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PubMed2000

Laparoscopic splenectomies for idiopathic thrombocytopenic purpura: experience of sixty cases.

We performed a laparoscopic splenectomy (LS) in 60 patients (age 9-83, 45 females) with idiopathic thrombocytopenic purpura (ITP) who did not achieve sustained remission on steroid therapy. Using a modified procedure, the mean duration of LS was 78 min (range 25-240 min) and surgery was associated with only 5% major and 5% minor complications. Ten patients had a platelet count less than 50 x 10(9)/l during surgery despite the administration of immune globulin (0.4 g/kg x 3-5 days) or pulsed oral dexamethasone (40 mg/day x 4 days). Three patients were refractory to these therapies and underwent LS with a platelet count less than 5 x 10(9)/l. Bleeding complications during or after surgery were rare (5%). Accessory spleens were removed in eight patients. Convalescence was rapid and the mean hospital stay was 2.3 days (range 1-7 days). The patients were followed for a mean of 16 months (range 1-36 months), and 49 patients (84%) are in complete remission. Seven patients (12.5%) relapsed despite an initial good response in 6 of them. Two patients underwent laparoscopic removal of accessory spleens with excellent response. We conclude that LS for ITP is safe and effective and associated with low morbidity and fast recovery. Thus, LS may be considered earlier in the course of ITP.

Adolescent↗
PubMed1976

Effects of nitrogen mustard and splenectomy on mouse bone marrow colony formation in vitro.

Improved tolerance of splenectomized patients with Hodgkin's disease (HD) to radiotherapy and chemotherapy has been reported. The present study was undertaken to determine the effects of splenectomy and nitrogen mustard (NM) on colony-forming cells (CFC's) of bone marrow cells obtained from CF1 male mice by in bitro agar-gel technique. Splenectomized mice were given NM intraperitoneally on day 11. On day 15, they were sacrificed and the bone marrow was cultured with a source of colony-stimulating factor (CSF). Spleen extract was prepared by grinding spleens from CF1 mice. On the eighth day of incubation, significantly higher numbers of CFC's were found in splenectomized animals at 1% confidence level (F Test) compared with the nonsplenectomized animals. Both splenectomized and non-splenectomized mice had a greater colony response after NM (at 5% confidence level) than saline-treated controls. Maximum numbers of colonies were obtained in the nustard-treated asplenic animals. Splenic extract, as well as extracts from other organs, when added to the culture plates resulted in inhibition of colony formation. The significance of in vitro inhibition after addition of organ extract is uncertain.

Animals↗
PubMed1976

Hemangiosarcoma of liver and spleen treated by hepatic artery ligation, intraportal infusion chemotherapy, and splenectomy.

Hepatic artery ligation is useful as a palliation of irressectable hepatic tumors, but does not always produce a satisfactory result. Hepatic tumor with high vascularity is expected to respond more favorably. In this context, primary liver cell carcinoma and carcinoid tumor or leiomyosarcoma of the liver have been satistfactorily treated by hepatic artery ligation. A case is presented of hemangiosarcoma of theliver and spleen treated effectively by hepatic artery ligation, splenectomy, and postoperative intraportal infusion of 5-fluorouracil, as indicated by the regression of hepatic tumors on postoperative scanning and arteriograpms.

Adult↗
PubMed1980

Polymorphonuclear neutrophil function in malignant lymphomas and effects of splenectomy.

Granulocyte (PMN) directional locomotion (migration) in vitro and in vivo, resting nitroblue tetrazolium (NBT)-reduction and adherence to nylon wool of polymorphonuclear neutrophils (PMN) were assayed in 7 patients with Hodgkin's disease (HD) and in 11 patients with non-Hodgkin's lymphoma (NHL) prior to therapy. In most patients with HD, NBT-reduction was increased and in all directional locomotion was markedly decreased both in vitro and in vivo. In addition to being depressed, accumulation of PMN into skin chambers in patients with HD correlated with the peripheral blood count (r = 0.95). In vitro directional migration of PMN in NHL was depressed in half the patients, but increased in the in vivo assay. After splenectomy, PMN-adherence tended to increase and NBT-reduction to decrease. These findings are compatible with a constant cellular defect of PMN in HD, whereas in NHL abnormal PMN function is more likely mediated by extracellular factors. Abnormal PMN function may correlate with clinical susceptibility to infection in malignant lymphomas.

Adult↗
PubMed2005

Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count.

Laparoscopic splenectomy (LS) is now performed routinely in patients with idiopathic thrombocytopenic purpura (ITP) refractory to the medical treatment. Low preoperative platelet count was deemed to be a contraindication for a laparoscopic approach; however, there is no data reporting the outcome in those patients. We aimed to evaluate the influence of the preoperative platelet count on the operative and postoperative course and complication rate. Retrospective cohort study that was conducted in tertiary care university-affiliated medical center and included 110 consecutive patients who underwent LS. All patients were divided into three groups by their preoperative platelet counts: 50 x 10(9)/L (n = 80). The outcome and the influence of preoperative factors predictive of complications, blood transfusion, and length of stay were compared between the groups. Patients with a platelet count of 20 x 10(9)/L before surgery. Patients with counts >20 x 10(9)/L can safely undergo LS.

