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At least 991 records · Page 55Linked to original sources
PubMed1993

Case report: increase in CD4 lymphocyte counts after splenectomy in HIV-infected patients.

The records were reviewed of five human immunodeficiency virus (HIV) type 1-infected patients who underwent splenectomy, four for HIV-associated thrombocytopenia and one for gastric compression secondary to splenomegaly. After splenectomy, the four adult patients all had marked, sustained increases in their absolute CD4 lymphocyte counts; greater increases were observed in CD8 lymphocyte counts, accounting for decreases in the CD4:CD8 ratios. In patients 5 (one of triplets, all of whom were infected with HIV after a blood transfusion), absolute CD4 lymphocyte counts were stabilized after splenectomy; the other siblings manifested a decline in CD4 counts, which was associated with a delay in physical development and recurrent episodes of varicella. Immunohistochemical staining of spleen sections demonstrated significantly higher numbers of CD4 cells in splenic tissue from HIV-infected patients than from patients splenectomized secondary to trauma (2,070 +/- 284 vs. 962 +/- 296; p = 0.025). In addition, the HIV-infected patients had significantly higher percentages of CD4 lymphocytes in splenic tissue than in peripheral blood (49.3 +/- 11.0 vs. 20.3 +/- 7.9; p = 0.005), suggesting that CD4 cells were sequestered in the spleens of these patients. These findings have implications for the management of splenectomized HIV-infected patients with regard to optimal timing of initiation of zidovudine therapy and for prophylaxis of Pneumocystis carinii pneumonia.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Pulmonary hypertension after splenectomy in hereditary stomatocytosis.

Hereditary stomatocytosis is an autosomal dominant, congenital hemolytic form of anemia, and thromboembolic complications may ensue after a splenectomy is performed in a patient with hereditary stomatocytosis. However, little is known about the relationship between pulmonary hypertension and hereditary stomatocytosis. We describe here a rare case of a patient with hereditary stomatocytosis who developed pulmonary hypertension due to thromboembolic disease after splenectomy. At the first presentation, he was diagnosed with hemolytic anemia, but the cause was unknown, and he was also diagnosed with pulmonary hypertension. Thereafter, we linked his pulmonary hypertension with hemolytic anemia because his red blood cells appeared as leptocytes, acanthytes, and stomatocytes on scanning electron microscopy. It is important to confirm the diagnosis of hemolytic anemia, and splenectomy should be performed with due consideration of whether patients have hemolytic anemia.

Anemia, Hemolytic↗
PubMed1977

Gastric fistula following splenectomy: its cause and prevention.

Gastro-cutaneous fistula following splenectomy, a rare but serious occurrence, may result in death or prolonged disability. Six previous cases have been reported in detail, while 8 others have been mentioned briefly. The current report reviews the literature and describes 4 additional instances of this complication. Two of the 4 patients died. Sever factors, acting singly or incombination, may predispose to the development of post-splenectomy gastrocutaneous fistulas. These include direct surgical trauma to the gastric wall, generalized arteriosclerotic disease, hematoma in the gastrosplenic omentum, and reflection of gastric muscle fibers into the gastrosplenic ligament. The usual site of rupture of stomach is along the greater curvature in the fundic portion. In circumstances in which splenectomy is associated with known or suspected compromise of the blood supply to this portion of the stomach, a method of enfolding the greater curvature is proposed to prevent the development of a gastro-cutaneous fistula. Awareness of the possibility of this uncommon but serious complication will aid in its early recognition and treatment.

Adult↗
PubMed1978

The role of splenectomy in the treatment of thrombocytopenic purpura due to systemic lupus erythematosus.

Splenectomy in the treatment of thrombocytopenic purpura associated with lupus erythematosus has afforded satisfactory overall results in a group of ten patients. Postoperative deaths occurred in two patients, each of whom had significant underlying problems. Clinical manifestations of SLE-induced thrombocytopenic purpura included ecchymoses, petechiae, menorrhagia, epistaxis, and hematuria. Splenectomy in this disorder should be reserved for cases in whom corticosteroids do not produce satisfactory results, or in whom unacceptably high doses are required. Follow-up indicates long term control of thrombocytopenic purpura following splenectomy.

Adolescent↗
PubMed1978

Thrombotic thrombocytopenic purpura (TTP) and splenectomy: a current appraisal.

Thrombotic thrombocytopenic purpura (TTP) is a disease process characterized by microangiopathic anemia, fever, neurologic manifestations, renal abnormalities, and thrombocytopenia. These clinical findings are caused by vascular occlusions of the microcirculation. At present the utilization of splenectomy, in the treatment of this illness, remains a highly controversial subject. However, review of the literature reveals that 70% of the long term survivors of TTP had undergone splenectomy. This report presents five patients with TTP, four of whom had been splenectomized. Long term survival (greater than one year) was achieved in three individuals. It is recommended that splenectomy be considered as part of the initial management of all patients with TTP, in addition to high dose corticosteroids and antiplatelet drugs.

