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PubMed1999

[Intrathoracic coelomic cysts].

Intrathoracic coelomic cysts are benign embryonic tumors with a mesothelial lining. The aim of this work was to review possible localizations (pleuropericardic and other), the remaining surgical indications, and the current situation of minimally invasive techniques. We reviewed retrospectively, 28 cases of intrathoracic coelomic cysts in 12 men and 16 women, mean age 44 years. We recorded the cyst localization, clinical signs, indication for surgery, access routes used, and outcome. Twenty-one cysts were pleuropericardial cysts and 7 were ectopic mediastinal cysts. In all 7 of the ectopic mediastinal cysts and 4 of the pleuropericardial cysts surgery was indicated for diagnosis; for the other pleuropericardial cysts the indication was based on clinical signs (n = 4), large volume (n = 4), progressing volume (n = 7), no apparent reason (n = 1) and association with surgery for pneumothorax (n = 1). Assess was by mediastinoscopy (n = 1), mediastinotomy (n = 1), sub-xyphoid route (n = 1), thoracotomy (n = 18), and videothoracoscopy (n = 7). Long-term outcomes (mean follow-up 4 years 4 months) were good with no recurrences. Postoperative sequelae were observed in 6 cases after thoracotomy and in 1 case after videothoracoscopy. In summary, pleuropericardial cysts warrant surveillance without surgery unless their volume increases or clinical signs develop. Ectopic mediastinal cysts usually require surgery for diagnosis. It would appear advisable to prefer videothoracoscopy which allows diagnosis and excision of pleuropericardial cysts. Minimal thoracotomy may be helpful for ectopic mediastinal cysts.

Adult↗
PubMed1999

Primary cysts in the iridociliary sulcus: ultrasound biomicroscopic features of 210 cases.

BACKGROUND: Primary cysts occur spontaneously, whereas secondary cysts arise following surgical or nonsurgical injury and can lead to further complications. We performed a study to observe and characterize primary iridociliary cysts through the examination of ultrasound biomicroscopic (UBM) images from affected patients. METHODS: The UBM images from 210 patients were analysed and the characteristics of each cyst were observed and recorded. The patients had been examined and received the diagnosis of iridociliary cysts between 1990 and early 1998 at a major referral centre for the diagnosis and treatment of cancer in Toronto. RESULTS: Of the 210 cysts 169 (80%) occurred in isolation, and the remainder occurred in the presence of a tumour. The mean horizontal diameter of the isolated cysts was 1.72 mm, and the mean vertical diameter was 1.04 mm. Isolated cysts were solitary in 101 cases (60%) and showed multiple loculations in 68 (40%). Solitary cysts were slightly larger than those with multiple loculations. Isolated cysts were associated with markedly narrowed or closed angles locally in 110 cases (65%). INTERPRETATION: Primary iridociliary cysts are common and need to be differentiated from iris and ciliary body tumours. UBM is a definitive method of diagnosing these lesions. Cysts can cause localized angle closure but rarely cause clinical complications. Cysts associated with anterior segment tumours may give an erroneous impression as to tumour size.

Anterior Chamber↗
PubMed2000

[Laparoscopy and laparotomy in the operative treatment of ovarian cysts].

OBJECTIVES: The purpose of our study was to compare operative procedures, histologic types of tumours, and intra- and postoperative complications of patients operated for benign ovarian cysts by laparotomy or laparoscopy. MATERIALS AND METHODS: 257 patients with different types of ovarian cysts underwent operations by laparoscopy (51 cases) or laparotomy (206 cases). Careful selection for operative treatment was made on the basis of clinical findings, ultrasound scans (using colour Doppler), patient's age and history. Operative laparoscopies were performed in patients with "unsuspected" ovarian cysts with diameter < or = 8 cm. During every operation, a histologic examination of tumour was performed. RESULTS: In 42 patients the cysts were found in both ovaries. Remaining 215 women had unilateral ovarian tumours. Adnexectomy was carried out in 142 cases, cystectomy in 131, ovariectomy in 18, and aspiration and electrocoagulation of ovarian cysts in 8 cases. The most common laparoscopic procedures were cystectomy (41) and aspiration and electrocoagulation of ovarian cysts (8); while by laparotomy: adnexectomy (142) and cystectomy (131); p < 0.0001. The histopathological assessment showed as follows: serous cysts in 98 cases, dermoid cysts in 75, endometrial cysts in 63, mucous cyst in 23, and others (mainly haemorrhagic, functional cysts and fibrothecomas) in 40 cases. The incidence of operative complications (3/257--all due to insufficient hemostasis) and postoperative complications (infection--7/257, anaemia--4/257, peritonitis--1/257) was rather low and similar in patients operated by laparoscopy and laparotomy. Patients were generally discharged from the hospital on the fourth (median) postoperative day after laparoscopies and the seventh (median) day after laparotomies (p < 0.0005). CONCLUSIONS: Operative treatment of ovarian benign cysts is connected with a very low risk for intra- and postoperative complications. The operative laparoscopy brings better cosmetic effects and seems to be safe and effective method of treatment of ovarian benign cysts.

