Percutaneous drainage versus surgery for treatment of hepatic hydatid cysts

Percutaneous drainage of hydatid cyst is relatively new; and data related to it are limited. The aim of this study was to compare the results of percutaneous aspiration of hepatic hydatid disease and surgical cystectomy with respect to effectiveness and safety. Between September 1998 and April 2001, 24 hepatic hydatid cysts in fifteen patients were treated with percutaneous drainage using one stage drainage technique under ultrasonographic guidance; while 21 cysts in another fifteen patients were treated with surgical cystectomy. The mean observation time was twelve months in both group of patients. Thorough history taking and clinical examinations for all the patients, abdominal ultrasonographic and occasionally CT abdomen, intradermal skin test for hydatid and serum IgG antibodies to E. granulosus were measured by ELISA and to prevent secondary dissemination all patients received Albendazol in dose of 10 mg/kg/body weight daily four weeks before and after procedure in both groups. Follow-up examination showed progressive shrinkage and solidification of cyst which was comparable in both groups. The mean hospital stay was significantly shorter in percutaneous group. Complications were mild and no fatal complications were reported. The most common complication was fever occurred in 5/15 [33.3%] and 3/15 [20%] patients at surgical and drainage groups respectively, urticura occurred in 2/15 [13.3%] at drainage group only anaphylaxis in 2/15[13.3%] and 1/15[6.7%]; recurrance in [6.7%] and [13.3%]; cyst infection in [6.7%] in both groups recpectively.Also peritonitis occurred only in one patient of surgery group. No patient in either group developed shock, biliary rupture or local dissemination. The ecchinococcal antibody titer fell progressively and at the last follow-up visit it was negative in 73.3% and 53.3% of drainage and surgery group respectively. The present study concluded that percutaneous drainage of uncomplicated hepatic hydatid cysts was effective and can be performed safely and it should be a good alternative to surgery for treatment of uncomplicated hydatid cyst and more experience should be gained by dealing with such cases in the presence of specialized center and cooperative medical team

Role of toxocariasis in some allergic skin diseases

Allergic skin diseases are cutaneous reaction attributed to multiple potential causes. One of these causes is toxocaral infection. In order to explore its role we examined two groups of children suffering from atopic dermatitis [AD] [26 children aging up to 15 years Group I] and chronic idiopathic urticaria [CIU] 24 children of the same age [Group II]. In addition to 30 apparently healthy children free from any skin disease, they were considered as control group [Group III]. Antitoxocaral IgG antibodies detected by ELISA were found among 15%. 21% and 10% of the three groups respectively with a statistical significant difference in the chronic idiopathic urticarial group [CIU] and the level of antitoxocaral IgG was significantly higher among the two groups versus the control one [P<0.05]. Specific antitoxocaral IgE detected by immunosorbent agglutination assay [ISAGA] revealed that, positivities to specific IgE were 7.7% and 12.5% in the atopic dermatitis and chronic idiopathic urticarial groups respectively with a high statistical significant difference versus the control group [P<0.001]. Estimation of eosinophils among the different groups revealed that, eosinophilia was found among the examined groups with a highly staistical significant difference than the control [P<0.001] and hypereosinophilia was present in patients showed positivity for IgE specific for toxocaral infection. It could be concluded that, toxocaral infection most probably has a role in some idiopathic skin allergic diseases as atopic dermatitis and chronic idiopathic urticaria