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Results for “Splenectomy”

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PubMed1983

[Analysis of suppressor cell activities in spleen cells from gastric cancer patients and the effect of splenectomy on prognosis of gastric cancer].

In gastric cancer patients, activities of Concanavalin-A induced suppressor cells ( ConAS ) and spontaneous suppressor cells (SpS) in spleen cells (SC), peripheral blood lymphocytes (PBL) and splenic vein lymphocytes (SVL) were comparatively investigated. Suppressions by ConAS in PBL were significantly increased in patients of Stages III and IV, while suppressions by SpS were increased in patients with recurrent tumors. Elevated activities of ConAS and SpS were observed in SCs and SVLs , respectively. ConAS activities were mostly indicated in the medium sized lymphocyte fractions which were fractionated on the basis of cell size, while SpS activities in the larger sized fraction. Cell numbers in the large sized lymphocyte fraction which contained higher proportion of Tg cells and OKT8 reactive T cells, tended to increase with advances of the disease. These results suggest that spleen contained much higher proportion of suppressor precursors which might be activated to become suppressor cells with advances of the disease. Furthermore, the effect of splenectomy on the prognosis of gastric cancer was investigated in randomized controlled trial. The patients who underwent total gastrectomy and had main location of the tumor on lesser curvature region were divided into two groups at random; splenectomy (+) and splenectomy (-) groups. A suggestive prolongation of survival time was observed in splenectomy (+) group. Thus, spleen seems to contribute to the immunosuppression in gastric cancer patients and splenectomy may lead to better prognosis.

Adult↗

PubMed1983

[The tumor--immunological significance of splenectomy for cancer therapy].

In animal experiment, 5 X 10(5) MH-134 tumor cells were transplanted s.c. on the back of the C3H/He mice. Three, seven, 14 and 21 days after tumor transplantation, splenectomy or sham operation were performed and the tumor growth and survival days were examined in each group. As the results, the tumor growth was inhibited and the survival days prolonged not only in the group splenectomized three days but also 21 days after tumor transplantation. Clinically, the effect of splenectomy in combination with immunotherapy on cell-mediated immunity and the survival rates were studied in the gastric cancer patients of upper and middle stomach with 90 cases of stage III and 48 cases at stage IV, totalling 138 cases who underwent total gastrectomy during 1965 and 1981. Immunotherapy was conducted with immunomodulator levamisole at a daily dose of 150 mg, three consecutive days every other week. As a result, splenectomy was not effective for advanced gastric cancer at stage III and in the patients spleen should be retained for immunotherapy. Splenectomy for gastric cancer at stage IV, particularly in combination with immunotherapy, produced augmentation of cell-mediated immunity and longer survival as well. Complications caused by splenectomy were small.

Animals↗

PubMed1984

Splenectomy in kala-azar.

At the beginning of the century, splenectomy was used in the treatment of kala-azar, but now is rarely needed, the major indication being for drug resistant kala-azar. Inadvertent splenectomy prior to the diagnosis of kala-azar continues to occur, probably because of a reluctance to perform splenic aspiration in the investigation of splenomegaly. Five Kenyan children underwent splenectomy for drug resistant kala-azar. All were immediately improved, but one died of overwhelming post splenectomy infection (OPSI) two months later and another of a malignant lymphoma seven months after surgery. The other three patients appear to be cured. Splenectomy was considered in a sixth child with kala-azar because of a Salmonella abscess in the spleen, but the abscess ruptured catastrophically before surgery could be arranged.

Adult↗

PubMedDate not supplied

Splenectomy in chronic myeloid leukaemia. A case report and review.

We report the case of a man with chronic myeloid leukaemia, whose disease had undergone transformation and whose life was threatened. Splenectomy was performed, and two years later he is alive and well, taking no anti-leukaemic therapy. Since splenectomy he has had one severe attack of malaria, and one episode of jaundice thought to be due to viral hepatitis. He discontinued his malaria prophylaxis one year ago and has not been ill since. Splenectomy as a last resort will benefit some patients with chronic myeloid leukaemia after transformation, and elective splenectomy should be considered in the management of patients with this disease. However, final unequivocal proof of the value of elective splenectomy is still awaited.

