ABSTRACT
PURPOSE: To measure the levels of NO production by monocytes in patients with the hepatosplenic form of schistosomiasis mansoni who underwent splenectomy, ligature of the left gastric vein and auto implantation of spleen tissue in the major omentum. METHODS: Four groups of volunteers were enrolled in the investigation: G1 - 12 patients with S. mansoni infection in its hepatosplenic form without any kind of treatment (SMH); G2 - 13 SMH patients who underwent medical treatment and portal hypertension decompression splenectomy and ligature of the left gastric vein (SMH/SLGV); G3 - 19 patients similar to the later group, but additionally received auto implantation of spleen morsels in the major omentum (SMH/SLGV/AI); and G4 - 15 individuals with no S. mansoni infection coming from the same geographical area and presenting similar socio economical status (CG). Nitrite production by monocytes was determined by a standard Griess reaction adapted to microplates. The results were presented by mean ± SD for each group. Significant differences in NO production by monocytes were determined by Tukey-Kramer multicomparisons test. Probability values of 0.05 were considered significant. RESULTS: Patients from G1 (SMH) showed lower level of NO production by monocytes (5.28 ± 1.28µmol/ml). Patients from G2 (SMH/SLGV) showed similar results (6.67 ± 0.44µmol/ml - q = 2.681 p > 0.05). Individuals of G4 (CG) showed higher level of NO production by monocytes (8.19 ± 2.74µmol/ml). Patients from G3 (SMH/SGLV/AI) showed similar NO production by PBMC as compared to individuals of G4 (CG) - (7.41 ± 1.65µmol/ml - q = 1.615 p > 0.05). The volunteers from G4 (CG) and G3 (SMH/SLGV/AI) showed significantly greater levels of NO production by monocytes as compared to those from G1 (SMH) - (q = 5.837 p < 0.01, and q = 4.285 p < 0.05). CONCLUSION: Collectively, the results point to a restoration of NO normal production by monocytes in SH...
OBJETIVO: Mensurar os níveis de produção de ON por monócitos do sangue periférico (MSP) em portadores de esquistossomose na forma hepatoesplênica que tinham se submetido a esplenectomia, ligadura da veia gástrica esquerda e auto-implante de tecido esplênico no omento maior. MÉTODOS: Quatro grupos de voluntários foram envolvidos na investigação: G1 - 12 portadores de esquistossomose hepatoesplênica sem nenhuma forma de tratamento (EHE); G2 - 13 portadores de EHE que receberam tratamento clínico e se submeteram cirurgia para descompressão do sistema porta esplenectomia e ligadura da veia gástrica esquerda (EHE/ELGE); G3 - 19 pacientes similares ao do último grupo, mas que receberam também auto-implante de fragmentos de tecido esplênico no omento maior (EHE/ELGE/AI); e G4 - 15 indivíduos sem infecção pelo S. mansoni advindos da mesma área geográfica e apresentando as mesmas condições sócio-econômicas (GC). A produção de ON pelos MSP foi determinada pela reação padrão de Griess, adaptada para poços em microplaca. Os resultados foram expressos por suas médias ± DP para cada grupo. Diferenças significantes nas medias de produção de ON pelos MSP foram determinadas pelo teste de comparações múltiplas de Tukey-Kramer. Foram aceito os limites de significância de p < 0,05. RESULTADOS: Os pacientes portadores de EHE não tratados (G1) evidenciaram os níveis mais baixos de produção de ON pelos MSP (5,28 ± 1,28µmol/ml). Os pacientes do G2 (EHE/ELGE) evidenciaram resultados similares (6,67 ± 0,44µmol/ml - q = 2,681 p > 0.05). Os indivíduos do G4 (GC) evidenciaram os mais altos níveis de produção de ON pelos MSP (8,19 ± 2,74µmol/ml). Os pacientes do G3 (EHE/ELGE/AI) evidenciaram produção de ON produzido pelos MSP similares aos indivíduos do - G4 (GC) (7.41 ± 1.65µmol/ml - q = 1.615 p > 0.05). Os voluntários do G4 (GC) e os do G3 (EHE/ELGE/AI) evidenciaram de forma significante maiores níveis de produção de ON pelos MS...
