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PubMed1989

[Early postoperative complications in elective splenectomy in hematologic diseases].

This study analyses frequency of complications and mortality after elective splenectomy done for various hematological diseases, dependent on the spleen weight. From 1979 to 1988 year, 236 patients were treated by splenectomy for various haematological disorders, including: autoimmune disorders (90), Hodgkin's disease (34), lymphoproliferative diseases (96) and myeloproliferative diseases (16 patients). In the early postoperative period, complications occurred in 51 (21.61%) patients, 10 of which (4.24%) died. Considering the size of the spleen (more or less than 1500 gr) there was no difference in the early postoperative mortality (p greater than 0.05; 3.30%:5.38%), while postoperative complications occurred significantly more often in patients with massive splenomegaly (p greater than 0.05; 1259%:3548%). The most frequent complications were septical (8.90%), prolonged fever (5.51 x), and postoperative bleeding (2.97%), while cardial, pulmonary and urinary complications occurred seldom, but more often caused patient's death. Defining the appropriate indications for splenectomy, performing suitable preoperative preparations and postoperative care, mortality was diminished from 7.14% in the period, 1979-1983 year, to 2.17% in the period 1984-1988.

Adolescent↗
PubMed1989

T lymphocyte subsets, natural killer cell cytotoxicity and autologous mixed lymphocyte response in children after splenectomy because of hereditary spherocytosis.

Lymphocyte subpopulations and autologous mixed lymphocyte reaction (AMLR) studied in 13 hereditary sphereocytosis and 21 postsplenectomy patients; the operation was performed because of hereditary spherocytosis. Significant increases of Th cells and the Th/Ts ratio have been noted in children with hereditary spherocytosis. Splenectomy because of spherocytosis has resulted in an increase in Ts cell number and diminution of Th/Ts ratio. Hereditary spherocytosis patients showed both diminished natural killer cell activity and AMLR proliferation. Splenectomy normalized the above parameters. The presented data demonstrated disturbances in T lymphocyte number and functions both before and after splenectomy in children with hereditary spherocytosis.

Child↗
PubMed1989

Second malignant neoplasms following childhood Hodgkin's disease: treatment and splenectomy as risk factors.

The risk of second malignant neoplasm (SMN) was evaluated in 979 children with Hodgkin's disease. This cohort was diagnosed between 1955 and 1979 at one of the institutions of the Late Effects Study Group. Solid tumors, non-lymphocytic leukemia, and non-Hodgkin's lymphoma (NHL) developed in 18, 17, and 3 patients, respectively. The estimated cumulative probability of developing any SMN was 2% at 5 years from diagnosis, 5% at 10 years, and 9% at 15 years. The incidence is ninefold greater than the risk of acquiring cancer in 19 year-olds, the median age at which the diagnosis of SMN was made in this study population. For leukemia and NHL the corresponding probabilities were 1%, 3%, and 4% for the group as a whole but were increased (2%, 6%, and 8%) in patients who had suffered one or more recurrences. In order to analyze the risk of leukemia and NHL associated with alkylating agent chemotherapy, each patient was assigned a score of one for each alkylating agent administered for a 6-month period. Scores of 2, 4, 6, and 8 were associated with probabilities of leukemia or NHL of 2%, 3%, 6%, and 10%, respectively. In a multivariate analysis for leukemia/lymphoma that included AAD score, stage, and splenectomy, the effect of AAD score and splenectomy did not change substantially compared to the univariate results. AAD score remained statistically significant (P = .0001), and splenectomy was of borderline significance (P = .09). Of the 18 solid tumor SMNs, 15 developed within the field of radiation, and one other developed in tissue irradiated 34 years earlier for hemangioma. This study of a large and unselected group of children with Hodgkin's disease who received a variety of therapies demonstrates that children are as likely as adults to develop acute leukemia after alkylating agents and solid tumors in the field of radiation therapy.

Adolescent↗
PubMed1989

Blood volume determinations in sheep before and after splenectomy.

