ABSTRACT
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 pneumococcal 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% and produced tuftsin inside the range of normality. It also provided the immunologic splenic response to pneumococcal vaccination in 65% of the patients of this series.
Subject(s)
Schistosomiasis mansoni/surgery , Spleen/physiology , Spleen/transplantation , Adolescent , Antibodies, Bacterial/isolation & purification , Child , Esophageal and Gastric Varices/etiology , Female , Gastrointestinal Hemorrhage/etiology , Humans , Hypertension, Portal/complications , Hypertension, Portal/etiology , Male , Omentum , Pneumococcal Vaccines/immunology , Schistosomiasis mansoni/complications , Spleen/immunology , Streptococcus pneumoniae/immunology , Transplantation, Autologous , Tuftsin/biosynthesis , Tuftsin/bloodABSTRACT
Esplenectomia, ligadura de veia gástrica esquerda e auto-implante esplênico tem sido a conduta cirúrgica adotada para as crianças portadoras de hepato-esplenomegalia esquistossomótica, com indicaçäo cirúrgica. A esclerose endoscópica das varizes esofageanas é reservada para os casos de recidiva. Quarenta crianças, sendo vinte e três do sexo masculino e dezessete do sexo feminino, portadoras de esquistossomose hepatoesplênica com varizes esofageanas, foram submetidas a esta conduta, entre janeiro de 1990 e dezembro de 1994. Após seguimento pós-operatório médio de 36 meses, houve recidiva hemorrágica em três pacientes, com controle do sangramento por escleroterapia endoscópica das varizes esofageanas. No seguimento endoscópico houve o desaparecimento das varizes em cinco pacientes e reduçäo das varizes de grosso para médio calibres em oito dos dezesseis pacientes. Entretanto, a análise estatística näo revelou diferença significativa entre a frequência dos graus das varizes antes do tratamento e por ocasiäo da última valiaçäo endoscópica. A evoluçäo clínica dos pacientes faz supor que a conduta proposta tenha, até o momento, sido efetiva
