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Article
Chronic Idiopathic Thrombocytopenic Purpura Effects of Certain Variables on the Response to Treatment.

Author: Khudhayer A. Al-Khalissi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 1 Pages: 45-49
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Idiopathic thrombocytopenic purpura is an acquired chronic autoimmune disease .Treatment whenindicated is usually by corticosteroids,then splenectomy if no acceptable response,with variableresponse rate to both types of treatment.OBJECTIVE:To look for the effects of certain variables on the type of response to steroid therapy in patients withadult idiopathic thrombocytopenic purpura, and to study the outcome of splenectomy in relation toprevious steroid therapy.METHOD:A prospective study on 80 patients, presented with bleeding and a platelet count of ≤ 30 X 109 / L.Initially treated with prednisolone and the response was studied in relation to gender , age , duration ofbleeding and platelet count on presentation. Patients who failed to maintain permanent completeremission were advised to have splenectomy.RESULTS:Of the 80 patients, 62 (77.5 %) were females and 18 (22.5%) were males. Mean age was 23 ± 10.1years. Ten (12.5%) patients only had permanent complete remission after steroid therapy. While 70(87.5%) patints failed. Response to steroid therapy was significantly related to duration of bleeding butnot to gender, age and platelet count. Thirty seven (46%) patients underwent splenectomy, permanentcomplete remission were achieved in 29 (78.2%).CONCLUSION:1. Duration of bleeding of ≤ 3 weeks is a good predictor of successful steroid therapy.2. Results after splenectomy is not related to previos steroid therapy


Article
Complications of High Serum Ferritin Level after Splenectomy in β Thalassemic Patients

Author: Zuhair Omran Easa
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2009 Volume: 12 Issue: 1 Pages: 243-250
Publisher: University of Kufa جامعة الكوفة

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Objectives: Compare between splenectomized and non splenectomized β -thalassemic patients regarding clinical, biochemical and therapeutic characteristics. Methods: This study was conducted on 140 patients with beta thalassemia major and thalassemia intermedia, expressed as two groups (group I) splenectomized patients and (group II) non splenectomized patients, who were attending Thalassemia Center in Karbala Teaching Hospital for Children from the first of November 2007 through 30th of April 2008. Both groups were studied by physical examination, biochemical analysis, hemoglobin level, serum ferritin, hepatitis C virus antibodies, and hepatitis B surface antigen. Echocardiography was done for most of patients. Results: In group I patients, 82.9% were under transfused and 80% were underchelated, whereas 91.4% of group II patients were under transfused and 74.3% of them were underchelated. Complications including, cardiac complications, diabetes mellitus, bone deformities, and gall stone were higher in group I than group II patients, moreover, only bone deformities was detected in β- thalassemia intermedia patients of both groups. Splenectomy was beneficial in reducing frequency of blood transfusion in 77.1% of group I patients. Conclusions: There is an aggravating effect of splenectomy on hemosiderosis. High serum ferritin level in splenectomized patients is associated with higher incidence of complications.


Article
ASSESSMENT OF RISK FACTORS FOR POSTSPLENECTOMY PULMONARY HYPERTENSION

Authors: Waseem F. Al Tameemi وسيم فاضل محمد التميمي --- Maan M.A. Hamid معن حميد --- Haider N. Dawood حيدر نوري داود
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2014 Volume: 12 Issue: 1 Pages: 66-71
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Splenectomy has been associated with several long-term complications; pulmonary arterial hypertension has gained special attention. It seems that the absence of a spleen, rather than underlying condition for which the splenectomy was performed, is the primary cause of this condition.Objectives:Assessing the risk factors for development of pulmonary hypertension in different indications of splenectomyMethod:Fifty postsplenectomy patients were included and transthoracic echocardiographic study looking for right ventricle size; ejection fraction and pulmonary artery pressure were performed for each patient in addition to complete blood count.Results:The patients' mean age was 32.5±1.8 years. The mean duration after splenectomy was 5.2±0.34 years with a range of 1-10 years. Hemoglobinopathies in different types formed 54% (27/50) of these indications, while non hematological indications were reported in 7 cases (14%). Pulmonary arterial hypertension was reported in 22% of patients with mean pressure 30.10±1.18 mmHg. It is positively correlated with right ventricular size. The highest risk of pulmonary arterial hypertension was reported with splenectomy due to hemolytic diseases in comparison with other indication despite persistence of similar risk in non hemolytic indication but of no statistical significance. The more severe degree of anemia has negative correlation with pulmonary arterial hypertension as well as high WBC count unlike thrombocytosis.Conclusion:Whatever the underlying indications of splenectomy, the risk of pulmonary hypertension exists, which may not related only to thrombocytosis but also for anemia and leucocytosis and it needs long duration follow up to be diagnosed.Key words:Splenectomy, pulmonary hypertension.


