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Nhungo CJ, Nsato SB, Lwakatare FA, Mbaga AA, Lyimo FR, Mwanga AH. Wandering Spleen in a 47-year-old female treated by non-operative conservative management. Case report and literature review. Int J Surg Case Rep 2024; 120:109834. [PMID: 38823227 PMCID: PMC11176938 DOI: 10.1016/j.ijscr.2024.109834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Wandering spleen (WS) is a rare clinical condition found in less than 0.5 % of splenectomies and is characterized by ectopic location of the spleen within the abdomen or pelvis. It is always caused by excessive mobility brought on by the ligamentous laxity of its peritoneal attachments. Abdominal ultrasonography and computed tomography are the key imaging modalities for inquiry of WS. CASE PRESENTATION We report the case of a 47-year-old woman who presented with painless abdominal swelling since the age of 6 years. An abdominal examination revealed a palpable, firm, mobile mass in the right lower abdomen approximately 15 × 15 cm in dimensions. A contrast CT scan of the abdomen revealed the absence of the spleen in the left upper quadrant. The patient was managed conservatively and followed for five years with favourable outcome. DISCUSSION Failure of the dorsal mesogastrium to merge with the posterior abdominal wall in the second month of embryonic development is one of the reasons for WS. The nonsurgical conservative approach is limited to patients who are high-risk surgical candidates and have minimal symptoms and no complications. CONCLUSION The good clinical outcome of our patient suggests that conservative non-surgical approach may be a reasonable alternative to unwarranted surgical intervention in selected clinically stable patients who have no evidence of splenic torsion or infarction, avoiding the possible complications of surgery.
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Affiliation(s)
- Charles John Nhungo
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Sylvia Bedas Nsato
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Flora A Lwakatare
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Amina A Mbaga
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Frederick R Lyimo
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ally Hamis Mwanga
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Ashraf Ganjouei A, Romero-Hernandez F, Wang JJ, Hamed A, Alaa A, Bartlett D, Alseidi A, Choudry MH, Adam M. A machine learning approach for predicting textbook outcome after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Surg 2024; 48:1404-1413. [PMID: 38651936 DOI: 10.1002/wjs.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Peritoneal carcinomatosis is considered a late-stage manifestation of neoplastic diseases. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be an effective treatment for these patients. However, the procedure is associated with significant morbidity. Our aim was to develop a machine learning model to predict the probability of achieving textbook outcome (TO) after CRS-HIPEC using only preoperatively known variables. METHODS Adult patients with peritoneal carcinomatosis and who underwent CRS-HIPEC were included from a large, single-center, prospectively maintained dataset (2001-2020). TO was defined as a hospital length of stay ≤14 days and no postoperative adverse events including any complications, reoperation, readmission, and mortality within 90 days. Four models (logistic regression, neural network, random forest, and XGBoost) were trained, validated, and a user-friendly risk calculator was then developed. RESULTS A total of 1954 CRS-HIPEC procedures for peritoneal carcinomatosis were included. Overall, 13% (n = 258) achieved TO following CRS-HIPEC procedure. XGBoost and logistic regression had the highest area under the curve (AUC) (0.76) after model optimization, followed by random forest (AUC 0.75) and neural network (AUC 0.74). The top preoperative variables associated with achieving a TO were lower peritoneal cancer index scores, not undergoing proctectomy, splenectomy, or partial colectomy and being asymptomatic from peritoneal metastases prior to surgery. CONCLUSION This is a data-driven study to predict the probability of achieving TO after CRS-HIPEC. The proposed pipeline has the potential to not only identify patients for whom surgery is not associated with prohibitive risk, but also aid surgeons in communicating this risk to patients.
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Affiliation(s)
| | | | - Jaeyun Jane Wang
- Department of Surgery, University of California, San Francisco, California, USA
| | - Ahmed Hamed
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ahmed Alaa
- University of California, Berkeley, California, USA
- University of California, San Francisco, California, USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Adnan Alseidi
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, California, USA
| | - Mohammad Haroon Choudry
- Division of Surgical Oncology, Department of Surgery, UPMC Cancer Pavilion, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mohamed Adam
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, California, USA
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Ladhani SN, Fernandes S, Garg M, Borrow R, de Lusignan S, Bolton-Maggs PHB. Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline. Br J Haematol 2024; 204:1672-1686. [PMID: 38600782 DOI: 10.1111/bjh.19361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 04/12/2024]
Abstract
Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were published by the British Committee for Standards in Haematology in 1996 and updated in 2002 and 2011. With advances in vaccinations and changes in patterns of infection, the guidelines required updating. Key aspects included in this guideline are the identification of patients at risk of infection, patient education and information and immunisation schedules. This guideline does not address the non-infective complications of splenectomy or functional hyposplenism (FH). This replaces previous guidelines and significantly revises the recommendations related to immunisation. Patients at risk include those who have undergone surgical removal of the spleen, including partial splenectomy and splenic embolisation, and those with medical conditions that predispose to FH. Immunisations should include those against Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus) and influenza. Haemophilus influenzae type b (Hib) is part of the infant immunisation schedule and is no longer required for older hyposplenic patients. Treatment of suspected or proven infections should be based on local protocols and consider relevant anti-microbial resistance patterns. The education of patients and their medical practitioners is essential, particularly in relation to the risk of serious infection and its prevention. Further research is required to establish the effectiveness of vaccinations in hyposplenic patients; infective episodes should be regularly audited. There is no single group ideally placed to conduct audits into complications arising from hyposplenism, highlighting a need for a national registry, as has proved very successful in Australia or alternatively, the establishment of appropriate multidisciplinary networks.
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Affiliation(s)
- Shamez N Ladhani
- Centre for Neonatal and Paediatric Infections (CNPI), St. George's University of London, London, UK
- Immunisation and Countermeasures Division, UK Health Security Agency Colindale, London, UK
| | - Savio Fernandes
- Department of Haematology, Dudley Group Foundation NHS Trust, Russell's Hall Hospital, Dudley, UK
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), University of Oxford, Oxford, UK
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Penizzotto A, Vespa F, López Grove R, Rendón O, Tsai R, Ocantos JA. CT and MR Enterography in the Evaluation of Celiac Disease. Radiographics 2024; 44:e230122. [PMID: 38483832 DOI: 10.1148/rg.230122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Celiac disease is a common inflammatory disease of the small bowel that induces mucosal intestinal lesions. The disease is mediated by an immune response and triggered by the ingestion of gluten in genetically predisposed individuals. Gluten contains gliadin, a component found mostly in wheat, barley, and rye. This process leads to gastrointestinal malabsorption with symptoms such as diarrhea, constipation, abdominal pain, and distention. It has a prevalence of 1%-2% in the general adult population, who present with symptoms at any age, but is more frequently found in adult women in the 3rd or 4th decade of life. Recognition of the disease has increased, but it remains a challenge to diagnose. CT and MR enterography are noninvasive studies used for evaluation of small bowel neoplasms and inflammatory small bowel pathologic conditions such as celiac disease. The authors review the spectrum of intestinal and extraintestinal findings of celiac disease at CT and MR enterography, as well as its complications, and the importance of recognizing certain imaging features that help in the diagnosis of celiac disease. More common and specific findings of celiac disease such as inversion of the jejunoileal fold pattern and mesenteric lymphadenopathy are reviewed. More uncommon entities that are more frequently associated with refractory or untreated celiac disease, such as ulcerative jejunoileitis, cavitary mesenteric lymph node syndrome, and malignancies including small bowel adenocarcinoma and lymphoma, are described. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. The slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Andrea Penizzotto
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Florencia Vespa
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Roy López Grove
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Omar Rendón
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Richard Tsai
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
| | - Jorge Alberto Ocantos
- From the Department of Radiology, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina C1199ABB (A.P., F.V., L.P.G., O.R., J.A.O.); and Mallinckrodt Institute of Radiology, Washington University St. Louis, St. Louis, Mo (R.T.)
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Duus S, Jespersen S, Wejse C. Infectious purpura fulminans associated with pneumococcal septicaemia in a patient with unacknowledged functional asplenia. BMJ Case Rep 2024; 17:e251397. [PMID: 38531552 PMCID: PMC10966724 DOI: 10.1136/bcr-2022-251397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Purpura fulminans (PF) is a life-threatening complication of septic shock that can occur due to disseminated infections with Streptococcus pneumoniae The spleen is an important organ in the immunisation process against encapsulated bacteria. Patients with asplenia, either functional or anatomical, are therefore at increased risk of developing serious infections and complications, such as PF, if infected with such bacteria.This case report presents a woman in her late 40s with unacknowledged functional asplenia who was admitted to the hospital with signs of an acute disseminated infection causing septic shock, signs of disseminated intravascular coagulation and infectious PF. A few days after admission, the blood cultures showed growth of S. pneumoniae With early sepsis treatment, the patient survived although with some complications. Clinical presentation, investigations, differential diagnosis, treatment and outcome are presented. Treatment and early recognition of PF are presented and discussed. Relevant recognition and preventative treatment strategies for patients with asplenia are also reviewed and discussed.This case demonstrates the importance of early recognition and treatment of PF in septic patients and the importance of preventive treatment strategies for patients with asplenia to avoid serious infections and complications.
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Affiliation(s)
| | - Sanne Jespersen
- Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Wejse
- Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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Cools M, Grijp C, Neirinck J, Tavernier SJ, Schelstraete P, Van De Velde J, Morbée L, De Baere E, Bonroy C, van Bever Y, Bruggenwirth H, Vermont C, Hannema SE, De Rijke Y, Abdulhadi-Atwan M, Zangen D, Verdin H, Haerynck F. Spleen function is reduced in individuals with NR5A1 variants with or without a difference of sex development: a cross-sectional study. Eur J Endocrinol 2024; 190:34-43. [PMID: 38128121 DOI: 10.1093/ejendo/lvad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE NR5A1 is a key regulator of sex differentiation and has been implicated in spleen development through transcription activation of TLX1. Concerns exist about hypo- or asplenism in individuals who have a difference of sex development (DSD) due to an NR5A1 disease-causing variant. We aimed to assess spleen anatomy and function in a clinical cohort of such individuals and in their asymptomatic family member carriers. DESIGN Cross-sectional assessment in 22 patients with a DSD or primary ovarian insufficiency and 5 asymptomatic carriers from 18 families, harboring 14 different NR5A1 variants. METHODS Spleen anatomy was assessed by ultrasound, spleen function by peripheral blood cell count, white blood cell differentiation, percentage of nonswitched memory B cells, specific pneumococcal antibody response, % pitted red blood cells, and Howell-Jolly bodies. RESULTS Patients and asymptomatic heterozygous individuals had significantly decreased nonswitched memory B cells compared to healthy controls, but higher than asplenic patients. Thrombocytosis and spleen hypoplasia were present in 50% of heterozygous individuals. Four out of 5 individuals homozygous for the previously described p.(Arg103Gln) variant had asplenia. CONCLUSIONS Individuals harboring a heterozygous NR5A1 variant that may cause DSD have a considerable risk for functional hyposplenism, irrespective of their gonadal phenotype. Splenic function should be assessed in these individuals, and if affected or unknown, prophylaxis is recommended to prevent invasive encapsulated bacterial infections. The splenic phenotype associated with NR5A1 variants is more severe in homozygous individuals and is, at least for the p.(Arg103Gln) variant, associated with asplenism.
