1/9. Extrahepatic alveolar echinococcosis without liver involvement: a rare manifestation.BACKGROUND: Alveolar echinococcosis (AE) primarily affects the liver and extrahepatic disease is considered the consequence of a secondary infection via metastatic spread from the hepatic focus. patients: Two patients with extrahepatic AE without liver involvement are presented. The first case is a patient with AE of the spleen and a small pulmonary calcification. In the second case exclusive affection of the spine was observed. DISCUSSION: Various pathogenetic explanations for hepatic omission appear plausible: a passage of oncospheres through hepatic sinuses without causing disease, a passage via lymphatic vessels or via portocaval anastomoses and the vascular passage in a retrograde fashion. Extrahepatic manifestation of AE without apparent liver involvement is rare. However, AE should be taken into account among other differential diagnoses even in cases of extrahepatic lesions without liver involvement.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
2/9. Salvage treatment with amphotericin b in progressive human alveolar echinococcosis.Most patients with alveolar echinococcosis are diagnosed at a late stage when the disease has advanced to unresectable hepatic lesions. These patients require lifelong therapy with benzimidazoles, the only medical treatment currently available. To date, no treatment option remains for patients with benzimidazole intolerance or treatment failure. amphotericin b was recently shown to exert antiparasitic activity in vitro. Here, we report the efficacy of amphotericin b in human alveolar echinococcosis. In three patients with extensive disease and without further treatment options, disease progression had been documented over several months. They were treated with amphotericin b intravenously at a dose of 0.5 mg/kg of body weight three times per week. Follow-up parameters were physical examination, laboratory parameters, and imaging techniques. amphotericin b treatment effectively halted parasite growth in all three patients. The antiparasitic effect was most evident by spontaneous closure of cutaneous fistulae in two patients and by constant size of parasitic lesions during treatment, as assessed radiologically. Metabolic activity in parasitic areas was visualized by positron emission tomography and significantly decreased during treatment. However, progressive affection of the heart in one patient could not be stopped. All patients currently continue on amphotericin b and have been treated for 25, 17, and 14 months, respectively. We introduce amphotericin b as salvage treatment for alveolar echinococcosis patients with intolerance or resistance to benzimidazoles, as it effectively suppresses parasite growth. amphotericin b is not parasitocidal; therefore long-term treatment has to be anticipated.- - - - - - - - - - ranking = 1.75keywords = alveolar (Clic here for more details about this article) |
3/9. Pulmonary cystic hydatid disease in ireland.BACKGROUND: Hydatid disease is rare in ireland and its incidence and prevalence are unknown. Most cases are diagnosed by a combination of clinical findings, morphological features on imaging and by serological testing. AIMS: We describe an Irish case of pulmonary hydatid disease detected at bronchoscopy by bronchoalveolar lavage, and discuss the diagnosis and treatment of the disorder. CONCLUSION: The diagnosis of this rare disease requires a high index of suspicion. Treatment is primarily surgical, with a role for antihelminthic agents.- - - - - - - - - - ranking = 0.25keywords = alveolar (Clic here for more details about this article) |
4/9. Hepatopulmonary fistula caused by alveolar echinococcosis: report of a case.Alveolar echinococcosis is a parasitosis endemic to red fox habitats in the northern hemisphere. The liver is the most commonly affected organ, followed by the lungs. We report the case of an elderly woman with hepatic alveolar echinococcosis (HAE) complicated by a hepatopulmonary fistula. We performed a one-stage operation for the hepatic and pulmonary lesions through the transdiaphragmatic route via a laparotomy. We report this case to emphasize that the first-line treatment for a hepatopulmonary fistula caused by HAE should be radical surgery, which results in relief of symptoms and a good outcome.- - - - - - - - - - ranking = 1.25keywords = alveolar (Clic here for more details about this article) |
5/9. Consequences of continuous mebendazole therapy in alveolar hydatid disease--with a summary of a ten-year clinical trial.The assessment of a ten-year clinical trial of continuous therapy in eight patients revealed further evidence of a significant therapeutic effect of mebendazole on alveolar hydatid disease. life-expectancy was increased when compared to untreated historical controls, especially in the patients over 55 years of age. All symptomatic patients showed subjective improvement. In four patients, three had a 50% or greater reduction in the diameter of massive hepatic lesions, and in the fourth, progressively enlarging metastases were arrested. Fall in the IHA titre suggested that the causative organism had been destroyed in two additional patients. Of greater significance was the absence of progression of the disease process as measured by changes in the size of the hepatic lesion or lack of development of distant metastases in patients under therapy. In contrast, progressive enlargement of hepatic lesions or the appearance of distant metastases