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At least 1,207 records · Page 67Linked to original sources
PubMed1994

[Concomitant operation of CABG and splenectomy following high-dose transvenous gamma-globulin therapy in a patient with idiopathic thrombocytopenic purpura--a case report].

A 60-year-old man with effort angina and idiopathic thrombocytopenic purpura (ITP) underwent concomitant operation of coronary artery bypass grafting (CABG) and splenectomy. High-dose transvenous gamma-globulin therapy (400 mg/kg/day) was performed for five days before surgery. The platelet count increased from 1.4 X 10(4)/mm3 to 8.7 X 10(4)/mm3. CABG was performed immediately followed by splenectomy. This is the first case with concomitant operation of cardiac surgery and splenectomy which was safely performed after high-dose transvenous gamma-globulin therapy.

Angina Pectoris↗
PubMed1995

Partial laparoscopic splenectomy for trauma: technique and case report.

We describe the course of a patient who underwent partial laparoscopic splenectomy after a fall while skiing. Computed tomography revealed intact liver and kidneys with fragmentation of the upper third of the spleen and a left upper quadrant hematoma. Splenic artery angiogram showed devascularization of the superior pole, and selective cannulation of the superior polar artery demonstrated extravasation of contrast media. The superior polar artery was embolized with three coils to control bleeding. After laparoscopic exploration, the patient underwent partial laparoscopic splenectomy of the superior pole, which consisted of ligating the short gastric vessels and incising the splenic parenchyma 6 to 8 mm above the ischemic demarcation line produced by embolization of the superior polar artery, where a deep transverse laceration was located. The specimen was retrieved in a plastic bag. Intraoperative blood loss was less than 50 ml, and the patient left the hospital on the 3rd postoperative day after an uneventful recovery. Partial laparoscopic splenectomy can be performed safely, and its role needs to be delineated.

Adolescent↗
PubMed1995

[Splenic neoformation following trauma-induced splenectomy--diagnosis and function].

GOAL: Regeneration of the spleen after posttraumatic splenectomy has been described in the literature. The goal of this study was to determine the rate of splenosis, its effect on hematology and postoperative infections and the value of sonography in the diagnosis of splenosis. PATIENTS AND METHODS: Fifty patients were examined sonographically one to 14 years after splenectomy. They were questioned concerning infections and a blood count was done. Data concerning the grading of the splenic rupture, additional injuries and postoperative complications were collected from their charts. RESULTS: Splenosis was detected sonographically in 17 patients. It was seen more often, the more severe the injury of the spleen had been. Patients under 30 years in the splenosis group had a shorter ICU and hospital stay and significantly less postoperative infections. Fourteen of 17 patients with splenosis had no hematological changes, while 32 of 33 patients without splenosis demonstrated Howell-Jolly bodies and acanthocytes. CONCLUSIONS: Sonography is a reliable method for visualisation of splenosis. The latter seems to prevent the hematological changes usually found after splenectomy. It also seems to reduce the number of postoperative infections in young patients.

Adolescent↗
PubMed1995

Risk factors associated with mortality and morbidity after elective splenectomy.

OBJECTIVE: To assess the effect of certain risk factors on the outcome of elective splenectomy. DESIGN: Retrospective cohort study. SETTING: University hospital, Norway. SUBJECTS: 135 patients who underwent elective splenectomy from 1978 to 1992 for autoimmune diseases (n = 58), myeloproliferative disorders (n = 58), and other diagnoses (n = 19). MAIN OUTCOME MEASURES: Morbidity and mortality, and the effect on outcome of age, malignancy, platelet count, treatment with steroids, and blood transfusion during the operative period. RESULTS: Three patients died, one from each diagnostic group; all had been treated with steroids. The overall complication rate was 31% (42/135). Most of the complications (31, 74%) were infective (pneumonia n = 23, abscess or sepsis n = 8). Nine patients required reoperation (haemorrhage, n = 6, and wound dehiscence, n = 2, and bowel obstruction, n = 1). Neither treatment with steroids nor severe thrombocytopaenia were risk factors for any complication, but age (p = 0.05) and a diagnosis of myeloproliferative disease (p = 0.08) had an important though not significant role. Blood transfusion during the operative period was the only independent risk factor (p = 0.001), and further analysis showed that transfusion of blood had a dose dependent effect on the incidence of infective complications (chi-square for linear trend 14.21 p < 0.001). CONCLUSION: To reduce the complication rate of elective splenectomy blood transfusion during the operative period should be avoided.

Adolescent↗
PubMed1995

[Role of thymopentin in the prevention of post-splenectomy infections].

