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PubMed1975

[The question of thrombocyte substitution as a prophylactic measure in splenectomy for idiopathic thrombocytopenic purpura (ITP)].

The problem of intraoperative thrombocyte transfusion in splenectomy of patients with ITP is discussed. The indication for splenectomy cannot be equalized with that for intra-operative platelet substitution. Thrombocyte kinetic examinations with a concurrent determination of the thrombocyte turnover enable those patients to be recognized by their bleeding tendency who are particularly endangered by operations. The intraoperative platelet substitution should be limited to those patients with ITP whose turnover is markedly lowered as a manifestation of reduced thrombocytopoiesis. In these cases it is advisable to shift splenectomy to a later date.

Blood Platelets↗
PubMed1978

Accessory splenectomy in management of recurrent idiopathic thrombocytopenic purpura.

Residual splenic tissue can occasionally be responsible for recurrent idiopathic thrombocytopenic purpura after splenectomy. Although this is an uncommon phenomenon, we have identified six such patients at the Mayo Clinic in the last 40 years, and a review of the literature revealed nine others. Only 4 of the 15 patients with sufficient follow-up were significantly improved after splenectomy, 1 requiring less medication to control his thrombocytopenia. The presence of residual splenic material is suggested by the absence of Howell-Jolly bodies in the peripheral smear and confirmed by technetium-99m scanning. Accessory splenectomy should be considered as an adjunct to the control of idiopathic thrombocytopenic purpura in previously splenectomized patients but with the realization that remission or improvement in the clinical course may occur in only about one-half of such patients.

Adolescent↗
PubMed1977

[Laparotomy and splenectomy in Hodgkin's disease].

Explorative laparotomy and splenectomy represents the most accurate methode to recognize a lymphogranulomatous process below the diaphragm. The demonstration or exclusion of a subdiaphragmatic propagation of disease plays an essential role in therapy. Since 1973 we have performed explorative laparotomy and splenectomy in stage (I) II-III a of Hodgkin's disease. In the course of this invasive diagnostic procedures (39 primary and 12 reassessing laparotomies and splenectomies) no case of death and no persisting postoperative complications were noticed. Clinical staging was altered in 47% of cases by the procedure but in only one quarter of patients this result influenced therapeutic regimen.

Hodgkin Disease↗
PubMed1983

Splenectomy causes auto-antibody formation.

Serum from 45 splenectomised patients was screened for 8 auto antibodies and compared with controls, either age and sex matched (35) or the same patients measured before splenectomy (10). Sixteen splenectomised patients had demonstrable auto-antibodies compared with 7 controls (p less than 0.05). Three patients who did not have auto-antibodies before splenectomy developed them after an interval of a few months. It is suggested that splenectomy-leads to loss of suppressor cell activity and this permits the development of auto-antibodies.

Adolescent↗
PubMed1984

Control of bleeding esophageal varices by transabdominal esophageal transection, gastric devascularization, and splenectomy.

Between November 1980 and October 1982, 11 patients underwent modified Sugiura procedures (esophageal transection, gastric devascularization, and splenectomy) for bleeding esophageal varices, with an operative mortality of 36%. One patient rebled at 2 months and was successfully managed by sclerotherapy. Intraoperative portal pressure fell approximately 25% after splenectomy. We contend that esophageal transection and gastric devascularization provide good short-term control of bleeding varices, and that the decrease in portal pressure provided by splenectomy allows scars to form during a period of reduced portal pressure, providing long-term arrest of variceal hemorrhage.

Adult↗
PubMed1983

Beneficial effect of pre-transplant splenectomy for leukopenia in primary cadaver kidney transplants.

Pre-transplant splenectomy is controversial. We compared 21 nondiabetic, transfused recipients of first cadaver kidney grafts who underwent pre-transplant splenectomy for steroid-resistant leukopenia to 114 without steroid-resistant leukopenia. Kidney graft survivals at 2 years were 80.2 plus or minus 8.9 and 48.5 plus or minus 5.3 per cent, respectively (p less than 0.05). The 2-year actuarial patient survivals were not significantly different (89.6 plus or minus 7.0 versus 87.8 plus or minus 3.9 per cent). Azathioprine doses and serum creatinine levels at 1 year were not significantly different. Pre-transplant splenectomy for steroid-resistant leukopenia resulted in a significant decrease in kidney graft losses owing to rejection without an increased risk of death of sepsis or thromboembolism.

