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Query: UMLS:C0038002 (splenomegaly)
 9,873 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two hundred and seventy patients with febrile splenomegaly and coming from areas where visceral leishmaniasis (VL; kala-azar) is endemic and in whom the diagnosis of kala-azar was strongly suspected were randomly divided into 3 groups, subjected to splenic aspiration by the intercostal route, splenic aspiration by the abdominal route, and bone marrow aspiration, respectively, for demonstration of amastigotes. Pain immediately after aspiration, requiring a few analgesic tablets, occurred in 8, 16 and 20 patients of the 3 groups, respectively. Pain on the day after aspiration was reported by 2, 4 and 6 patients, respectively. One patient, in the abdominal group, developed gastro-intestinal haemorrhage but this was managed with blood transfusion; he was not suffering from VL. No patient died. The abdominal route of splenic aspiration was not feasible in 12 patients (13%), as their spleen size was less than 3 cm, and they were subsequently aspirated by the intercostal route. On the first aspiration, amastigotes were seen in 68 patients (76%) in the intercostal group, 64 patients (71%) in the abdominal group and 42 patients (46%) in the bone marrow group. Two weeks later, 15 patients (17%) in the bone marrow group and in whom amastigotes had not been detected, but whose fever continued, were subjected to intercostal splenic aspiration and amastigotes were detected. After 2 months, 3 patients in the intercostal group and 4 patients in the abdominal group gave positive aspirates, and 2 patients in the intercostal group, one in the abdominal group, and one in the bone marrow group did so at the third aspiration. Thus only 200 (74%) of 270 patients were suffering from VL. It was concluded that, with some precautions, splenic aspiration is a safe and easy method for the diagnosis of VL, and the intercostal route is preferred because it is feasible in a larger proportion of cases and anatomically safer than the abdominal route, and it gives a positive result more often than bone marrow aspiration.
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PMID:A comparison of intercostal and abdominal routes of splenic aspiration and bone marrow aspiration in the diagnosis of visceral leishmaniasis. 950 75

Eight patients with tuberculosis of the head of the pancreas were retrospectively reviewed. They were 4 men and 4 women (mean age 42.8 years). All patients complained of fever, sweating, fatigue, weight loss, and in the pain in the upper right belly. Abdominal mass was noted in 4 patients, jaundice in 3, and splenomegaly with hypersplenism in 4. Among the 8 patients, 5 suffered tuberculosis of the pancreas before the operation. All of them received laparotomy. Pancreatic tuberculosis in the all patients was confirmed by pathologically. Tuberculosis abscess was drained operatively. Antituberculosis therapy was available for all patients after the operation.
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PMID:[Tuberculosis of the pancreatic head]. 959 92

Splenic infarct is a rare complication of portal hypertension. It has been reported as an early complication after successful liver transplantation when portal pressure returns to normal and the splenic size progressively declines. It has not been reported as a late complication of liver transplantation. We describe the case of a 19-year-old patient with a splenic infarct which occurred 11 months after successful orthotopic liver transplantation for decompensated cryptogenic liver cirrhosis. Following transplantation, the patient was in excellent general health, liver function tests were normal, there was no clinical evidence of portal hypertension and the splenic size had decreased significantly compared to the pre-transplantation period, although it remained increased. The patient presented with high fever, left pleuritic pain and vomiting. The splenic size had not changed and left pleuritic exudate fluid collection was detected. A hypoechoic region of the spleen was demonstrated in the ultrasound examination corresponding to a hypodense lesion in the computerized tomography scanning. The patient recovered completely, with the disappearance of the infarct in the imaging studies in 2 months time. This case report indicates that a symptomatic splenic infarct can occur late following successful liver transplantation for liver cirrhosis despite lack of any evidence of residual portal hypertension at a time that splenomegaly has not yet regressed. The differential diagnosis from a splenic abscess in transplanted patients can be difficult but the final prognosis seems to be good.
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PMID:Splenic infarct as a late complication of liver transplantation. 983 Dec 79

