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Sample records for techniques total splenectomy

  1. 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.

  2. Splenectomy

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    ... 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 ...

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

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    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.)

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

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    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.

  5. 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

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

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    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.

  7. 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

  8. 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.

  9. Evaluation of possible failure of the mononuclear phagocyte system after total splenectomy in rats

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    Marques Ruy Garcia

    2004-01-01

    Full Text Available Young and adult Wistar rats were submitted to total splenectomy and compared to animals not submitted to any surgical manipulation in order to evaluate the phagocytic function of spleen. The animals were infected with Escherichia coli labeled with technetium-99m and killed 20 minutes later. Liver, lung, spleen and a blood clot sample were taken. No significant differences were found in the percentage of bacterial radioactivity uptake in mononuclear phagocyte system (MPS organs in young and adult splenectomized rats. However, phagocytosis index by macrophages of MPS organs was smaller in splenectomized animals than in control group. Splenectomized rats were associated with a higher blood bacterial radioactivity uptake than animals of the control group (p<0.0001 due to a larger bacterial remnant in the bloodstream. This finding suggested that some failure in the MPS occurred in the absence of the spleen, demonstrating the need to develop alternative surgical techniques for total splenectomy.

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

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    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.

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

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    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.

  12. 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

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

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    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.

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

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    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

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

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    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.

  16. Anterior Versus Posterolateral Approach for Total Laparoscopic Splenectomy: A Comparative Study

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    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

  17. 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)

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

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    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

  19. 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

    2012-07-15

    Clinical outcomes of children with sickle cell disease (SCD) who undergo total or partial splenectomy (PS) 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. 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 PS between 2003 and 2010. Clinical outcomes were compared between cohorts, with follow-up to 1 year. Twenty-four children were included, TS (n = 15) and PS (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 (ACS) following TS and 2 (15%) patients had ACS after PS. During 1-year follow-up, no patient in either cohort had recurrent splenic sequestration, venous thrombosis or overwhelming postsplenectomy sepsis. All children who were transfused preoperatively to prevent recurrent splenic sequestration successfully discontinued transfusions. 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. Copyright © 2012 Wiley Periodicals, Inc.

  20. Technique of total thyroidectomy

    International Nuclear Information System (INIS)

    Rao, R.S.

    1999-01-01

    It is essential to define the various surgical procedures that are carried out for carcinoma of the thyroid gland. They are thyroid gland, subtotal lobectomy, total thyroidectomy and near total thyroidectomy

  1. Laparoscopic splenectomy using conventional instruments

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    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.

  2. MODIFIED TECHNIQUE OF TOTAL LARYNGECTOMY

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    Predrag Spirić

    2010-12-01

    Full Text Available Surgical technique of total laryngectomy is well presented in many surgical textbooks. Essentially, it has remained the same since Gluck an Soerensen in 1922 described all its details. Generally, it stresses the U shape skin incision with releasing laryngeal structures and removing larynx from up to down. Further, pharyngeal reconstruction is performed with different kinds of sutures in two or more layers and is finished with skin suture and suction drainage. One of worst complications following this surgery is pharyngocutaneous fistula (PF. Modifications proposed in this this article suggests vertical skin incision with larynx removal from below upwards. In pharyngeal reconstruction we used the running locked suture in submucosal plan with „tobacco sac“ at the end on the tongue base instead of traditional T shaped suture. Suction drains were not used.The aim of study was to present the modified surgical technique of total laryingectomy and its impact on hospital stay duration and pharyngocutanous fistula formation. In this randomized study we analyzed 49 patients operated with modified surgical technique compared to 49 patient operated with traditional surgical technique of total laryngectomy. The modified technique of total laryngectomy was presented. Using modified technique we managed to decrease the PF percentage from previous 20,41% to acceptable 8,16% (p=0,0334. Also, the average hospital stay was shortened from 14,96 to 10,63 days (t =-2.9850; p=0.0358.The modified technique of total laryngectomy is safe, short and efficient surgical intervention which decreases the number of pharyngocutaneos fistulas and shortens the hospital stay.

  3. Laparoscopic splenectomy: Consensus and debatable points | Bani ...

    African Journals Online (AJOL)

    Introduction. The emergence of minimally invasive techniques has broadened interest in splenectomy for a variety of haematological illnesses. Laparoscopic splenectomy (LS) is currently considered the gold standard for the treatment of various haematological disorders. Purpose. The literature was reviewed to highlight ...

  4. Laparoscopic Spleen Removal (Splenectomy)

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    ... 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 ...

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

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    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.

  6. 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

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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

  12. 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)

  13. [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.

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. [Functions of the splenic remnant after subtotal splenectomy for treatment of severe splenic injuries].

    Science.gov (United States)

    Resende, Viviam; Petroianu, Andy

    2002-01-01

    To evaluate clinical and laboratory variables in patients submitted to subtotal splenectomy. 34 patients with severe trauma of the spleen and its pedicle were studied: 25 patients were submitted to subtotal splenectomy, preserving only the upper pole of the spleen (Group I), 9 were submitted to total splenectomy (Group II), and other 22 people with intact spleen were the control (Group III). Immediate and late postoperative complications were investigated. Laboratory exams were performed in the late postoperative period (red blood cells, hemoglobin, white blood cells, platelets and Howell-Jolly bodies). We studied the B- and T-lymphocyte counts and the immunoglobulins A, G and M (IgA, IgG and IgM) levels. Splenic scintigraphy with technetium 99mTc sulfur colloid was carried out on all patients. Group II presented Howell-Jolly bodies increased and low level of immunoglobulin M. The splenic scintigraphy demonstrated the viability and the filtering function of the splenic remnant in Group I. Subtotal splenectomy is a surgical alternative technique for treatment of severe distal injuries of the spleen or when its main vessels are damaged.

  1. Total hip arthroplasty: a still evolving technique

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Galia

    Full Text Available ABSTRACT It has been advocated that total hip arthroplasty (THA is probably the most successful surgical intervention performed in Medicine. In the 1960s, Sir John Charnley not only introduced, but also modified and improved the technique of cemented arthroplasties. The concepts on biological , fixation established by Pillar and Galante served as the foundation for the development of uncemented implants that are now used worldwide. Currently, THA is a worldwide widespread surgery performed on millions of people. However, keeping abreast of the large number of information available on these procedures, especially on implant fixation, designs, different tribological pairings, and the long-term results can be challenging at times. This article is a brief update on the main aspects of THA.

  2. 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

  3. 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

  4. 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.

  5. 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.

  6. Total Body Opacification 'Technique Neonatal Adrenal Haemorrhage

    African Journals Online (AJOL)

    1971-12-11

    Dec 11, 1971 ... A case is reported illustrating the possible usefulness of total body opacification in the diagnosis of neonatal adrenal haemorrhage. To derive maximum benefit from this principle, the routine use of an early film coupled with high dosage is urged whenever an intravenous pyelogram is performed for ...

  7. 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.

  8. 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

  9. 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

  10. Experience with totally laparoscopic distal pancreatectomy with splenic preservation for pediatric trauma--2 techniques.

    Science.gov (United States)

    Rutkoski, John D; Segura, Bradley J; Kane, Timothy D

    2011-03-01

    Blunt pancreatic traumatic injury in children, although rare, can be managed with a variety of methods from nonoperative, early operative, or delayed operative strategies. In the appropriate setting, early operative intervention has been associated with shorter hospitalization and decreased morbidity for these patients. Case reports describe laparoscopic distal pancreatectomy for isolated pancreatic laceration in children. This article presents the experience and results of the first series of totally laparoscopic, spleen-preserving distal pancreatectomies for trauma in children. Three children aged 8 to 13 years underwent laparoscopic distal pancreatectomy with splenic preservation for traumatic pancreatic transection within 72 hours of initial injury. Computed tomography imaging in all patients demonstrated complete pancreatic transection. The details of 2 operative techniques used for totally laparoscopic distal pancreatectomy are described. The data for associated injuries, amylase/lipase levels, operative management, postoperative course, length of stay, complications, and follow-up were collected for all patients. All 3 children aged 8, 10, and 13 years underwent laparoscopic distal pancreatectomy without splenectomy within 72 hours of injury (23, 48, and 72 hours). The mechanism of injury was from a bicycle handle, knee to abdomen, and dirt bike handle, respectively. The length of hospital stay was 6, 15, and 7 days with follow-up of 12, 35, and 34 months. The 2 older children underwent pancreatic transection with an endostapler, and the 8-year-old had the pancreatic remnant oversewn by hand. Use of postoperative total parenteral nutrition continued for 0, 13, and 7 days. Complications included an abdominal wall hematoma and prolonged ileus with mild pancreatitis. There were no pancreatic fistulae or insufficiency. All patients are doing well and are asymptomatic from prior injury and laparoscopic distal pancreatectomy. In the appropriate pediatric patient

  11. 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

  12. 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 ...

  13. 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

  14. Clinical outcomes of splenectomy in children: report of the splenectomy in congenital hemolytic anemia 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

    2015-03-01

    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 to 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 g/dl, 52 week 12.8 ± 1.6 g/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. © 2014 Wiley Periodicals, Inc.

  15. 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

  16. SPLENECTOMY IN A RURAL SURGICAL PRACTICE E. Alufohai ...

    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 ...

  17. 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 ...

  18. 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.

  19. Comparison of three techniques for skin total irradiation with electrons

    International Nuclear Information System (INIS)

    Batista, Delano V.S.; Bardella, Lucia H.; Rosa, Luiz A.R. da

    2011-01-01

    This paper compared three techniques of skin total irradiation with electrons: 1) horizontal positioning, 2) vertical positioning - rotatory technique and 3) vertical positioning - six fields technique. For that, a anthropomorphic phantom was positioned according to the recommendation for each technique and was i radiated at the linear accelerator by using the 6 MeV electrons. Radiochromic films were positioned on the surface in various regions of the phantom for measurement of absorbed dose. A ionization chamber was positioned inside of equivalent issue plates for dose evaluation due to the photons produced by electron stopping. The technique 2 and 3 have shown too similar in the results and number or discrepant points (8 and 10 respectively) of prescription lower than the technique 1 (22 points). The total body dose of photons of the 1, 2 and 3 techniques was 2.2%, 5.3% and 5.2% respectively

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. Differences in sampling techniques on total post-mortem tryptase.

    Science.gov (United States)

    Tse, R; Garland, J; Kesha, K; Elstub, H; Cala, A D; Ahn, Y; Stables, S; Palmiere, C

    2017-11-20

    The measurement of mast cell tryptase is commonly used to support the diagnosis of anaphylaxis. In the post-mortem setting, the literature recommends sampling from peripheral blood sources (femoral blood) but does not specify the exact sampling technique. Sampling techniques vary between pathologists, and it is unclear whether different sampling techniques have any impact on post-mortem tryptase levels. The aim of this study is to compare the difference in femoral total post-mortem tryptase levels between two sampling techniques. A 6-month retrospective study comparing femoral total post-mortem tryptase levels between (1) aspirating femoral vessels with a needle and syringe prior to evisceration and (2) femoral vein cut down during evisceration. Twenty cases were identified, with three cases excluded from analysis. There was a statistically significant difference (paired t test, p sampling methods. The clinical significance of this finding and what factors may contribute to it are unclear. When requesting post-mortem tryptase, the pathologist should consider documenting the exact blood collection site and method used for collection. In addition, blood samples acquired by different techniques should not be mixed together and should be analyzed separately if possible.

  11. A modified gelatin zymography technique incorporating total protein normalization.

    Science.gov (United States)

    Raykin, Julia; Snider, Eric; Bheri, Sruti; Mulvihill, John; Ethier, C Ross

    2017-03-15

    Gelatinase zymography is a commonly used laboratory procedure; however, variability in sample loading and concentration reduce the accuracy of quantitative results obtained from this technique. To facilitate normalization of gelatinase activity by loaded protein amount, we developed a protocol using the trihalocompound 2,2,2-trichloroethanol to allow for gelatin zymography and total protein labeling within the same gel. We showed that detected protein levels increased linearly with loading, and describe a loading concentration range over which normalized gelatinase activity was constant. We conclude that in-gel total protein detection is feasible in gelatin zymography and greatly improves comparison of gelatinase activity between samples. Published by Elsevier Inc.

  12. Esophagojejunostomy reconstruction using a robot-sewing technique during totally robotic total gastrectomy for gastric cancer.

    Science.gov (United States)

    Jiang, Zhi-Wei; Liu, Jiang; Wang, Gang; Zhao, Kun; Zhang, Shu; Li, Ning; Li, Jie-Shou

    2015-01-01

    The aim of this study was to report on the feasibility of esophagojejunostomy reconstruction using a robot-sewing technique during a completely robotic total gastrectomy for gastric cancer. Between May 2011 and July 2012, 65 patients in whom gastric adenocarcinoma was diagnosed underwent a completely robotic total gastrectomy, including a robot-sewing esophagojejunal anastomosis. We demonstrated the surgical techniques with analysis of clinicopathologic data and short-term surgical outcomes. All robotic surgeries were successfully performed without conversion. Among the 65 patients, 46 were men and 19 were women. The mean age (± SD) was 57.8 ± 6.5 y. The mean total operative time (± SD), EJ anastomosis time (± SD), and blood loss (± SD) were 245 ± 53 min, 45 ± 26 min, and 75 ± 50 ml, respectively. The mean (± SD) post-operative hospital stay was 5.4 ± 2.5 d. One patient was readmitted for an intestinal obstruction and underwent re-operation 14 d post-operatively; he recovered uneventfully and was discharged 10 d post- operatively. During the follow-up, no patients developed an esophgojejunostomy stricture. A robot-sewing anastomosis for esophagojejunostomy reconstruction during robotic total gastrectomy for gastric cancer is feasible. Indeed, a robot-sewing anastomosis for esophagojejunostomy reconstruction may become a standard surgical technique during completely robotic total gastrectomy for gastric cancer.

  13. Liposomal Bupivacaine Injection Technique in Total Knee Arthroplasty.

    Science.gov (United States)

    Meneghini, R Michael; Bagsby, Deren; Ireland, Philip H; Ziemba-Davis, Mary; Lovro, Luke R

    2017-01-01

    Liposomal bupivacaine has gained popularity for pain control after total knee arthroplasty (TKA), yet its true efficacy remains unproven. We compared the efficacy of two different periarticular injection (PAI) techniques for liposomal bupivacaine with a conventional PAI control group. This retrospective cohort study compared consecutive patients undergoing TKA with a manufacturer-recommended, optimized injection technique for liposomal bupivacaine, a traditional injection technique for liposomal bupivacaine, and a conventional PAI of ropivacaine, morphine, and epinephrine. The optimized technique utilized a smaller gauge needle and more injection sites. Self-reported pain scores, rescue opioids, and side effects were compared. There were 41 patients in the liposomal bupivacaine optimized injection group, 60 in the liposomal bupivacaine traditional injection group, and 184 in the conventional PAI control group. PAI liposomal bupivacaine delivered via manufacturer-recommended technique offered no benefit over PAI ropivacaine, morphine, and epinephrine. Mean pain scores and the proportions reporting no or mild pain, time to first opioid, and amount of opioids consumed were not better with PAI liposomal bupivacaine compared with PAI ropivacaine, morphine, and epinephrine. The use of the manufacturer-recommended technique for PAI of liposomal bupivacaine does not offer benefit over a conventional, less expensive PAI during TKA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  14. Total laparoscopic gastrocystoplasty: experimental technique in a porcine model

    OpenAIRE

    Frederico R. Romero; Claudemir Trapp; Michael Muntener; Fabio A. Brito; Louis R. Kavoussi; Thomas W. Jarrett

    2007-01-01

    OBJECTIVE: Describe a unique simplified experimental technique for total laparoscopic gastrocystoplasty in a porcine model. MATERIAL AND METHODS: We performed laparoscopic gastrocystoplasty on 10 animals. The gastroepiploic arch was identified and carefully mobilized from its origin at the pylorus to the beginning of the previously demarcated gastric wedge. The gastric segment was resected with sharp dissection. Both gastric suturing and gastrovesical anastomosis were performed with absorbabl...

  15. Techniques for determining total body water using deuterium oxide

    Science.gov (United States)

    Bishop, Phillip A.

    1990-01-01

    The measurement of total body water (TBW) is fundamental to the study of body fluid changes consequent to microgravity exposure or treatment with microgravity countermeasures. Often, the use of radioactive isotopes is prohibited for safety or other reasons. It was selected and implemented for use by some Johnson Space Center (JCS) laboratories, which permitted serial measurements over a 14 day period which was accurate enough to serve as a criterion method for validating new techniques. These requirements resulted in the selection of deuterium oxide dilution as the method of choice for TBW measurement. The development of this technique at JSC is reviewed. The recommended dosage, body fluid sampling techniques, and deuterium assay options are described.

  16. 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

  17. Detection limit calculations for different total reflection techniques

    International Nuclear Information System (INIS)

    Sanchez, H.J.

    2000-01-01

    In this work, theoretical calculations of detection limits for different total-reflection techniques are presented.. Calculations include grazing incidence (TXRF) and gracing exit (GEXRF) conditions. These calculations are compared with detection limits obtained for conventional x-ray fluorescence (XRF). In order to compute detection limits the Shiraiwa and Fujino's model to calculate x-ray fluorescence intensities was used. This model made certain assumptions and approximations to achieve the calculations, specially in the case of the geometrical conditions of the sample, and the incident and takeoff beams. Nevertheless the calculated data of detection limits for conventional XRF and total-reflection XRF show a good agreement with previous results. The model proposed here allows to analyze the different sources of background and the influence of the excitation geometry, which contribute to the understanding of the physical processes involved in the XRF analysis by total reflection. Finally, a comparison between detection limits in total-reflection analysis at grazing incidence and at grazing exit is carried out. Here a good agreement with the theoretical predictions of the reversibility principle is found, showing that detection limits are similar for both techniques. (author)

  18. 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

  19. 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.

  20. 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.

  1. Total laparoscopic gastrocystoplasty: experimental technique in a porcine model

    Directory of Open Access Journals (Sweden)

    Frederico R. Romero

    2007-02-01

    Full Text Available OBJECTIVE: Describe a unique simplified experimental technique for total laparoscopic gastrocystoplasty in a porcine model. MATERIAL AND METHODS: We performed laparoscopic gastrocystoplasty on 10 animals. The gastroepiploic arch was identified and carefully mobilized from its origin at the pylorus to the beginning of the previously demarcated gastric wedge. The gastric segment was resected with sharp dissection. Both gastric suturing and gastrovesical anastomosis were performed with absorbable running sutures. The complete procedure and stages of gastric dissection, gastric closure, and gastrovesical anastomosis were separately timed for each laparoscopic gastrocystoplasty. The end-result of the gastric suturing and the bladder augmentation were evaluated by fluoroscopy or endoscopy. RESULTS: Mean total operative time was 5.2 (range 3.5 - 8 hours: 84.5 (range 62 - 110 minutes for the gastric dissection, 56 (range 28 - 80 minutes for the gastric suturing, and 170.6 (range 70 to 200 minutes for the gastrovesical anastomosis. A cystogram showed a small leakage from the vesical anastomosis in the first two cases. No extravasation from gastric closure was observed in the postoperative gastrogram. CONCLUSIONS: Total laparoscopic gastrocystoplasty is a feasible but complex procedure that currently has limited clinical application. With the increasing use of laparoscopy in reconstructive surgery of the lower urinary tract, gastrocystoplasty may become an attractive option because of its potential advantages over techniques using small and large bowel segments.

  2. 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

    2017-08-01

    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. Copyright© 2017 Ferrata Storti Foundation.

  3. 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

  4. A technique for pediatric total skin electron irradiation

    International Nuclear Information System (INIS)

    Bao, Qinan; Hrycushko, Brian A; Dugas, Joseph P; Hager, Frederick H; Solberg, Timothy D

    2012-01-01

    Total skin electron irradiation (TSEI) is a special radiotherapy technique which has generally been used for treating adult patients with mycosis fungoides. Recently, two infants presented with leukemia cutis isolated to the skin requiring TSEI. This work discusses the commissioning and quality assurance (QA) methods for implementing a modified Stanford technique using a rotating harness system to position sedated pediatric patients treated with electrons to the total skin. Commissioning of pediatric TSEI consisted of absolute calibration, measurement of dosimetric parameters, and subsequent verification in a pediatric patient sized cylindrical phantom using radiographic film and optically stimulated luminance (OSL) dosimeters. The depth of dose penetration under TSEI treatment condition was evaluated using radiographic film sandwiched in the phantom and demonstrated a 2 cm penetration depth with the maximum dose located at the phantom surface. Dosimetry measurements on the cylindrical phantom and in-vivo measurements from the patients suggested that, the factor relating the skin and calibration point doses (i.e., the B-factor) was larger for the pediatric TSEI treatments as compared to adult TSEI treatments. Custom made equipment, including a rotating plate and harness, was fabricated and added to a standard total body irradiation stand and tested to facilitate patient setup under sedated condition. A pediatric TSEI QA program, consisting of daily output, energy, flatness, and symmetry measurements as well as in-vivo dosimetry verification for the first cycle was developed. With a long interval between pediatric TSEI cases, absolute dosimetry was also repeated as part of the QA program. In-vivo dosimetry for the first two infants showed that a dose of ± 10% of the prescription dose can be achieved over the entire patient body. Though pediatric leukemia cutis and the subsequent need for TSEI are rare, the ability to commission the technique on a modified TBI stand

  5. 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.

  6. Histopathological audit of splenectomies received at a cancer hospital

    Directory of Open Access Journals (Sweden)

    Sumeet Gujral

    2011-01-01

    Full Text Available Background: There are few studies in the literature studying the yield of the diagnostic splenectomy in a suspicious lymphoma case. Moreover, their relevance is limited owing to low number of cases, the use of selection criteria, and the lack of modern ancillary studies. We present a histopathological review of splenectomy specimens referred as a case of lymphoma to our center. Materials and Methods: The medical charts and laboratory data on all patients of all splenectomy specimens between the years 2003 and 2008 were reviewed. Morphological and immunohistochemical features were analyzed and the lymphomas were sub-typed in accordance to 2008 WHO Classification of Hematolymphoid Neoplasms. Flow cytometry immunophenotyping available in few cases was correlated. Results: A total of 46 cases studied included splenic marginal zone lymphoma (SMZL (19 cases, splenic diffuse large B-cell lymphoma (DLBCL (14 cases, splenic diffuse red pulp B-cell lymphoma (DRP (five cases, follicular lymphoma (three cases, hairy cell leukemia (HCL (two cases, HCL variant (HCLv (1 case, 1 case of hepatosplenic gamma delta T-cell lymphoma (TCL, and 1 cases of TCL (not otherwise specified. Conclusions: Predominantly splenic lymphoma is a biologically heterogeneous entity, ranging from low-grade SMZL to high-grade DLBCLs. TCLs constituted only 4% of all our cases. DRP, HCL, and HCLv have similar diffuse red pulp patterns of splenic involvement and are differentiated based on flow cytometric immunophenotyping. We had a large number of splenic DLBCL and none of these involved bone marrow (BM, while all other lymphoma subtypes had BM involvement (stage IV disease. Morphological and immunophenotypic (immunohistochemistry and flow cytometry features of BM and splenectomy specimen need to be correlated to differentiate these rare though similar-looking entities with overlapping features.

  7. 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.

  8. 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

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. Electron tomography based on a total variation minimization reconstruction technique

    Energy Technology Data Exchange (ETDEWEB)

    Goris, B., E-mail: bart.goris@ua.ac.be [EMAT, University of Antwerp, Groenenborgerlaan 171, B-2020 Antwerp (Belgium); Van den Broek, W. [EMAT, University of Antwerp, Groenenborgerlaan 171, B-2020 Antwerp (Belgium); Batenburg, K.J. [Centrum Wiskunde and Informatica, Science Park 123, NL-1098XG Amsterdam (Netherlands); Vision Lab, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk (Belgium); Heidari Mezerji, H.; Bals, S. [EMAT, University of Antwerp, Groenenborgerlaan 171, B-2020 Antwerp (Belgium)

    2012-02-15

    The 3D reconstruction of a tilt series for electron tomography is mostly carried out using the weighted backprojection (WBP) algorithm or using one of the iterative algorithms such as the simultaneous iterative reconstruction technique (SIRT). However, it is known that these reconstruction algorithms cannot compensate for the missing wedge. Here, we apply a new reconstruction algorithm for electron tomography, which is based on compressive sensing. This is a field in image processing specialized in finding a sparse solution or a solution with a sparse gradient to a set of ill-posed linear equations. Therefore, it can be applied to electron tomography where the reconstructed objects often have a sparse gradient at the nanoscale. Using a combination of different simulated and experimental datasets, it is shown that missing wedge artefacts are reduced in the final reconstruction. Moreover, it seems that the reconstructed datasets have a higher fidelity and are easier to segment in comparison to reconstructions obtained by more conventional iterative algorithms. -- Highlights: Black-Right-Pointing-Pointer A reconstruction algorithm for electron tomography is investigated based on total variation minimization. Black-Right-Pointing-Pointer Missing wedge artefacts are reduced by this algorithm. Black-Right-Pointing-Pointer The reconstruction is easier to segment. Black-Right-Pointing-Pointer More reliable quantitative information can be obtained.

  18. 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

  19. 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 ...

  20. 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.

  1. Inter-technique validation of tropospheric slant total delays

    Directory of Open Access Journals (Sweden)

    M. Kačmařík

    2017-06-01

    Full Text Available An extensive validation of line-of-sight tropospheric slant total delays (STD from Global Navigation Satellite Systems (GNSS, ray tracing in numerical weather prediction model (NWM fields and microwave water vapour radiometer (WVR is presented. Ten GNSS reference stations, including collocated sites, and almost 2 months of data from 2013, including severe weather events were used for comparison. Seven institutions delivered their STDs based on GNSS observations processed using 5 software programs and 11 strategies enabling to compare rather different solutions and to assess the impact of several aspects of the processing strategy. STDs from NWM ray tracing came from three institutions using three different NWMs and ray-tracing software. Inter-techniques evaluations demonstrated a good mutual agreement of various GNSS STD solutions compared to NWM and WVR STDs. The mean bias among GNSS solutions not considering post-fit residuals in STDs was −0.6 mm for STDs scaled in the zenith direction and the mean standard deviation was 3.7 mm. Standard deviations of comparisons between GNSS and NWM ray-tracing solutions were typically 10 mm ± 2 mm (scaled in the zenith direction, depending on the NWM model and the GNSS station. Comparing GNSS versus WVR STDs reached standard deviations of 12 mm ± 2 mm also scaled in the zenith direction. Impacts of raw GNSS post-fit residuals and cleaned residuals on optimal reconstructing of GNSS STDs were evaluated at inter-technique comparison and for GNSS at collocated sites. The use of raw post-fit residuals is not generally recommended as they might contain strong systematic effects, as demonstrated in the case of station LDB0. Simplified STDs reconstructed only from estimated GNSS tropospheric parameters, i.e. without applying post-fit residuals, performed the best in all the comparisons; however, it obviously missed part of tropospheric signals due to non-linear temporal and spatial variations

  2. Total Ossicular Replacement Prosthesis: A New Fat Interposition Technique

    Directory of Open Access Journals (Sweden)

    Issam Saliba

    2018-01-01

    Full Text Available Objective: To compare audiometric results between the standard total ossicular replacement prosthesis (TORP-S and a new fat interposition total ossicular replacement prosthesis (TORP-F in pediatric and adult patients and to assess the complication and the undesirable outcome. Study design: This is a retrospective study. Methods: This study included 104 patients who had undergone titanium implants with TORP-F and 54 patients who had undergone the procedure with TORP-S between 2008 and 2013 in our tertiary care centers. The new technique consists of interposing a fat graft between the 4 legs of the universal titanium prosthesis (Medtronic Xomed Inc, Jacksonville, FL, USA to provide a more stable TORP in the ovale window niche. Normally, this prosthesis is designed to fit on the stapes’ head as a partial ossicular replacement prosthesis. Results: The postoperative air-bone gap less than 25 dB for the combined cohort was 69.2% and 41.7% for the TORP-F and the TORP-S groups, respectively. The mean follow-up was 17 months postoperatively. By stratifying data, the pediatric cohort shows 56.5% in the TORP-F group (n = 52 compared with 40% in the TORP-S group (n = 29. However, the adult cohort shows 79.3% in the TORP-F group (n = 52 compared with 43.75% in the TORP-S group (n = 25. These improvements in hearing were statistically significant. There were no statistically significant differences in the speech discrimination scores. The only undesirable outcome that was statistically different between the 2 groups was the prosthesis displacement: 7% in the TORP-F group compared with 19% in the TORP-S group ( P  = .03. Conclusions: The interposition of a fat graft between the legs of the titanium implants (TORP-F provides superior hearing results compared with a standard procedure (TORP-S in pediatric and adult populations because of its better stability in the oval window niche.

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

    Directory of Open Access Journals (Sweden)

    Meng Xu

    2016-01-01

    Full Text Available 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<0.05. Two rats in LMWH group died before euthanasia due to intra-abdominal hemorrhage. In RES group, significant decreases in platelet aggregation, platelet radical oxygen species (ROS production, and increase in platelet nitric oxide (NO synthesis and platelet apoptosis were observed when compared with Splenectomy II (all p<0.001, while in LMWH group only significant decrease in platelet aggregation was observed. Conclusion. Prophylactic application of RES could safely reduce the incidence of PVST after splenectomy in cirrhotic rat. Regulation of platelet function and induction of platelet apoptosis might be the underlying mechanisms.

  4. 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 ...

  5. Laparoscopic splenectomy for hematologic disorders: experience with the first fifty patients.

    Science.gov (United States)

    Chowbey, Pradeep K; Goel, Amit; Panse, Rashmi; Sharma, Anil; Khullar, Rajesh; Soni, Vandana; Baijal, Manish

    2005-02-01

    Splenectomy is increasingly being performed by various minimal access surgical modalities for select hematologic disorders. A retrospective analysis was performed on the first 50 patients on whom laparoscopic splenectomy (LS) was attempted. The data studied included indications for surgery, patient demographics, intraoperative parameters, and patient outcomes. A total laparoscopic approach (TLS) was employed in 38 patients and a hand-assisted technique (HALS) was used in 12 patients with massive splenomegaly. Eight patients had concomitant surgical procedures: 7 patients underwent laparoscopic cholecystectomy and 1 patient received a kidney transplant. The most common indications for LS were idiopathic thrombocytopenic purpura (ITP) (50%) and hereditary spherocytosis (24%). LS was successfully completed in 48 patients (96%). Thirty-four patients (68%) required perioperative blood or platelet transfusions. The mean spleen diameter was 17.1 cm (range, 11.2-28.4 cm) on imaging study and mean intact splenic weight was 1019 gm. The mean operative time was 188 minutes (range, 90-340 minutes) in the TLS group and 171 minutes (range, 120-240 minutes) in the HALS group. The mean intraoperative blood loss was 306 mL (range, 40-640 mL) in the TLS group and 163 mL (range, 100-300 mL) in the HALS group. The mean postoperative hospital stay was 3.2 days (range, 2-5 days). TLS is safe and feasible in patients with nonpalpable spleens. A concomitant laparoscopic procedure for treating coexisting abdominal pathology may be performed without additional morbidity. The HALS technique may be preferable in patients with splenomegaly (palpable spleens), as it appears to offer intraoperative advantages for retraction, dissection, hemostasis, and organ retrieval.

  6. Laparoscopic splenectomy: ligasure versus EndoGIA: a comparative study.

    Science.gov (United States)

    Romano, Fabrizio; Gelmini, Roberta; Caprotti, Roberto; Andreotti, Alessia; Guaglio, Marcello; Franzoni, Chiara; Uggeri, Franco; Saviano, Massimo

    2007-12-01

    Laparoscopic splenectomy (LS) is considered the gold standard for the treatment of hematologic disease of the spleen. Intraoperative bleeding is the main complication and main cause of conversion during LS. In this paper, we present our experience with 112 LS procedures, comparing two different techniques and instruments for spleen dissection and hilar vascular control. We have performed a total of 112 LS procedures in 9 years in two affiliated university hospitals. There were 48 males and 64 females (median age, 32.8 years). Indications were as follows: idiopathic thrombocytopenic purpura (ITP) in 42 patients, hereditary spherocitosis in 28, 6 with beta-talassemia, 1 with hemolitic anemia, 27 with lymphoma, 2 with leukemia, 3 with splenic cysts, and 3 PPT cases. Associated procedures were present in 25 cases (17 cholecystectomy and 4 liver/lymphnodal biopsies + lysis of adhesions). Patients were divided in two groups according to the method of dissection and hilar section (group 1, endostapler + monopolar coagulation with 38 patients; group 2, the Ligasure Vessel Sealing System (Valleylab, Boulder, CO) with 74 patients). Groups were well matched according to age, indications, spleen sizes, and procedures associated. Conversion rates (10 cases, 9%; 5 in each group), postoperative hospital stay (median 4 days in each group), and intra- and postoperative complications were similar in the 2 groups without any mortality in each group, while intraoperative blood loss (loss of 100 mL in 55 patients in group 2, 78%; and in 21 patients in group 1, 52%), transfusion rates (8 patients in group 1 versus 4 patients in group 2), and operative mean time (150 minutes in group 1 versus 125 minutes in group 2) were minor in the Ligasure Vessel Sealing System group, with a statistical significance. The approach to spleen dissection and hilum section was safe and efficacy in each case, otherwise the use of Ligasure results in a gain of time. Furthermore the average intraoperative

  7. 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

  8. 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

  9. Application of total reflection x-ray fluorescence (TXRF) technique ...

    African Journals Online (AJOL)

    Nigerian crude oils from eight oil wells have been analysed for the following trace elements: Ni, Cr, Mn, V, Fe, Zn. Pb, Cu, Co and S using total Reflection X-ray Fluorescence (TXRF) analytical method. Concentrations of these elements were found to range from 0.002 – 1.420 ppm. Results showed that Fe was the most ...

  10. 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.

  11. Functions of the splenic remnant after subtotal splenectomy for treatment of severe splenic injuries.

    Science.gov (United States)

    Resende, Vivian; Petroianu, Andy

    2003-04-01

    To evaluate the clinical and laboratory characteristics of patients submitted to subtotal splenectomy during the immediate and late postoperative period. The study was conducted on 34 patients, 25 of whom were submitted to subtotal splenectomy (group I), and 9 to total splenectomy without preservation of splenic tissue (group II), and on 22 patients with intact spleens (group III, control). The immediate and late postoperative complications were investigated. Hematological examinations were performed during the late postoperative period (red cell count, hemoglobin, platelets, total and segmented leukocytes, lymphocytes, and Howell-Jolly bodies). Immunoglobulins (IgA, IgM, and IgG) and total T lymphocytes (TTL), active T lymphocytes (ATL), and B lymphocytes were also determined. Splenic scintigraphy with (99m)Tc colloidal sulfur was performed. Groups I and III did not presented abnormal blood bodies and their hematological and immunological pattern were normal. None of the groups showed leukocytosis or thrombocytosis. Howell-Jolly bodies were observed only in group II, which also showed reduced IgM levels. Scintigraphy showed filtering splenic tissue in group I. We conclude that subtotal splenectomy is a good surgical alternative for serious distal spleen lesion or when the main splenic pedicle is injured.

  12. 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.

