Location Of Cyst Research Articles

Pseudoenhancement in Cystic Renal Lesions – Impact of Virtual Monoenergetic Images of Photon-Counting Detector CT on Lesion Classification

To investigate the impact of virtual monoenergetic images (VMI) from photon-counting detector CT (PCD-CT) on the enhancement and classification of renal cysts. Adults with renal cysts (≥7mm) who received a triphasic examination on a clinical PCD-CT (120kVp; IQ level 68) between July 2021 and March 2022 were retrospectively identified. Only non-enhancing cysts (enhancement<10HU between unenhanced and venous phase at 70keV) were included. VMI from 40 to 190keV with increments of 10keV were reconstructed from the venous phase. Enhancement was measured to classify each lesion as non-enhancing (<10HU), equivocally enhancing (10-19HU), and definitely enhancing (≥20HU). Classification changes as a function of VMI were assessed. Pearson correlation coefficient, the Kruskal-Wallis and the Chi-square test were used. A total of 86patients (mean age, 74±9 years; 74 male) with 160 non-enhancing renal cysts (17.6±10mm) were included. CT attenuation of the cysts increased from higher to lower VMI levels with a mean attenuation of 4±11HU at 190keV to 36±17HU at 40keV. Mean attenuation of the renal parenchyma was 43±4HU at 190keV and 414±71HU at 40keV. No cyst exhibited enhancement from 70keV to 190keV. At 40, 50, and 60keV, 35% (56/160), 29% (47/160) and 9% (15/160) of cysts showed equivocal and 46% (74/160), 10% (16/160), and 0% (0/160) definite enhancement, respectively. There was no significant influence of size (P=.13), cyst location (P=.9) and BMI (P=.19) on enhancement classification. VMI has a relevant impact on enhancement and classification of renal cysts with misclassification in a large number of cases at energy levels below 70keV.

Evaluation of the factors influencing the choice of laparoscopic echinococcectomy in liver echinococcosis (LE) and its impact on postoperative outcomes.

The aim of this article is to evaluate the factors influencing the choice of laparoscopic echinococcectomy (LapEE) in liver echinococcosis (LE) and its impact on postoperative outcomes. The article presents a retrospective analysis of the effectiveness of LapEE depending on gender, age, cyst location, size and stage of echinococcal cysts (EC) development, also taking into account the performance of drainage or abdominal interventions in relation to the residual cavity (RC). The study included patients with the primary form of LE - 46 patients who underwent LapEE at the State Institution "Republican Specialized Scientific and Practical Medical Center for Surgery, named after the academician V. Vakhidov", between 2019 and 2020. Taking into account the stage of cyst development, various difficulties with aspiration or removal of the cyst contents occurred in only 14 (30.4%) cases, more often with type II-IV cystic echinococcosis (CE). Another problem was the difficulty with adequate revision and treatment of RC (in 6 (13.0%) patients) with predominantly intraparenchymal localization. Difficulties with performing percytectomy with sufficient excision of the fibrous capsule were noted in 9 (19.6%) cases. In the period up to a week after the operation, the drainage was removed for cysts up to 8cm in 11 (36.7%) cases, with more than 8cm - in 5 (31.3%). By 3 weeks of observation, the drains were removed in all cases with cysts up to 8cm, while with large sizes in 12.5% (2 patients) cases, the drainage was removed on days 21-28 and in 1 (6.3%) patient at a later period. In general, in the group, complications from the RC on days 9-27 after LapEE were noted in 10 (21.7%) of 46 patients, fluid accumulation in 8 (17.4%) and suppuration in 2 (4.3%). Most complications were resolved conservatively - 13.0% (in 6 patients), a minimal invasive drainage of the RC was performed in 6.5% (3 patients), 1 (2.2%) patient was operated on with a RC abscess. Among the main factors that technically complicate LapEE, in addition to localization, difficulties with aspiration or removal of cyst contents in CE II, III, and IV are highlighted due to the presence of many daughter cysts that completely fill the maternal membrane (CE II, III) or thick viscous discharge (CE IV), as well as difficulties in performing a pericystectomy for adequate elimination of the RC when the hydatid is located 3/4 or more in the liver parenchyma.

