Cases reported "Cysts"

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1/48. Surgical resection of traumatic spleen cysts by laparoscopy.

    Surgical resection of traumatic cysts by means of laparoscopy in two female patients is reported. The patients had sustained severe trauma in the left upper quadrant, were symptomatic and developed large splenic cysts found by computerized tomography, with an average diameter of 8.5 cm. Both patients were submitted to puncture and capsule removal by means of videolaparoscopy and diathermy; splenic parenchyma was preserved and the cyst's bed drained. No intra or postoperative complications occurred. After an average 21 months postoperative follow-up, both patients are symptom-free and no late recurrences were found on tomographic studies. The advantages of this technique over others that have been reported are the preservation of splenic parenchyma, its easy performance and efficient relief of symptoms, as well as being minimally invasive, associated with minimal postoperative pain, shorter length of hospital stay, and no early recurrences.
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2/48. Congenital intraorbital optic nerve cyst. Case report.

    Congenital cystic lesions of the optic nerve are exceedingly rare; only one case is reported in the world literature. The authors describe a case of congenital simple glial cyst in the intraorbital portion of the optic nerve with a brief review of the literature and comment on its histogenesis. A 45-day-old male infant was admitted to the hospital because of progressive proptosis and hypotropia in the left eye, which had been present since birth. magnetic resonance imaging of the left orbit revealed an ovoid, well-demarcated, homogeneous cystic mass in the intraconal retrobulbar area. The mass compressed the left eyeball with downward and lateral displacement. The wall of the cystic mass was very thin, and a needle puncture of the cyst released clear, colorless, watery fluid. The cystic wall was lined by loose astroglial nerve fibers with some scattered glial cells.
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3/48. Needlescopic decapsulation of a splenic epithelial cyst.

    As technology advances, the techniques of laparoscopic surgery are being refined and their application is expanding to include many disease processes and organs. The new-generation laparoscopic instruments are becoming smaller (less than 5 mm). Expected advantages include improvements in cosmesis and patient satisfaction, and decreased postoperative analgesic requirements. Non-neoplastic cysts of the spleen are rare, and their management has evolved from total open splenectomy to laparoscopic cyst decapsulation. A 22-year-old woman with a symptomatic 10-cm epithelial cyst was treated by splenic decapsulation with needlescopic instruments (3 mm or smaller). Three trocars were used: one 12-mm umbilical and two 3-mm subcostal ports. The cyst was punctured by a Veress needle, and after drainage of straw-coloured fluid, circumferential decapsulation with 5-mm laparoscopic shears through the umbilical port site was done. The patient was discharged within 24 hours, having had a single intramuscular injection of meperidine and an excellent cosmetic result.
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4/48. Successful treatment of azoospermia secondary to ejaculatory duct cyst.

    Ejaculatory duct obstruction is considered a rare cause of infertility. Two cases are reported of an ejaculatory duct cyst with azoospermia preoperatively diagnosed by transrectal ultrasonography. The diagnosis of ejaculatory duct obstruction in one patient was confirmed by vasography with a combined iodinated contrast medium and methylene blue solution for radiological and direct visualization. Transrectal puncture and contrast filling of the cyst under the transrectal ultrasonographic guidance diagnosed the other patient. On the basis of these findings transurethral unroofing of the cyst was performed successfully. Transrectal ultrasonography facilitates evaluation and treatment of azoospermia caused by ejaculatory duct obstruction and may minimize the need for more invasive studies in such cases.
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5/48. Nasopharyngeal extension of a craniopharyngioma in a 4 year old girl.

    Nasopharyngeal extension of a craniopharyngioma is very rare and usually presents with headache, nasal obstruction and visual disturbances. We present a case of a 4 year old girl, who became symptomatic with visual deterioration. MRI showed a huge supra - and infrasellar cystic craniopharyngioma with extension into the sphenoid sinus. Primary treatment was a transnasal puncture of the cyst followed by a subfrontal approach with removal of the tumour preserving the chiasm and optic nerves. The visual acuity postoperatively improved while she needed hormone replacement due to panhypopituitarism. Follow-up 12 months after the operation showed no recurrence. This is the youngest patient of about 27 patients reported so far in the literature.
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6/48. Percutaneous expulsion of hydatid liver cyst following sclerotherapy.

