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1.
Medicine (Baltimore) ; 99(7): e19142, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049837

RESUMO

BACKGROUND: Depression is a kind of chronic and recurrent mental disorder, the main clinical characteristics of the patients are marked and persistent depression. At the same time, it is often accompanied by chronic physical disease, cognitive impairment, and functional damage, which is one of the common diseases that seriously threaten human health. At present, 3 kinds of oral Chinese patent medicine have clinical comparability in the treatment of depression of liver stagnation and spleen deficiency, but there is no evidence for clinical efficacy and safety. Therefore, this study aims to integrate the clinical related syndromes of direct and indirect comparison by using systematic evaluation and network meta-analysis (NMA). According to the data, the different Chinese patent medicines with the same evidence body for the treatment of the disease are collected, analyzed, and sequenced in a quantitative and comprehensive way, and then the advantages and disadvantages of the efficacy and safety between different Chinese patent medicines are screened out to get the best choice scheme, thus providing reference value and evidence-based theoretical evidence for the clinical optimization of drug selection. METHODS: Comprehensive retrieval of China National Knowledge Infrastructure, Chinese scientific journal database (VIP), China biological feature database (CBM) and WANFANG Data Chinese electronic database and the Cochrane Library, PubMed, Web of Science, and EMBASE foreign database. Search and publish the clinical randomized controlled trials of these 3 Chinese patent medicines combined with fluoxetine compared with fluoxetine. The retrieval time is from the establishment of the database to October 31, 2019. The 2 first authors will screen the literatures that meet the inclusion criteria, extract the data independently according to the predesigned rules, and evaluate the literature quality and bias risk of the included research according to the Cochrane 5.1 manual standard. R and Aggregate Data Drug Information System software were used for data consolidation and NMA to evaluate the ranking probability of all interventions. RESULTS: This result will show that the best oral Chinese patent medicine to assist the treatment of liver stagnation and spleen deficiency depression provides reliable evidence. CONCLUSION: This study will provide systematic evidence-based medicine evidence for TCM assisted treatment of depression of liver stagnation and spleen deficiency type, and help clinicians, patients with depression and decision-makers to make more effective, safer, and economic optimal treatment plan in the decision-making process. PROSPERO REGISTRATION NUMBER: CRD42019115695.


Assuntos
Depressão/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Hepatopatias/tratamento farmacológico , Medicina Tradicional Chinesa , Esplenopatias/tratamento farmacológico , Depressão/complicações , Humanos , Hepatopatias/etiologia , Esplenopatias/etiologia , Revisão Sistemática como Assunto
3.
Korean J Parasitol ; 57(4): 405-409, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31533407

RESUMO

In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.


Assuntos
Hemorragia/etiologia , Malária Vivax/complicações , Esplenopatias/etiologia , Adulto , Angiografia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemorragia/diagnóstico por imagem , Humanos , Masculino , Baço/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
Am J Case Rep ; 20: 1314-1319, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31484918

RESUMO

BACKGROUND Snakebite envenoming results from injection of a mixture different toxins following snakebite. Coagulopathy and life-threatening hemorrhage can occur, or venom-induced consumption coagulopathy (VICC). A rare case is presented of spontaneous splenic hemorrhage due to VICC that was successfully treated by non-surgical splenic artery embolization. CASE REPORT A 62-year-old man was admitted to the emergency department after an episode of dizziness and loss of consciousness following a snakebite. He was transferred to our hospital with hypotension and an abnormal blood coagulation test. On admission, he was hypotensive, with reduced hemoglobin and hematocrit levels, but did not complain of abdominal pain. The occult source of bleeding was identified by abdominal computed tomography (CT) as splenic hemorrhage. Treatment began with the administration of antivenom and blood transfusion. Splenic artery angio-embolization was performed to control the bleeding and was without complication. CONCLUSIONS Snakebite envenoming associated with VICC is a serious and life-threatening condition. Because of the possibility of associated occult bleeding from internal organs or blood vessels, imaging studies should be performed as soon as possible. For patients who are hemodynamically stabilized and have atraumatic hemorrhage from the spleen, non-operative treatment using angio-embolization may be performed with intensive monitoring and follow-up.


