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Khuroo MS, Khuroo NS, Rather AA. A Case Series and Literature Review of Alveolar Echinococcosis in Kashmir, India: An Emerging Endemic Zone for Echinococcus multilocularis. Life (Basel) 2024; 14:794. [PMID: 39063549 PMCID: PMC11277966 DOI: 10.3390/life14070794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
A prospective study on 110 patients with echinococcosis at Dr. Khuroo's Medical Clinic, Srinagar, Kashmir, India, from March 2019 to April 2024 identified 12 cases (4 males, 8 females; mean age of 46.58 ± 11.97 years) of Alveolar echinococcosis (AE). Two patients were detected through ultrasound examinations carried out for unrelated causes; one presented with features of liver abscess, and nine had pain in the right upper quadrant for a mean period of 2.2 ± 1.79 years. All had the liver as the primary organ involved, with 15 tumor masses of a mean maximum diameter of 9.22 ± 3.21 cm and volume of 426 ± 374.61 cm3. Tumors placed centrally had invaded vessels and the biliary tract in eight patients, and those placed peripherally had invaded the liver capsule and adjacent organs in nine patients. Histologic examination of liver biopsies or resected organs revealed necrotic lesions, calcifications, and granulomatous inflammation with slender, thin-walled vesicles of bizarre configuration that stained strongly eosinophilic with periodic acid Schiff. Two patients had segmental liver resections; one was treated with liver aspiration, while the other nine with advanced disease received chemotherapy with albendazole along with praziquantel. Patients showed clinical improvement on a median follow-up of 12 months (range 1 to 60 months); however, MRI T2-weighted images and 18F-FDG-PET-CECT scans in two patients showed active disease on follow-up at one and five years, respectively. A systematic review detected 146 cases of AE in India from 1980 to April 2024. Twenty cases were from foreign countries, mostly from Central Asian republics, and 118 (93.65%) of the remaining 126 Indian patients were permanent residents of Kashmir Valley. The disease affected a population of 79,197 residing in 22 villages from 5 border districts of the valley. These villages were either high in or adjacent to the Himalayan mountain range. Disease prevalence in the affected population was 146.47/105 (males 131.53/105 and females 163.18/105) and the incidence was 12.41/105/year (males 11.16/105/year and females 13.81/105/year). Possible causes of the emergence of AE are discussed, and future directions for research to face this challenge arebeen identified.
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Affiliation(s)
- Mohammad Sultan Khuroo
- Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Kashmir, Srinagar 190010, India;
| | - Naira Sultan Khuroo
- Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Kashmir, Srinagar 190010, India;
| | - Ajaz Ahmad Rather
- Department of Surgery and Registrar Academics, Sher-I-Kashmir Institute of Medical Sciences Medical College and Hospital, Bemina, Kashmir, Srinagar 190010, India;
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Calame P, Weck M, Busse-Cote A, Brumpt E, Richou C, Turco C, Doussot A, Bresson-Hadni S, Delabrousse E. Role of the radiologist in the diagnosis and management of the two forms of hepatic echinococcosis. Insights Imaging 2022; 13:68. [PMID: 35394226 PMCID: PMC8994011 DOI: 10.1186/s13244-022-01190-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Echinococcosis is a parasitic disease caused by two zoonotic tapeworms (cestodes) of the Echinocococcus genus. It can be classified as either alveolar or cystic echinococcosis. Although the two forms differ significantly in terms of imaging findings, they share similarities in terms of management and treatment. In parallel to medical treatment with albendazole (ABZ), and surgery, historically used in these diseases, various imaging-guided interventional procedures have recently emerged (drainage, stenting, or Puncture, aspiration, injection, and reaspiration (PAIR)). These options open up a new range of therapeutic options. As in oncology, multidisciplinary consultation meetings now play a major role in adapted management and patient care in hepatic echinococcosis. Consequently, diagnostic imaging and interventional expertise have brought radiologists to the fore as important members of these multidisciplinary team. The radiologist will need to evaluate parasite activity in both forms of the disease, to guide the choice of the appropriate therapy from among medical treatment, interventional radiology procedures and/or surgical treatment. Knowledge of the specific complications of the two forms of echinococcosis will also help radiologists to discuss the appropriate treatment and management. The aim of this review is to describe the core knowledge that what a radiologist should possess to actively participate in multidisciplinary meetings about hepatic echinococcosis. We discuss the role of imaging, from diagnosis to treatment, in alveolar (AE) and cystic echinococcosis (CE), respectively.
