Evaluation of Charlson comorbidity index as a predictor of postoperative complications in patients with hepatic cystic echinococcosis. A nested case-control study.

Postoperative complications (POC) following hepatic cystic echinococcosis (HCE) surgery remains a challenge. Frailty indices (FIs) as predictors of POC in this context has not been investigated. We aimed to evaluate the predictive value of three frailty assessment tools (mFI-11, FRAIL scale, and PRISMA-7 questionnaire), for POC in patients with HCE undergoing elective surgical treatment. Nested case-control study in a concurrent cohort. Consecutive patients who underwent elective open surgery for HCE between 2012 and 2020 with a minimum follow-up of 4 years were included. Cases were frail patients with mFI-11 ≥ 0.27, PRISMA-7 ≥ 3, or FRAIL ≥ 3. Cases and controls were matched in a 1:1 based on age, sex, cyst diameter, history of HCE surgery, ultrasonographic characteristics, and cyst location. Primary outcome was overall and severe POC. Sample size was based on overall POC of 28% for cases and 11% for controls, assuming 5% type I error and 80% statistical power. Descriptive and bivariate statistics were applied. Odds ratios (OR) and 95% confidence intervals were calculated, and predictive performance evaluated using area under the receiver operating characteristics curve (AUC), and its comparison applying DeLong test. 70 cases and 70 controls were included. mFI-11 ≥ 0.27 and PRISMA-7 ≥ 3 were identified as prognostic factors for overall and severe POC (p < 0.001 and p = 0.02; and p = 0.02 and p = 0.03, respectively); and FRAIL as an independent factor for overall POC (p = 0.005). Logistic regression adjusting for potential confounding variables confirmed mFI-11 ≥ 0.27 as an independent prognostic factor for overall POC (OR 4.8; p = 0.0001; AUC: 0.762) and severe POC (OR 10.7; p = 0.022; AUC: 0.763). The mFI-11 index showed the strongest predictive performance for both overall and severe POC in patients underwent HCE.

The prevalence of hepatic alveolar echinococcosis (AE) and cystic echinococcosis (CE) is notably high among children in western China, with the mortality rate for untreated children potentially reaching up to 90%. Meanwhile, hepatoblastoma is the most common malignant liver tumor in children, yet its treatment differs significantly from that of hepatic echinococcosis. This study aimed to compare and analyze the ultrasonographic and contrast-enhanced ultrasound (CEUS) characteristics of hepatic CE, AE, and hepatoblastoma in children, providing more imaging evidence for accurate clinical diagnosis. A retrospective analysis was conducted on preoperative data from children with pathologically confirmed hepatic echinococcosis in our hospital between 2012 and 2024. Furthermore, children consecutively diagnosed with hepatoblastoma between 2020 and 2024, confirmed by histopathological examination, were selected as the control group. Clinical data, conventional ultrasound images, and CEUS characteristics of hepatic echinococcosis and hepatoblastoma were analyzed and compared. The mean ages of 22 children with hepatic CE and nine children with hepatic AE were 11.6 ± 2.8 years and 11.8 ± 3.6 years, respectively. The mean age of 36 children with hepatoblastoma was 2.9 ± 3.0 years. Significant differences were observed in age and history of residence or travel to endemic areas among children with hepatic echinococcosis and hepatoblastoma (P < 0.001). Hepatic CE and hepatoblastoma showed a higher proportion of cystic degeneration [≥50% (54.5%, 12/22), and between 0% and <50% (47.2%, 17/36, respectively)], while hepatic AE predominantly showed no cystic degeneration (88.9%, 8/9). Clear boundaries were most commonly seen in hepatic CE lesions (95.5%, 21/22), while unclear boundaries were more frequent in hepatic AE lesions (88.9%, 8/9) (P < 0.05). Calcification was more prevalent in hepatic AE compared to hepatic CE and hepatoblastoma (P < 0.05). Hepatoblastoma exhibited richer color Doppler signals (94.4%, 34/36) compared to hepatic CE and AE (P < 0.05). CEUS was performed on two hepatic echinococcosis and nine hepatoblastoma lesions. On CEUS, one hepatic AE lesion showed peripheral hyperenhancement in the arterial phase, while one hepatic CE lesion showed no significant enhancement. In hepatoblastoma, nine lesions demonstrated hyperenhancement in the arterial phase and hypoenhancement in the late phase. This study demonstrates the value of ultrasound in differentiating hepatic echinococcosis from hepatoblastoma in children. Hepatic CE typically manifests as a well-defined cystic or cystic-solid mass, while hepatic AE often presents as an ill-defined cystic-solid or solid mass with diffuse calcifications. Conversely, hepatoblastoma appears as a partially well-defined cystic-solid or solid mass with abundant color Doppler signals within and around the lesion.