Adult↗

PubMed1982

Splenectomy for agnogenic myeloid metaplasia.

Only a fraction of the patients with myeloid metaplasia have indications for splenectomy develop. Palliation for symptomatic splenomegaly is highly successful. Significant relief from hypersplenism, anemia or thrombocytopenia was achieved, however, in less than half of the patients. Since patients with severe thrombocytopenia are at continuing risk of spontaneous hemorrhage and of bleeding after minor trauma, splenectomy appears to be justified in these patients, provided that studies of peripheral blood and bone marrow have excluded those with leukemic conversion. The benefit obtained from splenectomy in patients with chronic anemia requiring frequent transfusions in less certain, particularly in men and in patients converting to myeloid metaplasia from polycythemia vera. In some instances, the continuation of transfusions may result in less morbidity and better palliation than operation. Although the course of this myeloproliferative disorder from first symptoms to death frequently extends for more than a decade, the manifestations which may provide an indication for splenectomy usually occur late in the course of the disease. The element as well as the morbidity of the operation makes a thorough evaluation of each patients essential before splenectomy is considered.

Adult↗

PubMed1982

[Should splenic tissue be re-implanted after splenectomy due to birth trauma?].

Splenectomy results in loss of about 1/4 of the reticulo-endothelial system and 1/3 of the lymphatic tissue. Reduced phagocytosis and "clearing" capacity are reflected in the appearance of Howell Jolly bodies, thrombocytosis and decreased circulating immune-complexes. Reduction of IgM and compensatory increase of IgG and IgA levels further indicate immunological impairment. Transitory reduction of complement activity and the number of T-lymphocytes in the first weeks post-splenectomy constitute a significant limitation of immunological function and are accompanied by low serum tuftsin levels. These factors help explain the increased susceptibility to overwhelming infection seen in splenectomized patients. The lethality rate due to sepsis has been reported to be as high as 50%. Patients with hematological disorders, with systemic malignancies and children under 4 years of age who undergo splenectomy because of abdominal trauma are at especially high risk. The most common infectious agents are Haemophilus influenzae and Pneumococcus. The present report describes 2 infants who underwent splenectomy for the treatment of splenic rupture due to birth trauma. In one case, splenic tissue was homogenized and re-implanted; in the second case, splenectomy was followed by penicillin prophylaxis. The clinical course in the latter patient was complicated by Candida meningitis.

Bacterial Infections↗

PubMed1982

Accessory splenectomy for idiopathic thrombocytopenic purpura.

Not all patients who undergo splenectomy for idiopathic thrombocytopenic purpura (ITP) respond to operation. This may be due to the presence of an accessory spleen. This is a report of three patients who underwent successful accessory splenectomy after relapse of their disease. Each patient initially experienced a complete response to splenectomy, but recurrence occurred months to years later. All of the patients had persistent Howell-Jolly bodies on peripheral blood smear, yet two of the patients had complete and sustained remissions of their disease after accessory splenectomy. Intraoperative localization of an accessory spleen may be exceedingly difficult in the patient who has undergone a previous operation. However, localization of accessory splenic tissue is greatly facilitated by use of a sterile isotopic detector probe intraoperatively after the injection of technetium-99m-labeled red blood cells. Given the morbidity and mortality rates of refractory ITP, patients who have a relapse after, or who fail to respond to, splenectomy should be evaluated for the presence of an accessory spleen, even if Howell-Jolly bodies are present on peripheral blood smear.

Adult↗

PubMed1980

Critical evaluation of prophylactic splenectomy in total gastrectomy for the stomach cancer.

