Histology and cytology of laparoscopically operated "simple ovarian cysts"

In a retrospective study the histopathological findings of 127 laparoscopically operated unilocular anechoic smooth-walled ovarian cysts have been correlated with clinical characteristics (age, duration of observation, complaints, hormonal treatment), size by ultrasound, kind and colour of cysts content as well as cytological findings. The age of patients differed from 16-61 years (mean +/- s: 36 +/- 16). The histopathologic findings yielded 15 (11.8%) functional cysts, 30 (23.6%) persistent corpus luteum cysts, 9 (7.1%) endometriomas, 7 (5.5%) cystic teratomas, 9 (7.1%) undifferenciated cysts and 57 (44.9%) cystadenomas. There were no differences between histopathologic diagnosis groups according to age and cysts size by ultrasound. Functional cysts with complaints (n = 6) may explain that the observation time in 60% of all functional cysts was smaller than 6 weeks, whereas persistent corpus luteum cysts, endometriomas, cystic teratoma and cystadenomas had been observed for longer than 6 weeks in more than two thirds. Intraoperative evaluation of cysts content as "chocolate"-like was suspicious of endometriomas, but was also present in cysts of other histopathological findings. By means of cytology, endometrioma (siderophages) was suspected in 44.4% and a cystadenoma in 42.1% of all histopathologically verified cases. In all, the cytologic findings were useful for correct histopathological diagnosis in only 33.9% of all 127 cases. It is concluded that differential diagnosis of simple ovarian cysts is not possible by clinical characteristics, neither by ultrasound nor by cytological evaluation. Ovarian cysts should be observed for at least two hormonal cycles. A hormonal treatment by combination preparations containing high doses of oestrogen is also recommended. In cases of persisting ovarian cysts laparoscopic removal is necessary.     

Treatment of benign hepatic cysts by instillation of tetracycline hydrochloride

BACKGROUND/AIMS: Despite the high frequency of benign hepatic cysts, they rarely cause symptoms. Large cysts, however, may produce clinical manifestations. In these cases, ultrasonography-guided therapy has been proposed. We report the results of this therapy in patients with symptomatic benign hepatic cysts. METHODOLOGY: Seven patients with non-parasitic, non-neoplastic benign hepatic cysts were submitted to fine-needle ultrasonography-guided aspiration, followed by injection of diluted tetracycline hydrochloride (1 g). In all cases, cytology, tumour markers and microbiology analysis of aspirates were performed. One patient required two sessions. The grade of patient satisfaction and ultrasonography changes were assessed 1, 3 and 6 months after the procedure. RESULTS: Cyst size decreased in all patient, with total collapse in three. No major complications occurred. Cytology, alpha fetoprotein, CA19.9, CEA and microbiology of the cyst fluid confirmed the initial ultrasonographic diagnosis of simple biliary cysts. Clinical complaints improved in 2 cases, and 5 patients became asymptomatic. Ultrasonography evaluation 3 months after the procedure was more reliable in predicting successful treatment. CONCLUSION: Intracystic instillation of tetracycline hydrochloride is an effective and safe technique and may become the first choice therapy for benign hepatic cysts.     

Three approaches for laparoscopic unroofing of simple and complicated renal cysts

We report 2 cases of simple renal cysts which were marsupialized with 2 laparoscopic approaches involving either transperitoneal, with reflection of the colon medially or dissection through the mesocolon, and a case of a multilocular renal cyst which was treated by the retroperitoneal approach. Although laparoscopic unroofing of a renal cyst is a safe and effective alternative to open surgical techniques, the transperitoneal approach should only be used for simple renal cysts. The retroperitoneal approach for complicated renal cysts may be indicated if preoperative examinations exclude the possibility of malignancy.     