Objective To investigate the clinical efficacy of three-dimensional (3D) laparoscopic surgery in treatment of hepatic cystic echinococcosis. Methods The retrospective cross-sectional study was conducted. The clinical data of 40 patients with hepatic cystic echinococcosis who underwent 3D laparoscopic surgery in the Qinghai Province People′s Hospital from March 2016 to July 2017 were collected. All the 40 patients were treated using 100 mg hydrocortisone on preventing intraoperative anaphylaxis. The experienced surgeons with proficiency in the laparoscopic technology in the same team finished surgery. Patients underwent respectively 3D laparoscopic excision of internal capsule in hepatic echinococcosis+ residual cavity treatment, external capsule resection in hepatic echinococcosis and partial hepatectomy based on their conditions. Observation indicators: (1) intraoperative situations: operation completion, surgical procedures, operation time, volume of intraoperative blood loss and blood transfusion; (2) postoperative recovery situations: time to initial anal exsufflation, time for initial fluid diet intake, time for out-of-bed activity, time of indwelling drainage-tube, wound healing, postoperative complications and duration of postoperative hospital stay; (3) follow-up: number of patients with follow-up, follow-up time, oral anti-echinococcosis medical therapy during follow-up, hepatic echinococcosis recurrence and abdominal cavity implantation metastasis. Follow-up using outpatient examination and telephone interview was performed to detect the abdominal symptoms, oral anti-echinococcosis medicine, hepatic echinococcosis recurrence and metastasis up to September 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Results (1) Intraoperative situations: all the 40 patients underwent successful laparoscopic surgery, including 17 undergoing excision of internal capsule in hepatic echinococcosis+ residual cavity treatment, 15 undergoing external capsule resection in hepatic echinococcosis and 8 undergoing partial hepatectomy. Two patients were combined with abdominal and pelvic hydatids and underwent 3D laparoscopic excision. Operation time and volume of intraoperative blood loss of 40 patients were respectively (100±28)minutes and (86±24)mL, without intraoperative blood transfusion. (2) Postoperative recovery situations: time to initial anal exsufflation and time for initial fluid diet intake in 40 patients were (2.4±1.8)hours and (1.7±0.9)days. Forty patients had out-of-bed activity on the day of surgery. Of 40 patients, abdominal drainage-tubes of 39 were placed for 2-3 days; abdominal drainage-tube of 1 with postoperative residual cavity-induced bile leakage was indwelled for 2 months and then was removed. Wound healing and duration of postoperative hospital stay in 40 patients were Class-A healing and (10.5±2.1)days. During hospitalization, 39 patients didn′t have bleeding, bile leakage, anaphylactic shock, intestinal adhesion and obstruction; 1 patient with postoperative residual cavity-induced bile leakage had indwelling drainage-tube removal at 2 months postoperatively. (3) Follow-up: all patients were followed up for 2-15 months, with a median time of 9 months. During the follow-up, 40 patients were not complicated with discomforts and received oral anti-echinococcosis medical therapy, without hepatic echinococcosis recurrence and abdominal cavity implantation metastasis. Conclusion The 3D laparoscopic surgery is safe and feasible in the treatment of hepatic cystic echinococcosis, and has an obvious advantage in the treatment of irregular hepatic cystic echinococcosis, with good short-term outcomes. Key words: Echinococcosis, hepatic; Hepatic cystic echinococcosis; Minimally invasive surgery; Laparoscopy; Three-dimensional technology

