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Background: The toxicological effects of fine particulate matter (PM 2.5 ) on the cardiopulmonary and nervous systems have been studied widely, whereas the study of PM 2.5 on systemic toxicity is not in-depth enough. Lipopolysaccharide (LPS) can cause multiple organ damage. The combined effects of co-exposure of PM 2.5 plus LPS on the stomach, spleen, intestine, and kidney are still unclear. Purpose: This study was aimed to explore the toxicological effects of co-exposure of PM 2.5 and LPS on the different organs of mice. Research Design and Study Sample Using a real-ambient PM 2.5 exposure system and an intraperitoneal LPS injection mouse model, we investigated multiple organ damage effects on male BALB/c mice after co-exposure of PM 2.5 plus LPS for 23 weeks in Linfen, a city with a high PM 2.5 concentration in China. Data Collection: Eosin-hematoxylin staining, ELISA and the biochemical assay analysed the toxicological effects. Results: The pathological tissue injury on the four organs above appeared in mice co-exposed to PM 2.5 plus LPS, accompanied by the body weight and stomach organ coefficient abnormality, and significant elevation of pro-inflammatory cytokines levels, oxidative stress in the spleen and kidney, and levels of kidney injury molecule (KIM-1) increase in the kidney. There were tissue differences in the pathological damage and toxicological effects on mice after co-exposure, in which the spleen and kidney were more sensitive to pollutants. In the PM 2.5 + LPS group, the superoxide dismutase inhibition and catalase (CAT) activity promotion in the kidney or spleen of mice were significant relative to the PM 2.5 group; the CAT and interleukin-6 (IL-6) levels in the spleen were raised considerably compared with the LPS group. Conclusions: These findings suggested the severity and sensitivity of multiple organ injuries in mice in response to PM 2.5 plus LPS.

Background: H syndrome (HS) is a rare autoinflammatory disease caused by a mutation in the solute carrier family 29, member 3 (SCL29A3) gene. It has a variable clinical presentation and little phenotype-genotype correlation. The pathognomonic sign of HS is cutaneous hyperpigmentation located mainly in the inner thighs and often accompanied by other systemic manifestations. Improvement after tocilizumab treatment has been reported in a few patients with HS. We report the first patient with HS who presented cardiogenic shock, multiorgan infiltration, and digital ischemia., Case Presentation: 8-year-old boy born to consanguineous parents of Moroccan origin who was admitted to the intensive care unit during the Coronavirus Disease-2019 (COVID-19) pandemic with tachypnoea, tachycardia, and oliguria. Echocardiography showed dilated cardiomyopathy and severe systolic dysfunction compatible with cardiogenic shock. Additionally, he presented with multiple organ dysfunction syndrome. SARS-CoV-2 polymerase chain reaction (PCR) and antibody detection by chromatographic immunoassay were negative. A previously ordered gene panel for pre-existing sensorineural hearing loss showed a pathological mutation in the SCL29A3 gene compatible with H syndrome. Computed tomography scan revealed extensive alveolar infiltrates in the lungs and multiple poor defined hypodense lesions in liver, spleen, and kidneys; adenopathy; and cardiomegaly with left ventricle subendocardial nodules. Invasive mechanical ventilation, broad antibiotic and antifungal coverage showed no significant response. Therefore, Tocilizumab as compassionate use together with pulsed intravenous methylprednisolone was initiated. Improvement was impressive leading to normalization of inflammation markers, liver and kidney function, and stabilising heart function. Two weeks later, he was discharged and has been clinically well since then on two weekly administration of Tocilizumab., Conclusions: We report the most severe disease course produced by HS described so far in the literature. Our patient's manifestations included uncommon, new complications such as acute heart failure with severe systolic dysfunction, multi-organ cell infiltrate, and digital ischemia. Most of the clinical symptoms of our patient could have been explained by SARS-CoV-2, demonstrating the importance of a detailed differential diagnosis to ensure optimal treatment. Although the mechanism of autoinflammation of HS remains uncertain, the good response of our patient to Tocilizumab makes a case for the important role of IL-6 in this syndrome and for considering Tocilizumab as a first-line treatment, at least in severely affected patients.

Background: Endovascular embolization is increasingly used in treating traumatic hemorrhage and other applications. No endovascular-capable translational large animal models exist and coagulopathy's effect on embolization techniques is unknown. We developed a coagulation-adaptable solid organ hemorrhage model in swine for investigation of embolization techniques., Methods: Anesthetized swine (n = 26, 45 ± 3 kg) had laparotomy and splenic externalization. Half underwent 50% isovolemic hemodilution with 6% hetastarch and cooling to 33-35°C (COAG group). All had controlled 20 mL/kg hemorrhage and endovascular access to the proximal splenic artery with a 4F catheter via a right femoral sheath. Splenic transection and 5 min free bleeding were followed by treatment (n = 5/group) with 5 mL gelfoam slurry, three 6-mm coils, or no treatment (n = 3, control). Animals received 15 mL/kg plasma resuscitation and were monitored for 6 hr. Splenic blood loss was continuously measured and angiograms were performed at specified times., Results: Coagulopathy was successfully established in COAG animals. Pre-treatment blood loss was greater in COAG (11 ± 6 mL/kg) than non-COAG (7 ± 3 mL/kg, P = 0.04) animals. Splenic hemorrhage was universally fatal without treatment. Non-COAG coil survival was 4/5 (326 ± 75 min) and non-COAG Gelfoam 3/5 (311 ± 67 min) versus non-COAG Control 0/3 (82 ± 18 min, P < 0.05 for both). Neither COAG Coil (0/5, 195 ± 117 min) nor COAG Gelfoam (0/5, 125 ± 32 min) treatment improved survival over COAG Control (0/3, 56 ± 19 min). Post-treatment blood loss was 4.6 ± 3.4 mL/kg in non-COAG Coil and 4.6 ± 2.9 mL/kg in non-COAG Gelfoam, both lower than non-COAG Control (18 ± 1.3 mL/kg, P = 0.05). Neither COAG Coil (8.4 ± 5.4 mL/kg) nor COAG Gelfoam (15 ± 11 ml/kg) had significantly less blood loss than COAG Control (20 ± 1.2 mL/kg). Both non-COAG treatment groups had minimal blood loss during observation, while COAG groups had ongoing slow blood loss. In the COAG Gelfoam group, there was an increase in hemorrhage between 30 and 60 min following treatment., Conclusions: A swine model of coagulation-adaptable fatal splenic hemorrhage suitable for endovascular treatment was developed. Coagulopathy had profound negative effects on coil and gelfoam efficacy in controlling bleeding, with implications for trauma and elective embolization procedures., (Published by Elsevier Inc.)

