RESUMO
Two hundred and fifty two blood donors HBsAg positive (mean age = 32.6, 91, 7% male) were searched into a transversal study to determine their clinical, laboratorial and histological characteristics. It was also compared the positiviness and negativiness of the serologic markers HBeAg, anti-Hbe and IgM anti-HBc with the values of serum aminotransferases. Hepatomegaly and splenomegaly were detected in 9.9% (25/252) and in 2.4% (6/252) respectively. In 17.5% (44/251) and 28.3% (71/251) the AST and ALT were respectively, over 50 UI/I. The positive frequencies of the various serologic markers of hepatitis B virus in 120 patients were: anti-HBc total in 89.5% (102/114), HBeAg in 25.7% (28/109) anti-Hbe in 67.3% (66/98), IgM anti-HBc in 40.8% (49/120); anti-Delta in 0.0% (0.66). Thirty one patients were submitted to liver biopsy, due do clinical alteration and/or of the aminotransferases. The hystological findings were: normal liver in 16.1% (5/31), non specific hystological alterations in 22.6% (7/31), persistent chronic hepatitis in 22.6% (7/31), active chronic hepatitis in 6.5% (2/31), cirrhosis in 12.9% (4/31), alcoholic hepatitis in 3.2% (1/31), lobular chronic hepatitis in 3.2% (1/31) and alterations exclusively due to schistosomiasis in 12.9% (4/31). Schistosomiasis elements (granuloma and/or Symmers fibrosis) were also notived in 7 patients. The comparative analysis of positiveness and negativeness of the serologic markers with the aminotransferases ("t" test of Student) showed significative difference of the averages (p < 0.05) only in relation to the simultaneous positeveness and negativeness of the HBeAg and IgM anti-HBc (average of AST = 56.11 and ALT = 78.00 when HBeAg and IgM anti-HBc were positive; average of AST = 24.25 and ALT = 27.00 when HBeAg and IgM anti-HBc were negative). According to this study the conclusion are: 1) The presence of two markers (HBeAg and IgM anti-HBc) and not only one determinant of viral replication in asymptomatic HBsAg carriers can strongly indicate a significant biochemical activity suggestive of hepatocellular lesion. 2) The presence of HBeAg in 25.7% (28/109) clearly shows the high rate of carriers with a potential of infectivity. 3) The results of hepatic histology shows that the majority of our patients had either normal liver or mild histological alterations. It is important to notice that only the cases with elevated aminotransferases were submitted to liver biopsies. The alterations caused by schistosomiasis shows, as is well known, the high prevalence of the parasitism in our surroundings. 4) The clinical aspects of the patients studied did not show significant alterations. Risk factors to get the infection were low. The hematologic and biochemical parameters (except aminotransferases) were either normal or just slightly abnormal. It was not detected a statistically significant difference. 5) The co-infections by delta virus was null.
Assuntos
Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Doadores de Sangue , Antígenos de Superfície da Hepatite B/sangue , Hepatite B/diagnóstico , Adulto , Brasil , Estudos de Coortes , Estudos Transversais , Feminino , Hepatite B/imunologia , Humanos , Imunoglobulina M/sangue , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
Subtotal splenectomy preserving the upper splenic pole vascularized only by the splenogastric vessels has been performed by us in 91 patients since 1984. This procedure was combined with central splenorenal shunt or portal variceal disconnection to treating schistosomatic portal hypertension (n = 67); it was combined with distal pancreatectomy to treat pancreatic cystadenoma (n = 1), and it was carried out for severe splenic trauma (n = 14), and to control severe Gaucher's disease (n = 4) and myeloid metaplasia due to myelofibrosis (n = 5). All patients are alive. In the present paper, we present the late postoperative follow up of 32 patients operated in a period that ranges from 1 to 12 years. All patients are satisfied with the operation. Increased counts of white blood cell (n = 10) and platelets (n = 7) were the only hematological alterations. Esophageal varices were present in 23 of 27 patients operated due to portal hypertension, but all of them were shorter than in the preoperative period. The ultrasound confirmed the presence of the splenic remnant (30 of 32) without significant size changes. Splenic scintigraphies were positive in 30 of 32 patients. Subtotal splenectomy seems to be a safe procedure that can be useful in portal hypertension, some metabolic and hematological diseases, and benign growth of the distal pancreas.
Assuntos
Esplenectomia/métodos , Adolescente , Adulto , Idoso , Cistadenoma/cirurgia , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Seguimentos , Doença de Gaucher/cirurgia , Humanos , Hipertensão Portal/parasitologia , Hipertensão Portal/cirurgia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Satisfação do Paciente , Contagem de Plaquetas , Veia Porta/cirurgia , Mielofibrose Primária/cirurgia , Cintilografia , Segurança , Esquistossomose/cirurgia , Baço/irrigação sanguínea , Baço/diagnóstico por imagem , Baço/lesões , Derivação Esplenorrenal Cirúrgica , Taxa de Sobrevida , Ultrassonografia , Varizes/cirurgiaRESUMO
Twenty achlorhydric patients and five controls were submitted to gastric endoscopic biopsies in order to study the histological pattern of the gastric mucosa and the number of enterochromaffin (EC) and gastrin (G) cells of the antral mucosa. The histological changes of the oxyntic mucosa of achlorhydric patients were variable being the predominant pattern the severe chronic atrophic gastritis. The antral mucosa was normal in appearance or revealed mild degree of gastritis. In the most achlorhydric patients the antral EC cell number was decreased when compared to the controls and the G cell number were relatively numerous. The results of the present work are suggestive of an increased G:EC cell ratio in achlorhydric patients.
Assuntos
Acloridria/patologia , Sistema Cromafim/patologia , Células Enterocromafins/patologia , Mucosa Gástrica/patologia , Gastrite Atrófica/patologia , Gastrite/patologia , Contagem de Células , Humanos , Antro Pilórico/patologiaAssuntos
Duodeno/cirurgia , Gastrostomia , Úlcera Péptica/cirurgia , Antro Pilórico/cirurgia , Vagotomia , Adulto , Idoso , Feminino , Determinação da Acidez Gástrica , Esvaziamento Gástrico , Mucosa Gástrica/patologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-OperatóriasRESUMO
A prospective study of the effects of maximal doses of betazol hydrochloride ( Histalog ) on the endoscopic and histologic findings of the gastric mucosa of volunteers was made. Of the 11 patients examined, no alteration was seen on gastroscopic examination after Histalog in three, slight to moderate congestion of the mucosa in six and scattered oozing bleeding points in two. The study of the histologic findings revealed no statistical significant difference in the recurrence of erosion, hemorrhage and edema in the antrum and body gastric mucosa, before and after the administration of Histalog . It was concluded that maximal doses of Histalog cause no significant hemorrhage in the mucosa of the stomach and that the brown colour frequently seen in the gastric secretions of the final portions of a Histalog test is to be attributed to trauma to the mucosa by the nasogastric tube and to Histalog induced congestion of the mucosa.