Adolescent↗
PubMed2002

[A case of calvarial aneurysmal bone cyst: transcranial contrast sonographic examination with pulse inversion harmonic imaging method].

A 31-year-old female came to our hospital complaining of left frontal bulging with pain on 10 August 2000. The head x-p showed a radiolucent lesion and bulging at the same calvarial site. CT scan and MRI showed fluid-fluid levels, diploic cyst, deformity and hypertrophic calvarial change. There was a partial hypervascular part of cyst adjacent to the left frontal base by selective left external carotid angiography. Harmonic image is a contrast specific imaging modality that uses the nonlinear properties of contrast agents by transmitting at the fundamental frequency and receiving at multiples of these frequencies. Pulse inversion harmonic image(PIHI) using pulse inversion to eliminate and strengthen the harmonic frequency is more effective than conventional harmonic imaging. Transcranial sonographic examination showed hyper- and hypoechoic appearances in the cyst around abnormal hyperechoic appearances of the calvarial site. The transcranial contrast sonographic images with PIHI (hereinafter TCIpi) demonstrated an enhanced intracystic lower stratum and nearby the diploic part. That modality facilitates better visualization than the harmonic imaging method, enabling differentiation of vascular from avascular areas. As contrast agents are microbubbles, those are restricted in the vascular canal space. So TCIpi findings proved to be a blood circulation of the tumor, cyst and neighboring tissue. Enhanced areas changed by every minute and disappeared gradually. The findings were probably based on the vascular component of the tumor. We obtained images similar to those with CT and MRI. The patient underwent on 21 August. The tumor was removed along with the surrounding skull component. Fresh and old blood were mixed in the cyst. The clinical and pathological diagnosis was aneurysmal bone cyst. The postoperative course was uneventful and she was discharged on 29 August. Aneurysmal bone cyst is a rare calvarial tumor. An diagnostic finding is fluid-fluid levels that appear in approximately 30% of aneurysmal bone cysts. However, this is not a specific finding and has also been reported to occur in osteosarcoma, malignant fibrous histiocytoma, fibrous dysplasia, synovial sarcoma, hemangioma and simple bone cyst. Therefore, diagnosis of aneurysmal bone cyst is based on a combination of the various imaging applications, clinical and pathological findings. Gometz reported that sonographic examination was superior to any diagnostic imaging studies for aneurysmal bone cyst. Furthermore, the perfusion examination like TCIpi can directly observe blood circulation channels in tissue, so the specific enhancement changes of aneurysmal bone cyst could be observed. TCIpi is a useful method for diagnosis of aneurysmal bone cyst.

Adult↗
PubMed1992

A new concept of the pathogenesis of oral mucous cysts based on a study of 200 cases.

