Diagnosis and treatment experience of atypical hepatic cystic echinococcosis type 1 at a tertiary center in China

BACKGROUND Some hydatid cysts of cystic echinococcosis type 1(CE1)lack well-defined cyst walls or distinctive endocysts,making them difficult to differentiate from simple hepatic cysts.AIM To investigate the diagnostic methods for atypical hepatic CE1 and the clinical efficacy of laparoscopic surgeries.METHODS The clinical data of 93 patients who had a history of visiting endemic areas of CE and were diagnosed with cystic liver lesions for the first time at the People's Hospital of Xinjiang Uygur Autonomous Region(China)from January 2018 to September 2023 were retrospectively analyzed.Clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis,routine abdominal ultrasound,high-frequency ultrasound,abdominal computed tomography(CT)scan,and laparoscopy.Subsequent to the treatments,these patients underwent reexaminations at the outpatient clinic until October 2023.The evaluations included the diagnostic precision of diverse examinations,the efficacy of surgical approaches,and the incidence of CE recurrence.RESULTS All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scan.Among them,16 patients were preoperatively diagnosed with atypical CE1,and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound.All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy,of whom 14 patients were intraoperatively confirmed to have CE1,which was consistent with the postoperative pathological diagnosis,one patient was diagnosed with a mesothelial cyst of the liver,and the other was diagnosed with a hepatic cyst combined with local infection.Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts,4 received aspiration sclerotherapy of hepatic cysts,and 19 received laparoscopic fenestration.These patients were intraoperatively diagnosed with simple hepatic cysts.During the followup period,none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices.One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space.CONCLUSION Abdominal high-frequency ultrasound can detect CE1 hydatid cysts.The laparoscopic technique serves as a more effective diagnostic and therapeutic tool for CE.

Coinfection with hepatic cystic and alveolar echinococcosis with abdominal wall abscess and sinus tract formation:A case report

BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.

Coexistence of liver abscess, hepatic cystic echinococcosis and hepatocellular carcinoma: A case report

BACKGROUND Human cystic echinococcosis(CE)is a life-threatening zoonosis caused by the Echinococcus granulosus(sensu lato).Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality in the world.The coexistence of CE and HCC is exceedingly rare,and only several well-documented cases have been reported.In addition to this coexistence,there is no report of the coexistence of CE,HCC,and liver abscess to date.Herein,we aimed to report a case of coexistence of liver abscess,hepatic CE,and HCC.CASE SUMMARY A 65-year-old herdsman presented to the department of interventional therapy with jaundice,right upper abdominal distension and pain for 10 d.Laboratory test showed that he had positive results for HBsAg,HBeAb,HBcAb,and echino-coccosis IgG antibody.The test also showed an increased level of alpha fetopro-tein of 3400 ng/mL.An abdominal computed tomography(CT)scan revealed an uneven enhanced lesion of the liver at the arterial phase with enhancement and was located S4/8 segment of the liver.In addition,CT scan also revealed a mass in the S6 segment of the liver with a thick calcified wall and according to current guideline and medical images,the diagnoses of hepatic CE(CE4 subtype)and HCC were established.Initially,transarterial chemoembolization was performed for HCC.In the follow-up,liver abscess occurred in addition to CE and HCC;thus,percutaneous liver puncture drainage was performed.In the next follow-up,CE and HCC were stable.The liver abscess was completely resolved,and the patient was discharged with no evidence of recurrence.CONCLUSION This is the first reported case on the coexistence of liver abscess,hepatic CE,and HCC.Individualized treatment and multidisciplinary discussions should be performed in this setting.Therefore,treatment and diagnosis should be based on the characteristics of liver abscess,hepatic CE,and HCC,and in future clinical work,it is necessary to be aware of the possibility of this complex composition of liver diseases.

