Unusual presentation of severely disseminated and rapidly progressive hydatic cyst: Malignant hydatidosis

The infection caused by the tapeworm Echinococcus granulosus leads to the development of hydatic disease. It is the most frequent mediterranean parasitic infection that commonly affects the liver and rarely involves multiple organs. Herein, we report an exceptional and confusing presentation of hepatopulmonary and splenic hydatidosis due to Echinococcus granulosus that caused diagnostic problems occuring in a 70-year-old man, treated with chemotherapy, with favorable outcome. This was a very unusual case of disseminated hydatid cyst highlighting the interest of keeping a high level of clinical suspicion of this diagnosis every time we have a cystic lesion of the liver.     

Worldwide epidemiology of liver hydatidosis including the Mediterranean area

The worldwide incidence and prevalence of cystic echinococcosis have fallen dramatically over the past several decades. Nonetheless, infection with Echinococcus granulosus (E. granulosus) remains a major public health issue in several countries and regions, even in places where it was previously at low levels, as a result of a reduction of control programmes due to economic problems and lack of resources. Geographic distribution differs by country and region depending on the presence in that country of large numbers of nomadic or semi-nomadic sheep and goat flocks that represent the intermediate host of the parasite, and their close contact with the final host, the dog, which mostly provides the transmission of infection to humans. The greatest prevalence of cystic echinococcosis in human and animal hosts is found in countries of the temperate zones, including several parts of Eurasia (the Mediterranean regions, southern and central parts of Russia, central Asia, China), Australia, some parts of America (especially South America) and north and east Africa. Echinococcosis is currently considered an endemic zoonotic disease in the Mediterranean region. The most frequent strain associated with human cystic echinococcosis appears to be the common sheep strain (G1). This strain appears to be widely distributed in all continents. The purpose of this review is to examine the distribution of E. granulosus and the epidemiology of a re-emerging disease such as cystic echinococcosis.     

A province-based study using sampling method to investigate the prevalence of cystic echinococcosis among primary school children in Manisa, Turkey

A province-based field study using a portable ultrasound scanner (US) was performed for the first time using sampling method to investigate the prevalence of cystic echinococcosis (CE) in primary school children in Manisa, Turkey. A total of 6093 children from 37 primary schools was selected as the representative sample of the total number of 166,766 primary school children, and examined by the US. Prevalence was found to be 0.15%, as nine children were diagnosed with CE, seven new and two previously operated. A questionnaire applied to the children revealed no significant relationship between the risk factors and the infection (P > 0.05). In conclusion, it would be advisable to repeat the study at the same schools in eight years’ time, in order to evaluate the efficacy of the control programs, since nearly all students involved in this study will have graduated by then. Besides, it is recommended to choose a sampling group to find the prevalence of an infection in a defined region.     

乌鲁木齐南郊农牧区囊型包虫病流行病学研究

目的了解乌鲁木齐南郊农牧区囊型包虫病流行现状及其流行病学特征。方法采取定点整群抽样的方法，对居民进行体检和血清学检测，确定居民囊型包虫病的感染率和患病率;用粪抗原检测法调查家犬细粒棘球绦虫感染率，通过问卷调查方法了解居民养犬情况。结果乌鲁木齐南郊农牧区居民囊型包虫平均感染率为35.7%（687/1925），平均患病率为1.12%（23/2049）。高山牧场居民包虫感染率最高，半农半牧地区次之，单纯农业区最低。包虫病患病率以农牧结合区最高，单纯农业区次之，高山牧场最低。结论乌鲁木齐南郊牧区囊型包虫病的传播呈现高度活跃状态，居民包虫感染率和患病率与民族、性别、年龄及养犬等有关。     