were cardinal features of untreated cases (15 of the 16 cases followed). In vivo determination of viability of tissues of the larval echinococcus multilocularis from patients receiving long-term therapy was considered important in evaluating efficacy of the drug. Such tissues, obtained by autopsy from two patients under continuous therapy for four and ten years, failed to proliferate when inoculated into rodents (red-backed voles), whereas similar inoculations from untreated patients or those receiving 15 months' or less of therapy brought about production of vesicles in rodents in eight of 11 tests (73%). These two deaths, unrelated to therapy, resulted from late fibrotic constriction of end-stage parasitic lesions about the portal vein and major bile ducts. The clinical findings in combination with negative in vivo tests and other data indicate that the mebendazole therapy significantly alters the clinical course of alveolar hydatid disease. The evidence strongly indicates that long-term therapy may eventually have a lethal effect on the larval cestode in advanced disease.- - - - - - - - - - ranking = 1.5keywords = alveolar (Clic here for more details about this article) |
6/9. Effect of plasma mebendazole concentrations in the treatment of human echinococcosis.High oral doses of mebendazole were given for a mean period of 23 months to 22 patients with inoperable alveolar or cystic echinococcosis (echinococcus multilocularis n = 18, E. granulosus n = 4). Clinical, morphological, biochemical and serological findings and plasma mebendazole levels were monitored. Clinical and biochemical improvement or stabilization was observed in 17 patients but the parasitic lesions did not decrease in size in most instances. One patient died shortly after onset of therapy with hemorrhage of esophageal varices. Three patients with alveolar and one with cystic echinococcosis had evidence of progressive disease such as increase of cholestasis, destruction of lumbar vertebrae and growth of an intraperitoneal cyst. The plasma mebendazole levels (4 hr after the morning dose) of the latter 4 patients were 0.09 /- SD 0.02 mumol/l, while in those with clinical stabilization or improvement it was 0.30 /- SD 0.14 mumol/l (P less than 0.001). These preliminary data indicate 1) a good clinical response to chemotherapy in most patients despite unchanged size of the parasitic lesions, and 2) a direct correlation of clinical response with plasma mebendazole levels.- - - - - - - - - - ranking = 0.5keywords = alveolar (Clic here for more details about this article) |
7/9. A clinical trial of mebendazole in the treatment of alveolar hydatid disease.In July 1974, mebendazole was reported to be effective against the larval stage of echinococcus granulosus in experimentally infected mice. A clinical trial of mebendazole was initiated in December 1974 in 4 patients with far advanced, nonresectable lesions caused by echinococcus multilocularis. A daily dose of 40 mg of the drug per kg of body weight was administered to the 4 patients for more than 3 years. No evidence of toxicity or adverse reactions has been observed. Detectable plasma mebendazole concentrations were achieved with high-dose mebendazole therapy. serum concentrations of IgE increased and decreased early in therapy. There was no evidence that the larval cestode was killed. The metastatic lesions appeared to be stabilized or diminished, and over-all clinical results were encouraging. Progressively enlarging thoracic metastases in 2 patients regressed during therapy, and symptomatic improvement was observed in all 4 patients. mebendazole, a highly effective antihelmintic in enteric infections, is poorly absorbed by the gastrointestinal tract. Resulting low serum concentrations limit treatment of the massive, scirrhous lesions characteristic of E. multilocularis infections. Nevertheless, encouraging clinical responses observed with mebendazole therapy suggest that a more soluble form of this or a related drug might prove highly effective in the medical management of hydatid disease in humans.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
8/9. Pulmonary involvement by Echinococcus alveolaris.Twenty cases of pulmonary involvement by E. alveolaris were analyzed and classified into one of two radiological types-Type l: multiple, small, ill-defined, irregular lesions that are peripherally located and develop slowly; and Type II: variable changes of the right lung base. Type 1 has a hematogenous metastatic origin, while Type II is caused by hepatic processes penetrating the hemidiaphragm. Differential diagnosis, which includes neoplasms and infections, specifically E. cysticus, is difficult. diagnosis appears to be possible only when based on a combination of Type 1 changes, laboratory findings, and geographic occurrence.- - - - - - - - - - ranking = 1.25keywords = alveolar (Clic here for more details about this article) |
9/9. Bronchobiliary fistula due to alveolar hydatid disease: report of three cases.Bronchobiliary fistula is a serious complication of echinococcosis of the liver. Surgical and endoscopic treatments have been used successfully in the management of bronchobiliary fistula due to hepatic hydatid cysts. However, very little information exists on the management of bronchobiliary fistula due to alveolar hydatid disease. We report here the efficacy of various potential therapies in three cases.- - - - - - - - - - ranking = 1.25keywords = alveolar (Clic here for more details about this article) |