Historical changes in surgical strategy and complication management for hepatic cystic echinococcosis

Echinococcosis is a zoonotic parasitic disease caused by Escherichia larvae.It frequently involves the liver(70%-75%),followed by the lungs(15%-20%),and occasionally the brain,heart,spleen,bone,and other organs.The main pathogenic forms of human echinococcosis currently include cystic echinococcosis(CE)and alveolar echinococcosis(AE).CE is globally distributed,while the distribution of AE is generally restricted to the northern hemisphere.In China,CE accounts for 75%of all echinococcosis cases.With rapid advances in surgical techniques in recent decades,the surgical strategy for CE has changed,especially with the continuous improvement of surgical methods and the expansion of surgical contraindications.To further understand the changes in surgical treatment strategies for hepatic CE,we interpreted and analyzed the existing literature addressing the surgical treatment of hepatic CE both domestically and abroad and briefly summarized them in chronological order.This review aims to provide a deeper understanding of the progress in the surgical treatment of hepatic CE to provide clearer avenues for its clinical diagnosis and treatment.

Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report

BACKGROUND Hepatic cystic echinococcosis(CE)is an infectious zoonotic parasitic disease,and the insidious onset and slow progression of hepatic CE usually contributes to delayed diagnosis and treatment.Hepatocellular carcinoma(HCC)is the fourth most common malignant tumor.Co-existence of CE and HCC is fairly rare in clinical settings and the association between the two is still not well recognized.We report a case of hepatic CE complicated with HCC which are radically resected and raise some questions worth thinking about.CASE SUMMARY A 70-year-old man presented with upper abdominal pain.On admission,laboratory data showed that,except for hepatitis B surface antigen positivity,other indicators were normal,including alpha-fetoprotein.Computed tomography of the abdomen revealed a huge polycystic lesion in left liver lobe,without reinforcement after enhanced scanning and sized about 16.9 cm×12.2 cm,which was considered a type II hydatid cyst.Multiple small solid lesions were also found adjacent to it,and thus it was highly suspected as a malignant tumor.After a multidisciplinary team discussion,the diagnosis of co-occurrence of hepatic CE and HCC was made.According to Romic classification,the case belongs to type IIb,and radical left hemi-hepatectomy was performed.Postoperative pathological examination revealed CE co-existence with welldifferentiated HCC,consistent with the preoperative diagnosis.CONCLUSION With the combination of hepatitis B and obvious extrusion by large hydatid,the HCC risk of a patient might be higher.

Effects of 1-(2-chlorine)-phenyl-9-butyl-β-carboline(DH-330)on Cystic Echinococcosis in Mice in vivo

[Objectives]The paper was to evaluate the in vivo treatment efficacy of harmine derivative 1-(2-chloro)phenyl-9-butyl-β-carboline(DH-330)on mice cystic echinococcosis(CE).[Methods]Kunming mice were injected intraperitoneally into the protoscoleces and infected with secondary infection for 8 months to prepare CE model.The successfully modeled mice were randomly divided into 6 groups according to their body weight:model group,control-1,-2 groups and experimental-L,-M,-H groups,with 10 mice in each group.The model group was given distilled water and control-1,-2 groups were given 50 mg/kg albendazole and harmine,respectively.The experimental-L,-M,-H groups were given 25,50 and 100 mg/kg DH-330.After 8 weeks of intragastric administration,the mice were dissected and vesicles were taken,and the differences of cyst weight were compared.The ultrastructure changes of cysts were observed by transmission electron microscope(TEM).The histopathology of cysts and liver were observed by hematoxylin-eosin(HE)staining method.[Results]The cyst weight of model group,control-1,-2 groups and experimental-L,-M,-H groups were(34.38±4.32),(11.38±2.37),(15.89±1.31),(16.22±2.30),(11.69±2.95)and(9.78±1.14)g,respectively.Compared between drugs group and model group,the difference was significant(all P<0.05);compared between experimental-H group and harmine group,the difference was significant(P<0.05).Except for the model group and experimental-L group,all other groups can damage the hydatid nuclei,which lead to cell lysis and nucleoli disappear.Experimental groups can improve inflammatory cells infiltration in liver and vesicle.[Conclusions]DH-330 can reduce the cysts weight of CE mice,inhibit the growth of hydatid,and improve the inflammation of the liver and vesicles,showing a good resistance against Echinococcus granulosus,or may become an effective new drug against hydatid disease.

