الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Chronic liver diseases constitute one of the most
common health problems in Egypt. This is simply due to
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endemicity of schistosomiasis and viral hepatitis. The:
end result of these disorders, is usually the development
of fibrosis or cirrhosis with its major sequel,portal
hypertension. Indeed, portal hypertension and its
complications constitute a major health hazard in Egypt
and their management remains a challenging problem even
allover the world. The incidence of bleeding from oeso~
phageal varices in patients with schistosomal hepatic
fibrosis was reported to be 28.3%. Nowadays, there is
much interest in the use of beta blockers for the treatment
of portal hypertension.
In this work, efforts were made to study the effects
of both propranolol, a non-cardioselective beta
blocker and labetalol, an alpha and beta blocker on
portal venous pressure in patients with hepatosplenomegaly
and portal hypertension associated with schistosomiasis
and on the rate constant (K) as indicator for
effective hepatic blood flow.
25 male patients with hepatosplenomegaly were the
sUbject of this study and they were subjected to full
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clinical examination, routine laboratory investigations,
E.C.G. tracing, proctosigmoidoscopy, upper gastrointestinal
endoscopy, abdominal ultrasonography and liver
biopsy. Measurements of the portal venous pressure and
estimated hepatic blood flow were made by the intra splenic
pulp manometry and radiogold uptake technique respectively.
All patients came from endemic areas of sch Lst oeu-,
miasis, their age ranged between 12-43 years old, most:
of them had past history of schistosomiasis and or antischistosomal
treatment and according to Child-Turcotte
classification, all were Child-A.
They were included in the present study according
to good hepatic and renal functions with no previous history
of airway obstruction, heart failure or diabetes •
Patients then were divided into three groups:-
A) Propranolol group (la-patients): Patients were given
propranolol orally in doses ranging from 40-160 mg. daily
aiming at the reduction of resting heart rate by almost
25%. Each patient was then maintained on the appropriate
dose for eight weeks.
B) Labetalol group (5-patients): Patients were given labetalol
100 mg. orally twice daily for eight weeks(maximum
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dose tolerated by the patients and producing less untoward
side effects e.g. postural dizzness and easy
fatigability.
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placebo (Starch tab.) for eight weeks.”
c) Placebo group (iO-patients): PIlt1eiHswere given ,”i~I!
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Liver function tests, E.C.G. tracing, measuremente
of portal pressure and hepatic blood flow we~
uated in the three groups after eight weeks of
re-eval-i
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therapy. ’,’
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Schistosomiasis represents the mos,t common unde~-’:
lying hepatic pathology in the atudied groups as it waS
present in 50%, 60% and 50% of cases of the propranolol,
labetalol and placebo groups respectively. Schistosomiasis
was associated ,with chronic persistent hepatitis in
20% of cases in each group. In placebo group schistosomi
iasis was associated with chronic active hepatitis in 10% ,
and with cirrhosis in another 10%. Meanwhile it was assOciated
with cirrhosis in 20% of cases of the propranolol
group. Chronic active hepatitia waS found in one patient
of propranolol and labetalol groups.
Continuous oral administration of propranolol produced
significant reduction in portal pressure after eight
weeks. This was attributed to the decrease in splanchnic
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blood flow as consequences of the reduction in cardiac
output (due to blockade of BI receptors) and vasoconstriction
in the splanchnic vessels due to unopposed
alpha receptor activity. Simi1arl~tth~ unopposed al;p~:
receptor activity on the hepatic artery producing vasoi,
constriction may, by the principal of reciprocity ,
reduce portal vascular resistance. The significant re-’
duction in the estimated hepatic blood flow observedi,
the present study ,after propranolol ,therapy confirmed i
this explanstion as long as, the problem of portal vas~
cular resistance had not been solved.
No direct correlation waS observed between the,
fall in estimated hepatic blood flow and the reduction
in portal pressure in those recievingpropranolol.
In both labetalol and placebo groups, there was
no change in portal pressure and estimated hepatic blood
flow after eight weeks of therapy.
The less potent effect of labetalol on cardiac
output besides its blockade to alpha receptors can explain
its effect on portal pressure and hepatic blood
flow.
Neither propranolol nor labetalol had detrimental
effects on liver function tests in both groups.
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Propranolol, can thus be considered as an effective
portal hypotensive drug, though the associated
marked reduction in hepatic blood flow may have long
term deleterious .. effects on liver. funqtlons.Still ,the
role of propranolol in prevention of bleeding oesophageal
varices, a matter of controversy. It is concluded
therefore that, the use of propranolol in the treatment
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of portal hypertensioa and bleeding varices should for
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the time being limited to prolonged randomized contro~
lIed studies only.
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