The Experts below are selected from a list of 306 Experts worldwide ranked by ideXlab platform
Robert F Schilling - One of the best experts on this subject based on the ideXlab platform.
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risks and benefits of Splenectomy versus no Splenectomy for hereditary spherocytosis a personal view
British Journal of Haematology, 2009Co-Authors: Robert F SchillingAbstract:Splenectomy is indicated in hereditary spherocytosis to relieve symptoms due to anaemia or splenomegaly, reverse growth failure or skeletal changes due to over-robust erythropoiesis, and prevent recurrent gallstones. A life-long risk of bacterial infection has been recognised for many years as a concomitant cost of Splenectomy. The scope of this risk has expanded to include a number of organisms beyond the triad of pneumococcus, meningococcus, and haemophilus influenzae. Recently, it has been demonstrated that Splenectomy also confers a significant risk of delayed adverse vascular events in patients with hereditary spherocytosis, just as it does in patients undergoing Splenectomy for other indications. Further, these same studies demonstrated a benefit of avoiding Splenectomy: hereditary spherocytosis patients with a spleen have significantly fewer adverse vascular events than unaffected family members, probably because of the protective effect of chronic, mild anaemia. Accordingly, this review marshals the evidence favouring a conservative approach to Splenectomy in spherocytosis.
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delayed adverse vascular events after Splenectomy in hereditary spherocytosis
Journal of Thrombosis and Haemostasis, 2008Co-Authors: Robert F Schilling, Ronald E Gangnon, Myrna TraverAbstract:Summary. Background: It is probable that the variety and frequency of delayed adverse vascular events after Splenectomy are underappreciated. Splenectomy is performed for a wide variety of conditions, and delayed postSplenectomy hazards are not often studied. Objective: To estimate the relative risk of adverse vascular events in members of hereditary spherocytosis families who have or have not had a Splenectomy. Methods: Members of families in which hereditary spherocytosis exists were systematically questioned about adverse vascular events. Results: The cumulative incidence of arterial and venous events at age 70 years was greater in persons who had undergone a Splenectomy for spherocytosis (arterial, 22% females, 32% males; venous, 20% females, 19% males) than in affected persons who did not undergo Splenectomy (arterial, 3% females, 2% males; venous, 6% females, 4% males) or non-affected family members (arterial, 10% females, 17% males; venous, 4% females, 12% males). Affected subjects who undergo Splenectomy are at greatly increased risk of arterial events as compared to affected subjects who do not undergo Splenectomy [arterial, hazard ratio (HR) 7.2, 95% confidence interval (CI) 2.8–17.2; venous, HR 3.3, 95% CI 1.1–9.8]. Conclusion: There is a significant, long-lasting, increased risk of adverse arterial and venous thromboembolic events after Splenectomy performed for hereditary spherocytosis. A review of the literature indicates that this is also true when Splenectomy is performed for several other indications.
A. Tefferi - One of the best experts on this subject based on the ideXlab platform.
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Treatment advances in adult immune thrombocytopenic purpura
Annals of Hematology, 2003Co-Authors: M. R. Huber, S. Kumar, A. TefferiAbstract:Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by autoantibody-mediated destruction of platelets. The disease generally runs a mild clinical course, though significant morbidity and mortality can occur. Steroids and/or Splenectomy are effective in treating the disease in approximately 70% of patients. These treatments have been well established with approximately 50 years of clinical experience. While open Splenectomy is the traditional surgical procedure, laparoscopic Splenectomy, splenic artery embolization, and splenic irradiation are viable alternatives. For patients who relapse after the above therapies, treatment is more difficult and seldom results in a cure. The goals of therapy involve maintaining a safe platelet count while minimizing toxicities from the treatment. Multiple treatment options exist including corticosteroids, androgens, immunomodulatory drugs, cytotoxic chemotherapy, immunoglobulin preparations, bone marrow transplantation, Helicobacter pylori eradication, and others. While the standard treatment of steroids and Splenectomy has changed little over the past decades, a number of promising new therapies on the horizon may soon join the armamentarium upon which the clinician can draw to fight the disease. In this review, we will examine treatment for chronic ITP in adults in the pre-Splenectomy, Splenectomy, and post-Splenectomy settings.
