Cyst Volume Research Articles

Transarterial Embolization for Treatment of Symptomatic Polycystic Liver Disease

Background:Currently, treatment of symptomatic polycystic liver disease (PLD) is still a challenging problem, especially for these patients who are not feasible for surgery. Minimally invasive options such as laparoscopic fenestration and percutaneous cyst aspiration with sclerotherapy demonstrated disappointing results due to multiple lesions. Because the cysts in PLD are mostly supplied from hepatic arteries but not from portal veins, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply the major hepatic cysts can lead to shrinkage of the cyst and liver size, relieve symptoms, and improve nutritional status. This study aimed to evaluate the effectiveness of TAE with a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for patients with severe symptomatic PLD during a more than 2-year follow-up.Methods:Institutional review board had approved this study. Written informed consent was obtained from all patients. From February 2007 to December 2014, twenty-three patients (20 women and 3 men; mean age, 49.0 ± 14.5 years) infeasible for surgical treatments underwent TAE. Changes in the abdominal circumferences, volumes of intrahepatic cysts, hepatic parenchyma volume, and whole liver, clinical symptoms, laboratory data, and complications were evaluated after TAE.Results:Technical success was achieved in all cases. No procedure-related major complications occurred. The median follow-up period after TAE was 48.5 months (interquartile range, 30.0–72.0 months). PLD-related severe symptoms were improved remarkably in 86% of the treated patients; TAE failed to benefit in four patients (four patients did not benefit from TAE). The mean maximum abdominal circumference decreased significantly from 106.0 ± 8.0 cm to 87.0 ± 15.0 cm (P = 0.021). The mean intrahepatic cystic volume reduction rates compared with pre-TAE were 36% at 12 months, 37% at 24 months, and 38% at 36 months after TAE (P < 0.05). The mean liver volume reduction rates were 32% at 12 months, 31% at 24 months, and 33% at 36 months (P < 0.05).Conclusions:TAE with the mixture of NBCA and iodized oil appears to be a safe and effective treatment method for patients with symptomatic PLD, especially for those who are not good candidates for surgical treatments, to improve both hepatic volume and hepatic cysts volume.

Effectiveness of navigation-guided cyst aspiration before resection of large cystic brain tumors: a proof of concept for more radical surgery.

Resection of tumors close to the corticospinal tract (CST) carries a high risk of damage to the CST. For cystic tumors, aspirating the cyst before resection may reduce the risk of damage to vital structures. This study evaluated the effectiveness of cyst aspiration, by comparing the results before and after aspiration of diffusion tensor image (DTI) tractography. This study enrolled 23 patients with large cystic brain tumors (>20cm3) between 2012 and 2016. All underwent magnetic resonance imaging (MRI), including DTI tractography, followed by navigation-guided aspiration of the cyst and subsequent tumor resection via craniotomy. Distances between the tumor margin and CST before and after cyst aspiration, volume reduction, and postoperative outcomes were assessed. Median tumor volume decreased from 88cm3 (range, 25-153) to 29cm3 (range, 20-80) and distances between tumor margins and the CST increased from 5.7mm (range, 0.6-22.0) to 14.8mm (range, 0.6-41.4) after aspiration. Neurological symptoms of patients immediately improved after cyst aspiration. All patients, except for one with a secondary glioblastoma, underwent gross total resection of the tumor. No neurological deterioration was observed after tumor resection. Navigation-guided cyst aspiration followed by resection is a useful and safe procedure for brain tumors with large cystic components. Cyst aspiration resulted in expansion of the compressed brain tissue between the tumor margins and vital structures, making maximal safe resection possible.

