Dermatite verrucosa leprotica (Estudo de 3 casos)

The writer has discovered in Curupaity (National Leprosarium, Rio de Janeiro), three cases of verrucous dermatitis in C 3 type lepers. He suspected it to be an association of leprosy with Dermatilis verrucosa blastomycetica (Chromoblastocycosis) but various attempts to cultivate the fungus (Acrotheca or Hormodendrum Pedrosoi) responsible for the disease gave negative results and also the histopathologic aspect of the verrucous tissue proved it to be a leprotic granuloma without mycotic association. The writer's conclusion, based upon the cultural and histopathological studies, is that the verrucous dermatitis observed is due to leprosy alone, considering it as a new syndrome of the disease and not a new clinical form. He has called it « Dermatitis verrucosa leprotica » and made suggestions to all doctors of leprosaria to look for new cases and to study their etiology and pathogeny. Electrocoagulation improved the lesions.

Alterações cutâneas do cão no Kala-Azar sul-americano

According to E. Chagas (1938), South-American Kala Azar is a widespread disease from the jungle, several cases being reported from North Brazil (Estado do Pará: Marajó Island, Tocantins and Gurupi river valleys; Estados do Piauí and Ceará: coast and hinterland). Other cases were found in Northeast Brazil (Estados de Pernambuco, Alagôas and Sergipe: coast and hinterland; Estado da Bahia: hinterland). A few cases were described from Estado de Mato-Grosso (Brazil), Provincia de Salta and Território do Chaco (Argentine), and Zona contestada do Chaco (Paraguai-Bolívia). A well defined secondary anemia associated with enlargement of the liver and spleen are the chief symptoms. Death usually occurs in cachexia and with symptoms of heart failure. Half the patients were children aged less than ten years (CHAGAS, CASTRO & FERREIRA, 1937). Quite exhaustive epidemiological researches performed by CHAGAS, FERREIRA, DEANE, DEANE & GUIMARÃES (1938) in Municipio de Abaeté (Estado do Pará, Brazil) gave the incidence of 1.48% for the natural infection in human, 4.49% in dogs, and 2.63% in cats. The infection was arcribed (CUNHA & CHAGAS, 1937) to a new species of Leishmania (L. chagasi). Latter CUNHA (1938) state, that it is identical to L. infantum. ADLER (1940) found that so far it has been impossible to distinguish L. chagasi from L. infantum by any laboratory test but a final judgment must be reserved until further experiments with different species of sandflies have been carried out. Skin changes in canine Kala Azar were signaled by many workers, and their importance as regards the transmission of the disease is recognized by some of them (ADLER & THEODOR, 1931, 2. CUNHA, 1933). Cutaneous ulcers in naturally infected dogs are referred by CRITIEN (1911) in Malta, by CHODUKIN & SCHEVTSCHENKO (1928) in Taschkent, by DONATIEN & LESTOCQUARD (1929) and by LESTOCQUARD & PARROT (1929) in Algeria, and by BLANC & CAMINOPETROS (1931) in Greece. Depilation is signaled by YAKIMOFF & KOHL-YAKIMOFF (1911) in Tunis, by YAKIMOFF (1915) in Turkestan. Eczematous areas or a condition described as "eczema furfurace" is sometimes noted in the areas of depilation (DONATIEN & LESTOCQUARD). The skin changes noticed by ADLER & THEODOR (1932) in dogs naturally infected with Mediterranean Kala Azar can be briefly summarized as a selective infiltration of macrophages around hair follicles including the sebaceous glands and the presence of infected macrophages in normal dermis. The latter phenomenon in the complete absence of secondary infiltration of round cells and plasma cells is the most striking characteristic of canine Kala Azar and differentiates it from L. tropica. In the more advanced stages the dermis is more cellular than that of normal