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Zhang JH, Chen H, Ruan DD, Chen Y, Zhang L, Gao MZ, Chen Q, Yu HP, Wu JY, Lin XF, Fang ZT, Zheng XL, Luo JW, Liao LS, Li H. Adult type I Gaucher disease with splenectomy caused by a compound heterozygous GBA1 mutation in a Chinese patient: a case report. Ann Hematol 2024; 103:1765-1774. [PMID: 38509388 DOI: 10.1007/s00277-024-05710-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Gaucher disease (GD) is an autosomal recessive ailment resulting from glucocerebrosidase deficiency caused by a mutation in the GBA1 gene, leading to multi-organ problems in the liver, spleen, and bone marrow. In China, GD is extremely uncommon and has a lower incidence rate than worldwide. In this study, we report the case of an adult male with an enlarged spleen for 13 years who presented with abdominal distension, severe loss of appetite and weight, reduction of the three-line due to hypersplenism, frequent nosebleeds, and bloody stools. Regrettably, the unexpected discovery of splenic pathology suggestive of splenic Gaucher disease was only made after a splenectomy due to a lack of knowledge about rare disorders. Our patient's delayed diagnosis may have been due to the department where he was originally treated, but it highlights the need for multidisciplinary consultation in splenomegaly of unknown etiology. We then investigated the patient's clinical phenotypes and gene mutation features using genetically phenotypical analysis. The analysis of the GBA1 gene sequence indicated that the patient carried a compound heterozygous mutation consisting of two potentially disease-causing mutations: c.907C > A (p. Leu303Ile) and c.1448 T > C (p. Leu483Pro). While previous research has linked the p. Leu483Pro mutation site to neurologic GD phenotypes (GD2 and GD3), the patients in this investigation were identified as having non-neuronopathic GD1. The other mutation, p. Leu303Ile, is a new GD-related mutation not indexed in PubMed that enriches the GBA1 gene mutation spectrum. Biosignature analysis has shown that both mutations alter the protein's three-dimensional structure, which may be a pathogenic mechanism for GD1 in this patient.
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Affiliation(s)
- Jian-Hui Zhang
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
| | - Hui Chen
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
| | - Dan-Dan Ruan
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
| | - Ying Chen
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Li Zhang
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Mei-Zhu Gao
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Qian Chen
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
| | - Hong-Ping Yu
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
| | - Jia-Yi Wu
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
| | - Xin-Fu Lin
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
- Department of Pediatrics, Fujian Provincial Hospital, Fuzhou, China
| | - Zhu-Ting Fang
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China
| | - Xiao-Ling Zheng
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China.
- Department of Digestive Endoscopy, Fujian Provincial Hospital, Fuzhou, China.
| | - Jie-Wei Luo
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China.
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, China.
| | - Li-Sheng Liao
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China.
- Department of Hematology, Fujian Provincial Hospital, Fuzhou, China.
| | - Hong Li
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No.134 Dong Street, Fuzhou, 350001, China.
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, China.
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Koskinen SK, Alagic Z, Enocson A, Kistner A. The prevalence of early contained vascular injury of spleen. Sci Rep 2024; 14:7917. [PMID: 38575738 PMCID: PMC10995136 DOI: 10.1038/s41598-024-58626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
Contained vascular injuries (CVI) of spleen include pseudoaneurysms (PSA) and arterio-venous fistulae (AV-fistulae), and their reported prevalence varies. Our purpose was to assess the prevalence of early splenic CVI seen on admission CT in patients with splenic trauma admitted to a single level 1 trauma center in 2013-2021, and its detection in different CT protocols. A retrospective, single-center longitudinal cohort study. Nine-year data (2013-2021) of all patients with suspected or manifest abdominal trauma were retrieved. All patients, > 15 years with an ICD code for splenic trauma (S36.0XX) were included. CT and angiographic examinations were identified. Reports and images were reviewed. Splenic CVI CT criterion was a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Number of CVIs and treatment was based on medical records and/or available angioembolization data. Of 2805 patients with abdominal trauma, 313 patients (313/2805; 11.2%) fulfilled the study entry criteria. 256 patients (256/313; 81.8%) had a CT examination. Sixteen patients had splenectomy before CT, and the final study group included 240 patients (240/313; 76.7%). Median New Injury Severity Score (NISS) was 27 and 87.5% of patients had NISS > 15. Splenic CVI was found in 20 patients, which yields a prevalence of 8.3% (20/240; 95% CI 5.2-12.6%). In those cases with both late arterial and venous phase images available, CVI was seen in 14.5% of cases (18/124, 95% CI 8.6-22.0%). None of the patients with CVI died within 30 days of the injury. The prevalence of early splenic CVI in patients with a splenic trauma was 8.3-14.5% (95% CI 5.2-22.0%). Our data suggests that both arterial and venous phase are needed for CT diagnosis. The 30-day outcome in terms of mortality was good.
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Affiliation(s)
- Seppo K Koskinen
- Division for Radiology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, 171 76, Stockholm, Sweden.
- Department of Diagnostic Radiology, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Z Alagic
- Division for Radiology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Diagnostic Radiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - A Enocson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 77, Stockholm, Sweden
| | - A Kistner
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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Chu J, Mokkarala M, Zhang M, Dixe de Oliveira Santo I, Lanier MH. Splenogonadal Fusion. Radiographics 2024; 44:e230224. [PMID: 38512727 DOI: 10.1148/rg.230224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Jia Chu
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
| | - Mahati Mokkarala
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
| | - Meng Zhang
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
| | - Irene Dixe de Oliveira Santo
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
| | - M Hunter Lanier
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
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Jones B, Elbakri AS, Murrills C, Patil P, Scollay J. Splenic artery embolisation for blunt splenic trauma: 10 years of practice at a trauma centre. Ann R Coll Surg Engl 2024; 106:283-287. [PMID: 37365934 PMCID: PMC10904261 DOI: 10.1308/rcsann.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Splenic artery embolisation (SAE) has transformed the management of splenic trauma. The aim of this study was to review the outcomes and postprocedural management of blunt splenic trauma patients treated with SAE at a trauma centre over a 10-year period. METHODS Details of patients undergoing SAE for blunt trauma between January 2012 and January 2022 were acquired from a prospectively maintained database. Patient records were reviewed for demographic information, splenic injury grades, embolisation efficacy, complications, and associated injuries and mortality. Data relating to Injury Severity Scores (ISS) and postprocedural practice (vaccinations, antibiotic prescribing, follow-up imaging) were also obtained. RESULTS Thirty-six patients (24 male, 12 female) with a median age of 42.5 years (range 13-97 years) were identified. American Association for the Surgery of Trauma splenic injury grades were III (n = 7), IV (n = 20) and V (n = 9). Seventeen patients had isolated splenic injury and 19 had additional injuries to other organ systems. Median ISS was 18.5 (range 5-50). SAE succeeded first time in 35/36 cases, and upon the second attempt in 1/36 cases. No patients died because of splenic injury or SAE although four patients with polytrauma died owing to other injuries. SAE complications occurred in 4/36 cases. For survivors, vaccinations were administered in 17/32 cases, and long-term antibiotics were initiated in 14/32 cases. Formal follow-up imaging was arranged in 9/32 cases. CONCLUSIONS These data show that SAE is an effective means of controlling splenic haemorrhage secondary to blunt trauma with no patient requiring subsequent laparotomy. Major complications occurred in 11% of cases. Follow-up practice varied regarding further imaging, antibiotic and vaccination administration.
