Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Abstract

Objective: To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design: Case report; literature review.

Findings: Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion: Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Spinal epidural abscess with myelitis and meningitis caused by Streptococcus pneumoniae in a young child

Background

Spinal epidural abscess (SEA) in children is a rare infectious emergency warranting prompt intervention. Predisposing factors include immunosuppression, spinal procedures, and local site infections such as vertebral osteomyelitis and paraspinal abscess. Staphylococcus aureus is the most common isolate.

Design

Case report and literature review.

Findings

A 2.5-year-old boy with tetraparesis was found to have an SEA in the posterior lumbar epidural space with evidence of meningitis and myelitis on MRI spine in the absence of any local or systemic predisposing factors or spinal procedures. Streptococcus pneumoniae was isolated from the evacuated pus.

Conclusions

Definitive treatment of SEA is a combination of surgical decompression and iv antibiotics. Timely management limits the extent of neurological deficit.     

Ganglion cyst of the foot treated with electroacupuncture: A case report

Objective:

To present the clinical management of a ganglion cyst presenting on the dorsolateral aspect of the foot.

Clinical Features:

A 45-year-old female cyclist complaining of ganglion cyst following training period.

Intervention and Outcome:

Patient was treated with high-frequency electroacupuncture in four consecutive sessions over four weeks, and reported resolution of the cyst following therapeutic intervention.

Conclusions:

Ganglion cysts of the foot are relatively rare connective tissue tumours with variable treatment approaches. Electroacupuncture may be a novel and non-invasive conservative approach for the treatment of ganglion cysts. Further evaluation of the efficacy of such treatment is warranted.     

How to Build a Simple and Safe Laparoscopic Hydatid Evaluation System

Background:

One of the most common problems faced in laparoscopic treatment of hydatid cysts is the difficulty in evacuating the particulate contents (daughter cysts and laminated membrane). Although various instruments and laparoscopic techniques have been described to evacuate the contents of hydatid cysts, most are not available at many surgical centers.

Methods:

By assembling disposable, cheap, and available anesthesia equipment with common laparoscopic instruments, a laparoscopic system was made to evacuate the contents of a hydatid cyst. Ten patients with hepatic hydatid disease underwent laparoscopic surgery using this new hydatid system between June 2011 and January 2013.

Results:

The procedure was completely straightforward. Twelve hydatid cysts (2 patients had 2 separated cysts) were evacuated without any spillage. All patients were followed for at least 8 months, with no evidence of recurrence.

Conclusions:

This simple apparatus, which can be assembled anywhere, was safely used to evacuate the contents of hydatid cysts without causing any spillage.     

Endoscopic management of biliary hydatid disease

Objective

To determine the effect of endoscopic sphincterotomy in the management of biliary hydatid disease.

Design

A case study between January 1992 and December 1994.

Setting

A university-affiliated hospital in Adana, Turkey.

Patients

Five patients with biliary hydatid disease, in which the cyst had ruptured into the biliary tree. The follow-up ranged from 3 to 12 months.

Intervention

Endoscopic sphincterotomy.

Main Outcome Measures

Morbidity, mortality and recurrence of the disease.

Results

All patients underwent successful endoscopic sphincterotomy, including removal of daughter cysts. During the follow-up period, ultrasonography and laboratory investigations showed complete cure in all patients. There were no complications due to endoscopic sphincterotomy.

Conclusion

Endoscopic sphincterotomy is the treatment of choice for the management of hydatid cysts that have ruptured into the biliary tract causing obstructive jaundice.     

Traumatic rupture of hydatid cysts

Objective

To stress the relation between rupture of hydatid cysts and trauma.

Design

A case series.

Setting

A university-affiliated hospital for emergency medicine.

Patients

Four college students who suffered traumatic rupture of hydatid cysts. All injuries were sustained during sporting activities.

Interventions

Resection or unroofing of the cysts with careful removal of all hydatid elements, and suture-plication of the residual liver cavities.

Results

The ruptured cysts were located in the liver, spleen and splenic flexure of the colon. At exploration, additional hydatid cysts were found, usually in the liver. Treatment resulted in complete recovery in all patients.

