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Biomedical subjects

S Mies

Publications and source records attributed to S Mies.

At least 37 records · Page 2Linked to original sources
PubMed1990

Sclerotherapy of bleeding esophageal varices in schistosomiasis. Comparative study in patients with and without previous surgery for portal hypertension.

Ninety-seven patients with bleeding esophageal varices due to mansonic schistosomiasis were treated with endoscopic sclerotherapy. Seventy-five patients (Group I) had previously undergone surgery for portal hypertension and presented with bleeding recurrence. Twenty-two patients (Group II) had not undergone surgical treatment. The sclerotherapy technique employed was intravascular (IV) injections of ethanolamine in 40 patients and paravascular (PV) in 57 patients. Of a total of 38 (39%) patients who had bleeding recurrence, 27 (36%) were from Group I and 11 (50%) from Group II (p less than 0.005). Over a follow-up period of 48 to 132 months, 367 sessions of sclerotherapy were carried out in the 72 remaining patients from Group I (4.93 +/- 2.05). The remaining 16 patients from Group II needed 121 (7.56 +/- 2.70) sessions of sclerotherapy (p less than 0.001). Thus, sclerotherapy was effective in the control of rebleeding in 73 (97.3%) patients from Group I and 16 (72.7%) from Group II (p less than 0.05). We conclude that previous surgical treatment for portal hypertension in patients with mansonic schistosomiasis, greatly benefits treatment of rebleeding esophageal varices by endoscopic sclerotherapy. This is probably due to the lower portal pressure after splenectomy.

Adolescent↗
PubMed1989

A simple method for controlling hemorrhage during hepatectomy.

A technique of compressing the liver parenchyma without interfering with the blood supply to the remainder of the liver during anatomic and nonanatomic resections is presented. Two grooved nylon strips fitted into each other to form an ellipse that is tightened near the resection line permits the parenchymal incision in an unhurried and practically bloodless manner.

Hemorrhage↗
PubMed1988

Anatomic resection of liver segments V and VI.

We describe a surgical technique that allows identification and severing at the hilum of the hepatic artery and portal vein branches, which perfuse only segments V and VI of the right lobe of the liver. This is a technique that makes possible an anatomic resection of those segments. The bile duct and hepatic vein branches are ligated only when the liver parenchyma is sectioned. The technique was used in three patients with liver tumors. No patient received blood transfusions, and no postoperative local complications were observed.

Hepatectomy↗
PubMed1986

Hepatoportal sclerosis in childhood.

The clinical, angiographic, and pathologic features of hepatoportal sclerosis in five children are presented. Hepatosplenomegaly with preservation of liver function and esophageal varices were demonstrated. Histologically, portal alterations were consistent and prominent and included subintimal sclerosis of the intrahepatic venous branches and telangiectases. Angiographic patterns were variable, but all exhibited intrahepatic portal venous obstruction. In three patients, there was an association with extrahepatic portal vein obstruction at different sites. Our data suggest that intrahepatic portal vein thrombosis could be the primary disorder in hepatoportal sclerosis, which may vary in extent and site, involving the intrahepatic branches of the portal vein with or without the involvement of the portal trunk. Combined clinical, angiographic, and pathologic data can contribute to a better understanding of hepatoportal sclerosis in children.

Child↗
PubMed1986

A randomized trial for the study of the elective surgical treatment of portal hypertension in mansonic schistosomiasis.

From 1977 to 1983, 94 patients with esophageal varices and gastrointestinal bleeding secondary to mansonic schistosomiasis were entered into a prospective randomized trial comparing the three operations mainly used in Brazil: esophagogastric devascularization associated with splenectomy (EGDS, 32 patients), classical splenorenal shunt (SRS, 32 patients), and distal splenorenal shunt (DSRS, 30 patients). The randomization was interrupted because of a significant incidence of portosystemic encephalopathy (PSE) in the SRS group (26%), as compared to the DSRS (7%) and EGDS (0%) groups. The rate of rebleeding was the same in the three groups, but the rate of failure, as defined by the presence of technical problems, postoperative complications, or death, was significantly higher in the SRS group. This 2-year follow-up shows that SRS should be abandoned in hepatosplenic schistosomiasis and that a comparison between DSRS and EGDS with a longer follow-up is urgently needed.

Adult↗
PubMed1982

Distal splenorenal shunt (DSS) in children: analysis of the first 21 consecutive cases.

Twenty-one children from the ages of 4 to 12 years old were treated for esophageal hemorrhage by distal splenorenal shunt (DSS). In four patients, thrombosis of the shunt occurred within the first 24 hours after operation. In the other 17 children, long-term shunt patency was verified. Only one thrombosis has occurred in the last 15 consecutive cases. The patients were followed from one-half to six years. Late angiographic studies were performed in five patients. Forward flow through the portal vein was demonstrated in all patients. In addition, collateralization between the portomesenteric (PM) and gastrosplenic (GS) compartments was present in each case. In four patients with a wide-open shunt, the direction of collateral flow was from the PM to the GS compartment. In one child in whom the shunt was partially obstructed, the flow was from the GS to the PM compartment. In all 17 successful cases, esophageal variceal hemorrhage ceased, and there were no instances of hepatic encephalopathy. It is concluded that DSS is a safe and effective surgical procedure for the treatment of esophageal bleeding in children.

Child↗
PubMedDate not supplied

Portal hypertension in mansonic schistosomiasis.

Mansonic schistosomiasis is an endemic disease in Brazil, with an estimated 10-12 million people infested. Among its clinical manifestations, the hepatosplenic form causes portal hypertension which, in turn, brings about severe digestive hemorrhage, the most serious complication of the disease. Normally, the patients are young, and have hepatosplenomegaly, hypersplenism without clinical manifestations, and slightly reduced hepatic function. The angiographic findings are characteristic, differing from those of hepatic cirrhosis. In Brazil, the definitive treatment for gastrointestinal hemorrhage is surgery, which should be done under elective conditions whenever possible. During a short period of time, known as the "risk period" (the time between the hemorrhagic episode and the surgery), propranolol has been used to prevent further bleeding. Surgical treatment is indicated only after the first episode, and never on a prophylactic basis. In 1977, a prospective, randomized trial was begun in order to assess the delayed results of the 3 surgical operations most widely used in this country. The study was interrupted after 94 patients had been operated on due to the high incidence of encephalopathy in the group who underwent classical splenorenal shunt. After a follow-up of at least 60 months and, at most, 130 months, the results showed that classical splenorenal shunt caused encephalopathy in 39.3% of the cases and distal splenorenal shunt in 14.8%. None of those submitted to esophagogastric devascularization with splenectomy developed encephalopathy. The 3 procedures showed similar rates of hemorrhagic recurrence.

Adolescent↗