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PubMed1989

Effect of splenectomy on hepasor treatment in allyl-alcohol-traumatized rat liver.

Experimental liver injury was provoked in test rats with and without spleen intraperitoneally with allyl alcohol injections. The rats without spleen were used for tests 2 months after the splenectomy. Traumatized rats received further intraperitoneal injections of Hepasor, a protoberberine alkaloid mixture from Enantia chlorantha (Annonaceae). Biochemical assays from blood plasma, serum alanine transferase, serum alkaline phosphatase, serum creatinine, serum hydroxyproline and serum calcium were done and the total amount of blood obtained by decapitation was measured. Liver and kidney samples for histological processing were taken. The biochemical results obtained show significant changes in serum hydroxyproline which increases cumulatively due to traumatization, Hepasor treatment and splenectomy. In case of spenectomy, the absolute volume of circulating blood enhanced under Hepasor treatment. The histological findings in the liver sections show that a 2-week Hepasor therapy of the 2-week pretraumatized rats greatly furthers the healing process during prolonged traumatization. The preventive effect of Hepasor was seen as a diminished occurrence of Kupffer cells, improved cell architecture and promoted mitotic activity. The sedative effect of Hepasor was pivotally evaluated, when massive intra- and extracellular damages were provoked with allyl alcohol in splenectomized rats. This indicate the high regeneration potency of Hepasor on experimentally provoked liver dysplasia.

1-Propanol↗
PubMed1977

Effects of sympathetic blockade and splenectomy on cardiac output response to muscular work in dogs.

The effects of splenectomy and sympathetic blockade on cardiac output (Q) response to mild to moderate exercise were studied in chloralose-anesthetized vagotomized dogs during electrically-induced muscular work, which increased oxygen consumption (VO2) 4- to 5-fold. Splenectomy reduced the exercise factor (deltaQ/deltaVO2 ratio) from 5.86 +/- 0.43 (SE) to 3.30 +/- 0.34 (p less than 0.001), while left nephrectomy had no effect. The exercise factor was not affected by beta-adrenoceptor blockade produced by propranolol or practolol, but was reduced by mecamylamine. The spleen did not increase cardiac output by displacing blood into the general circulation because pulmonary artery wedge pressure did not change during exercise in normal dogs. Furthermore, cardiac output was increased 35 +/- 6% after intraportal infusion of splenic venous blood obtained during exercise, whereas arterial blood infusion increased cardiac output only 10%. We conclude that the cardiac output rise during exercise in part is caused by the inotropic action of a splenic noncatecholamine substance, which is released by sympathetic stimulation.

Animals↗
PubMed1986

Red cell pits appear preferentially in old cells after splenectomy.

The percentage of erythrocytes with pits in the peripheral blood after splenectomy was followed in 4 patients. The pit counts started to increase soon after surgery and were above 20% on the 20th postsplenectomy day. The results demonstrate that the majority of pits developed in circulating erythrocytes. Two other patients with autoimmune hemolytic anemia who had failed to respond to splenectomy presented an increase of pit counts from 5.5-13% to 29.8-47.4%, accompanying an increase of erythrocyte life-span during corticosteroid treatment. The data indicate that pits are formed preferentially in older erythrocytes.

Anemia, Hemolytic, Autoimmune↗
PubMed1981

'Early' splenectomy and survival in agnogenic myeloid metaplasia. An analysis of 338 cases published since 1940.

The data available for 338 cases of splenectomy in agnogenic myeloid metaplasia published since 1940 were retrieved from the literature and analyzed. The median survival of cases operated upon at an early stage of the disease (as judged by their hemoglobin level, platelet number, and splenic size) was compared with the survival reported in conservatively treated patients diagnosed at an early stage of agnogenic myeloid metaplasia. Survival time since diagnosis of patients with early splenectomy was similar to, or shorter than, that reported in conservatively treated patients with early agnogenic myeloid metaplasia.

Humans↗
PubMed1980

Sex and splenectomy in agnogenic myeloid metaplasia.

The available data of 338 cases of splenectomy in agnogenic myeloid metaplasia (AMM) published since 1940 were retrieved from the literature and analysed. There were no marked differences between male and female patients as to their survival since splenectomy, since the time of diagnosis or since the onset of the manifestations of AMM. Cardiac and thromboembolic complications caused death in 26% of the male patients, but only in 16% of the females, while hemorrhage and infections were more common causes of death among women. Leukemia developed in 11% of the males and in 6% of the female patients.

