Percutaneous aspiration and drainage with adjuvant medical therapy for treatment of hepatic hydatid cysts

AIM:To determine the efficacy and success of percutaneous aspiration irrigation and reaspiration(PAIR) in the management of hepatic hydatidosis.METHODS:Twenty-six patients with 32 hepatic hydatid cysts had PAIR.Twenty-two patients received at least 2 wk of drug therapy before the procedure was carried out to reduce the risk of recurrence from spillage during the procedure.The procedure was performed under local anesthesia with a 19-gauge 20 cm long needle,the cyst was punctured,cystic content(approximately 30 mL) was aspirated by a 12-14 F pigtail catheter and aspirated fluids were sent for analysis.Once the cyst was almost empty,two-thirds of the net amount of material aspirated was replaced by hypertonic saline and left in the cavity for about 30 min,with the catheter left in place for reaspiration of most of the fluid.When the amount of fluid drained was less than 10 mL per 24 h,the drainage catheter was removed.RESULTS:All 32 cysts showed evidence of immediate collapse after completion of the procedure,and before discharge from hospital,ultrasound examination showed fluid reaccumulation in all cysts.Serial follow-up showed a progressive decrease in the size and change in the appearance of cysts.To confirm the sterility of these cystic cavities,seven cysts were reaspirated on average 3 mo after the procedure.Investigations revealed no viable scolices.CONCLUSION:PAIR using hypertonic saline is very effective and safe with proper precautions.

Complicated hydatid cysts of the lung:surgical treatment in Kurdistan of Iraq

Objective:To review the problems encountered in surgical treatment of complicated pulmonary hydatid cysts and to evaluate the functional results in the surgery of complicated hydatid cysts.Methods:The medical records for 89 patients with complicated pulmonary hydatidosis were retrospectively investigated.The series consisted of 47 male and 42 female patients with a mean age of 32±8 years.Study performed during January 2000 to December 2007,all patients were treated surgically.Data related to surgical procedures performed,postoperative morbidity,hospitalization time,and cyst recurrence were collected from each individuals records,and the group findings were compared.Results:Among these cysts,58 were perforated,23 were infected,and 13 were cysts with pleural complications.Cystotomy plus capitonnage was the most frequently performed operative technique(n=43),followed by cystotomy plus closure of bronchial openings(n = 28),pericystectomy plus capitonnage(n=13),decortications(n=7),lobectomy and segmentectomy(n=3).The 11 cases with coexisting liver cysts were approached by right thoracophrenotomy.Postoperative complications developed in 12 patients(13.4%).Conclusion:Surgery is the primary mode of treatment for patients with pulmonary hydatid disease.Complicated cases have higher rates of preoperative and postoperative complications and require longer hospitalization time and more extensive surgical procedures than uncomplicated cases.This underlines the need for immediate surgery in any patient who is diagnosed with pulmonary hydatidosis when it is indicated.

Congenital hepatic cyst:Eleven case reports

BACKGROUND Liver cysts in infants are uncommon.With modern diagnostic imaging,we can achieve an early diagnosis of congenital hepatic cysts.Our purpose was to investigate the clinical features,surgical treatment methods and prognosis of infants with congenital hepatic cysts.Herein,we report a case series of congenital hepatic cysts.CASE SUMMARY Eleven infants with hepatic cysts were retrospectively analysed.Ten of them had simple hepatic cysts,and a girl with a large hepatic mass was diagnosed with a solitary intrahepatic biliary cyst accompanied by a choledochal cyst.Among the ten simple hepatic cysts,eight were solitary and two were multiple.A total of 87.5%(7 of 8)of infants with solitary hepatic cysts were detected before delivery,and 86%(6 of 7)of those cysts were located in the right lobe of the liver.Surgical intervention was required for symptomatic hepatic cysts.Cyst resection or unroofing with fulguration of the cyst bed was employed.No recurrence of cysts was observed in these infants.CONCLUSION Congenital hepatic cyst is a condition with a narrow differential diagnosis.Accurate diagnosis is essential for appropriate management.Unroofing is the favoured treatment in infants with symptomatic cysts.Most infants with congenital hepatic cysts have a good prognosis.

Combined Hepatocardiac Hydatid Cystic Disease

Cardiac echinococcus is a serious problem. Although it is rare, it could cause dangerous complications like anaphylactic shock which could be fatal. In our case a 14-year-old female complained with the intermittent chest pain and had combined cystic lesions in the heart and the liver. The liver cyst was treated conservatively, while the heart cyst was excised by open heart surgery.

