Management options in hepatic hydatid disease

Objective: The aim of this retrospective study is to analyse the outcome of 4 different methods in management of hepatic hydatid disease

Patients and Methods: The study was carried out in the Military Hospital, Riyadh: 110 patients were included; 37 were treated medically; 26 patients were subjected to percutaneous drainage via ultrasound guidance. Fifty patients required surgical treatment, while the remaining 10 patients were managed endoscopically

Results: The study showed different responses of the 4 methods applied

Conclusion: This retrospective analysis revealed that percutaneous draiange of the hydrated cysts achieved the best yield among all other methods

Comparative study of Nigella sativa and triple therapy in eradication of helicobacter pylori in patients with non-ulcer dyspepsia

A large number of diseases are ascribed to Helicobacter pylori [H. pylori], particularly chronic active gastritis, peptic ulcer disease and gastric cancer. Successful treatment of H. pylori infection with antimicrobial agents can lead to regression of H. pylori-associated disorders. Antibiotic resistance against used herb, possesses in vitro anti-helicobacter activity. The present study was undertaken to evaluate the efficacy of NS in eradication of H. pylori infection in non-ulcer dyspeptic patients. The study was conducted on 88 adult patients attending King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, from 2007 to 2008, with dyspeptic symptoms and found positive for H. pylori infection by histopathology and urease test. Patients were randomly assigned to four groups, receiving i] triple therapy [TT] comprising of clarithromycin, amoxicillin, omeprazole [n=23], ii] 1 g NS + 40 mg omeprazole [OM] [n=21, iii] 2 g NS+ OM [n=21] or iv] 3 g NS + OM [n=23]. Negative H. pylori stool antigen test four weeks after end of treatment was considered as eradication. H. pylori eradication was 82.6, 47.6, 66.7 and 47.8% with TT, 1 g NS, 2 g NS and 3 g NS, respectively. Eradication rates with 2 g NS and TT were statistically not different from each other, whereas H. pylori eradication with other doses was significantly less than that with TT [P <0.05]. Dyspepsia symptoms improved in all groups to a similar extent. N. sativa seeds possess clinically useful anti-H. pylori activity, comparable to triple therapy. Further clinical studies combining N. sativa with antibiotics are suggested

Katayama syndrome

Two schoolboys from a non-endemic region visited an endemic area of Schistosomiasis in Yemen. They developed cutaneous itching after swimming in infected ponds. Five weeks later both brothers were admitted to the hospital with high fever, abdominal pain, vomiting and diarrhea. The blood results exhibited marked eosinophilia and schistosomal serological test showed an evidence of exposure. Initially, stool examinations were negative, but the sigmoidoscopy was suggestive for acute bilharzial colitis and the biopsy showed schistosoma ova; a finding consistent with Katayama syndrome. Both patients treated with Praziquantel, and they became asymptomatic, and the eosinophilia normalized. This report shows the importance of endoscopic and histological examination in suspected acute colonic schistosomiasis, which allows early treatment and avoids possible complications

Treatment of Plummer-Vinson syndrome with Savary-Gilliard dilatation

The association of postcricoid dysphagia, iron deficiency anemia and upper esophageal webs is known as the Plummer-Vinson syndrome [PVS]. It is predominantly a disease of middle aged females. Four patients with cervical web of the esophagus were studied, dysphagia was mostly for solids, which were non-progressive and were present for years before they presented. Initial treatment in 3 patients consisted of esophageal dilatation with savary bougies after initial rupture of the web by endoscope. In one case, due to failure to visualize the esophageal lumen by fluoroscopy guidance, guide wire was introduced and breaking of the web was performed by the endoscope, followed by bougie dilatation. In 4 patients, webs were ruptured by the endoscope and had a single session of dilatation, with no recurrence during the 3-year period of follow up. Endoscopic esophageal dilatation is simple and the procedure of choice in the treatment of "PVS" and cervical web of the esophagus

Albendazole in hydatid disease: results in 22 patients

A prospective study to evaluate the effect of albendazole in the treatment of echinococcus granulosus was conducted at the Gastroenterology Unit, Armed Forces Hospital, Riyadh since April 1985 to present involving 22 patients mainly with liver hydatid disease. Of these patients, 30% had a previous history of surgery for recurrence of previously operated hydatid cysts. The duration treatment and follow up period ranged from two months to three years. The only side effect was hair loss in two patients which was fully reversible on the termination of treatment. The following results were achieved: Radiological disappearance of the liver cysts were achieved in eight patients. Four of eight patients were treated only with albendazole and the other four patients with ruptured liver cysts to the biliary tree were treated with a combination of non-surgical endoscopic method, hypertonic saline irrigation and albendazole. In the remaining 14 patients, 5 [22.72%] had a 30% to 60% reduction in cyst size. Intracystic change was noted in five patients [22.72%], in two patients the cyst ruptured and there was no change in the cyst size in two patients [9.9%]. This study demonstrates that albendazole is a promising drug for the treatment of hydatid disease

Endoscopic biliary drainage of postoperative biliary fistulae and leak

Five consecutive patients with postoperative biliary fistulae or leak were diagnosed and treated successfully by endoscopic intervention The development of the fistulae were related to distal common bile duct obstruction by stones in four patients and in one patient by hydatid daughter cysts. Endoscopic sphincterotomy with stone or cyst extractions achieved decompression of the biliary system and initiated closure of the fistulae. In two patients, nasobiliary tube was used and endoscopic endoprosthesis was needed to close the fistula in another patient. In such cases, endoscopic management seems to be superior to surgical re-intervention for repair of fistulae or leak