Doppler ultrasound for the assessment of conservatively treated blunt splenic injuries: a prospective study.

INTRODUCTION: The type and need for follow-up of non-operatively managed blunt splenic injuries remain controversial. The use of Doppler ultrasound to identify post-traumatic splenic pseudoaneurysms, considered to be the main cause of "delayed" splenic rupture, has not been well described. PATIENTS AND METHODS: A 5-year prospective study was performed from 2004 to 2008. All patients with blunt splenic injury diagnosed with computerized tomography, who were treated non-operatively, were included in the study. Doppler ultrasound examination was performed 24-48 h post-injury. Consecutive Doppler ultrasound examinations were done on 7, 14 and 21 days post-injury for patients diagnosed with a splenic pseudoaneurysm. Demographic and clinical data were collected. Ambulatory follow-up continued for 4 weeks after hospital discharge. RESULTS: A total of 38 patients were enrolled in the study. Grading of splenic injury demonstrated 19 (50%) patients with Grade I, 16 (42%) with Grade II and 3 (8%) with Grade III injuries. Two patients (5%) had pseudoaneurysms. All pseudoaneurysms underwent complete resolution within 2 weeks after diagnosis. No patients received blood products, or had angio-embolization or surgery during the study period. All patients were found to be asymptomatic and stable at the 4-week follow-up. CONCLUSIONS: Doppler ultrasound can be an effective and a safe noninvasive modality for evaluation and follow-up of patients with blunt splenic injury. The utility and cost-effectiveness of routine surveillance requires further study.

Identification of neurones of the brain and spinal cord involved in the innervation of the ductus deferens using the viral tracing method.

Using the viral transneuronal tracing technique cell groups of the spinal cord and brain transsynaptically connected with the ductus deferens were identified. Neurotropic (pseudorabies) virus was injected into the muscular coat of the ductus deferens and after survival times of 3, 4 and 5 days the spinal cord and brain were processed immunocytochemically. Virus-labelled neurones could be detected in the preganglionic sympathetic neurones and the dorsal commissural nucleus (upper lumbar segments) and in the sacral parasympathetic nucleus (L6-S1). Virus-infected perikarya were present in several brain stem nuclei including the gigantocellular and paragigantocellular nucleus, the lateral reticular nucleus, the nucleus of the solitary tract, the caudal raphe nuclei, the A1/C1, A2, A5 and A7 noradrenergic cell groups and the locus coeruleus. In the hypothalamus significant numbers of virus-infected neurones could be detected in the paraventricular nucleus. In most cases moderate numbers of virus-labelled cells were present in the lateral hypothalamic area, in the retrochiasmatic area, in the periventricular region and in the median preoptic area. Double-labelling immunofluorescence detection of virus-infected neurones and thyrosine hydroxylase (TH) showed colocalization of virus protein and TH in portion of neurones of the A1/C1, A2, A5 and A7 noradrenergic cell groups, in the locus coeruleus and in the hypothalamic paraventricular nucleus. The present results provide the first morphological data on the multisynaptic circuit of neurones innervating the ductus deferens.