Hydatid Cyst Surgery Research Articles

Intact and Perforated Pulmonary Hydatid Cyst: A Comparative Study from Damascus, Syria.

BackgroundHydatidosis is a major health problem around the world, especially in the Mediterranean region. Cysts can break open or develop secondary bacterial infections, altering the clinical presentation.MethodsPatients who underwent hydatid cyst surgery at Al-Mouassat University Hospital in Damascus, Syria between January 2006 and December 2017 were evaluated. Cases involving isolated hepatic cysts were excluded. The patients were divided into those with perforated hydatid cysts (group 1) and those with intact hydatid cysts (group 2).ResultsThis study included 224 cases 113 in group 1 (50.4%) and 111 in group 2 (49.6%). The median chest tube duration, hospitalization time, and postoperative complication rate were higher in group 1 than in group 2 (p=0.003, p=0.002, and p=0.006, respectively). In both groups, the most common symptom was cough (present in 178 patients in total [79.5%]), while chest pain (121 patients [54%]) and dyspnea (113 patients [50.4%]) were also common. Cough, hemoptysis, fever, and expectoration of cystic contents were significantly more frequent in group 1 than in group 2 (p<0.001).ConclusionThe early discovery and treatment of intact pulmonary hydatid cysts reduced the hospitalization time, chest tube duration, and postoperative complication rate. Relative to intact cysts, perforated cysts are more complex and are associated with more expensive and time-consuming surgical treatment.

Comparison of Videothoracoscopy and Thoracotomy in Surgical Treatment of Pulmonary Hydatid Cyst Disease.

To evaluate the outcomes of videothoracoscopic and open surgeries for pulmonary hydatid cysts. Descriptive study. Department of Thoracic Surgery, Faculty of Medicine, Balıkesir University, Turkey, between May 2015 and March 2020. Patients who underwent surgery for pulmonary hydatid cysts were evaluated retrospectively, for the age, gender, symptoms, cyst size and localisation, preferred surgery, duration of surgery, the extent of the intraoperative bleeding, duration of the chest drainage, hospitalisation time, and postoperative complications. The relationship between the categorical variables was examined with the Chi-square and Fisher's exact tests and the relationship between the non-parametric data and continuous variables with the Mann-Whitney U-test. A total of 60 patients included in the study; 23 underwent videothoracoscopic surgery and 37 had thoracotomy. There were no statistically significant differences between groups as gender, age, location and size of cyst. The videothoracoscopic surgery has superiority to thoracotomy group in terms of lower duration of operation, less perioperative bleeding (p = 0.005), early chest tube removal and lower hospitalisation time (both p <0.001). But there were no statistical difference between groups in complication rates (p = 0.340). Videothoracoscopic removal of pulmonary hydatid cyst is a safe and advantageous procedure comparing to thoracotomy. There is a need for prospective studies with a larger sample size. Key Words: Hydatid cyst, Thoracoscopic surgery, Thoracotomy, VATS.

Uncommon Locations of Cystic Echinococcosis: A Report of 46 Cases from Southern Iran.

Background Most cases of hydatid cysts form in the liver and lung and other tissues are considered as unusual locations in hydatid cysts. The current study aimed to find out the rate and features of hydatid cysts in uncommon locations in Fars Province, Southern Iran, over a 15-year period. Methods The hospital records of patients who underwent surgery for hydatid cysts in university-affiliated hospitals in Fars Province, Southern Iran, from 2004 to 2018, were retrospectively reviewed. For each patient, clinical and demographical data were recorded. Results During a 15-year period, a total of 501 patients were surgically treated for hydatid cysts, and out of these, 46 (9.2%) were presented with the unusual locations of hydatid disease. Males constituted 28 (60.9%) of these patients while 18 (39.1%) of the patients were females. The patients' age ranged from 5 to 80 years (mean = 40.49; SD = 20.37). The size of the cysts ranged from 2 to 20 cm (mean = 8.69, SD = 4.59). The most common unusual location for the hydatid cyst was the spleen with 30.4% of cases, followed by the pelvic cavity (15.2%). Out of 46 cases with unusual location of the hydatid cyst, 10 (21.7%) cases had lung, 22 (47.8%) cases had liver, and 5 (10.9%) cases had both liver and lung hydatid cysts, simultaneously with cysts in unusual locations. Conclusion In cystic echinococcosis- (CE) endemic areas, hydatid disease can affect any organ, from head to toe, in humans. The disease should be considered in the differential diagnosis of any cystic entities anywhere in the body.

