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PubMed2006

Early ligation of the splenic artery in the leaning spleen approach to laparoscopic splenectomy.

BACKGROUND: A variety of approaches have been proposed for laparoscopic splenectomy, including the anterior approach, the lateral approach (hanging spleen technique), and the semilateral approach (leaning spleen technique). We advocate a leaning spleen approach with early ligation of the splenic artery. MATERIALS AND METHODS: Since 1997, we have performed 120 laparoscopic splenectomies using the leaning spleen approach along with early ligation of the splenic artery. The patient is placed in a 70-degree semi-right lateral position. The operative steps are: exposure of the lesser sac, control of the splenic artery, mobilization of the splenic flexure, division of the splenocolic ligament, division of the splenophrenic ligament, hilar mobilization, mobilization of the upper pole of the spleen, and removal of the specimen. RESULTS: The most common indication for surgery was autoimmune hemolytic anemia (35.8%). One patient had severe perisplenitis with extensively vascularized adhesions, which led to oozing during surgery obscuring the laparoscopic view, requiring conversion to open surgery. The mean spleen diameter was 22.8 cm (range, 12.5-37.0 cm) on imaging. The mean operative time was 85 minutes (range, 54-124 minutes). Concomitant laparoscopic cholecystectomy for pigment stone cholelithiasis was performed in 8.3% of the patients. Accessory splenic tissue was found in 4.2%. The average hospital stay was 3 days (range, 1-6 days). There were no significant postoperative complications. The average follow-up has been 5.4 years (range, 1 month-9 years). CONCLUSION: In adopting the modification of early ligation of the splenic artery in the leaning spleen approach, we believe we have helped to advance laparoscopic splenectomy.

Anemia, Hemolytic, Autoimmune↗
PubMed1984

In vitro culture of coxsackievirus group B, type 3 immune spleen cells on infected endothelial cells and biological activity of the cultured cells in vivo.

Spleen cells from male BALB/c mice infected 7 days earlier by an intraperitoneal injection of 3 X 10(4) PFU of a myocarditic strain of coxsackievirus B-3 lysed virus-infected endothelial cells in a 51Cr release assay. Cytotoxic activity in the in vivo sensitized spleen cell population could be further increased by culturing the immune spleen cells from infected mice on virus-infected or uninfected endothelial cells for 6 to 7 days in vitro. Cytotoxicity of in vitro cultured spleen cells to infected targets was mediated by T lymphocytes since reactivity was abolished by treatment of the spleen cells with anti-thy 1.2 serum and complement. Reciprocal assays with BALB/c and C57BL cells indicated that maximum cytotoxicity occurred when spleen cells were sensitized on syngeneic endothelial cells. Other experiments showed that spleen cells sensitized to coxsackievirus B-3 or encephalomyocarditis virus were selectively cytolytic to targets infected with the homologous virus. Adoptive transfer of T cells cultured in vitro on infected endothelial cells retained their ability to induce myocarditis in T-lymphocyte-deficient mice.

Animals↗
PubMedDate not supplied

MR imaging of the spleen: spectrum of abnormalities.

The spleen has the same relationship to the circulatory system that the lymph nodes have to the lymphatic system. A wide range of diseases can affect the spleen. Pathologic conditions of the spleen can be classified into the following categories: congenital diseases (accessory spleen, polysplenia, and asplenia); trauma; inflammation (abscess, candidiasis, histoplasmosis, and sarcoidosis); vascular disorders (infarction, diseases affecting the splenic vasculature, and arteriovenous malformation); hematologic disorders (sickle cell disease and extramedullary hematopoiesis); benign tumors (cysts, hemangioma, diffuse hemangiomatosis of the spleen, and hamartoma); malignant tumors (sarcoma, lymphoma, and metastases); and other disease processes that affect the spleen diffusely (portal hypertension, Gaucher disease, and sickle cell disease) or focally (Gamna-Gandy nodules). New magnetic resonance (MR) imaging techniques have increased the role of MR imaging in detection and characterization of splenic diseases. MR imaging is an excellent tool for diagnosis and evaluation of focal lesions and pathologic conditions of the spleen.

