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1.
Abdom Radiol (NY) ; 47(3): 923-947, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35076742

RESUMO

Splenosis is an acquired form of ectopic splenic tissue that typically arises after trauma or splenectomy. It is often an incidental image finding in an otherwise asymptomatic patient, but the spectrum of symptoms varies based on the site of implantation. Radiologists should be familiar with the imaging features of splenosis to avoid mistaking it for malignancy. Splenosis has identical imaging features to that of the native spleen on US, CT, MRI, and nuclear medicine examinations. Therefore, when the radiologic findings support the diagnosis of splenosis, the patient can be spared invasive procedures for tissue sampling.


Assuntos
Esplenose , Abdome/patologia , Humanos , Imageamento por Ressonância Magnética , Esplenectomia , Esplenose/diagnóstico por imagem
2.
Medicine (Baltimore) ; 101(17): e29178, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35512074

RESUMO

RATIONALE: The spleen is an uncommon metastatic organ for malignant solid tumors because of its special anatomy and microenvironment. Isolated splenic metastasis of endometrial cancer is an extremely rare clinical event, with only 17 cases reported in literature. PATIENT CONCERNS: We report the case of a 58-year-old woman with abdominal distension and nausea for 7 months who had undergone surgery and chemotherapy for endometrioid adenocarcinoma 12 years previously. A space-occupying lesion in the upper pole of the spleen was observed on an abdominal ultrasound. DIAGNOSIS: The spleen was resected, and splenic metastasis of endometrial adenocarcinoma was histologically confirmed. INTERVENTIONS: Splenectomy was performed, and no lymph nodes or other metastases were observed. The patient received postoperative chemotherapy with 6 cycles of docetaxel and carboplatin. OUTCOMES: The patient recovered well 11 months postoperatively, with no evidence of recurrence or metastatic disease. LESSON: Since the time interval between the diagnosis of primary endometrial cancer and splenic metastasis may be very long, it may be necessary to monitor the recurrence of endometrial cancer after primary treatment.


Assuntos
Adenocarcinoma , Carcinoma Endometrioide , Neoplasias do Endométrio , Segunda Neoplasia Primária , Neoplasias Esplênicas , Adenocarcinoma/cirurgia , Carcinoma Endometrioide/cirurgia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Esplenectomia , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/tratamento farmacológico , Neoplasias Esplênicas/cirurgia , Microambiente Tumoral
3.
Khirurgiia (Mosk) ; (4): 91-95, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35477207

RESUMO

Splenic metastases are a rare finding and usually associated with advanced cancer. At the same time, isolated splenic metastases are an exception. The authors report a 62-year-old woman with isolated splenic metastasis from colon carcinoma in 28 months after surgery. Splenectomy was successfully performed.


Assuntos
Neoplasias do Colo , Segunda Neoplasia Primária , Neoplasias Esplênicas , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Esplenectomia , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/secundário , Neoplasias Esplênicas/cirurgia
5.
BMJ Case Rep ; 15(4)2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35444024

RESUMO

This case of acute rupture of a splenic artery aneurysm in a patient 35 weeks pregnant demonstrates the difficulties in diagnosis and importance of multidisciplinary team management for surgical emergencies in pregnancy. A women in her early 30s presented at 35 weeks pregnant with sudden onset of severe epigastric pain and shortness of breath and was found to be tachycardic with a raised lactate. Differentials included a possible vascular event or pulmonary embolism. A CT scan demonstrated free fluid and likely ruptured splenic artery aneurysm. A rapid, thorough preoperative meeting enabled us to integrate multidisciplinary care effectively. She underwent coiling of her splenic artery, which was essential to reduce further intraoperative blood loss, followed by a midline incision for caesarean section of her baby and splenectomy. She had a long stay in the intensive care unit (ITU) and complex postoperative course but was discharged after 2 months to be reunited with her baby who was in good condition.


