Liver-spleen Scan Research Articles

Light Chain Amyloidosis: A Case Presentation and Review

In 1977, an asymptomatic 68-year-old woman underwent biopsy of a supraclavicular node that had been detected at the time she presented for breast biopsy. While the breast biopsy was benign, pathology from the lymph node revealed amyloid. For unclear reasons, no further evaluation or treatment was undertaken then. Two years later, a paratracheal node was noted during screening chest x-ray. Biopsy again showed amyloid. At that time, the patient's spleen and liver were enlarged. Howell-Jolly bodies were identified on peripheral blood smear, suggesting hyposplenism. This was confirmed by a radionuclide liver-spleen scan, which showed decreased splenic uptake (1). Initial 24-hour urine specimen collected 5.1 g of protein, 64.4% of which was albumin by urine protein electrophoresis (Figure ​(Figure11). Despite significant albuminuria, her serum albumin was 3.9 g/dL. Quantitative immunoglobulins were depressed, with IgG of 385 mg/dL, IgA of 72 mg/dL, and IgM of 140 mg/dL. While serum immunofixation electrophoresis (IFE) was negative for monoclonal light chain (“Bence Jones”) protein, urine IFE did detect a monoclonal lambda protein (Figure ​(Figure22). Skeletal x-rays showed no lytic lesions. Bone marrow aspirate (Figure ​(Figure33) and biopsy revealed plasmacytosis of 10% to 15% and light chain amyloid, with a kappa:lambda ratio of 1:50. Subsequent renal biopsy also showed lambda light chain amyloid. Figure 1 Urine protein electrophoresis of our patient, showing heavy albuminuria but no clear-cut monoclonal protein. Anode is on the right. Urine concentrated 50x. Figure 2 Urine immunofixation electrophoresis from our patient. The dense, broad anodal band against anti–whole human serum (AWHS) in the upper left column indicates albumin. Antisera to kappa and lambda light chains showed a homogeneous band against the ... Figure 3 Bone marrow aspirate of our patient. Congo red staining revealed amorphous eosinophilic material lying free in the marrow space. These areas displayed apple-green birefringence under polarized light, confirming amyloid. After initiation of low-dose prednisone and colchicine, the patient's hepatomegaly, functional hyposplenism, albuminuria, and Bence Jones proteinuria resolved. She was maintained on this therapy for more than a decade. Despite eventual discontinuation of these medications, she remained in clinical complete remission through her last follow-up, 21 years after presentation. She died the following year of an unknown cause.

Renal Function in Infants with Sickle Cell Anemia: Baseline Data from the BABY HUG Trial.