Conclusions

Traumatic rupture of hydatid cysts related to sporting activities may be commoner than indicated by the rarity of reports. Increased awareness of this possibility in areas where hydatid disease is endemic is encouraged.     

Surgical treatment of hydatid cysts of the lung: analysis of 405 patients

Objective

The choice of operation, postoperative success and complications of surgery in patients with pulmonary hydatid cysts.

Design

A series of patients seen over 15 years.

Setting

A university clinic.

Patients

Four hundred and five patients (209 male, 196 female) ranging in age from 4 to 72 years (mean 29 years). Most (367 patients) had isolated lung cysts; 38 had both liver and lung cysts.

Interventions

A variety of procedures to remove cysts, including enucleation and capitonnage, wedge resection, segmentectomy, lobectomy and pneumonectomy. Six patients with bilateral cysts were operated on through a median sternotomy approach. Others underwent posterolateral thoracotomy.

Main outcome measures

Value of diagnostic tests, the most efficacious approach for cyst removal and recurrence and death rates.

Results

Chest radiography gave a correct diagnosis in 99% of patients. The Casoni and Weinberg tests were discontinued because of high false-negative rates (up to 35%). Hospital mortality was 1.2% and postoperative complications occurred in 5.2%. The recurrence rate was 1.5%.

Conclusions

Lung-preserving surgical interventions are the treatment of choice for pulmonary hydatid disease. In patients with bilateral cysts, the median sternotomy approach is preferred, and in the patients with right lung disease and coexisting liver cysts the transdiaphragmatic approach is the one of choice to remove cysts in 1 stage.     

The Accuracy of Magnetic Resonance Imaging in Radical Prostatectomy

Aims

The aim of this study was to examine the accuracy of standard magnetic resonance imaging (MRI) in the localised staging of prostate cancer in those who had undergone radical prostatectomy.

Patients and Methods

The cohort consisted of 110 patients who had undergone MRI for staging of prostate cancer and subsequently underwent radical prostatectomy. T stage was analysed both on MRI and from the specimen following radical surgery.

Results

Of the patients 57% of patients had their disease up-staged following radical surgery from preoperative MRI findings. Of those patients who had their disease up-staged following surgery, nearly 50% of patients had gone from organ confined disease at time of MRI to extra-prostatic involvement from the surgical specimen.

Conclusion

We have reported that MRI has a wide range of accuracy. Given developments in MRI technologies further work should be pursued to help in the staging of this disease for which decision to treat is difficult.Key Words: Magnetic resonance imaging, Prostate cancer, Prostatectomy     

MRI After Patellofemoral Replacement: the Component–Bone Interface and Rotational Alignment

Background

In an earlier paper, it was shown that tailored magnetic resonance imaging (MRI) allows for reproducible analysis of the preserved knee joint structures after patellofemoral replacement (PFR).

Purposes

This pilot study investigates to what degree MRI could produce reliable assessment of the implant–bone interface of femoral and patellar components and rotational alignment following PFR.

Methods

MRI tailored for reduction of metallic artefacts was performed in seven patients who had undergone PFR. Two independent investigators evaluated the implant–bone interface at femoral and patellar components and the rotational alignment of the femoral component. They also assessed their degree of confidence in evaluation using a five-point scale. The inter-observer reliability was determined.

Results

Implant-induced MRI artefact was barely observed and there was no interference with component–bone interface evaluation. There was excellent inter-observer reliability, inter-observer agreement, and confidence for the implant–bone interface at femoral and patellar components and for rotational alignment. The applied score for the interface was found to be reliable.

Conclusion

Tailored MRI allows reproducible analysis of the implant–bone interface and of rotational alignment of the femoral component in patients who have had PFR. It might prove helpful in the assessment of painful PFR.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9336-x) contains supplementary material, which is available to authorized users.     

Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: two case reports

Context

Acute hemiparesis is a common initial presentation of ischemic stroke. Although hemiparesis due to spontaneous spinal epidural hematoma (SSEH) is an uncommon symptom, a few cases have been reported and misdiagnosed as cerebral infarction.

Design

Case reports of SSEH with acute hemiparesis.

