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Search on : hypersplenism [Words]
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[PMID]: 29506574
[Au] Autor:Dalugama C; Gawarammana IB
[Ad] Address:Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. chamaradalugama@yahoo.com.
[Ti] Title:Fever with pancytopenia: unusual presentation of extrapulmonary tuberculosis: a case report.
[So] Source:J Med Case Rep;12(1):58, 2018 Mar 06.
[Is] ISSN:1752-1947
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Tuberculosis is a major health problem in the developing world. Diagnosis of extrapulmonary tuberculosis is delayed because the presentation is nonspecific. Extrapulmonary tuberculosis can present with various hematological manifestations, including pancytopenia. Pancytopenia could be due to hypersplenism, maturation arrest, hemophagocytic lymphohistiocytosis, or infiltration of the bone marrow by caseating or noncaseating granulomas causing reversible or irreversible fibrosis. CASE PRESENTATION: We report a case of a 56-year-old Sri Lankan Sinhalese man who presented with pyrexia of known origin with significant loss of weight and loss of appetite. He had mild pallor with mild hepatosplenomegaly. He had high inflammatory markers with pancytopenia in a peripheral blood smear. His chest radiograph was unremarkable, and he had a negative Mantoux test result. A diagnosis of disseminated tuberculosis was made on the basis of caseating tuberculous granulomas in the bone marrow. CONCLUSIONS: Disseminated tuberculosis remains a diagnostic challenge because the presentation is vague and nonspecific. In case of pyrexia of unknown origin with peripheral cytopenia, the possibility of disseminated tuberculosis should be considered, particularly in endemic areas. Simultaneous culture and histopathological examination of the bone marrow is important in such instances, because results of common tests such as chest radiography or Mantoux tests can be negative.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Process
[do] DOI:10.1186/s13256-018-1596-0

  2 / 2341 MEDLINE  
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[PMID]: 29521675
[Au] Autor:Freund MR; Reissman P; Zimran A; Alberton J
[Ad] Address:Department of General Surgery.
[Ti] Title:Splenectomy in Gaucher Disease: A Call for Minimally Invasive Surgery.
[So] Source:Surg Laparosc Endosc Percutan Tech;, 2018 Mar 07.
[Is] ISSN:1534-4908
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: The objective of this article was to demonstrate that Gaucher disease (GD) patients with refractory hypersplenism and massive splenomegaly may successfully undergo hand-assisted laparoscopic splenectomy (HALS). METHODS: This was a retrospective audit conducted at the Gaucher clinic at a national referral center over a 10-year period. PATIENT POPULATION: This study included 8 GD patients who underwent hand-assisted or conventional laparoscopic splenectomy for massive or complicated splenomegaly between the years 2007 and 2017. RESULTS: Seven patients underwent an elective HALS procedure because of refractory hypersplenism, whereas 1 patient underwent an urgent conventional laparoscopic splenectomy because of torsion of a wandering spleen. Only 1 patient required conversion to open surgery because of multiple adhesions from a previous partial splenectomy. The mean weight of the removed spleens was 2373 g (range, 480 to 4900 g), mean craniocaudal length of the removed spleens was 25 cm (range, 20 to 33.5 cm), and mean operating time was 150 minutes (range, 96 to 280 min). Postoperative complications were limited to 2 patients and included thrombosis of the splenic vein stump in 1 patient, and propagation of a preoperative splenic vein thrombus to the portal system, as well as an accumulation of an intra-abdominal hematoma in another patient. There was no mortality. Mean length of hospital stay was 5 days (range, 2 to 11 d). CONCLUSION: HALS for GD patients with refractory hypersplenism and massive splenomegaly is safe and feasible in experienced hands.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1097/SLE.0000000000000518

  3 / 2341 MEDLINE  
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[PMID]: 29391322
[Au] Autor:Zhan X; Chen Y; Wang Y
[Ad] Address:Department of General Surgery, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
[Ti] Title:Laparoscopic splenectomy and subsequent oncologic gastric surgery in cirrhotic patients with portal hypertension and hypersplenism.
[So] Source:Turk J Gastroenterol;29(1):132-133, 2018 01.
[Is] ISSN:2148-5607
[Cp] Country of publication:Turkey
[La] Language:eng
[Pt] Publication type:LETTER
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:In-Process
[do] DOI:10.5152/tjg.2018.17326

