Effects of saline nebulization on SARS-CoV-2 RNA spreading and exhaled bio-aerosol particles in COVID-19 patients

BACKGROUND

Nebulized therapy is the mainstay for treating obstructive airway diseases, but there is heightened concern about the potential risk for SARS-CoV-2 transmission during nebulization in COVID-19 patients.

AIM

To investigate the effects of 0.9% saline nebulization on SARS-CoV-2 RNA spreading in 11 COVID-19 patients (five females, mean age 62.45 ± 9.31 years); also to ascertain whether saline nebulization changed the number of exhaled bio-aerosol particles in six out of the 11 patients.

METHODS

Air samples were collected using suction pumps equipped with 0.45 μm PTFE filters and positioned around the patient's bed. Exhaled particles were quantified by using an optical particle counter.

FINDINGS

At baseline (i.e. before nebulization) SARS-CoV-2 was detected more frequently in the pumps close to the patient than in those far away. After saline nebulization, the detection of SARS-CoV-2 in the pumps close to the patient was comparable to that observed at baseline. In the pumps far from the patient, saline nebulization slightly, but not significantly, increased SARS-CoV-2 RNA detection compared to baseline. Overall, no significant changes in the SARS-CoV-2 RNA detection were observed after saline nebulization. At baseline, exhaled particle emission varied among patients, with two of them showing higher emission of particles than the remaining patients. Saline nebulization induced a marked decrease in exhaled particles in the two patients who displayed high emission at baseline, whereas no changes were observed in the remaining patients. Saline nebulization did not significantly change SARS-CoV-2 RNA spreading.

CONCLUSION

Saline nebulization does not significantly increase SARS-CoV-2 spreading.

A pilot study on the use of the super dimension navigation system for optimal cryobiopsy location in interstitial lung disease diagnostics

BACKGROUND

Transbronchial cryobiopsies has become increasingly important in the diagnostic workup for interstitial lung diseases. The rate of complications and mortality are low compared to surgical lung biopsies, but the diagnostic yield is not as high. The reason for the lower diagnostic yield could in some cases be explained by biopsies taken too centrally or in less affected areas. In this pilot study we examined the feasibility of using the electromagnetic navigation system, superDimension (SD), when performing cryobiopsies to increase the diagnostic yield.

METHODS

Electromagnetic navigation bronchoscopy and cryobiopsies were performed using SD. An electromagnetic board placed on the back of the patient and a position sensor at the tip of the navigational probe created a real-time 3D reconstruction of previously acquired computer tomography images. The procedure was performed with the patients in general anesthesia using a rigid bronchoscope when performed in Florence and with a flexible bronchoscope through an orotracheal tube when performed in Aarhus.

RESULTS

In total, 18 patients were included. Five patients were excluded, partly due to technical difficulties. Disposable 1.7 mm cryoprobes were used in Aarhus, and reusable 1.9 mm probes in Florence. Pneumothorax was detected in three (23%), mild hemorrhage was seen in one (8%) and moderate hemorrhage in six (46%). The biopsies contributed to the diagnosis in 11 of the patients (85%).

CONCLUSION

Using superDimension electromagnetic navigation system when performing cryobiopsies is feasible. A larger prospective trial is necessary to homogenize the technique between centres and to evaluate diagnostic advantage and complications.

Prevalence of pulmonary embolism among patients presenting to emergency department for hemoptysis

Background

Although hemoptysis is a well known symptom of presentation of pulmonary embolism (PE), and it is included in different diagnostic scores for PE, the prevalence of PE in patients with hemoptysis and the yield of evidence based PE diagnostic pathway in these patients has not been specifically investigated.

Objectives

To determine the prevalence of PE and the yield (n° of positive tests/n° of tests), the efficiency (the proportion of patients in whom PE could be considered to be excluded) and the failure rate (the false negative rate) of the classic diagnostic algorithm for PE in patients with hemoptysis.

Methods

Unselected patients presenting with hemoptysis to 7 italian EDs were prospectively enrolled in a diagnostic multicenter study. Pre-test clinical probability for PE was assessed using the 2-level Wells score and the results of D-dimer testing using age-adjusted cutoffs. Presence of PE was evaluated by CT pulmonary angiogram (CTPA), when ordered as part of the clinical assessment by the treating ED physician, or by one month follow-up data.

