Laparoscopic fenestration of a simple hepatic cyst

Hepatic cysts are usually asymptomatic, most being detected incidentally during imaging. Distinction has to be made between a simple hepatic cyst from more sinister types such as a parasitic cyst and a cyst occurring as part of a neoplastic process. Intervention in a simple hepatic cyst is only indicated when they become symptomatic or when they grow at a rapid rate. Surgery is the mainstay of treatment, with laparoscopic intervention becoming more and more widely accepted. We present here the first case of laparoscopic fenestration of liver cyst performed in our hospital and also review the literature on this modality of treatment.     

Gonorrhea screening. Comparison of three techniques

A total of 1,336 men were screened for gonococcal urethritis by one or more of three techniques: Gram-stain smears, urethral cultures, and cultures of first-voided urine (FVU). The sensitivity of these techniques in a group of 113 symptomatic patients was 99.1%, 98.2%, and 95.6%, respectively. In a group of 248 asymptomatic men, FVU cultures yielded a positivity rate of 2.4%, comparable to the 2.8% obtained with urethral cultures. In view of the reduction in time, cost, and patient discomfort associated with the use of FVU cultures, it appears to be a valuable diagnostic technique for asymptomatic gonococcal urethritis.     

成人纵隔支气管囊肿的外科治疗—附10例报告

纵隔支气管囊肿是一种先天性纵隔前肠畸形。发生率不高,临床少见。术前常不易确诊。我院自1962年至1988年共收治纵隔肿瘤及囊肿376例,其中纵隔支气管囊肿10例,均经手术治疗及病理证实。本文报告此10例的临床表现、诊断及治疗。     

Carbon dioxide laser excision of a big epiglottic cyst

Epiglottic cyst is usually asymptomatic and the commonest presentation is foreign body sensation in the throat. Treatment of epiglottic cysts depends on their size and on the clinical symptoms. Surgery is necessary for large ones. Various modalities of therapy include endoscopic excision, marsupialization and deroofing with or without a carbon dioxide laser. We report our experience of managing a case of a large epiglottic cyst with a carbon dioxide laser.     

Laboratory diagnosis in the problem of suspected gonococcal infection.

Proper laboratory techniques are indispensable for the diagnosis and detection of gonorrhea. While the smear is efficacious in diagnosing symptomatic urethral gonorrhea in men, it is not reliable for cervical, rectal, pharyngeal, or asymptomatic urethral infection. We have seen the development of four systems of culturing geared toward the office practitioner or where a complete laboratory is not available. They are as follows: Transgrow (transport), Neigon JEMBEC (transport or nontransport), Isocult, and Microcult systems. The Neigon JEMBEC system offers a good choice for the office practitioner. The use of proper diagnostic and culturing techniques and routine screening should bring about an increase in the amount of gonorrhea detected, treated, and subsequently removed from the reservoir of infection.     

腔镜下尿道成型术治疗后尿道断裂2例报告及文献复习

目的：探讨腔镜下尿道会师术治疗男性尿道损伤的手术时机、方法和疗效。方法：2006年3月至6月男性骨盆骨折创伤失血性休克并后尿道完全断裂2例，均经一期耻上膀胱造瘘，一周后自尿道外口、耻上膀胱造瘘孔行膀胱镜下后尿道断裂会师术。结论：2例均获得成功。结论：腔镜下尿道会师术治疗男性尿道损伤，只需膀胱造瘘单孔辅助。手术器械简便，手术方法简单，伤后一周手术，获得与一期手术同样效果。     

Persistent cloaca presenting with a perineal cyst: Prenatal ultrasound and magnetic resonance imaging findings

A 40-year-old, primigravid woman presented at 23 weeks of gestation for evaluation of an extra-abdominal echogenic cystic mass of the fetus. Amniocentesis revealed a karyotype of 46,XX. Prenatal ultrasound showed a two-vessel umbilical cord, hydrocolpos, and distended bladder, urethra, and colon, and a perineal cystic mass. The kidneys and amniotic fluid amount were normal. Fetal magnetic resonance imaging revealed ascites, hydrocolpos, distended urinary bladder and colon, high rectum, and a perineal cyst. The fetus postnatally manifested persistent cloaca. The perineum was distended and smooth, without patent anal, vaginal, and urethral openings. The external genitalia were ambiguous with no labia majora, labia minora, or clitoris. The perineal cyst had a very small single orifice. We suggest that cloacal anomalies be considered in any female fetus with hydrocolpos, distended bladder and colon, ascites, and a perineal cyst.     

