Total Cyst Research Articles

Bronchogenic cyst of the esophagus: clinical and imaging features of seven cases

Seven unusual cases of esophageal bronchogenic cyst (EBC) are presented. Different from mediastinal or pulmonary bronchogenic cysts, EBCs predominately affect young women (six out of seven cases; mean age, 29.9 years), and clinically, such cases were characterized by dysphagia and chest pain, especially during exercise. On radiographs and computed tomographs, EBCs typically appeared as 3- to 4-cm midthoracic cystic masses close abutting to the midthoracic esophagus. Rarely, exophytic lower thoracic EBC may mimic lung nodule. Total cyst excision usually offers satisfactory outcome with no recurrence in long-term follow-up.

In Vivo Confocal Microscopy of Filtering Blebs After Trabeculectomy

To analyze filtering blebs after trabeculectomy by means of in vivo confocal microscopy and to correlate the images with clinical bleb appearance and function. In vivo confocal microscopy using the Heidelberg Retina Tomograph/Rostock Cornea Module (Heidelberg Engineering, Heidelberg, Germany) was performed in 53 filtering blebs in 45 patients 6 days to 30 years postoperatively. In vivo confocal microscopic findings significantly correlated with good bleb function included the number of epithelial microcysts (P = .03), a large total stromal cyst area (P = .009), the absence of encapsulated stromal cysts (P = .002), minimal vascularization (P = .05), and the absence of tortuous conjunctival vessels (P = .01). In contrast, a hyperreflective condensed bleb stroma was significantly associated with bleb failure (P<.001). Bleb stroma mainly consisting of a rarified collagenlike network was significantly linked to trabeculectomy performed with mitomycin C (P = .001). Epithelial and stromal inflammation were observed at a median of 1 and 4 months after surgery, respectively. In vivo confocal microscopy using the Heidelberg Retina Tomograph/Rostock Cornea Module permits diagnostic imaging of filtering blebs and differentiation between good and insufficient bleb function. Moreover, the postoperative inflammatory reaction can be monitored directly for adapted postoperative anti-inflammatory treatment.

Pancreatitis After a Primary and Secondary Excision of Congenital Choledochal Cysts

Pancreatitis has been reported long after total choledochal cyst excision. The aim of this study was to determine if the disease process of postoperative pancreatitis differs between a primary and secondary cyst excision in a long-term follow-up. Among 53 postoperative patients who underwent a total cyst excision and were followed up, 44 patients underwent a primary cyst excision (primary excision group), while 9 patients underwent a secondary cyst excision after a previous cyst-duodenostomy for internal drainage (secondary excision group). The long-term clinical course, including the pancreatographic findings after a total cyst excision, was compared. In the primary excision group, six patients had mild pancreatitis. Endoscopic retrograde pancreatography demonstrated ductal dilatation that was limited to the common channel in two patients, concurrent with the ventral duct in three, and extended the duct of Santorini in three. Conservative treatments were carried out in three patients, and endoscopic irrigation in one patient with protein plugs in the ventral duct. A resection of the choledochal remnant in the pancreas was performed in two patients with choledochal remnant-associated pancreatitis. From the secondary excision group, 5 of the 9 patients had chronic pancreatitis. Endoscopic retrograde pancreatography showed entire pancreatic ductal dilatation. Two of these patients underwent duodenal papilloplasty at the same time as secondary surgery; however, the disease progressively worsened. In patients undergoing a secondary total excision after internal drainage, it is difficult to half the ongoing aggravating process in pancreatitis.

Reliability of Magnetic Resonance Imaging for Measuring the Volumetric Indices in Autosomal-Dominant Polycystic Kidney Disease: Correlation with Hypertension and Renal Function

Background: The purpose of this study was to determine if renal volumetric indices can be accurately measured using MRI, and if these volumetric indices are associated with hypertension and renal function in patients with autosomal-dominant polycystic kidney disease (ADPKD). Methods: For testing the accuracy of the MRI-based volume measurements that we proposed for clinical trial, we designed phantoms to simulate cysts within the kidney. Fifty-six patients with ADPKD were included in this study, and their respiratory compensated T₂-weighted fast spin-echo images were acquired. The total kidney volume (Vt), cyst volume (Vc), and noncystic parenchymal volume (Vp) were measured and the percent cyst volume (Pc) was calculated. These volumetric indices were compared with the disease progression in the ADPKD patients. Results: The MRI measures of the phantoms were accurate. The Vt, Vc and Pc were significantly greater in the hypertensive group (n = 35) than in the normotensive group (n = 21) (p < 0.01). The Vt, Vc and Pc were significantly greater in the renal failure group (n = 23) than in the normal renal function group (n = 33) (p < 0.01). The Vt, Vc, and Pc were inversely correlated with the creatinine clearance. Conclusion: MRI is a reliable method to measure renal volumetric indices. The MRI-based volume measurements can be employed as useful markers for the progression of disease in ADPKD patients.

