Laparoscopic Management of a Hydatid Cyst of the Adrenal Gland

Hydatid disease is endemic in parts of India, yet genitourinary involvement is rare. Laparoscopic management of such cases is uncommonly reported. We present a case of an adrenal hydatid and its management by laparoscopic aspiration, instillation of scolicidal solution, and partial excision of the cyst.

Polycystic echinococcosis in the state of Acre, Brazil: contribution to patient diagnosis, treatment and prognosis

The lack of knowledge regarding polycystic hydatid disease results in delayed or even incorrect diagnosis. The lack of systematic information regarding treatment also makes it difficult to assess the results and prognosis in patients with peritoneal and hepatic lesions caused by Echinococcus vogeli. Here we describe the clinical features of patients, propose a radiological classification protocol and describe a therapeutic option for the treatment of hydatid disease that previously had only been used for cases of cystic echinococcosis (Echinococcus granulosus). A prospective cohort study was initiated in 1999 and by 2009 the study included 60 patients. These patients were classified according to the PNM classification (parasite lesion, neighbouring organ invasion and metastases) and placed in one of three therapeutic modalities: (i) chemotherapy with albendazole at a dose of 10 mg/kg/day, (ii) surgical removal of cysts or (iii) percutaneous puncture of the cysts via puncture, aspiration, injection and re-aspiration (PAIR). The results were stratified according to therapeutic outcome: "cure", "clinical improvement", "no improvement", "death" or "no information". The PNM classification was useful in indicating the appropriate therapy in cases of polycystic hydatid disease. In conclusion, surgical therapy produced the best clinical results of all the therapies studied based on "cure" and "clinical improvement" outcomes. The use of PAIR for treatment requires additional study.

Neurocisticercosis intraventricular tratada eficazmente con agentes anticéstodos / Intraventricular Neurocysticercosis effectively treated with anticestodal agents

Antecedentes: La neurocisticercosis se produce cuando el hombre se convierte en huésped intermediario de la Taenia solium al ingerir sus huevecillos. Esto ocurre al consumir carne de cerdo (principal huésped intermediario) con una cocción incompleta. Estas condiciones son comunes en áreas rurales sobre todo en países en vías de desarrollo, como Honduras; en donde, la prevalencia es desconocida, pero se ha demostrado que una de las zonas más endémicas de neurocisticercosis en el país es el Occidente, zona en la cual el ganado porcino constituye una de las principales fuentes de alimentación. Con respecto al tratamiento, los agentes anticéstodos han modificado el pronóstico de esta entidad; sin embargo, a pesar de ello, algunos enfermos evolucionan de forma desfavorable, particularmente en quistes ventriculares en el cerebro. Con éste reporte se pretende demostrar que el uso de agentes anticéstodos, como el albendazol es una opción terapéutica eficaz en el manejo de la neurocisticercosis intraventricular. Caso Clínico: paciente femenino procedente de Santa Rosa de Copán, al occidente del país, con historia de cefalea bitemporal de 5 años de evolución, asociada a fiebre no cuantificada y episodios de vómito. Estudios radiológicos reportaron imagen quística en IV ventrículo, que correspondía a probable quiste neurocisticercósico sin hidrocefalia, la paciente recibió tratamiento con Albendazol a dosis de 15 mg/kg/día por 14 días, con lo cual se obtuvo remisión de los síntomas, además, de reducción en el tamaño del quiste. Conclusión: Puede considerarse el uso de albendazol como una opción terapéutica eficaz en pacientes con neurocisticercosis intraventricular no complicada con hidrocefalia...

First Successful Puncture, Aspiration, Injection, and Re-Aspiration of Hydatid Cyst in the Liver Presenting with Anaphylactic Shock in Korea

Hydatid disease is a parasitic infestation caused by the larval form of Echinocococcus. In human, the most commonly affected organs are liver and lung. Most cysts remain clinically silent and are diagnosed incidentally or when complications occur. In Korea, hydatid disease is rare and surgically treated cases have been reported in the Korean literature. However, it is expected to confront this disease sooner or later, because of recent increase in traveling to the endemic area and industrial workers originating from those areas. With this trend, we experienced a case of hydatid cyst of the liver in a male patient from Uzbekistan. This patient was presented with anaphylactic shock combined with hydatid cyst. We successfully treated using ultrasound-guided transhepatic percutaneous drainage [termed puncture, aspiration, injection, and re-aspiration (PAIR)] of the hydatid cyst and concomitant albendazole instead of surgery. In this clinical case report, we describe all the course of the patient and recommend the PAIR as a first choice method for treatment of hepatic hydatid cyst.

Diagnosis and treatment of pulmonary cystic hydatidosis.

