肝细粒棘球蚴周围纤维囊壁钙化分布及意义

目的 研究肝细粒棘球蚴周围纤维囊壁（外囊）的钙化分布特征并探讨其意义。方法应用特殊染色观察60例肝细粒棘球蚴外囊壁病理形态特点及钙盐沉着的分布特征．并结合病人血清生化指标及CT观察结果进行分析。结果肝细粒棘球蚴外囊壁中钙盐沉着集中分布于近虫体侧内层纤维性囊壁．且形态各异．与近肝侧外层纤维性囊壁比较有显著差异（P＜0．05）；病人血清钙代谢生化指标均为常值,钙化与非钙化组比较均无显著差异（P均＞0．05）；染色可见部分CT未见钙化的囊壁有钙盐沉着。结论 肝包虫周围纤维性囊壁可分为内层和外层，且各自形成机制不同；钙盐沉积量与内层纤维囊壁形成进程有关。     

肝脾棘球蚴囊周围纤维性囊壁形成机制的差异及临床意义

目的　探讨肝、脾棘球蚴囊周围纤维性囊壁的不同形成机制。　方法　苏木素 伊红染色 ,观察 40例肝棘球蚴囊、15例脾棘球蚴囊周围纤维囊壁及其邻近肝、脾实质病理组织学改变。免疫组织化学方法检测Ⅳ型胶原、纤维连接蛋白 (FN)、层粘连蛋白 (LN) ;原位杂交方法检测转化生长因子-β1(TGF-β1)及肿瘤坏死因子-α (TNF-α)的mRNA在肝、脾棘球蚴囊周围纤维囊壁及其邻近肝、脾实质中的表达。　结果　肝棘球蚴囊周围纤维囊壁分两层 ,虫体侧纤维囊壁为肉芽肿样组织 ,肝实质侧纤维囊壁内可见大量受挤压的门静脉、肝动脉和肝管系统 (Glisson)和肝静脉系统 ,并与Glisson鞘相延续。Ⅳ型胶原、FN、LN、TGF-β1及TNF-α在两层中的表达差异均有显著性意义 (P均 <0.01)。脾棘球蚴囊周围纤维囊壁不分层 ,为肉芽肿样组织 ,Ⅳ型胶原、FN、LN、TGF-β1及TNF-α无特异分层表达。 　结论　肝、脾棘球蚴囊周围纤维囊壁的形成机制不同。肝棘球蚴囊周围纤维性囊壁是人体形成肉芽肿样病理改变后被周围受挤压的Glisson系统和肝静脉系统包裹 ,过度肝纤维化所致 ,肉芽肿样组织与周围纤维化的Glisson系统和肝静脉系统间有可分离间隙。脾棘球蚴囊周围纤维性囊壁是肉芽肿样组织包裹虫体形成 ,其与脾实质间无可分离间隙     

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。     

肝包虫周围纤维囊壁中骨桥蛋白免疫印记与组化分析

目的:研究肝细粒棘球蚴(肝包虫)周围纤维囊壁中骨桥蛋白(osteopontin,OPN)的表达定位．方法:采用免疫印记法检测OPN在肝细粒棘球蚴(n=48)周围纤维囊壁中的表达,并结合免疫组化方法观察其组织学分布．结果:肝细粒棘球蚴周围纤维囊壁经免疫印记分析80％有OPN表达,形态学观察集中分布于近虫体侧纤维性囊壁(内层),与近肝侧纤维性囊壁(外层)比较有显著差异(75％ vs 8．3％, P<0．05)．结论:OPN参与肝细粒棘球蚴周围内层纤维性囊壁肉芽肿反应的调节．     

骨桥蛋白在肝细粒棘球蚴外囊壁中的表达

目的 研究骨桥蛋白（osteopontin，OPN）在肝细粒棘球蚴外囊壁中的分布及表达。 方法 用免疫组化、免疫荧光双标记法观察60例患者手术切除的肝细粒棘球蚴外囊壁及巨噬细胞中OPN的表达与分布；Von Kossa染色观察囊壁中钙化分布特征。 结果 肝细粒棘球蚴外囊壁中有不同程度OPN表达，75%（45/60）集中分布于近虫体侧纤维囊壁（内层），.3%（5/60）分布于近肝组织侧纤维性囊壁（外层），两者差异有统计学意义（P＜0.01）。在内、外层交界处可见巨噬细胞带，多数巨噬细胞胞浆内有OPN表达。OPN表达阳性的囊壁均合并有不同程度的钙盐沉积，其在囊壁内、外层的分布与OPN的基本一致。 结论 OPN主要分布在肝细粒棘球蚴外囊的内层纤维囊壁。     

