Cyst Dimensions Research Articles

Giant pelvic dermoid cyst in a 17-year-old girl

BACKGROUND: Dermoid cysts in the presacral and retrorectal space in children are relatively rare. However, even more rarely, they have clinical manifestations at patient’s early age and so, can be silent for a long time. CLINICAL CASE DESCRIPTION: The article describes a rare clinical observation — a giant dermoid cyst in the retrorectal space in a 17-year-old girl. The child had a tendency to constipation from her early childhood. Menses started at age 13, painful. During the last year, disorders in her menstrual cycle were noticed. The girl was examined by a gynecologist. Ultrasound examination revealed a cystic formation in the pelvic cavity up to 9 cm in diameter. Non-malignant nature of the process was confirmed by: normal level of cancer markers (α-fetoprotein, β-human chorionic gonadotropin), single node, clearly defined formation capsule, homogeneous nature of its contents, no invasive growth and lesions in the regional lymph nodes. Magnetic resonance imaging with intravenous contrasting defined a true relationship of the cystic formation with other organs and structures of the pelvic cavity. The cystic formation caused deformation of the cervix, vagina, and rectum. The obtained findings allowed to plan surgical intervention correctly. Surgical access-transverse in the coccyx projection up to 10 cm long. The cystic formation was a thin-walled connective tissue capsule with a yellowish content. Due to very large cyst dimensions, first it was opened in a limited area and emptied. Then the capsule was isolated and completely removed. The cyst intimately adhere to rectum, vagina, and cervix walls. Histological conclusion: "Capsule of a dermoid cyst with hemorrhages". The postoperative period was smooth. The patient recovered, all disease manifestations disappeared. She was discharged home in a satisfactory state. Follow-up visits were in 6 and 12 months after surgery. No evidence of possible relapse. CONCLUSION: There are only few descriptions of such cases in the available literature. Ultrasound and MRI examinations allowed to have a full picture of dermoid cyst position and its connection with other pelvic organs due to which surgeons could develop a correct plan for surgical intervention.

Comparison of the Recurrence Rate in Marsupialization with and Without Peripheral Sectomy in the Treatment of Odontogenic Keratocyte Tumor in Patients Referred to Bahoner Hospital, Kerman

Aim: Odontogenic keratocyte tumor is a developmental cyst with proliferative and invasive nature. which is often observed in the posterior region of the mandible and is commonly seen in the third decade of life. The highest age of prevalence is in the 3rd to 6th decades and the male to female ratio is 2 to 1. Normally, if there is no infection, it is not manifested and it is discovered accidentally in rayograph, but if the size increases, it manifests as an extension in the form of pain, swelling and infection in the dental and bone area if the tooth is hidden. In radiographs, it appears as a radiolucent lesion with distinct ionic or multilocular boundaries and sometimes with a scallop border in the dental area or even extending to the ascending ramus and condylar area. Research shows that the origin of this cyst is the remaining odontogenic epithelium of Ceres in the alveolar region. And it can be syndromic (Gorlin syndrome) or non-syndromic. This cyst has a thin epithelium and has multiple daughter cysts, which causes the risk of recurrence due to incomplete removal of the lesion. Enucleation, marsupialization, Carney’s solution and resection are treatment methods. What is investigated in this project is the comparison of the prevalence of the two therapeutic methods of marsupialization alone and the combination of marsupialization and peripheral sect my in patients with odontogenic keratocytes regardless of whether they are syndromic or sporadic. Method and Materials: In this study, which is conducted on 10 patients referred to Behoney Hospital in Kerman. First, the patient is selected with clinical examinations and then with the preparation of panoramic radiographs. If there is visible swelling, aspiration is performed with a 10-cc syringe, and then the patient is operated on for a biopsy to definitively diagnose the odontogenic keratocyte of the tumor. In this study, there is no difference between the age and sex of the patient, and whether KOT is syndromic or sporadic; Both are included in the review. The patient is subjected to marsupialization, then the patient undergoes follow-up and periodic x-rays are used to ensure that the lesion shrinks. In the lesions where there is involvement of the surrounding bone in the form of a saucerization, after the lesion is reduced, the patients are treated with peripheral sect my or removal of the bone around the lesion in the form of a curt shape, and in small lesions, the treatment is completed with marsupialization. arrives. Then the patients are followed up and the recovery process and the rate of recurrence are checked by preparing periodical x-rays. Results: In this study, out of ten patients, 4 patients (40%) had recurrence, and among these 4 patients, 3 patients (75%) were in the first group who were treated with marsupialization. The follow-up of the patients was one year, and after the preparation of OPG, the reduction of cyst dimensions was compared to the size before the operation. The criterion for the recurrence of keratocyte odontogenic lesion is the increase in the size of the lesion according to the qualitative scale and the comparison of the graph prepared before and after marsupialization. Out of 4 patients with recurrence, one case in the second group (25%) is treated with marsupialization and peripheral sitcom, a ten-year-old boy has multiple jaw cysts in the front of the mandible, behind the maxilla on both sides, and behind the mandible on both sides. The maxillary sinus is left. According to the obtained results, the treatment of marsupialization with peripheral sect my has more effectiveness and the results had a significant difference. p value=0.043 Conclusion: According to the obtained results, the treatment of marsupialization with peripheral sitcom has more effectiveness and less recurrence.

