A rare primary location of echinococcal disease: report of a case

A case of primary hydatid disease, a rare location, is presented. The patient was a 20 year old female who presented with complaining of painful mass in the right hypochondrium 2 months before presantation. This cyst was strongly adherent to the two layers of m.rectus abdominis fascias. It was completely removed. No other site of hydatid disease was found and the patient remained well postoperatively.     

Spontaneous intraperitoneal expulsion of an unruptured hydatid cyst

We report a 43-year-old man with a 20 x 20 cm hydatid cyst, spontaneously extruded out from the left lobe of the liver. This complication of hydatid cyst has not been recorded earlier, and makes the case unique in itself and worth reporting. The patient presented with a rare complication of biliary peritonitis of hydatid disease.     

A primary spinal hydatid cyst

Hydatid disease occurs in humans as a result of faeco-oral contamination. Spinal hydatid cyst is a rare entity and a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. Neural compression is common in vertebral hydatidosis where prognosis is always considered as very poor. Difficulty in management due to recurrence of this rare entity makes it a challenging disease to eradicate entirely. Efficacy of use of anthelminthic even after complete surgical removal is yet to be established. We are reporting diagnosis and management of a case of primary extradural and paraspinal hydatid cyst (HC) in an otherwise healthy patient who did not show any other evidence of systemic hydatid disease. The diagnosis was recognized preoperatively by magnetic resonance imaging (MRI) and confirmed postoperatively by histopathology. Surgical removal of the cysts/lesions was followed by anti-helminthic medication and recovery was satisfactory until the patient had recurrence after one year. The patient underwent surgery for the second time and was given anti-helminthic again for a longer period and was recurrence free for the next one year.     

肝包虫病手术病人及随访资料数据库管理系统的开发与应用

为满足医务工作者和研究人员对肝包虫病研究的工作需要,加强对肝包虫病病人资料的计算机信息化管理,采用EpiData3.0开发了肝包虫病病人资料数据库的录入及管理系统,从而使肝包虫病病人数据管理更加规范,对信息的查询更加方便.更重要的是,该数据库可将资料直接转换为Text 、dBaseⅢ、Excel、SPSS、SAS、Stata等文件,对临床资料管理及科研工作者来说数据统计非常方便.     

Caroli's disease misdiagnosed as hydatid liver cysts

A 27 year old woman who presented with upper abdominal pain was found on ultrasonography to have multiple liver cysts consistent with hydatid disease. Three years previously she had undergone evacuation of multiple infected liver cysts thought to be due to hydatid disease. Computed tomographic scanning supported the diagnosis of hydatid disease affecting the right lobe of the liver. At laparotomy the right lobe contained multiple cysts which were removed by right lobectomy. Histology revealed congenital dilatation of the intrahepatic bile ducts with fibrosis (Caroli's disease) but no evidence of hydatid disease.     

A rare presentation of hydatid cyst

Hydatid disease, although known to occur in most body areas, is extremely rare in the female reproductive system. There are different modes of presentation for the disease; however, we report and discuss a case presented with cystic vesicles passing through the vagina, which is considered as a rare presentation for secondary involvement of the uterus and both ovaries. We confirmed diagnosis with radiological examinations and serological tests. We operated on the patient, and studied the excised cysts microscopically. The gynecologist should be aware of hydatid cyst when vaginally passing a grape like vesicle is presented by the patient.     

Disappearance of recurrent intra-abdominal extrahepatic hydatid cyst following oral albendazole administration

A 44-year old male patient with a past medical history of a complete surgical excision of pelvic hydatid cyst two years previously presented with constant pelvic floor pain and plasma IgG anti-echinococcal antibody titres of 14.27 U/mL. Based on that and the imaging findings of abdominal ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) the diagnosis of a recurrent retrorectal pelvic hydatid cyst was made. Three courses of oral albendazole treatment were administered and sixteen weeks later, the patient was admitted for a planned elective operation. At that time, a new CT scan revealed disappearance of the cyst, while the serological tests showed a decrease in the IgG anti-echinococcal antibody titres to 0. 71 U/mL. Four different species of the Echinococcus tapeworm can produce infection in humans. E granulosus and E multilocularis are the most common, causing cystic and alveolar echinococcosis respectively, while E vogeli and E oligarthrus, have only rarely been associated with human infection. Although surgical resection remains the treatment of choice for hydatid disease, the present case could suggest that especially in cases of recurrent intraabdominal extrahepatic hydatid cyst, treatment with albendazole may lead to disappearance of the recurrent cyst therefore, should constitute a first line therapeutic option prior to any planned reoperation.     

