Résumé
Schistosomiasis mansoni affects the hepatic functional reserve. Clinical treatment with oxamniquine is not 100 percent effective and there has been found strain of this parasite resistant to this drug. The aims of this investigation were: (1) to examine the presence of residual parasite burden after medical and surgical treatment on adolescents with surgical schistosomiasis mansoni and (2) to assess the effect on the hepatic functional reserve in patients with and without residual infection. Twenty nine children with hepatosplenic schistosomiasis mansoni and bleeding esophageal varices were treated with oxamniquine. They underwent splenectomy, ligature of the left gastric vein and autologous implantation of spleen tissue into the greater omentum. After a mean post-operative follow up of five years they underwent rectal biopsy for schistosomotic egg search. They were divided in patients with and without infection. In 20 patients the submucosal egg search was negative, however, in 9 it was positive. The hepatic functional reserve in the patients without infection was as follows: 17 were Child-Pugh A and 3 Child-Pugh B. In the patients who were still infected 6 were Child-Pugh A and 3 Child-Pugh B. The chi2 analysis of the hepatic functional reserve showed chi2 = 3.19 - p= 0.07. From the results the following conclusion can be drawn: residual infection or reinfection in the follow up period had not interfered with the distribution of the hepatic functional reserve of the patients in this series. However, there was a trend for a decrease of this parameter in patients with residual infection
Sujets)
Humains , Animaux , Enfant , Adolescent , Parasitoses hépatiques/chirurgie , Foie/physiologie , Schistosoma mansoni/isolement et purification , Schistosomiase à Schistosoma mansoni/chirurgie , Maladies de la rate/chirurgie , Varices oesophagiennes et gastriques/traitement médicamenteux , Varices oesophagiennes et gastriques/chirurgie , Études de suivi , Hémorragie gastro-intestinale/traitement médicamenteux , Hémorragie gastro-intestinale/chirurgie , Parasitoses hépatiques/traitement médicamenteux , Foie/parasitologie , Oxamniquine/usage thérapeutique , Rectum/parasitologie , Récidive , Schistosomiase à Schistosoma mansoni/traitement médicamenteux , Schistosomicides/usage thérapeutique , Maladies de la rate/traitement médicamenteuxRésumé
Fibrose hepática congênita (FHC), doença fibropolicística, ocorre em várias formas, tendo como manifestação clínica inicial, em crianças, sangramento digestivo alto em pré-escolares entre um e três anos. História clínica similar à trombose portal congenita. Ainda está sob investigação os fatores etiopatogênicos da FHC, e o presente relato de um raro caso de associação entre estas duas afecções, aparentemente congênitas, adiciona argumento para a recente sugestão de que essa associação não seja apenas coincidência