A new hypothesis regarding the pathogenesis of mucous cysts of the oral mucosa is proposed. Based upon a histological study of 188 mucous cysts without epithelial lining out of a total of 200 cysts it is claimed that some cysts may not develop in any of the hitherto described ways as intraductal "mucous retention cysts" or extraductal "mucous extravasation cysts" or from destruction of acini due to the pressure of mucous caused by duct obstruction. It is suggested that some of the cysts, that are found to have developed intraglandularly, are caused by traumatic destruction of a large amount of glandular acini ("parenchymal destruction cysts") and continuous secretion from the remaining acini. The mucus from the disintegrated cells forms a pool, which in time is surrounded by a connective tissue capsule that contains remnants of parenchyma from the affected lobule. This parenchyma degenerates, and eventually the cyst shows the same histological picture as the "mucous extravasation cyst". It is argued that the presence of a feeder duct does not necessarily indicate an extravasation cyst, but may be seen in the "parenchymal destruction cysts" as well. Of the 188 cysts examined 20 (11 per cent) were found to develop intraglandularly, and 36 (19 per cent) were considered probably to have developed intraglandularly.

Adolescent↗
PubMed2003

[Cysts and cystoid formations of the neck: significance and possibilities of radiodiagnosis].

The differential diagnosis of lateral cysts of the neck, metastatically altered lymph nodes and malignant tumors sometimes is difficult because their X-ray images as well as their clinical manifestations can be alike. The data of examination of 55 patients were analyzed. They included 43 cases of cysts of the neck (26 lateral and 17 median), 10 cases of cystically altered metastases into the lymph nodes, 2 cases of malignant tumors. The examination included US investigation (USI), computed tomography (CT), USI controlled aspiration biopsy. The diagnosis was histologically verified in 46 patients, in 7 cases the material was investigated cytologically. The "atypical" echographic picture was noted in 30.9% of cases with lateral cysts and in 23.6% of cases with median cysts. They had irregular shape, defective contours, echostructure of the tissues with repeated complications in anamnesis, weak "dorsal reinforcement". The clinical investigation of cases with lateral cysts was exact in 76.9%, with median cysts--in 82.4%. The USI examination was exact in 96.2% of cases with lateral cysts and in 94.1% with median cysts. CT was exact in 94.4% of cases with lateral cysts, and in 100% with median cysts. Thus, USI is thought to be necessary as the first step of X ray examination when cyst of the neck was suspected. Large sizes, spread of the cyst into deep areas and into the larynx lumen are considered as indications to CT. Both the echographic and computed tomography picture of the neck cysts depend on their localization, character of the content and the presence of inflammatory symptoms. The USI controlled aspiration biopsy can make the "atypical" USI picture of the mass nature more exact.

Adolescent↗
PubMed1990

[Epithelial cyst in the central nervous system--characteristic expression of cytokeratin].

Twenty one cases of epithelial cysts in the central nervous system including six colloid cysts of the third ventricle, eight Rathke's cleft cysts in the sella, two enterogenous cysts in the posterior fossa, two epithelial cysts in the spinal canal and three neuroectodermal cysts in the cerebrum were examined immunohistochemically for expression of intermediate filamentous proteins-simple type, stratified type and skin type cytokeratins and GFAP. Colloid cysts of the third ventricle. Rathke's cleft cysts in the sella and epithelial cysts in the spinal canal expressed complexed type cytokeratins while enterogenous cysts and neuroectodermal cysts showed only simple type cytokeratins. In addition, several Rathke's cleft cysts demonstrated skin type differentiation and expressed GFAP in occasional lining cells. The characteristic composition and distribution of cytokeratins in various kinds of epithelial cysts in the central nervous system are demonstrated and discussed with regards to their origins.

Adult↗
PubMed1988

The natural history of theca lutein cysts.

The histories of 386 patients with untreated hydatidiform mole were reviewed to define the clinical aspects of accompanying theca lutein cysts. These cysts occurred in 102 patients (26.4%), with three patients experiencing cyst-related complications. Mean cyst size at diagnosis was 7.3 cm (3-20 cm), and did not correlate with post-molar trophoblastic disease development. Bilateralism occurred more often in patients developing post-molar trophoblastic disease. In patients with post-molar trophoblastic disease, 83% (45 of 54) experienced theca lutein cyst regression and 16.7% an increase in cyst size with falling beta-hCG titers. Post-molar trophoblastic disease developed in 44 patients. Theca lutein cyst growth occurred in 31.8% of the patients with beta-hCG plateau/rise and in 4.5% with falling titers. Disappearance of theca lutein cysts before diagnosis of post-molar trophoblastic disease occurred in 31.8%. Theca lutein cysts persisted in three patients for long periods (15-18 weeks) after beta-hCG regression. We conclude that theca lutein cysts commonly accompany hydatidiform mole and are associated with an increased risk of post-molar trophoblastic disease, a risk that is higher with cyst bilateralism or severe complications of hydatidiform mole. Theca lutein cysts uncommonly have serious complications; their clinical behavior does not depend entirely on changes in beta-hCG levels, as cysts may persist for long periods after beta-hCG regression.

