Postoperative Albendazole Therapy Research Articles

Current trends in the management of hydatid disease: Surgeons' perspective

Background: Surgery was the only known curative treatment for hydatid disease. Currently, this is being changed. Aims: The aim of this study was to explore the evolution of our management policy for hydatid disease. Patients and Methods: We retrieved records of patients with hydatid disease, treated in our unit in the period from January 1998 to February 2012. Results: Twenty-seven patients were identified. For comparison and driven by the appearance of nonsurgical means in the series, patients were divided into two groups: the first group included the first 12 patients and the second group included the last 15 patients. In the first group, all patients received surgery and only two (16.7%) received postoperative albendazole therapy. In the second group, only four patients (26.7%) received surgery with perioperative pharmacotherapy, eight patients (53.3%) received pharmacotherapy alone, and three patients (20%) received puncture-aspiration-injection-reaspiration (PAIR) with periprocedural pharmacotherapy. In those who received surgery with adjuvant pharmacotherapy, one patient died and the cyst disappeared in the remaining three. In those who received PAIR, the cyst disappeared in one case and regressed in the other two. In those who received pharmacotherapy alone, two patients showed disappearance of the cyst, one showed partial response, and five are under follow-up. Conclusions: Surgery is no longer the first-line treatment for hydatid disease. It should be reserved for complicated cases and those presenting as an emergency. When applied, surgery should be backed by pharmacotherapy which has a pivotal role, both as a sole agent and as an adjunctive to therapy.

PO-0906 Intraperitoneal Rupture Of Hepatic Hydatid Cyst Following Blunt Abdominal Trauma In A 7-year-old Boy

<h3>Background</h3> Although Hydatid liver disease may be asymptomatic, one complication of Hydatid disease is perforation of the cyst into the peritoneal cavity after trauma. We present herein a case presented after trauma and had a diagnosis of Hydatid cyst rupture into the peritoneum previously asymptomatic boy. <h3>Case</h3> A 7-year-old boy presented with mild abdominal pain for 6 h. His parents told that his abdominal pain was suddenly commenced after falling down from swing when playing at the playground. They also complained of itching on the whole body starting soon after the trauma. His blood pressure was 90/60 mmHg, heart rate 118/min, and temperature 37.0°C. On the physical examination, urticaria was seen over the thigh and trunk, abdominal examination revealed generalised tenderness. Ultrasonography and computed tomography showed multiple cystic lesions in the liver and one of them had hypoechoic contents and floating echogenic membranesand also free fluid were seen in the pelvis. Intravenous fluids were started followed Hydrocortisone and antihistamine administered along with antibiotic prophylaxis. The patient underwent surgery, 3 cysts at different localization and also a ruptured cyst 4 cm in diameter at the segment 1 were seen. The germinative membranes and the daughter vesicles were removed and abdomen was irrigated with hypertonic saline (3% NaCl). Postoperative albendazole therapy was given for two months. <h3>Conclusion</h3> Rupture of Hydatid cyst should be considered in the differential diagnosis at the presentation of acute abdominal findings with urticaria after abdominal blunt trauma. US and CT are effective in diagnosing of this rare condition.

A cardiac hydatid cyst in the interventricular septum

Cardiac hydatid cyst is a very rarely seen. It primarily involves the lungs and liver. Treatment of cardiac hydatid cysts is surgical and subsequent medical therapy with albendazole to prevent relapses. Herein, we report a 14-year-old male case who underwent a surgical operation six months ago due to a hydatid cyst in the liver and developed cardiac hydatid cyst in the interventricular septum despite postoperative albendazole therapy.

Vertebral Hydatidosis

Hydatid disease is prevalent in the sheep-raising areas. Bone hydatidosis is rare and occurs in 1% to 4% of all cases of human hydatidosis. About 50% of cases of bone hydatidosis are spinal. In a retrospective study, 9 patients with hydatid disease of spine who had treated surgically were evaluated. There were 5 men and 4 women, with mean age of 31 years and a range of 19 to 50 years. Diagnosis was made by means of myelography, computerized tomography, and magnetic resonance imaging. The main surgical intervention was laminectomy in all cases. In a case of recurrent disease, vertebrectomy and anterolateral spinal fusion and instrumentation was performed through an anterior transabdominal approach. Surgical field was irrigated by 0.5% silver nitrate and 10% hypertonic saline. Albendazole was given as an adjuvant therapy in the cases of bony involvement. Location of the disease was thoracic in 6 cases, cervical in 2 cases, and lumbar in 1 case. Outcome was excellent in 3 cases, improvement in 1 case, no recovery in 1 case, and recurrence in 3 cases. Spinal hydatidosis is a locally malignant disease with high recurrence rate. Eradication of the disease cannot be achieved even after radical surgery and chemotherapy. Although role of the chemotherapy in the prevention of the disease is not specifically determined, it is recommended in almost all reports. The preferred management is the spinal decompression, vertebrectomy, and instrumentation in appropriate cases and postoperative Albendazole therapy as a chemotherapic drug of choice. The best and ideal treatment is the prevention of the disease by eradication of parasites from the hosts in the endemic areas.

