Spontaneous rupture of the spleen secondary to amyloidosis

Spontaneous splenic rupture [SSR] is a rare condition. It may be an idiopathic event or may occur secondary to a pathological condition of the spleen. Systemic amyloidosis is characterized by the extracellular deposition of amyloid proteins in one or more organs. The spleen can be affected in 41% of patients. Amyloidosis and consequently, splenic rupture may occur as a complication of amyloid infiltration. We present the case of a 61-year-old male with abdominal pain and hypotension. There were peritoneal signs during physical examination and falling hematocrit was reported in the laboratory tests. The patient was suspected of having an aortic dissection. Thoraco-abdominal computed tomography [CT] angiogram was negative and ultrasonography revealed splenic rupture and free fluid in the abdominal cavity. The patient underwent laparotomy when found hemoperitoneum as a consequence of splenic rupture. The subsequent histopathological report of the spleen revealed amyloidosis. Thus, in patients with abdominal pain and hypotension, we should suspect the possibility of a spontaneous splenic rupture, even without trauma or infection history

Large omental cyst: a case report and review of the literature

Omental cysts occur rarely. Patients with Omental cysts usually present with abdominal distention and a painless abdominal mass. In children it may present as an acute abdomen due to intestinal obstruction. The most common physical finding of an omental cyst is a freely movable abdominal mass, which should be considered in differential diagnosis of these cases. The diagnostic procedures include ultrasonography and computed tomography [CT] scans. Complete excision of the cyst is considered as the treatment of choice. Recurrence and malignant deterioration of omental cysts are rare. We describe a 32-year-old female who presented with complaints of vague abdominal pain and distension. The patient underwent laparotomy with preoperative diagnosis of the ovarian cyst. The diagnosis of omental cyst was established by intraoperative findings. Thus, complete excision of the cyst was performed. The diagnosis was confirmed by pathological examination

[Prevalence of job stressors in male pre-hospital emergency technicians]

Emergency technicians meet various physical and psychological stresses in a working day which may affect their health and occupational qualification. This research was carried out to investigate the most common burn-out factors in EMS technicians and make a plan to reduce these stressors. This descriptive study was done to determine the individual, interpersonal, directional, environmental and patient care job stressors in 173 EMS technicians in 2009 in Mashhad, north eastern part of Iran. To collect data, standardized job stressors questionnaire for nurses had been modified for pre-hospital EMS technicians by two pilot studies. Data were analyzed by SPSS software, using chi square, Pearson correlation and ANOVA tests. The most common job stressors were insufficient resting time, facility insufficiencies, not having a precise occupational evaluation, shortage of personnel, dealing with contaminants and employment status. Directional and environmental job stressors had the most severe stressor effects, while interpersonal factors had the least effect. Job stressors were significantly related with age [P=0.0001], employment status [P=0.0000] and consecutive working shifts [P=0.0013]. Despite of personnel of hospitals, in EMS technicians, stress is intensified by directional and environmental factors

Multiple intussusceptions as primary manifestation of peutz-jeghers syndrome: report of a case

Peutz-Jeghers syndrome is a rare hereditary disorder characterized by hamartomatous polyps in the gastrointestinal tract and typical pigment lesions. It is a rare cause of multiple intussusceptions. Previous studies on Peutz-Jeghers syndrome reported only one case of multiple intussusceptions. We describe a case of appendiceal and multiple small intestine intussusceptions presenting as peritonitis in a patient with Peutz-Jeghers syndrome. A 17-year-old girl presented with an 8 day history of a sharp, non-radiating periumbilical pain. She underwent surgery with the diagnosis of peritonitis. Intraoperative findings included appendiceal and multiple small intestine intussusceptions. The final pathological evaluation of the specimen confirmed the diagnosis of Peutz-Jeghers syndrome. Multiple intussusceptions may occur as the primary manifestation of Peutz-Jeghers syndrome. Because of its complications, in view of the presence of multiple polyps, early intervention is strongly recommended

[Epidemiology of blunt abdominal trauma in Gorgan-Iran [2001-05]]

Trauma is the second most common cause of death regardless of age in Iran and the health system annually defrays a vast cost for trauma patients. The majority of cases comprise abdominal trauma. This study was performed to determine individual and pathologic characteristics of patients with blunt abdominal trauma in Gorgan - Iran. This descriptive and retrospective study was done on 239 patients with blunt abdominal trauma in 5 Azar hospital, Gorgan - Iran from March 2001 to March 2005. 197 [82.4%] of cases were male and 42 [17.6%] were female. The mean age of patients was 23.4 years. The mean of hospital stay was 8.8 days. The most common cause of blunt abdominal trauma was traffic injury. The most common damaged organs were spleen [49.4%] and liver [21.3%] respectively. Mortality rate was 16.3%. The hypovolumic shock was the major cause of mortality. This study showed that epidemiology of trauma is similar to those in other regions of our country. Therefore, programming and attempts of governmental organizations are needed to prevent and decrease traffic accidents