In vivo therapeutic effects of albendazole in combination with IFN-on cystic echinococcosis in mice

Objective:This study was aimed to evaluate the in vivo therapeutic effects of the combination of ABZ with interferon(IFN)-αon cystic echinococcosis(CE)in mice.Methods:After 5-month secondary infection with protoscolices,Balb/c mice were randomly divided into four groups:ABZtreated group,IFN-α-treated group,ABZ+IFN-αgroup and untreated control group.Drugs in different treated groups were respectively administered for 2 months.Blood was respectively taken from caudal veins in mice at treatment time points of 0 d,7 d,14 d,28 d,36 d,48 d and 60 d,in order to detect the changes in the level of antibodies in the serum.Mice were then sacrificed after the end of treatment,and related indicators were detected to evaluate the therapeutic effects.Results:In comparison with untreated control group(p<.01)and ABZ-treated group(p<.05),ABZ+IFN-αgroup showed a more significant decrease in the number of cysts,cyst size and cyst weight.After transmission electron microscopy(TEM)of the cysts in different treated groups,it was found that,there was an obvious change in cyst ultrastructure in ABZ+IFN-αgroup.ELISA experimental results showed that,in ABZ+IFN-αgroup,there was a significant decrease in IL-10 in serums and splenocytes(p<.01);In comparison with untreated control group,ABZ+IFN-αgroup showed a more significant decrease in the levels of IgE,IgG and its subtypes(p<.01).Conclusions:In this study,the combination of ABZ with IFN-αwas proved to be an effective CE treatment option.

Human cystic echinococcosis:epidemiologic,zoonotic,clinical,diagnostic and therapeutic aspects

This review represents an updated scenario on the transmission cycle,epidemiology,clinical features and pathogenicity,diagnosis and treatment,and prevention and control measures of a cestode parasite Echincoccus granulosus(E.granulosus) infection causing cystic echinococcosis (CE) in humans.Human CE is a serious life-threatening neglected zoonotic disease that occurs in both developing and developed countries,and is recognized as a major public health problem. The life cycle of E.granulosus involves a definitive host(dogs and other canids) for the adult E.granulosus that resides in the intestine,and an intermediate host(sheep and other herbivores) for the tissue-invading metacestode(larval) stage.Humans are only incidentally infected;since the completion of the life cycle of E.granulosus depends on carnivores feeding on herbivores bearing hydatid cysts with viable protoscoleces,humans represent usually the dead end for the parasite.On ingestion of E.granulosus eggs,hydatid cysts are formed mostly in liver and lungs, and occasionally in other organs of human body,which are considered as uncommon sites of localization of hydatid cysts.The diagnosis of extrahepatic echinococcal disease is more accurate today because of the availability of new imaging techniques,and the current treatments include surgery and percutaneous drainage,and chemotherapy(albendazole and mebendazole).But.the wild animals that involve in sylvatic cycle may overlap and interact with the domestic sheepdog cycle,and thus complicating the control efforts.The updated facts and phenomena regarding human and animal CE presented herein are due to the web search of SCI and non-SCI journals.

Cystic echinococcosis of the liver: A primer for hepatologists

Cystic echinococcosis(CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptom-atic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the "watch and wait" approach for inactive cysts. Allocation of patients to these treat-ments should be based on cyst stage, size and location, available clinical expertise, and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated. This paper reviews recent advances in classification and diagnosisand the currently available evidence for clinical deci-sion-making in cystic echinococcosis of the liver.