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Affiliation(s)
- Martine Cools
- Department of Internal Medicine and Pediatrics, Pediatric Endocrinology Service, Ghent University, Ghent University Hospital, 9000 Ghent, Belgium
| | - Celien Grijp
- Department of Internal Medicine and Pediatrics, Pediatric Endocrinology Service, Ghent University, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jana Neirinck
- Department of Diagnostic Science, Ghent University, Department of Laboratory Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | - Simon J Tavernier
- Department of Internal Medicine and Pediatrics, PID Research Lab, Ghent University, 9000 Ghent, Belgium
- Laboratory of Molecular Signal Transduction in Inflammation, Center for Inflammation Research, VIB, 9000 Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent, Belgium
| | - Petra Schelstraete
- Department of Internal Medicine and Pediatrics, Pediatric Pulmonology and Infectious Diseases, Ghent University, Ghent University Hospital, 9000 Ghent, Belgium
| | - Julie Van De Velde
- Department of Internal Medicine and Pediatrics, Pediatric Endocrinology Service, Ghent University, Ghent University Hospital, 9000 Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Elfride De Baere
- Center for Medical Genetics, Ghent University Hospital, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Carolien Bonroy
- Department of Diagnostic Science, Ghent University, Department of Laboratory Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | - Yolande van Bever
- Department of Clinical Genetics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Hennie Bruggenwirth
- Department of Clinical Genetics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Clementien Vermont
- Department of Pediatric Infectious Diseases and Immunology, Erasmus Medical Center-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Erasmus Medical Center-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
- Department of Paediatric Endocrinology, Gastroenterology Endocrinology Metabolism, Reproduction and Development, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Yolanda De Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center 3015 GD Rotterdam, The Netherlands
| | - Maha Abdulhadi-Atwan
- Department of Pediatrics, Pediatric Endocrinology Service, Palestine Red Crescent Society Hospital, PO Box 421, Hebron, Palestine
| | - David Zangen
- Division of Pediatric Endocrinology, Faculty of Medicine, Hadassah University Hospital, Hebrew University of Jerusalem, 91120 Jerusalem, Israel
| | - Hannah Verdin
- Center for Medical Genetics, Ghent University Hospital, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Filomeen Haerynck
- Department of Internal Medicine and Pediatrics, PID Research Lab, Ghent University, 9000 Ghent, Belgium
- Department of Pediatric Pulmonology and Immunology, Centre for Primary Immune Deficiency, Jeffrey Modell Diagnostic and Research Centre for PID, Ghent University Hospital, 9000 Ghent, Belgium
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Tanimoto K, Hoashi T, Shibagaki K, Ono Y, Komori M, Okuda N, Imai K, Iwai S, Ichikawa H. Long-term outcomes of functional single ventricles associated with heterotaxy syndrome†. Eur J Cardiothorac Surg 2023; 64:ezad311. [PMID: 37688564 DOI: 10.1093/ejcts/ezad311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/11/2023] Open
Abstract
OBJECTIVES The goal of this study was to determine the long-term surgical outcomes of patients with functional single ventricles associated with heterotaxy syndrome, risk factors for mortality and factors associated with Fontan stage completion. METHODS Overall, 279 patients with a functional single ventricle associated with heterotaxy syndrome who underwent an initial surgical procedure at our institute between 1978 and 2021 were grouped into 4 "eras" based on the surgical year during which the initial procedure was performed: era 1 (1978-1989, n = 71), era 2 (1990-1999, n = 98), era 3 (2000-2009, n = 64) and era 4 (2010-2021, n = 46). Neonatal surgery was more frequent in eras 3 and 4 than in eras 1 and 2. RESULTS Overall, 228 patients had right atrial isomerism; 120 patients (43.0%) had a total anomalous pulmonary venous connection; and 58 patients (20.8%) underwent an initial procedure as neonates. Overall survival rates at 10, 20 and 30 years after the initial procedure were 47.1%, 40.6% and 36.1%, respectively. Neonatal surgery (P < 0.001), total anomalous pulmonary venous connection repair at the initial procedure (P < 0.001) and early era (P < 0.001) were identified as risk factors for mortality, with the last 2 variables being negatively associated with Fontan stage completion (P < 0.001 for both). CONCLUSIONS Although era had a favourable effect on survival, total anomalous pulmonary venous connection with intrinsic pulmonary vein obstruction was associated with both mortality and Fontan stage completion. CLINICAL REGISTRATION NUMBER R19092.
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Affiliation(s)
- Kazuki Tanimoto
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Keisuke Shibagaki
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshikazu Ono
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Motoki Komori
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoki Okuda
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenta Imai
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shigemitsu Iwai
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Houtman BM, Walraven I, de Grouw E, van der Maazen RWM, Kremer LCM, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, Tissing WJE, Bresters D, van der Pal HJH, de Vries ACH, Louwerens M, van der Heiden-van der Loo M, Neggers SJC, Janssens GO, Blijlevens NMA, Lambeck AJA, Preijers F, Loonen JJ. The Value of IgM Memory B-Cells in the Assessment of Splenic Function in Childhood Cancer Survivors at Risk for Splenic Dysfunction: A DCCSS-LATER Study. J Immunol Res 2023; 2023:5863995. [PMID: 37901347 PMCID: PMC10611543 DOI: 10.1155/2023/5863995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 10/31/2023] Open
Abstract
Background Childhood cancer survivors (CCS) who received radiotherapy involving the spleen or total body irradiation (TBI) might be at risk for splenic dysfunction. A comprehensive screening test for examining splenic dysfunction is lacking. Objective We investigated whether IgM memory B-cells could be used to assess splenic dysfunction in CCS who received a splenectomy, radiotherapy involving the spleen, or TBI. Methods All CCS were enrolled from the DCCSS-LATER cohort. We analyzed differences in IgM memory B-cells and Howell-Jolly bodies (HJB) in CCS who had a splenectomy (n = 9), received radiotherapy involving the spleen (n = 36), or TBI (n = 15). IgM memory B-cells < 9 cells/µL was defined as abnormal. Results We observed a higher median number of IgM memory B-cells in CCS who received radiotherapy involving the spleen (31 cells/µL, p=0.06) or TBI (55 cells/µL, p = 0.03) compared to CCS who received splenectomy (20 cells/µL). However, only two CCS had IgM memory B-cells below the lower limit of normal. No difference in IgM memory B-cells was observed between CCS with HJB present and absent (35 cells/µL vs. 44 cells/µL). Conclusion Although the number of IgM memory B-cells differed between splenectomized CCS and CCS who received radiotherapy involving the spleen or TBI, only two CCS showed abnormal values. Therefore, this assessment cannot be used to screen for splenic dysfunction.
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Affiliation(s)
- Bente M. Houtman
- Department of Hematology, Center of Expertise for Cancer Survivorship, Radboud University Medical Center, Nijmegen, Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Elke de Grouw
- Department of Laboratory Medicine—Radboudumc Laboratory of Diagnostics, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
- Department of Pediatric Oncology, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | | | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Andrica C. H. de Vries
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sebastian J. C. Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Medicine, Section Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Geert O. Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Annechien J. A. Lambeck
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Frank Preijers
- Department of Laboratory Medicine—Laboratory for Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jacqueline J. Loonen
- Department of Hematology, Center of Expertise for Cancer Survivorship, Radboud University Medical Center, Nijmegen, Netherlands
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Rehman S, Rehman E, Holy O. Potential determinants of vaccine hesitancy among celiac disease patients: a single cohort analysis. Front Public Health 2023; 11:1061617. [PMID: 37614445 PMCID: PMC10442556 DOI: 10.3389/fpubh.2023.1061617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Though researchers and scholars have greatly emphasized addressing the influencing factors of vaccination hesitancy, little attention has been paid to patients with celiac disease. Addressing the variables hampering attitudes might help direct appropriate patient advocacy and doctor-patient communication endeavors to encourage vaccination among celiac disease patients. The present investigation seeks to explore the coverage against vaccine-preventable diseases, vaccination attitudes, and related possible factors among celiac disease patients in the Pakistani setting. Methods A self-reported online survey was conducted in Islamabad, Pakistan, for celiac disease patients aged 18 and above. The questionnaire was completed by 226 participants, with a response rate of 43.8%. The influencing variables for vaccination hesitancy were examined, and 95% confidence intervals for the crude and adjusted odds ratios were computed. Results Among the study population, the majority were females, with a ratio of 75.66%. A prominent proportion of 69.03% was observed for influenza vaccination, while 39.82% were unable to recall all of the vaccinations they had previously received. Only 7% of the patients were considered to have a negative attitude toward vaccination, compared to an estimated 76% who were in favor of it. The significantly positive influencing factors observed toward vaccination were being well-educated (graduate, master, or above), possible recurrence of vaccine-preventable diseases with declining vaccination coverage (adjusted OR: 13.36), and increased confidence in vaccines from health care experts compared to electronic media (adjusted OR: 8.41). Contrarily, practicing complementary and alternative medicines (adjusted OR: 5.59), willingness to get vaccinated again in the future (adjusted OR: 15.59), and prior negative perspectives (adjusted OR: 1.01) were the determinants with a significant negative association. Discussion In conclusion, the outcomes of the current work raise the possibility that health practitioners may be accountable for inappropriately prescribing vaccines to this demographic since 77% of the participants had a favorable attitude toward vaccination. These findings could serve as a springboard for creating targeted immunization efforts to raise vaccination coverage against vaccine-preventive diseases among celiac disease patients.
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Affiliation(s)
- Shazia Rehman
- Department of Psychiatry, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
| | - Erum Rehman
- Department of Mathematics, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Ondrej Holy
- Science and Research Centre, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czechia
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Real-World Evidence on Disease Burden and Economic Impact of Sickle Cell Disease in Italy. J Clin Med 2022; 12:jcm12010117. [PMID: 36614918 PMCID: PMC9821386 DOI: 10.3390/jcm12010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
A real-world analysis was conducted in Italy among sickle cell disease (SCD) patients to evaluate the epidemiology of SCD, describe patients' characteristics and the therapeutic and economic burden. A retrospective analysis of administrative databases of various Italian entities was carried out. All patients with ≥1 hospitalization with SCD diagnosis were included from 01/2010-12/2017 (up to 12/2018 for epidemiologic analysis). The index date corresponded to the first SCD diagnosis. In 2018, SCD incidence rate was 0.93/100,000, the prevalence was estimated at 13.1/100,000. Overall, 1816 patients were included. During the 1st year of follow-up, 50.7% of patients had one all-cause hospitalization, 27.8% had 2, 10.4% had 3, and 11.1% had ≥4. Over follow-up, 6.1-7.2% of patients were treated with SCD-specific, 58.4-69.4% with SCD-related, 60.7-71.3% with SCD-complications-related drugs. Mean annual number per patient of overall treatments was 14.9 ± 13.9, hospitalizations 1.1 ± 1.1, and out-patient services 5.3 ± 7.6. The total mean direct cost per patient was EUR 7918/year (EUR 2201 drugs, EUR 3320 hospitalizations, and EUR 2397 out-patient services). The results from this real-world analysis showed a high disease burden for SCD patients with multiple hospitalizations during the follow-up. High healthcare resource utilization and costs were associated with patient' management and were most likely underestimated since indirect costs and Emergency Room admissions were not included.
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11
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Abstract
Asplenia (the congenital or acquired absence of the spleen) and hyposplenism (defective spleen function) are common causes of morbidity and mortality. The spleen is a secondary lymphoid organ that is responsible for the regulation of immune responses and blood filtration. Hence, asplenia or hyposplenism increases susceptibility to severe and invasive infections, especially those sustained by encapsulated bacteria (namely, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b). Asplenia is predominantly due to splenectomy for either traumatic events or oncohaematological conditions. Hyposplenism can be caused by several conditions, including haematological, infectious, autoimmune and gastrointestinal disorders. Anatomical disruption of the spleen and depletion of immune cells, especially IgM memory B cells, seem to be predominantly responsible for the clinical manifestations. Early recognition of hyposplenism and proper management of asplenia are warranted to prevent overwhelming post-splenectomy infections through vaccination and antibiotic prophylaxis. Although recommendations are available, the implementation of vaccination strategies, including more effective and immunogenic vaccines, is needed. Additionally, screening programmes for early detection of hyposplenism in high-risk patients and improvement of patient education are warranted.