Assuntos
Coagulação Intravascular Disseminada/terapia , Hemorragia/terapia , Mordeduras de Serpentes/complicações , Esplenopatias/terapia , Animais , Antivenenos/uso terapêutico , Transfusão de Sangue , Coagulação Intravascular Disseminada/etiologia , Embolização Terapêutica , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Venenos de Serpentes/imunologia , Artéria Esplênica , Esplenopatias/etiologia
7.
Rozhl Chir ; 98(7): 297-300, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398991

RESUMO

INTRODUCTION: Extrapulmonary tuberculosis can involve any organ or tissue. It is a rare disease in the Czech Republic with an incidence rate of 0.62 cases per 100.000 persons. It affects mostly immunocompromised patients. The most common sites include lymph nodes, the urogenital system, skin, joints, bones and serous epithelium - the peritoneum, pleura, and pericardium. Splenic involvement is rare. Mycobacterium is a slow growing intracellular parasite. The diagnostic process is very difficult; microbiological diagnosis is critical. CASE REPORT: An 84 years old female patient with subcapsular splenic rupture with no trauma history as a cause of anemia. Splenic abscess was diagnosed during surgical revision and splenectomy. Tuberculosis was suspected based on subsequent histological analysis, which was confirmed after nine weeks of peritoneal fluid culture. The surgical procedure and postoperative hospitalization were not associated with any complications. The patient was referred to the respiratory clinic for further treatment. CONCLUSION: The diagnosis of extrapulmonary tuberculosis including splenic localization should always be considered. A sample from the affected tissue or effusion must be collected in the case of unclear perioperative findings and sent for complete bacteriological testing, including mycobacterial culture. If a tuberculous splenic abscess is found, the therapeutic process should involve its complete drainage in combination with long-term anti-TB medication.


Assuntos
Abscesso , Esplenopatias , Ruptura Esplênica , Tuberculose , Abscesso/etiologia , Idoso de 80 Anos ou mais , República Tcheca , Feminino , Humanos , Esplenectomia , Esplenopatias/etiologia , Tuberculose/complicações , Tuberculose/diagnóstico
8.
BMC Gastroenterol ; 19(1): 144, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416435

RESUMO

BACKGROUND: Splenic nodules are uncommon entities that occur rarely in the general population. Although an infectious etiology (primarily bacteria, followed by mycobacteria) is usually found, noninfectious diseases, including malignancies and autoimmune disorders, can also be involved. For instance, in course of inflammatory bowel diseases (IBDs), in particular Crohn's Disease, aseptic splenic abscesses have been reported in patients with a long history of illness, or in those unresponsive to medical treatments, while are only anecdotally reported in the early phase of the disease. Hence, we presented the case of aseptic splenic nodules as a first manifestation of Crohn's Disease. CASE PRESENTATION: A 21-year-old woman with a silent medical history was admitted to the Emergency Department of our hospital complaining of fever of 38-39 °C (mainly in the evening) for the past 10 days and left flank abdominal pain, accompanied by sweating and fatigue. An abdominal computed tomography showed multiple splenic nodules of unknown origin. Because of the absence of clinical improvement after several antibiotic therapiesand a positron emission tomography (PET) with hypercaptation strictly localized to spleen, she underwent splenectomy, in suspicion of lymphoma. For persistence of symptoms after splenectomy, she underwent many instrumental examination, including a colonoscopy with bowel and intestinal biopsies that poses diagnosis of Crohn's disease. A second PET confirmed this diagnosis showing this time also the gastrointestinal involvement. CONCLUSION: An unusual onset of Crohn's disease with multiple splenic nodules is reported. This case suggests that in light of splenic nodules of unknown etiology attention should be paid to all possible diagnoses of aseptic abscesses, including IBDs (primarily Crohn's Disease).