HighlightsWhat are the main findings?Preoperative six-minute walking distance (6MWD) of ≤450 m was independently associated with a 5.6-fold higher risk of 30-day postoperative pulmonary complications after VATS lobectomy for non-small-cell lung cancer.In the logistic regression analysis focusing on pulmonary complications, the length of hospital stay was further identified as a significant factor.What are the implications of the main findings?A simple, low-cost six-minute walk test (6MWT) can serve as a practical preoperative risk stratification tool, complementing routine spirometry to identify high-risk patients.Patients with a 6MWD of ≤450 m may benefit from targeted prehabilitation or intensified perioperative management to reduce postoperative morbidity.Introduction: Minimally invasive video-assisted thoracic surgery (VATS) for lung cancer has become a widely used approach. However, postoperative pulmonary complications (PCs) such as pneumonia, atelectasis, and lung fistula remain significant challenges, particularly in older adult patients with multiple comorbidities. The 6-minute walk test (6MWT) has been suggested as a predictor of postoperative outcomes in various surgical settings, but its relationship with postoperative complications following VATS lobectomy for lung cancer has not been thoroughly explored. The aim of this study was to determine if preoperative 6MWD predicted the occurrence of 30-day PCs among patients undergoing VATS lobectomy for non-small-cell lung cancer. Methods: This retrospective study examined 66 patients who underwent VATS lobectomy for lung cancer. Participants were categorized into two groups: those with postoperative pulmonary complications (n = 11) and those without (n = 55). The research period was from January to September 2022. The preoperative 6MWT distance, along with other clinical and demographic factors, was assessed to determine its predictive value for postoperative complications. Multivariate logistic regression analysis was performed to identify significant predictors. Results: The study found that preoperative 6MWT ≤ 450 m was a significant predictor of postoperative pulmonary complications (odds ratio: 5.674, 95% CI: 1.206–26.684, p = 0.028). Conclusions: The preoperative 6MWT distance is a useful predictor of postoperative pulmonary complications in patients undergoing VATS lobectomy for lung cancer. Patients with a 6MWT ≤ 450 m may be at higher risk for complications such as pneumonia, atelectasis, and lung fistula. Incorporating preoperative 6MWT as a risk stratification tool could help guide clinical decisions and rehabilitation efforts to improve postoperative outcomes in this patient population.

BackgroundSeveral studies have assessed various clinical variables to identify risk factors for postoperative complications in patients with acute appendicitis. However, few studies have focused on the relationships between systemic inflammatory variables and postoperative complications in patients with acute appendicitis. We investigated the relationships between postoperative complications and systemic inflammatory variables, and assessed the clinical utility of these variables as predictors of postoperative complications in patients with acute appendicitis.MethodsWe retrospectively reviewed 181 patients who underwent immediate appendectomy for acute appendicitis. All postoperative complications were classified as infectious or noninfectious, and we evaluated the relationships between postoperative complications and clinical factors including the preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio.ResultsIn total, 28 patients (15.5%) had postoperative Clavien-Dindo grade II–IV complications; 17 patients (9.4%) and 11 patients (6.1%) were categorized as the infectious and noninfectious complication groups, respectively. The cutoff value of the preoperative neutrophil-to-lymphocyte ratio for all complications was 11.3, and multivariate analysis revealed that the preoperative neutrophil-to-lymphocyte ratio was an independent predictor of any postoperative complication (odds ratio: 4.223, 95% confidence interval: 1.335–13.352; P = 0.014). The cutoff value of the preoperative neutrophil-to-lymphocyte ratio for infectious complications was 11.4, and multivariate analysis revealed that the preoperative neutrophil-to-lymphocyte ratio was an independent predictor of infectious complications (odds ratio: 4.235, 95% confidence interval: 1.137–15.776; P = 0.031).ConclusionsIn patients with acute appendicitis, the preoperative neutrophil-to-lymphocyte ratio may be a useful predictor of all postoperative complications, especially infectious complications.

