B- and T-lymphocyte compartments in the spleen in idiopathic thrombocytopenic purpura

The exstirpated spleens of 62 patients in each case with idiopathic thrombocytopenic purpura (ITP) and traumatic rupture of the spleen were comparatively examined macroscopically, histologically and morphometrically. The mean follicle diameters of the spleen were significantly greater in ITP patients than in those of controls. With 500 microns identified as an upper limit of normal follicle diameter, ITP patients could be divided into two groups of equal size below and above this limiting value. The thrombocyte values determined at the time of splenectomy and 6 months before it were significantly lower in ITP patients with enlargement of spleen follicles than in those ITP patients with spleen follicle being in the normal range. Thus, the morphometrical determination of the spleen follicle size can provide a semi-quantitative reference to the extent of synthesis of autothrombocytic antibodies. In T-lymphocyte compartiments there was no difference between ITP and controls.     

Prognostic significance of splenic follicle size in splenectomized idiopathic thrombocytopenic purpura patients

The prognostic significance of splenic follicle (B-lymphocyte compartment) size was studied in 62 patients splenectomized for idiopathic thrombocytopenic purpura (ITP). Patients with hyperplasia of splenic follicles (mean follicle diameter greater than 500 micron) were more likely to relapse or to develop additional autoimmune disorders than patients without hyperplastic splenic follicles (mean follicle diameter less than 500 micron) (p less than 0.01). The enlargement of splenic follicles had a positive predictive value of 27% and a negative predictive value of 100% for a poor outcome of splenectomy. Thus, the histological examination of spleens surgically removed for ITP seems to be an appropriate method to obtain the first indication of the possible long-term effect of splenectomy almost immediately after the operation.     

Function of reticuloendothelial system in splenectomised thalassemics

The activity of reticuloendothelial system (RES) was estimated in 19 patients with beta-thalassemia major, 20 +/- 4 years old, who had undergone successful splenectomy 6 +/- 5 years previously. The kinetics of 125I denatured human serum albumin in low and large doses was applied for this purpose and the parameters derived (effective RES blood flow-ERBF- and maximum phagocytic capacity-PCmax) were compared to those of nonsplenectomized thalassemics, detected in previous works, as well as to those of 13 healthy controls. In splenectomised thalassemics both parameters of RES activity were found significantly lower than those of nonsplenectomized patients (p less than 0.001). Compared to those of healthy controls, PCmax of splenectomised thalassemics was found not to be significantly different, while ERBF was significantly lower (p less than 0.001). No correlation was noted between the above parameters of RES function and the age of the patients, the age at which splenectomy was performed, the time lapsed since the operation, the amount of blood transfused to the patients after splenectomy or their serum ferritin levels. A pilot study performed in 6 out of the 19 splenectomised patients did not reveal any effect of blood transfusion on RES function parameters, by contrast to observations in nonsplenectomized thalassemics. The results of this study suggest that in splenectomised thalassemics the remaining RES reacts to the continuing hemolytic stimulus in a manner different than that of splenic RES of nonsplenectomized patients and account for, at least in part, the predisposition of the former group to infections.     

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.     

Blood volume determinations in sheep before and after splenectomy

Using 51Cr labelled RBCs, total blood volume, red cell volume and plasma volume were measured in fifteen adult, female, domestic sheep both before and after splenectomy. Eight of the fifteen animals studied were anemic. Statistical analyses revealed no significant differences in blood volume parameters whether animals were grouped together or separated into normal and anemic groups. We observed: (a) splenectomy produced modest reductions in blood volume parameters in 12 of 15 animals, (b) preoperative variability in blood volume parameters caused by release of sequestered RBCs from the spleen was eliminated after splenectomy, and (c) equilibration of 51Cr required at least 30 minutes in intact animals, but only 10 minutes in splenectomized animals. After volume parameters were normalized to body weight, they were found to agree closely with values reported previously. This study demonstrates the dynamic function of the sheep spleen in the regulation of blood volume.     