Volume Progression in Polycystic Kidney Disease

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive enlargement of cyst-filled kidneys. In a three-year study, we measured the rates of change in total kidney volume, total cyst volume, and iothalamate clearance in patients with ADPKD. Of a total of 241 patients, in 232 patients without azotemia who were 15 to 46 years old at baseline we used magnetic-resonance imaging to correlate the total kidney volume and total cyst volume with iothalamate clearance. Statistical methods included analysis of variance, Pearson correlation, and multivariate regression analysis. Total kidney volume and total cyst volume increased exponentially, a result consistent with an expansion process dependent on growth. The mean (+/-SD) total kidney volume was 1060+/-642 ml at baseline and increased by a mean of 204+/-246 ml (5.27+/-3.92 percent per year, P<0.001) over a three-year period among 214 patients. Total cyst volume increased by 218+/-263 ml (P<0.001) during the same period among 210 patients. The baseline total kidney volume predicted the subsequent rate of increase in volume, independently of age. A baseline total kidney volume above 1500 ml in 51 patients was associated with a declining glomerular filtration rate (by 4.33+/-8.07 ml per minute per year, P<0.001). Total kidney volume increased more in 135 patients with PKD1 mutations (by 245+/-268 ml) than in 28 patients with PKD2 mutations (by 136+/-100 ml, P=0.03). Kidney enlargement resulting from the expansion of cysts in patients with ADPKD is continuous and quantifiable and is associated with the decline of renal function. Higher rates of kidney enlargement are associated with a more rapid decrease in renal function.

Solar disinfection of poliovirus and Acanthamoeba polyphaga cysts in water – a laboratory study using simulated sunlight

To determine the efficacy of solar disinfection (SODIS) in disinfecting water contaminated with poliovirus and Acanthamoeba polyphaga cysts. Organisms were subjected to a simulated global solar irradiance of 850 Wm(-2) in water temperatures between 25 and 55 degrees C. SODIS at 25 degrees C totally inactivated poliovirus after 6-h exposure (reduction of 4.4 log units). No SODIS-induced reduction in A. polyphaga cyst viability was observed for sample temperatures below 45 degrees C. Total cyst inactivation was only observed after 6-h SODIS exposure at 50 degrees C (3.6 log unit reduction) and after 4 h at 55 degrees C (3.3 log unit reduction). SODIS is an effective means of disinfecting water contaminated with poliovirus and A. polyphaga cysts, provided water temperatures of 50-55 degrees C are attained in the latter case. This research presents the first SODIS inactivation curve for poliovirus and provides further evidence that batch SODIS provides effective protection against waterborne protozoan cysts.

Kyste hydatique de la thyroïde

Introduction Primary hydatid cyst of thyroid gland is an exceptional localization. The thyroid gland is an uncommon site even in Morocco where echinococcal disease is endemic. The aim of this study was to report our experience of this rare disease, and to review diagnosis problems and management. Patients and method Retrospective study of six patients with primary hydatid cyst of thyroid gland during a 4-year period. Results We report six cases of primary hydatid cyst of thyroid gland. Symptoms were isolated thyroid nodules. Diagnosis was based on echography and echinococcal immunologic test. However, hydatic origin was suspected in only 50% of patients preoperatively and immunologic test had 33% false positive rate. Surgical management was a lobo-isthmectomy with a total resection of the cyst in four cases (67%) and a resection of the cyst prominent dome in two cases (33%). Diagnosis was always confirmed by macroscopic aspects and pathology. In all cases, the postoperative course was uneventful and no recurrence occurred with a 19 months follow up. Conclusion Primary hydatid cyst of thyroid gland is a potential but rare situation. Positive diagnosis can be difficult during preoperative period. Cyst size and diagnosis doubt are two crucial criteria to decide the optimal surgical strategy (lobo-isthmectomy with total cyst resection vs resection of the cyst prominent dome).

