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PubMed1986

[Results of splenectomy with polychemotherapy in the treatment of 15 chronic myeloid leukemia patients].

The results of splenectomy followed by chemotherapy are analysed. Fifteen patients with chronic myeloid leukemia (CML) were entered into the study. The maximal survival of one of the patients subjected to splenectomy was 102 months. The authors come to the conclusion that it is desirable that CML patients should be subjected to splenectomy after preliminary preparation (chemotherapy and chemoprotectors) at the early stages of the illness, which is to be followed by monochemotherapy. Provided the latter is unsuccessful, the change over to polychemotherapy similar to the treatment protocols for myeloid leukemia is suggested.

Adult↗
PubMed1987

Influence of splenectomy on the levels of circulating immune complexes (CIC) in Hodgkin's disease (HD).

A 3.75% polyethylene glycol 6000-precipitation method was used to estimate the levels of circulating immune complexes (CIC) in pre- and postsplenectomy serum samples obtained from 34 patients suffering from Hodgkin's disease (HD). In 26 out of the 34 patients (76.47%) the postsplenectomy samples showed a considerable decrease in CIC levels compared to the levels in the presplenectomy samples. Two patients showed a marginal change while the remaining 6 patients exhibited elevated levels of CICs after splenectomy. The mean levels (in terms of OD 450 nm) in the pre- and postsplenectomy sample sets were 0.66 +/- 0.07 and 0.42 +/- 0.05, respectively (p less than 0.01). There was no apparent relationship between the interval elapsed after splenectomy (6-22 days) and the magnitude of decrease (1.7-91.8%). Patients with LP-type histology and splenic involvement formed a category that preferentially showed a substantial decrease in CIC levels after splenectomy.

Adolescent↗
PubMed1987

Operative technique and results of subtotal splenectomy for Gaucher disease.

Patients with type 1 (adult form) Gaucher disease complicated by massive splenomegaly and hypersplenism have previously been treated by total splenectomy. Subtotal splenectomy in Gaucher disease will retain splenic tissue which may protect the patient from the risk of overwhelming sepsis. Removal of at least 85 per cent of the splenic mass is necessary to eliminate hypersplenism and to decrease splenic size. The surgical technique and outcome of four patients undergoing subtotal splenectomy for massive splenomegaly due to type 1 Gaucher disease are discussed.

Adult↗
PubMed1987

[Effect of splenectomy in gastric carcinoma surgery on cell-mediated immunity; evaluation with alteration of peripheral blood lymphocyte subsets].

Peripheral blood lymphocyte subsets were studied in 70 patients who underwent gastrectomy for gastric carcinoma. Lymphocyte subsets were analysed before and after gastrectomy by use of monoclonal antibody for cell membrane markers. There were significant differences in the gastrectomized patients with splenectomy compared to the patients without splenectomy in postoperative changes of lymphocyte subsets as follows. Decrease of OKT4 and increase of OKT8. Temporary decrease of B-1. Continuous increase of Leu-7. These results suggest that gastrectomized patients with splenectomy show a decrease in helper activity, an increase of suppressor activity of T lymphocytes and a compensatory increase of population of natural killer cells in association with suppression of natural killer activity.

Female↗
PubMed1987

[The bone marrow in Hodgkin's disease following radiotherapy and splenectomy].

A study was made of the bone marrow status in unirradiated zones of 33 patients with stage I-II Hodgkin's disease in complete 9-12 year remission after therapeutic irradiation of the lymphatic collectors of the upper part of the trunk in combination with irradiation of the spleen (16 patients) or splenectomy (17 patients). The total count of myelokaryocytes, myelogram, a relative and absolute content of lymphoid cells, immature granulocytes and elements of the erythroid series were defined in the punctates of the upper portion of the ilium. T- and B-lymphocyte count, the number of granulocytomacrophage (CFU-C) and stromal (CFU-F) precursor cells were defined using morphocytochemical and immunological methods. At that time an increase in the relative and absolute content of C- and B-lymphocytes was noted. The T-cell count and the total number of myelokaryocytes, on the one hand, and the content of immature granulocytes and erythronormoblasts, on the other hand, showed correlation of various degree which was particularly noticeable in the group of unoperated patients. The total number of myelokaryocytes in 1 microliter of the bone marrow of the patients after splenectomy, on an average, significantly exceeded that in the group of patients with the irradiated spleen. These changes were considered to be a result of the rearrangement of T-differentiating lymphocytes with their raised accumulation in the bone marrow after irradiation of a considerable volume of the lymphoid tissue and spleen or after splenectomy.

Bone Marrow↗
PubMed1987

Splenectomy performed upon thirty-seven patients with hairy cell leukemia.

Thirty-seven patients with hairy cell leukemia underwent splenectomy. The postoperative course was uneventful for 34 patients. Improvement of peripheral cytopenia was obtained in the majority of patients. Survival time of patients who underwent splenectomy was significantly longer than for patients who did not undergo this procedure. Splenectomy is a habitually effective form of treatment for hairy cell leukemia, although not completely free of risks.

Adult↗
PubMed1986

Haematological remission of leukaemic polymorphic immunocytoma following splenectomy. Case report with longitudinal immunological and cytogenetic studies.