Adolescent↗
PubMed1981

Primary cysts of the iris.

This paper has presented the author's experience with the evaluation and follow-up of 62 patients with primary cysts of the iris. On the basis of these observations, a classification of iris cyst is proposed. Accordingly, primary iris cysts are divided into epithelial and stromal categories, each having different clinical characteristics. Epithelial cysts arise between the pigmented epithelial layers of the iris and occur at the pupillary margin (central cysts), in the mid-portion of the iris (midzonal cysts) or, more commonly, in the iridociliary sulcus (peripheral cysts). In some cases, the cysts apparently break free from their epithelial attachment and migrate into the anterior chamber of vitreous chamber (dislodged cysts). Primary stromal cysts occur within the iris stroma and are not directly continuous with the posterior epithelium. They apparently arise from ectopic surface epithelium which is trapped in the iris during embryologic development. A study of the natural course and complications of these lesions has shown that the great majority of primary iris cysts, particularly those which arise from the iris pigment epithelial layer, are stationary lesions which rarely progress or cause visual complications. This finding is contradictory to the contemporary belief of certain authorities who stress that many such lesions lead to severe complications with blindness and loss of the eye. The natural course of primary epithelial cysts differs from that of secondary iris cysts which follow surgical or non-surgical trauma. The latter lesions do frequently enlarge and lead to severe complications such as inflammation and glaucoma.

Adolescent↗
PubMed1993

Immunohistochemical study of intracranial cysts.

We present the immunohistochemical study of 11 cases of intracranial cysts: two extraventricular ependymal cysts, three colloid cysts of the third ventricle, four extraventricular choroidal cysts and two Rathke's cleft cysts. Antibodies against glial fibrillary acidic protein (GFAP), cytokeratins (AE1, CK5D, AE3), S-100 protein, epithelial membrane antigen (EMA), vimentin, neuron specific enolase (NSE), neurofilaments protein (NF) and prealbumin, were used. The epithelium of choroidal cysts, showed strong immunoreactivity for Prealbumin and cytokeratins, similar to the normal choroid plexus epithelium. The ependymal cysts showed epithelial immunoreactivity for GFAP and S-100, both glial markers expressed by the normal ependymal epithelium. On the contrary, the epithelial wall of colloid cysts and Rathke's cleft cyst, expressed epithelial markers (cytokeratins and EMA) but no neuroepithelial markers, with a immuno-phenotype similar to that of other cysts of endodermal nature. This finding supports the neuroepithelial origin for choroid and ependymal cysts, and an endodermal nature for colloid and Rathke's cleft cysts. We conclude that these immunohistochemical markers are useful in the differential diagnosis of intracranial cysts.

Brain Diseases↗
PubMed1993

[Ovarian cysts: strategy and prognosis].

The management of an adnexal masses involves several steps: establish the diagnosis of organic ovarian cyst, avoiding a useless and iatrogenic surgery of a functional cyst, knowing that functional cysts may persist more than 3 months and may occur even on low-dose oral contraceptives; cure painful cysts, by ultrasound guided aspiration of some functional cysts or laparoscopic detorsion of twisted adnexae; exclude malignancy, with the help of ultrasound, Doppler and Ca-125 preoperatively, then laparoscopic examination and pathology; failed diagnosis of cancer becomes rare (1 out of 300 laparoscopic surgeries for ovarian cyst); the association of a benign ultrasound and Doppler pattern and of a Ca-125 lower than 35 mUI/ml is almost pathognomonic of a benign cyst; cure benign ovarian cysts with a minimum of surgical trauma; in our series, 84.4% of ovarian cysts are managed laparoscopically, 11.1% by elective laparotomy, 4.5% by laparotomy after an attempt at laparoscopic surgery (that implies that the patient must be informed of the risk of laparotomy); adapt the surgical technique to the pathologic type and size of the cyst, with a high rate of laparotomy in large dermoid cysts, and a high rate of (salpingo-)oophorectomy in peri or postmenopausal cysts; ensure an adequate therapy of early ovarian carcinomas, avoiding understadification and undertreatment; prevent ovarian cancer by a careful long-term follow-up of patients with benign ovarian cysts and by the use of bilateral oophorectomy in postmenopausal patients.