BABY HUG is an NHLBI/NICHD-sponsored Phase III randomized double-blinded placebo-controlled clinical trial (NCT00006400) to test the hypothesis that hydroxyurea can prevent chronic organ damage in very young children with sickle cell anemia (SCA). Renal and splenic function measures are the co-primary endpoints. Renal disease in SCA begins early in life with impaired urine concentration and acidification, along with glomerular hyperfiltration; some patients will progress to microalbuminuria, glomerulosclerosis, macroalbuminuria, and even renal failure. In BABY HUG, glomerular filtration rate (GFR) elevation was selected as a primary endpoint, to be measured quantitatively by plasma clearance of injected 99mTc-DTPA and also estimated by the Schwartz equation where GFR = (height × 0.55)/(serum creatinine), with creatinine measured by HPLC to .01 mg/dL precision. Of 233 enrolled subjects, 193 completed screening and were randomized to study treatment. Quantitative GFR measurement was successful in most cases: 176 of 182 (97%) of DTPA clearance studies were adequate and 157 subjects had both baseline DTPA and Schwartz GFR values available for analysis. The average age at GFR measurement was 13.7 ± 2.6 months (range 9–19 months) and 59% of subjects were female. Baseline mean (± 1SD) hematological parameters included hemoglobin = 9.0 ± 1.4 gm/dL, absolute reticulocytes = 295.3 ± 137.4 × 109/L, WBC = 14.3 ± 5.8 × 109/L, and fetal hemoglobin (HbF) = 25.6 ± 8.8%. Baseline past medical history included dactylitis (34%), splenic sequestration (7%), and acute chest syndrome (5%). The average baseline quantitative GFR measurement determined by DTPA clearance was elevated at 125.4 ± 34.4 mL/min/1.73m2, (range 40.2 – 300.9 mL/min/1.73m2, normal value 100 ± 20 mL/min/1.73m2). The average baseline GFR estimate by Schwartz equation was substantially higher at 193.9 ± 53.8 mL/min/1.73m2, range 65.8 – 350.0 mL/min/1.73m2. In univariate analysis, the DTPA GFR value was positively correlated with the Schwartz GFR estimate (r=0.22, p=0.0059, slope=0.145) as well as age, weight, height (all p≤.001) but not with hemoglobin, HbF, WBC, reticulocytes, previous sickle cell-related events, or measures of splenic function including liver-spleen scan and quantitation of pitted erythrocytes and micronuclei. The Schwartz GFR estimate was positively correlated with age, height, WBC, and splenic function, and negatively correlated with hemoglobin and HbF. Using a quantitative GFR threshold of 120 mL/min/1.73m2 and an age threshold of 15 months, higher GFR values were observed in older infants, p=0.026. These data indicate thatrenal dysfunction measured by GFR elevation may begin early in life in SCA;quantitative GFR measurement is feasible but highly variable in this very young patient population;(3) the Schwartz and DTPA GFR values are strongly correlated, but the Schwartz estimate is usually greater and only modestly agrees with the quantitative DTPA GFR value. These baseline GFR measurements in BABY HUG support the hypothesis of age- and disease-related glomerular hyperfiltration in SCA. BABY HUG should yield important information regarding the ability of hydroxyurea to prevent renal damage among infants with SCA.

Retinol, Vitamins, and Cancer Prevention: 25 Years of Learning and Relearning

Retinol, Vitamins, and Cancer Prevention: 25 Years of Learning and Relearning

Correlation of liver-spleen scan findings with modified Child-Pugh classification

BackgroundThe Child-Pugh classification is used as an index of liver function. We assessed the relationship between modified Child score and sulfur colloid liver-spleen scintigraphy in histologically confirmed cirrhosis. MethodFollowing injection of 185 MBq 99mTechnetium-sulfur colloid, anterior and posterior images were obtained at 30 minutes with 500,000 counts. Liver-spleen scintigraphy pattern was divided visually into three categories: A (liver uptake ≥ spleen uptake, without visualization of ribs and vertebrae), B (spleen uptake > liver uptake without visualization of ribs and vertebrae), and C (remarkable visualization of ribs and vertebrae). ResultsOf 36 patients, 14 (38.8 %), 19 (58.8%) and 3 (8.3 %) patients were categorized into Child-Pugh grades A, B and C, respectively, whereas 13 (36.1 %), 12 (33.3 %) and 11 (30.6 %) patients were categorized into scintigraphic grades A, B and C, respectively. In 14 patients the results of Child and scan classifications were in agreement, but in 22 patients the results were discordant. Kappa value was 0.072 (poor agreement). ConclusionThere is no correlation between scintigraphic and Child-Pugh classifications. Scintigraphic classification may present a marker of body reactions to the disease, independent of Child-Pugh modified classification. Further studies are needed to determine which one of these classifications has better concordance with the patient's outcome.

