RESUMO
Benign solid liver tumors are composed by a heterogeneous group of lesions. Hepatic parasitosis is an infrequent etiological cause of benign solid liver tumors. Objective. To present the case of a patient with benign solid liver tumors treated with right portal vein embolization and, later, with hepatectomy. Clinical case. 60-year-old, male patient diagnosed with multiple solid liver tumors, due to a generalized case of jaundice. The decision to perform surgery was made on the basis of the clinical symptoms and the impossibility of discarding malignancy through complementary tests. Before surgery, hepatic volumetry and right portal vein embolization were done to increase future hepatic remnant. Right hepatectomy and hepatic resection of segment IVa were performed. The patient evolved positively from jaundice and the anatomopathological results showed a lesion related to hepatic parasitosis. Conclusion. In the presence of a solid liver tumor, it is necessary to rule out the malignant etiology of the lesion. If this is not possible, or if the patient continues with the symptomatology, surgical resection is prescribed, taking into account the volume of the hepatic gland and future hepatic remnant.
Los tumores hepáticos sólidos benignos están formados por un grupo heterogéneo de lesiones. Las parasitosis hepáticas conforman una causa etiológica poco frecuente de tumores hepáticos sólidos benignos. Objetivo. Reportar el caso de un paciente con tumores hepáticos solidos benignos tratado con embolización portal derecha y posteriormente hepatectomía. Caso clínico. Paciente de 60 años, sexo masculino, al cual se le diagnostican múltiples tumores hepáticos sólidos, debido a cuadro de ictericia generalizada. Debido al cuadro sintomático, y al no poder descartar malignidad con las pruebas complementarias, se decide realizar cirugía. Previamente se realiza volumetría de la glándula hepática y embolización portal derecha para aumentar el remanente hepático futuro. Se realiza hepatectomía derecha y segmentectomía hepática IVa. Evoluciona con mejoría del cuadro ictérico y el resultado anatomopatológico informa lesión vinculable a parasitosis hepática. Conclusión. Ante la presencia de un tumor hepático sólido, es necesario descartar etiología maligna de la lesión. Si no es posible descartar esto, o si el paciente persiste con sintomatología, la resección quirúrgica está indicada, teniendo en cuenta el volumen de la glándula hepática y del remanente hepático futuro.
Assuntos
Hepatectomia/métodos , Hepatopatias Parasitárias/complicações , Neoplasias Hepáticas/parasitologia , Diagnóstico Diferencial , Humanos , Hepatopatias Parasitárias/diagnóstico , Hepatopatias Parasitárias/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: A significant number of patients with schistosomiasis develop the hepatosplenic form, with portal hypertension, in which bleeding caused by rupture of esophagogastric varices emerged as the leading cause of morbidity and mortality. AIM: To investigate the effects of splenectomy and ligature of the left gastric vein on risk factors for bleeding of esophagogastric varices in patients with schistosomiasis mansoni, hepatosplenic form, with a history of upper gastrointestinal bleeding. METHODS: The main risk factors of bleeding from esophagogastric varices were studied in 34 patients. The following parameters were investigated: 1) esophageal variceal pressure, measured by the endoscopic pneumatic balloon technique; 2) size, fundamental color, extension and red signs of esophageal varices, gastric varices and gastropathy of portal hypertension. The evaluations were performed in the preoperative period, immediate postoperative period (between the sixth and eighth postoperative days) and the sixth month of follow-up. RESULTS: The variceal pressure has fallen from 22.3+/-2.6 mmHg before surgery to 16.0+/-3.0 mmHg in the immediate postoperative period (p<0.001), reaching 13.3+/- 2.6 mmHg in the sixth month of follow-up. A significant reduction of the frequency of the parameters associated with a greater risk of hemorrhage was observed between the preoperative period and six-month follow-up, when the proportion of large esophageal varices (p<0.05), varices extending to the upper esophagus (p<0.05), bluish varices (p<0.01), varices with red signs (p<0.01) and gastropathy (p<0.05) decreased. CONCLUSION: In patients with hepatosplenic schistosomiasis with a previous history of variceal hemorrhage, splenectomy and gastric vein ligation was effective in reducing the main hemorrhagic risk factors until the sixth month of follow-up, indicating a good way to control the bleeding episodes.
Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/etiologia , Hepatopatias Parasitárias/cirurgia , Esquistossomose mansoni/cirurgia , Esplenectomia/efeitos adversos , Esplenopatias/parasitologia , Esplenopatias/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Ligadura/efeitos adversos , Hepatopatias Parasitárias/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Esplenopatias/complicações , Estômago/irrigação sanguínea , Veias , Adulto JovemRESUMO
RACIONAL: Expressivo contingente de pacientes esquistossomóticos com a forma hepatoesplênica e hipertensão portal apresentam hemorragia causada pela ruptura de varizes esofagogástricas, principal causa de alta morbidade e mortalidade da doença. OBJETIVO: Investigar os efeitos da esplenectomia e ligadura da veia gástrica esquerda sobre fatores de risco de sangramento por varizes esofagogástricas em portadores de esquistossomose mansônica, forma hepatoesplênica, com antecedente de hemorragia digestiva alta. MÉTODO: Estudaram-se, de forma prospectiva, 34 pacientes, com idade entre 1 e 74 anos (média 44,14), sendo 18 (53%) mulheres. Analisaram-se: 1) pressão das varizes do esôfago, aferida pela técnica endoscópica do balão pneumático; 2) tamanho, local, cor e sinais de cor vermelha nas varizes do esôfago; 3) varizes gástricas e gastropatia da hipertensão portal. Realizaram-se avaliações no pré-operatório, no pós-operatório imediato e no sexto mês após a ligadura da veia gástrica esquerda. RESULTADOS: A pressão das varizes do esôfago diminuiu de 22,3+/-2,6 mmHg, antes da operação, para 16,0+/-3,0 mmHg no pós-operatório imediato (p<0,001), caindo para 13,3+/-2,6 mmHg no pós-operatório do sexto mês (p<0,001). A proporção de varizes de grosso calibre, varizes no esôfago superior, varizes de cor azul, varizes com sinais de cor vermelha e de gastropatia da hipertensão portal decresceu de forma significante apenas no sexto mês de pós-operatório. CONCLUSÃO: A ligadura da veia gástrica esquerda, em esquistossomóticos hepatoesplênicos, com antecedente de hemorragia digestiva alta, revelou-se eficaz em diminuir alguns dos principais fatores de risco de hemorragia por varizes esofagogástricas, indicando boa perspectiva no controle definitivo do sangramento.
BACKGROUND: A significant number of patients with schistosomiasis develop the hepatosplenic form, with portal hypertension, in which bleeding caused by rupture of esophagogastric varices emerged as the leading cause of morbidity and mortality. AIM: To investigate the effects of splenectomy and ligature of the left gastric vein on risk factors for bleeding of esophagogastric varices in patients with schistosomiasis mansoni, hepatosplenic form, with a history of upper gastrointestinal bleeding. METHODS: The main risk factors of bleeding from esophagogastric varices were studied in 34 patients. The following parameters were investigated: 1) esophageal variceal pressure, measured by the endoscopic pneumatic balloon technique; 2) size, fundamental color, extension and red signs of esophageal varices, gastric varices and gastropathy of portal hypertension. The evaluations were performed in the preoperative period, immediate postoperative period (between the sixth and eighth postoperative days) and the sixth month of follow-up. RESULTS: The variceal pressure has fallen from 22.3+/-2.6 mmHg before surgery to 16.0+/-3.0 mmHg in the immediate postoperative period (p<0.001), reaching 13.3+/- 2.6 mmHg in the sixth month of follow-up. A significant reduction of the frequency of the parameters associated with a greater risk of hemorrhage was observed between the preoperative period and six-month follow-up, when the proportion of large esophageal varices (p<0.05), varices extending to the upper esophagus (p<0.05), bluish varices (p<0.01), varices with red signs (p<0.01) and gastropathy (p<0.05) decreased. CONCLUSION: In patients with hepatosplenic schistosomiasis with a previous history of variceal hemorrhage, splenectomy and gastric vein ligation was effective in reducing the main hemorrhagic risk factors until the sixth month of follow-up, indicating a good way to control the bleeding episodes.
