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PubMed1991

The sequestration of 111-In-labelled autologous platelets and the efficiency of splenectomy.

The main information is the excellent correlation between the site of sequestration of autologous platelets (the use of 111-indium allows autologous labelling even in case of severe thrombocytopenia) and the efficiency of splenectomy. From 76 cases with splenic sequestration studied 2 to 10 weeks after splenectomy, an excellent increase of the platelet count (higher than 300 10(9)/l) was observed in 65 cases, a moderate increase (100-300) in 6, a failure in 5. In contrast, in the 16 cases with hepatic sequestration, only one success did occur, and failure (platelet count lower than 100) occurred 15 times. Beyond the 6th month, in spite of some relapses, the prediction remains excellent. From the 67 evaluated cases with initial splenic sequestration, 58 have a platelet count higher than 100 10(9)/l. From the 14 cases with hepatic sequestration, 13 have, at long term, less than 100 10(9)/l platelets.

Blood Platelets↗
PubMed1991

Peripheral blood leukocyte subpopulations a long time after posttraumatic splenectomy.

Peripheral blood leukocyte subpopulations have been determined in 50 patients a long time (2 to 20 years) after posttraumatic splenectomy. These otherwise healthy individuals had significant lymphocytosis and monocytosis, while the absolute number of granulocytes did not differ statistically from that of the controls. The absolute number of CD2+, CD3+ as well as CD4+ and CD8+ peripheral blood mononuclear cells was found to be elevated, while the number of CD21+, CD20+ and HLA-DR+ PBMN cells was significantly decreased. The absolute number of sIgM+ as well as CD16+ MN cells did not differ statistically from that of the controls. Two further patients were found to have developed B-chronic lymphocytic leukaemia 5 and 31 years following posttraumatic splenectomy, respectively.

Antigens, CD↗
PubMed1991

[Autotransplantation of splenic tissue after splenectomy in adults].

Splenectomy involves a risk of development of postsplenectomy sepsis, PSS. An assessment of the incidence of PSS is made on the basis of a review of the literature. Experimental studies on animals suggest that splenic autotransplantation exerts a protective effect following nasal exposure to Streptococcus pneumoniae. Where other routes of exposure are concerned, the results are contradictory, but no general effect has been found. Clinical data is limited and the effect cannot be assessed as yet. The technique of autotransplantation and the commonest complications are summarised. On this basis, several guidelines are presented. It is concluded that splenic autotransplantation is a potentially beneficial alternative to total splenectomy but that it involves a certain risk. The procedure should, therefore, only be carried out under clinically controlled conditions.

Adult↗
PubMed1991

[Partial splenectomy using a stapler and the role of regeneration of the residual splenic stump].

Current evidence indicates that only complete or partial intact spleen can protect the organism against pneumococcal sepsis. What is not clear is the amount of minimal splenic tissue needed to protect the organism against such infection. This study has been carried out on 20 dogs which underwent partial or total splenectomy with stapler. Animals were divided into 8 groups according to the quantity of the remnant splenic tissue: 0% (4 dogs); 5% (4); 15% (1); 25% (1); 35% (2); 50% (2); 75% (2); 100% (4), and were followed up for 6 and 12 months. No mortality or bleeding was registered. Results showed a splenic regeneration, histologically demonstrated as an increased number of germinal follicles, in 12 out of 16 dogs, more evident in the animals sacrificed at one year. In conclusion, even a small amount (5%) of splenic tissue preserved with its blood supply can regenerate and acquire with time enough immunological function to protect the organism against post-splenectomy sepsis.

Animals↗
PubMed1991

Splenic regeneration and phagocytic function after partial splenectomy in baboons.

Total splenectomy, especially in children, results in diminished ability to combat infection by capsulated bacteria. It is, however, uncertain how much splenic tissue is needed to maintain this ability. In this experimental study on baboons, in situ remnants after partial splenectomy were examined to evaluate regeneration and phagocytic function after injection of dual-labelled liposomes into their splenic arterial supply. The results showed that resection of as much as two-thirds of the spleen in baboons allowed sufficient regeneration to support adequate macrophage phagocytic function.