Complex liver cysts in Autosomal Dominant Polycystic Kidney Disease

PurposeTo determine prevalence of complex liver cysts in Autosomal Dominant Polycystic Kidney Disease (ADPKD). MethodsAbdominal MRI in 186 ADPKD subjects were evaluated by two independent observers to determine prevalence of complex liver cysts. Results23 (12%) of subjects, had at least 1 complex cyst. Only 8 (4%) were reported to have a complex cyst prospectively, representing an under-reporting rate of 65%. Median total cyst volume was 66-times greater for subjects with complex cysts compared to subjects without (p<0.0001). ConclusionComplex hepatic cysts were observed in 12% of ADPKD cases, occurring more frequently in livers with extensive cystic involvement.

Comparison of MRI segmentation techniques for measuring liver cyst volumes in autosomal dominant polycystic kidney disease

PurposeTo compare MRI segmentation methods for measuring liver cyst volumes in autosomal dominant polycystic kidney disease (ADPKD). MethodsLiver cyst volumes in 42 ADPKD patients were measured using region growing, thresholding and cyst diameter techniques. Manual segmentation was the reference standard. ResultsRoot mean square deviation was 113, 155, and 500 for cyst diameter, thresholding and region growing respectively. Thresholding error for cyst volumes below 500ml was 550% vs 17% for cyst volumes above 500ml (p<0.001). ConclusionFor measuring volume of a small number of cysts, cyst diameter and manual segmentation methods are recommended. For severe disease with numerous, large hepatic cysts, thresholding is an acceptable alternative.

Influence of surgical decompression on the expression of inflammatory and tissue repair biomarkers in periapical cysts

The biologic effects of surgical decompression on the epithelium and connective tissues of periapical cysts are not fully understood. The aim of this study was to evaluate the expression of tissue repair and inflammatory biomarkers in periapical cysts before and after surgical decompression. Nine specimens of periapical cysts treated with decompression before undergoing complete enucleation were immunohistochemically analyzed to investigate the expression of interleukin-1β, tumor necrosis factor-α, transforming growth factor-β1, matrix metalloproteinase-9, Ki-67, and epidermal growth factor receptor. Expression of the biomarkers was classified as positive, focal, or negative. Ki-67 immunoexpression was calculated as a cell proliferation index. The expression of the biomarkers was compared in the specimens from decompression and from the final surgical procedure. Computed tomography demonstrated that volume was reduced in all cysts after decompression. There were no differences in the immunoexpression of the proinflammatory and tissue repair biomarkers when comparing the specimens obtained before and after the decompression. Surgical decompression was efficient in reducing the volume of periapical cysts before complete enucleation. When comparing the specimens obtained from surgical decompression and from complete surgical removal, the immunohistochemical analysis did not show a decrease in proinflammatory biomarkers; neither did it show an increase in tissue repair biomarkers.

Treatment of Cystic Craniopharyngioma with Intracystic Stereotactic Instillation of Phosphorus 32.

Cystic craniopharyngiomas are considered the most common intracranial nonglial tumor in children with the tendency for cyst formations. The aim of this study was to evaluate the effect of intracystic phosphorus 32 (P32) therapies on controlling the growth of the cystic component of craniopharyngioma. This clinical study was conducted on 47 patients with cystic craniopharyngioma from March 1998 to June 2012 at Shohada Tajrish Hospital, Tehran, Iran. Patients were treated with stereotactic intracystic P32. The mean cyst volume was 23.5 ml, and the dose of radiation to the inner cyst wall was 250 Gy. The overall response rate was 78.1% and the mean survival was 113.1±11months. The survival rate at 1, 3, 5, and 10 years after p32 therapy was 91%, 77%, 73%, and 52%, respectively. There was no mortality related to the procedure and no visual or endocrinal deterioration. Visual improvement occurred in 88% of patients presented with recent deterioration due to the cyst enlargement. Intracystic p32 therapy was an effective and almost safe procedure for the treatment of cystic component of craniopharyngioma.

Effect of Taoren Quyu Decoction on human endometrial cells and its anti-endometriosis activity in rats.

