Clinical and roentgenographic findings in splenic abscess

A splenic abscess developed in a 16-year-old boy following a supposed viral illness and left lower thoracic trauma. Preoperative diagnosis was at first obscured, but a spleen scan suggested fractured spleen and a splenic arteriogram showed a "subcapsular hematoma" and an aneurysm of the left hepatic artery. A 1,800-gm spleen containing one large abscess and one small one was removed. Splenic abscess is rare and, before modern methods of spleen scan and arteriography, rarely diagnosed.     

Wandering spleen with torsion in a geriatric patient. Report of an unusual case with a brief review of the clinical picture and management

Wandering spleen is a rare condition that is extremely uncommon in the elderly. A case of wandering spleen with torsion in a 73-year-old female is described in detail. Our patient's presentation is unusual because in 1972, during a total hysterectomy, she had no evidence of a wandering spleen. Preoperative technetium-99 radionuclide liver-spleen studies were utilized to minimize the potential for vascular difficulties. Splenectomy was the treatment of choice for this condition and was performed to avoid splenic infarction. A review of the literature and etiologic considerations are discussed.     

Prognosis of residual spleen after partial splenic embolization for the treatment of hypersplenism in cirrhosis

The aim of this study was to elusidate the change in residual spleen volume after partial splenic embolization (PSE) in 43 cirrhotic patients with marked hypersplenism. Residual spleen volume was indicated as the rate (%) of residual spleen to initial spleen before PSE. Furthermore, the platelet count after PSE was observed in 23 patients followed up for 2 years. Residual spleen volume in patients with infarction rates of more than 80% (group A) had been maintained within 20 % even after 2 years, while they had obviously increased during the early stage after PSE in patients with infarction rates under 80% (group B), especially in patients with lower infarction rates (under 60%). Mean platelet count improved significantly in both groups after PSE (p < 0.001, respectively), but increased more in group A than in group B (p < 0.01). High fever and abdominal pain were observed in all cases of PSE. Other adverse effects such as pleural effusion and ascites that were frequent in group A were transient. These results suggest that PSE performed with a high infarction rate of the spleen provides effective, long-lasting results in the treatment of hypersplenism in cirrhosis.     

Cysts and pseudocysts of the spleen in children

A cyst in the upper pole of the spleen was diagnosed in three children. In all the pole of the spleen was resected -in two instances it contained a cyst, in one a pseudocyst. The postoperative course was without complications. All patients had scintigraphic check-up examinations, in all three instances functional lienal tissue was found which did not differ much as to its size from that of a normal spleen. In cysts situated in the splenic pole the authors consider partial resection of the affected portion of the spleen as the optimal surgical method. In cysts of other portions of the spleen it would be better to select a different surgical procedure, e.g. enucleation of the cysts, partial decapsulation of the cyst or percutaneous puncture of the cyst combined, if necessary, with sclerotization.     

Palatine tonsils and immunity. VIII. Soluble factors produced by lymphocytes of the palatine tonsils and other lymphoid formations in rabbits

A comparison was made of the activity of solbule factors produced by thelymphocytes of the palatine tonsils, the appendix, the spleen and thelymph nodes of rabbits in stimulation with a specific antigen (complete antigen of streptococcus, group A) and PHA. The blastogenic factor produced by the lymphoid cells of the spleen and the lymph nodes was highly active. Lymphocytes of the palatine tonsils and of the appendix produced a factor withlow activity after PHA stimulation. A factor intensifying the transformation in the presence of a complete streptococcus antigen was produced by lymphocytes of the spleen and the lymph nodes of the immunized animals. The lymphocytes of the palatine tonsils and the appendix failed to produce this factor.     

Development of Purkinje cells in absence of climbing fibers

A fresh spleen sample obtained from a patient with leukemic reticuloendotheliosis was homogenized and subjected to centrifugation on a sucrose density gradient. A major portion of acid phosphatase band 5 was observed in the lysosome, confirming that the elevated phosphatase activity in the neoplastic spleen is a lysosomal enzyme. However, a significant amount of brand 5 was also observed in the microsome. The microsomal and lysosomal enzymes have different affinity to CM-cellulose. The relationship between lysosomal and microsomal enzymes has not been established.     

