Patients After Splenectomy: Old Risks and New Perspectives

Dragomir, Mihnea P.; Petrescu, G; Manga, Graţiela; Calin, George A.; Vasilescu, C

doi:10.21614/chirurgia.111.5.393

Cited by 26 publications

(31 citation statements)

References 79 publications

(86 reference statements)

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“…Purportedly, a body of miRNAs have been proved to regulate genes correlated with HDL metabolism, especially miR- 33a/b [ 60 ], which may contribute to ABCA1 expression at the same time, while many others, such as miR-148a, miR-128-1, or miR-30c, are involved in controlling circulating LDL concentrations as well as hepatic LDLR expressions [ 61 ]. Shifts in miRNAs expression after splenectomy may possibly take part in the development of AS [ 62 ]. But the accurate mechanism remains still unclear.…”

Section: Introductionmentioning

confidence: 99%

The role of splenectomy in lipid metabolism and atherosclerosis (AS)

Han

et al. 2018

Lipids Health Dis

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The extensive performance of splenectomy worldwide for patients suffered from splenic trauma has given rise to high risks of postoperative complications, which has been attracting increasing attention in recent years. Nowadays the spleen is regarded as a versatile organ of the human body, invested with various excellent properties. The spleen has been recognized to take a great part in lipid metabolism. While removal of the spleen intends to alter lipid values, especially with an elevated LDL, splenic autotransplantation is able to normalize these lipid alterations. What is more, conservative surgical procedures like subtotal or partial splenectomy, could as well, afford a correction of dyslipidemia. At the same time, clinically, splenectomy demonstrates a high rate of atherosclerosis (AS), whereas non-surgical treatment after splenic trauma shows unchanged propagation of AS. Based on the intimate relationship between serum lipids and AS, the lipid changes modulated by splenectomy are believed to be responsible for the development of AS. Therefore, a “splenic factor” is most likely present in the regulation of lipidation and AS. Several theories have been postulated to elucidate the possible mechanism involved, among which most are primarily based on its forceful natural immune function, that is to say, the mononuclear phagocytic system.However, the accurate mechanisms behind this mysterious phenomenon still remain unclear so far. Of importance, lipid fractions should be monitored consecutively in case of inevitable splenectomy.

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Section: Introductionmentioning

confidence: 99%

The role of splenectomy in lipid metabolism and atherosclerosis (AS)

Han

et al. 2018

Lipids Health Dis

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“…Prophylactic administration of pneumococcal vaccine or polymicrobial vaccine would reduce the infection and mortality rates. Some studies indicated that most of the infections occur in the first 2 years following splenectomy [23]. Blood cultures from peripheral venous blood or abscess cultures content allow the isolation of aerobic or anaerobic germs in automated BACTEC systems.…”

Section: Resultsmentioning

confidence: 99%

Combined Treatment with Tenofovir (C9H14N5O4P), Emtricitabine (C8H10FN3O3S) and Efavirenz (C14H9ClF3NO2) in Multiple Spleen Abscesses with Bacterial and Fungal Etiology in HIV Infected Patients

Ţîrnea¹,

Belei²,

Tomescu³

et al. 2020

Rev. Chim.

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Patients with human immunodeficiency virus (HIV) infection represent a risk group for developing spleen abscesses. The paper presents a short review and case illustration, describing the characteristics and underling treatment of HIV-infected patients with infectious comorbidities. There are few reports in literature of multiple spleen abscesses with double, microbial and fungal etiology in HIV-infected patients. A 35 years old male patient was referred to the Infectious Diseases Clinic with prolonged fever. In the last 2 years he had worked as a waiter and had multiple unprotected sexual contacts. The physical examination showed: fever, tongue and pharynx with Candida albicans deposits, enlarged cervical, submandibular, axillar, inguinal lymph nodes and splenomegaly. Biological tests including HIV antibodies (Ab) ELISA, CD4, HIV Western blot test, cultures and paraclinical investigations-abdominal ultrasonography and computed tomography were performed. There was a significant inflammatory response, HIV Ab were positive, CD4 cells=17/�L and Western blot HIV test was positive. Abdominal ultrasonography showed: splenomegaly with 3 hypoechogenic round images (13-17mm) at the superior pole, in the hilum and inferior pole. HIV infection stage C3 with oropharyngeal candidiasis and multiple splenic abscesses were diagnosed. After 6 weeks of antibiotic and antifungal therapy total splenectomy was performed. The cultures from splenic abscess contents revealed Acinetobacter baumannii and Cryptococcus neoformans. Under appropriate antibiotic and antifungal treatment, the postoperatory evolution was favorable.

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“…Infecção fulminante pós-esplenectomia: o mais importante, tanto pela frequência quanto pela mortalidade, é a infecção fulminante pós-esplenectomia (IFPE), cujo risco de um paciente esplenectomizado desenvolver é, pelo menos, 35 vezes maior que em indivíduos não esplenectomizados (SABATINO; CARSETTI; CORAZZA, 2011; MARQUES; PETROIANU, 2003;DRAGOMIR et al, 2016).…”

Section: O Paciente Pós-esplenectomiaunclassified

“…Outros riscos: Pacientes esplenectomizados também têm riscos aumentados para eventos tromboembólicos e para qualquer grau de disfunção da imunidade humoral, ocorrendo, no entanto, em menor frequência, com menor mortalidade e com risco para tais eventos muito menor que para a IFPE (SABATINO; CARSETTI; CORAZZA, 2011; DRAGOMIR et al, 2016).…”

Section: O Paciente Pós-esplenectomiaunclassified