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1.
Hum Exp Toxicol ; 41: 9603271211061505, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35098763

RESUMO

Background: The toxicological effects of fine particulate matter (PM2.5) on the cardiopulmonary and nervous systems have been studied widely, whereas the study of PM2.5 on systemic toxicity is not in-depth enough. Lipopolysaccharide (LPS) can cause multiple organ damage. The combined effects of co-exposure of PM2.5 plus LPS on the stomach, spleen, intestine, and kidney are still unclear. Purpose: This study was aimed to explore the toxicological effects of co-exposure of PM2.5 and LPS on the different organs of mice. Research Design and Study Sample Using a real-ambient PM2.5 exposure system and an intraperitoneal LPS injection mouse model, we investigated multiple organ damage effects on male BALB/c mice after co-exposure of PM2.5 plus LPS for 23 weeks in Linfen, a city with a high PM2.5 concentration in China. Data Collection: Eosin-hematoxylin staining, ELISA and the biochemical assay analysed the toxicological effects. Results: The pathological tissue injury on the four organs above appeared in mice co-exposed to PM2.5 plus LPS, accompanied by the body weight and stomach organ coefficient abnormality, and significant elevation of pro-inflammatory cytokines levels, oxidative stress in the spleen and kidney, and levels of kidney injury molecule (KIM-1) increase in the kidney. There were tissue differences in the pathological damage and toxicological effects on mice after co-exposure, in which the spleen and kidney were more sensitive to pollutants. In the PM2.5 + LPS group, the superoxide dismutase inhibition and catalase (CAT) activity promotion in the kidney or spleen of mice were significant relative to the PM2.5 group; the CAT and interleukin-6 (IL-6) levels in the spleen were raised considerably compared with the LPS group. Conclusions: These findings suggested the severity and sensitivity of multiple organ injuries in mice in response to PM2.5 plus LPS.


Assuntos
Enteropatias/induzido quimicamente , Nefropatias/induzido quimicamente , Lipopolissacarídeos/toxicidade , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Insuficiência de Múltiplos Órgãos/fisiopatologia , Material Particulado/toxicidade , Esplenopatias/induzido quimicamente , Gastropatias/induzido quimicamente , Animais , China , Modelos Animais de Doenças , Humanos , Enteropatias/fisiopatologia , Nefropatias/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Esplenopatias/fisiopatologia , Gastropatias/fisiopatologia
2.
Pediatr Rheumatol Online J ; 19(1): 104, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193201

RESUMO

BACKGROUND: H syndrome (HS) is a rare autoinflammatory disease caused by a mutation in the solute carrier family 29, member 3 (SCL29A3) gene. It has a variable clinical presentation and little phenotype-genotype correlation. The pathognomonic sign of HS is cutaneous hyperpigmentation located mainly in the inner thighs and often accompanied by other systemic manifestations. Improvement after tocilizumab treatment has been reported in a few patients with HS. We report the first patient with HS who presented cardiogenic shock, multiorgan infiltration, and digital ischemia. CASE PRESENTATION: 8-year-old boy born to consanguineous parents of Moroccan origin who was admitted to the intensive care unit during the Coronavirus Disease-2019 (COVID-19) pandemic with tachypnoea, tachycardia, and oliguria. Echocardiography showed dilated cardiomyopathy and severe systolic dysfunction compatible with cardiogenic shock. Additionally, he presented with multiple organ dysfunction syndrome. SARS-CoV-2 polymerase chain reaction (PCR) and antibody detection by chromatographic immunoassay were negative. A previously ordered gene panel for pre-existing sensorineural hearing loss showed a pathological mutation in the SCL29A3 gene compatible with H syndrome. Computed tomography scan revealed extensive alveolar infiltrates in the lungs and multiple poor defined hypodense lesions in liver, spleen, and kidneys; adenopathy; and cardiomegaly with left ventricle subendocardial nodules. Invasive mechanical ventilation, broad antibiotic and antifungal coverage showed no significant response. Therefore, Tocilizumab as compassionate use together with pulsed intravenous methylprednisolone was initiated. Improvement was impressive leading to normalization of inflammation markers, liver and kidney function, and stabilising heart function. Two weeks later, he was discharged and has been clinically well since then on two weekly administration of Tocilizumab. CONCLUSIONS: We report the most severe disease course produced by HS described so far in the literature. Our patient's manifestations included uncommon, new complications such as acute heart failure with severe systolic dysfunction, multi-organ cell infiltrate, and digital ischemia. Most of the clinical symptoms of our patient could have been explained by SARS-CoV-2, demonstrating the importance of a detailed differential diagnosis to ensure optimal treatment. Although the mechanism of autoinflammation of HS remains uncertain, the good response of our patient to Tocilizumab makes a case for the important role of IL-6 in this syndrome and for considering Tocilizumab as a first-line treatment, at least in severely affected patients.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Doenças Hereditárias Autoinflamatórias/fisiopatologia , Isquemia/fisiopatologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Choque Cardiogênico/fisiopatologia , Anticorpos Monoclonais Humanizados/uso terapêutico , COVID-19 , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/terapia , Criança , Glucocorticoides/uso terapêutico , Doenças Hereditárias Autoinflamatórias/diagnóstico , Doenças Hereditárias Autoinflamatórias/genética , Doenças Hereditárias Autoinflamatórias/terapia , Humanos , Isquemia/terapia , Nefropatias/diagnóstico por imagem , Nefropatias/fisiopatologia , Nefropatias/terapia , Hepatopatias/diagnóstico por imagem , Hepatopatias/fisiopatologia , Hepatopatias/terapia , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/fisiopatologia , Linfadenopatia/terapia , Masculino , Metilprednisolona/uso terapêutico , Insuficiência de Múltiplos Órgãos/terapia , Proteínas de Transporte de Nucleosídeos/genética , Pulsoterapia , Respiração Artificial , SARS-CoV-2 , Choque Cardiogênico/terapia , Esplenopatias/diagnóstico por imagem , Esplenopatias/fisiopatologia , Esplenopatias/terapia , Dedos do Pé/irrigação sanguínea , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Ann Vasc Surg ; 70: 143-151, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32417282

