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1.
Arq. gastroenterol ; Arq. gastroenterol;55(2): 170-174, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-950518

ABSTRACT

ABSTRACT BACKGROUND: Schistosomiasis is an endemic health problem affecting about four million people. The hepatosplenic form of the disease is characterized by periportal hepatic fibrosis, pre-sinusoidal portal hypertension and splenomegaly. Liver function is preserved, being varices bleeding the main complication of the disease. The surgical treatment used in the majority of centers for the prevention of rebleeding is esophagogastric devascularization and splenectomy. Most authors reported better results with the association of surgical and postoperative endoscopic treatment. OBJECTIVE: The aim of this study was to compare the intra operative portal pressure decrease and esophageal varices behavior and rebleeding rates in patients submitted to surgical and postoperative endoscopic treatment after long-term follow-up. METHODS: A retrospective study of 36 patients with schistosomiasis with, at least, one previous bleeding from esophageal varices rupture submitted to esophagogastric devascularization and splenectomy, added to endoscopic varices postoperative treatment was performed. Patients were stratified according to the intra operative portal pressure decrease in two groups: reduction below and above 30%. Long-term varices presence, size and bleeding recurrence were evaluated. RESULTS: Regarding varices behavior, no significant influence was observed in both groups of portal pressure fall. Regarding bleeding recurrence, despite three times more frequent in the group with lower portal pressure fall, no significant difference was observed. All patients were submitted to postoperative endoscopic treatment. CONCLUSION: Esophageal varices banding, rather than portal pressure decrease, seems to be the main responsible factor for good results after combination of two therapies (surgery and endoscopy) for patients with portal hypertension due to schistosomiasis; further studies are necessary to confirm this hypothesis.


RESUMO CONTEXTO: A esquistossomose é um problema de saúde pública endêmico, afetando cerca de quatro milhões de pessoas. A forma hepato-esplênica da doença é caracterizada por fibrose peri-portal, hipertensão pré-sinusoidal e esplenomegalia. A função hepática está preservada, sendo o sangramento por varizes a principal complicação da afecção. O tratamento cirúrgico usado pela maioria dos serviços para prevenção do ressangramento é a desconexão ázigo-portal e esplenectomia. Muitos autores reportaram melhores resultados com a associação do tratamento cirúrgico e o tratamento endoscópico pós-operatório. OBJETIVO: O objetivo deste estudo foi comparar a queda da pressão portal intraoperatória com o comportamento das varizes esofagianas e as taxas de ressangramento em pacientes submetidos a tratamento cirúrgico e endoscópico pós-operatório após seguimento de longo prazo. MÉTODOS: Foi realizado um estudo retrospectivo de 36 pacientes esquistossomóticos com pelo menos um episódio de sangramento prévio por ruptura de varizes esofagianas, submetidos a desconexão ázigo-portal e esplenectomia, associada a tratamento endoscópico pós-operatório das varizes. Os pacientes foram divididos de acordo com a queda da pressão portal intraoperatória em dois grupos: redução menor e maior que 30%. Foram avaliadas a presença de tamanho das varizes a longo prazo e a recorrência do sangramento. RESULTADOS: Levando-se em conta o comportamento das varizes, não foi observada influência significativa em ambos os grupos de queda de pressão portal. Com relação ao ressangramento das varizes, embora três vezes mais frequente no grupo com menor queda de pressão portal, não foi observada diferença estatística. Todos pacientes foram submetidos a tratamento endoscópico pós-operatório. CONCLUSÃO: A ligadura elástica das varizes esofagianas, mais do que a queda da pressão portal, parece ser o principal fator responsável pelos bons resultados após a combinação das duas terapias (cirúrgica e endoscópica) para pacientes com hipertensão portal devido à esquistossomose. Estudos futuros serão necessário para confirmar esta hipótese.


Subject(s)
Humans , Male , Female , Adult , Schistosomiasis/surgery , Splenectomy , Esophageal and Gastric Varices/surgery , Endoscopy, Gastrointestinal/methods , Portal Pressure/physiology , Gastrointestinal Hemorrhage/etiology , Hypertension, Portal/etiology , Postoperative Complications/etiology , Postoperative Period , Recurrence , Vascular Surgical Procedures , Esophageal and Gastric Varices/complications , Retrospective Studies , Follow-Up Studies , Preoperative Period , Gastrointestinal Hemorrhage/prevention & control , Hypertension, Portal/surgery , Middle Aged
2.
Pesqui. vet. bras ; Pesqui. vet. bras;37(10): 1172-1176, out. 2017. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-895347