Assuntos
Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/etiologia , Hepatopatias Parasitárias/cirurgia , Esquistossomose mansoni/cirurgia , Esplenectomia/efeitos adversos , Esplenopatias/parasitologia , Esplenopatias/cirurgia , Seguimentos , Ligadura/efeitos adversos , Hepatopatias Parasitárias/complicações , Estudos Prospectivos , Esplenopatias/complicações , Estômago/irrigação sanguínea , VeiasRESUMO
OBJECTIVE: To investigate the serum levels of IL-10 and IL-13 in patients with hepatosplenic schistosomiasis mansoni (HSM), evaluating the role of these cytokines in the development of hepatic fibrosis. METHODS: The study was prospective and analytical, developed at the Department of Surgery, Federal University of Pernambuco, Keizo Asami Laboratory of Immunology. We studied three groups: Group I - 25 patients with hepatosplenic schistosomiasis mansoni who were not submitted to surgery; Group II - 30 individuals who underwent splenectomy and ligature of left gastric vein; Group III - 33 subjects without hepatosplenic schistosomiasis mansoni or any other disease or condition that could compromise the hepatic functional reserve. Serum concentrations of IL-10 and IL-13 were obtained through ELISA. Considering their non-parametric nature, all concentrations were analyzed by Kruskal-Wallis test, with p<0.05 used to reject the null hypothesis. RESULTS: The mean concentrations of IL-10 in ng/mL in serum were GI: 50.0 ± 59.0; GII: 38.0 ± 270; GIII: 38.0 ± 20.0. Concentrations of IL-13 in ng/mL in the serum of patients were respectively: 41.0 ± 93.0 in GI, 16.0 ± 17.0 in GII and 18.0 ± 34.0 in GIII. There was no significant difference between the mean concentrations of IL-10 and IL-13 between the study groups (p> 0.05). CONCLUSION: The mean serum concentrations of IL-10 and IL-13 were similar in all three groups, indicating that possibly the presence of these cytokines in serum is not associated with different degrees of Symmers fibrosis in patients with hepatosplenic schistosomiasis mansoni.
Assuntos
Interleucina-10/sangue , Interleucina-13/sangue , Cirrose Hepática/sangue , Cirrose Hepática/parasitologia , Hepatopatias Parasitárias/sangue , Esquistossomose mansoni/sangue , Esplenopatias/sangue , Esplenopatias/parasitologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Progressão da Doença , Feminino , Humanos , Cirrose Hepática/cirurgia , Hepatopatias Parasitárias/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Esquistossomose mansoni/cirurgia , Esplenopatias/cirurgia , Adulto JovemRESUMO
OBJETIVO: Investigar os níveis de IL-10 e IL-13 no soro de portadores da esquistossomose mansônica na forma hepatoesplênica (EHE), avaliando o papel destas citocinas no desenvolvimento da fibrose hepática. MÉTODOS: O estudo foi prospectivo e analítico, desenvolvido no Departamento de Cirurgia da Universidade Federal de Pernambuco, Laboratório de Imunologia Keizo Asami. Foram estudados três grupos: Grupo I - 25 portadores de esquistossomose mansônica na forma hepatoesplênica e não submetidos a tratamento cirúrgico; Grupo II - 30 submetidos à esplenectomia e ligadura da veia gástrica esquerda; Grupo III - 33 indivíduos sem esquistossomose mansônica na forma hepatoesplênica ou qualquer outra doença ou agravo que comprometesse a reserva funcional hepática. As concentrações séricas de IL-10 e IL-13 foram obtidas pelo método ELISA. Considerando-se a natureza não paramétrica, todas as concentrações foram analisadas pelo teste de Kruskal-Wallis. p<0,05 foi usado para rejeição da hipótese de nulidade. RESULTADOS: As médias das concentrações de IL-10, em ng/mL, no soro foram: GI 50,0 ± 59,0; GII 38,0 ± 270; GIII 38,0 ± 20,0. As concentrações de IL-13, em ng/mL, no soro dos pacientes foram respectivamente: GI 41,0 ± 93,0; GII 16,0 ± 17,0; GIII 18,0 ± 34,0. Não se observou diferença significante entre as médias das concentrações de IL-10 e IL-13 entre os grupos de estudo (p>0,05). CONCLUSÃO: As médias das concentrações séricas de IL-10 e IL-13 foram similares nos três grupos estudados, indicando que, possivelmente, estas citocinas no soro não estejam associadas aos diferentes graus de fibrose de Symmers nos pacientes.
