Splenic Length Research Articles

Sonographic assessment of the normal limits of the spleen in healthy school children in South-East Nigeria.

Ultrasonogrphy is a good modality for the detection of splenomegaly even when it is not clinically palpable. The objective of this study was to establish the normal values of splenic length in healthy school children in South-East, Nigeria and to correlate them with body indices. This is a cross-sectional prospective study of 1315 children (633 boys and 682 girls) between the ages of 5 and 17 years. The splenic length was measured between the most superiomedial and the most inferiolateral margins, at the level of the hilum. Only the spleens that had normal shape and echotexture were measured. The mean splenic length and the 5 th and 95 th percentiles were determined for each age. The length was correlated with the sex, age, weight (WT), height, body mass index (BMI) and body surface area (BSA) of the subjects. A regression model for prediction of spleen dimension from age and body habitus was computed. There was a significant correlation between splenic length and age, P < 0.001. Males had statistically significant longer spleen length than females. The splenic length correlated best with BSA, followed by body WT and least with BMI. This study noted racial variation between the established Nigerian values and results from other countries of the world. For the first time, a baseline value for splenic size for the Nigerian Children of various ages has been established with a regression model for predicting the splenic sizes.

Comparative Studies and Clinical Significance of the Spleens of Nigerian Indigenous Pig (Sus scrofa) and Goat (Capra hircus)

The mammalian spleen show peculiar histological differences. This study aims to compare the gross, histologic and histomorphometrics of the spleen of Nigerian indigenous pig, NIP (Sus scrofa) and West African Dwarf goat (WADG). Twenty spleens (10 each) from apparently healthy slaughtered adult pigs and goats were studied. Sections were neutral buffered formalin fixed and paraffin embedded for routine and special stains. Grossly, WADG spleen was quadrangular but slipper shaped in NIP. The difference in splenic length and weight in NIP (36.87±2.71cm and 180±17.32cm) was significant (P< 0.05) compared to WADG (9.2±0.77cm and 68±5.43cm). WADG has significantly thickened splenic capsule (1173±57.02µm) than NIP (271.8±17.08µm) (P<0.05). The distribution of white pulps was randomly even in WADG but somewhat clustered in NIP. There were dense population of white pulp in WADG. In conclusion, spleen of NIP and WADG showed relatively well defined histological features but more adaptive for immunological functions in the WADG.

Outcome Of Patients (pts) With Myelofibrosis (MF) After Ruxolutinib (Rux) Therapy

BackgroundRuxolitinib (Rux) is a potent, specific oral JAK1 and JAK2 inhibitor that is approved therapy for patients (pts) with intermediate- or high-risk MF. Its clinical benefit is seen in the majority of pts, as a marked and sustained improvement in splenomegaly and/or disease-associated symptoms. Rux therapy also prolongs the life-span of pts with advanced MF. Nonetheless, the prognosis of the minority of MF pts who either fail to primarily respond or lose clinical response over time to Rux has not been examined so far. AimsTo assess the outcome of pts with MF after a reasonable course of Rux therapy has been completed. This is important in relation to pts who might benefit from other strategies in this clinical setting, such as allogeneic stem cell transplantation (AlloSCT) or clinical studies with investigational agents. MethodsData from all pts with a diagnosis of MF who received Rux therapy at MDACC from Jun.2007 until Sep, 2011 were analyzed. Of those, 79 pts discontinued Rux but also provided adequate data during follow-up for this analysis. ResultsMedian age was 67 years (range, 40-84) and 56 pts (71%) were primary MF. Per International Prognostic Scoring System (IPSS), at baseline (BL), 8 (10%) pts had intermediate (int)-1, 19 (24%) int-2, and 52 (66%) high-risk MF. Per Dynamic (D)-IPSS, 19 (24%) pts were int-1, 49 (62%) int-2, and 11 (14%) high-risk. Karyotype was diploid in 45 pts (57%). The JAK2V617F mutation was identified in 62 pts (78%), with a median allele burden of 54%. At BL, median spleen size was 18 cm (range, 0-36); 3 pts had prior splenectomy; 25 pts (32%) were RBC transfusion-dependent. Median BL platelet count was 257 x 109/L (range, 100-1183). Rux was given for a median of 19 months (mo; range, 2-5+). Clinical improvement in splenomegaly per IWG, i.e., a 50% or greater reduction of splenic length by palpation, was observed in 40 pts (53%) for a median of 32 mo (range 6-57). In addition, 36 pts (46%) with post-BL assessments experienced a clinical benefit with up to 50% reduction in splenomegaly and improvement in symptoms. Only 3 pts had “primary” refractory disease. The characteristics of pts at the time of Rux discontinuation are shown in Table 1: 19 pts (24%) had int-1, 49 (62%) int-2, and 11 (14%) high-risk disease, by D-IPSS. Reasons for stopping Rux in 76 pts who initially responded to this medicine were: loss of clinical benefit in 53 pts (70%), transformation into acute myeloid leukemia in 6 pts (8%), progression in comorbidities in 4 pts (5%), limiting myelosuppression in 4 pts (5%), AlloSCT in 4 pts (5%), pts' personal request in 3 (4%), and splenectomy in 2 (3%). The median overall survival (OS) after Rux discontinuation was 6 mo with estimated 1- and 2-year OS rates of 34% and 25%, respectively. After a median follow-up of 10 mo from stopping Rux, 27 (34%) pts remain alive. There was no difference in survival depending upon D-IPSS categories (p=0.71).Table 1Pts characteristics at time of Rux failureCharacteristics at time of failure, N=79NMedian(%)/[Range]Age ≥ 65 years4658Sex (Male)5063MFPrimary5671Post-PV/ET2329Transfusion-dependent2532D-IPSSLow00Int-11924Int-24962High1114CytogeneticDiploid4557Abnormal3443Hgb < 10g/dL4152PLT (109/L)257100-1183PLT < 100 x 109/L00WBC ≥ 25 x 109/L2734PB BL>1%3848BM blasts %20-15D-IPSS at BLLow00Int-1810Int-21924High5266 ConclusionThe outcome of pts with MF who experience either ‘primary' failure (∼4%) of or loss of clinical benefit (∼96%) from Rux therapy is poor, with a median survival of only 6 mo. The D-IPSS risk model is not predictive of their outcome. Disclosures:Cortes:Incyte: Consultancy, Research Funding; Sanofi: Consultancy, Research Funding. Ravandi:Sunesis: Consultancy, Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Bristol Myers Squibb: Honoraria, Research Funding; Teva: Consultancy, Honoraria; Pfizer: Honoraria; Merck: Research Funding; Bayer/Onyx: Consultancy, Honoraria; EMD Serono: Research Funding; Medimmune: Research Funding; Amgen: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria. Verstovsek:Incyte: Research Funding.

BCR CDR3 length distributions differ between blood and spleen and between old and young patients, and TCR distributions can be used to detect myelodysplastic syndrome

Complementarity-determining region 3 (CDR3) is the most hyper-variable region in B cell receptor (BCR) and T cell receptor (TCR) genes, and the most critical structure in antigen recognition and thereby in determining the fates of developing and responding lymphocytes. There are millions of different TCR Vβ chain or BCR heavy chain CDR3 sequences in human blood. Even now, when high-throughput sequencing becomes widely used, CDR3 length distributions (also called spectratypes) are still a much quicker and cheaper method of assessing repertoire diversity. However, distribution complexity and the large amount of information per sample (e.g. 32 distributions of the TCRα chain, and 24 of TCRβ) calls for the use of machine learning tools for full exploration. We have examined the ability of supervised machine learning, which uses computational models to find hidden patterns in predefined biological groups, to analyze CDR3 length distributions from various sources, and distinguish between experimental groups. We found that (a) splenic BCR CDR3 length distributions are characterized by low standard deviations and few local maxima, compared to peripheral blood distributions; (b) healthy elderly people's BCR CDR3 length distributions can be distinguished from those of the young; and (c) a machine learning model based on TCR CDR3 distribution features can detect myelodysplastic syndrome with approximately 93% accuracy. Overall, we demonstrate that using supervised machine learning methods can contribute to our understanding of lymphocyte repertoire diversity.

Influence of detomidine and xylazine on spleen dimensions and on splenic response to epinephrine infusion in healthy adult horses

ObjectiveTo compare the changes in splenic length and thickness and in packed cell volume (PCV) following detomidine or xylazine administration and subsequent epinephrine infusion. Hypothesis: Spleen relaxation occurs following xylazine or detomidine administration and interferes with subsequent splenic contractile response to epinephrine. Study designRandomized non‐blinded crossover experimental study. Animals6 healthy adult mares. MethodsThe mares received an intravenous (IV) epinephrine infusion (1 μg kg−1minute−1 over 5 minutes) one hour after IV administration of detomidine (0.01 mg kg−1), xylazine (0.5 mg kg−1) or no drug (control), with a withdrawal period of at least 7 days between experiments. The splenic length measured in two different axes, the splenic thickness, and the PCV were measured prior to sedation (T0), 30 minutes later, and at 5‐minute intervals from the start of the epinephrine infusion (T1) until T1 + 40 minutes. Changes from base‐line and between treatments were compared using a two‐way anova for repeated measures. Significance was set at p < 0.05. ResultsSplenic length was significantly increased and PCV was significantly decreased after detomidine administration compared to baseline. Epinephrine infusion resulted in a significant decrease in splenic length and thickness, and a significant increase in PCV, irrespective of prior treatment with detomidine or xylazine. ConclusionsDetomidine administration was followed by a sonographically detectable increase of splenic length. Neither detomidine nor xylazine interfered with the ability of the spleen to contract following subsequent administration of an epinephrine infusion given one hour later. Clinical relevancePrevious sedation with alpha‐2 agonists does not preclude the efficiency of epinephrine as a medical treatment of left dorsal displacement of the large colon, but further investigations are required with other drug doses and different time intervals between administrations.

The learning curve for laparoscopic splenectomy for massive splenomegaly: a single surgeon’s experience

Background Laparoscopic splenectomy (LS) for massive splenomegaly is more technically challenging than for a normal-sized spleen. The purpose of this study was to determine the effect of operative experience on perioperative outcomes of LS for massive splenomegaly. Methods Between January 2008 and December 2010, 36 consecutive patients who were diagnosed with massive splenomegaly underwent LS in our department. The perioperative outcomes were evaluated for evidence of a learning curve effect. Patients were divided into three groups (1, 2, and 3) of 12 consecutive patients, and outcomes of each group were compared. Results The mean operative time decreased significantly from 252 minutes of Group 1 to 179 minutes of Group 3. The estimated blood loss and length of post-operative hospital stay showed a similar trend. No significant differences were found in the splenic length and weight, transfusion rate, or average amount of drainage. In this cohort, there were three cases with surgical complications and one conversion to open laparotomy. Conclusions The first 24 cases constitute the early stage of the learning curve for LS for massive splenomegaly. LS for massive splenomegaly is a technically challenging operation with a long learning curve, and strategies for developing training programs must address these challenges.

Sonographic measurement of the spleen: splenic length in adults and its correlation with different parameters

Aim: The purpose of this study was to establish guidelines for normal splenic length at different ages by using a simple and reproducible sonographic method and to find out a relation between spleen length, age, height, weight, and surface area. Materials and methods: One hundred sixty subjects, from 21 years to 60 years old, had sonography because of abdominal and/or pelvic problems unrelated to the spleen. The splenic size was measured by obtaining a coronal view that included the hilum during deep inspiration to minimize masking by lung. The greatest longitudinal distance between the dome of the spleen and the tip (splenic length) was measured and correlated with age, height, and weight. Results: The results show that the splenic length decreased with increase in age in both males and females. The length of the spleen increased with increase in the body height, body weight, and body surface area in both males and females. In most of the subjects, the splenic length was found to be <11 cm. The splenic size in males was greater than that in females. Discussion: The findings of present study that the splenic length decreases with age are similar to the findings of Loftus and Metreweli. Konus et al in 1998 proposed that the splenic length correlated best with the body height. This is similar to the findings of the present study. The finding of present study that the splenic length has positive correlation with the body height, weight, and surface area is similar to the finding of Megremis et al. Conclusion: On the basis of the above study, it was concluded that the splenic length decreased with increase in age in both males and females. The length of the spleen has positive correlations with increase in the body height, body weight, and body surface area in both males and females. The splenic length was less in females than that in males with the corresponding age, body height, body weight, and body surface area. In most of the subjects, the splenic length was found to be <11 cm.

Spleen size measured on enhanced mri for quantitatively staging liver fibrosis in minipigs

To investigate whether and how spleen size measured on magnetic resonance imaging (MRI) could be used to stage liver fibrosis. Sixteen minipigs were used to prospectively model liver fibrosis staged by biopsy. Abdominal gadolinium-enhanced MRI was performed on the 0, 5th, 9th, 16th, and 21st weekend after beginning of the modeling. Splenic maximal width (W), thickness (T), length (L), and area (S) together with spleen volume (SV) and liver volume (LV) were measured on enhanced MRI and the ratio of SV to LV (SV/LV) was calculated. Spleen multidimensional indexes 1 and 2 were obtained by W × T × L and S × L, respectively. Statistical analyses were performed to determine which parameter could best stage the fibrosis. W, T, L, S, SV, index 1 and 2, and SV/LV tended to increase with increasing stages of fibrosis (r = 0.46-0.796, all P < 0.001), and might predict liver fibrosis stage ≥1, ≥2, ≥3, and 4 (area under receiver operating characteristic curve [AUC] = 0.697-1.0, all P < 0.05). Among the parameters, splenic index 1, SV, and SV/LV might be best for predicting stage ≥1 (AUC = 0.941), ≥2 or ≥3 (AUC = 0.875 or 0.978, respectively), and 4 (AUC = 1.0), respectively. Spleen size measured on MRI could be used for staging liver fibrosis.

Sonographic evaluation of the splenic length in normal pregnancy in a tertiary hospital in Southern Nigeria: A pilot study

Background:The spleen is affected by the changes that occur in pregnancy. Ultrasound is the commonest imaging modality used in the evaluation of the abdominal organs in pregnancy; however, there is a paucity of information on the sonographic measurement of the splenic length in normal pregnancy in our environment.Aim:To establish sonographically the range of splenic length in normal pregnant women.Subjects and Methods:A prospective descriptive cross sectional study of the sonographic measurements of the splenic length was performed on 150 healthy normal pregnant women correlating this with the body mass index, gestational age and parity. Data were analyzed using software SPSS version 15 (SPSS Inc., Chicago, IL, USA). Correlations and variance between variables were calculated. P values 0.05 were considered as significant.Results:A mean splenic length of 10.0 cm (SD) 1.8 throughout pregnancy was obtained with a range of 9.7-10.3 cm. The splenic length significantly correlated positively with the body mass index (r = 0.006, P < 0.01) but not with parity (r = 0.94, P < 0.01), and gestational age (r = 0.31, P < 0.01).Conclusion:This study was able to establish a range of sonographic measurement of the splenic length for the locality.

Laparoscopic splenectomy for treatment of splenic marginal zone lymphoma

To investigate the short-term and long-term efficacy and safety of laparoscopic splenectomy (LS) for treatment of splenic marginal zone lymphoma (SMZL). A total of 18 continuous patients who were diagnosed with SMZL and underwent LS in our department from 2008 to 2012 were reviewed. The perioperative variables and long-term follow-up were evaluated. To evaluate the efficacy and safety of this procedure better, we also included 34 patients with liver cirrhosis who underwent LS, 49 patients with immune thrombocytopenia (ITP) who underwent LS, and 20 patients with SMZL who underwent open splenectomy (OS). The results observed in the different groups were compared. No differences were found in the sex and Child-Pugh class of the patients in SMZL-LS, SMZL-OS, ITP, and liver cirrhosis groups. The splenic length of the patients in the SMZL-LS group was similar to that in the SMZL-OS and liver cirrhosis groups but significantly longer than in the ITP group. The SMZL-LS group had a significantly longer operating time compared with the SMZL-OS, ITP, and liver cirrhosis groups, and the SMZL-LS group exhibited significantly less blood loss compared with the SMZL-OS group. No difference was found in the length of the postoperative hospital stay between the SMZL-LS, SMZL-OS, ITP, and liver cirrhosis-LS groups. After surgery, 6 (33.3%) SMZL-LS patients suffered slight complications. During mean follow-up periods of 13.6 and 12.8 mo, one patient from the SMZL-LS group and two from the SMZL-OS group died as a result of metastasis after surgery. None of the ITP and liver cirrhosis patients died. LS should be considered a feasible and safe procedure for treatment of SMZL in an effort to improve the treatment options and survival of patients.

Less-invasive MR indices of clinically evident esophageal variceal bleeding in biliary atresia patients

Esophageal variceal hemorrhaging is potentially life threatening for long-term survivors of biliary atresia. We evaluated the feasibility of less-invasive parameters for predicting the presence of clinically significant esophageal variceal bleeding in biliary atresia patients. A total of 30 patients aged 108-5314 days (median = 285 days) with biliary atresia underwent a magnetic resonance examination with fast spin-echo T2-weighted imaging and spin-echo, T1-weighted images with fat saturation after use of a contrast medium on a 1.5-tesla scanner. The splenic length-platelet ratio was divided by the each patient's body height (m) to produce the corrected splenic length-platelet ratios. In addition, the splenic volume index-to-platelet count ratio was divided by the patient's body weight (kg) to produce a corrected ratio. The corrected splenic length-platelet ratio was more significantly increased in 21 patients with esophageal variceal bleeding (Group A) than in nine patients without variceal bleeding [(Group B) 0.98 ± 0.64 vs. 0.44 ± 0.18, p < 0.01]. The splenic volume index-to-platelet count ratio corrected by body weight was significantly larger in Group A (510.7 ± 536.2) than in Group B (148.1 ± 88.9, p < 0.01). Less-invasive indices, including the corrected splenic length platelet ratio and the splenic volume index-to-platelet count ratio, may be valuable predictors of esophageal variceal bleeding in patients with biliary atresia.

A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease

Background/AimsThe aim of this study was to identify the parameters that could noninvasively predict the presence of esophageal/gastric varices and portal hypertensive gastropathy (PHG) in patients with chronic liver disease (CLD), and to determine the accuracy of those parameters.MethodsWe retrospectively analyzed 232 patients with CLD who underwent both upper endoscopy and liver CT within an interval of 3 months. The multidimensional index (M-Index) for spleen volume was obtained from the multiplication of splenic length, width, and thickness, as measured by computer tomography.ResultsThe multivariate analysis revealed that platelet, albumin, and M-Index were independently associated with the presence of varices and PHG. We combined three independent parameters, and developed a varices and portal hypertensive gastropathy (VAP) scoring system (=[platelet count (/mm3)×albumin (g/dL)]/[M-Index (cm3)]). The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confidence interval, 0.801-0.899). The VAP cut-off value of 861 had a sensitivity of 85.3%, a positive likelihood ratio of 3.17, and a negative predictive value of 86.4%. For predicting high-risk lesions for bleeding, with a cut-off value of 861 the sensitivity was 92.0%, the positive likelihood ratio was 2.20, and the negative predictive value was 96.4%.ConclusionsThe VAP score can predict the presence of varices and PHG in patients with CLD and may increase the cost-benefit of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future.

Ultrasonographic Measurement of Splenic Length in Relation with Height in Bihari Adult Population a Prospective Study

Spleen, the largest ductless gland in the body, shows variations in its size and weight at different periods of life, in different individuals, and in the same individual under different conditions. The splenic size may give information regarding diagnosis and course of various gastrointestinal and haematological diseases so the estimation of the splenic size in vivo is often important in the diagnosis, treatment and prognosis of a variety of disorders. The present study was done to determine the normal range of length of spleen in correlation with the height of adult male and female subjects. A total of 160 patients, 80 males and 80 females were selected. Height of each individual was measured and their splenic length was determined by ultrasonography. It was observed that the length of spleen increased with increase in the height in both male and female. The dimension was less in female than that of male with corresponding body height.

Enlargement of the spleen as an incidental finding on CT in post-partum females with fever

The aim was to evaluate whether enlargement of the spleen on CT in a post-partum female with fever is a common phenomenon. In this retrospective institutional review board-approved study, the spleen was measured by CT in 77 females (average age 30.7 years) examined for post-partum fever and a control group of 58 febrile females imaged for suspected appendicitis (average age 29.7 years). The splenic length, width and thickness were measured and used to calculate the splenic index. The measurements of both groups of patients were compared. The size of the spleen was assessed again in 12 of the 77 post-partum female who had a follow-up CT for unrelated reasons. Continuous variables were compared, by groups, using analysis of variance (ANOVA). ANOVA with repeated measures was used to evaluate changes over time. A p-value <0.05 was considered significant. The length, thickness and width of the spleen were significantly larger in the patients imaged after delivery compared with those in the control group (p<0.001 for all three comparisons). The mean splenic index was 686.6 cm(3) in the post-partum group and 408.1 cm(3) in the control group (p<0.001). The splenic dimensions and index were significantly smaller in the 12 post-partum females who had a follow-up study. An enlarged spleen in febrile females undergoing CT in the puerperium may reflect physiological changes occurring during pregnancy.

3.1 Natural History of Splenomegaly in CLL from Automated Volumetric Analysis

Introduction: We have developed a technique for the automated segmentation and quantification of spleens from contrast enhanced CT scan data. This technique was applied to a series of CT scans obtained from CLL patients enrolled in a natural history protocol at the NHLBI NIH to better understand the natural history of splenomegaly in CLL. Methods and Materials: Forty-three abdominal CT sets from 22 patients (13 males and 9 females) with CLL were acquired with/out IV contrast on a variety of scanners between 2000 and 2011. In addition to baseline CT scans, 12 patients had between 1 and 3 CT scans prior to treatment. The time interval between consecutive scans varied between 3 and 58 months. Images were acquired at either non-contrast, arterial or portal venous phases. When IV contrast was used, patients were administered Isovue 300 and the contrast-enhanced data were acquired using either fixed delays or bolus tracking. The image matrix was 512 512 pixels with sub-millimeter resolution in the axial slice and 5 to 10 mm slice thickness. For the validation of the segmentation technique, 14 additional cases (7 with normal spleens and 7 with splenomegaly) were used with similar acquisition parameters. The 14 cases were acquired at portal venous enhancement with 5 mm slice thickness and their spleens were manually segmented. The spleens were automatically segmented using a probabilistic atlas and non-linear registration. The organ locations were modeled in the physical space and normalized to the position of an anatomical landmark, the xiphoid process. The construction and exploitation of the spleen atlas enabled the automated quantifications of spleen volumes and cephalo-caudal lengths from abdominal CT data. The quantification was improved incrementally by a geodesic active contour, patient specific contrast-enhancement characteristics, and constraints for shape and location. Results: The spleens were robustly segmented from normal and pathological cases. The spleen quantification led to 0.94 symmetric volume overlap, 4.3/3.7% volume/length errors, 2.1 mm root mean square error and 1.3 mm average surface error. The correlation (R) between automated and manual measurements was 0.98 (p 0.001). The correlation (R) between automated splenic lengths and volumes was 0.71 (p 0.007). The average splenic volume and length at baseline of all patients (n 22) was 642.72 353.82 cm and 13.46 3.52 cm respectively. For the 12 patients with multiple time points, the average splenic volume and length changed from 724.06 305.77 cm and 14.52 3.49 cm at baseline to 1116.08 541.37 cm and 17.96 4.20 cm before starting treatment. There were statistically significant differences between the volumes (p 0.001) and heights (p 0.001) of spleens measured at baseline and before treatment. Of the 12 patients, 11 exhibited substantial increases in spleen volume, while 1 outlier showed a natural decrease. Consensus literature values for maximum spleen volume and length of normal individuals varies from 290 to 380 cm and from 9.8 to 12.0 cm respectively. Using a splenic volume cutoff of 380 cm to detect splenomegaly, 70% of all cases and 79% of the patients with multiple time points had abnormal spleens at baseline. 100% of the patients with multiple time points exhibited splenomegaly before the start of treatment. On average, splenic volume increased by 4.74 5.23% every 3 months (5.40 4.43% without the outlier). Using a splenic cephalo-caudal length cutoff of 12 cm to detect splenomegaly, 59% of all cases and 75% of the patients with multiple time points had abnormal spleens at baseline. 100% of the patients with multiple time points exhibited splenomegaly before the start of treatment. Conclusion: The automated method for spleen analysis allows the non invasive measurement of splenic volume from contrast-enhanced CT data. Automated computer-aided analysis of spleen data in CLL suggests that spleen volume is increased in several patients before it can be physically palpated. It remains to be seen if such subclinical splenic enlargement is associated with early thrombocytopenia. It is envisioned that an automated, standardized analysis would eventually be able to estimate spleen, liver and lymph node volume and yield a 3-dimensional, cross-sectional atlas of the distribution of the disease. Abstracts

Laparoscopic splenectomy using the anterior approach with sequential layered dissection

Objective To study the role of laparoscopic splenectomy （LS） using the anterior approach with sequential layered dissection. Methods From December 2007 to July 2009, we performed 27 LS using the anterior approach with sequential layered dissection. The clinical data were retrospectively analyzed. Results The range of splenic length was 8-20 cm. Accessory spleen was found in 6 patients （22.2%）. The mean operative time was 125 mins. The mean intraoperative blood loss was 90 ml, and the mean postoperative stay was 5.5 days. Conclusions Laparoscopic splenectomy using the anterior approach with sequential layered dissection could be carried out smoothly and rapidly. It reduced accidental injuries and shortened the operative time. Key words: Laparoscopic splenectomy; Anterior approach; Sequential layered dissection

Determination of normal dimension of the spleen by ultrasound in an endemic tropical environment

Background:To determine the normal dimensions of spleen by ultrasonography in our environment exposed to endemic tropical infection and infestation.Materials and Methods:A prospective study of normal spleen ultrasound-based measurements in 200 Nigerian adults at the University of Benin Teaching Hospital Benin, Nigeria.Results:There were 91 males and 109 females; their age ranged between 20 and 60 years. For the males the mean age was 32.4 years (± 9.2 SD), mean height was 175.0 cm (±7.3 SD), mean weight was 72.5 kg (±10.1 SD), and mean body mass index was 23.6 (±2.8 SD) and the females the mean age was 29.7 years (±9.0 SD) mean height was 164.6 cm (±5.8 SD), mean weight 64.1 kg (±12.9 SD), and mean BMI was 24.9 (±1.4 SD). For the males the mean splenic length, width, depth, and volume were 11.1 cm (±0.9 SD), 4.4 cm (±0.5 SD), 7.8 cm (±0.6 SD), and 202.7 cm3 (±49.4 SD), respectively. For the females the corresponding values of splenic length, width, depth, and volume were 10.1 cm (±0.7 SD), 4.0 cm (±0.4 SD), 7.1 cm (±0.5 SD), and 153.7 cm3 (±33.2 SD), respectively.Conclusion:Comparison between mean splenic dimension parameters for males and females (from unpaired t-test determination) showed a statistically significant difference (P<0.001 for splenic length, width, depth, and volume). There was also statistically significant increasing value correlation between subjects’ weight and height (in favor of height) when compared to spleen length, width, depth, and volume. The other parameters show no significant correlation in both female and male. In particular there was also no statistically significant correlation of splenic measurements with age in either sex. This is similar to what was noted in other centers.

Sonographic Measurements of the Spleen in Relation to Age; A Prospective Study in North Indian Adults

To establish the normal range of the splenic dimensions in North Indian adult population, we used ultrasonc graphy to examine 160 subjects (80 males &; 80 females) not known to have any condition likely to be associated with splenic enlargement. Splenic length was measured on longitudinal coronal image from dome to tip through the hilum. On tranverse coronal plane, measurement of the width of the spleen was made at the hilum, followed by thickness measurement taken in the longitudinal coronal plane at a point bisecting the line indicating length The results show that the splenic length, width &; thickness decreased with increase in age in both male and female. All the dimensions were greater in male than in female.

A Model for Chronic Mucosal Inflammation in IBD and Periodontitis

Chronic inflammation of mucosal surfaces is an aberrant immune response to luminal bacteria and generates an array of oxygen radicals leading to tissue destruction and loss of function, as noted in IBD and periodontitis. We hypothesized that mucosal injury after "oral delivery" of dextran sulfate sodium (DSS) or TNBS for an extended period of 18 weeks is reflected by chronic inflammatory responses in a time-dependent fashion. Dextran sulfate sodium was administered in the diet biweekly; TNBS or sham controls was administered orally twice a week. Additional groups received TNBS or sham injections into gingival tissue. Animals tolerated oral applications with no severe clinical symptoms. The DSS-group developed diarrhea during the period of administration, and returned to normal during DSS abstinence. The TNBS-group developed no systemic clinical symptoms. Splenic length and weight increased in the DSS-group in a time-dependent fashion (P < 0.01) and remained normal in the TNBS-group. Colons from the DSS-group were significantly shortened (P < 0.001) and colonic weight increased compared with controls or the TNBS-group (P < 0.05). The DSS-group developed extensive dilation of the stomach wall, ileum, and megacolon, with abdominal fat deposits. In addition, the DSS-group showed dysregulated hepatic concentrations of antioxidants (i.e. cysteine, GSH, SAMe) in a time-dependent manner that correlated with a significance increase in alveolar bone resorption. Localized TNBS-mucosal delivery caused severe inflammation, granuloma formation, and rapid bone resorption. This model of mucosal stimulation eliciting chronic inflammatory responses in the gut and oral cavity mimics aspects of IBD and periodontal disease progression in patients.

Splenic constriction during isometric handgrip exercise in humans

During the first minute of a moderate-intensity isometric handgrip (HG) exercise, there is an increase in stroke volume and cardiac output that occurs without any change in systemic vascular conductance. Although the mechanism of increased venous return is not yet known, current focus has been placed on the constriction of visceral organs. The human spleen represents a compliant organ with high perfusion that constricts during the rather severe stresses of maximal exercise, a diving reflex, or prolonged apnea. This study tested the hypothesis that spleen constriction occurs during isometric HG exercise. Eight participants performed a 1 min isometric HG test at 40% maximum voluntary contraction. Splenic length and width were measured (with ultrasound imaging) after 1 min of exercise, and volume was calculated. To investigate the reflex specificity of this response, spleen dimensions were also measured during 4 min of lower-body negative pressure (LBNP; -20 mm Hg). To test the additional impact of altered breathing and intra-abdominal pressures during the HG, measures were also taken during Valsalva's manoeuvre (VM) at 30 mm Hg. Compared with baseline, both length and width of the spleen were reduced by 0.20 to 0.55 cm (or 4.44%-6.09%; p < 0.05) during each test. This resulted in relative reductions in splenic volume of 13 +/- 1% (HG), 9% +/- 7% (LBNP) and 18% +/- 7% (VM) (p < 0.05; all mean +/- SD). It was concluded that the spleen can constrict during the first minute of isometric HG exercise.