In gastric cancer surgery, an extended radical operation is commonly performed, and in cases of total gastrectomy, there is a tendency to perform splenectomy at the same time. However, some surgeons have reservations regarding this treatment in connection with the possible preservation of the host resistance. The question arises, is it reasonable to accept, by simple analogy with prophylactic lymphadenectomy the concept of the prophylactic splenectomy? The present study was designed to cast light on this problem. In order to examine the value of prophylactic splenectomy in gastric cancer surgery, a comparable patient group was followed up, and it was found that the non-splenectomized group showed a significantly better late survival rate than the splenectomized group (P less than 0.005), the 4-year survival rate being 63% in the former group and 36% in the latter group. Although these results do not necessarily contraindicate combined splenectomy, it seems desirable to reappraise the value of prophylactic splenectomy in cases having no metastasis in the splenic hilar and adjacent lymph nodes.

Gastrectomy↗

PubMedDate not supplied

Decision-making in surgery: splenectomy.

Interest in splenectomy is topical because of the need to develop protocols for the prevention of overwhelming systemic infections postsplenectomy. Partial splenectomy is possible in only a few patients undergoing splenectomy for trauma. In haematological disorders, total splenectomy is mandatory. All patients who have had a total splenectomy will require vaccination and antibiotic prophylaxis.

Antibiotic Prophylaxis↗

PubMedDate not supplied

[Video-laparoscopic splenectomy: experience in 3 cases].

BACKGROUND: In selected cases the spleen can be removed: METHODS: 2 women and 1 men with immune thrombocytopenic purpura, with hypersplenism without splenomegaly, underwent splenectomy by laparoscopic means. RESULTS: In 2 cases the splenectomy has been performed entirely by laparoscopic means. In 1 case the operation has been converted as we have not been able to control a venous bleeding from injured hilar spleen vessels. DISCUSSION: No particular technical problems arose in the 2 cases entirely conducted by laparoscopic means. Care must be taken manipulating the hilar vessels as the veins are fragile and their bleeding is difficult to be controlled in laparoscopy. The laparoscopic splenectomy seems to offer less postoperative pain, shorter hospitalization and improved cosmesis according to our previous experience with open splenectomy. CONCLUSIONS: The good result of the operations encourages the laparoscopic approach to splenectomy, in selected cases.

Adolescent↗

PubMed1995

A comparison of laparoscopic versus open splenectomy in children.

Laparoscopic operative procedures are gaining wider acceptance in pediatric patients. Although laparoscopic splenectomy is being performed more frequently, no studies to date have compared this procedure with the standard open technique with respect to operative outcomes. We performed a case control study of seven laparoscopic splenectomies and 14 open splenectomies. Two-tailed t test was used to compare the two groups for mean operative time, mean hospital stay, mean interval before tolerating a regular diet, and total parenteral narcotic dose in morphine equivalents. Operative time was significantly longer in the laparoscopic group (221 minutes vs 59 minutes, P < 0.001). Hospital stay, interval before tolerating a regular diet, and postoperative narcotic dose did not differ significantly between the two groups. In the laparoscopic group, one operation was converted to an open procedure secondary to bleeding complications. Three patients required mini-laparotomies for removal of extremely large spleens after completion of the dissection. Pediatric laparoscopic splenectomy does not appear to have advantages over the traditional method with regard to operative time, hospital stay, postoperative ileus, or postoperative pain. Larger studies, including cost analysis, are needed before major proposed advantages of laparoscopic splenectomy can be accepted.

Adolescent↗

PubMed1994

Laparoscopic splenectomy: technical aspects and preliminary results.

UNLABELLED: The success of laparoscopic cholecystectomy has prompted the application of laparoscopic techniques to other abdominal procedures. Laparoscopic splenectomy poses certain specific difficulties for the control of the vascular pedicle, handling and mobilisation of a parenchymatous organ and the retrieval of the specimen. The aim of this paper is to present a technique for laparoscopic splenectomy. MATERIAL AND METHODS: Between February and October, 1993 we attempted laparoscopic splenectomy (LS) in 7 patients. Splenectomy was indicated in 5 patients for treatment of an idiopathic thrombocytopenic purpura and in two patients for treatment of hereditary microspherocytosis. One patient had concomitant cholelithiasis. RESULTS: LS was completed in 6 and converted in one patient to an open procedure due to blood from the splenic bed obscuring vision. Laparoscopic cholecystectomy and splenectomy were performed simultaneously in the patient with cholelithiasis. Three patients required transfusion of two packed cell units. In one patient, the bag broke during extraction of the spleen, and a minilaparotomy was required to remove the spleen. In one patient an accessory spleen was removed. Oral intake was started the next morning. Two patients developed pulmonary atelectasis. Analgesia requirements ranged between 2 and 10 doses, and postoperative stay ranged between 4-8 days. CONCLUSION: LS is technically feasible, and offers the functional and aesthetic advantages of laparoscopic surgery.

