Efficacy and safety of laparoscopic splenectomy in thrombocytopenia secondary to systemic lupus erythematosus
Identifieur interne : 001843 ( Istex/Corpus ); précédent : 001842; suivant : 001844Efficacy and safety of laparoscopic splenectomy in thrombocytopenia secondary to systemic lupus erythematosus
Auteurs : Jin Zhou ; Zhong Wu ; Zongguang Zhou ; Zhiqiang Wang ; Yi Liu ; Xiang-Yang Huang ; Bing PengSource :
- Clinical Rheumatology [ 0770-3198 ] ; 2013-08-01.
English descriptors
Abstract
Abstract: This study aims to investigate the efficacy and safety of laparoscopic splenectomy (LS) in the management of refractory thrombocytopenia associated with systemic lupus erythematosus (SLE). From January 2003 to February 2012, 20 patients underwent splenectomy for thrombocytopenia associated with SLE. Of these, 11 underwent open (SLE-OS group) and 9 underwent laparoscopic splenectomy (SLE-LS group). Another 15 patients with ITP underwent LS (ITP-LS group) were categorized as the control group. Surgical indications, perioperative details, and short- (90 days) and long- (median, 42 months) term hematological outcomes were assessed. Splenectomy was successful in all 20 SLE patients. The mean platelet count increased from 23 × 109/L before splenectomy to 289.2 × 109/L and 144.2 × 109/L after 3 and 6 months, respectively, and was 115.5 × 109/L at the last visit, with a 3-month complete response (CR) rate of 100 %. After a median follow-up of 42 months, 17 patients (85 %) had a CR or partial response (PR) to splenectomy plus medical therapy. SLEDAI score and dosage of steroids decreased significantly after splenectomy. None of these patients experienced any postoperative infection, bleeding, or thrombotic events. SLE-LS group had lower volumes of estimated blood loss and postoperative drainage and shorter postoperative hospital stay than SLE-OS group. There were no statistically significant differences between the SLE-LS and ITP-LS groups in operation time, estimated blood loss, and postoperative hospital stay. Splenectomy is effective and safe in the management of refractory thrombocytopenia secondary to SLE. LS may be safe and effective in thrombocytopenia associated with SLE.
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DOI: 10.1007/s10067-013-2230-6
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ISTEX:88B7E6594FD04C70223BF64E01E987DE5D61D232Le document en format XML
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Zhou</name><affiliation><mods:affiliation>Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</mods:affiliation></affiliation></author><author><name sortKey="Wang, Zhiqiang" sort="Wang, Zhiqiang" uniqKey="Wang Z" first="Zhiqiang" last="Wang">Zhiqiang Wang</name><affiliation><mods:affiliation>Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</mods:affiliation></affiliation></author><author><name sortKey="Liu, Yi" sort="Liu, Yi" uniqKey="Liu Y" first="Yi" last="Liu">Yi Liu</name><affiliation><mods:affiliation>Department of Rheumatology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</mods:affiliation></affiliation></author><author><name sortKey="Huang, Xiang Yang" sort="Huang, Xiang Yang" uniqKey="Huang X" first="Xiang-Yang" last="Huang">Xiang-Yang Huang</name><affiliation><mods:affiliation>Department of Rheumatology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: yangyang1029@yahoo.com.cn</mods:affiliation></affiliation></author><author><name sortKey="Peng, Bing" sort="Peng, Bing" uniqKey="Peng B" first="Bing" last="Peng">Bing Peng</name><affiliation><mods:affiliation>Department of Hepato-bilio-pancreatic Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: pengbing84@hotmail.com</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Clinical Rheumatology</title><title level="j" type="sub">Journal of the International League of Associations for Rheumatology</title><title level="j" type="abbrev">Clin Rheumatol</title><idno type="ISSN">0770-3198</idno><idno type="eISSN">1434-9949</idno><imprint><publisher>Springer London</publisher><pubPlace>London</pubPlace><date type="published" when="2013-08-01">2013-08-01</date><biblScope unit="volume">32</biblScope><biblScope unit="issue">8</biblScope><biblScope unit="page" from="1131">1131</biblScope><biblScope unit="page" to="1138">1138</biblScope></imprint><idno type="ISSN">0770-3198</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0770-3198</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Laparoscopic splenectomy</term><term>Systemic lupus erythematosus</term><term>Thrombocytopenia</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: This study aims to investigate the efficacy and safety of laparoscopic splenectomy (LS) in the management of refractory thrombocytopenia associated with systemic lupus erythematosus (SLE). From January 2003 to February 2012, 20 patients underwent splenectomy for thrombocytopenia