Recurrent multiple cardiac hydatidosis.

Cardiac hydatid cyst is an uncommon disease. We report on a woman admitted to our clinic with chest pain and palpitations. The ECG showed anterior ischemia, and coronary anatomy was normal. The diagnosis was: multiple cardiac hydatid cysts, for which she had undergone surgery 4 years earlier for a 5 x 5 hydatid cyst and treated with albendazole. Despite this, there was a recurrence of multiple cysts. Recurrence of intracavitary hydatid cyst is rare, and surgical treatment of multiple, small cysts remains controversial.     

A huge cardiac hydatid cyst: An unusual cause of chest pain revealing multivisceral hydatidosis in a young woman

Hydatid disease remains endemic in some parts of the world. Cardiac hydatidosis with multivisceral involvement is uncommon but potentially fatal. We report the case of a 36-year-old Tunisian woman admitted with chest pain and T-wave inversion in the inferior leads on her electrocardiogram. Transthoracic echocardiography revealed a large hydatid cyst in the epicardium throughout the left ventricle. Thoraco-abdominal computerized tomography (CT) scan showed several hydatid cysts in the left lung, the liver, and in both breasts.After one week of albendazole treatment, surgical excision of the cardiac cyst on cardiopulmonary bypass was carried out as well as excision of the pulmonary and breast cysts. The postoperative course was uneventful and albendazole treatment was continued for six months. Though hydatid cardiac involvement is very rare, it should be considered in the differential diagnosis of atypical chest pain in young patients, especially those living in regions where hydatid disease is endemic.     

Infected cardiac hydatid cyst

A 24 year old woman presented with chest pain and palpitation. The presence of a semisolid mass—an echinococcal cyst or tumour—in the left ventricular apex was diagnosed by echocardiography, computed tomography, and magnetic resonance imaging. The infected cyst was seen at surgery. The cyst was removed successfully by using cardiopulmonary bypass with cross clamp.


Keywords: cardiac hydatid cyst; infected cardiac hydatid cyst     

Incidental finding of multiple pulmonary and cardiac hydatid cysts

BackgroundCardiac hydatid cyst is a rare parasitic disease. Since it may be associated with fatal complications, early diagnosis and treatment of a cardiac hydatid cyst is very important, however, it may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation.Case presentationWe report a case of a young asymptomatic boy, who underwent a routine chest x ray in a pre employment check up in whom we discovered a multiple pulmonary lesions and a right ventricle hydatid cyst. He then underwent a successful treatmentConclusionDue to the high risk of associated complications, cardiac hydatid cysts should be removed surgically, even in asymptomatic patients.     

Contributions of pulmonary hypertension to HIV-related cardiac dysfunction

Background/Aim

To evaluate the prevalence of pulmonary hypertension among patients living with HIV/AIDS and to determine its contribution to cardiac dysfunction.

Method

A hospital based cross sectional study was carried out over a 6-month period at the Jos University Teaching Hospital. The subjects were 200 confirmed HIV positive patients, ≥18 years of age who consented to the study. Physical examination, laboratory investigations, 2 dimensional and Doppler echocardiography were conducted on the subjects.

Results

The mean age of the patients was 38 ± 9 years, and there were 142 females (71%).Females were younger, mean age 36 ± 8 years versus 41 ± 10 years for males (p-value <0.01). The median CD4 cell count was 312 cells/μl, there were no homosexual or intravenous drug user among the subjects.Eight of the subjects had pulmonary hypertension, with a case prevalence of 4%, and this had no relationship to CD4 cell count. Both systolic and diastolic functions were worse in subjects with pulmonary hypertension, with a negative correlation between mean pulmonary arterial systolic pressure (mPASP) and parameters like ejection fraction (r = −0.28, p-value 0.0003), fractional shortening (r = −0.21, p-value 0.003), deceleration time (r = −0.13. p-value 0.09).

Conclusion

Immune-suppression affects the cardiac function adversely and coexisting pulmonary hypertension contributes to poor systolic and diastolic function in affected patients. The subtle nature of presentation of pulmonary hypertension and other cardiac dysfunctions in HIV/AIDS patients demand a high-index of suspicion and early intervention if detected, to ensure better care for these emerging threats to our patients.     

经皮穿刺引流与吸刮治疗肝及腹腔包虫囊肿的临床应用

长期以来，包虫病经皮穿刺无论作为治疗或其它目的被看作禁忌。１９８６年始我们用经皮穿刺引流，吸刮囊腔，结合局部和全身用药对３０２例（３６１个囊肿）患者进行了治疗，仅１例出现明显过敏反应。对２１８例进行了随访，最长者已达５年。穿刺后６月，Ｂ超显示囊肿缩小停止生长者９７．２％（２１２／２１８）。１年后随访，Ｂ超显示８４．４％（１３０／１５４）囊肿已消失。５年后随访１８例，１４例囊肿消失。除２例因脱管导致复发外，均恢复顺利。随访未见异位复发及其它严重并发症发生。     

Recurrent acute pulmonary oedema and cardiac arrest secondary to intermittent electrical dyssynchrony: a role for cardiac resynchronization despite preserved left ventricular function

Recurrent pulmonary oedema with no obvious precipitant can prove difficult to treat in patients with preserved left ventricular (LV) systolic function. This report describes the novel use of cardiac resynchronization therapy (CRT) in the prevention of acute pulmonary oedema precipitated by intermittent electrical dyssynchrony in a patient with preserved LV systolic function.     

Results of alcohol and albendazole injections in hepatic hydatidosis: experimental study

BACKGROUND: Percutaneous drainage with alcohol injection for hydatid cysts has been commonly used in the last two decades. Albendazole is the drug of choice in the medical treatment of hydatidosis, and has also been used as an intraoperative scolicidal solution. The side-effects of its local application are not well known and have not been investigated. The purpose of the present study was to investigate the effects of the intracystic injections of alcohol and albendazole solutions on the hydatid cysts and hepatobiliary system of rabbits. METHODS: There were three groups of eight rabbits: a control group, an alcohol group and an albendazole group. In all groups hepatic hydatidosis was obtained. The control group received no therapeutic procedure. Cyst liquid was aspirated, and alcohol or albendazole solutions were injected in the other two study groups. alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) levels, echinococcus indirect hemagglutination (IHA) tests, and the size and volume of the residual cysts were investigated. Liver was histopathologically evaluated. RESULTS: The ALT, AST, GGT, and alkaline phosphatase (ALP) levels were significantly higher in the alcohol group, whereas echinococcus IHA level was highest in the control group than in the study groups. Albendazole had similar effects but of a lesser degree (P < 0.01). After therapy, the cyst volume was greater in the control than in the albendazole group (P < 0.01). In histopathological evaluation hepatocellular necrosis, portal inflammation and fibrosis were most severe in the alcohol group (P < 0.01). Conclusions: Alcohol and albendazole solutions are effective as scolicidal solutions. Higher scolicidal effect and lesser side-effects on hepatobiliary system are the advantages of albendazole solution.     

Recurrent acute pancreatitis secondary to a duodenal duplication cyst in an adult. A case report and literature review

Duodenal duplication cysts are rare congenital abnormalities that are most commonly diagnosed in infancy and childhood. However, in rare cases, the lesion can remain asymptomatic until adulthood. An extremely rare case of a previously healthy adult patient with recurrent acute pancreatitis, who was diagnosed with a duodenal duplication cyst is presented. At laparotomy, a duplication cyst measuring 4.8 cm × 4 cm × 4 cm was found adjacent to the ampulla of Vater. A partial cyst excision and marsupialization into the duodenal lumen was performed. The patient is healthy and asymptomatic four years after surgery. The present case illustrates the necessity of considering a duodenal duplication cyst in the differential diagnosis of recurrent acute pancreatitis in previously healthy adults.     

检测包虫病患者血清特异IgG4诊断价值的研究

目的探讨检测患者血清特异IgG4诊断包虫病的效果.方法采用两种抗原(棘球蚴囊液粗抗原及其抗原B)通过ELISA法检测棘球蚴病病人、非棘球蚴病病人和健康对照血清特异IgG4.结果粗抗原和抗原B检测棘球蚴患者血清特异IgG4的阳性率分别为94.4%和89.8%;与部分猪囊尾蚴病患者血清出现交叉反应外,与肺吸虫病、旋毛虫病、血吸虫病、肝囊肿等患者的血清以及健康对照血清均未出现交叉反应.结论检测棘球蚴患者血清特异IgG4敏感性高,特异性强,具有较好的诊断价值.     

Pleural complications of pulmonary hydatid disease

OBJECTIVE: The aim of this study was to determine the incidence and diagnostic features of pleural manifestations of pulmonary hydatid disease. METHODOLOGY: Patients with pleural pathology in association with surgery for pulmonary hydatid disease over an 8-year period were evaluated. RESULTS: Twenty-nine (6%) of 474 patients with histologically confirmed pulmonary hydatid disease had pleural abnormalities. The diagnosis was determined preoperatively in 22 patients and was based on radiographic, clinical, and/or serology findings. Bronchoscopic specimens were diagnostic in two of seven patients who had bronchoscopy. Five patients were not diagnosed until surgery. Radiographic abnormalities consisted of pleural thickening and/or free fluid without intrapleural rupture of the cysts in 21 patients. Eight patients had a hydropneumothorax. Sixteen patients had an exudative, uncomplicated effusion. The remaining patients had empyemas. All patients had resection of the pulmonary cysts, and 20 also underwent a pleurectomy. The mean length of hospital stay was 23 +/- 14 days. There was no hospital mortality. CONCLUSION: Pleural lesions associated with pulmonary hydatid disease are rare and have a variable radiographic appearance. In regions in which echinococcal disease is endemic, a high level of clinical suspicion is necessary for diagnosis and appropriate management of this condition.     

Primary cardiac hydatid cyst presenting as noncompaction cardiomyopathy

We report a case of cyst was initially labeled as left ventricular noncompaction cardiomyopathy. An accurate diagnosis is essential to establish the most effective treatment strategy. In particular, echocardiographic examination assists in identifying the correct diagnosis. In this case, two‐dimensional and three‐dimensional echocardiography and computed tomography were used for definitive diagnosis of cardiac hydatid cyst.     

肺动脉高压反复晕厥致猝死一例

肺动脉高压首发临床症状常见活动后气短、乏力,胸疼、干咳、咯血、眩晕或晕厥,表现无特异,诊断复杂,难以早期确诊,但以反复晕厥并致猝死却鲜有报道。     

Surgical management of liver hydatidosis: a multicentre series of 1412 patients

Background: The management of hydatid liver disease (HLD) includes various nonsurgical and surgical treatment options. Methods: The purpose of the present longitudinal study was to report the changes in surgical management and the consequent outcome of HLD patients in 10 referral surgical centres in Argentina from 1975 to 2007. The study result analysis was divided into two study periods (1975–1990 and 1991–2007). Results: A total of 1412 patients underwent radical (Group 1: 396 patients), conservative (Group 2: 748 patients) or combined (Group 3: 536 interventions in 268 patients) surgical procedures. The overall mortality and complication rate (Clavien I–IV) was 1.8 and 39% respectively. The complication rate was significantly lower in Group 1 (26%) compared with Group 2 (45%) and Group 3 (42%) There was a significant decrease in mortality (2.3 vs. 1%), complication (42 vs. 34%) and early reoperation (12 vs. 6%) rates between the first study part (918 patients) and the second study part (494 patients). During a median follow‐up of 7 years, there was a significant decrease in the first part of this study in the late reoperation rate (8.4–3%) and in disease recurrence (9–1.6%). Conclusion: This large national observational multicentre series shows a significant improvement in surgical management of HLD in Argentina, with a decrease in mortality, morbidity, early and late reoperation and recurrence rates. A recent trend was observed in favour of an earlier diagnosis, less complicated clinical presentation and recent use of minimally invasive approaches.     