Sonoguided Percutaneous Endoscopic Evacuation and Drainage (SPEED) Technique: Report of a Novel Surgery for Hydatid Cyst of the Liver

The spectrum of treatment for hydatid cyst varies from medical therapy, surgery, radiology-guided intervention to laparoscopy. Initially surgery was considered the gold standard. However, in the last few decades, percutaneous interventional therapy has been proved to be an effective and safe alternative to open surgery. Despite being the last entrant, laparoscopy has set significant standards in the care of hydatid disease. We describe a novel technique for the treatment of hydatid cyst of the liver. The technique is called Sonoguided Percutaneous Endoscopic Evacuation and Drainage (SPEED) ( https://youtu.be/ietvpAuxzDo ). This is based on the PAIR technique of sonography-guided puncture followed by introduction of rigid scope into the cyst. The technique was successful in the patient in terms of cyst evacuation and successful short-term outcome. The advantage of this procedure is that though minimally invasive, the procedure is very aggressive in terms of complete cyst evacuation. Thus, it can be a suitable replacement for the PAIR procedure, thereby increasing the chances of cure. The validation of the process is in progress.

IN-VITRO SCOLICIDAL EFFECTS OF GRAPE AND APPLE VINEGAR ON THE HYDATID CYST PROTSCOLECES

At present, surgery remains the preferred treatment for hydatid cyst. Various chemical scolicidal agents have been used for inactivation of protoscoleces during surgery, but most of them are associated with adverse side effects. In this study we investigated the effect of two commercial grape and apple vinegar on the viability of hydatid cyst protoscoleces. The protoscoleces of E. granulosus were aspirated from the infected livers and lungs of sheep slaughtered at Tiaret abattoir. 0.5 mL of two commercial grape and apple vinegar was used for 5, 10, and 15 min in the experiments. 0.1% eosin staining assessed viability of protoscoleces. All tests were carried in triplicate. The mortality rates of protoscoleces were 100% after 5min, 10 min and 15 min of incubation with grape vinegar and apple vinegar. To conclude, the results of the present survey indicated high scolicidal activity of apple vinegar and grape vinegar against protoscoleces of hydatid cyst and can be used in hydatid cyst surgery. However, further studies will be needed to confirm these results by checking this scolicidal activity in an in-vivo model.

In Vitro and Ex Vivo Evaluation of Capparis spinosa Extract to Inactivate Protoscoleces During Hydatid Cyst Surgery.