To study the effect of Taoren Quyu Decoction (TQD) on endometrial cells in patients with endometriosis (EMs) and EMs in rats. A total of 60 female Wistar rats were randomly divided into 4 groups, namely, normal group, model group, positive group and TQD group, each group having 15 rats. Except the normal group, EMs model was established in the other three groups by transplanting the rat autologous endometrium. After 4 weeks of intragastric administration, blood, eutopic and ectopic endometrial tissues of rats in each group were collected to detect the serum levels of estrogen (E2), cancer antigen 125 (CA125), endometrial antibody (EMAb), and expressions of microvessel density (MVD), vascular endothelial growth factor (VEGF) and angiopoietin (Ang-2). The volume of endometriosis cyst was determined simultaneously. For the invitro culture of human endometrial cells, 4 groups, namely, normal group, model group, positive group and TQD group were used. The positive group and TQD group were treated with danazol and TQD respectively. Then 24h after the treatment, the expressions of survivin and tumor suppressor gene (p53) of each group were detected. The volumes of the endometriosis cysts in the positive group and the TQD group were significantly reduced compared with the model group (P<0.05). The serum levels of E2, CA125 and EMAb, and the expressions of MVD, VEGF and Ang-2 in the model group were significantly increased compared with the normal group (P<0.05); while they were all significantly reduced in the positive group and TQD group (P<0.05). Compared with the normal group, the expression of survivin in the model group was significantly up-regulated (P<0.05), and expression of p53 was significantly reduced (P<0.05); compared with the model group, the expressions of survivin in the positive and TQD groups were significantly decreased (P<0.05), and expression of p53 was significantly up-regulated (P<0.05). The difference between positive group and TQD group was not statistically significant (P>0.05). TQD has a significant anti-EMs effect, and its mechanism of action may be related to anti-angiogenesis and promoting apoptosis of ectopic endometrial cell.

The structure of spermatogenic cysts and number of Sertoli cells in the testes of Bombina bombina and Bombina variegata (Bombinatoridae, Anura, Amphibia)

Spermatogenesis in amphibians occurs inside spermatogenic cysts formed by Sertoli cells (SCs). SCs do not constitute a permanent population and their number increases during spermatogenic cycle and ontogeny. The number of SCs per cyst is strongly correlated with the number of germ cells in the same cyst and with the cyst volume. The number of germ and Sertoli cells and cyst volumes are species-specific and increase along with age. The mean number of primary spermatocytes per one Sertoli cell (efficiency) was the same, irrespective of age and species. Late spermatids are not attached to the Sertoli cells and do not form bundles as in other amphibians. The number of primary spermatocytes inside a cyst was the yield of several mitotic cycles of a single primary spermatogonium (stem cell) and its descendants, i.e., secondary spermatogonia. In adult Bombina bombina, the majority of cysts contained germ cells after 6–8 cycles, in juveniles after 4–6 cycles, and in adult Bombina variegata after 5–7 cycles. The mean numbers of SCs per cyst were 27.4 ± 9.9 in adult B. bombina, 6.42 ± 2.32 in adult B. variegata, and 7.1 ± 2.33 in juvenile B. bombina. The number of primary spermatocytes per one SC (SC efficiency) in B. bombina in adults was 6.5 ± 2.2, in juveniles 9.0 ± 4.2, and in adult B. variegata 7.40 ± 2.96. Spermatogenesis in Bombinatoridae is exceptional owing to the lack of intimate contact between SCs and germ cells.

Radiological evolution of porcine neurocysticercosis after combined antiparasitic treatment with praziquantel and albendazole.

