WorldWideScience

Sample records for post splenectomy detected

  1. Post Splenectomy Outcome in β-Thalassemia.

    Science.gov (United States)

    Merchant, Rashid H; Shah, Ami R; Ahmad, Javed; Karnik, Alka; Rai, Nooralam

    2015-12-01

    To evaluate changes in annual blood transfusion requirements and complications after splenectomy in patients with β-thalassemia. Forty post-splenectomy β-thalassemic patients aged 8-33 y, receiving regular blood transfusions and chelation therapy were included and non transfusion dependant patients were excluded from this retrospective cross-sectional study. Details about their surgery, transfusion requirements, and platelet levels were recorded on a standard proforma. All patients underwent a B-mode and color-coded duplex sonography of the hepatoportal system during the study period. The average ferritin level in the year prior to the study was 4432 mcg/L (range 480-12,200 mcg/L). The annual blood transfusion requirement in the first year and 5 y post splenectomy [mean ± SD (138.41 ± 90.38 ml/kg/y); (116 ± 41.44 ml/kg/y)] were significantly different from requirements before splenectomy [(mean ± SD) 294.85 ± 226 ml/kg/y; p value splenectomy with a mean rise of 4,51,000/mm(3) (p value splenectomy. Increase in annual blood transfusion requirement should be investigated to find the cause.

  2. Medical complications following splenectomy.

    Science.gov (United States)

    Buzelé, R; Barbier, L; Sauvanet, A; Fantin, B

    2016-08-01

    Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever. Thromboembolic complications can involve both the caval system (deep-vein thrombophlebitis, pulmonary embolism) and the portal system. Portal vein thrombosis occurs more commonly in patients with myeloproliferative disease and cirrhosis. No thromboembolic prophylaxis is recommended apart from perioperative low molecular weight heparin. However, some authors choose to prescribe a short course of anti-platelet medication if the post-splenectomy patient develops significant thrombocytosis. Thrombosis of the portal or caval venous system requires prolonged warfarin anticoagulation for 3 to 6 months. Finally, some studies have suggested an increase in the long-term incidence of cancer in splenectomized patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  3. Residual tissue post splenectomy detected by splenic scintillography with erythrocytes damaged by heat

    International Nuclear Information System (INIS)

    Rivera B, B.; Garcia C, E.S.; Garcia O, J.R.

    2005-01-01

    Feminine of 26 years old with diagnostic of purple thrombocytopenic idiopathic to those 4 years of age, tried with steroids and splenectomy at 11 years old. Pathway practically asymptomatic until 4 months ago she had presented asthenia, adynamia and general uneasiness, with platelet figures of 40,000 plat/microliter. It was carried out scintillographic study with damaged erythrocytes for post surgical remainder search. Its were took two-dimensional images and tomography by single photon emission (SPECT), being knitted splenic residual in area of anatomical projection of the spleen. (Author)

  4. Management of Postoperative Complications Following Splenectomy

    Science.gov (United States)

    Qu, Yikun; Ren, Shiyan; Li, Chunmin; Qian, Songyi; Liu, Peng

    2013-01-01

    Complications of post-splenectomy, especially intra-abdominal hemorrhage can be fatal, with delayed or inadequate treatment having a high mortality rate. The objective of this study was to investigate the cause, prompt diagnosis, and outcome of the fatal complications after splenectomy with a focus on early diagnosis and management of hemorrhage after splenectomy. The medical files of patients who underwent splenectomy between January 1990 and March 2011 were reviewed retrospectively. The cause, characteristics, management, and outcome in patients with post-splenectomy hemorrhage were analyzed. Fourteen of 604 patients (1.19%) undergoing splenectomy had intraperitoneal hemorrhage: reoperation was performed in 13 patients, and 3 patients died after reoperation, giving the hospital a mortality rate of 21.43%; whereas, 590 of 604 patients (98%) had no hemorrhage following splenectomy, and the mortality rate (0.34%) in this group was significantly lower (P splenectomy, including pneumonia pancreatitis, gastric fistula, gastric flatulence, and thrombocytosis, in patients with postoperative hemorrhage were significantly higher than those without hemorrhage (P splenectomy, 14 patients with post-splenectomy hemorrhage were grouped into two groups: splenic trauma (n = 9, group I) and portal hypertension (n = 5, group II). The median interval between splenectomy and diagnosis of hemorrhage was 15.5 hours (range, 7.25–19.5 hours). No differences were found between groups I and II in terms of incidence of postoperative hemorrhage, time of hemorrhage after splenectomy, volume of hemorrhage, and mortality of hemorrhage, except transfusion. Intra-abdominal hemorrhage after splenectomy is associated with higher hospital mortality rate and complications. Early massive intraperitoneal hemorrhage is often preceded by earlier sentinel bleeding; careful clinical inquiry and ultrasonography are the mainstays of early diagnosis. PMID:23438277

  5. Adherence to vaccination guidelines post splenectomy: A five year follow up study.

    Science.gov (United States)

    Boam, Tristan; Sellars, Peter; Isherwood, John; Hollobone, Chloe; Pollard, Cristina; Lloyd, David M; Dennison, Ashley R; Garcea, Giuseppe

    Following a splenectomy patients are at increased risk of significant infections. In its most severe form, overwhelming post-splenectomy infection (OPSI) has a mortality rate of up to 80%. In this study we aim to establish the adherence to vaccination and antibiotic national guidelines in splenectomised patients. A retrospective study of 100 patients who underwent splenectomy (21 emergency, 79 elective), in two teaching hospitals was undertaken over a five-year period. Patients were followed up for five years. Hospital and GP records were reviewed for adherence to pre, intra and postoperative vaccination, thromboprophylaxis and antibiotic guidance. Eighty-six eligible patients (91.5%) received their Haemophilus influenzae B, meningococcal C and pneumococcus vaccinations peri-operatively. Eighty-one (86%) received post-operative antibiotics. Ninety-nine percent of patients received thromboprophylaxis treatment. Eighty-nine (95%) were treated with long-term antibiotic prophylaxis. Only 20 patients (23%) had an emergency supply of antibiotics. Ninety-five percent of patients were administered an annual influenza vaccination and 84% of eligible patients received a five-year pneumococcal booster vaccination. Improvement in the management of this patient cohort can be achieved by a multidisciplinary approach involving adherence to national guidelines, standardised trust protocols, patient information leaflets and advice detailing risk of infection, standardised GP letters and a splenectomy register to monitor and manage this vulnerable group of patients. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Post-splenectomy β-amyloid level changes in Rabbit

    International Nuclear Information System (INIS)

    Ji Xueli; Yu Jiwei; Ji Zhe; Zhou Zhengzhong

    2002-01-01

    Objective: To study the effect of splenectomy on serum β-amyloid (Aβ) levels in rabbit. Methods: Thirty 3yr-old rabbits underwent splenectomy and fifteen others underwent a sham-operation of laparectomy only. Serum Aβ levels were determined with RIA before and at regular intervals after operation. Results: In the splenectomy group, the Aβ levels were increased greatly after the operation and reached the peak at 5 th week. The levels then gradually declined but remained significantly higher than the pre-operative value at 6 th month. In the sham operation group, the value was no drastically changed but increased slowly (as an aging process). Conclusion: Splenectomy in rabbit would markedly increase the serum Aβ level, possibly due to a hypoimmune state impairing clearance of the substance

  7. The value of prophylactic vaccinations and antibiotic treatment in post-splenectomy patients: a review

    Directory of Open Access Journals (Sweden)

    Lammers AJ

    2012-06-01

    Full Text Available AJ Jolanda LammersDepartment of Infectious diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The NetherlandsAbstract: Although spleen preservation surgery and non-operative management are first-line treatment options, total splenectomy is frequently performed. Splenectomy is performed for a number of indications including idiopathic thrombocytopenic purpura, high-energetic trauma, and hematological malignancy. Following splenectomy, patients are at risk for overwhelming post-splenectomy infection (OPSI, a syndrome that presents with mild symptoms at onset but irreversible multi-organ-failure occurs within hours to days. Since the spleen plays an important role in the immune response to polysaccharide antigens, encapsulated bacteria such as pneumococci are the most frequently described causative organisms of OPSI. Although the incidence of OPSI is low, the associated mortality is reported to be as high as 80%. Because of the overwhelming and frequently irreversible nature of this syndrome, prophylactic measures to prevent OPSI have been recommended. These recommendations include vaccination, use of antibiotics, and continuous patient education. After splenectomy, patients should receive immunizations against the encapsulated bacteria S. pneumoniae, H. influenza, and N. meningitidis. Antibiotic therapy should include prophylaxis as well as “on-demand” antibiotics when infection is suspected. Importantly, patients should receive ongoing education regarding the risks associated with asplenia and precautions to take when infection occurs and when traveling.Keywords: S. pneumoniae, sepsis, splenectomy, vaccination

  8. Era of liver transplantation: combined anatomic splenectomy and anticoagulant therapy in prevention of portal vein thrombosis after splenectomy.

    Science.gov (United States)

    Hongwei, Chen; Zhang, Liang; Maoping, Li; Yong, Zhang; Chengyou, Du; Dewei, Li

    2015-01-01

    Portal vein thrombosis (PVT) is a common complication following splenectomy in patients with liver cirrhosis and portal hypertension, which also brings difficulties to future possible liver transplantation. This paper retrospectively analyzes the preventive effect of combined anatomic splenectomy and early anticoagulant therapy on post-splenectomy portal vein thrombosis in patients with portal hypertension. We retrospectively analyzed 136 patients who underwent splenectomy at our hospital between January 2010 and December 2013 due to liver cirrhosis and portal hypertension. Patient conditions, such as coagulation function, splenic and portal vein thrombosis, intra-abdominal hemorrhage, pancreatic leakage and intra-abdominal infections, are observed postoperatively. Despite the presence of liver cirrhosis and portal hypertension in patients, early postoperative anticoagulant therapy has no significant impact on coagulation function and intra-abdominal hemorrhage of these patients (p > 0.05). Anatomic splenectomy can reduce the occurrence of complications such as postoperative bleeding, pancreatic leakage and intra-abdominal infections (p splenectomy and early postoperative anticoagulant therapy can reduce post-splenectomy portal vein thrombosis in patients with portal hypertension, and is conducive to the future liver transplantation therapy may be needed by the patients.

  9. Short-term effects of splenectomy on serum fibrosis indexes in liver cirrhosis patients.

    Science.gov (United States)

    Kong, Degang; Chen, Xiuli; Lu, Shichun; Guo, Qingliang; Lai, Wei; Wu, Jushan; Lin, Dongdong; Zeng, Daobing; Duan, Binwei; Jiang, Tao; Cao, Jilei

    2015-01-01

    To determine the changing patterns of 4 liver fibrosis markers pre and post splenectomy (combined with pericardial devascularization [PCDV]) and to examine the short-term effects of splenectomy on liver fibrosis. Four liver fibrosis markers of 39 liver cirrhosis patients were examined pre, immediately post, 2 days post, and 1 week post (15 cases) splenectomy (combined with PCDV). The laminin (LN) level decreased immediately post surgery compared with the preoperative LN level (P splenectomy showed characteristic changes, splenectomy may transiently initiate the degradation process of liver fibrosis.

  10. Determinants of splenectomy in splenic injuries following blunt ...

    African Journals Online (AJOL)

    Introduction. The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic ...

  11. Splenectomy before adult liver transplantation: a retrospective study.

    Science.gov (United States)

    Kong, LingXiang; Li, Ming; Li, Lei; Jiang, Li; Yang, Jiayin; Yan, Lvnan

    2017-04-20

    A considerable number of patients with portal hypertension (PHT) have to undergo splenectomy because they do not meet the requirements for liver transplantation (LT) or cannot find a suitable liver donor. However, it is not known whether pre-transplantation splenectomy may create occult difficulties for patients who require LT in future. We analyzed 1059 consecutive patients who underwent adult liver transplantation (ADLT). Patients with pre-transplantation splenectomy Sp(+) and without splenectomy Sp(-) were compared using a propensity score analysis to create the best match between groups. There were no differences between patients in group Sp(+) and group Sp(-) with respect to the main post-operative infections (12.20% vs. 15.85%, P = 0.455), and the incidence of major complications (6.10% vs. 10.98%, P = 0.264). The post-operative platelet count was significantly higher in group Sp(+) (P = 0.041), while group Sp(-) had a higher rate of post-operative thrombocytopenia (91.46% vs. 74.39%, P = 0.006) and early allograft dysfunction (EAD) (23.20% vs. 10.98%, P = 0.038). The 5-year overall survival rates were similar in groups Sp(-) and Sp(+) (69.7% vs. 67.6%, P = 0.701). Compared with Sp(-), the risk of infection and post-operative complications in group Sp(+) was not increased, while group Sp(-) had a higher rate of post-operative EAD. Moreover, pre-transplantation splenectomy is very effective for the prevention of thrombocytopenia after LT. Pre-transplantation splenectomy is recommended in cases with risky PHT patients without appropriate source of liver for LT.

  12. Splenectomy for Children With Thalassemia: Total or Partial Splenectomy, Open or Laparoscopic Splenectomy.

    Science.gov (United States)

    Al-Salem, Ahmed H

    2016-01-01

    Splenomegaly and hypersplenism are common complications among children with thalassemia necessitating splenectomy. Thirty-six children (27 β-thalassemia major, 3 Hb H disease, and 6 thalassemia intermediate) had total splenectomy (11 laparoscopic and 13 open splenectomy) or partial splenectomy (12 patients). In the partial splenectomy group, 2 with Hb H required no transfusions. For those with β-thalassemia major who had partial splenectomy (9 patients), there was a reduction in the number of transfusions from a preoperative mean of 15.2 transfusions per year to a postoperative mean of 8.2 transfusions per year. Subsequently and as a result of increase in the size of splenic remnant, their transfusions increased, but none required total splenectomy. Twenty-four patients had total splenectomy (13 open and 11 laparoscopic splenectomy). Their postsplenectomy transfusions decreased from a preoperative mean of 17.8 transfusions per year to a postoperative mean of 10 transfusions per year. There was no mortality, and none developed postoperative sepsis or thrombotic complications. Total splenectomy is beneficial for children with β-thalassemia major and hypersplenism by reducing their transfusion requirements. Laparoscopic splenectomy is however more beneficial. Partial splenectomy reduces their transfusion requirements, but only as a temporary measure, and so it is recommended for children younger than 5 years of age.

  13. Splenectomy Versus Sham Splenectomy in a Swine Model of Controlled Hemorrhagic Shock.

    Science.gov (United States)

    Boysen, Søren R; Caulkett, Nigel A; Brookfield, Caroline E; Warren, Amy; Pang, Jessica M

    2016-10-01

    Splenectomy is controversial in acute hemorrhagic shock models. To compare splenectomized (SP) versus sham-splenectomized (SSP) swine during acute controlled hemorrhage. Twenty-six male Landrace White swine (mean body weight ± standard deviation, 33.8 ± 2.9 kg) were used. Ethics approval was obtained. Landrace swine underwent splenectomy (n = 13) or sham-splenectomy (n = 13), were bled to mean arterial blood pressure (MAP) of 40 mm Hg, which was held for 60 min, given 125 mL IV RescueFlow, held for a further 60 min, given whole blood, and held for a final 60 min. Tissue oxygen saturation, thromboelastography, oncotic pressure, urine volume and specific gravity, complete blood count, serum chemistry, body temperature, hematocrit, total solids, arterial and mixed venous blood gas, bispectral index, SAP, MAP, DAP, cardiac index, total blood volume (TBV) removed and returned, rate of hemorrhage and transfusion, spleen weight, heart rate (HR), arterial pH, lactate, PaO2, PaCO2, respiratory rate, cranial mesenteric and renal artery blood flow were recorded. Groups were compared using two-way ANOVA with post hoc Bonferroni (P splenectomy for the duration of the experiment (P splenectomy (P Splenectomy likely accounts for the transient increase in hematocrit and the higher HR in SP swine prior to hemorrhage, and the differences in TBV removed between the two groups during hemorrhage. With a fixed end point model using a moderate rate of acute hemorrhage and an MAP of 40 mm Hg, splenectomy is not necessary and may confound results.

  14. Postoperative infection risk after splenectomy: A prospective cohort study.

    Science.gov (United States)

    Barmparas, Galinos; Lamb, Alexander W; Lee, Debora; Nguyen, Brandon; Eng, Jamie; Bloom, Matthew B; Ley, Eric J

    2015-05-01

    Splenectomy is associated with a life-long risk for overwhelming infections. The risk for early post-operative infectious complications following traumatic and elective splenectomy is, however, understudied. This investigation aimed to determine if splenectomy increases the risk for post-operative infections. This was a retrospective review of prospectively collected data on patients admitted to the surgical intensive care unit (SICU) between 1/2011 and 7/2013 investigating the risk for infectious complications in patients undergoing a splenectomy compared with those undergoing any other abdominal surgery. During the 30-month study period, a total of 1884 patients were admitted to the SICU. Of those, 33 (2%) had a splenectomy and 493 (26%) had an abdominal surgery. The two groups were well balanced for age, APACHE IV score >20, and past medical history, including diabetes mellitus, cardiac history, renal failure or immunosuppression. Patients undergoing splenectomy were more likely to have sustained a traumatic injury (30% vs. 7%, p splenectomy was associated with increased risk for infectious complications (49% vs. 29%, Adjusted Odds Ratio (AOR) [95% CI]: 2.7 [1.3, 5.6], p = 0.01), including intra-abdominal abscess (9% vs. 3%, AOR [95% CI]: 4.3 [1.1, 16.2], p = 0.03). On a subgroup analysis, there were no differences between traumatic and elective splenectomy with regards to overall infectious complications (50% vs. 46%, p = 0.84), although, abdominal abscess developed only in those who had an elective splenectomy (0% vs. 12%, p = 0.55). Splenectomy increases the risk for post-operative infectious complications. Further studies identifying strategies to decrease the associated morbidity are necessary. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  15. A case report with atypical liver-spleen scan after splenectomy

    International Nuclear Information System (INIS)

    Gokcora, N.; Ilgin, N.; Basaklar, C.

    1992-01-01

    Remodeling of the liver following splenectomy may simulate hypertrophy of an accessory spleen on sulphur colloid scans. There are but a few reports about the persistent splenic activity as a prominent finding during the post-splenectomy period. Splenic simulation may be attributed to the unusual hepatic lobe displacement, as in this case. The clinician should be aware of possible splenic simulation in the post-splenectomy period, if hypersplenism is suspected

  16. Splenectomy is associated with higher infection and pneumonia rates among trauma laparotomy patients.

    Science.gov (United States)

    Fair, Kelly A; Connelly, Christopher R; Hart, Kyle D; Schreiber, Martin A; Watters, Jennifer M

    2017-05-01

    Splenectomy increases lifetime risk of thromboembolism (VTE) and is associated with long-term infectious complications, primarily, overwhelming post-splenectomy infection (OPSI). Our objective was to evaluate risk of VTE and infection at index hospitalization post-splenectomy. Retrospective review of all patients who received a laparotomy in the NTDB. Propensity score matching for splenectomy was performed, based on ISS, abdominal abbreviated injury score >3, GCS, sex and mechanism. Major complications, VTE, and infection rates were compared. Multiple logistic regression models were utilized to evaluate splenectomy-associated complications. 93,221 laparotomies were performed and 17% underwent splenectomy. Multiple logistic regression models did not demonstrate an association between splenectomy and major complications (OR 0.96, 95% CI 0.91-1.03, p = 0.25) or VTE (OR 1.05, 95% CI 0.96-1.14, p = 0.33). Splenectomy was independently associated with infection (OR 1.07, 95% CI 1.00-1.14, p = 0.045). Subgroup analysis of patients with infection demonstrated that splenectomy was most strongly associated with pneumonia (OR 1.41, 95% CI 1.26-1.57, p Splenectomy is not associated with higher overall complication or VTE rates during index hospitalization. However, splenectomy is associated with a higher rate of pneumonia. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Outcomes following splenectomy in patients with myeloid neoplasms.

    Science.gov (United States)

    Rialon, Kristy L; Speicher, Paul J; Ceppa, Eugene P; Rendell, Victoria R; Vaslef, Steven N; Beaven, Anne; Tyler, Douglas S; Blazer, Dan G

    2015-03-15

    Myeloid neoplasms are classified into five major categories. These patients may develop splenomegaly and require splenectomy to alleviate mechanical symptoms, to ameliorate transfusion-dependent cytopenias, or to enhance stem cell transplantation. The objective of this study was to determine which clinical variables significantly impacted morbidity, mortality, and survival in patients with myeloid neoplasms undergoing splenectomy, and to determine if operative outcomes have improved over time. The records of all patients with myeloid neoplasms undergoing splenectomy from 1993 to 2010 were retrospectively reviewed. Eighty-nine patients (n = 89) underwent splenectomy for myeloid neoplasms. Over half of patients who had symptoms preoperatively had resolution of their symptoms post-splenectomy. The morbidity rate was 38%, with the most common complications being bleeding (14%) or infection (20%). Thirty-day mortality rate was 18% and median survival after splenectomy was 278 days. Decreased survival was associated with a diagnosis of myelodysplastic syndrome/myeloproliferative neoplasm, anemia, abnormal white blood cell count, and hypoalbuminemia. Patients who underwent stem cell transplantation did not show an increased risk for morbidity or mortality. Patients with myeloid neoplasms have a poor prognosis after splenectomy and the decision to operate is a difficult one, associated with high morbidity and mortality. © 2014 Wiley Periodicals, Inc.

  18. Splenectomy

    Science.gov (United States)

    ... help you prepare. What you can expect During splenectomy Right before your surgery, you will be given ... removes the spleen and closes the incision. After splenectomy In the hospital. After surgery you're moved ...

  19. The value of prophylactic vaccinations and antibiotic treatment in post-splenectomy patients: a review

    OpenAIRE

    Lammers, Jolanda

    2012-01-01

    AJ Jolanda LammersDepartment of Infectious diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The NetherlandsAbstract: Although spleen preservation surgery and non-operative management are first-line treatment options, total splenectomy is frequently performed. Splenectomy is performed for a number of indications including idiopathic thrombocytopenic purpura, high-energetic trauma, and hematological malignancy. Following splenectomy, patients are at risk for overwhelmin...

  20. Optimal changes in portal hemodynamics induced by splenectomy during living donor liver transplantation.

    Science.gov (United States)

    Wang, Huanlin; Ikegami, Toru; Harada, Noboru; Yoshizumi, Tomoharu; Soejima, Yuji; Uchiyama, Hideaki; Yamashita, Yo-Ichi; Itoh, Shinji; Harimoto, Norifumi; Kawanaka, Hirofumi; Shirabe, Ken; Maehara, Yoshihiko

    2015-08-01

    The purpose of this study was to evaluate the impact of splenectomy in adult-to-adult living donor liver transplantation (LDLT). Adult-to-adult LDLTs (n = 276) were divided into those with simultaneous splenectomy during LDLT (Splenectomy group, n = 154) and those without (Non-Splenectomy group, n = 122). In the Splenectomy group, splenectomy decreased the portal venous pressure from 24.0 to 19.1 mmHg (p Splenectomy group compared with the Non-Splenectomy group. The graft portal venous flow was also better in the Splenectomy group (y = 625-5.1x; r (2) = 0.08, p Splenectomy group (y = 470-2.9x; r (2) = 0.04, p = 0.03). Fourteen days after LDLT, the total bilirubin and ascites output were lower in the Splenectomy group than in the Non-Splenectomy group. Among the patients with hepatitis C, splenectomy was associated with a significantly higher rate of a sustained viral response (59.4 vs. 35.9%, p = 0.020) than was noted in those without splenectomy (n = 39). There were no patients with post-splenectomy sepsis under vaccination. By decreasing the portal pressure and increasing the graft vascular compliance, splenectomy conferred better graft outcomes in adult-to-adult LDLT.

  1. Long-term outcomes of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura.

    Science.gov (United States)

    Qu, Yikun; Xu, Jian; Jiao, Chengbin; Cheng, Zhuoxin; Ren, Shiyan

    2014-01-01

    The long-term outcomes of laparoscopic splenectomy (LS) versus open splenectomy (OS) in patients with idiopathic thrombocytopenic purpura (ITP) are not known. A retrospective analysis of 73 patients who underwent splenectomy (32 LS and 41 OS) for refractory ITP between April 2003 and June 2012 was conducted. LS was associated with shorter hospital stay (P = 0.01), less blood loss and blood transfusion during surgery, quicker resumption of oral diet (P splenectomy is not different from that of open splenectomy for patients with ITP.

  2. Long-term outcome following splenectomy for chronic and persistent immune thrombocytopenia (ITP) in adults and children : Splenectomy in ITP.

    Science.gov (United States)

    Ahmed, Rayaz; Devasia, Anup J; Viswabandya, Auro; Lakshmi, Kavitha M; Abraham, Aby; Karl, Sampath; Mathai, John; Jacob, Paul M; Abraham, Deepak; Srivastava, Alok; Mathews, Vikram; George, Biju

    2016-09-01

    The purpose of this research is to study the outcomes of splenectomy for chronic and persistent immune thrombocytopenia (ITP). This study is a retrospective analysis of 254 patients with chronic or persistent ITP who underwent splenectomy at CMC, Vellore, India between 1995 and 2009. Responses were assessed based on standard criteria. One hundred and sixty seven adults and 87 children with a median age of 29 years (range 2-64) with persistent (n = 103) or chronic ITP (n = 151) was studied. Response was seen in 229 (90.2 %) including CR in 74.4 % at a median time of 1 day (range 1-54). Infections following splenectomy were reported in 16 %. Deaths related to post splenectomy sepsis occurred in 1.57 % and major bleeding in 0.78 %. At median follow-up of 54.3 months (range 1-290), 178 (70.1 %) remain in remission. The 5-year and 10-year overall survival (OS) is 97.4 ± 1.2 % and 94.9 ± 2.1 %, respectively, while the 5-year and 10-year event-free survival (EFS) is 76.5 + 2.9 % and 71.0 + 3.9 %, respectively. Splenectomy is associated with long-term remission rates of >70 % in chronic or persistent ITP.

  3. Residual tissue post splenectomy detected by splenic scintillography with erythrocytes damaged by heat; Tejido residual postesplenectomia detectado por centellografia esplenica con eritrocitos danados por calor

    Energy Technology Data Exchange (ETDEWEB)

    Rivera B, B; Garcia C, E S; Garcia O, J R [Centro Medico ABC, Departamento de Medicina Nuclear, Mexico, D.F. (Mexico)

    2005-07-01

    Feminine of 26 years old with diagnostic of purple thrombocytopenic idiopathic to those 4 years of age, tried with steroids and splenectomy at 11 years old. Pathway practically asymptomatic until 4 months ago she had presented asthenia, adynamia and general uneasiness, with platelet figures of 40,000 plat/microliter. It was carried out scintillographic study with damaged erythrocytes for post surgical remainder search. Its were took two-dimensional images and tomography by single photon emission (SPECT), being knitted splenic residual in area of anatomical projection of the spleen. (Author)

  4. [Robotic splenectomy--a personal view].

    Science.gov (United States)

    Vasilescu, C

    2010-01-01

    Until now 40 robotic splenectomies were performed in our department, the first case being done on February 25, 2008. Our data show that robotic splenectomy with the DaVinci surgical system is technically feasible and safe, with good results and without complications. The main advantages are a better tridimensional view and an increased versatility of the surgical instruments. The DaVinci system allows an accurate dissection around the splenic hilum and preservation of the splenic remnant vessels in partial splenectomy. Robotic splenectomy will probably not replace the laparoscopic splenectomy for the most common indications like ITP, hemolytic anemia. It may be a very useful surgical tool in difficult splenectomy: partial splenectomy, splenectomy in liver cirrhosis, splenic tumors or malignant hemopathies. In these cases the robotic approach may shorten the operative time, decrease the blood loss and the risk of remorrhagic complications during surgery and even make possible a minimally invasive splenectomy very difficult to be performed by classical laparoscopy.

  5. Splenectomy following MCAO inhibits the TLR4-NF-κB signaling pathway and protects the brain from neurodegeneration in rats.

    Science.gov (United States)

    Belinga, Victor Fabrice; Wu, Guan-Jin; Yan, Fu-Ling; Limbenga, Erica Audrey

    2016-04-15

    The Toll-like receptor 4(TLR4)/nuclear factor kappa B NF-κB inflammatory pathway contributes to secondary inflammation in many diseases including stroke. Moreover, the neuroprotective effect of splenectomy in stroke is supported by a vast body of experimental evidence. Nevertheless, the underlying mechanism(s) by which splenectomy enhance neuroprotection in stroke is still poorly understood. Our study aimed to investigate whether post-ischemic splenectomy modulate the TLR4/NF-κB inflammatory pathway in stroke. Immunohistochemistry was used to evaluate the levels of TLR4 and NF-κB expression in brain areas (parietal lobe, hippocampus and striatum) of rats that underwent: MCAO-splenectomy surgery (MS ); MCAO surgery without splenectomy (MCAO control or MC); Sham MCAO and splenectomy surgery (sham control group or SC group respectively. Apoptosis in these areas was assessed by TUNEL detection technique. The levels of TLR4 and NF-κB expression were significantly reduced in splenectomized rats relative to the MS group (Psplenectomy in ischemic stroke. Our results suggest that such an effect might be due to the inhibition of theTLR4/NF-κB inflammatory pathway. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Transforming management of patients undergoing splenectomy in an Irish teaching hospital.

    LENUS (Irish Health Repository)

    McHugh, S M

    2012-02-01

    BACKGROUND: Post-splenectomy infection has a mortality rate of up to 70%. Previously we have published data confirming the poor adherence to best practice guidelines with relation to management of the asplenic patient. A defined protocol of care was established, staff education commenced and a \\'patient information leaflet\\' made available. AIM: To ascertain whether management of the asplenic patient has improved since the implementation of a structured programme of care. METHOD: Retrospective chart review of all splenectomies performed in Beaumont Hospital between 2002 and 2008. RESULTS: Overall, 75.9% of patients were documented as having received the recommended vaccinations. Of these, 48.7% were not timed according to recommended guidelines. Prophylactic antibiotics were documented as prescribed in all but five patients discharged. CONCLUSIONS: These results demonstrate an improvement in post-splenectomy care between 2002 and 2008. However, further improvements are necessary.

  7. Transforming management of patients undergoing splenectomy in an Irish teaching hospital.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-02-06

    BACKGROUND: Post-splenectomy infection has a mortality rate of up to 70%. Previously we have published data confirming the poor adherence to best practice guidelines with relation to management of the asplenic patient. A defined protocol of care was established, staff education commenced and a \\'patient information leaflet\\' made available. AIM: To ascertain whether management of the asplenic patient has improved since the implementation of a structured programme of care. METHOD: Retrospective chart review of all splenectomies performed in Beaumont Hospital between 2002 and 2008. RESULTS: Overall, 75.9% of patients were documented as having received the recommended vaccinations. Of these, 48.7% were not timed according to recommended guidelines. Prophylactic antibiotics were documented as prescribed in all but five patients discharged. CONCLUSIONS: These results demonstrate an improvement in post-splenectomy care between 2002 and 2008. However, further improvements are necessary.

  8. Randomized clinical trial of ligasure™ versus conventional splenectomy for injured spleen in blunt abdominal trauma.

    Science.gov (United States)

    Amirkazem, Vejdan Seyyed; Malihe, Khosravi

    2017-02-01

    Spleen is the most common organ damaged in cases of blunt abdominal trauma and splenectomy and splenorrhaphy are the main surgical procedures that are used in surgical treatment of such cases. In routine open splenectomy cases, after laparotomy, application of sutures in splenic vasculature is the most widely used procedure to cease the bleeding. This clinical trial evaluates the role and benefits of the Ligasure™ system in traumatic splenectomy without using any suture materials and compares the result with conventional method of splenectomy. After making decision for splenectomy secondary to a blunt abdominal trauma, patients in control group (39) underwent splenectomy using conventional method with silk suture ligation of splenic vasculature. In the interventional group (41) a Ligasure™ vascular sealing system was used for ligating of the splenic vein and artery. The results of operation time, volume of intra-operation bleeding and post-operative complications were compared in both groups. The mean operation times in control and interventional group were 21 and 12 min respectively (p trauma for splenectomy not only can decrease the operation time but also can decrease the volume of bleeding during operation without any additional increase in post-operative complications. This method is recommendable in traumatic splenic injuries that require splenectomy in order to control the bleeding as opposed to use of traditional silk sutures. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Laparoscopic splenectomy: Current concepts

    Science.gov (United States)

    Misiakos, Evangelos P; Bagias, George; Liakakos, Theodore; Machairas, Anastasios

    2017-01-01

    Since early 1990’s, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes. PMID:28979707

  10. Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

    Science.gov (United States)

    Boyle, Soames; White, Richard H.; Brunson, Ann

    2013-01-01

    Patients with immune thrombocytopenia (ITP) who relapse after an initial trial of corticosteroid treatment present a therapeutic challenge. Current guidelines recommend consideration of splenectomy, despite the known risks associated with surgery and the postsplenectomy state. To better define these risks, we identified a cohort of 9976 patients with ITP, 1762 of whom underwent splenectomy. The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared with 1% in patients who did not undergo splenectomy; venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared with 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (splenectomy. There was increased risk of VTE both early (HR 5.2 [CI, 3.2-8.5]) and late (HR 2.7 [CI, 1.9-3.8]) after splenectomy. The cumulative incidence of sepsis was 11.1% among the ITP patients who underwent splenectomy and 10.1% among the patients who did not. Splenectomy was associated with a higher adjusted risk of sepsis, both early (HR 3.3 [CI, 2.4-4.6]) and late (HR 1.6 or 3.1, depending on comorbidities). We conclude that ITP patients post splenectomy are at increased risk for AbVTE, VTE, and sepsis. PMID:23637127

  11. Outcomes of splenectomy in patients with common variable immunodeficiency (CVID): a survey of 45 patients

    Science.gov (United States)

    Wong, G K; Goldacker, S; Winterhalter, C; Grimbacher, B; Chapel, H; Lucas, M; Alecsandru, D; McEwen, D; Quinti, I; Martini, H; Schmidt, R E; Ernst, D; Espanol, T; Vidaller, A; Carbone, J; Fernandez-Cruz, E; Lougaris, V; Plebani, A; Kutukculer, N; Gonzalez-Granado, L I; Contreras, R; Kiani-Alikhan, S; Ibrahim, M A A; Litzman, J; Jones, A; Gaspar, H B; Hammarstrom, L; Baumann, U; Warnatz, K; Huissoon, A P

    2013-01-01

    Splenectomy has been used in patients with common variable immunodeficiency disorders (CVID), mainly in the context of refractory autoimmune cytopenia and suspected lymphoma, but there are understandable concerns about the potential of compounding an existing immunodeficiency. With increasing use of rituximab as an alternative treatment for refractory autoimmune cytopenia, the role of splenectomy in CVID needs to be re-examined. This retrospective study provides the largest cohesive data set to date describing the outcome of splenectomy in 45 CVID patients in the past 40 years. Splenectomy proved to be an effective long-term treatment in 75% of CVID patients with autoimmune cytopenia, even in some cases when rituximab had failed. Splenectomy does not worsen mortality in CVID and adequate immunoglobulin replacement therapy appears to play a protective role in overwhelming post-splenectomy infections. Future trials comparing the effectiveness and safety of rituximab and splenectomy are needed to provide clearer guidance on the second-line management of autoimmune cytopenia in CVID. PMID:23480186

  12. Assay of splenectomy on reticuloendothelial system function with trace method of 99mTc-phytate

    International Nuclear Information System (INIS)

    Sang Shibiao; Dong Shenan; Jiang Yimin; Cheng Jun

    1996-01-01

    The effect of splenectomy on reticuloendothelial system (RES) function was investigated by measurement of 99m Tc-phytate in the presence or absence of sepsis in rats, and plasma fibronectin (PFn) and hyaluronic acid (HA) concentrations were measured. The results were as follows: following splenectomy, particularly in the presence of sepsis, the intravascular clearance (T 1/2 ) delayed and HA increased, phagocytic index (K) and hepatic uptake and PFn decreased. These results suggest that splenectomy may not only have deleterious effects in terms of the host defence system, but may also cause RES depression due to the post splenectomy infection

  13. Splenectomy in patients with Myeloproliferative Neoplasms: efficacy, complications and impact on survival and transformation

    Science.gov (United States)

    Santos, Fabio P S; Tam, Constantine S; Kantarjian, Hagop; Cortes, Jorge; Thomas, Deborah; Pollock, Raphael; Verstovsek, Srdan

    2013-01-01

    Background Splenectomy may be an effective therapeutic option for treating massive splenomegaly in patients with myeloproliferative neoplasms (MPNs). There is still limited data on its short- and long-term benefits and risks. Methods Efficacy and short-term complications were analyzed in 94 patients with different MPNs who underwent splenectomy at MD Anderson. The long-term impact of splenectomy on overall survival (OS) and transformation free survival (TFS) was evaluated in 461 patients with myelofibrosis (MF) seen at MD Anderson including 50 who underwent splenectomy during disease evolution. Results Splenectomy improved anemia and thrombocytopenia in 47% and 66% of patients, respectively. Most common complications were leukocytosis (76%), thrombocytosis (43%), and venous thromboembolism (16%). Post-operative mortality was 5%. Among patients with MF, splenectomy during disease evolution was associated with decreased OS (Hazard Ratio [HR] =2.17, pSplenectomy is a possible therapeutic option for patients with MF and other MPNs, and its greatest benefits are related to improvement in spleen pain and discomfort, anemia and thrombocytopenia. However, in patients with MF it appears to be associated with increased mortality. PMID:23573823

  14. Postoperative outcomes after open splenectomy versus laparoscopic splenectomy in cirrhotic patients: a meta-analysis.

    Science.gov (United States)

    Al-raimi, Khaled; Zheng, Shu-Sen

    2016-02-01

    Laparoscopic splenectomy is considered the gold standard for resecting normal-to-moderately bigger spleens in benign conditions, and in addition could be tried for patients with malignant splenic disorders. However, the safety of laparoscopic splenectomy in patients with hypersplenism is not well-known. This study aimed to investigate the efficacy and safety of laparoscopic splenectomy for patients with hypersplenism secondary to liver cirrhosis by comparing with the open splenectomy. Several databases were searched to identify comparative studies fulfilling the predefined selection criteria from January 2000 to June 2015. The subsequent key words were utilized for browsing "laparoscopy" or "laparoscopic", "open", "splenectomy", and "liver cirrhosis". Studies evaluating laparoscopic and open splenectomy for patients with liver cirrhosis were incorporated. Two evaluators personally strained the title and abstract of each publication. Citations with contemplated compliance within our eligibility criteria underwent compressed review. Meta-analysis was carried out according to the recommendations of the Cochrane Collaboration software (review manager 5.1). Seven studies containing 509 patients were included. Compared with the open splenectomy group, patients in the laparoscopic splenectomy group had significantly less intraoperative blood loss (MD=210.30; 95% CI: 11.28-409.32; P=0.04), longer operative time (MD=-31.58; 95% CI: -53.34--9.82; P=0.004), shorter duration of postoperative hospital stay (MD=3.41; 95% CI: 2.39-4.43; Psplenectomy.

  15. Massive splenomegaly in children: laparoscopic versus open splenectomy.

    Science.gov (United States)

    Hassan, Mohamed E; Al Ali, Khalid

    2014-01-01

    Laparoscopic splenectomy for massive splenomegaly is still a controversial procedure as compared with open splenectomy. We aimed to compare the feasibility of laparoscopic splenectomy versus open splenectomy for massive splenomegaly from different surgical aspects in children. The data of children aged splenectomy for hematologic disorders were retrospectively reviewed in 2 pediatric surgery centers from June 2004 until July 2012. The study included 32 patients, 12 who underwent laparoscopic splenectomy versus 20 who underwent open splenectomy. The mean ages were 8.5 years and 8 years in the laparoscopic splenectomy group and open splenectomy group, respectively. The mean operative time was 180 minutes for laparoscopic splenectomy and 120 minutes for open splenectomy. The conversion rate was 8%. The mean amount of intraoperative blood loss was 60 mL in the laparoscopic splenectomy group versus 110 mL in the open splenectomy group. Postoperative atelectasis developed in 2 cases in the open splenectomy group (10%) and 1 case in the laparoscopic splenectomy group (8%). Oral feeding postoperatively resumed at a mean of 7.5 hours in the laparoscopic splenectomy group versus 30 hours in the open splenectomy group. The mean hospital stay was 36 hours in the laparoscopic splenectomy group versus 96 hours in the open splenectomy group. Postoperative pain was less in the laparoscopic splenectomy group. Laparoscopic splenectomy for massive splenomegaly in children is safe and feasible. Although the operative time was significantly greater in the laparoscopic splenectomy group, laparoscopic splenectomy was associated with statistically significantly less pain, less blood loss, better recovery, and shorter hospital stay. Laparoscopic splenectomy for pediatric hematologic disorders should be the gold-standard approach regardless of the size of the spleen.

  16. PARTIAL SPLENECTOMY IN CHILDREN - AN ALTERNATIVE FOR SPLENECTOMY IN THE PATHOLOGICAL STAGING OF HODGKINS-DISEASE

    NARCIS (Netherlands)

    HOEKSTRA, HJ; TAMMINGA, RYJ; TIMENS, W

    1994-01-01

    Background: The more accurate staging of Hodgkin's disease in children is achieved with a staging laparotomy and splenectomy. A disadvantage of the splenectomy is the high risk for an overwhelming postsplenectomy sepsis (OPSI). Therefore, the partial splenectomy was introduced as an alternative to

  17. Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen.

    Science.gov (United States)

    Leo, C A; Pravisani, R; Bidinost, S; Baccarani, U; Bresadola, V; Risaliti, A; Terrosu, G

    2015-01-01

    Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice. At our Department, between July and November 2011 two patients underwent laparoscopic accessory splenectomy for recurrence of ITP. Both patients had a previously laparoscopic splenectomy. Preoperative Magnetic Resonance (MR) was performed in both the cases revealing the presence of an accessory spleen. The operative time was 105 and 100 minutes respectively. No perioperative complications occured. Hospital stay was four days in both cases. The first patient had a disease free period of two months; the second one of one month. Both patients restarted immunosuppressive therapy. The relapse of thrombocytopenia post-splenectomy can be associated with the presence of an accessory spleen. The laparoscopic accessory splenectomy should be considered the first choice approach. Surgical accessory splenectomy allows a transitory remission of the disease.

  18. The Impact of Splenectomy in Myelofibrosis Patients before Allogeneic Hematopoietic Stem Cell Transplantation.

    Science.gov (United States)

    Robin, Marie; Zine, Maryem; Chevret, Sylvie; Meignin, Véronique; Munoz-Bongrand, Nicolas; Moatti, Hannah; Xhaard, Aliénor; Sicre de Fontbrune, Flore; Peffault de Latour, Régis; Sarfati, Emile; Socié, Gérard

    2017-06-01

    Performing a pretransplantation splenectomy in patients with myelofibrosis (MF) is a matter of debate, as while the procedure improves hematological recovery, it may lead to severe morbidities. We retrospectively analyzed data from 85 consecutive patients who underwent transplantation in our center for MF, including 39 patients who underwent splenectomy before their transplantation. A majority of them had primary MF (78%), were considered high-risk patients (84% dynamic international prognostic scoring system intermediate-2 or higher), and had received transplants from HLA-matched sibling donors (56%) after a reduced-intensity conditioning regimen (82%). One-half of all splenectomized patients presented surgical or postsurgical morbidities, most frequently thrombosis and hemorrhage. After adjustment using Cox models, pretransplantation splenectomy was not associated with nonrelapse mortality or post-transplantation relapse but with an improved overall survival (OS) and event-free survival (EFS). We conclude that some patients with huge splenomegaly may undergo pretransplantation splenectomy without a deleterious impact on post-transplantation outcomes. OS and EFS improvement should in confirmed in controlled study. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  19. Minimally invasive splenectomy: an update and review

    Science.gov (United States)

    Gamme, Gary; Birch, Daniel W.; Karmali, Shahzeer

    2013-01-01

    Laparoscopic splenectomy (LS) has become an established standard of care in the management of surgical diseases of the spleen. The present article is an update and review of current procedures and controversies regarding minimally invasive splenectomy. We review the indications and contraindications for LS as well as preoperative considerations. An individual assessment of the procedures and outcomes of multiport laparoscopic splenectomy, hand-assisted laparoscopic splenectomy, robotic splenectomy, natural orifice transluminal endoscopic splenectomy and single-port splenectomy is included. Furthermore, this review examines postoperative considerations after LS, including the postoperative course of uncomplicated patients, postoperative portal vein thrombosis, infections and malignancy. PMID:23883500

  20. Laparoscopic Spleen Removal (Splenectomy)

    Science.gov (United States)

    ... Affairs and Humanitarian Efforts Login Laparoscopic Spleen Removal (Splenectomy) Patient Information from SAGES Download PDF Find a ... are suspected. What are the Advantages of Laparoscopic Splenectomy? Individual results may vary depending on your overall ...

  1. Determinants of splenectomy in splenic injuries following blunt abdominal trauma.

    Science.gov (United States)

    Akinkuolie, A A; Lawal, O O; Arowolo, O A; Agbakwuru, E A; Adesunkanmi, A R K

    2010-02-01

    The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic preservation. Files of 55 patients managed for isolated splenic injuries from blunt abdominal trauma between 1998 and 2007 were retrospectively analysed using a pro forma. Management options were classified into nonoperative, operative salvage and splenectomy. The majority of patients suffered splenic injury as a result of motor vehicle accident (MVA) trauma or falls. Splenectomy was undertaken in 33 (60%) patients, 12 (22%) had non-operative management, and operative salvage was achieved in 10 (18%) patients. Significant determinants of splenectomy were grade of splenic injury, hierarchy of the surgeon, and hierarchy of the assistant. MVA injury and falls accounted for the vast majority of blunt abdominal trauma in this study. The rate and magnitude of energy transferred versus splenic protective mechanisms at the time of blunt abdominal trauma seems to determine the grade of splenic injury. Interest in splenic salvage surgery, availability of technology that enables splenic salvage surgery, and the experience of the surgeon and assistant appear to determine the surgical management. Legislation on vehicle safety and good parental control may reduce the severity of splenic injury in blunt abdominal trauma. When surgery is indicated, salvage surgery should be considered in intermediate isolated splenic injury to reduce the incidence of OPSI.

  2. Thrombocytosis following splenectomy and aortic valve replacement for idiopathic thrombocytopaenic purpura with bicuspid aortic valve

    Directory of Open Access Journals (Sweden)

    Sarika Katiyar

    2015-01-01

    Full Text Available Idiopathic thrombocytopaenic purpura (ITP patients are at high risk for complications during and after cardiac surgeries involving cardiopulmonary bypass. The main clinical problem of primary ITP is an increased risk of bleeding although bleeding may not always be present. More recently, thrombosis has become appreciated as another potential complication of the procedure. We report a 22-year-old female patient with ITP with bicuspid aortic valve and splenomegaly, who underwent uncomplicated aortic valve replacement and splenectomy simultaneously. She was readmitted with chest pain due to coronary thrombosis following splenectomy which made the management difficult. We describe our experience in managing this patient who presented with thrombotic complication rather than bleeding in post-operative period and the challenges met in maintaining appropriate anticoagulation for aortic valve replacement as well as thrombosis, post-splenectomy

  3. Hand-assisted laparoscopic splenectomy

    NARCIS (Netherlands)

    Bemelman, W. A.; de Wit, L. T.; Busch, O. R.; Gouma, D. J.

    2000-01-01

    Laparoscopic splenectomy is performed routinely in patients with small and moderately enlarged spleens at specialized centers. Large spleens are difficult to handle laparoscopically and hand-assisted laparoscopic splenectomy might facilitate the procedure through enhanced vascular control, easier

  4. Gaucher's disease diagnosed by splenectomy.

    Science.gov (United States)

    Adas, Mine; Adas, Gokhan; Karatepe, Oguzhan; Altiok, Merih; Ozcan, Deniz

    2009-08-01

    Splenectomy continues to find common therapeutic indications for hematologic disorders. In addition, recently it is also performed in surgical clinics to assist diagnose of some illnesses. Gaucher's disease, especially Type I, is the most frequently encountered lysosomal storage disorder in man. Manifestations of it are highly variable. The most frequently found symptoms include splenomegaly with anaemia and thrombocytopenia, mostly due to hypersplenism, hepatomegaly and bone disease. Four patients were reported in the present study. Three of them were easily diagnosed with Gaucher's disease via bone marrow cytology, and one with Gaucher's disease was detected by pathological examination following the splenectomy. For the pouse of diagnosis of the Gaucher's disease, performing surgery is generally not necessary. However, for the cases of difficult to diagnose by classical methods, the corect diagnosis of Gaucher's disease can only be made by a special operation.

  5. Spleen hydatidosis treated by hemi-splenectomy: A low-morbidity, cost-effective management by a recently improved surgical technique.

    Science.gov (United States)

    Costi, Renato; Castro Ruiz, Carolina; Zarzavadjian le Bian, Alban; Scerrati, Daniele; Santi, Caterina; Violi, Vincenzo

    2015-08-01

    Splenic hydatidosis is a rare condition and is usually managed by total splenectomy, which is associated to various complications, including overwhelming post-splenectomy sepsis and thrombosis. Probably due to supposed technical difficulties, the partial splenectomy is rarely performed being often unknown to physicians, infectious disease specialists and surgeons. Demographic, clinical and surgical data were collected of four consecutive patients undergoing partial (or hemi-) splenectomy using an original, recently improved technique as a treatment for polar splenic hydatid cyst. The procedure implies a selective vascular ligation, a mechanical stapler-assisted section and haemostatic agents (Surgicel(®)) application on the cutting surface. Three patients were treated by laparotomy (including one affected by both liver and spleen localizations) whereas the last one was approached laparoscopically. Partial splenectomy operative time reached 74 min (range: 60-94 min) and blood loss was 8 ml (range: 5-10 ml). Hospital stay was 5.6 days (range: 5-7 days). At a mean follow-up of 20 months (range: 12-36 months), outcomes were uneventful. Partial splenectomy for hydatidosis is effective and safe. Physicians and surgeons should be aware of such an easy-to-catch option when dealing with benign splenic conditions, such as parasitic cysts. Cost-effectiveness, low morbidity and the possible prevention of splenectomy-related infectious complications should plead in favor of this technique in developing countries, where hydatidosis is endemic and post-splenectomy drugs and vaccines may be lacking. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  6. Paediatric splenectomy: The Johannesburg experience | Patel ...

    African Journals Online (AJOL)

    Background. Splenectomy is an uncommon procedure in children, and data on children who underwent splenectomy in South Africa are sparse. Objective. To describe the profile, operative management and outcomes of children undergoing splenectomy. Methods. The records for all children aged 0 to 16 years who ...

  7. Significant prolongation of hamster liver transplant survival in Lewis rats by total-lymphoid irradiation, cyclosporine, and splenectomy

    International Nuclear Information System (INIS)

    Yamaguchi, Y.; Halperin, E.C.; Harland, R.C.; Wyble, C.; Bollinger, R.R.

    1990-01-01

    The effects of total lymphoid irradiation, cyclosporine and splenectomy alone and in combination have been studied in liver transplants from the LVG hamster to the LEW rat. Neither CsA alone, splenectomy alone, nor TLI alone prolonged graft survival. CsA/splenectomy and TLI/CsA produced significant prolongation of graft survival. TLI/CsA/splenectomy prolonged graft survival by over sixfold compared with controls. While CsA alone was ineffective in reducing lymphocytotoxic antidonor antibody, splenectomy alone or CsA/splenectomy did significantly suppress production of antibody. Only very low levels of antibody could be detected in animals treated with TLI/CsA/splenectomy. TLI/CsA/splenectomy has an immunosuppressive effect sufficient to significantly prolong liver graft survival in the LVG hamster to LEW rat combination and may represent a promising treatment protocol in experimental cross-species transplantation

  8. Splenectomy increases the subsequent risk of systemic lupus erythematosus.

    Science.gov (United States)

    Hsu, Chao-Yu; Chen, Hsuan-Ju; Hsu, Chung Y; Kao, Chia-Hung

    2016-02-01

    Splenectomy may be necessary to treat systemic lupus erythematosus (SLE) patients with thrombocytopenia; however, whether performing a splenectomy on patients without SLE increases the subsequent risk of SLE remains unknown. Therefore, this study was conducted to determine the association between splenectomy and SLE. We conducted a cohort study by using data from the Taiwan National Health Institute Research Database to identify 10,298 patients with received a splenectomy between 2000 and 2006 and 41,192 participants without received a splenectomy who were selected by frequency matched based on sex, age, and the index year. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of developing SLE associated with splenectomy compared with patients who did not receive a splenectomy. During the study period, the overall incidence density rate of SLE was higher in the splenectomy cohort than in the non-splenectomy cohort (adjusted HR 10.55; 95 % CI 50.55-20.05). The incidence density rates of SLE in women and men who received a splenectomy were higher than those of patients who did not receive a splenectomy. Non-traumatic splenectomy increases the subsequent risk of SLE. The risk of SLE should be considered before performing a splenectomy, particularly in women and younger patients.

  9. Post-splenectomy infections in chronic schistosomiasis as a consequence of bacterial translocation

    Directory of Open Access Journals (Sweden)

    Kedma de Magalhães Lima

    2015-06-01

    Full Text Available INTRODUCTION : Bacterial translocation is the invasion of indigenous intestinal bacteria through the gut mucosa to normally sterile tissues and internal organs. Schistosomiasis may cause alterations in the immune system and damage to the intestines, portal system and mesenteric lymph nodes. This study investigated bacterial translocation and alterations in the intestinal microbiota and mucosa in schistosomiasis and splenectomized mice. METHODS : Forty female 35-day-old Swiss Webster mice were divided into the following four groups with 10 animals each: schistosomotic (ESF, splenectomized schistosomotic (ESEF, splenectomized (EF and control (CF. Infection was achieved by introduction of 50 Schistosoma mansoni (SLM cercariae through the skin. At 125 days after birth, half of the parasitized and unparasitized mice were subjected to splenectomy. Body weights were recorded for one week after splenectomy; then, the mice were euthanized to study bacterial translocation, microbiota composition and intestinal morphometry. RESULTS : We observed significant reductions in the weight increases in the EF, ESF and ESEF groups. There were increases of at least 1,000 CFU of intestinal microbiota bacteria in these groups compared with the CF. The EF, ESF and ESEF mice showed decreases in the heights and areas of villi and the total villus areas (perimeter. We observed frequent co-infections with various bacterial genera. CONCLUSIONS : The ESEF mice showed a higher degree of sepsis. This finding may be associated with a reduction in the immune response associated with the absence of the spleen and a reduction in nutritional absorption strengthened by both of these factors (Schistosoma infection and splenectomy.

  10. Massive Splenomegaly in Children: Laparoscopic Versus Open Splenectomy

    OpenAIRE

    Hassan, Mohamed E.; Al Ali, Khalid

    2014-01-01

    Background and Objectives: Laparoscopic splenectomy for massive splenomegaly is still a controversial procedure as compared with open splenectomy. We aimed to compare the feasibility of laparoscopic splenectomy versus open splenectomy for massive splenomegaly from different surgical aspects in children. Methods: The data of children aged

  11. Long-Term Outcomes of Laparoscopic Splenectomy Versus Open Splenectomy for Idiopathic Thrombocytopenic Purpura

    Science.gov (United States)

    Qu, Yikun; Xu, Jian; Jiao, Chengbin; Cheng, Zhuoxin; Ren, Shiyan

    2014-01-01

    The long-term outcomes of laparoscopic splenectomy (LS) versus open splenectomy (OS) in patients with idiopathic thrombocytopenic purpura (ITP) are not known. A retrospective analysis of 73 patients who underwent splenectomy (32 LS and 41 OS) for refractory ITP between April 2003 and June 2012 was conducted. LS was associated with shorter hospital stay (P = 0.01), less blood loss and blood transfusion during surgery, quicker resumption of oral diet (P < 0.0001), and earlier drain removal (P < 0.01). Conversion to OS was required in 4 patients (12.5%). Operation time was significantly longer in LS (P < 0.0001). Deep venous thrombosis (DVT) was observed in 1 patient after LS and in 4 patients after OS (P = 0.52). One patient died from intraperitoneal bleeding after OS, another patient developed pulmonary embolism. Median follow-up of 36 months was performed in LS group (29 of 32, 91%) and of 46 months in OS group (35 of 41, 85%), 25 patients (86%) in LS group and 32 (91%) in OS group reached sustained complete response (P = 0.792). Kaplan-Meier analysis showed that there was no significant difference in the relapse-free survival rate between the groups (P = 0.777). In conclusion, the long-term outcome of laparoscopic splenectomy is not different from that of open splenectomy for patients with ITP. PMID:24833154

  12. Laparoscopic Splenectomy

    International Nuclear Information System (INIS)

    Javed, I.; Malik, A. A.; Khan, A.; Shamim, R.; Allahnawaz, A.; Ayaaz, M.

    2014-01-01

    Patients undergoing laparoscopic splenectomy were observed for their postoperative recovery and development of complications. It was a retrospective analysis done at Services Hospital and National Hospital and Medical Center, Lahore, from January 2010 to December 2012. A total of 13 patients underwent laparoscopic splenectomy and were included in the study. Patients were followed for their postoperative recovery and development of any complications. The median age of patients was 19 years ranging from 13 to 69 years. Accessory spleens were removed in 3 patients. Mean operating time was 158 minutes. One operation had to be converted to open because of uncontrolled hemorrhage. Six patients experienced postoperative complications including unexplained hyperpyrexia (n=2), pleural effusion (n=4) and prolonged pain > 48 hours (n=1). No deaths or infections were seen. Seven out of 8 patients with idiopathic thrombocytopenic purpura developed a positive immediate response to the splenectomy, defined as a platelet count greater than 100 x 109/L after the surgery, which was maintained without medical therapy. Mean hospital stay was 5.5 days. Average time to return to activity was 15 days. All patients were followed for 6 months and no follow-up complications were noted. (author)

  13. Thrombopoietin receptor agonists for preparing adult patients with immune thrombocytopenia to splenectomy: results of a retrospective, observational GIMEMA study.

    Science.gov (United States)

    Zaja, Francesco; Barcellini, Wilma; Cantoni, Silvia; Carpenedo, Monica; Caparrotti, Giuseppe; Carrai, Valentina; Di Renzo, Nicola; Santoro, Cristina; Di Nicola, Massimo; Veneri, Dino; Simonetti, Federico; Liberati, Anna M; Ferla, Valeria; Paoloni, Francesca; Crea, Enrico; Volpetti, Stefano; Tuniz, Enrica; Fanin, Renato

    2016-05-01

    In patients with immune thrombocytopenia (ITP) refractory to corticosteroids and intravenous immunoglobulins (IVIG), splenectomy may result at higher risk of peri-operative complications and, for this reason, potentially contraindicated. The thrombopoietin receptor agonists (TPO-RAs) romiplostim and eltrombopag have shown high therapeutic activity in primary ITP, but data of efficacy and safety regarding their use in preparation for splenectomy are missing. Thirty-one adult patients, median age 50 years, with corticosteroids and/or IVIG refractory persistent and chronic ITP who were treated with TPO-RAs (romiplostim= 24; eltrombopag= 7) with the aim to increase platelet count and allow a safer execution of splenectomy were retrospectively evaluated. Twenty-four patients (77%) responded to the use of TPO-RAs with a median platelet count that increased from 11 × 10(9) /L before starting TPO-RAs to 114 × 10(9) /L pre-splenectomy, but a concomitant treatment with corticosteroids and/or IVIG was required in 19 patients. Twenty-nine patients underwent splenectomy while two patients who responded to TPO-RAs subsequently refused surgery. Post-splenectomy complications were characterized by two Grade 3 thrombotic events (1 portal vein thrombosis in the patient with previous history of HCV hepatitis and 1 pulmonary embolism), with a platelet count at the time of thrombosis of 260 and 167 × 10(9) /L, respectively and one Grade 3 infectious event. TPO-RAs may represent a therapeutic option to improve platelet count and reduce the risk of peri-operative complications in ITP candidates to splenectomy. An increased risk of post-splenectomy thromboembolic events cannot be ruled out and thromboprophylaxis with low-molecular weight heparin is generally recommended. © 2016 Wiley Periodicals, Inc.

  14. Laparoscopic Splenectomy in Patients With Spleen Injuries.

    Science.gov (United States)

    Ermolov, Aleksander S; Tlibekova, Margarita A; Yartsev, Peter A; Guliaev, Andrey A; Rogal, Mikhail M; Samsonov, Vladimir T; Levitsky, Vladislav D; Chernysh, Oleg A

    2015-12-01

    Spleen injury appears in 10% to 30% of abdominal trauma patients. Mortality among the patients in the last 20 years remains high (6% to 7%) and shows no tendency to decline. Nowadays nonoperative management is widely accepted management of patients with low-grade spleen injury, whereas management of patients with high-grade spleen injury (III and higher) is not so obvious. There are 3 methods exist in treatment of such patients: conservative (with or without angioembolization), spleen-preserving operations, and splenectomy. Today laparoscopic splenectomy is not a widely used operation and only few studies reported about successful use of laparoscopic splenectomy in patients with spleen injury.The aim of the study was to determine indications and contraindications for laparoscopic splenectomy in abdominal trauma patients and to analyze results of the operations. The study involved 42 patients with spleen injury grade III who were admitted in our institute in the years of 2010 to 2014. The patients were divided in 2 groups. Laparoscopic splenectomy was performed in 23 patients (group I) and "traditional" splenectomy was carried out in 19 patients (group II). There was no difference in the demographic data and trauma severity between the 2 groups. Noninvasive investigations, such as laboratory investigations, serial abdominal ultrasound examinations, x-ray in multiple views, and computed tomography had been performed before the decision about necessity of an operation was made. Patients after laparoscopic operations had better recovering conditions compared with patients with the same injury after "traditional" splenectomy. Neither surgery-related complications nor mortalities were registered in both groups. Laparoscopic splenectomy was more time-consuming operation than "traditional" splenectomy. We suggest that as experience of laparoscopic splenectomy is gained the operation time will be reduced. Laparoscopic splenectomy is a safe feasible operation in patients

  15. Single Incision Laparoscopic Splenectomy: Our First Experiences

    Directory of Open Access Journals (Sweden)

    Umut Barbaros

    2011-06-01

    Full Text Available Objective: Most laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using less and smaller trocars. Single incision laparoscopic splenectomy is a new laparoscopic procedure. Herein we would like to present our experiences.Material and Methods: Between January 2009 and June 2009, data of the 7 patients who underwent single incision laparoscopic splenectomy were evaluated retrospectively.Results: There were 7 patients (5 females and 2 males with a mean age of 29.9 years. The most common splenectomy indication was idiopathic thrombocytopenic purpura. Single incision laparoscopic splenectomy was performed successfully in 6 patients. In one patient the operation was converted to an open procedure.Conclusion: With surgeons experienced in minimally invasive surgery, single incision laparoscopic splenectomy could be performed successfully. However, in order to demonstrate the differneces between standard laparoscopic splenectomy and SILS splenetomy, prospective randomized comparative studies are required.

  16. Vaccination coverage and mortality after splenectomy: results from an Italian single-centre study.

    Science.gov (United States)

    Di Sabatino, Antonio; Lenti, Marco Vincenzo; Tinozzi, Francesco Paolo; Lanave, Marina; Aquino, Ivana; Klersy, Catherine; Marone, Piero; Marena, Carlo; Pietrabissa, Andrea; Corazza, Gino Roberto

    2017-12-01

    Splenectomy is a well-recognised risk factor for life-threatening overwhelming post-splenectomy infection (OPSI). To prevent OPSI, immunisations against encapsulated bacteria (S. pneumoniae, N. meningitidis, H. influenzae) and influenza virus are recommended. However, there is still a lack of uniformity and poor compliance with these recommendations. Following a local physicians' awareness campaign regarding the importance of vaccine prophylaxis of splenectomised patients, we aimed to register vaccination coverage, mortality and infection rates in all patients who underwent splenectomy at our hospital, over a six-year time span. Reasons for splenectomy, patients' compliance with vaccinations, mortality and infectious events were recorded. The reasons for splenectomy in the 216 identified patients (mean age 58.2 ± 14; M:F ratio 1.4:1) were haematologic disorders (38.8%), solid tumours (28.7%), traumatic rupture (22.7%) and other causes (9.7%). A total of 146 patients (67.6%) received at least one of the four vaccines. Overall, the mortality rate was significantly greater in unvaccinated compared to vaccinated patients (p splenectomy the statistical significance was lost (p = 0.085) due to the burden of solid tumour-related mortality. Among the 21 reported cases of OPSI, eight were fatal and five were potentially vaccine-preventable. Our results show that two-thirds of splenectomised patients comply with vaccine prophylaxis. Future interventional studies or ad hoc registries might overcome barriers to vaccination or intentional non-compliance.

  17. A rare case of post-splenectomy gastric volvulus managed by laparoscopic anterior gastropexy

    Directory of Open Access Journals (Sweden)

    Rahul Amreesh Gupta

    2017-01-01

    Full Text Available We report an extremely rare case of recurrent gastric volvulus after open splenectomy for hereditary spherocytosis. The initial episode was managed by endoscopic derotation. Later, for recurrent symptoms, she was successfully managed by laparoscopic anterior gastropexy.

  18. [Partial splenectomy in sickle cell disease].

    Science.gov (United States)

    Gutiérrez Díaz, A I; Svarch, E; Arencibia Núñez, A; Sabournin Ferrier, V; Machín García, S; Menendez Veitía, A; Ramón Rodriguez, L; Serrano Mirabal, J; García Peralta, T; López Martin, L G

    2015-04-01

    Total splenectomy in sickle cell disease is related to a high risk of fulminant sepsis and increased incidence of other events, which have not been reported in patients with partial splenectomy. In this study we examined the patients with sickle cell disease and partial splenectomy and compared the clinical and laboratory results with non-splenectomized patients. We studied 54 patients with sickle cell disease who underwent partial splenectomy in childhood from 1986 until 2011 at the Institute of Hematology and Immunology. They were compared with 54 non-splenectomized patients selected by random sampling with similar characteristics. Partial splenectomy was performed at a mean age of 4.1 years, with a higher frequency in homozygous hemoglobin S (70.4%), and the most common cause was recurrent splenic sequestration crisis. The most common postoperative complications were fever of unknown origin (14.8%) and acute chest syndrome (11.1%). After splenectomy there was a significant increase in leukocytes, neutrophils, and platelets, the latter two parameters remained significantly elevated when compared with non-splenectomized patients. There was no difference in the incidence of clinical events, except hepatic sequestration, which was more common in splenectomized patients. Partial splenectomy was a safe procedure in patients with sickle cell disease. There were no differences in the clinical picture in children splenectomized and non-splenectomized except the greater frequency of hepatic sequestration crisis in the first group. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  19. Recommendations regarding splenectomy in hereditary hemolytic anemias

    Science.gov (United States)

    Iolascon, Achille; Andolfo, Immacolata; Barcellini, Wilma; Corcione, Francesco; Garçon, Loïc; De Franceschi, Lucia; Pignata, Claudio; Graziadei, Giovanna; Pospisilova, Dagmar; Rees, David C.; de Montalembert, Mariane; Rivella, Stefano; Gambale, Antonella; Russo, Roberta; Ribeiro, Leticia; Vives-Corrons, Jules; Martinez, Patricia Aguilar; Kattamis, Antonis; Gulbis, Beatrice; Cappellini, Maria Domenica; Roberts, Irene; Tamary, Hannah

    2017-01-01

    Hereditary hemolytic anemias are a group of disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital dyserythropoietic anemias, thalassemia syndromes and hemoglobinopathies. As damaged red blood cells passing through the red pulp of the spleen are removed by splenic macrophages, splenectomy is one possible therapeutic approach to the management of severely affected patients. However, except for hereditary spherocytosis for which the effectiveness of splenectomy has been well documented, the efficacy of splenectomy in other anemias within this group has yet to be determined and there are concerns regarding short- and long-term infectious and thrombotic complications. In light of the priorities identified by the European Hematology Association Roadmap we generated specific recommendations for each disorder, except thalassemia syndromes for which there are other, recent guidelines. Our recommendations are intended to enable clinicians to achieve better informed decisions on disease management by splenectomy, on the type of splenectomy and the possible consequences. As no randomized clinical trials, case control or cohort studies regarding splenectomy in these disorders were found in the literature, recommendations for each disease were based on expert opinion and were subsequently critically revised and modified by the Splenectomy in Rare Anemias Study Group, which includes hematologists caring for both adults and children. PMID:28550188

  20. Splenectomy revised: manually assisted splenectomy with the dexterity device--a feasibility study in 22 patients

    NARCIS (Netherlands)

    Meijer, D. W.; Gossot, D.; Jakimowicz, J. J.; de Wit, L. T.; Bannenberg, J. J.; Gouma, D. J.

    1999-01-01

    Laparoscopic splenectomy claims a number of advantages over open surgery: less trauma, quicker recovery, and faster return to normal activity. On the other hand, laparoscopic splenectomy is complex and time consuming, and so far, many surgeons are reluctant to perform such an operation. A new device

  1. Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.

    Science.gov (United States)

    Huang, Gregory S; Chance, Elisha A; Hileman, Barbara M; Emerick, Eric S; Gianetti, Emily A

    2017-01-01

    No criteria define indications for laparoscopic splenectomy in trauma. This investigation compared characteristics of trauma patients and outcomes between laparoscopic and open splenectomies. Patients were identified retrospectively by using ICD-9 codes. Included patients were 18 or older, with a blunt splenic injury from January 1, 2011, through December 31, 2014, and required splenectomy. Excluded patients had penetrating trauma, successful nonoperative management, or successful embolization. Variables included demographics, presenting characteristics, injury severity scores, abdominal abbreviated injury scores, splenic injury grade, surgical indication and approach (open or laparoscopic), surgery length, intra-operative blood loss, transfusions, length of stay, complications, mortality, and discharge disposition. Forty-one patients underwent open splenectomy, and 11 underwent laparoscopic splenectomy. The mean age was 48.7 years, and men comprised the sample majority (36/52). The groups were well matched for age, abdominal injury scores, and admission vital signs. The open group had a significantly lower level of consciousness and more acidosis compared with the laparoscopic group. Most laparoscopic splenectomies were performed after failed nonoperative management or embolization. The indications for open splenectomy were a positive focused assessment with sonography for trauma and computed tomography results. Laparoscopic patients had significantly longer times between presentation and surgery and longer operations, but had significantly less blood loss and fewer transfusions compared with the open group. There were no differences in mortality, length of stay, complications, or discharge dispositions. Laparoscopic splenectomy is useful in patients with blunt trauma in whom conservative management produced no improvement and who do not have other injuries to preclude laparoscopy.

  2. Splenectomy for people with thalassaemia major or intermedia.

    Science.gov (United States)

    Easow Mathew, Manu; Sharma, Akshay; Aravindakshan, Rajeev

    2016-06-14

    surgery. Given the lack of detail regarding the study methods beyond randomisation, the overall risk of bias for this study was unclear. The study was carried out over a period of 3.5 years, with each participant followed up only until discharge (less than one week after the intervention); it did not assess the majority of the outcomes outlined in this review (including two of the three primary outcomes, frequency of transfusion and quality of life). A total of three serious post-operative adverse events (the review's third primary outcome) were reported in the laparoscopic splenectomy group (one case of atelectasis and two cases of bleeding), compared to two events of atelectasis in the open surgery group; however, there were no significant differences between the groups for either atelectasis, risk ratio 0.50 (95% confidence interval 0.05 to 4.90) or for bleeding, risk ratio 5.00 (95% confidence interval 0.26 to 95.61). In addition, the study also reported three serious cases of intra-operative bleeding in the laparoscopic group which mandated conversion to open surgery, although the difference between groups was not statistically significant, risk ratio 7.00 (95% confidence interval 0.39 to 124.14). These effect estimates are based on very small numbers and hence are unreliable and imprecise. From this small study, there appeared to be an advantage for the laparoscopic approach, in terms of post-operative hospital stay, although the group difference was not large (median difference of 1.5 days, P = 0.03). The review was unable to find good quality evidence, in the form of randomised controlled studies, regarding the efficacy of splenectomy for treating thalassaemia major or intermedia. The single included study provided little information about the efficacy of splenectomy, and compared open surgery and laparoscopic methods. Further studies need to evaluate the long-term effectiveness of splenectomy and the comparative advantages of surgical methods. Due to a lack of

  3. Hematologic outcomes after total splenectomy and partial splenectomy for congenital hemolytic anemia.

    Science.gov (United States)

    Englum, Brian R; Rothman, Jennifer; Leonard, Sarah; Reiter, Audra; Thornburg, Courtney; Brindle, Mary; Wright, Nicola; Heeney, Matthew M; Jason Smithers, C; Brown, Rebeccah L; Kalfa, Theodosia; Langer, Jacob C; Cada, Michaela; Oldham, Keith T; Scott, J Paul; St Peter, Shawn D; Sharma, Mukta; Davidoff, Andrew M; Nottage, Kerri; Bernabe, Kathryn; Wilson, David B; Dutta, Sanjeev; Glader, Bertil; Crary, Shelley E; Dassinger, Melvin S; Dunbar, Levette; Islam, Saleem; Kumar, Manjusha; Rescorla, Fred; Bruch, Steve; Campbell, Andrew; Austin, Mary; Sidonio, Robert; Blakely, Martin L; Rice, Henry E

    2016-01-01

    The purpose of this study was to define the hematologic response to total splenectomy (TS) or partial splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD). The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic outcomes of children with CHA undergoing TS or PS to 1 year after surgery. Using random effects mixed modeling, we evaluated the association of operative type with change in hemoglobin, reticulocyte counts, and bilirubin. We also compared laparoscopic to open splenectomy. The analysis included 130 children, with 62.3% (n=81) undergoing TS. For children with HS, all hematologic measures improved after TS, including a 4.1g/dl increase in hemoglobin. Hematologic parameters also improved after PS, although the response was less robust (hemoglobin increase 2.4 g/dl, p<0.001). For children with SCD, there was no change in hemoglobin. Laparoscopy was not associated with differences in hematologic outcomes compared to open. TS and laparoscopy were associated with shorter length of stay. Children with HS have an excellent hematologic response after TS or PS, although the hematologic response is more robust following TS. Children with SCD have smaller changes in their hematologic parameters. These data offer guidance to families and clinicians considering TS or PS. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Resveratrol Reduces the Incidence of Portal Vein System Thrombosis after Splenectomy in a Rat Fibrosis Model

    Science.gov (United States)

    Xu, Meng; Xue, Wanli; Ma, Zhenhua; Bai, Jigang

    2016-01-01

    Purpose. To investigate the preventive effect of resveratrol (RES) on the formation of portal vein system thrombosis (PVST) in a rat fibrosis model. Methods. A total of 64 male SD rats, weighing 200–300 g, were divided into five groups: Sham operation, Splenectomy I, Splenectomy II, RES, and low molecular weight heparin (LMWH), with the former two groups as nonfibrosis controls. Blood samples were subjected to biochemical assays. Platelet apoptosis was measured by flow cytometry. All rats were euthanized for PVST detection one week after operation. Results. No PVST occurred in nonfibrosis controls. Compared to Splenectomy II, the incidences of PVST in RES and LMWH groups were significantly decreased (both p Splenectomy II (all p splenectomy in cirrhotic rat. Regulation of platelet function and induction of platelet apoptosis might be the underlying mechanisms. PMID:27433290

  5. Emergency splenectomy for trauma in the setting of splenomegaly, axillary lymphadenopathy, and incidental B-cell chronic lymphocytic leukemia: A case report

    Directory of Open Access Journals (Sweden)

    Rodolfo J. Oviedo, MD, FACS

    2017-01-01

    Conclusion: An emergency splenectomy is an appropriate operative intervention for a grade V splenic laceration with hemoperitoneum, splenomegaly, and axillary lymphadenopathy regardless of the potential for a neoplastic process such as B-cell CLL. Post-splenectomy vaccinations and oncologic follow-up for systemic chemotherapy should be facilitated after recovery.

