Increased hepatic expression of miRNA-122 in patients infected with HCV genotype 3.

Hepatitis C virus (HCV) infection affects approximately 3 % of the world population. HCV targets hepatic tissue, and most infected patients develop a chronic infection. Currently, studies have demonstrated an association between HCV-RNA replication and miR-122, the most abundant microRNA in the liver. Our aim was to evaluate liver and serum expression of miR-122 in patients infected with HCV genotypes 1 and 3, and to identify possible associations between miR-122 expression and lipid profiles, HCV viral load, apolipoproteins and liver enzymes. MicroRNAs were isolated from blood and liver tissue, and miR-122 expression was quantified by real-time PCR. HCV viral load was quantified by real-time PCR and HCV genotype, and serum biomarkers were obtained from medical report. The levels of miR-122 were higher in liver than those in blood from individuals infected with HCV genotypes 1 and 3 (p < 0.0001). The tissue levels of miR-122 were higher in subjects infected with HCV genotype 3 (6.22-fold, p < 0.001). A positive correlation was observed between the blood and hepatic levels of miR-122 in patients infected with HCV genotype 1 (r = 0.302, p = 0.026); in these patients, an inverse correlation was observed between serum apolipoprotein A-II (ApoA-II) levels and the blood (r = -0.330; p = 0.014) and hepatic (r = -0.311; p = 0.020) levels of miR-122. In patients infected with HCV genotype 3, there was a positive correlation between the hepatic miR-122 and the high-density lipoprotein-HDL (r = 0.412, p = 0.036) and insulin (r = 0.478, p = 0.044). Lipid metabolism proteins and miR-122 expression levels have different relations in HCV-3- and HCV-1-infected patients.

Contribuição da ultrassonografia para o diagnóstico das alterações histopatológicas presentes na hepatite C crônica, com ênfase na esteatose hepática: Parte I / Contribution of ultrasonography to the diagnosis of chronic hepatitis C histopathological changes, with emphasis on hepatic steatosis: Part I

OBJETIVO: Avaliar a contribuição da ultrassonografia no estudo das alterações histopatológicas encontradas na hepatite crônica pelo vírus C, com ênfase para a esteatose hepática. MATERIAIS E MÉTODOS: Foram comparados os resultados dos exames ultrassonográficos do fígado de 192 pacientes portadores de hepatite crônica pelo vírus C, com os achados histopatológicos dos fragmentos obtidos por biópsia hepática. Todos os exames ultrassonográficos obedeceram a um mesmo protocolo, sendo analisados os seguintes critérios: ecogenicidade, ecotextura e atenuação. Os pacientes foram agrupados considerando-se os com alterações ultrassonográficas e os sem alterações ultrassonográficas, sendo comparados com as alterações histopatológicas presentes. RESULTADOS: Entre as alterações histopatológicas presentes, apenas os graus 0 e 3 de alteração arquitetural e a esteatose hepática apresentaram diferença estatística significante entre os dois grupos. Dentre os critérios ultrassonográficos avaliados, a atenuação foi o que apresentou melhor correlação com a esteatose hepática. CONCLUSÃO: Os resultados do trabalho demonstraram que, em pacientes com hepatite crônica pelo vírus C, a ultrassonografia apresentou limitações à caracterização das alterações histopatológicas, apresentando concordância regular com o diagnóstico de esteatose hepática. Destaca-se a capacidade do método em mostrar a probabilidade de inexistência de esteatose hepática, tendo em vista a especificidade de 77,9 por cento e o valor preditivo negativo de 95,5 por cento.

OBJECTIVE: To evaluate the role of ultrasonography in the assessment of histopathological changes in patients with chronic hepatitis C, with emphasis on hepatic steatosis. MATERIALS AND METHODS: Liver ultrasonography results were compared with histopathological findings of liver biopsy of 192 patients with chronic hepatitis C virus infection. All the US examinations followed a single protocol, analyzing the following aspects: echogenicity, echotexture and attenuation. The patients sample was divided into two groups as follows: patients with sonographic changes and patients with no sonographic changes. Sonographic findings of both groups were compared with histopathological findings after liver biopsy. RESULTS: Statistically significant intergroup differences were observed just regarding architectural changes grades 0 and 3 and hepatic steatosis. Attenuation was the sonographic criterion that was best correlated with hepatic steatosis. CONCLUSION: The results of the present study demonstrate that, in patients with chronic hepatitis C, ultrasonography has limitations in the characterization of histopathological changes, with an intermediate rate of agreement with the diagnosis of hepatic steatosis. Considering the specificity of 77.9 percent and the negative predictive value of 95.5 percent, the authors highlight the capacity of the method to demonstrate the probability of absence of hepatic steatosis.

