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PubMed1997

The decrease in nonsplenic interleukin-6 (IL-6) production after splenectomy indicates the existence of a positive feedback loop of IL-6 production during endotoxemia in dogs.

The spleen is involved in endotoxin-induced interleukin-6 (IL-6) production. To quantitate the relative contribution of the spleen to endotoxin-induced IL-6 production, we studied the effect of endotoxin (1.0 microg/kg of body weight) in control dogs (n = 7) and splenectomized dogs (n = 7). Blood for analysis of tumor necrosis factor (TNF) and IL-6 was sampled from the femoral artery and the portal, hepatic, and splenic (only in controls) veins. Arterial plasma endotoxin and cortisol levels were also measured. Whole-body IL-6 production was calculated by a deconvolution technique. Splenic IL-6 production in control dogs was measured from splenic blood flow and arteriovenous concentration differences. Endotoxin levels were higher in splenectomized dogs (P < 0.05) because of a decreased distribution volume (P < 0.05) and decreased clearance of endotoxin (P < 0.05). Endotoxin-induced plasma IL-6 levels were decreased by approximately 75% in splenectomized dogs (P < 0.01), and whole-body IL-6 production rates were severalfold lower (median of 8.7 mg/4 h and range of 3.9 to 11.4 mg/4 h versus a median of 32.3 mg/4 h and a range of 22.7 to 70.2 mg/4 h) (P < 0.05). However, in control dogs splenic IL-6 production (0.6 +/- 0.2 mg/4 h) was only approximately 2% of whole-body IL-6 production. Plasma TNF levels increased in both groups (P < 0.01) but were not different between the groups. Plasma cortisol levels were slightly higher in splenectomized dogs than in control dogs (P < 0.05). In conclusion, splenectomy decreases the distribution volume and clearance rate of endotoxin. Splenectomy results in decreased endotoxin-induced IL-6 production, which is caused not by the absence of splenic IL-6 production, but by a decrease in nonsplenic IL-6 production. Therefore, the spleen is an important mediator in the complete activation of nonsplenic IL-6 production by endotoxin.

Animals↗
PubMed2003

Partial splenectomy in cystic fibrosis patients with hypersplenism.

We report three cystic fibrosis (CF) patients with hypersplenism who underwent partial splenectomy. The postoperative course was uneventful in two patients; one patient developed a complication necessitating resection of the rest of the spleen. Haematological parameters improved and oesophageal varices regressed in all patients. On follow up, one patient showed a normal spleen, the other a normally functioning accessory spleen; the third patient again developed splenomegaly with hypersplenism. Partial splenectomy is a promising therapeutic option for CF patients with hypersplenism.

Adolescent↗
PubMed1975

Removal of abnormal clone of leukaemic cells by splenectomy.

A patient with chronic myelocytic leukaemia positive for the Philadelphia (Ph-1) chromosome underwent splenectomy in the "terminal phase" of his disease. Chromosomal analysis of a marrow aspirate obtained during the operation showed nothing abnormal. Material from the spleen, however, showed the absence of a C chromosome and the presence of a "marker" chromosome in all metaphases examined. The patient did well for almost three years after splenectomy, and serial cytogenetic studies of marrow specimens showed the Ph-1 chromosome to be the only significant abnormality. Six months before death from recurrent blastic transformation aneuploidy was found in a marrow specimen. Subsequently additional abnormalities, including cells with two Ph-1 chromosomes, were detected. The karyotypic abnormalities found in the splenic specimen, however, never recurred.

Adult↗
PubMed1975

Neutrophil alkaline phosphatase score in chronic granulocytic leukaemia: effects of splenectomy and antileukaemic drugs.

Staining with naphthol AS phosphate and Fast Blue BB salt has been used for the estimation of neutrophil alkaline phosphatase (NAP) scores in patients with chronic granulocytic leukaemia (CGL). The very low scores found at diagnosis rise when the disease is treated, and there is some inverse correlation between the NAP score and the absolute neutrophil count. Patients treated intensively developed high NAP scores. Elective splenectomy performed during the chronic phase of CGL is followed by a pronounced but transient neutrophilia and a concurrent striking rise in the NAP score. Similar changes were observed in patients without CGL who underwent splenectomy. These observations can be explained by assuming that newly formed neutrophils in CGL have a normal content of NAP but are rapidly sequestered in non-circulating extramedullary pools, whereas the circulating neutrophil with a typically low NAP content is a relatively aged cell which has lost enzyme activity. In subjects with or without CGL, removal of the spleen, a major site of such pooling, temporarily permits the circulation of newly formed neutrophils but eventually other organs assume the sequestering functions of the spleen. Thus the aberrations of NAP score seen in CGL might be attributable not to an intrinsic cellular defect but to an exaggeration of the granulocyte storage phenomena which also occur in subjects without CGL.

Alkaline Phosphatase↗
PubMed1979

Changes in T and B blood lymphocytes after splenectomy.