Stereological study of rat spleen following acute ethanol treatment

To investigate the acute effect of ethanol (4 g/kg, i.p.) on spleen adult female Wistar rats were treated intraperitoneally with: a) ethanol (4 g/kg body wt), b) naltrexone (5 mg/kg body wt) followed 45 minutes later by ethanol (4 g/kg body wt) and c) naltrexone (5 mg/kg body wt) alone. Untreated and saline-treated rats were used as controls. Twenty hours after the ethanol treatment the animals were sacrificed and the spleens were removed. A piece of tissue from the central part of each organ was fixed in Bouin's solution. Paraffin sections were stained with hematoxylin-eosin and analysed using stereological measurements. The volume densities of the following tissue compartments: red pulp, white pulp (divided in follicles, periarterioral lymphatic sheath and marginal zone) and the connective tissue were determined. Stereological analysis also included parameters of follicles: the areal numerical density (the number of follicles per 1 mm2 of tissue section), the numerical density (the number of follicles per mm3 of tissue) and the mean follicle diameter. The immunoarchitecture of the spleen was preserved following acute ethanol treatment. Unlike other parameters that were unaffected, ethanol evoked a decrease in both volume density of follicle and the mean follicle diameter. Naltrexone pretreatment had no influence on ethanol-induced changes. The data obtained indicate that a single dose of ethanol has a profound effect on rat spleen affecting the follicles, but the mechanism of its action remains to be elucidated.     

Regenerative capacity of the spleen in a splenectomized fish, Channa punctatus Bloch, with related investigations into changes in peripheral blood and haematopoiesis

The present investigation has provided evidence by a simultaneous study of the regenerating spleen, peripheral blood and the kidney of the haematopoietic tissue to establish the role of the spleen in the development of circulating blood cells in Channa ( Ophiocephalus ) punctatus Bloch. Regeneration of the spleen after eight to nine weeks of splenectomy was shown to be complete. Weekly observations a fortnight after splenectomy are recorded with reference to spleen morphology and weight, erythrocyte and differential leucocyte counts, haemoglobin content, haematocrit value and related red cell indices (MCV, MCH, MCHC). The results show that splenectomy leads to a macrocytic hypochromic anaemia and leucopenia, resulting in 25% reduction in haemoglobin content and a decrease in leucocyte numbers in five weeks following splenectomy. Thrombocytes and neutrophils show a relative ( P < 0·01) increase. The leucopenia is caused by large and small lymphocytes, eosinophils and basophils whose number was reduced from 50% to 67%.     

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。     

Effect of splenectomy on the development of neonatal lymphoid organs transplanted to animals of varying age]

The effect of splenectomy on the development of newborn thymus and spleen grafted under the kidney capsule of young and old mice has been investigated. Preliminary splenectomy is shown to increase cell counts in grafted spleen that is more conspicuous in young recipients as compared with old ones. This result suggests a decrease with age in the inhibitory effect of the host spleen on the maturation of spleen grafted from newborn donor. Combined transplantation of newborn thymus and spleen has revealed a decrease of cell counts in the donor spleen grafted to the young splenectomized recipients and, on the contrary, increase of this parameter in old ones. Immune response in donor spleen with combined transplantation of the thymus to the old splenectomized recipients is much higher as compared with the same parameter in recipient without splenectomy. It is concluded that partial destruction of the old immune system is essential for its correction.     

Spleen-dependent turnover of CD11b peripheral blood B lymphocytes in bovine leukemia virus-infected sheep

Lymphocyte homeostasis is determined by a critical balance between cell proliferation and death, an equilibrium which is deregulated in bovine leukemia virus (BLV)-infected sheep. We have previously shown that an excess of proliferation occurs in lymphoid tissues and that the peripheral blood population is prone to increased cell death. To further understand the mechanisms involved, we evaluated the physiological role of the spleen in this accelerated turnover. To this end, B lymphocytes were labeled in vivo using a fluorescent marker (carboxyfluorescein diacetate succinimidyl ester), and the cell kinetic parameters (proliferation and death rates) of animals before and after splenectomy were compared. We show that the enhanced cell death observed in BLV-infected sheep is abrogated after splenectomy, revealing a key role of the spleen in B-lymphocyte dynamics.     