Model for end-stage liver disease (MELD) exception for polycystic liver disease

Polycystic liver disease (PLD) is commonly associated with polycystic kidney disease, but is unaccompanied by renal cysts in 10% of cases. Symptomatic PLD is mainly limited to adults and rarely, if ever, presents in childhood. There is currently no effective medical therapy for PLD. Most patients who have PLD require no medical or surgical intervention. Patients with PLD rarely, if ever, experience biochemical hepatic deterioration, and classic symptoms of hepatic failure such as ascites, variceal hemorrhage, or encephalopathy are unusual.1-3 Although there is a typical lowering of the quality of life in these patients, to date, quality of life (although not well studied) has not been associated with decreased survival. Serious, life-threatening complications related to multiple hepatic cysts may occur, including cyst infection, hepatic vein outflow obstruction, portal hypertension, refractory ascites after cyst fenestration, cyst carcinoma, cholangiocarcinoma, and most importantly, pain and/or chronic wasting with malnutrition.2-4 Symptomatic PLD only occurs in patients with massive hepatic cystic disease in which the total cyst:parenchyma ratio is >1.5 Patients with PLD on hemodialysis are at greatest risk of life-threatening complications due to hepatic cysts complicated by infection, hemorrhage, and carcinoma. In one center, 10% of the mortality in patients with PLD on hemodialysis was attributed to these complications. However, this observation has not been confirmed by other centers. Nontransplant interventions that can relieve symptoms of massive hepatic cystic disease include percutaneous cyst puncture and sclerotherapy, laparoscopic cyst decompression, open laparotomy with fenestration, and liver resection.3, 6-10 These interventions can provide temporary or prolonged relief of symptoms but may be associated with significant morbidity and even mortality. Open surgical decompression is associated with a very low mortality rate but is associated with substantial morbidity. Laparoscopic decompression reduces hospital length of stay but is also associated significant morbidity.6 Liver resection is indicated only in highly selected patients and is associated with the potential for frequent morbidity and significant mortality. Liver transplantation (LT), the ultimate treatment for PLD, eliminates the disease and its complications and provides long-lasting relief of symptoms.11-14 Approximately 40% of those undergoing LT will require simultaneous kidney transplantation. Five-year survival after LT or liver-kidney transplantation is approximately 70 to 75%, and much of the mortality is in the first year. LT with or without kidney transplantation should be avoided in severely malnourished or debilitated patients. Patients with PLD may be candidates for living-donor LT. Patients with PLD generally have preserved liver function and normal Model for End-Stage Liver Disease (MELD) scores if they do not have renal involvement. Satisfy criteria for massive PLD (total cyst:parenchyma ratio >1) and have a complication of the PLD that is likely to resolve after LT. Are not candidates for, or have disease that has failed to respond to, nontransplant interventions for relief of symptoms; malnutrition may be considered a primary contraindication to nontransplant surgery. Have clinically significant manifestations of liver disease that can be attributed to massive PLD, which may include cachexia, ascites, portal hypertension (variceal bleeding), hepatic venous outflow obstruction, biliary obstruction, cholestasis, or recurrent cyst infection. Have severe malnutrition (assessment made on the basis of hypoalbuminemia or decreased lean body mass). Have serum albumin <2.2 mg/dL. Have lean body mass reflected by decreased midarm circumference, measured in the nondominant arm midway between the acromion and the olecranon process: <23.1 cm in female patients and <23.8 cm in male patients. PLD, polycystic liver disease; LT, liver transplantation; MELD, Model for End-Stage Liver Disease. There are insufficient data to justify automatic priority for patients with PLD. Patients without renal insufficiency may receive a MELD score of 15. The score may be increased by an additional 3 points every 3 months upon reapplication with submission of current clinical data. Patients with renal insufficiency (defined as glomerular filtration rate or creatinine clearance < 30 mL/min) may receive a MELD score of 20. The score may be increased by an additional 3 points every 3 months upon reapplication. Clinical data that need to prospectively collected and be submitted to the Regional Review Boards include documentation of recurrent cyst infection by culture reports, and weight of the explant liver and the ratio of the liver weight to patient height to determine whether these parameters correlate with patient outcome. In addition, the Regional Review Boards may require vascular studies (full reports with computed tomographic scans, magnetic resonance imaging, or angiography) to document cases of vascular occlusion.

