Chirurgische Therapie bei Echinococcus-Zysten der Leber

Hypochlorous Acid: A Novel Agent Against Echinococcus granulosus Protoscoleces

Objective

We aimed to determine the scolicidal effect of hypochlorous acid and its efficiency at different concentrations.

Materials and Methods

We tested the effectiveness of hypochlorous acid in-vitro on sterile gauze at different concentrations in test tubes. In addition, we compared its effectiveness with the scolicidal activity of other agents, povidone-iodine 10% and chlorhexidine-gluconate 0.04%.

Results

Hypochlorous acid was 100% effective in 5 minutes at 1/1 (200 ppm/mL), 1/10 (20 ppm/ml), and 1/100 (2 ppm/mL) concentrations and in 10 minutes at 1/1000 (0.2 ppm/mL) concentration. Povidone-iodine 10%, and chlorhexidine-gluconate 0.04% were studied undiluted and were effective at all study times. Hypochlorous acid maintained the same scolicidal activity on gauze at all study times at the described dilutions.

Conclusion

Hypochlorous acid is an effective scolicidal agent in 5 minutes at even 1/100 concentrations. In addition, it maintains the same scolicidal activity on gauze used in surgery to wall the surgical site.

Evaluation of <em>Echinococcus</em> DNA by polymerase chain reaction (PCR) in cystic <em>Echinococcosis</em> of the liver

OBJECTIVES

The aim of this study was to determine the DNA and genotypes of Echinococcus granulosus in liver cyst hydatids isolated in humans.

MATERIAL AND METHODS

This study was conducted prospectively at the Department of General Surgery of the Cerrahpaşa School of Medicine, University of İstanbul-Cerrahpaşa, between January 2015 and June 2016 in 30 patients who were operated on for cystic Echinococcosis. E. granulosus DNA was analyzed using the Polymerase Chain Reaction (PCR) method in the cyst samples (protoscolex and/or germinative membrane) obtained during the operation, and genotype was determined in the PCR positive samples by sequence analysis. At the same time, indirect hemagglutination (IHA) was used to test for the presence of antibodies in the patients' blood.

RESULTS

E. granulosus DNA was found in 29 out of 30 cystic Echinococcosis of the liver samples. All of the 29 cystic Echinococcosis samples were found to be G1 (sheep) species. Also, IHA was positive in 22 patients and negative in eight patients.

CONCLUSION

In the present study, G1 species was the most commonly seen liver cystic Echinococcosis species. We suggest that a vaccine, which could be developed against prevalent regional genotypes, would be efficacious in the prevention of the disease with a cause of mortality and morbidity.

Secondary Multiple Intraabdominal Hydatidosis as Presumptive Sequelae of Primary Renal Echinococcosis: Clinical and Histopathologic Correlation

To present an extraordinary and likely first case of secondary multiple intraabdominal hydatidosis, probably as a sequel to primary renal hydatid cyst surgery. A 34-year-old male who underwent a right nephrectomy four years ago for renal hydatidosis was admitted. His abdominopelvic computed tomography scan revealed the hypodense lesions adjacent to the anterior lobe of the liver, splenic hilus, right common iliac vein, and left paracolic area. He underwent the total surgical resection and the histopathologic evaluation revealed the hydatidosis (echinococcosis) and the medical therapy, Albendazole: 15 mg/kg/day, was administrated for three months. No recurrence has occurred after the clinical and radiologic follow-up. To the best of our knowledge, it is an extreme and first case of secondary multiple intraabdominal hydatidosis as a sequel to the primary renal echinococcosis surgery, in the English language literature. Providers should be aware of considering a primary focus as encountering multiple intraabdominal hydatidosis.

Hydatid cyst: open or laparoscopic approach? A retrospective analysis

AIM

The aim of this retrospective study was to evaluate the reliability and feasibility of the laparoscopic approach in hydatid cyst cystectomy.

MATERIALS AND METHODS

A retrospective review of the medical records of 21 patients diagnosed with hydatid cyst disease between July 1999 and January 2011 was conducted at Van State Hospital and Toyota Emergency Hospital. Two patients with calcified cysts were excluded. Hydatid cystectomy was performed by laparoscopy (LC) in 7 patients and by laparotomy (OC) in 12 patients. The preoperative and postoperative parameters were compared.

RESULTS

There were 11 female (52.3%) and 8 male (47.7%) patients with a mean age of 31.7 years (range, 14 to 50 y). The mean duration of hospitalization was 4.8 days (range, 2 to 15 d). Recurrence was not seen in any cases in both groups. The morbidity rates of LC and OC were 14.2% and 33.3%, respectively. The most frequent postoperative complications were wound infections (1 case in LC and 3 cases in OC), hemorrhage (1 patient in the OC group), and hernia (as the late complication in 2 patients in the OC group). The operation success was graded as excellent in 18 patients and good in 1 patient.

CONCLUSIONS

The laparoscopic technique is an easy-to-apply, safe, and effective method to conduct liver and spleen hydatid cyst surgery. This technique can be used in patients with unique, small-sized, superficially located cysts, and also has the advantages of other abdominal laparoscopic operations.

Laparoscopic treatment of hydatid cyst of the spleen without splenectomy: report of a case

Laparoscopic surgery is going to be the first-line operative technique for a variety of benign spleen lesions in selected patients. The anatomic location of the lesions is more important than another peculiarity in the laparoscopy. A 38-year-old woman presented with left-sided abdominal discomfort. Radiologic evaluation revealed a 6 x 7 hydatid cyst in spleen. The patient underwent laparoscopic spleen-preserving cystotomy and omentoplasty for the lesion. She was discharged on the second day of operation uneventfully. The aim of the study is to investigate the effects and feasibility of laparoscopic management of hydatid cyst of the spleen. The procedure was shown to be feasible and safe, offering the advantages of laparoscopic surgery.

A patient presenting with abdominal pain to the general practitioner: a case report

Introduction

Right-sided upper abdominal pain is a common cause of presentation to general practitioners.

Case presentation

An otherwise well 46-year-old woman presented to her general practitioner with intermittent abdominal pain that had been present for several months. The only abnormality found at the initial consultation was moderate tenderness in the right upper abdomen. The laboratory tests that were ordered showed elevated parameters of inflammation. Sonography suggested the presence of an echinococcal cyst in segment VIII of the liver. Computed tomography confirmed this finding and showed no other cysts. On the basis of serological tests and the clinical findings, a diagnosis of Echinococcus granulosus infection was made. The patient was therefore admitted to hospital for surgical removal of the cyst. Her postoperative recovery was without complication and she remained free of symptoms.

Conclusion

Echinococcus granulosus infections are rare in Germany, with an incidence of 1:1,000,000. The sonographic appearances are generally characteristic and permit diagnosis. Treatment is pharmacological (albendazole, mebendazole) and surgical. It is curative in the vast majority of cases. The possibility of echinococcal infection should be considered in patients, especially immigrants, with abdominal pain.