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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eighteen partial splenic embolization procedures (PSEs) were performed in 17 children for hypersplenism (13) and/or esophageal variceal hemorrhage (12). The underlying disease was biliary atresia (BA) in nine children, portal vein thrombosis (PVT) in four, and biliary cirrhosis (BC) in four. From 20% to 90% of the spleen was embolized. Immediate morbidity was high, albeit minor, and the initial hospitalization was protracted for an average of 16 days. The children were followed from 4 to 81 months (average, 34.2). Four patients with BA patients subsequently had liver transplantation at an average of 20 months after PSE. In ten of 13 patients with hypersplenism, hematologic indexes returned to and remained normal throughout follow-up. The three exceptional patients (who had only 20%, 60% and 60% splenic embolization) developed recurrent mild hypersplenism, one of whom was reembolized and is free from hypersplenism 22 months later. Variceal hemorrhage was ameliorated in all 12 patients (average, 2.4 episodes of hemorrhage per year before PSE, 0.5 per year afterwards). Overwhelming postsplenectomy sepsis did not occur in an aggregate follow-up of 48.5 years. PSE is a legitimate treatment alternative for hypersplenism and for esophageal varices in children.
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PMID:Splenic embolization in children: long-term efficacy. 278 59

We evaluated a noninvasive radionuclide technique to quantify splenic trapping function, which is a key step in the disposition of blood-borne particulates such as poorly opsonized encapsulated microorganisms implicated in hyposplenic fulminant sepsis. Using computerized external gamma imaging, the percentage of splenic uptake of heat-damaged radiolabeled red blood cells was determined in adult Sprague-Dawley rats with eutopic (partial splenectomy) or ectopic (single or multiple autotransplantation) remnants or whole spleens, and in 14 patients with either an intact spleen or splenic remnants after treatment for trauma or hypersplenism. The masses of both eutopic and ectopic remnants correlated directly with the percentage of heat-damaged red blood cell uptake, but the percentage of uptake per gram was higher in eutopic remnants, paralleling more vigorous compensatory growth. In patients, the percentage of heat-damaged red blood cell uptake by remnant spleens was similar to that seen in the rats and, in addition, was supernormal in those with congestive splenomegaly. This noninvasive technique both provides a vivid biplanar image and quantifies blood-borne particle trapping, which is a key splenic function. A heat-damaged red blood cell uptake of less than 15 percent after splenic salvage suggests marginal splenic performance and continued vulnerability to overwhelming sepsis.
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PMID:Splenic salvage quantified by uptake of heat-damaged radiolabeled red blood cells. Experimental and clinical studies. 230 23

Patients with type 1 (adult form) Gaucher disease complicated by massive splenomegaly and hypersplenism have previously been treated by total splenectomy. Subtotal splenectomy in Gaucher disease will retain splenic tissue which may protect the patient from the risk of overwhelming sepsis. Removal of at least 85 per cent of the splenic mass is necessary to eliminate hypersplenism and to decrease splenic size. The surgical technique and outcome of four patients undergoing subtotal splenectomy for massive splenomegaly due to type 1 Gaucher disease are discussed.
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PMID:Operative technique and results of subtotal splenectomy for Gaucher disease. 356 49

Gaucher's disease is an autosomal recessive disorder caused by deficiency of beta glucocerebrosidase, resulting in an accumulation of glucocerebroside in the reticuloendothelial system. These patients have massive splenomegaly and bone pain, but may have normal life expectancy. Traditionally, splenectomy has been used to treat hypersplenism, but may be associated with a high incidence of postsplenectomy sepsis and accelerated hepatic and bone lipid deposition. Two children are reported who had partial splenectomy for symptoms of Gaucher's disease. Both patients had laboratory evidence of hypersplenism. A 90% splenectomy was performed, and the residual splenic fragment was wrapped in Vicryl mesh. Both patients are currently asymptomatic with normal hematologic parameters. Postoperative radionuclide scans demonstrate increase in the size of the residual splenic fragment. Partial splenectomy may benefit patients with Gaucher's disease, but long-term follow-up care is necessary.
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PMID:Partial splenectomy for Gaucher's disease. 359 12

Embolization of splenic artery aneurysms is recommended in young women to prevent likely rupture and exsanguination during pregnancy. This report describes the successful coil occlusion of multiple mycotic aneurysms in such a patient, who was also treated interventionally for gastric hemorrhage and hypersplenism. Although infection or sepsis is a rare cause of visceral aneurysms, it is associated with a high incidence of rupture and peritonitis. Complications from elective embolization include abscess formation within the spleen and focal infarction in the upper alimentary tract. However, such risks should be minimized by appropriate selection of embolic materials and prophylactic care of the patient.
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PMID:Transcatheter embolization of multiple mycotic splenic artery aneurysms: a case report. 375 8