Azathioprine↗
PubMed1983

Effect of age and splenectomy in murine endotoxemia.

The protective role of the spleen in gram-positive infections, particularly in infancy and childhood, is well established. Since it is not known whether the spleen is protective in gram-negative sepsis, particularly in elderly individuals as compared to young subjects, the following study was undertaken. Splenectomized and nonsplenectomized Swiss Webster mice, 3 months old (young), or 12 months old (elderly) were utilized. Splenectomy was performed 4 weeks prior to administration of E coli endotoxin. Mortality in elderly nonsplenectomized mice was significantly greater than that of young nonsplenectomized mice. Prior splenectomy significantly increased the mortality in young mice at 48 h, whereas the mortality of E coli endotoxemia (ECE) in elderly mice was not altered by prior splenectomy. The spleen, therefore, appears to have a protective role for young mice but does not protect elderly mice with ECE. It is postulated that this loss of splenic protection reflects deteriorating splenic function with age.

Aging↗
PubMed1984

Enhancement of resistance in Mycobacterium lepraemurium infected C3H mice by treatment with sonicated M. lepraemurium or splenectomy.

C3H mice were first infected in a hind footpad with 10(7) freshly harvested Mycobacterium lepraemurium bacilli. Four weeks later, when a granulomatous reaction was detected at the inoculation site, the animals were treated with two doses of a whole sonicated preparation of M. lepraemurium administered 2 weeks apart in the contralateral footpad. Such treatment was found to prolong the survival time of infected mice by 55-60 days. To study the involvement of the spleen in the immunomodulation of resistance to M. lepraemurium infection, splenectomy was performed in mice prior to infection via two different routes. Splenectomy significantly prolonged the mean survival time of mice infected in the footpad but did not affect survival of those infected intraperitoneally. Treatment of splenectomized footpad infected mice with sonicated bacilli abrogated almost completely the beneficial effect of splenectomy.

Animals↗
PubMed1980

Effect of splenectomy upon tumor growth: characterization of splenic tumor-enhancing cells in vivo.

The effect of splenectomy upon neoplastic outgrowth was examined prior to and after implantation of methylcholanthrene-induced C3H/HeJ murine tumors. Splenectomy or sham operation performed 6 and 3 days prior to tumor inoculation significantly facilitated tumor growth compared to nonoperated, control mice. Operative procedures 12 days prior to tumor inoculation had no effect on tumor growth rate, suggesting that facilitated tumor growth was related to surgically induced, transient immunosuppression, rather than to the presence or absence of splenic tissue. On the other hand, 3 days after tumor inoculation, sham operations resulted in significant facilitation, but splenectomy yielded retardation of tumor growth. In local adoptive transfer assays, spleen cells from hosts bearing MCA-F tumors for 3 days nonspecifically facilitated the outgrowth of the antigenically noncrossreactive tumors MCA-F, MCA-D and MCA-C. These findings suggest that the spleen is a reservoir of suppressor cells during early stages of tumor growth, since the suppressor activity was not demonstrate 6 or 12 days after tumor inoculation. The nonspecific splenic suppressor cells were radioresistant (700 rads), capable of phagocytizing carbonyl-iron and adherent to plastic dishes. These findings suggest that perioperative immunodepression resulting in facilitated tumor growth is due to transient nonspecific activation of splenic suppressor macrophages.

Animals↗
PubMed1984

[Perioperative antibiotic prophylaxis in elective splenectomy. A randomized prospective study].