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Costantino A, Michelon M, Roncoroni L, Doneda L, Lombardo V, Costantino C, Vecchi M, Elli L. Vaccination Status and Attitudes towards Vaccines in a Cohort of Patients with Celiac Disease. Vaccines (Basel) 2022; 10:vaccines10081199. [PMID: 36016087 PMCID: PMC9413071 DOI: 10.3390/vaccines10081199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: The identification of vaccination status and attitudes towards vaccines among celiac disease (CD) patients is of great importance, but it has not yet been investigated. The aim of this study was to investigate coverage against vaccine-preventable diseases (VPDs), attitudes towards vaccinations, and its determinants among CD patients. (2) Methods: An anonymous web-based validated questionnaire was sent to a mailing list of CD adult patients. Patients were asked to self-report their previous vaccinations and attitudes towards vaccinations, which were defined as positive, negative, and partially positive/negative. The influencing factors towards vaccinations were investigated, and crude and adjusted odds ratios (AdjORs) with 95% confidence intervals (CIs) were calculated. (3) Results: The questionnaire was sent to 412 patients, with a response rate of 31.6% (130 patients, 105 women, median age 40 years, interquartile range 36–51). Patients self-reported vaccination against the following diseases: 73.8% tetanus, 42.3% flu, 20% measles, mumps and rubella, 19.2% meningitis, and 16.2% pneumococcus. Thirty-two people (24.6%) did not remember all of their previous vaccinations. In total, 104 (80%) respondents had a positive attitude towards vaccines, 25 (19.2%) a partially positive/negative one, and 1 a negative one. The determinants significantly influencing the positive attitude were being a graduate (AdjORs 7.49) and a belief in the possible return of VPDs with declining vaccination coverage rates (AdjORs 7.42), while the use of complementary and alternative medicines (AdjORs 0.11) and past negative experience (AdjORs 0.16) were associated with a negative attitude. (4) Conclusions: Despite four out of five CD patients showing a strong positive attitude towards vaccinations, one out of five had a partially negative one. Only a minority (16–20%) reported being vaccinated against some VPDs potentially harmful to their CD because of hyposplenism, such as meningitis and pneumococcus. The low vaccination rate against some VPDs, in spite of the 80% of CD patients stating a positive attitude towards vaccination, may be explained in part by patients’ vaccine hesitancy and in part by a possible role of physicians in under-prescribing vaccinations to these patients. These results may be a starting point for developing specific vaccination campaigns to increase vaccination rates against VPDs in CD patients.
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Affiliation(s)
- Andrea Costantino
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.L.); (M.V.); (L.E.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Correspondence: ; Tel.: +39-025-503-519-1
| | - Marco Michelon
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Leda Roncoroni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (L.R.); (L.D.)
| | - Luisa Doneda
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (L.R.); (L.D.)
| | - Vincenza Lombardo
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.L.); (M.V.); (L.E.)
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties “G. D’Alessandro”, University of Palermo, 90145 Palermo, Italy;
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.L.); (M.V.); (L.E.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.L.); (M.V.); (L.E.)
- Center for Prevention and Diagnosis of Celiac Disease, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Wehmeyer MH, Sekhri H, Wroblewski R, Galante A, Meyer T, Lohse AW, Schulze zur Wiesch J. Frequent detection of functional hyposplenism via assessment of pitted erythrocytes in patients with advanced liver cirrhosis. PLoS One 2022; 17:e0271541. [PMID: 35849612 PMCID: PMC9292104 DOI: 10.1371/journal.pone.0271541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Asplenia or functional hyposplenism are risk factors for severe infections, and vaccinations against encapsulated bacteria are advised. There are only limited data regarding the spleen function of cirrhotic patients. Methods We evaluated spleen function in patients with liver cirrhosis, who were prospectively enrolled in this study. Spleen function was evaluated by the measurement of pitted erythrocytes. Functional hyposplenism was defined as a percentage of PE of >15%. Results 117 patients, mean age 58.4 years and 61.5% (n = 72) male with liver cirrhosis were included. Functional hyposplenism was diagnosed in 28/117 patients (23.9%). Pitted erythrocytes correlated with albumin (p = 0.024), bilirubin (p<0.001), international normalized ratio (INR; p = 0.004), model of end-stage liver disease (MELD) score (p<0.001) and liver stiffness (p = 0.011). Patients with functional hyposplenism had higher MELD scores (median 13 vs. 10; p = 0.021), liver stiffness (46.4 kPa vs. 26.3 kPa; p = 0.011), INR (1.3 vs. 1.2; p = 0.008) and a higher Child-Pugh stage (Child C in 32.1% vs. 11.2%; p = 0.019) as compared to patients without functional hyposplenism. Functional hyposplenism was not associated with the etiology of cirrhosis. Importantly, 9/19 patients with Child C cirrhosis had functional hyposplenism. Conclusion A quarter of patients with liver cirrhosis and almost 50% of patients with Child C cirrhosis have functional hyposplenism. Functional hyposplenism is associated with poor liver function and the degree of portal hypertension, which is characterized by higher liver stiffness measurements in transient elastography.
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Affiliation(s)
- Malte H. Wehmeyer
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Harsha Sekhri
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Antonio Galante
- Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
| | - Thomas Meyer
- Department of Dermatology, Venerology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Ansgar W. Lohse
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Surgical Management of a Volvulus of a Wandering Spleen Associated with a Volvulus of the Small Intestine. Case Rep Surg 2022; 2022:8696492. [PMID: 35492869 PMCID: PMC9054486 DOI: 10.1155/2022/8696492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction A wandering spleen is a rare anatomical condition characterized by a free-floating splenic tissue that is not located in its normal position in the left upper quadrant. This condition is usually asymptomatic but can also manifest itself with volvulus of the spleen and consequent infarction and necrosis of the parenchyma, requiring an urgent surgical management. Additionally, a wandering spleen can be associated with other contemporaneous anatomical anomalies. Case Presentation. We report a case of a 21-year-old woman, admitted to our hospital for intense abdominal pain and vomiting. A CT scan revealed a wandering spleen in the mesogastric area with the spleen torted on its axis, associated with a volvulus of the small intestine. Abdominal exploration revealed a macroscopically normal free-floating spleen attached to an abnormally long vascular pedicle. The management of the wandering spleen was conservative, and a splenopexy was performed. Conclusions The torsion of the wandering spleen constitutes an infrequent but life-threatening abdominal emergency. The diagnosis of the wandering spleen is frequently challenging since clinical findings are usually not specific. Imaging such as computed tomography scan plays an important role in the differential diagnosis pathway. Treatment should be planned according to the splenic parenchyma conditions. Splenectomy is indicated when massive infarction and thrombosis of splenic vessels have occurred. When splenic parenchyma is not compromised, it is preferred to perform a conservative surgical technique, such as splenopexy, in order to avoid postsplenectomy complications.
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Thim-Uam A, Makjaroen J, Issara-Amphorn J, Saisorn W, Wannigama DL, Chancharoenthana W, Leelahavanichkul A. Enhanced Bacteremia in Dextran Sulfate-Induced Colitis in Splenectomy Mice Correlates with Gut Dysbiosis and LPS Tolerance. Int J Mol Sci 2022; 23:1676. [PMID: 35163596 PMCID: PMC8836212 DOI: 10.3390/ijms23031676] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 01/27/2023] Open
Abstract
Because both endotoxemia and gut dysbiosis post-splenectomy might be associated with systemic infection, the susceptibility against infection was tested by dextran sulfate solution (DSS)-induced colitis and lipopolysaccharide (LPS) injection models in splenectomy mice with macrophage experiments. Here, splenectomy induced a gut barrier defect (FITC-dextran assay, endotoxemia, bacteria in mesenteric lymph nodes, and the loss of enterocyte tight junction) and gut dysbiosis (increased Proteobacteria by fecal microbiome analysis) without systemic inflammation (serum IL-6). In parallel, DSS induced more severe mucositis in splenectomy mice than sham-DSS mice, as indicated by mortality, stool consistency, gut barrier defect, serum cytokines, and blood bacterial burdens. The presence of green fluorescent-producing (GFP) E. coli in the spleen of sham-DSS mice after an oral gavage supported a crucial role of the spleen in the control of bacteria from gut translocation. Additionally, LPS administration in splenectomy mice induced lower serum cytokines (TNF-α and IL-6) than LPS-administered sham mice, perhaps due to LPS tolerance from pre-existing post-splenectomy endotoxemia. In macrophages, LPS tolerance (sequential LPS stimulation) demonstrated lower cell activities than the single LPS stimulation, as indicated by the reduction in supernatant cytokines, pro-inflammatory genes (iNOS and IL-1β), cell energy status (extracellular flux analysis), and enzymes of the glycolysis pathway (proteomic analysis). In conclusion, a gut barrier defect after splenectomy was vulnerable to enterocyte injury (such as DSS), which caused severe bacteremia due to defects in microbial control (asplenia) and endotoxemia-induced LPS tolerance. Hence, gut dysbiosis and gut bacterial translocation in patients with a splenectomy might be associated with systemic infection, and gut-barrier monitoring or intestinal tight-junction strengthening may be useful.
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Affiliation(s)
- Arthid Thim-Uam
- Division of Biochemistry, School of Medical Sciences, University of Phayao, Phayao 56000, Thailand;
- Center of Excellence in Systems Biology, Faculty of Medicine, Chulalongkorn University, Bangkok 10400, Thailand;
| | - Jiradej Makjaroen
- Center of Excellence in Systems Biology, Faculty of Medicine, Chulalongkorn University, Bangkok 10400, Thailand;
| | - Jiraphorn Issara-Amphorn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10400, Thailand; (J.I.-A.); (W.S.); (D.L.W.)
| | - Wilasinee Saisorn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10400, Thailand; (J.I.-A.); (W.S.); (D.L.W.)
| | - Dhammika Leshan Wannigama
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10400, Thailand; (J.I.-A.); (W.S.); (D.L.W.)
- Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok 10400, Thailand
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, WA 6009, Australia
| | - Wiwat Chancharoenthana
- Tropical Nephrology Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
- Tropical Immunology and Translational Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Asada Leelahavanichkul
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10400, Thailand; (J.I.-A.); (W.S.); (D.L.W.)
- Translational Research in Inflammation and Immunology Research Unit (TRIRU), Department of Microbiology, Chulalongkorn University, Bangkok 10400, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10400, Thailand
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Weinzirl J, Garnitschnig L, Scheffers T, Andrae L, Heusser P. Splenic Rhythms and Postprandial Dynamics in Physiology, Portal Hypertension, and Functional Hyposplenism: A Review. Digestion 2021; 102:326-334. [PMID: 32408299 DOI: 10.1159/000507346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Before the discovery of immunological and haematological functions of the spleen, it had for centuries been considered to be a digestive organ of variable size with a role in the portal vein system and nutritional metabolism. In the 19th and 20th centuries, volume changes in the spleen related to nutrition were studied using plethysmographic measurements. Rhythmical and regulatory functions of the spleen were demonstrated in the haemodynamics of the splanchnic region and were described as a "hepatolienal pendulum," a "Windkessel function," or a "pressure compensation." These studies were mainly published in German-speaking countries and have not, as far as is known, been discussed in the English-speaking world so far. SUMMARY This review explores the historical development of the rhythmical regulatory function of the spleen in the splanchnic region. Older studies and results are followed up in the modern literature, wherever possible, up to the present. The clinical relevance is illustrated with portal hypertension (with congestive or hyperdynamic splenomegaly), coeliac disease, and chronic inflammatory bowel diseases (with functional hyposplenism). Key Message: The spleen's rhythmical regulatory function in nutrition is based on an autonomous rhythm comprising cycles of contractions and dilations of the spleen of around 1 min. These cycles can be influenced by sympathetically mediated single contractions with a release of pooled blood or by portal vein congestion. After food ingestion, the spleen responds either with contraction according to a vasomotor reaction or postprandial congestion with significant increases in volume. The spleen's rhythmical function is lost in the clinical picture of portal hypertension or in coeliac disease and chronic inflammatory bowel diseases. In the aforementioned gastrointestinal diseases, we recommend taking more account of the haemodynamics between the spleen, liver, and intestine. New innovative techniques for recording splenograms are required which, besides elastographic measurements of spleen stiffness, could offer an important tool for early detection, diagnosis, and therapeutic evaluation.