OBJECTIVE: Hydatidosis is a parasitic infection that is still an important public health problem in Turkey. In the present study, it was planned to review the diagnostic and treatment options. METHODS: The study was conducted in pediatric pulmonary chest ward of Izmir Chest Diseases and Surgery Training Hospital, a referral tertiary hospital for pulmonary diseases in Western Turkey. Cases were evaluated in clinical presentations, radiological, histopathologic and serological features retrospectively. RESULTS: Consecutive 17 (11 male and 6 female; mean age 11.29 + 2.44) pediatric cases between 1996 and 2001 were evaluated. Liver involvement was found in 8 (47%) cases. Casoni skin test and IHA test were found positive in 7 (63.6%) and 8 (72.7%) out of 11 cases, respectively. Surgical treatment was performed only in 7 (41.1%) cases as well as surgical plus medical treatment was given in 3 (17.6%) cases. Seven (41.1%) cases were treated just medically. CONCLUSION: Hydatidosis should be considered in the existence of appropriate clinical and radiological findings as a probable diagnosis in all children in our region. Surgery should be the first choice for treatment but, medical therapy was considered as effective for treatment complicated and/or nonsurgical pediatric cases.

Human neurocysticercosis managed at Nepalganj Medical College, Teaching Hospital, Kohalpur, Nepal.

INTRODUCTION: Neurocysticercosis is the most common parasitic infection of the central nervous system. It is endemic in Central Europe, South Africa, South America and parts of Asia including Nepal. OBJECTIVE: This study has been conducted with the objectives to know the diagnostic criteria for neurocysticercosis and the outcome of treated cases. METHODOLOGY: This retrospective study was done at Nepalganj Medical College, Teaching Hospital, Kohalpur, by reviewing the record of the patients managed as case of neurocysticercosis in one financial year. RESULTS: All patients presented with seizure as a main symptom started in adult life. The mean age was 21 years; 80% were male and 20% female. The diagnosis seemed to be based on clinical presentation, CT scan findings and high index of suspicion. All were put on albendazole, steroids and anticonvulsant drugs; 93% was discharged when fits got controlled, one patient left against medical advice. Follow up record was not available to comment on resolution. CONCLUSION: Neurocysticercosis is difficult to diagnose and has a significant socioeconomic impact because of chronic morbidity, variable mortality, decreased productivity of affected persons, and high cost of medical diagnosis and treatment. It is therefore suggested to develop criteria for diagnosis of neurocysticercosis to be followed at national level.

Hemichorea resulting from single enhancing computed tomography lesion.

A single small enhancing computerized tomographic lesion is a common finding in Indian patients with seizures, particularly focal seizures. A small single enhancing computed tomography lesion also presents with varied non-epileptic manifestations viz. focal neurological deficits, episodic vascular headache, syndrome of increased intracranial pressure, etc. Here we present a case of hemichorea resulting from single enhancing CT lesion. A 12-year-old female presented with acute onset abnormal movements involving right side of body. A clinical diagnosis of right hemichorea was made and patient was subjected to neuroimaging along with other investigations. CT scan showed a single ring-enhancing lesion with perifocal edema in left thalamic area suggestive of neurocysticercosis. Patient was treated with albendazole, steroids and haloperidol therapy. Patient showed marked improvement at follow-up after one month. Repeat CT scan revealed resolution of lesion. This case has been reported because hemichorea in young female is usually caused by post-streptococcal infection and it is quite rare presentation of small ring enhancing lesion.

The first human infection with Bertiella studeri in Vietnam.

This is the first case report of Bertiella studeri infection in Vietnam. The patient was a 4 year old boy in Cai Lay district of Tien Giang Province, noting some proglottids in his feces. The time and mode of infection were unknown, but anorexia, weight loss, and intermittent diarrhea were noted. Niclosamide (Yomesan) 1 gram was prescribed, and then albendazole (Zentel) 400mg daily for 3 days. Proglottids were found in the feces three months after the first treatment, and 1 month after the second course.

Transdiaphragmatic extension of hepatic hydatid cyst.

Transdiaphragmatic extension of hydatid cyst (HC) or cystic echinococcosis (CE) of the liver is a rare phenomenon. We report a case that presented as a right middle lobe consolidation. The diagnosis of transdiaphragmatic extension of hepatic hydatid cyst was suspected on CT scan of the chest and abdomen, and confirmed operatively. A successful outcome was achieved by a combination of pre- and post-operative albendazole therapy combined with surgery.

Hepatic hydatid cyst rupturing into sub-diaphragmatic space and pericardial cavity.

