[Clinical "maskas" of liver echinococcosis].

The Hydatid desease of the liver is without exactly pointed pathological syndrome. Frequently this disease is promoting with some kinds of masks: allergies, hyperpirexis without suppuration of the cyst bile duct pathological motilities, portal hypertension, icterus, abdominal mass, neuroses than all of those make medic difficulted at the diagnostic process. Some cases of diagnostic lapse are note rare or correct discover getting just on the surgical table. Because of this it is very imported to recognize those masks and always look for hydatid disease. Disappearing or keeping of this symptoms is exciting clinical sign about grading of healing processes in the liver after the operation and this radicality.

[Immunodiagnostic of liver echinococcosis].

Four immunological reactions of the liver echinococcosis are examined - Complement fixation test (CF), Latex agglutination test (LA), Bentonite agglutination test (BA) and Indirect haemagglutination test (IHA). The diagnostic "potentialities" of every sample are specified separately. IHA has given the best results, followed by LA. BA and CF in last place. The great significance of the immunodiagnostic with regard to diagnose of the disease is demonstrated and its place in the postoperative observation for clarifying of the prediction and for proving of the recidivation. It's obligatory to use several immunological samples, which complement one another. The immunological titers can stay at high rate in every stage of the illness, including during suppuration or partial calcification of the cyst.

[Experimental transplantation of the capsula fibrosa of patients with hepatic echinococcosis to white mice. Analysis of relapses after various surgical procedures]. / Experimentelle Transplantation der Kapsula fibrosa von Patienten mit Leberechinokokkose auf weisse Mäuse--Auswertung von Rezidiven nach den verschiedenen Operationsverfahren.

Systematic histological investigations concerning the existence of protoscolices in the fibrotic capsula and in the liver parenchyma of operated patients were carried out by means of the immuno-fluorescence. A protoscolex in the fibrotic capsula was detectable histologically only once. The theory of Napalkov about the relapses of the disease by protoscolices invaded in the fibrotic capsula and surrounded tissue cannot be corroborated after the transplantation of fibrotic capsula in white mice before and after sterilisation by Scolicid and the other investigations. A method for sterilisation of the fibrotic cavity and the fibrotic capsula is presented. In that way difficult traumatising operations with high lethality like pericystectomy and resection of the liver are avoidable.

[Clinical experiment studies in the treatment of echinococcosis with mebendazole (Vermox)]. / Klinisch-experimentelle Untersuchungen bei der Behandlung der Echinokokkose mit Mebendazol (Vermox).

3 patients with echinococcosis were treated with Mebendazol conservatively. One patient got a drug allergy. The other two were operated after a conservative therapy during 3 years in one case and in the course of 110 days in the other case. Dead as well as vital echinococcus cysts and protobrood-cysts were found intraoperatively. The intraabdominal transmission of protobrood-cysts to white infantile mice led to a secondary echinococcosis. The surgical therapy appeared more efficacious in contrast to the conservative treatment. A combination of surgical therapy and conservative treatment is to be recommended in severe disseminated forms of the echinococcosis.

Circulating antibodies in human echinococcosis before and after surgical treatment.

Antibody levels in 89 patients who had been operated on for hydatid disease were studied over a period of 4 years by complement fixation, latex agglutination, bentonite flocculation, and passive haemagglutination tests. The geometric mean titres were much higher in patients with liver echinococcosis than in those whose lungs were affected. In the first month after operation, an increase in antibody level was observed more often in the former than in the latter. The raised level usually persisted for 3-6 months.In one group of 77 patients, the serological tests either became negative 6 months to 2 years after operation or remained positive during the entire postoperative period. In the other 12 patients, who had recurrent echinococcosis, the tests did not become negative, although there was a reduction in antibody levels during the first and second postoperative years in 6 patients, followed by a rise when the disease recurred. Antibody levels remained high during the entire observation period in the other 6 patients.The prognosis can be considered favourable in patients with low pre-operative titres, or negative tests, provided the tests remain negative up to the end of the first year after operation or become negative within one and a half years. Where there is only a small reduction in antibody titre, the prognosis may still be favourable if the decrease continues to fall up to the end of the second year. Since a drop in antibody titres occurred in certain cases with recurrent infection, it is advisable to defer an opinion on the prognosis until the end of the second year. If the fall in antibody titres is followed by a steady rise, or if they remain high or show slight fluctuations, a recurrence is almost certain.

Antibody persistence after surgical treatment of echinococcosis.

Studies on the persistence and levels of antibodies in 280 patients at different intervals following surgery for echinococcosis are described. Post-operative antibody levels were investigated by means of four immunodiagnostic methods, namely, the complement fixation, latex agglutination, indirect haemagglutination, and intradermal tests. After surgical removal of the cysts the tests became negative in some patients, whereas in others they remained positive for many years. As the post-operative period increased, the percentage of positive results fell and this fall was faster in lung echinococcosis than in liver echinococcosis. The titres obtained with the serological tests decreased at the same rate as the percentage of positive results, but the intradermal test remained positive, with an unchanged titre, for many years. In the case of secondary echinococcosis, medium and high titres predominated in all the tests. These immunological investigations during the post-operative period make it possible to evaluate the results of surgery and, to some extent, to clarify the prognosis.