The blood lymphocytes of 37 splenectomised patients were analysed by means of T and B lymphocyte surface markers. Sixteen patients had had a splenectomy for non-haematological and 21 for haematological reasons. The results show that 15 had normal numbers of T and B cells; decreased T cells were found in two patients, raised B cells in seven, raised T and B cells in eight, and raised T cells in five patients. Increased numbers of 'null' cells were observed in some patients, especially in those with raised B cells. Follow-up studies indicate that raised levels of T and B cells can be established by one to three months post-splenectomy and may persist, although in some patients the cells fall to normal levels. The lymphocyte proliferative response to phytohaemagglutinin and Concanavalin A in vitro was normal in eight out of nine patients with raised T cells and was depressed in one patient, possibly due to an intrinsic cell defect.

Adolescent↗
PubMed1979

Assessment of thrombocytopenic patients for splenectomy.

Platelet survival and splenic sequestration patterns were studied in 32 patients with thrombocytopenia using donor platelets labelled with chromium-51. A shorter mean platelet lifespan was observed in immune thrombocytopenia (ITP) (mean 12 hours) than in hypersplenism (mean 56 hours) or marrow hypoplasia (mean 102 hours). There was no such correlation between diagnosis and splenic sequestration. A biphasic survival curve was seen in nine of 22 patients with ITP. Thirteen patients underwent splenectomy with complete (9) or partial (4) response, but no consistent pattern of results was manifest. It is concluded that in vivo isotope studies are of little value in predicting the benefit of splenectomy in thrombocytopenic patients, although they may demonstrate the mechanism of the thrombocytopenia, in particular the biphasic survival curve revealing separate 'immune' and 'hypersplenic' components of platelet destruction in ITP.

Adolescent↗
PubMed1985

Size of spleen rather than amount of platelet sequestration may determine long term responses to splenectomy in adult idiopathic thrombocytopenic purpura.

Fourteen adults with idiopathic thrombocytopenic purpura suffered a relapse after treatment with steroids, vinca alkaloids, or intravenous gammaglobulin. Splenic sequestration of platelets labelled with 111In-oxine was assessed, and the patients then underwent splenectomy. During follow up of four to 47 months (mean 20.7) none of the patients required further treatment, including three of 14 who showed partial relapses. Splenic sequestration patterns did not predict relapses, but an unexpected finding was that patients who relapsed had significantly smaller spleens. It is concluded that splenectomy is beneficial in most adult patients with idiopathic thrombocytopenic purpura and that radiological techniques to measure the size of the spleen may be useful in predicting which patients may relapse.

Adolescent↗
PubMed1989

Circulating immune complexes after splenectomy.

Circulating immune complexes were evaluated in 25 patients (age range 10 to 46 years) who had undergone splenectomy for non-malignant conditions by studying a polyethylene glycol insoluble serum fraction. Although the extent of binding to Clq was within normal limits, these patients had increased concentrations of factor B in the immune complex serum fraction. These findings indicate that an unusual type of circulating immune complex may be detected after splenectomy, suggesting a possible role for the spleen in the removal of circulating immune complexes.

Adolescent↗
PubMed1991

Partial splenectomy for massive splenomegaly secondary to Gaucher's disease.

A 16 year old girl with Type 1 Gaucher's disease presented with massive splenomegaly, hypersplenism and abdominal discomfort. Traditionally hypersplenism has been treated with splenectomy, but this results in a high incidence of overwhelming sepsis and accelerated sphingolipid deposition in both liver and bone. A 90% partial splenectomy was therefore performed leaving a fully vascularized inferior segment of the spleen and resecting 5.8 kg of splenic tissue. The patient made an uneventful recovery with a marked improvement in her haematological parameters and general condition.

Adolescent↗
PubMed1994

Splenectomy in patients with undiagnosed splenomegaly.

Of splenectomies performed in the Cork Regional Hospital over an 11 year period, ten were undertaken primarily for diagnostic purposes. A definitive histological diagnosis was established in nine patients, seven of whom had lymphoma, two with Hodgkin's disease and five with non-Hodgkin's lymphoma. The weight of the excised spleen in all patients with lymphoma exceeded 1 kg; in all those with a diagnosis other than lymphoma, the spleen weighed less than 1 kg. A majority of patients also had symptomatic improvement from reversal of hypersplenism and from relief of the mechanical pressure effects of an enlarged spleen. Operative mortality was zero. Diagnostic splenectomy is a worthwhile procedure. Most patients will have lymphoma.

Adult↗
PubMed2004

Laparoscopic splenectomy: multi-detector row CT for preoperative evaluation.