  13. Subtotal splenectomy preserving the lower pole in rats: technical, morphological and functional aspects

    Directory of Open Access Journals (Sweden)

    Paulo Danilo Nagib Salomão

    2006-01-01

    Full Text Available PURPOSE: To assess the possibility of preserving the lower pole of the spleen, supplied by the inferior lobar vessels and segmental vessels, or by vessels of the gastrosplenic ligament, in subtotal splenectomy; to study the viability and function of the lower pole of the spleen. METHODS: Thirty-six male Wistar rats were used in this study. Said animals weighed 273-390 g ( 355.2 ? 30.5 g , and were randomly distributed into three groups. Group 1 comprised ten animals which were submitted to exploratory laparotomy with spleen manipulation (sham operation. Group 2 comprised 16 animals which were submitted to total splenectomy. Group 3 comprised ten animals which were submitted to subtotal splenectomy, preserving the lower pole of the spleen. Blood was collected from all animals before and 90 days after surgery to measure the levels of cholesterol and triglycerides. The animals were sacrificed 90 days after surgery. Spleens and remaining spleens were removed for macroscopic and microscopic examination. RESULTS: Surgery was performed with no complications in all groups. Six animals died in group 2. Spleens of groups 1 and 2, and lower poles of group 3 were macroscopically viable. Apparent white pulp hyperplasia was observed in group 1. In group 3, slight inflammation and capsular fibrosis were observed at the incision site, as well as diffuse hemosiderosis in the red pulp. Average mass of remaining spleen was 35.84% ? 4.31%. No significant difference was observed between preoperative and late postoperative lipid levels in groups 1 and 3 (p > 0.05. Late postoperative lipid levels significantly increased in group 2. CONCLUSIONS: Preservation of the lower pole of the spleen (supplied by gastrosplenic vessels or inferior lobar vessels and segmental vessels was possible with subtotal splenectomy. The lower pole was macroscopically and microscopically viable in all cases. Subtotal splenectomy preserving the lower pole prevented changes in lipid levels

  14. 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

  15. Blunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study.

    Science.gov (United States)

    Demetriades, Demetrios; Scalea, Thomas M; Degiannis, Elias; Barmparas, Galinos; Konstantinidis, Agathoklis; Massahis, John; Inaba, Kenji

    2012-01-01

    The purpose of this study was to evaluate the effect of the method of splenic injury management on early infectious complications. Prospective observational, multicenter study which included all patients with blunt splenic injury surviving at least 72 hours. Epidemiologic and clinical data, grade of splenic injury, method of splenic management, and infectious complications during the initial hospitalization were collected according to a standardized collecting datasheet. Logistic regression analysis was used to identify independent risk factors for infectious complications. During a 22-month period, 269 eligible patients were enrolled in the study. Overall, 105 (39.0%) patients were observed; 48 (17.8%) underwent successful angioembolization, 19 (7.1%) underwent splenorrhaphy, and 97 (36.1%) underwent splenectomy. Multivariate analysis adjusting for age, hypotension on admission, Glasgow Coma Scale, Injury Severity Score, Abbreviated Injury Scale, laparotomy, grade of splenic injury, and associated solid and hollow viscus injuries, showed that splenectomy had a significantly higher incidence of infectious complications than splenic preservation (adjusted odds ratio [95% confidence interval], 9.62 [3.04-30.30]; p < 0.001). A regression model analysis identified splenectomy, hypotension on admission, associated hollow viscus injury, and high Injury Severity Score as independent risk factors for infectious complications. Forward logistic regression analysis, which included only the 176 patients with grades III to V splenic injuries, identified splenectomy as the most significant independent risk factors for infection (adjusted odds ratio [95% confidence interval], 16.67 [3.76-71.43]; p < 0.001). Splenectomy is an independent risk factor for early infectious complications. Splenic-preserving techniques should be considered more liberally.

  16. Splenectomy with chemotherapy vs surgery alone as initial treatment for splenic marginal zone lymphoma

    Science.gov (United States)

    Milosevic, Rajko; Todorovic, Milena; Balint, Bela; Jevtic, Miodrag; Krstic, Miodrag; Ristanovic, Elizabeta; Antonijevic, Nebojsa; Pavlovic, Mirjana; Perunicic, Maja; Petrovic, Milan; Mihaljevic, Biljana

    2009-01-01

    AIM: To evaluate the clinical characteristics of splenic marginal-zone lymphoma (SMZL) following antigen expression and the influence of therapeutic approaches on clinical outcome and overall survival (OS). METHODS: A total of 30 patients with typical histological and immunohistochemical SMZL patterns were examined. Splenectomy plus chemotherapy was applied in 20 patients, while splenectomy as a single treatment-option was performed in 10 patients. Prognostic factor and overall survival rate were analyzed. RESULTS: Complete remission (CR) was achieved in 20 (66.7%), partial remission (PR) in seven (23.3%), and lethal outcome due to disease progression occurred in three (10.0%) patients. Median survival of patients with a splenectomy was 93.0 mo and for patients with splenectomy plus chemotherapy it was 107.5 mo (Log rank = 0.056, P > 0.05). Time from onset of first symptoms to the beginning of the treatment (mean 9.4 mo) was influenced by spleen dimensions, as measured by computerized tomography and ultra-sound (t = 2.558, P = 0.018). Strong positivity (+++) of CD20 antigen expression in splenic tissue had a positive influence on OS (Log rank = 5.244, P 0.05) effects on the OS. The expression of other antigens (immunohistochemistry) also had no effect on survival-rate, as measured by a χ2 test (P > 0.05). CONCLUSION: Initial splenectomy combined with chemotherapy has been shown to be beneficial due to its advanced remission rate/duration; however, a larger controlled clinical study is required to confirm our findings. PMID:19705496

  17. 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

  18. 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.

  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. 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 ...

  1. 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 ...

  2. 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.

  3. 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 ...

  4. 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...

  5. Single-incision laparoscopic splenectomy with innovative gastric traction suture

    Directory of Open Access Journals (Sweden)

    Srikanth G

    2011-01-01

    Full Text Available Laparoscopic splenectomy is now the gold standard for patients with idiopathic thrombocytopenic purpura (ITP undergoing splenectomy. There are a few reports in literature on single-incision laparoscopic (SIL splenectomy. Herein, we describe a patient undergoing SIL splenectomy for ITP without the use of a disposable port device. We report a 20-year-old female patient with steroid-refractory ITP having a platelet count of 14,000/cmm who underwent a SIL splenectomy. Dissection was facilitated by the use of a single articulating grasper and a gastric traction suture and splenic vessels were secured at the hilum with an endo-GIA stapler. She made an uneventful postoperative recovery and was discharged on the second postoperative day. She is doing well with no visible scar at 8-month follow-up.

  6. 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

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. An overwhelming post-splenectomy infection (OPSI

    Directory of Open Access Journals (Sweden)

    Elbadawi O

    2012-09-01

    Full Text Available We present the case of a 25 year old man who had a splenectomy five years previously following a road traffic accident (RTA. He presented to our A&E department one evening with fever and upper abdominal pain associated with nausea and vomiting. Clinical examination was unremarkable. Initial investigations revealed only pyuria. He was treated symptomatically along with parenteral antibiotic and admitted to the general medical ward. Within few hours he deteriorated rapidly with septic shock, multi-organ failure, disseminated intravascular coagulation (DIC and eventually cardio-respiratory arrest. Despite all resuscitative measures he died within few hours of admission. Splenectomized patients are prone to develop severe infection, including sepsis and meningitis, due to OPSI, or overwhelming post-splenectomy infection. Presentation may be mild, but the course is rapid and the prognosis is very poor, even in young people. It is important that splenectomized patients receive vaccines according to guidelines, take antibiotic prophylaxis and are educated to seek medical attention at the earliest sign of even minor infections.

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. 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

  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. 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

  19. 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)

  20. 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

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. 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 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.

  6. A simple technique to remove well-fixed acetabular components in revision of total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Xiaoqi Zhang, MD

    2017-12-01

    Full Text Available Removing well-fixed acetabular components can be a challenge for orthopaedic surgeons in revision of total hip arthroplasty. Acetabular bone loss, fracture, and other complications occurred in extracting implants may result in instability and fail of revision. Thus, instruments are developed to avoid such complications. We report a simple technique by drilling a tunnel on the superolateral quadrant of acetabulum and using an offset staff to remove acetabular components without many matching units. The procedure of removing well-fixed acetabular components is a simple, efficient, inexpensive, bone stock preserving technique. Keywords: Total hip arthroplasty, Acetabular revision, Removing acetabular components

  7. Total ionizing dose effects and hardening techniques of anti-fuse FPGAs

    CERN Document Server

    Zhao Ju Chao

    2002-01-01

    Total ionizing dose hardening of commercial FPGAs for space applications is presented briefly. Total ionizing dose effects of Actel anti-fuse FPGAs are analysed in detail, including effects of fabrication technologies, bias condition and charge pump. The results show that degradation of the internal charge pump is a key factor in severe degradation of the systems. It is vitally important that radiation testing should include special measurements of start-up transients. Lastly, available hardening techniques are discussed

  8. Single incision versus reduced port splenectomy--searching for the best alternative to conventional laparoscopic splenectomy.

    Science.gov (United States)

    Monclova, Julio Lopez; Targarona, Eduardo M; Vidal, Pablo; Peraza, Yerald; Garcia, Francisco; Otero, Carlos Rodriguez; Pallares, Luis; Balague, Carmen; Trias, Manuel

    2013-03-01

    Laparoscopic splenectomy (LS) is a well accepted approach for the treatment of multiple hematologic diseases. Single port access splenectomy (SPAS) emphasizes the concept of surgery through one small incision. The reduced port access splenectomy (RPAS) entails the use of fewer trocars of smaller sizes. The aim of this study was to compare the clinical outcomes after LS, SPAS, and RPAS, and to analyze the aesthetic result and patient satisfaction. We included patients who underwent LS (group 1, n = 15), SPAS (group 2, n = 8), and RPAS (group 3, n = 10) between June 2008 and February 2012, whose final spleen weight was less of 500 g. The outcome parameters analyzed were operative time, need of additional trocars, blood loss, blood transfusion, weight of the spleen, postoperative complications, and duration of hospital stay. To evaluate the cosmetic result, patients were asked to take the Body Image Questionnaire. Patients in group 3 were younger than group 1. Operative time was significantly longer in group 2 compared to groups 1 and 3 (83 ± 19 vs. 131 ± 43 vs. 81 ± 22 min, p = 0.01). There was no need to convert to open surgery in any group, nor were there differences in intra- or postoperative outcome. There were no differences between the groups in relation to the analgesic requirements. Twenty-two out of the 33 patients answered the questionnaire. There was a significant advantage in group 2 and 3 in the body image index with respect to group 1. There were no differences between groups 2 and 3 (7.3 ± 2.8 vs. 5.8 ± 1.3 vs. 5.1 ± 0.4, p RPAS is a good alternative to LS and SPAS. It improves the aesthetic results as compared to LS, whereas minimizes the technical challenges faced with SPAS.

  9. Utilisation de la Technique D\\'électrophorèse des Protéines Totales ...

    African Journals Online (AJOL)

    Utilisation de la Technique D\\'électrophorèse des Protéines Totales sur Gel de Polyacrylamide-SDS (SDS-PAGE) pour L\\'étude de la Diversité des Rhizobiums D\\'Acacia tortilis (Forsk.) Hayne Subsp. Raddiana (Savi) Brenan.

  10. Real chimney technique for total debranching of supra-aortic trunks.

    Science.gov (United States)

    Kato, Masaaki; Kagaya, Hideo; Kubo, Yoji; Banno, Hiroshi; Ohkubo, Nobukazu

    2015-02-01

    Side-clamping of the ascending aorta is an indispensable technique for proximal anastomosis in total debranching of supra-aortic trunks and in endovascular aneurysm repair for arch aneurysm. However, this procedure may lead to the dislodging of multiple plaques and to clamp injury of the ascending aorta. We developed a clampless technique to achieve proximal anastomosis between the ascending aorta and an artificial graft used for total debranching of supra-aortic trunks. We applied this method in six patients with arch aneurysm and a plaque-rich ascending aorta and were able to achieve total debranching of the supra-aortic trunks in all of the patients without side-clamping the ascending aorta and no procedurally related complications. This clampless anastomosis technique ("real chimney technique") in the ascending aorta is a valuable option for total debranching of supra-aortic trunks in the hybrid repair of arch aneurysms. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  11. Information Landscaping: Information Mapping, Charting, Querying and Reporting Techniques for Total Quality Knowledge Management.

    Science.gov (United States)

    Tsai, Bor-sheng

    2003-01-01

    Total quality management and knowledge management are merged and used as a conceptual model to direct and develop information landscaping techniques through the coordination of information mapping, charting, querying, and reporting. Goals included: merge citation analysis and data mining, and apply data visualization and information architecture…

  12. Whole-body irradiation technique: physical aspects; Tecnica de irradiacion corporal total: aspectos fisicos

    Energy Technology Data Exchange (ETDEWEB)

    Venencia, D.; Bustos, S.; Zunino, S. [Instituto Privado de Radioterapia. Obispo Oro 425. Cordoba 5000 (Argentina)

    1998-12-31

    The objective of this work has been to implement a Total body irradiation technique that fulfill the following conditions: simplicity, repeatability, fast and comfortable positioning for the patient, homogeneity of the dose between 10-15 %, short times of treatments and In vivo dosimetric verifications. (Author)

  13. 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

  14. 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.

  15. Appraisal of soft computing techniques in prediction of total bed material load in tropical rivers

    Science.gov (United States)

    Chang, C. K.; Azamathulla, H. Md; Zakaria, N. A.; Ghani, A. Ab

    2012-02-01

    This paper evaluates the performance of three soft computing techniques, namely Gene-Expression Programming (GEP) (Zakaria et al 2010), Feed Forward Neural Networks (FFNN) (Ab Ghani et al 2011), and Adaptive Neuro-Fuzzy Inference System (ANFIS) in the prediction of total bed material load for three Malaysian rivers namely Kurau, Langat and Muda. The results of present study are very promising: FFNN ( R 2 = 0.958, RMSE = 0.0698), ANFIS ( R 2 = 0.648, RMSE = 6.654), and GEP ( R 2 = 0.97, RMSE = 0.057), which support the use of these intelligent techniques in the prediction of sediment loads in tropical rivers.

  16. 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...

  17. 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.

  18. Revision Total Hip Arthroplasty Using the Cement-in-Cement Technique.

    Science.gov (United States)

    Amanatullah, Derek F; Pallante, Graham D; Floccari, Lorena V; Vasileiadis, George I; Trousdale, Robert T

    2017-03-01

    The cement-in-cement technique is useful in the setting of revision total hip arthroplasty (THA), especially to gain acetabular exposure, change a damaged or loose femoral component, or change the version, offset, or length of a fixed femoral component. The goal of this retrospective study was to assess the clinical and radiographic characteristics of revision THA using the cement-in- cement technique. Between 1971 and 2013, a total of 63 revision THAs used an Omnifit (Osteonics, Mahwah, New Jersey) or Exeter (Howmedica, Mahwah, New Jersey) stem and the cement-in-cement technique at the senior author's institution. Aseptic loosening (74%) was the predominant preoperative diagnosis followed by periprosthetic fracture (14%), instability (8%), and implant fracture (6%). Mean clinical follow-up was 5.5±3.8 years. The Harris Hip Score had a statistically significant increase of 18.5 points (Prevision THA using the cement-in-cement technique. There were 13 returns to the operating room, resulting in an overall failure rate of 21%. Eleven (18%) cases required revision THA, but only 1 (2%) revision THA was for aseptic removal of the femoral component. All other femoral implants had no evidence of component migration, cement mantel fracture, or circumferential lucent lines at final follow-up. The patients who underwent cement-in-cement revision THA at the senior author's institution had good restoration of function but a high complication rate. [Orthopedics. 2017; 40(2):e348-e351.]. Copyright 2016, SLACK Incorporated.

  19. [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.

  20. 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.

  1. 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.

  2. Comparison of three techniques for skin total irradiation with electrons; Comparacao de tres tecnicas de irradiacao total da pele com eletrons

    Energy Technology Data Exchange (ETDEWEB)

    Batista, Delano V.S., E-mail: dbatista@ird.gov.b [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Instituto Nacional de Cancer (INCa), Rio de Janeiro, RJ (Brazil); Bardella, Lucia H. [Instituto Nacional de Cancer (INCa), Rio de Janeiro, RJ (Brazil); Rosa, Luiz A.R. da, E-mail: lrosa@ird.gov.b [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil)

    2011-10-26

    This paper compared three techniques of skin total irradiation with electrons: 1) horizontal positioning, 2) vertical positioning - rotatory technique and 3) vertical positioning - six fields technique. For that, a anthropomorphic phantom was positioned according to the recommendation for each technique and was i radiated at the linear accelerator by using the 6 MeV electrons. Radiochromic films were positioned on the surface in various regions of the phantom for measurement of absorbed dose. A ionization chamber was positioned inside of equivalent issue plates for dose evaluation due to the photons produced by electron stopping. The technique 2 and 3 have shown too similar in the results and number or discrepant points (8 and 10 respectively) of prescription lower than the technique 1 (22 points). The total body dose of photons of the 1, 2 and 3 techniques was 2.2%, 5.3% and 5.2% respectively

  3. 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

  4. Total reflection of x-ray fluorescence (TXRF): a mature technique for environmental chemical nanoscale metrology

    Science.gov (United States)

    Borgese, L.; Zacco, A.; Bontempi, E.; Colombi, P.; Bertuzzi, R.; Ferretti, E.; Tenini, S.; Depero, L. E.

    2009-08-01

    Total reflection x-ray fluorescence (TXRF) is a technique well established for chemical analysis of samples deposited as a thin layer. Nowadays it is mainly employed for electronic industry quality control. Recently, very compact and economic TXRF instrumentation was proposed. Combining this with the capability to analyze liquid samples, this technique is suitable to be employed in many different applications, comprising the very critical field of environmental analysis. Comparisons with the standard atomic absorption spectroscopy (AAS) technique show that TXRF is a practical, accurate, and reliable technique. Indeed, round-robin activities have already been started. Despite the efficiency and economy of the developed portable TXRF instrumentation, this is not widely employed for chemical laboratory analysis probably because TXRF is not an officially recognized technique, i.e. it is not yet normative-subjected. This fact could also be due to the long background of analytical applications developed for AAS, ICPS or inductively coupled plasma mass spectroscopy (ICP-MS) up to now. In this paper, we present a work of environmental monitoring of an industrial site, performed by means of bioindicators (lichens). The analysis of trace elements concentration in lichen was usually conducted with spectrophotometric techniques, such as AAS and ICP-MS, which were accepted by common regulations and normative-subjected. In this study, we accomplished a comparative lichen analysis by AAS and TXRF. The reproducibility of the obtained results showed the high correspondence between the two techniques. This comparison highlighted the versatility of the TXRF apparatus that allowed more rapid and simultaneous element detection. The obtained results suggested that this portable TXRF system could be suitable for regulation to produce certificated analysis upto ppb concentrations for some elements.

  5. Measuring human remains in the field: Grid technique, total station, or MicroScribe?

    Science.gov (United States)

    Sládek, Vladimír; Galeta, Patrik; Sosna, Daniel

    2012-09-10

    Although three-dimensional (3D) coordinates for human intra-skeletal landmarks are among the most important data that anthropologists have to record in the field, little is known about the reliability of various measuring techniques. We compared the reliability of three techniques used for 3D measurement of human remain in the field: grid technique (GT), total station (TS), and MicroScribe (MS). We measured 365 field osteometric points on 12 skeletal sequences excavated at the Late Medieval/Early Modern churchyard in Všeruby, Czech Republic. We compared intra-observer, inter-observer, and inter-technique variation using mean difference (MD), mean absolute difference (MAD), standard deviation of difference (SDD), and limits of agreement (LA). All three measuring techniques can be used when accepted error ranges can be measured in centimeters. When a range of accepted error measurable in millimeters is needed, MS offers the best solution. TS can achieve the same reliability as does MS, but only when the laser beam is accurately pointed into the center of the prism. When the prism is not accurately oriented, TS produces unreliable data. TS is more sensitive to initialization than is MS. GT measures human skeleton with acceptable reliability for general purposes but insufficiently when highly accurate skeletal data are needed. We observed high inter-technique variation, indicating that just one technique should be used when spatial data from one individual are recorded. Subadults are measured with slightly lower error than are adults. The effect of maximum excavated skeletal length has little practical significance in field recording. When MS is not available, we offer practical suggestions that can help to increase reliability when measuring human skeleton in the field. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. 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.

  7. 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.

  8. [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.

  9. 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.

  10. A new spacer-guided, PCL balancing technique for cruciate-retaining total knee replacement.

    Science.gov (United States)

    Heesterbeek, P J C; Labey, L; Wong, P; Innocenti, B; Wymenga, A B

    2014-03-01

    The goal of this study was to investigate whether a new posterior cruciate ligament (PCL) balancing approach with a spacer technique during total knee arthroplasty (TKA) reproduced the correct tibiofemoral contact point (CP) location. It was hypothesized that it should be possible to adequately balance the PCL with this geometrical technique, obtaining correct position and stability of the medial femoral condyle, independent of insert shape. Nine fresh-frozen full-leg cadaver specimens were used. After native testing, prototype components of a new PCL-retaining implant were implanted using navigation and a bone-referencing technique. After finishing the bone cuts, the spacer technique was used to ascertain balancing of the PCL and the tibial cut was corrected if necessary. Passive and squat motions were performed before and after TKA using a dynamic knee simulator while tibiofemoral kinematics were recorded using six infrared cameras. CPs (native and implant) were calculated as the projections of the femoral condylar centres on the horizontal plane of the tibia. The spacer technique resulted in correct PCL balancing in all specimens. The kinematic patterns of native and replaced knees showed no statistically significant differences in passive and squat motions. The medial CP after TKA was at the same position as in the native knee. No paradoxical sliding forward was seen after TKA, supporting our hypothesis. The spacer technique can be applied by surgeons during PCL-retaining TKA and will lead to good PCL balancing, indicated by a correct CP, no lift-off in flexion and no posterior sag.

  11. Primary correction of total anomalous pulmonary venous return with a modified sutureless technique.

    Science.gov (United States)

    Mueller, Christoph; Dave, Hitendu; Prêtre, René

    2013-03-01

    The objective was to evaluate primary sutureless repair of total anomalous pulmonary venous return (TAPVR) in neonates using a modified technique that minimizes hypothermia and circulatory arrest times. From 2009 to 2011, seven consecutive patients underwent primary sutureless repair for the treatment of TAPVR, by which the prepared posterior pericardium was sutured to an opening in the left atrium. Three patients had the obstructed infracardiac type, and four patients had the unobstructed supracardiac type of TAPVR. Moderate hypothermia was used in all patients with a median temperature of 28°C (26-32). Circulatory arrest was not used except for the opening of the collector, which lasted between 3 and 5 min. The connecting vein was ligated in all seven patients (five during repair and two early postoperatively). The follow-up was 100% complete, with a median duration of 652 (range 370-1023) days. There was no operative mortality and no late death. No patient required reoperation. Postoperative echocardiography showed unobstructed pulmonary venous flow in all patients. Recurrent pulmonary venous stenosis was not seen during the follow-up in any patient. The sutureless technique is an effective technique with potential advantages even for the primary correction of TAPVR. With the described technique, the need for circulatory arrest is substantially reduced. Not handling the pulmonary venous collector by avoiding a direct anastomosis may contribute to better compliance, better growth and the absence of subsequent stenosis.

  12. A differential absorption technique to estimate atmospheric total water vapor amounts

    Science.gov (United States)

    Frouin, Robert; Middleton, Elizabeth

    1990-01-01

    Vertically integrated water-vapor amounts can be remotely determined by measuring the solar radiance reflected by the earth's surface with satellites or aircraft-based instruments. The technique is based on the method by Fowle (1912, 1913) and utilizes the 0.940-micron water-vapor band to retrieve total-water-vapor data that is independent of surface reflectance properties and other atmospheric constituents. A channel combination is proposed to provide more accurate results, the SE-590 spectrometer is used to verify the data, and the effects of atmospheric photon backscattering is examined. The spectrometer and radiosonde data confirm the accuracy of using a narrow and a wide channel centered on the same wavelength to determine water vapor amounts. The technique is suitable for cloudless conditions and can contribute to atmospheric corrections of land-surface parameters.

  13. A TOTAL MANUFACTURING SOLUTIONS TECHNIQUE TO SELECT APPROPRIATE IMPROVEMENT STRATEGY: CASE STUDY OF A FOOTWEAR FACTORY

    Directory of Open Access Journals (Sweden)

    Gezahegn Tesfaye

    2014-09-01

    Full Text Available The Government of Ethiopia is promoting the manufacturing sector to join the global market in a large scale. Due to its comparative advantages, the Ethiopian leather and leather products industry have been given due attention. To fully utilize such advantages, the country shifted its export items from hides/skins to footwear products. Nevertheless, the performance of the leather sector in general and footwear sub-sector in particular is far below the desired standards. The improvement strategies applied hitherto were mainly to tackle a small portion of their total problems. If the Ethiopian footwear companies have to become globally competitive, their entire business spectrum has to be assessed and appropriate improvement strategies must be selected. In this research, we used a Total manufacturing solutions (TMS technique to identify areas of improvement and improvement strategy of one of Ethiopian footwear companies. For this purpose, we conducted two surveys using structured questionnaire. The first survey was to test the TMS technique against the context of footwear industry. The result proved that the original TMS model can be used to measure the performance of footwear companies. The second survey was done to identify company's total problems, map its current position and select appropriate improvement strategy. The result revealed that the company has company-wide problems and its current position is a plodder. For plodders which have company-wide problems, the improvement strategy must include aggressive application of BPR; and the implementation of best practices to develop workers skills that encourages networking and promotion, a market-led manufacturing strategy, employee involvement and team work cultures. According to the findings of this research, we suggested that a BPR technique followed by a continuous improvement programme could be an appropriate improvement strategy for this company. The company requires long-term improvement

  14. Experimental device for obtaining calibration factor for the total count technique

    International Nuclear Information System (INIS)

    Gonçalves, Eduardo R.; Braz, Delson; Brandão, Luís Eduardo B.

    2017-01-01

    Nuclear technologies have widely used on industry plants in order to help to solve troubles processes/design or just obtain information of them. The Total Count technique for flow measurement has as main advantages: being an absolute technique, because it is independent of additional devices readings unless the directly used for recording the radioactive cloud, requiring only a single detector to provide the final result; the independence of the internal volume of the transport duct, can be applied in the presence or absence of obstructions; no restriction as to the nature of the product or material to be conveyed; it is a noninvasive technique which allows real-time diagnostics. To use Total Count Technique, knowledge of a geometric calibration factor is required. Called Factor F, it is obtained in the laboratory using an experimental apparatus to faithfully reproduce the geometry of the detection system and the pipeline that being analyzed and using the same radiotracer, therefore, its value is constant for each specific measuring system under survey. This experimental apparatus for obtaining the factor F consisting by a pipe of 2 ″PVC, which simulates a transmission line, where they were deposited 500 ml oil and the use of a specific pipette for use viscous fluids were added sequentially aliquots (50.00 ± 0.01) μl radiotracer (radionuclide photopeak energy of 198 Au 411.8 keV) and analyzing data obtained by three distinct detection systems composed of detectors NaI scintillators 1″ x 1 ″ and a data acquisition system. (author)

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. Laparoscopic Splenectomy for Hairy Cell Leukemia in Pregnancy

    Directory of Open Access Journals (Sweden)

    Beni Adegoke Adeniji

    2010-01-01

    Conclusion. Hairy cell leukemia is a clonal B-Cell malignancy, for which there is very limited experience worldwide for its management when it occurs during pregnancy. Laparoscopic splenectomy should be considered as a therapeutic option, even with a significantly enlarged spleen, in order to avoid the risks of fetal exposure to chemotherapeutic agents. Unique considerations relating to pregnancy are highlighted.

  2. 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

  3. 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 ...

  4. 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.

  5. [Perioperative care by internists in splenectomy].

    Science.gov (United States)

    Remková, A

    1998-06-01

    Splenectomy (SE) is one of the surgical interventions requiring an increased internal care. The removal of the spleen which is an organ with an exceptional function can lead to complications even in people who are healthy in all other respects. The complications in coincidence with SE can arise early (up to 30 days after surgery) or later. Early complications can involve infections of the respiratory tract (especially bronchopneumonia), or subphrenic abscess. Thromboembolic complications occur not only in peri-operational period, but also in several weeks or months after SE. A severe complication resides in disseminated intravascular blood coagulation. Late complications represent a lifelong danger for asplenic patients. They include the fulminant sepsis, known as so-called OPSI syndrome (overwhelming postsplenectomy infection). The mortality rate in coincidence with the latter is very high despite intensive antibiotic therapy. The risk is especially high in children, in immuno-deficient states and immunosuppressive therapy. 60% of patients develop OPSI during the first two years, out of whom one third is afflicted in the first half of the year following SE. In more than 30% of patients OPSI manifests itself minimally 5 years later. The prevention of infection in coincidence with SE is performed by means of immunization, antibiotic prophylaxis and via education of patients. Immunization includes the administration of a polyvalent pneumococcus vaccine, in children it includes also the vaccine against Haemophilus inluenzae and Neisseria meningitidis. The appropriate antibiotic prophylaxis is represented especially by penicillin, amoxicillin, or amoxicillin with clavulanic acid. The children or other patients with disturbed immunity functions are administered with antibiotics in low doses per os for a long period. Antibiotics in the therapy of OPSI are administered in full doses together with immunoglobulin, both are applied intravenously. A specific approach is

  6. [Total-endoscopic Thyroid Resection in ABBA-Technique: Comments on the Integration of Intraoperative Neuromonitoring].

    Science.gov (United States)

    Jonas, J

    2016-10-01

    Background: Total endoscopic thyroid resections without any scars on the neck are a special challenge for the surgeon. Clinical results of intraoperative neuromonitoring (IONM) in the axillo-bilateral-breast-approach (ABBA) have not been described so far. Methods: 29 female patients (~ 40 years) were operated for one-sided thyroid pathology using the ABBA technique (20 subtotal resections, 9 hemithyroidectomies). Suspected malignoma, size > 35 mL, known thyroiditis and recurrencies were excluded. For stimulation a 30-cm handprobe and for signal deviation a tube adhesive electrode (ISIS; Fa. Inomed, Emmendingen, Germany) were used. Results: The average operation time was 132 minutes. Intraoperative blood loss necessitated conversion to the open procedure in 1 case. A single tube electrode dislocation occurred. In the alternative a bipolar needle electrode was inserted percutaneously through the cricothyroid ligament. One intraoperative signal loss was confirmed by the laryngoscopic finding of vocal cord paresis, which recovered within 6 months. An additional case of incomplete brachial plexus paralysis was observed with a 2-day recovery time. Conclusion: Direct neuromonitoring of the recurrent laryngeal nerve can be easily applied in the total endoscopic ABBA technique for thyroid resection. Vagal stimulation, which is obligatory in open thyroid surgery, cannot consequently be included in this endoscopic operation method. Unexpected tube electrode dislocation may cause IONM misinterpretation. A risk of double-sided vocal cord palsy is theoretically present. Georg Thieme Verlag KG Stuttgart · New York.

  7. Evolution of robotic nephrectomy for living donation: from hand-assisted to totally robotic technique.

    Science.gov (United States)

    Giacomoni, Alessandro; Di Sandro, Stefano; Lauterio, Andrea; Concone, Giacomo; Mangoni, Iacopo; Mihaylov, Plamen; Tripepi, Matteo; De Carlis, Luciano

    2014-09-01

    The application of robotic-assisted surgery offers EndoWrist instruments and 3-D visualization of the operative field, which are improvements over traditional laparoscopy. The results of the few studies published so far have shown that living donor nephrectomy using the robot-assisted technique is safe, feasible, and offers advantages to patients. Since November 2009, 16 patients have undergone robotic-assisted living donor nephrectomy at our Institute. Patients were divided into two groups according to the surgical technique adopted for the procedure: Group A, hand-assisted robotic nephrectomy (eight patients); Group B, totally robotic nephrectomy (eight patients). Intra-operative bleeding was similar in the two groups (90 vs 100 mL for Group A and B, respectively). Median warm ischemia time was significantly shorter in Group A (2.3 vs 5.1 min for Group A and B, respectively, P-value = 0.05). Switching to the open procedure was never required. Median operative time was not significantly longer in Group A than Group B (275 min vs 250 min, respectively). Robotic assisted living kidney recovery is a safe and effective procedure. Considering the overall technical, clinical, and feasibility aspects of living kidney donation, we believe that the robotic assisted technique is the method of choice for surgeon's comfort and donors' safety. Copyright © 2014 John Wiley & Sons, Ltd.

  8. Negligible water surface charge determined using Kelvin probe and total reflection X-ray fluorescence techniques.

    Science.gov (United States)

    Shapovalov, Vladimir L; Möhwald, Helmuth; Konovalov, Oleg V; Knecht, Volker

    2013-09-07

    The water surface charge has been extensively debated in recent decades. Electrophoretic mobilities of air bubbles in water and disjoining pressures between the surfaces of aqueous films suggest that the surface of water exhibits a significant negative charge. This is commonly attributed to a strong adsorption of hydroxide ions at the interface, though spectroscopic measurements and simulation studies suggest surface depletion of hydroxide ions. Alternatively, the negative surface charge could arise from surface contamination with trace charged surfactants. We have probed the variation in the surface charge of water with pH by measuring surface potentials using the Kelvin probe technique. Independently, the abundance in the interfacial layer of "reporter ions" (Rb(+) and Br(-)), which must be affected by a charged surface, has been monitored using the total reflection X-ray fluorescence (TRXF) technique. Special care was taken to prove the high sensitivity of this technique as well as to avoid surface contaminants. The magnitude of the surface charge was found to be below 1 e per 500 nm(2) (TRXF). No evidence of variations in the surface potential between pH 2-3 and pH 9-12 was detected within the accuracies of the methods (5 mV for Kelvin probe and 2 mV for TRXF). Hence, our findings suggest that the clean water surface exhibits negligible charge in a wide pH range.

  9. Revision of hemiarthroplasty to total hip arthroplasty using the cement-in-cement technique.

    Science.gov (United States)

    Mounsey, E J; Williams, D H; Howell, J R; Hubble, M J

    2015-12-01

    Revision of a cemented hemiarthroplasty of the hip may be a hazardous procedure with high rates of intra-operative complications. Removing well-fixed cement is time consuming and risks damaging already weak bone or perforating the femoral shaft. The cement-in-cement method avoids removal of intact cement and has shown good results when used for revision total hip arthroplasty (THA). The use of this technique for the revision of a hemiarthroplasty to THA has not been previously reported. A total of 28 consecutive hemiarthroplasties (in 28 patients) were revised to a THA using an Exeter stem and the cement-in-cement technique. There were four men and 24 women; their mean age was 80 years (35 to 93). Clinical and radiographic data, as well as operative notes, were collected prospectively and no patient was lost to follow-up. Four patients died within two years of surgery. The mean follow up of the remainder was 70 months (25 to 124). Intra-operatively there was one proximal perforation, one crack of the femoral calcar and one acetabular fracture. No femoral components have required subsequent revision for aseptic loosening or are radiologically loose. Four patients with late complications (14%) have since undergone surgery (two for a peri-prosthetic fracture, and one each for deep infection and recurrent dislocation) resulting in an overall major rate of complication of 35.7%. The cement-in-cement technique provides reliable femoral fixation in this elderly population and may reduce operating time and rates of complication. ©2015 The British Editorial Society of Bone & Joint Surgery.

  10. SU-E-T-357: Electronic Compensation Technique to Deliver Total Body Dose

    International Nuclear Information System (INIS)

    Lakeman, T; Wang, I; Podgorsak, M

    2015-01-01

    Purpose: Total body irradiation (TBI) uses large parallel-opposed radiation fields to suppress the patient’s immune system and eradicate the residual cancer cells in preparation of recipient for bone marrow transplant. The manual placement of lead compensators has conventionally been used to compensate for the varying thickness through the entire body in large-field TBI. The goal of this study is to pursue utilizing the modern electronic compensation technique to more accurately and efficiently deliver dose to patients in need of TBI. Methods: Treatment plans utilizing electronic compensation to deliver a total body dose were created retrospectively for patients for whom CT data had been previously acquired. Each treatment plan includes two, specifically weighted, pair of opposed fields. One pair of open, large fields (collimator=45°), to encompass the patient’s entire anatomy, and one pair of smaller fields (collimator=0°) focused only on the thicker midsection of the patient. The optimal fluence for each one of the smaller fields was calculated at a patient specific penetration depth. Irregular surface compensators provide a more uniform dose distribution within the smaller opposed fields. Results: Dose-volume histograms (DVH) were calculated for the evaluating the electronic compensation technique. In one case, the maximum body doses calculated from the DVH were reduced from the non-compensated 195.8% to 165.3% in the electronically compensated plans, indicating a more uniform dose with the region of electronic compensation. The mean body doses calculated from the DVH were also reduced from the non-compensated 120.6% to 112.7% in the electronically compensated plans, indicating a more accurate delivery of the prescription dose. All calculated monitor units were well within clinically acceptable limits. Conclusion: Electronic compensation technique for TBI will not substantially increase the beam on time while it can significantly reduce the compensator

  11. 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.

