Splenic Pregnancy: A New Minimally Invasive Approach to Treatment

The spleen is a rare site of abdominal ectopic pregnancy. In a review of the literature, we found 16 published cases of primary splenic pregnancies. Of the cases identified, all received surgical intervention, with one case successfully treated with laparoscopic methotrexate injection, and the rest underwent splenectomy. We would like to present a case of primary splenic pregnancy in a 35-year-old woman successfully treated with percutaneous image-guided injection of methotrexate and KCl.     

Sealed rupture of abdominal aortic aneurysms: CT features in 6 patients and a review of the literature

Purpose  

To assess the CT features of sealed rupture of abdominal aortic aneurysm.     

Factor XI activity and factor XI antigen in homozygous and heterozygous factor XI deficiency

A relatively potent antiserum against highly purified, unactivated human factor XI antigen was raised in a rabbit. This antiserum, after concentration, neutralized 50% of the factor XI clotting activity of a standard normal plasma at an antiserum dilution of 1/900. The antiserum was used in a neutralization-inhibition assay to study the relation between factor XI clotting activity and factor XI antigen in plasma from ten unrelated patients with homozygous factor XI deficiency and from 12 heterozygous family members of these patients. No evidence of factor XI antigen significantly in excess of factor XI activity was found in either group. All data to date have been consistent with the hypothesis that hereditary factor XI deficiency represents a genetic disorder resulting from the absence of factor XI molecule. Severity of bleeding in factor XI deficiency could not be correlated with the level of factor XI activity or factor XI antigen.     

Pyridoxine for the treatment of isoniazid-induced seizures in intentional ingestions: The experience of a national poison center

Background

Pyridoxine (vitamin B6) is used as an antidote for isoniazid (INH) overdose, especially in intentional ingestions. The active form of pyridoxine is pyridoxal 5′-phosphate (P5P), a cofactor for glutamic acid decarboxylase in gamma aminobutyric acid (GABA) synthesis. INH inhibits this enzymatic pathway causing a decrease in brain levels of GABA, the major inhibitory neurotransmitter in the central nervous system, with resultant increase in susceptibility to seizures. The aim of this study was to evaluate and document the role of pyridoxine in the treatment of patients with intentional ingestion of INH and to report our experience.

Large renal angiomyolipomas: digital subtraction angiographic grading and presentation with bleeding

AIM: To investigate whether a grading system of renal AMLs based on digital subtraction angiography (DSA) and computerized tomography (CT), could help to select patients for embolization. MATERIALS AND METHODS: Thirty patients with 35 renal angiomyolipomas (size range 4-20 cm, mean 9.9 cm) underwent both digital subtraction angiography (DSA) and computed tomography (CT). Based on the DSA appearance the tumours were graded into three grades: grade I, minimal vascularity; grade II, moderate vascularity; grade III, marked vascularity. RESULTS: There were seven grade I (mean 9.3 cm, range 4.5-20 cm), 18 grade II (mean 8.9 cm, range 5-18 cm) and 10 grade III tumours (mean 12.1 cm, range 4-20 cm). Five grade I tumours did not cause symptoms (71%) and two caused flank pain and haematuria, respectively (14.3% each). Nine of the grade II tumours were asymptomatic (50%), seven caused bleeding (39%) and two caused flank pain (11%). Four grade III tumours were asymptomatic (40%), five caused bleeding (50%) and one pain (10%). CONCLUSIONS: According to our criteria, large angiomyolipomas with minimal vascularity are less likely to bleed, and do not need prophylactic treatment. This needs to be confirmed in larger studies.     

Response to clomipramine after short course of lithium in treatment-resistant depression: Does lithium have a ‘priming’ effect?

A patient with a treatment-resistant depression of 15 months duration is reported. Initially he showed no response to clomipramine 150 mg daily for 1 month. When lithium carbonate 600 mg daily was added for 4 days he developed signs of lithium intoxication: drowsiness, confusion, and dystonia. After lithium was withdrawn the patient improved dramatically. We hypothesize that lithium may potentiate the antidepressant effect of tricyclic antidepressants (TCA) even if it is administered as a short course of treatment.