Radiographic,CT and MRI spectrum of hydatid disease of the chest: a pictorial essay

Thirty patients with thoracic hydatidosis (Echinococcus granulosus) were studied. The hydatid cysts were located in the lung parenchyma (70%), mediastinum (6.7%), inside the heart (10%), the pleurae (10%) and the chest wall (3.3%). complications of thoracic hydatid cysts, such as rupture, infection, pleural involvement, spread and calcifications are presented. Computed tomography (CT) without and/or with contrast enhancement was performed in all patients (30). Findings from conventional chest radiographs were compared with CT and confirmed by pathology (30). In 10 cases (33.3%), magnetic resonance imaging was also performed. The diagnostic spectrum of hydatid cysts, including variations and developmental stages, is presented in this pictorial essay.     

Surgical treatment of pulmonary hydatid disease: a comparison of children and adults

Background

Hydatid cyst still remains an important health problem in our country as in many Mediterranean countries. The disease may affect children, and its treatment may be challenging in this age group. Surgery is the primary way of treatment. In the current study, the features unique to childhood pulmonary hydatid disease are emphasized.

Methods

Between 1992 and 2003, 301 patients were operated on because of pulmonary hydatid cyst in our hospital; 44 of them were 14 years or younger. They were categorized as pediatric patients. We retrospectively evaluated the clinical data of the patients.

Results

The mean age of the patients was 10.6 ± 3.7 years (5-14 years) in children and 32.2 ± 14 years (16-75 years) in adults. The rate of intact cyst was 71% in children and 57% in adults (P = .07). The mean diameter of the cyst was 8.5 ± 3.1 cm (3-15 cm) and 6.6 ± 3 cm (2-16 cm) in children and adults, respectively (P < .001). The rate of parenchyme-saving procedures was 84.1% in children, whereas 94.9% in adults. Lobectomy was performed in 16% of children, whereas it was performed in 1.5% of adults (P < .001). Morbidity rates were 13.6% in children and 11.6% in adults. No children but 1 adult died. Long-term follow-up revealed the recurrence rates as 4.5% in children and 4.3% in adults.

Conclusions

Surgery, the primary method of treatment of hydatid cyst, is safe. Parenchyma-saving procedures such as cystotomy and capitonnage should be performed as much as possible. Nevertheless, hydatid cyst can reach relatively larger dimensions in children than in adults, which causes parenchyme destruction eventually leading to lung resection.     

骶骨包虫病的临床诊断及治疗分析

目的探讨骶骨包虫病的临床特点,为临床诊断和治疗提供依据。方法回顾分析1999年7月-2010年8月收治的14例骶骨包虫病患者临床资料。男6例,女8例;年龄16～58岁,平均28.7岁。病程6个月～11年,中位病程5.7年。其中12例来自畜牧区或有明显犬、羊密切接触史;12例有肺包虫或肝包虫病病史。主要临床症状为腰骶部及双下肢疼痛,一侧或双侧下肢及会阴部感觉减退,逐渐出现双下肢活动及大小便功能障碍、排尿无力等神经损害表现。影像学检查示多囊性骨质破坏。10例行包虫囊液皮内Casoni试验,其中8例呈阳性,2例呈阴性;4例行包虫病8项免疫血清学检查均为阳性。所有患者彻底清除病灶后,采用自体骨、同种异体骨、人工骨或骨水泥修复缺损。术后常规使用阿苯达唑,持续3个月预防复发。结果术后切口均Ⅰ期愈合,无相关并发症发生。术后14例均获随访,随访时间6个月～11年,中位时间5.7年,患者术前临床症状均缓解。8例于术后6个月～3年复发,其中5例行3次清创手术,1例行5次清创手术,2例行病灶边缘切除联合高速磨钻清理;术后未见复发,症状均不同程度缓解。患者术后均未出现包虫病局部种植或远处播散。结论骶骨包虫病临床症状不典型,易误诊、漏诊,结合MRI检查有助于骶骨包虫病的诊断,血清学检查是诊断骶骨包虫病的主要方法,手术是最主要的治疗方法。     

棘球蚴病重组双歧杆菌疫苗研究进展

双歧杆菌是目前较为理想的疫苗候选载体之一,双歧杆菌疫苗由于安全有效、价廉、操作简单,具有极大的潜在应用价值。本文主要对近年来棘球蚴病重组双歧杆菌疫苗的构建、保护力及其免疫机制等方面的研究进展进行综述。     

肾棘球蚴破裂所致过敏性休克抢救的讨论

目的总结抢救9例肾棘球蚴破裂所致过敏性休克患者的体会.方法调查收集1990-2007年新疆北疆地区收治的肾棘球蚴破裂致过敏性休克的患者,对其临床症状、抢救方法等进行总结讨论.结果 9例肾棘球蚴破裂所致过敏性休克患者中,4例为术前肾棘球蚴破裂,5例为术中破裂.对6例进行快速人体棘球蚴病免疫诊断试剂盒试验,均呈阳性.经积极采取包括手术在内的综合措施抢救,结果7例治愈,2例死亡.结论应迅速抽尽漏出的棘球蚴囊液防止其吸收而引起或加重休克,手术是去除病因的重要方法.     