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。     

多房棘球蚴在动物和人体内的发育与组织病变考察

1982～1985年在新疆、宁夏等地共记录人体多房棘球蚴病142例,其中男72,女70。最大年龄69岁,最小12岁,而30～40岁组65例(47％)。人体9例病理标本主要呈巨块型和巨块结节型病肝,质地坚硬。切片显示病肝纤维化,其间有大小不等的肉芽结节病变,近中央处有坏死空洞。多房蚴由许多细小泡囊组成。角质膜较厚,生发层脱落不见,缺原头节,全系不育囊。囊腔有豆渣样碎屑,无囊液。 宁夏固源流行区自然动物宿主调查发现中华鼢鼠(Myospalax fontanieri)是本虫宿主新记录,自然感染率0.3％。达乌尔黄鼠(Citellus dauricus alaschanicus)自然感染率为1.3％。二种鼠类的多房蚴发育状况良好,质软有丰富的次生泡囊和原头节。中华鼢鼠有60～80％的育囊,达乌尔黄鼠有40～60％的育囊。二者切片所见泡囊角质层薄,有断裂;生发层较厚,发育有原头节并有群多的石灰质颗粒。组织病变有炎症白细胞浸润,并有成纤维细胞和结缔组织增生以及肉芽肿病变,肝组织绝大部分被次生囊所取代。观察证明两种鼠类是我国多房棘球蚴的适宜动物宿主。 小白鼠人工感染实验阐明虫卵至多房棘球蚴的全程发育。感染孕节48小时后肝组织内有六钩蚴病灶。3天后虫体呈囊块,与肝组织有界限可辨。10～12天后虫体形成泡囊,有生发层细胞分化。30天后泡囊增大达1.3×1.0     

贾第虫包囊的扫描、透射和冷冻蚀刻电镜观察

扫描电镜观察包囊呈椭圆形,9～10×6～7μm大小,囊壁表面凹凸不平。冷冻蚀刻复型法:将包囊壁劈开,显示囊壁为十余层膜结构,各层复型膜表面尚光滑。透射电镜见囊壁厚0.16～0.29μm,其表面凹凸不平,囊壁与滋养体间的空隙内可见横纵切的鞭毛结构。囊内虫体的外界膜下有呈单层排列的空泡结构,细胞质内有两种大小不同的颗粒,近虫体的一端有两个泡状细胞核,基体位于两个细胞核前极之间近中线处,伸出前、后侧和尾鞭毛。平行排列的微管伴有垂直的带状结构,分散在细胞质内。     

细粒棘球蚴的组织学及组织化学观察

细粒棘球蚴囊的内外囊连结紧密,外囊主要由胶原纤维组成,其内的新生血管以肝侧较多,而在寄生虫侧未发现任何管样结构;外囊含有DNA、RNA、蛋白质结合的α-氨基、酪氨酸、色氨酸及组氨酸、碱性蛋白质、酚类物质、网状和胶原纤维等成分;内囊除上述生化物质外,还示有钙质小体及酸性粘多糖。     

不同药物杀灭原头节对小鼠肝细粒棘球蚴感染的影响

囊型肝包虫手术过程中原头节的药物处理选择一直是存在争议的,术中如果能够选择合适的药物杀灭头节,对于术后复发将起到积极的预防作用."肝包虫外膜内外囊完整摘除术"可完整剥离包虫外囊,消除了外囊残腔,从根本上解决了包虫复发和残腔并发症.为探讨此手术过程中头节外溢对术后复发的影响,我们采用动物模型,模拟"开放式-肝包虫外膜内外囊完整摘除术"的围手术期处理过程,在小鼠肝脏接种术前及术后同时运用阿苯达唑脂质体,免疫增强剂槐耳浸膏,以及两种药物的联合治疗,肝脏接种时头节分别用20%高渗盐水,75%酒精,阿苯达唑脂质体和平衡液处理头节,分别通过小鼠肝细粒棘球蚴感染率,外周血抗体和T淋巴细胞分类的检测,了解不同药物在术中对于原头节的杀灭作用,为临床治疗囊型肝包虫术后复发提供理论依据.     

Ruptured hydatid cyst in a patient with shock

Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the peritoneal cavity represents a rare but serious complication.Herein,we describe an acute occurrence of anaphylactic shock due to a spontaneous rupture of hydatid cyst in a 21-year-old Turkish patient unwittingly infected by Echinococcosis.Resection surgery of the perforated cyst in combination wit...     

Hématémèse révélant une hypertension portale sur kyste hydatique du foie. À propos d’un cas avec revue de la littérature

Echinococcosis of the liver is a frequent disease in our country. Usually asymptomatic, hydatic liver cyst can in rare cases produce clinical features such as compression and rupture in the biliary duct that depend on the size and localization in the liver. We report the case of a patient with portal hypertension and hydatic liver cyst revealed by hematemesis. Clinical, radiological and endoscopic findings are presented due to the uncommon presentation and the few cases reported in the literature about this association.     

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.     

Echinococcus granulosus cattle strain identification in an autochthonous case of cystic echinococcosis in central Mexico

Echinococcosis is a frequent hepatic parasitic disease in several countries but it is practically absent in Mexico. A cattle strain of Echinococcus granulosus was identified by RAPD, PCR-RFLP and mitochondrial CO1 gene analysis in an autochthonous case. The parasite was obtained after a laparoscopic excision of a liver cyst from a patient that was symptomatic for 6 years but mis-diagnosed before hospitalization.     

