Alveolar hydatid disease: imaging findings and surgical approach.

PURPOSE: We report six cases of Alveolar Hydatid Disease (five in the liver and one in the gastrosplenic ligament invading the spleen) in which curative resection of the liver (five cases) and splenectomy (one case) were performed. MATERIAL AND METHODS: The records of the six patients with AHD were retrospectively evaluated. Demographics of the patients, symptoms, laboratory findings, including serology were recorded. Imaging studies determined the extent of the disease preoperatively. Classification of the lesions was done according to the PNM (P = parasitic mass in the liver, N = involvement of neighbouring organs, and M = metastasis) staging system designed by the World Health Organization. All the surgical procedures were performed as complete resections, where negative margins were approved by frozen sections. Chemotherapy with albendazole (10 mg/kg/day) was continued postoperatively for two years in five of the six patients who were alive. RESULTS: All of the cases were from East Anatolia of Turkey, which is an endemic region. The mean age was 39.6 years (15-54 years). Major complications occurred post-operatively in all patients, possibly due to the extensive resection. No recurrence was seen during the 5 year follow-up of two cases and 2 year follow-up of three cases. CONCLUSION: The treatment of Alveolar Hydatid Disease is curative radical resection. Thus, pre-operative imaging studies to determine the extent and stage of the disease are of crucial importance.

Surgery in Fasciola hepatica pancreatitis: report of a case and review of literature.

Fasciola hepatica is a trematode rarely causing disease in humans. In symptomatic cases, while various pathologies such as damage to liver parenchyma, acute cholecystitis, and obstructive jaundice can be seen, the development of pancreatitis is rarely mentioned in the literature. The treatment of the disease is medical. In cases where no definite diagnosis can be made or in incidental cases where common bile duct exploration is being done, F. hepatica can be detected accidentally during operation. No consensus has yet been reached on the surgical procedure to be applied in this condition. We report on our case due to the rare occurrence of pancreatitis as a complication. In surgical cases, external drainage of the bile is both crucial in observing the response to the treatment, and also should be accepted as part of the treatment.

Histologic alterations in the thyroid gland after fine-needle aspiration.

To evaluate the histologic alterations due to the fine-needle aspiration (FNA), a comparative study between 20 aspirated and 20 nonaspirated thyroidectomy specimens was performed. The most common findings in the aspirated group were hemorrhage (80%) and vascular proliferation and/or vascular thrombosis (45%). In one of the aspirated cases with the cytologic diagnosis of follicular neoplasm, histologic sections revealed prominent vascular and endothelial proliferation. Fibrosis, cystic degeneration, and infarction were other histologic findings in the aspirated group. Hemorrhage was seen in 45% and cystic degeneration in 25% of the nonaspirated cases. Fifty percent of the nonaspirated cases did not have any additional findings. In conclusion, knowledge of previous FNA application and awareness of possible histologic alterations due to the needling is necessary while evaluating the histologic sections of the thyroidectomy specimens.

Symptomatic giant cavernous haemangioma of the liver: is enucleation a safe method? A single institution report.

Twenty-three patients with symptomatic giant hemangioma of the liver were treated by surgery between 1979 and 1996 at the department of General Surgery, Faculty of Medicine, University of Cukurova. Twenty-three enucleations were performed in 21 patients, left lateral segmentectomy in one patient and enucleation plus left lobectomy in one patient. The tumors were enucleated along the interface between the hemangioma and normal liver tissue. The diameters of the tumors ranged from 5 x 5 to 25 x 15 cm. The mean blood loss for enucleations was 525 ml (range 500-1000 ml). There was no mortality and no postoperative bleeding. Three patients had postoperative complications. Enucleation is the best surgical technique for symptomatic giant hemangioma of the liver. It may be performed with no mortality, low morbidity and the preservation of all normal liver parenchyma.

Surgical management of hydatid disease of the liver.

The authors review 143 consecutive, surgically treated cases of hydatid disease of the liver seen over the past 10 years. Of the 208 cysts found, 82 (39.4%) were complicated; the remainder were simple. The complications included rupture into the biliary system (16.3%), suppuration (11.0%), partial calcification of the pericyst (5.8%), intraperitoneal rupture (4.8%), bronchobiliary fistula (0.9%) and cystocutaneous fistula (0.5%). External capitonnage was the most commonly used surgical technique (63.0%), followed by cystectomy (17.8%), omentoplasty (10.6%), tube drainage (7.7%) and cystojejunostomy (0.9%). Capitonnage was carried out with or without tube drainage. The complications of surgery were higher with drainage than without. The main complications of surgery were infection in the residual cavity and biliary fistula. The patients who underwent external capitonnage without drainage or omentoplasty had good results with minimal complication rates (3.5% and 4.5% respectively). For the patients in whom the cystectomy was established, the complication rate was 8.1%.