OBJECTIVE: To investigate the serum levels of IL-10 and IL-13 in patients with hepatosplenic schistosomiasis mansoni (HSM), evaluating the role of these cytokines in the development of hepatic fibrosis. METHODS: The study was prospective and analytical, developed at the Department of Surgery, Federal University of Pernambuco, Keizo Asami Laboratory of Immunology. We studied three groups: Group I - 25 patients with hepatosplenic schistosomiasis mansoni who were not submitted to surgery; Group II - 30 individuals who underwent splenectomy and ligature of left gastric vein; Group III - 33 subjects without hepatosplenic schistosomiasis mansoni or any other disease or condition that could compromise the hepatic functional reserve. Serum concentrations of IL-10 and IL-13 were obtained through ELISA. Considering their non-parametric nature, all concentrations were analyzed by Kruskal-Wallis test, with p<0.05 used to reject the null hypothesis. RESULTS: The mean concentrations of IL-10 in ng/mL in serum were GI: 50.0 ± 59.0; GII: 38.0 ± 270; GIII: 38.0 ± 20.0. Concentrations of IL-13 in ng/mL in the serum of patients were respectively: 41.0 ± 93.0 in GI, 16.0 ± 17.0 in GII and 18.0 ± 34.0 in GIII. There was no significant difference between the mean concentrations of IL-10 and IL-13 between the study groups (p> 0.05). CONCLUSION: The mean serum concentrations of IL-10 and IL-13 were similar in all three groups, indicating that possibly the presence of these cytokines in serum is not associated with different degrees of Symmers fibrosis in patients with hepatosplenic schistosomiasis mansoni.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , /sangue , /sangue , Cirrose Hepática/sangue , Cirrose Hepática/parasitologia , Hepatopatias Parasitárias/sangue , Esquistossomose mansoni/sangue , Esplenopatias/sangue , Esplenopatias/parasitologia , Progressão da Doença , Cirrose Hepática/cirurgia , Hepatopatias Parasitárias/cirurgia , Estudos Prospectivos , Esquistossomose mansoni/cirurgia , Esplenopatias/cirurgiaRESUMO
BACKGROUND: Ascariasis is an endemic disease in developing countries. The parasite can invade the hepatobiliary tree and cause symptoms. Medical therapy can be ineffective in these patients and intervention techniques required. STUDY DESIGN: A retrospective review of patient charts between February 1992 and February 2007 in the Hospital Latinoamericano, Cuenca, Ecuador, was performed to identify patients having surgical or endoscopic treatment for hepatobiliary ascariasis. Patient demographics, treatment algorithms, and outcomes are described and analyzed. RESULTS: There were 13 cases of hepatobiliary infestation by ascaris treated through endoscopy or operation. All patients presented with colicky abdominal pain in the right upper quadrant. Hepatic and biliary ultrasonography identified parasites in 12 patients. In the other patient, a hepatic abscess containing ascaris was found incidentally during cholecystectomy. There were 11 patients with ascariasis in the common bile duct, 1 in whom the cystic duct was occluded, causing acute cholecystitis. In 12 patients, conservative management was attempted and was unsuccessful. Endoscopic extraction was successful in four of these patients. Six patients underwent laparoscopic cholecystectomy, common bile duct exploration with parasite extraction, and T-tube placement. Parasite extraction through common bile duct exploration followed by primary closure was performed in one patient. Cholecystotomy and parasite extraction followed by cholecystectomy were performed in one patient. The final patient had cholecystectomy and parasite extraction from a liver abscess without earlier medical therapy. CONCLUSIONS: Ascariasis in the hepatobiliary system should be considered in the differential diagnosis of upper abdominal pain for patients in populations at risk. When an operation is indicated, it can be accomplished by endoscopic or laparoscopic approach.
Assuntos
Ascaríase/cirurgia , Doenças Biliares/cirurgia , Laparoscopia , Hepatopatias Parasitárias/cirurgia , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
It is known that hepatic fibrosis may regress following partial hepatectomy, since the hepatic parenchyma regenerates very rapidly, but not the excess of fibrous tissue. The present study evaluated this hypothesis by observing the behavior of systematized septal fibrosis induced by either 30 or 90-day-old Capillaria hepatica infection, in rats subjected to partial hepatectomy. The results revealed that the morphology of the fibrosis was unaffected, but its relative quantity within the microscope field appeared significantly decreased, as a consequence of the increased liver tissue mass following regeneration.