The Authors evaluated the efficacy of thymopentin in the prevention of post-splenectomy infections. 14 splenectomized patients treated by thymopentin (50 mg s.c. every other day in the 4 weeks following splenectomy) were compared with 14 splenectomized control patients. Clinical evaluations and measurement of CD4 and CD8 lymphocyte subpopulations were made preoperatively and then after 3 and 6 months from splenectomy. Hyperthermia (37.5-38 degrees C) "sine materia", which disappeared spontaneously in 4-5 weeks, was observed in the post-operative phase in 4 control patients and in 1 patient treated by thymopentin. No statistical difference was demonstrated comparing pre- and post-operative percentages of CD4 and CD8 lymphocytes in the treated and control groups.

Adolescent↗
PubMed1994

[Recurrent pneumococcal meningitis after splenectomy].

We report the case of a female patient with thrombocytopenic purpura Werlhof. Splenectomy was followed by relapsing pneumococcal meningitis. Particularly, repetitive infections were caused by pneumococcus capsula type 13. This type is not included in the common 23-polyvalent vaccine matter. The necessity of splenectomy in autoimmunological diseases should be considered carefully in the individual case. Patients should be well informed of the high risk of infection after splenectomy and should undergo medical treatment immediately.

Adult↗
PubMed1994

Hairy cell leukemia. An update on a cohort of 93 patients treated in a single institution. Effects of interferon in patients relapsing after splenectomy and in patients with or without maintenance treatment.

We retrospectively analysed the results of interferon alpha-2 (IFN) treatment in 93 patients with hairy-cell leukaemia, of which 31 had previously undergone splenectomy. Induction treatment (3 x 10(6) U three times weekly for 12 months) was completed in 84 cases (90%). Peripheral hematological response was observed in 76 patients. Two patients had persistent splenomegaly, and response was observed in both cases after splenectomy. Five additional patients were responsive after 18-24 months of induction treatment and 1 was unresponsive. Of 28 patients on maintenance treatment (1 x 10(6) U 3 x per week), no patient relapsed after a median follow-up of 30 months. The toxicity level was acceptable and IFN resistance was not observed. On the other hand, of 56 patients without maintenance treatment, 37 relapsed at a median of 19 months. Thirty of 32 evaluable patients remained responsive to a second course of IFN. Of 19 patients without relapse, 11 had undergone splenectomy compared to 0/37 patients who relapsed (p < 0.001). In conclusion, the study shows the following, (1) IFN, provides excellent palliation without major toxic side effects; (2) long term maintenance was well tolerated and prevented peripheral haematological relapse; (3) lack of maintenance treatment was associated with peripheral haematological relapse requiring a second treatment; and (4) certain previously splenectomized patients may not require maintenance treatment. These long term results must be compared with the effectiveness and toxicity of new drugs, such as pentostatin and 2-chloro-deoxy-adenosine.

Cohort Studies↗
PubMed1994

[Decrease of insulin resistance after splenectomy in a diabetic patient with liver cirrhosis and portal hypertension. Physiopathologic evaluation].

Liver cirrhosis is characterized by an increased incidence of glucose intolerance, diabetes and insulin resistance. We report a cirrhotic man (41 years old) who developed glucose intolerance and diabetes with insulin resistance over a period of six years. This patient suffered from severe portal hypertension with oesophageal varices and a enormously increased spleen volume. The subject underwent prophylactic endoscopic sclerotherapy of oesophageal varices. Splenectomy was performed because of severe piastrinopenia with recurrent nose bleeding. During laparotomy, multiple liver biopsies confirmed diagnosis of liver cirrhosis. Intra-operatory exploration revealed a splenic vein thrombosis. For this reason the planned spleno-renal shunting was not performed and the patient was only submitted to splenectomy. Liver function improved in the month following splenectomy and concomitant decrease of insulin resistance was observed (with a reduction in daily insulin dosage from 126 to 10 I.U.). We propose the following explanations of this event: 1) A decrease of portal and pancreatic vein pressure may have induced a proportional decrease (as already reported) of glucagon secretion. 2) The ameliorated liver function may have induced an improvement of liver glucose, insulin and glucagon metabolism. 3) A reduction of insulin circulating level (proved by a decrease of C Peptide value) may have lessened the insulin receptor down-regulation.

Adult↗
PubMed1994

[Castleman's angiofollicular lymphoma as a cause of anemia and splenomegaly with indications for splenectomy].

