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PubMed1980

Splenectomy in children in Hong Kong.

A review of the hospital course of 82 splenectomies in children performed in the past 15 years has been carried out. Three indications have been identified: therapeutic, diagnostic, and traumatic. Thalassemia was identified as the commonest indication. Comparisons of the spleens removed showed that those from thalassaemia patients were the biggest, while those removed for idiopathic thrombocytopenic purpura (ITP), lymphoma staging, and trauma, were small. Twenty-eight per cent of patients had accessory spleens. Intrathoracic complications were frequent in the traumatic cases, whereas wound complications were commoner after splenectomies carried out for haematological reasons. No gallstones were detected. The platelet response to the various indications was studied and compared. There were two postoperative deaths.

Anemia, Hemolytic↗
PubMed1989

Splenectomy for trauma: morbidity, mortality and associated abdominal injuries.

Management of ruptured spleen still frequently requires splenectomy. A retrospective analysis of patients undergoing splenectomy for trauma at Box Hill Hospital, Melbourne, over a 14-year period was conducted; 141 of 145 cases were due to blunt trauma. The mortality rate was 10% and all deaths occurred as a result of road traffic accidents. The overall complication rate was 43%, varying from 25% in those with an isolated splenic injury to 100% with multiple system injuries. There was zero incidence of associated intra-abdominal injury in the group sustaining a ruptured spleen as a result of a fall, assault or sporting injury, in contrast to a nearly 50% incidence following road traffic and bicycle accidents. Whether these associated injuries would have been neglected had laparotomy for splenic trauma not been performed is uncertain, and so non-operative management of splenic trauma remains contentious, particularly in cases following vehicular accidents.

Abdominal Injuries↗
PubMed2001

Splenectomy combined with cesarean section in a patient with severe immunological thrombocytopenic purpura refractory to medical therapy.

Splenectomy as a treatment for severe immunological thrombocytopenic purpura is rarely performed in the third trimester of pregnancy. We report a 28-year-old patient who presented at the 34th gestational week with severe immunological thrombocytopenic purpura resistant to both corticosteroid and intravenous immunoglobulin therapies. Splenectomy combined with delivery by cesarean section provided remission of the disease.

Adrenal Cortex Hormones↗
PubMed2006

Cost-effectiveness of a post-splenectomy registry for prevention of sepsis in the asplenic.

BACKGROUND: Overwhelming, sometimes fatal infections represent a lifelong risk after surgical removal of the spleen, or in patients who develop hyposplenism as a consequence of illnesses. This risk may be reduced by all or a combination of vaccination, antibiotic prophylaxis and education. We aimed to determine if a registry approach to delivering these interventions would be cost effective using our own experience and published data. METHOD: The decision model compared a cohort of 1,000 people covered by a registry to a cohort of 1,000 people with no registry. The impact of the registry was assessed in terms of achieved rates of vaccination, chemoprophylaxis and education, consequent outcomes of overwhelming post-splenectomy infection (OPSI) and mortality (years of life lived). The cost-effectiveness of the registry compared with no registry was estimated in terms of additional cost per case of OPSI avoided and as additional cost per life year gained. RESULTS: In the first two years, the additional cost of the registry was dollar 152,611 per case of OPSI avoided or dollar 205,931 per life year gained. After this initial registration period the cost-effectiveness improves over time, such that over the cohort lifetime a post-splenectomy register is associated with an additional cost of dollar 105,159 per case of OPSI avoided or dollar 16,113 per life year gained. CONCLUSION: A registry-based approach is likely to prove cost effective in terms of mortality and rates of OPSI avoided.

Antibiotic Prophylaxis↗
PubMedDate not supplied

A technique for elective splenectomy of equidae using a transthoracic approach.

Splenectomy was performed electively on 80 ponies, horses, and donkeys for preparation in collecting Babesia antigens. Access to the abdomen was by resection of the sixteenth left rib and incision of the diaphragm. The technique afforded good exposure of the splenic vessels and attachments. Closure was facilitated by preservation of the periosteum of the resected rib. Difficulty was encountered both in surgical technique and postoperative complications in obese animals. The transthoracic approach was found to be a useful technique for equine splenectomy.