Aftercare↗
PubMed1996

Craniospinal arachnoid cyst: case report.

We encountered a rare case of craniospinal arachnoid cyst. A 54-year-old woman was admitted to our clinic for headache, posterior nuchal pain, and vomiting, which had started one month before. On admission she was drowsy, and neurological examination revealed papilledema and prompt deep tendon reflexes bilaterally. T1 weighted images of MRI revealed a homogeneous, round, low density mass in the left cerebellar hemisphere which extended down on the dorsal side of the spinal cord to the level of C2. It was high intensity on T2 weighted images and was not enhanced by Gd-DTPA. The fourth ventricle was compressed and obstructed and hydrocephalus was observed. An operation was performed via a left suboccipital craniectomy with C1 laminectomy. A large cyst was located in the left cerebellar hemisphere, and it extended into the spinal canal down to the C2 level where the cyst compressed the spinal cord right-anteriorly. The content of the cyst was xanthochromic fluid. After the removal of as much of the cyst as possible, the flattened tonsil was seen just dorsal to the medulla. The cyst extended into the cerebellar hemisphere via the widened fissura secunda. The arachnoid of the cisterna magna was incised and communication between the cisterna magna and the cyst was made. The cyst was markedly reduced on the following day, and disappeared on the 50th postoperative day. The patient was discharged without neurological deficit. Pathological diagnosis of the cyst wall in the cerebellum was that the molecular layer of the cerebellar cortex was covered by arachnoid membrane, which indicated arachnoid cyst. Five such cases have been reported apart from this one. The therapy is the extirpation of the cyst wall and making communication between the arachnoid cyst and the subarachnoid space. The etiology of craniospinal arachnoid cyst is not well known but postoperative prognosis is good.

Arachnoid Cysts↗
PubMed1976

Intracystic fluid pressure in non-keratinizing jaw cysts.

The technique for registration of fluid pressure in jaw cysts by means of pressure transducer and cannulation of the cyst cavity or cementation of a two-way valve into a tooth communicating with the cyst is described. Twenty-six closed cysts were subjected to registration of intracystic pressure. Subsequent histologic examination showed that all cysts were non-keratinized. Initial pressure values in apical periodontal cysts averaged +47 mmHg, in follicular cysts +44 mmHg, and in residual cysts +38 mmHg. A median palatine cyst exhibited a pressure of +81 mmHg. Most cysts showed intracystic pulsation corresponding to the number of heart beats on electrocardiograms obtained simultaneously. The intracystic pulsation disappeared when the intracystic pressure was experimentally increased and reappeared when it was lowered. In three cases in which registration of pressure was performed 7-14 days after the aspiration of the cyst fluid, an intracystic pressure in the same range as the initial one was found. The findings indicate deficient lymphatic drainage of non-keratinizing jaw cysts.

Bone Cysts↗
PubMed1997

Immunocytochemical expression of growth factors by odontogenic jaw cysts.

