[Splenectomy indications at a general hospital]. / Indicaciones de esplenectomía en un hospital general.

BACKGROUND: To analyse the evolution of indications for splenectomy for a 11-year period. METHODS: A review was made of cases of splenectomy from clinical records and the records of the Pathology Service at Hospital General Universitario Gregorio Marañón from 1986 to 1996. Both adult and pediatric cases were included. RESULTS: From 1986 to 1996 there was a total of 354 patients (273 males and 162 females) who underwent splenectomy. Mean age of patients was 44.6 years (SD +/- 20.5 years) and there was an average of 39.5 cases per year. The most common causes were trauma (32%), "incidental" splenectomy (14%), thrombopenia (12%) and non Hodgkin lymphoma (11%). Compared with the other causes, the mean age of patients with trauma was lower than that of the other groups (p < 0.0001), in contrast with patients with non Hodgkin lymphoma or extra-splenic tumors, where it was higher (p < 0.0001 for both groups). A decline was observed of cases due to trauma from the first to the last year of the study (p = 0.0009), as well as an increase in the group of splenectomy related to extrasplenic tumors (p = 0.01). In the group of the HIV infected patients (n = 30), thrombopenia was the most common indication for splenectomy (11 cases). CONCLUSIONS: Although the average of splenectomy cases remains relatively constant, a decrease in cases due to trauma was observed and an increase of splenectomies on account of abdominal oncologic resections.

[Primary large cell thyroid lymphoma. Report of 6 cases treated with chemotherapy]. / Linfoma de células grandes primario de tiroides. A propósito de 6 casos tratados con quimioterapia.

A series of 6 cases with primary thyroid lymphoma of aggressive histologic type (large cell lymphoma) is presented. Two patients had previous diagnosis of chronic lymphocytary thyroiditis and one also had ulcerative colitis. The Ann Arbor stage was I-E in 2 patients and II-E in four. LDH level was high in four patients and three had criteria of bulky disease. All developed compressive symptoms. As primary therapy 3 patients received polychemotherapy (ProMACE-CytaBOM). The remaining underwent surgery prior to cytostatic treatment. In the three patients with large tumoral volume complementary radiotherapy was also carried out. Five patients had rapid complete remission with chemotherapy and the other achieved partial response of 75% (had complete remission upon termination of radiotherapy). Five are alive without disease at 87, 47, 25, 23 and 16 months of the onset of treatment. One patient died due to cerebral infarction after the fourth cycle. Polychemotherapy is a good therapeutic option for primary thyroid lymphoma with unfavourable prognostic factors.