Rare Cortical and Intraparenchymal Epidermoid Cyst within the Right Occipital Lobe (P3-4.004)

<h3>Objective:</h3> N/A <h3>Background:</h3> The differential diagnosis for a diffusion-restricting cortical lesion on brain magnetic resonance imaging (MRI) is broad and includes acute ischemic stroke, abscess, demyelination, Creutzfeldt Jakob disease, encephalitis, and epidermoid cyst. <h3>Design/Methods:</h3> <h3>Case description:</h3> A 13-year-old boy with accelerated growth underwent MRI for pituitary assessment, which incidentally demonstrated a non-enhancing, T2 hyperintense right occipital lesion. No diffusion weighted imaging (DWI) sequences were obtained, and the lesion was suspected to represent encephalomalacia. Five years later, he developed left visual field difficulties and repeat MRI identified right occipital lesional growth with high DWI and low apparent diffusion coefficient (ADC) signal. The patient underwent resection of the right occipital lesion. Histopathology revealed keratin encapsulated by squamous epithelium, consistent with an epidermoid cyst. Our patient is currently doing well, and his left visual field vision is improved. <h3>Results:</h3> <h3>Discussion:</h3> Intracranial epidermoid cysts comprise 1% of primary intracranial tumors and are derived from ectodermal inclusions during neural tube closure. They usually present in middle age due to mass effect on adjacent structures. Epidermoid cysts most commonly occur at the cerebellopontine angle and parasellar region. A cortical location of an intracranial epidermoid cyst, as in our patient’s case, is very rare. The signal intensity of the epidermoid cyst on MRI is variable due to its composition of keratin and lipids and there is usually no associated edema. Total surgical excision is the mainstay of treatment for intracranial epidermoid cysts. Recurrence is not uncommon, but growth is usually slow over many years. <h3>Conclusions:</h3> Neurologists should include intraparenchymal epidermoid cysts in the differential diagnosis for a diffusion restricting lesion on MRI of the brain. <b>Disclosure:</b> Dr. Webb has nothing to disclose. The institution of Dr. Burns has received research support from NIH (NINDS, NCI), DOD, ABTA, Ivy foundation, insightec, Mayo Clinic, Abbvie, . Dr. Zhang has nothing to disclose. Dr. Sener has nothing to disclose.

Laparoscopic management of hydatid cysts using long ribbon gauze: An initial experience of 37 consecutive cases

ObjectiveThe laparoscopic approach is becoming the standard of care for many surgical disorders. However, in the case of hydatid cysts, laparoscopic management is challenging due to the risk of spillage of hydatid fluid, which can cause an anaphylactic reaction and recurrence. Here, we report our initial experience with laparoscopic partial pericystectomy of hydatid cysts using long ribbon gauze to decrease intra-operative spillage. MethodThis was a retrospective study (between January 2010 and December 2021) in the Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, a tertiary care referral center in northern India. Here, we have included 37 consecutive patients with hydatid cysts of the liver and spleen. Diagnosis was made by laboratory and imaging findings (abdominal sonography or contrast enhanced CT scans). All patients were managed with laparoscopic partial pericystectomy. Intraoperatively, a betadine-soaked long ribbon gauze, high-pressure suction canula, and an endo-bag were used in all patients. The collected data included patient demography, location, size, and number of cysts, WHO type, operative time, blood loss, postoperative complications, hospital stay and follow-up. ResultIn our series, the mean age was 38.4 ± 13.6 years, 15 (40.5%) were men and 22 (59.5%) were women. The right lobe of the liver was the most commonly affected site (21, 56.8%). The mean operative time was 80.0 ± 32.0 min, and intraoperative blood loss was 23.6 ± 11.5 mL. Bile leak was present in 6 (16.2%) patients. There was no mortality. The hospital stay was 5 (3, 9) days, and no recurrence was observed at a median follow-up of 36 months. ConclusionLaparoscopic partial pericystectomy using this technique is safe in the management of hydatid cysts. Simply, proper packing and safe removal of soaked gauzes can minimize the incidence of postoperative complications and recurrence.