Findings

In these two cases, acute stroke was suspected initially and administration of intravenous alteplase therapy was considered. In one case, the presentation was neck pain and in the other case, it was Lhermitte''s sign; brain magnetic resonance imaging (MRI) and magnetic resonance angiography were negative for signs of ischemic infarction, hemorrhage, or arterial dissection. Cervical MRI was performed and demonstrated SSEH.

Conclusion

Clinicians who perform intravenous thrombolytic treatment with alteplase need to be aware of this possible contraindication.     

Spontaneous resolution of symptoms associated with a facet synovial cyst in an adult female – a case report

Background:

Facet cysts are implicated in neural compression in the lumbar spine. Surgery is the definitive treatment for symptomatic facet cysts since the failure rate for conservative treatment is quite high; however, the role of physical/manual medicine practitioners in the management of symptomatic facet cysts has not been well explored. This case report will add to the body of evidence of spontaneous resolution of symptoms associated with facet cysts in the chiropractic literature.

Case:

A 58 year old female presented with acute low back and right leg pain which she attributed to a series of exercise classes that involved frequent foot stomping. Physical examination did not elicit any objective evidence of radiculopathy but MRI and CT scans revealed a facet cyst impinging on the right L5 nerve root. Injections and surgery were recommended; however, the patient’s radicular symptoms completely resolved after three months without surgical intervention.

Summary:

There is currently a paucity of data in the literature regarding the chiropractor’s role in the management of symptomatic facet cysts. The case presented here has added to this literature and possible areas for future research have been explored.     

Ganglion cyst in children: Reviewing treatment and recurrence rates

BACKGROUND:

Pediatric hand and wrist ganglia seem to have different epidemiological characteristics than those of adults – a majority are found on the volar aspect of the hands and wrists of patients younger than 10 years of age.

OBJECTIVE:

To determine the epidemiology, etiological factors, clinical presentation, treatment and outcome of patients with ganglion cysts at The Hospital for Sick Children (Toronto, Ontario).

METHODS:

The records of the pathology department at The Hospital for Sick Children were searched for all cases of ganglion cyst operated on between January 2000 and December 2008.

RESULTS:

Thirty-seven patients underwent treatment for symptomatic ganglion cyst. The mean age of the patients was 9.6 years, and there were 23 females. A mobile nodule was the initial presentation of the ganglion in 64% of the cases. Pain was the most common indication for surgical removal. Only 11.4% of patients experienced previous trauma. In 70% of the cases, the diagnosis was made clinically. The most common sites of occurrence were volar wrist (25.7%), dorsal wrist (22.8%) and the volar aspect of the base of the ring finger (17.1%). Surgical excision was the treatment of choice for 94.2% of the patients with symptomatic lesions. The minimum follow-up period was 12 months. Only one patient (2.8%) presented with recurrence in the series.

CONCLUSION:

Although it is possible that these findings might change with longer follow-up, the present data provide information to help guide the treatment of these cysts. Complete surgical removal is a very effective treatment, with low rates of recurrence.     

Minimally Invasive Treatment of Liver Hydatidosis

Background and Objectives:

Open surgery has been the mainstay treatment for liver hydatidosis in the past. Today, for treatment of simple and uncomplicated cysts, we have a variety of choices: antihelmintic therapy, the PAIR (puncture, aspiration, injection, and respiration) technique, and the laparoscopic approach. We reviewed our series of 267 cases of hepatic hydatidosis submitted to surgery over a period of 20 years, from 1995 through 2014, comparing the results of these minimally invasive treatments.

Methods:

In 92 patients (25.7% of cases) who presented with complicated liver hydatid cysts, we performed open surgery. In 16.4% of cases (59 patients), we used a laparoscopic approach, and in 208 patients (57.9% of cases), we used the PAIR technique. All patients were monitored after surgery for a mean of 61.7 months (range, 16–127). Postoperative follow-up consisted of clinical examination, laboratory investigation, abdominal ultrasound, and magnetic resonance imaging.

