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PubMed2001

[Popliteal cysts: sonography evaluation after arthroscopic treatment].

PURPOSE: To identify a set of sonomorphological parameters to evaluate the outcome of arthroscopic surgery for popliteal cysts by sonography. MATERIAL AND METHODS: We examined 30 patients (18 males, 12 females) before treatment and 3/6 months after arthroscopy. Patients were classified by clinical (4 groups) and sonographic criteria. The sonographic criteria were the morphological classification of the cysts (beak-shaped, X-shaped, grape-like, slit-shaped) and the volume measurement. RESULTS: Sonography identified beak-shaped popliteal cysts (the most frequent Baker cyst shape), 5 grape-like (the usual shape of complicated Baker cysts) and 1 X-shaped . The volume of cysts before treatment ranged from 5 to 38 cl. Most cysts were clinically rated as grade 2 (symptomatic and evident at physical examination, with a reduction of range of motion up to 20 degrees of flexion). No patient was rated as grade 0 (normal). After surgery the cyst was still evident at sonography. After 3 months we recorred a cyst volume decrease in all cases. Six months after surgery 29/30 cysts had a volume <5 cl with an almost virtual cavity that changed their appearance in to slit-shaped . In one case cyst volume increased. The clinical classification showed an increase of the grade 0 group unsymptomatic cysts (not detectable at physical examination). DISCUSSION AND CONCLUSIONS: Sonographic evaluation of popliteal cysts after arthroscopic surgical treatment allowed to recognize the cysts, which are not removed by this approach. The follow-up at 3 months showed a reduction in cyst volume. After six months, in the cases with a good surgical response, the cysts reached a volume <5 cl regardless of their original volume. The morphology of the cysts with a good surgical result, is slit-shaped with virtual cavity regardless of their original appearance. There is a high correlation between sonographic and clinical data. We believe that the volume reduction of the cyst three months after surgery is a good predictive element. After six months the preesence of a cyst with a volume <5 cl and a slit-shape with virtual cavity is a sign of good surgical result.

Arthroscopy↗
PubMed2003

Management of ovarian cysts in women undergoing restorative proctocolectomy for ulcerative colitis.

More than half of all patients undergoing restorative proctocolectomy (RP) for ulcerative colitis (UC) are women, yet there is a paucity of information regarding the frequency, management, and outcome of ovarian cysts. A single surgeon's (E.W.F.) experience with female patients (N = 165) who underwent RP for UC at an academic medical center was retrospectively evaluated for postoperative complications and overall outcome. Patients with large ovarian cysts (LOCs), defined as being greater than 5 cm in diameter, were further segregated for subanalysis. All results were analyzed using the Student's t test and Fisher's exact test. Patients were 29.3 +/- 13 years (mean) at the time of RP; 34 patients were less than 16 years old (21%), 113 patients (68%) were between the ages of 17 and 46 years, and 18 patients were over 46 years old (11%). All patients underwent total colectomy, mucosal proctectomy ileal pouch-anal anastomosis, and temporary end ileostomy. The ileostomy was closed 3 months later. Fifty-five of the 165 patients had ovarian cysts (33%) identified at operation, 46 had unilateral cysts, and nine had bilateral cysts. Mean ovarian cyst size was 4.6 +/- 2.7 cm (range <1-13 cm); 14 were LOCs. Patients with cysts <3 cm in diameter at operation were treated by observation with hormonal manipulation. Seventeen patients with cysts 3 to 5 cm in diameter required partial resection of one or both ovaries. Six of 14 patients with LOC underwent unilateral oophorectomy (cyst size range 10-13 cm). Twelve patients presented within 3 years after RP with malfunction of the pouch because of adhesions or minimal and uncontrolled passage of fecal material (soiling), partial obstruction due to LOC compression of the ileoanal pouch (n = 6), or adhesions. When evaluated on the basis of ovarian cyst size those without cysts and those with small cysts were significantly more likely to have children than those with LOC: 54 of 110 patients without cysts (49%), 18 of the 41 with cysts less than 5 cm in diameter (44%), and two of the 14 patients with LOC (14%) have had children (P = 0.047). Ovarian cysts are common in women undergoing RP for UC. Ovarian cysts often complicate postoperative intestinal function and are best treated by cyst resection or oophorectomy at the time of RP or ileostomy closure. Cysts under 3 cm in diameter may often be managed conservatively with few complications. Women with LOC after RP for UC have decreased fertility compared with those without cysts.

Colitis, Ulcerative↗
PubMedDate not supplied

Modified PAIR technique for percutaneous treatment of high-risk hydatid cysts.

