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Abnormal splenic artery diameter/hepatic artery diameter ratio in cirrhosis-induced portal hypertension

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World Journal of Gastroenterology 2013年第8期19卷 1292-1298页

作者： Dao-Bing Zeng Chuan-Zhou Dai Shi-Chun Lu Ning He Wei Wang Hong-Jun Li Department of Hepatobiliary Surgery and You-An Liver Transplantation Center Beijing You-An HospitalCapital Medical University Department of Radiology Beijing You-An HospitalCapital Medical University

AIM:To determine an optimal cutoff value for abnormal splenic artery diameter/proper hepatic artery diameter(S/P) ratio in cirrhosis-induced portal ***:Patients with cirrhosis and portal hypertension(n = 770) and healthy volunteers(n = 31) underwent volumetric computed tomography threedimensional vascular reconstruction to measure the internal diameters of the splenic artery and proper hepatic artery to calculate the S/P *** cutoff value for abnormal S/P ratio was determined using receiver operating characteristic curve analysis,and the prevalence of abnormal S/P ratio and associations between abnormal S/P ratio and major complications of portal hypertension were studied using logistic ***:The receiver operating characteristic analysis showed that the cutoff points for abnormal splenic artery internal diameter and S/P ratio were > 5.19 mm and > 1.40,*** sensitivity,specificity,positive predictive value,and negative predictive value were 74.2%,45.2%,97.1%,and 6.6%,*** prevalence of an abnormal S/P ratio in the patients with cirrhosis and portal hypertension was 83.4%.Patients with a higher S/P ratio had a lower risk of developing ascites [odds ratio(OR) = 0.708,95%CI:0.508-0.986,P = 0.041] and a higher risk of developing esophageal and gastric varices(OR = 1.483,95%CI:1.010-2.175,P = 0.044) and forming collateral circulation(OR = 1.518,95%CI:1.033-2.230,P = 0.034).After splenectomy,the portal venous pressure and maximum and mean portal venous flow velocities were reduced,while the flow rate and maximum and minimum flow velocities of the hepatic artery were increased(P < 0.05).CONCLUSION:The prevalence of an abnormal S/P ratio is high in patients with cirrhosis and portal hypertension,and it can be used as an important marker of splanchnic hemodynamic disturbances.

关键词： Portal hypertension Cirrhosis splenic artery internal diameter Proper hepatic artery internal diameter Complications Splenectomy

splenic lymphoma with massive splenomegaly: Case report with review of literature

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World Journal of Clinical Cases 2014年第9期2卷 478-481页

作者： Sachin B Ingle Chitra R Hinge Ingle Department of Pathology MIMSR Medical CollegeLatur Maharashtra 4132512 India Department of Physiology MIMSR Medical CollegeLatur Maharashtra 4132512 India

As per strict criteria of Das Gupta et al, primary splenic lymphoma is very rare. Herein, we are reporting an unusual case of primary large cell splenic lymphoma of B lineage in a middle aged female presenting with massive splenomegaly(3.8 kg) and hypersplenism. After performing therapeutic splenectomy for hypersplenism, a precise diagnosis of diffuse large B cell lymphoma was made on histopathology and confirmed by immunohistochemistry. The patient responded well to standard(Cyclophosphamide, Hydroxydaunorubicin, Oncovin(vincristine), Prednisone or prednisolone) regimen last year and is now in full remission. The splenectomy thereby has prevented the potential grave complications related to hypersplenism and splenic rupture. Our aim behind highlighting the topic is to specify that emergency splenectomy followed by anticoagulation therapy is an effective plan of management to prevent untoward complications related to disease and treatment.