Propensity for sleep and diurnal somnolence in the course of sleep apnea syndrome

We have compared the proliferative potential of IELs isolated from rat colon (CIEL) and small bowel (SBIEL), and compared this with that observed using spleen lymphocytes. Unless additional irradiated spleen cells were added as a source of accessory cells, both IEL populations show poor proliferation in response to Con A stimulation. The CD4/CD8 ratio in spleen, SBIEL and CIEL was markedly different (3:1, 1:3, and 1:1, respectively). Cells expressing surface markers characteristic of macrophages were not routinely found in SBIELs. Both IEL preparations inhibited spleen cell proliferation in response to Con A or immobilized anti-CD3, and produced a soluble factor(s) capable of causing similar inhibition. For CIEL this inhibition was dependent upon a proliferation-independent but cell-cell contact dependent event.     

Wandering spleen in childhood: a report of three cases

Wandering spleen is a rare cause of abdominal pain in children, and an accurate diagnosis is seldom made preoperatively. A splenectomy is the treatment of choice in cases of splenic torsion and infarction, while in patients with chronic symptoms splenopexy may also be attempted. We herein report three patients with wandering spleen, of whom two presented with acute torsion of the splenic pedicle and one demonstrated an asymptomatic mobile abdominal mass. In the first case splenopexy was attempted, but during follow-up the spleen was found to have undergone atrophy. The presentation, diagnostic procedures, and treatment modalities in pediatric wandering spleen are reviewed.     

Reversible hypersplenism after splenopexy for wandering spleen

Wandering spleen is a rare condition characterized by a normal spleen with extreme mobility associated with an elongated pedicle. The most common presentation is an acute surgical abdomen related to acute torsion. A case of wandering spleen complicated by symptomatic hypersplenism in a 29 year-old woman is presented. The hypersplenism was diagnosed after bleeding delivery, requiring blood transfusion. Wandering spleen was suspected after pre-operatively performed CT scan. The patient was successfully treated by splenopexy. This report illustrates that conservative surgical management may result in complete reversal of hematological symptoms.     

Sutureless "button and hole" splenopexy

A new technique for fixation of a mobile spleen is described. It offers the advantages of a minimally risky procedure that very effectively keeps a mobile spleen in its bed without foreign materials and is feasible even when the gastrosplenic ligament is absent and the splenic vessels are uncovered. Our "button and hole" sutureless splenopexy was performed in six patients from 1979 to 1995. Three had a gastric volvulus (GV) and an extremely mobile spleen; one of these also had a diaphragmatic eventration. Another three had torsion of the spleen; in one it occurred 9 months after repair of a diaphragmatic hernia. We achieved good results with splenopexy as the sole operation in two cases where a wandering spleen produced a GV.     

Cytotoxic T lymphocyte activity after intravitreal inoculation of herpes simplex virus type I in mice

After inoculating mice with herpes simplex virus (HSV) by a corneal or intravitreal route, cytotoxic T lymphocyte (CTL) activity in the cervical lymph nodes and spleen was assayed. The spleen and cervical lymph nodes were removed at various points till 2 weeks after inoculation, and CTL activity was assayed in a groups: (A) mice intravitreally inoculated with HSV, and (B) mice with topical application of HSV. The reactivity of delayed type sensitivity was determined by the thickness of the mouse ear pinna on the 6th day in both groups. CTL activity in the spleen was at the same level in both groups. Up to 10 days after inoculation CTL activity in the cervical lymph nodes in group (A) was lower than in group (B). The reactivity of delayed type sensitivity in group (A) was lower than in group (B). These results indicate that an anterior chamber associated immune deviation (ACAID)-like phenomenon occurred after HSV inoculation into the vitreous cavity.     

