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Re: Echinococcal cyst in pregnancy From: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au) Tue Feb 28 21:31:43 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard Lisse: "Re: Fundal Pressure" Previous message: RModugno@aol.com: "Re: Gyn:  Our friends, the ureters" Maybe in reply to: Elrod, Darryl G MAJ 48 MDOS/SGOBO: "Echinococcal cyst in pregnancy" OK, if you insist. We used Mebendazole for helminth infestations in pregnant women, but were not using it for echinococcus which I didn't see in South Africa. The single dose therapy for parasites in the gut was effective and safe. However, it is a different matter when you are talking about a ruptured hydatid cyst. She is at huge risk for generalised echinococcosis and a long lingering death now that the damn thing has ruptured. Therefore on the grounds that the benefits outweigh the risk I would start her on treatment pronto and keep it going for as long as the experts feel necessary - which, from the literature appears to be at least two years. I don't think there is any real cause for concern about the possibility of fetal malformations anyway now that she is in the second trimester. Incidentally, the surgical advice I remember from New Zealand, where it was a fairly prevalent disease, was to avoid rupturing the cyst by excising a large surrounding volume of tissue' as preventing local contamination was highly important. Not having excised it intact could be a very regrettable event. Steve -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod, Darryl G MAJ 48 MDOS/SGOBO Sent: Wednesday, 1 March 2006 9:26 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Echinococcal cyst in pregnancy I bet they will too. In fact, I'm counting on it! Nothing like having some faith that this won't be the time that the drug causes some anomaly. Obviously, the literature won't have much more than anecdotal stories of pregnant women being treated. Glen //SIGNED// D. Glen Elrod, Maj., USAF, MC -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art fougner, md Sent: Tuesday, February 28, 2006 6:51 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Echinococcal cyst in pregnancy No personal experience but I did find this: * Antiparasitic chemotherapy o The basic medical treatment is chemotherapy with benzimidazoles (eg, mebendazole, albendazole) at high doses. o According to the 1996 WHO Informal Working Group on Echinococcosis, long-term chemotherapy (for several years, possibly for life) is mandatory in inoperable patients. The decision to withdraw treatment is particularly difficult without objective and irrefutable proof of definitive cure. o Complementary chemotherapy is mandatory for at least 2 years following surgery. Careful follow-up examinations in these patients must continue for at least 10 years. In all cases of palliative operations, either surgical or ultrasonographically guided, chemotherapy is mandatory and follows the same therapeutic schedule as for patients who have not had operations. o Administer chemotherapy for at least 2 years after radical liver transplantation and for life in patients who demonstrate evidence of parasitic remnants in the liver area and/or of distant metastases outside the liver. http://www.emedicine.com/med/topic326.htm I'll bet Steve or el will be able to weigh in on clinical experience. Art At Tue, 28 Feb 2006, Elrod, Darryl G MAJ 48 MDOS/SGOBO wrote: > >Group, > >We have just had a 26 yo G2P1 at 19 wks present with diffuse abdominal >pain, vomiting, WBC count of 17K. Her workup included abdominal >ultrasound that showed a 12 cm liver cyst, c/w echinococcal cyst. CT >scan the next morning (today) showed probable rupture of this cyst with >an increased amount of free fluid. > >Because her temperature increased to 101, her WBC count increased to 19K >and the findings of the CT scan, the general surgeons decided to operate >and drain the cyst. > >At surgery, there was free fluid noted. The cyst was indeed ruptured >through a small hole. 150ml of clear fluid was removed from the cyst. >The cyst was opened and a large amount of white opaque gelatinous tissue >was removed. There were also noted some typical echinococcal cysts. > >My question for the group is more a question of management for the >remainder of the pregnancy. Treatment options appear to be mebendazole >or albendazole for 3-6 months. Both of these are listed as Category C >drugs and Reprotox shows possibly some benefit of mebendazole over >albendazole, but mostly for first trimester exposure. > >Has anyone continued drug therapy for this long or have experience at >all with treating this? > >Thanks, > >Glen > >//SIGNED// > >D. Glen Elrod, Maj., USAF, MC > -- art fougner, md Support Free Speech Buy Danish! Next message: Dr Eberhard Lisse: "Re: Fundal Pressure" Previous message: RModugno@aol.com: "Re: Gyn:  Our friends, the ureters" Maybe in reply to: Elrod, Darryl G MAJ 48 MDOS/SGOBO: "Echinococcal cyst in pregnancy"

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