Observed or Predicted Albendazole Hepatotoxicity as an Indication for a Resection Procedure in Hepatic Hydatid Disease - A Short Series of Cases

Asenov, Yavor; Akın, Melih; İbiş, Cem; Tekant, Yaman; Özden, İlgin

doi:10.21614/chirurgia.114.4.524

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…Albendazole is the preferred medical intervention for treatment of hydatid disease, though duration of therapy and efficacy is variable 12 13 18. In keeping with our case, elevation of hepatic enzymes is commonly reported after prolonged exposure to albendazole 8. This usually improves on discontinuation of administration, though there are case reports of severe hepatitis and fulminant liver failure 8 19–24.…”

Section: Discussionsupporting

confidence: 80%

“…In keeping with our case, elevation of hepatic enzymes is commonly reported after prolonged exposure to albendazole 8. This usually improves on discontinuation of administration, though there are case reports of severe hepatitis and fulminant liver failure 8 19–24. Given the limited treatment options, such reactions can significantly impact the decision-making around best practice for hydatid disease.…”

Section: Discussionsupporting

confidence: 76%

“…Albendazole is the mainstay of medical therapy, though treatment options include surgery (open or laparoscopic), and ultrasound-guided percutaneous drainage. Surgery is preferred in management of symptomatic illness as it has demonstrated the lowest incidence of recurrence, and medical management requires prolonged treatment and is only curative in approximately 30%–60% of cases 8–10. Adjunct albendazole is recommended for surgical or percutaneous drainage.…”

Section: Introductionmentioning

confidence: 99%

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Hydatid disease, hepatic injury and hypertonic saline: a clinical conundrum

Lane

Wright

2021

BMJ Case Rep

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Echinococcosis or human hydatid disease is a helminthic infection is caused by Echinococcus species. Classically, cystic echinococcosis is caused by Echinococcus granulosus sensu stricto, E. equinus, E. ortleppi and E. canadensis, though several other species have been implicated in hydatid disease. Echinococcus infection may lead to cystic disease of the liver, lungs and potentially other organs. Here we present a patient who had cystic disease of the lungs and liver. The patient initially experienced right upper quadrant pain and nausea, and later went on to develop a fever, cough and dyspnoea in the setting of hydropneumothorax. CT scan of the chest and abdomen revealed a large fluid collection at the left lung base and a large lobular complex fluid mass within the right lobe of the liver. Echinococcus titres were positive. The patient was commenced on albendazole; however, experienced significant derangement of liver enzymes within the following month. In light of this, the albendazole was ceased, and a hemi-hepatectomy was performed. During the hemi-hepatectomy there was some cyst content spillage, and subsequently a washout with hypertonic saline 3% was performed. This was followed by a course of praziquantel 1200 mg two times per day for 14 days. Repeat CT 6 months later demonstrated no evidence of recurrence.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

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Hydatid disease, hepatic injury and hypertonic saline: a clinical conundrum

Lane

Wright

2021

BMJ Case Rep

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“…The role of medical treatment before and after surgery for AE is essential. At present, drug treatment of echinococcosis mainly relies on ABZ, but the application of ABZ in the treatment of some patients is limited due to the need for long-term use, the selection of a single drug and other shortcomings [26,27]. For these reasons, the search for safer and more effective anti-echinococcosis drugs has been the focus of research.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Allicin Against Alveolar Echinococcosis In Vitro and in a Mouse Model

