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BORGHERESI A, COLLEONI R, SCALABRINI M, SHIGUEOKA D. O ÍNDICE ESPLÊNICO COMO PREDITOR DE SANGRAMENTO E RECIDIVA VARICOSA NO SEGUIMENTO TARDIO DE PACIENTE ESQUISTOSSOMÓTICOS APÓS TRATAMENTO ENDOSCÓPICO EXCLUSIVO. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1638. [PMID: 35107500 PMCID: PMC8846378 DOI: 10.1590/0102-672020210002e1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022]
Abstract
Endoscopic treatment for esophageal variceal has been used as the main
intervention in patients with portal hypertension secondary to schistosomiasis,
but with significant rates of recurrence of esophageal variceal and rebleeding.
The long-term results of exclusive endoscopic treatment are poorly studied as
the relationship of the splenic dimensions in this context.
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Colaneri RP, Coelho FF, de Cleva R, Herman P. Laparoscopic Treatment of Presinusoidal Schistosomal Portal Hypertension Associated With Postoperative Endoscopic Treatment: Results of a New Approach. Surg Laparosc Endosc Percutan Tech 2017; 27:90-93. [PMID: 27661203 DOI: 10.1097/sle.0000000000000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To propose a laparoscopic treatment for schistosomal portal hypertension. METHODS Ten patients with schistosomiasis and portal hypertension, with previous gastrointestinal hemorrhage from esophageal varices rupture, were evaluated. Patients were subjected to a laparoscopic procedure, with ligature of splenic artery and left gastric vein. Upper gastrointestinal endoscopy was performed on the 30th postoperative day, when esophageal varices diameter was measured and band ligature performed. During follow-up, other endoscopic procedures were performed according to endoscopy findings. RESULTS There was no operative mortality. One patient had a postoperative splenic infarction that was conservatively treated. Mean hospitalization time was 5 days. During endoscopy 30 days after surgery, a decrease in variceal diameters was observed in 6 patients. During follow-up (mean 84 mo), after endoscopic therapy 8 patients had eradicated varices, but 4 presented with recurrence. Considering the late postoperative evaluation, all patients had a decrease in variceal diameters. A mean of 3.8 endoscopic banding sessions were performed per patient. Two patients presented bleeding recurrence; one had a minor bleeding episode and the other had 2 episodes of bleeding varices requiring blood transfusion. In both patients, bleeding was controlled with endoscopic therapy. No late mortality was observed. CONCLUSIONS Laparoscopic ligature of the splenic artery and the left gastric vein is a promising and less-invasive method for the treatment of schistosomal portal hypertension.
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Affiliation(s)
- Renata P Colaneri
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
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Zoni AC, Catalá L, Ault SK. Schistosomiasis Prevalence and Intensity of Infection in Latin America and the Caribbean Countries, 1942-2014: A Systematic Review in the Context of a Regional Elimination Goal. PLoS Negl Trop Dis 2016; 10:e0004493. [PMID: 27007193 PMCID: PMC4805296 DOI: 10.1371/journal.pntd.0004493] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/04/2016] [Indexed: 12/11/2022] Open
Abstract
Background In 2012 the World Health Assembly adopted resolution WHA65.21 on elimination of schistosomiasis, calling for increased investment in schistosomiasis control and support for countries to initiate elimination programs. This study aims to analyze prevalence and intensity of Schistosoma mansoni infection in children in Latin America and the Caribbean countries and territories (LAC), at the second administrative level or lower. Methodology A systematic review of schistosomiasis prevalence and intensity of infection was conducted by searching at PubMed, LILACS and EMBASE. Experts on the topic were informally consulted and institutional web pages were reviewed (PAHO/WHO, Ministries of Health). Only SCH infection among children was registered because it can be a ‘proxi-indicator’ of recent transmission by the time the study is conducted. Principal Findings One hundred thirty two full-text articles met the inclusion criteria and provided 1,242 prevalence and 199 intensity of infection data points. Most of them were from Brazil (69.7%). Only Brazil published studies after 2001, showing several 'hot spots' with high prevalence. Brazil, Venezuela, Suriname and Saint Lucia need to update the epidemiological status of schistosomiasis to re-design their national programs and target the elimination of Schistosoma mansoni transmission by 2020. In Antigua and Barbuda, Dominican Republic, Guadeloupe, Martinique, Montserrat and Puerto Rico schistosomiasis transmission may be interrupted. However the compilation of an elimination dossier and follow-up surveys, per WHO recommendations, are needed to verify that status. Hence, the burden of subtle SCH chronic infection may be still present and