Cyst Volume Research Articles

ULTRASOUND-GUIDED MANAGEMENT OF OVARIAN CYSTS USING NEEDLE ASPIRATION AND INFILTRATING ANTI-MICROBIAL AGENTS: THE EXPERIENCE OF A PRIVATE DIAGNOSTIC CENTRE

Background: Ovarian cysts are common in reproductive women. They range from the simple to the complex type which has low consequence to be neoplastic in nature. Simple cysts detected on ultrasound can be managed without surgical intervention. Objective: To evaluate the management of ovarian cysts by aspiration and instilling of antimicrobial drugs into the cavities by trans-abdominal ultrasound guide. Materials and Methods: A mixture of stratified and convenience sampling methods were used as the patients came from their referral centres, and fifty-three (53) women who were diagnosed with ovarian cysts were enrolled for the study. The age range was between 18 and 55 years. They all had a transabdominal ultrasound (US)– guided cyst aspiration and Antibiotics were infiltrated into the cyst cavity to prevent post-aspiration infection. The aspirated samples were sent for culture and sensitivity, and cytology. The procedure was repeated in few patients because of recurrence. Results: Fifty-three patients satisfied the criteria for the procedure and follow-up. Nineteen (19) patients had right-sided cysts, while thirty-one (31) were left-sided, and three (3) bilateral. The drained cyst volume ranged from 10.2 to 2560mls, with an average cyst volume of 223mls. Staphylococcus aureus, klebsiella and Escherichia coli are the three organisms isolated from the aspirates, while 58.49% produced sterile culture results. No malignant cells were found in any of the cytologic specimens. During follow-up, only 3 (5.7%) aspirated cysts recurred. Patients received analgesics and antibiotics, as no major complication was observed. Conclusion: Aspiration of simple ovarian cysts is a suitable alternative to surgical exploration, particularly when drugs are infiltrated into the aspirated cyst cavity. Key words: Ovarian cysts, ultrasound-guided transabdominal aspiration, drug instillation

Comparison of Pineal Gland Volume Between Patients with Fibromyalgia and Healthy Controls Running Title: Pgv in Fibromyalgia

Objectives: The pineal gland is an important neuroendocrine organ accounting for the melatonin secretion and chronobiology that regulate circadian rhythm. This study was designed to compare pineal gland volume (PGV) with healthy controls and patients with fibromyalgia syndrome (FM), in which sleep quality and efficiency is reduced. Patient and Methods: In this cross-sectional study, PGV and functional pineal gland volume (FPGV) of FM patients with age- and sex-matched healthy controls were compared. All MR imaging studies were performed using a 3 Tesla scanner with a multi-channel phased array head coil. The volume of pineal glands and pineal cysts were calculated from 3D MP RAGE images using the formula: volume= AP x transverse x craniocaudal diameter x 0.523. Results: There was no significant difference in PGV and FPGV between the FM group and healthy controls (p=0.374 and p=0.421, respectively). In the correlation analysis, age was negatively correlated with PGV and FPGV in the FM group (r=-0.496, p=0.010; r=- 0.477, p=0.014, respectively). No significant correlation was detected between age, PGV and FPGV in the control group (r= 0.022, p=0.916; r= -0.019, p=0.925, respectively). Conclusions: Based on the results, there was no significant difference between the FM group and healthy controls regarding PGV and FPGV. However, PGV and FPGV were decreased by advancing age in the FM group in which melatonin therapy is offered as an option.

Stereological Estimation of Bone Cyst Volume Using Computed Tomography Images: A Comparison with the Planimetry Technique

Objective: The exact volume of the bone cyst is fundamental for evaluation, treatment, and surgical management of the pathology related to any bone. The aim of this study was to introduce the stereological point-counting technique in bone cyst volume measurements on computed tomography images and to compare it with the planimetry technique. Methods: A total of 30 bone cyst volumes were estimated on CT images using stereological point-counting and the planimetry technique, which is based on the Cavalieri principle. The planimetric measurements were regarded as reference values. The stereological and planimetric volume estimations were performed by two independent observers twice. The estimation results of the two volumetric techniques were compared with the Wilcoxon signed-rank test. Intra-observer and inter-observer reliability of each volumetric technique was assessed. Results: For each bone cyst, 7-11 systematically sampled CT slices enabled reliable cyst volume estimations with a low coefficient of error (0.39%-3.12%). There was no significant difference between point counting and planimetry methods regarding volume measurements in both sessions (p>0.05), and these methods correlated well with each other. There was a significant inter-and intra-observer agreement for each volumetric method (ICC=0.9984 to 0.9988). The stereological approach was observed to take less time than the planimetric approach (mean 01:43±0.44 vs. 03.33±1:47 minutes) Conclusion: The stereological point-counting method can be well pertained to CT images for the reliable and reproducible assessment of bone cyst volume. Application of the point-counting method for volume estimation of bone cysts with different morphological features provides a great advantage in terms of both time-saving, applicability, and practicality in comparison with the planimetry technique.