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

Retrospectıve Analysis Of Risk Factors In The Development Of Biliary Fistula After Liver Hydatid Cyst Surgery

Abstract&#x0D; Background: Cystic echinococcosis (CE) of the liver is a parasitic disease caused by the larvae of Echinococcus granulosus. Although CE is a disease with benign characteristics, its morbidity is high in the presence of complicated cysts. The most important complications are fistulization of the biliary tract and intraperitoneal cyst ruptures&#x0D; Material Methods: Patients who underwent surgery for CE in Atatürk University Research Hospital between 2011 and 2021 were analyzed retrospectively. Demographic information, CE localization, cyst size, CE classification, surgical techniques and hospitalization time of all operated patients were recorded. The effect of all data types on the categorical variable was analyzed using binary logistic regression. &#x0D; Results: Of the patients, 299 (60.2%) were female, and 198 (39.8%) were male. The mean age was 41 ± 15.48 and 41 ± 15.36 years in the group with and without bile fistula, respectively. We found a significant difference in mean cyst sizes between the two groups. Cyst location and cyst type according to WHO classification had a statistically significant effect on the cysto biliary communication (p: 0.00, p: 0.00, respectively. Analysis by cyst types showed that CE 1, CE2, CE3A, and CE3B cysts were statistically significantly effective on biliary fistula formation. CE 1 type cysts were more effective than other cyst types. CE 2, CE3A, and CE 3B cysts were less effective than CE1 &#x0D; Conclusion: The risk of bile leakage is higher in hepatic hydatid cysts located in the left lobe and in CE1 cysts. The incidence of bile leakage increases in large cysts.

Endoscopic Fenestration of an Intra-ventricular Arachnoid Cyst in a Young Male – A Rare Entity

Introduction: Among intracranial space-occupying lesions, arachnoid cysts compromise 1% only. Abnormal collection of cerebrospinal fluid occurs in these types of cysts leading to pressure symptoms. Developmental abnormalities of cerebrospinal structures in early fetal life lead to the primary type of arachnoid cysts, while the second type of arachnoid cyst is formed after some neurological insult like head injury, tumor, meningitis, or brain surgery. In 60 – 90% of cases, the primary type predominates and presents with pressure symptoms before the age of 20 years. The adjudged incidence is 1.4% in adults, the least frequent being intraventricular location. Clinical Case: A 23-year-old male presented with a long-standing left-sided cranial vault headache, right-sided focal seizures, and progressive right- hemiparesis. Neurological evaluation revealed upper motor neuron signs on the right side of the body. A computerized axial tomography raised the suspicion of an arachnoid cyst for which magnetic resonance imaging was done which revealed a large intraventricular cyst of lateral ventricles causing mass effect over the ipsilateral hemisphere and mild obstructive hydrocephalous. Surgical intervention was required as per symptomology (intractable headache, seizures, and hemiparesis) and large cyst size. Conclusion: Cerebrospinal fluid accumulation in the brain's arachnoid layer causes non-cancerous arachnoid cysts. Larger cysts may push on brain tissue and cause neurological difficulties. MRI may diagnose arachnoid cysts, and treatment options include cystoperitoneal shunt, craniotomy, and neuro-endoscopic fenestration, the least invasive. Cyst size and location determine therapy. In this example, endoscopic treatment reduced symptoms and consequences.

Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children

This study aimed to investigate factors that influence subdural haemorrhage (SDH) secondary to intracranial arachnoid cysts (IACs) in children. Data of children with unruptured IACs (IAC group) and those with SDH secondary to IACs (IAC-SDH group) were analyzed. Nine factors, sex, age, birth type (vaginal or caesarean), symptoms, side (left, right, or midline), location (temporal or nontemporal), image type (I, II, or III), volume, and maximal diameter, were selected. IACs were classified as types I, II, and III according to their morphological changes observed on computed tomography images. There were 117 boys (74.5%) and 40 girls (25.5%); 144 (91.7%) patients comprised the IAC group and 13 (8.3%) comprised the IAC-SDH group. There were 85 (53.8%) IACs on the left side, 53 (33.5%) on the right side, 20 (12.7%) in the midline region, and 91 (58.0%) in the temporal region. The univariate analysis showed significant differences in age, birth type, symptoms, cyst location, cyst volume, and cyst maximal diameter (P<0.05) between the 2 groups. Logistic regression using the synthetic minority oversampling technique model showed that image type III and birth type were independent factors that influenced SDH secondary to IACs (β0=4.143; β for image type=-3.979; β for birth type=-2.542) and that the representative area under the receiver-operating characteristic curve value was 0.948 (95% confidence interval, 0.898-0.997). IACs are more common in boys than in girls. They can be divided into 3 groups according to their morphological changes on computed tomography images. Image type III and caesarean delivery were independent factors that influenced SDH secondary to IACs.