even high in countries that may have eliminated transmission. Heterogeneity in the methodologies used for monitoring and evaluating the progress of the schistosomiasis programs was found, making cross-national and chronological comparisons difficult. Conclusions There is a need for updating the schistosomiasis status in the historically endemic countries and territories in LAC to address the required public health interventions for control and elimination programs or to verify the elimination of transmission of Schistosoma mansoni. Improved reporting and standardization of the monitoring and evaluation methodologies used are recommended, while using available WHO guidelines. Meeting a regional elimination goal will require additional and improved epidemiological data by age group and sex. Schistosomiasis (Schistosoma spp) is an intestinal parasitic infection that causes anaemia, stunted growth, impaired cognition, and decreased physical fitness among other pathological effects. Currently, the control of schistosomiasis relies principally on mass drug administration of praziquantel. In addition, the implementation of further interventions such as snail (intermediate host) control, improving access to safe water and sanitation are required to achieve elimination of transmission in humans. An updated epidemiological situation will help countries to design tailor-made interventions enabling a step-up in prevention and control measures with the goal of elimination of transmission of this disease by 2020. In the region of the Americas, Schistosoma mansoni is the only species present that infect humans. This systematic review shows that in this region there is a need for re-mapping the schistosomiasis epidemiological situation in certain areas and countries in order to implement and optimize the best public health interventions needed to interrupt transmission or verify elimination of transmission. The methodology for monitoring and evaluating schistosomiasis control programs are well defined by current WHO guidelines. However, further investigations and guidelines on suitable tools for monitoring and evaluating schistosomiasis elimination programs and criteria and procedures for validating the elimination are required, and are currently being undertaken by WHO.
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Affiliation(s)
| | - Laura Catalá
- Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
- * E-mail: ;
| | - Steven K. Ault
- Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
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Colaneri RP, Coelho FF, Cleva RD, Perini MV, Herman P. Splenic artery ligature associated with endoscopic banding for schistosomal portal hypertension. World J Gastroenterol 2014; 20:16734-16738. [PMID: 25469045 PMCID: PMC4248220 DOI: 10.3748/wjg.v20.i44.16734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/14/2014] [Accepted: 07/16/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To propose a less invasive surgical treatment for schistosomal portal hypertension.
METHODS: Ten consecutive patients with hepatosplenic schistosomiasis and portal hypertension with a history of upper gastrointestinal hemorrhage from esophageal varices rupture were evaluated in this study. Patients were subjected to a small supraumbilical laparotomy with the ligature of the splenic artery and left gastric vein. During the procedure, direct portal vein pressure before and after the ligatures was measured. Upper gastrointestinal endoscopy was performed at the 30th postoperative day, when esophageal varices diameter were measured and band ligature performed. During follow-up, other endoscopic procedures were performed according to endoscopy findings.
RESULTS: There was no intra-operative mortality and all patients had confirmed histologic diagnoses of schistosomal portal hypertension. During the immediate postoperative period, two of the ten patients had complications, one characterized by a splenic infarction, and the other by an incision hematoma. Mean hospitalization time was 4.1 d (range: 2-7 d). Pre- and post-operative liver function tests did not show any significant changes. During endoscopy thirty days after surgery, a decrease in variceal diameters was observed in seven patients. During the follow-up period (57-72 mo), endoscopic therapy was performed and seven patients had their varices eradicated. Considering the late postoperative evaluation, nine patients had a decrease in variceal diameters. A mean of 3.9 endoscopic banding sessions were performed per patient. Two patients presented bleeding recurrence at the late postoperative period, which was controlled with endoscopic banding in one patient due to variceal rupture and presented as secondary to congestive gastropathy in the other patient. Both bleeding episodes were of minor degree with no hemodynamic consequences or need for blood transfusion.
CONCLUSION: Ligature of the splenic artery and left gastric vein with supraumbilical laparotomy is a promising and less invasive method for treating presinusoidal schistosomiasis portal hypertension.