PURPOSE: To prospectively evaluate multi-detector row spiral computed tomography (CT) for determination of splenic volume, splenic vascular anatomy, and presence of accessory spleens and parenchymal lesions in patients who were undergoing laparoscopic splenectomy. MATERIALS AND METHODS: Twenty-two patients who were candidates for laparoscopic splenectomy underwent multiphasic multi-detector row CT. Two observers evaluated splenic volume with two hand-tracing editing modalities. Variability between the two observers was calculated with a reliability coefficient (Cronbach alpha). A linear regression equation for each modality was generated to identify the correlation between the two observers. Multi-detector row CT angiography was evaluated for assessment of splenic vascular anatomy. Presence and number of both accessory spleens and parenchymal lesions were recorded. RESULTS: Mean splenic volume was 1,050 and 1,046 mL, respectively, for observers A and B by using each-section editing (technique 1) and 1,067 and 1,068 mL for observers A and B by using distanced editing (technique 2). For each editing modality, alpha reliability coefficient was higher than 0.99. Both techniques 1 and 2 were very highly predictive of specimen weight and had R2 values of greater than 0.99 (P <.001). CT angiograms correctly showed polar arteries in all cases and the presence of the arteria pancreatica magna in one case. Multi-detector row CT demonstrated the presence, number, and size of all accessory spleens and of focal parenchymal lesions. CONCLUSION: Multi-detector row CT volumetric and anatomic evaluation provided accurate and reproducible information.

Adult↗
PubMed1980

Post-splenectomy: true mass and pseudomass ultrasound diagnosis.

Ultrasound plays a major role in the evaluation of mass lesions in the postoperative period. Diagnostic pitfalls may occur in post-splenectomy cases when stomach and bowel loops settle into the splenic fossa and simulate mass lesions. While true masses such as subphrenic abscess, pancreatitis and pancreatic pseudocyst are essentially unchanging in appearance or location when scanned in varying patient positions, pseudomasses of stomach or bowel loops often do change, Awareness of possible post-splenectomy pseudomass is important in order to avoid confusing the gastrointestinal tract with a pathological condition.

Adult↗
PubMed1985

Accessory spleen compromising response to splenectomy for idiopathic thrombocytopenic purpura.

Accessory spleens were sought in 28 patients who had undergone splenectomy for chronic idiopathic thrombocytopenic purpura (ITP), using a variety of techniques. Abdominal scintigraphy with autologous erythrocytes labeled with Tc-99m and opsonized with anti-D IgG (radioimmune method) proved to be most useful, clearly demonstrating one or more accessory spleens in 12 cases (43%). Computed tomography (CT) was also helpful. Four out of five patients demonstrated an increased platelet count following surgery, the effectiveness of which was illustrated by the radioimmune scan. Patients who have had splenectomy for chronic ITP should be scanned using radioimmune techniques and CT to determine whether an accessory spleen is present.

Abdominal Neoplasms↗
PubMed1989

Plasma gamma globulin levels after splenectomy and spleen salvage.

A series of plasma globulin studies was carried out on 108 patients who were operated on for splenic trauma during the last 3 years. The reasons for splenectomy or spleen salvage were; gunshot wounds in 22 patients (20.3%); stab injuries in 10 patients (9.2%) and blunt abdominal trauma in 76 patients (70.3%). Plasma gamma globulin determinations were made on the 8th postoperative day and at 3 months. In the splenectomy group; plasma gamma globulin determinations demonstrated a significant reduction in serum IgM levels (p less than 0.001) but no significant changes in IgA and IgG levels (p greater than 0.05). No changes were detected in IgA, IgG and IgM levels in the spleen salvage group (p greater than 0.05). We believe that the preservation of the traumatized spleen should be the prime aim of surgeons.

Adolescent↗
PubMedDate not supplied

Massive intracranial bleeding requiring emergency splenectomy in a patient with CMV-associated thrombocytopenia.

We describe a previously healthy male patient, with severe immune thrombocytopenic purpura (ITP) following CMV infection which was refractory to steroids and intravenous immunoglobulin, who developed massive intracranial bleeding. Despite an extremely low platelet count (2x10(9)/liter) which was refractory to platelet transfusions, successful emergency splenectomy was performed, with rapid resolution of the thrombocytopenia. Bleeding complications are extremely rare in viral-associated ITP. Emergency splenectomy should be considered in the presence of life-threatening bleeding when other modalities fail to produce a rise in the platelet count. Infection with CMV should be ruled out in cases of severe, treatment-resistant ITP.

Cerebral Hemorrhage↗
PubMed1998

Overproduction of antiplatelet antibody against glycoprotein IIb after splenectomy in a patient with Evans syndrome resulting in acquired thrombasthenia.

We treated a 33-year-old female with Evans syndrome. She received high dose gamma globulin, prednisolone, and azathioprine, and her platelet count transiently increased. After splenectomy, the platelet count markedly increased. However, the bleeding tendency worsened and the bleeding time was prolonged. A platelet defect, characteristic of thrombasthenia, was found. Antigen-captured ELISA and Western blotting revealed that the patient's serum had an IgG autoantibody against platelet membrane glycoprotein IIb and the patient's plasma inhibited normal platelet aggregation. These findings suggest that overproduction of the antiplatelet antibody is triggered by platelet recovery due to splenectomy and affects platelet function resulting in acquired thrombasthenia.

Adenine Nucleotides↗