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PubMedDate not supplied

[Splenectomy in idiopathic thrombocytopenic purpura].

Between January 1976 and December 1987, 44 patients with idiopathic thrombocytopenic purpura were submitted to splenectomy. This study analyzes the results of treatment and the usefulness of several prognostic markers. There were 38 female patients and six males with a median age of 28.5 years (range 11 to 66 years). Forty two out of 44 patients received preoperative steroids. Seventy five percent achieved a satisfactory response to this treatment but 31 relapsed (in eight recurrence was observed when the steroid dose was tapered). Eleven patients persisted symptomatic notwithstanding medical treatment. In two cases splenectomy was performed as an emergency procedure, and in one patient who was already in remission with previous steroid treatment, splenectomy was performed for other medical reasons. Operative mortality rate was 4 percent, and five patients developed postoperative complications (three had pneumonia, one pulmonary thromboembolism and one would infection). Eighty four percent of the patients were free of disease at one year followup survival at 10 year period was 80 percent. No correlation was found between age, duration of symptoms, previous response to steroids or time-period of medical treatment with the results obtained with splenectomy.

Adolescent↗
PubMed1990

[Splenectomy in the treatment of severe generalized myasthenia gravis (first experience)].

The authors discuss the results of splenectomy carried out on 20 patients with generalized myasthenia in whom previous complex treatment including thymectomy, corticosteroid and azathioprine therapy, repeated courses of plasmapheresis during medication with anticholinesterase agents, did not cause any essential improvement. Different values of homeostasis and immunological status were studied before and in different periods after splenectomy. The condition improved in 65% of patients, which was confirmed by the results of myography; the doses of corticosteroids and anticholinesterase agents were reduced. Bearing in mind the severe condition of patients selected for splenectomy, it is recommended to treat them only in medical centers possessing sufficient experience in treatment of myasthenia. The indications and contraindications for splenectomy in complex treatment of myasthenia must be specified further.

Adrenal Cortex Hormones↗
PubMed1989

[The role of splenectomy in patients with hepatocellular carcinoma and hypersplenism as an aid to hepatectomy].

To evaluate the clinical value of splenectomy for hepatic resection, a total of 20 patients with hepatocellular carcinoma and hypersplenism were examined focusing on a change of total serum bilirubin values after surgery. Both hepatectomy and splenectomy were simultaneously performed in 12 patients, and in 8 patients as a staged operation. Postoperatively, a significant depression of bilirubin values was observed in a group with the preoperative values between 1.0mg/dl and 2.0mg/ml. Three factors (bilirubin, albumin and prothrombin time) in clinical stage were improved just after splenectomy with a statistical significance (p less than 0.05) in a group received staged operation. In 7 out of 8 patients, clinical stages were getting better as one or two stages prior to the hepatectomies. Therefore, we recommend the addition of splenectomy to hepatectomy in the patients whose hyperbilirubinemia are assumed to be correlated with coexisting hypersplenism.

Adult↗
PubMed1989

[Segmental splenectomy. Usefulness of linear surgical staplers].

As the high risk of sepsis after splenectomy is well recognized, reliable conservative surgical techniques in splenic surgery are widely advocated. Among these, segmental splenectomy carries specific and increasing indications. The use of linear staplers makes this operation quicker and safer. On the basis of a personal observation, Authors examine the anatomical features on which this operation is based, the surgical technique and the technical details to be followed using these devices. The advantages offered by staplers in this surgery allow to widen the indications to partial splenectomy, so as to yield a true primary prophylaxis of the post-splenectomy sepsis.

Adolescent↗
PubMed1989

The impact of splenectomy on antibody response in the porcine model.

