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Optimal duration of preoperative anti‐helminthic therapy for pulmonary hydatid surgery
Author(s) -
Koul Parvaiz A.,
Singh Anurag Ambroze,
Ahanger Abdul G.,
Wahid Abdul,
Sofi Bashir A.
Publication year - 2010
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.05089.x
Subject(s) - medicine , albendazole , praziquantel , chemotherapy , surgery , gastroenterology , helminths , schistosomiasis , immunology
Background: The optimal duration of preoperative anti‐helminths for prevention of recurrences in pulmonary hydatidosis is unclear, although 1–3 weeks of therapy is routinely used. Methods: Forty‐five patients of pulmonary hydatid disease were randomly assigned into four groups to receive either 0, 2, 4 or 8 weeks of preoperative albendazole (ABZ) and praziquantel (PZQ). Viability of the scolices in the fluid harvested at surgery (methylene blue staining) and ability to produce peritoneal hydatids in mice (intra‐peritoneal inoculation) were compared in different groups. Results: The percentage viability of the scolices as a whole was significantly ( P < 0.001) lower in the treated cysts ( n = 36, mean 43.5 ± 35.69) compared with the untreated cysts ( n = 8, mean 94.75 ± 7.21). The viability progressively decreased with increasing durations of chemotherapy ( P < 0.001). Mean percentage viability of scolices was 88.72 ± 4.91% in patients treated for 2 weeks ( n = 12), 38.09 ± 9.10% after 4 weeks ( n = 11) and 8.1 ± 9.23% after 8 weeks ( n = 14). Intra‐peritoneal mice inoculation was positive in 90% of the cysts that received therapy for 2 weeks or less and none of the patients who received therapy for 8 weeks had a positive inoculation. Conclusions: Preoperative combination therapy with ABZ and PZQ effects a scolicidal response which increases with the increasing duration of the preoperative chemotherapy, and a 4‐week course of the combination chemotherapeutic agents seems to be the minimum required duration for ensuring scolicidal activity enough to prevent spillage‐induced recurrences following pulmonary hydatidosis.