Animals↗
PubMedDate not supplied

Splenectomy abolishes antitumor effect of immunotherapy with streptococcal preparation, OK-432, on mouse liver tumors.

In the present study, we investigated the therapeutic effects of oral and subcutaneous administration of OK-432 prior to or following the transplantation of murine liver tumors. In addition, the effect of splenectomy on the antitumor activity of OK-432 was investigated. Mice which received OK-432 orally prior to tumor transplantation exhibited significantly lower tumor weight and significantly improved survival, when compared to the control mice. Prior subcutaneous injection of OK-432 did not show any antitumor activity. On the other hand, both oral and subcutaneous administration of OK-432, subsequent to tumor transplantation, led to a significant improvement of survival and a decrease in the number of lung metastases, although tumor weight was not affected. The anti-tumor effect of OK-432 required the presence of the spleen, since the survival of the mice with liver tumors was not improved by OK-432 if splenectomy and tumor transplantation were performed simultaneously. These results suggest that immunotherapy with OK-432 may beneficial in the treatment of liver tumors and that these effects are dependent on the presence of the spleen.

Animals↗
PubMed1991

[Evaluation of the splenic function in patients with abdominal injuries undergoing splenectomy with autograft].

Splenectomy, required for splenic injuries in which conservative management is unsuitable, causes a fall of the immunological defenses, increasing the risk of sepsis. Immunological functions of the spleen can be maintained by autotransplant of splenic tissue. This is confirmed in our experience by a comparative study of haematological, immunological and scintigraphic features in 14 patients. Autotransplantation was performed in 8 cases, while the remaining 6 cases were treated with simple splenectomy.

Adolescent↗
PubMed1990

Immunoglobulin profiles and antibacterial antibody levels in 50 patients a long time after posttraumatic splenectomy.

Serum immunoglobulin and antibacterial antibody concentrations have been determined in 50 patients 2 to 20 years after posttraumatic splenectomy. The serum levels of IgG, IgA and IgM were found to be significantly greater in the group of posttraumatic splenectomy patients than in that of the healthy controls. The serum IgE concentrations did not differ statistically from that of the controls. The serum level of natural antibodies against intestinal bacteria were found to be elevated (Shigella 1b, 2a, 3 and Salmonella typhi 02 strains) or normal (Salmonella typhi 0901 as well as E Coli 026 and 055 strains). Our results show that the studied functional aspects of humoral immunity in this group of otherwise healthy splenectomized individuals were not impaired.

Adult↗
PubMed1990

[Immune thrombocytopenia and HIV-1 infection. Response to splenectomy].

We present a case of thrombocytopenic purpura associated to acquired immunodeficiency; this disease is very infrequently associated to AIDS; the clinical characteristics are similar to the classical Idiopathic Thrombocytopenic Purpura, including the response to splenectomy. We discuss the therapeutic approach of this condition and review the literature, adding this new case of a patient with AIDS, Walter and Reed's stage II, who responded to splenectomy.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Fatal post-splenectomy sepsis in a Papua New Guinean highlander.

A fatal case of overwhelming post-splenectomy sepsis (OPSS) occurring 5 years after splenectomy for trauma in a Papua New Guinean highlander is presented. The diagnosis of pneumococcal infection was made from a peripheral blood smear. The finding of OPSS in Papua New Guinea is cited as additional evidence in favour of a policy of conservative management, where possible, of ruptured spleen.

Adult↗
PubMed1990

[Splenectomy in hairy cell leukemia].

Splenectomy was performed in five patients with hairy cell leukemia at the Surgical Department of the Hospital with Policlinic, Bezrucova, Bratislava, over the years 1982-1987. One of the patients died 3 years after operation due to progression of the disease, the other four patients have been surviving for 2-7 years following surgery without relapse of the disease. The presented results, compared with the world literature, justify splenectomy to be advocated as the primary therapeutic procedure in hairy cell leukemia.

Adult↗
PubMed1990

[Effect of splenectomy for management of thrombocytopenia associated with systemic lupus erythematosus: a case report].

A 51-year-old female with systemic lupus erythematosus (SLE) was admitted in November 1987 because of general fatigue and muscular weakness. She was treated with prednisolone (PSL) 30 mg and azathioprine (AZP) 50 mg after failure in the management of thrombocytopenia by PSL 15 mg. She exhibited no splenomegaly. Muscular atrophy and weakness were seen in the proximal muscles. Her platelet count was 44,000/microliters. A bone marrow aspiration revealed an increase in megakaryocytes. The blood chemistry revealed a normal CPK level and an elevated LDH level, indicating a presence of steroid myopathy. A splenectomy was performed after an increase of platelet count by giving gamma-globulin 400 mg/kg for 5 days. The platelet count rose to 368,000/microliters on the 46th postoperative day. She was treated with PSL 5 mg and AZP 50 mg as postsplenectomy therapy. The splenectomy did not adversely affect other aspects of SLE, in particular, renal function. She had no major complications in the postoperative period. Her platelet count reached a plateau 4 months later and revealed 115,000/microliters 18 months postoperatively.

Female↗
PubMed1990

Splenectomy for haematological diseases.

Two hundred patients with various haematological diseases underwent splenectomy between 1974 and 1986. The diagnoses were: Hodgkin's disease (n = 76), hairy cell leukaemia (n = 25), idiopathic thrombocytopenic purpura (n = 20), chronic lymphatic leukaemia (n = 19), haemolytic anaemia (n = 18), non-Hodgkin lymphoma (n = 16), myelofibrosis (n = 10), chronic myeloid leukaemia (n = 6), spherocytosis (n = 4), and miscellaneous (n = 6). Many of the patients were treated with corticosteroids and in poor general condition, partly as a result of chemotherapy. There were 37 postoperative complications in 29 patients (14.5%); two died, both of septicaemia. Pneumonia, bleeding, and wound infection were the most common complications, occurring in 9, 8, and 6 patients, respectively. Twelve patients required reoperation, eight for bleeding, two for intra-abdominal abscesses, and one each for pancreatitis and bowel perforation. There was no association between the diagnosis and the type of postoperative complication, but patients whose spleens weighed more than 2 kg had an increased incidence of postoperative complications (30%). We conclude that elective splenectomy is a safe treatment for haematological diseases, even in high risk patients.

Adolescent↗
PubMed1990

[Benefits of splenectomy in the treatment of chronic leukemia].

Both chronic myeloid leukemias (CML) and lymphoid chronic leukemias (LCL) affect the spleen provoking the appearance of symptoms due to the size of the spleen or the sequestration of blood cells. Splenectomy has been utilized to prevent these conditions. We have a series of 12 patients suffering (CML) and 7 suffering LCL with a mean age of 34.4 and 60.14 respectively. All our patients underwent surgery since their splenomegaly did not respond to chemotherapy on radiotherapy with a general worsening of the patients condition. The postsurgery morbidity was greater in patients suffering CML than in those suffering LCL. The most important complications were pulmonary, followed by hemorrhages in the LCL group, and by the presence of fever of unknown origin in the splenectomized LCL patients. There were no fatalities in our series. Clinical and hematological improvement was evident in LCL patients, with increasing hematocrit and platelet number (100% of the cases). The CML results, however, are not so satisfactory, with a complete remission rate of 16.6%. Mortality was very high (83.3%) after a two year follow up, versus 14.3% in LCL, which, could be due to the natural course of the disease. In summary, we believe that splenectomy is a therapeutical approach to consider in all those cases with splenic symptoms improving their quality of life.

Adolescent↗
PubMed1990

[Diagnostic splenectomy. Apropos of 38 cases].