RESUMO

BACKGROUND: Endovascular embolization is increasingly used in treating traumatic hemorrhage and other applications. No endovascular-capable translational large animal models exist and coagulopathy's effect on embolization techniques is unknown. We developed a coagulation-adaptable solid organ hemorrhage model in swine for investigation of embolization techniques. METHODS: Anesthetized swine (n = 26, 45 ± 3 kg) had laparotomy and splenic externalization. Half underwent 50% isovolemic hemodilution with 6% hetastarch and cooling to 33-35°C (COAG group). All had controlled 20 mL/kg hemorrhage and endovascular access to the proximal splenic artery with a 4F catheter via a right femoral sheath. Splenic transection and 5 min free bleeding were followed by treatment (n = 5/group) with 5 mL gelfoam slurry, three 6-mm coils, or no treatment (n = 3, control). Animals received 15 mL/kg plasma resuscitation and were monitored for 6 hr. Splenic blood loss was continuously measured and angiograms were performed at specified times. RESULTS: Coagulopathy was successfully established in COAG animals. Pre-treatment blood loss was greater in COAG (11 ± 6 mL/kg) than non-COAG (7 ± 3 mL/kg, P = 0.04) animals. Splenic hemorrhage was universally fatal without treatment. Non-COAG coil survival was 4/5 (326 ± 75 min) and non-COAG Gelfoam 3/5 (311 ± 67 min) versus non-COAG Control 0/3 (82 ± 18 min, P < 0.05 for both). Neither COAG Coil (0/5, 195 ± 117 min) nor COAG Gelfoam (0/5, 125 ± 32 min) treatment improved survival over COAG Control (0/3, 56 ± 19 min). Post-treatment blood loss was 4.6 ± 3.4 mL/kg in non-COAG Coil and 4.6 ± 2.9 mL/kg in non-COAG Gelfoam, both lower than non-COAG Control (18 ± 1.3 mL/kg, P = 0.05). Neither COAG Coil (8.4 ± 5.4 mL/kg) nor COAG Gelfoam (15 ± 11 ml/kg) had significantly less blood loss than COAG Control (20 ± 1.2 mL/kg). Both non-COAG treatment groups had minimal blood loss during observation, while COAG groups had ongoing slow blood loss. In the COAG Gelfoam group, there was an increase in hemorrhage between 30 and 60 min following treatment. CONCLUSIONS: A swine model of coagulation-adaptable fatal splenic hemorrhage suitable for endovascular treatment was developed. Coagulopathy had profound negative effects on coil and gelfoam efficacy in controlling bleeding, with implications for trauma and elective embolization procedures.


Assuntos
Coagulação Sanguínea , Embolização Terapêutica/instrumentação , Esponja de Gelatina Absorvível/administração & dosagem , Hemorragia/terapia , Esplenopatias/terapia , Animais , Pressão Arterial , Modelos Animais de Doenças , Hemodiluição , Hemorragia/sangue , Hemorragia/fisiopatologia , Esplenopatias/sangue , Esplenopatias/fisiopatologia , Sus scrofa , Fatores de Tempo
4.
Intern Emerg Med ; 15(2): 225-229, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31214883