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Affiliation(s)
- Johannes Weinzirl
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany,
| | - Lydia Garnitschnig
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Tom Scheffers
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Lukas Andrae
- Department of Internal Medicine, Community Hospital Herdecke, Herdecke, Germany
| | - Peter Heusser
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
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Trenker C, Görg C, Freeman S, Jenssen C, Dong Y, Caraiani C, Ioanițescu ES, Dietrich CF. WFUMB Position Paper-Incidental Findings, How to Manage: Spleen. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2017-2032. [PMID: 34052061 DOI: 10.1016/j.ultrasmedbio.2021.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.
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Affiliation(s)
- Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse, Marburg, Germany
| | - Christian Görg
- Department of gastroenterology, Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse Marburg, Germany
| | - Simon Freeman
- University Hospitals Plymouth, Imaging Directorate, Derriford Hospital, Plymouth, United Kingdom
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH Strausberg/Wriezen, Akademisches Lehrkrankenhaus Medizinische Hochschule Brandenburg "Theodor Fontane", Germany; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena Simona Ioanițescu
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Center of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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COVID-19 Vaccine: A Survey of Hesitancy in Patients with Celiac Disease. Vaccines (Basel) 2021; 9:vaccines9050511. [PMID: 34065654 PMCID: PMC8156726 DOI: 10.3390/vaccines9050511] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: COVID-19 vaccination campaigns offer the best hope of controlling the pandemic. However, the fast production of COVID-19 vaccines has caused concern among the general public regarding their safety and efficacy. In particular, patients with chronic illnesses, such as celiac disease (CD), may be more fearful. Information on vaccine hesitancy plays a pivotal role in the development of an efficient vaccination campaign. In our study, we aimed to evaluate COVID-19 vaccine hesitancy among Italian CD patients. (2) Methods: an anonymous questionnaire was sent to CD patients followed at our tertiary referral center for CD in Milan, Italy. Patients were defined as willing, hesitant and refusing. We evaluated the reasons for hesitancy/refusal and the possible determinants, calculating crude and adjusted odds ratios [AdjORs] with 95% confidence intervals [CIs]. (3) Results: the questionnaire was sent to 346 patients with a response rate of 29.8%. Twenty-six (25.2%) of the 103 respondents were hesitant, with a total refusal rate of 4.8%. The main reason was fear of adverse events related to vaccination (68.2%). Among hesitant patients, 23% declared that their opinion was influenced by their CD. The determinants positively influencing willingness to be vaccinated against COVID-19 were adherence to a GFD, perception of good knowledge about COVID-19 and its vaccines, and a positive attitude to previous vaccines (AdjOR 12.71, 95% CI 1.82-88.58, AdjOR 6.50, 95% CI 1.44-29.22, AdjOR 0.70, 95% CI 0.11-4.34, respectively). (4) Conclusions: CD patients should be vaccinated against COVID-19 and a specific campaign to address the determinants of hesitancy should be developed.
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Characteristics of Patients With Congenital Heart Disease Requiring ICU Admission From Japanese Emergency Departments. Pediatr Crit Care Med 2020; 21:e1106-e1112. [PMID: 32769701 DOI: 10.1097/pcc.0000000000002440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the characteristics of patients with congenital heart disease requiring ICU admission from emergency departments and determine the associations between the reasons for emergency department visits and specific congenital heart disease types or cardiac procedures. DESIGN Retrospective observational study using data from a Japanese multicenter database. SETTING Twelve PICUs and 11 general ICUs in Japan. PATIENTS All patients requiring ICU admission from an emergency department during 2013-2018, divided into two groups: with congenital heart disease and without congenital heart disease groups. INTERVENTIONS None for this analysis. MEASUREMENTS AND MAIN RESULTS Of the 297 patients with congenital heart disease (9.2% of a total of 3,240 patients), more than half had moderate-to-high complexity congenital heart disease; most of them were pediatric patients who had visited specialized congenital heart disease centers. All the patients' clinical outcomes were similar. Regarding the reasons for emergency department admission, seizure was significantly associated with a single ventricle anatomy (odds ratio, 3.3; 95% CI, 1.1-10.0), post-Glenn shunt placement (odds ratio, 5.6; 95% CI, 1.1-29.4), and a Fontan-type operation status (odds ratio, 6.3; 95% CI, 1.5-25.5). Sepsis and gastrointestinal bleeding were associated with asplenia (odds ratio, 21.1; 95% CI, 4.3-104 and odds ratio, 21.0; 95% CI, 3.1-141, respectively); gastrointestinal bleeding was also associated with systemic-to-pulmonary artery shunt placement (odds ratio, 18.8; 95% CI, 2.8-125) and a Fontan-type operation status (odds ratio, 17.0; 95% CI, 2.6-112). Arrhythmia was associated with a single ventricle anatomy (odds ratio, 21.0; 95% CI, 3.1-141), systemic-to-pulmonary artery shunt placement (odds ratio, 18.8; 95% CI, 2.8-125), and a Fontan-type operation status (odds ratio, 17.0; 95% CI, 2.6-112). CONCLUSIONS Classification of the reasons for emergency department admission by congenital heart disease type and surgical stage may guide clinicians in the selection of appropriate treatments in such settings.
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Laparoscopic near-total splenectomy. Report of a case. Int J Surg Case Rep 2020; 77S:S44-S47. [PMID: 33191191 PMCID: PMC7876733 DOI: 10.1016/j.ijscr.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 01/11/2023] Open
Abstract
We describe a case report of near total splenectomy managed by laparoscopy for a large lesion of the upper pole of the spleen. When total splenectomy is performed, an increased risk of potentially lethal infections arises. Asplenia and impaired splenic function are related to the increase of morbidity and mortality from infectious complications. The overwhelming post splenectomy infections (OPSI) are mostly represented by fulminating sepsis, meningitis or pneumonia. laparoscopic near total splenectomy is an innovative partial splenectomy technique consisting on preserving a residual spleen volume. The comparison between other spleen preserving techniques shows that LNTS is associated with a lower rate of secondary surgery and postoperative recurrence of anaemia.
Introduction Splenectomy is a surgical procedure indicated for the treatment of most benign and malignant splenic diseases, especially hematologic disorders. Laparoscopic approach is preferable to the open surgery for most indications because it reduces intra- and post-operative complications and shortens hospital stay. Laparoscopic approach is also feasible for partial splenectomy. Spleen-preserving techniques reduce the risk of severe infections and thromboembolic events that can occur after total splenectomy Case presentation We report a case of a 50-year old woman with an incidentally discovered voluminous lesion in the superior pole of spleen. A laparoscopic near-total splenectomy was performed. Discussion The evidence about the potential complications in splenectomised patients speaks in favour of performing spleen-sparing surgical techniques whenever possible. Most common indications for laparoscopic partial splenectomy are non-parasitic splenic cystic, benign splenic tumors, splenic haematological diseases, non-cystic intraparenchymal lesions, spleen rupture, splenic abscess, vascular abnormalities. Laparoscopic near total splenectomy is an innovative partial splenectomy technique consisting on preserving a residual spleen volume. Conclusion LNTS seems to be a safe and effective technique for the management of benign spleen diseases. The comparison between other spleen preserving techniques shows that LNTS is associated with a lower rate of secondary surgery and postoperative recurrence of anaemia.
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Kang JM, Kim EH, Ihn K, Jung I, Han M, Ahn JG. Risk of invasive pneumococcal disease in patients with asplenia/hyposplenism: A nationwide population-based study in Korea, 2009–2018. Int J Infect Dis 2020; 98:486-493. [DOI: 10.1016/j.ijid.2020.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/28/2023] Open
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Nosocomial Severe Bacterial Infection After Cardiac Surgery for Complex Congenital Heart Disease in Heterotaxy Syndrome. Pediatr Infect Dis J 2020; 39:e163-e168. [PMID: 32235245 DOI: 10.1097/inf.0000000000002672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with heterotaxy syndrome (HS), commonly associated with hyposplenism and complex congenital heart disease (CCHD), require multiple-stage single ventricle type operation for long-term survival. Although a higher risk of community-acquired sepsis and mortality rate was reported in CCHD with HS compared with those without HS, whether the risk of postoperative severe bacterial infection (SBI) is higher in patients with HS remains unknown. METHOD All patients with CCHD (with and without HS) born between 2001 and 2013 who received cardiac surgery between 2001 and 2018 were enrolled. We analyzed the epidemiology and risk of postoperative SBI in this CCHD cohort. RESULT In total, 101 patients of CCHD with HS and 164 patients without HS were enrolled. The mean postoperative nosocomial SBI rate was 0.73/100 patient-days in patients with HS and 0.56/100 patient-days in patients without HS (P = 0.13). Multivariate Cox regression analysis demonstrated that the most critical risk factor for postoperative SBI was postoperative intubation >14 days. Preoperative risk factors, including a nonstandard surgical procedure and multiple surgeries, but not HS, were associated with an increased risk of postoperative nosocomial SBI. The pathogens of infection were also similar between these 2 groups. CONCLUSION Although commonly associated with hyposplenism, patients with HS have similar postoperative SBI risk and pathogens as those with CCHD alone.
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Passanisi S, Dipasquale V, Romano C. Vaccinations and Immune Response in Celiac Disease. Vaccines (Basel) 2020; 8:vaccines8020278. [PMID: 32517026 PMCID: PMC7349995 DOI: 10.3390/vaccines8020278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
Immune response to vaccinations in celiac patients is of growing scientific interest. However, some aspects of the relationship between celiac disease (CD) and vaccines are still unclear. A comprehensive search of published literature using the PubMed database was carried out using the following key terms: "adaptive immunity", "celiac disease", "humoral immune response", "immunization", and "vaccination". To date, there is no evidence showing any causative association between vaccines and CD development. Therefore, vaccinations may be administered according to the modalities and timing of the National Immunization Schedule for each country. The rotavirus vaccine is currently recommended for the general population, and according to some data, it appears to reduce the risk for the development of CD autoimmunity in the early years of life. Regarding the hepatitis B virus, a booster dose of the vaccine is often required due to the low or the lost immune response rate in CD. Furthermore, determination of hepatitis B antibody titers could be useful in newly diagnosed CD subjects regardless of age at diagnosis. Finally, pneumococcal vaccines may be administered in patients with advancing age at diagnosis and concomitant risk factors. Future clinical practice guidelines for vaccination and monitoring programs in celiac patients could be recommended.