Henry E. Rice - One of the best experts on this subject based on the ideXlab platform.
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Partial Splenectomy but not total Splenectomy preserves immunoglobulin M memory B cells in mice.
Journal of pediatric surgery, 2011Co-Authors: Elisabeth T Tracy, Karen M. Haas, Tracy Gentry, Melissa E. Danko, Joseph L. Roberts, Joanne Kurtzberg, Henry E. RiceAbstract:Abstract Purpose The mechanism by which partial Splenectomy preserves splenic immune function is unknown. Immunoglobulin (Ig) M memory B cells are critical for the immune response against encapsulated bacteria and are reduced in asplenic patients, although it is unknown whether partial Splenectomy can preserve memory B cells. We hypothesized that IgM memory B cells (murine B-1a cells) would be preserved after partial Splenectomy but not after total Splenectomy in mice. Methods We performed total Splenectomy (n = 17), partial Splenectomy (n = 10), or sham laparotomy (n = 16) on C57BL/6J mice. Mice were killed on postoperative day 10 or 30, and peritoneal washings were analyzed by multiparameter flow cytometry for expression of murine B-1a cells (IgM pos IgD dull CD5 pos B220 dull ). Results We found that B-1a cells were significantly reduced after both total and partial splenectomies compared with sham laparotomy in the early postoperative period, although normal levels of B-1a cells returned by postoperative day 30 in mice undergoing partial Splenectomy but not total Splenectomy. Conclusion Partial Splenectomy but not total Splenectomy preserves the B-1a B-cell population in mice within 30 days after surgery. Maintenance of these critical B cells may contribute to the preservation of a splenic-dependent immune response after partial Splenectomy.
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partial Splenectomy for hereditary spherocytosis
Pediatric Clinics of North America, 2008Co-Authors: Elisabeth T Tracy, Henry E. RiceAbstract:The significant risks associated with total Splenectomy have led to interest in the use of partial Splenectomy as an alternative surgical therapy for children who have congenital hemolytic anemia. Partial Splenectomy is designed to remove enough spleen to gain desired hematologic outcomes while preserving splenic immune function. Although preliminary data demonstrate successful laboratory and clinical outcomes after partial Splenectomy in various congenital hemolytic anemias, conclusive data comparing the efficacy of partial Splenectomy to total Splenectomy are not reported. Based on preliminary data, a definitive clinical trial of partial Splenectomy in children who have severe congenital hemolytic anemia may be warranted.
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clinical and hematologic benefits of partial Splenectomy for congenital hemolytic anemias in children
Annals of Surgery, 2003Co-Authors: Henry E. Rice, Keith T Oldham, Cheryl A Hillery, Michael A Skinner, Sara M Ohara, Russell E WareAbstract:Congenital hemolytic anemias frequently lead to severe hemolysis due to splenic sequestration of abnormal erythrocytes. 1 For children with hereditary spherocytosis (HS), a total Splenectomy eliminates the main source of erythrocyte destruction. For children with other hemolytic anemias, a Splenectomy eliminates splenic sequestration and reduces symptoms of hypersplenism. The use of total Splenectomy in children is restricted by concern of overwhelming postSplenectomy sepsis. 2–5 In children less than 5 years of age, the risk of overwhelming postSplenectomy sepsis may be increased 60- to 100-fold compared to children who have not had a Splenectomy. 4 Although the risk of overwhelming postSplenectomy sepsis is reduced by use of immunizations to Streptococcus pneumoniae, Meningococcus, and Haemophilus influenzae as well as postoperative antibiotic prophylaxis, its risk is never eliminated. 5 Moreover, concerns persist of incomplete protection by pneumococcal vaccinations, antibiotic resistance, and poor compliance with antibiotic prophylaxis. 5,6 For children with congenital hemolytic anemias, a partial Splenectomy has been proposed as an alternative to total Splenectomy, with the goal of removing enough spleen to gain a desired hematologic effect while preserving splenic immune function. 7–10 However, the use of partial Splenectomy is limited because of technical difficulties and concerns of splenic regrowth. 7,8,11,12 Recently several groups have renewed an interest in partial Splenectomy. 7–10 To assess the role of partial Splenectomy in symptomatic children with various congenital hemolytic anemias, we have followed 25 children with various congenital hemolytic anemias who underwent partial Splenectomy. We examined the effects of partial Splenectomy on hemolysis, splenic phagocytic and immune function, and splenic regrowth. Our results suggest that partial Splenectomy may be beneficial for a variety of congenital hemolytic anemias.