  4 / 2341 MEDLINE  
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[PMID]: 29452668
[Au] Autor:Kalpadakis C; Pangalis GA; Angelopoulou MK; Sachanas S; Vassilakopoulos TP
[Ad] Address:Department of Haematology, Heraklion University Hospital, 71001, University of Crete, Heraklion, Crete, Greece. Electronic address: xkalpadaki@yahoo.gr.
[Ti] Title:Should rituximab replace splenectomy in the management of splenic marginal zone lymphoma?
[So] Source:Best Pract Res Clin Haematol;31(1):65-72, 2018 Mar.
[Is] ISSN:1532-1924
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract: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.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180217
[Lr] Last revision date:180217
[St] Status:In-Data-Review

  5 / 2341 MEDLINE  
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[PMID]: 29249783
[Au] Autor:Tanaka Y; Matsumoto I; Saito D; Yoshida S; Kakegawa S; Tamura M; Takemura H
[Ad] Address:General, Thoracic and Cardiovascular Surgery, Kanazawa University, Kanazawa, Japan.
[Ti] Title:[Utility of Partial Splenic Embolization Prior to Lung Resection in Patients Demonstrating Platelet Transfusion Refractoriness Due to Hypersplenism].
[So] Source:Kyobu Geka;70(13):1063-1067, 2017 Dec.
[Is] ISSN:0021-5252
[Cp] Country of publication:Japan
[La] Language:jpn
[Ab] Abstract:It is often difficult to control perioperative bleeding in patients with liver cirrhosis and concurrent thrombocytopenia and coagulation factor deficiency. Partial splenic embolization (PSE), an auxiliary treatment strategy in management of liver cirrhosis and hepatocellular carcinoma, can not only increase platelets but also improve liver function. With advances in interventional radiology, PSE is a safer and more reliable procedure compared to a splenectomy. We present the case of a 69-year-old man diagnosed with left lung cancer, with thrombocytopenia, and hepatitis C virus-related cirrhosis. Although he was administered prophylactic platelet transfusion prior to operation, he was noted to be refractory to platelet transfusion. PSE was performed to improve his thrombocytopenia, following which we could safely perform left upper lobectomy of the lung and ND2a-1 lymph node dissection without any major bleeding. PSE is useful induction therapy to provide a wider choice of treatment options for patients with thrombocytopenia.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180208
[Lr] Last revision date:180208
[St] Status:In-Process

  6 / 2341 MEDLINE  
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[PMID]: 29199112
[Au] Autor:Maaloul I; Laaroussi O; Jedidi I; Sfaihi L; Kmiha S; Kamoun T; Aloulou H; Hachicha M
[Ad] Address:Service de pédiatrie générale, CHU Hédi Chaker, route El Ain km 0,5, 3029 Sfax, Tunisie. Electronic address: maaloul.ines@hotmail.fr.
[Ti] Title:Prise en charge thérapeutique des patients atteints de bêta-thalassémie majeure dans un service de pédiatrie du sud tunisien : à propos de 26 cas. [Management of patients with major beta thalassemia in a paediatric department in the south of Tunisia: About 26 cases].
[So] Source:Transfus Clin Biol;25(1):14-18, 2018 Feb.
[Is] ISSN:1953-8022
[Cp] Country of publication:France
[La] Language:fre
[Ab] Abstract:AIM: Our objectives were to assess the management of patients with major thalassemia and identify the various complications and monitoring means. PATIENTS AND METHODS: A retrospective study was conducted on 26 ß-thalassemic patients in the department of paediatrics, Hédi Chaker hospital, Sfax, Tunisia during a period of 25 years (from 1 January 1990 to 31 December 2014). RESULTS: The mean age of the beginning of transfusion was 11.5 months. That was with phenotyped red blood cells but not leukodepleted blood. Twenty-three patients received chelation. Before 2001, all patients received deferoxamine, poor adherence to this treatment was observed in 66% of cases. It was replaced by deferiprone since 2006 and deferasirox since 2009. A combination of 2 or 3 chelators was indicated for four patients. A total splenectomy was performed in 10 cases patients; it was due to hypersplenism. The bone marrow transplant was performed for one patient at the age of 9 year but it was rejected. Many complications were detected: endocrine complications (19 cases), immune complications (9 cases), gallbladder stones (5 cases), cardiac complications (4 cases), osteoporosis (3 cases), infectious complications (3 cases) and thromboembolic complications (2 cases). We noted some side effects related to chelation therapy in twelve cases. Four patients were dead. CONCLUSION: Improving the medical care of homozygous ß-thalassemic children requires adherence to transfusion regimen and chelation therapy. Bone marrow transplantation remains the only possible curative therapy, which must be promoted in our country.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180207
[Lr] Last revision date:180207
[St] Status:In-Process

