Preexisting Cysts Research Articles

Familial splenic epidermoid cyst.

The differential diagnosis of cystic lesions of the spleen includes cystic neoplasms (sarcoma, lymphangioma, hamartoma), parasitic cysts (echinococcosis), nonparasitic abscess, pseudocysts (without an epithelial lining), and epithelial cysts [1 -3]. Epithelial cysts can be classified as mesothelial, epidenmoid, and dermoid. Epidermoid cysts are now generally believed to be due to squamous metaplasia within preexisting mesothelial cysts [2, 4]. Dermoid cysts possess skin adnexa and squamous epithelium. Very few have been reported, and their existence is controversial [5]. We observed three siblings with splenic epidermoid cysts. Splenic rupture occurred in two of the three siblings. The familial occurrence of epidermoid cysts and their apparent tendency to rupture prompted this case report.

Choosing the best oral contraceptive.

This guide to choice of oral contraceptives, for U.S. clinicians, includes a review of the available types of pills, the pharmacology of the steroids in pills, safety issues regarding thrombosis, arterial disease and hypertension related to estrogens and progestins in pills, common side effects, and therapeutic uses of orals. Choice of an oral contraceptive narrows down to which of the 5 available progestins and their formulation, since all contain ethinyl estradiol as the estrogen. While Briggs' theory espoused picking a pill with the minimal metabolic effect, recent evidence suggests that some estrogenic activity may be preferable to the unopposed progestagen, actually an anti-estrogenic receptor effect, to prevent adverse lipid and blood pressure effects in users. Current pills with low doses of estrogens probably are not significant risks for women as regards thrombosis, particularly if predisposed women and smokers are excluded. Pills containing 0.35 mg ethinyl estradiol and 0.5 mg norethindrone, based on large population trials, are probably the minimal effective dose yet even these are more effective than most other contraceptive methods. Breakthrough bleeding and spotting have been further minimized, however, with multiphasic pills. It is best to start with a 0.30-0.35 mg estrogen oral contraceptive, such as Loestrin, Demulin, Orthonovum 1.35, Orthonovum 7/7/7 or Nordette, encouraging the patient to accept early side effects for 3 months before switching to others. Disorders that can be managed with oral contraceptives include recurring and pre-existing ovarian cysts, endometriosis, dysfunctional uterine bleeding and dysmenorrhea. Brief guidelines for handling normal side effects and treatment of the above disorders are included.

Scaphoid implant resection arthroplasty: Long-term results

A silicone scaphoid implant was developed in 1967 to help improve the results of simple resection arthroplasty in the treatment of arthritic changes associated with advanced scaphoid disease. Patients who had scaphoid implant surgery since 1967 were studied. Preoperative and postoperative roentgenograms, charts, surgical pathology, and clinical evaluations were reviewed. A total of 55 cases of scaphoid implant arthroplasty were evaluated. A classification system was developed based on progressive severity, and treatment recommendations were developed for each stage of disease progression. Cystic and degenerative changes in contiguous carpal bones were evaluated. No evidence of cystic change could be found in 37 wrists, minimal changes were found in 9, moderate changes in 5, and severe changes in 4. There were no implant infections or fractures. Implant rotation occurred in two cases. Functional use of the hand with decreased pain was observed. It is important to detect and treat carpal instability, which may be associated with scaphoid disease. Cystic formation can be minimized by avoiding oversized implants, treating the associated carpal instability, bone-grafting preexisting cysts, and avoiding Kirschner wire fixation. By following treatment protocols as established in the classification system, the scaphoid implant can be successfully used in the management of scaphoid pathology

Biliary Cystadenocarcinoma Diagnosed by Liver Biopsy Performed Under Ultrasonographic Guidance

A case of a 60-yr-old man with biliary cystadenocarcinoma is reported. By needle biopsy of a cystic lesion performed under ultrasonographic guidance, overt malignant tissue could be obtained successfully. Histologic examination on autopsy material revealed that the tumor arose from preexisting benign liver cysts. The tumor showed a feature of well-differentiated, mucin-producing papillary adenocarcinoma in the primary site while, in the metastatic foci, it produced solid cell clusters with a tendency toward the differentiation into squamous cells.

Renal cysts: curios and caveats.

Interesting, unusual, and confusing renal cysts from a group of 200 cysts punctured percutaneously during the past decade are presented. Some cases illustrate pressure phenomena in cysts adjacent to each other or causing calyceal obstruction. Also reported are cyst wall findings, unusual cyst configurations, infection in pre-existing cysts, examples of cysts simulating renal cell carcinoma, and renal cell carcinoma presenting as cysts. In unusual cases, percutaneous needle puncture remains the procedure of choice for establishing the diagnosis of benign simple cyst versus malignancy or infection, or for determining the relationship of a cyst with the collecting system or with other cysts. Cyst puncture may also result in iatrogenic changes.