The most common hematologic and oncologic indications for splenectomy in childhood are hereditary spherocytosis, chronic idiopathic thrombocytopenic purpura, hypersplenism, and Hodgkin's disease. Because of the increased incidence of septic complications after splenectomy, benefits to be gained from the operation should be weighed against the risks. A retrospective study was done on the charts of 42 consecutive children with hematologic and oncologic disorders, who underwent splenectomy between 1967 and 1982. The incidence of septic complications after splenectomy was 12%; sepsis, however, only occurred in patients with severe underlying diseases (three patients with Hodgkin's disease, one patient with systemic lupus erythematosus, and one patient with chronic pseudo-malignant immunoproliferation). In contrast, none of the patients who were splenectomized for other reasons (mainly hereditary spherocytosis and chronic immune thrombocytopenic purpura) had a septic complication. Two patients with end-stage Hodgkin's disease (5%) experienced fatal septic complications. Although splenectomy is well established for diagnostic and therapeutic considerations in patients with Hodgkin's disease, not all of them might benefit from this operation, and studies with a more limited approach to splenectomy might prove to be of the same therapeutical value.
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PMID:Hematological and oncological indications for splenectomy in children. 392 22

In 11 children with hypersplenism due to Gaucher's disease, partial splenectomy was planned with the aim to prevent the development of postsplenectomy sepsis and also to slow the advance of the disease in the rest of the reticuloendothelial system by permitting continuing accumulation of the beta-glucocerebroside in the remaining splenic tissue. In seven children, partial splenectomy was performed successfully, the weight of the splenic tissue removed ranging from 400 to 3,680 g. The postoperative course was uneventful and the average duration of hospitalization was 12 days. In subsequent follow-up, isotope scanning demonstrated continuing growth of the splenic remnant and there were no episodes of postsplenectomy sepsis nor evidence of increased accumulation of beta-glucocerebroside in the liver or bones. These children showed a marked improvement in the growth curve and dramatic improvement in the hematologic picture. Of the four remaining children, in two, partial splenectomy was followed by complete removal of the remaining spleen due to necrosis, whereas in two, total splenectomy was performed since the huge spleens were extensively infarcted. Our experience suggests that partial splenectomy is the treatment of choice in the management of young patients with hypersplenism due to Gaucher's disease.
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PMID:Partial splenectomy in Gaucher's disease. 395 Aug 49

60 Jamaican children with homozygous sickle cell (SS) disease underwent splenectomy, 14 for prophylaxis against recurrent acute splenic sequestration and 46 for treatment of sustained hypersplenism. Age at operation varied from 9 months to 16 years. Patients were followed up for 1 month to 27 years (median 6 years), with a total of 369 years of patient-observation. None of the 3 patients who died, at ages 2 1/2, 6 1/2, and 21 years, had received prophylaxis against infection. Overwhelming sepsis was possible but not confirmed in the first two deaths which occurred 11 months and 2 1/2 years after operation; the third died from chronic renal failure 11 years after splenectomy. After operation, there were no confirmed cases of pneumococcal septicaemia or meningitis, and the commonest clinical event was the acute chest syndrome.
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PMID:Role of splenectomy in homozygous sickle cell disease in childhood. 614 Apr 33

Patients with end-stage renal disease who develop hypersplenism, patients with mild neutropenia, and those patients whose WBC fails to increase in response to cortisol administration will develop significant neutropenia following transplantation with routine doses of azathioprine. This "intolerance" of azathioprine mandates a reduction in the dose of azathioprine often resulting in allograft rejection. Splenectomy will prevent azathioprine-induced neutropenia, but the hazards of splenectomy in these immunosuppressed patients have led to attempts to salvage at least part of the spleen. Partial splenic ablation by embolization has been utilized in adults prior to transplantation to prevent azathioprine-induced neutropenia while preserving the spleen's protective mechanisms against infection. Eight children in our series of transplant candidates required a reduction of splenic function to prevent azathioprine induced neutropenia. One child had a functioning renal allograft but had recurrent neutropenia limiting the azathioprine dose. Partial splenic embolization was attempted in four children and was initially successful in two. Both patients later developed recurrent neutropenia and needed partial splenectomy. The two patients in whom partial splenic embolization was unsuccessful and five further patients in whom embolization was not attempted also underwent partial splenectomy. Approximately 75% to 80% of the spleen was resected. Six children have since undergone renal transplantation and one child had a transplant with chronic rejection at the time of partial splenectomy. Routine doses of azathioprine have been used in these children with no episodes of neutropenia or sepsis observed. We recommend partial splenectomy in those children requiring renal transplantation who are at risk for development of azathioprine induced neutropenia.
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PMID:Partial splenic ablation in preparation for renal transplantation in children. 636 68

Because of the risk of overwhelming sepsis following splenectomy, and since it is possible to reduce the splenic function while preserving the spleen, the treatment of various hematologic disorders by splenic artery ligation has been attempted in 11 children, among whom 3 under 5 years of age. 3 patients had thalassemia, 4 had hereditary spherocytosis and 4 others suffered from secondary hypersplenism. One patient died of overlooked splenic necrosis. The other patients are well, with an average follow-up of 19 mo. The aim of this study is to find out whether the desarterization produces the expected results and is well tolerated and whether the desarterialized spleen still preserves its ability to protect the host against infection. The satisfactory treatment of hereditary spherocytosis and secondary hypersplenism would indicate that splenic artery ligation offers an alternative to splenectomy, especially in children under 5 year old.
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PMID:[Treatment of hematologic disorders in children by splenic artery ligation (author's transl)]. 707 16


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