C S F pseudocysts peritoneal cavity following V P shunt surgery: Report of three cases in children and review of literature

Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication following ventriculo-peritoneal (VP) shunt. The following report's our experience with three cases of CSF pseudocyst in children. VP shunt was done earlier for communicating hydrocephalus following tubercular meningitis (TBM) in all cases. Clinical presentation was with progressive abdominal distension and features of intestinal obstruction. Clinically we were able to diagnose all cases as CSF pseudocyst peritoneal cavity. Ultrasound examination confirmed the clinical findings in all. CT scan of abdomen and pelvis showed a large unilocular CSF pseudocyst with shunt catheter within it on one patient (case 3). Ultrasound guided aspiration of cyst was done in case 1 alone, but failed to resolve the symptoms. All patients needed formal exploration. Near total cyst excision, adhesiolysis and relocation of peritoneal end of VP shunt catheter in right supra hepatic space was done in all. Two patients who developed shunt tract infection needed shunt removal. The follow up period is 6-8 months.

Choledochal cysts in adults.

Fourteen adults who presented with choledochal cysts were studied. Symptoms in most cases were non-specific, which resulted in delayed diagnosis. Associated extracystic hepatobiliary disease occurred in 11 patients, including two with cholangiocarcinoma. Nine patients underwent total cyst excision (eight Todani classification type I and one type II), while four with type IVa cysts had excision of the extrahepatic cyst component. There were no surgical deaths. One patient with metastases was treated conservatively. Median follow-up was 6.5 years. Two of three patients who developed anastomotic strictures underwent successful revision surgery, while one with secondary sclerosing cholangitis developed biliary cirrhosis and died from hepatic failure after 8 years. Both patients with cholangiocarcinoma have died. Ten survivors are well and one patient was lost to follow-up. This study highlights the complexity of choledochal cysts in adults and emphasizes the need for earlier diagnosis and treatment. Cyst excision should be performed where possible, with reconstruction modified to deal with the cyst type as well as associated hepatobiliary pathology.

Magnetic Resonance Imaging Evaluation of Hepatic Cysts in Early Autosomal-Dominant Polycystic Kidney Disease

The objective of this study was to investigate the prevalence of hepatic cysts by age and gender in patients with early autosomal-dominant polycystic kidney disease (ADPKD) and to determine whether hepatic cyst volume is related to renal and renal cyst volumes by using magnetic resonance imaging (MRI). A total of 230 patients with ADPKD (94 men and 136 women) who were aged 15 to 46 yr and had relatively preserved renal function were studied. MRI images of the kidney and liver were obtained to measure renal, renal cyst, and hepatic cyst volumes. These volume measurements and hepatic cyst prevalence were compared in all patients and in subgroups on the basis of gender and age (15 to 24, 25 to 34, and 35 to 46 yr). The overall prevalence of hepatic cysts was 83%; the prevalence was 58, 85, and 94% in the sequential age groups and 85% in women and 79% in men. The prevalence was related directly to renal volume (chi2 = 4.30, P = 0.04) and to renal cyst volume (chi2 = 5.59, P = 0.02). The total hepatic cyst volume was significantly greater in women than in men (a logarithmic transformation mean of 5.27 versus 1.94 ml; P = 0.003). The average hepatic cyst volume was 0.25, 5.75, and 22.78 ml in sequential age groups. Hepatic cysts are evident in 94% of patients who are older than 35 yr and in 55% of individuals who are younger than 25 yr. Hepatic cysts are more prevalent and larger in total cyst volume in women than in men. Hepatic cyst prevalence and aggregate total hepatic cyst volume increased with age.

Dinoflagellate cysts in recent marine sediments from Thermaikos Gulf, Greece: Effects of resuspension events on vertical cyst distribution