Intra thoracic extra pulmonary hydatidosis: prognosis and outcomes of 8 operated patients

Hydatid cyst disease is a parasitic disease known from the times of hippocrates, and is still endemic in our country Morocco among others, affecting mainly the liver and lungs, while intra thoracic extra pulmonary location remains a rare entity of the disease. In our department of thoracic surgery, Mohamed VI University Hospital, Oujda, Morocco, we operated 92 patients for thoracic hydatid cyst in the period between January 2016 and December 2021, 8 patients of this group had exclusive extra pulmonary location of the hydatid cyst, epidemiological and clinical data were recorded for the 8 patients (5 men, 3 women). The mean age was 40.3 years, all patients presented mainly with chest pain, dyspnea and cough. The locations of the hydatid cysts were chest wall, pericardium, pleural space and diaphragm. The hydatid cysts were removed via extirpation technique through thoracotomy in all patients. The average duration of hospitalization was 7 days. Postoperative complications consisted of atelectasis in one patient, parietal hematoma in another, and surinfection with pleuro-cutaneous fistula and chronic neurological chest pain in one patient. No deaths were noted in our series.

Isolated multiple pericardial hydatid cysts in an asymptomatic patient: Role of the CMR

Hydatid cysts primarily affect the liver and secondary involvement may be seen in almost any anatomic location. We describe the unusual pericardial location of the Echinococcus cysts in an asymptomatic patient with suggestive cardiac magnetic resonance imaging.

Evaluation Of Serological, Biochemical And Imaging Findings With Hydatid Cyst Patients

Objective: Hydatid cyst is a serious disease caused. The liver (50-70%) and, less frequently, the lungs (18-35%), are affected most. Diagnosis is made by evaluating the patient's clinical history, imaging findings, and serologic and immunologic tests together. Ultrasonography, computed tomography, and magnetic resonance imaging are used as imaging methods. Most classifications are made according to imaging findings. We aimed to present our experience by evaluating the relationship between age, sex, location and size of cysts, stage, indirect hemagglutination test, and laboratory and imaging findings in patients with hydatid cyst. Methods and Material: Retrospectively, We have evaluated the demographic data, laboratory examinations and imaging from 60 patient with diagnosis of hydatid cyst. These results were analyzed to assess and compared with each other. Results: The most commonly affected age group was 25-45 years. The most frequently involved lobe was the right lobe and segment 6. No caudate lobe involvement was detected. There was no elevation of eosinophil count in patients with extrahepatic involvement. Conclusions: The combination of clinical history, radiological and serological test results is valuable in the diagnosis of hydatid cyst. In addition, the presence of multiple cysts should be investigated in patients with high eosinophil value. The possibility of multiple cysts in the liver should be kept in mind in hydatid cyst patients with elevated aspartate transaminase level.

Laparoscopic cyst enucleation is a promising technique for treatment of gastrointestinal tract duplications in children

BackgroundLaparoscopic cyst enucleation has its advantages and limitations in treatment of gastrointestinal tract (GIT) duplications. It allows to avoid bowel resection in such locations as ileocecal valve. We introduced laparoscopic cyst enucleation with further bowel plasty using cyst muscle layer and without monopolar coagulation, for cyst dissection we used straight scissors. Materials and methodsOur study included 20 children with GIT duplications, who underwent cyst enucleation from 2018 to 2021. Laparoscopy was performed in all cases with various cyst locations (stomach – 2, duodenum – 3, small bowel – 14, ileocecal area – 1). Mean age of surgery was 40 ± 35,3 days (min 6 days, max 150 days). ResultsMean operation time was 84,4 ± 27,35 min (min – 40 min, max – 160 min). We had no intraoperative complications. All patients received parenteral feeding for 3–5 days after the operation. Postoperative complications occurred in 3 cases: bowel perforation which required enterostomy (10%) and bowel volvulus required resection (5%). To our opinion, perforations occurred due to monopolar coagulation used for cyst enucleation in these children. No complications were observed in patients who underwent enucleation by straight scissors. Mean postoperative hospital stay was 15.6 ± 10.48 days (min – 4 days, max – 58 days). We observed neither stenosis nor any other complications in the long-term follow-up. ConclusionsLaparoscopic cyst enucleation is a feasible and safe approach for GIT duplications. It allows to avoid bowel resection, and the use of straight scissors instead of monopolar coagulation provides less postoperative complications such as perforation. The Level of evidenceIII.