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Affiliation(s)
- Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France. .,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, Besançon, France.
| | - Mathieu Weck
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Andreas Busse-Cote
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Eleonore Brumpt
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Carine Richou
- Department of Hepatology, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Celia Turco
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Solange Bresson-Hadni
- Laboratoire de Parasitologie-Mycologie, University Hospital Besançon, 25030, Besançon, France.,Centre National de Référence Echinococcoses, University Hospital Besançon, 25030, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France.,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, Besançon, France
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Graeter T, Shi R, Bao H, Liu W, Li W, Jiang Y, Schmidberger J, Brumpt E, Delabrousse E, Kratzer W. Intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis: a multicenter cohort study. Acta Radiol 2021; 62:997-1005. [PMID: 32847367 DOI: 10.1177/0284185120951958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The main endemic areas of alveolar echinococcosis (AE) are in central Europe and western China. The infiltration of intrahepatic vascular and bile ducts as well as extrahepatic disease can lead to complications and may increase morbidity in AE. PURPOSE To evaluate the vascular/biliary involvement of hepatic alveolar echinococcosis (HAE) and distant extrahepatic disease at each of four locations in Germany, France, and China. MATERIAL AND METHODS Contrast-enhanced abdominal magnetic resonance imaging (MRI) scans of patients with HAE, 200 in total, were evaluated by five examiners. AE liver lesions were classified according to Kodama's classification. Furthermore, distant extrahepatic manifestations were documented with additionally performed imaging modalities. Vascular/biliary involvement of hepatic manifestations as well as the presence of extrahepatic manifestations were correlated with the respective Kodama type of the liver lesion. RESULTS Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (12/100 vs. 3/100; Fisher's exact test: P=0.0286). A significant relationship exists between presence of distant extrahepatic disease manifestation and size of the AE liver lesion (132.53 ± 48.65 vs. 92.49 ± 50.06; P = 0.0030). Vascular/biliary involvement is significantly more frequent in China than in Europe (86/100 vs. 65/100; χ2 = 11.92; P = 0.0006). Vascular/biliary involvement depends on lesion size (111.10 ± 47.44 vs. 47.36 ± 24.36; P<0.0001). Different types of AE liver lesions are associated with differences in vascular/biliary involvement and extrahepatic manifestations. CONCLUSION Vascular/biliary involvement and presence of distant extrahepatic manifestations depend on size of the HAE lesions and are more frequently detected in China. Different MRI morphological patterns influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations.
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Affiliation(s)
- Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Haihua Bao
- Qinghai University, Qinghai University First Affiliated Hospital, Qinghai Province, Xining, PR China
| | - Wenya Liu
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi, Xinjiang Uyghur Autonomous Region, PR China
| | - Weixia Li
- Qinghai University, Qinghai University First Affiliated Hospital, Qinghai Province, Xining, PR China
| | - Yi Jiang
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi, Xinjiang Uyghur Autonomous Region, PR China
| | | | - Eleonore Brumpt
- University of Franche-Comté, WHO Collaborating Centre/National French Reference Centre for Echinococcosis, Besançon, France
- Department of Radiology, Besançon University Hospital, Besançon, France
| | - Eric Delabrousse
- University of Franche-Comté, WHO Collaborating Centre/National French Reference Centre for Echinococcosis, Besançon, France
- Department of Radiology, Besançon University Hospital, Besançon, France
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
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Graeter T, Bao HH, Shi R, Liu WY, Li WX, Jiang Y, Schmidberger J, Brumpt E, Delabrousse E, Kratzer W. Evaluation of intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis. World J Gastroenterol 2020; 26:4302-4315. [PMID: 32848335 PMCID: PMC7422544 DOI: 10.3748/wjg.v26.i29.4302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The main endemic areas of alveolar echinococcosis (AE) are in Central Europe and Western China. Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead to further complications and may increase morbidity in patients with AE.