Results:

Almost all patients (198, 95.2%) treated with the PAIR technique and 55 patients (93.2%) treated with the laparoscopic approach were cured. Six patients (2.8%) from the echo-guided puncture group had to undergo a repeat of the procedure because the cavity did not disappear after 2 years. In 4 patients (2%), we performed open surgery for 2 biliary fistulas and 2 hepatic abscesses. Four patients from the laparoscopic group needed additional procedures. Open surgery was necessary in 2 patients for a recurrence after 2 years; 1 patient had developed a liver abscess and the other had a biliary fistula.

Conclusions:

In conclusion, open surgery remains the viable option for complicated cysts, with biliary communication, with multiple daughter vesicles, or with calcified walls. For simple, uncomplicated hydatid cysts, both methods (the PAIR technique and laparoscopic procedure) are safe and efficient, with very good results and low morbidity rates.     

Thoracic Myelopathy Secondary to Intradural Extramedullary Bronchogenic Cyst

Background/Objective:

To report a case of thoracic myelopathy secondary to intradural extramedullary bronchogenic cyst.

Study Design:

Case report.

Methods/Findings:

A 20-year-old man presented to the emergency department with increasing back pain and lower-extremity weakness. Magnetic resonance imaging demonstrated a cystic lesion at the T4 level with mass effect on the spinal cord.

Results:

The lesion was resected, and histopathologic evaluation showed a cyst lined by respiratory-type epithelium consistent with a bronchogenic cyst.

Conclusions:

Intradural extramedullary bronchogenic cysts of the thoracic spine have been reported previously but are extremely rare. The treatment of choice is surgical resection.     

The management of liver hydatid cysts by percutaneous drainage.

Objective

To investigate the effect of percutaneous drainage on liver hydatid cysts.

Design

A retrospective case study.

Setting

Department of Surgery, Selçuk University, Konya, Turkey.

Patients

Forty-five patients with 83 liver hydatid cysts (types I and II according to the classification of Gharbi and colleagues) followed up for a mean of 30 months (range from 14 to 36 months).

Intervention

The cysts were drained percutaneously with ultrasonographic guidance and then irrigated with 0.05% silver nitrate solution through a fine needle. Albendazole was administered 48 hours before percutaneous drainage and for 2 months after the procedure to prevent the implantation of spilled scolices.

Main outcome measures

Complications of the procedure, decrease in size of the cyst cavity, recurrence and dissemination of the cysts.

Results

All the cysts were treated successfully by percutaneous drainage. Anaphylactic shock developed in 1 (2.2 %) patient, and mild allergic reactions were observed in 2 (4.4 %) patients during the interventional procedure. Follow-up ultrasonography and CT demonstrated a statistically significant (p < 0.01) decrease in the mean cyst size. Recurrence and dissemination were not observed during the follow-up period.

Conclusion

Percutaneous fine-needle aspiration and drainage is effective for managing cystic liver hydatid disease in selected cases.     

Paraovarian Cysts of Neoplastic Origin Are Underreported

Introduction:

We suspected that paraovarian cysts of neoplastic origin may be underreported. This study was designed to evaluate our data on the pathologic characteristics of cystic lesions located in the paraovarian area and compare them with previous studies that claimed the vast majority of these lesions were simple paraovarian cysts and only few (1.69% to 5%) were neoplastic ones.

Methods:

This is a retrospective analysis of the clinical, surgical, ultrasonographic, and pathologic features of 59 women operated on for cystic paraovarian lesions at our institution from January 2002 to April 2006.

Results:

Forty-four women (74.6%) had simple paraovarian cysts, and 15 (25.4%) had benign neoplastic paraovarian cysts (7 cystadenomas and 8 cystadenofibromas). There were no cases of malignant tumor. There was no difference in the clinical presentation of the women with either type of cyst. Preoperative ultrasound examinations (n=50) demonstrated more complex cysts with internal papillary projections in the group with neoplastic paraovarian cysts (41.7% compared with 7.9%, P=0.01). The macroscopic pathologic examinations revealed a significantly increased percentage of gross papillary excrescences in the group of neoplastic paraovarian cysts (10/ 15, 66.7%) compared with the group with simple paraovarian cysts (3/44, 6.8%, P<0.01). Other pathologic features did not differ between the 2 study groups.