Aging↗
PubMed1985

Effect of splenectomy on the development of experimental autoimmune encephalomyelitis in rats with different genetic background.

We studied the effect of total or partial splenectomy on experimental autoimmune encephalomyelitis (EAE) development in rats with different genetic background after immunization with guinea pig basic encephalitogenic protein in Freund's complete adjuvant. The operations did not affect some strains with a high susceptibility to EAE but may have reduced the EAE development in the Fischer strain, which shows only a weak susceptibility. In some hybrids and backcrosses, but not in others, splenectomy resulted in a clear-cut reduction of neurological signs of EAE. This effect may be ascribed to the elimination of contrasuppressive cell populations.

Animals↗
PubMed1983

Successful treatment of post-splenectomy sepsis in an 82-year-old male.

Six weeks after splenectomy for idiopathic thrombocytopenic purpura an 82-year-old man suddenly became drowsy with pyrexia and neck stiffness. Pneumococcal meningitis was diagnosed and treated with benzyl penicillin. Subsequently, penicillin-sensitive pneumococci (serotype 23) were isolated from both CSF and blood. He recovered fully. Review of recent literature confirms that absence of the spleen predisposes to overwhelming infection with encapsulated organisms in adults as well as in children. Use of pneumococcal vaccine would appear to be a prudent, if untested measure in all patients undergoing splenectomy.

Aged↗
PubMed2005

Laparoscopic splenectomy: what barriers remain?

Conditions that once were considered either relative or absolute contraindications for laparoscopic splenectomy have become fewer and less significant in the overall assessment of candidates for this procedure. Advances in surgical technique, operative conduct, and instrumentation have made it feasible to perform splenectomy laparoscopically with good outcomes and minimal morbidity in a variety of different pathologic conditions. Obesity, malignancy, pregnancy, and splenomegaly are assessed here in detail.

Contraindications↗
PubMed2004

Splenectomy for solitary splenic metastasis of ovarian cancer.

BACKGROUND: Splenic metastases occur in rare cases with a few case reports of patients in the literature. Generally, splenic metastases mean late dissemination of a disease. Solitary splenic metastases from solid tumors are extremely unusual. CASE PRESENTATION: We report a case of a patient with ovarian mucinous cystadenocarcinoma who underwent splenectomy for isolated parenchymal metastasis. CONCLUSION: Ovarian epithelial tumors comprised most of isolated splenic metastases from gynecologic tumor. When isolated splenic recurrence is suspected on image studies and serum tumor markers, intraabdominal gross findings should be examined to exclude peritoneal carcinomatosis. If only spleen was under suspicion of recurrence of ovarian cancer, splenectomy may play a therapeutic role.

Adult↗
PubMed2005

Coagulation and splenectomy: an overview.

Venous thromboembolic events, such as pulmonary embolism, deep venous thrombosis, and portal vein thrombosis, have been observed in adult thalassemia patients, mainly in beta-thalassemia intermedia. The clinical findings are consistent with the observation of several alterations that indicate a state of activation of the hemostatic mechanisms in thalassemias. These alterations have usually been related to high platelet counts due to splenectomy and/or liver dysfunction. In a retrospective study of a large cohort of adults with thalassemia, we found a larger prevalence of venous thromboembolic events in transfusion-independent patients with thalassemia intermedia (29%) than in regularly transfused patients with thalassemia major (2%); moreover, the higher prevalence occurred particularly in splenectomized thalassemia intermedia patients. More recently, a multicenter study involving 56 tertiary referral centers in 7 countries was planned to assess the magnitude of thrombotic risk in thalassemia patients. The total number of patients who had thrombotic events was 146 (1.65%) out of 8860, with a prevalence of 0.9% in thalassemia major and 4% in thalassemia intermedia. The highest prevalence was confirmed in splenectomized patients. The observation that thrombotic events are more frequent in beta-thalassemia patients who are not receiving regular transfusions (thalassemia intermedia or thalassemia major patients in less developed countries with limited transfusion resources) or in thalassemic patients who have undergone splenectomy strongly supports the procoagulant activity of circulating damaged red blood cells.

Blood Transfusion↗
PubMed1995

Effects of splenectomy on luteolysis in pseudopregnant rabbits.

The effects of splenectomy on luteolysis in pseudopregnant rabbits were observed. Pseudopregnancy was induced in the rabbits by mating with vasoligated mature males and injection of human chorionic gonadotrophin (D0). In these rabbits, the concentration of serum progesterone increased for 7 days after the induction of pseudopregnancy. In the control group (sham-operation), the concentration of serum progesterone returned to the level of the pre-ovulatory levels by 14 days of pseudopregnancy. On the other hand, in the splenectomized group, in which splenectomy was performed at D7, the serum progesterone concentration was maintained at the level of the functional luteal phase (D7) at least until 21 days of pseudopregnancy. These findings indicate that the spleen is concerned with luteolysis of the rabbit.

