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PubMed2006

Splenectomy and spontaneous remission in children with chronic idiopathic thrombocytopenic purpura.

Two hundred thirty of 696 evaluable children were identified as having chronic idiopathic thrombocytopenic purpura (ITP). Splenectomy was performed in 30 (13%), achieving remission in 22 (73%). Favorable response was associated to higher initial platelet count. Spontaneous remission was achieved by 53/200 non-splenectomized patients (26.5%), up to 10 years from diagnosis. More than half of them recovered between 6th and 12th month from diagnosis. The recovery rate was significantly higher (P=0.03) in children aged<9 years (31.2%) than in older children (14.6%). No reliable factor predictive of response in individual cases is still available.

Adolescent↗
PubMed2006

Post-splenectomy antibiotic prophylaxis--unfinished story: to treat or not to treat?

Overwhelming infection in asplenic patients is a well documented occurrence in the literature. The introduction of immunization with polyvalent pneumococcal, Hemophilus Influenza and meningococcal vaccines significantly cut down the incidence of post-splenectomy sepsis and mortality. However, the issue of prophylactic antibiotic therapy in these patients remains inconclusive. There are contradictory reports bouncing between life-long treatment to no treatment. There are also more flexible approaches emerging from patient difficulties complying with a prolonged therapy. This debate calls for developing a better predictive approach based on genetic profiling of patients with different susceptibility to infectious pathogens, host-pathogens interactions as well as to identify the impact of factors such as age, on immunological competence.

Anti-Bacterial Agents↗
PubMed1985

Immunological consequences of splenectomy.

A series of reports have dealt with the occurrence of overwhelming infections in splenectomized patients. Being the largest individual organ of the phagocytic apparatus, the spleen is responsible for the phagocytosis of insufficiently opsonized particles. These are taken up by macrophages, processed, and expressed, together with determinants of the HLA system, on the membrane of the macrophage. T cells recognize these structures and proliferate in response, thus inducing a series of immunoregulatory mechanisms. The anatomic design of the spleen allows for close contact between macrophages and T cells. Thus, splenectomy represents a major intervention into the immunologic system. Splenectomized patients have been shown to have low concentrations of IgM, decreased production of antibodies directed against pneumococci and Escherichia coli, and several defects in cellular immune function, including decreased numbers of T cells and a reduction in lymphocyte proliferative responses. Thus, the removal of the spleen affects certain immunological reactions, which are reflected by a number of clinical findings.

Animals↗
PubMed1985

Immunologic status of children after splenectomy.

Fifty-six splenectomized children were reexamined to verify their immune status and were compared with a control group. Except for Werlhof's disease, there was a significantly increased serum IgG level in splenectomized children, as compared with the control group, and diminished IgA and IgM levels. Susceptibility to postoperative infections is dependent on age and underlying disease. Generally, susceptibility cannot be predicted following splenectomy in the individual case.

Adolescent↗
PubMed1992

Control of humoral and cellular immunity-mediated accelerated heart allograft rejection in sensitized rats by low dose FK 506 and splenectomy.

UNLABELLED: ACI heart grafts are rejected, at an accelerated pace, in Lewis (LEW) rats sensitized by donor-type blood admixed with immunoadjuvant (adjuvant complete Freund, ACF) 7 days earlier. In an in vitro study, the anti-ACI cytotoxic antibody titers in the serum increased from 1:4 in nonsensitized rats to 1:128 in sensitized rats; the spontaneous blastogenesis in spleen cells was higher in sensitized rats than in nonsensitized rats; spleen cells from sensitized rats showed a strong proliferative response against donor strain stimulator cells compared with the control; the cytotoxic T cell activity of spleen cells from sensitized rats was higher than that of spleen cells from nonsensitized rats. Treatment with low dose FK 506 in combination with splenectomy (Spx) synergistically prolonged the heart allograft survival in this sensitized rat model. IN CONCLUSION: (1) Both humoral and cellular responses against the donor antigen appear in the serum and in the spleen of rats sensitized by donor-type blood admixed with immunoadjuvant ACF. (2) A low dose of FK 506 together with Spx appears to control this sensitization through different mechanisms, resulting in a prolongation of heart allograft survival.

Animals↗
PubMed1996

Laparoscopic splenectomy: an evolving technique. A comparison between anterior and lateral approaches.

BACKGROUND: The success of laparoscopic cholecystectomy has favored the application of this technique in abdominal surgery. Laparoscopic splenectomy (LS) suffers from several technical problems for mobilization and manipulation of a solid organ. Lateral approach has been proposed as an alternative to the anterior approach which facilitates LS. The aim of this paper is to compare the results of LS using and anterior or lateral approach. METHODS: Between February 1993 and May 1995, 27 LS were performed (group I, Ant-LS, n: 10; group II, Lat-SL, n: 17). LS was indicated in 19 patients for treatment of an idiopathic purpura, for spherocytosis in four; for AIDS-related thrombocytopenia in two; and for autoimmune anemia and leucopenia in two. Gallstones were associated in two cases and an ovarian cyst in another. RESULTS: LS was completed in 8 patients of group I (80%) and 17 of group II (100%). Operative time (236 +/- 21 min vs 159 +/- 71 min p < 0.003), number of trocars (4.5 +/- 0.5 vs 4 +/- 0.5, p < 0.02), transfusion requirements (60 vs 17%, p < 0.04) and mean stay (6.5 +/- 3.6 days vs 4 +/- 2 days, p < 0.05) were significantly lower in the group of LS with a lateral approach. CONCLUSIONS: The lateral approach significantly facilitates the performance of LS compared with the anterior approach.

