[Effects of adjusting doses of diuretics at different time in treatment of advanced schistosomiasis ascites].

OBJECTIVE: To investigate the efficacy and safety of adjusting the doses of diuretics of different time in the treatment of advanced schistosomiasis ascites. METHODS: A total of 80 advanced schistosomiasis patients with ascites were randomly divided into an observation group and a control group (40 cases each). The patients in the observation group received spironolactone and furosemide, and the first doses were 100 mg/d and 40 mg/d, respectively. If the efficacy was poor, according to the first doses of the standard increments once every four days, the doses gradually increased to the maximum doses of spironolactone 400 mg/d and furosemide 160 mg/d, respectively. The patients in the control group received spironolactone and furosemide, and the first doses were the same as those of the observation group. If the efficacy was poor, according to the first doses of the standard increments once every seven days, the doses gradually increased to the maximum doses as those of the observation group. Other conventional treatments were the same in both groups. RESULTS: In both groups, the reductions of the total amount of the weight were (5.62 +/- 1.28) kg and (5.42 +/- 1.37) kg respectively; the time of efficacy beginning was (3.84 +/- 2.36) days and (4.65 +/- 2.86) days respectively; the average daily amounts of weight loss were (0.41 +/- 0.16) kg and (0.35 +/- 0.11) kg respectively; the efficient rates were 95% and 92.5% respectively; and there were no significant differences between the two group(all P > 0.05). However, the time of reduction from moderate ascites to mild ascites was (10.70 +/- 3.01) days (6-20 days) in the observation group and the time was (14.75 +/- 5.62) days (7-30 days) in the control group (u = 3.876, P < 0.01). CONCLUSION: The therapy of diuretic doses adjusted by a four-day cycle is more useful for advanced schistosomiasis patients with ascites.

[Clinical analysis of early esophageal varices bleeding after endoscopic varices ligation in advanced schistosomiasis patients].

OBJECTIVE: To study the clinical characteristics of early esophageal varices bleeding after endoscopic varices ligation (EVL) in advanced schistosomiasis patients. METHODS: The data of 206 advanced schistosomiasis patients who received VEL were collected and studied retrospectively. RESULTS: There were 17 cases of early esophageal varices bleeding after EVL including 1 died case, the early hemorrhage rate was 8.25%, and the mortality rate was 0.5%. The early bleeding occurred from the 4th to 12th day, and 76% occurred from the 7th to 9th day postoperatively. The direct cause of hemorrhagic was ligation ring falling off, and the inducements were the improper diet (10 cases, 58.8%) and increased abdominal pressure (6 cases, 35%). All the cases of early esophageal varices bleeding occurred in the patients whose liver function being Child-Pugh C. CONCLUSIONS: The incidence and mortality of EVL early postoperative hemorrhage are both low, and mostly occur from the 7th to 9th day postoperatively. We should pay attention to the diet and nursing, and the patients with Child-Pugh C liver function are the high risk group.

[Endoscopic variceal ligation in prevention from esophageal variceal hemorrhage of advanced schistosomiasis patients].

OBJECTIVE: To evaluate the effect of the endoscopic esophageal variceal ligation on the prevention from recurrence of esophageal varices and variceal hemorrhage. METHODS: Forty-two advanced schistosomiasis patients with variceal hemorrhage in the treatment group received the endoscopic esophageal variceal ligation, and 30 patients in the control group did not, and all of them had oral propranolol, spironolactone and 5 single-isosorbide dinitrate etc. in hospital for the same period and had these drugs for 3-6 months after discharge. The re-examinations of endoscopy were performed once 3 to 6 months. RESULTS: The time of follow-up was from 2 to 3 years and the average was 29 months. In the treatment group, the rate of recurrence of esophageal varices was 19.0% (8/42) and the average time was 30 months; the incidence of esophageal variceal bleeding was 11.9% (5/42) and 2 patients died. In the control group, the rate of recurrence of esophageal varices was 43.3% (13/30) and the average time was 18 months; the incidence of esophageal variceal bleeding was 36.7% (11/30) and 7 patients died. The therapeutic efficacy of the treatment group was much superior to that of the control group. CONCLUSION: The endoscopic esophageal variceal ligation is effective and safe, and can become one of the preferred methods in the prevention from variceal hemorrhage.