Adolescent↗

PubMed1994

Splenectomy following complete response to alpha interferon (IFN) therapy in patients with hairy cell leukemia (HCL): results of the HCL88 protocol. Italian Cooperative Group for the Study of Hairy Cell Leukemia (ICGHCL).

In December 1987, the Italian Cooperative Study Group for Hairy Cell Leukemia (ICGHCL) started a multicenter trial designed with the aim of investigating the possible role of splenectomy in HCL patients responding to initial treatment with a-IFN. Patients aged less than 65 years, diagnosed within 6 months, were included into the trial and treated with a-IFN (3 MU/daily) for 3 additional months after the achievement of CR or for a maximum of 12 months, regardless of the quality of the response. Patients in CR could undergo splenectomy while patients achieving PR after 12 months of treatment were randomized between splenectomy and maintenance therapy. By June, 1992, the trial closed, with 182 enrolled patients. Nine were subsequently determined to be not eligible while nine additional patients were lost at follow up. One hundred and sixty-nine patients were assessable for both response and survival. At the end of the induction therapy with a-IFN (mean time of treatment 16.9 months), 29 CR (17.7%), 100 PR (61.0%), 26 minor responses (MR) (15.8%) and 9 (5.5%) treatment failures occurred. At the last follow up (March, 1993), with a mean follow up of 39 months, 5 patients had died and the overall survival rate at 4 years was 96%. Twelve patients underwent splenectomy after CR. After a mean follow up of 8.6 months, 8 relapses occurred. Thirty-one out of 100 were randomized between splenectomy (16 cases) and maintenance therapy (15 cases). The low accrual was mostly due to the rejection of randomization by the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Laparoscopic splenectomy for congenital spherocytosis with splenomegaly: a case report.

The traditional method of splenectomy involves a 7- to 10-cm abdominal incision, with its attendant morbidity that includes sepsis. Recently, the laparoscopic technique has been adopted for splenectomy. Many surgeons still believe that laparoscopic splenectomy should be carried out only for idiopathic thrombocytopenia purpura and Hodgkin's disease with a normal-sized spleen. A 16-year-old girl with marked splenomegaly (spleen size for times normal and weighing 600 g) due to congenital spherocytosis underwent laparoscopic splenectomy and retrieval of the spleen through the umbilical trocar site. Preoperative arterial embolization was not used, and the operative blood loss was estimated to be only 250 mL. Her postoperative course was uncomplicated, and she was discharged on the 4th postoperative day. The operative technique is described and the advantages of laparoscopic splenectomy are discussed.

Adolescent↗

PubMed1994

Homozygous beta-thalassaemia: a review of patients who had splenectomy at the Royal Alexandra Hospital for Children, Sydney.

Twenty-four patients with homozygous beta-thalassaemia who had been splenectomised and currently on treatment were studied retrospectively. They were divided into two groups. Group A: who had splenectomy prior to commencement of any regular blood transfusion. The mean haemoglobin for this group rose from 5.5 gm/dl pre-splenectomy to 7.7 gm/dl post splenectomy (p < 0.001). Group B: who were on regular blood transfusion when they had their splenectomy and the mean blood transfusion requirement dropped from 317 ml/kg/yr to 230 ml/kg/yr of packed red cells following splenectomy (p < 0.001). Three patients who were on regular blood transfusion and desferrioxamine developed Yersinia enterocolitica infection. They presented with fever and signs of an acute abdomen. At laparotomy, 2 of the patients had acute appendicitis. All 3 appendices grew Yersinia enterocolitica and one patient also had a Yersinia enterocolitica septicaemia. If a patient develops fever and enteritis, desferrioxamine should be stopped temporarily and cotrimoxazole started as prophylaxis against systemic Yersiniosis. No cases of pneumoccocal sepsis was reported.