PURPOSE: This paper presents a modification of the known method for percutaneous treatment of hydatid cyst, the PAIR technique. It aimed to achieve safe aspiration of large symptomatic cysts and cysts with a danger of impending rupture. METHODS: We designed a coaxial catheter system to achieve concomitant evacuation of cyst contents while infusing scolicidal agent. Hypertonic saline is used to wash out cyst contents and to kill protoscolices. This was followed by injection of a sclerosant (ethyl alcohol 95%) into the residual cyst cavity to prevent formation of a cyst collection after the procedure. Seventeen cysts in 14 patients were successfully aspirated. Follow-up plain radiographs, ultrasonography and CT were performed weekly in the first 4 weeks and then at 3, 6 and 12 months for all patients. Seven patients (9 drained cysts) were followed up for 2 years and 1 patient for 3 years. RESULTS: All cysts were successfully aspirated. The following morphologic changes were noticed: a gradual decrease in cyst size (17 cysts, 100%), thickening and irregularity of the cyst wall due to separation of endocyst from pericyst (7 cysts, 41%), development of a heterogeneous appearance of the cyst components (8 cysts, 47%) and development of pseudotumor (2 cysts, 12%). None of the treated cysts disappeared completely. No significant procedure-related complications were encountered. CONCLUSION: This modified PAIR technique is a reliable method for percutaneous treatment of risky and symptomatic hydatid cysts.

Anticestodal Agents↗
PubMed1989

Giardia cyst wall-specific carbohydrate: evidence for the presence of galactosamine.

Gas chromatographic (GC), mass spectrometric (MS), lectin binding and enzymatic analyses of the carbohydrates from Giardia cyst walls, intact cysts and trophozoites were performed to investigate the carbohydrate composition of Giardia cyst walls and to test the hypothesis that the Giardia cyst wall is composed largely of chitin. Galactosamine, verified by MS, was present in Giardia cyst walls and intact cysts (ca. 47 nmol 10(-6) cysts). Since not even trace amounts of it were detected in trophozoites by either GC or lectin binding, galactosamine is hypothesized to be a cyst wall-specific amino hexose. Based on the putative binding affinity of Phaseolus limensis lectin, galactosamine may be present in cyst walls as N-acetylgalactosamine. Neither glucosamine nor sialic acid were detected in as much as 11 mg dry weight of cysts, cyst walls, or trophozoites. Glucose, the most abundant carbohydrate, and ribose were detected in Giardia cysts and trophozoites. Galactose (ca. 10 nmol 10(-6) cysts) was detected in cysts but not in trophozoites. The lack of detectable levels of (1) glucosamine in cyst wall hydrolysates, (2) cyst staining by Calcofluor M2R, (3) endogenous chitinase activity and (4) N-acetylglucosamine when cysts served as a substrate for exogenous chitinase suggests that the Giardia cyst wall is not composed largely of chitin as previously reported. beta-N-Acetylgalactosaminidase, EC 3.2.1.32, activity was detected in cysts and trophozoites and represents the first carbohydrate splitting hydrolase detected in Giardia.

Animals↗
PubMed1998

Association of host cell intermediate filaments with Toxoplasma gondii cysts in murine astrocytes in vitro.

Toxoplasma gondii is an intracellular parasite that is a common opportunistic infection of AIDS patients where it causes a severe and often fatal encephalitis. Toxoplasmic encephalitis in AIDS patients results from a reactivation of the cyst stage of Toxoplasma gondii in the brain. A previous study found an association of host cell intermediate filaments with parasitophorous vacuoles and some studies have suggested the host cell cytoskeletal elements are incorporated into the cyst wall. In this study, the interaction of glial filaments with Toxoplasma gondii cysts was studied in cysts derived in vitro in mouse astrocytes and in cysts isolated from mouse brains. Glial filaments, detected by immunostaining of the glial fibrillary acidic protein, were found to accumulate around the perimeter of the cysts as they developed in mouse astrocytes. Transmission electron microscopy revealed a layer of glial filaments was wrapped around the cytoplasmic side of the cyst. The glial filaments were present in close apposition to the cyst wall and arranged around the cysts in a concentric layer, measuring 5-10 microns in thickness. The layer of glial filaments excluded host cell mitochondria and endoplasmic reticulum from the cytoplasmic surface of the cyst. Colocalisation of glial fibrillary acidic protein and the cyst wall via confocal and immunoelectron microscopy, confirmed that there was no glial fibrillary acidic protein present within the cyst wall. The cyst wall of cysts isolated from mouse brains were also found to be negative for glial fibrillary acidic protein. In conclusion, we found no evidence of structural integration of the host cell intermediate filaments in the cyst wall, but glial filaments were found to encase the cysts in the host cell during cyst development in host cells in vitro. The glial filaments wrapping of cysts may play a role in bradyzoite differentiation and/or cyst stabilisation in the host cell cytoplasm.

