Reviewer's report
Title:Life-threatening hypersplenism due to idiopathic portal hypertension in
early childhood: Case report
Version: 2Date:29 March 2010
Reviewer: jean de Ville de goyet
Reviewer's report:
Case report type paper; the authors present a patient with a remarkable clinical
presentation, being massive splenomegaly and secondary ipersplenism causing
a lifethreatining clinical condition, mostly ventilation failure by abdominal
distension and diafragmatic compression. They hypothetised idiopathic portal
hypertension as primary disease,with splenectomy being the radical and
complete treatment.
Major Compulsory Revisions:
They are few contradictions or inconcistencies:
- With the primary diagnosis in this child being idiopathic portal hypertension, it is
a requisite to demonstrate that there was an increase in portal pressure: there is
in fact no evidence at all in the paper that portal pressure was high. A grade 1
gastropathy is - per se and in the critical condition of the child - not indicative of
portal hypertension, when all other facts do not support the latter hypothesis.
- The authors refers to the size of portal vein (that is within the normal range for
age!) and hyperdynamic state as a sign of portal hypertension when in fact they
write also "absence of formally abnormal portal vein flow on Doppler Ultrasound"
- Splenomegaly per se is not a sign of portal hypertension, as is not
Hepatomegaly.
- In the worse condition of portal hypertesnion, splenomegaly develops
moderately with time and never causes such rapidly progressing organomegaly
in children; The latter rapid development suggest rather a malformative growth.
Vascular malformations and angiomas typically grow rapidly during early
childhood and some can be associated with major trombopenia and coagulation
disorders causing hemorrhagic diathesis. Even the results of immunochemistry
would be consistent within the latter context.
- Overall, the authors cannot prove that portal hypertension was present and this
is major weakness in discussing the case as presented; they may have faced a
condition with a primary disorder of the spleen causied secondary ipersplenism
and abdominal compression, and of course a resolution of the symptoms after
splenectomy.
Minor Essential Revisions
The terminology "Banti syndrome", a term mostly used in the past to describe
any condition with splenomegaly of uncertain origin, has been quasi abandonned
in literature and nearly disappeared from papers a decade ago. It is nowadays
accepted that in most cases portal hypertension had a specific, but
unrecognised, cause.
Discretionary Revisions
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Life-threatening hypersplenism due to idiopathic portal hypertension in
early childhood: Case report
Version: 2Date:29 March 2010
Reviewer: jean de Ville de goyet
Reviewer's report:
Case report type paper; the authors present a patient with a remarkable clinical
presentation, being massive splenomegaly and secondary ipersplenism causing
a lifethreatining clinical condition, mostly ventilation failure by abdominal
distension and diafragmatic compression. They hypothetised idiopathic portal
hypertension as primary disease,with splenectomy being the radical and
complete treatment.
Major Compulsory Revisions:
They are few contradictions or inconcistencies:
- With the primary diagnosis in this child being idiopathic portal hypertension, it is
a requisite to demonstrate that there was an increase in portal pressure: there is
in fact no evidence at all in the paper that portal pressure was high. A grade 1
gastropathy is - per se and in the critical condition of the child - not indicative of
portal hypertension, when all other facts do not support the latter hypothesis.
- The authors refers to the size of portal vein (that is within the normal range for
age!) and hyperdynamic state as a sign of portal hypertension when in fact they
write also "absence of formally abnormal portal vein flow on Doppler Ultrasound"
- Splenomegaly per se is not a sign of portal hypertension, as is not
Hepatomegaly.
- In the worse condition of portal hypertesnion, splenomegaly develops
moderately with time and never causes such rapidly progressing organomegaly
in children; The latter rapid development suggest rather a malformative growth.
Vascular malformations and angiomas typically grow rapidly during early
childhood and some can be associated with major trombopenia and coagulation
disorders causing hemorrhagic diathesis. Even the results of immunochemistry
would be consistent within the latter context.
- Overall, the authors cannot prove that portal hypertension was present and this
is major weakness in discussing the case as presented; they may have faced a
condition with a primary disorder of the spleen causied secondary ipersplenism
and abdominal compression, and of course a resolution of the symptoms after
splenectomy.
Minor Essential Revisions
The terminology "Banti syndrome", a term mostly used in the past to describe
any condition with splenomegaly of uncertain origin, has been quasi abandonned
in literature and nearly disappeared from papers a decade ago. It is nowadays
accepted that in most cases portal hypertension had a specific, but
unrecognised, cause.
Discretionary Revisions
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Life-threatening hypersplenism due to idiopathic portal hypertension in
early childhood: Case report
Version: 2Date:29 March 2010
Reviewer: jean de Ville de goyet
Reviewer's report:
Case report type paper; the authors present a patient with a remarkable clinical
presentation, being massive splenomegaly and secondary ipersplenism causing
a lifethreatining clinical condition, mostly ventilation failure by abdominal
distension and diafragmatic compression. They hypothetised idiopathic portal
hypertension as primary disease,with splenectomy being the radical and
complete treatment.
Major Compulsory Revisions:
They are few contradictions or inconcistencies:
- With the primary diagnosis in this child being idiopathic portal hypertension, it is
a requisite to demonstrate that there was an increase in portal pressure: there is
in fact no evidence at all in the paper that portal pressure was high. A grade 1
gastropathy is - per se and in the critical condition of the child - not indicative of
portal hypertension, when all other facts do not support the latter hypothesis.
- The authors refers to the size of portal vein (that is within the normal range for
age!) and hyperdynamic state as a sign of portal hypertension when in fact they
write also "absence of formally abnormal portal vein flow on Doppler Ultrasound"
- Splenomegaly per se is not a sign of portal hypertension, as is not
Hepatomegaly.
- In the worse condition of portal hypertesnion, splenomegaly develops
moderately with time and never causes such rapidly progressing organomegaly
in children; The latter rapid development suggest rather a malformative growth.
Vascular malformations and angiomas typically grow rapidly during early
childhood and some can be associated with major trombopenia and coagulation
disorders causing hemorrhagic diathesis. Even the results of immunochemistry
would be consistent within the latter context.
- Overall, the authors cannot prove that portal hypertension was present and this
is major weakness in discussing the case as presented; they may have faced a
condition with a primary disorder of the spleen causied secondary ipersplenism
and abdominal compression, and of course a resolution of the symptoms after
splenectomy.
Minor Essential Revisions
The terminology "Banti syndrome", a term mostly used in the past to describe
any condition with splenomegaly of uncertain origin, has been quasi abandonned
in literature and nearly disappeared from papers a decade ago. It is nowadays
accepted that in most cases portal hypertension had a specific, but
unrecognised, cause.
Discretionary Revisions
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
assistant