  12. Microcatheter balloon pinning technique to facilitate wiring of a left circumflex chronic total occlusion.

    Science.gov (United States)

    Oguayo, Kevin N; Oguayo, Chris C; Vallabhan, Ravi; Choi, James W

    2017-12-01

    Coronary chronic total occlusions (CTOs) are commonly encountered during diagnostic angiograms. With recent advances, especially in experienced centers, success rates with CTO percutaneous coronary intervention (PCI) have approached 80% or higher. It is important to note that despite these advancements in techniques, CTOs remain difficult to treat. We present a case of a left circumflex artery (LCX) CTO that was successfully revascularized using a microcatheter balloon pinning technique that allowed additional wire support. A 77-year-old woman status post-two-vessel coronary artery bypass graft surgery presented with new onset angina at rest and was found to have a patent graft to the left anterior descending artery, and an unrevascularized proximal LCX CTO. PCI was attempted with a microcatheter using an antegrade approach. This approach was unsuccessful due to the lack of support and the left circumflex angle. As a result, we used a balloon to pin the microcatheter to the wall of the left main to allow for successful wiring of the LCX. A stent was successfully deployed in the LCX, and the patient was discharged from the hospital 2 days later. At follow-up, the patient was asymptomatic and returned to her usual activity. After conducting a thorough literature search, it appears that this is the first case that a microcatheter has been pinned with a balloon. We believe that in LCX CTOs that require support, the microcatheter pinning technique can provide adequate support in wiring CTO's. LCX CTOs can be very difficult to treat, we present a case of a LCX CTO that required the use of the microcatheter balloon pinning technique to allow additional wire support for successful wiring and ultimately treatment. © 2017 John Wiley & Sons Ltd.

  13. SU-G-TeP1-13: Reclined Total Skin Electron Treatment Technique

    International Nuclear Information System (INIS)

    Mathew, D; Gerbi, B

    2016-01-01

    Purpose: The purpose is to describe a new reclined technique for treatment of weakened patients that require total skin electron irradiation. Methods: This technique is a modification of a previously published reclined technique differing in that all six patient positions are treated with the gantry angled 60° from vertically down. The patient is located at a treatment distance of 330 cm SSD along the CA of the beam. The 3/8′ thick Lexan beam spoiler is placed 25 cm from the most proximal surface of the patient for all patient treatment positions. To produce a flat, uniform field of ∼190 cm length, the patient was moved longitudinally by an experimentally determined distance. Kodak EDR2 and EBT3 Radiochromic film were placed around the periphery of the phantom, and OSLs were placed every 30° around the phantom periphery to determine output and surface dose uniformity. A piece of Kodak EDR2 was sandwiched between the two slabs of the 30 cm diameter phantom to determine beam penetration. Results: Field uniformity shifting the patient ±75 cm was ±5% over a treatment span of 190 cm. The dose variation around the periphery of the 30 cm diameter phantom varied by <±5% with the maximum values observed at the 0°-300°, 60° locations with the minimum values at the 30°-330°, 60° locations. Results obtained using Kodak EDR2, EBT3 Radiochromic film, and OSLs agreed to within ±5%. Conclusion: This technique provides a very efficient and convenient means by which to treat the entire skin surface of patients incapable of standing for treatment. It provides a treatment field that is both large and uniform enough for adults along with a convenient way to treat four of the six patient treatment positions. The beam spoiler lies to the side of the patient allowing easy access for patient positioning.

  14. 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

  15. 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.

  16. Total pleural covering technique for intractable pneumothorax in patient with Ehlers-Danlos syndrome.

    Science.gov (United States)

    Kadota, Yoshihisa; Fukui, Eriko; Kitahara, Naoto; Okura, Eiji; Ohta, Mitsunori

    2016-07-01

    We report a patient with vascular-type Ehlers-Danlos syndrome (vEDS) who developed pneumothorax and was treated with a total pleural covering technique (TPC). A 24-year-old man developed repeat pneumothorax with intermittent hemo-sputum. Based on unusual radiological manifestations of lung lesions and physical findings, EDS was suspected as an underlying cause of the pneumothorax. Surgical treatment was performed using a mediastinal fat pad and TPC, and no relapse was seen up to 2 years after surgery. TPC is a less invasive surgical approach for selected patients with vEDS. Accurate underlying diagnosis of vEDS and systemic evaluation of vascular complications are necessary before planning surgery.

  17. Application of the Spectral Structure Parameterization technique: retrieval of total water vapor columns from GOME

    Directory of Open Access Journals (Sweden)

    R. Lang

    2003-01-01

    Full Text Available We use a recently proposed spectral sampling technique for measurements of atmospheric transmissions called the Spectral Structure Parameterization (SSP in order to retrieve total water vapor columns (WVC from reflectivity spectra measured by the Global Ozone Monitoring Experiment (GOME. SSP provides a good compromise between efficiency and speed when performing retrievals on highly structured spectra of narrow-band absorbers like water vapor. We show that SSP can be implemented in a radiative transfer scheme which treats both direct-path absorption and absorption by singly-scattered light directly. For the retrieval we exploit a ro-vibrational overtone band of water vapor located in the visible around 590 nm. We compare our results to independent values given by the data assimilation model of ECMWF. In addition, results are compared to those obtained from the more accurate, but more computationally expensive, Optical Absorption Coefficient Spectroscopy (OACS.

  18. SU-F-T-83: Infant Total Skin Electron Therapy Using Five Fields Technique

    Energy Technology Data Exchange (ETDEWEB)

    Saleh, H; Howlin, T; Massey, V [University of Kansas Hospital, Overland Park, KS (United States)

    2016-06-15

    Purpose: We were presented with a 9 month old boy with Relapsed Acute Myeloid Leukemia (AML) involving the skin. The plan was to treat the entire skin using 6 MeV electrons with the infant under complete anesthesia. The purpose of this work is to commission the 6 MeV electron beam and to develop a technique that can be used to deliver total skin dose to infants with minimal patient immobilization. Methods: A baby mannequin phantom that mimics the child’s length was used to determine the best technique to treat the infant. The 76 cm long phantom was placed on the floor. The phantom was placed in four unique immobilization devices to simulate four different treatment positions (anterior, posterior, left lateral and right lateral). Radiochromic films were used to determine beam profile in both axial and radial directions, and percent depth dose (PDD). Absolute calibration of the machine output at 214 cm distance was measured using an Exradin A11 parallel-plate ion chamber. A 1.0 cm plexiglass scatter plate was inserted in the collimator. Mosfet dosimeters were used for dose verification for phantom and and patient. Results: At 214 cm source to surface distance (SSD) using gantry angle of + 20o from vertical beam flatness is + 10% in the radial direction over a region of 70 cm and + 4% in the axial direction over 60 cm. A five field arrangement was determined to optimally deliver the desired dose with > 90% uniformity. The fifth field was used to boost the head vertex. Conclusion: It is possible to treat sedated infants with total skin dose using five positions. Four positions were enough to cover the body and the fifth position boosts the vertex of the head. All fractions can be reproduced accurately daily because of the patient’s stable immobilization.

  19. Oil flow rate measurements using 198Au and total count technique

    International Nuclear Information System (INIS)

    Goncalves, Eduardo R.; Crispim, Verginia R.

    2013-01-01

    In industrial plants, oil and oil compounds are usually transported by closed pipelines with circular cross-section. The use of radiotracers in oil transport and processing industrial facilities allows calibrating flowmeters, measuring mean residence time in cracking columns, locate points of obstruction or leak in underground ducts, as well as investigating flow behavior or industrial processes such as in distillation towers. Inspection techniques using radiotracers are non-destructive, simple, economic and highly accurate. Among them, Total Count, which uses a small amount of radiotracer with known activity, is acknowledged as an absolute technique for flow rate measurement. A viscous fluid transport system, composed by four PVC pipelines with 13m length (12m horizontal and 1m vertical) and 1/2, 3/4, 1 and 2-inch gauges, respectively, interconnected by maneuvering valves was designed and assembled in order to conduct the research. This system was used to simulate different flow conditions of petroleum compounds and for experimental studies of flow profile in the horizontal and upward directions. As 198 Au presents a single photopeak (411,8 keV), it was the radioisotope chosen for oil labeling, in small amounts (6 ml) or around 200 kBq activity, and it was injected in the oil transport lines. A NaI scintillation detector 2'x 2', with well-defined geometry, was used to measure total activity, determine the calibration factor F and, positioned after a homogenization distance and interconnected to a standardized electronic set of nuclear instrumentation modules (NIM), to detect the radioactive cloud. (author)

  20. SU-F-T-83: Infant Total Skin Electron Therapy Using Five Fields Technique

    International Nuclear Information System (INIS)

    Saleh, H; Howlin, T; Massey, V

    2016-01-01

    Purpose: We were presented with a 9 month old boy with Relapsed Acute Myeloid Leukemia (AML) involving the skin. The plan was to treat the entire skin using 6 MeV electrons with the infant under complete anesthesia. The purpose of this work is to commission the 6 MeV electron beam and to develop a technique that can be used to deliver total skin dose to infants with minimal patient immobilization. Methods: A baby mannequin phantom that mimics the child’s length was used to determine the best technique to treat the infant. The 76 cm long phantom was placed on the floor. The phantom was placed in four unique immobilization devices to simulate four different treatment positions (anterior, posterior, left lateral and right lateral). Radiochromic films were used to determine beam profile in both axial and radial directions, and percent depth dose (PDD). Absolute calibration of the machine output at 214 cm distance was measured using an Exradin A11 parallel-plate ion chamber. A 1.0 cm plexiglass scatter plate was inserted in the collimator. Mosfet dosimeters were used for dose verification for phantom and and patient. Results: At 214 cm source to surface distance (SSD) using gantry angle of + 20o from vertical beam flatness is + 10% in the radial direction over a region of 70 cm and + 4% in the axial direction over 60 cm. A five field arrangement was determined to optimally deliver the desired dose with > 90% uniformity. The fifth field was used to boost the head vertex. Conclusion: It is possible to treat sedated infants with total skin dose using five positions. Four positions were enough to cover the body and the fifth position boosts the vertex of the head. All fractions can be reproduced accurately daily because of the patient’s stable immobilization.

  1. 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.

  2. Subtotal splenectomy for splenic abscess Esplenectomia subtotal para abscesso esplênico

    Directory of Open Access Journals (Sweden)

    Rachid Guimarães Nagem

    2008-06-01

    Full Text Available BACKGROUND: Splenic abscess is a rare condition but carries high mortality (up to 100% when untreated and surgery has been the standard of therapy. CASE REPORT: An adult male had been undergone thrombolytic therapy for a heart attack and presented spontaneous intrasplenic hematoma which, subsequently, have turned into an abscess. Once it was a large multiloculated collection, subtotal splenectomy was the only treatment that could spare some splenic tissue. This approach was carried out successfully and the patient is presently healthy. CONCLUSION: Subtotal splenectomy is an effective option for the management of splenic abscesses.INTRODUÇÃO: Abcesso esplênico é condição rara e trás consigo alta mortalidade (quase 100% quando não tratado e a cirurgia é a forma de tratamento de escolha. RELATO DE CASO: Homem adulto foi submetido à terapia tromboembólica como tratamento de enfarte de miocárdio e apresentou hematoma espontâneo de baço, o qual tranformou-se em abcesso. Desde que ele era multiloculado e grande, esplenectomia subtotal foi considerada o único tratamento que poderia retirar todo o tecido comprometido. Este procedimento foi realizado com sucesso e o paciente evoluiu bem sem complicações. CONCLUSÃO: Esplenectomia sub-total é uma efetiva opção para o manuseio dos abcessos esplênicos.

  3. 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

  4. Analysis of behavioral change techniques in community-led total sanitation programs.

    Science.gov (United States)

    Sigler, Rachel; Mahmoudi, Lyana; Graham, Jay Paul

    2015-03-01

    The lack of sanitation facilitates the spread of diarrheal diseases-a leading cause of child deaths worldwide. As of 2012, an estimated 1 billion people still practiced open defecation (OD). To address this issue, one behavioral change approach used is community-led total sanitation (CLTS). It is now applied in an estimated 66 countries worldwide, and many countries have adopted this approach as their main strategy for scaling up rural sanitation coverage. While it appears that many of the activities used in CLTS-that target community-level changes in sanitation behaviors instead of household-level changes-have evolved out of existing behavior change frameworks and techniques, it is less clear how these activities are adapted by different organizations and applied in different country contexts. The aims of this study are to (i) show which behavior change frameworks and techniques are the most common in CLTS interventions; (ii) describe how activities are implemented in CLTS interventions by region and context; and (3) determine which activities program implementers considered the most valuable in achieving open defecation free (ODF) status and sustaining it. The results indicate that a wide range of activities are conducted across the different programs and often go beyond standard CLTS activities. CLTS practitioners ranked follow-up and monitoring activities as the most important activities for achieving an ODF community, yet only 1 of 10 organizations conducted monitoring and follow-up throughout their project. Empirical studies are needed to determine which specific behavioral change activities are most effective at ending OD and sustaining it. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Gap-Balancing versus Measured Resection Technique in Total Knee Arthroplasty: A Comparison Study.

    Science.gov (United States)

    Churchill, Jessica L; Khlopas, Anton; Sultan, Assem A; Harwin, Steven F; Mont, Michael A

    2018-01-01

    Proper femoral component alignment in the axial plane during total knee arthroplasty (TKA) depends on accurate bone cuts and soft tissue balancing. Two methods that are used to achieve this are "measured resection" and "gap balancing." However, a controversy exists as to which method is more accurate and leads to better outcomes. Therefore, the purpose of this study was to evaluate: (1) implant survivorship, (2) patient outcomes, (3) complications, and (4) radiographic analysis comparing patients who underwent TKA with either gap-balancing or measured resection techniques. A total of 214 consecutive patients (221 knees) underwent primary TKA by a single surgeon between 2011 and 2012. Component alignment was achieved by using measured resection in 116 knees and gap balancing was used in 105 knees. The patients had a mean age of 66 years (range, 44-86 years) and a mean body mass index of 32 kg/m 2 (range, 22-52 kg/m 2 ). Patient range-of-motion (ROM) and Knee Society (KS) function and pain scores, and radiographic assessment, were assessed preoperatively and postoperatively at ∼6 weeks, 3 months, 1 year, and then annually. The mean follow-up time was 3 years. A Kaplan-Meier's analysis was performed to calculate the survivorship. The aseptic survivorship was 98% in both the measured resection and gap-balancing groups. The mean ROM was not significantly different between the measured resection and gap-balancing groups (123 vs. 123 degrees, p  = 0.990). There were no significant differences between the two groups in terms of the KS function scores (86 vs. 85 points, p  = 0.829) or the KS pain scores (93 vs. 92 points, p  = 0.425). Otherwise, the radiographic evaluation at latest follow-up did not demonstrate any evidence of progressive radiolucencies or loosening, of any prosthesis. The results of this study found that at a mean follow-up of 3 years, both the measured resection and gap-balancing techniques achieved excellent survivorship and

  6. [The standard implantation of a total hip prosthesis via two incisions (the Yale Technique)].

    Science.gov (United States)

    Kipping, Robert

    2009-09-01

    Implantation of a total hip endoprosthesis with minimal trauma to the soft tissue. The need for visual aids (e.g., navigation or X-rays) during the procedure is frequently avoided. All kinds of coxarthrosis for every age group, for every variation of bone construction, and even in obese patients. Extremely dysplastic hip joints involving the development of a secondary socket and the necessity of reconstruction of the acetabular socket (e.g., in the Harris method). Using a fixed lateral position, a small entry incision is made between the tensor fasciae latae and the sartorius muscles and the prosthesis socket is put into place. Via a second dorsal incision, after stripping the exterior rotators, the prosthesis stem and ball are implanted and the two parts of the prosthesis are attached. Full weight bearing allowed immediately. A luxation prophylaxis, in the form of a self-developed hip bodice (the so-called Yale bandage), is used until the end of the 4th postoperative week. Discharge from hospital is possible after just a few days. Upon discharge, the patient is sent to a rehabilitation facility, either as a resident or as an outpatient, for approximately 3 weeks. Return to the workplace, with only light physical activity, is possible once the wound has healed completely; this could be as soon as 14 days after the operation. Checkups are made after 4 weeks, 6 months, 1 year and then every year; these checkups include a full examination, X-rays and laboratory tests. Full exposure to sport or heavy manual labor is usually approved after the 6-month checkup. Between October 2004 and April 2006, a total of 221 patients underwent surgery using this new technique (of these 15 patients underwent two-stage bilateral hip joint replacements). Patients were followed up for a minimum of 12 months and a maximum of 30 months. The Harris Hip Score improved from an average of 45.25 preoperatively to 96.4 postoperatively.

  7. Elemental analysis within the electrical double layer using total reflection X-ray fluorescence technique.

    Science.gov (United States)

    Shapovalov, Vladimir L; Ryskin, Mikhail E; Konovalov, Oleg V; Hermelink, Antje; Brezesinski, Gerald

    2007-04-19

    A simplified total reflection X-ray fluorescence (TRXF) technique is proposed for the study of the electrical double layer (EDL) near charged monolayers at the air-water interface. In contrast to the parent NTEF (near total external reflection X-ray fluorescence) method, TRXF uses a fixed angle of incidence (below the critical one) and abandons both "spatial resolution" (which is poor anyway) and "absolute calibration" with the bulk reference. These modifications reduce both the duration of experiments and the complexity of the data treatment by 1-2 orders of magnitude and turn TRXF into a truly simple tool for elemental analysis within the EDL. A few TRXF experiments appear sufficient to disprove the model of simultaneous binding of alkali earth metal cations and inorganic anions to negatively charged phospholipid monolayers as proposed in literature. Direct experimental support was provided to the essential feature of the EDL near highly charged interfaces: The main amount of counterions is concentrated in the thin inner part of the EDL irrespective of the electrolyte concentration in the bulk. A study of the counterion competition for the participation in the EDL of highly negatively charged behenylsulfate (BS) monolayers (resulting from packing density limitations) revealed that univalent Cs+ is quite competitive with divalent Ca2+ and Ba2+ (which contradicts the classical Gouy-Chapman model). If the univalent/divalent ion ratio in bulk is 9:1, the corresponding ratio in the EDL is ca. 1.5 for Cs+/Ca2+ and 0.5 for Cs+/Ba2+, whereas the model predicts 0.14 only. Bearing in mind packing density limitations, these values are consistent with a series of sizes for hydrated ions: Cs+ < Ba2+ < Ca2+.

  8. 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

  9. 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

  10. 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.

  11. 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

  12. Total reflection X-ray fluorescence as a fast multielemental technique for human placenta sample analysis

    Science.gov (United States)

    Marguí, E.; Ricketts, P.; Fletcher, H.; Karydas, A. G.; Migliori, A.; Leani, J. J.; Hidalgo, M.; Queralt, I.; Voutchkov, M.

    2017-04-01

    In the present contribution, benchtop total reflection X-ray fluorescence spectrometry (TXRF) has been evaluated as a cost-effective multielemental analytical technique for human placenta analysis. An easy and rapid sample preparation consisting of suspending 50 mg of sample in 1 mL of a Triton 1% solution in deionized water showed to be the most suitable for this kind of samples. However, for comparison purposes, an acidic microwave acidic digestion procedure was also applied. For both sample treatment methodologies, limits of detection for most elements were in the low mg/kg level. Accurate and precise results were obtained using internal standardization as quantification approach and applying a correction factor to compensate for absorption effects. The correction factor was based on the proportional ratio between the slurry preparation results and those obtained for the analysis of a set of human placenta samples analysed by microwave acidic digestion and ICP-AES analysis. As a study case, the developed TXRF methodology was applied for multielemental analysis (K, Ca, Fe, Cu, Zn, As, Se, Br, Rb and Sr) of several healthy women's placenta samples from two regions in Jamaica.

  13. Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of "vessel architecture".

    Science.gov (United States)

    Azzalini, Lorenzo; Carlino, Mauro; Brilakis, Emmanouil S; Vo, Minh; Rinfret, Stéphane; Uretsky, Barry F; Karmpaliotis, Dimitri; Colombo, Antonio

    2018-03-01

    Despite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely. A modern approach to CTO PCI involves understanding the concept of "vessel architecture," which is based on the distinction between coronary structures (occlusive plaque, comprising the disrupted intima and media, and the outer adventitia) and extravascular space. The vessel architecture represents a safe work environment for guidewire and device manipulation. This review provides an anatomy-based description of the concept of vessel architecture, along with a historical perspective of subadventitial techniques for CTO PCI, and outcome data of CTO PCI utilizing the subadventitial space. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  14. Cementing the femoral component in total knee arthroplasty: which technique is the best?

    Science.gov (United States)

    Vaninbroukx, Michaël; Labey, Luc; Innocenti, Bernardo; Bellemans, Johan

    2009-08-01

    Although several techniques exist for cementing the femoral component in TKA, no data are available on which is the best one to use. We therefore compared four cementing techniques in an anatomical open pore sawbone model (n=20), in order to investigate the influence of cementation technique on overall cement penetration as well as length of the cement mantle over the different cuts. The technique which included cement application onto the anterior and distal bone surfaces, as well as the posterior flanges of the prosthesis, was statistically superior to the other techniques. We therefore advocate this technique as the standard for cementing the femoral component.

  15. [Abdominothoracic esophageal resection according to Ivor Lewis with intrathoracic anastomosis : standardized totally minimally invasive technique].

    Science.gov (United States)

    Runkel, N; Walz, M; Ketelhut, M

    2015-05-01

    The clinical and scientific interest in minimally invasive techniques for esophagectomy (MIE) are increasing; however, the intrathoracic esophagogastric anastomosis remains a surgical challenge and lacks standardization. Surgeons either transpose the anastomosis to the cervical region or perform hybrid thoracotomy for stapler access. This article reports technical details and early experiences with a completely laparoscopic-thoracoscopic approach for Ivor Lewis esophagectomy without additional thoracotomy. The extent of radical dissection follows clinical guidelines. Laparoscopy is performed with the patient in a beach chair position and thoracoscopy in a left lateral decubitus position using single lung ventilation. The anvil of the circular stapler is placed transorally into the esophageal stump. The specimen and gastric conduit are exteriorized through a subcostal rectus muscle split incision. The stapler body is placed into the gastric conduit and both are advanced through the abdominal mini-incision transhiatally into the right thoracic cavity, where the anastomosis is constructed. Data were collected prospectively and analyzed retrospectively. A total of 23 non-selected consecutive patients (mean age 69 years, range 46-80 years) with adenocarcinoma (n = 19) or squamous cell carcinoma (n = 4) were surgically treated between June 2010 and July 2013. Neoadjuvant therapy was performed in 15 patients resulting in 10 partial and 4 complete remissions. There were no technical complications and no conversions. Mean operative time was 305 min (range 220-441 min). The median lymph node count was 16 (range 4-42). An R0 resection was achieved in 91 % of patients and 3 anastomotic leaks occurred which were successfully managed endoscopically. There were no postoperative deaths. The intrathoracic esophagogastric anastomosis during minimally invasive Ivor Lewis esophagectomy can be constructed in a standardized fashion without an additional thoracotomy

  16. Wound Closure Techniques for Total Knee Arthroplasty: An Evidence-Based Review of the Literature.

    Science.gov (United States)

    Krebs, Viktor E; Elmallah, Randa K; Khlopas, Anton; Chughtai, Morad; Bonutti, Peter M; Roche, Martin; Mont, Michael A

    2018-02-01

    This literature review is aimed at identifying the different methods for superficial and deep wound closure in total knee arthroplasty and evaluating their outcomes. We evaluated (1) closure time, (2) infection and other complication rates, and (3) local wound-related outcomes. A thorough search of the literature was performed using 3 electronic databases. Inclusion criteria included manuscripts that were written in English and available in full-text format. Reports were stratified into those that describe deep closure (7) and those that describe superficial closure (11). In superficial closure, staples may provide the fastest closure, adhesives, lower incidence of superficial complications, and subcuticular suture closures, greatest blood flow. In deep closure, barbed sutures may allow for faster closure time while providing similar postoperative complication rates and outcomes when compared to traditional sutures. The use of barbed sutures has been shown to utilize fewer resources and may potentially lead to a slight reduction in costs. Ultimately, no optimal closure technique has been developed, and current studies do not provide a clear evidence-based answer. This field needs much more evidence-based studies before one can draw conclusions. Even though some of these studies are prospective and randomized, they may not be generalizable. Also, many of the studies have small numbers and are subject to type II errors and fragility. Certainly, more studies are needed to truly understand the advantages and disadvantages of these new methods. Nevertheless, this review allows orthopedists to evaluate the differences between closure methods. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Neonatal total liquid ventilation: is low-frequency forced oscillation technique suitable for respiratory mechanics assessment?

    Science.gov (United States)

    Bossé, Dominick; Beaulieu, Alexandre; Avoine, Olivier; Micheau, Philippe; Praud, Jean-Paul; Walti, Hervé

    2010-08-01

    This study aimed to implement low-frequency forced oscillation technique (LFFOT) in neonatal total liquid ventilation (TLV) and to provide the first insight into respiratory impedance under this new modality of ventilation. Thirteen newborn lambs, weighing 2.5 + or - 0.4 kg (mean + or - SD), were premedicated, intubated, anesthetized, and then placed under TLV using a specially design liquid ventilator and a perfluorocarbon. The respiratory mechanics measurements protocol was started immediately after TLV initiation. Three blocks of measurements were first performed: one during initial respiratory system adaptation to TLV, followed by two other series during steady-state conditions. Lambs were then divided into two groups before undergoing another three blocks of measurements: the first group received a 10-min intravenous infusion of salbutamol (1.5 microg x kg(-1) x min(-1)) after continuous infusion of methacholine (9 microg x kg(-1) x min(-1)), while the second group of lambs was chest strapped. Respiratory impedance was measured using serial single-frequency tests at frequencies ranging between 0.05 and 2 Hz and then fitted with a constant-phase model. Harmonic test signals of 0.2 Hz were also launched every 10 min throughout the measurement protocol. Airway resistance and inertance were starkly increased in TLV compared with gas ventilation, with a resonant frequency < or = 1.2 Hz. Resistance of 0.2 Hz and reactance were sensitive to bronchoconstriction and dilation, as well as during compliance reduction. We report successful implementation of LFFOT to neonatal TLV and present the first insight into respiratory impedance under this new modality of ventilation. We show that LFFOT is an effective tool to track respiratory mechanics under TLV.

  18. 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.

  19. Assessments of total hip replacements before and after revision surgery with use of computed tomography with metal artifact reduction techniques

    International Nuclear Information System (INIS)

    Robertson, D.D.; Fishman, E.K.; Kalender, W.A.; Magid, D.; Weiss, P.J.

    1986-01-01

    Radiographic assessment of revision total hip replacements suffers from the inability to provide adequate information regarding bone stock loss. Even CT, with its transaxial orientation, is limited because of metal artifacts. Three metal artifact reduction techniques are available for CT: material-dependent imaging, planar reformation of image data, and missing projection data replacement. These techniques were used to evaluate preoperatively seven patients with revision total hip replacements, and postoperatively eight patients with primary total hip replacements. Despite significant artifacts on the routine transaxial images, the metal artifact-reduced images were of sufficient quality to provide pertinent clinical information in all cases

  20. Laparoscopic versus open splenectomy: the impact of spleen size on outcomes.

    Science.gov (United States)

    Ardestani, Ali; Tavakkoli, Ali

    2013-09-01

    Although laparoscopic splenectomy (Lap-Spleen) has become the standard surgical approach for normal-sized spleens, open splenectomy (Open-Spleen) is still recommended by many in the setting of splenomegaly. We set out to compare the impact of spleen size on Lap-Spleen and Open-Spleen outcomes using a national database. We reviewed the American College of Surgeons' National Surgical Quality Improvement Program database to identify patients who had undergone non-emergency splenectomy during 2005-2010. To evaluate the impact of spleen size on outcomes, we considered patients with diagnoses of splenomegaly and hypersplenism as those having large spleens (Large-Sp group) and those with diagnoses of primary thrombocytopenia and immune thrombocytopenic purpura as having normal spleens (Normal-Sp group). Patients were also categorized based on surgical approach into Lap-Spleen and Open-Spleen groups. We identified 639 patients in the Large-Sp group and 879 patients in the Normal-Sp group. During 2005-2010 laparoscopy was used in 84.2% of cases in the Normal-Sp group (annual range, 77.8%-90.8%). However, the rate of laparoscopy in the Large-Sp group remained consistently below 50% with an average of 41.8% (annual range, 20%-47%). In the Lap-Spleen group, those with Large-Sp had longer operative time and length of stay and higher blood transfusion and morbidity compared with the Normal-Sp group. However, when looking specifically at the Large-Sp group, patients with Open-Spleen had more transfusion requirements, longer length of stay, and higher morbidity, compared with those with Lap-Spleen. Lap-Spleen leads to significant improvement in outcomes. These advantages were believed to be limited to normal-sized spleens, but this study demonstrates that laparoscopy can still be advantageous in patients with splenomegaly. We hope such data encourages wider utilization of laparoscopy in the setting of splenomegaly, especially among surgeons who are experienced with the technique.

  1. 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.

  2. 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.

  3. 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.

  4. 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)

  5. Integrated Data Fusion and Mining Techniques for Monitoring Total Organic Carbon Concentrations in a Lake

    Science.gov (United States)

    Total organic carbon (TOC) in surface waters, markedly of seasonal variations, is a known precursor of disinfection byproducts such as Total Trihalomethanes (TTHM) in drinking water treatment. Real-time knowledge of TOC distribution in source water can help treatment operation to...

  6. A simple technique for an accurate shielding of the lungs during total body irradiation

    Directory of Open Access Journals (Sweden)

    Hana Mekdash

    2017-09-01

    Conclusion: This new technique succeeded in reducing the length of the overall treatment session of the conventional TBI procedure and hence reduced patient discomfort while ensuring accurate shielding of the lungs.

  7. [RBCs inclusions after splenectomy: not only Howell-Jolly bodies!].

    Science.gov (United States)

    Solis, Morgane; Perrin, Julien; Guédenet, Jean-Claude; Lesesve, Jean-François

    2013-01-01

    We report on several abnormalities of the red blood cells, in particular erythrocytic inclusions, in a 49 year old man. The blood smear presented with marked anisocytosis, target cells, acanthocytes and Howell-Jolly bodies, as well as Pappenheimer bodies and basophilic stippling. These abnormalities can be explained by the clinical context which associated splenectomy, iron overload and severe denutrition. The patient died a few weeks after from kidney and liver insufficiency. We comment on the different features of erythrocytic inclusions and the clinical situations in which they can be found.

  8. Refractory Immunological Thrombocytopenia Purpura and Splenectomy in Pregnancy

    Directory of Open Access Journals (Sweden)

    Santiago Bernal-Macías

    2015-01-01

    Full Text Available Thrombocytopenia is defined as a platelet count of less than 100,000 platelets per microlitre (mcL. Thrombocytopenia develops in approximately 6-7% of women during pregnancy and at least 3% of these cases are caused by immunological platelet destruction. Herein, we present a pregnant woman who develops at the first trimester autoimmune thrombocytopenia purpura associated with positive antiphospholipid antibodies. The disease was refractory to pharmacological treatments but had a favourable response to splenectomy. The patient carried the pregnancy to term without complication and gave birth to a healthy baby girl.

  9. A Facile Technique to Make Articulating Spacers for Infected Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Yu-Ping Su

    2009-03-01

    Conclusion: Treating infected total knee arthroplasty with these self-made articulating spacers eradicates infection effectively, improves the life quality before reimplantation and provides good final results without significant complications.

  10. Shapes of the $^{192,190}$Pb ground states from beta decay studies using the total absorption technique

    CERN Document Server

    Estevez Aguado, M.E.; Agramunt, J.; Rubio, B.; Tain, J.L.; Jordan, D.; Fraile, L.M.; Gelletly, W.; Frank, A.; Csatlos, M.; Csige, L.; Dombradi, Zs.; Krasznahorkay, A.; Nacher, E.; Sarriguren, P.; Borge, M.J.G.; Briz, J.A.; Tengblad, O.; Molina, F.; Moreno, O.; Kowalska, M.; Fedosseev, V.N.; Marsh, B.A.; Fedorov, D.V.; Molkanov, P.L.; Andreyev, A.N.; Seliverstov, M.D.; Burkard, K.; Huller, W.

    2015-01-01

    The beta decay of $^{192,190}$Pb has been studied using the total absorption technique at the ISOLDE(CERN) facility. The beta-decay strength deduced from the measurements, combined with QRPA theoretical calculations, allow us to infer that the ground states of the $^{192,190}$Pb isotopes are spherical. These results represent the first application of the shape determination method using the total absorption technique for heavy nuclei and in a region where there is considerable interest in nuclear shapes and shape effects.

  11. Controlled antegrade intimal tracking with subintimal balloon inflation as a novel bailout technique for chronic total occlusion after failed intravascular ultrasound-guided parallel wire technique.

    Science.gov (United States)

    Imai, Yuta; Yajima, Junji; Hosaka, Fumitaka

    Failure to cross with a guidewire is the most common reason for failure of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). In cases of CTO PCI with no interventional collaterals, an intravascular ultrasound (IVUS)-guided parallel wire technique is usually the last-resort procedure. Failure of this technique sometimes causes enlarged subintimal space, resulting in procedure failure. We present a successful second attempt at left anterior descending artery CTO PCI with no interventional collaterals. After IVUS-guided parallel wire technique failed with an enlarged subintimal space, successful antegrade wire crossing was achieved using controlled antegrade intimal tracking with balloon inflation in the subintimal space to deflect a second wire. This technique may be useful as a bailout strategy in otherwise-failed CTO PCI with an enlarged subintimal space. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Managing the total cost of risk exposures through risk mapping techniques

    International Nuclear Information System (INIS)

    Unione, A.J.; Rode, D.M.

    1998-01-01

    In a competitive power market, power producers are exposed to an increasingly broad spectrum of financial risks. The cumulative impact of these financial risks is known collectively as the Total of Cost of Risk. The concept of Total of Cost of Risk presents the business reality of a company's exposure to potentially devastating financial consequences in an integrated and useful way. In this way, a strategy of managing Total Cost of Risk in the most cost effective way can become a means of ensuring long term business health and security. This paper will examine the use of risk mapping as a tool for visually understanding Total Cost of Risk, thus creating an enhanced situational awareness and an integrated basis for risk management decision. The evaluation process, available through the use of risk maps allows the power producers to pro-actively implement prudent business decisions concerning the design, operation and maintenance of power plants. Risk mapping is thus a means for harmonizing operational objectives, such as improved plant reliability, with corporate strategies and goals in terms of an effective risk management program

  13. Measurement of the Longitudinal Shift of Radiation at Total Internal Reflection by Microwave Techniques

    Science.gov (United States)

    Akylas, Victor; And Others

    1976-01-01

    Describes a method to experimentally determine the longitudinal shift of a microwave beam at total internal reflection. Suggests that the activity be incorporated into an undergraduate laboratory program due to its ease in set-up and clarity of results. (CP)

  14. Effect of referencing technique for the tibial slope in cruciate-retaining total knee arthroplasty

    NARCIS (Netherlands)

    Marra, Marco Antonio; Heesterbeek, Petra J.C.; van de Groes, Sebastiaan A.W.; Janssen, Dennis W.; Koopman, H.F.J.M.; Wymenga, A.B.; Verdonschot, N.J.J.

    2017-01-01

    Introduction: Tibial slope was shown to majorly affect the outcomes of Total Knee Arthroplasty (TKA). More slope of the tibial component could help releasing a too tight flexion gap in cruciate-retaining (CR) TKA and is generally associated with a wider range of post-operative knee flexion. However,

  15. Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results

    NARCIS (Netherlands)

    Capanna, R.; Totti, F.; Geest, I.C.M. van der; Muller, D.A.

