Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients ...Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).展开更多
BACKGROUND Esophageal bronchogenic cysts(EBCs)are usually discovered incidentally during radiologic or endoscopic examinations.They are rare and prone to misdiagnosis or mistreatment.As a submucosal lesion,the endosco...BACKGROUND Esophageal bronchogenic cysts(EBCs)are usually discovered incidentally during radiologic or endoscopic examinations.They are rare and prone to misdiagnosis or mistreatment.As a submucosal lesion,the endoscopic ultrasonography(EUS)characteristics of EBCs are unclear.AIM To analyze the clinicopathological and EUS characteristics of EBCs.METHODS A total of 22 patients with a histological diagnosis of EBCs who underwent EUS examination were retrospectively included.The clinicopathological and EUS features were collected and analyzed.RESULTS Most of the EBCs were asymptomatic,and no malignant transformation or precancerous changes was found histologically.Most of the EBCs were located in the lower esophagus(72.7%,16/22).A total of 90.9%(20/22)of the EBCs originated from the muscularis propria,and 9.1%(2/22)originated from the submucosa.All of the lesions had clear boundaries.In terms of echo,77.3%(17/22)had a hypoechoic pattern,and 22.7%(5/22)had an anechoic pattern.We found floating echoes inside the lesion,which presented as a punctiform hyperecho in 45.5%(10/22)and a flocculent hypoecho in 36.4%(8/22)of the patients.A total of 45.5%(10/22)displayed posterior wall enhancement.Fourteen patients underwent color doppler,and no blood flow signal was identified.On EUS elastography,the EBCs presented a yellow-green or green pattern(100%,6/6).When contrast-enhanced EUS was used,the EBCs showed no enhancement(100%,5/5).CONCLUSION When a submucosal lesion located at the lower esophagus originates from the intrinsic muscle layer,the possibility of EBCs should be noted,the EUS characteristics of which include a hypoecho with a clear boundary and a posterior wall enhancement,a floating echo inside and no blood flow signal,a yellow-green or green pattern on elastography,and no enhancement on contrast EUS.展开更多
BACKGROUND Gastric duplication cysts(GDCs)are rare congenital anomalies,and consensus guidelines for their diagnosis and management are currently lacking.We report a rare case of a GDC in a female child presenting as ...BACKGROUND Gastric duplication cysts(GDCs)are rare congenital anomalies,and consensus guidelines for their diagnosis and management are currently lacking.We report a rare case of a GDC in a female child presenting as a submucosal tumor in the gastric antrum.Subtotal resection was achieved using endoscopic submucosal dissection(ESD),resulting in complete symptom relief and pathological confirmation.This case demonstrates the therapeutic potential of ESD for intraluminal GDCs and underscores the importance of complete resection for definitive diagnosis.CASE SUMMARY A 12-year-old girl presented with abdominal distension and pain for>1 year.Gastroscopy revealed a protruding lesion approximately 30 mm in diameter in the gastric antrum.Superficial biopsies revealed moderate chronic inflammation and intestinal metaplasia.Contrast-enhanced computed tomography showed a mass protruding into the gastric lumen with homogeneous cyst wall enhancement.Endoscopic ultrasonography identified a hypoechoic mass originating from the muscularis mucosa.The patient underwent ESD for diagnosis and symptom relief.Intraoperatively,due to firm adhesion between the cyst base and the muscularis propria,selective preservation of the adherent cyst base was performed to mitigate perforation and stenosis risks.Histopathology confirmed a GDC,with cyst lumen lined by gastric-type columnar epithelium and an outer smooth muscle layer.Focal ectopic pancreatic tissues were identified.The patient recovered without complications and remained asymptomatic during 6-month follow-up.Repeat gastroscopy showed the residual cyst wall conforming to antral mucosa,with no recurrence.CONCLUSION Subtotal resection of GDCs using ESD demonstrates a favorable prognosis.展开更多
A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,...A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.展开更多
BACKGROUND Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation.Type IV(which affects the intrahepatic and extrahepatic ducts)is the mo...BACKGROUND Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation.Type IV(which affects the intrahepatic and extrahepatic ducts)is the most common subtype in adults.Its clinical manifestations are diverse and the disease can potentially become malignant.Currently,the mainstay treatment is surgical excision which is used as a definitive treatment to prevent complications and avoid carcinogenesis.However,the surgical operation for giant choledochal cysts is technically challenging.CASE SUMMARY Here,we present a case of a giant choledochal cyst in an 18-year-old female.The diagnosis of patient was confirmed through magnetic resonance cholangiopancreatography.The patient developed acute cholangitis,and was treated with percutaneous transhepatic cholangial drainage to alleviate symptoms.The final treatment approach was cyst excision followed by Roux-en-Y hepaticojejunostomy,which successfully achieved excellent postoperative recovery.CONCLUSION Ultrasonography and magnetic resonance cholangiopancreatography can effectively diagnose choledochal cysts.Combined percutaneous transhepatic cholangial drainage surgery for giant choledochal cysts is safe and effective.展开更多
BACKGROUND Aneurysmal bone cysts(ABCs)are usually treated with curettage or various minimally invasive percutaneous procedures.Patient refractory to these treatments,as well as those with locally advanced or unresecta...BACKGROUND Aneurysmal bone cysts(ABCs)are usually treated with curettage or various minimally invasive percutaneous procedures.Patient refractory to these treatments,as well as those with locally advanced or unresectable tumors,present a challenge for orthopedic surgeons and require new treatment approaches.Antiresorptive drugs inhibit osteoclastic resorption and increase intralesional osteogenesis.Denosumab induces tumor ossification,but this effect may disappear after drug withdrawal due to limited impact on neoplastic cells.Bisphosphonates(BPs)may induce apoptosis of tumor cells and allow for long-term local control.We hypothesized that after denosumab treatment,BPs would better accumulate in the tumor and exert an irreversible antitumor effect.AIM To test the hypothesis that the sequential use of BPs after denosumab induction improves treatment outcomes in surgically unsalvageable ABCs.METHODS Using data from five electronic databases(Scopus,MEDLINE,EMBASE,PubMed,Web of Science),we aimed to identify all patients who received denosumab therapy(DT)for unresectable ABCs.Among published case reports and case series,we identified patients who discontinued denosumab for various reasons and divided them into two groups:Group 1 included 31 patients without further anti-resorptive therapy and Group 2 included 12 patients who received BPs in the context of rebound hypercalcemia.Local control rates in both groups were analyzed.RESULTS As of December 2024,43 patients have been reported in the literature who received DT for locally advanced/unresectable ABCs.There were 27 males and 16 females with a mean age of 15.8 years.At a median follow-up time of 15.5 months,there were 10 confirmed and two pathologically unconfirmed relapses after denosumab discontinuation.All 10 relapses occurred in patients in Group 1 at a median time of 13.5 months.Among patients in Group 2,with a median follow-up time of 12.5 months after completion of therapy,no local relapses were observed.The difference between local recurrence rates(32%vs 0%)is statistically significant(P value=0.02).Kaplan-Meier estimates show the same trend with marginal statistical significance(P value=0.085).Here we put forward a novel treatment algorithm.CONCLUSION BPs used in post-denosumab ossifying ABCs appear to improve treatment outcomes,presumably by targeting residual tumor cells.Prospective clinical studies are warranted to validate this promising two-stage conceptual strategy in difficult-to-treat ABC.展开更多
BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these obser...BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these observations remain unclear.Additionally,research on the etiology of SBC remains inconclusive,and there has been no consensus on the appropriate timing and methodology for treatment.CASE SUMMARY Here,we present our experience in the successful surgical management of a 10-year-old girl with SBC,who presented with a pathological fracture complicated by malunion of the displaced fracture,varus deformity,and limb length discrepancy.We hypothesized two possible etiologies for the patient’s growth arrest and subsequent humerus varus deformity:(1)Direct disruption of the physis by fluid from the cyst itself;and(2)damage to the epiphysis due to repetitive pathological fractures associated with SBC.In addressing this case,surgical intervention was undertaken to correct the proximal humerus varus deformity.This approach offered the advantages of simultaneously correcting angular abnormalities,achieving mild limb lengthening,providing definitive SBC treatment,and reducing the overall treatment duration.CONCLUSION As per current literature,acute correction of acute angular deformity in proximal humeral SBC is not well comprehended.However,in this specific case,acute correction was considered an optimal solution.展开更多
BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation.It is usually characterized by well-defined cystic density and is filled with t...BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation.It is usually characterized by well-defined cystic density and is filled with transparent liquid.CASE SUMMARY We report on a 39-year-old male with a cystic-solid mass in the anterior mediastinum.Computer tomography(CT)imaging showed that the mass was irregular with unclear boundaries.After injection of contrast agent,there was a slight enhancement of stripes and nodules.According to CT findings,it was diagnosed as thymic cancer.CONCLUSION After surgery,MTC accompanied by bleeding and infection was confirmed by pathological examination.The main lesson of this case was that malignant thymic tumor and MTC of the anterior mediastinum sometimes exhibit similar CT findings.Caution is necessary in clinical work to avoid misdiagnosis.展开更多
Background Follicular cysts contribute significantly to reproductive loss in high-yield dairy cows.This results from the death of follicular granulosa cells(GCs)caused by oxidative stress.Quercetin is known to have si...Background Follicular cysts contribute significantly to reproductive loss in high-yield dairy cows.This results from the death of follicular granulosa cells(GCs)caused by oxidative stress.Quercetin is known to have significant antioxidant and anti-apoptotic effects.However,the effect of quercetin on follicular cysts has yet been elucidated.Therefore,this study aimed to explore the anti-oxidant and anti-apoptosis effects and potential molecular mechanisms of quercetin in H_(2)O_(2)-induced primary cow GCs and 3-nitropropionic acid(3-NPA)-induced mouse model of oxidative stress and thus treat ovarian cysts in dairy cows.Results In this study,compared with estrus cows,cows with follicular cysts showed heightened levels of oxidative stress and increased follicular cell apoptosis,while autophagy levels were reduced.A model of oxidative stress was induced in vitro by H_(2)O_(2)and showed significant increases in apoptosis together with reduced autophagy.These effects were significantly ameliorated by quercetin.Effects similar to those of quercetin were observed after treatmeat of cells with the reactive oxygen species(RCS)inhibitor N-acetylcysteine(NAC).Further investigations using chloroquine(autophagy inhibito r)]rapamycin(autophagy activato r),selisistat(SIRT1 inhibito r),and compound C(AMPK inhibitor)showed that chloroquine counteracted the effects of quercetin on oxidative stress-induced apoptosis,while rapamycin had the same effect as quercetin.In addition,the SIRT1/AMPK pathway inhibitors antagonized quercetin-mediated mitigation of the effects of oxidative stress on increased apoptosis and reduced autophagy.Consistent with the results in vitro,in mouse ovarian oxidative stress model induced by 3-NPA,quercetin activated autophagy through the SIRT1/AMPK signaling pathway,while alleviating oxidative stress damage and inhibiting apoptosis in mouse ovaries.Conclusions These findings indicate that quercetin can inhibit apoptosis in GCs and restore ovarian function by activating autophagy through the SIRT1/ROS/AMPK signaling pathway,suggesting a new direction for the treatment of ovarian follicular cysts in high-yield dairy cows.展开更多
This editorial provides insights from a case report by Sun et al published in the World Journal of Clinical Cases.The case report focuses on a case where a multilocular thymic cyst(MTC)was misdiagnosed as a thymic tum...This editorial provides insights from a case report by Sun et al published in the World Journal of Clinical Cases.The case report focuses on a case where a multilocular thymic cyst(MTC)was misdiagnosed as a thymic tumor,resulting in an unnecessary surgical procedure.Both MTCs and thymic tumors are rare conditions that heavily rely on radiological imaging for accurate diagnosis.However,the similarity in their imaging presentations can lead to misinterpretation,resulting in unnecessary surgical procedures.Due to the ongoing lack of comprehensive knowledge about MTCs and thymic tumors,we offer a summary of diagnostic techniques documented in recent literature and examine potential causes of misdiagnosis.When computer tomography(CT)values surpass 20 Hounsfield units and display comparable morphology,there is a risk of misdiagnosing MTCs as thymic tumors.Employing various differential diagnostic methods like biopsy,molecular biology,multi-slice CT,CT functional imaging,positron emission tomography/CT molecular functional imaging,magnetic resonance imaging and radiomics,proves advantageous in reducing clinical misdiagnosis.A deeper understanding of these conditions requires increased attention and exploration by healthcare providers.Moreover,the continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.展开更多