Defective spleen function increases susceptibility to bacterial infections which can be prevented by vaccine prophylaxis. Splenic hypofunction can be found in a number of autoimmune disorders; however, no data are available regarding autoimmune atrophic gastritis (AAG), autoimmune enteropathy (AIE) and autoimmune liver disease (AILD). Peripheral blood samples from patients with AAG (n = 40), AIE (n = 3) and AILD (n = 40) were collected. Patients affected by autoimmune disorders already known to be associated with splenic hypofunction, i.e. coeliac disease (CD) and ulcerative colitis (UC), were included as disease controls, while splenectomised patients and healthy subjects were evaluated as positive and negative controls, respectively. Counting of erythrocytes with membrane abnormalities, i.e. pitted red cells, was used as an indicator of spleen function (normal upper limit 4%). Defective splenic function was observed in 22 of the 40 patients with AAG (55.0%), in two of the three patients with AIE (66.6%) and in 35 of the 40 patients with AILD (87.5%). As expected, in untreated CD, refractory CD and UC there was a high prevalence of hyposplenism (43.7%, 88.2% and 54.4%, respectively). Due to the high prevalence of splenic hypofunction, patients with AAG, AILD and AIE should undergo pitted red cell evaluation and, if hyposplenic, they should be candidate to vaccine prophylaxis against encapsulated bacteria.

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an extremely rare benign lesion. We herein report a case of asymptomatic SANT of the spleen in a middle-aged woman with early breast carcinoma and an undiagnosed splenic mass, which was successfully treated by laparoscopic splenectomy and diagnosed postoperatively. We also review the literature on SANT to help make knowledge more accessible when clinicians encounter a splenic tumor. The present case taught us the following lesson: the presence of a splenic lesion during follow-up for malignancy is not always indicative of metastasis. Therefore, SANT should be considered in the differential diagnosis.

Numerous studies had investigated the biological basis of spleen deficiency syndrome on gastrointestinal dysfunctions. However, little was known about neuropsychological mechanism of spleen deficiency syndrome. The default model network (DMN) plays an important role in cognitive processing. Our aim is to investigate the change of neuropsychological tests and DMN in patients with spleen deficiency syndrome.Sixteen patients and 12 healthy subjects underwent functional magnetic resonance imaging examination, and 15 patients with spleen deficiency syndrome and 6 healthy subjects take part in the two neuropsychological tests.Compared with healthy subjects, patients with spleen deficiency syndrome revealed significantly increased functional connectivity within DMN, and significantly higher in the scores of 2-FT (P = .002) and 3-FT (P = .014).Our findings suggest that patients with spleen deficiency syndrome are associated with abnormal functional connectivity of DMN and part of neuropsychological tests, which provide new evidence in neuroimaging to support the notion of TCM that the spleen stores Yi and domains thoughts.

Competing Interests: Competing interests: None declared.

Given discrepancies between methods for diagnosing hyposplenism, the purpose of this study was to evaluate the effect of the spleen size on the correlation between the methods, and to propose a model for improving the interpretation. Patients with renal allografts were included, in whom the spleen was assessed using Doppler ultrasound, scintiscan, and the presence of Howell-Jolly bodies (HJBs) in peripheral smears. In 35 subjects, scintiscan and HJBs were normal (Group 0); 20 had an abnormal result in both methods (Group 1); 34 had discordant results with HJBs present (Group 2); and 14 had discordant results with decreased spleen uptake (Group 3). There was no association between HJBs and scintiscan. The patients of Groups 1 and 2 had smaller spleens. The patients with smaller spleen had more hematological evidence of hyposplenism and exhibit smaller discrepancies between the methods than patients with larger spleen. The spleen can tip the balance from a normal to impaired function provided that the spleen size is below the critical mass required to maintain splenic function. A mild impairment of phagocytic function and slight dyserythropoiesis along with a small spleen would result in decreased take up of radiocolloid or the appearance of HJBs in blood smears., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim of this study was to investigate the outcome of selective NOM for penetrating splenic injuries., Methods: A dual-centre study is performed in two level-one trauma centres. All identified patients treated for PSI were identified. Patients were grouped based on the treatment they received. Group one consisted of splenectomised patients, the second group included patients treated by a spleen-preserving surgical intervention, and group three included those patients who were treated by NOM., Results: A total of 118 patients with a median age of 27 and a median ISS of 25 (interquartile range (IQR) 16-34) were included. Ninety-six patients required operative intervention, of whom 45 underwent a total splenectomy and 51 underwent spleen-preserving surgical procedures. Furthermore, 22 patients (12 stab wounds and 10 gunshot wounds) were treated by NOM. There were several anticipated significant differences in the baseline encountered. The median hospitalization time was 8 (5-12) days, with no significant differences between the groups. The splenectomy group had significantly more intensive care unit (ICU) days (2(0-6) vs. 0(0-1)) and ventilation days (1(0-3) vs. 0(0-0)) compared to the NOM group. Mortality was only noted in the splenectomy group., Conclusions: Spleen-preserving surgical therapy for PSI is a feasible treatment modality and is not associated with increased mortality. Moreover, a select group of patients can be treated without any surgical intervention at all.

Background: Functional hyposplenism (FH) is indicated by an anatomically present spleen that fails to take up radiolabeled colloid. The occurrence of FH has been reported in a small group of renal transplant recipients based on hematologic parameters. The aim of this study was to replicate this association in a larger group of renal transplant recipients with the use of technetium-99m-stannous colloid liver-spleen scan to assess the spleen function., Methods: This survey based on single samples enrolled 101 unselected adult patients with functional kidney grafts >180 days after transplantation. All patients underwent 99m Tc-stannous colloid scan to assess spleen function as well as bone marrow uptake of radiocolloid along with an anatomic and blood flow study of the spleen and kidney with the use of Doppler sonography., Results: The prevalence of hyposplenism was 32.7% (33/101) for the cohort, and increased uptake of radiocolloid by the bone marrow was seen in 9.9% (10/101). According to the multivariate analysis, the frequency of hyposplenism was significantly influenced by indirect bilirubin and hemoglobin, and direct bilirubin and neutrophil count remained as independent predictors of bone marrow uptake., Conclusions: This study demonstrated that a group of renal transplant recipients has FH. In addition, bone marrow uptake might be interpreted as liver dysfunction. In this situation, the small amount of contrast (spleen compared with liver) would leave hyposplenism undiagnosed. Further prospective and longitudinal clinical studies are needed to determine the clinical impact of this condition on the management of renal transplant recipients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Coix seed has the functions of fortifying the spleen and inhibiting the dampness. However, it remains unclear which Coix seed compositions is responsible for these functions. Previous investigations have revealed that the main compositions of Coix seed are proteins, polysaccharides, oils and starches. The objectives of this study are to explore which is the most effective compositions in fortifying the spleen and examine how Coix seed works in regulating the water transport on the spleen deficiency and wet dampness (SDWD) rat model., Materials and Methods: The rats used were divided into (i) control group, (ii) model group, (iii) decoction group, (iv) protein group, (v) polysaccharide group, (vi) oil group and (vii) starch group. The urine volume, the drinking volume and the water loading index in each group were calculated. Agilent 8*60K array was used for microarray-based gene expression analysis. The differential mRNAs related to the transport activity were screened. qRT-PCR was used to validate the mRNA microarray., Results: The results demonstrated that all treatment groups could decrease the dampness of SDWD rats. mRNA microarray had significant effect on the protein group and the polysaccharide group in regulating the water transport, among which the most significant mRNA was Fabp6, Slc51a, Slc51b, Slc11a2, Slc4a10 and AQP3 respectively., Conclusion: The compositions of proteins and polysaccharides had the most significant effect in regulating the water transport of SDWD rat model. The contributing mRNA focused on Fabp, Slc and AQP family.

A 57-year-old previously healthy fisherman was admitted in fulminant pneumococcal septic shock, with disseminated intravascular coagulation, requiring aggressive management including bilateral below-knee amputations for ischaemic necrosis. He began to recover and was discharged for rehabilitation, however during his convalescence was found to be hypercalcaemic. No malignancy was found on CT scan, but it was noted that his spleen was absent, replaced by a 4 cm smooth-walled, fluid-filled lesion. This was unexpected as an ultrasound in intensive care 10 weeks previously had demonstrated a normal spleen. Functional hyposplenism was confirmed on a peripheral blood film with evidence of target cells, spherocytes and Howell-Jolly bodies. A diagnosis of autosplenectomy complicating pneumococcal sepsis was therefore made, of which there is just one case previously reported. The patient continues to recover well and was discharged on penicillin prophylaxis after receiving vaccinations for hyposplenism., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Schistosomiasis is endemic to several parts of the world. Among the species that affect humans, Schistosoma mansoni is one of the most common causes of illness. In regions where schistosomiasis mansoni is endemic, reinfection is responsible for the emergence of hepatosplenic schistosomiasis (HSS) with portal hypertension in about 10% of infected individuals. Regardless of its etiology, portal hypertension may bring about the formation of arteriovenous fistulas and pulmonary vascular dilation, thus constituting a pulmonary shunt and its presence has been associated with the occurrence of neurological complications. The objective of this study was to identify pulmonary shunt using TTCE in patients with HSS and esophageal varices, and to compare the abdominal ultrasound and endoscopy findings among patients with and without pulmonary shunt., Methodology/principal Findings: In this case series, a total of 461 patients with schistosomiasis mansoni were prospectively evaluated using abdominal ultrasound and endoscopy and 71 presented with HSS with esophageal varices. Fifty seven patients remained in the final analysis. The mean age of the patients was 55 ± 14 years, and 65% were female. Pulmonary shunts were observed in 19 (33.3%) patients. On comparing the groups with and without pulmonary shunt, no significant differences were observed in relation to the abdominal ultrasound and endoscopic findings. When comparing the two subgroups with pulmonary shunts (grade 1 vs grades 2 and 3), it was observed that the subgroup with shunt grades 2 and 3 presented with a significantly higher frequency of an enlarged splenic vein diameter (>0.9 cm), and an advanced pattern of periportal hepatic fibrosis (P = 0.041 and P = 0.005, respectively). None of the patients with pulmonary shunts had severe neurological complications., Conclusions/significance: Our findings suggest that in HSS with esophageal varices the pulmonary shunts may be present in higher grades and that in this condition it was associated with ultrasound findings compatible with advanced HSS.

Objective: To observe the effect of electroacupuncture (EA) at "Zusanli"(ST 36) on Ghrelin/cAMP/PKA expression in the jejunum in rats with spleen qi deficiency syndrome, so as to reveal its underlying mechanism in improving energy metabolism., Methods: Forty male SD rats were randomly divided into 4 groups:normal group, spleen qi deficiency syndrome (model) group, EA group and non-acupoint group ( n =10 in each group).The model of spleen qi deficiency syndrome was established by improper diet and overstrain. EA (2 Hz/15 Hz, 0.5 mA) was applied to bilateral "Zusanli" (ST 36) in the EA group and non-acupoint in non-acupoint group for 20 min, once a day for 6 days. The pathologic changes of the jejunum tissue were detected by H&E staining. Ghrelin, ATP and cAMP levels in jejunum tissue were determined by ELISA. The expression levels of PKA protein in jejunum tissue were determined by Western blot., Results: H&E staining showed that the intestinal villi of the model group were swelling, shortening and thickening, with a damaged or broken top-part in the model group, and basically restored to normal after EA treatment. ELISA results showed that the contents of Ghrelin, ATP and cAMP in the jejunum tissue were significantly lower in the model group than in the normal group ( P <0.05), while significantly higher in the EA group than in the model group ( P <0.05). Western blot results showed that the expression of PKA protein in the jejunum tissue was significantly lower in the model group than in the normal group ( P <0.05), and significantly higher in the EA group than in the model group and non-acupoint group ( P <0.05)., Conclusions: EA at ST 36 can improve the morphological changes in the jejunum of spleen qi deficiency rats, which may be associated with its effects in increasing Ghrelin, ATP and cAMP contents, and up-regulating PKA expression, leading to an increase of energy metabolism and spleen qi at last.

Background: Portal vein obstructive lesions associated with hypertrophy of the hepatic artery territory are observed in Schistosoma mansoni schistosomiasis. Liver perfusion scintigraphy is a method used for evaluation of hepatic perfusion changes in liver diseases. It has been suggested that, like in cirrhosis, where compensatory increase in perfusion through the hepatic artery is documented, perfusion changes occur in hepatosplenic schistosomiasis (HSS)., Aims: This study aims to determine changes in liver hemodynamics using hepatic perfusion scintigraphy and correlate them with clinical and laboratory variables and ultrasound findings in HSS., Methods: Nineteen patients with schistosomiasis underwent ultrasound evaluation of degree of liver fibrosis, splenic length, and splenic and portal vein diameter, digestive endoscopy, and quantification of platelets. Subsequently, perfusion scintigraphy with measurement of hepatic perfusion index (HPI) was performed., Results: It was observed that patients with hepatosplenic schistosomiasis had significantly higher HPI compared with normal individuals (p = 0.0029) and that this increase correlated with splenic length (p = 0.038) and diameter of esophageal varices (p = 0.0060). Angioscintigraphy showed high accuracy for predicting presence of large esophageal varices., Conclusions: Angioscintigraphy could show that patients with HSS had increased HPI, featuring greater liver "arterialization," as previously described for cirrhotic patients. Correlations were also observed between HPI and longitudinal splenic length, caliber of esophageal varices, caliber of portal vein, and blood platelet count. Angioscintigraphy is a promising technique for evaluation of hepatosplenic schistosomiasis.

We herein report a rare case of acute bilateral renal and splenic infarctions occurring during chemotherapy for lung cancer. A 60-year-old man presented with acute and intensive upper abdominal and back pain during chemotherapy with cisplatin and etoposide for lung cancer. Contrast-enhanced computed tomography (CT) revealed bilateral renal and splenic infarctions. After the administration of unfractionated heparin his pain was relieved with a clearance of the infarctions in the CT findings and a recovery of renal dysfunction. Enhanced coagulation by lung cancer and arterial ischemia by chemotherapy may therefore contribute to the development of these infarctions.

