[Evaluation of the effect of splenectomy with autologous spleen tissue implantation in some monocyte functions in children with hepatosplenic schistosomiasis mansoni]. / Avaliação do efeito da esplenectomia e auto-implante esplênico sobre algumas funções de monócitos em crianças com esquistossomose mansônica.

Adherence index, superoxide and TNF-alpha production in monocytes, with or without tuftsin treatment, were investigated in hepatosplenic schistosomiasis mansoni bearers with splenectomy with or without autologous implantation of spleen tissue. Three groups were evaluated: Healthy volunteers control group (CG) (n=12); Splenectomy with seft auto-transplant AG (n=18) and Splenectomy without auto-transplant WAG (n=9). Adherence index and TNF-alpha did not differ among the groups. Superoxide production was similar in CG and AG, in the 1st hour after cell stimulation. SP was larger in each hour time in CG and AG groups as compared WAS group. TT recovered normal pattern of SP in AG comparable with levels found in CG, with increase from the 1st to 2nd hour. However, TT did not alter SP in WAG, which remained reduced in all time points. Autologous implantation of spleen tissue seems to contribute for recovery and maintenance of the evaluated immunological reactions, which might be important in response to infections.

Brain magnetic resonance imaging findings in young patients with hepatosplenic schistosomiasis mansoni without overt symptoms.

The purpose of this study was to describe the brain magnetic resonance imaging (MRI) findings in young patients with hepatosplenic schistosomiasis mansoni without overt neurologic manifestations. This study included 34 young persons (age range = 9-25 years) with hepatosplenic schistosomiasis mansoni who had been previously treated. Patients were scanned on a 1.5-T system that included multiplanar pre-contrast and post-contrast sequences, and reports were completed by two radiologists after a consensus review. Twenty (58.8%) patients had MRI signal changes that were believed to be related to schistosomiasis mansoni. Twelve of the 20 patients had small focal hyperintensities on T2WI in the cerebral white matter, and eight patients had symmetric hyperintense basal ganglia on T1WI. There was a high frequency of brain MRI signal abnormalities in this series. Although not specific, these findings may be related to schistosomiasis.

Splenosis after splenectomy and spleen tissue autoimplantation: Late followup study.

AIM: In children suffering from severe hepatosplenic schistosomiasis, the surgical protocol includes splenectomy and autoimplantation of spleen morsels in the major omentum, which has the potential of reducing the overwhelming postsplenectomy infection (OPSI). The purpose of the study was to evaluate the remaining splenosis, with the mean postoperative followup of 12.1 ± 5.6 years; to compare the efficacy of the 2 evaluation tools. MATERIALS AND METHODS: Nineteen patients underwent, when they were children, portal decompression and autoimplantation of spleen. After a mean age of 23.4 ± 5.3 years, they were investigated regarding the number of infections and OPSI. They had undergone hepatosplenic scintigraphy with labeled colloidal SnTc(99m) and abdominal ultrasound. It was considered efficient splenosis when the patients presented with 5 or more spleen nodules. The evaluation was performed by 3 observers. RESULTS: None of the patients had increased infection rate or developed OPSI. Sixteen (84.2%) presented efficient splenosis. CONCLUSIONS: The remaining postoperative splenosis was considered efficient in the majority of patients in the long-term followup; and nuclear medicine was considered the gold standard for splenosis evaluation.

Laparoscopic repair of a ureter damaged during inguinal herniorrhaphy.

BACKGROUND: Laparotomy has been used generally to deal with ureteral injury. Recently, a few papers have reported the repair of gynecologic ureteral injuries by laparoscopy, with encouraging results; however, successful repair of a ureter damaged during an open inguinal herniorrhaphy fully performed by laparoscopy has not been reported yet. PATIENT: A 49-year-old obese man (body mass index=35) in the 10 years before surgery began to note a protrusion in the scrotal region. The protrusion evolved asymptomatically for 8 years, and began to cause pain in the lumbar spine to the right and paresthesia of the right leg. METHOD: An open right inguinal herniorrhaphy was performed. When the exeresis of the fatty tissue around the spermatic cord was being carried out, resection of a 12-cm tubular structure, supposedly the appendix, was performed. Wall defect was closed by a polypropylene mesh. Acute abdominal pain developed immediately in the postoperative period and investigation using laparoscopy was undertaken. After confirmation of ureteral injury, laparoscopic repair was performed, and the ureter was anastomosed without tension over a double-J catheter. A suction drain was left near the anastomosis. RESULT: Postoperative period was uneventful. The vesical catheter was withdrawn on the eighth postoperative day and the drain on the twelfth postoperative day. The histopathologic report confirmed that the resected structure was the ureter. The patient has remained asymptomatic for 2 years since the surgery.