Determinação do tamanho do fígado de crianças normais, entre 0 e 7 anos, por ultrassonografia / Sonographic determination of liver size in healthy newborns, infants and children under 7 years of age

OBJETIVO: Determinar o tamanho do fígado de crianças normais, entre 0 e 7 anos de idade, por ultrassonografia, correlacionando os valores obtidos com: idade, sexo, estatura, peso corporal e índice de massa corpórea. MATERIAIS E MÉTODOS: Foram examinadas 584 crianças saudáveis, subdivididas em 11 grupos etários, sendo medidos o diâmetro crânio-caudal do lobo esquerdo, na linha médio-esternal, e o diâmetro crânio-caudal da superfície posterior do lobo direito, na linha hemiclavicular. Na análise estatística foram aplicados: a) coeficiente de correlação de Pearson (estudo de correlação); b) teste t de Student não-pareado (comparação das medidas entre os sexos); c) modelos de regressão não linear (nomogramas). RESULTADOS: O tamanho hepático apresentou aumento progressivo, do nascimento aos 7 anos de idade, proporcionalmente menor que o crescimento corporal, correlacionado com idade, estatura e peso corporal (r > 0,70), não havendo correlação com índice de massa corpórea (r < 0,11). Não se observou diferença consistente das medidas hepáticas em relação ao sexo. CONCLUSÃO: Valores do tamanho do fígado de crianças normais (entre 0 e 7 anos) foram determinados mediante aplicação de técnica padronizada, verificando-se forte correlação com a idade e indicadores antropométricos. Nomogramas demonstram as variações normais do tamanho hepático na população estudada, com crescimento diferenciado para cada lobo.

OBJECTIVE: The present study was aimed at sonographically determining the liver size in healthy newborns, infants and children under 7 years of age, correlating results with age, sex, height, body weight and body mass index. MATERIALS AND METHODS: A total of 584 healthy children subdivided into 11 age groups were evaluated with measurements of the left lobe craniocaudal diameter at the midsternal line, and the craniocaudal diameter of the right lobe posterior surface at the midclavicular line. The following tests were utilized for statistical analysis: a) Pearson's correlation coefficient (correlation study); b) non-paired Student's t-test (comparison of measures between sexes); c) nonlinear regression models (nomograms). RESULTS: The liver size presented a progressive growth from the birth up to the age of 7, proportionally lower than the body growth, in correlation with age, height and body weight (r > 0.70). Correlation with the body mass index was not observed (r < 0.11). There was no significant difference in liver size between male and female individuals. CONCLUSION: Liver size was sonographically determined in healthy children under the age of 7 by means of a standardized method, demonstrating a strong correlation with age and anthropometric indicators. Nomograms demonstrate the typical variations of the liver size in the population evaluated with a different growth pattern for each hepatic lobe.

Clinical and histological characteristics of HIV and hepatitis C virus-co-infected patients in Brazil: a case series study.

UNLABELLED: Hepatitis C virus (HCV) is an important factor contributing to morbidity and mortality in patients co-infected with HIV and HCV. In addition, liver biopsy is an important tool in the clinical management of these patients. Although liver biopsy is controversial, it is recommended for all patients. Data regarding the clinical and histological characteristics of these patients are scarce not only in Brazil but in Latin America as a whole. With the goal of better understanding these characteristics and the benefit of liver biopsy indications in this disease setting, data collected from 234 patients followed from 1996 to 2004 at Casa da AIDS, São Paulo, were analyzed. The following variables were extracted from the patients' medical files at the time of liver biopsy: sex, age, hepatitis C infection risk factors, hepatitis C infection duration, ALT levels, CD4+ T cell counts, history of alcohol abuse, history of antiretroviral therapy, HCV genotype, and liver histological alterations. CONCLUSIONS: 1 - Hepatitis C virus 1 and 3 were the most frequently identified genotypes and were diagnosed in 72% and 25.5% of cases respectively; 2 - Structural liver alterations were found to be mild or absent in 48.2% (113/234) of the analyzed patients; 3 - Fifty-three patients (23%) had normal ALT levels and 4 - Significant liver architectural changes (F2-F3) were evident in 22.5% of the patients with normal ALT levels.

Incidence and predictors of severe liver fibrosis in HIV-infected patients with chronic hepatitis C in Brazil.

The aim of this study was to examine the incidence and factors associated with the severity of liver fibrosis in 234 coinfected patients in Brazil. Patients were cared for in our clinic, from 1996 to 2004. Eligible patients were defined as patients with documented HIV and hepatitis C virus (HCV) infections and had previously undergone a liver biopsy. Patients with persistently normal alanine aminotransferase (ALT) were also included. The variables selected for study were age, gender, risk category, history of high alcohol consumption, CD4(+) T cell count, antiretroviral therapy usage, HCV genotype and duration of HCV infection. Stage of fibrosis was scored as follows: F0, no fibrosis; F1, portal fibrosis with no septa; F2, portal fibrosis with few septa; F3, bridging fibrosis with many septa; and F4, cirrhosis. The liver fibrosis stage was F3 in 39 (16.6%) and F4 in 20(8.5%) patients. Among patients with normal ALT, the liver fibrosis stage was F3-F4 in three patients (5.6%). Predictors of severe liver fibrosis (F3-F4) by multivariate analysis were age (older patients) and genotype 3 (genotype 1 = odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12 0.65). In summary, in the present study severe liver fibrosis was found in 25% of our patients and was associated with an age of more than 38 years at the time of liver biopsy as well as, HCV genotype 3. No differences were found with respect to CD4(+) T cell counts although patients with a CD4(+) T cell count greater than 50 were excluded.

