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Splenectomy for thrombocytopenia
ABSTRACTS
cance of cholestasis in histiocytosis X: only two patients, aged 3 and 6 yr, are alive; the remaining patients died from progressive liver failure or sepsis at the ages of 11/2, 61/z, 71/2, and 19 yr.--Richard R. Ricketts
533
vitamin E deficiency. The authors speculate that the neurologic syndrome described may result from chronic vitamin E malabsorption in patients with chronic obstructive liver disease.--Eugene S. Wiener
CT of Choledochal Cyst. T. Araki, Y. Itai, and A. Tasaka.
Am J Roentgenol 135:729-734, (October), 1980. Ten patients undergoing CT scans prior to resection of a choledochal cyst ranged in age from 2 mo to 53 yr. CT revealed the diagnosis in 7 of l0 patients and suggested the diagnosis in three. The size, extent, and cystic character of the lesions were clearly seen, and more information concerning relationships with surrounding structures, certain postoperative complications, and status of the distal common bile duct was obtained compared to sonography. CT can be quite useful when sonography fails to provide adequate information. Five patients with abdominal pain, fever, abdominal mass, or jaundice after surgical treatment for choledochal cysts were also evaluated, and CT was found to be superior to sonography in evaluating postoperative complications. Three of the 15 patients were found to have cholangiocarcinomas arising in their cysts.--Randall W. Powell
Case Report: Case Records of the Massachusetts General Hospital. N Engl J Med 303:1466-1472, (December 18),
1980. This case report is of a 3-yr-old female with an abdominal mass associated with abdominal pain, anorexia, fever, and jaundice. Abdominal x-ray revealed a large mass in the right upper quadrant extending across the midline with a rim of calcification. An IVP revealed downward displacement of the right kidney. Arteriography demonstrated a large hypervascular mass in the area of the right adrenal and diffuse metastasis in the liver. Bone marrow and urine VMA were normal. The pathologic diagnosis was malignant teratoma with germ cell malignant component. The patient died shortly after removal of the primary lesion.---Eugene S. Wiener
Biliary Cystadenomas: Sonographic-Angiographic-Pathologic Correlations. M. E. Forrest. K. J. Cho, J. J. Shields,
Splenectomy for Thrnmbocytopenia. S. L Schwartz, L, M.
J. D. Wicks, T. M. Silver, and T. L. McCormick. Am J Roentgenol 135:723-727, (October), 1980.
One hundred and twenty patients ages 3-79 yr (mean 36 yr) underwent splenectomy for idiopathic thrombocytopenic purpura (ITP). The duration of disease was 1 day to 3 yr (mean 24 wk). All but six patients were taking steroids preoperatively. None received platelet infusions preoperatively. The incidence of accessory spleens was 18%. One hundred and five patients (88%) responded with normal platelet counts without relationship to prior steroid response--90% of these within 1 wk of splenectomy. Thrombocytopenia recurred after long intervals in three patients, one of whom had an accessory spleen subsequently removed with complete response. Five deaths occurred; none developed postsplenectomy sepsis. Thirteen patients, ages 6-76 yr (mean 34 yr) underwent splenectomy for ITP. Five patients died within 30 days and one died 1 yr postoperatively. Seven patients survived with normal platelet counts.--Eugene S. Wiener
One of the three reported patients was a 6-yr-old male presenting with abdominal pain, nausea and postprandial vomiting, and the presence of a palpable epigastric mass. A cystadenoma of the left lobe was resected. Sonographic appearance of this lesion is that of a large anechoic globular or ovoid mass containing multiple septations and papillary projections. Angiography usually reveals a hypovascular lesion with some neovascularity and a thin rim of contrast accumulation within the mass. The differential diagnosis includes congenital hepatic cysts, echinococcal cyst, abscesses, hematomas, cystic harmartomas, and other necrotic neoplasms.--Randall W. Powell A Progressive Neurologic Syndrome in Children With Chronic Liver Disease. J. L. Rosenhlum, J. P. Keating, A. L.
Hoepp, andS. Sachs. Surgery 88:497-506, (October), 1980.
Prensky, and J. S. Nelson. N Engl J Med 304:503-508, (February 26), 1981. The authors describe six patients with biliary atresia who developed a similar progressive neurologic syndrome at 2-10 yr of age. All were still jaundiced at the time of onset of neurologic symptoms. (With the exception of one who had undergone liver transplantation, it is unclear what operative procedures had been performed.) Three patients died at ages 5, 8, and 12 yr; the others were alive at ages 8 15 yr. The neurologic abnormalities included areflexia, gait disturbance, decreased vibratory and proprioceptive sensation, and paresis of gaze. In all patients serum vitamin E concentrations were below normal. Autopsy examinations in two patients revealed posterior column degeneration, loss of large-caliber, myelinated axons in peripheral nerves, and spheroids in the gracile and cuneate nuclei. These are similar to lesions found in animals with experimentally induced
Plasma Glucose Monitoring During Operation for Insulinomac A Critical Reappraisal. G. O. Yutt, Jr., A. J. Edis, F. J.
Service, and J. A. van Heerden. Surgery 88:351-356, (September), 1980. The authors analyzed the use of intraoperative plasma glucose monitoring as a determinant of complete removal of insulinomas. Of 37 patients (all adults?) operated between 1973-1979 all but 2 had curative excision by simple enucleation in 26 and by distal pancreatectomy in 9. In 27 patients there was a typical "hyperglycemic rebound" within 30 rain after curative excision; in 8 patients there was no increase in glucose until more than 90 rain after successful excision of insulinoma. Therefore 23% of patients exhibited inordinately delayed response, negating the predictive value of intraoperative glucose monitoring.--Eugene S. Wiener
cance of cholestasis in histiocytosis X: only two patients, aged 3 and 6 yr, are alive; the remaining patients died from progressive liver failure or sepsis at the ages of 11/2, 61/z, 71/2, and 19 yr.--Richard R. Ricketts
533
vitamin E deficiency. The authors speculate that the neurologic syndrome described may result from chronic vitamin E malabsorption in patients with chronic obstructive liver disease.--Eugene S. Wiener
CT of Choledochal Cyst. T. Araki, Y. Itai, and A. Tasaka.