Albendazole as an adjuvant to the standard surgical management of hydatid cyst liver

Background The treatment options for hydatid cyst liver include non-operative and operative methods. Operative methods include conservative and radical procedures. Non-operative methods include chemotherapy and percutaneous treatment of liver hydatidosis. Material and methods The study was conducted at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India, over a period of two years from March 2001 to February 2003 with further follow-up of 5–6 years. The study included 64 cases in the age group of 15 years to 64 years, comprising 36 males and 28 females. The aim of the study was to know the effect of preoperative and postoperative albendazole therapy on the viability of protoscolices and recurrence rate of hydatid disease of liver. Patients were divided into four group of 16 each. In group A, patients were directly subjected to surgery. In group B, patients were given albendazole for 8 weeks followed by surgery. In group C, patients were given albendazole for 8 weeks preoperatively followed by further postoperative course for 8 weeks. In group D, patients were first taken for surgery followed by postoperative course of albendazole for 8 weeks. Results Out of those patients who received preoperative albendazole only 9.37% had viable cysts at the time of surgery as compared to 96.87% of patients who did not receive any preoperative albendazole. In those patients who did not receive any albendazole therapy, recurrence rate was 18.75% whereas recurrence was 4.16% in patients who received albendazole therapy. Conclusion We conclude that albendazole is safe and effective adjuvant therapy in the treatment of hydatid liver disease.

Multiple Pulmonary and Multivesicular Interatrial Septum Hydatid Cysts in A Native Italian Patient

Multivesicular, pulmonary and cardiac hydatidosis are rarely observed and can give rise to serious complications. Cysts can remain asymptomatic for a long time, until they reveal themselves perforating into cardiac chambers and/or pulmonary arteries or the systemic circulation. A rare case of multivesicular interatrial septum hydatid cyst with multiple pulmonary involvement in a native Italian farm labourer is reported. Clinical, radiological, serological and histological findings are described. MR imaging showed the exact anatomic location and the multivesicular nature of the cardiac cyst and was useful in planning surgical treatment. A successful outcome was achieved with a combination of pre- and post-operative albendazole therapy and a three-step surgery procedure. The patient made a rapid recovery and his post-operative period was totally uneventful. This case highlights the importance of an early multidisciplinary surgical approach and long-term chemotherapy treatment of this serious and rare disease. MR Imaging was crucial in the pre-surgical and follow-up observations.

Unusual Cause of Obstructive Jaundice: A Case Report

Jaundice due to extra-hepatic biliary obstruction may be caused by many diseases some of which are quite rare. We are reporting a young boy who presented with obstructive jaundice caused by a hydatid cyst. He was operated upon. Preand postoperative albendazole therapy was given and follow-up showed complete resolution of jaundice clinically and biochemically.

Primary hydatid cyst of the neck

Hydatid cyst in the head and neck is very rare even in countries where echinococcus infestation is endemic. We report the case of a 33-year-old female patient presenting with a hydatid cyst in the lateral cervical region. The diagnosis of hydatid cyst is made mainly with the help of imaging methods and review of the patient's history. Serologic tests can also be useful. The diagnostic use of fine-needle aspiration biopsy generally has not been advised because of the potential to precipitate acute anaphylaxis or to spread daughter cysts. Treatment is surgical. Postoperative albendazole therapy is suggested especially when there is preoperative contamination risk.

Liver hydatid disease: Morphological changes of protoscoleces after albendazole therapy

Postoperative recurrence of the liver hydatid disease befalls approximately 10-30% of patients. Preoperative or postoperative therapy with albendazole in single therapeutic protocol (800 mg/d, within 28 days) indicated the need to evaluate the hydatid cyst liquid protoscoleces viability. Morphological changes of protoscoleces following the treatment with drugs are not well known. To estimate the viability of protoscoleces after preoperative or postoperative albendazole therapy, and their ability for cystic metamorphosis. A prospective, randomized clinical trial included 30 patients with liver hydatid disease, treated with albendazole and surgically (I group), and 30 patients in the control group treated only surgically (II group). The concentration of albendazole and its active metabolite albendazole sulphoxide in the cysts contents were determined using HPLC. Estimation of protoscoleces viability was based on the established micromorphologic criteria, and compared between the patients treated with albendazole, and the patients treated only surgically. Biological assessment of the viability was performed on protoscoleces with uncertain signs of the disturbed viability (unchanged structure, evaginated, without movements) using intraperitoneal injection of 1 ml of protoscoleces prepared suspension to AO type of rats. The concentration of albendazole in cysts' contents ranged from 0 to 64.9 microg/ml, and of its active metabolite from 0.5 to 40.8 microg/ml. The presence of fully viabile protoscoleces in the albendazol treated patients was significantly lower than in the control group. A significant difference was noticed in the presence of disintegrated protoscoleces without movements in the albendazol treated group, compared to the control group. Biological assessment of the viability showed incapability of these protoscoleces for cystic metamorphoses. Low viability of parasites due to medicamentous therapy is very useful and important to surgeons, because the fertility of cysts is lower, and the risk of the disease recurrence is reduced.