RESUMO

Defective spleen function increases susceptibility to bacterial infections which can be prevented by vaccine prophylaxis. Splenic hypofunction can be found in a number of autoimmune disorders; however, no data are available regarding autoimmune atrophic gastritis (AAG), autoimmune enteropathy (AIE) and autoimmune liver disease (AILD). Peripheral blood samples from patients with AAG (n = 40), AIE (n = 3) and AILD (n = 40) were collected. Patients affected by autoimmune disorders already known to be associated with splenic hypofunction, i.e. coeliac disease (CD) and ulcerative colitis (UC), were included as disease controls, while splenectomised patients and healthy subjects were evaluated as positive and negative controls, respectively. Counting of erythrocytes with membrane abnormalities, i.e. pitted red cells, was used as an indicator of spleen function (normal upper limit 4%). Defective splenic function was observed in 22 of the 40 patients with AAG (55.0%), in two of the three patients with AIE (66.6%) and in 35 of the 40 patients with AILD (87.5%). As expected, in untreated CD, refractory CD and UC there was a high prevalence of hyposplenism (43.7%, 88.2% and 54.4%, respectively). Due to the high prevalence of splenic hypofunction, patients with AAG, AILD and AIE should undergo pitted red cell evaluation and, if hyposplenic, they should be candidate to vaccine prophylaxis against encapsulated bacteria.


Assuntos
Doenças Autoimunes/etiologia , Gastroenteropatias/etiologia , Esplenopatias/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/complicações , Doenças Autoimunes/fisiopatologia , Suscetibilidade a Doenças/etiologia , Suscetibilidade a Doenças/fisiopatologia , Feminino , Gastroenteropatias/complicações , Gastroenteropatias/fisiopatologia , Humanos , Itália , Londres , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Baço/anormalidades , Baço/fisiopatologia , Esplenopatias/fisiopatologia , Estatísticas não Paramétricas
5.
Medicine (Baltimore) ; 98(5): e14372, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702629

RESUMO

Numerous studies had investigated the biological basis of spleen deficiency syndrome on gastrointestinal dysfunctions. However, little was known about neuropsychological mechanism of spleen deficiency syndrome. The default model network (DMN) plays an important role in cognitive processing. Our aim is to investigate the change of neuropsychological tests and DMN in patients with spleen deficiency syndrome.Sixteen patients and 12 healthy subjects underwent functional magnetic resonance imaging examination, and 15 patients with spleen deficiency syndrome and 6 healthy subjects take part in the two neuropsychological tests.Compared with healthy subjects, patients with spleen deficiency syndrome revealed significantly increased functional connectivity within DMN, and significantly higher in the scores of 2-FT (P = .002) and 3-FT (P = .014).Our findings suggest that patients with spleen deficiency syndrome are associated with abnormal functional connectivity of DMN and part of neuropsychological tests, which provide new evidence in neuroimaging to support the notion of TCM that the spleen stores Yi and domains thoughts.


Assuntos
Memória/fisiologia , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Tempo de Reação/fisiologia , Esplenopatias/diagnóstico por imagem , Esplenopatias/psicologia , Adulto , Mapeamento Encefálico , Estudos de Casos e Controles , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Esplenopatias/fisiopatologia , Adulto Jovem
6.
Intern Med ; 58(10): 1433-1441, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30626827

RESUMO

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an extremely rare benign lesion. We herein report a case of asymptomatic SANT of the spleen in a middle-aged woman with early breast carcinoma and an undiagnosed splenic mass, which was successfully treated by laparoscopic splenectomy and diagnosed postoperatively. We also review the literature on SANT to help make knowledge more accessible when clinicians encounter a splenic tumor. The present case taught us the following lesson: the presence of a splenic lesion during follow-up for malignancy is not always indicative of metastasis. Therefore, SANT should be considered in the differential diagnosis.


Assuntos
Neoplasias da Mama/complicações , Histiocitoma Fibroso Benigno/diagnóstico , Histiocitoma Fibroso Benigno/cirurgia , Laparoscopia/métodos , Esplenectomia/métodos , Esplenopatias/diagnóstico , Esplenopatias/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose/fisiopatologia , Resultado do Tratamento , Adulto Jovem
8.
World J Emerg Surg ; 12: 33, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28769999

RESUMO

BACKGROUND: Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim of this study was to investigate the outcome of selective NOM for penetrating splenic injuries. METHODS: A dual-centre study is performed in two level-one trauma centres. All identified patients treated for PSI were identified. Patients were grouped based on the treatment they received. Group one consisted of splenectomised patients, the second group included patients treated by a spleen-preserving surgical intervention, and group three included those patients who were treated by NOM. RESULTS: A total of 118 patients with a median age of 27 and a median ISS of 25 (interquartile range (IQR) 16-34) were included. Ninety-six patients required operative intervention, of whom 45 underwent a total splenectomy and 51 underwent spleen-preserving surgical procedures. Furthermore, 22 patients (12 stab wounds and 10 gunshot wounds) were treated by NOM. There were several anticipated significant differences in the baseline encountered. The median hospitalization time was 8 (5-12) days, with no significant differences between the groups. The splenectomy group had significantly more intensive care unit (ICU) days (2(0-6) vs. 0(0-1)) and ventilation days (1(0-3) vs. 0(0-0)) compared to the NOM group. Mortality was only noted in the splenectomy group. CONCLUSIONS: Spleen-preserving surgical therapy for PSI is a feasible treatment modality and is not associated with increased mortality. Moreover, a select group of patients can be treated without any surgical intervention at all.


