Liver dome hydatid cyst surgery: Laparotomy or thoracotomy?

Background: The liver is the most common organ of the body that is at risk of getting affected by hydatid cyst (75%). All lobes of the liver can be involved with the formation of hydatid cyst, but the right lobe is more involved than the left lobe. The rate of involvement of liver dome and segments 7 and 8 of the right lobe has not been reported so far, but the best treatment for liver hydatid cyst has been found to be surgery. Materials and Methods: In this study, 240 patients with liver hydatid cyst underwent surgery from 2005 to 2017. In this retrospective study, the variables of gender, age, number of liver cysts, involvement of lobe and segments, simultaneous involvement of liver and lung, laparotomy, thoracotomy, the number of patients referred due to the lack of finding cysts in laparotomy, and surgical complications were analyzed. Results: The results showed that the majority of patients were males with age ranging from 8 to 68 years. Right lobe involvement was observed in most of the patients. About 62 patients showed involvement of liver dome and segments 7 and 8. Therefore, 62 patients underwent thoracotomy according to the criteria introduced and the rest of the patients (n = 178) underwent laparotomy. The results showed that there was a potential for capitonnage in 46 patients in thoracotomy. The pain score was 4-5 according to the VAS criterion. The rate of using analgesic drug did not show significant difference between the two methods. Conclusion: During the manipulation, cysts might be ruptured and give rise to complications such as spread of the disease, shock, and anaphylaxis, which may be followed by legal complaints. Therefore, in order to perform the surgery successfully, a new method along with computed tomography (CT) scan has been introduced in this study, which can be very helpful.

Phytochemical analysis, antioxidant, cytotoxic, and antimicrobial activities of golden chamomile (Matricaria aurea (Loefl.) Schultz Bip).

Matricaria aurea (Loefl.) Schultz Bip. (Asteraceae), known as golden chamomile, has been traditionally used for the treatment of various diseases. In this study, total phenolic, flavonoid, and tannin contents of total extract and different fractions of this plant were determined. The antioxidant, cytotoxic, and antimicrobial activities were also evaluated. Moreover, the phenolic profiles of selected fractions were determined by HPLC and LC-MS/MS analysis. Results demonstrated total phenolic contents of 37.8-57.2 mg GAE/g and total flavonoid contents of 3.0-111.2 mg QE/g. The ethyl acetate and methanol fractions (EF and MF) had the highest concentrations of phenolic, tannin, and flavonoid compounds. In both DPPH radical scavenging assay and phosphomolybdenum reduction assay, EF showed the best antioxidant activity, followed by MF. EF and MF indicated also the best antibacterial activities against Bacillus subtilis (MIC 1.56 and 12.5 mg ml-1) and Staphylococcus aureus (MIC 0.78 and 12.5 mg ml-1). Hexane fraction (HF) had no antibacterial effect. None of the samples had antifungal effect. MTT (3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay revealed for EF and HF the highest antiproliferative activities (IC50 values ranged from 111.8 to 294.6 µg ml-1). The presence of chlorogenic acid, ferulic acid, and luteolin-7-O-glucoside in MF, and p-coumaric acid in EF was confirmed and quantified.

Giant thymolipoma of mediastinum and neck - initially misdiagnosed as liposarcoma by core needle biopsy.

Thymolipomas are rare benign tumors, constituting one of the differential diagnoses of an anterior mediastinal mass. These tumors may have an indolent, asymptomatic course, often achieving massive dimensions before presentation. When it is symptomatic, respiratory symptoms predominate. We report a case of thymolipoma in a 30-year-old male complaining of heaviness and constricting type of chest pain and neck swelling of 1-year duration. Computed tomography scan finding revealed a space-occupying lesion in the anterior mediastinum and extend to the right side of the mediastinum, neck, and left hemithorax. A sono-guided core needle biopsy was carried out which identified an atypical cell and was suspicious to liposarcoma. The tumor was completely excised through "posterolateral thoracotomy." Postoperative histopathological examination confirmed the diagnosis of thymolipoma. This is the second case we have reported from our institution.