Hydatid cyst of the colon:A systematic review of the literature

BACKGROUND Primary hydatid disease in the colon is an extremely rare finding. We performed a systematic review of cases of hydatidosis of the colon published to date. AIM To systematic review the published papers about hydatidosis of the colon. METHODS Following PRISMA guidelines, we performed an unlimited search for articles on CH in the MEDLINE (PubMed), EMBASE, Cochrane, Latindex and Scielo databases, published in English, Spanish, French, German or Italian between January 1, 1960 and December 15, 2018. The search items were:(Colon) AND [(hydatidosis) OR (hydatid disease) OR (echinococcosis)]. RESULTS Nine case reports were found [five men, four women, median age 64.55 years (range: 21-81)]. The most frequent clinical manifestation was abdominal pain (8/9)(88.9%). In almost all cases several image studies were carried out, but abdominal computed tomography was the most used (66.7%). Five resections of the colon (62.5%) and three sutures of the fistula between cyst and colon (37.5%) were performed. Four patients did not present post-operative complications, but one died. Postoperative period was recorded for a mean period of 35 months. No recurrences were recorded. CONCLUSION The most frequent symptom was abdominal pain (evidence level 4). Computed tomography was the most frequently used diagnostic imaging technique (evidence level 4). Colectomy was the most appropriate treatment (evidence level 5). All the diagnostic and therapeutic options for hydatid cysts located in colon have a low level of evidence.

Unexplainable development of a hydatid cyst

Echinococcosis is a cyclozoonosis characterized by cystic lesions usually situated inside or outside the liver. We discuss the case of a 77-year-old woman with a recurrent hydatidosis with a cyst arising from the liver, growing through the lateral right abdomen wall, and reaching the subcutaneous tissue of the lumbar region. In the literature, rare subcutaneous or muscular Iocalizations of hydatid cysts are described, however, there is no mention of a cyst growing over the abdominal wall muscles, shaped like an hourglass, partially in the liver and partially in the subcutaneous tissue, as in our case. We have not found any pathogenetic explanation for this growth pattern which is not typical of the biological behaviour of a hydatid cyst.

Surgical treatment and outcomes of hydatid cyst of the spleen

Aim: Discuss the different modalities of surgical treatment of splenic hydatid cyst and outcomes after treatment. Patients and Methods: Retrospectively, 14 patients were operated in our institution between 2002 and 2011. Results: A total splenectomy was performed in 8 cases. A conservative treatment was preferred in 6 cases: 2 patients underwent partiel splenctomy and two patients underwent partial cystectomy. The duration of hospitalization ranged from 5 to 15 days. The morbidity rate was 14%. One patient presented a recurrent hemorrhage and one patient developed a left pneumonia. There is no death in our series. The mean duration follow-up was 20 months and there is no recurrence. Conclusion: Management of a splenic hydatid cyst is not consensual. Surgery remains the treatment of choice to avoid serious complications. Total splenectomy is optimal because it provides definitive treatment. However, spleen-preserving surgery is the preferred treatment in some selected patients.

Case of takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst: A case report

BACKGROUND Takotsubo cardiomyopathy,also called apical ballooning syndrome,is a disease that is often triggered by stress factors in postmenopausal women and mimics acute coronary syndrome.The aim of this article is to draw attention to takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst.CASE SUMMARY A 50-year-old diabetic and hypertensive female patient was evaluated preoperatively before general surgery for liver hydatid cyst,and no cardiac problems were found.The patient was discharged on the 3rd postoperative day without any postoperative complications.On postoperative day 5,the patient presented to the emergency department with fever,shortness of breath,chills,and shivering and was hospitalized with the diagnosis of pneumonia.The troponin levels remained high during follow-up.Echocardiography was performed on postoperative day 7,after which the patient was referred to a tertiary center with the diagnosis of non-ST-elevation myocardial infarction due to akinesia in the apical region.Coronary angiography performed at the tertiary center showed normal coronary anatomy,and the patient was diagnosed with takotsubo cardiomyopathy.CONCLUSION Takotsubo cardiomyopathy mimicking myocardial infarction without ST segment elevation may develop after surgical treatment of liver hydatid cyst.

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.

Rare cystic liver lesions: A diagnostic and managing challenge

Cystic formations within the liver are a frequent finding among populations.Besides the common cystic lesions,like simple liver cysts,rare cystic liver lesions like cystadenocarcinoma should also be considered in the differential diagnosis.Thorough knowledge of each entity’s nature and course are key elements to successful treatment.Detailed search in PubMed,Cochrane Database,and international published literature regarding rare cystic liver lesions was carried out.In our research are included not only primary rare lesions like cystadenoma,hydatid cyst,and polycystic liver disease,but also secondary ones like metastasis from gastrointestinal stromal tumors lesions.Up-to date knowledge regarding diagnosis and management of rare cystic liver lesions is provided.A diagnostic and therapeutic algorithm is also proposed.The need for a multidisciplinary approach by a team including radiologists and surgeons familiar with liver cystic entities,diagnostic tools,and treatment modalities is stressed.Patients with cystic liver lesions must be carefully evaluated by a multidisciplinary team,in order to receive the most appropriate treatment,since many cystic liver lesions have a malignant potential and evolution.