AIM: To determine the immunocytochemical pattern of expression of transforming growth factor (TGF) alpha, epidermal growth factor (EGF), and TGF beta in the three most common types of odontogenic jaw cyst. METHODS: Growth factor expression was detected in paraffin wax sections of odontogenic cysts (27 odontogenic keratocysts, 10 dentigerous cysts, and 10 radicular cysts) using a streptavidin-biotin peroxidase technique with monoclonal antibodies directed against TGF alpha (clone 213-4.4) and TGF beta (clone TB21) and a polyclonal antibody directed against EGF (Z-12). RESULTS: The epithelial linings of all cysts showed reactivity for TGF alpha which was mainly localised to basal and suprabasal layers. Odontogenic keratocyst linings expressed higher levels of TGF alpha than those of dentigerous and radicular cysts, with 89% (24/27) of odontogenic keratocysts exhibiting a strong positive reaction compared with 50% (five of 10) of dentigerous and radicular cysts, respectively. EGF reactivity was similar in all cyst groups, weaker than that for TGF alpha and predominantly suprabasal. TGF alpha and EGF were also detected in endothelial cells, fibroblasts and inflammatory cells within the cyst walls. The most intense TGF beta staining in odontogenic cysts was extracellular within the fibrous tissue capsules, irrespective of cyst type. CONCLUSIONS: These results, together with previous studies of EGF receptor, indicate differential expression of TGF alpha, EGF and their common receptor between the different types of odontogenic cyst, suggesting that these growth factors (via autocrine or paracrine, or both, pathways) may be involved in their pathogenesis.

Dentigerous Cyst↗
PubMed1987

Immunohistochemical demonstration of keratins in the cysts of thyroid glands, parathyroid glands, and C-cell complexes of the dog.

Cyst structures were often detected in and around thyroid glands of the dog. The present study revealed the frequency of occurrence, the light microscopic features, and the immunoperoxidase reactions to anti-keratin and anti-19S-thyroglobulin antisera of each cyst located in parathyroid III, parathyroid IV, thymus IV, C-cell complexes, and thyroid parenchyma from 112 dogs. In each location, cysts showed characteristic features. In parathyroid III, the cysts were covered with single or pseudostratified epithelium composed of ciliated cells; whereas in parathyroid IV they were covered with keratinizing stratified squamous epithelium. In C-cell complexes, small cysts lined with small packed cells were predominant, and large cysts lined with single cuboidal cells or stratified squamous cells were also present. In thymus IV located in the close vicinity of parathyroid IV, cyst epithelium consisted of several types of cells showing variable features. In thyroid parenchyma, there were several types of cysts: some were covered with ciliated columnar cells, and others were covered with two or multilayers of small packed cells or cuboidal cells. In spite of these differences in appearance of the cysts located in different tissues, all their epithelia were immunoreactive to the keratin antisera, except for small cysts in C-cell complexes, which were regarded as immature structures. Thus, the presence of keratin filaments in epithelial cells seems to be a characteristic feature of all cysts. The lumens of each cyst contained variable amounts of amorphous materials, which showed colloid-like, flocculent, foamy, and granular features and were periodic acid-Schiff-positive in variable degrees, from weak to intense. Although the lumenal contents of the cysts in parathyroid III revealed no immunoreactivity for 19S-thyroglobulin, those in thyroid parenchyma, C-cell complexes, parathyroid IV, and thymus IV reacted strongly with the 19S-thyroglobulin antiserum.

Animals↗
PubMed1995

Abnormal function of renal tubules in patients with simple renal cysts.

The present study aimed to assess the function of proximal and distal tubules in patients with simple renal cysts. Thirty-one patients with simple renal cysts and 10 healthy subjects were examined. Based on the cyst fluid/plasma sodium ratio, 25 cysts were found to be of proximal origin and 6 of undetermined origin. In all patients cyst fluid and plasma concentrations of beta-2-microglobulin (beta-2-MG), sodium, potassium, calcium, phosphorus and total protein were assessed. Urinary excretions of sodium, potassium, calcium, phosphorus, beta-2-MG and Tamm-Horsfall protein (THP) were also estimated. Fractional excretion of beta-2-MG was calculated. The concentrations of beta-2-MG in fluid obtained from cysts of proximal origin were significantly higher than in fluid from cysts of undetermined origin (2.26 +/- 0 36 vs. 0.65 +/- 0.13 mg/l, p = 0.0004). Concentrations of THP (6.85 +/- 1.21 vs. 3.14 +/- 1.06 micrograms/ml, p < 0.05), and potassium (4.39 +/- 0.07 vs. 3.13 +/- 0.44 mmol/l, p < 0.05) were also higher in fluid from proximal cysts than in fluid from cysts of undetermined origin. Plasma beta-2-MG concentration was significantly higher in patients with proximal and undetermined cysts than in the control group (4.35 +/- 0.34 and 4.11 +/- 0.74 vs. 1.89 +/- 0.1 mg/l, p < 0.001). Urinary beta-2-MG excretion was also significantly higher in both groups of patients than in healthy subjects (474.8 +/- 165.9 and 346 +/- 94 vs. 100.2 +/- 19.6 micrograms/24 h, p < 0.05). Urinary THP excretion was significantly higher in patients with proximal cysts than in healthy subjects (31.0 +/- 5.1 vs. 16.3 +/- 2.5 mg/24 h, p < 0.05). From the results obtained in this study it seems that patients with simple renal cysts of proximal origin are characterized by abnormal tubular handling of beta-2-MG, and calcium and THP excretion. Thus, in patients with proximal cysts presence of a latent renal tubulopathy seems to be likely.

