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PubMed2001

Splenectomy of rats selectively reduces lymphocyte function-associated antigen 1 and intercellular adhesion molecule 1 expression on B-cell subsets in blood and lymph nodes.

Splenectomy increases the number of B cells in the blood of humans and animals. It is unknown whether this is due to changes in migration, proliferation, or both. The numbers of naïve (IgD(+)IgM(+)), memory (IgD(-)IgM(high)), newly formed (IgM(high)CD90(high)), early recirculating follicular (IgM(low)CD90(high)), recirculating follicular (IgM(low)CD90(-)), and marginal zone (IgM(high)CD90(-)) phenotype B cells were determined in control and splenectomized rats by flow cytometry. All subsets increased significantly in the blood after splenectomy. Because surface molecules are involved in the regulation of migration and proliferation, their expression (lymphocyte function-associated antigen 1 [LFA-1], intercellular adhesion molecule 1 (ICAM-1), L-selectin, alpha4-integrins, CD44, major histocompatability complex class II, interleukin 2 receptor-alpha chain) was determined on B- and T-cell subsets of both groups. B cells, but not T cells, showed a significantly reduced LFA-1 and ICAM-1 expression in blood and lymph nodes, whereas the expression of the other surface molecules analyzed remained unchanged. The down-regulation of these molecules did not influence the adherence of B cells to high endothelial venules in vitro. In vivo, however, ICAM-1(low)-expressing B cells migrated significantly faster through lymph nodes (ICAM-1(low) 41 +/- 5 hours versus ICAM-1(high) 58 +/- 3 hours), whereas proliferation of B cells in bone marrow, lymph node, and blood remained unchanged. Thus, the presence of one organ is necessary for appropriate expression of LFA-1 and ICAM-1 on B cells in other, distant organs. The more rapid transit of ICAM-1(low) B cells through lymph nodes may be responsible for the increased B-cell number in the blood after splenectomy.

Animals↗
PubMed2001

Gastric necrosis and perforation as a complication of splenectomy. Case report and related references.

Necrosis of the stomach after isolated splenectomy with the formation of gastrocutaneous fistula is a rare event that occurs in less than 1% of splenectomies. It is more frequent when the removal of the spleen is done because of hematological diseases. Its mortality index can reach 60% and its pathogenesis is controversial, as it may be attributed both to direct trauma of the gastric wall and to ischemic phenomena. Although the stomach may exhibit exuberant arterial blood irrigation, anatomical variations can cause a predisposition towards the appearance of potentially ischemic areas, especially after ligation of the short gastric vessels around the major curvature of the stomach. Once this is diagnosed in the immediate postoperative period, it becomes imperative to reoperate. The surgical procedure will depend on the conditions of the peritoneal cavity and patient's clinic status. The objective of this study was to report on the case of a patient submitted to splenectomy because of closed abdominal traumatism, who then presented peritonitis and percutaneous gastric fistula in the post-operative period. During the second operation, perforations were identified in anterior gastric wall where there had been signs of vascular stress. The lesion was sutured after revival of its borders, and the patient had good evolution. Prompt diagnosis and immediate treatment of this unusual complication are needed to reduce its high mortality rate.

Adolescent↗
PubMedDate not supplied

[Hepatosplenic schistosomiasis portal hypertension: effect of esophagogastric devascularization with splenectomy on the diameter and mean flow velocity in the portal system (ultra-sonographic Doppler].