A 56-year old man with a Rai stage IV B-cell chronic lymphocytic leukaemia (polymorphic immunocytoma according to the Kiel classification) of mu kappa-phenotype with a clonal chromosomal abnormality in cells from peripheral blood, bone marrow, and spleen is reported on. Following splenectomy (without further therapy) the blood lymphocytosis gradually decreased to normal and the patient entered a remission, assigned 42 months after splenectomy by immunological and cytogenetic studies that revealed no cells of clonal origin in blood or bone marrow. Utilizing cellular markers of clonality, we thus confirm that haematological remissions may follow splenectomy. A subsequently developed orbital lymphoma (without leukaemia) consisted of tumor cells derived from the initial leukaemia cell clone as indicated by their immune and cytogenetic phenotype. The case report is discussed in relation to previous reports on "spontaneous" remissions of lymphoid leukaemias.

Antigens, Neoplasm↗
PubMedDate not supplied

[Role of splenectomy in Chediak-Higashi syndrome in its accelerated phase].

Chediak-Higashi (C.H.S.) syndrome is a rare immunodeficiency, due to defective granulocyte activity. The syndrome is characterized by large inclusion bodies in the leukocytes, albinism, photophobia, nystagmus, and recurrent infections. Some patients develop hepatosplenomegaly, lymphadenopathy, pancytopenia and widespread organ infiltrates with mononucleated cells. This phase is called "accelerated (or lymphoma-like syndrome) phase". A 5 years old girl with C.H.S. in accelerated phase received initially medical treatment without improvement. A splenectomy was performed to remove the hypersplenism and the mechanical compression of the spleen on the gut. Few days after the splenectomy the fever and the pancytopenia disappeared. The pathological examination of the spleen showed multiple intraparenchymal abscesses. Unfortunately, six months after the operation, she died after an acute episode of pneumonia, with normal hematological pattern. The splenectomy may play a role in the "accelerated phase" of C.H.S., but new treatments (bone marrow transplantation) are necessary to remove the basic disease.

Chediak-Higashi Syndrome↗
PubMed1985

The limited role of splenectomy in patients with leukemia.

Splenectomy is a valuable method of management of approximately 80 per cent of patients with hairy cell leukemia who have hypersplenic complications develop; operation can be performed with minimal morality and morbidity. Removal of the spleen also provides useful palliation in patients with chronic lymphocytic leukemia who have symptomatic splenomegaly or autoimmune hemolytic anemia; success is less predictable when operation is performed for thrombocytopenia. Splenectomy is linked with a high mortality and is of little benefit in patients with chronic granulocytic leukemia except when operation is performed as a prerequisite to bone marrow transplantation. Several patients with acute leukemia who have signs of splenic infarction and intra-abdominal bleeding develop had a short survival period after splenectomy.

Adult↗
PubMed1985

[The immunological studies on the splenectomy and the splenic autotransplantation in BALB/C mice].

Recently, it has been demonstrated that the severe infectious diseases are often caused after splenectomy. The significance of spleen on humoral immunity has been pointed out, however the alterations of cellular immunity by splenectomy has not yet been investigated sufficiently. In this study, the effects of splenectomy on the immunological aspects were examined. And the reconstruction of immunological responses by the splenic autotransplantation was also examined. The results obtained were as follows. The antibody titers against SRBC of the splenectomized groups continued to be apparently lower than those of sham-operated groups. The IgM of the splenectomized groups showed lower values than that of the sham-operated groups, but concerning IgG, no distinct differences were noticed among these two groups. On the proliferation of peripheral lymphoid cells, the splenectomized groups from 4th week later showed a higher response than the sham operated groups. The splenic autotransplanted groups showed a similar response to the sham operated ones in the antibody production against SRBC, and the proliferations of lymphocytes. The splenic autotransplantation might be suggested to be a worthy application.

Animals↗
PubMed1985

Prophylactic cholecystectomy during splenectomy for beta thalassemia homozygous in Greece.

The impact of prophylactic cholecystectomy upon early mortality and morbidity of splenectomy for patients with beta TH H was investigated. The results of our study suggested that it is a safe procedure that is not associated with any increase in operative mortality and postoperative complications. This was true even when beta TH H was complicated by pigment cirrhosis and ascites. In view of increasing longevity of those patients with beta TH H, as well as the increased risk for gallstones even after splenectomy, we recommend the use of prophylactic cholecystectomy as a standard approach for all patients undergoing splenectomy for beta thalassemia homozygous.

Adolescent↗
PubMed1985

Platelet-associated immunoglobulin, platelet size, and the effect of splenectomy in the Wiskott-Aldrich syndrome.