关键词： Huge splenic lymphoma Pancytopenia Splenectomy Anticoagulation

splenic abscess in typhoid fever - Surgical management

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Asian Pacific Journal of Tropical Medicine 2009年第6期2卷 78-80页

作者： Col Prasan Kumar Hota Surgical Specialist Military HospitalJaipur- 302006RajasthanIndia

splenic abscess is an uncommon clinical presentation in surgical practice,associated with high morbidity and *** may be 100%if left *** abscess is also rarely encountered as a complication of typhoid *** present here a case of multiple splenic abscesses with neuropsychiatric complications due to typhoid fever,which was managed successfully with splenectomy and other supportive *** case of single splenic abscess due to enteric fever was treated successfully with CT-guided aspiration and appropriate *** a rare entity in clinical practice,splenic abscess has been poorly *** seeding of the spleen due to typhoid is a common cause of splenic abscess in the tropical *** multiple or multiloeulated abscesses aspiration usually does not succeed,which happened in our *** remains the definitive choice of ***,Ultra sonography(USG) or CT-guided aspiration may be tried in selective cases.

关键词： splenic abscess Typhoid fever Surgical management

Relationship between response to lusutrombopag and splenic volume

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World Journal of Gastroenterology 2018年第46期24卷 5271-5279页

作者： Haruki Uojima Yoshitaka Arase Norio Itokawa Masanori Atsukawa Takashi Satoh Koji Miyazaki Hisashi Hidaka Ji Hyun Sung Makoto Kako Kota Tsuruya Tatehiro Kagawa Katsuhiko Iwakiri Ryouichi Horie Wasaburo Koizumi Department of Gastroenterology Shonan Kamakura General Hospital Department of Gastroenterology Internal MedicineKitasato University School of Medicine Division of Gastroenterology and Hepatology Department of Internal MedicineTokai University School of Medicine Department of Internal Medicine Division of GastroenterologyNippon Medical School Chiba Hokusoh Hospital Department of Internal Medicine Division of Gastroenterology and HepatologyNippon Medical School Division of Hematology Department of Medical Laboratory SciencesKitasato University School of Allied Health Sciences Division of Molecular Hematology Kitasato University Graduate School of Medical Sciences Department of Transfusion and Cell Transplantation Kitasato University School of Medicine

AIM To assess the correlation between the efficacy of lusutrom-bopag and clinical characteristics in patients with chronic liver *** In this retrospective, multicenter study, which conducted at four locations in Japan, 50 thrombocytopenic patients with chronic liver disease were enrolled. All patients received oral lusutrombopag(3.0 mg/d for 7 d) for chronic liver disease. We assessed the increase in platelet count after the trial drug administration. A treatment response was defined as a platelet count ≥ 5 × 104/μL and an increased platelet count ≥ 2 × 104/μL from baseline after drug administration. We evaluated the response to lusutrombopag compared to baseline clinical characteristics in patients with chronic liver *** The numbers of responders and non-responders were 40(80.0%) and 10(20.0%), respectively. The patients were divided into a responder and non-responder group, and we added factors that may correspond to successful treatment with lusutrombopag. splenic volume and body weight were lower in the responder group than in the nonresponder group. White blood cell count and hemoglobin level were higher in responders compared with nonresponders. Using a logistic regression model to assess the relationship between response to lusutrombopag and clinical characteristics, multivariate analysis confirmed that splenic volume was an independent factor that predicted the response of platelet counts(P = 0.025; odds ratio = 11.2; 95% confidence interval: 1.354-103.0). splenic volume negatively correlated to changes in platelet count(r =-0.524, P = 0.001).CONCLUSION splenic volume influences the change in platelet counts after administration of lusutrombopag in patients with chronic liver disease.