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Liver Diseases, Parasitic/immunology , Monocytes/metabolism , Nitric Oxide/biosynthesis , Omentum/immunology , Splenectomy , Schistosomiasis mansoni/immunology , Cells, Cultured/metabolism , Hypertension, Portal/immunology , Hypertension, Portal/surgery , Ligation , Liver Diseases, Parasitic/surgery , Omentum/surgery , Schistosomiasis mansoni/surgery , Splenic Diseases/immunology , Splenic Diseases/surgery , Splenosis/immunology , Splenosis/surgery , Transplantation, Autologous , Veins/immunology , Veins/surgeryABSTRACT
Autotransplantation of spleen tissue has been done, in the past ten years, in children with schistosomiasis mansoni with bleeding varices. The purposes of this investigation were: (1) to study the morphology and function of the remnant spleen tissue; (2) to quantify the production of tuftsin; and (3) to assess the immune response to pneomococcal vaccine of these patients. Twenty three children, who underwent splenectomy and autologous implantation of spleen tissue into the greater omentum were included in this investigation. The average postoperative follow-up is five years. Splenosis was proved by colloid liver-spleen scans. Search for Howell-Jolly bodies assessed the filtration function. Tuftsin and the titer of pneumococcal antibodies were quantified by ELISA. Splenosis was evident in all children; however, it was insufficient in two. Howell-Jolly bodies were found only in these two patients. The mean tuftsin serum concentration (335.0 ± 29.8 ng/ml) was inside the normal range. The immune response to pneumococcal vaccination was adequate in 15 patients; intermediate in four; and inadequate in four. From the results the following conclusions can be drawn: splenosis was efficient in maintaining the filtration splenic function in more than 90 percent and produced tuftsin inside the range of normality. It also provided the immunologic splenic response to pneumococcal vaccination in 65 percent of the patients of this series
Subject(s)
Humans , Male , Female , Child , Adolescent , Schistosomiasis mansoni/surgery , Spleen/physiology , Spleen/transplantation , Splenosis/surgery , Antibodies, Bacterial/isolation & purification , Esophageal and Gastric Varices/etiology , Gastrointestinal Hemorrhage/etiology , Hypertension, Portal/complications , Hypertension, Portal/etiology , Omentum , Pneumococcal Vaccines , Schistosomiasis mansoni/complications , Spleen/immunology , Streptococcus pneumoniae/immunology , Transplantation, Autologous , Tuftsin/biosynthesis , Tuftsin/bloodABSTRACT
El bazo "nómade" se produce por una anomalía en el mesogastrio dorsal embrionario en la que el bazo carece de su fijación normal. No se forman los ligamentos lienorenal y lienogástrico ni los vasos cortos. La falta de esta fijación permite que el bazo se mueva libremente por la cavidad peritoneal, unido solamente a su pedículo vascular sobre el que puede volvularse. El bazo "nómade" puede ser asintomático y palparse como una masa abdominal móvil. La ubicación anómala puede ser constante o intermitente. En los casos sintomáticos, el bazo se volvula causando un infarto esplénico que se manifiesta como un abdomen agudo, o como un dolor abdominal cólico recurrente, si se produce la detorsión espontánea. En la mayoría de los casos comunicados, la forma de presentación del bazo "nómade" fue un infarto esplénico por vólvulo, que obligó a realizar una esplenectomía. La exéresis del bazo expone al riesgo de una sepsis incontrolable y es aceptado que ante una patología esplénica traumática o no, debe intentarse conservar el bazo. Sólo en muy raras ocasiones ha sido posible realizar una esplenopexia electiva en un paciente asintomático con un bazo "nómade", como en el caso aquí presentado.