    2015-01-01

    HYPOTHESIS: Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. METHODS: The data of 6 patients who underwent scapular allograft reconstruction after a

  16. Variaciones de la técnica convencional de histerectomía total abdominal Variations of the conventional technique of total abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Bárbaro Agustín Armas Pérez

    2008-12-01

    Full Text Available INTRODUCCIÓN. La histerectomía total abdominal es un procedimiento quirúrgico frecuente. El presente estudio pretendió mostrar y a la vez proponer una modificación de la técnica convencional de histerectomía total abdominal, en diferentes momentos de la técnica, y que comprende en conjunto tanto la apertura y cierre de la cavidad abdominal, la sutura y fijación de la cúpula vaginal como la ligadura de los pedículos vasculares. MÉTODOS. Se realizó un estudio descriptivo con el objetivo de exponer las modificaciones introducidas a la técnica tradicional de histerectomía total abdominal de Richardson en 155 pacientes operadas en el Hospital Universitario Clinicoquirúrgico «Amalia Simoni» (Camagüey, entre el 2002 y el 2007. La fuente primaria de la información fue una encuesta y los datos recogidos fueron procesados con medios automatizados mediante el paquete estadístico Microstat. RESULTADOS. La edad promedio fue de 42,35 años. La anestesia más utilizada fue la regional espinal (75,48 %, el tiempo quirúrgico medio fue de 56,15 min y se observó un 7,74 % de complicaciones posoperatorias. Entre ellas las más frecuentes fueron las hemorragias (3,23 % y las infecciones (2,58 %. No se reintervino ningún caso y se obtuvieron excelentes resultados en cuanto a estética, reducción del tiempo quirúrgico, disminución del dolor posoperatorio y de la estadía hospitalaria. CONCLUSIONES. Las complicaciones encontradas no se relacionaron con las variaciones de la técnica realizada, y las intervenciones fueron poco dolorosas y más estéticas que las convencionales.INTRODUCTION. Total abadominal histerectomy is a common surgical procedure. The objective of the present study was to show and propose at the same time a modification to the conventional technique of total abdominal hysterectomy at different moments of the technique, including the opening and closure of the abdominal cavity, the suture and fixation of the vaginal cupule

  17. [A method for assessing the total viable count of fresh meat based on hyperspectral scattering technique].

    Science.gov (United States)

    Song, Yu-Lin; Peng, Yan-Kun; Guo, Hui; Zhang, Lei-Lei; Zhao, Juan

    2014-03-01

    The objective of this study is to develop a hyperspectral imaging system to predict the bacteria total viable count in fresh pork. The hyperspectral scattering data were curvefitted by different fitting methods, and correlation differences of models were compared based on the bacteria total viable count of fresh pork, thus providing modeling basis of device for future study. Total 63 fresh pork samples which was used in the experiment were stored at 4 degrees C in the refrigerator of constant temperature. Experiment was performed everyday for 15 days. 4 or 5 random samples were used each day for the experiment. Hyperspectral scattering images and spectral scattering optical data in the wavelength region of 400 to 1 100 nm were acquired from the surface of all of the pork samples. Lorentz and Gompertz function and the modified function was applied to fit the scattering profiles of pork samples. Different parameters could be obtained by Lorentz and Gompertz fitting and the modified function fitting. The different parameters could represent the optical characteristic of the scattering profiles. The standard values of the bacteria total viable count of pork were obtained by classical microbiological plating methods. Because the standard value of the bacteria total viable count was big, log10 of the bacteria total viable count obtained by classical microbiological plating was used to simplify the calculation. Both individual parameters and integrated parameters were explored to develop the models. The multi-linear regression statistical approach was used to establish the models for predicting pork the bacteria total viable count. Both Lorentz and Gompertz function and the modified function included three and four parameters formula. The results showed that correlation coefficient of the models is higher with Lorentz three parameters combination, Lorentz four parameters combination and Gompertz four parameters combination than the individual parameters and other two or

  18. 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)

  19. Determination of lead in clay enameled by X-ray fluorescence technique in Total reflection and by Scanning Electron Microscopy

    International Nuclear Information System (INIS)

    Zarazua O, G.; Carapia M, L.

    2000-01-01

    This work has the objective of determining lead free in the glazed commercial stewing pans using the X-ray fluorescence technique in Total reflection (FRX) and the observation and semiquantitative determination of lead by Analytical Scanning Electron Microscopy (ASEM). (Author)

  20. [Splenectomy for splenomegaly of more than 1000 grams. A retrospective study of 36 patients].

    Science.gov (United States)

    Glehen, O; Caillot, J L; François, Y; Peyrat, P; Sadeghi Loyeeh, B; Griot, J B; Gilly, F N; Vignal, J

    1997-01-01

    Splenectomy for massive splenomegaly is frequently performed for hematologic disorders for diagnostic and therapeutic indications. The role of splenectomy is complex and controversial. The aims of our retrospective study were to focus on postoperative complications and advantages of splenectomy for massive splenomegaly. Thirty six patients with splenomegaly weighing 1000 g or more, underwent splenectomy at Centre Hospitalier Universitaire Lyon Sud, from January 1st, 1982, to December 31, 1995. Thirty-one (85%) of these patients had hematologic malignancy and more than half of them were older than sixty years. The main indications for splenectomy were hypersplenism (18 patients) and diagnosis (14). Preliminary ligation of the splenic artery was performed in 25 patients (42%). All patients had drainage. The mortality and morbidity rates were 5.5% and 20%, respectively. No major septic or thromboembolic complications occurred. There was only one major bleeding complication. The advantages of splenectomy included histopathological diagnosis in 13 of 14 patients with splenomegaly of unknown origin, permanent pain relief in all cases, and immediate correction of hematological cytopenia in 27 cases (75%). We conclude that the large weight of the spleen does not constitute a contraindication to splenectomy, but indications must be carefully selected, and the operative and perioperative management, must be appropriate.

  1. 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.

  2. 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

  3. 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

  4. Operative technique of two parallel compression screws and autologous bone graft for ankle arthrodesis after failed total ankle replacement.

    Science.gov (United States)

    Jehan, Shah; Hill, Simon O

    2012-09-01

    The management of failed total ankle replacement (TAR) depends on the primary indication, presence of infection, condition of adjacent joints, and available bone stock. In addition, the patient's expectations, age, and general health should also be taken into account. This article describes a technique of arthrodesis in failed TAR with two parallel screws inserted in opposite directions and autologous cancellous bone graft. Four patients were managed using this technique. The subtalar joint and both malleoli were preserved. The average time for radiological union was 14.8 weeks. There were no hardware-related complications or infections. One patient developed subsequent subtalar arthritis and is waiting for subtalar joint fusion. The results from this small series of patients suggest that arthrodesis following failed total ankle replacement with two parallel screws and bone graft may be an effective technique.

  5. Application of the weighted total field-scattering field technique to 3D-PSTD light scattering model

    Science.gov (United States)

    Hu, Shuai; Gao, Taichang; Liu, Lei; Li, Hao; Chen, Ming; Yang, Bo

    2018-04-01

    PSTD (Pseudo Spectral Time Domain) is an excellent model for the light scattering simulation of nonspherical aerosol particles. However, due to the particularity of its discretization form of the Maxwell's equations, the traditional Total Field/Scattering Field (TF/SF) technique for FDTD (Finite Differential Time Domain) is not applicable to PSTD, and the time-consuming pure scattering field technique is mainly applied to introduce the incident wave. To this end, the weighted TF/SF technique proposed by X. Gao is generalized and applied to the 3D-PSTD scattering model. Using this technique, the incident light can be effectively introduced by modifying the electromagnetic components in an inserted connecting region between the total field and the scattering field region with incident terms, where the incident terms are obtained by weighting the incident field by a window function. To optimally determine the thickness of connection region and the window function type for PSTD calculations, their influence on the modeling accuracy is firstly analyzed. To further verify the effectiveness and advantages of the weighted TF/SF technique, the improved PSTD model is validated against the PSTD model equipped with pure scattering field technique in both calculation accuracy and efficiency. The results show that, the performance of PSTD seems to be not sensitive to variation of window functions. The number of the connection layer required decreases with the increasing of spatial resolution, where for spatial resolution of 24 grids per wavelength, a 6-layer region is thick enough. The scattering phase matrices and integral scattering parameters obtained by the improved PSTD show an excellent consistency with those well-tested models for spherical and nonspherical particles, illustrating that the weighted TF/SF technique can introduce the incident precisely. The weighted TF/SF technique shows higher computational efficiency than pure scattering technique.

  6. Application of the Total Reflection X-ray Fluorescence technique to trace elements determination in tobacco

    International Nuclear Information System (INIS)

    Martinez, T.; Lartigue, J.; Zarazua, G.; Avila-Perez, P.; Navarrete, M.; Tejeda, S.

    2008-01-01

    Many studies have identified an important number of toxic elements along with organic carcinogen molecules and radioactive isotopes in tobacco. In this work we have analyzed by Total Reflection X-Ray Fluorescence 9 brands of cigarettes being manufactured and distributed in the Mexican market. Two National Institute of Standards and Technology standards and a blank were equally treated at the same time. Results show the presence of some toxic elements such as Pb and Ni. These results are compared with available data for some foreign brands, while their implications for health are discussed. It can be confirmed that the Total Reflection X-Ray Fluorescence method provides precise (reproducible) and accuracy (trueness) data for 15 elements concentration in tobacco samples

  7. Technique for fabrication of an "instant total-contact cast" for treatment of neuropathic diabetic foot ulcers.

    Science.gov (United States)

    Armstrong, David G; Short, Brian; Espensen, Eric H; Abu-Rumman, Patricia L; Nixon, Brent P; Boulton, Andrew J M

    2002-01-01

    Addressing pressure reduction in the treatment of diabetic foot wounds is a critical component of therapy. The total-contact cast has proven to be the gold standard of treatment because of its ability to reduce pressure and facilitate patient adherence to the off-loading regimen. Removable cast walkers have proven to be as effective as total-contact casts in pressure reduction, but this has not translated into equivalent time to healing. A simple technique to convert the removable cast walker into a device that is not as easily detached from the lower extremity, thereby encouraging the use of this device over a 24-hour period, is presented in this article. The procedure involves wrapping the cast walker with cohesive bandage or plaster of Paris. In the authors' opinion, this technique addresses many of the disadvantages of the total-contact cast, resulting in an adequate compromise in this aspect of care.

  8. 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.

  9. 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 splenectomy was 280 cc, but in the interventional group decreased significantly to 80 ml (p 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.

  10. 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.

  11. Totally robotic single-position 'flip' arm technique for splenic flexure mobilizations and low anterior resections.

    Science.gov (United States)

    Obias, Vincent; Sanchez, Caroline; Nam, Arthur; Montenegro, Grace; Makhoul, Rami

    2011-06-01

    Using the da Vinci robot in low anterior resection (LAR) has not been widely adopted due to limited range of motion of the robotic arms and the need to move the robot during operations. Our technique uses all three arms for both the splenic flexure and the pelvis, but with only one docking position. The robot is placed to the left of the patient. The camera port is 3 cm to the right of the umbilicus. Arm 1 is placed in the RLQ. Arm 2 is placed midepigastric. Arm 3 is placed in the LLQ. Arm 3 starts off on the left side of the robot, on the same side as Arm 1 aimed cephalad. During mobilization of colon and splenic flexure, Arms 2 and 3 help retract the colon while Arm 1 dissects. Our pelvic dissection begins with Arm 3 "flipped" to the right side of the robot and redocked to the same left sided port aimed caudally. The robot does not need to be repositioned and the patient does not need to be moved. The pelvic dissection can now be done in the standard fashion. Our early experience includes four patients: two LARs and two left hemicolectomies. Mean operative time = 347 minutes, docking time = 20 minutes, and robotic surgical time = 195 minutes. Two complications occurred: post-operative ileus and high ostomy output. Mean LOS = 5. The robotic "flip" arm technique allows the surgeon to fully utilize all the robotic arms in LAR, which is unique versus other techniques. Copyright © 2011 John Wiley & Sons, Ltd.

  12. Determination of Total Volatile Basic Nitrogen (TVB-N Content in Beef by Hyperspectral Imaging Technique

    Directory of Open Access Journals (Sweden)

    Liu Shanmei

    2016-01-01

    Full Text Available Non-destructive determination of TVB-N content in beef using hyperspectral imaging (HSI technique was evaluated. In order to create a robust model to predict the TVB-N content in beef, partition of sample set, spectral pretreatment, and the optimum wavelength selection were discussed. After the beef sample set was parted by concentration gradient (CG algortithm, and the spectra of beef samples were preprocessed by standard normalized variate (SNV combined with auto scale(AS, the partial least square regression (PLSR model was established using the full spectral range, which had the best prediction abilities with Rcv2 of 0.9124, Rp2 of 0.8816, RMSECV of 1.5889, and RMSEP of 1.7719, respectively. After the optimum wavelengths which is closely related to the TVB-N content of beef samples was obtained using the competitive adaptive re-weighted (CARS algorithm, a new PLSR model was established using the optimum wavelengths, which had outstanding prediction abilities with Rcv2 of 0.9235, Rp2 of 0.9241, RMSECV of 1.4881, and RMSEP of 1.4882, respectively.The study showed that HSI is a powerful technique to predict the TVB-N content in beef by a nondestructive way.

  13. Contrast echocardiography: a novel technique for assessment of total aortic regurgitation following transapical aortic valve implantation.

    Science.gov (United States)

    Kukucka, Marian; Pasic, Miralem; Habazettl, Helmut; Unbehaun, Axel; Dreysse, Stephan; Drews, Thorsten; Hillebrandt, Thorsten; Mladenow, Alexander; Buz, Semih

    2015-01-01

    Aortic regurgitation (AR) is a possible complication following transcatheter aortic valve implantation (TAVI) which is associated with less-favourable outcomes. Quantification of total regurgitation caused by multiple, multidirectional jets remains controversial. The purpose of this study was to assess the usefulness of retrograde contrast echocardiography in quantification of total AR following TAVI and to evaluate its prognostic significance. In 245 patients following Edwards Sapien valve (Edwards Lifesciences, Irvine, CA, USA) implantation, we performed retrograde contrast transoesophageal echocardiography to quantify AR immediately after TAVI. The contrast (20 ml agitated gelatine polysuccinate, Gelafundin 4%, Braun, Melsungen, Germany) was injected as a bolus into the sinotubular junction of the aorta through a pigtail catheter. We measured the area of the regurgitant cloud during mid- to end-diastole. A regurgitant area of ≥3.8 cm2 was determined as an indicator of relevant AR. Sensitivity of this was compared through angiography and Doppler echocardiography. To assess whether AR identified by this novel method independently determined survival, a multivariate model was applied. Angiography, Doppler echocardiography and contrast echocardiography recognized 15, 23 and 56 patients with relevant regurgitation. Multivariate analysis including a regurgitant area of ≥3.8 cm2, New York Heart Association (NYHA) class IV, age and creatinine concentration identified a regurgitant area of ≥3.8 cm2 (P=0.027) as independent risk factor for 2-year survival. Contrast echocardiography is a simple method for quantification of total AR following TAVI and is more sensitive than angiography or Doppler echocardiography. Its clinical relevance is demonstrated by the impact of the AR detected by contrast echocardiography on survival. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. 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......-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...

  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...... from the large spleen. Both patients underwent uneventful splenectomy and experienced significant improvement in cytopenia, daily activity and well-being. Furthermore the youngest patient showed a significant catch-up growth. We conclude that in selected patients with marked splenomegaly and ALPS......, splenectomy may be considered a treatment option....

  16. 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

  17. Comparison between cultivated and total bacterial communities associated with Cucurbita pepo using cultivation-dependent techniques and 454 pyrosequencing.

    Science.gov (United States)

    Eevers, N; Beckers, B; Op de Beeck, M; White, J C; Vangronsveld, J; Weyens, N

    2016-02-01

    Endophytic bacteria often have beneficial effects on their host plants that can be exploited for bioremediation applications but, according to the literature, only 0.001-1% of all endophytic microbes should be cultivable. This study compared the cultivated endophytic communities of the roots and shoots of Cucurbita pepo with the total endophytic communities as determined by cultivation-dependent techniques and 454 pyrosequencing. The ten most abundant taxa of the total communities aligned well with the cultivated taxa; however, the abundance of these taxa in the two communities differed greatly. Enterobacter showed very low presence in the total communities, whereas they were dominantly present in the cultivated communities. Although Rhizobium dominated in total root and shoot communities, it was poorly cultivable and even then only in growth media containing plant extract. Since endophytes likely contribute to plant-growth promotion, cultivated bacterial strains were tested for their plant-growth promoting capabilities, and the results were correlated with their abundance in the total community. Bacillus and Pseudomonas showed promising results when considering cultivability, abundance in the total community and plant-growth promoting capability. This study demonstrated that, although a limited number of bacterial genera were cultivable, current cultivation-dependent techniques may be sufficient for further isolation and inoculation experiments that aim to improve phytoremediation efficiency. Copyright © 2015 Elsevier GmbH. All rights reserved.

  18. Standard Test Methods for Total Normal Emittance of Surfaces Using Inspection-Meter Techniques

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    1971-01-01

    1.1 These test methods cover determination of the total normal emittance (Note) of surfaces by means of portable, inspection-meter instruments. Note 1—Total normal emittance (εN) is defined as the ratio of the normal radiance of a specimen to that of a blackbody radiator at the same temperature. The equation relating εN to wavelength and spectral normal emittance [εN (λ)] is where: L b(λ, T) = Planck's blackbody radiation function = c1π −1λ−5(ec2/λT − 1)−1, c1 = 3.7415 × 10−16 W·m 2, c2 = 1.4388 × 10−2 m·K, T = absolute temperature, K, λ = wavelength, m, Lb(λ, T)dλ = Δπ −1T4, and Δ = Stefan-Boltzmann constant = 5.66961 × 10 −8 W·m2·K−4 1.2 These test methods are intended for measurements on large surfaces when rapid measurements must be made and where a nondestructive test is desired. They are particularly useful for production control tests. 1.3 The values stated in SI units are to be regarded as standard. No other units of measu...

  19. Restriction techniques for the unit-commitment problem with total procurement costs

    International Nuclear Information System (INIS)

    Kaleta, Mariusz; Toczylowski, Eugeniusz

    2008-01-01

    Many discrete optimization problems may be solved much easier, if the solution space can be restricted in a convenient way. For a given specific problem, the restriction techniques can be helpful if an available optimization solver, perceived as a black box, is capable of solving quickly only reduced subproblems of a limited size. For the family of hard unit-commitment problems we investigate a hierarchical search algorithm, which is based on decomposition of the problem into two subproblems. The upper-level subproblem is a relatively small decision 'kernel' of the problem that can be solved approximately by a search algorithm. We define an appropriate restricted decision space for this subproblem. The lower-level subproblem is an appropriate restriction of the original problem that can be solved efficiently by a dedicated solver. Our approach was analyzed on a set of historical data from the Polish electrical balancing market and the best known solutions were improved by the average of about 2-5%

  20. Assessment of serum selenium levels in 2-month-old sucking calves using total reflection technique

    International Nuclear Information System (INIS)

    Bernardini, D.; Testoni, S.; Buoso, M.C.; Ceccato, D.; Moschini, G.; Valdes, M.; Torboli, A.

    2000-01-01

    The assessment of selenium status of livestock is an important aspect of production medicine as evidence for the influence of low Se levels on disease resistance in ruminants is reviewed with emphasis on susceptibility to various pathologies (such as infections, exudative diathesis, pneumonia, pancreatic degeneration). Additional evidence suggests that Se deficiency may cause muscular dystrophy in calves, while, severe deficiency has been associated with cardiomyopathy and even death. Serum Se content is a good indicator of the short term Se status and reflects the recent dietary intake of the element. Since serum Se content is a good indicator of the short term status of the element and reflects the its recent dietary intake, the present work is aimed to determine Se concentration in serum from a group of 2 months old sucking calves suspected to be severely deficient. We used the TX 2000 X-ray spectrometer manufactured by Ital Structures. The energy resolution (FWHM) of the Si(Li) detector was 137 eV for Mn Kα. Among nuclear techniques the TXRF method is the best suitable for trace element analysis in liquid or dissolved samples and can deal much easier with elemental investigation. Physical basis of used analytical method, experimental set up and the sample preparation procedure are described. The concentration data obtained are presented and discussed. (author)

  1. Technique of totally robotic delta-shaped anastomosis in distal gastrectomy

    Directory of Open Access Journals (Sweden)

    Hidehiko Kitagami

    2017-01-01

    Full Text Available Background: We aimed to clarify the utility of delta-shaped anastomosis (Delta, an intracorporeal Billroth-I anastomosis-based reconstruction technique used after laparoscopy-assisted distal gastrectomy (LADG, in robot-assisted distal gastrectomy (RADG. Methods: RADG was performed in patients with clinical Stage I gastric cancer, and reconstruction was performed using Delta. The Delta procedure was the same as that performed after LADG, and the operator practiced the procedure in simulated settings with surgical assistants before the operation. After gastrectomy, the scope and robotic first arm were reinserted from separate ports on the right side of the patient. Then, a port on the left side of the abdomen was used as the assistant port from which a stapler was inserted, with the robotic arm in a coaxial mode. The surgical assistant performed functional end-to-end anastomosis of the remnant stomach and duodenal stump using a powered stapler. Results: The mean anastomotic time in four patients who underwent Delta after RADG was 16.5 min. All patients were discharged on the post-operative day 7 without any post-operative complications or need for readmission. Conclusions: Pre-operative simulation, changes in ports for insertion of the scope and robotic first arm, continuation of the coaxial operation, and use of a powered stapler made Delta applicable for RADG. Delta can be considered as a useful reconstruction method.

  2. Technique and dosimetry for total body irradiation with an 8-MV linear accelerator

    International Nuclear Information System (INIS)

    Svahn-Tapper, G.; Nilsson, P.; Jonsson, C.; Alvegard, T.A.

    1987-01-01

    The aim of the study was to develop a method for calculation of the absorbed dose at an arbitrary point in the patient (adults and children). The method should be accurate but simple to use in clinical routine and it should as far as possible follow the recommendations by ICRU for conventional radiotherapy. An 8-MV linear accelerator is used with a diamond-shaped field and an isocentric technique at a focus-axis distance of 430 cm. The dose rate in an arbitrary point in the patient is calculated from the absorbed dose rate in dose maximum for a phantom size of 30 x 30 x 30 cm 3 in the TBI field, an inverse square law factor, the tissue-maximum ratio, an equivalent field size correction factor determined from the patient contour using the Clarkson method, a factor correcting for lack of backscattering material, an off-axis output correction factor, and a factor that corrects for off-axis variations in effective photon beam energy and for oblique beam penetration of the patient. A personal computer is used for the dose calculations. The formula was tested with TLD measurements in a RT Humanoid (adult) phantom and in a Pedo-RT Humanoid (child) phantom. In vivo dose measurements are also presented

  3. 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.

  4. Validation of a technique by high-performance liquid chromatography for the determination of total isoflavones

    Directory of Open Access Journals (Sweden)

    Pilar A. Soledispa Cañarte

    2017-04-01

    Full Text Available Context: Isoflavones may act as selective regulators in the prevention of various diseases. The most important source of isoflavones is the soy, from which different phytotherapeutics are elaborated of use in Ecuadorian population. However, its concentration varies depending on several factors, therefore quality assessment need to be carried out through out several analytical methods. Aims: To validate an analytical method by high precision liquid chromatography (HPLC to quantify total isoflavones in herbal medicine. Methods: To quantify isoflavones, it was used a brand liquid chromatography with UV/VIS detector at 260 nm, C-18 column using isocratic method. The mobile phase was composed of 2% acetic acid: acetonitrile (75:25. The quantification was performed against reference standard. The parameters for the validation followed the established in the USP 33. Results: The chromatogram presented six peaks with elution between 1.557 and 18.913 min. The linearity of the system and the method got r2 equal to 0.98 and 0.99 respectively. The coefficients of variation 1.5% in the study of repetitiveness and 2% in intermediate precision. The accuracy of the adjusted lineal model exhibited r=0.95 and intercept reliable interval (-0.921; 1.743. Conclusions: The validated method was specific, accurate, precise and linear. It can be used for quality control and stability studies of isoflavones present in herbal medicine.

  5. The Synergy Between Total Scattering and Advanced Simulation Techniques: Quantifying Geopolymer Gel Evolution

    Energy Technology Data Exchange (ETDEWEB)

    White, Claire [Los Alamos National Laboratory; Bloomer, Breaunnah E. [Los Alamos National Laboratory; Provis, John L. [The University of Melbourne; Henson, Neil J. [Los Alamos National Laboratory; Page, Katharine L. [Los Alamos National Laboratory

    2012-05-16

    With the ever increasing demands for technologically advanced structural materials, together with emerging environmental consciousness due to climate change, geopolymer cement is fast becoming a viable alternative to traditional cements due to proven mechanical engineering characteristics and the reduction in CO2 emitted (approximately 80% less CO2 emitted compared to ordinary Portland cement). Nevertheless, much remains unknown regarding the kinetics of the molecular changes responsible for nanostructural evolution during the geopolymerization process. Here, in-situ total scattering measurements in the form of X-ray pair distribution function (PDF) analysis are used to quantify the extent of reaction of metakaolin/slag alkali-activated geopolymer binders, including the effects of various activators (alkali hydroxide/silicate) on the kinetics of the geopolymerization reaction. Restricting quantification of the kinetics to the initial ten hours of reaction does not enable elucidation of the true extent of the reaction, but using X-ray PDF data obtained after 128 days of reaction enables more accurate determination of the initial extent of reaction. The synergies between the in-situ X-ray PDF data and simulations conducted by multiscale density functional theory-based coarse-grained Monte Carlo analysis are outlined, particularly with regard to the potential for the X-ray data to provide a time scale for kinetic analysis of the extent of reaction obtained from the multiscale simulation methodology.

  6. Factors affected by surgical technique when treating total colonic aganglionosis: laparoscopy-assisted versus open surgery.

    Science.gov (United States)

    Miyano, Go; Ochi, Takanori; Lane, Geoffrey J; Okazaki, Tadaharu; Yamataka, Atsuyuki

    2013-04-01

    We compared laparoscopy-assisted Duhamel (Lap-D) with open surgery (Duhamel or Soave = D/S) for treating total colonic aganglionosis (TCA) in children to establish what factors may affect outcome. Fourteen TCA cases treated between 1990 and 2010 were reviewed. Open D/S (O-D/S) through a vertical midline abdominal incision was routine from 1990 to 2005, whereupon Lap-D became routine. Lap-D involves laparoscopic colon resection, ileostomy take-down, and ileum pull-through through an additional Pfannenstiel incision. We compared pre-operative nutrition, operating time, intraoperative blood loss, duration until oral challenge, postoperative analgesic usage, incidence of enterocolitis, early complications that arose within 30 days of surgery, and late complications, and wound cosmesis 1 year postoperatively (Grade-1: unacceptable, Grade-2: passable, Grade-3: excellent). Six had O-D/S (2D, 4S) and eight had Lap-D. Differences in patient demographics, mean ages/weights at surgery, average length of the aganglionic segment from the terminal ileum, operating time, and time taken for oral challenge were all not significant, full feeding took longer in O-D/S (6.7 vs. 5.9 days). Preoperative central vein intravenous hyperalimentation was required for one case in O-D/S and two cases in Lap-D. These three required hospitalization for at least 30 days postoperatively and parenteral nutrition after discharge. Although there were no intraoperative complications in either group, there was one case of transient ileus in O-D/S that resolved conservatively. Cosmesis was significantly better in Lap-D (O-D/S = 1.2; Lap-D = 2.1; p < 0.05). Cosmesis was the only factor that was significantly different between Lap-D and O-D/S; all other factors were similar.

  7. Comparative methane estimation from cattle based on total CO2 production using different techniques

    Directory of Open Access Journals (Sweden)

    Md N. Haque

    2017-06-01

    Full Text Available The objective of this study was to compare the precision of CH4 estimates using calculated CO2 (HP by the CO2 method (CO2T and measured CO2 in the respiration chamber (CO2R. The CO2R and CO2T study was conducted as a 3 × 3 Latin square design where 3 Dexter heifers were allocated to metabolic cages for 3 periods. Each period consisted of 2 weeks of adaptation followed by 1 week of measurement with the CO2R and CO2T. The average body weight of the heifer was 226 ± 11 kg (means ± SD. They were fed a total mixed ration, twice daily, with 1 of 3 supplements: wheat (W, molasses (M, or molasses mixed with sodium bicarbonate (Mbic. The dry mater intake (DMI; kg/day was significantly greater (P < 0.001 in the metabolic cage compared with that in the respiration chamber. The daily CH4 (L/day emission was strongly correlated (r = 0.78 between CO2T and CO2R. The daily CH4 (L/kg DMI emission by the CO2T was in the same magnitude as by the CO2R. The measured CO2 (L/day production in the respiration chamber was not different (P = 0.39 from the calculated CO2 production using the CO2T. This result concludes a reasonable accuracy and precision of CH4 estimation by the CO2T compared with the CO2R.

  8. Comparison of 4 analytical techniques based on atomic spectrometry for the determination of total tin in canned foodstuffs

    OpenAIRE

    2011-01-01

    Abstract Different techniques for the determination of total tin in beverage and canned food by atomic spectrometry were compared. The performance characteristics of Inductively Coupled Plasma Mass Spectrometry (ICP-MS), Hydride Generation Inductively Coupled Plasma Atomic Emission Spectrometry (HG-ICP-AES), Electrothermal Atomization Atomic Absorption Spectrometry (ETA-AAS) and Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES) were determined in term of linearity, ...

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. 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)

  14. 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

  15. 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.

  16. 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 ...

  17. Investigation of a fusion technique for the determination of total sulfur in geological samples by ion chromatography

    Energy Technology Data Exchange (ETDEWEB)

    Stallings, E.A.; Candelaria, L.M.; Gladney, E.S.

    1988-06-01

    The authors have encountered the need for a rapid, accurate, precise, and sensitive method for measuring total sulfur in large numbers of geological samples. Numerous environmental studies of sulfur deposition due to sulfur dioxide emission from combustion and industry are currently under way. Several techniques for measuring total sulfur in soils and other silicate materials have been published including neutron activation analysis, thermal neutron capture prompt ..gamma..-ray spectrometry, inductively coupled plasma atomic emission spectrometry, isotope dilution mass spectrometry, X-ray fluorescence, turbidimetry, ion chromatography (IC), iodimetric titration, and fluorometry. However, none of these methods is completely satisfactory for routine analysis of large numbers of samples. Many have levels of detection that are inadequate for measuring low levels of total sulfur (<100 ..mu..g/g) often encountered in soils. Several utilize only aqueous extracts of the soils and do not provide a total sulfur determination. Others require extensive sample preparation, are susceptible to loss of sulfur during oxidation, or produce incomplete conversion of sulfur species to sulfate. The objective of this work was to evaluate the accuracy of IC determination of sulfate for Na/sub 2/O/sub 2/ soil fusions by comparing the results obtained for reference materials with literature values reported for other techniques. They were also interested in determining if this fusion method would be rapid enough to handle large numbers of samples.

  18. Splenectomy as part of primary cytoreductive surgery for advanced ovarian cancer: a retrospective cohort study.

    Science.gov (United States)

    Zapardiel, Ignacio; Peiretti, Michele; Zanagnolo, Vanna; Biffi, Roberto; Bocciolone, Luca; Landoni, Fabio; Aletti, Giovanni; Colombo, Nicoletta; Maggioni, Angelo

    2012-07-01

    The aim of surgical approach in advanced ovarian cancer should be the complete removal of all visible disease. Our purpose was to compare perioperative features and postoperative complications, and secondarily oncological outcomes, between patients who underwent splenectomy and those who did not at the time of surgery. Thirty-three subjects underwent splenectomy, and we selected 99 controls with similar surgical characteristics but who did not undergo splenectomy. Data collected included perioperative details and follow-up data. Longer operating time (33 minutes longer; P = 0.02), larger estimated blood loss (812 mL more; P = 0.03), higher rate of intraoperative blood transfusions (78.8% vs 42.4%; P < 0.01), and intensive care unit stay (1.4 vs 0.5 days; P < 0.01) as well as higher pneumonia rate (2% vs 0%; P = 0.01) were observed in the splenectomy group. Disease-free and overall survival rates were 30.3% and 66.6%, respectively, in the splenectomy group, and 33.3% and 59.6%, respectively, in the control group. Splenectomy at the time of primary cytoreductive surgery for advanced ovarian cancer may contribute to achieve complete cytoreduction with low perioperative complication rate. This procedure seems to be an acceptable and rational intervention to increase the survival rates of those patients.

  19. 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.

  20. 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.

  1. 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.

  2. 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.)

  3. Total gastric necrosis: A case report and literature review | Huang ...

    African Journals Online (AJOL)

    During the surgery, we found a total of 3500ml unclotted blood in the abdomen, splenic infarction and gastric necrosis. Total gastrectomy with Roux-en-Y esophagojejunostromy and splenectomy was performed. However, the patient died on the second day after the surgery. This case suggests that surgical treatment should ...

  4. Emergency total gastrectomy for massive haemorrhage in a low ...

    African Journals Online (AJOL)

    Five (5) patients out of these had emergency total gastrectomy for uncontrollable bleeding proximal ulcer cancer. All the cases were males with the mean age of 64.6years. A total gastrectomy with a D2 lymph node dissection and a Roux-en-Y oesophago-jejunostomy was carried out. A splenectomy was done in cases when ...

  5. Comparative studies of method for determining total mercury in fish. Dithizone and flameless atomic absorption spectrophotometry techniques

    International Nuclear Information System (INIS)

    Protasowicki, M.; Ociepa, A.; Chodyniecki, A.

    1977-01-01

    Two methods for determining total mercury in fish were compared: the dithizone and flameless atomic absorption spectrophotometry techniques. The studies involved determination of recovery when 1μg of mercury as solutions of HgCl 2 or CH 3 HgC were added to each sample of herring flesh. Mean recoveries in the dithizone method were found to be 91.4+-7.47% and 90.25+-4.73% for the two solutions respectively, while the recoveries obtained with the flameless atomic absorption spectrophotometry were 95.00+-9.13% and 98.70+-7.14%, respectively. Both techniques were used to determine the mercury content in the same herring flesh sample. The first technique showed the content of 0.050+-0.018μg Hg g -1 while the result obtained with the other one was 0.062+-0.013μg Hg g -1 . The statistical treatment of the results obtained showed no difference between the two techniques, the significance level being α=0.05. Therefore, the results obtained with the dithizone method are comparable with those obtained with the flameless atomic absorption spectrophotometry for mercury contents of the magnitude order of 0.050 ug.g -1 . (author)

  6. Side-by-side comparison of analytical techniques; organic acids, total organic carbon, and anions in PWR secondary cycles

    International Nuclear Information System (INIS)

    Hobart, S.A.; Byers, W.A.; Miller, M.R.; Richards, J.; Silva, H.; Palino, G.F.; Wall, P.S.

