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de Abreu ES, Nardelli MJ, Lima AMC, Cardoso JB, Osório FMF, Ferrari TCDA, Faria LC, Couto CA, Cançado GGL. Carvedilol as secondary prophylaxis for variceal bleeding in hepatosplenic schistosomiasis. Trans R Soc Trop Med Hyg 2022; 116:663-667. [DOI: 10.1093/trstmh/trab190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/24/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Upper variceal bleeding (UVB) is a possible complication of portal hypertension secondary to hepatosplenic schistosomiasis (HSS). Propranolol is a non-selective beta-blocker used as secondary prophylaxis for UVB, but no previous studies have addressed carvedilol effects in rebleeding prevention.
Methods
A retrospective exploratory study of 57 patients with chronic HSS and index UVB treated with endoscopic variceal ligation and propranolol or carvedilol was conducted. The primary outcome was UVB-free time in the first 12 mo after the initial bleeding episode.
Results
Propranolol was used for secondary UVB prophylaxis in 43 (75.4%) participants (median dose 80 [interquartile range – IQR 60–80] mg/d) and carvedilol in 14 (24.6%) participants (median dose 12.5 [IQR 7.9–25.0] mg/d). During a 12-mo follow-up, rebleeding was observed in 13 (22.8%) patients, 9 (20.9%) of those treated with propranolol and 4 (28.6%) treated with carvedilol (p=0.715). Mean time from the beginning of drug prophylaxis to rebleeding was 6±3 mo and there was no difference between that for propranolol vs carvedilol subgroups. Portal vein thrombosis did not influence the bleeding recurrence in either subgroup.
Conclusion
Carvedilol may be equally effective as propranolol in preventing secondary UVB in HSS at 12-mo follow-up.
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Affiliation(s)
- Eliabe Silva de Abreu
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Mateus Jorge Nardelli
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - André Mourão Costa Lima
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Jaqueline Brito Cardoso
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Fernanda Maria Farage Osório
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Teresa Cristina de Abreu Ferrari
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Luciana Costa Faria
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Cláudia Alves Couto
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Guilherme Grossi Lopes Cançado
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
- Hospital da Polícia Militar de Minas Gerais , Rua Pacífico Mascarenhas, s/n-Santa Efigěnia, Belo Horizonte, Minas Gerais 30110-013, Brazil
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Yuan HL, Wang M, Chu WW, Li FX, Lu JJ, Li Y. Nomogram Model for Prediction of Portal Vein Thrombosis in Patients with Liver Cirrhosis After Splenectomy: A Retrospective Analysis of 2 Independent Cohorts. Med Sci Monit 2021; 27:e929844. [PMID: 34075015 PMCID: PMC8183155 DOI: 10.12659/msm.929844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The aim of this study was to establish and validate an easy-to-use nomogram to predict portal vein thrombosis (PVT) in patients with cirrhosis after splenectomy and to test its predictive ability. Material/Methods This retrospective study included 315 patients with cirrhosis who underwent splenectomy at 2 high-volume medical centers. The least absolute shrinkage and selection operator (LASSO) regression method was used to select the predictors in the training cohort, and multivariable logistic regression analysis was performed to establish the predictive nomogram model. We determined the prediction value of the nomogram by the area under the receiver operating characteristic curve (AUROC), the calibration curve, and decision curve analysis. Finally, the applicability of the nomogram was internally and independently validated. Results The predictors of PVT included portal vein diameter, splenic vein diameter, body mass index, and platelet count. Based on the clinical and radiomic models, the nomogram had good predictive efficiency for predicting PVT in patients with cirrhosis after splenectomy, with an AUROC of 0.887 (0.856 in internal validation and 0.796 in independent validation). The decision curve analysis revealed that the nomogram had good clinical application value. Conclusions We successfully developed an easy-to-use nomogram to predict the probability of PVT in patients with cirrhosis after splenectomy. The nomogram can help clinicians make timely, individualized clinical decisions for PVT in patients with cirrhosis after splenectomy.