Humans↗
PubMed2000

Multimodality management in severe pediatric spleen trauma.

BACKGROUND: Trauma is the leading cause of death in children. In abdominal lesions the spleen is the most commonly involved organ. During the last two decades much effort has focused on spleen tissue conservation. OBJECTIVES: To analyze the rationale of a multimodality management policy that includes autotransfusion and mesh wrapping. METHODS: Data gathered over 14 years illustrate the introduction of new techniques and their impact on cases of severe spleen rupture. RESULTS: A total of 122 children were treated during the 14 year period, 1985-98. In 16 children an absorbable mesh wrapping, alone or in combination with other techniques, was used to obtain hemostatis and save spleen tissue. CONCLUSIONS: Mesh wrapping, partial splenectomy and autotransfusion can be used, alone or in combination, to preserve severely injured spleens. According to our records, all children survived with a functional spleen. There were no cases of rebleeding. In only one case of prolonged postoperative fever could the cause be traced to an infected spleen hematoma that was drained transcutaneously. Autotransfusion is performed simply and without the use of a "cell saver." Its use can be crucial in small or field hospitals or in a situation of mass casualty.

Adolescent↗
PubMedDate not supplied

[Hamartoma of the spleen].

Hamartoma is a rare benign lesion of the spleen. Between 140 and 150 cases seem to have been described so far. Hamartoma of the spleen may appear as a single or multiple lesions which may tend to converge. It appears in all ages, mainly in elderly persons. About 20% of patients were described in paediatric subjects. Half of the patients have no symptoms, so that hamartomas were discovered by chance at autopsy. Other 50% of patients had pain, splenomegaly, haematologic abnormalities (most frequently thrombocytopenia or pancytopenia) and spontaneous rupture with intra-abdominal bleeding. In children, hamartoma of the spleen with haematologic abnormalities may be followed by growth retardation, frequent infections, fever and night sweating. The bigger the hamartoma the greater probability to cause symptoms. The exact preoperative diagnosis is rarely established. Hamartoma has to be taken into account always when tumour of the spleen is diagnosed, particularly in children. Splenectomy is the most frequent treatment of symptomatic hamartoma of the spleen. Partial splenic resection is the preferred surgery whenever it may be carried out, particularly in children. We report a 58 year old woman with a five-year history of left subcostal and lumbar pain in whom in the lower pole of moderately enlarged spleen a tumorous mass, 107 x 75 mm in diameter, was discovered on ultrasonography. She was submitted to splenectomy as well as to cholecystectomy due to gall bladder stones. Histological findings of the spleen showed hamartoma. She had an uneventful recovery. The pain disappeared after surgery. She stayed symptom free so far.

Female↗
PubMed2002

[Establishment and characteristics of orthotopically transplanted model of human primary malignant spleen lymphoma in nude mice].

OBJECTIVE: To establish three orthotopically transplanted model of human primary malignant spleen lymphoma in the nude mice. METHODS: Orthotopic transplantation of histologically intact human primary malignant splenic lymphoma tissue obtained from patients was introduced into the splenic parenchyma of nude mice. Tumorigenicity, invasion, metastasis and morphological characteristics of the transplanted tumor were studied by light microscopy, electron microscopy and immunohistochemical methods. RESULTS: The first kind, a strain of human primary malignant spleen lymphoma (non-Hodgkin's, cleaved B cell, BFNHL-HMN-1) screened from 11 patients which had been passaged in vivo for 41 generations, a second kind, a liver metastasis model of human primary malignant spleen lymphoma (non-Hodgkin's, cleaved B cell, LM-BFNHL-HMN-2) which had been passaged for 47 generations and a third kind of human primary malignant spleen lymphoma (non-Hodgkin's, T-immunoblastic cell, TINHL-HMN-3) having passaged for 37 generations were all successfully transplanted in 611 nude mice. Models of BFNHL-HMN-1 and TINHL-HMN-3 tumor gave nodular growth and lymph node metastasis in the spleen hilum but without any metastasis in the abdominal lymph nodes or organs. In the LM-BFNHL-HMN-2 model, not only did the tumor cells grow in the spleen, but in spleen hilum, lymph nodes and liver also. The orthotopically transplanted tumor cells were similar to the original human tumor in light histopathology, ultrastructure features, DNA content and chromosomal karyotype. CONCLUSION: These three models are able to serve as useful tools for the study of biologic characteristics and experimental treatment of human primary malignant lymphoma.