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Ahmed TM, Fishman EK. Cinematic Rendering for Differentiation of Pancreatic Neuroendocrine Tumor From Intrapancreatic Accessory Spleen. AJR Am J Roentgenol 2024; 222:e2430862. [PMID: 38265000 DOI: 10.2214/ajr.24.30862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Taha M Ahmed
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3256, Baltimore, MD 21287
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3256, Baltimore, MD 21287
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Wang YX, Wu JQ, Li N. A case report on the use of 18F-FDG-PET/CT in the diagnosis of splenic abscess. Asian J Surg 2024; 47:1316-1317. [PMID: 38036344 DOI: 10.1016/j.asjsur.2023.11.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Ying-Xin Wang
- Department of Intensive Care Unit, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Jia-Qian Wu
- Department of Intensive Care Unit, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Ning Li
- Department of Intensive Care Unit, Affiliated Hospital of Hebei University, Baoding, 071000, China.
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7
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Li C, Wang Y, Dong B, Yang X. An immunocompetent patient with tuberculosis of the spleen. Asian J Surg 2024; 47:1139-1140. [PMID: 38123392 DOI: 10.1016/j.asjsur.2023.10.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Chunyan Li
- The First Clinical Medical School of Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou City, Gansu Province, China.
| | - Yifeng Wang
- The 1st Clinical Medicine College, Gansu University of Chinese Medicine, No.35 Dingxi East Road, Chengguan District, Lanzhou City, Gansu Province, China.
| | - Baolong Dong
- The Second Department of General Surgery, Gansu Provincial Hospital, No. 204, Donggang West Road, Chengguan District, Lanzhou City, Gansu Province, China.
| | - Xiaojun Yang
- The First Clinical Medical School of Lanzhou University, China; The Second Department of General Surgery, Gansu Provincial Hospital, China; Lanzhou University People's Clinical Hospital, China; Gansu Research Center of Prevention and Control Project for Digestive Oncology, Gansu Provincial Hospital, China; Gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology, Gansu Provincial Hospital, China.
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8
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Zhixiong H, Daguang T, Runlin F, Xiaoping W. Littoral cell angioma in the main and intrapancreatic accessory spleen: A case report. Asian J Surg 2024; 47:1101-1103. [PMID: 38036348 DOI: 10.1016/j.asjsur.2023.10.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Hu Zhixiong
- The Department of Hepatobiliary Surgery at the Second Clinical College at Kunming Medical University, The Second Affifiliated Hospital of Kunming Medical College, Kunming, Yunnan Province, China
| | - Tian Daguang
- Hepatobiliary Surgery Department, Kunming Medical University, The Second Affifiliated Hospital of Kunming Medical College, Kunming, Yunnan Province, China
| | - Feng Runlin
- Pathology Department, Kunming Medical University, The Second Affifiliated Hospital of Kunming Medical College, Kunming, Yunnan Province, China
| | - Wei Xiaoping
- Hepatobiliary Surgery Department, Kunming Medical University, The Second Affifiliated Hospital of Kunming Medical College, Kunming, Yunnan Province, China.
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Das CJ, Selvaraju A, Aggarwal P, Chumber S. Combined endovascular and percutaneous approach to the management of spontaneous splenic arteriovenous fistula. BMJ Case Rep 2024; 17:e255924. [PMID: 38262721 PMCID: PMC10826506 DOI: 10.1136/bcr-2023-255924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
A splenic arteriovenous fistula (AVF) is an uncommon splenic vascular disease which can be congenital or acquired. A 40yr old woman, without any history of chronic liver disease, presented with non-specific pain abdomen, underwent contrast-enhanced CT and was diagnosed to have a splenic AVF with multiple intervening venous aneurysms and early filling of the portal vein. The vascular abnormality was successfully treated with a combined percutaneous glue embolisation and endovascular balloon-assisted coil embolisation. Neither recurrence nor other complications were observed in the patient during the follow-up after 6 months.
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Affiliation(s)
- Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Anup Selvaraju
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Piyush Aggarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sunil Chumber
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Daveson AJM, O'Rourke T, Davis S. Splenic artery collateral masquerading as a gastric varix after splenic trauma. Gastrointest Endosc 2024; 99:120-121. [PMID: 37423537 DOI: 10.1016/j.gie.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/17/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Affiliation(s)
- A James M Daveson
- Coeliac Disease and Immune Health Research Program, Brisbane, Queensland, Australia, Wesley Research Institute, Brisbane, Queensland, Australia; St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia, endosQ, Mackay, Queensland, Australia; Coral Sea Clinical Research Institute, Mackay, Queensland, Australia, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Tom O'Rourke
- Greenslopes Private Hospital; Brisbane, Queensland, Australia, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Samuel Davis
- Qscan Radiology Clinics, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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11
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Atkins K, Schneider A, Charles A. Splenic Salvage: Is There a Role for Splenorrhaphy in the Management of Adult Splenic Trauma? Am Surg 2023; 89:5599-5608. [PMID: 36878857 DOI: 10.1177/00031348231156760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Nonoperative management of splenic injuries is recommended. Total splenectomy is the primary operative management, and the current role of splenorrhaphy in splenic salvage is not well delineated. METHODS We reviewed the National Trauma Data Bank (2007-2019) for adult splenic injuries. Operative splenic injury management were compared. We performed bivariate analysis and multivariable logistic regression to estimate the effect of surgical management on mortality. RESULTS 189,723 patients met the inclusion criteria. Splenic injury management was stable, with 18.2% undergoing a total splenectomy and 1.9% splenorrhaphy. Splenorrhaphy patients had lower crude mortality (2.7% vs 8.3%, P < .001) than total splenectomy patients. Failed splenorrhaphy patients had higher crude mortality (10.1% vs 8.3%, P < .001) than patients who underwent initial total splenectomy. Patients who underwent total splenectomy had an adjusted odd of 2.30 (95% CI 1.82-2.92, P < .001) for mortality compared to successful splenorrhaphy. Patients who failed splenorrhaphy had an adjusted odd of 2.36 (95% CI 1.19-4.67, P < .014) for mortality compared to successful splenorrhaphy. CONCLUSION Adults with splenic injuries requiring operative intervention have twice the odds of mortality when a total splenectomy is performed or when splenorrhaphy fails compared to successful splenorrhaphy.
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Affiliation(s)
- Kathryn Atkins
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew Schneider
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Colombatti R, Casale M. Early splenectomy in sickle cell disease: another piece of the puzzle. Haematologica 2023; 108:3197-3198. [PMID: 37439345 PMCID: PMC10690901 DOI: 10.3324/haematol.2023.283481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
Not available.
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Affiliation(s)
- Raffaella Colombatti
- Pediatric Hematology-Oncology Unit, Department of Women's and Child's Health, University of Padova, Padova.
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Harsha M, Praveen Kumar T, Varma M, Mukhopadhyay C. Dealing with the honey trap: a case of hepatic melioidosis. QJM 2023; 116:940-941. [PMID: 37462606 DOI: 10.1093/qjmed/hcad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Indexed: 11/26/2023] Open
Affiliation(s)
- M Harsha
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - T Praveen Kumar
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - M Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - C Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Aoki M, Matsumoto S, Abe T, Zarzaur BL, Matsushima K. Angioembolization for Isolated Severe Blunt Splenic Injuries with Hemodynamic Instability: A Propensity Score Matched Analysis. World J Surg 2023; 47:2644-2650. [PMID: 37679608 DOI: 10.1007/s00268-023-07156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND This study aimed to compare patient outcomes after splenic angioembolization (SAE) or splenectomy for isolated severe blunt splenic injury (BSI) with hemodynamic instability, and to identify potential candidates for SAE. METHODS Adult patients with isolated severe BSI (Abbreviated Injury Scale [AIS] 3-5) and hemodynamic instability between 2013 and 2019 were identified from the American College of Surgeons Trauma Quality Improvement (ACS TQIP) database. Hemodynamic instability was defined as an initial systolic blood pressure (SBP) <90 mmHg, heart rate (HR) >120 bpm, or lowest SBP <90 mmHg within 1 h after admission, with ≥1 unit of blood transfused within 4 h after admission. In-hospital mortality was compared between splenectomy and SAE groups using 2:1 propensity-score matching. The characteristics of unmatched and matched splenectomy patients were also compared. RESULTS A total of 478 patients met our inclusion criteria (332 splenectomy, 146 SAE). After propensity-score matching, 166 splenectomy and 83 SAE patients were compared. Approximately 85% of propensity-score matched patients sustained AIS 3/4 injuries, and 50% presented with normal SBP and HR before becoming hemodynamically unstable. The median time to intervention (splenectomy or SAE) was 137 min (interquartile range 94-183). In-hospital mortality between splenectomy and SAE groups was not significantly different (5.4% vs. 4.8%, p = 1.000). More than half of unmatched patients in the splenectomy group sustained AIS 5 injuries and presented with initially unstable hemodynamics. The median time to splenectomy in such patients was significantly shorter than in matched splenectomy patients (67 vs. 132 min, p < 0.001). CONCLUSION Splenectomy remains the mainstay of treatment for patients with AIS 5 BSI who present to hospital with hemodynamic instability. However, SAE might be a feasible alternative for patients with AIS 3/4 injuries.