Marked Narrowing of Right Heart Chambers Due to Compression by Giant Hepatic Hydatid Cyst

External compression of the heart may be presented as valvular heart disease. A 50‐year‐old woman with signs and symptoms of tricuspid stenosis was diagnosed with giant hepatic hydatid cyst. Symptoms were resolved after surgical excision. Echinococcosis should be in mind while evaluating patients with external cardiac compression.     

Pulmonary echinococcosis.

Echinococcosis or hydatid disease is caused by larvae of the tapeworm Echinococcus. Four species are recognised and the vast majority of infestations in humans are caused by E. granulosus. E. granulosus causes cystic echinococcosis, which has a worldwide distribution. Humans are exposed less frequently to E. multilocularis, which causes alveolar echinococcosis. E. vogeli and E. oligarthrus are rare species and cause polycystic echinococcosis. In cystic echinococcosis, humans are an accidental host and are usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. Pulmonary disease appears to be more common in younger individuals. Although most patients are asymptomatic, some may occasionally expectorate the contents of the cyst or develop symptoms related to compression of the surrounding structures. Other symptoms of hydatid disease can result from the release of antigenic material and secondary immunological reactions that develop from cyst rupture. The cysts are characteristically seen as solitary or multiple circumscribed or oval masses on imaging. Detection of antibody directed against specific echinococcal antigens is found in only approximately half of patients with pulmonary cysts. Surgical excision of the cyst is the treatment of choice whenever feasible.     

Cardiac echinococcosis with negative serologies: a report of two cases

Cardiac involvement in hydatid cyst disease is uncommon, occurring in approximately 2% of hydatid cases. Two cases of cardiac hydatid cysts with negative serologic tests are reported herein. In Case 1, the patient underwent surgery to remove cysts from the liver and 10 years later presented with symptoms and signs of ischaemic heart disease. In Case 2, the patient first underwent surgery to remove cysts from the brain and 3 years later for cyst removal from the breast. In both cases the diagnosis was established by transthoracic two-dimensional echocardiography and then confirmed by surgery and histological examination. These cases are of particular interest because of the rarity of cardiac localisation as a new site of the hydatid cyst after one or more previous surgeries for hydatid cyst removal, and stress the need for frequent reevaluation to detect new hydatid cyst formation in the heart and elsewhere caused by the Echinococcosis organism.     

Lone,Mobile Left Atrial Hydatid Cyst

Echinococcosis is endemic in various regions of Turkey. Cardiac involvement in echinococcosis is rare, and lone cardiac hydatid cysts are even more unusual. Because cardiac hydatid disease can be fatal, even asymptomatic patients are optimally referred for surgical treatment. We present a rare case of a lone, primary, mobile hydatid cyst in the left atrium of a 62-year-old woman. The cyst caused dyspnea from left ventricular inflow obstruction. In addition to reporting the patient''s fatal case, we discuss cardiac hydatid cysts in terms of the scant medical literature.     

An unusual presentation of hydatid cyst within the soft tissues of the back: re-investigation of the undiagnosed lung opacity

BACKGROUND: Echinococcosis is a zoonotic infection, affecting humans in a characteristic geographic distribution. The disease most commonly involves the liver and the lung and a soft tissue localization is very rare. METHODS: A case of a 68-year-old man, who presented with a cystic lesion on his back, which was presumed to be a lipoma or a sebaceous cyst. Surgical excision of the lesion was performed. RESULTS: Histopathology revealed a hydatid cyst and with further investigations, we identified the nature of a previously undiagnosed opacity in the right lung field. Although the patient previously presented with symptoms of hydatid cyst rupture (productive cough with haemoptysis), echinococcosis was not under consideration. CONCLUSIONS: This unusual case serves to demonstrate that echinococcosis, though rare, should be considered in the differential diagnosis of cystic lesions in every anatomic location, especially when they occur in endemic areas. We overview the diagnosis and treatment of this parasitic infection.     

New perspectives in the diagnosis of Echinococcus disease

Echinococcosis, an endemic disease on the Asian continent, is caused by the tapeworm Tenia Echinococcus, which produces cysts in the liver and other organs. I reviewed 157 patients with hydatid disease of the liver. The hydatid cysts were single in 125 patients and predominantly in the right lobe, but multiple in 31 patients, localized in both lobes or in the lung, spleen, pancreas, heart, or peritoneum. In 14 patients, early complications were manifested by rupture of the cyst into the biliary tract, the lung, or the peritoneum. Infection of the cysts was rare. Late postsurgical complications, noted in 10, were the development of an abscess or cirrhosis. I evaluated the importance of computed tomography (CT) in the diagnosis of hydatidosis of the liver and other visceral organs: It made a correct and accurate diagnosis in 96% of 157 patients. But, in ruptured or infected cysts, CT scans could not distinguish between a hydatid cyst and an abscess. Surgery is still the treatment of choice in hydatid disease. It is absolutely indicated in complicated cases, and is easy and curative in uncomplicated ones. I have used Mebendazole in 18 patients for 2 years without significant benefit, except in two patients with disseminated hydatidosis. Mebendazole stabilized the disease.