Animals↗
PubMed1992

The clinical spectrum of lymphangiomas and lymphangiomatosis of the spleen.

Lymphangiomas of the spleen are infrequent neoplasms of the spleen with clinical manifestations ranging from insignificant incidental findings to large, symptomatic cystic masses requiring surgical intervention. An associated syndrome may be lymphangiomatosis, in which the lymphangiomatous process involves other sites or organs, such as the liver, spleen, axilla, and mediastinum. Vasoformative neoplasms (hemangioma, lymphangioma) are relatively uncommon tumors or hamartomas of the spleen. Although well reported in the literature, their surgical significance is not well recognized. These lesions present a broad spectrum of pathologic findings of varied surgical importance. As incidental findings, they may be mistakenly considered as a valid indication for splenectomy. On the contrary, more extensive involvement of the spleen may cause symptomatic splenomegaly, which is a valid indication for splenectomy. When the spleen is diffusely involved (lymphangiomatosis), it may be part of a syndrome of generalized lymphangiomatosis involving structures and organs other than the spleen. This syndrome should be considered in obscure cases of splenomegaly in which the usual hematologic causes have been ruled out.

Adult↗
PubMedDate not supplied

[Uncommon etiology of acute abdomen in pediatric age: the torsion of spleen].

The torsion of spleen on its vascular shank represents an uncommon problem, responsible of acute and chronic pain. The mobile spleen is fixed only through hilus vessels the gastrosplenic ligament. The incidence is unknow, greater in the male with an M:F ratio 6.1 in the first ten years of life, even if an episode of intrauterine torsion has been reported. The diagnosis can be performed with ultrasonography, angiography, scintigraphy and CT scan. There are reported two cases: male of 2.5 years female of 14 years who presented with recurrent pain to the left side, vomit diarrhoea and fever. Objectively a palpable mass was present. Ultrasonography and angio-CT scan of abdomen revealed splenomegaly, ptosis of the spleen and malrotation with signs of obstruction of the vessels. The treatment in both cases was splenectomy. The spleen appeared rotated on its shank and increased of volume, deprived of anatomical structures of fixation. The histological report confirmed the haemorrhagic infarction. The excessive mobility of the spleen, from insufficiency or absence of the ligamentous attachments is case of abdominal pain or acute abdomen, that can complicate with the infarction of the spleen. Angio-CT scan, in the cases here reported, has shown to greater sensibility in comparison to the ultrasonography. The Authors believe that the video-laparoscopic splenopexy, when the diagnosis is made of "wandering spleen" with painful repeated episodes, can be finalized, to the preservation of organ.

Abdomen, Acute↗
PubMed1990

The ruptured spleen. A histological, morphometrical and immunohistochemical study.

A traumatically ruptured spleen is regarded as a proper control in many histological and immunological studies on the human spleen. This paper compares spleens that ruptured due to trauma and spleens which were removed during surgery in patients without splenic pathology. Based on a histological, morphometrical, and immunohistochemical description of the control spleens it is shown that the traumatically ruptured spleens contain alterations in the lymphoid tissue. The amount of white pulp is increased due to a larger amount of CD4-positive lymphocytes. Furthermore there are alterations in lymphocyte populations in the different splenic compartments. It is concluded that spleens that rupture may be predisposed due to immunological stimulation.

Antigens, CD↗
PubMed1981

Absorption of normal lymphocytes on allogeneic spleen monolayers: depletion of alloreactivity is due to inhibition of CTL induction by released monolayer cells.