A qualitative and semi-quantitative study of recent dinoflagellate cysts has been undertaken in the NW part of Aegean Sea, Thermaikos Gulf (Eastern Mediteranean), before (September 2001), during (October 2001) and after 120 days (February 2002) of intensive trawling activities. This is the first survey of recent dinoflagellate cysts from Greek marine coastal environments. Sediment samples were collected with a corer and the vertical distribution of the cysts was studied at five different layers, from 0 to 10 cm. Dinoflagellate cysts were both abundant and diverse. Cysts were found over the whole sampling area and periods, with concentrations ranging between 247–3202 cysts cm −3. Thirty-six cyst types were encountered, of which 32 were identified to species level, representing 12 genera. It seems that significant local resuspension, related to the onset of the trawling period and stirring up of the sediment, contributed to mixing of the upper layers, resulting to more homogenous cyst profiles in the sediment. Viable cysts constituted 16–60% of the total cyst abundance. The abundance peaks of viable cysts within the subsurface sediment layers, observed during the undisturbed period, disappeared during October. In February, the reduction of cyst concentration was associated to a loss of viable cysts, whilst the ratio of viable/empty cysts ranged between 0.30 and 0.67. The abundance of the different dinoflagellate species, in their active form, was monitored in order to detect any relationship between the concentration of cysts in the top 10 cm of sediment and blooms of algae in the water column. Cysts of potentially toxic species, causing Paralitic Shellfish Poisoning (PSP), such as Alexandrium cf. tamarense, A. cf. affine, A. cf. minutum, as well as Gymnodinium catenatum, were detected in the cyst survey.

Using of Particle Counter as a Monitoring Tool for Giardia and Cryptosporidium in a Water Purification Plant

Drinking water plays a major role in the spread of intestinal protozoa pathogenic for human, namely Giardia lamblia and Cryptosporidium parvum. Surface water is contaminated with Giardia or Cryptosporidium in two major ways: wastewater treatment plants may discharge effluent with cysts or by fecal pollution by various animals that live on the watersheds. So, they are of great concern to the water treatment industry because they are known to have caused a number of waterborne outbreaks of disease. Since, the identifying of Giardia cysts and Cryptosporidium oocysts require. special technique and lab personnel specially trained in microbiology. Particle counting is another physical technique for enumeration of Giardia cysts and Cryptosporidium oocysts by instrument depending on their size distribution. This study aims at evaluating the use of particle counter as a monitoring tool for particle removal in a conventional pilot water treatment plant. The results revealed that coagulation, sedimentation, and filtration removed the most percentage of the both parasites. The average removals of both parasites by coagulation and sedimentation were 76% and 71%, while filtration process only removed about ≥99.5%.On the other hand, the average removal of turbidity was 90.7% by coagulation and sedimentation and 95.2% by filtration. The average over-all removals of turbidity, Giardia, and Cryptosporidium were 99.53%, 99.95%, and 99.89%, respectively. While, the average log removal of parasites and turbidity were 3.3 log for Giardia, 3.02 log for Cryptosporidium, and 2.38 log for turbidity. A significant strong correlation was found between total particle removal and cyst and oocyst sizes removals, while a significant correlation between turbidity and parasites removal were observed. So, particle counter and turbidimeter can be used as surrogate indicator of Giardia and Cryptosporidium removal. The study recommended reducing the risk of raw water infection by Giardia and Cryptosporidium through the multiple barrier approach to treatment, including watershed protection, optimization of chemical pretreatment, filtration, disinfection, and a properly operated and maintained distribution system. It should be installed on-line instruments – particle counting and turbiditimeter monitoring – at various stages of the water treatment process to evaluate water purification plant performance for Giardia and Cryptosporidium removal and enable the operator to develop optimal operations conditions to achieve maximum particulates removal.

Adult Choledochal Cyst

Choledochal cyst is a rare disease in adults. Excellent results have been achieved with proper management. However, malignancy complicating choledochal cyst still carries a dismal prognosis despite radical surgery. The aim of this study was to review the clinical course and operative results of the disease in adulthood, with emphasis on the occurrence of malignancy. A retrospective review of adult patients who underwent surgery for choledochal cysts in a 12-year period was performed. Of the 25 adults, 80% were female and the median age was 30 years. A total of 32% of patients had previous drainage procedures for their choledochal cyst disease. Malignancy was noted in five patients (20%). There were significantly more males among the patients with malignancy than among those with benign disease (60% vs 10%), a greater number of older patients (median age, 39 vs 27 years) and more impaired liver function tests, but there was no difference in terms of incidence of previous drainage procedures between the two groups. There was no operative mortality; operative morbidity was 36%. No significant long-term complications were noted in the benign group but three of the five patients with malignancy died or developed recurrence within a few months after surgery. The prognosis for patients with malignancy complicating choledochal cyst remains poor despite aggressive radical surgery such as Whipple's operation or additional hepatectomy. Malignancy should be suspected in older and male patients who present with jaundice or impaired liver function tests. Total cyst excision and hepaticojejunostomy is an effective and safe treatment for patients with the common type I choledochal cyst in order to reduce the chance of subsequent development of malignancy.

