Splenectomy For Idiopathic Thrombocytopenic Purpura Research Articles

Phosphoglyceride crystal deposition disease requiring differential diagnosis from malignant tumors and confirmed by Raman spectroscopy: A case report

BACKGROUNDPhosphoglyceride crystal deposition disease (PCDD) is a rare acquired disease in which phospholipid crystals deposit in bone and soft tissue long after surgery, trauma, or repeated injections. CASE SUMMARYA 60-year-old-woman was referred to our department because of multiple abdominal masses after open splenectomy for idiopathic thrombocytopenic purpura 29 years earlier. All the masses showed marked fluorodeoxyglucose (FDG) uptake on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) and were strongly suspected to be malignant tumors. Surgical biopsies were performed, and the abdominal masses were found to be aligned vertically, three in a row, along the tissue layers cut in the patient’s previous surgery. Pathological finding of the specimens showed foreign body granuloma consisting of histiocytes and multinucleated giant cells accumulating around needle-like crystals. The crystals were confirmed as phosphoglyceride by Raman spectroscopy, and PCDD was diagnosed. To our knowledge, this is the first report of PCDD diagnosed by Raman spectroscopy.CONCLUSIONWe made a definitive diagnosis of PCDD in a patient with multiple tumors showing marked FDG uptake on 18F-FDG-PET by incisional biopsy and compo- sition analysis using Raman spectroscopy, a method that has not previously been reported for the diagnosis of PCDD.

Disseminated herpes simplex virus and varicella zoster virus co-infection in a patient with idiopathic thrombocytopenic purpura

Concomitant disseminated herpes simplex virus (HSV) and varicella zoster virus (VZV) infection is a rare event. We describe a case of disseminated HSV and VZV infection in an 80-year-old patient many years after splenectomy for idiopathic thrombocytopenic purpura (ITP). This is the first case of disseminated HSV-1 and VZV infection with molecular evidence of the simultaneous presence of both viruses in two different body sites (the skin and cerebrospinal fluid). This adds to the three reports of patients developing cutaneous disseminated herpes zoster multiple years after splenectomy for ITP.

Rediscovering splenectomy in the application of the adult idiopathic thrombocytopenic purpura

Traditionally, splenectomy is the second-line treatment method of primary thrombocytopenic purpura and a choice after the ineffectual treatment of glucocorticoid, but doctors never evaluate the curative effect of splenectomy before the operation and assess the necessity of splenectomy. In light of recent progresses on this topic, the current review summaries and pinpoints traditional application of splenectomy, side effects, new drug , and predicted factors of evaluation of operation, aiming to make accurate splenectomy for idiopathic thrombocytopenic purpura. Key words: Purpura, thrombocytopenic; Splenectomy; Forecasting; The new medicine treatment

The spleen

The spleen

Is laparoscopy a safe and a cost effective alternative in the surgical management of idiopathic thrombocytopenic purpura (ITP)?

Background : Splenectomy is indicated for idiopathic thrombocytopenic purpura (ITP) when medical management fails. Laparoscopy reduces the morbidity of open splenectomy. Objectives : To evaluate the technique, advantages and outcomes of laparoscopic splenectomy for ITP. Methods : A retrospective analysis of laparoscopic splenectomy performed at Teaching Hospital Peradeniya from 2008 to 2014 was carried out. Results : Thirty-two patients, with platelet counts less than 100 x 10 9 / l, underwent the procedure. The duration of surgery ranged from 60 to 270 minutes with minimum blood loss and no conversions to open surgery. All were discharged by the third or fourth day of surgery with the platelet counts rising above 150 x 10 9 / l. Conclusions : Laparoscopy is a safe and effective technique for splenectomy. It is associated with lower morbidity and early recovery.