Clinical and histological characteristics of HIV and hepatitis C virus-co-infected patients in Brazil: a case series study / Características clínicas e histológicas de pacientes co-infectados pelo HIV e vírus da hepatite C no Brasil: estudo de uma série de casos

Hepatitis C virus (HCV) is an important factor contributing to morbidity and mortality in patients co-infected with HIV and HCV. In addition, liver biopsy is an important tool in the clinical management of these patients. Although liver biopsy is controversial, it is recommended for all patients. Data regarding the clinical and histological characteristics of these patients are scarce not only in Brazil but in Latin America as a whole. With the goal of better understanding these characteristics and the benefit of liver biopsy indications in this disease setting, data collected from 234 patients followed from 1996 to 2004 at Casa da AIDS, São Paulo, were analyzed. The following variables were extracted from the patients' medical files at the time of liver biopsy: sex, age, hepatitis C infection risk factors, hepatitis C infection duration, ALT levels, CD4+ T cell counts, history of alcohol abuse, history of antiretroviral therapy, HCV genotype, and liver histological alterations. CONCLUSIONS: 1 - Hepatitis C virus 1 and 3 were the most frequently identified genotypes and were diagnosed in 72 percent and 25.5 percent of cases respectively; 2 - Structural liver alterations were found to be mild or absent in 48.2 percent (113/234) of the analyzed patients; 3 - Fifty-three patients (23 percent) had normal ALT levels and 4 - Significant liver architectural changes (F2-F3) were evident in 22.5 percent of the patients with normal ALT levels.

A infecção causada pelo vírus da hepatite C (VHC) constitui importante causa de morbidade e mortalidade entre pacientes co-infectados pelo HIV e VHC. A indicação da realização de biópsia hepática nesses pacientes é controversa, podendo constituir importante ferramenta no manejo clínico desses pacientes. São escassos os dados relativos às características clínicas e histopatológicas dos pacientes co-infectados no Brasil e em toda a América Latina. Com o objetivo de analisar as características clínicas e histopatológicas em co-infectados e avaliar os benefícios da realização de biópsia hepática nesse grupo de pacientes, analisamos dados relativos a 234 pacientes acompanhados na Casa da AIDS, São Paulo, de 1996 a 2004. A partir de informações obtidas em prontuários, foram analisadas as seguintes variáveis relativas aos pacientes, coletadas à época da realização da biópsia hepática: gênero, idade, fatores de risco para a transmissão da hepatite C, tempo estimado de infecção pelo VHC, níveis séricos de ALT, contagem de células CD4, antecedentes relativos ao uso de álcool, antecedente de uso de terapia antiretroviral, genótipo de VHC e alterações histológicas obtidas através da biópsia hepática. CONCLUSÕES: 1- Os genótipos 1 e 3 foram os mais freqüentes nessa população, representando cerca de 72 por cento e 25,5 por cento dos casos analisados respectivamente; 2- Alterações estruturais hepáticas leves ou ausentes foram observadas em 48,2 por cento dos pacientes (113/234); 3- Cinqüenta e três pacientes (23 por cento) apresentaram níveis de ALT persistentemente normais; 4- Alterações estruturais significativas (F2-F3) foram observadas em 22,5 por cento entre pacientes com níveis de ALT persistentemente dentro da normalidade.

Chronic hepatitis C: hepatic fibrosis evolution after ineffective specific treatment.

BACKGROUND/AIMS: Specific treatment of chronic hepatitis C is effective in 50% of patients, improving the liver's fibrosis, necroinflammatory changes and steatosis. However, in patients still viremic after treatment the extension of these benefits remains doubtful. The evolution of the disease in this group and its relationship to demographic data, biometric indices and time lapse between biopsies was evaluated. METHODOLOGY: In 141 patients, paired biopsies were classified and compared according to fibrosis grading. Necroinflammation, steatosis, demographic data (age and gender), body mass index (BMI) and time lapse between biopsies were compared with fibrosis grading. RESULTS: The grade of fibrosis of the patients, after approximately 3.5 years time lapse between biopsies, could be classified into 4 groups; Improved: 29 (20.0%), Unaltered: 64 (45.0%), Worsened: 48 (34%) and Cirrhotic: 14 (9.93%). For necroinflammation, the Improved/Unaltered groups were statistically similar but different from the Worsened and Cirrhotic. The mean age, BMI and time lapse between biopsies were statistically similar in all groups. Steatosis occurred in 35 (24.82%) between biopsies and its incidence was reduced in the Worsened and Cirrhotic groups. CONCLUSIONS: Fibrosis turned into cirrhosis in a significant number of patients, after a short time lapse. The reverse correlation of steatosis to fibrosis and its occurrence during the time lapse between biopsies suggests it might induce hepatic necrosis and contribute to fibrogenesis.

Real-time and Doppler US after pediatric segmental liver transplantation : I. Portal vein stenosis.