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Affiliation(s)
- Hai-Liang Yuan
- Department of Gastroenterology, Zhejiang University School of Medicine, First Affiliated Hospital, Beilun Branch, Ningbo, Zhejiang, China (mainland)
| | - Min Wang
- Department of Liver Diseases, The First Affiliated Hospital of Nanchang University, Nanchang, Jangxi, China (mainland)
| | - Wei-Wei Chu
- Department of Gastroenterology, Zhejiang University School of Medicine, First Affiliated Hospital, Beilun Branch, Ningbo, Zhejiang, China (mainland)
| | - Fang-Xian Li
- Department of Gastroenterology, Zhejiang University School of Medicine, First Affiliated Hospital, Beilun Branch, Ningbo, Zhejiang, China (mainland)
| | - Jing-Jing Lu
- Department of Gastroenterology, Zhejiang University School of Medicine, First Affiliated Hospital, Beilun Branch, Ningbo, Zhejiang, China (mainland)
| | - Yan Li
- Department of Gastroenterology, Zhejiang University School of Medicine, First Affiliated Hospital, Beilun Branch, Ningbo, Zhejiang, China (mainland)
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Tamarozzi F, Fittipaldo VA, Orth HM, Richter J, Buonfrate D, Riccardi N, Gobbi FG. Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature. PLoS Negl Trop Dis 2021; 15:e0009191. [PMID: 33764979 PMCID: PMC7993612 DOI: 10.1371/journal.pntd.0009191] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. We aimed to provide a comprehensive picture of consolidated findings and knowledge gaps on the diagnosis and treatment of HSS. METHODOLOGY/PRINCIPAL FINDINGS We reviewed relevant original publications including patients with HSS with no coinfections, published in the past 40 years, identified through MEDLINE and EMBASE databases. Treatment with praziquantel and HSS-associated pulmonary hypertension were not investigated. Of the included 60 publications, 13 focused on diagnostic aspects, 45 on therapeutic aspects, and 2 on both aspects. Results were summarized using effect direction plots. The most common diagnostic approaches to stratify patients based on the risk of variceal bleeding included the use of ultrasonography and platelet counts; on the contrary, evaluation and use of noninvasive tools to guide the choice of therapeutic interventions are lacking. Publications on therapeutic aspects included treatment with beta-blockers, local management of esophageal varices, surgical procedures, and transjugular intrahepatic portosystemic shunt. Overall, treatment approaches and measured outcomes were heterogeneous, and data on interventions for primary prevention of gastrointestinal bleeding and on the long-term follow-up after interventions were lacking. CONCLUSIONS Most interventions have been developed on the basis of individual groups' experiences and almost never rigorously compared; furthermore, there is a lack of data regarding which parameters can guide the choice of intervention. These results highlight a dramatic need for the implementation of rigorous prospective studies with long-term follow-up in different settings to fill such fundamental gaps, still present for a disease affecting millions of patients worldwide.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Veronica A. Fittipaldo
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Hans Martin Orth
- Department of Gastroenterology, Hepatology and Infectious Diseases, Duesseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Niccolò Riccardi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Federico G. Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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4
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Cançado GGL, Nardelli MJ, Barbosa FA, Silva CF, Osório FMF, Ferrari TCA, Couto CA, Faria LC. Portal vein thrombosis in patients with hepatosplenic schistosomiasis who underwent oesophagogastric devascularization combined with splenectomy. Trans R Soc Trop Med Hyg 2021; 115:1004-1009. [PMID: 33537723 DOI: 10.1093/trstmh/trab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/04/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Portal vein thrombosis (PVT) has been described in nearly 50% of patients who underwent oesophagogastric devascularization combined with splenectomy (EGDS), but no previous study has compared its occurrence in surgical and non-surgical groups. This study aimed to investigate PVT in hepatosplenic schistosomiasis (HSS) and its association with EGDS and upper variceal bleeding (UVB). METHODS Retrospectively, 104 HSS individuals were enrolled. Following EGDS, the occurrence of PVT, mesenteric vein thrombosis (MVT), hospital admissions and UVB were recorded. RESULTS EGDS was performed in 27 (26%) patients. PVT and MVT were detected in 30 (33%) and 8 (9.8%) patients, respectively. Patients who underwent EGDS were at greater risk of PVT (63% vs 19.7%; odds ratio [OR] 6.12 [95% confidence interval {CI} 2.3 to 16.1], p<0.001) when compared with a non-surgical approach. There was no significant difference in UVB occurrence and β-blocker usage. PVT was associated with more hospital admissions (p=0.030) and higher alkaline phosphatase levels (p=0.008). UVB occurrence in patients with and without thrombosis was similar. In multivariate analysis, after adjustment, PVT was associated with the surgical approach (OR 4.56 [95% CI 1.55 to 13.38], p=0.006) and age at HSS diagnosis (OR 0.94 [95% CI 0.90 to 0.99], p=0.021). CONCLUSIONS EGDS was not associated with a decreased frequency of UVB when compared with the non-surgical approach but was an independent risk factor for PVT.