Animals↗
PubMed1999

Diagnosing aneurysmal and unicameral bone cysts with magnetic resonance imaging.

The differential between aneurysmal bone cysts and unicameral bone cysts usually is clear clinically and radiographically. Occasionally there are cases in which the diagnosis is not clear. Because natural history and treatment are different, the ability to distinguish between these two entities before surgery is important. The authors reviewed, in a blinded fashion, the preoperative magnetic resonance images to investigate criteria that could be used to differentiate between the two lesions. All patients had operative or pathologic confirmation of an aneurysmal bone cyst or unicameral bone cyst. The authors analyzed the preoperative magnetic resonance images of 14 patients with diagnostically difficult bone cysts (eight children with unicameral bone cysts and six children with aneurysmal bone cysts) and correlated these findings with diagnosis after biopsy or cyst aspiration and contrast injection. The presence of a double density fluid level within the lesion strongly indicated that the lesion was an aneurysmal bone cyst, rather than a unicameral bone cyst. Other criteria that suggested the lesion was an aneurysmal bone cyst were the presence of septations within the lesion and signal characteristics of low intensity on T1 images and high intensity on T2 images. The authors identified a way of helping to differentiate between aneurysmal bone cysts and unicameral bone cysts on magnetic resonance images. Double density fluid level, septation, and low signal on T1 images and high signal on T2 images strongly suggest the bone cyst in question is an aneurysmal bone cyst, rather than a unicameral bone cyst. This may be helpful before surgery for the child who has a cystic lesion for which radiographic features do not allow a clear differentiation of unicameral bone cyst from aneurysmal bone cyst.

Adolescent↗
PubMed2003

Prolonged ICP monitoring in Sylvian arachnoid cysts.

BACKGROUND: The decision making process for patients with Sylvian fissure arachnoid cysts still represents a challenge for the neurosurgeon. A high percentage of patients are indeed asymptomatic, despite neuroimaging signs of apparently increased intracranial pressure (ICP). The present study was conducted to evaluate the usefulness of prolonged ICP recording in the preoperative work-up. METHODS: Eleven children (10 M/1 F) harboring temporal arachnoid cysts were investigated (mean age: 5.9 years). According to Galassi classification they were subdivided in three groups. Group I was made up of three patients with Type I cysts; Group II comprised six children with Type II cysts; Group III consisted of two children with Type III cysts. An extensible silicone microprocessor (Codman), developed for continuous ICP recording, was implanted intraparenchymally, adjacent to the major extension of the cyst. The collected information was cable unloaded to a PC and stored. All the patients underwent a minimum of 48 hours to a maximum of 72 hours of ICP continuous check. In resting conditions, 10 mm Hg was arbitrarily chosen as the upper normal limit of ICP, and the patients were classified according to the percentile distribution of their ICP daily and nightly pressure values. RESULTS: ICP recordings were in the normal range in all the three children with Type I cysts (49-86%< 10 mm Hg during the entire recording), despite the fact that two of them were apparently symptomatic. Three of the six children with a Type II temporal cyst had elevated ICP values (69-99%> 10 mm Hg), even though they had an incidental (1 case) or prenatal (2 cases) diagnosis. The remaining three patients had normal ICP values for more than 70% of the recording time period. The two patients with type III temporal arachnoid cysts had almost constantly abnormal ICP values (95-99%> 10 mm Hg). Five patients were operated; in four of them the surgical indication was based on ICP recordings (two of the three children with a Type II cyst and increased ICP and the two patients with a Type III cyst). The last child, harboring a Type I cyst, was operated upon parents' request, as a preventive measure. At a mean follow-up of 9.3 months all the patients operated on are in excellent clinical condition; one of them (Type II cyst) initially undergoing a craniotomy and cystic membrane excision required a subduro-peritoneal shunt implant 3 months after surgery for a symptomatic subdural hygroma on the side of the cyst. Postoperative computed tomography showed signs of brain expansion in the two patients operated on for a Type III cyst, and in the patient operated on for a Type I cyst. CONCLUSIONS: With the limit of the relatively small series presented here, prolonged ICP recording appeared to be an important preoperative tool to rule out the necessity of operating on children with Type I cysts. Furthermore, the study confirmed that an increase of the ICP is almost constantly present in children with Type III cysts. In cases of Type II lesions, the study results were less discriminating, though the ICP monitoring contributed in identifying those patients in whom surgery was indicated despite the absence of symptoms.

