ABSTRACT
BACKGROUND AND AIM: Although prophylaxis with beta-blockers has been shown to decrease variceal pressure and wall tension in cirrhotic patients, this has not been demonstrated in non-cirrhotic portal hypertension caused by Schistosoma mansoni infection. METHODS: Thirteen patients without history of previous gastrointestinal bleeding were included. All of them had high-risk esophageal varices at endoscopy. An endoscopic gauge and a high-frequency endoscopic ultrasonography miniprobe were used to assess transmural variceal pressure and wall tension before and after achieving beta-blockade with propranolol. RESULTS: Baseline variceal pressure decreased from 13.3 +/- 3.5 to 8.2 +/- 2.0 mmHg (P < 0.0001) and wall tension from 500.2 +/- 279.8 to 274.0 +/- 108.3 mg.mm(-1). The overall effect of propranolol on decreasing variceal pressure and wall tension expressed in percentage change in relation to baseline values was 35.7 +/- 18.4% and 35.9 +/- 26.7%, respectively (P = 0.9993). CONCLUSION: Propranolol significantly reduced variceal pressure and wall tension in schistosomiasis.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Esophageal and Gastric Varices/drug therapy , Gastrointestinal Hemorrhage/prevention & control , Hypertension, Portal/drug therapy , Propranolol/therapeutic use , Schistosomiasis mansoni/drug therapy , Venous Pressure/drug effects , Adult , Animals , Endosonography , Esophageal and Gastric Varices/parasitology , Esophageal and Gastric Varices/physiopathology , Esophagoscopy , Female , Gastrointestinal Hemorrhage/parasitology , Gastrointestinal Hemorrhage/physiopathology , Humans , Hypertension, Portal/parasitology , Hypertension, Portal/physiopathology , Male , Middle Aged , Pilot Projects , Schistosomiasis mansoni/complications , Schistosomiasis mansoni/physiopathology , Treatment OutcomeABSTRACT
BACKGROUND & AIMS: There is controversy over whether coagulation status predicts bleeding caused by ulceration after esophageal varices band ligation (EVL). METHODS: EVL was performed for primary (n = 45) or secondary (n = 105) prophylaxis in 150 patients with cirrhosis (Child A, n = 74, 49%; Child B, n = 42, 28%; Child C, n = 34, 23%). International normalized ratio (INR) and platelet counts were assessed in all. In 92 patients, levels of factor V, fibrinogen, D-dimer, protein C and protein S, von Willebrand factor, and thromboelastography (TEG) were assessed. Platelet count <50 x 10(3)/mm(3) and INR >1.5 were considered high-risk cutoff for bleeding. Conversely, platelet count >or=50 x 10(3)/mm(3) with INR Subject(s)
Anticoagulants/administration & dosage
, Esophageal and Gastric Varices/blood
, Esophageal and Gastric Varices/surgery
, Gastrointestinal Hemorrhage/epidemiology
, Liver Cirrhosis/blood
, Liver Cirrhosis/surgery
, Postoperative Hemorrhage/epidemiology
, Combined Modality Therapy
, Female
, Gastrointestinal Hemorrhage/prevention & control
, Humans
, International Normalized Ratio
, Ligation
, Male
, Middle Aged
, Platelet Count
, Postoperative Hemorrhage/prevention & control
, Predictive Value of Tests
, Prospective Studies
, Risk Assessment
, Risk Factors
ABSTRACT
Os autores fazem uma revisäo e análise do valor da ultrassonografia nas afecçöes do pescoço. O método tem ganho importância na última década, sobretudo com o aperfeiçoamento técnico dos aparelhos. O diagnóstico das afecçöes tireoideanas parece ter sido o maior beneficiado com isto
