Lymphotoxin and interferon production by rossette-separated human peripheral blood leukocytes.

When normal (CBA × DBA)F₁ spleen cells are cultured for 4 days in polyacrylamide vessels, clones of cytotoxic lymphocytes (CLs) are generated. The specificity of these apparently spontaneous CL clones has been investigated by assaying cells from individual clones against pairs of different target cells. CL clones were found to discriminate between the two parental strain splenic blasts, between splenic blasts and syngeneic tumour cells, and between two F₁ splenic blasts induced with different mitogens (LPS and PHA). The CL clones generated spontaneously in culture also discriminate between semisyngeneic targets [DBA blasts and (CBA × DBA)F₁ blasts]. Significant cross-reactivity however, was detected when CL clones were assayed against normal P815 targets and TNP-modified P815 targets.     

脾动脉栓塞术后出现严重粘连的脾切除手术体会

目的:探讨脾动脉栓塞术后严重脾粘连脾切除手术技巧,为临床实践提供可借鉴的方法。方法:收集我院2005年4月-2013年6月收治的18例脾动脉栓塞术后严重脾粘连行脾切除术的患者临床资料,分析手术时间、术中出血、术中特殊处理及术后恢复情况等。结果:18例患者均顺利恢复出院,无围手术期死亡,开腹后到脾切除完成平均耗时55 min、出血550 mL。术后并发症为腹水(8例)、肺部感染(1例)、胰瘘(1例)及腹腔内出血(1例)。结论:脾动脉栓塞术后出现严重脾粘连行脾切除术,手术风险较大,手术时间、术中出血较常规脾切除术明显延长、增多。规范手术操作,细致分离脾周粘连,合理处理脾蒂,是安全、有效完成此类脾切除术的关键。     

Spontaneous Splenic Rupture in a Vivax Malaria Case Treated with Transcatheter Coil Embolization of the Splenic Artery

An enlarged spleen is considered one of the most common signs of malaria, and splenic rupture rarely occurs as an important life-threatening complication. Splenectomy has been recommended as the treatment of choice for hemodynamically unstable patients. However, a very limited number of splenic rupture patients have been treated with transcatheter coil embolization. Here we report a 38-year-old Korean vivax malaria patient with ruptured spleen who was treated successfully by embolization of the splenic artery. The present study showed that angiographic embolization of the splenic artery may be an appropriate option to avoid perioperative harmful effects of splenectomy in malaria patients.     

Antibody response to technetium-99m-labeled sheep erythrocytes in mice treated with anti-lymphocyte serum and concanavalin A.

In the present series of experiments we have studied the effects of anti-lymphocyte serum (ALS) and concanavlin A (Con A) on the immune response to technetium-99m-labeled sheep erythrocytes (SRBC) and have related this to the localization and persistence of antigen at the site of induction and antibody synthesis. The number of ^99mTc-labeled SRBC in the spleen and liver was quantified by gamma scintillation counting and the cellular kinetics of the splenic antibody response was determined by means of the hemolytic plaque technique. After injection of normal rabbit serum (NRS)-treated control mice with 4 × 10^899mTc-labeled SRBC, the number of cells localizing in the spleen ranged from a high of 4.2 × 10⁶ on Day 1 to a low of 1.7 × 10⁶ on Day 4, while the number in the liver ranged from a high of 68.8 × 10⁸ on Day 1 to 18.6 × 10⁶ on Day 4. The number of splenic plaque-forming cells (PFC) increased from 321–429 on Day 1 to 93,000–101,000 PFC on Day 4 and this was paralled by a rise in serum hemagglutinin and hemolysin titers. In mice treated with ALS on the other hand, splenic localization initially was increased 10-fold, hepatic localization was unchanged, and the antibody response was markedly suppressed. Splenic PFC ranged from approximately 100 between days 1 and 3 and increased to only 500 on Day 4. Mice which received Con A on Day — 1 had a reduction in splenic PFC which ranged from 150 on Day 1 to 1900 on Day 4. Splenic localization of ^99mTc-labeled RBC initially was three- to fourfold greater than that in NRS-treated mice and then decreased to control levels. The increased numbers of SRBC detected in the spleens of immunosuppressed mice at the time of peak response can be attributed to decreased in vivo lysis by reduced numbers of splenic antibody-producing cells.     

