613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

Background Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Methods Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. Results We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. Conclusions Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture

Visualization of Micro-Particle Retention on a Heterogeneous Surface Using Micro-models: Influence of Nanoscale Surface Roughness

Nanoscale surface roughness and charge heterogeneity have been widely recognized to influence particle retention in porous media under unfavourable chemical conditions such as solutions of low ionic strength (IS) or high pH. However, previous researches have not appreciated the influence of nanoscale surface roughness on particle retention under favourable chemical conditions (e.g. high solution IS). This information is needed to better understand and predict particle transport and retention in such natural environments, such as enhanced oil recovery in a high-salinity reservoir. A glass-etched micro-model was employed to directly visualize retention of micro-sized particles and their spatial distribution on the glass surface under various chemical conditions. The extended DLVO calculations accounting for the effect of nanoscale surface roughness on the interaction energies were employed to quantitatively evaluate the experimental results. It was shown that nanoscale roughness on solid surfaces significantly reduced the strength of primary minimum attachment when the solution IS was high. In particular, increasing the density of roughness on the solid surface increased the strength of primary minimum, whereas increasing the roughness height decreased the strength of primary minimum interaction. Consequently, retained particles in the primary minimum are expected to be susceptible to detachment via hydrodynamic drag forces and movement of air–water interfaces during transient in water saturation (e.g. drainage or imbibition). Indeed, results obtained from the micro-model experiments demonstrated that only a fraction of solid surface was available for particle retention even at a very high IS of 0.6 M.Joel Argent, Saeed Torkzaban, Stephen Hubbard, Helen Le, Tahmineh Amirianshoja, Manouchehr Haghigh