Adolescent↗
PubMed2002

The management of fetal ovarian cysts.

BACKGROUND/PURPOSE: Ovarian torsion causing the loss of an ovary represents the most common complication of fetal ovarian cysts and occurs more frequently before than after birth. Thus, treatment of fetal simple ovarian cysts should be performed antenatally; however, criteria for prenatal decompression still need to be evaluated. Previous experience of the authors showed that large simple cysts have a poor outcome, whereas preliminary attempts of their "in utero" aspiration were all successful and uneventful. The authors evaluated the outcome of fetal simple ovarian cysts after prenatal aspiration and considered criteria for this procedure. The outcome of cysts showing a prenatal ultrasound pattern of torsion also was studied. METHODS: This prospective study includes 73 ovarian cysts (48 simple, 25 showing torsion) diagnosed in 72 fetuses from June 1992 to June 1999, and followed up until spontaneous resolution or surgery. Prenatal aspiration was performed in the case of simple cysts >/=5 cm in diameter. The outcome of these cysts was compared with that of similar cysts not aspirated in the authors previous study (X(2). Cysts with an US pattern of torsion persisting at birth were operated on. The outcome of simple cysts less than 5 cm and cysts with a prenatal ultrasound appearance of torsion also was evaluated. RESULTS: Prenatal decompression was performed without any complications in 14 cases: 12 (86%; 95% CI: 0.68 to 1.00) regressed subsequently; 2 (14%; 95% CI: 0.00 to 0.32) showed torsion postnatally. This outcome is significantly better than that of similar cysts not aspirated in the authors' previous study(10) (P =.0002). Among the 34 simple cysts less than 5 cm, 26 (76%; 95% CI: 0.62 to 0.90) resolved spontaneously; 8 (24%; 95% CI: 0.10 to 0.38) had complications, 7 of which showing torsion (diameter at evidence of torsion, 4.4 cm [median]; range, 3.3 to 5.2 cm). Among the 34 cysts showing torsion (25 with initial US pattern of torsion + 9 subsequently complicated simple cysts), 24 (71%; 95% CI: 0.56 to 0.86) required oophorectomy; 9 (26%; 95% CI: 0.11 to 0.41) spontaneously disappeared at ultrasound, one of which required surgery for intestinal obstruction secondary to adhesion of a necrotic ovary; one patient (3%; 95% CI: 0.00 to 0.09) was lost to follow-up. CONCLUSIONS: Prenatal aspiration of ovarian cysts appears effective and safe: a "cutoff" of 4 cm should be investigated. Cysts with ultrasound pattern of torsion persisting postnatally require surgery; options for their management, when sonographically disappearing and asymptomatic, need to be investigated.

Female↗
PubMed1999

Iris cysts in children: classification, incidence, and management. The 1998 Torrence A Makley Jr Lecture.

BACKGROUND: Iris cysts in children are uncommon and there is relatively little information on their classification, incidence, and management. METHODS: The records of all children under age 20 years who were diagnosed with iris cyst were reviewed and the types and incidence of iris cysts of childhood determined. Based on these observations recommendations were made regarding management of iris cysts in children. RESULTS: Of 57 iris cysts in children, 53 were primary and four were secondary. There were 44 primary cysts of the iris pigment epithelium, 34 of which were of the peripheral or iridociliary type, accounting for 59% of all childhood iris cysts. It was most commonly diagnosed in the teenage years, more common in girls (68%), was not recognised in infancy, remained stationary or regressed, and required no treatment. The five mid-zonal pigment epithelial cysts were diagnosed at a mean age of 14 years, were more common in boys (83%), remained stationary, and required no treatment. The pupillary type of pigment epithelial cyst was generally recognised in infancy and, despite involvement of the pupillary aperture, also required no treatment. There were nine cases of primary iris stromal cysts, accounting for 16% of all childhood iris cysts. This cyst was usually diagnosed in infancy, was generally progressive, and required treatment in eight of the nine cases, usually by aspiration and cryotherapy or surgical resection. Among the secondary iris cysts, two were post-traumatic epithelial ingrowth cysts and two were tumour induced cysts, one arising from an intraocular lacrimal gland choristoma and one adjacent to a peripheral iris naevus. CONCLUSIONS: Most iris cysts of childhood are primary pigment epithelial cysts and require no treatment. However, the iris stromal cyst, usually recognised in infancy, is generally an aggressive lesion that requires treatment by aspiration or surgical excision.

