A combined medical and surgical approach to hydatid disease: 12 years' experience at the Hospital for Tropical Diseases, London.
BACKGROUND
There is no consensus as to the most appropriate treatment for the varied and often complicated presentations of hydatid disease in Britain. We looked at our own results over a 12-year period to see if a consistent and logical plan had emerged.


METHODS
70 patients presenting between 1986 and 1998 were analysed retrospectively, with regard to their presentation, diagnosis, treatment and outcome, with particular reference to the use of chemotherapy, and to the difficulties of post-treatment assessment by serology and imaging.


RESULTS
37 patients had been treated previously. 35 had hepatic cysts and 26 multiple cysts. 4 patients were treated by surgery alone, 44 by chemotherapy and surgery, and 14 by chemotherapy alone. The combined use of albendazole and praziquantel pre-operatively reduced significantly the number of cysts that contained viable protoscolices: 1/25 versus 5/8 that received albendazole alone (P = 0.00013). During the 12-year period, it became our policy to aim for 3 months drug treatment (albendazole throughout with praziquantel for 2 weeks), re-assess and proceed either to surgery or to continue with chemotherapy.


CONCLUSIONS
It is possible to construct an algorithm for the management of patients with hydatid disease by chemotherapy and surgery, but the assessment of results by indirect techniques remains difficult.
Ayles
H M
HM
Hospital For Tropical Diseases, Mortimer Market Centre, London, UK.
Corbett
E L
EL
Taylor
I
I
Cowie
A G A
AG
Bligh
J
J
Walmsley
K
K
Bryceson
A D M
AD
D000293:Adolescent; D000328:Adult; D000368:Aged; D015766:Albendazole / Q000627:therapeutic use*; D000871:Anthelmintics / Q000627:therapeutic use*; D000923:Anticestodal Agents / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004443:Echinococcosis / Q000188:drug therapy* / Q000601:surgery*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011223:Praziquantel / Q000627:therapeutic use*; D011300:Preoperative Care / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D000871:Anthelmintics; D000923:Anticestodal Agents; D011223:Praziquantel; D015766:Albendazole