Animals↗
PubMedDate not supplied

Splenectomy in the dog by ligation of the splenic and short gastric arteries.

Splenectomy was performed in 15 crossbred dogs; hilar vessel ligation was used in eight dogs (group 1) and splenic and short gastric artery ligation were used in seven (group 2). Blood flow to six sites along the greater and lesser curvatures of the stomach was recorded with radioactive tracer microspheres. A significantly higher blood flow was recorded in group 2 for the site supplied by the right gastroepiploic artery (p = 0.0441). There was no difference between the groups for the site supplied by the left gastroepiploic and short gastric arteries. Histologically, there was no difference in gastric tissue samples from four sites. Splenic and short gastric artery ligation did not compromise stomach blood flow or the integrity of the stomach wall, and may be superior for splenectomy because of its relative simplicity and potentially shorter operative time.

Animals↗
PubMedDate not supplied

Ventricular arrhythmias in dogs undergoing splenectomy: a prospective study.

Fifty dogs undergoing splenectomy for splenic masses (n = 40), torsion of the splenic pedicle (n = 5), and immune-mediated disease (n = 5) were evaluated preoperatively and and postoperatively for ventricular arrhythmias and the relationship between ventricular arrhythmia splenic disease. The ability of 1-minute electrocardiograms recorded every 6 hours (ECGs/q6hr) to detect ventricular arrhythmia was compared with continuous 48-hour Holter monitoring. Based on continuous Holter monitoring, splenectomized dogs had a high incidence (22 of 50) of rapid ventricular tachycardia. The incidence of rapid ventricular tachycardia was significantly higher in dogs with ruptured splenic masses (16 of 23) than without rupture (1 of 17) (P < .001). When the results of ECG/q6hr were compared with the results of continuous Holter monitoring ECG/q6hr was normal in 29% (4 of 14) of dogs with rapid ventricular tachycardia at > 3,000 ventricular extrasystoles (VE)/hr; 50% (4 of 8) of dogs with rapid ventricular tachycardia at 1,000 to 3,000 VE/hr and 100% (6 of 6) of dogs with 10 to 300 VE/hr without rapid ventricular tachycardia. Although dogs undergoing splenectomy had a high incidence of ventricular arrhythmias, one-minute ECGs/q6h were unreliable for detection of ventricular arrhythmias even when high-frequency extrasystoles occurred.

Animals↗
PubMedDate not supplied

Refractoriness to platelet transfusion following double valve replacement in an ITP patient who had undergone splenectomy.

Reports of patients with idiopathic thrombocytopenic purpura (ITP) undergoing cardiac surgery are rare, and almost all of the reported cases required platelet transfusion. ITP patients, especially those having a history of splenectomy or a history of heavy bleeding, may have to undergo multiple platelet transfusions. Such transfusions may induce alloimmunization against the human leukocyte antigen (HLA) and result in refractoriness to subsequent platelet transfusions. We report a case of a 63-year-old female with ITP, with a history of splenectomy and multiple platelet transfusions, who underwent aortic and mitral valve replacement. Although corticosteroid administration, high-dose immunoglobulin therapy, and repeated platelet transfusion led to a temporary increase in platelet count and successful hemostasis, refractoriness to platelet transfusion occurred postoperatively because of the presence of the anti-HLA antibody. In addition, the patient showed complications of pyothorax. Corticosteroids might have exerted an inhibitory influence on the occurrence of pyothorax.

Aortic Valve↗
PubMed1979

Massive platelet transfusion after splenectomy in a case of myelofibrosis.

A patient with myelofibrosis complicated by massive splenomegaly underwent splenectomy to alleviate the increasing transfusion requirements and iron overload. The platelets exhibited qualitative defects pre-operatively. Following splenectomy the patient bled profusely and required massive blood and platelet transfusions. The postoperative haemorrhage was controlled by giving sufficient platelets to normalize the platelet aggregation.

Blood Platelets↗
PubMed1981

Monocyte cytotoxicity after splenectomy.