Treatment of Cystic Echinococcosis in Children: A Single Center Experience.

Cystic echinococcosis (CE) treatment is complicated, relying on cysts characteristics, host factors and possible treatment adverse events. We assessed childhood CE treatment characteristics. A retrospective cohort study, 2005-2021, which presents our experience with treating children with CE. We compared therapeutic interventions use in association with the location, size and number of cysts. Additionally, we assessed complications rate following those interventions. Sixty six children had CE; 97% were Bedouins. Overall, 183 cysts were identified in 74 organs: liver (n = 47, 64%), lungs (n = 23, 31%), brain, para-ovarian, kidney and peritoneum (other-grouped, n = 4, 5%). Mean ± Standard deviation largest cyst size (per patient) was 6.6 ± 3.2 cm. Treatment with albendazole was administered to 94% of CE, while albendazole monotherapy was used in 27% (n = 18, including 4 cases with extra-hepatic cysts). Surgical interventions included drainage/puncture, aspiration, injection and reaspiration (PAIR; n = 20), mainly performed in hepatic-CE (40% vs. 4% in pulmonary-CE, and 0% in other-CE), excision and drainage (n = 34) and complete excision (n = 10), mainly done in other-CE (50% vs. 26% and 4% in pulmonary-CE and hepatic-CE, respectively). Larger cyst size was associated with complete excision compared with albendazole monotherapy. The number of cysts was not associated with the chosen intervention. Fever was recorded following 39% of surgical interventions. Local surgical complications were relatively rare. Cysts location and size affected treatment choice among CE patients. Procedures with drainage had relatively higher rate of complications, including recurrence. Albendazole monotherapy may be a viable therapeutic option in selected CE cases.

CURRENT MODE OF TREATMENT OF THE HEPATIC HYDATID CYST

Purpose: The aim of the study is to analyze the clinical symptoms, surgical approach and postoperative complications of patients with hydatid cysts of the liver in UMHATEM “N.I.Pirogov”. Material and Methods: A total of 39 patients with a diagnosis of hydatid cyst of the liver were admitted to the hospital for a two-year period from 01.01.2019 to 01.01.2021 in the Department of General, Visceral and Emergency Surgery at UMHATEM "Pirogov". Confirmation of diagnosis was based on history, physical examination, laboratory results, ultrasound and CT. Of those hospitalized women were 14 (35.9%), men 25 (64.1%). Results: Тopographically,27 of the cases (69.23%) with liver cysts were located in the right lobe and 12 (30.77%) of them-in the left lobe of the liver. The diameter of the cysts varied from 7 cm-35 cm. There were two groups of patients. With multiple cyst were 29 (74.36%) of the cases, while the group of the single cyst were 10 (25.64%). The operating time varied between 49 and 135 minutes (average 57.4 minutes). The hospital stay ranged from 4 days to 9 days (average 7.1 days). Conclusion: The surgical approach of hydatid liver cyst with the appropriate election of the different therapy opportunities according to the size, number, and location of cysts in the liver, combined with medical therapy, remains the favorable solution.

Investigation on Descriptive Epidemiology, Geographical Distribution, and Genotyping of Echinococcus granulosus s.l. in Bovine from Romania.

