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PubMed2005

Ischemic enterocolitis examined by colonoscopy and selective angiography.

AIM: To study the value of colonoscopy and selective angiography in diagnosing ischemic enterocolitis. METHODS: Among the 16 cases under study, 10 cases had hypertension and a history of coronary artery disease (one was hospitalized for sub-ventricular-wall infarction). The blood pressure of 10 of the 16 cases ranged from 13.9-23.8 to 13.3-14.6 kPa (170-180/100-110 mmHg). Two cases had chronic auricular fibrillation, and in four cases, a cardiogram showed left-front branch conduction block. Sixteen patients were examined by colonoscopy. Among them, 14 cases had a long course of angiocardiac disease, and were further examined by selective mesenteric inferior angiography. RESULTS: The colonoscopy revealed local mucous hyperemia edema and blood on contact. Lesions were found in the sigmoid colon in four cases, in the descending colon in eight cases and in splenic flexure in four cases, which suggests that the lesion always appeared in the left part of colon. There were different degrees of inflammatory cell infiltration, submucous bleeding, edema, fibro-embolism and hemosiderosis by biopsy in the 16 patients whose membranes affect part of the enteral wall. Of the 14 patients examined by mesenteric inferior angiography, 3 cases showed mesenteric amphraxis inferior and formation of collateral circulation. There were different degrees of stenosis in the other 11 subjects' mesenteric inferior cavities which grew slim and their branches were stenotic, so the radiographic image was not complete and the ends of some branches even cannot be seen. CONCLUSION: The colonoscopy and the selective mesenteric inferior angiography are both helpful in the diagnosis of ischemic enterocolitis.

Aged↗
PubMed1986

Clinical presentation of sickle cell-hemoglobin C disease.

Early symptoms were observed in a representative sample of 166 children with sickle cell-hemoglobin C disease diagnosed at birth. Symptoms were uncommon in the first year of life; in approximately 50% specific symptoms had developed by 5 years, but 22% remained without specific symptoms to 10 years. The age at presentation was significantly earlier in patients with low hemoglobin F levels, but was not influenced by heterozygous alpha-thalassemia-2. Painful crisis was the initial manifestation in 77% of the children; other symptoms included dactylitis (14%) and pneumococcal septicemia and acute splenic sequestration (4% each). The commonest nonspecific symptom was acute chest syndrome. The relatively mild early clinical course of sickle cell-hemoglobin C disease indicates that neonatal diagnosis does not have the same urgency as for homozygous sickle cell disease.

Acute Disease↗
PubMed1977

Occurrence of amyloidosis secondary to the induction of experimental hypertension in mice.

Following the induction of three different forms of experimental hypertension, deposits of amyloid were found in the spleens of 5-20 per cent of the mice late in the course of the hypertension, Amyloidosis was found in nude (with genetical aplasia of the thymus) as well as in haired (normal) mice. The highest frequency of amyloidosis was observed in mice with hypertension due to partial infarction of one kidney and contralateral nephrectomy. The hypertensive vascular disease, involving lesion of the vessels and of the organs supplied by the affected vessels, is believed, to represent a stimulus for the reticulo endothelial system (RES) with development of amyloidosis as a secondary event.

Amyloidosis↗
PubMed1992

Stroke in a cohort of patients with homozygous sickle cell disease.

Strokes occurred in 17 of 310 children with homozygous sickle cell disease who were followed from birth, representing an incidence of 7.8% by the age of 14 years. Two children had subarachnoid hemorrhage, one having resolution of symptoms after aneurysm surgery and another dying of a presumed second hemorrhage 14 days later. The remaining 15 strokes were presumed to be cerebral infarction, although autopsy, angiographic, or computed tomographic evidence was available in only 8 children. There were 6 deaths, 2 in the acute event and 4 after recurrence, which occurred in 6 (46%) of 13 patients who survived the initial episode. There were 10 recurrent episodes at a median interval of 9 months after the initial event. Steady-state hematologic data revealed significantly higher leukocyte counts than in control subjects without strokes at age 1 year and in the last study preceding the stroke. The initial stroke coincided with an acutely lowered hemoglobin value in 5 patients (3 aplastic crises, 1 acute splenic sequestration, 1 probable pulmonary sequestration) and with painful crises in another 7 patients. We conclude that a high leukocyte count and an acute decrease of hemoglobin are risk factors for stroke in patients with homozygous sickle cell disease.

Adolescent↗
PubMed2005

Visceral botryomycosis in a case of Erysipelothrix rhusiopathiae endocarditis.

Botryomycosis is a rare bacterial infection of the skin and, rarely, viscera that is characterized by the formation of characteristic hyaline grains. We encountered a patient with Erysipelothrix rhusiopathiae endocarditis who developed visceral botryomycosis. He was a 54-year-old black man who presented in sepsis with a history of progressive weakness and severe weight loss. He died 10 hours after admission. At autopsy, endocarditis was identified, along with infarcts of the spleen and kidneys. Microscopically, visceral botryomycosis was seen. With these bacteria, an animal source is usually identified, although one was not found in this man. Erysipelothrix rhusiopathiae is an organism that is becoming identified in a range of infections in humans, the manifestations and pathophysiology of which are still being discovered.