BackgroundThe onset of anthelmintic treatment of neurocysticercosis (NCC) provokes an acute immune response of the host, which in human cases is associated with exacerbation of neurological symptoms. This inflammation can occur at the first days of therapy. So, changes in the brain cysts appearance may be detected by medical imaging. We evaluated radiological changes in the appearance of brain cysts (enhancement and size) on days two and five after the onset of antiparasitic treatment using naturally infected pigs as a model for human NCC.Methods and resultsContrast T1-weighted magnetic resonance imaging with gadolinium was performed before and after antiparasitic treatment. Eight NCC-infected pigs were treated with praziquantel plus albendazole and euthanized two (n = 4) and five (n = 4) days after treatment; another group of four infected pigs served as untreated controls. For each lesion, gadolinium enhancement intensity (GEI) and cyst volume were measured at baseline and after antiparasitic treatment. Volume and GEI quantification ratios (post/pre-treatment measures) were used to appraise the effect of treatment. Cysts from untreated pigs showed little variations between their basal and post treatment measures. At days 2 and 5 there were significant increases in GEI ratio compared with the untreated group (1.32 and 1.47 vs 1.01, p = 0.021 and p = 0.021). Cyst volume ratios were significantly lower at days 2 and 5 compared with the untreated group (0.60 and 0.22 vs 0.95, p = 0.04 and p = 0.02). Cysts with lower cyst volume ratios showed more marked post-treatment inflammation, loss of vesicular fluid and cyst wall wrinkling.Conclusion/SignificanceA significant and drastic reduction of cyst size and increased pericystic enhancement occur in the initial days after antiparasitic treatment as an effect of acute perilesional immune response. These significant changes showed that early anthelmintic efficacy (day two) can be detected using magnetic resonance imaging.

P.017 Efficacy of stereotactic intracavitary instillation of 90yttrium colloid for treatment of cystic sellar/parasellar tumors

Background: Traditional neurosurgical techniques and/or stereotactic radiotherapy, although effective for solid tumors, can be associated with high morbidity and be relatively ineffective for long-term control of cystic sellar/parasellar tumors. The rationale of our study was to examine the efficacy and safety of stereotactic intracavitary instillation of 90yttrium colloid for the primary treatment of cystic tumors. Methods: As part of a Health Canada approved clinical trial, we have enrolled nine patients (6 females, 3 males; mean age 64, range 43 to 83 years) for treatment of symptomatic and/or enlarging cysts. Ten cystic sellar/parasellar lesions underwent right frontal stereotactic insertion of 90yttrium colloid to deliver a radiation dose of 200 Gy to the cyst wall. Results: Compared with pre-treatment cyst volumes (mean 4.6 cc; range 0.8-16.1 cc), the cysts decreased in size at 3 months (2.6 cc; 0.2-10 cc) with further shrinkage (n=5) at 9 months (1 cc; 0.1-2.7 cc). Of 9 patients with pre-operation visual field defects, 6 showed improvement. The single complication was a delayed (1 month) incomplete CNIII palsy. Conclusions: Our early experience indicates that 90yttrium colloid delivered to a cystic craniopharyngioma provides an efficacious alternative to open surgery for primary treatment of these cystic lesions.

Can cyst volume be used to stratify risk of complications following cyst defect reconstruction with iliac crest graft?

IntroductionThe role of the volume of radicular and dentigerous cysts on clinical symptoms is unclear and potentially may predict development of pre- and postoperative complications, especially after cystectomies with large bony defects. Therefore the aim of this study was to assess pre- and postoperative symptoms associated to the volume of jaw cysts. Material and methodsRetrospective chart review of 111 patients with follicular or dentigerous cysts from 2008–2012. Anterior iliac crest grafts were used to fill defects after cystectomy. χ2-test was performed to analyze associations between two qualitative variables. Binary logistic regression analysis was used as multivariate analysis. P-values p < 0.05 were considered as significant. Volume measurement was performed in a semiautomatic segmentation method with the software “ITK-Snap”. ResultsPostoperative hypaesthesia correlated significantly with histology (p = 0.025) and localization (p = 0.006). Volume was associated significantly with preoperative hypaesthesia (p = 0.052), postoperative hypaesthesia (p < 0.001), wound healing complications (p < 0.001) and length of wound healing complications (p = 0.001). Multivariate analysis identified volume as independent risk factor for postoperative hypaesthesia (p = 0.015). ConclusionsVolume analysis appears to be a method that allows risk stratification after surgery of jaw cysts. Therefore we recommend a precise treatment planning with the means of volume analysis to improve therapy outcome of patients with jaw cysts.