Clinical Evidence Regarding the Dynamic of Baker Cyst Dimensions after Intermittent Vacuum Therapy as Rehabilitation Treatment in Patients with Knee Osteoarthritis.

The Baker cyst (BC), also known as the popliteal cyst or parameniscal cyst, is a fluid-filled sac that normally develops in the back of the knee, between the semimembranosus and medial head of the gastrocnemius. We aimed to evaluate the effectiveness of physiotherapy (10 days of treatment) that associates intermittent vacuum therapy (IVT) on the lower limbs in the treatment of the BC, respectively, in its size reduction. Sixty-five patients with knee osteoarthritis using Kellgren-Lawrence criteria and the presence of BC (ultrasonography evaluation), were divided into the Control and Vacuum groups. We collected the following features: sex, age, level of education, occupation, environment, body mass index, Knee Injury and Osteoarthritis Outcome Score, Western Ontario, and McMaster Universities Osteoarthritis Index, the Functional Independence Measurement, the Fall Risk Score, and the Visual Analog Scale were recorded at baseline and after 10 days. Both groups are similar in terms of demographic features. Regarding the clinical functional parameters, the results elicit a statistically significant change in all parameters between admission and discharge, including the echo volume at BC. Physical medicine and rehabilitation increase the autonomy of patients with BC. Clinical-functional improvement begins in the first 10 days of complex rehabilitation treatment; it is statistically significant and is not different between the two groups, which brings an additional argument for the effectiveness of conservative therapy in the treatment of BC. Although IVT has not demonstrated its superiority over classical balneo-physical therapy, additional research, and long-term monitoring are needed to provide additional arguments regarding this aspect.

Maternal choledochal cysts in pregnancy: A systematic review of case reports and case series.

Choledochal cysts (CC) are cystic dilatations of the biliary tract, usually diagnosed during childhood, with an estimated incidence in the general population of 1:100000. Complications related to CC include rupture, biliary obstruction, and cholangitis. Maternal CC in pregnancy are rarely reported, and there are no guidelines on optimal management. To systematically review maternal CC diagnosed during pregnancy or postpartum with regard to the clinical presentation of CC, the mode of treatment and delivery, and maternal outcomes. A literature search of cases and case series of maternal CC in pregnancy and postpartum was conducted using MEDLINE/PubMed, Web of Science, Google Scholar, and Embase. There were no restrictions on language or publication year. Databases were lastly accessed on September 1, 2022. Overall, 71 publications met the inclusion criteria, reporting 97 cases. Eighty-eight cases were diagnosed during pregnancy and nine in the puerperium. The most common symptoms were abdominal pain (81.2%) and jaundice (60.4%). Interventions for CC complications were required in 52.5% of the cases, and 34% of pregnancies were induced. Urgent cesarean section (CS) was done in 24.7%. The maternal mortality was 7.2%, while fetal mortality was inconsistently reported. Cholangitis, CC > 15 cm, and bilirubin levels > 80 mmol/L were associated with a higher likelihood of urgent CS and surgical intervention for CC. Bilirubin levels positively correlated with CC size. There was no correlation between age and cyst dimension, gestational age at cyst discovery, and CC size. Although rare, maternal CC in pregnancy should be included in the evaluation of jaundice with upper abdominal pain. Symptomatology and clinical course are variable, and treatment may range from an expectative approach to emergent surgical CC treatment and urgent CS. While most cases were managed by conservative measures or drainage procedures, CC > 15 cm and progressive cholangitis carry the risk of CC rupture and septic complications, which may increase the rates of unfavorable maternal and fetal outcomes. Therefore, such cases require specific surgical and obstetric interventions.