BACKGROUND: Esophagogastric devascularization with splenectomy has been used for the treatment of upper digestive bleeding due to esophagic varices in hepatoportal mansoni's schistosomic portal hypertension. Nevertheless, early portal thrombosis has hampered this surgical technique (13.3% and 53.2%), compromising the good results on the hemorrhagic side. Supposing that portal circulatory changes, due to the surgical treatment, may play an important role in this kind of complication, our objective was to identify the hemodynamic facilitating factors. Portal hemodynamic aspects, identified by ultra-sonographic Doppler study, from two groups of patients: non-operated upon and splenectomized with esophagogastric devascularization in late post-operatory phase (in excess of 6 moths), with portal hypertension due to mansoni hepatoesplenic portal hypertension and in similar clinical conditions, were compared. METHOD: Fifty eight ambulatorial patients were studied, all had portal hypertension caused by mansoni's hepatosplenic schistosomiasis and previous bouts of digestive bleeding. They were divided in two groups: A--29 followed clinically/endoscopically, and group B--29 previously submitted to esophagogastric devascularization with splenectomy. In all was measured the diameter and mean flow velocity in the portal vein and its right and left branches by ultra-sonographic Doppler study. The results were submitted to statistical analysis for inter- and intra-group comparison. RESULTS: Group A (non-operated): the portal vein diameter was greater than the right and left branches (10.6 +/- 2.9, 8.0 +/- 1.8, 9.1 +/- 2.6 cm), the mean flow velocities in the portal vein and its branches were similar (15.62 +/- 6.17, 14.92 +/- 5.33, 16.12 +/- 4.18 cm/seg). Group B (operated): the diameter and mean flow velocity in all vessels were reduced (8.8 +/- 1.7, 5.2 +/- 1.2, 7.5 +/- 2.2 cm/12.53 +/- 2.60, 8.86 +/- 1.75, 9.69 +/- 3.75 cm/seg). CONCLUSIONS: After esophagogastric devascularization with splenectomy, there was a reduction of the diameter and mean flow velocity in the portal vein, its right and left branches.

Animals↗
PubMed2005

[Evaluation of the effect of splenectomy with autologous spleen tissue implantation in some monocyte functions in children with hepatosplenic schistosomiasis mansoni].

Adherence index, superoxide and TNF-alpha production in monocytes, with or without tuftsin treatment, were investigated in hepatosplenic schistosomiasis mansoni bearers with splenectomy with or without autologous implantation of spleen tissue. Three groups were evaluated: Healthy volunteers control group (CG) (n=12); Splenectomy with seft auto-transplant AG (n=18) and Splenectomy without auto-transplant WAG (n=9). Adherence index and TNF-alpha did not differ among the groups. Superoxide production was similar in CG and AG, in the 1st hour after cell stimulation. SP was larger in each hour time in CG and AG groups as compared WAS group. TT recovered normal pattern of SP in AG comparable with levels found in CG, with increase from the 1st to 2nd hour. However, TT did not alter SP in WAG, which remained reduced in all time points. Autologous implantation of spleen tissue seems to contribute for recovery and maintenance of the evaluated immunological reactions, which might be important in response to infections.

Adolescent↗
PubMed2006

Open splenectomy in Jamaican children with sickle cell disease.

A total of 110 patients with sickle cell disease who had open splenectomy at the University Hospital of the West Indies over a 10-year period are reviewed Patients with homozygous sickle cell disease numbered 94, S beta0 and S beta+ thalassaemias (11 and 4 respectively) and one patient with SC disease. Postoperative acute chest syndrome was the most common complication (9 of 110). There were no life threatening emergencies and no mortalities. Eleven patients received preoperative blood transfusion and operative times were short averaging 60 minutes among the 110 patients. Open splenectomy remains the gold standard for patients with sickle cell disease requiring splenectomy.

Anemia, Sickle Cell↗
PubMed2005

[Rats resistance to fecal peritonitis when subjected to total splenectomy and auto-implant of the spleen in the retroperitoneum].

PURPOSE: This study was developed to evaluated the effects of spleen transplants in the protection against abdominal sepsis in young and old Wistar rats. METHODS: Fifty-four young and old Wistar rats were utilized (90 and 180 days respectively) being distributed in three groups as follows: Sham Group, where the animal were submitted to laparotomy with manipulation of only intestine (n=12 young and adult animals), Splenectomy Group, in which the animals were subjected to total splenectomy (n=20 young and adult animals) and an Auto-implant Group, where the animals were subjected to total splenectomy and a third of the spleen was implanted in a bag in the retroperitoneum (n=22 young and adult animals). After three months the animals were subjected to a new laparotomy with binding and caecum perforation to stimulate abdominal sepsis and were accompanied until the moment of death to establish a mortality curve. RESULTS: There was recuperation of the spleen implanted in all animals. There was no significant difference in the time of death among the groups. The young animals apparently had a better response, however it was not statistically significant. CONCLUSION: This study demonstrated that spleen implant in the retroperitoneum do not prove to be an effective protection against abdominal sepsis in comparison with the splenectomized rats.