  6. A case of thoracic splenosis in a post-splenectomy patient following abdominal trauma: Hello Howell-Jolly.

    Science.gov (United States)

    Viviers, Petrus J

    2014-08-01

    Seeding of splenic tissue to extra-abdominal sites is a relatively infrequent consequence of open abdominal trauma. Immunological function of these small foci of ectopic splenic tissue is unknown and their use in determining the splenic function may be limited. In this case report, a patient is described who had previously undergone an emergency splenectomy. The absence of Howell-Jolly bodies on the blood smear in a patient who had previously undergone surgical splenectomy raised the suspicion of splenosis. The immunological features as well as non-invasive evaluation of these ill-defined splenic tissue sites are discussed.

  7. Splenectomy Associated Changes in IgM Memory B Cells in an Adult Spleen Registry Cohort

    Science.gov (United States)

    Cameron, Paul U.; Jones, Penelope; Gorniak, Malgorzata; Dunster, Kate; Paul, Eldho; Lewin, Sharon; Woolley, Ian; Spelman, Denis

    2011-01-01

    Asplenic patients have a lifelong risk of overwhelming post-splenectomy infection and have been reported to have low numbers of peripheral blood IgM memory B cells. The clinical value of quantitation of memory B cells as an indicator of splenic abnormality or risk of infection has been unclear. To assess changes in B cell sub-populations after splenectomy we studied patients recruited to a spleen registry (n = 591). A subset of 209 adult asplenic or hyposplenic subjects, and normal controls (n = 140) were tested for IgM memory B cells. We also determined a) changes in IgM memory B cells with time after splenectomy using the cross-sectional data from patients on the registry and b) the kinetics of changes in haematological markers associated with splenectomy(n = 45). Total B cells in splenectomy patients did not differ from controls, but memory B cells, IgM memory B cells and switched B cells were significantly (psplenectomy. Changes of asplenia in routine blood films including presence of Howell-Jolly bodies (HJB), occurred early (median 25 days) and splenectomy associated thrombocytosis and lymphocytosis peaked by 50 days. There was a more gradual decrease in IgM memory B cells reaching a stable level within 6 months after splenectomy. IgM memory B cells as proportion of B cells was the best discriminator between splenectomized patients and normal controls and at the optimal cut-off of 4.53, showed a true positive rate of 95% and false positive rate of 20%. In a survey of 152 registry patients stratified by IgM memory B cells around this cut-off there was no association with minor infections and no registry patients experienced OPSI during the study. Despite significant changes after splenectomy, conventional measures of IgM memory cells have limited clinical utility in this population. PMID:21829713

  8. Splenectomy associated changes in IgM memory B cells in an adult spleen registry cohort.

    Directory of Open Access Journals (Sweden)

    Paul U Cameron

    Full Text Available Asplenic patients have a lifelong risk of overwhelming post-splenectomy infection and have been reported to have low numbers of peripheral blood IgM memory B cells. The clinical value of quantitation of memory B cells as an indicator of splenic abnormality or risk of infection has been unclear. To assess changes in B cell sub-populations after splenectomy we studied patients recruited to a spleen registry (n = 591. A subset of 209 adult asplenic or hyposplenic subjects, and normal controls (n = 140 were tested for IgM memory B cells. We also determined a changes in IgM memory B cells with time after splenectomy using the cross-sectional data from patients on the registry and b the kinetics of changes in haematological markers associated with splenectomy(n = 45. Total B cells in splenectomy patients did not differ from controls, but memory B cells, IgM memory B cells and switched B cells were significantly (p<0.001 reduced. The reduction was similar for different indications for splenectomy. Changes of asplenia in routine blood films including presence of Howell-Jolly bodies (HJB, occurred early (median 25 days and splenectomy associated thrombocytosis and lymphocytosis peaked by 50 days. There was a more gradual decrease in IgM memory B cells reaching a stable level within 6 months after splenectomy. IgM memory B cells as proportion of B cells was the best discriminator between splenectomized patients and normal controls and at the optimal cut-off of 4.53, showed a true positive rate of 95% and false positive rate of 20%. In a survey of 152 registry patients stratified by IgM memory B cells around this cut-off there was no association with minor infections and no registry patients experienced OPSI during the study. Despite significant changes after splenectomy, conventional measures of IgM memory cells have limited clinical utility in this population.

  9. Laparoscopic splenectomy using conventional instruments

    Directory of Open Access Journals (Sweden)

    Dalvi A

    2005-01-01

    Full Text Available INTRODUCTION : Laparoscopic splenectomy (LS is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4, 197-200 (2004], trauma [Ren et al., Surg Endosc 15(3, 324 (2001; Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4, 283-286 (2002], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45, 847-852 (2002]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported. MATERIALS AND METHODS : Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision. RESULTS : A total of 26 patients underwent LS. Twenty-two (85% of patients had spleen size more than 500 g (average weight being 942.55 g. Mean operative time was 214 min (45-390 min. The conversion rate was 11.5% ( n = 3. Average duration of stay was 5.65 days (3-30 days. Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease. CONCLUSION : Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS.

  10. Splenectomy Is Modifying the Vascular Remodeling of Thrombosis

    Science.gov (United States)

    Frey, Maria K.; Alias, Sherin; Winter, Max P.; Redwan, Bassam; Stübiger, Gerald; Panzenboeck, Adelheid; Alimohammadi, Arman; Bonderman, Diana; Jakowitsch, Johannes; Bergmeister, Helga; Bochkov, Valery; Preissner, Klaus T.; Lang, Irene M.

    2014-01-01

    Background Splenectomy is a clinical risk factor for complicated thrombosis. We hypothesized that the loss of the mechanical filtering function of the spleen may enrich for thrombogenic phospholipids in the circulation, thereby affecting the vascular remodeling of thrombosis. Methods and Results We investigated the effects of splenectomy both in chronic thromboembolic pulmonary hypertension (CTEPH), a human model disease for thrombus nonresolution, and in a mouse model of stagnant flow venous thrombosis mimicking deep vein thrombosis. Surgically excised thrombi from rare cases of CTEPH patients who had undergone previous splenectomy were enriched for anionic phospholipids like phosphatidylserine. Similar to human thrombi, phosphatidylserine accumulated in thrombi after splenectomy in the mouse model. A postsplenectomy state was associated with larger and more persistent thrombi. Higher counts of procoagulant platelet microparticles and increased leukocyte–platelet aggregates were observed in mice after splenectomy. Histological inspection revealed a decreased number of thrombus vessels. Phosphatidylserine‐enriched phospholipids specifically inhibited endothelial proliferation and sprouting. Conclusions After splenectomy, an increase in circulating microparticles and negatively charged phospholipids is enhanced by experimental thrombus induction. The initial increase in thrombus volume after splenectomy is due to platelet activation, and the subsequent delay of thrombus resolution is due to inhibition of thrombus angiogenesis. The data illustrate a potential mechanism of disease in CTEPH. PMID:24584745

  11. Splenectomy and risk of renal and perinephric abscesses

    Science.gov (United States)

    Lai, Shih-Wei; Lin, Hsien-Feng; Lin, Cheng-Li; Liao, Kuan-Fu

    2016-01-01

    Abstract Little epidemiological research is available on the relationship between splenectomy and renal and perinephric abscesses. The purpose of the study was to examine this issue in Taiwan. We conducted a population-based retrospective cohort study using the hospitalization dataset of the Taiwan National Health Insurance Program. A total of 16,426 participants aged 20 and older who were newly diagnosed with splenectomy from 1998 to 2010 were assigned to the splenectomy group, whereas 65,653 sex-matched, age-matched, and comorbidity-matched, randomly selected participants without splenectomy were assigned to the nonsplenectomy group. The incidence of renal and perinephric abscesses at the end of 2011 was measured in both groups. The multivariable Cox proportional hazards regression model was used to measure the hazard ratio (HR) and 95% confidence interval (CI) for risk of renal and perinephric abscesses associated with splenectomy and other comorbidities including cystic kidney disease, diabetes mellitus, urinary tract infection, and urolithiasis. The overall incidence rate of renal and perinephric abscesses was 2.14-fold greater in the splenectomy group than that in the nonsplenectomy group (2.24 per 10,000 person-years vs 1.05 per 10,000 person-years, 95% CI 2.02, 2.28). After controlling for sex, age, cystic kidney disease, diabetes mellitus, urinary tract infection, and urolithiasis, the multivariable regression analysis demonstrated that the adjusted HR of renal and perinephric abscesses was 2.24 for the splenectomy group (95 % CI 1.30, 3.88), when compared with the nonsplenectomy group. In further analysis, the adjusted HR markedly increased to 7.69 for those comorbid with splenectomy and diabetes mellitus (95% CI 3.31, 17.9). Splenectomy is associated with renal and perinephric abscesses, particularly comorbid with diabetes mellitus. In view of its potential morbidity and mortality, clinicians should consider the possibility of renal and perinephric

  12. Safety of splenectomy during pregnancy.

    Science.gov (United States)

    Bleau, Nathalie; Czuzoj-Shulman, Nicholas; Spence, Andrea R; Abenhaim, Haim Arie

    2017-07-01

    The aim of our study is to evaluate the risk of morbidity and mortality of splenectomy in pregnant women compared with non-pregnant women. We conducted a retrospective population-based matched cohort study using the Health Care Cost and Utilization Project, Nationwide Inpatient Sample database from 2003 to 2011. Pregnant women with splenectomy were age-matched to non-pregnant women with splenectomy. We compared risks of morbidity and mortality between pregnant and non-pregnant women using conditional logistic regression analysis. The non-pregnant group had an excess of white patients and a greater proportion of Medicaid and private insurance users. There was a tendency for greater frequency of laparotomies in pregnant patients. Risk of VTE, portal vein thrombosis, renal failure and sepsis were comparable between the groups. Risk for transfusion was higher amongst pregnant women (OR 2.2, 95% CI (1.7-2.8)), as was the risk for a longer hospital stay (OR 1.7, 95% CI (1.4-2.1)). Caution should be taken when performing splenectomy during pregnancy as risk for complications and mortality may be increased. Additional measures should be undertaken to have blood units on reserve for this population.

  13. Hematologic outcomes after total splenectomy and partial splenectomy for congenital hemolytic anemia☆☆☆

    Science.gov (United States)

    Englum, Brian R.; Rothman, Jennifer; Leonard, Sarah; Reiter, Audra; Thornburg, Courtney; Brindle, Mary; Wright, Nicola; Heeney, Matthew M.; Smithers, C. Jason; Brown, Rebeccah L.; Kalfa, Theodosia; Langer, Jacob C.; Cada, Michaela; Oldham, Keith T.; Scott, J. Paul; St Peter, Shawn D; Sharma, Mukta; Davidoff, Andrew M.; Nottage, Kerri; Bernabe, Kathryn; Wilson, David B.; Dutta, Sanjeev; Glader, Bertil; Crary, Shelley E.; Dassinger, Melvin S.; Dunbar, Levette; Islam, Saleem; Kumar, Manjusha; Rescorla, Fred; Bruch, Steve; Campbell, Andrew; Austin, Mary; Sidonio, Robert; Blakely, Martin L.; Rice, Henry E.

    2016-01-01

    Purpose The purpose of this study was to define the hematologic response to total splenectomy (TS) or partial splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD). Methods The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic outcomes of children with CHA undergoing TS or PS to 1 year after surgery. Using random effects mixed modeling, we evaluated the association of operative type with change in hemoglobin, reticulocyte counts, and bilirubin. We also compared laparoscopic to open splenectomy. Results The analysis included 130 children, with 62.3% (n = 81) undergoing TS. For children with HS, all hematologic measures improved after TS, including a 4.1 g/dl increase in hemoglobin. Hematologic parameters also improved after PS, although the response was less robust (hemoglobin increase 2.4 g/dl, p < 0.001). For children with SCD, there was no change in hemoglobin. Laparoscopy was not associated with differences in hematologic outcomes compared to open. TS and laparoscopy were associated with shorter length of stay. Conclusion Children with HS have an excellent hematologic response after TS or PS, although the hematologic response is more robust following TS. Children with SCD have smaller changes in their hematologic parameters. These data offer guidance to families and clinicians considering TS or PS. PMID:26613837

  14. Splenectomy Leads to Amelioration of Altered Gut Microbiota and Metabolome in Liver Cirrhosis Patients

    Directory of Open Access Journals (Sweden)

    Yang Liu

    2018-05-01

    Full Text Available Dysbiosis of gut microbiota and metabolome is a frequently encountered condition in liver cirrhosis (LC patients. The severity of liver dysfunction was found to be correlated with the degree of microbial dysbiosis. Several clinical studies have indicated liver function improvement after therapeutic splenectomy for LC-induced hypersplenism. We sought to determine whether such post-splenectomy outcome is pertinent to modulation of the abnormal gut microenvironment in LC patients. A cross-sectional study including 12 LC patients and 16 healthy volunteers was first conducted, then a before–after study in the cohort of patients was carried out before and 6 months after splenectomy. Fecal samples were collected in hospital. Temporal bacterial (n = 40 and metabolomics (n = 30 profiling was performed using 16s rRNA gene sequencing and ultra performance liquid chromatography/mass spectrometer (UPLC/MS, respectively. Our results revealed that microbial composition in patients was clearly different from that in healthy controls (HCs, evidenced by considerable taxonomic variation. Along with improved liver function (Child–Pugh score, the patients also displayed similar gut microbiota profile and predicted metagenome function to that of HCs after splenectomy. Enterobacteriaceae and Streptococcaceae, two LC-enriched families showing positive relation with Child–Pugh score, exhibited significantly decreased abundance after splenectomy. At the genus level, 11 genera were differentially abundant between patients and HCs, but 9 genera of them restituted to normal levels by certain degree after splenectomy. PICRUSt analysis showed that the relative abundance of 17 KEGG pathways was partially restored after splenectomy. Four of them were amino acid-related pathways: lysine degradation, tryptophan degradation, amino acid metabolism, and protein digestion and absorption. These findings were supported by metabonomics results which showed that relative abundance

  15. Effects of prednisone and splenectomy in patients with idiopathic thrombocytopenic purpura : only splenectomy induces a complete remission

    NARCIS (Netherlands)

    Louwes, H; Vellenga, E; Houwerzijl, EJ; de Wolf, JTM

    2001-01-01

    Idiopathic thrombocytopenic purpura (ITP) is a heterogeneous disease, whereby it is unclear if and in which way prednisone and splenectomy affect the platelet kinetics leading to a complete remission. To determine the effects of prednisone and splenectomy on the mean platelet life (MPL) and platelet

  16. Splenectomy for hematological diseases: The Qatif Central HospitalExperience

    International Nuclear Information System (INIS)

    Al-Salem, Ahmed H.; Naserullah, Z.; Qaisaruddin, S.; Al-Dabbous, I.; Al-Abkari, H.; Al-Jama, A.; Al-Faraj, A.; Yassin, Yassin M.

    1999-01-01

    In the Eastern Province of Saudi Arabia, an area known for varioushemoglobinopathies, splenectomy is performed rather frequently. This study isan analysis of our experience with splenectomy performed for varioushematological disorders between 1988 and 1997, outlining the indications,complications and outcome. This is a retrospective analysis of all patientswho had splenectomy at our hospital during this period. One hundred andforty-three patients were treated for various hematological disorders at ourhospital. These disorders included sickle cell disease (SCD) (100 patients),sickle thalassemia (S-B-thalassemia) (13 ITP) (5 patients), Gaucher's disease(2 patients), hereditary spherocytosis (1 patient), autoimmune hemolyticanemia (1 patient), thalssemia intermediate (2 patients) and chronic myeloidleukemia (1 patient). The indications for splenectomy in those with SCD andthalassemia were: hypersplenism (26 patients), major splenic sequestrationcrisis (50 patients), splenic abscess (12 patients), and massive splenicinfarction (2 patients). Splenectomy in these patients was beneficial inreducing their transfusion requirements and its attendant risks, eliminatingthe discomfort from mechanical pressure of the enlarged spleen, avoiding therisks of acute splenic sequestration crisis, and managing splenic abscess.For those with Thalassemia, total splenectomy was beneficial in reducingtheir transfusion requirements, while partial splenectomy was beneficial onlyas a temporary measure, as regrowth of splenic remnant in these patientssubsequently led to increase in their transfusion requirements. Those withITP, hereditary spherocytosis, and autoimmune hemolytic anemia showedexcellent response following splenectomy. There was no mortality, and thepostoperative morbidity was 5.6%. With careful perioperative management,splenectomy is both safe and beneficial in a selected group of patients withhematological diseases. (author)

  17. Laparoscopic splenectomy for hereditary spherocytosis-preliminary report.

    Science.gov (United States)

    Rogulski, Robert; Adamowicz-Salach, Anna; Matysiak, Michał; Piotrowski, Dariusz; Gogolewski, Michał; Piotrowska, Anna; Roik, Danuta; Kamiński, Andrzej

    2016-06-01

    Splenectomy is considered standard surgical therapy in hereditary spherocytosis. The procedure is indicated in patients with severe anemia, recurrent hemolytic, and aplastic crises. The aim of the study was to assess treatment outcomes in patients with hereditary spherocytosis who underwent total or partial laparoscopic splenectomy. Fifteen patients aged 4-17 yr underwent laparoscopic splenectomy from 2009 to 2012. Partial and total splenectomies were performed (five and 10 children, respectively). Hematologic parameters, liver function tests, and splenic volume before and after the surgery were analyzed retrospectively. Total follow-up was 1-30 months. Hospitalization and operating time were similar in both groups. In partial splenectomy group, branches of splenic arteries gave better blood supply than short gastric vessels. In both groups, hematologic parameters were improved. Postoperative markedly elevated platelet count was maintained up to 6 months, and after that, platelet count gradually decreased to normal values. Bilirubin level was decreased in early postoperative period; however, it increased later to achieve levels lower than in preoperative period. No severe general infections were observed in both groups. Laboratory parameters (hemoglobin and bilirubin concentrations and RBC) after the surgery improved in all patients, and the effect was maintained during 12 months of follow-up. Platelet count increased significantly after the surgery and was maintained at high levels during the next 6 months. However, it returned to preoperative levels within a year after the surgery. Our study showed that partial splenectomy was not inferior to total splenectomy. However, full assessment requires longer follow-up and larger group of patients. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Assessment of the incidence of GDV following splenectomy in dogs.

    Science.gov (United States)

    Goldhammer, M A; Haining, H; Milne, E M; Shaw, D J; Yool, D A

    2010-01-01

    To establish if splenectomy increases the incidence of gastric dilatation and volvulus (GDV) in dogs. Two case-series studies of cases and controls were performed. Records of dogs that had undergone splenectomy (37 cases) were compared with records of dogs that had undergone other abdominal surgery (43 cases). Records of dogs that presented for non-elective gastropexy (33 cases) were compared with records of dogs presented to the hospital for unrelated reasons (39 cases). Survival following splenectomy and development of GDV in the first 12 months following surgery were retrieved from the clinical records and by questionnaire-based canvassing of the referring clinician. The incidence of GDV following splenectomy was established and the association between a current episode of GDV and previous splenectomy was assessed. There was no evidence that splenectomy was associated with an increased incidence of subsequent GDV (P=0.469). No association between a current episode of GDV and previous splenectomy was found. Splenectomy is not associated with an increase in the incidence of GDV.

  19. Long-term complications of splenectomy in adult immune thrombocytopenia.

    Science.gov (United States)

    Thai, Lan-Huong; Mahévas, Matthieu; Roudot-Thoraval, Françoise; Limal, Nicolas; Languille, Laetitia; Dumas, Guillaume; Khellaf, Mehdi; Bierling, Philippe; Michel, Marc; Godeau, Bertrand

    2016-11-01

    The recent large decrease in splenectomy use for chronic immune thrombocytopenia (ITP) is partly due to still-unsolved questions about long-term safety. We performed the first single-center exposed/unexposed cohort study evaluating the long-term incidence of splenectomy complications in patients with primary ITP. Overall, 83 patients who underwent splenectomy more than 10 years ago (exposed) were matched with 83 nonsplenectomized patients (unexposed) on the date of ITP diagnosis ±5 years, age and gender. After a median follow-up of 192 months (range 0.5-528), 43 patients (52%) achieved overall response after splenectomy. Splenectomized patients experienced more venous thromboembolism (VTE) than controls (n = 13 vs n = 2, P = 0.005). On multivariate analysis, splenectomy was an independent risk factor of VTE (hazard ratio = 4.006, P = 0.032 [95% confidence interval: 1.13-14.21]). Splenectomized patients presented more severe infections on long-term follow-up: all required hospitalization, and 5/26 (19%) infections led to severe sepsis or septic shock and to death for 3 cases (none in controls). However, the incidence of malignancy was similar in both groups, as was cardiovascular risk, which appeared to be related more to ITP than splenectomy. Finally, splenectomy did not significantly decrease overall survival. Despite the risk of thrombosis and severe sepsis, splenectomy remains an effective and curative treatment for ITP.

  20. Patients After Splenectomy: Old Risks and New Perspectives.

    Science.gov (United States)

    Dragomir, Mihnea; Petrescu, Dragoş George Emil; Manga, Graţiela Elena; Călin, George A; Vasilescu, Cătălin

    2016-01-01

    The risks that arise after splenectomy can be divided in infectious and non-infectious. The link between splenectomy and these hazards remains partially unknown. Host defense against infection is altered after splenectomy and such individuals develop sepsis more easily and the infection has a fulminant course. Splenectomy is also a potential risk factor for several vascular complications that result from partial or total obstruction of an arterial or venous blood vessel. Furthermore, pulmonary hypertensioncan be a severe and sometimes fatal complication following splenectomy. Some authors also consider that malignancies, diabetes mellitus and acute pancreatitis are non-infectious complications after splenectomy. The most feared complication for splenectomized patients remains sepsis. The pathophysiology of sepsis is still controversial. Death in sepsis can occur due to either hyper-inflammation or immune paralysis. Multiple experimental evidences link cellular and viral microRNAs with sepsis. We presume that miRNAs are also associated with the immunosuppression of the asplenic patients which leads to the high risk of deadly sepsis. Studying the expression level of circulating miRNAs in asplenic patients could help us better understand the postsplenectomy immunosuppression and develop new diagnostic and therapeutic tools. Celsius.

  1. Splenectomy Does Not Improve Long-Term Outcome After Stroke.

    Science.gov (United States)

    Zierath, Dannielle; Shen, Angela; Stults, Astiana; Olmstead, Theresa; Becker, Kyra J

    2017-02-01

    Immune responses to brain antigens after stroke contribute to poor outcome. We hypothesized that splenectomy would lessen the development of such responses and improve outcome. Male Lewis rats (275-350 g) underwent 2-hour middle cerebral artery occlusion immediately after splenectomy or sham splenectomy. Animals were survived to 4 weeks (672 hrs), and immune responses to myelin basic protein determined at euthanasia. Infarct volume was determined in a subset of animals euthanized at 72 hours. Behavioral outcomes were assessed to 672 hours. Splenectomy was associated with worse neurological scores early after stroke, but infarct size at 72 hours was similar in both groups. Behavioral outcomes and immune responses to myelin basic protein were also similar among splenectomized and sham-operated animals 672 hours after middle cerebral artery occlusion. Splenectomy did not alter the immune responses to brain antigens or improve outcome after stroke. Differences between this study and other studies of splenectomy and stroke are examined. © 2017 American Heart Association, Inc.

  2. Evaluation of Partial and Total Splenectomy in Children with Sickle Cell Disease Using an Internet-Based Registry

    Science.gov (United States)

    Mouttalib, Sofia; Rice, Henry E.; Snyder, Denise; Levens, Justin S.; Reiter, Audra; Soler, Pauline; Rothman, Jennifer A.; Thornburg, Courtney D.

    2011-01-01

    Background Clinical outcomes of children with sickle cell disease (SCD) who undergo total or partial splenectomy are poorly defined. The purpose of this retrospective study was to initiate an internet-based registry to facilitate analysis of clinical outcomes for these children. We hypothesized that both surgical procedures would be well tolerated and would eliminate risk of splenic sequestration. Methods We developed a web-based registry using the Research Electronic Data Capture (REDCap) platform. Children were included if they had SCD and underwent total splenectomy (TS) or partial splenectomy (PS) between 2003 to 2010. Clinical outcomes were compared between cohorts, with follow-up to one year. Results Twenty-four children were included, total splenectomy (n=15) and partial splenectomy (n=9). There were no differences in surgical time or intraoperative blood loss. The length of stay was longer after PS (4.1±1.7 days) compared to TS, (2.4±1.2 days, p=0.02). Within 30 days of surgery, 2 (20%) patients had acute chest syndrome following TS and 2 (15%) patients had acute chest syndrome after PS. During one year follow-up, no patient in either cohort had recurrent splenic sequestration, venous thrombosis or overwhelming post-splenectomy sepsis. All children who were transfused preoperatively to prevent recurrent splenic sequestration successfully discontinued transfusions. Conclusions Both TS and PS result in favorable hematologic outcomes and low risk of adverse events for children with SCD. A REDCap based registry may facilitate data entry and analysis of clinical outcomes to allow for comparison between different types of splenectomy. PMID:22238140

  3. Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases

    Science.gov (United States)

    Leone, Giuseppe; Pizzigallo, Eligio

    2015-01-01

    Splenectomy, while often necessary in otherwise healthy patients after major trauma, finds its primary indication for patients with underlying malignant or nonmalignant hematologic diseases. Indications of splenectomy for hematologic diseases have been reducing in the last few years, due to improved diagnostic and therapeutic tools. In high-income countries, there is a clear decrease over calendar time in the incidence of all indication splenectomy except nonmalignant hematologic diseases. However, splenectomy, even if with different modalities including laparoscopic splenectomy and partial splenectomy, continue to be a current surgical practice both in nonmalignant hematologic diseases, such as Immune Thrombocytopenic Purpura (ITP), Autoimmune Hemolytic Anemia (AIHA), Congenital Hemolytic Anemia such as Spherocytosis, Sickle Cell Anemia and Thalassemia and Malignant Hematological Disease, such as lymphoma. Today millions of people in the world are splenectomized. Splenectomy, independently of its cause, induces an early and late increase in the incidence of venous thromboembolism and infections. Infections remain the most dangerous complication of splenectomy. After splenectomy, the levels of antibody are preserved but there is a loss of memory B cells against pneumococcus and tetanus, and the loss of marginal zone monocytes deputed to immunological defense from capsulated bacteria. Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients. Vaccination with polysaccharide and conjugate vaccines again Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis should be performed before the splenectomy. This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria. At present, most of infections found in splenectomized patients are due to Gram

  4. Indications and complications of splenectomy for children with sickle cell disease.

    Science.gov (United States)

    Al-Salem, Ahmed H

    2006-11-01

    Sickle cell anemia (SCA), which is characterized by high hemoglobin (Hb) F level and persistent splenomegaly into the older age group (up to 18 years of age) or even adults, is one of the commonest hemoglobinopathies in the Eastern Province of Saudi Arabia. This makes them liable to develop splenic complications requiring splenectomy. This is a review of our experience in the management of 134 children with SCA who had splenectomy as part of their management at our hospital, with emphasis given to the indications and complications of splenectomy. The medical records of all children who had splenectomy at our hospital were retrospectively reviewed for the following: age at splenectomy, sex, Hb electrophoresis, indication for splenectomy, preoperative investigations, type of surgery, spleen weight, histology, perioperative management, and postoperative complications. From 1990 to 2004, 170 children with various hematologic disorders had splenectomy at our hospital. Of these, 134 had SCA (118 had sickle cell disease and 16 had sickle-beta-thalassemia). Recurrent acute splenic sequestration crisis (ASSC) was the commonest indication for splenectomy in 103 (76.9%) patients, followed by hypersplenism in 18 (13.4%). Seven (5.2%) of our patients had splenectomy for splenic abscess (SA) and 2 had splenectomy for massive splenic infarction; 103 (61 boys, 42 girls) patients with a mean age of 7.6 years (range, 1.8-13 years) had splenectomy for ASSC. Their mean Hb F level was 20.5% (range, 9.2%-39.6%). Thirty-two of them had major attacks. Their Hb levels at the time of admission ranged from 1.4 to 4.1 g/dL (mean, 2.5 g/dL). The remaining 71 had minor recurrent attacks. Eighteen had splenectomy for hypersplenism and all had a significant increase in their blood parameters after splenectomy. Seven had splenectomy for SA. In 5 patients, Salmonella was the causative organism; in 1, it was Enterobacter sakazaki, whereas in 1, no organisms were identified. Two of our patients had

  5. Laparoscopic and Open Splenectomy and Hepatectomy.

    Science.gov (United States)

    Li, Jing-Feng; Bai, Dou-Sheng; Jiang, Guo-Qing; Chen, Ping; Jin, Sheng-Jie; Zhu, Zhi-Xian

    2017-01-01

    Patients undergoing synchronous open splenectomy and hepatectomy (OSH) for concurrent hepatocellular carcinoma (HCC) and hypersplenism usually have major surgical trauma caused by the long abdominal incision. Surgical procedures that contribute to rapid recovery with the least possible impairment are desired by both surgeons and patients. The objective of this study was to explore outcomes in patients treated with simultaneous laparoscopic or open splenectomy and hepatectomy for hepatocellular carcinoma (HCC) with hypersplenism. We retrospectively evaluated the treatment outcomes in 23 patients with cirrhosis, HCC, and hypersplenism, who underwent simultaneous laparoscopic splenectomy and hepatectomy (LSH; n = 12) or open splenectomy and hepatectomy (OSH; n = 11) from January 2012 through December 2015. Their perioperative variables were compared. LSH was successful in all patients. There were nonsignificant similarities between the 2 groups in duration of operation, estimated blood loss, and volume of blood transfused ( P > .05 each). Compared with OSH, LSH had a significantly shorter postoperative visual analog scale pain score ( P 38.0°C ( P < .01); fewer postoperative complications ( P < .05); and better liver and renal function on postoperative days 7 ( P < .05 each). Simultaneous LSH is safe for selected patients with HCC and hypersplenism associated with liver cirrhosis.

  6. Splenectomy and increased subsequent cancer risk: a nationwide population-based cohort study.

    Science.gov (United States)

    Sun, Li-Min; Chen, Hsuan-Ju; Jeng, Long-Bin; Li, Tsai-Chung; Wu, Shih-Chi; Kao, Chia-Hung

    2015-08-01

    Splenectomy has been suggested to have an impact on immunological function, and subsequent development of cancer has been recognized as a possible adverse effect of splenectomy. This study evaluated the possible association between splenectomy and malignancy in Taiwan. A cohort study consisted of including 2,603 patients with nontraumatic and 2,295 patients with traumatic splenectomy, and then randomly frequency matched with 4 participants without splenectomy. The Cox proportional hazard regression analysis was conducted to estimate the influence of splenectomy on cancer risk. Both nontraumatic and traumatic splenectomy had a significantly higher risk for overall cancer development (adjusted hazard ratios are 2.64 and 1.29 for nontraumatic and traumatic reasons, respectively). After adjusting for age, sex, and comorbidities, patients with splenectomy were associated with significantly higher risks for developing certain gastrointestinal tract cancers, other head and neck cancers, and hematological malignancies, and the phenomenon is more prominent in nontraumatic splenectomy group. This nationwide population-based study found that people with splenectomy have higher risks of developing overall cancer, as well as certain site-specific cancers, especially for patients with nontraumatic reasons. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Laparoscopic splenectomy for spontaneous rupture of the spleen

    Directory of Open Access Journals (Sweden)

    Pinky M Thapar

    2016-01-01

    Full Text Available Laparoscopic splenectomy is a gold standard for management of planned benign splenic pathologies. Spontaneous rupture of the spleen (SRS leading to acute abdomen occurs in only 1% of all splenic ruptures. Laparoscopic splenectomy in traumatic and atraumatic rupture due to intra-splenic pathology is reported. We present the first reported case of laparoscopic splenectomy in a 23-year-old male who presented with hemoperitoneum due to idiopathic or SRS. The procedure was safely accomplished with slight modified technique and minimum usage of advanced gadgets.

  8. A long-term follow-up study of subtotal splenectomy in children with hereditary spherocytosis.

    Science.gov (United States)

    Rosman, C W K; Broens, P M A; Trzpis, M; Tamminga, R Y J

    2017-10-01

    Hereditary spherocytosis (HS) is a heterogeneous hemolytic anemia treated with splenectomy in patients suffering from severe or moderate disease. Total splenectomy, however, renders patients vulnerable to overwhelming postsplenectomy infection despite preventive measures. Although subtotal splenectomy has been advocated as an alternative to total splenectomy, long-term follow-up data are scarce. We investigated how often hematologic recurrences requiring secondary total splenectomy occurred. With a follow-up of at least 5 years, we analyzed the data of 12 patients, aged 11 years maximum (median 6.5 years), who had undergone intended subtotal splenectomy, and 9 patients (median age 11.9 years), who had undergone total splenectomy. We compared their hematologic results and searched for factors associated with secondary spleen surgery. Hemolysis was reduced after subtotal splenectomy and absent after total splenectomy. Subtotal splenectomy was not successful in three children because no functional splenic remnant remained after 6 months (one conversion at surgery; one necrosis of splenic remnant; one early secondary splenectomy). Four children required secondary splenectomy after a median of 5 years for hematologic recurrence. In the remaining five patients, a functional splenic remnant was present for at least 5.5 years. The median time to secondary total splenectomy after intended subtotal splenectomy was 5.2 years. In all patients requiring secondary total splenectomy, increased reticulocyte levels within 2 years indicated hematologic recurrence. Subtotal splenectomy can be an alternative for total splenectomy in young patients with HS. It allows for hematologic improvement and may preserve splenic immune function for as many as 5 years. © 2017 Wiley Periodicals, Inc.

  9. Laparoscopic versus open splenectomy in children with benign ...

    African Journals Online (AJOL)

    2017-06-28

    Jun 28, 2017 ... Thalassemia was present in 36 cases, idiopathic thrombocytopenic purpura ... hemoglobinopathies) and extracellular defects particu- larly autoimmune .... Thalassemia. 2. 2. Spherocytosis. 1. 0. ITP, idiopathic thrombocytopenic purpura; LS, laparoscopic splenectomy;. OS, open splenectomy. Laparoscopic ...

  10. Fatal pulmonary embolism following splenectomy in a patient with Evan's syndrome: case report and review of the literature.

    Science.gov (United States)

    Monga, Varun; Maliske, Seth M; Perepu, Usha

    2017-01-01

    Evans syndrome (ES) is a rare disease characterized by simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) with or without immune neutropenia. Splenectomy is one of the treatment options for disease refractory to medical therapy. Venous thromboembolism (VTE) following splenectomy for hematological diseases has an incidence of 10%. Here we describe a case report of a young patient hospitalized with severe hemolytic anemia with Hgb 4.8 g/dl. He developed thrombocytopenia with platelet nadir of 52,000/mm 3 , thus formally diagnosed with ES. He failed standard medical therapy. He underwent splenectomy and had a fatal outcome. Autopsy confirmed the cause of death as pulmonary embolism (PE). This case report and review of the literature highlight important aspects of the association between VTE, splenectomy, and hemolytic syndromes including the presence of thrombocytopenia. The burden of the disease is reviewed as well as various pathophysiologic mechanisms contributing to thromboembolic events in these patients and current perioperative prophylactic anticoagulation strategies. Despite an advancing body of literature increasing awareness of VTE following splenectomy, morbidity and mortality remains high. Identifying high risk individuals for thromboembolic complications from splenectomy remains a challenge. There are no consensus guidelines for proper perioperative and post-operative anti-coagulation. We encourage future research to determine which factors might be playing a role in increasing the risk for VTE in real time with hope of forming a consensus to guide management.

  11. Partial splenectomy in children with Gaucher's disease

    International Nuclear Information System (INIS)

    Bar-Maor, J.A.; Govrin-Yehudain, J.

    1985-01-01

    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

  12. Splenectomy Increases Postoperative Complications Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

    Science.gov (United States)

    Dagbert, Francois; Thievenaz, Remy; Decullier, Evelyne; Bakrin, Naoual; Cotte, Eddy; Rousset, Pascal; Vaudoyer, Delphine; Passot, Guillaume; Glehen, Olivier

    2016-06-01

    Complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is increasingly performed on patients with peritoneal carcinomatosis of various origins. Splenectomy often is required in these patients to achieve complete tumor removal. Although splenectomy has been associated with increased morbidity in many major abdominal surgeries, its effect in patients undergoing CRS + HIPEC is unknown. The purpose of this study was to evaluate the impact of splenectomy during CRS + HIPEC on postoperative outcomes. We retrospectively identified 39 patients who underwent CRS + HIPEC with splenectomy during a 3-year study period from a prospective database. We compared them to case controls (CRS + HIPEC without splenectomy) that were matched for the complexity of the procedure. We evaluated the complication rate and outcomes of patients in each group. During the study period, splenectomy was performed in 32 % of patients undergoing CRS + HIPEC procedure. Patients in the splenectomy group experienced more grade 3-4 complications than patients in the control group (59 vs. 35.9 %, p = 0.041) as well as more pulmonary complications (41 vs. 7.7 %, p = 0.0006). Multivariate analysis identified splenectomy as the only predictor of overall major complications (odds ratio = 2.57, 95 % confidence interval = 1.03-6.40). Mortality was similar in both groups. Splenectomy increases major complication rate in patients undergoing CRS + HIPEC and efforts should be made to preserve the spleen during the surgery.

  13. The impact of splenectomy on outcomes after distal and total pancreatectomy

    Directory of Open Access Journals (Sweden)

    Bramhall Simon

    2007-06-01

    Full Text Available Abstract Background Several authors advocate spleen preserving distal pancreatectomy, because of the increased complication rate after splenectomy. Methods Postoperative complications and survival after distal and total pancreatectomy, were recorded and retrospectively analyzed according to spleen preservation. Patients, who underwent distal and total pancreatectomy without histologically proven adenocarcinoma, or extrapancreatic disease, were included in the cohort which was divided into splenectomy and no splenectomy groups. Statistical analysis was performed using Fisher's test. Results The study group consisted of 62 patients who underwent distal and total pancreatectomy between 26/11/1987 to 6/1/2006. Splenectomy was performed in 35 out of 62 patients (56.5%, distal pancreatectomy was performed in 49 out of 62 patients (79%. Morbidity rate was 28.6% in splenectomy group and 14.8% in the no splenectomy group (p = 0.235, while 30 days mortality rate was 2.9%; one patient died in the splenectomy group (p = 1. Conclusion Spleen-preservation did not influence the outcomes after distal and total pancreatectomy in our series.

  14. Use of radionuclide techniques for assessment of splenic function and detection of splenic remnants

    International Nuclear Information System (INIS)

    Ganguly, S.; Sinha, S.; Sarkar, B.R.; Basu, S.; Ghosh, S.

    1998-01-01

    Full text: The spleen is often involved in hematological malignancies; it is also the site of RBC destruction in thalassemia and ITP. In latter cases, splenectomy is often performed and postoperatively, detection of functioning splenic remnants affect the prognosis adversely. In this study, we assessed the usefulness of radionuclide techniques in : a) assessment of splenic function in primarily non-splenic diseases (benign or malignant), and b) detection of splenic remnant after splenectomy. 12 patients of splenomegaly and 5 patients after splenectomy underwent splenic imaging; imaging was performed using both 99m Tc-sulphur colloid (with first pass) and 99m Tc labelled heat denatured RBCs as tracers. Thus splenic perfusion, morphology and RBC trapping functions were all assessed. The colloid images usually matched the RBC images except in 2 cases where photogenic areas (presumably infarcts) were visualized on RBC scans that were missed on colloid scans. Three of the post splenectomy cases revealed functioning splenic remnants, which was also better visualized on RBC scans. It is concluded that radionuclide imaging could be used regularly for assessing function of spleen, or detecting splenic remnants

  15. Laparoscopic hemi-splenectomy

    NARCIS (Netherlands)

    de Pastena, Matteo; Nijkamp, Maarten W.; van Gulik, Thomas G.; Busch, Olivier R.; Hermanides, H. S.; Besselink, Marc G.

    2018-01-01

    Laparoscopic splenectomy is now established as a safe and feasible procedure. However, it remains associated with some short- and long-term postoperative complications, especially infectious complications. To our knowledge, this is the first report (with video) focusing on the safety and feasibility

  16. Blood Changes after Splenectomy in Portal Hypertension. The ...

    African Journals Online (AJOL)

    Background: Splenectomy is a frequently performed operation for patients with portal hypertension and hypersplenism in areas endemic for schistosomiasis. Reactive thrombocytosis (RT) has been described following splenectomy. Nevertheless, data are lacking on the long term changes of platelet count and other blood ...

  17. Reemergence of Splenectomy for ITP Second-line Treatment?

    Science.gov (United States)

    Chater, Charbel; Terriou, Louis; Duhamel, Alain; Launay, David; Chambon, Jean P; Pruvot, François R; Rogosnitzky, Moshe; Zerbib, Philippe

    2016-11-01

    Corticosteroids are still the standard first-line treatment for immune thrombocytopenic purpura (ITP). As second-line therapy, splenectomy and Rituximab are both recommended. The aim of our study was to compare the efficacy of Rituximab to splenectomy in persistent or chronic ITP patients. Between January 1999 and March 2015, we retrospectively selected all consecutive patients who underwent an ITP second-line treatment: Rituximab or splenectomy. The distinction between open (OS) and laparoscopic splenectomy (LS) was analyzed. Primary outcome was composite: hospitalization for bleeding and/or thrombocytopenia and death from hemorrhage or infection. Secondary outcomes were based on response (R) and complete response (CR) rates as defined by the American Society of Hematology. Ninety-six patients were included: 30 patients received Rituximab, 37 underwent OS, and 29 underwent LS. The follow-up was 30, 60, and 120 months in Rituximab, LS, and OS groups, respectively. At 30 month, the primary outcome-free survival rate was higher in splenectomy groups (84% for OS, 86% for LS) than Rituximab group (47%) (P = 0.0002). Similarly, at 30 month, R and CR rates were higher for OS (86.5% and 75.7%, respectively) and LS groups (93.1% and 89.7%) than Rituximab (46.7% and 30%) (P = 0.0001). Moreover, R rates remained elevated at 60 month for OS and LS groups (83.7% and 89.6% respectively) and 78.4% at 120 month for OS group. We observed that splenectomy for ITP second-line treatment was more effective than Rituximab regarding maintenance of R, CR, and overall response rates. OS and LS had similar efficacy.

  18. Laparoscopic versus open splenectomy in children with benign ...

    African Journals Online (AJOL)

    Introduction: Splenectomy whether open or laparoscopic addresses the role of the spleen in the hematology disorders, particularly that of the cellular sequestration and destruction and antibody production. Laparoscopic splenectomy (LS) has been increasingly used for the removal of spleen in children. However, there are ...

  19. The role of splenectomy before liver transplantation in biliary atresia patients.

    Science.gov (United States)

    Takahashi, Yoshiaki; Matsuura, Toshiharu; Yanagi, Yusuke; Yoshimaru, Koichiro; Taguchi, Tomoaki

    2016-12-01

    There is currently no unified view regarding whether liver transplantation or splenectomy should be performed for hypersplenism before liver transplantation in biliary atresia (BA) patients. We herein describe the efficacy of splenectomy before liver transplantation. Splenectomy was performed in ten patients with hypersplenism associated with BA. We retrospectively reviewed their perioperative and postoperative courses, the number of leukocytes and thrombocytes, and the MELD score. The mean age was 17.5±7.0years (range 11-31years), and the male-to-female ratio was 1:1. The platelet and leukocyte levels increased after splenectomy and returned to normal levels one month postoperatively. The mean MELD score after splenectomy was significantly decreased after splenectomy: 10±2.1 vs 7.6±1.8. In particular, PT-INR improved. Five patients underwent liver transplantation because of hepatopulmonary syndrome and repeated bouts of cholangitis, whereas the remaining five patients did not undergo liver transplantation because of improvements in the liver function (the mean follow-up period was 56months). The postoperative complications included portal vein thrombosis and intestinal perforation, but the patient survival rates remained at 100%. After splenectomy, both pancytopenia and the liver function clearly improved. Splenectomy should therefore be a treatment option for patients with hypersplenism before liver transplantation. Retrospective Comparative Study - Level III. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. The Place of Splenectomy in Haematological Disorders | Gale ...

    African Journals Online (AJOL)

    The results of 67 consecutive splenectomies carried out in patients attending the Haematology Clinic at the Johannesburg Hospital between 1965 and 1972 are reported. Forty patients underwent splenectomy because of the presence of cytopenia due in part at least to hypersplenism. The best results were achieved in 21 ...

  1. Successful Splenectomy for Hypersplenism in Wilson's Disease: A Single Center Experience from China.

    Science.gov (United States)

    Li, Liang-Yong; Yang, Wen-Ming; Chen, Huai-Zhen; Wu, Yun-Hu; Fang, Xiang; Zhang, Jing; Wang, Zhen; Han, Yong-Sheng; Wang, Yu

    2015-01-01

    Splenomegaly and pancytopenia are common in Wilson's disease (WD) and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS). All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson's Disease Rating Scale (UWDRS) showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most patients

  2. Laparoscopic versus open splenectomy for portal hypertension: a systematic review of comparative studies.

    Science.gov (United States)

    Cai, Yunqiang; Liu, Zhihong; Liu, Xubao

    2014-08-01

    Laparoscopic splenectomy has become the gold-standard procedure for normal to moderately enlarged spleens. However, the safety of laparoscopic splenectomy for patients with portal hypertension remains controversial. We carried out this systematic review to identify the feasibility and safety of laparoscopic splenectomy in treating portal hypertension. A systematic search for comparative studies that compared laparoscopic splenectomy with open splenectomy for portal hypertension was carried out. Studies were independently reviewed for quality, inclusion and exclusion criteria, demographic characteristics, and perioperative outcomes. Although laparoscopic splenectomy is associated with longer operating time, it offers advantages over the open procedure in terms of less blood loss, lower operative complications, earlier resumption of oral intake, and shorter posthospital stay. Therefore, laparoscopic splenectomy is a safe and feasible intervention for portal hypertension. © The Author(s) 2014.

  3. Review of the Association between Splenectomy and Chronic Thromboembolic Pulmonary Hypertension.

    Science.gov (United States)

    Kimmig, Lucas M; Palevsky, Harold I

    2016-06-01

    Recent evidence suggests that there may be a link between splenectomy and the later development of pulmonary hypertension, in particular World Health Organization group IV pulmonary hypertension (chronic thromboembolic pulmonary hypertension). Epidemiological studies have demonstrated an odds ratio as high as 18 for the development of chronic thromboembolic pulmonary hypertension after splenectomy in comparison with matched control subjects who have not undergone splenectomy. The mechanisms governing the association between removal of the spleen and the subsequent development of chronic thromboembolic pulmonary hypertension remain incompletely understood; however, recent advances in understanding of coagulation homeostasis have shed some light on this association. Splenectomy increases the risk of venous thromboembolic disease, a necessary precursor of chronic thromboembolic pulmonary hypertension, by generating a prothrombotic state. This prothrombotic state likely results from a reduction in the removal of circulating procoagulant factors from the bloodstream after splenectomy. Although much is to be learned, circulating microparticles have emerged as the most likely mediator for the development of thrombosis after splenectomy. Apparently because of a reduction in reticuloendothelial cell clearance, microparticle levels are elevated in patients after splenectomy. Elevated circulating microparticle levels have been linked to thromboembolism and pulmonary hypertension in a dose-dependent fashion. It is important for health care providers to be aware of the link between splenectomy and chronic thromboembolic pulmonary hypertension. We are optimistic that clarification of the exact mechanisms that govern this association will yield clinical guidelines and potential treatments.

  4. Evaluation of splenectomy as a risk factor for gastric dilatation-volvulus.

    Science.gov (United States)

    Grange, Andrew M; Clough, William; Casale, Sue A

    2012-08-15

    To evaluate whether dogs undergoing splenectomy had an increased risk of gastric dilatation-volvulus (GDV), compared with a control group of dogs undergoing enterotomy. Retrospective case-control study. 219 dogs that underwent splenectomy for reasons other than splenic torsion (splenectomy group; n = 172) or enterotomy (control group; 47) without concurrent gastropexy. Medical records were reviewed for information on signalment, date of surgery, durations of surgery and anesthesia, reason for splenectomy, histopathologic findings (if applicable), whether gastropexy was performed, duration of follow-up, and date of death (if applicable). Follow-up information, including occurrence of GDV, was obtained via medical records review and a written client questionnaire. Reasons for splenectomy included splenic neoplasia, nonneoplastic masses, infarction, traumatic injury, and adhesions to a gossypiboma. Incidence of GDV following surgery was not significantly different between dogs of the splenectomy (14/172 [8.1 %]) and control (3/47 [6.4%]) groups. Median time to GDV for the 17 affected dogs was 352 days (range, 12 to 2,368 days) after surgery. Among dogs that underwent splenectomy, sexually intact males had a significantly higher incidence of GDV (4/16) than did castrated males and sexually intact or spayed females (10/156). Incidence of GDV among sexually intact male dogs did not differ between groups. Results did not support a recommendation for routine use of prophylactic gastropexy in dogs at the time of splenectomy. Other patient-specific risk factors should be assessed prior to recommending this procedure.

  5. Laparoscopic RFA with splenectomy for hepatocellular carcinoma.

    Science.gov (United States)

    Hu, Kunpeng; Lei, Purun; Yao, Zhicheng; Wang, Chenhu; Wang, Qingliang; Xu, Shilei; Xiong, Zhiyong; Huang, He; Xu, Ruiyun; Deng, Meihai; Liu, Bo

    2016-07-27

    The treatment of hepatocellular carcinoma (HCC) is complicated and challenging because of the frequent presence of cirrhosis. Therefore, we propose a novel surgical approach to minimize the invasiveness and risk in patients with HCC, hypersplenism, and esophagogastric varices. This was a retrospective study carried out in 25 patients with HCC and hypersplenism and who underwent simultaneous laparoscopic-guided radio-frequency ablation and laparoscopic splenectomy with endoscopic variceal ligation. Tumor size was restricted to a single nodule of splenectomy. Laparoscopic-guided radio-frequency ablation with laparoscopic splenectomy and endoscopic variceal ligation could be an available technique for patients with HCC <3 cm, hypersplenism, and esophagogastric varices. This approach may help to minimize the surgical risks and results in a fast increase in platelet counts with an acceptable rate of complications.

  6. Splenectomy combined with gastrectomy and immunotherapy for advanced gastric cancer.

    Science.gov (United States)

    Miwa, H; Orita, K

    1983-06-01

    We studied the effects of a splenectomy in combination with immunotherapy on the survival of patients who had undergone a total gastrectomy. It was found that a splenectomy was not effective against advanced gastric cancer at stage III, and that the spleen should be retained for immunotherapy. Splenectomy for gastric cancer at terminal stage IV, particularly in combination with immunotherapy, produced not only augmentation of cellular immunity, but also increased survival.

  7. Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading greater curvature.

    Science.gov (United States)

    Ohkura, Yu; Haruta, Shusuke; Shindoh, Junichi; Tanaka, Tsuyoshi; Ueno, Masaki; Udagawa, Harushi

    2017-05-25

    For proximal gastric cancer invading the greater curvature, concomitant splenectomy is frequently performed to secure the clearance of lymph node metastases. However, prognostic impact of prophylactic splenectomy remains unclear. The aim of this study was to clarify the oncological significance of prophylactic splenectomy for advanced proximal gastric cancer invading the greater curvature. Retrospective review of 108 patients who underwent total or subtotal gastrectomy for advanced proximal gastric cancer involving the greater curvature was performed. Short-term and long-term outcomes were compared between the patients who underwent splenectomy (n = 63) and those who did not (n = 45). Patients who underwent splenectomy showed higher amount of blood loss (538 vs. 450 mL, p = 0.016) and morbidity rate (30.2 vs. 13.3, p = 0.041) compared with those who did not undergo splenectomy. In particular, pancreas-related complications were frequently observed among patients who received splenectomy (17.4 vs. 0%, p = 0.003). However, no significant improvement of long-term outcomes were confirmed in the cases with splenectomy (5-year recurrence-free rate, 60.2 vs. 67.3%; p = 0.609 and 5-year overall survival rates, 63.7 vs. 73.6%; p = 0.769). On the other hand, splenectomy was correlated with marginally better survival in patients with Borrmann type 1 or 2 gastric cancer (p = 0.072). For advanced proximal gastric cancer involving the greater curvature, prophylactic splenectomy may have no significant prognostic impact despite the increased morbidity rate after surgery. Such surgical procedure should be avoided as long as lymph node involvement is not evident.

  8. Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

    Science.gov (United States)

    Lin, Hsien-Feng; Liao, Kuan-Fu; Chang, Ching-Mei; Lin, Cheng-Li; Lai, Shih-Wei

    2017-01-01

    Objective This study aimed to investigate the association between splenectomy and empyema in Taiwan. Methods A population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20–84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities. Results The overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone. Conclusion The incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities. PMID:28947439

  9. Partial Splenectomy in the treatment of an adult with β thalassemia intermedia: A case report.

    Science.gov (United States)

    Correia, João Guardado; Moreira, Nídia; Costa Almeida, Carlos Eduardo; Reis, Luís Simões

    2017-01-01

    Thalassemia is a common disease which treatment is often based on splenectomy. The risks associated with total splenectomy stimulated partial splenectomy as a potentially alternative therapy. A 45 year-old female patient with long term follow-up for β thalassemia intermedia started to develop signs of hypersplenism and iron overload. A partial splenectomy was performed and was observed a marked hematologic improvement while preserving the desired splenic function. Partial splenectomy proved to provide a persistent decrease in hemolytic rate while preserving the integrity of splenic phagocytic function, presenting itself as an effective alternative to total splenectomy. After being subjected to partial splenectomy, our patient experienced a sustained control of hemolysis and showed no signs of hypersplenism or iron overload. No splenic regrowth or infectious complications were observed. The major drawbacks of partial splenectomy are the increased risk of intra- and postoperative bleeding, splenic remnant torsion and splenic regrowth. Partial splenectomy is an alternative to total splenectomy for the treatment of adult β Thalassemia intermedia patients avoiding the risks associated with total splenectomy.

  10. Splenectomy increases the survival time of heart allograft via developing immune tolerance

    Science.gov (United States)

    2013-01-01

    Background The spleen is an active lymphoid organ. The effect of splenectomy on the immune response remains unclear. This study investigated whether splenectomy can induce immune tolerance and has a beneficial role in cardiac allograft. Methods Wistar rats were used for heart donors. The Sprague–Dawley (SD) rats designated as the recipients of heart transplantation (HT) were randomly assigned into four groups: sham, splenectomy, HT, splenectomy + HT. The survival of transplanted hearts was assessed by daily checking of abdominal palpation. At various time points after transplantation, the transplanted hearts were collected and histologically examined; the level of CD4+CD25+ T regulatory lymphocytes (Tregs) and rate of lymphocyte apoptosis (annexin-v+ PI+ cells) in the blood were analyzed by using flow cytometric method. Results 1) Splenectomy significantly prolonged the mean survival time of heart allografts (7 ± 1.1 days and 27 ± 1.5 days for HT and splenectomy + HT, respectively; n = 12-14/group, HT vs. splenectomy + HT, p Splenectomy delayed pathological changes (inflammatory cell infiltration, myocardial damage) of the transplanted hearts in splenectomy + HT rats; 3) The level of CD4+CD25+ Tregs in the blood of splenectomized rats was significantly increased within 7 days (2.4 ± 0.5%, 4.9 ± 1.3% and 5.3 ± 1.0% for sham, splenectomy and splenectomy + HT, respectively; n = 15/group, sham vs. splenectomy or splenectomy + HT, p splenectomy surgery and gradually decreased to baseline level; 4) Splenectomy increased the rate of lymphocyte apoptosis (day 7: 0.3 ± 0.05%, 3.9 ± 0.9% and 4.1 ± 0.9% for sham, splenectomy and splenectomy + HT, respectively; n = 15/group, sham vs. splenectomy or splenectomy + HT, p Splenectomy inhibits the development of pathology and prolongs the survival time of cardiac allograft. The responsible mechanism is associated with induction of immune

  11. The impact of splenectomy on human coronary artery atherosclerosis and vascular macrophage distribution.

    Science.gov (United States)

    Li, Yu; Stone, James R

    Splenectomy can potentially impact atherosclerosis through multiple mechanisms including altered lipid homeostasis, increased coagulation, and altered macrophage recruitment to the plaque. In patients, splenectomy has been associated with increased rates of coronary artery events, while in experimental mice, splenectomy causes increased atherosclerosis but reduces systemic monocyte supply. In this study, the direct impact of splenectomy on human coronary artery atherosclerotic plaque severity and macrophage content was investigated. Coronary artery atherosclerotic plaque severity was determined at autopsy in 18 long-term (≥10 years) splenectomy patients and 90 matched control patients. Coronary artery macrophage content was evaluated in mild atherosclerotic plaques of 11 mid- to long-term (≥1 year) splenectomy patients and 11 matched control patients. Splenectomy was associated with reduced coronary artery atherosclerosis (P=.03). The association was most pronounced for the subgroup of patients who had undergone splenectomy 20 years or more prior to death (P=.02). There was no difference in the density of macrophages in the plaque, media, or adventitia upon comparing splenectomy and control patients. In the control group, there was no correlation between the macrophage densities in the three arterial layers. However, in the splenectomy patients, there was a strong correlation in the macrophage densities across the plaque, media, and adventitia (P≤.0002), with resulting slopes that were significantly greater than seen in the control patients (P=.0007-.011). These findings indicate that, in humans, splenectomy is associated with lower coronary artery atherosclerotic plaque severity and altered coronary artery macrophage distribution. These results suggest that the spleen can modulate the recruitment of macrophages into human coronary arteries and the progression of atherosclerosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Contrast analysis of the partial splenic artery embolization with splenectomy

    International Nuclear Information System (INIS)

    Lu Wusheng; He Qing; Zheng Zhiyong; Wu Shaoping; Xu Dawei

    2006-01-01

    Objective: To analyze the effects and the complications of partial splenic artery embolization (PSE) and splenectomy offering a feasible way to choose different therapeutic methods for hypersplenism. Methods: Forty-six patients treated with PSE and thirty-three undergone splenectomy were compared for their effectivenesses and complications in treating hypersplenism. Results: Thrombocyte and leucocyte counts increased markedly after the two kinds of treatment (P 0.05). The complication rate of the PSE was far more than that of the splenectomy (P<0.001). Conclusions Splenectomy is prior to PSE on patients with large mount of ascites, serious portal hypertension and splenomegaly. PSE is suitable for patients with poor liver function, blood coagulation disturbance, liver cancer complicated with hypersplenism and aging. (authors)

  13. Successful Splenectomy for Hypersplenism in Wilson’s Disease: A Single Center Experience from China

    Science.gov (United States)

    Chen, Huai-Zhen; Wu, Yun-Hu; Fang, Xiang; Zhang, Jing; Wang, Zhen; Han, Yong-Sheng; Wang, Yu

    2015-01-01

    Splenomegaly and pancytopenia are common in Wilson’s disease (WD) and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS). All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson’s Disease Rating Scale (UWDRS) showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most patients

  14. Long-term results of splenectomy in adult chronic immune thrombocytopenia.

    Science.gov (United States)

    Guan, Yue; Wang, Shixuan; Xue, Feng; Liu, Xiaofan; Zhang, Lei; Li, Huiyuan; Yang, Renchi

    2017-03-01

    We performed this study in adult patients with chronic primary immune thrombocytopenia to explore the long-term efficacy and safety of splenectomy. Data of 174 patients who underwent splenectomy in our hospital from 1994 to 2014 were analyzed. After splenectomy, 126 (72.4%) patients achieved a complete response (CR) and 28 (16.1%) achieved a response (R). Thirty-two (20.8%) responders relapsed with a median time of 24 months. Compared with non-responders and recurrent patients, the stable responders were younger and had higher preoperation and postoperation peak platelet count, later peak platelet count emergence time, and more megakaryocytes. Corticosteroid-dependent patients were more likely to response to splenectomy than those refractory to corticosteroid. We performed a relapse-free survival analysis among the 154 responders. In univariate analyses, corticosteroid dependent and time from diagnosis to splenectomy ≤24 months showed predictive value to persistent response. But only corticosteroid dependent was a significant predictor in multivariate analysis. The 30-d complication rate after the surgery was 25.9%. There were five (2.9%) patients experienced thrombosis and three (1.7%) refractory patients died during follow-up. Splenectomy was a safe treatment with a cure rate of 58.0%. Corticosteroid dependent showed predictive value to persistent response. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Splenectomy Correlates With Increased Risk of Pyogenic Liver Abscess: A Nationwide Cohort Study in Taiwan

    Science.gov (United States)

    Lai, Shih-Wei; Lai, Hsueh-Chou; Lin, Cheng-Li; Liao, Kuan-Fu

    2015-01-01

    Objectives Little is known about the risk of pyogenic liver abscess in patients with splenectomy. We explored the relationship between splenectomy and pyogenic liver abscess in Taiwan. Methods We conducted a nationwide cohort analysis using the hospitalization dataset of the Taiwan National Health Insurance Program. We included 17 779 subjects aged 20–84 years who underwent splenectomy in 1998 to 2010 (splenectomy group) and 70 855 randomly selected subjects without splenectomy (non-splenectomy group). Both groups were matched by sex, age, other comorbidities, and hospitalization year of receiving splenectomy. The incidence of pyogenic liver abscess at the end of 2011 was measured. The multivariable Cox proportional hazard regression model was used to estimate the hazard ratios and 95% confidence intervals for pyogenic liver abscess associated with splenectomy and other comorbidities. Results The overall incidence rate was 3.75-fold higher in the splenectomy group than that in the non-splenectomy group (2.15 vs 0.57 per 1000 person-years; 95% confidence interval, 3.57–3.94). After controlling for potential confounding factors, the adjusted hazard ratio of pyogenic liver abscess was 3.89 in subjects with splenectomy (95% confidence interval, 3.20–4.72) when compared with subjects without splenectomy. In further analysis, the hazard ratio markedly increased to 14.34 for those with splenectomy and having any of the assessed comorbidities, including alcoholism, biliary stone, chronic kidney disease, chronic liver diseases, and diabetes mellitus (95% confidence interval, 10.61–19.39). Conclusions Patients with splenectomy are at an increased risk of developing pyogenic liver abscess, particularly when they have comorbid conditions. PMID:26256773

  16. Splenectomy is associated with a higher risk for venous thromboembolism: A prospective cohort study.

    Science.gov (United States)

    Lee, Debora H; Barmparas, Galinos; Fierro, Nicole; Sun, Beatrice J; Ashrafian, Sogol; Li, Tong; Ley, Eric J

    2015-12-01

    Thrombocytosis following splenectomy is a common occurrence. Whether this thrombocytosis leads to a higher risk for venous thromboembolism (VTE) remains unclear. This investigation aimed to determine if splenectomy increases the risk for VTE. This was a prospective study conducted in the SICU between 1/2011 and 11/2013 investigating the VTE risk in patients undergoing a splenectomy compared with those undergoing any other abdominal procedure. In total 2503 patients were admitted to the SICU: 37 (2%) after a splenectomy and 638 (26%) after any other abdominal surgery. Splenectomy patients had a higher incidence of VTE compared to patients undergoing any other abdominal procedure (29.7% vs. 12.1%, p splenectomy was associated with a higher adjusted risk for VTE compared to the no-splenectomy group (AOR [95% CI]: 2.6 [1.2, 5.9], p = 0.02). Reactive thrombocytosis did not predict the development of VTE. Splenectomy increases the risk for VTE, however reactive thrombocytosis is not associated with this higher incidence. Further investigations are required to characterize the pathophysiologic mechanisms of VTE development following splenectomy. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  17. Effect of splenectomy on liver cirrhosis and related surgical issues

    Directory of Open Access Journals (Sweden)

    KONG Degang

    2016-12-01

    Full Text Available Patients with liver fibrosis and cirrhosis experience certain changes in spleen morphology and function, and there is always a controversy over whether to perform splenectomy in patients with liver cirrhosis. As a surgical treatment of recurrent portal hypertension complicated by esophagogastric variceal bleeding, splenectomy can reduce portal venous pressure, reduce the possibility of gastrointestinal bleeding, and correct the reduced white blood cell count and platelet count. It can also protect the liver by improving liver function, promoting regeneration of hepatocytes, and inhibiting the progression of liver fibrosis. With reference to available clinical and laboratory data, this article reviews the effect of splenectomy on the cirrhotic liver and related issues such as selection of surgical procedures and prevention and treatment of postoperative complications, in order to promote splenectomy in patients with liver cirrhosis.

  18. A case of uneventful early post partum phase of pregnancy with LSCS in a known case of portal hypertension with splenectomy & a delayed peritonitis.

    Directory of Open Access Journals (Sweden)

    Dr. Dhruvkumar Baru

    2017-06-01

    Full Text Available This is a case of 32 year old multigravida, a known case of portal hypertension with episodes of haemetemesis on and off since last 12 years with history of splenectomy 2.5 years ago with uneventful 1st LSCS presented with pain abdomen and abdominal distension post- LSCS. Blood investigations showed microcytic anaemia corrected by blood transfusion while hypo -proteinemia by FFP transfusion. USG showed portal vein thrombosis with ascites. CT scan was done which confirmed signs of portal hypertension with cavernoma formation and gross ascites, Fluid cytology suggestive of PMN's. Patient was managed by controlled tapping and fluid monitoring along with appropriate antibiotics.

  19. Portal vein thrombosis after splenectomy for beta-thalassemia major

    International Nuclear Information System (INIS)

    Al-Hawsawi, Zakaria M.; Tarawah, Ahmed M.; Hassan, Ruhul Amin A.; Haouimi, Ammar S.

    2004-01-01

    Portal vein thrombosis is a recognized complication after splenectomy for beta-thalassemia major due to the chronic hypercoagulable state which has been recognized to exist in childhood thalassemia and contribute to thromboembolic events. We reporting one patient with beta-thalassemia major developed portal vein thrombosis following splenectomy. (author)

  20. Significance of lymphadenectomy with splenectomy in radical surgery for advanced (pT3/pT4) remnant gastric cancer.

    Science.gov (United States)

    Sugita, Hiroki; Oda, Eri; Hirota, Masahiko; Ishikawa, Shinji; Tomiyasu, Shinjiro; Tanaka, Hiroshi; Arita, Tetsumasa; Yagi, Yasushi; Baba, Hideo

    2016-04-01

    To date, the optimal surgical strategy for remnant gastric cancer has not been determined. The purpose of this study was to clarify the significance of lymphadenectomy with splenectomy in remnant gastric cancer surgery. This retrospective cohort study was conducted at the Kumamoto Regional Medical Center. The primary endpoint was overall survival after surgery. We retrospectively analyzed the clinicopathologic features, surgical treatments, and long-term prognosis of remnant gastric cancer patients treated with total gastrectomy. A total of 80 patients with gastric cancer in the remnant stomach after distal gastrectomy and who underwent total gastrectomy were enrolled in the study. Splenectomy was performed in 38 patients. Lymph node metastasis in the splenic hilum was not observed in the patients with pT1/pT2 tumors, whereas nodal metastasis at the splenic hilum was detected in 30.4% of the patients with pT3/pT4 tumors. The survival rate of the patients with pT3/pT4 tumors who underwent splenectomy was significantly higher than that of the patients who did not undergo splenectomy, although there was no difference in the patients with pT1/pT2 tumors. Among the patients classified as R0, the survival rate of the patients with pT3/pT4 tumors who underwent splenectomy was significantly higher than that of the patients who did not undergo splenectomy. Lymphadenectomy with splenectomy in radical surgery is beneficial for patients with advanced (pT3/pT4) remnant gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. MANAGEMENT OF CHRONIC IDIOPATHIC THROMBOTIC THROMBOCYTOPENIC PURPURA WITH SPLENECTOMY

    Directory of Open Access Journals (Sweden)

    Mojca Modic

    2002-07-01

    Full Text Available Background. Treatment of thrombotic thrombocytopenic purpura (TTP with plasma exchange (PE has reduced mortality rates from 90% in untreated patients to less than 20%. Despite primary effective PE, relapses occur in up to 40% of patients. Beside PE, second line treatment options are corticosteroids, vincristine, defibrotide, prostacycline. We describe two patients with relapsing TTP treated successfully with splenectomy.Patients and methods. Case 1. A 20–year female was diagnosed in October 2000 with idiopathic chronic relapsing TTP. First episode of PE plus methylprednisolone treatment led to complet remission. Subsequent relapses occured 3, 6 and 8 months after first TTP episode. Every relaps was effectivelly treated with PE and methylprednisolone. Because of more and more frequent TTP relapses laparoscopic splenectomy was performed. Currently, 7 months after splenectomy she is in complet TTP remission.Case 2. A 18–year female, was diagnosed in January 1997 with idiopathic TTP. After PE and methylprednisolone complete remission was established. Relaps occured after nearly three years. Later on, TTP got chronic course with neurological clinical symptoms and plateled drops as soon as PE treatment was withdrawn. Besides PE and methylprednisolone she received also defibrotide. Because of chronic, PE dependant TTP, laparoscopic splenectomy was performed. Today, 15 months after splenectomy she is in complete TTP remission.Conclusions. In idiopathic relapsing and chronic TTP, PE treatment only is usually not sufficient for durable remission. Second line TTP treatment drugs have limited efficacy. Based on our experience in patients with relapsing and/or chronic TTP, laparoscopic splenectomy should be considered as a first treatment option, especialy in junger patients.

  2. OUTCOMES OF HILAR PEDICLE CONTROL USING SUTURE LIGATION DURING LAPAROSCOPIC SPLENECTOMY.

    Science.gov (United States)

    Makgoka, M

    2017-06-01

    Laparoscopic splenectomy is a well described gold standard procedure for various indications. One of the key steps during laparoscopic splenectomy is the hilar pedicle vessels control, which can be challenging in most cases. Most centres around the world recommend the use Ligaclib or endovascular staplers as Methods of choice for hilar pedicle control but the issue is the cost and efficiency of the laparoscopic haemostatic devices. A descriptive retrospective study of patients who had laparoscopic splenectomy from 2013 to present. Hilar splenic vessel control was done with suture ligation. We looked at outcomes of patients offered this technique, complications of this technique, and describing the technique of hilar control in laparoscopic splenectomy. Total of 27 patients had laparoscopic splenectomy with splenic hilar pedicle control with suture ligation. Mean operative time, mean blood volume loss, length of hospital stay, postoperative complications conversion to laparotomy. Laparoscopic hilar pedicle control with suture ligation is safe and effective for the patient in our hospital setting.