Blood Transfusion↗
PubMed1976

Idiopathic thrombocytopenic purpura in Hodgkin's disease after splenectomy.

This is a report of a patient with Hodgkin's disease who underwent a staging splenectomy and extensive radiation therapy and then developed "idiopathic" thrombocytopenic purpura. This appears to be the second known instance of such a combination of events. The patient was in complete remission of his Hodgkin's disease from radiation therapy at the time and continues in remission 56 mo since completing therapy. There was a complete and, apparently, permanent response of the thrombocytopenic purpura to a course of corticosteroid therapy.

Adult↗
PubMed1976

Staging laparotomy and splenectomy: treatment and complications of Hodgkin's disease in children.

Twenty-five cases of hodgkin's Disease (15 males and 10 females) aged 5 to 17 years were studied from April 1970 to July 1976 (75 month period). Histology revealed that 2 had lymphocytic predominance, 12 had nodular sclerosis, and 11 had mixed cellularity. Pathologic staging revealed that 3 were IA, 1 IB, 5 IIA, 4IIB, 6IIIA, and 6 IIIB. Laparotomy altered the staging in 12 patients (9 were staging up and 3 down). All but 2 patients received extended field radiation, and 5 had recurrence of disease and were treated with combination chemotherapy. Twenty-three are alive without evidence of disease (21-75 months), and the 2 deaths were not due to Hodgkin's Disease but to hemobilia (postliver biopsy) and penumococcal septicemia, purpura fulminans, and disseminated intravascular coagulation (14 months postsplenectomy). Other complications included 2 patients with intestinal obstruction, 1 with postoperative subphrenic abscess, and 1 with streptococcal septicemia and polyarthritis. Nineteen patients received continuous penicillin prophylaxis postoperatively and the 2 with serious infections were amongst the 6 who had not received penicillin or whose penicillin had been discontinued at the time of infection. It is concluded that laparotomy and splenectomy in children is essential for accurate staging but carries significant risk, and continuous penicillin prophylaxis is recommended.

Adolescent↗
PubMed1984

Disappearance of microspherocytes in peripheral circulation and normalization of decreased lipids in plasma and in red cells of patients with hereditary spherocytosis after splenectomy.

A possible mechanism of the formation of microspherocytosis in unsplenectomized patients with hereditary spherocytosis (HS) was investigated in relation to lipid metabolism in plasma and in red cells of these patients. Plasma lipids (total cholesterol, free cholesterol, high density lipoprotein cholesterol, free fatty acids, and phospholipids) were markedly reduced in unsplenectomized HS patients with microspherocytosis. Red cell membrane lipids (free cholesterol and phospholipids such as phosphatidyl ethanolamine, sphingomyelin, phosphatidyl choline, and lysophosphatidyl choline) were also decreased in these unsplenectomized HS patients. After splenectomy, microspherocytosis disappeared concomitant to substantial normalization of plasma and red cell membrane lipids. These observations suggest that plasma lipid decrement in the unsplenectomized HS patients is at least one of the causative factors in pathogenesis of the formation of microspherocytosis. So-called "splenic conditioning" may not imply a physical "loss" of membrane by fragmentation or pitting of the once-formed HS red cells in the peripheral circulation. Instead, the decreased plasma lipids in the presence of the spleen may affect the de novo synthesis of red cell membrane lipids, resulting in the formation of microspherocytosis.

Adolescent↗
PubMed1980

Haemodynamic effects of splenectomy and vasoligation in bilharzial hepatic fibrosis.

Patients with bilharzial hepatic fibrosis, when compared with control subjects, were found to be hypervolaemic as a result of increased plasma volume. The estimated hepatic blood flow in these patients was not significantly different from that of healthy individuals. Splenectomy and vasoligation was followed by a drop in portal pressure measured through an omental vein at operation. The estimated hepatic blood flow, however, was not altered by this surgical procedure. The blood volume, which was found to correlate with the size of the spleen, diminished and so did the plasma volume when measured after this operation.

Adolescent↗
PubMed1982

Splenectomy and vasoligation for patients with haematemesis secondary to bilharzial hepatic fibrosis.

One hundred and thirteen patients with haematemesis secondary to bilharzial hepatic fibrosis had splenectomy and vasoligation. There were 6 deaths in the immediate and 28 in the late postoperative period. The commonest cause of death was recurrent haematemesis followed by hepatic failure. Transient jaundice, ascites and infection were common in the postoperative period. The operation improved the cellular elements of the blood but the 20 per cent incidence of recurrent bleeding is unacceptable.

Adolescent↗
PubMed1985

Intraperitoneal low-pressure suction drainage following splenectomy.

A consecutive series of 282 patients undergoing splenectomy on one surgical unit has been studied to ascertain the incidence of postoperative subphrenic abscess. Only two atypical subphrenic abscesses occurred (0.17 per cent), a rate of abscess formation much lower than that reported in other series. We believe that the use of low-pressure closed suction drainage to the splenic bed accounts for this low rate.

