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PubMed1984

[Effectiveness of the treatment of severe aplastic anemia (splenectomy and immunosuppression)].

The authors appraise the efficacy of the treatment of severe aplastic anemia by splenectomy, antilymphocyte globulin and cyclophosphamide. A total of 120 patients were placed under observation. Of these, 103 patients had a severe disease pattern, one hundred and 112 patients with aplastic anemia including 96 with a severe pattern were subjected to splenectomy. Of the 112 splenectomized patients, 78 (69.6%) are alive. Of the 96 patients with severe aplasia, 60 patients (62.5%) are alive. Of 43 deceased patients, 7 had been admitted to the hospital 2-12 days before death and had not been subjected to splenectomy. Three patients died shortly after splenectomy, 8 patients died at the second month after operation. During the first 6 months after operation 20% of the operated patients died, whereupon 10 more per cent of the patients died for 5 months. The patients who survived 10 months may happen to develop a complete or partial remission. Complete remission was attained in 18.8% of the patients, almost complete recovery in 17.7% of the operated, considerable improvement of the estimates was attained in 17.7% of the patients. Antilymphocyte globulin was administered to 23 splenectomized patients. The remission was attained in 6 patients, and 8 more patients improved. If the patients did not respond to the treatment with antilymphocyte globulin, or if they developed relapses, the authors administered cyclophosphamide. Of the 15 patients, 9 responded to the treatment (5 patients improved, remission was attained in 4 patients, 3 of whom are in a state of remission until now). On the 15 patients treated with cyclophosphamide 12 patients have been alive for not less that 2 years.

Adolescent↗
PubMed1984

Factors influencing the risk of early and late serious infection in adults after splenectomy for trauma.

We reviewed the clinical course of 245 adults who underwent splenectomy for trauma to assess the risk of both early and late serious infection. Twenty-one patients (9%) had an early serious infection (sepsis) during hospitalization for splenectomy. The mortality rate was 62% in patients with early sepsis, and encapsulated bacteria were isolated from the blood of 43% of patients with sepsis. Only one of 58 patients with isolated splenic injury had sepsis (2%), and the risk of early sepsis increased when three or more concomitant injuries were present (p less than 0.05). Stepwise multiple regression analysis revealed that patients with injuries to the pancreas, colon, or central nervous system or with extremity fractures had an increased risk of sepsis (p less than 0.05). The risk of sepsis was not influenced by age, the type of injury, delay in operation, use of drains, or other individual injuries. Sufficient information was available to assess the risk of late serious infection for 140 surviving patients (63%). Follow-up ranged from 2 to 277 months. Three late infections occurred at 2, 8, and 15 years after splenectomy; two were due to Streptococcus pneumoniae. None of these patients died. There were no identifiable factors influencing the risk of late infection. These results suggest that the risk of early serious infection in adults after splenectomy for trauma is low when isolated splenic injury is present but that this risk is increased by both the degree of injury and the presence of certain associated injuries. Encapsulated bacteria are frequent pathogens in both early and late infections. The mortality rate related to an early septic episode is high, but the risk of late serious infection is low and is not related to identifiable factors that decrease host defenses.

Adolescent↗
PubMed1984

Infectious complications after splenectomy.

The incidence of early infectious complications after splenectomy was retrospectively studied in 133 patients operated on between 1975 and 1982. Comparisons were made with a control group. Among the patients in whom splenectomy was performed because of trauma, iatrogenic injury during surgery for benign disorders, as a staging operation in malignant lymphoma or for haematologic reasons, the rate of early postoperative infection ranged from 14 to 29%. In the controls, who underwent selective proximal vagotomy in the same period, the post-operative infection rate was 5%. Of the 133 patients in the splenectomy group, 17 were subsequently hospitalized for infectious disorders (18 months-8 years postoperatively). Because of the high incidence of postoperative infections, prophylactic antibiotic treatment in connection with splenectomy is recommended.

Adult↗
PubMed1983

[Postsplenectomy infection and immunologic aspects of splenectomy].

