Another alternative in the treatment of hepatic cystic echinococcosis (Part three)
The recurrence cases have been high (14 – 25%), but in general, they have been sensitive to a second treatment (Todorov, 1997).
Horton has treated 665 cysts with albendazole with a daily dose of 10-15 mg/Kg (Divided into two daily doses) and has noticed a 48% disappearance of the cysts and a 24% reduction in their volume. (10)
Treatment with chemotherapeutic agents is a non-invasive treatment that can be used in patients of all ages and should continue for 3-6 months with unpredictable results that vary from individual to individual. The treatment should be limited in pregnant women. (11)
The medication Praziquantel (PZQ) has been recommended as an adjunctive medication to be given once a week with a dose of 40 mg/kg, during treatment with benzimidazole. (12).
New cysts respond much better to treatment, probably as a result of a thinner pericystic membrane as well as a more active metabolism. (13)
All patients under treatment should be under periodic control, especially for the leukocyte formula (every 2 weeks in the first trimester), because leukopenia, not always reversible, may occur during the early stages of treatment. (14)
| Ultrasonographic Follow-up of a case treated with PAIR: |
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Fig. 9. Right subcostal oblique section. Hydatid cyst in the 4th segment treated with percutaneous ethanol injection under ultrasound guidance. a. Presence of the catheter inside the cyst. b. Ethanol injection after aspiration of the cystic fluid. c. Shriveling of the membrane. d. Hardening of the cyst. Ultrasonographic management of hydatid cysts M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani** * Infectious Diseases Unit - S. Donato Hospital - Arezzo; ** Hematology Section - S. Donato Hospital – Arezzo. Page 147 |
| Ultrasonographic Follow-up of a case treated with PAIR: |
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Fig. 10. Hydatid cyst of the 5th segment of the liver. a. Hydatid cyst before treatment. b. After 48 hours, the wall becomes thicker with artifacts reflecting and giving hypoechoic shadows. c. After a few days, the hypoechoic shadow is even more evident, with disappearance of the liquid component and appearance of echogenic material inside. d. After 3 months, the lesion is completely hardened. Ultrasonographic management of hydatid cysts M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani** * Infectious Diseases Unit - S. Donato Hospital - Arezzo; ** Hematology Section - S. Donato Hospital – Arezzo. Page 148. |
CONCLUSION
* Ultrasound is a good method for diagnosis, treatment, and follow-up after therapy, in hydatid cysts.
* In cystic echinococcosis, ultrasound and interventional ultrasound have changed the natural history of this pathology, allowing for a quicker diagnosis with high sensitivity and specificity, improving treatment and achieving complete, sustainable improvements with much less risk and minor complications. (15)
* Within a few years, the PAIR technique has undoubtedly gained one of the top spots in Italy for the treatment of hepatic cystic echinococcosis, as its efficacy has been confirmed with long-term Check-Ups. (C. Filice., E. Brunetti).
* For developing countries, PAIR represents not only an alternative but also a first-rate diagnostic and therapeutic solution in the treatment of human cystic echinococcosis. (16)
Greetings! I would like to have contact with Dr. Viktor Qershniku because my mother has such a disease. She has been operated on twice within a four-year period and it has recurred again. I would like a consultation from your side. Thank you!
Sent by Monika, më 24 October 2017 në 06:04
Dear Monika,
Can you contact me by phone at
Number 0672161158.
With respect,
Viktori
Replay from Dr. Viktor QERESHNIKU, më 24 October 2017 në 13:13
Hello doctor. Many doctors suspect that my mom has this kind of disease, but the examinations conducted at the American Hospital in Tirana show that she has a cyst with fluid in the liver. She has been treated with medications recommended by the American Hospital and herbal remedies for almost 6 months and there has been no result. Please respond to this case because I am very worried about it. Once again, I am pleading
Sent by Eva Mucmata, më 18 February 2019 në 00:38
Honored ....... ,
I recommend that in your possibility of consulting the patient in Tirana, to send me the Echos made in Kukës and in Tirana as well as all the analyses available, as well as to inform me about the concerns of the patient.