Results

Out of 327 adult patients presenting to ED with hemoptysis, 15 (4.6%) were excluded because of diagnostic protocol violation and absence of one month follow-up. Among 312 included patients, PE was detected at presentation in 15 patients (4.8%; 95% confidence interval [CI]: 2.72–7.81%). During follow-up, 5 patients died (1.6%; 95% CI: 0.52%-3.7%) not due to PE. Among 165 patients with a “likely” score or a high D-dimer, 13 (7.9%; 95% CI: 4.72–13.8%) had PE. The efficiency was 32.8% and the failure rate was 1.7% in patients tested by D-dimer.

Conclusions

PE seems an uncommon cause of hemoptysis among patients presenting to the ED and the yield of classic diagnostic algorithm is low. PE-screening in patients with hemoptysis deserves further investigation aimed at improving the diagnostic yield.

Funding Acknowledgement

Type of funding sources: None.

A perfect refractory electrical storm by acute toxicity of accidental aconitine intake

A 51-years-old male presented with drooling, hematemesis and diarrhea in emergency department after accidental ingestion of homemade aconitine tincture. Examination revealed shock and initial ECG showed atrial fibrillation. The patient suddenly developed a pulseless wide QRS complex tachycardia requiring resuscitation maneuvers. The rhythm varied from monomorphic ventricular tachycardia to torsade de point to ventricular fibrillation. Repeated direct-current cardioversions were unsuccessful. After intravenous electrolyte correction and anti-arrhythmic drugs administration, a last direct-current shock was finally successful. Bradycardia and ventricular excitability persisted over 12 hours with gradual normalization. Patient was discharged in normal sinus rhythm without any medication and on follow-up he was totally asymptomatic. With the increasing popularity of traditional medicine, clinicians should be alerted to the risk of herbal substances with low margins of safety like Aconitum in order to allow correct diagnosis and treatment. The general public should be educated that herbal medicine is not always safe.

Exploring the Effect of the Composition of Three Different Oregano Essential Oils on the Growth of Multidrug-Resistant Cystic Fibrosis Pseudomonas aeruginosa Strains

Oregano essential oils (EOs) could represent interesting therapeutic strategies to treat multidrug-resistant (MDR) pathogens as Pseudomonas aeruginosa, responsible for respiratory infections in cystic fibrosis (CF) patients. There could be a great variability in EOs composition when extracted from different plant species. The aim of this study was to chemically characterize and to test EOs, extracted from Origanum compactum, Origanum vulgare and Origanum vulgare var. hirtum, for in vitro antimicrobial activity against a panel of twenty MDR P. aeruginosa strains isolated from CF patients. EOs main components were carvacrol (71.8-73.8-47.1%), thymol (1.6-2.3-21.5%), p-cymene (11.6-7.4-10.8%) and γ-terpinene (1.7-3.1-8.4%). In general, the EOs showed inhibitory activity even at low concentration: 0.5% (v/v) OvEO and OhEO were able to inhibit the 80% of P. aeruginosa strains. Furthermore, the three EOs killed at least 75% of the strains at concentrations lower than 1% (v/v). Average MIC and MBC values were not significantly different. Similar levels of OEOs antimicrobial activities might be related to the fact that the main chemical class (i.e. carvacrol/thymol) is represented in quite similar percentages. Hence, the results of the present study shed light on a carvacrol/thymol-rich EO with a well-represented monoterpene hydrocarbons class as promising standardized antimicrobial herbal product.

Endophytic and rhizospheric bacterial communities isolated from the medicinal plants Echinacea purpurea and Echinacea angustifolia

In this work we analyzed the composition and structure of cultivable bacterial communities isolated from the stem/leaf and root compartments of two medicinal plants, Echinacea purpurea (L.) Moench and Echinacea angustifolia (DC.) Hell, grown in the same soil, as well as the bacterial community from their rhizospheric soils. Molecular PCR-based techniques were applied to cultivable bacteria isolated from the three compartments of the two plants. The results showed that the two plants and their respective compartments were characterized by different communities, indicating a low degree of strain sharing and a strong selective pressure within plant tissues. Pseudomonas was the most highly represented genus, together with Actinobacteria and Bacillus spp. The presence of distinct bacterial communities in different plant species and among compartments of the same plant species could account for the differences in the medicinal properties of the two plants.