Of 619 trauma patients undergoing splenectomy, 503 lived more than 10 days. In this group, 114 patients (22.7%) developed systematic sepsis and 36 patients (7.2%) succumbed from sepsis. Septic morbidity and mortality rates in splenectomized patients were significantly greater than those in 2180 consecutive trauma patients treated in 1978-1979. Septic mortality rate in septic patients was significantly greater than that in 2180 consecutive trauma patients. Septic mortality rate in the patients whose trauma were seen only in the spleen or associated with only one organ injury was also very high. Long-term follow-up information was obtained in 242 splenectomized patients with a mean patient follow-up interval of 4.4 years. Severe bacterial infections have occurred in six patients. Thus far, there have been no deaths from overwhelming sepsis. Of interest, 10% of the patients complained of more severe viral infection following splenectomy. On the other hand, the incidence of postoperative infection in the patients who underwent total gastrectomy with splenectomy was not different from that of the patients who underwent total gastrectomy without splenectomy. However, the incidence of the postoperative infection in the splenectomized patients together with total gastrectomy was greater than that of the the splenectomized patients in trauma.

Adolescent↗
PubMed1984

The risk of improperly staging Hodgkin's disease with partial splenectomy.

Partial splenectomy has been proposed for staging Hodgkin's disease, but the risk of thereby missing limited splenic involvement is unknown. To assess that risk, we reviewed all spleens removed during staging laparotomies for Hodgkin's disease at our institution, assessing splenic weight, the characteristics of all nodules, and grossly visible subcapsular disease. Among 180 spleens, 65 had splenic disease. Fifty-three had six or more nodules; for 49 of those, other abdominal involvement had been present or the disease was so diffuse that staging by partial splenectomy would have been correct. The remaining 12 spleens (18%) contained five or fewer nodules. Eleven had no grossly visible subcapsular nodules, and five of the 11 were associated with no other abdominal involvement. In four of those five, the disease was localized to one area in such a way that it could have been missed by partial splenectomy. All positive spleens averaged 415 g; the four spleens with localized involvement averaged 287 g. Thus, in four of 65 patients, a few splenic nodules in a localized distribution not visible grossly were the only evidence of abdominal Hodgkin's disease, and if partial splenectomy had been done there would have been a 6.2 per cent risk of understaging their Hodgkin's disease.

Hodgkin Disease↗
PubMed1983

Response to splenectomy in 65 patients with hairy cell leukemia: an evaluation of spleen weight and bone marrow involvement.

Sixty-five patients with hairy cell leukemia underwent splenectomy; 27 had a complete remission as defined by a return in WBC, RBC, and platelet counts to a defined level, and 38 had a partial remission with a return of only one or two of these parameters to the defined level. The 5-yr actuarial survival for all patients is 68%; for CR patients it is 76%, and for PR patients 62%. The response to splenectomy did not correlate with the spleen weight. Seventeen patients had a postsplenectomy platelet count of less than 200 x 10(9)/liter, and 34 patients had a postsplenectomy platelet count of 200 x 10(9)/liter or greater. A presplenectomy bone core biopsy hairy cell index (HCI) was calculated by multiplying the percent marrow cellularity by the percent of hairy cells in the marrow for 51 patients. The difference in the mean HCI between the two platelet response groups is statistically significant (p less than 0.05). Of the 15 patients with a presplenectomy HCI of 0.7 or greater, 9 (60%) did not have a satisfactory platelet response to splenectomy, whereas of 36 patients with an HCI of 0.7 or less, only 8(22%) did not have a satisfactory platelet response to splenectomy (p less than 0.01). The HCI appears to indicate the significance of underproduction of platelets as a result of marrow replacement by hairy cells.

Adult↗
PubMed1982

Effect of splenectomy on establishment of hematopoietic chimerism in nonirradiated mice.

When spleen cells (1.5 x 10(8)) from beige C57BL/6 (bgJ/bgJ, Chediak-Higashi syndrome) mice were injected into nonirradiated (C57BL/6 x CBA)F1 hybrid mice, the hematopoietic stem cells of the hybrid host were eradicated by graft-versus-host (GVH) reaction, and peripheral neutrophils of the host changed from normal type to beige type with giant sudanophilic granules in 20 days after the cell injection. Effect of splenectomy on the establishment of such hematopoietic chimerism was investigated. The splenectomy carried out either before or after the cell injection reduced the proportion of mice in which more than 90% of peripheral neutrophils became of beige type. Since the mortality of mice which received splenectomy at various days prior to or after the cell injection paralleled the proportion of establishment of chimerism, the splenectomy does not seem to affect directly the establishment of chimerism but indirectly through the modification of the intensity of GVH reaction.