(031) Bartholin Cysts Can Be Treatable Causes of Female Sexual Dysfunction: Four Year Review of Diagnosis and Treatment Principles

Abstract Introduction Bartholin glands are major vestibular androgen dependent glands that release mucus secretions during sexual arousal through a 2.5 cm duct that drains at the 5 o'clock and 7 o'clock positions of the vestibule. Bartholin's glands are innervated by a branch of the pudendal nerve; mucous secretion is activated by the efferent pelvic nerve. Unilateral or bilateral obstruction of the Bartholin's ducts may occur (e.g. from trauma, infection, surgery, or idiopathic), however as long as innervation is intact, Bartholin glands continue to produce mucus despite outlet ductal occlusion. This leads to dilation of the duct with subsequent cyst formation that can result in Bartholin cyst-associated sexual dysfunction symptoms. Objectives To review patient records of women presenting to a sexual medicine clinic over a four-year period diagnosed with and surgically treated for Bartholin cyst-associated sexual dysfunction. Methods Grayscale ultrasound was performed (see figure) using the Aixplorer and cyst dimensions were measured after visual sexual stimulation in the office. Vulvoscopy was performed with the Wallach Zoomscope. Bartholin cyst anesthesia testing was performed using benzocaine 20%, lidocaine 8% and tetracaine 6%. Marsupialization surgery was performed as an out-patient. Results We identified 11 patients (mean age 26 +/− 6 years) diagnosed with Bartholin cyst-associated sexual dysfunction between January 2019 and November. 2010 who met inclusion criteria and were surgically treated by marsupialization for unilateral (4) and bilateral (7) Bartholin cysts. Their symptoms of Bartholin cyst-associated sexual dysfunction included dryness with sexual arousal (73%), pain with sexual arousal (82%), pain with orgasm (36%), spontaneous drainage (18%), and a mass at the introitus interfering with penetration (45%). 55% had been treated previously at other facilities unsuccessfully, including cyst aspiration, Word catheter placement, and marsupialization. The mean cyst size on ultrasound was 2.9 +/− 1.5 cm. Bartholin cyst anesthesia testing was positive in all (4/4) that underwent this test. Surgical principles to encourage post-op mucin drainage through the Bartholin duct included visualization of the duct at surgery (see figure) and direct anastomosis of the duct to the inferior portion of the incision at 5 and/or 7 o’clock locations (see figure). Post-operative daily arousal was encouraged and mucin secretion through the marsupialized ducts was documented by placement of gauze in the introitus and observing the mucous (see figure). At the time of this review, with an average follow-up of 8 months, 15 of 18 (83%) cysts are still draining and 9/11 patients are somewhat better, much better and very much better with resolution of Bartholin cyst-associated sexual dysfunction symptoms. Conclusions Bartholin cysts are a sexual dysfunction that can be successfully treated. Diagnosis involves an ultrasound after sexual arousal and a positive Bartholin cyst anesthesia test. Treatment involves marsupialization with visualization and anastomosis of the Bartholin duct to the inferior portion of the incision at the 5:00 and 7:00 locations. Post-operative daily arousal is encouraged with documentation of mucinous drainage detected. Disclosure No.

Arthroscopically guided lag screw fixation of subchondral bone cysts in the medial femoral condyle in Thoroughbred racehorses: description of technique and comparative results.

To describe an arthroscopically guided technique for lag screw placement across subchondral bone cyst (SBC)in the medial femoral condyle (MFC) and to compare postoperative racing performance with corticosteroid injection and cyst debridement. Retrospective cohort study. One hundred twenty-three horses with 134 MFC SBCs undergoing treatment at a single referral hospital in the UK between January, 2009, and December, 2020. Sex, age, limb affected, radiographic cyst dimensions, preoperative and postoperative lameness, surgical technique (lag screw placement, cyst debridement, intralesional corticosteroid injection), and, where applicable, screw positioning were recorded retrospectively. A ratio was calculated using measurements from preoperative and postoperative radiographs. Outcome was assessed by resolution or improvement in lameness, reduction in cyst size, and starting one race after treatment. Outcome data was compared between treatment groups. Twenty-six of 45 (57.8%) horses that underwent transcondylar screw placement raced postoperatively, at a median of 403 days between surgery and first postoperative race. There was no difference between treatment groups with regard to racing or preoperative and postoperative lameness. Cysts treated with transcondylar screw placement had a greater reduction in cyst size and a reduced period of convalescence in comparison with those that underwent debridement; the results were similar to those treated by intralesional corticosteroid injection. Postoperative racing rates were similar for all techniques. Convalescence was reduced for lag screw placement and corticosteroid injection compared to debridement. The arthroscopically guided technique results in radiographically consistent screw placement and cyst engagement and offers a viable alternative to other treatments.

