Hilar biliary cysts in hepatic transplantation. Report of three symptomatic cases and occurrence in resected liver grafts

Hilar cysts are infrequent post-transplant biliary tract complications. Thirteen cases were discovered among 493 consecutive liver transplants (2.6 %). Three (0.60 %) were symptomatic (obstructive jaundice) while the other ten were found by systematically searching in the hilum in a series of 129 consecutive, resected grafts at retransplantation or autopsy (n = 54). Two types of cysts were detected: in eight grafts (1.6 %), these were blind unilocular cavities with viscid mucous content, located adjacent to the biliary tract anastomoses. These had been inadvertently created as a result of the sequestered remnant cystic duct after cholecystectomies and biliary tract reconstructions, where a double-barreled common duct and long cystic duct had been present in the donor liver. These mucoceles ranged from 0.5 to 5.5 cm in diameter (median 1.7 cm). The three symptomatic cases were diagnosed by imaging techniques 3.5 years after transplantation; however, this type of cyst was found as early as the 2nd month post-transplantation when detected in lost liver grafts. Five livers (1 %), lost between 5 months and 2.8 years post-transplantation, showed cystically dilated peribiliary glands, sometimes with multilocular, and occasionally multiple, cavities ranging from 0.5 to 2 cm in diameter (median 0.8 cm). This type of cyst was asymptomatic and located adjacent to the left, right, or common hepatic ducts. Threads were found near four cysts, suggesting that surgical injury may have been responsible for obstructing the neck of the glands. With the increasing number of long-term survivors of liver transplantation, unless preventive surgical methods are implemented, the number of symptomatic cysts of these origins can be expected to grow. Transplantation teams should, therefore, be aware of these potential causes of biliary tract complications. Received: 3 June 1997 Received after revision: 21 October 1997 Accepted: 19 November 1997     

The distribution of bone islands and juxta-articular bone cysts in the growing hand

Bone islands and juxta-articular bone cysts are relatively common incidental findings when X-rays are taken for other purposes. We have identified that the incidence of bone islands in the hands of asymptomatic children between the ages of 5 and 13 years is 3.8% and the incidence of cysts in the same population is 2.8%. Bone islands were most common in the scaphoid, whilst juxta-articular bone cysts were most common in the capitate. The age at which they appear has not been reported previously. This study first identifies their presence in the hands of children of age 10 years and 2 months (bone islands) and 10 years 0 months (juxta-articular bone cysts). Most of the lesions were already present on the first radiograph taken. New bone islands appeared in five cases between the ages of 13 years and 1 month and 15 years and 3 months. New juxta-articular bone cysts were observed to appear in five cases between the ages of 10 years 10 months and 15 years 0 months. No island or cyst changed in size during the review period.     

Oral cysticercosis: a collaborative study of 16 cases.

Cysticercosis is a potentially fatal parasitic disease that rarely involves the oral region in humans. This study includes 21 lesions seen in 16 Latin American patients. There were 8 men and 8 women, with an age range from 6 to 67 years (mean 33.6 years). Most cases appeared as asymptomatic submucosal nodules that resembled mucous cysts or benign mesenchymal neoplasms. Most were found in the tongue (11 cases), followed by buccal mucosa and the lower lip (4 cases each) and upper lip (2 cases). These were well circumscribed, and ranged in size from 1 to 2.5 cm in diameter. Typical histologic features of viable cysticerci were observed in 15 cases, and the presence of colloid degeneration and granular mineralization were detected in only 1 case. In all cases, simple surgical excision was sufficient to ensure complete removal of the lesions without postoperative complications. It is important to carry out a detailed study in every case, in order to exclude the presence of the parasite in other sites.     