Assuntos
Abscesso Abdominal , Doença de Crohn , Intestinos/patologia , Linfoma/diagnóstico , Baço , Esplenectomia/métodos , Esplenopatias , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Biópsia/métodos , Colonoscopia/métodos , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Tomografia por Emissão de Pósitrons/métodos , Baço/diagnóstico por imagem , Baço/patologia , Baço/cirurgia , Esplenopatias/diagnóstico , Esplenopatias/etiologia , Esplenopatias/cirurgia , Adulto Jovem
9.
Ann Clin Microbiol Antimicrob ; 18(1): 23, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307480

RESUMO

BACKGROUND: Cat-scratch disease (CSD) is a zoonotic infection caused by Bartonella henselae and B. clarridgeiae. The typical manifestations of CSD include regional lymphadenitis and fever. However, CSD can have a wide variety of clinical manifestations that can lead to incorrect diagnoses and prolonged hospital stays. CASE PRESENTATION: We present a case of a 3-year-old boy admitted to the pediatric service due to prolonged fever and abdominal pain. He received empirical antimicrobial treatment due to suspicion of infection. Abdominal ultrasound showed hepatosplenic abscesses. An IFA detected the presence of IgG antibodies against B. henselae (1:256). Patient was successfully treated with azithromycin and discharged after 7 weeks. CONCLUSIONS: Hepatosplenic abscesses in CSD are rarely reported, particularly in immunocompetent children, with this, only 36 cases in PubMed, Web of Sciences and Scopus bibliographical databases. High rate of suspicion and serological tests availability are of utmost importance in order to detect it and treat it successfully and promptly.


Assuntos
Anticorpos Antibacterianos/sangue , Bartonella henselae/imunologia , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/patologia , Abscesso Hepático/patologia , Esplenopatias/patologia , Abdome/diagnóstico por imagem , Bartonella henselae/isolamento & purificação , Pré-Escolar , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imunoglobulina G/sangue , Abscesso Hepático/etiologia , Masculino , Peru , Esplenopatias/etiologia , Ultrassonografia
10.
BMC Infect Dis ; 19(1): 635, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315582

RESUMO

BACKGROUND: The outcomes of deep-seated abscesses attributed to chronic disseminated candidiasis (CDC) in patients with hematological malignancies have rarely been reported in recent years. METHODS: We retrospectively reviewed and analyzed the data of patients with hematological malignancies who received a diagnosis of CDC at a medical center in Taiwan between 2008 and 2013. RESULTS: Sixty-one patients (32 men and 29 women) were diagnosed with CDC. The median age was 51 years (range: 18-83). The overall incidence of CDC was 1.53 per 100 patient-years in patients with hematological malignancies between 2008 and 2013. The highest incidence of CDC was 4.3 per 100 patient-years for acute lymphoblastic leukemia, followed by 3.6 for acute myeloid leukemia. We detected 3 (4.9%) proven, 13 (21.3%) probable, and 45 (73.8%) possible cases of CDC. A total of 13 patients had positive blood cultures for Candida species: C. tropicalis (8), C. albicans (2), C. glabrata (2), and C. famata (1). The median duration of antifungal treatment was 96 days (range: 7-796 days). Serial imaging studies revealed that the resolution rate of CDC was 30.0% at 3 months and 54.3% at 6 months. Five patients (8.2%) had residual lesions that persisted beyond one year. A multivariate analysis of the 90-day outcome revealed that shock was the only independent prognostic factor of 90-day survival in patients with CDC. CONCLUSION: The incidence of CDC did not decrease between 2008 and 2013. Patients with acute leukemia had a higher risk of CDC than those with other hematological malignancies. Imaging studies conducted at 6 months after diagnosis revealed that only half of the patients showed complete resolution. CDC requires prolonged treatment, and serial imaging at 6 months interval is suggested. Shock is the only independent prognostic factor of 90-day survival in patients with CDC.


Assuntos
Candidíase/etiologia , Neoplasias Hematológicas/complicações , Abscesso Hepático/microbiologia , Esplenopatias/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Candida/patogenicidade , Candidíase/diagnóstico por imagem , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Doença Crônica , Feminino , Neoplasias Hematológicas/microbiologia , Humanos , Abscesso Hepático/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esplenopatias/etiologia , Taxa de Sobrevida , Taiwan/epidemiologia
11.
Eur J Pediatr ; 178(9): 1363-1367, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312939