dogs and may even contain a few small dense areas of infiltration with macrophages and some round cells and polymorphs. The external changes, i. e., seborrhea and depilation are roughly proportional to the number of affected hair follicles. In dogs experimentally infected with South-American Kala Azar the parasites were regularly found in blocks of skin removed from the living animal every fortnight (CUNHA, 1938). The changes noticed by CUNHA, besides the presence of Leishmania, were perivascular and diffuse infiltration of the cutis with mononuclears sometimes more marked near hair follicles, as well as depilation, seborrhea and ulceration. The parasites were first discovered and very numerous in the paws. Our material was obtained from dogs experimentally infected by Dr. A. MARQUES DA CUNHA< and they were the subject of a previous paper by CUNHA (1938). In this study, however, several animals were discarded as it was found that they did develop a superimposed infection by Demodex canis. This paper deals with the changes found in 88 blocks of skin removed from five dogs, two infected with two different canine strains, and three with two distinct human strains of South-American Kala Azar. CUNHA'S valuable material affords serial observations of the cutaneous changes in Kala Azar as most of the blocks of skin were taken every fortnight. The following conclusions were drawn after a careful microscopic study. (1) Skin changes directly induced in the dog by the parasites of South-American Kala Azar may b described as an infiltration of the corium (pars papillaris and upper portion of the reticular layer) by histocytes. Parasites are scanty, at first, latter becoming very numerous in the cytoplasm of such cells. Sometimes the histocytes either embedding or not leishman bodies appear as distinct nodes of infiltration or cell aggregations (histocytic granuloma, Figs. 8 and 22) having a perivascular distribution. The capillary loops in the papillae, the vessels of the sweat glands, the subpapillary plexus, the vertical twigs connecting the superficial and deep plexuses are the ordinary seats of the histocytic Kala Azar granulomata. (2) Some of the cutaneous changes are transient, and show spontaneous tendency to heal. A gradual transformation of the histocytes either containing or not leishman bodies into fixed connective tissue cells or fibroblasts occut and accounts for the natural regression just mentioned. Figs. 3, 5, 18, 19 and 20 are good illustrations of such fibroblastic transformation of the histocytic Kala Azar granulomata. (3) Skin changes induced by the causative organism of South-American Kala Azar are neither uniform nor simultaneous. The same stage may be found in the same dog in different periods of the disease, and not the same changes take place when pieces from several regions are examined in the same moment. The fibroblastic transformation of the histocytic granulomata marking the beginning of the process of repair, e. g., was recognised in dog C, in the 196th as well as in the 213rd (Fig. 18) and 231st (Fig. 19) days after the inoculation. (4) The connective tissue of the skin in dogs experimentally infected with South-American Kala Azar is overflowed by blood cells (monocytes and lymphocytes) besides the proliferation in situ of undifferentiated mesenchymal cells. A marked increase in the number of cells specially the "ruhende Wanderzellen" (Figs. 4 and 15) is noticed even during the first weeks after inoculation (prodomal stage) when no leishman bodies are yet found in the skin. Latter a massive infiltration by amoeboid wandering cells similar to typical blood monocytes (Fig. 21) associated to a small number of lymphocytes and plasma cells (Figs. 9, 17, 21, and 24) indicates that the emigration of blood cells...