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.

Treatment of liver hydatidosis:How to treat an asymptomatic carrier?

Liver hydatidosis is the most common clinical presentation of cystic echinococcosis(CE).Ultrasonographic mass surveys have demonstrated the true prevalence,including the asymptomatic characteristic of the majority of cases,providing new insight into the natural history of the disease.This raises the question of whether to treat or not to treat these patients,due to the high and unsuspected prevalence of CE.The high rate of liver/lung frequencies of cyst localization,the autopsy findings,and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion.The decision to treat an asymptomatic patient by surgery,albendazole,or puncture aspiration injection and reaspiration or to wait and watch,is based on conflicting reports in the literature,the lack of complications in untreated patients over time,and the spontaneous disappearance and involution of cysts.All these points contribute to difficulties of individual clinical decisions.The patients should be informed of the reasons and the risks of watchful/waiting without treatment,the possibility of complications,and the risks of the other options.As more information on the natural history of liver hydatidosis is acquired,selection of the best treatment will be come easier.Without this knowledge it would be very difficult to establish definitive rules of treatment.At present,it is possible to manage these patients over time and to wait for the best moment for treatment.Followup studies must be conducted to achieve this objective.

Acute complications of liver hydatidosis: Still associated with significant morbidity

Objective: To detail the pattern of postoperative morbidity in patients with acute complications of liver hydatidosis. Methods: We retrospectively studied all patients with liver hydatidosis, managed in a tertiary university centre between January 2011 and December 2016. Results:Fifty-three patients with cystic liver echinococcosis and a mean age of (43.64±17.54) years were selected. The mean diameter of the cyst was (8.11± 4.84) cm. Thirty-five (66%), 12 (22.6%), 4 (7.5%), and 2 (3.8%) patients had one, two, three, or four cysts, respectively. Nine (17%) patients were admitted in an emergency setting. The surgical approach was by laparotomy in 43 (81.1%) and by laparoscopy in 10 (18.9%) patients. Eleven (20.8%) patients developed postoperative complications: Class Ⅰ - 3 (5.7%), Class Ⅱ - 7 (13.3%), Class Ⅲ -1 (1.9%), Class Ⅳ - 1 (1.9%) patient according to Clavien-Dindo classification. Four (7.5%) patients developed long-term complications. 18 (34%) patients had more than one hospital admissions. Conclusions: Acute complications of the liver hydatid disease are associated with significant post-therapeutic morbidity, which correlates with the cyst's type according to Gharbi classification.

Radical versus conservative surgical treatment of liver hydatid cysts： a meta-analysis

To date, the efficacy of radical surgery （RS） versus conservative surgery （CS） for liver hydatid cysts （LHC） remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.

Treatment of intracranial hydatid cysts

Background Echinococcosis is still endemic in many countries, including China, where it is especially prevalent in the northwest. The aim of this study was to enrich the international literature about the treatment of intracranial hydatid cysts. Methods We retrospectively reviewed the clinical features, radiological manifestations, and surgical outcome of 97 patients with intracranial hydatid cysts, who received surgical treatment at the Neurosurgical Department of First Affiliated Hospital of Xinjiang Medical University from 1985 to 2010 and followed up the patient via sending a questionnaire or telephone contact. Clinical outcome was evaluated using the Karnofsky Performance Scale Index. Results Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases. On the X-ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round-shaped and thin-walled homogeneous low-density cystic lesions without surrounding edema and enhancement were the main findings on computerized tomography （CT） in g5 patients with intraparenchymal hydatid cysts, whi}e two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging （MR0, hydatid cyst presented as a round-shaped low signal lesion in Tl-weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts presented as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulting in two surgery-related mortalities. There was no other additional neurological deficit caused directly by surgery. In 97.2% of the patients, the Karnofsky Performance Scale score was 80 to 90 at the last follow-up. Conclusions Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas for echinococcosis. CT and MRI are the best diagnostic methods and surgery is the treatment of choice for intracranial hydatid cysts.