Age Factors↗
PubMed2004

[Effects of splenectomy on peritonitis produced by a colonic injury: study in rats].

BACKGROUND: Study the effects of splenectomy on the intra-abdominal infection by bowel flora, consequent to a colonic injury in Wistar rats. METHODS: We used 64 animals, 20 for Group A1 (normal with colon lesion left open), 22 for Group A2 (normal with colon lesion sutured) and 22 for Group B (spleen removed). The animals were submitted to a laparatomy through a midline abdominal incision and peritonitis was induced by a colonic lesion in the colon previously distended with 2 ml of saline introduced in the rectum. Bacteriological studies of the abdominal wash obtained with a sterilized swab and microscopic studies of samples of the segment of the sutured colon obtained at 48 hrs, 96 hrs and on the 12 post op day, were made in each group. All rats were submitted to an autopsy on the day of death or on the 12th post op day when the survivors were sacrificed. RESULTS: Similar bacteria were found in the three groups. E. coli (100%); Enterococcus fecalis (97%); Klebsiela pneumoniae (70%); Citrobacter freundi (70%) and Enterobacter aglomerans (63%). In the first 96 hours the rats without spleen had a lesser inflammatory reaction when compared to the group with spleen. The leading cause of death was generalized peritonitis in the first 96 hours. There was a significant statistical difference in the mortality rate between Group B (80%), Group A2 (no mortality) and Group A1 (35%). CONCLUSION: There was a significant statistical difference in the mortality rate caused by peritonitis between the groups with splenectomy when compared to the group with no splenectomy.

Animals↗
PubMed2005

Late postoperative follow-up of patients undergoing subtotal splenectomy.

PURPOSE: Over the past 21 years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. METHODS: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1 to 20 years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n = 43), trauma (n = 31), Gaucher's disease (n = 4), myeloid hepatosplenomegaly due to myelofibrosis (n = 3), splenomegalic retarded growth and sexual development (n = 2), severe pain due to splenic ischemia (n = 2) and pancreatic cystadenoma (n = 1). Patients underwent a hematologic exam, an immunologic assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. RESULTS: Increased white blood cell count and platelets were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension although without rebleeding. The ultrasound, tomography and scintigraphy exams confirmed the presence of functional splenic remnants without significant size alteration. CONCLUSIONS: Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.

Follow-Up Studies↗
PubMed1998

T cell hypofunctions and glomerular sclerotic and angiogenic changes found both in rats received unilateral nephrectomy plus transplantation of syngeneic mesenteric lymph nodes and in rats received unilateral nephrectomy plus splenectomy.

Five male and 7 female Lewis rats unilaterally nephrectomized at the ages of 44-46 days were transplanted with the mesenteric lymph nodes (MLN) obtained from syngeneic rats 4 months after the nephrectomy. In addition, 6 males received unilateral nephrectomy plus splenectomy at the age of 38 days. All of these rats were observed for 8.5 months after the nephrectomy. Flow cytometry analyses indicated that 17-32% of MLN lymphocytes and 4-20% of peripheral blood (PB) lymphocytes lost CD2 antigen in the unilaterally nephrectomized rats. Approximately 20% of PB and MLN lymphocytes had lost CD2 antigen in the males with combined splenectomy and nephrectomy, one of which died of severe infection. The survival rates of the MLN graft after 4.5 months were 100% in the 5 nephrectomized males and 14% in the 7 nephrectomized females. The CD2 antigen on immunologically activated T cells was up-regulated. Twenty-eight% lymphocytes of the survived MLN graft and 51% PB T cells of the 7 females with MLN graft rejection showed the CD2 up-regulation. It was shown immunohistochemically that not only CD2-positive (+) cells but also CD4+ cells were increased in the cortex of the survived MLN graft. The hepatocyte growth factor receptor gene, c-met gene, was shown to be present in lymphocytes. The c-met was considered to cooperate with the CD2. Interstitial mononuclear cell infiltrations with glomerulosclerosis were found in the remaining kidneys of the males with unilateral nephrectomy plus MLN grafts. Glomerular angiogenesis and accompanying endothelial cell apoptosis were demonstrated without mesangial cell proliferation in the males with unilateral nephrectomy plus splenectomy.