et al. 2021

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Purpose At present, the chemotherapy for alveolar echinococcosis (AE) is mainly based on albendazole (ABZ). However, more than 20% of patients fail chemotherapy. Therefore, new and more effective treatments are urgently needed. Allicin has been reported to have antibacterial and antiparasitic effects. The objectives of the present study were to investigate the in vivo and in vitro efficacy of allicin against Echinococcus multilocularis (E. multilocularis). Methods The effects of allicin on protoscolex survival and structural changes were evaluated in vitro. The 4-week-old BALB/c male mice used for in vivo modelling underwent inoculation of E. multilocularis protoscoleces by intraperitoneal injection, followed by intragastric administration of allicin for 6 weeks. Then, the effects of allicin on lymphocyte subsets, metacestode growth and host tissue matrix metalloproteinase 2 (MMP2)/MMP9 expression around metacestodes in mice were evaluated. The toxicity of allicin was further evaluated in vivo and in vitro. Results Att 40 μg/mL, allicin showed a killing effect on protoscoleces in vitro and treatment resulted in the destruction of protoscolex structure. Molecular docking showed that allicin could form hydrogen bonds with E. multilocularis cysteine enzymes. After 6 weeks of in vivo allicin treatment, the spleen index of mice was increased and the weight of metacestodes was reduced. Allicin increased the proportion of CD4+ T cells and decreased the proportion of CD8+ T cells in the peripheral blood and spleen. Pathological analysis of the metacestodes showed structural disruption of the germinal and laminated layers after allicin treatment. In addition, allicin inhibited the expression of MMP2 and MMP9 in metacestode-surrounding host tissues. At 160 μg/mL, allicin had no significant toxicity to normal hepatocytes but could inhibit hepatoma cell proliferation. At 30 mg/kg, allicin had no significant hepatorenal toxicity in vivo. Conclusion These results suggest that allicin exerts anti-E. multilocularis effects in vitro and in vivo and can enhance immune function in mice, with the potential to be developed as a lead compound against echinococcosis.

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“…Bu yöntemlerin avantajları geride kavite kalmaması, ameliyat sonrasında medikal tedavi gereksinimini ortadan kaldırması ve nüks riskinin düşük olmasıdır. Dezavantajları ise uygulanan cerrahinin daha karmaşık, uzun ve riskli olması ve rezeksiyonun karaciğer parenkim kaybı yaratmasıdır (5,10,11).…”

Section: Introductionunclassified

Karaci̇ğer Ki̇st Hi̇dati̇ği̇nde Peri̇ki̇stektomi̇: Tek Merkez Deneyi̇mi̇mi̇z

Serin¹,

İbiş²,

Tekant³

et al. 2020

J Istanb Fac Med

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Karaciğer kist hidatiğinde total perikistektomi uygulanan hastaların sonuçlarını irdelemek. Gereç ve Yöntem: 1999-2019 yılları arasında yatırılarak tedavi edilmiş hastaların verileri incelenerek, total perikistektomi yapılan hastalar çalışmaya dahil edilmiştir. Bulgular: Toplam 308 hastanın 32'sinde (17 kadın, 15 erkek, ortanca yaş 44 (17-73)) perikistektomi yapıldığı saptandı. Perikistektomi endikasyonları, ulaşımı kolay anatomik yerleşim (20), albendazol toksisitesi (4), albendazole cevapsız kist (4), kistik tümör kuşkusu (2), hamilelik (1) ve albendazol kullanımına uyumsuzluktu (1). Ortanca kist boyutu 75 mm (42-100), ortanca kist sayısı 1 (1-8) saptanırken, 14 hastada birden fazla kist vardı. Yirmi üç hastaya sadece total perikistektomi uygulanırken 9 hastada mevcut ek kistlere de drenaj uygulandı. Sadece perikistektomi uygulanan 23 hastadan 18'ine kapalı, 5'ine açık perikistektomi yapıldı. Perikistektomi sırasında 10 hastada ortanca 36 dk (12-78) Pringle klampajı uygulandı. Ortanca yatış süresi 6 gündü (1-60). Üç hastada düşük debili (<150 cc/gün) safra fistülü, 2 hastada karın içi enfeksiyon, 2 hastada da yüzeyel yara yeri enfeksiyonu gelişti. Sadece total perikistektomi yapılan ve ortanca 62 ay (14-236) takip edilen 20 hastanın hiçbirisinde nüks gözlenmedi. Sonuç: Perikistektomi, deneyimli merkezde, seçilmiş hastalarda düşük morbidite ve mortalite ile uygulanmaktadır. Nüks riskinin de düşük olduğu gösterilmiştir.

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Observed or Predicted Albendazole Hepatotoxicity as an Indication for a Resection Procedure in Hepatic Hydatid Disease - A Short Series of Cases

Cited by 6 publications

References 24 publications

Hydatid disease, hepatic injury and hypertonic saline: a clinical conundrum

Hydatid disease, hepatic injury and hypertonic saline: a clinical conundrum

Evaluation of Allicin Against Alveolar Echinococcosis In Vitro and in a Mouse Model

Karaci̇ğer Ki̇st Hi̇dati̇ği̇nde Peri̇ki̇stektomi̇: Tek Merkez Deneyi̇mi̇mi̇z

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