Bovine echinococcosis is a zoonotic disease with worldwide distribution, causing significant economic losses in the affected animals and important public health concerns. The aim of the current study was to investigate the presence and geographical distribution of cystic echinococcosis, and molecular characterization of Echinococcus granulosus s.l. from slaughtered cattle in Romania. In the period 2020-2021, a total of 2693 cattle (aged 2-21 years) slaughtered from the breeds Bruna de Maramureș, Bălțată Românească, and a mixed breed were examined to identify hydatid cysts. Cysts were identified in 66 cattle (2.45%). The predominant location of hydatid cysts was the lungs. Most cysts were non-fertile. By age categories, hydatidosis was reported in the age categories 2-12 years (6/2341; 0.25%), 13-16 years (11/244; 4.5%), 17-20 years (41/85; 48.23%), and over 21 years (8/23; 34.78%). Following the PCR analysis of 10 samples from the lungs (protoscoleces/proliferative membrane/hydatid liquid), DNA fragments were identified in 5 samples. Following sequencing, the identified species was Echinococcus granulosus&amp;nbsp;sensu stricto (s.s.). The study results indicate that the disease is still present in several of the investigated regions of Romania, highlighting a potential public health risk.

Genetic diversity of Echinococcus granulosus sensu lato from animals and humans in Bosnia and Herzegovina

Cystic echinococcosis (CE) is recognized as one of the most prevalent zoonotic diseases in Bosnia and Herzegovina. However, no systemic investigation of the genetic diversity of Echinococcus granulosus sensu lato circulating among animals and humans in the country has been performed to date. In this preliminary study, we analysed one cyst each from 36 sheep, 27 cattle, 27 pigs, 11 wild boars and 16 human patients for amplification and partial sequencing of the adenosine triphosphate 6 (atp6) and cytochrome c oxidase 1 (cox1) genes. The host species, fertility rate and organ cyst location were recorded for each subject involved in the study. Overall, the atp6 gene was successfully amplified and sequenced from 110 samples, while 96 of the PCRs for cox1 were positive. Three zoonotic genotypes of E. granulosus sensu stricto (G1 and G3) and Echinococcus canadensis (G7) were identified in our isolates based on analyses of the atp6 gene. These genotypes were represented by 11 different genetic variants (haplotypes), six of which were identified for the first time in the present study. This study demonstrates, for the first time, that CE in Bosnia and Herzegovina is predominantly caused by E. granulosus sensu stricto and E. canadensis clusters, which exhibited a lower genetic diversity compared to isolates from other European countries. Further molecular studies employing other mitochondrial and nuclear genes are required to better understand the transmission cycles of E. granulosus sensu stricto among intermediate and definitive hosts in the country.

Short-term outcomes in patients with center-involving diabetic macular edema after a single dose of intravitreal bevacizumab

BackgroundA significant portion of diabetic macular edema (DME) is refractory to anti-vascular endothelial growth factor (anti-VEGF) agents. This study investigates morphological and functional outcomes to a single intravitreal bevacizumab (IVB) injection in patients with center-involving DME (ciDME) at 4–6 weeks and compares treatment responders and non-responders based on spectral domain optical coherence tomography (SD-OCT) features.MethodsIRB approved observational, retrospective chart review of patients with ciDME, identified by ICD-10 code, who received IVB and underwent baseline and 4–6 weeks follow-up SD-OCT imaging between January 1, 2016 and January 19, 2021. Patients who had received previous treatment with anti-VEGF or intraocular steroids within 1 year were excluded. Variables included best-corrected visual acuity (BCVA), central subfield thickness (CST) and total macular volume (TMV). Eyes were classified as responders if CST reduction was greater than 10%. OCT scans were graded qualitatively by two masked graders using Imagivault software. Paired Student’s t-tests, Wilcoxon signed rank tests and Chi-Square tests were used for analysis.ResultsA total of 334 prospective subjects were identified, and after applying exclusion criteria 52 eyes from 46 patients (mean age 64.22 ± 8.12 years, 58.7% male) were included. Mean BCVA did not significantly change with treatment, 63.9 ETDRS letters (~ 20/50) at baseline and 65.9 ETDRS letters (~ 20/50) post-treatment (p = 0.07). Mean CST decreased from 466 ± 123 μm at baseline to 402 ± 86 μm post-treatment (p < 0.001). 22 (42.3%) of eyes were categorized as responders and 30 (57.7%) as non-responders. Average change in CST from baseline in responders was -164 μm (p < 0.001) and + 9 μm in non-responders (p = 0.47). Vitreomacular adhesion (VMA) was more prevalent in non-responders (28.7% vs. 4.8%, p = 0.03). In addition, cyst location in the inner nuclear layer (INL) was present more frequently in responders (95.5% vs. 73.3%, p = 0.037) as was subretinal fluid (45.5% vs. 13.3%, p = 0.01).ConclusionThe short-term response to a single IVB was sub-optimal with structural but no functional improvements. Greater baseline CST, presence of INL cysts and subretinal fluid may represent factors indicative of a better treatment response.