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Affiliation(s)
- Makoto Aoki
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, 371-0811, Japan.
| | - Shokei Matsumoto
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Ben L Zarzaur
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
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Lete C, Brichard M, Rosa ML, Salavracos M, Hubert C, Navez B, Closset J, Pezzullo M, Navez J. Spleen-preserving pancreatectomy with removal of splenic vessels: impact on splenic parenchyma ? BMC Surg 2023; 23:245. [PMID: 37605170 PMCID: PMC10441733 DOI: 10.1186/s12893-023-02133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND While outcomes after spleen-preserving distal pancreatectomy (SP-DP) have been widely reported, impacts on splenic parenchyma have not been well studied. This study aimed to compare postoperative outcomes, particularly spleen-related outcomes, by assessing splenic imaging after SP-DP with or without splenic vessels removal. METHODS Data for all patients who underwent SP-DP with splenic vessels removal (Warshaw technique, WDP) or preservation (Kimura technique, KDP) between 2010 and 2022 in two tertiary centres were retrospectively analysed. Splenic ischemia and volume at early/late imaging and postoperative outcomes were reviewed. RESULTS Eighty-seven patients were included, 51 in the WDP and 36 in the KDP groups. Median Charlson's Comorbidity Index was significantly higher in the WDP group compared with the KDP group. Postoperative morbidity was similar between groups. There was more splenic ischemia at early imaging in the WDP group compared to the KDP group (55% vs. 14%, p = 0.018), especially severe ischemia (23% vs. 0%). Partial splenic atrophy was observed in 29% and 0% in the WDP and KDP groups, respectively (p = 0.002); no complete splenic atrophy was observed. Platelet levels at POD 1, 2 and 6 were significantly higher in the WDP group compared to KDP group. At univariate analysis, age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction were prognostic factors for development of splenic atrophy. No episodes of overwhelming post-splenectomy infection or secondary splenectomy were recorded after a median follow-up of 9 and 11 months in the WDP and KDP groups, respectively. CONCLUSIONS Splenic ischemia appeared in one-half of patients undergoing SP-DP with splenic vessels removal at early imaging, and partial splenic atrophy in almost 30% at late imaging, without clinical impact or complete splenic atrophy. Age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction could help to predict the occurrence of splenic atrophy.
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Affiliation(s)
- Coralie Lete
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Route de Lennik 808, Brussels, 1070, Belgium
| | - Martin Brichard
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Maria Luisa Rosa
- Department of Radiology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, 1070, Belgium
| | - Mike Salavracos
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, Brussels, 1200, Belgium
- Surgiprint 3D Intelligence, Louvain-La-Neuve, 1348, Belgium
| | - Catherine Hubert
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Benoit Navez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Route de Lennik 808, Brussels, 1070, Belgium
| | - Martina Pezzullo
- Department of Radiology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, 1070, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Route de Lennik 808, Brussels, 1070, Belgium.
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Ing SK, Lee GWC, Leong TS, Lee YH, Lau GYL, Yusof NN, Chang AKW, Wong KKY. Secondary hemophagocytic lymphohistiocytosis: an unusual complication in disseminated Mycobacterium tuberculosis. Clin Med (Lond) 2023; 23:414-416. [PMID: 38614658 PMCID: PMC10541036 DOI: 10.7861/clinmed.2023-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Tuberculosis-associated hemophagocytic lymphohistiocytosis (TB-HLH) is a rare and life-threatening complication of tuberculosis infection. Early recognition and treatment of TB-HLH is crucial for improving outcomes. Treatment typically involves a combination of antituberculosis therapy and immunosuppressive therapy to control the immune system's overreaction. In this report, we present the case of a 53-year-old ambulance driver who was diagnosed with TB-HLH. His CT scan revealed splenic abscesses, hepatomegaly and bilateral lung consolidation. He subsequently developed multiorgan failure, including acute respiratory distress syndrome (ARDS), transaminitis and bone marrow dysfunction. The clinical course and simultaneous increase in serum ferritin raised the suspicion of HLH. His Hscore was 254, indicating a high probability of hemophagocytic syndrome. TB diagnosis was confirmed by positive endotracheal TB GeneXpert and bone marrow aspiration (BMA) which detected acid-fast bacilli organisms. The patient was promptly started on anti-TB, dexamethasone and IVIG. The patient responded well to treatment and made a full recovery without any lasting complications. This case highlights the importance of promptly recognising HLH and identifying the underlying cause. In critically ill patients, it is crucial not to delay HLH-specific treatment while working up for differential diagnosis.
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Füssel LM, Müller-Wille R, Dinkhauser P, Schauer W, Hofer H. Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis: A case report and literature review. World J Gastroenterol 2023; 29:3922-3931. [PMID: 37426315 PMCID: PMC10324528 DOI: 10.3748/wjg.v29.i24.3922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/27/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may result in the development of colonic varices (CV) with a high risk of severe gastrointestinal bleeding. While clear guidelines for treatment are lacking, splenectomy or splenic artery embolization are often used to treat bleeding. Splenic vein stenting has been shown to be a safe option.
CASE SUMMARY A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding. She was anemic with a hemoglobin of 8.0 g/dL. As a source of bleeding, CV were identified. Computed tomography scans revealed thrombotic occlusion of the splenic vein, presumably as a result of a severe acute pancreatitis 8 years prior. In a selective angiography, a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed. The hepatic venous pressure gradient was within normal range. In an interdisciplinary board, transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting, as well as coiling of the aberrant veins was discussed and successfully performed. Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.
CONCLUSION Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV. However, a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.
