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PubMed1989

Morphology and viability of the spleen after subtotal splenectomy.

1. Postsplenectomy complications have stimulated surgeons to opt for partial splenectomy as a more desirable technique for several diseases and in some cases for trauma to the spleen. 2. We studied spleen viability in 15 dogs submitted to subtotal splenectomy while maintaining the upper pole and upper splenogastric vessels. Macro- and microscopic histological studies as well as Tc99m-labeled heat-damaged erythrocyte scintigraphic analysis of splenic blood irrigation were carried out. 3. We conclude that: a) the splenogastric vessels are sufficient for the maintenance of spleen irrigation and drainage; b) the spleen remnants develop increased cellularity of the splenic cords and lymphoid folliculi; c) the length of the spleen remnants does not change for at least 2 months after surgery.

Animals↗
PubMed1989

[Clinical study on splenic autotransplantation after splenectomy in idiopathic thrombocytopenic purpura].

Splenic autotransplantation after splenectomy for idiopathic thrombocytopenic purpura (ITP) is one of the effective treatments for maintaining the patients' immunity in children. We investigated this surgical method in 10 adult ITP patients. This method was extremely effective for thrombocytopenia. Cellular immunity of the patients was maintained as evidenced by the normal response of peripheral lymphocytes to phytohemagglutinin (PHA) and concanavalin-A (Con-A) after the operation. The mitogenic response of peripheral lymphocytes to PHA and Con-A might be a useful indication for predicting the effect of splenectomy.

Adult↗
PubMed1989

Overwhelming infection occurring in the immediate post-splenectomy period.

Overwhelming post-splenectomy infection (OPSI) is a serious condition associated with a high mortality rate. Occurring most often in the first two years after splenectomy, it has also been described up to 47 years after this operation. We report a further occurrence of this syndrome and stress the importance of early detection and aggressive treatment of this type of infection.

Hodgkin Disease↗
PubMed1989

[Regeneration of splenic tissue after splenectomy].

From analysis of experience in 284 splenectomies undertaken for various indications, in cases with accessory spleens and the formation of splenoids, and the results of heterotopic autotransplantation of splenic tissue, the authors concluded that the latter possesses high regenerative properties. The possibility of hematogenous spreading of pulp cells with subsequent formation of accessory spleens cannot be excluded, in view of which scrupulous care is needed in relation to operative techniques in performing splenectomy for hematological indications.

Adolescent↗
PubMed1989

[The role of splenectomy in traumatic rupture of the spleen with comments on related material].

The authors present their ten-year series of traumatic rupture of spleen. During the ten-year period 24 of such cases have been registered. In all ruptures of spleen the total splenectomy was performed, due to severe ruptures of capsule and parenchyma. In 87.5% the operations were done immediately. The delayed rupture of spleen was in three patients, without complications and mortality. The authors put the particular stress on fast and accurate diagnosis and note all methods of diagnosis, which can be used according to possibilities of Surgical Department. The authors suggest that the hesitation for laparatomy and that the splenectomy is justifiable operative method in traumatic rupture of spleen.

Adult↗
PubMed1989

Emergency splenectomy in adult idiopathic thrombocytopenic purpura. A report of seven cases.

Seven adult patients with idiopathic thrombocytopenic purpura underwent emergency splenectomy. Six were female and one was a male, aged 16 to 61 years. All of them had a life-threatening episode. Six patients had progressive intracranial bleeding and one had postsurgical intra-abdominal bleeding. All patients were saved by surgery, except one for whom operation was delayed. There was no postoperative bleeding or surgical complication. Immediate splenectomy should be the treatment of choice in any patient with idiopathic thrombocytopenic purpura complicated by life-threatening hemorrhage.

Adolescent↗
PubMed1989

[Epidermoid cyst of the spleen in a newborn infant. Prenatal diagnosis and partial splenectomy].