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Melo EVD, Costa WD, Conceição MJ, Coura JR. A comparative cross-sectional study on the prevalence and morbidity of schistosomiasis in a community in northeastern Brazil (1979-2010). Mem Inst Oswaldo Cruz 2014; 109:340-4. [PMID: 24831552 PMCID: PMC4131787 DOI: 10.1590/0074-0276130353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 12/27/2013] [Indexed: 11/21/2022] Open
Abstract
A cross-sectional study on the prevalence and morbidity of schistosomiasis was conducted in the main settlement of the municipality of Alhandra, in the southern coastal region of the state of Paraíba, in 2010. The results of this study were compared with the results of a previous study conducted in the same area in 1979. The systematic sampling per family conglomerate included approximately 10% of the resident population in the urban area of Alhandra. Faecal examinations were performed using the Kato-Katz method. The clinical forms of the disease were classified in accordance with FS Barbosa as Type I - intestinal form, Type II - hepatointestinal form and Type III - hepatosplenic form. The prevalence of the infection in 2010 was 10.05%, whereas in 1979 it was 46.6% among untreated patients. The percentages of the three clinical forms in 2010 were as follows: 95.3% Type I, 4.6% Type II and 0% Type III; in 1979, the percentages were 94.4%, 3% and 2.6% for Types I, II and III, respectively. In 1979, 6.07% of the Biomphalaria glabrata specimens (the intermediate host in this area) excreted cercariae, where in 2010 only 1.27% of the specimens caught excreted the parasite.
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Affiliation(s)
- Eric Vinaud de Melo
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brasil
| | - Walfredo da Costa
- Núcleo de Medicina Tropical, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - Maria José Conceição
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brasil
| | - José Rodrigues Coura
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brasil
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Conceição MJ, Carlôto AE, de Melo EV, da Silva IM, Coura JR. Prevalence and Morbidity Data on Schistosoma mansoni Infection in Two Rural Areas of Jequitinhonha and Rio Doce Valleys in Minas Gerais, Brazil. ISRN PARASITOLOGY 2013; 2013:715195. [PMID: 27335859 PMCID: PMC4890927 DOI: 10.5402/2013/715195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 01/13/2013] [Indexed: 11/23/2022]
Abstract
Objective. This study aimed to compare the prevalence and morbidity data on Schistosoma mansoni infection in two rural areas: the Jequitinhonha valley (area 1) and the Rio Doce valley (area 2) in the state of Minas Gerais, Brazil, covering the period from 2007 to 2010. Material and Methods. The parasitological stool tests were based on the quantitative method of Kato modified by Katz et al. Three clinical forms were considered: type I-schistosomiasis infection, type II-hepatointestinal form, and type III-hepatosplenic form. Results. The prevalence of infection among inhabitants of area 1 was 22.9%, with 2.1% presenting the hepatosplenic form and two cases of schistosomal myeloradiculopathy. The infection prevalence rate in area 2 was 20.2%, with 3.3% presenting the hepatosplenic form. Conclusion and Recommendation. There was no difference in the prevalence and in the morbidity of Schistosoma mansoni infection between the two areas, but it was predominant in young men with a low intensity of infection. The cases of schistosomal myeloradiculopathy in area 1 can be highlighted: these emphasize that schistosomiasis should not be neglected in Brazil. The lack of infection control in both areas may be related to the poor sanitation system, the absence of previous treatment, and the reinfection process.
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Affiliation(s)
- Maria José Conceição
- Department of Preventive Medicine, Infectious and Parasitic Diseases Post-Graduation, Clementino Fraga Filho Hospital, Universidade Federal do Rio de Janeiro (UFRJ), 21045-900 Rio de Janeiro, RJ, Brazil
- Laboratory of Parasitic Diseases, Instituto Oswaldo Cruz, Fiocruz, Manguinhos, 21045-900 Rio de Janeiro, RJ, Brazil
| | - Aline Eduardo Carlôto
- Department of Preventive Medicine, Infectious and Parasitic Diseases Post-Graduation, Clementino Fraga Filho Hospital, Universidade Federal do Rio de Janeiro (UFRJ), 21045-900 Rio de Janeiro, RJ, Brazil
- Laboratory of Parasitic Diseases, Instituto Oswaldo Cruz, Fiocruz, Manguinhos, 21045-900 Rio de Janeiro, RJ, Brazil
| | - Eric Vinaud de Melo
- Laboratory of Parasitic Diseases, Instituto Oswaldo Cruz, Fiocruz, Manguinhos, 21045-900 Rio de Janeiro, RJ, Brazil
- Tropical Medicine Post-Graduation, Fiocruz, 21045-900 Rio de Janeiro, RJ, Brazil
| | | | - José Rodrigues Coura
- Laboratory of Parasitic Diseases, Instituto Oswaldo Cruz, Fiocruz, Manguinhos, 21045-900 Rio de Janeiro, RJ, Brazil
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Pereira LF, Gazzaneo AL, Melo RMPAD, Tenório HC, Oliveira DSD, Alves MSC, Gama DC, Wyszomirska RMDAF. Clinical and laboratory evaluation of schistosomiasis mansoni patients in Brazilian endemic areas. Mem Inst Oswaldo Cruz 2011; 105:449-53. [PMID: 20721489 DOI: 10.1590/s0074-02762010000400016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 12/18/2009] [Indexed: 11/22/2022] Open
Abstract
A total of 60% of the territory of Alagoas (AL) is considered endemic for the occurrence of schistosomiasis and the classification of clinical forms of the disease are not known. This paper aimed to evaluate an endemic schistosomiasis population in AL, taking into account the prevalence, classification of the clinical forms and the results of laboratory analyses. The sample consisted of residents in endemic areas. The participants were submitted to a stool examination by the Kato-Katz technique and the diagnosis was based on the reading of two microscopic slides for each sample. The patients whose examinations were positive for schistosomiasis mansoni were submitted to a clinical examination and blood collection. Based on this examination, 8.11% of the study population were positive for schistosomiasis. The medium parasite load was 79.1 +/- 174.3 eggs. The intestinal (90.57%) and hepatointestinal (9.43%) forms were found at statistically significant levels (p < 0.001). The results of the present study update information on schistosomiasis in the city of Rio Largo. These data, although referring only to three locations in that city, suggest a decrease either in the parasite load or in the severity of clinical forms.