Assuntos
Baço/lesões , Ferimentos Penetrantes/terapia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , África do Sul , Esplenopatias/fisiopatologia , Esplenopatias/terapia , Tomografia Computadorizada por Raios X/métodos , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Ferimentos por Arma de Fogo , Ferimentos Perfurantes
9.
Transplant Proc ; 49(6): 1301-1306, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28735998

RESUMO

BACKGROUND: Functional hyposplenism (FH) is indicated by an anatomically present spleen that fails to take up radiolabeled colloid. The occurrence of FH has been reported in a small group of renal transplant recipients based on hematologic parameters. The aim of this study was to replicate this association in a larger group of renal transplant recipients with the use of technetium-99m-stannous colloid liver-spleen scan to assess the spleen function. METHODS: This survey based on single samples enrolled 101 unselected adult patients with functional kidney grafts >180 days after transplantation. All patients underwent 99mTc-stannous colloid scan to assess spleen function as well as bone marrow uptake of radiocolloid along with an anatomic and blood flow study of the spleen and kidney with the use of Doppler sonography. RESULTS: The prevalence of hyposplenism was 32.7% (33/101) for the cohort, and increased uptake of radiocolloid by the bone marrow was seen in 9.9% (10/101). According to the multivariate analysis, the frequency of hyposplenism was significantly influenced by indirect bilirubin and hemoglobin, and direct bilirubin and neutrophil count remained as independent predictors of bone marrow uptake. CONCLUSIONS: This study demonstrated that a group of renal transplant recipients has FH. In addition, bone marrow uptake might be interpreted as liver dysfunction. In this situation, the small amount of contrast (spleen compared with liver) would leave hyposplenism undiagnosed. Further prospective and longitudinal clinical studies are needed to determine the clinical impact of this condition on the management of renal transplant recipients.


Assuntos
Cintilografia/métodos , Compostos Radiofarmacêuticos , Baço/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Compostos de Tecnécio , Compostos de Estanho , Adulto , Feminino , Humanos , Rim/cirurgia , Transplante de Rim/efeitos adversos , Fígado/diagnóstico por imagem , Fígado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Baço/fisiopatologia , Esplenopatias/etiologia , Esplenopatias/fisiopatologia , Ultrassonografia/métodos
10.
Afr J Tradit Complement Altern Med ; 14(4): 239-246, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28638886

RESUMO

BACKGROUND: Coix seed has the functions of fortifying the spleen and inhibiting the dampness. However, it remains unclear which Coix seed compositions is responsible for these functions. Previous investigations have revealed that the main compositions of Coix seed are proteins, polysaccharides, oils and starches. The objectives of this study are to explore which is the most effective compositions in fortifying the spleen and examine how Coix seed works in regulating the water transport on the spleen deficiency and wet dampness (SDWD) rat model. MATERIALS AND METHODS: The rats used were divided into (i) control group, (ii) model group, (iii) decoction group, (iv) protein group, (v) polysaccharide group, (vi) oil group and (vii) starch group. The urine volume, the drinking volume and the water loading index in each group were calculated. Agilent 8*60K array was used for microarray-based gene expression analysis. The differential mRNAs related to the transport activity were screened. qRT-PCR was used to validate the mRNA microarray. RESULTS: The results demonstrated that all treatment groups could decrease the dampness of SDWD rats. mRNA microarray had significant effect on the protein group and the polysaccharide group in regulating the water transport, among which the most significant mRNA was Fabp6, Slc51a, Slc51b, Slc11a2, Slc4a10 and AQP3 respectively. CONCLUSION: The compositions of proteins and polysaccharides had the most significant effect in regulating the water transport of SDWD rat model. The contributing mRNA focused on Fabp, Slc and AQP family.


Assuntos
Coix/química , Medicamentos de Ervas Chinesas/administração & dosagem , Baço/efeitos dos fármacos , Esplenopatias/tratamento farmacológico , Animais , Aquaporina 3/genética , Aquaporina 3/metabolismo , Proteínas de Ligação a Ácido Graxo/genética , Proteínas de Ligação a Ácido Graxo/metabolismo , Feminino , Hormônios Gastrointestinais/genética , Hormônios Gastrointestinais/metabolismo , Humanos , Masculino , Ratos , Ratos Wistar , Receptores Acoplados a Proteínas G/genética , Receptores Acoplados a Proteínas G/metabolismo , Sementes/química , Baço/metabolismo , Baço/fisiopatologia , Esplenopatias/genética , Esplenopatias/metabolismo , Esplenopatias/fisiopatologia , Água/metabolismo
11.
BMJ Case Rep ; 20172017 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-28476929

RESUMO

A 57-year-old previously healthy fisherman was admitted in fulminant pneumococcal septic shock, with disseminated intravascular coagulation, requiring aggressive management including bilateral below-knee amputations for ischaemic necrosis. He began to recover and was discharged for rehabilitation, however during his convalescence was found to be hypercalcaemic. No malignancy was found on CT scan, but it was noted that his spleen was absent, replaced by a 4 cm smooth-walled, fluid-filled lesion. This was unexpected as an ultrasound in intensive care 10 weeks previously had demonstrated a normal spleen. Functional hyposplenism was confirmed on a peripheral blood film with evidence of target cells, spherocytes and Howell-Jolly bodies. A diagnosis of autosplenectomy complicating pneumococcal sepsis was therefore made, of which there is just one case previously reported. The patient continues to recover well and was discharged on penicillin prophylaxis after receiving vaccinations for hyposplenism.


