Splenic artery aneurysm rupture.

Splenic artery aneurysms are the most common visceral artery aneurysms and are known for their potential for rupture. Pregnancy and portal hypertension have been known as major risk factors. With improved methods of diagnosis and minimally invasive therapy, management and outcome of SAA may change significantly. SAA may rupture at any age. When rupture of the aneurysm occurs, the mortality rate remains low if immediate resuscitation is performed and an aggressive surgical approach is taken. Conservation of the spleen might have been preferred.

Domino effect from hypertriglyceridemia to sinistral portal hypertension.

Patient with hypertriglyceridemia history tends to develop a pancreatitis episode. Triglyceride levels > 1000 mg/dl may trigger this pathology. Amylase is not a good predictor for pancreatitis associated with hypertriglyceridemia. Because of the close relation between pancreas and splenic vein, pancreatitis is the most common etiologic factor in developing thrombosis or occlusion in splenic vein. The impairment or cessation of venous flow in splenic vein results in back pressure which is transmitted through short gastric and gastroepiploic veins and subsequently via the coronary vein into the portal system. Increased flow across the short gastric veins creates sinistral portal hypertension. Recurrent upper gastrointestinal hemorrhage is the last scene of this sequence in general, and may be unique sign. This case is extremely rare to understand all the cascade mechanism at once.

Symptoms of depression and diabetes-specific emotional distress are associated with a negative appraisal of insulin therapy in insulin-naïve patients with Type 2 diabetes mellitus. A study from the European Depression in Diabetes [EDID] Research Consortium.

AIMS: A meta-analysis concluded that depression is associated with poor glycaemic control in Type 2 diabetes (DM2). In DM2 patients with deteriorating glycaemic control, the initiation of insulin therapy is often postponed. The aim of the present study was to determine whether symptoms of depression and diabetes-specific emotional distress are associated with a more negative appraisal of insulin therapy. METHODS: We collected cross-sectional data in two outpatient university clinics in Istanbul, Turkey. The study sample consisted of 154 insulin-naïve patients with DM2. A self-report questionnaire was used to obtain demographic and clinical data. Main instruments were the Centre for Epidemiologic Studies Depression Scale, (CES-D), the Problem Areas In Diabetes scale (PAID) and the Insulin Treatment Appraisal Scale (ITAS). RESULTS: Analysis of variance revealed that patients with a higher depression score rated insulin therapy significantly more negative then patients with lower depression scores. Moreover, 47% of patients with a high depression score had a negative appraisal of insulin therapy on 7 or more of the 20 ITAS-items, compared to 25 to 29% of those with low-moderate depression scores. Multiple regression analyses showed that a negative appraisal of insulin therapy was significantly associated with higher depression and diabetes-distress scores and low education, but not with sex, age or duration of diabetes. CONCLUSIONS: Our results suggest that in insulin-naïve Type 2 diabetes patients, higher levels of depression and diabetes-distress tend to be associated with more negative beliefs about insulin. Whether these negative attitudes translate into postponing initiation of insulin therapy needs to be tested in longitudinal research.