Short notesseparation of the aponeuroses occurs within the first few days. This is a question yet to be answered. References 1. 2.Ellis H, Gajraj H , George CD. Recurrence is one of the most significant postoperative complications following surgery in man for Echinococcus granulosus, occurring in approximately 10 per cent of patients'. When recurrence occurs, further surgery is associated with increasing morbidity and mortality'. It has previously been reported that a short course of oral albendazole after spillage of viable protoscolices can significantly reduce the risks of cyst development in a gerbil model3 and that the timing of albendazole prophylaxis to spillage was of great importance4: it was ineffective when given 15 days later. The isoquinoline praziquantel has been found to be a more effective scolicidal agent in in uitro cultures of E. granulosus4. We have previously shown that combinations of albendazole and praziquantel are more effective than either agent alone in in uitro culture5. In this paper we study in uivo results in an animal model of peritoneal spillage. Materials and methodsThirty-nine gerbils were each injected intraperitoneally with approximately 4000 viable protoscolices obtained from viable ovine cysts of E. granulosus. The gerbils were divided into a control and three treatment groups: ten received a I-month course of albendazole (50mgkg-' day-'), ten received a 1-month course of praziquantel (500 mg kg-day-') and ten gerbils received I month of a combination of praziquantel (500mg kg-lday-') and albendazole (50mg kg-' day-'). All drugs were given by once daily gavage starting within 24 h of intraperitoneal infection. The remaining nine animals became the infected untreated controls. Eight months after inoculation, the gerbils were killed. The number of cysts in each animal in each group was measured at necropsy. The Mann-Whitney U test was used.

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SUMMARY The efficacy of albendazole (50 mg/kg/d), mebendazole (50 mg/kg/d) and praziquantel (500 mg/kg/d) against established intraperitoneal infections of Echinococcus multilocularis in gerbils was compared by monitoring parasite weight and making ultrastructural observations on treated and untreated material. Praziquantel was the most active protoscolicidal agent, reducing protoscolex viability to <2%, although it did not inhibit cyst growth. Albendazole was the most effective agent in reducing cyst growth and was, when compared with other regimes significantly more effective than mebendazole (p<005), praziquantel (p<001) or untreated controls (p<001).

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The minimum effective concentration of praziquantel against protoscoleces of Echinococcus granulosus (ovine strain) was determined in vitro; 20 micrograms/litre gave statistically significant results. No difference was seen between the sensitivity of ovine and equine protoscoleces at 50 micrograms/litre. Morphological observations on treated protocsoleces and passage into gerbils both suggested that the eosin-exclusion technique overestimates viability. Electron microscopy of treated protoscoleces showed severe, disruptive tegumentary damage. Praziquantel is thus an extremely active protoscolicidal agent that may have an important peri-operative role in preventing recurrence.