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AIH 79th Argentine Congress of Surgery. Buenos Aires, 11-14 November 2008


Presented at the case of a child with a liver hydatid cyst (HCL) type III (classification of Gharby) detected by ultrasound cadastre. In general this type of HCL we operate, but considering its size and the possibility of appropriate follow-up we decided to treat with albendazole obtaining an excellent result.

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IX Refresher Course in hydatidosis - Ing Jacobacci (Black River) in October 2008

Location *: Engineer Jacobacci, BLACK RIVER, ARGENTINA.

Details of the proposal:

Start date *. End Date 29/10/1908 30/10/2008

* * MARIO DEL CARPIO Coordinator

Teachers *: (Name and number of hours assigned)

MARIO DEL CARPIO (SURGEON)

CARLOS Hugo MERCAPIDE (SURGEON)

SALVITTI JUAN CARLOS (SURGEON) LEONARDO

UCHIUMI (SURGEON)

JORGE PANOMARENKO (GENERAL)

LARRIEU EDMUND (VET)

Guillermo Mujica (VET)

Audience:

• medical

  second year General Practice Residency,

• Doctors working in rural hospitals, even untrained

• Veterinary
  control program

Duration *: theoretical hours (16) Hours of practice (8) Total (24)

Number of participants: 20

Brief merits of the proposal *

The course of diagnosis and treatment of hydatidosis allocated to resident physicians in general medicine to 2 º course and General Practitioners south line (endemic area for hydatid disease) is still not formed is intended to support policy for early detection and early treatment made up for the program since 1998

Objective:

Training general practitioners and veterinarians for the support of the activities of control programs, maintain the decline in the prevalence of the disease and help achieve early diagnosis of hydatid disease, especially in children by providing systematic modern treatment.

Methodology:

exhibition activities are included with audiovisual sustained theoretical and practical activities carried ultrasound with 3 clinics located in 3 hospital Cortizo Jacobacci Engineer and included in the practical activities a first screening of 100 healthy students and a second practice with approximately 30 cases of hydatid disease with different types of cysts. It concludes with a discussion workshop and a written evaluation.

Content *:

• Modern aspects of the epidemiology of hydatidosis. (Dr. Edmundo Larrieu)

• normal ultrasound diagnosis: technique (Dr. Mario del Carpio)

• normal ultrasound practice. (Dr. Mario del Carpio, Dr Jose Panomarenko, Dr. Leonardo Uchiumi).

• ultrasound diagnosis of hydatid cyst, types of cyst. differential diagnosis, interpretation of images (Dr Mario del Carpio)

• Use of Ultrasonography in the primary care level. (Dr. Mario del Carpio)

• Organization

  ultrasonographic survey. Epidemiological objectives. Evaluation of results (Dr. Edmundo Larrieu)

• Practice hydatid cyst ultrasound (Dr. Mario del Carpio, Dr. Oscar Panomarenko, Dr Leonardo Uchiumi)

• medical treatment of asymptomatic carriers and symptomatic, chemotherapy and PAIR (Dr. Mario Del Carpio)

• Medical treatment of asymptomatic and symptomatic. chemotherapy, surgery and videolaparascopía (Dr. Carlos Mercapide, Dr John C. Salvitti, Dr Leonardo Uchiumi)

• Provincial Standards for Diagnosis and Treatment. (Drs. Carlos Mercapide and Mario del Carpio)

• Hydatid Control: control and surveillance strategies. (Dr. Edmundo Larrieu)

• control activities in a Rural Hospital (Dr. Guillermo Mujica)

Material Resources: gun, hand-carried ultrasound

Bibliography:

Del Carpio, M., Moguilansky, S., Costa, M., Panomarenko, H., Bianchi, C., Bendersky, S. , Larrieu, E. 2000. Diagnosis of human hydatidosis: predictive value of ultrasonographic survey in the rural population apparently helth. Medicine 60:466-468

Friderici, B., Losada. C., Larrieu, E., De Zavaleta, O. 1988. Asymptomatic abdominal hydatidosis detected by Ultrasonography. Acta. Radiol. 29: 431-434

Frider, B., Ledesma, C., Odriozzola, M., Larieu, E. 1990. echographic specificity in the early diagnosis of human hydatidosis. Acta Gastroenterol Latinoam . 20:13-5.