Efficacy of minocycline hydrochloride aspiration sclerotherapy with additional monoethanolamine oleate aspiration sclerotherapy for symptomatic hepatic cysts.

Minocycline hydrochloride (MINO) aspiration sclerotherapy (AS) has been widely used for treating hepatic cysts (HC). However, cyst recurrence remains problematic. Information on monoethanolamine oleate (EO) AS, another effective HC treatment, is currently limited. We investigated the efficacy of EO on ineffective MINO treatments, and the relationship between MINO AS and cyst fluid pH. A total of 22 cases with symptomatic HC underwent AS with 500mg of MINO from January 2016 to June 2021. Cyst fluid pH was measured before and after MINO injection. Cyst volume ratio (CVR, %) after 2weeks was calculated as follows:cyst volume 2weeks after MINO injection/pre-treatment cyst volume×100. Treatment was completed if CVR after 2weeks was ≤35% (MINO-group). For patients with CVR >35%, 2g of EO was added (MINO/EO-group). Cyst volume ratio was measured every 12months thereafter. There were no recurrence symptoms in any of the patients during follow-up. Of the 22 cases, 21 had CVR ≤20% after 12months. The MINO/EO-group (n=8) tended to have smaller CVRs after 12months than the MINO-group (n=14). Cyst volume ratio after 2weeks was correlated to pH change (p=0.012) and was larger in patients whose pH decreased by <1.5 (p=0.015). All adverse events were mild, including in elderly patients. Adding EO is an effective and safe treatment for symptomatic HC when MINO AS alone is insufficient. Patients with pH decreases of <1.5 should be considered for additional EO treatment.

Neuroendoscopic surgery combined with Ommaya reservoir placement for cystic craniopharyngiomas: 11 years of experience in a single institution

Introduction Total resection of cystic craniopharyngiomas is challenging, especially for some large cystic tumors, because it is often associated with high recurrence and morbidity rates. Minimally invasive cyst decompression and continuous drainage are appropriate to manage clinical symptoms. We reviewed our experience of the past 11 years to determine the long-term effects of neuroendoscopic surgery (NES) combined with Ommaya reservoir (OR) for the treatment of cystic craniopharyngiomas. Methods We retrospectively analyzed the data of 15 adult patients with cystic craniopharyngiomas at a single institution with the primary goal to evaluate the treatment mode with initial adequate decompression of the cyst under visualization and continuous drainage. The study endpoints were functional outcome, cyst volume changes, and tumor progression. Results The median follow up was 77 (20–136) months. Clinical symptoms, e.g. increased intracranial pressure and visual impairment, could be rapidly improved after NES. The postoperative reduction in cyst volume (p < 0.001) and improvement in Karnofsky performance status (p < 0.001) were significant, and long-term tumor control was achieved in 10 patients (67%). Aspiration from the OR after progression of the tumor’s cystic portion remains a major option, with only few patients requiring repeat NES procedures. No patient developed acute or severe clinical symptoms during follow up. Conclusions NES could decompress the craniopharyngioma cyst under visualization and enable faster clinical-symptom improvement. The minimally invasive NES combined with OR allowed long-term symptom control in most patients without surgery-related injury. This palliative treatment strategy could be an alternative modality for cystic craniopharyngioma treatment.

Early phase trial of intracystic injection of large surface area microparticle paclitaxel for treatment of mucinous pancreatic cysts.