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Affiliation(s)
- Lisa-Michaela Füssel
- Department of Internal Medicine I, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
| | - Rene Müller-Wille
- Department of Radiology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
| | - Patrick Dinkhauser
- Department of Internal Medicine I, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
| | - Walter Schauer
- Department of Abdominal Surgery, Klinikum Wels-Grieskirchen, Wels 4600, Austria
| | - Harald Hofer
- Department of Internal Medicine I, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels 4600, Austria
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Shen D, Li Y, Zhang Y, Chang X, Zhao X, Li J, Zhang X, Guo G. Seminoma arising in splenogonadal fusion: a case report and literature review. Diagn Pathol 2023; 18:42. [PMID: 36998078 PMCID: PMC10064669 DOI: 10.1186/s13000-023-01332-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/22/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Splenogonadal fusion (SGF) is a rare congenital malformation in which the spleen is abnormally connected to the gonads or to the mesonephric derivatives. There is no obvious causality between SGF and testicular neoplasm. However, cryptorchidism, which is a well-known risk factor of testicular germ cell tumors, are the most frequent malformations associated with SGF. To our knowledge, there are only four reported cases of SGF associated with testicular neoplasm so far. Herein, we reported a patient of this condition, and briefly reviewed the related literature. CASE PRESENTATION A 48-year-old man was diagnosed with bilateral cryptorchidism 30 years prior, and only underwent a right orchiopexy for the left testicle could not be explored during the operation. At that time, doctors failed to realize the possibility of SGF due to the lack of sufficient knowledge of this condition. This time, the patient was treated for a left abdomen mass that was diagnosed as stage III metastatic seminoma. Then, a right orchiectomy, robot-assisted laparoscopic left retroperitoneal tumor resection, and left retroperitoneal lymph node dissection was performed after four cycles of BEP (bleomycin + etoposide + cisplatin) systemic chemotherapy in our center. The final diagnosis of SGF was made by postoperative pathology. The patient was re-examined in our center at 3 months and 6 months after the operation, and no obvious abnormalities were found. CONCLUSIONS Surgeons should always bear in mind the possibility of association between bilateral cryptorchidism and splenogonadal fusion to avoid malignant transformation caused by delayed treatment.
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Affiliation(s)
- Donglai Shen
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Yuzhu Li
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Yu Zhang
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Xiao Chang
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Xupeng Zhao
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, China
| | - Jiabin Li
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Xu Zhang
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China.
| | - Gang Guo
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China.
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de Padua V Alves V, Dillman JR, Somasundaram E, Taylor ZP, Brady SL, Zhang B, Trout AT. Computed tomography-based measurements of normative liver and spleen volumes in children. Pediatr Radiol 2023; 53:378-386. [PMID: 36471169 DOI: 10.1007/s00247-022-05551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/29/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Quantification of organ size has utility in clinical care and research for diagnostics, prognostics and surgical planning. Volumetry is regarded as the best measure of organ size and change in size over time. Scarce reference values exist for liver and spleen volumes in healthy children. OBJECTIVE To report liver and spleen volumes for a sample of children defined by manual segmentation of contrast-enhanced CT images with the goal of defining normal values and thresholds that might indicate disease. MATERIALS AND METHODS This retrospective study included clinically acquired contrast-enhanced CTs of the abdomen/pelvis for children and adolescents imaged between January 2018 and July 2021. Liver and spleen volumes were derived through manual segmentation of CTs reconstructed at 2.5-, 3- or 5-mm slice thickness. A subset of images (5%, n=16) was also segmented using 0.5-mm slice thickness reconstructions to define agreement based on image slice thickness. We used Pearson correlation and multivariable regression to assess associations between organ volumes and patient characteristics. We generated reference intervals for the 5th, 25th, 50th (median), 75th and 95th percentiles for organ volumes as a function of age and weight using quantile regression models. Finally, we calculated Bland-Altman plots and intraclass correlation coefficients (ICC) to quantify agreement. RESULTS We included a total of 320 children (mean age ± standard deviation [SD] = 9±4.6 years; mean weight 38.1±18.8 kg; 160 female). Liver volume ranged from 340-2,002 mL, and spleen volume ranged from 28-480 mL. Patient weight (kg) (β=12.5), age (months) (β=1.7) and sex (female) (β = -35.3) were independent predictors of liver volume, whereas patient weight (kg) (β=2.4) and age (months) (β=0.3) were independent predictors of spleen volume. There was excellent absolute agreement (ICC=0.99) and minimal absolute difference (4 mL) in organ volumes based on reconstructed slice thickness. CONCLUSION We report reference liver and spleen volumes for children without liver or spleen disease. These results provide reference ranges and potential thresholds to identify liver and spleen size abnormalities that might reflect disease in children.
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Affiliation(s)
- Vinicius de Padua V Alves
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elanchezhian Somasundaram
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
| | - Zachary P Taylor
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
| | - Samuel L Brady
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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20
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Riaz A, Ali HT, Ali F, Ali J. Refractory immune thrombocytopenic purpura (ITP) after accessory splenectomy: A case report and literature review. Clin Hemorheol Microcirc 2023; 85:189-194. [PMID: 37599530 DOI: 10.3233/ch-231881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a platelet count of less than 100 x 109 /L, resulting from antibody-mediated platelet destruction. Treatment for ITP typically involves steroids, and intravenous immunoglobulins (IVIG) can be added. Splenectomy is performed in cases with refractory ITP. Rituximab can suppress immunity but has limited efficacy in ITP cases. Herein, we present a rare case of a 30-year-old female who was first diagnosed with ITP and underwent a splenectomy two years later. However, seven years after surgery, she was presented with symptoms of ITP. A splenic scan showed an accessory spleen in the spleen bed, for which she underwent accessory spleen removal surgery. Her laboratory tests three days post-operation showed a rise in platelet count and hence was discharged a few days later. The patient had recurrent attacks of ITP even after the removal of the normal and accessory spleen, suggesting that accessory spleen removal may not always be an effective treatment for ITP. The patient eventually died. While splenectomy is a common treatment for ITP, it may not always be effective in all cases, and other treatments such as bone marrow transplantation may be necessary.
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Affiliation(s)
- Asad Riaz
- Ayub Teaching Hospital, Abbottabad, Pakistan
| | | | - Fawad Ali
- Hayatabad Medical Complex, Peshawar, Pakistan
| | - Jawad Ali
- Ayub Teaching Hospital, Abbottabad, Pakistan
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21
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Hojo N, Kitani K, Okuni N, Shikimi Matsuda H. Gastrosplenic Fistula Due to Diffuse Large B-cell Lymphoma. Intern Med 2022; 61:3149-3150. [PMID: 35283392 PMCID: PMC9646331 DOI: 10.2169/internalmedicine.9150-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nobumasa Hojo
- Department of General Medicine, National Hospital Organization Hamada Medical Center, Japan
| | - Kashu Kitani
- Department of General Medicine, National Hospital Organization Hamada Medical Center, Japan
| | - Noriko Okuni
- Department of General Medicine, National Hospital Organization Hamada Medical Center, Japan
| | - Hanako Shikimi Matsuda
- Department of General Medicine, National Hospital Organization Hamada Medical Center, Japan
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22
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Martino A, Di Serafino M, Zito FP, Maglione F, Bennato R, Orsini L, Iacobelli A, Niola R, Romano L, Lombardi G. Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report. World J Gastroenterol 2022; 28:5506-5514. [PMID: 36312836 PMCID: PMC9611706 DOI: 10.3748/wjg.v28.i37.5506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/17/2022] [Accepted: 09/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric submucosal arterial collaterals (GSAC) secondary to splenic artery occlusion is an extraordinary rare and potentially life-threatening cause of acute upper gastrointestinal bleeding. Here, we report a case of massive bleeding from GSAC successfully treated by means of a multidisciplinary minimally invasive approach.
CASE SUMMARY A 60-year-old non-cirrhotic gentleman with a history of arterial hypertension was admitted due to hematemesis. Emergent esophagogastroduodenoscopy revealed pulsating and tortuous varicose shaped submucosal vessels in the gastric fundus along with a small erosion overlying one of the vessels. In order to characterize the fundic lesion, pre-operative emergent computed tomography-angiography was performed showing splenic artery thrombosis (SAT) and tortuous arterial structures arising from the left gastric artery and the left gastroepiploic artery in the gastric fundus. GSAC was successfully treated by means of a minimally invasive step-up approach consisting in endoscopic clipping followed by transcatheter arterial embolization (TAE).
CONCLUSION This was a previously unreported case of bleeding GSAC secondary to SAT successfully managed by means of a multidisciplinary minimally invasive approach consisting in endoscopic clipping for the luminal bleeding control followed by elective TAE for the definitive treatment.