    1986-01-01

    Total Organic Carbon TOC samples should be analyzed no later than one week after they are taken and they should be stored in a refrigerated condition, if at all possible. It can be inferred that for TOC levels in the range of 50 to 120 ppb, state-of-the-art sampling and analysis techniques can produce results varying by 20 to 50 ppb. Any proposed limits for TOC should be reviewed in that light. Agreement between anion results appeared to improve over the course of the project. Both contractors agree that increased attention and care with sampling and analytical techniques probably accounted for this improvement. Utility personnel can therefore conclude that proper employee training, supervision, and motivation for proper sampling and analysis are critical if accurate anion results are to be obtained. Resonable agreement between calculated and measured values of cation conductivity suggest that both contractors had accurately determined all major anionic species

  7. Impact of radiation technique, radiation fraction dose, and total cisplatin dose on hearing. Retrospective analysis of 29 medulloblastoma patients

    International Nuclear Information System (INIS)

    Scobioala, Sergiu; Kittel, Christopher; Ebrahimi, Fatemeh; Wolters, Heidi; Eich, Hans Theodor; Parfitt, Ross; Matulat, Peter; Am Zehnhoff-Dinnesen, Antoinette

    2017-01-01

    To analyze the incidence and degree of sensorineural hearing loss (SNHL) resulting from different radiation techniques, fractionation dose, mean cochlear radiation dose (D mean ), and total cisplatin dose. In all, 29 children with medulloblastoma (58 ears) with subclinical pretreatment hearing thresholds participated. Radiotherapy (RT) and cisplatin had been applied sequentially according to the HIT MED Guidance. Audiological outcomes up to the latest follow-up (median 2.6 years) were compared. Bilateral high-frequency SNHL was observed in 26 patients (90%). No significant differences were found in mean hearing threshold between left and right ears at any frequency. A significantly better audiological outcome (p < 0.05) was found after tomotherapy at the 6 kHz bone-conduction threshold (BCT) and left-sided 8 kHz air-conduction threshold (ACT) than after a combined radiotherapy technique (CT). Fraction dose was not found to have any impact on the incidence, degree, and time-to-onset of SNHL. Patients treated with CT had a greater risk of SNHL at high frequencies than tomotherapy patients even though D mean was similar. Increase in severity of SNHL was seen when the total cisplatin dose reached above 210 mg/m 2 , with the highest abnormal level found 8-12 months after RT regardless of radiation technique or fraction dose. The cochlear radiation dose should be kept as low as possible in patients who receive simultaneous cisplatin-based chemotherapy. The risk of clinically relevant HL was shown when D mean exceeds 45 Gy independent of radiation technique or radiation regime. Cisplatin ototoxicity was shown to have a dose-dependent effect on bilateral SNHL, which was more pronounced in higher frequencies. (orig.) [de

  8. Optical property dimensionality reduction techniques for accelerated radiative transfer performance: Application to remote sensing total ozone retrievals

    Science.gov (United States)

    Efremenko, Dmitry; Doicu, Adrian; Loyola, Diego; Trautmann, Thomas

    2014-01-01

    In this paper, we introduce several dimensionality reduction techniques for optical parameters. We consider the principal component analysis, the local linear embedding methods (locality pursuit embedding, locality preserving projection, locally embedded analysis), and discrete orthogonal transforms (cosine, Legendre, wavelet). The principle component analysis has already been shown to be an effective and accurate method of enhancing radiative transfer performance for simulations in an absorbing and a scattering atmosphere. By linearizing the corresponding radiative transfer model, we analyze the applicability of the proposed methods to a practical problem of total ozone column retrieval from UV-backscatter measurements.

  9. Total ‘rib’-preservation technique of internal mammary vessel exposure for free flap breast reconstruction: A 5-year prospective cohort study and instructional video

    Directory of Open Access Journals (Sweden)

    Anais Rosich-Medina

    2015-09-01

    Discussion & conclusion: The total ‘rib’-preservation technique of IMV exposure is a safe, reliable and versatile method for microvascular breast reconstruction and should be considered as a valid alternative to the ‘rib’-sacrificing techniques.

  10. 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.

  11. 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.

  12. 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

  13. [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.

  14. Robotic-assisted total mesorectal excision with the single-docking technique for patients with rectal cancer.

    Science.gov (United States)

    Huang, Ching-Wen; Tsai, Hsiang-Lin; Yeh, Yung-Sung; Su, Wei-Chih; Huang, Ming-Yii; Huang, Chun-Ming; Chang, Yu-Tang; Wang, Jaw-Yuan

    2017-12-05

    The robotic system has advantages of high-definition three-dimensional vision and articular instruments with high dexterity, allowing more precise dissection in the deep and narrow pelvic cavity. We enrolled 95 patients with stage I-III rectal cancer (adenocarcinoma) who underwent totally robotic-assisted total mesorectal excision (TME) with single-docking technique at a single institution between September 2013 and December 2016. Of the 95 patients, 48 (50.5%) and 30 (31.6%) patients had lower and middle rectal cancers, respectively. Of the 75 (78.9%) patients undergoing preoperative concurrent chemoradiotherapy (CCRT), 27 (28.4%) exhibited pathologic complete response (pCR). Only four (4.2%) patients underwent abdominoperineal resection and the sphincter preservation rate was 95.8%. R0 resection was performed in 92 (96.8%) patients. Circumferential resection margin (CRM) and distal resection margin (DRM) were positive in 2 (2.1%) and 1 (1.1%) patients, respectively. The anastomotic leakage rate was 5.4% (5/95 patients). The overall complication rate was 17.9% (17/95 patients); most of them were mild. No 30-day hospital mortality occurred, and no patients required conversion to open surgery. In 92 patients undergoing R0 resection, 2-year overall survival was 94% and 2-year disease-free survival was 83%. The results demonstrated that totally robotic-assisted TME with the single-docking technique is safe and feasible for patients with rectal cancer, with or without preoperative CCRT. Moreover, favorable pCR rate, R0 resection rate, CRM, DRM, sphincter preservation rate, and short-term oncological outcomes can be achieved by combining this approach with appropriate preoperative CCRT.

  15. Side-by-side comparison of techniques for analyzing organic acids, total organic carbon, and anions. Final report

    International Nuclear Information System (INIS)

    Byers, W.A.; Richards, J.; Silva, H.; Miller, M.R.; Palino, G.F.; Wall, P.S.

    1986-09-01

    The objective of this project was to compare the organic acids sampling and analysis methods of Westinghouse and NWT Corporation. Sampling was performed at three sites, chosen to represent units with high, intermediate and low levels of organic contamination. To check the precision of each method, concurrent sampling was employed. To check the accuracy of each method, additions of standard organic solutions were made at one of the sites. Inorganic anions were also analyzed at each site by each contractor. Theoretical values of cation conductivity were calculated from organic and inorganic analytical data and compared to values measured onsite at the time of sampling. Total organic carbon (TOC) analyses were performed to evaluate different instruments and sampling techniques, as well as provide additional information on the relationship between TOC and organic acids concentrations. It was concluded that either of the organic acid sampling/analysis techniques used by the contractors can produce reliable results. TOC samples lose organics content with storage time and should be analyzed no later than one week after they are taken; if at all possible, they should be stored in a refrigerated condition. State-of-the art techniques for TOC sampling and analysis can produce results varying by 20 to 50 ppB for levels in the range of 50 to 120 ppB; any proposed limits for TOC should be reviewed in that light. Results of anion analyses are quite sensitive to sampling and analytical techniques. Reasonable agreement between calculated and measured values of cation conductivity suggests that both contractors had accurately determined all major anionic species

  16. Estimating Global Seafloor Total Organic Carbon Using a Machine Learning Technique and Its Relevance to Methane Hydrates

    Science.gov (United States)

    Lee, T. R.; Wood, W. T.; Dale, J.

    2017-12-01

    Empirical and theoretical models of sub-seafloor organic matter transformation, degradation and methanogenesis require estimates of initial seafloor total organic carbon (TOC). This subsurface methane, under the appropriate geophysical and geochemical conditions may manifest as methane hydrate deposits. Despite the importance of seafloor TOC, actual observations of TOC in the world's oceans are sparse and large regions of the seafloor yet remain unmeasured. To provide an estimate in areas where observations are limited or non-existent, we have implemented interpolation techniques that rely on existing data sets. Recent geospatial analyses have provided accurate accounts of global geophysical and geochemical properties (e.g. crustal heat flow, seafloor biomass, porosity) through machine learning interpolation techniques. These techniques find correlations between the desired quantity (in this case TOC) and other quantities (predictors, e.g. bathymetry, distance from coast, etc.) that are more widely known. Predictions (with uncertainties) of seafloor TOC in regions lacking direct observations are made based on the correlations. Global distribution of seafloor TOC at 1 x 1 arc-degree resolution was estimated from a dataset of seafloor TOC compiled by Seiter et al. [2004] and a non-parametric (i.e. data-driven) machine learning algorithm, specifically k-nearest neighbors (KNN). Built-in predictor selection and a ten-fold validation technique generated statistically optimal estimates of seafloor TOC and uncertainties. In addition, inexperience was estimated. Inexperience is effectively the distance in parameter space to the single nearest neighbor, and it indicates geographic locations where future data collection would most benefit prediction accuracy. These improved geospatial estimates of TOC in data deficient areas will provide new constraints on methane production and subsequent methane hydrate accumulation.

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

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    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

  18. 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.

  19. 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.

  20. 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

  1. Single incision multi-trocar hepatic cyst excision with partial splenectomy

    Directory of Open Access Journals (Sweden)

    Palanivelu Chinnusamy

    2013-01-01

    Full Text Available Introduction: Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments. Patient and Technique: The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5. Conclusion: Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness.

  2. Single incision multi-trocar hepatic cyst excision with partial splenectomy

    Science.gov (United States)

    Chinnusamy, Palanivelu; Ahluwalia, Jasmeet Singh; Palanisamy, Senthilnathan; Seshiyer, Rajan Pidigu

    2013-01-01

    INTRODUCTION: Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments. PATIENT AND TECHNIQUE: The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5. CONCLUSION: Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness. PMID:23741118

  3. Atmospheric measurements of total OH reactivity: Intercomparison of the pump-probe technique and the comparative reactivity method

    Science.gov (United States)

    Dusanter, Sebastien; Hansen, Robert; Leonardis, Thierry; Schoemaecker, Coralie; Blocquet, Marion; Fittschen, Christa; Hanoune, Benjamin; Sinha, Vinayak; Stevens, Philip; Locoge, Nadine

    2013-04-01

    The hydroxyl radical (OH) drives the oxidation of organic trace gases that can lead to the production of ozone and secondary organic aerosols in the atmosphere. A complete understanding of the sources and sinks of OH is therefore important to address issues related to both air quality and climate change. However, recent measurements of total OH reactivity [1-2], which is the inverse of the OH lifetime, have pointed out that our understanding of OH sinks is still incomplete and important reactive trace gases have not yet been identified. These measurements of total OH reactivity are of particular interest since they provide a critical test of our understanding of the OH budget. Three techniques are available to measure the total OH reactivity, including the total OH loss rate method [3], the pump-probe method [4], and the comparative reactivity method (CRM) [5]. While the first two methods are based on direct measurements of OH decays using laser-induced fluorescence instruments, the CRM is based on a different approach in which a tracer molecule is detected instead of OH to determine the ambient OH loss rate. As these instruments were deployed in different field campaigns, intercomparison exercises would be useful to ensure the accuracy of the measurements. However, such intercomparisons have not yet been published. An informal intercomparison involving a CRM instrument from the Ecole des Mines de Douai (EMD) and a pump-probe instrument from the laboratory Physicochimie des Processus de Combustion et de l'Atmosphere (PC2A) took place in an urban environment at the university of Lille (France). The two OH reactivity instruments measured continuously side by side for a duration of two weeks. Collocated measurements of trace gases were also performed using O3, NOx and SO2 monitors, as well as two automated chromatographic instruments capable of measuring more than 50 volatile organic compounds (VOC). We will present cross calibrations of the two OH reactivity

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

    Science.gov (United States)

    Yamamoto, Naoto; Oshima, Takashi; Sato, Tsutomu; Makino, Hirochika; Nagano, Yasuhiko; Fujii, Shoichi; Rino, Yasushi; Imada, Toshio; Kunisaki, Chikara

    2008-10-10

    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. 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. 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 (>or=25) and a high CA depth ratio (>or=0.370) independently predicted the occurrence of POPF (odds ratio = 19.007, p = 0.002; odds ratio = 13.656, p = 0.038, respectively). 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.

  5. 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.

  6. Posterolateral Corner Reconstruction Alone Using a Fibular-Based Technique in a Patient with Persistent Unstable Revision Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Joseph T. Cline

    2015-01-01

    Full Text Available Posterolateral rotatory instability is a relatively uncommon cause of unstable total knee arthroplasty (TKA. In most cases, surgical treatment requires revision TKA into a more constrained design or thicker polyethylene liner. We present a case of a patient with unstable TKA who remained unstable after increasing thickness of the polyethylene liner and undergoing more constrained TKA. After several revision surgeries, the patient was still unstable. Posterolateral corner reconstruction with a fibular-based technique using a tibialis anterior allograft was performed. At 1-year follow-up, the patient was stable and asymptomatic and with excellent function. A soft-tissue procedure only (fibular-based posterolateral corner reconstruction can be effective at restoring posterolateral rotatory stability in a patient with persistent instability after revision TKA.

  7. Quality control of total alpha and beta activity analysis in water using the Proportional Counter of Gaseous Flux technique

    International Nuclear Information System (INIS)

    Neto, Alberto P.; Bastos, Thiago M.R.; Santos, Thiago O.; Filho, Crescêncio A.S.; França, Elvis J. de

    2017-01-01

    The analytical capacity of the CRCN (Centro Regional de Ciências Nucleares do Nordeste) for quantification of total alpha and beta concentrations in water samples using the Proportional Counter of Gaseous Flux is presented. To demonstrate the traceability of the results, the National Intercomparison Program (PNI) samples were used, promoted by the Institute of Radioprotection and Dosimetry (IRD) from which the Regional Nuclear Science Center of the Northeast (CRCN-NE) participates since 2011. The results reported to the PNI demonstrate the analytical capacity of the CRCN to detect the emission of alpha and beta radioactivities in water within the potability standards in analytical detection of quantification in radioactivity by the technique of the Proportional Flow Counter

  8. 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.

  9. 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.

  10. 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

  11. The effect of relaxation techniques and back massage on pain and anxiety in Turkish total hip or knee arthroplasty patients.

    Science.gov (United States)

    Büyükyılmaz, Funda; Aştı, Türkinaz

    2013-09-01

    The purpose of this study was to examine the effects of relaxation techniques and back massage on postoperative pain, anxiety, and vital signs on postoperative days 1-3 in patients who had undergone total hip or knee arthroplasty (THA, TKA). Sixty patients having a THA or TKA were randomly assigned to either a experimental group or a control group. The McGill Pain Questionnaire Short Form (MPQ-SF) and State Anxiety Inventory (SAI) were used to measure pain and anxiety, respectively. Vital signs, including blood pressure (systolic and diastolic), pulse, and respiratory rate, were also obtained. Statistically significant differences in pain intensity (F = 14.50; p = .000), anxiety level (F = 19.13; p = .000), and vital signs (F = 169.61, 9.14, 14.23, 65.64; p = .000) measured over time were found between the experimental and the control group. Results of this research provide evidence to support the use of relaxation techniques and back massage at bed rest times of patients to decrease pain and anxiety. The interventions helped them to forget about their pain for a while and improved their anxiety state. After an evaluation of the conclusions, use of these interventions should be implemented by nurses into routine plans of care for patients. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  12. Total Energy Expenditure in Obese Kuwaiti Primary School Children Assessed by the Doubly-Labeled Water Technique

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    Lena Davidsson

    2016-10-01

    Full Text Available The aim of this pilot study was to assess body composition and total energy expenditure (TEE in 35 obese 7–9 years old Kuwaiti children (18 girls and 17 boys. Total body water (TBW and TEE were assessed by doubly-labeled water technique. TBW was derived from the intercept of the elimination rate of deuterium and TEE from the difference in elimination rates of 18O and deuterium. TBW was used to estimate fat-free mass (FFM, using hydration factors for different ages and gender. Fat mass (FM was calculated as the difference between body weight and FFM. Body weight was not statistically different but TBW was significantly higher (p = 0.018 in boys (44.9% ± 3.3% than girls (42.4% ± 3.0%, while girls had significantly higher estimated FM (45.2 ± 3.9 weight % versus 41.6% ± 4.3%; p = 0.014. TEE was significantly higher in boys (2395 ± 349 kcal/day compared with girls (1978 ± 169 kcal/day; p = 0.001. Estimated physical activity level (PAL was significantly higher in boys; 1.61 ± 0.167 versus 1.51 ± 0.870; p = 0.034. Our results provide the first dataset of TEE in 7–9 years old obese Kuwaiti children and highlight important gender differences to be considered during the development of school based interventions targeted to combat childhood obesity.

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

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    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.

  14. Hand-assisted laparoscopic splenectomy for idiopathic thrombocytopenic purpura during pregnancy.

    Science.gov (United States)

    Iwase, K; Higaki, J; Yoon, H E; Mikata, S; Tanaka, Y; Takahashi, T; Hatanaka, K; Tamaki, T; Hori, S; Mitsuda, N; Kamiike, W

    2001-02-01

    A successful case of a hand-assisted laparoscopic splenectomy with low-pressure pneumoperitoneum for autoimmune thrombocytopenic purpura in a patient at 23 weeks' gestation is reported. Preoperative splenic arterial embolization was performed on the same day as the operation using painless contour embolic material and super-absorbent polymer microspheres. The abdominal wall retraction method first was applied to avoid the effects of pneumoperitoneum on systemic hemodynamic alterations. However, a sufficient surgical view could not be obtained, as the intra-abdominal organs were elevated because of the enlarged uterus. A surgical view with 4 to 6-mm Hg pneumoperitoneum was available for the hand-assisted splenectomy. The postoperative course was uneventful, and the patient vaginally delivered a healthy infant. A hand-assisted laparoscopic splenectomy with low-pressure pneumoperitoneum after splenic arterial embolization would be feasible for patients with autoimmune thrombocytopenic purpura during a relatively advanced pregnancy.

  15. Laparoscopically assisted splenectomy following preoperative splenic artery embolization using contour emboli for myelofibrosis with massive splenomegaly.

    Science.gov (United States)

    Iwase, K; Higaki, J; Mikata, S; Tanaka, Y; Yoshikawa, M; Hori, S; Osuga, K; Kosugi, S; Tamaki, T; Kamiike, W

    1999-06-01

    Laparoscopically assisted splenectomy with an 8- to 10-cm left upper paramedian laparotomy was performed following preoperative splenic artery embolization using painless contour emboli (super absorbent polymer microsphere) with early successful results in two men (46 and 37 years old) with myelofibrosis accompanied by massive splenomegaly. Dissection around the lower part of the spleen and the hilum initially was performed intracorporeally with the usual laparoscopic view under 12 mm Hg pneumoperitoneum. The alternating changes of viewpoints between the direct view through an 8- to 10-cm incision and the usual laparoscopic view with or without application of a retraction method were effective for safe hilar devascularization. Preoperative splenic artery embolization at the distal site was effective for safe dissection around the enlarged spleen. The patients did not complain of pain before operation. Preoperative painless embolization and laparoscopically assisted splenectomy with small laparotomy promotes the feasibility and safety of minimally invasive splenectomy for myelofibrosis with massive splenomegaly.

  16. Splenic artery embolization using contour emboli before laparoscopic or laparoscopically assisted splenectomy.

    Science.gov (United States)

    Iwase, Kazuhiro; Higaki, Jun; Yoon, Hyung-Eun; Mikata, Shoki; Miyazaki, Minoru; Nishitani, Akiko; Hori, Shinichi; Kamiike, Wataru

    2002-10-01

    The present study assessed preoperative splenic artery embolization using spherical embolic material, super absorbent polymer microspheres (SAP-MS), before laparoscopic or laparoscopically assisted splenectomy. Distal splenic artery embolization using 250 to 400 microm SAP-MS was performed in nine cases with ITP and in seven cases with the other diseases with splenomegaly. Laparoscopic or laparoscopically assisted splenectomies, including a hand-assisted procedure and the procedure involving left upper minilaparotomy, were done 2 to 4 hours after embolization. Conversion to traditional laparotomy was not required in any of the 16 cases, while conversion to 12-cm laparotomy was required in one case with massive splenomegaly. Mean operating time was 161 minutes, and mean intraoperative blood loss was 290 mL. No major postoperative complications were identified, and only one patient reported postembolic pain before surgery. Preoperative splenic artery embolization using painless embolic material, SAP-MS, would be effective for easy and safe laparoscopic or laparoscopically assisted splenectomy.

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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.

  6. Impact of radiation technique, radiation fraction dose, and total cisplatin dose on hearing. Retrospective analysis of 29 medulloblastoma patients

    Energy Technology Data Exchange (ETDEWEB)

    Scobioala, Sergiu; Kittel, Christopher; Ebrahimi, Fatemeh; Wolters, Heidi; Eich, Hans Theodor [University Hospital of Muenster, Department of Radiotherapy and Radiooncology, Muenster (Germany); Parfitt, Ross; Matulat, Peter; Am Zehnhoff-Dinnesen, Antoinette [University Hospital of Muenster, Department of Phoniatrics and Pediatric Audiology, Muenster (Germany)

    2017-11-15

    To analyze the incidence and degree of sensorineural hearing loss (SNHL) resulting from different radiation techniques, fractionation dose, mean cochlear radiation dose (D{sub mean}), and total cisplatin dose. In all, 29 children with medulloblastoma (58 ears) with subclinical pretreatment hearing thresholds participated. Radiotherapy (RT) and cisplatin had been applied sequentially according to the HIT MED Guidance. Audiological outcomes up to the latest follow-up (median 2.6 years) were compared. Bilateral high-frequency SNHL was observed in 26 patients (90%). No significant differences were found in mean hearing threshold between left and right ears at any frequency. A significantly better audiological outcome (p < 0.05) was found after tomotherapy at the 6 kHz bone-conduction threshold (BCT) and left-sided 8 kHz air-conduction threshold (ACT) than after a combined radiotherapy technique (CT). Fraction dose was not found to have any impact on the incidence, degree, and time-to-onset of SNHL. Patients treated with CT had a greater risk of SNHL at high frequencies than tomotherapy patients even though D{sub mean} was similar. Increase in severity of SNHL was seen when the total cisplatin dose reached above 210 mg/m{sup 2}, with the highest abnormal level found 8-12 months after RT regardless of radiation technique or fraction dose. The cochlear radiation dose should be kept as low as possible in patients who receive simultaneous cisplatin-based chemotherapy. The risk of clinically relevant HL was shown when D{sub mean} exceeds 45 Gy independent of radiation technique or radiation regime. Cisplatin ototoxicity was shown to have a dose-dependent effect on bilateral SNHL, which was more pronounced in higher frequencies. (orig.) [German] Analyse von Inzidenz und Schweregrad einer sensorineuralen Schwerhoerigkeit (''sensorineural hearing loss'', SNHL) infolge der Wirkung unterschiedlicher Bestrahlungstechniken, Fraktionierungen, mittlerer

  7. Measuring coral calcification under ocean acidification: methodological considerations for the 45Ca-uptake and total alkalinity anomaly technique

    Directory of Open Access Journals (Sweden)

    Stephanie Cohen

    2017-09-01

    Full Text Available As the oceans become less alkaline due to rising CO2 levels, deleterious consequences are expected for calcifying corals. Predicting how coral calcification will be affected by on-going ocean acidification (OA requires an accurate assessment of CaCO3 deposition and an understanding of the relative importance that decreasing calcification and/or increasing dissolution play for the overall calcification budget of individual corals. Here, we assessed the compatibility of the 45Ca-uptake and total alkalinity (TA anomaly techniques as measures of gross and net calcification (GC, NC, respectively, to determine coral calcification at pHT 8.1 and 7.5. Considering the differing buffering capacity of seawater at both pH values, we were also interested in how strongly coral calcification alters the seawater carbonate chemistry under prolonged incubation in sealed chambers, potentially interfering with physiological functioning. Our data indicate that NC estimates by TA are erroneously ∼5% and ∼21% higher than GC estimates from 45Ca for ambient and reduced pH, respectively. Considering also previous data, we show that the consistent discrepancy between both techniques across studies is not constant, but largely depends on the absolute value of CaCO3 deposition. Deriving rates of coral dissolution from the difference between NC and GC was not possible and we advocate a more direct approach for the future by simultaneously measuring skeletal calcium influx and efflux. Substantial changes in carbonate system parameters for incubation times beyond two hours in our experiment demonstrate the necessity to test and optimize experimental incubation setups when measuring coral calcification in closed systems, especially under OA conditions.

  8. Total Skin Electron Therapy for Cutaneous T-Cell Lymphoma Using a Modern Dual-Field Rotational Technique

    Energy Technology Data Exchange (ETDEWEB)

    Heumann, Thatcher R. [Emory University School of Medicine, Emory University, Atlanta, Georgia (United States); Esiashvili, Natia [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia (United States); Parker, Sareeta [Department of Dermatology, Emory University, Atlanta, Georgia (United States); Switchenko, Jeffrey M. [Biostatistics Shared Core Resource at WCI, Emory University, Atlanta, Georgia (United States); Dhabbaan, Anees [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia (United States); Goodman, Michael [Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (United States); Lechowicz, Mary Jo; Flowers, Christopher R. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Department of Hematology and Oncology, Emory University, Atlanta, Georgia (United States); Khan, Mohammad K., E-mail: drkhurram2000@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia (United States)

    2015-05-01

    Purpose: To report our experience with rotational total skin electron irradiation (RTSEI) in cutaneous T-cell lymphoma (CTCL), and to examine response by disease stage and race. Methods and Materials: We reviewed our outcomes for 68 CTCL patients who received RTSEI (≥30 Gy) from 2000 to 2013. Primary outcomes were complete clinical response (CCR), recurrence-free survival (RFS), and overall survival (OS). Using log–rank tests and Cox proportional hazards, OS and RFS were compared across tumor stages at time of RTSEI with further racial subgroup analysis. Results: Median age at diagnosis and at time of radiation was 52 and 56 years, respectively. Median follow-up was 5.1 years, 49% were African American, and 49% were female. At time of treatment, 18, 37, and 13 patients were T stage 2, 3, and 4, respectively. At 6 weeks after RTSEI, overall CCR was 82% (88%, 83%, and 69% for T2, T3, and T4, respectively). Median RFS was 11 months for all patients and 14, 10, and 12 months for stage T2, T3, and T4, respectively. Tumor stage was not associated with RFS or CCR. Maintenance therapy after RTSEI was associated with improved RFS in both crude and multivariable analysis, controlling for T stage. Median OS was 76 months (91 and 59 months for T3 and T4, respectively). With the exception of improved OS in African Americans compared with whites at stage T2, race was not associated with CCR, RFS, or OS. Conclusions: These results represent the largest RTSEI clinical outcomes study in the modern era using a dual-field rotational technique. Our observed response rates match or improve upon the standard set by previous outcome studies using conventional TSEI techniques, despite a large percentage of advanced CTCL lesions in our cohort. We found that clinical response after RTSEI did not seem to be affected by T stage or race.

  9. New Techniques Used in Modeling the 2017 Total Solar Eclipse: Energizing and Heating the Large-Scale Corona

    Science.gov (United States)

    Downs, Cooper; Mikic, Zoran; Linker, Jon A.; Caplan, Ronald M.; Lionello, Roberto; Torok, Tibor; Titov, Viacheslav; Riley, Pete; Mackay, Duncan; Upton, Lisa

    2017-08-01

    Over the past two decades, our group has used a magnetohydrodynamic (MHD) model of the corona to predict the appearance of total solar eclipses. In this presentation we detail recent innovations and new techniques applied to our prediction model for the August 21, 2017 total solar eclipse. First, we have developed a method for capturing the large-scale energized fields typical of the corona, namely the sheared/twisted fields built up through long-term processes of differential rotation and flux-emergence/cancellation. Using inferences of the location and chirality of filament channels (deduced from a magnetofrictional model driven by the evolving photospheric field produced by the Advective Flux Transport model), we tailor a customized boundary electric field profile that will emerge shear along the desired portions of polarity inversion lines (PILs) and cancel flux to create long twisted flux systems low in the corona. This method has the potential to improve the morphological shape of streamers in the low solar corona. Second, we apply, for the first time in our eclipse prediction simulations, a new wave-turbulence-dissipation (WTD) based model for coronal heating. This model has substantially fewer free parameters than previous empirical heating models, but is inherently sensitive to the 3D geometry and connectivity of the coronal field---a key property for modeling/predicting the thermal-magnetic structure of the solar corona. Overall, we will examine the effect of these considerations on white-light and EUV observables from the simulations, and present them in the context of our final 2017 eclipse prediction model.Research supported by NASA's Heliophysics Supporting Research and Living With a Star Programs.

  10. Minimally invasive total knee arthroplasty: comparison of jig-based technique versus computer navigation for clinical and alignment outcome.

    Science.gov (United States)

    Hasegawa, Masahiro; Yoshida, Kakunoshin; Wakabayashi, Hiroki; Sudo, Akihiro

    2011-06-01

    Correct alignment of the leg and positioning of the components are important factors in good long-term outcome of total knee arthroplasty (TKA). Computer-assisted navigation systems were introduced to improve component alignment accuracies. The three main hypotheses of this study were that the navigated compared to jig-based patient will show the following: (1) No difference in clinical outcomes. (2) Better alignment in the frontal and sagittal plane. (3) Better rotational positioning of components. The authors evaluated 100 patients who had minimally invasive TKA using either an image-free computer-assisted navigation system (n=50) or a jig-based technique (n=50). Six months postoperatively, clinical and radiological evaluations were performed using full-length standing anteroposterior and lateral radiographs and CT scans of the knee. Knee Society knee score, function score, and range of motion were comparable in the two groups after surgery. The percentage of patients with a frontal tibiofemoral angle within ±3° of the ideal was significantly higher in the navigated group than in the jig-based group (94% vs. 78%, respectively; P=0.041). No significant differences were found between groups in terms of the frontal and sagittal planes as well as rotational alignment of the femoral or tibial components. Computer-assisted TKA gives a better correction of alignment of the leg compared with jig-based TKA when combined with a minimally invasive surgical approach.

  11. Factors Predicting Difficulty of Laparoscopic Low Anterior Resection for Rectal Cancer with Total Mesorectal Excision and Double Stapling Technique.

    Directory of Open Access Journals (Sweden)

    Weiping Chen

    Full Text Available Laparoscopic sphincter-preserving low anterior resection for rectal cancer is a surgery demanding great skill. Immense efforts have been devoted to identifying factors that can predict operative difficulty, but the results are inconsistent.Our study was conducted to screen patients' factors to build models for predicting the operative difficulty using well controlled data.We retrospectively reviewed records of 199 consecutive patients who had rectal cancers 5-8 cm from the anal verge. All underwent laparoscopic sphincter-preserving low anterior resections with total mesorectal excision (TME and double stapling technique (DST. Data of 155 patients from one surgeon were utilized to build models to predict standardized endpoints (operative time, blood loss and postoperative morbidity. Data of 44 patients from other surgeons were used to test the predictability of the built models.Our results showed prior abdominal surgery, preoperative chemoradiotherapy, tumor distance to anal verge, interspinous distance, and BMI were predictors for the standardized operative times. Gender and tumor maximum diameter were related to the standardized blood loss. Temporary diversion and tumor diameter were predictors for postoperative morbidity. The model constructed for the operative time demonstrated excellent predictability for patients from different surgeons.With a well-controlled patient population, we have built a predictable model to estimate operative difficulty. The standardized operative time will make it possible to significantly increase sample size and build more reliable models to predict operative difficulty for clinical use.

  12. Finding the origin of pulmonary emboli with a total-body magnetic resonance direct thrombus imaging technique

    Science.gov (United States)

    van Langevelde, Kirsten; Šrámek, Alexandr; Vincken, Patrice W.J.; van Rooden, Jan-Kees; Rosendaal, Frits R.; Cannegieter, Suzanne C.

    2013-01-01

    Pulmonary embolism is considered to originate from embolization of a deep-vein thrombosis, resulting in two manifestations of one disease: venous thrombosis. However, in up to 50% of patients with pulmonary embolism no deep-vein thrombosis is found with ultrasonography. An explanation for this low proportion is currently lacking. Other imaging modalities may increase the yield of detection of deep-vein thrombosis in the calf or in the abdominal region. Alternatively, not all pulmonary emboli may originate from deep-vein thromboses in the extremities. We searched for the origin of pulmonary emboli, by performing total-body magnetic resonance imaging-scans to visualize thrombi. Ninety-nine patients with a first pulmonary embolism confirmed by computed tomography underwent a magnetic resonance direct thrombus imaging-scan, a validated technique using endogenous contrast. Additionally, acquired and genetic risk factors were assessed. No thrombus was found in 55 patients, whereas a thrombus was identified in 44 patients. The commonest thrombus location was the lower leg; 12 patients had isolated calf vein thrombosis and five had isolated superficial vein thrombosis. A peripheral thrombus was found by magnetic resonance imaging in less than half of patients with pulmonary embolism. We propose several hypotheses to explain the absence of thrombi, such as a cardiac thrombus origin or embolization of the whole deep-vein thrombus. The possibility that pulmonary embolism arises de novo in the lungs, due to local inflammation-driven coagulation, needs to be considered. PMID:22801962

  13. The Advantages of an Attenuated Total Internal Reflection Infrared Microspectroscopic Imaging Technique for the Analysis of Polymer Laminates.

    Science.gov (United States)

    Ling, Chen; Sommer, André J

    2015-06-01

    Until recently, the analysis of polymer laminates using infrared microspectroscopy involved the painstaking separation of individual layers by dissection or by obtaining micrometer thin cross-sections. The latter usually requires the expertise of an individual trained in microtomy and even then, the very structure of the laminate could affect the outcome of the spectral results. The recent development of attenuated total internal reflection (ATR) infrared microspectroscopy imaging has provided a new avenue for the analysis of these multilayer structures. This report compares ATR infrared microspectroscopy imaging with conventional transmission infrared microspectroscopy imaging. The results demonstrate that the ATR method offers improved spatial resolution, eliminates a variety of competing optical processes, and requires minimal sample preparation relative to transmission measurements. These advantages were illustrated using a polymer laminate consisting of 11 different layers whose thickness ranged in size from 4-20 μm. The spatial resolution achieved by using an ATR-FTIR (Fourier transform infrared spectroscopy) imaging technique was diffraction limited. Contrast in the ATR images was enhanced by principal component analysis.

  14. Large primary splenic cyst: A laparoscopic technique.

    LENUS (Irish Health Repository)

    Geraghty, M

    2009-01-01

    Splenic cysts are rare lesions with around 800 cases reported in the world literature. Traditionally splenectomy was the treatment of choice. However, with the recognition of the important immunological function of the spleen, new techniques to preserve splenic function have been developed. This case emphasizes that in selected cases splenic preservation is appropriate.

  15. 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.

  16. [Company Wide Quality Control (total quality): methodological principles and intervention techniques for step-by-step improvement].

    Science.gov (United States)

    Corbara, F; Di Cristofaro, E

    1996-01-01

    The concept of Quality is particularly up to date and not a new one for the Journal. The need for better Quality is a must also in Medical care. Quality doesn't mean additional costs and excessive burden for the co-workers. On the contrary, initial costs can be compensated for through a more rational utilisation of the resources. The consequent better service for the patient results in an ameliorated working environment, with high profits. Fundamental requirements for reaching concrete results are: 1) the convinced involvement in the idea of all levels (division, service, laboratory) in order to have the different groups act in synergism towards common goals; 2) the knowledge of appropriate methods. The Authors examine this last point with a deep analysis of the techniques involved in Company Wide Quality Control (C.W.Q.C.) or Total Quality. The improving process has to the continuous and proceed in small steps, each time being constituted by 4 different phases, represented by the PDCA cycle, or Demining wheel, where: P = PLAN, which means plan before acting; D = DO, perform what has been planned; C = CHECK, verify the results; A = ACT, standardize if the results are positive, repeat the process if negative. Each process of improvement implies a prior precise definition of a project, i.e. a problem whose solution has been planned. The project must always presume: a specific subject--a goal--one or more people to reach it--a limited time to work it out. The most effective way to ameliorate Quality is performing projects. Step by Step amelioration is synonymous of performance of many projects. A brilliant way to produce many projects remains their "industrialization", which can be reached by means of 6 basic criteria: 1) full involvement of the Direction; 2) potential co-working in the projects of all employees; 3) employment of simple instruments; 4) respect of a few procedural formalities; 5) rewarding of personnel; 6) continuous promotion of the concepts of

  17. 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.

  18. 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.

  19. Pharmacologic Prophylaxis of Portal Venous System Thrombosis after Splenectomy: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Xingshun Qi

    2014-01-01

    Full Text Available Portal venous system thrombosis (PVST is a life-threatening complication of splenectomy. A meta-analysis was conducted to explore the role of pharmacologic prophylaxis of PVST after splenectomy. Overall, 359 papers were initially identified via the PubMed, EMBASE, and Cochrane Library databases. Eight of them were eligible. 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]: 0.33, 95% confidence interval [CI]: 0.22–0.47, P<0.00001. Subgroup analyses demonstrated that the significant difference remained in studies including patients with portal hypertension (n=6, but not in those including patients with hematological diseases (n=2; the significant difference remained in studies using any type of prophylactic drugs (anticoagulants [n=6], thrombolytics [n=1], and prostaglandin E1 [n=1]; the significant difference remained in nonrandomized studies (n=5, but not in randomized studies (n=3. The risk of bleeding was similar between the two groups (OR: 0.65, 95% CI: 0.10–4.04, P=0.64. In conclusion, pharmacologic prophylaxis might decrease the incidence of PVST after splenectomy in patients with portal hypertension and did not increase the risk of bleeding. However, the effect of pharmacologic prophylaxis of PVST in patients with hematological diseases remained questioned.

