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At least 577 records · Page 32Linked to original sources

Louse-borne relapsing fever in the Sudan. A historical review and a clinico-pathological study.

A small outbreak of louse-borne relapsing fever in Khartoum (May-June 1974) provided material for a clinico-pathological study. The history of the disease in the Sudan is reviewed and the clinical and laboratory findings in 32 patients are presented. Fever, headache, jaundice, epistaxis and hepatosplenomegaly were the commonest clinical findings; thrombocytopenia was detected in 93% of cases. Although elevated levels of fibrin degradation products were found in most patients, disseminated intravascular coagulation could not be diagnosed. Hepatocellular derangement was found in 68% of cases, while 78% had high blood urea. In five autopsied bodies there was bronchopneumonia, interstitial edema with focal myocardial fibrosis, hepatic necrosis, splenic infarcts, increase in size and cellularity of the glomeruli and brain edema and congestion. Intracranial haemorrhage was found in three of the autopsied cases.

Female↗

[A case of infective endocarditis with subtotal rupture of the posterior papillary muscle].

We recently experienced a case of infective endocarditis with multiple embolic complications. The patient was a 21-year-old male who was admitted to our hospital with high fever and dyspnea. Echocardiography showed vegetation on the aortic valve, severe aortic regurgitation and mild mitral regurgitation. Abdominal echography revealed large splenic infarction. First we performed aortic valve replacement and splenectomy. But infective endocarditis developed after surgery, and echocardiography revealed severe mitral regurgitation, which has been a change for the worse. After treatment with antibiotics, mitral valve replacement (the second surgery) was performed. Intraoperative findings were confirmative of subtotal rupture of the posterior papillary muscle. Histological examination of the subtotal ruptured muscle revealed presence of coagulation necrosis. The patient is healthy without recurrence of infective endocarditis after the second surgery. It is exceedingly rare to experience a case of surgically treated subtotal papillary muscle rupture due to infective endocarditis.

Adult↗

[Focal lesions of the spleen: contribution of magnetic resonance imaging].

MR findings in the study of focal splenic pathology are discussed in this paper. MR examination of the spleen shows some technical limits in the diagnosis of masses affecting this organ. On the contrary, the introduction of new paramagnetic contrast agents, with organospecific affinity, will no doubt improve the diagnostic power of MR imaging, in order to gain more information about these diseases.

Cysts↗

Hyaline splenic and hepatic plaques. Correlation with cirrhosis, pulmonary tuberculosis, and asbestos exposure.

Nine hundred twenty-five unselected autopsies were investigated for the presence or absence of hyaline peritoneal (splenic or hepatic) plaques, hyaline pleural plaques, asbestos, liver cirrhosis, heart failure, previous peritoneal dialysis or abdominal surgery, chronic peritonitis, splenomegaly, splenic infarcts, and pulmonary or abdominal tuberculosis. Lung asbestos body concentrations were calculated in 570 subjects. Peritoneal plaques were recorded in 163 cases. In both univariate and multivariate analyses, they were associated with cirrhosis, pulmonary nonactive tuberculosis, pleural plaques, and asbestosis. Association with asbestos body counts was also found, with a significant trend. Peritoneal plaques were described long ago in different pathologic conditions, for some of which (cirrhosis and nonactive pulmonary tuberculosis) the association is confirmed by the present analysis. It is suggested that they are significantly associated, moreover, with indicators of asbestos exposure.

Adult↗

Chemoembolization for hepatocellular carcinoma via the inferior pancreaticoduodenal artery in patients with celiac artery stenosis.

Twenty-one patients with hepatocellular carcinoma (HCC) accompanied by extensive celiac artery stenosis or obstruction were treated by chemoembolization via the inferior pancreaticoduodenal artery (IPDA). The tip of the catheter was placed in the arteries in front of the confluence with the proper hepatic artery in 12 patients (group A: the proximal portion of the IPDA in 10, and common hepatic artery in 2), and in the proper hepatic artery or branches of it (group B) in 9 using a coaxial catheter system. Transient hyperamylasemia was observed in 10 of the 12 patients in group A and in 3 of the 9 patients in group B after chemoembolization. Splenic infarction developed in 8 patients in group A and in none in group B. Intrapancreatic fluid collection was present in 2 patients in group A following chemoembolization. No fatal complications were encountered. The 1-, 2-, and 3-year survival rates of the 10 patients in group A treated by only chemoembolization were 90, 57, and 23%, respectively (mean survival 780 days). The 1- and 2-year survival rates of 9 patients in group B were 85.8 and 85.8% (mean 879 days), respectively. Considering the severity of complications and the survival rates in groups A and B, chemoembolization by superselective catheterization into the hepatic artery via the IPDA is the treatment of choice. However, chemoembolization from the arteries in front of the confluence with the proper hepatic artery seems to be acceptable in cases of hypervascular HCC which fail to be superselectively catheterized.

Adult↗

Experimental reproduction of endocarditis with Pasteurella gallinarum in mature leghorn chickens.