  3. Splenectomy as Part of Cytoreductive Surgery in Recurrent Epithelial Ovarian Cancer.

    Science.gov (United States)

    Bacalbasa, Nicolae; Balescu, Irina; Dima, Simona; Brasoveanu, Vladislav; Popescu, Irinel

    2015-09-01

    To determine the impact of survival of peritoneal versus splenic metastasis in cases submitted to splenectomy as part of cytoreductive surgery in recurrent epithelial ovarian cancer. Between January 2002 and May 2014, 28 patients were submitted to splenectomy as part of secondary, tertiary and beyond tertiary cytoreduction at the Dan Setlacec Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest. Splenectomy was performed as follows: at secondary cytoreduction in 21 cases, at tertiary cytoreduction in six cases, and beyond tertiary cytoreduction in one case. An R0 resection was attempted in all cases; however, in two cases submitted to splenectomy as part of tertiary cytoreduction, R1 and R2 resection, were performed, respectively. Histopathological studies revealed the presence of peritoneal seeding in 11 cases at secondary cytoreduction and in four cases submitted to splenectomy as part of tertiary cytoreduction. Parenchymatous lesions were described in nine cases submitted to splenectomy as part of secondary cytoreduction and in two cases at tertiary cytoreduction. In a single case in which splenectomy was performed in the context of secondary cytoreduction, hilar involvement was found. Peritoneal seeding was described in the patient for whom splenectomy was performed at quaternary cytoreduction. Early postoperative mortality for the entire cohort (within 30 days) was 7.1% (death occurred in two cases submitted to splenectomy during the secondary cytoreduction). The median overall survival in patients with splenic involvement via peritoneal route was 35 months, while in cases with hematogenous splenic lesions, it was 12 months (p=0.2) at secondary cytoreduction. In the sub-group of patients submitted to splenectomy as part of tertiary cytoreduction, the median overall survival in patients with splenic involvement via peritoneal route was 21 months, while in cases with hematogenous splenic lesions it was 4 months (p=0

  4. Randomized Controlled Trial to Evaluate Splenectomy in Total Gastrectomy for Proximal Gastric Carcinoma.

    Science.gov (United States)

    Sano, Takeshi; Sasako, Mitsuru; Mizusawa, Junki; Yamamoto, Seiichiro; Katai, Hitoshi; Yoshikawa, Takaki; Nashimoto, Atsushi; Ito, Seiji; Kaji, Masahide; Imamura, Hiroshi; Fukushima, Norimasa; Fujitani, Kazumasa

    2017-02-01

    To clarify the role of splenectomy in total gastrectomy for proximal gastric cancer. Splenectomy in total gastrectomy is associated with increased operative morbidity and mortality, but its survival benefit is unclear. Previous randomized controlled trials were underpowered and inconclusive. We conducted a multiinstitutional randomized controlled trial. Proximal gastric adenocarcinoma of T2-4/N0-2/M0 not invading the greater curvature was eligible. During the operation, surgeons confirmed that R0 resection was possible with negative lavage cytology, and patients were randomly assigned to either splenectomy or spleen preservation. The primary endpoint was overall survival (OS) and the secondary endpoints were relapse-free survival, operative morbidity, operation time, and blood loss. The trial was designed to confirm noninferiority of spleen preservation to splenectomy in OS with a noninferiority margin of the hazard ratio as 1.21 and 1-sided alpha of 5%. Between June 2002 and March 2009, 505 patients (254 splenectomy, 251 spleen preservation) were enrolled from 36 institutions. Splenectomy was associated with higher morbidity and larger blood loss, but the operation time was similar. The 5-year survivals were 75.1% and 76.4% in the splenectomy and spleen preservation groups, respectively. The hazard ratio was 0.88 (90.7%, confidence interval 0.67-1.16) (splenectomy should be avoided as it increases operative morbidity without improving survival.

  5. Clinical Outcomes of Splenectomy in Children: Report of the Splenectomy in Congenital Hemolytic Anemia (SICHA) Registry

    Science.gov (United States)

    Rice, Henry E; Englum, Brian R; Rothman, Jennifer; Leonard, Sarah; Reiter, Audra; Thornburg, Courtney; Brindle, Mary; Wright, Nicola; Heeney, Matthew M; Smithers, Charles; Brown, Rebeccah L; Kalfa, Theodosia; Langer, Jacob C; Cada, Michaela; Oldham, Keith T; Scott, J Paul; St. Peter, Shawn; Sharma, Mukta; Davidoff, Andrew M.; Nottage, Kerri; Bernabe, Kathryn; Wilson, David B; Dutta, Sanjeev; Glader, Bertil; Crary, Shelley E; Dassinger, Melvin S; Dunbar, Levette; Islam, Saleem; Kumar, Manjusha; Rescorla, Fred; Bruch, Steve; Campbell, Andrew; Austin, Mary; Sidonio, Robert; Blakely, Martin L

    2014-01-01

    The outcomes of children with congenital hemolytic anemia (CHA) undergoing total splenectomy (TS) or partial splenectomy (PS) remain unclear. In this study, we collected data from 100 children with CHA who underwent TS or PS from 2005–2013 at 16 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a patient registry. We analyzed demographics and baseline clinical status, operative details, and outcomes at 4, 24, and 52 weeks after surgery. Results were summarized as hematologic outcomes, short-term adverse events (AEs) (≤ 30 days after surgery), and long-term AEs (31–365 days after surgery). For children with hereditary spherocytosis, after surgery there was an increase in hemoglobin (baseline 10.1 ± 1.8 gm/dl, 52 week 12.8 ± 1.6 gm/dl; mean ± SD), decrease in reticulocyte and bilirubin as well as control of symptoms. Children with sickle cell disease had control of clinical symptoms after surgery, but had no change in hematologic parameters. There was an 11% rate of short-term AEs and 11% rate of long-term AEs. As we accumulate more subjects and longer follow-up, use of a patient registry should enhance our capacity for clinical trials and engage all stakeholders in the decision-making process. PMID:25382665

  6. [Advances in Pathogenesis and Related Clinical Research of Thromboembolism in Patients with Thalassemia after Splenectomy].

    Science.gov (United States)

    Sun, Na; Cheng, Peng; Deng, Dong-Hong

    2016-06-01

    Thalassemia is the most common human hereditary hemolytic anemia. Due to splenomegaly and hypersp-lenism, splenectomy can be used as a means of treatment for thalassemia. Various complications following splenectomy, however, especially thromboembolic complications are remarkable. This review summarizes the incidence, clinical manifestations and development time of thromboembolism. The pathogenesis of thromboembolism after splenectomy in thalassemia, such as abnormal platelet number and function, changes in red cell membrane, endothelial cell damage, dysfunction of other procoagulant and anticoagulant factors, and local factors associated with splenectomy are elaborated and the trategies to prevent and treat the thromboembolic events in thalassemia after splenectomy, including the attention to risk factors associated with splenectomy, a reassessment of splenectomy, regular blood transfusion to reduce the ratio of abnormal red blood cells, treatment with anticoagulant and antiplatelet drugs, application of hydroxyurea and stem cell transplantation are discussed.

  7. No further incidence of sepsis after splenectomy for severe trauma: a multi-institutional experience of the trauma registry of the DGU with 1,630 patients

    Directory of Open Access Journals (Sweden)

    Heuer M

    2010-06-01

    Full Text Available Abstract Objective Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure. Methods 13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score > 16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I and conservative managed patients (II. Results From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients. 96 (18.3% of the patients with splenectomy and 102 (18.5% without splenectomy had apparent infection after operation. Additionally, there was no difference in mortality (24.8% versus 22.2% in both groups. After massive transfusion of red blood cells (> 10 non-splenectomy patients showed a significant increase of multi-organ failure (46% vs. 40% and sepsis (38% vs. 25%. Conclusions Non-operative management leads to lower systemic infection rates and mortality in adult patients with moderate blunt splenic injury (grade 1-3 and should therefore be advocated. Patients with grade 4 and 5 injury, patients with massive transfusion of red blood cells and unstable patients should be managed operatively.

  8. Single-port laparoscopic partial splenectomy: a case report.

    Science.gov (United States)

    Hong, Tae Ho; Lee, Sang Kuon; You, Young Kyoung; Kim, Jun Gi

    2010-10-01

    With the better understanding of the importance of the spleen as a primary organ of the human immune system, there has been an increased interest in performing the partial splenectomy for a number of indications such as nonparasitic cysts, benign tumors, staging of lymphomas, etc. Moreover, laparoscopic partial splenectomy has been gaining more interest as the recommended approach for benign splenic disorders to preserve the splenic function with very low recurrence rates. Meanwhile, many surgeons have attempted to reduce the number and size of the ports in laparoscopic surgery with the aim of inducing less parietal trauma and fewer scars. One of these efforts is single-port laparoscopic surgery, which is a rapidly evolving field all over the world. Here, we describe a feasible method of single-port laparoscopic partial splenectomy for treating a benign splenic cyst that was located in the upper medial aspect of the spleen.

  9. [Routine screening of splenic or portal vein thrombosis after splenectomy].

    Science.gov (United States)

    Bouvier, A; Gout, M; Audia, S; Chalumeau, C; Rat, P; Deballon, O

    2017-01-01

    Portal and/or splenic vein thrombosis (PSVT) is common after splenectomy. It can be a life-threatening complication, with a risk of bowel ischemia and portal hypertension. An early diagnosis allows an effective medical treatment and prevents life-threatening complications. There is no consensus regarding the benefit of systematic screening of patients after splenectomy for PSVT. We started in January 2012 a routine screening of PSVT after elective splenectomy. The aim of this study was to assess this policy. Since January 2012, all patients undergoing an elective splenectomy had an abdominal CT-scan on postoperative-day 7. Demographic data, pathology, type of surgery, platelet counts before and after surgery, outcome, results of medical imaging, and management of PSVT and its results were recorded. Over 3 years, 52 patients underwent an elective splenectomy. All of them had a CT-scan at postoperative-day 7. A PSVT was found in 11 patients (21.2 %). They were all asymptomatic. Lymphoma and splenomegaly were the main factors associated with PSVT in the univariate analysis. All patients with PSVT were treated with anticoagulation and no complication of PSVT occurred. The follow-up CT confirmed the efficacy of anticoagulation therapy in all patients. Routine screening of PSVT after elective splenectomy is warranted because it allows to start anticoagulant therapy and avoid further life-threatening complications. The incidence of PSVT is particularly high among patients operated on for lymphoma or with splenomegaly. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  10. Increased Risk of Hemorrhagic and Ischemic Strokes in Patients With Splenic Injury and Splenectomy

    Science.gov (United States)

    Lin, Jiun-Nong; Lin, Cheng-Li; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Kao, Chia-Hung

    2015-01-01

    Abstract The spleen is a crucial organ in humans. Little is known about the association between stroke and splenic injury or splenectomy. The aim of this study was to determine the risk of stroke in patients with splenic injury and splenectomy. A nationwide cohort study was conducted by analyzing the National Health Insurance Research Database in Taiwan. For comparison, control patients were selected and matched with splenic injury patients in a ratio of 4:1 according to age, sex, and the year of hospitalization. We analyzed the risks of stroke using a Cox proportional-hazards regression analysis. A total of 11,273 splenic injury patients, including 5294 splenectomized and 5979 nonsplenectomized patients, and 45,092 control patients were included in this study. The incidence rates of stroke were 8.05, 6.53, and 4.25 per 1000 person-years in splenic injury patients with splenectomy, those without splenectomy, and the control cohort, respectively. Compared with the control cohort, splenic injury patients with splenectomy exhibited a 2.05-fold increased risk of stroke (95% confidence interval [CI] 1.8–2.34), whereas those without splenectomy exhibited a 1.74-fold increased risk (95% CI 1.51–2). Splenectomy entailed an additional 1.21-fold increased risk of stroke compared with nonsplenectomy in patients with splenic injury. This study revealed that splenic injury and splenectomy were significantly associated with an increased risk of hemorrhagic and ischemic strokes. The results of this study may alert physicians and patients to the complications of splenic injury and splenectomy. PMID:26334909

  11. Born-again spleen. Return of splenic function after splenectomy for trauma

    International Nuclear Information System (INIS)

    Pearson, H.A.; Johnston, D.; Smith, K.A.; Touloukian, R.J.

    1978-01-01

    We assessed splenic activity after splenectomy by interference phase microscopical examination of circulating red cells. Normal eusplenic children had a low number (<1%) of red cells with surface indentations or pits. About 20% of red cells of children who had electively been subjected to splenectomy for hematologic indications were pitted. Thirteen of 22 children who had had emergency splenectomy because of traumatic injury had a low percentage of pitted red cells, suggesting a return of splenic function. In five of these children a /sup 99m/Tc sulfur colloid scan demonstrated multiple nodules of recurrent splenic tissue. In contrast to the prevailing opinion that splenosis is rare, we have found it to be a frequent occurrence. Return of splenic function may, in part, account for the low frequency with which overwhelming bacterial sepsis and meningitis have been documented after splenectomy for traumatic indications

  12. Effective Prevention for Portal Venous System Thrombosis After Splenectomy: A Meta-Analysis.

    Science.gov (United States)

    Zhang, Xiao; Wang, Yadong; Yu, Miao; Huang, Jinzhao; Deng, Dongfeng; Xue, Huanzhou

    2017-03-01

    Portal venous system thrombosis (PVST) is a common and potentially life-threatening complication of splenectomy for portal hypertension due to cirrhosis. A meta-analysis was conducted to study the necessity of pharmacologic prophylaxis of PVST after splenectomy and how to select the feasible treatment method. Articles were searched through the PubMed, EMBASE, Cochrane Library databases, and CNKI. Overall, 404 articles were initially identified, and 11 of them were eligible. Among these selected articles, 7 articles were associated with the necessity of anticoagulation for prevention of PVST, while 5 were about the drug selection. We first demonstrated that the incidence of PVST after splenectomy was significantly lower in patients who received the preventive measures than in those who did not (odds ratio [OR]: 0.22, 95% confidence interval [CI]: 0.13-0.39, P splenectomy and devascularization. Preventative use of anticoagulant drugs might decrease the incidence of PVST after splenectomy in patients with portal hypertension, new anticoagulant drugs such as low-molecular-weight heparin should be used, and early or combination use of anticoagulation drugs might lead to lower PVST incidence for patients.

  13. Thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism.

    Science.gov (United States)

    Duan, Ya-Qi; Liang, Ping

    2013-05-01

    Many studies have been conducted on splenic thermal ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In this article, we review the evolution and current status of radiofrequency and microwave ablation in the treatment of spleen diseases. All publications from 1990 to 2011 on radiofrequency and microwave ablation for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism were retrieved by searching PubMed. Thermal ablation in the spleen for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism can preserve part of the spleen and maintain splenic immunologic function. Thermal ablation for assisting hemostasis in partial splenectomy minimizes blood loss during operation. Thermal ablation for spleen trauma reduces the number of splenectomy and the amount of blood transfusion. Thermal ablation for splenic metastasis is minimally invasive and can be done under the guidance of an ultrasound, which helps shorten the recovery time. Thermal ablation for hypersplenism increases platelet (PLT) and white blood cell (WBC) counts and improves liver function. It also helps to maintain splenic immunologic function and even improves splenic immunologic function in the short-term. In conclusion, thermal ablative approaches are promising for partial splenectomy hemostasis, spleen trauma, splenic metastasis and hypersplenism. In order to improve therapeutic effects, directions for future studies may include standardized therapeutic indications, prolonged observation periods and enlarged sample sizes.

  14. Results after laparoscopic partial splenectomy for children with hereditary spherocytosis: Are outcomes influenced by genetic mutation?

    Science.gov (United States)

    Pugi, Jakob; Carcao, Manuel; Drury, Luke J; Langer, Jacob C

    2018-05-01

    Laparoscopic partial splenectomy (LPS) theoretically maintains long-term splenic immune function for children with hereditary spherocytosis (HS). Our goal was to review our results after LPS and to determine if specific genetic mutations influence outcome. All children with HS undergoing LPS between 2005 and 2016 were reviewed. Thirty-one children underwent LPS (16 male) at a median age of 9 (range 2-18) years. All experienced an increase in hemoglobin and decrease in reticulocyte count early after LPS and at last follow-up. Twenty-two were sent for genetic analysis. Mutations in α-spectrin, β-spectrin, and Ankyrin were identified in 6, 5, and 11 patients, respectively. Gene mutation was not correlated with complications, perioperative transfusion, length of hospital stay, or median hemoglobin, platelet, or reticulocyte counts. Three children required completion splenectomy at 10.9, 6.9, and 3.2years post-LPS, each with a different gene mutation. LPS is effective in reversing anemia and reducing reticulocytosis. So far less than 10% have required completion splenectomy, and those children did benefit from delaying the risks of asplenia. In this preliminary analysis, genetic mutation did not influence outcome after LPS. A larger multicenter study is necessary to further investigate potential correlations with specific genetic mutations. Prognosis Study. IV. Copyright © 2018. Published by Elsevier Inc.

  15. Distal pancreatectomy and splenectomy: a robotic or LESS approach.

    Science.gov (United States)

    Ryan, Carrie E; Ross, Sharona B; Sukharamwala, Prashant B; Sadowitz, Benjamin D; Wood, Thomas W; Rosemurgy, Alexander S

    2015-01-01

    The role and application of robotic surgery are debated, particularly given the expansion of laparoscopy, especially laparoendoscopic single-site (LESS) surgery. This cohort study was undertaken to delineate differences in outcomes between LESS and robotic distal pancreatectomy and splenectomy. With Institutional Review Board approval, patients undergoing LESS or robotic distal pancreatectomy and splenectomy from September 1, 2012, through December 31, 2014, were prospectively observed, and data were collected. The results are expressed as the median, with the mean ± SD. Thirty-four patients underwent a minimally invasive distal pancreatectomy and splenectomy: 18 with robotic and 16 with LESS surgery. The patients were similar in sex, age, and body mass index. Conversions to open surgery and estimated blood loss were similar. There were two intraoperative complications in the group that underwent the robotic approach. Time spent in the operating room was significantly longer with the robot (297 vs 254 minutes, P = .03), although operative duration (i.e., incision to closure) was not longer (225 vs 190 minutes; P = .15). Of the operations studied, 79% were undertaken for neoplastic processes. Tumor size was 3.5 cm for both approaches; R0 resections were achieved in all patients. Length of stay was similar in the two study groups (5 vs 4 days). There was one 30-day readmission after robotic surgery. Patient outcomes are similar with LESS or robotic distal pancreatectomy and splenectomy. Robotic operations require more time in the operating room. Both are safe and efficacious minimally invasive operations that follow similar oncologic principles for similar tumors, and both should be in the surgeon's armamentarium for distal pancreatectomy and splenectomy.

  16. Association between previous splenectomy and gastric dilatation-volvulus in dogs: 453 cases (2004-2009).

    Science.gov (United States)

    Sartor, Angela J; Bentley, Adrienne M; Brown, Dorothy C

    2013-05-15

    To evaluate the association between previous splenectomy and gastric dilatation-volvulus (GDV) in dogs. Multi-institutional retrospective case-control study. Animals-151 dogs treated surgically for GDV and 302 control dogs with no history of GDV. Computerized records of dogs evaluated via exploratory laparotomy or abdominal ultrasonography were searched, and dogs with GDV and dogs without GDV (control dogs) were identified. Two control dogs were matched with respect to age, body weight, sex, neuter status, and breed to each dog with GDV. Data were collected on the presence or absence of the spleen for both dogs with GDV and control dogs. Conditional logistic regression analysis was used to investigate the association of previous splenectomy with GDV. 6 (4%) dogs in the GDV group and 3 (1%) dogs in the control group had a history of previous splenectomy. The odds of GDV in dogs with a history of previous splenectomy in this population of dogs were 5.3 times those of dogs without a history of previous splenectomy (95% confidence interval, 1.1 to 26.8). For the patients in the present study, there was an increased odds of GDV in dogs with a history of splenectomy. Prophylactic gastropexy may be considered in dogs undergoing a splenectomy, particularly if other risk factors for GDV are present.

  17. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up

    Science.gov (United States)

    Kristinsson, Sigurdur Y.; Gridley, Gloria; Hoover, Robert N; Check, David; Landgren, Ola

    2014-01-01

    Although preservation of the spleen following abdominal trauma and spleen-preserving surgical procedures have become gold standards, about 22,000 splenectomies are still conducted annually in the USA. Infections, mostly by encapsulated organisms, are the most well-known complications following splenectomy. Recently, thrombosis and cancer have become recognized as potential adverse outcomes post-splenectomy. Among more than 4 million hospitalized USA veterans, we assessed incidence and mortality due to infections, thromboembolism, and cancer including 8,149 cancer-free veterans who underwent splenectomy with a follow-up of up to 27 years. Relative risk estimates and 95% confidence intervals were calculated using time-dependent Poisson regression methods for cohort data. Splenectomized patients had an increased risk of being hospitalized for pneumonia, meningitis, and septicemia (rate ratios=1.9–3.4); deep venous thrombosis and pulmonary embolism (rate ratios=2.2); certain solid tumors: buccal, esophagus, liver, colon, pancreas, lung, and prostate (rate ratios =1.3–1.9); and hematologic malignancies: non-Hodgkin lymphoma, Hodgkin lymphoma, multiple myeloma, acute myeloid leukemia, chronic lymphocytic leukemia, chronic myeloid leukemia, and any leukemia (rate ratios =1.8–6.0). They also had an increased risk of death due to pneumonia and septicemia (rate ratios =1.6–3.0); pulmonary embolism and coronary artery disease (rate ratios =1.4–4.5); any cancer: liver, pancreas, and lung cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, and any leukemia (rate ratios =1.3–4.7). Many of the observed risks were increased more than 10 years after splenectomy. Our results underscore the importance of vaccination, surveillance, and thromboprophylaxis after splenectomy. PMID:24056815

  18. Spleen scanning with 99Tcsup(m)-labelled red blood cells after splenectomy

    International Nuclear Information System (INIS)

    Spencer, G.R.; Bird, C.; Prothero, D.L.; Brown, T.R.; Mackenzie, F.A.F.; Phillips, M.J.

    1981-01-01

    In order to correlate the haematological changes which occur after splenectomy, with the presence or absence of residual splenic tissue, spleen scans using 99 Tcsup(m)-labelled red blood cells were performed in 36 patients who had had a splenectomy. Positive spleen scans were found in 44 per cent (8 out of 18) of patients who had undergone splenectomy for trauma and in 17 per cent (3 out of 18) of patients who had undergone elective splenectomy. No relationship was found between the presence of Howell-Jolly bodies, platelet counts, the levels of IgG, IgM and IgA and the scan result. It is concluded that these findings are due to the presence of splenunculi, whose incidence is more common than the 12 per cent usually quoted. (author)

  19. Simultaneous splenectomy during liver transplantation augments anti-viral therapy in patients infected with hepatitis C virus.

    Science.gov (United States)

    Chu, Heng-Cheng; Hsieh, Chung-Bao; Hsu, Kuo-Feng; Fan, Hsiu-Lung; Hsieh, Tsai-Yuan; Chen, Teng-Wei

    2015-01-01

    Simultaneous splenectomy in liver transplantation (LT) is selectively indicated because of splenoportal venous thromboses and increased sepsis. Therefore, its impact should be further investigated. Of the 160 liver transplant patients, only 40 underwent simultaneous splenectomy. Clinicopathologic characteristics and outcomes were compared between the splenectomy and non-splenectomy group using retrospective analysis. Although the groups were similar and had no significant difference in the intra- and postoperative data, non-splenectomy group had more male patients. However, splenectomy group showed significantly higher platelet and leukocyte counts at 1 month and 6 months after the transplantation and higher hepatitis C virus anti-viral therapy completion. Furthermore, 3 patients developed portal or splenic vein thrombosis during the postoperative follow-up, but the overall survival rate did not significantly differ between these groups. Simultaneous splenectomy in LT can be safely performed, particularly in patients with hepatitis C virus cirrhosis, small-for-size grafts, hypersplenism, and ABO blood group incompatible (ABO - incompatible) LT. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Splenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism.

    Science.gov (United States)

    Pommerening, Matthew J; Rahbar, Elaheh; Minei, Kristin; Holcomb, John B; Wade, Charles E; Schreiber, Martin A; Cohen, Mitchell J; Underwood, Samantha J; Nelson, Mary; Cotton, Bryan A

    2015-09-01

    Previous investigators have demonstrated that postinjury thrombocytosis is associated with an increase in thromboembolic (TE) risk. Increased rates of thrombocytosis have been found specifically in patients after splenectomy for trauma. We hypothesized that patients undergoing splenectomy (1) would demonstrate a more hypercoagulable profile during their hospital stay and (2) that this hypercoagulable state would be associated with increased TE events. This was a 14-month, prospective, observational trial evaluating serial rapid thrombelastography (rTEG) at 3 American College of Surgeons-verified, level 1 trauma centers. Inclusion criteria were highest-level trauma activation and arrival within 6 hours of injury. Exclusion criteria were 20% total body surface area. Serial rTEG (activated clotting time, k-time, α-angle, MA, lysis) and traditional coagulation testing (prothrombin time, partial thromboplastin time, fibrinogen and platelet count) were obtained at admission and then at 3, 6, 12, 24, 48, 72, 96, and 120 hours. Thromboembolic complications were defined as the development of deep-vein thrombosis, pulmonary embolism, acute myocardial infarction, or ischemic stroke during hospitalization. Patients were stratified into splenectomy versus nonsplenectomy cohorts. Univariate analysis was then conducted followed by longitudinal analysis using generalized estimating equations to evaluate the effects of time, splenectomy, and group-time interactions on changes in rTEG and traditional coagulation testing. We used an adjusted generalized estimating equation model to control for age, sex, ISS, admission blood pressure, base deficit, and hemoglobin. A total of 1,242 patients were enrolled; 795 had serial rTEG data. Of these, 605 had serial values >24 hours and made up the study population. Splenectomy patients were younger, more hypotensive, and in shock on arrival. Although there was no difference in 24-hour or 30-day mortality, splenectomy patients were more

  1. Splenectomy as a treatment for adults with relapsed hemophagocytic lymphohistiocytosis of unknown cause.

    Science.gov (United States)

    Jing-Shi, Wang; Yi-Ni, Wang; Lin, Wu; Zhao, Wang

    2015-05-01

    Our aim was to evaluate the clinical value of splenectomy as a treatment for relapsed hemophagocytic lymphohistiocytosis (HLH) of unknown cause in adults. We retrospectively reviewed the clinical data from medical records of 19 adults with relapsed HLH of unknown cause treated with splenectomy in our institution from June 2007 to March 2014. To rule out possible underlying diseases, including infection, autoimmune disease, neoplasms, and primary HLH, the patients had undergone examinations including F18 fluoro-2-deoxyglucose positron emission tomography/computed tomography, HLH-associated gene defects, and lymph node biopsies. Twelve patients (63.2%) achieved partial responses (PR), whereas seven patients (36.8%) had no response (NR) prior to splenectomy. Infection and hemorrhage were the main complications of splenectomy. Eighteen cases were evaluable after follow-up. Seven cases with histopathologic diagnoses of lymphoma had received chemotherapy, four of whom had achieved complete responses (CR), one PR, and two NR. Maintenance treatment was ceased 2 or 3 months after splenectomy in the other 11 cases, five of whom had CR, four PR, and two NR. Eleven of 18 cases (61.1%) survived with a median follow-up of 25 months (range 3-79 months) for survivors. Twelve- and 36-month progression-free survival rates were 48 and 24%, respectively; 12- and 36-month overall survival rates were 57 and 25%, respectively. Median survival time was 22 months. Our results indicate splenectomy may be an effective means of diagnosis and treatment of relapsed HLH of unknown cause. Further study is required to establish the mechanism and value of splenectomy in this disease.

  2. Splenectomy attenuates severe thermal trauma-induced intestinal barrier breakdown in rats.

    Science.gov (United States)

    Liu, Xiang-dong; Chen, Zhen-yong; Yang, Peng; Huang, Wen-guang; Jiang, Chun-fang

    2015-12-01

    The severe local thermal trauma activates a number of systemic inflammatory mediators, such as TNF-α, NF-κB, resulting in a disruption of gut barrier. The gastrointestinal tight junction (TJ) is highly regulated by membrane-associated proteins including zonula occludens protein-1 (ZO-1) and occludin, which can be modulated by inflammatory cytokines. As splenectomy has been shown to reduce secretion of cytokines, we hypothesized that (1) severe scald injury up-regulates TNF-α and NF-κB, meanwhile down-regulates expression of ZO-1 and occludin, leading to the increased intestinal permeability, and (2) splenectomy can prevent the burn-induced decrease in ZO-1 and occludin expression, resulting in improved intestinal barrier. Wistar rats undergoing a 30% total body surface area (TBSA) thermal trauma were randomized to receive an accessorial splenectomy meanwhile or not. Intestinal injury was assessed by histological morphological analysis, and serum endotoxin levels, TNF-α, NF-κB, ZO-1 and occludin levels were detected by Western blotting in the terminal ileum mucosal tissue. 30% TBSA burn caused a significant increase in serum endotoxin levels, but NF-κB, and TNF-α, and the average intestinal villus height and mucosal thickness were decreased significantly. Burn injury could also markedly decrease the levels of ZO-1 and occludin in terminal ileum mucosal tissue (all PSplenectomy at 7th day after burn significantly reversed the burn-induced breakdown of ZO-1 and occludin (all PSplenectomy may provide a therapeutic benefit in restoring burn-induced intestinal barrier by decreasing the release of inflammatory cytokines and recovering TJ proteins.

  3. Laparoscopic Splenectomy for Traumatic Splenic Injury after Screening Colonoscopy

    Directory of Open Access Journals (Sweden)

    Salim Abunnaja

    2012-09-01

    Full Text Available Colonoscopy is a widespread diagnostic and therapeutic procedure. The most common complications include bleeding and perforation. Splenic rupture following colonoscopy is rarely encountered and is most likely secondary to traction on the splenocolic ligament. Exploratory laparotomy and splenectomy is the most commonly employed therapeutic intervention for this injury reported in the literature. We present the case of a patient with this potentially fatal complication who was treated successfully at our institution. To our knowledge it is the first report in the literature of laparoscopic splenectomy as a successful minimally invasive treatment of splenic rupture following colonoscopy. The patient was a 62-year-old female who underwent screening colonoscopy with polypectomies at the cecum, descending colon and rectum. Immediately following the procedure she developed abdominal pain and had a syncopal episode. Clinical, laboratory and imaging findings were suggestive of hemoperitoneum and a ruptured spleen. A diagnostic laparoscopy was emergently performed and revealed a grade IV splenic laceration and hemoperitoneum. Laparoscopic splenectomy was completed safely and effectively. The patient’s postoperative recovery was uneventful. We conclude that splenic rupture after colonoscopy is a rare but dangerous complication. A high index of suspicion is required to recognize it early. Awareness of this potential complication can lead to optimal patient outcome. Laparoscopic splenectomy may be a feasible treatment option.

  4. Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study.

    Science.gov (United States)

    Lin, Jiun-Nong; Chen, Hsuan-Ju; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Kao, Chia-Hung

    2016-01-01

    The spleen is a crucial organ in humans. However, little is known about the association of venous thromboembolism (VTE) with splenic injury and splenectomy in trauma patients. The aim of this study was to determine the subsequent risk of VTE following splenic injury and splenectomy. A nationwide retrospective cohort study was conducted by analysing data from the National Health Insurance Research Database in Taiwan. We included 6,162 splenic injury patients (3,033 splenectomised and 3,129 nonsplenectomised patients) and 24,648 comparison patients who were selected by frequency match based on sex, age, and the index year during 2000-2006. All patients were followed until the occurrence of VTE, 31 December, 2011, death, or withdrawal from the insurance program. The age of patients with splenic injury was 41.93 ± 16.44 years. The incidence rates of VTE were 11.81, 8.46, and 5.21 per 10,000 person-years in the splenic injury patients with splenectomy, splenic injury patients without splenectomy, and comparison patients, respectively. Compared with the comparison cohort, splenic injury patients with splenectomy exhibited a 2.21-fold risk of VTE (95% confidence interval [CI], 1.43-3.43), whereas those without splenectomy exhibited a 1.71-fold risk of VTE (95% CI, 1.05-2.80). The overall incidence rate of VTE was 1.97-fold higher in the splenic injury cohort than the comparison cohort (95% CI, 1.38-2.81). Although splenectomy increased the risk of VTE 1.35-fold compared with no splenectomy, the difference was not statistically significant (95% CI, 0.74-2.45). These results may alert physicians and patients to the complications of splenic injury and splenectomy.

  5. Splenectomy and risk of renal and perinephric abscesses: A population-based cohort study in Taiwan.

    Science.gov (United States)

    Lai, Shih-Wei; Lin, Hsien-Feng; Lin, Cheng-Li; Liao, Kuan-Fu

    2016-08-01

    Little epidemiological research is available on the relationship between splenectomy and renal and perinephric abscesses. The purpose of the study was to examine this issue in Taiwan.We conducted a population-based retrospective cohort study using the hospitalization dataset of the Taiwan National Health Insurance Program. A total of 16,426 participants aged 20 and older who were newly diagnosed with splenectomy from 1998 to 2010 were assigned to the splenectomy group, whereas 65,653 sex-matched, age-matched, and comorbidity-matched, randomly selected participants without splenectomy were assigned to the nonsplenectomy group. The incidence of renal and perinephric abscesses at the end of 2011 was measured in both groups. The multivariable Cox proportional hazards regression model was used to measure the hazard ratio (HR) and 95% confidence interval (CI) for risk of renal and perinephric abscesses associated with splenectomy and other comorbidities including cystic kidney disease, diabetes mellitus, urinary tract infection, and urolithiasis.The overall incidence rate of renal and perinephric abscesses was 2.14-fold greater in the splenectomy group than that in the nonsplenectomy group (2.24 per 10,000 person-years vs 1.05 per 10,000 person-years, 95% CI 2.02, 2.28). After controlling for sex, age, cystic kidney disease, diabetes mellitus, urinary tract infection, and urolithiasis, the multivariable regression analysis demonstrated that the adjusted HR of renal and perinephric abscesses was 2.24 for the splenectomy group (95 % CI 1.30, 3.88), when compared with the nonsplenectomy group. In further analysis, the adjusted HR markedly increased to 7.69 for those comorbid with splenectomy and diabetes mellitus (95% CI 3.31, 17.9).Splenectomy is associated with renal and perinephric abscesses, particularly comorbid with diabetes mellitus. In view of its potential morbidity and mortality, clinicians should consider the possibility of renal and perinephric abscesses when

  6. Splenectomy Correlates With Increased Risk of Acute Pancreatitis: A Case-Control Study in Taiwan

    Science.gov (United States)

    Lai, Shih-Wei; Lin, Cheng-Li; Liao, Kuan-Fu

    2016-01-01

    Objective The objective of the study was to investigate the association between splenectomy and acute pancreatitis. Methods We conducted a case-control study using the database of the Taiwan National Health Insurance Program. We included 7666 subjects aged 20–84 years with first-time acute pancreatitis during the period of 1998–2011 as cases and 30 664 randomly selected subjects without acute pancreatitis as controls. Both cases and controls were matched for sex, age, and index year of acute pancreatitis diagnosis. The association of acute pancreatitis with splenectomy was examined using a multivariable unconditional logistic regression model and reported as an odds ratio and its 95% confidence interval (CI). Results After adjustment for covariables, the adjusted odds ratio of acute pancreatitis was 2.90 for subjects with splenectomy (95% CI, 1.39–6.05) compared with subjects without splenectomy. Conclusions Splenectomy is associated with acute pancreatitis. Further studies are necessary to clarify the underlying mechanism. PMID:27087607

  7. [Long-term infectious risks after splenectomy: A retrospective cohort study with up to 10 years follow-up].

    Science.gov (United States)

    Meriglier, E; Puyade, M; Carretier, M; Roblot, F; Roblot, P

    2017-07-01

    Although most infections occur within the first 2 years after splenectomy, the relatively short follow-up reported in many studies may underestimate the frequency of infections. The objective of the study was to determine the incidence of infective outcomes and factors associated with infection after splenectomy by studying a group of patients who underwent splenectomy over a 10-year period. A retrospective and monocentric study of patients who underwent splenectomy between January 1st, 1997 and December 31st, 2004 in a French university hospital. Age, sex, indication for splenectomy, infectious events, death, vaccination and antibiotic prophylaxis were collected in January 2015. One hundred and sixty-five patients were included. The most common reasons for splenectomy were therapeutic hematological indications (37.5%). Ninety-seven per cent received pneumococcal vaccine. Prophylactic antibiotics were prescribed in 78% of patients. Thirty-seven patients had 42 severe infections with a median incidence rate of 4 years after splenectomy (2 days-12 years). The rate of infection after splenectomy declined over time but 57% occurred after 2 years and 14.3% after 10 years. Respiratory infections were the most common sites of infections. The incidence of infection differed according to age was highest among the elderly (HR=6.2; 95%CI: 1.4-27.1; after 65 years old) and underlying reason for splenectomy (P=0.02). There is no difference with or without prophylactic antibiotics. After splenectomy, the incidence of severe infection declined over time but can occur after 10 years. The onset of infection is linked to age and reason for splenectomy. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  8. Platelet count evolution as a predictor of outcome after splenectomy for immune thrombocytopenic purpura.

    Science.gov (United States)

    Kim, Moonhwan; Park, Keun Myoung; Shin, Woo Young; Choe, Yun-Mee; Lee, Keon-Young; Ahn, Seung-Ik

    2017-04-01

    Splenectomy is the definitive second-line therapy for refractory immune thrombocytopenic purpura (ITP), and has a reported response rate of 50-80%. Medical attention should be reconsidered when there is no evidence of accessory spleen in refractory ITP patients after splenectomy. The purpose of this study was to determine whether platelet count evolution differs between patients with a successful or unsuccessful result after splenectomy for ITP. Archived records of 104 consecutive patients that underwent splenectomy for ITP were reviewed. Patients were divided into two groups (failures and successes) using a final follow-up platelet count of 100,000/μL as a cut-off. Platelet count evolutions in these two groups were compared using the Student's t test. Successes and failures were found to have significantly different platelet counts from two days postoperatively (P = 0.016). The area under the receiver operating characteristic curve was 0.630 (95% confidence interval, 0.518-0.741, P = 0.030), and when a cut-off value of 100,000/μL was used, sensitivity and specificity were 68.2 and 51.2%, respectively. To obtain positive and negative predictive values exceeding 50%, additional platelet counts were required at one week and one month after splenectomy. We propose a protocol for ITP follow-up after splenectomy.

  9. Splenectomy for solitary splenic metastasis of ovarian cancer

    International Nuclear Information System (INIS)

    Koh, Yang Seok; Kim, Jung Chul; Cho, Chol Kyoon

    2004-01-01

    Splenic metastases occur in rare cases with a few case reports of patients in the literature. Generally, splenic metastases mean late dissemination of a disease. Solitary splenic metastases from solid tumors are extremely unusual. We report a case of a patient with ovarian mucinous cystadenocarcinoma who underwent splenectomy for isolated parenchymal metastasis. Ovarian epithelial tumors comprised most of isolated splenic metastases from gynecologic tumor. When isolated splenic recurrence is suspected on image studies and serum tumor markers, intraabdominal gross findings should be examined to exclude peritoneal carcinomatosis. If only spleen was under suspicion of recurrence of ovarian cancer, splenectomy may play a therapeutic role

  10. Dynamics of immune indices in patients with Hodgkin's disease following splenectomy and radiation therapy

    International Nuclear Information System (INIS)

    Ankudinov, V.A.; Aslyaev, L.A.; Khvorostenko, M.I.; Krugovov, B.A.; Kosse, V.A.

    1981-01-01

    The effect of splenectomy and radiation therapy on immunoreactivity in patients with Hodgkin's disease is studied. It is established that splenectomy and laparatomy are advisable prior to radiation therapy [ru

  11. Effect of splenectomy in patients with haemopoietic diseases on the thrombocytopoietic activity of sera (ATS)

    International Nuclear Information System (INIS)

    Sylwestrowicz, T.; Sokolowska, K.; Szczepanik, A.; Pawelski, S.

    1981-01-01

    Thrombocytopoietic activity (ATS) was determined in tests on mice on the day before and on the 1st, 7th and 14th days after splonectomy in 18 patients (13 with idiopathic thrombocytopenia, 5 with haemolytic anaemia). It was found that in patients with ITP and high-grade splenic destruction of platelets ATS increased on the first days after splenectomy. On the other hand, in ITP patients with low-grade splenic platelet destruction splenectomy decreased the value of ATS immediately after the operation. Splenectomy performed in cases with normal platelet count caused no greater changes in ATS in the first week. These observations suggest that in patients with increased splenic destruction of platelets ATS may be inhibited and this inhibition may be removed after splenectomy. Absent correlation between ATS and platelet count may indicate that the value of ATS is not of decisive importance in thrombocytopenia regression following splenectomy. (author)

  12. Hematological long-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case control study

    NARCIS (Netherlands)

    Berends, F. J.; Schep, N.; Cuesta, M. A.; Bonjer, H. J.; Kappers-Klunne, M. C.; Huijgens, P.; Kazemier, G.

    2004-01-01

    Laparoscopic splenectomy (LS) for idiopathic thrombocytopenic purpura (ITP) appears, when compared to open splenectomy (OS), associated with immediate important advantages. However, in a number of patients splenectomy does not lead to an adequate response, or after initial adequate response a

  13. Splenectomy exacerbates lung injury after ischemic acute kidney injury in mice

    Science.gov (United States)

    Andrés-Hernando, Ana; Altmann, Christopher; Ahuja, Nilesh; Lanaspa, Miguel A.; Nemenoff, Raphael; He, Zhibin; Ishimoto, Takuji; Simpson, Pete A.; Weiser-Evans, Mary C.; Bacalja, Jasna

    2011-01-01

    Patients with acute kidney injury (AKI) have increased serum proinflammatory cytokines and an increased occurrence of respiratory complications. The aim of the present study was to examine the effect of renal and extrarenal cytokine production on AKI-mediated lung injury in mice. C57Bl/6 mice underwent sham surgery, splenectomy, ischemic AKI, or ischemic AKI with splenectomy and kidney, spleen, and liver cytokine mRNA, serum cytokines, and lung injury were examined. The proinflammatory cytokines IL-6, CXCL1, IL-1β, and TNF-α were increased in the kidney, spleen, and liver within 6 h of ischemic AKI. Since splenic proinflammatory cytokines were increased, we hypothesized that splenectomy would protect against AKI-mediated lung injury. On the contrary, splenectomy with AKI resulted in increased serum IL-6 and worse lung injury as judged by increased lung capillary leak, higher lung myeloperoxidase activity, and higher lung CXCL1 vs. AKI alone. Splenectomy itself was not associated with increased serum IL-6 or lung injury vs. sham. To investigate the mechanism of the increased proinflammatory response, splenic production of the anti-inflammatory cytokine IL-10 was determined and was markedly upregulated. To confirm that splenic IL-10 downregulates the proinflammatory response of AKI, IL-10 was administered to splenectomized mice with AKI, which reduced serum IL-6 and improved lung injury. Our data demonstrate that AKI in the absence of a counter anti-inflammatory response by splenic IL-10 production results in an exuberant proinflammatory response and lung injury. PMID:21677145

  14. Peritoneal carcinomatosis-like implants of extramedullary hematopoiesis. An insolite occurrence during splenectomy for myelofibrosis

    Directory of Open Access Journals (Sweden)

    Marco Casaccia

    Full Text Available Introduction: Primary myelofibrosis (MF is a myeloproliferative neoplasm that results in debilitating constitutional symptoms, splenomegaly, and cytopenias. In patients with symptomatic splenomegaly, splenectomy remains a viable treatment option for MF patients with medically refractory symptomatic splenomegaly that precludes the use of ruxolitinib. Case presentation: We present the clinical case of a patient who was admitted to our Department to perform a splenectomy in MF as a therapeutic step prior to an allogeneic stem cell transplantation (ASCT. A laparotomic splenectomy and excision of whitish wide-spread peritoneal and omental nodulations was performed. There were no operative complications and the surgery was completed with minimal blood loss. The histopathological exam revealed an extramedullary hematopoiesis in both spleen and peritoneal nodules. Conclusion: In primary myelofibrosis it must always be kept in mind the possible presence of peritoneal implants of extramedullary hematopoiesis and ascites of reactive genesis. We report a rare case of peritoneal carcinomatosis-like implants of extramedullary hematopoiesis found at splenectomy for MF. Keywords: Myelofibrosis, Splenomegaly, Splenectomy, Extramedullary hematopoiesis

  15. Imaging diagnosis of portal vein thrombosis following splenectomy in 23 patients with hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Yamashita, Kohsuke; Takayasu, Kenichi; Muramatsu, Yukio; Moriyama, Noriyuki; Yamada, Tatsuya; Makuuchi, Masatoshi; Hasegawa, Hiroshi

    1988-01-01

    During the past two years, the postoperative development of portal vein thrombosis (PVT) following splenectomy with simultaneous or subsequent hepatectomy for hepatocellular carcinoma was detected in 3 of 23 patients (13 %) utilizing ultrasound and/or computed tomography. These 3 patients were clinically asymptomatic. Two of these patients were treated medically with urokinase, and aspirin or dipyridamole, with documented resolution of the PVT by ultrasound. (author)

  16. CD4 T lymphocyte counts in patients undergoing splenectomy during living donor liver transplantation.

    Science.gov (United States)

    Natsuda, Koji; Eguchi, Susumu; Takatsuki, Mistuhisa; Soyama, Akihiko; Hidaka, Masaaki; Hara, Takanobu; Kugiyama, Tota; Baimakhanov, Zhassulan; Ono, Shinichiro; Kitasato, Amane; Fujita, Fumihiko; Kanetaka, Kengo; Kuroki, Tamotsu

    2016-02-01

    The role of splenectomy in increasing the CD4-positive T lymphocyte counts (hereafter: CD4 counts) and the CD4 to CD8 ratio have not yet been fully investigated, especially in the case of HIV-positive patients undergoing liver transplantation (LT). The change in the total lymphocyte counts of 32 patients who underwent one-stage splenectomy with living donor (LD) LT with (n=13) or without rituximab (RTX, n=19) therapy were examined to validate our cohort of ABO-incompatible LDLT with RTX. Subsequently, perioperative changes in CD4 counts and the CD 4 to CD8 ratio were measured in 13 patients who underwent ABO-incompatible LDLT/RTX with splenectomy. (1) The administration of RTX did not significantly affect the total lymphocyte counts of patients after LDLT/splenectomy in any of the observation periods. (2) The CD4 counts were significantly higher at 2years after LDLT in comparison to the perioperative CD4 counts but not within the 3-month period (p=0.039). The CD4/CD8 ratio gradually decreased after LDLT/splenectomy under RTX treatment. An immediate increase in the CD4 counts therefore cannot be expected after LDLT with splenectomy. The total lymphocyte and CD4 counts were rather stable in the peritransplant period even in ABO incompatible LDLT with RTX. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. A long-term follow-up study of subtotal splenectomy in children with hereditary spherocytosis

    NARCIS (Netherlands)

    Rosman, Colin; Broens, P M A; Trzpis, M; Tamminga, R Y J

    2017-01-01

    BACKGROUND: Hereditary spherocytosis (HS) is a heterogeneous hemolytic anemia treated with splenectomy in patients suffering from severe or moderate disease. Total splenectomy, however, renders patients vulnerable to overwhelming postsplenectomy infection despite preventive measures. Although

  18. Splenectomy enhances the therapeutic effect of adipose tissue-derived mesenchymal stem cell infusion on cirrhosis rats.

    Science.gov (United States)

    Tang, Wei-Ping; Akahoshi, Tomohiko; Piao, Jing-Shu; Narahara, Sayoko; Murata, Masaharu; Kawano, Takahito; Hamano, Nobuhito; Ikeda, Tetsuo; Hashizume, Makoto

    2016-08-01

    Clinical studies suggest that splenectomy improves liver function in cirrhotic patients, but the influence of splenectomy on stem cell transplantation is poorly understood. This study investigated the effect of splenectomy on stem cell infusion and elucidated its mechanism. Rat adipose tissue-derived mesenchymal stem cells were infused into cirrhosis rats with or without splenectomy, followed by the assessment of the in vivo distribution of stem cells and pathological changes. Stromal cell-derived factor-1 and hepatocyte growth factor expression were also investigated in splenectomized cirrhosis patients and rats. Splenectomy, prior to cell infusion, improved liver function and suppressed fibrosis progression more efficiently than cell infusion alone in the experimental cirrhosis model. Stromal cell-derived factor-1 and hepatocyte growth factor levels after splenectomy were increased in patients and rats. These upregulated cytokines significantly facilitated stem cell motility, migration and proliferation in vitro. C-X-C chemokine receptor type 4 neutralization weakened the promotion of cell migration by these cytokines. The infused cells integrated into liver fibrosis septa and participated in regeneration more efficiently in splenectomized rats. Direct coculture with stem cells led to inhibition of hepatic stellate cell proliferation. In addition, hepatocyte growth factor induced hepatic stellate cell apoptosis via the c-jun N-terminal kinase-p53 pathway. Splenectomy prior to cell infusion enhanced the therapeutic effect of stem cells on cirrhosis, which involved upregulation of stromal cell-derived factor-1 and hepatocyte growth factor after splenectomy. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Splenectomy reduces packed red cell transfusion requirement in children with sickle cell disease.

    Science.gov (United States)

    Haricharan, Ramanath N; Roberts, Jared M; Morgan, Traci L; Aprahamian, Charles J; Hardin, William D; Hilliard, Lee M; Georgeson, Keith E; Barnhart, Douglas C

    2008-06-01

    The purpose of the study was to measure the effect of splenectomy on packed-cell transfusion requirement in children with sickle cell disease. Thirty-seven sickle cell children who underwent splenectomies between January 2000 and May 2006 at a children's hospital were reviewed. Data were collected 6 months preoperatively to 12 months postsplenectomy. Paired t test, analysis of variance, and multivariable regression analyses were performed. Of 37 children with median age 11 years (range, 2-18 years), 34 (21 males) had data that allowed analyses. Twenty-six had Hgb-SS, 5 had Hgb-SC, and 3 had Hgb S-Thal. Laparoscopic splenectomy was attempted in 36 and completed successfully in 34 (94% success). The number of units transfused decreased by 38% for 0 to 6 months and by 45% for 6 to 12 months postsplenectomy. Postoperatively, hematocrit levels increased and reticulocytes concurrently decreased with a reduction in transfusion clinic visits. The decrease in transfusion was not influenced by spleen weight, age, or hemoglobin type. Two children had acute chest syndrome (6%), and 1 had severe pneumonia (3%). Laparoscopic splenectomy can be successfully completed in sickle cell children. Splenectomy significantly reduces the packed red cell transfusion requirement and frequency of clinic visits, in sickle cell children for at least 12 months postoperatively.

  20. The beneficial role of simultaneous splenectomy after extended hepatectomy: experimental study in pigs.

    Science.gov (United States)

    Athanasiou, Antonios; Papalois, Apostolos; Kontos, Michael; Griniatsos, John; Liakopoulos, Dimitrios; Spartalis, Eleftherios; Agrogiannis, George; Liakakos, Theodoros; Pikoulis, Emmanouil

    2017-02-01

    The role of hepatic hemodynamic modulation in the development of "small-for-size" syndrome (SFSS) after extended hepatectomy (EH) or living-donor liver transplantation is still controversial. We have designed an experimental study to investigate the effect of hemodynamic parameters of the liver circulation on the development of SFSS after EH in a porcine model. Eighteen pigs were randomly divided into two groups: group A has received EH (75%-80%) without splenectomy, and group B with EH and simultaneous splenectomy was carried out. Portal hemodynamics, liver function tests, histologic findings, injury and survival rates were compared between groups A and B. The 7-d survival rate in the splenectomy group was significantly improved compared with group A (88.9% versus 44.4%, P splenectomy group were significantly lower than in group A immediately after splenectomy and postoperatively until the day of sacrifice. Histologic findings in group A clearly illustrate severe inflammation, bridging necrosis, ischemic cholangitis, and severe congestion, while in group B there were less serious histologic changes. Our experimental study indicates that perioperative portal modulation can successfully prevent the manifestation of SFSS after EH. Therefore, by focusing on "flow" rather than on "size," researchers may understand better the pathophysiology of this syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. CT diagnosis of subphrenic abscess after splenectomy for trauma; Ruolo della tomografia computerizzata nella valutazione degli ascessi subfrenici dopo splenectomia post-traumatica

    Energy Technology Data Exchange (ETDEWEB)

    Salzano, A. [Ospedale Loreto-Mare, Neaples (IT). Serv. di Radiologia] [and others

    1999-09-01

    The paper studies subphrenic inflammatory abscesses and splenic fluid collections after splenectomy for trauma. These complications may appear early or late postoperatively; they are easily demonstrated with computerized tomography, which permits accurate spatial assessment of the lesions and appropriate treatment with percutaneous drainage. It has been also investigates the diagnostic accuracy of the CT in subphrenic inflammatory conditions after emergency splenectomy for traumatic spleen rupture and found that CT is a precious tool for rapid and easy diagnosis and follow-up of subphrenic abscesses treated with percutaneous drainage. [Italian] Scopo del lavoro e' di valutare il ruolo della tomografia computerizzata nelle flogrosi subfreniche secondarie a splenectomia d'urgenza per rottura traumatica della milza, documentando come tale metodica risulti accurata nel diagnosticare e monitorare in modo semplice e rapido l'evoluzione e il controllo degli ascessi subfrenici trattati con drenaggio percutaneo.

  2. Long-term outcomes of laparoscopic versus open splenectomy for immune thrombocytopenia.

    Science.gov (United States)

    Tada, Kazuhiro; Ohta, Masayuki; Saga, Kunihiro; Takayama, Hiroomi; Hirashita, Teijiro; Endo, Yuichi; Uchida, Hiroki; Iwashita, Yukio; Inomata, Masafumi

    2018-02-01

    Splenectomy is the standard therapy for medically refractory immune thrombocytopenia (ITP). Laparoscopic splenectomy (LS) has gained wide acceptance; however, the long-term outcomes of LS versus open splenectomy (OS) for patients with ITP remain unclear. We analyzed, retrospectively, 32 patients who underwent splenectomy, as LS in 22 and OS in 10, for refractory ITP at our institute. Data were evaluated based on the American Society of Hematology 2011 evidence-based practice guidelines for ITP. Although the operation time was significantly longer in the LS group (p < 0.01), LS was associated with less blood loss (p < 0.01), infrequent blood transfusion during surgery (p < 0.01), quicker resumption of oral intake (p < 0.01), and shorter hospital stay (p < 0.01) than OS. Positive responses, including complete and partial remission, were achieved in 90% of the OS group patients and 77% of the LS group patients. The mean follow-up periods were 183 and 92 months, respectively. Relapse-free survival rates, 15 years after the operation were 63% in the OS group and 94% in the LS group. LS can provide better short-term results and comparable long-term results to those of OS for ITP.

  3. Bacterial clearance after total splenectomy and splenic autotransplantation in rats

    Energy Technology Data Exchange (ETDEWEB)

    Marques, R.G. E-mail: rmarques@uerj.br; Petroianu, Andy; Oliveira, M.B.N. de; Bernardo-Filho, M.; Boasquevisque, E.M.; Portela, M.C

    2002-12-01

    Wistar rats submitted to isolated total splenectomy or total splenectomy combined with splenic autotransplantation were inoculated with {sup 99m}technetium-labeled Escherichia coli. Measurement of isotope uptake in the organs of the mononuclear phagocytic system showed a greater bacterial bloodstream clearance in rats with splenic autotransplantation. Although uptake of bacteria in the spleen was higher in the control group, the number of bacteria remaining in the bloodstream did not differ between groups. These results indicate that splenic autotransplantation preserves the phagocytic function of the spleen.

  4. Bacterial clearance after total splenectomy and splenic autotransplantation in rats

    International Nuclear Information System (INIS)

    Marques, R.G.; Petroianu, Andy; Oliveira, M.B.N. de; Bernardo-Filho, M.; Boasquevisque, E.M.; Portela, M.C.

    2002-01-01

    Wistar rats submitted to isolated total splenectomy or total splenectomy combined with splenic autotransplantation were inoculated with 99m technetium-labeled Escherichia coli. Measurement of isotope uptake in the organs of the mononuclear phagocytic system showed a greater bacterial bloodstream clearance in rats with splenic autotransplantation. Although uptake of bacteria in the spleen was higher in the control group, the number of bacteria remaining in the bloodstream did not differ between groups. These results indicate that splenic autotransplantation preserves the phagocytic function of the spleen

  5. Analysis of abscesses after splenectomy performed during surgical treatment of gastric and cardia cancer

    International Nuclear Information System (INIS)

    Szpakowski, M.; Szawlowski, A.; Olesinski, T.; Tlarek, M.; Kerol, D.; Albinski, J.; Saramak, P.; Jeziorski, K.

    2007-01-01

    The aim this study was to estimate the appearance of abscesses after splenonectomy in patients with gastric and cardia cancer after surgical treatment. Between June 1996 and December 2002, 75 splenectomies were performed during the surgical treatment of gastric cancer (52% pts) and cardia cancer (48%). The studied group included 58 men (77%) and 17 women (23%), aged from 48 to 72 years. The surgical treatment was paliative in 9% of patients while 91% underwent radical operation. 93.33% of the splenectomies were performed due to oncological reasons, 6.6% due to ' technical ' reasons. The studied group included 20% patients with grade I of progression, 20% in grade II, 37% in III and 23% in IV grade. The overall rate of specific complications in patients after surgical treatment due gastric and cardia cancer was 24.8%. Abscesses after splenectomies were observed in 9.33% of patients (7/75 pts). The study has shown no statistically significant differences (p≥ 0.005) regarding all the analyzed parameters (age, grade of progression, nutritioron, etc.) in patients with abscesses, as compared to the control group without abscesses. The overall mortality was estimated to be 2.66%, and 14.33% for patients with abscesses after splenectomy. The most frequent isolated pathogenes were: S. epidermidis MRS, C. albicans, E. faecium, P. aeruginosa. The duration of hospitalization in patients with observed abscesses was estimated to be 55 days (relaparotomy) and 45.5 days (percutaneous drainage). In patients with gastric and cardia cancer undergoing surgical treatment with splenectomy all analyzed the parameters (age, grade of progression, period of drainage, malnutrition, used antibiotics in prophylaxy) were not statistically significant in regard to the appearance of abscesses after splenectomies. Percutaneous drainage with ultrasound control is recommended in treatment of abscesses after splenectomies. (author)

  6. Splenectomy correlates with increased risk of pulmonary tuberculosis: a case-control study in Taiwan.

    Science.gov (United States)

    Lai, S-W; Wang, I-K; Lin, C-L; Chen, H-J; Liao, K-F

    2014-08-01

    This study investigated whether there was an association between splenectomy and pulmonary tuberculosis. This was a case-control study using the database of the Taiwan National Health Insurance Programme. We identified 18 960 patients (aged 20 years or older) with newly diagnosed pulmonary tuberculosis as the case group and 73 988 participants without pulmonary tuberculosis as the control group from 1998 to 2011. Both groups were matched for sex, age (per 5 years) and index year of pulmonary tuberculosis diagnosis. The risk of pulmonary tuberculosis associated with splenectomy and other co-morbidities was estimated. After controlling for confounders, multivariable logistic regression analysis showed that the odds of pulmonary tuberculosis were 1.91 in patients with splenectomy (95% CI 1.06-3.44), compared with the participants without splenectomy. Chronic obstructive pulmonary diseases (OR 3.07, 95% CI 2.94-3.21), pneumoconiosis (OR 2.20, 95% CI 1.90-2.56), chronic kidney diseases (OR 1.49, 95% CI 1.33-1.67), diabetes mellitus (OR 1.57, 95% CI 1.50-1.64) and chronic liver diseases (OR 1.31, 95% CI 1.25-1.37) were associated with an increased risk of pulmonary tuberculosis. The sub-analysis demonstrated that the odds of pulmonary tuberculosis were 4.81 (95% CI 2.31-10.0) for patients co-morbid with splenectomy and any of the above diseases. Splenectomy is associated with a 1.9-fold increased risk of pulmonary tuberculosis in Taiwan. There is a synergistic effect between splenectomy and other co-morbidities on the risk of pulmonary tuberculosis. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  7. Kinetics of small lymphocytes in normal and nude mice after splenectomy

    DEFF Research Database (Denmark)

    Hougen, H P; Hansen, F; Jensen, E K

    1977-01-01

    Autoradiography and various quantitations on lymphoid tissues have been used to evaluate the kinetics of small lymphocytes in normal (+/nu or +/+) and congenitally athymic nude (nu/nu) NMRI mice 1 month after splenectomy or sham-splenectomy. The results indicate that splenectomy causes depressed...... thymic activity and diminished numbers of T lymphocytes in peripheral lymphoid tissues. The total number of cells in these tissues as well as the blast cell activity, were within normal limits. Bone marrow lymphocyte numbers and kinetics as well as blood lymphocyte levels in splenectomized and sham......-splenectomized normal animals were comparable. Blood lymphocyte numbers were at normal levels in splenectomized nude mice, in spite of reduced numbers of bone marrow and thoracic duct lymphocytes. It is suggested that increased number of newly-formed lymphocytes, found in lymph nodes and blood of splenectomized mice...

  8. Histopathological Study of Splenectomy Specimens with Correlation with Age, Sex, and Cause of Splenectomy.

    Directory of Open Access Journals (Sweden)

    Dr Hiral Patel

    2016-12-01

    Full Text Available Spleen is mysterious organ. It can be troublesome specimen for surgical pathologist due to discordance between patient’s clinical condition and perceived finding. The weight of spleen is about 150 grams and lies beneath 9th to 12th thoracic rib in healthy adult and between fundus of stomach & diaphragm. It composed of red pulp (76-79% and white pulp (5-20% which are separated by marginal zone. A total of 100 cases were studied at histopathology section of our laboratory during the period of January 2015 to December 2015. The specimens were received in 10% neutral buffer formalin with duly filled request form. All specimens were examined macroscopically. After routine processing the sections were stained with routine haematoxylin and eosin stain. The most common age group to be affected is 3rd decade (29%, next was 4th decade (23% with slightly male predominance. Male: female ratio is 1.3:1. Most common cause for splenectomy was portal hypertension (33% followed by trauma (15%. Most common microscopic finding is fibrocongestive splenomegaly (68% which is correlated with clinical and radiological finding. In adult Portal hypertension as a hepatic cause and in paediatric age group thalassemia is the most common indication for splenectomy.

  9. Increased Risk of Hemorrhagic and Ischemic Strokes in Patients With Splenic Injury and Splenectomy: A Nationwide Cohort Study.

    Science.gov (United States)

    Lin, Jiun-Nong; Lin, Cheng-Li; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Kao, Chia-Hung

    2015-09-01

    The spleen is a crucial organ in humans. Little is known about the association between stroke and splenic injury or splenectomy. The aim of this study was to determine the risk of stroke in patients with splenic injury and splenectomy.A nationwide cohort study was conducted by analyzing the National Health Insurance Research Database in Taiwan. For comparison, control patients were selected and matched with splenic injury patients in a ratio of 4:1 according to age, sex, and the year of hospitalization. We analyzed the risks of stroke using a Cox proportional-hazards regression analysis.A total of 11,273 splenic injury patients, including 5294 splenectomized and 5979 nonsplenectomized patients, and 45,092 control patients were included in this study. The incidence rates of stroke were 8.05, 6.53, and 4.25 per 1000 person-years in splenic injury patients with splenectomy, those without splenectomy, and the control cohort, respectively. Compared with the control cohort, splenic injury patients with splenectomy exhibited a 2.05-fold increased risk of stroke (95% confidence interval [CI] 1.8-2.34), whereas those without splenectomy exhibited a 1.74-fold increased risk (95% CI 1.51-2). Splenectomy entailed an additional 1.21-fold increased risk of stroke compared with nonsplenectomy in patients with splenic injury.This study revealed that splenic injury and splenectomy were significantly associated with an increased risk of hemorrhagic and ischemic strokes. The results of this study may alert physicians and patients to the complications of splenic injury and splenectomy.

  10. Operative and Immediate Postoperative Differences Between Traditional Multiport and Reduced Port Laparoscopic Total Splenectomy in Pediatric Patients.

    Science.gov (United States)

    Seims, Aaron D; VanHouwelingen, Lisa; Mead, Jessica; Mao, Shenghua; Loh, Amos; Sandoval, John A; Davidoff, Andrew M; Wu, Jianrong; Wang, Winfred C; Fernandez-Pineda, Israel

    2017-02-01

    Laparoscopy offers many benefits to splenectomy, such as reduced incisional pain and shortened hospital duration. The purpose of this study is to evaluate procedural and outcome differences between multiport (MP) and reduced port (RP) splenectomy when utilized to treat children. An institutional review board approved retrospective analysis of all consecutive laparoscopic total splenectomies performed at a single institution between January 2010 and October 2015 was conducted. We evaluated demographics, surgical technique, instance of conversion, operative duration, estimated blood loss, need for intraoperative blood transfusion, postoperative length of stay, time to full feeds, complications, and follow-up duration. Over a 5-year period, 66 patients less than 20 years of age underwent laparoscopic total splenectomy. RP splenectomy was attempted in 14 patients. The remaining 52 were MP operations. Populations were comparable with regard to demographics. Preoperative splenic volumes (mL) were greater in the RP population (median [IQR]: 1377 [747-1508] versus 452 [242-710], P = .039). RP splenectomy demonstrated no difference compared to MP splenectomy in operative time (153 versus 138 minutes, P = .360), estimated blood loss (120 versus 154 mL, P = .634), or percent of cases requiring intraoperative blood transfusion (14 versus 23, P = .716). By the first postoperative day, 57% of RP and 17% of MP patients could be discharged (P = .005). Thirty-day readmission rates were similar, at 7% for RP and 8% for MP operations. Fever was the indication for all readmissions. Mean duration of follow-up is 28 months for MP and 13 months for RP cases. A reduced number of ports can be safely utilized for total splenectomy in pediatric patients without increasing procedural duration or need for intraoperative blood transfusion. In addition, rate of discharge on the first postoperative day was significantly higher in the RP splenectomy group.

  11. Laparoscopic versus open splenectomy in children: a systematic review and meta-analysis.

    Science.gov (United States)

    Feng, Shaoguang; Qiu, Yuhui; Li, Xiang; Yang, Huajun; Wang, Chen; Yang, Junjia; Liu, Weiguang; Wang, Aihe; Yao, Xianming; Lai, Xin-He

    2016-03-01

    We conducted a systematic review and meta-analysis to compare the clinical outcomes between laparoscopic splenectomy and the traditional open splenectomy in children. Literature searches were conducted to identify studies having compared the laparoscopic splenectomy (LS) and open splenectomy (OS) for children. Parameters such as operative time, blood loss, length of postoperative stay, the removal of accessory spleens and postoperative complications including postoperative high fever, acute chest syndrome (ACS), and ileus were pooled and compared by meta-analysis. Among the 922 pediatric participants included in the 10 studies, 508 had received LS and 414 OS. There were shorter length of hospital stays, less blood loss, and longer operative times with the LS approach compared with OS. However, no significant difference was found between LS and OS in the secondary outcome, such as the removal of accessory spleens or postoperative complications including postoperative high fever, ACS, and ileus. LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. Compared with OS, LS has the advantage of shorter hospital stay and less blood loss. Besides, total postoperative complications may be slightly lower in LS. We conclude that LS should be considered an acceptable option for children.

  12. Splenectomy versus conservative management for acute sequestration crises in people with sickle cell disease.

    Science.gov (United States)

    Owusu-Ofori, Shirley; Remmington, Tracey

    2015-09-07

    Acute splenic sequestration crises are a complication of sickle cell disease, with high mortality rates and frequent recurrence in survivors of first attacks. Splenectomy and blood transfusion, with their consequences, are the mainstay of long-term management used in different parts of the world. This is a 2015 update of a Cochrane review first published in 2002, and previously updated in 2013. To assess whether splenectomy (total or partial), to prevent acute splenic sequestration crises in people with sickle cell disease, improved survival and decreased morbidity in people with sickle cell disease, as compared with regular blood transfusions. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which comprises of references identified from comprehensive electronic database searches and handsearching relevant journals and abstract books of conference proceedings.Additional trials were sought from the reference lists of the trials and reviews identified by the search strategy.Date of the most recent search: 10 June 2015. All randomized or quasi-randomized controlled trials comparing splenectomy (total or partial) to prevent recurrence of acute splenic sequestration crises with no treatment or blood transfusions in people with sickle cell disease. No trials of splenectomy for acute splenic sequestration were found. No trials of splenectomy for acute splenic sequestration were found. Splenectomy, if full, will prevent further sequestration and if partial, may reduce the recurrence of acute splenic sequestration crises. However, there is a lack of evidence from trials showing that splenectomy improves survival and decreases morbidity in people with sickle cell disease. There is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of splenectomy compared to transfusion programmes, as a means of improving survival and decreasing mortality from acute splenic

  13. Laparoscopic partial vs total splenectomy in children with hereditary spherocytosis.

    Science.gov (United States)

    Morinis, Julia; Dutta, Sanjeev; Blanchette, Victor; Butchart, Sheila; Langer, Jacob C

    2008-09-01

    Open partial splenectomy provides reversal of anemia and relief of symptomatic splenomegaly while theoretically retaining splenic immune function for hereditary spherocytosis. We recently developed a laparoscopic approach for partial splenectomy. The purpose of the present study is to compare the outcomes in a group of patients undergoing laparoscopic partial splenectomy (LPS) with those in a group of children undergoing laparoscopic total splenectomy (LTS) over the same period. Systematic chart review was conducted of all children with hereditary spherocytosis who had LTS or LPS from 2000 to 2006 at the Hospital for Sick Children, Toronto, Ontario, Canada. T tests were used for continuous data, and chi(2) for proportional data; P value of less than .05 was considered significant. There were 9 patients (14 males) in each group. Groups were similar in sex, age, concomitant cholecystectomy, and preoperative hospitalizations, transfusions, and spleen size. Estimated blood loss was greater in the LPS group (188 + 53 vs 67 + 17 mL; P = .02), but transfusion requirements were similar (1/9 vs 0/9). Complication rate was similar between groups. The LPS group had higher morphine use (4.1 + 0.6 vs 2.4 + 0.2 days; P = .03), greater time to oral intake (4.4 + 0.7 vs 2.0 + 0.2 days; P = .01), and longer hospital stay (6.3 + 1.0 vs 2.7 + 0.3 days; P = .005) than the LTS group. Nuclear scan 6 to 8 weeks postoperatively demonstrated residual perfused splenic tissue in all LPS patients. No completion splenectomy was necessary after a mean follow-up of 25 months. These data suggest that LPS is as effective as LTS for control of symptoms. However, LPS is associated with more pain, longer time to oral intake, and longer hospital stay. These disadvantages may be balanced by retained splenic immune function, but further studies are required to assess long-term splenic function in these patients.

  14. Splenectomy inhibits non-small cell lung cancer growth by modulating anti-tumor adaptive and innate immune response

    Science.gov (United States)

    Levy, Liran; Mishalian, Inbal; Bayuch, Rachel; Zolotarov, Lida; Michaeli, Janna; Fridlender, Zvi G

    2015-01-01

    It has been shown that inhibitors of the immune system reside in the spleen and inhibit the endogenous antitumor effects of the immune system. We hypothesized that splenectomy would inhibit the growth of relatively large non-small lung cancer (NSCLC) tumors by modulating the systemic inhibition of the immune system, and in particular Myeloid Derived Suppressor Cells (MDSC). The effect of splenectomy was evaluated in several murine lung cancer models. We found that splenectomy reduces tumor growth and the development of lung metastases, but only in advanced tumors. In immune-deficient NOD-SCID mice the effect of splenectomy on tumor growth and metastatic spread disappeared. Splenectomy significantly reduced the presence of MDSC, and especially monocytic-MDSC in the circulation and inside the tumor. Specific reduction of the CCR2+ subset of monocytic MDSC was demonstrated, and the importance of the CCL2-CCR2 axis was further shown by a marked reduction in CCL2 following splenectomy. These changes were followed by changes in the macrophages contents of the tumors to become more antitumorigenic, and by increased activation of CD8+ Cytotoxic T-cells (CTL). By MDSC depletion, and adoptive transfer of MDSCs, we demonstrated that the effect of splenectomy on tumor growth was substantially mediated by MDSC cells. We conclude that the spleen is an important contributor to tumor growth and metastases, and that splenectomy can blunt this effect by depletion of MDSC, changing the amount and characteristics of myeloid cells and enhancing activation of CTL. PMID:26137413

  15. Hereditary spherocytosis and partial splenectomy in children: review of surgical technique and the role of imaging

    International Nuclear Information System (INIS)

    Hollingsworth, Caroline L.; Rice, Henry E.

    2010-01-01

    The risks associated with total splenectomy, including overwhelming postsplenectomy infection, have led to an interest in the use of partial splenectomy as an alternative surgical option for children with congenital hemolytic anemias and hypersplenism. Partial splenectomy, a procedure designed to remove enough spleen to improve anemia and avoid complications of splenic sequestration while preserving splenic function, has shown promise in children. Radiologic imaging is essential for the preoperative evaluation and postoperative care for children undergoing partial splenectomy and offers a broad range of critical clinical information essential for care of these complex children. It is imperative for radiologists involved in the care of these children to be familiar with the surgical technique and imaging options for these procedures. This article reviews the surgical technique as well as the current status of various diagnostic imaging options used for children undergoing partial splenectomy, highlighting technical aspects and specific clinical information obtained by each modality. (orig.)

