جستجوی مقالات مرتبط با کلیدواژه « Splenectomy » در نشریات گروه « پزشکی »

Hydatid disease is endemic in some regions of the world. Even in endemic regions, splenic hydatid cysts are rare, especially in pregnancy. The most serious presentation is intra peritoneal rupture, which is a surgical emergency. Exploration with splenectomy is the favoured management. We present a case of splenic hydatid cyst, detected late in pregnancy, with intraperitoneal rupture in the postpartum period. Cystic lesions located anywhere in the body in endemic regions could be hydatid cysts. Prompt treatment should be planned immediately on detection in order to prevent potentially serious complications like rupture.

This study aimed to evaluate the outcome and risk factors in operative and non-operativemanagement of splenic injury. This cross-sectional study was conducted on patients with traumatic splenic injuries who werehospitalized in Kashani Hospital (Isfahan, Iran) from 2017 to 2019. The studied variables were extracted fromthe medical records of the enrolled participants. The outcomes such as mortality complications and risk factorswere compared based on treatment methods. A total of 240 patients were investigated. The mean age of the patients was 29.8±12.2, with 180(77.5%) patients being men. 154 (64.2%) patients underwent operative treatment. The mortality rate was 18.9%and 4.6% among operative and non-operative groups (p<0.001). Complications were observed in 11.5% and46.1% of non-operative and operative groups, respectively (p<0.001). Operative treatment inversely correlatedwith mortality (p<0.001) and complications (p<0.05). Splenic injury severity was correlated positivelywith mortality (p<0.001) and negatively with complications (p<0.001). Unstable hemodynamic status waspositively correlated with complications (p<0.001). Age had a positive correlation with mortality (p<0.001)and complications (p<0.001). Male sex had a negative correlation with complications (p<0.001). GCS score andadmission were positively correlated with mortality (p<0.001). There was no statistically significant correlationbetween correlated injuries and outcomes (p≥0.05). Patients who received surgery had higher rates of mortality and complications. However, aftercontrolling for confounders, operative treatment was found to be inversely correlated with mortality andcomplications.

Thalassemia is one of the most prevalent genetic disorders globally, and infections are one of the major causes of death in these patients. Various studies have attributed the increased susceptibility to bacterial infections in thalassemia patients to changes in their immunological status. 

This research aimed to measure serum levels of immunoglobulins (Igs) in Thalassemia Major (TM) patients and in the control group. 

The study included forty TM patients (20 splenectomized and 20 non-splenectomized) and 20 healthy participants (the control group). Three groups were matched for age and gender. Mean serum levels of immunoglobulins (IgG, IgA and IgM) were measured for all individuals by ELISA. P<0.05 was considered the significance level. 

Increased serum IgG and IgA levels and significantly reduced serum IgM levels were observed in the splenectomized patients compared to the non-splenectomized ones. A comparison of the study groups revealed that serum IgG and IgA levels in the splenectomized patients and the mean serum IgM and IgG levels in the non-splenectomized patients were higher than those of the healthy participants. The mean serum IgM levels in the splenectomized patients and the mean serum IgG levels in the non-splenectomized patients were lower than those of the control group.

The results showed that splenectomy could change the immunological status of thalassemia patients. Nevertheless, the exact mechanism for this change was not clear. Studying the serum levels of immunoglobulins might be useful in determining the severity of infections in TM patients.

Many medical and surgical conditions may need to be treated with splenectomy. As this lymphoid tissue plays an important role in controlling various infections, and many life-threatening infections can occur in the absence of the spleen, any episode of fever should be taken seriously.

This study aims to assess the bacterial etiology of fever episodes in splenectomized patients in three medical centers in Mashhad, a city in northeastern Iran.

Between 2006 and 2017, splenectomized patients in Imam Reza, Ghaem, and Dr. Sheikh hospitals were included in a cross-sectional study. Data collected included, age at splenectomy, hospitalization duration, indications for admission to the intensive care unit, vital signs at admission, bacterial species responsible for sepsis, times of hospitalization due to fever episodes, clinical signs and symptoms, antibiotic prophylaxis, and outcomes at six and one years. The data were analyzed using SPSS Statistics 20.