Am J Roentgenol 135:729-734, (October), 1980. Ten patients undergoing CT scans prior to resection of a choledochal cyst ranged in age from 2 mo to 53 yr. CT revealed the diagnosis in 7 of l0 patients and suggested the diagnosis in three. The size, extent, and cystic character of the lesions were clearly seen, and more information concerning relationships with surrounding structures, certain postoperative complications, and status of the distal common bile duct was obtained compared to sonography. CT can be quite useful when sonography fails to provide adequate information. Five patients with abdominal pain, fever, abdominal mass, or jaundice after surgical treatment for choledochal cysts were also evaluated, and CT was found to be superior to sonography in evaluating postoperative complications. Three of the 15 patients were found to have cholangiocarcinomas arising in their cysts.--Randall W. Powell
Case Report: Case Records of the Massachusetts General Hospital. N Engl J Med 303:1466-1472, (December 18),
1980. This case report is of a 3-yr-old female with an abdominal mass associated with abdominal pain, anorexia, fever, and jaundice. Abdominal x-ray revealed a large mass in the right upper quadrant extending across the midline with a rim of calcification. An IVP revealed downward displacement of the right kidney. Arteriography demonstrated a large hypervascular mass in the area of the right adrenal and diffuse metastasis in the liver. Bone marrow and urine VMA were normal. The pathologic diagnosis was malignant teratoma with germ cell malignant component. The patient died shortly after removal of the primary lesion.---Eugene S. Wiener
Biliary Cystadenomas: Sonographic-Angiographic-Pathologic Correlations. M. E. Forrest. K. J. Cho, J. J. Shields,
Splenectomy for Thrnmbocytopenia. S. L Schwartz, L, M.
J. D. Wicks, T. M. Silver, and T. L. McCormick. Am J Roentgenol 135:723-727, (October), 1980.
One hundred and twenty patients ages 3-79 yr (mean 36 yr) underwent splenectomy for idiopathic thrombocytopenic purpura (ITP). The duration of disease was 1 day to 3 yr (mean 24 wk). All but six patients were taking steroids preoperatively. None received platelet infusions preoperatively. The incidence of accessory spleens was 18%. One hundred and five patients (88%) responded with normal platelet counts without relationship to prior steroid response--90% of these within 1 wk of splenectomy. Thrombocytopenia recurred after long intervals in three patients, one of whom had an accessory spleen subsequently removed with complete response. Five deaths occurred; none developed postsplenectomy sepsis. Thirteen patients, ages 6-76 yr (mean 34 yr) underwent splenectomy for ITP. Five patients died within 30 days and one died 1 yr postoperatively. Seven patients survived with normal platelet counts.--Eugene S. Wiener
One of the three reported patients was a 6-yr-old male presenting with abdominal pain, nausea and postprandial vomiting, and the presence of a palpable epigastric mass. A cystadenoma of the left lobe was resected. Sonographic appearance of this lesion is that of a large anechoic globular or ovoid mass containing multiple septations and papillary projections. Angiography usually reveals a hypovascular lesion with some neovascularity and a thin rim of contrast accumulation within the mass. The differential diagnosis includes congenital hepatic cysts, echinococcal cyst, abscesses, hematomas, cystic harmartomas, and other necrotic neoplasms.--Randall W. Powell A Progressive Neurologic Syndrome in Children With Chronic Liver Disease. J. L. Rosenhlum, J. P. Keating, A. L.
Hoepp, andS. Sachs. Surgery 88:497-506, (October), 1980.
Prensky, and J. S. Nelson. N Engl J Med 304:503-508, (February 26), 1981. The authors describe six patients with biliary atresia who developed a similar progressive neurologic syndrome at 2-10 yr of age. All were still jaundiced at the time of onset of neurologic symptoms. (With the exception of one who had undergone liver transplantation, it is unclear what operative procedures had been performed.) Three patients died at ages 5, 8, and 12 yr; the others were alive at ages 8 15 yr. The neurologic abnormalities included areflexia, gait disturbance, decreased vibratory and proprioceptive sensation, and paresis of gaze. In all patients serum vitamin E concentrations were below normal. Autopsy examinations in two patients revealed posterior column degeneration, loss of large-caliber, myelinated axons in peripheral nerves, and spheroids in the gracile and cuneate nuclei. These are similar to lesions found in animals with experimentally induced
Plasma Glucose Monitoring During Operation for Insulinomac A Critical Reappraisal. G. O. Yutt, Jr., A. J. Edis, F. J.
Service, and J. A. van Heerden. Surgery 88:351-356, (September), 1980. The authors analyzed the use of intraoperative plasma glucose monitoring as a determinant of complete removal of insulinomas. Of 37 patients (all adults?) operated between 1973-1979 all but 2 had curative excision by simple enucleation in 26 and by distal pancreatectomy in 9. In 27 patients there was a typical "hyperglycemic rebound" within 30 rain after curative excision; in 8 patients there was no increase in glucose until more than 90 rain after successful excision of insulinoma. Therefore 23% of patients exhibited inordinately delayed response, negating the predictive value of intraoperative glucose monitoring.--Eugene S. Wiener