Using 51Cr labelled RBCs, total blood volume, red cell volume and plasma volume were measured in fifteen adult, female, domestic sheep both before and after splenectomy. Eight of the fifteen animals studied were anemic. Statistical analyses revealed no significant differences in blood volume parameters whether animals were grouped together or separated into normal and anemic groups. We observed: (a) splenectomy produced modest reductions in blood volume parameters in 12 of 15 animals, (b) preoperative variability in blood volume parameters caused by release of sequestered RBCs from the spleen was eliminated after splenectomy, and (c) equilibration of 51Cr required at least 30 minutes in intact animals, but only 10 minutes in splenectomized animals. After volume parameters were normalized to body weight, they were found to agree closely with values reported previously. This study demonstrates the dynamic function of the sheep spleen in the regulation of blood volume.

Anemia↗
PubMed1989

Blood clearance and tissue distribution of 99Tc-labelled pneumococci following splenectomy in rabbits.

Female New Zealand White rabbits, following sham laparotomy, total splenectomy and splenectomy with 50% splenic autotransplantation, have been injected intravenously with 99Tc-labelled type 2 Streptococcus pneumoniae. The blood clearance of isotope has been measured and the numbers of circulating bacteria quantitated by blood culture. On sacrifice of the animals the tissue uptake of the isotope has been measured. The results indicate 98% bacterial clearance from the blood within 7 min. The liver is the principal organ for reticuloendothelial uptake of the bacteria accounting for 60% of the total injected dose; 15% of the isotope clearance occurred in the lungs, and the spleen contributed only 3% of the total bacterial clearance. There was no difference in the observed pattern of clearance following splenectomy and following splenic reimplantation. Following the uptake of the bacteria in the tissues, the isotope dissociated from the bacterium and was excreted in the urine. The secondary rise in blood isotope level consequent upon this release was not accompanied by a secondary bacteraemia.

Animals↗
PubMed1989

[Contraindications to splenectomy in primary total extrahepatic portal hypertension].

The authors studied changes of hepatic circulation, hepatoportal hemodynamics, and homeostasis of peripheral and portal venous blood in response to removal of the spleen in primary total extrahepatic portal hypertension. The findings of rheohepatography, isotope hepatography, and ultrasonic flow measurement provided proof that splenectomy does not lead to intensification of the flow of arterial blood to the liver. Study of the portal pressure level did not demonstrate any significant hypotensive effect of splenectomy. Considerable changes occur after removal of the spleen, which creates real preconditions for the development of portal system thrombosis. All the above-said provides the basis for reducing considerably the range of indications for splenectomy and recommending it only in cases with marked clinical manifestations of hypersplenism hemolysis and increased tendency to bleeding.

Humans↗
PubMed1989

Results of the splenectomy in children with thalassemia.

Sixty-nine children with beta-thalassemia/E disease, hemoglobin H disease and beta-thalassemia major who were followed for at least 2 years before and after splenectomy were studied retrospectively for the results of the splenectomy. It was found that. 1. The hematocrit increased significantly in beta-thalassemia/E from 18 to 22 per cent, in hemoglobin H disease from 21 to 34 per cent and in beta-thalassemia major from 14-15 to 18-19 per cent. 2. The requirement of blood transfusions per year decreased significantly from 6 to 2 times in beta-thalassemia/E, 10 to 4-5 times in beta-thalassemia major and no transfusion was needed in hemoglobin H disease. 3. Postoperatively, there was a significant increase (p less than 0.05) in the liver size by the third year in beta-thalassemia/Hb E disease, and in the first year in beta-thalassemia major but the liver-size was decreased significantly by the fourth year in hemoglobin H disease. 4. Within 2 years postoperatively, the growth velocity in height kept up with their presplenectomy period in hemoglobin H and beta-thalassemia major (except two cases). The growth in weight kept up with their presplenectomy period in 40/49 cases (81.63%) in beta-thalassemia/Hb E but there was no change in the weight velocity in hemoglobin H and beta-thalassemia major. 5. There were 5 cases with immediate postoperative complications. Three cases had pneumonia, one case had septicaemia and one case had bleeding at the operative wound. Episodes of URI decreased in the post-operative period. Five cases of bacteremia developed within 6 years post-splenectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Splenectomy in hematologic diseases].