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Fabian E, Tinchon C, Lueger A, Bauer PK, Mayer-Pickel KI, Raggam RB, Hammer HF, Langner C, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 169: A 32-year-old woman with anemia in pregnancy. Wien Klin Wochenschr 2020; 132:322-331. [PMID: 32468113 PMCID: PMC7297834 DOI: 10.1007/s00508-020-01679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christoph Tinchon
- Division of Hematology and Oncology, Department of Internal Medicine, State Hospital Hochsteiermark, Leoben, Austria
| | - Andreas Lueger
- Division of Emergency Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp K Bauer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Reinhold B Raggam
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Heinz F Hammer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Cord Langner
- Department of Pathology, Medical University of Graz, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Anai S, Ibusuki R, Takao T, Okushima K, Sakurai Y, Hisasue J, Furukawa T, Shiraishi N, Takaki Y, Hara N. Splenic volume in pneumococcal pneumonia patients is associated with disease severity and mortality. J Infect Chemother 2020; 26:977-985. [PMID: 32376162 DOI: 10.1016/j.jiac.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Abstract
Splenectomy is a risk factor for serious pneumococcal disease like overwhelming post-splenectomy infection (OPSI). In healthy individuals with small spleen, fulminant pneumococcal infection similar to OPSI has been reported. Furthermore, it is reported that small spleen was associated with severe pneumococcal infection patients treated in an intensive care unit. However, the association between the small spleen and pneumococcal pneumonia was not investigated enough. We retrospectively analyzed patients with pneumococcal pneumonia who underwent computed tomography examination with measurement of the splenic volume at Harasanshin Hospital between 2004 and 2019. Data on their background characteristics, laboratory findings, and clinical courses were collected. 413 patients were included in the final analysis. The splenic volume was significantly lower in the moderate (P < 0.001), severe (P < 0.00005), and extremely severe (P < 0.001) pneumonia groups compared with the mild pneumonia group. Furthermore, the splenic volume was significantly lower in patients died within 30 days of pneumonia treatment (median of 73.49 versus 110.77 cm3, P < 0.005) or during hospitalization (median of 71.69 versus 111.01 cm3, P < 0.0005). Splenic volume <40 cm3 was significantly associated with mortality within 30 days and total hospital mortality as a risk factor in univariate analysis. Splenic volume <40 cm3 was an independent risk factor for mortality within 30 days (odds ratio: 5.0, 95% confidence interval: 1.2-21.1, P < 0.05) and total hospital mortality (odds ratio: 7.4, 95% confidence interval: 1.8-30.6, P < 0.01) in multivariate logistic regression analysis. These results suggest that small spleen is a risk factor for severity and mortality of pneumococcal pneumonia.
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Affiliation(s)
- Satoshi Anai
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan.
| | - Ritsu Ibusuki
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Tomoaki Takao
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Kazuhiro Okushima
- Division of Clinical Radiology, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Yuko Sakurai
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Junko Hisasue
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Tatsuya Furukawa
- Division of Clinical Radiology, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Naotaka Shiraishi
- Division of Clinical Radiology, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Yoichi Takaki
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Naohiko Hara
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
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Balaceanu A, Omer S, Stirban R, Zara O, Dina I. Hyposplenism, Hashimoto's Autoimmune Thyroiditis and Overlap Syndrome (Celiac Disease and Autoimmune Hepatitis Type 1). Am J Med Sci 2020; 360:293-299. [PMID: 32563569 DOI: 10.1016/j.amjms.2020.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/02/2020] [Accepted: 04/18/2020] [Indexed: 01/25/2023]
Abstract
Hyposplenism is associated with autoimmune diseases, inflammatory bowel disease, severe celiac disease, autoimmune thyroiditis, untreated HIV infection and chronic graft-versus-host disease. The aim of this study was to review the existing data on hyposplenism associated with celiac disease and Hashimoto's autoimmune thyroiditis. Our research was based on a clinical case concerning a 41-year-old female who presented with asthenia, fatigue, dyspepsia and chronic diarrhea. The medical history revealed autoimmune Hashimoto's thyroiditis, type 2 diabetes, fatty liver disease, chronic gastritis and thrombocytosis. Multiple investigations showed hyposplenism and complex autoimmune dysfunction with positive serum markers for celiac disease and type 1 autoimmune hepatitis along with minor symptomatology. The intestinal symptomatology of celiac disease is often hid by hypothyroidism-associated autoimmune thyroiditis. Asymptomatic or minimally symptomatic celiac disease associated with Hashimoto's autoimmune thyroiditis is diagnosed by biomarkers. Hyposplenism in celiac disease can occur regardless of the disease stage, latent or symptomatic.
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Affiliation(s)
- Alice Balaceanu
- "Carol Davila" University of Medicine and Pharmacy, "Sf. Ioan" Clinical Emergency Hospital, Internal Medicine Department, Bucharest, Romania.
| | - Secil Omer
- "Carol Davila" University of Medicine and Pharmacy, "Sf. Ioan" Clinical Emergency Hospital, Gastroenterology Department, Bucharest, Romania
| | - Raluca Stirban
- "Sf. Ioan" Clinical Emergency Hospital, Internal Medicine Department, Bucharest, Romania
| | - Octavian Zara
- "Sf. Ioan" Clinical Emergency Hospital, Interventional Cardiology Department, Bucharest, Romania
| | - Ion Dina
- "Carol Davila" University of Medicine and Pharmacy, "Sf. Ioan" Clinical Emergency Hospital, Gastroenterology Department, Bucharest, Romania
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Lenti MV, Mengoli C, Vernero M, Aronico N, Conti L, Borrelli de Andreis F, Cococcia S, Di Sabatino A. Preventing Infections by Encapsulated Bacteria Through Vaccine Prophylaxis in Inflammatory Bowel Disease. Front Immunol 2020; 11:485. [PMID: 32269571 PMCID: PMC7109446 DOI: 10.3389/fimmu.2020.00485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/03/2020] [Indexed: 12/23/2022] Open
Abstract
Inflammatory bowel disease (IBD), which comprises ulcerative colitis and Crohn's disease, is an immune-mediated, chronic-relapsing, disabling disorder which is associated with increased mortality and poor patients' quality of life. Patients with IBD are at increased risk of infections for many reasons. In fact, IBD often requires a lifelong immunosuppressive and/or biologic therapy, both commonly associated with respiratory and opportunistic infections, but also gastrointestinal, urinary tract infections, and sepsis. Moreover, impaired spleen function has been found in a considerable proportion of IBD patients, further increasing the risk of developing infections sustained by encapsulated bacteria, such as S. pneumoniae, H. influenzae, and N. meningitidis. Finally, comorbidities and surgery represent additional risk factors for these patients. Despite the availability of vaccinations against the most common serotypes of encapsulated bacteria, uncertainties still exist regarding a proper vaccination strategy and the actual effectiveness of vaccinations in this particular setting. Aim of this narrative review is to focus on the broad topic of vaccinations against encapsulated bacteria in IBD patients, discussing the clinical impact of infections, predisposing factors, vaccinations strategies, and unmet research and clinical needs.
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Affiliation(s)
- Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Caterina Mengoli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marta Vernero
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Nicola Aronico
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Laura Conti
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Sara Cococcia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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Long B, Koyfman A, Gottlieb M. Complications in the adult asplenic patient: A review for the emergency clinician. Am J Emerg Med 2020; 44:452-457. [PMID: 32247651 DOI: 10.1016/j.ajem.2020.03.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The spleen performs several important physiologic functions. However, patients can have functional asplenia or have their spleen removed for a number of reasons, which can put them at risk for several dangerous complications. OBJECTIVE This narrative review provides a focused evaluation of adult asplenic patients and complications in the emergency departing setting. DISCUSSION The spleen plays integral roles in the immune and reticuloendothelial systems and also modulates the inflammatory and coagulation cascades. Asplenia refers to the anatomic or physiologic loss of splenic function, which may be due to trauma, immunological, hematological, or oncological etiologies. Asplenic patients are at risk for several complications including infection, arterial and venous thrombosis, and pulmonary hypertension. Fever in an asplenic patient and overwhelming post-splenectomy infection (OPSI) are medical emergencies with a high mortality and require rapid evaluation and management with broad-spectrum antibiotics. Asplenic patients are at increased risk of arterial thrombosis, such as coronary artery disease, and venous thrombosis including deep venous thrombosis, pulmonary embolism, and splenic and portal vein thrombosis. Management of venous thrombosis includes anticoagulation. Pulmonary hypertension with associated right ventricular dysfunction may also occur in asplenia. These patients require hemodynamic stabilization with an emphasis on inciting causes and treatment of the pulmonary hypertension. CONCLUSIONS The spleen is an integral organ involved in several physiologic functions. Asplenia, or absence of spleen function, is associated with severe complications. Knowledge of these complications can improve the care of these patients.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, United States
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Sickle Cell Disease and Infections in High- and Low-Income Countries. Mediterr J Hematol Infect Dis 2019; 11:e2019042. [PMID: 31308918 PMCID: PMC6613623 DOI: 10.4084/mjhid.2019.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/21/2019] [Indexed: 01/17/2023] Open
Abstract
Infections, especially pneumococcal septicemia, meningitis, and Salmonella osteomyelitis, are a major cause of morbidity and mortality in patients with sickle cell disease (SCD). SCD increased susceptibility to infection, while infection leads to SCD-specific pathophysiological changes. The risk of infectious complications is highest in children with a palpable spleen before six months of age. Functional splenectomy, the results of repeated splenic infarctions, appears to be a severe host-defense defect. Infection is the leading cause of death, particularly in less developed countries. Defective host-defense mechanisms enhance the risk of pneumococcal complications. Susceptibility to Salmonella infections can be explained at least in part by a similar mechanism. In high-income countries, the efficacy of the pneumococcal vaccine has been demonstrated in this disease. A decreased in infection incidence has been noted in SCD patients treated prophylactically with daily oral penicillin. Studies in low-income countries suggest the involvement of a different spectrum of etiological agents.
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Zhu H, Liu Y, Li S, Jin Y, Zhao L, Zhao F, Feng J, Yan W, Wei Y. Altered gut microbiota after traumatic splenectomy is associated with endotoxemia. Emerg Microbes Infect 2018; 7:197. [PMID: 30498207 PMCID: PMC6265257 DOI: 10.1038/s41426-018-0202-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022]
Abstract
Splenectomy carries a long-term risk of postoperative infection, and the chronic, low-grade inflammation associated with endotoxemia may be related to the gut microbiota. In this study, to increase our understanding of the potential cause of the high rate of infection in postsplenectomy patients, we evaluated the differences in the gut microbiota and plasma lipopolysaccharide level of patients after splenectomy relative to those of healthy controls. Thirty-two patients having undergone splenectomy and 42 healthy individuals were enrolled into the splenectomy (SP) and healthy control (HC) groups, respectively. The SP group was subdivided into three subgroups according to the length of their postoperative time. Fecal samples were used for gut microbiota analysis via 16s rRNA gene sequencing, blood examinations and plasma lipopolysaccharide measurements were also taken. Significant differences were observed in gut microbiota composition with regard to the relative bacterial abundances of 2 phyla, 7 families, and 15 genera. The lipopolysaccharide level was significantly higher in the SP group than in the HC group and were negatively associated with five bacterial families with low abundance in the SP group. The degree of the microbiota alteration increased with the length of the postoperative time. The PICRUSt analysis showed that the relative abundances of lipopolysaccharide biosynthesis proteins and lipopolysaccharide biosynthesis pathways were higher in the SP group and were positively associated with the plasma lipopolysaccharide level. Significant alterations were observed in the gut microbiota of the splenectomized patients and were associated with plasma lipopolysaccharide level. Further studies are needed to verify whether such alterations after splenectomy are related to an increased risk of complications.
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Affiliation(s)
- Hua Zhu
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Yang Liu
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Shengda Li
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Ye Jin
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Lei Zhao
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Fuya Zhao
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Jing Feng
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Wei Yan
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Yunwei Wei
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China.
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Weiberg D, Basic M, Smoczek M, Bode U, Bornemann M, Buettner M. Participation of the spleen in the IgA immune response in the gut. PLoS One 2018; 13:e0205247. [PMID: 30286198 PMCID: PMC6171922 DOI: 10.1371/journal.pone.0205247] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/23/2018] [Indexed: 11/18/2022] Open
Abstract
The role of the spleen in the induction of an immune response to orally administered antigens is still under discussion. Although it is well known that after oral antigen administration specific germinal centres are not only formed in the Peyers patches (PP) and the mesenteric lymph nodes (mLN) but also in the spleen, there is still a lack of functional data showing a direct involvement of splenic B cells in an IgA immune response in the gut. In addition, after removal of mLN a high level of IgA+ B cells was observed in the gut. Therefore, in this study we analysed the role of the spleen in the induction of IgA+ B cells in the gut after mice were orally challenged with antigens. Here we have shown that antigen specific splenic IgM+ B cells after in vitro antigen stimulation as well as oral immunisation of donor mice were able to migrate into the gut of recipient mice, where they predominantly switch to IgA+ plasma cells. Furthermore, stimulation of recipient mice by orally administered antigens enhanced the migration of the splenic B cells into the gut as well as their switch to IgA+ plasma cells. Removal of the mLN led to a higher activation level of the splenic B cells. Altogether, our results imply that splenic IgM+ B cells migrate in the intestinal lamina propria, where they differentiate into IgA+ plasma cells and subsequently proliferate. In conclusion, we demonstrated that the spleen plays a major role in the gut immune response serving as a reservoir of immune cells that migrate to the site of antigen entrance.
