Acute Disease ; Aged ; Anti-Bacterial Agents/therapeutic use* ; Bacteremia/microbiology* ; Female ; Hepatitis B, Chronic/complications* ; Hepatitis C, Chronic/complications* ; Humans ; Hypersplenism/complications* ; Liver Cirrhosis/complications* ; Meningococcal Infections/microbiology* ; Neisseria meningitidis/isolation & purification* ; Peritonitis/microbiology*

Idiopathic portal hypertension (IPH) is a rare disorder which is clinically characterized by portal hypertension, splenomegaly, hypersplenism and the absence of liver cirrhosis. Patients with IPH have massive splenomegaly leading to increased portal venous flow and subsequent portal hypertension. In selected IPH patients with splenomegaly and hypersplenism, splenectomy can be regarded as an effective treatment protocol for decreasing portal hypertension. We report a case of a 44-year-old woman who was diagnosed with IPH accompanied by splenomegaly and hypersplenism. She underwent laparoscopic splenectomy and clinical symptoms and hypersplenism resolved. Our study shows that laparoscopic splenectomy can be considered as a procedure for treating patients with splenomegaly and hypersplenism due to IPH.
Adult ; Clinical Protocols ; Female ; Humans ; Hypersplenism* ; Hypertension, Portal* ; Liver Cirrhosis ; Splenectomy* ; Splenomegaly*

This study aimed to examine the efficacy of the laparoscopic vs. traditional open splenectomy for hepatocellular carcinoma (HCC) with hypersplenism. Between 2002 and 2013, 51 Chinese HCC patients with hypersplenism underwent either simultaneous laparoscopic splenectomy plus anticancer therapies (Lap-S&A) (n=25) or traditional open splenectomy plus anti-cancer therapies (TOS&A) (n=26). The outcomes were reviewed during and after the operation. Anti-cancer therapies for HCC included laparoscopic hepatectomy (LH) and laparoscopic microwave ablation (LMA). The results showed that there was no significant difference in the operating time between the two groups, but the blood loss and blood transfusion were less, pain intensity after surgery was weaker, the time to first bowel movement, time to the first flatus and postoperative hospital stay were shorter, and the postoperative complication rate and the readmission rate were lower in the Lap-S&A group than in the TO-S&A group. Two patients in the Lap-S&A group and one patient in the TO-S&A group died 30 days after surgery. However, no significant difference in the mortality rate was noted between the two groups. It was concluded that simultaneous Lap-S&A holds the advantages of more extensive indications, lower complication incidence and less operative expenditure than conventional open approach and it is a feasible and safe approach for HCC with hypersplenism.
Adult ; Aged ; Carcinoma, Hepatocellular ; complications ; pathology ; surgery ; Female ; Hepatectomy ; Humans ; Hypersplenism ; complications ; pathology ; surgery ; Laparoscopy ; Liver ; pathology ; surgery ; Liver Neoplasms ; complications ; pathology ; surgery ; Male ; Middle Aged ; Spleen ; pathology ; surgery ; Splenectomy ; Treatment Outcome

BACKGROUNDLymphocyte subsets play important roles in rejection in liver transplant recipients, and the effect of splenic function on these roles remains unknown. The aim of this study was to explore the feasibility to adjust immunosuppressive agents based on splenic function status through detecting the lymphocyte subsets in liver transplantBeijing recipients.

METHODSThe lymphocyte subsets of 49 liver transplant recipients were assessed in the 309th Hospital of Chinese People's Liberation Army between June 2014 and August 2015. The patients were divided into splenectomy group (n = 9), normal splenic function group (n = 24), and hypersplenism group (n = 16). The percentages and counts of CD4+ T, CD8+ T, natural killer (NK) cell, B-cell, regulatory B-cell (Breg), and regulatory T-cell (Treg) were detected by flow cytometer. In addition, the immunosuppressive agents, histories of rejection and infection, and postoperative time of the patients were compared among the three groups.

RESULTSThere was no significant difference of clinical characteristics among the three groups. The percentage of CD19+CD24+CD38+ Breg was significantly higher in hypersplenism group than normal splenic function group and splenectomy group (3.29 ± 0.97% vs. 2.12 ± 1.08% and 1.90 ± 0.99%, P = 0.001). The same result was found in CD4+CD25+FoxP3+ Treg percentage (0.97 ± 0.39% vs. 0.54 ± 0.31% and 0.56 ± 0.28%, P = 0.001). The counts of CD8+ T-cell, CD4+ T-cell, and NK cell were significantly lower in hypersplenism group than normal splenic function group (254.25 ± 149.08 vs. 476.96 ± 225.52, P= 0.002; 301.69 ± 154.39 vs. 532.50 ± 194.42, P= 0.000; and 88.56 ± 63.15 vs. 188.33 ± 134.51, P = 0.048). Moreover, the counts of CD4+ T-cell and NK cell were significantly lower in hypersplenism group than splenectomy group (301.69 ± 154.39 vs. 491.89 ± 132.31, P= 0.033; and 88.56 ± 63.15 vs. 226.00 ± 168.85, P = 0.032).