Long-term outcomes after endoscopic ultrasound-guided ablation of pancreatic cysts

Background and study aims The aim of this study was to investigate the long-term outcomes after endoscopic ultrasound (EUS)-guided pancreatic cyst ablation. Patients and methods In a single-center, prospective study, 164 patients with pancreatic cysts underwent EUS-guided cyst ablation using ethanol with paclitaxel. The inclusion criteria were as follows: unilocular or oligolocular cysts; clinically indeterminate cysts that required EUS fine-needle aspiration; and/or cysts that grew during the observation period. Treatment response was classified as complete resolution, partial resolution, or persistent cyst, with < 5 %, 5 % - 25 %, and 25 % of the original cyst volume, respectively. Results The median largest diameter of the cyst was 32 mm and the median volume was 17.1 mL. Based on cyst fluid analysis there were 71 mucinous cystic neoplasms, 16 serous cystic neoplasms, 11 intraductal papillary mucinous neoplasms, 3 pseudocysts, and 63 indeterminate cysts. Sixteen treated patients (9.8 %) had adverse events (1 severe, 4 moderate, and 11 mild). Treatment response was as follows: complete resolution in 114 (72.2 %), partial resolution in 31 (19.6 %), and persistent cysts in 13 (8.2 %). Twelve of the 13 patients with persistent cysts underwent surgery. During clinical and imaging follow-up (median 72 months, interquartile range 50 - 85 months) of the 114 patients with complete resolution, only two patients (1.7 %) showed cyst recurrence. Based on multivariate analysis, the absence of septa (odds ratio [OR] 7.12, 95 % confidence interval [CI] 2.72 - 18.67) and cyst size less than 35 mm (OR 2.39, 95 %CI 1.11 - 5.16) predicted complete resolution. Conclusion Among patients with pancreatic cysts in whom complete resolution was achieved after EUS-guided cyst ablation, 98.3 % remained in remission at 6-year follow-up. Unilocular form and small cyst size were predictive of complete resolution. This treatment approach may be an effective and durable alternative to surgery.Trial registered at ClinicalTrials.gov (NCT 00689715).

Comparison of Total Kidney Volume Quantification Methods in Autosomal Dominant Polycystic Disease for a Comprehensive Disease Assessment

Background: In recent times, the scientific community has been showing increasing interest in the treatments aimed at slowing the progression of the autosomal dominant polycystic kidney disease (ADPKD). Therefore, in this paper, we test and evaluate the performance of several available methods for total kidney volume (TKV) computation in ADPKD patients - from echography to MRI - in order to optimize patient classification. Methods: Two methods based on geometric assumptions (mid-slice [MS], ellipsoid [EL]) and a third one on true contour detection were tested on 40 ADPKD patients at different disease stage using MRI. The EL method was also tested using ultrasound images in a subset of 14 patients. Their performance was compared against TKVs derived from reference manual segmentation of MR images. Patient clinical classification was also performed based on computed volumes. Results: Kidney volumes derived from echography significantly underestimated reference volumes. Geometric-based methods applied to MR images had similar acceptable results. The highly automated method showed better performance. Volume assessment was accurate and reproducible. Importantly, classification resulted in 79, 13, 10, and 2.5% of misclassification using kidney volumes obtained from echo and MRI applying the EL, the MS and the highly automated method respectively. Conclusion: Considering the fact that the image-based technique is the only approach providing a 3D patient-specific kidney model and allowing further analysis including cyst volume computation and monitoring disease progression, we suggest that geometric assumption (e.g., EL method) should be avoided. The contour-detection approach should be used for a reproducible and precise morphologic classification of the renal volume of ADPKD patients.