RESUMO

Emergency splenectomy is rarely performed since a widespread consensus exists towards conservative management of splenic injury. However, in selected conditions, mainly hematological, there is a role for emergency or urgent splenectomy. This study aims to retrospectively review these cases and discuss outcome in relation to the pre-existing splenic pathologies. Between 2000 and 2015, 12 patients, five girls, and seven boys, with a median age of six years (3 months-13.11 years), underwent emergency or urgent splenectomy for non-traumatic conditions. All patients had major associated disorders; mainly hematological (11 cases) including hemolytic anemia with pancytopenia (1), sickle cell anemia (1), AML (1), ALL (2), CML (1), T cell lymphoma (1), Burkitt lymphoma (1), and ITP (3). One patient had a microvillous inclusion disease. Indications for splenectomy included diffuse resistant splenic abscesses (4), intracranial hemorrhage (4) or hypersplenism (3) with refractory thrombocytopenia, and spontaneous splenic rapture (1). Nine patients improved following surgery but three died, owing to massive intracranial hemorrhage (1) and severe respiratory failure (2) despite aggressive management.Conclusions: Rarely, an emergency splenectomy is required in complex settings, mostly refractory hematological conditions, in a deteriorating patient when all other measurements have failed. A multidisciplinary team approach is mandatory in the treatment of these complex cases. What is known • Conservative treatment is advised for splenic injury. • Many hematological disorders are responsible of splenic pathology. What is new • Emergency splenectomy in children for reasons other than trauma is a treatment of last resort that should be performed in a multidisciplinary context. • The outcome of emergency splenectomy in children for reasons other than trauma depends on the underlying medical condition.


Assuntos
Esplenectomia , Esplenopatias/cirurgia , Adolescente , Criança , Pré-Escolar , Emergências , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Esplenopatias/etiologia , Resultado do Tratamento
12.
Ann Hematol ; 98(6): 1333-1339, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30891614

RESUMO

We determined the prevalence of incidental extracardiac findings (IEF) at Magnetic Resonance Imaging (MRI) potentially related to anemia and hypoxia in age- and sex-matched populations (N = 318) with thalassemia major (TM) and thalassemia intermedia (TI) enrolled in the Myocardial Iron Overload in Thalassemia network. Overall, IEFs were detected in 33.3% and 25.8% of patients with TI and TM, respectively (P = 0.114). TI and TM patients had elevated but comparable prevalence of renal, splenic and liver cysts, and vertebral hemangiomas while TI patients had a significant higher frequency of extramedullary hematopoiesis (EMH) (15.1% vs 4.4%; P = 0.002). The prevalence of total IEFs increased with advancing age. TI non-transfusion-dependent patients had a significantly lower frequency of renal cysts than TI transfusion-dependent patients (8.8% vs 26.4%; P = 0.005). The prevalence of renal cysts in the thalassemic population was significantly higher than that in the general population (19.2% vs 1.9%; P < 0.0001). Our data on renal cysts indicate a significant higher prevalence of these IEFs compared to the general population, suggesting the role of the inappropriate activation of the hypoxia-inducible factor system linked to the chronic hypoxia. The significant prevalence of IEF in thalassemia patients undergoing MRI for iron quantification should prompt the discussion of the inclusion of IEF in the MRI report.


Assuntos
Cistos/epidemiologia , Hemangioma/epidemiologia , Hematopoese Extramedular , Doenças Renais Císticas/epidemiologia , Neoplasias da Coluna Vertebral/epidemiologia , Esplenopatias/epidemiologia , Talassemia/complicações , Adulto , Distribuição por Idade , Anemia/complicações , Transfusão de Sangue , Cistos/diagnóstico por imagem , Cistos/etiologia , Feminino , Hemangioma/diagnóstico por imagem , Hemangioma/etiologia , Humanos , Hipóxia/complicações , Serviços de Informação , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Sobrecarga de Ferro/epidemiologia , Sobrecarga de Ferro/etiologia , Itália/epidemiologia , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/etiologia , Esplenopatias/diagnóstico por imagem , Esplenopatias/etiologia , Talassemia/sangue , Talassemia/terapia , Adulto Jovem
13.
Environ Toxicol ; 34(7): 788-795, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30843661

RESUMO

The present study was to evaluate the radiomitigative effect of naringenin (NRG) on the modulation of ionizing radiation (IR)-induced spleen injury. Rats were exposed to 12 Gy (3Gy/two times/week). NRG (50mg/Kg), was orally given one hour after the first radiation dose, and daily continued during the irradiation period. Rats were sacrificed 1 day after the last dose of radiation. NRG showed a significant decrease of malondialdehyde, hydrogen peroxide with a significant elevation of superoxide dismutase, catalase and glutathione peroxidase activities and glutathione content. Moreover, NRG confirmed the intracellular defense mechanisms through activation of nuclear factor (erythroid-derived 2)-like2 (Nrf2) and haem oxygenase-1 (HO-1) levels and their protein expression. In addition, NRG deactivated the nuclear factor-κB (NF-κB) and reduced the pro-inflammatory cytokines. Further, NRG showed positive modulation in the haematological values (WBCs, RBCs, Hb, Hct% and PLt). In conclusion, these results suggested that NRG reversed the IR-induced redox-imbalance in the rat spleen.


