Surgical treatment of schistosomal portal hypertension.

Schistosomiasis mansoni is a widespread parasitic disease in the Brazilian territory that affects over 8 million individuals. Hepatosplenic schistosomiasis is a serious clinical presentation of this disease, associated with splenomegaly, liver fibrosis, and portal hypertension, and is responsible for approximately 7% of schistosomotic patients. The surgical treatment of portal hypertension in schistosomotic patients has distinct features when compared with cirrhotic patients, mostly because hepatic function is preserved in schistosomotic liver disease. Therefore, when attempting to reduce the portal pressure, the surgeon must be aware that the surgery might interfere with hepatic perfusion, and consequently with hepatic function. The aim of this study was to report the results achieved with splenectomy, division of the left gastric vein, devascularization of great gastric curvature, and postoperative endoscopic variceal sclerosis, as a surgical option to esophageal varices in hepatosplenic schistosomiasis. A total of 111 patients were studied, and the following is a list of inclusion criteria: age >16 years, history of gastrointestinal (GI) bleeding, presence of esophageal varices on preoperative endoscopy, hematocrit >22% and prothrombin enzymatic activity >50%, negative viral hepatitis on serologic tests (anti-HBV and anti-HCV), and definition, after liver biopsy, of exclusive schistosomotic liver disease. The following list includes exclusion criteria used: presence of liver disease other than schistosomotic, history of alcohol abuse, and preoperative thrombosis of the portal vein. The rebleeding rate was 14.4% during a mean 30-month follow-up period; portal vein thrombosis was 13.2%, and there was a global mortality of 5.4%. Gastric varices were present in 46.9% of the patients; for those patients, a gastrotomy and running suture of the varices achieved an eradication rate of the varices of 75.6%. The degree of periportal fibrosis was also analyzed. Periportal fibrosis staging revealed that patients with class II or III liver fibrosis had a significant increased risk of recurrent GI bleeding when compared with patients with class I liver fibrosis. Despite the elevation on alanine aminotransferase (ALT) and aspartate aminotransferase (AST), most other liver function tests showed no alteration or were corrected after surgery. We conclude that splenectomy, division of the left gastric vein, devascularization of great gastric curvature, and postoperative endoscopic variceal sclerosis showed good results globally and should be considered as therapeutic options in the treatment of hepatosplenic schistosomiasis.

Isquemia normotérmica y reperfusión de hígado en perros: evaluación de las concentraciones séricas en enzimas hepatocelulares / Normothermic ischemia and reperfusion in dogs

La lesion corriente de isquemia y reperfusion hepáticas normotermicas ha sido investigada a traves de varios modelos experimentales en perros. La intensidad de necrosis hepatocitica ha sido admitida como proporcional al tiempo de isquemia y a la cantidad de higado desvascularizado. En el presente trabajo, un modelo de isquemia y reperfusion hepáticas en perros fue evaluado a traves de enzimas indicativas de necrosis hepatocelular. Veinte perros mestizos con peso corporal de 15.25 ñ 1.25 kilos, bajo anestesia general, fueron agrupados de la siguiente manera: 1- Grupo test (n=10), los animales fueron sometidos a desvascularizacion hepática del 70 por ciento durante noventa minutos, con descompresion venosa esplénica a traves de los lobulos lateral derecho y caudado, seguido de revascularizacion del higado. 2- Grupo control (n=10), los perros fueron sometidos a operacion simulada. Se determinaron las concentraciones sericas de aspartato aminotransferasa, alanino aminotransferasa, deshidrogenasa lactica, 5 minutos antes de la isquemia (T0), 5 minutos antes de la revascularizacion (T1), 1 hora (T2) y 5 horas (T3) despues de la revascularizacion hepática, en la sangre de la vena cava inferior, a nivel de la auricula derecha. Con una seguridad del 95 por ciento, los resultados demostraron que: a) En el periodo de isquemia no se detectó alteracion alguna significativa en las Concentraciones de aspartato aminotransferasa, alanino aminotransferasa, deshidrogenasa lactica. b) Despues de la reperfusion hepática, hubo aumento significativo y persistente de los niveles de estas enzimas. Los resultados son indicativos de que el tiempo de isquemia y el volumen de higado desvascularizado fueron capaces de producir la necrosis hepática buscada.

Complete acute occlusion of the portal vein in dogs: I. a study based on hemodynamic and hematologic data aimed at its application in liver transplantation

Como etapa inicial de um plano de pesquisa sobre avaliacao de medidas descompressivas portosistemicas, comumente utilizadas em transplante hepatico experimental, foram estudados 20 caes mesticos, adultos, de ambos os sexos e com peso corporal de 15,2ñ1,7kg. Em dez caes praticou-se oclusao total e aguda da veia porta por um periodo de 2 horas (grupo oclusao portal). Em dez outros desses animais procedeu-se a operacao simulada (grupo controle). Foram investigados de modo sistematico dados hemodinamicos de pressao arterial (PA), pressao venosa central (PVC) e pressao portal (PP), assim como dados hematologicos de concentracao de hemoglobina (cHb) nos animais dos grupos estudados...