BACKGROUND: Accurate diagnosis of portal vein (PV) stenosis by real-time and color Doppler US (CD-US) after segmental liver transplantation in children can decrease morbidity by avoiding unnecessary biopsy, PV hypertension, thrombosis and loss of the graft. OBJECTIVE: To evaluate CD-US parameters for the prediction of PV stenosis after segmental liver transplantation in children. MATERIALS AND METHODS: We retrospectively reviewed 61 CD-US examinations measuring the diameter at the PV anastomosis, velocities at the anastomosis (PV1) and in the segment proximal to the anastomosis (PV2), and the PV1/PV2 velocity ratio. The study group comprised patients with stenosis confirmed by angiography and the control group comprised patients with a good clinical outcome. RESULTS: PV stenosis was seen in 12 CD-US examinations. The mean PV diameter was smaller in the study group (2.6 mm versus 5.7 mm) and a PV diameter of <3.5 mm was highly predictive of stenosis (sensitivity 100%, specificity 91.8%). CONCLUSION: A PV diameter of <3.5 mm is a highly predictive CD-US parameter for the detection of hemodynamically significant stenosis on angiography.

Real-time and Doppler US after pediatric segmental liver transplantation : II. Hepatic vein stenosis.

BACKGROUND: Accurate diagnosis of hepatic vein (HV) stenosis by real-time and color Doppler US (CD-US) after segmental liver transplantation in children can decrease morbidity because it allows unnecessary biopsy, obstruction or thrombosis and loss of the graft to be avoided. OBJECTIVE: To evaluate CD-US parameters to predict HV stenosis after segmental liver transplantation in children. MATERIALS AND METHODS: Retrospective review of 79 CD-US examinations measuring velocity at the HV anastomosis (HV1) and the main trunk 1-2 cm proximal to the HV/IVC anastomosis (HV2), the HV1/HV2 ratio and the spectral waveform of HV2. The study group comprised patients with stenosis confirmed by angiography. The control group comprised patients with a good clinical outcome. RESULTS: HV stenosis was seen in 12 CD-US examinations. The mean HV1/HV2 ratio was higher in the study group (6.0 versus 4.0). An HV1/HV2 ratio of >4.1 was predictive of HV stenosis (sensitivity 83%, specificity 76%). CONCLUSION: An HV1/HV2 ratio of >4.1 is a highly predictive CD-US parameter for the detection of hemodynamically significant HV stenosis on angiography.

Thyroid nodules: evaluation with power Doppler and duplex Doppler ultrasound.

This study purposes a new classification of thyroid nodules blood flow by power duplex Doppler ultrasound. A total of 177 nodules were studied with B-mode scanning, power Doppler, and spectral analysis. These data were compared with cytological results from ultrasound-guided fine-needle aspiration biopsy. Univariate and multivariate logistic regression analysis were performed. The power Doppler analysis of the nodules produced 5 vascular patterns: I, absence of signal blood flow; II, exclusively perinodular blood flow; III, perinodular >/= central blood flow; IV, central blood flow > perinodular blood flow; V, exclusively central blood flow. Statistical analysis revealed a significant relationship between these vascular patterns and cytological results. The spectral analysis demonstrated that the resistance index were higher in nodules with malignant versus other cytology ( P < 0.001). The results indicate that power duplex Doppler facilitates screening of thyroid nodules at high risk for malignancy with elevated sensitivity (92.3%) and specificity (88%).

Portal thrombosis: late postoperative prevalence in Mansoni's schistosomiasis.

BACKGROUND/AIMS: Splenectomy with esophagogastric devascularization and distal splenorenal anastomosis are used for the treatment of bleeding esophageal varices in Mansoni's hepatosplenic schistosomiasis. Portal thrombosis followed by ascitis has been observed in the early postoperative phase, but there are no studies about the spontaneous and late postoperative prevalence of this vascular complication. The aim was to evaluate the spontaneous and late postoperative prevalence of total portal vein thrombosis and of ascitis in these patients. METHODOLOGY: US-Doppler examination was performed on 168 patients divided in three groups: 1) 92 non-operated (preoperative); 2) 62 after splenectomy with esophageal devascularization, 3) 14 after distal splenorenal anastomosis. The presence of ascitis was sought in all. RESULTS: Group 1 had 5.43% (5/92) of spontaneous total portal vein thrombosis, groups 2 and 3, presented 19.35% (12/62) and 50.00% (7/14) in the late postoperative follow-up, respectively. The Fisher's test showed that group 3 had higher incidence of this vascular occlusive complication (p = 0.038). No ascites were found. CONCLUSIONS: Surgical treatment of portal hypertension boosts the natural tendency to total portal vein thrombosis in this disease. The difference in the occurrence of this vascular complication during the late postoperative phase suggests the existence of a hemodynamic factor determined by the surgical technique.

Aspectos morfológicos e hemodinâmicos do baço em indivíduos normais: estudo por ultra-som Doppler / Morphological and hemodynamic features of the spleen in normal subjects: a Doppler ultrasound study

ANTECEDENTES: A diversidade de técnicas de mensuração esplênica pelo ultra-som Doppler (US Doppler), a falta de valores biométricos e dopplervelocimétricos dificultam a avaliação deste órgão e de suas características hemodinâmicas. OBJETIVO: Estabelecer padrões biométricos e hemodinâmicos por US-Doppler em indivíduos adultos sadios. MATERIAIS E MÉTODOS: Estudo prospectivo de 44 indivíduos sadios, sendo 19 do sexo masculino e 25 do sexo feminino, na faixa etária de 23 a 60 anos (37,4 ± 9,6). Morfometria (US modo-B): baço: eixos longitudinal (L), transversal (T) e ântero-posterior (AP); diâmetro da artéria esplênica (DAE) e diâmetro da veia esplênica (DVE). índices morfométricos do baço: uniplanar (IBU), biplanar (IBB) e volume esplênico (VE). Dopplervelocimetria (US Doppler): a) artéria esplênica: velocidade de pico sistólico (VPS), média das velocidades máximas de fluxo (TAMax); índices de impedância vascular: índice de resistividade (IR); índice de pulsatilidade (IP); b) veia esplênica: média das velocidades máximas de fluxo (TAMax). RESULTADOS: Morfometria: L = 9,3 ± 1,3 cm; T= 3,9 ± 0,7 cm; AP = 8,4 ± 1,2 cm; DAE = 0,3 ± 0,07 cm; DVE: 0,5 ± 0,12 cm. índices morfométricos do baço: IBU = 33,5 ± 9,9; IBB = 36,7 ± 10,3; VE = 164,3 ± 62,9 cm³. Dopplervelocimetria: a) artéria esplênica: VPS = 59,8 ± 23,6 cm/s; TAMax = 40,2 ± 15,9 cm/s; IP = 0,86 ± 0,30; IR = 0,55 ± 0,09; b) veia esplênica: TAMax = 16,8 ± 8,3 cm/s. CONCLUSÃO: Relato de valores biométricos e dopplervelocimétricos do baço em indivíduos sadios.

BACKGROUND: The diversity of existing techniques for the measurement of the spleen using Doppler ultrasound (Doppler-US) as well as the lack of biometrical and Doppler velocimetry reference values make the evaluation of this organ and its hemodynamics quite difficult. OBJECTIVES: To establish biometrical and hemodynamics Doppler-US standard values for healthy adult individuals. MATERIALS AND METHODS: This is a prospective study involving 44 healthy individuals (19 males and 25 females) with mean age of 37.4 ± 9.6 years (23–60 years). Morphometry (US-B mode): spleen: longitudinal (L), transversal (T) and anteroposterior (AP) axes; splenic artery diameter (AD) and splenic vein diameter (VD). Morphometrical spleen indexes: uniplanar (UI), biplanar (BI) and the splenic volume (SV). Doppler velocimetry (US-Doppler): a) splenic artery: systolic peak velocity (SPV), mean of the highest flow speeds (TAMax); pulsability index (PI) and vascular impedance resistivity index(RI); b) splenic vein: mean of the highest flow speeds (TAMax). RESULTS: Morphometry: L = 9.3 ± 1.3 cm; T= 3.9 ± 0.7 cm; AP = 8.4 ± 1.2 cm; AD = 0.3 ± 0.07 cm; VD: 0.5 ± 0.12 cm. Morphometrical spleen indexes: UI = 33.5 ± 9.9; BI = 36.7 ± 10.3; SV = 164.3 ± 62.9 cm³. Doppler velocimetry: a) splenic artery: SPV = 59.8 ± 23.6 cm/s; TAMax = 40.2 ± 15.9 cm/s; PI = 0.86 ± 0.30; RI = 0.55 ± 0.09; b) splenic vein: TAMax = 16.8 ± 8.3 cm/s. CONCLUSION: Report of biometrical and Doppler velocimetry standard values of the spleen in healthy individuals.

Hepatometria ultra-sonográfica em crianças: proposta de novo método / Sonographic biometry of the liver in children: proposal of a new method

OBJETIVO: Padronizar método ultra-sonográfico de biometria hepática em crianças, visando estabelecer maior precisão nos planos de corte e minimizar o fator operador-dependência; testar a reprodutibilidade intra-observador. CASUíSTICA E MÉTODO: A hepatometria ultra-sonográfica foi realizada em 32 crianças, entre 0 e 6 anos de idade, sem doença hepática ou das vias biliares. Todas as crianças foram examinadas por um mesmo observador, em duas ocasiões diferentes (exames 1 e 2). Os planos seccionais foram estabelecidos inter-relacionando linhas de orientação externas a reparos anatômicos intra-abdominais, extra e intra-hepáticos. Para análise comparativa das medidas dos exames 1 e 2 foi utilizado o teste t pareado. O coeficiente de Pearson foi empregado para análise de correlação: a) dos parâmetros entre si; b) entre a idade das crianças e a diferença das medidas dos exames 1 e 2. RESULTADOS: A análise estatística não houve: a) diferença significante no estudo da variabilidade intra-observador; b) correlação significante entre a diferença das medidas e as idades dos pacientes. Verificamos que os parâmetros estão, no geral, direta e altamente correlacionados entre si (r > 0,60). CONCLUSÃO: O método é reprodutível por um mesmo observador. As medidas dos diâmetros crânio-caudal na linha médio-esternal e crânio-caudal posterior na linha hemiclavicular, usando referenciais anatômicos intra-hepáticos, mostraram-se precisas e mais práticas que as demais

OBJECTIVE: The objectives of this study are: (1) to standardize the sonographic biometry method to determine the size of the liver in children in order to obtain a greater precision of the section planes and to minimize operator-dependant error; (2) to test intra-observer reproducibility. CASUISTIC AND METHOD: Sonographic measurements of the liver were performed by a single examiner in 32 children (aged 0 to 6 years) with no liver or biliary system disease. The measurements were done in two different occasions (exams 1 and 2) to determine reproducibility. The section planes were based on external orientation lines related to intra-abdominal anatomic references, both extra and intra-hepatic. The values obtained in exams 1 and 2 were compared using a Student's paired t-test. The Pearson's coefficient was employed to determine the correlation among parameters as well as the correlation between the children's age and the difference in the values of exams 1 and 2. RESULTS: The statistical analysis revealed no significant intra-observer variability and no significant correlation between measurements' difference and children's age. In general, parameters were directly and highly correlated (r > 0.60). CONCLUSION: We concluded that the method is reproducible when performed by a same examiner. The measurements of the cranio-caudal diameter at the midsternal line and the posterior cranio-caudal diameter at the midclavicular line, based on intra-hepatic anatomic references, were precise and easier to perform than other routine measurements.

Alteraçöes morfológicas e hemodinâmica tardias no território esplênico de pacientes com esquitomosse mansônica hepatoesplênica pós-anastomose esplenorrenal distal. (Estudo com ultra-som Doppler) / Late morphologic and hemodynamic changes in the splenic territory of patients with mansoni's hepatosplenic schistosomiasis after distal splenorenal shunt. (Ultrasonography-Doppler study)

RACIONAL: A anastomose esplenorrenal distal (operaçäo de Warren) tem sido indicada para tratamento do sangramento digestivo provocado pelas varizes esofágicas pois, idealmente, reduziria a pressäo venosa no território cardiotuberositário sem alterar o fluxo mesentérico-portal. Entretanto, as mudanças que esta operaçäo provoca no território esplênico näo foram totalmente esclarecidas. OBJETIVO: Avaliar alteraçöes morfológicas e hemodinâmicas tardias no território esplênico decorrentes da anastomose esplenorrenal distal, em pacientes com hipertensäo portal por esquistossomose mansônica hepatoesplênica complicada com hemorragia pelas varizes esofágicas. MÉTODO: Estudo, mediante ultra-som-Doppler, da regiäo esplênica de 52 pacientes com hipertensäo portal por esquistossomose hepatoesplênica divididos em dois grupos: 40 näo-operados e 12 com anastomose esplenorrenal distal. Neles foram comparados: a) parâmetros morfométricos (diâmetro da artéria e veia esplênicas, diâmetros esplênicos: longitudinal, transversal e ântero-posterior); b) parâmetros velocimétricos do fluxo nos vasos esplênicos (velocidade de pico sistólico na artéria esplênica e velocidade média de fluxo na veia esplênica); c) índice biométrico do baço (longitudinal x transversal); d) índice volumétrico do baço (longitudinal x transversal x ântero-posterior x 0,523); e) índices hemodinâmicos de impedância na artéria esplênica (pulsatilidade e resistividade). RESULTADOS: Nos pacientes com anastomose esplenorrenal distal observaram-se: a) reduçäo - índice volumétrico (näo-operados 903,83 ± 452,77 cm³/anastomose esplenorrenal distal 482,32 ± 208,02 cm³ (46,64 por cento)) e biométrico esplênico (näo-operados 138,14 ± 51,89 cm²/anastomose esplenorrenal distal 94,83 ± 39,83 cm² (33,35 por cento)); b) ausência de variaçäo - artéria esplênica: diâmetro (näo-operados 0,57 ± 0,16 cm/anastomose esplenorrenal distal 0,57 ± 0,23 cm)), velocidade de pico sistólico na artéria esplênica (näo-operados 107 ± 42,02 cm/seg/ anastomose esplenorrenal distal 89,81 ± 41,20 cm/seg)), índice de resistividade (näo-operados 0,58 ± 0,008/anastomose esplenorrenal distal 0,56 ± 0,06)) e índice de pulsatilidade (näo-operados 0,91 ± 0,19/anastomose esplenorrenal distal 0,86 ± 0,15); - veia esplênica (näo-operados 1,10 ± 0,30 cm/anastomose esplenorrenal distal 1,19 ± 0,29 cm)); c) aumento...

[Late morphologic and hemodynamic changes in the splenic territory of patients with mansoni's hepatosplenic schistosomiasis after distal splenorenal shunt. (Ultrasonography-Doppler study)]. / Alterações morfológicas e hemodinâmica tardias no território esplênico de pacientes com esquitomosse mansônica hepatoesplênica pós-anastomose esplenorrenal distal. (Estudo com ultra-som Doppler).

BACKGROUND: The distal splenorenal anastomosis (Warren's operation) has been indicated for the treatment of high digestive bleeding caused by esophagic varices because it would ideally reduce the venous pressure in the cardiotuberositary territory without changing the mesenteric-portal venous flow. However, the changes it produce in the splenic territory have not been fully understood. AIM: To appraise the late morphologic and hemodynamic changes in the splenic territory produced by the distal splenorenal anastomosis in patients with portal hypertension due to mansoni's hepatosplenic schistosomiasis complicated by esophagic bleeding. METHOD: Ultrasonography-Doppler study of the splenic region of 52 patients with portal hypertension due to mansoni's schistosomiasis and previous bleeding by esophagic varices. They were divided in two groups: 40 non operated upon and 12 with a distal splenorerenal anastomosis. The following parameters and indices were compared between the two groups: a) morphometric parameters (splenic artery and vein's diameter, splenic diameters (longitudinal, transversal and antero-posterior); b) velocimetric parameters of the splenic vessels (systolic peak velocity in the splenic artery, mean flow velocity in the splenic vein; c) biometric index of the spleen (longitudinal x transversal); volumetric index of the spleen (longitudinal x transversal x antero-posterior x 0,523); hemodynamic indices of the splenic artery's impedance: pulsatility and resistivity. RESULTS: The patients with distal splenorenal anastomosis showed: a) reduction in splenic indices: volumetric (non operated 903,83 +/- 452, 77 cm / distal splenorenal anastomosis 482,32 +/- 208,02 cm (46,64%)) and biometric (non operated 138,14 +/- 51,89 cm /distal splenorenal anastomosis 94,83 +/- 39,83 cm (33,35%)); b) no change: splenic artery's diameter (non operated 0,57 +/- 0,16 cm/distal splenorenal anastomosis 0,57 +/- 0,23 cm); velocity in the splenic artery non operated 107 +/- 42,02 cm/seg/distal splenorenal anastomosis 89,81 +/- 41,20 cm/seg), resistivity (non operated 0,58 +/- 0,008/distal splenorenal anastomosis 0,56 +/- 0,06) and pulsatility (non operated 0,91 +/- 0,19/distal splenorenal anastomosis 0,86 +/- 0,15, splenic vein (non operated 1,10 +/- 0,30 cm/distal splenorenal anastomosis 1,19 +/- 0,29 cm); c) increase: mean flow velocity in the splenic vein (non operated 20,54 +/- 8,45 cm/seg/distal splenorenal anastomosis 27,83 +/- 9,29 cm/seg). CONCLUSIONS: The comparison of the ultrasonography Doppler results of the two groups of patient (non operated and distal splenorenal anastomosis) showed that in patients with distal splenorenal anastomosis there was a decrease of the volume of spleen; increase in the mean flow velocity in the splenic vein; no changes in the morphologic and hemodinamyc parameters of the splenic artery neither in its velocimetric indices.

Veia paraumbilical pérvia: importânci hemodinâmica na hipertensão portal por esquistossomose mansônica hepatoesplênica (Estudo com ultra-sonografia Doppler) / Patent paraumbilical vein: hemodynamic importance in Mansoni's hepatosplenic portal hypertension (Study with ultrasonography doppler

The hemodynamical effect of the collateral portosystemic circulation upon the portal system has not yet been fully understood. The US-Doppler made possible the non-invasive study of the portal system by evaluating the parameters: flow direction, diameter and flow velocity in it's vessels. AIMS: To study the paraumbilical vein as a collateral portosystemic pathway and identify patterns for appraising its hemodynamic importance to the portal system. METHOD: US-Doppler study of the portal system of 24 patients with Mansoni's hepatosplenic schistosomic portal hypertension, previous esophagic variceal bleeding and patent paraumbilical vein with hepatofugal flow. The diameter and the mean flow velocity were measured in the paraumbilical vein and so were the mean flow velocity in the portal vein, right and left portal branches. The Pearson test (linear correlation) was applied to the portal vein's mean flow velocity and the paraumbilical vein's diameter and mean flow velocity. The patients were divided in four groups: D1-paraumbilical vein with diameter < 0.68 cm (n = 14), D2-paraumbilical vein with diameter > or = 0.68 cm (n = 10), V1-paraumbilical vein with mean flow velocity < 18.41 cm/seg (n = 13) and V2-paraumbilical vein with mean flow velocity > or = 18.41 cm/seg (n = 11). The mean flow velocity in the portal vein, right and left portal branches of the four groups were compared. RESULTS: The paraumbilical vein diameter was 0.68 +/- 0.33 cm (range: 0.15-1.30 cm) and the mean flow velocity was 18.41 +/- 11.51 cm/seg (range: 5.73-38.20 cm/seg). The linear correlation between the portal vein's mean flow velocity/paraumbilical vein diameter and the paraumbilical vein's mean flow velocity showed r = 0.504 and r = 0.735, respectively. In the group D2 there was an increase in the mean flow velocity in the portal vein (17.80 +/- 3.42/22.30 +/- 7.67 cm/seg) and in the left portal branch (16.00 +/- 4.73/22.40 +/- 7.90 cm/seg). In the group V2 there was an increase in the mean flow velocity in the portal vein (16.31 +/- 3.49/21.96 +/- 5.89 cm/seg) and in the left portal branch (14.22 +/- 4.41/21.94 +/- 7.20 cm/seg). There was no change in the right portal branch (13.67 +/- 5.74/15.43 +/- 3.43 cm/seg). CONCLUSIONS: In portal hypertension due to hepatosplenic schistosomiasis, the patent paraumbilical vein, with hepatofugal flow, diameter > or = 0.68 cm and mean flow velocity > or = 18.41 cm/seg...