Assuntos
Aneurisma Roto , Complicações Cardiovasculares na Gravidez , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Cesárea , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/cirurgia , Ruptura Espontânea/cirurgia , Esplenectomia , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/cirurgia
6.
Gan To Kagaku Ryoho ; 49(4): 441-443, 2022 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-35444130

RESUMO

An 82-year-old woman presented to our hospital with chief complaints of lower abdominal pain and nausea. Contrast- enhanced CT showed ileus of sigmoid colon cancer and a solitary splenic tumor. A metallic stent was placed for the primary lesion. FDG-PET showed high FDG accumulation in the solitary splenic tumor, and synchronous solitary splenic metastasis was diagnosed. Laparoscopic sigmoid colectomy and laparoscopic splenectomy were performed without changing the intraoperative position or port arrangement. Postoperative progress was favorable. The patient was discharged 9 days after surgery, and no sign of recurrence has been observed to date, at 4 months after surgery. Solitary splenic metastasis of colorectal cancer is extremely rare. This is the first case report of synchronous solitary splenic metastasis of colorectal cancer treated with laparoscopic resection in Japan. This procedure is considered effective and minimally invasive. We review and discuss the Japanese literature on this rare disease.


Assuntos
Laparoscopia , Neoplasias do Colo Sigmoide , Neoplasias Esplênicas , Idoso de 80 Anos ou mais , Feminino , Fluordesoxiglucose F18 , Humanos , Neoplasias do Colo Sigmoide/patologia , Neoplasias do Colo Sigmoide/cirurgia , Esplenectomia , Neoplasias Esplênicas/secundário
7.
Gan To Kagaku Ryoho ; 49(4): 459-461, 2022 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-35444135

RESUMO

We report a case of sclerosing angiomatoid nodular transformation(SANT)5 years after remission of diffuse large B-cell lymphoma(DLBCL). A 64-year-old woman was diagnosed a nodular mass at the spleen by a contrast-enhanced CT scan 5 years after the relief for DLBCL. The mass showed accumulation of FDG. Because the possibility of the recurrence of malignant lymphoma could not be ruled out, laparoscopic splenectomy was performed for diagnosis and treatment. Immunohistologically, the resected mass revealed 3 different vascular components pattern(CD31, CD34 and CD8), so we diagnosed SANT. It is difficult to distinguish from malignant lymphoma or cancer even with various examination, so laparoscopic splenectomy is useful for diagnosis and treatment.


Assuntos
Histiocitoma Fibroso Benigno , Linfoma Difuso de Grandes Células B , Neoplasias Esplênicas , Doença Crônica , Feminino , Histiocitoma Fibroso Benigno/diagnóstico , Histiocitoma Fibroso Benigno/patologia , Histiocitoma Fibroso Benigno/cirurgia , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Baço/patologia , Esplenectomia , Neoplasias Esplênicas/diagnóstico por imagem , Neoplasias Esplênicas/cirurgia
8.
J Coll Physicians Surg Pak ; 32(4): 514-518, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35330527

RESUMO

OBJECTIVE: To evaluate the clinicopathological differences between splenectomy during gastric cancer surgery and splenectomy during extra-gastric abdominal cancer surgery. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Erzurum Regional Education and Research Hospital, Erzurum, Turkey between January 2015 and January 2020. METHODOLOGY: Patients who were operated due to intra-abdominal malignancies were searched retrospectively. Among those patients, concomitant splenectomy cases were filtered for the study. The patients' general clinicopathological characteristics were retrieved from their medical records. Patients were divided into two groups, according to the objectives. The clinicopathological differences between the groups were evaluated with appropriate statistical tests, assuming significant p value of less than 0.05. RESULTS: The study included 45 patients. The mean age of the patients was 62.84 ± 12.59 (30-86 years), and male to female ratio was 19:26. Splenectomy was performed during gastric cancer surgery in 30 patients (66.7%) and 43 patients (95.6%) were operated in elective conditions. There was a need for more erythrocyte suspension in patients, who underwent splenectomy during gastric cancer surgery (p=0.040). However, length of hospital stay and overall morbidity were higher at splenectomy with extra-gastric cancer group, (p = 0.036 and p = 0.011, respectively). CONCLUSION: Splenectomy during gastric cancer surgery is more demanding; and requires more erythrocyte suspension. However, these patients had less morbidity tendencies. Length of stay was longer with splenectomy during extra-gastric abdominal cancer group. KEY WORDS: Splenectomy, Gastric cancer, Length of stay, Morbidity.