BACKGROUND Various animal models have been used to explore the pathogenesis of choledochal cysts(CCs),but with little convincing results.Current surgical techniques can achieve satisfactory outcomes for treatment of C...BACKGROUND Various animal models have been used to explore the pathogenesis of choledochal cysts(CCs),but with little convincing results.Current surgical techniques can achieve satisfactory outcomes for treatment of CCs.Consequently,recent studies have focused more on clinical issues rather than basic research.Therefore,we need appropriate animal models to further basic research.AIM To establish an appropriate animal model that may contribute to the investigation of the pathogenesis of CCs.METHODS Eighty-four specific pathogen-free female Sprague-Dawley rats were randomly allocated to a surgical group,sham surgical group,or control group.A rat model of CC was established by partial ligation of the bile duct.The reliability of the model was confirmed by measurements of serum biochemical indices,morpho-logy of common bile ducts of the rats as well as molecular biology experiments in rat and human tissues.RESULTS Dilation classified as mild(diameter,≥1 mm to<3 mm),moderate(≥3 mm to<10 mm),and severe(≥10 mm)was observed in 17,17,and 2 rats in the surgical group,respectively,while no dilation was observed in the control and sham surgical groups.Serum levels of alanine aminotransferase,aspartate aminotrans-ferase,total bilirubin,direct bilirubin,and total bile acids were significantly elevated in the surgical group as compared to the control group 7 d after surgery,while direct bilirubin,total bilirubin,and gamma-glutamyltransferase were further increased 14 d after surgery.Most of the biochemical indices gradually decreased to normal ranges 28 d after surgery.The protein expression trend of signal transducer and activator of transcription 3 in rat model was consistent with the human CC tissues.CONCLUSION The model of partial ligation of the bile duct of juvenile rats could morphologically simulate the cystic or fusiform CC,which may contribute to investigating the pathogenesis of CC.展开更多
BACKGROUND Congenital enteric duplication cysts are tubular or cystic structures that normally lie alongside the gastrointestinal(GI)tract.Enteric duplication cysts are typically solitary lesions that occur anywhere n...BACKGROUND Congenital enteric duplication cysts are tubular or cystic structures that normally lie alongside the gastrointestinal(GI)tract.Enteric duplication cysts are typically solitary lesions that occur anywhere near the GI tract from the neck to the rectum,but having multiple duplication cysts is rare,and presentation within the pancreas is extremely rare.CASE SUMMARY We herein demonstrate a case of esophageal,gastric,and gastric-type duplication cyst of the pancreas in a seventeen-month-old girl who presented with failure to thrive,abdominal pain,vomiting,hematemesis,and melena since the age of three months.The cysts were excised by thoracoscopy and laparoscopy in the same setting.To our knowledge,no such case has been published.CONCLUSION Enteric duplications can occur throughout the entire alimentary tract.When they occur in the pancreas,they present a formidable challenge in both diagnosis and treatment.Due to the risk of complications and malignant transformation,surgical removal is the recommended treatment of all duplication cysts.展开更多
Introduction: Synovial cyst of the tibial tunnel in connection with anterior cruciate ligament (ACL) reconstruction is a rare but particularly troublesome complication. Medical treatment is often doomed to failure, an...Introduction: Synovial cyst of the tibial tunnel in connection with anterior cruciate ligament (ACL) reconstruction is a rare but particularly troublesome complication. Medical treatment is often doomed to failure, and surgical treatment usually consists of excising the cyst and filling the tunnel with bone. The aim of this study was to evaluate the results of filling the tunnel with acrylic cement. Hypothesis: Filling the tibial bone tunnel with acrylic cement should eliminate communication between the joint cavity and the pre-tibial surface and prevent cyst recurrence. Patients and Methods: This retrospective series is composed of 13 patients, 9 men and 4 women, mean age 48.5 years (31 to 64) operated on between 2011 and 2019 for an intra- and extraosseous synovial cyst consecutive to the tibial tunnel of an ACL graft. Between 1983 and 2016, 12 of the patients had had a bone graft without bone block fixation (DI-DT or Mac Intosh) and one patient, a bone-bone transplant (KJ). The cyst was of variable size, located on the anteromedial aspect of the proximal end of the tibia, and often painful, warranting consultation. At the time of the initial operation, 9 patients had undergone meniscectomies (6 medial, 2 lateral, 1 double). In 7 knees, there were 7 cartilage lesions in the femorotibial and/or patellofemoral compartments (one stage 1 lesion, 2 stage 2 lesions, 4 stage 3 lesions, and no stage 4 lesions). Only 2 knees had neither cartilage nor meniscus lesions. After curettage of the bone tunnel /− removal of the non-resorbed or PEEK interference screw, the tunnel was filled with acrylic cement /− reinforced with a ligament staple to prevent expulsion. All patients underwent regular follow-up consultations until recovery. Results: At a maximum follow-up of 8 years, only 1 cyst recurred, representing a 7.69% failure rate. It was reoperated with another technique, which involved filling the tibial bone tunnel with bone graft taken from a half-bank head. After recovery, the cyst healed definitively. All patients were able to return to their previous activity within 15 days of surgery. Conclusion: Filling the tibial tunnel with acrylic cement reinforced /− with a ligament staple is a reliable and rapid solution for the treatment of intra- and extra-articular synovial cysts in relation to the tibial tunnel of ACL grafts.展开更多
Thirty species of dinoflagellate cysts in 15 genus are identified from KMZK5 Core samples of recent marine sediment at the Luoyuan Bay mouth, Fujian. All of these dinoflagellate cysts are first recorded in the Luyuan ...Thirty species of dinoflagellate cysts in 15 genus are identified from KMZK5 Core samples of recent marine sediment at the Luoyuan Bay mouth, Fujian. All of these dinoflagellate cysts are first recorded in the Luyuan Bay, 12 species of them are not distributing in the near sea area such as Sansha Bay and Minjiang estuary, including 6 kinds of toxic species, such as Alexandrium affine, A. minutum, A. tamarense, Gonyaulax spinifera, Gymnodinium catenatum and Scrippsiella trochoidea. The abundance and vertical distribution characterestics of the main and the toxic dinoflgellate cysts are also studied in the paper.展开更多
Objective: Vacuolating megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a recently described syndrome with autosomal recessive mode of inheritance. Its possible gene was located on chromosomal 22q ...Objective: Vacuolating megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a recently described syndrome with autosomal recessive mode of inheritance. Its possible gene was located on chromosomal 22q tel with 3-cM. The purpose of this study was to narrow down the genetical distance on chromosomal 22q tel with MLC. Methods: Thirty-nine MLC patients in 33 families were collected,and the linkage analysis and haplotype analysis of twelve informative families were done, using seven microsatellite markers and four SNP markers. Results: The maximum tow-point LOD score for marker 355c18 was 6.65 at recombination fraction 0.02. The haplotype analysis narrowed down the critical region of MLC to 250 kb on chromosomal 22q tel. Conclusion: One of the causing genes of MLC was located on chromosomal 22q tel with 250 kb. Four candidate genes were considered. The heterogeneity of one informative family indicated possible existence of a second locus for MLC.展开更多