肥厚型梗阻性心肌病的外科治疗

【摘要】目的 评价外科手术治疗肥厚梗阻性心肌病的临床疗效。方法 2010年1月～2013年10月，72例患者因肥厚梗阻性心肌病在我院行外科手术治疗，男36例、女36例，年龄13～70(46.51±13.45)岁。手术在全麻低温体外循环下完成，按常规经主动脉切口行室间隔心肌切除术，同期行冠状动脉旁路移植术4例，二尖瓣置换术8例，二尖瓣成形术2例，主动脉瓣置换术2例，主动脉瓣成形术1例，动脉导管结扎术1例，右室流出道疏通术1例，左房血栓清除1例，左心耳结扎2例，冲洗式射频消融改良迷宫术4例，术中安装永久起搏器2例。围术期心脏超声心动图(UCG)或食道超声心动图(TEE)评价左心室舒张末径、左室流出道流速及压差(LVOT)、室间隔厚度、左室射血分数(EF)、二尖瓣结构和功能。结果 与术前比较，左室流出道压差（9.42±7.48 vs 79.76±51.9）（mmHg） (P<0．01)及室间隔厚度（1.87±0.57 vs 2.36±0.48）（cm）(P<0．01)明显下降，长期随访发现左室流出道压差进一步下降（7.57±5.21）（mmHg），室间隔厚度进一步变薄（1.69±0.45）（cm）。左室舒张末径在出院时有所扩大，长期随访有进一步扩大趋势。EF值较术前有所下降(P<0.01)，但仍在正常范围内。手术死亡0例。主要并发症：完全性左束支传导阻滞52例，右束支传导阻滞2例，室内传导阻滞3例，心房颤动7例（其中3例为阵发性房颤），短暂II～III度房室传导阻滞5例，持续Ⅲ度房室传导阻滞2例，室间隔穿孔1例，术后脑出血2例，急性胆囊炎1例。远期随访：5例失访，余67例术后随访3～53月（平均18个月），所有患者症状消失，生活质量明显改善，心功能I～Ⅱ级，无远期死亡或并发症。结论 肥厚梗阻性心肌病外科手术治疗可有效的减轻左室流出道梗阻，提高患者的生活质量。     

Epidemiology and clinical features of cystic hydatidosis in Western Sicily:A ten-year review

AIM:To assess retrospectively the epidemiological and clinical aspects of cystic echinococcosis(CE)and to evaluate follow-up and response to treatment in patients affected by CE.METHODS:From January 2000 to December 2010,all patients affected by CE at the Infectious Diseases Units of the University of Catania and of Basilotta Hospital in Nicosia-Enna,were enrolled as participants in the study.Epidemiological,clinical and laboratory data were collected for each patient.Diagnosis of CE was performed using clinical imaging and laboratory parameters.Response to treatment was categorized as follows:"cure"as the disappearance or complete calcification of cyst/s;"improvement"as a reduction in the diameter and/or number of existing cysts;and"impairment"as an increase in the diameter and/or number of existing cyst/s and the onset of relapses(i.e.,the onset of new cyst/s and an increase in the diameter of previously existing cyst/s and/or complications.Immunoglobulin E(IgE)titers and eosinophil percentages were evaluated at diagnosis,at six months after the initiation of treatment and again in the case of relapse.Hyper-eosinophilia was defined as an eosinophil percentage of≥6%.RESULTS:Thirty-two patients were diagnosed with CE in our Unit during the research period,with a malefemale ratio of 2:1.At the time of diagnosis,40%of patients presented a single CE cyst.Sixty percent showed multi-organ involvement.The liver-lung localization ratio was 2:1.Patients below the age of 50 at diagnosis were more likely to have multiple cysts(73.7%vs 35.5%,P<0.05).Regarding treatment,30 patients were treated medically and 16 surgically.Fourteen patients were treated both medically and surgically.Relapses were seen to be less frequent in patients treated with albendazole before and after surgery.Complete cure or an improvement was achieved in 23 patients.Impairment was observed in one patient.Two patients showed no improvement.Relapses were more frequent in those patients treated before 2005.At diagnosis,71%of patients were positive     