ABSTRACT

Pulsed Doppler ultrasound was used to evaluate portal blood flow, portal velocity and portal congestion index in 24 healthy sheep divided into groups (lambs, yearlings and ewes), according to age. Measurements were performed at the 11th right intercostal space using ideal insonation angle and uniform insonation method. Mean values obtained in each group were compared with one-way ANOVA, followed by Tukey post-hoc test. Portal velocity and portal blood flow were statistically similar between the groups (P>0.05). Mean portal velocity were 17.75; 17.13 and 16.75; while mean portal blood flow were 26.65; 31.04 and 24.32 for lambs, yearlings and ewes, respectively. Portal congestion index was statistically distinct between the groups and values for lambs, yearlings and ewes were 0.009; 0.058 and 0.09, respectively (P<0.01). Statistical differences were observed in portal vein diameter, portal vein area and portal congestion index between the groups, presumably due to influence of weight and not to age.(AU)


A ultrassonografia com Doppler pulsado foi utilizado para avaliar o fluxo sanguíneo portal, velocidade portal e índice de congestão portal em 24 ovinos saudáveis divididos em grupos (cordeiros, borregos e ovelhas), de acordo com a idade. As medições foram realizadas no 11o espaço intercostal direito utilizando ângulo de insonação ideal e método de inclusão uniforme. Os valores médios obtidos em cada grupo foram comparados com ANOVA, seguido pelo teste post-hoc de Tukey. A velocidade portal e o fluxo de sangue portal foram estatisticamente semelhantes entre os grupos (P>0,05). A velocidade portal média foram 17,75; 17,13 e 16,75; enquanto o fluxo de sangue portal médios foram 26,65; 31,04 e 24,32 para cordeiros, borregos e ovelhas, respectivamente. O índice de congestão portal foi estatisticamente diferente entre os grupos e os valores para cordeiros, novilhos e ovelhas foram 0,009; 0,058 e 0,09, respectivamente (P<0.01). Observaram-se diferenças estatísticas nos diâmetros da veia porta, na área da veia porta e nos índices de congestão portal entre os grupos, provavelmente devido à influência do peso e não pela idade.(AU)


Subject(s)
Animals , Sheep/physiology , Portal Pressure/physiology , Ultrasonography, Doppler, Pulsed/veterinary , Liver Circulation/physiology , Liver/injuries
3.
Article in English | IMSEAR | ID: sea-63728

ABSTRACT

Portal hypertension is a clinical syndrome defined by a pathological increase in portal pressure. The development of cirrhosis of the liver is characterized by clinical manifestations related to portal hypertension like esophageal varices, ascites, bleeding, and encephalopathy. Direct measurement of portal pressure is invasive, inconvenient, and clinically impractical. Currently, the most commonly used parameter is the Hepatic Venous Pressure Gradient (HVPG), i.e., the difference between the wedged (WHVP) and the free hepatic venous pressures. HVPG represents the gradient between pressures in the portal vein and the intra-abdominal portion of inferior vena cava. When blood flow in a hepatic vein is stopped by a wedged catheter, the proximal static column of blood transmits the pressure from the preceding communicated vascular territory (hepatic sinusoids) to the catheter. Thus, WHVP reflects hepatic sinusoidal pressure and not the portal pressure itself. In the normal liver, due to pressure equilibration through interconnected sinusoids, wedged pressure is slightly lower than portal pressure, though this difference is clinically insignificant. In liver cirrhosis, the static column created by balloon inflation cannot be decompressed at the sinusoidal level due to disruption of the normal intersinusoidal communications; therefore, WHVP gives an accurate estimation of portal pressure in cirrhosis. The normal HVPG value is between 1 to 5 mmHg. Pressure higher than this defines the presence of portal hypertension, regardless of clinical evidence. HVPG >or= 10 mmHg (termed clinically significant portal hypertension) is predictive of the development of complications of cirrhosis, including death. HVPG above 12 mmHg is the threshold pressure for variceal rupture. The main advantages of HVPG are its simplicity, reproducibility, and safety. This review summarizes the technique of the HVPG measurement.