Biliary cysts(BC) are rare dilatations of different parts of a biliary tract.They account for approximately 1% of all benign biliary diseases.BC occur the most frequently in Asian and female populations.They are an im...Biliary cysts(BC) are rare dilatations of different parts of a biliary tract.They account for approximately 1% of all benign biliary diseases.BC occur the most frequently in Asian and female populations.They are an important problem for pediatricians,gastroenterologists,radiologists and surgeons.Clinical presentation and management depend on the BC type.Cholangiocarcinoma is the most serious and dangerous BC complication.The other complications associated with BC involve cholelithiasis and hepatolithiasis,cholangitis,acute and chronic pancreatitis,portal hypertension,liver fibrosis and secondary liver cirrhosis and spontaneous cyst perforation.Different BC classifications have been described in the literature.Todani classification dividing BC into five types is the most useful in clinical practice.The early diagnosis and proper treatment are very important,because BC are associated with a risk of carcinogenesis.A malignancy risk increases with the age.Radiological investigations(ultrasonography,computed tomography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography) play an important role in BC diagnostics.Currently,prenatal diagnosis using ultrasonography is possible.It allows to differentiate biliary disorders in fetals and to perform the early surgical treatment that improves results.In most patients,total cyst excision with Roux-Y hepaticojejunostomy is the treatment of choice.Surgical treat-ment of BC is associated with high success rate and low morbidity and mortality.The early treatment is associated with a lower number of complications.Patients following BC surgery require permanent and careful postoperative observation using laboratory and imaging investigations because of possibility of biliary anastomosis stricture and biliary cancer in tissue remnant.展开更多
AIM: To determine whether the outcomes of laparoscopic fenestration (LF) were superior to open fenestration (OF) for congenital liver cysts.METHODS: Comparative studies published between January 1991 and May 2010 on M...AIM: To determine whether the outcomes of laparoscopic fenestration (LF) were superior to open fenestration (OF) for congenital liver cysts.METHODS: Comparative studies published between January 1991 and May 2010 on Medline (Ovid),Emsco,PubMed,Science Direct;Cochrane Reviews;CNKI;Chinese Biomedical Database,VIP and other electronic databases were searched.Randomized controlled trials (RCTs) and retrospective case-control studies on the management of congenital hepatic cysts were collected according to the pre-determined eligibility criteria to establish a literature database.Retrieval was ended in May 2010.Meta-analysis was performed using RevMan 5.0 software (Cochrane library).RESULTS: Nine retrospective case-control studies involving 657 patients,comparing LF with OF were included for the final pooled analysis.The meta-analysis results showed less operative time [mean difference (MD): -28.76,95% CI: -31.03 to 26.49,P < 0.00001];shorter hospital stay (MD: -3.35,95% CI: -4.46 to -2.24,P < 0.00001);less intraoperative blood loss (MD: -40.18,95% CI: -52.54 to -27.82,P < 0.00001);earlier return to regular diet (MD: -29.19,95% CI: -30.65 to -27.72,P < 0.00001) and activities after operation (MD: -21.85,95% CI: -31.18 to -12.51,P < 0.0001) in LF group;there was no significant difference between the two groups in postoperative complications (odds ratio: 0.99,95% CI: 0.41 to 2.38,P = 0.98) and cysts recurrence rates.CONCLUSION: The short-term outcomes of LF for patients with congenital hepatic cysts were superior to open approach,but its long-term outcomes should be verified by further RCTs and extended follow-up.展开更多
BACKGROUND: The traditional therapy for hepatic cysts has limited success because of recrudescence. Radiofrequency ablation (RFA) has become popular because of its advantages including little damage, therapeutic effec...BACKGROUND: The traditional therapy for hepatic cysts has limited success because of recrudescence. Radiofrequency ablation (RFA) has become popular because of its advantages including little damage, therapeutic effect and reduced suffering. This report describes the effects and reliability of RFA in the treatment of 29 patients with hepatic cysts. METHODS: B-ultrasound-guided REA was used to treat hepatic mono-cyst or multi-cysts of 29 patients (63 tumors). Ablative efficiency and complications were assessed by imaging and clinical symptoms. RESULTS: The tumors were abated completely in 34 cysts with a diameter <5 cm and no recurrence was seen after 3 months. In 21 cysts with a diameter of 5-10 cm, tumor volume was decreased by over 70%, then reduction and fiberosis were found. In 8 cysts with a diameter greater than 10 cm, tumor volume was decreased by more than 60%, and in 2 cysts it was increased more slightly than that at I month after REA. In subsequent follow-up (6 and 12 months after REA), tumors <10 cm in diameter were fully ablated. No significant discomfort and complications were found in any patient. CONCLUSION: RFA for the treatment of hepatic cysts is safe, and free from complications.展开更多
Liver cysts are common,affecting 5%-10% of the population.Most are asymptomatic,however 5% of patients develop symptoms,sometimes due to complications and will require intervention.There is no consensus on their manag...Liver cysts are common,affecting 5%-10% of the population.Most are asymptomatic,however 5% of patients develop symptoms,sometimes due to complications and will require intervention.There is no consensus on their management because complications are so uncommon.The aim of this study was to perform a collected review of how a series of complications were managed at our institutions.Six different patients presenting with rare complications of liver cysts were obtained from Hepatobiliary Units in the United Kingdom and The Netherlands.History and radiological imaging were obtained from case notes and computerised radiology.As a result,1 patient admitted with inferior vena cava obstruction was managed by cyst aspiration and lanreotide;1 patient with common bile duct obstruction was first managed by endoscopic retrograde cholangiopancreatography and stenting,followed by open fenestration;1 patient with ruptured cysts and significant medical co-morbidities was managed by percutaneous drainage;1 patient with portal vein occlusion and varices was managed by open liver resection;1 patient with infected cysts was treated with intravenous antibiotics and is awaiting liver transplantation.The final patient with a simple liver cyst mimicking a hydatid was managed by open liver resection.In conclusion,complications of cystic liver disease are rare,and we have demonstrated in this series that both operative and non-operative strategies have defined roles in management.The mainstays of treatment are either aspiration/sclerotherapy or,alternatively laparoscopic fenestration.Medical management with somatostatin analogues is a potentially new and exciting treatment option but requires further study.展开更多
Technological advances and the widespread use of medical imaging have led to an increase in the identification of pancreatic cysts in patients who undergo crosssectional imaging. Current methods for the diagnosis and ...Technological advances and the widespread use of medical imaging have led to an increase in the identification of pancreatic cysts in patients who undergo crosssectional imaging. Current methods for the diagnosis and risk-stratification of pancreatic cysts are suboptimal, resulting in both unnecessary surgical resection and overlooked cases of neoplasia. Accurate diagnosis is crucial for guiding how a pancreatic cyst is managed, whether with surveillance for low-risk lesions or surgical resection for high-risk lesions. This review aims to summarize the current literature on confocal endomicroscopy and cyst fluid molecular analysis for the evaluation of pancreatic cysts. These recent technologies are promising adjuncts to existing approaches with the potential to improve diagnostic accuracy and ultimately patient outcomes.展开更多
文摘Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).
