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PubMedDate not supplied

Particle embolization for hepatocellular carcinoma.

PURPOSE: To evaluate the outcome of all patients undergoing particle embolization for hepatocellular carcinoma at a single institution from January 1, 1993, through December 31, 1995. MATERIALS AND METHODS: The charts and radiographs of all patients undergoing particle embolization during the study period were reviewed. The following information was collected: patient demographics, Child class and Okuda stage, number of embolization treatment sessions, length of hospital stay, complications related to the embolization procedure, including postembolization syndrome, current patient status, and date of death. RESULTS: Forty-six patients underwent 86 embolization sessions during the study period. Postembolization syndrome developed after 70 of the 86 sessions (81%); in four cases (4.6%) this required treatment that extended the patient's hospital stay. Three other complications occurred (3.5%), including a splenic infarct and two episodes of transient hepatic failure, all treated supportively. There was one death within 30 days, but it was not directly attributable to embolotherapy. Follow-up was available for all of the patients who underwent treatment. Thirty-four patients were classified as Child class A, and 12 were classified as Child class B. Thirty patients were classified as Okuda stage I, 14 were classified as Okuda stage II, and two were classified as Okuda stage III. Overall actuarial survival was 50% at 1 year and 33% at 2 years. There was a statistically significant difference in survival between Okuda stage I and stage II patients, but not between Child class A and class B patients. CONCLUSION: Particle embolization for hepatocellular carcinoma is well tolerated and demonstrates actuarial survival of 50% at 1 year and 33% at 2 years.

Carcinoma, Hepatocellular↗
PubMed2000

Characterization of lesions caused by a South American virulent isolate ('Quillota') of the hog cholera virus.

In this study, macroscopic and histopathological lesions produced by a virulent South American isolate ('Quillota') of hog cholera virus were studied. The virus was inoculated in doses of 10(5)TCID50 in each of 35 pigs of 20 kg live weight. The animals were slaughtered from 4 to 18 days post-inoculation. The presence of virus antigens in lymphatic tissue was confirmed by both direct immunofluorescence and Avidin-Biotin-Peroxidase techniques in formalin-embedded tissue samples. Histological sections were stained with haematoxylin-eosin and Mallory's phosphotungstic acid haematoxylin methods. The 'Quillota' isolate used in this study caused a disease characterized by vascular lesions (splenic infarcts, haemorrhages in the lymph nodes and the urinary system and disseminated microthrombosis), and necrosis of lymphocytes, particularly in the B-areas of the lymphoid organs, lesions that are characteristic of the acute form of the disease. Other lesions observed were a non-purulent meningoencephalitis, the necrosis of the epithelial cells of tonsils, the presence of fibrin nets in the red pulp and a marked thickening of the alveolar septa.

Animals↗
PubMed2002

[Ultrasound of non traumatic acute abdomen: extra-digestive causes].

In recent years, management of abdominal pain in emergency care units (ECU) has undergone a radical change. Chronic work overload of ECU and increase in severity and complexity of cases required an optimal medical imaging method, such as ultrasound, to establish an accurate diagnosis as quickly as possible. A great variety of causes may cause acute abdominal pain and the role of sonography is to accurately distinguish between these aetiologies. For the application of sonography, perhaps more so than with other imaging methods, a perfect knowledge of sonographical characteristics and technical possibilities is essential to achieve an optimal answer. The purpose of this review is to present and discuss the sonographic characteristics of extra-digestive causes of acute abdominal pain such as splenic infarction, thoracic pathologies, urinary and gynaecologic diseases or retroperitoneal pathologies.

Abdomen, Acute↗
PubMed2003

[Functional asplenia after severe varicella zoster-infection diagnosis by colour Doppler ultrasound].

Infiltrative, inflammatory or thromboembolic processes in the parenchyma of the spleen can cause a functional loss of the organ. This phenomenon is called functional asplenia and occurs as a complication especially in sickle cell disease, lupus erythematosus and after bone marrow transplantation. We present the case of a patient with Crohn's disease under immunosuppressive therapy who developed a spontaneous covered spleen rupture in the course of a septic shock with DIG due to a Varizella zoster infection. Later on, sonography showed a diminution of the spleen size. No flow signals could be derived by colour doppler measurements from the spleen. Because of the colour doppler findings we suspected a functional asplenia which was then verified by spleen scintigraphy and Howell-Jolly-Bodies in the blood count. Remarkably, the Crohn's disease remains in complete remission since the development of the functional asplenia (for 4 years now). The underlying pathomechanism remains unclear.

