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Background: Hydatid liver cysts are rare in North America. The objective of this study was to determine the optimal surgical management for hydatid liver cysts treated outside endemic areas., Methods: We reviewed the cases of consecutive patients who underwent management of hydatid liver cysts. Radical liver resections were compared with other types of procedures. Clinical presentation, investigations, perioperative outcomes and longterm follow-up were evaluated. We evaluated disease recurrence using the Kaplan- Meier method., Results: Forty patients underwent surgery for hydatid liver cysts. Most patients had single (68%) right-sided (46%) cysts with a median size of 10 cm. Most (83%) underwent liver resection with or without drainage/marsupialization. Radical liver resection was carried out in 60% (19 major, 5 minor). Additional procedures were required in 50% (biliary fistulization 30%, diaphragmatic fistulization 20% or paracaval location/ fusion 8%). Postoperative complications occurred in 48%. The median follow-up was 39 months. The 3-year recurrence-free survival was significantly different between patients who had radical resection and those who had other procedures (100% v. 71%, p = 0.002)., Conclusion: The surgical management of hydatid liver cysts in North America remains rare and challenging and is frequently associated with fistulizing complications. Excellent long-term outcomes are best achieved using principles of radical liver resection that are familiar to North American surgeons.

Objectives: This paper presents the exposure assessment and job-exposure matrix (JEM) used to estimate coal tar pitch volatile (CTPV) exposure for a study of mortality and cancer incidence in aluminum smelter workers in Quebec, Canada., Methods: Historical CTPV exposure was assessed by estimating benzene-soluble material (BSM) and benzo[a]pyrene (B[a]P) levels for combinations of job and time period. Estimates were derived by using several procedures including averaging measurement data, a deterministic mathematical model using process-related correction factors, and expert-based extrapolation., Results: The JEM comprised 28,910 jobs, covering 7 facilities from 1916 to 1999. Estimated exposures ranged from 0.01 microg/m(3) to 68.08 microg/m(3) (B[a]P) and 0.01 mg/m(3) to 3.64 mg/m(3) (BSM) and were lowest before 1940 and after 1980., Conclusion: This methodology constitutes an improvement compared with methods used for previous studies of the Quebec cohort.