Adolescent↗
PubMed2002

Pancreatic cysts: depiction on single-shot fast spin-echo MR images.

PURPOSE: To evaluate single-shot fast spin-echo (SE) magnetic resonance (MR) imaging for depiction of pancreatic cysts in a large number of patients and to analyze cyst prevalence with respect to patient age and sex and other clinical information. MATERIALS AND METHODS: Single-shot fast SE images of the pancreas were obtained in 1,444 patients. The images were reviewed for presence of pancreatic cysts, which were classified as simple and nonsimple types, and cyst diameters were measured. kappa statistic, Fisher exact, McNemar Q, and Pearson product moment correlation tests were performed. RESULTS: Two hundred eighty-three (19.6%) patients had at least one pancreatic cyst. The prevalence of pancreatic cysts increased with age (r = 0.96). The percentages of male and female patients with pancreatic cysts (20.4% vs 18.8%) were not significantly different. Two hundred seventy-one (18.8%) patients had simple cysts, and 147 (10.2%) had nonsimple cysts. Of 283 patients with pancreatic cysts, 158 (55.8%) had only one pancreatic cyst. The number of patients with multiple cysts increased with age after 70 years. Four hundred fifteen (83.8%) cysts were 10 mm in diameter or smaller; 56 (11.3%), 11-20 mm in diameter; and 24 (4.9%), 21 mm in diameter or larger. Sixteen (5.7%) patients with pancreatic cysts had malignant pancreatic tumors, and 75 (26.5%) patients had pancreatitis. CONCLUSION: The prevalence of pancreatic cysts at single-shot fast SE MR imaging-especially cysts with a diameter smaller than 10 mm-is similar to that of pancreatic cysts at autopsy and higher than that of pancreatic cysts at transabdominal ultrasonography. Prevalence is especially high in patients with pancreatitis.

Adolescent↗
PubMed1982

Ovarian cysts in dairy cattle: a review.

Ovarian cysts in dairy cattle are generally defined as follicular structures of at least 2.5 cm in diameter that persist for at least 10 d in the absence of a corpus luteum. The incidence of ovarian cysts has been reported to be from 6 to 19% and, therefore, cystic ovarian disease is a serious cause of reproductive failure in dairy cattle. There have been several different hypotheses about the cause of ovarian cysts. After monitoring postpartum cows that spontaneously developed ovarian cysts and postpartum cows with or without ovarian cysts administered estradiol benzoate, the authors have suggested that postpartum ovarian cysts developed when the hypothalamus and pituitary appeared to be less responsive in releasing luteinizing hormone (LH) under the influence of estradiol. Spontaneous reestablishment of ovarian cycles occurred in about 60% of the cows that developed ovarian cysts before the first postpartum ovulation. In contrast, only about 20% of the cows that developed ovarian cysts after the first postpartum ovulation spontaneously reestablished ovarian cycles. The authors have also reported that even if ovarian cycles are not reestablished, ovarian cysts may regress, but only in the presence of follicular development, which subsequently develops into ovarian cysts. Investigators have shown that 40 to 80% of the cows with ovarian cysts reestablished ovarian cycles following treatment with products high in LH activity. Gonadotropin releasing hormone (GnRH), which stimulates reestablishment of ovarian cysts in about 80% of the cows treated, has more recently been recommended as a treatment for ovarian cysts. The GnRH-induced LH surge appears to stimulate luteinization of the ovarian cyst wall. Cows then exhibit estrus about 21 d following GnRH treatment. The conception rate at the first estrus after GnRH treatment has been reported to be 40 to 50%. The interval from GnRH treatment to estrus has been reduced by administering prostaglandin F2 alpha (PGF2 alpha) 9 d after GnRH. The PGF2 alpha appears to regress the luteinized ovarian cysts and cows exhibit estrus 2 to 3 d after PGF2 alpha treatment (11 to 12 d after GnRH). Gonadotropin releasing hormone has also been used to reduce the incidence of ovarian cysts in postpartum cows. To be effective in reducing the incidence of ovarian cysts, GnRH should be administered about 2 wk postpartum. However, cows may have a predisposition for cystic ovarian disease and treatments, therefore, are only temporary solutions. A better alternative would probably be to select against ovarian cysts.

Animals↗
PubMed2002

[Mesenteric cysts].