Background and study aims Mucinous pancreatic cystic lesions (PCLs) have the potential for malignant transformation, for which the only accepted curative modality is surgery. A novel intracystic therapy with large surface area microparticle paclitaxel (LSAM-PTX) may treat PCLs without local or systemic toxicities. Safety and preliminary efficacy of LSAM-PTX for the treatment of PCLs administered by endoscopic ultrasound-guided fine-needle injection (EUS-FNI) was evaluated. Patients and methods Ten subjects with confirmed PCLs (size > 1.5 cm) received intracystic LSAM-PTX via EUS-FNI at volumes equal to those aspirated from the cyst in sequential cohorts at 6, 10, and 15 mg/mL in a standard "3 + 3" dose-escalation protocol. The highest dose with acceptable safety and tolerability was taken into the confirmatory phase where nine additional subjects received two injections of LSAM-PTX 12 weeks apart. Subjects were followed for 6 months after initial LSAM-PTX treatment for endpoints including: adverse events (AEs), tolerability, pharmacokinetic analysis of systemic paclitaxel drug levels, and change in cyst volume. Results Nineteen subjects completed the study. No dose-limiting toxicities, treatment-related serious AEs, or clinically significant laboratory changes were reported. Systemic paclitaxel concentrations did not exceed 3.5 ng/mL at any timepoint measured and fell below 1 ng/mL by Week 2, supporting the lack of systemic toxicity. By Week 24 a cyst volume reduction (10-78 %) was seen in 70.6 % of subjects. Conclusions Intracystic injection of LSAM-PTX into mucinous PCLs resulted in no significant AEs, a lack of systemic absorption, and resulted in reduction of cyst volume over a 6month period.

Evaluation of the effects of dexamethasone iontophoresis, galvanic current, and conservative treatment on pain and disability in patients with knee osteoarthritis and Baker's cyst.

This study aims to evaluate the effectiveness of galvanic current and dexamethasone iontophoresis in the treatment of knee osteoarthritis and Baker's cyst (BC). This prospective, randomized, controlled, single-blind study included 37 patients (9 males, 28 females; mean age: 57.8+10.3 years; range 40 to 75 years) with knee osteoarthritis and BC, between January and August 2020. The patients were randomized into three groups: the iontophoresis group (n=13), the galvanic current group (n=11), and the control group (n=13). The numerical rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and ultrasonographic measurements of BC were recorded at baseline, two weeks, and six weeks. All groups received the same physiotherapy program. Dexamethasone iontophoresis and galvanic current therapy were administered to the patients in the iontophoresis and galvanic current groups, respectively, with a galvanic current at an intensity of 0.1-0.2 mA/cm2 for 10 days. There was no significant dissimilarity in demographic and clinical characteristics, basal NRS (resting and exercise) and WOMAC scores, and basal cyst volumes between groups. A significant temporal change was found in three groups for resting NRS, exercise NRS, and WOMAC scores and cyst volumes, except for the cyst volume in the control group. There was a notable difference in terms of improvement in cyst volumes between baseline and the second week in the iontophoresis group compared to the galvanic current group (p=0.046). There was a significant improvement in resting NRS and exercise NRS scores between baseline and the second week in the galvanic current group compared to the control group (p=0.015 and p=0.002, respectively). Additionally, a significant improvement was observed in resting NRS and exercise NRS scores between baseline and the second week in the iontophoresis group compared to the control group (p=0.009 and p=0.001, respectively). A significant clinical and functional improvement was detected with dexamethasone iontophoresis in the treatment of patients with knee osteoarthritis and BC.

The evolution of pituitary cysts in growth hormone-treated children.

We have previously shown that pituitary cysts may affect growth hormone secretion. This study sought to determine cyst evolution during growth hormone treatment in children. Forty-nine patients with short stature, a pituitary cyst, and at least two brain MRI scans were included. The percent of the pituitary gland occupied by the cyst (POGO) was calculated, and a cyst with a POGO of≤15% was considered small, while a POGO >15% was considered large. Thirty-five cysts were small, and 14 were large. Five of the 35 small cysts grew into large cysts, while 6 of the 14 large cysts shrunk into small cysts. Of 4 cysts that fluctuated between large and small, 3 presented as large and 1 as small. Small cysts experienced greater change in cyst volume (CV) (mean=61.5%) than large cysts (mean=-0.4%). However, large cysts had a greater net change in CV (mean=44.2mm3) than small cysts (mean=21.0mm3). Older patients had significantly larger mean pituitary volume than younger patients (435.4 mm3 vs. 317.9mm3) and significantly larger mean CV than younger patients (77.4 mm3 vs. 45.2mm3), but there was no significant difference in POGO between groups. Pituitary cyst size can vary greatly over time. Determination of POGO over time is a useful marker for determining the possibility of a pathologic effect on pituitary function since it factors both cyst and gland volume. Large cysts should be monitored closely, given their extreme, erratic behavior.

Embolization of Large and Giant Posterior Fossa Hemangioblastomas: The Experience of a Single Tertiary Care Center.