We present the results of splenectomy in 45 patients with haematological diseases during the period 1975-85. Of 16 patients with immunologic thrombocytopenia, splenectomy resulted in a satisfactory and sustained platelet elevation in 11 (69%). Splenectomy corrected anaemia in all five patients with hereditary spherocytosis. Of seven patients with autoimmunohaemolytic anaemia, four responded satisfactorily. Postoperative complications occurred in ten of 45 patients (22%). There was no post-operative mortality. Only 49 per cent of the patients had received antipneumococcal vaccination. This is not satisfactory, and all unvaccinated, splenectomized patients should be offered vaccine. If possible, the vaccination should be performed before operation.

Adolescent↗
PubMed1978

Effect of splenectomy on the expression of regulatory T cell activity.

The effect of adult splenectomy on the expression of suppressor and amplifier T cell activity was examined with respect to the serum antibody response to Type III pneumococcal polysaccharide (SSS-III) by using a sensitive radioimmunoassay. Suppressor T cell activity, as measured by the degree of low-dose paralysis induced, was not impaired in the least by splenectomy; however, amplifier T cell activity was almost completely eliminated within 7 days after splenectomy. These findings indicate that suppressor T cell activity is not confined solely to the spleen, the major site of antibody synthesis after immunization with SSS-III, and that the spleen may be an important site for the generation and/or maintenance of amplifier T cell activity.

Animals↗
PubMedDate not supplied

[Splenectomy in histiocytosis X].

Present concepts of histiocytosis X are reviewed and the results obtained in three patients that underwent splenectomy are described; postoperative survival is analyzed in order to evaluate the possible beneficial influence of splenectomy. One case corresponded to a female with a survival of nine years and another one a male with a survival of fifteen months; both received postoperative treatment with corticosteroids and are asymptomatic at the present time. The third case had an unfavorable evolution (he did not receive postoperative treatment). Even though present experience dose not alow to establish definitive conclusions, we must consider in the usefulness of splenectomy as a part of the treatment of histiocytosis X.

Child, Preschool↗
PubMed1988

Preoperative splenic artery occlusion as an adjunct for high risk splenectomy.

High risk splenectomy is often encountered in cases of hypersplenism with massive splenomegaly (10 times usual weight of 150-200 g) resulting from myelophthisic processes. Intra-operative ligation of the splenic artery through the lesser sac is a technically useful method of gaining vascular control prior to mobilizing the challenging spleen. However, a massive or inaccessible spleen imposes mechanical limitations during surgery and may be complicated by torrential intra-operative hemorrhage in the setting of severe thrombocytopenia refractile to platelet transfusions. The authors describe pre-operative intravascular proximal splenic artery control in four adult patients (3 men, 1 woman) with extreme splenomegaly (2,250-10,000 g). The massive splenomegaly in this group resulted from chronic myelogenous leukemia (n = 2), isolated splenic lymphoma (n = 1), and agnogenic myeloid metaplasia (n = 1). Chief symptom manifestations included left upper quadrant abdominal pain, early satiety, post-prandial emesis, dyspnea, petechiae, and associated easy bruising. Prior to surgery, all the patients were taken to the radiology suite where either detachable silastic balloons or stainless steel coils were placed selectively into the splenic artery under fluoroscopic guidance requiring approximately 35 minutes. Splenic artery occlusion aided normalization of thrombocytopenia (average increases 19,000/microliter to 215,000/microliter) with prolongation in survival of platelets. Successful splenectomy was subsequently performed with no additional transfusion requirements and was made technically easier by reducing splenic bulk. There were no adverse consequences of intravascular occlusion and no peri-operative morbidity or mortality. Preoperative intravascular selective splenic artery occlusion, used as an important potential adjunct to anticipated high risk splenectomy, is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Changes in the proliferative activity of the corneal epithelium and the regenerating liver in partial splenectomy in mice].