associated with SLE. Of these, 11 underwent open (SLE-OS group) and 9 underwent laparoscopic splenectomy (SLE-LS group). Another 15 patients with ITP underwent LS (ITP-LS group) were categorized as the control group. Surgical indications, perioperative details, and short- (90 days) and long- (median, 42 months) term hematological outcomes were assessed. Splenectomy was successful in all 20 SLE patients. The mean platelet count increased from 23 × 109/L before splenectomy to 289.2 × 109/L and 144.2 × 109/L after 3 and 6 months, respectively, and was 115.5 × 109/L at the last visit, with a 3-month complete response (CR) rate of 100 %. After a median follow-up of 42 months, 17 patients (85 %) had a CR or partial response (PR) to splenectomy plus medical therapy. SLEDAI score and dosage of steroids decreased significantly after splenectomy. None of these patients experienced any postoperative infection, bleeding, or thrombotic events. SLE-LS group had lower volumes of estimated blood loss and postoperative drainage and shorter postoperative hospital stay than SLE-OS group. There were no statistically significant differences between the SLE-LS and ITP-LS groups in operation time, estimated blood loss, and postoperative hospital stay. Splenectomy is effective and safe in the management of refractory thrombocytopenia secondary to SLE. LS may be safe and effective in thrombocytopenia associated with SLE.</div></front></TEI><istex><corpusName>springer-journals</corpusName><author><json:item><name>Jin Zhou</name><affiliations><json:string>Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</json:string></affiliations></json:item><json:item><name>Zhong Wu</name><affiliations><json:string>Department of Hepato-bilio-pancreatic Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</json:string></affiliations></json:item><json:item><name>Zongguang Zhou</name><affiliations><json:string>Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</json:string></affiliations></json:item><json:item><name>Zhiqiang Wang</name><affiliations><json:string>Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</json:string></affiliations></json:item><json:item><name>Yi Liu</name><affiliations><json:string>Department of Rheumatology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</json:string></affiliations></json:item><json:item><name>Xiang-Yang Huang</name><affiliations><json:string>Department of Rheumatology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</json:string><json:string>E-mail: yangyang1029@yahoo.com.cn</json:string></affiliations></json:item><json:item><name>Bing Peng</name><affiliations><json:string>Department of Hepato-bilio-pancreatic Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</json:string><json:string>E-mail: pengbing84@hotmail.com</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Laparoscopic splenectomy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Systemic lupus erythematosus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Thrombocytopenia</value></json:item></subject><articleId><json:string>2230</json:string><json:string>s10067-013-2230-6</json:string></articleId><arkIstex>ark:/67375/VQC-S68JXZBT-J</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>OriginalPaper</json:string></originalGenre><abstract>Abstract: This study aims to investigate the efficacy and safety of laparoscopic splenectomy (LS) in the management of refractory thrombocytopenia associated with systemic lupus erythematosus (SLE). From January 2003 to February 2012, 20 patients underwent splenectomy for thrombocytopenia associated with SLE. Of these, 11 underwent open (SLE-OS group) and 9 underwent laparoscopic splenectomy (SLE-LS group). Another 15 patients with ITP underwent LS (ITP-LS group) were categorized as the control group. Surgical indications, perioperative details, and short- (90 days) and long- (median, 42 months) term hematological outcomes were assessed. Splenectomy was successful in all 20 SLE patients. The mean platelet count increased from 23 × 109/L before splenectomy to 289.2 × 109/L and 144.2 × 109/L after 3 and 6 months, respectively, and was 115.5 × 109/L at the last visit, with a 3-month complete response (CR) rate of 100 %. After a median follow-up of 42 months, 17 patients (85 %) had a CR or partial response (PR) to splenectomy plus medical therapy. SLEDAI score and dosage of steroids decreased significantly after splenectomy. None of these patients experienced any postoperative infection, bleeding, or thrombotic events. SLE-LS group had lower volumes of estimated blood loss and postoperative drainage and shorter postoperative hospital stay than SLE-OS group. There were no statistically significant differences between the SLE-LS and ITP-LS groups in operation time, estimated blood loss, and postoperative hospital stay. Splenectomy is effective and safe in the management of refractory thrombocytopenia secondary to SLE. LS may be safe and effective in thrombocytopenia associated with SLE.