Background Hemangioblastomas pose an inherent surgical risk due to the potential for high intraoperative blood loss, especially in larger tumors. One approach to minimize this risk is to use preoperative embolization. Herein, we present our institutional experience treating large and giant cerebellar hemangioblastomas. Methods We performed a retrospective chart review of 19 patients with cerebellar hemangioblastomas that had a maximal diameter of >3 cm. We performed a literature review and included individual patient-level data that met our >3 cm diameter cerebellar hemangioblastoma inclusion criteria. Results Our cohort consisted of 19 patients that received a total of 20 resections for their cerebellar hemangioblastomas. Preoperative embolization was utilized in eight cases (38.1%). One patient experienced transient neurological complications after embolization (12.5%). Tumors of patients in the embolization group had larger median total, solid, and cystic volumes and were more likely to involve the cerebellopontine angle than those in the non-embolized group. Compared with non-embolized patients, embolized patients had less decrease in their hemoglobin, lower volumes of estimated blood loss, reduced rates of postoperative complications and permanent deficits, and greater instances of neurological improvement. The larger cohort (obtained from the combining our cohort with patients identified during a literature review) consisted of 99 patients with 39 receiving preoperative embolization. Conclusion It is important to examine individual patient characteristics when determining eligibility for preoperative embolization. However, improvements in endovascular techniques have made preoperative embolization a safe and effective procedure with minimal risks that can be performed in many patients.

An interdural spinal cyst in the cervicothoracic spine: a review and proposal for a revised classification of spinal meningeal cysts. Illustrative case.

Spinal cysts in the interdural space are extremely rare and are not included in the standard classification of spinal meningeal cysts. A 60-year-old female presented to our hospital with a spastic gait and numbness in both palms. Magnetic resonance imaging (MRI) revealed a spinal cyst from C4 to T4 compressing the spinal cord. Computed tomography myelography revealed a fistula at C4-5 and C5-6 that connected the cyst along the right C5 and C6 root sleeves. The cyst was located within the dura mater, and communication with the arachnoid space was achieved using a shunt tube. There was partial spastic gait amelioration after the procedure, but the patient experienced a relapse 2 months postoperation. A repeat procedure was performed without a shunt tube to allow greater communication between the cyst and the subarachnoid space. After this, marked improvement in gait function was observed, and MRI showed a significant reduction in cyst volume. Interdural spinal meningeal cysts are rare. When the interdural cyst cannot be removed entirely, surgery may be appropriate for providing a shunt tube or establishing communication between the cyst and arachnoid space to maintain the circulation of cerebrospinal fluid collected in the cyst cavity.

PMON331 The Natural History of Pituitary Cysts in Patients with Growth Hormone Deficiency and Idiopathic Short Stature

Abstract Background Pituitary cysts may be implicated in short stature and affect growth hormone secretion. The natural history of cysts is not known in patients with GHD and ISS. Objective To characterize the progression of cyst volume (CV) and percentage of the gland occupied by the cyst (POGO) over time in GHD and ISS patients. Subjects and Methods A pediatric health system's database was queried for patients diagnosed with short stature and a cyst with at least one follow up MRI between 2007-21. Data up to 7 years after first follow up was included in this study. The mean and median follow up time were 1.32±1.24 and 1.00. Cysts with a POGO≤15% were considered small, while a POGO&amp;gt;15% were considered large. Results The mean and median %ΔCV for all patients for all their follow up MRIs were 38.27%±179.14 and 0%. The mean and median %ΔPOGO for all patients were 38.32%±219.85 and -5.79%. The mean and median %ΔCV for patients with a small cyst (SC) (n=34) were 61.49%±215.60 and 0%. The mean and median %ΔPOGO for patients with a SC were 61.62%±267.25 and -2.89%. The mean and median %ΔCV for patients with a large cyst(LC)(n=14) were -0.4% ±-79.25 and 0%. The mean and median %ΔPOGO for patients with a LC were -1.08%±90.50 and -15.67%. 5 of the 35(14.3%) SCs grew into LCs and stayed large while 6 of the 14 LCs shrunk into SCs. 4 cysts fluctuated between large and small: 3 started large and 1 started small. CV of patients with LCs has a significant negative correlation with time (-0.37, p=0.01). The slope of the regression line is -0.01 mm3/month. The CV of patients with SCs does not show any change in time (-0.02, p=0.84). There is no significant difference in POGO (p=0.86) or in CV (p=0.96) in GHD and ISS patients. In GHD and ISS patients, the difference in POGO is different in each group at each MRI date (p=0.02), but not in CV (p=0.38). GHD patients had an average ΔPOGO of -1.05, while ISS patients had an average ΔPOGO of 1.26. Conclusion POGO can change greatly over time. LCs tend to take up less of the gland over time. SCs tend not to change significantly over time, but a minority can still enlarge and need to be monitored. So far, there have been no significant clinical consequences related to these cysts. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