Correlates of a Sustained Virologic Response in the Treatment of HCV

Purpose: The quantitative liver spleen scan (QLSS) was assessed along with other markers of liver disease severity for correlates of an sustained virologic response (SVR) and relapse (R) compared to Non-response (NR). It is our hypothesis that the QLSS parameters will correlate with treatment response. Methods: Patients: 106 consecutive patients complelting treatment for hepatitis C with pegylated interferon alpha 2a and ribavirin were retrospectively evaluated for treatment response. Routine laboratory tests (106 patients), histology (101), virologic tests, prior treatment and QLSS results at baseline (95) were recorded. The PHM, liver volume (LV/IBW) and spleen volume (SV/IBW) (ideal body weight = IBW in lb}. Early virologic response (EVR) was < 1/100 baseline RNA at 12 weeks treatment. Statistics: Chi-square test compared treatment response and discrete variables. Analysis of variance tested for differences in treatment response for mean values of continuous predictors. Logistic regression determined the most parsimonious set of predictors of virologic reponse. Results: The patients were Caucasian (80%), naïve (70%), 59% male, age (52 ± 9 yrs), and height (68 ± 4 inches), and weight (174 ± 39 lbs). The baseline blood tests and QLSS PHM, LV/IBW, and SV/IBWare in the table. Fibrosis stage was 0 (10), 1 (25), 2 (16), 3 (19) and 4 (31) (where 4 indicated cirrhosis), Genotype 1,4,6 (81) and 2,3 (25) and RNA levels 3,639,022 ± 6,342,534 IU/ml. Treatment resulted in an SVR in 46, R in 27 and NR in 33. No differences in treatment response were noted for sex, race, ALT, Alb, INR. Significant differences (p <.01) to treatment from univariate analysis were found for EVR (p <.0001), prior treatment (p <.001), genotype (p=.004), cirrhosis (p=.02), platelets (p=.0029) and LV/IBW (p=.0089). By multivariate analysis, SVR compared to NR correlated with gender (p=.0128), prior treatment (p=.0006), IBW (p=.0079) and LV/IBW (p=.0219). By multivariate analysis, R compared to NR was associated with Caucasian race (p=.02), prior treatment (p=.0029) and LV/IBW (p=.042). For 74 naïve patients, significant differences by multivariate analysis between groups were found for platelets (p < 0.001) and for LV/IBW (p < 0.05).Table: Liver TestsConclusions: Prior treatment and LV/IBW were major determinants of the SVR and relapse compared to non-response.

The value of staging and serial follow-up investigations in patients with completely resected, primary, cutaneous malignant melanoma

The purpose of this study was to determine the value of staging and serial follow-up investigations in newly diagnosed patients with completely excised primary cutaneous malignant melanoma. We reviewed the records of the 393 patients with completely excised primary malignant melanoma who were referred to the Ontario Cancer Institute and the Toronto-Bayview Regional Cancer Centre between 1 January 1978 and 31 March 1982. Initial investigations included history and physical examination in all 393 patients, complete blood count (199 patients), liver function tests (198 patients), urinary melanins (159 patients), chest X-rays (345 patients), whole lung tomography (182 patients), radionuclide liver-spleen scans (207 patients), and bone scans (116 patients), bipedal lymphangiograms (78 patients), CT scans of the chest (59 patients), and CT brain scans (51 patients). The clinical stage of ten patients was changed as a result of history and physical examination or lymphangiogram. All other investigations failed to detect metastatic melanoma. Follow-up investigations included history and physical examinations, complete blood counts, liver function tests, radionuclide liver spleen and bone scans. History and physical examinations, chest X-rays and patients' awareness of abnormalities were responsible for detection of subsequent melanoma recurrences. All other tests failed to identify metastatic melanoma at the time of its occurrence. Therefore, we recommend that initial staging investigations be limited to history and physical examination with clinical photographs, and baseline chest X-ray. We recommend that subsequent follow-up include only history and physical examinations and chest X-rays.