Hydatidosis is one of the most dangerous zoonosis diseases in the world caused by the larval stage of the broad-worm or Echinococcus granulosus parasite. Today, cysts' rupture or content leakage during surgery and involvement of organs adjacent to the organ involved, and consequently secondary cysts, are the major concern for hydatid cyst surgeons. Therefore, using scolicidal substances such as hypertonic saline 20%, silver nitrate and formalin has been considered to reduce the risk of protoscoleces spread and recurrence of disease in recent years. The current work was designed to assess the antiparasitic effects of Capparis spinose L. extract against hydatid cyst protoscoleces. Collected protoscoleces from liver fertile hydatid cysts of infected sheep were exposed to the different concentrations of the essential oil (150, 300, 600 mg/mL) for 5-60 min in vitro and ex vivo. Then by using the eosin exclusion assay, the viability of protoscoleces was studied. The primary phytochemical analysis of the C. spinosa extract was done to assess the presence of tannins, alkaloids, saponins, flavonoids, terpenoids and glycosides. C. spinosa extract exhibited a powerful protoscolicidal activity in vitro so at the dose of 300 and 600 mg/ml, it entirely eliminated the parasite after 10 and 5 minutes; whereas at lower doses, it demonstrated weak protoscolicidal activity. In ex vivo assay, no similar effect to in vitro assay was observed, so more time was required to show a potent protoscolicidal activity. C. spinosa extract, at the concentrations of 300 and 600 mg/mL after an exposure time of 20 and 12 min, killed 100% of protoscoleces within the hydatid cyst, respectively. The findings of primary phytochemical screening of the C. spinosa extract demonstrated the existence of flavonoids, tannins, terpenoids, glycosides and alkaloids in this plant. The obtained results in vitro and ex vivo exhibited potent protoscolicidal effects of C. spinosa extract particularly at the concentrations of 600 and 300 mg/ml, which entirely eliminated the parasite after 5-20 min exposure. However, more supplementary works are required to verify these findings through assessing in animal models and clinical subjects.

Mid-term Outcomes of Laparoscopic Total Cystectomy Versus Open Surgery for Complicated Liver Hydatid Cysts.

Background:Total cystectomy is a challenging procedure in patients with complicated liver hydatid cysts (HCs). This study aimed to evaluate the feasibility and safety of laparoscopic total cystectomy in patients with complicated liver HCs.Methods:Prospectively collected clinical data of 50 consecutive patients, who underwent laparoscopic procedures for complicated liver HCs between January 2017 and January 2019, were retrospectively analyzed. One hundred patients who underwent open procedures were compared with the laparoscopic group in terms of perioperative outcomes during the 1-year follow-up period.Results:Conversion to open surgery occurred in 1 (2%) case. The number of single and multiple lesions and the size of HCs were similar between the 2 groups (P>0.05). Sixty-six percent of patients underwent total cystectomy, 10% subtotal cystectomy, and 24% hepatectomy in the laparoscopic group (P>0.05). Decompression and hepatic inflow occlusion were performed in high-risk cases. No differences were noted in average blood loss volume, and transfusion rate between the 2 groups. Postoperative recovery in the laparoscopic group was significantly shorter than that in the open group. There was no difference in the incidence of postoperative complications between the laparoscopic and open groups. No recurrence or death was observed in either group during this period.Conclusions:Laparoscopic total cystectomy was a curative and safe surgical approach to the treatment of complicated HC with favorable mid-term outcomes. Subtotal cystectomy combined with decompression is the preferred option for patients with high surgical risk(s). However, long-term outcomes need to be validated in prospective studies with larger sample sizes and prolonged follow-up.

Evaluation of Prognostic Factors Associated with Postoperative Complications Following Pulmonary Hydatid Cyst Surgery.

Background:Hydatid cysts are one of the serious complications following echinococcus infection. The liver and the lungs are the most affected organs, respectively. The severity of the disease is associated with the increase in the number and the size of the cysts, cysts rupture, and systemic effects. The aim of this study is to evaluate prognostic factors that are associated with the increased incidence of postoperative complications following pulmonary hydatid cyst surgery.Methods:Patients referred to Madani hospital from 2014-2018, presenting pulmonary hydatid cysts were included in this study. All the patients were evaluated based on the following parameters: age, gender, location and size of the cysts, rupture status of the cysts (intact or perforated), type of surgical intervention (capitonnage or segmentectomy) and Erythrocyte Sedimentation Rate (ESR). The factors were then compared with postoperative complications. Statistical analysis of the data obtained was conducted using R-softwareResults:Of 76 patients enrolled in our study, 52.63% were males and 47.36% were female. Air leak complication was reported in 13.15% of the patients and 3.94% of the patients were presented with pleural effusion. Postoperative complications were significantly associated with the perforated (ruptured) cysts p= 0.001, segmentectomy p= 0.013, giant hydatid cysts p= 0.007 and ESR p= 0.014. However, the side of the lung was not significantly related to postoperative complications.Conclusion:Our study reports that perforated cysts, increased size, segmentectomy and abnormal ESR are likely to increase postoperative complications following pulmonary hydatid cysts surgery. Prospective studies with perioperative parameters and greater sample size can help to deduce better inferences.