  16. Hereditary spherocytosis and partial splenectomy in children: review of surgical technique and the role of imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hollingsworth, Caroline L. [Duke University Medical Center, Department of Radiology, Box 3808, Durham, NC (United States); Rice, Henry E. [Duke University Medical Center, Department of Surgery, Durham, NC (United States)

    2010-07-15

    The risks associated with total splenectomy, including overwhelming postsplenectomy infection, have led to an interest in the use of partial splenectomy as an alternative surgical option for children with congenital hemolytic anemias and hypersplenism. Partial splenectomy, a procedure designed to remove enough spleen to improve anemia and avoid complications of splenic sequestration while preserving splenic function, has shown promise in children. Radiologic imaging is essential for the preoperative evaluation and postoperative care for children undergoing partial splenectomy and offers a broad range of critical clinical information essential for care of these complex children. It is imperative for radiologists involved in the care of these children to be familiar with the surgical technique and imaging options for these procedures. This article reviews the surgical technique as well as the current status of various diagnostic imaging options used for children undergoing partial splenectomy, highlighting technical aspects and specific clinical information obtained by each modality. (orig.)

  17. Robotic splenectomy with ex vivo bench surgery and hemi-spleen autotransplant: the first report.

    Science.gov (United States)

    Giulianotti, Pier Cristoforo; Daskalaki, Despoina; Gonzalez-Ciccarelli, Luis F; Bianco, Francesco M

    2017-06-01

    We describe our experience with what is, to our knowledge, the first case of robotic assisted ex vivo partial splenectomy with auto-transplantation for a benign non parasitic cyst. The patient is a 32 year-old female with a giant, benign splenic cyst causing persistent abdominal pain. Preoperative imaging showed a cystic lesion measuring 8.3 × 7.6 cm, in the middle portion of the spleen. Due to the central location of the bulky lesion a partial splenectomy was not feasible. As an alternative to a total splenectomy, a possible reimplantation of hemi-spleen after bench surgery was offered. We proceeded with a robotic total splenectomy and bench hemisplenectomy, preserving the lower pole and a portion of the middle segment of the organ. A robotic reconstruction of the splenic vessels was then performed intra-abdominally. The reperfusion was optimal. The total operative time was 305 min, with 78 min of robotic time. Postoperative ultrasound confirmed a patent arterial and venous flow. The postoperative course was uneventful and the patient was discharged on postoperative day 4. The pathology report was consistent with epithelial cyst of the spleen. The patient is doing well at 6-month follow-up. The optimized vision and dexterity provided by the robotic system allowed a safe and precise reconstruction of the splenic vessels, even in a deep and narrow operative field. Partial splenectomy with autotransplantation of the organ was thus achieved, avoiding a total splenectomy in a young patient.

  18. Evaluation the efficacy and safety of simultaneous splenectomy in liver transplantation patients

    Science.gov (United States)

    He, Chao; Liu, Xiaojuan; Peng, Wei; Li, Chuan; Wen, Tian-fu

    2018-01-01

    Abstract Background: Simultaneous splenectomy during liver transplantation (LT) is debated. The present meta-analysis assessed the efficacy and safety of splenectomy on the outcome of LT patients. Methods: We searched PubMed, Embase, and Wanfang databases for relevant studies published until the date of July 15, 2017. Quality assessment of the included studies was performed using a modified Newcastle-Ottawa Scale judgment. The data were analyzed using RevMan5.3 software. Results: A total of 16 studies consisting of 2198 patients (892 patients received splenectomy during LT [SPLT group] and 1306 patients received LT only [LT group]) were included in the present meta-analysis. Efficacy analysis revealed that pooled hazard ratio for overall survival (OS) between 2 groups was not significantly different (hazard ratio = 1.03; 95% confidence interval [CI]: 0.71–1.50). SPLT group had less postoperative rejection (odds ratio [OR] = 0.63, 95% CI: 0.50–0.79) and small for size syndrome (OR = 0.23, 95% CI: 0.07–0.79). SPLT group had significantly lower preoperative platelet (mean difference [MD] = −17.23, 95% CI: −19.54, −14.91), but significantly higher postoperative platelet (MD = 170.45, 95% CI: 108.33–232.56). Conversely, SPLT group had significant higher preoperative portal pressure (MD = 1.54, 95% CI: 0.75–2.33) and significant lower postoperative portal pressure (MD = −1.17, 95% CI: −2.24, −0.11). Safety analysis revealed that SPLT group had significantly longer operation time (MD = 56.66, 95% CI: 35.96–77.35), more intraoperative blood loss (MD = 1.08, 95% CI: 0.25–1.91), and more intraoperative red blood cell (RBC) transfusion (MD = 3.77, 95% CI: 3.22–4.33). Furthermore, SPLT group had significantly higher incidence of postoperative hemorrhage (OR = 3.07, 95% CI: 1.92–4.91), postoperative thrombosis (OR = 3.63, 95% CI: 1.06–12.45), and perioperative infection (OR = 2.62, 95% CI: 1.76

  19. Biodistribution of the radiopharmaceutical technetium-99m-sodium phytate in rats after splenectomy

    International Nuclear Information System (INIS)

    Pereira, Kercia Regina Santos Gomes; Acucena, Maria Kadja Meneses Torres; Villarim Neto, Arthur; Rego, Amalia Cinthia Meneses; Bernardo-Filho, Mario; Azevedo, Italo Medeiros; Araujo Filho, Irami; Medeiros, Aldo Cunha

    2008-01-01

    Drugs and surgery can interfere with the biodistribution of radiopharmaceuticals and data about the effect of splenectomy on the metabolism of phytate-Tc-99m are scarce. This study aimed at evaluating the interference of splenectomy on phytate-Tc-99m biodistribution and liver function in rats. The SP group rats (n=6) underwent splenectomy. In group C (control) the animals were not operated on. After 15 days, all rats were injected with 0.1 mL of Tc-99m-phytate via orbital plexus (0.66 MBq). After 30 minutes, liver samples were harvested, weighed and the percentage of radioactivity per gram (%ATI/g) was determined by a Wizard Perkin-Elme gamma counter. The ATI%/g in splenectomized rats (0.99±0.02) was significantly higher than in controls (0.4±0.02), (p=0.034). ALT, AST and HDL were significantly lower in SP rats (p= 0.001) and leucocytosis was observed in SP rats. In conclusion, splenectomy in rats changed the hepatic biodistribution of Tc-99m-phytate and liver enzymatic activity. (author)

  20. Biodistribution of the radiopharmaceutical technetium-99m-sodium phytate in rats after splenectomy

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Kercia Regina Santos Gomes; Acucena, Maria Kadja Meneses Torres; Villarim Neto, Arthur; Rego, Amalia Cinthia Meneses [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Centro de Ciencias da Saude; Bernardo-Filho, Mario [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes. Dept. de Biofisica e Biometria; Azevedo, Italo Medeiros; Araujo Filho, Irami; Medeiros, Aldo Cunha [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Dept. de Cirurgia]. E-mail: aldo@ufrnet.br

    2008-12-15

    Drugs and surgery can interfere with the biodistribution of radiopharmaceuticals and data about the effect of splenectomy on the metabolism of phytate-Tc-99m are scarce. This study aimed at evaluating the interference of splenectomy on phytate-Tc-99m biodistribution and liver function in rats. The SP group rats (n=6) underwent splenectomy. In group C (control) the animals were not operated on. After 15 days, all rats were injected with 0.1 mL of Tc-99m-phytate via orbital plexus (0.66 MBq). After 30 minutes, liver samples were harvested, weighed and the percentage of radioactivity per gram (%ATI/g) was determined by a Wizard Perkin-Elme gamma counter. The ATI%/g in splenectomized rats (0.99{+-}0.02) was significantly higher than in controls (0.4{+-}0.02), (p=0.034). ALT, AST and HDL were significantly lower in SP rats (p= 0.001) and leucocytosis was observed in SP rats. In conclusion, splenectomy in rats changed the hepatic biodistribution of Tc-99m-phytate and liver enzymatic activity. (author)

  1. Effect of laparoscopic splenectomy in patients with Hepatitis C and cirrhosis carrying IL28B minor genotype

    Science.gov (United States)

    2012-01-01

    Background IL28B and ITPA genetic variants are associated with the outcome of pegylated-interferon and ribavirin (PEG-IFN/RBV) therapy. However, the significance of these genetic variants in cirrhotic patients following splenectomy has not been determined. Methods Thirty-seven patients with HCV-induced cirrhosis who underwent laparoscopic splenectomy (Spx group) and 90 who did not (non-Spx group) were genotyped for IL28B and ITPA. The outcome or adverse effects were compared in each group. Interferon-stimulated gene 15 (ISG15) and protein kinase R expression in the spleen was measured using total RNA extracted from exenterate spleen. Results Sustained virological response (SVR) rate was higher in patients carrying IL28B major genotype following splenectomy (50% vs 27.3%) and in patients carrying minor genotype in the Spx group compared to non-Spx group (27.3% vs 3.6%, P splenectomy did not increase hemoglobin (Hb) level, Hb decline tended to be greater in the non-Spx group. In contrast, splenectomy significantly increased platelet count (61.1 × 103/μl vs 168.7 × 103/μl, P splenectomy. Splenectomy improved SVR rate among patients carrying IL28B minor genotype and protected against anemia and thrombocytopenia during the course of PEG-IFN/RBV therapy regardless of ITPA genotype. PMID:23145809

  2. [Role of splenectomy in the treatment of non-cirrhotic portal hypertension: about 3 cases].

    Science.gov (United States)

    Belhamidi, Mohamed Said; Hammi, Salah Eddine; Bouzroud, Mohamed; Benmoussa, Mustapha; Ali, Abdelmounaim Ait; Bounaim, Ahmed

    2017-01-01

    Non-cirrhotic portal hypertension was first described by Guido BANTI in 1898 as a condition characterized by the association of portal hypertension with splenomegaly, anemia and healthy liver. The diagnosis was based on abdominal ultrasound, splenoportography and liver biopsy. Our study aimed to evaluate the role of splenectomy in non-cirrhotic portal hypertension. We conducted a retrospective study of 3 patients (2 women and 1 man) treated by our staff over the period January 2010 -September 2016. The diagnosis of idiopathic portal hypertension was based on the following criteria: portal hypertension, the presence of oesophageal varices associated with splenomegaly, the absence of cirrhosis or of other liver disorders responsible of portal hypertension. All patients underwent splenectomy. Outcome after splenectomy was marked by the standardization of clinical, radiological and biological signs of this disease associated with the absence of oesophageal varices recurrence. Splenectomy associated with ligation of oesophageal varices may be sufficient to treat this syndrome and especially its consequences without using splenorenal bypass.

  3. Incidence of gastric dilatation-volvulus following a splenectomy in 238 dogs.

    Science.gov (United States)

    Maki, Lynn C; Males, Kristina N; Byrnes, Madeline J; El-Saad, Anthony A; Coronado, George S

    2017-12-01

    There is contradicting information in the veterinary literature regarding canine splenectomy and the increased risk for subsequent gastric dilatation-volvulus. The main purpose of this study was to determine the rate of occurrence of gastric dilatation-volvulus following splenectomy in medium to large breed dogs compared with a control group undergoing other abdominal procedures. Follow-up was performed by reviewing the medical records and conducting phone interviews. Weight, gender, and presence of a hemoabdomen at the time of surgery were not significantly associated with occurrence of gastric dilatation-volvulus, while increasing age was. Ten of 238 (4%) dogs in the splenectomy group and 3/209 (1.4%) dogs in the control group subsequently developed gastric dilatation-volvulus, which was not significantly different ( P = 0.08). While the findings approach significance and support a need for future investigation, the current recommendation for gastropexy at time of splenic removal should be made on a case by case basis and while considering previously documented risk factors.

  4. Splenectomy Improves Hemostatic and Liver Functions in Hepatosplenic Schistosomiasis Mansoni.

    Directory of Open Access Journals (Sweden)

    Luiz Arthur Calheiros Leite

    Full Text Available Schistosomiasis mansoni is a chronic liver disease, in which some patients (5-10% progress to the most severe form, hepatosplenic schistosomiasis. This form is associated with portal hypertension and splenomegaly, and often episodes of gastrointestinal bleeding, even with liver function preserved. Splenectomy is a validated procedure to reduce portal hypertension following digestive bleeding. Here, we evaluate beneficial effects of splenectomy on blood coagulation factors and liver function tests in hepatosplenic schistosomiasis mansoni compared to non-operated patients.Forty-five patients who had undergone splenectomy surgery were assessed by laboratory analyses and ultrasound examination and compared to a non-operated group (n = 55. Blood samples were obtained for liver function tests, platelet count and prothrombin time. Coagulation factors (II, VII, VIII, IX and X, protein C and antithrombin IIa, plasminogen activator inhibitor-1 were measured by routine photometric, chromogenic or enzyme-linked immunosorbent assays, while hyperfibrinolysis was defined by plasminogen activator inhibitor-1 levels. Both groups had similar age, gender and pattern of periportal fibrosis. Splenectomized patients showed significant reductions in portal vein diameter, alkaline phosphatase and bilirubin levels compared to non-operated patients, while for coagulation factors there were significant improvement in prothrombin, partial thromboplastin times and higher levels of factor VII, VIII, IX, X, protein C and plasminogen activator inhibitor-1.This study shows that the decrease of flow pressure in portal circulation after splenectomy restores the capacity of hepatocyte synthesis, especially on the factor VII and protein C levels, and these findings suggest that portal hypertension in patients with hepatosplenic schistosomiasis influences liver functioning and the blood coagulation status.

  5. Selective spleen scintigraphy to evaluate frequency of splenosis after posttraumatic splenectomy

    International Nuclear Information System (INIS)

    Loew, A.; Tischler, E.; Mahlstedt, J.; Wolf, F.; Meier, H.

    1981-01-01

    In 60 patients having had posttraumatic splenectomy between 9 months and 12 years ago frequency of splenosis was investigated in comparison to immunological and hematological parameters. Selective spleen scintigraphy was performed with sup(99m)-Tc-labelled heat-damaged auto-erythrocytes. In 46,7% of the patients splenosis was found without age dependence. Between patients with and without splenosis no significant differences concerning the immunological and hematological parameters were seen. Therefore, the lack of pathological manifestations after posttraumatic splenectomy is not to be related to autotransplantation of splenic tissue. (orig.) [de

  6. Splenectomy in patients with idiopathic thrombocytopenic purpura: Analysis of 109 cases

    Directory of Open Access Journals (Sweden)

    Enver Ay

    2012-03-01

    Full Text Available Objectives: Splenectomy is performed in order to provide the treatment in the patients with severe idiopathic thrombocytopenic purpura, refractory to medical treatment. In this study, we aimed to investigate the postoperatif and longterm outcomes in the patients who underwent splenectomy with the diagnosis of idiopathic thrombocytopenic purpura.Materials and Methods: Between 2001-2010 at Dicle University Medical Faculty, General Surgery Department, a retrospective review of the 109 patients who had undergone splenectomy for ITP was reviewed. Age, gender, presence of accessory spleens and location, duration of the operation, number of preoperative platelet tranfusion, number of preoperative and postoperative blood transfusion, length of hospital stay, long-term outcomes, morbidity and mortality were recorded.Results: The mean age was 37.10 ± 16.62 (16-72, and there were 88 (80.7% female and 21 (19.3% male patients. The mean operation time was 44.87 ± 10:32 (30-120 minutes. The average postoperative blood and preoperative platelet transfusion were 1.63 ± 0.85 (0-3 and 2.01 ± 0.71 (1-3 units, respectively. The accessory spleens were encountered in 20 (18.3% patients at the ultrasonographic examination. And also the accessory spleens were encountered in 23 (21.1% patients during operation and confirmed with histopathologic examination. The most common localization of accessory spleens were splenic hilus. The postoperative complications were occurred in 16 patients (14.7% and the most complication was atelectasia. The mean length of hospital stay was 4:56 ± 2:45 (2-12 days. Patients were followed for an average of 28 (9-48 months. At the follow-up period, 1 (0.9 % patient had died.Conclusion: Splenectomy can be performed safely in the treatment of the patients with idiopathic thrombocytopenic purpura unresponsive to medical treatment. Long-term good results can be obtained with splenectomy in these patients. The accessory spleens should not be

  7. Accessory spleen compromising response to splenectomy for idiopathic thrombocytopenic purpura

    International Nuclear Information System (INIS)

    Ambriz, P.; Munoz, R.; Quintanar, E.; Sigler, L.; Aviles, A.; Pizzuto, J.

    1985-01-01

    Accessory spleens were sought in 28 patients who had undergone splenectomy for chronic idiopathic thrombocytopenic purpura (ITP), using a variety of techniques. Abdominal scintigraphy with autologous erythrocytes labeled with Tc-99m and opsonized with anit-D IgG (radioimmune method) proved to be most useful, clearly demonstrating one or more accessory spleens in 12 cases (43%). Computed tomography (CT) was also helpful. Four out of five patients demonstrated an increased platelet count following surgery, the effectiveness of which was illustrated by the radioimmune scan. Patients who have had splenectomy for chronic ITP should be scanned using radioimmune techniques and CT to determine whether an accessory spleen is present

  8. Peritoneal carcinomatosis-like implants of extramedullary hematopoiesis. An insolite occurrence during splenectomy for myelofibrosis.

    Science.gov (United States)

    Casaccia, Marco; Fornaro, Rosario; Frascio, Marco; Palombo, Denise; Stabilini, Cesare; Firpo, Emma; Gianetta, Ezio

    2017-01-01

    Primary myelofibrosis (MF) is a myeloproliferative neoplasm that results in debilitating constitutional symptoms, splenomegaly, and cytopenias. In patients with symptomatic splenomegaly, splenectomy remains a viable treatment option for MF patients with medically refractory symptomatic splenomegaly that precludes the use of ruxolitinib. We present the clinical case of a patient who was admitted to our Department to perform a splenectomy in MF as a therapeutic step prior to an allogeneic stem cell transplantation (ASCT). A laparotomic splenectomy and excision of whitish wide-spread peritoneal and omental nodulations was performed. There were no operative complications and the surgery was completed with minimal blood loss. The histopathological exam revealed an extramedullary hematopoiesis in both spleen and peritoneal nodules. In primary myelofibrosis it must always be kept in mind the possible presence of peritoneal implants of extramedullary hematopoiesis and ascites of reactive genesis. We report a rare case of peritoneal carcinomatosis-like implants of extramedullary hematopoiesis found at splenectomy for MF. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Retrospective analysis of rituximab therapy and splenectomy in childhood chronic and refractory immune thrombocytopenic purpura.

    Science.gov (United States)

    Ay, Yilmaz; Karapinar, Tuba H; Oymak, Yesim; Toret, Ersin; Demirag, Bengu; Ince, Dilek; Ozcan, Esin; Moueminoglou, Nergial; Koker, Sultan A; Vergin, Canan

    2016-06-01

    Immune thrombocytopenic purpura (ITP) results from accelerated platelet destruction mediated by autoantibodies to platelet glycoproteins. Some patients with chronic ITP are refractory to all therapies [steroids, intravenous immunoglobulin (IVIG), anti-D and immunosuppresive drugs] and have chronic low platelet counts and episodic bleeding. We retrospectively evaluated the efficacy and safety of rituximab treatment and splenectomy in paediatric patients diagnosed with chronic and refractory ITP who were unresponsive to steroids, IVIG, cyclosporine and mycophenolate mofetil. Records of patients with chronic and refractory ITP in 459 patients with primary ITP who were followed up in our hospital from January 2005 to December 2014 were reviewed. Fifteen of patients received rituximab and/or applied splenectomy. Fifteen chronic ITP patients (10 boys, five girls) with a mean age of 10 years were enrolled in the study. Two of these patients were suffering from Evans syndrome. The median time since diagnosis of ITP was 10 years. The median follow-up duration after starting Rituximab and splenectomy were 13 and 9.5 months, respectively.None of the seven patients who were treated with rituximab achieved a response. A splenectomy was performed in six of the seven patients who had been treated with rituximab. Complete and partial responses were achieved in 67 and 33% of the patients, respectively. We evaluated the clinical characteristics and responses of chronic ITP patients who did not receive rituximab therapy and underwent a splenectomy. The success rate was 100% in the eight patients with chronic and refractory ITP. Rituximab therapy might not be beneficial for some children with severe chronic ITP who are refractory to standard agents. A splenectomy might be useful and preferable to rituximab.

  10. Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review.

    Science.gov (United States)

    Moris, Demetrios; Dimitriou, Nikoletta; Griniatsos, John

    2017-01-01

    Since its introduction in the early 1990s, laparoscopic splenectomy (LS) has gained worldwide acceptance for spleen removal, especially in hematological patients. The present review summarizes the current knowledge and results of LS for the treatment of benign hematological diseases in adults. A MEDLINE/PubMed database research was performed using the terms: "laparoscopic splenectomy" OR "laparoscopy" OR "splenectomy" AND "hematological disorders" OR "hematological disease" OR "hematology" AND "adults" as key words. We set our analysis starting date as January 1st 2010 and the end date as December 31st 2016. We identified 247 relative articles. All the references from the identified articles were searched for relevant information. Twenty-seven articles were deemed appropriate for our analysis. LS was found to be feasible and safe in the majority of patients with benign hematological disorders, with a mortality rate ranging from 0% to less than 4% and the postoperative complications rate from 0% to 35.7%. The conversion rate was also very low (4%) and response (complete or partial) was achieved in more than 80% of patients. Lateral approach with four trocars was the most commonly used approach with concommitant cholecystectomy being correlated with increased operative time and morbidity. Current literature holds that whenever splenectomy is required for the treatment of hematological disorders in adults, a laparoscopic approach should be offered as the gold standard. However, to strengthen the clinical evidence in favor of LS, more high-quality clinical trials on several issues of the procedure are necessary. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  11. The Place of Splenectomy Disorders In Haematological

    African Journals Online (AJOL)

    1974-06-15

    Jun 15, 1974 ... Forty patients underwent splenectomy because of the presence of .... postoperative day, the period of follow-up varied from. 1 month to 6 years ... the patient was admitted to hospital, critically ill, with a short history ... Diagnosis uncertain. 2. 1 ... haemoglobin rose to 16 g/100 ml, at which level it stabilised.

  12. Clinical Outcome and Predictive Factors in the Response to Splenectomy in Elderly Patients with Primary Immune Thrombocytopenia: A Multicenter Retrospective Study.

    Science.gov (United States)

    Park, Young Hoon; Yi, Hyeon Gyu; Kim, Chul Soo; Hong, Junshik; Park, Jinny; Lee, Jae Hoon; Kim, Ho Young; Kim, Hyo Jung; Zang, Dae Young; Kim, Se Hyung; Park, Seong Kyu; Hong, Dae Sik; Lee, Guk Jin; Jin, Jong-Youl

    2016-01-01

    Because many physicians seem reluctant to recommend splenectomy for elderly patients with immune thrombocytopenia (ITP), we investigated the safety and efficacy of splenectomy and the predictive factors for response in these patients. 184 patients with primary ITP were retrospectively analyzed based on age at splenectomy: an elderly group (≥60 years, n = 52) and a younger group (splenectomy (HR 2.9, 95% CI: 1.24-6.80, p = 0.014) and platelet count on postoperative day 14 ≥200 × 109/l (HR 31.43, 95% CI: 4.15-238.28, p = 0.001) were independent factors for a favorable response. Age ≥60 years did not influence the response to splenectomy but was associated with increased relapse and postoperative complications. Splenectomy could provide a durable long-term response for elderly ITP patients. © 2016 S. Karger AG, Basel.

  13. Site of destruction of 111 indium-labeled autologous platelets and effectiveness of splenectomy

    International Nuclear Information System (INIS)

    Najean, Y.; Dufour, Y.

    1991-01-01

    Platelet life-span was studied in 165 patients (including 25 children) with chronic idiopathic thrombocytopenic purpura (of at least one year duration) using 111 indium-oxinate-labeled autologous platelets. The site of platelet destruction was not correlated with age, severity of the disease or presence of immunologic anomalies; this site was characteristic of each individual and remained unchanged in a given patient when the test was repeated several times. Splenectomy was performed in 79 patients (at the discretion of physicians who elected splenectomy in 63% of patients with splenic destruction versus 26% only of patients with hepatic destruction). A very close correlation was found between site of destruction and efficiency of splenectomy. However, 13% of initially improved patients developed a recurrence. Spontaneous improvement was seen in only 8 of the non-splenectomized patients with long-term follow-ups (1-5 years) [fr

  14. Potential benefits of therapeutic splenectomy for patients with Hodgkin's disease and non-Hodgkin's lymphomas

    International Nuclear Information System (INIS)

    Schreiber, D.P.; Jacobs, C.; Rosenberg, S.A.; Cox, R.S.; Hoppe, R.T.

    1985-01-01

    Thirty-four patients with Hodgkin's disease and non-Hodgkin's lymphoma underwent therapeutic splenectomies to improve hematologic tolerance for chemotherapy. The mean age was 40 years; there were 16 males and 18 females. Fourteen had Hodgkin's disease, 19 had non-Hodgkin's lymphoma, and 1 had malignant histocytosis. Nineteen had palpable splenomegaly, 19 had marrow involvement and 20 had splenic involvement by lymphoma. The following data were analyzed before and after splenectomy: mean white blood cell count (WBC) and platelet count on planned first day of cycle, delay ratio of chemotherapy delivery and percent maximal dose rate. Thirteen patients had non-Hodgkin's lymphoma, splenomegaly and positive bone marrow and showed significant benefit in all of the aforementioned parameters. Of the patients with prior irradiation, only those who completed their radiation greater than six months prior to splenectomy showed benefit. Ten patients had Hodgkin's disease, negative bone marrow and no splenomegaly. This group showed significant improvement in mean platelet count but more limited benefit in delay ratio and percent maximal dose rate. Thus, selected patients with lymphoma who are experiencing delays in chemotherapy because of poor count tolerance may benefit from splenectomy

  15. Splenectomy for the treatment of thrombotic thrombocytopenic purpura

    NARCIS (Netherlands)

    Kappers-Klunne, MC; Wijermans, P; Fijnheer, R; Croockewit, AJ; van der Holt, B; de Wolf, JTM; Lowenberg, B; Brand, A

    Plasma exchange is the treatment of choice for patients with thrombotic thrombocytopenic purpura (TTP) and results in remission in >80% of the cases. Treatment of patients who are refractory to plasma therapy or have relapsing disease is difficult. Splenectomy has been a therapeutic option in these

  16. Splenectomy during whole liver transplantation: a morbid procedure which does not adversely impact long-term survival.

    Science.gov (United States)

    Golse, Nicolas; Mohkam, Kayvan; Rode, Agnès; Pradat, Pierre; Ducerf, Christian; Mabrut, Jean-Yves

    2017-06-01

    Indications for splenectomy (SP) during whole liver transplantation (LT) remain controversial and SP is often avoided because of common complications. We aimed to evaluate specific complications of these combined procedures. Data were retrospectively analysed. Splenectomy was performed in patients with splenorenal shunt and/or splenic artery aneurysms or hypersplenism. Patients undergoing simultaneous transplantation and splenectomy (LTSP group) were matched to a non-splenectomy group (LT group). Between 1994 and 2013, we included 47 and 94 patients in LTSP and LT groups, respectively. The LTSP patients had a higher rate of pre-LT portal vein thrombosis (PVT). The LTSP group had a longer operative time and greater blood loss. Mean follow-up was 101 months and 5-year survivals were identical (LTSP 85% vs LT 88%, p = 0.831). Hospital morbidity and rejection incidence were comparable, whereas de novo PVT (34% vs 2%, p Splenectomy during LT is technically demanding and exposes recipients to a higher thrombosis rate, therefore portal vein patency must be specifically assessed postoperatively. In selected recipients, SP can be performed without increased mortality but at the price of worsening outcome as evidenced by greater risk of infection and PVT. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  17. Peritoneal carcinomatosis-like implants of extramedullary hematopoiesis. An insolite occurrence during splenectomy for myelofibrosis

    OpenAIRE

    Casaccia, Marco; Fornaro, Rosario; Frascio, Marco; Palombo, Denise; Stabilini, Cesare; Firpo, Emma; Gianetta, Ezio

    2017-01-01

    Introduction: Primary myelofibrosis (MF) is a myeloproliferative neoplasm that results in debilitating constitutional symptoms, splenomegaly, and cytopenias. In patients with symptomatic splenomegaly, splenectomy remains a viable treatment option for MF patients with medically refractory symptomatic splenomegaly that precludes the use of ruxolitinib. Case presentation: We present the clinical case of a patient who was admitted to our Department to perform a splenectomy in MF as a therapeutic ...

  18. Splenectomy in massive tropical splenomegaly: two-to six-year follow-up in 14 patients.

    Science.gov (United States)

    Vriend, W H; Hoffman, S L; Silaban, T; Zaini, M

    1988-10-01

    Between 1978 and 1982, 14 patients underwent splenectomy for disabling massive splenomegaly at the Regency Hospital in Wamena in the highlands of Irian Jaya, Indonesia. All patients were clinically diagnosed as having tropical splenomegaly syndrome (hyperreactive malarial splenomegaly), but in no case was the diagnosis confirmed. In May 1984 nurses and physicians caring for these 14 patients were asked to fill in a questionnaire regarding the patients' conditions. Two to 6 years after splenectomy, 8 of the 14 patients were alive and able to work; at least 6 of the 8 at normal or near normal capacity. One patient died 4 days after surgery and 5 died from 2 to 20 months after surgery. We conclude that splenectomy is beneficial for some highly selected patients with the clinical diagnosis of tropical splenomegaly syndrome.

  19. Bacterial Meningitis in Adults After Splenectomy and Hyposplenic States

    NARCIS (Netherlands)

    Adriani, Kirsten S.; Brouwer, Matthijs C.; van der Ende, Arie; van de Beek, Diederik

    2013-01-01

    Objective: To examine the occurrence, disease course, prognosis, and vaccination status of patients with community-acquired bacterial meningitis with a history of splenectomy or functional hyposplenia. Patients and Methods: Patients with bacterial meningitis proven by cerebrospinal fluid culture

  20. Acute Central Retinal Vein Occlusion Secondary to Reactive Thrombocytosis after Splenectomy

    Directory of Open Access Journals (Sweden)

    Nursen Oncel Acir

    2014-01-01

    Full Text Available The diagnosis and treatment of central retinal vein occlusion was reported in a young patient. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after splenectomy. The patient was treated with steroids for papilledema and administered coumadin and aspirin. The symptoms resolved, and the findings returned to normal within three weeks. Current paper emphasizes that, besides other well-known thrombotic events, reactive thrombocytosis after splenectomy may cause central retinal vein occlusion, which may be the principal symptom of this risky complication. Thus, it can be concluded that followup for thrombocytosis and antithrombotic treatment, when necessary, are essential for these cases.

  1. Evaluation the efficacy and safety of simultaneous splenectomy in liver transplantation patients: A meta-analysis.

    Science.gov (United States)

    He, Chao; Liu, Xiaojuan; Peng, Wei; Li, Chuan; Wen, Tian-Fu

    2018-03-01

    Simultaneous splenectomy during liver transplantation (LT) is debated. The present meta-analysis assessed the efficacy and safety of splenectomy on the outcome of LT patients. We searched PubMed, Embase, and Wanfang databases for relevant studies published until the date of July 15, 2017. Quality assessment of the included studies was performed using a modified Newcastle-Ottawa Scale judgment. The data were analyzed using RevMan5.3 software. A total of 16 studies consisting of 2198 patients (892 patients received splenectomy during LT [SPLT group] and 1306 patients received LT only [LT group]) were included in the present meta-analysis. Efficacy analysis revealed that pooled hazard ratio for overall survival (OS) between 2 groups was not significantly different (hazard ratio = 1.03; 95% confidence interval [CI]: 0.71-1.50). SPLT group had less postoperative rejection (odds ratio [OR] = 0.63, 95% CI: 0.50-0.79) and small for size syndrome (OR = 0.23, 95% CI: 0.07-0.79). SPLT group had significantly lower preoperative platelet (mean difference [MD] = -17.23, 95% CI: -19.54, -14.91), but significantly higher postoperative platelet (MD = 170.45, 95% CI: 108.33-232.56). Conversely, SPLT group had significant higher preoperative portal pressure (MD = 1.54, 95% CI: 0.75-2.33) and significant lower postoperative portal pressure (MD = -1.17, 95% CI: -2.24, -0.11). Safety analysis revealed that SPLT group had significantly longer operation time (MD = 56.66, 95% CI: 35.96-77.35), more intraoperative blood loss (MD = 1.08, 95% CI: 0.25-1.91), and more intraoperative red blood cell (RBC) transfusion (MD = 3.77, 95% CI: 3.22-4.33). Furthermore, SPLT group had significantly higher incidence of postoperative hemorrhage (OR = 3.07, 95% CI: 1.92-4.91), postoperative thrombosis (OR = 3.63, 95% CI: 1.06-12.45), and perioperative infection (OR = 2.62, 95% CI: 1.76-3.90). In addition, perioperative mortality was significantly higher in

  2. Splenectomy suppresses growth and metastasis of hepatocellular carcinoma through decreasing myeloid-derived suppressor cells in vivo.

    Science.gov (United States)

    Long, Xin; Wang, Jian; Zhao, Jian-Ping; Liang, Hui-Fang; Zhu, Peng; Cheng, Qi; Chen, Qian; Wu, Yan-Hui; Zhang, Zhan-Guo; Zhang, Bi-Xiang; Chen, Xiao-Ping

    2016-10-01

    The function of the spleen in tumor development has been investigated for years. The relationship of the spleen with hepatocellular carcinoma (HCC), a huge health burden worldwide, however, remains unknown. The present study aimed to examine the effect of splenectomy on the development of HCC and the possible mechanism. Mouse hepatic carcinoma lines H22 and Hepa1-6 as well as BALB/c and C57 mice were used to establish orthotopic and metastatic mouse models of liver cancer. Mice were divided into four groups, including control group, splenectomy control group (S group), tumor group (T group) and tumor plus splenectomy group (T+S group). Tumor growth, metastases and overall survival were assessed at determined time points. Meanwhile, myeloid-derived suppressor cells (MDSCs) were isolated from the peripheral blood (PB), the spleen and liver tumors, and then measured by flow cytometery. It was found that liver cancer led to splenomegaly, and increased the percentage of MDSCs in the PB and spleen in the mouse models. Splenectomy inhibited the growth and progression of liver cancer and prolonged the overall survival time of orthotopic and metastatic models, which was accompanied by decreased proportion of MDSCs in the PB and tumors of liver cancer-bearing mouse. It was suggested that splenectomy could be considered an adjuvant therapy to treat liver cancer.

  3. [Infectious complications after surgical splenectomy in children with sickle cell anemia disease].

    Science.gov (United States)

    Monaco Junior, Cypriano Petrus; Fonseca, Patricia Belintani Blum; Braga, Josefina Aparecida Pellegrini

    2015-01-01

    To evaluate the frequency of infectious complications in children with sickle cell disease (SCD) after surgical splenectomy for acute splenic sequestration crisis. Retrospective cohort of children with SCD who were born after 2002 and were regularly monitored until July 2013. Patients were divided into two groups: cases (children with SCD who underwent surgical splenectomy after an episode of splenic sequestration) and controls (children with SCD who did not have splenic sequestration and surgical procedures), in order to compare the frequency of invasive infections (sepsis, meningitis, bacteremia with positive blood cultures, acute chest syndrome and/or pneumonia) by data collected from medical records. Data were analyzed by descriptive statistical analysis. 44 patients were included in the case group. The mean age at the time of splenectomy was 2.6 years (1-6.9 years) and the mean postoperative length of follow-up was 6.1 years (3.8-9.9 years). The control group consisted of 69 patients with a mean age at the initial follow-up visit of 5.6 months (1-49 months) and a mean length of follow-up of 7.2 years (4-10.3 years). All children received pneumococcal conjugate vaccine. No significant difference was observed between groups in relation to infections during the follow-up. Surgical splenectomy in children with sickle cell disease that had splenic sequestration did not affect the frequency of infectious complications during 6 years of clinical follow-up. Copyright © 2015 Associação de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  4. Can children with sickle cell disease undergo open splenectomy ...

    African Journals Online (AJOL)

    We report three children with sickle cell anaemia presenting with chronic massive splenomegaly and hypersplenism. The children were initially denied surgery because of extremely low haemoglobin levels and the inefficacy of transfusion. Subsequently, they underwent successful open abdominal splenectomy without any ...

  5. Effect of laparoscopic splenectomy in patients with Hepatitis C and cirrhosis carrying IL28B minor genotype

    Directory of Open Access Journals (Sweden)

    Motomura Takashi

    2012-11-01

    Full Text Available Abstract Background IL28B and ITPA genetic variants are associated with the outcome of pegylated-interferon and ribavirin (PEG-IFN/RBV therapy. However, the significance of these genetic variants in cirrhotic patients following splenectomy has not been determined. Methods Thirty-seven patients with HCV-induced cirrhosis who underwent laparoscopic splenectomy (Spx group and 90 who did not (non-Spx group were genotyped for IL28B and ITPA. The outcome or adverse effects were compared in each group. Interferon-stimulated gene 15 (ISG15 and protein kinase R expression in the spleen was measured using total RNA extracted from exenterate spleen. Results Sustained virological response (SVR rate was higher in patients carrying IL28B major genotype following splenectomy (50% vs 27.3% and in patients carrying minor genotype in the Spx group compared to non-Spx group (27.3% vs 3.6%, P 3/μl vs 168.7 × 103/μl, P Conclusions IL28B genetic variants correlated with response to PEG-IFN/RBV following splenectomy. Splenectomy improved SVR rate among patients carrying IL28B minor genotype and protected against anemia and thrombocytopenia during the course of PEG-IFN/RBV therapy regardless of ITPA genotype.

  6. Capnocytophaga canimorsus: an emerging cause of sepsis, meningitis, and post-splenectomy infection after dog bites.

    Science.gov (United States)

    Butler, T

    2015-07-01

    Newly named in 1989, Capnocytophaga canimorsus is a bacterial pathogen found in the saliva of healthy dogs and cats, and is transmitted to humans principally by dog bites. This review compiled all laboratory-confirmed cases, animal sources, and virulence attributes to describe its epidemiology, clinical features, and pathogenesis. An estimated 484 patients with a median age of 55 years were reported, two-thirds of which were male. The case-fatality rate was about 26%. Its clinical presentations included severe sepsis and fatal septic shock, gangrene of the digits or extremities, high-grade bacteremia, meningitis, endocarditis, and eye infections. Predispositions were prior splenectomy in 59 patients and alcoholism in 58 patients. Dog bites before illness occurred in 60%; additionally, in 27%, there were scratches, licking, or other contact with dogs or cats. Patients with meningitis showed more advanced ages, higher male preponderance, lower mortality, and longer incubation periods after dog bites than patients with sepsis (p spleens (p dog bites.

  7. Splenectomy attenuates murine liver fibrosis with hypersplenism stimulating hepatic accumulation of Ly-6C(lo) macrophages.

    Science.gov (United States)

    Yada, Akito; Iimuro, Yuji; Uyama, Naoki; Uda, Yugo; Okada, Toshihiro; Fujimoto, Jiro

    2015-10-01

    Splenectomy in cirrhotic patients has been reported to improve liver function; however the underlying mechanism remains obscure. In the present study, we investigated the mechanism using a murine model, which represents well the compensated liver cirrhosis. C57BL/6 male mice were allowed to drink water including thioacetamide (TAA: 300 mg/L) ad libitum for 32 weeks. After splenectomy at 32 weeks, mice were sacrificed on days one, seven, and 28, respectively, while TAA-administration was continued. Perioperative changes in peripheral blood and liver tissues were analyzed. TAA treatment of mice for 32 weeks reproducibly achieved advanced liver fibrosis with splenomegaly, thrombocytopenia, and leukocytopenia. After splenectomy, liver fibrosis was attenuated, and macrophages/monocytes were significantly increased in peripheral blood, as well as in the liver. Progenitor-like cells expressing CK-19, EpCAM, or CD-133 appeared in the liver after TAA treatment, and gradually disappeared after splenectomy. Macrophages/monocytes accumulated in the liver, most of which were negative for Ly-6C, were adjacent to the hepatic progenitor-like cells, and quantitative RT-PCR indicated increased canonical Wnt and decreased Notch signals. As a result, a significant amount of β-catenin accumulated in the progenitor-like cells. Moreover, relatively small Ki67-positive hepatic cells were significantly increased. Protein expression of MMP-9, to which Ly-6G-positive neutrophils contributed, was also increased in the liver after splenectomy. The hepatic accumulation of macrophages/monocytes, most of which are Ly-6C(lo), the reduction of fibrosis, and the gradual disappearance of hepatic progenitor-like cells possibly play significant roles in the tissue remodeling process in cirrhotic livers after splenectomy. Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  8. Laparoscopic-assisted splenectomy in dogs: 18 cases (2012-2014).

    Science.gov (United States)

    Wright, Tanya; Singh, Ameet; Mayhew, Philipp D; Runge, Jeffrey J; Brisson, Brigitte A; Oblak, Michelle L; Case, J Brad

    2016-04-15

    To describe the operative technique and perioperative outcome for laparoscopic-assisted splenectomy (LAS) in dogs. Retrospective case series. 18 client-owned dogs. Medical records of dogs with naturally occurring disease of the spleen treated by means of LAS between 2012 and 2014 were reviewed. History, signalment, results of physical examination, results of preoperative diagnostic testing, details of surgical technique, intraoperative findings including results of abdominal exploration and staging, concurrent surgical procedures, complications, histopathologic diagnoses, duration of postoperative hospitalization, and perioperative outcome were recorded. The perioperative period was defined as the time from hospital admission for LAS until discharge or death (within the same visit). All dogs underwent initial abdominal exploration and staging via multiple 5-mm laparoscopic ports (n = 2) or a single commercially available multichannel port (16), followed by minilaparotomy with insertion of a wound retraction device, progressive exteriorization of the spleen, sealing of hilar vessels, and splenectomy. Splenectomy was performed for treatment of a splenic mass (n = 15), suspected neoplasia (2), or refractory immune-mediated disease (1). Median size (width × length) of splenic masses was 5 × 5 cm (range, 1.6 to 11.0 cm × 1.5 to 14.5 cm). Complications were limited to minor intraoperative hemorrhage in 1 dog; no patient required conversion to open laparotomy. Results indicated that LAS was technically feasible in dogs and not associated with major complications. Further evaluation is required; however, in appropriately selected patients, LAS may offer the benefits of a minimally invasive technique, including a smaller incision and improved illumination and magnification during exploration and staging.

  9. Perioperative spleen embolization as a useful tool in laparoscopic splenectomy for simple and massive splenomegaly in children: a prospective study.

    Science.gov (United States)

    Van Der Veken, E; Laureys, M; Rodesch, G; Steyaert, H

    2016-11-01

    The purpose of this prospective study is to evaluate the efficiency of perioperative spleen embolization prior to laparoscopic splenectomy indicated for hypersplenism. We conducted a prospective study exploring a technique combining ultra-selective perioperative embolization and splenectomy. Between January 2008 and March 2013, 16 splenectomies were performed in children suffering from hypersplenism due to varying hematologic diseases. Spleen embolization was performed by an interventional radiologist in the operating room (OR) just before splenectomy and during the same general anesthesia. Ages varied from 3 to 17 years. Spleen volume was measured by preoperative ultrasound. One patient underwent a laparotomy because of suspected adhesions due to previous surgery. All other operations were performed laparoscopically. One complication arose from embolization: a perforation of the splenic artery. After immediately placing a platinum coil proximal to the perforation, the splenectomy was carried out as usual. Fourteen children (87.5 %) had splenomegaly, of which eight (50 %) had massive splenomegaly. There were no deaths, no conversions to laparotomy, no reoperations and none of these patients had to be transfused. Perioperative spleen embolization performed in the OR by an interventional radiologist makes laparoscopic splenectomy a safer procedure. We propose a preoperative method for spleen measurement that is adapted to children: simple and massive splenomegaly is defined through patient body weight and a preoperative ultrasound. We conclude that spleen size is no more a limiting factor for laparoscopic splenectomy in children.

  10. Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients.

    Science.gov (United States)

    Qi, Xingshun; Han, Guohong; Ye, Chun; Zhang, Yongguo; Dai, Junna; Peng, Ying; Deng, Han; Li, Jing; Hou, Feifei; Ning, Zheng; Zhao, Jiancheng; Zhang, Xintong; Wang, Ran; Guo, Xiaozhong

    2016-07-19

    BACKGROUND Portal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis. MATERIAL AND METHODS All cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS Overall, 113 cirrhotic patients were enrolled. The prevalence of PVST was 16.8% (19/113). Splenectomy (any PVST: OR=11.494, 95%CI=2.152-61.395; MPV thrombosis >50%: OR=29.987, 95%CI=3.247-276.949; clinically significant PVST: OR=40.415, 95%CI=3.895-419.295) and higher hemoglobin (any PVST: OR=0.974, 95%CI=0.953-0.996; MPV thrombosis >50%: OR=0.936, 95%CI=0.895-0.980; clinically significant PVST: OR=0.935, 95%CI=0.891-0.982) were the independent predictors of PVST. The prevalence of PVST was 13.3% (14/105) after excluding splenectomy. Higher hemoglobin was the only independent predictor of MPV thrombosis >50% (OR=0.952, 95%CI=0.909-0.997). No independent predictors of any PVST or clinically significant PVST were identified in multivariate analyses. Additionally, PVST patients who underwent splenectomy had a significantly higher proportion of clinically significant PVST but lower MELD score than those who did not undergo splenectomy. In all analyses, the in-hospital mortality was not significantly different between cirrhotic patient with and without PVST. CONCLUSIONS Splenectomy may increase by at least 10-fold the risk of PVST in liver cirrhosis independent of severity of liver dysfunction.

  11. Laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension

    Science.gov (United States)

    Zhan, Xiao-Li; Ji, Yun; Wang, Yue-Dong

    2014-01-01

    Since the first laparoscopic splenectomy (LS) was reported in 1991, LS has become the gold standard for the removal of normal to moderately enlarged spleens in benign conditions. Compared with open splenectomy, fewer postsurgical complications and better postoperative recovery have been observed, but LS is contraindicated for hypersplenism secondary to liver cirrhosis in many institutions owing to technical difficulties associated with splenomegaly, well-developed collateral circulation, and increased risk of bleeding. With the improvements of laparoscopic technique, the concept is changing. This article aims to give an overview of the latest development in laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension. Despite a lack of randomized controlled trial, the publications obtained have shown that with meticulous surgical techniques and advanced instruments, LS is a technically feasible, safe, and effective procedure for hypersplenism secondary to cirrhosis and portal hypertension and contributes to decreased blood loss, shorter hospital stay, and less impairment of liver function. It is recommended that the dilated short gastric vessels and other enlarged collateral circulation surrounding the spleen be divided with the LigaSure vessel sealing equipment, and the splenic artery and vein be transected en bloc with the application of the endovascular stapler. To support the clinical evidence, further randomized controlled trials about this topic are necessary. PMID:24914339

  12. Rare case of isolated splenic metastases from gastric cancer detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography

    International Nuclear Information System (INIS)

    Kamaleshwaran, Koramadai Karuppusamy; Shibu, Deepu; Sugunan Shinto, Ajit; Sivanesan, Balasubramanian

    2013-01-01

    We report a rare case of isolated splenic metastasis from gastric cancer detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT). A 55-year-old man with gastric cancer 1 year post surgery, evaluated with PET/CT showed focal, intense uptake in the spleen, with no other abnormal findings. On splenectomy, the lesion was confirmed as metastasis from gastric cancer pathologically. (author)

  13. Trauma centers with higher rates of angiography have a lesser incidence of splenectomy in the management of blunt splenic injury.

    Science.gov (United States)

    Capecci, Louis M; Jeremitsky, Elan; Smith, R Stephen; Philp, Frances

    2015-10-01

    Nonoperative management (NOM) for blunt splenic injury (BSI) is well-established. Angiography (ANGIO) has been shown to improve success rates with NOM. Protocols for NOM are not standardized and vary widely between centers. We hypothesized that trauma centers that performed ANGIO at a greater rate would demonstrate decreased rates of splenectomy compared with trauma centers that used ANGIO less frequently. A large, multicenter, statewide database (Pennsylvania Trauma Systems Foundation) from 2007 to 2011 was used to generate the study cohort of patients with BSI (age ≥ 13). The cohort was divided into 2 populations based on admission to centers with high (≥13%) or low (Splenectomy rates were then compared between the 2 groups, and multivariable logistic regression for predictors of splenectomy (failed NOM) were also performed. The overall rate of splenectomy in the entire cohort was 21.0% (1,120 of 5,333 BSI patients). The high ANGIO group had a lesser rate of splenectoy compared with the low ANGIO group (19% vs 24%; P splenectomy compared with low ANGIO centers (odds ratio, 0.68; 95% CI 0.58-0.80; P splenectomy rates compared with centers with lesser rate of ANGIO. Inclusion of angiographic protocols for NOM of BSI should be considered strongly. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

    Directory of Open Access Journals (Sweden)

    Brandt Carlos Teixeira

    1998-01-01

    Full Text Available Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

  15. The THUNDERBEAT system for tissue dissection and vascular control in laparoscopic splenectomy.

    Science.gov (United States)

    Ceccanti, Silvia; Falconi, Ilaria; Frediani, Simone; Boscarelli, Alessandro; Catani, Marco; Cozzi, Denis A

    2017-08-01

    The advent of new energy sources for hemostasis has greatly facilitated advanced laparoscopic procedures. We describe a straightforward technique of laparoscopic splenectomy (LS) accomplished using the THUNDERBEAT™ system (TS) (Olympus Medical Systems Corp., Tokyo, Japan) as the sole means of tissue dissection and hemostasis in two patients aged 19 and 6 years, respectively. The specimens were removed intact via a Pfannenstiel incision. Total operative time was 165 and 150 min, and length of hospital stay was three and 4 d, respectively. The TS is an appealing and reliable alternative to currently available energy devices, allowing fast dissection and secure hemostasis during laparoscopic splenectomy.

  16. Comparison between single and three portal laparoscopic splenectomy in dogs

    Directory of Open Access Journals (Sweden)

    Khalaj Alireza

    2012-09-01

    Full Text Available Abstract Background Single incision laparoscopic surgery (SILS is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS with three portal (Conventional laparoscopic splenectomy in dogs. Mongrel dogs (n = 18, weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional. The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments. Results All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P  Conclusion This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional for splenectomy in dog.

  17. Does the site of platelet sequestration predict the response to splenectomy in adult patients with immune thrombocytopenic purpura?

    Science.gov (United States)

    Navez, Julie; Hubert, Catherine; Gigot, Jean-François; Navez, Benoit; Lambert, Catherine; Jamar, François; Danse, Etienne; Lannoy, Valérie; Jabbour, Nicolas

    2015-01-01

    Splenectomy is the only potentially curative treatment for chronic immune thrombocytopenic purpura (ITP) in adults. However, one-third of the patients relapse without predictive factors identified. We evaluate the predictive value of the site of platelet sequestration on the response to splenectomy in patients with ITP. Eighty-two consecutive patients with ITP treated by splenectomy between 1992 and 2013 were retrospectively reviewed. Platelet sequestration site was studied by (111)Indium-oxinate-labeled platelets in 93% of patients. Response to splenectomy was defined at last follow-up as: complete response (CR) for platelet count (PC) ≥100 × 10(9)/L, response (R) for PC≥30 × 10(9)/L and splenectomy was performed in 81 patients (conversion rate of 16%), and open approach in one patient. Median follow-up was 57 months (range, 1-235). Platelet sequestration study was performed in 93% of patients: 50 patients (61%) exhibited splenic sequestration, 9 (11%) hepatic sequestration and 14 patients (17%) mixed sequestration. CR was obtained in 72% of patients, R in 25% and NR in 4% (two with splenic sequestration, one with hepatic sequestration). Preoperative PC, age at diagnosis, hepatic sequestration and male gender were significant for predicting CR in univariate analysis, but only age (HR = 1.025 by one-year increase, 95% CI [1.004-1.047], p = 0.020) and pre-operative PC (HR = 0.112 for > 100 versus splenectomy was independent of the site of platelet sequestration in patients with ITP. Pre-operative platelet sequestration study in these patients cannot be recommended.

  18. Splenectomy after partial hepatectomy accelerates liver regeneration in mice by promoting tight junction formation via polarity protein Par 3-aPKC.

    Science.gov (United States)

    Liu, Guoxing; Xie, Chengzhi; Fang, Yu; Qian, Ke; Liu, Qiang; Liu, Gao; Cao, Zhenyu; Du, Huihui; Fu, Jie; Xu, Xundi

    2018-01-01

    Several experimental studies have demonstrated that removal of the spleen accelerates liver regeneration after partial hepatectomy. While the mechanism of splenectomy promotes liver regeneration by the improvement of the formation of tight junction and the establishment of hepatocyte polarity is still unknown. We analyzed the cytokines, genes and proteins expression between 70% partial hepatectomy mice (PHx) and simultaneous 70% partial hepatectomy and splenectomy mice (PHs) at predetermined timed points. Compared with the PHx group mice, splenectomy accelerated hepatocyte proliferation in PHs group. The expression of Zonula occludens-1 (ZO-1) indicated that splenectomy promotes the formation of tight junction during liver regeneration. TNF-α, IL-6, HGF, TSP-1 and TGF-β1 were essential factors for the formation of tight junction and the establishment of hepatocytes polarity in liver regeneration. After splenectomy, Partitioning defective 3 homolog (Par 3) and atypical protein kinase C (aPKC) regulate hepatocyte localization and junctional structures in regeneration liver. Our data suggest that the time course expression of TNF-α, IL-6, HGF, TSP-1, and TGF-β1 and the change of platelets take part in liver regeneration. Combination with splenectomy accelerates liver regeneration by improvement of the tight junction formation which may help to establish hepatocyte polarity via Par 3-aPKC. This may provide a clue for us that splenectomy could accelerate liver regeneration after partial hepatectomy of hepatocellular carcinoma and living donor liver transplantation. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Laparoscopic splenectomy for a simultaneous wandering spleen along with an ectopic accessory spleen. Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Antonia Rizzuto

    Full Text Available Background: Wandering spleen and accessory spleen are uncommon entity occurring during embryonic development. Wandering spleen results in an excessive mobility and migration of the spleen from its normal position in the left hypochondrium while accessory spleen is characterized by ectopic splenic masses or tissue disjointed from the main body of spleen.Due to the nonspecific and multiple symptoms the clinical diagnosis of both conditions is uncertain even with imaging techniques, such as CT and MRI. The coexistence of both diseases (wandering spleen ad accessory spleen is uncommon. Case report: A 17–year old European female with a history of minor beta thalassemia and recurrent attacks of abdominal pain. Pre- operative management consisted of routine laboratory tests, ultrasound, CT scan. An ectopic spleen along with an accessory spleen were diagnosed. After a multidisciplinary board a laparoscopic splenectomy was performed. Post-operative recovery was uneventful, and the patient was discharged on the 6th post-operative day with the indication to continue the therapy with low molecular weight heparin (LMWH for 30 days Conclusions: This case represents a simultaneous condition of wandering splenomegaly along with an ectopic wandering spleen. The coexistence of these two rare conditions is peculiar such as the age of the patient, as literature reports such diseases to affect children or more commonly people in the range of 20–40 years of age. Laparoscopic treatment for this particular condition is also unusual. Keywords: Ectopic spleen, Wandering spleen, Laparoscopic splenectomy

  20. Extrahepatic portal venous obstruction: The effects of early ligation of splenic artery during splenectomy.

    Science.gov (United States)

    Gazula, Suhasini; Pawar, D K; Seth, T; Bal, C S; Bhatnagar, V

    2009-10-01

    To objectively demonstrate the gain in blood volume and blood components following early ligation of splenic artery during splenectomy and splenorenal shunts in children with extra hepatic portal venous obstruction (EHPVO). Twenty-eight children (20 males and 8 females, mean age: 9.9 (+/-3.2) years) with EHPVO and hypersplenism were recruited. We followed a protocol of systematically locating and ligating the splenic artery first, followed by a 30-minute waiting period to allow the massive spleen to decongest via the splenic vein and venous collaterals and then completing the splenectomy by standard procedure. No intravenous fluid was administered during this 30-minute period. Blood samples were drawn just prior to splenic artery ligation and soon after splenectomy for the estimation of hematological and biochemical parameters. We noticed a highly significant increase in the hemoglobin, hematocrit, leukocyte, platelet, and RBC counts by early ligation of the splenic artery (p platelet count was equivalent to a platelet transfusion of atleast 4 units of platelet concentrates in an adult. There is a positive correlation between the splenic weight and the platelet gain (p= 0.0568) and the splenic volume on preoperative imaging and the platelet gain (p= 0.0251). Early ligation of the splenic artery during splenectomy results in passive splenic decongestion and thereby a significant gain in blood components. This protocol appears to be a feasible blood conservation method to avoid blood transfusions in this group of hypersplenic EHPVO patients.

  1. Inadvertent Splenectomy During Resection for Colorectal Cancer Does Not Increase Long-term Mortality in a Propensity Score Model: A Nationwide Cohort Study.

    Science.gov (United States)

    Lolle, Ida; Pommergaard, Hans-Christian; Schefte, David F; Bulut, Orhan; Krarup, Peter-Martin; Rosenstock, Steffen J

    2016-12-01

    Previous studies suggest that long-term mortality is increased in patients who undergo splenectomy during surgery for colorectal cancer. The reason for this association remains unclear. The purpose of this study was to investigate the association between inadvertent splenectomy attributed to iatrogenic lesion to the spleen during colorectal cancer resections and long-term mortality in a national cohort of unselected patients. This was a retrospective, nationwide cohort study. Data were collected from the database of the Danish Colorectal Cancer Group and merged with data from the National Patient Registry and the National Pathology Databank. Danish patients with colorectal cancer undergoing curatively intended resection between 2001 and 2011 were included in the study. The primary outcome was long-term mortality for patients surviving 30 days after surgery. Secondary outcomes were 30-day mortality and risk factors for inadvertent splenectomy. Multivariable and propensity-score matched Cox regression analyses were used to adjust for potential confounding. In total, 23,727 patients were included, of which 277 (1.2%) underwent inadvertent splenectomy. There was no association between inadvertent splenectomy and long-term mortality (adjusted HR = 1.15 (95% CI, 0.95-1.40); p = 0.16) in the propensity score-matched model, whereas 30-day mortality was significantly increased (adjusted HR = 2.31 (95% CI, 1.71-3.11); p splenectomy was most often seen during left hemicolectomy (left hemicolectomy vs right hemicolectomy: OR = 24.76 (95% CI, 15.30-40.06); p splenectomy during resection for colorectal cancer does not seem to increase long-term mortality. The previously reported reduced overall survival after inadvertent splenectomy may be explained by excess mortality in the immediate postoperative period.

  2. Splenectomy in a rural surgical practice | Alufohai | Nigerian Journal ...

    African Journals Online (AJOL)

    We reviewed the clinical presentation and indications for splenectomy in a rural community in Southern Nigeria from January 1988 – December, 2000, a period of 12 years. A total of 17 cases were seen. Twelve (70.6%) were for big spleens due to sickle-cell anaemia , tropical splenomegaly syndrome, malignancy and 5 ...

  3. Is splenectomy a dyslipidemic intervention? Experimental response of serum lipids to different diets and operations.

    Science.gov (United States)

    Paulo, Danilo N S; Paulo, Isabel Cal; Morais, Alvaro A C; Kalil, Mitre; Guerra, Alvino J; Colnago, Geraldo L; Faintuch, Joel

    2009-01-01

    Spleen removal may be recommended during organ transplantation in ABO-incompatible recipients as well as for hypoperfusion of the grafted liver, besides conventional surgical indications, but elevation of serum lipids has been observed in certain contexts. Aiming to analyze the influence of two dietary regimens on lipid profile, an experimental study was conducted. Male Wistar rats (n = 86, 333.0 +/- 32.2 g) were divided in four groups: group 1: controls; group 2: sham operation; group 3: total splenectomy; group 4: subtotal splenectomy with upper pole preservation; subgroups A (cholesterol reducing chow) and B (cholesterol-rich mixture) were established, and diet was given during 90 days. Total cholesterol (Tchol), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and triglycerides were documented. After total splenectomy, hyperlipidemia ensued with cholesterol-reducing chow. Tchol, LDL, VLDL, triglycerides, and HDL changed from 56.4 +/- 9.2, 24.6 +/- 4.7, 9.7 +/- 2.2, 48.6 +/- 11.1, and 22.4 +/- 4.3 mg/dL to 66.9 +/- 11.4, 29.9 +/- 5.9, 10.9 +/- 2.3, 54.3 +/- 11.4, and 26.1 +/- 5.1 mg/dL, respectively. Upper pole preservation inhibited abnormalities of Tchol, HDL, VLDL, and triglycerides, and LDL decreased (23.6 +/- 4.9 vs. 22.1 +/- 5.1, P = 0.002). Higher concentrations were triggered by splenectomy and cholesterol-enriched diet (Tchol 59.4 +/- 10.1 vs. 83.9 +/- 14.3 mg/dL, P = 0.000), and upper-pole preservation diminished without abolishing hyperlipidemia (Tchol 55.9 +/- 10.0 vs. 62.3 +/- 7.8, P = 0.002). After splenectomy, hyperlipidemia occurred with both diets. Preservation of the upper pole tended to correct dyslipidemia in modality A and to attenuate it in subgroup B. (c) 2008 Wiley-Liss, Inc.

  4. Comparison between single and three portal laparoscopic splenectomy in dogs

    Science.gov (United States)

    2012-01-01

    Background Single incision laparoscopic surgery (SILS) is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs. Mongrel dogs (n = 18), weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional). The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments. Results All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min) and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P hernia formation and dehiscence up to one month after surgery. Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches. Conclusion This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional) for splenectomy in dog. PMID:22963734

  5. Splenic simulation by left hepatic lobe following splenectomy

    International Nuclear Information System (INIS)

    Noel, A.; Harbert, J.C.

    1984-01-01

    Remodeling of the liver following splenectomy may simulate hypertrophy of an accessory spleen on sulfur colloid scans. Two patients are reported. In one case splenic simulation is attributed to unusual hepatic scarring confirmed at autopsy. In the second the unusual configuration appears to have been caused by molding of the liver. The clinician should be aware of possible splenic simulation in postsplenectomy patients suspected of hypersplenism

  6. Partiële in plaats van complete splenectomie bij kinderen voor pathologische stadiëring van de ziekte van Hodgkin

    NARCIS (Netherlands)

    Hoekstra, H J; Tamminga, R Y; Timens, W

    1993-01-01

    OBJECTIVE: Evaluation of partial splenectomy in children for pathological staging of Hodgkin's disease. DESIGN: Prospective clinical study. PLACE: University Hospital Groningen. METHOD: From 1982 to 1988, 12 children with Hodgkin's disease underwent partial splenectomy during laparotomy for

  7. Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl4-induced liver fibrosis.

    Science.gov (United States)

    Wang, Ming-Jun; Ling, Wen-Wu; Wang, Hong; Meng, Ling-Wei; Cai, He; Peng, Bing

    2016-12-14

    To investigate the diagnostic performance of liver stiffness measurement (LSM) by elastography point quantification (ElastPQ) in animal models and determine the longitudinal changes in liver stiffness by ElastPQ after splenectomy at different stages of fibrosis. Liver stiffness was measured in sixty-eight rabbits with CCl 4 -induced liver fibrosis at different stages and eight healthy control rabbits by ElastPQ. Liver biopsies and blood samples were obtained at scheduled time points to assess liver function and degree of fibrosis. Thirty-one rabbits with complete data that underwent splenectomy at different stages of liver fibrosis were then included for dynamic monitoring of changes in liver stiffness by ElastPQ and liver function according to blood tests. LSM by ElastPQ was significantly correlated with histologic fibrosis stage ( r = 0.85, P fibrosis, moderate fibrosis, and cirrhosis, respectively. Longitudinal monitoring of the changes in liver stiffness by ElastPQ showed that early splenectomy (especially F1) may delay liver fibrosis progression. ElastPQ is an available, convenient, objective and non-invasive technique for assessing liver stiffness in rabbits with CCl 4 -induced liver fibrosis. In addition, liver stiffness measurements using ElastPQ can dynamically monitor the changes in liver stiffness in rabbit models, and in patients, after splenectomy.

  8. Robotic single-access splenectomy using the Da Vinci Single-Site® platform: a case report.

    Science.gov (United States)

    Corcione, Francesco; Bracale, Umberto; Pirozzi, Felice; Cuccurullo, Diego; Angelini, Pier Luigi

    2014-03-01

    Single-access laparoscopic splenectomy can offer patients some advantages. It has many difficulties, such as instrument clashing, lack of triangulation, odd angles and lack of space. The Da Vinci Single-Site® robotic surgery platform could decrease these difficulties. We present a case of single-access robotic splenectomy using this device. A 37 year-old female with idiopathic thrombocytopenic purpura was operated on with a single-site approach, using the Da Vinci Single-Site robotic surgery device. The procedure was successfully completed in 140 min. No intraoperative and postoperative complications occurred. The patient was discharged from hospital on day 3. Single-access robotic splenectomy seems to be feasible and safe using the new robotic single-access platform, which seems to overcome certain limits of previous robotic or conventional single-access laparoscopy. We think that additional studies should also be performed to explore the real cost-effectiveness of the platform. Copyright © 2013 John Wiley & Sons, Ltd.

  9. Role of nuclear medicine imaging in differential diagnosis of accessory spleens in patients after splenectomy

    International Nuclear Information System (INIS)

    D’Amico, Andrea; Cofalik, Anna; Przeorek, Cesary; Gawlik, Tomasz; Olczyk, Tomasz; Kalemba, Michał; Modorowska, Alicja; Turska-d’Amico, Maria; Bobek-Billewicz, Barbara; Jarzab, Barbara

    2012-01-01

    More than 10% of healthy population has one or more accessory spleens. The most common location is the hilum of the spleen or area near the tail of the pancreas. The radiological appearance of accessory spleens in oncologic patients who underwent splenectomy can be misinterpreted as a recurrence, especially in the case of compensatory growth of an accessory spleen in successive radiological examinations. We present the cases of three patients who underwent splenectomy for gastric carcinoid, gastric adenocarcinoma and cancer of the left adrenal gland, respectively. CT examination and/or PET-CT scan revealed suspicious findings in the left upper abdomen. In one patient, the dimensional increase of this finding in successive examinations was initially considered suggestive for cancer recurrence. Scintigraphy with 99m Tc-nanocolloid was able to confirm the presence of an accessory spleen in all these patients. Splenic scintigraphy is an economical, accessible and accurate tool in differential diagnosis of accessory spleens in patients after splenectomy

  10. Acute myelomonocytic leukemia following splenectomy in a patient with long-standing Hodgkin disease

    International Nuclear Information System (INIS)

    Rosenbloom, B.E.; Klein, E.J.; Uszler, J.M.; Ellis, R.; Block, J.B.; Tanaka, K.R.

    1978-01-01

    The association of acute nonlymphocytic leukemia with Hodgkin disease has been recorded in more than 100 instances. In most of these cases the patient has had long-standing Hodgkin disease and radiotherapy has been carried out. The combination of previous radiotherapy and chemotherapy appears to further increase the risk of leukemia developing. In a patient under our care with Hodgkin disease acute myelomonocytic leukemia developed following splenectomy for hypersplenism. The onset of acute leukemia immediately following splenectomy in a patient with Hodgkin disease has not previously been noted. In addition, because the patient's usual bone marrow sampling sites were hypoplastic, we utilized an 111 In-chloride bone marrow scan to find a site that was accessible for aspiration

  11. Splenectomy vs. rituximab as a second-line therapy in immune thrombocytopenic purpura: a single center experience.

    Science.gov (United States)

    Al Askar, Ahmed S; Shaheen, Naila A; Al Zahrani, Mohsen; Al Otaibi, Mohammed G; Al Qahtani, Bader S; Ahmed, Faris; Al Zughaibi, Mohand; Kamran, Ismat; Mendoza, May Anne; Khan, Altaf

    2018-01-01

    Immune thrombocytopenic purpura (ITP) is a common hematological disease treated primarily by corticosteroids. The aim of the present study was to compare response rate between patients, underwent splenectomy vs. rituximab as second-line therapy. Adult patients diagnosed with ITP who did not respond to corticosteroids or relapsed during the period 1990-2014 were included in a quasi-experimental study. Categorical variables were compared using Fisher exact test. Response to treatment was compared using logistic regression. Data were analyzed using SAS V9.2. One-hundred and forty-three patients with ITP were identified through medical records. Of 62 patients treated, 30 (48.38%) required second-line therapy. 19 (63%) patients received rituximab, and 11 (37%) underwent splenectomy. Platelets at diagnosis were not different between study groups (p = 0.062). Splenectomy group patients were younger (p = 0.011). Response to second-line therapy showed no significant difference between two groups (OR 2.03, 95% CI (0.21-22.09), p = 0.549). Results did not show a statistically significant difference in platelet counts over time between treatment groups (p = 0.101). When used exclusively as a second-line therapy for steroid-refractory ITP, the response rate was not statistically different between rituximab and splenectomy. However, further large studies are needed to assess the response rates for these treatment modalities as a second-line therapy.

  12. A Test for the Effectiveness of Splenectomy in Werlhof's Disease Based on Body-Surface Measurement

    Energy Technology Data Exchange (ETDEWEB)

    Fontein, D. L.; Beekhuis, H.; Woldring, M. G.; Zanten, A.K. van; Nieweg, H. O. [University of Groningen, Groningen (Netherlands)

    1971-02-15

    Body-surface measurements were performed during {sup 51}Cr-platelet survival studies in patients with a normal or a reduced platelet life-span. As quantification of organ activity from surface recordings is hardly feasible, we tried to reach conclusions from the course of surface activity during platelet destruction. Continuous recording was applied during 30 or 50 min after platelet infusion, in order to avoid the problems raised by variations in counter positioning in spaced recordings. Surface activity was recorded over liver and spleen and/or heart independently by collimated Nal(Tl) crystals, and registered either by a rate-meter and recorder or by a 400-channel analyser. The exponential survival curve and reduced 2-h platelet recovery in patients with reduced platelet life-span suggest that in most cases a substantial destruction occurs in these first 50 min. Detection of platelet destruction in the spleen in this period is obscured, however, by the normal pooling of platelets in the spleen. Over the liver it is more easy to recognize platelet destruction because the rising course of activity differs distinctly from the normal , course. In all five patients with reduced platelet survival after splenectomy, hepatic platelet destruction was demonstrated. In 22 patients with reduced platelet survival and an intact spleen, hepatic platelet destruction was demonstrated in six. Hepatic platelet destruction was observed not only in patients with an extremely short platelet life-span, but also in patients with only moderately impaired platelet survival. The hypothesis that a failure from splenectomy can be predicted from a rising course of activity over the liver was tested in 11 patients. One of these had a failure from splenectomy in spite of a normal preoperative liver curve. Evidence is presented that in this case corticosteroid therapy had obscured hepatic platelet destruction. The results of operation in the other 10 patients (nine remissions and one failure

  13. Extrahepatic portal venous obstruction: The effects of early ligation of splenic artery during splenectomy

    Directory of Open Access Journals (Sweden)

    Gazula Suhasini

    2009-01-01

    Full Text Available Aim: To objectively demonstrate the gain in blood volume and blood components following early ligation of splenic artery during splenectomy and splenorenal shunts in children with extra hepatic portal venous obstruction (EHPVO. Methods: Twenty-eight children (20 males and 8 females, mean age: 9.9 (±3.2 years with EHPVO and hypersplenism were recruited. We followed a protocol of systematically locating and ligating the splenic artery first, followed by a 30-minute waiting period to allow the massive spleen to decongest via the splenic vein and venous collaterals and then completing the splenectomy by standard procedure. No intravenous fluid was administered during this 30-minute period. Blood samples were drawn just prior to splenic artery ligation and soon after splenectomy for the estimation of hematological and biochemical parameters. Results: We noticed a highly significant increase in the hemoglobin, hematocrit, leukocyte, platelet, and RBC counts by early ligation of the splenic artery (p < 0.0004. The gain in hemoglobin and hematocrit was equivalent to a transfusion of atleast 100-150 ml of packed RBC. The increase in platelet count was equivalent to a platelet transfusion of atleast 4 units of platelet concentrates in an adult. There is a positive correlation between the splenic weight and the platelet gain (p= 0.0568 and the splenic volume on preoperative imaging and the platelet gain (p= 0.0251. Conclusion: Early ligation of the splenic artery during splenectomy results in passive splenic decongestion and thereby a significant gain in blood components. This protocol appears to be a feasible blood conservation method to avoid blood transfusions in this group of hypersplenic EHPVO patients.

  14. Clinical significance of the changes of distribution of peripheral blood lymphocyte subsets in patients after splenectomy for acute injury

    International Nuclear Information System (INIS)

    Zhou Guozhong

    2005-01-01

    Objective: To study the short-term effect of splenectomy on immuno-function as expressed by changes of peripheral lymphocyte subsets distribution in patients with acute injury. Methods: Peripheral blood lymphocyte subsets distribution types were studied with flow-cytometry in 74 patients before and 1 week after splenectomy for acute injury. Results: The percentage of CD 3 , CD 4 T cells were significantly higher (P 16-56 (NK), CD 19 B cells were significantly lower (P 8 T cell and CD 4 /CD 8 ratio were not significantly (P>0.05). Conclusion: There were significant changes of immunofunction right after splenectomy for acute injury, with enhancement of cellular immunofunction and depression of humoral immunofunction. (authors)

  15. Splenectomy in two children with autoimmune lymphoproliferative syndrome and massive splenomegaly

    DEFF Research Database (Denmark)

    Glerup, Mia; Thelle, Thomas; Grønbaek, Kirsten

    2009-01-01

    Treatment of patients with ALPS has varied but presently there is no consensus about the optimal therapy. Splenectomy is an option but data regarding the postsplenectomy outcome in pediatric ALPS patients remain very limited. We present two children who suffered from anemia and physical discomfort...

