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PubMed1987

Splenectomy for idiopathic thrombocytopenic purpura.

Over a period of 20 years, splenectomy has been performed upon 216 patients with idiopathic thrombocytopenic purpura. Splenectomy resulted in an immediate and sustained platelet response in 72 per cent of these patients. An additional 7.4 per cent of the patients had a sustained platelet count of 150,000 per cubic millimeter develop while off all drug therapy within the first postoperative year. Of the remaining patients who failed to meet these criteria, only one died of subsequent thrombocytopenic bleeding and only eight remained on any therapy with steroids or other immunosuppressive agents at last follow-up examination.

Adolescent↗
PubMed1986

[Long-term results of splenectomy in children with closed injuries of the spleen].

Under study were indices of the immune reactivity and infectious morbidity in 30 persons subjected to splenectomy in childhood for traumatic rupture of the spleen. They were shown to have lower resistance to infections. Children after splenectomy need a continuous dispensary observation. Prophylactic measures require further development. The most perspective method of preserving the functioning splenic tissue in the organism after trauma of the organ is thought to be autotransplantation of the splenic pulp.

Adolescent↗
PubMed1985

Partial splenectomy in children with Gaucher's disease.

Because of hypersplenism and mechanical problems, partial splenectomy was performed in four children with Gaucher's disease. Subsequently, one of the patients underwent a total splenectomy due to bleeding from the remnant of the spleen. At the follow-up of the other three patients, an isotope scan showed that the remaining spleen was functioning well.

Adolescent↗
PubMed1986

Outcome of pneumococcal challenge in rats after splenic artery ligation or splenectomy.

Reports of postsplenectomy septicemia led to development of various methods for splenic salvage, including ligation of the splenic artery. For study of susceptibility to pneumococci after splenectomy or splenic artery ligation, 35 Sprague-Dawley rats, in three groups, underwent splenectomy or central ligation of the splenic artery, or sham operation with omental resection. Blood cell counts prior to injection of pneumococci (3 X 10(3) intravenously in each rat) showed no intergroup differences. All the splenectomized rats died, but only 20% of those with splenic artery ligation (p = 0.000047). None of the rats with sham operation died, but this was not significantly different from the mortality in the group with splenic artery ligation (p = 0.22).

Animals↗
PubMed1985

[Changes in the immunological indices after splenectomy and the reimplantation of splenic fragments in an experiment].

Splenectomized guinea-pigs underwent autotransplantation of splenic fragments into the greater omentum or mesentery of small intestine. Twenty-five to thirty days after operation the animals were infected with S. aureus and then were examined over time before and after infection at different times. Measurements were taken of T lymphocytes, B lymphocytes, lymphocytes with staphylococcal receptors, as well as of the content of neutrophils with IgG Fc-fragment and complement receptors. It was established that in guinea-pigs subjected to splenectomy followed by autotransplantation of decapsulated splenic fragments, the experimental generalized staphylococcal infection took a milder course, which was manifested by an increase in the above immunologic characteristics as compared to animals undergoing splenectomy alone.

Animals↗
PubMed1985

Fatal, overwhelming sepsis after splenectomy in the community hospital.

Charts of all patients who underwent splenectomy between 1965 and 1981 at the Orillia Soldiers' Memorial Hospital were reviewed. At the end of 1983, the patient, relatives or family physician were contacted for follow-up. Eighty spleens were removed, 36 for medical reasons, 30 for trauma and 14 because of iatrogenic injury. Of the patients followed up, 51 were alive and 13 had died. Three died in the postoperative period and seven died of unrelated causes. Three patients died of overwhelming sepsis, 1, 3 and 7 years after splenectomy. If the three postoperative deaths are excluded and it is assumed none of the 16 untraced patients died of overwhelming sepsis, the incidence of death from this cause was 3.9%.

Acute Disease↗
PubMed1985

Splenectomy and extravascular platelet destruction in thrombotic thrombocytopenic purpura.

Intravascular platelet deposition has been considered an essential pathophysiologic mechanism in thrombotic thrombocytopenic purpura. Splenectomy resulted in prompt and sustained hematologic improvement in a patient with the chronic form of the disease. The response to splenectomy, normal plasma levels of secretable platelet proteins, and phagocytosis of erythrocyte fragments and platelets by splenic macrophages demonstrated by electron microscopy suggest that platelet destruction may occasionally be predominantly extravascular in this disease.