CONCLUSIONSplenic function status might affect the immunity of liver transplant recipients, that should be considered when we make immunosuppressive protocols.

CD4-Positive T-Lymphocytes ; drug effects ; immunology ; Female ; Humans ; Hypersplenism ; immunology ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Killer Cells, Natural ; drug effects ; immunology ; Liver Transplantation ; methods ; Lymphocyte Subsets ; drug effects ; immunology ; Male ; Middle Aged ; Retrospective Studies ; Sirolimus ; administration & dosage ; therapeutic use ; Spleen ; drug effects ; immunology ; T-Lymphocytes, Regulatory ; drug effects ; immunology

OBJECTIVETo investigate the expression of ASK1 and PRKCD in the process of monocyte differentiation, and explore their role in functional changes of hypersplenism spleen macrophages (Mφ) in portal hypertension (PH).

METHODSU937 cells were stimulated to differentiate into monocyte/macrophage-like cells by cultivation in PMA and the mRNA expressions of ASK1 and PRKCD were detected by q-PCR and the changes of protein expression were identified by western blot analysis. The secretion of phagocytose related cytokines such as IL-10 and TNF-α were tested by ELISA, and the function of the macrophage-like cells were studied by chicken red blood cell phagocytose test.

RESULTSThe expressions of PRKCD and ASK1 mRNA were gradually decreased along with the cell differentiation, while the secretion of TNF-α was increased, IL-10 secretion reached a maximum at 24 h after PAM stimulation, and then gradually fell. The expression of ASK1 and p-ASK1 were rapidly increased compared with the non-stimulated U937 cells, while the expression of PRKCD and p-PRKCD were sightly declined. The phagocytose test show that U937 cells induced with PMA were able to swallow the chicken red blood cell.

CONCLUSIONUp-regulated protein expression of ASK1 and p-ASK1 and down-regulated protein expression of PRKCD and p-PRKCD in the process of PMA induced monocyte differentiation, are consist with the expression changes of splenic macrophage phagocytosis in hypersplenism, which leads to increased activity of Mφ.

Cell Differentiation ; Down-Regulation ; Humans ; Hypersplenism ; Hypertension, Portal ; Interleukin-10 ; secretion ; MAP Kinase Kinase Kinase 5 ; physiology ; Macrophages ; cytology ; Phagocytosis ; Protein Kinase C-delta ; physiology ; RNA, Messenger ; Tumor Necrosis Factor-alpha ; secretion ; U937 Cells

OBJECTIVETo investigate the efficacy of detachable balloon for splenic artery trunk embolization in patients with cirrhotic portal hypertension and hypersplenism.

METHODSEight patients with cirrhotic portal hypertension received splenic artery trunk disconnection using detachable balloons under the guidance of digital subtraction angiography. The diameter and blood flow of the portal vein, the superior mesenteric vein, the splenic vein and the hepatic artery were measured by color Doppler ultrasound. Markers of liver function and blood coagulation, and routine blood parameters were assessed. Gastroscopy was used to evaluate to the degree of gastroesophageal varices. All complications experienced during the perioperative period were recorded.

RESULTSThe portal vein diameter decreased from 1.55±0.38 cm to 1.55±0.38 cm, and the splenic artery diameter decreased from 1.45±0.10 cm to 1.41±0.09 cm (P < 0.05). The portal vein blood flow was reduced from 971.52±174.77 ml/min to 785.86±100.17 ml/min, and the splenic vein blood flow decreased from 938.01±208.86 ml/min to 644.02±188.15 ml/min, while the hepatic artery blood flow increased from 261.25±65.47 ml/min to 449.32±84.05 ml/min (P < 0.05). The symptoms of splenism were improved effectively, with platelet counts rising from 37.75±10.61*109/L to 138.63±28.22*109/L after the procedure (P < 0.05). There were no episodes of severe complications or death in the perioperative period, and all patients showed remarkable improvement in markers of liver function and coagulation function, and improvement of esophagogastric varices.

CONCLUSIONSThe interventional disconnection technique of the splenic artery trunk using detachable balloon for the treatment of portal hypertension and hypersplenism is safe and effective.