Background: In hepatosplenic schistosomiasis occurs diffuse hepatic fibrosis associated with venous congestion of the portal system resulting in hepatosplenomegaly. It can produce digestive hemorrhage caused by rupture of esophageal and stomach varices or peptic gastroduodenal mucosal lesions., Aim: To study the effects of splenectomy and ligature of the left gastric vein on portohepatic hemodynamics., Method: Twenty-three patients with hepatosplenic schistosomiasis mansoni were studied before and about two weeks after operation through angiographic diameter of the common and proper hepatic artery, splenic artery, superior mesenteric artery, portal vein, superior mesenteric vein and left gastric vein. The pressures of the inferior vena cava and central venous pressure, free hepatic vein, the hepatic sinusoidal and occluded vein were measured., Results: The splenectomy and ligature of the left gastric vein determined low morbidity and null mortality. It determined significant addition to the following variables: diameters of the common and proper hepatic artery; diameter of the superior mesenteric vein. It determined non significant increase on the following measurements: right atrial pressure and diameter of the superior mesenteric artery. It determined non significant decrease to the following variables: inferior vena cava pressure; free hepatic vein pressure; occluded hepatic vein pressure; sinusoidal pressure, diameter of the portal vein., Conclusion: Splenectomy and ligature of the left gastric vein do not determine portal hemodynamic changes capable of breaking the functional hemodinamic balance that characterizes the hepatosplenic mansoni schistosomiasis.

Several clinical studies show a gender dimorphism of immune and organ responsiveness in the susceptibility to and morbidity from shock, trauma, and sepsis. However, there are conflicting reports on the role of gender in outcomes. Animal studies of shock, trauma, and sepsis have confirmed that alterations in immune and organ functions are more markedly depressed in adult males and in ovariectomized and aged females. In this review, we discuss the effect of estrogen on liver, intestinal, splenic, and renal functions in an experimental model of sepsis, trauma, and reperfusion injury. To establish the role of gender in the outcome of these patients, more studies in clinical and experimental settings are required to determine whether gender-specific responses are global across the injuries or are observed in specific injury situations. Studies are also needed to delineate underlying mechanisms responsible for differences between males and females. The findings gained from the experimental studies will help in designing innovative therapeutic approaches for the treatment of sepsis, trauma, and reperfusion injury patients.

Objective: To explore the mechanism of reinforcing function of moxibustion to spleen-stomach., Methods: Forty healthy Sprague Dawley rats were randomly divided into 4 groups: group A (blank group), group B (model group), group C (moxibustion group) and group D (herbs group). The rat model of spleen-deficiency was established by intragastric administration with 200% Dahuang (Rhubarb) infusion. The rats in group A and B, and D served as the blank control, model, and Sijunzi decoction group respectively, while those in group C received moxibustion at "Zusanli" (ST 36), "Zhongwan" (CV 12), "Guanyuan" (CV 4), "Pishu" (BL 20) and "Weishu" (BL 21), etc. The common symptoms and intestinal propulsive rate were observed. The content of I-xylose in serum was detected by phloroglucinol method. Colorimetry method was used to detected content of ATP in jejunum tissues., Results: Compared with group A, the symptom score in group B was increased significantly (both P < 0.01), while the intestinal propulsive rates, the content of D-xylose in serum and ATP in jejunum tissues were decreased significantly (P < 0.05, P < 0.01). Compared with group B, the symptom score in group C and D was decreased significantly (both P < 0.01), while the intestinal propulsive rates, the content of D-xylose in serum and ATP in jejunum tissues were increased significantly (P < 0.05, P < 0.01). There were no significant difference between group C and D (P > 0.05)., Conclusion: Moxibustion at "Zusanli" (ST 36) etc. could relieve symptoms of spleen-deficiency, enhance motility and absorption functions of small intestine and improve metabolism of small intestine. The efficacy is equal to administration of Sijunzi decoction.

Hyposplenic patients are at risk of overwhelming post-splenectomy infection (OPSI), which carries mortality of up to 70%. Therefore, preventive measures are warranted. However, patients with diminished splenic function are difficult to identify. In this review we discuss immunological, haematological and scintigraphic parameters that can be used to measure splenic function. IgM memory B cells are a potential parameter for assessing splenic function; however, more studies are necessary for its validation. Detection of Howell-Jolly bodies does not reflect splenic function accurately, whereas determining the percentage of pitted erythrocytes is a well-evaluated method and seems a good first-line investigation for assessing splenic function. When assessing spleen function, (99m)Tc-labelled, heat-altered, autologous erythrocyte scintigraphy with multimodality single photon emission computed tomography (SPECT)-CT technology is the best approach, as all facets of splenic function are evaluated. In conclusion, although scintigraphic methods are most reliable, they are not suitable for screening large populations. We therefore recommend using the percentage of pitted erythrocytes, albeit suboptimal, as a first-line investigation and subsequently confirming abnormal readings by means of scintigraphy. More studies evaluating the value of potentially new markers are needed.

Mainly because it is possible to live without it, the spleen has always been considered a secondary and mysterious organ. However, recent observations have revealed new unsuspected functions for this organ whose patho-physiological importance should be reconsidered. Much less known than the hypersplenism, the hyposplenism corresponds historically to the loss or the insufficiency of the two principal functions of spleen: the filtration of faded or senescent elements from the blood and the fight against infections. In this article, after a short recall of the physiological functions of spleen, three innovations relating to hyposplenism will be explored: the vascular complications, the loss of the splenic pool of regenerating monocytes and the loss of the splenic pool of pluripotent mesenchymal stem cell.

Unlabelled: To observe the effect of Spleen-Meridian-acupoint injection of Lentinan on the immunologic function in spleen-deficiency rabbits., Methods: A total of 54 Newzealand rabbits were randomly divided into normal (n = 10), model (n = 8), intramuscular injection (n = 10), Sanyinjiao (SP6, n = 10), Diji (SP8, n = 8) and Xuehai (SP 12, n = 8) groups. Spleen-qi deficiency model was established by intragastric administration of 100% crude Radix et Rhizoma Rhei decoction (15 mL/kg/day x 10 d), and then Lentinan (LNT, 0.025 mg/kg/2 day x 5) was injected into the aforementioned acupoints of the Spleen Meridian. The erythrocyte immunologic function (RBC-C3 bR, RBC-IC), hemolysin (lgM) and changes of physical signs of the rabbits were observed., Results: In comparison with the control group, the rabbits' body weight, rectal temperature, RBC-C3 bR% and serum IgM level were decreased significantly in model group (P < 0.05); while in comparison with the model group, the body weight in SP 8 group,retal temperature in SP 9 and SP 8 groups, RBC-C3 bR% in SP 9 and SP 12 groups, and serum IgM levels in SP 9, SP 8 and SP 12 groups increased considerably (P < 0.05, P < 0.01). Comparison among the 4 treatment groups showed that the effect of SP 12 was superior to that of intramuscular injection group in upregulaing RBC-C3 bR%, and the effects of SP 9, SP 8 and SP 12 groups were significantly superior to those of intramuscular injection group in upregulating serum IgM level (P < 0.05)., Conclusion: The Spleen-Meridian-acupoint injection of LNT is superior to that of intramuscular injection of LNT in improving the spleen-qi deficiency rabbits' symptoms and immunologic function.