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Affiliation(s)
- Desiree Weiberg
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Marijana Basic
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Margarethe Smoczek
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Ulrike Bode
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Melanie Bornemann
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Manuela Buettner
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
- * E-mail:
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Farhat K, Bodart G, Charlet-Renard C, Desmet CJ, Moutschen M, Beguin Y, Baron F, Melin P, Quatresooz P, Parent AS, Desmecht D, Sirard JC, Salvatori R, Martens H, Geenen VG. Growth Hormone (GH) Deficient Mice With GHRH Gene Ablation Are Severely Deficient in Vaccine and Immune Responses Against Streptococcus pneumoniae. Front Immunol 2018; 9:2175. [PMID: 30333823 PMCID: PMC6176084 DOI: 10.3389/fimmu.2018.02175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/03/2018] [Indexed: 01/01/2023] Open
Abstract
The precise impact of the somatotrope axis upon the immune system is still highly debated. We have previously shown that mice with generalized ablation of growth hormone (GH) releasing hormone (GHRH) gene (Ghrh−/−) have normal thymus and T-cell development, but present a marked spleen atrophy and B-cell lymphopenia. Therefore, in this paper we have investigated vaccinal and anti-infectious responses of Ghrh−/− mice against S. pneumoniae, a pathogen carrying T-independent antigens. Ghrh−/− mice were unable to trigger production of specific IgM after vaccination with either native pneumococcal polysaccharides (PPS, PPV23) or protein-PPS conjugate (PCV13). GH supplementation of Ghrh−/− mice restored IgM response to PPV23 vaccine but not to PCV13 suggesting that GH could exert a specific impact on the spleen marginal zone that is strongly implicated in T-independent response against pneumococcal polysaccharides. As expected, after administration of low dose of S. pneumoniae, wild type (WT) completely cleared bacteria after 24 h. In marked contrast, Ghrh−/− mice exhibited a dramatic susceptibility to S. pneumoniae infection with a time-dependent increase in lung bacterial load and a lethal bacteraemia already after 24 h. Lungs of infected Ghrh−/− mice were massively infiltrated by inflammatory macrophages and neutrophils, while lung B cells were markedly decreased. The inflammatory transcripts signature was significantly elevated in Ghrh−/− mice. In this animal model, the somatotrope GHRH/GH/IGF1 axis plays a vital and unsuspected role in vaccine and immunological defense against S. pneumoniae.
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Affiliation(s)
- Khalil Farhat
- GIGA-I3 Center of Immunoendocrinology, University of Liège, Liège, Belgium
| | - Gwennaëlle Bodart
- GIGA-I3 Center of Immunoendocrinology, University of Liège, Liège, Belgium
| | | | - Christophe J Desmet
- GIGA-I3 Cellular and Molecular Immunology, University of Liège, Liège, Belgium
| | - Michel Moutschen
- GIGA-I3 Infectious diseases, University of Liège, Liège, Belgium
| | - Yves Beguin
- GIGA-I3 Hematology, University of Liège, Liège, Belgium
| | | | - Pierrette Melin
- Department of Clinical Microbiology, University Hospital of Liège, University of Liège, Liège, Belgium
| | | | - Anne-Simone Parent
- Division of Pediatric Endocrinology, University Hospital of Liège, Liège, Belgium
| | - Daniel Desmecht
- Department of Veterinary Pathology, University of Liège, Liège, Belgium
| | - Jean-Claude Sirard
- CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, U1019-UMR8204-Center for Infection and Immunity of Lille, University of Lille, Lille, France
| | - Roberto Salvatori
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Henri Martens
- GIGA-I3 Center of Immunoendocrinology, University of Liège, Liège, Belgium
| | - Vincent G Geenen
- GIGA-I3 Center of Immunoendocrinology, University of Liège, Liège, Belgium
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Miko I, Nemeth N, Peto K, Furka A, Toth L, Furka I. Changes of red blood cell aggregation parameters in a long-term follow-up of splenectomy, spleen-autotransplantation and partial or subtotal spleen resections in a canine model. Clin Hemorheol Microcirc 2018; 67:91-100. [PMID: 28598833 DOI: 10.3233/ch-170264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Decrease or loss in splenic filtration function may influence the hemorheological state. OBJECTIVE To follow-up the long-term effects of splenectomy, spleen autotransplantation and spleen resections on red blood cell aggregation in a canine model. METHODS Beagle dogs were subjected to control (n = 6), splenectomy (SE, n = 4), spleen autotransplantation (AU, Furka's spleen-chip method, n = 8) or partial and subtotal spleen resection (n = 4/each) groups, and followed-up for 18 postoperative (p.o.) months. Erythrocyte aggregation was determined in parallel by light-transmittance aggregometry (Myrenne MA-1 aggregometer) and syllectometry (LoRRca). RESULTS Erythrocyte aggregation decreased three months after splenectomy, with lower aggregation index and elongated aggregation time. It was more or less associated with relatively lower hematocrit and fibrinogen concentration. However, in autotransplantated animals a relatively higher fibrinogen did not increase the aggregation markedly. Spleen resection resulted in the most controversial red blood cell aggregation findings, and it seems, that the degree of the resection is an influencing factor. CONCLUSIONS Splenectomy alters erythrocyte aggregation, spleen autotransplantation can be useful to preserve filtration function. However, the degree of restoration shows individual differences with a kind of 'functional periodicity'. Spleen resection controversially influences erythrocyte aggregation parameters. The subtotal resection is supposed to be worse than spleen autotransplantation.
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Affiliation(s)
- Iren Miko
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Norbert Nemeth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Peto
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Furka
- Department of Clinical Oncology, Division of Radiotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Laszlo Toth
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Istvan Furka
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Miko I, Nemeth N, Sogor V, Kiss F, Toth E, Peto K, Furka A, Vanyolos E, Toth L, Varga J, Szigeti K, Benkő I, Olah AV, Furka I. Comparative erythrocyte deformability investigations by filtrometry, slit-flow and rotational ektacytometry in a long-term follow-up animal study on splenectomy and different spleen preserving operative techniques: Partial or subtotal spleen resection and spleen autotransplantation. Clin Hemorheol Microcirc 2017; 66:83-96. [PMID: 28128749 DOI: 10.3233/ch-160231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Partial or subtotal spleen resection or spleen autotransplantation can partly preserve/restore the splenic filtration function, as previous studies demonstrated. OBJECTIVE For better evaluation and follow-up of the various spleen-preserving operative techniques' effectiveness versus splenectomy, a composite methodological approach was applied in a canine experimental model. METHODS Beagle dogs were subjected to control (n = 6), splenectomy (SE, n = 4), partial and subtotal spleen resection (n = 4/each) or spleen autotransplantation groups (AU, Furka's spleen-chip method, n = 8). The follow-up period was 18 postoperative (p.o.) months. Erythrocyte deformability was determined in parallel by bulk filtrometry (Carat FT-1 filtrometer), slit-flow ektacytometry (RheoScan D-200) and rotational ektacytometry (LoRRca MaxSis Osmoscan). RESULTS By filtrometry, relative cell transit time increased in the SE group (mostly in animal Nr. SE-3), showing the highest values on the 3rd, 9th and in 18th p.o. months. Elongation index values decreased in this group (both by slit-flow and rotational ektacytometers). In general, AU and two resection groups' values were lower versus control and higher than in SE. CONCLUSIONS Forasmuch in the circulation both elongation by shear stress and filtration occur, these various erythrocyte deformability testing methods together may describe better the alterations. Considering the possible complications related to functional asplenic-hyposplenic conditions, individual analysis of cases is highly important.
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Affiliation(s)
- Iren Miko
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Norbert Nemeth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Viktoria Sogor
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ferenc Kiss
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eniko Toth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Peto
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Furka
- Department of Clinical Oncology, Division of Radiotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Erzsebet Vanyolos
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Laszlo Toth
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Jozsef Varga
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Krisztian Szigeti
- Department of Biophysics and Radiation Biology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ilona Benkő
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anna V Olah
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Istvan Furka
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Saxena A, Liauw W, Morris DL. Splenectomy is an independent risk factor for poorer perioperative outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: an analysis of 936 procedures. J Gastrointest Oncol 2017; 8:737-746. [PMID: 28890825 DOI: 10.21037/jgo.2017.07.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is a paucity of data on the impact of splenectomy on peri-operative outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). We report the largest series to date which addresses this topic. METHODS Nine hundred and thirty six consecutive patients underwent CRS/HIPEC from 1996 to 2016 at a high-volume institution in Sydney, Australia. Of these, 418 (45%) underwent splenectomy. Peri-operative complications were graded according to the Clavien-Dindo Classification. The association of splenectomy with 19 peri-operative outcomes was assessed using univariate and multivariate analyses. RESULTS In-hospital mortality was 1.8%. Patients undergoing splenectomy had a higher disease burden (peritoneal cancer index ≥17) (71% vs. 22%, P<0.001) and underwent a longer operation (≥9 hours) (73% vs. 34%, P<0.001). Even after accounting for confounding factors, splenectomy was independently associated with an increased risk of grade III/IV morbidity [relative risk (RR), 1.94; 95% confidence interval (CI), 1.29-2.91; P=0.01], infective complications (RR, 1.63; 95% CI, 1.09-2.44; P=0.018), pancreatic leak (RR, 5.2; 95% CI, 1.81-14.89, P=0.002) and intra-abdominal collection (RR, 1.86; 95% CI, 1.23-2.84, P=0.004). It was also an independent risk factor for long hospital stay (≥28 days) (RR, 1.98; 95% CI, 1.25-3.11; P=0.003). Splenectomy was not associated with in-hospital mortality (RR, 1.68; 95% CI, 0.32-9.32, P=0.556). CONCLUSIONS Splenectomy is an independent risk factor for poorer peri-operative outcomes. Minimizing the likelihood of inadvertent splenic injury through careful dissection and routine vaccination can improve outcomes.