Adult↗
PubMed2002

Evacuation of hydatid liver cysts using laparoscopic trocar.

Several methods of reducing the likelihood of spilling live scolices during surgical removal of hydatid liver disease have been described. The aim was to determine the effectiveness and safety of laparoscopic trocar insertion for evacuation of hydatid liver cysts. This technique was used for 30 cysts in 19 patients who had surgery for hydatid liver disease. After establishing protection of the operative area, a laparoscopic trocar was inserted into the cyst at the most prominent point and the cyst was aspirated with large-bore suction and filled with a scolicidal agent. The technique was not attempted in two small cysts (<6 cm) located near the major blood vessels or in a single intraparenchymal cyst. Insertion of the trocar was successful in all remaining cysts, and there were no complications during the insertion or the evacuation. Successful evacuation (excellent and good outcomes) in unilocular, multilocular, and degenerated cysts were 100%, 84%, and 57%, respectively (p = 0.144), with a total success rate of 82%. Although successful evacuation was achieved in both anterior (92%) and posterior-superior located cysts (73%) (p = 0.203), excellent outcomes were higher for the anterior cysts (73%) than for the posterior-superior cysts (13%) (p = 0.005). Successful evacuation outcomes for the large (> 10 cm), middle-sized (6 to 10 cm), and small cysts (<6 cm) were 100%, 79%, and 67%, respectively (p = 0.591). The patients have been followed for a mean of 11 months (range 3 to 24 months), and no recurrence has been recorded. Insertion and evacuation of the hydatid liver cysts with a laparoscopic trocar is a safe and effective procedure, and its limitations are minimal.

Adolescent↗
PubMedDate not supplied

Acetic acid as a sclerosing agent for renal cysts: comparison with ethanol in follow-up results.

PURPOSE: To compare follow-up results of sclerotherapy for renal cyst using 50% acetic acid with those using 99% ethanol as sclerosing agents. METHODS: Eighty-one patients underwent sclerotherapy and 58 patients, 23 males, 35 females, aged 6-76 years, having a total of 60 cysts, were included in this study; the others were lost to follow-up. The renal cysts were diagnosed by sonography, computed tomography (CT), or magnetic resonance imaging (MRI). Sclerotherapy was performed using 50% acetic acid for 32 cysts in 31 patients and 99% ethanol for 28 cysts in 27 patients. Under fluoroscopic guidance, cystic fluid was aspirated as completely as possible. After instillation of a sclerosing agent corresponding to 11.7%-25% (4-100 ml) of the aspirated volume, the patient changed position for 20 min and then the agent was removed. Patients were followed up by sonography for a period of 1-49 months. The volume of the renal cyst after sclerotherapy was compared with that of the renal cyst calculated before sclerotherapy. Medical records were reviewed to analyze complications. RESULTS: The mean volume after sclerotherapy of the 17 cysts followed for 3-4 months in the acetic acid group was 5.1% of the initial volume, and for the 14 cysts in the ethanol group it was 10.2%. Complete regression during follow-up was shown in 21 cysts (66%) in the acetic acid group; the mean volume of these cysts before the procedure was 245 ml. The mean volume of the nine (32%) completely regressed cysts in the ethanol group was 184 ml. Mild flank pain, which occurred in three patients in each group, was the only complication and resolved the next day. CONCLUSION: Acetic acid was an effective and safe sclerosing agent for renal cysts, tending to induce faster and more complete regression than ethanol.

Acetic Acid↗