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[Surgical therapy of liver echinococcosis].

There is still no other therapeutic management for echinococcosis of the liver than surgical treatment. Indeed, drug therapy with Mebendazol prevents parasitosis from spreading. However, a complete regression has not been observed hitherto. Surgical procedure is dependent on expansion, localisation and type of echinococcosis. Generally, cystectomy is possible and adequate in case of Echinococcus granulosus, in case of Echinococcus multilocularis with its infiltrating growth, a complete healing can only be attained by lobectomy. With the hilus being invaded and obstructive jaundice proceeding, an improvement can be reached by Mebendazol or a palliative endless drainage tube.

Combined Modality Therapy↗

Case report: left ventricular echinococcosis diagnosed by coronary cineangiography.

This report presents a case of echinococcosis of the left ventricle treated surgically with success. Coronary cineangiography showed a circular capillary blush. This supports the view that this sign might well prove to be pathognomonic of this condition, as has been recently pointed out in another similar case. The diagnostic value of coronary cineangiography in left ventricular echinococcosis is emphasized.

Adult↗

[Anaphylactic reactions in mediastinal echinococcosis].

A boy with inoperable mediastinal echinococcosis is reported, who developed anaphylactic reactions during chemotherapy with mebendazole. IgE-mediated hypersensitivity was demonstrated by elevated echinococcus-specific serum IgE-antibody concentrations, by allergen-induced histamine release from washed leukocytes, and by passive sensitization of nonsensitized leukocytes with the patient's serum. During hyposensitization with echinococcus antigen no further anaphylactic symptoms were observed over a two years period. There was a decrease in allergen-specific serum IgE-concentrations and in basophil sensitivity to echinococcus antigen. The indication for hyposensitization in echinococcosis is discussed.

Adolescent↗

[Cardiac echinococcosis simulating myocardial necrosis in a 9 year-old boy. Diagnosis and surgical treatment (author's transl)].

The case of a 9 year-old, admitted for precordial pain, electrocardiographic signs of myocardial necrosis, deformity of the cardiac border at X Rays examinations, is reported. The diagnosis of cardiac echinococcosis was suspected once excluded other causes of myocardial infarction in children. Angiocardiography was the most useful diagnostic tool. The cyst was successfully removed with the aid of cardiopulmonary bypass. Cardiac echinococcosis gives rise, usually, to minor electrocardiographic changes; nevertheless, patients with electrocardiographic signs of necrosis can undergo surgical treatment without increased operative risk. Follow-up at several months after successful operation does not show return to normal electrocardiogram.

Cardiac Surgical Procedures↗

[Echinococcosis of the kidneys in children].

Echinococcosis of kidneys was observed in 4 (1,5%) out of 257 children with different localizations of echinococcosis. The author describes the clinical picture, diagnosis and specific means of treatment. Organ-preserving operations are recommended.

Adolescent↗

[Treatment of cholestasis caused by stenosis of the intrahepatic bile ducts in alveolar echinococcosis. Trial of biliary drainage by the percutaneous transhepatic approach].

Six cases of hepatic alveolar echinococcosis with involvement of the hepatic hilum and cholestasis were treated by percutaneous biliary drainage. Clinical and morphological follow-up ranged from 18 to 34 months. A decrease of jaundice and bilirubinemia and the regression of the intrahepatic bile duct dilatation were observed in all cases. Biliary drainage was associated with percutaneous drainage of an hepatic necrotic cavity in four cases. Left hepatectomy was performed later in three cases. These results are encouraging and suggest that percutaneous biliary drainage is an effective and useful procedure for biliary drainage in hepatic alveolar echinococcosis with cholestasis due to obstruction of the intrahepatic bile ducts.

Adult↗

[Treatment of human alveolar echinococcosis with flubendazole. Clinical, morphological and immunological study].

Flubendazole has been given at a daily dosage of 50 mg/kg for 16 months (extremes 10 and 24 months) to 10 patients with hepatic alveolar echinococcosis. Clinical, morphological and immunological evaluations have been performed every 2 months during the treatment, and in 6 patients after discontinuation of the drug for 24 months. Jaundice persisted or occurred in 7 patients; infectious complications were observed in 4 patients; portal hypertension appeared in 5 patients; metastatic spread was suspected in 2 patients. Subjective improvement and weight gain were reported by 6 patients during the first 4 months of treatment. Severe complications occurring during the period of FZ therapy or within 2 months after withdrawal of the drug led to surgery in 6 patients, and death occurred in 3 cases. These observations demonstrate the inefficacy of FZ in this series of 10 patients with alveolar echinococcosis, possibly related to the extremely poor bioavailability of FZ. Higher plasma concentrations obtained with mebendazole and albendazole could explain the better efficacy of these two drugs despite their similar chemical structures and experimental toxicity upon larval cestodes.

Adult↗

Application of the enzyme-linked immunosorbent assay (ELISA) for the diagnosis of filariasis and echinococcosis.

The Enzyme-Linked Immunosorbent Assay (ELISA) was compared with the Indirect Fluorescent Antibody Test (IFAT), the Indirect Haemagglutination Test (IHA) and Counter Immuno Electrophoresis (CIE) in the serological examination for filariasis and echinococcosis. The ELISA was the most sensitive but least specific method. The most striking phenomena were the cross-reactions observed when filariasis sera and E. granulosus hydatid fluid antigen were tested and vice versa, when echinococcosis sera were tested with D. viteae antigen. Crossreacting antibodies could be absorbed with the non-corresponding antigens. ELISA proved to be the most convenient test for the screening of large numbers of sera. For a specific diagnosis however it was nevertheless essential to test ELISA reactive sera with other methods.

Cross Reactions↗

[Epidemiology of echinococcosis in domestic animals and man in Bulgaria].

