Liver cystic echinococcosis and human host immune and autoimmune follow-up: A review

Cystic echinococcosis (CE) is an infectious disease caused by the larvae of parasite Echinococcus granulosus (E. granulosus). To successfully establish an infection, parasite release some substances and molecules that can modulate host immune functions, stimulating a strong anti-inflammatory reaction to carry favor to host and to reserve self-survival in the host. The literature was reviewed using MEDLINE, and an open access search for immunology of hydatidosis was performed. Accumulating data from animal experiments and human studies provided us with exciting insights into the mechanisms involved that affect all parts of immunity. In this review we used the existing scientific data and discuss how these findings assisted with a better understanding of the immunology of E. granulosus infection in man. The aim of this study is to point the several facts that challenge immune and autoimmune responses to protect E. granulosus from elimination and to minimize host severe pathology. Understanding the immune mechanisms of E. granulosus infection in an intermediate human host will provide, we believe, a more useful treatment with immunomodulating molecules and possibly better protection from parasitic infections. Besides that, the diagnosis of CE has improved due to the application of a new molecular tool for parasite identification by using of new recombinant antigens and immunogenic peptides. More studies for the better understanding of the mechanisms of parasite immune evasion is necessary. It will enable a novel approach in protection, detection and improving of the host inflammatory responses. In contrast, according to the "hygiene hypothesis", clinical applications that decrease the incidence of infection in developed countries and recently in developing countries are at the origin of the increasing incidence of both allergic and autoimmune diseases. Thus, an understanding of the immune mechanisms of E. granulosus infection is extremely important

Evaluation of a surgical method of tumor ablation as an optimal treatment of biliary mucinous cystadenoma of the liver

Bilijarni cistadenom (BCA) i njegova maligna strana bilijarni cistadenokarcinom (BCACa) retki su cistični tumori poreklom iz bilijarnog sistema...Biliary cystadenoma (BCA) and its malignant side, biliary c<stadenocarcinoma (BCACa) are rare cystic tumors originating from the biliary system..

Evaluation of a surgical method of tumor ablation as an optimal treatment of biliary mucinous cystadenoma of the liver

Bilijarni cistadenom (BCA) i njegova maligna strana bilijarni cistadenokarcinom (BCACa) retki su cistični tumori poreklom iz bilijarnog sistema...Biliary cystadenoma (BCA) and its malignant side, biliary c<stadenocarcinoma (BCACa) are rare cystic tumors originating from the biliary system..

Hydatid cyst of the liver which demaged the confluence of the hepatic ducts causing deep obstructive jaundice

Complications of the hydatid cyst of the liver on bile ducts appear in 5-25% representing almost two third of all complications of the hydatid liver cysts. Fortunately a damage to the bile ducts causes only an infection of the cyst usually without major consequences. More serious complications such as cholangitis and deep obstructive jaundice are much rarer. The defect of the bile duct usually is a periferal one. Damage to the major ducts are rarer and those on the confluence of hepatic ducts itself are the rarity. In that case biliary reconstruction may be a serious chalenge. The authors present a 23 year-old man in whom a centrally localised hydatid cyst made a major damage of the confluence of all three hepatic ducts causing deep obstructive jaundice. After standard procedure for hydatid cyst an intracavital mucosa to mucosa hepaticoje-junostomy was carried out with excellent success. More then six years after surgery the patient stayed symptom-free with bilirubin and alkaline phosphatase within normal limits

Giant liver abscess due to almost asymptomatic common bile duct stone

Solitary pyogenic liver abscess is usually caused by a meta-static infection through the portal blood flow or through the hepatic arterial blood flow from extra-abdominal pyogenic foci. Besides, it may be the result of local inflammatory diseases, such as cholecystitis, hydatid cyst, haematomas particularly with retained foreign bodies, etc. Suppurative cholangitis usually causes multiple pyogenic liver abscesses. Solitary pyogenic abscess is rarely caused by cholangitis, but practically always by suppurative cholangitis. Giant pyogenic liver abscess due to asymptomatic or mild cholangitis is a rarity. We present on a 63 year old man who developed a giant solitary pyogenic liver abscess in whom no other possible cause could be found or anticipated except practically almost asymptomatic choledocholithiasis accompanied with mild elevation of bilirubin content alkaline phosphatase and gamma-GT. The patient was successfully treated operatively. Over 1800 ml. of pus was aspirated from the abscess cavity. Operative cholangiography performed in spite of the absence of gall bladder stones undilated and noninflamed common bile duct stone showed a small nonobstructing distal common bile duct stone. The duct was not dilated, the bile was clear and there were no signs of cholangitis in the inside of the common bile duct. Cholecystectomy and abscess cavity drainage led to uneventful recovery. The patient has been symptom-free for more than 3.5 years