Assuntos
Flavanonas/farmacologia , Heme Oxigenase-1/fisiologia , Fator 2 Relacionado a NF-E2/fisiologia , Estresse Oxidativo , Lesões por Radiação/prevenção & controle , Esplenopatias/prevenção & controle , Animais , Catalase/metabolismo , Raios gama/efeitos adversos , Glutationa/metabolismo , Heme Oxigenase-1/efeitos dos fármacos , Heme Oxigenase-1/metabolismo , Peróxido de Hidrogênio/metabolismo , Masculino , Malondialdeído/metabolismo , Fator 2 Relacionado a NF-E2/efeitos dos fármacos , Fator 2 Relacionado a NF-E2/metabolismo , NF-kappa B/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/fisiologia , Estresse Oxidativo/efeitos da radiação , Lesões por Radiação/etiologia , Lesões por Radiação/metabolismo , Ratos , Ratos Wistar , Fatores de Risco , Baço/efeitos dos fármacos , Baço/metabolismo , Baço/efeitos da radiação , Esplenopatias/etiologia , Esplenopatias/metabolismo , Superóxido Dismutase/metabolismo
15.
Radiol Med ; 124(3): 163-169, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30361922

RESUMO

AIMS: To assess mean healing time of blunt spleen injuries managed nonoperatively using CEUS (contrast-enhanced ultrasound); to analyze whether spleen injury grade, subcapsular hematoma (SCH) presence, SCH grade and spleen infarct after spleen artery angioembolization could be related to healing time; and to evaluate CEUS sensitivity in diagnosing spleen injury and to assess CEUS performance in classifying spleen injury grade compared to CT. MATERIALS AND METHODS: After CT evaluation in the Emergency Department, 101 hemodynamic stable blunt spleen trauma patients (73 males; 28 females; mean age 46.4 years, range 18-92) underwent serial CEUS follow-up examinations at pre-established intervals (1, 3, 8, 15, 30, 60, 90 and 180 days after trauma), until spleen injury became no more identifiable. RESULTS: Mean CEUS examinations performed before spleen injury healing were 4.5; mean spleen injury healing time was 22.6 days. Spleen injury healing time was significantly related to spleen injury grade, subcapsular hematoma (SCH) presence, SCH grade and spleen infarct. CEUS spleen injury diagnostic sensitivity was 96.9% and, according to the American Association for the Surgery of Trauma (AAST)-spleen injury scale (SIS), CEUS-CT concordance was 95.8%. CONCLUSIONS: Spleen injury healing time in blunt abdominal trauma nonoperatively managed is significantly related to AAST-SIS grade, SCH presence and grade, and spleen infarct development, and CEUS can be used in order to evaluate spleen injury grade.


Assuntos
Baço/diagnóstico por imagem , Baço/lesões , Cicatrização , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Embolização Terapêutica , Feminino , Hematoma/etiologia , Hematoma/terapia , Humanos , Infarto/terapia , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Baço/irrigação sanguínea , Esplenopatias/etiologia , Esplenopatias/terapia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ultrassonografia/métodos , Ferimentos não Penetrantes/complicações , Adulto Jovem
16.
Ann Thorac Surg ; 107(4): e235-e237, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30326233

RESUMO

The spleen is the most common abdominal site for systemic septic emboli that often complicate infective endocarditis. Management of an embolic splenic abscess usually involves surgical splenectomy or image-guided drainage, but the natural history of splenic abscess without drainage is unknown. We describe the successful conservative treatment of a large complex splenic abscess with antibiotics alone in a patient with aortic valve infective endocarditis who required an emergent valve replacement surgical procedure. Previous complex abdominal wall operation with the presence of a synthetic mesh made abdominal surgical intervention unfavorable. The splenic abscess resolved completely with no recurrence of infection at the 3-year follow-up.


