Splenic artery aneurysm: an important cause of hemoperitoneum and shock.

BACKGROUND: Splenic artery aneurysm ruptures are rare and highly morbid events that are frequently associated with pregnancy. However, approximately 15% may occur in men, and it is important to have this possibility in the differential diagnosis in cases of hemoperitoneum and hemorrhagic shock. Rapid diagnosis and treatment is essential to survival. OBJECTIVES: The aim of this report is to educate emergency physicians on the early recognition and treatment of this life-threatening event and to increase the awareness of this condition in male patients. CASE REPORT: We describe the evaluation and management of two cases of splenic artery rupture in male patients with unique presentations. CONCLUSION: Splenic artery aneurysm ruptures should be considered in the differential diagnosis in any patient with undifferentiated shock. Early diagnosis and treatment can save lives.

A ready-to-use therapeutic food containing 10% milk is less effective than one with 25% milk in the treatment of severely malnourished children.

Standard therapy for severe acute malnutrition (SAM) is home-based therapy with ready-to-use therapeutic food (RUTF) containing 25% milk. In an effort to lower the cost of RUTF and increase availability, some have suggested that a portion of milk be replaced with soy. This trial was designed to determine whether treating children with SAM with 10% milk RUTF containing soy would result in a similar recovery rate compared with the 25% milk RUTF. This was a randomized, double-blind, controlled, clinical, quasi-effectiveness trial of isoenergetic amounts of 2 locally produced RUTF to treat SAM in Malawi among children aged 6-59 mo. A total of 1874 children were enrolled. Children were assessed every fortnight and participated in the study until they clinically recovered or received 8 wk of treatment. The primary outcome was recovery (weight-for-height Z score > -2 and no edema). Secondary outcomes were rates of weight and height gain. Survival analysis was used to compare the recovery rates. Recovery among children receiving 25% milk RUTF was greater than children receiving 10% milk RUTF, 64% compared with 57% after 4 wk, and 84% compared with 81% after 8 wk (P < 0.001). Children receiving 25% milk RUTF also had higher rates of weight and height gain compared with children receiving 10% milk RUTF. Treating children with SAM with 10% milk RUTF is less effective compared with treatment with the standard 25% milk RUTF. These findings also emphasize that clinical evidence should be examined before recommending any changes to the formulation of RUTF.