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

A new valuation question: analysis of and insights from interval open-ended data in contingent valuation

Classic and interval open-ended (CIOE) question, Contingent valuation, Middle-censored data, Salmon, Valuation uncertainty, Willingness to pay,

Archaeology and Sclerochronology of Marine Bivalves

International audienceIn a rapidly changing world, maintenance of the good health of the marine environment requires a detailed understanding of its mechanisms of change, and the ability to detect early signals of a shift away from the equilibrium state that we assume characterized it before there was any significant human impact. Given that instrumental measurements of the oceans go back no further than a few decades, the only way in which we can assess the long-term baseline variability that characterizes the pre-perturbation equilibrium state of the marine environment is by the use of proxy records contained in stratified or layered natural archives such as corals, fish otoliths and bivalve mollusc shells.In this chapter we will look at the ways in which the environmental signals recorded in the shells of bivalve molluscs can be used to shed light on marine variability both in the present and over past centuries and millennia, and specifically how they can be used to study marine climate, the marine environment and the economic and cultural history of the relationship between humans and the oceans.The chapter is divided into two parts: section one describes the morphological, geochemical and crystallographic techniques that are used to obtain information from the shells, while section two covers the use of bivalve shells in a wide range of applications, including ecosystem services, environmental monitoring, archaeology, climate reconstruction, and climate modeling