    A 20-year-old woman underwent alcohol sclerotherapy for a symptomatic liver cyst, initially diagnosed as simple liver cyst. Five months later, she presented with expulsion of the cyst from the puncture site. The cyst was proved to be due to hydatid disease. Spontaneous expulsion is a rare complication of sclerotherapy.
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7/48. A new method of ultrasonic guidance of neuroendoscopic procedures. Technical note.

    The authors present a newly designed device for ultrasonic guidance of neuroendoscopic procedures. It consists of a puncture adapter that attaches to a rigid endoscope having an outer diameter of 6 mm and is mounted on a small, bayonet-shaped ultrasound probe. This adapter directs the movement of the endoscope precisely within the ultrasonic field of view. The targeted region is identified by transdural insonation via an enlarged single burr-hole approach, and the endoscope is tracked in real time throughout its approach to the target. The procedure has been performed in 10 patients: endoscopic ventriculocystostomy in four cases; removal of a colloid cyst of the third ventricle in two cases; and intraventricular tumor biopsy, intraventricular tumor resection, third ventriculostomy, and removal of an intraventricular hematoma in one case each. The endoscope was depicted on ultrasonograms as a hyperechoic line without disturbing echoes and, consequently, the target (cyst, ventricle, or tumor) was safely identified in all but one case, in which intraventricular air hid a colloid cyst in the foramen of Monro. The method presented by the authors proved to be very effective in the guidance and control of neuroendoscopic procedures. Combining this method with image guidance is recommended to define the entry point of the endoscope precisely.
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8/48. Diagnostic difficulty arising from displaced epithelium after core biopsy in intracystic papillary lesions of the breast.

    This study reports two cases of intracystic papillary carcinoma of the breast, which had been biopsied preoperatively using a 14 gauge (14G) core biopsy needle. In each case, a needle tract containing groups of epithelial cells within granulation tissue could be identified on histology of the excised specimen. Both cases showed extracapsular tumour, which was interpreted as displacement of epithelium related to preoperative core biopsy. Subsequent axillary lymph node sampling showed no evidence of metastasis. In one case, extracapsular tumour appeared to be in blood vessels, but flattened cells lining the spaces containing tumour failed to react with factor 8 related antigen or CD34 on immunohistochemistry. It is likely that intracystic papillary carcinomas are particularly prone to this artefact because friable tumour fragments escape, accompanied by cyst fluid, when the capsule is punctured by a 14G core biopsy needle.
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9/48. Percutaneous spinal cord puncture and myelocystography. Its role in the diagnosis and treatment of intramedullary neoplasms.

    Three patients with cystic tumors of the cervical spinal cord were evaluated with percutaneous cord puncture and myelocystography. This procedure gives relief of symptoms and permits delineation of the extent and character of the cystic mass.
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10/48. Corneoscleral cyst treated with distilled water injection.

    To describe the first case of the treatment of a corneoscleral cyst by distilled water injection into a corneal cyst. The anterior wall of a cyst of the limbal communication was punctured with a surgical blade. Aspiration and irrigation of the contents of the cyst with a 27-gauge anterior chamber cannula were performed repeatedly, three times. Distilled water, instead of balanced salt solution, was injected into the collapsed cyst, and was then aspirated completely after 5 minutes. The injection and aspiration of distilled water was repeated once more. The scleral cyst was surgically excised. Twelve months after surgery, several small white granular opacities, presumably epithelial cell nests, were observed on the interface of the collapsed cyst cavity, but there was no recurrence of the cyst. The best spectacle-corrected visual acuity (BSCVA) was 1.0 with a correction of 1.25-2.00 X 45. No significant change in central corneal endothelial cell density was noted. We suggest that this simple technique may represent an alternative method for the management of corneal cysts, and may have less risk of developing a corneal opacity or causing other serious damage to surrounding tissues.
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