To evaluate the therapeutic efficacy for surgical treatments among patients with hepatic cystic echinococcosis in Gansu Province from 2006 to 2023, so as to provide insights into optimization of the diagnosis and treatment strategies against hepatic cystic echinococcosis. The demographic and clinical data of all echinococcosis cases included in central government fiscal transfer payment program for echinococcosis control and undergoing surgical treatments in Gansu Province from 2006 to 2023 were captured. Hepatic cystic echinococcosis patients with complete medical records and follow-up data were included in the study, and patients' characteristics, including hospital where patients received diagnosis and treatment, methods of case identification, year of surgery, classification of lesions, number of lesions, size of lesions, course of disease, surgical methods, and post-surgical follow-up data. The cure and recurrence of hepatic cystic echinococcosis were evaluated according to the Guidelines for Management of Echinococcosis Patients in the Central Government Fiscal Transfer Payment Program, and the cure and recurrent rates were calculated. Data were collected from 1 686 surgical patients with hepatic cystic echinococcosis. According to the inclusion and exclusion criteria, 1 222 hepatic cystic echinococcosis patients undergoing surgical treatments were included during the period from 2006 to 2022, including 1 166 cured patients (95.42%) and 88 patients with postsurgical recurrence (7.20%), and the cure rate of surgical treatments appeared a tendency towards a rise among patients with hepatic cystic echinococcosis from 2008 to 2022 (χ2trend = 19.39, P < 0.05). The cure rates of hepatic cystic echinococcosis were 100% (177/177), 94.81% (128/135) and 94.62% (861/910) among patients detected through regular physical examinations, screened by the central government fiscal transfer payment program for echinococcosis control, and those who passively sought healthcare services, respectively (χ2 = 9.95, P < 0.05). The cure rates of hepatic cystic echinococcosis were 95.96% (1 046/1 090) among patients with a disease course of 2 years and less and 90.90% (120/132) among patients with a disease course of over 2 years (χ2 = 6.87, P < 0.05), and there were significant differences in the cure rates among patients with hepatic cystic echinococcosis in terms of number of lesions (χ2 = 24.44, P < 0.05) and surgical methods (P < 0.05). The cure rate of hepatic cystic echinococcosis patients was significantly higher following initiation of the central government fiscal transfer payment program for echinococcosis control (96.06%, 1 096/1 141) than before the program (86.42%, 70/81) (χ2 = 16.06, P < 0.05), and the cure rate of hepatic cystic echinococcosis patients was significantly higher in designated hospitals (96.48%, 741/768) than in non-designated hospitals (93.37%, 366/392) (χ2 = 5.78, P < 0.05). The median follow-up period was 4 (interquartile range, 7) years among 1 222 hepatic cystic echinococcosis patients undergoing surgical treatments. The recurrent rate of hepatic cystic echinococcosis appeared a tendency towards a decline from 2008 to 2022 (χ2trend = 36.86, P < 0.05), with a reduction from 23.08% (9/39) in 2008 to 1.85% (1/54) in 2021, and the post-surgical recurrence rate of hepatic cystic echinococcosis was lower following initiation of the central government fiscal transfer payment program for echinococcosis control (5.87%, 67 / 1 141) than before the program (25.93%, 21/81) (χ2 = 45.51, P < 0.05). In addition, the post-surgical recurrence rate of hepatic cystic echinococcosis was higher in non-designated hospitals (10.46%, 41/392) than in designated hospitals (5.60%, 43/768) (χ2 = 9.12, P < 0.05), and there was a significant difference in the post-surgical recurrence rate among patients with hepatic cystic echinococcosis in terms of surgical methods (P < 0.05), with the highest recurrence rate (11.54%) seen among patients undergoing percutaneous fine-needle aspiration of cyst fluids-based surgical procedures (P < 0.05). Since the initiation of the central government fiscal transfer payment program for echinococcosis control in Gansu Province in 2006, an increase in the surgical cure rate and a reduction in the recurrence of hepatic cystic echinococcosis had been found among patients with hepatic cystic echinococcosis, indicating a high overall therapeutic efficacy.