AIM To evaluate vascular/biliary involvement in hepatic AE and its distant extrahepatic disease manifestations in an international collective was the aim.
METHODS Consecutively, five experienced examiners evaluated contrast-enhanced abdominal computed tomography (CT) scans for 200 patients with hepatic AE of each of four locations (n = 50) in Germany, France and China. Therefore, we retrospectively included the 50 most recent abdominal contrast-enhanced CT examinations at each center, performed because of hepatic AE from September 21, 2007 to March 21, 2018. AE liver lesions were classified according to the echinococcosis multilocularis Ulm classification for CT (EMUC-CT). Distant extrahepatic manifestations were documented either by whole body positron emission tomography–CT or with the addition of thoracic CT and cranial magnetic resonance imaging. Vascular/biliary involvement of the hepatic disease as well as the presence of distant extrahepatic manifestations were correlated with the EMUC-CT types of liver lesion. Statistical analysis was performed using SAS Version 9.4 (SAS Institute Inc., Cary, NC, United States).
RESULTS Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (P = 0.0091). A significant relationship was found between the presence of distant extrahepatic disease and AE liver lesion size (P = 0.0075). Vascular/biliary structures were involved by the liver lesions significantly more frequently in China than in Europe (P < 0.0001), and vascular/biliary involvement depended on lesion size. Different morphological types of AE liver lesions led to varying frequencies of vascular/biliary involvement and were associated with different frequencies of distant extrahepatic manifestations: Vascular/biliary involvement as a function of lesions primary morphology ranged from 5.88% of type IV liver lesions to 100% among type III lesions. Type IV differed significantly in these associations from types I, II, and III (P < 0.0001). With respect to extrahepatic disease, the primary morphology types IV and V of liver lesions were not associated with any case of distant extrahepatic disease. In contrast, distant extrahepatic manifestations in types I–III were found to varying degrees, with a maximum of 22% for type III.
CONCLUSION Different CT morphological patterns of hepatic AE lesions influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations. There are intercontinental differences regarding the characteristics of AE manifestation.
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Affiliation(s)
- Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm 89081, Germany
| | - Hai-Hua Bao
- Qinghai University, Qinghai University First Affiliated Hospital, Xining 810001, Qinghai Province, China
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm 89081, Germany
| | - Wen-Ya Liu
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi 830054, Xinjiang Uyghur Autonomous Region, China
| | - Wei-Xia Li
- Qinghai University, Qinghai University First Affiliated Hospital, Xining 810001, Qinghai Province, China
| | - Yi Jiang
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi 830054, Xinjiang Uyghur Autonomous Region, China
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Eleonore Brumpt
- WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, University Bourgogne Franche-Comté and Besançon University Hospital, Besançon 25030, France
| | - Eric Delabrousse
- WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, University Bourgogne Franche-Comté and Besançon University Hospital, Besançon 25030, France
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
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Ran B, Jiang TM, Yasen A, Aini A, Guo Q, Zhang RQ, Shao YM, Wen H, Tuerganaili A. Left trisectionectomy and supra-hepatic caval reconstruction with vascular prosthesis for chronic Budd-Chiari syndrome caused by hepatic alveolar echinococcosis. Chin Med J (Engl) 2019; 132:2886-2888. [PMID: 31856063 PMCID: PMC6940081 DOI: 10.1097/cm9.0000000000000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Bo Ran
- Department of Hepatobiliary & Hydatid Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
| | - Tie-Min Jiang
- Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
| | - Aimaiti Yasen
- Department of Hepatobiliary & Hydatid Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
| | - Abudusalamu Aini
- Department of Hepatobiliary & Hydatid Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
