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

Insect – Tree Interactions in Thaumetopoea pityocampa

The pine processionary moth is, by far, the most important insect defoliator of pine forests in Southern Europe and North Africa, both in terms of its temporal occurrence, geographic range and socioeconomic impact. Monitoring and pest management actions are therefore required on a regular basis, to ensure the detection, evaluation and mitigation of potential risks to forest and public health. However, we still lack some of the basic knowledge required for relevant analyses of the risk posed by the pine processionary moth. Pest risk is defined as a combination of three components: (1) pest occurrence, which depends on the spatiotemporal dynamics of populations; (2) plant vulnerability to the pest, resulting in a certain amount of damage; and (3) the socioeconomic impact of damage, depending on the potential value of the plants damaged (Jactel et al. 2012). The population dynamics of the processionary moth has been extensively studied, in particular within the context of climate change (see Battisti et al. 2014, Chap. 2, this volume). Several studies have recently addressed the question of tree and forest vulnerability to pine processionary attacks but a comprehensive review of evidence was missing. This is the first objective of this chapter. In particular we were interested in a better understanding of the ecological mechanisms responsible for the host tree selection, at both the species and individual tree levels. In a second part we show that pine susceptibility to the pine processionary moth could be reduced by improving forest diversity at different spatial scales. In the last part of this chapter we provide quantitative estimate of the growth losses caused by defoliations of the pine processionary moth. Altogether this information paves the way for quantitative risk analyses on pine processionary moth infestations based on forest growth models