The mitotic activity in epithelial cells of the mouse cornea was studied 4 h, 1, 2, 5, 8 and 14 days after a sham operation or partial (2/3) splenectomy. The decrease in the number of dividing cells in the corneal epithelium was observed within two days after a sham operation and within five days after partial splenectomy. On the contrary, partial hepatectomy increased the number of mitoses in the corneal epithelium. Liver regeneration against the background of a sham operation or partial splenectomy was accompanied by a lesser number of mitoses (by a factor of 2.5-4) in hepatocytes than in the animals subjected to partial hepatectomy only.

Animals↗
PubMed1988

Splenectomy in massive tropical splenomegaly: two-to six-year follow-up in 14 patients.

Between 1978 and 1982, 14 patients underwent splenectomy for disabling massive splenomegaly at the Regency Hospital in Wamena in the highlands of Irian Jaya, Indonesia. All patients were clinically diagnosed as having tropical splenomegaly syndrome (hyperreactive malarial splenomegaly), but in no case was the diagnosis confirmed. In May 1984 nurses and physicians caring for these 14 patients were asked to fill in a questionnaire regarding the patients' conditions. Two to 6 years after splenectomy, 8 of the 14 patients were alive and able to work; at least 6 of the 8 at normal or near normal capacity. One patient died 4 days after surgery and 5 died from 2 to 20 months after surgery. We conclude that splenectomy is beneficial for some highly selected patients with the clinical diagnosis of tropical splenomegaly syndrome.

Adolescent↗
PubMed1987

[Staging in Hodgkin's lymphoma. Exploratory laparotomy with splenectomy].

In the present paper, 66 Studies on exploratory laparotomy with splenectomy in Hodgkin's lymphoma from Western Europe and the USA are presented in tables. This statistical compilation on 7183 laparotomies shows that the spleen was involved in 39.9% (2685 out of 6900 cases investigated), the liver in only 7.7% (446 out of 5789) and the abdominal lymph nodes were involved in 30.3% (1389 out of 4578) of the cases. Altogether, laparotomy with splenectomy led to a change in staging in 33% of the patients (1892 out of 5745). In the period from 1970 to 1986, 123 patients with Hodgkin's lymphoma were laparotomized (and also splenectomied apart from one exception) at the Surgical Division, University of Göttingen. The patients comprised 52 cases in the context of primary staging and 71 cases in the context of secondary staging. In 43 cases (35.2%) the spleen was affected, in seven cases (5.7%) the liver was affected, and there was combination with spleen involvement in each case. Infiltration of abdominal lymph nodes was shown in 38.2% (26/68). Exploratory laparotomy led to a change in stage in 46 cases (37.1%) comprising 28 improvements and 18 deteriorations. Before laparotomy, 15 patients were in stage I, 29 in stage II, 44 in stage III and 21 in stage IV. After pathological staging, 14 were in stage I, 40 were in stage II, 47 were in stage II and 19 were in stage IV. Out of the 14 patients who could not be assigned to any stage before the operation, 11 could be definitively staged afterwards. In addition, lymphography was performed in 103 patients, liver and spleen scintigraphy in 51 patients, sonography in 30 patients and computer tomography in 22 patients. In the re-examination of the lymph node situation in the retroperitoneal space, lymphography attained a specificity of 48% and a sensitivity of 71.4% with a positive prediction precision of 35.7% and a negative prediction precision of 88.8%.

Hodgkin Disease↗
PubMed1988

Confounding factors in the hemorrhage of conscious swine: a retrospective study of physical restraint, splenectomy, and hyperthermia.

A retrospective study showed that variability in the responses of heart rate and mean arterial pressure to hemorrhage in conscious swine can be induced by handling procedures, hyperthermia, and splenectomy. All animals were hemorrhaged 38.5 ml/kg over 1 hour. Physical restraint caused tachycardia prior to hemorrhage, an effect that was enhanced during hemorrhage; hemorrhage had no effect on the heart rate of unrestrained animals. Animals restrained in a sling also had an attenuated fall in mean arterial pressures throughout the experiment compared to normothermic swine. Splenectomized swine had elevated heart rates compared to sham-operated animals, with the difference persisting throughout hemorrhage. No difference in mean arterial pressure was noted due to splenectomy. These sources (handling, hyperthermia, and splenectomy) of experimental variability should be considered in the design and interpretation of experiments using conscious swine.