Induction of protective immunity against murine secondary hydatidosis

Significant protective immunity against secondary hydatidosis in mice was achieved by immunization with a preparation of surface molecules of E. granulosus protoscoleces with Freund's incomplete adjuvant (PSEx-IFA). Study of PSEx-IFA immunogenicity demonstrates that glucidic epitopes evoke mainly IgM responses while peptidic epitopes evoke mainly IgG responses; however both types of epitopes elicit both types of responses. Analysis of the possible association between susceptibility or resistance to infection and antibody responses after challenge was also performed. Cyst fluid antigen (CFAg) specific antibody titres on month eight after challenge correlated with number and size of cysts. On the other hand no correlation was observed between protection and PSEx specific IgG titres either on the day of challenge or one month later. Nonetheless, immunoblot analysis revealed that some PSEx molecules were recognized on day 30 after challenge only by sera from immunized mice.     

Assessment of pulmonary function tests in cardiac patients

This study was aimed to assess the pulmonary function tests (PFTs) in cardiac patients; with ischemic or rheumatic heart diseases as well as in patients who underwent coronary artery bypass graft (CABG) or valvular procedures. For the forty eligible participants, the pulmonary function was measured using the spirometry test before and after the cardiac surgery. Data collection sheet was used for the patient’s demographic and intra-operative information. Cardiac diseases and surgeries had restrictive negative impact on PFTs. Before surgery, vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), ratio between FEV1 and FVC, and maximum voluntary ventilation (MVV) recorded lower values for rheumatic patients than ischemic patients (P values were 0.01, 0.005, 0.0001, 0.031, and 0.035, respectively). Moreover, patients who underwent valvular surgery had lower PFTs than patients who underwent CABG with significant differences for VC, FVC, FEV1, and MVV tests (P values were 0.043, 0.011, 0.040, and 0.020, respectively). No definite causative factor appeared to be responsible for those results although mechanical deficiency and incisional chest pain caused by cardiac surgery are doubtful. More comprehensive investigation is required to resolve the case.     

Bronchoscopic Diagnosis of Ruptured Pulmonary Hydatid Cyst Presenting As Nonresolving Pneumonia: Report of Two Patients

The diagnosis and management of pulmonary hydatid disease represents an important clinical problem in areas of the world endemic to echinococcal infection. We report two patients, ages 14 and 34, respectively, who were admitted to our clinic for investigation of nonresolving pneumonia. Neither had responded to antibiotics prior to admission. Chest x-rays demonstrated lobar collapse and consolidation in both patients. Fiberoptic bronchoscopy revealed laminated membrane of hydatid cyst occluding the bronchus of apicoposterior and anterior segmental bronchi of the left upper lobe in the first patient and the anterior segment of the right upper lobe in the second patient. The diagnoses were confirmed at the time of surgery.     

心脏外科术后肺部并发症危险因素分析

目的:分析心脏外科术后肺部并发症的围手术期危险因素及其影响。方法:分析1995年1月～2002年2月间连续2084例正中切口右房-升主动脉体外循环心脏外科手术术前、术中及术后相关因素,观察它们在围手术期肺部并发症中的作用。结果:共有136例肺部并发症(6.5%)。肺部并发症的术前危险因素包括女性(相对危险度OR=1.49)、吸烟(OR=1.64)、慢性阻塞性肺部疾病(OR=2.36),术中危险因素包括应用冷心脏停搏液(OR=1.56),术后危险因素包括需要血管活性药物支持(OR=2.00)、2次开胸(OR=2.08)、主动脉内球囊反搏(OR=2.39)、胸腔积液(OR=2.63)、术后脑血管意外(OR=5.45)、膈神经损伤(OR=8.09)、以及术后肾功能衰竭需用肾透析(OR=12.87)。围手术期肺部并发症不是围手术期死亡的危险因素。结论:心脏外科术后多种围手术期危险因素增加术后肺部并发症的发生,特别是术后脑血管意外、膈神经损伤、以及肾功能衰竭需要肾透析对围手术期肺部并发症的发生影响最为明显。对此类患者需特别注意保护肺功能,以减少并发症的发生。围手术期肺部并发症不是围手术期死亡的危险因素。