Amylases↗
PubMed1976

Exploratory laparotomy and splenectomy in the diagnosis of Hodgkin's disease in children.

Thirty-three children with histologically proved Hodgkin's disease underwent exploratory laparotomy with splenectomy and biopsy of lumbar lymph nodes, liver, and bone marrow. In 13 patients (39%) the lesion of spleen and/or splenic hilar lymph nodes was diagnosed. The involvement of spleen was mostly found in patients with mixed cellularity type, in the presence of systemic symptoms ("B"), and in the biological stage "b." Involvement of the liver was found in 1 patient, of the hepatic hilar lymph nodes in 3 patients, and of the bone marrow in 4 patients. The lymphographic and histologic data as regards lumbar lymph nodes coincided in 65% of cases. After operation the stage of the disease was changed in 48% patients. The early and late complications were not numerous.

Adolescent↗
PubMed1983

Effect of splenectomy on the growth of murine colon tumors.

We have previously demonstrated a high incidence of splenomegaly in BALB/c mice bearing colon tumor C-C36, but not colon tumor C-C26. To characterize this difference, tumor development in mice splenectomized seven days before tumor inoculation was compared to that of unoperated control mice. Our findings indicate that during the early phase, tumor growth is enhanced for both C-C26 and C-C36 in the splenectomized animals. The lag period for tumor appearance was also somewhat shorter in these splenectomized animals as compared to the controls, and metastatic tendency to the lungs was unaffected by splenectomy. These findings may have useful implications for the role of the spleen in the tumor-bearing animal.

Adenocarcinoma↗
PubMed1984

Ischemic necrosis of proximal gastric remnant following subtotal gastrectomy with splenectomy.

Ischemic necrosis of the gastric remnant is a rare and serious complication of high subtotal gastrectomy, rarely of the distal resection of the stomach. The authors report one case after subtotal gastrectomy with splenectomy, review the literature about this subject, and suggest that in all procedures the surgeon must take full account of the variability of gastric blood flow. Conservative therapy of this complication with total parenteral nutrition is proposed.

Adult↗
PubMed1989

Effect of splenectomy upon the growth of B16-F10 melanoma and its relation to the interferon system.

The influence of splenectomy upon the growth of B16-F10 malignant melanoma and changes in interferon-synthesizing ability in mice were studied. Surgical stress alone temporarily diminished the ability of mice to respond to interferon induction by poly rIrC. Two weeks following the surgery, mock-splenectomized mice fully regained their interferon synthesis ability. However, this was not true in the case of splenectomized mice. They remained refractory to interferon induction. The removal of the spleen had no obvious effect on the rate of pulmonary metastasis in mice injected with B16-F10 malignant melanoma in relation to the mock-splenectomized or control mice. Mice that were splenectomized and inoculated with B16-F10 melanoma also remained refractory to interferon induction.

Animals↗
PubMed1981

Partial splenectomy with CO2 laser: an experimental study.

A freehand carbon dioxide laser is now available for surgical procedures. A comparison of its utility with the electrocautery was carried out in five dogs by the performance of hemisplenectomy. All dogs survived without complications. The laser proved to be an effective instrument for partial splenectomy under the terms of the experiment.

Animals↗
PubMed2006

Distribution of peripheral blood cells in mice after splenectomy or autotransplantation.

Our aim was to compare the distribution changes of peripheral leukocytes and erythrocytes in splenectomized and spleen-autotransplanted BALB/c female mice (n = 96), 2 and 8 months after surgery. In total, there were eight groups of animals: splenectomy, autotransplantation, sham, and untreated controls at both time points. We used the spleen-apron method of Furka et al. (Khirurgiia (Mosk) 1989;9:125-127), inserting five spleen chips into the greater omentum, for autotransplantation. Quantitative and qualitative blood cell counts and the phagocytic activity of cells (stimulated with zymosan) were determined. In splenectomized animals, the number of neutrophils significantly increased 8 months after surgery. The greatest phagocytic activity of neutrophils, however, was observed in autotransplanted animals of the same age. In splenectomized animals, erythrocyte volumes were significantly higher in the second postoperative month, but normalized by the eighth month. In conclusion, spleen autotransplantation has some beneficial effects, including clearing erythrocytes and preserving the phagocytic activity of neutrophils in peripheral blood.

Animals↗
PubMed1980

Adriamycin and splenectomy in the treatment of histiocytic medullary reticulosis.

Histiocytic medullary reticulosis (HMR) is a rare, malignant disorder with unsatisfactory response to various chemotherapeutic agents that have been used up to the present time. The purpose of this communication is to describe the first patient with this disease in whom an immediate, complete remission was obtained using only adriamycin. Four months after institution of this treatment, a staging laparotomy and splenectomy revealed residual disease in the spleen only. Adriamycin was continued as the sole agent, to the full calculated dose, followed by maintenance therapy consisting of cyclophosphamide. The patient continues to be in complete remission 35 months after diagnosis was established.

Adolescent↗