Hypoglycemia is reported to be one of the manifestations of a patient with hypothalamic sarcoid infiltrates due to impaired counter-regulation of glucose. But, without hypothalamic lesion, patients with sarcoidosis would not be expected to have hypoglycemia. We recently identified a patient with an isolated sarcoidosis of the spleen who had experienced frequent fasting hypoglycemia which completely disappeared after splenectomy. During hypoglycemia, serum insulin was undetectable. Endocrinological examination revealed no abnormality. The objective was to investigate whether the patient's hypoglycemia was due to ectopic secretion of an insulin-mimetic factor by the splenic sarcoidosis. Serum insulin-like growth factor-I (IGF-I) and IGF-II were measured by RIA. Serum visfatin and free IGF-I were by ELISA. A high molecular weight form of IGF-II, termed "big" IGF-II, was identified by Western blotting. Tissue IGF-I was quantified by real time RT-PCR after RNA extraction. Before operation, total and free serum IGF-I, serum IGF-II and serum visfatin were within reference range. Big IGF-II was not detected in patient's serum extract. After operation, hypoglycemia did not recur and serum insulin returned to normal, while serum IGF-I decreased by half the preoperative level. RT-PCR revealed that mRNA level of IGF-I in the sarcoidosis tissue was about 1.8-fold greater than that in the normal spleen tissue. These data suggest that ectopic secretion of IGF-I by the splenic sarcoidosis and its direct access to the liver via the portal vein might cause fasting hypoglycemia mainly by suppressing hepatic gluconeogenesis.

Purpose: to evaluate the repercussion of portal hypertension in the indexes of the ovarian, uterine and luteus body periphery arterial resistance, at the medium luteal phase of the menstrual cycle., Methods: in an observational study with transversal cohort, 28 patients with hepatosplenic schistosomiasis mansoni, submitted to splenectomy and ligation of the left gastric vein (HESO), a similar group of 28 patients who had not had the surgery (HESNO) and 29 healthy volunteers (HV) were submitted to Doppler fluxmetry in the medium luteal phase of the menstrual cycle. Pourcelot's resistance index has been used as RI=[(S-D)/S], in which S means the highest systolic speed, and D, the end of diastole. The best record in the ascendant branch of the uterine artery, in the ovarian artery, when accessible, or in the intraovarian artery, was chosen. When the luteus body was present, the RI was measured in its periphery. The data obtained were analyzed by Kruskal-Wallis and Mann-Whitney tests., Results: there was no significant difference among the groups, concerning the mean RI of the ovarian arteries (Kruskal-Wallis, p=0.50). There was a tendency for higher right uterine artery RI in the HESNO group (Kruskal-Wallis, p<0.07), but it was similar in the left uterine artery (Kruskal-Wallis, p=0.14). Arterial RIs significantly lower have been observed in the luteus body periphery, when compared to the contralateral ovarian arteries in all the groups (Mann-Whitney, p<0.0001)., Conclusions: there was no difference among the groups, regarding the ovarian and uterine RIs. The portal hypertension in patients with hepatosplenic schistosomiasis does not affect the natural phenomenon of arterial RI decrease in the ovary where ovulation occurs.

Objective: To observe the effects of Sijunzi Decoction on D-xylose excretion rate and ATP content in the mucosa membranes of small intestines of rats with spleen deficiency., Methods: Spleen deficiency model rats were made by reserpine injection. D-xylose excretion rate was measured with p-bromoaniline method, and the ATP content of small intestines mucosa was detected with bioluminescence method. The correlation between D-xylose excretion rate and ATP content of mucosa was also analyzed., Results: Rats' body weight and D-xylose excretion rate decreased after reserpine injection (P < 0.01, vs control group), but increased after treated with Sijunzi Decoction (P < 0.05, vs model group). The ATP content of mucosa showed no significant difference between model group and control group. There was obviously positive correlation between the change of urine's D-xylose excretion rate and mucosa ATP content., Conclusion: Sijunzi Decoction has the activity of improving xylose absorption in spleen deficiency rats, but no obvious effect on their mucosa ATP content. The reducing of urine's D-xylose excretion rate in spleen deficiency rats is accompanied with the decrease of mucosa ATP content.

In early life, patients with sickle cell disease (SCD) can have acute, life-threatening emergencies related to splenic hypofunction (overwhelming bacterial sepsis), as well as anemic crises from acute splenic sequestration because of sudden pooling of blood in the spleen. The landmark penicillin prophylaxis study in 1985 showed a remarkable decrease in mortality from sepsis in young children with SCD who were treated with oral penicillin prophylaxis compared to placebo. Since that study, newborns are screened for SCD and placed on oral penicillin prophylaxis in nearly all of the United States, as well as in other countries where the disease is highly prevalent. The previously described permanent, complete and nearly universal "autosplenectomy" emerging by late childhood or early adulthood is now challenged by recent findings of reversibility of splenic dysfunction by the antisickling drug hydroxyurea or by successful allogeneic stem cell transplantation, even in older patients. Imaging techniques for hypofunction of the spleen are the most commonly used modalities to guide the clinician in decisions regarding medical or surgical management.

Acute splenic sequestration crisis is a common, potentially life-threatening complication of sickle cell anemia in children that is uncommon in adults.We present the case of a 44-year-old gentleman with undiagnosed hemoglobin S-C disease who developed intense back pain, marked abdominal distension, systemic inflammatory response syndrome, and multisystem organ failure that first presented as acute splenic sequestration crisis. The hemoglobinopathy SC is a disease caused by heterozygous-globin chain mutations with over-lapping clinical features of sickle cell disease with changes in the frequency of these manifestations reflected by the combination of characteristics of hemoglobin C and hemoglobin S. In hemoglobin S-C disease, autosplenectomy is rare and splenomegaly usually persists until adulthood;vasoocclusive complications are seen less habitually and become evident at a later time compared with sickle cell disease. The diagnosis of hemoglobin S-C disease is essentially done by exclusion. Transfusion of red blood cells is the treatment of choice, but splenectomy is indicated if transfusion therapy fails. A review of the literature and keypoints for the emergency practitioner are included.