Non parasitic splenic cysts are an uncommon clinical and pathologic entities, out of these, epitelias splenic cysts (ESC) occurred in 10% of cases. Until recently the treatment of choice for the large ESC consisted of splenectomy. Splenic preservation, for avoiding risks of sepsis, is a modern concept uniformly accepted for treating childhood splenic injury and benign pathology. The Authors report a case of prenatal diagnosis of large left upper quadrant mass that was apparent at Ultrasonography (US) at 32th week of gestational age. Laparotomy at 3rd day of life: a large cyst splenic mass was found (7 x 7 cm), it was situated all in lower pole. Partial splenectomy was performed; cysts were not found in other organs. Histology of specimen: ESC. The postoperative course was uneventful. Postoperative (6 months) Scintigraphy demonstrated the good vascularization of the spleen.

Epidermal Cyst↗
PubMed1977

Splenectomy: follow-up of patients in the Solomon Islands.

The case histories of 19 splenectomy patients are discussed. Of these, four have died, five have had subsequent attacks of malaria, and the remainder have enjoyed good health, although only two patients have been taking regular malaria prophylaxis in this malaria endemic area. The roles of the reticulo-endothelial system and the spleen are discussed in relation to the effects of splenectomy.

Adult↗
PubMed1989

[The role of splenectomy in surgical hematology].

The authors review the literature on the importance of splenectomy in hematologic diseases, its indications, contraindications and complications. Classification of diseases of definite importance in surgical hematology, for which splenectomy is considered, is presented.

Hematologic Diseases↗
PubMed1989

[Heterotopic autotransplant of the spleen after splenectomy in traumatic rupture. Personal experience and scintigraphic follow-up].

Certain aspects of OPSI (Overwhelming Post-Splenectomy Infection) are examined, mainly its considerable gravity, its relatively high incidence, especially in children; its difficult prophylaxis with a report on personal experience of ectopic autotransplant of spleen tissue in two young patients after splenectomy for traumatic rupture. The technique was found to be simple and quickly performed. Scintigraphic follow-up for over 4 years after the operation showed satisfactory growth in the transplanted spleen tissue.

Adolescent↗
PubMed1989

[Immunologic risks in patients after splenectomy].

The more frequent incidence of infections after splenectomy, some leading even to OPSI syndrome, is known from the literature and practice. The authors investigated in two groups of 20 splenectomized patients (on account of injury of the spleen or for haematological reasons) in particular changes of immunological indicators. On both groups they revealed a predominating increase of the absolute number of leucocytes, lymphocytes, the phagocytic index of PMN leucocytes, the ratio of active nucleoli, FW. They found also in both groups a predominating reduction of the number of T lymphocytes (p less than 0.05), with a high probability also NK cells, and a reduction of the late type reactivity of the skin test (Immunoskin test USOL, Praha). In patients splenectomized on account of injury the number of B lymphocytes was raised in 50% of the patients. In both groups of patients IgG serum levels were elevated, alpha-1-antitrypsin and haptaglobin levels were reduced. The CRP level in patients with haematological diagnoses was elevated as compared with the group of patients splenectomized on account of injury (p less than 0.05). In both groups after splenectomy a greater susceptibility to respiratory infections was found. On examination patients with a greater risk were detected and included under dispensary care.

Adult↗
PubMed1989

[Splenectomy of the giant spleen].

From 1982 to 1987 splenectomy was performed in 45 patients with massive splenomegaly (greater than 1.5 kg). Only three patients could be cured surgically. In 42 patients a serious hematological disorder was the indication for operation, and splenectomy served as palliative treatment of mechanical complaints and to achieve a correction of cytopenias. 56% of the patients sustained postoperative complications, mainly respiratory problems and wound infections. None of the patients died as a result of the operation.

Adolescent↗
PubMed1989

[Splenectomy in the treatment of hairy cell leukemia].

Splenectomy still remains the method of choice in treatment of patients with hairy cell leukemia (HCL) due to high efficiency and low percentage of complications. Five-year survival of patients with HCL after splenectomy was 74%. Because of the low percent of hairy cells in the patient's blood the diagnosis of HCL should widely include trephine biopsy of the bone marrow as well as immunological studies of the leukemic cells. In order to detect pathological processes in the spleen and estimate the topographo-anatomical alterations in the left quadrant of the abdomen before operation, it is expedient to use computed tomography, ultrasound examination, scintigraphy.