Article
Splenic Injuries atAl-Kadhimiya Teaching Hospital

Authors: Nahidh A. Abdulshaheed ناهد عداي عبد الشهيد --- Anees K. Nile انيس نايل --- Hikmat A. Hatam حكمت حاتم
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2009 Volume: 5 Issue: 1 Pages: 83-90
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The spleen is the most common solid organ injured in patients who had sustained abdominal trauma. Such injuries to the spleen represent approximately one quarter of all blunt injuries of the abdominal viscera.Due to its remarkable vasculature and its fragile structure, splenic rupture is the most widespread cause of intra-abdominal hemorrhage.Objective: To assess the magnitude of splenic injury, the management of splenic injury, and to evaluate the postoperative complications.Methods: A prospective study of 57 cases of splenicinjury was performed in Al-Kadhimiya TeachingHospital during the period between the 1st of October2004 and the 1st of October 2006. Statistical analysiswas then performed to identify the causes, managementand postoperative complications. Splenic injuries weregraded into 5 grades.Results: The highest incidence of splenic injury was recorded in age group s31-40 year. Penetrating injury was much more common than blunt trauma (73.68% versus 26.31%).Fifty patients (87 %) were diagnosed by exploratory laparotomy, ultrasonography in 5 patients (8.77 %), CT scan was positive in 2 patients (3.5 %). Associated injuries were recorded in 41 patients 71.92%. Pulmonary complications were the most frequent complications (18 patients, 31.57 %).Conclusion: Splenic injuries are common surgical problems in Al-Kadhimiya Teaching Hospital. Still there are many difficulties in establishing the diagnosis of the splenic injury with shortage in the new diagnostic modalities especially (CT -Scan, MR1 and even U/S scan) in the emergency situations.In spite of the dangerous post-operative complications of splenectomy, it is still the most commonly performed surgical procedure in cases of splenic injury.

Keywords

Spleen --- Splenic Injury --- Splenectomy --- Repair


Article
Splenic abscess: A rare presentation

Author: Dr. Najeeb S. Jabbo
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2013 Volume: 12 Issue: 1 Pages: 65-67
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Splenic abscess is a rare entity with a wide variability of causative pathogens Its reported mortality rate is still high, up to 47%, and can potentially reach 100% among patients who do not receive antibiotic treatment. The timely and widespread use of imaging methods (eg, computed tomography [CT] scanning, ultrasonography) facilitates early diagnosis and guides treatment, thus improving the prognosis. We are reporting a 42-year-male patient presented with an abscess in the spleen. The etiology was due to typhoid fever. It was diagnosed by CT-scan and treated by splenectomy. A review of the modalities of treatment is discussed