Adult↗
PubMed1979

Splenectomy for Gaucher's disease.

The records of ten patients who underwent splenectomy for Gaucher's disease were reviewed. All patients had the adult type of the disease. The indications for splenectomy were hypersplenism and mechanical problems. The hematological picture returned to normal in all cases and has remained so throughout the follow-up period. The different forms Gaucher's disease and specific diagnostic tests are discussed. Even though splenectomy is indicated when hematological and mechanical problems exist, selective enzymatic replacement therapy seems to be the preferred future mode of treatment.

Adolescent↗
PubMed1985

A four-year experience with splenectomy versus splenorrhaphy.

From 1980 to 1984, 326 patients requiring splenectomy or splenorrhaphy were treated at one urban trauma center. Splenic injuries were graded in severity from one to five at the time of celiotomy. Splenorrhaphy was attempted in all patients, except when the spleen was shattered or avulsed or when multiple injuries were present. The mechanisms of injury were: penetrating wounds in 51.2%, blunt trauma in 46%, and iatrogenic mishaps in 2.8% of patients. Grade 1 or 2 injuries were present in 23.9%, Grade 3, 4, or 5 injuries were present in 59.8%. Spleens removed or repaired with unknown grading or removed as part of distal pancreatectomies accounted for 16.3% of patients. Excluding uninjured spleens removed with pancreatectomies, 55.4% (169) of injured spleens required splenectomy and 44.6% (136) had a splenorrhaphy performed. Splenorrhaphy was most commonly performed with chronic suture with or without the addition of topical agents. Grade 1 and 2 injuries were repaired in 88.5%; Grade 3 injuries were repaired in 61.5%; and Grade 4 and 5 injuries were repaired in 7.7% of patients. Splenectomy is generally performed in patients with multiple associated intraabdominal injuries and the more severe grades of splenic injury, and has a mortality rate 13.5 times as great as that for patients undergoing splenorrhaphy. Splenorrhaphy can be performed in approximately 50% of patients with injured spleens and has practically no risk of rebleeding.

Abscess↗
PubMed2006

Splenectomy for thrombocytopenia in patients with hepatitis C cirrhosis.

BACKGROUND: Many patients with hepatitis C cirrhosis and low Model for End-Stage Liver Disease scores are too early for transplant but too thrombocytopenic to treat with interferon. GOAL: To report a case series of splenectomy to raise platelet counts so that pegylated interferon and ribavirin can be given in patients with hepatitis C cirrhosis. METHODS: Retrospective chart and computer record review. RESULTS: Seven patients with hepatitis C cirrhosis (mean age=45.4+/-11.1 y, 4 men) had elective splenectomy for thrombocytopenia before pegylated interferon-alpha 2b therapy. All had thrombocytopenia contraindicating antiviral therapy. Five were Child's-Pugh Class A; 2 were B. All 7 had increases in platelet count (mean 32,400 to 222,140 /mL, P<0.01) at 221+/-151 days postsurgery. Median hospital stay and blood loss were 9 days (4 to 25) and 750 mL (100 to 2500 mL). Median platelet packs, units of packed red blood cells and fresh frozen plasma given were 1 (0 to 7), 0 (0 to 14) and 0 (0 to 2), respectively. There were no deaths or portal vein thrombosis. One patient who was status-post liver transplantation had significant morbidity. Five completed pegylated interferon-alpha 2b and ribavirin therapy; 1 is on therapy and 1 awaits initiation. Of the 5 who completed therapy, there were 2 with sustained virologic response, 1 nonresponse, 1 breakthrough, and 1 relapse. CONCLUSIONS: Splenectomy in patients with hepatitis C cirrhosis can be done safely to allow application of antiviral treatment and potentially avoid transplantation. It may be considered in patients with Child's-Pugh A cirrhosis, no prior abdominal surgeries and with non-1 HCV viral genotype.

Adult↗
PubMed1980

Influence of selective splenectomy on survival of cardiac and skin allografts in enhanced rats.

Pretreatment of LEW rats with donor cells and antidonor antiserum 11 and 12 days before transplantation, respectively, extends survival of (LEW x FN)F1 heart grafts from 1 to about 4 weeks. Previous investigations have shown that the spleen responds dynamically to the immunization regimen and to the graft itself by transient trapping of antigen-sensitive cells and massive proliferation of antibody-producing cells. In the present study we have noted that splenectomy performed before recipient pretreatment decreases graft survival. When splenectomy is performed during the periods in which the spleen is responding substantially after immunization and after transplantation, graft survival is increased remarkably (MST greater than 10 weeks, with the majority of grafts surviving indefinitely). Removal of antigen-sensitive cells trapped transiently in the spleen does not fully explain this striking effect, as an 11-day interval between pretreatment and transplantation is required for optimal graft survival in splenectomized hosts. Additionally, splenectomy is ineffective in increasing survival of skin grafts in enhanced animals, reconfirming the primary importance of the regional draining lymph nodes in rejection of these grafts.