INTRODUCTION: Mesenteric cysts and cystic mesenteric tumors are very rare abdominal growths. They may be localized all over the mesentery, from duodenum to rectum, however, they are mostly found in the ileum and right colon mesentery. There are several classifications of these formations, among which the one based on histopathologic features including 6 groups has been most commonly used: 1) cysts of lymphatic origin--lymphatic (hilar cysts) and lymphangiomas; 2) cysts of mesothelial origin--benign or malignant mesothelial cysts; 3) enteric cysts; 4) cysts of urogenital origin; 5) dermoid cysts; and 6) pseudocysts--infectious or traumatic etiology. PATIENTS AND METHODS: Two adult female patients treated at the Department of Surgery, Zabok General Hospital, are presented. The diagnosis of mesenteric cyst was based on explorative laparotomy indicated for a cystic abdominal growth and characteristic palpatory finding, US and CT findings. In both patients, the cysts were successfully treated by total cystectomy. Pathohistologic findings pointed to lymphatic cysts. Control US finding at 3 months postoperatively was normal in both patients. DISCUSSION: Cystic lymphangioma mostly occurs in the first decade of life, with a female predominance. It is usually accompanied by acute abdominal symptomatology. Lymphatic cysts occur later in life (1:100,000 in adults and 1:20,000 in children), also show female predominance, and as a rule are asymptomatic. A mesenteric cyst, especially lymphatic, should be suspected in the presence of painless abdominal tumor, with occasionally painful abdominal pressure, normal laboratory findings, and good general condition in a female patient. In symptomatic cases, acute or chronic abdominal pain is the most common feature, whereas other symptomatology depends on the localization, size and consequential abdominal organ compression (intestinal obstruction, hydronephrosis, lower extremity lymphedema). The term of cystic mesenteric tumor is mostly used to refer to cystic lymphangiomas and lymphatic cysts. In the former, smooth muscle tissue is found, with endothelial lining towards the cavity. The wall of hilar mesenteric cysts does not contain smooth muscle tissue, however, they also show endothelial lining towards the cavity. Exact differentiation between these two entities is necessary for the disease prognosis. Lymphangiomas are prone to recurrence and infiltrating growth. The diagnosis should be made by use of all standard methods of abdominal tumor diagnosis, with ultrasonography (US) and computed tomography (CT), and especially nuclear magnetic resonance providing most information of the growth size and localization. Total cystectomy is the therapeutic method of choice. Open method has been preferred, although reports on successful cystectomy by the laparoscopic method have already appeared in the literature. CONCLUSION: Intraoperative differentiation between lymphatic cyst and lymphangioma is of utmost importance, and can only be achieved by pathohistologic examination of the cyst wall. If intraoperative biopsy cannot be performed or the finding is uncertain, each cyst should be extirpated in toto due to the above mentioned risk associated with cystic lymphangioma.

Adult↗
PubMed2003

[Prolonged ICP monitoring in children with sylvian fissure arachnoid cysts].

BACKGROUND: The decision making process for patients with sylvian fissure arachnoid cysts still represents a challenge for the neurosurgeon. A high proportion of the patients is indeed asymptomatic, in spite of neuroimaging signs of apparently increased intracranial pressure (ICP). The aim of the present study was to evaluate the usefulness of prolonged ICP recording in the preoperative work-out. METHODS: Twelve children (11 M/1 F) harboring temporal arachnoid cysts were investigated (men age 6.3 years). According to Galassi classification they were subdivided into 3 groups. Group I included 3 patients with Type I cysts; group II comprised 6 children with Type II cysts; group III consisted of 3 children with Type III cysts. An extensible silicone microprocessor (Codman ), developed for continuous ICP recording, was implanted intraparenchymally, adjacent to the major extension of the cyst. The collected information was cable unloaded to a PC and stored. All the patients underwent a minimum of 48 hours to a maximum of 72 hours ICP continuous check. Ten mmHg was arbitrarily chosen as the upper normal limit of ICP in resting conditions and the patients were classified according to the percentile distribution of their ICP daily and nightly pressure values. RESULTS: ICP recordings were in the normal range in all the 3 children with Type I cysts (49-86% <10 mmHg during the entire recording), in spite of the fact that 2 of them were apparently symptomatic. Three of the 6 children with a Type II temporal cyst had elevated ICP values (69-99% >10 mmHG), even though they had an incidental (1 case) or prenatal (2 cases) diagnosis. The remaining 3 patients had normal ICP values for more than 70% of the recording time period. Two of the 3 patients with type III temporal arachnoid cysts had almost constantly abnormal ICP values (95=99% >10 mmHg); conversely the third patient showed normal ICP values for more than 80% of the recording time period. Five patients were operated on; in 4 of them the surgical indication was based on ICP recordings (2 of the 3 children with a Type II cyst and increased ICP and the 2 patients with a Type III cyst and increased ICP). The last child, harboring a Type I cyst, was operated on under parents request, as a preventive measure. At a mean follow-up of 10.1 months all the patients operated on are in excellent clinical conditions; 1 of them (Type II cyst) initially submitted to craniotomy and cystic membrane excision needed a subdural-peritoneal shunt implant 3 months after surgery for the appearance of a symptomatic subdural hygroma on the side of the cyst. Postoperative CT showed signs of brain expansion in the 2 patients operated on for a Type III cyst, and in the patients operated on for a Type I cyst. CONCLUSIONS: With the limit of the relatively small series here presented, prolonged ICP recording appeared to be an important preoperative tool to rule out the necessity of operating on children with Type I cysts. Furthermore, it was particularly useful in the decision-making process for children with Type III cysts. In cases of Type II lesions, the investigation resulted less discriminating, though the ICP monitoring contributed to find out those patients in whom surgery was indicated in spite of the absence of symptoms.