基金Supported by Zhejiang Provincial Medical and Health Science and Technology Project,No.2022-KY1-001-198.
文摘BACKGROUND Esophageal bronchogenic cysts(EBCs)are usually discovered incidentally during radiologic or endoscopic examinations.They are rare and prone to misdiagnosis or mistreatment.As a submucosal lesion,the endoscopic ultrasonography(EUS)characteristics of EBCs are unclear.AIM To analyze the clinicopathological and EUS characteristics of EBCs.METHODS A total of 22 patients with a histological diagnosis of EBCs who underwent EUS examination were retrospectively included.The clinicopathological and EUS features were collected and analyzed.RESULTS Most of the EBCs were asymptomatic,and no malignant transformation or precancerous changes was found histologically.Most of the EBCs were located in the lower esophagus(72.7%,16/22).A total of 90.9%(20/22)of the EBCs originated from the muscularis propria,and 9.1%(2/22)originated from the submucosa.All of the lesions had clear boundaries.In terms of echo,77.3%(17/22)had a hypoechoic pattern,and 22.7%(5/22)had an anechoic pattern.We found floating echoes inside the lesion,which presented as a punctiform hyperecho in 45.5%(10/22)and a flocculent hypoecho in 36.4%(8/22)of the patients.A total of 45.5%(10/22)displayed posterior wall enhancement.Fourteen patients underwent color doppler,and no blood flow signal was identified.On EUS elastography,the EBCs presented a yellow-green or green pattern(100%,6/6).When contrast-enhanced EUS was used,the EBCs showed no enhancement(100%,5/5).CONCLUSION When a submucosal lesion located at the lower esophagus originates from the intrinsic muscle layer,the possibility of EBCs should be noted,the EUS characteristics of which include a hypoecho with a clear boundary and a posterior wall enhancement,a floating echo inside and no blood flow signal,a yellow-green or green pattern on elastography,and no enhancement on contrast EUS.
文摘BACKGROUND Gastric duplication cysts(GDCs)are rare congenital anomalies,and consensus guidelines for their diagnosis and management are currently lacking.We report a rare case of a GDC in a female child presenting as a submucosal tumor in the gastric antrum.Subtotal resection was achieved using endoscopic submucosal dissection(ESD),resulting in complete symptom relief and pathological confirmation.This case demonstrates the therapeutic potential of ESD for intraluminal GDCs and underscores the importance of complete resection for definitive diagnosis.CASE SUMMARY A 12-year-old girl presented with abdominal distension and pain for>1 year.Gastroscopy revealed a protruding lesion approximately 30 mm in diameter in the gastric antrum.Superficial biopsies revealed moderate chronic inflammation and intestinal metaplasia.Contrast-enhanced computed tomography showed a mass protruding into the gastric lumen with homogeneous cyst wall enhancement.Endoscopic ultrasonography identified a hypoechoic mass originating from the muscularis mucosa.The patient underwent ESD for diagnosis and symptom relief.Intraoperatively,due to firm adhesion between the cyst base and the muscularis propria,selective preservation of the adherent cyst base was performed to mitigate perforation and stenosis risks.Histopathology confirmed a GDC,with cyst lumen lined by gastric-type columnar epithelium and an outer smooth muscle layer.Focal ectopic pancreatic tissues were identified.The patient recovered without complications and remained asymptomatic during 6-month follow-up.Repeat gastroscopy showed the residual cyst wall conforming to antral mucosa,with no recurrence.CONCLUSION Subtotal resection of GDCs using ESD demonstrates a favorable prognosis.
文摘A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.
基金Supported by Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital,No.CY2024-MS-B04Gansu Provincial Natural Science Foundation Project,No.24JRRA331the Traditional Chinese Medicine Research Project of Gansu Province,No.GZKZ-2024-26.
文摘BACKGROUND Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation.Type IV(which affects the intrahepatic and extrahepatic ducts)is the most common subtype in adults.Its clinical manifestations are diverse and the disease can potentially become malignant.Currently,the mainstay treatment is surgical excision which is used as a definitive treatment to prevent complications and avoid carcinogenesis.However,the surgical operation for giant choledochal cysts is technically challenging.CASE SUMMARY Here,we present a case of a giant choledochal cyst in an 18-year-old female.The diagnosis of patient was confirmed through magnetic resonance cholangiopancreatography.The patient developed acute cholangitis,and was treated with percutaneous transhepatic cholangial drainage to alleviate symptoms.The final treatment approach was cyst excision followed by Roux-en-Y hepaticojejunostomy,which successfully achieved excellent postoperative recovery.CONCLUSION Ultrasonography and magnetic resonance cholangiopancreatography can effectively diagnose choledochal cysts.Combined percutaneous transhepatic cholangial drainage surgery for giant choledochal cysts is safe and effective.
