Navegando por Palavras-chave "variceal bleeding"

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    Endoscopic, ultrasonographic, and US-Doppler parameters as indicators of variceal bleeding in patients with schistosomiasis
    (Kluwer Academic/plenum Publ, 2000-05-01) Martins, R. D.; Szejnfeld, J.; Lima, F. G.; Ferrari, A. P.; Universidade Federal de São Paulo (UNIFESP)
    Bleeding from esophagogastric varices is a potentially deadly complication in patients with hepatosplenic schistosomiasis. the aim of this study is to establish indicators of variceal bleeding. We studied 40 patients with compensated hepatosplenic schistosomiasis and varices, analyzing four endoscopic (variceal size, red color signs, fundic var-ices, and congestive gastropathy), nine ultrasonographic (right and left hepatic lobe size, periportal and gallbladder wall thickness, portal and splenic veins diameter, spleen longitudinal axis and volume, and presence of collateral circulation), and five US-Doppler parameters (portal and splenic veins velocity and flaw and portal vein congestion index). Patients were divided in two groups according to previous history of variceal bleeding. the group with bleeding episodes was again divided in two groups: with and without treatment, namely endoscopic sclerotherapy. All endoscopic parameters and two ultrasonographic (periportal thickness and portal vein diameter) were statistically different between the groups with and without previous bleeding. the likelihood index, adopted to determine the best parameters related to previous bleeding showed that the most important combinations are: gastropathy and red signs followed by portal vein diameter and variceal size. in conclusion, although aware of the limits of the statistical analysis due to the small number of patients, our results demonstrated that endoscopic and US parameters (isolated or combined) can identify patients with a high risk of variceal bleeding, allowing physicians to optimize prophylactic therapy.
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    Late clinical, biochemical, endoscopic and electroencephalographic evaluation of patients with schistosomal portal hypertension treated with distal splenorenal shunt
    (Edizioni Minerva Medica, 1998-01-01) Lopes, G. D.; Haddad, Chibly Michel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The authors performed a late evaluation of a distal splenorenal anastomosis minimum of five years following operation on 13 patients with schistosomiasis of the compensated liver-splenic type. The study of the anastomosis had been proven patent when the evaluation took place. Each patient underwent clinical,laboratorial, endoscopic and electroencephalographic assessment. The results demonstrated that no patient had shown any sign of recurrence of upper gastrointestinal hemorrhage,Among the endoscopic aspects, esophageal varices disappeared in 46.1% of the cases. There was reduction in the number, extent and volume of esophageal varices in 46.1%, 38.4% and 53.8% of the cases. Gastric varices disappeared in 91.6% of the cases. Only one patient (7.6%) had shown clinical and electroencephalographic signs of hepatic encephalopathy in the late final evaluation (non-significant), Only one patient (7.6%) had shown late postoperative ascites (non-significant), There were no significant alterations in serum levels of sodium, potassium, urea and creatinine in all the 13 patients. The values of indirect serum bilirubin increased in 92.3% of the patients. There was regression of splenomegaly in all 13 patients, as well as a significant improvement in their hematological values. There were no significant changes in the serum levels of aspartate aminotransferase and alanine aminotransferase or in the activity of the plasma prothrombin, The authors concluded that the distal splenorenal anastomosis became a protection factor against upper gastrointestinal hemorrhage and led to long-term improvement in the endoscopic aspects of esophagogastric varices, a significant improvement in the laboratorial aspects of hypersplenism and a marked reduction of splenomegaly with no significant changes in the hydroelectrolytic metabolism, renal function and hepatic function and had not compromised,long term, the quality of life of the majority of patients.