Article
Management Approaches of Splenic Surgery

Authors: Issam Salih Abduljabbar Al-Janabi --- Maha Abduljabbar Lattuf Al-Rudaini --- Hareth Abbas Hassan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 235-242
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Splenic surgery is common surgical procedure with different indications and approaches that carries some potential complications which can be avoided. OBJECTIVE: To analyze the indications, management and complications of splenic surgery. PATIENTS AND METHOD: Prospective study conducted in the 3rd unit of general surgery department of Baghdad teaching hospital & private hospital over a period of 3 years, from the first of January 2008 till the end of December 2011. Ninety six patients with traumatic and non traumatic splenic pathologies were evaluated and followed up. RESULTS: This study includes ninety six patients with different splenic pathologies were included in this study with mean age of 23.69 ± 14.853 years. Sixty five patients with non traumatic pathology were treated by elective surgery with mean age of 20.25 ± 12.857 years, fifty eight of them by open splenectomy, four by laparoscopic splenectomy, two cystectomy of hydatid disease of the spleen and one by drainage of splenic abscess. Idiopathic thrombocytopenic purpura (I.T.P.) was the most common indication of non-traumatic splenectomy followed by thalassemia. Thirty one patients with trauma with mean age of 30.90 ± 16.325 years (16 of them had penetrating injury and 15 had blunt trauma) were treated by emergency splenectomy in 24 patients, splenorrhaphy in 5 and conservative treatment in 2 of them. Post-operative complications occurred in 25(26%) patients, pulmonary complication was the most common one, and the overall mortality was 5.2%.CONCLUSION: Splenectomy still the most common option in traumatic cases but the availability of new diagnostic imaging might improve the future results to conserve some injured spleen and there is a place for laparoscopic approach in selected cases of elective splenectomy and splenic preservation in some splenic hydatid cyst.


Article
Minimally Invasive Splenectomy for splenomegaly by traditional technique:A comparative study with conventional laparoscopic Splenectomy

Authors: Fadhil A. MuhiAldeen فاضل احمد محي الدين --- Kalandar H. Kasnazan
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2013 Volume: 9 Issue: 15 Pages: 97-107
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Minimally invasive surgery is a well known advantageous technique to all health systems, it is still possible to do minimal invasive technique, without using expensive equipments and its burden regarding; cost, maintenance and other disadvantages. This study was performed to compare minimally invasive surgery with classical traditional surgical technique in the aspects of reduced post-operative pain, shorter hospital stay and shorter convalescence period. In this study our cases underwent splenectomy through small incisions, which are almost equal to laparoscopic procedures and compared to equal number of cases underwent splenectomy through classical traditional technique. Decisions for splenectomy were made by physicians for a variety of well known disease status that complete cure or improvement will be gained by splenectomy. In this study, eighteen cases were studied, from which nine were males (mean age34.3±20.45) and nine were females (mean age=21.6±15.99). Nine of them were underwent splenectomy through minimally invasive incisions, the other group splenectomized through classical traditional incisions. The first group was discharged earlier; need much lesser narcotic medication and shorter convalescence period. In summary, compared to conventional classical method approach, Minimally Invasive Splenectomy is significantly facilitates the surgical procedure, reduces the risk and difficulty in the cases of splenomegaly. So this technique is more feasible and more effective than conventional clasical method for the removing of the splenomegaly.

الجراحات الغازية الحد الأدنىMinimally invasive surgery) )هو أسلوب معروف لجميع النظم الصحية، فإنه لا يزال من الممكن القيام بالتقنية الغازية الحد الأدنى، من دون استخدام معدات باهظة التكاليف والأعباء التي تتعلق؛بالتكلفة والصيانة وغيرها من المشاكل. وقد أجريت هذه الدراسة للمقارنة بين الجراحات مع التقنية الكلاسيكية الجراحية التقليدية في جوانب قلة الألم بعد العملية، البقاء لفترة أقصر في المستشفى وقصرفترة النقاهة. في هذه الدراسة تم استئصال الطحال من خلال فتحات صغيرة، والتي هي على قدم المساواة تقريبالإجراء العمليات بالمنظار، وبالمقارنة مع عدد متساو من الحالات التي خضعت لاستئصال الطحال من خلال التقنية التقليدية الكلاسيكية. واتخذت قرارات لاستئصال الطحال من قبل الأطباءالمختصين لمجموعة متنوعة من الحالات المرضية المعروف جيدا أن تكتسب الشفاء التام أوتتحسن بعد استئصال الطحال. في هذه الدراسة، تمت دراسة 18 حالة وخضع تسعة منهم استئصال الطحال من خلال شقوق صغيرة،وخضع البقية منهم لاستئصال الطحال من خلال الشقوق التقليدية الكلاسيكية. وتم تسريح المجموعة الأولى في وقت مبكر، واحتاجوالى الادوية المخدرة بنسب أقل بكثير وكانت فترة نقاهتم اقصر.