Nomogram Analysis and Internal Validation to Predict the Risk of Cystobiliary Communication in Patients Undergoing Hydatid Liver Cyst Surgery

PurposeBiliary leakage caused by cystobiliary communication (CBC) is a common clinical concern. This study sought to identify predictors of CBC in hepatic cystic echinococcosis (HCE) patients undergoing hydatid liver cyst surgery and establish nomograms to predict CBC.MethodsA predictive model was established in a training cohort of 310 HCE patients diagnosed between January 2013 and May 2017. Upon revision of the records of clinical parameters and imaging features of these patients, the lasso regression model was used to optimize feature selection for the CBC risk model. Combined with feature selection, a CBC nomogram was developed with multivariable logistic regression. C-index and calibration plots were used to analyze and evaluate the discrimination and calibration. The net benefit and predictive accuracy of the nomogram were performed via decision curve analysis (DCA) and receiver operating characteristic (ROC) curve. An independent validation cohort of 132 patients recruited from June 2017 to May 2019 was used to evaluate the practicability of the nomogram.ResultsPredictors contained four features, namely alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), cyst size and cyst location. The C-index of the nomogram is 0.791 (95% CI, 0.736–0.845), while the C-index verified by bootstrap is 0.746, indicating high prediction accuracy. The area under the curve (AUC) of the CBC in training was 0.766. ROC curve analysis demonstrated high sensitivity and specificity. Decision curve analysis confirmed the CBC nomogram was clinically useful when the intervention was determined at the non-adherence possibility threshold of 8%.ConclusionThe nomogram developed using the ALP, GGT, cyst size and cyst location could be used to facilitate the CBC risk prediction in HCE patients.

Particularités de la prise en charge de l’hémoptysie massive d’origine hydatique

Massive hemoptysis is a rare but serious presentation of pulmonary hydatid cysts. The literature reporting this clinical phenomenon is limited to sporadic cases. We undertook a retrospective study considering patients who had undergone lung surgery because of hydatid cyst from January 2000 o December 2015 and examined features associated with massive hemoptysis. Among 270 patients operated on for lung hydatidosis, 13 (4.8%) had experienced massive hemoptysis. This sub group had an average age of 24±12 years (13-60 years) and a sex ratio of 0.85. Preoperative embolization was attempted in 5 patients but failed in all cases. All patients with massive hemoptysis were operated on emergency. The origin of bleeding was determined and controlled in all cases (from a vein or an artery from the pulmonary circulation). Pulmonary re-expansion was satisfactory after obliteration of the residual cavity and no pulmonary resection was necessary. The postoperative course was uneventful in 11 patients. Prolonged air-leak beyond 7 days was noted in two patients but settled subsequently with simple follow-up. Average postoperative follow-up was 32 months (8-63 months). One patient (who had hydatid vomit with massive hemoptysis) developed controlateral hydatid recurrence that was also successfully operated on. No recurrence of hemoptysis was noted during the follow-up period for all patients. Massive haemoptysis secondary to pulmonary hydatidosis may be life-threatening. Surgery of hydatid cysts associated with direct vascular control of eroded vessels is sufficient to control hemoptysis.

