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Splenic Injury

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61. Non-operative management for penetrating splenic trauma: how far can we go to save splenic function? Full Text available with Trip Pro

Non-operative management for penetrating splenic trauma: how far can we go to save splenic function? 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.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.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

2017 World journal of emergency surgery : WJES

62. Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa. (Abstract)

managed with OP or NOM for splenic trauma were identified and analyzed descriptively. Multiple logistic regression analysis identified patients and clinical factors associated with management type.There were 127 patients with splenic injury. Median age was 29 [19-35] years with 42 (33%) women and 85 (67%) men. Blunt injuries occurred in the majority (81, 64%). Organ Injury Scale (OIS) grades included I (25, 20%), II (43, 34%), III (36, 28%), IV (15, 11%), and V (8, 6%). Nine patients expired (...) ratio, 1.4; 95%CI 1.1-1.9) were significantly associated with OP compared to NOM (p = 0.002; area under the curve 0.81).We have identified injury mechanism and admission lactate as factors predictive of OP in South African patients with splenic trauma. Timely presentation to definitive care affects both ICU duration of stay and mortality outcomes. Future global surgical efforts may focus on expanding non-operative management protocols and improving pre-hospital care in patients with splenic trauma.

2020 World Journal of Surgery

63. Blunt Splenic Injury: Use of a Multidetector CT-based Splenic Injury Grading System and Clinical Parameters for Triage of Patients at Admission. Full Text available with Trip Pro

Blunt Splenic Injury: Use of a Multidetector CT-based Splenic Injury Grading System and Clinical Parameters for Triage of Patients at Admission. To assess the use of a dual-phase multidetector computed tomography (CT)-based grading system alone and in combination with assessment of clinical parameters at triage of patients with blunt splenic injury for determination of appropriate treatment (observation, splenic artery embolization [SAE], or splenic surgery).This HIPAA-compliant retrospective (...) study was approved by the institutional review board, and the requirement for informed consent was waived. Between January 2009 and July 2011, 171 hemodynamically stable patients with blunt splenic injury underwent multidetector CT at admission to the hospital. Images were reviewed by applying a multidetector CT-based grading system, and the amount of hemoperitoneum was quantified. Demographic data, vital signs, laboratory values, injury severity score, abbreviated injury severity, final treatment

2014 Radiology

64. Management of paediatric splenic injury in the New South Wales trauma system. (Abstract)

Management of paediatric splenic injury in the New South Wales trauma system. Since the 1980's, paediatric surgeons have increasingly managed blunt splenic injury (BSI) in children non-operatively. However, studies in North America have shown higher operation rates in non-paediatric centres and by adult surgeons. This association has not been examined elsewhere.To investigate the management of BSI in New South Wales (NSW) children, to determine the patient and hospital factors related (...) , factors associated with operation included age (OR 1.11, 95% CI 1.01-1.18, p<0.05), massive splenic disruption (OR 3.10, 95% CI 1.61-6.19, p<0.001), hollow viscus injury (OR 11.03, 95% CI 3.46-34.28, p<0.001) and transfusion (OR 7.70, 95% CI 4.54-13.16, p<0.001). Management outside a paediatric trauma centre remained significantly associated with operation, whether it be metropolitan adult trauma centre (OR 4.22 95% CI 1.70-10.52, p<0.01), rural trauma centre (OR 3.72 95% CI 1.83-7.83, p<0.001

2016 Injury

65. Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan. Full Text available with Trip Pro

Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan. The aim of the present study was to assess whether angiography after contrast-enhanced CT (CECT) as per the policy of non-operative management would add to the risk of acute kidney injury in patients with blunt splenic injuries (BSIs).Cross-sectional study.Taiwan.Patients with BSI aged >16 years, admitted

2016 BMJ open

66. Splenic Artery Ligation for Iatrogenic Injury in Esophagectomy Operations. Full Text available with Trip Pro

Splenic Artery Ligation for Iatrogenic Injury in Esophagectomy Operations. Studies have shown that splenic artery ligation without splenectomy can successfully control hemorrhage and preserve the spleen in splenic trauma. The short gastric arteries and left gastroepiploic arteries may be the most important part of the collateral blood supply to the spleen. Moreover, that the human spleen can also survive even if most of the short gastric arteries have been ligated along with the splenic artery (...) has also been proven. Revascularization of the spleen by collateral vessels from the superior mesenteric, pancreatic, and left inferior phrenic arteries has been demonstrated by celiac angiography. Thus, splenic artery ligation could be also an alternative to splenectomy for iatrogenic spleen injury in esophagectomy operations.Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