Animals↗
PubMed1987

The critical period in which splenectomy causes functional disorder of the ovary in adult rats.

On account of recent reports suggesting that ovulation and luteinization involve immunological reactions, we examined the effect of splenectomy in rats on the recurrence of an estrous cycle. The spleen was removed from adult female rats at various times during an estrous cycle. A delay in ovulation was specifically induced in the rats splenectomized on the metestrous morning between 0700 and 0900 h. This delay in ovulation was reversed by an injection of splenocytes obtained either from estrous or metestrous donors, but not from diestrous or proestrous donors. The isolated splenic macrophage preparation mimicked the effect of splenocytes. Measurement of progestin levels throughout the estrous cycle suggested that the delay in ovulation was caused primarily by a delay in luteolysis; progesterone levels in ovulation delayed rats were higher and 20 alpha-dihydroprogesterone levels were lower than those of intact rats on the diestrous day. These results suggest that the macrophages in the spleen under the influence of endocrine milieu probably play a role in the recurrence of an estrous cycle by controlling luteolysis. The specific time of splenectomy to cause delay in ovulation will afford a new approach in analyzing the function of immunocytes in the ovary.

Animals↗
PubMed2006

Cyclosporin A as an immunosuppressive treatment modality for patients with refractory autoimmune thrombocytopenic purpura after splenectomy failure.

The treatment of autoimmune thrombocytopenic purpura (AITP) remains unsatisfactory in patients refractory to first-line management such as corticosteroid therapy and/or splenectomy. Patients with refractory AITP usually require unacceptably high doses of corticosteroids to maintain a safe platelet count. Immunosuppressive treatment with cyclosporin A (CsA) is a relatively new treatment modality, and no large studies of this drug have been conducted. We used CsA in 6 patients with refractory AITP who had platelet counts of less than 20 x 10(9)/L without any therapy or who had evidence of subcutaneous and mucosal bleeding. All 6 patients had undergone splenectomy. When CsA therapy was begun, 5 of the patients were receiving methylprednisolone (MP) at a daily dose of 32 mg or greater. During the following months, the MP dosage was tapered, or the drug was withdrawn. Three patients achieved a complete remission (CR), whereupon CsA treatment was gradually discontinued. Two of these 3 patients later relapsed, but both responded to an additional course of CsA and achieved a second CR. The remaining 3 patients achieved a partial remission (PR). One patient, a woman with an AITP history of more than 30 years, obtained a stable PR with a platelet count substantially greater than 20 x 10(9)/L, which was successfully maintained by low doses of CsA and MP. The most frequent side effect of CsA therapy in our patients was a painful edema of the lower extremities. Our experience shows that CsA is a safe and effective treatment option for patients with refractory (chronic) AITP. It may be given at a low dose as maintenance therapy, and remissions may be sustained even after the drug has been discontinued.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Splenectomy plus left gastric vein ligature and devascularization of the great curvature of the stomach in the treatment of hepatosplenic schistosomiasis. Postoperative endoscopic sclerosis is necessary?].

OBJECTIVE: With the intention of evaluating the effectiveness and the maintenance of the postoperative endoscopic sclerosis as routine, in association to splenectomy with left gastric vein ligature and devascularization of the great curvature of the stomach, the present study was accomplished. METHOD: Between 1992 and 1998, 131 patient were operated in the General Division of the "Hospital das Clínicas" (Federal University of Pernambuco, Recife, PE, Brazil). The medium follow-up was 30 months. All patients were requested to come back to the clinic for accomplishment of clinical and laboratory control. Of the 111 patients that came back to the clinic, 80 patients had a digestive endoscopy done. Of these 80 patients, 36 followed the recommendation and underwent to a postoperative endoscopic sclerosis program (group 1), while 44 did not accomplish postoperative endoscopic sclerosis (group 2). RESULTS: Regarding the eradication of the esophagus varices, the authors found a statistical difference between the groups (52.7% of the group 1 vs. 18.2% of the group 2). Other analyzed items (mortality, rebleeding rate, thrombosis of the portal vein, gastric varices and degree of periportal fibrosis) statistical relevance was not observed. CONCLUSION: The association of the postoperative endoscopic sclerosis to the splenectomy with left gastric vein ligature and devascularization of the great curvature of the stomach, in the treatment of schistosomotic portal hypertension with digestive hemorrhage antecedent, should be maintained.

