OBJETIVOS: O presente estudo teve por objetivo analisar as alterações pulmonares de pacientes portadores de esquistossomose hepatoesplênica, tratados clínica e cirurgicamente, através da cintilografia pulmonar de perfusão e espirometria. MÉTODO: Trinta pacientes jovens portadores de esquistossomose mansônica hepatoesplênica, previamente tratados clínica e cirurgicamente, se submeteram a cintilografia pulmonar de perfusão e avaliação da capacidade respiratória pela espirometria. RESULTADOS: Ao exame cintilográfico, constataram-se alterações em 33,3% dos pacientes e padrão restritivo pulmonar em 30% das espirometrias. CONCLUSÕES: A prevalência do acometimento pulmonar, avaliado pela Medicina Nuclear, se situou abaixo do observado em pacientes não tratados, relatados na literatura. O padrão restritivo pulmonar, entretanto, avaliado pela espirometria, foi elevado e merece atenção especial no seguimento e manuseio desses pacientes.

BACKGROUND: The purpose of this investigation was to study with lung scintigraphy and spirometry, the lung involvement in patients with hepatosplenic masonic schistosomiasis previously treated clinically and surgically. METHOD: Thirty young patients with hepatoesplenic mansonic schistosomiasis previously treated clinical and surgically were examined by pulmonary scintigraphy and spirometry. RESULTS: Pulmonary perfusion scintigraphy detected alterations in 33.3% of the patients and the spirometry demonstrated a restrictive respiratory pattern in 30% of them. From these results one can observe a small prevalence of the pulmonary schistosomiasis as compared to the literature. The probable explanation could be due to precocious clinical and surgical treatment, which promote the involution of the granuloma, the basic lesion of the pulmonary schistosomiasis. CONCLUSIONS: The prevalence of lung involvement, based on Nuclear Medicine study, was lower than non treated patients reported in the literature, however restrictive respiratory pattern remains high and deserves special attention in the follow up and management of these patients.

Autotransplantation of spleen tissue has been done, in the past ten years, in children with schistosomiasis mansoni with bleeding varices. The purposes of this investigation were: (1) to study the morphology and function of the remnant spleen tissue; (2) to quantify the production of tuftsin; and (3) to assess the immune response to pneomococcal vaccine of these patients. Twenty three children, who underwent splenectomy and autologous implantation of spleen tissue into the greater omentum were included in this investigation. The average postoperative follow-up is five years. Splenosis was proved by colloid liver-spleen scans. Search for Howell-Jolly bodies assessed the filtration function. Tuftsin and the titer of pneumococcal antibodies were quantified by ELISA. Splenosis was evident in all children; however, it was insufficient in two. Howell-Jolly bodies were found only in these two patients. The mean tuftsin serum concentration (335.0 ± 29.8 ng/ml) was inside the normal range. The immune response to pneumococcal vaccination was adequate in 15 patients; intermediate in four; and inadequate in four. From the results the following conclusions can be drawn: splenosis was efficient in maintaining the filtration splenic function in more than 90% and produced tuftsin inside the range of normality. It also provided the immunologic splenic response to pneumococcal vaccination in 65% of the patients of this series.

Foram submetidas 40 crianças, portadoras de esquistosomíase mansônica hepatoesplemica e sangramento de varizes esofágica, à esplenectomia e ligadura da veia gástrica esquerda. Foram acompanhadas durante 48 meses de pós-operatório, determinando-se a reserva funcional hepática durante esse período. Antes do tratamento cirúrgico, 13 crianças classificadas como grau A de Child's e 27 como grau B. A concentração média da albumina sérica era 3.16g/dl ± 0.62g/dl. Apenas em 1 paciente a concentração de bilirrubina sérica era pouco maior do que 2mg/dl. Após intervenção operatória, 15 pacientes foram diagnosticados como grau A de Child's e 25 como grau B. A concentração média de albumina sérica foi 3.25g/dl ± 0.50g/dl. Um paciente apresentava ainda na evolução pós-operatória concentração de bilirrubina sérica maior que 2mg/dl. Houve melhora significante após operação dos níveis de protrombina plásmica. Concluiu-se que não houve deteriorização da reserva funcional hepática nos pacientes operados.

Splenectomy and ligature of the left gastric vein in children with hepatosplenic schistosomiasis mansoni and bleeding esophageal varices produce a decrease of the portal hepatic blood flow and increase in the hepatic arterial flow. The effects of these hemodinamic changes in the liver could, theoretically, deteriorate the hepatic functional reserve of these patients. Forty children with this pathology underwent that kind of treatment and they were followed-up, prospectively , mean follow up of 48 months, regard to their hepatic functional reserve. Before surgery, thirteen children were classified as "good risk - grade A" in the Child’s criteria for assessment of the hepatic reserve and twenty seven as "moderate risk - grade B". The mean serum albumin concentration was 3.16g/dl ± 0.62g/dl. Only in one patient the serum bilirubin concentration was slightly greater than 2mg/dl. After surgery, fifteen patients were diagnosed as "good risk - A" and twenty five as "moderate risk - B". The mean serum albumin concentration was 3.25g/dl ± 0.50g/dl. Similarly one patient in the post-operative follow-up has presented with serum bilirubin concentration greater than 2mg/dl. Additionally, after surgery there was a significant improvement in the plasma prothrombin levels. These findings support the idea that there has been no deterioration of the hepatic functional reserve of these patients.