Importance of Tc-99m Sulfur Colloid Liver???Spleen Scans Performed Before Indium-111 Labeled Leukocyte Imaging for Localization of Abdominal Infection

The localization of intraabdominal abscesses is a difficult imaging problem in nuclear medicine, especially when the location of the abscess is in the area of the liver and spleen. The need for performing Tc-99m sulfur colloid liver-spleen scans before injecting indium-111 leukocytes for improved lesion detection and characterization versus performing In-111 leukocyte scans alone has been questioned in the literature We present 3 patients with intraabdominal abscesses in the liver-spleen area, in which liver-spleen scans were performed before In-111 leukocyte scans. The findings of all were correlated with computed tomography and interventional procedures. In all patients, the Tc-99m liver-spleen scan helped for accurate recognition of the location of the abscess, correlated with computed tomography findings, and were helpful for intervention and exclusion of the other sources of infection. Data from these 3 patients reinforces the need for Tc-99m sulfur colloid liver-spleen scans before performing In-111 WBC scans for better localization and interventional treatment of intraabdominal abscesses.

Factors Affecting the Quantitative Liver?Spleen Scan in Normal Individuals

The quantitative liver-spleen scan (QLSS) can estimate the functional hepatic mass and the organ volumes by precise measurement of sulfur colloid (SC) distribution. The normal range determined in prior studies was estimated from patients with absence of chronic liver disease in which intense fasting appeared to produce slightly abnormal values. This study was to determine the effect of fasting or fed status and colloid particle size on quantitative measurements from the QLSS in a small cohort of normal individuals. Twelve persons without any medical problems had QLSS taken twice, 2 weeks apart, one fasting and one postprandial. Patients were scanned after injection of 5-6 mCi of SC; six patients were given solution A (5- to 12-microm particle size) and six patients solution B (2- to 12-microm particle size). SPECT and planar analysis were performed. SC distribution of total counts between the liver and the spleen {[L/(L + S)]t ratio}, liver-spleen index (LSI), and liver-bone marrow index (LBI) were calculated. The perfused hepatic mass (PHM) is the average of the LSI and LBI. Spleen and liver volumes are expressed as milliliters per pound ideal body weight (IBW). Results showed that the liver and spleen volumes (solution B postprandial, 9.27 +/- 2.48 and 1.47 +/- 0.57 ml/lb IBW, respectively) and LBI were not affected by the type of SC solution or by ingestion status. L/(L + S) total and pixel count ratios were significantly higher for solution B and postprandial studies. [L/(L + S)]t, LSI, and PHM increased significantly (P < 0.05) from fasting to postprandial for solution A (0.71 +/- 0.13 vs 0.79 +/- 0.08, 80 +/- 14 vs 91 +/- 8, and 102 +/- 10 vs 106 +/- 8, respectively) and for solution B (0.81 +/- 0.05 vs 0.90 +/- 0.02, 86 +/- 4 vs 95 +/- 3, and 101 +/- 5 vs 110 +/- 3). Neither fasting nor postprandial LSI and PHM were significantly different between solution A and solution B. We conclude the following. (1) The QLSS functional indices in "true" normal patients fall within the previously reported normal range. (2) Calculated liver and spleen volumes are not altered by fasting or sulfur colloid particle size. (3) Fasting significantly decreased the [L/(L + S)]t, LSI, and PHM. (4) A postprandial scan may be preferable since the normal values for [L/(L + S)]t, LSI, and PHM are greater, with a narrower range, than fasting values.

EVALUATION OF HYPERAMMONIA IN PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION

Patients with chronic hepatitis c virus infection can develop portal hypertension leading to porto-systemic encephalopthy. Presence of this complication can exclude patients from treatement. Porto-systemic hepatic encephalopa-thy is diagnosed clinically and at times in combination with elevated plasma ammonia level. Mr. “X” is a 47 year caucasian male with chronic hepatitis c virus infection was referred by his primary care physician for management of porto-systemic hepatic encephalopathy. Patient was diagnosed with hepatitis C virus infection in 1994 and had history of IVDA and blood transfusion in 1984 after MVA complicated by splenectomy. In June 2003, while at work, patient became confused and disoriented and was seen in emergency room of nearby hospital. Patient was suspected to have hepatic encephalothy as serum ammonia level was 130. He was treated with lactulose and had an uneventful recovery in next 12 hours and was discharged home. A month later patient was seen at my office a month later. Patient complaint of excessive fatigue and RUQ discomfort. He has history of bipolar disorder and chronic pain syndrome. Medications included Zoloft, Ritalin, Methadone and lactulose. Until two weeka ago patient had been on Val-proic acid which was stopped by psychiatrist. On examination, had anicteric sclera, liver 11 cm on percussion, alert and oriented with no focal deficit and asterixis absent. Blood tests showed only mild elevation of transaminases with normal bilirubin, albumin, platelets and INR. Patient was suspected to have hyperammonic encephalopathy secondary to Valproic acid. During work up, liver spleen scan did not show increase colloid uptake in bone marrow compare to the liver and had periportal fibrosis only liver biopsy. He underwent standard treatment had ETR. Other than porto-systemic hepatic encephalopathy, hyperammonia is generally seen in urea cycle genetic defects. There are five urea cycle enzymes present in the liver are responsible to process ammonia obtained from amino acid. Among them, most important is the Ornithine transcarbamylase enzyme. More commonly, Valproic acid also causes hyperammonemia and hyperaamoniemic encephalopathy. In addition, Valproic acid also causes hepatitis, elevated liver function tests and hepatic failure. Hyperammonia is suspected to be caused by by inibition of ornithine transcarbamylase enzyme and considered to be an idiosyncratic reaction. These effects of valproic acid can be completely reversed on stopping the drug.

Quantitative liver-spleen scan using single photon emission computerized tomography (SPECT) for assessment of hepatic function in cirrhotic patients

Background/Aims: Accurate quantitative determination of liver function is critical in cirrhotic patients in order to predict outcome, particularly in patients who undergo hepatic resection or non-hepatic surgery. As colloid uptake by perfused Kupffer cells is proportional to perfused hepatocyte mass, quantitative liver spleen scan may be used as an index of perfused hepatocyte mass. Thus, this study was conducted to evaluate quantitative single photon emission computerized tomography (SPECT) of Tc-99mm-phytate colloid uptake by the liver as a test for hepatic function in cirrhotic patients. Methods: Quantitative SPECT was used to measure liver volume, quantitative colloid uptake by the liver and percentage of injected dose/ml of liver tissue in cirrhotic patients ( n=75), non-cirrhotic patients with chronic liver disease ( n=52) and patients without liver disease ( n=36). Results: Although liver volume was similar among the three groups, the cirrhotic patients had significantly lower total quantitative uptake and quantitative uptake/ml compared to groups 2 and 3 ( P<0.001). Quantitative liver uptake in the cirrhotic patients was highly correlated with Child-Pugh score ( r=−0.64, P<0.0001) and with indocyanine green retention at 15 min ( r=−0.84, P<0.0001). Conclusions: Quantitative SPECT of the liver may be an additional, useful, non-invasive quantitative test for assessment of hepatic function and severity of liver disease in cirrhotic patients.

Duplex Doppler ultrasound of the hepatic artery in patients with acute alcoholic hepatitis.