A ten-year-old male child presented with a large hepatic hydatid cyst which ruptured into the sub-diaphragmatic space and pericardial cavity, giving rise to a pericardial effusion. This communication between the hydatid cyst and the pericardium was documented on computerised tomographic scan of the chest and abdomen. The cyst was aspirated carefully and then enucleated. There was an associated right-sided reactionary pleural effusion. The pericardial effusion and pleural effusion resolved on albendazole therapy and did not require surgical intervention.

Cysticidal therapy: impact on seizure control in epilepsy associated with neurocysticercosis

OBJECTIVE: To evaluate the clinical features and seizure control of epilepsy related to neurocysticercosis. METHOD: 18 patients with partial epilepsy and neurocysticercosis were treated with albendazol or praziquantel and followed from 3 months to 12 years. We analyzed results from the CSF exam, interictal electroencephalogram (EEG), head computerized tomography and/or magnetic resonance imaging. RESULTS: The patients' mean age was 36.4 years. The mean duration of epilepsy was 16 years. 83 percent patients had simple partial seizures ; 17 percent had complex partial seizures . All patients underwent routine EEGs: 62 percent had abnormalities and 38 percent were normal. A relationship was observed between focal EEG abnormality and the location of cyst in 28 percent of the patients. The CSF exams showed pleocytosis in 33 percent of the patients, and 28 percent had elevated protein levels. Only 22 percent of patients had positive titer for cysticercosis in the CSF. In all patients who had somatosensory and special sensory seizures there was a relationship between location of the cysts and seizure semiology (n=11). After cysticidal therapy, 83 percent patients had a significant improvement in controlling seizures. CONCLUSION: In this group, we found a predominance of simple partial seizures and a relationship between somatosensory and special sensory seizures and the location of the cysts. Cysticidal therapy was effective in controlling seizures in these patients and should be considered for patients with partial seizures and semiology related to cyst location

Mepacrine therapy in niclosamide resistant taeniasis.

OBJECTIVE: To evaluate the efficacy of mepacrine (quinacrine) in patients with niclosamide resistant Taenia saginata infection. METHODS: Eighty six cases with niclosamide resistant Taenia saginata (unresponsive to 2-8 courses of niclosamide) were treated with quinacrine (1 g) administered orally or via a nasogastric tube, and followed at 2, 4, 8 and 12 weeks for recurrence of passage of proglottids and presence of Taenia eggs in the stool examinations. Pre and post-therapy egg counts were obtained and egg viability was tested by staining with methylene blue. RESULTS: Eighty-one (94.2%) patients responded promptly with passage of the worm within 4-72 hours. The egg counts showed a drastic fall in 79 cases and a fall in viability from a median of 100% to 0% was observed. Only one patient demonstrated a relapse at 4 weeks. Gastrointestinal side effects occurred in 9 cases but were controlled easily by symptomatic therapy. CONCLUSION: We conclude that quinacrine is a safe, inexpensive, effective and generally well tolerated drug for the treatment of niclosamide resistant Taenia saginata infestations.

Cestodosis del equino y las posibilidad de su control / Equine cestodosis and its control possibilities

En consideración a que ha aumentado la prevalencia y los casos clínicos de la cestodosis del equino en Chile, se revisó la literatura de los últimos 15 años. La especie más frecuentemente descrita es Anoplocephala perfoliata. La presente revisión resume, prevalencia e intensidad de infección a nivel mundial, ciclo biológico, patogénesis y las dificultades del diagnóstico y tratamiento. Se analizan las posibilidades del control de la parasitosis en base a una hipótesis epidemiológica

Bertiellosis in man: a review of cases

En este trabajo se hace una arevision de los casos humanos parasitados por Bertiella mucronata y Bertiella studeri (Cestoda: Anoplocephalidae), que incluye la casuistica internacional y bibliografia actualizada. Se analizan varios aspectos de esta zoonosis como son: taxonomia, ciclo biologico, epidemiologia, patologia, diagnostico, control, prevencion y terapeutica. Se discuten aspectos relacionados con la potencialidad zoonotica creciente de esta parasitosis

A survey report--July 1993: cysticercosis in the Grand Dani Valley, Jayawijaya District, Irian Jaya Province, Indonesia.

A community survey was conducted in Gran Dani Valley, Jayawijaya District, Irian Jaya Province, Indonesia. A total of 537 adults were asked whether they experienced epilepsy, and were physically examined for cysticercosis cysts. Forty-eight percent experienced at least one attack of epilepsy. Men had attacks 2.5 times more often than woman. Cysticercosis cysts were found in 26.5% men having 4.6 times more cysts than women. The cysts were mostly found in the pectoral region. The survey showed a raise cysticercosis in the Highlands of Irian Jaya and is considered a public health problem. Treatment was not available, but improvement of personal and environmental hygiene would be important. Mass de-worming activity should be a part of routine public health service in the district.