A technique for the haplotype-specific depletion of precursors of alloreactive cytolytic T lymphocytes (CTL-P) by absorption of unprimed spleen cells on allogeneic lymphocyte monolayers has been examined. When H-2d spleen cells were incubated on monolayers of H-2b spleen cells and the nonadherent cells were cultured in mixed leukocyte culture (MLC), CTL activity generated against the monolayer haplotype was 30- to 1000-fold lower than the equivalent cultures of unabsorbed H-2d cells. Cytolytic reactvity to a 3rd-party haplotype, H-2k, was reduced no more than 6-fold. However, culture of the same cells at limiting dilution indicated that the frequency of CTL-P against the monolayer haplotype in monolayer-nonadherent H-2d populations was not significantly different from the frequency in normal H-2d spleen. It was noted that MLC of monolayer-nonadherent H-2d populations were highly cytolytic for H-2d target cells. This reaction was reduced and the ability to generate anti-H-2b CTL was restored when the nonadherent cells were treated with anti-H-2b antibody and complement to eliminate contaminating monolayer cells released during absorption, and when monolayers were prepared from spleen cells depleted of Lyt 2-bearing cells (and hence CTL-P). These data suggested that the reduction in anti-H-2b reactivity of monolayer-nonadherent cells in MLC was due to inhibition by the competing anti-H-2d reaction of contaminating, monolayer-derived CTL-P. Although fluorescent labeling of monolayer cells indicated that these cells represented only 10% of the nonadherent population, flow cytometry and further limiting dilution analysis demonstrated that cells that detached from H-2b monolayers during absorption were enriched 2-fold in T lymphocytes and CTL-P over normal spleen. The strength of the anti-H-2d reaction by a minority of monolayer cells can thus be attributed both to the higher frequency of H-2b anti-H-2d than H-2d anti-H-2b CTL-P in spleen populations and to the preferential detachment of monolayer T lymphocytes during absorption.

Absorption↗
PubMed1997

C3H mice have larger spleens, lower platelet counts, and shorter platelet lifespans than C57BL mice: an animal model for the study of hypersplenism.

Several studies have shown that C3H mice have a modal megakaryocyte ploidy class of 32N as opposed to the 16N found in all other mouse strains tested. In addition to higher megakaryocyte DNA content, C3H mice are characterized by greater 35S-sulfate incorporation into platelets but somewhat lower platelet counts than C57BL mice. The aim of this study was to determine the etiology of mild thrombocytopenia in C3H mice. Several studies have indicated that an increase in platelet 35S incorporation parallels increased megakaryocyte ploidy. Thus the higher 35S incorporation by C3H mouse platelets is likely related to their higher megakaryocyte ploidy, but these differences do not explain the lower platelet counts observed in C3H mice. To elucidate the paradox of relatively low platelet counts in C3H mice despite elevated platelet 35S incorporation, we performed a hematological evaluation (including assessment of platelet counts and lifespans) and measured (relative) spleen size in C3H and C57BL mice. Our data confirm earlier reports of significantly lower platelet counts in C3H mice (p < 0.0005) compared with C57BL mice. We also found that C3H mice have larger spleens (p < 0.0005) than C57BL mice. Other groups of C3H and C57BL mice were splenectomized to determine the role of the spleen in decreasing platelet counts in C3H mice compared with C57BL mice. C3H mice had an average platelet lifespan of 4.8 days, which was significantly shorter (p < 0.01) than the 5.7-day platelet lifespan observed in normal C57BL mice. Platelet lifespans for splenectomized C3H mice were significantly (p < 0.005) longer than those found in intact C3H control mice, but splenectomy of C57BL mice had no effect on their platelet lifespans (p < 0.40). The lengthened platelet lifespans of splenectomized C3H mice indicate that the spleens of C3H mice were sequestering or destroying platelets at a faster rate than the spleens of C57BL mice. These data lead to the hypothesis that the relatively large spleens of C3H mice produce mild thrombocytopenia with increased platelet production (shorter platelet lifespan) compared with spleens of C57BL mice.

Animals↗
PubMed1964

THE DIFFERING SURVIVAL OF NORMAL AND SENSITIZED SPLEEN CELLS TRANSFERRED TO ALLOGENEIC HOSTS.