Adolescent↗

PubMed1994

[Surgical therapy of stomach cancer--indications for splenectomy in gastrectomy].

The indication for (obligatory) splenectomy in case of total gastrectomy for gastric carcinoma remains controversial. Overall, an increase of morbidity, but not of postoperative mortality following splenectomy is assumed. Among the prognostic parameters, splenectomy is not an independent indicator. The indication for splenectomy results from the depth of tumor infiltration, tumor site and pattern of lymph node metastases. In T1/2 lesions of the mid-stomach and of the antrum the spleen may be preserved, but splenectomy should be performed in all advanced tumors, carcinomas of proximal sites and infiltration of the spleen. Surgical radicality may be further increased by simultaneous left pancreatic or left upper quadrant resection.

Gastrectomy↗

PubMed1993

Splenectomy and/or bone marrow transplantation in the management of the Wiskott-Aldrich syndrome: long-term follow-up of 62 cases.

This study describes the effects of two major treatment options, splenectomy and/or bone marrow transplantation, on the natural history of the Wiskott-Aldrich (WAS) syndrome. The records of 62 patients with the WAS evaluated at the National Institutes of Health Clinical Center from 1966 to 1992 were reviewed. Nineteen patients were treated with bone marrow transplantation (BMT) and the results were largely dependent on the source of the graft. Twelve of 12 patients receiving HLA-matched sibling marrow achieved satisfactory immunologic and hematologic reconstitution. By contrast, only 2 of 7 patients receiving haploidentical, parental, or matched unrelated marrow survived more than 1 year after BMT. Thirty-nine patients who lacked suitable bone marrow donors early in their course underwent splenectomy for management of their thrombocytopenia; most received prophylactic antibiotics to minimize the risk of sepsis. Nearly all these patients achieved normal platelet counts and the rate of serious bleeding was reduced nearly sevenfold. Median survival in the untransplanted splenectomy group was 25 years, compared with less than 5 years in unsplenectomized patients. We conclude that HLA-matched sibling donor BMT is the treatment of choice for patients with WAS and that splenectomy and daily prophylactic antibiotics provide a significant survival advantage to those boys without a matched sibling donor. Splenectomy should probably be used in preference to unmatched BMT until results with alternative donor BMT significantly improve or gene therapy becomes available.

Adolescent↗

PubMed1993

Splenectomy is safe and effective in human immunodeficiency virus-related immune thrombocytopenia.

Sixty-eight patients, followed in a prospective cohort study of 185 human immunodeficiency virus (HIV)-infected patients with severe immune thrombocytopenia (platelets < 50 x 10(9)/L), underwent splenectomy, 2 to 41 months (median: 10 months) after immune thrombocytopenic purpura (ITP) was diagnosed. The mean platelet count increased from 18 x 10(9)/L to 223 x 10(9)/L with a persistent increase in 56 (82%). It also led to a significant increase of the mean CD4 cell count from 475 x 10(6)/L to 725 x 10(6)/L within a mean delay of 10 months. In the whole cohort, with a mean follow-up of 63 months (range, 6 to 126), the 5-year estimated rate for progression to acquired immunodeficiency syndrome (AIDS) was 23% (95% confidence interval [CI], 15% to 31%) and the AIDS-free survival was 69% (95% CI, 61% to 77%). To investigate the potential impact of splenectomy, a Cox's multiple regression model was used; as splenectomy was not randomly assigned, it was incorporated as a time-dependent covariate. After adjustment on the CD4 cell count, no statistically significant differences were observed between the splenectomized and the nonsplenectomized patients: AIDS progression rate (P = 0.23), survival (P = 0.64) and AIDS-free survival (P = 0.72) were not influenced by splenectomy. Splenectomy is both effective and safe in the treatment of severe, refractory ITP associated with HIV infection.

Female↗