Endocarditis, Bacterial↗
PubMed1985

Dual radionuclide subtraction imaging of the spleen.

Dual radionuclide subtraction imaging of the spleen using 67Ga citrate and 99mTc is useful in further delineating lesions that are identified on either a routine radiogallium survey or on a conventional sulfur colloid liver-spleen image. Better anatomic localization of left subphrenic abscesses may be obtained. Differentiation of tumors and abscesses from less serious lesions such as cysts, infarcts, and hematomas is possible. We have found this technique to be generally applicable to any organ that can be selectively imaged using a technetium radiopharmaceutical, including the liver, bones, and kidneys. In addition, we are currently evaluating thallium-pertechnetate subtraction imaging in the evaluation of parathyroid adenomata.

Aged↗
PubMedDate not supplied

[Uncommon etiology of acute abdomen in pediatric age: the torsion of spleen].

The torsion of spleen on its vascular shank represents an uncommon problem, responsible of acute and chronic pain. The mobile spleen is fixed only through hilus vessels the gastrosplenic ligament. The incidence is unknow, greater in the male with an M:F ratio 6.1 in the first ten years of life, even if an episode of intrauterine torsion has been reported. The diagnosis can be performed with ultrasonography, angiography, scintigraphy and CT scan. There are reported two cases: male of 2.5 years female of 14 years who presented with recurrent pain to the left side, vomit diarrhoea and fever. Objectively a palpable mass was present. Ultrasonography and angio-CT scan of abdomen revealed splenomegaly, ptosis of the spleen and malrotation with signs of obstruction of the vessels. The treatment in both cases was splenectomy. The spleen appeared rotated on its shank and increased of volume, deprived of anatomical structures of fixation. The histological report confirmed the haemorrhagic infarction. The excessive mobility of the spleen, from insufficiency or absence of the ligamentous attachments is case of abdominal pain or acute abdomen, that can complicate with the infarction of the spleen. Angio-CT scan, in the cases here reported, has shown to greater sensibility in comparison to the ultrasonography. The Authors believe that the video-laparoscopic splenopexy, when the diagnosis is made of "wandering spleen" with painful repeated episodes, can be finalized, to the preservation of organ.

Abdomen, Acute↗
PubMed2004

Partial splenic embolization for the treatment of hypersplenism in cirrhotic HIV/HCV patients prior to pegylated interferon and ribavirin.

Partial splenic embolization (PSE), a non-surgical treatment for hypersplenism, has also been reported to improve hepatic function. As severe thrombocytopaenia or leukopaenia contraindicate the use of combined therapy with pegylated interferons (PEG-IFNs) and ribavirin (RBV) in HCV-related cirrhosis, we evaluated, from July 2002 to October 2003, the safety and effectiveness of PSE as a procedure to allow therapy for HCV in three Child-Pugh class B cirrhotic patients with hypersplenism and HIV co-infection. HCV genotypes were 1b (n=2) and 3a (n=1). Severe thrombocytopaenia (in all) and leukopaenia (in two) precluded therapy for HCV. PSE was successfully performed in all with a mean infarcted area of 80%, leading to a significant increase in platelet and leukocyte counts that allowed therapy with weight-adjusted RBV and PEG-IFN-alpha-2b (patients 1 and 3) or 180 microg of PEG-IFN-alpha-2a (patient 2) 8 weeks after the procedure. Moderate pain, well controlled with conservative measures, followed PSE in 100% of cases, but during follow-up (mean 422 days) there were no infectious complications or liver decompensation episodes. Although preliminary, these results suggest the potential role of PSE in HIV/HCV-cirrhotic subjects with hypersplenism as a procedure to allow the use of combined PEG-IFN and RBV.

Adult↗
PubMed1988

Inflammatory pseudotumour of spleen.

A case of inflammatory pseudotumour of spleen in which plasma cells were the predominant cell type, is described. It presented as multiple nodules in the spleen of a 37 year old woman who died of myocardial infarction, and was an incidental finding at necropsy. Plasma cells were the dominant cell type, and the admixture of other cells within the mass and the lack of a monotypic light chain/immunoglobulin phenotype on immunohistochemical analysis precluded a diagnosis of malignant disease. The potential for misinterpretation of this lesion as a neoplasm is considerable and its recognition may therefore be of great clinical importance.

Adult↗
PubMed1994

[Survival of autologous indium-111-oxine-labeled blood platelets in patients with ischemic diseases].

Platelet half-life was assessed with autologous 111In-marked platelets in fourteen subjects, four women and ten men, who previously had suffered vascular accidents (myocardial infarction, TIA, stroke or peripheral obstructive arterial disease). Results, compared to findings in low risk subjects showed a statistically significant correlation of platelet half-life to certain pathologies (TIA, stroke) as well as to habits (tobacco, alcohol) and biological variables (age, sex). By and large, data were analogous to those of the current scientific literature in so far as certain factors shorten platelet half-life. A correlation was also found between platelet half-life and time elapsed since the pathological event. Liver sequestration evaluated by total body scintigraphy showed high levels in one case each with a history of stroke, a history of TIA, and a history of peripheral arterial disease, and splenic sequestration in only one case with a history of stroke.