Incidental findings on brain MRI of cognitively normal first-degree descendants of patients with Alzheimer's disease: a cross-sectional analysis from the ALFA (Alzheimer and Families) project

ObjectivesTo describe the prevalence of brain MRI incidental findings (IF) in a cohort of cognitively normal first-degree descendants of patients with Alzheimer's disease (AD).DesignCross-sectional observational study.SettingAll scans were obtained with...

Does subjective improvement in adults with intracranial arachnoid cysts justify surgical treatment?

OBJECTIVE Subjective improvement of patients who have undergone surgery for intracranial arachnoid cysts has justified surgical treatment. The current study aimed to evaluate the outcome of surgical treatment for arachnoid cysts using standardized interviews and assessments of neuropsychological function and balance. The relationship between arachnoid cyst location, postoperative improvement, and arachnoid cyst volume was also examined. METHODS The authors performed a prospective, population-based study. One hundred nine patients underwent neurological, neuropsychological, and physiotherapeutic examinations. The arachnoid cysts were considered symptomatic in 75 patients, 53 of whom agreed to undergo surgery. In 32 patients, results of the differential diagnosis revealed that the symptoms were due to a different underlying condition and were unrelated to an arachnoid cyst. Neuropsychological testing included target reaction time, Grooved Pegboard, Rey Auditory Verbal Learning, Rey Osterrieth complex figure, and Stroop tests. Balance tests included the extended Falls Efficacy Scale, Romberg, and sharpened Romberg with open and closed eyes. The tests were repeated 5 months postoperatively. Cyst volume was pre- and postoperatively measured using OsiriX software. RESULTS Patients who underwent surgery did not have results on balance and neuropsychological tests that were different from patients who declined or had symptoms unrelated to the arachnoid cyst. Patients with a temporal arachnoid cyst performed within the normal range on the neuropsychological tests. Seventy-seven percent of the patients who underwent surgery reported improvement, yet there were no differences in test results before and after surgery. Arachnoid cysts in the temporal region and posterior fossa did not influence the preoperative results of neuropsychological and motor tests. The arachnoid cyst volume decreased postoperatively (p < 0.0001), but there was no relationship between volume reduction and clinical improvement. CONCLUSIONS The results of this study speak against objectively verifiable improvement following surgical treatment in adults with intracranial arachnoid cysts.

The safety and efficacy for percutaneous ureteroscopic laser deroofing in the management of renal cysts

