This review confirms that in hepatic bilharziaI fibrosis the hepatic blood flow (HBF) values obtained indirectly by the depuration constant of IlII rose bengal are within the limits of normality. The variations of the HBF before and after splenectomy and splenorenal shunt were also studied.S. Afr. Med. J., 48, 1312 (1974)

de Lima, JJP

Garcia, DS

Viana, RL

English

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1312 S.A. MEDICAL JOURNAL 22 June 1974QHepatic Blood Flow in Hepatic Bilharzial FibrosisBefore and Mter SurgeryJ. J. P. DE LIMA, R. L. VIANA, D. S. GARCIASUMMARYThis review confirms that in hepatic bilharziaI fibrosisthe hepatic blood flow (HBF) values obtained indirectlyby the depuration constant of IlII rose bengal are withinthe limits of normality.The variations of the HBF before and after splenectomyand splenorenal shunt were also studied.S. Air. Med. J., 48, 1312 (1974).The values of hepatic blood flow (HBF) are importantin the studies of portal hypertension.The radio-isotopic measurements of HBF with 19SAucolloid or "'I rose bengal, which have the advantages oftechnical ease and comfort for the patients, are suitablefor correlation studies between BBF and portalhypertension.Several authors have suggested that in bilharzial fibrosisthe BBF values are within nomgl limits.' ·' In the presenttudy this statement is reaffirmed and the variations ofHBF for periods up to 2 months after splenectomy andsplenorenal shunt are also shown.Although it is claimed to have disadvantages comparedwith '9SAu colloid, 1311 rose bengal has been used in thisstudy. It became apparent that for our local conditionsthe efficiency of depuration by the liver of 1311 rose bengalhas less individual variation than is the case with '9SAucolloid.THEORY OF THE MEmODThe BBF can be calculated using a single injection of"'I rose bengal if the depuration constant of the dyeKRB, the efficiency 'of dye depuration by the liverCRB, and the volemy are known by the equationKeBRBF = --. VeRBThe efficiency of depuration CRB depends on the functionalstate of the hepatic parenchyma and varies from 0,2 inFaculty of Medicine, University of L-ourenco Marques,Mozambique]. J. P. DE LIMA, PH.D., Director of Radio-isotope DepartmentR. L. VIANA, PH.D., Directar of Department of Medicine IIID. S. GARCIA, Research Fellow ill Radio-isotope DepartmentDate received: 25 October 1973.severe liver deficiency to about 0,4 of the value found IIInormal subjects.'For mAu colloid the depuration efficiency CAU isgenerally near unity, and it is supposed to be independentof the functional state of the liver. So the BBF isobtained approximately from BBF = KAU . Vwhere KAU is the depuration constant of the colloid.In work previously published' it has been describedthat in a group of 39 Black individuals with no sympto-matology of hepatic disease, the mean value of thedepuration constant KAU for '''Au colloid wasKAU = 0,203 min'""" which is considerably less than thevalues found by other authors.'In another work' the values of the depuration constantsfor '''Au colloid and ""I rose bengal KRB were comparedin a group of 20 patients with hepatic bilharzial fibrosis.It was found that in about 50°{, of the cases the valuesof KAU were below the normal values generally accepted,although in all the cases the values of KnB were normal.This discrepancy between the values of K.w and K1<Bsuggests that the efficiency of depuration CAU for themAu colloid is less than unity in a large number ofcases and that under our local co.nditions the hepaticdepuration of colloids is bound to have more individualvariations than KRB.In this article two assumptions are made, firstly, thatindividuals with normal values of KRB have normal RBFvalues; and secondly, that the variations of KRB beforeand after splenectomy and splenorenal shunt are pro-portional to the variations in BBP. In other words, it isassumed that the efficiency of depuration CRB is unalteredafter surgery.PATIENTS AND METHODSThe values of KRB were determined using the method ofexternal detection of the hepatic activity: the response ofa collimated scintillation detector aimed at the· upperportion of the right lobe of the liver in function of timewas recorded by a pen recorder and KnB calculatedgraphically.An activity of 25 p.Ci of 131 1 rose bengal was usedexcept in the determinations before surgery where scanningwas carried out simultaneously. In these cases 150 jLCiof. 