Assuntos
Coagulação Intravascular Disseminada/etiologia , Infecções Pneumocócicas/complicações , Choque Séptico/complicações , Baço/anormalidades , Esplenopatias/complicações , Diagnóstico Diferencial , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/tratamento farmacológico , Inclusões Eritrocíticas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/diagnóstico , Doenças Raras , Sepse/etiologia , Choque Séptico/microbiologia , Choque Séptico/cirurgia , Baço/diagnóstico por imagem , Esplenopatias/fisiopatologia , Streptococcus pneumoniae/isolamento & purificação , Resultado do Tratamento , Ultrassonografia/métodos
12.
PLoS Negl Trop Dis ; 11(4): e0005417, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28369056

RESUMO

BACKGROUND: Schistosomiasis is endemic to several parts of the world. Among the species that affect humans, Schistosoma mansoni is one of the most common causes of illness. In regions where schistosomiasis mansoni is endemic, reinfection is responsible for the emergence of hepatosplenic schistosomiasis (HSS) with portal hypertension in about 10% of infected individuals. Regardless of its etiology, portal hypertension may bring about the formation of arteriovenous fistulas and pulmonary vascular dilation, thus constituting a pulmonary shunt and its presence has been associated with the occurrence of neurological complications. The objective of this study was to identify pulmonary shunt using TTCE in patients with HSS and esophageal varices, and to compare the abdominal ultrasound and endoscopy findings among patients with and without pulmonary shunt. METHODOLOGY/PRINCIPAL FINDINGS: In this case series, a total of 461 patients with schistosomiasis mansoni were prospectively evaluated using abdominal ultrasound and endoscopy and 71 presented with HSS with esophageal varices. Fifty seven patients remained in the final analysis. The mean age of the patients was 55 ± 14 years, and 65% were female. Pulmonary shunts were observed in 19 (33.3%) patients. On comparing the groups with and without pulmonary shunt, no significant differences were observed in relation to the abdominal ultrasound and endoscopic findings. When comparing the two subgroups with pulmonary shunts (grade 1 vs grades 2 and 3), it was observed that the subgroup with shunt grades 2 and 3 presented with a significantly higher frequency of an enlarged splenic vein diameter (>0.9 cm), and an advanced pattern of periportal hepatic fibrosis (P = 0.041 and P = 0.005, respectively). None of the patients with pulmonary shunts had severe neurological complications. CONCLUSIONS/SIGNIFICANCE: Our findings suggest that in HSS with esophageal varices the pulmonary shunts may be present in higher grades and that in this condition it was associated with ultrasound findings compatible with advanced HSS.


Assuntos
Varizes Esofágicas e Gástricas/diagnóstico por imagem , Hipertensão Portal/diagnóstico por imagem , Hepatopatias Parasitárias/diagnóstico por imagem , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Abdome/diagnóstico por imagem , Adulto , Idoso , Animais , Ecocardiografia/métodos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/parasitologia , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/parasitologia , Hipertensão Portal/fisiopatologia , Hepatopatias Parasitárias/complicações , Hepatopatias Parasitárias/parasitologia , Hepatopatias Parasitárias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Esquistossomose mansoni/complicações , Esquistossomose mansoni/fisiopatologia , Esplenopatias/complicações , Esplenopatias/parasitologia , Esplenopatias/fisiopatologia , Ultrassonografia
13.
Medicine (Baltimore) ; 96(51): e9242, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29390481

RESUMO

Given discrepancies between methods for diagnosing hyposplenism, the purpose of this study was to evaluate the effect of the spleen size on the correlation between the methods, and to propose a model for improving the interpretation. Patients with renal allografts were included, in whom the spleen was assessed using Doppler ultrasound, scintiscan, and the presence of Howell-Jolly bodies (HJBs) in peripheral smears. In 35 subjects, scintiscan and HJBs were normal (Group 0); 20 had an abnormal result in both methods (Group 1); 34 had discordant results with HJBs present (Group 2); and 14 had discordant results with decreased spleen uptake (Group 3). There was no association between HJBs and scintiscan. The patients of Groups 1 and 2 had smaller spleens. The patients with smaller spleen had more hematological evidence of hyposplenism and exhibit smaller discrepancies between the methods than patients with larger spleen. The spleen can tip the balance from a normal to impaired function provided that the spleen size is below the critical mass required to maintain splenic function. A mild impairment of phagocytic function and slight dyserythropoiesis along with a small spleen would result in decreased take up of radiocolloid or the appearance of HJBs in blood smears.