结石性胆囊炎患者胆囊粘膜病变分析

目的　探讨结石性胆囊炎患者胆囊粘膜病变与临床的关系。方法　应用组织化学技术 ,对连续收集的 1 0 0例结石性胆囊炎患者的胆囊标本进行观察。按年龄和结石病史不同进行分组比较。结果　 53例粘膜上皮出现化生 ,1 9例出现不典型增生 ,其中重度不典型增生 2例。化生和不典型增生的发生率与患者的年龄、结石病史呈正相关。年龄大于 50岁、结石病史超过 5年 ,胆囊粘膜上皮化生和不典型增生的发生率明显增高。结论　结石是引起胆囊粘膜上皮化生和不典型增生的主要原因。年龄大于 50岁、结石病史超过 5年是胆囊癌发生的高危因素     

Treatment of mucous cysts of the toes

The outcome of surgically treated mucous cysts of the foot is poorly documented in the orthopaedic literature. This study reports on the treatment of mucous cysts of the toes by simple excision and joint debridement. This is in contrast to treatment of similar lesions in the fingers which is often treated by excision of the cyst, joint debridement, and rotational flap. Following this procedure on 15 patients (15 cysts), at a minimum of 2 years postoperatively, only one cyst had recurred at 9 months. All patients were satisfied by the cosmetic appearance of their toe. The authors reviewed the available literature on this condition and suggest that this method of treatment provides good functional and cosmetic results with a minimal rate of recurrence.     

影像引导下经皮穿刺注射甲基泼尼松龙及注射型硫酸钙治疗单房性骨囊肿

目的 探讨在影像引导下经皮双针注射甲基泼尼松龙及注射型硫酸钙治疗单房性骨囊肿的方法与疗效.方法 回顾性分析2006年10月至2010年8月治疗的单房性骨囊肿患者37例,男26例,女11例;年龄8～22岁,平均13.2岁.股骨近端病变5例,患者均有大腿近端酸痛、跛行等症状;肱骨近端病变32例,其中16例有上臂近端酸痛等症状,余16例无症状.术前均行X线、CT与MR检查.在"C"型臂X线机透视下将两枚穿刺针分别穿入囊腔内的近端与远端,欧乃派克造影确认两针相通,生理盐水反复冲洗后,注入甲基泼尼松龙120 mg及可注射型硫酸钙,直至囊腔完全充填.根据改良Neer X线评级标准对骨囊肿愈合进行评估.结果 术后住院1～3d,平均2.3d.术后每个月摄片复查,如连续2个月骨囊腔面积较前不再缩小则再次注射.37例患者中,6例注射2次,31例注射1次.注射后囊肿均愈合.改良Neer X线评级标准对骨囊肿愈合进行评估:术后3个月时随访37例,其中Ⅱ级6例,Ⅲ级8例,Ⅳ级23例;术后6个月时随访31例,其中Ⅱ级2例,Ⅲ级4例,Ⅳ级25例;术后24个月时随访26例,其中Ⅲ级3例,Ⅳ级23例;术后36个月时随访19例,均为Ⅳ级.结论 影像引导下经皮穿刺注射甲基泼尼松龙及注射型硫酸钙治疗单房性骨囊肿,具有创伤小、并发症少、术后恢复快等优点.

Abstract：

Objective To investigate the methods and therapeutic effects of image-guided percutaneous needle iniection of methylprednisolone and injectable calcium sulfate for simple bone cysts.Methods Thirty-seven patients with simple bone cysts from 0ctober 2006 to August 2010 were analysed retrospectively in our hospital,including 26 males and 11 females with the average age of 13.2 years(range,8-22 years).Five cases of proximal femus lesions,with proximal thigh pain,limp and other symptoms.Thirty-two cases of proximal humeral lesions,16 patients had proximal pain and other symptoms of upper arm,the other 16 cases were asymptomatic.Preoperative AP and lateral X-ray.CT and MRl were taken.Under the C-arm X-ray monitor.two needles were inserted into the proximal and distal of cysts respectively,Omnipaque contrast was iniected to confirm the two needles is interlinked,then repeated rinsing with normal saline,then 120 mg methylprednisolone and iniectable calcium sulfate were injected,till the cysts were full up.Patients after treatment were assessed according to modified Neer X-ray criteria.Resuits The average hospitalization was 2.3 days (range.1-3 days).X-ray was reviewed every month,additional injection was performed if bone cysts stopped decreasing for 2 consecutive months,iniection 2 times in 6 eases,and 31 cases were injected only once.After 3 months follow.up 37 cases,according to modified Neer X-ray criteria,6 eases regarded as grade Ⅱ,8 as grade Ⅲ,23 as grade Ⅳ;after 6 months,31 patients were followed up,including 2 cases as grade Ⅱ,4 cases as grade Ⅲ,25 as grade Ⅳ;after 24 months of follow-up 26 cases,3 as grade Ⅲ,23 as grade Ⅳ;after 36 months follow-up,19 cases were all grade Ⅳ.Conclusion Imaging-guided percutaneous iniection of methylprednisolone and inieetable calcium sulfate for simple bone cysts has demonstrated,with less trauma,lower complications incidence and quicker recovery.     