Endoscopic management of colloid cysts

OBJECTIVE: Several surgical approaches have been proposed for the treatment of colloid cysts, which still remains controversial. The most recent technique used is endoscopy. By its nature, endoscopy cannot offer complete removal, as compared to microsurgical techniques, but can do more than puncture. To evaluate the usefulness of endoscopy for colloid cyst surgery, a series of 15 patients who were operated on for colloid cysts under endoscopic control since 1994 was reviewed. METHODS: The presenting symptoms of our patients (10 men and 5 women) were intermittent headache (10 patients), nausea (3 patients), short-term memory loss (4 patients), coma (2 patients), gait disturbance (3 patients), blurred vision (2 patients), and mental status changes (3 patients). The sizes of the cysts ranged from 4 to 50 mm (median, 22.93 mm). Depending on the radiological appearance, the procedure was performed via a right (10 patients) or left (5 patients) precoronal burr hole. A rigid neuroendoscope was used. Initial stereotactic placement of the neuroendoscope was used in two patients who had moderate hydrocephalus. In the other patients, hand-guided endoscopy was performed using an articulated arm. The cysts were perforated with a needle. The opening was enlarged with microscissors. The cyst material was aspirated, and the remaining capsule was coagulated. RESULTS: The average follow-up was 15.26 months (range, 1-28 mo). Total aspiration of the cysts was achieved in 12 patients, as revealed by normal postoperative magnetic resonance imaging. Control magnetic resonance imaging revealed residual cysts in three patients. One patient presented with an asymptomatic recurrence at 1 year. Resolution of the symptoms was obtained in all patients except for two of the four patients with preoperative memory deficit (improvement without complete recovery). There was no mortality or morbidity. CONCLUSION: These results show that endoscopy is a safe and promising percutaneous technique for the treatment of colloid cysts of the third ventricle. Longer follow-up is, however, still required.     

Percutaneous management of benign renal cysts

Percutaneous emptying of benign renal cysts represents the adopted treatment for this kind of pathology. The introduction of pure ethilic alcohol (95 degrees) is usually associated with emptying because it determines the necrosis of the secreting epithelious with recurrences and little significant complications. This treatment is the less bloody solution that can be executed in surgery and for this reason it is proposed in the time as an alternative to surgery treatment of removal.     

The management of breast cysts by aspiration

A review is given of 75 patients presenting with breast cysts treated by aspiration. The patients have been followed for an average of four years and in no case has a carcinoma been detected. The technique is considered to be safe provided the guidelines laid down by the writers are followed.     

Splenic epithelial cysts and splenomegaly: diagnosis and management

Little consideration has been given to the philosophical tenets that underlie existing family nursing theory and practice and that ultimately influence the content and process of family nursing education. This article emphasizes the importance of students and faculty engaging in a critical analysis of family nursing theory and practice. A pedagogical approach that employs phenomenology, feminism, and critical social theory as observational lenses for examining the ontology and epistemology of family nursing is described. While family nursing is coming to be recognized as an essential element of any nursing curriculum, family nursing pedagogy is in its infancy. Family nurse educators are currently working toward developing curricula and educative processes that will furnish students with a theoretical (scientific) base for family nursing practice and will provide them with opportunities to develop the practice skills they need to work with families (Hanson & Heims, 1992; Wright & Bell, 1989). However, little consideration has been given to examining the philosophical tenets that underlie existing family nursing theory and practice and that ultimately influence the content and process of family nursing education (Richards & Lansberry, 1995). This article asserts that critical analysis of family nursing theory and practice is integral to family nursing pedagogy and must be a primary consideration in the advancement of family nursing education. The discussion is in two parts. Part I highlights the importance of a critical analysis of family nursing theory and practice including both ontological and epistemological inquiries. Part II describes a critical pedagogy of family nursing that addresses both ontology and epistemology.     

Clinical course, diagnosis and treatment of ovarian tumors and cysts in children

The experience of diagnosis and treatment of the ovarial tumor and cyst in 68 girls was summarized. Children were admitted to the hospital with an acute abdomen signs and in a planned order as well. All the patients were operated on. Children with benign ovarial tumor and cyst are alive. Four patients with malignancy have died.     