文摘BACKGROUND Aneurysmal bone cysts(ABCs)are usually treated with curettage or various minimally invasive percutaneous procedures.Patient refractory to these treatments,as well as those with locally advanced or unresectable tumors,present a challenge for orthopedic surgeons and require new treatment approaches.Antiresorptive drugs inhibit osteoclastic resorption and increase intralesional osteogenesis.Denosumab induces tumor ossification,but this effect may disappear after drug withdrawal due to limited impact on neoplastic cells.Bisphosphonates(BPs)may induce apoptosis of tumor cells and allow for long-term local control.We hypothesized that after denosumab treatment,BPs would better accumulate in the tumor and exert an irreversible antitumor effect.AIM To test the hypothesis that the sequential use of BPs after denosumab induction improves treatment outcomes in surgically unsalvageable ABCs.METHODS Using data from five electronic databases(Scopus,MEDLINE,EMBASE,PubMed,Web of Science),we aimed to identify all patients who received denosumab therapy(DT)for unresectable ABCs.Among published case reports and case series,we identified patients who discontinued denosumab for various reasons and divided them into two groups:Group 1 included 31 patients without further anti-resorptive therapy and Group 2 included 12 patients who received BPs in the context of rebound hypercalcemia.Local control rates in both groups were analyzed.RESULTS As of December 2024,43 patients have been reported in the literature who received DT for locally advanced/unresectable ABCs.There were 27 males and 16 females with a mean age of 15.8 years.At a median follow-up time of 15.5 months,there were 10 confirmed and two pathologically unconfirmed relapses after denosumab discontinuation.All 10 relapses occurred in patients in Group 1 at a median time of 13.5 months.Among patients in Group 2,with a median follow-up time of 12.5 months after completion of therapy,no local relapses were observed.The difference between local recurrence rates(32%vs 0%)is statistically significant(P value=0.02).Kaplan-Meier estimates show the same trend with marginal statistical significance(P value=0.085).Here we put forward a novel treatment algorithm.CONCLUSION BPs used in post-denosumab ossifying ABCs appear to improve treatment outcomes,presumably by targeting residual tumor cells.Prospective clinical studies are warranted to validate this promising two-stage conceptual strategy in difficult-to-treat ABC.
文摘BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these observations remain unclear.Additionally,research on the etiology of SBC remains inconclusive,and there has been no consensus on the appropriate timing and methodology for treatment.CASE SUMMARY Here,we present our experience in the successful surgical management of a 10-year-old girl with SBC,who presented with a pathological fracture complicated by malunion of the displaced fracture,varus deformity,and limb length discrepancy.We hypothesized two possible etiologies for the patient’s growth arrest and subsequent humerus varus deformity:(1)Direct disruption of the physis by fluid from the cyst itself;and(2)damage to the epiphysis due to repetitive pathological fractures associated with SBC.In addressing this case,surgical intervention was undertaken to correct the proximal humerus varus deformity.This approach offered the advantages of simultaneously correcting angular abnormalities,achieving mild limb lengthening,providing definitive SBC treatment,and reducing the overall treatment duration.CONCLUSION As per current literature,acute correction of acute angular deformity in proximal humeral SBC is not well comprehended.However,in this specific case,acute correction was considered an optimal solution.
文摘BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation.It is usually characterized by well-defined cystic density and is filled with transparent liquid.CASE SUMMARY We report on a 39-year-old male with a cystic-solid mass in the anterior mediastinum.Computer tomography(CT)imaging showed that the mass was irregular with unclear boundaries.After injection of contrast agent,there was a slight enhancement of stripes and nodules.According to CT findings,it was diagnosed as thymic cancer.CONCLUSION After surgery,MTC accompanied by bleeding and infection was confirmed by pathological examination.The main lesson of this case was that malignant thymic tumor and MTC of the anterior mediastinum sometimes exhibit similar CT findings.Caution is necessary in clinical work to avoid misdiagnosis.
基金supported by the Science and Technology Department of Gansu Province(21JR7RA858)the National Natural Science Foundation of China(32160858)+2 种基金Gansu Youth Science and Technology Fund Program(21JR7RA843)the Beijing University of Agriculture Youth Science Innovation Ability Improvement Project(QJKC2022007)Research Project of Guangdong Vocational College of Science and Trade(GDKM2022-96)。
文摘Background Follicular cysts contribute significantly to reproductive loss in high-yield dairy cows.This results from the death of follicular granulosa cells(GCs)caused by oxidative stress.Quercetin is known to have significant antioxidant and anti-apoptotic effects.However,the effect of quercetin on follicular cysts has yet been elucidated.Therefore,this study aimed to explore the anti-oxidant and anti-apoptosis effects and potential molecular mechanisms of quercetin in H_(2)O_(2)-induced primary cow GCs and 3-nitropropionic acid(3-NPA)-induced mouse model of oxidative stress and thus treat ovarian cysts in dairy cows.Results In this study,compared with estrus cows,cows with follicular cysts showed heightened levels of oxidative stress and increased follicular cell apoptosis,while autophagy levels were reduced.A model of oxidative stress was induced in vitro by H_(2)O_(2)and showed significant increases in apoptosis together with reduced autophagy.These effects were significantly ameliorated by quercetin.Effects similar to those of quercetin were observed after treatmeat of cells with the reactive oxygen species(RCS)inhibitor N-acetylcysteine(NAC).Further investigations using chloroquine(autophagy inhibito r)]rapamycin(autophagy activato r),selisistat(SIRT1 inhibito r),and compound C(AMPK inhibitor)showed that chloroquine counteracted the effects of quercetin on oxidative stress-induced apoptosis,while rapamycin had the same effect as quercetin.In addition,the SIRT1/AMPK pathway inhibitors antagonized quercetin-mediated mitigation of the effects of oxidative stress on increased apoptosis and reduced autophagy.Consistent with the results in vitro,in mouse ovarian oxidative stress model induced by 3-NPA,quercetin activated autophagy through the SIRT1/AMPK signaling pathway,while alleviating oxidative stress damage and inhibiting apoptosis in mouse ovaries.Conclusions These findings indicate that quercetin can inhibit apoptosis in GCs and restore ovarian function by activating autophagy through the SIRT1/ROS/AMPK signaling pathway,suggesting a new direction for the treatment of ovarian follicular cysts in high-yield dairy cows.
基金Project of Special Funds for Science and Technology Cooperation in Guizhou Provinces and Zunyi City,No.Shengshikehe(2015)53.
文摘This editorial provides insights from a case report by Sun et al published in the World Journal of Clinical Cases.The case report focuses on a case where a multilocular thymic cyst(MTC)was misdiagnosed as a thymic tumor,resulting in an unnecessary surgical procedure.Both MTCs and thymic tumors are rare conditions that heavily rely on radiological imaging for accurate diagnosis.However,the similarity in their imaging presentations can lead to misinterpretation,resulting in unnecessary surgical procedures.Due to the ongoing lack of comprehensive knowledge about MTCs and thymic tumors,we offer a summary of diagnostic techniques documented in recent literature and examine potential causes of misdiagnosis.When computer tomography(CT)values surpass 20 Hounsfield units and display comparable morphology,there is a risk of misdiagnosing MTCs as thymic tumors.Employing various differential diagnostic methods like biopsy,molecular biology,multi-slice CT,CT functional imaging,positron emission tomography/CT molecular functional imaging,magnetic resonance imaging and radiomics,proves advantageous in reducing clinical misdiagnosis.A deeper understanding of these conditions requires increased attention and exploration by healthcare providers.Moreover,the continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.
