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PubMed1983

[Splenectomy and pneumococcal septicemia].

A literature review, following the observation of 4 cases of pneumococcal septicemia in splenectomized patients, demonstrated that infection was frequent in subjects with functional or anatomical asplenia, usually in the form of a pneumococcal septicemia. Infection occurs one hundred times more frequently in splenectomized patients than in the general population. The risk of developing an infection varies from one patient to another, and is related to the motive for splenectomy, the period since operation, and the age of the patient at the time of surgery. Pneumococcal septicemia in such cases is distinguished by its insidious nature and its very poor prognosis, the outcome being fatal in 50 to 70 p. cent of cases. This justifies intensive prophylactic measures: partial splenectomy, heterotopic transplantation, anti-pneumococcal vaccination, and long-term antibiotic therapy. None of these methods offers absolute protection, and indications for splenectomy should therefore be limited to the strict minimum.

Adult↗
PubMedDate not supplied

[Immunologic and hematologic sequelae of splenectomy].

This article summarizes the hematological and immunological consequences of splenectomy in children. The hematological consequences are mainly noticed in the number of white cells and platelets. Indeed, platelets can remain elevated several weeks and even several months after surgery. Rarely antiplatelets aggregant drugs will be given if the platelet count is higher than one million per cubic millimeter. The immunological consequences of splenectomy in children are mainly manifested if the surgery was performed before the age of 6 or 7. The major consequence is a rapid and often lethal infectious complication. In diseases like thalassemia major or lymphoma, there is an increased risk of infection. The immunological mechanism seems linked to a decreased antibody formation in presence of higher antibody titre needed by the reticuloendothelial system to eliminate the microorganisms responsible for the infection. Therapeutic measures can be proposed: delay the age of splenectomy, leave some splenic tissue, administration of penicillin and lastly immunization against some antigens mainly responsible of the infection.

Age Factors↗
PubMed1981

Early splenectomy in chronic myelogenous leukemia: surgical aspects.

A retrospective study was conducted to analyze the surgical aspects of the splenectomy in chronic myelogenous leukemia. Twenty patients, Philadelphia chromosome-positive, were initially treated with busulfan until remission was reached. Elective splenectomy was then performed and chromosomal studies repeated at four- and six-month intervals yielding the indication for cyclic intensive chemotherapy. There ws no mortality, one episode of gram-negative sepsis with shock, and five instances of minimal complications. The spleen weights averaged 265 g, ranging from 60 to 800 g. All patients had normal coagulation profiles at the time of surgery, but four of them developed a postoperative thrombocytosis without related complications. A specific correlation was noted between postoperative thrombocytosis and splenomegaly (average weight 570 g). Eleven patients showed a high postoperative leukemoid reaction (average 40,500 cells/cu mm). The interval between diagnosis and splenectomy was shorter (average 7.5 months) in this group than for the patients who had a lower granulocytosis (average 19.5 months).

Adult↗
PubMed1978

Hairy cell leukaemia. Clinical features and effect of splenectomy.

Hairy-cell leukaemia (leukaemic reticuloendotheliosis) is a well-defined clinical entity. Most of the recent reports are almost entirely concerned with the pathological and functional aspects of the disease. In the present retrospective study the clinical features and laboratory data of 12 patients were analyzed together with a series of 123 adequately clinically documented cases from the literature. The Hb level and the sex of the patient proved to be the only parameters having some prognostic value for the survival time after diagnosis. The effect of splenectomy was assessed in two comparable groups of 24 splenectomized and 51 non-splenectomized patients. The operation seemed to be beneficial, but after 2 years the difference was not significant(.05 less than P less than .10). Analysis of subgroups showed that splenectomy was definitely beneficial in women, in patients with a Hb level over 8.0 g/dl or a platelet level above 50 X 10(9)/1, in patients with leucocytes below 3 X 10(9/1, , and also in patients with hepatomegaly (P less than .05 in all cases). These findings suggest that splenectomy is beneficial in cases where anaemia and thrombocytopenia are not very severe; in severe cytopenia the operation does not increase the life expectancy.

Adult↗
PubMed1980

Effects of splenectomy on blood coagulation and fibrinolysis in patients with liver cirrhosis: possible role of the spleen in haemostasis.

Blood coagulation and fibrinolysis before and after splenectomy was studied in 74 cases of liver cirrhosis. A hypocoagulable state was found before splenectomy, but the platelet count, and the levels of fibrinogen, plasminogen, alpha 2-macroglobulin and antithrombin III increased significantly after splenectomy (p less than 0.05 to p less than 0.001). A marked improvement was observed on the values of r (reaction time), k (clot formation time) and ma (maximal amplitude) of thrombelastograms (p less than 0.05 to p less than 0.001). The prothrombin time was reduced after the surgery, but not significantly (p less than 0.1, greater than 0.05). The levels of alpha 1-antitrypsin remained almost unchanged, while serum fibrinogen-fibrin degradation products (FDP) showed a slight decrease postoperatively. The immunohistologic study of the spleen excised from 7 cases with liver cirrhosis, with the use of the direct immunofluorescence technique, demonstrated the deposits of fibrin in the splenic cords in all cases. It was not recognized in the spleens of 4 cases without cirrhosis used as the control. A further study of the spleen weight and plasma fibrinogen level showed that a significant inverse correlation exists between these two parameters (p less than 0.01). These findings suggest that localized intravascular coagulation (LIC) occurs in the enlarged spleen associated with liver cirrhosis.

