Portal hyperflow in patients with hepatosplenic mansonic schistosomiasis Hiperfluxo portal na forma hepatosplênica da esquistossomose mansônica

PURPOSE: The purpose of this study was to assess portal hemodynamics in patients with portal hypertension due to hepatosplenic schistosomiasis as well as to assess the contribution of splanchnic hyperflow to the pathophysiology of the portal hypertension. METHODS: Sixteen patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophageal varices rupture underwent elective esophagogastric devascularization and splenectomy and were prospectively studied. All patients underwent intraoperative invasive hemodynamic portal monitoring with a 4F-thermodilution catheter. The intraoperative portal hemodynamic assessment was conducted after laparotomy (initial) and after esophagogastric devascularization (final). RESULTS: The initial portal pressure was elevated (mean 28.5 ± 4.5 mm Hg), and a significant drop of 25% was observed at the end of the surgery (21.9 ± 4.9 mm Hg). The initial portal flow was elevated (mean 1766.9 ± 686.6 mL/min). A significant fall (42%) occurred at the end of the surgical procedure (1025.62 ± 338.7 mL/min). Fourteen patients (87.5%) presented a portal flow of more than 1200 mL/min, and in 5 cases, values greater than 2000 mL/min were observed. CONCLUSIONS: Esophagogastric devascularization and splenectomy promote a significant reduction of the elevated portal pressure and flow in schistosomal portal hypertension. These data favor the hypothesis of portal hyperflow in the physiopathology of portal hypertension of schistosomiasis.<br>OBJETIVOS: o objetivo do presente estudo é estudar a hemodinâmica portal em pacientes com hipertensão portal secundária a forma hepatoesplênica da esquistossomose e avaliar a contribuição do hiperfluxo esplênico na sua fisiopatologia CASUÍSTICA E MÉTODOS: Foram estudados prospectivamente 16 pacientes portadores de hipertensão portal secundária à forma hepatoesplênica da esquistossomose mansônica com indicação de tratamento cirúrgico. Todos foram submetidos a avaliação hemodinâmica portal com cateter de termodiluição 4F antes e após a realização de desvascularização esofago-gástrica com esplenectomia. RESULTADOS: Na avaliação intra-operatória inicial observou-se pressão (28,5 + 4,5 mmHg ) e fluxo (1750,59 ± 668,14 ml/min) portais iniciais bem acima dos valores considerados normais. Houve queda significante de 25% na pressão (21,65 ± 5,55 mmHg ) e de 42% no fluxo (1011,18 ± 332,73 ml/min) ao término da cirurgia. Quatorze pacientes (87.5%) apresentavam fluxo portal superior a 1200 ml/min e, em 5 casos, valores superiores a 2000 ml/min foram observados. CONCLUSÕES: A pressão e o fluxo portais estão aumentados na hipertensão portal esquistossomótica. A desvascularização esofago-gástrica com esplenectomia reduz significativamente tanto a pressão quanto o fluxo portais. Estes dados favorecem a hipótese do hiperfluxo esplâncnico (esplênico e mesentérico) na fisiopatologia da hipertensão portal na esquistossomose forma hepatoesplênica

Multiple common variants for celiac disease influencing immune gene expression

We performed a second-generation genome-wide association study of 4,533 individuals with celiac disease (cases) and 10,750 control subjects. We genotyped 113 selected SNPs with P-GWAS < 10(-4) and 18 SNPs from 14 known loci in a further 4,918 cases and 5,684 controls. Variants from 13 new regions reached genome-wide significance (P-combined < 5 x 10(-8)); most contain genes with immune functions (BACH2, CCR4, CD80, CIITA-SOCS1-CLEC16A, ICOSLG and ZMIZ1), with ETS1, RUNX3, THEMIS and TNFRSF14 having key roles in thymic T-cell selection. There was evidence to suggest associations for a further 13 regions. In an expression quantitative trait meta-analysis of 1,469 whole blood samples, 20 of 38 (52.6%) tested loci had celiac risk variants correlated (P < 0.0028, FDR 5%) with cis gene expression.Developmen