Animals↗
PubMed1996

Splenectomy complicating left nephrectomy.

PURPOSE: We attempted to clarify the details of incidental splenectomy complicating left nephrectomy. MATERIALS AND METHODS: We reviewed the literature and operations involving splenectomy performed during left nephrectomy between 1984 and 1994 at our university. Factors reviewed included patient characteristics, renal pathology, mechanisms of injury, blood transfusions and postoperative complications. RESULTS: Of the 418 left nephrectomies 18 (4.3%) resulted in splenectomy via a transperitoneal approach. Patients with a large or upper pole renal lesion, malignancy or advanced age are increasingly likely to undergo unanticipated splenectomy. CONCLUSIONS: Our results, combined with recommendations from the Centers for Disease Control and Prevention, suggest that all patients older than 65 years undergoing left transperitoneal nephrectomy or those at increased risk for splenic injury should receive preoperative pneumococcal vaccination.

Age Factors↗
PubMedDate not supplied

Anticardiolipin antibody-related thrombocytopenia: persistent remission after splenectomy.

The lupus anticoagulant (LAC) and anticardiolipin antibody (ACA) syndromes require particular therapeutic approaches: thrombotic accidents are an indication for oral anticoagulant therapy (OAT), whereas severe thrombocytopenia may require the special treatments used for immunologic thrombocytopenic purpura (ITP). We describe the case of a 21-year-old male who presented with axillary vein thrombosis associated with LAC and ACA at high titers in December 1990. OAT was begun and, due to repeated episodes of thrombocytopenia, high-dose steroid therapy was later added with success. The daily steroid dose was reduced because of patent hypercortisolism, but the platelet count fell to 4 x 10(9)/L. A bone marrow biopsy was characteristic for ITP. Splenectomy was performed in June 1993, and the platelet count rapidly normalized. Platelet antibodies were always detectable before and after splenectomy. The patient is currently asymptomatic, with platelet counts above 300 x 10(9)/L at one and a half years after splenectomy. This case indicates that ACA-associated thrombocytopenia, like ITP and HIV-related thrombocytopenias, can be successfully treated with steroids and splenectomy, even though different pathogenetic mechanisms are responsible for the antibody-induced platelet consumption.

Adult↗
PubMed1995

[Hereditary spherocytosis: clinical characteristics and treatment with splenectomy].

PURPOSE: To analyse the clinico-biological characteristics at diagnosis, the clinical course, and the response to splenectomy of a series of patients with hereditary spherocytosis (HS). PATIENTS AND METHODS: The clinical records of 61 patients diagnosed of HS along 30 years were reviewed. The diagnosis was based upon the existence of family history, physical findings, blood cell examination, reticulocyte count, peripheral blood spherocytes, red-cell osmotic fragility, auto-haemolysis, serum haptoglobin, LDH, non-conjugated bilirubin and direct anti-human globulin test. Data regarding the time of diagnosis and clinical course were taken into account in every case. Within the sub-group of 29 patients undergoing splenectomy, the changes in haemoglobin rates and reticulocyte and platelet counts after surgery were evaluated. RESULTS: Of the 61 patients, 35 were men and 26 women; the median age at diagnosis was 13 years (range: 0-64 years). Family history was positive in only 40% of the cases. The mean haemoglobin rate was 112 g/L (range: 46-151 g/L), over 60% of the patients having anaemia. The mean reticulocyte count was 282 x 10(9)/L (range: 31-583 x 10(9)/L), this being above 100 x 10(9)/L in 91% of the cases. Red-cell osmotic fragility with fresh blood was increased in 86% of the cases, and in 97% after blood incubation. Serum haptoglobins were decreased, whereas LDH was increased in 58% of the patients and non-conjugated bilirubin in 72%. Splenomegaly appeared in the clinical course in 87% of the patients; cholelithiasis was present in 31.5% of them. Haemoiytic crises were seen in 45% of patients, aplastic phases in 7%, and transfusion was needed by 16% of the patients to variable extents. Splenectomy was performed in 50% of the instances before 14 years of age (range: 4-64 years), and it increased haemoglobin rates in 40 g/L, anaemia being corrected in all cases; the mean reticulocyte count returned to normal, but thrombocytosis developed after surgery, it being present in 82% of the cases 2-3 months later. CONCLUSIONS: (1) Wide clinical variability is seen in HS, from severe forms requiring frequent transfusion to asymptomatic cases. (2) Highly frequent findings in HS are reticulocytosis and splenomegaly; relatively frequent were anaemia, haemolytic crisis and cholelithiasis, in this order. (3) Anaemia was always corrected after splenectomy, which also rose the haemoglobin rate even in the cases without anaemia, and returned the reticulocyte count to normal values.

