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Objectives. To evaluate a population of asymptomatic thalassemia major (TM) and thalassemia intermedia (TI) patients using cardiovascular magnetic resonance (CMR). We supposed that TI group could be differentiated from the TM group based on T2∗ and that the TI group could demonstrate higher cardiac output. Methods. A retrospective analysis of 242 patients with TM and TI was performed (132 males, 110 females; mean age 39.6 ± 8 years; 186 TM, 56 TI). Iron load was assessed by T2∗ measurements; volumetric functions were analyzed using steady-state-free precession sequences. Results. Significant difference in left-right heart performance was observed between TM with iron overload and TI patients and between TM with iron overload and TM without iron overload (P < 0.05); no significant differences were observed between TM without iron overload and TI patients. A significant correlation was observed between T2∗ and ejection fraction of right ventricle- (RV-) ejection fraction of left ventricle (LV); an inverse correlation was present among T2∗ values and end-diastolic volume of LV, end-systolic volume of LV, stroke volume of LV, end-diastolic volume of RV, end-systolic volume of RV, and stroke volume of RV. Conclusions. CMR is a leading approach for cardiac risk evaluation of TM and TI patients.

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BackgroundCoccydynia has many causes, including fracture, subluxation, and hypermobility of sacrococcygeal segments. Existing treatments are limited in their effectiveness. Coccygeoplasty (CP) is a relatively new, minimally invasive treatment that appears to address this difficult clinical challenge.ObjectiveTo describe clinical results at the time of the procedure and at 3- and 12-months' follow-up of patients with coccydynia related to subluxation and coccyx hypermobility treated with the CP technique. Additionally, to determine if there is any correlation between the final imaging and clinical results at 3- and 12-months' follow-up.MethodsA prospectively maintained database was used, and all patients who underwent CP for chronic coccydynia between January 2005 and October 2018 were retrospectively reviewed. All the patients had painful hypermobility (greater than 25°) with anterior flexion confirmed on radiological imaging. Alternative causes of coccydynia were excluded using CT and MRI. Procedures were performed under local anesthesia with combined fluoroscopic and CT guidance. Clinical follow-up was performed at two time points: 3 and 12 months after treatment using the Visual Analogue Scale (VAS).ResultsTwelve patients were treated in a single center. No procedural complications occurred. At 3- and 12-months' follow-up, the majority (75%) of patients had significantly lower VAS scores than at baseline, with mean changes of 3.5 and 4.9, respectively. There was no pain recurrence at 12 months and just one patient had no improvement of the pain. Follow-up CT images confirmed fixation of the sacrococcygeal bone segments in nine patients; however, no correlation was found between final imaging results and clinical outcome (p=0.1).ConclusionsPatients with refractory painful coccyx subluxation and hypermobility undergoing CP have a favorable clinical response at 3- and 12-months' follow-up. Further studies are required to validate this technique and to identify predictors of treatment response. Coccygeoplasty may be considered a reasonable alternative to coccygectomy.

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