Frider, B., Larieu, E., Vargas, F., Odriozzola, M., Lester, R. 1985. An echographic, serologic and Radiologic register of human hydatidosis. Contributions to a control program. Acta Gastroenterol Latinoam . 115:199-211

Gatti, A. 1996. Standardization of an enzyme immunoassay technique for the diagnosis of human hydatidosis. A. Bioq. Clin. Latinoamer. 30:333-342

Cavagion, L., Perez, A., Santillan, G., Zanini, F., Jensen, O., Saldia, L., Diaz , M., Canton, G., Smith, E., Costa, MT., Volpe, M., Araya, D., Rubianes, NA., Aguado, C., Meglio, G., Guarnera, E., Larrieu E. 2005. Diagnosis of cystic echinococcosis on sheep farms in the south of Argentina: areas with a control program. Vet Parasitol. 128:73-81

Craig, PS., Larieu, E. 2006. Control of cystic echinococcosis/hydatidosis: 1863-2002. Adv Parasitol. 61:443-508

Frider, B., Moguilensky, J., Salvitti, J., Odriozola, M., Cantoni, G., Larrieu, E. 2001. Epidemiological surveillance of human hydatidosis by means of ultrasonography: its controbutions to the evaluation of control programs. Acta Tropica 79:219-223

Larrieu, E., Costa, M., Cantoni, G., Labanchi, J., Bigatti, R., Araya, D., Herrero, E., Iglesias, L., Mancini, S., Thakur, A. 1999. Rate of infection and of reinfection by Echinococcus granulosus in rural dogs of the Province of Rio Negro. Vet. Parasitol. 87: 281-286

Larrieu, E., Costa, M., Cantoni, G., Labanchi, J., Bigatti, R., Perez, A., Araya, D., Mancini, S., Herrero, E., Talmon, G., Romeo, S., Thakur, A. 2000a. Control program of hydatid disease in the Province of Río Negro, Argentina, 1980-1997. Bol. Chilena. Parasitol. 55:49-53

Larrieu, E., Costa, M., Cantoni, G., Alvarez, R., Cavagion, L., Labanchi, J., Bigatti, R ., Araya, D., Herrero, E., Mancini, S., Cabrera, P. 2,001th. Ovine Echinococcus granulosus transmission dynamics in the provinces of Rio Negro, Argentina, 1980-1999. Vet. Parasitol. 98:263-272

Larrieu, E., Del Carpio, M., Costa, M., Yadon, Z. 2002. Risks factors for hydatidosis in children of Rio Negro Province. A study of homes and control. Ann. Trop. Med. Parasitol. 96:43-52

Friden, B., Larrieu. E., Odrizola. M. 1999. Long term outcome of asymptomatic liver hydatidosis. J. Hepatol. 30:2 28-231

Larrieu, E., Friden, B., Salvitti, J., Mercapide, C., Del Carpio, M., Costa, M., Odriozola, M., Perez, A., Sustercis, J. 2000b asymptomatic carriers of Hydatid disease: epidemiology, diagnosis and Treatment. Rev. Panam. Public Health 79: 250-256

Larrieu, E., Frider, B. 2001b. Human cystic echinococcosis: Contributions to the natural history of the disease. Ann. Trop. Med Parasitol. 7:679-687

Larrieu, E., Del Carpio, M., Salvitti, J., Mercapide, C., Panomarenko, J., Costa, M., Cantoni, G., Odriozola, M. 2003. Diagnosis and treatment of human hydatid disease in schoolchildren. Preliminary report. Rev. Arg Pediat. 100:448-455

Larrieu, E., Del Carpio, M., Salvitti, J., Mercapide, C., Sustersic, J., Panomarenko, J., Costa, M., Bigatti, R., Labanchi, J., Smith, E., Cantoni, G., Perez, A., Odriozola, M. 2004. Ultrasonographic Medical Treatment and diagnosis of human cystic echinococcosis in Asymptomatic carriers school age: 5 years of follow-up. Acta Tropica 91: 5-13

Dr. Edmundo Larrieu (The Boss), giving the opening talk.

Final exam.

Dr. Carlos Salvitti (Bariloche) expounding on Pulmonary hydatidosis

Studying in the service station

Jacobacci

Ultrasound Practice

Station Engineer Jacobacci

Dr. Mario del Carpio (Eng Jacobacci)

Dr. Marcelo Riera (San Luis) by ultrasound

Practice normal ultrasound

Vet. Guillermo Mujica (Eng Jacobacci)

Drs Edmundo Larrieu (Viedma), Marcelo Riera (San Luis), Leonardo Uchiumi (Viedma)

Drs Carlos Mercapide and Leonardo Kiichi "Uchiumi (Viedma),

Carlos Salvitti (Barilcohe), Mario del Carpio (Eng Jacobacci)

Cadastre ultrasound in schoolchildren

In the "waiting room" for the land registry scans

hydatid index continues to fall at Black River
Cases down although there is growing dogs.