Angiography, Digital Subtraction ; Embolization, Therapeutic ; Esophageal and Gastric Varices ; Hemodynamics ; Hepatic Artery ; Humans ; Hypersplenism ; Hypertension, Portal ; Mesenteric Veins ; Platelet Count ; Portal Vein ; Splenic Artery

Thrombocytopenia is a common manifestation of rickettsial disease. However, the pathogenesis of thrombocytopenia in many rickettsial diseases is poorly understood. Thrombocytopenia may be associated with consumption due to widespread endothelial damage or disseminated intravascular coagulation, hypersplenism, decreased marrow production, and immune-mediated platelet destruction. Some reports have found anti-platelet antibodies detected in thrombocytopenic patients with rickettsial disease. In addition to thrombocytopenia, facial palsy and Guillain-Barre syndrome were also reported as immune-mediated phenomena in scrub typhus. Here we report a case diagnosed as immune-mediated thrombocytopenia associated with scrub typhus. This is the first report of immune thrombocytopenic purpura (ITP) associated with scrub typhus in Korea. The patient exhibited eschar with a high titer of anti-tsutsugamushi antibody, thrombocytopenia, severe gastrointestinal hemorrhage, and purpura on the lower region of both legs. After steroid treatment, the sustained thrombocytopenia recovered.
Antibodies ; Blood Platelets ; Bone Marrow ; Disseminated Intravascular Coagulation ; Facial Paralysis ; Gastrointestinal Hemorrhage ; Guillain-Barre Syndrome ; Humans ; Hypersplenism ; Korea ; Leg ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Scrub Typhus* ; Thrombocytopenia

BACKGROUND AND OBJECTIVES: Niemann Pick A disease causes a progressive accumulation of sphyngomyelin in several organs and the survival of the patients is usually limited to three years. We describe the outcome of a patient suffering from Niemann Pick A disease, who first underwent an haploidentical bone marrow transplantation, and then intrathecal and I.V injections of mesenchymal cells. METHODS AND RESULTS: While the outcome of bone marrow transplantation was a complete failure, one month after the treatment with the mesenchymal cells the patient improved from the psychomotor and the parenchymal storage perspective. When hypersplenism was solved platelets rose quickly from 20,000 to 120,000/microliter. CONCLUSIONS: Therefore cellular therapy should be considered as a possible choice of treatment of NPA disease.
Bone Marrow Transplantation ; Humans ; Hypersplenism ; Niemann-Pick Diseases* ; Stem Cells*

OBJECTIVETo compare the clinical effect of glucocorticoids and NSAID in the treatment of partial splenic embolization syndrome.

METHODSSixty patients with cirrhosis and spleen hyperactivity who developed partial splenic embolization syndrome after partial splenic embolization with Seldinger technique were randomized equally into two groups to receive treatments with intravenous dexamethasone or oral nonsteroidal anti-inflammatory drugs (NSAIDs). White blood cell counts, liver functions, fever duration, abdominal pain duration, hospital stay, and occurrence of upper gastrointestinal hemorrhage and spleen abscess were recorded and analyzed.

RESULTSIn dexamethasone group, the average fever duration, abdominal pain duration, and hospitalization days was 3.36∓2.31, 7.39∓4.00, and 11.48∓3.29 days, respectively, significantly shorter than those in NSAIDs group (5.72∓3.83, 9.59∓4.22, and 15.07∓7.93 days, respectively, P<0.05). Seven days after the operation, white blood cell count (×10(9)=L) significantly increased from 4.23∓5.09 to 8.49∓3.53 in dexamethasone group (P<0.05), and from 3.21∓1.33 to 6.52∓2.37 in NSAIDs group (P<0.05); the increment was more obvious in dexamethasone group (P<0.05). The two groups of patients showed no significant difference in liver functions after the operation. None of the patients developed upper gastrointestinal hemorrhage or spleen abscess.

CONCLUSIONIntravenous dexamethasone produces better therapeutic effect than oral NSAIDs in the management of partial splenic embolization syndrome.

Abdominal Pain ; drug therapy ; etiology ; Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal ; therapeutic use ; Dexamethasone ; therapeutic use ; Embolization, Therapeutic ; adverse effects ; Female ; Fever ; drug therapy ; etiology ; Humans ; Hypersplenism ; etiology ; therapy ; Length of Stay ; Leukocyte Count ; Liver Cirrhosis ; complications ; Liver Function Tests ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo study the value of dynamic contrast-enhanced magnetic resonance imaging (MRI) in evaluating the curative effect of high intensity focused ultrasound (HIFU) for hypersplenism.

METHODSA retrospective analysis of dynamic contrast enhanced MRI data was conducted in 15 patients with hypersplenism before and after HIFU treatment to observe the signal changes and enhancement features of the lesions.

RESULTSCompared with that before treatment, the signal intensity of the lesions after HIFU could be increased, reduced or remained unchanged on T(1)WI without specificity; on T(2)WI, the signal intensity of the lesions was reduced after HIFU treatment. Dynamic contrast-enhanced MRI showed larger ablation areas than those displayed by T(1)WI and T(2)WI, and no enhancement was found in the lesions.

CONCLUSIONT(2)WI has a greater specificity in demonstrating coagulation necrosis of hypersplenism after HIFU ablation, and dynamic contrast-enhanced MRI has a higher sensitivity in displaying the ablation area by highlighting the blood supply and enhancement characteristics of the lesions. MRI is efficient and noninvasive in follow-up evaluation of the signal intensity as well as histological changes of the treated region after HIFU.

Adult ; Aged ; Female ; High-Intensity Focused Ultrasound Ablation ; Humans ; Hypersplenism ; diagnosis ; therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome