This case report describes a 49-year-old woman who presented with abdominal pain and weight loss. Imaging revealed a large cystic mass in her liver consistent with a hydatid cyst. She was treated with albendazole and referred for surgery. Hydatid disease is caused by the tapeworm Echinococcus and commonly involves the liver or lungs. Diagnosis involves history, imaging, and serology. Treatment options include medical therapy with albendazole or surgery to remove the cyst. Percutaneous aspiration, injection and re-aspiration (PAIR) is a minimally invasive alternative to surgery but has a higher risk of allergic reactions.
Hydatid cyst disease of the liver الدكتور طارق المنيزل Tariq Al munaizel
A comprehensive lecture about the hydatid cyst disease of the liver including the parasite life cycle, infection, clinical presentation, complications, diagnosis , medical and surgical treatment.
Surgical management of hepatic hydatid diseaseKETAN VAGHOLKAR
Hydatidosis is strictly a zoonosis. Humans are an accidental host. The disease is endemic in rural agricultural areas. However if acquired by humans, it can cause extensive spread affecting a wide range of organs with predilection for the liver. Managing such cases requires a sound fundamental knowledge of the parasite and its pathogenicity. It is essential that surgeons who deal with such cases have a good working knowledge of the disease. The approaches to hepatic hydatids with respect to the principles of surgical treatment are presented in this article.
Hydatid cyst disease of the liver الدكتور طارق المنيزل Tariq Al munaizel
A comprehensive lecture about the hydatid cyst disease of the liver including the parasite life cycle, infection, clinical presentation, complications, diagnosis , medical and surgical treatment.
Surgical management of hepatic hydatid diseaseKETAN VAGHOLKAR
Hydatidosis is strictly a zoonosis. Humans are an accidental host. The disease is endemic in rural agricultural areas. However if acquired by humans, it can cause extensive spread affecting a wide range of organs with predilection for the liver. Managing such cases requires a sound fundamental knowledge of the parasite and its pathogenicity. It is essential that surgeons who deal with such cases have a good working knowledge of the disease. The approaches to hepatic hydatids with respect to the principles of surgical treatment are presented in this article.
Presentation of a case of liver Hydatid Cyst (HC) treated in Al Hammadi Hospital, Suwaidi, Riyadh, Kingdom of Saudi Arabia in 2017. Includes US and CT images findings and operative technique. Followed by a review of HC including epidemiology, presentation, diagnosis, treatment and prevention in an illustrated presentation.
This presentation is hoped to be of help to medical students, junior doctors, trainees in surgery as well as senior surgeons.
Dr. Mohamad Al-Gailani FRCS
Consultant Surgeon
Medical Education & Training Director
Al Hammadi Hospital, Suwaidi
Riyadh
KSA
2017
Presentation of a case of liver Hydatid Cyst (HC) treated in Al Hammadi Hospital, Suwaidi, Riyadh, Kingdom of Saudi Arabia in 2017. Includes US and CT images findings and operative technique. Followed by a review of HC including epidemiology, presentation, diagnosis, treatment and prevention in an illustrated presentation.
This presentation is hoped to be of help to medical students, junior doctors, trainees in surgery as well as senior surgeons.
Dr. Mohamad Al-Gailani FRCS
Consultant Surgeon
Medical Education & Training Director
Al Hammadi Hospital, Suwaidi
Riyadh
KSA
2017
ANESTHETIC MANAGEMENT OF TRACHEOESOPHAGEAL FISTULA by Dr.Sravani VishnubhatlaDrSravaniVishnubhatl
Learning Objectives:
Review the clinical presentation of a patient with tracheoesophageal fistula (TEF)
Understand the prevalence of TEF, types, and associated syndrome
Discuss the diagnosis of TEF
Describe the medical and surgical management of TEF
Understand the anesthetic-related implications and develop an anesthetic plan
Hydatid cysts are most commonly found in the liver and lungs, although they may also occur in other organs, bones and muscles. The cysts can increase in size to 5 – 10 cm or more and may survive for decades. Non-specific signs include loss of appetite, weight loss and weakness
Echinococcus granulosus sensu lato occurs practically worldwide, and more frequently in rural, grazing areas where dogs ingest organs from
diagnosis
epidemiology
managment
In this presentation, I discussed the various liver swellings- both cystic and solid swellings. Cystic lumps are Pyogenic liver abscess, Amebic liver abscess and hydatid cyst. Benign solid swellings are Hepatic adenoma, Focal nodular hyperplasia and Hemangioma. The malignant solid swelings are secondary carcinoma of the liver, primary Hepatocellular carcinoma and Hepatoblastoma.
The neonatal bowel obstruction is suspected based on polyhydramnios in utero, bilious vomiting, failure to pass meconium in the first day of life, and abdominal distension.The presentations of NBO may vary. It may be subtle and easily overlooked on physical examination or can involve massive abdominal distension, respiratory distress and cardiovascular collapse.Unlike older children, neonates with unrecognized intestinal obstruction deteriorate rapidly.