Adolescent↗
PubMed1991

The role of lysosomes in the pathogenesis of unicameral bone cysts.

Unicameral bone cyst fluid possesses N-acetyl-beta-D-glucosaminidase, beta-glucuronidase, PZ-peptidase, cathepsin D, acid phosphatase, N-acetyl-beta-D galactosaminidase, and beta-galactosidase activities. The activities of lysosomal enzymes in the cyst fluid are, as a rule, higher than in the serum, whereas the total protein content is lower. The content of collagen degradation products in the cyst fluid is higher compared to the serum. In bone cavity wall tissues, the collagen content is decreased. Adenosine 3':5'-cyclic phosphate and cyclic guanosine 3,5'-monophosphate accumulate in the cyst cavity. However, in some cases, there is no correlation among the activities of lysosomal enzymes in the cyst fluid, blood serum, and cyst wall tissues. The ratios of lysosomal enzyme activities in the cyst fluid differ from those in the cyst wall tissues, cultured skin fibroblasts, and blood polymorphonuclear leucocytes. The lack of coincidence of enzymatic spectra of the cyst fluid, wall tissues, and serum is suggestive of the diversity of ways of lysosomal enzyme enter the cyst cavity, i.e., blood, cyst fluid cells, and cyst cavity walls. The cysts with different locations (i.e., active and latent cysts) have similar lysosomal lytic potentials. The presence in the cyst cavity of extracellular lysosomal enzymes and collagen degradation products testifies to the permanent corrosion of the cyst cavity walls from the inside as well as to the increase in the osmotic pressure of the cyst fluid. Lysosome destruction should be regarded as an important pathogenetic factor that requires surgical or pharmacologic correction or both in the course of bone cyst management.

Bone Cysts↗
PubMed1988

Cytology of Lepidoptera. III. Giant cysts: a morphological trait of apyrene spermatogenesis in an Ephestia kuehniella strain.

A comparative investigation of testicular eupyrene cysts (in larvae) and apyrene cysts (in pupae) of Ephestia kuehniella laboratory strains was conducted using light and electron microscopy. Eupyrene cysts in the first meiotic division contained 64 spermatocytes, which showed only moderate asynchrony. In one of the strains, a wild-type strain, L, normal-sized cysts occurred together with abnormally large cysts. These are called giant cysts in this article. One of the premeiotic cysts, early giant cysts, studied in detail, contained approximately a fourfold number of cells compared with the number in a eupyrene cyst of the same stage. In cysts harboring spermatocytes and spermatids, late giant cysts, cell differentiation was highly asynchronous. Failure in one of two control mechanisms in early cyst development may have caused the appearance of the cysts. Control of cell division might have been sloppy in apyrene spermatogonia. Hence, the spermatogonia within the cyst could have passed through additional division cycles. Alternatively, the giant cysts may have originated from more than one predefinitive gonial cell enclosed in a common envelope of sheath cells. As a third possibility, giant cysts could have arisen by fusion of normal cysts at a later stage. In either case, this is evidence that separation of eupyrene and apyrene pathways is earlier than was previously expected. In two other Ephestia strains, apyrene sperm development proceeded without formation of giant cysts. One was a mutant strain, a, and the other one was a recently established wild-type strain, Sbr. Apyrene sperm development is considered an example of degenerate evolution in which enhanced variability between species and even between populations of one species is a common phenomenon.

