Sir,-the spec trums of find ings in volv ing spleen dur ing an acute pan cre ati tis ep i sode in clude intrasplenic pseudocyst, splenic abscess, in flam ma tion of the splenic ves sels and pseudoaneurysms, splenic in farc tion, splenic hem or rhage, hematoma and rup ture [Fish man et al. 1995]. Al though sub capsular splenic hematoma and lim ited parenchymal le sions prob a bly re solve spon ta ne ously, any case of splenic rup ture re quires sur gery [Roderick et al. 1977]. A 65-year-old man un der chronic hemodialysis for the last 2 years was ad mit ted to our de part ment be cause of up per ab dom i nal pain the last 24 hours. The pa tient had a history of re cur rent ep i sodes of acute pan cre atitis dur ing the last 3 years. There was no ev idence of intrasplenic ab nor mal ity, biliary tract lithiasis, re cent ab dom i nal trauma nor his tory of al co hol abuse. Clin i cal ex am i nation re vealed up per left quad rant ten der ness, de creased bowel move ments and fe ver up to 40 °C. Lab o ra tory ex am i na tion showed anemia, leucocytosis and a 6-fold se rum am y lase in crease. Con ser va tive treat ment was started, but on day 6 the pa tient be came hypotensive. Com puted to mog ra phy showed hemoperitoneum due to splenic subcapsular hematoma rup ture (Fig ure 1) and splenectomy was performed with peritoneal drain age. Pa tient recov ered to tally on day 14 and lives on in good health in the 2-year fol low-up. Lab o ra tory di ag no sis of pan cre ati tis in ure mia by means of se rum pan cre atic en zyme de ter mi na tion is dif fi cult, be cause in uremic pa tients, am y lase se rum lev els may rise in the ab sence of acute pan cre ati tis. In these in
The effectiveness as well as the metabolic effects of the combination of diuretics [hydrochlorothiazide (HCT) vs indapamide (IND)] and perindopril (P) in 14 patients (7 male, 7 female) aged 37-62 years with mild idiopathic hypertension were studied. Following a 4-week washout period and a 4-week period of monotherapy with P (4 mg/daily), IND (2.5 mg/daily) or HCT (25 mg/daily) was added for 4 weeks. Selection of the diuretic agent was random. Following a 4-week wash-out period from the diuretic, in which only P was given, the alternative diuretic was administered for another period of 4 weeks. P decreased blood pressure levels significantly. However, the drug was more efficacious in patients with higher plasma renin activity (PRA). Combination treatment induced an additional decrease in the blood pressure levels, mainly in patients with lower PRA. The combination of P ؉ HCT was more effective than the combination P ؉ IND. The addition of either HCT or IND
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