Acute alcoholic hepatitis (AAH) is a clinical diagnosis associated with increased hepatic artery diameter and flow. Duplex Doppler ultrasound (DDU) has been shown to accurately measure arterial flow in both liver and kidney transplant patients. The authors conducted a blinded, controlled study to evaluate the accuracy of measuring hepatic artery parameters with DDU in diagnosing AAH. Duplex Doppler ultrasound was performed by an investigator, blinded to group makeup, on 22 consecutive hospital inpatients with the clinical diagnosis of AAH. The diagnosis of AAH was based on specific criteria, including the following: recent alcohol abuse, hyperbilirubinemia, prolonged prothrombin time, leukocytosis, hepatomegaly, hepatic bruit, and marked redistribution of isotope on 99mTc-sulfur colloid liver-spleen scan. Controls were 12 cirrhotic patients without AAH and 17 healthy volunteers. Duplex Doppler ultrasound measurements were obtained most consistently from the proximal right hepatic artery. Measured parameters included the following: peak systolic velocity (PSV); resistive index = (PSV - end diastolic velocity [EDV])/PSV; pulsatility index = (PSV - EDV)/mean velocity; and hepatic artery diameter. The mean hepatic artery diameter was significantly larger in patients with AAH (3.55 +/- 0.72 mm) than in patients with cirrhosis (2.75 +/- 0.69 mm; p = 0.003) and healthy controls (2.68 +/- 0.69 mm; p = 0.001). The mean PSV was significantly higher in patients with AAH (187 +/- 52 cm/s) compared with cirrhotic (67 +/- 51 cm/s) and healthy (66 +/- 51 cm/s) controls (p = 0.0001). The mean resistive index was lower in AAH patients (0.60 +/- 0.11) compared with cirrhotic (0.69 +/- 0.10; p value was not significant) and healthy controls (0.72 +/- 0.11; p = 0.004). The mean pulsatility index was lower in AAH patients (1.04 +/- 0.47) compared with cirrhotic (1.36 +/- 0.45; p value was not significant) and healthy controls (1.53 +/- 0.45; p = 0.01). In the appropriate clinical setting, an elevated hepatic artery diameter or PSV measurement is suggestive of AAH. Duplex Doppler ultrasound offers a noninvasive test to assist in the diagnosis of AAH.

Autotransplant of spleen tissue in children with schistosomiasis: evaluation of splenic function after splenosis.

Autotransplantation of spleen tissue has been done, in the past ten years, in children with schistosomiasis mansoni with bleeding varices. The purposes of this investigation were: (1) to study the morphology and function of the remnant spleen tissue; (2) to quantify the production of tuftsin; and (3) to assess the immune response to pneumococcal vaccine of these patients. Twenty three children, who underwent splenectomy and autologous implantation of spleen tissue into the greater omentum were included in this investigation. The average postoperative follow-up is five years. Splenosis was proved by colloid liver-spleen scans. Search for Howell-Jolly bodies assessed the filtration function. Tuftsin and the titer of pneumococcal antibodies were quantified by ELISA. Splenosis was evident in all children; however, it was insufficient in two. Howell-Jolly bodies were found only in these two patients. The mean tuftsin serum concentration (335.0 +/- 29.8 ng/ml) was inside the normal range. The immune response to pneumococcal vaccination was adequate in 15 patients; intermediate in four; and inadequate in four. From the results the following conclusions can be drawn: splenosis was efficient in maintaining the filtration splenic function in more than 90% and produced tuftsin inside the range of normality. It also provided the immunologic splenic response to pneumococcal vaccination in 65% of the patients of this series.

Quantitative liver-spleen scan (LSS) using single photon emission computerized tomography (SPECT) for assessment of functional liver volume in cirrhotic patients

Quantitative liver-spleen scan (LSS) using single photon emission computerized tomography (SPECT) for assessment of functional liver volume in cirrhotic patients

Quantitative liver-spleen scan (LSS) using single photon emission computerized tomography (SPECT) for assessment of functional liver volume in cirrhotic patients

Quantitative liver-spleen scan (LSS) using single photon emission computerized tomography (SPECT) for assessment of functional liver volume in cirrhotic patients

‘Liver Tail’ Pseudospleen Appearance in Denatured Erythrocyte Scintigraphy with Computed Tomographic and Magnetic Resonance Correlations

A patient had thrombocytopenia 15 years after splenectomy for idiopathic thrombocytopenia. A liver-spleen scan was requested to identify possible splenic regrowth. Heat-denatured erythrocyte scintigraphy showed normal hepatic activity, with increased radiotracer activity in the splenic bed, possibly representing significant splenic regrowth. However, both computed tomographic and magnetic resonance images of the abdomen confirmed that the scintigraphic findings represented contiguous tissues arising from the left lobe of the liver, giving a liver-tail appearance with all imaging methods. There was no evidence of splenosis elsewhere. Pseudospleen appearance on labeled erythrocyte studies is a potential problem in patients after splenectomy.