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Affiliation(s)
- Akshat Saxena
- UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia
| | - Winston Liauw
- UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia
| | - David L Morris
- UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia
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Kanhutu K, Jones P, Cheng AC, Grannell L, Best E, Spelman D. Spleen Australia guidelines for the prevention of sepsis in patients with asplenia and hyposplenism in Australia and New Zealand. Intern Med J 2017; 47:848-855. [DOI: 10.1111/imj.13348] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kudzai Kanhutu
- Victorian Infectious Diseases Service; Royal Melbourne Hospital; Melbourne Victoria Australia
- Dentistry and Health Sciences, Faculty of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Penelope Jones
- Spleen Australia, Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
| | - Allen C. Cheng
- Spleen Australia, Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
- Infection Prevention and Healthcare Epidemiology Unit; Alfred Health; Melbourne Victoria Australia
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Louise Grannell
- Spleen Australia, Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
- Pharmacy Department; Alfred Health; Melbourne Victoria Australia
| | - Emma Best
- University of Auckland and Starship Children's Hospital; Auckland New Zealand
| | - Denis Spelman
- Spleen Australia, Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
- Microbiology Unit, Department of Pathology; Alfred Health; Melbourne Victoria Australia
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Araújo NC, Neves MB, Mandarim-de-Lacerda CA, Orlando MMC. Assessment of Spleen Filtrate Function in Renal Transplant Recipients Using Technetium-99m Stannous Colloid Liver-Spleen Scan. Transplant Proc 2017; 49:1301-1306. [PMID: 28735998 DOI: 10.1016/j.transproceed.2017.02.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Functional hyposplenism (FH) is indicated by an anatomically present spleen that fails to take up radiolabeled colloid. The occurrence of FH has been reported in a small group of renal transplant recipients based on hematologic parameters. The aim of this study was to replicate this association in a larger group of renal transplant recipients with the use of technetium-99m-stannous colloid liver-spleen scan to assess the spleen function. METHODS This survey based on single samples enrolled 101 unselected adult patients with functional kidney grafts >180 days after transplantation. All patients underwent 99mTc-stannous colloid scan to assess spleen function as well as bone marrow uptake of radiocolloid along with an anatomic and blood flow study of the spleen and kidney with the use of Doppler sonography. RESULTS The prevalence of hyposplenism was 32.7% (33/101) for the cohort, and increased uptake of radiocolloid by the bone marrow was seen in 9.9% (10/101). According to the multivariate analysis, the frequency of hyposplenism was significantly influenced by indirect bilirubin and hemoglobin, and direct bilirubin and neutrophil count remained as independent predictors of bone marrow uptake. CONCLUSIONS This study demonstrated that a group of renal transplant recipients has FH. In addition, bone marrow uptake might be interpreted as liver dysfunction. In this situation, the small amount of contrast (spleen compared with liver) would leave hyposplenism undiagnosed. Further prospective and longitudinal clinical studies are needed to determine the clinical impact of this condition on the management of renal transplant recipients.
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Affiliation(s)
- N C Araújo
- Division of Nephrology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - M B Neves
- Division of Nuclear Medicine, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - M M C Orlando
- Division of Nuclear Medicine, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Shao PL, Wu MH, Wang JK, Hsu HW, Huang LM, Chiu SN. Pneumococcal vaccination and efficacy in patients with heterotaxy syndrome. Pediatr Res 2017; 82:101-107. [PMID: 28419083 DOI: 10.1038/pr.2017.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 01/23/2017] [Indexed: 12/18/2022]
Abstract
BackgroundPneumococcal vaccines, including pneumococcal polysaccharide vaccine (PPV) and pneumococcal conjugated vaccine (PCV), are crucial in preventing invasive pneumococcal diseases. We analyzed the pneumococcal vaccination rate, efficacy, and durability in patients with heterotaxy.MethodsAll patients with heterotaxy and CCHD who were followed up at our institution between 2010 and 2015 were included. Pneumococcal vaccine status and geometric mean concentration (GMC) of serotypes 6B, 14, 19F, and 23F were analyzed. Splenic function was considered abnormal when the percentage of IgM memory B cell was less than 1%.ResultsThe GMCs of the four serotypes did not differ significantly between patients with heterotaxy and those with CCHD; the GMCs were also not affected by abnormal splenic function. Most patients had GMCs >0.35 μg/ml (protection level) 4-5 years after either PPV or PCV injection; however, it may decay gradually in some serotypes. In addition, 21.4% of 42 patients with heterotaxy did not receive pneumococcal vaccine, and none completely adhered to the vaccine guidelines.ConclusionsVaccine efficacy was acceptable, even in patients with abnormal splenic function. In some patients, the durability of PPV and PCV decreased with time, highlighting the importance of booster doses. Vaccination rate in patients with heterotaxy is unsatisfactory.
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Affiliation(s)
- Pei-Lan Shao
- Department of Laboratory Medicine and Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, Taipei, Taiwan
| | - Hui-Wen Hsu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, Taipei, Taiwan
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Baldolli A, Coeuret S, Le Pennec V, Agostini D, Verdon R. Thoracic splenosis mimicking a pleuropneumonia: A case report. Medicine (Baltimore) 2017; 96:e7552. [PMID: 28723778 PMCID: PMC5521918 DOI: 10.1097/md.0000000000007552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/31/2017] [Accepted: 06/27/2017] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Splenosis is the development of one or more heterotopic splenic tissue autoimplants following rupture of the spleen and remains mostly asymptomatic. PATIENT CONCERNS We report a case of a 50-year old post-traumatic splenectomized man admitted for a left side community acquired pneumonia resistant to antibiotics. DIAGNOSES The diagnosis of intrathoracic ectopic spleen was suspected because of the history of spleen trauma with diaphragm rupture and the absence of Howell-Jolly bodies. INTERVENTIONS Technetium (Tc)-m colloid scintigraphy SPECT, fused with CT scan showed an intense radionuclide uptake on hyper vascularized masses without any additional pathologic uptake and confirmed the diagnosis of thoracic splenosis. OUTCOMES Despite any lifelong penicillin prophylaxis, he had no history of infections eight years after the diagnosis. LESSONS Physician must be aware of this differential diagnosis and of its consequences. Depending on its size and location, it may lead to incorrect diagnosis (tumor, empyema, abscess ...), treatment and invasive procedures while the diagnosis of splenosis only relies upon imaging studies associated with functionnal study of the uptake of particles or cells.
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Affiliation(s)
- Aurélie Baldolli
- CHU de Caen, France, Infectious Diseases Department
- Groupe de Recherche sur l’Adaptation Microbienne (GRAM 2.0), Normandie University, UNICAEN Caen, PFRS, 2 rue des Rochambelles, Caen, France
| | | | | | | | - Renaud Verdon
- CHU de Caen, France, Infectious Diseases Department
- Groupe de Recherche sur l’Adaptation Microbienne (GRAM 2.0), Normandie University, UNICAEN Caen, PFRS, 2 rue des Rochambelles, Caen, France
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Hassenpflug M, Tjaden C, Hinz U, Volpert J, Hackert T, Büchler MW, Werner J. Hypercoagulability after distal pancreatectomy: Just meaningless alterations? Pancreatology 2017; 17:478-483. [PMID: 28372957 DOI: 10.1016/j.pan.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/05/2017] [Accepted: 03/17/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Perioperative and short-term postoperative parameters are similar comparing spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). But there are no sound data evaluating the long term risk of postoperative thromboses and infectious complications after splenectomy. The present study evaluated whether the coagulation status differs in patients after SPDP and DPS, and whether that matters clinically. METHODS A total of 41 patients after DP (SPDP = 20; DPS = 21) were followed up, focusing on alterations of patient coagulation and immune status. To assess kinetics of the coagulation process, qualitative tests (multiple platelet function analyzer, rotational thrombelastography) were used in addition to global coagulation tests. RESULTS Coagulation tests revealed a significant enhanced tendency for blood-platelet aggregation and coagulation activation in patients after DPS compared to patients after SPDP. No septic or thromboembolic events were observed in any patient. CONCLUSION Hypercoagulability in splenectomized patients persists over years. Thus, a correlation of this finding with thromboembolic events and mortality years after splenectomy should to be performed in a large cohort.
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Affiliation(s)
| | - Christin Tjaden
- Department of General, Visceral, and Transplantation Surgery, Germany
| | - Ulf Hinz
- Department of General, Visceral, and Transplantation Surgery, Germany; Division of Biostatistics, University of Heidelberg, Heidelberg, Germany
| | - Johanna Volpert
- Department of General, Visceral, and Transplantation Surgery, Germany
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplantation Surgery, Germany
| | - Jens Werner
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University of Munich, Germany
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van Gils T, Nijeboer P, van Waesberghe JHT, Coupé VM, Janssen K, Zegers JA, Nurmohamed SA, Kraal G, Jiskoot SC, Bouma G, Mulder CJ. Splenic volume differentiates complicated and non-complicated celiac disease. United European Gastroenterol J 2016; 5:374-379. [PMID: 28507749 DOI: 10.1177/2050640616663571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/19/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies in small groups of patients indicated that splenic volume (SV) may be decreased in patients with celiac disease (CD), refractory CD (RCD) type II and enteropathy-associated T-cell lymphoma (EATL). OBJECTIVE The objective of this article is to evaluate SV in a large cohort of uncomplicated CD, RCD II and EATL patients and healthy controls. METHODS The retrospective cohort consisted of 77 uncomplicated CD (of whom 39 in remission), 29 RCD II, 24 EATL and 12 patients with both RCD II and EATL. The control group included 149 healthy living kidney donors. SV was determined on computed tomography. RESULTS The median SV in the uncomplicated CD group was significantly larger than in controls (202 cm3 (interquartile range (IQR): 154-275) versus 183 cm3 (IQR: 140-232), p = 0.02). After correction for body surface area, age and gender, the ratio of SV in uncomplicated CD versus controls was 1.28 (95% confidence interval: 1.20-1.36; p < 0.001). The median SV in RCD II patients (118 cm3 (IQR 83-181)) was smaller than the median SV in the control group (p < 0.001). CONCLUSION This study demonstrates large inter-individual variation in SV. SV is enlarged in uncomplicated CD. The small SV in RCD II may be of clinical relevance considering the immune-compromised status of these patients.
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Affiliation(s)
- Tom van Gils
- Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Petula Nijeboer
- Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Veerle Mh Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Kiki Janssen
- Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jessy A Zegers
- Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Shaikh A Nurmohamed
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Georg Kraal
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sabine Ci Jiskoot
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Radiology, St Jansdal, Harderwijk, The Netherlands
| | - Gerd Bouma
- Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris Jj Mulder
- Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
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Winter M, Funk J, Körner A, Alberati D, Christen F, Schmitt G, Altmann B, Pospischil A, Singer T. Effects of GlyT1 inhibition on erythropoiesis and iron homeostasis in rats. Exp Hematol 2016; 44:964-974.e4. [PMID: 27403535 DOI: 10.1016/j.exphem.2016.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 01/19/2023]
Abstract
Glycine is a key rate-limiting component of heme biosynthesis in erythropoietic cells, where the high intracellular glycine demand is primarily supplied by the glycine transporter 1 (GlyT1). The impact of intracellular glycine restriction after GlyT1 inhibition on hematopoiesis and iron regulation is not well established. We investigated the effects of a potent and selective inhibitor of GlyT1, bitopertin, on erythropoiesis and iron homeostasis in rats. GlyT1 inhibition significantly affected erythroid heme biosynthesis, manifesting as microcytic hypochromic regenerative anemia with a 20% steady-state reduction in hemoglobin. Reduced erythropoietic iron utilization was characterized by down-regulation of the transferrin receptor 1 (TfR1) on reticulocytes and modest increased iron storage in the spleen. Hepatic hepcidin expression was not affected. However, under the condition of reduced heme biosynthesis with reduced iron reutilization and increased storage iron, hepcidin at the lower and higher range of normal showed a striking role in tissue distribution of iron. Rapid formation of iron-positive inclusion bodies (IBs) was observed in circulating reticulocytes, with an ultrastructure of iron-containing polymorphic mitochondrial remnants. IB or mitochondrial iron accumulation was absent in bone marrow erythroblasts. In conclusion, GlyT1 inhibition in rats induced a steady-state microcytic hypochromic regenerative anemia and a species-specific accumulation of uncommitted mitochondrial iron in reticulocytes. Importantly, this glycine-restricted anemia provides no feedback signal for increased systemic iron acquisition and the effects reported are pathogenetically distinct from systemic iron-overload anemias and erythropoietic disorders such as acquired sideroblastic anemia.