Adult↗
PubMed1989

[Autotransplantation of splenic tissue after splenectomy in splenic injury in children].

Long-term results and indices of immune reactivity in 30 patients who had splenectomy performed in childhood for trauma of the spleen were studied. The organ-preserving approach for this pathology is substantiated. Autotransplantation of the spleen pulp into the pocket formed from the greater omentum was performed in 5 children during splenectomy for trauma of the organ. An original device was used for better preparing the autotransplant. The postoperative period was without complications. The laboratory, sonographic and scintigraphic examinations have shown high functional activity of the transplanted spleen tissue.

Child↗
PubMed1978

Effect of early splenectomy and cyclic acute leukemia-like chemotherapy on the course of chronic myeloid leukemia.

This report provides information on the progress of two trials by the Italian Cooperative Study on Chronic Myeloid Leukemia (CML). Both trials were designed in order to test the effect of early splenectomy and of cyclic administration of either arabinosyl cytosine and vincristine plus prednisone, or arabinosyl cytosine plus thioguanine plus daunomycin, on the course of CML and on the survival. A preliminary analysis, performed on September, 1977, suggests that neither splenectomy nor the chemotherapy scheduled have resulted in a significant decrease of the rate of blastic transformation of CML, during the first 2 to 3 years from diagnosis.

Adult↗
PubMed1979

[Spleen irradiation and splenectomy for treatment of hypersplenism in chronic myeloid leukemia and chronic lymphatic leukemia (author's transl)].

Hypersplenism is characterized by cytopenia, splenomegaly (possibly hyperplastic bone-marrow), and lienal hypersequestration. It is necessary, in view of the rather important surgical risks of splenectomy, to clarify if the hypersplenism may be influenced by splenic irradiation in case of chronic myeloid leukemia (CML) or chronic lymphatic leukemia (CLL). References in literature are rare and do not present a reliable differentiation of the syndrome, according to its present definition. Of our patients, three cases with hypersplenism verified by radioiron studies are reported: in one patient with chronic myeloid leukemia, irradiation of the spleen had no effect, whereas pancytopenia was completely repaired by means of splenectomy. The same results were seen in a patient with chronic lymphatic leukemia. In the last patient, however, who had chronic lymphatic leukemia, fractionated irradiation of the spleen led to a distinct improvement of anemia and thrombopenia, but the recovery lasted only six months. This effect is due to transient normalization of the lienal hypersequestration.

Aged↗
PubMed1989

Distal pancreatectomy with and without splenectomy. A comparative study.

Twenty-one patients undergoing distal pancreatectomy from January 1980 through April 1987 were studied retrospectively. Group I (n = 10) had distal pancreatectomy with splenectomy, and Group II (n = 11) had distal pancreatectomy with splenic preservation. The groups were comparable in mean age and extent of pancreatic resection. Operative time in Group I patients who did not require additional major procedures was 3.74 +/- 1.01 hours, compared with 2.86 +/- 1.68 hours for similar Group II patients. The overall complication rate in Group I was 40 per cent, including two pancreatic fistulas, one subphrenic abscess, and one gastric fistula. In Group II the overall complication rate was 36.4 per cent, with one pancreatic fistula, one subphrenic abscess, and one colonic fistula. Splenic infarction occurred in only one patient (Group II), in whom both splenic vessels were ligated. No patient developed insulin-dependent diabetes. There were no deaths. The mean hospitalization time was 18.8 days in Group I, and 17.5 days in Group II. Splenectomy should not be considered a routine part of distal pancreatic resection. Splenic preservation can be achieved in selected cases with no increase in complication rate, operative time, or length of postoperative hospitalization.

Adult↗
PubMedDate not supplied

Splenectomy in early chronic myeloid leukemia.

The authors report their experience with 25 patients suffering from C.M.L. who underwent splenectomy in an early phase of the disease. There were no operative deaths; seven patients had postoperative complications, three of which required re-operation for intra-abdominal hemorrhage. The follow-up is still too short to permit definite conclusions, but the results so far obtained suggest that splenectomy is useful in reducing leukemic tissue, improving the quality of life, and potentially efficacious in delaying the onset of blastic transformation.

Adult↗