Portal vein thrombosis after laparoscopic splenectomy: an ongoing clinical challenge.

ObjectivesPortal vein thrombosis (PVT) following open splenectomy is a potentially lethal complication with an incidence of up to 6%. The objective of this report is to describe our management of a recent laparoscopic case, discuss current therapies, and consider antiplatelet therapy for prophylaxis.MethodsMedical records, laboratory studies, and imaging studies pertaining to a recent case of a laparoscopic splenectomy were examined. Current literature related to this topic was reviewed.ResultsA 16-year-old girl underwent laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Her preoperative platelet count was 96K. She was discharged on postoperative day 1 after an uneventful operation including division of the splenic hilum with an endoscopic linear stapler. On postoperative day 20, she presented with a 5-day history of epigastric pain, nausea, and low-grade fevers without peritoneal signs. Her white blood cell count was 17.3; her platelets were 476K. Computed tomography demonstrated thrombosis of the splenic, superior mesenteric, and portal veins propagating into the liver. Heparinization was begun followed by an unsuccessful attempt at pharmacologic and mechanical thrombolysis by interventional radiology. Over the next 5 days, her pain resolved, she tolerated a full diet, was converted to oral anticoagulation and sent home. Follow-up radiographic studies demonstrated the development of venous collaterals and cavernous transformation of the portal vein.DiscussionNo standard therapy for PVT exists; several approaches have been described. These include systemic anticoagulation, systemic or regional medical thrombolysis, mechanical thrombolysis, and surgical thrombectomy. Unanswered questions exist about the most effective acute therapy, duration of anticoagulation, and the potential efficacy of routine prophylaxis with perioperative antiplatelet agents. PVT following splenectomy occurs with both the open and laparoscopic approach

A Puzzling Merger in A3266: the Hydrodynamic Picture from XMM-Newton

Using the mosaic of nine XMM-Newton observations, we study the hydrodynamic state of the merging cluster of galaxies Abell 3266. The high quality of the spectroscopic data and large field of view of XMM-Netwon allow us to determine the thermodynamic conditions of the intracluster medium on scales of order of 50 kpc. A high quality entropy map reveals the presence of an extended region of low entropy gas, running from the primary cluster core toward the northeast along the nominal merger axis. The mass of the low entropy gas amounts to approximately 2e13 solar masses, which is comparable to the baryonic mass of the core of a rich cluster. We test the possibility that the origin of the observed low entropy gas is either related to the disruption a preexisting cooling core in Abell 3266 or to the stripping of gas from an infalling subcluster companion. We find that both the radial pressure and entropy profiles as well as the iron abundance of Abell 3266 do not resemble those in other known cooling core clusters (Abell 478). Thus we conclude that the low entropy region is subcluster gas in the process of being stripped off from its dark matter halo. In this scenario the subcluster would be falling onto the core of A3266 from the foreground. This would also help interpret the observed high velocity dispersion of the galaxies in the cluster center, provided that the mass of the subcluster is at most a tenth of the mass of the main cluster.Comment: 6 pages, ApJ sub

Radio observations of ZwCl 2341.1+0000: a double radio relic cluster

Context: Hierarchal models of large scale structure (LSS) formation predict that galaxy clusters grow via gravitational infall and mergers of (smaller) mass concentrations, such as clusters and galaxy groups. Diffuse radio emission, in the form of radio halos and relics, is found in clusters undergoing a merger, indicating that shocks or turbulence associated with the merger are capable of accelerating electrons to highly relativistic energies. Here we report on radio observations of ZwCl 2341.1+0000, a complex merging structure of galaxies located at z=0.27, using Giant Metrewave Radio Telescope (GMRT) observations. Aims: The main aim of the observations is to study the nature of the diffuse radio emission in the galaxy cluster ZwCl 2341.1+0000. Methods: We have carried out GMRT 610, 241, and 157 MHz continuum observations of ZwCl 2341.1+0000. The radio observations are combined with X-ray and optical data of the cluster. Results: The GMRT observations show the presence of a double peripheral radio relic in the cluster ZwCl 2341.1+0000. The spectral index is -0.49 \pm 0.18 for the northern relic and -0.76 \pm 0.17 for the southern relic respectively. We have derived values of 0.48-0.93 microGauss for the equipartition magnetic field strength. The relics are probably associated with an outwards traveling merger shock waves.Comment: 14 pages, 10 figures, accepted for publication in A&A on July 30, 200

Perfusion SPECT in patients with suspected pulmonary embolism.

PURPOSE: Ventilation/perfusion tomography (V/PSPECT), with new interpretation criteria and newer tracers for ventilation imaging, has markedly improved the diagnostic yield in acute pulmonary embolism (PE). Here, we evaluated the diagnostic performance of perfusion SPECT (PSPECT) without ventilation imaging. METHODS: We studied 152 patients with clinically suspected PE who had been examined with both V/PSPECT and multidetector computed tomographic angiography (MD-CTA). The diagnosis or exclusion of PE was decided by the referring clinician based on both the V/PSPECT and/or MD-CTA findings in combination with the clinical findings. PSPECT images were retrospectively examined by a physician with experience in the interpretation of planar perfusion scans who was blinded to clinical, V/PSPECT and MD-CTA data. PSPECT images were interpreted without the aid of chest radiography. All the patients who were deemed to have PE were given anticoagulant therapy. RESULTS: Of the 152 patients, 59 (39 %) received a final diagnosis of PE, and 19 (32 %) had associated cardiopulmonary diseases such as pneumonia, COPD, or left heart failure. PSPECT correctly identified 53 (90 %) of the 59 patients with PE. The specificity was 88 of 93 (95 %). None of the PSPECT images was rated nondiagnostic. PSPECT yielded an overall diagnostic accuracy of 93 % (95 % confidence interval, CI, 87-96 %). At the observed PE prevalence of 39 %, the positive and negative predictive values of PSPECT were 91 % (95 % CI, 80-97 %) and 94 % (95 % CI, 86-97 %), respectively. CONCLUSION: In managing critically ill patients, PSPECT might be a valid alternative to V/PSPECT or MD-CTA since it was able to identify most patients with PE with a low false-positive rate and no inconclusive results