Adult↗
PubMed1978

Splenectomy for hypersplenism.

The five-year experience with 75 consecutive splenectomies has been reviewed. Special detail was given to eight critically ill hypersplenic patients. Their diagnoses included Hodgkin's disease, lymphoma, leukemia, myelofibrosis and Felty's syndrome. Three presented with sepsis, two with anemia not responsive to transfusion, three had pathologic bleeding and two could not receive additional needed therapy of underlying disease because of low counts. All cases responded to splenectomy favorably. Hypersplenism is primarily a loss of balance between the splenic destruction-sequestration and bone marrow production. The demonstrated rapid consumption of transfused cells and some degree of functional reserve of the bone marrow is the prerequisite and clue for splenectomy response in critically ill patients.

Adult↗
PubMed1982

Splenectomy for the treatment of hairy-cell leukemia.

In conclusion, patients with hairy-cell leukemia may need no therapy for prolonged periods. If they are symptomatic from hypersplenism, they may be expected to benefit from splenectomy. Some patients will have a relapse after splenectomy. At this time, there is no method to predict which patients will have a long term benefit from splenectomy, and we believe that operation should not be recommended as the primary therapy for hairy-cell leukemia.

Adult↗
PubMed1982

Splenectomy for myelofibrosis.

In 30 consecutive splenectomies for myelofibrosis (MF) with cytopenia(s) and/or massive splenomegaly the operative mortality was 6.7% (2 patients). Postoperative complications were observed in 11 (37%) patients. When surgery was undertaken within one year of the diagnosis of MF the postoperative morbidity rate was 13% (2/16), but significantly (p less than 0.01) higher at 64% (9/14) in patients operated on later. A similar significant difference was observed in the amount of intraoperative blood loss. Of the patients undergoing splenectomy for anaemia and/or thrombocytopenia, 79% gained definite benefit from the operation for 2 to 70 months (median 10 months). It is concluded that, although splenectomy probably does not prolong the life of patients with MF, it gives considerable symptomatic relief in cases with massive splenomegaly, and can improve the patient's haematological status and reduce blood transfusion requirements. To avoid the increased risks of postoperative complications surgery is best undertaken as soon as cytopenia is present.

Aged↗
PubMed1981

Thrombosis of the portal vein following splenectomy for myeloid metaplasia.

The records of 28 patients undergoing splenectomy for myeloid metaplasia were reviewed. Portal and mesenteric venous thrombosis was proved or suspected in five patients. The time interval between splenectomy and portal and mesenteric venous thrombosis varied from six days to three years. The incidental postmortem finding of portal vein thrombosis in one patient suggests that the incidence may be greater than clinically appreciated and may, at times, be asymptomatic. Postsplenectomy thrombocytosis was not found to be a significant risk factor, occurring in only one of the five patients in whom portal vein thrombosis developed. Recommendations for prevention include ligation of the splenic vein close to its junction with the inferior mesenteric vein at the time of splenectomy. In addition, prophylactic anticoagulation therapy or the use of antiplatelet drug therapy postoperatively, or both, should be considered.

Adult↗
PubMed1980

Post-splenectomy septicemia in Hodgkin's disease and other disorders.

The frequencies of splenectomy and post-splenectomy septicemia over a 10-year period in the Stockholm area were studied. The main observation was a significantly increased risk of pneumococcal septicemia in splenectomized patients, in particular HD patients. At the two clinics for infectious diseases in Stockholm, 1310 septicemia patients were treated, and among these, 14 splenectomized patients. In the total material, pneumococci were the causative agent in 4.7% but splenectomized patients had pneumococcal septicemia in 71% (10/14). In the 12 surgical clinics of Stockholm, 1148 splenectomies had been performed during the period, among these, 76 in HD patients. Pneumococcal septicemia occurred in 5 splenectomized HD patients.

Adolescent↗
PubMed1981

[Difficult splenectomies. Usefulness of pancreatic tail mobilization for initial ligature of splenic vessels (author's transl)].

Splenectomy may be difficult when the spleen is deep-seated, with a short and wide pedicle, or when it is associated with portal hypertension and immobilized by epiploic or peritoneal adhesions. In such cases the conventional technique of splenectomy, even with initial ligature of the splenic artery along the superior border of the pancreas, may be insufficient to prevent hazardous bleeding. Mobilisation of the pancreatic tail in the posterior mesogastrium is recommended, as it gives access to the splenic vessels in the hilum, where they can be isolated and ligated prior to splenectomy.

Humans↗
PubMed1981

Effect of splenectomy of hepatic bilirubin clearance in patients with hereditary spherocytosis. Implications for the diagnosis of Gilbert's syndrome.