Successful robotic radical resection of hepatic echinococcosis located in posterosuperior liver segments

BACKGROUND Radical resection is an important treatment method for hepatic echinococcosis.The posterosuperior segments of the liver remain the most challenging region for laparoscopic or robotic hepatectomy.AIM To demonstrate the safety and preliminary experience of robotic radical resection of cystic and alveolar echinococcosis in posterosuperior liver segments.METHODS A retrospective analysis was conducted on the clinical data of 5 patients with a median age of 37 years(21-56 years)with cystic and alveolar echinococcosis in difficult liver lesions admitted to two centers from September to December 2019.The surgical methods included total pericystectomy,segmental hepatectomy,or hemihepatectomy.RESULTS Among the 5 patients,4 presented with cystic echinococcosis and 1 presented with alveolar echinococcosis,all of whom underwent robotic radical operation successfully without conversion to laparotomy.Total caudate lobectomy was performed in 2 cases,hepatectomy of segment Ⅶ in 1 case,total pericystectomy of segment Ⅷ in 1 case,and right hemihepatectomy in 1 case.Operation time was 225 min(175-300 min);blood loss was 100 mL(50-600 mL);and postoperative hospital stay duration was 10 d(5-19 d).The Clavien-Dindo complication grade was Ⅰ in 4 cases and Ⅱ in 1 case.No recurrence of echinococcosis was found in any patient at the 3 mo of follow-up.CONCLUSION Robotic radical surgery for cystic and selected alveolar echinococcosis in posterosuperior liver segments is safe and feasible.

Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation:An ex-vivo pilot experimental study in animal models

AIM： To evaluate radiofrequency thermal ablation （RTA） for treatment of cystic echinococcosis in animal models （explanted organs）. METHODS： Infected livers and lungs from slaughtered animals, 10 bovine and two ovine, were collected. Cysts were photographed, and their volume, cyst content, germinal layer adhesion status, wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound. Some cysts were treated with RTA at 150 W, 80℃, 7 min. Temperature was monitored inside and outside the cyst. A second needle was placed inside the cyst for pressure stabilization. After treatment, all cysts were sectioned and examined by histology. Cysts were defined as alive if a preserved germinal layer at histology was evident, and as successfully treated if the germinal layer was necrotic. RESULTS： The subjects of the study were 17 cysts （nine hepatic and eight pulmonary）, who were treated with RTA. Pathology showed 100% success rate in both hepatic （919） and lung cysts （8/8）; immediate volume reduction of at least 65%; layer of host tissue necrosis outside the cyst, with average extension of 0.64 cm for liver and 1.57 cm for lung; and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts. CONCLUSION： RTA appears to be very effective in killing hydatid cysts of explanted liver and lung. Bile duct and bronchial wall necrosis, persistence of endocyst attached to pericystium, should help avoid or greatly decrease in v/vo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration, injection and reaspiration. In vivo studies are required to confirm and validate this new therapeutic approach.