Aspectos angiográficos das veias hepáticas na hipertensäo portal esquistosommótica: importância na medida da pressäo venosa hepática / Angiographic aspects of the hepatic veins in the portal hypertension in schistosomiasis: the importance in assessing the hepatic vein pressure

Admite-se que a pressao venosa ocluída em uma veia hepática reflita as condiçoes pressóricas do sistema portal em pacientes com cirrose hepática. No entanto, em pacientes com esquistossomose hepatoesplênica essas medidas mostram irregularidades nos resultados. A partir da análise de angiografias das veias hepáticas realizadas na avaliaçao pré-operatória de pacientes com esquistossomose hepatoesplênica complicada por hemorragia digestiva, identificamos imagens radiográficas que poderiam explicar a variabilidade dos resultados dessas medidas. As angiografias foram feitas durante a injeçao do contraste através do cateter com ponta em posiçao livre dentro da veia hepática D ou em uma veia hepática acessória do lobo D do fígado. As imagens angiográficas foram classificadas em duas categorias: a) tipo I - opacificaçao de porçao variável do território sinusoidal dependente da veia cateterizada. Presença de circulaçao através deste território ou de veias intra-hepáticas, estabelecendo comunicaçao entre a veia hepática cateterizada e veias acessórias do lobo D do fígado; b) tipo II - ausência de opacificaçao de território sinusoidal. Presença de múltiplas anastomoses intra-hepáticas entre a veia hepática D e veias acessórias do lobo D do fígado. Dada a existência dessas anastomoses no território de drenagem hepática venosa, questiona-se a validade da utilizaçao das medidas de pressao da veia hepática, na avaliaçao da pressao venosa portal em pacientes com esquistossomose hepatoesplênica, sem o controle radiográfico.

Portal hypertension with arterioportal fistula through an hepatic tumor: diagnosis and treatment

Apresenta-se o caso de uma paciente da raca branca que deu entrada em servico de emergencia com sangramento digestivo alto e dispneia ao exame fisico, foi verificado tratar-se de doente com hepatopatia child-Pugh C com ascite hipertensa...

Estenose aterosclerótica dos principais troncos arteriais da aorta abdominal. (prevalência em pacientes com arteriopatia oclusiva dos membros inferiores) / Atherosclerotic stenosis of the main branches of abdominal aorta. (occurence in patients with lower limb occlusive vascular disease)

Os autores apresentam estudo radiológico aortográfico de 100 doentes consecutivos, portadores de arteriopatia aterosclerótica obstrutiva sintomática dos membros inferiores, em que avaliam a incidência de estenose do tronco celíaco, artéria mesentérica superior, artérias renais e a presença da artéria mesentérica inferior. Foram excluídos do estudo sete pacientes: seis por arterite e umm por impossibilidade de análise. Os parâmetros considerados foram: idade, sexo, incidência de estenose solitárias e concomitância. Verificaram que dos 93 pacientes analisados 64 (68,81 por cento) apresentavam estenose acentuada (> 30 por cento) de um ou mais ramos de aorta abdominal. Apontam para o acentuado aumento da incidência a partir da década de 60 anos e notaram nao haver diferença de incidência relativamente ao sexo dos pacientes. Ao analisar a freqüência de estenose solitária e múltiplas, verificaram haver predominância de estenoses únicas, sendo mais freqüentes as do tronco celíaco (16 - 16,1 por cento), seguidas pela renais (13 - 13,0 por cento). A concomitância mais freqüente de vários troncos foi do tronco celíaco com artéria renal (oito - 8,6 por cento) seguida da artéria mesentérica superior com artéria renal (seis - 6,4 por cento) e de tronco celíaco e artéria mesentérica superior (cinco - 5,3 por cento). Concluem que apesar do grande número de estenose dos troncos da aorta abdominal neste tipo de doentes, a baixa incidência de concomitância entre as artérias digestivas torna difícil caracterizar, radiologicamente, a síndrome de isquemia digestiva. Apontam este grupo de pacientes, altamente selecionado em virtude de sua doença, como objetivo para pesquisas mais extensas no sentido de identificar as repercussoes destas estenoses sobre o aparelho digestivo e orientar seu eventual tratamento.