Twenty-four-hour rhythms in immune responses in rat submaxillary lymph nodes and spleen: effect of cyclosporine

Twenty-four-hour variations in cellularity, lipopolysaccharide (LPS)- and concanavalin A (Con A)-induced cell proliferation, and natural killer (NK) activity were examined in submaxillary lymph nodes and spleen of rats injected with Freund's complete adjuvant or its vehicle and kept under light from 08:00 to 20:00 h daily. A significant daily variation in cellularity was detected, exhibiting maxima at 09:00 h in submaxillary lymph nodes (nonimmunized and immunized rats) and at 13:00 h in spleen (immunized rats only). Submaxillary lymph node LPS- and Con A-mitogenic effect displayed maximal activity during daytime (peak at 13:00-17:00 h). In spleen, the maxima for 24-h rhythm in LPS-induced cell proliferation and NK activity occurred at midnight and at early morning (09:00 h), respectively. Con A-induced spleen cell proliferation peaked at midday in nonimmunized rats only. Injection of the immunosuppressive drug cyclosporine decreased Freund's adjuvant-induced augmentation of LPS and Con A mitogenic effect in both tissues and diminished spleen cell number. Cyclosporine blunted circadian rhythms in submaxillary lymph node Con A response and cell number, while it shifted the maximum in LPS effect to peak at 01:00 h. Cyclosporine also suppressed the circadian changes in LPS- and Con A-induced spleen cell proliferation, but not those found in NK activity. The results indicate the existence of 24-h rhythms in immune responses of rat submaxillary lymph nodes and spleen with maxima at different times of the day and that were significantly affected by cyclosporine injection.     

Liver and spleen enhancement after intravenous injection of carboxydextran magnetite: effect of dose, delay of imaging, and field strength in an ex vivo model

It has been predicted that liver and spleen enhancement after administration of superparamagnetic contrast agents may be different, depending on the strength of the main magnetic field. With the use of an ex vivo model, we investigated at 0.3, 0.5, and 1.5 T the effects on liver and spleen signal intensity of 5, 15, and 45 mumol/kg body weight of dextran magnetite (SHU 555A) in 54 rats. Nine rats served as controls. At different time delays since injection, the animals were killed, and after perfusion with saline, the liver, brain, and spleen were fixed in formalin. The specimens were embedded in an agar gel matrix and imaged with inversion recovery T1-weighted, proton density spin echo, and T2*-weighted gradient recalled echo (GRE) sequences. At each magnetic field strength, peak liver and spleen signal loss increased with increasing dose of the contrast medium. Signal loss was significantly more conspicuous after a dose of 15 than 5 mumol/kg body weight, but not after a dose of 45 compared with 15 mumol/kg. No signal change was observed in the brain. GRE images showed higher enhancement than proton density-weighted spin echo and inversion recovery images but were noisier. The enhancement showed a plateau between 30 min and 24 hours. Only the signal decrease of the liver after a low dose of contrast medium on GRE images was significantly higher (p < 0.01) at 1.5 than at 0.5 and 0.3 T. Other differences in respect to the field strength were less significant (p < 0.05) or nonsignificant. Differences in the spleen enhancement were nonsignificant. SHU 555A at a dose of 15 mumol/kg is an efficient intracellular contrast agent for liver and spleen at low, mid, and high field strength. Proton density spin echo images are probably the sequence of choice to exploit SHU 555A contrast effects and a wide time window for imaging after its intravenous injection does exist.     

Polyclonal stimulation of lymphocytes by macrophages

To analyze the interaction between macrophages and splenic lymphocytes with reference to time and concentration, the Mishell-Dutton system was divided into two experimental steps. Step 1 consisted of the cocultivation of spleen cells with various doses of macrophages for different periods of time, while in step 2 macrophages were removed, spleen cells transferred to fresh petri dishes and cultivated until plaque assay. Cocultivation of spleen cells with high doses of macrophages for 4--8 h markedly enhanced the DNA synthesis and plaque-forming cell (PFC) response of sheep red blood cell-stimulated and unstimulated cultures. A cocultivation longer than 24 h resulted in an inhibition of both DNA synthesis and PFC response of spleen cells. These studies suggest a nonspecific function of macrophages on proliferation and differentiation processes in antibody formation.     