  7 / 2341 MEDLINE  
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[PMID]: 29273377
[Au] Autor:Du Z; Dong J; Zhang J; Bi J; Wu Z; Lv Y; Zhang X; Wu R
[Ad] Address:Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Xi'an, Shaanxi Province, China; Institute of Advanced Surgical Technology and Engineering, Xi'an, Shaanxi Province, China; Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an,
[Ti] Title:Incidence and risk factors associated with a high comprehensive complication index score after splenectomy in cirrhotic patients with hypersplenism.
[So] Source:J Surg Res;222:69-74, 2018 Feb.
[Is] ISSN:1095-8673
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Postoperative complications after splenectomy are not rare and can be serious in cirrhotic patients. The purpose of this study was to assess postoperative complications using the comprehensive complication index (CCI) after splenectomy in cirrhotic patients and identify risk factors for those who developed a high postoperative CCI score. MATERIALS AND METHODS: This retrospective study included 208 adult patients with viral hepatitis-related cirrhosis, who underwent elective splenectomy at our hospital from January 2002 to June 2012. The primary outcome was the CCI score. A CCI score >30 was considered to be a high CCI score. RESULTS: The median CCI score in this cohort was 25.6 (range: 8.7-62.9), and 66 patients (31.7%) had a CCI score >30. Univariable and multivariable analyses showed that the risk factors independently associated with a high CCI score were a history of hypertension and a model for end-stage liver disease (MELD) score ≥10 prior to splenectomy. CONCLUSIONS: A high CCI score is common in cirrhotic patients undergoing splenectomy. The CCI is a useful grading system to assess postoperative morbidity in cirrhotic patients undergoing splenectomy. Preoperative blood pressure control is recommended and cirrhotic patients with an elevated MELD score should consider other treatment options for hypersplenism.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171223
[Lr] Last revision date:171223
[St] Status:In-Data-Review

  8 / 2341 MEDLINE  
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[PMID]: 29255554
[Au] Autor:Belhamidi MS; Hammi SE; Bouzroud M; Benmoussa M; Ali AA; Bounaim A
[Ad] Address:Service de Chirurgie Viscérale I, Hôpital Militaire d'Instruction Mohamed V, Université de Souissi, Rabat, Maroc.
[Ti] Title:Place de la splénectomie dans la prise en charge de l'hypertension portale non cirrhotique: à propos de 3 cas. [Role of splenectomy in the treatment of non-cirrhotic portal hypertension: about 3 cases].
[So] Source:Pan Afr Med J;28:84, 2017.
[Is] ISSN:1937-8688
[Cp] Country of publication:Uganda
[La] Language:fre
[Ab] Abstract:Non-cirrhotic portal hypertension was first described by Guido BANTI in 1898 as a condition characterized by the association of portal hypertension with splenomegaly, anemia and healthy liver. The diagnosis was based on abdominal ultrasound, splenoportography and liver biopsy. Our study aimed to evaluate the role of splenectomy in non-cirrhotic portal hypertension. We conducted a retrospective study of 3 patients (2 women and 1 man) treated by our staff over the period January 2010 -September 2016. The diagnosis of idiopathic portal hypertension was based on the following criteria: portal hypertension, the presence of oesophageal varices associated with splenomegaly, the absence of cirrhosis or of other liver disorders responsible of portal hypertension. All patients underwent splenectomy. Outcome after splenectomy was marked by the standardization of clinical, radiological and biological signs of this disease associated with the absence of oesophageal varices recurrence. Splenectomy associated with ligation of oesophageal varices may be sufficient to treat this syndrome and especially its consequences without using splenorenal bypass.
[Mh] MeSH terms primary: Esophageal and Gastric Varices/etiology
Hypertension, Portal/surgery
Liver Cirrhosis/surgery
Pancytopenia/surgery
Splenectomy/methods
Splenomegaly/surgery
[Mh] MeSH terms secundary: Adult
Female
Humans
Hypertension, Portal/diagnosis
Hypertension, Portal/physiopathology
Liver Cirrhosis/diagnosis
Liver Cirrhosis/physiopathology
Male
Pancytopenia/diagnosis
Pancytopenia/physiopathology
Retrospective Studies
Splenomegaly/diagnosis
Splenomegaly/physiopathology
Treatment Outcome
Young Adult
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171222
[Lr] Last revision date:171222
[Js] Journal subset:IM
[Da] Date of entry for processing:171220
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.28.84.11712