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Affiliation(s)
- Alberto Martino
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Francesco Paolo Zito
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Franco Maglione
- Department of Radiology, Sanatrix Clinic, Napoli 80127, Italy
| | - Raffaele Bennato
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Luigi Orsini
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | | | - Raffaella Niola
- Department of Interventional Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Giovanni Lombardi
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
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Abuelo JM, García Carro J, Caneiro J, El-Diasty M, Fernandez Gonzalez AL. Left Atrial Myxoma Infected With Fusobacterium Nucleatum. Port J Card Thorac Vasc Surg 2022; 29:55-57. [PMID: 36197820 DOI: 10.48729/pjctvs.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Indexed: 06/16/2023]
Abstract
Cardiac myxomas are the most common primary cardiac tumours in adults. Clinical presentation is variable, with few cases of infected myxomas reported in the literature. We describe a rare case of a 63-year-old patient who presented with splenic abscesses and a left atrial mass suggestive of emboligen myxoma. The patient underwent a successful emergency sur- gical excision of the atrial mass followed by splenectomy. Blood cultures were positive for Fusobacterium nucleatum, whereas the histopathological examination of the excised mass confirmed the presence of a myxoma with a marked inflammatory infiltrate. All these findings allowed us to confirm the diagnosis of definite infected myxoma. Some aspects related to the aetiology, diagnosis and management of this entity are discussed.
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Affiliation(s)
- José M Abuelo
- Department of Surgery and Medico-Surgical Specialities. University of Santiago de Compostela, Spain
| | - Javier García Carro
- Division of Cardiac Surgery, University Hospital, Santiago de Compostela, Spain
| | - Javier Caneiro
- Division of Pathology, University Hospital, Santiago de Compostela, Spain
| | - Mohammad El-Diasty
- Division of Cardiac Surgery, Kingston General Hospital, Kingston, Canada
| | - Angel Luis Fernandez Gonzalez
- Department of Surgery and Medico-Surgical Specialities. University of Santiago de Compostela, Spain; Division of Cardiac Surgery, University Hospital, Santiago de Compostela, Spain
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Zafar SI, Halim A, Khalid W, Shafique M, Nasir H. Two Cases of Interrupted Inferior Vena Cava with Azygos / Hemiazygos Continuation. J Coll Physicians Surg Pak 2022; 32:S101-S103. [PMID: 36210661 DOI: 10.29271/jcpsp.2022.supp2.s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/19/2020] [Indexed: 06/16/2023]
Abstract
Interrupted inferior vena cava (IVC) is a rare disease, occurring either in isolation or in association with asplenia or polysplenia syndromes. Infrahepatic part of the IVC is absent representing the failure of fusion of the vitelline and subcardinal embryological portions of the IVC. It is replaced by an enlarged azygos or hemiazygos vein continuing into the thorax, either into the superior vena cava or into the brachiocephalic veins. We present two cases of interrupted IVC, one occurring in isolation with hemiazygos continuation and discovered incidentally, and the second one is a child with azygos continuation, associated with polysplenia syndrome. Key Words: Inferior vena cava, Polysplenia, Azygous vein, Hemiazygos vein.
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Affiliation(s)
- Saerah Iffat Zafar
- Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, Pakistan
| | - Aliya Halim
- Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, Pakistan
| | - Waqas Khalid
- Armed Forces Institute of Cardiology (AFIC), Rawalpindi, Pakistan
| | - Mobeen Shafique
- Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, Pakistan
| | - Hina Nasir
- Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, Pakistan
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Wehmeyer MH, Sekhri H, Wroblewski R, Galante A, Meyer T, Lohse AW, Schulze zur Wiesch J. Frequent detection of functional hyposplenism via assessment of pitted erythrocytes in patients with advanced liver cirrhosis. PLoS One 2022; 17:e0271541. [PMID: 35849612 PMCID: PMC9292104 DOI: 10.1371/journal.pone.0271541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Asplenia or functional hyposplenism are risk factors for severe infections, and vaccinations against encapsulated bacteria are advised. There are only limited data regarding the spleen function of cirrhotic patients. Methods We evaluated spleen function in patients with liver cirrhosis, who were prospectively enrolled in this study. Spleen function was evaluated by the measurement of pitted erythrocytes. Functional hyposplenism was defined as a percentage of PE of >15%. Results 117 patients, mean age 58.4 years and 61.5% (n = 72) male with liver cirrhosis were included. Functional hyposplenism was diagnosed in 28/117 patients (23.9%). Pitted erythrocytes correlated with albumin (p = 0.024), bilirubin (p<0.001), international normalized ratio (INR; p = 0.004), model of end-stage liver disease (MELD) score (p<0.001) and liver stiffness (p = 0.011). Patients with functional hyposplenism had higher MELD scores (median 13 vs. 10; p = 0.021), liver stiffness (46.4 kPa vs. 26.3 kPa; p = 0.011), INR (1.3 vs. 1.2; p = 0.008) and a higher Child-Pugh stage (Child C in 32.1% vs. 11.2%; p = 0.019) as compared to patients without functional hyposplenism. Functional hyposplenism was not associated with the etiology of cirrhosis. Importantly, 9/19 patients with Child C cirrhosis had functional hyposplenism. Conclusion A quarter of patients with liver cirrhosis and almost 50% of patients with Child C cirrhosis have functional hyposplenism. Functional hyposplenism is associated with poor liver function and the degree of portal hypertension, which is characterized by higher liver stiffness measurements in transient elastography.
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Affiliation(s)
- Malte H. Wehmeyer
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Harsha Sekhri
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Antonio Galante
- Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
| | - Thomas Meyer
- Department of Dermatology, Venerology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Ansgar W. Lohse
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Butel-Simoes GI, Jones P, Wood EM, Spelman D, Woolley IJ, Ojaimi S. Congenital asplenia study: clinical and laboratory characterisation of adults with congenital asplenia. Ann Hematol 2022; 101:1421-1434. [PMID: 35451619 DOI: 10.1007/s00277-022-04765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
Congenital asplenia is a rare disorder commonly associated with other visceral and cardiac congenital anomalies. Isolated congenital asplenia is even less common than syndromic forms. The risk of severe bacterial infections associated with asplenia is the most concerning clinical implication and carries a significant mortality risk. Prophylactic measures against the clinical syndrome known as overwhelming postsplenectomy infections (OPSI) include vaccination, prophylactic and emergency antibiotics and health education including fever management and travel advice. This case series describes fourteen adults with congenital asplenia and polysplenia syndrome, most of whom were diagnosed incidentally as adults, and outlines the nature of their diagnosis, clinical phenotype, family history and key pathology findings.
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Affiliation(s)
| | - Penelope Jones
- Spleen Australia, Alfred Health, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Victoria, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- Department of Haematology, Monash Health, Victoria, Australia
| | - Denis Spelman
- Spleen Australia, Alfred Health, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Victoria, Australia
| | - Ian J Woolley
- Monash Infectious Diseases, Monash Health, Victoria, Australia
- Spleen Australia, Alfred Health, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Victoria, Australia
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Samar Ojaimi
- Monash Infectious Diseases, Monash Health, Victoria, Australia
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Victoria, Australia
- Immunology Laboratory, Monash Pathology, Monash Health, Victoria, Australia
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27
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Ebrahimi K, Nabilou P, Steineck IIK. [Far East scarlet-like fever in a Caucasian man with Yersinia pseudotuberculosis bacteriaemia]. Ugeskr Laeger 2022; 184:V06210523. [PMID: 34983723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Yersinia pseudotuberculosis is a Gram-negative bacterium causing infection in humans through contaminated water and/or food. The infection commonly occurs as gastroenteritis and fever, abdominal pain due to mesenteric lymphadenitis and diarrhoea. Bacteraemia is rare and is typically seen in immunocompromised patients and occurs with different clinical presentations like Far East scarlet-like fever, splenic abscess, or mimic appendicitis. This is a case report of Y. pseudotuberculosis bacteraemia and splenic abscess in a Caucasian male.