Management of complex liver cystic hydatidosis: challenging benign diseases for the hepatic surgeon: A case series report from an endemic area

Hydatid cysts of the liver are benign lesions which require a wide range of surgical strategies for their treatment. We hypothesized that cysts larger than 15 cm, or compressing main vascular structures, or located in both hemilivers should be considered, as well as complicated cysts, in the category of complex hydatid cysts.In a retrospective study including 55 patients, we evaluated the characteristics of complex hydatid cysts, and compared surgical outcomes between patients operated on for complex cysts (Complex Group) and those operated on for non-complex cysts (non-Complex Group).In the Complex Group, 19% of patients had cysto-biliary communication with recurrent cholangitis, 9.5% had cysts eroding the diaphragm or chest wall, or communicating with the bronchial tree, 31% had cysts with contact with main vascular structures, 11.9% had multiple bilobar cysts, 14.3% had giant cysts with organ displacement, and 14.3% had a combination of the above-mentioned types. Type of surgical treatment was different between the two groups (P < .001). Additional procedures were statistically more frequent in the Complex Group (P = .02). Postoperative morbidity was higher in the Complex Group, although not in a significant manner (P = .07). Median hospital stay was longer in the Complex Group (12 vs 7 days, P < .001). No 30-day mortality occurred. Four patients (7.3%), all belonging to the Complex Group, required reoperation for postoperative complications.Surgery for complex hydatid cysts of the liver is potentially burdened by serious complications. This kind of benign liver disease requires skill-demanding procedures and should be treated in centers with expertise in both hepato-biliary surgery and hydatid disease management.     

Retrospective surgical incidence and case distribution of cystic echinococcosis in Jordan between 1994 and 2000

A retrospective follow-up study on the surgical incidence of cystic echinococcosis (CE) was carried out in major governmental, military and private hospitals throughout Jordan between 1994 and 2000. A total of 472 cases were recorded over the 7-year period and an overall mean annual surgical incidence (MASI) of 2.3 per 100,000 inhabitants was estimated. The highest number of surgical cases was recorded in hospitals of the middle region of the country. The highest MASI (3.6 per 100,000) was found in the southern region while the lowest (1.4 per 100,000) was in the northern region of the country. Taking into consideration the population size and the origin of surgically confirmed cases of each region, a relative surgical index (RSI) was calculated at which the highest (RSI=3.4) was among cases originated from the southern region and the lowest (RSI=0.7) was among those originated from the middle region of Jordan. The northern region and desert areas (badia) showed comparable RSI at 1.0 and 1.1, respectively. Males younger than 15 years of age showed significantly higher surgical incidence than females of comparable age at a ratio of 1.6:1, whereas the number of female cases of different age groups over 15 years of age was consistently higher than that of males at a ratio of 1.25-2.5:1.0. The liver was the primary site of cyst development in 69.4% of the cases and the lung involvement accounted for 13.3% of the cases. Diagnosis of CE in Jordan relies mostly on imaging methods with serological techniques being rarely used for diagnosis. The frequency of CE recurrence was 27.5% of the cases, which may be attributed to the low use of chemotherapeutic antihelminthics among surgically treated cases.     

Treatment of retroperitoneal echinococcosis: the experience of a single center

Retroperitoneal echinococcosis (RE) is a rare condition that is associated with a high mortality and disability rate. It is associated with a high rate of misdiagnosis, a high risk of surgery, and is extremely difficult to manage. There is no uniform standard for determining the exact form of surgical method and the timing of surgery.This was a retrospective analysis of the characteristics and surgical management of patients diagnosed with RE in our hospital between 2012 and 2019.Between 2012 and 2019, 1257 cases of echinococcosis and 121 cases of RE were diagnosed in our hospital. Of these, 68 cases involved surgical treatment, 53 involved non-surgical treatment, and 12 cases were lost to follow-up (4 cases in the surgical group and 8 cases in the non-surgical group). Thus, 109 cases were followed-up. RE cases were divided according to different treatment methods into a radical resection group (Group A, 31 cases), a non-radical resection group (Group B, 37 cases), and a non-surgical group (Group C, 53 cases). We carried out a detailed analysis of the 109 cases experiencing surgical intervention with effective follow-up.Our analysis found that radical resection is the first line of treatment of RE, although non-radical surgery can benefit most patients. It is important to emphasize the importance of the first round of surgery, particularly in cases involving hepatic echinococcosis. If the lesion can be removed radically during the first round of surgery, then radical surgery should be performed.     