Epidemiological Studies on Cystic Echinococcosis in China─A Review

In the four decades from 1951 to 1990, the six provinces or autonomous regions (Xinjiang, Gansu, Qinghai, Ningxia, Xizang and Nei Monggol) reported a total of 26 065surgical cases of hydatid disease, most of which were reported in the recent decade. About one third of the patients was children and adolescents under 15 years old. So far, cystic hydatid infections of local origin have been confirmed in 22 provinces, autonomous regions and municipalities in the whole nation. Findings of X-ray examination and real-time B-mode ultrasonography in agricultural and pastoral areas of Xinjiang, Gansu, Qinghai,Ningxia and Xizang showed that the morbidity rate of hydatidosis in human population varied between 0.5% and 4.5%. The main animal intermediate host in all these regions is sheep, the morbidity of which varied between 3.3% and 90%. The infection rate of adult Echinococcus granulosus in dogs varied between 7% and 71%. The high-risk period for humans contracting hydatid disease is the pre-school age. Direct contact of children with dogs and ingestion of water, vegetables and foods contaminated by worm eggs are the chief mode of transmission for human hydatidosis. The common practices of home slaughter and of feeding dogs on offal containing hydatid cysts facilitate the life cycIe of the parasite.On the basis of hydatid control efforts for several years, the Ministry of Public Health promulgated officially the '1992-1995 National Programme for Hydatid Disease Control'in April, 1992, and pilot studies in which the control of hydatidosis is composed of extensive health education, sanitation of slaughtering and management and deworming of dogs are being established.Cystic echinococcosis has wide distribution in China and is a major public health problem in hyperendemic areas, poses a great threat against people's health and influences the development of livestock husbandry. This problem has received great attention from the medical and veterinary departments. In the rencent decade great efforts have been made in the epidemiology, parasitology and clinical treatment of echinococcosis, resulting in a better understanding of the disease and procedures effective in bringing about control of the disease

Evaluation of Usefulness of Three Serological Tests Using Native Crude Antigen in Diagnosis of Hepatic Cystic Echinococcosis Patients

Objective: To evaluate three different serological tests [Indirect Hemaglutination (IHA), Enzyme Linked Immunosorbent Assay (ELISA) and Western Blotting (WB)] using native crude antigen for diagnosis of hepatic cystic echinococcosis (HCE) patients. Materials and Methods: Sheep hydatid fluid (HF) was collected from fertile cysts obtained from a slaughterhouse and used as an antigen. Forty patients who were attended the Dr. Ersin Arslan Training and Research Hospital in Gaziantep, Turkey, were investigated. Serum samples were obtained from surgically confirmed CE patients. Healthy Turkish people and 16 patients with other helminthic infections were included as a control group. Results: Of the 40 analyzed patients, 10 (25%) were men and 30 (75%) were female. The average age was 46.97 years (s.d.;18.95). The majority of the patients had a single cystic lesion situated in one lobe of the liver (usually in the right lobe) (55%), 32.5% of patients had two cystic lesions and 12.5% of patients had multiple cyst formations with various numbers. In all cases, ultrasound (US) examinations were positive and the size of cysts was between 2.1 - 12.7 cm. Twenty-three patients of the total 40 patients were classified according to the WHO classification system based on US findings. According to the results of WB analysis, molecular weights of 8 kDa (80%), 12 kDa (80%), 22 - 24 kDa (97.5%), 26 kDa (97.5%), 34 kDa (100%), 36 - 38 kDa (90%), 45 - 50 - 55 kDa (97.5%), and 60 - 75 kDa (97.5%) bands were identified. But 34, 50, and 55 kDa bands were also found in other helminthic diseases. Conclusion: The specificity and sensitivity of three serological tests (IHA, ELISA and WB) using crude antigen were compared by diagnosing hepatic cystic echinococcosis patients. IHA and ELISA showed high sensitivity but low specificity. Western blotting showed low sensitivity but high specificity.

Study of Infection of Echinococcus granulosus in Yak in Spring and Its Potential Role in Transmission of Cystic Echinococcosis in Rangtang County of Sichuan,China

Dear Editor, Cystic echinococcosis （CE）, caused by Echinococcus granulosus in larval stage, is considered as one of the most dangerous parasitic zoonosis in the world. The obligate 2-host parasitic cycle of Echinococcus granulosus is predominantly synanthropic. Dogs are the usual definitive hosts, and lots of mammalian species can be intermediate hosts, including domestic livestock and human[I2]. In the Tibetan plateau, China, the population is mainly Tibetans primarily engaged in livestock husbandry and CE is therefore a health problem for both people and animal in Tibetan communities. The reported infection rate of Echinococcus gronulosus in slaughtered yak in slaughterhouses is usually very high, being about 50% or higher as reported, and the liver and lungs are the main affected organs[34].

