Boné mineral density in children and adolescents with hepatosplenic mansonic schistosomiasis and esophageal varices who underwent splenectomy and ligature of the left gastric vein

Abstract

Twenty eight children and adolescents from 7 to 19 years of age, suffering from hepatosplenic mansonic schistosomiasis and bleeding esophageal varices were evaluated for bone mineral density (BMD), before undergoing medical and surgical treatment. The surgical protocol was splenectomy, autoimplantation of spleen tissue into a pouch of the greater omentum and ligature of the left gastric vein. Twenty one patients were evaluated after a follow up from two to nine years post surgical treatment. The BMD was measured at the lumbar spine (L2 - L4) through the dual energy absorptionmetry X-ray (DEXA), using a LUNAR DPX-L densitometer. Preoperatively, all patients showed deficit of the BMD varying from 1 to 7.07 standard deviations (Mean <FONT FACE="Symbol">±</FONT> SEM - 2.64 <FONT FACE="Symbol">±</FONT> 0.28), considering the mean line of the control curve for healthy children accepted as normal. The BMD deficit was more evident among the females than the males. After treatment there was a significant increment (<FONT FACE="Symbol">C</FONT>2 = 9.19 - p =0.01) of the BMD and 29% of the patients (six out of twenty one) were considered without bone mineral deficit. It was concluded that the patients included in this series, who suffer from hepatosplenic mansonic schistosomiasis, showed an important BMD deficit, specially among the females which has had a significant improvement after medical and surgical treatment.

Surgical hepatosplenic mansonic schistosomiasis in adolescents: repercussions of the post-treatment schistosomotic burden on the hepatic functional reserve

“…When bleeding recurrence occurs the patients undergo endoscopic sclerotherapy of the esophageal varicose veins (Sakai 1995, Brandt et al 1997). This treatment results in cure of the hypersplenism, decreasing of the upper digestive bleeding bouts, improvement of the hepatic functional reserve, improvement of the somatic development and increment of the bone mineral content (Brandt et al 1995a(Brandt et al , b,1997(Brandt et al , 1999.…”

“…Historical mortality rate for children with this condition had been 30% to 40% and nowadays is 3.1%. In the past ten years there has been no patient with OPSI in the Department of Pediatric Surgery, Federal University of Pernambuco, Brazil (Brandt et al 1997(Brandt et al , 1995a(Brandt et al , b, 1997(Brandt et al , 1999.…”