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Sahin NE, Oner Z, Oner S, Turan MK. A study on the correlation between spleen volume estimated via cavalieri principle on computed tomography images with basic hemogram and biochemical blood parameters. Anat Cell Biol 2022; 55:40-47. [PMID: 35000931 PMCID: PMC8968228 DOI: 10.5115/acb.21.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/22/2021] [Accepted: 11/20/2021] [Indexed: 11/27/2022] Open
Abstract
Considering its hematological and immunological functions, spleen is a very important organ. A change occurs in its size as the spleen performs these functions. This study aims to examine the possible relationships between spleen volume and the basic hemogram and biochemical parameters in serum. Multidetector computed tomography images and basic hemogram and biochemical parameters of 74 adult individuals, 34 male and 40 female, who were found to be healthy, were used in the study. Spleen volume was estimated using the Cavalieri method on multidetector computed tomography images and the correlations between the volume value with basic hemogram and biochemistry parameters were researched. While negative significant correlations were found between the estimated spleen volume and lymphocyte percentage (r=–0.224) and platelet level (r=–0.271); positive significant correlations were found between hemoglobin level (r=0.228), hematocrit level (r=0.237), alanine aminotransferase (r=0.345), and erythrocyte level (r=0.375). As a result of this study, a relationship was found between spleen volume and lymphocyte percentage, hematocrit level, erythrocyte level, platelet level, and alanine aminotransferase level in serum. We believe that the results of the study will provide a larger perspective to clinicians in the diagnosis of diseases associated with spleen.
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Affiliation(s)
- Necati Emre Sahin
- Department of Anatomy, Faculty of Medicine, Karabük University, Karabük, Turkey
| | - Zulal Oner
- Department of Anatomy, Faculty of Medicine, İzmir Bakırçay University, İzmir, Turkey
| | - Serkan Oner
- Department of Radiology, Faculty of Medicine, İzmir Bakırçay University, İzmir, Turkey
| | - Muhammed Kamil Turan
- Department of Medical Biology, Faculty of Medicine, Karabük University, Karabük, Turkey
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Kang YS, Kim JY, Bruening SA, Pack M, Charalambous A, Pritsker A, Moran TM, Loeffler JM, Steinman RM, Park CG. The C-type lectin SIGN-R1 mediates uptake of the capsular polysaccharide of Streptococcus pneumoniae in the marginal zone of mouse spleen. Proc Natl Acad Sci U S A 2003; 101:215-20. [PMID: 14694198 PMCID: PMC314165 DOI: 10.1073/pnas.0307124101] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
SIGN-R1, a recently discovered C-type lectin expressed at high levels on macrophages within the marginal zone of the spleen, mediates the uptake of dextran polysaccharides by these phagocytes. We now find that encapsulated Streptococcus pneumoniae are rapidly cleared by these macrophages from the bloodstream, and that capture also takes place when different cell lines express SIGN-R1 after transfection. To assess the role of the capsular polysaccharide of S. pneumoniae (CPS) in the interaction of SIGN-R1 with pneumococci, we first studied binding and uptake of serotype 14 CPS in transfected cells. Binding was observed and was of a much higher avidity (3000-fold) for CPS 14 than dextran. The CPSs from four different serotypes were also cleared by marginal zone macrophages in vivo. To establish a role for SIGN-R1 in this uptake, we selectively down-regulated expression of the lectin by pretreatment of the mice with SIGN-R1 antibodies, including a newly generated hamster monoclonal called 22D1. For several days after this transient knockout, the marginal zone macrophages were unable to take up either CPSs or dextrans. Therefore, marginal zone macrophages in mice have a receptor that interacts with capsular pneumococcal polysaccharides, setting the stage for further studies of the functional consequences of this interaction.
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Affiliation(s)
- Young-Sun Kang
- Laboratory of Cellular Physiology and Immunology and Chris Browne Center for Immunology and Immune Diseases, The Rockefeller University, 1230 York Avenue, New York, NY 10021, USA
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Patel AG, Parker JE, Wallwork B, Kau KB, Donaldson N, Rhodes MR, O'Rourke N, Nathanson L, Fielding G. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy. Ann Surg 2003; 238:235-40. [PMID: 12894017 PMCID: PMC1422687 DOI: 10.1097/01.sla.0000080826.97026.d8] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the impact of spleen weight on operative and clinical outcome in a series of 108 consecutive laparoscopic splenectomies. BACKGROUND Laparoscopic splenectomy as an alternative to open splenectomy for splenomegaly is regarded as controversial. METHODS Patients underwent laparoscopic splenectomy for a range of hematological disorders between November 1992 and February 2000. Multiple linear and logistic regression analysis were used to assess the effect of massive splenomegaly (>1000 g) on perioperative mortality and morbidity, after adjusting for the joint effects of patient age, weight, pre- and postoperative full blood counts, operating time, estimated blood loss, conversion rate, reoperation rate, and duration of hospital stay. RESULTS Massive splenomegaly was recorded in 27 of 108 (25%) cases. In this group, splenic weight ranged from 1000 to 4750 g (median, 2500 g). Patients with splenic weight >1000 g had a significantly longer median operating time (170 vs. 102 minutes, P < 0.01), conversion rate (5/27 vs. 4/81, P < 0.05), postoperative morbidity (15/27 vs. 4/81, P < 0.01), and median postoperative stay (5 vs. 3 days, P < 0.01). Multivariate analysis found splenic weight to be the most powerful predictor of morbidity (P < 0.01). Patients with splenomegaly (>1000 g) were 14 times likely to have post operative complications. One patient died 3 days after surgery, following a pulmonary embolus (spleen weight 500 g, mortality 1/108, 0.9%). CONCLUSIONS Laparoscopic splenectomy is feasible in patients with giant spleens. However, it is associated with greater morbidity, and the advantages of minimal access surgery in this subgroup of patients are not so clear.
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Affiliation(s)
- Ameet G Patel
- Departments of Surgery, Haematology, and Biostatistics, King's College Hospital, London, United
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Hoekstra HJ, Tamminga RY, Timens W. Partial splenectomy in children: an alternative for splenectomy in the pathological staging of Hodgkin's disease. Ann Surg Oncol 1994; 1:480-6. [PMID: 7850554 DOI: 10.1007/bf02303613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
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 splenectomy in the staging of Hodgkin's diseases in children. METHODS During the period 1982-1988, 12 children with Hodgkin's disease underwent a staging laparotomy with partial splenectomy. All patients were preoperatively vaccinated with Pneumococcus vaccine. The first three patients received 44 Gy locoregional radiotherapy, whereas nine patients received 25 Gy locoregional radiotherapy and two courses of MOPP/ABVD (mitoxin, oncovin [vincristine], procarbazine, prednisone/adriamycin, bleomycin, vinblastine, decarbazine). RESULTS The morbidity was negligible. The pathological stage changed in three patients (25%). During a median follow-up of 6 years (range 4-10), no OPSI was diagnosed. One patient developed a secondary leukaemia. CONCLUSIONS Staging laparotomy for Hodgkin's disease is being performed with less frequency because the majority of patients are treated with chemotherapy and low-dose radiation therapy. After splenectomy and chemotherapy regimens with alkylating agents, there is an increased risk for secondary acute leukemia. With partial splenectomy an adequate staging of the disease can be achieved, allowing a more tailored therapy so that systemic chemotherapy will not be used as frequently, resulting in a lower treatment morbidity without decreasing survival.