The pathogenicity of Pasteurella gallinarum for mature leghorn chickens was investigated by inoculating thirty 52-week-old chickens intravenously with live P. gallinarum. Each chicken was inoculated once daily for 5 days at one of three different dosage levels with either the type strain ATCC 13361 or a field isolate from a chicken with endocarditis. Chickens were necropsied after death or euthanasia. Valvular endocarditis was present in seven chickens given the field isolate and five chickens given the type strain. Other lesions detected were myocarditis, hepatic and splenic infarcts, nephritis, pneumonia, and encephalitis. At necropsy, P. gallinarum was reisolated from hearts, livers, spleens, lungs, kidneys, and blood. Controls injected with sterile broth had no lesions of endocarditis, nor was P. gallinarum isolated from them. The results confirm the pathogenicity of P. gallinarum for the heart valves of mature chickens.

Animals↗

Splenic emergencies.

Of medical and surgical emergencies in the pediatric abdomen, those involving the spleen are relatively less common than other abdominal organs, though equally important to recognize. A more sophisticated clinical understanding of the important role of the spleen in immunocompetence has developed in parallel with advancements in imaging. A healthy respect for the preservation of splenic tissue has emerged, altering traditional surgical management of splenic emergencies. Non-invasive imaging has come to play a vital role in depicting acute abnormalities and in determining the need for conservative, interventional, or surgical management.

Adolescent↗

Massive extra-enteric gastrointestinal hemorrhage secondary to splanchnic artery aneurysms.

BACKGROUND/AIMS: Gastrointestinal hemorrhages of obscure origin are often difficult to diagnose and manage. Of these, splanchnic artery aneurysms have emerged as an important disorder because of the increasing prevalence and formidable mortality rate associated with their rupture. We herein evaluated extra-enteric gastrointestinal bleeding related to these ruptured aneurysms. METHODOLOGY: The medical records of 17 patients with splanchnic artery aneurysms known to be exclusively manifested as gastrointestinal bleeding were reviewed. The pathogenesis, clinical picture, diagnostic tests, management, complications, and outcomes were compiled and analyzed. RESULTS: Of the seventeen patients, 12 patients had true aneurysms; 5 patients had false aneurysms. Pancreatitis, trauma, iatrogenic hepatobiliary injury, and atherosclerosis were the four major etiologies. The sensitivity rates measured by endoscopy, ultrasonography, computed tomography and visceral angiography were 20%, 50%, 67%, and 100%, respectively. An exact diagnosis was attained in 94% of the patients at the time of management. Transcatheter embolization was employed in 7 patients, complicated with hepatic and splenic infarcts, and pyogenic liver abscesses in 2 instances. Two patients had recurrent bleeding aneurysms post embolotherapy. Ten patients underwent surgical intervention which resulted in 2 cases of hepatic failure. One out of 5 patients with a true aneurysm died, while 4 out of 12 patients with false aneurysms eventually died. Overall, the mortality rate was 29%. CONCLUSION: Even though the exact diagnosis can be made in most of the patients by modern imaging studies, the mortality rate was still formidable, especially in patients with false aneurysms, in whom the underlying causal diseases substantially influenced the major outcome.

Adult↗

[Hanseniasis virchowiana in Chagas cardiopathy: an autopsy report].

This is a case report of lepromatous infection diagnosed at necropsy, with cardiac alterations directly caused by mycobacteria, in a 34-year-old black male with the cardiac form of Chagas' disease. The possible role of inflammatory mediators on cardiac dysfunction, and the possibility that immune depression may be due to factors associated with heart failure, as congestive splenomegaly and splenic infarctions, are emphasized.

Adult↗

Radiologic diagnosis of wandering spleen complicated by splenic volvulus and infarction.

Wandering spleen is a rare condition caused by malattachment of the dorsal mesogastrium. This condition is prone to torsion of the splenic pedicle leading to splenomegaly, hypersplenism, and infarction. Preoperative diagnosis can be suggested radiologically. A case of wandering spleen is reported and its embryologic, clinical, and radiographic features are discussed.

Adult↗

Sonography after splenic embolization: the wedge-shaped acute infarct.

After undergoing therapeutic transcatheter embolization of the splenic artery for treatment of portal hypertension, 11 consecutive patients were evaluated with sulfur colloid scintigraphy and real-time sonography of the left upper quadrant to determine which method was better for follow-up evaluation of the spleen. Six splenic infarcts were documented by both imaging methods; sonography, however, demonstrated the characteristic wedge shape of the infarct in four of the six cases. There were no cases of splenic abscess formation. Sonography should be the primary method for evaluation of the spleen after transcatheter embolization and can help in planning treatment to avoid abscess formation.

Abscess↗

Imaging of the spleen: CT with supplemental MR examination.

Splenic lesions tend to be small or infiltrating and vary in size and configuration, making detection difficult, particularly without use of an organ-specific contrast agent. The authors present a series of selected cases to show the value of computed tomography (CT) and magnetic resonance (MR) imaging in depiction of splenic disease. Six major categories are presented: (a) inflammatory disease, (b) splenic cysts, (c) infarction, (d) nonneoplastic and noninfectious diffuse splenic disease, (e) benign tumors, and (f) malignant tumors. CT attenuation of splenic tissue is homogeneous, typically measuring 40-60 HU on non-contrast material-enhanced scans. Splenic attenuation is normally 5-10 HU less than that of liver, a standard of reference used in evaluation of either hepatic or splenic disease. On T1-weighted MR images, the normal signal intensity of the spleen is less than that of hepatic tissue and slightly greater than that of muscle. On T2-weighted images, the spleen shows higher signal intensity, appearing brighter than the liver. CT is currently the choice for evaluation of the spleen; however, MR imaging may be increasingly used as newer pulse sequences and organ-specific contrast agents are developed.

Abscess↗