连接酶链反应检测男性就诊者尿标本中的沙眼衣原体

OBJECTIVE: To determine the sensitivity and specificity of ligase chain reaction (LCR) for detection of Chlamydia trachomatis (C. trachomatis) in the urine of symptomatic and asymptomatic men. METHODS: C. trachomatis was detected by LCR in both first-void urine (FVU) and urethral swab cultures from 852 randomly selected male outpatients seeking medical attention for sexually transmitted diseases. In cases with discrepancy between the results yielded by the two methods, a second LCR directed against a gene fragment encoding the major outer membrane protein was performed. The results were evaluated on the basis of an expanded gold standard. RESULTS: The sensitivity and specificity was 98.6% and 99.4% with LCR, respectively, and was 77.4% and 99.5% with urethral swab culture. The sensitivity of LCR was much higher than that of urethral swab culture P<0.001 .The presence or absence of urethral symptoms did not show any influence on the results. CONCLUSION: LCR is sensitive and specific for detecting C. trachomatis infections, and FVU can be used for non-invading diagnosis and screening of the infection in men.     

巨大上皮性脾囊肿

Splenic cysts are unusual in daily surgical practice and less than 1000 cases have been reported. Primary, true or epithelial splenic cysts, are even rarer. Usually, most of the cysts are asymptomatic until of significant size, at which time they are then detected incidentally on ultrasonography or CT scan. We report a case of a 25-year-old woman with giant epithelial splenic cyst with about 3000 ml of clear-yellow fluid was collected from the cyst. The splenectomy specimen measured 205 mm×192 mm×137 mm and weighed 4000 g.

     

Incomplete urethral duplication in an adult male

Introduction

Urethral duplication is a rare congenital anomaly with less than 200 cases reported. It predominantly occurs in males and is nearly always diagnosed in childhood or adolescence. It is defined as a complete second passage from the bladder to the dorsum of the penis or as an accessory pathway that ends blindly on the dorsal or ventral surface.

Methods

We present the case of a 54-year-old patient with incomplete urethral duplication.

Discussion

Urethral duplication commonly occurs in the sagittal plane with one urethral channel lying dorsal to the other. Symptoms vary from completely asymptomatic to urinary incontinence which can lead to a mucopurulent discharge from a low grade urinary tract infection. Other symptoms include double stream (most common complaint) and intermittent urinary discharge.     

Low risk of invasive amebiasis in cyst carriers. A longitudinal molecular seroepidemiological study.

A seroepidemiological study of a household cohort, using both clinical observational and molecular criteria was conducted in a periurban area endemic for E. histolytica infection. This longitudinal study was undertaken to determine the risk of asymptomatic cyst carriers to develop invasive illness. Zymodeme patterns of strains isolated from these patients were correlated both with the clinical presentation of disease and with the serological response against the M-17 ameba antigen and further compared with that found in 16 proven cases of amebic liver abscess. From a total of 163 housewives screened, 39, (24%) were asymptomatic cyst carriers; 31 of them (index cases) and 114 members of their households remained in the study over an 8 month follow-up period to detect ameba infection and illness. Of the household members at risk, 46 (40%) became infected within 6 weeks. None of the index or secondary cases developed ameba-related symptoms and cyst excretion followed a chronic persistent, intermittent, or transient pattern over the period of the study. Amebas were recovered and zymodemes determined in 19 of 71 (27%) cyst carriers. Ameba shed from each of these 19 carriers exhibited nonpathogenic zymodeme 1, except for one index case where zymodeme 2 was recovered in one sampling, and returned to zymodeme 1 in subsequent samples. Of 48 of 71 cyst carriers studied, antibodies to crude E. histolytica antigen were detected by ELISA in 16 (31%); antibodies to the M-17 fusion protein were found in 8 (16%) by ELISA and in 2 (4%) by Western-Blot (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males

We evaluated the ability of the urinary leukocyte esterase test to predict culture-verified chlamydial and gonococcal urethritis among asymptomatic adolescent males. Nine hundred forty-eight sexually active males provided first-catch urine samples for esterase screening, and 76 (8%) tested positive (greater than or equal to 1+). Among 435 boys who agreed to undergo urethral culture, the esterase was positive in 66 (15%), Chlamydia trachomatis was isolated from 39 (9%), and Neisseria gonorrhoeae was isolated from 14 (3%). The sensitivity, specificity, and positive and negative predictive values for the esterase test were 72%, 93%, and 58% and 96%, respectively. Using the esterase test to screen asymptomatic males for urethritis, we identified 38 culture-verified infections that otherwise would have remained undetected. The urinary leukocyte esterase test is a noninvasive and cost-effective screening method to detect urethritis among asymptomatic adolescent males.     