Splenectomy is indicated in several hematological disorders and it can be particularly challenging in children with sickle cell disease, splenomegaly, and recurrent sequestration. Over the last 6 months, we have developed a new technique for laparoscopic splenectomy (LS) for hypersplenism and splenomegaly in five children with sickle cell disease. The average age of our patients was 6 years (range, 2-11), and the average weight was 18.7 kg (range, 13.2-30.1). On preoperative ultrasound, spleen size index ranged from 0.42 to 0.76. For the LS, four trochars were placed. One patient, who also underwent a laparoscopic cholecystectomy, had six trochars placed, two of which were used for both cholecystectomy and splenectomy. After laparoscopic mobilization of the spleen and hilar vascular stapling, a Steiner electromechanical morcellator was inserted through the 12-mm port to extract cores of splenic tissue until complete splenectomy was achieved. No patient required conversion to an open procedure or creation of a larger incision to remove the massively enlarged spleen. Operative time averaged 190 minutes; the combined LS and cholecystectomy took 245 minutes. Postoperative length of stay was <2 days for all patients. There were no complications, and no patient required postoperative transfusion. Based on these early findings, we conclude that intracorporeal coring of splenic tissue allows for safe and complete laparoscopic removal of very large spleens in small children. It provides expedient recovery and minimal postoperative pain and scarring. This new technique should enable surgeons to perform LS even in patients with massive splenomegaly, eliminating the need for large and cumbersome intracorporeal bags or the creation of additional incisions to remove the spleen.
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PMID:A new technique for laparoscopic splenectomy with massively enlarged spleens. 984 36

For the majority of leukemic patients, leukapheresis represents emergency treatment aimed at reducing the number of white blood cells and producing an immediate improvement in the clinical picture. We have shown that leukapheresis procedures performed for the therapy of leukocytosis in 4 patients with acute leukemia (2 myelocytic; 1 lymphocytic; 1 monoblastic) resulted in marked reduction in the white blood cell count and a considerable reduction in symptomatology. Repeat removal of white blood cells applied in 20 instances for patients with chronic myelocytic leukemia also produced a significant decrease in the cell count and relief of symptoms such as sweating, malaise, and pain due to splenomegaly. In chronic lymphocytic leukemia (31 patients), intensive and frequent leukapheresis procedures were followed by a marked fall in white blood cell count, regression of splenomegaly/lymphadenopathy and resolution of many symptoms and signs induced by the large number of cells.
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PMID:Therapeutic leukapheresis. 1014 47

Histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease (KFD) was described in 1972. Painful, palpable lymphadenitis is localized to one or two sites in the head and neck territories in young adults (third decade) and is associated with fever. Other clinical manifestations are infrequent: arthromyalgias, cutaneous rash, sweating, splenomegaly. Leukopenia is present in 50% of the cases with sometimes "atypical" lymphocytes. A spontaneously favorable outcome is noted after a mean 3 months. Histopathology of the lymph node is the key for the diagnosis of KFD showing lymph node necrosis of 25 to 75% of the surface, in the cortex and the medulla of the lymph nodes with histiocytic proliferation and plasma cells. Histochemistry shows positive straining for monocytic markers (CD68+, KiM1P+). Alpha-beta CD8+ T cells are abundant, NK and B cells are scarce. Pathological examination enables to differentiate KFD from other types of necrotizing lymphadenitis (SLE, malignant lymphoma, pyogenic infections). Kikuchi disease can be the result of local hyperimmune stimulation after viral, bacterial or parasitic infection. CD4+ cells would then become apoptotic cells. In some cases KJD is associated with systemic diseases such as systemic lupus erythematosus or adult Still's disease.
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PMID:[Kikuchi disease]. 1044 90

Despite the prevalence of splenomegaly as a sign in many disorders, there have been no studies that correlate the degree of organomegaly with the symptoms generally ascribed to splenic enlargement. The degree of splenomegaly was compared with five overt symptoms of mechanical displacement, i.e. chronic abdominal pain, abdominal discomfort, early satiety, pain while lying on the side, or attacks of acute (colicky) left upper quadrant pains. We have also employed splenomegaly as seen in Gaucher disease as a paradigm to determine whether there is a correlation between the degree of splenomegaly and the parameters of hypersplenism. Although there was a statistically significant correlation between degree of splenomegaly and blood counts, this proved to be clinically negligible. Surprisingly, there was also no correlation between degree of splenomegaly and any of symptoms investigated.
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PMID:Is there a correlation between degree of splenomegaly, symptoms and hypersplenism? A study of 218 patients with Gaucher disease. 1046 78