Essential Oil from Origanum vulgare Completely Inhibits the Growth of Multidrug-Resistant Cystic Fibrosis Pathogens

Essential oils (EOs) are known to inhibit the growth of a wide range of microorganisms. Particularly interesting is the possible use of EOs to treat multidrug-resistant cystic fibrosis (CF) pathogens. We tested the essential oil (EO) from Origanum vulgare for in vitro antimicrobial activity, against three of the major human opportunistic pathogens responsible for respiratory infections in CF patients; these are methicillin-resistant Staphylococcus aureus, Stenotrophomonas maltophilia and Achromobacter xylosoxidans. Antibiotic susceptibility of each strain was previously tested by the standard disk diffusion method. Most strains were resistant to multiple antibiotics and could be defined as multi-drug-resistant (MDR). The antibacterial activity of O. vulgare EO (OEO) against a panel of 59 bacterial strains was evaluated, with MIC and MBC determined at 24, 48 and 72 hours by a microdilution method. The OEO was effective against all tested strains, although to a different extent. The MBC and MIC of OEO for S. aureus strains were either lower or equal to 0.50%, v/v, for A. xylosoxidans strains were lower or equal to 1% and 0.50%, v/v, respectively; and for S. maltophilia strains were lower or equal to 0.25%, v/v. The results from this study suggest that OEO might exert a role as an antimicrobial in the treatment of CF infections.

Essential Oil from Origanum vulgare Completely Inhibits the Growth of Multidrug-Resistant Cystic Fibrosis Pathogens

Essential oils (EOs) are known to inhibit the growth of a wide range of microorganisms. Particularly interesting is the possible use of EOs to treat multidrug-resistant cystic fibrosis (CF) pathogens. We tested the essential oil (EO) from Origanum vulgare for in vitro antimicrobial activity, against three of the major human opportunistic pathogens responsible for respiratory infections in CF patients; these are methicillin-resistant Staphylococcus aureus, Stenotrophomonas maltophilia and Achromobacter xylosoxidans. Antibiotic susceptibility of each strain was previously tested by the standard disk diffusion method. Most strains were resistant to multiple antibiotics and could be defined as multi-drug-resistant (MDR). The antibacterial activity of O. vulgare EO (OEO) against a panel of 59 bacterial strains was evaluated, with MIC and MBC determined at 24, 48 and 72 hours by a microdilution method. The OEO was effective against all tested strains, although to a different extent. The MBC and MIC of OEO for S. aureus strains were either lower or equal to 0.50%, v/v, for A. xylosoxidans strains were lower or equal to 1% and 0.50%, v/v, respectively; and for S. maltophilia strains were lower or equal to 0.25%, v/v. The results from this study suggest that OEO might exert a role as an antimicrobial in the treatment of CF infections.

Pharmacovigilance of herb-drug interactions among preoperative patients

The Pharmacovigilance Center of the University of Florence conducted a survey across 3 hospitals in Tuscany (Empoli, Florence, and Prato) on a sample population consisting of 478 patients admitted to the hospital for a preoperative assessment before surgical intervention. The aim of the study was to assess the concomitant use of herbal remedies (HRs) and prescribed medications and to evaluate the most important potential interactions. Almost 50% of the patients surveyed-238 of 478 (49.8 %)-used at least 1 HR. Among them, 55 (23.1%) were actually exposed to at least 1 potential interaction. In particular, 42 participants had an HR-drug interaction and 17 participants had a dietary supplement drug interaction. A large percentage of patients undergoing surgery take HRs that could potentially interact with drugs administered perioperatively. Antihypertensive, antiplatelet, anticoagulant, and central nervous system (CNS) agents were the main products involved. The use of HRs is not devoid of risks and adverse effects due to potential interactions that may be serious or even lifethreatening. HR-drug interactions should be deeply investigated, especially in high-risk patient populations. Health care professionals should pay close attention and always investigate the consumption of HRs among their patients.

Herbal medicine today: clinical and research issues

Herbal medicine is the use of medicinal plants for prevention and treatment of diseases: it ranges from traditional and popular medicines of every country to the use of standardized and tritated herbal extracts. Generally cultural rootedness enduring and widespread use in a Traditional Medical System may indicate safety, but not efficacy of treatments, especially in herbal medicine where tradition is almost completely based on remedies containing active principles at very low and ultra low concentrations, or relying on magical-energetic principles.