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Affiliation(s)
- Guilherme G L Cançado
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena 110, 30130-100, Belo Horizonte, Brazil.,Department of Gastroenterology and Hepatology, Hospital da Polícia Militar de Minas Gerais, Belo Horizonte, Brazil
| | - Mateus J Nardelli
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda A Barbosa
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Catherine F Silva
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda M F Osório
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena 110, 30130-100, Belo Horizonte, Brazil
| | - Teresa C A Ferrari
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Claudia A Couto
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena 110, 30130-100, Belo Horizonte, Brazil.,Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciana C Faria
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena 110, 30130-100, Belo Horizonte, Brazil.,Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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5
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Su AP, Zhang ZD, Tian BL, Zhu JQ. Transjugular intrahepatic portosystemic shunt versus open splenectomy and esophagogastric devascularization for portal hypertension with recurrent variceal bleeding. Hepatobiliary Pancreat Dis Int 2017; 16:169-175. [PMID: 28381381 DOI: 10.1016/s1499-3872(16)60129-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) and open splenectomy and esophagogastric devascularization (OSED) are widely used to treat patients with portal hypertension and recurrent variceal bleeding (PHRVB). This study aimed to compare the effectiveness between TIPS and OSED for the treatment of PHRVB. METHODS The data were retrospectively retrieved from 479 cirrhotic patients (Child-Pugh A or B class) with PHRVB, who had undergone TIPS (TIPS group) or OSED (OSED group) between January 1, 2010 and October 31, 2014. RESULTS A total of 196 patients received TIPS, whereas 283 underwent OSED. Within one month after TIPS and OSED, the rebleeding rates were 6.1% and 3.2%, respectively (P=0.122). Significantly lower incidence of pleural effusion, splenic vein thrombosis, and pulmonary infection, as well as higher hepatic encephalopathy rate, shorter postoperative length of hospital stay, and higher hospital costs were observed in the TIPS group than those in the OSED group. During the follow-up periods (29 months), significantly higher incidences of rebleeding (15.3% vs 4.6%, P=0.001) and hepatic encephalopathy (17.3% vs 3.9%, P=0.001) were observed in the TIPS group than in the OSED group. The incidence of in-stent stenosis was 18.9%. The survival rates were 91.3% in the TIPS group and 95.1% in the OSED group. The long-term liver function did not worsen after either TIPS or OSED. CONCLUSION For the patients with liver function in the Child-Pugh A or B class, TIPS is not superior over OSED in terms of PHRVB treatment and rebleeding prevention.