Neonatal bowel obstruction is grouped into two general categories: high, or proximal, obstruction and low, or distal obstruction, both of which are suspected by failure to pass meconium at birth. High obstruction can be suspected based on the double bubble sign. Cases without distal gas are usually related to duodenal atresia, while high obstruction with distal gas need an upper gastrointestinal series because of the need to distinguish duodenal web, duodenal stenosis and annular pancreas from midgut volvulus, the latter being a surgical emergency. Confirmation is ultimately by surgical intervention.
Jejunal and ileal atresia are caused by in utero vascular insults, leading to poor recanalization of distal small bowel segments, a condition in which surgical resection and reanastamosis are mandatory. Hirschsprung disease is due to an arrest in neural cell ganglia, leading to absent innervation of a segment distal bowel, and appears as a massively dilated segment of distal bowel on contrast enema. Surgical resection is necessary for this condition as well. Imperforate anus also requires surgical management, with the diagnosis made by inability to pass the rectal tube through the anal sphincter.[6] Supportive intravenous hydration, gastric decompression, and ventilatory support may be needed due to poor neonatal nutrition resulting from dysfunctional bowel absorption.
A low obstruction is suspected on plain film, but needs follow up with a gastrografin enema, which itself can be therapeutic. The differential for low obstruction is ileal atresia, meconium ileus, meconium plug syndrome and Hirschsprung disease. In cases of meconium ileus or ileal atresia, the colon distal to the obstruction is hypoplastic, usually less than 1 cm in caliber, as development of normal colonic caliber in utero is due to the passage of meconium, which does not occur in either of these conditions. When diffusely small caliber is seen, it is referred to as microcolon. Radiographs in meconium ileus classically demonstrate a bubbly appearance in the right lower quadrant due to a combination of ingested air and meconium. If, on contrast enema, reflux into the dilated distal small bowel loops can be achieved, the study is both diagnostic and therapeutic, as the ionic contrast medium can dissolve the meconium to allow passage of enteric content into the unused colon.
If contrast cannot be refluxed into the distal small bowel, ileal atresia remains a diagnostic possibility.
With early intervention, morbidity and mortality.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. CASE PRESENTATION
49 yo, Malay woman
No known medical illness
Presented with :
epigastric and RHC discomfort for 3 mo
loss of weight
fever for 1 day
No loa/ no jaundice/ no obstructive symptoms
Non smoker/ not alcoholic
No family history of malignancy
3. PHYSICAL EXAMINATION
Not jaundice, pink
On abdominal examination
hepatomegaly, non tender, irregular margin and firm in
consistency, no splenomegaly
Respiratory and cardiovascular system was unremarkable
Lymph nodes not palpable
No stigmata of liver disease
Vital signs stable
Afebrile
7. IMAGING
Usg HBS
Huge heterogenous cystic mass in the right liver
lobe measuring > 20.5cm X 12cm.Presence of
gallstone in GB.IHD and CBD not dilated
Imp : suggestive of hydatid cyst with diffrential of
amoebic liver abcess
*** further history : h/o of multiple visits to egypt
within past few years. Last visit was in feb 2013 whr
she took local salad dish with grilled fish and snails
delicacies
13. INVESTIGATIONS (ODERED BY ID TEAM)
Echinococcosis serology
Amoebiasis serology
Meliodosis serology
Stool ova and cyst
Blood c & s
14. MANAGEMENT
Was referred to ID team
Started on iv metronidazole 750mg TDS for
10 days
Albendazole 400mg bd
Referred to Hosp Selayang planned for op
on 28/6
15. INTRODUCTION
Hydatid disease tapeworm of genus echinococcus
4 types E. granulosus ( commonest)
E. multilocularis (most virulent)
E.vogeli/ oligathrus ( rare)
Definitive host dog/ wolf
Intermediate host human/ sheep
16.
17.
18. EPIDEMIOLOGY
found worldwide
E. granulosus in broad regions of Eurasia,
several South American countries, and Africa
E. multilocularis endemic in the central
part of Europe, parts of the Near East,
Russia, the Central Asian Republics, China,
northern Japan, and Alaska.
E. vogeli humid tropical forests in central
and northern South America.
19. THE DISEASE CAN EFFECT ALMOST ANY ORGAN
BUT COMMONLY
Liver
Lung
Brain
22. CLINICAL MANIFESTATION
Involved organs
Size of cysts and their sites within the
affected organ
Interaction between the expanding cysts and
adjacent organ structures, particularly bile
ducts and the vascular system of the liver
23. LABORATORY
Full blood count eosinophilia
Indirect hemagglutination test and enzyme-linked
immunosorbent assay are the most widely used
methods for detection of anti-Echinococcus
antibodies
26. CLASSIFICATION OF HYDATID CYSTS BASED ON
THE ULTRASOUND APPEARANCE.
CL Active; Single cysts. Cysts are developing and are fertile. Cyst
wall not visible.
CE1 Active; simple cyst often full of hydatid sand (snow flake sign).
Visible cyst wall.
