To evaluate the efficacy and safety of splenectomy in patients with human immunodeficiency virus (HIV)-related thrombocytopenia, 30 HIV-infected patients with thrombocytopenia (platelet count < 50 x 10(9)/l) who underwent splenectomy were followed prospectively for a mean period of 42 months. There were no perioperative deaths and morbidity was minimal. Twenty-one patients had a persistent complete response, six had a partial response and were asymptomatic after splenectomy, and only three showed no response. Three patients developed acquired immune deficiency syndrome during follow-up, an incidence that was no different from that expected. Splenectomy is a safe and effective treatment in HIV-infected patients with severe symptomatic thrombocytopenic purpura resistant to medical therapy.

In 145 patients submitted to elective portacaval anastomosis for intrahepatic block and followed up for periods ranging from 1 to 9 years, long-term survival has been analysed in its relation to the 4 classical preoperative parameters – age, liver size, hepatic histology, and hepatic function. No relation was detected between age at time of operation and mortality. Patients whose livers were of normal size had a better survival than those whose livers were atrophic or hypertrophic, but there was no difference in survival between the groups with atrophic and hypertrophic livers, respectively. Histological change and impairment of hepatic function were related to mortality in the first postoperative year only.

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Exploratory laparotomy with splenectomy was performed before or after multiple chemotherapy in 182 patients with clinically localised Hodgkin's disease in clinical stages IB, II3A, IIB, III A and III B. There was a 50% probability of clinically not diagnosed infradiaphragmatic involvement in patients with clinically localised stage IB, II B or II3A. Restaging was necessary in 20% of patients with clinical stage III, because infradiphragmatic involvement was histologically not demonstrable. Infradiaphragmatic involvement occurred in 12% of patients who had received six chemotherapy cycles according to the MOPP scheme, before exploratory splenectomy. When chemotherapy produced complete clinical remission, only 2.7% patients had any infradiaphragmatic involvements. Exploratory laparotomy with splenectomy is not required, therefore, in such patients.