PSAT323 Ultrasound-guided Percutaneous Ethanol Ablation for the treatment of Benign Cystic Thyroid Nodules: Report of Three Cases on The Initial Ecuadorian Experience

Abstract Introduction Ultrasound-guided Percutaneous Ethanol Ablation (UPEA) is one of the first-line treatments for benign pure cysts and predominantly cystic thyroid nodules (TN). This non-surgical procedure has been used for years worldwide, however, in Latin America, this was recently adopted. Therefore, the aim of this report is to characterize our initial experience with UPEA in Ecuador. Clinical cases description: We report on the cases of a woman (F1: 49 y) and two men (M1: 38 y, M2: 69 y) that underwent UPEA for three predominantly cystic TN at ITECC (Instituto de la Tiroides y Enfermedades de Cabeza y Cuello) in Ecuador. All nodules were non-functioning and graded as Bethesda II. Our approach in regards to the total ethanol volume injected was approximately calculated at 1/3 of the TN volume, using 75% ethanol. 10 ml of 2% lidocaine was used for anesthetic purposes. Initial volume and change in TN volume were calculated with the ATA calculator. Patient F1 had a 40 mm (23.5 ml) right lobe TN and underwent needle extraction of 5 ml of cystic fluid before the injection of 6 ml of ethanol. At 1-month follow-up, the nodule reduced 78.1% in volume (28 mm, 5.1 ml). Similarly, patient M1 had a 59 mm (44.8 ml) right lobe TN treated with 6 ml of ethanol after 20 ml of cystic fluid was extracted from the TN. At 3-month follow-up, the nodule reduced 99% in volume (7 mm, 0.1 ml). Finally, patient M2 had a 36 mm (14.5 ml) right lobe TN treated with 5 ml of ethanol. At 6-moth follow-up, the nodule reduced 99% in volume (0.5 mm, 0.04 ml). No patients developed complications and only needed one session. Conclusions To the best of our knowledge, we are the pioneers in Ecuador and the fourth country in Latin America that implemented UPEA in the management of cystic TN. In this small report, UPEA seems to be an effective and safe treatment option for cystic TN. Patients had &amp;gt;75% reduction in cyst volume along with symptomatic relief and no complications. Our results are consistent with other series. Data on a longer follow-up are needed to confirm long-term efficacy. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

RF14 | PMON328 The Effect of Pituitary Cysts on Pituitary Volume in Patients with Growth Hormone Deficiency and Idiopathic Short Stature

Abstract Background Pituitary cysts (PCs) may be related to the development of diminished growth hormone secretion because they may limit the proliferation of somatotrophs. This study seeks to investigate the mass effect of PCs on the pituitary function. Methods Patients aged 6-18 with cysts and follow-ups between 2007–21 were compared to normal controls (NCs) aged 6-18 from a neuroradiology center. Pituitary volume (PV) is the volume of the pituitary gland including the cyst, while net pituitary volume (netPV) is the volume of the pituitary gland excluding the cyst. Since NCs did not have PCs, only PV was utilized. PVs and netPVs are reported in mm3. Data were stratified into prepubertal (age &amp;lt; 11 yrs) and pubertal (age &amp;gt; 11 yrs). The Kruskal-Wallis One Way ANOVA on Ranks was utilized to compare multiple means, and the Kruskal-Wallis Multiple-Comparison Z Value test (with Bonferroni adjustment) was utilized for pairwise comparisons. Results The mean and median PVs of prepubertal GHD (n=37), ISS (n=5), and NCs (n=58) were 290.2 ± 109.7 and 305.0, 314.4 ± 100.8 and 299.8, and 246.8 ± 63.7 and 241.6, respectively. The difference between mean PVs of prepubertal GHD, ISS, and NCs was not significant. The mean and median PVs of pubertal GHD (n=58), ISS (n=33), and NCs (n=112) were 391.5 ± 163.5 and 370.2, 409.2 ± 215.8 and 382.9, and 424.2 ± 138.9 and 402.7, respectively. The difference between mean PVs of pubertal GHD, ISS, and NCs was not significant. For netPV, the mean and median values for prepubertal GHD and ISS patients were 252.2 ± 83.3 and 272.2, and 245.2 ± 85.7 and 244.9, respectively. The difference between mean netPVs of prepubertal GHD, ISS, and NCs was not significant. For netPV, the mean and median values for pubertal GHD and ISS patients were 332.7 ± 121.3 and 346.4, and 333.9 ± 146.1 and 330.7, respectively. The mean netPVs of pubertal GHD and ISS patients were both significantly lower than the mean PV of pubertal NCs. The mean and median PVs for cyst patients were 364.8 ± 170.0 and 347.8 which was not significantly different from the NCs. The mean and median netPVs for cyst patients were 307.3 ± 122.9 and 289.0 which was significantly different from the NCs (p&amp;lt;0.001). Conclusion When considering the functional component of the pituitary gland, cyst volume should be subtracted from the overall pituitary gland. Presentation: Sunday, June 12, 2022 12:36 p.m. - 12:41 p.m., Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