Pancreatic fistula through the distal common bile duct

Pancreatic fistula is usually caused by acute or chronic pancreatitis, injury and operations of the pancreas. The pancreatic juice comes either from the main pancreatic duct or from side branches. Extremely rare pancreatic fistula may come through the distal end of the common bile duct that is not properly sutured or ligated after traumatic or operative transaction. We present a 58-year old man who developed a life threatening high output pancreatic fistula through the distal end of the common bile duct that was simply ligated after resection for carcinoma. Pancreatic fistula was developed two weeks after original surgery and after two emergency reoperations for serious bleeding from the stump of the right gastric artery resected and ligated during radical limphadenectomy. The patient was treated conservatively by elevation of the drain- age bag after firm tunnel round the drain was formed so that there was no danger of spillage of the pancreatic juice within abdomen

Abdominal pregnancy with placenta inserted in the spleen left in situ causing subphrenic abscess

Abdominal pregnancy appears once in 3000 pregnancies. It usually terminates with abortion and urgent surgery. Thanks to ultrasonography and computed tomography the diagnosis is possible before surgery. Most frequently the diagnosis has been established during emergency laparotomy. Gynaecologists are not in agreement wheather removal of placenta is mandatory or not, as it may include removal of parts or entire organs or may be followed with serious bleeding difficult to control. We present a 21-year old woman in whom during an urgent laparotomy performed for abdominal pregnancy placenta inserted in the spleen was left in situ. Postoperatively the patient developed subphrenic abscess which could not be solved without reoperation during which both the placenta and the spleen were removed. Ten years after surgery she is symptom-free

Floating spleen with chronic torsion of the pedicle causing splenomegaly and secondary hypersplenism

If the spleen is not fixed within the left subphrenic space, it gradually passes into the lower abdomen, where is much more exposed to trauma. Torsion of the splenic pedicle can also occur, causing the infarct necessitating an immediate surgery. Venous stasis causes splenomegaly and sometimes secondary hypersplenism. The authors present 16.5-year old girl with torsion of the splenic pedicle of floating spleen for 720°: in spite of that, the patient had neither splenic infarct nor splenic vein thrombosis, possibly due to thrombocytopenia, but she had splenomegaly and secondary hypersplenism with pancytopenia causing bleeding, sideropenic anemia and mild jaundice. After treatment with iron, the patient underwent splenectomy which resulted in almost immediate rise of the number of all blood cells, and even thrombocytosis. The authors suggest early surgical treatment of the floating spleen, preferably splenopexy, before development of severe complications when splenectomy had to be performed in the majority of patients. Accessory spleens, if present, should be saved

Hydatid cyst of the pancreas

Hydatid cyst of the pancreas is rare. During the last 30 years, less than 40 cases have been reported in journals on Medline. This is a case report of a 35-year old woman with 2-year history of epigastric pain in whom an ultrasound and computed tomography showed the cyst of the body and tail of the pancreas 6x7 cm in diameters, which was supposed to be hydatid one. During surgery, an isolated hydatid cyst of the pancreas was found without communication with the pancreatic duct. The content of the cyst was removed, and pericyst was partially excised and drained. The recovery was uneventful and the patient has remained symptom free so far. Although rare, hydatid cyst should be considered in the differential diagnosis of the cystic lesions of the pancreas, particularly in patients coming from endemic areas and without history of pancreatitis

Microcystic adenoma of the pancreas

Microcystic adenoma of the pancreas is a rare benign tumour of the pancreas without malignant potential which usually appears in older women. Pain weight loss, palpable mass and jaundice (if the tumor is localized in the head of the pancreas) are the main symptoms. Thanks to the modern imaging techniques (US, CT, FNB) the tumor is discovered and with rising frequency exactly preoperatively diagnosed. Surgical excision is the treatment of choice. In risk patients without symptoms surgery is not necessary but patients have to be regularly followed-up. The authors present a 70-year old woman in whom, because of constant epigastric pain, a multicystic mass of the pancreatic body, 58 x 40 mm in diameter, was discovered and removed by distal pancreatectomy. The spleen could not be saved. Histologic examination showed a microcystic adenoma. Three years after surgery the patient is symptom-free with normal ultra-sonographic findings