Coma and haemolysis after cetrimide washout of epidural hydatid cyst

Cetrimide-chlorhexidine-induced multiorgan failure in surgery of pulmonary hydatid cyst

Savlon (0.5% cetrimide/0.05% chlorhexidine) is used as a scolicidal during surgery of hydatid cysts. It is considered a safe and effective agent. However, there are no recommendations for the appropriate concentration or dosage of these agents. Previously reported to cause severe metabolic acidosis, its effects on the pulmonary system have not been explored. We present a case of acute lung injury and respiratory distress along with acute cardiopulmonary distress, severe metabolic acidosis, and renal failure following its use during surgical removal of pulmonary hydatid cyst. The agent may act as a chemical sclerosant causing pulmonary parenchymal damage through bronchial openings present in the pericyst. Till safe dose limits are known, use of this agent should be limited, especially in large or multiple cyst surgery.

Spinal cystic echinococcosis--a systematic analysis and review of the literature: part 2. Treatment, follow-up and outcome

Bone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques, surgical treatment and introduction of pharmacological therapy, spinal echinococcosis remains associated with a high degree of morbidity, disability and mortality. We systematically reviewed the published literature of the last five decades to update and summarize the currently existing data on treatment, follow-up and outcome of spinal CE.

Efficacy of chlorhexidine gluconate during surgery for hydatid cyst

BACKGROUND

Dissemination of protoscolices-rich fluid during surgery for hydatid cyst disease is a major cause of recurrence. Instillation of a scolicidal agent into a hepatic hydatid cyst before opening is the most commonly employed measure to prevent this serious complication. In this clinical study, the efficacy of 0.04% chlorhexidine gluconate (Chx-Glu) during hydatid cyst surgery was tested, and early-term results were evaluated.

METHODS

A total of 30 consecutive patients with 45 liver cysts were studied. Only type I and type II cysts were included. Cysts were punctured, and fluid was aspirated. The viability of protoscolices in this fluid was determined. Chx-Glu 0.04% was instilled into the cyst cavity. After 5 minutes of exposure, the cyst fluid was reaspirated and evaluated for the viability of protoscolices. Imprints of the germinative membranes were determined for protoscolices viability.

RESULTS

All protoscolices in 45 cysts evaluated were killed by 5 minutes of exposure to 0.04% Chx-Glu. The whole of the germinative membrane imprints contained dead protoscolices. Chx-Glu 0.04% did not cause any adverse effect on biliary tracts in communication with cysts. There was no recurrence during the 2-year follow-up period. There were also no mortality and no cavity-related complications.

CONCLUSIONS

This study shows that intracystic injection of 0.04% Chx-Glu is an effective measure against the dissemination of viable protoscolices. In addition, Chx-Glu is the most convenient scolicidal agent as per the criteria defined by the World Health Organization. Therefore, it can be used safely during hydatid cyst surgery. However, there remains the need to perform advanced comparative clinical studies on the efficacy of Chx-Glu and other scolicidal agents.