A total of 280 splenectomized patients were reviewed, and 23 of them had episodes of fever. The most common causes of splenectomy were spleen masses and idiopathic thrombocytopenic purpura (ITP), each accounting for 17.4% of cases. The mean age of the patients was 24.2 ± 1.6 years. 47.8% of the patients were male, and 52.2% were female. The median admission duration was seven days. A majority of admissions were due to intra-abdominal infections (26.7%), pneumonia (13.3%), and bacteremia (10.0%). There were 30 episodes of fever recorded, of which 2 (6.7%) resulted in death. Blood culture was positive in four cases (13.3%) for Streptococcus pneumoniae, Staphylococcus aureus, Citrobacter, and Brucella. A suitable antibiotic coverage was obtained in 13.3% of cases (i.e., ceftriaxone + vancomycin or fluoroquinolone + vancomycin), and a minimum suitable empiric coverage was obtained in 10.0% of cases, and no appropriate antibiotic coverage was obtained in 76.7% of cases.

The present study highlights widespread inappropriate empiric therapy of fever episodes in splenectomized patients, as well as a lack of due attention to timely sample collection before antibiotic administration. Despite this, the isolated organisms were varied and included S. pneumoniae, S. aureus, coagulase negative staphylococci, P. aeruginosa, Brucella, and Citrobacter.

Chronic idiopathic thrombocytopenic purpura (ITP), is an autoimmune disease associated with a reduction in circulating blood platelets under 150x109/L which persists longer than 6 months without any specific cause. With the current study, we aimed to evaluate the efficacy and safety of laparoscopic splenectomy in ITP patients with a very low platelet count and normal coagulation status.

From April 2007 to January 2012, laparoscopic splenectomy was performed on 60 patients with chronic ITP who could not achieve a sustained recovery after steroid therapy.

Patients consisted of male/female ratio of 24 (40%):36 (60%) with the mean age of 53±15.1 years. All patients had normal coagulation state even with very low platelet count (below 5×103) before laparoscopic splenectomy. The mean operative time was 140.00±15.00 minutes. Blood transfusion was required in 10 (16.7%) and 8 (13.3%) patients before and after the operation, respectively. Preoperative transfusion of PRBC was not statistically significant between groups (P=0.265). Bleeding complications during within or after surgery was rare (5.0%). Convalescence was rapid and the mean hospital stay was 3.58±0.68 days (1-14 days) which shows that there was no significant difference in operative time and after operative hospitalization time among the three groups (P=0.070). The patients made a good uneventful recovery and were followed for at least one week who exhibited no postoperative problems.

Laparoscopic splenectomy should be considered initially in the management of ITP. Also, very low platelet count should not be contraindicated for laparoscopic splenectomy in ITP patients and sometimes perioperative platelet transfusion may be unnecessary.

COVID-19 results in an imbalance between procoagulant and anticoagulant homeostatic mechanisms that could be complicated with thrombotic events. In β-thalassemia patients, the presence of comorbidities, iron overload, adrenal hypofunction, splenectomy, and chronic hypercoagulable state might increase the susceptibility to COVID-19 and its severity.

 The search was conducted in PubMed, Web of Science, and Scopus databases for the key terms of β-thalassemia/thalassemia and COVID-19 until July 2021.

The survey of published observational studies (mostly multicenter and case reports) indicated a lower prevalence of COVID-19 in β-thalassemia patients compared with the general population, as well as mild to moderate COVID-19 in these patients, especially in those without comorbidity. β-Thalassemia children were susceptible to COVID-19 but with less severity compared to adults. There is no report of pulmonary embolism and thrombotic events in β-thalassemia patients with COVID-19; however, coagulation abnormality and pulmonary microembolism have been found in these patients.

Findings could be interpreted by the presence of high hemoglobin F (HbF) levels, the advantage of hydroxyurea (HU) therapy, splenectomy, and iron chelation therapy in these patients. However, due to the low sample size and studying mainly young patients, the results should be interpreted with caution, and it still needs more studies with a larger sample size to confirm these findings.

The spleen is the mostly common injured solid organ in blunt abdominal trauma and contributes to mortality and morbidity. Epidermoid splenic cysts are sample of primary congenital cysts that contain an epithelial lining, unlike secondary cysts, which are collected of fibrous tissues.

An 18-year-old male presented with acute left upper abdominal pain, feeling of fullness and dyspepsia from 10 days ago. His past history was renal transplantation from deceased doner, 5 year prior to presentation. Physical examination revealed normal findings except a palpable soft mass with size of 15x20 cm in the left upper quadrant (LUQ).

Recent studies suggest that the spleen has an important role as a source of multipotent stemcells and precursors of beta cells of pancreas islets. In addition, increased risk of developing hyperglycemiawas reported in patients who underwent splenectomy due to trauma in long-term follow up. Therefore, theremight be an association between splenectomy and an increased risk of type 2 diabetes mellitus. In this study,we evaluated the risk of type 2 diabetes and its risk factors including hyperglycemia, dyslipidemia, obesity andhypertension in trauma patients with splenectomy.