Adult↗
PubMed1985

Evaluation of immunity of sheep after splenectomy, splenic artery ligation and autotransplantation of splenic tissue.

The studies aiming at evaluation of immunity after splenectomy, splenic artery ligation, and autotransplantation of splenic tissue were performed in sheep. It was found that splenectomy alters both humoral and cellular immunity. The phagocytic activity of granulocytes, reduced level of IgG, drop in T and ARF cells as well as bone marrow stimulation were noted. In animals subjected to splenic artery ligation or autotransplantation of splenic tissue no significant differences in parameters studied were observed. These results correlated with histological examinations indicate that in the case of spleen trauma two important steps should be followed: the spleen, if possible, should be saved or a spleen saving procedure should be employed; in case of extensive trauma or if contraindications for spleen saving exist, autotransplantation of splenic tissue should be performed.

Animals↗
PubMedDate not supplied

[Hemorheologic characteristics in beta-thalassemic homozygotes before and after splenectomy].

In a group of 36 homozigous beta-thalassaemic children we studied the effect of splenectomy on hemorheologic characteristics. The aim of the work was to evaluate the importance of such operation either on anemia or on erythrocyte deformability. Whole blood viscosity was measured with a Brookfield Microviscometer (LVT) and erythrocyte deformability was evaluated with the erythrocyte filtration technique using policarbonate membranes. The more the erythrocyte deformability decreases, the more the erythrocyte filtration rate decreases. Our data show that splenectomized children, have worse hemorheologic characteristics according to the longer survival time of pathological red blood cells in spite of their reduced deformability. This behaviour can be modified only by blood transfusion that we have seen to be able to reduce whole blood viscosity and to increase erythrocyte filtration rate in splenectomized children. We think that splenectomy must be delayed as long as possible so that hemodinamyc conditions cannot be worsened. An hemorheologic monitorage could be useful for diagnostic and prognostic evaluations both in splenectomized and not splenectomized children.

Adolescent↗
PubMed1979

Compartmentalized gastrosplenic and mesenteric venous hypertension after distal splenorenal shunt occlusion: response to mesocaval shunt and splenectomy.

This is a report of a patient with a thrombosed Warren shunt and recurrent variceal hemorrhage who demonstrated compartmentalized venous hypertension in the mesenteric and gastrosplenic systems. Although the mesenteric presssure was normalized by the construction of a mesocaval interposition shunt, the gastrosplenic venous pressure remained elevated until splenectomy was performed. Warren shunt occlusion should be considered as a cause of segmental portal hypertension. Splenectomy may be a necessary adjunct in patients suitable for reshunting.

Adult↗
PubMedDate not supplied

[Splenectomy in chronic hepatitis with an autoimmune component].

The authors present a synthesis of studies performed on the role of the spleen in chronic active-digestive hepatitis with auto-immune participation. The study was based on a group of 48 patients out of which a lot of 20 patients was selected, with histological diagnosis of chronic active and aggressive hepatitis, in whom the presence of AgAu was ascertained, as well as of antiliver antibodies. From the immunological viewpoint, the effect of splenectomy was manifested, by a rapid and significant decrease of anti-liver antibodies mainly produced by the spleen, immediately following the intervention. In most of the patients the IgM antibodies disappeared somewhat later. At the same time the chronic hepatitis lesions were stabilized, the biological signs were improved and the clinical evolution of the patients was good. The authors consider that splenectomy in this category of hepatopathies is an immuno-suppressive therapy that may arrest the evolution towards cirrhosis.

Adult↗
PubMed1979

[Diagnostic and therapeutic importance of splenectomy in patients with non-Hodgkin's lymphoma].

Whereas the contribution of exploratory laparotomy in Hodgkin's disease is well characterized, its value in Non-Hodgkin lymphoma (NHL) is not yet defined. This retrospective analysis of 31 cases is a contribution to the ongoing discussion. Laparotomy/splenectomy (LS) was done in 17 patients for diagnostic reasons and in 14 with therapeutic intent. Perioperative morbidity was low. In 17 cases the NHL had infiltrated the spleen. Indications for therapeutic LS were hemolytic anemia, pancytopenia and excessive lymphocytosis with granulocytopenia. The therapeutic benefit from splenectomy was satisfactory, especially in patients with well-differentiated lymphocytic leukemia of type CLL. In contrast, the diagnostic value of LS was minimal, except in patients with first diagnosis of NHL through LS. There was no change in tumor stage in any case. However, 4 false-negative findings contrast with the rapidly adverse course in these patients. Routine LS in patients with NHL does not appear to be justified, but has its value in NHL with primary abdominal localization. Therapeutic splenectomy is of benefit for the majority of patients, particularly those with CLL.