关键词： Lusutrombopag Portal hypertension splenic volume Thrombocytopenia Thrombopoietin receptor agonist

Short-term efficacy of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy via Huang’s three-step maneuver for advanced upper gastric cancer: Results from a propensity scorematched study

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World Journal of Gastroenterology 2019年第37期25卷 5641-5654页

作者： Jia-Bin Wang Zhi-Yu Liu Qi-Yue Chen Qing Zhong Jian-Wei Xie Jian-Xian Lin Jun Lu Long-Long Cao Mi Lin Ru-Hong Tu Ze-Ning Huang Ju-Li Lin Hua-Long Zheng Si-Jin Que Chao-Hui Zheng Chang-Ming Huang Ping Li Department of Gastric Surgery Fujian Medical University Union HospitalFuzhou 350001Fujian ProvinceChina Key Laboratory of Ministry of Education of Gastrointestinal Cancer Fujian Medical UniversityFuzhou 350001Fujian ProvinceChina

BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated *** To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy(SPSHL)for advanced gastric cancer(GC)by Huang’s three-step *** A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017,including 35 patients who underwent robotic SPSHL(RSPSHL)and 608 who underwent laparoscopic SPSHL(LSPSHL).One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic *** In all,175 patients were matched,including 35 patients who underwent RSPSHL and 140 who underwent *** matching,there were no significant differences detected in the baseline characteristics between the two *** differences in total operative time,estimated blood loss(EBL),splenic hilar blood loss(SHBL),splenic hilar dissection time(SHDT),and splenic trunk dissection time were evident between these groups(P<0.05).Furthermore,no significant differences were observed between the two groups in the overall noncompliance rate of lymph node(LN)dissection(62.9%vs 60%,P=0.757),number of retrieved No.10 LNs(3.1±1.4 vs 3.3±2.5,P=0.650),total number of examined LNs(37.8±13.1 vs 40.6±13.6,P=0.274),and postoperative complications(14.3%vs 17.9%,P=0.616).A stratified analysis that divided the patients receiving RSPSHL into an early group(EG)and a late group(LG)revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG(P<0.05).Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT(P<0.05).CONCLUSION RSPSHL is safe and feasible,especially after overcoming the early learning curve,as this procedure results in a radical curative effect equivalent to that of LSPSHL.

关键词： Advanced gastric cancer Robotic surgery Laparoscopic surgery Dissection of splenic hilar lymph node Propensity score matching Huang’s three-step maneuver

Case report of primary splenic angiosarcoma with hepatic metastases

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World Journal of Gastroenterology 2015年第39期21卷 11199-11204页

作者： Fang Chen Hai-Feng Jin Yi-Hong Fan Li-Jun Cai Zhuo-Yi Zhang Bin Lv Department of Gastroenterology The First Affiliated Hospital of Zhejiang Chinese Medical University Department of Emergency The First Affiliated Hospital of Zhejiang Chinese Medical University

Primary splenic angiosarcoma(PSA) is the most unusual type of malignancy with early multifocal metastasis through hematogenous spread. PSA is generally believed to originate from splenic sinusoidal vascular endothelium with a high rate of metastasis and to have a poor prognosis. Its etiology and pathogenetic mechanisms have not yet been clearly described. Thus far, only approximately 200 cases have been reported. PSA has variable symptomatology with the potential to present with life-threatening complications. The diagnosis of PSA is challenging; and often late. PSA should be considered in the differential diagnosis of patients with splenomegaly and anemia of unknown etiology. Surgical treatment with splenectomy is considered the only curative intervention for potential long-term disease-free survival. Early diagnosis and treatment are very important. It is important that clinical doctors improve the understanding of PSA. Herein, we report one rare case of PSA with hepatic metastases, along with a review of the current literature.

