1/81. Surgical removal of a free floating cyst of the iris pigment epithelium causing disturbing visual symptoms.Pigmented cysts in the anterior chamber, fixed or free floating, are considered to be unusual but not very infrequent. However, most of these cases usually do not need any treatment other than a periodic observation. We report the surgical removal of an iris pigment epithelial cyst floating freely in the anterior chamber. The reason for surgical removal was, disturbance in near vision being caused by movement of the cyst across the visual axis. This specific symptom of disturbed near vision, to the best of our knowledge, is a rare indication for surgery that has not been pointed out earlier. Histopathological confirmation of the clinical diagnosis was also obtained.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/81. Familial fatal and near-fatal third ventricle colloid cysts.BACKGROUND: Despite having a presumed congenital origin, familial cases of colloid cysts have been reported only rarely. The first case of a brother and sister with colloid cysts is reported here, and the relevant literature is reviewed. methods: A 25-year-old man presented with a 24-h history of headache and vomiting. He rapidly became unconscious and fulfilled the criteria for brain death on arrival at hospital. No surgical intervention was performed. RESULTS: The patient's sister presented at the age of 41 with headaches and rapidly became unconscious. The sister had urgent bilateral ventriculostomies. followed by transcallosal removal of a colloid cyst. CONCLUSIONS: These cases support the hypothesis that colloid cysts are congenital lesions and provide some evidence of a possible genetic predisposition to their formation. Sudden death remains a real risk for patients harbouring a colloid cyst.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
3/81. Screening for cerebral aneurysm in patients with polycystic liver disease.BACKGROUND: Polycystic liver disease (PCLD) is an autosomal dominant disease characterized by multiple macrocystic lesions throughout the liver. The association between PCLD and cerebral aneurysm is well documented, and approximately 20% of patients with PCLD have demonstrable cerebral aneurysms at autopsy. The prevalence reported from autopsy series, however, may not reflect the true prevalence in patients with PCLD. We undertook this study to evaluate the prevalence and diagnosis of cerebral aneurysms in screening cerebral studies in patients with PCLD. methods: patients were identified by searching the hepatobiliary surgical service data base and hospital medical records. Hospital charts were reviewed to confirm presence of PCLD and to identify screening studies for cerebral aneurysms. RESULTS: Ten patients with PCLD received screening studies of the cerebral vasculature during a 10 1/2-year period. One patient was found to have an asymptomatic cerebral aneurysm. A 45-year-old woman with no other significant medical history was referred for evaluation of PCLD. Screening magnetic resonance angiography (MRA) revealed a 5 mm aneurysm extending anteriorly near the origin of the right ophthalmic artery, without evidence of rupture. cerebral angiography confirmed these findings, and the aneurysm was clipped. CONCLUSIONS: Because cerebral aneurysms can be an important source of morbidity and mortality in PCLD, we recommend screening by MRA or by computed tomographic angiography (CTA) of the cerebral vasculature in all patients who have PCLD.- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |
4/81. Anaesthetic management of a parturient with a colloid cyst of the third ventricle.A colloid cyst in the third ventricle near the foramen of Monroe can obstruct cerebrospinal fluid (CSF) flow from the lateral ventricles. Any change in the CSF pressure on either side of the cyst can lead to displacement and thus precipitate acute hydrocephalus. Management of the confinement of a patient with a colloid cyst must therefore aim to minimize changes in CSF pressure. We describe our management of a patient with a small colloid cyst who was permitted to labour with the assistance of patient-controlled epidural analgesia. The available alternatives are discussed.- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |
5/81. Ectopic lacrimal gland cyst of the orbit.Lacrimal duct cysts are not common. It is extremely rare when a lacrimal duct cyst and an ectopic lacrimal gland develop in the orbital cavity. A unique case of an ectopic lacrimal gland cyst of the orbit is presented. A 33-year-old man had a palpable mass above the inferior medial orbital rim for nearly two years. An ocular examination was normal except for a movable, firm mass found in the anterior nasal inferior orbit of the right eye. An echogram revealed a homogeneous, hypoechoic cystic mass. Computed tomography of the orbit showed a well-encapsulated lesion in the lower orbit of the right eye near the inferior rectus muscle, without bony erosion. A tense, thin-walled, clear fluid-filled cyst measuring 15 x 12 x 13 mm in size was completely enucleated without rupture by anterior orbitotomy. Pathologic examination disclosed a small nest of normal gland tissue surrounded by a cystic lesion lined with two layers of lacrimal duct epithelium cells. No recurrent signs were noticed during a 12-month period of follow-up.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/81. Band-shaped and whorled microcystic dystrophy of the corneal epithelium.OBJECTIVE: To report the clinical, histopathologic, and electron microscopic features of band-shaped and whorled microcystic corneal epithelial dystrophy. DESIGN: Two interventional case reports. PARTICIPANTS: Two patients, two eyes. INTERVENTION: The involved area of corneal epithelium was scraped from each cornea. RESULTS: Histopathologic examination showed microscopic vacuoles in the epithelial cytoplasm in both cases. Electron microscopic examination revealed mainly empty cytoplasmic vacuoles with scant nonspecific osmophilic material. The process recurred clinically in one patient. Changes in corneal topography are documented in one patient. CONCLUSION: Clinical findings and pathologic studies seem nearly identical to those in the original report. No pattern of systemic disorder or medication use was found. The cause of this condition remains unknown.- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |
7/81. Surgical treatment of an intrastromal epithelial corneal cyst.PURPOSE: To describe corneal intrastromal epithelial cysts and present a minimally invasive surgical technique successfully used to treat such a lesion. methods: A 5-year-old girl with a progressive, vision-threatening, intrastromal corneal opacity in the left eye is described. The patient had a history of accommodative esotropia and bilateral medial rectus recession two years before presentation. A presumptive diagnosis of an epithelial cyst secondary to iatrogenic seeding of the limbal corneal stroma was made. Because of documented growth toward the visual axis and a decrease in best-corrected visual acuity, surgical treatment was initiated. The cyst was incised and debrided through a 2.0-mm, partial-thickness, limbus-parallel, clear corneal incision. RESULTS: Cytologic analysis of the cyst contents showed intact and degenerated epithelial cells, thereby confirming the diagnosis. The cyst walls were scraped through the nonenlarged incision, and irrigation resulted in nearly complete clearing of the opacity. Stable vision and no recurrences were documented with 21 months of follow-up. CONCLUSION: This minimally invasive surgical approach may be a good alternative to previously described treatments for intrastromal corneal cysts.- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |
8/81. Occult papillary carcinoma of the thyroid presenting as a cervical cyst.BACKGROUND. A cystic neck mass representing metastatic papillary thyroid cancer to a cervical lymph node may be the presenting symptom in patients with an occult papillary cancer of the thyroid. This cystic change can cause diagnostic problems and not infrequently delay identification of the primary thyroid tumor. This study investigates the frequency, treatment, and pathologic features of this entity. methods. All clinical charts and microscopic slides of 136 consecutive patients who underwent thyroid operation for papillary carcinoma (PC) from 1990 to 1995 were reviewed. hematoxylin-and-eosin and immunohistochemical stains (IMHS) for thyroglobulin also were reviewed. RESULTS. Eight patients (5.8%) presented with a cystic neck mass and no palpable thyroid lesion. In all 8 patients, the diagnosis was made by an excision of the cystic neck mass. In 3 patients, the cyst demonstrated classical features of PC, such as papillae and psammoma bodies. In the remaining 5 (62%), only focal papillae or nuclear features of papillary carcinoma were present. A careful review of the histology and IMHS were necessary to arrive at the correct diagnosis in these 5 patients. CONCLUSIONS. Occult papillary cancer of the thyroid presenting as a cystic neck mass is not uncommon and must be considered in the differential diagnosis. Excision and careful review of the histology and IMHS is necessary to prevent delay of the proper diagnosis. Although the thyroid tumor was less than 1 cm and sometimes only microscopic, the extensive nodal metastasis has led us to favor near total or total thyroidectomy and modified neck dissection in this entity.- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |
9/81. Presence of delayed myelination and macrocephaly in the sister of a patient with vacuolating leukoencephalopathy with subcortical cysts.Leukoencephalopathy with swelling and a discrepantly mild clinical course ("van der Knaap disease") is a recently identified syndrome. It is characterised by macrocephaly occurring during the first year of life, initially normal or nearly normal development, and slowly progressive ataxia and spasticity with initial preservation of intellectual functions. MRI shows diffuse abnormality in signal intensity, as well as swelling of the hemispheral white matter with subcortical cyst-like spaces in the fronto-parietal and anterior temporal areas. It is thought to have an autosomal recessive mode of inheritance, since many patients have consanguineous parents and more than one affected patient is often present within the same family. We report on two sibs: a 5-year old boy affected with "van der Knaap disease" and his macrocephalic sister whose first MRI (2 years 6 months) showed delayed myelination, which led us to suspect the same disease as her brother, however with subsequent normalisation at the second MRI (3 years 6 months).- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |
10/81. Lateral laparoscopic port sites should all be closed: the incisional "spigelian" hernia.Incisional hernias are a recognized complication of all abdominal surgery, including laparoscopic surgery. Although most cases of laparoscopic port incisional hernias are seen in the midline, particularly around the umbilicus, there are several reports of herniation at laterally placed ports. Accepted surgical practice is to close the deep fascial layers at midline laparoscopic ports. However, the deep layers at the lateral ports are not usually closed. Two near-identical cases are reported in which incisional hernias have developed at the site where laterally placed 10-mm ports have pierced the spigelian fascia. hernia development at an iatrogenic defect in an area that is already potentially weak, and therefore prone to herniation, has implications for lateral 10-mm port site closure. The closure of the deep layers of all lateral laparoscopic ports is advocated, especially if the spigelian fascia is pierced.- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |
| | Next -> |