Objective To summarize the features of computed tomography (CT) and magnetic resonance imaging (MRI) of hepatic cystic echinococcosis, and investigate the key points of identification and diagnosis. Methods The clinical data of 58 patients with hepatic cystic echinococcosis who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from August 2011 to August 2014 were retrospectively analyzed. Patients received plain and enhanced scan of CT and MRI. Hepatic cystic echinococcosis was divided into the 5 types according to the literatures, including unilocular echinococcasis in type Ⅰ, multivesicular hydatid cysts in type Ⅱ, anechoic content with detachment of laminated membrane from the cyst wall in type Ⅲ, calcification of lesions in type Ⅳ and mixed echinococcosis in type Ⅴ. Patients who were diagnosed as with definite or suspected hepatic cystic echinococcosis underwent surgery. The follow-up including observing the recurrence of hepatic cystic echinococcosis was performed by outpatient examination and telephone interview at postoperative month 3, 6, 12 for 1 year and then once every year up to August 2015, and was ended if there was no recurrence for more than 5 years. Results (1) The results of CT and MRI examinations: of the 58 patients, 54 received scan of CT and 21 received scan of MRI. Seventeen patients were detected in type I with clear-boundary and low-density cystic lesions by CT examination; MRI examinations showed there were single or multiple, round or oval abnormal signal including low T1WI signal, high T2WI signal and low T1WI and T2WI signal of cyst wall. Thirteen patients were detected in type Ⅱ, CT examination showed the daughter cysts of multiple sizes were found in the mother cyst, arranged in honeycomb or wheel shape; MRI examination showed there were lower T1WI signal in the daughter cyst and higher T2WI signal in the daughter cyst compared with signal in the mother cyst, and low signal in the cyst wall of the daughter cyst and mother cyst. Six patients were detected in type III with in sign and water snake sign by CT examination and ribbon sign by MRI examination. Thirteen patients were detected in type Ⅳ, CT examination showed there were irregular high-density calcified shadow with the performances for return or sample volume skins changes. Nine patients in type Ⅴ had more than 2 kinds of lesions. (2) Diagnosis: 4 patients were misdiagnosed by CT examination including 3 with preoperative diagnosis of hepatic cyst and 1 with preoperative diagnosis of metastatic carcinoma of liver, with an accurate rate of diagnosis of 92.6%(50/54). Two patients with preoperative diagnosis of hepatic cystic adenocarcinoma were misdiagnosed by MRI examination, with an accurate rate of diagnosis of 90.5%(19/21). (3) Treatment and follow-up: 58 patients underwent surgery, including 40 undergoing internal capsule removal with external capsule suturing (31 with open operation and 9 with laparoscopic operation), 10 undergoing partial hepatectomy and 8 undergoing external capsule enucleation. Of 58 patients, 3 were complicated with effusion of residual cavity, 2 with unclosed external capsule, 1 with bile leakage and then was cured after 4-8 week drainage. Fifty patients were followed up for 12.0-48.0 months with a median time of 27.1 months and a follow-up rate of 86.2%(50/58). During the follow-up, 1 patient undergoing internal capsule removal had recurrence at postoperative month 8 and was cured by CT-guided interventional therapy using absolute alcohol, and other patients had no recurrence. Conclusions There was a higher accuracy in CT and MRI examinations for hepatic cystic echinococcosis. Honeycomb and wheel shapes are characteristic findings of hepatic cystic echinococcosis in type II. The characteristic performances of CT examination for hepatic cystic echinococcosis in type III are in capsule and water snake signs, and characteristic performances of MRI examination is ribbon sign. The ring-like enhancement of edge by MRI examination is an essential of identification and diagnosis between hepatic cystic echinococcosis and hepatic cyst, and irregular calcification is a differential point between hepatic echinococcosis and hepatic tumor. Key words: Echinococcosis, hepatic; Tomography, X-ray computed; Magnetic resonance imaging; Diagnosis

Background:The prevalence of obesity in the Eastern Mediterranean is increasing significantly up to 20.8% in 2016. Therefore, a higher percentage of colorectal cancer (CRC) patients are expected to be obese. Laparoscopic colorectal cancer surgery (LCRCS) is regarded as a safe and feasible procedure as laparoscopic approach is becoming the gold standard in CRC surgery, especially in the early stages of disease. However, LCRCS is correlated with a higher risk of short-term post-operative complications in obese patients (body mass index [BMI] ≥30 Kg/m2) than in patients with BMI <30 Kg/m2. This study aims to evaluate the impact of obesity on short-term post-operative complications in patients undergoing LCRCS.Materials and Methods:A retrospective study was conducted. Clinical data of case and control patients were extracted from medical records. These patients underwent LCRCS between January 2018 and June 2021 at Hôtel-Dieu de France Hospital, Beirut-Lebanon. Patients were divided into two groups: obese and non-obese. BMI ≥30 Kg/m2 was used to define obese patients. Post-operative complications in the 30 days following surgery were the primary outcome. The severity of post-operative complications was evaluated using the Clavien–Dindo score. Chi-square test was used to evaluate the statistical correlation between collected variables.Results:We identified 107 patients who underwent LCRCS during this study period at our institution. Among the patients, 23 were obese (21.49%). At 30 days post-operative, 26 patients were reported to having at least one complication. Non-significant differences were found between the two groups regarding the early post-operative complications rate (obese 26.1% and non-obese 23.8% with P = 0.821). Obesity was not demonstrated as a stratification risk by severity of the early post-operative complications (P = 0.92).Conclusion:Obesity, which was defined as BMI ≥30 Kg/m2, was not a risk factor for early post-operative complications as well as a stratification risk by severity of post-operative complications in LCRCS.