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Wang H, So H, Nah YW, Kim M, Lee TY, Seo M, Bang SJ. Acute Abdominal Pain due to Accessory Splenic Infarction in an Adult: A Case Report. Korean J Gastroenterol 2021; 78:183-187. [PMID: 34565788 DOI: 10.4166/kjg.2021.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
Accessory spleens are common congenital anatomic variations that are usually asymptomatic. On the other hand, they can be clinically significant if complicated by hemorrhage, torsion, or infarction. This paper describes a case of an infarcted accessory spleen in a 30-year-old male who presented with abdominal pain. Abdominal CT and MRI revealed an isolated mass, 4.5 cm in size, in the perisplenic area. An infarcted accessory spleen was suspected. The patient underwent laparoscopic accessory splenectomy. Histopathology identified the mass as splenic tissue that had undergone ischemic necrosis. A definitive diagnosis of an infarcted accessory spleen was made, and the patient was discharged on day 5 after surgery symptom-free.
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Affiliation(s)
- Hoyoung Wang
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hoonsub So
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yang Won Nah
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Misung Kim
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Tae Young Lee
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Minjung Seo
- Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung-Jo Bang
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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29
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Kofinas AG, Stavrati KE, Symeonidis NG, Pavlidis ET, Psarras KK, Shulga IN, Marneri AG, Nikolaidou CC, Pavlidis TE. Non-Operative Management of Delayed Splenic Rupture 4 Months Following Blunt Abdominal Trauma. Am J Case Rep 2021; 22:e932577. [PMID: 34417433 PMCID: PMC8392706 DOI: 10.12659/ajcr.932577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Delayed splenic rupture is a rare complication of non-operative management of a primary splenic trauma which, without proper clinical vigilance, may result in life-threatening events. It usually occurs 4-8 days after injury and, in most cases, surgery is the treatment of choice. Since non-operative management of splenic trauma, which allows splenic salvage, has become increasingly popular, the same approach could also be applied in delayed splenic rupture. We herein present a case of delayed splenic rupture that occurred 4 months after the trauma and was successfully managed non-operatively. CASE REPORT A 32-year-old woman presented with diffuse abdominal pain, chest pain, and dyspnea 4 months after sustaining minor thoracoabdominal blunt trauma due to a car accident. That event was inadequately investigated and was not admitted for further monitoring. Computerized tomography revealed a rupture of a splenic hematoma in the context of the previous splenic trauma. She was closely monitored and remained hemodynamically stable. She was discharged and followed up, with no reported relapse of her clinical condition. CONCLUSIONS Delayed splenic rupture occurring 4 months after the primary splenic trauma is extremely rare. Due to its prolonged delay, delayed rupture of the spleen can easily be overlooked and not be included in the original differential diagnosis. Negligence of this event can result in dreaded complications with hemodynamic instability or even death. Furthermore, its higher mortality rate compared to primary splenic rupture highlights the importance of proper clinical vigilance. Non-operative management should be attempted in hemodynamically stable patients.
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Vignesh P, Loganathan SK, Sudhakar M, Chaudhary H, Rawat A, Sharma M, Shekar A, Vaiphei K, Kumar N, Singh Sachdeva MU, Jindal AK, Suri D, Gupta A, Ray P, Imai K, Ohara O, Nonoyama S, Lau YL, Singh S. Hemophagocytic Lymphohistiocytosis in Children with Chronic Granulomatous Disease-Single-Center Experience from North India. J Allergy Clin Immunol Pract 2020; 9:771-782.e3. [PMID: 33259975 DOI: 10.1016/j.jaip.2020.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/07/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic granulomatous disease (CGD) is an inherited defect in components of the nicotinamide adenine dinucleotide phosphate oxidase complex that results in potential life-threatening infective and noninfective complications. Hemophagocytic lymphohistiocytosis (HLH) is an unusual but important inflammatory complication of CGD. Optimal management strategies have not yet been identified in children with CGD who develop HLH. OBJECTIVE To analyze clinical and laboratory features of HLH in CGD from a tertiary-care center in North India. METHODS A retrospective review of medical records of children with CGD diagnosed in the last 20 years was performed. Clinical and laboratory features of children with CGD who developed HLH were analyzed. RESULTS Of 80 patients diagnosed with CGD, 5 (6.25%) had evidence of HLH. All 5 were males; 4 had X-linked CGD and 1 had autosomal recessive CGD (NCF2 defect). Two children with CGD had HLH as the predominant presenting manifestation mimicking the clinical presentation of congenital HLH. Infectious triggers identified were bloodstream infections (n = 3) (Candida albicans, Burkholderia cenocepacia, Francisella noatuensis), pneumonia (n = 4), and splenic abscess (n = 1). We document the first human infection with a fish pathogen, F. noatuensis, in a child with X-linked CGD. Although mortality was seen in 3 children who received only intravenous (IV) immunoglobulin therapy, the other 2 who received IV methylprednisolone pulse therapy survived. CONCLUSION HLH can be a presenting manifestation of CGD, and workup for CGD must be considered in children with HLH. Early recognition with optimal management of both infectious trigger and HLH is very important to prevent mortality.
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Affiliation(s)
- Pandiarajan Vignesh
- Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sathish Kumar Loganathan
- Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Murugan Sudhakar
- Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Himanshi Chaudhary
- Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aravind Shekar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim Vaiphei
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narender Kumar
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Man-Updesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anju Gupta
- Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kohsuke Imai
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Osamu Ohara
- Department of Applied Genomics, Kazusa DNA Research Institute, Kisarazu, Chiba, Japan
| | - Shigeaki Nonoyama
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yu Lung Lau
- Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | - Surjit Singh
- Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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31
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Liu HH, Ouyang LZ, Ge JY, Liu Q, Hu H, Chang XR, Liu ML. [Analysis of theoretical basis and clinical application of dog-days moxibustion]. Zhongguo Zhen Jiu 2020; 40:745-748. [PMID: 32648399 DOI: 10.13703/j.0255-2930.20200103-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The present situation of the clinical application of dog-days moxibustion (moxibustion applied in the three periods of the hot season) is summarized so as to provide the guide for the theoretic study and clinical application of dog-days moxibustion. The intervention time of dog-days moxibustion is on the 1st day of each of the three periods of the hot season. Simultaneously, the geographic factors are considered. The disorders of lung system are mostly dominant among the indications of dog-days moxibustion, complicated with spleen and stomach disorders as well as cold and deficiency syndromes/patterns. The acupoints are mainly selected from the front-mu points on the chest and the back-shu points on the back, in combination with the differentiation of diseases, symptoms/patterns and the disorder stages. The duration of treatment is ranged from 1 to 3 years. The clinical therapeutic effect is improved constantly along with the increase of treatment periods by years.