Increased resistance of (CBAxC57BL/6)Fl hybrids to the graft-versus-host reaction during spleen regeneration]

Partial splenectomy was performed in CBAXXC57BL/6/F1 hybrids 2, 12, 15 and 20 days before the graft-versus-host reaction induction (GVHR) and 2, 10 days after administration of parenteral immunocompentent cells. The recipients with the intact spleen or complete splenectomy and sham operated recipients served as control. Hybrids with the regenerating spleen were more resistant to GVHR within 12 days of regeneration, while splenectomy increased hybrid resistance to GVHR only when performed 2 days before or 2 days following the GVHR induction.     

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。     

Effect of splenectomy on the expression of regulatory T cell activity.

The effect of adult splenectomy on the expression of suppressor and amplifier T cell activity was examined with respect to the serum antibody response to Type III pneumococcal polysaccharide (SSS-III) by using a sensitive radioimmunoassay. Suppressor T cell activity, as measured by the degree of low-dose paralysis induced, was not impaired in the least by splenectomy; however, amplifier T cell activity was almost completely eliminated within 7 days after splenectomy. These findings indicate that suppressor T cell activity is not confined solely to the spleen, the major site of antibody synthesis after immunization with SSS-III, and that the spleen may be an important site for the generation and/or maintenance of amplifier T cell activity.     

脾切除对肝纤维化大鼠肝脏TGFβ 1的表达和血清TGFβ 1水平的影响

目的：研究脾切除对肝纤维化大鼠肝脏TGFβ1的表达和血清TGFβ1水平的影响,探讨脾切除在肝纤维化中的意义。方法：用CCL4建立50例肝纤维化大鼠模型。于建模第3周,6周,及8周分别取大鼠肝脏和脾脏标本。用免疫组化SP方法测定其TGFβ1的表达,HE和姬姆萨染色检测肝纤维化。应用双抗体夹心ELISA方法测定15例模型大鼠行脾脏切除前后的血清TGFβ1水平,以及15例对照组大鼠的血清TGFβ1水平,并于术后4周取两组大鼠的肝脏标本,用免疫组化SP方法测定其TGFβ1的表达。应用CMIAS8彩色图像系统对阳性目标进行分析和处理。结果：随着肝纤维化程度的进展,大鼠肝脏和脾脏TGFβ1的表达也随之增加（P〈0.01）。脾切除组大鼠其血清TGF-β1的水平显著低于对照组大鼠（P〈0.05）,且脾切除组大鼠肝脏TGFβ1的表达低于对照组大鼠（P〈0.05）。结论：脾切除术在一定程度上可延缓肝纤维化的发展。     

Megakaryocytes and thrombocytopoiesis in idiopathic thrombocytopenic purpura

In idiopathic thrombocytopenic purpura (ITP) patients with histological signs of stronger auto-antibody synthesis (spleen follicle hyperplasia) more frequently revealed megakaryocyte changes due to antibodies and less frequently thrombocyte production compensatory increased than ITP patients with signs of weaker auto-antibody synthesis (spleen follicle normoplasia). The observation suggest that insufficient and frequently lacking compensatory increase of thrombocyte production in ITP is caused by an autoallergic disturbance of megakaryocyte maturation.     

Spleen is a primary site for activation of platelet-reactive T and B cells in patients with immune thrombocytopenic purpura