Notas sôbre o gênero Colobogaster Solier, 1833, com a descrição de duas novas espécies da Região Amazônica: (Coleoptera, Buprestidae)

The study of materials belonging to several brazilian collections led us discover 2 new species of the genus Colobogaster which are here described. C. seabrai sp. n. seems to be related to C. puncticollis Waterhouse, 1882, from which it can be distinguished by: a) apical alitral tooth placed suturally, b) pronotum with 3 pairs of depressions, the 1st. pair transversal and conigous to the 2nd one, c) elitral suture brilliantgreen coloured but not the marginal edge, d) front without a horse-shoe shaped structure, e) pronotum with the discal region concolor. The structures of pronotum, the elitral and pronotal colour paterns and the genial morphology separate this one from other species of the genus. C. paraensis sp. n. is closely related to C. cupricollis Kerremans, 1897, but it is distinguished by the absence of depressions on the pronotum, by the elitral tooth placed suturally, by the abscence of humeral rip and by the general colour. Eleven other species were studied and their apical segment of the abdomen and scutellum were illustrated. It was also established the synonymy of C. ecuadoricus Obengerger, 1926.

Lymnaea rupestris sp. n. from Southern Brazil (Pulmonata: Lymnaeidae)

A new species of South American lymnaeid snail, Lymnaea rupestris, is described. So far it has been found only in its type-locality, Nova TeuTõnia, a village in the municipality of Seara (27° 07' S, 52° 17' W), state of Santa Catarina, Brazil. It is distinguishable, by characteristics of the shell and internal organs, from the other two lymnaeid species known to occur in the area, Lymnaea columella and L. viatrix. Its shell has 4 markedly shouldered whorls, deep suture, ovoid or rounded aperture occupying about half the length of the shell, and reaches about 6 mm in length in adults; in columella and viatrix the shell has 4-5 rounded whorls, shallow suture, and reaches over 10 mm in adults; the aperture is ovoid, occupying about half the length of the shell in viatrix, about two thirds in columella. Anatomically it is readily separated from L. columella by the shape of the ureter, straight in rupestris, with a double flexure in columella. Comparison with L. viatrix shows the following main differences: distalmost portion of the oviduct with a low, caplike lateral swelling in rupestris, with a well-developed pouch in viatrix; uterus bent abruptly caudalward in rupestris, only slightly curved rightward in viatrix; basal half of the spermathecal duct hidden by the prostate in rupestris, wholly visible or nearly so in viatrix; spermiduct sinuous and uniformly wide in rupestris, straight and gradually narrowing in viatrix; prostate more than half as long and nearly as wide as the nidamental gland, and with a slit-like lumen in cross-section in rupestris, less than half as long as and much narrower than the nidamental gland, and with an inward fold in cross-section in viatrix; penial sheath about as long and as wide as the prepuce in rupesris, shorter and narrower than the prepuce in viatrix. An important ecological characteristic of L. rupestris is its habitat on wet rocks most often outside bodies of water, although in close proximity to them. Specimens were deposited in the following malacological collections: Instituto OswaldoCruz, Rio de Janeiro; Academy of Natural Sciences, Philadelphia; Museum of Zoology, University of Michigan; and British Museum (Natural History).

Lymnaea Diaphana; a study of Topotypic specimens (Pulmonata: Lymnaeidae)

A description of the species Lymnaea diaphana King, 1830 is presented, on the basis of material collected at its type-locality, San Gregorio, on the north coast of the Strait of Magellan, in the Chilean province of Magallanes. It may be identified by the following characters taken together: adult shell over 10 mm in length, whorls inflated, regularly convex, separated by a well-marked suture, aperture ovate occupying about half the shell length; renal organ forming an approximately right angle with the ureter; pouch of the oviduct well noticeable high on the right ventral surface and on the right side of the nidamental gland; uterus bent to the right into an approximately right angle; body of the spermatheca projected into the pulmonary cavity and adhered to the pericardium and to the roof of the pulmonary cavity; spermiduct highly sinuous, folding dorsalward between the left half of the oviduct and the left shoulder of the nidamental gland, and then winding on ventralward to reach the prostate on the middle line; prostate voluminous, convex on the left, pushed in on the right, with a deep dorsal furrow corresponding to a fold which projects into the prostatic lumen and is more developed at the fore half of the organ; apical end of the penial sheath with about six minute protuberances corresponding to inner chambers; prepuce from about as long about twice as long as the penial sheath, with some variation beyond those limits; lateral teeth of the radula basically tricuspid, with a usually simple ectocone which may show a bifid or trifid point. A diagnosis between lymnaea diaphana and three other lymnaeids which also occur in South America and were previously studied by the author - L. columella, L. viatrix and L. rupestris - is presented.

Physa cubensis Pfeiffer, 1839 (Pulmonata: Physidae)