The authors report a retrospective study of 38 splenectomies performed as a diagnostic procedure. In the first group, the diagnosis was made by surgery: 27 cases (71.1%) included the usual large number of lymphomas. In the second group, there was no conclusion: 11 cases (28.9%), patients were younger and the spleen was lighter with a statistical significance (p less than 0.006 and p less than 0.003). Three of the 11 patients in the second group subsequently developed a malignant blood disease. Morbidity was high: out of 38 cases, 14 complications occurred in 11 patients (28.9%). One patient died on the fifty fifth postoperative day. The authors consider that splenectomy for undiagnosed splenomegaly is an effective procedure for diagnosing lymphoma, but not without risk. Indications for surgery must be carefully evaluated. It is more questionable in young, asymptomatic patients or in the case of moderate splenomegaly. After surgery, with no histologic diagnosis only a long-term survey will differentiate patients with malignant blood diseases from patients with idiopathic splenomegaly.

Adolescent↗
PubMed1990

[Excision of a splenic cyst using a surgical stapler in partial splenectomy].

The authors extirpated the splenic cyst of a young girl with the use of stapler in such a way that the distal part of the spleen was preserved. During this case the types of splenic preservative operations and the question of fulminant sepsis found in the patients went under splenectomy were surveyed. According to us the advantage of using stapler in partial splenectomy than the others is that firstly it is technically simple, less time consuming, and the haemostasis is safe. This is thought to be a valuable additional procedure to the ultimately known and the procedures which are used.

Adolescent↗
PubMed1989

Plasma levels of soluble CD8 antigen and interleukin-2 receptor antigen in patients with hairy cell leukemia, relationship with splenectomy and with clinical response to therapy.

A soluble form of CD8 antigen (sCD8) has been shown to be released by activated CD8 + lymphocytes. Measurements of sCD8 may serve as an index of suppressor/cytotoxic cell activity. To assess the clinical significance of this observation in response to malignancy, we have investigated the sCD8 concentrations in 38 patients with hairy cell leukemia (HCL) not yet treated with any systemic therapy. The median plasma sCD8 level of the 20 nonsplenectomized patients was 1,025 U/ml and was significantly higher than that in the 18 patients who had previous splenectomy (median = 200 U/ml, p less than 0.0001), or in 14 normal controls (median = 350 U/ml, p less than 0.0001). Compared to controls, splenectomized patients had also significantly lower levels of sCD8 (p less than 0.01). The median concentration of soluble interleukin-2 receptor (sIL2R) in nonsplenectomized patients was 14,500 U/ml and was in the same range as in splenectomized patients (15,000 U/ml). There was no overlap in sIL2-R levels between controls (median = 300 U/ml) and patients. Investigation of serial plasma samples in 7 patients who received deoxycoformycin (DCF) and 11 patients treated with interferon alpha (IFN-alpha) showed a normalization of sCD8 levels and a decrease of sIL2R concentrations in those patients who showed hematological improvement. Normalization of sIL2R was, however, only observed in patients with complete remission. Our observation indicates that splenectomy might cause a reduction of the activation of suppressor/cytotoxic cells in patients with HCL. Treatment with either DCF or IFN-alpha also modulates the sCD8 levels to normal range. Measurements of sCD8 and sIL2-R might give more insight into the pathogenesis of HCL and serve as parameters for monitoring different phases of the disease and response to therapy.

Antigens↗
PubMed1989

[Effect of splenectomy on the growth of W256 carcinosarcoma and T cell subsets of peripheral blood in rat].

Rats were randomized into splenectomised and sham-splenectomised groups (n = 15 in each). W256 carcinosarcoma cells were implanted in the subcutis of each animal 10 days after splenic operation. T cell subsets of peripheral blood were evaluated serially before and after the operation. The growth rate of implanted tumor and diameter of local tumor in the splenectomised were larger than those of the sham-splenectomised. Simultaneously T cell subsets of peripheral blood presented severe reduction of pan-T and T h/i cells and slight increase of T s/c cells in the splenectomised, all of which still remained at the lower level after tumor inoculation, as compared with the non-tumor and tumor growth in sham-splenectomised (P less than 0.01). From these data, it is evident that splenectomy results in the reduction of T h/i cells and a relative increase of T s/c cells, which shows a close correlation with the rapid growth of the tumor following splenectomy.

Animals↗