Dynamics of the O. felineus Infestation Intensity and Egg Production in Carcinogenesis and Partial Hepatectomy in the Setting of Superinvasive Opisthorchiasis.

Clinical and experimental studies have shown that opisthorchii tend to evade tumour growth foci to colonize more distant areas of the liver. When modelling tumours with various carcinogens in the setting of superinvasive opisthorchiasis, the intensity of invasion is reduced both before the formation of neoplasms (>120 days) and after the development of tumours of various histogeneses (liver, pancreas, and stomach) (>240 days). Egg production was observed to increase with the decrease in the number of parasites in the liver. The smallest changes in the infestation intensity indicators and egg production were observed in the experimental stomach tumours (p > 0.05). A partial hepatectomy in the setting of opisthorchiasis did not affect the number of parasites in the ecological niche (liver) or the production of eggs by the helminth. With the deterioration of the vegetation state, parasite clumps of opisthorchii increase egg production under the conditions of distress.

Opisthorchiasis mimicking primary biliary cirrhosis as an indication for liver transplantation.

BACKGROUND/AIMS: Opisthorchiasis, a helminthic infection occurring endemically in certain areas of Europe and Asia is caused by parasites of the class trematoda. Failure to treat or a significant delay in the institution of an adequate therapy can lead to considerable complications in the further course of the disease. CASE: A 56-year-old patient diagnosed with primary biliary cirrhosis (PBC) with Child-Pugh stage B was referred to our surgical department from a peripheral hospital for liver transplantation. She had spent 50 years of her life in Kazakhstan. RESULTS: As the treatment of choice, orthotopic liver transplantation was carried out. The routine postoperative pathological analysis of the explanted liver showed the histological picture of opisthorchiasis. Further work-up in an effort to confirm the histological diagnosis was repeatedly negative. CONCLUSIONS: Opisthorchiasis should always be a diagnostic consideration in an unclear case of chronic liver disease especially in patients living in endemic areas.

[Prevention and treatment of opisthorchiasis of the liver]. / Profilaktika i lechenie oslozhnenii opistorkhoza pecheni.

Rare cases of lethal outcomes after surgical operations on the liver were analyzed which were caused by invasion of helminth Opisthorchis felineus. It was shown that prolonged and massive invasion, in the absence of specific treatment, can result in failure of the compensatory potencies of the liver. It occurs mainly due to activation of the pathogenic flora in the bile tree against the background of the intraductal hypertension characteristic of opisthorchiasis. Destructive purulent cholangitis, cholangitic abscesses in the liver and suppuration of opisthorchiasis cysts can develop. The direct cause of death was progressing hepatic insufficiency. The postoperative lethality among patients with opisthorchiasis cysts of the liver was 5.7%, with liver abscesses--12.5%. The external drainage of the biliary tree in patients with this pathology and intraportal infusions reduce lethality and the number of specific postoperative complications.

Cholangiocarcinoma in patients with opisthorchiasis.

Cholangiocarcinoma is very common in areas endemic for the liver fluke Opisthorchis viverrini. Survival after surgical treatment of cholangiocarcinoma associated with opisthorchiasis was studied prospectively in 30 patients, all of whom resided in an endemic area. The median age was 52 (range 32-69) years and twenty-five patients were men. Seven patients had their tumours removed, four with concomitant liver resection. Twenty-two patients underwent palliative biliary bypass procedures to a segmental duct. Laparotomy with biopsy of metastatic lesions was undertaken in one patient with multiple lymph node metastases and peritoneal seedlings. No patient received postoperative chemotherapy or radiation treatment. Patients were followed for 2 years or until death. The 1-year survival rate after tumour resection was 86 per cent and the 2-year survival rate 43 per cent. After palliative procedures the 1-year survival rate was 26 per cent; no patient reached 2 years and the median survival time was 8 months. Survival after surgical treatment of cholangiocarcinoma in patients with opisthorchiasis is broadly similar to that reported for cholangiocarcinoma without liver fluke infestation.

[The diagnosis and treatment of mechanical jaundice of parasitic origin]. / Diagnostika i lechenie mekhanicheskikh zheltukh parazitarnogo proiskhozhdeniia.