Assuntos
Inclusões Eritrocíticas/patologia , Transplante de Rim , Fígado/diagnóstico por imagem , Baço/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Adulto , Idoso , Aloenxertos , Análise de Variância , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Seguimentos , Humanos , Falência Renal Crônica/cirurgia , Fígado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cintilografia/métodos , Baço/anormalidades , Esplenopatias/fisiopatologia , Ultrassonografia Doppler em Cores/métodos
15.
Intern Med ; 55(24): 3635-3639, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27980265

RESUMO

We herein report a rare case of acute bilateral renal and splenic infarctions occurring during chemotherapy for lung cancer. A 60-year-old man presented with acute and intensive upper abdominal and back pain during chemotherapy with cisplatin and etoposide for lung cancer. Contrast-enhanced computed tomography (CT) revealed bilateral renal and splenic infarctions. After the administration of unfractionated heparin his pain was relieved with a clearance of the infarctions in the CT findings and a recovery of renal dysfunction. Enhanced coagulation by lung cancer and arterial ischemia by chemotherapy may therefore contribute to the development of these infarctions.


Assuntos
Antineoplásicos/efeitos adversos , Infarto/induzido quimicamente , Nefropatias/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Esplenopatias/induzido quimicamente , Dor Abdominal/etiologia , Anticoagulantes/uso terapêutico , Dor nas Costas/etiologia , Cisplatino/efeitos adversos , Cisplatino/uso terapêutico , Etoposídeo/efeitos adversos , Etoposídeo/uso terapêutico , Heparina/uso terapêutico , Humanos , Infarto/diagnóstico por imagem , Infarto/tratamento farmacológico , Infarto/fisiopatologia , Rim/irrigação sanguínea , Nefropatias/diagnóstico por imagem , Nefropatias/tratamento farmacológico , Nefropatias/fisiopatologia , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Baço/irrigação sanguínea , Esplenopatias/diagnóstico por imagem , Esplenopatias/tratamento farmacológico , Esplenopatias/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Dig Dis Sci ; 61(7): 2118-26, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26921079

RESUMO

BACKGROUND: Portal vein obstructive lesions associated with hypertrophy of the hepatic artery territory are observed in Schistosoma mansoni schistosomiasis. Liver perfusion scintigraphy is a method used for evaluation of hepatic perfusion changes in liver diseases. It has been suggested that, like in cirrhosis, where compensatory increase in perfusion through the hepatic artery is documented, perfusion changes occur in hepatosplenic schistosomiasis (HSS). AIMS: This study aims to determine changes in liver hemodynamics using hepatic perfusion scintigraphy and correlate them with clinical and laboratory variables and ultrasound findings in HSS. METHODS: Nineteen patients with schistosomiasis underwent ultrasound evaluation of degree of liver fibrosis, splenic length, and splenic and portal vein diameter, digestive endoscopy, and quantification of platelets. Subsequently, perfusion scintigraphy with measurement of hepatic perfusion index (HPI) was performed. RESULTS: It was observed that patients with hepatosplenic schistosomiasis had significantly higher HPI compared with normal individuals (p = 0.0029) and that this increase correlated with splenic length (p = 0.038) and diameter of esophageal varices (p = 0.0060). Angioscintigraphy showed high accuracy for predicting presence of large esophageal varices. CONCLUSIONS: Angioscintigraphy could show that patients with HSS had increased HPI, featuring greater liver "arterialization," as previously described for cirrhotic patients. Correlations were also observed between HPI and longitudinal splenic length, caliber of esophageal varices, caliber of portal vein, and blood platelet count. Angioscintigraphy is a promising technique for evaluation of hepatosplenic schistosomiasis.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Hipertensão Portal/complicações , Hepatopatias Parasitárias/complicações , Fígado/irrigação sanguínea , Esquistossomose mansoni/patologia , Esplenopatias/complicações , Adulto , Idoso , Estudos Transversais , Técnicas de Diagnóstico por Radioisótopos , Feminino , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/fisiopatologia , Hepatopatias Parasitárias/diagnóstico por imagem , Hepatopatias Parasitárias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Esquistossomose mansoni/complicações , Esplenopatias/diagnóstico por imagem , Esplenopatias/fisiopatologia , Ultrassonografia
17.
Zhen Ci Yan Jiu ; 41(6): 497-501, 2016 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-29071891