  16. The value of N staging with the positive lymph node ratio, and splenectomy, for remnant gastric cancer: A multicenter retrospective study.

    Science.gov (United States)

    Son, Sang-Yong; Kong, Seong-Ho; Ahn, Hye Seong; Park, Young Suk; Ahn, Sang-Hoon; Suh, Yun-Suhk; Park, Do Joong; Lee, Hyuk-Joon; Kim, Hyung-Ho; Yang, Han-Kwang

    2017-12-01

    Surgery for remnant gastric cancer (RGC) frequently fails to obtain the >15 lymph nodes necessary for tumor-node-metastasis (TNM) staging. We aimed to evaluate the utility of the recently developed tumor-ratio-metastasis (TRM) staging system. We also examined the pattern of lymph node metastasis and the role of prophylactic splenectomy in RGC. Between May 2003 and December 2012, data from 170 patients who underwent surgery for RGC were retrospectively analyzed. RGC arising after previous benign disease (n = 46) was associated with retrieval of more lymph nodes (27.3 vs 10.0; P splenectomy and non-splenectomy groups at each stage (P = 0.751, 0.723, 0.151, and 0.706 for stage I, II, III, and IV, respectively). The analyses did not identify a survival benefit from prophylactic splenectomy or show an improvement in staging with the TRM system for RGC. © 2017 Wiley Periodicals, Inc.

  17. Laparoscopic versus open splenectomy in dogs

    Directory of Open Access Journals (Sweden)

    Rafael Stedile

    2009-08-01

    Full Text Available In the last few years, the use of laparoscopy in veterinary medicine has expanded and consequently so was the need for studies that establish the advantages, disadvantages and possible complications of each procedure. The purpose of the current study was to describe a laparoscopic splenectomy technique and the alterations due to this access, and compare it to the open procedure in dogs. A total of 15 healthy female mongrel dogs were used, with mean weight of 17.4±2.5kg. The animals were distributed into three groups: Group IA of open splenectomy (laparotomy using double ligation of the vessels of the splenic hilum with poliglicolic acid, Group IB of open splenectomy (laparotomy with bipolar electrocoagulation of the splenic hilum, and Group II of laparoscopic access with bipolar electrocoagulation of the splenic hilum. Operative time, blood loss, size of incisions, complications during and after surgery were evaluated. Other parameters included pain scores, white blood cell (WBC counts and postoperative serum concentrations of alanine aminotransferase (ALT, alkaline phosphatase (ALP, creatine kinase (CK, C-reactive protein (CRP, glucose and cortisol. No differences were found in the evaluation of parameters between both open splenectomy techniques employed. Laparoscopic access presented significant differences (pNos últimos anos, a utilização da laparoscopia em Medicina Veterinária vem expandindo e, conseqüentemente, a necessidade de pesquisas que determinem as vantagens, desvantagens e possíveis complicações de cada procedimento. Este estudo teve como objetivo descrever uma técnica de esplenectomia laparoscópica, assim como as alterações decorrentes deste acesso, e compará-la ao procedimento convencional em cães. Foram utilizadas 15 cadelas hígidas, sem raça definida, com peso médio de 17,4 ±2,5kg. Os animais foram distribuídos em três grupos: Grupo IA de acesso convencional (por laparotomia utilizando ligadura com

  18. Inadvertent Splenectomy During Resection for Colorectal Cancer Does Not Increase Long-term Mortality in a Propensity Score Model

    DEFF Research Database (Denmark)

    Lolle, Ida; Pommergaard, Hans-Christian; Schefte, David F

    2016-01-01

    BACKGROUND: Previous studies suggest that long-term mortality is increased in patients who undergo splenectomy during surgery for colorectal cancer. The reason for this association remains unclear. OBJECTIVE: The purpose of this study was to investigate the association between inadvertent...... splenectomy attributed to iatrogenic lesion to the spleen during colorectal cancer resections and long-term mortality in a national cohort of unselected patients. DESIGN: This was a retrospective, nationwide cohort study. SETTINGS: Data were collected from the database of the Danish Colorectal Cancer Group...... for patients surviving 30 days after surgery. Secondary outcomes were 30-day mortality and risk factors for inadvertent splenectomy. Multivariable and propensity-score matched Cox regression analyses were used to adjust for potential confounding. RESULTS: In total, 23,727 patients were included, of which 277...

  19. Splenectomy reduces infarct volume and neuroinflammation in male but not female mice in experimental stroke

    Science.gov (United States)

    Dotson, Abby L.; Wang, Jianming; Saugstad, Julie; Murphy, Stephanie J.; Offner, Halina

    2014-01-01

    The peripheral immune response contributes to neurodegeneration after stroke yet little is known about how this process differs between males and females. The current study demonstrates that splenectomy prior to experimental stroke eliminates sex differences in infarct volume and activated brain monocytes/microglia. In the periphery of both sexes, activated T cells correlate directly with stroke outcome while monocytes are reduced by splenectomy only in males. This study provides new information about the sex specific mechanisms of the peripheral immune response in neurodegeneration after stroke and demonstrates the need for representation of both sexes in basic and clinical stroke research. PMID:25434281

  20. Influence of splenectomy on the biodistribution of technetium-99m dimercaptosuccinic acid (99mTc-DMSA) in rats

    International Nuclear Information System (INIS)

    Acucena, Maria Kadja Meneses Torres; Pereira, Kercia Regina Santos Gomes; Villarim Neto, Arthur; Rego, Amalia Cinthia Meneses; Bernardo-Filho, Mario; Azevedo, Italo Medeiros; Araujo Filho, Irami; Medeiros, Aldo Cunha

    2008-01-01

    This study aimed to evaluate if the splenectomy alters the biodistribution of 99mTc-DMSA and renal function in Wistar rats. The animals were separated in the groups: splenectomy (n = 6) and control (n = 6). After splenectomy (15 days), the administration of 0.1 ml of 99mTc-DMSA IV (0.48 MBq) was carried out. Thirty minutes later, kidney, heart, lung, thyroid, stomach, bladder and femur and samples of blood were isolated. The organs were weighed, counted and the percentage of radioactivity /g (%ATI/g) determined. Serum urea and creatinine, hematocrit, leukocytes and platelets were measured. Statistics by t test (p<0.05) was done. There was a significant reduction in %ATI/g in kidney and blood (p<0.05) of splenectomized animals, a significant increase (p<0.05) of urea (88.8 ± 18.6 mg/dL) and creatinine (0.56 ± 0.08 mg/dL), compared to the controls (51.5±1.6, 0.37±0.02 mg/dL, respectively), as well as increase in platelets and leucocytes, and hematocrit reduction. The analysis of the results indicates that in rats, splenectomy seems to alter the renal function and the uptake of 99mTc-DMSA. (author)

  1. Influence of splenectomy on the biodistribution of technetium-99m dimercaptosuccinic acid (99mTc-DMSA) in rats

    Energy Technology Data Exchange (ETDEWEB)

    Acucena, Maria Kadja Meneses Torres; Pereira, Kercia Regina Santos Gomes; Villarim Neto, Arthur; Rego, Amalia Cinthia Meneses [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Centro de Ciencias da Saude; Bernardo-Filho, Mario [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes. Dept. de Biofisica e Biometria; Azevedo, Italo Medeiros; Araujo Filho, Irami; Medeiros, Aldo Cunha [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Dept. de Cirurgia]. E-mail: aldo@ufrnet.br

    2008-12-15

    This study aimed to evaluate if the splenectomy alters the biodistribution of 99mTc-DMSA and renal function in Wistar rats. The animals were separated in the groups: splenectomy (n = 6) and control (n = 6). After splenectomy (15 days), the administration of 0.1 ml of 99mTc-DMSA IV (0.48 MBq) was carried out. Thirty minutes later, kidney, heart, lung, thyroid, stomach, bladder and femur and samples of blood were isolated. The organs were weighed, counted and the percentage of radioactivity /g (%ATI/g) determined. Serum urea and creatinine, hematocrit, leukocytes and platelets were measured. Statistics by t test (p<0.05) was done. There was a significant reduction in %ATI/g in kidney and blood (p<0.05) of splenectomized animals, a significant increase (p<0.05) of urea (88.8 {+-} 18.6 mg/dL) and creatinine (0.56 {+-} 0.08 mg/dL), compared to the controls (51.5{+-}1.6, 0.37{+-}0.02 mg/dL, respectively), as well as increase in platelets and leucocytes, and hematocrit reduction. The analysis of the results indicates that in rats, splenectomy seems to alter the renal function and the uptake of 99mTc-DMSA. (author)

  2. Laparoscopic splenectomy for medically refractory immune thrombocytopenia (ITP): a retrospective cohort study on longtime response predicting factors based on consensus criteria.

    Science.gov (United States)

    Rijcken, Emile; Mees, Soeren Torge; Bisping, Guido; Krueger, Kristin; Bruewer, Matthias; Senninger, Norbert; Mennigen, Rudolf

    2014-12-01

    Laparoscopic splenectomy has been proposed to be the standard therapy for adult patients with medically refractory immune thrombocytopenia (ITP). However, due to inconsistent definitions of response, variable rates of long term response have been reported. Furthermore, new medical treatment options are currently challenging the role of splenectomy. The aims of this study were to (1) analyze long term response after splenectomy according to recently defined consensus criteria, (2) identify possible predictive response factors. A case series of 72 consecutive patients with ITP undergoing laparoscopic splenectomy was retrospectively studied using univariate and multivariate analysis as well as logrank tests. Median follow-up was 32 (2-110) months. Mortality was 0% and morbidity was 8.2%. Response to splenectomy was achieved in of 63/72 patients (87.5%). Loss of response occurred in 19/63 (30.2%) in median after 3 (range 2-42) months. Preoperative platelet counts after boosting with steroids and immunoglobulins as well as the postoperative rise in platelet counts were statistically significant factors for response upon both univariate and multivariate analysis, whereas age, gender, body mass index, ASA classification, disease duration, accessory spleens, splenic weight, conversion to open surgery, or perioperative complications were not. Patients with a postoperative rise in platelet counts >150,000/μL had a significant better chance on stable long term response than those with a smaller increment (P splenectomy is an effective and safe treatment option in order to obtain stable long term response in patients with ITP. Perioperative platelet counts are predictive factors of long term response. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Serial CT Findings of Resolving Extramedullary Hematopoiesis as Unilateral Posterior Mediastinal Mass after Splenectomy in Hereditary Spherocytosis: A Case Report

    International Nuclear Information System (INIS)

    Nam, Mi Yeon; Lee, Ju Won; Kim, Yeo Ju; Kim, Youn Jeong; Kang, Young Hye; Lee, Kyung Hee

    2012-01-01

    Intrathoracic extramedullary hematopoiesis (EMH) is a rare condition of the hereditary spherocytosis. EMH usually regresses or disappears after treatment; such as splenectomy in the case of spherocytosis. We report a case of hereditary spherocytosis. It is presented with an unilateral paravertebral posterior mediastinal mass. After splenectomy, it revealed shrinkage and fatty replacement on serial CT scans.

  4. Serial CT Findings of Resolving Extramedullary Hematopoiesis as Unilateral Posterior Mediastinal Mass after Splenectomy in Hereditary Spherocytosis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Mi Yeon; Lee, Ju Won; Kim, Yeo Ju; Kim, Youn Jeong; Kang, Young Hye; Lee, Kyung Hee [Dept. of Radiology, Inha University Hospital, Incheon (Korea, Republic of)

    2012-03-15

    Intrathoracic extramedullary hematopoiesis (EMH) is a rare condition of the hereditary spherocytosis. EMH usually regresses or disappears after treatment; such as splenectomy in the case of spherocytosis. We report a case of hereditary spherocytosis. It is presented with an unilateral paravertebral posterior mediastinal mass. After splenectomy, it revealed shrinkage and fatty replacement on serial CT scans.

  5. Results of emergency surgery in patients with Moschowitz's disease refractory to hematological treatment: is splenectomy always advisable?

    Science.gov (United States)

    Caronna, R; Cardi, M; Meloni, G; Mangioni, S; Spera, G; Benedetti, M; Frantellizzi, V; Layek, D; Catinelli, S; Schiratti, M; Chirletti, P

    2005-01-01

    Patients with thrombotic thrombocytopenic purpura (TTP), Moschowitz's disease, run a high risk of perioperative bleeding and need intensive hematologic support. In some patients, TTP is associated with cancer but the surgical role in these patients is still unclear. To illustrate the surgical problems and outcome we present the case histories of three patients with TTP observed in our emergency department. Two patients had TTP secondary to cancer and one patient with primary TTP (no evidence of neoplasia) had emergency operation for gastric hemorrhage, occlusion and TTP unresponsive to plasmapheresis. The first two patients who had not radical resection of cancer and no splenectomy, died for TTP complications. The third patient who underwent emergency splenectomy, had an uneventful postoperative course and TTP completely regressed. These case reports suggest that patients with TTP should be screened to rule out cancer. In patients with acute cancer-related complications emergency surgery should aim to resect the cancer. An associated splenectomy may increase the effectiveness of postoperative hematologic therapy.

  6. Elevation of CD16+CD56+ NK-cells and down-regulation of serum interleukin-21 (IL-21) and IL-1α after splenectomy in relapsed hemophagocytic lymphohistiocytosis of unknown cause.

    Science.gov (United States)

    Wang, Jingshi; Han, Wei; Gao, Zhuo; Wang, Yini; Wu, Lin; Zhang, Jia; Lai, Wenyuan; Wang, Zhao

    2017-09-01

    Encouraging progress has been made in application of splenectomy in the treatment of relapsed hemophagocytic lymphohistiocytosis (HLH) of unknown cause. The aim was to determine the roles of lymphocyte subpopulations and inflammatory cytokines in splenectomy. We retrospectively analyzed changes in lymphocyte subpopulations and levels of inflammatory cytokines at different time-points before and after splenectomy in the patients with relapsed HLH of unknown cause, as well as the correlations between these changes and the disease prognosis. During the period from June 2006 to June 2016, we enrolled 107 patients with relapsed HLH of unknown cause, of whom 29 were treated with splenectomy. Among the 29 patients, 7 cases were non-Hodgkin lymphomas based on spleen pathology, 1 case withdrew and the remaining 21 non-lymphoma cases were available for analysis. Results showed a significant increase in both percentage of CD16 + CD56 + NK cells (P = 0.003) and NK cell activity (P = 0.028) at 24 wk after splenectomy compared to their baseline pre-surgery levels. We also examined seven patients for the changes in cytokine levels before and after splenectomy and found that IL-21 and IL-1α decreased at 4 wk after splenectomy (P splenectomy had significantly longer survival (P = 0.001) compared to the 24 patients with relapsed HLH of unknown cause who were also determined as NR but not treated by splenectomy. Splenectomy can improve clinical symptoms and survival of patients with relapsed HLH of unknown cause. The mechanism is likely related to the changes in percent NK cells and cytokines (IL-21 and IL-1α) after surgery.

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

    Energy Technology Data Exchange (ETDEWEB)

    Zwas, S.T.; Samra, D.; Samra, Y.; Sibber, G.R.

    1986-07-01

    Twenty-three subjects who had a splenectomy as a result of trauma underwent scintigraphic evaluation with a sensitive heat-denatured sup(99m)Tc-labeled red blood cells (DRBC). This method enabled detection of ectopic splenic tissue foci (ESTF) as small as 1x1 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 1x1 to 5x10 cm (0.8-40 cm/sup 2/), and 53% were less than 2x2 cma (3 cm/sup 2/). 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 sup(99m)Tc-DRBC method described is recommended for verification of ESTF existence, localization, and function.

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

    International Nuclear Information System (INIS)

    Zwas, S.T.

    1986-01-01

    Twenty-three subjects who had a splenectomy as a result of trauma underwent scintigraphic evaluation with a sensitive heat-denatured sup(99m)Tc-labeled red blood cells (DRBC). This method enabled detection of ectopic splenic tissue foci (ESTF) as small as 1x1 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 1x1 to 5x10 cm (0.8-40 cm 2 ), and 53% were less than 2x2 cma (3 cm 2 ). 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 sup(99m)Tc-DRBC method described is recommended for verification of ESTF existence, localization, and function. (orig.)

  9. First experience with single incision laparoscopic surgery in Slovakia: concomitant cholecystectomy and splenectomy in an 11-year-old girl with hereditary spherocytosis.

    Science.gov (United States)

    Cingel, Vladimir; Zabojnikova, Lenka; Kurucova, Patricia; Varga, Ivan

    2014-09-01

    Hereditary spherocytosis is an autosomal dominant inheritance disorder of the red blood cell membrane characterized by the presence of spherical-shaped erythrocytes (spherocytes) in the peripheral blood. The main clinical features include haemolytic anemia, variable jaundice, splenomegaly and cholelithiasis caused by hyperbilirubinemia from erythrocyte hemolysis. Splenectomy does not solve the congenital genetic defect but it stops pathological hemolysis in the enlarged spleen. If gallstones are present, it is appropriate to perform cholecystectomy at the time of splenectomy, although the patient has symptoms of gall bladder disease. We present the case of single incision laparoscopic surgical (SILS) concomitant splenectomy and cholecystectomy performed with conventional laparoscopic instruments in an 11-year-old girl with the diagnosis of hereditary spherocytosis. A 2-3 cm umbilical incision was used for the placement of two 5 mm trocars and one 10 mm flexible videoscope. Conventional laparoscopic dissector, grasper, Ligasure, Harmonic Ace and hemoclips were the main tools during surgical procedure. We prefer Single Incision Laparoscopic Surgery Foam Port (Covidien) as the single umbilical device for introduction into the abdominal cavity. First, we performed cholecystectomy, then the gallbladder was put aside over the liver and after that we peformed splenectomy. To remove the detached spleen and gallbladder, a nylon extraction bag is introduced through one of the port sites. The spleen is than morcellated in the bag with forceps and removed in fragments. After that we removed them and the umbilical fascial incision was closed. Splenectomy is the only effective therapy for this disorder and often it is performed in combination with cholecystectomy. Conventional surgery requires a wide upper abdominal incision for correct exposure of the gallbladder and spleen. Our experience shows that SILS splenectomy and cholecystectomy is feasible even in young children and

  10. Effects of splenectomy on the humoral immune system

    International Nuclear Information System (INIS)

    Rozing, J.; Brons, N.H.C.; Benner, R.

    1978-01-01

    Experiments were performed to investigate the influence of neonatal and adult splenectomy on humoral immunity in mice. In the bone marrow and lymph nodes of both groups of splenectomized mice the number of immunoglobulin (Ig)-positive (B) lymphocytes was significantly higher than in sham-operated mice. These higher numbers of B cells probably reflect a compensation for the absence of the B cell population of the spleen. Hardly any quantitative differences in the serum immunoglobulins were found between splenectomized and sham-splenectomized mice. Only for the IgM class was a significantly lower concentration found in the serum of splenectomized animals. This low concentration of IgM in the blood of splenectomized mice was caused by a failure of the remaining organs to compensate completely for the removal of the quantitatively important population of IgM-producing plasma cells in the spleen. Nevertheless, the number of precursors of IgM-producing plasma cells in bone marrow and lymph nodes and their ability to differentiate into IgM-producing plasma cells was not diminished by splenectomy. Probably the spleen provides a highly efficient environment for the differentiation into IgM-producing plasma cells. By investigating the synergistic ability of bone marrow cells and thymus cells from neonatally splenectomized mice it was found that these cells were fully capable of co-operating in the adoptive plaque-forming cell response to sheep red blood cells (SFBC). (author)

  11. Platelet survival in idiopathic thrombocytopenic purpura and response to splenectomy

    International Nuclear Information System (INIS)

    Monteiro, M.E.; Verhaeghe, R.; Devos, P.

    Platelet survival combined with surface counting was performed in 9 patients with idiopathic thrombocytopenic purpura, resistent to steroid therapy. All patients had a markedly enhanced platelet turnover, five of them showed an augmented trapping of radioactivity over the spleen compared to liver and heart. These five patients underwent splenectomy: the platelet count increased in all of them but this increase was not always sustained. (Author) [pt

  12. Chronic idiopathic thrombocytopenic purpura (ITP): site of platelet sequestration and results of splenectomy

    International Nuclear Information System (INIS)

    Gugliotta, L.; Guarini, A.; Motta, M.R.; Bachetti, G.; Tura, S.; Isacchi, G.; Ciccone, F.; Lattarini, C.; Mazzucconi, M.G.; Mandelli, F.; Baccarani, M.

    1981-01-01

    51 Cr-platelet kinetics study was performed in 197 patients with chronic ITP after corticosteroid therapy had failed to induce a long lasting remission. The incidence of splenic, spleno-hepatic, hepatic and diffuse platelet sequestration site was 58%, 17%, 6% and 19%, respectively. Splenic and spleno-hepatic sequestration sites were more frequent in patients less than 30 years old and in patients with a platelet count lower than 50 x 10 9 /l. 111 patients were splenectomized shortly after the study. Normalization of the platelet count was obtained more frequently in patients with splenic and spleno-hepatic sequestration than in the others. Labelled platelet sequestration site was the best predictor of the outcome of splenectomy. Platelet kinetics is a non-invasive investigation that should be performed early after the diagnosis of chronic ITP in all patients eligible for splenectomy. (author)

  13. Distal pancreatectomy with splenectomy for the management of splenic hilum metastasis in cytoreductive surgery of epithelial ovarian cancer.

    Science.gov (United States)

    Xiang, Libing; Tu, Yunxia; He, Tiancong; Shen, Xuxia; Li, Ziting; Wu, Xiaohua; Yang, Huijuan

    2016-11-01

    Distal pancreatectomy with splenectomy may be required for optimal cytoreductive surgery in patients with epithelial ovarian cancer (EOC) metastasized to splenic hilum. This study evaluates the morbidity and treatment outcomes of the uncommon procedure in the management of advanced or recurrent EOC. This study recruited 18 patients who underwent distal pancreatectomy with splenectomy during cytoreductive surgery of EOC. Their clinicopathological characteristics and follow-up data were retrospectively analyzed. All tumors were confirmed as high-grade serous carcinomas. The median diameter of metastatic tumors located in splenic hilum was 3.5 cm (range, 1 to 10 cm). Optimal cytoreduction was achieved in all patients. Eight patients (44.4%) suffered from postoperative complications. The morbidity associated with distal pancreatectomy and splenectomy included pancreatic leakage (22.2%), encapsulated effusion in the left upper quadrant (11.1%), intra-abdominal infection (11.1%), pleural effusion with or without pulmonary atelectasis (11.1%), intestinal obstruction (5.6%), pneumonia (5.6%), postoperative hemorrhage (5.6%), and pancreatic pseudocyst (5.6%). There was no perioperative mortality. The majority of complications were treated successfully with conservative management. During the median follow-up duration of 25 months, nine patients experienced recurrence, and three patients died of the disease. The 2-year progression-free survival and overall survival were 40.2% and 84.8%, respectively. The inclusion of distal pancreatectomy with splenectomy as part of cytoreduction for the management of ovarian cancer was associated with high morbidity; however, the majority of complications could be managed with conservative therapy.

  14. Anaesthetic implications of laparoscopic splenectomy in patients with sickle cell anaemia.

    LENUS (Irish Health Repository)

    Doodnath, R.

    2010-04-01

    With the increasing immigrant population in the Republic of Ireland, the number of patients with sickle cell disease (SCD) seen in the paediatric hospitals is climbing. In this case report, we review the anaesthetic implications and outcome of the first two paediatric patients with SCD to have a laparoscopic splenectomy due to repeated splenic infarcts in the Republic of Ireland.

  15. Anaesthetic implications of laparoscopic splenectomy in patients with sickle cell anaemia.

    LENUS (Irish Health Repository)

    Doodnath, R

    2012-02-01

    With the increasing immigrant population in the Republic of Ireland, the number of patients with sickle cell disease (SCD) seen in the paediatric hospitals is climbing. In this case report, we review the anaesthetic implications and outcome of the first two paediatric patients with SCD to have a laparoscopic splenectomy due to repeated splenic infarcts in the Republic of Ireland.

  16. Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years

    Science.gov (United States)

    Vianelli, Nicola; Palandri, Francesca; Polverelli, Nicola; Stasi, Roberto; Joelsson, Joel; Johansson, Eva; Ruggeri, Marco; Zaja, Francesco; Cantoni, Silvia; Catucci, Angelo Emanuele; Candoni, Anna; Morra, Enrica; Björkholm, Magnus; Baccarani, Michele; Rodeghiero, Francesco

    2013-01-01

    The treatment of choice in steroid-resistant immune thrombocytopenia is still controversial due to the recent advent of new drugs (anti-CD20 antibodies and thrombopoietin mimetics) that have encouraged a generalized tendency to delay splenectomy. Consequently, it is extremely importance to define the efficacy and safety of splenectomy in the long term. We retrospectively analyzed the data of 233 patients affected by immune thrombocytopenia who underwent splenectomy between 1959 and 2001 in 6 European hematologic institutions and who have now a minimum follow up of ten years from surgery. Of the 233 patients, 180 (77%) achieved a complete response and 26 (11%) a response. Sixty-eight of 206 (33%) responsive patients relapsed, mostly (75%) within four years from first response. In 92 patients (39.5%), further treatment was required after splenectomy that was effective in 76 cases (83%). In 138 patients (59%), response was maintained free of any treatment at last contact. No significant association between baseline characteristics and likelihood of stable response was found. Overall, 73 (31%) and 58 (25%) patients experienced at least one infectious or hemorrhagic complication, which was fatal in 2 and 3 patients, respectively. A stable response to splenectomy was associated with a lower rate of infections (P=0.004) and hemorrhages (PSplenectomy achieved a long-term stable response in approximately 60% of cases. Complications mainly affected non-responding patients and were fatal in a minority. PMID:23144195

  17. Subtotal splenectomy preserving the inferior splenic pole for the treatment of Hodgkin’s lymphoma

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    2017-01-01

    Conclusion: Subtotal splenectomy is efficacious to preserve the splenic functions and to prevent adverse effects of a large spleen on the treatment of Hodgkin’s lymphoma confined to superior pole and producing significant abdominal symptoms and hematological effects.

  18. Splenectomy in a Nigerian Teaching Hospital: A comparison of sonographic correlation with intra-operative findings in trauma

    Directory of Open Access Journals (Sweden)

    Oludolapo Afuwape

    2013-01-01

    Full Text Available Background: Missed or inappropriately-treated splenic injury is a significant cause of preventable trauma-related death. Physical examination and abdominal ultrasonography are essential tools for early diagnosis of splenic injury. However, some injuries may not be accurately diagnosed by ultrasonography at initial evaluation. Aim: The aim of this study was to audit indications for splenectomy at the University College Hospital, Ibadan and to compare the intra-operative findings in trauma-related cases with the sonographic findings. Materials and Methods: We retrospectively reviewed all adult (12 years and older patients′ records who had splenectomy between July 2003 and June 2010. The data extracted included patient demographics and indications for splenectomy. In trauma cases, the mode of injury and vital signs at presentation, sonographic findings, and operation findings were recorded. The intervals between injury and sonography and duration to surgery were also noted respectively. Results: Eighty-four patients were reviewed in the 7-year review period. The male to female ratio was approximately 2:1. The ages ranged from 14 to 76 years with a peak incidence in the third decade. Elective indications for splenectomy were 14 (16.6%, while 70 (83.3% were emergency cases. Forty-four of the trauma-related patients had pre-operative abdominal ultrasound, of which 31 (70% was reported as sonographically normal prior to surgery, while the rest of the trauma-related cases were considered too ill for ultrasonography. Conclusion: Potentially significant injuries may be missed with screening sonography. For this reason, a physician must maintain a high index of suspicion and consider the patient′s clinical status or an alternative imaging modality in excluding a diagnosis of splenic injury.

  19. Optimal and sub-optimal post-detection timing estimators for PET

    International Nuclear Information System (INIS)

    Hero, A.O.; Antoniadis, N.; Clinthorne, N.; Rogers, W.L.; Hutchins, G.D.

    1990-01-01

    In this paper the authors derive linear and non-linear approximations to the post-detection likelihood function for scintillator interaction time in nuclear particle detection systems. The likelihood function is the optimal statistic for performing detection and estimation of scintillator events and event times. The authors derive the likelihood function approximations from a statistical model for the post-detection waveform which is common in the optical communications literature and takes account of finite detector bandwidth, random gains, and thermal noise. They then present preliminary simulation results for the associated approximate maximum likelihood timing estimators which indicate that significant MSE improvements may be achieved for low post-detection signal-to-noise ratio

  20. Sclerosing Angiomatoid Nodular Transformation: Laparoscopic Splenectomy as Therapeutic and Diagnostic Approach at the Same Time.

    Science.gov (United States)

    Cipolla, Calogero; Florena, Ada Maria; Ferrara, Gabriella; Di Gregorio, Riccardo; Unti, Elettra; Giannone, Antonino G; Lazzaro, Luigi A; Graceffa, Giuseppa; Pantuso, Gianni

    2018-01-01

    Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion with unknown etiopathogenesis and with definite features of imaging, histopathology, and immunohistochemistry. It was first described by Martel et al. in 2004, and to date, only 151 cases have been reported. We report a case of SANT of the spleen detected in a 66-year-old Caucasian, without comorbidities, presented to our department with epigastric pain. We, also, presented a review of the literature. SANT is a benign incidentally vascular condition in the majority of cases. The wide age and gender distribution in our review is in accordance with that in previous studies in English literature. In our opinion, splenectomy is the choice treatment because it is at the same time diagnostic and therapeutic in a definitive way.

  1. Antibody formation in mouse bone marrow. IV. The influence of splenectomy on the bone marrow plaque-forming cell response to sheep red blood cells

    International Nuclear Information System (INIS)

    Benner, R.; Oudenaren, A. van

    1975-01-01

    Mouse bone marrow is barely capable of plaque-forming cell (PFC) activity during the primary response to sheep red blood cells (SRBC). However, during the secondary response, it becomes the major center of activity containing IgM-, IgG- and IgA-PFC. In the present paper the influence of splenectomy was studied on primary and secondary PFC activity in the bone marrow. Differences in primary and secondary bone marrow PFC responses are probably related to the presence of B and T memory cells in situ. Therefore the effect of splenectomy on the appearance of B and T memory cells in the bone marrow was also investigated. iv.plenectomy before intravenous (iv) immunization with 4 x 10 8 SRBC prevented any primary PFC activity in the bone marrow. The influence of splenectomy before priming on secondary PFC activity in the bone marrow depended on the priming dose of SRBC. Splenectomy before priming with 10 7 SRBC iv completely prevented IgM-, IgG-, and IgA-PFC activity in the bone marrow upon subsequent boosting with 4 x 10 8 SRBC iv. By means of cell transfer experiments it was shown that after splenectomy no B or T memory cells appeared in the bone marrow after priming with 10 7 SRBC iv. Cell transfer experiments showed that splenectomy before priming with 10 7 SRBC iv not only interfered with the appearance of B and T memory cells in the bone marrow, but also with the appearance of B memory cells in peripheral lymph nodes, mesenteric lymph node, Peyer's patches, thymus, and blood. Immunization of spenectomized mice with 4 x 10 8 SRBC iv induced the appearance of B memory cells in peripheral lymph nodes, mesenteric lymph node, Peyer's patches, thymus, and blood

  2. Effect of radiotherapy and splenectomy on the bone marrow status in patients with Hodgkin's disease

    International Nuclear Information System (INIS)

    Bajsogolov, G.D.; Pavlov, V.V.; Bogatyreva, T.I.; Khait, S.E.; Kuz'mina, E.G.; Khoptynskaya, S.K.; Kolesnikova, A.I.

    1987-01-01

    A study was made of the bone marrow status in unirradiated zones on 33 patients with stage 1-2 Hodgkin's disease in complete 9-12 year remission after therapeutic irradiation of the lymphatic collectors of the upper part of the trunk in combination with irradiation of the system (16 patients) or splenectomy (17 patients). The total count of myelokaryocytes, myelogram, a relative and absolute content of lymphoid cells, immature granulocytes and elements of the erythroid series were defined in the punctates of the upper portion of the ilium. T- and B-lymphocyte count, the number of granulocytomacrophage (CFU-C) and stromal (CFU-F) precursor cells were defined using morphocytochemical and immunological methods. At that time an increase in the relative and absolute content of C- ad B-lymphocytes was noted. The T-cell count and the total number of myelokaryocytes, on the one hand, and the content of immature granulocytes and erythronormoblasts, on the other had, showed correlation of various degree which was particularly noticeable in the group of unoperated patients. The total number of myelokaryocytes in 1 μl of the bone marrow of the patients after splenectomy, on an average, significantly exceeded that in the group of patients with the irradiated spleen. These changes were considered to be a result of the rearragement of T-differentiating lymphocytes with their raised accumulation in the bone marrow after irradiation of a considerable volume of the lymphoid tissue and spleen or after splenectomy

  3. Synchronous splenectomy and hepatectomy for patients with hepatocellular carcinoma and hypersplenism: A case-control study

    Science.gov (United States)

    Zhang, Xiao-Yun; Li, Chuan; Wen, Tian-Fu; Yan, Lu-Nan; Li, Bo; Yang, Jia-Yin; Wang, Wen-Tao; Jiang, Li

    2015-01-01

    AIM: To investigate whether the use of synchronous hepatectomy and splenectomy (HS) is more effective than hepatectomy alone (HA) for patients with hepatocellular carcinoma (HCC) and hypersplenism. METHODS: From January 2007 to March 2013, 84 consecutive patients with HCC and hypersplenism who underwent synchronous hepatectomy and splenectomy in our center were compared with 84 well-matched patients from a pool of 268 patients who underwent hepatectomy alone. The short-term and long-term outcomes of the two groups were analyzed and compared. RESULTS: The mean time to recurrence was 21.11 ± 12.04 mo in the HS group and 11.23 ± 8.73 mo in the HA group, and these values were significantly different (P = 0.001). The 1-, 3-, 5-, and 7-year disease-free survival rates for the patients in the HS group and the HA group were 86.7%, 70.9%, 52.7%, and 45.9% and 88.1%, 59.4%, 43.3%, and 39.5%, respectively (P = 0.008). Platelet and white blood cell counts in the HS group were significantly increased compared with the HA group one day, one week, one month and one year postoperatively (P Splenectomy and micro-vascular invasion were significant independent prognostic factors for disease-free survival. Gender, tumor number, and recurrence were independent prognostic factors for overall survival. CONCLUSION: Synchronous hepatectomy and hepatectomy potentially improves disease-free survival rates and alleviates hypersplenism without increasing the surgical risks for patients with HCC and hypersplenism. PMID:25741142

  4. Short-Term Outcome of Multiple Port Laparoscopic Splenectomy in 10 Dogs.

    Science.gov (United States)

    Shaver, Stephanie L; Mayhew, Philipp D; Steffey, Michele A; Hunt, Geraldine B; Mayhew, Kelli N; Culp, William T N

    2015-07-01

    To describe surgical techniques for multiple port laparoscopic splenectomy (MLS) in dogs and report short-term outcome. Retrospective case series. Dogs (n = 10) with naturally occurring splenic disease. Medical records (March 2012-March 2013) of dogs that had MLS were reviewed. Data retrieved included signalment, weight, clinical signs, physical examination findings, preoperative laboratory and ultrasonographic findings, port number, size, and location, patient positioning, additional procedures performed, surgical duration, histopathologic diagnosis, duration of hospitalization, and perioperative complications. Ten dogs (median weight, 28.7 kg; range, 20.2-46.0 kg) had MLS using a 3 or 4 port technique and a vessel-sealing device for tissue dissection along the splenic hilus. Dog positioning varied because of additional laparoscopic or laparoscopic-assisted procedures including adrenalectomy (n = 2), ovariectomy (1), gastropexy (1), and intestinal resection and anastomosis (1). Conversion to an open approach was necessary in 1 dog because of inadequate visibility caused by omental adhesions. One dog had hemorrhage from an omental vessel, but open conversion was not required. MLS was associated with little perioperative morbidity and few complications in this cohort of dogs and may be a reasonable option for surgical management of dogs requiring elective splenectomy. © Copyright 2014 by The American College of Veterinary Surgeons.

  5. Successful Treatment of Bleeding Gastric Varices with Splenectomy in a Patient with Splenic, Portal, and Mesenteric Thromboses

    Directory of Open Access Journals (Sweden)

    Lior Menasherian-Yaccobe

    2013-01-01

    Full Text Available A 59-year-old female with a history of multiple splanchnic and portal thromboses treated with warfarin underwent an esophagogastroduodenoscopy for cancer screening, and a polypoid mass was biopsied. One week later, she was admitted with upper gastrointestinal hemorrhage. Her therapeutic coagulopathy was reversed with fresh frozen plasma, and she was transfused with packed red blood cells. An esophagogastroduodenoscopy demonstrated an erosion of a gastric varix without evidence of recent bleeding. Conservative measures failed, and she continued to bleed during her stay. She was not considered a candidate for a shunt procedure; therefore, a splenectomy was performed. Postoperative esophagogastroduodenoscopy demonstrated near complete resolution of gastric varices. One year after discharge on warfarin, there has been no recurrence of hemorrhage. Gastric varices often arise from either portal hypertension or splenic vein thrombosis. Treatment of gastric variceal hemorrhage can be challenging. Transjugular intrahepatic portosystemic shunt is often effective for emergency control in varices secondary to portal hypertension. Splenectomy is the treatment for varices that arise from splenic vein thrombosis. However, treatment of gastric variceal hemorrhage in the context of multiple splanchnic and portal vein thromboses is more complicated. We report splenectomy as a successful treatment of gastric varices in a patient with multiple extrahepatic thromboses.

  6. Sclerosing Angiomatoid Nodular Transformation: Laparoscopic Splenectomy as Therapeutic and Diagnostic Approach at the Same Time

    Directory of Open Access Journals (Sweden)

    Calogero Cipolla

    2018-01-01

    Full Text Available Introduction. Sclerosing angiomatoid nodular transformation (SANT of the spleen is a rare benign vascular lesion with unknown etiopathogenesis and with definite features of imaging, histopathology, and immunohistochemistry. It was first described by Martel et al. in 2004, and to date, only 151 cases have been reported. Case Description. We report a case of SANT of the spleen detected in a 66-year-old Caucasian, without comorbidities, presented to our department with epigastric pain. We, also, presented a review of the literature. Conclusions. SANT is a benign incidentally vascular condition in the majority of cases. The wide age and gender distribution in our review is in accordance with that in previous studies in English literature. In our opinion, splenectomy is the choice treatment because it is at the same time diagnostic and therapeutic in a definitive way.

  7. Temporal changes in hematologic markers after splenectomy, splenic embolization, and observation for trauma.

    Science.gov (United States)

    Wernick, B; Cipriano, A; Odom, S R; MacBean, U; Mubang, R N; Wojda, T R; Liu, S; Serres, S; Evans, D C; Thomas, P G; Cook, C H; Stawicki, S P

    2017-06-01

    The spleen is one of the most commonly injured abdominal solid organs during blunt trauma. Modern management of splenic trauma has evolved to include non-operative therapies, including observation and angioembolization to preclude splenectomy in most cases of blunt splenic injury. Despite the shift in management strategies, relatively little is known about the hematologic changes associated with these various modalities. The aim of this study was to determine if there are significant differences in hematologic characteristics over time based on the treatment modality employed following splenic trauma. We hypothesized that alterations seen in hematologic parameters would vary between observation (OBS), embolization (EMB), and splenectomy (SPL) in the setting of splenic injury. An institutional review board-approved, retrospective study of routine hematologic indices examined data between March 2000 and December 2014 at three academic trauma centers. A convenience sample of patients with splenic trauma and admission lengths of stay >96 h was selected for inclusion, resulting in a representative sample of each sub-group (OBS, EMB, and SPL). Basic demographics and injury severity data (ISS) were abstracted. Platelet count, red blood cell (RBC) count and RBC indices, and white blood cell (WBC) count with differential were analyzed between the time of admission and a maximum of 1080 h (45 days) post-injury. Comparisons between OBS, EMB, and SPL groups were then performed using non-parametric statistical testing, with statistical significance set at p splenic injury grade varied by interventional modality (grade 4 for SPL, 3 for EMB, and 2 for OBS, p splenic injuries managed with SPL, EMB, or OBS. As expected, observed WBC counts were highest following SPL, then EMB, and finally OBS. No differences were noted in RBC count between the three groups, but RDW was significantly greater following SPL compared to EMB and OBS. We also found that MCV was highest following OBS

  8. From CT scanning to 3-D printing technology for the preoperative planning in laparoscopic splenectomy.

    Science.gov (United States)

    Pietrabissa, Andrea; Marconi, Stefania; Peri, Andrea; Pugliese, Luigi; Cavazzi, Emma; Vinci, Alessio; Botti, Marta; Auricchio, Ferdinando

    2016-01-01

    Three-dimensional printing technology is rapidly changing the way we produce all sort of objects, having also included medical applications. We embarked in a pilot study to assess the value of patient-specific 3-D physical manufacturing of spleno-pancreatic anatomy in helping during patient's counseling and for preoperative planning. Twelve patients scheduled for a laparoscopic splenectomy underwent contrast CT and subsequent post-processing to create virtual 3-D models of the target anatomy, and 3-D printing of the relative solid objects. The printing process, its cost and encountered problems were monitored and recorded. Patients were asked to rate the value of 3-D objects on a 1-5 scale in facilitating their understanding of the proposed procedure. Also 10 surgical residents were required to evaluate the perceived extra value of 3-D printing in the preoperative planning process. The post-processing analysis required an average of 2; 20 h was needed to physically print each model and 4 additional hours to finalize each object. The cost for the material employed for each object was around 300 euros. Ten patients gave a score of 5, two a score of 4. Six residents gave a score of 5, four a score of 4. Three-dimensional printing is helpful in understanding complex anatomy for educational purposes at all levels. Cost and working time to produce good quality objects are still considerable.

  9. Laparoscopic splenectomy is a better surgical approach for spleen-relevant disorders: a comprehensive meta-analysis based on 15-year literatures.

    Science.gov (United States)

    Cheng, Ji; Tao, Kaixiong; Yu, Peiwu

    2016-10-01

    Currently, whether laparoscopic or open splenectomy is a gold standard option for spleen abnormalities remains in controversy. There is in deficiency of academic evidence concerning the surgical efficacy and safety of both comparative managements. In order to surgically appraise the applied potentials of both approaches, we hence performed this comprehensive meta-analysis on the basis of 15-year literatures. Via searching of PubMed, EMBASE, Web of Science, and Cochrane Library databases, overall 37 original articles were eligibly incorporated into our meta-analysis and subdivided into six sections. In accordance with the Cochrane Collaboration protocol, all statistical procedures were mathematically conducted in a standard manner. Publication bias was additionally evaluated by funnel plot and Egger's test. Irrespective of the diversified splenic disorders, laparoscopic splenectomy was superior to open technique owing to its fewer estimated blood loss, shorter postoperative hospital stay as well as lower complication rate (P  0.05). Technically, laparoscopic splenectomy should be recommended as a prior remedy with its advantage of rapid recovery and minimally physical damage, in addition to its comparably surgical efficacy against that of open manipulation.

  10. Salmonella sepsis following posttraumatic splenectomy and implantation of autologous splenic tissue

    DEFF Research Database (Denmark)

    Schrøder, H M; Hovendal, C

    1985-01-01

    A severe complication following implantation of autologous splenic tissue occurred in a 51-year-old man. Indirect injury to abdomen resulted in a lesion of the splenic artery. Following splenectomy and reimplantation of splenic tissue into three pouches, a severe Salmonella sepsis developed withi...... 24 hours. At second look laparotomy two pouches were infected. Recently there had been moderate signs of gastroenteritis and the same bacteria was cultivated from feces. Modifications of the implantation procedure are discussed....

  11. Curative resection by splenectomy for solitary splenic metastasis from early gastric cancer: a case report and literature review.

    Science.gov (United States)

    Yoshizawa, Junichi; Kubo, Naoki; Ishizone, Satoshi; Karasawa, Fumitoshi; Nakayama, Ataru

    2017-06-20

    Solitary metastasis of a malignancy to the spleen is rare, particularly for gastric cancer. Only a few case reports have documented isolated splenic metastasis from early gastric cancer. We describe a case of splenic metastasis from early gastric cancer. A 60-year-old man underwent a distal gastrectomy for early gastric cancer. It infiltrated the submucosa with pathological nodal involvement (pT1bN2M0, stage IIB). One year after the gastrectomy, an abdominal computed tomography scan showed a low-density lesion, 17 mm in diameter, at the upper pole of the spleen. Positron emission tomography/computed tomography showed focal accumulation of fluorine-18 fluorodeoxyglucose in the spleen without extrasplenic tumor dissemination or metastasis. We diagnosed splenic metastasis of gastric cancer, and performed a splenectomy. Histological examination confirmed moderately differentiated tubular adenocarcinoma and poorly differentiated adenocarcinoma (solid type) that was consistent with the features of the primary gastric cancer. The splenic tumor was pathologically and immunohistochemically diagnosed as a metastasis from the gastric carcinoma. More than 18 months after the splenectomy, the patient has had no evidence of recurrent gastric cancer. When solitary metastasis to the spleen is suspected during the postoperative follow-up of a patient with gastric cancer, a splenectomy is a potentially effective treatment.

  12. Spontaneous occlusion of post-traumatic splenic pseudoaneurysm: report of two cases in children

    Energy Technology Data Exchange (ETDEWEB)

    Raghavan, Ashok; Wong, Christopher Kah Fook; Lam, Albert; Stockton, Vivienne [Department of Medical Imaging, The Children' s Hospital at Westmead, Sydney (Australia)

    2004-04-01

    Conservative therapy for splenic injuries is widely advocated. The advantages of conservative therapy for splenic injuries include the preservation of splenic immune function, prevention of overwhelming post-splenectomy sepsis, and avoidance of laparotomy and its associated early and late complications. Pseudoaneurysms of the splenic artery branch are encountered because of the prevalence of conservative management and widespread use of imaging techniques in the follow-up of these cases. We report two cases of post-traumatic splenic pseudoaneurysm in children which thrombosed spontaneously, one during the diagnostic angiogram examination and another on follow-up studies. (orig.)

  13. Diabetes induction by total pancreatectomy in minipigs with simultaneous splenectomy: a feasible approach for advanced diabetes research.

    Science.gov (United States)

    Heinke, Sophie; Ludwig, Barbara; Schubert, Undine; Schmid, Janine; Kiss, Thomas; Steffen, Anja; Bornstein, Stefan; Ludwig, Stefan

    2016-09-01

    Safe and reliable diabetes models are a key prerequisite for advanced preclinical studies on diabetes. Chemical induction is the standard model of diabetes in rodents and also widely used in large animal models of non-human primates and minipigs. However, uncertain efficacy, the potential of beta-cell regeneration, and relevant side effects are debatable aspects particularly in large animals. Therefore, we aimed to evaluate a surgical approach of total pancreatectomy combined with splenectomy for diabetes induction in an exploratory study in Goettingen minipigs. Total pancreatectomy was performed in Goettingen minipigs (n = 4) under general anesthesia and endotracheal intubation. Prior to surgery, a central venous line was established for drug application and blood sampling. After median laparotomy, splenectomy was performed and the lobular pancreas was carefully dissected with particular attention to the duodenal vascular arcade. Close monitoring of blood glucose was initiated immediately after surgery by standard glucometer measurement or continuous glucose monitoring systems (CGMS). Exogenous insulin was given by multiple daily subcutaneous (s.c.) injections or via insulin pump systems (CSII). Complete endogenous insulin deficiency was confirmed by intravenous glucose tolerance test (ivGTT) and measurement of c-peptide. For establishing a suitable regimen for diabetes management, the animals were followed for 4-6 weeks. Following pancreatectomy and splenectomy, the animals showed a quick recovery from surgery and initial analgetic medication and volume substitution could be terminated within 24 h. A rapid increase in blood glucose was observed immediately following pancreatectomy necessitating insulin therapy. The induced exocrine insufficiency did not cause any clinical symptoms. Complete insulin deficiency could be confirmed in all animals by determination of negative c-peptide during glucose challenge. The two regimen of insulin treatment (multiple daily

  14. A comparative study of partial vs total splenectomy in thalassemia major patients

    Directory of Open Access Journals (Sweden)

    Bahador Ali

    2007-01-01

    Full Text Available Background : In this study, we show the advantages of partial splenectomy (PS over total splenectomy (TS regarding the chances of overwhelming postsplenectomy sepsis (OPSI. Materials and Methods: From February 1991 to December 1999, 143 cases of β-thalassemia underwent PS. 1/3, 1/4 of the splenic tissue was preserved. One hundred and ten cases were followed for an average of 5 years. None of the patients received vaccination or prophylactic antibiotics. Pre- and postoperative hematological profiles, IgM levels, recurrence of hypersplenism and septic episodes were compared among the data of 60 cases TS; all these cases have been operated in the same hospital. Results: Hematological profile significantly increased and transfusion requirement approximately reduced to three-fold. After 3 years, 22.7% in PS and 13.3% in TS groups required the same amount of preoperative transfusion. After 5 years, these percentages were 27.3 and 18.3%, respectively. Two patients in PS and six in TS group developed signs of sepsis. Conclusion : Vaccination or prophylactic antibiotics are not necessary after PS. The risk of sepsis in PS without antibiotics is less than that in TS with antibiotics, and resplenectomy after PS is not associated with serious complications.

  15. Analysis of risk factors for rebleeding after splenectomy and pericardial devascularization in treatment of portal hypertension due to liver cirrhosis

    Directory of Open Access Journals (Sweden)

    ZHANG Lei

    2015-03-01

    Full Text Available ObjectiveTo investigate the possible risk factors for rebleeding after splenectomy and pericardial devascularization in the treatment of portal hypertension due to liver cirrhosis, and to provide a certain basis for reducing the incidence of digestive tract re-hemorrhage for these patients. MethodsA retrospective analysis was performed on 238 cirrhotic patients with portal hypertension who underwent splenectomy and pericardial devascularization in the First Hospital of Lanzhou University from December 2003 to December 2013. These patients were divided into postoperative rebleeding group (n=32 and non-bleeding group (n=206. Univariate analysis (t test or chi-square test and multivariate logistic regression analysis were performed to investigate the risk factors for rebleeding after splenectomy and pericardial devascularization. ResultsOf the 32 patients with postoperative rebleeding, 17 had esophagogastric variceal bleeding, 11 had bleeding due to portal hypertensive gastropathy, and 4 had stress ulcer bleeding. The univariate analysis showed that there were significant differences between the two groups in the following factors: Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, pathological changes of the gastric mucosa, platelet count, prothrombin time (PT, activated partial thromboplastin time (APTT, and presence of diabetes (all P<0.05. The multivariate logistic regression analysis suggested that the significant independent influential factors for postoperative rebleeding were presence of diabetes, Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, diffuse lesion of the gastric mucosa, PT, and APTT. ConclusionFor cirrhotic patients with portal hypertension, the appropriate methods for managing these risk factors are of great clinical significance for preventing rebleeding after splenectomy and pericardial devascularization.

  16. Effects of radiochemotherapy and splenectomy on cellular immunity in long-term survivors of Hodgkin's disease and non-Hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Steele, R.; Han, T.

    1978-01-01

    Thirty-six patients treated for Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) who had been in complete remission and off all therapy for greater than two years were examined for evidence of immunosuppression. All patients were found to have marked depression of their lymphocyte blastogenic response to phytohemagglutinin (PHA) and of their skin test responses. No abnormalities of serum protein or immunoglobulins were found. T cells were significantly lower than normal in patients who had had Hodgkin's disease, but not in those who had had NHL. B cells, on the other hand, were significantly elevated in both groups. Splenectomy elevated the total lymphocyte count, while those who had not had a splenectomy had lower than normal lymphocyte counts. B cells were elevated while T cells tended to be lower in both splenectomy and nonsplenectomy groups, though only in the nonsplenectomized patients did this reach statistical significance. The PHA response tended to be higher in patients with less advanced disease and less extensive treatment than in those with more advanced disease and more extensive treatment, although there was no statistically significant difference. Skin test response though, was shown to correlate well with both stage of disease at diagnosis and extent of treatment

  17. Implementation of laparoscopic splenectomy in children and the incidence of portal vein thrombosis diagnosed by ultrasonography

    NARCIS (Netherlands)

    Oomen, Matthijs W. N.; Bakx, Roel; van Minden, Minke; van Rijn, Rick R.; Peters, Marjolein; Heij, Hugo A.

    2013-01-01

    The aim of this study is to evaluate if symptomatic or asymptomatic PVT, as diagnosed with ultrasonography (US), occurs more often in children after the introduction and implementation of LS compared to open splenectomy. A retrospective cohort of 76 splenectomized patients for benign hematological

  18. Laparoscopic splenectomy in pediatric age: long-term follow-up.

    Science.gov (United States)

    Ates, Ufuk; Tastekin, Nil Y; Gollu, Gulnur; Ergun, Ergun; Yagmurlu, Aydin

    2017-12-01

    In the last century, with the advancement of the diagnostic procedures, hematologic disorders in pediatric age group have been increased dramatically. In parallel with this increase, splenectomy procedures have also been popularized with different techniques and surgical outcomes. Laparoscopic splenectomy (LS) in the pediatric age group is generally accepted as a technically demanding procedure, which needs experience. The purpose of this study is to present the long-term follow-up results of a case series of children who underwent LS for a variety of hematologic disorders, evaluate possible complications and outcomes. All patients who were admitted to the clinic and who were scheduled for LS from 2005 to 2016 were considered for this study. The study parameters were grouped in four categories including socio-demographic data, preoperative evaluation, clinical follow-up and complications. There were 24 male (48.9%) and 25 (51.1%) female patients. The median age and body weight for the study group was 12 years and 35 kg. Most common indications for LS were thalassemia (13; 26.5%) and hereditary spherocytosis (12; 24.4%). As a technical standpoint, 2 patients (4%) underwent singleport LS surgery. The mean time for LS surgeries was found as 80 minutes. The total intraoperative complication rate was 4% (2/57). The mean time for hospital stay was 5 days. Mean follow-up period was 6.4 years (range: 6 months-16 years). There was no long-term complication. Bilirubin levels and need for blood transfusion significantly decreased in the long term follow-up period (p <0.05). LS is a powerful tool in the hands of an experienced surgeon. It's a safe and effective procedure in children with hematologic disorders resulting in shorter length of stay and lower complication rates. Sociedad Argentina de Pediatría

  19. The influence of increased hepatic sequestration after splenectomy on the survival and osmotic fragility of red cells in rats, with reference to protein levels in diets

    International Nuclear Information System (INIS)

    Hisaoka, Fumiko; Shiraki, Keizo; Sagawa, Sueko

    1977-01-01

    The sequestration of erythrocytes in rats was studied using an isologous 51-Cr labeled population of either normal or N-ethyl-maleimide treated red cells. Experiments were performed for observing the effects of the change in the hepatic sequestration of altered red cells on the osmotic fragility and the survival time of circulating red cells. The rate of sequestration in liver at different period after splenectomy was measured with respect to the survival time and osmotic fragility of red cells. The parameters of the proliferative response imposed on liver were also observed. The spleen sequestered selectively damaged red cells, while the liver compensated and overshot the sequestration for spleen after splenectomy. The sequestering response in liver increased gradually and reached the maximum level around 8 weeks after splenectomy, and then declined toward the control level. This compensatory response in liver was not observed in the rats fed with low protein diet. Therefore, the proliferative response imposed on liver by an extra work after splenectomy was not stimulated in the rats fed with low protein diet. Splenectomy prolonged erythrocyte survival and reduced the osmotic fragility of normal red cells, but the compensatory increase in the sequestration of damaged red cells in liver did not alter the survival and osmotic fragility of normal red cells. This fact indicates that the increased sequestration of reticuloendothelial cells in liver is basically reparative, and it is impossible to compensate for the absence of the spleen because of the inability to duplicate certain anatomic features peculiar to the spleen. (Iwakiri, K.)

  20. Modelling Gaucher disease progression: long-term enzyme replacement therapy reduces the incidence of splenectomy and bone complications

    NARCIS (Netherlands)

    van Dussen, Laura; Biegstraaten, Marieke; Dijkgraaf, Marcel Gw; Hollak, Carla Em

    2014-01-01

    Long-term complications and associated conditions of type 1 Gaucher Disease (GD) can include splenectomy, bone complications, pulmonary hypertension, Parkinson disease and malignancies. Enzyme replacement therapy (ERT) reverses cytopenia and reduces organomegaly. To study the effects of ERT on

  1. A Rare Presentation of Extramedullary Hematopoiesis in Post-polycythemic Myelofibrosis.

    Science.gov (United States)

    Konca Degertekin, Ceyla; Ozkurt, Zübeyde Nur; Akyürek, Nalan; Yağcı, Münci

    2014-09-01

    Polycythemia vera is a clonal proliferative disorder of the bone marrow that could possibly evolve into myelofibrosis in its natural course. Progression to myelofibrosis is usually a late stage complication and presents clinically with refractory cytopenias and extramedullary hematopoiesis (EMH). EMH can occur in any tissue during the course of post-polycythemic myelofibrosis. However, skin and cardiac involvements seems to be very rare. We present a 56-year-old woman with post-polycythemic myelofibrosis refractory to treatment, developing EMH after splenectomy in various organs, exceptionally the skin and the heart. Along with the case, the clinical presentations, treatment options, prognostic significance of EMH and the role of cytogenetics is discussed in the light of the literature.

  2. [Multidisciplinary protocol for computed tomography imaging and angiographic embolization of splenic injury due to trauma: assessment of pre-protocol and post-protocol outcomes].

    Science.gov (United States)

    Koo, M; Sabaté, A; Magalló, P; García, M A; Domínguez, J; de Lama, M E; López, S

    2011-11-01

    To assess conservative treatment of splenic injury due to trauma, following a protocol for computed tomography (CT) and angiographic embolization. To quantify the predictive value of CT for detecting bleeding and need for embolization. The care protocol developed by the multidisciplinary team consisted of angiography with embolization of lesions revealed by contrast extravasation under CT as well as embolization of grade III-V injuries observed, or grade I-II injuries causing hemodynamic instability and/or need for blood transfusion. We collected data on demographic variables, injury severity score (ISS), angiographic findings, and injuries revealed by CT. Pre-protocol and post-protocol outcomes were compared. The sensitivity and specificity of CT findings were calculated for all patients who required angiographic embolization. Forty-four and 30 angiographies were performed in the pre- and post-protocol periods, respectively. The mean (SD) ISSs in the two periods were 25 (11) and 26 (12), respectively. A total of 24 (54%) embolizations were performed in the pre-protocol period and 28 (98%) after implementation of the protocol. Two and 7 embolizations involved the spleen in the 2 periods, respectively; abdominal laparotomies numbered 32 and 25, respectively, and 10 (31%) vs 4 (16%) splenectomies were performed. The specificity and sensitivity values for contrast extravasation found on CT and followed by embolization were 77.7% and 79.5%. The implementation of this multidisciplinary protocol using CT imaging and angiographic embolization led to a decrease in the number of splenectomies. The protocol allows us to take a more conservative treatment approach.

  3. Combined Treatment with Splenectomy and Cladribine in Hairy Cell Leukemia in Taiwan: A Clinicopathologic Study of 5 Cases

    Directory of Open Access Journals (Sweden)

    Yuan-Bin Yu

    2007-12-01

    Conclusion: For the HCL patients in this study, splenectomy had a role not only in improving cytopenia but in aiding diagnosis. Cladribine is safe and highly effective for Taiwanese patients and should be considered as first-line treatment for HCL.

  4. Late follow-up of patients submitted to subtotal splenectomy: late clinical, laboratory, imaging and functional with preservation of the upper splenic pole

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    2008-09-01

    Full Text Available objective: To evaluate the follow-up of patients submitted to splenectomy with preservation of the upper splenic pole. Methods: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients submitted to this surgery were studied. The procedure was performed due to one of the following conditions: portal hypertension due to schistosomiasis (n = 43, trauma (n = 31, Gaucher’s disease (n = 4, myeloid hepatosplenomegaly due to myelofibrosis (n = 3, splenomegalic retarded growth and sexual development (n = 2, severe pain due to splenic ischemia (n = 2 and pancreatic cystadenoma (n = 1. All patients underwent hematologic tests, immunological assessment, abdominal ultrasonography, computed tomography (CT, scintigraphy and endoscopy. Rresults: Increased white blood cell and platelet counts were the only hematological abnormalities. No immune deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension, but none had a re-bleeding event. The ultrasonography, tomography and scintigraphy confirmed the presence of functional splenic remnants without significant size alteration. Conclusions: Subtotal splenectomy seems to be a safe procedure that can be useful to treat conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.

  5. Changes of red blood cell aggregation parameters in a long-term follow-up of splenectomy, spleen-autotransplantation and partial or subtotal spleen resections in a canine model.

    Science.gov (United States)

    Miko, Iren; Nemeth, Norbert; Peto, Katalin; Furka, Andrea; Toth, Laszlo; Furka, Istvan

    2017-01-01

    Decrease or loss in splenic filtration function may influence the hemorheological state. To follow-up the long-term effects of splenectomy, spleen autotransplantation and spleen resections on red blood cell aggregation in a canine model. Beagle dogs were subjected to control (n = 6), splenectomy (SE, n = 4), spleen autotransplantation (AU, Furka's spleen-chip method, n = 8) or partial and subtotal spleen resection (n = 4/each) groups, and followed-up for 18 postoperative (p.o.) months. Erythrocyte aggregation was determined in parallel by light-transmittance aggregometry (Myrenne MA-1 aggregometer) and syllectometry (LoRRca). Erythrocyte aggregation decreased three months after splenectomy, with lower aggregation index and elongated aggregation time. It was more or less associated with relatively lower hematocrit and fibrinogen concentration. However, in autotransplantated animals a relatively higher fibrinogen did not increase the aggregation markedly. Spleen resection resulted in the most controversial red blood cell aggregation findings, and it seems, that the degree of the resection is an influencing factor. Splenectomy alters erythrocyte aggregation, spleen autotransplantation can be useful to preserve filtration function. However, the degree of restoration shows individual differences with a kind of 'functional periodicity'. Spleen resection controversially influences erythrocyte aggregation parameters. The subtotal resection is supposed to be worse than spleen autotransplantation.

  6. Splenectomy in a patient with treatment-resistant visceral leishmaniasis: a case report

    Directory of Open Access Journals (Sweden)

    Robson Azevedo Dutra

    2012-02-01

    Full Text Available Visceral leishmaniasis (VL, also known as Kala-azar, is a systemic infection caused by a protozoan (Leishmania and, in its classic form, is a serious illness associated with malnutrition, anemia, hepatosplenomegaly, infectious processes and coagulopathies. The effect of splenectomy in patients with visceral leishmaniasis is not well defined; however, it is known that the spleen is the largest reservoir of infected cells belonging to the reticulo endothelial system. Therefore, the surgical procedure is an option for the debulking of parasites, providing a cure for refractory VL and minimizing the complications of hypersplenism.

  7. Impact of splenectomy on surgical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction

    NARCIS (Netherlands)

    Pultrum, B. B.; van Bastelaar, J.; Schreurs, Liesbeth; van Dullemen, H. M.; Groen, H.; Nijsten, M. W. N.; van Dam, G. M.; Plukker, J. T. H. M.

    We aim to determine the effect of splenectomy on clinical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction (GEJ) after a curative intended resection. From January 1991 to July 2004, 210 patients underwent a potentially curative gastroesophageal resection with an

  8. Predictive model of portal venous system thrombosis in cirrhotic portal hypertensive patients after splenectomy

    OpenAIRE

    He, Shasha; He, Fangping

    2015-01-01

    Objective: This study is to investigate the risk factors of portal venous system thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy and to establish a Logistic regression prediction model. Methods: A total of 119 patients with cirrhotic portal hypertension were enrolled. Their clinical data was retrospectively analyzed. They were divided into PVT group (n = 18) and non-PVT group (n = 101). One-way analysis and multivariate Logistic regression analysis were perfo...

  9. Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis: effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications.

    Science.gov (United States)

    Tsutsumi, Norifumi; Tomikawa, Morimasa; Akahoshi, Tomohiko; Kawanaka, Hirofumi; Ota, Mitsuhiko; Sakaguchi, Yoshihisa; Kusumoto, Tetsuya; Ikejiri, Koji; Hashizume, Makoto; Maehara, Yoshihiko

    2016-11-01

    This study aimed to determine the effect of fibrin glue and polyglycolic acid (PGA) felt on prevention of pancreatic fistula (PF) after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis. Fifty consecutive patients were enrolled in this prospective study. Twenty-three patients underwent laparoscopic splenectomy with a fibrin sheet (fibrin sheet group). The sealing ability of each treatment was evaluated by an ex vivo pressure test model. Based on the results from ex vivo experiments, 27 patients received prophylaxis using fibrin glue and PGA felt (PGA with fibrin group). The primary endpoint was the incidence of PF. Significantly more (5, 22%) patients developed PF in the fibrin sheet group than in the PGA with fibrin group (0%, P = .037). Our new application of fibrin glue and PGA felt is an effective prophylactic procedure for preventing development of PF after laparoscopic splenectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Massive splenic infarction in children with sickle cell anemia and the role of splenectomy.

    Science.gov (United States)

    Al-Salem, Ahmed H

    2013-03-01

    Massive splenic infarction (MSI) is a very rare condition. Few reports of splenic infarction of various etiologies including hematological and non-hematological causes have been published. On the other hand, MSI in patients with sickle cell anemia (SCA) is extremely rare. This report describes our experience with 15 children with SCA and MSI outlining aspects of presentation, diagnosis and management. The records of all children with MSI were retrospectively reviewed for age at diagnosis, sex, clinical features, precipitating factors, investigations, management and outcome. 15 children (11 M: 4 F) with SCA were treated for MSI. Their mean age was 10.9 years (6-17 years). All presented with severe left upper quadrant abdominal pain. In nine, this was associated with nausea and vomiting. Three were febrile and all had a tender splenomegaly. Their mean hemoglobin was 8.2 g/dl (5.7-11.3 g/dl), mean WBC was 10.97 × 10(3) mm(-3) (3.6 × 10(3)-22.3 × 10(3) mm(-3)) and mean platelet count was 263.3 × 10(3) mm(-3) (40 × 10(3)-660 × 10(3) mm(-3)). In seven, there was a precipitating cause including high altitude in two, acute chest syndrome in two, septicemia in two and severe vasooclusive crisis in one. Abdominal ultrasound and CT scan confirmed the diagnosis of MSI which involved more than half of the spleen in 12 and whole spleen in 3. All were treated with IV fluids, analgesia and blood transfusion where appropriate. Eleven had splenectomy because of persistent abdominal pain, three developed splenic abscess and underwent splenectomy and one settled on conservative treatment. Histology confirmed the diagnosis of splenic infarction in 11 and infarction with abscess in the remaining 3. MSI is extremely rare in children with SCA. It can develop spontaneously or precipitated by other factors namely high altitude, acute chest syndrome and severe stress. Most reported cases of splenic infarction are small in size, focal and can be treated conservatively. MSI, on the other

  11. Splenectomy in children with idiopathic thrombocytopenic purpura : A prospective study of 134 children from the Intercontinental Childhood ITP Study Group

    NARCIS (Netherlands)

    Kuehne, Thomas; Blanchette, Victor; Buchanan, George R.; Ramenghi, Ugo; Donato, Hugo; Tamminga, Rienk Y. J.; Rischewski, Johannes; Berchtold, Willi; Imbach, Paul

    2007-01-01

    Background. Splenectomy is an effective procedure for children and adults with severe or refractory idiopathic thrombocytopenic purpura (ITP). Data regarding pediatric patients are limited. Procedure. Sixty-eight Intercontinental Childhood ITP Study Group (ICIS) investigators from 57 institutions in

  12. Haematological and biochemical characteristics of the splenic effluent blood in schistosomal patients undergoing splenectomy

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    Full Text Available OBJECTIVE: To assess hematological and biochemical features of splenic effluent blood and their influence on the rise of hematological values after splenectomy. METHODS: we studied 20 patients undergoing surgical treatment for schistosomatic portal hypertension. We collected blood samples for CBC, coagulation, bilirubin and albumin in the splenic vein (perioperative and peripheral blood (immediately pre and postoperative periods. RESULTS: the splenic blood showed higher values of red blood cells, hemoglobin, hematocrit, platelet count, total leukocytes, neutrophils, lymphocytes, monocytes, eosinophils and basophils, as well as reduction of laboratory coagulation parameters in relation to peripheral blood collected preoperatively. In the postoperative peripheral blood there was an increase in the overall leukocytes and in their neutrophil component, and decreased levels of basophils, eosinophils and lymphocytes. The other postoperative variables of complete blood count and coagulation tests were not different compared with the splenic blood. The albumin values were lower postoperatively when compared to preoperative and splenic blood. There were higher values of direct bilirubin in the postoperative period when compared with the preoperative and splenic blood. Postoperative indirect bilirubin was lower compared to its value in the splenic blood. CONCLUSION: hematological and biochemical values of splenic effluent blood are higher than those found in peripheral blood in the presence of schistosomal splenomegaly. However, the splenic blood effluent is not sufficient to raise the blood levels found after splenectomy.

  13. Detection of splenosis and ectopic spleens with sup(99m)Tc-labelled heat damaged autologous erythrocytes in 90 splenectomized patients

    International Nuclear Information System (INIS)

    Lanng Nielsen, J.; Ellegaard, J.

    1981-01-01

    Splenosis or ectopic spleens were determined in 22 of 45 patients splenectomized after either abdominal trauma or accidental lesions of the spleen during operation. The incidence of ectopic spleen in various groups of splenectomized patients has been investigated by a sensitive scanning method employing reinjection of sup(99m)Tc-labelled heat damaged autologous erythrocytes. In comparison 7 cases were found among 45 patients who underwent splenectomy for haematological reasons. The time span between the operation and a positive scan varied between 3 months and 11 years. None of the patients in the haematological group with reoccurrence of spleen tissue presented any signs of relapse of their primary disorder. The only patient with overwhelming infection was a girl in whom splemectomy was performed for hereditary spherocytosis. She recovered from the sepsis and her scan was negative. It is concluded that recurrence of spleen tissue is frequent after traumatic lesions of the spleen but rare after selective splenectomy for haematological reasons. This may account for the lesser tendency to overwhelming sepsis after post-traumatic splenectomy. (author)

  14. Scintigraphic determination of the spleen volume in case of partial splenectomy for a Minkowski-Chauffard disease. About 15 cases; Determination scintigraphique du volume splenique en cas de splenectomie partielle pour une maladie de Minkowski-Chauffard. A propos de 15 cas

    Energy Technology Data Exchange (ETDEWEB)

    Berehou, F.; Ben Rais, N. [CHU Ibn Sina, Rabat, Service de medecine nucleaire (Morocco); Calzada, M.; Keller, I.; Devaux, J. [Hopital Saint-Antoine, service de medecine nucleaire, 75 - Paris (France)

    2010-07-01

    Splenic scintigraphy with labeled and fragile red blood cells is a simple, reliable, noninvasive and low radiating method to assess at long-term residual splenic volume after partial splenectomy, it is the only treatment for a good quality of life with fewer infections, fewer transfusions and without use of lifelong vaccinations for a chronic illness. (N.C.)

  15. Partial splenectomy and autotransplantation of splenic fragments in pigs: a model for prevention of septicemia

    International Nuclear Information System (INIS)

    Pabst, R.; Binns, R.M.

    1986-01-01

    Normal young piglets and miniature piglets of the Gottingen breed were used as animal models for autotransplantation of splenic fragments. In pigs, regeneration kinetics seem to be comparable to man. Even after six mo, only small splenic nodules with a reduced blood flow were found. No effective stimulator of splenic regeneration has been found for pigs. Pig spleen size and blood supply enable partial splenectomies and ligation of the splenic artery which are models for spleen surgery in man

  16. Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl4-induced liver fibrosis

    OpenAIRE

    Wang, Ming-Jun; Ling, Wen-Wu; Wang, Hong; Meng, Ling-Wei; Cai, He; Peng, Bing

    2016-01-01

    AIM To investigate the diagnostic performance of liver stiffness measurement (LSM) by elastography point quantification (ElastPQ) in animal models and determine the longitudinal changes in liver stiffness by ElastPQ after splenectomy at different stages of fibrosis. METHODS Liver stiffness was measured in sixty-eight rabbits with CCl4-induced liver fibrosis at different stages and eight healthy control rabbits by ElastPQ. Liver biopsies and blood samples were obtained at scheduled time points...

  17. Detection of irradiation induced modifications in foodstuff DNA using 32p post-labelling

    International Nuclear Information System (INIS)

    Hoey, B.M.; Swallow, A.J.; Margison, G.P.