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Affiliation(s)
- Hong-Hua Liu
- Nursing School, Hunan University of CM, Changsha 410208, China
| | - Li-Zhi Ouyang
- School of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
| | - Jun-Yun Ge
- School of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
| | - Qiong Liu
- School of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
| | - Hui Hu
- First Affiliated Hospital of Hunan University of CM
| | - Xiao-Rong Chang
- School of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
| | - Mai-Lan Liu
- School of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
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32
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Sakamoto T, Takeda Y, Ohmura Y, Katsura Y, Imada A, Takase K, Toya K, Yukawa Y, Kawai K, Murakami K, Kagawa Y, Masuzawa T, Takeno A, Hata T, Murata K. [A Case of Epithelial Cyst Occurring in Intrapancreatic Accessory Spleen]. Gan To Kagaku Ryoho 2020; 47:673-675. [PMID: 32389980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although accessory spleens are often found in clinical practice, it is rare to identify cystic disease in an intrapancreatic accessory spleen. Here, we report a case of an epithelial cyst that occurred in the intrapancreatic accessory spleen. The patient was a 54-year-old male. Liver dysfunction was identified by the primary care doctor, and abdominal CT showed a tumorous lesion in the pancreatic tail. The patient was then referred to our hospital. Contrast-enhanced CT revealed a multilocular cystic lesion in the pancreatic tail. In endoscopic ultrasound, there was no obvious solid tumor in the cyst. A cystic disease such as serous cystic neoplasm(SCN)or mucinous cystic neoplasm(MCN)was suspected, and we performed a laparoscopic distal pancreatectomy. Postoperative pathological examination revealed an accessory spleen in the tail of the pancreas. The identified epithelial cyst was present in this accessory spleen. An epithelial cyst that occurs in the intrasplenic accessory spleen is a rare disease, but it is necessary to keep in mind as a possible differential diagnosis.
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33
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Uchino K, Ato F, Yamada S, Matsumura S, Kanasugi J, Nakamura A, Takasugi S, Horio T, Murakami S, Mizuno S, Yamamoto H, Watarai M, Hanamura I, Takami A. [Emergence of Howell-Jolly bodies in a patient with splenic hypoplasia complicated by fulminant pneumococcal infection]. Rinsho Ketsueki 2020; 61:318-321. [PMID: 32378573 DOI: 10.11406/rinketsu.61.318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report the case of a patient with fulminant pneumococcal infection along with the presence of Howell-Jolly bodies (HJBs) and splenic hypoplasia at the onset. A 71-year-old man developed fever during outpatient chemotherapy for IgG-κ multiple myeloma and was diagnosed with septic shock due to invasive pneumococcal infection. HJBs were observed on peripheral blood smears at this visit. Computed tomography revealed marked hypoplasia of spleen, suggesting the presence of hyposplenic function. Antibacterial therapy was initiated and the pneumococcal infection was cured; however, there was no notable change in his splenic hypoplasia. Splenic hypoplasia can be associated with fatal infections; hence, care should be taken when it is found in the elderly and in patients with cancer and those receiving immunosuppressive treatment. Even today, when automated hematology analyzers have become common, not all patients with hematological diseases have peripheral blood smears checked with a normal optical microscope. This study suggests that HJBs may be useful for simple and rapid screening of splenic hypofunction. The importance of detecting HJBs in peripheral blood smears with a normal optical microscope should be re-recognized.
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Affiliation(s)
- Kaori Uchino
- Department of Hematology, Aichi Medical University School of Medicine
| | - Fuminori Ato
- Postgraduate clinical training center, Aichi Medical University Hospital
| | - Saki Yamada
- Department of Hematology, Aichi Medical University School of Medicine
| | - Saori Matsumura
- Department of Hematology, Aichi Medical University School of Medicine
| | - Jo Kanasugi
- Department of Hematology, Aichi Medical University School of Medicine
| | - Ayano Nakamura
- Department of Hematology, Aichi Medical University School of Medicine
| | - Soichi Takasugi
- Department of Hematology, Aichi Medical University School of Medicine
| | - Tomohiro Horio
- Department of Hematology, Aichi Medical University School of Medicine
| | - Satsuki Murakami
- Department of Hematology, Aichi Medical University School of Medicine
| | - Shohei Mizuno
- Department of Hematology, Aichi Medical University School of Medicine
| | - Hidesuke Yamamoto
- Department of Hematology, Aichi Medical University School of Medicine
| | - Masaya Watarai
- Department of Hematology, Aichi Medical University School of Medicine
| | - Ichiro Hanamura
- Department of Hematology, Aichi Medical University School of Medicine
| | - Akiyoshi Takami
- Department of Hematology, Aichi Medical University School of Medicine
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34
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Kruger R, Freeman S. An unusual pelvic mass: Contrast-enhanced sonographic diagnosis of pelvic splenosis. J Clin Ultrasound 2019; 47:172-174. [PMID: 30443965 DOI: 10.1002/jcu.22671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
Splenosis is an unusual condition representing auto-transplantation of splenic tissue following splenic trauma or surgery. When detected on imaging studies, the splenosis deposits are usually misinterpreted as pathological masses. We present a case where a pelvic mass incidentally visualized on an MRI examination, was proven to represent a deposit of splenosis by contrast enhanced ultrasound (CEUS). CEUS demonstrated persistent late-phase enhancement characteristic of splenic tissue. Ultrasound practitioners should be aware of this condition when an unusual abdominal or pelvic mass is encountered in a patient with a history of splenic trauma or surgery. CEUS is ideally suited to confirming the diagnosis.
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Affiliation(s)
- Ross Kruger
- South West Peninsula Training Scheme, Peninsula Radiology Academy, Plymouth International Business Park, Plymouth, PL6 5WR, United Kingdom
| | - Simon Freeman
- Department of Radiology, Imaging Directorate, University Hospitals Plymouth NHS Trust, Derriford Road, Crownhill, Plymouth, Devon, PL6 8DH, United Kingdom
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35
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Delforge X, Buisson P. Reply to Letter to the Editor. J Pediatr Surg 2018; 53:1633. [PMID: 29680276 DOI: 10.1016/j.jpedsurg.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Xavier Delforge
- CHU Amiens Picardie, Chirurgie Pédiatrique Viscérale, Amiens cedex 1, 80054, France.
| | - Philippe Buisson
- CHU Amiens Picardie, Chirurgie Pédiatrique Viscérale, Amiens cedex 1, 80054, France
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36
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Rosenbaum MW, Cauley CE, Kulemann B, Liss AS, Castillo CFD, Warshaw AL, Lillemoe KD, Thayer SP, Pitman MB. Cytologic characteristics of circulating epithelioid cells in pancreatic disease. Cancer 2017; 125:332-340. [PMID: 28257167 PMCID: PMC5432380 DOI: 10.1002/cncy.21841] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Circulating epithelioid cells (CECs), also known as circulating tumor, circulating cancer, circulating epithelial, or circulating nonhematologic cells, are a prognostic factor in various malignancies that can be isolated via various protocols. In the current study, the authors analyzed the cytomorphologic characteristics of CECs isolated by size in a cohort of patients with benign and malignant pancreatic diseases to determine whether cytomorphological features could predict CEC origin. METHODS Blood samples were collected from 9 healthy controls and 171 patients with pancreatic disease who were presenting for surgical evaluation before treatment. Blood was processed with the ScreenCell size-based filtration device. Evaluable CECs were analyzed in a blinded fashion for cytomorphologic characteristics, including cellularity; nucleoli; nuclear size, irregularity, variability, and hyperchromasia; and nuclear-to-cytoplasmic ratio. Statistical differences between variables were analyzed via the Fisher exact test. RESULTS No CECs were identified among the 9 normal healthy controls. Of the 115 patients with CECs (positive or suspicious for), 25 had nonmalignant disease and 90 had malignancy. There were no significant differences in any of the cytologic criteria noted between groups divided by benign versus malignant, neoplastic versus nonneoplastic, or pancreatic ductal adenocarcinoma versus neuroendocrine tumor. CONCLUSIONS CECs were observed in patients with malignant and nonmalignant pancreatic disease, but not in healthy controls. There were no morphologic differences observed between cells from different pancreatic diseases, suggesting that numerous conditions may be associated with CECs in the circulation and that care must be taken not to overinterpret cells identified by cytomorphology as indicative of circulating tumor cells of pancreatic cancer. Additional studies are required to determine the origin and clinical significance of these cells. Cancer Cytopathol 2017;125:332-340. © 2017 American Cancer Society.