Adult↗
PubMedDate not supplied

Effect of splenectomy and ligature of the left gastric vein on portal hypertensive colopathy in carriers of surgical hepatosplenic schistosomiasis mansoni.

PURPOSE: Esophageal variceal sclerotherapy and band ligation seem not to affect the endoscopic findings of Portal Hypertensive Colopathy (PHC) of cirrhotic patients. The aim was to assess the effect of splenectomy and ligature of the left gastric vein on the PHC in carriers of hepatosplenic schistosomiasis mansoni who underwent this surgery when they were between 9 and 18 year-old. METHODS: Fourteen patients, mean age of 19.1 +/- 3.1 years, were included in the postoperative group (GI). The follow-up was from 1 to 9 years. The preoperative group (GII) consisted of nine patients, mean age of 14.0 +/- 3.1 years. Full-length colonoscopy was carried out in all patients. Search was made for PHC lesions. RESULTS: Telangiectasy (GI 100% vs GII 100%), increased vascularisation (GI 57.1% vs GII 100%), focal and diffuse hyperemia (GI 14.3% vs GII 66.7%), angiodysplasia (GI 7.1% vs GII 33.3%), and rectal varix (GI 0% vs GII 55.6%) were the most frequent findings. It was observed that the patients of this series tended to exhibit fewer hemodynamic manifestations of the PHC after treatment (postoperative versus preoperative - chi2 = 8.155 - p = 0.004). CONCLUSION: Splenectomy and ligature of the left gastric vein tend to reduce the abnormal vascular findings of PHC in carriers of hepatosplenic schistosomiasis mansoni.

Adolescent↗
PubMed1997

[A fatal case of overwhelming postsplenectomy infection syndrome developing 10 years after splenectomy].

UNLABELLED: Splenectomized patients are likely to suffer from severe infections, such as sepsis and meningitis. This syndrome is called overwhelming postsplenectomy infection (OPSI) in Europe and America. The course is rapid, the clinical symptoms are serious, and the prognosis is very poor. We treated one adult patient with OPSI syndrome that developed 10 years after splenectomy. CASE: A 26-year-old man had undergone a splenectomy following a traffic accident 10 years previously. On January 7, 1996, he had diarrhea and nausea. On January 10, he became drowsy and presented at our hospital with multiple organ failure. He underwent hemodialysis and plasmapheresis because of acute renal failure and also received immune globulin, antibiotics and prednisolone. However, these medications were not effective. He died 7 hours later. We identified diplococcus on a blood smear, IgG 3 deficiency and a low titer of specific pneumococcal IgG 2 antibody. The autopsy findings included bilateral acute hemorrhagic necrosis of the adrenal glands (Waterhouse-Friderichsen syndrome).

Adult↗
PubMed1995

Percutaneous drainage of subphrenic fluid collections that occur after splenectomy: efficacy and safety of transpleural versus extrapleural approach.

OBJECTIVE: The purpose of this study was to compare the safety and efficacy of transpleural and extrapleural approaches for draining left subphrenic abscesses in patients who have had splenectomy. MATERIALS AND METHODS: Twenty-five patients who had percutaneous catheter drainage (28 drainages) of postsplenectomy fluid collections were studied. Twenty drainages were transpleural and eight were extrapleural. In eight of the 20 transpleural drainages, it was elected to place the catheter transpleurally. In the remaining 12 patients, catheter drainage was judged to be transpleural on review, despite efforts to use an extrapleural approach. RESULTS: Sixteen of 18 patients who had transpleural percutaneous drainage and six of seven patients who had true extrapleural (subcostal) percutaneous drainage were cured by catheter drainage requiring no further intervention. The mean number of days of drainage was not significantly different (p > .05) for the group drained transpleurally (mean, 18 days; range, 1-90 days) versus the group drained extrapleurally (mean, 20 days; range, 6-43 days). Complications (pneumothorax) requiring treatment were seen in two patients in whom a transpleural approach was used and in none of the patients in whom an extrapleural approach was used. Complications that did not require treatment were seen in four further patients drained transpleurally. These were inadvertent placement of catheter into pleural space (two patients) and pneumothorax not requiring treatment (two patients). No patient had an empyema. CONCLUSION: Transpleural drainage of left subphrenic collections occurring after splenectomy is associated with a slightly increased complication rate but has a success rate similar to that of extrapleural drainage.

Adult↗