Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038002 (splenomegaly)
 9,873 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The role of laparoscopy in medical practice was assessed by studying 238 consecutive laparoscopies performed under local anaesthesia by physicians in a single teaching hospital. Indications for laparoscopy were assessment of possible and known hepatic disease, possible disseminated abdominal malignancy, abdominal mass, and conditions such as ascites and splenomegaly. A definitive diagnosis was reached in 223 cases (76.5%). No organic disease was detected in 41 patients, though findings were false-negative in two of them (0.8%). The procedure failed in 15 (6.3%), mostly because adhesions from previous surgery hindered adequate visualisation. Six patients (2.5%) had complications, one of whom subsequently died. If patients are appropriately selected laparoscopy is relatively free of postoperative complications, and is an effective diagnostic procedure in abdominal malignancy and decompensated liver disease. Cost-effectiveness is an additional advantage.
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PMID:Physician's use of laparoscopy. 15 41

It has been previously reported that NK cell function decreases following surgery in mice. To explore the basis of this observation, we compared the relative influence of anesthesia, surgical amputation and bleeding on NK cell cytotoxicity in C57BL/6 mice. After hind limb amputation, including with blood loss, there was a statistically significant decrease in NK cell cytotoxicity and the appearance of splenomegaly on the 4th day postoperative day. The increase in spleen size appeared to be due to either the surgical stress-induced expansion of splenic erythroblasts or erythroblast generation following blood loss. In contrast, if blood loss was minimal there was no suppression of NK cell cytotoxicity following hind limb amputation. Moreover, there was a statistically significant correlation of NK cell activity and the quantitation of total blood loss. Interestingly, the decrement in NK cell activity was not observed if blood transfusion was made, even in the presence of surgical amputation. These observations are important for defining the immune suppression reported following surgery and suggest that in human, chronic blood loss may also be associated with immune suppression.
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PMID:Stress and murine NK cell function: the role of blood loss. 134 May 8

Splenomegaly associated with myelodysplastic disorders in children may be massive and can result in pancytopenia, abdominal discomfort, and respiratory distress. When these symptoms cannot be relieved by nonsurgical means, splenectomy may be indicated. Under such conditions, surgical splenectomy carries increased risks, as the thrombocytopenia is difficult to correct secondary to splenic sequestration. Additionally, the surgical anatomy is often distorted secondary to the massive spleen and dissection can be difficult. These factors can lead to uncontrollable hemorrhage. In an attempt to decrease intraoperative blood loss, the authors successfully performed preoperative splenic artery embolization in 11 of 12 children (age range, 1-11 years) with pancytopenia due to hypersplenism. Hypersplenism requiring surgical splenectomy was due to leukemia (n = 9), myelodysplastic syndrome (n = 1), immune thrombocytopenia (n = 1), and osteopetrosis (n = 1). Embolization was performed under general anesthesia, prior to surgery, with gelatin sponge particles alone, Gianturco coils alone, or a combination of polyvinyl alcohol sponge particles and Gianturco coils. Embolization allowed for safe surgical splenectomy.
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PMID:Preoperative embolization of the spleen in children with hypersplenism. 144 26

Magnetic resonance imaging was applied to measure the volumes of spleens and lymph nodes of mice infected with three different leukemia retroviruses (LP-BM5 murine leukemia virus, Friend, and Rauscher) in vivo. Anesthesia by rapid intraperitoneal injection of Saffan was sufficient for magnetic resonance imaging and could be repeated at appropriate intervals. Eleven frontal magnetic resonance images through the abdomen with a center-to-center distance of 1.5 mm between adjacent slices were acquired simultaneously. To optimally demarcate spleens from the surrounding tissues, the magnetic resonance images were mildly T2-weighted for mice infected with LP-BM5 murine leukemia virus and mildly T1-weighted for those infected with Friend and Rauscher virus. Measurements requiring only 3 to 4 hours in groups of 24 to 28 mice were accomplished by using a standardized holder (i) accommodating two animals in the supine position and (ii) ensuring reproducible positioning in the magnetic resonance-instrument, and (iii) by reducing the number of phase-encoding steps of mildly T2-weighted magnetic resonance images from 256 to 128. Volumes of spleens and inguinal lymph nodes were calculated from the respective cross-sectional areas. The weights and magnetic resonance image-derived volumes of spleens and inguinal lymph nodes correlated well (r greater than 0.95). Despite large variations in the extent of splenomegaly and lymphadenopathy at any given time, the progression of the disease could easily be followed by repeating magnetic resonance imaging at intervals. Thus, statistically relevant results can be obtained in an infection model requiring the use of only a few animals.
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PMID:Course of murine leukemia retrovirus infection determined in vivo by magnetic resonance imaging. 217 50