The Cardiac Hydatid Cyst: A Case Report

Hydatid cyst commonly affects liver and lung. Cardiac hydatid cyst is an extremely rare disease, due to the development in the heart of the larval form of Taenia Echinococcus granulosus. The diagnosis of this location is difficult due to the absence of specific clinical signs, and its prognosis is often guarded due to the risk of rupture and hematogenous dissemination. Clinical polymorphism, latency and severity of complications are the essential characteristics. We report the case of a child who has this exceptional location of hydatic cyst. The aim of this study is to report the presentation and management of cardiac Hydatid diseases.

Two Methods for Adenomyotic Cyst Excision

<h3>Study Objective</h3> The objective of this video is to demonstrate two techniques for hysteroscopic resection of adenomyotic cysts. <h3>Design</h3> N/A. <h3>Setting</h3> A patient desiring fertility presents for further evaluation. Imaging is notable for two fundal cysts on ultrasound consistent with adenomyosis. After informed consent is obtained, OR hysteroscopy is performed under ultrasound guidance. <h3>Patients or Participants</h3> One patient with adenomyotic cysts is highlighted. <h3>Interventions</h3> The patient is taken to the operating room and a 5.5mm rigid hysteroscope is advanced to the fundus under ultrasound guidance. After confirming the location of adenomyotic cysts via ultrasound, hysteroscopic scissors are used to open the cysts, with adenomyosis confirmed by release of chocolate brown fluid. Cyst walls are resected in their entirety, one sharply and one with bipolar loop. <h3>Measurements and Main Results</h3> Direct visualization of the endometrial cavity as well as intraoperative ultrasound confirm complete removal of adenomyotic cysts. Pathology of the cyst walls confirmed adenomyosis. <h3>Conclusion</h3> Hysteroscopic resection of adenomyosis is safe and effective in select patients with focal disease, allowing for targeted removal under direct visualization. Here we demonstrate two hysteroscopic techniques for resection of adenomyotic cyst wall: sharp dissection, and the bipolar loop electrode.

Diagnosis and Treatment of Intraosseous Ganglion in the Ankle Region.

To investigate the diagnosis and treatment of intraosseous ganglion cyst in the ankle region. A retrospective analysis was performed on the diagnosis and treatment of 18 patients with intraosseous ganglion in the ankle region from January 2005 to March 2016. There were 11 males and 7 females, with an average age of 40.4 years (22-74 years). Thirteen of these had mild intermittent localized pain in the ankle and five were asymptomatic and fortuitously found on images. According to the location of the intraosseous ganglion cyst, nine were located in the distal end of tibia, seven were in the distal end of the fibula, and two were in the talus. After curettage of intraosseous ganglion, 15 cases were filled with autogenous iliac bone and 3 cases with artificial bone. Fifteen cases were diagnosed with radiographs and CT scans, two cases with MR images, and one case was confirmed by postoperative pathology. The cyst contents were jelly-like material with sclerotic bone margins. The mean size of the intraosseous ganglion cyst was 1.5cm × 1.5cm × 1cm. Hematoxylin and eosin (H&E) staining of the tissue showed fibrous tissue, collagenous fiber, mucoid, and a few fibroblasts. Eighteen cases were followed up for 11 months to 10 years, with an average of 5.4 years. No recurrence was found. Sixteen patients were asymptomatic after surgery. Two cases of ankle pain occurred at 1 year and 6 months postoperatively, respectively. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the mean AOFAS ankle-hindfoot score improved from 78.2±13.7 points preoperatively to 97.3±4.5 points at the final follow-up. For the intraosseous ganglion cyst in the ankle region, whether there are clinical symptoms or not, the cyst should be curettaged and the cavity should be filled with bone graft. The operation result is satisfactory.