The Spleen


by

Andy Petroianu

DOI: 10.2174/97816080527381110101
eISBN: 978-1-60805-273-8, 2011
ISBN: 978-1-60805-082-6



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Indexed in: Book Citation Index, Science (BKCI-S), Web of Science, Scopus, EBSCO.

The spleen is an organ responsible for many biological functions, such as immunological defense, the removal of foreign particles from...[view complete introduction]

Table of Contents

Foreword

- Pp. i

Leon Morgenstern

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Preface

- Pp. ii

Andy Petroianu

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List of Contributors

- Pp. iii-iv (2)

Andy Petroianu

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Historical Aspects of Spleen and Splenic Surgeries

- Pp. 3-19 (17)

Andy Petroianu

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Functions of the Spleen and their Evaluation

- Pp. 20-36 (17)

Catalin Vasilescu

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Histology and Histopathology of the Spleen

- Pp. 37-74 (38)

Kim Vaiphei

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Some Aspects of Splenic Pathology

- Pp. 75-83 (9)

Alfredo J. A. Barbosa

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Sepsis and the Spleen

- Pp. 84-116 (33)

Ruy Garcia Marques

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Surgical Anatomy of the Spleen

- Pp. 117-133 (17)

Andy Petroianu

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The Spleen in Patients with Portal Hypertension

- Pp. 134-152 (19)

Ahmed Helmy

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Benign Vascular, Cystic and Solid Diseases of the Spleen

- Pp. 153-178 (26)

Eelco de Bree, Vasilis Charalampakis and John Melissas

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Chronic Lymphocytic Leukemia, Follicular Lymphoma and the Spleen

- Pp. 179-191 (13)

Andre Marcio Murad and Andy Petroianu

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Primary and Metastatic Cancer of the Spleen

- Pp. 192-201 (10)

Jorg Sauer

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Pre- and Postoperative Care for Surgical Procedures on the Spleen

- Pp. 201-216 (16)

Mircea Dan Venter

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Conservative Surgical Procedures on the Spleen

- Pp. 217-249 (33)

Andy Petroianu

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Laparoscopic Splenectomy

- Pp. 250-258 (9)

Rene Berindoague Neto

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Robotic Splenectomy

- Pp. 259-263 (5)

Catalin Vasilescu

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Splenic Trauma

- Pp. 264-275 (12)

Takeshi Shimazu

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Index

- Pp. 276-279 (4)

Andy Petroianu

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Foreword

I welcome this work with enthusiasm. Having devoted most of my professional life to study the spleen and to research on techniques of splenic resection, I was pleased and honored when the editor of this book, Dr. Andy Petroianu, asked me to write a Forward to it. Books solely on the spleen are relatively rare and books on splenic surgery are even rarer. Among human solid organs, the spleen seems to be an orphan. With most other organs, such as the brain, heart, and kidney, much has been written on their history, anatomy, function and surgical treatment. An up-to-date volume on the current concepts and techniques of splenic surgery is the most necessary and commendable addition.

Why has the spleen lagged behind other organs in published works? In the popular mind, many people are unaware that they even have a spleen. Still others do not know where in the body it is located. Almost no one knows what it does. For surgeons, it has long been a bête noir, accessible only with difficulty high in the left upper quadrant and so fragile that even minor inadvertent injury could lead to lethal hemorrhage. That this is no longer true which is amply written about in this book by a group of international experts in splenic disease and splenic surgery.

Modern splenic surgery owes its spectacular rise partially to advances in other fields. In the diagnosis of splenic diseases, the explosive growth of imaging capabilities has been added immensely to our capabilities. These have included radionuclide scanning, ultrasound, computerized tomography and magnetic resonance imaging. They all contributed to elucidating difficult diagnostic problems. New hemostatic techniques can also be credited, since the spleen is so unforgivably fragile and subject to obstinate and dangerous bleeding. For this problem, there were advances such as electro cautery, stapling, argon beam, high frequency ultrasound and a great variety of topical hemostatic agents such as fibrin glue, microfibrillar collagen and a host of others. Finally, the laparoscopic revolution has been truly transformative. Frankly, when it was first mentioned to me, I was incredulous as I recalled my many years of struggle in the left upper quadrant with the abdomen open. To think that all of that could be accomplished remotely through a narrow tube was beyond my imagination. I was proven wrong in my own institution when bold surgeons looked past my doubts and were among the first to perform and publish on laparoscopic splenectomy. It has now become the standard of care for many splenic diseases.

What is there to look forward to some future edition of this book on the same subject material? Predictions are always dangerous but are good mental exercises and sometimes come true. I think that a number of diseases now requiring splenectomy will be eliminated by advances in genomic medicine, targeted chemotherapy and stem cell therapy and other new approaches. Splenectomy in the leukemias will become increasingly rare or non-existent. Witness, for example, the success of Gleevec for myelogenous leukemia and the purine analogues for hairy cell leukaemia. Splenectomy for metabolic diseases like Gaucher Disease will also become rarer. Witness the success of the replacement enzyme, glucocerebrocidase. Splenectomy for parasitic diseases will yield to specific therapies as they are discovered. Splenectomy for a malignant neoplasm such as Hodgkin’s Lymphoma has virtually disappeared and other tumors will also be conquered as the cure or cures for cancer are found. Splenectomy for benign neoplasms such as hemangioma will yield to better diagnosis and conservative surgery.

I also believe that the technique of laparoscopic splenectomy will be enhanced by three dimensional imaging, zoom capabilities and texture detecting technology. There will also be new hemostatic manoeuvres and topical agents that will ease the bleeding problem. Finally, I am convinced that conservative surgery of the spleen will become the standard of care world-wide, it is an organ that is much better left in than taken out.