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Rollemberg CVV, Santos CMB, Silva MMBL, Souza AMB, Silva ÂMD, Almeida JAPD, Almeida RPD, Jesus ARD. Aspectos epidemiológicos e distribuição geográfica da esquistossomose e geo-helmintos, no Estado de Sergipe, de acordo com os dados do Programa de Controle da Esquistossomose. Rev Soc Bras Med Trop 2011; 44:91-6. [DOI: 10.1590/s0037-86822011000100020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 10/06/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A esquistossomose é endêmica no Brasil, com elevada prevalência no Estado de Sergipe, apesar da existência do Programa de Controle da Esquistossomose (PCE). MÉTODOS: Foi realizado levantamento de dados do PCE-Sergipe de 2005 a 2008. A partir da matriz bruta formulou-se planilha de dados no software Access e analisou-se frequência e distribuição geográfica das infecções por Schistosoma mansoni e outros enteroparasitos. Estes dados foram exportados para o software Spring 5.0.5 para georreferenciamento e confecção de mapas temáticos de distribuição espacial e temporal por ano de avaliação. RESULTADOS: Foram positivos para S. mansoni 13,6% (14471/106287) de exames nos anos de 2005, 11,2% (16196/145069) em 2006, 11,8% (10220/86824) em 2007 e 10,6% (8329/78859) em 2008. A análise de mapas mostrou elevada prevalência da doença em Sergipe, em particular nos municípios Ilha das Flores, Santa Rosa de Lima, Santa Luzia do Itanhi e São Cristóvão. Além disso, avaliamos a associação entre as frequências dessas doenças parasitárias com indicadores sociais e de desenvolvimento dos diferentes municípios, de acordo com os dados do Instituto Brasileiro de Geografia e Estatística (IBGE) e da Superintendência de Recursos Hídricos (SRH). Observamos que os municípios com prevalência da esquistossomose maior do que 15% têm menor concentração de rede de esgotos (índice de higiene); p = 0,05. Adicionalmente, os municípios com prevalência de infecção por ancilostomídeos maior do que 10% apresentam um menor IDH educacional; p = 0,04. CONCLUSÕES: Ressalta-se a importância de maior controle dos fatores de risco ambientais e educacionais, na tentativa de reduzir prevalências dessas doenças parasitárias.