2016 Annals of Thoracic Surgery

67. Beneficial effect of Punica granatum peel extract on murine malaria-induced spleen injury. Full Text available with Trip Pro

Beneficial effect of Punica granatum peel extract on murine malaria-induced spleen injury. Multiple drug-resistant malaria parasites have been widely detected, which has encouraged research studies focused on discovering alternative therapies. Medicinal plants such as pomegranate, Punica granatum, have been proven to exhibit antiprotozoal effects and therefore, we examined its effects on murine malaria-induced splenic injury and oxidative stress in this study.Mice were divided into three groups (...) , a vehicle control and two groups that were infected with 10(6) Plasmodium chabaudi-parasitized red blood cells (RBCs). The third group was gavaged with 100 μL of 300 mg/kg pomegranate peel extract for 6 days. All mice were euthanized on day 6 post-infection.The results revealed the potential antimalarial, antioxidant, and anti-inflammatory effects of pomegranate. Furthermore, pomegranate peel extracts significantly reduced parasitemia and spleen index of the treated mice compared to the untreated group

2016 BMC Complementary and Alternative Medicine

68. Non-Operative Management Is As Effective As Immediate Splenectomy For Adult Patients with High-Grade Blunt Splenic Injury. (Abstract)

Non-Operative Management Is As Effective As Immediate Splenectomy For Adult Patients with High-Grade Blunt Splenic Injury. The comparative effectiveness of nonoperative management (NOM) vs immediate splenectomy (IS) for hemodynamically stable adult patients with grade IV or V blunt splenic injury (BSI) has not been clearly established in the literature.We performed a retrospective analysis of adult patients, from the 2013 to 2014 American College of Surgeons Trauma Quality Improvement Program (...) was not different between the IS and NOM patients (11.5% vs 10.0%, p = 0.33), although IS patients had a higher incidence of infectious complications (21.4% vs 16.9%, p = 0.02). The rate of NOM failure in our sample was 20.1%. Independent predictors of failed NOM included the presence of a bleeding disorder, early blood transfusion requirement, and grade V injury. Splenic artery embolization was associated with a decreased risk of NOM failure. Patients who had failed NOM had a lower in-hospital mortality rate

2016 Journal of the American College of Surgeons

69. The spleen as an extramedullary source of inflammatory cells responding to acetaminophen-induced liver injury Full Text available with Trip Pro

The spleen as an extramedullary source of inflammatory cells responding to acetaminophen-induced liver injury Macrophages have been shown to play a role in acetaminophen (APAP)-induced hepatotoxicity, contributing to both pro- and anti-inflammatory processes. In these studies, we analyzed the role of the spleen as an extramedullary source of hepatic macrophages. APAP administration (300mg/kg, i.p.) to control mice resulted in an increase in CD11b(+) infiltrating Ly6G(+) granulocytic and Ly6G (...) (-) monocytic cells in the spleen and the liver. The majority of the Ly6G(+) cells were also positive for the monocyte/macrophage activation marker, Ly6C, suggesting a myeloid derived suppressor cell (MDSC) phenotype. By comparison, Ly6G(-) cells consisted of 3 subpopulations expressing high, intermediate, and low levels of Ly6C. Splenectomy was associated with increases in mature (F4/80(+)) and immature (F4/80(-)) pro-inflammatory Ly6C(hi) macrophages and mature anti-inflammatory (Ly6C(lo)) macrophages

2016 Toxicology and applied pharmacology

70. Laparascopic Splenectomy Due to Splenic Injury after Colonoscopy Full Text available with Trip Pro

Laparascopic Splenectomy Due to Splenic Injury after Colonoscopy Colonoscopy, which is routinely performed in diagnosis and treatment of colorectal disorders, is a reliable procedure. Its most frequent complications are bleeding and perforation. Splenic rupture is a very rarely met complication of colonoscopy, and delay in its diagnosis leads to increased morbidity and mortality. We presented a 69 years old female patient, who was diagnosed by computerized abdominal tomography, performed (...) bleeding, in other words, if there is a sub-capsular hematoma of the spleen, medical management by monitoring the vital signs may be preferred. Then, splenectomy should be performed at an appropriate time.