Normal and isoimmune C(3)H and C57BL spleen cells were transferred intravenously into normal and irradiated allogeneic recipients and the fate of the donor cells determined by differential cytotoxicity and radioautographic techniques. It was found that spleen cells sensitized against their prospective recipients could be identified in the host's spleen for 1 day, whereas normal donor cells survived 2 to 3 days. Spleen cells presensitized with an indifferent antigen had survival times similar to normal donor cells. Irradiation of the recipients prior to cell transfer eliminated any difference in survival times between normal and presensitized donor cells in allogeneic hosts. It is concluded that the host plays an important role in the rapid destruction of spleen cells presensitized against host antigens. Experiments in which sensitized and normal C57BL spleen cells were mixed and transferred into normal C(3)H mice indicated that as little as 5 to 10 per cent of the donor cell population need be sensitized for the entire mixture to behave as if it were obtained from a sensitized animal, as shown by its elimination in the 1-day interval.

Animals↗
PubMed1988

Conservation of the spleen with distal pancreatectomy.

This report describes a rapid, easy, and safe means of saving the spleen while resecting or fully mobilizing the pancreatic tail. The pancreas is separated from the spleen by dividing the splenic artery and vein distal to the tip of the pancreas. The spleen survives on the short gastric vessels, which are carefully preserved. The technique has been applied successfully in 22 of 25 consecutive patients with chronic pancreatitis (n = 13), acute pancreatitis and pancreatic necrosis (n = 3), cystic neoplasm of the pancreas (n = 4), islet cell tumor (n = 2), and ductal adenocarcinoma (n = 3). The spleen could not be saved in three patients because of splenic hilar involvement by tumor or scar. Normal postoperative blood cell counts and spleen scans proved splenic viability and function. There was only one complication, a late splenic abscess that developed in a spleen of twice-normal size. It is concluded that in most instances the distal pancreas can be mobilized for resection or inspection without the need for splenectomy. Splenomegaly may be a contraindication because the short-vessel gastric blood supply may be inadequate to nourish the increased tissue mass. The technique is applicable to the treatment of pancreatic tumors, trauma, and pancreatitis.

Humans↗
PubMed1976

Use of the dog spleen for studying effects of irradiation and chemotherapeutic agents, with suggested uses of other organs.

The irradiation of the exteriorized spleen of the dog, with the animal lead-shielded, produced constant changes in the white blood cells. The time of recovery from the irradiation effect was determined. The normal canine spleen could handle live pneumococci injected into the splenic artery, as proven by sterile cultures of splenic vein samples. The size of the bolus used was determined by repeated trials and proved to be one billion pneumococci per pound of body weight. The capacity of the irradiated spleen to handle this number of pneumococci was impaired. It was found that whole body irradiation, nitrogen mustard, thio-tepa, cyclophosphamide, methotrexate, 5-fluorouracil, vinblastine, and azothioprine all impaired this capacity of the spleen. The dose of the chemotherapeutic agent was the same in milligrams per kilogram as that used in the cancer clinic. A method for determining the recovery time following the use of one or more agents was developed with the repeated use of the spleen model. By extending the methods used with the spleen it was found that similar use could be made, usually without surgery, of the liver, gut, and lungs (and probably the kidney and brain).

Animals↗
PubMed1976

Arteriovenous shunts in the human spleen.

The mission of this study was to determine whether or not arteriovenous connections, indicative of a "closed" type of circulation, existed in the human spleen. Spleens from four patients requiring therapeutic splenectomy were the basis for this report. Scanning electron microscopy of plastic corrosion casts, prepared from these four spleens, revealed direct vascular conduits between splenic pulp arteries or arterial capillaries and the venous sinuses in the red pulp. Also demonstrated were a few arteriovenous shunts between pulp arteries or arterial capillaries and pulp or trabecular veins. Inclusion of sized microspheres in low-viscosity perfusion plastic illustrated that some diameters of the connecting shunts were 7-10 mum, with other shunts even smaller. Not only do arteriovenous connections exist in human spleens, but their frequency, as revealed by methods accentuating three-dimensional aspects of the splenic microcirculation, justify future reconsiderations of the functional significance of this closed type of circulation. Examination of samples of the same intact spleens, prepared by freeze-fracture and conventional critical-point drying, also revealed an "open" type circulation structure, namely, pore-patterned sinus walls that could facilitate blood cell movement from pulp cords into venous sinuses. Scanning electron microscopy thus has provided direct evidence that human spleens have both "open" and "closed" circulatory pathways in their microvasculature.