Correlation of central hemodynamics and tissue blood flow in patients with hypertensive disease

A study was made of the effect of thymectomy carried out in guinea pigs aged 1 month on the antibody-forming cell (AFC) count (cells forming antibodies against sheep erythrocytes), and also the effect of thymosin on the AFC distribution in the spleen and the lymph nodes of thymectomized animals. It was shown that as a result of thymectomy the AFC content increased in the peripheral lymphoid organs, and, particularly, in the spleen. But under the effect of thymosin the AFC count in the spleen decreased and in the lymph nodes somewhat increased; this permitted one to suggest a normalizing influence of thymosin on the AFC count in the thymectomized animals.     

Involvement of IFN-gamma and transforming growth factor-beta in graft-vs-host reaction-associated immunosuppression

The mechanisms of the suppressive activity of spleen cells from mice undergoing a graft-vs-host reaction (GVH) to non-H-2 histocompatibility Ag were investigated. In our model GVH is induced by injecting bone marrow and spleen cells from B10.D2 (H-2d Mlsb) donors into lethally irradiated (DBA/2 x B10.D2)F1 (H-2d/d Mlsa/b) recipients that differ only with regard to non-H-2 Ag. GVH spleen cells inhibit the mitogenic responses to Con A and LPS, as well as the anti-bromelain-treated mouse RBC (Br-MRBC) antibody response. This suppression was nonspecific and non-H-2-restricted and was not modified after treatment with anti-Thy-1 plus C. Conversely it was abrogated after treatment with L-leucyl methyl ester. These features permitted the identification of non-T cell, L-leucyl methyl ester-sensitive, cells involved in this type of suppression. The suppression mediated by GVH spleen cells was linked to the activity of IFN-gamma and transforming growth factor-beta 1 (TGF-beta 1) (TGF-beta 1 was found to be synthesized by GVH spleen T cells). mAb to IFN-gamma abrogated the suppression of the mitogenic response to Con A and the anti-Br-MRBC response and slightly reversed the suppression of the mitogenic response to LPS. Anti-TGF-beta 1 antibody partially abrogated the suppression of the mitogenic response to LPS and totally abrogated that of the anti-Br-MRBC response but left unmodified the suppression of the mitogenic response to Con A. These results are discussed within the framework of the mechanisms underlying the immunosuppression associated with GVH.     

Consumption coagulopathy in a case of cystic spleen (author's transl)]

A case of a 65-year old female patient is reported, dealing with consumption coagulopathy and secondary hyperfibrinolysis due to cystic spleen. Following treatment with heparin, antifibrinolytic agents and replacement of clotting factors prior to surgery, the patient attained a satisfactory condition to be operated on. After removal of the cystic spleen, which was interspersed with massive hemorrhages, blood coagulation returned to normal quickly and continuously. The pathogenesis of consumption coagulopathy in relation to cystic spleen is discussed and it is referred to the pathomechanism of similar blood disorders in hemangiomatous and cavernous lesions of Kasabach-Merritt-syndrome, Klippel-Trenaunay-syndrome and pachymeningeosis haemorrhagica interna.     

Splenic injury due to indirect torsion

A patient with subcapsular rupture of the spleen in association with indirect torsion trauma is reported. The spleen was surrounded by bands and adherent organs. The injury was considered to have been caused by a stretched band. In patients with hemoperitoneum, celiac angiography is advocated for diagnosis when immediate surgery is not indicated.     

Sequential invasions of pancreatic pseudocysts in pancreatic tail, hepatic left lobe, caudate lobe, and spleen

A 66-year-old male patient without a history of risk factors for pancreatitis suffered from pancreatitis and developed pseudocyst. During the course of treatment and follow-up, the pseudocyst was found to have migrated through the pancreatic tail, left hepatic lobe, caudate lobe, and spleen on abdominal sonography and computed tomography scan. Finally, emergent laparotomy was done for splenic abscess and removal of infected pseudocyst in the spleen and lesser sac of the abdomen. The patient made a full recovery after operation.