A description of Physa cubensis Pfeiffer, 1839, based on 15 speciments collected in Havana, Cuba, is presented. The shell, measuring 9.0 x 4,8mm to 12.3 x 6.4mm, is ovate-oblong, thin, diaphanous, horncolored, shining. Spire elevated, broadly conical; protoconch distinct, roundish, reddish-brown. About five moderately shouldered, roundly convex whorls, penultimate whorl expanded; spiral striation subobsolete; growth line faint on the intermediate whorls, clearly visible on the body whorl, crowded here and there. Suture well impressed. Aperture elongated 2.05 - 2.67 (mean 2.27) times as long as the remaining length of the shell, narrow obovulate-lunate; upper half acute-angled, lower half oval, narrowly rounded at the base; outer lip sharp, inner lip completely closing the umbilical region; a thick callus on the parietal wall; columellar plait well marked. Ratios: shell width/shell length - 0.52-0.61 (mean 0.55); spire length/shell length = 0.27 - 0.33 (mean 0.31); aperture length/shell length = 0.67 - 0.73 (mean 0.69). Oral lappets laterally mucronate; foot spatulate with acuminate tail. Mantle relection with 6 - 8 short triangular dentations in the right lobe (columellar side) and 4 - 6 in the left lobe (near the pneumostome). Renal tube tightly folded into a zigzag course. Ovotestis, ovispermiduct, seminal vesicle, oviduct, nidamental gland, uterus and vagina as in Physa marmorata (see Paraense, 1986, Mem. Inst. Oswaldo Cruz, 81: 459-469). Spermathecal body egg-shaped or pear-shaped; spermathecal ducta uniformly narrow with expanded base, a little longer than the body. Spermiduct, prostate and vas deferens as in P. marmorata (Paraense, loc. cit.). Penis wide proximally, narrowing gradually apicad; penial canal with subterminal outlet. Penial sheath following the width of the penis and ending up by a bulbous expansion somewhat narrower than the proximal portion. Penaial sheath/prepuce ration = 1,25 - 1,83 (mean 1.49). Prepuce much wider than the bulb of the penial shealth, moderately shouldered owing to the intromission of the bulb, and with a large gland in one side of its proximal half occupating about a third of its length. Extrinsic muscles of the penial complex as in P. marmorata. Jaw a simple obtusely V-shaped plate. Radula to be described separetely.

Observations on the morphology of Pomacea lineata (Spix, 1827) (Mollusca, Ampullariidae)

This paper deals with the morpholgy of Pomacea lineata (Spix, 1827) collected at its type locality. The shell is globose, moderately heavy, horn-colored with brown spiral bands; apex subelevated; 4 - 5 rounded whorls increasing in diameter rather rapidly, separated by deep suture. Aperture large and ovoid; outer lip sharp; umbilicus narrow and deep; operculum concentric, corneous. Ratios: shell width/shell length = 0.74 - 0.83 (mean 0.78); spire length/shell length = 0.10 - 0.18 (mean 0.13); aperture length/shell length = 0.70 - 0.77 (mean 0.73). The animal is longisiphonate. Renal organ brownish with marked invagination at its right edge. Ureter elongated with its long axis transverse to the main axis of the kidney. The radula is taenioglossate (2.1.1.1.2) and has on average 35 transverse rows of teeth. The form and arrangement of the radula teeth are nearly the same as in other Ampullariidae. The testis is cream-colored and lies in the first three whorls of the spire. Spermiduct uniformly narrow, running to the base of the spire. Seminal vesicle whitish, slightly pressed dorsoventrally. Prostate cylindric and thick, similar in color to the testis. Penis whiplike, with a closed circular spermiduct. Penis pouch ovoid completely envelping the penis. Penis sheath elongated, broad prosimally, tapering distally. Its inner surface shows a longitudinal channel along its proximal half and two glands, one on the middle and the other apical. Ovary composed of branched whitish tubules situated on the surface of the digestive gland. Oviduct slender running along the columellar axis toward the base of the spire. Seminal receptalble tubiform, thick-walled and rounded proximally. Albumen gland large, pink, enclosing the receptacle and the spiral capsule gland. Vestigial male copulatory apparatus (penis and its sheath) present in all females examined.

Comparison of pathologic changes in mammalian hosts infected with Schistosoma mansoni, S. japonicum and S. haematobium

The hepatic, intestinal and cardiopulmonary lesions produced by Schistosoma mansoni, S. haematobium and S. japonicum in man and experimental animals often bear striking similarities but usually have distinctive features as well. These are often related to parasitologic differences. Thus S. japonicum and S. haematobium lay their eggs in clusters which elicit the formation of large composite granulomas. The worms of these two species also tend to be sedentary, remaining in a single location for prolonged periods, thus producing large focal lesions in the intestines or urinary tract. Worm pairs of these two species also are gregarious and many worm pairs are often found in a single lesion. The size of circumoval granulomas, and the degree of fibrosis, are T cell dependent. The modulation of granuloma size is largely T cell dependent in mice infected with S. mansoni but is mostly regulated by serum factors in S. japonicum infected mice. In spite of these differences in egg laying and immunoregulation both S. mansoni and S. japonicum produce Symmers' fibrosis in the chimpanzee while S. haematobium does not, despite the presence of numerous eggs in the liver.