Antibody-dependent cell-mediated cytotoxicity (ADCC) by monocytes was determined in 45 adults approximately 4 years after splenectomy for either abdominal trauma or accidental injury during operation for benign gastroduodenal ulcer. Compared to controls, both groups of splenectomized persons showed increased numbers of monocytes and decreased monocyte ADCC. The decrease of monocyte ADCC was only significant in those splenectomized persons in whom accessory splenic tissue was not detectable by isotope scanning. Addition of the spleen-dependent peptide tuftsin to monocytes in vitro did not augment their ADCC. An increase serum concentration of immune complexes was neither related to the presence of splenic tissue nor to the monocyte cytotoxicity. Vaccination with pneumococcal polysaccharide had no effect on monocyte ADCC. It is suggested that the defective monocyte cytotoxicity observed in splenectomized persons without detectable splenic tissue might be relevant to post splenectomy infectious susceptibility.

Adult↗
PubMed1981

Chronic idiopathic thrombocytopenic purpura (ITP): site of platelet sequestration and results of splenectomy. A study of 197 patients.

51Cr-platelet kinetics study was performed in 197 patients with chronic ITP after corticosteroid therapy had failed to induce a long lasting remission. The incidence of splenic, spleno-hepatic, hepatic and diffuse platelet sequestration site was 58%, 17%, 6% and 19%, respectively. Splenic and spleno-hepatic sequestration sites were more frequent in patients less than 30 years old and in patients with a platelet count lower than 50 x 10(9)/1. 111 patients were splenectomized shortly after the study. Normalization of the platelet count was obtained more frequently in patients with splenic and spleno-hepatic sequestration than in the others. Labelled platelet sequestration site was the best predictor of the outcome of splenectomy. Platelet kinetics is a non-invasive investigation that should be performed early after the diagnosis of chronic ITP in all patients eligible for splenectomy.

Adolescent↗
PubMed1982

Immunocompetence after incidental splenectomy.

Of 377 patients with chronic duodenal ulcer undergoing highly selective vagotomy, 13 were splenectomized peroperatively because of capsular tear. 12 of these patients were alive at the time of the subsequent investigation and each was matched with a non-splenectomized patient. The postoperative interval was almost 5 years (median). The splenectomized patients were characterized by their longer hospitalization, and increased blood counts of lymphocytes, monocytes and platelets. Analysis of lymphocyte subsets revealed increased numbers of both T and B lymphocytes after splenectomy Among the T cells, those with receptors for Fc of IgG were significantly more numerous in the splenectomized group. It is a matter of controversy whether or not this population contains T suppressor cells. Hence further functional investigations are needed to clarify whether our observations bear any relation to the low level of plasma IgM found by us and others in splenectomized individuals. Screening for complement activation by the classical and alternative pathways did not reveal any defects resulting from splenectomy.

Adult↗
PubMed1986

Thrombotic thrombocytopenic purpura unresponsive to plasma infusion and plasma exchange, but responsive to splenectomy.

A 60-yr-old female presented with typical thrombotic thrombocytopenic purpura (TTP). She remained in coma with frequent seizures for 1 wk, with persisting severe thrombocytopenia and microangiopathic haemolytic anaemia, despite treatment with prednisolone, plasma exchange, fresh frozen plasma, sulphinpyrazone and dipyridamole. Splenectomy induced haematological improvement within 1 d, there was cessation of fitting after 2 d, and full neurological recovery ensued over 3 wk. Laboratory studies did not reveal the presence of a platelet-aggregating factor (PAF), stated to be present in some two-thirds of cases. While plasma exchange and plasma infusion are beneficial in many cases, splenectomy appears still to be of value in unresponsive disease.

Blood Transfusion↗
PubMed1988

Reticulocyte crisis after splenectomy: evidence for delayed red cell maturation?