CE2 Active; multiple, or multi loculated cysts. May appear
honeycomb like with daughter cysts.
CE3 Transition; degenerating cysts but still contain viable
protoscoleces. Often see floating membranes in fluid filled cysts
CE4 Inactive; degeneration is advanced. Cysts may be calcified.
Not likely to be fertile. Heterogeneous appearance with few or no
daughter cysts.
CE5 Inactive. Often calcified. Usually infertile.
29. MEDICAL/PHARMACOLOGICAL
Not curative
Indication inoperable / surgery in
contraindicated
Used as adjunct to surgery to kill spilled
scolices/ to avoid peritoneal contamination
Drugs albendazole,mebendazole,
praziquantel
30. THE PRINCIPLES OF SURGERY
total removal of all infective components of
the cysts
the avoidance of spillage of cyst contents at
time of surgery
management of communication between cyst
and adjacent structures
management of the residual cavity
minimize risks of operation.
31. SURGERY CURATIVE TREATMENT !!!
Uncomplicated hydatid cysts :
Radical/ conservative surgery
Radical procedures complete removal of the cyst with or without hepatic
resection.
greater intraoperative risks
Cystectomy, pericystectomy, lobectomy and hepatectomy
Conservative procedures sterilization and evacuation of cyst content,
including the hydatid membrane (hydatidectomy), and partial removal of
the cyst .
residual cavity remains, bearing the risk of secondary bacterial infection
and abscess formation & Higher recurrence rate
32. Laparoscopic surgery
offers a lower morbidity outcome and a shorter hospital
laparoscopic procedure gives a better visual control of the cyst cavity
under magnification which allows a better detection of biliary fistula. This
approach is possible only in selected cases.
The criteria to exclude laparoscopic treatment of hydatid cyst of liver are:
Rupture of the cyst in biliary tract
Central localization of the cyst
Cysts dimension >15 cm
Number of cysts > 3
Thickened or calcified walls
opening of bile ducts that leak bile
disadvantage is the lack of precautionary measures to prevent spillage
and allergic reactions are more common in laparoscopic interventions due
to peritoneal spillage.
33. PAIR ULTRASOUND GUIDED
PERCUTANOUS, ASPIRATION, INJECTION &
REASPIRATION
percutaneous drainage of echinococcal cysts located
in the abdomen
drainage is performed with a fine needle or a catheter
killing of the protoscolices remaining in the cyst
cavity by a protoscolicide agent.
If a catheter is temporarily left in the cyst PAIRD
If numerous and large daughter cysts are present, an
alternative percutaneous technique “Percutaneous
Puncture with Drainage and Curettage” (PPDC)”
surgical settings, using specified materials.
34.
35.
36.
37. COMPLICATIONS
Intrabiliary rupture leading to:
Biliary colic
Obstructive jaundice
Intraperitoneal rupture leading to:
Acute abdomen (peritonitis)
Anaphylactic shock
Intrapleural rupture leading to:
Dyspnea
Blood and bile stained sputum
39. Semago conducted a meta-analysis comparing
769 patients with echinococcosis hepatic cysts
managed with PAIR method and compared it
with era matched 952 patients managed
surgically.
PAIR was either combined with albendazole or
with out albendazole.
Cases of hepatic ecchinococcus diagnosed and
included in analysis on basis of
clinical,radiological, cytologic and serologic
Exclusion criteria: pregnant/infected cyst
41. PAIR meets almost all the goals open
surgery of in activation of the cestode
parasite,evacuation of the cyst, removal of
germinal layer, and obliteration of the
remaining cavity
42. Anaphylaxis, cyst infection, intra abdominal
abscess, sepsis, and biliary fistula occurred in
7.9 % and 25.1 % of PAIR treated and surgical
control subjects respectively
Fever and allergic reactions were ecountered
more frequently in PAIR group(5.5 % and 2.5%)
respectively
Minor reactions occurred more commonly
among surgical groups then PAIR, 13.1% and
33 %
43. No peritoneal dissemination in PAIR group.
Clinical and parasitologic cure occurred in
95.8 % in PAIR and 89.8 % in surgery
Incomplete response occurred in 2.0 % and
3.2 % respectively
Disease recurrence occurred in 1.6 and 6.3 %
respectively
One procedure related death in PAIR due to
anaphylaxis compared to 0.7% ( 7 deaths) among
surgical controls.Causes of mortality includes
pulmonary complications,liver failure myocardial
infarction, generalised peritonitis and anaphylaxis
44. PAIR greater clinical efficacy
low rates of major and minor
complications, mortality, recurrence rate
and short hospitalization days.
45. LIMITATIONS OF THIS STUDY
Shorter followup period for patients
underwent PAIR (20.5 mo) than surgical
control subjects (32 mo)
It is not clear what type of patients have gone
to surgery
46. SOURCES
1. PAIR: Puncture, Aspiration, Injection, Re-Aspiration.An option for the
treatment of Cystic echinococcosis.http://www.who.int/emc
2. http//www.dpd.cdc.gov/dpdx
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