Assuntos
Neoplasias Abdominais , Neoplasias Gástricas , Neoplasias Abdominais/cirurgia , Idoso , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esplenectomia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
9.
BMJ Case Rep ; 15(3)2022 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-35256358

RESUMO

Gastrosplenic fistula is a rare and potentially fatal clinical entity unknown to most healthcare providers. Its diagnosis and management are challenging; and addressing it too late can have devastating consequences for patients. To increase awareness about this pathology, we hereby present a case of asymptomatic gastrosplenic fistula arising from a diffuse large B cell lymphoma in a 60-year-old Caucasian man with no significant medical history. The patient was successfully treated with open en-bloc splenectomy and partial gastrectomy. The patient was discharged from the hospital 3 days after the surgery. At 1-month postoperatively, the patient was asymptomatic and presented no complication of the surgery. He went on to finish six cycles of chemotherapy (R-EPOCH, rituximab, etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, doxorubicin hydrochloride) and achieved complete metabolic response. At 2 years after the surgery, the patient remains asymptomatic and presents no sign of disease recurrence.


Assuntos
Fístula , Linfoma Difuso de Grandes Células B , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Etoposídeo/uso terapêutico , Fístula/complicações , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Esplenectomia , Vincristina/uso terapêutico
10.
Ann Ital Chir ; 92: 59-64, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35342100

RESUMO

AIM: Splenectomy has been performed for various indications. In this study, we aimed to present the experience of a tertiary center on splenic surgery and analyze what has changed in the last 10 years. MATERIAL AND METHODS: Three hundred and sixteen patients who underwent splenic surgery were enrolled in the study. Demographic data, comorbidities, American Society of Anesthesiologists score, indications, operation type, postoperative complications, and mortality were analyzed retrospectively. RESULTS: The most common indication was traumatic splenic injury. Immune thrombocytopenic purpura (ITP) and gastric cancer were the second and third. Splenectomy was performed on 300 (94.9%) patients. Splenorrhaphy, partial splenectomy, and splenopexy were the other procedures performed. Postoperative complications occurred in almost onethird of the patients (n=118, 37.3%). Most of them were grade 5 according to the Clavien-Dindo classification. CONCLUSIONS: Splenectomy has become a less preferred treatment option with the development of non-operative management in splenic trauma, medical treatments for hematological diseases, and a better understanding of the immune, hematological and metabolic functions of the spleen. In the future, minimally invasive and spleen-sparing surgeries will be performed more frequently for patients who need splenectomy even for those with trauma. KEY WORDS: Cyst, Hematology, Laparoscopy, Sepsis, Splenectomy, Trauma.


Assuntos
Esplenectomia , Esplenopatias , Humanos , Estudos Retrospectivos , Esplenectomia/métodos , Esplenopatias/cirurgia , Turquia/epidemiologia
11.
Cir Cir ; 90(2): 157-164, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35349562

RESUMO

BACKGROUND: There are some difficulties regarding the evaluation of the post-splenectomy state. OBJECTIVE: The objective of the study is to compare the post-splenectomy blood changes of immune thrombocytopenia (ITP) patients with those of trauma patients, 1 month and ≥ 6 months after surgery. METHODS: Medical records of patients, who had undergone total splenectomy for ITP and trauma at a tertiary center between January 2009 and December 2019, were retrospectively reviewed. RESULTS: The current study included 52 patients, who had undergone splenectomy for ITP (57.7%), and trauma (42.3%). Splenectomy, irrespective of the indications, resulted in an increase in hemoglobin concentration, hematocrit, and platelet levels. Neutrophils were responsible for the preoperative leukocytosis in ITP patients, and neutrophilia was ameliorated by splenectomy and also withdrawal of the steroid therapy in some patients. Decreased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio supported the finding that splenectomy ameliorated inflammation in ITP patients. Splenectomy resulted in a change in percentages of leukocytes in favor of basophils in ITP patients. CONCLUSIONS: Splenectomy, irrespective of the indications, resulted in an increase in hemoglobin concentration, hematocrit and platelet levels, lymphocyte, monocyte, and eosinophil counts. Splenectomy ameliorated inflammation in ITP patients and resulted in a change in percentages of leukocytes in favor of basophils.