In the age of globalization and of the so-called ‘plate world’, assessing the ‘transferability’ of treatments between different cultures is not a relevant goal for clinical research, while are the assessment of efficacy and safety that should be based on the regular patterns of mainstream clinical medicine.

The other black box of herbal-based treatments is the lack of definite and complete information about the composition of extracts. Herbal derived remedies need a powerful and deep assessment of their pharmacological qualities and safety that actually can be realized by new biologic technologies like pharmacogenomic, metabolomic and microarray methology. Because of the large and growing use of natural derived substances in all over the world, it is not wise to rely also on the tradition or supposed millenarian beliefs; explanatory and pragmatic studies are useful and should be considered complementary in the acquisition of reliable data both for health caregiver and patients.

Black Cohosh Hepatic Safety: Follow-Up of 107 Patients Consuming a Special Cimicifuga racemosa rhizome Herbal Extract and Review of Literature

European Medicines Agency (EMEA) and the Committee on Herbal Medicinal Products (HMPC) on July 2006 have released an alert to get European sanitary authorities aware of 42 cases of suspected hepatotoxic reactions in patients consuming Cimicifuga racemosa rhizome. In the public statement EMEA itself considered reliable as hepatotoxic reactions only four cases, on the base of RUCAM score: two were considered possible and two probable. Lacking in almost all of them a precise description of cases, especially a botanical-chemical analysis of the suspected substance, we think there is no real proof of supposed C. racemosa rhizome hepatotoxicity. In our department we administer from about 10 years C. racemosa as special herbal dry extract as single substance or mixed with other medicinal plants at the dose of 500–1000 mg daily, for treatment of menopause related disorders without any reported adverse effect. After EMEA's official signal we have contacted all our patients using a C. racemosa rhizome herbal extract continuously from more than 12 months to verify possible hepatotoxic effects. We followed-up 107 women, and asked them by telephone (33/107) and/or after anamnesis and clinical examination (74/107) to undergo a blood sample examination. In all the patients there was no sign of hepatic disease, or worsening of already altered but stable parameters. We think on the base of these data and current literature C. racemosa rhizome extract should not be considered a potential hepatotoxic substance.

Use, Attitudes and Knowledge of Complementary and Alternative Drugs (CADs) Among Pregnant Women: a Preliminary Survey in Tuscany

To explore pregnant women's use, attitudes, knowledge and beliefs of complementary and alternative drugs (CADs) defined as products manufactured from herbs or with a natural origin. A preliminary survey was conducted among 172 pregnant women in their third trimester of pregnancy, consecutively recruited in two obstetrical settings; 15 women were randomly selected to compute a test-to-retest analysis. Response rate was 87.2%. Test-to-retest analysis showed a questionnaire's reproducibility exceeding a K-value of 0.7 for all items. Mean age was 32.4 ± 0.4 years; most women were nulliparae (62.7%). The majority of subjects (68%) declared to have used one or more CADs during their lifetime; 48% of pregnant women reported taking at least one CAD previously and during the current pregnancy. Women's habitual use of CADs meant they were at higher risk of taking CADs also during pregnancy (adjusted odds ratio = 10.8; 95% confidence interval: 4.7-25.0). Moreover, 59.1% of the subjects were unable to correctly identify the type of CADs they were using. The majority of women resorted to gynecologists as the primary information source for CADs during pregnancy, while they mainly referred to herbalists when not pregnant. Habitual use of CADs seems to be a strong predictor for their ingestion also during pregnancy; in addition most subjects were unable to correctly identify the products they were taking. In the light of the scanty data concerning the safety of CADs during pregnancy, these preliminary results confirm the need to investigate thoroughly the situation of pregnant women and CADs consumption.

The Medicinal Mushroom Agaricus blazei Murrill: Review of Literature and Pharmaco-Toxicological Problems

Agaricus blazei Murrill (ABM) popularly known as 'Cogumelo do Sol' in Brazil, or 'Himematsutake' in Japan, is a mushroom native to Brazil, and widely cultivated in Japan for its medicinal uses, so it is now considered as one of the most important edible and culinary-medicinal biotechnological species. It was traditionally used to treat many common diseases like atherosclerosis, hepatitis, hyperlipidemia, diabetes, dermatitis and cancer. In vitro and in vivo ABM has shown immunomodulatory and antimutagenic properties, although the biological pathways and chemical substances involved in its pharmacological activities are still not clear. The polysaccharides phytocomplex is thought to be responsible for its immunostimulant and antitumor properties, probably through an opsonizing biochemical pathway. Clinical studies are positive confirmations, but we are still at the beginning, and there are perplexing concerns especially relative to the content of agaritine. Argantine is a well-known carcinogenic and toxic substance in animals, that must be completely and fully evaluated.