Do you have a dog at home?
With respect,
Viktor QERESHNIKU
Replay from Dr. Viktor QERESHNIKU, më 18 February 2019 në 01:59
Dear Eva,
I recommend that if you have the possibility to consult the patient in Tirana, to send me the Echos done in Kukës and in Tirana as well as all the available analyses, and to inform me about the patient's concerns.
Do you keep a dog at home?
With respect,
Viktor QERESHNIKU
Replay from Dr. Viktor QERESHNIKU, më 18 February 2019 në 02:01
Hello doctor, my father has cysts in his liver, one is 9cm and another is 6cm. They have told him to undergo surgery but my father does not want to do it now but rather in October. I would like to know if there is a possibility that the cysts could rupture and what kind of risk comes from the rupture of a cyst?
Please return an answer.
Thank you!
Sent by Majlinda, më 06 May 2019 në 11:37
Honorable Majlinda,
as you have been informed, I believe, you must be aware that echinococcus cysts are in various stages of development, depending on which the treatment also depends. With as much as you have informed, I cannot give a precise answer on how to proceed.
However, it is important to start treatment with ALBENDAZOLE 2 x 400 Mg. Once daily for 28 days, 14 days break, and then repeat another two cycles.
After these cycles, do a good ultrasound and the antigen analysis.
We can communicate further in the future.
Regards
Replay from Dr. Viktor QERESHNIKU, më 08 May 2019 në 09:38
Hello Dr. Viktori. I am Silvana and my mom has a cyst in her liver. The doctor recommended not to treat it for 6 months. Is it normal not to take any medicine during this time? And can it heal without treatment? With respect, Silvana from Lushnja
Sent by Mikela Xhyra, më 07 July 2019 në 13:23
Dear Silvana,
If it has been proven to be a
CYST OF THE CYSTIC ECHINOCOCCUS OF THE LIVER,
of course, it must be treated first
and followed dynamically.
Best regards.
Respect
Replay from Dr. Viktor QERESHNIKU, më 14 July 2019 në 02:29
Honorable Silvana,
If it has been proven to be a
CYST OF THE LIVER HYDATID CYST,
it certainly needs to be treated first
and followed dynamically.
Past events.
Respects
Replay from Dr. Viktor QERESHNIKU, më 14 July 2019 në 02:30
Hello Doctor,
I have a brother with Echinococcosis and it has progressed, recently it has enlarged to 14 by 12 and I wanted to ask you if there is any treatment without surgical intervention. I have also done a scan and it says that it is a Cystic Echinococcus of the Liver.
How can I proceed in this case because I am very confused and honestly, I don't have much faith in surgical interventions
Sent by Maliq Mici, më 04 Agust 2019 në 23:57
Dear Maliq,
When the diagnosis is confirmed,
Treatment must begin with
ALBENDASOL 2X400 Mg daily for
at least 1 to 2 cycles of 21 days and
Then there are 2 alternatives:
1. Open surgery with a scalpel
2. PAIR technique without opening, which
maybe should be inquired at the American Hospital if they perform it.
It should not be left untreated.
Best regards
Replay from Dr. Viktor QERESHNIKU, më 09 Agust 2019 në 03:59
Dear Maliq,
When the diagnosis is confirmed,
Treatment must begin with
ALBENDAZOLE 2X400 Mg per day for
at least 1 to 2 cycles of 21 days and
Then there are 2 alternatives:
1.: Open surgery with scalpel
2.: PAIR technique without incision, which
maybe should be inquired at the American Hospital if they do it.
It should not be left untreated.
Best regards
Replay from Dr. Viktor QERESHNIKU, më 09 Agust 2019 në 03:59
Where can we find you for a visit, please the address, phone, and do we need to make an appointment?
Sent by Nora, më 14 September 2019 në 19:34
With pleasure, we can communicate
to help you as much
as we can.
I am in Tirana and my phone number
is 0682151598.
Regards,
Viktori
Replay from Dr. Viktor QERESHNIKU, më 15 September 2019 në 10:25