Assuntos
Capillaria , Infecções por Enoplida/complicações , Cirrose Hepática Experimental/cirurgia , Hepatopatias Parasitárias/cirurgia , Regeneração Hepática , Animais , Infecções por Enoplida/patologia , Feminino , Hepatectomia , Cirrose Hepática Experimental/parasitologia , Cirrose Hepática Experimental/patologia , Hepatopatias Parasitárias/parasitologia , Hepatopatias Parasitárias/patologia , Masculino , Ratos , Fatores de TempoRESUMO
It is known that hepatic fibrosis may regress following partial hepatectomy, since the hepatic parenchyma regenerates very rapidly, but not the excess of fibrous tissue. The present study evaluated this hypothesis by observing the behavior of systematized septal fibrosis induced by either 30 or 90-day-old Capillaria hepatica infection, in rats subjected to partial hepatectomy. The results revealed that the morphology of the fibrosis was unaffected, but its relative quantity within the microscope field appeared significantly decreased, as a consequence of the increased liver tissue mass following regeneration.
Sabe-se que a fibrose hepática pode sofrer uma redução em seqüência uma hepatectomia parcial, uma vez que o parênquima hepático se regenera muito rápido, mas não o excesso de tecido fibroso. O presente trabalho avalia esta hipótese ao observar como se comporta a fibrose septal sistematizada induzida pela Capillaria hepática no rato, após infecção de 30 ou 90 dias de duração, em animais submetidos à hepatectomia parcial. Os resultados revelaram que a fibrose em si mesma não foi afetada na sua morfologia, mas a sua quantidade relativa apareceu diminuída significativamente no campo microscópico como conseqüência do aumento da massa de tecido hepático pós-regeneração.
Assuntos
Animais , Feminino , Masculino , Ratos , Capillaria , Infecções por Enoplida/complicações , Regeneração Hepática , Cirrose Hepática Experimental/cirurgia , Hepatopatias Parasitárias/cirurgia , Infecções por Enoplida/patologia , Hepatectomia , Cirrose Hepática Experimental/parasitologia , Cirrose Hepática Experimental/patologia , Hepatopatias Parasitárias/parasitologia , Hepatopatias Parasitárias/patologia , Fatores de TempoRESUMO
Mansonic schistosomiasis remains a medical-social issue in Northeastern Brazil. In children, surgical treatment includes splenectomy and spleen autoimplantation. This procedure reduces post-splenectomy sepsis. The aim of this study was to analyze the phagocyte rate and the cellular viability of monocytes in patients with hepatosplenic schistosomiasis, who underwent splenectomy and spleen autoimplantation from 1991 to 2001. Of the 22 individuals analyzed, 11 were patients who underwent splenectomy and spleen autoimplantation (Study group) and 11 were healthy individuals from the same region (Control group). Both groups presented similar mean age. No difference was found in the phagocyte rate between the control group (36.1%+/-4.9%) and study group (33.5%+/-5.7%). However, phagocyte viability after stimulation with lipopolysaccharide was higher (94%) in control group, when compared to the study group (65%), p<0.001. It is possible to hypothesize that monocytes from the study group patients presented a reduced response to the microorganism challenge, in the face of a harmful and long-lasting stimulus.
Assuntos
Hepatopatias Parasitárias/parasitologia , Monócitos/fisiologia , Fagocitose/fisiologia , Esquistossomose mansoni/cirurgia , Baço/transplante , Esplenopatias/parasitologia , Adolescente , Adulto , Estudos de Casos e Controles , Sobrevivência Celular , Estudos Transversais , Feminino , Humanos , Hepatopatias Parasitárias/imunologia , Hepatopatias Parasitárias/cirurgia , Masculino , Monócitos/imunologia , Fagocitose/imunologia , Estudos Prospectivos , Esquistossomose mansoni/imunologia , Baço/imunologia , Esplenectomia , Esplenopatias/imunologia , Esplenopatias/cirurgia , Transplante AutólogoRESUMO
OBJETIVO: Estudar a camada de fibras nervosas da retina de portadores de esquistossomose mansônica hepatoesplênica. MÉTODOS: Foram submetidos ao exame com o GDx Scanning Laser System, 23 portadores de esquistossomose na forma hepatoesplênica que tinham sido submetidos, quando crianças, a esplenectomia, ligadura da veia gástrica esquerda e auto-implante de tecido esplênico no omento maior. Todos apresentaram pressão intra-ocular menor que 21 mmHg. No grupo controle foram estudados 23 indivíduos com idade e condição socioeconômico-geográfica similar, sem esquistossomose. RESULTADOS: Em apenas um paciente do grupo portador de esquistossomose foram observadas alterações em quatro parâmetros: superior nasal, média superior, média da espessura e número de fibra. Todos os indivíduos do grupo controle apresentaram GDx com parâmetros dentro da normalidade. CONCLUSÃO: No estudo realizado não foi encontrado diferença significante entre os dois grupos. Apenas um paciente mostrou redução da camada de fibras nervosas.
