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    • br Comments The prevalence of LUTS in the general population

    2018-11-02


    Comments The prevalence of LUTS in the general population is related to age. Health care-seeking behavior is influenced by age-related factors and symptom severity, particularly if they are bothersome. The disease progression of BPH may be associated with a higher IPSS, lower Qmax, increased PVR, and enlarged PV. BPH is associated with a deteriorated clinical or symptomatic natural progression. Thus, early treatment may benefit patients with bothersome symptoms.
    Introduction Hydatid disease usually presents in adults (19–64 years) and is relatively uncommon in children. It is characterized by cystic lesions occurring in different parts of the body, most commonly the liver (70%) and lungs (20%). Unusual sites of involvement include muscle (5%), bones (3%), kidneys (2%), heart (1%), pancreas (1%), central nervous system (1%), and spleen (1%). The peritoneal cavity, thyroid, breast, gallbladder, thigh, supraclavicular region, soft tissue of the face, pericardium, diaphragm, mediastinum and pleural cavity are rarely involved. In about 5–13% of cases, two organs are affected simultaneously. No site in the body is completely immune from it, except for the hair, nails, and teeth. Although hydatid cyst is uncommon in the pediatric age group, there have been isolated cases of unusual or atypical presentations reported in the literature, particularly from the Mediterranean region and North Africa. Here, we present a series of pediatric cases with usual and unusual presentations from India in an effort to raise awareness among surgeons of this entity in children.
    Methods
    Results The results of the study are shown in Tables 1 and 2. There were 18 cases of hydatid disease in children, whose mean age was 11.2 years (range, 7–16 years). The male to female ratio was 8:1 (16 boys, 2 girls). All patients were from a rural background or a farming apigenin and of low socioeconomic status. Cattle rearing was common to the household of all the patients. Nine (50%) patients had isolated involvement of the liver: seven (38.9%) had cyst(s) smaller than 10 cm in diameter and two (11.1%) had isolated giant hydatid cyst (>10 cm in diameter) of the liver. Three (16.7%) patients had isolated primary involvement of the lung. Two (11.1%) patients had multiple cysts with involvement of the lungs and liver (Figs. 1–5). Four (22.2%) patients had hydatid disease with unusual presentation: primary hydatid cyst of the spleen (Fig. 6) in three (16.7%) and primary hydatid cyst of the brain (Fig. 7) in one (5.6%). All of the patients were managed surgically. Pericystectomy, capitonnage and omentopexy were performed for those who had hydatid liver disease. Posterolateral thoracotomy and cyst excision were carried out for those with hydatid lung disease. All patients with splenic hydatid disease underwent splenectomy (Fig. 6). Left frontotemporal craniotomy was performed for removal of intracranial hydatid cyst (Fig. 7). The details of the procedures undertaken for multiple hydatid cysts in patients with involvement of both lobes of the liver and bilateral lung disease are summarized in Table 3. All were given albendazole, corticosteroids and antihistamines perioperatively. Albendazole was continued postoperatively for 6 weeks. Histopathologic examination confirmed hydatid cyst in all (100%) patients (Fig. 8). There was no recurrence in our series, owing to the preoperative planning and meticulous perioperative precautions to prevent spillage.
    Discussion Hydatid disease has been known since the time of Hippocrates. It is endemic in areas with tropical or subtropical climates, particularly in cattle-grazing areas where the sheep–dog cycle is dominant. Most cases have been seen in the Mediterranean region, North Africa, Middle East, Australia, South America and Indian subcontinent. It has an annual incidence of 0.03–1.2 per 100,000 inhabitants in the northern hemisphere. The close association of people with sheep and dogs, compounded with non-availability of clean potable water supplies make the disease endemic to the rural areas of the Indian subcontinent.