38 research outputs found
Long-term Sonographic Follow-up of inactive echinococcal cysts located to the liver.
No full textThe sonographic classification of echinococcal cysts proposed by the WHO Informal Working Group on Echinococcosis (WHO-IWGE) allows the distinction between active, transitional and inactive cysts, thus facilitating selection of treatment modalities. For uncomplicated, inactive cysts (CE4, CE5), recent expert opinion recommends they should be left untreated and monitored, but no data exists on the safety and effectiveness of this approach. To fill this gap, we report our experience with long-term sonographic monitoring of inactive cysts.
Records of patients who presented at our clinic and were diagnosed with inactive echinococcal cysts of the liver were searched. Inclusion criteria were:
• presence of cysts exclusively in inactive stage at the time of diagnosis;
• follow-up with abdominal ultrasound performed every 6 or 12 months;
• minimal length of follow up of 24 months.
For each patient, demographic details, characteristics of the cyst within the liver and complications and sonographic changes if they occurred during follow-up were obtained.
From March 1994 to May 2011, 94 patients with exclusively inactive liver cysts were seen in our clinic with 41 meeting all inclusion criteria. 16 patients were male and 25 were female (mean age at time of diagnosis: 48 years, range: 14-86 years). They harbored a total of 55 cysts (of which 33 were CE4 type and 22 were CE5 type). The average cyst diameter was 52 mm.
27 patients had 1 cyst each, 14 patients had 2 cysts each. 42 cysts were located in the right lobe, 4 in the left lobe and 9 in the fourth segment.
The mean follow-up period was 78 months (range: 24-453 months) and in 40 patients (97.6%) the cysts remained in the inactive stage (reactivation occurred only in 1 patient).
Our observations indicate that a proportion of cysts become completely inactive without any treatment and cysts that reached this stage are likely to remain inactive over time. Our data suggest that “Watch and Wait” may be a viable management option for uncomplicated inactive liver cysts
Spinal cystic echinococcosis - a systematic analysis and review of the literature : part 2. treatment, follow-up and outcome
No full textBone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques, surgical treatment and introduction of pharmacological therapy, spinal echinococcosis remains associated with a high degree of morbidity, disability and mortality. We systematically reviewed the published literature of the last five decades to update and summarize the currently existing data on treatment, follow-up and outcome of spinal CE
Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review
No full textUltrasound can rapidly identify abnormal signs, which in high prevalence settings, are highly suggestive of extra-pulmonary tuberculosis (EPTB). Unfortunately experienced sonographers are often scarce in these settings.A protocol for focused assessment with sonography for HIV-associated tuberculosis (FASH) which can be used by physicians who are relatively inexperienced in ultrasound was developed.The technique as well as normal and pathological findings are described and the diagnostic and possible therapeutic reasoning explained. The protocol is intended for settings where the prevalence of HIV/TB co-infected patients is high.FASH is suitable for more rapid identification of EPTB even at the peripheral hospital level where other imaging modalities are scarce and most of the HIV and TB care will be delivered in the future
Ultrasound in tropical medicine. Human Immunodeficiency Virus (HIV) Infection
No full textThe European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) is continuously working for improved education in many ways: One way has been since 1992 to arrange Euroson Schools throughout Europe. By end of 2009 over 50 of these post-graduate courses has been arranged and provided state-of-the-art lectures to the European ultrasound community. . The present book is intended to support all who want to organise courses by providing up-to-date chapters in central fields of ultrasonography.
The chapter on HIV provides update information on the enormous scope for use of ultrasound in resource-poor settings where HIV and TB are enormous scourges to the resident populations, particularly in Sub-Saharan countries
Spinal cystic echinococcosis - a systematic analysis and review of the literature : part 1. Epidemiology and anatomy
No full textBone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques as well as surgical and medical treatment of spinal CE, our basic understanding of the parasite's predilection for the spine remains incomplete. To fill this gap, we systematically reviewed the published literature of the last five decades to summarize and analyze the currently existing data on epidemiological and anatomical aspects of spinal CE
Ultrasound and Tropical Medicine. Parasitic Diseases of the Liver.
No full textThe chapter provides an overview of clinical and sonographic features of the hepatic involvement of 8 different parasitic infections.
This book is going to be standard reference book for European practitioners of Ultrasound as it is the official Course Book of the European Federation od Societies for Ultrasound in Medicine and Biology (www.efsumb.org) .
The authors are all leaders in the field of ultrasound of infectious disease or parasitologists who practice ultrasound
Justified concern or exaggerated fear: the risk of anaphylaxis in percutaneous treatment of cystic echinococcosis-a systematic literature review
No full textPercutaneous treatment (PT) emerged in the mid-1980s as an alternative to surgery for selected cases of abdominal cystic echinococcosis (CE). Despite its efficacy and widespread use, the puncture of echinococcal cysts is still far from being universally accepted. One of the main reasons for this reluctance is the perceived risk of anaphylaxis linked to PTs. To quantify the risk of anaphylactic reactions and lethal anaphylaxis with PT, we systematically searched MEDLINE for publications on PT of CE and reviewed the PT-related complications. After including 124 publications published between 1980 and 2010, we collected a total number of 5943 PT procedures on 5517 hepatic and non-hepatic echinococcal cysts. Overall, two cases of lethal anaphylaxis and 99 reversible anaphylactic reactions were reported. Lethal anaphylaxis occurred in 0.03% of PT procedures, corresponding to 0.04% of treated cysts, while reversible allergic reactions complicated 1.7% of PTs, corresponding to 1.8% of treated echinococcal cysts. Analysis of the literature shows that lethal anaphylaxis related to percutaneous treatment of CE is an extremely rare event and is observed no more frequently than drug-related anaphylactic side effects
Abdominal tuberculosis: sonographic diagnosis and treatment response in HIV-positive adults in rural South Africa
No full textSummaryObjectiveTo investigate the diagnostic value of abdominal ultrasound in HIV-positive inpatients in a rural African setting.MethodsThis was a prospective case series over 3 months of adult HIV-positive patients with symptoms suggestive of abdominal tuberculosis (TB). Diagnostic ultrasound was performed for all patients: sonographic criteria included abdominal lymph node enlargement (>1.5cm) and focal splenic lesions; ascites was a supportive finding. Further diagnostic studies, e.g., aspiration or biopsy were not routinely performed. TB treatment was initiated on the basis of clinical and sonographic features. The patients were contacted after 4 months to evaluate the clinical outcome.ResultsOne hundred and eighty adult HIV-positive patients were screened; 30 (16.7%) showed sonographic signs of abdominal TB. The median CD4 count was 78 cells/mm3. Presenting symptoms were weight loss (86.7%), abdominal pain (76.7%), and diarrhea (60%). Abdominal lymph node enlargement was the diagnostic finding in almost all cases (96.7%); hypoechoic lesions of the spleen were seen in 50% and ascites in 73.3%. Follow-up information was available for 25 patients: 24% had died and the remaining 76% reported symptomatic improvement and weight gain.ConclusionsCharacteristic sonographic features of abdominal TB are common in HIV-infected inpatients in a rural African setting. Ultrasound should be introduced into clinical algorithms for the diagnosis of extrapulmonary TB