On Natural History and Management of Colloid Cysts: Time to Rethink?

Colloid cysts, although benign, may occasionally cause obstructive hydrocephalus and sudden death. Reliable prognostic factors for symptomatic progression have been sought, with heterogenous results. We conducted a retrospective review of all cases of colloid cysts of the third ventricle managed at our center between 2009 and 2019. Clinical and neuroimaging characteristics were analyzed using logistic regression in relation to symptomatic status and hydrocephalus. The cutoff values for outcome prediction were calculated using the receiver operating characteristic curve analysis. There were 82 patients with colloid cysts, of whom 60 were asymptomatic and 22 symptomatic. None of the asymptomatic patients experienced acute neurologic decline or hydrocephalus during follow-up, whereas half (n= 11) of the symptomatic patients presented with hydrocephalus, 8 of whom had acute hydrocephalus. We found 3 putative candidate risk factors for symptomatic colloid cysts: T1-weighted magnetic resonance imaging hyperintense/mixed signal appearance (P= 0.004), location in risk zone I (P= 0.007), and a volume >236.49 mm3 (P= 0.007). Cyst diameter and volume/foramen of Monro diameter ratios had a decreasing trend over time among asymptomatic patients, providing new insights into the natural history of the disease. Only a few asymptomatic colloid cysts showed progression requiring surgery, with no acute deterioration or fatal events, whereas the rest remained stable over time, thus supporting a more conservative approach for this group of patients. Higher risk for developing symptomatic colloid cyst was defined by a risk score that included T1-weighted magnetic resonance imaging appearance, risk zone, and colloid cyst volume, aiding the detection of patients at risk of clinical deterioration.

Anti-echinococcal effects of sumac, Rhus coriaria, in a murine model of cystic echinococcosis: Parasitological and molecular evaluation

Sumac has been traditionally used by people as a medicinal plant for the treatment of different disorders. Cystic echinococcosis (CE) is one of the major zoonotic diseases of human with a worldwide distribution. Long term albendazole therapy is usually associated with side effects including impaired liver function and leukopenia.The present study investigated the efficacy of the methanolic extract of Sumac, Rhus coriaria, on the secondary hydatid cyst development in mice and evaluated sumac effects on the expression of a profile of genes with a potential role in parasite development.Thirty-six mice were intraperitoneally inoculated with of with 3000 protoscoleces and six months after induction of infection were divided into three groups that received either oral sumac extract, albendazole or distilled water. The mice were necropsied 45 days later and the volume and weight of cysts were measured. The expression level of five target genes were analyzed using RT-qPCR.The volume and weight of the cysts were significantly lower in the sumac group compared to the controls. Decreased expressions were found in four out of the five genes following sumac administration. While significantly lower expressions in the sumac group were found for the cdk6, b-raf, fgfr and ras genes, no significant difference was found in cdk2 expression as compared with the control groups.Findings of the present study indicate high efficacy of sumac on the size and volume of secondary hydatid cysts in a murine CE model. Further studies are required to explore the most active and effective ingredients of this natural product.

Effect of barbed suture versus conventional suture in laparo-endoscopic single-site cystectomy for ovarian mature cystic teratoma: An ambispective cohort study.