Laparoscopic management of ovarian tumors

BACKGROUND: Laparoscopy can be used with minimal operative morbidity to evaluate adnexal masses. We report our experience with the endoscopic approach to the diagnosis and treatment of ovarian tumors. In particular, we describe 11 patients who incidentally underwent laparoscopy and in whom the ovarian masses were found to be malignant. METHODS: Between September 1994 and September 1996, 292 patients with 316 ovarian tumors were treated laparoscopically in the Department of Obstetrics-Gynaecology, University of Ulm. We assessed vaginal ultrasonography, clinical assessment, the tumor marker CA 12-5, and the intraoperative low-power magnification for their value in predicting the final diagnosis in all laparoscopically treated ovarian tumors. RESULTS: From a total of 292 patients with ovarian tumors, 11 were diagnosed, intraoperatively or after final histologic examination, as having a malignant or borderline ovarian tumor. All applied pre- and intraoperative diagnostic procedures were by themselves too unreliable to exclude early stages of ovarian carcinoma exactly. CONCLUSIONS: On the basis of the present findings, we are tempted to conclude that laparoscopic surgery is justified in the management of ovarian tumors. Even with an accurate preoperative selection of suitable patients for laparoscopic surgery, the presence of an undetected ovarian carcinoma cannot be entirely excluded.     

Conservative management of wrist ganglia. Aspiration versus steroid infiltration

Wrist ganglia were randomly allocated for conservative treatment by either aspiration or aspiration and injection of steroid. Both treatment methods had 33% success rates. Almost all ganglia which recurred after one aspiration did not resolve with further aspirations. After aspiration and explanation of the benign nature of ganglia, only a quarter of patients requested surgical treatment.     

Solitary non-parasitic cysts of the liver: presentation and management

Four cases (one asymptomatic and three symptomatic) of solitary non-parasitic cysts of the liver are presented. The asymptomatic cysts was an incidental finding at laparotomy. The other three patients presented with abdominal distension, jaundice and malignant transformation respectively. Management of these patients has been discussed and the literature reviewed.     

良性卵巢囊肿腹腔镜微创手术治疗体会

目的 分析研究腹腔镜手术治疗良性卵巢囊肿的临床效果.方法 回顾性分析2010年1月～2011年1月期间我院收治的96例卵巢囊肿患者的临床资料.96例患者中56例行腹腔镜手术,40例行开腹手术,比较两组患者手术时间、术中出血以及术后恢复情况.结果 腹腔镜组患者手术时间、术中出血量、患者下床活动时闻和排气时间均少于开腹组,两组比较差异有统计学意义(P<0.05);微创手术56例患者中2例为转为开腹手术,余均在腹腔镜下顺利完成手术,无并发症发生.结论 腹腔镜手术治疗卵巢囊肿与开腹手术相比,具有创伤小、临床疗效好等优点,是目前治疗卵巢良性肿瘤的最佳手术方式.     