Ear acupuncture in European traditional medicine

Auricular acupuncture is a diagnostic and treatment system based on normalizing the body's dysfunction through stimulation of definite points on the ear. Rudimentary forms of acupuncture which probably arose during the Stone Age have survived in many parts of the world right down to present day. It was used in the ancient Egypt, Rome, Greece and all the Mediterranean area. It is a microacupuncture technique similar to reflexology, and was first described in France in 1950 by Paul Nogier who is considered the Father of modern ear acupuncture. It was speculated that the technique works because groups of pluripotent cells contain information from the whole organism and create regional organization centers representing different parts of the body. Nevertheless stimulation of a reflex point in the ear seems relieve symptoms of distant pathologies. Modern research is confirming the efficacy of ear acupuncture for analgesia and anxiety related disease, while tobacco dependence and other substance abuse still need confirmation. Actually main methodological problems with auricular acupuncture are that exist too many maps with little agreement regarding point location in the ear, and that the correspondence or reflex systems does not correlated with modern knowledge of anatomy and physiology.

[Herbs on the Internet: risky information]

We analyzed Internet information about herbal products and dietary supplements regulated by Ministry of Public Health. We screened 522 Italian web sites and we found information about toxic risks on Germander (Teucrium chamaedrys), Red yeast fermented rice (Monascus ruber), Borage (Borago officinalis) and Coltsfoot (Tussilago farfara) respectively in: 63%, 47%, 3% and 22% of the web sites. It is also possible the on-line purchase. Results show that in Internet there are not correct instructions about risks of herbal products.

Adverse reaction to an adrenergic herbal extract (Citrus aurantium)

We report the case of a 52 year old woman that had an adverse reaction after taking a dry herbal extract of an unripe fruit of Citrus aurantium L. var. amara, as dietary supplement for weight loosing. The fruit is also known as zhi shi (in traditional Chinese Medicine) or bitter orange in other parts of the world.

[Posturology. Methodological problems and scientific evidence]

In the last years, the word "posturology" has been used in complementary medicine to define the discipline studying the relation between posture and many pathologies, above all chronic pain. Posturology is more and more frequently recommended as a diagnostic-therapeutic system for treatment of chronic complaints, on the base of which different health caregivers (physicians and not) treat the same clinical problem, with very different methodological patterns and therapies. If it is true that many scientific papers highlight a relation between body posture and muscoloskeletal disorders; nevertheless on the base of scientific literature, it is not possible to demonstrate any scientific principle showing that the correction of small alterations of posture on the base of a stabilometric analysis can improve muscoloskeletal pain or other diseases. Rather, it is true the opposite. Today a positive stabilometric test can be referred only to an alteration of the vestibulo-spinal system.

[Clinical phytotherapy: opportunities and problematics]

In every country traditional medicines find foundation in magical or religious beliefs, or popular experience. The World Health Organization is engaged to establish guidelines for methodology of clinical research and the appraisal of effectiveness of traditional medicine. In Italy it has been adopted the term non-conventional medicines in order to group one series of therapies and medicines which are radically different one from the other. Phytotherapy uses medicinal plants prepared by means of adapted extractive technologies and proper pharmacological preparations, purified and standardized in their chemical principles. As for any shape of therapy there are possible side effects, contraindications, pharmacological interactions. It is deemed necessary that a basic knowledge of the pharmacological aspects of phytotherapy be included in the regular Course of Medicine.

[Flavonoids: risks or therapeutic opportunities?]

Flavonoids are polyphenolic compounds that occur ubiquitously in fruits and vegetables. Over 4,000 different flavonoids have been described, and they are categorized into flavonols, flavones, catechins, flavanones, anthocyanidins and isoflavonoids. Flavonoids have many different biological effects in numerous mammalian cell systems, showed both in vitro and in vivo. Recently, much attention has been paid to their antioxidant properties and to their inhibitory role in various stages of tumour development in animal studies. In epidemiological studies the intake of flavonoids was inversely associated with subsequent coronary heart disease and cancer. Soy, St. John's Wort, Silybum marianum, Ginkgo biloba, Citrus species, Vaccinum mirtillus, Hawthorn and tea are medicinal plants containing flavonoids whose efficacy in the treatment of a variety of diseases has been demonstrated in numerous clinical studies. The main question that has not been answered satisfactorily deal with the triad absorption/metabolism/efficacy of flavonoids and is actually an important unsolved problem in judging their many alleged health effects. The aim of this review is based on providing by means of experimental and clinical studies information about efficacy and toxicity of flavonoids, especially focusing on infantile leukaemia for which there has been an international warning without sufficient and affordable scientific data.