After elective splenectomy septic complications in the early postoperative period occur up to 45%. In a prospective, randomised, controlled study of 61 patients the incidence of postoperative infections with and without prophylactic use of an antibiotic was compared. 61 patients undergoing elective splenectomy were divided into two groups. 28 patients were operated without any antibiotic, 33 patients were given 3 X 1500 mg Cefuroxim (Zinazef) for three days, starting 1 h prior to the operation. Infections of the urinary tract and the lung were excluded preoperatively. With a standardized program we searched for intraabdominal abscesses, infections of the lung, the urinary system and the abdominal incision postoperatively. No fatal complication occurred. A significant reduction in total septic complication rate (p less than 0.01) and in pneumonia was found as well in benign as in malignant disease. The study shows, that the apparently disturbed immunological defense following splenectomy can be improved by the prophylactic use of antibiotics.

Adult↗
PubMed1984

Splenectomy versus splenic salvage for spleens ruptured by blunt trauma.

Of 339 patients treated in three Charlotte hospitals from January 1960 through March 1983 for splenic rupture caused by blunt trauma, 317 (93.5%) underwent splenectomy, and 22 (6.5%) underwent splenic salvage operations. Perioperative mortality for splenectomized patients was 7.9 per cent, and that for those who received splenic salvage operations was 22.7 per cent. Perioperative sepsis occurred in 4.4 per cent of the splenectomized patients and in 9 per cent of those whose spleens were salvaged. Perioperative deaths and sepsis in both groups were related to associated injuries, not to splenic injuries. Follow-ups from 5 months to 22.4 years (mean, 9.5 years) of the 292 splenectomized patients who survived their injuries show that 252 (86.3%) are living, 22 (7.5%) have died of causes unrelated to splenic injuries, 18 (6.1%) could not be found, and none of the patients traced has died of sepsis. One patient (0.34%) experienced an episode of sepsis i.e., a nonfatal septicemia 7 years postsplenectomy, that may be related to splenectomy. These data suggest that the importance of splenic salvage for prevention of postsplenectomy sepsis has been overemphasized and that expeditious splenectomy remains the procedure of choice for patients with ruptured spleens, especially for those with hypovolemic hypotension, anemia from hemorrhage, or multiple injuries. Data to substantiate these views will be presented.

Accidents, Traffic↗
PubMed1984

Splenectomy and susceptibility to infection in childhood Hodgkin's disease.

In a ten-year analysis (1970-1979) of lymphogranulomatosis performed at the Clinic of Pediatry of the Wilhelm Pieck University, Rostock, special attention was paid to susceptibility to infection after splenectomy. Of 22 children treated for lymphogranulomatosis, 20 underwent explorative laparotomy and splenectomy. After removal of the spleen the rate of infectious complications (of both viral and bacterial origin) doubled as compared to that seen before splenectomy. The finding of immunological investigations did not sufficiently explain the clinically proven susceptibility to infection.

Adolescent↗
PubMed1984

[Partial conservation of the splenic parenchyma in the prevention of hyposplenism after splenectomy. A note on modifications of blood platelet number from the 40th day until normalization (experimental research)].

The authors report the modifications of platelet rate in the blood in a succession of total and partial splenectomies (25%, 50%, 75%) from the 40th day after operation till normalization. The values of platelet rate got back to standard in the 50th day in the animals subjected to 25% splenectomy, and in the 60th, 70th and 80th day from operation in the rats with 50%, 75% and 100% splenectomy. The data remarked suggest the period of thrombocytosis is in direct relation with the entity of plastrinosis, whereas the modalities of decrease are similar in all groups of animals.

Animals↗
PubMed1983

Splenectomy for trauma in children: risks and alternatives.

The problem of postsplenectomy sepsis in children who have had splenectomy secondary to trauma is reviewed. Alternatives to splenectomy should be considered when appropriate. Pneumococcal vaccination and the use of prophylactic antibiotics are necessary if splenectomy is unavoidable.

Bacterial Infections↗
PubMed1983

[Evaluation of splenectomy and possible metastasis from gastric cancer, with reference to nonspecific immunological parameters and postoperative survival].

For the complete removal of metastasized lymph nodes at splenic hilus in the operation for gastric cancer, the splenectomy has been widely accepted. In order to reveal justifiable of such splenectomy, nonspecific immunological parameters and postoperative survival were compared between the groups of splenectomized (S) and nonsplenectomized cases (N) in the same stage of gastric cancer. The immunological parameters in N were more stable after surgery than those in S. As to the postoperative survival there was no significant difference. The survival rates showed no definite difference. The postoperative platelet count of S was higher than that of N. It may be concluded that the splenectomy should be avoided unless the metastases are remarkable.