Adult↗
PubMed1996

Laparoscopic splenectomy in the management of hematological diseases. Surgical technique and outcome of 17 patients.

After being successfully applied to other intraabdominal organs, the laparoscopic approach has been applied to the spleen since 1991. The experience with 17 cases of laparoscopic splenectomy performed due to immune thrombocytopenia purpura (10 instances), hereditary spherocytosis (2 cases), and Hodgkin's disease where the staging was done according to Standford (5 cases), have been reported. With the patient in anti-Trendelenburg position, and the surgeon between the patient's legs, four or five trocars are introduced into the upper abdominal quadrants and the spleen hilum is isolated. Hilar vessels are dissected and ligated with a surgical stapler. A plastic bag is introduced into the abdomen cavity and the spleen is slipped inside; it is then extracted through an umbilical incision after morcellation. Advantages of the open operation include a decrease in postoperative pain, a decrease in pulmonary sequelae, a reduced incidence of subphnic abscesses, and cosmetic advantages. The decrease of postoperative sequelae reduces hospitalization and costs, which are higher for the operation itself (materials and staff's training).

Adult↗
PubMed1986

Scintigraphic assessment of ectopic splenic tissue localization and function following splenectomy for trauma.

Twenty-three subjects who had a splenectomy as a result of trauma underwent scintigraphic evaluation with a sensitive heat-denatured 99mTc-labeled red blood cells (DRBC). This method enabled detection of ectopic splenic tissue foci (ESTF) as small as 1 X 1 cm in diameter. ESTF splenosis or accessory spleen was detected in 15 cases (65%), a higher incidence than previously reported. The size of the ESTF ranged from 1 X 1 to 5 X 10 cm (0.8-40 cm2), and 53% were less than 2 X 2 cma (3 cm2). A new multiparametric scintigraphic evaluating technique is described, which estimates the quantity of ESTF and its grade of activity, relative to that of the liver. The technique is a highly efficient assessor of ESTF function. Good correlation was found between the size and activity of the ESTF and the presence of Howell-Jolly bodies (HJB), but with a low sensitivity for detecting small ESTF. Correlation was low between residual splenic tissue and concentrations of IgM, IgA and IgG immunoglobulins. The 99mTc-DRBC method described is recommended for verification of ESTF existence, localization, and function.

Adult↗
PubMed1981

Immunological changes following posttraumatic splenectomy.

In 31 splenectomized individuals blood lymphocytes and serum immunoglobulins were examined 1-11 years after splenectomy. The results demonstrate: 1. Increase of the surface immunoglobulin bearing lymphocytes. 2. Reduction of the E-rosette forming lymphocytes, especially in a combined test assay. 3. Reduction of serum IgM. A surface-restoring effect of the RES of the spleen is discussed as a reason for the diminished E-rosette formation in splenectomized individuals.

Adolescent↗
PubMed1984

Plasma fibronectin (Fn) study in homozygous beta-thalassemia: relation to splenectomy and transfusion.

The concentration of plasma Fn was determined in non-splenectomized and splenectomized patients with homozygous beta-thalassemia, before and 7-10 days after blood transfusion. The mean Fn concentration of non-splenectomized patients before transfusion did not differ from that of matched normal controls but appeared significantly decreased following blood transfusion. On the other hand, in splenectomized thalassemics, Fn levels were increased but were unrelated to transfusion. It is concluded that Fn plays some homeostatic function when RES activity of thalassemic patients is altered either as a result of splenectomy or blood transfusion.

Adolescent↗
PubMed1988

Glucuronyl transferase deficiency and mild hereditary spherocytosis: effect of splenectomy.

In a 6-year-old girl an association of hereditary spherocytosis and a defect in hepatic bilirubin metabolism has been found. The patient suffered from mild compensated haemolytic anaemia and excessive hyperbilirubinaemia (maximum concentration 581 mumol/l), the serum activity of liver enzymes was slightly increased. Examination of the erythrocyte membrane proteins revealed a deficiency of the major membrane skeletal protein, spectrin (about 75% of normal) which is probably the basic genetic defect of hereditary spherocytosis. Examination of the patient's family revealed a recessive mode of inheritance. The concentration of bilirubin conjugates in the patient's serum was decreased due to a reduced UDP-glucuronyl transferase activity found in homogenates of liver tissue. Histological liver examination showed an intrahepatic cholestasis, which is a secondary and reversible alteration resulting from severe hyperbilirubinaemia. After splenectomy, normalization of the increased haemolysis and hepatic dysfunction was observed. The excessive hyperbilirubinaemia can be explained by the association of an increased bilirubin load due to haemolytic anaemia and the diminished hepatic conjugation of bilirubin.