1311 rose bengal were administered.The values of KRB were determined in 39 normal subjectsand 21 patients with hepatic bilharzial fibrosis. The clinicaldiagnosis of these patients was e~tablished by hepaticbiopsy and bilharzia eggs in faeces and urine.22 Junie 1974 S.-A. MEDIESE TYDSKRIF 1313RESULTSThe mean value of !<RB obtained in 39 normal subjects wasKRB = 0,113 min- I , SD 2 (normal range 0,061 - 0,165 min-I ).In the group of 21 patients with hepatosplenic bilharziaIfibrosis, KRB values determined before surgery werewithin the normal limits, with the exception of cases 5, 17and 21 whose values were slightly lower, as seen in TablesI and n, which also show the time intervals between thedeterminations immediately before and after surgery.TABLE I. SPLENECTOMYOnly case 14 showed a value of KRB decreased below50% of the value before surgery. An increase occurred5,7 months after surgery. The rest of the patients in thisgroup, studied from 1 to 6 months after surgery, showedincreased KRB values.In the 6 patients subjected to sp:enorenal shunt (Fig. 2)3 showed a decrease in KRB and the remaining patientsan increase after surgery.2.0Before After TimePatient No. (min- I) (min-I ) (months)1 0,124 0,144 102 0,091 0,112 43 0,121 0,108 3,44 0,117 0,071 1,10,110 4,25 0,058 0,115 3,26 0,099 0,068 1,60,068 6,47 0,112 0,053 1,10,102 9,18 0,062 0,040 1,79 0,066 0,086 3,210 0,063 0,077 1,411 0,112 0,074 3 0.112 0,087 0,102 0,913 0,096 0,064 2,614 0,139 0,094 10,040 2,60,079 5,715 0;084 0,041 1,7Splenectomy~2 ~:=:::---2----~~==----__----'I156 month 7Fig. 1. The variation of K RB v. time normalised to anunitary value of KRB for the patients subjected tosplenectomy.1.521TABLE 11. SPLENORENAL SHUNTBefore After TimePatient No. (min- I) (min- I) (months)16 0,068 0,082 117 0,055 0,043 0,50,102 2,618 0,067 0,071 2,719 0,069 0,054 20,069 4,520 0,082 0,067 0,721 0,040 0,059 1,216Splenorena I sbunl18173195 - 6monthOf the 21 patients 15 were subjected to splenectomywith ligature of collateral circulation, and 6 to spleno-renal shunt.Fig. 1 shows the variation of !<RB v. time normalisedto a unitary value of KnB before surgery in the case ofsplenectomy. Of the 15 patients subjected to splenectomy9 showed a decrease in !<RB after surgery. In 4 of thesethere was further recuperation with increase of !<RB.Fig. 2. The variation of K RB v. time normalised to anunitary value of KRB for the patients subjected tosplenorenal shunt.CONCLUSIONSThe values of KRB obtained in 21 patients with confirmedhepatic bilharzial fibrosis before surgery, are in agreementwith the accepted idea that in this disease the KRB valuesare within the normal range.1314 S.A. MEDICAL JOURNAL 22 June 1974The comparison of the KRB values before and aftersplenectomy and splenorenal shunt showed individualvariations mainly when the values of KBB after surgeryare obtained shortly after the operation. In all the patientsstudied for periods longer than 3 months, and in whomthere was a decrease in KRB at first determination a shorttime after surgery, an increase in KRB values was laterobserved.REFERENCES1. Razzak, M. A. (1964): J. Nuc!. Med., 5, 125.2. Viana, R. L. (1972): Thesis.3. Belcher, E. H. and Vetter, H. (1971): Radioisotopes in MedicalDiagnosis. London: Butterworths.4. De Lima, J. J. P., Rego, A. S., Viana, R. J. L. and Dias, F. A.