Impact of Preoperative Platelet Count on Perioperative Outcome After Laparoscopic Splenectomy for Idiopathic Thrombocytopenic Purpura

IntroductionLaparoscopic splenectomy (LS) is the preferred treatment of idiopathic thrombocytopenic purpura (ITP) when medical treatment fails. The objective was to evaluate the feasibility and safety of LS according to the preoperative platelet count. MethodsThis study is a retrospective analysis of a series of 199 patients who underwent LS for ITP from 1993 to 2015. The patients were divided into 3 groups according to platelet count: group I (<10×109/L), group II (10–50×109/L) and group III (>50×109/L). ResultsOperative time was significantly lower in Group III compared to Group I and II (100±53 and 105±61min, P<.025)). Intraoperative blood loss was statistically higher in group I (263±551ml) with respect to the other 2: group II (128±352ml) and group III (24±62ml) (P<.003). Hospital stay was 6.4±5.8 days in group I, significantly higher compared to groups II and III (3.8±2.3 and 3.2±1.8 days, respectively (P<.003)). ConclusionConducting a LS in ITP patients with low platelet counts is effective and safe.

General Gastroenterological Surgery: Spleen.

General Gastroenterological Surgery: Spleen.

Long-Term Results After Splenectomy in Adult Idiopathic Thrombocytopenic Purpura: Comparison Between Open and Laparoscopic Procedures

Only a few studies have addressed long-term results comparing laparoscopic and open splenectomy in idiopathic thrombocytopenic purpura (ITP). We analyzed the 1-year results comparing age, sex, length of preoperative steroid therapy, diagnosis-to-splenectomy interval, and preoperative platelet count in relation to postoperative response after open and laparoscopic splenectomy. Data collected from two groups, treated by laparoscopic and open splenectomy, respectively, of 20 patients each were retrospectively reviewed. Positive response to splenectomies, evaluated according to the International Working Group guidelines reported by the American Society of Hematology, was statistically related through Student's t test and the Pearson correlation test to the above-mentioned factors. Positive response to splenectomy was observed in 80% and 85% of patients, respectively, in the laparoscopic and open groups (P > .10). No statistical differences were observed comparing each of the studied factors between laparoscopic and open splenectomy responder patients (P > .10). When percentage increase of postoperative platelet count was related to diagnosis-to-splenectomy interval, a positive correlation was found in the laparoscopic group (r = 0.544, P < .05). In addition, a significant negative correlation in both groups was observed comparing preoperative platelet count and percentage postoperative platelet increase, with a greater increase of postoperative platelet count in patients with a lower preoperative platelet count (laparoscopic group, r = -0.663; open group, r = -0.656; P < .01). In this series long-term results after laparoscopic splenectomy in ITP patients were as effective as after the open approach. Higher postoperative platelet percentage increase was achieved in both groups in patients with a lower preoperative platelet count. Finally, laparoscopic splenectomy in this study seems to be superior to the open approach in patients with a longer diagnosis-to-splenectomy interval.

Herpes Zoster with Cutaneous Dissemination in a Patient 21 Years after Splenectomy for Idiopathic Thrombocytopenic Purpura

Varicella-zoster virus is a member of the herpes virus family that causes varicella during a primary infection and herpes zoster (HZ) when reactivated. Patients who are immunocompromised often have atypical presentations of HZ and experience complications such as multidermal involvement and dissemination. We report a case of disseminated HZ in an immunocompetent patient with a history of splenectomy for idiopathic thrombocytopenic purpura (ITP). Our 46-year-old female patient presented with a painful vesiculopapular dermatomal rash with approximately 80 other lesions diffusely spread over her body. She was in good health but had a splenectomy for ITP 21 years earlier and a history of recurrent herpes labialis. The latter led to the tentative diagnosis of a widespread herpes simplex infection. However, laboratory results confirmed a diagnosis of disseminated herpes zoster. A workup of the patient's immune status did not reveal any abnormalities other than the patient's previously noted splenectomy. This case adds to the two reports of patients developing cutaneous disseminated HZ several years after splenectomy. Our case serves as a reminder that patients with a history of splenectomy appear to be at increased risk for cutaneous dissemination of HZ.

Capnocytophaga canimorsus in a postsplenectomy patient

<i>Capnocytophaga canimorsus</i>, formally known as Dysgonic fer-menter 2 (DF-2), is a commensal bacteria of dog and cat saliva. It can be transmitted to humans by bite, scratch, or mere exposure to animals by licking. It is a Gram negative rod that typically causes septicaemia and disseminated intravascular coagulopathy. Derma-tological lesions and gangrene are common. The reported mortality rate is up to 30%. Most of the patients affected have compromised immunity, secondary to splenectomy or alcoholism. However, in one of the review articles, up to 40% of septicaemia occurred in patients with no predisposing factors. We described a 60-year-old female who presented with septicaemia secondary to <i>Capnocytophaga canimorsus</i>, following a minor bite by a dog. Her medical history included splenectomy for idiopathic thrombocytopenic purpura 24 years ago, with normal blood count since the sple-nectomy. The diagnosis was strongly suspected on peripheral blood film, which was later confirmed on blood cultures. Despite maximal therapy and surgical intervention, the patient succumbed to the infection. In view of the severity of this infection, clinicians should be aware of the possibility of <i>Capnocytophaga canimorsus</i> infection in the management of animal bites, especially in patients with predisposing factors.

Single-incision laparoscopic splenectomy for idiopathic thrombocytopenic purpura: Report of a case

We herein report a case of single-incision laparoscopic access (SILA) splenectomy for idiopathic thrombocytopenic purpura (ITP). A 24-year-old female patient with a diagnosis of ITP received corticosteroid therapy. However, as the side effects became serious, a splenectomy option was chosen. The SILA splenectomy using a transumbilical approach is cosmetically more attractive than a conventional laparoscopic approach, but it has an increased risk of major bleeding due to technical considerations. Therefore, we prioritized the patient's safety during the SILA splenectomy by choosing a left lower abdominal approach. The operating time was 123 min and blood loss was 1 ml. This was comparable to a conventional laparoscopic splenectomy. The present case appears to be the first SILA splenectomy reported in Japan. In our experience, a SILA splenectomy is feasible and safe, with favorable perioperative and shortterm patient outcomes. Further studies are necessary before the universal adoption of this new technique.

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura in a woman with situs inversus: Report of a Case

A 51-year-old woman with previously diagnosed situs inversus (SI) totalis was admitted to our hospital with nasal bleeding. Blood tests showed severe thrombocytopenia, with a platelet count of 1.9 × 104/mm(3), and idiopathic thrombocytopenic purpura (ITP) was diagnosed. She was refractory to medical treatment, so we performed laparoscopic splenectomy (LS). The mirrorimage anatomy made the procedure difficult for the right-handed surgeon, so we modified the technique to enable it to be performed via an anterior approach through the subxiphoid area using the right hand, with an ultrasonic dissecting device and an endostapling device. The operation was performed safely, the patient recovered uneventfully, and her platelet count normalized. To our knowledge, there has been no other report of LS in a patient with SI; however, it can be performed safely with careful management.

Vergleich der laparoskopischen Splenektomie in Steinschnittlage mit der Hanging-Spleen-Technik bei idiopathischer thrombozytopenischer Purpura

Laparoscopic splenectomy has become the gold standard intervention for elective splenectomy. Several techniques have been described, which differ in trocar localisations and patient positions. The hanging-spleen technique was examined in comparison to the conventional laparoscopic splenectomy in the supine position among the patient population in our institution over a period of 8 years. On the basis of a retrospective analysis, data were collected on all patients who underwent elective laparoscopic splenectomy for idiopathic thrombocytopenic purpura between May 1994 and April 2002 and were examined for operation time, blood loss and peri-operative complications. Two types of operation were compared, the conventional laparoscopic splenectomy in the supine position (group A) and the hanging-spleen technique (group B). Finally, the costs of materials of the two operation techniques were compared. For 51 patients (43.1 % men, 56.9 % women) (mean age: 45.5 ± 17.5 years) the mean operation times were 134.2 ± 47.3 min (group A) and 9.8 ± 39.9 min (group B). The mean blood losses were 691.3 ± 544.4 mL in group A and 638.3 ± 1050.6 mL in group B. The perioperative complications were 38.8 % in group A and 21.2 % in group B. There was no significant difference found for operation time, blood loss and perioperative complications in a multivariate analysis. The cost of materials was reduced in group B (use of Endo-GIA 42.4 % in group B, 100 % in group A). In group A 4 incisions, in group B 3 incisions were necessary. Regarding operation time, blood loss and perioperative complications the 2 laparoscopic techniques for splenectomy do not differ significantly. Merely reduced material costs and a reduction of incisions were found in patients -operated with the hanging-spleen technique. Whether the hanging-spleen technique is the method of choice will have to be shown by further prospective studies.

Portal Vein Thrombosis Postlaparoscopic Splenectomy Presenting With Infarction of Gut: Review of Risk Factors, Investigations, Postoperative Surveillance, and Management

Portal vein thrombosis after laparoscopic splenectomy is a known complication even though it is underappreciated. Presenting symptoms are usually mild and nonspecific. Progression to intestinal infarction and portal hypertension are potentially life threatening complications. The short hospital stay associated with laparoscopic approach could delay early diagnosis, unless routine imaging studies is planned after discharge. We present a patient who after laparoscopic splenectomy for idiopathic thrombocytopenic purpura developed portal vein thrombosis leading to infarction of small intestine 9 days after the surgery. She made uneventful recovery after resection and anticoagulation. Literature is reviewed to assess the risk factors and discuss the present status regarding investigations, surveillance in postoperative period, management of established case, and role of prophylactic anticoagulation.

Systemic thromboembolic complications after laparoscopic splenectomy for idiopathic thrombocytopenic purpura in comparison to open surgery in the absence of anticoagulant prophylaxis

Idiopathic thrombocytopenic purpura (ITP) in adults has a chronic course and may necessitate splenectomy. The current study was undertaken to study the systemic thromboembolic complications of laparoscopic splenectomy (LS) versus open splenectomy (OS) in patients with ITP at two large referral hospitals. We conducted a retrospective analysis of 49 patients who underwent splenectomy (21 LS and 28 OS) for primary/relapsing refractory ITP between June 1995 and November 2004. Clinically and/or radiologically confirmed deep venous thrombosis (DVT) and/or pulmonary embolism (PE) were assessed within 2 weeks before and after splenectomy. None had prophylactic anticoagulants immediately after surgery. Follow up of those who developed complications continued for at least 2 additional years to assess for contributing factors that may have been masked at the time of occurrence. Two (9.5%) LS group had acute PE within 5 days of LS and their platelet count reached 500A103/I(1/4)L within 4 days and 1000A103/I(1/4)L within 7 days after surgery. Three conversions to OS occurred; none had VTE. DVT occurred in 3 patients (10.7%) in the OS group; none were life threatening. There were no deaths. Life-threatening venous thromboembolic events are serious complications after LS and OS for ITP patients if prophylactic anticoagulants are not administered. Patients at risk are those who both have an exponential rise of the platelet count, although factors other than the platelet count may be contributing in OS. Postsplenectomy, ITP should be considered as a thrombophilic condition and studies of additional measures to prevent such events are warranted.

Health-Related Lifestyle among Adult & Pediatric Patients with Idiopathic Thrombocytopenic Purpura in the United Kingdom.

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune condition characterized by autoantibody-mediated platelet destruction and suboptimal megakaryocytic production. Primarily acute (< 6 months) in duration among children, ITP manifests predominantly chronically among adults, increasing susceptibility to bleeding events.Despite recent growth, published literature on health-related quality of life in ITP remains limited. The objective of our investigation was to identify lifestyle concerns associated with ITP among adult and pediatric patients in the United Kingdom.In collaboration with ITP specialists, a 43 question, closed-field lifestyle survey was developed, addressing social engagement, work and school performance, sports and activities, treatment, and travel. Patient members of the United Kingdom ITP Support Association (N = 1,767) were asked to complete and return mailed surveys. Pearson's chi-square and Fisher's exact tests were used to evaluate differences in dichotomized variables between groups.790 (45%) completed surveys were returned. As illustrated in the table below, roughly one-quarter of adults (≥ 16 years) and one-fifth of children reported ‘always’, ‘sometimes’, or ‘often’ missing school or work owing to fatigue and having encountered difficulty obtaining insurance. Nearly one-third of adults further revealed having an elective surgery delayed owing to a low platelet count.Disparities were noted across gender with regard to bruise concealment (adults: p < 0.01; children: p = 0.03) and suspicions of subjection to violence (adults: p < 0.01; children: p = 0.49). In contrast with adults, pediatric patients reported being more likely to having requests for referral denied (p = 0.03).This study represents the largest quality of life investigation of ITP to date. Although the survey utilized remains to be validated, its findings nonetheless successfully highlight avenues for future investigation.Subgroups: ‘Yes’ %AdultsChildrenQuestionTotal ‘Yes’ % N = 790Male N = 199Female N = 497Male N = 51Female N = 43Have you ever been unable to go to work or school because of tiredness and fatigue?29% 710[1]26% 18631% 43520% 4930% 40Have you had difficulty obtaining or been refused travel and life insurance?29% 61130% 54018% 71Have you ever had surgery (other than splenectomy for ITP) postponed or delayed because of a low platelet count?30% 62034% 15830% 39113% 3919% 32Do you try to hide your bruises?29% 75610% 19037% 47520% 5042% 41Are people ever suspicious that the bruises are a result of physical violence?17% 7505% 19319% 46831% 4938% 40Have you ever been refused a referral to an ITP specialist or hospital of5% 5743% 1444% 35810% 4110% 31[1] Total number of responses recorded for the given question.