In this study, 221 patients whounderwent splenectomy surgery due to trauma in the surgical ward of Imam Hossein Hospital 5 to 10 yearsago were selected. Those with a history of diabetes, cancer, hyperthyroidism, Cushing’s syndrome, pancreatitis,renal failure, and cirrhosis were excluded from the study. Then fasting plasma glucose, hemoglobin A1c (HbA1c),triglyceride, cholesterol and high density lipoprotein (HDL), body mass index and blood pressure have beenevaluated in 90 patients who had had a history of splenectomy due to trauma from 2007, July 23 to 2012, July 22.

The results indicate that none of these patients has diabetes, 14.4 percent are in pre-diabetic stage, 56.6percent has dyslipidemia, 57.7 percent has obesity and 20 percent has hypertension.

The resultsof this study suggest that splenectomy does not increase the risk of type 2 diabetes. Prevalence of diabetes riskfactors was approximately the same with those of Tehran population.

Splenectomy is a common treatment for beta thalassemia. It not only eliminates many complications by reducing the need for blood transfusion, but also causes new complications that threaten the patientschr('39') health. The aim of this study was to determine if splenectomy could alter the lipid profile and glucose metabolism in beta thalassemia major patients.

In this case-control study, 41 splenectomized and 42 non-splenectomized eligible beta thalassemia patients were selected from Zafar Thalassemia Clinic, Tehran, Iran. Anthropometric, demographic, and biochemical data were collected using standard methods. Physical activity and food intake were measured using International Physical Activity Questionnaire (IPAQ) and food frequency questionnaires (FFQ), respectively.

Demographic characteristics and dietary intake were not significantly different between the two groups. However, triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), very low density lipoprotein cholesterol (VLDL-C), TC/HDL-C, LDL-C/TG, and LDL-C/HDL-C ratios were significantly higher, but HDL-C was significantly lower in splenectomized patients (P < 0.05). Furthermore, fasting blood glucose (P < 0.39) and oral glucose tolerance test (P < 0.53) did not significantly differ between the two groups.

Reduced activity of the reticuloendothelial system and reduced removal of cholesterol might be the reason for higher plasma lipid profile and greater risk of cardiovascular diseases in splenectomized patients. On the other hand, glucose metabolism was not affected by splenectomy in adult patients. To clarify this relationship, prospective studies are suggested.

The description of histopathological features of spleen specimens in those undergoing splenectomy is necessary and even vital for selecting the best patient's diagnostic and therapeutic management. However, in some cases, the histological findings of those with dramatic clinical presentation may be imperceptible and vice versa.

What we did in the present study was to assess the clinical and histopathological findings as well as the main indications for splenectomy in a sample of Iranian affected population.

This cross-sectional study was conducted on 616 spleen specimens following complete or partial splenectomy performed at pathology laboratory at Besat Hospital in Hamadan, Iran between 2007 and 2017. Demographic characteristics, the main reasons for splenectomy, grading of trauma, and histopathological findings were retrospectively collected by reviewing the hospital recorded files and laboratory reports.

The most common cause for splenectomy included trauma in 59.25% followed by idiopathic thrombocytopenic purpura in 15.58% and symptomatic splenomegaly in 9.09%. The specimens were normal in 38.0%. Among those with lymphoma, the definitive diagnosis included diffused large B cell lymphoma in 42.85%, Hodgkin lymphoma in 42.85%, Follicular cell lymphoma in 9.52% and Marginal cell lymphoma in 4.76%.

Trauma and idiopathic thrombocytopenic purpura are the most common indications for splenectomy. Given the normality of the pathologic findings in more than one-third of patients undergoing splenectomy, closer attention to indications for this procedure through further evaluation of patients and predicting outcome of the procedure is necessary.

The spleen is subject to a variety of benign and malignant disorders, which can be manifested by nonspecific symptoms or signs. Hence, the diagnosis is often made based on radiological examinations and histopathological studies.