Animals↗
PubMed1988

Effects of splenectomy on hemodynamic performance in fixed volume canine hemorrhagic shock.

Studies of canine hemorrhagic shock commonly use a splenectomized fixed-pressure model. Splenectomy is recommended in this model to avoid variable degrees of autotransfusion that reduce the reliability of mortality estimates and blood volume measurements. The effects of splenectomy on a non-lethal fixed-volume canine hemorrhage have not been established. The purpose of this study was to investigate cardiovascular and biochemical effects of splenectomy in fixed-volume canine hemorrhagic shock. Nineteen beagles of uniform size and weight were bled 50% of their estimated blood volumes over 1 hr and then left without therapeutic intervention for a 90 min stabilization period. Arterial blood pressure (MAP), central venous pressure, pulmonary artery pressure, heart rate (HR), cardiac output, glucose, lactate, arterial and mixed venous blood gases, and hematocrit (HCT) were measured at regular intervals. Cardiac index (CI), stroke volume, and oxygen saturation (O2SAT), delivery (O2DEL) and consumption (O2CON) were calculated at these intervals. Results from ten control animals were compared to those from nine animals that had been splenectomized 2 wk prior to hemorrhage. During the hemorrhage period, there were no significant differences observed between groups for HR, MAP, or O2DEL. CI remained higher (P less than 0.025) and HCT lower (28.9 +/- 4.7 vs 39.8 +/- 4.5) (P less than 0.001) in splenectomized animals. Immediately following hemorrhage there were no significant differences in the mean values for HR, CI, MAP, or serum lactate. O2DEL however, was significantly higher in control animals (P less than 0.05). During stabilization MAP, CI, and O2DEL rose while HCT fell in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Elective splenectomy in haematological disorders.

We report on 106 elective splenectomies performed for haematological disorders between March 1979 and January 1986. The most common indications were immune thrombocytopenic purpura (30 patients) and Hodgkin's disease (19 patients). However, staging laparotomy is no longer performed routinely for patients with Hodgkin's disease and the reasons for this are discussed. Other indications for splenectomy included splenic pain (13 patients), autoimmune haemolytic anaemia (12 patients), hereditary spherocytosis (11 patients) and hypersplenism (9 patients). The overall morbidity and mortality was 48% and 5% respectively. The most common postoperative complication was thrombocytosis (defined as a platelet count greater than 800 X 10(9)/l) and occurred in 26 patients. This review confirms that splenectomy continues to have an important role in the management of certain haematological disorders.

Adolescent↗
PubMed1988

Effect of splenectomy on exercise-induced pulmonary and systemic hypertension in ponies.

Large increases in systemic and pulmonary arterial pressures of exercising healthy ponies have been observed. Because exercise causes a considerable increase in PCV of ponies, we examined the effect of splenectomy on exercise-induced changes in systemic and pulmonary pressures. These pressures (taken with catheter-tip micromanometers) and indicator dilution cardiac output were determined on 9 healthy ponies that had undergone splenectomy 4 to 9 weeks before the study. Data obtained at rest and during submaximal (10.5 to 11.0 mph) and maximal (14 to 15 mph) exercise from these ponies were compared with similar data from clinically normal ponies. Following splenectomy, PCV increased by only 4 vol% during maximal exercise, but cardiac output of splenectomized ponies reached values similar to those of clinically normal ponies. Despite this similarity in cardiac output, the systemic and pulmonary arterial pressures of exercising splenectomized ponies increased to significantly lower levels than those in clinically normal ponies (P less than 0.01); total pulmonary vascular resistance and total peripheral resistance decreased to values significantly less than those in clinically normal ponies (P less than 0.01). Thus, it appears that increases in blood viscosity induced by increases in PCV may contribute substantially to the pulmonary and systemic hypertension of exercise in clinically normal ponies.

Animals↗