| | - Qiang Guo
- Department of Hepatobiliary & Hydatid Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
| | - Rui-Qing Zhang
- Department of Hepatobiliary & Hydatid Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
| | - Ying-Mei Shao
- Department of Hepatobiliary & Hydatid Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- WHO Collaborating Center on Prevention and Management of Echinococcosis, Clinical Medicine Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- State Key Laboratory on Pathogenesis Prevention & Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Hao Wen
- Department of Hepatobiliary & Hydatid Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- WHO Collaborating Center on Prevention and Management of Echinococcosis, Clinical Medicine Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- State Key Laboratory on Pathogenesis Prevention & Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Aji Tuerganaili
- Department of Hepatobiliary & Hydatid Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- Digestive & Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- WHO Collaborating Center on Prevention and Management of Echinococcosis, Clinical Medicine Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
- State Key Laboratory on Pathogenesis Prevention & Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang 830011, China
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A report on three patients with Echinococcus multilocularis: Lessons learned. Indian J Gastroenterol 2018; 37:353-358. [PMID: 30121887 DOI: 10.1007/s12664-018-0860-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/23/2018] [Indexed: 02/04/2023]
Abstract
Echinococcus multilocularis (EM) is the most virulent species of the genus Echinococcus. It causes a highly lethal helminthic disease in humans. The disease may present as hepatic mass mimicking a malignant neoplasm. Due to the vascular and neural invasion, protean clinical manifestations including Budd-Chiari syndrome (BCS) may be the clinical presentation of this condition. We herein report three cases of Echinococcus multilocularis; the first case presenting as multiple hepatic space-occupying lesions, second as liver mass infiltrating the nerve bundles, and the third as a hepatic mass infiltrating the large vessels including inferior vena cava and right hepatic vein presenting as BCS. EM is a parasite with capabilities of mass-forming effect, neural and vascular invasion. Though cases of BCS have been described, most of these are due to secondary compression and rarely by direct parasitic invasion.
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Xu L, Siyiti S, Song X, Wen H, Ding L, Yunus A, Tian Z, Wang C, Chen J. Recurrent multiple-organ involvement of disseminated alveolar echinococcosis in 3 patients: Case report. Medicine (Baltimore) 2017; 96:e7632. [PMID: 29049181 PMCID: PMC5662347 DOI: 10.1097/md.0000000000007632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Alveolar echinococcosis (AE) is a rare but highly malignant form of echinococcosis caused by Echinococcus multilocularis. There have been very few reports on multiple-organ AE, especially AE in bones. Here we report 3 rare cases of disseminated multiple-organ AE from western China and its neighboring areas. PATIENT CONCERNS Patient 1 had back and left hip pain, headache, and weakness in left lower limb, often with minor epilepsy and fluctuation of blood pressure. Lower limbs Babinski sign was positive and muscular tension was above normal range. The second patient had pain in lower limbs and chest discomfort without fever, cough, sputum, chest tightness, or hemoptysis. Patient 3 had masses and pain in the back side of his right shoulder. DIAGNOSES The patients had been treated for AE multiple times and were positive for serum hydatid antigens. They were diagnosed as multiorgan AE involving liver, spinal cord, and many other organs. INTERVENTIONS The patients had undergone surgeries to decompress the spinal cord, remove lesions from tissues as required, and were put on albendazole for at least 2 years. OUTCOMES The patients responded well and AE recurrence has not occurred. LESSONS All 3 cases experienced multiple recurrences of AE due to missed diagnosis, misdiagnosis, or inappropriate treatment, which resulted in metastatic multiorgan AE. These cases demonstrated the need for more policy attention to battle AE endemic in western China.