ANTECEDENTES: Existen algunas dificultades con respecto a la evaluación del estado post-esplenectomía. OBJETIVO: Comparar los cambios sanguíneos post-esplenectomía de pacientes con PTI con los de pacientes traumatizados, 1 mes y ≥ 6 meses después de la cirugía. MÉTODOS: Se revisaron retrospectivamente las historias clínicas de los pacientes que habían sido sometidos a esplenectomía total por PTI y trauma en un centro terciario entre enero de 2009 y diciembre de 2019. RESULTADOS: El presente estudio incluyó a 52 pacientes, que habían sido sometidos a esplenectomía por PTI (57.7%) y traumatismo (42.3%). La esplenectomía, independientemente de las indicaciones, resultó en un aumento de la concentración de hemoglobina, hematocrito y niveles de plaquetas. Los neutrófilos fueron responsables de la leucocitosis preoperatoria en pacientes con PTI, y la neutrofilia mejoró mediante esplenectomía y también la suspensión de la terapia con esteroides en algunos pacientes. La disminución de NLR y PLR apoyó el hallazgo de una disminución de la inflamación en la esplenectomía en pacientes con PTI. La esplenectomía resultó en un cambio en los porcentajes de leucocitos a favor de los basófilos en pacientes con PTI. CONCLUSIONES: La esplenectomía, independientemente de las indicaciones, resultó en un aumento de la concentración de hemoglobina, niveles de hematocrito y plaquetas, recuentos de linfocitos, monocitos y eosinófilos. Una disminución de la inflamación en la esplenectomía en pacientes con PTI resultó en un cambio en los porcentajes de leucocitos a favor de los basófilos.


Assuntos
Púrpura Trombocitopênica Idiopática , Plaquetas , Humanos , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/cirurgia , Estudos Retrospectivos , Esplenectomia/métodos , Resultado do Tratamento
12.
Adv Med Sci ; 67(1): 154-162, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35272246

RESUMO

PURPOSE: Portal hypertension (PH)-associated splenomegaly is caused by portal venous congestion and splanchnic hyperemia. This can trigger hypersplenism, which favors the development of cytopenia. We investigated the time-dependent impact of splenectomy on portal pressure and blood cell counts in animal models of non-cirrhotic and cirrhotic PH. MATERIALS AND METHODS: Ninety-six rats underwent either partial portal vein ligation (PPVL), bile duct ligation (BDL), or sham operation (SO), with subgroups undergoing additional splenectomy. Portal pressure, mean arterial pressure, heart rate, blood cell counts and hemoglobin concentrations were evaluated throughout 5 weeks following surgery. RESULTS: Following PPVL or BDL surgery, the animals presented a progressive rise in portal pressure, paralleled by decreased mean arterial pressure and accelerated heart rate. Splenectomy curbed the development of PH in both models (PPVL: 16.25 vs. 17.93 â€‹mmHg, p â€‹= â€‹0.083; BDL: 13.55 vs. 15.23 â€‹mmHg, p â€‹= â€‹0.028), increased mean arterial pressure (PPVL: +7%; BDL: +9%), and reduced heart rate (PPVL: -10%; BDL: -13%). Accordingly, splenectomized rats had lower von Willebrand factor plasma levels (PPVL: -22%; BDL: -25%). Splenectomy resulted in higher hemoglobin levels in PPVL (14.15 vs. 13.08 â€‹g/dL, p â€‹< â€‹0.001) and BDL (13.20 vs. 12.39 â€‹g/dL, p â€‹= â€‹0.097) animals, and significantly increased mean corpuscular hemoglobin concentrations (PPVL: +9%; BDL: +15%). Thrombocytopenia only developed in the PPVL model and was alleviated in the splenectomized subgroup. Conversely, BDL rats presented with thrombocytosis, which was not affected by splenectomy. CONCLUSIONS: Splenectomy improves both cirrhotic and non-cirrhotic PH, and ameliorates the hyperdynamic circulation. Hypersplenism related anemia and thrombocytopenia were only significantly improved in the non-cirrhotic PH model.