Physiological clearance of Aβ by spleen and splenectomy aggravates Alzheimer‐type pathogenesis

BackgroundA previous study demonstrated that nearly 40%–60% of brain Aβ flows out into the peripheral system for clearance. However, where and how circulating Aβ is cleared in the periphery remains unclear. The spleen acts as a blood filter and an immune organ. The aim of the present study was to investigate the role of the spleen in the clearance of Aβ in the periphery.MethodsWe investigated the physiological clearance of Aβ by the spleen and established a mouse model of AD and spleen excision by removing the spleens of APP/PS1 mice to investigate the effect of splenectomy on AD mice.ResultsWe found that Aβ levels in the splenic artery were higher than those in the splenic vein, suggesting that circulating Aβ is cleared when blood flows through the spleen. Next, we found that splenic monocytes/macrophages could take up Aβ directly in vivo and in vitro. Splenectomy aggravated behaviour deficits, brain Aβ burden and AD‐related pathologies in AD mice.ConclusionOur study reveals for the first time that the spleen exerts a physiological function of clearing circulating Aβ in the periphery. Our study also suggests that splenectomy, which is a routine treatment for splenic rupture and hypersplenism, might accelerate the development of AD.     

Atypical presentation of angiosarcoma of the scalp in the setting of Human Immunodeficiency Virus (HIV)

Background

Splenosis is a heterotropic implantation of splenic fragments onto exposed vascularised peritoneal and intrathoracic surfaces, following splenic injury or elective splenectomy.

Case presentation

A 60 year old cirrhotic patient was referred to us with a hepatic mass, suspected to be HCC in a cirrhotic liver. A computerized tomography scan (CT) demonstrated a cirrhotic liver with a 2 × 2.7 cm focal hypervascular nodule, lying peripherally at the junction of segment 7 and 8. Diagnostic laparoscopy demonstrated a 3 cm exofitic dark brown splenunculus attached to the diaphragm and indenting the surface of segment 7 of the liver. The lesion was easily resected laparoscopically and shaved from the live surface with no need for a liver resection. The histopathological assessment confirmed the diagnosis of splenunculus, with no evidence of neoplasia.

Conclusion

Hepatic splenosis is not a rare event and should be suspected in patients with a history of splenic trauma or splenectomy. Correct diagnosis is essential and will determine subsequent management plans. In doubtful cases laparoscopic investigation can offere essential information and should be part of the standard protocol for investigating suspected splenosis.     

Evidence of immunological activity in heterotropic autotransplanted splenic tissue in DBA/2 mice

After total splenectomy, a portion of the spleen was autotransplanted into subcutaneous ectopic sites of DBA/2 mice. These implanted fragments regenerated into splenic tissue that are microscopically indistinguishable from the structure of the original spleen. These implants are also immunologically functional as demonstrated by their ability to produce antibodies to sheep red blood cells (SRBC) and SRBC inhibition of splenic (implant) cell migration.     