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Affiliation(s)
- Leilei Xu
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Sikandaer Siyiti
- Orthopedic Department, The Sixth Affiliated Hospital of Xinjiang Medical University
| | - Xinghua Song
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Hao Wen
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Liwen Ding
- Xinjiang Medical University, Urumqi, PR China
| | - Akbar Yunus
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Zheng Tian
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Chong Wang
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
| | - Jiangtao Chen
- Orthopedic Department, The First Affiliated Hospital of Xinjiang Medical University
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Diagnosis and treatment guidelines for aberrant portal hemodynamics: The Aberrant Portal Hemodynamics Study Group supported by the Ministry of Health, Labor and Welfare of Japan. Hepatol Res 2017; 47:373-386. [PMID: 28058764 DOI: 10.1111/hepr.12862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 12/18/2022]
Abstract
Idiopathic portal hypertension (IPH), causing aberrant portal hemodynamics, is a disease with an as yet unidentified cause and no established treatment protocol. The Japanese research group on IPH in Japan was set up in 1975 by the Ministry of Health, Labor and Welfare. Extrahepatic portal obstruction and Budd-Chiari syndrome (BCS) have since been added to the group's research subjects. The aims of the research group are to accurately evaluate the current status of the three diseases in Japan, elucidate their etiology and pathogenesis, and develop new treatments. Due to the long-term efforts of the Japanese research group, aberrant portal hemodynamics has been investigated in a variety of aspects, from epidemiological and pathological studies to molecular biology analyses. As a result, it has been shown that there are abnormal genes in the liver, specific for IPH. In addition, pathological findings of BCS were internationally compared and the difference in findings between Japan and Europe (or North America) has been clarified. Furthermore, it was found that complication rates of hepatocellular carcinoma in BCS were higher in Japan. Based on the research, "Diagnosis and treatment of aberrant portal hemodynamics (2001)", including diagnostic criteria for aberrant portal hemodynamics, was published in 2001. In 2013, it was revised to "Diagnosis and treatment guidelines for aberrant portal hemodynamics (2013)" after the incorporation of diagnosis and treatment in accordance with its current status.
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SABZI F, FARAJI R. Multiple Complications by Hydatid Cyst-induced Budd Chiary Syndrome: A Case Report. IRANIAN JOURNAL OF PARASITOLOGY 2017; 12:148-151. [PMID: 28761473 PMCID: PMC5522693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of the Budd Chiary Syndrome (BCS) in a 43-yr-old man with hydatid cyst (HC) in the liver is reported from Imam Ali Hospital, Kermanshah, western Iran in 2016. This case was complicated by inferior vena cava (IVC) thrombosis, right atrial clot and pulmonary emboli. Compression of IVC was the likely mechanism. Abdominal ultrasonography revealed a huge HC located in segments near IVC and caused compression of IVC. Transthoracic echocardiography (TTE) revealed IVC and right atrium thrombosis, however pulmonary emboli was not documented in TTE but intra operative exploration showed multiple clot in main and left pulmonary artery branch. The patient recovered after open-heart surgery with removal of right atrial, IVC and pulmonary artery emboli. BCS should be looked for routinely in patients with HC of the liver.
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Bernard C, Bailly F, Craigherot F, Bancel B, Brevet M, Broussolle C, Sève P, Bélénotti P. [Asthenia, weight loss and abdominal pain in a 64-year-old woman]. Rev Med Interne 2015; 36:706-9. [PMID: 26140744 DOI: 10.1016/j.revmed.2015.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 11/18/2022]
Affiliation(s)
- C Bernard
- Service de médecine interne, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Villeurbanne 69622 cedex, France
| | - F Bailly
- Service d'hépato-gastroentérologie, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - F Craigherot
- Service de radiologie, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - B Bancel
- Service d'anatomopathologie, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - M Brevet
- Service d'anatomopathologie, hôpital Louis-Pradel, hospices civils de Lyon, Bron, France
| | - C Broussolle
- Service de médecine interne, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Villeurbanne 69622 cedex, France
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Villeurbanne 69622 cedex, France.
| | - P Bélénotti
- Service de médecine interne, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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Graeter T, Ehing F, Oeztuerk S, Mason RA, Haenle MM, Kratzer W, Seufferlein T, Gruener B. Hepatobiliary complications of alveolar echinococcosis: A long-term follow-up study. World J Gastroenterol 2015; 21:4925-4932. [PMID: 25945006 PMCID: PMC4408465 DOI: 10.3748/wjg.v21.i16.4925] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/17/2014] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the long-term hepatobiliary complications of alveolar echinococcosis (AE) and treatment options using interventional methods.
