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

Processes in Pathogenic Biocolloidal Contaminants Transport in Saturated and Unsaturated Porous Media: A Review

There are several classes of subsurface colloids, abiotic and biotic. Basically, small particles of inorganic, organic and pathogenic biocolloids variety exist in natural subsurface system. Transport of these pathogenic biocolloidal contaminants (Viruses, bacteria and protozoa) pose a great risk in water resources and have caused large outbreaks of waterborne diseases. Biocolloid transport processes through saturated and unsaturated porous media is of significant interest, from the perspective of protection of groundwater supplies from contamination, assessment of risk from pathogens in groundwater and for the design of better water treatment systems to remove biocolloids from drinking water supplies This paper has reviewed the large volume of work that has already been done and the progress that has been made towards understanding the various basic multi-processes to predicting the biocolloid transport in saturated and unsaturated porous media. There are several basic processes such as physical, chemical and biological processes which are important in biocolloid transport. The physical processes such as advection, dispersion, diffusion, straining and physical filtration, adsorption and biological processes such as growth/decay processes and include active adhesion/detachment, survival and chemotaxis are strongly affected on biocolloid transport in saturated and unsaturated porous media.The unsaturated zone may play an important role in protecting aquifers from biocolloidal contamination by retaining them in the solid phase during their transport through the zone. Finally, author here highlighted the future research direction based on his critical review on biocolloid transport in saturated and unsaturated porous media