ABSTRACT
Hydatid cyst is a parasitic infection which causes enormous morbidity and mortality worldwide. The pathogenic organism responsible for hydatid cyst is Echinococcus granulosus. Despite the fact that the characteristic cysts of the disease usually occur in liver and lungs, they may also occur in aberrant localisations. Subjects either present with symptoms of infection itself or local complications due to compressive mass effect of the cyst. Here, we report a case of secondary hypertension due to extrinsic compression of the right renal artery by a giant hepatic hydatid cyst. A 78-year woman presented with poorly controlled hypertension. She has been treated for hypertension with an angiotensin converting enzyme inhibitor plus calcium channel blocker for the last 2 years. Imaging studies revealed narrowing of the right renal artery and external compression, caused by a giant hydatid cyst. The giant hydatid cyst was treated by cyst aspiration and alcohol injection. Despite cessation of angiotensin converting enzyme inhibitor plus calcium channel blocker, she remained normotensive on follow-up visits. New onset and resistant hypertension cases in elderly should be carefully evaluated for secondary causes of hypertension, including renovascular conditions. Mass effect of the hydatid cyst disease should be considered in the differential diagnosis
ABSTRACT
Hydatid cyst is a parasitic infection which causes enormous morbidity and mortality worldwide. The pathogenic organism responsible for hydatid cyst is Echinococcus granulosus. Despite the fact that the characteristic cysts of the disease
usually occur in liver and lungs, they may also occur in aberrant localisations. Subjects either present with symptoms of infection itself or local complications due to compressive mass effect of the cyst. Here, we report a case of secondary hypertension due to extrinsic compression of the right renal artery by a giant hepatic hydatid cyst. A 78-year woman presented with poorly controlled hypertension. She has been treated for hypertension with an angiotensin converting enzyme inhibitor plus calcium channel blocker for the last 2 years. Imaging studies revealed narrowing of the right renal artery and external compression, caused by a giant hydatid cyst. The giant hydatid cyst was treated by cyst aspiration and alcohol injection. Despite cessation of angiotensin converting enzyme inhibitor plus calcium channel blocker, she remained normotensive on follow-up visits. New onset and resistant hypertension cases in elderly should be carefully evaluated for secondary causes of hypertension, including renovascular conditions. Mass effect of the hydatid cyst disease should be considered in the differential diagnosis
ABSTRACT
OBJECTIVE: To evaluate the potential effects of risedronate (RIS) which shows a higher anti-resorptive effect among bisphosphonates, after a posterolateral lumbar intertransverse process spinal fusion using both autograft and allograft in a rat model. METHODS: A totoal of 28 Sprague-Dawley rats were randomized into 2 study groups. A posterolateral lumbar intertransverse process spinal fusion was peformed using both autograft and allograft in a rat model. Group I (control) received 0.1 mL of steril saline (placebo) and Group II (treatment) received risedronate, equivalent to human dose (10 microgram/kg/week) for 10-weeks period. RESULTS: The fusion rates as determined by manual palpation were 69% in the group I and 46% in the group II (p = 0.251). According to radiographic score, the spinal segment was considered to be fused radiographically in 7 (53%) of the 13 controls and 9 (69%) of the 13 rats treated with RIS (p = 0.851). The mean histological scores were 5.69 +/- 0.13 and 3.84 +/- 0.43 for the control and treatment groups, respectively. There was a significant difference between the both groups (p = 0.001). The mean bone density of the fusion masses was 86.9 +/- 2.34 in the control group and 106.0 +/- 3.54 in the RIS treatment group. There was a statistical difference in mean bone densities of the fusion masses comparing the two groups (p = 0.001). CONCLUSION: In this study, risedronate appears to delay bone fusion in a rat model. This occurs as a result of uncoupling the balanced osteoclastic and osteoblastic activity inherent to bone healing. These findings suggest that a discontinuation of risedronate postoperatively during acute fusion period may be warranted.