病毒性肝炎肝硬化并脾功能亢进的治疗进展

病毒性肝炎肝硬化合并脾功能亢进是临床上常见的肝脏疾病,其产生的脾脏肿大占位效应和血细胞过度消耗及伴随骨髓移植等临床综合症状,严重影响了针对病毒性肝炎肝硬化的抗病毒治疗。目前通过非手术治疗难以控制脾脏肿大,且无特异性药物有效遏制,极易造成重度贫血和血小板减少症导致的出血现象,此时外科和介入治疗手段则为首选方式,一般包括脾脏切除、脾脏部分切除、介入治疗(目前以脾动脉栓塞为主)等,其中又以脾脏切除术疗效最直接和确切。然而脾切除对人体免疫功能的损害使人们认识到保脾的重要性,但如何最大限度的保留脾组织和脾功能,至今争议仍然存在。因此,本文综述了肝硬化脾功能亢进的发病原因及机制,脾亢的诊断标准以及脾功能亢进的外科和介入治疗方法,为脾功能亢进的研究提供一定的理论基础。     

Epstein�CBarr virus-associated inflammatory pseudotumor of the spleen: report of two cases and review of the literature

We report two rare examples of Epstein–Barr virus (EBV)-associated inflammatory pseudotumor of the spleen. One patient presented with night sweats, abdominal pain, and weight loss and was found to have a splenic mass on CT scan suspected of lymphoma. The splenic mass in second patient was found incidentally at the time of work up for kidney stones. The pathologic examination of these splenectomy specimens showed similar histologic features. However, the spindle cells were composed of EBV-infected follicular dendritic cells in one case whereas the second case lacked significant follicular dendritic cell proliferation and showed only focal EBV-infected cells suggesting that these proliferations are heterogenous in nature.     

Splenic role in the regulation of immune responses.

Evidence for a splenic role in regulating antibody production in other lymphoid tissue was obtained in a system in which cyclical fluctuations of splenic plaque-forming cells (PFC) occur following a single intravenous injection of aggregated human γ-globulin in rabbits. First, PFC arising simultaneously in the mesenteric nodes, peripheral blood, and spleen appear to be derived from the spleen since splenectomy prior to antigen injection abrogated these responses. Second, a noncyclical appearance of PFC in popliteal nodes of rabbits responding to subcutaneous injection of antigen was converted to a cyclical response by simultaneous intravenous injection of antigen, an effect which was abolished by splenectomy prior to antigen injection. It is suggested that, following an intravenous injection of antigen, both suppressor cells as well as antibody-forming precursors may be activated in the spleen and disseminated to other lymphoid tissue.     

Splenectomy exacerbates lung injury after ischemic acute kidney injury in mice

Patients with acute kidney injury (AKI) have increased serum proinflammatory cytokines and an increased occurrence of respiratory complications. The aim of the present study was to examine the effect of renal and extrarenal cytokine production on AKI-mediated lung injury in mice. C57Bl/6 mice underwent sham surgery, splenectomy, ischemic AKI, or ischemic AKI with splenectomy and kidney, spleen, and liver cytokine mRNA, serum cytokines, and lung injury were examined. The proinflammatory cytokines IL-6, CXCL1, IL-1β, and TNF-α were increased in the kidney, spleen, and liver within 6 h of ischemic AKI. Since splenic proinflammatory cytokines were increased, we hypothesized that splenectomy would protect against AKI-mediated lung injury. On the contrary, splenectomy with AKI resulted in increased serum IL-6 and worse lung injury as judged by increased lung capillary leak, higher lung myeloperoxidase activity, and higher lung CXCL1 vs. AKI alone. Splenectomy itself was not associated with increased serum IL-6 or lung injury vs. sham. To investigate the mechanism of the increased proinflammatory response, splenic production of the anti-inflammatory cytokine IL-10 was determined and was markedly upregulated. To confirm that splenic IL-10 downregulates the proinflammatory response of AKI, IL-10 was administered to splenectomized mice with AKI, which reduced serum IL-6 and improved lung injury. Our data demonstrate that AKI in the absence of a counter anti-inflammatory response by splenic IL-10 production results in an exuberant proinflammatory response and lung injury.     

