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1.
J Gastrointest Surg ; 14(7): 1121-7, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20464525

RESUMO

BACKGROUND AND AIMS: Hydatid disease is still a major health problem in sheep-raising areas. Surgery remains the basic treatment for liver hydatid cyst (LHC). However, recurrences can occur after all therapies. Surgery for recurrence of LHC becomes technically more difficult with higher rate of morbidity and mortality. The aim of this study was to determine perfective factors associated to hepatic recurrence after LHC surgery and to propose and discuss postoperative follow-up schedules. METHODS: It is a retrospective cohort study of 672 patients with LHC treated at the surgery department "A" at Ibn Sina University Hospital, Rabat, Morocco, from January 1990 to December 2004. Recurrence rates have been analyzed by the Kaplan-Meier method for patients undergoing surgery. RESULTS: Fifty-six patients (8.5%) had LHC recurrence after surgery. There were 34 females (60.7%) and 22 males (39.3%). Median duration of recurrence's diagnosis was 24 months (interquartile range: 10-48 months). Recurrence's risk was 2.3% +/- 0.6% at 1 year and 9.1% +/- 1.3% at the 10th year. The history of LHC (hazard ratio, 2; 95% confidential interval, 1.13-3.59) and three cysts or more (hazard ratio, 3.8; 95% confidential interval, 2.07-6.98) was an independent risk factor for recurrence. CONCLUSION: We think that the surgeon's practice and experience are the most important to success the surgical treatment. It prevents complications and recurrences.


Assuntos
Equinococose Hepática/cirurgia , Adulto , Competência Clínica , Estudos de Coortes , Equinococose Hepática/patologia , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco
2.
BMC Surg ; 10: 16, 2010 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-20398342

RESUMO

BACKGROUND: Incidence of liver hydatid cyst (LHC) rupture ranged 15%-40% of all cases and most of them concern the bile duct tree. Patients with biliocystic communication (BCC) had specific clinic and therapeutic aspect. The purpose of this study was to determine witch patients with LHC may develop BCC using classification and regression tree (CART) analysis METHODS: A retrospective study of 672 patients with liver hydatid cyst treated at the surgery department "A" at Ibn Sina University Hospital, Rabat Morocco. Four-teen risk factors for BCC occurrence were entered into CART analysis to build an algorithm that can predict at the best way the occurrence of BCC. RESULTS: Incidence of BCC was 24.5%. Subgroups with high risk were patients with jaundice and thick pericyst risk at 73.2% and patients with thick pericyst, with no jaundice 36.5 years and younger with no past history of LHC risk at 40.5%. Our developed CART model has sensitivity at 39.6%, specificity at 93.3%, positive predictive value at 65.6%, a negative predictive value at 82.6% and accuracy of good classification at 80.1%. Discriminating ability of the model was good 82%. CONCLUSION: we developed a simple classification tool to identify LHC patients with high risk BCC during a routine clinic visit (only on clinical history and examination followed by an ultrasonography). Predictive factors were based on pericyst aspect, jaundice, age, past history of liver hydatidosis and morphological Gharbi cyst aspect. We think that this classification can be useful with efficacy to direct patients at appropriated medical struct's.


Assuntos
Doenças Biliares/epidemiologia , Equinococose Hepática/classificação , Equinococose Hepática/epidemiologia , Adulto , Distribuição por Idade , Análise de Variância , Doenças Biliares/diagnóstico por imagem , Doenças Biliares/etiologia , Estudos de Coortes , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Marrocos/epidemiologia , Valor Preditivo dos Testes , Probabilidade , Análise de Regressão , Estudos Retrospectivos , Ruptura Espontânea/epidemiologia , Ruptura Espontânea/etiologia , Índice de Gravidade de Doença , Distribuição por Sexo , Ultrassonografia , Adulto Jovem
3.
J Am Coll Surg ; 206(4): 629-37, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18387467

RESUMO

BACKGROUND: Operations are the mainstay of liver hydatid cyst (LHC) treatment. Operations are still associated with high morbidity and mortality because of specific postoperative complications (bile leaks, bilomas, deep bleeding, and deep suppurations) and deep abdominal complications (DAC). The aim of this study was to identify the predictive factors of DAC after LHC operation. STUDY DESIGN: We conducted a retrospective study of 672 patients with LHC treated at the Surgery Department "A" at Ibn Sina University Hospital, Rabat, Morocco. Specific morbidity (DAC) and 30 variables were assessed. Univariate and multivariate logistic regression were performed to identify predictive factors for DAC. An associated risk scoring system was developed. RESULTS: Six hundred sixty-four patients underwent operations. Mortality rate was 0.8% (n = 5) and DAC rate was 18.4% (n = 121). Five independent predictive factors of DAC after LHC operation were retained, ie, presence of cyst preoperative complications (odds ratio [OR] = 3.10; 95% CI, 1.85 to 5.17), 3 or more cysts in the liver (OR = 2.55; 95% CI, 1.42 to 4.59), thick pericyst (OR = 2.59; 95% CI, 1.27 to 5.29), biliary fistula (OR = 2.27; 95% CI, 1.38 to 3.72), and capitonnage alone as residual cavity management (OR = 2.23; 95% CI, 1.12 to 4.44). Multivariate model showed a good fit. Discriminating ability of the model was fair. In theoretical risk, scores ranged from 0 to 5. When the score was 2 or more, sensitivity of the scoring model was 80.3%, specificity was 58.5%, positive predictive value was 30.3%, and negative predictive value was 93%. CONCLUSIONS: Identification of these five factors will allow more appropriate therapeutic care after LHC operation.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Equinococose Hepática/complicações , Equinococose Hepática/cirurgia , Abscesso Abdominal/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bile , Fístula Biliar/etiologia , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco
6.
Sante ; 17(3): 177-9, 2007.
Artigo em Francês | MEDLINE | ID: mdl-18180220

RESUMO

While hydatid cysts may occur in any area of the body, isolated muscular localizations are rare. Only some thirty-odd such cases have been reported. The authors report the case of a 38-year-old man who consulted for isolated abdominal pain in the left iliac region. Radiographic study showed a simple hydatid cyst of the left psoas muscle. The cyst was removed by extraperitoneal transverse laparotomy. Crural nerve palsy occurred but regressed after 2 months and had not recurred after 24 months. Ultrasonography is the preferred method for detecting muscular hydatid cysts. No other diagnostic tool is needed. Surgical treatment remains best. We recommend the unroofing technique over pericystectomy. Other cyst localizations must be sought before any therapeutic decision, since they determine the initial surgical management and allow consideration of other therapeutic methods to be combined with surgery.


Assuntos
Equinococose/diagnóstico , Doenças Musculares/parasitologia , Músculos Psoas/parasitologia , Dor Abdominal/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Laparotomia , Masculino
7.
Gastroenterol Clin Biol ; 30(10): 1214-6, 2006 Oct.
Artigo em Francês | MEDLINE | ID: mdl-17075481

RESUMO

The incidence of the rupture of hydatid cyst of the liver is about 15 to 40% of the cases. In 2 to 7% of the cases the cyst can perforate into the peritoneum. The occurrence of a sclerosing peritonitis secondary to the rupture of the hydatid cyst of the liver was described, to our knowledge, only once. We report the observation of a 43 year-old woman in whom the diagnostis of peritoneal rupture of a liver hydatid cyst was made after 3 months. The patient was treated by albendazole (10 mg/kg/d). Two months after the beginning of this treatment, the patient was operated. A sclerosing peritonitis was discovered. The parasitologic studies of the different specimens were negative. The surgical treatment consisted of a good washing with H2O2 of the fibrous hull of the sclerosing peritonitis and drainage without any dissection. The evolution was satisfactory with albendazole treatment for 14 months. Currently, she is in good health without recurrence and without any abnormalities with a 2 years follow-up. We think that albendazole in the treatment of the hydatid disease is very effective in condition to give a continuous treatment for a long time. The occurrence of a sclerosing peritonitis is fortunately an exceptional situation whose surgical management is very delicate.


Assuntos
Equinococose Hepática/complicações , Peritonite/etiologia , Adulto , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Anticestoides/administração & dosagem , Anticestoides/uso terapêutico , Drenagem , Equinococose Hepática/diagnóstico , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/tratamento farmacológico , Feminino , Seguimentos , Humanos , Peritonite/cirurgia , Radiografia Abdominal , Ruptura Espontânea , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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