Arteriovenous Anastomosis↗
PubMed1978

Surface morphology of bone marrow lymphocytes. I. Scanning electron microscopy of small lymphocytes bone marrow and spleen.

Cell separation techniques and scanning electron microscopy (SEM) were used to characterize the surface morphology of small lymphocytes in mouse bone marrow. Lymphocyte-rich fractions and unfractionated suspensions of bone marrow and spleen cells from 9--10-week-old C3H male mice were glutaraldehyde-fixed, syringed onto gelatin-coated silver membranes, dehydrated in ethanol, infiltrated with amyl acetate, critical point dried, coated with gold-palladium and examined by SEM. High proportions of cells were retained on the membranes. Purified spleen small lymphocytes showed unimodal distribution curves for cell diameter (mode, 3.4 micrometer) and for number of surface microvilli (mode, 55--60). Bone marrow small lymphocytes were identified initially in lymphocyte-rich marrow fractions and in erythroblast-depleted marrow from polycythemic mice as well as in normal whole marrow. The cells resembled spleen small lymphocytes in size distribution and they showed microvilli. However, the number of visible microvilli was lower on small lymphocytes in the bone marrow (mode, 35--40) than in the spleen. While in each small lymphocyte population the total number of microvilli was greater on larger cells than on smaller ones, the density of microvilli per unit area of cell surface tended to decrease with increasing cell size. The results establish that the small lymphocytes in mouse bone marrow, mainly locally-produced immature cells, have villous surfaces, but the number of microvilli per unit cell surface area is less than that on peripheral small lymphocytes, as seen in the spleen. Neither in the bone marrow nor in the spleen are subpopulations of small lymphocytes distinguishable solely by numbers of microvilli. The findings suggest that microvilli on bone marrow small lymphocytes may undergo further development during post-mitotic maturation, surface receptor expression and migration of the cells to peripheral lymphoid tissues.

Animals↗
PubMed1989

Primary in situ immune response in popliteal lymph nodes and spleen of mice after subcutaneous immunization with thymus-dependent or thymus-independent (type 1 and 2) antigens.

Mice were immunized subcutaneously with thymus-independent (TI)-type 1 antigen trinitrophenylated lipopolysaccharide (TNP-LPS), TI-type 2 antigen TNP-Ficoll or thymus-dependent (TD) antigen TNP-keyhole limpet haemocyanin (TNP-KLH) in order to study the primary in situ immune response in popliteal lymph nodes (PLN) and spleen. The spleen responded more rapidly in developing specific antibody-forming cells (AFC) than the lymph nodes did, in spite of the fact that antigens reach the spleen only after passing several lymph node stations. This difference between lymph nodes and spleen in developing AFC was particularly significant with respect to the responses to TI (both type 1 and type 2) antigens. No differences in the distribution of specific AFC in PLN and spleen were observed after immunization with TI and TD antigens. Results are discussed with respect to the relative contributions of lymph nodes and spleen to immune responses to antigens injected subcutaneously.

Animals↗
PubMed1978

Primary in vitro antibody formation in the rat: partial characterization and properties of an inhibitor cell present in normal spleen.

Rat spleen cells are shown to be unresponsive to sheep red cells (SRBC) in vitro under conditions in which thoracic duct lymphocytes (TDL) respond very well. By adding unresponsive spleen cells to responsive TDL cultures, the spleen cells are shown to contain an inhibitor capable of preventing the response to SRBC. The inhibitory activity is a property of live cells; it is sensitive to radiation doses as low as 100 R x rays and to mitomycin C. It can be completely removed from spleen cell suspensions by extraction with large amounts of carbonyl iron or by filtration through nylon wool columns. It is less efficiently removed by filtration through Sephades G-10 columns, and is completely resistant to the cytotoxic effects of silica. From a practical point of view, extraction of a spleen cell suspension with carbonyl iron is a useful method of obtaining fully responsive lymphocyte populations from rat spleen.

Animals↗