</abstract><qualityIndicators><score>8.94</score><pdfWordCount>4084</pdfWordCount><pdfCharCount>27735</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>8</pdfPageCount><pdfPageSize>595.276 x 790.866 pts</pdfPageSize><refBibsNative>false</refBibsNative><abstractWordCount>238</abstractWordCount><abstractCharCount>1709</abstractCharCount><keywordCount>3</keywordCount></qualityIndicators><title>Efficacy and safety of laparoscopic splenectomy in thrombocytopenia secondary to systemic lupus erythematosus</title><genre><json:string>research-article</json:string></genre><host><title>Clinical 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From January 2003 to February 2012, 20 patients underwent splenectomy for thrombocytopenia associated with SLE. Of these, 11 underwent open (SLE-OS group) and 9 underwent laparoscopic splenectomy (SLE-LS group). Another 15 patients with ITP underwent LS (ITP-LS group) were categorized as the control group. Surgical indications, perioperative details, and short- (90 days) and long- (median, 42 months) term hematological outcomes were assessed. Splenectomy was successful in all 20 SLE patients. The mean platelet count increased from 23 × 109/L before splenectomy to 289.2 × 109/L and 144.2 × 109/L after 3 and 6 months, respectively, and was 115.5 × 109/L at the last visit, with a 3-month complete response (CR) rate of 100 %. After a median follow-up of 42 months, 17 patients (85 %) had a CR or partial response (PR) to splenectomy plus medical therapy. SLEDAI score and dosage of steroids decreased significantly after splenectomy. None of these patients experienced any postoperative infection, bleeding, or thrombotic events. SLE-LS group had lower volumes of estimated blood loss and postoperative drainage and shorter postoperative hospital stay than SLE-OS group. There were no statistically significant differences between the SLE-LS and ITP-LS groups in operation time, estimated blood loss, and postoperative hospital stay. Splenectomy is effective and safe in the management of refractory thrombocytopenia secondary to SLE. LS may be safe and effective in thrombocytopenia associated with SLE.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keyword</head><item><term>Laparoscopic splenectomy</term></item><item><term>Systemic lupus erythematosus</term></item><item><term>Thrombocytopenia</term></item></list></keywords></textClass><textClass><keywords scheme="Journal-Subject-Collection"><list><label>SC11</label><item><term>Medicine</term></item></list></keywords></textClass><textClass><keywords scheme="Journal-Subject-Group"><list><label>SCH</label><item><term>Medicine & Public Health</term></item><label>SCH57009</label><item><term>Rheumatology</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2012-09-18">Created</change><change 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Article</ArticleCategory><ArticleFirstPage>1131</ArticleFirstPage><ArticleLastPage>1138</ArticleLastPage><ArticleHistory><RegistrationDate><Year>2013</Year><Month>2</Month><Day>28</Day></RegistrationDate><Received><Year>2012</Year><Month>9</Month><Day>18</Day></Received><Revised><Year>2013</Year><Month>1</Month><Day>11</Day></Revised><Accepted><Year>2013</Year><Month>2</Month><Day>27</Day></Accepted><OnlineDate><Year>2013</Year><Month>4</Month><Day>3</Day></OnlineDate></ArticleHistory><ArticleCopyright><CopyrightHolderName>Clinical Rheumatology</CopyrightHolderName><CopyrightYear>2013</CopyrightYear></ArticleCopyright><ArticleGrants Type="Regular"><MetadataGrant Grant="OpenAccess"></MetadataGrant><AbstractGrant Grant="OpenAccess"></AbstractGrant><BodyPDFGrant Grant="Restricted"></BodyPDFGrant><BodyHTMLGrant Grant="Restricted"></BodyHTMLGrant><BibliographyGrant Grant="Restricted"></BibliographyGrant><ESMGrant Grant="Restricted"></ESMGrant></ArticleGrants></ArticleInfo><ArticleHeader><AuthorGroup><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>Jin</GivenName><FamilyName>Zhou</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff2"><AuthorName DisplayOrder="Western"><GivenName>Zhong</GivenName><FamilyName>Wu</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>Zongguang</GivenName><FamilyName>Zhou</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>Zhiqiang</GivenName><FamilyName>Wang</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff3"><AuthorName DisplayOrder="Western"><GivenName>Yi</GivenName><FamilyName>Liu</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff3" CorrespondingAffiliationID="Aff3"><AuthorName DisplayOrder="Western"><GivenName>Xiang-Yang</GivenName><FamilyName>Huang</FamilyName></AuthorName><Contact><Phone>+86-28-85422393</Phone><Fax>+86-28-85423459</Fax><Email>yangyang1029@yahoo.com.cn</Email></Contact></Author><Author