Severe thrombocytopenia in idiopathic thrombocytopenic purpura may recur owing to retained accessory spleens. Accessory spleen may hide in unusual and difficult locations. We present an interesting case in which we used a handheld gamma probe intraoperatively to localize two accessory spleens. The two accessory spleens were successfully retrieved and removed. A handheld gamma probe is used as a valuable tool in localizing residual splenic tissue following splenectomy.

Inflammatory reactions of the spleen occur in the context of two pathophysiological settings. First, lymphoid hyperplasia of the spleen can be the result of a principally physiological production of immune effector cells e.g. due to systemic viral infections, autoimmune diseases and acquired or inherited immunodeficiencies. Second, the spleen itself may be the target of a pathological inflammatory reaction; this setting is exemplified by abscess formation due to septicopyemic spread of bacteria and by granulomatous inflammations, e.g. due to tuberculosis or sarcoidosis. Differential diagnostic considerations have to include splenic inflammatory pseudotumors, mycobacterial spindle cell tumors and lymphomas with granulomatous or histiocyte-rich reactive changes.

We report a case of a splenic inflammatory pseudotumor (myofibroblastic tumor) in a 43-year-old man with a 5-year history of chronic bronchitis and sleep apnea syndrome. The patient was hospitalized because of a screen-detected splenic mass lesion. His sputum cultures revealed Mycobacterium avium complexes on only one occasion. Imaging studies revealed a 7 cm solitary tumorous lesion, and differential diagnoses of splenic hamartoma, hemangioma, lymphoma, and angiosarcoma were obtained from the radiologist. A splenectomy followed by pathological investigations was performed. By histology, the lesion contained fibroblastic or myofibroblastic spindle cell proliferations, accompanied by variable degrees of inflammatory cell infiltration. Ziehl-Neelsen staining did not reveal acid-fast bacteria. Immunohistochemically, the fibroblastic or myofibroblastic spindle cells were positive for vimentin, human smooth muscle actin, and muscle actin, but negative for desmin, CD8, CD21, CD23, CD35, p80, Epstein-Barr virus LMP, and human herpesvirus type 8. The infiltrating lymphoid cells demonstrated a nonneoplastic pattern. The results of in situ hybridization for Epstein-Barr virus encoded RNA were negative. The postoperative course was uneventful and he has had no recurrence in 22 months. His sleep apnea syndrome and chronic bronchitis have resolved spontaneously since the splenectomy.

Hypoparathyroidism, retardation, and dysmorphism (HRD) syndrome is the first reported disease caused by a defect in the tubulin folding and assembly pathway. We aimed to summarize our experience with a cohort of patients with HRD, analyze their growth, and evaluate patients' polymorphonuclear cell (PMN) functions. The records of 22 HRD patients in a single medical center were reviewed. Growth during infancy and early childhood were analyzed by the Infancy-Childhood-Puberty (ICP) growth model. PMN functions were compared with healthy controls. Twelve patients died and many hospitalizations due to infections and convulsions were recorded. Growth measurements, expressed as weight and height SD scores in boys at a mean age of 4 y were -13.1+/-3.8 and -8.7+/-1 and -16.6+/-4.4 and -9.5+/-2.4, respectively, in girls at a mean age of 6.4 y. Chemotactic migration, random migration, and phagocytosis of PMN from HRD patients were significantly lower than that of PMN from healthy controls. No significant differences were found in superoxide production of PMN from patients compared with controls. Functional hyposplenism has been demonstrated in most of the studied patients. The defect in the tubulin folding and assembly pathway, previously described in HRD, has grave consequences on growth and PMN functions.

Abdominal complaints in patients with infectious mononucleosis should alert the surgeon to the potential, and possibly fatal, risk of splenic rupture. Radiologic evaluation by ultrasonography and computed tomography is indicated for appropriate management. We describe a case in which a diagnosis of splenic rupture occurring spontaneously on a background of infectious mononucleosis was made as a result of a high index of suspicion. The patient was treated conservatively.

Hyposplenism is not a rare condition and can complicate a remarkable number of illnesses. The two most time-honored diseases associated with the development of hyposplenism are sickle cell anemia and celiac disease. Hyposplenism is relatively easy to recognize by typical changes observed on the peripheral blood smear; including Howell-Jolly bodies, monocytosis, lymphocytosis, and increased platelet counts. Diagnosis can be confirmed by pitted RBC counts or 99Tc-labelled radiocolloid scan of the spleen; wherever available. Diagnosis needs to be made promptly to institute pneumococcal vaccination in a timely fashion and to recognize and treat bacterial infections promptly and aggressively because of the tendency of hyposplenic subject to develop fatal invasive disease. Overwhelming pneumococcal sepsis accounts for the major mortality cases in hyposplenic subjects; however severe infections with other encapsulated bacteria and protozoa have been reported. Hyposplenic individuals may also be at a higher risk for vascular, autoimmune and thrombotic diseases and they may have a higher risk of developing solid tumors. The commonly used pneumococcal polysaccharide vaccine is ineffective in asplenic subjects, because it requires the presence of IgM memory B cells, and should be given before splenectomy. In splenectomized, and functionally hyposplenic subjects, the pneumococcal conjugate vaccine is more effective, because it utilizes a T cell dependent mechanism, and should be the preferred vaccine in these circumstances.

The aim of this study was to compare portal and splenic blood flows and the liver morphology in hepatosplenic (HS) and hepatointestinal (HI) schistosomiasis. Doppler ultrasound measurements were performed in 48 adult patients with schistosomiasis, according to the criteria of the World Health Organization, and compared with those performed in 20 healthy controls. Portal flow was significantly higher (P < 0.0001) in both HS and HI (2481 +/- 1467 and 2159 +/- 1446 ml/min, respectively) than in normal individuals (842 +/- 322 ml/min). There was no difference in splenic blood flow (822 +/- 685 and 458 +/- 292 ml/min, respectively) between HS and HI, but these values were significantly higher than those of normal controls (243 +/- 94 ml/min). Portal and splenic overflow are found in both the HS and the HI forms of schistosomiasis.

Pancreatic pseudocysts are common complication of both chronic and acute pancreatitis. Sanguination from damaged peripancreatic vessels into the lumen of pseudocyst results in pseudoaneurysm. The rupture of pancreatic pseudoaneurysm into the lumen of digestive tract causes massive bleeding witch source is often difficult to find during endoscopic examination. We present a case of patient with chronic alcohol pancreatitis, with pancreatic pseudocyst and of acute bleeding from upper digestive tract. In the endoscopy we found gastric ulcer with visible vessel. During hospitalization we observed increase the diameter of pseudocyst and circulation of it's liquid contence. Second-look endoscopy showed gastric fundic varices. Surgical operation revealed pseudoaneurysm of splenic artery inserting pressure on gastric wall.