Animals↗
PubMed1983

Echinococcus granulosus equinus: an ultrastructural study of murine tissue response to hydatid cysts.

Peritoneal hydatids of Echinococcus granulosus equinus of 9 months standing in BALB/c mice occurred as free cysts or cysts within cyst masses. Both showed wide variation in size and in host tissue response, and all had a well-developed laminated layer separating the host tissue response from the germinal layer. In the smallest cyst-mass cysts the host tissue response was present as remnants of the initial cellular attack involving eosinophils. Slightly larger cyst-mass cysts possessed a primary macrophage invasion which phagocytosed the remnants of the initial attack and also, though to little effect, the laminated layer material. In the largest cyst-mass cysts a second macrophage invasion, of monocyte origin, had commenced and transformation stages of these cells to macrophages were observed. No fibroblasts surrounded individual cyst-mass cysts but they were present around the cyst mass, encapsulating it and possibly preventing further host cell invasion. Thus, the host tissue response around individual cyst-mass cysts remained 'preserved' at an early stage such as existed at the time of encapsulation. Small free cysts showed a primary macrophage invasion and transformation stages of cells of a secondary infiltration of peritoneal origin. Peripheral to the macrophages were fibroblasts demonstrating limited fibrinogenesis, and each cyst was surrounded by a layer of mesothelial cells. Large free cysts, also delimited by a mesothelial layer, possessed peripheral connective tissue, a deep fibrous layer and a monolayer of very compressed macrophages lying adjacent to the laminated layer. It is emphasized that an understanding of the host tissue response in cysts of different sizes and from different locations is an essential pre-requisite for the design of experimental studies.

Animals↗
PubMed2003

Reduced kidney size in patients with simple renal cysts.

BACKGROUND: Renal cysts frequently occur in the absence of genetic diseases but their significance is unknown. Since multiple cysts develop in many patients with advanced renal disease, we tested the hypothesis that isolated cysts are associated with early nephron loss. METHODS: All inpatient and outpatient sonograms performed by the Renal Division since 1995 were reviewed and, after exclusion of duplicate studies, patients with genetic cystic disorders, complex cysts, hydronephrosis, peripelvic cysts, end-stage renal disease and transplanted kidneys, 2526 were selected for this study, of which 385 had one or more cysts. Maximum renal length was used as an indication of size, and renal function was estimated by serum creatinine concentration. RESULTS: Both right and left kidney length were significantly less in patients with cysts (P < 0.0001), independent of which kidney contained the cyst(s). Renal lengths were less in patients with multiple cysts as opposed to single cysts but not in patients with bilateral cysts as compared to unilateral cysts. Cysts were twice as frequent in solitary kidneys than in dual kidneys (P = 0.01). In outpatients matched for age and gender, those with cysts had a higher serum creatinine concentration but with borderline significance (P = 0.06). Multivariate analysis revealed that age, gender, and renal length were each independent variables and together accounted for one third of the incidence of cysts. CONCLUSION: Kidney size is reduced in patients with simple renal cysts noted on renal sonography, and cysts may be associated with reduced renal function. This suggests that isolated cysts are an indication of nephron loss in patients with renal abnormalities.

Age Distribution↗
PubMed1991

[Uptake and release of mebendazole, albendazole and albendazole sulfoxide by secondary cysts of Echinococcus granulosus in vitro].

Mebendazole (Meb), albendazole (Alb) or albendazole sulfoxide (AlbSO) were taken rapidly in vitro by secondary cysts of Echinococcus granulosus removed out from mice infected with protoscoleces 8-9 months previously. The amounts of the drugs taken by the cysts were apparently increased followed by exposure of the cysts to the drugs at 10 micrograms.ml-1. The Alb penetrated into the cysts was distributed mainly in cyst wall, whereas the content of Meb in cyst wall was twice as much as that in cyst fluid. The distributions of AlbSO in cyst wall and cyst fluid were similar. When the cysts in the medium were exposed to Alb, some AlbSO and albendazole sulphone were detected in both cyst wall and cyst fluid, indicating that a part of Alb was metabolized by the cysts. In another experiment cysts exposed to the drug for 2 h were transferred to the medium without the drug for another 24 h. The release rates of the 3 drugs from the cysts were alike. In 1-2 h after transfer about 65-70% of the drugs absorbed by the cysts previously were released. Twenty-four hours after exposure the release rates increased to 75-85%, and the release of the drugs from the cyst wall was somewhat faster than that from cyst fluid.

Albendazole↗