Subject(s)
Hepatic Veins/physiology , Humans , Hypertension, Portal/diagnosis , Portal Pressure/physiology
4.
Arq. gastroenterol ; Arq. gastroenterol;41(3): 150-154, jul.-set. 2004. tab
Article in Portuguese | LILACS | ID: lil-392600

ABSTRACT

RACIONAL: No Brasil a principal causa de hipertensão portal é a esquistossomose mansônica na sua forma hepatoesplênica. Com relação ao seu tratamento, a preferência da maioria dos autores no Brasil recai sobre a desconexão ázigo-portal e esplenectomia geralmente associada à escleroterapia endoscópica pós-operatória para tratamento dessa enfermidade. No entanto, não estão bem estabelecidas as alterações hemodinâmicas portais decorrentes do tratamento cirúrgico da hipertensão portal e sua influência no resultado desse tratamento. OBJETIVOS: Avaliar o impacto imediato da desconexão ázigo-portal e esplenectomia na pressão portal e também os resultados do tratamento cirúrgico da hipertensão portal no que se refere à recidiva hemorrágica e ao calibre das varizes de esôfago. CASUíSTICA E MÉTODO: Foram estudados 19 pacientes com esquistossomose hepatoesplênica e hipertensão portal, com história de hemorragia digestiva alta por ruptura de varizes esofágicas, com idade média de 37,9 anos. Estes pacientes não haviam sido submetidos a tratamento prévio e foram, eletivamente, tratados cirurgicamente com desconexão ázigo-portal e esplenectomia. Durante a cirurgia, foi avaliada a pressão portal, no início e no final do procedimento, através da cateterização da veia porta por cateter de polietileno introduzido por veia jejunal. Todos os pacientes foram submetidos a endoscopia no pré e no pós-operatório (em torno do 60º dia do pós-operatório) para avaliar, segundo classificação de Palmer, a variação do calibre das varizes esofagianas após a desconexão ázigo-portal e esplenectomia. RESULTADOS: Todos os pacientes apresentaram queda da pressão portal, sendo a média desta queda, após a desconexão ázigo-portal e esplenectomia, de 31,3 por cento. Na avaliação pós-operatória (endoscopia após cerca de 60 dias) houve redução significativa do calibre das varizes esofagianas quando comparadas ao pré-operatório. CONCLUSÃO: A desconexão ázigo-portal e esplenectomia promoveram queda imediata na pressão portal, com conseqüente diminuição do calibre das varizes esofágicas. Observou-se ainda que não é insignificante o risco de mortalidade e complicações graves relacionados a essa técnica.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Esophageal and Gastric Varices/surgery , Hypertension, Portal/surgery , Portal Pressure/physiology , Schistosomiasis mansoni/surgery , Splenectomy/methods , Esophageal and Gastric Varices/physiopathology , Esophagus/blood supply , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Hypertension, Portal/etiology , Intraoperative Period , Retrospective Studies , Rupture/complications , Rupture/surgery , Schistosomiasis mansoni/complications , Schistosomiasis mansoni/physiopathology , Stomach/blood supply , Treatment Outcome
5.
Article in English | IMSEAR | ID: sea-63638

ABSTRACT

The major theme of this discussion is how portal pressure after portosystemic shunt procedures may modulate the expression of hepatic encephalopathy. Decades of emphasis on the paramount importance of maintaining portal venous perfusion after shunt procedures is now being re-examined. In countries where non-cirrhotic portal hypertension is common, physicians have long recognized that hepatic encephalopathy is rare even with total portosystemic shunting. However, once decompressive shunts are created, hepatic encephalopathy becomes a clinical problem. Why this occurs needs to be better understood. In the meantime, there has been virtual abandonment of surgical shunts in favor of endoscopic variceal ablation treatment. This is despite the fact that surgical shunts that only partially decompress the portal hypertension are associated with excellent long-term control of variceal bleeding and low rates of hepatic encephalopathy. The time has come to once again examine the key relationship between portal pressure, portal perfusion with hepatic arterial inflow in inducing hepatic encephalopathy after creation of portosystemic shunts.


Subject(s)
Hepatic Encephalopathy/physiopathology , Humans , Hypertension, Portal/physiopathology , Portal Pressure/physiology , Portal System/physiopathology , Portasystemic Shunt, Surgical , Portasystemic Shunt, Transjugular Intrahepatic
7.
Article in English | IMSEAR | ID: sea-63845