Animals↗
PubMed1983

Splenectomy combined with gastrectomy and immunotherapy for advanced gastric cancer.

We studied the effects of a splenectomy in combination with immunotherapy on the survival of patients who had undergone a total gastrectomy. It was found that a splenectomy was not effective against advanced gastric cancer at stage III, and that the spleen should be retained for immunotherapy. Splenectomy for gastric cancer at terminal stage IV, particularly in combination with immunotherapy, produced not only augmentation of cellular immunity, but also increased survival.

Gastrectomy↗
PubMed2003

Idiopathic thrombocytopenic purpura: a retrospective analysis in 139 patients of the influence of age on the response to corticosteroids, splenectomy and danazol.

OBJECTIVE: To review the influence of age on the response of patients with idiopathic thrombocytopenic purpura (ITP) to corticosteroids, splenectomy and danazol. METHODS: We retrospectively reviewed a cohort of 139 consecutively treated patients with ITP diagnosed between 1985 and 1994. In particular, we analysed the therapies used, their response rates, prognostic indicators of response and adverse effects. Furthermore, we compared the efficacy and tolerability of the various therapies between younger and older patients (<60 and > or =60 years old). RESULTS: Corticosteroids were used as first-line treatment in 118 patients with an initial response rate of 83%. Age did not affect the outcome of corticosteroid therapy, but all the patients aged > or =60 years reported adverse effects. A splenectomy was performed in 55 patients with an initial response rate of 87%. Older patients had significantly poorer outcomes from splenectomy with higher postoperative morbidity. Finally, danazol was given in 33 patients with a favourable response in 72% of cases. Compared with younger patients, older patients had a significantly better outcome with danazol. CONCLUSIONS: Age may have significant effects on the response to and adverse effects of therapy in ITP, and this should be considered when choosing the treatment modality for the elderly.

Adrenal Cortex Hormones↗
PubMed2001

[Brain abscess developed five years after splenectomy in a patient with idiopathic thrombocytopenic purpura].

The increased susceptibility to infection following splenectomy has been well documented. We report here, a case of brain abscess developed five years after splenectomy in a patient with idiopathic thrombocytopenic purpura (ITP). A 65-year-old woman was admitted to our hospital because of fever, mental disorientation, and weakness in August, 1999. She had been followed with diagnoses of essential hypertension and type 2 diabetes mellitus (DM) since 1988. The patient was diagnosed as having ITP in 1992, and then underwent splenectomy in 1994. Monoclonal gammopathy of undetermined significance (MGUS) of IgG, lambda type was found in February 1999. Though high grade fever persisted after admission, blood cultures were negative. Antibiotics were given without a satisfactory effect. Right hemiparesis and worsening of consciousness developed subsequently. Contrast enhanced cranial computed tomography (CT) disclosed a ringed enhanced low density mass in the left parieto-occipital lobe compatible with a diagnosis of brain abscess. Surgical drainage was performed and 20 ml of pus was obtained. No primary infectious focus of the brain abscess was detected with intensive examinations.

Aged↗
PubMed2003

[Severe type of Epstein-Barr virus associated hemophagocytic syndrome successfully treated with T-COP-E and splenectomy].

A 16-year-old girl was admitted to our hospital because of high fever, abdominal pain, and jaundice. Abnormal lymphocytes and hemophagocytic cells had infiltrated the bone marrow. Laboratory data revealed a severe type of hemophagocytic syndrome accompanied by an initial Epstein-Barr virus (EBV) infection. Persistent EBV infection was identified by polymerase chain reaction (PCR) detection of EBV-DNA in peripheral blood and bone marrow mononuclear cells. The limited efficacy of initial treatment with high-dose gamma-globulin, plasmapheresis, and high-dose methylprednisolone prompted us to administration of T-COP-E (VP-16). Two courses of T-COP-E improved the patient's clinical symptoms and laboratory data; however, marked splenomegaly remained. In addition, fever and serum increase of lactate dehydrogenase (LDH) and cytokines such as gamma-interferon recurred shortly after chemotherapy. On day 53 after diagnosis, the patient underwent laparoscopic splenectomy. The resected spleen weighted 420 g and abnormal lymphocytes in the spleen were positive for CD 8 and negative for CD 56. In situ hybridization revealed EBV-encoded small RNAs (EBERs) in the abnormal lymphocytes. Clinical symptoms including high fever disappeared shortly after the splenectomy, and laboratory data returned to normal. Lymphocytosis after the splenectomy was not observed. We continued out patient monitoring of the case, and 16 months after diagnosis, EBV-DNA in peripheral blood mononuclear cells was not detected, even by PCR.