Assuntos
Anemia , Hipertensão Portal , Anemia/complicações , Animais , Modelos Animais de Doenças , Hipertensão Portal/complicações , Ligadura/efeitos adversos , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Pressão na Veia Porta , Ratos , Esplenectomia/efeitos adversos
13.
Zhonghua Wai Ke Za Zhi ; 60(5): 424-431, 2022 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-35359082

RESUMO

Although the treatment strategy of esophageal and gastric varices bleeding in portal hypertension has been diversified and multidisciplinary now,the surgical treatment represented by pericardial devascularization operation will still play an important and irreplaceable role in China. In order to standardize the surgical procedure,guide clinical practice and improve the level of surgical treatment of portal hypertension,Chinese Society of Spleen and Portal Hypertension Surgery,Chinese Surgical Society,Chinese Medical Association organized Chinese experts to formulate this consensus. The main contents include:the position of surgical treatment,surgical indications and contraindications,preoperative evaluation,key points and precautions of surgical procedure,perioperative treatment,prevention and treatment of postoperative complications. The consensus emphasizes the standardization of surgical treatment of portal hypertension,pay attention to the prevention and treatment of postoperative portal vein thrombosis,and expect to provide surgeons with clinical guidance.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Consenso , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/cirurgia , Cirrose Hepática/complicações , Estudos Retrospectivos , Esplenectomia/efeitos adversos
14.
Expert Rev Vaccines ; 21(5): 723-733, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35236233

RESUMO

INTRODUCTION: Streptococcus pneumoniae is the most frequent cause of overwhelming post-splenectomy infections. Pneumococcal vaccination is generally recommended for splenectomized individuals. However, most of our knowledge comes from a few observational studies or small randomized clinical trials. We conducted this systematic review to assess the evidence of efficacy, antibody response, and the best timing for pneumococcal vaccination in splenectomized individuals. AREAS COVERED: The systematic review was conducted according to the PRISMA guidelines. We screened 489 articles, included 21 articles, and assessed the risk of bias using Cochrane RoB 2 and ROBINS-I. We summarized the findings narratively due to the heterogeneity of the studies. EXPERT OPINION: Splenectomized individuals seem to have adequate antibody responses to pneumococcal vaccines. No differences in antibody responses were observed compared to healthy controls, except in one study. The studies were heterogeneous, and the majority had moderate to high degree of bias. There is a lack of clinical evidence for efficacy and best timing of pneumococcal vaccination in splenectomized individuals. Randomized clinical trials addressing these issues are needed.


Assuntos
Infecções Pneumocócicas , Adulto , Anticorpos Antibacterianos , Humanos , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Esplenectomia/efeitos adversos , Streptococcus pneumoniae , Vacinação/efeitos adversos
15.
J Visc Surg ; 159(2): 121-135, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35249857

RESUMO

The spleen can be affected by many conditions, some of which are easily diagnosed by conventional imaging, mainly using computed tomography scans and magnetic resonance imaging. Despite the contribution of functional radiology techniques such as positron emission tomography, it is sometimes difficult to diagnose certain focal splenic lesions and definitive diagnosis sometimes requires histological confirmation by percutaneous biopsy or more rarely by diagnostic intervention. Once a diagnosis has been established, treatment is based mainly on surgery: total splenectomy for malignant lesions, or partial splenectomy whenever possible for benign lesions benign that are symptomatic and/or at risk of rupture.


Assuntos
Esplenopatias , Neoplasias Esplênicas , Humanos , Imageamento por Ressonância Magnética/métodos , Esplenectomia/métodos , Esplenopatias/diagnóstico por imagem , Esplenopatias/cirurgia , Neoplasias Esplênicas/diagnóstico por imagem , Neoplasias Esplênicas/cirurgia , Tomografia Computadorizada por Raios X/métodos
16.
Hematol Oncol Clin North Am ; 36(2): 325-339, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35282949

RESUMO

Warm autoimmune hemolytic anemia (wAIHA) is an uncommon and heterogeneous disorder caused by autoantibodies to RBC antigens. Initial evaluation should involve the DAT, with wAIHA typically IgG positive with or without C3 positivity, and a search for underlying conditions associated with secondary wAIHA, which comprise 50% of cases. First-line therapy involves glucocorticoids, increasingly with rituximab, though a chronic relapsing course is typical. While splenectomy and a number of immunosuppressive therapies have been used in the setting of relapsed and refractory disease, the optimal choice and sequence of therapies is unknown, and clinical trials should be offered when available. Newer investigational targets include spleen tyrosine kinase inhibitors, monoclonal antibodies targeting CD38, Bruton's tyrosine kinase inhibitors, complement inhibitors, and antibodies against neonatal Fc receptors.


