Ethyl Alcohol: Is it necessary in the P.A.I.R Technique?

Abstract

The study was carried out to evaluate the effect of 95% ethyl alcohol in the pair technique using sheep and goat modes. A total of 6 animals (4 sheep and 2 goats) were used in this study. The animals were randomly divided into two groups of 3 animals each (2 sheep and 1 goat). In the first group (test group), 7 cysts were punctured in vivo, cyst fluid drained and injected with 95% ethyl alcohol while the second group (controls) 9 cysts were only punctured and cysts fluid drained. The procedure was done under ultrasound guidance. The animals were then monitored for one month. Ultrasound showed that in both groups there was collapse of the endocysts after cyst puncture. One month later, the cysts showed decrease in size, increased echogenicity, and completed or partial detachment of the endcoyst. Post mortem examination showed that in 95% ethyl alcohol group (test group), the cysts were grossly degenerated with marked fibrosis of the surroundings liver tissue. Incision of the cysts revealed turbid yellow cystic fluid and degenerated endocysts. On microscopic examination of the cyst fluid, the protocols were dead, with detached hooks, in the puncture only group (control group), the cysts appeared grossly intact but flaccid. Incision of these cysts showed clear fluid with intact endcoysts. However, microscopic examination of the cyst fluid showed that the protocoleces were dead with detachments of hooks. A histopathological examination of the test group showed marked host cell reaction consisting of infiltration of the adventiatl layer with neutrophils, eosinophils, and plasma cells. In addition, the liver tissue was severely destroyed and replaced with you and disorganised fibroblasts and mesenchmal cess. In most necrotic areas, the laminate layer could not be collected together with adherent liver tissue and the adventiatil layer appeared completely degenerate and was replaced by acute inflammatory cells. In the control group, there was detachment of the laminate layer of the cyst from the adventitia. Additionally inflammatory cells were observed in the adventitia and the liver tissues. However, the degree of inflammation was markedly less than in the test group. Inflammatory cells were identified only in small parts of the liver tissues while most of the tissues were intact with hepatocytes being predominant in an organised appearance. The findings suggest that puncture alone may be sufficient to kill the protoscholeces, possibly due to detachment of the endocyst used; more studies need to be carried out to verify the necessity for using ethyl alcohol in PAIR techniques