棘球蚴(包虫)病预防疫苗的研制与应用

棘球蚴(包虫)病的控制是一个长期的过程。20世纪90年代以前,寄生虫病的防治手段主要是药物防治,但近年来,由于寄生虫耐药风险的增加和不理想的控制效果,以及大面积药物的使用对环境的不良影响等,寄生虫病控制的研究方向逐渐向免疫预防转移。本文从棘球绦虫疫苗研制的策略,中间宿主和终末宿主抗虫疫苗的研制,以及所面临的挑战和机遇等做一综述。在我国,EG95已经大面积接种绵羊用于囊性包虫病的控制。但泡球蚴病病原的传播是循环于犬,狐狸和狼等终末宿主和鼠类之间,终末宿主抗虫疫苗研制是泡球蚴病控制研究的方向之一。     

肝胆管结石病的临床分型与手术方式选择

摘要：手术是治疗肝胆管结石病的主要手段,但是我国许多医疗机构对肝胆管结石病的手术方式选择很是不规范,导致肝胆管结石病术后结石残留率和复发率居高不下。本文认为肝胆管结石病的临床分型对肝胆管结石病手术方式的选择具有重要的临床价值,根据临床经验,分别对肝切除术、胆肠吻合术、胆管切口取石术以及肝移植治疗肝胆管结石病的适应症予以阐述。同时,将解放军总医院应用肝切除治疗肝胆管结石的手术技巧以及解剖性肝切除治疗肝胆管结石病的创新技术予以简述。     

Antigens for the immunodiagnosis of Echinococcus granulosus infection: An update

The taeniid tapeworm Echinococcus granulosus is the causative agent of the echinococcal disease, an important zoonosis with worldwide distribution. Accurate immunodiagnosis of the infection requires highly specific and sensitive antigens to be used in immunodiagnostic assays. The choice of an appropriate source of antigenic material is a crucial point in the improvement of the diagnostic features of tests, and must be based on the developmental stage of the parasite and the host. The most common antigenic sources used for the immunodiagnosis of echinococcal disease are hydatid cyst fluid, somatic extracts and excretory-secretory products from protoscoleces or adults of E. granulosus. Hydatid cyst fluid is the antigenic source of reference for immunodiagnosis of human hydatidosis, which is mainly based on the detection of antigens B and 5. Somatic extracts have been widely used in the serodiagnosis for E. granulosus infection in dogs and ruminant intermediate hosts, although in the last few years the detection of excretory-secretory products of the worm in faeces (coproantigens) have become the most reliable method for the detection of the parasite in the definitive host. This review emphasizes recent advances in the identification and characterization of novel antigens with potential for the immunodiagnosis of echinococcal disease. Progress in recombinant technologies and synthetic peptides are also discussed. The paper highlights the need to search for new antigenic components with high diagnostic sensitivity and specificity, a fact that remains a crucial task in the improvement of the immunodiagnosis of the disease.     