Assuntos
Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Insuficiência da Valva Aórtica/cirurgia , Endocardite Bacteriana/complicações , Esplenopatias/tratamento farmacológico , Staphylococcus epidermidis/isolamento & purificação , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Insuficiência da Valva Aórtica/etiologia , Tratamento Conservador , Quimioterapia Combinada , Serviço Hospitalar de Emergência , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Seguimentos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Multimorbidade , Diálise Renal/métodos , Esplenopatias/diagnóstico por imagem , Esplenopatias/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
Clin Imaging ; 54: 6-11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30476679

RESUMO

PURPOSE: Splenic abscesses represent a major complication following splenic artery embolization. The purpose of this study was to assess the effectiveness of intra-arterial antibiotics administered during splenic artery embolization in reducing splenic abscess formation. MATERIALS AND METHODS: 406 patients were screened. 313 (77.1%) patients who underwent splenic artery embolization and were >18 years old were included. Mean age of the cohort was 58 ±â€¯15 years (range: 18-88 years). There were 205 (65.5%) male patients and 108 (34.5%) female patients. 197 (62.9%) patients underwent embolization without intra-arterial antibiotics and 116 (37.1%) patients underwent embolization with 1 g ampicillin and 80 mg gentamicin administered in an intra-arterial fashion. Primary outcome was splenic abscess formation. Secondary outcomes included type of splenic artery embolization, embolic agent, and technical success. RESULTS: Partial splenic embolization was performed in 229 (73.1%) patients. Total splenic embolization was performed in 84 (26.8%) patients. Platinum coils were the most commonly used embolic agent overall (n = 178; 56.9%) followed by particulates (n = 114; 36.4%). Embolization technical success was achieved in 312 (99.7%) patients. 7 (3.6%) splenic abscesses were detected in the non-intra-arterial antibiotic group and 1 (0.9%) in the intra-arterial antibiotic cohort (P = 0.27). Coils were found to be statistically more likely to result in splenic abscesses than any other embolic agent (P = 0.03). Mean time to abscess identification was 74 days ±120 days (range: 9-1353 days). CONCLUSION: Splenic abscesses occurred more frequently in patients who did not receive intra-arterial antibiotics during splenic embolization; however, this did not reach statistical significance.


Assuntos
Abscesso/prevenção & controle , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Embolização Terapêutica/efeitos adversos , Gentamicinas/uso terapêutico , Artéria Esplênica , Esplenopatias/prevenção & controle , Abscesso/etiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esplenopatias/etiologia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
18.
Digestion ; 100(3): 170-175, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30423563

RESUMO

PURPOSE: In contrast to splenomegaly, the clinical value of a small spleen (hyposplenia) is unclear. Contrast-enhanced ultrasound (CEUS) has not been investigated systematically in hyposplenia. METHODS: Between February 2005 and January 2017, 43 patients with hyposplenia (< 7 × 3 cm) were examined by B-mode ultrasound (US) and CEUS. A retrospective data analysis was performed. RESULTS: A total of 39 (91%) patients had an underlying disease (UD; allogenic stem cell transplantation, n = 16; autoimmune-diseases, n = 7; sickle cell anemia, n = 5; solid tumors, n = 5; others, n = 6). In 4 (9%) cases, hyposplenia was an incidental finding. The echogenicity of the spleen was normal (homogeneous, isoechogenic) in 17 (39.5%) and abnormal in 26 (60.5%) cases (inhomogeneous, n = 26 and hyperechoic, n = 9). In CEUS, 21 (49%) patients presented a normal isoenhancement. An abnormal enhancement was detected in 22 (51%) patients with UD (arterial/parenchymal inhomogeneous, n = 1; no [arterial, n = 3 and parenchymal, n = 6]; reduced [arterial, n = 8 and parenchymal, n = 15]). CONCLUSIONS: Hyposplenia is a rare pathologic finding and often associated with hematological/oncological and autoimmune diseases. Furthermore, altered B-mode US appearance and a pathological CEUS pattern are frequently found. However, the clinical implication, especially regarding splenic function remains obscure to date.