PURPOSE: To study the retinal nerve fiber layer in young patients suffering from hepatosplenic schistosomiasis mansoni. METHODS: Twenty-three patients with hepatosplenic schistosomiasis mansoni who were submitted, when children, to splenectomy, ligature of the left gastric vein and auto-implantation of spleen tissue in the major omentum underwent GDx Scanning Laser System evaluations. All patients presented with intraocular pressure below 21 mmHg. RESULTS: Only one patient suffering from hepatosplenic schistosomiasis mansoni showed abnormalities on the GDx examination. There were no abnormalities on GDx examination in the control group. CONCLUSION: There was no significant difference between the two groups of this study. Only one patient showed retinal nerve fiber layer reduction.
Assuntos
Humanos , Masculino , Feminino , Adulto , Técnicas de Diagnóstico Oftalmológico , Hepatopatias Parasitárias/cirurgia , Fibras Nervosas/patologia , Vasos Retinianos/patologia , Esquistossomose mansoni/cirurgia , Esplenopatias/cirurgia , Estudos de Casos e Controles , Métodos Epidemiológicos , Pressão Intraocular , Lasers , Esplenectomia , Esplenopatias/parasitologia , Fatores de TempoRESUMO
PURPOSE: To measure the levels of NO production by monocytes in patients with the hepatosplenic form of schistosomiasis mansoni who underwent splenectomy, ligature of the left gastric vein and auto implantation of spleen tissue in the major omentum. METHODS: Four groups of volunteers were enrolled in the investigation: G1 - 12 patients with S. mansoni infection in its hepatosplenic form without any kind of treatment (SMH); G2 - 13 SMH patients who underwent medical treatment and portal hypertension decompression splenectomy and ligature of the left gastric vein (SMH/SLGV); G3 - 19 patients similar to the later group, but additionally received auto implantation of spleen morsels in the major omentum (SMH/SLGV/AI); and G4 - 15 individuals with no S. mansoni infection coming from the same geographical area and presenting similar socio economical status (CG). Nitrite production by monocytes was determined by a standard Griess reaction adapted to microplates. The results were presented by mean ± SD for each group. Significant differences in NO production by monocytes were determined by Tukey-Kramer multicomparisons test. Probability values of 0.05 were considered significant. RESULTS: Patients from G1 (SMH) showed lower level of NO production by monocytes (5.28 ± 1.28µmol/ml). Patients from G2 (SMH/SLGV) showed similar results (6.67 ± 0.44µmol/ml - q = 2.681 p > 0.05). Individuals of G4 (CG) showed higher level of NO production by monocytes (8.19 ± 2.74µmol/ml). Patients from G3 (SMH/SGLV/AI) showed similar NO production by PBMC as compared to individuals of G4 (CG) - (7.41 ± 1.65µmol/ml - q = 1.615 p > 0.05). The volunteers from G4 (CG) and G3 (SMH/SLGV/AI) showed significantly greater levels of NO production by monocytes as compared to those from G1 (SMH) - (q = 5.837 p < 0.01, and q = 4.285 p < 0.05). CONCLUSION: Collectively, the results point to a restoration of NO normal production by monocytes in SH...