Splenic recurrence of liver hydatid cyst and spleen preserving therapy

Hydatid cyst disease remains a considerable public health problem, especially in pastoral and farming regions. Although the spleen is the third most commonly affected organ after the liver and lungs, splenic hydatid cyst is an uncommon entity even in areas that are endemic for echinococcosis. The recurrence rate after surgical therapy of the liver hydatid cyst is reported as 6.8-22.3 percent. Recurrences most frequently occur in the liver. Extrahepatic recurrences occur in the lung or peritoneum and the serosa of the abdominal organs. Splenic recurrence of liver hydatid cyst has not previously been reported. The most common surgical therapy is splenectomy, and the other option is spleen preserving surgery. We report the first case of recurrent splenic hydatid cyst in the spleen and liver synchronously after surgical therapy for liver hydatid disease. The patient was treated with liver resection and spleen preserving surgery.     

肝包虫破入胆道15例临床分析

目的：探讨肝包虫破入胆道的诊断和治疗方法。方法：B超诊断肝包虫病及肝包虫破入胆道造成的胆道阻塞,对确诊及高度可疑的患者施行肝包虫内囊摘除并进行肝包虫残腔引流、胆总管探查、“T”型管引流术。结果：全组无术后严重并发症及死亡病例,均顺利康复,平均术后12d出院,2例病人残腔感染经持续引流治疗后好转。结论：B超是该病有效的检查方法。及时的胆道探查引流、清除包虫内囊及残腔引流是该病有效而安全的治疗方法。     

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 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging (MRI), hydatid cyst presented as a round-shaped low signal lesion in T1-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.

     

Huge omental hydatid cyst: a case report

Omental hydatid cyst is a rare cause of intra-abdominal hydatids. A 38-year-old female was presented with complaint of progressive abdominal distension. USG revealed a cystic lesion involving almost whole of the abdominal cavity. The patient was operated on and the cyst was removed followed with a course of albendazole.     

Hydatid disease of the spine: case report

A rare case of spinal hydatid disease presenting with paraparesis and sensory loss is reported. The patient was treated with albendazole resulting in significant improvement within eight weeks. Investigations and treatment modalities are discussed.     

脊柱棘球蚴病的诊断与治疗

目的：了解罕见的脊柱棘球蚴病的诊断与治疗情况。方法：对５ 例脊柱棘球蚴病进行回顾分析。结果：２ 例单纯脊柱棘球坳病在术前未明确诊断,３ 例脊柱棘球蚴病同时合并其它脏器棘球蚴病在术前明确了诊断。１ 例因全身情况欠佳而未能手术,另４ 例行手术治疗,术后平均随诊４０ ｍｏ,２ 例复发,２ 例良好。结论：单纯脊柱棘球蚴病因缺乏典型特征而不易诊断,合并其它脏器棘球蚴病时对脊柱棘球蚴病的诊断有重要的参考价值。彻底切除病变、解除脊髓压迫和防止术中污染是取得良好疗效的关键。彻底切断棘球蚴的生活周期与污染途径是根治此病的基础。     

Hydatid disease: an unusual breast lump

Hydatid disease of the breast is rare, but it should be included under differential diagnosis of a breast lump especially in endemic areas of this disease. Fine needle aspiration cytology can provide a safe pre-operative diagnosis, although mammogram, ultrasonography of breast, magnetic resonance imaging and serological tests like Casoni's test can also be done. Complete excision of the cyst without spillage can be a curative procedure for primary hydatid cyst of the breast. It is important to explore other common sites like liver and lung by means of ultrasonography and chest x-ray and treat accordingly. Here in this report, a lady of 27 years old presented with a painless lump of the left breast. Fine needle aspiration cytology was inconclusive. Lumpectomy was done. Histopathological examination confirmed it to be a case of hydatid disease involving the left breast.     

Evaluation of three serological tests for the diagnosis of hydatid disease.

A number of techniques is used for the serological diagnosis of hydatid disease; however previous investigations suggest variable degrees or reliability for each test. This study reports an evaluation of the sensitivity and specificity of three commonly used serological tests for hydatid disease; complement fixation (CF), haemagglutination (HA) and the fluorescent antibody (FA) techniques. The results of these serological tests are compared in a series of specimens from 116 hospital patients, 21 of whom were confirmed surgically as having hydatid disease. A similar high degree of sensitivity was found for each of the three serological tests examined. The CF and HA tests gave negative results in two patients with confirmed hydatid disease, and the result of the FA test was negative in only one patient. The HA test was the most specific with no false positive reactions, but only two false positive reactions occurred with the FA test. The CF test was the least specific as the reaction was positive in nine patients without hydatid disease. When the results of both FA and HA tests were considered together, all 21 cases of hydatid disease were detected and false positive reactions occurred in only two patients.     