Jacobacci ENGINEER (AJ) .- The rate hydatid in the province continues to fall despite the overpopulation of dogs, a problem that affects most urban centers around the country.
This was stated by the highest regard Control Program Hydatidosis that is implemented in the province since 1984, under the Ninth Course of Epidemiology, Diagnosis and Treatment of Hydatid that developed last week in this city, which also assessed the progress of the program.
The training was provided for general medical students, doctors and hospitals in the province of San Luis, veterinarians and professionals involved in rural work in order to transmit the new strategies developed Black River through the medical staff of hospitals Viedma, rock, Bariloche and Jacobacci to combat this disease.
regard to the progress of the program, the veterinarian Edmundo Larrieu, responsible Environmental Health of the province, said there was a critical finding that, although it is a rural disease, with the urbanization of the country people began to detect some cases in children in the towns. He explained that this year
detected Jacobacci some cases, in 2007 and in 2006 Comallo Ñorquinco. They deal with an overpopulation of dogs is a national problem.
"hydatidosis index fell to a new level endemic. Today detected between 3 and 5 children per year and most are treated with drugs," he said.

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Treatment of hepatic hydatidosis with albendazole - Case Report "(Pictures)

Patient
(NLQ): asymptomatic, 7 year old girl, 29 kg. weight. Scheduled ultrasound detected Cadastre in the town of Ramos Mexia (río Negro Southern Line) in January 2007.

We do not have the first image of the liver hydatid cyst (conducted during the land), it was a HCL 5.5 cm in diameter -Gharbi Type I-. 10/01/2007
The following laboratory studies (20% eosinophils) and normal chest radiograph, began chemotherapy with albendazole (ABZ) (15mg/kg/día): One tablet of 400 mg per day (Made in Public Health PROZOME Black River) for three months with a rest period of 15 days upon completion of the first and second month of treatment. Controls were run according to rules governing the province.

This first ultrasound dated 02/09/2007 (one month after starting therapy with ABZ) shows an HCL paravesicular of 52.6 mm in diameter with detachment of the germinative membrane without altering the content (Gharbi type II).

Gharbi type II (detail)

Gharbi Type II (09-02-2007)

Gharbi type II (detail)

Gharbi type II (12/03/2007)

The clinical and laboratory upon completion of the second month of treatment was detected gastric intolerance (epigastric pain) and a decrease of eosinophilia to 2% of the formula. Ranitidine 300mg/day was associated to ABZ.

The ultrasound image is seen: a total membrane folding germination no changes in the density of the liquid.

Gharbi type II (detail)

Gharbi type II to IV (30/04/2007)

asymptomatic patient who continues to start the third month of chemotherapy (30 - 2004-2007). In the ultrasound image can be observed: dissolution of the germinative membrane and marked changes in the density of the liquid contents (Gharbhi positive development of a Type II to Type IV).

Gharbi type II to IV (detail)

Gharbi type IV (04/06/2007)

ABZ treatment ended, he continued asymptomatic and unaltered the laboratory results.

Gharbi type IV (detail)

Gharbi type IV (07/12/2007)

Gharbi type IV (detail)

Gharbi type IV (12-07-2007)

Gharbi type IV (detail)

Gharbi Tipo IV (01-11-2007)

Control ecográfico a los 10 meses de iniciado el tratamiento: presenta imágen del QHH deformada y disminuida de tamaño (42,6 mm diametro mayor); con contenido densidad heterogenea.

Gharbi Tipo IV (detalle)

Gharbi Tipo IV -42,6 mm diámetro- (detalle)

Gharbi Tipo IV (11-07-2008)

Imágen del control ecográfico realizado a los 18 meses de iniciado the treatment: almost homogeneous density, semi-and reduced upper diameter (37 mm).

Gharbi type IV (detail)

Gharbi type IV (11/07/2008)

Gharbi type IV ( detail)
Last

control (11-07-2008) , remains without symptoms and without changes in laboratory results. The follow-up ultrasound studies were performed with abdominal and chest X-ray every 6 months to age 3 starting treatment.