The Relationship Between Preoperative Systemic Immune Inflammation Index and Prognostic Nutritional Index and the Prognosis of Patients With Alveolar Hydatid Disease

BackgroundTo explore the relationship between the preoperative immune inflammation index (SII) and the prognostic nutritional index (PNI) and the overall survival rate (OS) of patients with alveolar hydatid disease.MethodsThe clinical data of patients with hepatic alveolar echinococcosis treated by surgery in the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qinghai University from January 2015 to January 2019 were analyzed retrospectively, and the SII, PNI, PLR and NLR were calculated. Spearman correlation analysis was utilized to analyze the correlation among SII, PNI, PLR and NLR. Receiver operating characteristic curve (ROC) was utilized to determine the best intercept values of SII, PNI, PLR and NLR, and Chi-square test was used to evaluate the relationship between SII, PNI and various clinicopathological features in patients with hepatic alveolar echinococcosis. The kaplan-Meier method was used to draw survival curves and analyze the relationship between them and the total survival time of patients. A cox regression model was used to analyze the relationship between SII, PNI and the prognosis of patients with hepatic alveolar echinococcosis. Finally, ROC curve was used to estimate the predictive efficacy of SII, PNI and COSII-PNI for the prognosis of patients with hepatic alveolar echinococcosis.ResultsA total of 242 patients were included, including 96 males and 146 females, aged 11.0-67.0 (36.6 ± 11.7) years. The values of SII, PNI, PLR and NLR are calculated, and the best truncation values of SII, PNI, PLR and NLR are given in ROC curve. The kaplan-Meier survival curve was used to analyze the relationship between SII, PNI, PLR, NLR and the overall survival time of patients with hepatic alveolar echinococcosis. The results showed that the median follow-up time was 45 months (95%CI: 39.484-50.516), and the average survival time was 49 months (95%CI: 47.300-51.931), which was low p<0.001); The 5-year OS rate of low PNI was significantly lower than that of high PNI group (37.7% vs 71.6%; p<0.001); The 5-year OS rate in low PLR group was significantly higher than that in high PLR group (70.4% vs 24.3%; p<0.001); The 5-year OS rate in low NLR group was significantly higher than that in high NLR group (67.2% vs 28.8%; p<0.001). Cox unifoliate analysis showed that SII, PNI, PLR and NLR were important prognostic factors related to OS. Cox multivariate analysis showed that SII(HR=4.678, 95% CI: 2.581-8.480, P<0.001) and PNI(HR=0.530, 95%CI: 0.305-0.920, P<0.05) were identified as independent risk indicators of OS, while NL was identified as independent risk indicators of OS ROC curve analysis showed that AUC of SII, PNI, PLR, NLR and COSII-PNI were 0.670(95%CI: 0.601-0.738), 0.638(95%CI: 0.561-0.716) and 0.618(95% CI: 0.541-0.694), respectively COSII-PNI is superior to SII and PNI in evaluating prognosis (P < 0.05).ConclusionsSII and PNI can be regarded as independent risk factors reflecting the prognosis of patients with hepatic alveolar echinococcosis. The lower SII and the higher PNI before operation, the better the prognosis of patients, and the combined application of SII and PNI before operation can improve the accuracy of prediction.

Primary Alveolar Hydatid Disease: A Rare Case Series with Review of Imaging Findings

Alveolar hydatid disease is a rare but potentially fatal parasitic infection caused by Echinococcus multilocularis. To the best of our knowledge, only few cases have been reported from India till date. We present 6 cases of pathologically proven alveolar hydatid disease with review of imaging findings. The objective of this case series was to share our experiences of pitfalls in diagnosis of alveolar hydatid disease. Materials and Methods. The study was conducted in Post Graduate Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar, Jammu and Kashmir. Our study was conducted between 6th January 2017 to 22nd May 2019. A total of 6 patients were taken up for study. The patients were evaluated clinically and investigated using the relevant imaging modalities. Diagnosis was confirmed by histopathologic examination following core biopsy of lesion. Results. There were two males and four females with most of patients in age group of 20 to 40 years. Imaging findings in our cases suggest that typical radiological appearance of alveolar hydatid disease can be summarized as an irregular hypoattenuating mass lesion having typical calcifications (can be peripheral, as well as central) with tiny cystic components.

Clinical profile, diagnostic challenge and management of alveolar hydatid disease: a prospective study

Background: Although a rare entity, alveolar hydatid disease is associated with significant morbidity. This disease presents a diagnostic challenge because of its low prevalence, unfamiliarity and nonspecific presentation. Aim: To look about the clinical profile, diagnosis and management of these patients.Methods: This prospective study was conducted in the department of surgery at SMHS (Shri Maharaja Harisingh) hospital. All patients with a diagnosis of alveolar hydatid disease of liver during this time period were enrolled in the study.Results: Eight patients in our study were females and 5 patients were males. The age ranged from 21 to 56 years with mean age of 42.07±8.88 years (SD =8.88). The most common presentation in our study was pain abdomen (38%). The most common finding on physical examination was hepatomegaly (30.76%). CT (computerized tomography) scan abdomen gave an impression of alveolar hydatid disease in 5 patients, a suspicion of malignancy in 3 patients and tuberculosis in one patient, and a possibility of liver abscess in one patient. Results of tru cut biopsy were suggestive of alveolar hydatid disease in 4 out of 6 patients. Twelve patients were operated on elective basis (liver radical resection in 8 patients, while “laparotomy and only tumor biopsy” in 4 unresectable patients) and one patient on emergency basis, and all were subjected to histopathological examination. ABZ (albendazole) was given orally at a dosage of 10-15 mg/kg per day.Conclusions: Alveolar hydatid is a rare disease with atypical (unfamiliar) and nonspecific clinical features and atypical radiological features. Also, the disease is associated with significant morbidity, hence a high index of suspicion is needed along with supplementary imaging studies for timely intervention to prevent further complications arising from the disease.

Bronchoscope saline injection method (ME Hejazi Method) in ruptured peripheral and central pulmonary hydatid cysts: a case series

Background<br />This paper mainly focuses on patients with ruptured pulmonary Echinococcus granulosus infections (alveolar hydatid disease), who suffered from ruptured alveolar hydatid cyst. In this study we aimed to remove these ruptured central and peripheral pulmonary hydatid cysts by the bronchoscopic saline injection method (ME Hejazi method). <br /><br />Case description<br />In this retrospective study, we evaluated eight patients from an endemic area who were non-surgically treated for ruptured pulmonary hydatid cysts at Imam Reza hospital between 2016-2017. By the bronchoscopic saline injection method (ME Hejazi method), we extracted the entire hydatid cysts of all patients by fiber optic bronchoscopy for the detachment of the underlying membrane from the cavity wall. There were three female and five male patients, with a mean age of 40 ± 23 years (range 17–63 years). Ruptured cysts were located in the peripheral (2) and central (6) parts of the lungs. All of our experiences have been successful without any complications and residual cyst membrane. During the follow-ups, clinical and radiological recovery were seen in these patients.<br /><br />Conclusions<br />In the peripheral ruptured hydatid cysts, accurate recognition and location of the cyst is essential and the blind approach is not recommended because it needs several bronchoscopic interventions. Therefore the Hejazi method will be a beneficial and suitable alternative method for surgery in the treatment of patients with ruptured pulmonary hydatid cyst with cyst membrane adhesions.