Assuntos
Anemia Hemolítica Autoimune , Anemia Hemolítica Autoimune/diagnóstico , Anemia Hemolítica Autoimune/terapia , Autoanticorpos/uso terapêutico , Humanos , Recém-Nascido , Inibidores de Proteínas Quinases/uso terapêutico , Rituximab/uso terapêutico , Esplenectomia
17.
Thromb Res ; 213: 114-118, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35334441

RESUMO

INTRODUCTION: Thrombopoietin receptor agonists (TPO-RAs) are a reliable second-line immune thrombocytopenia (ITP) treatment. Despite an increase in use of TPO-RAs, the treatment pattern among adults with ITP is not well understood. MATERIALS AND METHODS: From January 2015 to December 2018, ITP patients were identified using the Korean Health Insurance Review and Assessment Service database. RESULTS: Of the total 3885 adult patients with ITP, 1745 (44.9%) required treatment, with a median follow-up duration of 31.4 months (range, 0.1-59.8 months). Of these, 46.5% and 36.6% continued treatment for more than 6 months and more than 12 months, respectively. Corticosteroids were the most common first-line therapy. Of the treated patients, 83 (4.8%) received TPO-RAs (eltrombopag, 86.7%; romiplostim, 13.3%). The median age of the group treated with TPO-RAs was 62 years, 62.6% were female, and the median time from first diagnosis to initial TPO-RA treatment was 12.5 months (range, 0.4-48.0 months). A total of 52 (62.7%) patients received TPO-RAs as a second-line treatment for ITP. Splenectomy was performed in 19 patients (22.9%) before initiation of TPO-RAs. When clinical efficacy was analyzed before and during TPO-RA use, there was a significant decrease in platelet transfusion and a tendency toward reduced bleeding events. CONCLUSIONS: This population-based study is the first to describe the treatment pattern of TPO-RAs for ITP among patients in Korea.


Assuntos
Púrpura Trombocitopênica Idiopática , Trombocitopenia , Adulto , Benzoatos/efeitos adversos , Pré-Escolar , Feminino , Humanos , Hidrazinas/efeitos adversos , Lactente , Recém-Nascido , Masculino , Púrpura Trombocitopênica Idiopática/diagnóstico , Receptores Fc/uso terapêutico , Receptores de Trombopoetina , Proteínas Recombinantes de Fusão/uso terapêutico , Estudos Retrospectivos , Esplenectomia , Trombocitopenia/induzido quimicamente , Trombopoetina/uso terapêutico
18.
Sci Rep ; 12(1): 1967, 2022 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-35121800

RESUMO

Neutrophil dysfunction contributes to a high susceptibility to severe bacterial infection which is a leading cause of morbidity and mortality in ß-thalassaemia/HbE, especially in splenectomised patients. This study demonstrated another abnormality of neutrophil function, namely neutrophil extracellular trap (NET) formation in splenectomised and non-splenectomised ß-thalassaemia/HbE patients who had iron overload. A classification system of morphological NET formation using confocal microscopy was developed, and samples were categorized into early and late phases which were subdivided into web-like and non-web structures. At baseline, neutrophils from non-splenectomised patients (58 ± 4%) and splenectomised patients (65 ± 3%) had higher early phase NETs than those from normal subjects (33 ± 1%). As a mimic of iron overload and infection, haemin/PMA/LPS treatment led to a significant reduction of early NETs and an increase of late NETs in neutrophils from normal and non-splenectomised patients. Interestingly, neutrophils from splenectomised patients had impaired development of late NETs. This suggests that during infection bacteria might not be trapped and may spread from the site of infection resulting in higher susceptibility to severe bacterial infection in splenectomised patients.