Adolescent↗
PubMed1995

[Laparoscopic splenectomy for immune thrombocytopenic purpura].

Splenectomy is effective in treating immune thrombocytopenic purpura (ITP). Recent advances in laparoscopic technique and technology have made laparoscopic splenectomy feasible. We performed it in 8 cases of ITP (16-34 years old, and 2-24 months after the diagnosis was made and appropriate treatment started). Indications for splenectomy were no response to corticosteroid therapy (2 patients), decrease in platelet count when attempting to taper off therapy (3), or severe side-effects of the treatment (3). 4-5 ports were used. The splenic artery was first double-clipped through an opening in the gastrocolic ligament and then the lower splenic pole and the posterolateral attachments were dissected using endoclips and electrocautery. The hilum and short gastric vessels were separated using an endostapler. The spleen was placed in a plastic bag whose open end was pulled out through an umbilical incision and the spleen fragmented and aspirated out of the bag, while it was still inside the abdomen. Blood or platelet transfusions were not needed and the postoperative course was uneventful in all, with early return to full normal activity. Postoperatively, platelets increased to more than 150,000/mm3 in all patients, and there was no further need for corticosteroids during a follow-up of 2-12 months. We recommend laparoscopic splenectomy for ITP because of the reduced operative trauma, better recovery and rehabilitation, less postoperative pain, cosmetic advantage, and possibly fewer postoperative complications.

Adolescent↗
PubMed1994

[The risk of splenectomy].

BACKGROUND: The controversely discussed effect of splenic loss and disturbances of the general state of health are to be reported by means of several check sheets. There is a control group for comparison and statistic evaluation. The results will be considered in relation to laboratory serum parameters. PATIENTS AND METHOD: 111 patients splenectomized for various reasons could be examined 3 to 17 years following surgery. We applied the depression check sheet by Beck, the Giessen complaint check sheet, and a specific splenectomy check sheet. The latter served to inquire an additional control group of statistic twins who underwent comparable upper abdominal surgery, but not splenectomy. Furthermore, 42 laboratory serum parameters were determined in every splenectomized patient. RESULTS: Compared to random tests with the Federal Republic's population, the Giessen complaint check sheet detected a more frequently disturbed state of health in "spleenless". An evaluation of the specific splenectomy check sheet detected an increased trend for infections after splenectomy (p = 0.0000001) compared to those after upper abdominal surgery. There was no statistical proof for other typical symptoms such as incompatibility with alcohol or vegetative dystonia. There was no significant anomaly in the 42 parameters measured. CONCLUSION: Every other splenectomized patient complained about frequent infections and, consequently, disturbed state of health (physical weakness, early exhaustion). These complaints did not correlate to the measured laboratory serum parameters.

Adult↗
PubMed1994

Risks and benefits of splenectomy in myelofibrosis: an analysis of 39 cases.

From 1980 to 1993, 39 splenectomies were performed in the Department of Visceral Surgery of Saint-Louis Hospital, in patients referred for myelofibrosis associated with myeloid splenomegaly. The short term morbidity was considerable: 33 serious haemorrhagic, infectious or thrombotic complications including 5 fatal accidents were observed in 18 patients. Severe thrombotic or infectious complications leading to 6 further deaths occurred in 8 patients over the two years following splenectomy, while six cases of acute leukaemia appeared between 6 months and 3 years after splenectomy. In 40% of cases with regular follow-up, the operation did not provide any haematological improvement and all these patients died. Only patients with minimally progressive or stable myelofibrosis and residual marrow activity in isotope studies showed an amelioration of general status with relief of pain and reduction of transfusional requirements. The indication for splenectomy should therefore probably be limited to such cases.