门静脉高压症脾切断流术后血栓形成的临床研究

目的:探讨门静脉高压症脾切断流术后门静脉系统血栓形成的相关原因。方法:回顾性分析2010年4月-2011年12月我科450例因肝硬化门静脉高压症行脾切断流术患者的临床资料,应用超声多普勒检测手术前后门静脉血流速度、门静脉直径及脾静脉、肠系膜上静脉、门静脉血栓情况,用Logistic回归分析术前肝功能Child-Pugh分级、门静脉直径、门静脉血流速度、脾脏的质量及术后血小板数量与门静脉系统血栓形成的关系。结果:术前门静脉系统有血栓患者75例,占16.7%。术后门静脉血栓再形成率52.9%。Logistic单因素分析提示门静脉系统血栓形成与门静脉内径、门静脉血流速度、脾脏质量、血清总胆红素、术后血小板数量有关。多因素分析发现门静脉系统血栓形成与门静脉内径、门静脉血流速度、脾脏质量有关,而与血清总胆红素、术后血小板数量无关。结论:肝硬化门静脉高压症脾切除术后门静脉系统血栓形成与门静脉内径、门静脉血流速度、脾脏质量有关。     

THE KINETICS OF LYMPHOCYTE RECIRCULATION WITHIN THE RAT SPLEEN

The migration of lymphocytes from the blood into the splenic pulp and the release of lymphocytes from the spleen into the blood was studied by isolating the rat spleen and perfusing it with 15 ml of recirculating, oxygenated blood. When thoracic duct lymphocytes labelled with tritiated uridine were added to the initial perfusate the concentration of these cells fell exponentially for 2–3 hr and then rose to a flat secondary peak. From this pattern it was inferred that small lymphocytes entered the spleen at a rate proportional to their instantaneous concentration in the perfusate, traversed the splenic pulp and re-entered the perfusate with a minimum transit time of 2–3 hr. The rate of release of small lymphocytes from the spleen was not influenced by the prevailing concentration of small lymphocytes in the perfusate but probably reflected the rate of migration into the spleen over a period earlier than 2 hr before. The rate of exchange of small lymphocytes between the blood and the intact spleen in vivo was estimated to be about 84 × 10⁶ cells/hr. The size of the intrasplenic pool of recirculating small lymphocytes was probably 400–500 × 10⁶ cells. The rate of migration of small lymphocytes into the spleen was not affected by prior irradiation of the spleen donor. When either of two antigenic materials were added to the perfusate no inhibition of lymphocyte migration into the spleen was noted although the release of lymphocytes from the spleen was diminished by the addition of a large dose of sheep erythrocytes.     

Splenic irradiation in treating warm autoimmune haemolytic anaemia.

An elderly man with severe congestive heart failure was noted to have a haemoglobin concentration of 87 g/l and a reticulocyte count of 13%. Direct Coombs test yielded a positive result and the serum contained a moderate amount of warm antibody (IgG class). Steroids were given, but to no avail, and the patient''s condition precluded splenectomy. A course of splenic irradiation was therefore tried (midline dose 2000 cGy (rads)), and 60 days later the blood film showed similar appearances to those in patients treated successfully by splenectomy. Haemoglobin concentration subsequently rose to normal. Splenic irradiation may offer a simple treatment for resistant warm autoimmune haemolytic anaemia when splenectomy is contraindicated.     

Spontaneous splenic rupture in infectious mononucleosis: a review.

Spontaneous rupture of the spleen is a rare complication of infectious mononucleosis (IM) occurring in 0.1-0.5 percent of patients with proven IM [1]. Although splenectomy has been advocated as the definitive therapy in the past, numerous recent reports have documented favorable outcomes with non-operative management. A review of the literature suggests that non-operative management can be successful if appropriate criteria, such as hemodynamic stability and transfusion requirements are applied in patient selection. We report the case of a 36 year old man with infectious mononucleosis who had a spontaneous splenic rupture and who was successfully managed by splenectomy. Based on review of the literature, an approach to management of a spontaneously ruptured spleen secondary to IM is suggested.     