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Affiliation(s)
- H J Hoekstra
- Department of Surgical Oncology, University Hospital Groningen, The Netherlands
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Coad JE, Matutes E, Catovsky D. Splenectomy in lymphoproliferative disorders: a report on 70 cases and review of the literature. Leuk Lymphoma 1993; 10:245-64. [PMID: 8220125 DOI: 10.3109/10428199309148547] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Between February, 1970 and September, 1991, we performed splenectomies on 70 patients with chronic lymphoproliferative disorders including primary leukemias: 19 B-cell chronic lymphocytic leukemia, 1 B-cell prolymphocytic leukemia, 22 hairy cell leukemias, 4 large granular lymphocytic leukemias, 1 T-cell prolymphocytic leukemia, and non-Hodgkin's lymphomas (NHL): 10 splenic lymphomas with villous lymphocytes, 4 follicular lymphomas, 5 mantle cell lymphomas, 3 lymphoplasmacytic and 1 large cell NHL. The primary indications for surgery in this series were therapy-resistant disease (40%) and therapeutic splenectomy (38%). Postsplenectomy, 70% of patients had a complete hematological response, 23% had a partial response, and 7% were nonresponsive. Median treatment-free survival correlated with the hematologic response postsplenectomy and the underlying diagnosis. Better treatment-free survivals were seen in patients with lesser degrees of anemia and thrombocytopenia. Overall, improvements were more pronounced in the B-cell than in the T-cell disorders. Indications for further therapy, postoperative morbidity and mortality, and survival times are discussed along with a review of the literature. These findings advocate a continuing role for splenectomy in symptomatic lymphoid malignancies running with splenomegaly and hypersplenism.
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Affiliation(s)
- J E Coad
- Academic Department of Hematology and Cytogenetics, Royal Marsden Hospital, London, England, UK
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Letoquart JP, La Gamma A, Kunin N, Grosbois B, Mambrini A, Leblay R. Splenectomy for splenomegaly exceeding 1000 grams: analysis of 47 patients. Br J Surg 1993; 80:334-5. [PMID: 8472144 DOI: 10.1002/bjs.1800800322] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Forty-seven patients who underwent splenectomy for splenomegaly > or = 1000 g were studied retrospectively. There were 29 men and 18 women of mean age 56 (range 19-87) years. Haematological malignancy was the most common disorder (42 patients). The main indications for splenectomy were cytopenia (20 patients), diagnosis (14), initial treatment of leukaemia (eight), pain (four) and spontaneous rupture (one). Thirteen patients underwent an associated surgical procedure. One patient died (mortality rate 2 per cent) and 12 (26 per cent) had postoperative complications. The advantages of splenectomy included histopathological diagnosis in 13 of 14 patients with splenomegaly of unknown origin, effective initial treatment in prolymphocytic and hairy cell leukaemia, definitive relief of pain in all affected patients, and long-term improvement of cytopenia in most.
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Affiliation(s)
- J P Letoquart
- Service de Chirurgie Générale A, Centre Hospitalier et Universitaire de Rennes, Hôpital Sud, France
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Onuigbo MA, Ozoh JO, Onuigbo WI, Ibeachum GI. Chronic Gaucher's disease masquerading as tropical splenomegaly syndrome in a Nigerian woman. Trans R Soc Trop Med Hyg 1991; 85:834-5. [PMID: 1801369 DOI: 10.1016/0035-9203(91)90473-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- M A Onuigbo
- University of Nigeria Teaching Hospital, Enugu
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Ge YG, Gao H, Kong XT. Changes of peripheral T-cell subsets in asplenic W256 tumor-bearing rats. J Surg Oncol 1989; 42:60-8. [PMID: 2788779 DOI: 10.1002/jso.2930420113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In exploring the mechanism of the effect of splenectomy on tumor growth, splenectomized rats and other control rats were implanted subcutaneously with Walker 256 carcinosarcoma cells (5 x 10(5] on day 10 after splenic operation; meanwhile, peripheral T-lymphocyte subsets were analysed successively. It was found that splenectomy enhanced the rate of tumor appearance and mean tumor diameter and disturbed the equation of T-lymphocyte subsets in peripheral blood, i.e., a subnormal level of Th/Ts ratio. Interestingly, a significant correlation was noted between decreasing values of Th/Ts ratio and increasing average diameters of implanted tumor in splenectomized rats, but not in sham-splenectomized or nonoperated rats with tumor growth. In spleen cells from tumor-bearing rats, a distinct increase of B-lymphocytes and a decrease of T cells were demonstrated. Data from this investigation provide striking evidence that a relationship exists between enhancement of tumor growth and disproportion of T-lymphocyte subsets in peripheral blood and offer some reasonable explanation for the causes of the promotive role of tumor growth following splenectomy.