[Rhabdomyolysis due to licorice ingestion]

Liquorice, a medicinal plant of the Italian pharmacopoeia, can give rise to adverse reactions and drugs interferences. On the main international scientific databases we made an "all years" search to find out case reports dealing with rhabdomyolisis due to liquorice ingestion. We found 77 cases, 7 of which in Italy.

Drug resistant bacteria in non carbonated mineral waters

The presence of antibiotic resistant bacteria was revealed among bacteria isolated from non carbonated mineral waters bottled in plastic (PVC) and in glass containers. Heterotrophic plate count values ranged between < 10 and 4.3 x 10(3) and between < 10 and 1.2 x 10(4) colony forming units/ml for the waters bottled in PVC and glass, respectively. The greatest resistance to a single antibiotic, 39.1% of 320 isolates from mineral waters, was found for nalidixic acid. Resistance to the other antibiotics was as follows: ampicillin (26.2%), bacitracin (19.7%), cotrimoxazole (18.7%), streptomycin (15.0%), tetracycline (14.4%), gentamycin (11.6%), chloramphenicol and rifampin (9.7%). The strains resistant to two or more antibiotics (multiple antibiotic resistant, MAR) provided 51% of the total isolates. Identification of 127 MAR strains showed that in the mineral waters gram-positive cocci dominated. The second, third and fourth group of identified MAR phenotypes were, in order to importance, gram-negative non-fermentative rods, gram-positive rods and gram-negative fermentative rods. The importance of the antibiotic resistant bacteria in mineral water is discussed.

Increased thromboxane A2 production at primary tumor site in metastasizing squamous cell carcinoma of the larynx

In order to evaluate the possible role of prostaglandins (PG) in invasion and metastasis of malignant cells in larynx carcinoma, arachidonic acid (AA) metabolite production by tumor tissue, peritumor tissue and node metastasis was investigated in comparison to that by healthy mucosa and unaffected lymph nodes. The study was performed by evaluating PGE2, 6ketoPGF1 alpha and thromboxane B2 (TXB2) production by radioimmunoassay in specimens from eight patients who underwent surgical treatment. The highest rate of AA metabolism was observed in peritumor tissue. PGE2 was the main metabolite produced in all tissues and its levels were significantly higher than those of 6ketoPGF1 alpha and TXB2 (p < 0.05). 6ketoPGF1 alpha production was higher (p < 0.01) than that of TXB2 and did not significantly change among the different tissues. TXB2 production was significantly increased (p < 0.05) by peritumor tissue as compared to healthy mucosa. The ratio between TXB2 and 6ketoPGF1 alpha production was found to be almost twofold higher in tumor tissue, peritumor tissue, metastatic and non-metastatic lymph nodes as compared to control tissue. The lowest AA metabolism was found in affected lymph nodes. These findings demonstrate a different AA metabolism at primary tumor sites in comparison to healthy mucosa suggesting a prometastatic role of TXB2 and supporting the hypothesis of the occurrence of an imbalance between TXB2 and 6ketoPGF1 alpha production in favouring metastatic spread.

[Cardiac echinococcosis. Case report and review of the literature]

Cardiac echinococcosis is a rare disease. We report the case of a patient affected by cardiac echinococcosis who underwent surgical treatment successfully. A forty year old woman was hospitalized referring palpitation and dyspnea. The patient had undergone surgical pericystectomy of the right lobe of the liver for echinococcosis 6 month before. Chest X-ray film showed a round opacity well delineated on the left side of the heart, Ghedini reaction was negative, ECG was normal. After a review of literature we analyze anatomo-clinic and therapeutic aspects of the disease.

Extrahepatic abdominal hydatidosis: surgical features of 11 cases

We have described 11 cases of rare abdominal localization of hydatosis in the kidney, spleen and serous tissues. The clinical and surgical features have also been discussed.