RESUMEN
BACKGROUND: Hydatid disease is a global problem. We report our experience with such cases where the dominant cysts were located outside the liver and lungs. In particular, these cysts were found in the peritoneum which is an uncommon location. METHODS: Between 1967 and 2007 a total of 34 patients were operated for primary or secondary peritoneal cysts. Most of the patients were asymptomatic or had atypical symptoms. The diagnosis was based on the preoperative history, rupture of the cysts, serology, ultrasound (USS) and computer tomography (CT). Open surgery was the procedure of choice with conservative (18 cysts) and radical (25 cysts) methods. RESULTS: The outcome of surgery was good without postoperative mortality or severe morbidity and the recurrence rate was 23.5%. CONCLUSIONS: Conservative surgery can provide good results in symptomatic peritoneal cysts. Radical therapy is also ideal but only in properly selected cases. The management of this situation is difficult requiring sound operative experience preferably with a one-stage procedure after an appropriate preoperative preparation.
RESUMEN
This study shows the rapid and differential production of the 40-43 kDa and the 70-90 kDa alpha1-acid glycoprotein (AGP) fucosylated glycoforms after treatment of the dorsal air pouch with bacterial lipopolysaccharide (LPS), HgCl(2) or Freund's complete adjuvant (FCA). The 40-43 kDa and the 70-90 kDa AGP production is peaked 1-3 h post-LPS treatment. We observed that the responses to LPS and FCA are similar in that both AGP isoforms are induced whereas they differ in that the FCA exhibits a 6 h lag period. The response to HgCl(2,) however, exhibits the specific biphasic induction only of the 40-43 kDa AGP. The serum 40-43 kDa AGP glycoform gradually increases in response to all of the above stimulants and peaks by 24 h post- treatment. The increase of the 70-90 kDa AGP levels in the air pouch occurs in association with the accumulation of polymorphonuclear (PMN) cells while dexamethasone (DEX) increases only the 40-43 kDa AGP production in the absence of PMN accumulation. Macrophage-monocyte lineage cells forming the air pouch lining tissue may potentially be the cells that secrete the 40-43 kDa AGP while polymorphonuclear cells that infiltrate the air pouch secrete the 70-90 kDa AGP. The 40-43 kDa and 70-90 kDa AGP production induced by LPS in the air pouch precedes that of interleukin-1 (IL-1) or interleukin-6 (IL-6) while the 40-43 kDa AGP glycoform potentially increases IL-6 production by air pouch PMN exudate cells. These significant differences suggest a local pro-inflammatory role of AGP. Honeybee venom suppressed arthritis development and exhibited differential local or systemic regulation of AGP in serum vs. air pouch exudate or synovial fluid. This study with the air pouch model of facsimile synovium tissue suggests that local alpha1-acid glycoprotein (AGP) production may contribute to pro-inflammatory and anti-inflammatory activities during the local acute phase response or during chronic inflammatory stress as in arthritis.