Splenic function in sickle cell anemia patients in Qatif, Saudi Arabia

A prospective study was conducted to study the splenic function among sickle cell anemia (SCA) patients in Qatif (Eastern Province of Saudi Arabia). Seventy-seven patients (30 children and 47 adults aged 2–57 years) were included. 99mTc stannous colloid liver–spleen scan was done for each patient during steady state. The splenic function was graded from 0 to 4 in relation to liver uptake. Seventy percent of our patients showed evidence of splenic hypofunction, and most of them (83%) had severe hyposplenism. Up to the age of 4 years, only 17% of the children showed evidence of functional hyposplenism, but by the age of 10 years >50% were hyposplenic. Most of the hyposplenic children had functional hyposplenism, whereas only one-third of hyposplenic adults had autosplenectomy. There was no effect of level of HbF on the frequency of hyposplenism, but on the other hand low MCV seems to be protective against hyposplenism. A significant number of adult SCA patients have clinically enlarged spleens, and almost a third have normally functioning spleens. Because of the low prevalence of hyposplenism in children younger than 4 years of age, routine penicillin prophylaxis is probably not indicated in this population, an issue which needs further evaluation. Am. J. Hematol. 63:68–73, 2000. © 2000 Wiley-Liss, Inc.

Splenic function in sickle cell anemia patients in Qatif, Saudi Arabia.

A prospective study was conducted to study the splenic function among sickle cell anemia (SCA) patients in Qatif (Eastern Province of Saudi Arabia). Seventy-seven patients (30 children and 47 adults aged 2-57 years) were included. (99m)Tc stannous colloid liver-spleen scan was done for each patient during steady state. The splenic function was graded from 0 to 4 in relation to liver uptake. Seventy percent of our patients showed evidence of splenic hypofunction, and most of them (83%) had severe hyposplenism. Up to the age of 4 years, only 17% of the children showed evidence of functional hyposplenism, but by the age of 10 years >50% were hyposplenic. Most of the hyposplenic children had functional hyposplenism, whereas only one-third of hyposplenic adults had autosplenectomy. There was no effect of level of HbF on the frequency of hyposplenism, but on the other hand low MCV seems to be protective against hyposplenism. A significant number of adult SCA patients have clinically enlarged spleens, and almost a third have normally functioning spleens. Because of the low prevalence of hyposplenism in children younger than 4 years of age, routine penicillin prophylaxis is probably not indicated in this population, an issue which needs further evaluation.

Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

Laparoscopic splenopexy for wandering (pelvic) spleen.

Wandering spleen is a rare clinical diagnosis with a high incidence of splenic torsion and infarction. The preferred treatment for this condition currently is splenopexy to reposition and fixate the spleen in the left upper quadrant of the abdomen to preserve splenic function. We recently performed the first splenopexy for a wandering spleen using laparoscopic techniques. The patient was a 19-year-old woman who had an asymptomatic lower abdominal/pelvic mass found on physical examination. Diagnostic evaluation (ultrasound, computed tomography scan, and liver-spleen scan) showed an absent spleen in the upper abdomen, normal uterus and ovaries, and an 11 x 7-cm pelvic spleen. Laparoscopic splenopexy was performed using Vicryl mesh to suspend and fixate the spleen in the left upper quadrant of the abdomen. Total operative time was 175 min, there were no intra- or postoperative complications, and the patient was discharged on the 1st postoperative day. Follow-up at 2 and 7 months indicated that she was asymptomatic with a nonpalpable spleen. The results suggest that a laparoscopic approach to splenopexy should be considered for the treatment of patients with a wandering spleen.

Index of Suspicion

Index of Suspicion