Hepatic echinococcosis:Clinical and therapeutic aspects

Echinococcosis or hydatid disease （HD） is a zoonosis caused by the larval stages of taeniid cestodes belong- ing to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoc- cus multilocularis （E. multi/ocular/s） and Echinococcus granulosus （E. granulosus） infection, respectively. Cys- tic echinococcosis （CE） has a worldwide distribution, while hepatic alveolar echinococcosis （AE） is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the per/cyst; old cysts typically present internal septa- tions and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration （PAIR）] and more effective drugs （such as benzoimidazoles） have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.

Arthroereisis in juvenile flexible flatfoot:Which device should we implant?A systematic review of literature published in the last 5 years

BACKGROUND Flexible flatfoot(FFF)is a very common condition in children,characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot.Arthroereisis(AR)procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop(CS).AIM We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients.We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population,young athletes,and obese people according to material device.METHODS Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses,a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6,2020.The research string used was(pediatric OR children OR Juvenile NOT adult)AND(flexible NOT rigid)AND(flat foot OR pes planus)AND(calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal).The risk of bias assessment was performed using the Dutch checklist form for prognosis.RESULTS A total of 47 articles were found.Ultimately,after reading the full text and checking reference lists,we selected 17 articles that met the inclusion and exclusion criteria.A total of 1864 FFFs were identified.Eight studies concerned the subtalar AR(47.1%)and nine concerning CS(52.9%).The average age of patients at start of treatment was 11.8 years,the average follow-up of the studies was 71.9 mo(range 29.1-130).Globally,complications occurred in 153 of the 1864 FFF treated,with a rate of 8.2%.CONCLUSION Both AR procedures are valid surgical techniques for treating FFF.Surgeon experience,implant cost,and cosmetic correction are the most common considerations included in the orthopedic device decision-making process.In obese patients,the subtalar AR is not recommended.In adolescents who need to improve sports performance,the CS screw had better results compared with other implants.