ABSTRACT

BACKGROUND: Color Doppler is a noninvasive method for assessing portal hemodynamics. Laser Doppler velocimetry is useful in assessment of microcirculatory abnormalities in portal hypertensive gastropathy (PHG). AIMS: To study portal hemodynamics by color Doppler and gastric mucosal blood flow (GMBF) by laser Doppler velocimetry in patients with cirrhosis. METHODS: Twenty-eight patients with cirrhosis of liver (24 men) and 10 healthy subjects (7 men) were studied. Portal venous blood flow (PVBF) and portal flow velocity (PFV) were assessed by color Doppler at the level where the hepatic artery crosses the portal vein, and GMBF was measured by laser Doppler velocimetry. RESULTS: PVBF (379.5 [102.9] mL/min), PFV (5.3 [1.1] cm/sec) and GMBF (3.5 [0.8] volts) were significantly lower in patients with cirrhosis than in controls. PVBF and PFV were significantly lower in patients in Child class B and C than those in class A. Patients with ascites had significantly lower PVBF, PFV and GMBF than those without; values were also lower in patients with PHG than in those without. History of bleeding had no relation with PVBF and PFV. GMBF showed good correlation with PVBF (r=0.58, p<0.001) and with PFV (r=0.48, p<0.01). CONCLUSIONS: In cirrhosis of liver, PVBF, PFV and GMBF are significantly lower, and the changes increase with increasing severity of liver disease.


Subject(s)
Adult , Blood Flow Velocity , Female , Gastric Mucosa/blood supply , Humans , Laser-Doppler Flowmetry/methods , Liver Cirrhosis/physiopathology , Male , Portal Pressure/physiology , Portal Vein/physiology , Prospective Studies , Ultrasonography, Doppler, Color/methods
9.
Medicina (B.Aires) ; Medicina (B.Aires);60(4): 477-81, 2000. tab
Article in Spanish | LILACS | ID: lil-273473

ABSTRACT

El aumento de la producción de óxido nítrico juega un papel importante en la fisiopatología de la cir- culación hiperdinámica asociada a la hipertensión portal. El probable mecanismo por el cual se produce este aumento no se encuentra aún bien definido. Con el objetivo de evaluar si la isoforma inducible es la responsable de estos cambios hemodinámicos, hemos estudiado el efecto de la administración de dexametasona, un inhibidor de la expresión de la óxido nítrico sintasa II, en ratas cirróticas tras la ligadura y sección del colédoco. Se determinaron los diferentes parámetros hemodinámicos sistémicos y esplácnicos, mediante la técnica de microesferas radiactivas, luego de la administración de dexametasona (3 mg/kg/día durante 3 días, ip) o su vehículo. En los animales cirróticos el efecto glucocorticoideo se puso de manifiesto a través de una disminución significativa en la ganancia de peso corporal y un moderado aumento, pero no significativo, de la presión arterial media. La administración de dexametasona no se asoció a cambios significativos de la resistencia vascular sistémica y esplácnica como así tampoco del flujo sanguíneo portal y presión portal. Similares resultados se observaron en el grupo de animales utilizados como controles. Se detectaron niveles significativamente más elevados de endotoxina en sangre portal y sistémica en 5 de 6 animales cirróticos. Nuestros resultados muestran que la administración de dexametasona no modifica los parámetros hemodinámicos sistémicos y esplácnicos en ratas cirróticas y endotoxémicas sugiriendo que la estimulación de la sintasa inducible no juega un papel importante en el aumento de la síntesis de óxido nítrico en la cirrosis.


Subject(s)
Animals , Male , Rats , Dexamethasone/pharmacology , Hypertension, Portal/physiopathology , Liver Cirrhosis/physiopathology , Nitric Oxide Synthase/antagonists & inhibitors , Blood Pressure/drug effects , Body Weight/drug effects , Dexamethasone/therapeutic use , Endotoxins/blood , Hemodynamics/physiology , Hypertension, Portal/blood , Liver Cirrhosis/drug therapy , Portal Pressure/drug effects , Portal Pressure/physiology , Rats, Wistar , Splanchnic Circulation/physiology , Spleen/physiology
10.
Medical Journal of Cairo University [The]. 1997; 65 (2): 347-359
in English | IMEMR | ID: emr-45732

ABSTRACT

Portal hypertension is a common complication of chronic liver disease in Egypt due to high prevalence of schistosomiasis and viral hepatitis. The aim of this study is to assess duplex and color Doppler hemodynamic parameters of portal hypertensive patients. Twenty-five patients with portal hypertension were studied and 15 cases [undergoing upper endoscopy for reasons other than portal hypertension] were taken as a control. All patients were subjected to history taking clinical examination, laboratory work-up upper gastrointestinal endoscopy, abdominal ultrasonography and color Doppler ultrasonography. The results of this study revealed a significant increase in the diameter of the portal vein, a significant decrease in blood flow velocity in the portal and superior mesenteric veins as well as the development of collateral vessels, the commonest is the coronary vein


Subject(s)
Humans , Female , Ultrasonography, Doppler/methods , Portal Pressure/physiology , Portal System/diagnostic imaging , Chronic Disease , Liver Diseases/complications , Liver Cirrhosis/complications , Schistosomiasis/complications
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