Adolescent↗
PubMed2002

[Splenectomy technic].

Splenectomy has been performed in trauma in a number of benign lesions of the spleen and in a certain haematological diseases. When performed for trauma a luxation technique of splenectomy is applied since it allows quick haemostasis. When performed in other indications, the spleen is usually enlarged. In those patients "splenectomy in situ" is recommended. That means, first, division of the short gastric vessels and gastrosplenic ligament, second, ligation of the splenic artery and finally division of the hilar vessels after which the spleen may be simply removed. Details of operative technique, management of accessory spleens and prevention of operative complications are described.

Hematologic Diseases↗
PubMed1976

Effect of splenectomy on anemia in patients on regular dialysis treatment.

Splenectomy was performed in 7 patients on regular hemodialysis treatment who had disabling anemia. All patients had a short 51Cr red cell survival time and an increased splenic uptake of red cells verified by external counting and computer-aided scintigraphy. The need for blood-transfusions was eliminated in all except one. In all patients the hemoglobin concentration rose after splenectomy. This was probably an effect of a reduced plasma volume and the removal of a large pool of non-circulating red cells. No consistent changes in the red blood cell survival time or the red cell volume were observed. The white cell and the platelet counts in the blood rose to twice the preoperative value. No adverse effect of the splenectomy was observed.

Adolescent↗
PubMed1976

Splenectomy--a surgical panorama.

A five-year material of splenectomies (1970-74) is presented. The material was divided according to the indications for splenectomy as follows: radicality (Group I), iatrogenic hemorrhage Group II), traumatic ruptures (Group III), hematological cases (Group IV) and miscellaneous cases (Group V). There was a large increase in the hematological group over the period due to the addition of splenectomy in the staging procedure for Hodgkin's disease. The mortality was highest in group I and lowest in group IV, as also was the incidence of complications. No patient with Hodgkin's disease died of the operation and the staging laparotomy for this disease, which gives valuable information, thus seems sufficiently safe to warrant routine use.

Humans↗
PubMed2000

Idiopathic myelofibrosis developing isolated granulocytic sarcoma with der (1;7)(q10; p10) after splenectomy and finally transforming to acute myelogenous leukemia.

A 47-year-old female with idiopathic myelofibrosis developed isolated granulocytic sarcoma with der (1; 7)(q10; p10) after splenectomy, followed by acute myelogenous leukemia. The patient had myelofibrosis since 22 years of age, received splenectomy at 47 years, and developed isolated submandibular granulocytic sarcoma, 8 months later. Although the initial tumor disappeared after irradiation, recurrent tumors selectively appeared in the areas of operative scars. She subsequently developed blastic transformation with der (1; 7)(q10; p10), and the blasts were refractory to different chemotherapy. This case is very rare in the following aspects: the onset of myelofibrosis occurred at a relatively young age; isolated granulocytic sarcoma after splenectomy preceded the transformation to acute leukemia; and the subcutaneous tumors developed in areas of operative scars.

Chromosomes, Human, Pair 1↗
PubMedDate not supplied

Palliative splenectomy in myelofibrosis with myeloid metaplasia.

Myelofibrosis with myeloid metaplasia (MMM) is a chronic myeloproliferative disorder in which the accumulation and growth of circulating myeloid progenitors in the spleen lead to pathologic enlargement of the organ with resulting mechanical discomfort, hypercatabolic symptoms, anemia, thrombocytopenia, and portal hypertension. Medical therapy and splenic irradiation may be of benefit in certain patients, yet many may still require splenectomy to palliate their symptoms. Although there is no clear survival advantage to splenectomy in MMM, the procedure can result in substantial palliation of symptoms. However, the surgical procedure is associated with an approximately 9% mortality rate, and the postsplenectomy occurrence of extreme thrombocytosis, hepatomegaly, and leukemic transformation is of major concern. The management of splenomegaly and the role of splenectomy in MMM are discussed in this review.

Disease Management↗