Non-operative Management of Asymptomatic Liver Hydatids Cysts

For the past 90 years all asymptomatic hydatid cysts of the liver are routinely removed surgically to prevent serious complication. The mortality of such operations are above 6 percent, while major complications of untreated liver hydatid cysts are less than 6 percent. The best way to manage incidentally discovered asymptomatic liver hydatid cysts is to fully understand their natural history: 1] the pericyst layer surrounding most liver hydatid cysts will become thicker and calcified. Such changes are known as PDCs [Pericyst Degenerative Changes] on computed tomography [CT] and indicate that these cysts can no longer grow in size and, therefore, need not to be operated upon. They can be followed up by CT [not sonography or magnetic resonance imaging [MRI]] at intervals of 1-5 years, and no sooner, to avoid radiation exposure. Albendazole can be prescribed for them under supervision if they show no PDCs on CT. Mild, intermittent pain of abdomen or flank is not a sign of complication. 2] The inside field of hydatid cysts on CT and not sonography or MRI] should be inspected at intervals of 1-5 years. Finding any structures [usually some lines] suggests that there has been detachment of the parasite from the host, called LMD[Laminated Membrane Detachment]. These cysts will reach involution or develop daughter cysts over next 10 years, and also need not to be operated upon. Patients who develop jaundice, sever pain and fever, or have air in their cysts on CT, or have developed complications need to be operated upon, including ERCP [Endoscopic Retrograde Cholangio Pancreatography]

gastro-esophageal malignancies in Northern Iran research project: impact on the health research and health care systems of Iran

The Gastro-Esophageal Malignancies in Northern Iran [GEMINI] research project is an example of recent progress in health research in Iran. The original aim of this project was to identify etiologic factors and prevention measures for upper gastrointestinal cancers in Northern provinces of Iran, but its achievements have gone much beyond this initial goal. GEMINI consists of several projects including cancer registries, pilot studies, case-control studies, and the Golestan Cohort Study. GEMINI has been conducted through extensive collaborations between the Digestive Disease Research Center of Tehran University of Medical Sciences with other domestic and international health organizations. The achievements of GEMINI include producing new knowledge, introducing new research methods, developing and expanding health research and health care infrastructures, investing in human resources, and increasing the awareness and knowledge of policy makers and officials at all levels about the importance of chronic diseases in Iran's health priorities. The success of GEMINI reveals the feasibility of large-scale health research studies in developing countries and serves as a successful model not only for health research in Iran, but also for similar research studies in other developing nations

new technical approach to cancers of the cervical esophagus

Background: The aim of this study was to assess the possibility of a primary end-to-end pharyngoesophageal anastomosis after standard tumor resection of the cervical esophagus by acute Aexion of the neck

Methods: A total of 34 consecutive patients with primary cervical esophageal cancer, none having received prior radio-or chemotherapy, were treated by two methods based on intraoperative findings. In 18 patients, reconstruction after esophageal resection was carried out by the standard gastric pull-through technique [control group]. In 16 patients, acute flexion of the neck after tumor resection allowed for recon-struction by primary end-to-end pharyngoesophagostomy [experimental group]

Results: There was no operative mortality in either group. The mean operative time for the experimental group was about 50 minutes less compared to the control group. Self-limited postoperative anastomotic leakage in the neck was twice as common in the experimental group. Postoperative dysphagia was about three times as common in the experimental group [5 patients [31%]] compared to the control group [2 patients [11%]]

Conclusion: In selected cases, segmental resection of primary cervical esophageal cancers reconstructed by end-to-end pharyngoesoph-agostomy is technically feasible by bending the neck acutely forward during anastomosis and maintaining it in the Aexed position during a postoperative period of about 7 days. The advantages are reduced scope and duration of the operation. The downside is doubling of the frequency of postoperative cervical leakage