Splenectomy for massive splenomegaly and hypersplenism carries a significant morbidity and mortality. We have used partial splenic embolization (PSE) as an effective alternative to splenectomy. Ten PSE procedures were performed on nine patients without mortality and with minimal morbidity. The age of the patients ranged from 8 months to 32 years (mean 14 years). The causes of splenomegaly and hypersplenism included cystic fibrosis with cirrhosis (2), tyrosinemia and cirrhosis (1); thalassemia (1), hemophilia with Human Immune Deficiency Virus infection (2), chronic hepatitis with portal hypertension (1), malignant histiocytosis (1), and Wiskott-Aldrich Syndrome (1). All procedures were performed under local anesthesia with sedation. A percutaneous femoral artery approach to the splenic artery was used to deliver Ivalon sponge particles (280-800 microns) into the spleen. Splenic infarction was assessed by postembolization angiograms. All of the patients except one demonstrated improvement of hematologic parameters. In one patient, however, cytopenia improved only after a second embolization. In the total series, there was an early mean rise of 8,600/mm3 in the leukocyte count (range 2,900-14,900) and 212,000/mm3 in the platelet count (range 30,000-718,000). Follow-up ranged from 4 months to 7 years. Improvement of the blood picture has been persistent in seven of the eight patients who showed initial improvement. Transient procedural complications included fever (5), pleural effusion (2), pneumonia (1), and splenic abscess (1). One patient had paralytic ileus lasting for 10 days and one patient developed a streptococcal peritonitis 3 weeks after embolization. No patient developed pancreatitis or vascular compromise of other abdominal viscera.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Partial splenic embolization. An effective alternative to splenectomy for hypersplenism. 226 5

Uninfected male and female BALB/c mice were given a twice weekly intraperitoneal injection, of supernatants obtained from 24-h cultures of Plasmodium berghei-infected and control mouse red blood cells, for 5 weeks. The mice were then weighed along with uninjected controls. All the animals were sacrificed by chloroform anaesthesia and their spleen weights measured. Mice receiving malaria culture supernatants had statistically similar spleen weights to those receiving control culture supernatants. The results fail to show the involvement of a malaria 'mitogen' in the pathogenesis of the splenomegaly associated with this infection.
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PMID:Failure to induce splenomegaly in BALB/c mice using rodent malaria culture supernatants. 635 8

Mucopolysaccharidosis IVA (Morquio-Brailsford syndrome) results from an inborn deficiency of n-acetyl-galactosamine-6-sulphate sulphatase. Clinical features include skeletal deformities with hypoplasia or absence of the odontoid process of the axis. The resulting atlanto-axial subluxation compresses the spinal cord, resulting in cervical myelopathy. Without treatment, quadriplegia ensues sooner or later; consequently, surgical decompression and dorsal fusion of the cervical vertebrae is recommended, either prophylactically or therapeutically. Anaesthesiological management must focus on protection of the airway without compromising integrity of the cervical spinal cord; quadriplegia subsequent to positioning of the head under anaesthesia has been reported. We have performed fiberendoscopic nasotracheal intubation in a 23-month-old child presenting for neurosurgical treatment of cervical myelopathy resulting from Morquio-Brailsford syndrome. CASE REPORT. A 23-month-old girl (84 cm, 11 kg) with Morquio-Brailsford syndrome presented for surgical decompression and dorsal fusion of the cervical spine. Pre-anaesthetic examination revealed enamel defects, chronic bronchitis, and splenomegaly; the neck was immobilised with a collar. Radiological examinations (X-ray and NMR) revealed narrowing of the atlanto-occipital and atlanto-axial spaces (Fig. 1) and compression of the cervical spinal cord (Figs. 2 and 3). Pre-anaesthetic medication consisted of midazolam juice (4 mg). After establishing intravenous access, atropine (0.5 mg), midazolam (1 mg), and ketamine (10 mg) were administered. A 22 Fr nasopharyngeal airway (Wendl) was lubricated with local anaesthetic gel and introduced into the right nostril; oxygen was administered through a probe to the left nostril. The Wendl-airway was then removed, another 5 mg ketamine was administered, and a 3.5-mm flexible fiberendoscope--over which a 20 Fr armored tube was slipped--was introduced through the right nostril. With the child spontaneously breathing, the glottis was visualised and the fiberscope introduced into the trachea (Fig. 4); 1 mg midazolam and 35 mg ketamine was administered and the endotracheal tube was advanced through the nose into the trachea, utilizing the fiberscope as a guide. The distance between endotracheal tube and carina was assessed endoscopically, the fiberscope withdrawn, and the tube connected to the breathing system. Pulse oxymetric readings were 98% during induction of anaesthesia including endotracheal intubation. Anaesthesia was continued with enflurane, alfentanil, midazolam, and atracurium; 315 min after induction the trachea was extubated and the child discharged to the paediatric intensive care unit. The postsurgical course was uneventful, and the child resumed co-ordinated gait. DISCUSSION. Airway management in patients with mucopolysaccharidoses may be extremely difficult. Recommended methods such as blind nasal intubation are not feasible in small children. Anaesthetic management in children younger than 2 years with Morquio-Brailsford syndrome presenting for cervical spine surgery has not yet been described. Fiberoptically guided nasotracheal intubation is a means of airway management that does not require repositioning of the head and may be performed with the stabilising collar left in place (Fig. 4); preservation of cervical spinal cord integrity may hence be assumed. Analgosedation with ketamine and midazolam allows sufficient spontaneous breathing and--to some extent--maintenance of protective laryngeal reflexes. In conclusion, anaesthetic management of patients with Morquio-Brailsford syndrome is a challenge that is further increased by extending indications for surgical intervention to include infants. With respect to protecting the airway, fiberoptic nasotracheal intubation of the spontaneously breathing child is our method of choice.
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PMID:[Securing the airway in children with the Morquio-Brailsford syndrome]. 836 34

