Splenic palpation for the evalution of morbidity due to schistosomiasis mansoni

This study was undertaken to determine the accuracy of splenic palpation for the diagnosis of splenomegaly, and to determine whether the frequency of individuals with a palpable spleen in an endemic area can be considered as an index of morbidity of schistosomiasis. For the clinical diagnosis of splenomegaly, two criteria have been tested: (A) presence of a palpable spleen and (B) presence of a palpable spleen whose border could be felt more than 4 cm below the costal margin. In an area of high prevalence of the disease (66.3 per cent) 285 individuals aged 18 years or more have been submitted to abdominal ultrasonography and physical examination. Splenomegaly was defined as a splenic lengh greater than 120 mm by ultrasound and the sensitivity, specificity, positive and negative predictive values of criterion A were 72.2 per cent, 90.5 per cent, 35.1 per cent and 97.8 per cent. The values for criterium B were 27.8 per cent, 98 per cent, 50 per cent and 95 per cent, respectively. In an non endemic area, 517 individuals were submitted to the same protocol and 22 individuals had a palpable spleen, but no patient fulfilled criterium B for splenomegaly, and only one met the ultrasonographic criterium for splenomegaly. The authors concluded that abdominal palpable is a poor method for the diagnosis of splenomegaly.

Chronic carriers of hepatitis B surface antigen in an endemic area for shistosomiasis mansoni in Brazil

Data on the association of schistosomiasis and hepatitis B in field-based studies are scarce. Two areas have been selected for this study: i) Queixadinha, endemic for shistosomiasis, with a population of 693 individuals, and ii) Capäo, a control non-endemic area, with 515 inhabitants. Sera of all individuals in both areas were tested for hepatitis B infection, yearly, from 1994 to 1997. In the first area hepatitis B was found in 32.1 per cent of children up to one year old and reached a peak of 68.7 per cent in the age range of 15 to 19 years. In the control area the prevalence of hepatitis B was under 5 per cent up to 19 years of age and the highest prevalence was observed in adults over 45. HBsAg was detected in 9.4 per cent of the individuals living in the endemic area for shistosomiasis and in 1.4 per cent of the controls (OR=4.98; 95 per centCI=3.7-6.7). The index of chronicity of HBsAg was not statistically different in the studied areas (8.1 per cent x 7.3 per cent; OR=1.09; 95 per cent CI=0.42-3.03) nor was it different for people with and without schistosomiasis in Queixadinha (8.7 per cent x 7.0 per cent). We conclude that the Schistosoma mansoni infection has not altered the course of hepatitis B in the studied area.

Punçäo biópsia com agulha fina guiada pela ultra-sonografia; análise de 46 punçöes / Ultrasound guided fine needle biopsy; analysis of 46 punctures

No período de junho de 1988 a junho de 1989 foram realizadas 46 punçöes com agulha fina guiada pela ultra-sonografia em 41 pacientes. As punçöes destinavam-se a esclarecer a natureza das massas abdominais ou o estadiamento de tumores conhecidos. Tentou-se confirmar a posiçäo da agulha na massa pela ultra-sonografia. Após aspiraçäo, foram confeccionadas lâminas fixadas em álcool 95%. O órgäo mais puncionado foi o fígado, seguido pelo pâncreas, massas abdominais, rim e retroperitônio. A exceçäo de um hematoma subcapsular esplênico, näo houve complicaçöes imediatas, bem como infecçöes. Foram diagnosticadas 21 neoplasias, a maioria adenocarcinomas. Houve 9 falsos negativos, a maioria por falta de material adequado na aspiraçäo; destes, 7 ocorreram nos seis primeiros meses de estudo. Em um dos casos, a repetiçäo do procedimento foi diagnóstica. Näo houve falso positivo. Em 10 casos, o resultado foi verdadeiro negativo. A sensibilidade geral do método foi de 70%. Concluimos ser a biópsia com agulha fina guiada por ultra-sonografia um procedimento seguro e valioso no diagnóstico e estadiamento de tumores abdominais