基金the Key R&D Program of Zhejiang,No.2023C03029Health Science and Technology Plan of Zhejiang Province,No.2022RC201Zhejiang Provincial Natural Science Foundation Project,No.LY20H030007.
文摘BACKGROUND Various animal models have been used to explore the pathogenesis of choledochal cysts(CCs),but with little convincing results.Current surgical techniques can achieve satisfactory outcomes for treatment of CCs.Consequently,recent studies have focused more on clinical issues rather than basic research.Therefore,we need appropriate animal models to further basic research.AIM To establish an appropriate animal model that may contribute to the investigation of the pathogenesis of CCs.METHODS Eighty-four specific pathogen-free female Sprague-Dawley rats were randomly allocated to a surgical group,sham surgical group,or control group.A rat model of CC was established by partial ligation of the bile duct.The reliability of the model was confirmed by measurements of serum biochemical indices,morpho-logy of common bile ducts of the rats as well as molecular biology experiments in rat and human tissues.RESULTS Dilation classified as mild(diameter,≥1 mm to<3 mm),moderate(≥3 mm to<10 mm),and severe(≥10 mm)was observed in 17,17,and 2 rats in the surgical group,respectively,while no dilation was observed in the control and sham surgical groups.Serum levels of alanine aminotransferase,aspartate aminotrans-ferase,total bilirubin,direct bilirubin,and total bile acids were significantly elevated in the surgical group as compared to the control group 7 d after surgery,while direct bilirubin,total bilirubin,and gamma-glutamyltransferase were further increased 14 d after surgery.Most of the biochemical indices gradually decreased to normal ranges 28 d after surgery.The protein expression trend of signal transducer and activator of transcription 3 in rat model was consistent with the human CC tissues.CONCLUSION The model of partial ligation of the bile duct of juvenile rats could morphologically simulate the cystic or fusiform CC,which may contribute to investigating the pathogenesis of CC.
文摘BACKGROUND Congenital enteric duplication cysts are tubular or cystic structures that normally lie alongside the gastrointestinal(GI)tract.Enteric duplication cysts are typically solitary lesions that occur anywhere near the GI tract from the neck to the rectum,but having multiple duplication cysts is rare,and presentation within the pancreas is extremely rare.CASE SUMMARY We herein demonstrate a case of esophageal,gastric,and gastric-type duplication cyst of the pancreas in a seventeen-month-old girl who presented with failure to thrive,abdominal pain,vomiting,hematemesis,and melena since the age of three months.The cysts were excised by thoracoscopy and laparoscopy in the same setting.To our knowledge,no such case has been published.CONCLUSION Enteric duplications can occur throughout the entire alimentary tract.When they occur in the pancreas,they present a formidable challenge in both diagnosis and treatment.Due to the risk of complications and malignant transformation,surgical removal is the recommended treatment of all duplication cysts.
文摘Introduction: Synovial cyst of the tibial tunnel in connection with anterior cruciate ligament (ACL) reconstruction is a rare but particularly troublesome complication. Medical treatment is often doomed to failure, and surgical treatment usually consists of excising the cyst and filling the tunnel with bone. The aim of this study was to evaluate the results of filling the tunnel with acrylic cement. Hypothesis: Filling the tibial bone tunnel with acrylic cement should eliminate communication between the joint cavity and the pre-tibial surface and prevent cyst recurrence. Patients and Methods: This retrospective series is composed of 13 patients, 9 men and 4 women, mean age 48.5 years (31 to 64) operated on between 2011 and 2019 for an intra- and extraosseous synovial cyst consecutive to the tibial tunnel of an ACL graft. Between 1983 and 2016, 12 of the patients had had a bone graft without bone block fixation (DI-DT or Mac Intosh) and one patient, a bone-bone transplant (KJ). The cyst was of variable size, located on the anteromedial aspect of the proximal end of the tibia, and often painful, warranting consultation. At the time of the initial operation, 9 patients had undergone meniscectomies (6 medial, 2 lateral, 1 double). In 7 knees, there were 7 cartilage lesions in the femorotibial and/or patellofemoral compartments (one stage 1 lesion, 2 stage 2 lesions, 4 stage 3 lesions, and no stage 4 lesions). Only 2 knees had neither cartilage nor meniscus lesions. After curettage of the bone tunnel /− removal of the non-resorbed or PEEK interference screw, the tunnel was filled with acrylic cement /− reinforced with a ligament staple to prevent expulsion. All patients underwent regular follow-up consultations until recovery. Results: At a maximum follow-up of 8 years, only 1 cyst recurred, representing a 7.69% failure rate. It was reoperated with another technique, which involved filling the tibial bone tunnel with bone graft taken from a half-bank head. After recovery, the cyst healed definitively. All patients were able to return to their previous activity within 15 days of surgery. Conclusion: Filling the tibial tunnel with acrylic cement reinforced /− with a ligament staple is a reliable and rapid solution for the treatment of intra- and extra-articular synovial cysts in relation to the tibial tunnel of ACL grafts.
基金the National Natural Science Foundation of China under the contract No.40306018 the Natural Science Foundation of Fujian Province under the contract No.2001F001.
文摘Thirty species of dinoflagellate cysts in 15 genus are identified from KMZK5 Core samples of recent marine sediment at the Luoyuan Bay mouth, Fujian. All of these dinoflagellate cysts are first recorded in the Luyuan Bay, 12 species of them are not distributing in the near sea area such as Sansha Bay and Minjiang estuary, including 6 kinds of toxic species, such as Alexandrium affine, A. minutum, A. tamarense, Gonyaulax spinifera, Gymnodinium catenatum and Scrippsiella trochoidea. The abundance and vertical distribution characterestics of the main and the toxic dinoflgellate cysts are also studied in the paper.
文摘Objective: Vacuolating megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a recently described syndrome with autosomal recessive mode of inheritance. Its possible gene was located on chromosomal 22q tel with 3-cM. The purpose of this study was to narrow down the genetical distance on chromosomal 22q tel with MLC. Methods: Thirty-nine MLC patients in 33 families were collected,and the linkage analysis and haplotype analysis of twelve informative families were done, using seven microsatellite markers and four SNP markers. Results: The maximum tow-point LOD score for marker 355c18 was 6.65 at recombination fraction 0.02. The haplotype analysis narrowed down the critical region of MLC to 250 kb on chromosomal 22q tel. Conclusion: One of the causing genes of MLC was located on chromosomal 22q tel with 250 kb. Four candidate genes were considered. The heterogeneity of one informative family indicated possible existence of a second locus for MLC.