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Affiliation(s)
- An-Ping Su
- Department of Thyroid Surgery and Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
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Pitta GBB, Pereira DA, Oliveira MDFQ, Guedes EA, Sampaio JA. Cateterismo de artéria mesentérica para tratamento de trombose de veia porta. J Vasc Bras 2017; 16:43-47. [PMID: 29930622 PMCID: PMC5829691 DOI: 10.1590/1677-5449.008416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/01/2017] [Indexed: 12/01/2022] Open
Abstract
A trombose de veia porta é uma causa rara de abdome agudo vascular e está diretamente relacionada a trombofilias hereditárias ou adquiridas. O caso de um paciente de 60 anos, sexo masculino, com quadro clínico de isquemia mesentérica confirmada por exame de imagem é apresentado. Foi submetido a enterectomia e enteroanastomose e, após esplenoportografia que detectou trombose de veia porta, indicou-se tratamento medicamentoso com infusão contínua de ativador tecidual do plasminogênio recombinante (Alteplase) através de cateterismo seletivo da artéria mesentérica superior. Trata-se de um tratamento inovador. Obteve-se sucesso na recanalização do sistema porta. O paciente evoluiu com quadro de sepse abdominal, necessitando de assistência em terapia intensiva por 25 dias. Evoluiu bem e recebeu alta hospitalar com o uso de anticoagulante. O artigo apresenta uma breve revisão de literatura e discussão do caso clínico.
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Toda KS, Kikuchi L, Chagas AL, Tanigawa RY, Paranaguá-Vezozzo DC, Pfiffer T, Rocha MDS, Alves VAF, Carrilho FJ. Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review. J Clin Transl Hepatol 2015; 3:260-4. [PMID: 26807381 PMCID: PMC4721893 DOI: 10.14218/jcth.2015.00027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIMS Schistosomiasis is a major chronic disease of humans in endemic regions, and infected individuals may develop a spectrum of pathology, including hepatic fibrosis, hepatosplenomegaly, and portal hypertension. Hepatocellular carcinoma (HCC) is considered the fifth most common cancer in the world, and there is limited and controversial evidence suggesting that Schistosoma mansoni infection may be a possible risk factor for HCC. The aim of this study was to report a case series of patients with HCC and S. mansoni infection and to conduct a literature review on the topic. METHODS From January 2002 to January 2015, an institutional database was screened retrospectively to identify patients with HCC and S. mansoni infection at a single center in the Department of Gastroenterology of University of São Paulo School of Medicine and Hospital das Clínicas, Brazil. RESULTS Seven cases were included. The mean age of patients was 62.1±10.3 years; six (85.7%) were male and one (14.3%) was female. All cases had positive epidemiology, coming from endemic areas of S. mansoni infection in Brazil, and four (57.1%) had previous complications (upper gastrointestinal bleeding) related to portal hypertension or surgery intervention (splenectomy) performed more than 10 years before the HCC diagnosis. Nontumoral portal vein thrombosis was identified in five (71.4%) patients. All patients had negative serology for HCV, and four (57.1%) had positivity of HBVcore antibodies without evidence of viral replication. According to BCLC staging, one (14.3%) patient was BCLC A and received TACE instead of RFA because HCC size was >30 mm; three (42.8%) BCLC B patients received sorafenib instead of local regional treatment due to the presence of nontumoral TPV. During follow-up, all patients developed tumoral progression and died. CONCLUSIONS It remains unclear if S. mansoni infection alone has carcinogenic potential. The available literature indicates that S. Mansoni, in the presence of HBV and HCV infections, likely acts as a cofactor for the hepatic lesion and potentiates injury.