Herein we present a case report of a patient with pathologically approved primary splenic lymphoma (PSL). The patient was a 63-year-old woman presented with abdominal pain, predominantly in the left upper quadrant, since 1 month. Complete blood count (CBC) was normal except for mild anemia. Liver enzyme studies showed an elevated alkaline phosphatase level. Ultrasound (US) depicted a huge hypoechoic splenic mass and computed tomography (CT) confirmed the lesion to be a hypodense mass partially exophytic from the superior aspect of the spleen measuring up to 124 mm in size. The patient underwent a midline laparotomy and splenectomy and the spleen was sent for histopathological examination, which revealed high-grade B-cell lymphoma measuring 17 × 16 × 10 cm in size with capsular invasion and without any lymphovascular invasion.

This case report highlights the importance of considering splenic lymphoma as a differential diagnosis, although rare, in a patient with abdominal pain and nonspecific clinical findings

The aim of this study is to clarify nitric oxide (NO)-production by spleen and the importance of spleen in malaria infection in murine model. Thirty outbred NMRI female mice were divided into four groups, Group I: No intervention (Healthy control), Group II: With splenectomy (Healthy test), Group III: No intervention, Inoculation of contaminated blood (Infected control), Group IV: With splenectomy, inoculation of contaminated blood (Infected test). The Parasitemia was counted every other day through Giemsa stain examination of animal blood. The parasitemia and survival rates, hepatosplenomegaly and body weight were recorded. After terminal anesthesia, plasma and liver/spleen suspensions were assessed by the Griess micro assay for measurement of NO-levels. At the end of the experiment (on day 16), the parasitemia was 26.99±0.46 % among the group of non-splenectomized animals (Group III) compared with 31.25±0.72% among the group of splenectomized animals (Group IV). The average parasitemia among the groups at the end of the experiment was statistically significant (Group III, Group IV: p= 0.0002). Survival rate was statistically significant (p<0.0001). NO concentrations in plasma, liver and spleen were determined. The amount of NO in plasma increased significantly in the infected groups (p=0.0003). Although, splenectomy decreased immune function against rodent malaria, it did not solely changed the pattern of antimalarial activity via NO-pathway. It is concluded that NO possibly comes from several sources rather than spleen during rodent malaria disease and is released into circulation, which may replace NO shortage by splenic cells to combat malaria parasites.

Typhoid splenic abscess is a rare clinical entity that can be fatal if left untreated. Herein, we reported a case of typhoid splenic abscess who responded to ultrasound-guided aspiration and antibiotic therapy. A 25-year-old Nepalese man with no significant medical history presented to the emergency department with fever and the left upper abdominal pain lasting for seven days. One month before his presentation to our hospital, he returned from an eight-week holiday in Nepal. Splenic abscess was diagnosed by abdomen ultrasound and enhanced-computerized tomography. The patient refused surgical intervention and ultrasound-guided abscess aspiration was performed while piperacillin-tazobactam was initiated. Blood and aspirated pus microscopy revealed Gram-negative bacilli and the culture grew Salmonella typhi, which was sensitive to piperacillin-tazobactam, ampicillin, ciprofloxacin, and ceftriaxone. Piperacillin-tazobactam was continued for 4 weeks with successful recovery. This case highlights the importance of considering typhoid splenic abscess in the differential of fever and abdominal pain in returning travelers.

The known early and late complications following splenectomy increase the tendency to preserve splenic tissue after splenic trauma.

This study was conducted to determine the safety and feasibility of auto-transplantation of splenic fragments in patients with severe splenic injury.

Nineteen patients with severe splenic blunt trauma, who underwent total splenectomy and autotransplantation of splenic fragments at Besat hospital, Hamadan University of Medical Sciences, Iran during years 2015 and 2016, were enrolled in the study. Complete blood counts, blood smear for Howell-Jolly bodies, and phagocytic function tests were performed just before, at 3 months, and 6 months after surgery.

The means of red blood cell counts increased significantly at both 3 and 6 months after surgery (P = 0.01 and 0.049, respectively) and the means of hemoglobin, hematocrit, and the percentage of lymphocytes increased significantly at 3 months after surgery (P = 0.001, 0.046, and 0.01 respectively) while this increase was not significant 6 months after surgery (P = 0.52, 0.15, and 0.34, respectively). The Howell-Jolly bodies were present in 5 patients (26.3%) at 3 months after surgery, which was significantly reduced to 3 (15.8%), at 6 months after surgery (P = 0.042). The median of splenic phagocytic function significantly increased from 3 ± 1.2 hotspots (range = 2 to 6) at 3 months after surgery to 4 ± 1.4 (range = 2 to 8) at 6 months after surgery (P = 0.044).

Auto-transplantation of splenic fragments may be feasible and safe and a suitable option for splenic tissue salvage in patients with severe splenic lesions, who require total splenectomy.