Assuntos
Infecções Bacterianas/genética , Armadilhas Extracelulares/genética , Neutrófilos/microbiologia , Talassemia beta/genética , Infecções Bacterianas/microbiologia , Infecções Bacterianas/patologia , Armadilhas Extracelulares/microbiologia , Humanos , Imunidade Inata/genética , Ferro/metabolismo , Sobrecarga de Ferro/genética , Sobrecarga de Ferro/microbiologia , Sobrecarga de Ferro/patologia , Neutrófilos/patologia , Esplenectomia , Talassemia beta/microbiologia , Talassemia beta/patologia
19.
ANZ J Surg ; 92(3): 471-476, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35146892

RESUMO

BACKGROUND: This retrospective study aimed to present our surgical experience in patients with benign tumour or trauma in spleen who underwent laparoscopic partial splenectomy (LPS) and to compare the results with those of patients who underwent an open partial splenectomy (OPS). METHODS: We analysed the medical data of patients who underwent LPS or OPS between January 2010 and January 2020. RESULTS: In total, 41 patients were enrolled. Nine patients underwent open surgery, 32 patients underwent laparoscopic surgery. The proportion of patients with tumours in the upper pole in LPS group was more than patients in OPS group. No difference was observed in estimated blood loss, allogeneic transfusion, postoperative stay, pathology and complications between LPS and OPS groups. The operation time in the LPS group (137.5 ± 30.8 min) was longer than that in the OPS group (88.3 ± 30.1 min) for patients with splenic traumatic rupture (P = 0.019). CONCLUSIONS: LPS is an effective and safe spleen-preserving surgery as OPS. The advantages are small trauma, light pain and quick recovery. It is suitable for patients with benign tumours or trauma confined to one side of the spleen.


Assuntos
Laparoscopia , Neoplasias , Humanos , Laparoscopia/métodos , Lipopolissacarídeos , Estudos Retrospectivos , Esplenectomia/métodos , Resultado do Tratamento
20.
Int J Mol Sci ; 23(3)2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35163596

RESUMO

Because both endotoxemia and gut dysbiosis post-splenectomy might be associated with systemic infection, the susceptibility against infection was tested by dextran sulfate solution (DSS)-induced colitis and lipopolysaccharide (LPS) injection models in splenectomy mice with macrophage experiments. Here, splenectomy induced a gut barrier defect (FITC-dextran assay, endotoxemia, bacteria in mesenteric lymph nodes, and the loss of enterocyte tight junction) and gut dysbiosis (increased Proteobacteria by fecal microbiome analysis) without systemic inflammation (serum IL-6). In parallel, DSS induced more severe mucositis in splenectomy mice than sham-DSS mice, as indicated by mortality, stool consistency, gut barrier defect, serum cytokines, and blood bacterial burdens. The presence of green fluorescent-producing (GFP) E. coli in the spleen of sham-DSS mice after an oral gavage supported a crucial role of the spleen in the control of bacteria from gut translocation. Additionally, LPS administration in splenectomy mice induced lower serum cytokines (TNF-α and IL-6) than LPS-administered sham mice, perhaps due to LPS tolerance from pre-existing post-splenectomy endotoxemia. In macrophages, LPS tolerance (sequential LPS stimulation) demonstrated lower cell activities than the single LPS stimulation, as indicated by the reduction in supernatant cytokines, pro-inflammatory genes (iNOS and IL-1ß), cell energy status (extracellular flux analysis), and enzymes of the glycolysis pathway (proteomic analysis). In conclusion, a gut barrier defect after splenectomy was vulnerable to enterocyte injury (such as DSS), which caused severe bacteremia due to defects in microbial control (asplenia) and endotoxemia-induced LPS tolerance. Hence, gut dysbiosis and gut bacterial translocation in patients with a splenectomy might be associated with systemic infection, and gut-barrier monitoring or intestinal tight-junction strengthening may be useful.


Assuntos
Bacteriemia/imunologia , Colite/imunologia , Sulfato de Dextrana/toxicidade , Disbiose/imunologia , Tolerância Imunológica/efeitos dos fármacos , Lipopolissacarídeos/toxicidade , Esplenectomia , Animais , Colite/induzido quimicamente , Disbiose/induzido quimicamente , Masculino , Camundongos
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