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Affiliation(s)
- Karla Sawada Toda
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luciana Kikuchi
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Aline Lopes Chagas
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Ryan Yukimatsu Tanigawa
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Pathology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Denise Cerqueira Paranaguá-Vezozzo
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Túlio Pfiffer
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Oncology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Manoel de Souza Rocha
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Radiology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Venâncio Avancini Ferreira Alves
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Pathology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flair José Carrilho
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Correspondence to: Flair José Carrilho, Department of Gastroenterology, University of São Paulo School of Medicine, Av Dr Enéas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil. Tel: +55-11-2661-7830, Fax: +55-11-2661-7830, E-mail:
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Splenectomy Improves Hemostatic and Liver Functions in Hepatosplenic Schistosomiasis Mansoni. PLoS One 2015; 10:e0135370. [PMID: 26267788 PMCID: PMC4534302 DOI: 10.1371/journal.pone.0135370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 07/08/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Schistosomiasis mansoni is a chronic liver disease, in which some patients (5-10%) progress to the most severe form, hepatosplenic schistosomiasis. This form is associated with portal hypertension and splenomegaly, and often episodes of gastrointestinal bleeding, even with liver function preserved. Splenectomy is a validated procedure to reduce portal hypertension following digestive bleeding. Here, we evaluate beneficial effects of splenectomy on blood coagulation factors and liver function tests in hepatosplenic schistosomiasis mansoni compared to non-operated patients. METHODOLOGY/PRINCIPAL FINDINGS Forty-five patients who had undergone splenectomy surgery were assessed by laboratory analyses and ultrasound examination and compared to a non-operated group (n = 55). Blood samples were obtained for liver function tests, platelet count and prothrombin time. Coagulation factors (II, VII, VIII, IX and X), protein C and antithrombin IIa, plasminogen activator inhibitor-1 were measured by routine photometric, chromogenic or enzyme-linked immunosorbent assays, while hyperfibrinolysis was defined by plasminogen activator inhibitor-1 levels. Both groups had similar age, gender and pattern of periportal fibrosis. Splenectomized patients showed significant reductions in portal vein diameter, alkaline phosphatase and bilirubin levels compared to non-operated patients, while for coagulation factors there were significant improvement in prothrombin, partial thromboplastin times and higher levels of factor VII, VIII, IX, X, protein C and plasminogen activator inhibitor-1. CONCLUSION/SIGNIFICANCE This study shows that the decrease of flow pressure in portal circulation after splenectomy restores the capacity of hepatocyte synthesis, especially on the factor VII and protein C levels, and these findings suggest that portal hypertension in patients with hepatosplenic schistosomiasis influences liver functioning and the blood coagulation status.
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Long-term results of esophagogastric devascularization and splenectomy associated with endoscopic treatment in schistosomal portal hypertension. World J Surg 2011; 34:2682-8. [PMID: 20645097 DOI: 10.1007/s00268-010-0717-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Esophagogastric devascularization and splenectomy (EGDS) is the most performed operation for prophylaxis of esophageal varices bleeding recurrence in hepatosplenic schistosomiasis. Lower rebleeding rates are obtained through the association of postoperative endoscopic treatment; however, there is a dearth of studies showing long-term results. METHODS Clinical, laboratory, and endoscopic data of 97 patients submitted to EGDS with at least 5 years of follow-up, were analyzed. RESULTS The mean follow-up was 116.4 months. Bleeding recurrence occurred in 24.7% of patients; however, this percentage was 14.6% when only variceal hemorrhage was considered. Bleeding recurrence occurred in four patients even after endoscopic evaluation demonstrated esophageal varices eradication. In the late follow-up we observed normalization of anemia, leukopenia, thrombocytopenia, hyperbilirubinemia, and a prothrombin activity time increase. No clinical or laboratory hepatic insufficiency was observed. CONCLUSIONS The EGDS procedure with postoperative endoscopic treatment led to good clinical results and avoided hemorrhagic recurrence in 75.3% of schistosomal patients. There was improvement of laboratory measures of hepatic function, as well as correction of hypersplenism. Variceal hemorrhagic recurrence may occur even when esophageal varices eradication is reached.
