[Metastases in alveolar hepatic echinococcosis].
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Emphasis is laid on the utilization of longitudinal sternotomy as an operative method of choice, practicable in echinococcosis with bilateral pulmonary location, eventually associated with liver involvement. Experience had with performing longitudinal sternotomy in some of the patients operated in the clinic of thoracic surgery of the Higher Medical Institute--Sofia and in other surgical units throughout the country, covering the period 1985 through 1990, is shared. A clinical case of interest concerning bilateral lung echinococcosis, partially complicated, and associated with hydatid disease of the liver, is described. A new and rational treatment tactics yielding a very good outcome is introduced, namely--single-stage longitudinal sternotomy with right-side frenotomy and echinococcotomy of the lung and liver cysts according to well-established surgical tenets, with ensuing plastic reconstruction of the disrupted right hemidiaphragm integrity and osteosynthesis of the sternum.
Fourteen patients, affected with hepatic echinococcosis, who underwent total pericystectomy at II Patologia Chirurgica, University of Bari-Italy, were retrospectively evaluated. The period considered was July 1987-December 1988. Immediate (low morbidity and no mortality) and late (no recurrences) results showed that total pericystectomy is the treatment of choice in hepatic hydatidosis.
Eighty children suffering from pulmonary and/or hepatic echinococcosis are reported. The epidemiological and parasitological aspects are reviewed, and the importance of the radiological signs and differential diagnosis are emphasized.
OBJECTIVE: To make an early and correct diagnosis of hepatic echinococcosis. METHODS: A total of 1092 patients with hepatic echinococcosis underwent operation in our hospital between 1984 and 1995. Of these patients, 427 (39.1%) were cases with complications, including secondary infection, rupture, obstructive jaundice, anaphylactic shock, disseminated implantation with resultant multiple echinococcosis and portal hypertension. The ultrasonic examination has been generally used in clinical practice for comprehensive evaluation which can dectedct the preoperative diagnostic accuracy rate. RESULTS: B-mode ultrasonography can be used not only to detect the location, dimension and pathological characteristics of hydatid cyst but also to show the pathological changes of various complications caused by echinococcosis. Seven patterns specific ultrasonic scanning images were revealed. In this series the diagnostic accuracy rate reached 98.8%. CONCLUSIONS: Ultrasonic examination is harmless to human body, and has been widely used in combination with immunological tests in clinical and epidemiological studies to detect the asymptomatic parasite carriers in early stage and to improve the preoperative diagnostic accuracy rate.
The authors present an unusual form of hepatic echinococcosis characterized by a cystic mass that occupied the whole abdomen. The clinical features and the results of the diagnostic imaging procedures (ultrasound, computed tomography) are commented on.
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Over 11 years 280 patients underwent surgery for hepatic echinococcosis. A complicated form of the disease was revealed in 151 (54%) patients. Suppuration of cyst was in 88 (31.4%) patients, perforation of cyst into biliary tract--in 87 (31.1%), compression of bile ducts by cyst with mechanical jaundice--in 5 (1.8%), perforation into abdominal cavity--in 2 (0.7%) and cyst's calcification--in 9 (3.2%). The diagnosis was based on clinical, objective and instrumental examinations. The most informative methods in diagnosis of hepatic echinococcosis were US (96.7%) and CT (100%). Radical operations were performed in 26 patients: pericystectomy--6, "ideal" echinococcectomy--11, resection of the liver--9. In true bursting of parasite's elements into biliary tract with mechanical jaundice and cholangitis, the correction of biliary tract's passability was carried out. Postoperative complications were revealed in 33.2% patients, in the most cases they were non-specific. Lethality was 1.7% (3 patients).
Laparoscopic intervention was performed in 39 patients with hepatic echinococcosis. The operation was conducted with the use of 3 trochars. Fibrous capsule was cleansed with the betadine solution or by non-focused laser radiation of YAG-laser. The operation lasted from 40 to 120 minutes with an average +/- SD (65.3 +/- 3.4) min. The transition to the laparotomy was not necessary. Mean duration of hospitalization was (3.6 +/- 1.2) days. All patients remained alive. 8 of them (20.5%) developed complications: in 5 the bile flowed out from the residual cavity following the drain, 2 developed the suppuration of post-operative wound. Patients were observed during 4-36 month after operation (an average 18 months). The recurrence of echinococcosis was diagnosed in 1 patient (5.9%).
Results of treatment of 72 patients with festered hepatic echinococcosis were analyzed. Ultrasonic examination was the main method of examination. Method of residual cavity liquidation was determined by localization of cyst. Original method of liquidation of residual cavity using omentum and oxygen insufflations has been successfully applied in 21 patients. Open methods of residual cavity liquidation are often accompanied by complications (bile-purulent fistulas, residual purulent cavities, long period of treatment).
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