Adult↗
PubMedDate not supplied

Transcatheter embolization with microfibrillar collagen in swine.

Transcatheter embolization of the gastrosplenic and renal arteries was performed in 7 domestic swine with suspensions of microfibrillar collagen (MFC), a recently developed topical hemostatic agent. Embolized vessels remained occluded 2 days following embolization. Recanalization occurred by 14 days, although some occlusion in distal vessel persisted at 3 months. Pathologically a marked granulomatous arteritis was noted at 14 days which resolved by 3 months. Gastric ulcers or infarcts were present in two animals. The severe vasculitis and gastric pathology observed with MFC in this study would seem to preclude its use as a general embolic agent. It may be useful, however, in the preoperative embolization of neoplasms, especially in pediatric patients since its physical characteristics allow it to be easily injected through small diameter catheters.

Animals↗
PubMed1975

[Prolonged anuria during bacterial endocarditis].

The authors report a case of anuria which lasted 3 months in a patient with sub-acute streptoccocal endocarditis. The investigations led to the discovery, at the level of the kidneys, of arterial aneurysms, renal infarction and diffuse endo-capillary proliferative glomerulonephritis, with deposits of complement and immunoglobulin and finally, interstitial nephritis, perhaps of metastatic origin, which was probably the lesion responsible for the renal failure. Renal function progressively improved and hemodialysis was stopped at the 6th month after correction of the mitral and aortic valve disease.

Acute Kidney Injury↗
PubMed2001

Mucormycosis resulting in a pseudoaneurysm in the spleen.

Mucormycosis is an uncommon and frequently fatal fungal infection. It characteristically affects patients with diabetes mellitus or patients with severe immunosuppression. The hallmark of mucormycosis infection is tissue infarction and vascular invasion. We present clinical data and imaging studies of a 16 year-old child with acute lymphoblastic leukemia complicated by disseminated mucormycosis resulting in a pseudoaneurysm of the spleen. This was successfully managed by a combination of systemic antifungal therapy (Amphotericin B) and surgery (splenectomy). This entity has not been described in the literature.

Adolescent↗
PubMed1981

The clinical effects of Hb S, an overview.

Although there is as yet no definitive treatment for patients with sickle cell disease there has been considerable improvement in the overall management of these patients in recent years. This stems largely from a better understanding of the disease process. The risks from infection in infancy and childhood due to asplenia ae now well known, and children at risk ar being identified and treated. The role of platelets and the activation of clotting factors, while still controversial, are now acknowledged as appropriate areas for research. The judicious use of blood transfusions for cerebral infarction has improved the prognosis for this complication, as it has for pregnancy and the fetus. Blood transfusion, however, has its own hazards in sickle cell disease and the extent to which it can be used requires further investigation. Finally, the broad spectrum of hematological findings and individual clinical variations in sickle cell disease is now better understood.

Anemia, Sickle Cell↗
PubMed1995

MR imaging of patients with type 1 Gaucher's disease: relationship between bone and visceral changes.

OBJECTIVE: Because treatment is now available for patients with Gaucher's disease, methods of follow-up have become important in making treatment decisions. Bone abnormalities (infarct and avascular necrosis) tend to be irreversible while visceral volumes are not, suggesting that it may be useful to follow patients with visceral volume determinations. In order to do so, the relationship of one to the other must first be understood. The purpose of this paper is to determine the relationships between bone and visceral changes identified with MR imaging. MATERIALS AND METHODS: Sixty-two consecutive patients from 1 to 78 years old with type 1 Gaucher's disease were studied by MR imaging. The examination consisted of two parts: T1-weighted MR images and gradient-echo coronal MR images of the hips and femurs, and axial breath-holding MR images of the abdomen that allowed measurement of hepatic and splenic volume. The bone changes were classified and were correlated with the liver and spleen volumes. Specific imaging features of the liver and spleen were noted and correlation sought. RESULTS: A statistically significant difference in liver size was found between patients with and without avascular necrosis. A statistically significant correlation was also found between liver size and avascular necrosis. Patients with marrow changes classified as grade 2 or higher were significantly more likely to have avascular necrosis. Nineteen percent of patients had splenic nodules and 7% had hepatic nodules; however, there was no correlation between the nodules and bone changes. CONCLUSION: MR imaging showed a statistical relationship between marrow changes, liver size, and avascular necrosis in patients with type 1 Gaucher's disease. Knowledge of this relationship may be used in dosage and treatment considerations in the follow-up and clinical management of these patients.

Adolescent↗
PubMed1979

Bile duct cysts secondary to liver infarcts: report of a case and experimental production by small vessel hepatic artery occlusion.

Hepatic bile duct cysts were demonstrated on an abdominal CT scan and confirmed at autopsy in a patient with polyarteritis nodosa. The cysts developed in close proximity to hepatic artery aneurysms and occlusions visualized at hepatic arteriography and confirmed postmortem. The development of similar bile duct cysts following hepatic artery occlusion was demonstrated in 13 Rhesus monkeys.

Aneurysm↗