    1991-01-01

    DNA post-labelling has been used successfully to detect damage to DNA caused by a range of damaging agents. The assay results in a fingerprint of changes induced in DNA which might, in principle, be useful as a test for the detection of the irradiation of foods. The authors present their DNA extraction and 32 p post-labelling methods from chicken or cooked prawn samples and their analysis method (High Performance liquid chromatography). It's hoped that these results could form the basis of a test to detect if foods have been irradiated

  18. Upper abdominal body shape is the risk factor for postoperative pancreatic fistula after splenectomy for advanced gastric cancer: A retrospective study

    Directory of Open Access Journals (Sweden)

    Fujii Shoichi

    2008-10-01

    Full Text Available Abstract Background Postoperative pancreas fistula (POPF is a major complication after total gastrectomy with splenectomy. We retrospectively studied the effects of upper abdominal shape on the development of POPF after gastrectomy. Methods Fifty patients who underwent total gastrectomy with splenectomy were studied. The maximum vertical distance measured by computed tomography (CT between the anterior abdominal skin and the back skin (U-APD and the maximum horizontal distance of a plane at a right angle to U-APD (U-TD were measured at the umbilicus. The distance between the anterior abdominal skin and the root of the celiac artery (CAD and the distance of a horizontal plane at a right angle to CAD (CATD were measured at the root of the celiac artery. The CA depth ratio (CAD/CATD was calculated. Results POPF occurred in 7 patients (14.0% and was associated with a higher BMI, longer CAD, and higher CA depth ratio. However, CATD, U-APD, and U-TD did not differ significantly between patients with and those without POPF. Logistic-regression analysis revealed that a high BMI (≥25 and a high CA depth ratio (≥0.370 independently predicted the occurrence of POPF (odds ratio = 19.007, p = 0.002; odds ratio = 13.656, p = 0.038, respectively. Conclusion Surgical procedures such as total gastrectomy with splenectomy should be very carefully executed in obese patients or patients with a deep abdominal cavity to decrease the risk of postoperative pancreatic fistula. BMI and body shape can predict the risk of POPF simply by CT.

  19. Pancreatic tail pseudocyst of type II treated with resection of the tail of the pancreas and splenectomy

    Directory of Open Access Journals (Sweden)

    Latinčić Stojan

    2011-01-01

    Full Text Available Introduction. Pancreatic pseudocysts of type II are postnecrotic cysts that appear during an acute-on-chronic pancreatitis. In case that surgical treatment is necessary, as a rule it is performed using internal drainage operations. Pancreatic resections are rarely indicated. Case Outline. The authors present a 34 year-old man with a long-lasting history of moderate alcohol consumption in whom an episode of drinking caused an acute-on-chronic pancreatitis so that a 7 cm in diameter cyst was developed inside the tail of the pancreas causing left subcostal pain, mild pleural effusion and pain in the left shoulder. At operation almost entirely inside the tail of the pancreas a cyst of type II unsuitable for internal drainage operation was found so that a spared resection of the tail of the pancreas and splenectomy were carried out. The post-operative recovery was prolonged due to recurrent left pleural effusion requiring punctions, mild suppurative secretion from the splenic fossa and transient postsplenectomy thrombocytosis. Six months after surgery the patient is in good condition and with normal findings. Conclusion. Although rare, pancreatic cysts of type II may be unsuitable for internal drainage operations so that resection of the effected part of the pancreas could be a much better solution than external drainage.

  20. Cirurgias conservadoras do baço para tratamento da doença de Gaucher Partial splenectomy in the treatment of Gaucher's disease

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    2004-03-01

    , have been treated by partial splenectomy. However, the splenic remnant, vascularized by the hilar vessels, may enlarge leading to recurrent splenomegaly and all its adverse effects. More than eighteen years of experience treating portal hypertension, splenic trauma, myeloid splenomegaly, splenomegalic somatic and sexual hypodevelopment, chronic lymphocytic lymphoma and cystadenoma of pancreatic tail by subtotal splenectomy, maintaining the upper pole supplied only by the splenogastric vessels showed that the splenic remnant does not increase its size. Based on evidence that the hilar vessels may contribute to the increase of the splenic remnant, we performed in five cases with Gaucher's disease subtotal splenectomy, maintaining the upper pole supplied only by the splenogastric vessels. The splenic remnant did not modify in size during a postoperative follow-up of more than twelve years, and the hematological parameters remained normal. Another patient whose splenogastric vessels were insufficient to maintain the upper splenic pole, was submitted to total splenectomy and autologous splenic tissue transplantation on the greater omentum. The autotransplant survived and presented with function. All six patients had uneventful postoperative follow-up in relation to the splenic conservative procedure. In conclusion, in presence of giant splenomegaly with severe hematologic and clinical symptoms the spleen must be resected in a conservative fashion such as subtotal splenectomy or total splenectomy followed by autotransplants of splenic tissue.

  1. Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

    International Nuclear Information System (INIS)

    Maleux, G.; Wilms, G.; Vermylen, J.

    2002-01-01

    Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

  2. Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Maleux, G.; Wilms, G. [Department of Radiology, University Hospitals, Leuven (Belgium); Vermylen, J. [Department of Internal Medicine-Vascular Diseases, University Hospitals, Leuven (Belgium)

    2002-06-01

    Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

  3. Pharmacokinetics of Deferiprone in Patients with β-Thalassaemia : Impact of Splenectomy and Iron Status.

    Science.gov (United States)

    Limenta, Lie Michael George; Jirasomprasert, Totsapol; Jittangprasert, Piyada; Wilairat, Prapin; Yamanont, Praveena; Chantharaksri, Udom; Fucharoen, Suthat; Morales, Noppawan Phumala

    2011-01-01

    Iron-rich transfusions and/or a compensatory increase in iron absorption ultimately result in iron loading in patients with β-thalassaemia. Hence, without iron chelation, iron accumulates relentlessly. Deferiprone has been shown to be capable of reducing the iron burden in patients with b-thalassaemia. However, there is wide interpatient variation in deferiprone-induced urinary iron excretion (UIE). We hypothesized that splenectomy and iron status might influence the pharmacokinetic profiles of deferiprone in patients with β-thalassaemia/haemoglobin E, and the present study was aimed at examining this hypothesis. Thirty-one patients with β-thalassaemia/haemoglobin E (20 splenecto-mized and 11 non-splenectomized patients) were enrolled in the study. After an overnight fast, the subjects received a single oral dose of deferiprone 25 mg/kg of body weight. Blood samples were collected pre-dosing and at 15, 30, 45, 60, 90, 120, 180, 240, 300, 360 and 480 minutes after dosing. Urine output was pooled and collected at 0-2, 2-4, 4-8, 8-12 and 12-24 hour intervals. Serum and urine concentrations of deferiprone and its metabolite deferiprone glucuronide were determined using a validated high-performance liquid chromatography method. Serum deferiprone-chelated iron and UIE were determined using a validated colourimetric method. No significant difference in the pharmacokinetic parameters of non-conjugated deferiprone was observed between splenectomized and non-splenectomized patients. However, the maximum serum concentration (C max ) and the area under the serum concentration-time curve (AUC) from time zero to infinity (AUC∞) values of deferiprone glucuronide were significantly lower (both p values of serum deferiprone-chelated iron, as well as UIE, were significantly higher (p values 7.1 µmol/L, 1645 mmol · min/L and 77.1 mmol, respectively) than in non-splenectomized patients (median values 3.1 µmol/L, 545 mmol · min/L and 12.5 µmol, respectively). Urinary

  4. Splenectomy alters distribution and turnover but not numbers or protective capacity of de novo generated memory CD8 T cells.

    Directory of Open Access Journals (Sweden)

    Marie eKim

    2014-11-01

    Full Text Available The spleen is a highly compartmentalized lymphoid organ that allows for efficient antigen presentation and activation of immune responses. Additionally, the spleen itself functions to remove senescent red blood cells, filter bacteria, and sequester platelets. Splenectomy, commonly performed after blunt force trauma or splenomegaly, has been shown to increase risk of certain bacterial and parasitic infections years after removal of the spleen. Although previous studies report defects in memory B cells and IgM titers in splenectomized patients, the effect of splenectomy on CD8 T cell responses and memory CD8 T cell function remains ill defined. Using TCR-transgenic P14 cells, we demonstrate that homeostatic proliferation and representation of pathogen-specific memory CD8 T cells in the blood are enhanced in splenectomized compared to sham surgery mice. Surprisingly, despite the enhanced turnover, splenectomized mice displayed no changes in total memory CD8 T cell numbers nor impaired protection against lethal dose challenge with Listeria monocytogenes. Thus, our data suggest that memory CD8 T cell maintenance and function remain intact in the absence of the spleen.

  5. Use of contact Nd:YAG sapphire-laser system for performing partial hepatectomy and splenectomy in dogs

    Science.gov (United States)

    Yu, Chibing; Jing, Shujuan; Cai, Huimin; Shao, Lanxing; Zou, Hegui

    1993-03-01

    An Nd:YAG Sapphire laser blade was used for performing hepatectomy and splenectomy in dogs. The results suggest that a laser blade provides a new way to reduce intraoperative bleeding and to minimize tissue damage. In recent years, there have been some reports on performing surgical procedures using a contact Nd:YAG Sapphire laser system. The current animal study was conducted in order to explore the capability of incision and excision of the laser tip, the damage to the tissue, and the recovery course.

  6. Value of transoperative scintigraphy in the detection of accessory spleens

    International Nuclear Information System (INIS)

    Sezeur, A.; Goujard, F.; Labriolle-Vaylet, C.L. de; Wioland, M.; Douay, L.; Desmarquet, J.

    1990-01-01

    A case of accessory spleen, 1 cm in diameter, responsible for recurrence of an idiopathic thrombocytopenic purpura after splenectomy is reported. This case is original in that the accessory spleen could only be detected by transoperative scintigraphy. Transoperative scintigraphy is a simple method to be used when one or several unrecognized accessory spleens are responsible for recurrence of a blood disease after excision of the principal spleen [fr

  7. Studies of the incidence of post-operative deep-vein thrombosis in Sudan, using 125I-fibrinogen

    International Nuclear Information System (INIS)

    Hassan, M.A.

    1974-01-01

    Sudanese patients undergoing surgery in Khartoum Civil Hospital were investigated for evidence of post-operative deep vein thrombosis by means of the 125 I-fibrinogen test. An analysis of the results obtained in an initial series of 100 patients undergoing various operations including prostatectomy (transvesical or retropubic), vagotomy and drainage, cholocystectomy, various operations on the urinary bladder, various operations on the hip, splenectomy, herniorrhaphy, nephrectomy and haemorrhoidectomy revealed an incidence of post-operative deep vein thrombosis of 12.0%. There was no significant variation of incidence with age or sex. A subsequent analysis of the results obtained in 104 patients undergoing prostatectomy (transvesical or retropubic) revealed an incidence of deep vein thrombosis of 9.6%. These values differ markedly from the incidences of 21-47% reported in Sweden and UK. It is suggested that the indicence of post-operative deep vein thrombosis is lower in Sudan than in European countries

  8. Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis.

    Science.gov (United States)

    Duchesne, Juan C; Simmons, Jon D; Schmieg, Robert E; McSwain, Norman E; Bellows, Charles F

    2008-12-01

    Although splenic angioembolization (SAE) has been introduced and adopted in many trauma centers, the appropriate selection for and utility of SAE in trauma patients remains under debate. This study examined the outcomes of proximal SAE as part of a management algorithm for adult traumatic splenic injury compared with splenectomy. A retrospective cohort analysis was performed on all hemodynamically stable (HDS) blunt trauma patients with isolated splenic injury and computed tomographic (CT) evidence of active contrast extravasation that presented to a level 1 Trauma Center over a period of 5 years. The cohorts were defined by two separate 30 month periods and included 78 patients seen before (group I) and 76 patients seen after (group II) the introduction of an institutional SAE protocol. Demographics, splenic injury grade, and outcomes of the two groups were compared using Student's t test, or chi2 test. Analysis was by intention-to-treat. Six hundred eighty-two patients with blunt splenic injury were identified; 154 patients (29%) were HDS with CT evidence of active contrast extravasation. Group I (n = 78) was treated with splenectomy and group II (n = 76) was treated with proximal SAE. There was no difference in age (33 +/- 14 vs. 37 +/- 17 years), Injury Severity Score (31 +/- 13 vs. 29 +/- 11), or mortality (18% vs. 15%) between the two groups. However, the incidence of Adult Respiratory Distress Syndrome (ARDS) was 4-fold higher in those patients that underwent proximal SAE compared with those that underwent splenectomy (22% vs. 5%, p = 0.002). Twenty two patients failed nonoperative management (NOM) after SAE. This failure appeared to be directly related to the grade of splenic organ injury (grade I and II: 0%; grade III: 24%; grade IV: 53%; and grade V: 100%). Introduction of proximal SAE in NOM of HDS splenic trauma patients with active extravasation did not alter mortality rates at a Level 1 Trauma Center. Increased incidence of ARDS and association of

  9. A review of recent advances in data analytics for post-operative patient deterioration detection.

    Science.gov (United States)

    Petit, Clemence; Bezemer, Rick; Atallah, Louis

    2018-06-01

    Most deaths occurring due to a surgical intervention happen postoperatively rather than during surgery. The current standard of care in many hospitals cannot fully cope with detecting and addressing post-surgical deterioration in time. For millions of patients, this deterioration is left unnoticed, leading to increased mortality and morbidity. Postoperative deterioration detection currently relies on general scores that are not fully able to cater for the complex post-operative physiology of surgical patients. In the last decade however, advanced risk and warning scoring techniques have started to show encouraging results in terms of using the large amount of data available peri-operatively to improve postoperative deterioration detection. Relevant literature has been carefully surveyed to provide a summary of the most promising approaches as well as how they have been deployed in the perioperative domain. This work also aims to highlight the opportunities that lie in personalizing the models developed for patient deterioration for these particular post-surgical patients and make the output more actionable. The integration of pre- and intra-operative data, e.g. comorbidities, vitals, lab data, and information about the procedure performed, in post-operative early warning algorithms would lead to more contextualized, personalized, and adaptive patient modelling. This, combined with careful integration in the clinical workflow, would result in improved clinical decision support and better post-surgical care outcomes.

  10. Anaesthetic management of splenectomy in Evan′s syndrome during pregnancy with pregnancy induced hypertension.

    Directory of Open Access Journals (Sweden)

    Sherke R

    2001-07-01

    Full Text Available The management of idiopathic thrombocytopenic purpura (ITP during pregnancy, especially with ongoing bleeding diathesis, has not been highlighted sufficiently in the literature. Aortocaval compression and reduction in uteroplacental circulation resulting in foetal hypoxia and acidosis, Mendelson′s syndrome due to gravid uterus, trauma to airway with resultant haemorrhage and aspiration into lungs, compromised airway due to short neck, anasarca and heavy breast, limitation in using invasive monitoring and regional anaesthesia and uncontrolled bleeding leading to placental hypoperfusion and foetal hypoxia are some of the important risks. In the present case report, anaesthetic management for splenectomy during pregnancy complicated with pregnancy induced hypertension and bleeding diathesis secondary to ITP is described with reference to above risks.

  11. Detecting spam comments on Indonesia’s Instagram posts

    Science.gov (United States)

    Septiandri, Ali Akbar; Wibisono, Okiriza

    2017-01-01

    In this paper we experimented with several feature sets for detecting spam comments in social media contents authored by Indonesian public figures. We define spam comments as comments which have promotional purposes (e.g. referring other users to products and services) and thus not related to the content to which the comments are posted. Three sets of features are evaluated for detecting spams: (1) hand-engineered features such as comment length, number of capital letters, and number of emojis, (2) keyword features such as whether the comment contains advertising words or product-related words, and (3) text features, namely, bag-of-words, TF-IDF, and fastText embeddings, each combined with latent semantic analysis. With 24,000 manually-annotated comments scraped from Instagram posts authored by more than 100 Indonesian public figures, we compared the performance of these feature sets and their combinations using 3 popular classification algorithms: Na¨ıve Bayes, SVM, and XGBoost. We find that using all three feature sets (with fastText embedding for the text features) gave the best F 1-score of 0.9601 on a holdout dataset. More interestingly, fastText embedding combined with hand-engineered features (i.e. without keyword features) yield similar F 1-score of 0.9523, and McNemar’s test failed to reject the hypothesis that the two results are not significantly different. This result is important as keyword features are largely dependent on the dataset and may not be as generalisable as the other feature sets when applied to new data. For future work, we hope to collect bigger and more diverse dataset of Indonesian spam comments, improve our model’s performance and generalisability, and publish a programming package for others to reliably detect spam comments.

  12. A piezoresistive cantilever for lateral force detection fabricated by a monolithic post-CMOS process

    International Nuclear Information System (INIS)

    Ji Xu; Li Zhihong; Li Juan; Wang Yangyuan; Xi Jianzhong

    2008-01-01

    This paper presents a post-CMOS process to monolithically integrate a piezoresistive cantilever for lateral force detection and signal processing circuitry. The fabrication process includes a standard CMOS process and one more lithography step to micromachine the cantilever structure in the post-CMOS process. The piezoresistors are doped in the CMOS process but defined in the post-CMOS micromachining process without any extra process required. A partially split cantilever configuration is developed for the lateral force detection. The piezoresistors are self-aligned to the split cantilever, and therefore the width of the beam is only limited by lithography. Consequently, this kind of cantilever potentially has a high resolution. The preliminary experimental results show expected performances of the fabricated piezoresistors and electronic circuits

  13. Splenic abscess in Jos | Kidmas | Nigerian Journal of Surgical ...

    African Journals Online (AJOL)

    All except one patient had antibiotics and splenectomy. The commonest organism cultured was staphylococcus aureus, 5 of 7 cultures (71.4%). Postoperative complication included wound infection two, acute pancreatitis one and over- whelming post splenectomy infection (OPSI) in one. There was one mortality (12.5%).

  14. Morphometric study of gastric mucosa in dogs submitted to proximal gastric vagotomy, splenectomy or proximal gastric vagotomy associated with splenectomy Estudo morfométrico da mucosa gástrica de cães submetidos à vagotomia gástrica proximal, esplenectomia ou vagotomia gástrica proximal associada com esplenectomia

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Real Martinez

    2002-09-01

    Full Text Available OBJECTIVE: The aim of the present study was to evaluate the effects of total splenectomy and proximal gastric vagotomy (PGV isolated or associated to the vascularization of the stomach. METHODS: Twenty-eight dogs were distributed in: group A - animals undergoing laparotomy and gastric manipulation; group B - animals undergoing PGV; group C - animals undergoing PGV and splenectomy; and group D - animals undergoing splenectomy alone. All animals were sacrificed on the 7th postoperative day, and immediately followed by infusion of xanthene dye into the thoracic aorta. On the gastric mucous surface, the formation of stained areas and other areas lacking staining was measured by millimeter squares, planimetry and the computerized morphometry method. RESULTS: The formation of an area lacking in staining along the lesser gastric curvature was seen in all animals of groups B and C, which was significantly increased in group C, although in groups A and D such areas were not observed. CONCLUSION: These results showed that, in animals with splenectomy, the vascularization of the stomach was capable of perfusing the whole organ surface, but in animals with PGV alone or associated with splenectomy there was a notable decrease in blood supply throughout the area of the lesser gastric curvature, which suggests the ischemic impairment of this region.OBJETIVO: Avaliar os efeitos da esplenectomia total e da vagotomia gástrica proximal (VGP isoladas e associadas sobre a vascularização gástrica. MÉTODOS: Utilizaram-se 28 cães, distribuídos em quatro grupos: grupo A, laparotomia e manipulação gástrica; grupo B, VGP; grupo C, VGP associada à esplenectomia; grupo D, esplenectomia isolada. Todos os animais foram mortos no 7º pós-operatório e imediatamente infundiu-se o corante na aorta torácica. O estômago aberto pela grande curvatura foi fotografado. Na superfície mucosa gástrica, a formação de áreas coradas e desprovidas de coloração foi

  15. Concurrent gall bladder, liver lobe torsion, and bile peritonitis in a German shepherd dog 2 months after gastric dilatation/volvulus gastropexy and splenectomy.

    Science.gov (United States)

    Tubby, Kurtis G

    2013-08-01

    Postmortem examination of a 7-year-old German shepherd dog which had gastric dilatation/volvulus and splenectomy 2 months earlier revealed that the right middle and quadrate liver lobes were diffusely congested and torsed. The gall bladder was grossly distended and torsed along its long axis and there was evidence of bile peritonitis.

  16. Improved multi-stage neonatal seizure detection using a heuristic classifier and a data-driven post-processor.

    Science.gov (United States)

    Ansari, A H; Cherian, P J; Dereymaeker, A; Matic, V; Jansen, K; De Wispelaere, L; Dielman, C; Vervisch, J; Swarte, R M; Govaert, P; Naulaers, G; De Vos, M; Van Huffel, S

    2016-09-01

    After identifying the most seizure-relevant characteristics by a previously developed heuristic classifier, a data-driven post-processor using a novel set of features is applied to improve the performance. The main characteristics of the outputs of the heuristic algorithm are extracted by five sets of features including synchronization, evolution, retention, segment, and signal features. Then, a support vector machine and a decision making layer remove the falsely detected segments. Four datasets including 71 neonates (1023h, 3493 seizures) recorded in two different university hospitals, are used to train and test the algorithm without removing the dubious seizures. The heuristic method resulted in a false alarm rate of 3.81 per hour and good detection rate of 88% on the entire test databases. The post-processor, effectively reduces the false alarm rate by 34% while the good detection rate decreases by 2%. This post-processing technique improves the performance of the heuristic algorithm. The structure of this post-processor is generic, improves our understanding of the core visually determined EEG features of neonatal seizures and is applicable for other neonatal seizure detectors. The post-processor significantly decreases the false alarm rate at the expense of a small reduction of the good detection rate. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  17. A review of post-column photochemical reaction systems coupled to electrochemical detection in HPLC

    International Nuclear Information System (INIS)

    Fedorowski, Jennifer; LaCourse, William R.

    2010-01-01

    Post-column photochemical reaction systems have developed into a common approach for enhancing conventional methods of detection in HPLC. Photochemical reactions as a means of 'derivatization' have a significant number of advantages over chemical reaction-based methods, and a significant effort has been demonstrated to develop an efficient photochemical reactor. When coupled to electrochemical (EC) detection, the technique allows for the sensitive and selective determination of a variety of compounds (e.g., organic nitro explosives, beta-lactam antibiotics, sulfur-containing antibiotics, pesticides and insecticides). This review will focus on developments and methods using post-column photochemical reaction systems followed by EC detection in liquid chromatography. Papers are presented in chronological order to emphasize the evolution of the approach and continued importance of the application.

  18. Anterior Versus Posterolateral Approach for Total Laparoscopic Splenectomy: A Comparative Study

    Science.gov (United States)

    Ji, Bai; Wang, Yingchao; Zhang, Ping; Wang, Guangyi; Liu, Yahui

    2013-01-01

    Objective: Although the anterior approach is normally used for elective laparoscopic splenectomy (LS), the posterolateral approach may be superior. We have retrospectively compared the effectiveness and safety of these approaches in patients with non-severe splenomegaly scheduled for elective total LS. Methods: Patients with surgical spleen disorders scheduled for elective LS between March 2005 and June 2011 underwent laparoscopic splenic mobilization via the posterolateral or anterior approach. Main outcome measures included operation time, intraoperative blood loss, frequency of postoperative pancreatic leakage, and length of hospital stay. Results: During the study period, 203 patients underwent LS, 58 (28.6%) via the posterolateral and 145 (71.4%) via the anterior approach. Three patients (1.5%) required conversion to laparotomy due to extensive perisplenic adhesions. The posterolateral approach was associated with significantly shorter operation time (65.0 ± 12.3 min vs. 95.0 ± 21.3 min, P 0.05) Conclusions: The posterolateral approach is more effective and safer than the anterior approach in patients without severe splenomegaly (< 30 cm). PMID:23372427

  19. Post-Processing Approach for Refining Raw Land Cover Change Detection of Very High-Resolution Remote Sensing Images

    Directory of Open Access Journals (Sweden)

    Zhiyong Lv

    2018-03-01

    Full Text Available In recent decades, land cover change detection (LCCD using very high-spatial resolution (VHR remote sensing images has been a major research topic. However, VHR remote sensing images usually lead to a large amount of noises in spectra, thereby reducing the reliability of the detected results. To solve this problem, this study proposes an object-based expectation maximization (OBEM post-processing approach for enhancing raw LCCD results. OBEM defines a refinement of the labeling in a detected map to enhance its raw detection accuracies. Current mainstream change detection (preprocessing techniques concentrate on proposing a change magnitude measurement or considering image spatial features to obtain a change detection map. The proposed OBEM approach is a new solution to enhance change detection accuracy by refining the raw result. Post-processing approaches can achieve competitive accuracies to the preprocessing methods, but in a direct and succinct manner. The proposed OBEM post-processing method synthetically considers multi-scale segmentation and expectation maximum algorithms to refine the raw change detection result. Then, the influence of the scale of segmentation on the LCCD accuracy of the proposed OBEM is investigated. Four pairs of remote sensing images, one of two pairs (aerial image with 0.5 m/pixel resolution which depict two landslide sites on Landtau Island, Hong Kong, China, are used in the experiments to evaluate the effectiveness of the proposed approach. In addition, the proposed approach is applied, and validated by two case studies, LCCD in Tianjin City China (SPOT-5 satellite image with 2.5 m/pixel resolution and Mexico forest fire case (Landsat TM images with 30 m/pixel resolution, respectively. Quantitative evaluations show that the proposed OBEM post-processing approach can achieve better performance and higher accuracies than several commonly used preprocessing methods. To the best of the authors’ knowledge, this type

  20. Risk factors for Epstein-Barr virus-related post-transplant lymphoproliferative disease after allogeneic hematopoietic stem cell transplantation.

    Science.gov (United States)

    Uhlin, Michael; Wikell, Helena; Sundin, Mikael; Blennow, Ola; Maeurer, Markus; Ringden, Olle; Winiarski, Jacek; Ljungman, Per; Remberger, Mats; Mattsson, Jonas

    2014-02-01

    Allogeneic hematopoietic stem cell transplantation is a successful treatment for hematologic malignancies and a variety of genetic and metabolic disorders. In the period following stem cell transplantation, the immune-compromised milieu allows opportunistic pathogens to thrive. Epstein-Barr virus-associated post-transplant lymphoproliferative disease can be a life-threatening complication for transplanted patients because of suppressed T-cell-mediated immunity. We analyzed possible risk factors associated with post-transplant lymphoproliferative disease in a cohort of over 1,000 patients. The incidence of post-transplant lymphoproliferative disease was 4%. Significant risk factors identified by multivariate analysis were: human leukocyte antigen-mismatch (PEpstein-Barr virus mismatch recipient-/donor+ (Pdisease grade II to IV (P=0.006), pre-transplant splenectomy (P=0.008) and infusion of mesenchymal stromal cells (P=0.015). The risk of post-transplant lymphoproliferative disease has increased in more recent years, from less than 2% before 1998 to more than 6% after 2011. Additionally, we show that long-term survival of patients with post-transplant lymphoproliferative disease is poor despite initial successful treatment. The 3-year survival rate among the 40 patients with post-transplant lymphoproliferative disease was 20% as opposed to 62% among patients without post-transplant lymphoproliferative disease (Pdisease after transplantation in need of pre-emptive measures.

  1. The Effect of Dosage, Gestational Age and Splenectomy on Anti-IgM Interception of Prenatal B-cell Development in Sheep

    Directory of Open Access Journals (Sweden)

    P. McCullagh

    2003-01-01

    Full Text Available The administration of a single bolus of anti-IgM antibody to foetal lambs early in pregnancy produces prolonged B-cell depletion. The present study investigated this depletion by examining the effect, on B-cell development in the ileal Peyer's patches, of varying the timing and dosage of antibody administration and by supplementing anti-IgM with surgical splenectomy. The capacity of a 1 mg bolus of anti-IgM to deplete Peyer's patches of B cells was lost if its administration was deferred until two thirds of the way through pregnancy, but persisted beyond this time if weight-adjusted doses were used. Splenectomy of the foetus performed at an earlier age failed to extend the age at which a 1 mg dose of antibody remained effective. As the concentration of murine immunoglobulin in foetal serum was greatly reduced after 21 days, it is inferred that ongoing suppression of B-cell development is not dependent on the continued presence of murine immunoglobulin. The enduring nature of suppression could be attributable to a limited period during which differentiation of B cells from stem cells normally occurs, although further studies will be needed to investigate this and other possible explanations for the effect of anti-IgM treatment on prenatal B-cell development in sheep.

  2. Spontaneous splenic artery aneurysm rupture in a 38-year old female: a case report.

    Science.gov (United States)

    Koutserimpas, C; Papachristou, E; Nikitakis, N; Zannes, N; Tellos, A; Velimezis, G

    2017-01-01

    Splenic artery aneurysm (SAA) is a rare and extremely difficult diagnosis. A rare case of a ruptured SAA in a 38-year old female, firstly treated with endovascular embolization and then with splenectomy, is presented. A 38-year old female presented to the emergency department with epigastric pain and fainting episodes. Direct catheter angiography revealed a ruptured SAA and distal, as well as proximal coil embolization was performed. Due to abdominal compartment syndrome the patient underwent open surgery with splenic artery ligation and splenectomy. Postoperative she showed signs of sepsis and was treated with i.v. fluids, steroids, packed red blood cells, platelets, fresh frozen plasma and antimicrobial treatment. Additionally, a multidrug resistant Acinetobacter baumanni was yielded from the urine culture. She had a satisfactory recovery. She is followed up a total of 5 years with no signs of overwhelming post-splenectomy infection syndrome. Direct catheter angiography is a very helpful option in diagnosis, as well as treatment, but a close monitoring after embolization is essential. Furthermore, post-splenectomy sepsis is a severe disease with high mortality rates that requires immediate appropriate treatment.

  3. Preoperative computed tomography and scintigraphy to facilitate the detection of accessory spleen in patients with hematologic disorders

    International Nuclear Information System (INIS)

    Koyanagi, Nobuhiro; Kanematsu, Takashi; Sugimachi, Keizo

    1988-01-01

    Accessory spleens of 1.5 cm in size were preoperatively identified by the combined use of computerized tomography and splenic scintigraphy in two patients with hematologic diseases. After the accessory spleen had been removed from the first patient, who had persistent hereditary spherocytosis and had undergone a splenectomy 15 months before, a postoperative decrease in hyperbilirubinemia was noted. In the other patient who had idiopathic thrombocytopenic purpura, a successful accessory splenectomy was done at the same time as her splenectomy, and was followed by 6 months' complete remission. These events indicate that preoperative investigations using computerized tomography and scintigraphy are indispensable for ruling out an accessory spleen in those patients for whom splenectomy needs to be done in order to alleviate hematologic disorders. (author)

  4. Detection of Cases of Noncompliance to Drug Treatment in Patient Forum Posts: Topic Model Approach.

    Science.gov (United States)

    Abdellaoui, Redhouane; Foulquié, Pierre; Texier, Nathalie; Faviez, Carole; Burgun, Anita; Schück, Stéphane

    2018-03-14

    Medication nonadherence is a major impediment to the management of many health conditions. A better understanding of the factors underlying noncompliance to treatment may help health professionals to address it. Patients use peer-to-peer virtual communities and social media to share their experiences regarding their treatments and diseases. Using topic models makes it possible to model themes present in a collection of posts, thus to identify cases of noncompliance. The aim of this study was to detect messages describing patients' noncompliant behaviors associated with a drug of interest. Thus, the objective was the clustering of posts featuring a homogeneous vocabulary related to nonadherent attitudes. We focused on escitalopram and aripiprazole used to treat depression and psychotic conditions, respectively. We implemented a probabilistic topic model to identify the topics that occurred in a corpus of messages mentioning these drugs, posted from 2004 to 2013 on three of the most popular French forums. Data were collected using a Web crawler designed by Kappa Santé as part of the Detec't project to analyze social media for drug safety. Several topics were related to noncompliance to treatment. Starting from a corpus of 3650 posts related to an antidepressant drug (escitalopram) and 2164 posts related to an antipsychotic drug (aripiprazole), the use of latent Dirichlet allocation allowed us to model several themes, including interruptions of treatment and changes in dosage. The topic model approach detected cases of noncompliance behaviors with a recall of 98.5% (272/276) and a precision of 32.6% (272/844). Topic models enabled us to explore patients' discussions on community websites and to identify posts related with noncompliant behaviors. After a manual review of the messages in the noncompliance topics, we found that noncompliance to treatment was present in 6.17% (276/4469) of the posts. ©Redhouane Abdellaoui, Pierre Foulquié, Nathalie Texier, Carole

  5. A miniaturized and integrated gel post platform for multiparameter PCR detection of herpes simplex viruses from raw genital swabs.

    Science.gov (United States)

    Manage, Dammika P; Lauzon, Jana; Atrazhev, Alexey; Morrissey, Yuen C; Edwards, Ann L; Stickel, Alexander J; Crabtree, H John; Pabbaraju, Kanti; Zahariadis, George; Yanow, Stephanie K; Pilarski, Linda M

    2012-05-07

    Herpes simplex virus (HSV) is one of the most prevalent viruses, with acute and recurrent infections in humans. The current gold standard for the diagnosis of HSV is viral culture which takes 2-14 days and has low sensitivity. In contrast, DNA amplification by polymerase chain reaction (PCR) can be performed within 1-2 h. We here describe a multiparameter PCR assay to simultaneously detect HSV-1 and HSV-2 DNA templates, together with integrated positive and negative controls, with product detection by melting curve analysis (MCA), in an array of semi-solid polyacrylamide gel posts. Each gel post is 0.67 μL in volume, and polymerized with all the components required for PCR. Both PCR and MCA can currently be performed in one hour and 20 min. Unprocessed genital swabs collected in universal transport medium were directly added to the reagents before or after polymerization, diffusing from atop the gel posts. The gel post platform detects HSV templates in as little as 2.5 nL of raw sample. In this study, 45 genital swab specimens were tested blindly as a preliminary validation of this platform. The concordance of PCR on gel posts with conventional PCR was 91%. The primer sequestration method introduced here (wherein different primers are placed in different sets of posts) enables the simultaneous detection of multiple pathogens for the same sample, together with positive and negative controls, on a single chip. This platform accepts unprocessed samples and is readily adaptable to detection of multiple different pathogens or biomarkers for point-of-care diagnostics.

  6. Comparison of post contrast CT urography phases in bladder cancer detection

    Energy Technology Data Exchange (ETDEWEB)

    Helenius, Malin; Dahlman, Par; Lonnemark, Maria; Magnusson, Anders [Uppsala University Hospital, Department of Surgical Sciences, Section of Radiology, Uppsala (Sweden); Brekkan, Einar [Uppsala University Hospital, Department of Surgical Sciences, Section of Urology, Uppsala (Sweden); Wernroth, Lisa [Uppsala University Hospital, Uppsala Clinical Research Center, Uppsala (Sweden)

    2016-02-15

    The aim of this study was to investigate which post-contrast phase(s) in a four-phase CT urography protocol is (are) most suitable for bladder cancer detection. The medical records of 106 patients with visible haematuria who underwent a CT urography examination, including unenhanced, enhancement-triggered corticomedullary (CMP), nephrographic (NP) and excretory (EP) phases, were reviewed. The post-contrast phases (n = 318 different phases) were randomized into an evaluation order and blindly reviewed by two uroradiologists. Twenty-one patients were diagnosed with bladder cancer. Sensitivity for bladder cancer detection was 0.95 in CMP, 0.83 in NP and 0.81 in EP. Negative predictive value (NPV) was 0.99 in CMP, 0.96 in NP and 0.95 in EP. The sensitivity was higher in CMP than in both NP (p-value 0.016) and EP (p-value 0.0003). NPV was higher in CMP than in NP (p-value 0.024) and EP (p-value 0.002). In the CT urography protocol with enhancement-triggered scan, sensitivity and NPV were highest in the corticomedullary phase, and this phase should be used for bladder assessment. (orig.)

  7. Comparison of post contrast CT urography phases in bladder cancer detection

    International Nuclear Information System (INIS)

    Helenius, Malin; Dahlman, Par; Lonnemark, Maria; Magnusson, Anders; Brekkan, Einar; Wernroth, Lisa

    2016-01-01

    The aim of this study was to investigate which post-contrast phase(s) in a four-phase CT urography protocol is (are) most suitable for bladder cancer detection. The medical records of 106 patients with visible haematuria who underwent a CT urography examination, including unenhanced, enhancement-triggered corticomedullary (CMP), nephrographic (NP) and excretory (EP) phases, were reviewed. The post-contrast phases (n = 318 different phases) were randomized into an evaluation order and blindly reviewed by two uroradiologists. Twenty-one patients were diagnosed with bladder cancer. Sensitivity for bladder cancer detection was 0.95 in CMP, 0.83 in NP and 0.81 in EP. Negative predictive value (NPV) was 0.99 in CMP, 0.96 in NP and 0.95 in EP. The sensitivity was higher in CMP than in both NP (p-value 0.016) and EP (p-value 0.0003). NPV was higher in CMP than in NP (p-value 0.024) and EP (p-value 0.002). In the CT urography protocol with enhancement-triggered scan, sensitivity and NPV were highest in the corticomedullary phase, and this phase should be used for bladder assessment. (orig.)

  8. Fatal adverse drug reactions of anticancer drugs detected by all-case post-marketing surveillance in Japan.

    Science.gov (United States)

    Mori, Jinichi; Tanimoto, Tetsuya; Miura, Yuji; Kami, Masahiro

    2015-06-01

    All-case post-marketing surveillance of newly approved anticancer drugs is usually conducted on all patients in Japan. The present study investigates whether all-case post-marketing surveillance identifies fatal adverse drug reactions undetected before market entry. We examined fatal adverse drug reactions identified via all-case post-marketing surveillance by reviewing the disclosed post-marketing surveillance results, and determined the time points in which the fatal adverse drug reactions were initially reported by reviewing drug labels. We additionally scanned emergency alerts on the Japanese regulatory authority website to assess the relationship between all-case post-marketing surveillance and regulatory action. Twenty-five all-case post-marketing surveillances were performed between January 1999 and December 2009. Eight all-case post-marketing surveillances with final results included information on all fatal cases. Of these, the median number of patients was 1287 (range: 106-4998), the median number of fatal adverse drug reactions was 14.5 (range: 4-23). Of the 111 fatal adverse drug reactions detected in the eight post-marketing surveillances, only 28 (25.0%) and 22 (19.6%) were described on the initial global and the initial Japanese drug label, respectively, and 58 (52.3%) fatal adverse drug reactions were first described in the all-case post-marketing surveillance reports. Despite this, the regulatory authority issued only four warning letters, and two of these were prompted by case reports from the all-case post-marketing surveillance. All-case post-marketing surveillance of newly approved anticancer drugs in Japan was useful for the rigorous compilation of non-specific adverse drug reactions, but it rarely detected clinically significant fatal adverse drug reactions. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. Novelty detection methods for online health monitoring and post data analysis of turbopumps

    International Nuclear Information System (INIS)

    Lei Hu; Niaoqing, Hu; Xinpeng, Zhang; Fengshou, Gu; Ming, Gao

    2013-01-01

    As novelty detection works when only normal data are available, it is of considerable promise for health monitoring in cases lacking fault samples and prior knowledge. We present two novelty detection methods for health monitoring of turbopumps in large-scale liquid propellant rocket engines. The first method is the adaptive Gaussian threshold model. This method is designed to monitor the vibration of the turbopumps online because it has minimal computational complexity and is easy for implementation in real time. The second method is the one-class support vector machine (OCSVM) which is developed for post analysis of historical vibration signals. Via post analysis the method not only confirms the online monitoring results but also provides diagnostic results so that faults from sensors are separated from those actually from the turbopumps. Both of these two methods are validated to be efficient for health monitoring of the turbopumps.

  10. A new framework for analysing automated acoustic species-detection data: occupancy estimation and optimization of recordings post-processing

    Science.gov (United States)

    Chambert, Thierry A.; Waddle, J. Hardin; Miller, David A.W.; Walls, Susan; Nichols, James D.

    2018-01-01

    The development and use of automated species-detection technologies, such as acoustic recorders, for monitoring wildlife are rapidly expanding. Automated classification algorithms provide a cost- and time-effective means to process information-rich data, but often at the cost of additional detection errors. Appropriate methods are necessary to analyse such data while dealing with the different types of detection errors.We developed a hierarchical modelling framework for estimating species occupancy from automated species-detection data. We explore design and optimization of data post-processing procedures to account for detection errors and generate accurate estimates. Our proposed method accounts for both imperfect detection and false positive errors and utilizes information about both occurrence and abundance of detections to improve estimation.Using simulations, we show that our method provides much more accurate estimates than models ignoring the abundance of detections. The same findings are reached when we apply the methods to two real datasets on North American frogs surveyed with acoustic recorders.When false positives occur, estimator accuracy can be improved when a subset of detections produced by the classification algorithm is post-validated by a human observer. We use simulations to investigate the relationship between accuracy and effort spent on post-validation, and found that very accurate occupancy estimates can be obtained with as little as 1% of data being validated.Automated monitoring of wildlife provides opportunity and challenges. Our methods for analysing automated species-detection data help to meet key challenges unique to these data and will prove useful for many wildlife monitoring programs.

  11. Effect of titanium and stainless steel posts in detection of vertical root fractures using NEWTOM VG cone beam computed tomography system

    International Nuclear Information System (INIS)

    Mohammadpour, Mahdis; Bakhshalian, Neema; Shahab, Shahriar; Sadeghi, Shaya; Ataee, Mona; Sarikhani, Soodeh

    2014-01-01

    Vertical root fracture (VRF) is a common complication in endodontically treated teeth. Considering the poor prognosis of VRF, a reliable and valid detection method is necessary. Cone beam computed tomography (CBCT) has been reported to be a reliable tool for the detection of VRF; however, the presence of metallic intracanal posts can decrease the diagnostic values of CBCT systems. This study evaluated and compared the effects of intracanal stainless steel or titanium posts on the sensitivity, specificity, and accuracy of VRF detection using a NewTom VG CBCT system. Eighty extracted single-rooted teeth were selected and sectioned at the cemento-enamel junction. The roots were divided into two groups of 40. Root fracture was induced in the test group by using an Instron machine, while the control group was kept intact. Roots were randomly embedded in acrylic blocks and radiographed with the NewTom VG, both with titanium and stainless steel posts and also without posts. Sensitivity, specificity, and accuracy values were calculated as compared to the gold standard. The sensitivity, specificity, and accuracy of VRF diagnosis were significantly lower in teeth with stainless steel and titanium posts than in those without posts. Interobserver agreement was the highest in teeth without posts, followed by stainless steel posts, and then titanium posts. Intracanal posts significantly decreased the VRF diagnostic values of CBCT. The stainless steel posts decreased the diagnostic values more than the titanium posts.

  12. Effect of titanium and stainless steel posts in detection of vertical root fractures using NEWTOM VG cone beam computed tomography system

    Energy Technology Data Exchange (ETDEWEB)

    Mohammadpour, Mahdis [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Qazvin University of Medical Sciences, Qazvin (Iran, Islamic Republic of); Bakhshalian, Neema [Dept. of Advanced Periodontology, Ostrow School of Dentistry, University of Southern California, Los Angeles (United States); Shahab, Shahriar [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Shahed University, Tehran (Iran, Islamic Republic of); Sadeghi, Shaya; Ataee, Mona [Radmehr Oral and Maxillofacial Radiology Clinic, Ghazvin (Iran, Islamic Republic of); Sarikhani, Soodeh [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, University of Golestan, Gorgan (Iran, Islamic Republic of)

    2014-06-15

    Vertical root fracture (VRF) is a common complication in endodontically treated teeth. Considering the poor prognosis of VRF, a reliable and valid detection method is necessary. Cone beam computed tomography (CBCT) has been reported to be a reliable tool for the detection of VRF; however, the presence of metallic intracanal posts can decrease the diagnostic values of CBCT systems. This study evaluated and compared the effects of intracanal stainless steel or titanium posts on the sensitivity, specificity, and accuracy of VRF detection using a NewTom VG CBCT system. Eighty extracted single-rooted teeth were selected and sectioned at the cemento-enamel junction. The roots were divided into two groups of 40. Root fracture was induced in the test group by using an Instron machine, while the control group was kept intact. Roots were randomly embedded in acrylic blocks and radiographed with the NewTom VG, both with titanium and stainless steel posts and also without posts. Sensitivity, specificity, and accuracy values were calculated as compared to the gold standard. The sensitivity, specificity, and accuracy of VRF diagnosis were significantly lower in teeth with stainless steel and titanium posts than in those without posts. Interobserver agreement was the highest in teeth without posts, followed by stainless steel posts, and then titanium posts. Intracanal posts significantly decreased the VRF diagnostic values of CBCT. The stainless steel posts decreased the diagnostic values more than the titanium posts.

  13. Visual long-term memory and change blindness: Different effects of pre- and post-change information on one-shot change detection using meaningless geometric objects.

    Science.gov (United States)

    Nishiyama, Megumi; Kawaguchi, Jun

    2014-11-01

    To clarify the relationship between visual long-term memory (VLTM) and online visual processing, we investigated whether and how VLTM involuntarily affects the performance of a one-shot change detection task using images consisting of six meaningless geometric objects. In the study phase, participants observed pre-change (Experiment 1), post-change (Experiment 2), or both pre- and post-change (Experiment 3) images appearing in the subsequent change detection phase. In the change detection phase, one object always changed between pre- and post-change images and participants reported which object was changed. Results showed that VLTM of pre-change images enhanced the performance of change detection, while that of post-change images decreased accuracy. Prior exposure to both pre- and post-change images did not influence performance. These results indicate that pre-change information plays an important role in change detection, and that information in VLTM related to the current task does not always have a positive effect on performance. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Effect of thymectomy and splenectomy on the course of x-ray induced progressive intercapillary glomerulosclerosis in the mouse kidney

    Energy Technology Data Exchange (ETDEWEB)

    Guttman, P H

    1967-01-01

    Whole body neonatal irradiation (450 rads) of Swiss-Webster mice resulted in progressive intercapillary glomerulosclerosis (IGS). Neonatal thymectomy potentiated the effect of irradiation. Removal of the spleen at 18 days markedly reduced the effect of irradiation on the kidney when combined with thymectomy at birth. In the presence of an intact thymus, splenectomy had no effect on the course of radiation induced IGS. Germinal center formation and plasma cell infiltration were observed in the thymus of splenectomized-irradiated mice. The possible role of immunity in the pathogenesis of late effects of x-ray on the kidney is considered in the light of these findings.

  15. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture.

    Science.gov (United States)

    Winklhofer, Sebastian; Stoeck, Christian T; Berger, Nicole; Thali, Michael; Manka, Robert; Kozerke, Sebastian; Alkadhi, Hatem; Stolzmann, Paul

    2014-11-01

    To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture. Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI. Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p Analysis of HA distribution demonstrated remodelling of myofibre architecture, with significant differences between healthy segments and segments with chronic (p  0.05). Post-mortem cardiac DTI enables differentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI. • DTI enables post-mortem detection of myocardial infarction with good accuracy. • A decrease in right-handed helical fibre indicates myofibre remodelling following chronic myocardial infarction. • DTI allows for ruling out myocardial infarction by means of FA. • Post-mortem DTI may represent a valuable screening tool in forensic investigations.

  16. Erythrocyte deformation in ischemic acute tubular necrosis and amelioration by splenectomy in the dog.

    Science.gov (United States)

    Mandal, A K; Taylor, C A; Bell, R D; Hillman, N M; Jarnot, M D; Cunningham, J D; Phillips, L G

    1991-11-01

    Bilateral renal artery occlusion (RAO) for 120 minutes in dogs results in acute tubular necrosis (ATN) and peritubular capillary (PTC) congestion with rapidly deteriorating renal function. We have shown that prior splenectomy minimizes RAO-induced renal functional and histopathologic changes. The purpose of this study was to examine whether this renal protection is due to prevention of red blood cell echinocyte formation and resultant renal PTC congestion. Echinocytes (burr cells) are poorly deformable, impart high viscosity to the blood, and may hinder reperfusion by increasing resistance to renal capillary blood flow. Splenectomized (SPLX) or sham-SPLX dogs were treated with bilateral RAO for 120 minutes. After RAO, renal function and renal blood flow were monitored, and peripheral blood red blood cells were examined at 1 hour and at 24-hour intervals for 96 hours. Renal biopsies were taken 1 hour after RAO and the kidneys removed 96 hours after RAO. The RBCs and renal tissues were studied using scanning electron microscopy. Renal function was assessed by endogenous creatinine clearance. Sham-SPLX animals showed a marked and sustained decrease in creatinine clearance, consistently elevated serum creatinine levels and fractional excretion of sodium, and diffuse ATN and PTC congestion with echinocytes. These animals had a peak in circulating echinocytes 1 hour after RAO (p less than 0.05), which showed an excellent negative correlation with creatinine clearance (r = -0.999; p less than 0.001). On the contrary, SPLX animals had essentially no change in serum creatinine or fractional excretion of sodium, minimal tubular changes, no PTC congestion, and no rise in circulating echinocytes during the 96-hour observation. In vitro treatment of the postischemic red blood cells from sham animals with adenosine-inosine or fresh postischemic plasma from the SPLX animals showed almost complete reversal to discocytes (normal red blood cells), whereas in vitro treatment of

  17. Effect of splenectomy and radiation on the level of the natural antiglobulin factor homoreactant in rabbits

    International Nuclear Information System (INIS)

    Bartova, L.M.; Ivanov, A.A.; Fishevskaya, E.V.; Nevinnaya, A.P.; Kul'berg, A.Ya.

    1980-01-01

    In the course of determining the place of homoreactant synthesis in the organism it is established that the titer of pepsin homoreactant in defferent sections of a venous blood flow (in abducing, splenic vn and veins of kidneys and liver) in normal rabbits, is similar. It is found that the titer of the above factor does not change during 3 months after splenectomy. After irradiation of rabbits in the doses of 6 Gy (FD 10/30) and 9 Gy (FD 70/30) against the background of IgG reduced level and the titer of heterophyllous antibodies, the level of homoreactant does not reduce. On the contrary, the increase of its titers in blood is registered, in the recovery period. It is supposed that homoreactant synthesis is carried out by cells, relatively more radioresistant than cells which synthesize IgG [ru

  18. Brain MR post-gadolinium contrast in multiple sclerosis: the role of magnetization transfer and image subtraction in detecting more enhancing lesions

    Energy Technology Data Exchange (ETDEWEB)

    Gavra, M.M.; Gouliamos, A.D.; Vlahos, L.J. [Department of Radiology, ' ' Aretaieion' ' Hospital,University of Athens Medical School, Athens (Greece); Voumvourakis, C.; Sfagos, C. [Department of Neurology, ' ' Eginiteion' ' Hospital, University of Athens Medical School, Athens (Greece)

    2004-03-01

    Our purpose was to evaluate the role of magnetization transfer and image subtraction in detecting more enhancing lesions in brain MR imaging of patients with multiple sclerosis (MS). Thirty-one MS patients underwent MR imaging of the brain with T1-weighted spin echo sequences without and with magnetization transfer (MT) using a 1.5 T imager. Both sequences were acquired before and after intravenous injection of a paramagnetic contrast agent. Subtraction images in T1-weighted sequences were obtained by subtracting the pre-contrast images from the post-contrast ones. A significant difference was found between the numbers of enhanced areas in post-gadolinium T1-weighted images without and with MT (p=0.020). The post-gadolinium T1-weighted images with MT allowed the detection of an increased (13) number of enhancing lesions compared with post-gadolinium T1-weighted images without MT. A significant difference was also found between the numbers of enhanced areas in post-gadolinium T1-weighted images without MT and subtraction images without MT (p=0.020). The subtraction images without MT allowed the detection of an increased (10) number of enhancing lesions compared with post-gadolinium T1-weighted images without MT. Magnetization transfer contrast and subtraction techniques appear to be the simplest and least time-consuming applications to improve the conspicuity and detection of contrast-enhancing lesions in patients with MS. (orig.)

  19. Brain MR post-gadolinium contrast in multiple sclerosis: the role of magnetization transfer and image subtraction in detecting more enhancing lesions

    International Nuclear Information System (INIS)

    Gavra, M.M.; Gouliamos, A.D.; Vlahos, L.J.; Voumvourakis, C.; Sfagos, C.

    2004-01-01

    Our purpose was to evaluate the role of magnetization transfer and image subtraction in detecting more enhancing lesions in brain MR imaging of patients with multiple sclerosis (MS). Thirty-one MS patients underwent MR imaging of the brain with T1-weighted spin echo sequences without and with magnetization transfer (MT) using a 1.5 T imager. Both sequences were acquired before and after intravenous injection of a paramagnetic contrast agent. Subtraction images in T1-weighted sequences were obtained by subtracting the pre-contrast images from the post-contrast ones. A significant difference was found between the numbers of enhanced areas in post-gadolinium T1-weighted images without and with MT (p=0.020). The post-gadolinium T1-weighted images with MT allowed the detection of an increased (13) number of enhancing lesions compared with post-gadolinium T1-weighted images without MT. A significant difference was also found between the numbers of enhanced areas in post-gadolinium T1-weighted images without MT and subtraction images without MT (p=0.020). The subtraction images without MT allowed the detection of an increased (10) number of enhancing lesions compared with post-gadolinium T1-weighted images without MT. Magnetization transfer contrast and subtraction techniques appear to be the simplest and least time-consuming applications to improve the conspicuity and detection of contrast-enhancing lesions in patients with MS. (orig.)

  20. Post-mortem hemoparasite detection in free-living Brazilian brown brocket deer (Mazama gouazoubira, Fischer 1814

    Directory of Open Access Journals (Sweden)

    Júlia Angélica Gonçalves da Silveira

    Full Text Available Tick-borne infections can result in serious health problems for wild ruminants, and some of these infectious agents can be considered zoonosis. The aim of the present study was the post-mortem detection of hemoparasites in free-living Mazama gouazoubira from Minas Gerais state, Brazil. The deer samples consisted of free-living M. gouazoubira (n = 9 individuals that died after capture. Necropsy examinations of the carcasses were performed to search for macroscopic alterations. Organ samples were collected for subsequent imprint slides, and nested PCR assays were performed to detect hemoparasite species. Imprint slide assays from four deer showed erythrocytes infected with Piroplasmida small trophozoites, and A. marginale corpuscles were observed in erythrocytes from two animals. A. marginale and trophozoite co-infections occurred in two deer. A nested PCR analysis of the organs showed that six of the nine samples were positive for Theileria sp., five were positive for A. phagocytophilum and three were positive for A. marginale, with co-infection occurring in four deer. The results of the present study demonstrate that post-mortemdiagnostics using imprint slides and molecular assays are an effective method for detecting hemoparasites in organs.

  1. Post-mortem hemoparasite detection in free-living Brazilian brown brocket deer (Mazama gouazoubira, Fischer 1814).

    Science.gov (United States)

    Silveira, Júlia Angélica Gonçalves da; Rabelo, Elida Mara Leite; Lima, Paula Cristina Senra; Chaves, Bárbara Neves; Ribeiro, Múcio Flávio Barbosa

    2014-01-01

    Tick-borne infections can result in serious health problems for wild ruminants, and some of these infectious agents can be considered zoonosis. The aim of the present study was the post-mortem detection of hemoparasites in free-living Mazama gouazoubira from Minas Gerais state, Brazil. The deer samples consisted of free-living M. gouazoubira (n = 9) individuals that died after capture. Necropsy examinations of the carcasses were performed to search for macroscopic alterations. Organ samples were collected for subsequent imprint slides, and nested PCR assays were performed to detect hemoparasite species. Imprint slide assays from four deer showed erythrocytes infected with Piroplasmida small trophozoites, and A. marginale corpuscles were observed in erythrocytes from two animals. A. marginale and trophozoite co-infections occurred in two deer. A nested PCR analysis of the organs showed that six of the nine samples were positive for Theileria sp., five were positive for A. phagocytophilum and three were positive for A. marginale, with co-infection occurring in four deer. The results of the present study demonstrate that post-mortem diagnostics using imprint slides and molecular assays are an effective method for detecting hemoparasites in organs.

  2. TREATMENT OF SEVERE AUTOIMMUNE CYTOPENIAS AFTER ALLOGENEIC STEM CELL TRANSPLANTATION – REPORT OF TWO CASES

    Directory of Open Access Journals (Sweden)

    Irena Preložnik Zupan

    2004-12-01

    Full Text Available Background. Autoimmune cytopenias, thrombocytopenia, anemia and neutropenia, are rare but serious complications after stem cell transplantation (SCT. There are only a few reports concerning their treatment. We performed splenectomy in two patients with severe autoimmune cytopenias after allogeneic SCT resistant to immunosuppressive treatment.Patients, methods and results. First patient had unrelated alloSCT at Royal Free Hospital London for chronic granulocytic leukemia (CGL in July 2000. Post-transplant period was complicated with cytomegalovirus reactivation and septicemia. Seven months later RBC and platelet counts went down. Direct Coomb’s test was intermittently positive. She was resistant to steroids and high dose immunoglobulin. Splenectomy was performed in February 2001. After splenectomy hemoglobin concentration and platelet count improved. Her blood counts remained stable with hemoglobin about 110 g/L and platelets over 100 x109/L. She continued therapy with Itraconazol, Valacyclovir and Penicillin. Three months later she was readmitted for E. Coli fulminated septic infection with fatal outcome.Second patient had related alloSCT at University Medical Centre Ljubljana for CGL in January 2003. Post-transplant course was uneventful. Seven months later he was readmitted for retinal bleeding with severe thrombocytopenia with positive anti-platelet antibodies. He was resistant to steroids and high dose immunoglobulin. Splenectomy was performed in September 2003. His platelet count normalized and remains stable so far. He continues therapy with Itraconazol, Valacyclovir and Penicillin and didn’t experience any serious infection.Conclusions. We assume that splenectomy is an efficient treatment for resistant immune cytopenias after alloSCT. However, severe late infections may compromise the outcome.

  3. Fully automatic detection and segmentation of abdominal aortic thrombus in post-operative CTA images using Deep Convolutional Neural Networks.

    Science.gov (United States)

    López-Linares, Karen; Aranjuelo, Nerea; Kabongo, Luis; Maclair, Gregory; Lete, Nerea; Ceresa, Mario; García-Familiar, Ainhoa; Macía, Iván; González Ballester, Miguel A

    2018-05-01

    Computerized Tomography Angiography (CTA) based follow-up of Abdominal Aortic Aneurysms (AAA) treated with Endovascular Aneurysm Repair (EVAR) is essential to evaluate the progress of the patient and detect complications. In this context, accurate quantification of post-operative thrombus volume is required. However, a proper evaluation is hindered by the lack of automatic, robust and reproducible thrombus segmentation algorithms. We propose a new fully automatic approach based on Deep Convolutional Neural Networks (DCNN) for robust and reproducible thrombus region of interest detection and subsequent fine thrombus segmentation. The DetecNet detection network is adapted to perform region of interest extraction from a complete CTA and a new segmentation network architecture, based on Fully Convolutional Networks and a Holistically-Nested Edge Detection Network, is presented. These networks are trained, validated and tested in 13 post-operative CTA volumes of different patients using a 4-fold cross-validation approach to provide more robustness to the results. Our pipeline achieves a Dice score of more than 82% for post-operative thrombus segmentation and provides a mean relative volume difference between ground truth and automatic segmentation that lays within the experienced human observer variance without the need of human intervention in most common cases. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. The use of contrast-enhanced post Mortem CT in the detection of cardiovascular deaths.

    Directory of Open Access Journals (Sweden)

    Jonas Christoph Apitzsch

    Full Text Available OBJECTIVES: To evaluate the diagnostic value of contrast enhanced post mortem computed tomography (PMCT in comparison to non-enhanced post mortem CT in the detection of cardiovascular causes of death (COD. BACKGROUND: As autopsy rates decline, new methods to determine CODs are necessary. So contrast enhanced PMCT shall be evaluated in comparison to established non-enhanced PMCT in order to further improve the method. METHODS: In a prospective study, 20 corpses were examined using a 64-row multisclice CT (MSCT before and after intraarterial perfusion with a newly developed, barium-bearing contrast agent and ventilation of the lungs. The cause of death was determined in enhanced and unenhanced scans and a level of confidence (LOC was given by three experienced radiologists on a scale between 0 and 4. Results were compared to autopsy results as gold standard. Autopsy was performed blinded to PMCT-findings. RESULTS: The method allowed visualization of different types of cause of death. There was a significant improvement in LOC in enhanced scans compared to unenhanced scans as well as an improvement in the detection of COD. The cause of death could be determined in 19 out of 20 patients. CONCLUSIONS: PMCT is feasible and appears to be robust for diagnosing cardiovascular causes of death. When compared with unenhanced post-mortem CT intraarterial perfusion and pulmonary ventilation significantly improve visualization and diagnostic accuracy. These promising results warrant further studies.

  5. Post-PCR detection of nucleic acids using metalloporphyrin labels and time-resolved fluorescence

    International Nuclear Information System (INIS)

    O'Shea, Desmond J.; O'Sullivan, Paul J.; Ponomarev, Gelii V.; Papkovsky, Dmitri B.

    2005-01-01

    Phosphorescent platinum(II)-coproporphyrin label (PtCP) was evaluated in post-PCR detection of nucleic acids by time-resolved fluorescence (TR-F) using three common formats. PtCP-labelled oligonucleotide primers and PtCP-dUTP were incorporated in a PCR to produce labelled amplified target -173 or 305 bp DNA. Alternatively, aminoallyl-dUTP was incorporated in a PCR and the product was subsequently labelled with PtCP. The resulting PCR mixtures containing labelled dsDNA were separated on 1.5% agarose gels and then analysed by ethidium bromide staining and by direct detection of PtCP label on a commercial TR-F plate reader Victor 2 (Perkin Elmer Life Sciences) used in scanning mode. In all cases label incorporation and high yields of amplified DNA were observed. Direct TR-F detection of PtCP-labelled DNA from a gel provided high sensitivity and signal to noise ratio, with limits of detection in the range of 9-22 pg for all three formats. The sensitivity achieved with PtCP label was considerably better than that achieved with ethidium bromide staining (∼1 ng of dsDNA) or with conventional fluorescent label FITC. Neither the FITC label nor ethidium bromide staining interfered with PtCP detection, thus allowing multiplexed detection

  6. Factors associated with the effect of open splenectomy for immune thrombocytopenic purpura.

    Science.gov (United States)

    Li, Ying; Zhang, Dawei; Hua, Fanli; Gao, Song; Wu, Yangjiong; Xu, Jianmin

    2017-01-01

    To assess the effect and complications of open splenectomy (OS) for immune thrombocytopenic purpura (ITP) and determine preoperative factors associated with surgical effect. This was a retrospective analysis of ITP patients who failed medical therapy and were treated with OS between 1997 and 2014 at the Jinshan Hospital, China. Follow-up was 60 months. Surgical effect was determined from platelet counts and bleeding episodes. Complications were assessed including bleeding episodes. Preoperative factors were identified by logistic regression analysis. Fifty-six patients (48.2 ± 16.2 yr old; 39 females) were included. Disease course was 31.2 ± 48.2 months; 91.1% patients had preoperative platelet count effect at 1 wk, 1 month, 1 yr, and 5 yrs was in 91.1%, 92.9%, 91.1%, and 89.3% patients, respectively. Pneumonia or lower extremity thrombosis occurred in 7.1% patients. Postoperative mild, moderate, and severe bleeding occurred in 33.9%, 50.0%, and 16.1% patients, respectively. No patients required blood transfusion. Mortality was zero. Larger spleen size associated with surgical effect at 1 wk, 1 month, and 1 yr, and lower preoperative minimum platelet count associated with effect at 5 yrs (P effective treatment with less complications for the management of ITP. Lower preoperative minimum platelet count associated with successful OS at 5 yrs. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. [Postoperative complications and survival analysis of 1 118 cases of open splenectomy and azygoportal disconnection in the treatment of portal hypertension].

    Science.gov (United States)

    Qi, R Z; Zhao, X; Wang, S Z; Zhang, K; Chang, Z Y; Hu, X L; Wu, M L; Zhang, P R; Yu, L X; Xiao, C H; Shi, X J; Li, Z W

    2018-06-01

    Objective: To analyze the recent postoperative and long-term postoperative complications of open-splenectomy and disconnection in patients with portal hypertension. Methods: There were 1 118 cases with portal hypertension who underwent open splenectomy and azygoportal disconnection from April 2010 to September 2015 at Department of Surgery, People's Liberation Army 302 Hospital. Retrospective case investigation and telephone follow-up were conducted in October 2016. All patients had history of upper gastrointestinal bleeding before operation. Short-term complications after surgery were recorded including secondary laparotomy of postoperative abdominal hemostasis, severe infection, intake disorders, liver insufficiency, postoperative portal vein thrombosis and perioperative mortality. Long-term data including postoperative upper gastrointestinal rebleeding, postoperative survival rate and incidence of postoperative malignancy were recorded, too. GraphPad Prism 5 software for data survival analysis and charting. Results: Postoperative short-term complications in 1 118 patients included secondary laparotomy of postoperative abdominal hemostasis(1.8%, 21/1 118), severe infection(2.9%, 32/1 118), intake disorders(1.0%, 11/1 118), liver dysfunction (1.6%, 18/1 118), postoperative portal vein thrombosis(47.1%, 526/1 118)and perioperative mortality(0.5%, 5/1 118). After phone call following-up, 942 patients' long-term data were completed including 1, 3, 5 years postoperative upper gastrointestinal rebleeding rate(4.4%, 12.1%, 17.2%), 1, 3, 5-year postoperative survival rate(97.0%, 93.5%, 90.3%); the incidence of postoperative malignant tumors in 1, 3 and 5 years were 1.7%, 4.4% and 6.2%. Conclusions: Reasonable choosing of surgical indications and timing, proper performing the surgery process, effective conducting perioperative management of portal hypertension are directly related to the patient's short-term prognosis after portal hypertension. Surgical intervention can

  8. Knowledge-Based Detection and Assessment of Damaged Roads Using Post-Disaster High-Resolution Remote Sensing Image

    OpenAIRE

    Wang, Jianhua; Qin, Qiming; Zhao, Jianghua; Ye, Xin; Feng, Xiao; Qin, Xuebin; Yang, Xiucheng

    2015-01-01

    Road damage detection and assessment from high-resolution remote sensing image is critical for natural disaster investigation and disaster relief. In a disaster context, the pairing of pre-disaster and post-disaster road data for change detection and assessment is difficult to achieve due to the mismatch of different data sources, especially for rural areas where the pre-disaster data (i.e., remote sensing imagery or vector map) are hard to obtain. In this study, a knowledge-based method for ...

  9. Efficacy and surgical procedures of preoperative splenic artery embolization for laparoscopic splenectomy of a massive splenomegaly: A case report

    Directory of Open Access Journals (Sweden)

    Toshikatsu Nitta

    2015-01-01

    Full Text Available Here, we describe the case of a 58-year-old woman diagnosed with massive splenomegaly with a malignant lymphoma that had a maximum diameter of 24 cm. Splenectomy was indicated because of thrombocytopenia and abdominal distention. Therefore, a balloon catheter was inserted preoperatively through the splenic artery for embolization and continuous infusion to reduce the spleen volume. It enabled easy handling of the spleen and minimized bleeding. The volume of the spleen was estimated at 1896 g through the skin incision, as measured by volumetric computed tomography; thus, laparoscopy seemed difficult. However, the surgery was successfully performed only with laparoscopic surgery, and the volume of the resected spleen was 1020 g. This preoperative preparation is an effective alternative to laparoscopic removal of a huge splenomegaly.

  10. 99 mTc-sulphur-colloid and heat-denatured 99mTc-labelled red cell scans demonstrating a giant intrapelvic spleen in a girl after splenectomy

    International Nuclear Information System (INIS)

    Kao, P.F.; Tzen, K.Y.; Tsai, M.F.; Lin, J.N.

    2001-01-01

    A 17 x 12 x 5-cm giant intrapelvic mass in a 14-year-old girl is reported. This mass developed 6 years after a splenectomy for splenic torsion. The heat-denatured 99 m Tc-labelled red cell scan and 99 m Tc- sulphur-colloid scan confirmed the specific red cell sequestration function and reticuloendothelial activity in the giant intrapelvic spleen. The size and development of the giant intrapelvic spleen are unusual. The usefulness of functional images to diagnosis the nature of the intrapelvic mass is well demonstrated. (orig.)

  11. Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J. [NHS Foundation Trust, Department of Radiology Great Ormond Street Hospital for Children, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom); Calder, Alistair D. [NHS Foundation Trust, Department of Radiology Great Ormond Street Hospital for Children, London (United Kingdom); Kiho, Liina [Camelia Botnar Laboratories Great Ormond Street Hospital for Children, Department of Paediatric Pathology, London (United Kingdom); Taylor, Andrew M. [Great Ormond Street Hospital for Children, Cardiorespiratory Unit, London (United Kingdom); UCL Institute of Cardiovascular Science, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom); Sebire, Neil J. [Camelia Botnar Laboratories Great Ormond Street Hospital for Children, Department of Paediatric Pathology, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom)

    2014-03-15

    Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities. The aim of this study was to review the diagnostic yield of this practice. We identified 1,027 cases performed in a single institution over a 21/2-year period, including babygrams (whole-body examinations) and full skeletal surveys. Images were reported prior to autopsy in all cases. Radiology findings were cross-referenced with the autopsy findings using an autopsy database. We scored each case from 0 to 4 according to the level of diagnostic usefulness. The overall abnormality rate was 126/1,027 (12.3%). There was a significantly higher rate of abnormality when a skeletal survey was performed (18%) rather than a babygram (10%; P < 0.01); 90% (665/739) of babygrams were normal. Of the 74 abnormal babygrams, we found 33 incidental non-contributory cases, 19 contributory, 20 diagnostic, and 2 false-positive cases. There were only 2 cases out of 739 (0.27%) in whom routine post-mortem imaging identified potentially significant abnormalities that would not have been detected if only selected imaging had been performed. A policy of performing selected, rather than routine, foetal post-mortem radiography could result in a significant cost saving. Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings. (orig.)

  12. Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice

    International Nuclear Information System (INIS)

    Arthurs, Owen J.; Calder, Alistair D.; Kiho, Liina; Taylor, Andrew M.; Sebire, Neil J.

    2014-01-01

    Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities. The aim of this study was to review the diagnostic yield of this practice. We identified 1,027 cases performed in a single institution over a 21/2-year period, including babygrams (whole-body examinations) and full skeletal surveys. Images were reported prior to autopsy in all cases. Radiology findings were cross-referenced with the autopsy findings using an autopsy database. We scored each case from 0 to 4 according to the level of diagnostic usefulness. The overall abnormality rate was 126/1,027 (12.3%). There was a significantly higher rate of abnormality when a skeletal survey was performed (18%) rather than a babygram (10%; P < 0.01); 90% (665/739) of babygrams were normal. Of the 74 abnormal babygrams, we found 33 incidental non-contributory cases, 19 contributory, 20 diagnostic, and 2 false-positive cases. There were only 2 cases out of 739 (0.27%) in whom routine post-mortem imaging identified potentially significant abnormalities that would not have been detected if only selected imaging had been performed. A policy of performing selected, rather than routine, foetal post-mortem radiography could result in a significant cost saving. Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings. (orig.)

  13. POST-DISASTER DAMAGE ASSESSMENT THROUGH COHERENT CHANGE DETECTION ON SAR IMAGERY

    Directory of Open Access Journals (Sweden)

    L. Guida

    2018-04-01

    Full Text Available Damage assessment is a fundamental step to support emergency response and recovery activities in a post-earthquake scenario. In recent years, UAVs and satellite optical imagery was applied to assess major structural damages before technicians could reach the areas affected by the earthquake. However, bad weather conditions may harm the quality of these optical assessments, thus limiting the practical applicability of these techniques. In this paper, the application of Synthetic Aperture Radar (SAR imagery is investigated and a novel approach to SAR-based damage assessment is presented. Coherent Change Detection (CCD algorithms on multiple interferometrically pre-processed SAR images of the area affected by the seismic event are exploited to automatically detect potential damages to buildings and other physical structures. As a case study, the 2016 Central Italy earthquake involving the cities of Amatrice and Accumoli was selected. The main contribution of the research outlined above is the integration of a complex process, requiring the coordination of a variety of methods and tools, into a unitary framework, which allows end-to-end application of the approach from SAR data pre-processing to result visualization in a Geographic Information System (GIS. A prototype of this pipeline was implemented, and the outcomes of this methodology were validated through an extended comparison with traditional damage assessment maps, created through photo-interpretation of high resolution aerial imagery. The results indicate that the proposed methodology is able to perform damage detection with a good level of accuracy, as most of the detected points of change are concentrated around highly damaged buildings.

  14. Post-Disaster Damage Assessment Through Coherent Change Detection on SAR Imagery

    Science.gov (United States)

    Guida, L.; Boccardo, P.; Donevski, I.; Lo Schiavo, L.; Molinari, M. E.; Monti-Guarnieri, A.; Oxoli, D.; Brovelli, M. A.

    2018-04-01

    Damage assessment is a fundamental step to support emergency response and recovery activities in a post-earthquake scenario. In recent years, UAVs and satellite optical imagery was applied to assess major structural damages before technicians could reach the areas affected by the earthquake. However, bad weather conditions may harm the quality of these optical assessments, thus limiting the practical applicability of these techniques. In this paper, the application of Synthetic Aperture Radar (SAR) imagery is investigated and a novel approach to SAR-based damage assessment is presented. Coherent Change Detection (CCD) algorithms on multiple interferometrically pre-processed SAR images of the area affected by the seismic event are exploited to automatically detect potential damages to buildings and other physical structures. As a case study, the 2016 Central Italy earthquake involving the cities of Amatrice and Accumoli was selected. The main contribution of the research outlined above is the integration of a complex process, requiring the coordination of a variety of methods and tools, into a unitary framework, which allows end-to-end application of the approach from SAR data pre-processing to result visualization in a Geographic Information System (GIS). A prototype of this pipeline was implemented, and the outcomes of this methodology were validated through an extended comparison with traditional damage assessment maps, created through photo-interpretation of high resolution aerial imagery. The results indicate that the proposed methodology is able to perform damage detection with a good level of accuracy, as most of the detected points of change are concentrated around highly damaged buildings.