Surgical management of hydatid cyst disease of the liver: An improvement from our previous experience?

Hydatid liver disease remains an important issue in endemic areas, which may require immediate surgery. Although laparoscopic surgery is on the rise, the presence of certain complications may require conversion to the open approach. To compare the results of laparoscopic treatment and the open approach in the context of a 12-year single institution experience, and to perform a further comparison between results from the current study and those from a previous study. Between January 2009 and December 2020, 247 patients underwent surgery for hydatic disease of the liver in our department. Of the 247 patients, 70 underwent laparoscopic treatment. A retrospective analysis between the two groups was performed, as well as a comparison between current and previous laparoscopic experience (1999-2008). There were statistically significant differences between the laparoscopic and open approaches regarding the cyst dimension, location, and presence of cystobiliary fistula. There were no intraoperative complications in the laparoscopic group. The cutoff value for the cyst size regarding the presence of cystobiliary fistula was 6.85 cm (P = 0.001). Laparoscopic surgery still plays an important role in the treatment of hydatid disease of the liver, with an increase in its usage over the course of years that has shown benefits regarding the postoperative recovery with a decreased rate of intraoperative complications. Although experienced surgeons can perform laparoscopic surgery in the most difficult conditions, there are some selection criteria that need to be maintained for higher quality results.

USAGE OF CBCT IN DIAGNOSTIC DILEMMA: A CASE REPORT

Dentigerous cysts are a common type of odontogenic cysts that arise from the follicle surrounding an unerupted tooth. Although they are typically asymptomatic, they can cause tooth displacement, resorption, and even facial disfigurement in rare cases. In this case report, a 20-year-old male presented with a diffused swelling in the lower left cheek region that gradually increased in size over five days, along with pain and difficulty in mouth opening. A cone-beam computed tomography (CBCT) imaging was performed, revealing a well-circumscribed, unilocular radiolucent lesion consistent with a dentigerous cyst surrounding the crown of the impacted tooth 38. The therapeutic approach for dentigerous cysts varies depending on the cyst's dimensions and location, the patient's age, and the cyst's proximity to adjacent vital teeth. Conservative surgical approaches are preferred for younger patients, while cyst/tooth removal is the treatment of choice for older patients. In conclusion, proper interpretation of radiographic images is critical for diagnosing dentigerous cysts and developing appropriate management plans

Reduction of Porencephalic Cyst Along with the Revival of Motor Control Using the Deep Brain Sound Stimulation (DBSS) Technology as a Novel Approach

A porencephalic cyst is a rare disorder, with the etiology of brain parenchymal loss as a result of perinatal cerebral ischemia or hemorrhage leading to the accumulation of cerebrospinal fluid within the parenchyma. It is diagnosed radiologically, and management depends on the clinical manifestations. The present case depicts a porencephalic cyst presenting with cerebral right-sided hemiparesis in adulthood. The cyst dimensions measured 2.6*0.6*0.5 cm in the left lateral ventricle with associated hemiparesis of the right side at the time of the first MRI scan before Deep Brain Sound Stimulation (DBSS) sessions. A reduction in the size of the cyst to 16*7*7 mm and then to a subsequent 8 mm was documented during a novel, non-invasive deep brain stimulation via sound (DBSS) treatment. In addition, right upper and lower limb power increased to 5/5 with improved coordination in a complete neurological evaluation. DEXA scan showed an increased bone density and muscle bulk.

Minimally invasive treatment of a giant pancreatic pseudocyst

The authors present minimally invasive treatment of a giant infected pancreatic pseudocyst. Throughout in-hospital period, the patient underwent endosonography-guided transgastric drainage of the pseudocyst, 7 endoscopic debridement of the cavity with sequestrectomy, laparoscopy for enzymatic peritonitis and external percutaneous drainage of the pseudocyst. Effectiveness of minimally invasive treatment was assessed considering laboratory data (CRP, white blood cell count), clinical data (hyperthermia, complaints) and follow-up ultrasound and computed tomography data (cyst dimension, sequestration). We observed with positive dynamics with decrease of intoxication syndrome, serum CRP and white blood cell count after two debridement procedures. After the seventh endoscopic debridement and sequestrectomy, granulations occurred in the cyst cavity and there was no further sequestration. At discharge, CT revealed dry residual small cavity 1.5×3 cm. There were no any complaints.

Evaluation of the Response of Odontogenic Keratocysts to Tube Decompression: A Clinical and Radiographic Study

Background and Objectives: Keratocyst is the most aggressive entity of odontogenic cysts with a high tendency to recure after enucleation. This study was conducted to assess the effect of decompression in inducing cyst shrinkage before enucleation. Materials and Methods: A prospective non-randomized study was conducted on 11 patients with odontogenic keratocyst the department of maxillofacial surgery, university-affiliated teaching hospital, between February 2016 to March 2021. There were 8 males and 3 females, with a mean age of 57 years. Tube decompression was conducted as a preliminary treatment, before enucleation. The size of the cyst was measured on orthopantomograph, before, during, and after decompression. The percentage of reduction was calculated, as well as, the correlation of cyst regression with the initial size of the lesion and age of the patient. Results: The mean duration time of decompression was 208 days (152-316). The pre- and post-decompression size of the cysts was 14.51 cm2 (5.63 cm2 -32.37 cm2) and 6.69 cm2 (1.76 cm2-14.81 cm2), respectively. The total and monthly percentage of reduction in the size of the cysts was 54.39% (37.29%-76.37%) and 7.84% (4.45%-11.27%), respectively. The initial size of the lesion has no significant correlation with the percentage of reduction, whereas the age of the patients showed a significant negative correlation with the percentage of reduction. Conclusion: Decompression is a well-tolerated conservative treatment, which leads to marked reduction in cyst dimensions. It induces shrinkage of the cyst away from anatomical structures, to reduce the morbidity associated with subsequent surgical treatment.

Tarlov cysts in back pain patients: prevalence, measurement method and reporting points.

Determining the prevalence of Tarlov cysts in low back pain patients. The picture archiving & communication system (PACS) & hospital information system (HIS) of a corporate hospital were retrospectively analyzed to determine the percentage of Tarlov cysts among patients undergoing spinal MRI for back pain over 3 years (January 2017 to December 2019). 384 patients had undergone spinal MRI for back pain over the study period, and 25 of them (6.51%) had Tarlov cysts. Vast majority (15 cases) showed cysts located at S2/S3 level, and few were found at S1/S2 and other levels. Single cysts were found in most (=18) of the cases, while 7 cases of multiple / bilateral cysts were found. Cyst dimensions were higher in craniocaudal than anteroposterior or transverse directions. In case of multiple cysts, one or two cysts were noted as dominant, having higher dimensions than the others. The study data revealed no gender or age predilection. We conclude that including the entire sacrum with a T2 sagittal sequence in all MRI for low back pain can increase detection of Tarlov cysts, and thereby provide more data for further analysis. We propose the concept of one "dominant" cyst when there are multiple Tarlov cysts. We recommend that diameter or size of Tarlov cysts be specified to their craniocaudal dimension. We also suggest reporting points for contextual structured reporting, viz. presence or absence of bony scalloping, neural foraminal narrowing, nerve root compression or extraforaminal extension.

A Pancreatic Cystic Neoplasms Drama. Accuracy of Diagnostic Presumption and Surgical Indication on a Ten-year Experience