Ⅰ、Ⅲ、Ⅳ型胶原在肝包虫囊肿周围人体纤维囊壁中的特异性分层表达

探讨Ⅰ、Ⅲ和Ⅳ型胶原在形成肝包虫囊肿周围人体纤维囊壁中的作用及其临床意义。采用免疫组织化学方法检测Ⅰ、Ⅲ和Ⅳ型胶原在40例肝包虫囊肿周围纤维囊壁中表达。Ⅰ、Ⅲ和Ⅳ型胶原在肝包虫囊肿周围纤维囊壁中出现特异性分层表达。靠近虫体侧纤维囊壁中,Ⅰ、Ⅲ和Ⅳ型胶原的表达阳性率分别为500%、375%和400%。靠近肝实质侧纤维囊壁中,Ⅰ、Ⅲ和Ⅳ型胶原的表达阳性率分别为875%、825%和850%。Ⅰ、Ⅲ、Ⅳ型胶原在两层中表达的差异均有显著意义(P<001,P<001,P<001)。肝包虫囊肿周围人体纤维囊壁分层,Ⅰ、Ⅲ和Ⅳ型胶原与肝实质侧纤维囊壁的形成有密切关系。

TGF-β1、TNF-α mRNA在肝包虫囊肿周围人体纤维囊壁中的特异性分层表达

目的探讨TGF鄄β1、TNF鄄αmRNA在形成肝包虫囊肿周围人体纤维囊壁中的作用及其临床意义。方法采用原位杂交方法检测转化生长因子鄄β1(TGF鄄β1)及肿瘤坏死因子鄄α(TNF鄄α)的mRNA在40例肝包虫囊肿周围纤维囊壁中表达。结果TGF鄄β1、TNF鄄α在肝包虫囊肿周围纤维囊壁中出现特异性分层表达。靠近虫体侧纤维囊壁中,TGF鄄β1、TNF鄄α的阳性细胞表达率分别为(10.24±2.90)%、(16.22±2.84)%。靠近肝实质侧纤维囊壁中,TGF鄄β1、TNF鄄α的阳性细胞表达率分别为(37.51±7.45)%、(25.76±5.05)%。TGF鄄β1、TNF鄄α在2层中表达的差异均有显著意义(P<0.01)。靠近肝实质侧纤维囊壁中TGF鄄β1与TNF鄄α之间表达的差异也有显著意义(P<0.05)。结论肝包虫囊肿周围人体纤维囊壁分层,TGF鄄β1、TNF鄄α与肝实质侧纤维囊壁的形成有密切关系。

PDGF、TNF-α在人肝细粒棘球蚴囊壁周围组织的分层表达

采用原位杂交方法检测血小板衍生生长因子 (PDGF )及肿瘤坏死因子α(TNF α )在 4 0例人肝细粒棘球蚴囊肿周围纤维囊壁中表达。结果显示PDGF、TNF α在肝细粒棘球蚴囊肿周围纤维囊壁中出现特异性分层表达。靠近虫体侧纤维囊壁中 ,PDGF、TNF α阳性细胞率分别为 (9 36 %± 2 13% )、 (10 5 2 %± 2 6 4 % )。靠近肝实质侧纤维囊壁中 ,PDGF、TNF α阳性细胞率分别为 (37 5 1%± 7 4 5 % )、 (2 5 76 %± 5 0 5 % )。PDGF、TNF α在两层中表达的均有显著性差异 (P <0 0 1)。同时 ,靠近肝实质侧纤维囊壁中PDGF与TNF α的表达也有显著性差异 (P <0 0 5 )。提示肝细粒棘球蚴囊肿周围人体纤维囊壁分层 ,PDGF、TNF α与肝实质侧纤维囊壁的形成有密切关系。

囊型肝包虫病CT诊断价值与分型

目的 探讨囊型肝包虫病CT诊断价值、病理基础与分型。方法 收集我们两院经手术病理及临床随访证实的肝包虫囊肿 66例 ,根据CT表现和病理结果进行对照分型。结果 囊型肝包虫病在CT上因病程和病理的不同 ,表现为单囊单房型、单囊多房型、单囊假分隔型、实变钙化型及多囊型。结论 囊型肝包虫病在CT上有特征性表现 ,不仅可早期诊断无症状带虫者 ,并可准确地显示各种病理形态的典型影像。

超声及声触诊组织量化技术在肝囊肿与囊性肝包虫诊断中的初步应用

目的探讨超声及声触诊组织量化技术（VTQ）在肝囊肿与囊性肝包虫诊断中的应用价值。方法选择48例均进行了常规超声检查的患者,被纳入研究范围：肝脏囊性局灶病变直径〉3cm和深度在4-8cm之间。48例经手术切除或穿刺活检病理证实的肝囊肿及囊型肝包虫,应用超声成像技术检查获得囊肿的声像图特征并采用VTQ检测囊内容物的剪切波速度（Vs）。对每一患者,在触摸组织量化区进行5次测量得到的结果,区分单纯囊肿和肝包虫囊肿。判读方法：5次测量至少有2次获得数值者诊断为肝包虫囊肿;5次测量均为无值者诊断为肝囊肿。结果敏感性、特异性、阳性预测值、阴性预测值和准确性分别为86.7%、83.3%、89.7%、78.9%和85.4%。结论超声及VTQ在肝囊性病变的鉴别诊断中有重要的价值。