Determination of free and total cyst(e)ine in plasma of dogs and cats

In human blood, the amino acid cysteine forms disulfide bonds with itself and with other sulfhydryl compounds in their free form and with sulfhydryls in protein. Protein-bound cysteine is lost when plasma proteins are removed before amino acid analysis. The purpose of this study was to assess the time course and extent of cyst(e)ine (cysteine + half-cystine) loss in dog and cat plasma. An equal volume of 6% sulfosalicylic acid was added to plasma aliquots at 0, 2, 4, 10, 16, 24, 36, 48, 60, and 72 hours after separation of blood cells. Tris-2-carboxyethyl-phosphine hydrochloride (TCEP - HCl), a reducing agent, was used to regenerate total plasma cyst(e)ine after 3 months of sample storage (-20 degrees C). Initial free cyst(e)ine concentrations (mean +/- SEM) were higher in canine plasma (77 +/- 4 micromol/L) than in feline plasma (37 +/- 3 micromol/L). Free plasma cyst(e)ine concentrations in dogs and cats decreased after first-order kinetics, with a half-life of 23 and 69 hours, respectively. Total plasma cysteine after TCEP - HCl treatment was similar for dogs (290 micromol/L) and cats (296 micromol/L), but the percentage of free cysteine was higher (P = .02) in dogs (27%) than in cats (13%). Over half of the cyst(e)ine, homocysteine, cysteinylglycine, and glutathione were bound in vivo to plasma proteins. These results emphasize the importance of removing plasma proteins within 1 hour after blood collection for reliable assay of free plasma cyst(e)ine.

Horizontal dinoflage11ate cyst distribution, sediment characteristics and benthic flux in Manila Bay, Philippines

SUMMARYThe lateral variation of sediment properties and associated cyst content of sediment in Manila Bay were determined and their possible role/s in the occurrences of Pyrodinium bahamense Plate var. compressum (Bohm) Steidinger, Tester et Taylor toxic blooms were assessed. Manila Bay's surface sediment was determined to be silt dominated. Clay generally increased towards the coast, probably as a result of flocculation and rapid deposition upon entry of sediments from the rivers. High sand content characterized the southeastern part of the bay attributed to the greater sand inputs and relatively strong currents in this area. Bulk densities were lower in the eastern side of the bay from dilution by high organic load from sewage and urban areas. Benthic flux calculations, particularly NH3, suggest more than 50% nutrient contribution comes from sediments.In general, dinoflagellate cyst density increased from the center of the bay towards the coast, except in Pampanga Bay where it deceased near the coasts. A maximum of 23 dinoflagellate species were identified: 5 were autotrophic (Lingulodinium polyedrum (Stein) Dodge, Gonyaulax spp., Pyrophacus steinii (Schiller) Wall et Dale, Protoceratium reticulatum (Claparede et Lachmann) Butschli, and Pyrodinium bahamense var. compressum), and the rest were predominantly composed of Protoperidinium spp. and Diplopsalis spp. Heterotrophs comprised about 70% of the total cyst counts. Pyrodinium counts increased towards the northwestern part of the bay where it was the dominant autotroph species. Negative correlations were observed for live Pyrodinium cyst density and N flux, P flux, ratio of N to P and total organic carbon (TOC) content. However, areas with high N:P ratio contain abundant Pyrodinium live cysts.

Laparoscopic-assisted total cyst excision of choledochal cyst and Roux-en-Y hepatoenterostomy

