Complications of renal cyst exploration versus renal mass aspiration.

This report presents a comparison of the complications of surgical exploration with unroofing and renal cyst puncture. Two hundred fifty-five patients were operated on, with a mortality rate of 1 per cent and a morbidity rate of 28 per cent. The complications in 63 patients examined by mass aspiration included a morbidity rate of 6.4 per cent and no mortality. The possibilities of over-looking carcinomas through cyst aspiration are weighed against the demonstrated morbidity of surgical exploration and found to be much less significant. The authors recommend that an asymptomatic renal mass that radiographically appears to be a cyst and is unaccompanied by urine changes or clinical stigmata of renal neoplasia be treated by cyst aspiration and not subjected to surgical exploration.     

Percutaneous renal cyst aspiration and treatment with alcohol

Twenty-two simple renal cysts of 16 patients were aspirated under guidance of ultrasound, with a 20-gauge needle with stylet. Sixteen of those cysts were treated with 96% alcohol. All cysts that were not treated with alcohol recurred within 10 weeks. Treatment with alcohol revealed no recurrences in 3 months follow-up for 12 patients and 6 months follow-up for 4 patients. No major complications were encountered.     

Laparoscopic treatment for renal hydatid cyst

A multivesicular hydatid cyst was removed from the left kidney of a 26-year-old woman by retroperitoneal laparoscopy to avoid contamination of the abdominal cavity. A scolicidal agent (20% hypertonic saline) was injected around the kidney initially and then instilled into the cyst after the contents had been evacuated. There were no complications and no anaphylactic shock. This appears to be the first reported case of treatment of renal hydatid cyst by laparoscopy.     

Multilocular renal cyst

A case of multilocular renal cyst histologically consistent with clear cell carcinoma is reported. This case is unusual in that the cyst had features indicative of a developmental malformation superimposed by a neoplasm. The controversy over the pathogenesis of multilocular cyst--neoplasm versus developmental anomaly--is unsettled. This case illustrates the possibility that multilocular cysts can be developmental defects which subsequently become the origin of neoplastic transformation of the dysgenetic tissue.     

Percutaneous renal cyst puncture

Ultrasound-guided renal cyst puncture was performed on 31 cysts which were then 95% ethanol instilled to prevent recurrence of cystic fluid. Ethanol was allowed to remain in place for 20 minutes and removed through the catheter. Morphological improvement was observed on IVP and Tc-99m-DMSA renal scintigram, and DMSA renal uptake rate increased slightly. The cystic wall became thicker, and cystic fluid did not remain any more. The renal tissue near the cyst was intact. One third of the patients had hotflush and/or somewhat drunken sense but these symptoms were only temporary. This method of therapy is a safe and effective way of treating renal cysts.     

Death from renal cyst

Simple renal retention cysts are the most common masses of the kidney, but rarely cause any clinical difficulty, are usually without attendant symptoms, generally posing only a differential diagnostic problem when discovered. However, renal cysts can predispose to hemorrhage, particularly in a setting of anticoagulation therapy. In this case, the patient died of massive hemorrhage from a small renal cyst while under anticoagulation treatment.     

Evaluation of fine-needle aspiration cytology for renal masses

OBJECTIVE: To evaluate the accuracy and use of fine-needle aspiration (FNA) cytology for the diagnosis of renal masses because with the improved quality and increasing use of ultrasonography and computed tomography (CT), asymptomatic renal masses, particularly small (< 5 cm) tumours, are being discovered more frequently. PATIENTS AND METHODS: Between 1995 and 1997, 49 patients (mean age 67.5 years, range 42-88, 34 men and 14 women) underwent FNA of a solid or complex cystic mass under radiological guidance. All masses were further evaluated and staged by CT. Solid masses were divided according to size (< 5 cm and >/= 5 cm). Patients were followed up to the determination of a final diagnosis on tissue histology, after nephrectomy where possible. RESULTS: Thirty-six patients had histologically confirmed carcinoma at nephrectomy, and nine had presumed carcinoma (four unfit for surgery, five with advanced malignancy). The remaining four patients had benign diagnoses. FNA produced insufficient sample in eight cases (16%). The sensitivity was 89% for large (>/= 5 cm) solid masses, 64% for small (< 5 cm) solid masses and 50% for complex cysts. CONCLUSION: FNA does not contribute to the diagnosis of malignancy in large (> 5 cm) masses, as good radiological imaging is nearly always diagnostic. For smaller (< 5 cm) masses and complex cysts, FNA can occasionally confirm malignancy, but lack of diagnostic yield and low sensitivity means that FNA is unreliable as a diagnostic tool and will rarely help in the routine management of these patients.     

Pitfall in renal cyst surgery: serous cystadenoma of pancreas mimicking renal cyst

Pancreatic lesions, particularly cysts, can simulate various diseases. We report a case of a 43-year-old woman with a large, symptomatic, retroperitoneal cyst misdiagnosed as a "renal cyst." During the retroperitoneoscopic marsupialization, the correct diagnosis of a pancreatic cyst was made, leading to an open pancreas tail resection. Histologic evaluation revealed serous cystadenoma. Especially in large retroperitoneal cysts on the left side, the correct diagnosis of a pancreatic cyst can be difficult.     

Massive aspiration during surgery for a hydatid cyst of the lung.

A case of massive aspiration of hydatid liquid during an operation for excision of hydatid cyst of the lung is presented. Some considerations about the treatment and the anaesthetic approach to the problem are given. An analysis of 42 operations performed during 1963-1973 in the Rambam Hospital is discussed. Rupture of cyst with cyanosis and fall in blood pressure occurred in only 5 of these cases and among them, only one patient died.     

Complications of renal cyst puncture

One hundred nineteen renal cyst punctures have been reviewed. There have been four complications (3.4 per cent), three requiring surgery. This should be expected, as all invasive diagnostic procedures core accompanied by some morbidity. The relative: benefit of nonoperative diagnostic procedures in differentiating benign renal cyst front adenocarcinoma is discussed.     

纤毛与肾囊肿性疾病

纤毛是一类古老的细胞器，早在1898年生物学家就在单细胞真核生物中观察到纤毛（鞭毛）结构，其后在多细胞哺乳动物体内发现纤毛结构广泛存在。纤毛和鞭毛是一组结构上高度保守并由微管蛋白为主构成的细胞器，两者名称在真核生物中常互相替代．差异仅体现在发挥功能的方式：鞭毛是通过对称性地波动，而纤毛则是通过非对称性地摆动——根部弯曲来实现。纤毛按其结构功能可分为运动纤毛和初级纤毛。运动纤毛由9＋2轴丝结构组成，分布于呼吸道上皮，脑室室管膜上皮，输卵管上皮及精子等，主要功能参与推动液体流动，