  20. The Significance of Splenectomy in Experimental Swine Models of Controlled Hemorrhagic Shock

    Science.gov (United States)

    2013-11-01

    Antonio, TX REFERENCES 1. Lehman E, Amole C. The function of the spleen in the retardation of shock from hemorrhage. Surgery . 1938;4:44 50. 2. Horton...stressful circum stances.4Because it requires laparotomy ,organ manipulation, vascular control and spleen removal, prehemorrhagic splenectomy consti tutes a

  1. 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.

  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. 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)

  4. 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.

  5. 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)

  6. 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.

  7. 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 within...

  8. 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

  9. 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

  10. [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.

  11. Leg and Femoral Neck Length Evaluation Using an Anterior Capsule Preservation Technique in Primary Direct Anterior Approach Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Stephen J Nelson

    2017-04-01

    Full Text Available Background Achieving correct leg and femoral neck lengths remains a challenge during total hip arthroplasty (THA.  Several methods for intraoperative evaluation and restoration of leg length have been proposed, and each has inaccuracies and shortcomings.  Both the supine positioning of a patient on the operating table during the direct anterior approach (DAA THA and the preservation of the anterior capsule tissue  are simple, readily available, and cost-effective strategies that can lend themselves well as potential solutions to this problem. Technique The joint replacement is performed through a longitudinal incision (capsulotomy of the anterior hip joint capsule, and release of the capsular insertion from the femoral intertrochanteric line. As trial components of the prosthesis are placed, the position of the released distal capsule in relationship to its original insertion line is an excellent guide to leg length gained, lost, or left unchanged. Methods The radiographs of 80 consecutive primary THAs were reviewed which utilized anterior capsule preservation and direct capsular measurement as a means of assessing change in leg/femoral neck length. Preoperatively, the operative legs were 2.81 +/- 8.5 mm (SD shorter than the nonoperative leg (range: 17.7 mm longer to 34.1 mm shorter.  Postoperatively, the operative legs were 1.05 +/- 5.64 mm (SD longer than the nonoperative leg (range: 14.9 mm longer to 13.7 mm shorter. Conclusion The preservation and re-assessment of the native anterior hip capsule in relationship to its point of release on the femur is a simple and effective means of determining leg/femoral neck length during DAA THA.

  12. 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

  13. Rapid prediction of total petroleum hydrocarbons concentration in contaminated soil using vis-NIR spectroscopy and regression techniques.

    Science.gov (United States)

    Douglas, R K; Nawar, S; Alamar, M C; Mouazen, A M; Coulon, F

    2018-03-01

    Visible and near infrared spectrometry (vis-NIRS) coupled with data mining techniques can offer fast and cost-effective quantitative measurement of total petroleum hydrocarbons (TPH) in contaminated soils. Literature showed however significant differences in the performance on the vis-NIRS between linear and non-linear calibration methods. This study compared the performance of linear partial least squares regression (PLSR) with a nonlinear random forest (RF) regression for the calibration of vis-NIRS when analysing TPH in soils. 88 soil samples (3 uncontaminated and 85 contaminated) collected from three sites located in the Niger Delta were scanned using an analytical spectral device (ASD) spectrophotometer (350-2500nm) in diffuse reflectance mode. Sequential ultrasonic solvent extraction-gas chromatography (SUSE-GC) was used as reference quantification method for TPH which equal to the sum of aliphatic and aromatic fractions ranging between C 10 and C 35 . Prior to model development, spectra were subjected to pre-processing including noise cut, maximum normalization, first derivative and smoothing. Then 65 samples were selected as calibration set and the remaining 20 samples as validation set. Both vis-NIR spectrometry and gas chromatography profiles of the 85 soil samples were subjected to RF and PLSR with leave-one-out cross-validation (LOOCV) for the calibration models. Results showed that RF calibration model with a coefficient of determination (R 2 ) of 0.85, a root means square error of prediction (RMSEP) 68.43mgkg -1 , and a residual prediction deviation (RPD) of 2.61 outperformed PLSR (R 2 =0.63, RMSEP=107.54mgkg -1 and RDP=2.55) in cross-validation. These results indicate that RF modelling approach is accounting for the nonlinearity of the soil spectral responses hence, providing significantly higher prediction accuracy compared to the linear PLSR. It is recommended to adopt the vis-NIRS coupled with RF modelling approach as a portable and cost effective

  14. Determination of lead in clay enameled by X-ray fluorescence technique in Total reflection and by Scanning Electron Microscopy; Determinacion de plomo en esmaltado de barro por Fluorescencia de rayos X en reflexion total y Microscopia Electronica de Barrido

    Energy Technology Data Exchange (ETDEWEB)

    Zarazua O, G.; Carapia M, L. [Instituto Nacional de Investigaciones Nucleares, C.P. 52045 Estado de Mexico (Mexico)

    2000-07-01

    This work has the objective of determining lead free in the glazed commercial stewing pans using the X-ray fluorescence technique in Total reflection (FRX) and the observation and semiquantitative determination of lead by Analytical Scanning Electron Microscopy (ASEM). (Author)

  15. Outcome and Prognostic Factors for Canine Splenic Lymphoma Treated by Splenectomy (1995-2011) : A VSSO Retrospective Study

    NARCIS (Netherlands)

    van Stee, Lucinda L; Boston, Sarah E; Singh, Ameet; Romanelli, Giorgio; Rubio-Guzman, Alejandro; Scase, Tim J

    2015-01-01

    OBJECTIVE: To assess the outcome of canine splenic lymphoma treated with splenectomy and to evaluate prognostic factors, including involvement of other sites, adjuvant chemotherapy, and the effect of World Health Organization (WHO) histological classification of canine malignant lymphoma. DESIGN:

  16. 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

  17. 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

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

    OpenAIRE

    Viviers, Petrus J.

    2014-01-01

    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 suspicio...

  19. 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.

  20. 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.

  1. Characterization of unconventional electron fields for the treatment of mycosis fungoides using the total skin irradiation technique

    Energy Technology Data Exchange (ETDEWEB)

    González, M. A. Pagnan, E-mail: miguelangel.pagnan@hotmail.com; Mitsoura, E., E-mail: meleni@uaemex.mx [Medical Physics Graduate Programme, Universidad Autónoma del Estado de México, Facultad de Medicina, Paseo Tollocan esquina Jesús Carranza Colonia Moderna de la Cruz, C.P. 50180, Toluca, Estado de México (Mexico); Oviedo, J.O. Hernández [The American British Cowdray Medical Center, Centro de Cáncer, Calle Sur 136, no. 116, Colonia las Américas, C.P. 01120, México, D.F. (Mexico); Vázquez, D. R. Ruesga, E-mail: druesga@yahoo.com.mx [Hospital General de México Dr. Eduardo Liceaga, Dr. Balmis 148, Colonia Doctores, C.P. 06726, México, D.F. (Mexico)

    2014-11-07

    Mycosis fungoides is a cutaneous lymphoma that accounts for 2–3% of all lymphomas. Several clinical studies have demonstrated the effectiveness of TSEBT (Total Skin Electron Beam Therapy) in patients with mycosis fungoides. It is important to develop this technique and make it available to a larger number of patients in Mexico. Because large fields for electron TSEBT are required in order to cover the entire body of the patient, beam characterization at conventional treatment distances is not sufficient and a calibration distance of 500cm or higher is required. Materials and methods: Calibration of radiochromic Gafchromic® EBT2 film (RCF) for electrons was performed in a solid water phantom (Scanditronix Wellhöfer) at a depth of 1.4cm and a Source Axis Distance (SAD) of 100cm. A polynomial fit was applied to the calibration curve, in order to obtain the equation relating dose response with optical density. The spatial distribution is obtained in terms of percentage of the dose, placing 3×3cm samples of RCF on the acrylic screen, which is placed in front of the patient in order to obtain maximum absorbed dose on the skin, covering an area of 200×100cm{sup 2}. The Percentage Depth Dose (PDD) curve was obtained placing RCF samples at depths of 0, 1, 1.2, 1.4, 1.5, 2, 3, 4, 5, 6, 7, 8 and 9cm in the solid water phantom, irradiated with an ELEKTA SINERGY Linear Accelerator electron beam, with an energy of 6 MeV, at a Source Skin Distance (SSD) of 500cm, with 1000MU = 100Gy, with a cone of 40×40cm and gantry angle of 90°. The RCFs were scanned on a flatbed scanner (EPSON EXPRESSION 10000 XL) and the images were processed with the ImageJ program using a region of interest (ROI) of 1×1cm{sup 2}. Results: The relative spatial dose distribution and the percentage depth dose for a SSD of 500±0.5cm, over an area of 200×100cm{sup 2} was obtained, resulting to an effective maximum dose depth (Z{sub ref}) for electrons of 1.4±0.05cm. Using the same experimental data

  2. 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.

  3. 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.

  4. 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.

  5. Spleen irradiation and splenectomy for treatment of hypersplenism in chronic myeloid leukemia and chronic lymphatic leukemia

    International Nuclear Information System (INIS)

    Stolzenbach, G.; Franke, H.D.; Montz, R.; Schulze, P.J.; Hamburg Univ.; Hamburg Univ.

    1979-01-01

    Hypersplenism is characterized by cytopenia, splenomegaly (possibly hyperplastic bone-marrow), and lienal hypersequestration. It is necessary, in view of the rather important surgical risks of splenectomy, to clarify if the hypersplenism may be influenced by splenic irradiation in case of chronic myeloid leukemia (CML) or chronic lymphatic leukemia (CLL). References in literature are rare and do not present a reliable differentiation of the syndrome, according to its present definition. Of our patients, three cases with hypersplenism verified by radioiron studies are reported: in one patient with chronic myeloid leukemia, irradiation of the spleen had no effect, whereas pancytopenia was completely repaired by means of splenectomy. The same result were seen in a patient with chronic lymphatic leukemia. In the last patient, however, who had chronic lymphatic leukemia, fractionated irradiation of the spleen led to a distinct improvement of anemia and thrombopenia, but the recovery lasted only six months. This effect is due to transient normalization of the lienal hypersequestration. (orig.) [de

  6. 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

  7. 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)

  8. 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.

  9. Single-Incision Laparoscopic Splenectomy and Splenic Autotransplantation for an Enlarged Wandering Spleen with Torsion

    OpenAIRE

    Katsura, Shunsaku; Kawamura, Daichi; Harada, Eijiro; Enoki, Tadahiko; Hamano, Kimikazu

    2013-01-01

    A wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant, but instead is found in the lower abdomen or in the pelvic region because of the laxity of the peritoneal attachments. The unusually long pedicle is susceptible to twisting, which can lead to ischemia, and eventually to necrosis. We herein report a case of an enlarged wandering spleen with torsion, successfully treated by single-incision laparoscopic splenectomy and autotransplantation. The t...

  10. Infectious complications after surgical splenectomy in children with sickle cell disease

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    Cypriano Petrus Monaco Junior

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the frequency of infectious complications in children with sickle cell disease (SCD after surgical splenectomy for acute splenic sequestration crisis. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

  11. [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.

  12. 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)

  13. 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.)

  14. 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.)

  15. 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.

  16. FORCED OSCILLATION TECHNIQUE - REFERENCE VALUES FOR TOTAL RESPIRATORY RESISTANCE OBTAINED WITH THE SIEMENS SIREGNOST-FD5

    NARCIS (Netherlands)

    GIMENO, F; VANDERWEELE, LT; KOETER, GH; VANALTENA, R

    Total respiratory resistance (Rrs) was measured by the application of a sine wave of airflow to the mouth at an oscillation frequency of 10 Hz. The instrument used was the Siemens Siregnost FD5. The Rrs data were correlated with height, age, sex, and weight in 73 patients and 29 healthy subjects.

  17. Effects of Splenectomy on Spontaneously Chronic Pancreatitis in aly/aly Mice

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    Heng-Xiao Wang

    2010-01-01

    Full Text Available Background and Aim. Mice with alymphoplasia (aly/aly mutation characterized by a lack of lymph nodes, Peyer's patches, and well-defined lymphoid follicles in the spleen were found. In this study, we used splenectomized aly/aly mice to elucidate the effects of secondary lymphoid organs in the development of aly/aly autoimmune pancreatitis. Methods. Forty-eight 10-week-old aly/aly mice were divided into two groups for splenectomy and sham operation. Histological and immunohistochemical analyses of the pancreas were performed at the ages of 20, 30, and 40 weeks old after operation, respectively. Results. Our results showed that mononuclear cell infiltration was restricted to the interlobular connective tissues at the age of 20 weeks, and not increase obviously at the age of 30 and 40 weeks in splenectomized aly/aly mice. Furthermore, an apparent decrease in the expressions of CD4+ T, CD8+ T, and B cells was detected in the pancreatic tissues compared with sham aly/aly mice, however, no significant difference in macrophage expression between mice with and without a splenectomy. Conclusions. Inflammation infiltration and development of the pancreatitis in aly/aly mice were suppressed effectively after splenectomy, which was, at least partly, correlated to inhibition of the infiltration of T and B cells in pancreatic tissues but not to macrophages.

  18. 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.

  19. Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications.

    Science.gov (United States)

    Wilches, C; Sulbarán, J D; Fernández, J E; Gisbert, J M; Bausili, J M; Pelfort, X

    To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups. Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months. There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy: An analytical technique to understand therapeutic responses at the molecular level.

    Science.gov (United States)

    Kalmodia, Sushma; Parameswaran, Sowmya; Yang, Wenrong; Barrow, Colin J; Krishnakumar, Subramanian

    2015-11-16

    Rapid monitoring of the response to treatment in cancer patients is essential to predict the outcome of the therapeutic regimen early in the course of the treatment. The conventional methods are laborious, time-consuming, subjective and lack the ability to study different biomolecules and their interactions, simultaneously. Since; mechanisms of cancer and its response to therapy is dependent on molecular interactions and not on single biomolecules, an assay capable of studying molecular interactions as a whole, is preferred. Fourier Transform Infrared (FTIR) spectroscopy has become a popular technique in the field of cancer therapy with an ability to elucidate molecular interactions. The aim of this study, was to explore the utility of the FTIR technique along with multivariate analysis to understand whether the method has the resolution to identify the differences in the mechanism of therapeutic response. Towards achieving the aim, we utilized the mouse xenograft model of retinoblastoma and nanoparticle mediated targeted therapy. The results indicate that the mechanism underlying the response differed between the treated and untreated group which can be elucidated by unique spectral signatures generated by each group. The study establishes the efficiency of non-invasive, label-free and rapid FTIR method in assessing the interactions of nanoparticles with cellular macromolecules towards monitoring the response to cancer therapeutics.

  1. 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

  2. Meloxicam improves object recognition memory and modulates glial activation after splenectomy in mice.

    Science.gov (United States)

    Kamer, Angela R; Galoyan, Samuel M; Haile, Michael; Kline, Richard; Boutajangout, Allal; Li, Yong-Sheng; Bekker, Alex

    2012-07-01

    Surgery-induced neuroinflammation has been implicated in the development of postoperative cognitive dysfunction (POCD). To test the hypothesis that meloxicam, a selective cyclooxygenase (COX)-2 inhibitor, preserves postoperative cognitive function and inhibits surgery-induced neuroinflammation in a mouse model. A mouse model of splenectomy-induced inflammation. Sixty Swiss Webster male mice (6-8 week old) were randomised into six groups that underwent splenectomy. Animals in groups 1-4 were tested once on day 1, 5, 9 or 14 to determine the time course of delayed transient cognitive dysfunction associated with splenectomy. Animals in groups 5 and 6 were tested once on day 5 or 9 to determine the ability of the NSAID meloxicam to attenuate cognitive dysfunction. Animals in groups 1-4 received one dose 500 μl intraperitoneal physiological saline 24 h after splenectomy. Animals in groups 5 and 6 received one dose of intraperitoneal meloxicam (60 mg kg in 500 μl saline) 24 h after splenectomy. Short-term working memory as determined by Object Recognition Test (ORT) index on days 1, 5, 9 and 14 was the first main outcome. Tomato lectin staining histochemistry of glial cells was assessed on days 1, 5, 9 and 14 as a second main outcome. Compared with day 1 (group 1), the mean ORT indices at day 5 (group 2) and day 9 (group 3) were decreased by 27.5% [95% confidence interval (CI): 0.9 to 54.1%, P = 0.04] and 23.8% (95% CI, 4.3 to 51.9%, P = 0.09), respectively. At day 5 (group 5) and day 9 (group 6), the ORT indices in the meloxicam groups were reduced by 6.6% (95% CI: -11.4 to 24.5%) and 4.3% (95% CI: -25.3 to 34.0). Thus, the administration of meloxicam attenuated the decrease in ORT indices (P = 0.031). Histochemical staining with tomato lectin showed features of microglia activation at day 5 and 9, which was reduced by the administration of meloxicam. These findings suggest that COX-2-dependent mechanisms may play a role in the development of POCD. This effect may be

  3. Radiographic study of patients submitted to total gastrectomy using Safatle reconstruction technique Estudo radiológico em doentes submetidos a gastrectomia total com reconstrução à Safatle

    Directory of Open Access Journals (Sweden)

    Alberto Luiz Monteiro Meyer

    2008-09-01

    Full Text Available BACKGROUND: Ever since the first total gastrectomy, there has always been a great concern in increasing the survival of patients, and with the advance of techniques, in improving the quality of life of these patients. The most common reconstruction technique of the gastrointestinal transit is the Roux-en-Y. The reposition of a functional pouch in place of the resected stomach was proposed to minimize the postprandial symptoms, improve the nutritional grade and consequently, the quality of life. The Safatle reconstruction of the gastrointestinal transit technique consists of, in short, in the association of the interposition of the jejunal loop with partial transit through the duodenum, with an inverted Roux-en-Y and with the creation of a pouch which resembles the dynamics of the stomach, achieved by duodenojejunal segment which has an antiperistalsis emptying. AIM: To assess, by radiographic means, the emptying of the duodenojejunal pouch in patients submitted to total gastrectomy using the Safatle reconstruction technique. METHOD: Twelve patients submitted to total gastrectomy using the Safatle technique due to gastric cancer were studied. They were summoned to perform contrasted radiographies of the esophagus-duodenum-jejunum by the videofluoroscopic method during the months of July and August, 2005. RESULTS: All the patients presented satisfactory movement of the duodenojejunal pouch and an adequate emptying in antiperistalsis without food stasis. There has been an average 25-minute drainage time of the duodenojejunal pouch. CONCLUSION: The duodenojejunal pouch, in the patients submitted to total gastrectomy using the Safatle reconstruction, presented adequate emptying and movement.RACIONAL: Desde a primeira gastrectomia total, houve sempre a preocupação em aumentar a sobrevida e, com o aprimoramento das técnicas, de melhorar a qualidade de vida. A técnica mais aceita para a reconstrução do trânsito intestinal após gastrectomia total

  4. A method optimization study for atomic absorption spectrophotometric determination of total zinc in insulin using direct aspiration technique

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    Sadia Ata

    2015-03-01

    Full Text Available A sensitive, reliable and relative fast method has been developed for the determination of total zinc in insulin by atomic absorption spectrophotometer. This designed study was used to optimize the procedures for the existing methods. Spectrograms of both standard and sample solutions of zinc were recorded by measuring the absorbance at 213.9 nm for determination of total zinc. System suitability parameters were evaluated and were found to be within the limits. Linearity was evaluated through graphical representation of concentration versus absorbance. Repeatability (intra-day and intermediate precision (inter-day were assessed by analyzing working standard solutions. Accuracy and robustness were experimented from the standard procedures. The percentage recovery of zinc was found to be 99.8%, relative standard deviation RSD 1.13%, linearity of determination LOD 0.0032 μg/mL, and limit of quantization LOQ 0.0120 μg/mL. This developed and proposed method was then validated in terms of accuracy, precision, linearity and robustness which can be successfully used for the quantization of zinc in insulin.

  5. [Study on predicting total acid content and soluble sugar of tomato juice by near infrared optical fiber spectrometer technique].

    Science.gov (United States)

    Zhang, Bing-Fang; Yuan, Li-Bo; Zhang, Bing-Xiu

    2014-02-01

    In order to explore a simple, rapid and efficient tomato quality detection method, in the present experiment near infrared spectroscopy and optical fiber sensing technology were applied to quickly measure the nutrition ingredient content in tomato juice samples. The main instrument used in this experiment was near infrared optical fiber spectrometer in a wavelength range from 900 to 2 500 nm, which measured the absorbance of the tomato juice samples; A collection of one hundred and sixty-four tomato juice samples were selected as the standard samples, the spectra and the corresponding chemical value were measured. Partial least squares (PLS) was adopted to establish the mathematical model of the total acid and soluble sugar content in tomato juice samples, and the regression equation was statistically analysed. The total acid in tomato juice prediction correlation coefficient was 0.967, calibration standard deviation (RMSEC) was 0.133, standard error of prediction (RMSEP) was 0.103; the soluble sugar prediction correlation coefficient is 0.976, calibration standard deviation (RMSEC) was 0.463, and the standard error of prediction (RMSEP) was 0. 460. The above data achieved better forecasting results, which showed that the method of quantitative analysis of tomato fruit multicomponent content was feasible. The method is rapid, simple and can do multicomponent analysis on the same sample simultaneously. It is a promising sensor and gradually becoming a international research focus in sensor field.

  6. Relationship between wheat characteristics and nutrient digestibility in broilers: comparison between total collection and marker (titanium dioxide) technique.

    Science.gov (United States)

    Smeets, N; Nuyens, F; Van Campenhout, L; Delezie, E; Pannecoucque, J; Niewold, T

    2015-07-01

    Three wheat cultivars (Orpheus, Rustic, and Viscount) were used to formulate 3 test feeds (62.4% wheat) in a broiler digestibility trial. The diets were fed to male Ross 308 broiler chickens. The wheat cultivars mainly differed in their amount of non-starch polysaccharides ( NSP: ). The cultivar Orpheus was chosen to represent a high amount of NSP (102 g/kg DM), whereas the cultivars Rustic and Viscount represented low amounts of NSP (83.4 g/kg DM and 73.9 g/kg DM, respectively). Furthermore, the cultivars Orpheus and Viscount were feed quality wheat, whereas Rustic was a milling quality wheat. Nutrient digestibilities and AMEn contents of the diets were measured from 18 to 22-days-old by total excreta collection, or with the use of the indigestible marker titanium dioxide. In addition, the ileal viscosity was measured when the broilers were 25-days-old. Wheat cultivar affected N retention, DM digestibility, and AMEn. In general, the feed formulated with the high NSP wheat cultivar Orpheus resulted in the least favorable nutrient digestibilities and AMEn, whereas the results were better when the feed was formulated with the low NSP cultivars Viscount and Rustic. Feeding the Rustic cultivar caused the highest intestinal viscosity, although this was not reflected in the animal responses. Nutrient digestibilities and AMEn content of the diets were lower when calculated with the titanium dioxide marker than with the total excreta collection procedure. Moreover, the P-values of the effect of wheat cultivar on DM digestibility, N retention, crude fat digestibility and AMEn were lower with the use of the titanium dioxide marker. It can be concluded that wheat cultivar affected nutrient digestibility and AMEn, and that the observed differences were related to the amount of NSP. Furthermore, both the titanium dioxide marker and the total excreta collection methods showed the same trends despite the different values obtained. The titanium dioxide marker method was the

  7. A Computer Navigation System Analysis of the Accuracy of the Extramedullary (Tibial Alignment Technique in Total Knee Arthroplasty (TKA

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    EK Chee

    2010-07-01

    Full Text Available In total knee arthroplasty, mechanical alignment guides have improved the accuracy of implant alignment, but errors are not uncommon. In the present study, an image-free computer-assisted navigation system was used to analyse the accuracy of an extramedullary (tibial alignment system, which is based on predetermined, fixed anatomical landmarks. Comparisons were made between two surgeons, with different levels of competency in order to determine if experience affected the accuracy of extramedullary tibial jig placement, in either the coronal and sagittal planes or both planes. The results showed that the accuracy of the extramedullary tibial alignment system, in the coronal plane (in up to 80-87% of cases was much better than for posterior slope, and sagittal plane. Surgeon experience was not a significant factor.

  8. Intercomparison of the comparative reactivity method (CRM) and pump-probe technique for measuring total OH reactivity in an urban environment

    Science.gov (United States)

    Hansen, R. F.; Blocquet, M.; Schoemaecker, C.; Léonardis, T.; Locoge, N.; Fittschen, C.; Hanoune, B.; Stevens, P. S.; Sinha, V.; Dusanter, S.

    2015-10-01

    The investigation of hydroxyl radical (OH) chemistry during intensive field campaigns has led to the development of several techniques dedicated to ambient measurements of total OH reactivity, which is the inverse of the OH lifetime. Three techniques are currently used during field campaigns, including the total OH loss rate method, the pump-probe method, and the comparative reactivity method. However, no formal intercomparison of these techniques has been published so far, and there is a need to ensure that measurements of total OH reactivity are consistent among the different techniques. An intercomparison of two OH reactivity instruments, one based on the comparative reactivity method (CRM) and the other based on the pump-probe method, was performed in October 2012 in a NOx-rich environment, which is known to be challenging for the CRM technique. This study presents an extensive description of the two instruments, the CRM instrument from Mines Douai (MD-CRM) and the pump-probe instrument from the University of Lille (UL-FAGE), and highlights instrumental issues associated with the two techniques. It was found that the CRM instrument used in this study underestimates ambient OH reactivity by approximately 20 % due to the photolysis of volatile organic compounds (VOCs) inside the sampling reactor; this value is dependent on the position of the lamp within the reactor. However, this issue can easily be fixed, and the photolysis of VOCs was successfully reduced to a negligible level after this intercomparison campaign. The UL-FAGE instrument may also underestimate ambient OH reactivity due to the difficulty to accurately measure the instrumental zero. It was found that the measurements are likely biased by approximately 2 s-1, due to impurities in humid zero air. Two weeks of ambient sampling indicate that the measurements performed by the two OH reactivity instruments are in agreement, within the measurement uncertainties for each instrument, for NOx mixing ratios

  9. 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.

  10. 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.

  11. Determination of diffusible and total hydrogen concentration in coated and uncoated steel using melt and solid extraction techniques: Part I.

    Science.gov (United States)

    Mabho, Nonhlangabezo; Bergers, Karin; Flock, Jörg; Telgheder, Ursula

    2010-09-15

    It is essentially to know the bulk hydrogen concentration in various types of steel because it indicates the amount of hydrogen that can be trapped by the different alloys of steel. This information leads to more knowledge about the interactions of steel alloys with hydrogen containing environment and stability of the steel material during usage. To get this information precise analytical methods are necessary. Although the analytical methods for the determination of hydrogen in steel samples are often discussed, there are no sufficient systematic studies as far as the influence of the sample preparation on the analytical value is concerned. The influence of different sample preparation methods on the hydrogen determination in steel at parts per million levels by melting extracting methods has been investigated in this work. The hydrogen was measured by thermal conductivity and infrared detection. The flat sheet samples were zinc coated and uncoated ferritic types of steel. The zinc coating was removed by chemical (acid etching) and physical (paper scraping) methods. Dichloromethane acetone/ethanol, tetrachloromethane and alkaline steel cleaner (Ridoline C72) have been used for cleaning the surface of uncoated samples. The results of the total hydrogen content obtained by applying the different methods were evaluated. Copyright (c) 2010 Elsevier B.V. All rights reserved.

  12. Total arsenic concentrations in toenails quantified by two techniques provide a useful biomarker of chronic arsenic exposure in drinking water

    International Nuclear Information System (INIS)

    Adair, Blakely M.; Hudgens, Edward E.; Schmitt, Michael T.; Calderon, Rebecca L.; Thomas, David J.

    2006-01-01

    Accurate quantitation of any contaminant of interest is critical for exposure assessment and metabolism studies that support risk assessment. A preliminary step in an arsenic exposure assessment study in Nevada quantified total arsenic (TAs) concentrations in tissues as biomarkers of exposure. Participants in this study (n=95) were at least 45 years old, had lived in the area for more than 20 years, and were exposed to a wide range of arsenic concentrations in drinking water (3-2100ppb). Concentrations of TAs in blood, urine, and toenails determined by hydride generation-atomic fluorescence spectrometry (HG-AFS) ranged from below detection to 0.03, 0.76, and 12ppm, respectively; TAs in blood rarely exceeded the limit of detection. For comparison, TAs in toenails determined by neutron activation analysis (NAA) ranged from below detection to 16ppm. Significant (P 2 =0.3557 HG-AFS, adjusted r 2 =0.3922 NAA); TAs concentrations in urine were not described by drinking water As (adjusted r 2 =0.0170, P=0.1369). Analyses of TAs in toenails by HGAFS and NAA yielded highly concordant estimates (r=0.7977, P<0.0001). These results suggest that toenails are a better biomarker of chronic As exposure than urine in the current study, because the sequestration of As in toenails provides an integration of exposure over time that does not occur in urine

  13. Análise de sobrevivência relacionada ao sexo, após esplenectomia, em modelo animal Post-splenectomy survival analysis related to gender in animal model

    Directory of Open Access Journals (Sweden)

    Luiz R. Alberti

    2007-06-01

    Full Text Available É sabido que a esplenectomia causa propensão a infecções, principalmente aquelas causadas por microorganismos capsulados. Essas complicações acompanham-se de maior mortalidade e conseqüente menor sobrevida dos indivíduos asplênicos. O objetivo do presente trabalho foi avaliar a sobrevida em relação ao sexo de ratos submetidos a esplenectomia total. Foram estudados 34 ratos, distribuídos em dois grupos, sendo o Grupo 1 (n=14 controle, animais submetidos apenas a laparotomia e o Grupo 2 (n=20 submetidos a esplenectomia total. Os animais de cada grupo foram distribuídos em dois subgrupos iguais, sendo o Subgrupo A composto por machos e o Subgrupo B por fêmeas. Os ratos foram acompanhados por um período máximo de noventa dias com vista à sua sobrevivência. Observou-se que a mortalidade após esplenectomia total foi de 80% no Subgrupo dos animais machos e de 30% no das fêmeas. Não houve óbitos no Grupo 1. Os ratos esplenectomizados apresentaram sobrevida inferior à das ratas esplenectomizadas (p = 0,034. De acordo com os resultados obtidos, a esplenectomia diminui a sobrevida de ratos, e as fêmeas murinas apresentam maior resistência à asplenia e conseqüentemente menor mortalidade do que os machos.It is well known that splenectomy increases the risk of infections, mainly those caused by capsulated bacteria. These complications are associated with greater mortality and lower survival rates in asplenic individuals. The objective of the present work was to assess the survival of rats submitted to total splenectomy. Thirty-four rats were divided into 2 groups: Group 1 (n = 14: control animals, submitted only to laparotomy; Group 2 (n = 20: animals submitted to splenectomy. Both groups were subdivided into 2 subgroups, namely, subgroup A, male rats, and subgroup B, female rats. The animals were followed during a 90-day period to assess their survival. The mortality of animals in Group 2 was 80% for males and 30% for females. No

  14. The Effects of Spinal, Inhalation, and Total Intravenous Anesthetic Techniques on Ischemia-Reperfusion Injury in Arthroscopic Knee Surgery

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    Müge Koşucu

    2014-01-01

    Full Text Available Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA, ischemia-modified albumin (IMA and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t1, 30 min after tourniquet inflation (t2, immediately before (t3, and 5 min (t4, 15 min (t5, 30 min (t6, 1 h (t7, 2 h (t8, and 6 h (t9 after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t2–t9 and t2–t7. MDA levels in Group T and Group I were significantly lower than those in Group S at t2–t8 and t2–t9. IMA levels in Group T were significantly lower than those in Group S at t2–t7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.

  15. Total-Factor Energy Efficiency (TFEE Evaluation on Thermal Power Industry with DEA, Malmquist and Multiple Regression Techniques

    Directory of Open Access Journals (Sweden)

    Jin-Peng Liu

    2017-07-01

    Full Text Available Under the background of a new round of power market reform, realizing the goals of energy saving and emission reduction, reducing the coal consumption and ensuring the sustainable development are the key issues for thermal power industry. With the biggest economy and energy consumption scales in the world, China should promote the energy efficiency of thermal power industry to solve these problems. Therefore, from multiple perspectives, the factors influential to the energy efficiency of thermal power industry were identified. Based on the economic, social and environmental factors, a combination model with Data Envelopment Analysis (DEA and Malmquist index was constructed to evaluate the total-factor energy efficiency (TFEE in thermal power industry. With the empirical studies from national and provincial levels, the TFEE index can be factorized into the technical efficiency index (TECH, the technical progress index (TPCH, the pure efficiency index (PECH and the scale efficiency index (SECH. The analysis showed that the TFEE was mainly determined by TECH and PECH. Meanwhile, by panel data regression model, unit coal consumption, talents and government supervision were selected as important indexes to have positive effects on TFEE in thermal power industry. In addition, the negative indexes, such as energy price and installed capacity, were also analyzed to control their undesired effects. Finally, considering the analysis results, measures for improving energy efficiency of thermal power industry were discussed widely, such as strengthening technology research and design (R&D, enforcing pollutant and emission reduction, distributing capital and labor rationally and improving the government supervision. Relative study results and suggestions can provide references for Chinese government and enterprises to enhance the energy efficiency level.

  16. Site of destruction of 111 indium-labeled autologous platelets and effectiveness of splenectomy. Site de destruction des plaquettes autologues marquees par 111 indium et efficacite de la splenectomie

    Energy Technology Data Exchange (ETDEWEB)

    Najean, Y.; Dufour, Y. (Hopital Saint-Louis, 75 - Paris (FR))

    1991-03-01

    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).

  17. 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

  18. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Conversion Total Hip Arthroplasty: Is it a Primary or Revision Hip Arthroplasty.

    Science.gov (United States)

    Baghoolizadeh, Mahta; Schwarzkopf, Ran

    2016-09-01

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, no study has identified whether patients undergoing conversion THA better resemble patients undergoing primary THA or revision THA. The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database collects data from hospitals nationwide about preoperative characteristics, intraoperative factors, and 30-day postoperative complications. The purpose of our study was to use these variables in the ACS-NSQIP dataset to compare patients undergoing conversion THA to those undergoing primary and revision THA in order to ensure proper DRG classification of these procedures. Between 2009-2014, the ACS-NSQIP database identified 2,009 conversion THA patients, 5,089 revision THA patients, and 67,854 primary THA patients. Univariate analysis was used to compare fifty-three preoperative, intraoperative, and postoperative variables among these groups. A conservative Bonferroni-adjusted P-value of .0003 was calculated, and a less conservative P-value of .01 was used for comparison. Seventeen variables exhibited a significant difference (P ≤ .0003) only between conversion and primary THA, one variable exhibited a difference only between conversion and revision THA, and three variables exhibited a difference between both conversion and primary THA, and conversion and revision THA. With P ≤ .01, twenty-three, zero, and six differences were observed, respectively. The disproportionate number of differences between conversion and primary THAs suggests that patients undergoing conversion THAs better resemble patients undergoing revision THAs. DRGs are traditionally comprised of procedures that have similar diagnoses and require comparable levels of resources from a hospital, so these results suggest that conversion THA should rather be bundled in the same DRG as

  19. Comparison of different CCD detectors and chemometrics for predicting total anthocyanin content and antioxidant activity of mulberry fruit using visible and near infrared hyperspectral imaging technique.

    Science.gov (United States)

    Huang, Lingxia; Zhou, Yibin; Meng, Liuwei; Wu, Di; He, Yong

    2017-06-01

    This study investigated the potential of using hyperspectral imaging technique in tandem with chemometrics for rapid and invasive predicting total anthocyanin content and antioxidant activity of mulberry fruit. Two calibration methods of partial least square regression and least-squares support vector machines and three wavelength selection algorithms of successive projections algorithm, uninformation variable elimination, and competitive adaptive reweighted sampling were applied. The best prediction models for the analysis of total anthocyanin content and antioxidant activity had R val 2 of 0.959 and 0.995 respectively. The performances of two CCD detectors named silicon (Si) and indium gallium arsenide (InGaAs) were compared. The results show that hyperspectral imaging has a great potential for the assessment of total anthocyanin content and antioxidant activity of mulberry fruit. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. 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)

  1. Nondestructive measurement of total volatile basic nitrogen (TVB-N) in pork meat by integrating near infrared spectroscopy, computer vision and electronic nose techniques.