OBJETIVO: Mensurar os níveis de produção de ON por monócitos do sangue periférico (MSP) em portadores de esquistossomose na forma hepatoesplênica que tinham se submetido a esplenectomia, ligadura da veia gástrica esquerda e auto-implante de tecido esplênico no omento maior. MÉTODOS: Quatro grupos de voluntários foram envolvidos na investigação: G1 - 12 portadores de esquistossomose hepatoesplênica sem nenhuma forma de tratamento (EHE); G2 - 13 portadores de EHE que receberam tratamento clínico e se submeteram cirurgia para descompressão do sistema porta esplenectomia e ligadura da veia gástrica esquerda (EHE/ELGE); G3 - 19 pacientes similares ao do último grupo, mas que receberam também auto-implante de fragmentos de tecido esplênico no omento maior (EHE/ELGE/AI); e G4 - 15 indivíduos sem infecção pelo S. mansoni advindos da mesma área geográfica e apresentando as mesmas condições sócio-econômicas (GC). A produção de ON pelos MSP foi determinada pela reação padrão de Griess, adaptada para poços em microplaca. Os resultados foram expressos por suas médias ± DP para cada grupo. Diferenças significantes nas medias de produção de ON pelos MSP foram determinadas pelo teste de comparações múltiplas de Tukey-Kramer. Foram aceito os limites de significância de p < 0,05. RESULTADOS: Os pacientes portadores de EHE não tratados (G1) evidenciaram os níveis mais baixos de produção de ON pelos MSP (5,28 ± 1,28µmol/ml). Os pacientes do G2 (EHE/ELGE) evidenciaram resultados similares (6,67 ± 0,44µmol/ml - q = 2,681 p > 0.05). Os indivíduos do G4 (GC) evidenciaram os mais altos níveis de produção de ON pelos MSP (8,19 ± 2,74µmol/ml). Os pacientes do G3 (EHE/ELGE/AI) evidenciaram produção de ON produzido pelos MSP similares aos indivíduos do - G4 (GC) (7.41 ± 1.65µmol/ml - q = 1.615 p > 0.05). Os voluntários do G4 (GC) e os do G3 (EHE/ELGE/AI) evidenciaram de forma significante maiores níveis de produção de ON pelos MS...
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Hepatopatias Parasitárias/imunologia , Monócitos/metabolismo , Óxido Nítrico/biossíntese , Omento/imunologia , Esplenectomia , Esquistossomose mansoni/imunologia , Células Cultivadas/metabolismo , Hipertensão Portal/imunologia , Hipertensão Portal/cirurgia , Ligadura , Hepatopatias Parasitárias/cirurgia , Omento/cirurgia , Esquistossomose mansoni/cirurgia , Esplenopatias/imunologia , Esplenopatias/cirurgia , Esplenose/imunologia , Esplenose/cirurgia , Transplante Autólogo , Veias/imunologia , Veias/cirurgiaRESUMO
Esquistossomose mansônica persiste como problema médico-social no nordeste brasileiro. Em crianças, o tratamento cirúrgico inclui esplenectomia e auto-implante esplênico. Este procedimento reduz a septicemia pós-esplenectomia. O objetivo deste estudo foi analisar a taxa de fagocitose e viabilidade de fagócitos mononucleares em portadores de esquistossomose hepatoesplênica, submetidos à cirurgia, de 1991 a 2001. Dos 22 indivíduos analisados, 11 eram portadores de esquistossomose hepatoesplênica, submetidos à esplenectomia e auto-implante esplênico (Grupo estudo) e 11 eram sadios (Grupo Controle). Os grupos tinham média de idades similar e procediam da mesma zona endêmica (Timbaúba-PE). Não se evidenciou diferença na taxa de fagocitose comparando-se o grupo controle (36,1 por cento±4,9 por cento) e o grupo estudo (33,5 por cento±5,7 por cento), p=0,2773. Todavia, a viabilidade dos fagócitos após estímulo com lipopolissacarídio foi maior (94 por cento) no grupo controle, quando comparado ao grupo estudo (65 por cento), p<0,001. Pode-se concluir que a esplenose assegura função fagocitária normal em monócitos, entretanto, os fagócitos possuem menor viabilidade frente a um estímulo nocivo e duradouro.
