[Splenectomy in programmed therapy of aplastic anemia].

AIM: To define efficacy of splenectomy (SE) in current programmed therapy of aplastic anemia (AA). MATERIALS AND METHODS: SE efficacy was analysed in 2 stages: a retrospective study of efficacy of surgery as monotherapy (1986-1996) (74 AA patients) and of SE in programs of immunosuppressive therapy (IST) (1991-2002). Program treatment of AA patients was conducted on the base of IST algorithm developed in Hematological Research Center after many year investigations. RESULTS: SE as monotherapy improved AA course in 73.3% patients with non-severe AA (NAA) and 18.2% patients with severe AA (SAA). Three and five year survival in NAA postsplenectomy patients was 80%. One-year survivors after surgery were likely to survive long. Overall survival of SAA after SE was significantly less (p < 0.0001): 3-year survival - 6%. SE efficacy in programs including antilymphocytic globulin (ALG) and cyclosporin A (CsA) was studied in 69 AA patients. A 85.5% response was registered to program treatment including ALG, CsA and SE, being 81% in SAA and 1% in NAA patients. Efficacy of SE in combination with CsA at the first stage NAA treatment (a 30% positive response) was much inferior to ALG+CsA (68% response). At stage two treatment SE improved treatment results in most of SAA patients. Long-term survival in SAA patients after program treatment with SE is 60%. CONCLUSION: SE in the program of combined therapy in adult AA patients including CsA is an alternative to ALG in NAA patients. In SAA, SE can be included in the program at the first stage in ALG intolerance or in the absence of the drug, at the second stage--to overcome resistance to conducted therapy.

[Preoperative embolization of the splenic artery in patients with blood system diseases]. / Predoperatsionnaia émbolizatsiia selezenochnoi arterii u bol'nykh s zabolevaniiami sistemy krovi.

AIM: To develop and introduce X-ray endovascular preocclusion of the splenic artery in general surgical patients with different forms of cytopenias as preparation for further surgical treatment. MATERIALS AND METHODS: Data on 12 splenic arterial occlusions in patients with different diseases of the blood system. RESULTS: Despite the severity of the underlying process, the use of X-ray endovascular preocclusion of the splenic artery in patients with different hematological diseases made it possible to make the so-called bloodless splenectomy on short notice, then a required cavitary operation or in the immediate postembolization period if there were emergency indications or some time later if the patient's status allowed. CONCLUSION: When patients with blood system diseases attended by thrombocytopenia, anemia, leukopenia are indicated to have surgical treatment of some contaminant diseases, it is necessary to perform X-ray endovascular splenic arterial occlusion at the first stage, then make a major intervention when blood parameters have improved.

[The embolization of the splenic artery in hematologic surgery]. / Embolizatsiia seleznochnoi arterii v gematologicheskoi khirurgii.

The short- and long-term results of embolization of the splenic artery are analyzed in 143 patients with different diseases of the blood system. Two methods of splenic artery occlusion have been examined: one-stage total and staged embolization of the splenic artery. The course of the postembolization period is considered depending on the type of splenic artery occlusion as is the treatment policy for such conditions. The authors hold that transcatheter embolization of the splenic artery required in some diseases of the blood system is, in terms of its clinical effect, an alternative to splenectomy.

[The comparative efficacy of splenectomy and antilymphocyte globulin therapy in patients with aplastic anemia]. / Sravnitel'naia éffektivnost' splenéktomii i terapii antilimfotsitarnym globulinom u bol'nykh aplasticheskoi anemiei.

Analysis of the clinical efficacy and long-term survival of patients with grave and not grave forms of aplastic anemia, subjected to splenectomy or treated with antilymphocytic globulin has shown that in grave aplastic anemia, the clinical efficacy of antilymphocytic globulin is higher than the efficacy of the operative treatment methods. The 30-month survival can be attained in 42% of the patients given globulin and in 28% of the patients after splenectomy. In patients with grave aplastic anemia, it is recommended that the treatment be instituted from the use of antilymphocytic globulin in a dose of 15 mg/kg bw daily for 5 days, provided there are no contraindications. In patients with not grave aplastic anemia, the results of splenectomy and therapy with antilymphocytic globulin are approximately the same: the 5-year survival amounts to 94 and 93%, respectively. Therefore, the use of globulin may be recommended as a method of choice for the above patients' group, since surgical approaches to the treatment are still coupled with a high risk for the patient's life.

[Intravascular occlusion of the splenic artery--a new method of treating hypoplastic anemia]. / Endovaskuliarnaia okkliuziia selezenochnoi arterii--novyi metod lecheniia gipoplasticheskoi anemii.

The paper is concerned with the results of embolization of the splenic artery in 30 patients with hypoplastic anemia. Two methods of occlusion of the splenic artery have been considered: one-stage total and two-stage embolization of the splenic artery. The results obtained indicated the efficacy of this therapeutic method; immediate and long-term results of embolization of the splenic artery did not differ from those following operation. The authors have arrived at a conclusion that the new method of treatment of hypoplastic anemia by means of endovascular embolization of the splenic artery can be an alternative to splenectomy.