the two groups was performed. Results The area under the curve (AUC) of PSVR in predicting EV or HRV in each group (85.5%-92.6%) was higher than PSDR, SV, spleen diameter, and platelet count. The AUC of PSDR in diagnosing HRV was higher than SV, and the AUC of SV in diagnosing EV was higher than PSDR, but the difference was not significant (P>0.05). In Child-Pugh A patients, Multivariate logistic regression analysis showed PSVR could be a predictor of HRV (P<0.05), SV was a reliable predictor of EV (P<0.05). Conclusion PSVR is better than PSDR, spleen diameter, platelet count in predicting EV; in the absence of serological results, SV could be used instead of PSDR. Both can predict EV or HRV of patients with hepatitis B cirrhosis.

Successful treatment of atypical type A aortic dissection after heart transplantation

We report a case of a 58-year-old female with Stanford type A aortic dissection sparring the donor aorta 2 years after heart transplantation. Lumbar spine magnetic resonance examination for low back pain discovered the aortic dissection which was confirmed by following computed tomography angiography. The patient received surgical treatment including total arc replacement and thoracic aortic endovascular repair and recovered well.

Comparison of Echocardiography and Magnetic Resonance Imaging in the Analysis of Patients Diagnosed with Ischemic Cardiomyopathy

Objective: The occurrence of ischemic cardiomyopathy poses a serious threat to the health of patients. At present, there are different treatments for ischemic cardiomyopathy. In the course of treatment, it is necessary to analyze the cause of the patient's disease and the actual condition of the disease through accurate medical images. Methods: Echocardiography and cardiac MRI were performed on all patients with ischemic cardiomyopathy, and the interval between the two tests was less than one week. In the ultrasound examination, the inner diameter of the atrioventricular cavity and the inner diameter of the aorta were routinely measured, the left ventricular ejection fraction was estimated, and the wall motion was observed. During magnetic resonance examination, we performed the following: (1) cardiac morphology examination, (2) cardiac function examination, (3) myocardial first perfusion, and (4) myocardial activity examination. Results: Our study found that echocardiography could not accurately detect ischemic myocardium, and magnetic resonance was significantly better than echocardiography. The number of infarcted myocardial segments detected by conventional echocardiography and MRI was statistically significant. Conclusion: In medical practice, cardiac magnetic resonance examination can be used asan early clinical diagnosis and early intervention to treat ischemic cardiomyopathy.

Diagnostic Dilemma of Recurrent Pulmonary Embolism

Popliteal venous aneurysms are rare vascular disorders associated with a high risk of pulmonary embolism. We present the case of a 56-year-old woman hospitalized for a third episode of unprovoked pulmonary embolism. Venous ultrasonography identified a popliteal aneurysm, repeatedly missed by two-point compression venous ultrasonography, which was eventually confirmed by a magnetic resonance examination. Because of its highly symptomatic nature despite optimal anticoagulant treatment, the decision was made to undergo surgery, consisting of aneurysmectomy followed by patch angioplasty. The goal of this paper is to report a rare case of popliteal venous aneurysm and its treatment strategies and postoperative evolution.

Treatment strategy for elderly patients with the isolated greater trochanteric fracture

Background: The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment. Methods: Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination. Results: This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404). Conclusion: Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery