Normal mesenteric lymph ameliorates lipopolysaccharide challenge-induced spleen injury

PURPOSE: This study was conducted to investigate the effect of normal mesenteric lymph (NML) from mice on the spleen injury induced by lipopolysaccharide (LPS) challenge.METHODS: Mice in the LPS and LPS+NML groups received an intraperitoneal injection of LPS (35 mg/kg) and kept for 6 h.. The mice in the LPS+NML group received NML treatment at 1 h after LPS injection. Afterward, the splenic morphology, the levels of lipopolysaccharide-binding protein (LBP), cluster of differentiation 14 (CD14), phosphorylation mitogen-activated protein kinases (MAPKs), and inflammatory mediators in splenic tissue were investigated.RESULTS:LPS injection induced spleen injury, increased the levels of LBP, CD14, tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), and interferon γ (IFN-γ), and decreased the IL-4 content in the spleen. By contrast, NML treatment reversed these changes. Meanwhile, the LPS challenge decreased the phosphorylation levels of p38 MAPK, extracellular regulated protein kinases 1/2, and c-Jun N-terminal kinase (JNK). Moreover, the phosphorylation levels of p38 MAPK and JNK were further decreased by the NML administration.CONCLUSION:rRdThe normal mesenteric lymph treatment alleviated lipopolysaccharide induced spleen injury by attenuating LPS sensitization and production of TNF-α, IL-6, and IFN-γ.

A Case of Pancreatic Pseudocyst with a Large Subcapsular Splenic Hematoma Treated Successfully by Ultrasonography-guided Percutaneous Drainage / 대한소화기학회지

A subcapsular splenic hematoma is a very rare hemorrhagic complication of pancreatitis. We report here on a case of pseudocyst with a large subcapsular splenic hematoma in a 43-year-old man who presented with severe left flank pain for one week. Despite the initial conservative treatment consisting of pain control, bowel rest, intravenous fluids and antibiotics, the pain was not relieved. An abdominal computed tomography (CT) was performed, and it showed a pseudocyst that was increasing in size with a large subcapsular splenic hematoma measuring 6x13 cm compared to the images at admission. Ultrasonography (US)-guided percutaneous drainage was performed without any complications, and splenectomy was avoided. After the discharge, the patient remained asymptomatic for eight months. We suggest that percutaneous drainage of a large subcapsular hematoma complicating pancreatitis might be a useful treatment option in selected patients.

A Case of Pancreatic Pseudocyst with a Large Subcapsular Splenic Hematoma Treated Successfully by Ultrasonography-guided Percutaneous Drainage / 대한소화기학회지

A subcapsular splenic hematoma is a very rare hemorrhagic complication of pancreatitis. We report here on a case of pseudocyst with a large subcapsular splenic hematoma in a 43-year-old man who presented with severe left flank pain for one week. Despite the initial conservative treatment consisting of pain control, bowel rest, intravenous fluids and antibiotics, the pain was not relieved. An abdominal computed tomography (CT) was performed, and it showed a pseudocyst that was increasing in size with a large subcapsular splenic hematoma measuring 6x13 cm compared to the images at admission. Ultrasonography (US)-guided percutaneous drainage was performed without any complications, and splenectomy was avoided. After the discharge, the patient remained asymptomatic for eight months. We suggest that percutaneous drainage of a large subcapsular hematoma complicating pancreatitis might be a useful treatment option in selected patients.

Acute splenic sequestration in a cohort of children with sickle cell anemia / Sequestro esplênico agudo em coorte de crianças com anemia falciforme

OBJETIVO: Analisar o sequestro esplênico agudo (SEA) em crianças com anemia falciforme, provindas da triagem neonatal de Minas Gerais e acompanhadas pelo Hemominas de Belo Horizonte (MG). MÉTODOS: Coorte retrospectiva de 255 crianças com hemoglobinopatia SS/Sβº, nascidas entre 01/01/2000 e 31/12/2004 e acompanhadas até 31/12/2006. Os dados foram extraídos dos prontuários médicos. RESULTADOS: Oitenta e nove pacientes apresentaram 173 eventos de SEA (10,2 primeiros eventos por 100 pacientes/ano), sendo que 75% dos primeiros episódios de SEA ocorreram até 2 anos de vida. A probabilidade estimada de ocorrência do primeiro episódio de SEA foi de 40%. A recorrência atingiu 57,3%. Após o primeiro episódio de SEA, a esplenectomia foi indicada em apenas 12,4% dos casos; após o segundo, em 60,4% dos casos. Após o terceiro episódio, 41,7% dos casos ainda permaneceram sob observação clínica. A mediana do tempo entre indicação e realização da esplenectomia foi de 2 meses. Nesse intervalo, 37,2% das crianças tiveram novo episódio de SEA e uma delas faleceu. A letalidade no primeiro episódio foi de 1,1% e de 7,8% em episódios subsequentes. Entre as 255 crianças ocorreram 19 óbitos: 36,8% devido a infecções e 26,3% após SEA. CONCLUSÕES: O SEA é um evento comum na anemia falciforme, principalmente nos 2 primeiros anos de vida, com recidiva em mais da metade dos casos. Predominou conduta conservadora na indicação da esplenectomia. Embora a letalidade tenha sido baixa, o SEA representou a segunda causa de óbito. Isso aponta para fragilidades estruturais do sistema de saúde de MG e para a necessidade de melhor capacitação profissional na abordagem do problema.

OBJECTIVE: To analyze acute splenic sequestration (ASS) in children with sickle cell anemia diagnosed through a newborn screening program in the state of Minas Gerais, Brazil, and followed up at the hematology center in the city of Belo Horizonte, Minas Gerais, Brazil. METHODS: Retrospective cohort of 255 children with sickle cell anemia (Hb SS/Sβº) born between January 01, 2000, and December 31, 2004, and followed up until December 31, 2006. Data were abstracted from the patients' medical records. RESULTS: A total of 89 patients had 173 episodes of ASS (10.2 first episodes per 100 patient-years); 75% of the first episodes occurred before 2 years of age. The estimated probability of occurrence of the first episode of ASS during the study period was 40%. Recurrence rate reached 57.3%. After the first episode, splenectomy was indicated in only 12.4% of the cases; after the second, in 60.4% of the cases. After the third episode, 41.7% of the patients remained under clinical observation. The median time between indication for splenectomy and the actual surgical procedure was 2 months. During the intervening period, 37.2% of the children suffered a new episode of ASS and one child died. Case-fatality rate was 1.1% for the first episode and 7.8% for the subsequent episodes. Among a total of 255 children, 19 died: 36.8% due to infections and 26.3% after ASS. CONCLUSIONS: ASS is relatively common in sickle cell anemia, mainly in the first 2 years of life; relapse occurs in more than half of the cases. Conservative management instead of immediate splenectomy was the method of choice. Although the case-fatality rate was low, ASS was the second most common cause of death. These results disclose some fragilities of the health system in the state of Minas Gerais and the need for better professional education to approach ASS crises.

Splenic abscess: outcome and prognostic factors

To determine the spectrum of presentation, treatment outcome and prognostic factors of splenic abscess in a tertiary care hospital. Study Design: Case-series. Place and Duration of Study: Department of General Surgery, the Aga Khan University Hospital, Karachi, from July 1988 to July 2007. Methodology: The records of 27 patients with splenic abscess, diagnosed from 1988 to 2007, were retrieved through ICD-10 coding system. The demographic data, physical and radiological findings, treatment modalities, bacteriology reports, morbidity and mortality were collected on a proforma. There were 12 males and 15 females with a mean age of 43.52 +/- 17.49 years. Common symptoms were fever [92.6%], abdominal pain [55.6%] and malaise [29.6%]. Majority of patients [89%] had leukocytosis and 63% patients had associated diseases with which they were admitted. The most common pathogenic organism was Staphylococcus species and gram-negative rods. Ultrasound was used as a preliminary diagnostic modality, which was often followed by CT scan. Thirteen patients were treated with intravenous antibiotics, 8 underwent percutaneous drainage and 6 patients required splenectomy with respective survival rates of 84%, 87.5% and 83%. Mortality rate was 14.81% but no statistically significant difference between 3 treatment groups was manifested. There was significant difference between treatment groups regarding the size of the abscess [p=0.01] and hospital stay [p=0.04]. Splenectomy was done when abscess size was >10 cm and hospital stay were increased in the radiological drainage group. Splenic abscess is an uncommon surgical entity. High index of suspicion and liberal use of radiological studies is essential for timely diagnosis. Most of the patients could be cured with non-operative treatment. Splenectomy is a safe procedure for patients with abscess size more than 10 cm and patients not responding to non-operative treatment

Febre crônica associada a abscesso esplênico causado por Staphylococcus epidermidis / Chronic fever associated with splenic abscess due to Staphylococcus epidermidis

Abscessos ocultos são causa freqüente de febre crônica. Os abscessos esplênicos são entidades raras, usualmente associadas a quadros subjacentes de cirurgia abdominal, endocardite ou imunodepressão. Apresenta-se um caso de paciente com febre prolongada causada por um abscesso esplênico, cujo principal diagnóstico diferencial era leishmaniose visceral, que provavelmente esteve associado a traumatismo abdominal. O tratamento consistiu em antibioticoterapia seguida de esplenectomia.

Occult abscesses are frequent causes of chronic fever. Splenic abscesses are rare entities that are usually associated with underlying conditions such as abdominal surgery, endocarditis or immunodepression. We report on the case of a patient with prolonged fever caused by a splenic abscess, whose main differential diagnosis was visceral leishmaniasis. However, this condition was probably related to abdominal trauma. The treatment consisted of antibiotics followed by splenectomy.

Abscesos esplénicos: presentación de nueve casos / Splenic abscess: presentation of nine cases

El absceso esplénico es una entidad poco frecuente, que presenta dificultad diagnóstica y tiene alta letalidad si no se trata. Se estima que la enfermedad está en aumento en relación al incremento en el número de pacientes inmunocomprometidos. Varios serían los mecanismos implicados en su patogenia. Algunos estudios muestran la preexistencia de lesiones esplénicas sumadas a bacteriemia como necesarios en su génesis. En nuestra serie se identificaron 9 pacientes inmunocompetentes en un período de 6 años. Entre los patógenos se aislaron Salmonella sp, Staphyloccus sp y Enterococcus sp. En tres casos se realizó esplenectomía, y en uno se efectuó drenaje percutáneo. Un paciente falleció. En definitiva, aunque infrecuentes, los abscesos esplénicos presentan una gran morbimortalidad. Factores de riesgo como inmunodeficiencia no son tan prevalentes en nuestra experiencia, debiéndose considerar esta patología en la evaluación completa de los pacientes con fiebre de origen no precisado.

Manejo diagnóstico y terapéutico moderno del absceso esplénico bacteriano: metanalisis de las experiencias regionales / Management and diagnosis and modern therapeutic bacterial of the splemic abscess: analysis of regional experiences

Se analiza la experiencia clínica en veintiséis casos recientemente documentados de absceso esplénico por bacterias diversas, reportados en la literatura médica regional, los cuales provenían de Venezuela (17 de ellos) y de otros países de Sur América o del área del Caribe. Veinticinco (96 por ciento) de los pacientes eran adultos, con una edad media de 37,6 años y una predominante de varones con respecto a mujeres (14:11). Uno de los casos correspondió a una niña de 10 años de edad. Condiciones predisponentes fueron identificadas en veinte individuos (77 por ciento. Veinte (77 por ciento) casos fueron documentados por técnicas de diagnóstico imageneológico. En cuatro pacientes, se requirió de diagnóstico exploratorio mediante laparotomía. Esplenectomía fue practicada en dieciocho pacientes, mientras que otros dos casos respondieron a cursos prolongados de antimicrobacterium tuberculosis y VIH, a antimicrobianos orales solo, tres pacientes (11,5 por ciento) murieron debido a ruptura esplénica preoperatorio en el transcurso de procedimientos de esplecnectomía, un paciente tratado con drenaje percutáneo desarrolló pneumotorax izquierdo y dos pacientes adicionales experimentaron relaparatomias por el desarrollo de abscesos subfrenicos izquierdo. A excepción de los tres individuos VIH+, todos los otros veintitres pacientes imunocompetentes o no, tuvieron lesiones solitarias. La Salmonella thypi fue por Salmonella spp (19 por ciento), la cual fue recuperada en cinco pacientes adicionales

Absceso esplénico: una complicación poco frecuente en el paciente diabético / Splenic abscess: an infrequent complication in the diabetic patient

Objetivo: Informar un caso de absceso explénico tratado con drenaje externo y antimicrobianos adecuados con buen resultado. Sede: Hospital General de Zona No. 1 "Gabriel Mancera" IMSS, México, D.F. Diseño: Estudio Informativo. Paciente: Presentamos el caso de una paciente diabética de 45 años de edad, que preentó un absceso esplénico. Fue tratada con drenaje externo mediante laparotomía exploradora, metronidazol y gentamicina, con resultados satisfactorios. Revisamos las manifestaciones clínicas, los métodos diagnósticos y el tratamiento de esta entidad

Inflammatory pseudotumour of the spleen: report of a case and review of the literature

A case of inflammatory pseudotumour of the spleen in a 34-year-old female patient is described. We have briefly reviewed the literature on the subject and discussed aetiopathogenesis, pre-operative differential diagnosis and treatment modalities.

Traumatismo esplénico en el niño / Spleen injuries in children

Se revisa los resultados de una conducta conservadora del bazo frente a un traumatismo esplénico en una población de 28 pacientes menores de edad. Todos habían sufrido un traumatismo abdominal cerrado y el diagnóstico fue hecho por laparatomía, ecografía o TAC. El tratamiento a que fueron sometidos incluye la abstención quirúrgica, la cirugía reparadora, el autotrasplante y la esplenectomía. Se analiza las diversas alternativas y sus resultados

Specific treatment of hepatosplenic schistosomiasis can increase T-lymphocyte reactivity

Tendo sido observado que infecçäo por Schistosoma mansoni pode causar imunodepressäo celular. Neste trabalho foi avaliado se a imunodepressäo associada à esquistossomose pode ser revertida pelo tratamento específico. A resposta imune celular foi determinada através de testes cutâneos de hipersensibilidade retardada em 22 pacientes com a forma hepatoesplênica da esquistossomose um ano após tratamento com oxamniquine e comparado com aquela observada em um grupo de pacientes hepatoesplênicos näo tratados. Somente 27 por cento destes pacientes apresentaram alergia a todos os antígenos testados, em contraste com 80 por cento de indivíduos anérgicos observados entre aqueles näo tratados. Embora a maioria dos indivíduos tratados tenha mostrado algum grau de resposta aos antígenos testados, alguns indivíduos permaneceram anérgicos após o tratamento específico. Anergia a todos os antigenos aplicados näo foi observada em nenhum dos indivíduos normais. Nossos dados indicam que pacientes esquistossomóticos podem recuperar sua reatividade imune após a eliminaçäo do verme pelo tratamento específico

Absceso esplénico tratado con drenaje percutáneo / Splenic abscess treated with percutaneus drainage

Presentamos la historia de un paciente con cirrosis y absceso esplénico que fue drenado percutáneamente. Se hace una revisión de la etiología, fisiopatología y terapeútica de los abscesos esplénicos, así como de los datos radiológicos