The physiology of the spleen is very complex and has a series of factors, which request a more detailed explanation. With different blood diseases, namely, the reticulo endothelium system the spleen more or less, plays the central part in the general pathological events. Indication for splenectomy requests many internal, haemotologic, immunologic examinations and a close cooperation with the surgeon. The failure of a performed splenectomy is seldom related, directly to the surgical techniques, more frequent with a bad ante operationem assessment, namely predictable assessory spleen, which continues to play the splenogenous disfunction. Such a "clinical misunderstanding" we had in the case presented in the paper. We spoke of our experiences with a patient who suffered from anaemia and an enormous enlargement of the spleen. After the splenectomy anaemia, unfortunately, was persistent. During the operation we found a tomefact (as big as a nut) located on the right side, paravertebral in peritoneum. The probatory cutting off was sent to the pathologist, we asked for a verification. We were warned by the pathologist to extract in toto. Only in that way the mentioned symptoms might disappear, the existing anaemia, too.

Adult↗
PubMed1994

Complications of splenectomy for splenic injury.

From March 1986 to October 1991, there were 97 patients undergoing splenectomy for traumatic spleen injury at Chang Gung Memorial Hospital at Kaohsiung. Their ages ranged from 6 to 73 years with a mean of 39. The most common cause was blunt abdominal trauma (94/97). Sixty-five patients received splenectomy only and thirty-two patients had other operative procedures in addition to splenectomy. The most common complication in this study was intraabdominal abscess (7/97); followed by respiratory problems (5/97); postoperative hemorrhage (3/97) and wound infection (3/97). Postsplenectomy sepsis occurred in one case. There were nine cases of in-hospital mortality. Sepsis, prolonged shock and severe head injury were the main causes of death.

Adolescent↗
PubMed1993

[Effect of splenectomy on disorder of cellular immunoregulation in patients with advanced schistosomiasis].

The peripheral blood natural killer (NK) cell activity, the percentage of E-CabR rosettes, phagocytosis of neutrophil and lymphocyte blastogenesis were studied to assess the cellular immunoregulation in patients with advanced schistosomiasis. The results showed that the NK cell activity and the percentage of E-CabR rosettes were significantly lower in patients with splenomegaly than in patients who had undergone splenectomy and in normal subjects. The phagocytic index of neutrophil and lymphocyte blastogenesis was reduced in patients with advanced schistosomiasis, but no significant difference was found between the patients with and without splenectomy. These results suggested that splenectomy not only reduce the portal hypertension but also improve the regulatory functions of cellular immunity which may enhance the patient's resistance against pathogens.

Adolescent↗
PubMedDate not supplied

Splenectomy outcome in a hemophilic patient with HIV-related immune thrombocytopenia.

We report the case of a young hemophilic patient with antibodies against the human immunodeficiency virus (HIV) who was affected by immune thrombocytopenic purpura (ITP). This condition did not respond to pharmacological therapy with steroids and alpha-2b-r-IFN, and the patient was splenectomized. Immune status evaluation was performed before and after surgery and during follow-up with CD4-CD8 monoclonal antibodies and cytofluorimetric analysis in order to explore possible correlations between splenectomy and the cytologic immune regulatory system. Splenectomy resulted in a resolution of ITP with consequent disappearance of the hemorrhagic diathesis related to thrombocytopenia. Moreover, at 30 months from splenectomy the patient is still in remission, his CD4 count is not decreased, and no progression to AIDS has been evidenced. These aspects are analyzed and briefly discussed.

Adult↗
PubMed1993

[Splenectomy by celioscopy. Experience of 20 cases].

We describe the clinical course of 20 patients considered for laparoscopic splenectomy. One patient was excluded on the basis of preoperative angiography findings and two (10.5%) were converted to open surgery. The first patient in the series was converted for a hemorrhagic incident and the eight patient, who had a 34 cm spleen, for dissection difficulties. In the remaining 17 patients who successfully underwent laparoscopic splenectomy, no mortality was reported and there were four postoperative complications (23.5%). Mean operating time was 3 h 40 min (135-300 min). After a mean postoperative stay of four days, all patients, except two, were back to normal activities within 2 weeks of hospital discharge. Preoperative splenic artery embolization was begun with the third patient and was found to significantly reduce operative blood loss and make the procedure easier to perform. Laparoscopic splenectomy has become our procedure of choice for elective removal of normal-sized or moderately enlarged spleens.

Adolescent↗
PubMed1994

Combination of cyclosporine and splenectomy suppresses interleukin-6 production and major histocompatibility complex class II expression and prolongs cardiac xenograft survival.