  15. Efeitos da esplenectomia na peritonite causada por lesão traumática do cólon: estudo em ratos Effects of splenectomy on peritonitis produced by a colonic injury: study in rats

    Directory of Open Access Journals (Sweden)

    Luís Sérgio Nassif

    2004-09-01

    A2 (normal with colon lesion sutured and 22 for Group B (spleen removed. The animals were submitted to a laparatomy through a midline abdominal incision and peritonitis was induced by a colonic lesion in the colon previously distended with 2 ml of saline introduced in the rectum. Bacteriological studies of the abdominal wash obtained with a sterilized swab and microscopic studies of samples of the segment of the sutured colon obtained at 48hrs, 96hrs and on the 12 post op day, were made in each group. All rats were submitted to an autopsy on the day of death or on the 12th post op day when the survivors were sacrificed. RESULTS: Similar bacteria were found in the three groups. E. coli (100%; Enterococcus fecalis (97%; Klebsiela pneumoniae (70%; Citrobacter freundi (70% and Enterobacter aglomerans (63%. In the first 96 hours the rats without spleen had a lesser inflammatory reaction when compared to the group with spleen. The leading cause of death was generalized peritonitis in the first 96 hours. There was a significant statistical difference in the mortality rate between Group B (80%, Group A2 (no mortality and Group A1 (35%. CONCLUSION: There was a significant statistical difference in the mortality rate caused by peritonitis between the groups with splenectomy when compared to the group with no splenectomy.

  16. Safety and cost-effectiveness analysis of laparoscopic splenectomy by secondary pedicle division using monopolar electrocautery.

    Science.gov (United States)

    Zhou, Jianyin; Liu, Pingguo; Yin, Zhenyu; Zhao, Yilin; Wang, Xiaomin

    2013-09-01

    The expense of laparoscopic splenectomy (LS) has limited its use in developing countries, while medical costs are increasing worldwide. In this study, we performed LS by secondary pedicle division using monopolar electrocautery to achieve cost savings. Over seven years, we performed 45 consecutive LSs by secondary pedicle division using monopolar electrocautery (n=17) or ultrasonic shears (n=28) at a single center. These were reviewed to assess outcome and cost. Mean operating time was 179.7min, 7 conversions to open operation (15.6%) were necessary. There were four postoperative complications (8.9%) and no deaths. Twenty-three of 28 (82.1%) patients with idiopathic thrombocytopenic purpura developed a long-term positive response; and mean operative cost was RMB6,577 (US$1,034), which was much lower than that of Endo-GIATM in published reports. Between the monopolar electrocautery and ultrasonic shears groups, there were no significant differences in demographic characteristics or intraoperative and postoperative details, but operative cost was significantly lower in the former (RMB4,416, US$696 vs. RMB7,889, US$1,243; pelectrocautery is safe, efficacious and economical.

  17. Detection of exercise induced ischemia in the asymptomatic recent post myocardial infarction patient: comparison of stress electrocardiography and radionuclide angiography

    International Nuclear Information System (INIS)

    Jengo, J.A.; Brizendine, M.; Dykstra, L.; Sweet, J.; Bruno, M.; Garcia, A.

    1982-01-01

    The purpose of this study was to compare the techniques of low level stress electrocardiography and radionuclide angiographic wall motion analysis for the detection of new areas of myocardial ischemia in the asymptomatic recent post-myocardial infarction patient. The protocol consisted of obtaining a resting, RAO upright first pass radionuclide angiocardiogram using 15 mCi of 99m technetium-DTPA. The study suggests that assessment of segmental wall motion during low level stress can detect areas of myocardium at high risk either intermixed with or in addition to recently infarcted areas in the asymptomatic post-infarction patient, which are not detected by ECG. This high risk subset of patients can then be observed or treated in a more vigorous manner. This technique allows for not only the identification of additional areas of myocardium at jeopardy but also provides information regarding the severity of ischemic dysfunction, an important prognostic and therapeutic factor

  18. Role of static fluid MR urography in detecting post urinary diversion complications

    Directory of Open Access Journals (Sweden)

    Amr Farouk Ibrahim Moustafa

    2018-06-01

    Full Text Available Aim of work: The aim of the study was to assess the diagnostic performance of static MR urography in detection of post cystectomy complications & the ability of static fluid MR urography in visualization of urinary tract segments. Material & methods: We prospectively reviewed 21 MR urograms with urinary diversion. The most common surgical procedures included Ileal conduit & Ileocecal neobladder diversion.Magnetic resonance urography examinations were performed with 1.5-T MR scanners. T2 weighted (static fluid MR urography techniques were done, in addition to conventional T1- and T2-weighted axial and coronal sequences. Urinary tract was divided in different parts: pelvicalyceal systems, upper, mid and lower ureteric segments & the reservoir or conduit Imaging features of the urinary collecting systems were evaluated for their visualization and complications detection. Results: T2-weighted MR urography could demonstrate 95% of urinary tract segments & together with conventional MR sequences all urinary tract segments can be visualized. Urinary diversion related complications were encountered included in 15 patients (71.4% & no urological complications were seen in 6 patients (28.6%. Conclusion: Comprehensive T2-weighted MR urography is an effective imaging method for the visualization of the urinary system and detection of early and late postoperative complications in patients with urinary diversion. Keywords: MR urography, Urinary diversion, Cancer bladder

  19. An attempt of using straight-line information for building damage detection based only on post-earthquake optical imagery

    International Nuclear Information System (INIS)

    Dong, Laigen; Ye, Yuanxin; Shan, Jie

    2014-01-01

    It is important to grasp damage information in stricken areas after an earthquake in order to perform quick rescue and recovery activities. Recent research into remote sensing techniques has shown significant ability to generate quality damage information. The methods based on only post-earthquake data are widely researched especially because there are no pre-earthquake reference data in many cities of the world. This paper addresses a method for detection of damaged buildings using only post-event satellite imagery so that scientists and researchers can take advantage of the ability of helicopters and airplanes to fly over the damage faster. Statistical information of line segments extracted from post-event satellite imagery, such as mean length (ML) and weighted tilt angel standard deviation (WTASD), are used for discriminating the damaged and undamaged buildings

  20. Late postoperative follow-up of patients undergoing subtotal splenectomy Acompanhamento pós-operatório tardio de pacientes submetidos a esplenectomia subtotal

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    2005-12-01

    Full Text Available PURPOSE: Over the past 21 years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. METHODS: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1 to 20 years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n = 43, trauma (n = 31, Gaucher's disease (n = 4, myeloid hepatosplenomegaly due to myelofibrosis (n = 3, splenomegalic retarded growth and sexual development (n = 2, severe pain due to splenic ischemia (n = 2 and pancreatic cystadenoma (n = 1. Patients underwent a hematologic exam, an immunologic assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. RESULTS: Increased white blood cell count and platelets were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hyperension although without rebleeding. The ultrasound, tomography and scintigraphy exams confirmed the presence of functional splenic remnants without significant size alteration. CONCLUSIONS: Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.OBJETIVO: Durante 21 anos, realizamos mais de 200 esplenectomias subtotais para tratar diferentes condições patológicas. É fundamental conhecer os resultados pós-operatórios desse procedimento. MÉTODO: Todos os pacientes submetidos a esplenectomia subtotal foram convidados para serem submetidos a revisão. Pudemos reunir

  1. Multi-center evaluation of post-operative morbidity and mortality after optimal cytoreductive surgery for advanced ovarian cancer.

    Directory of Open Access Journals (Sweden)

    Arash Rafii

    Full Text Available PURPOSE: While optimal cytoreduction is the standard of care for advanced ovarian cancer, the related post-operative morbidity has not been clearly documented outside pioneering centers. Indeed most of the studies are monocentric with inclusions over several years inducing heterogeneity in techniques and goals of surgery. We assessed the morbidity of optimal cytoreduction surgery for advanced ovarian cancer within a short inclusion period in 6 referral centers dedicated to achieve complete cytoreduction. PATIENTS AND METHODS: The 30 last optimal debulking surgeries of 6 cancer centers were included. Inclusion criteria included: stage IIIc- IV ovarian cancer and optimal surgery performed at the site of inclusion. All post-operative complications within 30 days of surgery were recorded and graded using the Memorial secondary events grading system. Student-t, Chi2 and non-parametric statistical tests were performed. RESULTS: 180 patients were included. There was no demographic differences between the centers. 63 patients underwent surgery including intestinal resections (58 recto-sigmoid resection, 24 diaphragmatic resections, 17 splenectomies. 61 patients presented complications; One patient died post-operatively. Major (grade 3-5 complications requiring subsequent surgeries occurred in 21 patients (11.5%. 76% of patients with a major complication had undergone an ultraradical surgery (P = 0.004. CONCLUSION: While ultraradical surgery may result in complete resection of peritoneal disease in advanced ovarian cancer, the associated complication rate is not negligible. Patients should be carefully evaluated and the timing of their surgery optimized in order to avoid major complications.

  2. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture

    International Nuclear Information System (INIS)

    Winklhofer, Sebastian; Berger, Nicole; Stolzmann, Paul; Stoeck, Christian T.; Kozerke, Sebastian; Thali, Michael; Manka, Robert; Alkadhi, Hatem

    2014-01-01

    To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture. Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI. Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p 0.05). Post-mortem cardiac DTI enablesdifferentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI. (orig.)

  3. {sup 99} {sup m}Tc-sulphur-colloid and heat-denatured {sup 99} {sup m}Tc-labelled red cell scans demonstrating a giant intrapelvic spleen in a girl after splenectomy

    Energy Technology Data Exchange (ETDEWEB)

    Kao, P.F. [Dept. of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University School of Medicine, Tauyuan, Taiwan (Taiwan); Dept. of Nuclear Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan (Taiwan); Tzen, K.Y.; Tsai, M.F. [Dept. of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University School of Medicine, Tauyuan, Taiwan (Taiwan); Lin, J.N. [Dept. of Paediatric Surgery, Chang Gung Childrens Hospital and Chang Gung University School of Medicine, Tauyuan, Taiwan (Taiwan)

    2001-04-01

    A 17 x 12 x 5-cm giant intrapelvic mass in a 14-year-old girl is reported. This mass developed 6 years after a splenectomy for splenic torsion. The heat-denatured {sup 99} {sup m}Tc-labelled red cell scan and {sup 99} {sup m}Tc- sulphur-colloid scan confirmed the specific red cell sequestration function and reticuloendothelial activity in the giant intrapelvic spleen. The size and development of the giant intrapelvic spleen are unusual. The usefulness of functional images to diagnosis the nature of the intrapelvic mass is well demonstrated. (orig.)

  4. Detection of prostate cancer-specific transcripts in extracellular vesicles isolated from post-DRE urine.

    Science.gov (United States)

    Pellegrini, Kathryn L; Patil, Dattatraya; Douglas, Kristen J S; Lee, Grace; Wehrmeyer, Kathryn; Torlak, Mersiha; Clark, Jeremy; Cooper, Colin S; Moreno, Carlos S; Sanda, Martin G

    2017-06-01

    The measurement of gene expression in post-digital rectal examination (DRE) urine specimens provides a non-invasive method to determine a patient's risk of prostate cancer. Many currently available assays use whole urine or cell pellets for the analysis of prostate cancer-associated genes, although the use of extracellular vesicles (EVs) has also recently been of interest. We investigated the expression of prostate-, kidney-, and bladder-specific transcripts and known prostate cancer biomarkers in urine EVs. Cell pellets and EVs were recovered from post-DRE urine specimens, with the total RNA yield and quality determined by Bioanalyzer. The levels of prostate, kidney, and bladder-associated transcripts in EVs were assessed by TaqMan qPCR and targeted sequencing. RNA was more consistently recovered from the urine EV specimens, with over 80% of the patients demonstrating higher RNA yields in the EV fraction as compared to urine cell pellets. The median EV RNA yield of 36.4 ng was significantly higher than the median urine cell pellet RNA yield of 4.8 ng. Analysis of the post-DRE urine EVs indicated that prostate-specific transcripts were more abundant than kidney- or bladder-specific transcripts. Additionally, patients with prostate cancer had significantly higher levels of the prostate cancer-associated genes PCA3 and ERG. Post-DRE urine EVs are a viable source of prostate-derived RNAs for biomarker discovery and prostate cancer status can be distinguished from analysis of these specimens. Continued analysis of urine EVs offers the potential discovery of novel biomarkers for pre-biopsy prostate cancer detection. © 2017 Wiley Periodicals, Inc.

  5. Clinical significance of atypical squamous cells of undetermined significance in detecting preinvasive cervical lesions in post- menopausal Turkish women.

    Science.gov (United States)

    Tokmak, Aytekin; Guzel, Ali Irfan; Ozgu, Emre; Oz, Murat; Akbay, Serap; Erkaya, Salim; Gungor, Tayfun

    2014-01-01

    To evaluate the clinical significance of atypical squamous cells of undetermined significance (ASCUS) in PAP test in post-menopausal women and compare with reproductive age women. A total of 367 patients who referred to our gynecologic oncology clinic were included to the study between September 2012 and August 2013. Data for 164 post-menopausal (group 1) and 203 pre-menopausal (group 2) women with ASCUS cytology were evaluated retrospectively. Immediate colposcopy and endocervical curettage was performed for both groups and conization for all women with a result suggestive of CIN2-3. Histopathological results and demographic features of patients were compared between the two groups. Mean age of the patients was 54.6±6.5 years in group 1 and 38±6.6 years in group 2. Some 14 (8.5%) of post- menopausal women and 36 (17.7%) of pre-menopausal women were current smokers (p=011). Totals of 38 (23.2%) post-menopausal and 64 (31.5%) pre-menopausal women were assessed for HPV-DNA. High risk HPV was detected in 7 (4.3%) and 21 (10.3%), respectively (p=0.029). Final histopathological results recorded were normal cervix, low grade cervical intra-epithelial neoplasia (CIN 1), and high grade cervical intra-epithelial neoplasia (CIN2-3). In group 1 results were 84.8%, 12.2% and 1.8%, respectively, and in group 2 were 71.9%, 23.2% and 4.9%. There were no cases of micro invasive or invasive cervical carcinoma in either group. Two cases were detected as endometrial carcinoma in the menopausal group (1.2%). In current study we found that preinvasive lesions were statistically significantly higher in pre-menopausal women than post- menopausal women with ASCUS. Cervicitis was more common in menopausal women. Therefore, we think that in case of ASCUS in a post-menopausal woman there is no need for radical management.

  6. Gastric necrosis and perforation as a complication of splenectomy. Case report and related references Necrose e perfuração gástrica como complicação de esplenectomia. Relato de caso e referências relacionadas

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Real MARTINEZ

    2000-10-01

    Full Text Available Necrosis of the stomach after isolated splenectomy with the formation of gastrocutaneous fistula is a rare event that occurs in less than 1% of splenectomies. It is more frequent when the removal of the spleen is done because of hematological diseases. Its mortality index can reach 60% and its pathogenesis is controversial, as it may be attributed both to direct trauma of the gastric wall and to ischemic phenomena. Although the stomach may exhibit exuberant arterial blood irrigation, anatomical variations can cause a predisposition towards the appearance of potentially ischemic areas, especially after ligation of the short gastric vessels around the major curvature of the stomach. Once this is diagnosed in the immediate postoperative period, it becomes imperative to reoperate. The surgical procedure will depend on the conditions of the peritoneal cavity and patient's clinic status. The objective of this study was to report on the case of a patient submitted to splenectomy because of closed abdominal traumatism, who then presented peritonitis and percutaneous gastric fistula in the post-operative period. During the second operation, perforations were identified in anterior gastric wall where there had been signs of vascular stress. The lesion was sutured after revival of its borders, and the patient had good evolution. Prompt diagnosis and immediate treatment of this unusual complication are needed to reduce its high mortality rate.A necrose do estômago após a esplenectomia isolada com formação de fístula gastrocutânea é evento raro que ocorre em menos de 1% das esplenectomias, sendo mais comum quando a retirada do baço é feita por doenças hematológicas. Seus índices de mortalidade atingem 60% e sua patogênese gera controvérsias, podendo ser atribuída tanto ao trauma direto sobre a parede gástrica, quanto a fenômenos isquêmicos. Apesar do estômago exibir exuberante irrigação sangüínea arterial, variações anatômicas podem

  7. Scintigraphic diagnosis and computed tomographic localization of an accessory spleen following relapse of chronic immune thrombocytopaenia

    International Nuclear Information System (INIS)

    Cardaci, G.T.; Blake, M.P.

    1992-01-01

    Chronic immune thrombocytopaenia is an immunologically mediated disorder resulting in disordered platelet kinetics and potentially life-threatening disease. Failure of medical therapy is an indication for splenectomy, and responses are seen in 80% of patients following this procedure. An important cause of relapse following splenectomy is the presence of an accessory spleen. A patient with Hodgkin's Disease developed chronic immune thrombocytopaenia despite previous splenectomy. A remission was induced with immunosuppressive therapy, but he later relapsed. An accessory spleen was detected using 99 m Tc denatured red blood cells and localized using computed tomography. Resection of the accessory spleen resulted in clinical remission. As accessory spleens are often small in size, combined modality imaging is recommended in the evaluation of this disorder. 15 refs., 2 figs

  8. Detection and characterization of Leishmania in tissues of patients with post kala-azar dermal leishmaniasis using a specific monoclonal antibody

    DEFF Research Database (Denmark)

    Ismail, A; Kharazmi, A; Permin, H

    1997-01-01

    Sections from skin lesions and draining lymph nodes of patients with post kala-azar dermal leishmaniasis were examined using an immunoperoxidase method and a monoclonal antibody directed against Leishmania donovani. Parasites were detected in 22 of 25 biopsies (88%). In parallel sections stained...

  9. Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

    International Nuclear Information System (INIS)

    Foley, P. T.; Kavnoudias, H.; Cameron, P. U.; Czarnecki, C.; Paul, E.; Lyon, S. M.

    2015-01-01

    PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function

  10. Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

    Energy Technology Data Exchange (ETDEWEB)

    Foley, P. T., E-mail: pfoley@doctors.org.uk [The Canberra Hospital, Department of Medical Imaging (Australia); Kavnoudias, H., E-mail: h.kavnoudias@alfred.org.au [The Alfred Hospital, Radiology Research Unit, Radiology Department (Australia); Cameron, P. U., E-mail: paul.cameron@unimelb.edu.au [The Alfred Hospital, Infectious Diseases Unit (Australia); Czarnecki, C., E-mail: caroline.czarnecki@gmail.com [Royal Melbourne Hospital, Radiology Department (Australia); Paul, E., E-mail: eldho.paul@monash.edu [Monash University, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Alfred Hospital (Australia); Lyon, S. M., E-mail: lyonsey@optusnet.com.au [Melbourne Endovascular (Australia)

    2015-10-15

    PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

  11. Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

    Science.gov (United States)

    Foley, P T; Kavnoudias, H; Cameron, P U; Czarnecki, C; Paul, E; Lyon, S M

    2015-10-01

    To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation-a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

  12. Ultrasound-guided percutaneous core needle biopsy of splenic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-05-15

    To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications.

  13. Ultrasound-guided percutaneous core needle biopsy of splenic lesions

    International Nuclear Information System (INIS)

    Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu

    2017-01-01

    To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications

  14. Analysis of the postoperative status of peripheral blood caused by gastric volvulus of dogs

    OpenAIRE

    VATNIKOV Y.A.; SAHNO N.V.; GOLEVA A.A.

    2016-01-01

    The paper presents analysis of post-operative state of peripheral blood caused by volvulus of the dogs’ stomach. The use of erythrocyte mass in early post-operative period reduces severity of anemia and inflammatory process. The introduction of donor red blood cells reduces severity of action immunosuppressive splenectomy and effects of anesthesia, causing the production of platelets, reticulocytes thus improving reparative processes in the postoperative period.

  15. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture

    Energy Technology Data Exchange (ETDEWEB)

    Winklhofer, Sebastian; Berger, Nicole; Stolzmann, Paul [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Stoeck, Christian T.; Kozerke, Sebastian [Institute for Biomedical Engineering University and ETH Zurich, Zurich (Switzerland); Thali, Michael [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Manka, Robert [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Institute for Biomedical Engineering University and ETH Zurich, Zurich (Switzerland); University Hospital Zurich, Clinic for Cardiology, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)

    2014-11-15

    To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture. Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI. Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p < 0.01) and lower MD (p < 0.001) compared to segments with MI. Multivariate logistic regression demonstrated that FA (p < 0.10) and MD (p = 0.01) with the covariate post-mortem time (p < 0.01) predicted MI with an accuracy of 0.73. Analysis of HA distribution demonstrated remodelling of myofibre architecture, with significant differences between healthy segments and segments with chronic (p < 0.001) but not with acute MI (p > 0.05). Post-mortem cardiac DTI enablesdifferentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI. (orig.)

  16. Decision support methods for the detection of adverse events in post-marketing data.

    Science.gov (United States)

    Hauben, M; Bate, A

    2009-04-01

    Spontaneous reporting is a crucial component of post-marketing drug safety surveillance despite its significant limitations. The size and complexity of some spontaneous reporting system databases represent a challenge for drug safety professionals who traditionally have relied heavily on the scientific and clinical acumen of the prepared mind. Computer algorithms that calculate statistical measures of reporting frequency for huge numbers of drug-event combinations are increasingly used to support pharamcovigilance analysts screening large spontaneous reporting system databases. After an overview of pharmacovigilance and spontaneous reporting systems, we discuss the theory and application of contemporary computer algorithms in regular use, those under development, and the practical considerations involved in the implementation of computer algorithms within a comprehensive and holistic drug safety signal detection program.

  17. A decision-tree model to detect post-calving diseases based on rumination, activity, milk yield, BW and voluntary visits to the milking robot.

    Science.gov (United States)

    Steensels, M; Antler, A; Bahr, C; Berckmans, D; Maltz, E; Halachmi, I

    2016-09-01

    Early detection of post-calving health problems is critical for dairy operations. Separating sick cows from the herd is important, especially in robotic-milking dairy farms, where searching for a sick cow can disturb the other cows' routine. The objectives of this study were to develop and apply a behaviour- and performance-based health-detection model to post-calving cows in a robotic-milking dairy farm, with the aim of detecting sick cows based on available commercial sensors. The study was conducted in an Israeli robotic-milking dairy farm with 250 Israeli-Holstein cows. All cows were equipped with rumination- and neck-activity sensors. Milk yield, visits to the milking robot and BW were recorded in the milking robot. A decision-tree model was developed on a calibration data set (historical data of the 10 months before the study) and was validated on the new data set. The decision model generated a probability of being sick for each cow. The model was applied once a week just before the veterinarian performed the weekly routine post-calving health check. The veterinarian's diagnosis served as a binary reference for the model (healthy-sick). The overall accuracy of the model was 78%, with a specificity of 87% and a sensitivity of 69%, suggesting its practical value.

  18. In-Hospital Risk Prediction for Post-stroke Depression. Development and Validation of the Post-stroke Depression Prediction Scale

    NARCIS (Netherlands)

    Thóra Hafsteinsdóttir; Roelof G.A. Ettema; Diederick Grobbee; Prof. Dr. Marieke J. Schuurmans; Janneke van Man-van Ginkel; Eline Lindeman

    2013-01-01

    Background and Purpose—The timely detection of post-stroke depression is complicated by a decreasing length of hospital stay. Therefore, the Post-stroke Depression Prediction Scale was developed and validated. The Post-stroke Depression Prediction Scale is a clinical prediction model for the early

  19. Nested PCR Assay for Detection of Leishmania donovani in Slit Aspirates from Post-Kala-Azar Dermal Leishmaniasis Lesions

    Science.gov (United States)

    Sreenivas, Gannavaram; Ansari, N. A.; Kataria, Joginder; Salotra, Poonam

    2004-01-01

    A nested PCR assay to detect parasite DNA in slit aspirates from skin lesions of patients with post-kala-azar dermal lesihmaniasis (PKDL) is described. PCR results were positive in 27 of 29 (93%) samples by nested PCR assay, while only 20 of 29 (69%) were positive in a primary PCR assay. The nested PCR assay allowed reliable diagnosis of PKDL in a noninvasive manner. PMID:15071047

  20. Nested PCR Assay for Detection of Leishmania donovani in Slit Aspirates from Post-Kala-Azar Dermal Leishmaniasis Lesions

    OpenAIRE

    Sreenivas, Gannavaram; Ansari, N. A.; Kataria, Joginder; Salotra, Poonam

    2004-01-01

    A nested PCR assay to detect parasite DNA in slit aspirates from skin lesions of patients with post-kala-azar dermal lesihmaniasis (PKDL) is described. PCR results were positive in 27 of 29 (93%) samples by nested PCR assay, while only 20 of 29 (69%) were positive in a primary PCR assay. The nested PCR assay allowed reliable diagnosis of PKDL in a noninvasive manner.

  1. Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Dona, Manjola; Massi, Lucia; Settimo, Leonardo; Bartolini, Matteo; Gianni, Gianluca; Pupi, Alberto; Sciagra, Roberto [University of Florence, Nuclear Medicine Unit, Department of Clinical Physiopathology, Florence (Italy)

    2011-03-15

    The prognostic meaning of a post-stress ejection fraction (EF) decrease detected by perfusion gated SPECT is still unclear. We therefore followed up patients with post-stress EF decrease in the absence of stress-induced perfusion abnormalities. We prospectively enrolled 57 consecutive patients with post-stress EF drop {>=} 5 EF units and summed difference score (SDS) {<=} 1. They were followed up for more than 1 year and their outcome was compared with a group of sex- and age-matched controls with the same SDS but without EF decrease. During follow-up there were 13 events (1 cardiac death, 1 non-fatal myocardial infarction, 1 congestive heart failure and 10 late revascularizations). In the control group we registered six events. There was a significant difference (p < 0.0001) between the event-free survival curves of the two groups. The event rate of patients with post-stress EF decrease {>=} 5 EF units is relatively high and is significantly worse than that of a control group of patients with similarly normal SDS but without EF changes. Therefore, a post-stress EF decrease without stress-induced perfusion abnormalities should be cautiously interpreted. (orig.)

  2. Non-target activity detection by post-radioembolization yttrium-90 PET/CT: Image assessment technique and case examples

    Directory of Open Access Journals (Sweden)

    Yung Hsiang eKao

    2014-02-01

    Full Text Available High-resolution yttrium-90 (90Y imaging of post-radioembolization microsphere biodistribution may be achieved by conventional positron emission tomography with integrated computed tomography (PET/CT scanners that have time-of-flight capability. However, reconstructed 90Y PET/CT images have high background noise, making non-target activity detection technically challenging. This educational article describes our image assessment technique for non-target activity detection by 90Y PET/CT which qualitatively overcomes the problem of background noise. We present selected case examples of non-target activity in untargeted liver, stomach, gallbladder, chest wall and kidney, supported by angiography and 90Y bremsstrahlung single photon emission computed tomography with integrated computed tomography (SPECT/CT or technetium-99m macroaggregated albumin SPECT/CT.

  3. Comparison of the Mini-Mental State Examination and Montreal Cognitive Assessment executive subtests in detecting post-stroke cognitive impairment.

    Science.gov (United States)

    Fu, Chen; Jin, Xianglan; Chen, Baoxin; Xue, Feiran; Niu, Huanmin; Guo, Rongjuan; Chen, Zhigang; Zheng, Hong; Wang, Le; Zhang, Yunling

    2017-12-01

    The Montreal Cognitive Assessment (MoCA) has been shown to be more sensitive in detecting executive dysfunction than the Mini-Mental State Examination (MMSE). However, it is still not known whether all the MoCA executive subtests contribute to the superior sensitivity. Thus, the present study aimed to determine how much executive abnormality was detected by the MMSE and MoCA executive subtests in a population-based cohort of Chinese post-stroke patients. The MMSE and MoCA were collected from post-stroke patients (within 15 days to 1 month after stroke, including ischemic stroke and hemorrhagic stroke) in 14 hospitals of northern and southern China (including 10 top-graded hospitals and 4 community hospitals) between June 2011 and September 2013. The proportions of patients with incorrect MoCA executive subtests and the proportions of patients with incorrect MMSE executive subtests were compared. A total of 1222 patients (703 men and 519 women, aged 62.06 ± 10.68 and 62.76 ± 9.86 years, respectively) were recruited. The MoCA detected more patients with executive dysfunction than the MMSE (OR 15.399, 95% CI 12.631-18.773; P < 0.001). The likelihood of incorrect MMSE executive tasks increased across decreasing scores of MoCA executive tasks (P < 0.001 for trend). Compared with the MMSE three-step command test (15.5%), the MoCA trail-making (57.8%), abstraction (48.0%) and abstraction (measurement tool; 45.7%) detected more patients with executive dysfunction (P < 0.001), whereas the MoCA digit span forwards (4.3%) and backwards (11.6%) detected fewer patients (P < 0.001 and P = 0.005, respectively). The MoCA executive tasks are more sensitive in detecting executive dysfunction compared with the MMSE executive tasks. Geriatr Gerontol Int 2017; 17: 2329-2335. © 2017 Japan Geriatrics Society.

  4. Spot restoration for GPR image post-processing

    Science.gov (United States)

    Paglieroni, David W; Beer, N. Reginald

    2014-05-20

    A method and system for detecting the presence of subsurface objects within a medium is provided. In some embodiments, the imaging and detection system operates in a multistatic mode to collect radar return signals generated by an array of transceiver antenna pairs that is positioned across the surface and that travels down the surface. The imaging and detection system pre-processes the return signal to suppress certain undesirable effects. The imaging and detection system then generates synthetic aperture radar images from real aperture radar images generated from the pre-processed return signal. The imaging and detection system then post-processes the synthetic aperture radar images to improve detection of subsurface objects. The imaging and detection system identifies peaks in the energy levels of the post-processed image frame, which indicates the presence of a subsurface object.

  5. Detection of furcation involvement using periapical radiography and 2 cone-beam computed tomography imaging protocols with and without a metallic post: An animal study

    Energy Technology Data Exchange (ETDEWEB)

    Salineiro, Fernanda Cristina Sales; Gialain, Ivan Onone; Kobayashi-Velasco, Solange; Pannuti, Claudio Mendes; Cavalcanti, Marcelo Gusmao Paraiso [Dept. of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo (Brazil)

    2017-03-15

    The purpose of this study was to assess the accuracy, sensitivity, and specificity of the diagnosis of incipient furcation involvement with periapical radiography (PR) and 2 cone-beam computed tomography (CBCT) imaging protocols, and to test metal artifact interference. Mandibular second molars in 10 macerated pig mandibles were divided into those that showed no furcation involvement and those with lesions in the furcation area. Exams using PR and 2 different CBCT imaging protocols were performed with and without a metallic post. Each image was analyzed twice by 2 observers who rated the absence or presence of furcation involvement according to a 5-point scale. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy, sensitivity, and specificity of the observations. The accuracy of the CBCT imaging protocols ranged from 67.5% to 82.5% in the images obtained with a metallic post and from 72.5% to 80% in those without a metallic post. The accuracy of PR ranged from 37.5% to 55% in the images with a metallic post and from 42.5% to 62.5% in those without a metallic post. The area under the ROC curve values for the CBCT imaging protocols ranged from 0.813 to 0.802, and for PR ranged from 0.503 to 0.448. Both CBCT imaging protocols showed higher accuracy, sensitivity, and specificity than PR in the detection of incipient furcation involvement. Based on these results, CBCT may be considered a reliable tool for detecting incipient furcation involvement following a clinical periodontal exam, even in the presence of a metallic post.

  6. Post-factum detection of food irradiation

    International Nuclear Information System (INIS)

    Meier, W.

    1991-01-01

    Irradiation of food containing bones or shells can be detected with a high degree of certainty by means of ESR and by analysis of the volatile hydrocarbons or of the o-tyrosine. The last two methods are used for identification of irradiated pure meat samples. Detection of irradiation in spices and dried vegetables is possible with the thermoluminescence method and ESR, if non-irradiated control samples are available. These methods are being tested in the period 1990/1991 by an EC Commission-sponsored interlaboratory study of spices and food containing bones or shells, whereas the two chemical methods need further optimisation by work done in smaller working groups. (orig.) [de

  7. Object-Oriented Analysis of Satellite Images Using Artificial Neural Networks for Post-Earthquake Buildings Change Detection

    Science.gov (United States)

    Khodaverdi zahraee, N.; Rastiveis, H.

    2017-09-01

    Earthquake is one of the most divesting natural events that threaten human life during history. After the earthquake, having information about the damaged area, the amount and type of damage can be a great help in the relief and reconstruction for disaster managers. It is very important that these measures should be taken immediately after the earthquake because any negligence could be more criminal losses. The purpose of this paper is to propose and implement an automatic approach for mapping destructed buildings after an earthquake using pre- and post-event high resolution satellite images. In the proposed method after preprocessing, segmentation of both images is performed using multi-resolution segmentation technique. Then, the segmentation results are intersected with ArcGIS to obtain equal image objects on both images. After that, appropriate textural features, which make a better difference between changed or unchanged areas, are calculated for all the image objects. Finally, subtracting the extracted textural features from pre- and post-event images, obtained values are applied as an input feature vector in an artificial neural network for classifying the area into two classes of changed and unchanged areas. The proposed method was evaluated using WorldView2 satellite images, acquired before and after the 2010 Haiti earthquake. The reported overall accuracy of 93% proved the ability of the proposed method for post-earthquake buildings change detection.

  8. Drainage of Splenic Abscess: A Case Report | Kombo | Nigerian ...

    African Journals Online (AJOL)

    ... and was managed by tube drainage. His post operative recovery was uneventful. Conclusion: Tube drainage of the splenic abscess is encouraged if there is easy access to the abscess and there is evidence of residual splenic tissue in the critically ill patient. Key Word: Tube drainage, splenic abscess, splenectomy.

  9. Post-mortem detection of gasoline residues in lung tissue and heart blood of fire victims.

    Science.gov (United States)

    Pahor, Kevin; Olson, Greg; Forbes, Shari L

    2013-09-01

    The purpose of this study was to determine whether gasoline residues could be detected post-mortem in lung tissue and heart blood of fire victims. The lungs and heart blood were investigated to determine whether they were suitable samples for collection and could be collected without contamination during an autopsy. Three sets of test subjects (pig carcasses) were investigated under two different fire scenarios. Test subjects 1 were anaesthetized following animal ethics approval, inhaled gasoline vapours for a short period and then euthanized. The carcasses were clothed and placed in a house where additional gasoline was poured onto the carcass post-mortem in one fire, but not in the other. Test subjects 2 did not inhale gasoline, were clothed and placed in the house and had gasoline poured onto them in both fires. Test subjects 3 were clothed but had no exposure to gasoline either ante- or post-mortem. Following controlled burns and suppression with water, the carcasses were collected, and their lungs and heart blood were excised at a necropsy. The headspace from the samples was analysed using thermal desorption-gas chromatography-mass spectroscopy. Gasoline was identified in the lungs and heart blood from the subjects that were exposed to gasoline vapours prior to death (test subjects 1). All other samples were negative for gasoline residues. These results suggest that it is useful to analyse for volatile ignitable liquids in lung tissue and blood as it may help to determine whether a victim was alive and inhaling gases at the time of a fire.

  10. Comparative erythrocyte deformability investigations by filtrometry, slit-flow and rotational ektacytometry in a long-term follow-up animal study on splenectomy and different spleen preserving operative techniques: Partial or subtotal spleen resection and spleen autotransplantation.

    Science.gov (United States)

    Miko, Iren; Nemeth, Norbert; Sogor, Viktoria; Kiss, Ferenc; Toth, Eniko; Peto, Katalin; Furka, Andrea; Vanyolos, Erzsebet; Toth, Laszlo; Varga, Jozsef; Szigeti, Krisztian; Benkő, Ilona; Olah, Anna V; Furka, Istvan

    2017-01-01

    Partial or subtotal spleen resection or spleen autotransplantation can partly preserve/restore the splenic filtration function, as previous studies demonstrated. For better evaluation and follow-up of the various spleen-preserving operative techniques' effectiveness versus splenectomy, a composite methodological approach was applied in a canine experimental model. Beagle dogs were subjected to control (n = 6), splenectomy (SE, n = 4), partial and subtotal spleen resection (n = 4/each) or spleen autotransplantation groups (AU, Furka's spleen-chip method, n = 8). The follow-up period was 18 postoperative (p.o.) months. Erythrocyte deformability was determined in parallel by bulk filtrometry (Carat FT-1 filtrometer), slit-flow ektacytometry (RheoScan D-200) and rotational ektacytometry (LoRRca MaxSis Osmoscan). By filtrometry, relative cell transit time increased in the SE group (mostly in animal Nr. SE-3), showing the highest values on the 3rd, 9th and in 18th p.o. months. Elongation index values decreased in this group (both by slit-flow and rotational ektacytometers). In general, AU and two resection groups' values were lower versus control and higher than in SE. Forasmuch in the circulation both elongation by shear stress and filtration occur, these various erythrocyte deformability testing methods together may describe better the alterations. Considering the possible complications related to functional asplenic-hyposplenic conditions, individual analysis of cases is highly important.

  11. Selective on-line detection of boronic acids and derivatives in high-performance liquid chromatography eluates by post-column reaction with alizarin

    NARCIS (Netherlands)

    Duval, F.L.; Wardani, P.A.; Zuilhof, H.; Beek, van T.A.

    2015-01-01

    An on-line high-performance liquid chromatography (HPLC) method for the rapid and selective detection of boronic acids in complex mixtures was developed. After optimization experiments at an HPLC flow rate of 0.40 mL/min, the HPLC-separated analytes were mixed post-column with a solution of 75 µM

  12. Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy.

    Science.gov (United States)

    Kawanaka, Hirofumi; Akahoshi, Tomohiko; Nagao, Yoshihiro; Kinjo, Nao; Yoshida, Daisuke; Matsumoto, Yoshihiro; Harimoto, Norifumi; Itoh, Shinji; Yoshizumi, Tomoharu; Maehara, Yoshihiko

    2018-01-01

    Laparoscopic gastric devascularization(Lap GDS) and splenectomy (SPL) for gastric varices is technically challenging because of highly developed collateral vessels and bleeding tendency. We investigated the feasibility of customization of Lap GDS and SPL based on CT vascular anatomy. We analyzed 61 cirrhotic patients with gastric varices who underwent Lap GDS and SPL between 2006 and 2014. Lap GDS was customized according to the afferent feeding veins (left gastric vein (LGV) and/or posterior gastric vein (PGV)/short gastric vein (SGV)) and efferent drainage veins (gastrorenal shunt and/or gastrophrenic shunt, or numerous retroperitoneal veins) based on CT imaging. Thirty-four patients with efferent drainage veins suitable for balloon-occluded retrograde transvenous obliteration (B-RTO) underwent B-RTO instead of surgical GDS, with subsequent Lap SPL. Among 27 patients with gastric varices unsuitable for B-RTO, 15 patients with PGV/SGV underwent Lap GDS of the greater curvature and SPL, and 12 patients with LGV or LGV/PGV/SGV underwent Lap GDS of the greater and lesser curvature and SPL. The mean operation time was 294 min and mean blood loss was 198 g. There was no mortality or severe morbidity. Gastric varices were eradicated in all 61 patients, with no bleeding or recurrence during a mean follow-up of 55.9 months. The cumulative 3-, 5-, and 7-year survival rates were 92, 82, and 64%, respectively. Lap GDS and SPL customized based on CT vascular anatomy is a safe and effective procedure for treating gastric varices.

  13. Post-column derivatization capillary electrochromatography for detection of biogenic amines in tuna-meat.

    Science.gov (United States)

    Oguri, Shigeyuki; Okuya, Yukie; Yanase, Yukiko; Suzuki, Sayaka

    2008-08-15

    A system to perform post-column derivatization capillary electrochromatography (CEC) was developed for the first time. The system mainly included a 4-microm (O.D.) silica packed column (200 mm effective length x 0.1 mm inner diameter I.D.) with micro-magnetic particles (MMPs) frits, a T-junction connector, an in-line fluorescence detector and a high-voltage power supply. The system was evaluated by using histamine (HA) as a standard biogenic amine for this study. A 5 microM HA solution was loaded at the anodic site of the capillary column by applying 3 kV for 5s. Then, HA was electrophoretically eluted with a 20mM phosphate buffer (pH 7) by applying 3 kV, and was derivatized with 3mM o-phthalaldehyde (OPA)/N-acetylcysteine (NAC) in 100 mM borate (pH 10), which was continuously delivered through the reagent-loading capillary tube by gravity into the T-junction connector. HA derivative was finally detected with the in-line fluorescence detector (lambda(Ex)=340 nm, lambda(Em)=450 nm) at 9.7 min after sample loading. To test the utility of this system, it was next employed for its ability to detect the presence of HA and other kinds of biogenic amines, including cadaverine (Cad), spermidine (Spm) and tyramine (Tyr) in tuna-meat, once the validity of the method had been confirmed.

  14. Video segmentation for post-production

    Science.gov (United States)

    Wills, Ciaran

    2001-12-01

    Specialist post-production is an industry that has much to gain from the application of content-based video analysis techniques. However the types of material handled in specialist post-production, such as television commercials, pop music videos and special effects are quite different in nature from the typical broadcast material which many video analysis techniques are designed to work with; shots are short and highly dynamic, and the transitions are often novel or ambiguous. We address the problem of scene change detection and develop a new algorithm which tackles some of the common aspects of post-production material that cause difficulties for past algorithms, such as illumination changes and jump cuts. Operating in the compressed domain on Motion JPEG compressed video, our algorithm detects cuts and fades by analyzing each JPEG macroblock in the context of its temporal and spatial neighbors. Analyzing the DCT coefficients directly we can extract the mean color of a block and an approximate detail level. We can also perform an approximated cross-correlation between two blocks. The algorithm is part of a set of tools being developed to work with an automated asset management system designed specifically for use in post-production facilities.

  15. Evaluating cessation of the type 2 oral polio vaccine by modeling pre- and post-cessation detection rates.

    Science.gov (United States)

    Kroiss, Steve J; Famulare, Michael; Lyons, Hil; McCarthy, Kevin A; Mercer, Laina D; Chabot-Couture, Guillaume

    2017-10-09

    The globally synchronized removal of the attenuated Sabin type 2 strain from the oral polio vaccine (OPV) in April 2016 marked a major change in polio vaccination policy. This change will provide a significant reduction in the burden of vaccine-associated paralytic polio (VAPP), but may increase the risk of circulating vaccine-derived poliovirus (cVDPV2) outbreaks during the transition period. This risk can be monitored by tracking the disappearance of Sabin-like type 2 (SL2) using data from the polio surveillance system. We studied SL2 prevalence in 17 countries in Africa and Asia, from 2010 to 2016 using acute flaccid paralysis surveillance data. We modeled the peak and decay of SL2 prevalence following mass vaccination events using a beta-binomial model for the detection rate, and a Ricker function for the temporal dependence. We found type 2 circulated the longest of all serotypes after a vaccination campaign, but that SL2 prevalence returned to baseline levels in approximately 50days. Post-cessation model predictions identified 19 anomalous SL2 detections outside of model predictions in Afghanistan, India, Nigeria, Pakistan, and western Africa. Our models established benchmarks for the duration of SL2 detection after OPV2 cessation. As predicted, SL2 detection rates have plummeted, except in Nigeria where OPV2 use continued for some time in response to recent cVDPV2 detections. However, the anomalous SL2 detections suggest specific areas that merit enhanced monitoring for signs of cVDPV2 outbreaks. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  16. Determination of uranium in aqueous solutions by HPLC post column UV/VIS detection

    International Nuclear Information System (INIS)

    Abbasi, W.A.; Street, M.

    1995-01-01

    Analysis of uranium in different nitric acid concentration solutions is interest in nuclear industry where it is present in various process and waste streams. A method for the determination of uranium(VI) in nitric acid solution in described using ion chromatography and post-column derivatization with 4-(2-pyridylazo) resorcinol (PAR). The method does not require any sample treatment for acid removal or neutralization and can be used for routine laboratory analysis. The effluent used was ammonium sulphate / sulphuric acid and PAR was present in ammonium hydroxide/acetic acid buffer. The column effluents is reacted with PAR in a reaction coil and U(VI)-PAR complex is detector at 528 nm. The lowest uranium concentration detected was 100 ppb (0.1 mg/sup -1/) and linearity of up to 8 mgl -1 concentration was verified. The standard deviation in reproducibility at uranium concentration of 0.1 mgl/sup -1/ was 0.82%. (author)

  17. [Spleen-preserving surgery after blunt abdominal trauma with splenic hilum involvement].

    Science.gov (United States)

    Navas-Cuéllar, José Aurelio; Cañete-Gómez, Jesús; López-Bernal, Francisco; García-Rivera, Carla; Pareja-Ciuró, Felipe; Padillo-Ruiz, Javier

    2015-01-01

    Splenic involvement secondary to blunt abdominal trauma is often treated by performing a splenectomy. The severity of the post-splenectomy syndrome is currently well known (blood loss, sepsis), so there is an increasing tendency to preserve the spleen. The case is presented of splenic preservation after blunt abdominal trauma with hilum involvement, emphasising the role of Floseal as a haemostatic agent, as well as the use of resorbable meshes to preserve the spleen. A 22-year-old woman presenting with a grade IV splenic lesion secondary to a blunt abdominal trauma after a traffic accident. Partial splenic resection was performed and bleeding was controlled with Floseal and use of a reinforcing polyglycolic acid mesh. No postoperative complications occurred, being discharged on day 5. The long-term follow-up has been uneventful. The use of haemostatic agents such as thrombin and the gelatine gel (FloSeal) and the use of polyglycolic acid meshes enable spleen-preserving surgery, making it a feasible and reproducible procedure and an alternative to classical splenectomy. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  18. Function of the replanted spleen in dogs

    International Nuclear Information System (INIS)

    Velcek, F.T.; Kugaczewski, J.T.; Jongco, B.; Shaftan, G.W.; Rao, P.S.; Schiffman, G.; Kottmeier, P.K.

    1982-01-01

    The function of replanted splenic fragments was studied by comparing three groups of five dogs each, one group with intact spleens; one, post-splenectomy; and one with splenic replantation. Fifteen fragments were implanted into the omentum. Howell-Jolly bodies appeared after splenectomy but cleared in the replanted group after several months. 125 I-tagged attenuated pneumococcal clearance studies showed a significant difference between control and replanted group compared with the splenectomized group. The increase of pneumococcal antibody titers after vaccination differed significantly between the splenectomized and the replanted group. All replanted fragments were viable and showed growth over a 2-year period. These studies demonstrate that omental replantation of the canine spleen leads to the maintenance of certain functional splenic parameters comparable to the normal spleen which are significantly different from the splenectomized animal

  19. Function of the replanted spleen in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Velcek, F.T.; Kugaczewski, J.T.; Jongco, B.; Shaftan, G.W.; Rao, P.S.; Schiffman, G.; Kottmeier, P.K.

    1982-06-01

    The function of replanted splenic fragments was studied by comparing three groups of five dogs each, one group with intact spleens; one, post-splenectomy; and one with splenic replantation. Fifteen fragments were implanted into the omentum. Howell-Jolly bodies appeared after splenectomy but cleared in the replanted group after several months. /sup 125/I-tagged attenuated pneumococcal clearance studies showed a significant difference between control and replanted group compared with the splenectomized group. The increase of pneumococcal antibody titers after vaccination differed significantly between the splenectomized and the replanted group. All replanted fragments were viable and showed growth over a 2-year period. These studies demonstrate that omental replantation of the canine spleen leads to the maintenance of certain functional splenic parameters comparable to the normal spleen which are significantly different from the splenectomized animal.

  20. A sensitive mass spectrometric method for hypothesis-driven detection of peptide post-translational modifications: multiple reaction monitoring-initiated detection and sequencing (MIDAS).

    Science.gov (United States)

    Unwin, Richard D; Griffiths, John R; Whetton, Anthony D

    2009-01-01

    The application of a targeted mass spectrometric workflow to the sensitive identification of post-translational modifications is described. This protocol employs multiple reaction monitoring (MRM) to search for all putative peptides specifically modified in a target protein. Positive MRMs trigger an MS/MS experiment to confirm the nature and site of the modification. This approach, termed MIDAS (MRM-initiated detection and sequencing), is more sensitive than approaches using neutral loss scanning or precursor ion scanning methodologies, due to a more efficient use of duty cycle along with a decreased background signal associated with MRM. We describe the use of MIDAS for the identification of phosphorylation, with a typical experiment taking just a couple of hours from obtaining a peptide sample. With minor modifications, the MIDAS method can be applied to other protein modifications or unmodified peptides can be used as a MIDAS target.

  1. Splenomegaly in sarcoidosis: Frequency, treatment, prognosis and long-term follow-up

    Directory of Open Access Journals (Sweden)

    Pavlović-Popović Zora

    2015-01-01

    Full Text Available Introduction. The splenic involvement is common in sarcoidosis, but its real frequency is still obscure, depending doubtless on the method of splenomegaly detection. Splenomegaly may be accompanied with pain or anemia, leucopenia and thrombocytopenia. Objective. The aim of this study was to investigate the frequency of splenomegaly related to clinical characteristics of sarcoidosis and to solve the dilemma - whether to introduce medicaments, and when to perform splenectomy. Methods. The method of the study is a retrospective and prospective analysis of the patients’ material. Results. The study included 540 patients with sarcoidosis in a 20-year period. Of them, 26% had splenomegaly detected by computerized tomography screening. Splenomegaly was more frequently registered in the patients with a longer history of sarcoidosis (38%, as compared to those with a shorter history of the disease (23% (p<0.05. Splenomegaly was more frequently registered in the patients with other extrapulmonary lesions detected (33% than in those who had no extrapulmonary manifestations of sarcoidosis (17% (p<0.01. Indications, possible benefits and complications of splenectomy were analysed in 11 sarcoidosis patients undergoing this intervention for various reasons, of which the follow-up period ranged from one to 20 years. Conclusion. Splenomegaly was more frequent in chronic cases or in the patients with established sarcoid lesions of other extrapulmonary organs. The primary treatment of uncomplicated symptomatic splenic sarcoidosis includes medicamentous therapy. Occasionally, splenectomy is required. Prognostically, splenomegaly indicates an unfavorable course of the disease.

  2. Epstein-Barr virus load in transplant patients: Early detection of post-transplant lymphoproliferative disorders.

    Science.gov (United States)

    Fellner, María Dolores; Durand, Karina A; Solernou, Veronica; Bosaleh, Andrea; Balbarrey, Ziomara; García de Dávila, María T; Rodríguez, Marcelo; Irazu, Lucía; Alonio, Lidia V; Picconi, María A

    2016-01-01

    High levels of circulating EBV load are used as a marker of post-transplant lymphoproliferative disorders (PTLD). There is no consensus regarding the threshold level indicative of an increase in peripheral EBV DNA. The aim of the study was to clinically validate a developed EBV quantification assay for early PTLD detection. Transversal study: paired peripheral blood mononuclear cells (PBMC), plasma and oropharyngeal lymphoid tissue (OLT) from children undergoing a solid organ transplant with (n=58) and without (n=47) PTLD. Retrospective follow-up: 71 paired PBMC and plasma from recipients with (n=6) and without (n=6) PTLD history. EBV load was determined by real-time PCR. The diagnostic ability to detect all PTLD (categories 1-4), advanced PTLD (categories 2-4) or neoplastic PTLD (categories 3 and 4) was estimated by analyzing the test performance at different cut-off values or with a load variation greater than 0.5log units. The higher diagnostic performance for identifying all, advanced or neoplastic PTLD, was achieved with cut-off values of 1.08; 1.60 and 2.47log EBVgEq/10(5) PBMC or 2.30; 2.60; 4.47loggEq/10(5) OLT cells, respectively. EBV DNA detection in plasma showed high specificity but low (all categories) or high (advanced/neoplastic categories) sensitivity for PTLD identification. Diagnostic performance was greater when: (1) a load variation in PBMC or plasma was identified; (2) combining the measure of EBV load in PBMC and plasma. The best diagnostic ability to identify early PTLD stages was achieved by monitoring EBV load in PBMC and plasma simultaneously; an algorithm was proposed. Copyright © 2016 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. HABITABLE ZONES OF POST-MAIN SEQUENCE STARS

    International Nuclear Information System (INIS)

    Ramirez, Ramses M.; Kaltenegger, Lisa

    2016-01-01

    Once a star leaves the main sequence and becomes a red giant, its Habitable Zone (HZ) moves outward, promoting detectable habitable conditions at larger orbital distances. We use a one-dimensional radiative-convective climate and stellar evolutionary models to calculate post-MS HZ distances for a grid of stars from 3700 to 10,000 K (∼M1 to A5 stellar types) for different stellar metallicities. The post-MS HZ limits are comparable to the distances of known directly imaged planets. We model the stellar as well as planetary atmospheric mass loss during the Red Giant Branch (RGB) and Asymptotic Giant Branch (AGB) phases for super-Moons to super-Earths. A planet can stay between 200 million years up to 9 Gyr in the post-MS HZ for our hottest and coldest grid stars, respectively, assuming solar metallicity. These numbers increase for increased stellar metallicity. Total atmospheric erosion only occurs for planets in close-in orbits. The post-MS HZ orbital distances are within detection capabilities of direct imaging techniques.

  4. HABITABLE ZONES OF POST-MAIN SEQUENCE STARS

    Energy Technology Data Exchange (ETDEWEB)

    Ramirez, Ramses M.; Kaltenegger, Lisa [Carl Sagan Institute, Cornell University, Ithaca, NY (United States)

    2016-05-20

    Once a star leaves the main sequence and becomes a red giant, its Habitable Zone (HZ) moves outward, promoting detectable habitable conditions at larger orbital distances. We use a one-dimensional radiative-convective climate and stellar evolutionary models to calculate post-MS HZ distances for a grid of stars from 3700 to 10,000 K (∼M1 to A5 stellar types) for different stellar metallicities. The post-MS HZ limits are comparable to the distances of known directly imaged planets. We model the stellar as well as planetary atmospheric mass loss during the Red Giant Branch (RGB) and Asymptotic Giant Branch (AGB) phases for super-Moons to super-Earths. A planet can stay between 200 million years up to 9 Gyr in the post-MS HZ for our hottest and coldest grid stars, respectively, assuming solar metallicity. These numbers increase for increased stellar metallicity. Total atmospheric erosion only occurs for planets in close-in orbits. The post-MS HZ orbital distances are within detection capabilities of direct imaging techniques.

  5. Lipidic profile among rats submitted to total splenectomy isolated or combined with splenic autotransplant Perfil lipídico em ratos submetidos a esplenectomia total isolada ou combinada com auto-implante esplênico

    Directory of Open Access Journals (Sweden)

    Fernanda Correia Simões

    2007-01-01

    Full Text Available PURPOSE: To evaluate the alterations on plasmatic lipids levels among rats submitted to total splenectomy isolated or combined with splenic autotransplant receiving standard chow during the postoperative period. METHODS: Thirty Wistar rats were divided into three groups: control (C - sham-operated, total splenectomy - isolated (TS or combined with splenic autotransplantation (SA. Since the postoperative period, all animals received standard rat chow manipulated in accordance to the American Institute of Nutrition Rodents Diets (1993. The plasmatic levels of total cholesterol (TC, triglycerides (TG, high-density lipoprotein (HDL, low-density lipoprotein (LDL, very-low-density lipoprotein (VLDL, and glucose (GLUC were analyzed before the surgical procedure and after 6 and 12 weeks. RESULTS: All the animals presented significant increase of TG and VLDL levels. In relation to the other parameters there was no difference among the weeks 0 and 12 in the animals of group C. In TS group significant increase was observed in TC and GLUC levels during the experiment. In SA group TC, HDL, and GLUC levels remained unaffected while HDL levels increased. CONCLUSION: Our findings suggest that isolated total splenectomy alters lipids metabolism in rats fed with standard chow and splenic autotransplantation is effective in restoring its control.OBJETIVO: Avaliar as alterações nos níveis de lipídios plasmáticos em ratos submetidos a esplenectomia total isolada ou combinada com auto-implante esplênico, recebendo dieta padrão no período pós-operatório. MÉTODOS: Trinta ratos Wistar foram distribuídos em três grupos: controle (C - operação simulada, esplenectomia total isolada (ET ou combinada com auto-implante esplênico (AE. A partir do período pós-operatório, todos os animais receberam ração padrão, manipulada segundo o American Institute of Nutrition (1993. Os níveis plasmáticos de colesterol total (CT, triglicerídeos (TG, lipoproteína de

  6. Dapsone Induced Methaemoglobinemia: Early Intraoperative Detection by Pulse Oximeter Desaturation

    Directory of Open Access Journals (Sweden)

    Mahmood Rafiq

    2008-01-01

    Case signifies the importance of knowledge of any preoperative drug intake and its anaesthetic implications. Also patients on dapsone therapy especially children should be monitored for methaemoglobin levels. Since children with immune thrombocy-topenic purpura are being treated with dapsone these days and many of these patients would be planned for splenectomy, monitoring of preoperative methaemoglobin levels and methaemoglobinemia as a cause of intraoperative pulse oximeter desaturation should be kept in mind.

  7. Detection and differentiation of early acute and following age stages of myocardial infarction with quantitative post-mortem cardiac 1.5T MR.

    Science.gov (United States)

    Schwendener, Nicole; Jackowski, Christian; Persson, Anders; Warntjes, Marcel J; Schuster, Frederick; Riva, Fabiano; Zech, Wolf-Dieter

    2017-01-01

    Recently, quantitative MR sequences have started being used in post-mortem imaging. The goal of the present study was to evaluate if early acute and following age stages of myocardial infarction can be detected and discerned by quantitative 1.5T post-mortem cardiac magnetic resonance (PMCMR) based on quantitative T1, T2 and PD values. In 80 deceased individuals (25 female, 55 male), a cardiac MR quantification sequence was performed prior to cardiac dissection at autopsy in a prospective study. Focal myocardial signal alterations detected in synthetically generated MR images were MR quantified for their T1, T2 and PD values. The locations of signal alteration measurements in PMCMR were targeted at autopsy heart dissection and cardiac tissue specimens were taken for histologic examinations. Quantified signal alterations in PMCMR were correlated to their according histologic age stage of myocardial infarction. In PMCMR seventy-three focal myocardial signal alterations were detected in 49 of 80 investigated hearts. These signal alterations were diagnosed histologically as early acute (n=39), acute (n=14), subacute (n=10) and chronic (n=10) age stages of myocardial infarction. Statistical analysis revealed that based on their quantitative T1, T2 and PD values, a significant difference between all defined age groups of myocardial infarction can be determined. It can be concluded that quantitative 1.5T PMCMR quantification based on quantitative T1, T2 and PD values is feasible for characterization and differentiation of early acute and following age stages of myocardial infarction. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Cantilever steel post damaged by wind

    Directory of Open Access Journals (Sweden)

    Wei Sha

    2014-10-01

    Full Text Available An analysis for the cause of fracture failure of a cantilever steel sign post damaged by wind has been carried out. An unusual cause of failure has been identified, which is the subject of this paper. Microscopy and microanalysis of the fracture surface showed that the failure was due to pre-existing cracks, from the fabrication of the post. This conclusion was reached after detecting and analysing a galvanised layer on the fracture surfaces.

  9. Detection and quantitation of twenty-seven cytokines, chemokines and growth factors pre- and post-high abundance protein depletion in human plasma

    Directory of Open Access Journals (Sweden)

    Seong-Beom Ahn

    2014-06-01

    Full Text Available Cytokines, chemokines and growth factors (CCGFs in human plasma are analyzed for identification of biomarkers. However concentrations of CCGFs are very low; it is difficult to identify and quantify low abundance proteins in the presence of the high abundance proteins (HAPs unless HAPs are removed prior to analysis. However, there is a concern that the low abundance proteins such as CCGFs may also be removed during the HAP depletion process. In this study, we have examined whether or not depletion of the HAPs enhances detection of the CCGFs by immuno-assays. Top 14 HAPs were depleted from 10 healthy volunteers’ plasma using MARS-14 immuno-depletion column and a total of 27 CCGFs were analyzed by bead-based multiplexed immuno-assay. All 27 CCGFs were detected in neat plasma (NP, 25 were detected in flow through fraction (FT and 21 were detected in bound protein (BP fraction. Concentrations of 22 CCGFs were significantly higher in NP compared to FT and BP. Only one CCGF had higher concentration in FT compared to NP. The remaining 2 CCGFs were not different between NP and FT. It was counter-productive for the detection of 24 CCGFs after HAP removal, primarily due to post-depletion protein precipitation and/or re-suspension of pellets.

  10. Spatially assisted down-track median filter for GPR image post-processing

    Science.gov (United States)

    Paglieroni, David W; Beer, N Reginald

    2014-10-07

    A method and system for detecting the presence of subsurface objects within a medium is provided. In some embodiments, the imaging and detection system operates in a multistatic mode to collect radar return signals generated by an array of transceiver antenna pairs that is positioned across the surface and that travels down the surface. The imaging and detection system pre-processes the return signal to suppress certain undesirable effects. The imaging and detection system then generates synthetic aperture radar images from real aperture radar images generated from the pre-processed return signal. The imaging and detection system then post-processes the synthetic aperture radar images to improve detection of subsurface objects. The imaging and detection system identifies peaks in the energy levels of the post-processed image frame, which indicates the presence of a subsurface object.

  11. Detecting post-fire burn severity and vegetation recovery using multitemporal remote sensing spectral indices and field-collected composite burn index data in a ponderosa pine forest

    Science.gov (United States)

    Chen, Xuexia; Vogelmann, James E.; Rollins, Matt; Ohlen, Donald; Key, Carl H.; Yang, Limin; Huang, Chengquan; Shi, Hua

    2011-01-01

    It is challenging to detect burn severity and vegetation recovery because of the relatively long time period required to capture the ecosystem characteristics. Multitemporal remote sensing data can providemultitemporal observations before, during and after a wildfire, and can improve the change detection accuracy. The goal of this study is to examine the correlations between multitemporal spectral indices and field-observed burn severity, and to provide a practical method to estimate burn severity and vegetation recovery. The study site is the Jasper Fire area in the Black Hills National Forest, South Dakota, that burned during August and September 2000. Six multitemporal Landsat images acquired from 2000 (pre-fire), 2001 (post-fire), 2002, 2003, 2005 and 2007 were used to assess burn severity. The normalized difference vegetation index (NDVI), enhanced vegetation index (EVI), normalized burn ratio (NBR), integrated forest index (IFI) and the differences of these indices between the pre-fire and post-fire years were computed and analysed with 66 field-based composite burn index (CBI) plots collected in 2002. Results showed that differences of NDVI and differences of EVI between the pre-fire year and the first two years post-fire were highly correlated with the CBI scores. The correlations were low beyond the second year post-fire. Differences of NBR had good correlation with CBI scores in all study years. Differences of IFI had low correlation with CBI in the first year post-fire and had good correlation in later years. A CBI map of the burnt area was produced using regression tree models and the multitemporal images. The dynamics of four spectral indices from 2000 to 2007 indicated that both NBR and IFI are valuable for monitoring long-term vegetation recovery. The high burn severity areas had a much slower recovery than the moderate and low burn areas.

  12. Electromagnetic packable technology (EMPACT) for detection and characterization of ordnance in post-conflict areas

    Science.gov (United States)

    Schultz, Gregory; Miller, Jonathan; Keranen, Joe

    2013-06-01

    Land reclamation efforts in post-conflict regions are often hampered by the presence of Unexploded Ordnance (UXO) or other Explosive Remnants of War (ERW). Surface geophysical methods, such as Electromagnetic Induction (EMI) and magnetometry, are typically applied to screen rehabilitation areas for UXO prior to excavation; however, the prevalence of innocuous magnetic clutter related to indigenous scrap, fragmentation, or geology can severely impede the progress and efficiency of these remediation efforts. Additionally, the variability in surface conditions and local topography necessitates the development of sensor technologies that can be applied to a range of sites including those that prohibit the use of vehicle-mounted or large array systems. We present a man-portable EMI sensor known as the Electromagnetic Packable Technology (EMPACT) system that features a multi-axis sensor configuration in a compact form factor. The system is designed for operation in challenging site conditions and can be used in low ground-standoff modes to detect small and low-metal content objects. The EMPACT acquires high spatial density, multi-axis data that enable high resolution of small objects. This high density data can also be used to provide characterization of target physical features, such as size, material content, and shape. We summarize the development of this system for humanitarian demining operations and present results from preliminary system evaluations against a range of target types. Specifically, we assess the general detection capabilities of the EMPACT system and we evaluate the potential for target classification based on analysis of data and target model features.

  13. Buried object detection in GPR images

    Science.gov (United States)

    Paglieroni, David W; Chambers, David H; Bond, Steven W; Beer, W. Reginald

    2014-04-29

    A method and system for detecting the presence of subsurface objects within a medium is provided. In some embodiments, the imaging and detection system operates in a multistatic mode to collect radar return signals generated by an array of transceiver antenna pairs that is positioned across the surface and that travels down the surface. The imaging and detection system pre-processes the return signal to suppress certain undesirable effects. The imaging and detection system then generates synthetic aperture radar images from real aperture radar images generated from the pre-processed return signal. The imaging and detection system then post-processes the synthetic aperture radar images to improve detection of subsurface objects. The imaging and detection system identifies peaks in the energy levels of the post-processed image frame, which indicates the presence of a subsurface object.

  14. Investigating the real translucency of the endodontic fiber posts

    Science.gov (United States)

    Camilotti, Fernando; Bonardi, Cláudia; Somer, Aloisi; Novatski, Andressa; Szesz, Anna Luiza; Loguércio, Alessandro Dourado; Kniphoff da Cruz, Gerson

    2018-02-01

    Researchers have been investigating the light intensity scattered by a translucent fiber post with application in dentistry by different methods. In this work, we introduce a new system capable to record a light scattered profile, step-by-step, as a function of the length of the translucent fiber post. To support our studies, an extensive characterization of the system was carried out and this is presented and discussed here. The system was implemented using the phase sensitive detection. The equipment measures the light scattered without the need of any preparing parts and the fiber post is fixed directly in the fiber post holder becoming ready for measurement. Measures can be recorded with a spatial resolution smaller than 0.01 mm throughout the length of the fiber post being investigated. The system was implemented by using a photomultiplier tube that improves sensitivity for the optical detection. The recorded result is a signal directly proportional to the scattered light and it allows us to obtain a normalized profile that can be used as a map of the scattered light of the fiber post in study. Furthermore, we are able to demonstrate a low intensity of light in the tip region of the fiber post, along with the dependency of the light attenuation with the fiber post body volume and shape. This new system will certainly contribute to achieve better results in fiber post designing and in restoration of endodontic treated teeth because it provides a more well-founded choice of the fiber post to be used, and of the time of exposure to the curing light.

  15. Investigating the real translucency of the endodontic fiber posts

    Directory of Open Access Journals (Sweden)

    Fernando Camilotti

    2018-02-01

    Full Text Available Researchers have been investigating the light intensity scattered by a translucent fiber post with application in dentistry by different methods. In this work, we introduce a new system capable to record a light scattered profile, step-by-step, as a function of the length of the translucent fiber post. To support our studies, an extensive characterization of the system was carried out and this is presented and discussed here. The system was implemented using the phase sensitive detection. The equipment measures the light scattered without the need of any preparing parts and the fiber post is fixed directly in the fiber post holder becoming ready for measurement. Measures can be recorded with a spatial resolution smaller than 0.01 mm throughout the length of the fiber post being investigated. The system was implemented by using a photomultiplier tube that improves sensitivity for the optical detection. The recorded result is a signal directly proportional to the scattered light and it allows us to obtain a normalized profile that can be used as a map of the scattered light of the fiber post in study. Furthermore, we are able to demonstrate a low intensity of light in the tip region of the fiber post, along with the dependency of the light attenuation with the fiber post body volume and shape. This new system will certainly contribute to achieve better results in fiber post designing and in restoration of endodontic treated teeth because it provides a more well-founded choice of the fiber post to be used, and of the time of exposure to the curing light.

  16. Hidden psychiatric morbidity. Part II: Training health care workers in detection: a pre- and post-study at Karanda Mission Hospital.

    Science.gov (United States)

    Hall, A; Williams, H

    1987-11-01

    A simple 5-session training program covering basic mental health problems, and instruction in the use of the Harding Self Report Questionaire, was instituted at Karanda Mission Hospital to help medical students recognise hidden psychiatric morbidity in somatically presenting patients. The Harding Self Report Questionaire was used as both a detection and training instrument, together with a Health Staff Rating Scale. Medical Assistants were assessed pre- and post-training on 2 measures--specificity and sensitivity. The training program demonstrated that health care workers can be trained to more accurately detect and diagnose hidden psychiatric disorder in this group of patients. An additional benefit was that workers developed an increased interest in this difficult area of patient care. In a previous study, the prevalence of hidden psychiatric morbidity in a general medical outpatient population in Bindura Provincial was found to be in line with other developing countries (i.e., in excess of 10%) and detection rate by health care workers (4.25%) was low, although comparable to that found in other studies. One of the conclusions reached after the Bindura study was that a simple program was needed to alert workers to recognise underlying psychiatric disorder in somatically presenting patients. With this in mind, the training program was devised and given at Karanda Mission Hospital which is situated about 220 km from Harare, Zimbabwe. It has 120 beds and is staffed by 2 doctors, 3 locally trained SRNs, several American trained SRNs, and 3 locally trained medical assistants. It also runs a nursing school for medical assistants. The hospital serves a population drawn from both subsistence and purchase area farmers, but is less diverse that that of Bindura. The training program was shown to be effective, as demonstrated in the improved accuracy in detection and diagnosis by medical assistants. The improvement post-training is perhaps all the more remarkable when the

  17. Limbic encephalitis presenting as a post-partum psychiatric condition.

    OpenAIRE

    Gotkine, Marc; Ben-Hur, Tamir; Vincent, Angela; Vaknin-Dembinsky, Adi

    2011-01-01

    OBJECTIVE: We describe a woman who presented with a psychiatric disorder post-partum and subsequently developed seizures and cognitive dysfunction prompting further investigation. A diagnosis of limbic encephalitis (LE) was made and antibodies to voltage-gated potassium channel complex (VGKC) detected. These antibodies are found in many non-paraneoplastic patients with LE. Although antibody-mediated conditions tend to present or relapse post-partum, VGKC-LE in the post-partum period has not b...

  18. In first-time mothers, post-partum depressive symptom prospectively predict symptoms of post-traumatic stress.

    Science.gov (United States)

    Shahar, Golan; Herishanu-Gilutz, Shirley; Holcberg, Gershon; Kofman, Ora

    2015-11-01

    Symptoms of both depression and Post-Traumatic Stress Disorder (PTSD) are prevalent among first-time mothers following birth. However, the direction of the association between the two types of symptoms is unclear. Ninety six first-time mothers giving birth via vaginal delivery (N=38), emergency C-Section (N=27) and planned C-Section (N=21) were assessed for depression and PTSD twice: Six weeks post-partum and six-weeks later. Cross-lagged Structural Equation Modeling (SEM) analyses revealed a prospective effect of depressive symptoms on PTSD symptoms. No moderating factors were identified. A relatively modest sample size and only two assessment waves. An early detection and intervention with symptoms of post-partum depression might also prevent the development of PTSD symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Welcome to the Twilight Zone: The Mid-infrared Properties of Post-starburst Galaxies

    Science.gov (United States)

    Alatalo, Katherine; Bitsakis, Theodoros; Lanz, Lauranne; Lacy, Mark; Brown, Michael J. I.; French, K. Decker; Ciesla, Laure; Appleton, Philip N.; Beaton, Rachael L.; Cales, Sabrina L.; Crossett, Jacob; Falcón-Barroso, Jesús; Kelson, Daniel D.; Kewley, Lisa J.; Kriek, Mariska; Medling, Anne M.; Mulchaey, John S.; Nyland, Kristina; Rich, Jeffrey A.; Urry, C. Meg

    2017-07-01

    We investigate the optical and Wide-field Survey Explorer (WISE) colors of “E+A” identified post-starburst galaxies, including a deep analysis of 190 post-starbursts detected in the 2 μm All Sky Survey Extended Source Catalog. The post-starburst galaxies appear in both the optical green valley and the WISE Infrared Transition Zone. Furthermore, we find that post-starbursts occupy a distinct region of [3.4]-[4.6] versus [4.6]-[12] WISE colors, enabling the identification of this class of transitioning galaxies through the use of broadband photometric criteria alone. We have investigated possible causes for the WISE colors of post-starbursts by constructing a composite spectral energy distribution (SED), finding that the mid-infrared (4-12 μm) properties of post-starbursts are consistent with either 11.3 μm polycyclic aromatic hydrocarbon emission, or thermally pulsating asymptotic giant branch (TP-AGB) and post-AGB stars. The composite SED of extended post-starburst galaxies with 22 μm emission detected with signal-to-noise ratio ≥slant 3 requires a hot dust component to produce their observed rising mid-infrared SED between 12 and 22 μm. The composite SED of WISE 22 μm non-detections (S/N systems. This could mean that including selections capable of identifying AGNs as part of a search for transitioning and post-starburst galaxies would create a more complete census of the transition pathways taken as a galaxy quenches its star formation.