Objective To assess the safety and efficacy of a novel technology referred to as percutaneous ureteroscopic laser deroofing in the management of renal cysts. Methods From November 2014 to August 2016, 59 patients having surgical indications with renal cysts were enrolled and evaluated by ultrasound and CT scan. Of all the 59 patients, 36 were males and 23 were females. Their mean age was 46 years (ranging 35-64 years). 41 patients complained about the reported flank and abdominal pain. 18 patients were found by imaging examination. Their mean diameter of cyst was 6.3cm(ranging 4.9-9.1cm). In regards to the 59 patients, include 6 patients suffered with parapelvic cysts and 4 patients suffered with renal cyst complicated with ipsilateral renal calculi. Their mean stone surface area was 5.7 cm2 (ranging 3.4-9.8 cm2). All of the patients received combined spinal and epidural analgesia or paravertebral nerve block anesthesia. Patients were placed in the prone position for percutaneous puncture and tract dilation. Under ultrasound guidance, an eighteen gauge needle was placed inside the cyst cavity percutaneously, a metal guidewire was introduced followed by sequential dilation up to F26-28. 9.8F rigid ureteroscope was inserted through the Amplazt access sheath and advanced into the cyst cavity. Then sheath and ureteroscope both returned to the exterior cyst together. Cyst wall was dissociated from perirenal adipose tissue by used ureteroscope. A majority of the collapsed cyst wall was grasped and gently pulled towards the Amplazt sheath interior using grasping forceps and incised using either Thulium (Power 40~50W) or Holmium laser(Power 60~70W) and was taken for pathological examination. Nephrostomy tube was left in place for 2-3 days and removed before discharge. For parapelvic cysts patients, ureter stent was inserted into the renal pelvis in the dorsal lithotomy position firstly. Patients were then placed in the prone position for percutaneous puncture and tract dilation. Laser was used to incise cyst wall towards identified pelvis to create a permanent communication between the cyst and adjacent renal collecting system. F6 double-J stent was inserted into the cyst cavity at the end to prevent auto-closure for at most two months. F22 nephrostomy tube was left in renal pelvis for two weeks. For renal cyst complicated with ipsilateral renal calculi patients, a puncture was created targeting the stone through the cyst, after fragmenting and extracting the stone, the same laser was used to deroof the cyst. More than 50% reduction in cyst volume was considered a success. The perioperative complications, hospitalization days and the effective rate of surgery were evaluated. Results All operations were conducted without intraoperative complications such as bleeding, urinary leakage or injury of the renal parenchyma and the adjacent organs. The hospital stay after the surgery was 2-4 days (mean 2.5 days). After 3-12 months follow-up (mean 8.1 months), patients underwent imaging examinations. 42 out of 59 cases were completely resolved, 15 were reduced to less than 50%, the total effective rate for the operation is 96.6%(57/59). 4 patients with ipsilateral renal calculi were completely clear. However, two cases failed probably due to incomplete resection and follow treated with laparoscopic renal cyst deroofing. Conclusions Percutaneous ureteroscopy renal cyst laser deroofing is a safe, effective, less invasive, which can be performed in any endourological center without the need of special instruments and training. Key words: Percutaneous ureteroscopy; Renal cysts; Deroofing; Safety; Effectiveness

Dermoid cysts: clinical predictors of complex lesions and surgical complications

To evaluate the clinical characteristics and role of imaging in the evaluation of dermoid cysts and to determine predictors of cyst rupture during surgical excision of dermoid cysts. In this single-center, consecutive, nonrandomized comparative case series, the records of consecutive patients with suspected dermoid cysts who underwent surgery between January 1, 2000, and December 31, 2014, were reviewed retrospectively for demographic information, clinical findings, preoperative imaging, surgical details, and pathology reports. A total of 100 patients were included. Cyst volume was similar between superomedial and superotemporal lesions (P=0.61) but greater in patients >10years of age (P<0.001). Immobility of the cyst was present in all complex dermoids (4/4), but there was no difference in the mobility of superotemporal or superomedial cysts (P=0.69). Forty-two patients underwent imaging; superomedial lesions were more likely to be imaged than superotemporal lesions (P=0.073). All 4 patients with complex dermoids presented with orbital signs and underwent preoperative imaging. None of the remaining 38 patients who underwent imaging had orbital signs, and the results of imaging had no effect on surgical planning. Intraoperative cyst rupture occurred in 18 patients. There was no significant difference in cyst rupture between superotemporal and superomedial cysts (P=0.452). Smaller cyst volume was associated more often with intraoperative cyst rupture (P<0.001). Preoperative imaging of superomedial and superolateral dermoid cysts is likely unnecessary unless associated with orbital signs. Intraoperative cyst rupture is not influenced by cyst location but does appear to be more likely in smaller cysts.

Total Kidney Volume as a Biomarker of Disease Progression in Autosomal Dominant Polycystic Kidney Disease.