Purpose: Pancreatic cystic neoplasms (PCN) represent a challenging diagnosis despite imaging improvement and guidelines updates. Endoscopic Ultra Sound (EUS) is able to add valuable diagnostic information such as fine needle aspiration (FNA) but the accuracy of this procedure alone is extremely variable and not surely superior to classic MRI and CT-scan. The main aim of this study is to assess the importance of EUS and main cystic features in PCN preoperative work-up in terms of diagnostic accuracy, analyzing at the same those patients with any kind of PCN who could have performed, in retrospect, a close surveillance instead of surgical resection. Method: Patients with a preoperative or pathological diagnosis of PCN were retrospectively reviewed from a prospective database. Data included cases operated from 2010 to 2019 directly or under the supervision of an experienced pancreatic surgery team in three different institutions with a radiologic-oriented diagnostic approach or mixed (radiologic and endoscopic). Preoperative diagnosis was matched with final histology to confirm the diagnostic accuracy of the PCN. Patients with a benign histological who did not show absolute indication on preoperative evaluation, as defined by current guidelines, were categorized as “unrequested surgery”. Results: 587 patients were retrospectively analyzed and in 109/587 cases (18.6%) final histology did not confirm preoperative diagnosis. When performing EUS a significantly lower incidence of diagnostic fallacy was observed (p= 0.024) but risk of overtreatment was similar regardless instrumental diagnostic path (p= 0.356). MPD dilatation and cytologic sampling were the only variables independently related to a correct diagnosis (p <0.001 and p= 0.036). Based on final histology, pancreatic resection could be avoided in 145/461 patients (31.5%). The rate of “unrequested surgery” changed significantly over the years (p= 0.033) and was related with age (p <0.001) , an elevated Ca 19-9 (p= 0.012), cyst dimension (p= 0.023) and type of operation (p <0.001). Conclusions: EUS is an effective procedure in the diagnostic management of PCN, influencing in this series the diagnostic accuracy. Nevertheless, it does not seem to be able to reduce surgical overtreatment. Risk of “unrequested surgery” reduced over the years and it seems correlated with the type of pancreatic resection, being higher for distal pancreatectomies.Tabled 1RadiologicDiagnosis n/tot (%)Radiologic + Endoscopic diagnosis n/tot (%)pDiagnostic accuracyAll cohort148/194 (76.3)330/393 (84)0.024IPMN83/90 (92.2)265/274 (96.7)0.071SCA18/32 (56.3)18/30 (60)0.765MCN29/39 (74.4)25/39 (64.1)0.326Other18/33 (54.5)22/50 (44)0.377Unrequested SurgeryAll cohort46/133 (34.6)99/328 (30.2)0.356IPMN26/90 (28.9)73/274 (26.6)0.678SCA13/32 (40.6)5/30 (16.7)0.038Other7/11 (63.6)21/24 (87.5)0.101 Open table in a new tab Rate of diagnostic accuracy and “unrequested surgery”

Antenatally detected abdominal cyst: Does cyst size and nature determine postnatal symptoms and outcome?

BackgroundThe outcome of antenatally detected fetal intra-abdominal cysts is highly variable and challenging to predict. Antenatal ultrasound scans may be of value in predicting postnatal outcome. AimsTo report antenatal and postnatal course of fetal intra-abdominal cysts identified on antenatal ultrasound and establish the value of cyst dimensions for predicting outcome. Study designRetrospective observational study. SubjectsAll intra-abdominal cysts diagnosed in a single centre between 2013 and 2019. Outcome measuresCyst characteristics were recorded from radiological reports and postnatal diagnosis and outcomes documented. Growth characteristics were identified to distinguish different diagnosis. The maximum antenatal diameter of all cysts was identified and the best cut-off diameter to predict whether a cyst would persist postnatally or require surgery was identified. Best cut-off values were identified using Youden index. ResultsOf the 38 cysts identified on antenatal ultrasound, 24 (63%) persisted postnatally, 8 required surgery (21%) and 4 (11%) were not considered an intra-abdominal cyst postnatally. Ovarian cyst and duplication cyst may have different growth characteristics. In the prediction of cysts persisting postnatally, the area under the ROC curve (AUC) was 0.81 (95% CI, 0.66–0.95). Two cut off values were identified, 37.5 mm (50% sensitivity, specificity 100%, Youden's index 0.50) and 28.5 mm (sensitivity 65%, specificity 85%, Youden's index 0.50). In the prediction of surgery, no optimal diameter was found; AUC was 0.57 (95% CI, 0.34–0.81). ConclusionsMaximum antenatal cyst diameter is useful for the prediction of whether a cyst will persist postnatally but not for the prediction of surgery.

Self-Retained Voice Prosthesis in the Decompression of the Odontogenic Keratocyst: A Technical Note

Decompression of the odontogenic keratocyst has been a long-standing treatment modality in the armamentarium of oral-maxillofacial surgeons. Many different types of effective decompression tubes have been described in the literature. They reduce the size of the cystic lesion by decreasing the intraluminal pressure, induce histologic structural changes in the epithelial lining of the cyst, and allow for bone deposition to occur from the periphery of the cystic cavity. However, many of these have pitfalls including tube dislodgement, traumatization of the oral mucosa, and mucosal overgrowth. We describe a novel technique using an indwelling voice prosthesis (Inhealth Technologies, Carpinteria, CA) to decompress odontogenic keratocysts. We found that our method provides effective decompression using appropriate-length prostheses fit to the cyst dimensions. It provides improved comfort in patients, with less mucosal irritation or overgrowth, improved ease of irrigation, and improved retention that often does not require sutures.

Clinical features and treatment of ruptured pulmonary hydatid cyst in children.

