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

Electron microscopic aspects of goitre: Correlation with immunocytochemistry and histochemistry

For over a century, non- toxic goitre has been looked upon as the simple consequence of iodine deficiency. This view is now no longer tenable. Indeed, many characteristics of goitre do not fit with the iodine deficiency concept. For example, nodular goitre is a frequent disease even in those countries where the population is never exposed to iodine shortage. It is an important point to differentiate between the adenomatous goitre- common type and the adenomatous goitre- variant type, which is reported to be due to hereditary abnormality in thyroglobulin sythesis or abnormal iodoprotein production. This study included forty patients of goitre, which was more common in females than in males in a ratio 12: 1 with average age incidence of 50 years old. We did Routine Hx. and E. for diagnosis, immunohistochemistry using monoclonal antibody for thyroglobulin, Histochemical stain using Masson's trichrome for collagen sheath around the follicles. For electron microscope, five fresh specimens of simple and multinodular goitre were included. Excess rough endoplasmic reticulum was evident. Numerous secretory vesicles, which were variable in size, were found. Mitochondria were swollen and disrupted. In multinodular goiter.The nuclei showed marked invaginations, chromatin condensation under nuclear membrane and visible nucleoli.Immunocytochemistry shows the intense positive staining for thyroglobulin in almost all the follicles in the lumen and intracytoplasmic as well. Masson's trichrome showed that the perifollicular sheaths differed in size and in shape according to the stage, but they were always composed of thick collagen bands and fine fibrils. In conclusion, it is essential to differentiate between the different types of goitre using ultrastructural and immunohistochemical methods in conjuction with the clinical findings to differentiate between the common type of goitre and the variant type in which a hereditary abnormality in thyroglobulin origin is suggested. As regrowth of the thyroid gland is more anticipated in this variant than the common type, so follow-up of the patient will be different