Use of the Monti principle for constructing a continent gastrostomy.

OBJECTIVE: To research technical alternatives for permanent gastrostomy that minimizes the drawbacks and complications reported by several authors. MATERIALS AND METHODS: An experimental model was developed where the material was divided into 2 groups: the study group (SG) composed of 12 half-breed dogs where the proposed technique was applied, and the control group (CG) composed of 10 animals where a gastrostomy as proposed by Webster in 1974 was applied. On the 90th postoperative day, both groups underwent tests for assessing competence concerning leakage. These were performed under general anesthesia and following sacrifice. RESULTS: In the SG, under anesthesia only one animal had leakage through the gastrostomy. Following sacrifice, leakage was observed in 2 animals. In the CG, under anesthesia, 2 animals had leakage and, following sacrifice, only 1 animal did not present leakage. On histopathological analysis of the SG, gastric mucosa was evidenced around the jejunal tubes, with normal features, moderate inflammatory mononuclear infiltrate in jejunal tubes and only slight infiltrate around the gastrostomy stoma. In the CG, ulceration was constant around the external stoma of the gastrostomy tubes. In the corium, the inflammatory infiltrate was less intense than in the SG. The SG proved to be more efficacious than the CG concerning leakage, and this efficacy is attributed to the submucous valvular system. CONCLUSIONS: The featured technique showed competence concerning leakage, allowing its clinical applicability as an alternative for permanent gastrostomy.

Use of the monti principle for constructing a continent gastrostomy

OBJECTIVE: To research technical alternatives for permanent gastrostomy that minimizes the drawbacks and complications reported by several authors. MATERIALS AND METHODS: An experimental model was developed where the material was divided into 2 groups: the study group (SG) composed of 12 half-breed dogs where the proposed technique was applied, and the control group (CG) composed of 10 animals where a gastrostomy as proposed by Webster in 1974 was applied. On the 90th postoperative day, both groups underwent tests for assessing competence concerning leakage. These were performed under general anesthesia and following sacrifice. RESULTS: In the SG, under anesthesia only one animal had leakage through the gastrostomy. Following sacrifice, leakage was observed in 2 animals. In the CG, under anesthesia, 2 animals had leakage and, following sacrifice, only 1 animal did not present leakage. On histopathological analysis of the SG, gastric mucosa was evidenced around the jejunal tubes, with normal features, moderate inflammatory mononuclear infiltrate in jejunal tubes and only slight infiltrate around the gastrostomy stoma. In the CG, ulceration was constant around the external stoma of the gastrostomy tubes. In the corium, the inflammatory infiltrate was less intense than in the SG. The SG proved to be more efficacious than the CG concerning leakage, and this efficacy is attributed to the submucous valvular system. CONCLUSION: The featured technique showed competence concerning leakage, allowing its clinical applicability as an alternative for permanent gastrostomy.

Avaliação do efeito da esplenectomia e auto-implante esplênico sobre algumas funções de monócitos em crianças com esquistossomose mansônica / Evaluation of the effect of splenectomy with autologous spleen tissue implantation in some monocyte functions in children with hepatosplenic schistosomiasis mansoni

Investigamos em portadores de esquistossomose hepatoesplênica após esplenectomia com ou sem auto-implante esplênico: índice de aderência, produção de superóxido (SP) e de TNF-alfa em monócitos, tratados ou não com tuftsina. Avaliamos três grupos: voluntários sadios CG (grupo controle) (n=12); esplenectomizados com auto-implante AG (n=18) e esplenectomizados sem auto-implante WAG (n=9). índice de aderência e TNF-alfa não diferiram entre os grupos. SP foi semelhante em CG e AG na 1ª hora após estimulação celular. SP foi maior em todos intervalos de tempo nos grupos CG e AG, comparados ao WAG. O tratamento com tuftsina recuperou o padrão de normalidade de SP em AG, com aumento da 1ª para a 2ª hora nos níveis do CG. O tratamento com tuftsina não alterou SP em WAG, permanecendo reduzida em todos intervalos. O auto-implante esplênico parece recuperar e manter os parâmetros imunológicos avaliados, que têm participação importante na resposta do hospedeiro às infecções.

Fibrose hepática congênita associada à trombose portal: coincidência? / Congenital hepatic fibrosis associated with portal vein thrombosis: Is it coincidental?

Fibrose hepática congênita (FHC), doença fibropolicística, ocorre em várias formas, tendo como manifestação clínica inicial, em crianças, sangramento digestivo alto em pré-escolares entre um e três anos. História clínica similar à trombose portal congenita. Ainda está sob investigação os fatores etiopatogênicos da FHC, e o presente relato de um raro caso de associação entre estas duas afecções, aparentemente congênitas, adiciona argumento para a recente sugestão de que essa associação não seja apenas coincidência