Autotransplant of spleen tissue in children with schistosomiasis: evaluation of splenic function after splenosis.

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.

Surgical hepatosplenic schistosomiasis mansoni in children: a Doppler duplex study of the portal vein and the hepatic artery.

From January 1990 to September 1993, 25 children with hepatosplenic schistosomiasis mansoni and oesophageal varices underwent splenectomy, ligature of the left gastric vein and autoimplantation of 100 g of spleen into the great omentum at the University Hospital, Recife, Brazil. The diameters and the blood flow velocities of the portal vein and the hepatic artery were measured before and after surgery. A Doppler Duplex (Aloka 680) with a convex transductor of 3.5 MHz was used. Post-operative follow-up revealed (i) a significant decrease in the mean diameter of the portal vein from 12.6 +/- 2.1 mm to 9.6 +/- 1.9 mm, (ii) a significant increase in the mean diameter of the hepatic artery from 5.0 +/- 1.4 mm to 5.3 +/- 1.2 mm, (iii) a significant decrease in the mean blood flow velocity in the portal vein from 31.1 +/- 8.0 cm/s to 22.4 +/- 7.1 cm/s, and (iv) no significant change in blood flow velocity in the hepatic artery. The study supports the concept that surgical treatment for portal hypertension in patients with hepatosplenic schistosomiasis mansoni, which includes splenectomy, results in a decrease of venous portal blood flow to the liver associated with an increase in the arterial hepatic blood flow. The physiological implications of these haemodynamic changes in the long term remain to be investigated.

Hipertensäo portal esquistossomótica na criança-avaliaçäo critica / Schistomotic portal hypertension in children-Critical evaluation

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