2016 The Eurasian journal of medicine

71. Salmonella typhi Splenic Abscess Following Blunt Abdominal Injury: A Case Report Full Text available with Trip Pro

Salmonella typhi Splenic Abscess Following Blunt Abdominal Injury: A Case Report Splenic abscess as a complication of enteric fever due to Salmonella typhi is a rare entity. Here, we are presenting a case of splenic abscess caused by Salmonella typhi with a blunt injury to the abdomen as the predisposing factor. The patient underwent total splenectomy due to failure of conservative management. Splenic abscess is a potential life threatening disease if left untreated. In spite of its rarity

2016 Journal of clinical and diagnostic research : JCDR

72. Editor’s Highlight: Role of Spleen-Derived Macrophages in Ozone-Induced Lung Inflammation and Injury Full Text available with Trip Pro

Editor’s Highlight: Role of Spleen-Derived Macrophages in Ozone-Induced Lung Inflammation and Injury Macrophages and inflammatory mediators have been implicated in ozone toxicity. In these studies, we used splenectomized (SPX) mice to assess the contribution of splenic monocytes to pulmonary inflammation and injury induced by ozone. Cells and tissue were collected 24-72 h after exposure of mice to air or ozone (0.8 ppm, 3 h). Following ozone exposure, increased numbers of pro-inflammatory (...) ozone toxicity, as measured by decreases in bronchoalveolar lavage protein content and reduced 4-hydroxynonenal expression in the lung. These data suggest that the spleen is a source of pro-inflammatory/cytotoxic macrophages that contribute to ozone-induced lung injury, inflammation, and oxidative stress.© The Author 2016. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

2016 Toxicological Sciences

73. Noninvasive management for iatrogenic splenic injury caused by chest tube insertion: a case report Full Text available with Trip Pro

Noninvasive management for iatrogenic splenic injury caused by chest tube insertion: a case report Splenic injury is one of the most critical complications of chest tube insertion and often requires invasive emergency management. However, noninvasive management such as delayed removal of the malpositioned tube may be considered for a stable patient without severe adverse event.

2016 Clinical Case Reports

74. Organ crushing tackle: pancreatic, bowel and splenic artery injury from blunt abdominal trauma playing rugby union Full Text available with Trip Pro

Organ crushing tackle: pancreatic, bowel and splenic artery injury from blunt abdominal trauma playing rugby union 26786533 2016 12 13 2018 11 13 1757-790X 2016 2016 Jan 19 BMJ case reports BMJ Case Rep Organ crushing tackle: pancreatic, bowel and splenic artery injury from blunt abdominal trauma playing rugby union. 10.1136/bcr-2015-214124 bcr2015214124 Moore Timothy T NSW Health, Manly, New South Wales, Australia. eng Case Reports Journal Article 2016 01 19 England BMJ Case Rep 101526291 1757 (...) -790X IM Abdominal Injuries diagnostic imaging etiology pathology surgery Adult Colectomy Football injuries Humans Laparotomy methods Male Pancreas injuries surgery Pancreatectomy Shock, Hemorrhagic diagnosis etiology Splenectomy Splenic Artery injuries surgery Wounds, Nonpenetrating diagnosis etiology pathology surgery 2016 1 21 6 0 2016 1 21 6 0 2016 12 15 6 0 epublish 26786533 bcr-2015-214124 10.1136/bcr-2015-214124 PMC4735394 Acta Radiol. 2015 Apr;56(4):387-96 24760286 N Engl J Med. 1994 Oct

2016 BMJ case reports

75. Comparison of MDCT protocols in trauma patients with suspected splenic injury: superior results with protocol that includes arterial and portal venous phase imaging Full Text available with Trip Pro

Comparison of MDCT protocols in trauma patients with suspected splenic injury: superior results with protocol that includes arterial and portal venous phase imaging We aimed to determine which intravenous contrast-enhanced multidetector computed tomography (MDCT) protocol produced the most accurate results for the detection of splenic vascular injury in hemodynamically stable patients who had sustained blunt abdominal trauma.We retrospectively reviewed 88 patients from 2003 to 2011 who (...) , which includes the arterial phase, in patients with suspected splenic injury and question the utility of obtaining a delayed sequence.