The management of midline transcranial nasal dermoid sinus cysts

The most common congenital midline nasal masses are nasal dermoid sinus cysts (NDSC) [Hughes GB, Sharpino G, Hunt W, Tucker HM. Management of the congenital midline nasal mass—a review. Head Neck Surg 1980;2:222–33.¹]. Their clinical importance hinges on their potential to communicate with the central nervous system. Preoperative diagnosis of an intracranial extension allows for referral to a craniofacial team with the appropriate skills and experience for a transcranial approach. All patients with a NDSC require imaging with high resolution multiplanar MRI scans and complimentary fine cut CT scan to reveal the anatomical extent of the tract and its relationship to the anterior cranial fossa.A single-stage craniofacial approach to resection of midline NDSC extending to the anterior cranial base is effective with minimal morbidity [Yavuzer R, Bier U, Jackson IT. Be careful: it might be a nasal dermoid cyst. Plast Reconstr Surg 1999;103:2082–3; Denoyelle F, Ducroz V, Roger G, Garabedian EN. Nasal dermoid sinus cysts in children. Laryngoscope 1997;107:795–800; Rohrich RJ, Lowe JB, Schwartz MR. The role of open rhinoplasty in the management of nasal dermoid cysts. Plast Reconstr Surg 1999;104:2163–70; Rahbar R, Shah P, Mulliken JB, et al. The presentation and management of nasal dermoid—a 30-year experience. Arch Otolaryngol Head Neck Surg 2003;129:464–71; Posnick JC, Bortoluzzi P, Armstrong DC, Drake JM. Intracranial nasal dermoid sinus cysts: computed tomographic scan findings and surgical results. Plast Reconstr Surg 1994;93:745–54 [discussion 755–56]; Bartlett SP, Lin KY, Grossman R, Kratowitz J. The surgical management of orbitofacial dermoids in the pediatric patient. Plast Reconstr Surg 1993;91:1208–15. ^{[2] , [3] , [7] , [9] , [11] and [18]} ]. The cyst and tract are accessed through a combination of a nasal and transcranial approach. This allows visualisation and dissection of the tract with only a small incision on the nasal dorsum to include the cutaneous punctum when present. Transnasal endoscopic techniques have been advocated where the dermoid is located within the nasal cavity and there is little or no cutaneous involvement [Weiss DD, Robson CD, Mulliken JB. Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base. Plast Reconstr Surg 1998;101:2119–23.²⁶].We present a review of five cases referred to our unit between 1999 and 2004 with a diagnosis of a midline nasal dermoid sinus cyst and radiological evidence of intracranial communication. All cases had a communication with the anterior cranial fossa diagnosed preoperatively and were treated surgically with a craniofacial approach. An intracranial extension was identified at operation in each case and this was confirmed on histopathology. The only significant complication resulted from an early postoperative infection, requiring re-operation. There were no recurrences and acceptable aesthetic outcomes have been observed in all cases.     

Conservative management of post-operative peritoneal cysts associated with endometriosis

BACKGROUND: Early amniocentesis has been claimed to confer a higher risk of fetal loss than standard amniocentesis after the 15th gestational week. Our experience of early amniocentesis in single and twin gestations from 1990 - 1995 is presented with 99.3% follow-up. METHODS: Amniocentesis was performed between 11 gestational weeks + 5 days and 14 gestational weeks + 6 days. RESULTS: In 1646 pregnancies 1678 amniocenteses were performed. Thirty-two reamniocenteses were done, 17 due to amniocyte culture failure and 15 due to failure to obtain sufficient amount of amniotic fluid on the first occasion. After puncture 1.49% (25/1678) suffered a spontaneous abortion. Twenty twin pregnancies were included. One spontaneous abortion was noted in this group, as well as three cases where one fetus was normal and the other had a severe defect. Selective abortions were performed without complications. CONCLUSIONS: The difference of postprocedure fetal loss in our population between early and standard amniocentesis is 0.8%. A comparison of postprocedure losses is not appropriate when amniocenteses are performed at a different gestational age, as spontaneous loss decreases with increased gestational age. Our results compare well with the only randomized study between early and standard amniocentesis where the fetal loss after early amniocentesis is similar to that in standard amniocentesis.     

Presentation and surgical management of bronchogenic and esophageal duplication cysts in adults

OBJECTIVE: Bronchogenic and esophageal duplication cysts are congenital anomalies of the tracheobronchial tree and foregut that are often asymptomatic at initial presentation in adults. Surgery is always recommended, even for patients with asymptomatic disease, because of the possible development of symptoms and complications during the natural course of the disease and because definitive diagnosis can be established only on surgical specimen. METHODS: Twenty-seven patients with bronchogenic and esophageal duplication cysts were treated in our institution over the last 2 decades. Ten patients (37%) were asymptomatic at initial presentation. Chest pain and dysphagia were the most common complaints in symptomatic patients affected by bronchogenic and duplication cysts, respectively. RESULTS: A complete excision of the cyst was performed in 26 cases, whereas one patient with intrapulmonary cyst underwent a right upper pulmonary lobectomy. A posterolateral thoracotomy was performed in 23 patients, and a video-assisted thoracoscopy using a three-port technique was performed in the last 4 patients. No postoperative morbidity was recorded. All patients, except one, were asymptomatic at a median follow-up time of 4 years. CONCLUSIONS: Surgery is the treatment of choice for bronchogenic and esophageal duplication cysts. Video-assisted thoracoscopy should represent the first-line approach in these patients.