  9 / 2341 MEDLINE  
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[PMID]: 29198895
[Au] Autor:Long L; Jinshan Z; Zhen C; Qi L; Ning D; Mei D; Wei C
[Ad] Address:Department of Pediatric Surgery, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, 100021, People's Republic of China; Medical Department, Peking University, Beijing, 100000, People's Republic of China. Electronic address: lilong23@126.com.
[Ti] Title:Portal-to-right portal vein bypass for extrahepatic portal vein obstruction.
[So] Source:J Pediatr Surg;, 2017 Nov 04.
[Is] ISSN:1531-5037
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Rex shunt (mesenteric-to-left portal vein bypass) is considered a more physiologically rational treatment for EHPVO than other portosystemic systemic shunts in children. However, about 13.6% of children with EHPVO do not have usable left portal veins and up to 28.1%. Rex operations in children are not successful. Hence, a Rex shunt in these children was impossible. This study reports a novel approach by portal-to-right portal vein bypass for treatment of children with failed Rex shunts. MATERIAL AND METHODS: Eight children (age 6.1years, range 3.5-8.9years) who underwent Rex shunts developed recurrent gastrointestinal bleeding and hypersplenism 13months (11-30months) postoperatively. After ultrasound confirmation of blocked shunt, they underwent exploration. Three patients were found to have right portal vein agenesis. Five patients (62.5%) were found to have the patent right portal vein, with the diameter of 3-6mm. Four patients underwent bypass between the main portal vein in the hepatoduodenal ligament and the right portal vein by interposing an inferior mesenteric vein autograft, whereas the remaining patient underwent a bypass using ileal mesenteric vein autograft. RESULTS: The operations took 2.3h (1.9-3.5h). The estimated blood loss was 50ml (30-80ml), with no complication. The portal venous pressure dropped from 34.6cmH O (28-45 cmH O) before the bypass to 19.6cmH O (14-24cmH O) after the bypass. The 5 patients were followed up for 10.2months (4-17months) and the post-operative ultrasound and CT angiography confirmed the patency of all the grafts and disappearance of the portal venous cavernova in all five patients. CONCLUSION: The portal-to-right portal vein bypass technique is feasible and safe for treatment of children with EHPVO who have had failed Rex shunts. Our preliminary result indicates that this technique extends the success of Rex shunt from left portal vein to right portal vein and open a new indication of physiological shunt for some of the children who not only have had failed Rex shunts or but also are not suitable for the Rex shunts. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171204
[Lr] Last revision date:171204
[St] Status:Publisher

  10 / 2341 MEDLINE  
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[PMID]: 29196972
[Au] Autor:Maki H; Kaneko J; Arita J; Akamatsu N; Sakamoto Y; Hasegawa K; Tamura S; Takao H; Shibata E; Kokudo N
[Ad] Address:Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
[Ti] Title:Proximal total splenic artery embolization for refractory hepatic encephalopathy.
[So] Source:Clin J Gastroenterol;, 2017 Dec 01.
[Is] ISSN:1865-7265
[Cp] Country of publication:Japan
[La] Language:eng
[Ab] Abstract:A Japanese woman with a history of Kasai operation for biliary atresia had living-donor liver transplantation at the age of 22. The first episode of refractory HE and late cellular rejection was treated by a high dose of methylprednisolone. The second episode of refractory HE was treated by balloon-occluded retrograde transvenous obliteration for a spleno-renal shunt. However, the third episode of refractory HE occurred 11 years after liver transplantation. The liver cirrhosis and hypersplenism were present with a Child-Pugh score of C-10. Although portal vein flow was hepatopetal, superior mesenteric vein flow regurgitated. We performed proximal total splenic artery embolization (TSAE). Superior mesenteric vein flow changed to a hepatopetal direction and she became clear. At a year after proximal TSAE, her spleen volume had decreased to 589 mL (20% decrease) on computed tomography. She is well and has a Child-Pugh score of 8 without overt HE. We report the first case of refractory HE treated by proximal TSAE that is a possible less invasive treatment option for a selected patient.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171202
[Lr] Last revision date:171202
[St] Status:Publisher
[do] DOI:10.1007/s12328-017-0805-5


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