AffiliationIDS="Aff2" CorrespondingAffiliationID="Aff2"><AuthorName DisplayOrder="Western"><GivenName>Bing</GivenName><FamilyName>Peng</FamilyName></AuthorName><Contact><Phone>+86-28-85422474</Phone><Fax>+86-28-85422474</Fax><Email>pengbing84@hotmail.com</Email></Contact></Author><Affiliation ID="Aff1"><OrgDivision>Department of Gastrointestinal Surgery, West China Hospital</OrgDivision><OrgName>Sichuan University</OrgName><OrgAddress><City>Chengdu</City><Postcode>610041</Postcode><State>Sichuan Province</State><Country Code="CN">China</Country></OrgAddress></Affiliation><Affiliation ID="Aff2"><OrgDivision>Department of Hepato-bilio-pancreatic Surgery, West China Hospital</OrgDivision><OrgName>Sichuan University</OrgName><OrgAddress><City>Chengdu</City><Postcode>610041</Postcode><State>Sichuan Province</State><Country Code="CN">China</Country></OrgAddress></Affiliation><Affiliation ID="Aff3"><OrgDivision>Department of Rheumatology, West China Hospital</OrgDivision><OrgName>Sichuan University</OrgName><OrgAddress><City>Chengdu</City><Postcode>610041</Postcode><State>Sichuan Province</State><Country Code="CN">China</Country></OrgAddress></Affiliation><Affiliation ID="Aff4"><OrgDivision>Department of Hepato-biliary-pancreatic Surgery, West China Hospital</OrgDivision><OrgName>Sichuan University</OrgName><OrgAddress><City>Chengdu</City><Postcode>610041</Postcode><State>Sichuan Province</State><Country Code="CN">China</Country></OrgAddress></Affiliation></AuthorGroup><Abstract ID="Abs1" Language="En" OutputMedium="All"><Heading>Abstract</Heading><Para>This study aims to investigate the efficacy and safety of laparoscopic splenectomy (LS) in the management of refractory thrombocytopenia associated with systemic lupus erythematosus (SLE). From January 2003 to February 2012, 20 patients underwent splenectomy for thrombocytopenia associated with SLE. Of these, 11 underwent open (SLE-OS group) and 9 underwent laparoscopic splenectomy (SLE-LS group). Another 15 patients with ITP underwent LS (ITP-LS group) were categorized as the control group. Surgical indications, perioperative details, and short- (90 days) and long- (median, 42 months) term hematological outcomes were assessed. Splenectomy was successful in all 20 SLE patients. The mean platelet count increased from 23 × 10<Superscript>9</Superscript>/L before splenectomy to 289.2 × 10<Superscript>9</Superscript>/L and 144.2 × 10<Superscript>9</Superscript>/L after 3 and 6 months, respectively, and was 115.5 × 10<Superscript>9</Superscript>/L at the last visit, with a 3-month complete response (CR) rate of 100 %. After a median follow-up of 42 months, 17 patients (85 %) had a CR or partial response (PR) to splenectomy plus medical therapy. SLEDAI score and dosage of steroids decreased significantly after splenectomy. None of these patients experienced any postoperative infection, bleeding, or thrombotic events. SLE-LS group had lower volumes of estimated blood loss and postoperative drainage and shorter postoperative hospital stay than SLE-OS group. There were no statistically significant differences between the SLE-LS and ITP-LS groups in operation time, estimated blood loss, and postoperative hospital stay. Splenectomy is effective and safe in the management of refractory thrombocytopenia secondary to SLE. LS may be safe and effective in thrombocytopenia associated with SLE.</Para></Abstract><KeywordGroup Language="En" OutputMedium="All"><Heading>Keyword</Heading><Keyword>Laparoscopic splenectomy</Keyword><Keyword>Systemic lupus erythematosus</Keyword><Keyword>Thrombocytopenia</Keyword></KeywordGroup><ArticleNote Type="Misc"><SimplePara>Zhong Wu, Jin Zhou, Bing Peng and Xiang-Yang Huang contributed equally to this work.</SimplePara></ArticleNote></ArticleHeader><NoBody></NoBody></Article></Issue></Volume></Journal></Publisher></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Efficacy and safety of laparoscopic splenectomy in thrombocytopenia secondary to systemic lupus erythematosus</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Efficacy and safety of laparoscopic splenectomy in thrombocytopenia secondary to systemic lupus erythematosus</title></titleInfo><name type="personal"><namePart type="given">Jin</namePart><namePart type="family">Zhou</namePart><affiliation>Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Zhong</namePart><namePart type="family">Wu</namePart><affiliation>Department of Hepato-bilio-pancreatic Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Zongguang</namePart><namePart type="family">Zhou</namePart><affiliation>Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Zhiqiang</namePart><namePart type="family">Wang</namePart><affiliation>Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yi</namePart><namePart type="family">Liu</namePart><affiliation>Department of Rheumatology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Xiang-Yang</namePart><namePart