The medical records of children who had undergone surgery between January 1999 and December 2017 for pulmonary HC were retrospectively evaluated. One hundred forty seven of these patients had ruptured HC at the time of diagnosis. The gender, age at the time of diagnosis, sociogeographic status (i.e., from urban or rural population group), symptoms, affected lung region, cyst dimensions, preoperative complications, medical treatment duration, and associated morbidities were evaluated. The study included 649 patients with pulmonary HC. Mean age was 9,8 (2-17) years. Three hundred forty four patients were male and 305 were female. The most common symptoms were, cough accompanying mucopurulent sputum, hydropthysis and dyspnea in patients with ruptured HC. The diagnosis of all the patients were established in the light of the findings obtained from two-sided chest x-ray and CT of the thorax. Simple cystotomy via posterolateral thoracotomy was the treatment of choice. Cappitonage was not performed in any patients. Lung resection was performed only if there was an irreversible and disseminated pulmonary destruction. Rupture of the pulmonary HC is the most common and also the most feared complication. Rupture may be either intrabronchial or intrapleural. Radiologic imaging is diagnostic. Rupture of the pulmonary HC must be considered as an emergent issue. Simple cystotomy amd removal of the laminated membranes are adequate treatment of choice. Meticulous closure of the bronchial openings is mandatory to avoid prolonged air leak. Cappitonage is unnecessary.

Long Term Radiological and Clinical Outcome of Symptomatic Lumbar Intraspinal Synovial Cyst: A Retrospective 4-Year Study.

To examine the prevalence of symptomatic lumbar synovial facet cysts in lumbar spinal magnetic resonance imaging (MRI) of patients who admitted to neurosurgery clinic, retrospectively. Also, we aimed to report the clinic and radiologic outcome of patients with symptomatic spinal synovial cyst, who undergo conservative treatment. One thousand two hundred forty-three patients who admitted to Ordu University Neurosurgery outpatient clinic between 2015-2019 and underwent lumbosacral MRI and lumbosacral computed tomography examinations were reviewed retrospectively. The disappearance of cysts during radiologic follow up was accepted as spontaneous complete resolution, besides reduction in cyst dimensions and/or contrast enhancement were considered as radiologic regression. Decrease in radiculopathy, back pain and neurologic deficit complaints were also considered as clinical improvement. Thirteen patients (8 men, 5 women) with lumbar synovial cysts who admitted to the neurosurgery outpatient clinic with low back and radicular pain complaints were included in the study. Nine patients (69.2%) had clinical and radiological improvement, 1 female patient (7.7%) was operated due to the leg pain, progressive motor deficit and lumbar disc hernia. Radiological spontaneous complete resolution was detected in 3 patients (23.1%). Spontaneous complete resolution period was determined between 3 months to 24 months. The symptomatic lumbosacral synovial cyst treatment algorithm has not been fully demonstrated. However, as in our series, spontaneous complete resolution of cysts and effectiveness of conservative treatment in symptomatic patients should not to be underestimated and immediate invasive procedures should be postponed.

Rathke's cleft cysts: a 6-year experience of surgery vs. observation with comparative volumetric analysis.

Rathke's cleft cysts (RCCs) are common sellar lesions. Their management remains controversial, particularly when small or asymptomatic. Herein we review a consecutive series of RCC patients managed with surgery or observation. All patients with a new diagnosis of presumed RCC, based on MRI, from February 2012-March 2018 were retrospectively divided into observational and surgical cohorts based on an intent-to-treat model. The cohorts were compared for clinical presentation, and cyst volume. The observational cohort was followed for change in cyst size. The surgical cohort was followed for changes in endocrinopathy, visual symptoms, headache and recurrence. Of 90 patients (mean age 36.7 ± 19.4years; 68% female), 60% (n = 54) were in the observational cohort and 40% (n = 36) in the surgical cohort. Average follow-up was 13 ± 23months in the observational cohort and 24 ± 19months in the surgical group. In comparing the cohorts, mean ages were similar with more women in the surgical group (81% vs. 56%, p = 0.04). Most patients in the observational cohort had incidentally-discovered RCCs (n = 50, 88%) as opposed to the surgical cohort (n = 6, 17%). The surgical cohort had higher rates of headache (89% vs 26%, p < 0.001), endocrinopathy (36% vs 0%, p < 0.001), and visual dysfunction (19% vs 0%, p = 0.001). Mean cyst volume and maximal cyst dimensions were greater in the surgical cohort (0.94 ± 0.77cm3 and 14.2 ± 4.1mm), compared to the observational cohort (0.1 ± 0.14cm3 and 6.4 ± 3mm), (p < 0.001). Among the 53% (n = 30/54) of patients in the observational group with follow-up, 3 (10%) had spontaneous RCC shrinkage, 1 (3%) had modest asymptomatic growth (at 10months from initial MRI), and 87% had stable cyst size. Of the 36 patients recommended to have surgery, 89% (n = 32) did so. Post-operatively, complete or partial resolution of headache, endocrinopathy and visual dysfunction were documented in 90% (n = 28/30), 75% (n = 10/12), and 100% (n = 7/7), respectively. On follow-up MRI, 8 (22%) patients had some cyst reaccumulation, of whom 3 (8%) were symptomatic and underwent uneventful reoperation. No major complications such as hematoma, CSF leak, new endocrinopathy or visual deficits occurred. From this consecutive series, a majority (60%) of RCCs do not appear to warrant surgical intervention and have a low risk of cyst progression. However, surgical cyst removal appears to be indicated and safe for patients with larger, symptomatic RCCs. Simple cyst drainage has a high rate of improvement in pituitary gland function, visual function and headache resolution with low complication rates and symptomatic recurrence risk. These findings stress the importance of careful case selection and potential utility of volumetric assessment for patients with RCCs.