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Coura JR, Conceição MJ. Specific schistosomiasis treatment as a strategy for disease control. Mem Inst Oswaldo Cruz 2010; 105:598-603. [DOI: 10.1590/s0074-02762010000400040] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 08/05/2009] [Indexed: 11/22/2022] Open
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Makdissi FF, Herman P, Machado MAC, Pugliese V, D'Albuquerque LAC, Saad WA. Trombose de veia porta após desconexão ázigo-portal e esplenectomia em pacientes esquistossomóticos: Qual a real importância? ARQUIVOS DE GASTROENTEROLOGIA 2009; 46:50-6. [DOI: 10.1590/s0004-28032009000100014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 06/04/2008] [Indexed: 11/22/2022]
Abstract
CONTEXTO: A complicação mais frequente após a desconexão ázigo-portal e esplenectomia em doentes com esquistossomose mansônica hepatoesplênica é a trombose da veia porta. OBJETIVOS:Avaliar a incidência, os fatores preditivos dessa complicação, assim como, a evolução clínica, laboratorial, endoscópica e ultrassonográfica desses pacientes. MÉTODOS: Foram analisados retrospectivamente os prontuários de 155 doentes esquistossomóticos submetidos a desconexão ázigo-portal e esplenectomia. RESULTADOS: Trombose de veia porta foi observada em 52,3% dos pacientes, sendo 6,5% de trombose total e 45,8% de trombose parcial. Os pacientes que evoluíram com trombose de veia porta apresentaram mais frequentemente diarreia no pós-operatório. Febre foi evento habitual que ocorreu em 70% dos casos, mais frequente, entretanto, nos doentes com trombose total da veia porta (100%). Trombose de veia mesentérica superior ocorreu em quatro doentes (2,6%), sendo mais frequente entre os com trombose total da veia porta. Não se encontrou diferença estatística quanto aos parâmetros clínicos, laboratoriais, endoscópicos e recidiva hemorrágica no pós-operatório tardio, quando comparados os pacientes com e sem trombose portal. CONCLUSÕES: A trombose de veia porta no pós-operatório da desconexão ázigo-portal e esplenectomia é evento frequente, sem nenhum fator preditivo para sua ocorrência; na maioria dos casos a trombose é parcial e apresenta evolução benigna, com baixa morbidade; trombose total da veia porta está mais frequentemente associada à trombose da veia mesentérica superior, com elevada morbidade; a trombose da veia porta, parcial ou total, não acarretou complicações no período pós-operatório tardio.
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Conceição MJ, Borges-Pereira J, Coura JR. A thirty years follow-up study on Schistosomiasis mansoni in a community of Minas Gerais, Brazil. Mem Inst Oswaldo Cruz 2007; 102:1007-9. [DOI: 10.1590/s0074-02762007000800019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 12/13/2007] [Indexed: 11/22/2022] Open
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Coura JR, Amaral RS. Epidemiological and control aspects of schistosomiasis in Brazilian endemic areas. Mem Inst Oswaldo Cruz 2004; 99:13-9. [PMID: 15486629 DOI: 10.1590/s0074-02762004000900003] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present work analyzes the epidemiology of schistosomiasis in Brazil, its expansion, the attempts to control the disease, and the overall difficulties. The authors present the distribution of schistosomiasis intermediary hosts in Brazil, the migration routes of the human population, and disease distribution in highly and lowly endemic areas and isolated foci. They also analyze the controlling programs developed from 1977 to 2002, indicating the prevalence evolution and the reduction of disease morbi-mortality. In addition, the authors also evaluate controlling methods and conclude that: (a) no isolated method is able to control schistosomiasis, and every controlling program should consider the need of a multidisciplinary application of existing methods; (b) in long term, basic sanitation, potable water supply, as well as sanitary education, and community effective participation are important for infection control; (c) in short term, specific treatment at endemic areas, associated with control of intermediary hosts at epidemiologically important foci, are extremely relevant for controlling disease morbidity, although not enough for interrupting infection transmission.
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Affiliation(s)
- J R Coura
- Departamento de Medicina Tropical, Instituto Oswaldo Cruz-Fiocruz, Av. Brasil 4365, 21045-900 Rio de Janeiro, RJ, Brazil.
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Conceição MJ, Argento CA, Vieira OM, Takiya CM, Chagas VLA. Surgical indication in Schistosomiasis mansoni portal hypertension: follow-up from 1985 to 2001. Mem Inst Oswaldo Cruz 2003; 97 Suppl 1:165-6. [PMID: 12426613 DOI: 10.1590/s0074-02762002000900031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The study had the objective to evaluate the benefits of surgical indication for portal hypertension in schistosomiasis patients followed from 1985 to 2001. Schistosoma mansoni eggs were confirmed by at least six stool examinations or rectal biopsy. Clinical examination, abdominal ultrasonography, and digestive endoscopy confirmed the diagnosis of esophageal varices. A hundred and two patients, 61.3% male (14-53 years old) were studied. Digestive hemorrhage, hypersplenism, left hypochondrial pain, abdominal discomfort, and hypogonadism were, in a decreasing order, the major signs and symptoms determining surgical indication. Among the surgical techniques employed, either splenectomy associated to splenorenal anastomosis or azigoportal desvascularization, esophageal gastric descompression and esophageal sclerosis were used. Follow-up of patients revealed that, independent on the technique utilized, a 9.9% of death occurred, caused mainly by digestive hemorrhage due to the persistence of post-treatment varices. The authors emphasize the benefits of elective surgical indication allowing a normal active life.
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Affiliation(s)
- Maria José Conceição
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, UFRJ, Rio de Janeiro, RJ, Brasil.
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