Hepatic cystic echinococcosis is a chronic parasitic disease caused by the infection with the larvae of Echinococcus granulosus in human or animal liver tissues. As a chronic active infectious disease, tuberculous empyema mainly invades the pleural space and then causes visceral and parietal pleura thickening. It is rare to present comorbidity for hepatic cystic echinococcosis and tuberculous empyema. This case report presents a case of hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis, aiming to improve clinicians' ability to distinguish this disorder.

Hepatic cystic and alveolar echinococcosis coinfections, particularly with concurrent abscesses and sinus tract formation, are extremely rare. This article presents a case of a patient diagnosed with this unique presentation, discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof. A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis, accompanied by abdominal wall abscesses and sinus tract formation. Initial conventional imaging examinations suggested only hepatic cystic echinococcosis, but intraoperative and postoperative pathological examination revealed the coinfection. Following radical resection of the lesions, the patient's condition improved, and she was discharged soon thereafter. Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing. Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare, the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis. Lesions involving the abdominal wall and sinus tract formation, may require radical resection. Long-term prognosis includes albendazole and follow-up examinations.

Background: The number of elderly patients undergoing surgery is steadily growing. Therefore, this study was designed to determine the prevalence and predictors of postoperative complications in patients older than 80 years. Methods: The medical records of 532 patients above 80 years in age who underwent elective or emergent noncardiac surgery between June 2011 and May 2013 were reviewed retrospectively. Preoperative concomitant disease, operation site, anesthetic technique, and postoperative complications were analyzed. Results: A total of 81.4% of the patients had pre-existing concomitant diseases, while 22.9% had severe systemic diseases. The incidence of severe complications within the first month after operation was 4.1%, and the in-hospital mortality rate was 1.3%. Among the severe postoperative complications, respiratory and cardiovascular complications were commonly observed. In multivariate logistic regression analysis, the predictors of postoperative severe complications included American Society of Anesthesiologists physical status classification of 3 or greater (odds ratio [OR], 5.271; 95% confidence interval [CI], 2.019-13.758; p=0.001), neurosurgery (OR, 23.132; 95% CI, 2.528-211.707; p=0.005) and duration of operation (OR, 1.006; 95% CI, 1.001-1.012; p=0.027). Conclusion: Proper preoperative evaluation and appropriate treatment for age-related concomitant diseases are suggested for patients older than 80 years in order to reduce postoperative complications. After operation, the respiratory and cardiovascular systems should be carefully monitored.

Objective To study the results of emergency treatment of ruptured hepatic cystic echinococcosis (HCE).Methods A standardized management protocol for hepatic echinococcosis was introduced by the First Hospital of Xinjiang Medical University in 2002.This study included 185 patients who received emergency treatment for ruptured HCE between 1994 and 2009.The patients were divided into group A (from 1994 to 2001) and group B (from 2002 to 2009).The clinical characteristics and surgical treatment results were compared retrospectively.Results In patients with ruptured HCE into the abdomen,classical endocystectomy (Group A1 ) resulted in significantly more postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay,recurrence and peritoneal seeding than improved endocystectomy (Group B1 ) (P＜0.05).The operation time and blood loss were not significantly different between group A1 and B1 (P＞0.05).For patients with ruptured HCE into the biliary tree,classical endocystectomy (Group A2 ) resulted in significantly higher postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay and recurrence than improved endocystectomy (B2) (P＜0.05).Operation time,blood loss and peritoneal seeding were not significantly different between group A2 and B2 (P ＞ 0.05). Only one patient (0.54％) died from allergic shock in this series of patients.Conclusions Improved endocystectomy was an efficacious surgical treatment for ruptured HCE and it is recommended for emergency surgery. Key words: Hepatic cystic echinococcosis; Rupture; Emergency treatment