Clinical and molecular features of human cystic echinococcosis in Tehran,Iran,2011-2019

Objective:To evaluate the clinical and molecular features of human cystic echinococcosis in Tehran,Iran.Methods:In this cross-sectional study,all human cystic echinococcosis patients admitted to Tehran’s hospitals from 2011 to 2019 were enrolled,and demographic characteristics,clinical findings,and laboratory data were collected.Formalinfixed,paraffin-embedded and fresh tissue samples of 175 cystic echinococcosis patients were evaluated for molecular characterization.The samples’isolated DNA was used to amplify cytochrome c oxidaseⅠand NADH dehydrogenase subunitⅠgenes.Also,the morphological features of fresh samples were examined.Results:In total,175 patients with a mean age of 45(9-98)years were admitted to Tehran’s hospitals diagnosed with cystic echinococcosis.Moreover,the highest(26.9%)and the lowest(2.9%)prevalence of cystic echinococcosis cases were in the 16-30 and 1-15 years range,respectively.Male/female ratio was 0.96(49.1%vs.50.9%).The liver was affected in 92 patients(52.6%),and two or more organs were infected in 7 patients(4.0%).The cysts’diameter varied from 1 to 25 cm,and 96.0%of the patients had a single hydatid cyst.All patients underwent radical surgery and the PAIR technique was applied for all cases.No significant difference was observed between the protoscolex hooks of pulmonary and hepatic cysts.G1-G3 had the highest percentage(99.4%)over other identified G6 genotypes(0.6%).Conclusions:The sheep-dog cycle plays an important role in transmitting the human cystic echinococcosis infection in Tehran.

Identification of a gene engineering antibody against cystic echinococcosis in liver

OBJECTIVE: To identify a gene engineering antibody against cystic echinococcosis in liver. METHODS: A single chain of variable fragment of human antibodies (ScFvs) was selected from the library by using affinity selection technique with the recombinant antigen on solid surface. The positive clones were demonstrated by ELISA and their DNA sequences were also determined. RESULTS: The DNA sequence data showed that the antibody gene is composed of 768bp. In addition, a specific combination capacity with recombinant Echinococcus granulosus antigen B (r-EgB) was demonstrated by ELISA. CONCLUSION: The obtained gene engineering antibody against r-EgB may have potential implications in immunological treatment and drug targeting delivery.

Incurable and refractory spinal cystic echinococcosis: A case report

BACKGROUND Although the incidence and cure rate of spinal hydatidosis are low,the recurrence rate of spinal hydatidosis is high,and the prognosis of spinal hydatidosis is poor.Therefore,we report a typical case of refractory spinal hydatidosis to increase spine surgeons’awareness of the disease and reduce misdiagnosis and recurrence.CASE SUMMARY A 48-year-old man presented with back pain,significant weight loss,and paralysis of both lower limbs.The patient was misdiagnosed with spinal tuberculosis in an outside hospital.However,spinal magnetic resonance imaging(MRI)showed hyperintense cystic components on T2-weighted images and hypointensity on T1-weighted images.A lobulated,multiocular,honeycombappearance,septated cystic mass protruding intraspinally and compressing the spinal cord at segments T8–T9 was present.Paravertebral polycystic lobular lesions presented as a“bunch of grapes”.The ELISA test result for Echinococcus granulosus was positive.Then,a diagnosis of spinal hydatidosis and lung hydatid disease was made,and the patient underwent left transthoracic approach lobectomy,paravertebral lesion debridement,and subtotal vertebrectomy with vertebral body replacement of segments T8 and T9 by a mesh cage.The patient also underwent albendazole chemotherapy before and after surgery.One year after stopping the drug therapy,the patient developed recurrent T5 vertebral lesions and underwent a second subtotal vertebrectomy surgery.The patient is currently in good condition and is receiving long-term medication and follow-up.CONCLUSION The MRI feature of a“bunch of grapes”is a typical imaging indication of spinal hydatidosis.Subtotal vertebrectomy is a risk factor for postoperative recurrence.Total spondylectomy makes it possible to cure spinal hydatidosis,but antiparasitic drug therapy is also an important supplementary therapy to multimodal therapy.It is preferable for patients with spinal hydatidosis to receive life-long antiparasitic medication therapy and follow-up.