    Science.gov (United States)

    Huang, Lin; Zhao, Jiewen; Chen, Quansheng; Zhang, Yanhua

    2014-02-15

    Total volatile basic nitrogen (TVB-N) content is an important reference index for evaluating pork freshness. This paper attempted to measure TVB-N content in pork meat using integrating near infrared spectroscopy (NIRS), computer vision (CV), and electronic nose (E-nose) techniques. In the experiment, 90 pork samples with different freshness were collected for data acquisition by three different techniques, respectively. Then, the individual characteristic variables were extracted from each sensor. Next, principal component analysis (PCA) was used to achieve data fusion based on these characteristic variables from 3 different sensors data. Back-propagation artificial neural network (BP-ANN) was used to construct the model for TVB-N content prediction, and the top principal components (PCs) were extracted as the input of model. The result of the model was achieved as follows: the root mean square error of prediction (RMSEP) = 2.73 mg/100g and the determination coefficient (R(p)(2)) = 0.9527 in the prediction set. Compared with single technique, integrating three techniques, in this paper, has its own superiority. This work demonstrates that it has the potential in nondestructive detection of TVB-N content in pork meat using integrating NIRS, CV and E-nose, and data fusion from multi-technique could significantly improve TVB-N prediction performance. Copyright © 2013. Published by Elsevier Ltd.

  2. 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.

  3. 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.

  4. [Effects of splenectomy on peritonitis produced by a colonic injury: study in rats].

    Science.gov (United States)

    Nassif, Luís Sérgio; Repka, João Carlos Domingues; Nassif, Ana Cláudia Thá; Branco Filho, Alcides José; Olandoski, Márcia

    2004-01-01

    Study the effects of splenectomy on the intra-abdominal infection by bowel flora, consequent to a colonic injury in Wistar rats. We used 64 animals, 20 for Group A1 (normal with colon lesion left open), 22 for Group 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 48 hrs, 96 hrs 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. 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%). 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.

  5. 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

  6. 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)

  7. 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.

  8. A New Total Digital Smile Planning Technique (3D-DSP to Fabricate CAD-CAM Mockups for Esthetic Crowns and Veneers

    Directory of Open Access Journals (Sweden)

    F. Cattoni

    2016-01-01

    Full Text Available Purpose. Recently, the request of patients is changed in terms of not only esthetic but also previsualization therapy planning. The aim of this study is to evaluate a new 3D-CAD-CAM digital planning technique that uses a total digital smile process. Materials and Methods. Study participants included 28 adult dental patients, aged 19 to 53 years, with no oral, periodontal, or systemic diseases. For each patient, 3 intra- and extraoral pictures and intraoral digital impressions were taken. The digital images improved from the 2D Digital Smile System software and the scanner stereolithographic (STL file was matched into the 3D-Digital Smile System to obtain a virtual previsualization of teeth and smile design. Then, the mockups were milled using a CAM system. Minimally invasive preparation was carried out on the enamel surface with the mockups as position guides. Results. The patients found both the digital smile design previsualization (64.3% and the milling mockup test (85.7% very effective. Conclusions. The new total 3D digital planning technique is a predictably and minimally invasive technique, allows easy diagnosis, and improves the communication with the patient and helps to reduce the working time and the errors usually associated with the classical prosthodontic manual step.

  9. Effect of soil contamination due to wastewater irrigation on total cesium as determined by destructive and nondestructive analytical techniques in some soils of egypt

    International Nuclear Information System (INIS)

    Abdel-Sabour, M.F.; Abdel-Lattif, A.

    2005-01-01

    Fifteen soil samples were chosen from different locations to represent different soils irrigated with different sources of contaminated wastewater (sewage and industrial effluent). Sequential extraction experiment was carried out to determine different forms of Cs in soils. Moreover, Soil samples were analyzed for total Cs using two analytical methods i.e. destructive wet digestion technique (Atomic Absorption Spectrometry, AAS or by summation of all sequential extracted fractions, SUM) and non-destructive technique (Neutron Activation Analysis, NAA). The aim of this study was to evaluate soil total Cs-forms (especially, bio-available fraction) as affected by soil pollution. Cesium was mostly concentrated in the residual fraction, and its values ranged from 57.4% to 82.9 % of total Cs in sandy soils and from 31.5% to 64.5 % of total Cs in tested clayey soil. Then organically bound Cs- fraction followed by Cs-occluded in Fe-Mn fraction, carbonate, exchangeable and water soluble fractions. Results suggested that, Cs level is affected by soil organic matter content, Fe-Mn oxides and clay content. The mobile Cs fraction (the sum of soluble and exchangeable fractions) ranged from 2% up to 9.9 % of total Cs in sandy soils. However, a higher value (9.82% to 15.31 %) could be observed in case of the tested clayey soils. Soils D and E were more contaminated than other tested soils. Data show obviously, that soil contaminated due to the irrigation with either sewage effluent or industrial wastewater has resulted in a drastic increase in both metal-organic and occluded in Fe and Mn oxide fractions followed by the carbonate fraction

  10. Field in field technique in two-dimensional planning for whole brain irradiation; Tecnica field in field em planejamentos bidimensionais para irradiacao de cerebro total

    Energy Technology Data Exchange (ETDEWEB)

    Castro, A.L.S.; Campos, T.P.R., E-mail: radioterapia.andre@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (Brazil). Departamento de Engenharia Nuclear

    2016-11-01

    Radiotherapy is the most used clinical method used for brain metastases treatment, the most frequent secondary tumors provided by breast, lung and melanomas as primary origin. The protocols often use high daily doses and, depending on the irradiation technique there is high probability of complications in health tissues. In order to minimize adverse effects, it is important the dosimetric analysis of three-dimensional radiotherapy planning through tomographic images or, concerning to the 2D simulations, by the application of techniques that optimize dose distribution by increasing the homogeneity. The study aimed to compare the 2D and 3D conformal planning for total brain irradiation in a individual equivalent situation and evaluate the progress of these planning applying the field in field technique. The methodology consisted of simulating a two-dimensional planning, reproduce it on a set of tomographic images and compare it with the conformal plan for two fields and four fields (field in field). The results showed no significant difference between 2D and 3D planning for whole brain irradiation, and the field in field technique significantly improved the dose distribution in brain volume compared with two fields for the proposal situation. As conclusion, the two-dimensional plane for the four fields described was viable for whole brain irradiation in the treatment of brain metastases at the proposal situation. (author)

  11. Total boron assessment in soil samples from dry Mediterranean region using the thick target-particle induced gamma-ray emission technique

    Energy Technology Data Exchange (ETDEWEB)

    Nsouli, B. [IBA Laboratory, Lebanese Atomic Energy Commission, National Council for Scientific Research, P.O. Box 11, 8281 Beirut (Lebanon)]. E-mail: bnsouli@cnrs.edu.lb; Darwish, T. [National Center for Remote Sensing, National Council for Scientific Research, P.O. Box 11, 8281 Beirut (Lebanon); Zahraman, K. [IBA Laboratory, Lebanese Atomic Energy Commission, National Council for Scientific Research, P.O. Box 11, 8281 Beirut (Lebanon); Bejjani, A. [IBA Laboratory, Lebanese Atomic Energy Commission, National Council for Scientific Research, P.O. Box 11, 8281 Beirut (Lebanon); Roumie, M. [IBA Laboratory, Lebanese Atomic Energy Commission, National Council for Scientific Research, P.O. Box 11, 8281 Beirut (Lebanon); Thomas, J.P. [Institut de Physique Nucleaire de Lyon, Universite Claude Bernard Lyon 1, 43 Bd. 11 novembre 1918, 69622 Villeurbanne Cedex (France)

    2006-08-15

    Among other trace elements, boron assessment in soils is important for assessing land quality in accordance with international criteria for landuse planning. In this paper the total boron concentrations, for more than 100 soil samples from one of the most important agricultural region in Lebanon (i.e. Akkar plain in the North), have been measured by the TT-PIGE technique using a proton beam. The specific boron gamma ray at 429 keV produced via the {sup 10}B(p, {alpha}{gamma}){sup 7}Be nuclear reaction was used. Results are presented and discussed in relation to the lithological classes of the studied area. Furthermore, the method validation, for boron quantification in thick target soil samples using the TT-PIGE technique, employing external standards and using the so-called E {sub 1/2} analytical approach, is highlighted and discussed.

  12. 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.

  13. 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

  14. 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)

  15. 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)

  16. 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.

  17. Our Totally Intra-Articular "Needle-Anchor" Tenodesis Technique Applied in Isolated Long Head of the Biceps Tendinopathy: Clinical and Functional Results in 60 Patients.

    Science.gov (United States)

    Vitali, Matteo; Pedretti, Alberto; Naim Rodriguez, Nadim; Valenti, Mario; Fraschini, Gianfranco

    2016-03-01

    The disorders of the long head of the biceps (LHB) are a common cause of shoulder pain. Among all surgical treatments used to resolve LHB tendon disorders, tenodesis is one of the most frequent.The literature describes many arthroscopic and open surgical techniques, but there is still no general consensus on the standard of care.The purpose of this paper is to describe the clinical and functional outcomes of our totally intra-articular "Needle-Anchor" arthroscopic tenodesis technique applied to isolated LHB tendinopathy. We present a case study of 60 patients with an isolated LHB tendon disorder, treated with our totally intra-articular Needle-Anchor arthroscopic technique between 2011 and 2013.All patients were assessed preoperatively with University of California, Los Angeles (UCLA) and Constant-Murley (CS) shoulder scores and the visual analogue scale (VAS) for subjective pain assessment. Imaging studies were performed through magnetic resonance imaging. Patients were reevaluated with a follow-up at 3 and 12 months with VAS, UCLA, and CS scores.Statistical analysis was performed with the Mann-Whitney score where values of P<0.05 were considered as significant. CS showed a significant (P<0.05) improvement at 3 and 12 months follow-up, 81.54 ± 7.5 and 88.90 ± 5.2, respectively; when compared with preoperative values of 55.14 ± 9.8.Moreover, the UCLA score showed significant improvement (P<0.05) at the same follow-ups with values of 28.49 ± 2.1 and 30.88 ± 1.7, respectively, with preoperative scores of 14.03 ± 2.4.VAS values were significant at both follow-ups, 2.54 ± 0.2 and 0.58 ± 0.08, respectively, when compared with preoperative values of 5.34 ± 0.3. Biceps tenodesis performed with our Needle-Anchor technique applied to selected patients affected by isolated LHB pathology demonstrated to be effective both in terms of pain and functionality. Moreover, the described technique proved to be reliable, safe, time efficient, easily reproducible, and

  18. Development and application of the diffusive gradients in thin films technique for the measurement of total dissolved inorganic arsenic in waters

    International Nuclear Information System (INIS)

    Panther, Jared G.; Stillwell, Kathryn P.; Powell, Kipton J.; Downard, Alison J.

    2008-01-01

    The diffusive gradients in thin films (DGT) technique, utilizing an iron-hydroxide adsorbent, has been investigated for the in situ accumulation of total dissolved inorganic As in natural waters. Diffusion coefficients of the inorganic As V and As III species in the polyacrylamide gel were measured using a diffusion cell and DGT devices and a variety of factors that may affect the adsorption of the As species to the iron-hydroxide adsorbent, or the diffusion of the individual As species, were investigated. Under conditions commonly encountered in environmental samples, solution pH and the presence of anions, cations, fulvic acid, Fe III -fulvic acid complexes and colloidal iron-hydroxide were demonstrated not to affect uptake of dissolved As. To evaluate DGT as a method for accumulation and pre-concentration of total dissolved inorganic As in natural waters, DGT was applied to two well waters and a river water that was spiked with As. For each sample, the concentration obtained with use of DGT followed by measurement by hydride generation atomic absorption spectrometry with a Pd modifier (HG-AAS) was compared with the concentration of As measured directly by HG-AAS. The results confirmed that DGT is a reliable method for pre-concentration of total dissolved As

  19. Medial Protrusio Technique in Cementless Total Hip Arthroplasty for Developmental Dysplasia of the Hip: A Prospective 6- to 9-Year Follow-Up of 43 Consecutive Patients.

    Science.gov (United States)

    Zha, Guo-Chun; Sun, Jun-Ying; Guo, Kai-Jin; Zhao, Feng-Chao; Pang, Yong; Zheng, Xin

    2016-08-01

    The medial protrusio technique may be used during total hip arthroplasty (THA) on patients with developmental dysplasia. However, studies have yet to determine whether a cementless cup can be sufficiently stable to withstand loading forces. This study aimed to assess the clinical and radiographic outcomes of this technique. Furthermore, we sought to determine the relationship between the rate of medial protrusion and the incidence of cup loosening. Thirty-nine patients (43 hips) underwent cementless THA between April 2006 and March 2009 by using the medial protrusio technique. These patients participated in a 6- to 9-year follow-up. Their clinical and radiographic data were gathered prospectively. The average Harris Hip Score improved from 43.1 ± 15.4 points preoperatively to 91.9 ± 12.8 points at the final follow-up (P hip center and the distance of hip center medialization were 2.4 ± 0.6 and 2.5 ± 0.9 cm, respectively. The rate of medial protrusion and the rate of cup coverage were 42.1 ± 12.4% and 96.8 ± 5.1%, respectively. The rate of medial protrusion ranged from 18.3% to 58.3% in 38 hips (group A) and from 61.3% to 68.9% in 5 hips (group B). None of the cups in group A loosened or failed, 2 failures occurred in group B (0% vs 40.0%; P = .011). Developmental dysplasia was treated through THA using the medial protrusio technique, which easily achieves a sufficient superolateral host bony coverage of the cup and promotes socket reconstruction at the true acetabulum. The rate of medial protrusion of <60% may be necessary to obtain excellent clinical and radiographic midterm results. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Retrievals of aerosol optical depth and total column ozone from Ultraviolet Multifilter Rotating Shadowband Radiometer measurements based on an optimal estimation technique

    Science.gov (United States)

    Liu, Chaoshun; Chen, Maosi; Shi, Runhe; Gao, Wei

    2014-12-01

    A Bayesian optimal estimation (OE) retrieval technique was used to retreive aerosol optical depth (AOD), aerosol single scattering albedo (SSA), and an asymmetry factor ( g) at seven ultraviolet wavelengths, along with total column ozone (TOC), from the measurements of the UltraViolet Multifilter Rotating Shadowband Radiometer (UV-MFRSR) deployed at the Southern Great Plains (SGP) site during March through November in 2009. The OE technique specifies appropriate error covariance matrices and optimizes a forward model (Tropospheric ultraviolet radiative transfer model, TUV), and thus provides a supplemental method for use across the network of the Department of Agriculture UV-B Monitoring and Research Program (USDA UVMRP) for the retrieval of aerosol properties and TOC with reasonable accuracy in the UV spectral range under various atmospheric conditions. In order to assess the accuracy of the OE technique, we compared the AOD retreivals from this method with those from Beer's Law and the AErosol RObotic Network (AERONET) AOD product. We also examine the OE retrieved TOC in comparison with the TOC from the U.S. Department of Agriculture UV-B Monitoring and Research Program (USDA UVMRP) and the Ozone Monitoring Instrument (OMI) satellite data. The scatterplots of the estimated AOD from the OE method agree well with those derived from Beer's law and the collocated AERONETAOD product, showing high values of correlation coefficients, generally 0.98 and 0.99, and large slopes, ranging from 0.95 to 1.0, as well as small offsets, less than 0.02 especially at 368 nm. The comparison of TOC retrievals also indicates the promising accuracy of the OE method in that the standard deviations of the difference between the OE derived TOC and other TOC products are about 5 to 6 Dobson Units (DU). Validation of the OE retrievals on these selected dates suggested that the OE technique has its merits and can serve as a supplemental tool in further analyzing UVMRP data.

  1. Extreme heterogeneity of myeloablative total body irradiation techniques in clinical practice: a survey of the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

    Science.gov (United States)

    Giebel, Sebastian; Miszczyk, Leszek; Slosarek, Krzysztof; Moukhtari, Leila; Ciceri, Fabio; Esteve, Jordi; Gorin, Norbert-Claude; Labopin, Myriam; Nagler, Arnon; Schmid, Christoph; Mohty, Mohamad

    2014-09-01

    Total body irradiation (TBI) is widely used for conditioning before hematopoietic cell transplantation. Its efficacy and toxicity may depend on many methodological aspects. The goal of the current study was to explore current clinical practice in this field. A questionnaire was sent to all centers collaborating in the European Group for Blood and Marrow Transplantation and included 19 questions regarding various aspects of TBI. A total of 56 centers from 23 countries responded. All centers differed with regard to at least 1 answer. The total maximum dose of TBI used for myeloablative transplantation ranged from 8 grays (Gy) to 14.4 Gy, whereas the dose per fraction was 1.65 Gy to 8 Gy. A total of 16 dose/fractionation modalities were identified. The dose rate ranged from 2.25 centigrays to 37.5 centigrays per minute. The treatment unit was linear accelerator (LINAC) (91%) or cobalt unit (9%). Beams (photons) used for LINAC were reported to range from 6 to 25 megavolts. The most frequent technique used for irradiation was "patient in 1 field," in which 2 fields and 2 patient positions per fraction are used (64%). In 41% of centers, patients were immobilized during TBI. Approximately 93% of centers used in vivo dosimetry with accepted discrepancies between the planned and measured doses of 1.5% to 10%. In 84% of centers, the lungs were shielded during irradiation. The maximum accepted dose for the lungs was 6 Gy to 14.4 Gy. TBI is an extremely heterogeneous treatment modality. The findings of the current study should warrant caution in the interpretation of clinical studies involving TBI. Further investigation is needed to evaluate how methodological differences influence outcome. Efforts to standardize the method should be considered. © 2014 American Cancer Society.

  2. Methods and Techniques Used to Convey Total System Performance Assessment Analyses and Results for Site Recommendation at Yucca Mountain, Nevada, USA

    International Nuclear Information System (INIS)

    Mattie, Patrick D.; McNeish, Jerry A.; Sevougian, S. David; Andrews, Robert W.

    2001-01-01

    Total System Performance Assessment (TSPA) is used as a key decision-making tool for the potential geologic repository of high level radioactive waste at Yucca Mountain, Nevada USA. Because of the complexity and uncertainty involved in a post-closure performance assessment, an important goal is to produce a transparent document describing the assumptions, the intermediate steps, the results, and the conclusions of the analyses. An important objective for a TSPA analysis is to illustrate confidence in performance projections of the potential repository given a complex system of interconnected process models, data, and abstractions. The methods and techniques used for the recent TSPA analyses demonstrate an effective process to portray complex models and results with transparency and credibility

  3. Identification of Combined Power Quality Disturbances Using Singular Value Decomposition (SVD and Total Least Squares-Estimation of Signal Parameters via Rotational Invariance Techniques (TLS-ESPRIT

    Directory of Open Access Journals (Sweden)

    Huaishuo Xiao

    2017-11-01

    Full Text Available In order to identify various kinds of combined power quality disturbances, the singular value decomposition (SVD and the improved total least squares-estimation of signal parameters via rotational invariance techniques (TLS-ESPRIT are combined as the basis of disturbance identification in this paper. SVD is applied to identify the catastrophe points of disturbance intervals, based on which the disturbance intervals are segmented. Then the improved TLS-ESPRIT optimized by singular value norm method is used to analyze each data segment, and extract the amplitude, frequency, attenuation coefficient and initial phase of various kinds of disturbances. Multi-group combined disturbance test signals are constructed by MATLAB and the proposed method is also tested by the measured data of IEEE Power and Energy Society (PES Database. The test results show that the new method proposed has a relatively higher accuracy than conventional TLS-ESPRIT, which could be used in the identification of measured data.

  4. Merged-beams energy-loss technique for electron-ion excitation: Absolute total cross sections for O5+(2s→2p)

    International Nuclear Information System (INIS)

    Bell, E.W.; Guo, X.Q.; Forand, J.L.; Rinn, K.; Swenson, D.R.; Thompson, J.S.; Dunn, G.H.; Bannister, M.E.; Gregory, D.C.; Phaneuf, R.A.; Smith, A.C.H.; Mueller, A.; Timmer, C.A.; Wahlin, E.K.; DePaola, B.D.; Belic, D.S.

    1994-01-01

    A merged-beams electron-energy-loss technique is described, by which absolute cross sections can be measured for near-threshold electron-impact excitation of multipy charged ions. Results are reported here for absolute total electron-impact excitation cross sections for the O 5+ (2s→2p) transition from below threshold to 1.6 eV above threshold. The experimental data are in good agremeent with a seven-state close-coupling calculation throughout the energy range of the experiment. Results agree with calculations showing that more than 90% of the electrons causing excitation are ejected in the backward direction in the center-of-mass frame. This backscattering is shown in both quantum-mechanical and semiclassical calculations. Evidence is observed for high-lying metastable autoionizing states with a lifetime of approximately 0.9 μs which are made to ionize by electron impact

  5. Study on total and methyl mercury levels in human scalp hairs of lying-in women and newborns by NAA and other techniques

    International Nuclear Information System (INIS)

    Chai Chifang; Feng Weiye; Qian Qinfang; Guan Ming; Li Xinji; Lu Yilun; Zhang Xioumei

    1995-01-01

    Since the Second Research Co-ordinating Meeting in Malaysia, 24-28 August 1992, our research group has completed the analysis of total and methylmercury in scalp hair samples of 1179 fishermen living at a typical Hg-polluted region in Northeast China and of 27 lying-in women and their newborns in a Beijing hospital by INAA, GC(EC) and other techniques. The longitudinal Hg patterns of the lying-in women show a gradually decreasing tendency during the pregnancy period. Further, the hair Hg contents of the newborn babies are generally above or close to those of their mothers, confirming the mechanism that the methylmercury, an organic species of Hg with high toxicity, is readily able to penetrate the placental barrier and accumulate in the fetus. Thus, the mercury exposure has occurred at the early stage of pregnancy. (author)

  6. Measurement of total electron content of midlatitude ionosphere and protonosphere via Faraday rotation and group relay techniques using transmission from geostationary satellites ATS-3 and ATS-6

    Science.gov (United States)

    Paul, M. P.

    1982-01-01

    Measurement of integrated columnar electron content and total electron content for the local ionosphere and the overlying protonosphere via Faraday rotation and group delay techniques has proven very useful. A field station was established having the geographic location of 31.5 deg N latitude and 91.06 deg W longitude to accomplish these objectives. A polarimeter receiving system was set up in the beginning to measure the Faraday rotation of 137.35 MHz radio signal from geostationary satellite ATS 3 to yield the integrated columnar electron content of the local ionosphere. The measurement was continued regularly, and the analysis of the data thus collected provided a synopsis of the statistical variation of the ionosphere along with the transient variations that occurred during the periods of geomagnetic and other disturbances.

  7. Precision measurements of the total and partial widths of the {psi}(2S) charmonium meson with a new complementary-scan technique in p-bar p annihilations

    Energy Technology Data Exchange (ETDEWEB)

    Andreotti, M. [Istituto Nazionale di Fisica Nucleare and University of Ferrara, 44100 Ferrara (Italy); Bagnasco, S. [Istituto Nazionale di Fisica Nucleare and University of Genova, 16146 Genova (Italy); Istituto Nazionale di Fisica Nucleare and University of Torino, 10125 Turin (Italy); Baldini, W.; Bettoni, D. [Istituto Nazionale di Fisica Nucleare and University of Ferrara, 44100 Ferrara (Italy); Borreani, G. [Istituto Nazionale di Fisica Nucleare and University of Torino, 10125 Turin (Italy); Buzzo, A. [Istituto Nazionale di Fisica Nucleare and University of Genova, 16146 Genova (Italy); Calabrese, R. [Istituto Nazionale di Fisica Nucleare and University of Ferrara, 44100 Ferrara (Italy); Cester, R. [Istituto Nazionale di Fisica Nucleare and University of Torino, 10125 Turin (Italy); Cibinetto, G.; Dalpiaz, P. [Istituto Nazionale di Fisica Nucleare and University of Ferrara, 44100 Ferrara (Italy); Garzoglio, G.; Gollwitzer, K.E. [Fermi National Accelerator Laboratory, Batavia, IL 60510 (United States); Graham, M. [University of Minnesota, Minneapolis, MN 55455 (United States); Hu, M. [Fermi National Accelerator Laboratory, Batavia, IL 60510 (United States); Joffe, D.; Kasper, J. [Northwestern University, Evanston, IL 60208 (United States); Lasio, G. [University of California, Irvine, CA 92697 (United States); Lo Vetere, M. [Istituto Nazionale di Fisica Nucleare and University of Genova, 16146 Genova (Italy); Luppi, E. [Istituto Nazionale di Fisica Nucleare and University of Ferrara, 44100 Ferrara (Italy); Macri, M. [Istituto Nazionale di Fisica Nucleare and University of Genova, 16146 Genova (Italy)] (and others)

    2007-10-11

    We present new precision measurements of the {psi}(2S) total and partial widths from excitation curves obtained in antiproton-proton annihilations by Fermilab experiment E835 at the Antiproton Accumulator in the year 2000. A new technique of complementary scans was developed to study narrow resonances with stochastically cooled antiproton beams. The technique relies on precise revolution-frequency and orbit-length measurements, while making the analysis of the excitation curve almost independent of machine lattice parameters. We study the {psi}(2S) meson through the processes p-bar p{yields}e{sup +}e{sup -} and p-bar p{yields}J/{psi}+X{yields}e{sup +}e{sup -}+X. We measure the width to be {gamma}=290{+-}25(sta){+-}4(sys) keV and the combination of partial widths {gamma}{sub e{sup +}}{sub e{sup -}}{gamma}{sub p-bar} p/{gamma}=579{+-}38(sta){+-}36(sys) meV, which represent the most precise measurements to date.

  8. Synchrotron radiation based micro X-ray fluorescence analysis of the calibration samples used in surface sensitive total reflection and grazing emission X-ray fluorescence techniques

    Science.gov (United States)

    Kubala-Kukuś, A.; Banaś, D.; Pajek, M.; Szlachetko, J.; Jagodziński, P.; Susini, J.; Salomé, M.

    2013-12-01

    Total reflection X-ray fluorescence (TXRF) and grazing emission X-ray fluorescence (GEXRF) are surface sensitive techniques and can be used for detailed surface studies of different materials, including ultra-low concentration contamination or the lateral and depth distributions of elements. The calibration procedure typically used involves placing a micro-droplet (˜μl) of the standard solution onto a silicon wafer (or quartz backing). After evaporation of the solvent, the residual amount of elements is used as a reference standard. Knowledge of the distribution of residue material on the substrate surface is crucial for precise quantification. In the present work the investigation of the lateral distribution of elements in the multielemental calibrating samples, containing the 23 most commonly studied elements, by using the synchrotron radiation based micro X-ray fluorescence is presented. The goal of this project was the study of a uniformity of the elemental distributions and determination of the residual elements morphology depending on the temperature of the drying process. The X-ray images were compared with optical and SEM images. Paper presents in details the experimental setup, sample preparation procedures, measurements and results. In the analysis of the X-ray images of the sample dried in high temperature the censoring approach was applied improving the quality of statistical analysis. The information on the elements distribution in the calibrating samples can be useful for developing more accurate calibration procedures applied in quantitative analysis of surface sensitive TXRF and GEXRF techniques.

  9. SU-C-213-04: Application of Depth Sensing and 3D-Printing Technique for Total Body Irradiation (TBI) Patient Measurement and Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Lee, M; Suh, T [Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Han, B; Xing, L [Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA (United States); Jenkins, C [Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA (United States); Department of Mechanical Engineering, Stanford University, Palo Alto, CA (United States)

    2015-06-15

    Purpose: To develop and validate an innovative method of using depth sensing cameras and 3D printing techniques for Total Body Irradiation (TBI) treatment planning and compensator fabrication. Methods: A tablet with motion tracking cameras and integrated depth sensing was used to scan a RANDOTM phantom arranged in a TBI treatment booth to detect and store the 3D surface in a point cloud (PC) format. The accuracy of the detected surface was evaluated by comparison to extracted measurements from CT scan images. The thickness, source to surface distance and off-axis distance of the phantom at different body section was measured for TBI treatment planning. A 2D map containing a detailed compensator design was calculated to achieve uniform dose distribution throughout the phantom. The compensator was fabricated using a 3D printer, silicone molding and tungsten powder. In vivo dosimetry measurements were performed using optically stimulated luminescent detectors (OSLDs). Results: The whole scan of the anthropomorphic phantom took approximately 30 seconds. The mean error for thickness measurements at each section of phantom compare to CT was 0.44 ± 0.268 cm. These errors resulted in approximately 2% dose error calculation and 0.4 mm tungsten thickness deviation for the compensator design. The accuracy of 3D compensator printing was within 0.2 mm. In vivo measurements for an end-to-end test showed the overall dose difference was within 3%. Conclusion: Motion cameras and depth sensing techniques proved to be an accurate and efficient tool for TBI patient measurement and treatment planning. 3D printing technique improved the efficiency and accuracy of the compensator production and ensured a more accurate treatment delivery.

  10. SU-C-213-04: Application of Depth Sensing and 3D-Printing Technique for Total Body Irradiation (TBI) Patient Measurement and Treatment Planning

    International Nuclear Information System (INIS)

    Lee, M; Suh, T; Han, B; Xing, L; Jenkins, C

    2015-01-01

    Purpose: To develop and validate an innovative method of using depth sensing cameras and 3D printing techniques for Total Body Irradiation (TBI) treatment planning and compensator fabrication. Methods: A tablet with motion tracking cameras and integrated depth sensing was used to scan a RANDOTM phantom arranged in a TBI treatment booth to detect and store the 3D surface in a point cloud (PC) format. The accuracy of the detected surface was evaluated by comparison to extracted measurements from CT scan images. The thickness, source to surface distance and off-axis distance of the phantom at different body section was measured for TBI treatment planning. A 2D map containing a detailed compensator design was calculated to achieve uniform dose distribution throughout the phantom. The compensator was fabricated using a 3D printer, silicone molding and tungsten powder. In vivo dosimetry measurements were performed using optically stimulated luminescent detectors (OSLDs). Results: The whole scan of the anthropomorphic phantom took approximately 30 seconds. The mean error for thickness measurements at each section of phantom compare to CT was 0.44 ± 0.268 cm. These errors resulted in approximately 2% dose error calculation and 0.4 mm tungsten thickness deviation for the compensator design. The accuracy of 3D compensator printing was within 0.2 mm. In vivo measurements for an end-to-end test showed the overall dose difference was within 3%. Conclusion: Motion cameras and depth sensing techniques proved to be an accurate and efficient tool for TBI patient measurement and treatment planning. 3D printing technique improved the efficiency and accuracy of the compensator production and ensured a more accurate treatment delivery

  11. Technique of Robotic-assisted Total Proctocolectomy with Lymphadenectomy and Ileal Pouch-Anal Anastomosis for Transverse Colitic Cancer of Ulcerative Colitis, Using the Single Cart Position.

    Science.gov (United States)

    Hanai, Tsunekazu; Maeda, Koutarou; Masumori, Koji; Katsuno, Hidetoshi; Matsuoka, Hiroshi

    2015-11-01

    Robotic surgery offers advantages for operating in a narrow space such as inside the pelvis. We report on the technique of robotic-assisted laparoscopic total proctocolectomy with lymphadenectomy and ileal pouch-anal anastomosis for ulcerative colitis with transverse colitic cancer, using the single cart position. A 46-year-old female patient was diagnosed with colitic cancer of the transverse colon during the surveillance of ulcerative colitis. Six port sites were used. Mobilization of the left-sided colon through to the rectum and mobilization of the transverse colon with lymphadenectomy around the middle colic artery were performed using the robotic surgical system. After rectal mobilization was conducted near the anus, the right side of the colon was mobilized and the ileum resected laparoscopically. Thereafter, a mucosectomy of the proctorectum was carried out through a trans-anal approach, and a hand-sewn J-pouch was performed. Finally, a diverting ileostomy was constructed through the right lower abdomen. The operative time was 460 minutes, including the console time of 361 minutes. The amount of blood loss was 76 g. The patient was discharged on postoperative day nine. Pathological results demonstrated that the depth of the lesion was T3, and the positive lymph node was 1 of 115 retrieved lymph nodes. There were no complications or mortality. Robotic-assisted total proctocolectomy and lymphadenectomy with ileal pouch-anal anastomosis for transverse colitic cancer of ulcerative colitis was performed safely using the single cart position.

  12. 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.

  13. Comparison of Total OH Reactivity Measurement Methods in Ambient Air between a Comparative Reactivity Method using PTR-MS and a LASER Technique

    Science.gov (United States)

    Okazaki, H.; Osada, T.; Nakashima, Y.; Kato, S.; Kajii, Y.

    2008-12-01

    OH radical plays an important role in atmospheric chemistry. OH reactivity measurement is essential to understand atmospheric chemical reaction processes. We have developed LASER technique to measure OH reactivity. This system requires both pump and probe lasers and high vacuum system. We have to pay a lot of efforts to bring the instrument in the field for ambient observation. Therefore we have developed a comparative reactivity method for measuring total OH reactivity recently. Since this method does not need a large space and complicated devices, it makes relatively easy to measure OH reactivity anywhere. The result of this non-laser OH reactivity measurement was compared with that of laser pump and probe technique as conducted an intensive field measurement of sub-urban air in Tokyo, July 2008. In comparative reactivity method, a regent species (X), which is ideally not present in ambient air, is introduced into the flow tube reactor and its concentration (C1) is monitored by a suitable detector under nitrogen atmospheric condition. A constant amount of OH radicals is then introduced into the flow tube to react with X under either nitrogen atmosphere (the concentration of X became C2) or ambient air (the concentration of X became C3). Total OH reactivity can be calculated by comparing C1, C2 and C3. OH radicals were produced in the photolysis of water vapor by a UV lamp. In our experiment, Pyrrole is selected as X and PTR-MS is used as a detector. The concentrations of NO, NO2, CO, SO2 were also measured. In some case, the two methods indicated some differences, for example, OH reactivity of 10 to 30 s-1 measured by LASER technique while the comparative reactivity method showed the value of only 5 to 12 s-1.This reason appears to be humidity dependence of PTR-MS sensitivity. Good agreements, for trends and absolute values, were found for comparison between the two methods during another day of experiment where both methods reveal OH reactivity ranging between

  14. Single-incision laparoscopic splenectomy and splenic autotransplantation for an enlarged wandering spleen with torsion.

    Science.gov (United States)

    Katsura, Shunsaku; Kawamura, Daichi; Harada, Eijiro; Enoki, Tadahiko; Hamano, Kimikazu

    2014-06-01

    A wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant, but instead is found in the lower abdomen or in the pelvic region because of the laxity of the peritoneal attachments. The unusually long pedicle is susceptible to twisting, which can lead to ischemia, and eventually to necrosis. We herein report a case of an enlarged wandering spleen with torsion, successfully treated by single-incision laparoscopic splenectomy and autotransplantation. The transplanted splenic tissues could be identified on a spleen scintigram obtained 3 months after the surgery. Howell-Jolly bodies were not observed in blood specimens. This procedure is able to prevent an overwhelming postsplenectomy infection, and leads to satisfactory cosmetic results.