滤纸干血滴间接荧光抗体试验法诊断阿米巴病的研究

作者于1985年7月～1987年10月,用滤纸干血滴作间接荧光试验诊断31例阿米巴肝脓肿,13例阿米巴痢疾和15例阿米巴包囊携带者,其阳性率分别在100％,69.23％和33.3％,无假阳性和交叉反应。与血清比较无明显差异。该方法诊断阿米巴肝脓肿有较高的特异性、敏感性和重复性。     

Precoccygeal epidermal inclusion cyst presenting as coccygodynia

Although there are numerous aetiologies for coccygodynia described in the medical literature, precoccygeal epidermal inclusion cyst presenting as a coccygodynia has not been reported. We report a 30-year-old woman with intractable coccygodynia. Magnetic resonance imaging showed a circumscribed precoccygeal cystic lesion. The removed cyst was pearly-white in appearance and contained cheesy material. Histological evaluation established the diagnosis of epidermal inclusion cyst with mild nonspecific inflammation. The patient became asymptomatic and remained so at two years follow-up. This report suggests that precoccygeal epidermal inclusion cyst should be considered as one of the differential diagnosis of coccygodynia. Our experience suggests that patients with intractable coccygodynia should have a magnetic resonance imaging to rule out treatable causes of coccygodynia.     

中枢神经系统囊虫病(1400例临床研究)

本文分析了1400例脑囊虫病,男性1064例,女性336例,青壮年(31—45岁)最多(62.6％)。根据我国分型标准:癫痫型561例,蛛网膜下腔型129例,脑实质型184例,脑室型102例,混合型419例,无症状型5例。癫痫发作是最常见的症状。囊虫性脑膜炎或蛛网膜粘连预后最差。少数可表现为缺血性卒中、脑炎、单纯头痛或单发巨大囊肿。CT扫描是目前最有效的诊断手段。吡喹酮治疗本病有效,本组有效率为64.4％,个别颅压增高患者可造成致死性副作用,值得警惕。     

Adrenal cyst

Adrenal cysts are rarely seen lesions. Most are asymptomatic and less than 10 cm. Adrenal cysts, most of which are diagnosed incidentally, can be diagnosed more by wide usage of diagnostic imaging methods. Symptoms appear when they grow to a large size causing pain or gastrointestinal disturbance or become palpable. In this article, a case of a large left adrenal cyst, 12 cm diameter was causing abdominal pain in a 20-year-old female patient subsequently removed totally by surgical excision with adrenalectomy is presented and treatment modalities was discussed.     

Stricture urethra: aetiology and management

Seventy-four male cases of stricture urethra, in all age groups up to 70 years were studied with regard to the aetiology of stricture, clinical presentation, investigations and treatment in Medical College Hospitals, Calcutta during June 1984 to May 1986. Depending on the site of affection and the aetiological consideration the treatment consisted of meatal dilatations, meatotomy, urethral dilatation and various methods of urethroplasty. Sixty-seven patients could be rendered asymptomatic. Traumatic strictures specially of the anterior urethra was found to have a better prognosis. Preventive aspects like gentle urethral instrumentation, use of appropriately sized catheters made of non-reactive material and referral of patients with stricture urethra to urological centres were stressed upon.     

Oesophageal duplication cyst: an unusual cause of retrosternal pain and dysphagia in an adult

Oesophageal duplication cysts in adults are a rare entity and are mostly asymptomatic. We describe the imaging findings in a rare case of oesophageal duplication cyst simulating cold abscess, causing retrosternal pain and dysphagia in a 25-year-old man.     

Ultrasound biomicroscopy in the diagnosis of a primary peripheral iris cyst

A primary peripheral cyst behind the iris is difficult to detect during a routine slit lamp examination. It is usually asymptomatic unless the cyst is sufficiently large. We report on a 73-year-old woman who underwent phacoemulsification of a cataract and incidentally presented a small dark mass behind the peripheral iris. The lesion was initially suspected of being a melanoma, but it could not be localized by conventional techniques postoperatively. A diagnosis of primary iris cyst was not made until 1 year later when high-frequency ultrasound biomicroscopy (UBM) was employed. UBM displayed a distinct thin-wall cystic lesion (0.5 x 0.8 x 0.6 mm) with low internal reflectivity at the iridociliary sulcus of the inferotemporal quadrant. UBM allows good imaging access to a lesion behind the iris that is otherwise difficult to detect with traditional techniques.     

手术治疗颅内蛛网膜囊肿效果及适应证

目的 探讨颅内蛛网膜囊肿（ＩＡＣ）有效的手术方式和适应证。方法 比较不同时期５５例颅内蛛网膜囊肿手术适应证、术式及其效果的跟踪随访。结果 外侧裂ＩＡＣ２９例施行单纯囊肿－腹腔分流或囊壁部分切除的有效率６０％（３／５）,复发率４０％（２／５）;囊壁大部分切除加带蒂肌瓣附贴有效率为７８％（７／１０）,无复发。其他部位ＩＡＣ施行囊壁大部分切除有效率８２％（１４／１７）,显效率４１％（７／１７）,复发率２