Morphological changes in spleen after dietary zinc deficiency and supplementation in Wistar rats.

BACKGROUND: Study was conducted to determine the effect of dietary zinc deficiency and supplementation on the spleen morphology. METHODS: Pre-pubertal Wistar rats (40-50 g) were divided into two groups with 6 sub-groups each viz. zinc control (ZC, 100 µg/g zinc diet), pair fed (PF, 100 µg/g zinc diet), zinc deficient (ZD, <1 µg/g zinc diet, zinc supplementation control (ZCS), zinc supplementation pair-fed (PFS) and zinc supplementation deficient (ZDS, 100 µg/g zinc control diet). Experiments were set for 2- and 4-weeks followed by 4 weeks of zinc supplementation. RESULTS: In the present study body weight and BMI decreased significantly along with incidence of splenomegaly as typified by the increased splenic index in deficient groups compared with that of respective control groups. Histopathological changes such as disorganization of red pulp, several infiltered lymphocytes, vacuolization, loss of cellularity, karyolysis, dissolution of matrix, indistinct differentiation between red and white pulp were evident in spleen of 2ZD and 4ZD group animals. Degeneration was more severe after 4 weeks of zinc deficiency as giant cells formation and hypertrophy were also evident. CONCLUSION: The findings revealed that zinc deficiency causes growth retardation and splenomegaly. Degenerative and atrophic changes in rat spleen suggest reduced cellular defense potential which will have a direct effect on immunity. Zinc supplementation may prove to be beneficial as there were varying degrees of cellular recovery after cessation of zinc deficiency.

Should rituximab replace splenectomy in the management of splenic marginal zone lymphoma?

BACKGROUND: SMZL is a relatively rare low grade B-cell lymphoma, characterized usually by an indolent clinical behavior. Since there is no prospective randomized trials to establish the best treatment approach, decision on therapeutic management should be based on the available retrospective series. Based on these data, rituximab and splenectomy appear to be the most effective. Splenectomy represented the standard treatment modality until early 2000s. More than 90% of the patients present quick amelioration of splenomegaly related symptoms along with improvement of cytopenias related to hypersplenism. The median progression free survival was 8.25 years in the largest series of patients published so far, while the median 5- and 10- year OS were 84% and 67%, respectively. Responses to splenectomy are not complete since extrasplenic disease persists. Patients with heavy bone marrow infiltration, lymphadenopathy or other disease localization besides the spleen are not good candidates for splenectomy. Furthermore splenectomy is a major surgical procedure accompanied by acute perioperative complications as well as late toxicities mainly due to infections. For that reasons splenectomy is not appropriate for elderly patients or patients with comorbidities with a high surgical risk. On the other hand rituximab monotherapy displays high efficacy with minimal toxicity. Several published series have shown an ORR more than 90%, with high CR rates (∼50%). The 10-year PFS and OS were 63% and 85%, respectively in a series of 104 SMZL patients. The role of rituximab maintenance has been investigated by only one group. Based on these data, maintenance with rituximab further improved the quality of responses by increasing significantly the CR rates (from 42% at the end of induction to 71% at the end of maintenance treatment), as well as the duration of responses: 7-year PFS was 75% for those patients who received maintenance vs 39% for those who did not (p < 0.0004). However no difference in OS has been noticed between the two groups, so far. Summarizing the above data, it is obvious that Rituximab monotherapy is associated with high response rates, long response duration and favorable safety profile, rendering it as the treatment of choice in SMZL.

ß-Thalassemia intermedia: a comprehensive overview and novel approaches.

ß-Thalassemia intermedia is a clinical condition of intermediate gravity between ß-thalassemia minor, the asymptomatic carrier, and ß-thalassemia major, the transfusion-dependent severe anemia. It is characterized by a significant clinical polymorphism, which is attributable to its genetic heterogeneity. Ineffective erythropoiesis, chronic anemia, and iron overload contribute to the clinical complications of thalassemia intermedia through stepwise pathophysiological mechanisms. These complications, including splenomegaly, extramedullary erythropoiesis, iron accumulation, leg ulcers, thrombophilia, and bone abnormalities can be managed via fetal hemoglobin induction, occasional transfusions, chelation, and in some cases, stem cell transplantation. Given its clinical diversity, thalassemia intermedia patients require tailored approaches to therapy. Here we present an overview and novel approaches to the genetic basis, pathophysiological mechanisms, clinical complications, and optimal management of thalassemia intermedia.

Long-term dietary vitamin E retards development of retrovirus-induced disregulation in cytokine production.

A 15-fold increase in dietary vitamin E (160 IU/liter) normalized hepatic and serum levels of vitamin E normally reduced by retrovirus infection. It also significantly retarded development of splenomegaly and hypergammaglobulinemia induced by retrovirus infection, while significantly restoring release of interleukin-2 (IL) and interferon-gamma by splenocytes which are suppressed by retrovirus infection. Retrovirus infection elevated production of IL-4 and IL-6 by splenocytes, but this elevation was inhibited by vitamin E. Increased levels of IL-6 and tumor necrosis factor-alpha produced by splenocytes during progression to murine AIDS were also inhibited by vitamin E. Vitamin E supplementation also helped restore retrovirus-suppressed splenocyte proliferation. These data indicate that vitamin E supplementation can help overcome retrovirus-induced reduction in tissue vitamin E, modulate cytokine release, and normalize immune dysfunctions during progression to murine AIDS.

Um caso clinico com esplenomegalia / A clinical case with splenomegaly

A autora apresenta o caso de um paciente com esplenomegalia consequente a leucopenia provocada por intoxicacao medicamentosa, com reversao do quadro apos tratamento homeopatico

Um caso clinico com esplenomegalia / A clinical case with splenomegaly

A autora apresenta o caso de um paciente com esplenomegalia consequente a leucopenia provocada por intoxicacao medicamentosa, com reversao do quadro apos tratamento homeopatico