Retrospective evaluation of postsurgical outcomes of patients operated with the diagnosis of pulmonary hydatid cyst

Objective: Hydatid cysts may occur in almost every organ and tissue of human the body. Because they can be found in more than one organ/tissue, sometimes many operations may need for them and surgical intervention may be required due to complications that may develop secondary to hydatid cyst surgery albeit few. Method: Data on patient files retrieved from the hospital information management system or archive were analyzed retrospectively. Surgical results of patients operated with the diagnosis of hydatid cyst between 2008 and 2018 in our clinic were discussed retrospectively. Results: Ninety-three operations were performed in 84 patients due to pulmonary hydatid cysts. Fourty-four of them were male (52.4%), 40 were female and their mean age was 44 (5-85) years. Twenty-two (26.2%) patients were asymptomatic and 62 (73.8%) were symptomatic. Hydatid cysts were located in right hemithorax in 45 (53.6%) patients, in left hemithorax in 30 (35.7%) patients and bilaterally in 9 (10.7%) patients. Twenty-six patients (31%) had both pulmonary and hepatic hydatid cysts. Posterolateral thoracotomy and cystotomy-capitonnage were the most common methods (89.3%), 9 patients (10.7%) underwent wedge resection. Four patients developed atelectasis, 2 patients had hydropneumothorax, 4 patients had isolated prolonged air leak, 1 patient developed massive pulmonary embolism, and 1 patient developed Aspergillus infection the quilted cavity. Conclusions: Hydatid cyst disease has still been a serious health concern in Turkey. When the careful and experienced surgeons perform the operations, the postoperative period is usually uneventful and morbidity is extremely low.

Is It Necessary to Terminate Pregnancy before Hydatid Cyst Surgery?

The article's abstract is no available.

Main compounds and in vitro effectiveness of Syzygium aromaticum essential oil on protoscoleces of hydatid cyst

Surgery remains the preferred treatment for cystic echinococcosis. On the other hand, one of the side effects of hydatid cyst surgery is recurrence. Many scolicidal agents have been used for inactivation of the hydatid cyst content. However, many of these scolicidal agents may cause undesirable complications that limit their usage. The aims of this study are to investigate the chemical composition and in vitro scolicidal effect of S. aromaticum essential oil against protoscoleces from hydatid cysts of Echinococcus granulosus. The essential oil was obtained by hydrodistillation. Gas chromatography with flame ionization detection (GC-FID) and gas chromatography–mass spectrometry (GC/MS) was employed to determine the chemical composition of the essential oil. Protoscoleces were aseptically collected from infected organs (liver and lung) of animals slaughtered at the Tiaret slaughterhouse containing hydatid cysts. Protoscoleces were exposed to two concentrations of essential oil (10 and 15 μl/mL) for 5, 10, 15, and 20 min. Viability of protoscoleces was confirmed by 0.1% eosin staining. Eugenol was the major compound of the studied essential oil (78.72%) followed by β-caryophyllene (8.82%) and eugenyl acetate (8.74%). The scolicidal activity of S. aromaticum essential oil at the concentration of 10 μl/ml was 55.99%, 60.05%, 80.37%, and 99.76% after 5, 10, 15, and 20 min of exposure, respectively. S. aromaticum essential oil at the concentrations of 15 μl/ml killed 100% protoscoleces after 5 min of exposure. The present study confirmed that S. aromaticum essential oil has high scolicidal power in vitro. However, further studies (ex vivo and in vivo) will be needed to confirm these results.

What Is the Role of Endoscopic Retrograde Cholangio-Pancreato-Grahy in the Management of Hepatic Hydatid Disease Complications?