Purpose of review:Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by the formation of kidney cysts and kidney enlargement, which progresses to kidney failure by the fifth to seventh decade of life in a majority of patients. Disease progression is evaluated primarily through serum creatinine and estimated glomerular filtration rate (eGFR) measurements; however, it is known that serum creatinine and eGFR values typically do not change until the fourth or fifth decade of life. Until recently, therapy only existed to target complications of ADPKD. As therapeutic agents continue to be investigated for use in ADPKD, a suitable biomarker of disease progression in place of serum creatinine is needed.Sources of information:This review summarizes recent research regarding the use of total kidney volume as a biomarker in ADPKD, as presented at the Canadian Society of Nephrology symposium held in April 2015.Findings:Measurement of patients’ total kidney volume made using ultrasound (US) or magnetic resonance imaging (MRI) has been shown by the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) study to be directly correlated with both increases in cyst volume and change in glomerular filtration rate (GFR). Additional studies have shown total kidney volume to have an association with complications of ADPKD as well.Limitations:Areas for further study continue to exist in comparison of methods of measuring total kidney volume.Implications:We believe that the evidence suggests that total kidney volume may be an appropriate surrogate marker for ADPKD disease progression.

Outcome, Pain Perception, and Health-Related Quality of Life in Patients Submitted to Percutaneous Ethanol Injection for Simple Thyroid Cysts.

Thyroid cysts are usually benign lesions that when voluminous may induce cosmetic concerns or local discomfort. Percutaneous ethanol injection (PEI) has been demonstrated to be effective for shrinkage of such cysts. In this retrospective study, we evaluated the efficacy, pain perception, and health-related quality of life (HRQL) in patients submitted to PEI for pure cystic lesions. We reviewed the data of 101 patients who underwent ≤3 PEI. In the whole group of patients, the volume reduction was 66% after the first, 74.4% after the second, and 79.4% after the third PEI treatment. 55.4% had a cystic volume ≤ 10 ml; 85.7% of cysts ≤ 10 ml were cured by just one PEI. The number of PEI was significantly higher in the >30.0 ml group; this latter group obtained the smallest percent reduction versus baseline after the first PEI when compared with smaller cysts. The sensation of pain reported during PEI was absent in 78.3% of cases, and HRQL significantly improved from pre- to the posttreatment. PEI is a safe and effective technique for pure cystic lesions. In addition, HRQL significantly improves, providing a further support for this procedure.

Long-term outcomes after endoscopic ultrasonography-guided ablation of pancreatic cysts

Objectives:The aim of this study was to investigate the long-term outcomes after endoscopic ultrasonography (EUS)-guided pancreatic cyst ablation.Methods:In a single-center, prospective study, 164 patients with pancreatic cysts underwent EUS-guided cyst ablation using ethanol with paclitaxel. The inclusion criteria were as follows: unilocular or oligolocular cysts, clinically indeterminate cysts that required EUS fine-needle aspiration, and/or cysts that grew during the observation period. Treatment response was classified as complete resolution (CR), partial resolution (PR), or persistent cyst, with <5%, 5%–25%, and 25% of the original cyst volume, respectively.Results:The median largest diameter of the cyst was 32 mm and the median volume was 17.1 mL. Based on cyst fluid analysis, there were 71 mucinous cystic neoplasms, 16 serous cystic neoplasms, 11 intraductal papillary mucinous neoplasms, 3 pseudocysts, and 63 indeterminate cysts. Sixteen treated patients (9.8%) had adverse events (severe 1, moderate 4, and mild 11). Treatment response was as follows: CR, 114 (72.2%); PR, 31 (19.6%); and persistent cysts, 13 (8.2%). Twelve of 13 patients with persistent cysts underwent surgery. During clinical and imaging follow-up (median 72 months, interquartile range 50–85 months) of the 114 patients with CR, only two patients (1.7%) showed cyst recurrence. Based on multivariate analysis, the absence of septa (odds ratio [OR], 7.12; 95% confidence interval [CI], 2.72–18.67) and cyst size <35 mm (OR, 2.39; 95% CI, 1.11–5.16) predicted CR.Conclusion:Among patients with pancreatic cysts who achieved CR after EUS-guided cyst ablation, 98.3% remain in remission at 6-year follow-up. Unilocular and small cyst was predictive of CR.