Purpose The aim of this study was to describe the technical experience and outcome in laparoscopic-assisted total cyst excision of choledochal cyst with Roux-en-Y hepatoenterostomy. Methods Thirty-five patients with choledochal cyst were studied. Their age ranged from 3 months to 9 years (average age, 3.6 years). The choledochal cysts were cyst type in 33 cases and fusiform type in the other 2 cases. Four trocars were utilized with 3- to 5-mm instrumentation. Under laparoscopic guidance, the gallbladder and the dilated bile duct were excised completely. The Roux-en-Y jejunojejunostomy was performed extracorporeally by exteriorizing the jejunum through the extending umbilical incision (1.5 to 2 cm), and an end-to-side hepaticojejunostomy was carried out intracorporeally by the hand suture methods. Results Average duration of operation was 4.3 hours (range, 3.5 to 7.6 hours), intraoperative blood loss was 5 to 10 mL, and 8 of the 35 patients had associated hepatic ductal stenosis and underwent laparoscopic excision of the cyst and ductoplasty. In 1 of the 8 cases, bile leak was noticed from day 1 through 26 postoperatively. The postoperative course was uneventful in the other 34 patients with a hospital postoperative stay ranging from 3 to 6 days. There were no postoperative complications in the 3-month to 1 1 2 -year follow-up. Conclusions Laparoscopic-assisted total cyst excision with Roux-en-Y hepatoenterostomy is feasible for the treatment of choledochal cyst in children.

Primary hydatid disease of the gallbladder: a rare clinical entity

Hydatid disease is endemic in Greece, and has been known from Hippocrates' time to cause cysts in the liver. We report here three very rare cases of primary gallbladder hydatid disease without prior history or evidence of concurrent disease activity in any other location. To our knowledge, only two previous reports exist, each of one patient suffering from primary gallbladder hydatid disease. Unlike the insidious hydatid cysts of the liver, gallbladder hydatidosis in our patients was associated with early diagnosis, due to gallbladder dysfunction symptoms presenting early in its course. Moreover, the size of gallbladder cysts compared to liver cysts at diagnosis was small (maximal diameter, <5 cm), making total cyst excision along with cholecystectomy feasible for all of our patients. During long-term follow up of the patients (up to 10 years), no disease recurrences were noted. We provide supporting evidence that primary gallbladder hydatidosis presents a different pathophysiological and clinical course, having better prognosis, when compared with the usual liver disease.

Total cyst excision with ultrasonic scalpel under the laparoscope for choledochal cyst

To discuss the technique and its advantage on application of ultrasonic scalpel in laproscopic cyst excision with Roux-en-Y hepatoenterostomy. Forty-five cases were undergone laparoscopic cyst excision with Roux-en-Y hepatoenterostomy by ultrasonic scalpel. After intraoperative cholangiogram, the gallbladder and the dilated bile duct were completely excised by ultrasonic scalpel. Roux-en-Y hepatoenterostomy was performed extracorporeally through umbilical incision, then an end-to-side anastomosis was carried out intracorporeally. All 45 cases were completely accomplished under laparoscope combined with ultrasonic scalpel. Median duration of operation was 4.2 h (3.5-6.0 h). Intraoperative bleeding was between 10-50 ml (median 15 ml). No complication were found during operation. All children were discharged in 3-9 d (median 5.5 d) after operation. Thirty-eight cases were followed up 1-18 months. No stenosis or ileus occurred. Liver functions were in normal level. Total cyst excision with Roux-en-Y hepatoenterostomy by ultrasonic scalpel under the laparoscope was effective and safe for choledochal cyst. The most excellence was that clearly viewing during operation, less bleeding and injury, free of pain postoperation, microincision and scar.

Dinoflagellate cysts in recent marine sediments from Scapa Flow, Orkney, Scotland

To determine the composition, abundance and horizontal distribution of resting cysts in modern coastal sediments from Scapa Flow, Orkney, Scotland, sediment samples were collected from 12 stations. Twenty-six dinoflagellate cyst types representing eight motile-defined genera and one cyst-defined genus were observed. Four species or species groups dominated the assemblage for the Flow as a whole, Scrippsiella trochoidea, unidentified round brown cysts, Polykrikos schwartzii and Alexandrium tamarense. Total cyst abundance ranged from 37–1524 cysts ml−1 wet sediment. The majority of cysts occurred in the central area of the Flow, where higher densities were observed. Of particular importance is the distribution and abundance of cysts of A. tamarense. Since 1991 there have been annual toxic episodes of paralytic shellfish poisoning, caused by the vegetative stage of A. tamarense, in Scapa Flow, leading to widespread bans on all shellfish activities for months at a time. Cysts of A. tamarense were widely distributed within the Flow and ranged from 0–212 cysts ml−1 wet sediment. The overall widespread distribution and higher abundances of cysts of A. tamarense in the central areas of the Flow indicate potential seedbeds for initiation of future vegetative growth and subsequent outbreaks of paralytic shellfish poisoning.