(1967): Rev. dos Estudos Gerais Universitarios de M~ambique, 4,series rn, p. 389.5. Rosario, M. R., De Lima, J. J. P., Ferreira, F. M. F., Dias, F. A.and Viana, R. L. (1968): Revista Ciencias Med., 1, 37.6. Coutinho, A. (1968): Amer. J. Med., 44, 547.The Use of Antimalarial DrugsC. F. HANSFORDSUMMARYA general review is given of the antimalarial drugs cur-rently available and in common use, with special referenceto those found to be of most benefit in Southern Africa.S. Afr. Med. J., 48, 1314 (1974~LIFE CYCLE OF THE PARASITEBefore discussing the action of antimalarial drugs someaspects of the malaria parasite cycle should be considered.The parasite is inoculated by the mosquito as the sporo-zoite form, which within an hour enters liver cellsand commences growth and subdivision, forming primaryexo-erythrocytic or pre-erythrocytic schizonts. After a fewdays these schizonts mature and rupture,. each releasinghundreds of merozoites which invade circulating red bloodcells. In Plasmodium vivax, malariae and ovale infectionssome of these merozoites also enter liver cells, starting anew cycle of exo-erythrocytic division called secondaryexo-erythrocytic schizogony. This stage is responsible forthe late relapses associated with these species of parasite.It does not occur in P. falciparum infections.In fue red blood cells the parasites become trophozoites,take 2 - 3 days to develop, divide and form matureschizonts which rupture, forming merozoites which inturn invade further red blood cells. The breaking-up of themature schizonts releases products responsible for thepyrexial attacks typical of malaria. A few trophozoites doState Health Department, Pietersburg, TvlC. F. HANSFORD, M.B. CH.B., D.T.M. &H., D.P.H.Paper presented at the Malaria Symposium. held in Nelspruit, EasternTransvaal, on 27 January 1973 under the auspIces of the Lowveld Divisionof the Northern Transvaal Branch of the Medical Association of SouthAfrica.not form schizonts but develop into male and femalegarnetocytes. These may continue to circulate for periodsup to a month unless they are ingested by suitable mos-quitoes in which fuey mate, develop further and sub-divide, forming sporozoites which migrate to the salivaryglands.Individual antimalarial drugs do not have a similaraction against all stages of malaria parasites, nor againstall 4 species of human malaria, and this fact must betaken into consideration when drugs are prescribed forprophylaxis, cure or gametocidal purposes.CLASSIFICATION OF ANTIMALARIALDRUGSAntimalarial drugs are commonly classified by their chemi-cal characteristics and by their site of action on theparasite.Aminoquinoline DrugsBasically these have a benzene and a pyridine ring fusedtogether and are divided into 4- and 8-aminoquinolines,depending on the position of the side chain. J"he 4-amino-quinoline drugs include chloroquine and amodiaquine, themost important of present antimalarial drugs. They havea low toxity, are highly effective against the asexual bloodtrophozoite and for these reasons are the drugs of choicein the treatment of the acute attack. Unfortunately theyhave no action against any other stage of the parasite.They are rapidly absorbed, slowly metabolised and ex-creted, necessitating the use of a loading dose at thecommencement of treatment. At the oral dosages nor-mally employed, toxic effects are minor, usually cmisistingof nausea, headaches and dizziness, but care must betaken during parenteral use, especially with children, sincehypotension may result.J

Hepatic Blood Flow in Hepatic Bilharzial Fibrosis Before and After Surgery

This review confirms that in hepatic bilharziaI fibrosis the hepatic blood flow (HBF) values obtained indirectly by the depuration constant of  I3II rose bengal are within the limits of normality. The variations of the HBF before and after splenectomy and splenorenal shunt were also studied.S. Afr. Med. J., 48, 1312 (1974)

Hepatic Blood Flow in Hepatic Bilharzial Fibrosis Before and After Surgery

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