2016 Diagnostic and Interventional Radiology

76. Variation in ICU Utilization and Mortality After Blunt Splenic Injury Full Text available with Trip Pro

Variation in ICU Utilization and Mortality After Blunt Splenic Injury Although trauma patients are frequently cared for in the intensive care unit (ICU), admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission.We conducted a retrospective cohort study of patients treated for blunt splenic injuries from 2011-2014 at 30 level I and II Pennsylvania trauma (...) centers.Of 2587 patients with blunt splenic injuries, 63.9% (1654) were admitted to the ICU. Median injury severity score was 17 overall, 13 for non-ICU patients and 17 for ICU patients (P < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9%-87.3%. Risk-adjusted mortality rates ranged from 1.2%-9.6%. There was no correlation between observed-to-expected ratios for ICU utilization

2016 The Journal of surgical research

77. Colonoscopic Splenic Injury: A Simplified Radiologic Approach Full Text available with Trip Pro

Colonoscopic Splenic Injury: A Simplified Radiologic Approach Colonoscopy is a commonly performed procedure for diagnosis and treatment of large bowel diseases. Recognized complications include bleeding and perforation. Splenic injury during colonoscopy is a rare complication. We report a case of a 73-year-old woman who presented with left-sided abdominal pain after colonoscopy with finding of splenic injury on CT scan. She was managed conservatively. We discuss the diagnostic and therapeutic (...) approach to colonoscopic splenic injury.

2016 Case reports in gastrointestinal medicine

78. Splenic injury following elective colonoscopy: a rare complication Full Text available with Trip Pro

Splenic injury following elective colonoscopy: a rare complication Splenic injury is an extremely rare, yet serious, complication related to colonoscopy. So far, less than 80 cases have been reported worldwide since 1970. With the increasing use of colonoscopy, endoscopists, surgeons and radiologists are more likely to encounter this unusual complication. Increased splenocolic adhesions, splenomegaly or underlying splenic disease might, inter alia, constitute a predisposing factor. However (...) , it might also occur in patients without significant adhesions or underlying splenic pathology. Patients with abdominal pain, hypotension and a fall in hematocrit without rectal bleeding after colonoscopy, should be suspected of having splenic injury. Most patients present with symptoms within 24 hours after colonoscopy, nevertheless, delayed presentations have been described as well. We report such a case of splenic injury secondary to colonoscopy. The patient was presented with hemorrhagic shock

2016 Journal of surgical case reports

79. Iatrogenic splenic injury: review of the literature and medico-legal issues Full Text available with Trip Pro

Iatrogenic splenic injury: review of the literature and medico-legal issues Iatrogenic splenic injury is a recognized complication in abdominal surgery. The aim of this paper is to understand the medico-legal issues of iatrogenic splenic injuries. We performed a literature review on PubMed and Scopus using iatrogenic splenic or spleen injury and iatrogenic splenic rupture as keywords. Iatrogenic splenic injury cases were identified. Most cases were related to colonoscopy, but we also identified (...) cases related to upper gastrointestinal procedures, colonic surgery, ERCP, left nephrectomy and/or adrenalectomy, percutaneous nephrolithotomy, vascular operations involving the abdominal aorta, gynecological operation, left lung biopsy, chest drain, very rarely spinal surgery and even cardiopulmonary resuscitation. There are several surgical procedures that can lead to a splenic injury. However, from a medico-legal point of view, it is important to assess whether the cause can be attributed

2016 Open Medicine

80. Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis. Full Text available with Trip Pro

Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis. Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE with historical controls. The aim of this study was to investigate whether SAE improves (...) success rate compared to observation alone in contemporaneous patients with blunt splenic injury.We included adult patients with blunt splenic injury admitted to five Level 1 Trauma Centers between January 2009 and December 2012 and selected for NOM. Successful treatment was defined as splenic salvage and no splenic re-intervention. We calculated propensity scores, expressing the probability of undergoing SAE, using multivariable logistic regression and created five strata based on the quintiles

2015 World Journal of Surgery

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