Myrna Traver - One of the best experts on this subject based on the ideXlab platform.
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delayed adverse vascular events after Splenectomy in hereditary spherocytosis
Journal of Thrombosis and Haemostasis, 2008Co-Authors: Robert F Schilling, Ronald E Gangnon, Myrna TraverAbstract:Summary. Background: It is probable that the variety and frequency of delayed adverse vascular events after Splenectomy are underappreciated. Splenectomy is performed for a wide variety of conditions, and delayed postSplenectomy hazards are not often studied. Objective: To estimate the relative risk of adverse vascular events in members of hereditary spherocytosis families who have or have not had a Splenectomy. Methods: Members of families in which hereditary spherocytosis exists were systematically questioned about adverse vascular events. Results: The cumulative incidence of arterial and venous events at age 70 years was greater in persons who had undergone a Splenectomy for spherocytosis (arterial, 22% females, 32% males; venous, 20% females, 19% males) than in affected persons who did not undergo Splenectomy (arterial, 3% females, 2% males; venous, 6% females, 4% males) or non-affected family members (arterial, 10% females, 17% males; venous, 4% females, 12% males). Affected subjects who undergo Splenectomy are at greatly increased risk of arterial events as compared to affected subjects who do not undergo Splenectomy [arterial, hazard ratio (HR) 7.2, 95% confidence interval (CI) 2.8–17.2; venous, HR 3.3, 95% CI 1.1–9.8]. Conclusion: There is a significant, long-lasting, increased risk of adverse arterial and venous thromboembolic events after Splenectomy performed for hereditary spherocytosis. A review of the literature indicates that this is also true when Splenectomy is performed for several other indications.
Amy M Fremgen - One of the best experts on this subject based on the ideXlab platform.
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Role of Splenectomy in gastric cancer surgery : adverse effect of elective Splenectomy on longterm survival
Journal of the American College of Surgeons, 1997Co-Authors: Harold J. Wanebo, B.j Kennedy, David P. Winchester, Andrew K Stewart, Amy M FremgenAbstract:Abstract Background: Splenectomy, and in some cases pancreatico Splenectomy, has been advocated by surgeons in an effort to improve clearance of metastatic nodes to splenic hilum (node 10) and splenic artery (node 11). Although Splenectomy has known effects on increasing morbidity and even mortality after a variety of surgical maneuvers including gastrectomy, the longterm effect on survival is controversial. The purpose of this study is to review and analyze the effect of Splenectomy on survival in patients having curative gastrectomy for stomach cancer. Methods: We reviewed the role of Splenectomy in patients having curative gastrectomy in a data base of stomach cancer patients that had been collected in 1987 as part of an American College of Surgeons Patterns of Care Study. This analysis had involved 18,344 patients, of whom 11,252 were first diagnosed in 1982 as part of a longterm study, and 7,092 were first diagnosed in 1987 as part of a shortterm study. From the two data collection periods information was available on 12,439 patients who received cancer directed abdominal surgery; 21.2% of these patients received a Splenectomy. Among the 3,477 patients reported as having a curative gastrectomy (pathologically clear margins), 26.2% received a Splenectomy. Results: The operative mortality was 9.8% with Splenectomy and 8.6% without Splenectomy. In patients having a curative gastrectomy, the 5-year observed survival rate was 20.9% in patients having Splenectomy versus 31% in patients who did not receive Splenectomy (p Conclusions: The data suggest elective Splenectomy should generally be avoided in patients with stage II and III gastric cancer. In patients with resectable proximal advanced (stage IV) cancer or who have extension to spleen and pancreas or macroscopic nodal metastases to splenic hilum, Splenectomy might be necessary to facilitate complete removal of the tumor in an effort to achieve longterm tumor control. The importance of surgical judgment is emphasized as the major deciding factor in determining the need for Splenectomy in the individual cancer patient.
