Apparent MRI diffusion coefficient of lesions and normal appearing white matter in acute disseminated encephalomyelitis

To study the MRI diffusion characteristics of the lesions and normal appearing white matter [NAWM] in Acute Disseminated Encephalomyelitis [ADEM]. Average apparent MRI diffusion coefficient [ADC] of the lesions and NAWM in 6 patients [Their with ADEM was calculated. The ADC of the normal white matter of age and sex matched 6 normal subjects served as a control. The average ADC in the lesions from ADEM patients [1.46 x 10[-3] mm[2]/sec] was significantly higher than that of ADEM NAWM [0.745 x 10[-3] mm[2]/sec], [P < 0.0001] and the normal white matter of their control subjects [0.748 x 10[-3] mm[2]/sec], [P < 0.0001]. No significant difference was noted between the ADC values of the NAWM of ADEM patients [0.745 x 10[-3] mm[2]/sec] and their age and sex matched controls [0.748 x 10[-3] mm[2]/sec], [P =0.837]. The ADC of the NAWM is not affected in ADEM patients. The ADC of the lesions of ADEM is significantly higher than its NAWM. Mapping the ADC of the lesions and NAWM is a potential and promising tool to characterize ADEM. More studies are needed to confirm these findings

Coil embolization of splenic artery as an adjunctive therapeutic technique before splenectomy in patients with massive splenomegaly and secondary hypersplenism

Splenectomy for massive splenomegaly, [splenic weight 10 times usual weight of 150-200 gm], with secondary hypersplenism, has uncommonly high morbidity and mortality because of technical challenges and problems of hemostasis due to severe thrombocytopenia refractory to platelet transfusion. In an attempt to decrease intraoperative blood loss and to improve the preoperative general condition of the patients, preoperative splenic artery embolization is advised. To study the effects of preoperative coil embolization of the splenic artery in patients with massive splenomegaly and secondary hypersplenism and its impact on improvement of hypersplenism specially thrombocytopenia and subsequent Splenectomy. This study included 15 patients with massive splenomegaly and secondary hypersplenism. The causes of splenomegaly were liver cirrhosis with portal hypertension [5 patients], spherocytosis [5 patients], isolated splenic lymphoma [3 patients] and sickle cell-beta thalassemia [one patient] and one patient with unknown cause. All patients with liver cirrhosis were selected to be Child-Pough grade A. All patients were subjected to coil embolization of the splenic artery after infusion of one unit of fresh blood and another unit of platelet concentrates in some patients. Then subsequent splenectomy was done within 2 to 5 days. In patients with liver cirrhosis and portal hypertension, ligation of the left gastric vein was also done in conjunction to splenectomy. This study was done in Assiut University Hospital during the period between February 2001 to October 2006. This study was done on 15 patients with massive splenomegaly, 9 males [60%] and 6 females [40%] with their ages ranged between 15-48 years with the mean age of 29.2 years. The preembolization platelet count ranged between 19x10[9]/L to 78 x10[9]/L with a mean value 45x10[9]/L. One of the patients, known to have heterozygos sickle cell disease presented by acute splenic sequestration crisis. Splenic artery occlusion aided normalization of the thrombocytopenia within 2 to 5 days in all patients by fresh blood transfusion. The postembolization platelet count ranged from 143 to 210 x10[9]/L with a mean 168x10[9]/L. Successful splenectomy was subsequently done with no intraoperative significant blood loss and additional transfusion. No serious complications resulted from both procedures. Preoperative proximal coil embolization of the splenic artery is a safe technique and allows safe splenectomy in patients with massive splenomegaly with secondary hypersplenism that carries high risk splenectomy. It is a life saving technique in patients with acute splenic sequestration crisis. After proximal coil embolization, it is advisable to perform splenectomy before dilatation of the collateral and recurrence of hypersplenism