This book serves the purpose of a comprehensive survey and description of the current state of the art of splenic surgery. It is timely, necessary and indeed welcome.

Leon Morgenstern

UCLA School of Medicine,

Califórnia

USA


Preface

The spleen is one of the most important organs, and is responsible for many pivotal functions, such as defense of the organism, the removal of foreign particles from the blood flow, the metabolism of bilirubins, lipids and several aminoacids, the control of the number of blood leukocytes and platelets, the maturity of lymphocytes and opsonins, hematopoesis, among others. Thus, this organ belongs to several medical specialties, mainly Haematology, Immunology, Oncology, Infectology and Surgery.

Splenectomy is a general surgical procedure which is most commonly used in trauma, but it is also performed to treat haematological, immunological, metabolic and oncological diseases. Other indications for splenectomy include morphological disturbances, retarded somatic and sexual development, portal hypertension, parasitic infections, abscesses haemangiomas and cysts.

Until recently, the absence of the spleen was not considered as a risk factor for severe complications, even with the knowledge of death provoked by postsplenectomy sepsis, which has existed since the nineteenth century. Recent studies have proved that the complete removal of the spleen is mostly useless, and is commonly followed by a high rate morbidity and mortality. Moreover, asplenic patients are more susceptible to severe infections, including overwhelming sepsis, meningitis and pneumonia. The estimated incidence of severe sepsis after total splenectomy is 8%.

Another critical postsplenectomy complication is pulmonary thromboembolism. The incidence of this affection may reach 35%. This complication is apparently not due to thrombocytosis, although the number of platelets may increase considerably in asplenic patients.

Haematological diseases, such as myeloid hepatosplenomegaly, leukemias and lymphomas, as well as metabolic affections, including dyslipidemias, are followed by high morbidity and mortality rates when the spleen is removed. In these cases, conservative surgeries are proposed to avoid this problem. On the other hand, total splenectomy may be inevitable in cases such as trauma or even in elective conditions (eg. hypersplenism, idiopathic thrombotic purpura, spherocytosis, among others). The benefits generated by this procedure must be weighed against the risks of asplenism.

This book is written exclusively to show the spleen in relation to basic sciences (anatomy, physiology) and the clinical practice of specialties related to this organ is useful for clinical physicians, haematologists, oncologists, infectologists, general surgeons, oncologic surgeons, trauma surgeons, resident physicians and medical students.

The Bentham Science Publishers gave the honour of editing this book. I am proud to accept the challenge and have the privilege of bringing together distinguished researchers from several countries on medical procedures concerning the spleen. Professor Leon Morgenstern, who is the most esteemed reference in studies regarding the spleen agreed to write the Forward of this book. All participating authors have written pivotal chapters and have contributed to advances in research on medical procedures concerning the spleen. Thanks to these contributors, as well as, many other investigators around the world, the spleen is no longer as mysterious as it was once described by Claudius Galen.

Andy Petroianu

Federal University of Minas Gerais,

Brazil

List of Contributors

Editor(s):
Andy Petroianu
Federal University of Minas Gerais
Brazil




Contributor(s):
Ahmed Helmy
Associate Professor and Consultant
Director of Viral Hepatitis Services and Research Centre of the Department of Tropical Medicine and Gastroenterology
Faculty of Medicine of the Assiut University Hospitals
Egypt


Alfredo José Afonso Barbosa
Professor of the Department of Pathology
School of Medicine
Federal University of Minas Gerais
Belo Horizonte
Brazil


André Márcio Murad
Associate Professor of the Department of Clinics and Medical Oncology of the School of Medicine
Federal University of Minas Gerais
Brazil


Andy Petroianu
Professor of Surgery of the Department of Surgery of the School of Medicine of the Federal University of Minas Gerais
Belo Horizonte
Brazil


Avenida Afonso Pena
Belo Horizonte
MG, 30130-005
Brazil


Catalin Vasilescu
Associate Professor of the Fundeni Institute of Digestive and Liver Transplantation
258 Fundeni Street - Bucharest
Romania


Eelco Bree
Associate Professor of Surgical Oncology
University Hospital, Heraklion
Greece - P.O. Box 1352
Heraklion, 71110
Greece


J. Melissas
Professor of Surgery and Head of the Department of Surgical Oncology
University Hospital, Heraklion
Greece - P.O. Box 1352
Heraklion, 71110
Greece


Jörg Sauer
Professor of Surgery
Karolinen-Hospital Hüsten
Department of General and Visceral Surgery - D-59759 Arnsberg
Germany


Kim Vaiphei
Additional Professor of the Department of Histopathology
PGIMER Chandigarh
India


Mircea Dan Venter
Associate Professor of the Department of Surgery of the Emergency Clinical Hospital
Bucharest
Romania


René Berindoague Neto

Associate Professor of the Faculty of Medical Sciences of Minas Gerais and Surgeon of the Institution of Teaching and Research of the Holly House of Misericorde of Belo Horizonte
Brazil


Rua dos Otoni
909 - sala 404 - Belo Horizonte
Brazil


Ruy Garcia Marques
Associate Professor of the Department of Surgery of the School of Medicine
State University of Rio de Janeiro
Rio de Janeiro
Brazil


Takeshi Shimazu
Professor of Surgery of the Department of Traumatology and Acute Critical Medicine of the Faculty of Medicine
(D-8) of the Osaka University (D-8) 2-15 Yamadoaka
Suite-shi
Osaka, 565-0871
Japan


Vasilis Charalampakis
Associate Professor of Surgical Oncology
University Hospital, Heraklion
Greece - P.O. Box 1352
Heraklion, 71110
Greece




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