Animals↗
PubMed1990

Significant prolongation of hamster liver transplant survival in Lewis rats by total-lymphoid irradiation, cyclosporine, and splenectomy.

The effects of total lymphoid irradiation, cyclosporine and splenectomy alone and in combination have been studied in liver transplants from the LVG hamster to the LEW rat. Neither CsA alone, splenectomy alone, nor TLI alone prolonged graft survival. CsA/splenectomy and TLI/CsA produced significant prolongation of graft survival. TLI/CsA/splenectomy prolonged graft survival by over sixfold compared with controls. While CsA alone was ineffective in reducing lymphocytotoxic antidonor antibody, splenectomy alone or CsA/splenectomy did significantly suppress production of antibody. Only very low levels of antibody could be detected in animals treated with TLI/CsA/splenectomy. TLI/CsA/splenectomy has an immunosuppressive effect sufficient to significantly prolong liver graft survival in the LVG hamster to LEW rat combination and may represent a promising treatment protocol in experimental cross-species transplantation.

Animals↗
PubMed2001

Treatment of multiple aneurysms of the splenic artery after liver transplantation by percutaneous embolization and laparoscopic splenectomy.

A high incidence of aneurysms of the splenic artery is found in liver transplant patients. Their significance is related to the risk of rupture, particularly in the postoperative period. Classically, their management is surgical, with ligation or resection of the aneurysmal arterial segment with or without splenectomy, depending on the location of the aneurysm. Recently, laparoscopy and percutaneous embolization have appeared as alternative treatment options. We describe here the treatment of multiple aneurysms of the splenic artery in a patient who had undergone liver transplantation 10 years earlier. She was treated with percutaneous embolization of the aneurysms followed by laparoscopic splenectomy. To our knowledge, this is the first report of laparoscopic splenectomy following liver transplantation. It demonstrates that prior liver transplantation does not represent an absolute contraindication to minimally invasive surgery.

Aneurysm↗
PubMed1984

Alternatives to splenectomy in the management of chronic idiopathic thrombocytopenic purpura in childhood.

Chronic idiopathic thrombocytopenic purpura (ITP) in childhood exerts influence on the medical, social, and psychologic life of the child. Chronic platelet destruction takes place in the spleen and splenectomy results in complete and permanent recovery of normal platelet counts in most patients. Splenectomy is not without risks, however, and alternative methods of management have been sought. Chronic corticosteroid administration, immunosuppressive agents, infusions of fresh-frozen plasma, plasmapheresis, and high-dose intravenous gammaglobulin administration have all met with variable degrees of success. At the present time, there appears to be no completely satisfactory alternative to splenectomy in the management of the child with chronic ITP.

Adolescent↗
PubMed2002

Splenic artery embolization using contour emboli before laparoscopic or laparoscopically assisted splenectomy.

The present study assessed preoperative splenic artery embolization using spherical embolic material, super absorbent polymer microspheres (SAP-MS), before laparoscopic or laparoscopically assisted splenectomy. Distal splenic artery embolization using 250 to 400 microm SAP-MS was performed in nine cases with ITP and in seven cases with the other diseases with splenomegaly. Laparoscopic or laparoscopically assisted splenectomies, including a hand-assisted procedure and the procedure involving left upper minilaparotomy, were done 2 to 4 hours after embolization. Conversion to traditional laparotomy was not required in any of the 16 cases, while conversion to 12-cm laparotomy was required in one case with massive splenomegaly. Mean operating time was 161 minutes, and mean intraoperative blood loss was 290 mL. No major postoperative complications were identified, and only one patient reported postembolic pain before surgery. Preoperative splenic artery embolization using painless embolic material, SAP-MS, would be effective for easy and safe laparoscopic or laparoscopically assisted splenectomy.

Adult↗
PubMed2003

Laparoscopic splenectomy for chronic recurrent thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) is a serious hematologic disorder with a high rate of morbidity and mortality when it fails to go into remission. The primary treatment is total plasma exchange. The addition of corticosteroids, chemotherapeutic agents, or antiplatelet agents is of unproven benefit, and splenectomy has been offered as salvage therapy in refractory cases. We performed laparoscopic splenectomy (LS) on two patients with chronic refractory TTP. The early and late postoperative courses, including hematologic data, are presented here. The mean duration of surgery was 113 minutes and the mean estimated blood loss was 35 mL. Mean hospital stay was 1.5 days. The early postoperative platelet count showed an immediate rise in both patients. After 19 months and 16 months of follow-up, respectively, both patients remain in remission without further episodes of TTP. Laparoscopic splenectomy is a safe and effective therapy for patients with chronic relapsing and refractory TTP. The inherent benefits of the minimally invasive approach, its low morbidity, short hospital stay, and faster recovery, are significant advantages for these patients.