Between January 1990 and January 2005, incidental hypoechoic, vascular tumours of the spleen were identified in 13 patients using B-mode and colour Doppler ultrasound (CDS). All lesions found were well demarcated, intrasplenically located, and ranged in size between 1 cm and 4 cm. The increased vascular pattern on CDS was confirmed in 9 of the 13 cases by contrast enhanced ultrasound (CES), while two patients showed reduced vascularity on CES. In 10 patients, lesions were confirmed by contrast enhanced CT. Histological examination was performed in three patients with the diagnosis of capillary haemangioma (n = 2) and hamartoma (n = 1). In the remaining cases, ultrasound follow-up was performed (range 4 months to 13 years) and demonstrated no evidence of tumour growth in all but one patient. During a 4 year follow-up, one lesion increased in size from 1.0 cm to 1.5 cm and in the same patient an additional 0.5 cm sized hypoechoic increased vascular lesion was also found. In the spleen a hypoechoic lesion with an increased vascular pattern incidentally found by ultrasound most likely indicates a benign tumour with capillary haemangioma/hamartoma as the most likely diagnosis. However, it should be emphasised that in all cases a careful ultrasound follow-up is warranted.

Aim: To analyze 67 cases of splenic abscess in a medical center of Taiwan during a period of 19 years., Methods: From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, APACHE II scores, and mortality rates were analyzed., Results: There were 41 males and 26 females with the mean age of 54.1+/-14.1 years. Multiple splenic abscesses (MSA) account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixty-seven patients (35.8%) had extrasplenic abscesses, with leading site of liver (34.6%). Microbiological cultures were positive in 58 patients (86.6%), with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus (GNB) infection predominated (55.2%), with leading pathogen of Klebsiella pneumoniae (22.4%), followed by gram positive coccus (GPC) infection (31%). Splenectomy was performed in 26 patients (38.8%), percutaneous drainage or aspiration in 21 (31.3%), and antibiotic therapy alone in 20 patients (29.9%). Eventually, 12 of 67 patients expired (17.9 %). By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC (P=0.036). Patients with GNB infection (P=0.009) and multiple abscesses (P=0.011) experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE II score of 12 expired patients (16.3+/-3.2) was significantly higher than that of the 55 survivals (7.2+/-3.8) (P<0.001)., Conclusion: MSA, GNB infection, and high APACHE II scores are poor prognostic factors. Early surgical intervention should be encouraged when these risk factors are present.

Background: The spleen is one of the most frequently affected organ in Sickle cell anaemia (SCA). This has been attributed to its complex anatomy and prominent reticuloendothelial functions which include clearance of unwanted particulate matter in blood ( culling), defense against infection and reservoir for blood cells. This paper aims to highlight the current information on the changes that occur in the spleen of Sickle Cell Disease patients in this environment., Method: A review of relevant literature on the subject of splenic changes in Sickle Cell Disease sourced by manual library and medline search., Results: The essential splenic change in SCA is splenomegaly and subsequent shrinkage in size (autosplenectomy), which maybe due to several factors. These include: high levels of irreversible sickle cells, decreased HbF associated with increased intravascular sickling and chronic Malaria infection secondary to hyperplasia of the reticulo-endothelial system and increased antibody production especially IgG and IgM. Finally, the clinical complications of these splenic changes such as increased susceptibility to infection, acute splenic sequestration and hypersplenism are also reviewed in this paper., Conclusion: In view of the above changes, it is important to ensure regular monitoring and follow-up in order to prevent complications, recurrent crisis and death.

This is a survey of normal variants and pathologic conditions involving the spleen and retroperitoneum. The study focuses on the various sonographic appearances of trauma, infection, and neoplasm involving these areas in an attempt to complement works dealing specifically with the pancreas, kidneys, and great vessels. Ultrasound-guided intervention (biopsy, drainage) is included.

We present the gray-scale ultrasonography (GSUS), power Doppler ultrasonography (PDUS), abdominal computed tomography (CT), and magnetic resonance imaging (MRI) findings for a case of splenic hamartoma in a 27-year-old man, showing a phi 50 mm homogeneous, iso- and hypo-echoic splenic mass with evidence of a small plural cystic lesion. This splenic hamartoma showed increased vascularity on power Doppler sonograms. PDUS showed multiple circular blood flow signals inside the mass (i.e. a basket pattern), which was consistent with the small plural cystic lesion shown by GSUS. Spectral analysis also confirmed arterial and venous flow. CT scans showed that the mass had low-density relative to the normal spleen and MRI showed that the mass was isodense, relative to the normal spleen. Therefore, CT and MRI are not useful for the diagnosis of splenic hamartoma. Ultrasonography can be used to diagnose splenic hamartoma without administration of a contrast material and therefore is an indispensable method for the diagnosis of splenic hamartoma.

Aim: This report gives a comprehensive overview of ultrasonography of splenic abnormalities. Certain ultrasonic features are also discussed with pathologic correlation., Methods: We review the typical ultrasonic characteristics of a wide range of splenic lesions, illustrating them with images obtained in our institution from 2000 to 2003. One hundred and three patients (47 men, 56 women), with a mean age of 54 years (range 9-92 years), were found to have an abnormal ultrasonic pattern of spleen., Results: We describe the ultrasonic features of various splenic lesions such as accessory spleen, splenomegaly, cysts, cavernous hemangiomas, lymphomas, abscesses, metastatic tumors, splenic infarctions, hematomas, and rupture, based on traditional gray-scale and color Doppler sonography., Conclusion: Ultrasound is a widely available, noninvasive, and useful means of diagnosing splenic abnormalities. A combination of ultrasonic characteristics and clinical data may provide an accurate diagnosis. If the US appearance alone is not enough, US may also be used to guide biopsy of suspicious lesions.

The objective of the present study was to perform a spectral analysis of the electrical activity of the left colon of patients with hepatosplenic schistosomiasis. Thirty patients were studied, divided into 2 groups: group A was composed of 14 patients (9 males and 5 females) with hepatosplenic schistosomiasis and group B was composed of 16 female patients without schistosomiasis mansoni. Three pairs of electrodes were implanted in the left colon at the moment of the surgical treatment. The signals of the electric activity of the colon were captured after postoperative recovery from the ileus and fed into a computer by means of a DATAQ data collection system which identified and captured frequencies between 0.02 and 10 Hz. Data were recorded, stored and analyzed using the WINDAQ 200 software. For electrical analysis, the average voltage of the electrical wave in the three electrodes of all patients, expressed as millivolts (mV), was considered, together with the maximum and minimum values, the root mean square (RMS), the skewness, and the results of the fast Fourier transforms. The average RMS of the schistosomiasis mansoni patients was 284.007 mV. During a long period of contraction, the RMS increased in a statistically significant manner from 127.455 mV during a resting period to 748.959 mV in patients with schistosomiasis mansoni. We conclude that there were no statistically significant differences in RMS values between patients with schistosomiasis mansoni and patients without the disease during the rest period or during a long period of contraction.