We have recently reported that in patients with chronic immune thrombocytopenic purpura (IMTP), circulating T and B cells that are responsive to gpIIb-IIIa can induce anti-platelet autoantibody production. In this study, the frequencies and activation status of gpIIb-IIIa-reactive T and B cells were evaluated in the peripheral blood and spleen obtained from nine IMTP patients undergoing splenectomy. There was no difference in gpIIb-IIIa-reactive T cell frequencies between peripheral blood and spleen (6.4 +/- 2.6 vs 5.2 +/- 2.4 per 10(5) T cells), as determined by limiting dilution analysis, but activated T cells responsive to gpIIb-IIIa showing accelerated proliferation kinetics and those expressing CD154 were more frequent in spleen than in peripheral blood. The frequencies of anti-gpIIb-IIIa Ab-producing B cells, as determined by ELISPOT assay, were also similar in peripheral blood and spleen (61.2 +/- 24.0 vs. 77.7 +/- 45.3 per 10(5) B cells); however, an anti-gpIIb-IIIa Ab was spontaneously produced by splenocytes in vitro, but scarcely secreted by PBMCs. CD19(-)/surface Ig(-)/CD38(+)/CD138(+) plasma cells secreting anti-gpIIb-IIIa Ab were exclusively detected in the spleen. In serial analysis, the frequencies of circulating gpIIb-IIIa-reactive T and B cells were markedly decreased after splenectomy in patients with a complete response, but were unchanged in nonresponders. These findings indicate that an interaction between gpIIb-IIIa-reactive T and B cells inducing anti-platelet Ab production in IMTP patients occurs primarily in the spleen and that the significant number of gpIIb-IIIa-reactive T and B cells activated in the spleen are released into the circulation as memory cells.     

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。     

Non-secretory solitary plasmacytoma of the spleen

A case of primary nonsecretory plasmacytoma of the spleen is reported. On laparotomy and splenectomy a 920 g spleen was removed, measuring 16×14×6 cm. The cut surface of the entire spleen showed that the tumour occupied most of the splenic tissue. A bone marrow aspirate and trephine, skeletal survey showed no signs of myeloma. Biopsy of the liver and regional lymph nodes was normal. Immunocytochemistry of the splenic tumour showed positivity for pan-B and plasma cell markers. After splenectomy the patient was treated with chemotherapy according to protocol VBCMP (M2).     

Booster irradiation to the spleen following total body irradiation. A new immunosuppressive approach for allogeneic bone marrow transplantation

Graft rejection presents a major obstacle for transplantation of T cell-depleted bone marrow in HLA-mismatched patients. In a primate model, after conditioning exactly as for leukemia patients, it was shown that over 99% of the residual host clonable T cells are concentrated in the spleen on day 5 after completion of cytoreduction. We have now corroborated these findings in a mouse model. After 9-Gy total body irradiation (TBI), the total number of Thy-1.2+ cells in the spleen reaches a peak between days 3 and 4 after TBI. The T cell population is composed of both L3T4 (helper) and Lyt-2 (suppressor) T cells, the former being the major subpopulation. Specific booster irradiation to the spleen (5 Gy twice) on days 2 and 4 after TBI greatly enhances production of donor-type chimera after transplantation of T cell-depleted allogeneic bone marrow. Similar enhancement can be achieved by splenectomy on day 3 or 4 after TBI but not if splenectomy is performed 1 day before TBI or 1 day after TBI, strengthening the hypothesis that, after lethal TBI in mice, the remaining host T cells migrate from the periphery to the spleen. These results suggest that a delayed booster irradiation to the spleen may be beneficial as an additional immunosuppressive agent in the conditioning of leukemia patients, in order to reduce the incidence of bone marrow allograft rejection.     

A chronomorphological structural model of rat thyroid gland

Circadian rhythmicity of the structural morphometric model of thyroid has been studied in 36 Wistar rats kept in LD 12:12. The parameters evaluated are: a. the volume fraction occupied by: 1. follicle epithelium, 2. colloid, 3. interstitium at 6 time points in 24h; b. the follicle size distribution; c. the number of follicles per unit tissue volume. The circadian rhythms of mean follicular diameter and of follicular cavity mean diameter have been demonstrated (p less than 0.03 and p less than 0.01 respectively) and show overlapping acrophases of -120 degrees (-64 degrees/-176 degrees) and -108 degrees (-99 degrees/-116 degrees). The synchronization between rhythms, shown for mean follicular diameter and for follicular cavity mean diameter, suggests a rhythmical pulsation of the whole follicle, while the thickness of the follicular epithelium does not undergo a statistically significant periodic variation.