Historical review. The light and shadow of Paul Kaznelson: his life and contribution to hematology

Paul Kaznelson is credited with describing the first case of pure red cell aplasia. He was also known for his contribution to the discovery of the therapeutic role of splenectomy in idiopathic thrombocytopenic purpura. Most of his academic works appeared in 1910s and 1920s, when he used to work in Karl-Ferdinand University in Prague. Trail of his rather tragic postwar life is briefly added.

Laparoscopic splenectomy for splenic masses

This study aimed to evaluate the perioperative outcomes and pathology of patients undergoing laparoscopic splenectomy for splenic masses. The records for 174 patients who underwent laparoscopic splenectomy from May 1994 to August 2006 were reviewed. Patient demographics, preoperative imaging, American Society of Anesthesiologists (ASA) score, body mass index (BMI), estimated blood loss (EBL), operative time, spleen size, complications, hospital length of stay (LOS), pathology, and mortality were extracted from the records. Data are expressed as means +/- standard deviation. Statistical significance (p < 0.05) was determined using a two-tailed t-test and Fisher's exact test. A splenic mass was diagnosed preoperatively for 18 patients (10.3%) (7 males and 11 females). The mean patient age was 51.4 +/- 13.7 years. The mean ASA was 2.3 +/- 0.8, and the mean BMI was 27.3 +/- 5.8 kg/m(2). Computed tomography scans demonstrated splenic masses in all the patients. The mean mass size was 4.3 +/- 3.3 cm (range, 1.0-11.0 cm), and the mean spleen length was 14.6 +/- 7.5 cm (range, 5.5-40.2 cm). Total laparoscopic splenectomy was completed for 15 patients, and hand-assisted splenectomy was performed for 3 patients (2 converted). The mean operative time was 128.3 +/- 38.5 min, and the mean EBL was 110 +/- 137.5 ml. There were no intraoperative complications or 30-day mortalities. The postoperative complication rate was 11.1%, and the mean LOS was 1.9 +/- 1.0 days. The pathology for six patients (33.3%) was malignant (5 lymphomas and 1 adenocarcinoma). There were three false-positive positron emission tomography (PET) scans. Compared with 73 patients undergoing laparoscopic splenectomy for idiopathic thrombocytopenic purpura, there was no significant difference in mean EBL, operative time, conversion rate, complication rate, LOS, or 30-day mortality rate (p > 0.05). Laparoscopic splenectomy is appropriate for patients whose indication for surgery is splenic mass. Suspicious splenic masses should be removed due to the relatively high incidence of malignant pathology, most commonly lymphoma.

An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura

Background Laparoscopic splenectomy has become the preferred surgical procedure for the management of idiopathic thrombocytopenic purpura (ITP). However, there studies have directly compared the incidence of recurrent ITP secondary to missed accessory spleens in open versus laparoscopic splenectomy. Methods Open and laparoscopic splenectomies performed for ITP at 4 sites over 18 years were analyzed. The incidence of recurrent disease secondary to missed accessory spleens was compared between the open and laparoscopic splenectomy groups. Results A total of 105 splenectomies (54 open/51 laparoscopic) were performed. Accessory spleens were identified in 6 laparoscopic and 6 open cases ( P = .57). Recurrent disease occurred in 27.6% of open and 14.6% of laparoscopic cases ( P = .222). There were no cases of recurrent ITP secondary to a missed accessory spleen in either group. Conclusions The incidence of missed accessory spleens causing recurrent disease is similar when splenectomy is performed either open or laparoscopically.

Splenectomy in idiopath0cthrombocytopenic purpura.

Splenectomy in idiopath0cthrombocytopenic purpura.