Discussion:

Our analysis revealed a higher percentage of paraovarian cysts of neoplastic origin (∼25%) than the figures quoted in most previous reports.

Conclusion:

Intraoperative inspection for diagnosing the cyst type and more frequent use of endobag devices to avoid spillage of cystic fluid are recommended.     

Guillain-Barr�� Syndrome and Postbariatric Surgery Polyneuropathies

Background:

Postbariatric surgery poly-neuropathies (BSP) are infrequent events. However, with the number of gastric bypasses performed each year increasing, the incidence of BSP is expected to increase as well. The long-term sequelae of BSP worsen with delays in diagnoses. Therefore, early evaluation, recognition, and treatment are important in minimizing morbidity and mortality.

Methods:

We present the case report of a patient who developed a poly-neuropathy after a laparoscopic Roux-en-Y gastric bypass.

Results:

The patient''s symptoms were ultimately determined to result from Guillain-Barré syndrome. Symptoms resolved with proper treatment.

Conclusion:

Characteristic differences exist between the various surgery poly-neuropathies. With proper evaluation, this determination will aid in prompt and appropriate treatment and will prevent morbidity and mortality.     

Kienbock��s disease in a varsity football player: a case report and review of the literature

Objective:

To present the diagnostic, clinical features, and management of Kienbock’s disease and create awareness of the differential diagnosis of this condition in patients presenting with insidious, progressive dorsal wrist pain.

Clinical Features:

A 23-year old male varsity football player presented with insidious progressive dorsal sided wrist pain with reduced wrist flexion and extension. A diagnosis of Kienbock’s disease was made based on radiographs and magnetic resonance imaging.

Intervention and Outcome:

A 3mm ulnar-minus variance was found and a joint leveling procedure to shorten the radius was performed. Conservative therapy was provided pre and post surgical management.

Summary:

This case report demonstrates the importance of findings on radiographs, MRI, and clinical examination in the accurate diagnosis and management of a patient with wrist pain.     

Case report of rare chronic myelogenous leukemia related multibacterial splenic abscess presenting with scrotal swelling

INTRODUCTION

Splenic abscesses associated with leukemia are rare. Most reported cases of splenic abscesses occur after chemotherapy and are related to the immunosuppressive effects of the chemotherapy. Their etiology is most frequently fungal.

PRESENTATION OF CASE

A 58-year-old male presented with splenomegaly and scrotal swelling secondary to a multibacterial splenic abscess which required a splenectomy. Upon investigation he was found to suffer from chronic myeloid leukemia (CML) and epididymitis.

DISCUSSION

Splenic abscesses are rarely found in leukemic patients. Reported cases are fungal and commonly occur after chemotherapy due to immunosuppression. Scrotal swelling with concurrent splenomegaly can be found in other pathologies including brucellosis, Lyme disease and even non-Hodgkin primary testicular lymphoma. Scrotal swelling in our case was likely secondary to epididymitis and exacerbated by the effects of splenomegaly upon the systemic circulation promoting venous congestion.

CONCLUSION

This case illustrated an unusual presentation of CML because the patient presented with splenomegaly, a multibacterial splenic abscess, and scrotal swelling.     

Biocompatibility of Ricinus communis polymer with addition of calcium carbonate compared to titanium. Experimental study in guinea pigs

Objective

The aim of the present investigation was to determine whether the difference in inflammatory tissue reaction between the Riccinus communis (castor) polymer with calcium carbonate and the titanium implant is statistically significant.

Methods

Thirty-two Cavia porcellus were allocated into four groups of eight animals each. We implanted the two types of materials in the retroperitoneal space of all the animals. They were euthanized at 7, 20, 30 and 40 days after surgery, and an histological study of the samples was conducted.

Results

All implants showed characteristics of chronic inflammation regardless of the material and timepoint of evaluation. There was no statistically significant difference between Pm+CaCO₃ and Ti with regard to the presence of granulation tissue, tissue congestion, histiocytes, lymphocytes, neutrophils, giant cells, and fibrosis (P> 0.05).

Conclusion

The castor oil polymer plus calcium carbonate implant was not statistically different from the titanium implant regarding inflammatory tissue reaction.