Adult↗
PubMed2003

Hand-assisted laparoscopic splenectomy for splenic vascular tumors: report of two cases.

We report 2 cases of splenic vascular tumors that were successfully treated by hand-assisted laparoscopic splenectomy. Two patients, a 41-year-old woman and a 33-year-old man, were admitted to our department for investigation of a splenic tumor. After ultrasonography, computed tomography, and magnetic resonance imaging, we suspected that the masses were hemangioma or inflammatory pseudotumor in the spleen. However, we preoperatively could not rule out the possibility of a malignant neoplasm because they each had previously undergone surgical treatment, one for cervical cancer of the uterus and the other for testicular seminoma. Hand-assisted laparoscopic splenectomy was safely performed for the diagnosis and treatment of the splenic tumors. A histologic diagnosis was venous hemangioma and littoral cell angioma, respectively. Hand-assisted laparoscopic splenectomy may be a good indication for splenic vascular tumors that are difficult to diagnose preoperatively whether they are malignant or benign.

Adult↗
PubMed2003

Successful ABO-incompatible kidney transplantations without splenectomy using antigen-specific immunoadsorption and rituximab.

BACKGROUND: Historically, ABO-incompatible kidney transplantations have only been undertaken after splenectomy and unspecific plasmapheresis and with quadruple drug immunosuppression plus B-cell specific drugs. We have evaluated a protocol for ABO-incompatible kidney transplantation without splenectomy using antigen-specific immunoadsorption, rituximab, and a conventional triple-drug immunosuppressive regimen. METHODS: The protocol called for a 10-day pretransplant conditioning period starting with one dosage of rituximab and followed by full dose tacrolimus, mycophenolate mofetil, and prednisolone. Antigen-specific immunoadsorption was performed on pretransplant days -6, -5, -4, and -1. After the last session, 0.5 g/kg of intravenous immunoglobulin was administered. Postoperatively, three more apheresis sessions were given every third day. Furthermore, if there was a significant increase in the antibody titers, extra sessions were considered. RESULTS: Four patients have received transplants with this protocol. The donor-recipient blood groups were A2/O, B/O, B/A, and A1/O. The ABO-antibodies were readily removed by the antigen-specific immunoadsorption and were kept at a low level posttransplantation by further adsorptions. There were no side effects, and all patients have normal renal-transplant function. CONCLUSIONS: We conclude that after one infusion each of rituximab and intravenous immunoglobulin and antigen-specific immunoadsorption, blood-group-incompatible renal transplantations can be performed with standard immunosuppression and without splenectomy.

ABO Blood-Group System↗
PubMed2007

Matched unrelated bone marrow transplantation without splenectomy for a child with Gaucher disease caused by homozygosity of the L444P mutation, who also suffered from schizencephaly.

Splenectomy followed by bone marrow transplantation (BMT) has been applied successfully in the treatment of neuronopathic Gaucher disease (GD). GD in combination with schizencephaly has not previously been reported. We describe a girl who presented with hemiparesis and oculomotor apraxia since infancy, and thereafter developed progressive anemia, thrombocytopenia, hepatosplenomegaly, psychomotor retardation, and skeletal abnormalities. GD caused by homozygosity of the L444P mutation was diagnosed, in combination with schizencephaly. The child received enzyme replacement therapy for 3 years, followed by successful matched unrelated BMT without splenectomy. The strategy of BMT without splenectomy after a period of enzyme replacement may be feasible in neuronopathic GD.

Anemia↗
PubMed1986

Prognostic influence of early diagnostic splenectomy in Hodgkin's disease. A long-term follow-up.

The influence of early laparotomy with splenectomy on prognosis in patients with Hodgkin's disease who were regarded as having uncertain prognostic indices (all patients except those with lymphocytic predominance and nodular sclerosis stages IA and IIA with right-sided presentation, stage IV disease, splenomegaly or age greater than 65 years) was evaluated in a randomized trial initiated in Jan. 1973. The patients were treated with total nodal irradiation (excluding the splenic and hepatic areas) and 33 of 69 patients were randomized to laparotomy with splenectomy. No significant difference in relapse-free or overall survival was found between the two groups after a median observation time of 85 months. Progressive or recurrent disease was as common in splenectomized as in non-splenectomized patients. Splenectomized patients with splenic tumour involvement fared worse than those without. It is concluded that diagnostic laparotomy with splenectomy is of no benefit in this clinical setting.

Adolescent↗