Wiskott-Aldrich syndrome (WAS) thrombocytopenia is frequently improved by splenectomy, although the mechanism of the thrombocytopenia and its resolution are unknown. Previous studies in two patients have shown that mean platelet volume, which is characteristically reduced in WAS, increased along with platelet count postsplenectomy. Additional studies in a limited number of patients have also demonstrated that platelet-associated immunoglobulin G (PAIgG) is elevated presplenectomy, but to date no postsplenectomy data have been reported. The present study was performed to more fully evaluate the effect of splenectomy on platelet volume and PAIgG in WAS. Before splenectomy, mean platelet volume was reduced but platelet size was broadly distributed with substantial overlap of the normal range. PAIgG was significantly elevated in 13 of 14 presplenectomy WAS patients (means = 78.9 fg per platelet) and fell to normal levels postoperatively (means = 4.0 fg per platelet). Platelet count and clinical status improved postsplenectomy, and mean platelet volume and platelet volume distribution returned to the normal range. WAS subjects who relapsed with recurrent thrombocytopenia redeveloped elevated PAIgG but maintained normal platelet size. The spleen appears to play a critical role in a process that may be immunologically mediated and results in reduced platelet size.

Blood Platelets↗
PubMed1985

Increased platelet aggregation following splenectomy in patients with myeloproliferative disease.

In 30 patients with myeloproliferative disorders, decreased platelet aggregation in response to both ADP and collagen was demonstrated. The hypoaggregability was more drastic in patients with large spleens. Patients who had had splenectomy in the past showed normal platelet aggregation. In order to understand the role of the spleen in platelet function, platelet aggregation was studied in three patients with myeloproliferative disorders during the week following splenectomy and was compared to platelet aggregation in three control patients undergoing orthopedic operations. After splenectomy, platelet aggregation significantly increased, reaching a maximum after 3 to 4 days, but returned to presplenectomy values after 1 week. This is in contrast to the control patients, in whom no significant changes in platelet aggregation were observed. Our results suggest that the spleen retains or catabolizes the most hemostatically effective platelets.

Adult↗
PubMed1985

[Splenectomy for idiopathic thrombopenic purpura. A retrospective study of 40 cases].

The authors analysed retrospectively the files of 40 patients who underwent splenectomy for idiopathic thrombocytopenic purpura and who were totally or partially (relapse) resistant to a therapeutic trial of corticosteroids. There was no operative mortality but morbidity, especially respiratory, was substantial, being 40%. Drainage of the splenic bed should be avoided because this is clearly associated with a greater frequency of pulmonary complications. In 37 patients with a mean follow-up of 30.3 months, there was complete remission in 89.2% after splenectomy. This confirms the therapeutic value of splenectomy in idiopathic thrombocytopenic purpura, especially in those who showed a partial (transitory) response to corticosteroids.

Adolescent↗
PubMed1985

Splenectomy as adjunctive therapy for immune-mediated thrombocytopenia and hemolytic anemia in the dog.

Splenectomy was done in 9 dogs having immune-mediated hematologic disorders refractory to medical therapy. These disorders were immune-mediated thrombocytopenia (n = 3), immune hemolytic anemia (n = 3), and Evan's syndrome (n = 3). The diagnoses were based on clinical observations, laboratory test data, and differential of other conditions. In the 12 months after splenectomy was done, the dogs reflected clinical improvement and return of platelet and/or erythrocyte counts to clinically acceptable limits; medical treatment was stopped or reduced in 8 of 9 patients. The exceptional patient had shown clinical improvement without change in the platelet count. At the end of 1 year, survival rate was excellent, and postsplenectomy complications, such as hemobartonellosis, did not appear. It is believed that splenectomy may be useful for treating immune-mediated thrombocytopenia, anemia, and Evan's syndrome that seem refractory to medication.

Anemia, Hemolytic↗
PubMed1967

Exacerbation of latent erythrocytic infections in deer following splenectomy.

Eight adult deer and 4 fawns, from wild populations, were splenectomized and observed for evidence of hemo-parasitic relapses. The animals were maintained indoors under tick-free conditions and in the absence of known arthropod vectors. Following splenectomy 2 adult deer and 2 fawns developed acute Eperythrozoon infections, 3 adult deer developed acute Theileria infections, 2 adult deer developed a demonstrable Anaplasma marginale parasitemia, and 1 adult deer exhibited a low level parasitemia of a plasmodial-like intraerythrocytic parasite. The remaining deer failed to develop a parasitemia following splenectomy. In the absence of a specific parasitemia no drop occurred in packed cell volume following splenectomy.

Anaplasmosis↗
PubMed1979

Splenectomy for hemocytopenia in systemic lupus erythematosus. A controlled appraisal.

We compared 15 patients with systemic lupus erythematosus (SLE) treated with splenectomy for thrombocytopenic purpura and/or hemolytic anemia to 15 similar SLE patients treated only medically. There was no significant difference between the splenectomized and the nonsplenectomized patients when their entire course, as well as the presplenectomy and postsplenectomy or their equivalent control periods, were compared by means of an overall severity index. Splenectomized patients, however, had a significantly higher frequency of cutaneous vasculitis after splenectomy than in their own presplenectomy period and a significantly higher frequency of cutaneous vasculitis than the nonsplenectomized patients. Serious infections were more frequent in the postsplenectomy period than in an equivalent period in the nonsplenectomized patients. Splenectomy produced only short-term benefit in the management of hemocytopenic episodes in SLE and seems only warranted as an emergency procedure in patients unresponsive to medical treatment.

Anemia, Hemolytic↗