文摘Biliary cysts(BC) are rare dilatations of different parts of a biliary tract.They account for approximately 1% of all benign biliary diseases.BC occur the most frequently in Asian and female populations.They are an important problem for pediatricians,gastroenterologists,radiologists and surgeons.Clinical presentation and management depend on the BC type.Cholangiocarcinoma is the most serious and dangerous BC complication.The other complications associated with BC involve cholelithiasis and hepatolithiasis,cholangitis,acute and chronic pancreatitis,portal hypertension,liver fibrosis and secondary liver cirrhosis and spontaneous cyst perforation.Different BC classifications have been described in the literature.Todani classification dividing BC into five types is the most useful in clinical practice.The early diagnosis and proper treatment are very important,because BC are associated with a risk of carcinogenesis.A malignancy risk increases with the age.Radiological investigations(ultrasonography,computed tomography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography) play an important role in BC diagnostics.Currently,prenatal diagnosis using ultrasonography is possible.It allows to differentiate biliary disorders in fetals and to perform the early surgical treatment that improves results.In most patients,total cyst excision with Roux-Y hepaticojejunostomy is the treatment of choice.Surgical treat-ment of BC is associated with high success rate and low morbidity and mortality.The early treatment is associated with a lower number of complications.Patients following BC surgery require permanent and careful postoperative observation using laboratory and imaging investigations because of possibility of biliary anastomosis stricture and biliary cancer in tissue remnant.
文摘AIM: To determine whether the outcomes of laparoscopic fenestration (LF) were superior to open fenestration (OF) for congenital liver cysts.METHODS: Comparative studies published between January 1991 and May 2010 on Medline (Ovid),Emsco,PubMed,Science Direct;Cochrane Reviews;CNKI;Chinese Biomedical Database,VIP and other electronic databases were searched.Randomized controlled trials (RCTs) and retrospective case-control studies on the management of congenital hepatic cysts were collected according to the pre-determined eligibility criteria to establish a literature database.Retrieval was ended in May 2010.Meta-analysis was performed using RevMan 5.0 software (Cochrane library).RESULTS: Nine retrospective case-control studies involving 657 patients,comparing LF with OF were included for the final pooled analysis.The meta-analysis results showed less operative time [mean difference (MD): -28.76,95% CI: -31.03 to 26.49,P < 0.00001];shorter hospital stay (MD: -3.35,95% CI: -4.46 to -2.24,P < 0.00001);less intraoperative blood loss (MD: -40.18,95% CI: -52.54 to -27.82,P < 0.00001);earlier return to regular diet (MD: -29.19,95% CI: -30.65 to -27.72,P < 0.00001) and activities after operation (MD: -21.85,95% CI: -31.18 to -12.51,P < 0.0001) in LF group;there was no significant difference between the two groups in postoperative complications (odds ratio: 0.99,95% CI: 0.41 to 2.38,P = 0.98) and cysts recurrence rates.CONCLUSION: The short-term outcomes of LF for patients with congenital hepatic cysts were superior to open approach,but its long-term outcomes should be verified by further RCTs and extended follow-up.
文摘BACKGROUND: The traditional therapy for hepatic cysts has limited success because of recrudescence. Radiofrequency ablation (RFA) has become popular because of its advantages including little damage, therapeutic effect and reduced suffering. This report describes the effects and reliability of RFA in the treatment of 29 patients with hepatic cysts. METHODS: B-ultrasound-guided REA was used to treat hepatic mono-cyst or multi-cysts of 29 patients (63 tumors). Ablative efficiency and complications were assessed by imaging and clinical symptoms. RESULTS: The tumors were abated completely in 34 cysts with a diameter <5 cm and no recurrence was seen after 3 months. In 21 cysts with a diameter of 5-10 cm, tumor volume was decreased by over 70%, then reduction and fiberosis were found. In 8 cysts with a diameter greater than 10 cm, tumor volume was decreased by more than 60%, and in 2 cysts it was increased more slightly than that at I month after REA. In subsequent follow-up (6 and 12 months after REA), tumors <10 cm in diameter were fully ablated. No significant discomfort and complications were found in any patient. CONCLUSION: RFA for the treatment of hepatic cysts is safe, and free from complications.
文摘Liver cysts are common,affecting 5%-10% of the population.Most are asymptomatic,however 5% of patients develop symptoms,sometimes due to complications and will require intervention.There is no consensus on their management because complications are so uncommon.The aim of this study was to perform a collected review of how a series of complications were managed at our institutions.Six different patients presenting with rare complications of liver cysts were obtained from Hepatobiliary Units in the United Kingdom and The Netherlands.History and radiological imaging were obtained from case notes and computerised radiology.As a result,1 patient admitted with inferior vena cava obstruction was managed by cyst aspiration and lanreotide;1 patient with common bile duct obstruction was first managed by endoscopic retrograde cholangiopancreatography and stenting,followed by open fenestration;1 patient with ruptured cysts and significant medical co-morbidities was managed by percutaneous drainage;1 patient with portal vein occlusion and varices was managed by open liver resection;1 patient with infected cysts was treated with intravenous antibiotics and is awaiting liver transplantation.The final patient with a simple liver cyst mimicking a hydatid was managed by open liver resection.In conclusion,complications of cystic liver disease are rare,and we have demonstrated in this series that both operative and non-operative strategies have defined roles in management.The mainstays of treatment are either aspiration/sclerotherapy or,alternatively laparoscopic fenestration.Medical management with somatostatin analogues is a potentially new and exciting treatment option but requires further study.
文摘Technological advances and the widespread use of medical imaging have led to an increase in the identification of pancreatic cysts in patients who undergo crosssectional imaging. Current methods for the diagnosis and risk-stratification of pancreatic cysts are suboptimal, resulting in both unnecessary surgical resection and overlooked cases of neoplasia. Accurate diagnosis is crucial for guiding how a pancreatic cyst is managed, whether with surveillance for low-risk lesions or surgical resection for high-risk lesions. This review aims to summarize the current literature on confocal endomicroscopy and cyst fluid molecular analysis for the evaluation of pancreatic cysts. These recent technologies are promising adjuncts to existing approaches with the potential to improve diagnostic accuracy and ultimately patient outcomes.