Animals↗
PubMed1983

[Experimental study on immunological effect of splenectomy on tumor-bearers].

In view of popularity of splenectomy in combination with gastrectomy for gastric cancer, immunological effect of splenectomy was studied experimentally, using SD rats and 3-methylcholanthrene-induced mammary cancer, MRMT -1. Splenectomy was performed on day -14, 2, 7, 14 or 21 of sc inoculation of 200 mg (about 4 X 10(6) cells) of MRMT -1 at the back of 4-week-old female rats. Tumor growth and immunocompetence of peripheral lymphocytes, spleen cells and thymus cells were examined. Tumor growth on day 35 tended to be inhibited in rats splenectomized on day -14, 2, or 14, while it tended to be promoted in rats splenectomized on day 7. PHA-induced blastogenesis and NK activity of spleen cells were reduced on day 2, rose on day 7 and gradually decreased on days 14 and 21. Winn's neutralization assay revealed that spleen cells on days 2, 14 and 21 of tumor inoculation had suppressor activities. In conclusion, spleen cells of tumor-bearing rats showed a reduced immunocompetence on day 2 (the early tumor-bearing stage) and on day 14 and later (the late tumor-bearing stage), while they showed a raised immunocompetence on day 7 (the middle tumor-bearing period).

Animals↗
PubMed1983

[Immunological evaluation of splenectomy in tumor-bearing mice].

The effect of splenectomy upon neoplastic outgrowth was examined after inoculation of methylcholanthrene-induced C3H/He murine tumors. Three days or 20 days after tumor inoculation, splenectomy resulted in significant retardation of tumor growth when compared with sham operation, while splenectomy 6, 9, 15 days after tumor inoculation did not alter the tumor outgrowth. These results suggest that spleen might have immunologically negative element in early or late stage of tumor burden. In fact, spleen cells from mice bearing MCA-F tumors for 3 days or 30 days nonspecifically facilitated the tumor outgrowth in Winn assay. The non-specific tumor-enhancing cells were radioresistant (700 rads), capable of phagocytizing carbonyl-iron and adherent to plastic dish suggesting those were tumor enhancing macrophages. On the other hand, spleen cells from tumor-bearing mice for 9 to 15 days specifically reduced the tumor growth in Winn assay, and those cytotoxic cells were radio-sensitive (700 rads) T cell population.

Animals↗
PubMed1984

Lymphocyte subsets in human peripheral blood after splenectomy and autotransplantation of splenic tissue.

Leucocyte and lymphocyte subpopulations and serum immunoglobulins were studied in 14 patients who underwent splenectomy for trauma, nine patients with an autologous replant of splenic tissue after traumatic rupture of the spleen, and 23 age- and sex-matched healthy individuals. Buffy coat cells were stained by direct or indirect immunofluorescence with goat antihuman F(ab')2 immunoglobulin (B cells), Leu-1 (T cells), Leu-2a (T suppressor cells), and Leu-3a (T helper cells). Leucocytes and lymphocyte subsets were analyzed in a cytofluorograf . After splenectomy, patients showed a marked increase in both monocytes (135%) and lymphocytes (137%), with a fourfold rise in B cells, a nearly twofold rise in T cells, a reduced T/B cell ratio, and an unchanged T helper/T suppressor cell ratio. The number of B cells was significantly related to the serum immunoglobulin M level (r = 0.807, p less than 0.001). Patients with an autologous replant had moderate monocytosis (35%) and lymphocytosis (42%), with a selective rise of B cells (60%) and T suppressor cells (75%), which led to a 50% reduction of the T helper/T suppressor cell ratio. The changes observed after splenectomy indicate the major role of the spleen in cellular homing. In patients with an autologous replant , there is a tendency for normal storage of most cells, but an altered contribution of T suppressor cells to the circulating pool.

Adolescent↗