Liver hydatid cyst is a parasitic disease that is endemic in Morocco. Its gravity is essentially due to its complications, such as Intrabiliary rupture. The aim of our study was to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy in the management of intrabiliary rupture of hydatid disease of the liver. Materials and Methods: This is a retrospective study in the department of Gastroenterology in the University Hospital Hassan II of Fez over a period of 12 years from March 2005 to October 2017. All patients admitted for hepatic hydatid disease and who received ERCP were included. We analyzed the success rate of catheterization of the common bile duct (CBD), the successful clearance of the bile duct and the complications. Results: 2860 patients had received therapeutic ERCP, 151 patients (5.3%) had hepatic hydatid disease, 112 of which had intrabiliary disruption of hepatic hydatid and 39 patients were admitted for sphincteromy for reversal of the flow after surgery of hydatid cyst. The average age of our patients was 41 years old [12 - 85]. The sex ratio F/H = was 1.12. 74% (N = 112) patients were admitted to a table cholangitis and 26% of cases were operated for KHF fistulized in the bile ducts with persistence of a large biliary flow in post-operative (39 cases). The success of initial catheterization of the commun bile duct was achieved for 138 patients (91%) or obtained secondarily after precut for 13 patients. The evacuation of hydatid membranes was carried out in 51% of them (N = 78); twenty two (14.5%) patients had one or more calculations with or without hydatid membranes. A case of gastrointestinal bleeding post ERCP was observed. All the patients followed evolved well in the long term except for two patients who presented in few months after the first ERCP severe cholangitis which required the use of a second ERCP with successful evacuation of membranes. Conclusion: In our study, endoscopic management of hydatid cyst remains a dominant position, with a very satisfactory success rate and an acceptable rate of morbidity and mortality.

Cetrimide-Chlorhexidine-Induced acute hepatic failure

Hydatid cystsarefrequently found in the liver and may be asymptomatic until growth occurs. Scolicidal agents, such as cetrimide-chlorhexidine, have been used safely in hydatid cyst surgery for many years. Here we presenta case of acute hepatic failure after the usage of the cetrimide-chlorhexidine solution during hepatic hydatid cyst surgery. To the best of our knowledge, this is the first such report in the literature.

Human hydatidosis in Alborz Province: a 5-year retrospective epidemiological analysis of hospitalized cases (2014-2019).

Hydatid cyst is a neglected zoonotic infection that is transmitted by the larval form of Echinococcus granulosus. It is widely distributed around the world and also it is endemic in many developing countries such as Iran. The aim of the current study is an assessment of the surgical cases in the general population of Alborz Province in Iran. The surgical cases of cystic echinococcosis were studied in the Educational and Therapeutic Centers or hospitals related to Alborz University of Medical Sciences from 2014 to 2019. Out of 26 records from patients with hydatid cyst surgery, 15 (57.7%) were female and 11 (42.3 %) were male. The age range was between 15-70 years old. The most infected organ was liver 21 (80.8%) followed by lungs 4 (15.4%) and one case of pelvic cyst 1 (3.8%). Based on residential status, 61.4% and 38.6% were living in rural and urban areas, respectively. The most and the least groups effected by hydatid cyst were housewives (38.46%) and employees (7.69%), accordingly. Twelve (46.15%) patients stated had a history of contact with dog. The prevalence of hydatid cyst in Alborz Province confirmed the importance of a proper protection plan against infection and it must be under control in main hosts. However, there is lack of data on status of parasitic infections in stray dogs in current region, as they play a key role in the transmission of the hydatid disease to humans.

Retrospective Review of Complications of Liver Hydatid Cyst Surgery with Emphasis on Outcomes of Omentoplasty.