Some controversy exists regarding the antibody response after splenectomy and spleen preserving operations. In a porcine model the specific IgG antibody response to tetanus toxoid and type 6B pneumococcal polysaccharide was studied in 10 animals with splenectomy, 11 animals with splenic resection, 10 animals with splenic autotransplantation and 10 sham operated control animals. The operative groups were divided in two subgroups, receiving either the immuno adjuvant MTP-PE or the vehicle alone. Specific antibodies were determined by ELISA. Immunization with tetanus toxoid led to slightly lower peak IgG levels in splenectomized animals, but this was statistically not significant as compared to controls. In addition, the distribution of responders (78%) was not influenced by type of operation. Type 6B-pneumococcal polysaccharide proved to be a weak immunogen (19% responders). Splenectomy or spleen preserving surgery had no impact on the proportion of responders and peak IgG antibody titers of responders to this antigen. Additional administration of MTP-PE did not significantly increase the proportion of responders and had no impact on peak IgG antibody levels to tetanus toxoid and type 6B pneumococcal polysaccharide. These results show in contrast to previous studies in man, that under controlled conditions in the porcine model serum antibody responses to T-cell dependent and T-cell independent antigens are only slightly decreased by splenectomy. In addition, no effects of spleen preserving operations on antibody response are observed, and there is no change after concomitant administration of a muramyl peptide.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMedDate not supplied

[Results of splenectomy in 45 cases of idiopathic thrombocytopenic purpura: search of prognostic indices].

We report on the effects of splenectomy in 45 consecutive patients affected by idiopathic thrombocytopenia who did not obtain lasting remission with prednisone therapy. None of the patients had serious complications after surgery, and only one died a year later from an infectious disease. Two years after surgery, 89% of the patients were in remission; 79% had no therapy after splenectomy, while 10% achieved remission in response to additional medical treatment. A significantly better response to splenectomy was obtained in the subjects under 50 years old (90% remission) and by the younger patients who had had a transient response to initial prednisone therapy (100% remission). All patients with thrombocytosis 15 days after surgery were in remission two years later. We were unable to identify parameters constantly associated with a poor response to splenectomy, since at least 25% of the patients with the worst prognostic features obtained lasting remission.

Adolescent↗
PubMed1989

[Splenectomy in the treatment of idiopathic thrombocytopenic purpura].

During the period from 1985 till 1988, 48 patients with this disease were treated; in 28 patients (58%) conservatively treated with pronisone, immunated with thrombocytes that possessed onkovin, a remission had been achieved. In 20 patients (41%), following an unsuccessful conservative treatment, splenectomy was performed; of whom 14 were female (70%) and 6 were male (30%), with an average age of 36 years (between 20-52 years). Prior to that they were conservatively treated from 1-15 years (on the average 4.7 years). Despite the failure of the conservative treatment, an indication for splenectomy was the high doses of corticosteroids needed, as well as the appearance of serious unwanted effects of this therapy (ulcer, steroid diabetes, hypertension, osteoporosis), also the unsuccessful treatment with thrombocytes which carried onkovin. There was no surgical lethality; 2 female patients developed deep ileofemoral thrombophlebitis of the left leg, one 7 days, and the other 1 1/2 months following the surgery, and after an adnexoparametritis of the left side. Following intensive anticoagulant and fibrinolytic therapy, a complete recanalization of the vein was achieved in both female patients, without any signs of a postphlebitis syndrome. One patient who had previously been treated for 15 years with high doses of pronisone and persistently refused surgery during this period, followed splenectomy developed miliary tuberculosis which ended lethally 2 months following the splenectomy. In 14 patients (73.6%) a complete remission was attained. In 2 patients (10.5%) the number of thrombocytes was not necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Effects of splenectomy on changes in hemorrheologic parameters following coronary occlusion in dogs].

Effects of splenectomy on changes of hemorrheologic parameters in the early stage of myocardial ischemia were observed in dogs. The results showed that splenectomy alleviated the increase in hematocrit and high shear viscosity of whole blood (r = 230 s-1) during 120 min of myocardial ischemia induced by coronary occlusion. Splenectomy reduced the increase in low shear viscosity of whole blood (r = 5.75 s-1) at 40 min and 80 min post-occlusion, but did not affect it at 120 min post-occlusion. Splenectomy had no effect on changes in blood viscosity fibrinogen concentration and plasma viscosity following coronary occlusion.

Animals↗
PubMed1989

Splenectomy in Nigerian children with sickle cell anaemia.

A total of 4359 children with sickle cell anaemia were treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria in an eight year period 1979-1986. Of this number 4 children with hypersplenism associated with intractable complaints were offered splenectomy as the treatment of choice. Following splenectomy they had improved haematological indices and general wellbeing, but splenectomy did not abolish abdominal or bone pain crises. This study emphasizes that though splenectomy could be of beneficial effect on carefully chosen cases of hypersplenism, it has not become a major form of therapy for the majority of children with sickle cell anaemia in Nigeria.