The clinical characteristics and isolated pathogens from 49 cases of splenic abscess treated at a medical center in southern Taiwan between 1981 and 2001 were retrospectively analyzed. Male patients were predominant (63%). Mean age at presentation was 55 years (range, 19 to 78 years). The most common presentations were fever (95.9%, 47/49), abdominal pain confined to the left upper quadrant (67.3%, 33/49), left pleural effusion (55.1%, 27/49) and splenomegaly (55.1%, 27/49). Leukocytosis occurred in 39 patients (79.6%), and leucopenia in 3 (6.1%). Blood cultures were positive in 32 patients (65.3%). The most common pathogen was Klebsiella pneumoniae (16.3%, 8/54), a well-known Gram-negative bacillus causing liver abscess in Taiwan, followed by Escherichia coli and Salmonella spp. (each 11.1%, 6/54). Multiple splenic abscesses occurred predominantly in patients with underlying malignancies. Due to the rarity of splenic abscess and the increasing number of immunocompromised patients, multicenter study is needed to determine the epidemiological features and optimal management of this disease.

Purpose: The purpose of this study was to assess portal hemodynamics in patients with portal hypertension due to hepatosplenic schistosomiasis as well as to assess the contribution of splanchnic hyperflow to the pathophysiology of the portal hypertension., Methods: Sixteen patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophageal varices rupture underwent elective esophagogastric devascularization and splenectomy and were prospectively studied. All patients underwent intraoperative invasive hemodynamic portal monitoring with a 4F-thermodilution catheter. The intraoperative portal hemodynamic assessment was conducted after laparotomy (initial) and after esophagogastric devascularization (final)., Results: The initial portal pressure was elevated (mean 28.5 +/- 4.5 mm Hg), and a significant drop of 25% was observed at the end of the surgery (21.9 +/- 4.9 mm Hg). The initial portal flow was elevated (mean 1766.9 +/- 686.6 mL/min). A significant fall (42%) occurred at the end of the surgical procedure (1025.62 +/- 338.7 mL/min). Fourteen patients (87.5%) presented a portal flow of more than 1200 mL/min, and in 5 cases, values greater than 2000 mL/min were observed., Conclusions: Esophagogastric devascularization and splenectomy promote a significant reduction of the elevated portal pressure and flow in schistosomal portal hypertension. These data favor the hypothesis of portal hyperflow in the physiopathology of portal hypertension of schistosomiasis.

Background/aims: Thirty-four patients with portal hypertension and previous history of esophageal varices hemorrhage due to hepatosplenic Mansonic schistosomiasis were prospectively studied., Methodology: All patients underwent invasive hemodynamic monitoring with introduction of a pulmonary artery catheter. Hemodynamic evaluation was characterized by an increased cardiac index (4.90 +/- 1.27 L/min/m2) associated to a decrease in systemic vascular resistance index (1461 +/- 443.04 dynes.sec/cm5.m2)., Results: Mean pulmonary artery pressure (17.97 +/- 6.97 mmHg) and right atrial pressure (7.65 +/- 3.67 mmHg) were increased while pulmonary vascular resistance index was decreased (147.95 +/- 126.21 dynes.sec/cm5.m2). Twenty-four patients (70.5%) presented pulmonary hypertension (mean pulmonary artery pressure > 15 mmHg); in fifteen (44.1%) pulmonary pressure was between 15 and 20 mmHg, in three between 20 and 25 mmHg and, in four patients, pulmonary pressure was higher than 25 mmHg., Conclusions: In conclusion, pulmonary hypertension is a frequent complication in patients with portal hypertension due to hepatosplenic Mansonic schistosomiasis and, in 20.6% of the cases, it can be considered as moderate or severe. Our results suggest that shunt surgeries, which can aggravate pulmonary hypertension, should be employed very cautiously in the treatment of schistosomal portal hypertension.

Aim: To explore the mechanism of spleen deficiency (SD) by studying the relationship of gastro-intestinal peptides level and ileal electro-mechanical activity of SD rats and cold restrain rats., Methods: (1) spleen deficiency (SD) model was established by feeding Houpou:Zhishi: Dahuang in the ratio of 3:3:2, 3 ml/time, for 42 days. (2) The cold restrain stress model: Animals were restrained on grille and placed in a cool water at 18 degrees for 3 h. (3) Substance P (SP) and vasoactive intestinal peptide (VIP) levels in all layers of initial part of ileum and blood in rats were measured by radioimmunoassays (RIA) while changes of electric activity and motility in ileum of rats were recorded with electrode and strain gauge., Results: SP levels in ileum and blood of experimental SD rats were significantly higher than that of the control groups (9.89+/-5.65 vs 1.22+/-1.18, P<0.005, in ileum; 22.7+/-3.95 vs 6.60+/-1.47, P<0.001, in blood) while the VIP levels of the SD rats were significantly lower than that of the controls (3.50+/-2.01 vs 9.10+/-4.91, P<0.05, in ileum; 229.8+/-62.4 vs 560.4+/-151.3, P<0.001, in blood). As compared with the controls, the average frequency of slow electric waves (21.3+/-0.96 vs 18.2+/-2.28, P<0.05) and motility (21.5+/-0.58 vs 18+/-2.65, P<0.005) of SD rats increased obviously and the frequency of fast waves of SD rat also increased. In spontaneous recovery cases, SP levels recovered significantly (compared with the SD groups, 2.99+/-0.62 vs 9.89+/-5.65, P<0.001, in ileum; 14.4+/-4.22 vs 22.7+/-3.95, P<0.001, in blood) but did not drop to normal. After the SD rats treated with Chinese herbs (Jiawei Sijun zi Tang), SP improved (compared with SD cases, 2.20+/-1.25 vs 9.89+/-5.65, (P<0.001), in ileum; 10.7+/-1.88 vs 22.7+/-3.95, (P<0.001), in blood) and VIP in blood also improved (compared with SD rats, 485.7+/-229.0 vs 229.8+/-62.4, P<0.01) while the amplitude of motility decreased apparently (compared with the SD rats, 0.64+/-0.096 vs 0.89+/-0.15, P<0.01). The ileal SP levels of cool stress didn't change while the ileal VIP levels of cool stress became significantly lower than that of the control groups (2.87+/-0.87 vs 9.10+/-4.91, P<0.01). The blood SP levels of cool stress were significantly higher (15.60+/-1.83 vs 6.60+/-1.47, P<0.001) whereas the blood VIP levels of cool stress were significantly lower than that of the control group (153.4+/-70.46 vs 560.4+/-151.30, P<0.001)., Conclusion: Changes of SP and VIP levels in initial part of ileum and blood of SD rats and cool stress rats may be closely related to the gastrointestinal motility disorders presented in SD and cool stress rats. the Chinese herbs (Jiawei Sijun zi Tang) currently used have partially therapeutic effect.

We report a case of isolated splenic cat scratch disease in an immunocompetent woman. The clinical presentation of prolonged fever, night sweats, weakness, and intrasplenic lesions was highly suggestive of lymphoma. This is the second reported case of isolated splenic cat scratch disease in an adult and the first in a healthy adult.