Although untreated Lewis rat recipients will reject a transplanted hamster heart in 3 days, accommodation of heart xenografts can be induced by treatment with cyclosporine and splenectomy, improving graft survival to greater than 50 days. Both humoral and cellular arms of the immune system may be involved in the mechanisms responsible for the prolongation of graft survival. Our objective was to study the impact of cyclosporine and splenectomy on the deposition of antibodies, complement, or both within the graft. We also compared the cellular component of inflammation in treated recipients with that in untreated controls. Inbred male Lewis rats given cyclosporine 15 mg/kg per day were splenectomized 2 days after they had received heterotopic heart transplants from Golden Syrian hamsters. Recipients of syngeneic grafts or untreated xenografts served as controls. Plasma interleukin-6 activity was measured in a standard proliferation assay with 7TD1 hybridoma cells. Deposition of immunoglobulin M, immunoglobulin G, and complement in heart tissue was evaluated by immunofluorescence. Cells infiltrating the graft that expressed major histocompatibility complex class II antigens were identified by immunohistochemical staining with OX6 antibodies. In xenograft recipients receiving immunosuppression, interleukin-6 activity, immunoglobulin M and complement deposition were significantly reduced, graft infiltration was mild, and cardiac function was good compared with the results in those without treatment 3 and 10 days after implantation. Inflammatory cells expressing major histocompatibility complex class II antigens were significantly reduced in immunosuppressed xenograft recipients (2.8 +/- 0.4 cells/high power field) compared with those in xenogeneic controls (9.5 +/- 0.6 cells/high power field; p < 0.0005). The significant decrease in deposition of humoral components (immunoglobulin M and complement), interleukin-6 plasma levels, and expression of major histocompatibility complex class II antigens by inflammatory cells within the nonrejecting grafts suggests that the synergistic benefit of cyclosporine and splenectomy depends on the attenuation of both cellular and humoral mechanisms of xenograft rejection.

Animals↗
PubMed1994

[Splenectomy in adult patients with idiopathic thrombocytopenic purpura after intravenous immunoglobulin treatment].

Eight patients with idiopathic thrombocytopenic purpura (ITP) and no response to steroids therapy were prepared for splenectomy, for 5 consecutive days, with intravenous immunoglobulin (IVIG, 0.4 g/kg body weight). Increase of platelet counts and/or remission of haemorrhagic diathesis were observed in 7 patients, in one case IVIG proved ineffective. Splenectomy was performed in 7 cases and the postoperative course was uneventful. IVIG treatment has proved efficient in preparing ITP patients for splenectomy.

Adolescent↗
PubMed1993

[Partial splenectomy requiring ligation of splenic vessels. Apropos of 40 cases].

Conservative treatment of the spleen is generally based on segmental terminal vascularization of the spleen. The practise of partial splenectomies in the case of major trauma and hilar hydatid cyst led us to perform subtotal splenectomies after splenic vessel ligation. The upper pole splenic remnant after reduction of its volume, remains vascularized by other short vessels through the gastro-splenic ligament. The lower pole splenic remnant remains vascularized by the left gastro-epiploic artery. The follow-up of 40 subtotal splenectomies performed in these conditions revealed better results than those obtained after spleen autotransplantation in the omentum. Conservation of all the vessels of the gastro-epiploic ligament allows gastric transposition of the spleen.

Echinococcosis↗
PubMed1993

[Acute mesenteric vein thrombosis. A rare complication after splenectomy due to autoimmune hemolytic anemia in childhood].

Mesenteric vein thrombosis is a rare but severe complication in children requiring splenectomy. We report on a 5-year-old boy with an autoimmune hemolytic anemia who underwent splenectomy because of severe side effects from cortisone therapy. 10 months after splenectomy he presented with signs of a paralytic ileus. Laparotomy showed mesenteric vein thrombosis with hemorrhagic bowel infarction requiring resection of two thirds of the small intestine. An early recognition and thrombolytic or surgical treatment of mesenteric vein thrombosis may reduce the incidence of hemorrhagic infarction, peritonitis, and secondary complications in these patients.

Anemia, Hemolytic, Autoimmune↗
PubMed1993

[Partial instead of complete splenectomy in children for the pathological staging of Hodgkin disease].

OBJECTIVE: Evaluation of partial splenectomy in children for pathological staging of Hodgkin's disease. DESIGN: Prospective clinical study. PLACE: University Hospital Groningen. METHOD: From 1982 to 1988, 12 children with Hodgkin's disease underwent partial splenectomy during laparotomy for pathological staging. A follow-up of these children was conducted up for a median of 6 years (range 4-10) postoperatively. RESULTS: The median hospital stay after the laparotomy was 7 days. There was no postoperative mortality; one patient needed a relaparotomy. During a median follow-up of 6 years, one patient died of secondary leukaemia. All the other children were well. None of the patients developed sepsis and no Howell-Jolly bodies could be found in their blood. CONCLUSION: Partial splenectomy for pathological staging of Hodgkin's disease is a safe procedure which causes hardly any underestimation of the stage of the disease and which ensures adequate spleen function, depending on the treatment used for Hodgkin's disease.

Antineoplastic Combined Chemotherapy Protocols↗