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Affiliation(s)
- Y G Ge
- Department of Surgery, Chang Zheng Hospital, Shanghai, China
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Abstract
During the period 1972-85, 3712 splenectomies were performed in the Trent region giving a mean splenectomy rate of 5.8 per 100,000 population per year. Of these, 37.4% were incidental to other surgical operations and 23.4% were as a result of trauma. During this period there was a marked reduction in the splenectomy rate in children aged under 10 years for trauma and for haematological diseases. No such reduction was observed in older patients for these indications. Splenectomy for lymphoma fell progressively after 1977.
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Affiliation(s)
- I W Fellows
- University Hospital, Queen's Medical Centre, Nottingham, UK
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Abdi EA, Ding JC, Cooper IA. Nocardia infection in splenectomized patients: case reports and a review of the literature. Postgrad Med J 1987; 63:455-8. [PMID: 3324089 PMCID: PMC2428323 DOI: 10.1136/pgmj.63.740.455] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Opportunistic infections are increasingly becoming a problem in cancer patients amongst whom infection with Nocardia species is particularly difficult to detect due to the capricious natural history of the disease. Three cases of Nocardia infection in patients who had undergone splenectomy for haematological malignancy are presented. These cases illustrate the diverse mode of presentation, the natural history and the difficulties in early and accurate diagnosis of Nocardia infection. Despite the difficulties in arriving at the correct diagnosis, these cases highlight the importance of early institution of appropriate antibiotic therapy. Antibiotics should be given in adequate doses to control the initial infection and be maintained for a prolonged period to prevent relapses.
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Affiliation(s)
- E A Abdi
- Haematology Research Unit, Peter MacCallum Hospital, Melbourne, Australia
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Senécal JL, St-Antoine P, Béliveau C. Legionella pneumophila lung abscess in a patient with systemic lupus erythematosus. Am J Med Sci 1987; 293:309-14. [PMID: 3591819 DOI: 10.1097/00000441-198705000-00005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Lung abscess is an infrequently reported complication of Legionella pneumophila pneumonia associated with a high mortality rate. The risk factors, natural course, optimal method of diagnosis, and optimal therapy of this complication are not well defined. One case of Legionella pneumophila lung abscess occurring in a patient with systemic lupus erythematosus is described, and the reports of 26 other cases are reviewed. This complication is usually hospital-acquired and occurs predominantly in transplant recipients and systemic lupus erythematosus patients treated with corticosteroids with or without a cytotoxic drug. The time interval between the onset of immunosuppressive therapy and infection is usually of several weeks. Progression from pneumonia to abscess formation may be rapid, more commonly within an upper lobe. Transthoracic aspiration within the abscess cavity may be diagnostic, thus obviating the need for open lung biopsy. The prompt institution of erythromycin 4 gm daily intravenously followed by oral therapy for at least 4 weeks is associated with a high survival rate. Adequate drainage from the abscess cavity must be maintained. Radiologic healing may be slow. Long-term survival without relapse does occur. That the clinical spectrum of Legionella pneumophila infection includes lung abscess has not been sufficiently emphasized. This agent should be considered early in the differential diagnosis of lung abscess.
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Abstract
Splenomegaly results from a variety of illnesses that can interfere with normal splenic function. The great number of potential predisposing factors and clinical settings necessitates a thorough history and careful physical examination that includes well-defined laboratory studies. Appropriate therapy covers a broad range, from doing nothing more than periodic follow-up to laparotomy with splenectomy, depending upon the factors involved in the individual case.
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Abstract
Recognition of the spleen's important immune function has led to a more conservative surgical approach to the spleen. This has proved to be both safe and beneficial to the patient.
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