[A boy with a spontaneous rupture of the spleen; a complication of infectious mononucleosis]. / Een jongen met een spontane miltruptuur.

BACKGROUND: Spontaneous rupture of the spleen occurs in 0.1-0.2% of patients with infectious mononucleosis and is associated with a high mortality (9-13%). Rupture is not normally preceded by a trauma. CASE DESCRIPTION: A previously healthy 17- year-old boy presented at the Emergency Department with acute onset of pain in his left upper abdomen and left shoulder. Initially he showed no signs of shock, but he did have signs of an acute abdomen. In addition, spots of pus were seen on both pharyngeal arches. Urgent ultrasound showed free fluid in his abdomen, and CT scan revealed active bleeding from the spleen. The patient underwent embolisation of the splenic artery. Serological investigations were positive for a recent infection with the Epstein-Barr virus. CONCLUSION: In young patients with signs of acute abdomen and pharyngitis, in the absence of prior trauma, spontaneous rupture of the spleen should be considered. The severity of a rupture of the spleen may initially be underestimated as haemodynamic instability and signs of shock occur only at a late stage.

Short-term Results of the RAPID Randomized Trial of the Legflow Paclitaxel-Eluting Balloon With Supera Stenting vs Supera Stenting Alone for the Treatment of Intermediate and Long Superficial Femoral Artery Lesions.

PURPOSE: To report a randomized trial comparing the Legflow paclitaxel-eluting balloon (PEB) + Supera stenting to Supera stenting alone in patients with intermediate to long superficial femoral artery (SFA) lesions. METHODS: The multicenter RAPID trial ( controlled-trials.com ; identifier ISRCTN47846578) randomized (1:1) 160 patients (mean age 67 years; 102 men) with Rutherford category 2-6 ischemia to treatment with Legflow PEB + Supera stent or Supera stent alone in intermediate to long SFA lesions (mean lesion length 15.8±7.4 vs 15.8±7.6 cm, respectively). The efficacy outcome was primary patency, defined as freedom from restenosis on duplex ultrasound or angiography. RESULTS: Baseline characteristics including the percentage of occlusions were similar between groups. In the intention-to-treat analysis, the estimated primary patency at 1 year was 68.3% (95% CI 56.7% to 79.9%) in the PEB + Supera group vs 62.0% (95% CI 49.1% to 74.9%) in the Supera group (p=0.900). Per-protocol analysis showed a 12-month primary patency estimate of 74.7% (95% CI 63.1% to 86.3%) in the PEB + Supera group vs 62.0% (95% CI 49.1% to 74.9%) in the control group (p=0.273). Secondary patency estimates at 12 months (per-protocol analysis) were 89.0% (95% CI 80.6% to 97.4%) vs 98.0% (95% CI 94.1% to 100%; p=0.484); the estimates for freedom from clinically driven target lesion revascularization (CD-TLR) were 83.0% (95% CI 72.8% to 93.2%) and 77.8% (95% CI 66.6% to 89.0%; p=0.277), respectively. CONCLUSION: The short-term results from the multicenter RAPID randomized controlled trial indicate that the Legflow PEB is safe and feasible for the treatment of intermediate to long SFA lesions. In this trial, at least 70% of the patients suffered an occlusion. The PEB group had higher rates of primary patency and freedom from CD-TLR, although there were no statistically significant differences vs controls.