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Zusanli"(ST 36) on Ghrelin/cAMP/PKA expression in the jejunum in rats with spleen qi deficiency syndrome, so as to reveal its underlying mechanism in improving energy metabolism. METHODS: Forty male SD rats were randomly divided into 4 groups:normal group, spleen qi deficiency syndrome (model) group, EA group and non-acupoint group (n=10 in each group).The model of spleen qi deficiency syndrome was established by improper diet and overstrain. EA (2 Hz/15 Hz, 0.5 mA) was applied to bilateral "Zusanli" (ST 36) in the EA group and non-acupoint in non-acupoint group for 20 min, once a day for 6 days. The pathologic changes of the jejunum tissue were detected by H&E staining. Ghrelin, ATP and cAMP levels in jejunum tissue were determined by ELISA. The expression levels of PKA protein in jejunum tissue were determined by Western blot. RESULTS: H&E staining showed that the intestinal villi of the model group were swelling, shortening and thickening, with a damaged or broken top-part in the model group, and basically restored to normal after EA treatment. ELISA results showed that the contents of Ghrelin, ATP and cAMP in the jejunum tissue were significantly lower in the model group than in the normal group (P<0.05), while significantly higher in the EA group than in the model group (P<0.05). Western blot results showed that the expression of PKA protein in the jejunum tissue was significantly lower in the model group than in the normal group (P<0.05), and significantly higher in the EA group than in the model group and non-acupoint group (P<0.05). CONCLUSIONS: EA at ST 36 can improve the morphological changes in the jejunum of spleen qi deficiency rats, which may be associated with its effects in increasing Ghrelin, ATP and cAMP contents, and up-regulating PKA expression, leading to an increase of energy metabolism and spleen qi at last.


Assuntos
Pontos de Acupuntura , Proteína Quinase Tipo I Dependente de AMP Cíclico/metabolismo , AMP Cíclico/metabolismo , Eletroacupuntura , Grelina/metabolismo , Jejuno/metabolismo , Qi , Baço/fisiopatologia , Esplenopatias/terapia , Animais , Proteína Quinase Tipo I Dependente de AMP Cíclico/genética , Modelos Animais de Doenças , Grelina/genética , Humanos , Jejuno/enzimologia , Masculino , Ratos , Ratos Sprague-Dawley , Baço/metabolismo , Esplenopatias/genética , Esplenopatias/metabolismo , Esplenopatias/fisiopatologia
18.
ABCD (São Paulo, Impr.) ; 26(4): 302-308, nov.-dez. 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-701253

RESUMO

RACIONAL: Na esquistossomose mansônica na forma hepatoesplênica ocorre fibrose hepática difusa que associada à congestão venosa do sistema porta resulta em hepatoesplenomegalia. Pode produzir hemorragia digestiva alta por rotura das varizes de esôfago e do estômago ou lesões pépticas da mucosa gastroduodenal. OBJETIVO: Estudar os efeitos da esplenectomia e ligadura da veia gástrica esquerda sobre a hemodinâmica portohepática. MÉTODO: Vinte e três portadores de esquistossomose mansônica na forma hepatoesplênica foram estudados prospectivamente, antes e cerca de duas semanas após a operação, através de estudos angiográficos dos diâmetros da artéria hepática comum e própria, artéria esplênica, artéria mesentérica superior, veia porta, veia mesentérica superior e veia gástrica esquerda. Foram aferidas as pressões da veia cava inferior, venosa central, da veia hepática livre, da veia hepática ocluída e sinusoidal. RESULTADOS: A ligadura da veia gástrica esquerda determinou acréscimo significante nas seguintes variáveis: diâmetros da artéria hepática comum e própria; diâmetro da veia mesentérica superior; o acréscimo não foi significante nas seguintes medidas: pressão venosa central e diâmetro da artéria mesentérica superior. Ela promoveu decréscimo não significante nas variáveis: pressão da veia cava inferior; pressão da veia hepática livre; pressão da veia hepática ocluída; pressão sinusoidal; diâmetro da veia porta. CONCLUSÃO: A ligadura da veia gástrica esquerda, na maioria dos casos, não determina alterações hemodinâmicas significantes do sistema porta capazes de quebrar o equilíbrio hemodinâmico funcional, que caracteriza a esquistossomose mansônica na forma hepatoesplênica.


