Laparascopic-assisted endoscopic mucosal resection of a polyp in sigma and laparoscopic right hemicolectomy for adenocarcinoma in colon ascendens - case report

Today, endoscopic polypectomy has become a daily-performed routine procedure in the operating room. Almost every polyp in the colon can be removed endoscopically, but there are some problematic adenomas which are either large in size or difficult to approach. We present 80 years old white woman with a tubulo­villous adenoma with high-grade dysplasia on a flat surface located in sigma with 4 x 5cm in size and also synchronously found in colon ascendens a well differentiated G1 adenocarcinoma with 2 x 2cm in size on a flat surface. The abdominal ultrasound did not find any liver metastases. Because of the difficult location and the size of the two lesions in the right and left colon, we make a decision for a laparoscopic-assisted en­doscopic mucosal resection (piece-meal) of the polyp in sigma and for the adenocarcinoma in colon ascen­dens the procedure was followed by laparoscopic right hemicolectomy in one step approach. The both inter­ventions were performed without complications and good postoperative period. Hybrid endoscopic and lap­aroscopic interventions are very effective approach that can resect large tubulovillous polyps and adenocar­cinoma of the colon, with a lesser risk of complications. Combining the methods in one surgery save time, make endoscopy more easy to perform and can save one-half of the colon in cases of synchronous lesions of the colon. Scr Sci Med 2017; 49(3): 49-5

Efficacy and Safety of PAIR for Cystic Echinococcosis: Experience on a Large Series of Patients from Bulgaria

We report our experience with puncture, aspiration, injection, and reaspiration (PAIR) for the treatment of cystic echinococcosis in Bulgaria. PAIR was performed in 230 patients with 348 echinococcal cysts. At 12-month follow-up, 77.6% of the cysts, all cystic echinococcosis (CE) 1 and CE3a cysts according to the World Health Organization Informal Working Group classification, showed various degrees of obliteration. In 11.5% of cysts, all of which were > 10 cm-type CE1, a significant amount of fluid persisted, and they were punctured again. Of those, 16 (4.6%) contained protoscolices and were treated by a second PAIR. The remaining 24 (6.9%) cysts were treated by simple aspiration or drainage. No significant reduction in size and no changes in the structure were observed in 10.9% of cysts, all of which were classified as CE2 or CE3b. Complications developed in 25.2% of patients, including severe anaphylactic reaction in two (0.9%) patients. Our experience confirms that PAIR is a successful first-choice treatment when a stage-specific approach is taken

Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey: a cross-sectional, ultrasound-based, population study from the HERACLES project

BACKGROUND: Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey. METHODS: We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the country's rural population as a reference. FINDINGS: From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41% (95% CI 0·29-0·58) in Bulgaria, 0·41% (0·26-0·65) in Romania, and 0·59% (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces. INTERPRETATION: Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control