Laparoscopically assisted splenectomy with an 8- to 10-cm left upper paramedian laparotomy was performed following preoperative splenic artery embolization using painless contour emboli (super absorbent polymer microsphere) with early successful results in two men (46 and 37 years old) with myelofibrosis accompanied by massive splenomegaly. Dissection around the lower part of the spleen and the hilum initially was performed intracorporeally with the usual laparoscopic view under 12 mm Hg pneumoperitoneum. The alternating changes of viewpoints between the direct view through an 8- to 10-cm incision and the usual laparoscopic view with or without application of a retraction method were effective for safe hilar devascularization. Preoperative splenic artery embolization at the distal site was effective for safe dissection around the enlarged spleen. The patients did not complain of pain before operation. Preoperative painless embolization and laparoscopically assisted splenectomy with small laparotomy promotes the feasibility and safety of minimally invasive splenectomy for myelofibrosis with massive splenomegaly.
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PMID:Laparoscopically assisted splenectomy following preoperative splenic artery embolization using contour emboli for myelofibrosis with massive splenomegaly. 1080

Splenectomy for massive splenomegaly is frequently performed for hematologic disorders for diagnostic and therapeutic indications. The role of splenectomy is complex and controversial. The aims of our retrospective study were to focus on postoperative complications and advantages of splenectomy for massive splenomegaly. Thirty six patients with splenomegaly weighing 1000 g or more, underwent splenectomy at Centre Hospitalier Universitaire Lyon Sud, from January 1st, 1982, to December 31, 1995. Thirty-one (85%) of these patients had hematologic malignancy and more than half of them were older than sixty years. The main indications for splenectomy were hypersplenism (18 patients) and diagnosis (14). Preliminary ligation of the splenic artery was performed in 25 patients (42%). All patients had drainage. The mortality and morbidity rates were 5.5% and 20%, respectively. No major septic or thromboembolic complications occurred. There was only one major bleeding complication. The advantages of splenectomy included histopathological diagnosis in 13 of 14 patients with splenomegaly of unknown origin, permanent pain relief in all cases, and immediate correction of hematological cytopenia in 27 cases (75%). We conclude that the large weight of the spleen does not constitute a contraindication to splenectomy, but indications must be carefully selected, and the operative and perioperative management, must be appropriate.
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PMID:[Splenectomy for splenomegaly of more than 1000 grams. A retrospective study of 36 patients]. 1086 32

Recent studies have shown that involvement of the gastrointestinal tract is much more frequent than originally reported in patients with systemic mastocytosis. Seventy percent to 80% of patients with systemic mastocytosis are found to have gastrointestinal symptoms when a careful history is taken, and abnormalities in the gastrointestinal tract are frequently detected by endoscopic studies, functional studies of absorption, and barium studies. Because of the rarity of the disease, there are few prospective studies of gastrointestinal involvement, so the actual frequency of upper and lower gastrointestinal lesions is unknown. Furthermore, there have been no studies correlating endoscopic abnormalities of the lower gastrointestinal tract with the presence or absence of diarrhea, which is a frequent symptom (mean, 43% [range 14%-100%]). A review of gastric acid studies reveals that a proportion of patients develop gastric acid hypersecretion because of the hyperhistaminemia, which can result in ulcer disease that in turn can cause dyspeptic pain, small intestinal mucosal damage, and malabsorption. In some patients gastric acid hypersecretion in the range seen in Zollinger-Ellison syndrome can develop. A number of studies suggest that the prevalence of peptic ulcer disease has been underestimated in these patients and is certainly higher than the general population. The exact physiologic basis for the diarrhea or nondyspeptic abdominal pain remains largely unknown in these patients. Whereas some studies suggest small intestinal mucosal abnormalities are responsible for most cases of malabsorption not associated with gastric acid hypersecretion, this supposition also remains unproven. Hepatomegaly, portal hypertension, splenomegaly, and ascites occur frequently in patients with systemic mastocytosis, especially those with category II through IV disease. Whereas the histology of the liver and spleen and alterations in hepatic function studies have been well studied, the pathogenesis of each of these abnormalities has not been well studied, and almost all the information comes from a few well-studied case reports.
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PMID:Gastrointestinal abnormalities and involvement in systemic mastocytosis. 1090 42


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