Percutaneous renal cyst puncture with CO2 instillation therapy

Ultrasound-guided percutaneous puncture of renal cysts replaced by CO2 was performed on 9 renal cysts of 6 patients from May 1993 through September 1993. Puncture and aspiration of cysts was performed using a 5.5 Fr one-step fluid drain kit (pig tail stent) under ultrasonography inspection. Aspirated volume of cyst contents was 15-292ml (mean 115 ml), and the instilled CO2 volume was 15-150 ml (mean 73 ml). All patients were checked by CT scan. In one month, the reduction rate of cyst volume was 46-84% (mean 69%) and lumbago, their chief complaint, was improved in all patients. No complications were observed in patients treated by CO2 instillation. Although long-term followup is needed to draw a definite conclusion, this therapy may be useful for benign renal cystic lesions.     

Complications of cardiac hydatid cyst. 2 cases

BACKGROUND: Cardiac localization of hydatiosis is uncommon, involving 0.5 to 2% of all cases. CASE REPORTS: The first patient was a 15 year old adolescent whose cardiac hydatidosis was revealed by tamponade. The second case was discovered in a 28-year-old woman without cardiac signs who was explored for allergy manifestations with fever, urticaria and joint point. Both patients underwent surgery. Eighteen months after the operation, the second patient developed hemiplegia leading to the discovery of multi-organ localizations (brain, spleen, kidney) which were not evidenced at the initial work-up. The neurological deficit and brain cysts regress with albendazole treatment. DISCUSSION: The risk of rupture of the cardiac hydatic cyst requires rapid surgical cure. Medical treatments are discussed. Anti-hydatic drugs can be used alone in case of a contraindication for surgery. In other patients they are given during the perioperatie period and for a prolonged period after surgery.     

Calcified solitary renal cyst in childhood

There is a 20% incidence of malignancy in renal masses with rim calcification in adults. A case of rim calcification in a solitary renal cyst in a child is presented and the diagnostic approach and surgical management are described. Solitary renal cysts are extremely rare in children, with no reported cases of rim calcification.     

Preoperative diagnosis of hypernephroma in a renal cyst wall by selective renal angiography

Presented is a case in which preoperative diagnosis of a hypernephroma in the wall of a renal cyst was made by selective renal arteriography. Reviewed are the incidence and possible causative relationship between the two lesions and the potential and limitations of presently available diagnostic procedures for this entity.     

Complications and management of methods of dialysis access for renal failure

The management of dialysis access requires the awareness that any single access site is finite. A commitment to maintain access is reasonable with a planned approach. Dialysis for the end-stage renal disease patient must continue acutely during the management of access complications, and chronically. The goal of treatment is to return the patient to a routine dialysis regimen as soon as possible. Suspected infections should be treated immediately with systemic antibiotics specific for resistant Staphylococcus aureus. Systemic infection should be controlled before a new foreign body is implanted. My personal philosophy of access includes the following principles. (1) distal is good, (2) preserve all possible sites, (3) arm is better than leg, and (4) everything is relative.     

Post-therapy iodine-131 localization in unsuspected large renal cyst: possible mechanisms

Sensitive and specific, whole-body 131I scintigraphy remains an important technique for diagnosing metastases from differentiated papillary or follicular thyroid carcinoma. False-positive 131I localization is well recognized and can occur in a variety of conditions. We present a case of intense 131I localization in a previously unsuspected large renal cyst; the lesion was not visualized on routine preablation diagnostic 131I scintigraphy but was obvious on post-therapeutic whole-body imaging, underscoring the value of post-therapy imaging in detecting abnormalities not apparent on diagnostic studies. Radioiodine within the urinary bladder or, at times, the renal collecting system is expected, because 131I excretion is primarily by glomerular filtration. In the case presented here, 131I activity within the renal cyst supports the concept that iodide is subject to an active secretory process by the renal tubule.     