Background:The outcome and complications of liver hydatid cyst surgeries with new and old techniques are not well determined. We intended to present the results of operations done for patients with hepatic hydatid cyst in an endemic area.Methods:Data of 112 patients referred and operated for liver hydatid cyst, in Imam Khomeini Hospital complex, Tehran, Iran, from 2015 to 2018, were collected including demographic characteristics, operation parameters and complication related statistics. The variables were presented for different surgical methods including operations with and without omentoplasty.Results:Patients aged 39. 3 ± 13. 9 yr (70 females; 63. 5%). Most frequent clinical complaint was vague abdominal pain (n=45; 40. 2%). The most prevalent comorbidity was hypertension (18; 16.0%). Conservative methods were chosen more frequently including omentoplasty (44; 39. 3%), cyst drainage (27; 24. 1%), cyst resection (19; 17%) and marsupialization (3; 2. 7%). Overall, 56 patients (50%) were operated with omentoplasty as the single method or in combination with segmentectomy. Complications occurred less in patients operated with omentoplasty (41. 1 vs. 23. 2%; P=0. 043); particularly, biloma was more frequent in surgeries without omentoplasty (7. 1 vs 0. 0%; P=0. 042). Persistence and recurrence rates were 12. 5% and 3. 6% with relative predilection in, respectively, segmentectomy and lobectomy surgical methods compared to Omentoplasty. No mortality was recorded.Conclusions:In our case series of hepatic hydatid cyst patients, omentoplasty was safe with less complication and similar long-term recurrence rate.

Radical surgery in hepatic hydatidosis: analysis of results in an endemic area.

radical surgery in hepatic hydatidosis is associated with less morbidity and recurrence than conservative surgery. a retrospective observational study of patients with liver hydatid cyst surgery was performed. Seventy-one patients with 90 cysts were included between 2007 and 2017, and radical surgery was performed in 69.01 %. there was no difference in morbidity, mortality, biliary leakage or recurrence according to surgery. Complicated cysts were associated with a longer hospital stay and morbidity. decision-making should consider age, comorbidity, cyst characteristics and available resources. Radical surgery should be applied whenever feasible as it achieves better results with an adequate selection of patients.

Portal Cavernoma Complicating a Persistent Postoperative Bile Leak after Liver Hydatid Cyst Surgery: -a Report Case-

INTRODUCTION: Hydatid cyst is a parasitic infection caused by the larval form of Echinococcus granulosis. Portal hypertension is an unusual postoperative complication after a liver hydatid cyst surgery. CASE PRESENTATION: To illustrate this rare condition, we present the case of a 32-year-old patient operated for a liver hydatid cyst with late-onset postoperative complications. The patient suffered from secondary digestive bleeding because of portal hypertension and was therefore treated with a distal splenorenal shunt (Warren). CONCLUSION: Surgery of hydatid cyst may cause severe complications like portal hypertension and in certain cases, distal splenorenal anastomosis might represent an important treatment option that needs to be performed in specialised centres. Keywords: Liver cyst, Portal hypertension, Splenorenal shunt.

The High Potential of Ozone Gas to Inactivate Echinococcus granulosus Protoscoleces During Hydatid Cyst Surgery.

In medicine, ozone therapy is effectively used in a broad spectrum of diseases. Reviews have shown that ozone gas demonstrates potent antimicrobial effects against a wide range of pathogenic microorganisms, such as oral bacteria, fungi, viruses, and parasite even in resistant strains. The present investigation was designed to assess the protoscolicidal effects of ozone gas on hydatid cysts protoscoleces in vitro and in vivo. Hydatid cyst protoscoleces were acquired from sheep livers that were slaughtered at Kerman slaughterhouse, Iran. The viability of protoscoleces was assessed by the eosin exclusion examination after exposure with ozone gas for 1 to 14 min in vitro and ex vivo. In this study, in vitro assay showed that ozone gas at the concentration of 20 mg/L killed 85 and 100% of hydatid cyst protoscoleces after 4 and 6 min of treatment, respectively. However, in the ex vivo analysis, a longer time was needed to confirm a potent protoscolicidal activity such that ozone gas after an exposure time of 12 min, 100% of the protoscoleces were killed within the hydatid cyst. In conclusion, the findings of the present study showed that ozone gas at low concentrations (20 mg/L) and short times (4-6 min) might be used as a novel protoscolicidal drug for use in hydatid cyst surgery. However, more clinical surveys are required to discover the precise biological activity of ozone gas in animal and human subjects.