[Hydatidosis bone wall chest: About three cases]. / Hydatidose osseuse de la paroi thoracique : à propos de trois cas.

INTRODUCTION: Bone hydatidosis of the chest wall is rarely reported in the literature. Costal and sternal location are uncommon. Through 3 observations and literature review, we report particular pathophysiological and diagnostic aspects of costal and sternal hydatidosis. We also discuss therapeutic and prognostic aspects of this disease. OUR CASES: we report the cases of 45, 41 and 17 years old male patients, 2 of them had previous surgery for thoracic wall mass in general surgery service. Clinical presentation was thoracic wall painful mass sticking to bone. One patient had isolated costal location, the 2 others had sternal location; in one of them, the disease is located in sterno-costo-clavicular area. In all 3 cases, the disease was diagnosed by computed tomography (CT) scan, showing bone lysis or mediastinum enlargement. Patients undergo extended bone resection removing away all destructed parts of the bone. After surgery, albendazole has been prescribed to all patients. No recurrence was observed after 12 months follow-up. CONCLUSION: Chest wall bone hydatidosis is unusual even in endemic regions, with slow evolution and inconspicuous symptoms. Radiology plays a key role in the management of this disease. Extended surgical resection associated with medical treatment (albendazole) is a reliable treatment without recurrence.

Live Dirofilaria immitis found during coronary artery bypass grafting procedure.

Dirofilaria immitis is a parasite transmitted by mosquito bites, where the most common primary hosts are dogs, cats and some wild animals. Humans become accidental hosts after being bitten by an infected mosquito and the number of such infections has rapidly increased during the last decade. We present a patient in which a live D. immitis has been found during myocardial revascularization. To the best of our knowledge, live D. immitis found in the substernal area during open heart surgery has never before been described. D. immitis in humans most often cause pulmonary nodules known as 'coin lesions' which are benign and asymptomatic, but it is very important for thoracic surgery that they are considered in the differential diagnosis of pulmonary nodules. Video assisted thoracic surgery has been proven as the best method for diagnosing and treating pulmonary dirofilariasis.

[Particular localisation of hydatic disease--sternum]. / Localizare particulara a bolii hidatice la om--sternul.

Bones localization of hydatic disease is extremely rare (0.5-2.5 %). In approximative 50% of the cases of bones hydatidosis, the cysts are localized at spines vertebrae, broad bones and mandible. We present a case of a 38 years old female. The patient related an insidious beginning of symptoms, about 3-4 years before, with anterior chest pain, and 3-4 month before hospitalization, the presence of a sternal tumor, in upper portion of the bone. Clinical examination of the patient showed a sternal tumor, at manubrium, painful at palpation, increased consistency, with local inflammation signs. Also, the patient related pain at sterno-clavicular articulation, increased by left upper limb motions, but without mobility restriction. Biochemical analysis revealed an moderate inflammatory syndrome: blood cell sedimentation speed = 40 mm/h, WBC = 9600/mmc, E = 3%, Hb = 11.8g/100ml, alcaline and acid phosphatase - normal range. Thoracic scan: sternal tumor at manubrium with invasion at sternoclavicular joint and bone destruction. Intraoperative we discovered that the sternal tumor was in fact an hydatic cysts, confirmed by the anatomo-pathological exam; we performed cysts removal and resection of osteitic bone. Postoperative outcome was favorable, with antiparasitic treatment after surgery; no recurrence of the hydatic disease or secondary localization.

Trypanosoma cruzi: experimental parasitism of bone and cartilage.

Trypanosoma cruzi causes Chagas' disease, a systemic infection that affects cells of meso-, endo-, and ectodermic origin. However, as far as we know, the presence of T. cruzi stages in bone has not been reported previously, and it has scarcely been investigated in cartilage. We inoculated 7- and 20-day-old (8 and 15 g) NMRI albino mice i.p. with metacyclic trypomastigotes from Rhodnius prolixus used for xenodiagnosis of mice previously infected with mammalian, human, and triatomines isolates, characterized by randomly amplified polymorphic DNA as zymodeme 1 (equivalent to T. cruzi I). Tissular parasitism (quantified according to the number of pseudocysts/50 fields 400x) showed amastigotes, intermediate forms, or trypomastigotes in sternum chondroblasts, osteoblasts, macrophages, and fibroblasts; chondrocyte and osteocyte invasion was rare. All isolates parasitized bone marrow macrophages, with few amastigotes. We observed marked associated myotropism, with or without inflammatory infiltration; there were small numbers of intensely parasitized mononuclear cells in perichondrium and periosteum. We discuss the results in relation to the marked differences of the T. cruzi tropism toward the different types of sternum cells, and, additionally, we outline the possibility of transmitting parasitized bone marrow through transplants. The fact of finding parasite stages in sternum bone and cartilage may be considered important due to the studies on Chagas' disease paleoparasitology that are based on histological and molecular analysis.