外科治疗56例心脏非黏液性肿瘤的临床分析

目的探讨心脏非黏液性肿瘤临床特点,总结外科治疗经验。方法对我院1996年10月至2005年3月进行外科治疗的56例心脏非黏液性肿瘤的临床资料进行回顾性分析,总结其临床表现、发生部位、肿瘤性质和外科治疗特点等。结果心脏非粘液性肿瘤占本院同期手术患者的0.14%,良性肿瘤28例,恶性肿瘤28例,其中继发性心脏肿瘤8例。良性肿瘤最常见的是生长在心室,共18例;恶性肿瘤最常见的生长部位是心房,共15例。外科治疗行急诊手术者12例。心包开窗引流术2例,探查术1例,术中肿瘤全部切除者26例,部分切除27例,术后住院期间死亡1例。结论心脏非黏液性肿瘤临床表现各异、病理类型多样、病变广泛,手术原则为尽可能切除肿瘤和保持心脏结构的完整性和功能。     

肝囊型棘球蚴病术后腐蚀性硬化性胆管炎1例

腐蚀性硬化性胆管炎是一种肝囊型棘球蚴病术后罕见并发症,此类疾病虽罕见但病情进展迅速、缺乏有效治疗措施,病人往往预后较差。本文回顾性分析1例肝囊型棘球蚴病术后腐蚀性硬化性胆管炎患者诊疗过程,从而为腐蚀性硬化性胆管炎诊治提供参考。     

Examination of murine antibody response to secondary hydatidosis using ELISA and immunoelectrophoresis

Summary Antibody responses in mice with up to 64 weeks of secondary Echinococcus granulosus hydatidosis were examined by ELISA using hydatid protoscolex antigen (Px), Antigen 5 (Ag5) and Antigen B (AgB), and by immunoelectrophoresis (IEP) using sheep hydatid cyst fluid (SHCF). Anti-Px IgG antibodies, evident from 3–5 days post infection (p.i.), increased steadily until 16 weeks and maintained a high level afterwards. Anti-Ag5 IgG antibodies were negligible up to two weeks, but they showed a small increase around 2–3 weeks which was followed by a big increase around 16 weeks p.i. The high level of anti-Ag5 IgG antibodies persisted to the end of experiment. The level of anti-AgB IgG antibodies remained relatively low throughout infection. Anti-Px IgM antibodies appeared in the early period of infection, but became insignificant as the infection proceeded. Specific IgM antibodies to Ag5 and AgB showed two waves of increase, one between 3 days to 4 weeks p.i. and the other between 16 weeks to 46 weeks p.i. The level of IgA antibodies to Ag5 and AgB was low and only a moderate amount of anti-Px IgA antibodies was detected. Generally, a higher level of serum antibodies are associated with a larger number of mature cysts. Serum samples from 5 of 8 mice harbouring hydatid cysts formed 1–3 bands with SHCF in IEP, including Arc 5, but a precipitation arc with AgB was not observed. Analysis of hydatid cyst fluid from the infected mice (MHCF) in IEP also failed to demonstrate AgB. Despite the high levels of antihydatid antibodies generated in the infected mice, protoscoleces appeared to be unhindered in their growth to mature cysts.     

左位三房心的诊断和外科治疗

三房心是少见的先天性心脏病,占所有先天性心脏畸形的0．1％,男女分布相同。在先天性心脏病死亡患者的尸检中,其发病率上升至0．4％。左位三房心作为单独畸形占33％-50％,合并其他畸形占12％～50％。在此畸形中,肺静脉与左心房之间的连接存在,但肺总静脉与真正左心房之间有梗阻。梗阻以纤维肌性隔膜的形式出现,     

Public health education/importance and experience from the field. Educational impact of community-based ultrasound screening surveys