BRT and CBR were determined from studies of radiobilirubin kinetics in 14 patients undergoing splenectomy for hereditary spherocytosis. Studies were conducted both before and after the operation in order to assess the effects of the postsplenectomy fall in BRT on CBR. Splenectomy led to a doubling of the RBC-t1/2 from 13.0 +/- 1.7 (S.E.) days to 26.1 +/- 1.5 and a fall in BRT from 15.9 +/- 4.4 mg/kg/day to 4.3 +/- 0.9. In seven patients (group A) initially normal values for CBR were unaltered by surgery. In the remaining seven (group B), low preoperative values for CBR, suggestive of Gilbert's syndrome, uniformly improved after splenectomy, becoming normal in five patients. Nevertheless, family studies and reduced values for UDPGT activity supported the initial impression of concomitant Gilbert's syndrome in group B. These studies suggest the existence of a latent state for Gilbert's syndrome that, in some patients, may be unmasked by a hemolytic stress. As such, they have important implications for both pedigree analysis and incidence studies of this condition.

Adolescent↗
PubMed1981

The effect of partial splenectomy on platelet production in mice.

The effect of total and partial splenectomy on the number and production of circulating platelets was studied in mice. Five days after total and partial splenectomy the number of the peripheral blood platelets increased by 87% and 60%, respectively and the incorporation of 75selenium methionine (75Se-Met) into platelets was enhanced indicating that the thrombocytosis was due to increased platelet production. The results obtained by the two operative procedures were compared. Since previous work from our laboratory has shown that a factor produced by splenic lymphocytes affects the platelet number in mice, it is suggested that the differences in the number of circulating platelets observed in animals after total and partial splenectomy may reflect a difference in the number of spleen lymphocytes removed.

Animals↗
PubMedDate not supplied

Partial splenectomy in staging laparotomy for Hodgkin's disease.

Partial splenectomy with resection of the lower third of the spleen was performed in three children as part of a standard staging laparotomy for Hodgkin's disease. The technique proved to be simple and safe with no post-operative complications. The ability to preserve splenic tissue and to prevent post-splenectomy sepsis in children is weighed against the probably low risk of missing solitary splenic lesions with partial splenectomy. This procedure should play a major role in the surgery of various splenic disorders in children, including Hodgkin's disease.

Child↗
PubMed1981

Protection against pneumococcal bacteremia by partial splenectomy.

An animal model of partial splenectomy and its effect upon subsequent challenge with pneumococcus were evaluated. Results of these studies support the contention that partial splenectomy protects the host against pneumococcal bacteremia. The data show that small splenic remnant attached to identifiable blood vessels afford protection against sepsis. Thus, partial splenectomy may be used in massive splenic fractures if hemostasis can be achieved, even if less than 25 per cent of the spleen remains in continuity with its vascular supply. The conclusion that the filtering effect of the spleen is paramount in protecting against sepsis appears justified.

Animals↗
PubMed1980

The spleen-hypophysis relationship - the effect of splenectomy on the young rat growth.

The spleen-hypophysis relationship particularly the effect of splenectomy on the body growth rate was studied on young rats from both sexes. The following experimental groups were tested: 1. sham-operated controls; 2. splenectomized rats; 3. marsupialized-spleen rats; 4. parabiosis rats; 5. parabiosis plus splenectomy from only one animal. The results were taking in basis on the regression lines of the body weight increasing on time, during 11 weeks. In addition, the hypophysis weight, the volume of its lobes and the adenohypophysis alpha, beta and cromophobe cells nuclear volume were estimated. The results show that splenectomy provides a significant increasing of body weight. The splenectomized rats show furthermore, a significant hypophysis weight increasing, a hypertrophy of its anterior lobe and morphological evidences of functional hyperactivity of its alpha-cells (estimated towards its nuclear volume increasing). The results suggest that the growth rate increasing of splenectomized young rats depends upon the adenohypophysis alpha-cells hypersecretion.

Animals↗
PubMed1995

[Cancer risk after splenectomy].

Removal of the spleen may possibly affect functions of the immune system. Cancer risk following splenectomy was evaluated by performing a linked register study in Denmark from 1977-89. From the Hospital Discharge Register we identified 1103 patients splenectomized after traumatic rupture of the spleen and 5212 patients splenectomized for various malignant or non-malignant disorders and both groups were followed for cancer occurrence in the Danish Cancer Registry. No increased risk for cancer was observed among patients who underwent splenectomy due to trauma. In contrast, there were excesses of a number of specific cancers among patients who underwent splenectomy for non-traumatic reasons, but to a large extent this could be explained by factors related to the underlying disease and/or treatment of the disease.

Adult↗
PubMed1995

[Laparoscopic splenectomy: comments on the surgical technic].

The authors describe the technique applied in their first case of laparoscopic splenectomy, in a patient with idiopathic thrombocytopenic purpura. Different technical approaches adopted by other surgeons are referred and discussed. The laparoscopic approach to splenectomy seems safe and allows the patients to re return to normal activity sooner than the "open" technique. Laparoscopy should be considered in patients who require splenectomy for benign disease.

Adult↗