From analysis of 230 cases of obstructive jaundice consequent upon opisthorchiasis, alveococcosis, and echinococcosis its causes and the peculiarities of the clinical course were revealed: gradual development, a long duration, disturbed hepatocyte function in the early period, high incidence of cholangitis, deep disorders of immunological reactivity, and allergic reorganization of the organism. With due regard for these characteristics, recommendations are given in respect of the diagnosis, operative treatment, prevention of postoperative complications, and postoperative management.

[Opisthorchiasis of the liver]. / Opistorkhoznye kisty pecheni.

The authors discuss 34 patients with opisthorchiasis cysts of the liver, 17 of them were treated by operation. The disease is not a rare occurrence in endemic foci. Ultrasonography is considered to be the most informative method in the diagnosis of opisthorchiasis hepatic cysts. Patients with cysts of moderate and large size (more than 5 cm) are subjected to surgery. Those with cysts of a small diameter are kept under dynamic observation. It is claimed that in untreated opisthorchiasis additional drainage of the biliary tract during the operation is expedient. Opisthorchiasis cysts of the liver possess characteristic morphological signs; the wall of the cyst is usually formed by the walls of the distended bile ducts with marked adenomatous growths of the epithelium. The authors show the late-term results of surgery in follow-up periods of 2 to 11 years, which they claim to be quite satisfactory.

[Outcomes of injuries of the liver and gallbladder in patients with opisthorchiasis]. / Iskhody travm pecheni i zhelchnogo puzyria u bol'nykh opistorkhozom.

The authors had 10 patients with isolated injury to the gallbladder and 51 patients with injury to the liver in coexistent opisthorchiasis. An emergency operation was undertaken in all of them. The structural changes of the hepatobiliary system in chronic opisthorchiasis in man and the intraductal biliary hypertension induced by them form a morphofunctional complex which promotes the escape of bile and the development of the biliary peritonitis even in mild injury to the liver. Cholecystectomy in indicated in isolated injuries to the gallbladder. Decompression of the biliary tract and drainage of the abdominal cavity are necessary for the prevention of biliary peritonitis in the postoperative period in patients with opisthorchiasis. The total mortality was 17.6%.

[Opisthorchiasis of the liver]. / Opistorkhoznye kisti pecheni.

The authors have observed 10 patients with opisthorchiasic cysts of the liver. These cysts are multiple and disposed mainly in the left lobe of the liver. Sonography and laparotomy are expedient methods for diagnosis of the disease. Operations were performed on 7 patients and gave good immediate and long-term results.

[Comparative characteristics of nonparasitic and opisthorchiasis cysts of the liver]. / Sravnitel'naia kharakteristika neparazitarnykh i opistorkhoznykh kist pecheni.

The authors observed 24 patients with opisthorchiasis and 14--with nonparasitic cysts of the liver. No essential differences in the tactics of surgical treatment of these cysts were noted. In medium-size and large cysts, the operative treatment--excision of cystic walls with omentoplasty, liver resection--is recommended; in small opisthorchiasis and nonparasitic cysts--dynamic observation with the performance of ultrasound scanning.

[Possibilities of surgical and drug therapy of parasitic cholestasis]. / Möglichkeiten chirurgischer und medikamentöser Therapie bei parasitärer Cholostase.

Out of 123 patients with hydatid-disease of the liver in 15 patients biliary engorgement by compression from cysts or parasites in the biliary system were observed. Diagnosis can be established by serology, sonography, scintigraphy, ERCP and CT. Invasive diagnostic procedures are not indicated. Surgical therapy of echinococcosis is in the first place; long-term adjuvant chemotherapy by Mebendazole is indicated if the resection of the cysts is not complete.

[Hepatic blood flow in the surgical complications of opisthorchiasis]. / Pechenochnyi krovotok pri khirurgicheskikh oslozhneniiakh opistorkhoza.

The article presents the results obtained during the investigation of hepatic blood flow by the method of rheohepatography in 63 patients. Complicated opisthorchiasis is accompanied by disorders in hepatic hemodynamics. The data of rheohepatography and the parameters of the hepatic clearance allow fulfilling the immediate control of the efficiency of the surgical methods of correction as well as of the conservative treatment.