Systemic and hepatic hemodynamics in hepatosplenic Manson's schistosomiasis with and without propranolol.
Systemic and hepatic hemodynamics were prospectively studied in 11 patients with Manson's schistosomiasis and portal hypertension, as well as alterations resulting from the use of propranolol. It was decided that patients whose portal pressure was reduced by 30% with the use of the drug would not undergo surgery and that treatment would consist of the chronic use of propranolol, associated with sclerosis of esophageal varices. This objective was not met by any of the patients whose portal pressure was measured and the study was interrupted. Results show that patients with Manson's schistosomiasis and portal hypertension have hyperdynamic circulation, mild pulmonary hypertension, greatly increased splenic blood flow, and preservation of total hepatic blood flow. Administration of propranolol corrects hyperdynamic circulation, aggravates pulmonary hypertension, does not alter portal pressure and reduces the sectorial portal blood flows, especially of the azygos vein, with maintenance of total hepatic blood flow. These data favor the hypothesis of portal overflow in the physiopathology of portal hypertension of schistosomiasis.
Mies
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Department of Surgery, and Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Neto
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Beer
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Baía
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Alfieri
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Pereira
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Sette
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MJ
Raia
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D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D001783:Blood Flow Velocity / Q000187:drug effects; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008102:Liver Circulation / Q000187:drug effects; D008109:Liver Diseases, Parasitic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects; D011433:Propranolol / Q000627:therapeutic use*; D011446:Prospective Studies; D012555:Schistosomiasis mansoni / Q000150:complications / Q000503:physiopathology*; D015911:Sclerotherapy; D013154:Spleen / Q000098:blood supply; D013158:Splenic Diseases / Q000150:complications / Q000503:physiopathology*
D000319:Adrenergic beta-Antagonists; D011433:Propranolol