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Affiliation(s)
- Michael Winter
- Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland.
| | - Jürgen Funk
- Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Annette Körner
- Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Daniela Alberati
- Pharmaceutical Research and Early Development, Neuroscience Discovery, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Francois Christen
- Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Georg Schmitt
- Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Bernd Altmann
- Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Andreas Pospischil
- Institute of Veterinary Pathology, Vetsuisse-Faculty, University Zurich, Switzerland
| | - Thomas Singer
- Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
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Wernick B, Cipriano A, Odom SR, MacBean U, Mubang RN, Wojda TR, Liu S, Serres S, Evans DC, Thomas PG, Cook CH, Stawicki SP. Temporal changes in hematologic markers after splenectomy, splenic embolization, and observation for trauma. Eur J Trauma Emerg Surg 2016; 43:399-409. [PMID: 27167236 DOI: 10.1007/s00068-016-0679-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/02/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The spleen is one of the most commonly injured abdominal solid organs during blunt trauma. Modern management of splenic trauma has evolved to include non-operative therapies, including observation and angioembolization to preclude splenectomy in most cases of blunt splenic injury. Despite the shift in management strategies, relatively little is known about the hematologic changes associated with these various modalities. The aim of this study was to determine if there are significant differences in hematologic characteristics over time based on the treatment modality employed following splenic trauma. We hypothesized that alterations seen in hematologic parameters would vary between observation (OBS), embolization (EMB), and splenectomy (SPL) in the setting of splenic injury. METHODS An institutional review board-approved, retrospective study of routine hematologic indices examined data between March 2000 and December 2014 at three academic trauma centers. A convenience sample of patients with splenic trauma and admission lengths of stay >96 h was selected for inclusion, resulting in a representative sample of each sub-group (OBS, EMB, and SPL). Basic demographics and injury severity data (ISS) were abstracted. Platelet count, red blood cell (RBC) count and RBC indices, and white blood cell (WBC) count with differential were analyzed between the time of admission and a maximum of 1080 h (45 days) post-injury. Comparisons between OBS, EMB, and SPL groups were then performed using non-parametric statistical testing, with statistical significance set at p < 0.05. RESULTS Data from 130 patients (40 SPL, 40 EMB, and 50 OBS) were analyzed. The median age was 40 years, with 67 % males. Median ISS was 21.5 (21 for SPL, 19 for EMB, and 22 for OBS, p = n/s) and median Glasgow Coma Scale (GCS) was 15. Median splenic injury grade varied by interventional modality (grade 4 for SPL, 3 for EMB, and 2 for OBS, p < 0.05). Inter-group comparisons demonstrated no significant differences in RBC counts. However, mean corpuscular volume (MCV) and RBC distribution width (RDW) were elevated in the SPL and EMB groups (p < 0.01). Similarly, EMB and SPL groups had higher platelet counts than the OBS group (p < 0.01). In aggregate, WBC counts were highest following SPL, followed by EMB and OBS (p < 0.01). Similar trends were noted in neutrophil and monocyte counts (p < 0.01), but not in lymphocyte counts (p = n/s). CONCLUSION This study describes important trends and patterns among fundamental hematologic parameters following traumatic splenic injuries managed with SPL, EMB, or OBS. As expected, observed WBC counts were highest following SPL, then EMB, and finally OBS. No differences were noted in RBC count between the three groups, but RDW was significantly greater following SPL compared to EMB and OBS. We also found that MCV was highest following OBS, when compared to EMB or SPL. Finally, our data indicate that platelet counts are similarly elevated for both SPL and EMB, when compared to the OBS group. These results provide an important foundation for further research in this still relatively unexplored area.
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Affiliation(s)
- B Wernick
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - A Cipriano
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - S R Odom
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - U MacBean
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - R N Mubang
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - T R Wojda
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - S Liu
- Temple University School of Medicine-St. Luke's University Hospital Campus, Bethlehem, PA, USA
| | - S Serres
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - D C Evans
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - P G Thomas
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - C H Cook
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA. .,Department of Research & Innovation, St. Luke's University Health Network, EW2 Research Administration, 801 Ostrum Street, Bethlehem, PA, 18020, USA.
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Chiu SN, Shao PL, Wang JK, Hsu HW, Lin MT, Chang LY, Lu CY, Lee PI, Huang LM, Wu MH. Low immunoglobulin M memory B-cell percentage in patients with heterotaxy syndrome correlates with the risk of severe bacterial infection. Pediatr Res 2016; 79:271-7. [PMID: 26524717 DOI: 10.1038/pr.2015.221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 08/05/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with heterotaxy syndrome, commonly associated with complex congenital heart disease (CHD), exhibit a higher risk of severe bacterial infection (SBI). We sought to define the change of a novel immunologic marker, the immunoglobulin M (IgM) memory B-cell percentage, and its association with SBI. METHODS We enrolled 46 (M/F 29/17) heterotaxy syndrome patients (42 right atrial isomerism (RAI) and 4 left atrial isomerism (LAI)) aged > 1 y during the period 2010-2012 in a tertiary care center. We analyzed IgM(+)CD27(+) memory B-cell percentages. Patients with simple and complex CHD served as controls. RESULTS The mean IgM memory B-cell percentages were the lowest in the heterotaxy syndrome group, compared with those in complex and simple CHD groups (1.8 ± 2.1 vs. 3.9 ± 3.2 vs. 5.1 ± 4.7, P < 0.001). In the heterotaxy syndrome group, 41.3% had low IgM memory B-cell percentages (<1% of B cells). Seven had a history of community-acquired SBI and 85.7% of these had low IgM memory B-cell percentages, which was the only significant factors related to community-acquired SBI (P = 0.028). CONCLUSION The memory B cell and IgM memory B-cell percentages are low in patients with heterotaxy syndrome, and the presence of IgM memory B-cell percentage < 1% correlates with community-acquired SBI.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Pei-Lan Shao
- Department of Laboratory Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan.,Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Hui-Wen Hsu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Ballegaard VC, Schejbel L, Hoffmann S, Kantsø B, Fischer CP. Recurrent severe invasive pneumococcal disease in an adult with previously unknown hyposplenia. BMC Infect Dis 2015; 15:171. [PMID: 25887530 PMCID: PMC4407880 DOI: 10.1186/s12879-015-0883-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/12/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The risk of life-threatening and invasive infections with encapsulated bacteria is increased in patients with hyposplenia or asplenia. We report a case of recurrent invasive pneumococcal meningitis in a woman with previous unknown hyposplenia. She was vaccinated after the first episode of meningitis and developed sufficient levels of pneumococcal antibodies. The pneumococcal strains isolated were serotype 7 F and 17 F. To our knowledge, there has been no previously reported case of recurrent invasive pneumococcal disease in a pneumococcal vaccinated adult with hyposplenia and apparently sufficient antibody response. CASE PRESENTATION We report the course of a 38-year-old Caucasian woman presenting with recurrent episodes of invasive pneumococcal disease (IPD) and previously unknown hyposplenia. Hyposplenia was discovered during the second episode of IPD and no underlying medical condition was found. Despite immunization against S. pneumoniae and measurement of what was interpreted as protective levels of serotype-specific IgG antibodies after vaccination, the patient suffered from a third episode of IPD. CONCLUSIONS Individuals with predisposing medical conditions or a history of severe infections with encapsulated bacteria should be screened for spleen dysfunction. If splenic function is impaired, prevention against severe invasive infection with encapsulated bacteria are a major priority.
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Affiliation(s)
- Vibe C Ballegaard
- Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, DK 2100, Rigshospitalet, Denmark. .,Department of Microbiology & Infection Control, Statens Serum Institute, Copenhagen, Denmark.
| | - Lone Schejbel
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Steen Hoffmann
- Department of Microbiology & Infection Control, Statens Serum Institute, Copenhagen, Denmark.
| | - Bjørn Kantsø
- Department of Microbiological Diagnostics & Virology, Statens Serum Institute, Copenhagen, Denmark.
| | - Christian P Fischer
- Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, DK 2100, Rigshospitalet, Denmark.
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Robier C, Schoberl M, Reiher H, Neubauer M. Bacteria on a peripheral blood smear as presenting sign of overwhelming post-splenectomy infection in a patient with secondary acute myeloid leukemia. Clin Chem Lab Med 2015; 53:e203-5. [PMID: 25816311 DOI: 10.1515/cclm-2015-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/02/2015] [Indexed: 11/15/2022]
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Wojtowicz JM, Jones GL. Streptococcus pneumoniae–induced purpura fulminans in a woman with functional asplenia. CAN J EMERG MED 2015; 16:339-42. [DOI: 10.2310/8000.2013.130990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACTPurpura fulminans is a rare complication of septic shock, often associated withStreptococcus pneumoniae. Patients with anatomic or functional asplenia are at increased risk for infection because of impairment of their ability to defend against encapsulated pathogens. We report the case of a previously healthy, unimmunized 33-year-old female with functional asplenia who presented in septic shock and purpura fulminans and died in spite of maximal resuscitative measures. The clinical presentation, diagnosis, and management of purpura fulminans are reviewed. Purpura fulminans is a rare condition that requires early diagnosis and aggressive management by emergency physicians.
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McIntosh ED, Carey V, Toneatto D, Dull P, Wassil J. Prevention of rare diseases: how revolutionary techniques can help vulnerable individuals-the example of serogroup B meningococcal infection. THERAPEUTIC ADVANCES IN VACCINES 2015; 3:13-23. [PMID: 25553243 DOI: 10.1177/2051013614557477] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In countries with established programmes for vaccination of infants, toddlers and adolescents with meningococcal conjugate vaccines, serogroup B invasive meningococcal disease remains the major cause of septicaemia and meningitis in the paediatric and adolescent age groups. Novartis has developed a serogroup B meningococcal vaccine, 4CMenB, to meet this need. We reviewed all 4CMenB studies. The studies found 4CMenB to be highly immunogenic when administered in all schedules, with protective antibody levels (serum bactericidal antibody titres ≥4 or ≥5 with human complement, hSBA) against serogroup B strains expressing vaccine antigens in >95% of vaccinated cohorts. When antibody levels waned, all tested groups demonstrated booster responses. Although possibly an underestimation, the Meningococcal Antigen Typing System (MATS) technique predicts that global coverage of 4CMenB against all serogroup B strains is in the range 66% (Canada) to 91% (USA). The vaccine was found to be generally well tolerated, although local and systemic reactions, notably fever in infants, typical of many vaccines, were increased following concomitant administration of 4CMenB with routine vaccines. When tested, prophylactic paracetamol significantly decreased the frequency and severity of reactions in infants, with no clinically significant impact on immunogenicity of 4CMenB or concomitant routine vaccines. The vaccine is approved for use in the following age groups in the European Union (2 months+), Canada (2 months through 17 years), Australia (2 months+) and Chile (2 months+), following clinical evaluation in 4843 infants and toddlers, and 1712 adolescents and adults, in schedules including a three-dose (2, 3, 4 or 2, 4, 6 months) and a two-dose (6-11 months) infant series with a booster in the second year of life, a two-dose series in toddlers (12-23 months) and children (2-10 years) given 2 months apart (with a booster at least in the EU), and a two-dose series in adolescents (11-17 years) given 1-6 months apart. 4CMenB presents a solution to the unmet medical need of offering protection against serogroup B invasive meningococcal disease in all age groups above 2 months.
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Affiliation(s)
- E David McIntosh
- Novartis Vaccines, Hullenbergweg 83-85, 1101CL Amsterdam, The Netherlands
| | | | | | - Peter Dull
- Novartis Vaccines, Amsterdam, The Netherlands
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Abstract
Sickle cell disease (SCD) is a single gene disorder causing a debilitating systemic syndrome characterised by chronic anaemia, acute painful episodes, organ infarction and chronic organ damage and by a significant reduction in life expectancy. The origin of SCD lies in the malarial regions of the tropics where carriers are protected against death from malaria and hence enjoy an evolutionary advantage. More recently, population migration has meant that SCD now has a worldwide distribution and that a substantial number of children are born with the condition in higher-income areas, including large parts of Europe and North and South America. Newborn screening, systematic clinical follow-up and prevention of sepsis and organ damage have led to an increased life expectancy among people with SCD in many such countries; however, in resource-limited settings where the majority continue to be born, most affected children continue to die in early childhood, usually undiagnosed, due to the lack of effective programmes for its early detection and treatment. As new therapies emerge, potentially leading to disease amelioration or cure, it is of paramount importance that the significant burden of SCD in resource-poor countries is properly recognised.
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Affiliation(s)
| | - Thomas N Williams
- Department of Medicine, Imperial College, London, UK,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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