Many serological tests are widely used in the diagnosis of cystic echinococcosis (CE), caused by the larval stages of Echinococcus granulosus. The present study was carried for differentiation between hepatic and pulmonary cystic echinococcosis by Western Blotting (WB). A total of 121 sera from patients with hepatic CE (37), pulmonary CE (31) and controls (53; consisting of six healthy, seven Hymenolepis nana infection, 20 hepatic and 20 pulmonary diseases other than CE) were examined. In all of the CE patients, E. gronulosus infection was confirmed by surgical intervention. Sera were previously tested using IHA and ELISA to detect the E. gronulosus specific antibodies. Sera from hepatic cases of CE reacted with 16 polypeptides of 6-116 kDa and sera from pulmonary cases of CE reacted with 14 polypeptides of 4-130 kDa by Western Blotting. The WB test enabled the detection of antibodies in the hepatic CE samples for proteins of 24, 32 34, 44-46 and 52-54 kDa in molecular weight in 78.4%, 75.7%, 78.4% and 89.2% of the patients, respectively. In the pulmonary CE samples sera WB test enabled the detection of antibodies 24, 44-46, 100, 110, 116 and 120 124 kDa in molecular weight in 81.3%, 75.0%, 87.5%, 71.9%, 84.4% and 65.6% of the patients, respectively. We indicated that the antigenic components of high molecular weight can be good candidates for differentiation of hepatic CE from pulmonary CE.

Introduction: Retroperitoneal sarcomas (RPSs) are large in size and often involve adjacent organs or vital structures. Completeness of resection is critical for long-term survival; however, this often involves extensive surgeries. This study aimed to identify predictors of early severe postoperative complications after RPS surgery. Methodology: In patients who underwent surgery for RPS, intraoperative variables and patient characteristics were assessed to determine predictors for severe postoperative complications. Results: Two hundred and thirty-three patients were included. In comparison to patients who had no comorbidity, those with one or more comorbidities were more likely to have postoperative complications (odds ratio [OR]: 2.38; confidence interval [CI]: 1.03–5.48). Patients who avoided admission to the intensive care unit (ICU) within 24 h of surgery had less complications postoperatively (OR: 0.08; CI: 0.02–0.30). Multiple organ resection during surgery and patients' age had no impact on the occurrence of severe complications. Conclusion: This study showed that a high patient comorbidity index, male gender, and early admission to the ICU were independently associated with an increased risk of postoperative severe complications. However, the age of the patient and degree of surgical resection had no impact on this occurrence. These findings suggest that age and extent of resection should not be used as a sole determinant of patient's eligibility for curative surgery.

Objective: to study the diagnostic and prognostic values of the Mannheim peritoneal index (MPI) in the development of postoperative local and systemic complications in patients with peritonitis. Materials and methods. The case histories of 92 patients with generalized peritonitis of varying etiology (other than pancreatogenic one) were analyzed. The patients were retrospectively divided into 3 groups according to the outcomes and occurrence of postoperative local complications. The postoperative complications were classified by the procedure developed by A. L. Kostyuchenko et al. as local and systemic ones. When the patients had two signs or more of the systemic inflammatory response syndrome, they were stated to have systemic complications and to be diagnosed as having abdominal sepsis with the pattern of organ dysfunctions being described in accordance with the sepsis classification proposed by R. S. Bone et al. (1992). The number of organ dysfunctions was daily counted in each patient over time in the postoperative period. On the first postoperative day, MPI was calculated in scores for each patient; the mean MPI was estimated for all patient groups. The predictable mortality was calculated using the MPI plot. Results. All the patients with generalized peritonitis in the development of local postoperative complications were observed to have sepsis in the postoperative period, without developing local complication in 84.6% of the patients. A direct correlation was found between the MPI and the quantity of organ dysfunctions (r=0.6; p=0.001). In patients with local postoperative complications being developed, the MPI values were higher (p&lt;0.05) than in those without them. The mortality rates that have been predicted by means of MPI (16.3%) and actual (15.2%) are actually in agreement. Conclusion. There is evidence for the diagnostic and prognostic values of MPI in the development of local and systemic postoperative complications in patients with peritonitis. MPI calculation from postoperative day 1 along with later dynamic estimation of the number of organ dysfunctions makes it to objectively assess not only prognosis, but also the pattern of postoperative peritonitis. The major advantage of MPI is the simplicity of calculation, which permits its use in clinics. Key words: peritonitis, prognosis, complications, sepsis, Mannheim peritoneal index.