METHODS: Included in the study were 35 patients with AE enrolled in the Echinococcus Multilocularis Data Bank of the University Hospital of Ulm. Patients underwent endoscopic intervention for treatment of hepatobiliary complications between 1979 and 2012. Patients’ epidemiologic data, clinical symptoms, and indications for the intervention, the type of intervention and any additional procedures, hepatic laboratory parameters (pre- and post-intervention), medication and surgical treatment (pre- and post-intervention), as well as complications associated with the intervention and patients‘ subsequent clinical courses were analyzed. In order to compare patients with AE with and without history of intervention, data from an additional 322 patients with AE who had not experienced hepatobiliary complications and had not undergone endoscopic intervention were retrieved and analyzed.
RESULTS: Included in the study were 22 male and 13 female patients whose average age at first diagnosis was 48.1 years and 52.7 years at the time of intervention. The average time elapsed between first diagnosis and onset of hepatobiliary complications was 3.7 years. The most common symptoms were jaundice, abdominal pains, and weight loss. The number of interventions per patient ranged from one to ten. Endoscopic retrograde cholangiopancreatography (ERCP) was most frequently performed in combination with stent placement (82.9%), followed by percutaneous transhepatic cholangiodrainage (31.4%) and ERCP without stent placement (22.9%). In 14.3% of cases, magnetic resonance cholangiopancreatography was performed. A total of eight patients received a biliary stent. A comparison of biochemical hepatic function parameters at first diagnosis between patients who had or had not undergone intervention revealed that these were significantly elevated in six patients who had undergone intervention. Complications (cholangitis, pancreatitis) occurred in six patients during and in 12 patients following the intervention. The average survival following onset of hepatobiliary complications was 8.8 years.
CONCLUSION: Hepatobiliary complications occur in about 10% of patients. A significant increase in hepatic transaminase concentrations facilitates the diagnosis. Interventional methods represent viable management options.
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Pilaca A, Vyshka G, Pepa A, Shytaj K, Shtjefni V, Boçari A, Beqiri A, Kraja D. A Neglected Zoonosis in Albania: why Echinococcosis is Becoming a Surgeon's Exclusivity? Mediterr J Hematol Infect Dis 2014; 6:e2014013. [PMID: 24678390 PMCID: PMC3965721 DOI: 10.4084/mjhid.2014.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/07/2014] [Indexed: 02/08/2023] Open
Abstract
Echinococcosis is an endemic zoonosis in the Mediterranean area, with Albania interested actually to a level that is becoming a public health concern. Authors describe preliminary data from the only tertiary (university) medical facility of Albania, positioned in the capital of the country (Tirana), with 333 new cases diagnosed and treated during the period 2005 - 2011. Out of all these 333 new cases an impressive majority of 91% had a surgical treatment right from the first admission, rendering the disease almost a surgical exclusivity. Even more, 80% of all patients from the study group were hospitalized straightforwardly in surgical wards, with options of surgical intervention's percentages outrunning figures from other sources and authors of the same geographical area. Such a situation, together with a very important level of patients' origin from highly urbanized areas such as those of the capital, suggest the necessity of well-organized interventions, among which might be the mandatory notification of all human cases with Echinococcus infection.
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Affiliation(s)
- Arben Pilaca
- Service of Infective Diseases, University Hospital Centre “Mother Theresa”, Tirana, Albania
| | - Gentian Vyshka
- Biomedical and Experimental Department, Faculty of Medicine, University of Tirana, Albania
- Correspondence to: Dr. Gentian Vyshka. Biomedical and Experimental Department, Faculty of Medicine, University of Tirana, Albania. Tel: +355697566130; Fax: +35542362268. E-mail:
| | - Arben Pepa
- Obstetrical and Gynecological Hospital, Tirana, Albania
| | - Kastriot Shytaj
- Faculty of Medical and Technical Sciences, University of Medicine in Tirana, Albania
| | | | - Arben Boçari
- Faculty of Veterinary Medicine, Agricultural University of Tirana, Albania
| | - Arben Beqiri
- Service of Surgery, University Hospital Centre “Mother Theresa”, Tirana, Albania
| | - Dhimitër Kraja
- Service of Infective Diseases, University Hospital Centre “Mother Theresa”, Tirana, Albania
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