Adolescent↗
PubMed1989

Splenectomy in mild hereditary spherocytosis: is it worth the risk?

Patients with mild hereditary spherocytosis (HS) often undergo splenectomy for the sole purpose of preventing gallstone formation. Splenectomy carries a surgical risk as well as the risk of postsplenectomy sepsis. Gallstones develop in less than half of mild HS patients and do not always cause symptomatic biliary tract disease. Using decision analysis, a quantitative approach to problem solving under conditions of uncertainty, we have compared the likelihood of surviving the complications of gallstones with the likelihood of surviving routine splenectomy. Probability figures for critical events were obtained from the medical literature; final outcome is recovery (utility = 1.0) or death (utility = 0.0). Our analysis shows that expectant management of gallstones is the preferred choice, being associated with a higher utility than is routine splenectomy (0.9980 vs 0.9755, respectively). The utility values for the two choices become equivalent only when the risk of postsplenectomy sepsis is lowered from 0.022 to 0.0001.

Cholecystectomy↗
PubMed1989

[Effects of splenectomy on long-term results of the surgical treatment of stomach cancer].

The long-term results of surgery including splenectomy as treatment for stomach cancer were evaluated in 321 such cases. Tumor- and surgical procedure--related splenectomies were considered separately. Splenectomy did not influence long-term results of treatment in the study group. The effect of splenectomy on cell-mediated immunity within six postoperative months is discussed.

Evaluation Studies as Topic↗
PubMed1989

Splenectomy for immune thrombocytopenic purpura: Auckland experience 1979-87.

Of 148 elective splenectomies performed in Auckland during 1979-87, 48 were performed as therapy for immune thrombocytopenic purpura (ITP). In all cases medical therapy had either failed to maintain their platelet count (36 patients), or side-effects of medical treatment had made continuation unacceptable (12 patients). The mean age of the group was 31 years and there were 15 males and 33 females. Thirty-four of 48 patients (71%) had a favourable response to splenectomy: platelet count was maintained above 150 x 10(9)/l and medical therapy was no longer required. There was no operative or inhospital mortality. Seven patients experienced postoperative complications (mainly infections) of which none were life-threatening. There was no difference in response between males and females (67% and 73% response rate, respectively), and the response rates of Europeans and non-Europeans were similar (71% and 69%, respectively). By contrast, the average age of the responders [29 years) was almost 10 years younger than the non-responders (38 years). It is concluded that the use of splenectomy as therapy for patients with ITP, who have either failed to respond to medical management or for various reasons cannot tolerate the complications associated with steroid therapy, is a safe procedure which in the present series was associated with no operative mortality and an acceptably low rate of morbidity. Younger ITP patients (less than 30 years) have a better chance of responding favourably to splenectomy than do older patients (greater than 40 years).

Adolescent↗
PubMed1978

[What are the dangers of splenectomy in Hodgkin's disease?].

Splenectomy is a surgical procedure of medium severity, the mean lethality rate is 1%, the complication rate 10 to 20%. The surgical risk is dependent upon age and general condition of the patient, the severity of the disease, and the experience of the surgeon. The risk of late complications due to surgery is determined mainly by infections as well as ileus, requiring relaparatomy. The risk of infections is higher in children than in adults: one has to be aware of miningitis and sepsis in about 10% of the patients; half of those cases end lethal. An analysis of advantages versus risks of splenectomy must be made for each patient individually. For optimal treatment it is necessary to know the stage of the disease. Concerning M. Hodgkin, explorative laparatomy combined with splenectomy should be performed in stage I to III A. If, however, the surgical risk is rather high primarily and if there are no therapeutical consequences to be expected, splenectomy should not be performed because of the known risks and disadvantages.

Adult↗
PubMed1985

Incidence of serious infections after splenectomy in childhood.

Ten groups of authors investigated their cases of splenectomized children in four different indication groups for frequency of postsplenectomy infection. Only severe infections were included and defined. A total of 1039 splenectomized patients were evaluated for the rate of infection and lethality following splenectomy. It was seen that in all groups there was a definite rate of infection and resultant deaths which was lowest in traumatic splenectomies and highest in malignant hematological diseases. The frequency of infection was highest in the early postoperative phase. Infections, however, still occurred more than 6 years after splenectomy. In older children the vulnerability to infection was less than in younger ones, but the mortality in older children was higher. The gravity of this danger can be seen, and effective therapeutic measures must be found and carried out. Especially, the attitude towards splenectomies should be changed in favor of spleen-preserving surgical procedures.