To compare the effects of barbed suture (BS) and conventional suture (CS) on perioperative conditions and ovarian function in the excision of ovarian mature cystic teratoma (MCT) by laparo-endoscopic single-site surgery (LESS). The present study is an ambispective cohort study conducted in an affiliated tertiary hospital between May 2019 and October 2020. Women treated by LESS cystectomy for unilateral ovarian MCT were included. BS or CS were applied in the surgery. BS and CS groups were matched 1:1 for age, body mass index and ovarian cyst volume (40 women per group). There were no significant differences in baseline characteristics. Mean operating time (53.89 ± 14.80 versuss 67.93 ± 19.23 min, P=0.004) and suturing time (11.85 ± 6.68 versus 19.76 ± 12.75 min, P=0.006) were significantly shorter in the BS group than the CS group. No significant differences were found in serum anti-Müllerian hormone (AMH) levels between groups at baseline, postoperative day 1, 3months, and 12 months. However, serum AMH was significantly lower than baseline at postoperative day 1, 3months, and 12 months in both groups. BS provides shorter operating and suturing time than CS, without increasing damage to ovarian function in LESS cystectomy for ovarian MCT.

The Safety and Efficacy of Hepatic Transarterial Embolization Using Microspheres and Microcoils in Patients with Symptomatic Polycystic Liver Disease.

Purpose: We investigated the long-term safety and efficacy of hepatic transarterial embolization (TAE) in patients with symptomatic polycystic liver disease (PLD). Materials and Methods: A total of 26 patients were included, mean age of 52.3 years (range: 33–78 years), undergoing 32 TAE procedures between January 2012 and December 2019 were included in this retrospective study. Distal embolization of the segmental hepatic artery was performed with 300–500 µm embolic microspheres associated with proximal embolization using microcoils. The primary endpoint was clinical efficacy, defined by an improvement in health-related quality of life using a modified Short Form-36 Health Survey and improvement in symptoms (digestive or respiratory symptoms and chronic abdominal pain), without invasive therapy during the follow-up period. Secondary endpoints were a decrease in total liver volume and treated liver volume and complications. Results: Hepatic embolization was performed successfully in 30 of 32 procedures with no major adverse events. Clinical efficacy was 73% (19/26). The mean reduction in hepatic volume was −12.6% at 3 months and −27.8% at the last follow-up 51 ± 15.2 months after TAE (range: 30–81 months; both ps < 0.01). The mean visual analog scale pain score was 5.4 ± 2.8 before TAE and decreased to 2.7 ± 1.9 after treatment. Three patients had minor adverse events, and one patient had an adverse event of moderate severity. Conclusion: Hepatic embolization using microspheres and microcoils is a safe and effective treatment for PLD that improves symptoms and reduces the volume of hepatic cysts.

Early Autosomal-Dominant Polycystic Kidney Disease is Related to Liver and Cyst Volumes, Hepatic Parenchyma Volume, and Patient-Reported Effects

Aim: Polycystic liver infections are the most prevalent extra renal manifestation of autosomal-dominant polycystic kidney disease (PKD). People are living longer and there are more chances of spread on infections and these infections may cause different diseases but these can be improved by providing the proper knowledge among the lay men and control over these diseases can be made like better kidney survival, less death from heart disease, new treatments for kidney transplants, and more people with polycystic liver failure. There is a lack of research that completely characterizes PKD in big cohorts. Many other researchers has also been made to observe the size of the liver and the number of cysts which are linked to the size of the hepatic parenchyma, but this study is the specific to the polycystic kidney disease and its effect over the liver with the volume of cyst. This is the only studyin the region. . Methods: cross-sectional studies has been conducted to investigate the relationship between the initial volumes of the liver which was determined by MRI, and the patient’s demographics, the outcomes of these results also depends upon the quality of life of the patients. This research was conducted from January 2021 to June 2021 at Mayo Hospital, Lahore Pakistan. The information is gathered from the randomized, placebo-controlled trial that is currently being conducted at five tertiary-care medical facilities. In this the comparison was made between the groups of angiotensin I–converting enzyme inhibitor and an angiotensin II–receptor blocker. These findings were based on the normal situation o fthe blood [ressure. Because normal blood pressure related with the proper renal functioning. These tests were performed for 558 patients with ADPK (age, 16–50 y). Practical implication: We can easily implement these findings to PKD in hospitals and find the best treatment method according to this. Results: The significant level of hepatomegaly was seen in number of individuals diagnosed with ADPKD. Hepatomegaly was also existed in cysts as well as parenchyma. Cysts were found more often in women, and both the liver and cyst sizes were observed to be larger in women with the increase in age. Patients whose illness had progressed significantly demonstrated a significant reduction in the situation of liver parenchyma. In this study some minor irregularities were noticed in the results of laboratory testing on the liver, and splenomegaly and hypersplenism remained related to the severity of PLD. Inferior quality of life was connected with having a larger amount of damage in the liver tissue. Conclusion: Even in the earliest stages of ADPKD, hepatomegaly is rather prevalent, and it cannot be diagnosed properly just by the presence of cysts. Even for those who didn't have cysts, parenchymal volumes have been discovered to be substantially bigger than liver volumes in people without ADPKD or these predicted by basic tests performed in the specific laboratories. The harshness of PLD remained linked to changed biochemical also hematologic characteristics, in addition to a worse quality of life in patients. Keywords: Hepatomegaly, Polycystic liver infections, extra-renal manifestation, autosomal-dominant polycystic kidney diseases.

