Analysis of CT characteristics in the diagnosis of Schistosoma japonicum associated appendicitis with clinical and pathological correlation: a diagnostic accuracy study.

PURPOSE: To clarify unique non-contrast CT (NCCT) characteristics for early recognition of Schistosomal associated appendicitis (SAA) differentiating from Non-schistosomal associated appendicitis (NSA). MATERIAL AND METHODS: Clinical and pathological data of 50 cases with SAA and 60 cases with NSA who underwent emergency appendectomy were retrospectively compared to pre-surgical NCCT features such as direct and indirect signs of acute appendicitis as well as appendicoliths, colon calcifications as diagnostic criteria. Statistical methods such as Chi-square (χ2), t-tests, Principal component analysis (PCA), Binary Logistic regression (LR) and Factor Analysis (FA) were utilized to observe differences and isolate recognizable CT features of SAA. Pre and post hoc diagnostic performance of all criteria was calculated as sensitivity, specificity, and the Odds Ratio (OR). RESULTS: Age > 50 years, diameter > 13 mm, pneumatosis, peri appendiceal abscess, focal wall defect, perforation; Orbital, linear and point types of appendicular wall calcifications; sigmoid colon and cecal curvilinear calcifications were observed as unique characteristics with a sensitivity of 84-95% and specificity of 91-98% in predicting SAA by OR of 6.2 times. Pre and post hoc hypothetical analysis did not show any significance for all other factors. CONCLUSION: Factors such as elderly age, CT features such as larger appendicular diameter, appendicular wall calcifications along with sigmoid colon, and cecal calcifications, signs of perforation or abscess are characteristic for early recognition of SAA.

Surgical treatment of 42 patients with cerebral schistosomiasis caused by Schistosoma japonicum.

OBJECTIVE: To investigate the clinical value of surgical treatment for cerebral schistosomiasis. METHODS: The clinical data of 42 patients with cerebral schistosomiasis caused by Schistosoma japonicum undergoing surgical therapy were analyzed retrospectively. RESULTS: There were 25 cases undergoing total resection of schistosomal granulomas and 17 cases undergoing partial resection of the lesions involving the functional areas or more than 2 lobes, and none died of the surgery. The post-surgical follow-up showed that 31 cases recovered completely and returned to the normal work and life, 2 developed mild weaknesses of all extremities, 3 had post-surgical epileptic seizures, 2 died of schistosomal hepatic cirrhosis, and 1 died naturally. CONCLUSION: Surgical treatment is an effective approach for cerebral schistosomiasis.

Severe hepatosplenic schistosomiasis: clinicopathologic study of 102 cases undergoing splenectomy.

We present the preoperative findings of 102 patients who underwent successful splenectomy for advanced schistosomiasis japonica. All patients were symptomatic for schistosomiasis and had splenomegaly greater than or equal to II according to the Hackett criteria. Before surgery, all patients underwent clinical examination including full blood count; fibrinogen and serum protein levels; liver function tests; and serology for hepatitis B, C, and D. Ultrasound examination of the liver and spleen and liver histology for evidence of pathology were also undertaken. Ninety patients had a treatment history for schistosomiasis. Fifty-six patients were seropositive for hepatitis B virus antibody, and 6 patients were seropositive for hepatitis C virus antibody. Immunohistochemical testing of the liver samples confirmed that 45 patients were positive for hepatitis B virus surface antigen, thereby indicating active infection. A total of 66.7% of patients had fibrosis stages II to III by ultrasound; and 76.5% of patients had portal vein inner diameter greater than 12 mm, indicating portal vein hypertension. A total of 83.2% of patients showed various stages of esophageal varicosis via x-ray, and 81.4% had fibrotic stages III to IV by liver biopsy. Coinfection with hepatitis B virus accelerated the development of liver fibrosis. There was moderate concordance between the fibrosis assessed by ultrasonography and histopathology, indicating that ultrasound underestimates the true pathology. Combined assessment is needed to improve the diagnosis of clinical hepatic fibrosis.

Surgical treatment of epilepsy with chronic cerebral granuloma caused by Schistosoma japonicum.

PURPOSE: To study the surgical treatment of epilepsy with cerebral granuloma caused by Schistosoma japonicum. METHODS: Two hundred fifty cases of epilepsy caused by cerebral schistosomiasis from 1955 to 2004 were analyzed retrospectively. RESULTS: There were no deaths. Follow-up of 196 cases for 4-5 years after operation demonstrated that 180 cases (92%) were seizure-free or well-controlled. CONCLUSIONS: Surgical treatment should be considered when drug therapy fails to control epilepsy or the lesion shows mass effect. Intraoperative electrocorticography monitoring is helpful to define the extent of the resection of the lesion.

[Intestinal schistosomiasis, a facultative precancerous condition? Review of the literature with reference to Schistosoma japonicum associated rectum carcinoma]. / Die intestinale Schistosomiasis, eine fakultative Präcancerose? Eine Literaturübersicht anlässlich eines Schistosomia japonicum assoziierten Rectumcarcinoms.

After a latency period of 20 years, in a 39-year-old Austrian citizen of Chinese origin, a surgically removed rectal carcinoma, as well as the neighboring chronic inflammatory rectal mucosa with various degrees of dysplasia and one positive neighboring lymph node, showed helminthiasis in the histopathological examination, convincing us of a link between carcinoma and chronic helminthiasis. Whereas the etiological context between chronic infection by Schistosoma haematobium and endemic frequent urinary bladder carcinoma is considered a matter of fact, whether of not the incidence of intestinal carcinoma is increased in connection with chronic intestinal schistosomiasis is controversial. The etiological and pathogenetic link between helminthiasis and carcinoma should be considered in the same way as for other related inflammatory large-bowel diseases. In the sequence chronic inflammation-severe dysplasia, the formation of carcinoma could possibly occur. Besides a survey of trematodes parasitology and pathology, the link between rectal carcinoma and Schistosomiasis japonicum is pointed out by means of appropriate literature investigations.

Neuroschistosomiasis myelopathy: case report.

A case of intramedullary neuroschistosomal granuloma in a 15-year-old girl is reported. Despite the fact that Saudi Arabia is endemic for schistosomiasis, neuroschistosomiasis has rarely been reported from that country. A review of the literature on the incidence, pathogenesis, clinical patterns and management of neuroschistosomiasis, particularly myelopathy, is given.

[Effect of splenectomy on disorder of cellular immunoregulation in patients with advanced schistosomiasis].

The peripheral blood natural killer (NK) cell activity, the percentage of E-CabR rosettes, phagocytosis of neutrophil and lymphocyte blastogenesis were studied to assess the cellular immunoregulation in patients with advanced schistosomiasis. The results showed that the NK cell activity and the percentage of E-CabR rosettes were significantly lower in patients with splenomegaly than in patients who had undergone splenectomy and in normal subjects. The phagocytic index of neutrophil and lymphocyte blastogenesis was reduced in patients with advanced schistosomiasis, but no significant difference was found between the patients with and without splenectomy. These results suggested that splenectomy not only reduce the portal hypertension but also improve the regulatory functions of cellular immunity which may enhance the patient's resistance against pathogens.

Proximal tubal obstruction associated with tubal schistosomiasis.

The gynecologic consequences of schistosomiasis may range from minimal inflammation of tubal serosa to more intense reactions involving the periadnexal regions. Complete obliteration of the tubal lumen has not been described. We describe a case of proximal tubal obstruction associated with tubal schistosomiasis.