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Martins RN, Cleva RD, Gouveia ÉM, Ghosn NB, Herman P. Correlação entre esplenomegalia e plaquetopenia na forma hepatoesplênica da esquistossomose mansônica. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2010. [DOI: 10.1590/s0102-67202010000400010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RACIONAL: Sabe-se que tanto a leucopenia quanto a plaquetopenia têm relação direta com a esplenomegalia, mas não existem estudos correlacionando de forma direta ou precisa o tamanho do baço com o número de plaquetas. Ainda há controvérsia se a plaquetopenia observada em pacientes com doenças hepáticas crônicas está mais relacionada à esplenomegalia ou à própria hipertensão portal. OBJETIVO: Correlacionar o nível sérico das plaquetas nos períodos pré e pós-operatório imediato com peso e volume do baço em pacientes portadores da forma hepatoesplênica da esquistossomose com indicação para tratamento cirúrgico da hipertensão portal. MÉTODO: Foram analisados os prontuários de pacientes portadores da forma hepatoesplênica da esquistossomose mansônica submetidos a tratamento cirúrgico da hipertensão portal. Foram incluídos portadores com a doença confirmada pelo diagnóstico anatomopatológico da biópsia hepática realizada no período intra-operatório. Foram excluídos todos os doentes que apresentavam antecedentes de etilismo crônico, hepatite viral, evidências clínico-laboratoriais de insuficiência hepática ou alterações histopatológicas compatíveis com cirrose hepática. Foram avaliados: o tamanho e volume do baço; o nível sérico de plaquetas; o número de plaquetas. RESULTADOS: Foram identificados 141 pacientes que preenchiam os critérios de inclusão do total de 160 prontuários analisados. A idade média foi de 39,03 ± 12,74 anos (15 a 74 anos), sendo 84 homens (59,5%) e 57 mulheres (40,5%). O peso médio do baço foi de 966,27 ± 464,61 g (120 a 2700 g). O volume elíptico médio foi de 966,68 ± 499,12 cm3 (236,13 a 2782,36 cm³. Houve correlação estatisticamente significativa entre o peso e o volume elíptico do baço (p<0,0001). O número médio de plaquetas no período pré-operatório foi 76,84 ± 43,64 x10³/mm³, abaixo dos valores considerados normais (150 - 400 x10³/mm³). Observou-se correlação estatisticamente significante entre o número e valor logarítmico das plaquetas no período pré-operatório tanto com peso (p<0,01) quanto com o volume elíptico (p<0,05) do baço. O número de plaquetas no pós-operatório imediato esteve correlacionado de modo inverso com o peso do baço retirado (p=0,0297); o valor logaritmo das plaquetas também se correlacionou com o peso. Não se conseguiu, através do modelo empregado, prever o valor sérico das plaquetas baseando-se no peso e volume esplênicos. CONCLUSÃO: As variações do nível sérico de plaquetas tanto no pré como no pós-operatório, em pacientes portadores da forma hepatoesplênica da esquistossomose mansônica, apresentam-se diretamente correlacionadas às variações de peso e volume do baço. A esplenomegalia foi diretamente responsável pela variação do número de plaquetas.
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Sikuler E, Kravetz D, Groszmann RJ, Gomes HMP, Rodrigues DAB, Leme PLS. Evolution of portal hypertension and mechanisms involved in its maintenance in a rat model. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 1985; 26:206-12. [PMID: 4003545 DOI: 10.1590/s0102-67202013000300010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/16/2013] [Indexed: 12/16/2022]
Abstract
In rats with portal hypertension induced by partial ligation of the portal vein, we have recently demonstrated an increased portal venous inflow that becomes an important factor in the maintenance of portal hypertension. The sequence of events that leads into this circulatory disarray is unknown. We evaluated chronologically the chain of hemodynamic changes that occurred after portal hypertension was induced by partial ligation of the portal vein. In this model it is possible to follow, from the initiation of the portal-hypertensive state, the interaction between blood flow and resistance in the portal system as well as the relation between the development of portal-systemic shunting and the elevated portal venous inflow. The study was performed in 45 portal-hypertensive rats and in 29 sham-operated rats. Blood flow and portal-systemic shunting were measured by radioactive microsphere techniques. The constriction of the portal vein was immediately followed by a resistance-induced portal hypertension characterized by increased portal resistance (9.78 +/- 0.89 vs. 4.18 +/- 0.71 dyn X s X cm-5 X 10(4), mean +/- SE, P less than 0.01), increased portal pressure (17.7 +/- 0.9 vs. 9.5 +/- 0.6 mmHg, P less than 0.001), and decreased portal venous inflow (3.93 +/- 0.26 vs. 6.82 +/- 0.49 ml X min-1 X 100 g body wt-1, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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