Adult↗
PubMed1995

Two unusual cases of wandering spleen requiring splenectomy.

The occurrence of wandering spleen is rarely referred to in the pediatric surgical literature. We treated two unusual cases with this anomaly. The first case had an acute abdominal problem associated to a wandering spleen and a diaphragmatic eventration. Splenectomy was performed because of splenic infarction. In the second case the wandering spleen was associated with gastric bleeding due to left-sided portal hypertension, and splenectomy was inevitable.

Abdomen, Acute↗
PubMed2004

Intermittent hepatic artery antibiotic infusion therapy for pyogenic hepatic abscess.

PURPOSE: To study the efficacy and problems associated with intermittent hepatic artery antibiotic infusion therapy for pyogenic hepatic abscess. MATERIAL AND METHODS: The material comprised eight patients with pyogenic hepatic abscess in whom percutaneous drainage could not be performed and intravenous administration of antibiotics was ineffective. An injection catheter was introduced into the common hepatic artery. Almost the same dose of antibiotics as with intravenous administration was infused intra-arterially 2-4 times per day. RESULTS: A therapeutic effect was achieved in six of the eight cases. In these 6 cases, the mean period of intra-arterial infusion was 10.8 days, while the mean period of catheter placement was 14.7 days. Using broad spectrum antibiotics, the therapeutic effect was obtained regardless of the numbers, morphologic characteristics, and differences in location of the abscesses. No significant complications were noted except in one case of splenic infarction. CONCLUSION: Intermittent hepatic artery antibiotic infusion therapy is useful as an alternative therapeutic procedure for pyogenic hepatic abscess in which percutaneous drainage cannot be performed and intravenous administration of antibiotics is ineffective.

Aged↗
PubMed2003

An extreme consequence of splenectomy in dehydrated hereditary stomatocytosis: gradual thrombo-embolic pulmonary hypertension and lung-heart transplantation.

Dehydrated hereditary stomatocytosis (DHS) belongs to the heterogeneous class of hemolytic anemias with leaky red cell membranes. Splenectomy is a highly deleterious treatment, because it favors, with virtually no exception, the occurrence of thromboembolic disease. We describe here the extreme case of a patient with DHS and an associated sickle cell trait. Splenectomy was carried out due to a splenic infarction that occurred during an airplane journey. About 12 years later, the patient noticed an exertional dyspnea, which gradually worsened to such a degree that she became severely incapacitated within 5 years. Eventually, the patient developed a cor pulmonale associated with chronic thromboembolic pulmonary hypertension (CTEPH) and successfully underwent a heart-lung transplant operation. This case ranks as one of the most severe examples ever recorded of the effect that splenectomy may have in DHS patients. Nonetheless, it represents the first case to receive a heart-lung transplant.

Adult↗
PubMed1980

The incidence and causes of death in a follow-up study of individuals with haemoglobin AS and AA.

A cohort of 574 black Adults (mean age 47 years with a range of 28-73 years) with sickle cell trait (haemoglobin AS) which had been age and sex matched with 1148 controls (haemoglobin AA) was monitored for 7 years. We found no evidence of excess mortality or differential causes of mortality between cases and controls. There were no case deaths related to kidney disease, splenic infarcts, or pregnancy. Reports in the literature have been inconsistent with regard to the health effects of sickle cell trait. These findings suggest that discrimination against trait carriers in terms of life insurance premiums and some job opportunities are unjustified.

Adolescent↗
PubMed2000

Hepatic ischemia as a complication after correction of post-traumatic gibbus at the thoracolumbar junction.