Prenatal ultrasound-and MRI-based imaging predictors of respiratory symptoms at birth for congenital lung malformations

BackgroundCongenital lung malformations (CLM) are rare developmental anomalies of the fetal lung with a minority of patients exhibiting symptoms around the time of birth. Although ultrasound remains the gold standard, fetal MRI has recently been incorporated as an adjunct imaging modality in the workup and prenatal counseling of patients with CLM as it is thought to more accurately delineate lesion boundaries and diagnose lesion type. We evaluate what prenatal variables correlate with postnatal respiratory symptoms. MethodsWe performed a retrospective review of patients with prenatal diagnosis of CLM treated at our institution between 2006-2020. Fetal ultrasound and magnetic resonance imaging (MRI) parameters including maximal congenital pulmonary airway malformation volume ratio (CVR), absolute cyst volume, and observed to expected normal fetal lung volume (O/E NFLV) were correlated with outcomes including postnatal respiratory symptoms, need for supplementary oxygen or mechanical ventilation, delay in tolerating full feeds, resection in the neonatal period. ResultsOur study included 111 patients, all of whom underwent fetal ultrasound with 64 patients additionally undergoing fetal MRI. Postnatal respiratory symptoms were noted in 22.5% of patients, 19.8% required supplemental oxygen, 2.7% mechanical ventilation and two patients requiring urgent resection. Ultrasound parameters including absolute cyst volume and maximal CVR correlated with need for mechanical ventilation (p=0.034 and p=0.024, respectively) and for urgent resection (p=0.018 and p=0.023, respectively) and had a marginal association with postnatal respiratory symptoms (p=0.050 and p=0.052). Absolute cyst volume became associated with postnatal respiratory symptoms (p=0.017) after multivariable analysis controlling for maternal steroid administration and gestational age. O/E NFLV did not correlate with perinatal outcomes. ConclusionWe have found that ultrasound-based measurements correlate with postnatal respiratory symptoms, while MRI derived O/E NFLV does not. Further studies are needed to elucidate the role of MRI in the prenatal workup of congenital lung malformations. Type of StudyStudy of Diagnostic Test. Level of EvidenceLevel I.

A custom-made removable appliance for the decompression of odontogenic cysts fabricated using a digital workflow

ObjectivesThis case series aimed to assess the feasibility of a custom-made decompression appliance fabricated using a digital workflow to decompress odontogenic cysts. Additionally, the treated cysts were assessed for volumetric changes. MethodsA three-dimensional (3D) reconstruction software (CoDiagnostiX version 10.4) was used to obtain the master cast STL (Standard Tessellation Language) file by placing a customized virtual implant to create a recess for the tube of the decompression device. The decompression appliance was planned using Dental Wings Open Software (DWOS). Following rapid prototyping, the tube of the appliance was perforated using round burs. In cases where the appliances were designed to replace teeth, denture teeth were added using the conventional workflow. The appliances were delivered on the day of the cystostomy. Following decompression, cyst enucleation was performed. Cyst volume was assessed by manual segmentation of pre- and post-operative cone-beam computed tomography (CBCT) reconstructions using slice-by-slice boundary drawing with a scissors tool in the 3DSlicer 4.10.2 software. Percentage of volume reduction was calculated as follows: volume reduction/pre-operative volume × 100. ResultsSix odontogenic cysts in six patients (5 male, 1 female; age 40 years, range: 15–49 years) with a pre- and post-operative cyst volume of 5597 ± 3983 mm3 and 2330 ± 1860 mm3 respectively (p < 0.05) were treated. Percentage of volume reduction was 58.84 ± 13.22 % following a 6-month-long decompression period. ConclusionsThe digital workflow described in this case series enables the delivery of decompression appliances at the time of cystostomy, thus effectively reducing the volume of odontogenic cysts. The resulting bone formation established a safe zone around the anatomical landmarks; therefore, during enucleation surgery, complications to these landmarks can be avoided.