Article
Comparison of thyroid function tests between splenectomised and non-splenectomised β-thalassemia major patients
مقارنة فحوصات وظيفة الغدة الدرقية بين مرضى الثلاسيميا الكبرى نوع بيتا ممن استؤصلت لهم طحالاتهم مع من لم تستأصل لهم

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Abstract

This study was to evaluate and compare thyroid function tests and serum levels of ferritin in splenectomised and non-splenectomised β-thalassemic patients. This study is a case control study that was conducted in the Thalassemia Center in Ibn Al-Atheer Teaching Hospital in Nineveh Province/ Iraq during March-June 2014. Fifty patients of homozygous β-thalassemia major (TM) and twenty five apparently healthy controls were included in this study. The patients were divided into splenectomised and non-splenectomised patients (each 25 patients). Medical history and blood samples were collected from all participants and serum levels of Thyroid stimulating hormone (TSH), Thyroxine (T4), Free thyroxine (FT4), Triiodothyronie (T3), Free triiodothyronine (FT3), and ferritin in addition to body mass index (BMI) were measured.There were significant decreases in BMI and serum FT4, while there were significant increases in serum TSH and ferritin in β-thalassemia major (in which 10% were diagnosed with hypothyroidism) in comparison with control participants. No significant differences were found between splenectomised and non-splenectomised patients in all parameters measured except a significant positive correlation between serum ferritin and TSH and a significant negative correlation between serum ferritin and T4 that reflects 16% hypothyroidism in splenectomised patients. In addition, significant increases were found in serum TSH and ferritin and a significant decrease in serum FT4 in splenectomised patients when compared with the control. Moreover, a comparison of non-splenectomised patients with control group showed no significant difference in all parameters measured except a significant increase in serum ferritin level. In conclusion, there were certain significant differences in thyroid function tests between β-thalassemia major patients and the controls, whereas there were no significant differences in the means of all studied parameters between splenectomised and non- splenectomised patients except for the positive significant correlation of serum ferritin with TSH level in splenectomised patients which reflect the hypothyroidism in splenectomised TM patients.

الهدف من هذه الدراسة هو لتقييم و اجراء مقارنة فحوصات وظيفة الغدة الدرقية و مستويات الفريتين في مصل الدم بين مرضى الثلاسيميا الكبرى نوع بيتا ممن استؤصلت لهم طحالاتهم مع من لم تستأصل لهم. اجريت هذه الدراسة في مركز الثلاسيميا في مستشفى ابن الاثير التعليمي في محافظة نينوى حيث، شملت الدراسة 50 شخصا من مرضى الثلاسيميا الكبرى نوع بيتا و 25 شخصا سليما كمجموعة ضابطة. قسم المرضى الى مجموعتين مجموعة من المرضى ممن قد تم استئصال الطحال لديهم ومجموعة من المرضى ممن لم يستأصل لهم الطحال (25 مريض لكل مجموعة). تم اخذ التاريخ الطبي و عينات الدم واجريت الفحوصات المختبرية الخاصة بوظيفة الغدة الدرقية ومصل الفريتين وتم قياس مؤشر كتلة الجسم لكل المشاركين.وجد مؤشر كتلة الجسم وال FT4 منخفض بشكل معنوي, بينما وجد الفريتين, وال TSH لمصل الدم كان مرتفع بشكل معنوي في مرضى الثلاسيميا (حيث كان قد شخص 10% منهم مصابين بكسل في الغدة الدرقية) مقارنة بالأشخاص السليمين. لم يكن هناك اي اختلاف معنوي في مجموعة المرضى الذين استؤصل منها الطحال عن مجموعة المرضى بدون استئصال الطحال في الفحوصات المختبرية ماعدا وجود علاقة معنوية طردية بين مصل الفرتين وال TSH وعلاقة معنوية عكسية بين مصل الفريتين وال T4 في مجموعة المرضى الذين استؤصل منها الطحال حيث وجد 16% منهم لديهم كسل في الغدة الدرقية. عند مقارنة مجموعة المرضى الذين استؤصل منها الطحال مع المجموعة الضابطة، وجدنا ارتفاع معنوي في مصل الفريتين وال TSH وانخفاض معنوي في ال FT4, بينما عند مقارنة مجموعة المرضى الذين بدون استئصال الطحال مع المجموعة الضابطة، لم يلاحظ اي فرق معنوي ما عدا الارتفاع في فريتين مصل الدم. نستنتج من هذه الدراسة ان هنالك عدد من الفروقات المعنوية لفحوصات وظيفة الغدة الدرقية بين مرضى الثلاسيميا الكبرى نوع بيتا وبين مجموعة السيطرة بينما لا يوجد فروقات معنوية في معدلات جميع الفحوصات التي تم دراستها بين مرضى الثلاسيميا ممن استؤصل لهم طحالاتهم مع من لم تستأصل لهم. كما وجد فرق معنوي طردي للعلاقة بين الفريتين وال TSH في مصل الدم والعلاقة المعنوية العكسية للفريتين وال T4 في مصل الدم لدى مجموعة المرضى المستأصل طحالاتهم مما ادّى الى كسل الغدة الدرقية لديهم.


