PAIR vs Örmeci technique for the treatment of hydatid cyst

Abstract

Hydatid disease is caused by the larval stages of Echinococcus Granulosus. Most patients with hydatid disease have no symptoms, unless there is compression of vital organs such as the hepatic veins, portal vein, hepatic artery in the liver, bronchia in the lungs or the brain, resulting in life threatening complications like anaphylactic shock and sudden death. There are four treatment strategies for cystic echinococcosis (CE)-surgery, percutaneous methods, medical treatments and watch and wait strategies.Medical treatment with albendazol, mebendazole or prazyquentel may cure only 2/3 of patients with CE. More than 30% of patients will reoccur after stopping the treatment. Watch and wait strategy is followed for asymptomatic and small cysts or CE type IV and Type V cysts. Surgical treatments were the gold standard for treatment of CE until the last 30 years. Consequently, surgical methods decreased while percutaneous methods of treatment increased. Due to higher mortality, morbidity, recurrence rates, longer hospital stays and higher costs in comparison to percutaneous methods like PAIR and ÖRMECİ technique, surgical treatment must be limited for the complicated hydatid cyst. Both the PAIR and Örmeci techniques are safe and effective. However, the Örmeci technique offers a simpler, inexpensive method of treatment, with no mortality, lower morbidity, low recurrence rate, while being out patient based. It can be used as the first choice of treatment modality in patients with cysts type CE type one, CE type two, CE Type 3A and CE Type 3B. In this review, treatment modalities for CE, but mainly percutaneous treatment, will be discussed.

Polar‐Covalent Bonding Beyond the Zintl Picture in Intermetallic Rare‐Earth Germanides

“…[9,42,45] Similarly,p olar TÀBa bondingh as been previouslyr eportedi nc lathrates Ba 8 T 6 Ge 40 . [46] Whilst in all these compounds TÀR/Ba bonding was found to be indicated by corresponding ELI-D attractors in the valence region, in the actually investigated compounds the situation is no longers ou niform. The largest similarity to those previous works is found for Y 2 PdGe 6 ,w here PdÀYb onding is indicated by three ELI-D attractors between Pd and each of its Yn eighbours (Figure 6a).…”

Rare But Life-Threatening Complication of Hydatid Disease

“…Hydatid cysts have the potential to develop complications such as the formation of fistulae between cysts and biliary ducts, rupture of the cyst and leakage of its contents in the biliary ducts, fistulization of the cyst into the pleural or peritoneal spaces or into structures located within the thoracic cavity, abscess formation because of secondary infections at the cyst site, fistulization of the cyst to the skin or gastrointestinal tract, and sudden death (3,6). It is recommended that patients with such complications of hydatid disease should be treated by endoscopic or surgical methods.…”

“…Such a rupture results in obstructive jaundice and cholangitis. The latter can cause the development of life-threatening septicemia and hence should be immediately treated by endoscopic retrograde cholangiopancreatography (ERCP) (3,4).…”

Liver hydatid disease: Still a problem

“…PAIR indications, contraindications, morbidity and mortality are shown in Table 4. 26 Modified catheterization techniques are reserved for multivesicular HCs (types 2 and 3a) in an attempt to avoid surgery and its goal is to eliminate all endocyst and daughter vesicles using large-calibre catheters and cutting and aspiration tools. 9,24 The combination of PAIR and albendazole seems more effective than either of the two separately, 21 so albendazole should be administered 4 h before the puncture until a month after it or, if not available or contraindicated, mebendazole 4 h before until 3 months later.…”