Radiologist Identification of Occult Dorsal Wrist Ganglion Cysts on MRI.

Background Occult dorsal ganglion cysts (ODGC) require imaging or an operation for detection. It is currently unknown how often a radiologist identifies an ODGC on magnetic resonance imaging (MRI) and whether surgeon indication for MRI aids the radiologist in detection. Questions/Purposes The aim of the study was to investigate the following questions: how accurately do radiologists identify ODGC on MRIs? What factors may be associated with missed ODGCs? Patients and Methods We retrospectively studied patients who underwent an operation for an ODGC and had a preoperative wrist MRI. Radiology report and surgeon's notes were evaluated to determine whether identification of the ODGC was noted and whether the surgeon indicated that the MRI was to evaluate for an ODGC. MRIs were reviewed, dimensions of cysts measured and volume of cyst calculated. Results Twenty-four patients and 25 MRIs were analyzed. The radiologist identified the ODGC in 19 cases (76%). Fifteen of the 25 MRIs (60%) ordered had ODGC listed in the requisition comment by the ordering surgeon. Thirteen of these 15 (87%) ODGCs were seen by the radiologist. Ten of the 25 MRIs (40%) ordered did not mention ODGC in the requisition. Six of these 10 (60%) ODGCs were seen by the radiologist. The volume of the ODGCs missed by radiologists was smaller (mean, 0.049 cm 3 ) than those the radiologists identified (mean, 0.31 cm 3 ; p = 0.004). Conclusions Radiologists will not always identify the ODGC on an MRI, but they were more likely to if the surgeon was concerned for one. Hand surgeons should report suspicion of an ODGC on MRI requisition and review all imaging independently. Level of Evidence This is a Level III, prognostic study.

Can be Considered the CA-125 and Neutrophil-to-lymphocyte Ratio Values as a Diagnostic Value in Ovarian Endometriosis?

In Romania it is estimated that there are half a million patients with endometriosis. The main symptoms are pain (70% of patients with chronic pelvic pain have endometriosis) and infertility (50% of infertile patients have endometriosis). It is difficult to make an accurate diagnosis. Numerous studies show a 7-10-year delay in diagnosis in women in developing countries. 47% of patients should be seen by more than 5 physicians over time until the diagnosis is established. The treatment for endometriosis is the surgical procedure and it is most often performed laparoscopically. The present study was carried in the Obstetrics and Gynecology Departments of the Pius Brinzeu Emergency Clinical Hospital Timisoara. We have included in this study patients who were hospitalized between 2013 and 2017. We have 142 patients who qualified for this study. All the patients had made the same medical tests: we collected information about their age, the neutrophil, lymphocyte and CA125 values, the position of the cyst and the cyst dimension. The aim of this study is to find if there is any association between the CA-125 markers (coelomic epithelial antigen) and the neutrophil-to-lymphocyte ratio in patients who were diagnosed with ovarian endometriosis by transvaginal ultrasound. In all cases the patients underwent laparoscopic surgery. After performing a correlation and regression analysis we obtained that we have a positive strong significant association between the CA 125 values and the ratio values (r=0.94; R2=0.88; p[0.001) . After the surgical excision of endometriosis, CA-125 can be used to monitor the evolution of endometriosis outbreaks, especially when there is a recurring severe pain.