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MESH Headings
- Adenocarcinoma/blood
- Adenocarcinoma/pathology
- Adenoma/blood
- Adenoma/pathology
- Ampulla of Vater/pathology
- Bile Duct Neoplasms/blood
- Bile Duct Neoplasms/pathology
- Carcinoma, Acinar Cell/blood
- Carcinoma, Acinar Cell/pathology
- Carcinoma, Pancreatic Ductal/blood
- Carcinoma, Pancreatic Ductal/pathology
- Case-Control Studies
- Cholangiocarcinoma/blood
- Cholangiocarcinoma/pathology
- Common Bile Duct Neoplasms/blood
- Common Bile Duct Neoplasms/pathology
- Cystadenoma, Serous/blood
- Cystadenoma, Serous/pathology
- Epidermal Cyst
- Humans
- Neoplasms, Cystic, Mucinous, and Serous/blood
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplastic Cells, Circulating/pathology
- Neuroendocrine Tumors/blood
- Neuroendocrine Tumors/pathology
- Pancreatic Diseases/blood
- Pancreatic Diseases/pathology
- Pancreatic Neoplasms/blood
- Pancreatic Neoplasms/pathology
- Pancreatitis, Chronic/blood
- Pancreatitis, Chronic/pathology
- Prognosis
- Splenic Diseases
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Affiliation(s)
- Matthew W Rosenbaum
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Birte Kulemann
- Department of Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Andrew S Liss
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah P Thayer
- Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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37
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Hayashi TY, Matsuda I, Hagiwara K, Takayanagi T, Hagiwara A. Massive splenic infarction and splenic venous thrombosis observed in a patient with acute splenic syndrome of sickle cell traits on contrast-enhanced thin-slice computed tomography. Abdom Radiol (NY) 2016; 41:1718-21. [PMID: 27251735 DOI: 10.1007/s00261-016-0786-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a case of splenic infarction in a patient with sickle cell traits (SCT), focusing on the computed tomography (CT) findings. The patient was an African-American man in his twenties with no past medical history who experienced sudden left upper quadrant pain while climbing a mountain (over 3000 m above sea level). Dynamic contrast-enhanced CT revealed massive non-segmental splenic infarction accompanied with nodule-like preserved splenic tissue. The region of splenic infarction did not coincide with the arterial vascular territory and differed from the features of infarction caused by large arterial embolism. In addition, thrombotic occlusion of the distal splenic vein was depicted on plain and contrast-enhanced thin-slice CT images. Early-phase contrast-enhanced images also showed inhomogeneous enhancement of the hepatic parenchyma. The patient's symptoms improved with conservative therapy. A hemoglobin electrophoresis test confirmed the diagnosis of SCT. SCT is usually asymptomatic, but hypoxic environments may induce acute splenic syndrome, which is commonly manifested as splenic infarction. We observed splenic venous thrombosis and inhomogeneous hepatic parenchymal enhancement in addition to a huge splenic infarction in our patient. To the best of our knowledge, this is the first report describing the specific imaging findings, particularly splenic venous thrombosis and inhomogeneous hepatic parenchymal enhancement, of acute splenic syndrome in a patient with previously undiagnosed SCT. These findings demonstrate the pathophysiology of SCT, and may help with the diagnosis of this disease.
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Affiliation(s)
- Takana Yamakawa Hayashi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Izuru Matsuda
- Department of Diagnostic Radiology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan
| | - Kazuchika Hagiwara
- Department of Diagnostic Radiology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan
| | - Tomoko Takayanagi
- Department of Radiology, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-ku, Tokyo, 179-0072, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Cai Y, Yang S, Sun R, Li X. [Splenic hamartoma: report of a case]. Zhonghua Bing Li Xue Za Zhi 2014; 43:837-838. [PMID: 25623983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Cartanese C, Carbotta G, Di Candia L, De Marini F, Girau A, Zocchi G. A rare case of colon cancer with splenic abscess. Ann Ital Chir 2013; 84:201-204. [PMID: 22615043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cancer of the colon does not always present with the familiar symptoms. Perforation and penetration of adjacent organs, with abscess formation as the initial presentation, is uncommon. Splenic abscess is a rare clinical entity. The four causes of a splenic abscess described are: primary pyogenic infection, splenic trauma, hemoglobinopathies and contiguous disease. In this paper we report a case of splenic abscess from colon cancer in an 50-year-old man who had a left lower chest contusion two-week before and review pertinent literature. Only 11 reported cases of splenic abscess from colorectal cancer were found in Medline.
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Yew KL, Ng TH, How SH, Kuan YC. The bug and the big heart --melioidotic pericardial effusion. Med J Malaysia 2011; 66:71-72. [PMID: 23765151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Melioidosis is an infection caused by Gram negative bacterium Burkholderia pseudomallei leading to abscesses in lungs, liver, spleen, musculoskeletal system, prostate and sepsis. We present a rare case of purulent pericardial effusion caused by melioidosis with concomitant pneumonia and splenic abscesses. The patient underwent pericardiocentesis and successfully recovered from cardiogenic and septic shock.
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Affiliation(s)
- K L Yew
- Hospital Umum Sarawak, Jalan Tun Ahmad Zaidi Adruce, 93586, Kuching, Sarawak, Malaysia.
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Centers for Disease Control and Prevention (CDC). Updated recommendation from the Advisory Committee on Immunization Practices (ACIP) for revaccination of persons at prolonged increased risk for meningococcal disease. MMWR Morb Mortal Wkly Rep 2009; 58:1042-3. [PMID: 19779400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The Advisory Committee on Immunization Practices (ACIP) recommends quadrivalent meningococcal conjugate vaccine, (MCV4) (Menactra, Sanofi Pasteur, Swiftwater, Pennsylvania) for all persons aged 11-18 years and for persons aged 2-55 years at increased risk for meningococcal disease. MCV4 is licensed as a single dose. Because of the high risk for meningococcal disease among certain groups and limited data on duration of protection, at its June 2009 meeting ACIP recommended that persons previously vaccinated with either MCV4 or MPSV4 (Menomune, Sanofi Pasteur) who are at prolonged increased risk for meningococcal disease should be revaccinated with MCV4. Persons who previously were vaccinated at age >or=7 years and are at prolonged increased risk should be revaccinated 5 years after their previous meningococcal vaccine, and persons who previously were vaccinated at ages 2-6 years and are at prolonged increased risk should be revaccinated 3 years after their previous meningococcal vaccine. Persons at prolonged increased risk for meningococcal disease include 1) persons with increased susceptibility such as persistent complement component deficiencies (e.g., C3, properdin, Factor D, and late complement component deficiencies), 2) persons with anatomic or functional asplenia, and 3) persons who have prolonged exposure (e.g., microbiologists routinely working with Neisseria meningitidis, or travelers to or residents of countries where meningococcal disease is hyperendemic or epidemic). This report provides the rationale for the new recommendation and updates and replaces previous recommendations for revaccination with MCV4.
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Lindner A, Kutkam T, Lindner F. Granuloma formation induced by lipid extracts of pine pollen. Acta Med Scand Suppl 2009; 425:51-6. [PMID: 5884518 DOI: 10.1111/j.0954-6820.1964.tb05697.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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PONTONI L. Some Clinical Aspects of Hyposplenism. Acta Medica Scandinavica 2009; 141:262-4. [PMID: 14923249 DOI: 10.1111/j.0954-6820.1952.tb14218.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vajda M, Drávucz S, Török M, Cesko I. Pregnancy and delivery of a patient with Ivemark syndrome (with polysplenia). Eur J Obstet Gynecol Reprod Biol 2007; 140:129-31. [PMID: 17555862 DOI: 10.1016/j.ejogrb.2007.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 03/14/2007] [Accepted: 03/23/2007] [Indexed: 10/23/2022]
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