On Pomacea sordida (Swainson, 1823) (Prosobranchia, Ampullariidae)

A description of Pomacea sordida (Swainson, 1823) collected in Caxias and Nova Iguaçu, state of Rio de Janeiro, is presented. The shell is globose, heavy, whith greenish or horn-colored periostracum and dark spinal bands; apex subelevated, 4-5 moderately shoudered whorls, increasing rather rapidly and separated by deep suture. Aperture large, moderately round, yellowish or violaceous; lip thick and sometimes dark brown; umbilicus large and deep; operculum corneous and heavy, entirely closing the aperture. Ratios: shell width/shell length = 0.81-0.91 (mean 0.86); aperture length/shell length = 0.66-0.75 (mean 0.70). Testis, spermiduct and penis pouch as in Pomacea lineata (Spix, 1827). Seminal vesicle whitish and bean-shaped. Prostate cylindric and narrow, cream in coloar as the testis. Penis whiplike whith a closed circular spermiduct. Penial sheath elongated and tapered, with its distal tip turned to the right; outer basal gland situated on the left; inner median gland rounded; apical gland elongated and wrinkled. Ovary composed of branched whitish tubules lying superficially on the digestive gland; oviduct and seminal receptacle as in P. lineata; albumen gland yellowish - orange. Vestigial male copulatory apparatus (penis and its sheath) present in all females examined.

Biomphalaria obstructa (Morelet, 1849): a study of topotypic specimens (Mollusca: pulmonata: planorbidae)

A description of Biomphalaria obstructa (Morelet, 1849), based on specimens collected at its type locality - isla del carmen, state of Campeche, Mexico - is presented. The Shell is small, 13 mm in diameter, 3.5 mm in width and with 5.75 whorls in the largest specimen, thin, moderately lustrous and translucent, horn-colored. Whorls increasing regularly (neither slowly nor rapidly) in diameter, rounded on the periphery side, bluntly angular on the left. Suture well-marked, deeper on the left. Right side widely concave, with first whorl deeply situated and partly hidden by the next. Left side shallower than right one, largely flattened, with first whorl plaintly visible. Aperture roundly heart-shaped, usually in the same plane as the body whorl but somewhat deflected to the left (less frequently to the right) in some specimens. Peristome sharp, seldom blunt; a distinct callus on the parietal wall. A number of young shells develop one set (seldom more) of apertural lamellae which tend to be resorbed as the shell grows. Absence of renal ridge. Ovotestis with about 70 mostly unbrached diverticula. Seminal vesicle beset with well-developed knoblike to fingerlike diverticula. Vaginal pouch more or less developed. Spermatheca club-shaped when empty, egg-shaped when full, and with intermediate forms between those extremes. Spermathecal body usually somewhat longer than the duct. Prostate with 7 to 20 (mean 12.06 ± 2.51) usually short diverticula which give off plumpish branches spreading out in a fan shape and overlapping to some extent their immediate neighbors. Foremost prostatic diverticulum nearly always partially or completely inserted between the spermathecal body and the uterine wall. Penial sheath consistently narrower and shorter than the prepuce. Muscular coat of the penis consisting of an inner longitudinal and an outer circular layers. Ratios between organ lengths: caudal to cephalic parts of female duct = 0.55 to 1.37 (mean 0.85 +- 0.17); cephalic parte of female duct to penial complex = 1.36 to 2.81 ((mean 1.90 +- 0.33); penial sheath to prepuce = 042 to 0.96 (mean 0.67 +- 0.13). Comparison with Morelet’s type specimens of Planorbis orbiculus and P. retusus points to the identity of those nominal species with B. obstructa.

Dynamics of fibrosis production and resorption in intestinal schistosomiasis of mice

A histological, morphometric and immunocytochemical study of schistosomal periovular granulomas in the liver and intestines of mice revealed that intestinal granulomas are smaller and contain less collagen than those in the liver. After curative treatment intestinal granulomas undergo a relatively more rapid resorption, although the general pattern of collagen degradation apparently does not differ from that observed in the liver. Tendency to form scattered, usually isolated granulomas that are only mildly fibrogenic, coupled with a well-balanced process of resorption appear as the explanation why intestinal fibrosis is not an outstanding feature of schistosomiasis as it is in the liver.