Anemia, Hemolytic↗
PubMed1976

[Postoperative changes in immunoglobulin-concentrations after splenectomy. A prospective survey series (author's transl)].

The three immunoglobulin classes A, G and M were quantitatively determined through immune diffusion preoperatively as well as in the first 60 days in 31 patients after splenectomy and the results were statistically evaluated. In comparison with the initial preoperative values, a temporary, significant elevation of the serum concentration of the IgA and IgG was found, whereby the IgA concentration on the 60th postoperative day corresponded already to the preoperative initial values, whilst the IgG were at this time still significantly elevated. There was a beginning significant decrease in serum concentration of the IgM between the 15th and 20th postoperative day, which was very pronounced on the 60th day. This determination coincides with the half-life time of the IgM and can be regarded as an indication for a localisation of the IgM producing cells in the spleen.

Female↗
PubMed1989

[Splenectomy in idiopathic thrombocytopenic purpura].

In the period between 1978 to 1987 16 female and 11 male patients with a median age of 35 years (range: 14 years to 85 years) underwent splenectomy for ITP. There was no lethality in the postoperative period. 77.8% of all patients are in a complete remission, only 22.2% showed a recurrence and need further conservative therapy.

Adolescent↗
PubMed1986

[Indications for splenectomy in non-malignant systemic diseases].

The benign systemic disorders with involvement of the spleen are divided into haematologic diseases, thesaurismosis, collagenosis, morbus Boeck, infectious diseases, parasitosis and others. 4/5 of the cases are haematologic diseases of the erythrocytic, the thrombocytic and lymphatic system as well as myeloproliferative and aplastic syndromes. 227 of 1214 splenectomies of the last 20 years were done in benign systemic diseases. The functional and mechanical hypersplenism as a rule is the cause for operation. The specific indications, the medical pretreatment and the combination of surgery and non-surgical measures are discussed.

Collagen Diseases↗
PubMed1987

Noncirrhotic portal hypertension due to lymphoma. Reversal following splenectomy.

We report a case of bleeding esophageal varices associated with lymphoma. Splenectomy alone reversed the patient's portal hypertension as assessed hemodynamically and clinically. Mechanisms leading to portal hypertension in the setting of splenomegaly from hematologic disorders are discussed. An approach to operative management of these patients, based on preoperative hemodynamic measurements, is suggested for future consideration.

Aged↗
PubMed1975

[Quantitative behavior of immunoglobulins in Hodgkin patients following splenectomy].

The values of immunoglobulins in 14 patients with malignant lymphoma were determined before and 1 to 44 weeks following splenectomy. The IgM-fraction showed a significant decrease in all cases, whereas the IgG- and IgA-fraction showed no change in its concentrations. The reason for the IgM-decrease is probably due to the absence of IgM-producing cells in the spleen.

Adolescent↗
PubMed1981

[Alterations of humoral and cellular immunity after splenectomy (author's transl)].

In twenty-seven splenectomized patients, who had undergone splenectomy for trauma (n=13) and thirty-one immunologically healthy persons, matched for age and sex, the following immunological parameters were examined: Serum immunoglobulins M, A, G, D and E, complement factors C3, C4 and the serum haemolytic complement activity (Ch 50), as well as the ratio and in vitro reagibility of B-and T-lymphocytes measured by transformation responses to the non-specific mitogens Phytohämagglutinin, Concanavalin A and Pokeweed-Mitogen. The phagocytic capacity of polymorphonuclear neutrophils was tested by the Nitroblue tetrazolium test. Total peripheral lymphocytes, B- und T-lymphocytes from splenectomized patients were significantly higher than in healthy controls (p less than 0.01). The PHA response in splenectomized patients was significantly depressed (p less than 0.01) as compared to nonsplenectomized controls. Also IgM serum concentration was found to be significantly lower in these patients (p less than 0.01). No differences were observed between patients, who had been splenectomized 7 months to 5 years or 6 to 14 years ago. The comparison of persons splenectomized for traumatological or haematological disorders showed statistically no significant differences. The importance of the spleen for the primary immune response is discussed.

Adolescent↗
PubMed1985

CT evaluation of pancreatic injury following splenectomy.

A fluid collection in the left subphrenic space immediately after splenectomy is often associated with pancreatic injury. The configuration, location, and vascular supply of the tail of the pancreas explain this postoperative complication. Depending on the degree of injury, the CT findings may show swelling of the tail of the pancreas, ill-defined fluid collections, or a well-encapsulated pancreatic pseudocyst. The diagnosis is confirmed by percutaneous aspiration with amylase determinations and the demonstration of a pancreatic fistula. Failure to diagnose this complication promptly may lead to a protracted postoperative clinical course and the development of a subphrenic abscess or a pancreatic pseudocyst.

Adult↗