Female↗
PubMed1979

The effect of splenectomy on pulmonary infection in newborn mice.

Overwhelming postsplenectomy infection is a widely discussed and studied problem. The route of infection, the specific organisms involved, and the age at splenectomy and bacterial challenge are crucial factors in determining the genuine threat of the disease. We studied Staphylococcus aureus respiratory infection in 10-day-old mice who had undergone splenectomy or sham operation 7 days earlier. We did not find an increase in fatal staphylococcal pneumonitis under these conditions. Further laboratory definition of this complex issue is warranted.

Animals↗
PubMed1979

Closure of splenic bed after splenectomy in cases of huge splenomegaly.

After splenectomy, in cases where large spleens are present, a raw surface is left behind with an accumulation of serous sanguinolent material that may lead to complications. The authors report a technique to obliterate and peritonealize the splenic fossa after splenectomy for huge spleens. Twenty-one cases are reported, in which no complications from bleeding, subphrenic collections or pleuropulmonary complications were noted.

Adolescent↗
PubMed1978

[Post-splenectomy hyperthermia].

After an examination of the most important physiopathological alterations of splenectomised patients and on the basis of careful research into the literature on study and classification of post-splenectomy hyperthermia, the Authors stress the importance of infections in the genesis of such hyperthermia, until a few years ago defined as "sine causa". On the basis of the consideration that this fever is due to an infection acting on an area (the a-splenic area) which is more vulnerable as it is deprived of a certain part of the reticulo-endothelial system, it was possible to postulate and verify that such hyperthermia could arise only in patients with altered extra-splenic reticulo-endothelial system and hence does not normally occur in patients splenectomised for trauma. On the basis of extensive personal experience, the authors conclude by stressing the therapeutic principles which seem to be most suitable for management of this insidious complication of splenectomy.

Anemia, Hemolytic↗
PubMed1979

[Splenectomy. Medical and surgical indications (observations on 95 cases)].

95 splenectomies carried out at the General Surgery Division of the Busto Arsizio Circolo Hospital between 1967 and 1977 are reported. After some brief historical notes, stress is laid on those forms of primary or secondary splenopathy which are receptive to surgical intervention. Splenectomies with surgical indication (traumatic ruptures during other operations for various conditions) are distinguished from those with medical indication: Cooley, Werlhoff, Hodgkin, hair cell leukaemia, Banti. The clinical, haematological and physiopathological aspects responsible for splenic change are considered for each individual disease on the basis of personal experience.

Cysts↗
PubMed1980

Severe platelet dysfunction in hairy cell leukemia with improvement after splenectomy.

A patient with hairy cell leukemia developed purpura not attributable to thrombocytopenia. We found markedly reduced platelet aggregation responses and malondialdehyde production, decreased serotonin uptake, and depleted dense granule contents. Ultrastructural studies showed that most platelets had few or nor granules. All of the clinical and laboratory studies of platelet function and morphology improved after splenectomy. These findings indicate that qualitative defects in platelet function occurring in hairy cell leukemia may cause clinically important bleeding and that the bleeding diathesis may be ameliorated by splenectomy.

Adenosine Diphosphate↗
PubMed1982

[Fulminant infection in a splenectomized patient with Hodgkin disease. Fatal pneumococcal meningitis in a cured patient seven years after splenectomy].

Ten years ago, because of the increasing number of patients recovering from Hodgkin disease, some authors advocated systematic laparotomy with splenectomy for more accurate staging in order to adjust therapy with more precision. This attitude now seems questionable because of the occurence of several complications, particularly of life-threatening infections, which can be fatal even after recovery from Hodgkin disease. The case of a twenty-three-year-old male patient with Hodgkin disease stage III A, histological grade I, is reported. MOPP chemotherapy, splenectomy and cobalt radiotherapy were followed by complete recovery. Seven years later the patient died from fulminant pneumococcal meningitis. A review of previously published cases show that prolonged prophylaxis with oral penicillin is mandatory in splenectomized patients. Immunization with the pneumococcal polysaccharide vaccine should be attempted even though the long-term results are still unknown.

Adult↗