Assuntos
Baço/patologia , Esplenopatias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Falciforme/complicações , Doenças Autoimunes/complicações , Meios de Contraste/administração & dosagem , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Tamanho do Órgão , Estudos Retrospectivos , Baço/diagnóstico por imagem , Esplenopatias/etiologia , Esplenopatias/patologia , Transplante Homólogo/efeitos adversos , Ultrassonografia/métodos
19.
Brain Dev ; 41(3): 271-275, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30384989

RESUMO

OBJECTIVE: To assess the clinical and imaging features of reversible splenial lesion syndrome (RESLES) with benign convulsions associated with mild gastroenteritis (CwG) in children. PATIENTS AND METHODS: We retrospectively reviewed the clinical course, blood and stool examinations, cerebrospinal fluid (CSF) examination, magnetic resonance imaging (MRI), electroencephalography (EEG) findings, therapy and prognosis of five children with RESLES associated with CwG. RESULTS: Five previously healthy patients, four girls and one boy, with mean age 26.4 ±â€¯8.1 months, had clusters of general tonic-clonic or clonic seizures within the first two days of gastroenteritis. Rotavirus antigen was positive in the stool of one case. Interictal EEG was normal except in one case, which showed occipital slow wave. The initial MRI was performed within five days of onset, four patients had an isolated lesion in the splenium of the corpus callosum (SCC), and one patient had lesions extending outside the SCC that involved the genu of the corpus callosum. The follow-up MRI was performed 10-15 days after onset, and all lesions had completely disappeared. All patients were treated with antiviral, rehydration and anticonvulsant therapy in the acute phase. They had good prognosis and normal psychomotor development, with no neurological sequelae after 26-30 months of follow-up. CONCLUSIONS: CwG and RESLES can coexist in young children. The patients present with clusters of general tonic-clonic or clonic seizures in the acute phase. Brain MRI shows focal lesion in the SCC with high signal intensity on T2-weighted and FLAIR sequences. It has good prognosis and excessive treatment is not necessary.


Assuntos
Gastroenterite/complicações , Convulsões/complicações , Esplenopatias/etiologia , Pré-Escolar , Eletroencefalografia , Feminino , Gastroenterite/líquido cefalorraquidiano , Gastroenterite/diagnóstico por imagem , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Exame Neurológico , Estudos Retrospectivos , Convulsões/líquido cefalorraquidiano , Convulsões/diagnóstico por imagem , Esplenopatias/líquido cefalorraquidiano , Esplenopatias/diagnóstico por imagem
20.
Niger J Clin Pract ; 21(12): 1615-1621, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30560826

RESUMO

Introduction: In sickle cell anemia patients (SCA), the spleen suffers multiple occlusion of its microvasculature causing ischemia and subsequently autosplenectomy. Among the functions of the spleen is the production of gamma interferon (IFN-γ) which has several immunological roles. This function could be impaired in these patients. Therefore, this study aimed at determining the extent to which autosplenectomy affects the immunity of SCA patients as reflected by the level of IFN-γ, frequency of infections, and crises (vaso-occlusive, hemolytic, aplastic) in these patients. Materials and Methods: Forty SCA patients in steady state condition were recruited into the study. A self-administered questionnaire was completed by all patients, and venous blood sample was analyzed for IFN-γ levels. All patients underwent abdominal ultrasound scan. Results: Autosplenectomy was observed in 20% of the sickle cell patients. Bone pain was the most frequent type of crisis in the study population; this occurred in 100% and 85% of patients with autosplenectomy and those without autosplenectomy, respectively. Infection rates of more than once a year was reported in 87.5% of SCA patients with autosplenectomy compared with 50% of SCA patients without autosplenectomy. There was no significant difference in IFN-γ plasma levels between SCA patients with autosplenectomy and those without autosplenectomy. Conclusion: This study showed a higher prevalence of infection and bone pain crisis among SCA patients with autosplenectomy than in SCA patients without autosplenectomy. It also showed comparable level of IFN-γ in the 2 groups of patients. Patients with autosplenectomy may benefit from early institution of drugs such as hydroxyurea to improve quality of life.


Assuntos
Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Eritrócitos Anormais/metabolismo , Interferon gama/sangue , Baço/patologia , Esplenopatias/epidemiologia , Adulto , Anemia Falciforme/sangue , Feminino , Hemólise , Humanos , Masculino , Morbidade , Nigéria/epidemiologia , Prevalência , Esplenopatias/etiologia , Adulto Jovem
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