Diagnosis and treatment of mixed infection of hepatic cystic and alveolar echinococcosis:Four case reports

BACKGROUND Mixed infection of hepatic cystic and alveolar echinococcosis is extremely rare.This article reveals the typical imaging manifestations of cystic and alveolar echinococcosis and investigates the diagnosis and surgical experience of mixed infection of hepatic cystic and alveolar echinococcosis.CASE SUMMARY From January 2017 to May 2019,4 cases with rare mixed infection of hepatic cystic and alveolar echinococcosis were admitted and treated by the Division of General Surgery of Qinghai Provincial People’s Hospital.Three of the patients occasionally had upper abdominal discomfort,but it did not affect their daily lives.However,hepatic echinococcosis was found in one patient by physical examination,and the patient had no discomfort.All 4 cases were Tibetans who had lived in pastoral areas of southern Qinghai for a long time.Enzyme-linked immunosorbent assay for echinococcosis was positive for all patients.Moreover,abdominal computed tomography showed typical imaging manifestations of cystic and alveolar echinococcosis including coexisting"honeycomb sign,"and"spotted calcification."Three of the patients underwent radical resection,and 1 case underwent palliative resection.All 4 patients developed different types of surgical complications after the operation,but all of them recovered and were discharged after symptomatic treatment.CONCLUSION There are no problems diagnosing mixed infection of hepatic cystic and alveolar echinococcosis.The difficulties involve preoperative evaluation and treatment of surgical complications.

Multiple recurrent cystic echinococcosis with abdominal aortic involvement: A case report

BACKGROUND Recurrent cystic echinococcosis(CE)with vital organ involvement is a challenge for clinicians.Herein,we report a case of aortic involvement in recurrent retroperitoneal CE lesions following primary splenic CE resection.CASE SUMMARY A 60-year-old male was admitted due to progressive abdominal pain and poor appetite.He was diagnosed with multiple recurrent CE with abdominal aortic involvement according to preoperative evaluation.During surgical resection,major aortic bleeding accidentally occurred while dissecting the cyst,which was firmly attached to the abdominal aortic wall.Hemostasis attempts were conducted to deal with this emergency situation and maintain circulation.Postinterventional recovery was uneventful,and 2-year follow-up showed no sign of recurrence or any other complications.CONCLUSION Radical resection of recurrent complicated CE with aortic involvement should be carefully planned and performed to prevent possible severe adverse complications,thereby improving the postoperative outcome.

Evaluation of Hepatic Cystic Echinococcosis’ CT image in Xinjiang Uygur Autonomous Region based on Kolmogorov Complexity Model

Designing and developing computer-assisted image processing techniques to help doctors improve their diagnosis has received considerable interests over the past years. In this paper, we used the kolmogorov complexity model to analyze the CT images of the healthy liver and multiple daughter hydatid cysts. Before the complexity characteristic calculating, the image preprocessing methods had been used for image standardization. From the kolmogorov complexity model, complexity characteristic were calculated in order to quantify the complexity, between healthy liver and multiple daughter hydatid cysts. Then we use statistical method to analyze the complexity characteristic of those two types of images. Our preliminary results show that the complexity characteristic has statistically significant (p<0.05) to analyze these two types CT images, between the healthy liver and the multiple daughter hydatid cysts. Furthermore, the result leads us to the conclusion that the kolmogorov complexity model could use for analyze the hydatid disease and will also extend the analysis the other lesions of liver.