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

    Directory of Open Access Journals (Sweden)

    Kércia Regina Santos Gomes Pereira

    2008-12-01

    Full Text Available 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 0.1mL of Tc-99m-phytate via orbital plexus (0.66MBq. After 30 minutes, liver samples were harvested, weighed and the percentage of radioactivity per gram (%ATI/g was determined by a Wizard Perkin-Elme gama 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 leukocytosis was observed in SP rats. In conclusion, splenectomy in rats changed the hepatic biodistribution of Tc-99m-phytate and liver enzimatic activity.O radiofármaco fitato-Tc-99m é usado no diagnóstico através de exames de imagem, na dependência de sua biodistribuição. O objetivo do trabalho foi avaliar efeito da esplenectomia na biodistribuição do fitato-Tc-99m e função hepática em ratos Wistar. Sob anestesia e técnica asséptica, os animais do grupo SP (n=6 foram esplenectomizados. Grupo C(controle; n=6 não operado. Após 15 dias, injeção de 0,1ml de fitato-Tc-99m via plexo orbital (0,66MBq. Após 30 minutos, retiradas biópsias hepáticas para determinação do percentual de radioatividade/grama (% ATI/g, usando-se contador gama WizardPerkin-Elmer®. Realizada dosagem de ALT, AST e HDL, e leucometria. Estatística pelo teste t, significância 0,05. O %ATI/g nos ratos esplenectomizados foi 0,99 ± 0,2 e nos controles 0,40 ± 0,2 (p=0,034. ALT, AST e HDL tiveram dosagens significativamente menores nos esplenectomizados (p=0,01, com leucocitose, comparando com controles. Em conclusão, em ratos a esplenectomia

  16. 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

  17. Attenuated Total Reflectance Fourier transform infrared spectroscopy for determination of Long Chain Free Fatty Acid concentration in oily wastewater using the double wavenumber extrapolation technique.

    Science.gov (United States)

    Hao, Zisu; Malyala, Divya; Dean, Lisa; Ducoste, Joel

    2017-04-01

    Long Chain Free Fatty Acids (LCFFAs) from the hydrolysis of fat, oil and grease (FOG) are major components in the formation of insoluble saponified solids known as FOG deposits that accumulate in sewer pipes and lead to sanitary sewer overflows (SSOs). A Double Wavenumber Extrapolative Technique (DWET) was developed to simultaneously measure LCFFAs and FOG concentrations in oily wastewater suspensions. This method is based on the analysis of the Attenuated Total Reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) spectrum, in which the absorbance of carboxyl bond (1710cm -1 ) and triglyceride bond (1745cm -1 ) were selected as the characteristic wavenumbers for total LCFFAs and FOG, respectively. A series of experiments using pure organic samples (Oleic acid/Palmitic acid in Canola oil) were performed that showed a linear relationship between the absorption at these two wavenumbers and the total LCFFA. In addition, the DWET method was validated using GC analyses, which displayed a high degree of agreement between the two methods for simulated oily wastewater suspensions (1-35% Oleic acid in Canola oil/Peanut oil). The average determination error of the DWET approach was ~5% when the LCFFA fraction was above 10wt%, indicating that the DWET could be applied as an experimental method for the determination of both LCFFAs and FOG concentrations in oily wastewater suspensions. Potential applications of this DWET approach includes: (1) monitoring the LCFFAs and FOG concentrations in grease interceptor (GI) effluents for regulatory compliance; (2) evaluating alternative LCFFAs/FOG removal technologies; and (3) quantifying potential FOG deposit high accumulation zones in the sewer collection system. Published by Elsevier B.V.

  18. 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.

  19. A novel technique for impaction bone grafting in acetabular reconstruction of revision total hip arthroplasty using an ex vivo compaction device

    International Nuclear Information System (INIS)

    Akiyama, Haruhiko; Takemoto, Mitsuru; Morishima, Takkan

    2011-01-01

    Impaction bone grafting allows restoration of the acetabular bone stock in revision hip arthroplasty. The success of this technique depends largely on achieving adequate initial stability of the component. To obtain well-compacted, well-graded allograft aggregates, we developed an ex vivo compaction device to apply it in revision total hip arthroplasty on the acetabular side, and characterized mechanical properties and putative osteoconductivity of allograft aggregates. Morselized allograft bone chips were compacted ex vivo using the creep technique and subsequent impaction technique to form the bone aggregates. Impaction allograft reconstruction of the acetabulum using an ex vivo compaction device was performed on eight hips. The mechanical properties and three-dimensional micro-CT-based structural characteristics of the bone aggregates were investigated. In clinical practice, this technique offered good reproducibility in reconstructing the cavity and the segmental defects of the acetabulum, with no migration and no loosening of the component. In vitro analysis showed that the aggregates generated from 25 g fresh-frozen bone chips gained compression stiffness of 13.5-15.4 MPa under uniaxial consolidation strain. The recoil of the aggregates after compaction was 2.6-3.9%. The compression stiffness and the recoil did not differ significantly from those measured using a variety of proportions of large- and small-sized bone chips. Micro-CT-based structural analysis revealed average pore sizes of 268-299 μm and average throat diameter of pores in the bone aggregates of more than 100 μm. These sizes are desirable for osteoconduction, although large interconnected pores of more than 500 μm were detectable in association with the proportion of large-sized bone chips. Cement penetration into the aggregates was related to the proportion of large-sized bone chips. This study introduces the value of an ex vivo compaction device in bone graft compaction in clinical

  20. Two different preparation techniques for trace element determination of single Daphnia specimen using total reflection x-ray fluorescence analysis (TXRF)

    International Nuclear Information System (INIS)

    Woelfl, S.; Mages, M.

    2000-01-01

    Bio accumulation gives first information about the bio-availability of elements in waters and becomes more and more important for the characterization of the water quality. The use of common analytical techniques like ICP-MS and AAS requires large quantities of biologic sample material. Single preparation for example of Daphnia, a common species for bio-test experiments, are hardly possible with these procedures. Therefore alternatively quantitative TXRF element determination of individually prepared Daphnia was developed. Two preparation techniques for single freshwater crustacean specimen from a eutrophic branch of the river Elbe in the 'Rothehorn Park', Magdeburg (Daphnia: dry weight: 10 - 50 μg individuum -1 ) had been tested: (1) Wet preparation: the single Daphnia specimen had been washed with 0.45 μm filtered lake water and put onto quartz sample carriers. After air drying, the body length were determined in order to calculate the dry weight according to previously established body lengths-dry weight relationships. (2) Dry preparation: after collection specimen were washed with 0.45 μm filtered lake water and frozen in liquid nitrogen. The individual lyophilisated dried Daphnia were weighted using an ultrafine micro-balance and put onto quartz sample carriers. After preparation, addition of some μl Gallium standard solution and air drying the individual Daphnia were digested at the quartz sample carriers with 10 μl HNO 3 on a hot plate and dried once more. Finally the element concentrations were determined using a EXTRA IIA total-reflection x-ray fluorescence spectrometer. As a result of these investigations we can conclude that both, the 'dry' and 'wet' preparation method can be used for the element determination in small single crustaceans using TXRF spectrometry. It seems that the 'dry' method yields more precise results, but the wet method is easier to handle in field when samples cannot be fixed with liquid nitrogen. (author)

  1. Remote sensing estimation of the total phosphorus concentration in a large lake using band combinations and regional multivariate statistical modeling techniques.

    Science.gov (United States)

    Gao, Yongnian; Gao, Junfeng; Yin, Hongbin; Liu, Chuansheng; Xia, Ting; Wang, Jing; Huang, Qi

    2015-03-15

    Remote sensing has been widely used for ater quality monitoring, but most of these monitoring studies have only focused on a few water quality variables, such as chlorophyll-a, turbidity, and total suspended solids, which have typically been considered optically active variables. Remote sensing presents a challenge in estimating the phosphorus concentration in water. The total phosphorus (TP) in lakes has been estimated from remotely sensed observations, primarily using the simple individual band ratio or their natural logarithm and the statistical regression method based on the field TP data and the spectral reflectance. In this study, we investigated the possibility of establishing a spatial modeling scheme to estimate the TP concentration of a large lake from multi-spectral satellite imagery using band combinations and regional multivariate statistical modeling techniques, and we tested the applicability of the spatial modeling scheme. The results showed that HJ-1A CCD multi-spectral satellite imagery can be used to estimate the TP concentration in a lake. The correlation and regression analysis showed a highly significant positive relationship between the TP concentration and certain remotely sensed combination variables. The proposed modeling scheme had a higher accuracy for the TP concentration estimation in the large lake compared with the traditional individual band ratio method and the whole-lake scale regression-modeling scheme. The TP concentration values showed a clear spatial variability and were high in western Lake Chaohu and relatively low in eastern Lake Chaohu. The northernmost portion, the northeastern coastal zone and the southeastern portion of western Lake Chaohu had the highest TP concentrations, and the other regions had the lowest TP concentration values, except for the coastal zone of eastern Lake Chaohu. These results strongly suggested that the proposed modeling scheme, i.e., the band combinations and the regional multivariate

  2. Influência da esplenectomia na capacidade física em ratos Influence of splenectomy on the physical performance in rats

    Directory of Open Access Journals (Sweden)

    Daniel A. M. Caldeira

    2005-09-01

    Full Text Available Muitas das alterações fisiológicas provocadas pela esplenectomia ainda são pouco compreendidas. Embora, desde a Antigüidade, o baço seja relacionado com o desempenho físico, ainda não há suporte científico que tenha avaliado essa relação. Nesse sentido, o presente trabalho teve por objetivo estudar a influência da esplenectomia na capacidade física de ratos de ambos os sexos. Foram estudados 36 ratos adultos, com peso entre 150 e 250 g, distribuídos aleatoriamente em quatro grupos: Grupo 1 (n=8: fêmeas esplenectomizadas; Grupo 2 (n=8: fêmeas controle; Grupo 3 (n=10: machos esplenectomizados e Grupo 4 (n=10: machos controle. Os animais dos Grupos 1 e 3 foram submetidos a esplenectomia total; nos Grupos 2 e 4 o procedimento cirúrgico limitou-se a laparotomia mediana seguida de laparorrafia. O período de recuperação foi de 120 dias. A capacidade física foi pesquisada por meio de corrida em esteira elétrica, à velocidade de 24 metros por minuto e inclinação de 12 graus, até a exaustão do animal. Os ratos machos esplenectomizados correram por um período maior que os do grupo controle do mesmo sexo (p Many of the physiological changes caused by splenectomy are still little understood. Even though in ancient civilizations an association between spleen function to physical performance was reported, there has been no scientific assessment to support this relation until now. Thus, the present work aimed at studying the influence of splenectomy on the physical capacity of rats of both sexes. Thirty-six adult rats were distributed into four groups: Group 1 (n=8: splenectomized females; Group 2 (n=8: control females; Group 3 (n=10: splenectomized males; and Group 4 (n=10: control males. Animals from Groups 1 and 3 underwent total splenectomy; the surgical procedure performed on Groups 2 and 4 consisted of only laparotomy followed by suturing of the abdominal wall. The rats were allowed 120 days for recovery. The physical

  3. Antioxidant activity, the content of total phenols and flavonoids in the ethanol extracts of Mentha longifolia (L. Hudson dried by the use of different techniques

    Directory of Open Access Journals (Sweden)

    Stanisavljević Dragana M.

    2012-01-01

    Full Text Available In this study, we have examined the yield of extracted substances obtained by means of extraction using 70 % ethanol (v/v, the content of total phenols and flavonoids, as well as the antioxidant activity of the extracts obtained from the samples of the herbs dried by means of different techniques. Wild mint Mentha longifolia (L. Hudson was dried naturally in a laboratory oven at a temperature of 45 °C and in an absorptive low temperature condensation oven at 35°C. The highest yield of extracts was obtained from the naturally dried herbs and the lowest from the herbs dried in the low temperature condensation drying oven. The content of total phenols and flavonoids was determined by spectrophotometric methods with an FC reagent and by the complexation reaction with aluminium-chloride, respectively. The extract of the naturally dried herbs had the highest overall content of phenols (113.8±2.0 mg of gallic acid/g of the dry extract and flavonoids (106.7±0.3 mg of rutin/g of the dry extract. The highest antioxidant activity determined by the FRAP and DPPH assay was determined in the extracts obtained from naturally dried herbs (2.76±0.15 mmol Fe2+/mg of the dry extract and EC50=0.022±0.001 mg/ml, while the lowest was obtained from the extracts of herbs dried in the laboratory oven (1.13±0.11 mmol Fe2+/mg of the dry extract and EC50=0.033±0.001 mg/ml. The HPLC-DAD analysis result show that the greatest content of phenolic compounds show extract obtained from naturally dried plant material. The dominant phenolic component in the all extracts is Kaempferol 3-O-glucoside. The content of all phenolic compound strongly depend on the drying conditions.

  4. Study of air pollution in terms of heavy metals and particulate matter at Ambodin'isotry using the technique of total reflection X-ray fluorescence

    International Nuclear Information System (INIS)

    AHMED, H.

    2011-01-01

    The present work is devoted to study the air pollution in terms of particulate matters and heavy metals in Ambodin'isotry in Antananarivo city by the method of total reflection X-ray fluorescence. This work has been done within the Institut National des Sciences et Techniques Nucleaires (Madagascar-INSTN). GENT air sampler has been used for the collections of the aerosol samples. This air sampler is placed at about 7 meters above the ground in order to avoid the contaminations. The samplings were carried out from 14 April to 29 August 2008. The duration of sampling is 24 hours. The results show that the analyzed aerosol samples contain the elements like the titanium , the chromium, the manganese, the iron, the nickel, the copper, the zinc, the bromine, the strontium and the lead. The average concentrations in element lead are lower than the standards ones adopted by the World Health Organization (WHO) (500 ng.m -3 ) and the United States Environmental Protection Agency (US EPA) (1500 ng.m -3 ). The total average concentrations in element lead are lower than the standards ones adopted by the World Health Organization (WHO) (500 ng.m -3 ). The total of average concentrations in lead doesn't present a danger for the population of Ambodin'isotry. The average concentrations of PM10 in the aerosols do not respect the guideline values of 50μg.m -3 adopted by the WHO and the European Union according to the directive 2005 and those of PM 2.5 exceed extensively the guideline values of the WHO (25μg.m -3 ) and of the US EPA (35μg.m -3 ). Consequently, the site of Ambodin'Isotry is polluted in term of airborne particulate matters. The calculation of enrichment factors by Mason's model shows the titanium, the iron, the nickel and the strontium are natural origin while the chromium, the nickel, the copper, the zinc, the bromine and the lead are from anthropogenic sources. [fr

  5. Analysis of heavy metals and minerals elements in the turmeric using Total-Reflection X-ray Fluorescence analysis technique and Atomic Absorption Spectrometry

    International Nuclear Information System (INIS)

    Andriamisetra, V.M.Z.

    2014-01-01

    Currently, many studies demonstrate anti-cancer and anti-inflammatory benefits of turmeric. The aims of this work is to perform analysis of metals such as calcium, chromium, manganese, iron, cobalt, nickel, copper, zinc, arsenic, bromine, rubidium, strontium, cadmium and lead in the turmeric collected from various places in Madagascar. The analysis by total reflection X-ray fluorescence technique is used to determine the concentrations of heavy metals, while the atomic absorption spectrometry is used for the determination of trace elements. Analysis results show that the concentration of calcium in the turmeric is very high, its average concentration is 1025.8 mg.kg -1 . The average concentrations of manganese, of copper and of iron are respectively 44.7 mg.kg -1 ; 19.7 mg.kg -1 and 53.6 mg.kg -1 . The average concentrations of zinc, of rubidium and of strontium are respectively 17.3 mg.kg -1 ; 35.2 mg.kg -1 and 21.7 mg.kg -1 [fr

  6. Behaviour of total surface charge in SiO2-Si system under short-pulsed ultraviolet irradiation cycles characterised by surface photo voltage technique

    International Nuclear Information System (INIS)

    Kang, Ban-Hong; Lee, Wah-Pheng; Yow, Ho-Kwang; Tou, Teck-Yong

    2009-01-01

    Effects of time-accumulated ultraviolet (UV) irradiation and surface treatment on thermally oxidized p-type silicon wafers were investigated by using the surface photo voltage (SPV) technique via the direct measurement of the total surface charge, Q SC . The rise and fall times of Q sc curves, as a function of accumulated UV irradiation, depended on the thermal oxide thickness. A simple model was proposed to explain the time-varying characteristics of Q sc based on the UV-induced bond breaking of SiOH and SiH, and photoemission of bulk electrons to wafer surface where O 2 - charges were formed. While these mechanisms resulted in charge variations and hence in Q sc , these could be removed by rinsing the silicon wafers in de-ionized water followed by spin-dry or blow-dry by an ionizer fan. Empirical parameters were used in the model simulations and curve-fitting of Q SC . The simulated results suggested that initial changes in the characteristic behaviour of Q sc were mainly due to the net changes in the positive and negative charges, but subsequently were dominated by the accumulation of O 2 - during the UV irradiation.

  7. Precision measurements of the total and partial widths of the psi(2S) charmonium meson with a new complementary-scan technique in anti-p p annihilations

    Energy Technology Data Exchange (ETDEWEB)

    Andreotti, M.; Bagnasco, S.; Baldini, W.; Bettoni, D.; Borreani, G.; Buzzo, A.; Calabrese, R.; Cester, R.; Cibinetto, G.; Dalpiaz, P.; Garzoglio, G.

    2007-03-01

    We present new precision measurements of the {Psi}(2S) total and partial widths from excitation curves obtained in antiproton-proton annihilations by Fermilab experiment E835 at the Antiproton Accumulator in the year 2000. A new technique of complementary scans was developed to study narrow resonances with stochastically cooled antiproton beams. It relies on precise revolution-frequency and orbit-length measurements, while making the analysis of the excitation curve almost independent of machine lattice parameters. For the {Psi}(2S) meson, by studying the processes {bar p}p {yields} e{sup +}e{sup -} and {bar p}p {yields} J/{Psi} + X {yields} e{sup +}e{sup -} + X, we measure the width {Gamma} = 290 {+-} 25(sta) {+-} 4(sys) keV and the combination of partial widths {Gamma}{sub e{sup +}e{sup -}}{Gamma}{sub {bar p}p}/{Gamma} = 579 {+-} 38(sta) {+-} 36(sys) meV, which represent the most precise measurements to date.

  8. Stratigraphic analysis of organic materials in wall painting samples using micro-FTIR attenuated total reflectance and a novel sample preparation technique.

    Science.gov (United States)

    Martin de Fonjaudran, Charlotte; Nevin, Austin; Piqué, Francesca; Cather, Sharon

    2008-09-01

    Wall paintings typically contain low concentrations of organic materials within a largely inorganic matrix and are characterised by their high porosity and long-term exposure to severe environmental conditions. The identification of organic materials within specific paint or plaster layers is challenging and the inherent characteristics of wall painting samples present further complications. Embedding materials (such as epoxy, polyester and acrylic-based resins) used to produce cross-sections often infiltrate porous and leanly bound samples, and compromise the interpretation of Fourier transform infrared attenuated total reflectance (FTIR-ATR) spectra and the qualitative identification of natural organic materials. An alternative method for the preparation of cross-sections of wall painting samples was developed using cyclododecane (C(12)H(24)) as a temporary consolidant and barrier coating to encapsulate the sample, and to provide necessary support to produce a cross-section through microtoming. Impacts of traditional and novel sample preparation techniques on the identification of organic materials with micro-FTIR-ATR were examined for both replica and real wall painting samples.

  9. A simple, sensitive and non-destructive technique for characterizing bovine dental enamel erosion: attenuated total reflection Fourier transform infrared spectroscopy.

    Science.gov (United States)

    Kim, In-Hye; Son, Jun Sik; Min, Bong Ki; Kim, Young Kyoung; Kim, Kyo-Han; Kwon, Tae-Yub

    2016-03-30

    Although many techniques are available to assess enamel erosion in vitro, a simple, non-destructive method with sufficient sensitivity for quantifying dental erosion is required. This study characterized the bovine dental enamel erosion induced by various acidic beverages in vitro using attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. Deionized water (control) and 10 acidic beverages were selected to study erosion, and the pH and neutralizable acidity were measured. Bovine anterior teeth (110) were polished with up to 1 200-grit silicon carbide paper to produce flat enamel surfaces, which were then immersed in 20 mL of the beverages for 30 min at 37 °C. The degree of erosion was evaluated using ATR-FTIR spectroscopy and Vickers' microhardness measurements. The spectra obtained were interpreted in two ways that focused on the ν1, ν3 phosphate contour: the ratio of the height amplitude of ν3 PO4 to that of ν1 PO4 (Method 1) and the shift of the ν3 PO4 peak to a higher wavenumber (Method 2). The percentage changes in microhardness after the erosion treatments were primarily affected by the pH of the immersion media. Regression analyses revealed highly significant correlations between the surface hardness change and the degree of erosion, as detected by ATR-FTIR spectroscopy (Ptechnique for the quantification of enamel erosion.

  10. 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.

  11. 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.

  12. Epidemiological profile and vaccination coverage in splenectomy patients in a health area of Murcia (1993-2012).

    Science.gov (United States)

    Molina-Salas, Yolanda; Romera-Guirado, Francisco José; Pérez-Martín, Jaime Jesús; Peregrín-González, María Nieves; Góngora-Soria, David

    2017-03-22

    Splenectomy patients have a high risk of suffering severe infections, many of them preventable by vaccination. The aim of the study was to analyse the clinical epidemiological characteristics and vaccine coverage of these patients in Health Area III of the Region of Murcia. A cross-sectional study was conducted on a population of patients that were splenectomised during the period 1993-2012, according to the Register of the Basic Minimum Data Set. Patients were classified on the basis of splenectomy (neoplasm, haematological diseases, trauma, and others), vaccination, and vital status, using official records of health data. Statistical analysis was performed using SPSS 21.0 statistics program. The sample consisted of 196 patients, of which 68.4% (n=134) were male. The mean age at which they underwent splenectomy was 50.1 years (SD: 22.2). The most common reason for removal of the spleen was neoplasia in 39.1% (n=59). Splenectomy due to trauma reasons was associated with lower patient age (p<.001) and male gender (p=.03). Vaccination coverage for Streptococcus pneumoniae was 23.8%, 5.7% for Neisseria meningitidis C, and 8.6% for Haemophilus influenzae B. Only 2.9% of patients were correctly vaccinated for all three. Vaccination coverage was insufficient for this fragile patient profile. It should be taken into account in the early detection and counselling in this group so susceptible to disease, with nurses being a decisive part in the process. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  13. Preserved antibody levels and loss of memory B cells against pneumococcus and tetanus after splenectomy: tailoring better vaccination strategies.

    Science.gov (United States)

    Rosado, M Manuela; Gesualdo, Francesco; Marcellini, Valentina; Di Sabatino, Antonio; Corazza, Gino Roberto; Smacchia, Maria Paola; Nobili, Bruno; Baronci, Carlo; Russo, Lidia; Rossi, Francesca; Vito, Rita De; Nicolosi, Luciana; Inserra, Alessandro; Locatelli, Franco; Tozzi, Alberto E; Carsetti, Rita

    2013-10-01

    Splenectomized patients are exposed to an increased risk of septicemia caused by encapsulated bacteria. Defense against infection is ensured by preformed serum antibodies produced by long-lived plasma cells and by memory B cells that secrete immunoglobulin in response to specific antigenic stimuli. Studying a group of asplenic individuals (57 adults and 21 children) without additional immunologic defects, we found that spleen removal does not alter serum anti-pneumococcal polysaccharide (PnPS) IgG concentration, but reduces the number of PnPS-specific memory B cells, of both IgM and IgG isotypes. The number of specific memory B cells was low in splenectomized adults and children that had received the PnPS vaccine either before or after splenectomy. Seven children were given the 13-valent pneumococcal conjugated vaccine after splenectomy. In this group, the number of PnPS-specific IgG memory B cells was similar to that of eusplenic children, suggesting that pneumococcal conjugated vaccine administered after splenectomy is able to restore the pool of anti-PnPS IgG memory B cells. Our data further elucidate the crucial role of the spleen in the immunological response to infections caused by encapsulated bacteria and suggest that glycoconjugated vaccines may be the most suitable choice to generate IgG-mediated protection in these patients. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. 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.

  15. 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.

  16. Subtotal splenectomy preserving the lower pole in rats: technical, morphological and functional aspects Esplenectomia subtotal com preservação do pólo inferior em ratos: aspectos técnicos, morfológicos e funcionais

    Directory of Open Access Journals (Sweden)

    Danilo Nagib Salomão Paulo

    2006-10-01

    Full Text Available PURPOSE: To assess the possibility of preserving the lower pole of the spleen, supplied by the inferior lobar vessels and segmental vessels, or by vessels of the gastrosplenic ligament, in subtotal splenectomy; to study the viability and function of the lower pole of the spleen. METHODS: Thirty-six male Wistar rats were used in this study. Said animals weighed 273-390 g ( 355.2 ± 30.5 g , and were randomly distributed into three groups. Group 1 comprised ten animals which were submitted to exploratory laparotomy with spleen manipulation (sham operation. Group 2 comprised 16 animals which were submitted to total splenectomy. Group 3 comprised ten animals which were submitted to subtotal splenectomy, preserving the lower pole of the spleen. Blood was collected from all animals before and 90 days after surgery to measure the levels of cholesterol and triglycerides. The animals were sacrificed 90 days after surgery. Spleens and remaining spleens were removed for macroscopic and microscopic examination. RESULTS: Surgery was performed with no complications in all groups. Six animals died in group 2. Spleens of groups 1 and 2, and lower poles of group 3 were macroscopically viable. Apparent white pulp hyperplasia was observed in group 1. In group 3, slight inflammation and capsular fibrosis were observed at the incision site, as well as diffuse hemosiderosis in the red pulp. Average mass of remaining spleen was 35.84% ± 4.31%. No significant difference was observed between preoperative and late postoperative lipid levels in groups 1 and 3 (p > 0.05. Late postoperative lipid levels significantly increased in group 2. CONCLUSIONS: Preservation of the lower pole of the spleen (supplied by gastrosplenic vessels or inferior lobar vessels and segmental vessels was possible with subtotal splenectomy. The lower pole was macroscopically and microscopically viable in all cases. Subtotal splenectomy preserving the lower pole prevented changes in lipid levels

  17. 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

  18. Total Energy Expenditure (TEE) measured with the doubly labeled water technique in women from 60 to 70 years of age from Havana City, Cuba

    International Nuclear Information System (INIS)

    Hernandez-Triana, M.H.; Porrata, C.; Estrada, G.; Diaz, M.E.; Martin, I.; Bayley, H.; McCormack, B.A.; Jones, P.J.H.

    2002-01-01

    Aim: With the purpose to measure the Total Energy Expenditure (TEE) and to validate the Cuban Dietary Energy Allowance for elderly subjects, energy expenditure was assessed by the doubly labeled water technique in 11 women aged 65.9 ± 2.8 y with a mean BMI of 21.4 ± 4.2 kg/m2 during 14 days under free-living conditions in their own environment in Havana City. Materials and Methods: After taking a basal urine sample, the women received an oral dose of 2.5 g H218O (10%) and 0.12 g 2H2O (99.8%) body weight and samples of saliva and urine were collected 14 days after. Resting Metabolic Rate (RMR) was estimated by the Schofield equations proposed by the 1985 FAO/WHO/UNU Expert Committee Report and energy intake was measured by trained dietitians using the 3-day weighed dietary record. A mean value of the food quotient of 0.85 was used for the calculations of the CO2 production by the isotopic method. Results: In spite of the expected variability, the differences between TEE measured by the isotopic method (7.57 MJ/d) and estimated according to FAO/WHO/UNU, 1985 (7.24 MJ/d) were not significant (0.625). The recommended dietary allowance for energy valid for Cuban elderly subjects (7.66 MJ/d) was only slight over the value of the measured TEE. The value of energy expenditure measured in free-living elderly women from Havana City was in the range of acceptable values (6-8 MJ/d) for this group of age. Conclusions: The total energy expenditure of elderly women from Havana City was lower than reported values for women living in developed countries but coincident with those of women of the developing world. The differences between dietary energy intake and TEE measured by the isotopic method were around 27% and coincident with previous reports in elderly people. The Cuban allowance for dietary energy for elderly women was enough for covering their energy requirements

  19. Cementless two-staged total hip arthroplasty with a short term interval period for chronic deep periprosthetic infection. Technique and long-term results.

    Science.gov (United States)

    Erhart, Jochen; Jaklitsch, Karl; Schurz, Mark; Vécsei, Vilmos; Ehall, Reinhard

    2010-05-01

    The two-staged exchange with delayed reimplantation is the most reliable method to treat a deep periprosthetic infection after a total hip arthroplasty (THR). Nether uniform recommendations for the technique of cementless reimplantation, nor long term clinical and radiological results are reported. Our protocol is performed under short term antibiosis with cementless primary porous hip implants to treat chronic deep periprosthetic infections following THR. A retrospective study was performed to evaluate the clinical and radiological long term outcome and the rate of persistent infection of 14 patients. In a five year minimum follow up persistent infection was observed twice in a two-staged revision THR. A dislocation of the hip components was observed in three cases, and could be surgically treated in twice and by wearing a hip-brace in one case. We could not find a loosening of THR components. Three patients had a good or excellent, 11 patients a fair or bad functional outcome. There was a significant correlation between functional outcome and length of interval of prosthesis exand reimplantation. Patients have an increased comfort resulting from a short, CRP depending time interval between ex- and reimplantation. Functional outcome is the better the shorter the interval is. The reinfection rate is comparable to those of cemented revision THR's with a long term interval. We could observe advantages in a reduced amount of bone loss and better osseous integration of the uncemented implants, compared to cemented implants reviewing literature. Alterations of acetabular bone stock and soft tissue are responsible for a high rate of instability of the THR. An inaccurate gait pattern is caused by gluteal weakness in the majority of patients. Repeated surgical intervention and duration of immobilization have to be minimalized.

  20. 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.

  1. Delayed Presentation of Intussusception with Perforation after Splenectomy in Patient with Blunt Abdominal Trauma

    Science.gov (United States)

    Afifi, Ibrahim; Al-Thani, Hassan; Attique, Sajid; Khoschnau, Sherwan; El-Menyar, Ayman; Latifi, Rifat

    2013-01-01

    Adult intussusception (AI) following blunt abdominal trauma (BAT) is a rare surgical condition. We present a case of delayed diagnosis of ileocecal junction intussusception with a perforation of small bowel in a 34-year-old male with a history of fall from height. Initial exploratory laparotomy revealed shattered spleen requiring splenectomy. Initial abdominal computerized tomography scanning (CT) scan showed dilated small bowel with no organic obstruction. Patient started to improve with partial distention and was shifted to rehabilitation unit. On the next day, he experienced severe abdominal distention and vomiting. Abdominal CT showed characteristic intussusception at the distal ileum. Secondary exploratory laparotomy revealed severe adhesions of stomach and small bowel to the anterior abdominal wall with dilated small bowel loops and intussusception near the ileocecal junction with perforation of small bowel. The affected area was resected and side-to-side stapled anastomosis was performed. Though small bowel intussusception is a rare event, BAT patients with delayed symptoms of bowel obstruction should be carefully evaluated for missed intussusception. PMID:24455385

  2. The effect of splenectomy on the levels of PCV-13-induced memory B- and T cells.

    Science.gov (United States)

    Gazi, Umut; Karasartova, Djursun; Sahiner, Ibrahim Tayfun; Gureser, Ayse Semra; Tosun, Ozgur; Derici, Mehmet Kursat; Dolapci, Mete; Taylan Ozkan, Aysegul

    2018-03-13

    Splenectomised patients are associated with lifelong risk of fatal overwhelming post-splenectomy infection (OPSI), which is mostly caused by Streptococcus pneumoniae. Today OPSI cases can still be reported even in patients with appropriate vaccination. In our study, the levels of vaccine-specific memory B- and T cells were compared between control and splenectomised patients to enlighten the underlying reason. Five healthy and 14 post-traumatic splenectomised individuals were vaccinated with 13-valent pneumococcal conjugate vaccine (PCV-13) followed by 23-valent pneumococcal polysaccharide vaccine (PPV-23). The levels of memory B- and T cells were compared by ELISPOT analysis. Splenectomised patients generated reduced levels of memory IgG B cells in response to PCV-13 vaccination, while the memory IFN-γ T-cell levels were undetectable in asplenic patients. This was despite the detection of vaccine-induced memory T-cell levels in control patients, which were analysed simultaneously following the same experimental protocol. Our results suggest that spleen is important, but not essential, for survival and/or generation of memory IgG B cells. In contrast, it seems to be indispensable for PCV-13-specific memory T H 1-cell levels. Studies enhancing the levels of vaccine-induced memory cells and further enlightening the immune responses in asplenic individuals are required to develop more effective vaccination strategies against OPSI. © 2018 John Wiley & Sons Ltd.

  3. 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.)

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

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    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

  5. Three-dimensional analysis of accuracy of patient-matched instrumentation in total knee arthroplasty: Evaluation of intraoperative techniques and postoperative alignment.

    Science.gov (United States)

    Kuwashima, Umito; Mizu-Uchi, Hideki; Okazaki, Ken; Hamai, Satoshi; Akasaki, Yukio; Murakami, Koji; Nakashima, Yasuharu

    2017-11-01

    It is questionable that the accuracies of patient-matched instrumentation (PMI) have been controversial, even though many surgeons follow manufacturers' recommendations. The purpose of this study was to evaluate the accuracy of intraoperative procedures and the postoperative alignment of the femoral side using PMI with 3-dimensional (3D) analysis. Eighteen knees that underwent total knee arthroplasty using MRI-based PMI were assessed. Intraoperative alignment and bone resection errors of the femoral side were evaluated with a CT-based navigation system. A conventional adjustable guide was used to compare cartilage data with that derived by PMI intraoperatively. Postoperative alignment was assessed using a 3D coordinate system with a computer-assisted design software. We also measured the postoperative alignments using conventional alignment guides with the 3D evaluation. Intraoperative coronal alignment with PMI was 90.9° ± 1.6°. Seventeen knees (94.4%) were within 3° of the optimal alignment. Intraoperative rotational alignment of the femoral guide position of PMI was 0.2° ± 1.6°compared with the adjustable guide, with 17 knees (94.4%) differing by 3° or less between the two methods. Maximum differences in coronal and rotation alignment before and after bone cutting were 2.0° and 2.8°, respectively. Postoperative coronal and rotational alignments were 89.4° ± 1.8° and -1.1° ± 1.3°, respectively. In both alignments, 94.4% of cases were within 3° of the optimal value. The PMI group had less outliers than conventional group in rotational alignment (p = 0.018). Our 3D analysis provided evidence that PMI system resulted in reasonably satisfactory alignments both intraoperatively and postoperatively. Surgeons should be aware that certain surgical techniques including bone cutting, and the associated errors may affect postoperative alignment despite accurate PMI positioning. Copyright © 2017 The Japanese Orthopaedic Association. Published by

  6. Técnicas de análisis de tendencias en mediciones espectrales y de nivel total de parámetros de diagnóstico // Trend analysis techniques in spectral and total level mensurations

    Directory of Open Access Journals (Sweden)

    L. Penabad Sanz

    2000-01-01

    Full Text Available En el presente artículo se muestra la implementación del análisis de tendencia, como tecnología predictiva, a través de laestadística matemática y su utilización en mediciones de parámetros de diagnóstico tanto espectral como de nivel total. Elempleo de esta tecnología resulta de gran importancia debido a que permite pronosticar el momento de fallo, según elcomportamiento de los niveles de los parámetros medidos, lo cual facilita la gestión del mantenimiento.Palabras claves: mantenimiento, análisis de tendencia, medición espectral, medición de nivel total, pronósticode fallo, vibraciones.______________________________________________________________________AbstractIn this article is shown the implementation of the trend analysis, as predictive technology, through the mathematical statisticand its use in spectral and total level mensurations of diagnosis parameters. The use of this technology has a great importancebecause it allows to predict the failure moment, according to the behavior of the levels of measured parameters, that whichfacilitates the administration of the maintenance.Key words: maintenance, tendency analysis, spectral mensuration, total level mensuration, failure presage,vibrations, diagnosis.

  7. Spirulina can increase total-body vitamin A stores of Chinese school-age children determined by a paired isotope dilution technique

    Science.gov (United States)

    Spirulina is an alga rich in high-quality protein and carotenoids. It is unclear whether spirulina can improve the total-body vitamin A stores of school-age children in China with a high prevalence of vitamin A malnutrition. We aimed to evaluate the efficacy of spirulina in improving the total-body ...

  8. Application of an ultrasound-guided low-approach insertion technique in three types of totally implantable access port

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    Hung-Wei Cheng

    2014-05-01

    Conclusion: Our study highlights a revised technique for placement of TIAP systems of differing types of material or size. Not only was the curvature of the device catheter smooth, but patients were satisfied with the cosmetic appearance.

  9. 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

  10. 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, Tomo