Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen

Aim

Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice.

Patients and methods

At our Department, between July and November 2011 two patients underwent laparoscopic accessory splenectomy for recurrence of ITP. Both patients had a previously laparoscopic splenectomy. Preoperative Magnetic Resonance (MR) was performed in both the cases revealing the presence of an accessory spleen.

Results

The operative time was 105 and 100 minutes respectively. No perioperative complications occured. Hospital stay was four days in both cases. The first patient had a disease free period of two months; the second one of one month. Both patients restarted immunosuppressive therapy.

Conclusions

The relapse of thrombocytopenia post-splenectomy can be associated with the presence of an accessory spleen. The laparoscopic accessory splenectomy should be considered the first choice approach. Surgical accessory splenectomy allows a transitory remission of the disease.     

Granulocyte—macrophage colony stimulating factor in acute non-lymphocytic leukaemia

Abstract. Background. Granulocyte-macrophage colony stimulating factor (GM-CSF) is required to maintain and to regulate granulocyte and monocyte productions. It is potentially useful for accelerating and enhancing haemopoietic recovery and neutrophil function. Results. In acute non-lymphocytic leukaemia (ANLL) the dependence of blast cells on GM-CSF and its role in the development and maintenance of leukaemia are still poorly defined. In vitro exposure of fresh leukaemic blast cells to a wide range of concentrations of GM-CSF leads to a stimulation of cell proliferation in the majority of cases but does not induce any detectable maturation. Conclusions. Granulocyte-macrophage colony stimulating factor may be used in the management of ANLL and the myelodysplastic syndrome (MDS) with the aim of: (i) accelerating the recovery of normal haemopoiesis; (ii) increasing cell killing by chemotherapy; and (iii) inducing cell maturation. Therefore the application of GM-CSF can potentially improve treatment outcome in ANLL and is worth testing in a clinical setting.     

Immunohistochemical detection of the multidrug transport protein P1 70 in human normal tissues and malignant lymphomas

Two monoclonal antibodies, MRK16 and C219, both directed at the 170 kDa P-glycoprotein multidrug resistance agent, were applied to frozen sections or cytospin preparations from normal human tissues and 60 non-Hodgkin's malignant lymphomas. Adrenal gland, kidney, liver and pancreas were always stained by the reagents, albeit with slightly different patterns. Brain capillaries as well as macrophages and some elements of the bone marrow, peripheral blood, ovarian stroma and colonic, gastric and jejunal mucosa were positive in all examined preparations. There were differences in the staining patterns with the two antibodies. Among the 60 non-Hodgkin's lymphomas, 25 contained a number of positive cells, which ranged from 2% to 100%. No correlation was seen between the expression of P170 and histological type, stage, clinical symptoms or growth fraction. A close relationship was shown between the presence of P170 positive elements and the clinical course of the disease (P less than 0.001).