Adult↗
PubMed1994

Effect of splenectomy on HIV-related thrombocytopenia and progression of HIV infection in patients with severe haemophilia.

Between May 1983 and September 1991 eleven patients with severe haemophilia underwent splenectomy for HIV-related thrombocytopenia. The sustained complete remission rate (platelets > 100 x 10(9)/l) was 82% over a mean follow-up period of 54 months. The group was compared with 22 age-matched non-thrombocytopenic HIV seropositive haemophiliacs who had not undergone splenectomy. Both groups had equivalent use of factor concentrate and there was no significant difference between the groups in terms of anti-retroviral treatment. Analysis of clinical progression of HIV infection and CD4 positive lymphocyte (CD4+) counts, for the time since splenectomy, revealed no significant difference in progression of HIV infection in the splenectomized group compared with the control group. It is concluded that splenectomy is an effective treatment for HIV-related thrombocytopenia and has no adverse effect on the progression of HIV infection.

CD4-Positive T-Lymphocytes↗
PubMed1994

Operative strategy in laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy was attempted in 17 consecutive patients and was successful in 15. STUDY DESIGN: This study is a critical analysis of the operative strategy in laparoscopic splenectomy, as reviewed in the operative video recordings and operative summaries of the 17 patients discussed. RESULTS: The 15 successful laparoscopic splenectomies were all conducted according to the same strategy: mobilization of both the upper and lower pole of the spleen, division of the short gastric vessels close to the spleen, and dissection and separate ligation of the main trunk of the splenic artery and vein. An erroneous strategy that diverged from the one proposed, resulted in parenchymatous hemorrhage and open conversion in two patients. CONCLUSIONS: In this series of 15 successful laparoscopic splenectomies, the most important technical aspect seems to be full mobilization of the spleen before the hilum is dissected.

Adolescent↗
PubMedDate not supplied

[The regulation of bone marrow hematopoiesis in splenectomy and splenic autotransplantation in mice].

The method of heterotopic transplantation of the bone marrow was used to study the influence of splenectomy and autotransplantation of the spleen onto the hemopoietic and osteogenic tissues of the bone marrow in mice. After splenectomy at early stages of the formation of the heterotopic hemopoiesis focus the amount of myelokaryocytes increased while in the stationary bone marrow population (the femur bone) their amount dropped by the same time. Autotransplantation of the spleen made the amount of myelokaryocytes equal to the level of control, but did not eliminate the effect of decrease of the mass of osteogenic tissue in the heterotopic hemopoiesis focus arising after splenectomy, which might be related with the influence of splenectomy on the stem osteogenic cells-precursors of the bone marrow.

Animals↗
PubMed1994

[Partial splenectomy in thalassemia major. Apropos of 19 cases].

Nineteen cases of B Thalassemia have benefited from partial splenectomy at the General Surgery Service of Farhat Hached Hospital in Sousse (Tunisia). The partial splenectomy indication was to reduce hypersplenism, thus transfusion needs, to suppress splenic pain and to conserve a splenic remnant, which preserves patients' immunity. The operation was in reality a subtotal splenectomy keeping the lower pole in all cases. We had no per-operatory complication. The preoperatory bleeding was not more serious than in total splenectomy. In all the patients, we noticed reduction of about half the transfusion need, except one who had also a chronic deficit in glyco-six phospho-dehydrogenase. The average hemoglobin rate increased from 60 g/L in the pre-operatory to 80 g/L after the operation. Consequently, this reduction of transfusion needs results in the decrease of the hemochromatosis, which is one of the main complications of hypertransfused thalassemia.

Adolescent↗
PubMed1993

[Portal venous thrombosis following splenectomy in portal hypertension: risks and management].

Splenectomy intended to treat hypersplenism can, in the presence of portal hypertension (PTH), lead to extrahepatic portal and mesenteric vein thrombosis. The management of possible variceal bleeding in patients with extrahepatic portal vein occlusion following splenectomy in portal hypertension is a problematic and challenging undertaking. We report on the management of variceal bleeding in 2 noncirrhotic patients with PTH who developed portal vein thrombosis following ill-advised splenectomy. It must be stressed again that splenectomy alone intended to control hypersplenism in portal hypertension is to be avoided at all costs. Options for the treatment of portal and mesenteric vein thrombosis and variceal bleeding are proposed.

Adult↗