type="family">Huang</namePart><affiliation>Department of Rheumatology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</affiliation><affiliation>E-mail: yangyang1029@yahoo.com.cn</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Bing</namePart><namePart type="family">Peng</namePart><affiliation>Department of Hepato-bilio-pancreatic Surgery, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, China</affiliation><affiliation>E-mail: pengbing84@hotmail.com</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="OriginalPaper" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Springer London</publisher><place><placeTerm type="text">London</placeTerm></place><dateCreated encoding="w3cdtf">2012-09-18</dateCreated><dateIssued encoding="w3cdtf">2013-08-01</dateIssued><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><abstract lang="en">Abstract: This study aims to investigate the efficacy and safety of laparoscopic splenectomy (LS) in the management of refractory thrombocytopenia associated with systemic lupus erythematosus (SLE). From January 2003 to February 2012, 20 patients underwent splenectomy for thrombocytopenia associated with SLE. Of these, 11 underwent open (SLE-OS group) and 9 underwent laparoscopic splenectomy (SLE-LS group). Another 15 patients with ITP underwent LS (ITP-LS group) were categorized as the control group. Surgical indications, perioperative details, and short- (90 days) and long- (median, 42 months) term hematological outcomes were assessed. Splenectomy was successful in all 20 SLE patients. The mean platelet count increased from 23 × 109/L before splenectomy to 289.2 × 109/L and 144.2 × 109/L after 3 and 6 months, respectively, and was 115.5 × 109/L at the last visit, with a 3-month complete response (CR) rate of 100 %. After a median follow-up of 42 months, 17 patients (85 %) had a CR or partial response (PR) to splenectomy plus medical therapy. SLEDAI score and dosage of steroids decreased significantly after splenectomy. None of these patients experienced any postoperative infection, bleeding, or thrombotic events. SLE-LS group had lower volumes of estimated blood loss and postoperative drainage and shorter postoperative hospital stay than SLE-OS group. There were no statistically significant differences between the SLE-LS and ITP-LS groups in operation time, estimated blood loss, and postoperative hospital stay. Splenectomy is effective and safe in the management of refractory thrombocytopenia secondary to SLE. LS may be safe and effective in thrombocytopenia associated with SLE.</abstract><note>Original Article</note><subject lang="en"><genre>Keyword</genre><topic>Laparoscopic splenectomy</topic><topic>Systemic lupus erythematosus</topic><topic>Thrombocytopenia</topic></subject><relatedItem type="host"><titleInfo><title>Clinical Rheumatology</title><subTitle>Journal of the International League of Associations for Rheumatology</subTitle></titleInfo><titleInfo type="abbreviated"><title>Clin Rheumatol</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>Springer</publisher><dateIssued encoding="w3cdtf">2013-07-27</dateIssued><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><subject><genre>Journal-Subject-Collection</genre><topic authority="SpringerSubjectCodes" authorityURI="SC11">Medicine</topic></subject><subject><genre>Journal-Subject-Group</genre><topic authority="SpringerSubjectCodes" authorityURI="SCH">Medicine & Public Health</topic><topic authority="SpringerSubjectCodes" authorityURI="SCH57009">Rheumatology</topic></subject><identifier type="ISSN">0770-3198</identifier><identifier type="eISSN">1434-9949</identifier><identifier type="JournalID">10067</identifier><identifier type="IssueArticleCount">21</identifier><identifier type="VolumeIssueCount">12</identifier><part><date>2013</date><detail type="volume"><number>32</number><caption>vol.</caption></detail><detail type="issue"><number>8</number><caption>no.</caption></detail><extent unit="pages"><start>1131</start><end>1138</end></extent></part><recordInfo><recordOrigin>Clinical Rheumatology, 2013</recordOrigin></recordInfo></relatedItem><identifier type="istex">88B7E6594FD04C70223BF64E01E987DE5D61D232</identifier><identifier type="ark">ark:/67375/VQC-S68JXZBT-J</identifier><identifier type="DOI">10.1007/s10067-013-2230-6</identifier><identifier type="ArticleID">2230</identifier><identifier type="ArticleID">s10067-013-2230-6</identifier><accessCondition type="use and reproduction" contentType="copyright">Clinical Rheumatology, 2013</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-3XSW68JL-F">springer</recordContentSource><recordOrigin>Clinical Rheumatology, 2013</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/VQC-S68JXZBT-J/record.json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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