The role of cytokines in the pathogenesis of hepatic granulomatous disease in Schistosoma mansoni infected mice

Cytokines are important in the cell-mediated response to Schistosoma mansoni eggs. We have found that Th2 cytokine responses (e.G. IL-4 and IL-5) are argumented after egg laying begins while the response (IL-2 and IFN-*) are down regulated in S. mansoni infected mice. Treatment of mice with anti-IL-5 monoclonal antibodies (Mab) suppressed the eosinophil response almost completley but did not affect granuloma size and slightly increased hepatic fibrosis. Anti-IL-4 treatment abolished IgE responses in infected mice and decreased hepatic fibrosis slightly. Anti-IFN-* treatment had no effect on hepatic pathology. Anti-IL-2 treatment decreased granuloma size significantly and decreased hepatic fibrosis markedly. Anti-IL-2 treatment dramatically decreased IL-5 secretion by splenic cells in vitro and decreased peripheral blood and tissue eosinophilia. In contrast IL-4 secretion was unaffected and serum IgE was normal or increased. IL-2 and IFN-* secretion by splenic cells of treated mice were slightly but not significantly increased suggesting that anti-IL-2 treatment affecting Th2 rather than Th1 responses.

Molecular and cellular basis of hepatic fibrogenesis in experimental schistosomiasis mansoni infection

Morbidity in schistosomiasis mansoni occurs primaryly as a result of the complications of hepatic fibrosis. Yet, the pathogenesis of schistosomal hepatic fibrosis is poorly understood. The fact that hepatic egg granuloma is the hallmark of this infection suggests a potential role for granulomatous inflamation in hepatic fibrogenesis. Our studies in a murine schistosomiasis model indicate that hepatic granuloma cells secrete a variety of fibrogenic cytokines that may initiate the scarring process. Among these cytokines, we identified a novel protein that we designated fibroplast stimulating factor-1 (FsF-1). FsF-1 is a lymphokine that can stimulate fibroplast growth and matrix synthesis. A notable feature of hepatic fibrosis in this model is that production of FsF-1 and other granuloma-derived fibrogenic cytokines is down-regulated in chronic infection, an event that may be under immunological control. The spontaneous reduction of FsF-1 secretion presumably accounts for reduced scar formation late in infection of mice. In the context of relevant clinical studies, our findings engender the hypothesis that Symmer's fibrosis may develop in a small suppopulation of individuals as a result of immunogenetically-determined dysregulation of fibrogenic cytokine production.

Effector functions of eosinophils in schistosomiasis

The dual function of eosinophils is clearly illustred in schistosomiasis. Well equipped in membrane receptors for immunoglobulins and complement, and due to the presence of granule basic proteins, eosinophils can become cytotoxic for parasite larvae and thus participate to protective immunity. However mediators can also exert their cytolytic effect on normal cells or tissues, inducing therefore pathology. Through ADCC mechanisms against schistosome larvae in vitro involving different antibody isotypes (IgG, IgE and IgA) and also in experiments performed in vivo, eosinophils have been clearly involved in protective immunity. Although no direct evidence of the protective role of eosinophils were brought in humans, the striking association of eosinophil-dependent cytotoxic antibody isotypes with resistance to reinfection (for instance IgE and IgA antibodies), whereas in vitro blocking antibody isotypes (IgG4, IgM) were detected in susceptible subjects, strongly, suggested the participation of eosinophils in antibody-dependent protective immune response. However eosinophils could also participate to granuloma formation around S. mansoni eggs and consequently to the pathological reactions induced by schistosomiasis.

Avaliação crítica da cirurgia na hipertensão portal esquistossômica

There are over 100.000 patients affected by schistosomotic portal hipertension, that may suffer rupture of the esophageal varices. Besides the portal hypertension, local factors must be emphazised as responsible for the three distal centimeters of the esophagus, called "zona vulnerável" (vulnerable zone). The beter liver functional reserve of these schistosomotic patients as compared to the cirrhotic, present two favorable condititions: (1) beter possibility of conservative treatment during acute hemorrhage; (2) elective surgical treatment may be undergo without a mandatory step of large portal descompression. The Author only indicate surgical treatment in patients with hemorrhage antecedence and his preference consist in splenectomy plus obliterative suture of the varices at the "vulnerable zone" and when possible, ligature of left gastric vein also; 358 patients were undergone surgery with operative mortality 3.07%, 347 were followed during 1 to 25 years; late mortality 8.38%; recurrence hemorrage 11.58%; none porto-sustemic encephalopaty was observed.