Mansonic schistosomiasis remains a medical-social issue in Northeastern Brazil. In children, surgical treatment includes splenectomy and spleen autoimplantation. This procedure reduces post-splenectomy sepsis. The aim of this study was to analyze the phagocyte rate and the cellular viability of monocytes in patients with hepatosplenic schistosomiasis, who underwent splenectomy and spleen autoimplantation from 1991 to 2001. Of the 22 individuals analyzed, 11 were patients who underwent splenectomy and spleen autoimplantation (Study group) and 11 were healthy individuals from the same region (Control group). Both groups presented similar mean age. No difference was found in the phagocyte rate between the control group (36.1 percent±4.9 percent) and study group (33.5 percent±5.7 percent). However, phagocyte viability after stimulation with lipopolysaccharide was higher (94 percent) in control group, when compared to the study group (65 percent), p<0.001. It is possible to hypothesize that monocytes from the study group patients presented a reduced response to the microorganism challenge, in the face of a harmful and long-lasting stimulus.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Hepatopatias Parasitárias/parasitologia , Monócitos/fisiologia , Fagocitose/fisiologia , Esquistossomose mansoni/cirurgia , Baço/transplante , Esplenopatias/parasitologia , Estudos de Casos e Controles , Sobrevivência Celular , Estudos Transversais , Hepatopatias Parasitárias/imunologia , Hepatopatias Parasitárias/cirurgia , Monócitos/imunologia , Estudos Prospectivos , Fagocitose/imunologia , Esplenectomia , Esquistossomose mansoni/imunologia , Baço/imunologia , Esplenopatias/imunologia , Esplenopatias/cirurgia , Transplante AutólogoRESUMO
PURPOSE: To measure the levels of NO production by monocytes in patients with the hepatosplenic form of Schistosomiasis mansoni who underwent splenectomy, ligature of the left gastric vein and auto implantation of spleen tissue in the major omentum. METHODS: Four groups of volunteers were enrolled in the investigation: G1 - 12 patients with S. mansoni infection in its hepatosplenic form without any kind of treatment (SMH); G2 - 13 SMH patients who underwent medical treatment and portal hypertension decompression splenectomy and ligature of the left gastric vein (SMH/SLGV); G3 - 19 patients similar to the later group, but additionally received auto implantation of spleen morsels in the major omentum (SMH/SLGV/AI); and G4 - 15 individuals with no S. mansoni infection coming from the same geographical area and presenting similar socio-economical status (CG). Nitrite production by monocytes was determined by a standard Griess reaction adapted to microplates. The results were presented by mean +/- SD for each group. Significant differences in NO production by monocytes were determined by Tukey-Kramer multicomparisons test. Probability values of 0.05 were considered significant. RESULTS: Patients from G1 (SMH) showed lower level of NO production by monocytes (5.28 +/- 1.28 micromol/ml). Patients from G2 (SMH/SLGV) showed similar results (6.67 +/- 0.44 micromol/ml-q = 2.681 p > 0.05). Individuals of G4 (CG) showed higher level of NO production by monocytes (8.19 +/- 2.74 micromol/ml). Patients from G3 (SMH/SGLV/AI) showed similar NO production by PBMC as compared to individuals of G4 (CG) - (7.41 +/- 1.65 micromol/ml- q = 1.615 p > 0.05). The volunteers from G4 (CG) and G3 (SMH/SLGV/AI) showed significantly greater levels of NO production by monocytes as compared to those from G1 (SMH) - (q = 5.837 p < 0.01, and q = 4.285 p < 0.05). CONCLUSION: Collectively, the results point to a restoration of NO normal production by monocytes in SHM patients who underwent medical and surgical treatments, especially in those who had received auto implantation of spleen tissue in the major omentum after splenectomy and ligature of the left gastric vein. The data gives further support to the hypothesis that this additional procedure is important in the restoration of the immune response of these patients, since NO synthesis by the monocytes correlates with protective immunity against infection; thus, protecting them against overwhelming post splenectomy infection.
Assuntos
Hepatopatias Parasitárias/imunologia , Monócitos/metabolismo , Óxido Nítrico/biossíntese , Esquistossomose mansoni/imunologia , Esplenopatias/parasitologia , Adolescente , Adulto , Células Cultivadas , Criança , Feminino , Humanos , Hipertensão Portal/imunologia , Hipertensão Portal/cirurgia , Ligadura , Hepatopatias Parasitárias/cirurgia , Masculino , Omento/imunologia , Esquistossomose mansoni/cirurgia , Baço/transplante , Esplenectomia , Esplenopatias/imunologia , Esplenopatias/cirurgia , Estômago/irrigação sanguínea , Transplante Autólogo , VeiasRESUMO
Pentastomiasis is a rare zoonotic disease. Almost all recorded cases of human pentastomiasis had been incidental findings at autopsy. We report an unusual case of human pentastomiasis mimicking liver tumor successfully treated by liver resection. This clinical presentation is uncommon and it was probably caused by a pentastomid that exited its cyst and migrated to the liver causing an infarct that was mistaken as a primary liver tumor. Diagnosis could not be made before the surgery. This is the first reported case of human pentastomiasis in Brazil.