Bacterial Infections↗
PubMed1985

[Partial splenectomy in homozygous beta-thalassemia].

Six children, 2 1/2 to 6 years old, with homozygous beta-thalassemia underwent partial splenectomy as indicated by splenomegaly and high blood transfusion requirement. A marked reduction of blood requirement has been achieved in 2 children with an annual blood transfusion volume up to 150 ml per kg body weight. The other four children required total splenectomy as blood requirement remained high and significant splenomegaly developed within few weeks after the partial splenectomy. The immunological function of the spleen residue remains still controversial and needs further evaluation. Partial splenectomy might be indicated therefore only in selected children with homozygous beta-thalassemia.

Blood Transfusion↗
PubMed1985

Blood coagulation and platelet profiles in persistent post-splenectomy thrombocytosis. The relationship to thromboembolism.

To clarify the possible role of persistent thrombocytosis after splenectomy being a predisposing factor causing development of thromboembolism, blood coagulation profiles and platelet functions were studied in 34 cases being 1-18 years post-splenectomy from non-malignant diseases. Persistent thrombocytosis was observed in 16 with significant negative correlation between hemoglobin level and platelet count indicated the role of anemia on persistent post-splenectomy thrombocytosis. Blood coagulation profiles showed accelerated thrombin formation or hypercoagulability as measured by thrombin generation test especially in cases with thrombocytosis, together with decreased fibrinolytic activity and high fibrinogen, but in presence of high antithrombin III activity. Concerning the platelet, the aggregation to ristocetin was defective, the improved aggregation to ADP and adrenaline was achieved only in whom with intact spleen giving defective platelet aggregation. The finding indicated the role of spleen contributing to abnormal platelet aggregation. Another interesting observation was the decreased platelet 5-hydroxytryptamine content in splenectomized cases. The overall changes on blood coagulation and platelets post-splenectomy including those with persistent thrombocytosis did not thoroughly shift to hypercoagulable state, since a high antithrombin III activity and some platelet defect remained. These present findings, therefore, unlikely predisposed to the occurrence of thromboembolism even in those with persistent thrombocytosis.

Adolescent↗
PubMed1985

[Evaluation of splenectomy in total gastrectomy for gastric cancer].

It has been well accepted that extensive prophylactic lymphadenectomy is certainly effective for elevating cure rate after gastric cancer surgery, however, regarding to the prophylactic splenectomy the arguments are controversial. We studied the value of splenectomy in total gastrectomy for gastric cancer by examining the late survival rates, the accuracy of intraoperative judgement of splenic hilar lymph node metastasis and postoperative changes of serum immunosuppressive factors. In curatively resected stage III cases without splenic hilar lymph node metastasis, the nonsplenectomized group showed a significant better late survival rate than the splenectomized group, 5-year survival rate being 59.9% in the former and 30.8% in the latter. In cases with splenic hilar lymph node metastases, 2 of 9 splenectomized patients survived more than 10 years. In cases of noncuratively resection, splenectomy did not enhance the survival rate. Although further clinical randomized study is needed to draw a definitive conclusion, we had better take a splenic reserve operation for the patients without splenic hilar lymph node metastasis. On the other hand, splenectomy should be performed in cases with splenic hilar lymph node metastases.

Gastrectomy↗
PubMed1984

[Critical evaluation of prophylactic splenectomy in total gastrectomy for stomach cancer].

In gastric cancer surgery, an extended radical operation is commonly performed, and in cases of total gastrectomy, there is a tendency to perform splenectomy at the same time. In order to examine the value of prophylactic splenectomy in gastric cancer surgery, a comparable patient group was followed up, and it was formed that the non-splenectomized group showed a better late survival rate than the splenectomized group. Although these results do not necessarily contraindicate combined splenectomy, it seems desirable to reappraise the value of prophylactic splenectomy in cases having no metastasis in the splenic hilar and adjuvant lymph nodes.

Cardia↗