The public health educational impact of community-based ultrasound (US) surveys for cystic echinococcosis (CE) can form an important part of the development about the awareness of the importance of the disease in an endemic area. In addition to identifying asymptomatic carriers and thereby facilitating early diagnosis and treatment, such surveys can be used to impart important educational messages at the individual, household, community, regional and national levels. US surveys are usually appealing to rural communities where such services are not available but where the technique is generally appreciated by its application in a wide field of medical applications. The qualities of the test (painless, non-invasive and gives instant recordable results) are also attractive to participants during such surveys and the majority of the population in a selected study area choose to be screened. Two such surveys were carried out amongst the Berber people of the mid-Atlas mountains in central Morocco in May 2000 and 2001. Over 11,000 people were screened in the two 10-day surveys. Informed consent had been obtained through community meetings and with the chiefs of villages prior to the surveys being conducted. Individuals who volunteered to be screened entered the study and as far as is known there were no refusals. The concept of voluntary participation, the explanation of the life cycle and clinical manifestations of the disease and its prevention are all-important educational messages. The occurrence of CE is almost always known in an endemic community but is usually very poorly understood leading in many cases to a fear of the disease, especially amongst families with an infected individual who has previously undergone surgery. During the US survey considerable attention was paid to provide educational input before, during and after the survey. Information was provided at the start of the survey to local leaders, doctors, veterinarians and school teachers on the aims of the study and to obtain informed consent. At the start of the study everyone was individually schooled about the route of transmission of the parasite and how this may be best prevented. The knowledge level of those screened was assessed by showing hydatid cysts, either freshly obtained from the abattoir of from photographs. Animal cysts were recognised by almost everyone but its transmission and link to human disease was invariably unknown. Patients found to be infected with CE were always confidentially counselled and followed up for treatment, if required. Treatment options were explained to the individual or to parents in the case of a child. Local physicians participated in discussions on the WHO guidelines for the treatment of CE and all cases were fully discussed providing an educational element for the local doctors. The 1% US prevalence found sent an important message to the local politicians and the perceived importance of the disease had an impact at the leadership level. Local leaders made calls for a control programme. The long term educational impact remains to be evaluated as does the role such surveys play in the future collaboration of communities with the implementation of a control programme.     

脾切除术对肝硬化的影响及手术相关问题的探讨

肝病患者在肝纤维化和肝硬化阶段,脾脏形态功能产生相应变化。是否对肝硬化患者进行脾切除一直以来存有争议。脾切除术作为外科治疗复发性门静脉高压伴食管胃底静脉曲张破裂出血的方法,除能降低门静脉压、减少消化道出血机会及纠正WBC和PLT减少外,还具有改善肝功能、促进肝细胞再生、抑制肝纤维化进展等保护肝脏的作用。结合现有临床及实验室数据,综述了脾切除术对硬化肝脏的影响,以及手术术式选择、术后并发症防治等相关问题,以期对肝硬化患者推广行脾切除术。     

Detection of specific circulating antigen, immune complexes and antibodies in human hydatidosis from Turkana (Kenya) and Great Britain, by enzyme-immunoassay

Circulating antigen, specific immune complexes (IgG and IgM) and specific antibodies (IgG, IgM, IgE and IgA) were detected by enzyme-linked immunosorbent assay (ELISA) in the sera of hydatid (Echinococcus granulosus) patients from Turkana (Kenya) and the UK. Specific IgG and IgM antibodies predominated in current UK hydatid infections, while all classes of specific antibodies were lower in the Turkana patients. Circulating antigen, detected in 3% polyethylene glycol (PEG) precipitated complexes, using peroxidase conjugated hyperimmune human hydatid IgG (Fab) was more specific in ELISA than either antibody or immune complex assays where peroxidase conjugated anti-human IgG was used. Anti-human immunoglobulin ('rheumatoid' factor) was not detected in hydatid sera. Serum antigen, specific IgM immune complexes and specific IgM antibodies were associated with UK cases of current hydatid infection in contrast to patients with previous histories of hydatidosis. In 3 hydatid patients (from UK) levels of circulating antigen and specific IgM immune complexes rapidly declined within 1-4 months after surgical cyst removal. The detection of specific IgG and antigen in PEG precipitated immune complexes from false-negative/low responder Turkana hydatid sera, suggests that antibody 'mopping' by specific antigen may be occurring. After SDS-PAGE/immunoblotting analysis, antigen of mol. wt 67 000, present in hydatid cyst fluid and protoscoleces, was identified as putative circulating antigen in 3% PEG precipitates of sera from albendazole treated hydatid patients.