  20. Influence of post pattern and resin cement curing mode on the retention of glass fibre posts.

    Science.gov (United States)

    Poskus, L T; Sgura, R; Paragó, F E M; Silva, E M; Guimarães, J G A

    2010-04-01

    To evaluate the influence of post design and roughness and cement system (dual- or self-cured) on the retention of glass fibre posts. Two tapered and smooth posts (Exacto Cônico No. 2 and White Post No. 1) and two parallel-sided and serrated posts (Fibrekor 1.25 mm and Reforpost No. 2) were adhesively luted with two different resin cements--a dual-cured (Rely-X ARC) and a self-cured (Cement Post)--in 40 single-rooted teeth. The teeth were divided into eight experimental groups (n = 5): PFD--Parallel-serrated-Fibrekor/dual-cured; PRD--Parallel-serrated-Reforpost/dual-cured; TED--Tapered-smooth-Exacto Cônico/dual-cured; TWD--Tapered-smooth-White Post/dual-cured; PFS--Parallel-serrated-Fibrekor/self-cured; PRS--Parallel-serrated-Reforpost/self-cured; TES--Tapered-smooth-Exacto Cônico/self-cured; TWS--Tapered-smooth-White Post/self-cured. The specimens were submitted to a pull-out test at a crosshead speed of 0.5 mm min(-1). Data were analysed using analysis of variance and Bonferroni's multiple comparison test (alpha = 0.05). Pull-out results (MPa) were: PFD = 8.13 (+/-1.71); PRD = 8.30 (+/-0.46); TED = 8.68 (+/-1.71); TWD = 9.35 (+/-1.99); PFS = 8.54 (+/-2.23); PRS = 7.09 (+/-1.96); TES = 8.27 (+/-3.92); TWS = 7.57 (+/-2.35). No statistical significant difference was detected for posts and cement factors and their interaction. The retention of glass fibre posts was not affected by post design or surface roughness nor by resin cement-curing mode. These results imply that the choice for serrated posts and self-cured cements is not related to an improvement in retention.

  1. 99Tcm-MIBI imaging with liposomal prostaglandin E1 infusion to detect viable myocardium in post-myocardial infarction patients

    International Nuclear Information System (INIS)

    Zheng Yong; Cai Hongbin; Miao Weibing; Lin Jun; Pan Runyang; Lin Haoxue

    2007-01-01

    Objective: The pharmacological efficiencies of liposomal prostaglandin E 1 (Lipo-PGE 1 ) infusion and nitrate infusion on 99 Tc m -methoxyisobutylisonitrile (MIBI) imaging detection of viable myocardium in post-myocardial infarction (MI) patients were compared in the current study. Methods: Thirty-two patients with MI underwent 99 Tc m -MIBI imaging at rest, nitrate infusion and Lipo-PGE 1 infusion respectively. The semi-quantitative analysis of 99 Tc m -MIBI imaging was carried out in 16 segments over each left ventricle. Results: Abnormal 99 Tc m -MIBI distribution in 216 segments (42.2%) at rest, 178 segments (34.8%) at nitrate infusion, and 184 segments (35.9%) at Lipo-PGE 1 infusion were identified. Among the 216 abnormal segments at rest, 89 (41.2%) and 81 (37.5%) were found improved after nitrate infusion and Lipo-PGE 1 infusion respectively. Detecting viable myocardium with Lipo-PGE 1 infusion imaging was accordant with that of nitrate infusion imaging in 89.8% of the cases. The mean uptake scores of abnormal segments at rest, nitrate infusion, and Lipo-PGE 1 infusion were 15.3 ± 3.3, 10.5 ± 1.4 (P 1 infusion imaging can be used for detection of viable myocardium in patients with MI. (authors)

  2. Drowning - post-mortem imaging findings by computed tomography

    International Nuclear Information System (INIS)

    Christe, Andreas; Aghayev, Emin; Jackowski, Christian; Thali, Michael J.; Vock, Peter

    2008-01-01

    The aim of this study was to identify the classic autopsy signs of drowning in post-mortem multislice computed tomography (MSCT). Therefore, the post-mortem pre-autopsy MSCT- findings of ten drowning cases were correlated with autopsy and statistically compared with the post-mortem MSCT of 20 non-drowning cases. Fluid in the airways was present in all drowning cases. Central aspiration in either the trachea or the main bronchi was usually observed. Consecutive bronchospasm caused emphysema aquosum. Sixty percent of drowning cases showed a mosaic pattern of the lung parenchyma due to regions of hypo- and hyperperfused lung areas of aspiration. The resorption of fresh water in the lung resulted in hypodensity of the blood representing haemodilution and possible heart failure. Swallowed water distended the stomach and duodenum; and inflow of water filled the paranasal sinuses (100%). All the typical findings of drowning, except Paltau's spots, were detected using post-mortem MSCT, and a good correlation of MSCT and autopsy was found. The advantage of MSCT was the direct detection of bronchospasm, haemodilution and water in the paranasal sinus, which is rather complicated or impossible at the classical autopsy. (orig.)

  3. Clinical Investigation Service Annual Research Progress Report Fiscal Year 1980,

    Science.gov (United States)

    1980-10-01

    piror to stimulation will be 3tudied. The amount of DNA synthesis will be measured by incorporation of tritiated thymidine (3HT). The time of optimum...required for optimal DNA synthesis by nitrogen- stimulated T-lymphocytes. Most human beings are far from being saturated with PLP, and, therefore, their...splenectomy, immediate and remote, including fulminating infections, and (e) effective- ness of penicillin prophylaxis in the prevention of post

  4. Splenic implant preservation after conservation in lactated Ringer´s solution

    OpenAIRE

    MATOS FILHO, ARGOS SOARES DE; PETROIANU, ANDY; CARDOSO, VALBERT NASCIMENTO; VIDIGAL, PAULA VIEIRA TEIXEIRA

    2018-01-01

    ABSTRACT Objective: to evaluate the morphology and function of autogenous splenic tissue implanted in the greater omentum, 24 hours after storage in Ringer-lactate solution. Methods: we divided 35 male rats into seven groups (n=5): Group 1: no splenectomy; Group 2: total splenectomy without implant; Group 3: total splenectomy and immediate autogenous implant; Group 4: total splenectomy, preservation of the spleen in Ringer-lactate at room temperature, then sliced and implanted; Group 5: tot...

  5. Post-mortem radiology-a new sub-speciality?

    International Nuclear Information System (INIS)

    O'Donnell, C.; Woodford, N.

    2008-01-01

    Computed tomography (CT) and magnetic resonance imaging (MRI) examinations of deceased individuals are increasingly being utilized in the field of forensic pathology. However, there are differences in the interpretation of post-mortem and clinical imaging. Radiologists with only occasional experience in post-mortem imaging are at risk of misinterpreting the findings if they rely solely on clinical experience. Radiological specialists working in a co-operative environment with pathologists are pivotal in the understanding of post-mortem CT and MRI, and its appropriate integration into the autopsy. This has spawned a novel subspecialty called post-mortem radiology or necro-radiology (radiology of the deceased). In the future it is likely that whole-body CT will be incorporated into the routine forensic autopsy due its ability to accurately detect and localise abnormalities commonly seen in forensic practice, such as haematoma, abnormal gas collections, fractures, and metallic foreign bodies. In the next 5-10 years most forensic institutes will seek regular access to such CT facilities or install machines into their own mortuaries. MRI is technically more problematic in the deceased but the improved tissue contrast over CT means that it is also very useful for investigation of pathology in the cranial, thoracic, and abdominal cavities, as well as the detection of haematoma in soft tissue. In order for radiologists to be an integral part of this important development in forensic investigation, radiological organizations must recognize the subspecialty of post-mortem radiology and provide a forum for radiologists to advance scientific knowledge in the field

  6. Avaliação intra-operatória da pressão portal e resultados imediatos do tratamento cirúrgico da hipertensão portal em pacientes esquistossomóticos submetidos a desconexão ázigo-portal e esplenectomia Intra-operative evaluation of portal pressure and immediate results of surgical treatment of portal hypertension in schistosomotic patients submitted to esophagogastric devascularization with splenectomy

    Directory of Open Access Journals (Sweden)

    Walter De Biase da Silva-Neto

    2004-09-01

    é-operatório. CONCLUSÃO: A desconexão ázigo-portal e esplenectomia promoveram queda imediata na pressão portal, com conseqüente diminuição do calibre das varizes esofágicas. Observou-se ainda que não é insignificante o risco de mortalidade e complicações graves relacionados a essa técnica.BACKGROUND: The main cause of portal hypertension in Brazil is the hepato-splenic form of mansonic schistosomiasis and the most employed technique for the surgical approach of this disease is the esophagogastric devascularization with splenectomy, generally associated to postoperative endoscopical esophageal varices sclerotherapy. The hemodynamic alterations after surgical treatment and its possible influence on the outcome are not well established. AIM: To evaluate the immediate impact of esophagogastric devascularization with splenectomy upon portal pressure as well as the results of the surgical treatment on digestive hemorrhage recurrence and on esophageal varices. METHODS: Nineteen patients with mean age of 37.9 years and portal hypertension and previous episodes of digestive hemorrhage caused by esophageal varices rupture due to hepato-splenic schistosomiasis were studied. None of the patients had received any treatment prior to the surgery and underwent to elective esophagogastric devascularization with splenectomy. Portal pressure was assessed at the beginning and at the end of esophagogastric devascularization with splenectomy through portal vein catheterization with a polyethylene catheter introduced through a jejunal branch vein. All patients were submitted to digestive endoscopy before and after the surgery, in order to classify the size of esophageal varices after esophagogastric devascularization with splenectomy according to Palmer’s classification. RESULTS: In all patients the portal pressure had diminished with a mean decrease of 31.3% after esophagogastric devascularization with splenectomy. In the postoperative endoscopic follow-up (1 month, the esophageal varices

  7. Occurrence of viral pathogens in Penaeus monodon post-larvae from aquaculture hatcheries

    Directory of Open Access Journals (Sweden)

    Toms C. Joseph

    2015-09-01

    Full Text Available Viral pathogens appear to exert the most significant constraints on the growth and survival of crustaceans under culture conditions. The prevalence of viral pathogens White Spot Syndrome Virus (WSSV, Hepatopancreatic Parvo Virus (HPV, Monodon Baculo Virus (MBV and Infectious Hypodermal and Hematopoietic Necrosis Virus (IHHNV in Penaeus monodon post-larvae was studied. Samples collected from different hatcheries and also samples submitted by farmers from Kerala were analyzed. Out of 104 samples collected, WSSV was detected in 12.5% of the post-larvae samples. Prevalence of concurrent infections by HPV, MBV and WSSV (either dual or triple infection was present in 60.6% of the total post-larvae tested. Out of the 51 double positives, 98% showed either HPV or IHHNV infection. HPV or IHHNV was detected in 11 post-larval samples showing triple viral infection. This is the first report of IHHNV from India. Result of this study reveals the lack of efficient screening strategies to eradicate viruses in hatchery reared post-larvae.

  8. Measurement of bromate in bread by liquid chromatography with post-column flow reactor detection.

    Science.gov (United States)

    Himata, K; Noda, M; Ando, S; Yamada, Y

    2000-01-01

    This method is suitable for the determination of bromate residues in a variety of baked goods. The peer-verified method trial was performed on white bread, multigrain bread, and coffee cake spiked with known levels of potassium bromate. The analytical portion is extracted with deionized water to remove bromate from the bulk of the baked product. The aqueous extract is carried through a series of steps to remove co-extractives that would interfere with the liquid chromatography (LC) in the determinative step or hasten the deterioration of the LC column. The extract is filtered before passing it through a reversed-phase solid-phase extraction (SPE) column and a cation-exchange column in the silver form to remove lipids and chloride, respectively. Ultrafiltration is then used to remove proteins with molecular weights of >30,000 daltons. Finally, a cation-exchange column in the sodium form is used to remove silver ions from the extract. The determinative step uses LC with a reversed-phase column and an ion-pairing agent in the mobile phase. Detection is based on the post-column reaction of bromate with o-dianisidine to form an oxidation product that is quantitated spectrophotometrically at 450 nm. Overall agreement between the submitting and peer laboratories was quite good. For bromate levels of 10-52 ppb, overall mean recoveries were 76.9 and 78.8% for the submitting and peer laboratories, respectively. The standard deviations were higher for the results of the peer laboratory, probably because of the generally higher level of baseline noise present in the chromatograms. The results demonstrate that the method provides adequate accuracy with low-fat as well as high-fat foods. Bromate at levels as low as 5 ppb (ng/g) can be detected with the method.

  9. Splenic rupture and intracranial haemorrhage in a haemophilic neonate: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Ibrahim Adamu

    2012-01-01

    Full Text Available Splenic rupture and intracranial haemorrhage are life-threatening conditions infrequently encountered in neonates without history of birth trauma. External manifestations of birth trauma; namely, capput succadeneum and cephalhematoma, when present raise suspicions for more serious intracranial or visceral damage. Rupture of normal spleen without an obvious source of trauma in haemophilic neonate is a rare event. The concurrence of both conditions and the unusual presentation make this case a rare one that is seldom encountered in the literature. Additionally, when splenic rupture occurs, the consensus is to employ all non-operative techniques aimed at salvaging the spleen, thus avoiding the immune-compromised state associated with splenectomy. However, in this case, we present a 3-day-old male with family history of haemophilia A, who was diagnosed with splenic rupture and bilateral subdural haematomas and underwent splenectomy, albeit with post-operative complications, in light of haemodynamic instability and high ongoing transfusion requirements.

  10. Post-mortem imaging compared with autopsy in trauma victims--A systematic review.

    Science.gov (United States)

    Jalalzadeh, Hamid; Giannakopoulos, Georgios F; Berger, Ferco H; Fronczek, Judith; van de Goot, Frank R W; Reijnders, Udo J; Zuidema, Wietse P

    2015-12-01

    Post-mortem imaging or virtual autopsy is a rapidly advancing field of post-mortem investigations of trauma victims. In this review we evaluate the feasibility of complementation or replacement of conventional autopsy by post-mortem imaging in trauma victims. A systematic review was performed in compliance with the PRISMA guidelines. MEDLINE, Embase and Cochrane databases were systematically searched for studies published between January 2008 and January 2014, in which post-mortem imaging was compared to conventional autopsy in trauma victims. Studies were included when two or more trauma victims were investigated. Twenty-six studies were included, with a total number of 563 trauma victims. Post-mortem computer tomography (PMCT) was performed in 22 studies, post-mortem magnetic resonance imaging (PMMRI) in five studies and conventional radiography in two studies. PMCT and PMMRI both demonstrate moderate to high-grade injuries and cause of death accurately. PMCT is more sensitive than conventional autopsy or PMMRI in detecting skeletal injuries. For detecting minor organ and soft tissue injuries, autopsy remains superior to imaging. Aortic injuries are missed frequently by PMCT and PMMRI and form their main limitation. PMCT should be considered as an essential supplement to conventional autopsy in trauma victims since it detects many additional injuries. Despite some major limitations, PMCT could be used as an alternative for conventional autopsy in situations where conventional autopsy is rejected or unavailable. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. [Implementation of a post-discharge surgical site infection system in herniorrhaphy and mastectomy procedures].

    Science.gov (United States)

    San Juan Sanz, Isabel; Díaz-Agero-Pérez, Cristina; Robustillo-Rodela, Ana; Pita López, María José; Oliva Iñiguez, Lourdes; Monge-Jodrá, Vicente

    2014-10-01

    Monitoring surgical site infection (SSI) performed during hospitalization can underestimate its rates due to the shortening in hospital stay. The aim of this study was to determine the actual rates of SSI using a post-discharge monitoring system. All patients who underwent herniorraphy or mastectomy in the Hospital Universitario Ramón y Cajal from 1 January 2011 to 31 December 2011 were included. SSI data were collected prospectively according to the continuous quality improvement indicators (Indicadores Clinicos de Mejora Continua de la Calidad [INCLIMECC]) monitoring system. Post-discharge follow-up was conducted by telephone survey. A total of 409patients were included in the study, of whom 299 underwent a herniorraphy procedure, and 110 underwent a mastectomy procedure. For herniorrhaphy, the SSI rate increased from 6.02% to 7.6% (the post-discharge survey detected 21.7% of SSI). For mastectomy, the SSI rate increased from 1.8% to 3.6% (the post-discharge survey detected 50% of SSI). Post-discharge monitoring showed an increased detection of SSI incidence. Post-discharge monitoring is useful to analyze the real trend of SSI, and evaluate improvement actions. Post-discharge follow-up methods need to standardised. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  12. Prospects for detecting supersymmetric dark matter at Post-LEP benchmark points

    International Nuclear Information System (INIS)

    Ellis, J.; Matchev, K.T.; Feng, J.L.; Ferstl, A.; Olive, K.A.

    2002-01-01

    A new set of supersymmetric benchmark scenarios has recently been proposed in the context of the constrained MSSM (CMSSM) with universal soft supersymmetry-breaking masses, taking into account the constraints from LEP, b→sγ and g μ -2. These points have previously been used to discuss the physics reaches of different accelerators. In this paper, we discuss the prospects for discovering supersymmetric dark matter in these scenarios. We consider direct detection through spin-independent and spin-dependent nuclear scattering, as well as indirect detection through relic annihilations to neutrinos, photons, and positrons. We find that several of the benchmark scenarios offer good prospects for direct detection via spin-independent nuclear scattering and indirect detection via muons produced by neutrinos from relic annihilations inside the Sun, and some models offer good prospects for detecting photons from relic annihilations in the galactic centre. (orig.)

  13. Dynamic contrast-enhanced MRI of the prostate. Comparison of two different post-processing algorithms

    International Nuclear Information System (INIS)

    Beyersdorff, Dirk; Franiel, T.; Luedemann, L.; Dietz, E.; Galler, D.; Marchot, P.

    2011-01-01

    Purpose: To evaluate the usefulness of a commercially available post-processing software tool for detecting prostate cancer on dynamic contrast-enhanced magnetic resonance imaging (MRI) and to compare the results to those obtained with a custom-made post-processing algorithm already tested under clinical conditions. Materials and Methods: Forty-eight patients with proven prostate cancer were examined by standard MRI supplemented by dynamic contrast-enhanced dual susceptibility contrast (DCE-DSC) MRI prior to prostatectomy. A custom-made post-processing algorithm was used to analyze the MRI data sets and the results were compared to those obtained using a post-processing algorithm from Invivo Corporation (Dyna CAD for Prostate) applied to dynamic T 1-weighted images. Histology was used as the gold standard. Results: The sensitivity for prostate cancer detection was 78 % for the custom-made algorithm and 60 % for the commercial algorithm and the specificity was 79 % and 82 %, respectively. The accuracy was 79 % for our algorithm and 77.5 % for the commercial software tool. The chi-square test (McNemar-Bowker test) yielded no significant differences between the two tools (p = 0.06). Conclusion: The two investigated post-processing algorithms did not differ in terms of prostate cancer detection. The commercially available software tool allows reliable and fast analysis of dynamic contrast-enhanced MRI for the detection of prostate cancer. (orig.)

  14. A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je [KEPCO Medical foundation Hanil General Hospital, Seoul (Korea, Republic of); Lee, Hye Seung [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2007-06-15

    Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

  15. A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

    International Nuclear Information System (INIS)

    Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je; Lee, Hye Seung

    2007-01-01

    Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

  16. The splenic injury outcomes trial: An American Association for the Surgery of Trauma multi-institutional study.

    Science.gov (United States)

    Zarzaur, Ben L; Kozar, Rosemary; Myers, John G; Claridge, Jeffrey A; Scalea, Thomas M; Neideen, Todd A; Maung, Adrian A; Alarcon, Louis; Corcos, Alain; Kerwin, Andrew; Coimbra, Raul

    2015-09-01

    Delayed splenic hemorrhage after nonoperative management (NOM) of blunt splenic injury (BSI) is a feared complication, particularly in the outpatient setting. Significant resources, including angiography (ANGIO), are used in an effort to prevent delayed splenectomy (DS). No prospective, long-term data exist to determine the actual risk of splenectomy. The purposes of this trial were to ascertain the 180-day risk of splenectomy after 24 hours of NOM of BSI and to determine factors related to splenectomy. Eleven Level I trauma centers participated in this prospective observational study. Adult patients achieving 24 hours of NOM of their BSI were eligible. Patients were followed up for 180 days. Demographic, physiologic, radiographic, injury-related information, and spleen-related interventions were recorded. Bivariate and multivariable analyses were used to determine factors associated with DS. A total of 383 patients were enrolled. Twelve patients (3.1%) underwent in-hospital splenectomy between 24 hours and 9 days after injury. Of 366 discharged with a spleen, 1 (0.27%) required readmission for DS on postinjury Day 12. No Grade I injuries experienced DS. The splenectomy rate after 24 hours of NOM was 1.5 per 1,000 patient-days. Only extravasation from the spleen at time of admission (ADMIT-BLUSH) was associated with splenectomy (odds ratio, 3.6; 95% confidence interval, 1.4-12.4). Of patients with ADMIT-BLUSH (n = 49), 17 (34.7%) did not have ANGIO with embolization (EMBO), and 2 of those (11.8%) underwent splenectomy; 32 (65.3%) underwent ANGIO with EMBO, and 2 of those (6.3%, p = 0.6020 compared with no ANGIO with EMBO) required splenectomy. Splenectomy after 24 hours of NOM is rare. After the initial 24 hours, no additional interventions are warranted for patients with Grade I injuries. For Grades II to V, close observation as an inpatient or outpatient is indicated for 10 days to 14 days. ADMIT-BLUSH is a strong predictor of DS and should lead to close

  17. The post-secular city

    DEFF Research Database (Denmark)

    Greve, Anni

    ) elements in ritual and ceremonies. Second, emergent spaces of post-secular practices are not only connected to traditional religious sites. With Schmautz (1998) it is necessary to understand a sacred site in its original social and cultural setting, and in the present experience of it. With a point...... in research on trans-national identity making (Fortier 2002). This paper suggests a displacement of focus from trans-national to international identity making and the possible role of religious societies. It is argued that an international culture is not mainstream culture however there are (universal......’ the paper argues for a possible potential of storytelling and mutual recognition. Third, it offers an argument for detectingpost-secular sites’ at the urban level from two angles: From architecture (the iconic consciousness) and from performance (the sacred drama). Fourth, the paper closes with a case...

  18. Post-oral sugar detection rapidly and chemospecifically modulates taste-guided behavior

    Science.gov (United States)

    Spector, Alan C.

    2016-01-01

    Several recent studies have shown that post-oral sugar sensing rapidly stimulates ingestion. Here, we explored the specificity with which early-phase post-oral sugar sensing influenced ingestive motivation. In experiment 1, rats were trained to associate the consumption of 0.3 M sucrose with injections of LiCl (3.0 meq/kg ip, conditioned taste aversion) or given equivalent exposures to the stimuli, but in an unpaired fashion. Then, all rats were subjected to two brief-access tests to assess appetitive and consummatory responses to the taste properties of sucrose (0.01–1.0 M), 0.12 M NaCl, and dH2O (in 10-s trials in randomized blocks). Intraduodenal infusions of either 0.3 M sucrose or equiosmolar 0.15 M NaCl (3.0 ml) were administered, beginning just before each test. For unpaired rats, intraduodenal sucrose specifically enhanced licking for 0.03–1.0 M sucrose, with no effect on trial initiation, relative to intraduodenal NaCl. Rats with an aversion to sucrose suppressed licking responses to sucrose in a concentration-dependent manner, as expected, but the intraduodenal sucrose preload did not appear to further influence licking responses; instead, intraduodenal sucrose attenuated trial initiation. Using a serial taste reactivity (TR) paradigm, however, experiment 2 demonstrated that intraduodenal sucrose preloads suppressed ingestive oromotor responses to intraorally delivered sucrose in rats with a sucrose aversion. Finally, experiment 3 showed that intraduodenal sucrose preloads enhanced preferential licking to some representative tastants tested (sucrose, Polycose, and Intralipid), but not others (NaCl, quinine). Together, the results suggest that the early phase-reinforcing efficacy of post-oral sugar is dependent on the sensory and motivational properties of the ingesta. PMID:27511277

  19. Influence of intracanal post on apical periodontitis identified by cone-beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Estrela, Carlos; Porto, Olavo Cesar Lyra; Rodrigues, Cleomar Donizeth [Federal University of Goias (UFG), Goiania, GO (Brazil). Dental School; Bueno, Mike Reis [University of Cuiaba (UNIC), MT (Brazil). Dental School; Pecora, Jesus Djalma, E-mail: estrela3@terra.com.b [University of Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Dental School

    2009-07-01

    The determination of the success of endodontic treatment has been often discussed based on outcome obtained by periapical radiography. The aim of this study was to verify the influence of intracanal post on apical periodontitis detected by cone-beam computed tomography (CBCT). A consecutive sample of 1020 images (periapical radiographs and CBCT scans) taken from 619 patients (245 men; mean age, 50.1 years) between February 2008 and September 2009 were used in this study. Presence and intracanal post length (short, medium and long) were associated with apical periodontitis (AP). Chi-square test was used for statistical analyses. Significance level was set at p<0.01. The kappa value was used to assess examiner variability. From a total of 591 intracanal posts, AP was observed in 15.06%, 18.78% and 7.95% using periapical radiographs, into the different lengths, short, medium and long, respectively (p=0.466). Considering the same posts length it was verified AP in 24.20%, 26.40% and 11.84% observed by CBCT scans, respectively (p=0.154). From a total of 1,020 teeth used in this study, AP was detected in 397 (38.92%) by periapical radiography and in 614 (60.19%) by CBCT scans (p<0.001). The distribution of intracanal posts in different dental groups showed higher prevalence in maxillary anterior teeth (54.79%). Intracanal posts lengths did not influenced AP. AP was detected more frequently when CBCT method was used. (author)

  20. Influence of intracanal post on apical periodontitis identified by cone-beam computed tomography

    International Nuclear Information System (INIS)

    Estrela, Carlos; Porto, Olavo Cesar Lyra; Rodrigues, Cleomar Donizeth; Bueno, Mike Reis; Pecora, Jesus Djalma

    2009-01-01

    The determination of the success of endodontic treatment has been often discussed based on outcome obtained by periapical radiography. The aim of this study was to verify the influence of intracanal post on apical periodontitis detected by cone-beam computed tomography (CBCT). A consecutive sample of 1020 images (periapical radiographs and CBCT scans) taken from 619 patients (245 men; mean age, 50.1 years) between February 2008 and September 2009 were used in this study. Presence and intracanal post length (short, medium and long) were associated with apical periodontitis (AP). Chi-square test was used for statistical analyses. Significance level was set at p<0.01. The kappa value was used to assess examiner variability. From a total of 591 intracanal posts, AP was observed in 15.06%, 18.78% and 7.95% using periapical radiographs, into the different lengths, short, medium and long, respectively (p=0.466). Considering the same posts length it was verified AP in 24.20%, 26.40% and 11.84% observed by CBCT scans, respectively (p=0.154). From a total of 1,020 teeth used in this study, AP was detected in 397 (38.92%) by periapical radiography and in 614 (60.19%) by CBCT scans (p<0.001). The distribution of intracanal posts in different dental groups showed higher prevalence in maxillary anterior teeth (54.79%). Intracanal posts lengths did not influenced AP. AP was detected more frequently when CBCT method was used. (author)

  1. Limbic encephalitis presenting as a post-partum psychiatric condition.

    Science.gov (United States)

    Gotkine, Marc; Ben-Hur, Tamir; Vincent, Angela; Vaknin-Dembinsky, Adi

    2011-09-15

    We describe a woman who presented with a psychiatric disorder post-partum and subsequently developed seizures and cognitive dysfunction prompting further investigation. A diagnosis of limbic encephalitis (LE) was made and antibodies to voltage-gated potassium channel complex (VGKC) detected. These antibodies are found in many non-paraneoplastic patients with LE. Although antibody-mediated conditions tend to present or relapse post-partum, VGKC-LE in the post-partum period has not been described. Case report. Clinical and imaging data were consistent with limbic encephalitis. High titres of anti-VGKC-complex antibodies confirmed the diagnosis of VGKC-LE. The similarities between the psychiatric symptomatology of VGKC-LE and post-partum psychiatric disorders raise the possibility that some instances of post-partum psychiatric conditions are manifestations of immune-mediated, non-paraneoplastic LE. Copyright © 2011 Elsevier B.V. All rights reserved.

  2. Post-tensioning tendon force loss detection using low power pulsed eddy current measurement

    Science.gov (United States)

    Kim, Ji-Min; Lee, Jun; Sohn, Hoon

    2018-04-01

    In the field of bridge engineering, pre-fabrication of a bridge member and its construction in site have been issued and studied, which achieves improved quality and rapid construction. For integration of those pre-fabricated segments into a structural member (i.e., a concrete slab, girder and pier), post-tensioning (PT) technique is adopted utilizing a high-strength steel tendon, and an effective investigation of the remaining PT tendon force is essential to assure an overall structural integrity. This study proposes a pulsed eddy current based tendon force loss detection system. A compact eddy current sensor is designed to be installed on the surface of an anchor holding a steel PT tendon. The intensity of the induced eddy current varies with PT tendon force alteration due to the magnetostriction effect of a ferromagnetic material. The advantages of the proposed system are as follows: (1) low power consumption, (2) rapid inspection, and (3) simple installation. Its performance was validated experimentally in a full-scale lab test of a 3.3-m long, 15.2-mm diameter mono-tendon that was tensioned using a universal testing machine. Tendon force was controlled from 20 to 180 kN with 20 kN interval, and eddy current responses were measured and analyzed at each force condition. The proposed damage index and the amount of force loss of PT tendon were monotonically related, and an excessive loss as much as 30 % of an initially-introduced tendon force was successfully predicted.

  3. Development of new radiopaque glass fiber posts

    Energy Technology Data Exchange (ETDEWEB)

    Furtos, Gabriel, E-mail: gfurtos@yahoo.co.uk [Raluca Ripan Institute of Research in Chemistry, Babes-Bolyai University, Cluj-Napoca (Romania); Baldea, Bogdan [Dep. of Prosthodontics, Faculty of Dental Medicine, Timisoara (Romania); Silaghi-Dumitrescu, Laura [Raluca Ripan Institute of Research in Chemistry, Babes-Bolyai University, Cluj-Napoca (Romania)

    2016-02-01

    The aim of this study was to analyze the radiopacity and filler content of three experimental glass fiber posts (EGFP) in comparison with other glass/carbon fibers and metal posts from the dental market. Three EGFP were obtained by pultrusion of glass fibers in a polymer matrix based on 2,2-bis[4-(2-hydroxy-3-methacryloyloxypropoxy)-phenyl]propane (bis-GMA) and triethyleneglycol dimethacrylate (TEGDMA) monomers. Using intraoral sensor disks 27 posts, as well as mesiodistal sections of human molar and aluminum step wedges were radiographed for evaluation of radiopacity. The percentage compositions of fillers by weight and volume were investigated by combustion analysis. Two EGFP showed radiopacity higher than enamel. The commercial endodontic posts showed radiopacity as follows: higher than enamel, between enamel and dentin, and lower than dentin. The results showed statistically significant differences (p < 0.05) when evaluated with one-way ANOVA statistical analysis. According to combustion analyses, the filler content of the tested posts ranges between 58.84 wt.% and 86.02 wt.%. The filler content of the tested EGFP ranged between 68.91 wt.% and 79.04 wt.%. EGFP could be an alternative to commercial glass fiber posts. Future glass fiber posts are recommended to present higher radiopacity than dentin and perhaps ideally similar to or higher than that of enamel, for improved clinical detection. The posts with a lower radiopacity than dentin should be considered insufficiently radiopaque. The radiopacity of some glass fiber posts is not greatly influenced by the amount of filler. - Highlights: • AR glass fibers for dental applications • AR glass fibers have a great potential for obtaining radiopaque glass fiber posts. • Experimental AR glass fiber posts could be an alternative to commercial glass fiber posts for clinical application.

  4. Development of new radiopaque glass fiber posts

    International Nuclear Information System (INIS)

    Furtos, Gabriel; Baldea, Bogdan; Silaghi-Dumitrescu, Laura

    2016-01-01

    The aim of this study was to analyze the radiopacity and filler content of three experimental glass fiber posts (EGFP) in comparison with other glass/carbon fibers and metal posts from the dental market. Three EGFP were obtained by pultrusion of glass fibers in a polymer matrix based on 2,2-bis[4-(2-hydroxy-3-methacryloyloxypropoxy)-phenyl]propane (bis-GMA) and triethyleneglycol dimethacrylate (TEGDMA) monomers. Using intraoral sensor disks 27 posts, as well as mesiodistal sections of human molar and aluminum step wedges were radiographed for evaluation of radiopacity. The percentage compositions of fillers by weight and volume were investigated by combustion analysis. Two EGFP showed radiopacity higher than enamel. The commercial endodontic posts showed radiopacity as follows: higher than enamel, between enamel and dentin, and lower than dentin. The results showed statistically significant differences (p < 0.05) when evaluated with one-way ANOVA statistical analysis. According to combustion analyses, the filler content of the tested posts ranges between 58.84 wt.% and 86.02 wt.%. The filler content of the tested EGFP ranged between 68.91 wt.% and 79.04 wt.%. EGFP could be an alternative to commercial glass fiber posts. Future glass fiber posts are recommended to present higher radiopacity than dentin and perhaps ideally similar to or higher than that of enamel, for improved clinical detection. The posts with a lower radiopacity than dentin should be considered insufficiently radiopaque. The radiopacity of some glass fiber posts is not greatly influenced by the amount of filler. - Highlights: • AR glass fibers for dental applications • AR glass fibers have a great potential for obtaining radiopaque glass fiber posts. • Experimental AR glass fiber posts could be an alternative to commercial glass fiber posts for clinical application.

  5. PHYSICAL PARAMETERS OF ASTEROIDS ESTIMATED FROM THE WISE 3-BAND DATA AND NEOWISE POST-CRYOGENIC SURVEY

    Energy Technology Data Exchange (ETDEWEB)

    Mainzer, A.; Masiero, J.; Bauer, J. [Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 (United States); Grav, T. [Planetary Science Institute, Tucson, AZ 85719 (United States); Cutri, R. M. [Infrared Processing and Analysis Center, California Institute of Technology, Pasadena, CA 91125 (United States); McMillan, R. S. [Lunar and Planetary Laboratory, University of Arizona, 1629 East University Boulevard, Tucson, AZ 85721-0092 (United States); Nugent, C. R. [Department of Earth and Space Sciences, UCLA, 595 Charles Young Drive East, Box 951567, Los Angeles, CA 90095-1567 (United States); Tholen, D. [Institute for Astronomy, University of Hawaii, 2680 Woodlawn Drive, Honolulu, HI 96822 (United States); Walker, R. [Monterey Institute for Research in Astronomy, Monterey, CA 93933 (United States); Wright, E. L., E-mail: amainzer@jpl.nasa.gov [Department of Physics and Astronomy, UCLA, P.O. Box 91547, Los Angeles, CA 90095-1547 (United States)

    2012-11-20

    Enhancements to the science data processing pipeline of NASA's Wide-field Infrared Survey Explorer (WISE) mission, collectively known as NEOWISE, resulted in the detection of >158,000 minor planets in four infrared wavelengths during the fully cryogenic portion of the mission. Following the depletion of its cryogen, NASA's Planetary Science Directorate funded a four-month extension to complete the survey of the inner edge of the Main Asteroid Belt and to detect and discover near-Earth objects (NEOs). This extended survey phase, known as the NEOWISE Post-Cryogenic Survey, resulted in the detection of {approx}6500 large Main Belt asteroids and 86 NEOs in its 3.4 and 4.6 {mu}m channels. During the Post-Cryogenic Survey, NEOWISE discovered and detected a number of asteroids co-orbital with the Earth and Mars, including the first known Earth Trojan. We present preliminary thermal fits for these and other NEOs detected during the 3-Band Cryogenic and Post-Cryogenic Surveys.

  6. Post-processing of structural MRI for individualized diagnostics

    Science.gov (United States)

    Bender, Benjamin; Focke, Niels K.

    2015-01-01

    Currently, a relevant proportion of all histopathologically proven focal cortical dysplasia (FCD) escape visual detection; this shows the need for additional improvements in analyzing MRI data. A positive MRI is still the strongest prognostic factor for postoperative freedom of seizures. Among several post-processing methods voxel-based morphometry (VBM) of T1- and T2-weighted sequences and T2 relaxometry are routinely applied in pre-surgical diagnostics of cryptogenic epilepsy in epilepsy centers. VBM is superior to conventional visual analysis with 9-15% more identified epileptogenic foci, while T2 relaxometry has its main application in (mesial) temporal lobe epilepsy. Further methods such as surface-based morphometry (SBM) or diffusion tensor imaging are promising but there is a lack of current studies comparing their individual diagnostic value. Post-processing methods represent an important addition to conventional visual analysis but need to be interpreted with expertise and experience so that they should be apprehended as a complementary tool within the context of the multi-modal evaluation of epilepsy patients. This review will give an overview of existing post-processing methods of structural MRI and outline their clinical relevance in detection of epileptogenic structural changes. PMID:25853079

  7. Impact of Methane Leak Detection and Repair Programs: Determining Pre- and Post-Survey Emissions Profiles

    Science.gov (United States)

    Roda-Stuart, D. J.; Ravikumar, A. P.; Brandt, A. R.

    2017-12-01

    Upstream production sites contribute 66 percent of methane emissions from natural gas systems [1]. Being a major greenhouse gas, many states and national governments are developing policies to reduce methane emissions. Recent policies to address this issue have focused on periodic leak detection and repair (LDAR) surveys at oil and gas facilities [2]. Development of effective LDAR surveys is complicated by two things. First, available empirical data makes it difficult to say anything definitive about which facilities or equipment are most prone to leakage. Second, there has been little research done on post-LDAR emissions profiles and the time evolution of leaks, two measures that would influence survey effectiveness and cost. In this work, we present data from LDAR operations conducted at upstream facilities of a Canadian natural gas producer. Surveys were done by an outside contractor using a FLIR optical gas imaging camera. Twenty-two well pads, five processing plants, and three compressor stations were surveyed, of which four, two, and one, respectively, were revisited. We examine the persistence of leaks over time periods ranging from 6 months to 15 months following the initial LDAR survey. Developing pre- and post-survey emission factors and distributions can help inform survey schedules and help update and monitor mitigation targets. Furthermore, we analyze the effect of weather conditions, survey frequency, and operational characteristics of equipment on the effectiveness of the LDAR program. For instance, we find that a survey done at the commissioning of a gas processing plant yields both safety and emissions reduction benefits. Using leak frequency distributions, we identify components and equipment that require more frequent and targeted surveying. Insights from this study can assist businesses and policy makers develop methane mitigation policies aimed at maximizing the marginal benefits of LDAR programs. [1] Inventory of U.S. Greenhouse Gas Emissions

  8. Parasite detection in patients with post kala-azar dermal leishmaniasis in India: a comparison between molecular and immunological methods

    Science.gov (United States)

    Salotra, P; Sreenivas, G; Beena, K R; Mukherjee, A; Ramesh, V

    2003-01-01

    Aims: To evaluate the sensitivity and specificity of serological, immunohistochemical, and molecular methods in the diagnosis of post kala-azar dermal leishmaniasis (PKDL). Methods: Twenty five patients with confirmed PKDL and 25 controls were included in the study. G2D10, a monoclonal antibody against Leishmania, was used for the immunohistochemical (IHC) staining of lesion sections to visualise anti-Leishmania donovani antibodies. The diagnostic usefulness of IHC was compared with enzyme linked immunosorbent assay (ELISA) with a recombinant (rk39) antigen, and a species specific polymerase chain reaction (PCR) assay, amplifying a kinetoplast minicircle DNA sequence. Results: IHC detected 22 of 25 PKDL cases, giving a sensitivity of 88%. The diagnostic sensitivity of both the ELISA and PCR tests was higher (96%). All of the 25 controls examined were negative in PCR, indicating 100% specificity of the test, whereas ELISA showed 96% specificity. Conclusions: IHC with G2D10 significantly enhances the sensitivity of detection of PKDL over routine haematoxylin and eosin staining. ELISA with a recombinant antigen is an economical and practical assay. PCR is the most sensitive and specific diagnostic method for PKDL. The tests described would facilitate the recognition of patients with PKDL, enabling timely treatment, which would contribute greatly to the control of kala-azar. PMID:14600129

  9. A Hybrid Change Detection Approach for Damage Detection and Recovery Monitoring

    Science.gov (United States)

    de Alwis Pitts, Dilkushi; Wieland, Marc; Wang, Shifeng; So, Emily; Pittore, Massimiliano

    2014-05-01

    Following a disaster, change detection via pre- and post-event very high resolution remote sensing images is an essential technique for damage assessment and recovery monitoring over large areas in complex urban environments. Most assessments to date focus on detection, destruction and recovery of man-made objects that facilitate shelter and accessibility, such as buildings, roads, bridges, etc., as indicators for assessment and better decision making. Moreover, many current change-detection mechanisms do not use all the data and knowledge which are often available for the pre-disaster state. Recognizing the continuous rather than dichotomous character of the data-rich/data-poor distinction permits the incorporation of ancillary data and existing knowledge into the processing flow. Such incorporation could improve the reliability of the results and thereby enhance the usability of robust methods for disaster management. This study proposes an application-specific and robust change detection method from multi-temporal very high resolution multi-spectral satellite images. This hybrid indicator-specific method uses readily available pre-disaster GIS data and integrates existing knowledge into the processing flow to optimize the change detection while offering the possibility to target specific types of changes to man-made objects. The indicator-specific information of the GIS objects is used as a series of masks to treat the GIS objects with similar characteristics similarly for better accuracy. The proposed approach is based on a fusion of a multi-index change detection method based on gradient, texture and edge similarity filters. The change detection index is flexible for disaster cases in which the pre-disaster and post-disaster images are not of the same resolution. The proposed automated method is evaluated with QuickBird and Ikonos datasets for abrupt changes soon after disaster. The method could also be extended in a semi-automated way for monitoring

  10. Reactive Hypertrophy of an Accessory Spleen Mimicking Tumour Recurrence of Metastatic Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Christin Tjaden

    2011-01-01

    Full Text Available De novo occurrence of an accessory spleen after splenectomy is worth noting for two reasons. First, it is known that splenectomy can cause reactive hypertrophy of initially inactive and macroscopically invisible splenic tissue. Second, it can mimic tumour recurrence in situations in which splenectomy has been performed for oncological reasons. This might cause difficulties in differential diagnosis and the clinical decision for reoperation. We report the case of a patient with suspected recurrence of renal cell carcinoma after total pancreatectomy and splenectomy for metastatic renal cell carcinoma, which finally revealed an accessory spleen as the morphological correlate of the newly diagnosed mass in the left retroperitoneum.

  11. Post retention and post/core shear bond strength of four post systems.

    Science.gov (United States)

    Stockton, L W; Williams, P T; Clarke, C T

    2000-01-01

    As clinicians we continue to search for a post system which will give us maximum retention while maximizing resistance to root fracture. The introduction of several new post systems, with claims of high retentive and resistance to root fracture values, require that independent studies be performed to evaluate these claims. This study tested the tensile and shear dislodgment forces of four post designs that were luted into roots 10 mm apical of the CEJ. The Para Post Plus (P1) is a parallel-sided, passive design; the Para Post XT (P2) is a combination active/passive design; the Flexi-Post (F1) and the Flexi-Flange (F2) are active post designs. All systems tested were stainless steel. This study compared the test results of the four post designs for tensile and shear dislodgment. All mounted samples were loaded in tension until failure occurred. The tensile load was applied parallel to the long axis of the root, while the shear load was applied at 450 to the long axis of the root. The Flexi-Post (F1) was significantly different from the other three in the tensile test, however, the Para Post XT (P2) was significantly different to the other three in the shear test and had a better probability for survival in the Kaplan-Meier survival function test. Based on the results of this study, our recommendation is for the Para Post XT (P2).

  12. Detecting depression stigma on social media: A linguistic analysis.

    Science.gov (United States)

    Li, Ang; Jiao, Dongdong; Zhu, Tingshao

    2018-05-01

    Efficient detection of depression stigma in mass media is important for designing effective stigma reduction strategies. Using linguistic analysis methods, this paper aims to build computational models for detecting stigma expressions in Chinese social media posts (Sina Weibo). A total of 15,879 Weibo posts with keywords were collected and analyzed. First, a content analysis was conducted on all 15,879 posts to determine whether each of them reflected depression stigma or not. Second, using four algorithms (Simple Logistic Regression, Multilayer Perceptron Neural Networks, Support Vector Machine, and Random Forest), two groups of classification models were built based on selected linguistic features; one for differentiating between posts with and without depression stigma, and one for differentiating among posts with three specific types of depression stigma. First, 967 of 15,879 posts (6.09%) indicated depression stigma. 39.30%, 15.82%, and 14.99% of them endorsed the stigmatizing view that "People with depression are unpredictable", "Depression is a sign of personal weakness", and "Depression is not a real medical illness", respectively. Second, the highest F-Measure value for differentiating between stigma and non-stigma reached 75.2%. The highest F-Measure value for differentiating among three specific types of stigma reached 86.2%. Due to the limited and imbalanced dataset of Chinese Weibo posts, the findings of this study might have limited generalizability. This paper confirms that incorporating linguistic analysis methods into online detection of stigma can be beneficial to improve the performance of stigma reduction programs. Copyright © 2018 Elsevier B.V. All rights reserved.

  13. Abbreviated protocol for breast MRI: Are multiple sequences needed for cancer detection?

    International Nuclear Information System (INIS)

    Mango, Victoria L.; Morris, Elizabeth A.; David Dershaw, D.; Abramson, Andrea; Fry, Charles; Moskowitz, Chaya S.; Hughes, Mary; Kaplan, Jennifer; Jochelson, Maxine S.

    2015-01-01

    Highlights: • Abbreviated breast MR demonstrates high sensitivity for breast carcinoma detection. • Time to perform/interpret the abbreviated exam is shorter than a standard MRI exam. • An abbreviated breast MRI could reduce costs and make MRI screening more available. - Abstract: Objective: To evaluate the ability of an abbreviated breast magnetic resonance imaging (MRI) protocol, consisting of a precontrast T1 weighted (T1W) image and single early post-contrast T1W image, to detect breast carcinoma. Materials and methods: A HIPAA compliant Institutional Review Board approved review of 100 consecutive breast MRI examinations in patients with biopsy proven unicentric breast carcinoma. 79% were invasive carcinomas and 21% were ductal carcinoma in situ. Four experienced breast radiologists, blinded to carcinoma location, history and prior examinations, assessed the abbreviated protocol evaluating only the first post-contrast T1W image, post-processed subtracted first post-contrast and subtraction maximum intensity projection images. Detection and localization of tumor were compared to the standard full diagnostic examination consisting of 13 pre-contrast, post-contrast and post-processed sequences. Results: All 100 cancers were visualized on initial reading of the abbreviated protocol by at least one reader. The mean sensitivity for each sequence was 96% for the first post-contrast sequence, 96% for the first post-contrast subtraction sequence and 93% for the subtraction MIP sequence. Within each sequence, there was no significant difference between the sensitivities among the 4 readers (p = 0.471, p = 0.656, p = 0.139). Mean interpretation time was 44 s (range 11–167 s). The abbreviated imaging protocol could be performed in approximately 10–15 min, compared to 30–40 min for the standard protocol. Conclusion: An abbreviated breast MRI protocol allows detection of breast carcinoma. One pre and post-contrast T1W sequence may be adequate for detecting

  14. Abbreviated protocol for breast MRI: Are multiple sequences needed for cancer detection?

    Energy Technology Data Exchange (ETDEWEB)

    Mango, Victoria L., E-mail: vlm2125@columbia.edu [Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, New York, NY 10032 (United States); Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Morris, Elizabeth A., E-mail: morrise@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); David Dershaw, D., E-mail: dershawd@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Abramson, Andrea, E-mail: abramsoa@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Fry, Charles, E-mail: charles_fry@nymc.edu [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595 (United States); Moskowitz, Chaya S. [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Hughes, Mary, E-mail: hughesm@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Kaplan, Jennifer, E-mail: kaplanj@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Jochelson, Maxine S., E-mail: jochelsm@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States)

    2015-01-15

    Highlights: • Abbreviated breast MR demonstrates high sensitivity for breast carcinoma detection. • Time to perform/interpret the abbreviated exam is shorter than a standard MRI exam. • An abbreviated breast MRI could reduce costs and make MRI screening more available. - Abstract: Objective: To evaluate the ability of an abbreviated breast magnetic resonance imaging (MRI) protocol, consisting of a precontrast T1 weighted (T1W) image and single early post-contrast T1W image, to detect breast carcinoma. Materials and methods: A HIPAA compliant Institutional Review Board approved review of 100 consecutive breast MRI examinations in patients with biopsy proven unicentric breast carcinoma. 79% were invasive carcinomas and 21% were ductal carcinoma in situ. Four experienced breast radiologists, blinded to carcinoma location, history and prior examinations, assessed the abbreviated protocol evaluating only the first post-contrast T1W image, post-processed subtracted first post-contrast and subtraction maximum intensity projection images. Detection and localization of tumor were compared to the standard full diagnostic examination consisting of 13 pre-contrast, post-contrast and post-processed sequences. Results: All 100 cancers were visualized on initial reading of the abbreviated protocol by at least one reader. The mean sensitivity for each sequence was 96% for the first post-contrast sequence, 96% for the first post-contrast subtraction sequence and 93% for the subtraction MIP sequence. Within each sequence, there was no significant difference between the sensitivities among the 4 readers (p = 0.471, p = 0.656, p = 0.139). Mean interpretation time was 44 s (range 11–167 s). The abbreviated imaging protocol could be performed in approximately 10–15 min, compared to 30–40 min for the standard protocol. Conclusion: An abbreviated breast MRI protocol allows detection of breast carcinoma. One pre and post-contrast T1W sequence may be adequate for detecting

  15. Computed tomographic characteristics of interval and post screen carcinomas in lung cancer screening

    International Nuclear Information System (INIS)

    Scholten, Ernst T.; Horeweg, Nanda; Koning, Harry J. de; Vliegenthart, Rozemarijn; Oudkerk, Matthijs; Mali, Willem P.T.M.; Jong, Pim A. de

    2015-01-01

    To analyse computed tomography (CT) findings of interval and post-screen carcinomas in lung cancer screening. Consecutive interval and post-screen carcinomas from the Dutch-Belgium lung cancer screening trial were included. The prior screening and the diagnostic chest CT were reviewed by two experienced radiologists in consensus with knowledge of the tumour location on the diagnostic CT. Sixty-one participants (53 men) were diagnosed with an interval or post-screen carcinoma. Twenty-two (36 %) were in retrospect visible on the prior screening CT. Detection error occurred in 20 cancers and interpretation error in two cancers. Errors involved intrabronchial tumour (n = 5), bulla with wall thickening (n = 5), lymphadenopathy (n = 3), pleural effusion (n = 1) and intraparenchymal solid nodules (n = 8). These were missed because of a broad pleural attachment (n = 4), extensive reticulation surrounding a nodule (n = 1) and extensive scarring (n = 1). No definite explanation other than human error was found in two cases. None of the interval or post-screen carcinomas involved a subsolid nodule. Interval or post-screen carcinomas that were visible in retrospect were mostly due to detection errors of solid nodules, bulla wall thickening or endobronchial lesions. Interval or post-screen carcinomas without explanation other than human errors are rare. (orig.)

  16. Computed tomographic characteristics of interval and post screen carcinomas in lung cancer screening

    Energy Technology Data Exchange (ETDEWEB)

    Scholten, Ernst T. [University Medical Centre, Department of Radiology, Utrecht (Netherlands); Kennemer Gasthuis, Department of Radiology, Haarlem (Netherlands); Horeweg, Nanda [Erasmus University Medical Centre, Department of Public Health, Rotterdam (Netherlands); Erasmus University Medical Centre, Department of Pulmonary Medicine, Rotterdam (Netherlands); Koning, Harry J. de [Erasmus University Medical Centre, Department of Public Health, Rotterdam (Netherlands); Vliegenthart, Rozemarijn [University of Groningen, University Medical Centre Groningen, Department of Radiology, Groningen (Netherlands); University of Groningen, University Medical Centre Groningen, Center for Medical Imaging-North East Netherlands, Groningen (Netherlands); Oudkerk, Matthijs [University of Groningen, University Medical Centre Groningen, Center for Medical Imaging-North East Netherlands, Groningen (Netherlands); Mali, Willem P.T.M.; Jong, Pim A. de [University Medical Centre, Department of Radiology, Utrecht (Netherlands)

    2015-01-15

    To analyse computed tomography (CT) findings of interval and post-screen carcinomas in lung cancer screening. Consecutive interval and post-screen carcinomas from the Dutch-Belgium lung cancer screening trial were included. The prior screening and the diagnostic chest CT were reviewed by two experienced radiologists in consensus with knowledge of the tumour location on the diagnostic CT. Sixty-one participants (53 men) were diagnosed with an interval or post-screen carcinoma. Twenty-two (36 %) were in retrospect visible on the prior screening CT. Detection error occurred in 20 cancers and interpretation error in two cancers. Errors involved intrabronchial tumour (n = 5), bulla with wall thickening (n = 5), lymphadenopathy (n = 3), pleural effusion (n = 1) and intraparenchymal solid nodules (n = 8). These were missed because of a broad pleural attachment (n = 4), extensive reticulation surrounding a nodule (n = 1) and extensive scarring (n = 1). No definite explanation other than human error was found in two cases. None of the interval or post-screen carcinomas involved a subsolid nodule. Interval or post-screen carcinomas that were visible in retrospect were mostly due to detection errors of solid nodules, bulla wall thickening or endobronchial lesions. Interval or post-screen carcinomas without explanation other than human errors are rare. (orig.)

  17. Post-Traumatic Cognition Mediates the Relationship between a History of Sexual Abuse and the Post-Traumatic Stress Symptoms in Sexual Assault Victims

    Science.gov (United States)

    2017-01-01

    More than half of all sexual assault victims report experiencing sexual victimization more than once. The aim of this paper was to determine the role post-traumatic cognition plays in the relationship between a history of sexual abuse and post-traumatic stress symptoms in sexual assault victims. The relationship between a history of sexual assault and the severity of post-traumatic stress symptoms was investigated retrospectively using data from a sexual assault crisis center in Korea. Data on psychological symptoms were collected in person at the initial assessment and by telephone 1 month later using the Post-traumatic Cognitions Inventory and the Post-traumatic Stress Disorder Symptoms Scale: Self-report Version. Of 105 women included in the analysis, 10 (9.5%) reported prior sexual abuse and were classified as sexually revictimized. Revictimized women had more post-traumatic negative cognition at initial assessment (t = −2.98; P = 0.004) and more post-traumatic symptoms at 1 month follow-up (t = −2.39; P = 0.019) than singly victimized women. At 1 month follow-up, the severity of post-traumatic stress symptoms had increased in revictimized women but had decreased slightly in singly victimized women. Negative post-traumatic cognition fully mediated the association between a history of sexual abuse and the severity of post-traumatic stress symptoms. Early detection of sexually revictimized women and tailored service and treatment intervention is needed to better serve this group of victims. Interventions targeted at preventing revictimization or post crime victimization may also help victims recover from the trauma and prevent future abuse. PMID:28875614

  18. Imaging evaluation of post pancreatic surgery

    International Nuclear Information System (INIS)

    Scialpi, Michele; Scaglione, Mariano; Volterrani, Luca; Lupattelli, Luciano; Ragozzino, Alfonso; Romano, Stefania; Rotondo, Antonio

    2005-01-01

    The role of several imaging techniques in patients submitted to pancreatic surgery with special emphasis to single-slice helical computed tomography (CT) and multidetector-row CT (MDCT) was reviewed. Several surgical options may be performed such as Whipple procedure, distal pancreatectomy, central pancreatectomy, and total pancreatectomy. Ultrasound examination may be used to detect peritoneal fluid in the early post-operative period as well as lesion recurrence in long-term follow-up. Radiological gastrointestinal studies has a major role in evaluation of intestinal functionality. In spite of the advent of other imaging modalities, CT is the most effective after pancreatic surgery. On post-operative CT, the most common findings were small fluid peritoneal or pancreatic collections, stranding of the mesenteric fat with perivascular cuffing, reactive adenopathy and pneumobilia. In addition, CT may demonstrate early (leakage of anastomosis, pancreatico-jejunal fistula, haemorrage, acute pancreatitis of the remnant pancreas, peritonitis), and late (chronic fistula, abscess, aneurysms, anastomotic bilio-digestive stenosis, perianastomotic ulcers, biloma, and intra-abdominal bleeding) surgical complications. In the follow-up evaluation, CT may show tumor recurrence, liver and lymph nodes metastasis. Magnetic resonance may be used as alternative imaging modality to CT, when renal insufficiency or contrast sensitivity prevents the use of iodinated i.v. contrast material or when the biliary tree study is primarily requested. The knowledge of the type of surgical procedures, the proper identification of the anastomoses as well as the normal post-operative imaging appearances are essential for an accurate detection of the complications and recurrent disease

  19. Imaging evaluation of post pancreatic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Scialpi, Michele [Department of Radiology, ' Santissima Annunziata' Hospital, Via Bruno 1, I-74100 Taranto (Italy)]. E-mail: michelescialpi@libero.it; Scaglione, Mariano [Department of Radiology, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Volterrani, Luca [Institute of Radiology, University of Siena, I-53100 Siena (Italy); Lupattelli, Luciano [Institute of Radiology, University of Perugia, I-06122 Perugia (Italy); Ragozzino, Alfonso [Department of Radiology, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Romano, Stefania [Department of Radiology, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Rotondo, Antonio [Section of Radiology, Department ' Magrassi-Lanzara' , Second University, I-80138 Naples (Italy)

    2005-03-01

    The role of several imaging techniques in patients submitted to pancreatic surgery with special emphasis to single-slice helical computed tomography (CT) and multidetector-row CT (MDCT) was reviewed. Several surgical options may be performed such as Whipple procedure, distal pancreatectomy, central pancreatectomy, and total pancreatectomy. Ultrasound examination may be used to detect peritoneal fluid in the early post-operative period as well as lesion recurrence in long-term follow-up. Radiological gastrointestinal studies has a major role in evaluation of intestinal functionality. In spite of the advent of other imaging modalities, CT is the most effective after pancreatic surgery. On post-operative CT, the most common findings were small fluid peritoneal or pancreatic collections, stranding of the mesenteric fat with perivascular cuffing, reactive adenopathy and pneumobilia. In addition, CT may demonstrate early (leakage of anastomosis, pancreatico-jejunal fistula, haemorrage, acute pancreatitis of the remnant pancreas, peritonitis), and late (chronic fistula, abscess, aneurysms, anastomotic bilio-digestive stenosis, perianastomotic ulcers, biloma, and intra-abdominal bleeding) surgical complications. In the follow-up evaluation, CT may show tumor recurrence, liver and lymph nodes metastasis. Magnetic resonance may be used as alternative imaging modality to CT, when renal insufficiency or contrast sensitivity prevents the use of iodinated i.v. contrast material or when the biliary tree study is primarily requested. The knowledge of the type of surgical procedures, the proper identification of the anastomoses as well as the normal post-operative imaging appearances are essential for an accurate detection of the complications and recurrent disease.

  20. Pre and post garter spring repositioning ultrasonic inspection of pressure tubes

    International Nuclear Information System (INIS)

    Desimone, C.; Katchadjian, P.; Tacchia, Mauricio

    1997-01-01

    This paper present a description of the ultrasonic cracked hydride blister detections system used for pre and post inspection of pressure tubes during garter spring repositioning in CNE (Embalse Nuclear Power Station). Ultrasonic system setup configuration, transducers characteristics, blister detection head, calibration of parameters, operating procedure, records of ultrasonic inspections and evaluation. (author) [es

  1. Leaf elemental analysis in mycorrhizal post oak seedlings

    Energy Technology Data Exchange (ETDEWEB)

    Boling, B.C. [Department of Biology, University of North Texas, P.O. Box 305220, Denton, TX 76203-5220 (United States); Naab, F.U. [Ion Beam Modification and Analysis Laboratory, Department of Physics, University of North Texas, P.O. Box 311427, Denton, TX 76203-1427 (United States)]. E-mail: fun001@unt.edu; Smith, D. [Department of Biology, University of North Texas, P.O. Box 305220, Denton, TX 76203-5220 (United States); Duggan, J.L. [Ion Beam Modification and Analysis Laboratory, Department of Physics, University of North Texas, P.O. Box 311427, Denton, TX 76203-1427 (United States); McDaniel, F.D. [Ion Beam Modification and Analysis Laboratory, Department of Physics, University of North Texas, P.O. Box 311427, Denton, TX 76203-1427 (United States)

    2006-09-15

    Growth and element assimilation was investigated in the leaves of post oak seedlings exposed to four different treatment combinations of fertilization and ectomycorrhizal inoculation. Element concentration was analyzed via particle-induced X-ray emission spectrometry (PIXE). PIXE detected 10 of the 13 essential macro and micronutrients: P, S, Mg, Ca, K, Cu, Zn, Mn, Fe and Cl. Mean growth and dry weight was significantly different across the treatment groups as well as the mean concentration of Mg, Al, S, K, Ca, Fe, Cu and Zn. The data suggest that fertilization rather than mycorrhizal inoculation had a stronger influence on nutrient uptake. This study is the first to analyze element concentration in post oak and to investigate the potential benefits of mycorrhizal symbiosis in post oak seedlings in terms of nutrient uptake.

  2. The spleen can influence the metastasis of AH130 hepatoma cells in rats.

    Science.gov (United States)

    Toyonaga, M; Hiraoka, T; Tanaka, H; Miyauchi, Y

    1993-06-01

    The effect of pathophysiological conditions due to disturbance of the spleen is still unclear. We studied the effects of splenectomy in normal and methylcellulose-induced hypersplenic rats on the development of pulmonary metastases created by intravenous injection of ascites containing AH130 hepatoma cells from male Hos-Donryu rats. Growth of metastatic lesions in the lung was not affected by splenectomy in normal rats, but was increased by splenectomy in hypersplenic rats. Overall, there were fewer pulmonary metastases in rats with hypersplenism, but after splenectomy rats with hypersplenism had a significantly greater number of metastases than did normal rats. The metastases rate correlated somewhat with changes in the blood coagulation and T lymphocyte profile. There is a relationship between the spleen and formation of metastases in cancer. Formation of metastases in the lung was affected most by splenectomy in hypersplenism. To elucidate the mechanism by which metastases are formed in the lung under these pathologic conditions, further studies on the exact role of the spleen are required.

  3. Effect of disinfecting teats post-milking or pre- and post-milking on intramammary infection and somatic cell count.

    Science.gov (United States)

    Williamson, J H; Lacy-Hulbert, S J

    2013-09-01

    To determine the effects of (a) post-milking teat disinfection compared with no disinfection and (b) pre- and post-milking teat disinfection compared with post-milking disinfection alone, on the incidence of new intramammary infection (IMI), somatic cell count (SCC) and teat skin abnormalities in dairy cows. In Experiment 1, dairy cows in five dairy herds were randomly allocated to a post-milking teat disinfection group (n=230), that was sprayed with an iodine-based disinfectant (TeatguardPlus) for a complete lactation, or to a non-disinfected group (n=239). In Experiment 2, cows were randomly allocated to post-milking teat disinfection (n=239) or both pre- and post-milking teat disinfection (n=235), using a chloramine-T-based disinfectant (Teatsweet) for both treatments, from calving to 118-127 days in milk. The incidence of new IMI was determined by aseptic sampling of all quarters at calving, during lactation, and at trial end or at drying-off, with clinical mastitis cases sampled on detection. SCC and teat skin abnormalities were measured at 2-monthly intervals during lactation. In both experiments, disinfectant was applied by spray application. Cows that received post-milking teat disinfection had a lower incidence of new IMI caused by Staphylococcus aureus, Streptococcus uberis, Corynebacterium spp and coagulase negative staphylococci, had lower bulk milk SCC during lactation, and had fewer teat skin abnormalities compared with the non-disinfected cows (p disinfection, in addition to post-milking teat disinfection, did not reduce the incidence of new IMI for any pathogens and did not reduce SCC (p> 0.05). Post-milking teat disinfection applied as a spray is a key component in mastitis control in New Zealand. There was no benefit from the addition of pre-milking disinfection. This study confirms previous findings of the effectiveness of post-milking teat disinfection in reducing the incidence of IMI caused by the common mastitis-causing pathogens in New

  4. Discrepancy detection in the retrieval-enhanced suggestibility paradigm.

    Science.gov (United States)

    Butler, Brendon Jerome; Loftus, Elizabeth F

    2018-04-01

    Retrieval-enhanced suggestibility (RES) refers to the finding that immediately recalling the details of a witnessed event can increase susceptibility to later misinformation. In three experiments, we sought to gain a deeper understanding of the role that retrieval plays in the RES paradigm. Consistent with past research, initial testing did increase susceptibility to misinformation - but only for those who failed to detect discrepancies between the original event and the post-event misinformation. In all three experiments, subjects who retrospectively detected discrepancies in the post-event narratives were more resistant to misinformation than those who did not. In Experiments 2 and 3, having subjects concurrently assess the consistency of the misinformation narratives negated the RES effect. Interestingly, in Experiments 2 and 3, subjects who had retrieval practice and detected discrepancies were more likely to endorse misinformation than control subjects who detected discrepancies. These results call attention to limiting conditions of the RES effect and highlight the complex relationship between retrieval practice, discrepancy detection, and misinformation endorsement.

  5. Apoptosis as a post-phagocytic winnowing mechanism in a coral-dinoflagellate mutualism.

    Science.gov (United States)

    Dunn, Simon R; Weis, Virginia M

    2009-01-01

    This study was aimed at detecting apoptosis as a post-phagocytic mechanism of symbiont selection during the onset of symbiosis in larvae of the scleractinian coral Fungia scutaria. Larvae were infected with one of three Symbiodinium types: freshly isolated homologous ITS-type C1f from adult F. scutaria, heterologous C31 from adult Montipora capitata, known to be unable to successfully colonize F. scutaria larvae, and type B1 from the symbiotic sea anemone Aiptasia spp. Apoptosis was detected by the activation of caspases, enzymes specific to apoptosis. Caspase activity was measured in situ by cleavage of a specific fluorophore and detection with confocal microscopy. At 6 h post infection, there was a significant increase in caspase activation in gastrodermal cells in C31-infected larvae, compared with larvae infected with C1f or B1 types. Compared with control larvae infected with C31, which had decreased infection rates present by 24 h post infection, when C31-infected larvae were incubated with a broad-scale caspase inhibitor, the per cent of larvae infected with C31 did not significantly decrease over time. This indicates that the reduction in infection success observed in untreated C31-infected larvae can be rescued with inhibition of caspases and apoptosis. This suggests the presence of a post-phagocytic recognition mechanism. Larvae infected with freshly isolated B1 retained infection success over time compared with C31-infected larvae, suggesting that there is host discrimination between heterologous algae. Initiation of this post-phagocytic response may occur more readily with a highly specific heterologous symbiont type such as C31, compared with a generalist heterologous type such as clade B1.

  6. New bone post-processing tools in forensic imaging: a multi-reader feasibility study to evaluate detection time and diagnostic accuracy in rib fracture assessment.

    Science.gov (United States)

    Glemser, Philip A; Pfleiderer, Michael; Heger, Anna; Tremper, Jan; Krauskopf, Astrid; Schlemmer, Heinz-Peter; Yen, Kathrin; Simons, David

    2017-03-01

    The aim of this multi-reader feasibility study was to evaluate new post-processing CT imaging tools in rib fracture assessment of forensic cases by analyzing detection time and diagnostic accuracy. Thirty autopsy cases (20 with and 10 without rib fractures in autopsy) were randomly selected and included in this study. All cases received a native whole body CT scan prior to the autopsy procedure, which included dissection and careful evaluation of each rib. In addition to standard transverse sections (modality A), CT images were subjected to a reconstruction algorithm to compute axial labelling of the ribs (modality B) as well as "unfolding" visualizations of the rib cage (modality C, "eagle tool"). Three radiologists with different clinical and forensic experience who were blinded to autopsy results evaluated all cases in a random manner of modality and case. Rib fracture assessment of each reader was evaluated compared to autopsy and a CT consensus read as radiologic reference. A detailed evaluation of relevant test parameters revealed a better accordance to the CT consensus read as to the autopsy. Modality C was the significantly quickest rib fracture detection modality despite slightly reduced statistic test parameters compared to modalities A and B. Modern CT post-processing software is able to shorten reading time and to increase sensitivity and specificity compared to standard autopsy alone. The eagle tool as an easy to use tool is suited for an initial rib fracture screening prior to autopsy and can therefore be beneficial for forensic pathologists.

  7. Post-Traumatic Cognition Mediates the Relationship between a History of Sexual Abuse and the Post-Traumatic Stress Symptoms in Sexual Assault Victims.

    Science.gov (United States)

    Shin, Kyoung Min; Chung, Young Ki; Shin, Yee Jin; Kim, Miran; Kim, Nam Hee; Kim, Kyoung Ah; Lee, Hanbyul; Chang, Hyoung Yoon

    2017-10-01

    More than half of all sexual assault victims report experiencing sexual victimization more than once. The aim of this paper was to determine the role post-traumatic cognition plays in the relationship between a history of sexual abuse and post-traumatic stress symptoms in sexual assault victims. The relationship between a history of sexual assault and the severity of post-traumatic stress symptoms was investigated retrospectively using data from a sexual assault crisis center in Korea. Data on psychological symptoms were collected in person at the initial assessment and by telephone 1 month later using the Post-traumatic Cognitions Inventory and the Post-traumatic Stress Disorder Symptoms Scale: Self-report Version. Of 105 women included in the analysis, 10 (9.5%) reported prior sexual abuse and were classified as sexually revictimized. Revictimized women had more post-traumatic negative cognition at initial assessment (t = -2.98; P = 0.004) and more post-traumatic symptoms at 1 month follow-up (t = -2.39; P = 0.019) than singly victimized women. At 1 month follow-up, the severity of post-traumatic stress symptoms had increased in revictimized women but had decreased slightly in singly victimized women. Negative post-traumatic cognition fully mediated the association between a history of sexual abuse and the severity of post-traumatic stress symptoms. Early detection of sexually revictimized women and tailored service and treatment intervention is needed to better serve this group of victims. Interventions targeted at preventing revictimization or post crime victimization may also help victims recover from the trauma and prevent future abuse. © 2017 The Korean Academy of Medical Sciences.

  8. Spectrum of centrosome autoantibodies in childhood varicella and post-varicella acute cerebellar ataxia

    Directory of Open Access Journals (Sweden)

    Stinton Laura M

    2003-09-01

    Full Text Available Abstract Background Sera from children with post-varicella infections have autoantibodies that react with centrosomes in brain and tissue culture cells. We investigated the sera of children with infections and post-varicella ataxia and related conditions for reactivity to five recombinant centrosome proteins: γγ-enolase, pericentrin, ninein, PCM-1, and Mob1. Methods Sera from 12 patients with acute post-varicella ataxia, 1 with post-Epstein Barr virus (EBV ataxia, 5 with uncomplicated varicella infections, and other conditions were tested for reactivity to cryopreserved cerebellum tissue and recombinant centrosome proteins. The distribution of pericentrin in the cerebellum was studied by indirect immunofluorescence (IIF using rabbit antibodies to the recombinant protein. Antibodies to phospholipids (APL were detected by ELISA. Results Eleven of 12 children with post-varicella ataxia, 4/5 children with uncomplicated varicella infections, 1/1 with post-EBV ataxia, 2/2 with ADEM, 1/2 with neuroblastoma and ataxia, and 2/2 with cerebellitis had antibodies directed against 1 or more recombinant centrosome antigens. Antibodies to pericentrin were seen in 5/12 children with post-varicella ataxia but not in any of the other sera tested. IIF demonstrated that pericentrin is located in axons and centrosomes of cerebellar cells. APL were detected in 75% of the sera from children with post-varicella ataxia and 50% of children with varicella without ataxia and in none of the controls. Conclusion This is the first study to show the antigen specificity of anti-centrosome antibodies in children with varicella. Our data suggest that children with post-varicella ataxia have unique autoantibody reactivity to pericentrin.

  9. Splenic implant preservation after conservation in lactated Ringer´s solution.

    Science.gov (United States)

    Matos Filho, Argos Soares DE; Petroianu, Andy; Cardoso, Valbert Nascimento; Vidigal, Paula Vieira Teixeira

    2018-01-01

    to evaluate the morphology and function of autogenous splenic tissue implanted in the greater omentum, 24 hours after storage in Ringer-lactate solution. we divided 35 male rats into seven groups (n=5): Group 1: no splenectomy; Group 2: total splenectomy without implant; Group 3: total splenectomy and immediate autogenous implant; Group 4: total splenectomy, preservation of the spleen in Ringer-lactate at room temperature, then sliced ​​and implanted; Group 5: total splenectomy, ​​spleen sliced and preserved in Ringer-lactate at room temperature before implantation; Group 6: total splenectomy with preservation of the spleen in Ringer-lactate at 4°C and then sliced ​​and implanted; Group 7: total splenectomy and the spleen sliced for preservation in Ringer-lactate at 4°C before implantation. After 90 days, we performed scintigraphic studies with Tc99m-colloidal tin (liver, lung, spleen or implant and clot), haematological exams (erythrogram, leucometry, platelets), biochemical dosages (protein electrophoresis) and anatomopathological studies. regeneration of autogenous splenic implants occurred in the animals of the groups with preserv