[Spontaneous splenic hematoma: trauma injury or drug reaction or both?]. / Hématome spontané de la rate: traumatisme et/ou médicament?

INTRODUCTION: Spontaneous splenic hematomas are uncommon and frequently associated with infectious, hematologic, or neoplastic diseases. Presentation is typically acute but progressive forms have been described. CASE: We report the case of a 45-year-old man consulting for abdominal pain that was found to be due to a spontaneous splenic hematoma. No recent injuries, infections, or hematologic, neoplastic or gastrointestinal diseases were found, but the patient had had a minor injury 9 months earlier and had been treated with selective serotonin reuptake inhibitors (venlafaxine) for the past year. This history suggested that the drug might play a role. DISCUSSION: Although the likely cause of this splenic hematoma appears to be a minor injury 9 months before the onset of pain, we cannot rule out the possibility that selective serotonin reuptake inhibitor treatment was a predisposing factor.

[Respiratory morbidity and mortality following transhiatal esophagectomy in patients with severe chronic obstructive pulmonary disease]. / Morbidité et mortalité respiratoires des oesophagectomies trans-hiatales chez les patients porteurs d'un syndrome obstructif sévère.

In order to assess the influence of severe chronic obstructive pulmonary disease on the pulmonary morbidity and mortality following transhiatal oesophagectomy, the authors reviewed 136 consecutive patients who underwent oesophageal cancer resection by a transhiatal approach. Nineteen patients had a forced expiratory volume in one second (FEV) lower than 60% of the theoretical value, indicating severe chronic obstructive pulmonary disease. The other group of 117 patients had a FEV higher than 60% of the theoretical value. Pulmonary complications occurred in 36 patients: 23 (64%) were minor and 13 (36%) were major. Severe chronic obstructive pulmonary disease did not significantly increase pulmonary morbidity. However, pulmonary complications occurring in this group of patients appeared more severe with a significant increase in major pulmonary complications (21% versus 8%, p = 0.05) and respiratory mortality rates (10% versus 1.6%, p = 0.04). One factor was significantly correlated to respiratory mortality: age higher than 75 years (p = 0.006). Severe chronic obstructive pulmonary disease does not constitute a contraindication for transhiatal oesophagectomy. However, this approach should be reserved for patients under 75 years of age, in order to obtain respiratory morbidity and mortality rates comparable to those of patients with normal spirometry.