盆腔细粒棘球蚴病的诊断及治疗

目的 探讨盆腔细粒棘球蚴病的诊治方法.方法 对1980年1月至2009年1月收治的16例盆腔棘球蚴病病例的资料进行分析.结果 16例患者均有疫区犬、羊接触史,以下腹部包块为主要临床表现.用棘球蚴病囊液抗原(EgCF)、头节抗原(EgP)、囊液半纯化抗原B(EgB)、泡球蚴抗原(Em 2)等4项免疫试验检查4例,3例阳性.超声波和CT诊断符合率分别为35.7%和55.6%.采用内囊摘除术或外囊完整摘除术为主的手术治疗.16例中8例术前诊断明确.2例术前外伤破裂、1例术中囊液外溢共3例出现过敏性休克,经手术、抗过敏、抗感染治疗后治愈.4例术后复发.结论 流行病学、免疫学、CT及超声波检查是诊断盆腔棘球蚴病的主要方法.膀胱部分切除或内囊摘除术是治疗的主要手段.     

包虫IgG抗体检测试剂用血清国家参考品的研制

目的建立新的包虫IgG抗体检测试剂用血清国家参考品,以控制该类试剂的质量,促进包虫病诊断试剂的发展。方法从新疆某医院包虫囊肿手术后病理检查确诊的包虫病人中采集13份阳性血清,从北京某血站收集10份健康献血者的血清作为阴性血清,应用点免疫胶体金渗滤法和酶联免疫法分别在3个实验室进行协作标定。结果与结论该套参考品包括了18份样品,其中包括阳性参考品8份,阴性参考品8份,最低检出量参考品1份及精密性参考品1份,阳性符合率、阴性符合率及精密度都符合要求,最低检出量在1∶16左右,为国内外包虫病诊断试剂生产单位提供了开发和筛选高质量产品的参考材料,有利于控制该类诊断试剂的质量,推动试剂质量的提高。     

2008-2012年溧阳市棘球蚴病监测

目的 目的 了解溧阳市人畜棘球蚴或棘球绦虫感染情况, 为制定棘球蚴病防控措施提供科学依据。方法 方法 对确诊病 例和线索病例进行个案调查。采用ELISA法检测重点地区和对照地区7～12岁儿童、 成人血清特异抗体, 对血清学检查阳 性者及其家属和邻居作B超检查; 采用ELISA法检测重点地区犬粪棘球绦虫抗原; 对羊肉屠宰交易市场羊只内脏进行剖 检。结果 结果 儿童、 成人血清抗体阳性率分别为0.93%和0.52%, 两者差异无统计学意义 （χ2 = 2.124, P＞0.05）。B超检查未 发现阳性病人。羊只内脏剖检未发现棘球蚴感染情况, 犬粪阳性率为0.95%。结论 结论 溧阳市棘球蚴病监测中检出人群血 清抗体阳性者和粪便抗原阳性犬, 且该市存在完整传播链。因此, 在棘球蚴病防控工作中, 应加强对重点地区犬粪监测、 外来羊只检疫以及人群健康教育。     

小儿体部棘球蚴病CT表现

目的探讨小儿体部棘球蚴病的CT表现特点。方法经手术及病理证实的20例小儿体部棘球蚴病,其中单发棘球蚴病7例,多发棘球蚴病13例,共有32个囊肿,包括肝包虫囊肿17个,肺包虫囊肿9个,腹腔包虫囊肿4个,颈部包虫囊肿1个,胸膜包虫囊肿1个。20例患儿全部接受CT扫描,其中14例同时接受增强扫描。结果 20例患儿32个病灶中,21个表现为单纯性囊肿,11个呈囊肿破裂表现,未见钙化和多子囊征象。结论小儿体部棘球蚴病以多发和单纯性囊肿为主,CT表现特点与成人棘球蚴病存在差异。     

超声诊断不典型肝包虫病1例

患者女,38岁,以"义诊时超声检查发现肝脏包块"入院.患者来自肝包虫流行区,有牛、羊、犬密切接触史,无不适主诉.入院查体无阳性发现.