Laparoscopic splenectomy can be performed more safely today, and therefore it is becoming the first-choice technique for splenectomy when the spleen is of normal size. However, for massive splenomegaly there have been few reports of the use of this technique and its safety has not been confirmed. We performed laparoscopic splenectomy for massive splenomegaly with transarterial embolization of the splenic artery before surgery. A 37-year-old man underwent splenectomy due to the lack of effect of an approximately 4-month course of chemotherapy for chronic myeloid leukemia whose spleen was over 20 cm in length. Before surgery, splenic artery embolization was performed to prevent intraoperative bleeding and to debulk the spleen. Under general anesthesia the patient was positioned in the lateral decubitus position lying on the right side. There was no bleeding from the capsule of the spleen throughout the procedure and no intraoperative complications occurred. Blood loss was 100 ml, and the weight of the resected spleen was 1,100 g. The postoperative course was uneventful. We conclude that laparoscopic splenectomy is safe and feasible in cases of splenomegaly, when combined with preoperative embolization of the splenic artery.
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PMID:[Laparoscopic splenectomy for a massive splenomegaly using a transcatheter technique]. 986 40

Intravenous injection of BCG in rats induces protection against liver cell necrosis produced by CCl4. Impairment of hepatic mixed function oxidases by cytokines produced by activated Kupffer cells is the mechanism proposed to explain that protection. To verify the function of hepatic mixed function oxidases after Kupffer activation, the sleeping time after sodium pentobarbital anesthesia was evaluated in rats after intravenous injection of BCG. Male adult albino rats received BCG (50 micrograms, intravenous) and 48 h or 6 days after were anestethized with sodium pentobarbital (33 or 66 mg/g i.p.). The sleeping time was measured from the beginning of sleep until the animal started having spontaneous movement and stand up on the forepaws. The results showed that the animals treated with BCG presented a significative increase in the sleeping time, indicating reduced inactivation of the pentobarbital, an indirect evidence of inhibition of mixed function oxidase system. BCG treated rats showed hepatic and splenomegaly, both 48 and 6 days after treatment. Histology showed an increase in number of mononuclear cells in the sinusoids in the liver and in the red pulp of the spleen 48 h after injection. Small epitheliod granulomas scattered in the hepatic lobules and in the red pulp were observed in rats killed six days after the BCG injection. Hepatocyte injury, induced by activated macrophages, would be not responsible for the reduced pentobarbital inactivation, because at six days there were several granulomas scattered in lobules, but the increase of sleep time in this group was similar to that observed in rats 48 h after injection of BCG. These results demonstrate that activation of Kupffer cells with BCG induces impairment of mixed function oxidase system soon as 48 h after injection of activator, probably due to production of IL-1, IL-6 and TNF alpha by activated Kupffer cells and other mononuclear cells migrated to the liver.
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PMID:Increased sleeping time after pentobarbital anesthesia in rats treated with intravenous injection of BCG. 1075 4

Tangier disease is a rare, autosomally-inherited disorder of lipoprotein metabolism characterized by absence or marked deficiency of normal high density lipoprotein (HDL) cholesterol in plasma resulting in the accumulation of cholesteryl esters in various organs. The patient was a 55-yr-old male diagnosed as Tangier disease 16 years before. He had angina on exercise and his coronary angiogram revealed triple vessel disease including left main trunk (LMT) lesion. Stenosis of the right coronary artery was treated by percutaneous transluminal coronary angioplasty (PTCA). He was scheduled for a MIDCAB for further PTCA to be performed to relieve the stenosis of LMT. Preoperative laboratory data and physical examination showed total cholesterol 36 mg.dl-1, HDL-cholesterol 2 mg.dl-1, apoprotein A-I not-detected, pancytopenia, hyperplastic orange tonsils, splenomegaly and hepatomegaly. Clonidine 0.225 mg was orally given as a preanesthetic medication. Anesthesia was induced with fentanyl and midazolam and maintained with propofol, sevoflurane and supplemental fentanyl. Nitroglycerin and diltiazem were infused continuously. ST segment was elevated transiently during the clamping of the left anterior descending branch. Hemodynamic parameters were stable during the operation. He was extubated 2 hours after the end of the operation. No significant changes were found in postoperative EKG, total cholesterol, HDL-cholesterol and triglyceride. Perioperative course was uneventful.
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PMID:[Anesthesia for MIDCAB (minimally invasive direct coronary bypass) in a patient with Tangier disease: a case report]. 1079 27


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