Effects of topical instillation of minocycline hydrochloride on cyst size and renal function in polycystic kidney disease

To reduce renal cyst size in autosomal dominant polycystic kidney disease (ADPKD), minocycline hydrochloride solution was instilled into the enlarged cysts in three ADPKD patients. In one patient with reduced renal function, such sclerotherapy apparently diminished cyst size, but without apparent improving effect on renal function at 7 months of follow-up. The second patient, who needed the replacement therapy on admission, had been free from hemodialysis over 4 months after the therapy. Persistent flank pain disappeared in both patients. In the third patient with normal renal function, sclerotherapy was done to get a better control of hypertension. Initially blood pressure decreased, but it returned up to the pre-therapy level irrespective of definite reduction of the enlarged cysts at 8 months of follow-up. The therapy with minocycline hydrochloride did not appear harmful, and may be helpful in the management of ADPKD.     

Diagnosing the combination of renal dysgenesis, Gartner's duct cyst and ipsilateral müllerian duct obstruction

PURPOSE: We describe the differential points in the diagnosis of the combination of renal dysgenesis, Gartner's duct cyst and ipsilateral müllerian duct obstruction. Various imaging studies and urological procedures were performed. We report our experience in detecting these anomalies in 10 girls and review the literature. MATERIALS AND METHODS: Ten girls, 7 to 13 years old, with this combination of anomalies were identified in the last 10 years. Imaging studies as well as urological procedures were selectively performed, especially at puberty following menarche. Patients received long-term followup with ultrasound. RESULTS: Cystic dilation of Gartner's duct protruded into the bladder and presented as a ureterocele in 5 patients and posterior to the bladder in 5. Surgical removal of a partial portion of a Gartner's duct cyst was performed in 5 patients for alleviation of urinary symptoms. Unilateral müllerian duct obstruction was demonstrated in all 10 patients. Excision of the vaginal septum was performed in 6 patients for relief of genital obstruction. CONCLUSIONS: When cystic dilatation of the pelvis, especially a ureterocele-like cyst without ureteral dilatation, is found in girls with ipsilateral renal dysgenesis, the possibility of a Gartner's duct cyst should be considered. For early detection and treatment of unilateral obstruction of duplicated müllerian ducts pelvic sonography should be performed at puberty, especially just after menarche, in girls with renal dysgenesis and ipsilateral Gartner's duct cyst.     

Complications of thoracoscopy

BACKGROUND: The revolution in video technology has led to the acceptance of thoracoscopy as an important tool in thoracic surgery. METHODS: A review of all patients undergoing thoracoscopy at the University of Maryland between November 1991 and March 1995 was performed to identify the incidence of intraoperative and postoperative complications. In addition, the role of computed tomography for predicting intraoperative complications was analyzed. RESULTS: Three hundred forty-eight procedures were performed in 321 patients. Twenty-seven patients required conversion to thoracotomy for various indications. In 12 patients further resection was required after frozen section diagnosis confirmed lung carcinoma. Six patients were opened due to adhesions. Two patients were opened due to inability to find the lesion (this represents 1.6% of all solitary pulmonary nodules). Three cases were converted to thoracotomy for lesions that were too large to remove (representing 2.5% of all solitary pulmonary nodules resected). Two patients required conversion to thoracotomy because of inability to obtain one-lung ventilation. One case required a limited thoracotomy for a lost needle used for needle localization of a solitary intraparenchymal nodule, and 1 patient had emergent exploration for bleeding. Early postoperative complications developed in 10 patients. There were two explorations in the immediate postoperative period for bleeding. Prolonged air leak occurred in 3 patients, empyema in 2, and recurrent pneumothorax, pulmonary edema, and pneumonia in 1 patient each. Computed tomography failed to diagnose adhesions in the majority of patients requiring conversion to thoracotomy. CONCLUSIONS: Thoracoscopy is a safe and effective procedure with low intraoperative and postoperative complication rates.     

Complications of blepharoplasty

Although blepharoplasty is a technically straightforward procedure, many postoperative complications may occur. Some of the untoward effects may be only a transient nuisance for the patient, such as mild ocular dryness, whereas other sequelae can lead to severe visual loss. An extensive review of the prevention, diagnosis, and management of complications associated with blepharoplasty is presented.