Purpose The purpose of this study was to evaluate the relation between pelvic fracture patterns and the angiographic findings, and to assess the effectiveness of the embolisation. Methods This retrospective study, included patients with pelvic fractures and angiographic evaluation. Demographics, Injury Severity Score (ISS), associated injuries, embolisation time, blood units needed, method of treatment and complications were recorded and analysed. Fractures were classified according to the Burgess system. Results Between 1998 and 2008, 34 patients with pelvic fractures underwent angiographic investigation. Twenty six were males. The mean age was 41 years. Twenty-seven were motor vehicle accidents and seven were falls. There were 11 anterior posterior (APC) fractures, 12 lateral compression (LC), eight vertical shear (VS) patterns and three with combined mechanical injuries. The median ISS was 33.1 (range 5-66). From the 34 who underwent angiography, 29 had positive vascular extravasations. From them, 21 had embolisation alone, two had vascular repair and embolisation, five required vascular repair alone and one patient died while being prepared for embolisation. Five cases were re-embolised. The findings suggested that AP fractures have a higher tendency to bleeding compared with LC fractures. Both had a higher chance of blood loss compared to VS and complex fracture patterns. We reported 57 additional injuries and 65 fractures. The complications were: one non lethal pulmonary embolism, one renal failure, one liver failure, one systemic infection, two deep infections and two psychological disorientations. Seven patients died in hospital. Conclusion Control of pelvic fracture bleeding is based on the multidisciplinary approach mainly related to hospital facilities and medical personnel's awareness. The morphology of the fracture did not have a predictive value of the vascular lesion and the respective bleeding.

Introduction: Renal artery stenosis (RAS) is associated with renal dysfunction, neurohormonal activation and suboptimal heart failure (HF) treatment. However, few data exists on the prevalence and the prognostic impact of RAS in HF patients. Methods: Patients with treated HF underwent cardiac and renal magnetic resonance imaging (MRI) examination. The renal MRI data were reviewed offline by an expert who identified the presence and severity of RAS. Patients were divided in 3 groups according to renal MRI findings: normal renal arteries or mild (<50%) RAS (No-RAS), unilateral RAS>50% (Uni-RAS) and bilateral RAS>50% (Bi-RAS). Statistics: Continuous variables are presented as mean±standard deviation while categorical variables as absolute values. Comparison of continuous variables was made with the Kruskal-Wallis test with Chi-square test for the categorical variables. Uni-and multi-variable Cox regression analyses were used. A p value <0.05 was considered statistically significant. Results: Of 234 patients, 133, 62 and 39 (give %) had No RAS, Uni-RAS and Bi-RAS respectively. Their mean age was 70±10 years, mean EF 38±14%, and 81% were men. Patients who had Uni-RAS or Bi-RAS were older compared to patients without RAS (73±8 and 74±9 vs. 67±11, p<0.0001), had lower GFR (45±19ml/min and 40±18mil/min vs. 57±22ml/min) and were more likely to have ischemic heart disease (81% and 85% vs. 66, p=0.02) and hypertension (47% and 56% vs. 31%, p=0.006). Bi-RAS patients had higher NT-BNP levels comparing to the Uni-RAS and No-RAS patients (383±385pmol/L vs. 269±701pmol/L and 251±290pmol/L respectively, p=0.038) and most of them had peripheral oedema (53% vs. 18% and 23%, p<0.0001). There were no statistical significant differences in the cardiac MRI measurements in the 3 groups. During a follow up period of 33±19 months, 10% without RAS patients, 27% of the patients with unilateral RAS and 38% of the patients with bilateral RAS died (p=0.007). Applying multivariate Cox regression analysis and after adjustment for sex, age, GFR, diabetes mellitus, NYHA classification and EF, RAS (HR: 2.388, 95% CI: 1.156-4.932; p=0.019,), IHD (HR: 4.610, p=0.015) and left ventricular enddiastolic volume (HR: 1.009, CI 1.002-1.016; p=0.010) were found to be indepedent predictors of mortality. Conclusions: RAS is common in patients with HF and is associated with increased mortality. Whether renal artery revascularisation will improve the prognosis in these patients needs further investigation. 66Evaluation of hand grip strength as a marker of clinical deterioration in heart failure patients

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