棘球蚴病患者血清特异性IgE免疫应答的研究

以纯化的棘球蚴抗原对棘球蚴病患者、非棘球蚴病患者和健康人血清进行斑点免疫结合试验,以检测棘球蚴病患者特异性IgE抗体。当血清稀释度为1:100时,79例棘球蚴病患者血清的阳性符合率为94.9％,69例非棘球蚴病患者血清和119名健康人血清的假阳性率为3.2％,标准误差为2.79％。不同部位的棘球蚴病患者血清的阳性符合率分别为:肝肺并发棘球蚴病100.0％,肝棘球蚴病97.5％,肺棘球蚴病93.5％,腹腔棘球蚴病75.0％。阻断试验、替代试验和诊断试验结果提示棘球蚴病患者特异性IgE免疫应答检测试验可以作为棘球蚴病血清学诊断的参考试验之一。     

Preliminary observation of continuous albendazole therapy in alveolar echinococcosis.

Fifteen cases of alveolar hydatid disease were treated with albendazole in the dosage of 20 mg/kg/d x 30 days for 12-60 courses. All cases were followed up 1-5 years (average 38 months) by ultrasonic scanning of liver and chest X-ray films. One patient whose hepatic lesion was converted into fibro-calcific after treatment was apparently cured. Twelve patients were symptomatically improved: jaundice (4 cases) and hemoptysis (2 cases) disappeared, with reduction in size of lesions in the liver and lung. Two patients in the late stage of disease with huge and extensive nodular masses in both lobes of the liver were not improved. Evidently, albendazole is effective in the treatment of alveolar hydatid disease. Early diagnosis and early treatment are to be emphasized.

     

Echinococcosis (Hydatid Disease): Review and Report of a Case of Secondary Echinococcosis

Echinococcosis is a disease caused by the larval form of Echinococcus granulosus. The adult worm lives parasitically in the intestine of the definitive host, the dog, wolf and other wild carnivores. The ova, which are passed in the feces, are ingested by grazing animals. The intestinal juices free the ovum from its cuticle and, having entered a capillary, it is carried by the blood stream to the liver or lung, where it develops into a hydatid cyst. Man becomes infected by ingesting contaminated vegetables or drinking contaminated water.

In a mature hydatid cyst there may be thousands of scolices and each one of these, if released from the hydatid cyst, may form a new cyst if it is planted in a suitable environment. Hydatid cysts are most commonly found in the liver and the lung, but may occur in other organs.

A hepatic cyst may rupture into the peritoneal cavity and produce a hydatidoperitoneum. A pulmonary cyst frequently ruptures into a bronchus and is thus evacuated.

The disease is of world-wide distribution. In Canada most of the cases of this disease have occurred among Indians and Eskimos. It is now known that a sylvatic cycle has been established in North America and that it serves as a source of infection of the dog and man.

The patient reported herein had spontaneous rupture of a hepatic hydatid cyst, with subsequent development of secondary peritoneal echinococcosis. Repeated laparotomies had to be performed to relieve pressure on or obstruction of various organs. The patient made an uneventful recovery and is again usefully employed. No effective medical treatment for this disease is available.

     

Hospital records of hydatid disease in Victoria for 1970 to 1974

The records of hydatid disease in 10 Melbourne hospitals and 12 rural hospitals in Victoria from 1970 to 1974 have been studied. In a total of 183 in-patients, the final diagnosis of hydatid disease had been confirmed surgically in 81 first admissions and in 56 readmissions. In 24 cases it was confirmed by necropsy, but in only one of these was hydatid disease believed to have been the cause of death. Figures are given for the age distribution and the organs involved.     

包虫病诊断抗原的纯化及诊断效价

[目的]建立一种简便快速、适合基层的包虫病诊断方法。[方法]采用简便的一步层析方法从包囊液内纯化具有诊断价值的脂蛋白抗原,应用酶联免疫吸附试验(ELISA)和诊断试纸法(Dipstick法),对血清进行检测,评价其效果。[结果]ELISA检测包虫病人血清48份,阳性45份,检出率93.7％,和10份羊多房棘球蚴血清中的1份起交叉反应,而和羊细颈囊尾蚴、弓形虫、血吸虫血清不起反应。用Dipstick方法检测24份包虫病人血清,19份阳性,检出率79.2％,和其它寄生虫血清无交叉反应。[结论]本试验为包虫病诊断试剂盒的研制奠定了基础。