关键词： Primary splenic angiosarcoma Hepatic metastases Ru

Laparoscopic splenic hilum lymph node dissection for advanced proximal gastric cancer:A modified approach for pancreasand spleen-preserving total gastrectomy

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World Journal of Gastroenterology 2013年第30期19卷 4992-4999页

作者： Ting-Yu Mou Yan-Feng Hu Jiang Yu Hao Liu Ya-Nan Wang Guo-Xin Li Department of General Surgery Nanfang HospitalSouthern Medical University

AIM:To investigate the feasibility and optimal approach for laparoscopic pancreasand spleen-preserving splenic hilum lymph node dissection in advanced proximal gastric ***:Between August 2009 and August 2012,12 patients with advanced proximal gastric cancer treated in Nanfang Hospital,Southern Medical University,Guangzhou,China were enrolled and subsequently underwent laparoscopic total gastrectomy with pancreasand spleen-preserving splenic hilum lymph node(LN)*** clinicopathological characteristics,surgical outcomes,postoperative course and followup data of these patients were retrospectively collected and analyzed in the ***:Based on our anatomical understanding of peripancreatic structures,we combined the characteristics of laparoscopic surgery and developed a modified approach(combined supraand infra-pancreatic approaches)for laparoscopic pancreasand spleenpreserving splenic hilum LN *** was completed in all 12 patients laparoscopically without *** one patient experienced intraoperative bleeding when dissecting LNs along the splenic artery and was handled with laparoscopic *** mean operating time was 268.4 min and mean number of retrieved splenic hilum LNs was *** patient had splenic hilum LN metastasis(8.3%).Neither postoperative morbidity nor mortality was *** metastasis occurred in one patient and none of the other patients died or experienced recurrent disease during the follow-up ***:Laparoscopic total gastrectomy with pancreasand spleen-preserving splenic hilum LN dissection using the modified approach for advanced proximal gastric cancer could be safely achieved.

关键词： Proximal stomach Stomach neoplasm Laparoscopy Lymph node excision splenic hilum

Partial embolization as re-treatment of hypersplenism after unsuccessful splenic artery ligation

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World Journal of Gastroenterology 2015年第4期21卷 1365-1370页

作者： Zheng-Ju Xu Lian-Qiu Zheng Xing-Nan Pan Clinical Liver Center 180~(th) Hospital of the People’s Liberation Army

Ligation of splenic artery(LSA) is used for the treatment of liver cirrhosis with hypersplenism. However, hypersplenism is not significantly improved following LSA treatment in some cases, and there are few reports of retreatment of hypersplenism after LSA. We report the case of a47-year-old man with liver cirrhosis and hypersplenism who underwent LSA treatment, but did not significantly improve. Laboratory tests revealed severe leukocytopeniaand thrombocytopenia. Celiac computed tomography arteriogram and digital subtraction angiography revealed two compensatory arteries connected to the hilar splenic artery from the left gastro-epiploic artery and from the dorsal pancreatic artery. Partial splenic embolization(PSE) was performed through the compensatory arteries. As a result, the patient achieved partial splenic ischemic infarction, and white blood cell and platelet counts rose and remained in the normal range. PSE is an effective therapeutic modality for the retreatment of hypersplenism when other modalities have failed.

关键词： Hypersplenism Partial splenic embolization splenic

Multiple splenic infarcts in acute Plasmodium vivax malaria:A rare case report

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Asian Pacific Journal of Tropical Medicine 2013年第5期6卷 416-418页

作者： Hari Krishan Aggarwal Deepak Jain Vipin Kaverappa Promil Jain Ashwani Kumar Sachin Yadav Department of Medicine Pt.B.D.Sharma University of Health SciencesRohtak-124001HaryanaIndia Department of Pathology Pt.B.D.Sharma University of Health SciencesRohtak-124001HaryanaIndia

In tropical countries like India,malaria has been one of the most common parasitic illnesses leading to frequent hospitalization and causing major economic burden among the masses. Although Plasmodium vivax infection is considered to be benign,in contrast to Plasmodium, falciparum infection which is notorious for its severe splenic complications can occur frequently. Splenomegaly tends not to receive special attention,as it is not usually accompanied by any symptoms and can be gradually resolved via standard antimalarial *** infarction, although rarely attributable to malaria in an endemic region with high parasitemia,can be a rare presentation of this disease entity.

关键词： Malaria splenic infarcts Plasmodium vivax