Article
Evaluation of Interleukin 8, Interleukin 2 Receptor and Serum Ferritin in 60 Patients with BetaThalassemia Major: Relationship to Splenectomy

Author: Basma Dawood Hanoon*, Subuh Salim AL-Mudalal **
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 1 Pages: 6-11
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: β-Thalassemia is an inhereted hemoglobin disorder characterized by the absence or reduced synthesis of the β-globin chain. Several immunological defects can be found in patients with β-thalassaemia. Increased IL-8 level was documented in patients with β-thalassaemia and it is probably due to overstimulation of macrophages.OBJECTIVE: Evaluation of serum levels of IL-8, soluble IL-2 Receptor, and serum ferritin in the splenectomized and the non-splenectomized β-thalassemia major patients.METHODS: A cross sectional study was conducted on 60 patients with homozygous β-thalassemia major who were attending Al Karama Teaching hospital from May 2011 to Auguest 2011. Place of work was Al-Kadhmia and Al Karama teaching hospital. Patients were divided into two groups; thirty splenectomized, thirty non-splenectomized, and thirty healthy age and sex matched as control group. RESULT:The mean level of IL-8 was increased in both groups of thalassaemia with significantly higher in the splenectomized 333.06±255.50 pg/ml compare to the non-splenectomized 118.61±46.59 pg/ml and the control 38.39±9.52 pg/ml , P-value<0.05. The mean level of sIL-2R was not increased above the reference range in the control subjects, the non-splenectomized and the splenectomized, which was 732.96+28.96 pg/ml, 723.42±74.15pg/ml and 777.38±86.93pg/ml respectively .The mean serum ferritin level in the splenectomized was 2050.1 ng/ml which was significantly higher compared to the non- splenectomized 1212.2 ng/ml, P-value<0.05. There was significant correlation between IL-8 and serum ferritin, P-value<0.05 while there was no significant correlation between s IL-2R and serum ferritin, in both groups of Thalassaemia P value> 0.05. CONCLUSION: - β-thalassemia major patients had increased level of IL- 8 which was more prominent in splenectomized patients, while no increase in IL-2R levels in both groups of Thalassemia.-IL-8 levels correlated with ferritin levels, while no significant correlation between IL-2R levels and ferritin levels in both groups of Thalassaemia.- Splenectomized thalassaemic patients display higher ferritin levels compared to the non-splenectomized. .


Article
Primary splenic follicular lymphoma treated with splenectomy and adjuvant chemotherapy; a case report

Authors: Anju A. Abraham --- Sreejith G. Nair --- Rony Benson --- Jayasudha A. Vasudevan
Journal: Iraq Joural of Hematology المجلة العراقية لامراض الدم ISSN: 20728069/25432702 Year: 2018 Volume: 7 Issue: 2 Pages: 90-92
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Primary splenic lymphoma is a rare low‑grade non‑Hodgkin’s lymphoma. This is a case of a 52‑year‑oldwoman who had an incidental detection of a lesion in the spleen during evaluation for fever whichwas found to be a case of primary grade III follicular lymphoma of the spleen. The patient wasstarted on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapypostsplenectomy. Rituximab was not added initially as the patient had a high viral load of hepatitis Bvirus (HBV). The patient completed six cycles of chemotherapy and rituximab added after four cycleswhen HBV DNA titer became negative. The outcome in patients with primary follicular lymphoma isgood with splenectomy followed by multi‑agent chemotherapy.

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