In whole blood from splenectomized subjects (n = 8) in a steady state an increased number of reticulocytes was observed (14.0 +/- 7.8% versus 3.6 +/- 2.4% controls: p less than 0.05). Cell fractionation on density showed that reticulocytes, as in normals, are more or less confined to the least dense fraction; cell fractionation on volume revealed that reticulocytes form a heterogeneous cell population with diverging volume, but sharing a low density. Immediately after splenectomy (n = 4), a reticulocytosis is observed, mainly manifest in the top fractions (262.0 +/- 49.0% versus 40.0 +/- 32.4% preoperatively; p less than 0.01). This reticulocytosis is not due to pre- or postoperative complications, but is associated with the splenectomy itself and probably is the consequence of a delayed, but ultimately occurring red cell maturation. The increase of reticulocytes is not accompanied by significant alterations in cell morphology, as far as cell volume is concerned.

Adult↗
PubMed1996

Splenectomy-reduced hepatic injury induced by ischemia/reperfusion in the rat.

In the present study, we investigated the role of the spleen in experimental hepatic ischemia/reperfusion in the rat. After a 90-min period of ischemia in the left and middle hepatic lobes, the ischemia was released and the liver was reperfused for up to 24 h. Plasma alanine aminotransferase reached a peak 3 h after the onset of reperfusion, and gradually decreased thereafter. A histological examination revealed evidence of hepatocellular necrosis and degeneration, especially 24 h after the onset of reperfusion. In addition, there was a noticeable accumulation of polymorphonuclear cells in the liver following ischemia/reperfusion. A splenectomy performed just prior to ischemia/reperfusion reduced both biochemical and histological hepatocellular injury. The number of polymorphonuclear cells in the liver following ischemia/reperfusion was significantly reduced in rats subjected to splenectomy, suggesting that the increase in polymorphonuclear cells may contribute to liver injury. The number of mononuclear cells also increased in the marginal zones of the spleen following ischemia/reperfusion, and appeared to be derived from the splenic monocyte/macrophage population, based on immunohistochemical studies. The spleen plays an important role in the pathogenesis of hepatic ischemia/reperfusion injury and the splenic monocyte/ macrophage population contributes to liver damage.

Alanine Transaminase↗
PubMed1990

Rapidly progressive type III Gaucher disease: deterioration following partial splenectomy.

Total splenectomy has been found to accelerate disease progression in Type III Gaucher disease, therefore partial splenic resection was performed in a 28 month old girl with rapidly progressive (non-Norrbottnian) Type III disease to alleviate the effects of hypersplenism. Surgery failed to arrest the disease process and splenomegaly recurred within three months. The erythrocyte glucosylceramide level increased post-operatively. Post-mortem studies revealed dense accumulation of Gaucher cells in spleen, liver, lungs, bone marrow and within the central nervous system. The glucosylceramide content of brain and liver was elevated to the range previously noted in splenectomised Norrbottnian patients. Thus, in rapidly progressive Type III Gaucher disease, neither total nor partial splenectomy alone provides a favourable outcome.

Child, Preschool↗
PubMed1984

Effect of splenectomy on production of interferon and colony-stimulating factor in Listeria monocytogenes-infected mice.

Splenectomy of mice genetically susceptible to Listeria monocytogenes genetically susceptible mouse strains increased their resistance to L. monocytogenes infection but had no effect on the course of infection in L. monocytogenes-resistant mice. However, splenectomy led to a dramatic decrease in the production of colony-stimulating factor and interferon after L. monocytogenes infection in all mouse strains examined.

Animals↗
PubMed1985

Effects of splenectomy on antibody-independent immunity to Plasmodium chabaudi adami malaria.

Splenectomy of B-cell-deficient mice and immunologically intact mice before infection with Plasmodium chabaudi adami led to the development of significant parasitemias which eventually resolved in the latter mice. Whereas both eusplenic B-cell-deficient mice and immunologically intact mice resolved their acute P. chabaudi adami infection, only B-cell-deficient mice subsequently developed chronic low-grade malaria. Splenectomy of B-cell-deficient mice with chronic malaria led to recrudescing infections, suggesting that the expression of antibody-independent immunity to reinfection was spleen dependent. When dispersed spleen cells were injected into splenectomized mice before challenge with P. chabaudi adami, the kinetics of the resulting infection resembled that seen in splenectomized mice which had not been grafted with normal spleen cells. This finding indicates that immunity to P. chabaudi adami requires the presence of an architecturally intact spleen.

Animals↗