应用脾动脉结扎法行全腹腔镜巨脾切除术的临床研究

目的:探讨应用脾动脉结扎法行全腹腔镜巨脾切除术的安全性、可行性及手术技巧。方法:将2010年1月1日至2012年1月1日因肝硬化门脉高压脾机能亢进巨脾患者随机分为腹腔镜脾切除(Laparoscopic Splenectomy,LS)组及开腹脾切除(OpenSplenectomy,OS)组,比较两组的临床特征及围手术期差异。结果:LS组与OS组在性别组成、术前肝功能child分级、年龄组成及脾脏长径方面均无统计学意义。LS组手术时间比OS组略长,但无统计学意义,LS组术中出血量明显低于OS组(P<0.01),LS组术后进食、术后排气、引流管拔除及出院时间均明显早于OS组(P<0.01)。结论:腹腔镜脾切除术为治疗门脉高压巨脾的一种有效、安全、可行的手术方式。     

SPLENECTOMY IN BLOOD DYSCRASIA

The decision for splenectomy must be based on a knowledge of the three functions of the spleen: Hematopoiesis (usually ceasing during fetal life but sometimes resuming when bone marrow function fails); filtration of abnormal and senescent cells and control of bone marrow activity, most probably humoral.When bone marrow function fails, splenectomy is contraindicated since splenic hematopoiesis becomes a vital function. On the other hand, when a large proportion of erythrocytes are abnormally shaped (spherocytes), although otherwise adequate, the spleen may trap these cells in its filter and destroy large numbers. Splenectomy is beneficial in almost every case of congenital spherocytosis, but in only half the cases of the acquired defect.In panhematocytopenia, thrombocytopenia and neutropenia, all apparently due to depression of hematopoiesis by endocrine or other action of the spleen, splenectomy may be beneficial if medical therapy fails.A surgeon undertaking splenectomy should recognize two special problems: (1) The presence of accessory spleens, which if not removed may negate the effects of the operation, and (2) the apparently high rate of infection in infants and children who have undergone splenectomy.     

脾全切除术与脾部分切除术治疗外伤性脾破裂的临床疗效对比

目的:比较脾全切除术和脾部分切除术治疗外伤性脾破裂的临床疗效和安全性。方法:选择我院2013年3月~2016年3月收治的84例外伤性脾破裂患者并平均分为两组,脾全切除组42例采用脾全切除术治疗,脾部分切除组42例采用脾部分切除术治疗,比较两组的手术效果、治疗前后血小板计数、血清Ig A、Ig G、Ig M、CD3~+、CD4~+、CD8~+及CD4~+/CD8~+水平的变化以及术后并发症的发生情况。结果:部分切除组术中失血量、排气时间、住院时间均短于全切除组,但部分切除组手术时间显著长于全切除组,差异有统计学意义(P0.05)。部分切除组血小板计数、Ig M、CD8~+水平明显低于对照组,Ig A、Ig G、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+显著高于全切除组(P0.05)。部分切除组并发症发生率显著低于全切除组(P0.05)。结论:脾部分切除术治疗外伤性脾裂的手术效果优于脾全切除术,且对患者血小板及免疫功能的影响较小。     

Alteration of allospecific t-cell receptors after differentiation from prethymic precursor cells in semiallogeneic environments

Murine bone marrow cells (strain A) have been allowed to differentiate in vivo in syngeneic (A) or semiallogeneic hosts (A × B) to produce mature splenic T lymphocytes. After stimulation of these cells with irradiated allogeneic (C) spleen cells in tissue cultures, the cytotoxic T-cell blasts (CTL) were purified by velocity sedimentation and used to immunize (A × C) F₁ hybrid mice, to produce antisera recognizing the receptor structure (for C) on the relevant A cytotoxic cells (and their precursors). Using these sera we have been able to show that the T-cell receptor for alloantigen C on strain A cytotoxic precursor lymphocytes (CTLp) seems to differ according to the host environment in which those T cells differentiate from immature bone marrow precursors.