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Volume 62 - 1999 - Fasc.2 - Original articles

Severe bleeding following endoscopic variceal ligation: should EVL be avoided in Child C patients ?

In the last decade there has been an evolution in the treatment of bleeding oesophageal varices. Endoscopic variceal ligation (EVL) is one of those new techniques that not only has shown to be more effective than sclerotberapy, but also causes less side effects, resulting in less episodes of rebleeding and improving survival. We describe severe bleeding in 3 patients after EVL, occurring between 5 and 10 days after the initial ligation. Two Child C patients could not be resuscitated and died shortly after this event. Severely impaired cloffing function as a result of the liver disease and the greater size of the ulcers induced by EVL may contribute to this dramatic complication. Severe bleeding due to postligation ulceration may lead to death, which occurred in 2 of our Child C patients. Since more and more endoscopists are using EVL in the treatment of oesopbageal variceal bleeding, they should be aware of the possible complications caused by this rather new technique.


Distinct B-cell populations are present in hepatic and intestinal Schistosoma mansoni granulomas

Although it is generally accepted that schistosomal granuloma formation results from a T-cell dependent host response towards the parasite egg, attention has recently been focused on the involvement of B-cells in the induction of schistosome-induced pathology. In this study we investigated the involvement of two functionally different B-cell populations in the formation of the Schislosoma mansoni granuloma : naive and antigen-stimulated B-cells. In liver granulomas two distinct B-cell populations were found, namely unstimulated Bcells at the periphery of the granuloma and antigen-stimulated, syndecan-1 positive B-cells in the inner part near the deposited egg. Intestinal granulomas differed by their relative lack of unstimulated B-cells at the granuloma periphery, but like hepatic granulomas intestinal granulomas also have syndecan-1 positive B-cells. From our results, we conclude that B-celis are important constituents Of the S. mansoni granuloma.