Reviewer's report
Title:Life-threatening hypersplenism due to idiopathic portal hypertension in
early childhood: Case report
Version: 2Date:7 April 2010
Reviewer: moritz M ziegler
Reviewer's report:
Major Revisions:
1.The author's have concluded that management of IPH may best be done by
splenectomy when secondary sequestration is a complication and the
normalization of the liver and disease process has indicated the role of the
spleeen in its etiology. However, the author's have made no mention of the
well-described observation that splenectomy or even spelenic transposition may
be an effective treatment of portal hypetension alone, and the reduction in the
degree of flow thru the spleen into the portal circulation would be expected to
enhance liver function and reduce portal pressures post-splenectomy
independent of any causality of the spleen and IPH. eNOS, VCAM-1, and ET-1
may play a role in the pathogenesis of IPH, but it is equally plausible that the
author's are reporting a secondary benefit of splenectomy in portal hypertension
reducuing portal pressures. This requires elaboration in the manuscript.
2. The author's have made no mention of the possible role of partial
spelencectomy in this IPH disease management. This would hve the benefit of
treating the high-flow portal state yet salvagng portion of the spleeen for
protecting the infant form blood post-splenectomy infections.
Minor Revisions:
1. A series of spelling and grammatical errors require correction.
Discretionary Revisions:
1. The illustrative figures and tables are valuable and add positively to the quality
of the manuscript.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
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:7 April 2010
Reviewer: moritz M ziegler
Reviewer's report:
Major Revisions:
1.The author's have concluded that management of IPH may best be done by
splenectomy when secondary sequestration is a complication and the
normalization of the liver and disease process has indicated the role of the
spleeen in its etiology. However, the author's have made no mention of the
well-described observation that splenectomy or even spelenic transposition may
be an effective treatment of portal hypetension alone, and the reduction in the
degree of flow thru the spleen into the portal circulation would be expected to
enhance liver function and reduce portal pressures post-splenectomy
independent of any causality of the spleen and IPH. eNOS, VCAM-1, and ET-1
may play a role in the pathogenesis of IPH, but it is equally plausible that the
author's are reporting a secondary benefit of splenectomy in portal hypertension
reducuing portal pressures. This requires elaboration in the manuscript.
2. The author's have made no mention of the possible role of partial
spelencectomy in this IPH disease management. This would hve the benefit of
treating the high-flow portal state yet salvagng portion of the spleeen for
protecting the infant form blood post-splenectomy infections.
Minor Revisions:
1. A series of spelling and grammatical errors require correction.
Discretionary Revisions:
1. The illustrative figures and tables are valuable and add positively to the quality
of the manuscript.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
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:7 April 2010
Reviewer: moritz M ziegler
Reviewer's report:
Major Revisions:
1.The author's have concluded that management of IPH may best be done by
splenectomy when secondary sequestration is a complication and the
normalization of the liver and disease process has indicated the role of the
spleeen in its etiology. However, the author's have made no mention of the
well-described observation that splenectomy or even spelenic transposition may
be an effective treatment of portal hypetension alone, and the reduction in the
degree of flow thru the spleen into the portal circulation would be expected to
enhance liver function and reduce portal pressures post-splenectomy
independent of any causality of the spleen and IPH. eNOS, VCAM-1, and ET-1
may play a role in the pathogenesis of IPH, but it is equally plausible that the
author's are reporting a secondary benefit of splenectomy in portal hypertension
reducuing portal pressures. This requires elaboration in the manuscript.
2. The author's have made no mention of the possible role of partial
spelencectomy in this IPH disease management. This would hve the benefit of
treating the high-flow portal state yet salvagng portion of the spleeen for
protecting the infant form blood post-splenectomy infections.
Minor Revisions:
1. A series of spelling and grammatical errors require correction.
Discretionary Revisions:
1. The illustrative figures and tables are valuable and add positively to the quality
of the manuscript.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
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.
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