Embolia pulmonar por hidatidosis / Hydatidic pulmonary embolism

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[The recurrent lung hydatid cysts in children].

The treatment results of 199 children with lung echinococcosis was performed. 78 (39.2%) had complicated forms of the disease. The organ-preserving operations were predominately performed: traditional echinococcectomy in 177 (89%) and videothoracoscopic echinococcectomy in 15 (7.5%). Lobe resection was performed in 2 patients. 5 patients cured without surgery thank to bronchial cyst evacuation. The long-term follow-up data were obtained from 163 (82%) of patients. Reccurense of the hydatid disease was registered in 8 (4.9%) patients. The study demonstrated the importance of immediate surgery after the cyst rupture with pleural dissemination and early recurrence diagnostics, which allows conservative treatment.

A case of pulmonary and hepatic cystic Echinococcosis of CE1 stage in a healthy Japanese female that was suspected to have been acquired during her stay in the United Kingdom.

We herein report a case of a young Japanese female who was confirmed to have cystic echinococcosis (CE) 1 stage based on the World Health Organization Informal Working Group on Echinococcosis pathological classification of CE, and she was also suspected to be infected with eggs of the G1 Echinococcus granulosus sensu stricto during her stay in the United Kingdom and therefore, suffered from synchronous pulmonary and hepatic CE. Oral albendazole was administered initially, but rupture of a lung hydatid cyst was observed. To avoid additional rupture, we performed two surgeries. CE is very rare in Japan; all CE cases in Japan during the past two decades have been confirmed to be imported, and almost all cases are hepatic CE. This case is the first case report of a Japanese patient who had concomitant giant lung and liver CE with early-stage CE1 and was successfully treated by surgery and pharmacotherapy with a serological follow-up.

Erythrocyte glutamine depletion, altered redox environment, and pulmonary hypertension in sickle cell disease.

Erythrocyte glutathione depletion has been linked to hemolysis and oxidative stress. Glutamine plays an additional antioxidant role through preservation of intracellular nicotinamide adenine dinucleotide phosphate (NADPH) levels, required for glutathione recycling. Decreased nitric oxide (NO) bioavailability, which occurs in the setting of increased hemolysis and oxidative stress, contributes to the pathogenesis of pulmonary hypertension (PH) in sickle cell disease (SCD). We hypothesized that altered glutathione and glutamine metabolism play a role in this process. Total glutathione (and its precursors) and glutamine were assayed in plasma and erythrocytes of 40 SCD patients and 9 healthy volunteers. Erythrocyte total glutathione and glutamine levels were significantly lower in SCD patients than in healthy volunteers. Glutamine depletion was independently associated with PH, defined as a tricuspid regurgitant jet velocity (TRV) of at least 2.5 m/s. The ratio of erythrocyte glutamine:glutamate correlated inversely to TRV (r = -0.62, P < .001), plasma arginase concentration (r = -0.45, P = .002), and plasma-free hemoglobin level (r = -0.41, P = .01), linking erythrocyte glutamine depletion to dysregulation of the arginine-NO pathway and increased hemolytic rate. Decreased erythrocyte glutathione and glutamine levels contribute to alterations in the erythrocyte redox environment, which may compromise erythrocyte integrity, contribute to hemolysis, and play a role in the pathogenesis of PH of SCD.

Socioeconomic and behavior risk factors of human alveolar echinococcosis in Tibetan communities in Sichuan, People's Republic of China.

Data from two cross-sectional investigations on 7,138 subjects were used to explore risk factors of human alveolar echinococcosis (AE) in Tibetan communities. The overall human AE prevalence was 3.1% (223 of 7,138), females had a higher prevalence (3.6%, 132 of 3,713) than males (2.7%, 91 of 3,425; P = 0.011), and herdsmen had a higher prevalence (5.2%, 154 of 2,955) than farmers (1.8%, 12 of 661; P < 0.001) and urban populations (2.1%, 49 of 2,360; P < 0.001). Age in all populations, number of dogs kept, fox skin ownership in farmers, not preventing flies from landing on food in herdsmen, using open streams as drinking water sources, and playing with dogs in urban populations were statistically significant risk factors. The results suggest that AE is highly endemic in the eastern Tibetan plateau, in Sichuan Province, the role of the dog is important for human infection, and other factors associated with environmental contamination may vary according to structure and practices of communities.

[Hydatic pulmonary embolism complicating a cardiac hydatic cyst. A case report]. / Embolie pulmonaire hydatique compliquant un kyste hydatique du coeur. A propos d'un cas.

Hydatic pulmonary embolism: complication of a cardiac hydatic cyst:a case report hydatic cardiac cyst is a rare condition and represents only 0.5 to 2% of all visceral localisations of the hydatid disease. We reported a 28 year old patient with a multiple hydatic pulmonary embolism caused by the rupture of a hydatic cyst of the interventricular septum. The diagnosis was established by transthoracic echocardiography and CT Scan. Surgery was performed without delay and the outcome was good after a five month follow-up. This case illustrates the diagnostic value of the non invasive imaging means in hydatic cyst of the heart and underlines the importance of surgery realized before complications occur.

Echinococcus multilocularis: parasite-specific humoral and cellular immune response subsets in mouse strains susceptible (AKR, C57B1/6J) or 'resistant' (C57B1/10) to secondary alveolar echinococcosis.

Parasite-specific humoral and cell-mediated immune responses were investigated in highly susceptible (AKR and C57B1/6J) and relatively resistant (C57B1/10) mice undergoing secondary alveolar echinococcosis (infection with Echinococcus multilocularis metacestode). The parasite-specific proliferative immune response of lymph node cells upon in vitro antigen stimulation remained weak in all three mouse strains. By day 30 p.i., CD4+ lymphoblast cells dominated the total population of blast cells in all three mouse strains. There was, however, an unexpectedly high proportion of CD8+ blast cells; by day 90 p.i., a marked proportional increase in CD8+ cells was seen in susceptible (AKR and C57B1/6J), but not in resistant (C57B1/10) mice. Susceptible, but not resistant mice exhibited a significantly decreased responsiveness of lymph node cells to concanavalin A (Con A) stimulation on day 90 p.i. Analysis of the humoral immune response by ELISA showed that resistance in C57B1/10 mice was associated with the ability of the host to synthesize antibodies to Em2 of the IgG3 and IgG1 isotype. Em2 is a lectin-binding carbohydrate antigen of the laminated layer. In susceptible AKR and C57B1/6J mice, low levels of anti-Em2 antibodies of the IgG2a isotype were detected. Anti-Em2 antibodies of the IgG3/IgG1 isotype, however, were absent. Differences in subclass-specific IgG responses were confirmed by immunoblot analyses. Our findings suggest that differences in antigen recognition (with respect to subsets of humoral and cellular immune components), probably controlled by non-H-2 gene(s), coupled to immune suppression modulated by CD8+ cells and/or respective cytokines, may determine susceptibility or resistance in experimental infection with E. multilocularis.

[The mebendazole treatment of patients with alveolar echinococcosis]. / Lechenie mebendazolom bol'nykh al'veoliarnym ékhinokokkozom.

Chemotherapy was administered to 17 alveolar echinococcosis patients. Two of these patients developed an uncomplicated disease (a subtotal involvement of both liver lobes), fifteen a complicated condition. In 13 patients with the complicated condition metastases to the lungs, peritoneum, as well as diaphragmatic and abdominal organs' growth were detected, in 4 ones jaundice developed. Mebendazole was administered in a daily dose of 50 mg/kg together with the drugs improving its absorption. 30-day courses with 1-3 month intervals were administered. The efficacy of this therapy and its tolerance were assessed from clinical, laboratory and instrumental findings, including serologic tests. Intolerance presenting as alopecia was observed in 4 women, in one of them twice. Mebendazole efficacy in these patients was compared to that in patients administered the drug in a daily dose of 100 mg in 1978-1980. A positive time course was observed in 53% of patients.

[Secondary bronchogenic pulmonary hydatidosis]. / L'hydatidose pulmonaire secondaire bronchogénétique.

Secondary bronchogenic hydatid disease is a rare and little known complication of primary hydatid cyst of the lung, which is even refuted by some authors. We report 7 cases of secondary bronchogenic hydatid after surgical cure of a hydatid cyst which had ruptured into the bronchi, while the last case concerned a young girl who was treated by corticosteroids for rheumatoid arthritis and who developed secondary bronchogenic hydatid from a cyst rupturing into the bronchi in the absence of surgery. Hydatid dissemination was ipsilateral to the primary cyst in 5 cases, contralateral in one case and bilateral in one case. Five patients underwent radical surgery. The patient with bilateral dissemination was operated on one side and a large number of residual cysts were eliminated by vomica, as for the last patient; these two patients are still under surveillance. The operation and general anaesthesia played a predisposing role in the pathogenesis of this complication and inhibition of immune mechanisms could also play a role. Prevention is necessary when treating a hydatid cyst of the lung which has ruptured into the bronchi. Treatment is surgical, bearing in mind that a large number of secondary cysts can be eliminated by vomica or may involute spontaneously.

[Secondary bronchogenic pulmonary hydatidosis]. / L'hydatidose pulmonaire secondaire bronchogénétique.

Secondary bronchogenic hydatid disease is a rare and little known complication of primary hydatid cyst of the lung, which is even refuted by some authors. We report 7 cases of secondary bronchogenic hydatid after surgical cure of a hydatid cyst which had ruptured into the bronchi, while the last case concerned a young girl who was treated by corticosteroids for rheumatoid arthritis and who developed secondary bronchogenic hydatid from a cyst rupturing into the bronchi in the absence of surgery. Hydatid dissemination was ipsilateral to the primary cyst in 5 cases, controlateral in one case and bilateral in one case. Five patients underwent radical surgery. The patient with bilateral dissemination was operated on one side and a large number of residual cysts were eliminated by vomica, as for the last patient; these two patients are still under surveillance. The operation and general anaesthesia played a predisposing role in the pathogenesis of this complication and inhibition of immune mechanisms could also play a role. Prevention is necessary when treating a hydatid cyst of the lung which has ruptured into the bronchi. Treatment is surgical, bearing in mind that a large number of secondary cysts can be eliminated by vomica or may involute spontaneously.

Quiste hidatídico en tránsito hepatotorácico / Hydatid cyst in hepatothoracic transit

Análisis retrospectivo de 47 fichas clínicas de pacientes portadores de un quiste en tránsito hepatotorácico tratados entre 1964 y 1988 (2 casos anuales entre 97,8 de incidencia en la Región). Se encuentra igualdad de sexos, 83% de ruralidad, 80,8% en edad productiva y 34,1% con tratamiento previo por hidatidosis. Compromiso del estado general, fiebre, dolor torácico o en hipocondrio derecho, matidez basal disminucción o abolición del murmullo vesicular en hemitórax derecho y desgarro purulento son los síntomas o signos clínicos más frecuentes. Biliptisis sólo en 12,7% (patognomónico). Leucocitosis y VHS elevada son constantes. Eosinofilia sólo en 42,6%. La Rx tórax simple presenta alteraciones em 100% (velamiento basal derecho, nivel hidroaéreo u otro). Lóbulo inferior derecho se compromete más frecuentemente y con lesiones que van desde neumonitis por vecindad hasta fístula biliobrónquica (14,8%). El tratamiento se plantea en etapas (2 o más operaciones en 27,6% por el grave compromiso del estado general, drenando cavidades intermedias o colecciones y tratamiento antibiótico a dosis de sepsis previo a la cirugía definitiva (loctomías 53,2%). Mortalidad perioperatoria 10,6% y morbilidad general 36,1%

[Hepatic alveolar echinococcosis: diagnosis and treatment]. / L'échinococcose alvéolaire hépatique: diagnostic et traitement.

Alveolar echinococcosis is a parasitic disease which is relatively rare in humans. It almost exclusively affects patients of rural origin living in enzootic regions (Eastern France, Auvergne) and most lesions are in the liver. Several anatomico-clinical forms have been described; the most frequent is the multilocular form, but the disease may consist of one single cyst or abscess. The liver structure is always deeply altered, with compression, inflammation or superinfection. Jaundice, liver enlargement, abdominal pain or signs of secondary localizations are manifestations that lead to the discovery of hepatic alveolar echinococcosis. The anatomical features of the lesions are demonstrated by ultrasounds and computerized tomography. The main differential diagnosis is tumoral pathology of the liver. In most cases the diagnosis of echinococcosis is confirmed by serological tests, although needle or even surgical biopsy might be necessary. Diagnosed at an early stage, alveolar echinococcosis can be amenable to surgical treatment (hepatectomy), and liver transplantation may even be performed. Medical treatment with benzimidazoles seems to be promising.