BACKGROUND: In hepatosplenic schistosomiasis occurs diffuse hepatic fibrosis associated with venous congestion of the portal system resulting in hepatosplenomegaly. It can produce digestive hemorrhage caused by rupture of esophageal and stomach varices or peptic gastroduodenal mucosal lesions. AIM: To study the effects of splenectomy and ligature of the left gastric vein on portohepatic hemodynamics. METHOD: Twenty-three patients with hepatosplenic schistosomiasis mansoni were studied before and about two weeks after operation through angiographic diameter of the common and proper hepatic artery, splenic artery, superior mesenteric artery, portal vein, superior mesenteric vein and left gastric vein. The pressures of the inferior vena cava and central venous pressure, free hepatic vein, the hepatic sinusoidal and occluded vein were measured. RESULTS: The splenectomy and ligature of the left gastric vein determined low morbidity and null mortality. It determined significant addition to the following variables: diameters of the common and proper hepatic artery; diameter of the superior mesenteric vein. It determined non significant increase on the following measurements: right atrial pressure and diameter of the superior mesenteric artery. It determined non significant decrease to the following variables: inferior vena cava pressure; free hepatic vein pressure; occluded hepatic vein pressure; sinusoidal pressure, diameter of the portal vein. CONCLUSION: Splenectomy and ligature of the left gastric vein do not determine portal hemodynamic changes capable of breaking the functional hemodinamic balance that characterizes the hepatosplenic mansoni schistosomiasis.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Hepatopatias/fisiopatologia , Hepatopatias/cirurgia , Esquistossomose mansoni/fisiopatologia , Esquistossomose mansoni/cirurgia , Esplenectomia , Esplenopatias/parasitologia , Esplenopatias/fisiopatologia , Angiografia , Pressão Sanguínea , Hemodinâmica , Ligadura , Hepatopatias/parasitologia , Período Pós-Operatório , Período Pré-Operatório , Esplenopatias/cirurgia , Veias/cirurgia
19.
Arq Bras Cir Dig ; 26(4): 302-8, 2013.
Artigo em Inglês, Português | MEDLINE | ID: mdl-24510039

RESUMO

BACKGROUND: In hepatosplenic schistosomiasis occurs diffuse hepatic fibrosis associated with venous congestion of the portal system resulting in hepatosplenomegaly. It can produce digestive hemorrhage caused by rupture of esophageal and stomach varices or peptic gastroduodenal mucosal lesions. AIM: To study the effects of splenectomy and ligature of the left gastric vein on portohepatic hemodynamics. METHOD: Twenty-three patients with hepatosplenic schistosomiasis mansoni were studied before and about two weeks after operation through angiographic diameter of the common and proper hepatic artery, splenic artery, superior mesenteric artery, portal vein, superior mesenteric vein and left gastric vein. The pressures of the inferior vena cava and central venous pressure, free hepatic vein, the hepatic sinusoidal and occluded vein were measured. RESULTS: The splenectomy and ligature of the left gastric vein determined low morbidity and null mortality. It determined significant addition to the following variables: diameters of the common and proper hepatic artery; diameter of the superior mesenteric vein. It determined non significant increase on the following measurements: right atrial pressure and diameter of the superior mesenteric artery. It determined non significant decrease to the following variables: inferior vena cava pressure; free hepatic vein pressure; occluded hepatic vein pressure; sinusoidal pressure, diameter of the portal vein. CONCLUSION: Splenectomy and ligature of the left gastric vein do not determine portal hemodynamic changes capable of breaking the functional hemodinamic balance that characterizes the hepatosplenic mansoni schistosomiasis.


Assuntos
Hepatopatias/fisiopatologia , Hepatopatias/cirurgia , Esquistossomose mansoni/fisiopatologia , Esquistossomose mansoni/cirurgia , Esplenectomia , Esplenopatias/fisiopatologia , Esplenopatias/parasitologia , Adulto , Idoso , Angiografia , Pressão Sanguínea , Feminino , Hemodinâmica , Humanos , Ligadura , Hepatopatias/parasitologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Esplenopatias/cirurgia , Veias/cirurgia , Adulto Jovem
20.
J Anesth ; 26(6): 892-9, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22729228

RESUMO

Several clinical studies show a gender dimorphism of immune and organ responsiveness in the susceptibility to and morbidity from shock, trauma, and sepsis. However, there are conflicting reports on the role of gender in outcomes. Animal studies of shock, trauma, and sepsis have confirmed that alterations in immune and organ functions are more markedly depressed in adult males and in ovariectomized and aged females. In this review, we discuss the effect of estrogen on liver, intestinal, splenic, and renal functions in an experimental model of sepsis, trauma, and reperfusion injury. To establish the role of gender in the outcome of these patients, more studies in clinical and experimental settings are required to determine whether gender-specific responses are global across the injuries or are observed in specific injury situations. Studies are also needed to delineate underlying mechanisms responsible for differences between males and females. The findings gained from the experimental studies will help in designing innovative therapeutic approaches for the treatment of sepsis, trauma, and reperfusion injury patients.


Assuntos
Estrogênios/fisiologia , Estrogênios/uso terapêutico , Enteropatias/fisiopatologia , Nefropatias/fisiopatologia , Hepatopatias/fisiopatologia , Traumatismo por Reperfusão/fisiopatologia , Sepse/fisiopatologia , Esplenopatias/fisiopatologia , Ferimentos e Lesões/fisiopatologia , Animais , Feminino , Humanos , Enteropatias/tratamento farmacológico , Nefropatias/tratamento farmacológico , Hepatopatias/tratamento farmacológico , Masculino , Receptores de Estrogênio/fisiologia , Traumatismo por Reperfusão/tratamento farmacológico , Sepse/tratamento farmacológico , Caracteres Sexuais , Esplenopatias/tratamento farmacológico , Ferimentos e Lesões/tratamento farmacológico
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