الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
The prime objecte:t this work, was to stlldy the e:tfeut of propranolol on portal ~,pressure in patients
with hepatio 8Ohistosomiasis and portal hypertension.
Twenty-four patients, presenting with schistosOlllalhepatio
fibrosis and splenomegaly were therefore the subjeot
of this work. All cases were subjeoted to full clinioal,
laborat0r.J, ultrasonographio, gastrointestinal
endosoopio, liver biopsy and intrasplenio pulp manometery
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studies. Patients were divided into two groups I
1) Propranolol group ”Sixteen patients” : Petients
were given propranolol orally twioe/day in a dose su:tfioient
to deorease the resting he~rt rate by almost 25 %
for eight weeks.
2) Plaoebo grOllP ”eight patients” : These patients
reoeived placebo orally twice/day :tor eight weeks.
There was no significant di:t:te;renoe between the two
groups as regards age, sex (all !D8·1es),blood picture,
11ver funotion tests, 11ver pathology, portal pressure
and period o:tstay in the hospital.
The portal pressure was measured by intrasplenio
pulp manometry method and liver funotion tests were made,
before and eight weeks after the beginning o:ttherapy.
Liver function tests did not ohange signi:t1cantly after
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therap;, in both groQps. Portal pressure in the propranolol
group was decreased Signif’ioantl;,. In the placebo
groQp, it was also reduoed but to a just signif’-
ioant degree b;, paired observation t test. However,the
dif’f’erenoe in peroentage of’ reduction between both
groQps was signif’ioant •
•
Fromthe above data, propranolol was ef’f’ective in
lowering portal pressure. However, a spontaneous deorease
did alao occur. Taking into oonsideration that
there is no relationship between the height of’ portal
pressure end tendenc;, to bleeding. 1I0reover, the ef’f’ect
of’ propranolol in prevention of’ reourrent varioeal
bleeding is controversial. Theref’ore it is cono1uded
that, the use of’ propranolol in the treatment of’ portel
h;rpertension and bleeding varices should be 11m!ted to
prolonged randomized controlled stu41es on1;,. Also, the
reduotion of’ portal pressure did not reach the normal
basal level. Propranolol reduces the portal blood f’low,
still the problem of’ .increased portal VI!Iso’Uler res1’B1;anee
had not been solved.
The present stud;, reoommendsthat, large nlll1bers
of’ unselected patients with liver oirrhosis or f’ibrosis
are needed to assess the value of’ propranolol in prevention
of’ recurrent variceal bleeding and also to assess
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long term side effects. Also the lUIe of other Beta Blockers
may- be tried I
1- Bl-selective blocker drugs e.g. Metoprolol as
their effect on hepatic blood flcw i8 less than propranolol
so they-mey- be used safely- in severe liver disease.
2- B2- selective blocker drugs e.g. IOI 118551 as
their etteot on cardiaC haemodynamiC& i& negligible ,so
they-may be used safely in scutt variceal bleeding.
However.the main recommendation of the present
studY’ and considering the other studies that dealt with
the problem ot portal hy-perhnsion.. is the golden true rule or ”prevention i8 better thau treatment”.