STUDY DESIGN: This is a case report of hepatic ischemia secondary to celiac trunk stenosis as a complication after correction of a preoperative 30 degrees gibbus at the thoracolumbar junction. OBJECTIVES: A high index of suspicion is needed to make a timely diagnosis of hepatic ischemia in any setting. After spinal reconstruction involving lengthening, symptoms suggestive of an acute abdomen accompanied by markedly elevated liver enzymes should be evaluated with an angiogram to check for celiac trunk stenosis. SUMMARY OF BACKGROUND DATA: Review of the literature showed no reported cases of hepatic ischemia or descriptions of the status of celiac trunk stenosis after spinal surgery. Even in more commonly associated settings, diagnosis of both phenomena is often delayed, with possible morbid consequences. METHODS: A case is presented of a patient who underwent gibbus correction and re-establishment of lost anterior intervertebral distance at the thoracolumbar junction. After surgery, ischemic hepatitis, a perforated gallbladder, and splenic infarction developed secondary to celiac trunk stenosis-a result of cephalad displacement of the celiac trunk and compression of the artery by the diaphragmatic ligament. RESULTS: An emergent exploratory laparotomy with cholecystectomy was performed followed by an angiogram, which demonstrated stenosis of the celiac trunk. After release of the arcuate ligament, the patient's condition improved rapidly, and he made a complete recovery. CONCLUSIONS: The consequences of a delay in diagnosis of hepatic ischemia can be disastrous. An awareness of the possibility of this complication after spinal lengthening should facilitate a timely angiogram and operative intervention.

Adult↗
PubMed2006

Spontaneous coeliac artery dissection.

A patient with spontaneous coeliac artery dissection that presented as upper abdominal pain is reported. This was diagnosed on contrast-enhanced multislice helical CT. The patient was treated conservatively and follow-up CT showed mild aneurysmal change of the splenic artery and a small splenic infarct. Isolated dissection of the visceral arteries (and, in particular, the coeliac artery) is extremely rare. With such limited evidence, decisions over best management are difficult, but depend on initial severity and progression at follow up.

Aortic Dissection↗
PubMed2005

Protracted pain following partial splenic embolization in an adolescent female with hypersplenism.

A 17-year-old female with massive splenomegaly underwent partial splenic embolization (PSE) for hypersplenism. The postoperative course was characterized by recurrent painful splenic infarctions requiring hydromorphone PCA for an extended period resulting in an unanticipated, prolonged hospital stay. Massive splenomegaly treated with PSE may require an extended hospital stay to achieve pain control. Such patients may subsequently require transition to enteral opioids and weaning.

Adolescent↗
PubMed1998

Endocarditis and aortal embolization caused by Aspergillus terreus in a patient with acute lymphoblastic leukemia in remission: diagnosis by peripheral-blood culture.

Disseminated infection with Aspergillus terreus is a rare disease that affects only the immunocompromised host. We report a case of systemic infection with A. terreus resulting in endocarditis, aortic embolization, and splenic infarction in a patient with acute lymphoblastic leukemia. Diagnosis through peripheral blood culture, lack of pulmonary involvement, and onset of disease during complete remission from leukemia constitute uncommon features of this case.

Aorta, Abdominal↗
PubMed1991

Hypercoagulability in a patient with Marfan syndrome.

A 39 year old man with Marfan syndrome presented with multiple pulmonary emboli and renal, hepatic, and splenic infarcts of unknown aetiology. The combination of thromboemboli and physical features initially suggested homocystinuria; however, laboratory examination showed no evidence for this disorder. Laboratory evaluation identified no coagulation abnormalities. This patient represents the unusual occurrence of hypercoagulability in a patient with Marfan syndrome.

Adult↗
PubMed1977

Visualization of the spleen with a bone-seeking radionuclide in a child with sickle-cell anemia.

99mTc-methylene diphosphonate, a bone-seeking radionuclide, accumulated in the spleen of a 16-year-old boy with sickle-cell anemia even though no splenic calcification was visible. This may be explained by the presence of microscopic calcium deposits in the spleen, which form at an early age in this disease. Bone-seeking radionuclides may accumulate in regions of recent splenic infarction, as has been demonstrated in cerebral and myocardial infarction. Such radionuclides may be the only means of demonstrating the spleen in such patients.

Adolescent↗