Angiography for Blunt Splenic Trauma Does Not Improve the Success Rate of Nonoperative Management

Harbrecht, Brian G.; Ko, Sae Hee; Watson, Gregory A.; Forsythe, Raquel M.; Rosengart, Matthew R.; Peitzman, Andrew B.

doi:10.1097/ta.0b013e3180686531

Cited by 87 publications

(77 citation statements)

References 31 publications

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“…Consequently, most patients will respond to non-operative treatment. Our personal results support the principle of conservative treatment in all haemodynamically stable patients, with overall efficacy rate more than 91%, as was reported in modern literature (7,8).…”

Section: Discussionsupporting

confidence: 72%

Blunt Trauma in Pediatric Patients- Experience from Small Center

et al. 2015

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Section: Discussionsupporting

confidence: 72%

Blunt Trauma in Pediatric Patients- Experience from Small Center

et al. 2015

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“…But the decrease of complications remains highly debated. When comparing splenectomy with arterial embolization the complications rates differ between the institutions where the procedures are performed (71)(72)(73). In order to prove the benefits of splenic embolization over total splenectomy, Walusimbi et al compared the level of several immune cells and small proteins of the complement system.…”

Section: Future Perspectives Future Perspectivesmentioning

confidence: 99%

Patients After Splenectomy: Old Risks and New Perspectives

Dragomir¹,

Petrescu²,

Manga³

et al. 2016

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Rezumat Pacienåii post-splenectomie: complicaåii cunoscute aei perspective noiComplicaåiile care survin în urma splenectomiei pot fi împãråite în infecåioase aei non-infecåioase. Legãtura dintre splenectomie aei aceste riscuri este doar paråial înåeleasã. Rãspunsul imun al gazdei împotriva infecåiei este profund modificat post-splenectomie, iar aceaeti indivizi sunt mai susceptibili sã dezvolte sepsis aei infecåia are o evoluåie fulminantã. Splenectomia este de asemenea un potenåial factor de risc pentru numeroase complicaåii vasculare care rezultã în urma obstrucåiei paråiale sau totale ale unei artere sau vene. În plus, hipertensiunea pulmonarã poate fi o complicaåie severã aei uneori fatalã a splenectomiei. Unii autori includ aei neoplaziile, diabetul zaharat aei pancreatita acutã în categoria complicaåiilor non-infecåioase post-splenectomie. Cea mai de temut complicaåie pentru pacienåii splenectomizaåi rãmâne sepsisul. Fiziopatologia sepsisului încã este controversatã. Decesul în sepsis poate surveni fie în urma hiperinflamaåiei, fie în urma imunosupresiei. Multiple dovezi experimentale au dovedit implicarea microRNA-urilor celulare aei virale în sepsis. Considerãm faptul cã microRNA-urile sunt de asemenea asociate cu imunosupresia pacientului asplenic, ceea ce determinã o creaetere a riscului de sepsis fatal. Studierea nivelului expresiei plasmatice a microRNA-urilor circulante la pacienåii asplenici, ar putea conduce la o mai bunã înåelegere a imunosupresiei post-splenectomie aei la dezvoltarea unor noi metode diagnostice aei terapeutice.Cuvinte cheie: splenectomie, microRNA, sepsis, microRNA-uri virale, OPSI AbstractThe risks that arise after splenectomy can be divided in infectious and non-infectious. The link between splenectomy and these hazards remains partially unknown. Host defense against infection is altered after splenectomy and such individuals develop sepsis more easily and the infection has a fulminant course. Splenectomy is also a potential risk factor for several vascular complications that result from partial or total obstruction of an arterial or venous blood vessel. Furthermore, pulmonary hypertensioncan be a severe and sometimes fatal complication following splenectomy. Some authors also consider that malignancies, diabetes mellitus and acute pancreatitis are non-infectious complications after splenectomy. The most feared complication for splenectomized patients remains sepsis. The pathophysiology of sepsis is still controversial. Death in sepsis can occur due to either hyper-inflammation or "immune paralysis". Multiple experimental evidences link cellular and viral microRNAs with sepsis. We presume that General ReportChirurgia (2016)

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“…It is important to keep in mind that in the current study many of the patients were severely injured and had a long hospital length of stay increasing the chance that splenectomies would be observed while the patients were hospitalized. (3,36). The authors argue that the success attributed to ANGIO with EMBO in studies using historical controls may be the result of time dependent increase in the detection of relatively minor BSI (which are less likely to bleed in the first place) as opposed to the effect of ANGIO and EMBO.…”

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confidence: 99%