Echinococcosis is an important agricultural and public health problem in the People's Republic of Bulgaria. Organized and purposeful control since 1960 has proved to be effective. In the investigated period from 1975 to 1979 a decreased infestation with Echinococcus granulosus of man and farm animals could be observed. Infestation degree of sheep is below 20% in flat areas, whereas in mountainous regions it is well over 50%. The infestation of the population with echinococcosis is not equally distributed. It varies between 0.7 and 5.77 in 100,000 persons in different areas. The most common sources of infection are "domestic" dogs (57.76%), followed by hunting dogs (28.58%) and herding dogs (13.56%).

Animals↗

[Indications for the various surgical procedures in hepatic echinococcosis].

This report deals with 38 patients suffering from hydatid disease of the liver. The most frequently performed operative procedures were hepatic resection (n = 16), filling the cavity with normal saline solution (n = 16), filling the cavity with normal saline solution (n = 8), and total cystectomy (n = 6). Hepatic resection is mainly indicated in patients with alveolar echinococcosis of the liver lobe have to be removed. In patients with only one hydatid cyst of the liver the simple method of saline filling should be preferred. The prerequisite of saline filling is that no biliary fistula exists. If the remaining cavity of the hydatid cyst fills with bile, it can be easily drained under local anaesthesia with computertomographic control. Mebendazole was given in two cases with alveolar echinococcosis of the liver that could not be treated surgically. In both cases this treatment proved to be effective.

Adult↗

[Echinococcosis of the heart].

Although echinococcosis in different parts of the world and also in some sheep raising regions of our country belongs to a pretty frequent parasitary entity, the localisation of hydatid cyst in cardiac muscle is relatively rare: according to different authors it amounts only to 0,02-2% of all the echinococcoses. Heyat and al. in their cummulative world statistic up to 1971 collected only 118 surgically treated cases. The problematic of this pathology is presented. Beside a proper in extracorporeal circulation successfully operated case of an echinococcosis of the left ventricle, recent possibilities of exact preoperative localisation with the aid of coronarography and left ventricular cineangiography are presented.

Adolescent↗

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 26,065 surgical 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 cycle 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 recent 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.

Adolescent↗

[Echinococcosis with crural localization. A case report].

The authors report a case of echinococcosis with an atypical localisation. It involved hydatid cysts with a single, extramuscular and extravasal primary right crural localisation. After examining the international literature the authors affirm that this localisation has not been described previously in other reports. They conclude that surgery is vital for the remission of the disease, as is the use of an atraumatic and accurate technique in order to avoid possible sequelae linked to the iatrogenic diffusion of echinococcosis.

Echinococcosis↗

[Echinococcosis in pregnancy. A rare differential diagnosis in cystic intra-abdominal tumors in pregnancy].

Pregnancy and intraabdominal masses rarely cointcidate. Therapeutical consequences are associated with possible complications such as intraabdominal pain, torquation of cystic tumors, rupture of cystic masses and pelvic inflammation. In less than 5% of the cases a malignant process during pregnancy can be expected. Prior to therapy of intraabdominal masses patients from typical endemic areas ought to be checked up for parasitic infections such as cystic echinococcosis treated specifically. Based on the following case report we present the epidemiology, diagnosis and therapy of cystics echinococcosis in pregnancy.

Abdominal Neoplasms↗

[Recurrent, life-threatening anaphylaxis as initial manifestation of cystic echinococcosis (granulosus) of the liver].

A 34-year-old, previously healthy Yugoslav developed relapsing generalized anaphylactic reactions associated with life-threatening laryngospasm. After successful life support with volume-replacement, epinephrine, antihistamines and steroids, clinical workup disclosed a slight tenderness in the right upper abdomen and sonography a polycystic tumor with coarse calcification within the wall. The presumptive diagnosis of cystic liver echinococcosis with spontaneous rupture of a hydatid cyst was confirmed surgically and serologically. This case history shows that liver echinococcosis should be considered in otherwise unexplained anaphylaxis.

Adult↗

[CT and MR imaging findings in a case of cerebral alveolar echinococcosis masquerading as brain tumor].

We report a rare case of cerebral alveolar echinococcosis that was verified by pathological examination. The lesion presented as an intracranial mass which was slightly hyperdense on CT scans and very hypointense with central hyperintensity on T2-weighted MR images. The lesion exhibited marked contrast enhancement on both CT and MR images and was accompanied by extensive white matter edema. Although radiological differentiation from brain tumor was difficult, hypointensity on T2-weighted MR images appeared to be characteristic of lesions of cerebral alveolar echinococcosis.

Brain↗

Long-term disease-free survival after liver transplantation for alveolar echinococcosis.

Alveolar echinococcosis of the liver is an uncommon and fatal disease resulting from hepatic infection by Echinococcus multilocularis. Liver transplantation has been proposed for unresectable cases with chronic complications, but up to now, no long-term follow-up has been reported. We report the case of a 29-year-old female who is disease-free more than six years after liver transplantation for a recurrent alveolar echinococcosis of the liver, confirming the place for liver transplantation in this disorder.

Adult↗

[Pre-, intra- and postoperative allergic manifestations in hepatic echinococcosis].

Data obtained from 502 patients operated for echinococcosis (hydatid disease) are analyzed. In 61 of them (12,15 per cent) a variety of allergic manifestations are observed before the operation. Serious allergic shocks intraoperatively, and lethal outcome due to allergic shock in the postoperative period are described. Inferences are reached about the necessity of performing mandatory examination of all allergic patients for echinococcosis as an eventual underlying cause of allergy, as well as mandatory preoperative tests for allergy to drugs and anesthetics along with undertaking antiallergic prophylaxis of patients in the postoperative period to obviate eventual allergic accidents, regardless of their presence or not in the previous history.

Adult↗