Mucoid cysts of the penile skin.

A study of 28 patients with mucoid cysts of the penile skin is reported. The lesions were seldom diagnosed correctly, either clinically or pathologically. The distinctive histologic features of the cysts include a lining of stratified columnar epithelium, often associated with intra-epithelial mucous cells and/or mucous glands. These cysts most likely arise from ectopic urethral mucosa sequestered in the penile skin during embryologic development.     

Surgical treatment of appendiceal mucocele

HYPOTHESIS: Clinical presentation of appendiceal mucocele is related to malignancy and can influence surgical approach. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: All cases of primary appendiceal mucoceles (simple mucocele, cystadenoma, cystadenocarcinoma) diagnosed between 1976 and 2000 were reviewed. There were 135 patients, 74 of whom were female. Mean age at diagnosis was 59 years. Mean follow-up was more than 6 years. INTERVENTIONS: A total of 129 patients underwent surgery, consisting of appendectomy (22 patients), right hemicolectomy (25 patients), or more extensive procedures (82 patients). MAIN OUTCOME MEASURES: Clinical, diagnostic, and surgical variables were statistically compared with postoperative morbidity and mortality and the presence of malignancy. P<.05 was considered significant. RESULTS: The presence of symptoms was associated with malignancy (58% vs 15%, P<.001), particularly abdominal pain (56% vs 29%, P =.005) and weight loss (77% vs 31%, P =.002). Abdominal mass was also associated with malignancy (86% vs 25%, P<.001). Moreover, pseudomyxoma peritonei and mucocele extravasation were associated with malignancy (95% vs 13%, P<.001, and 83% vs 15%, P<.001, respectively). The lesion size was not associated with malignancy; however, cystadenomas were significantly larger than simple mucoceles (8.1 cm vs 4.1 cm, P<.001), and no cystadenoma was less than 2 cm in largest diameter. CONCLUSIONS: A number of clinical, diagnostic, and intraoperative findings are associated with malignant mucoceles. All mucoceles greater than 2 cm should be excised to remove premalignant lesions.     

乳房缩小术与乳房上提术后切口皮脂腺囊肿产生原因及预防

目的探讨乳房缩小整形术及乳房上提术后,切口皮脂腺囊肿的形成原因以及预防措施。方法 2004年5月至2007年5月,接受乳房缩小术及乳房上提术的患者60例,随机分为A、B两组。A组手术中去表皮厚度不超过真皮的1/3厚度,B组切除几乎全层真皮,对比两组术后出现切口皮脂腺囊肿情况。结果术后随访2～4年,A组中有4例术后出现切口皮脂腺囊肿(13.3%),B组中未出现切口皮脂腺囊肿。两组中均无病例出现乳头乳晕血运障碍。结论在乳房缩小整形术和乳房上提术中增加去表皮的厚度,可以减少术后出现切口皮脂腺囊肿的发生率,且不会影响乳头乳晕的血运。     

Endoscopic excision for postrhinoplasty mucous cyst of the nose.

Mucous cysts formation following a rhinoplasty is a rare complication. Only 16 cases have been reported. The cysts seem to arise from mucosal remnants left in the subcutaneous layer and must be distinguished from other complications causing postoperative swelling of the nose, such as foreign body, paraffinoma and bony or cartilagineous fragments. We describe two cases of dorsal mucous cysts following rhinoplasty, provide a review of the concerning literature and discuss the removal of the lesions by nasal endoscopy. Nasal endoscopy allows excellent exposure of the operative field, without the need of open rhinoplasty technique, allowing fast healing, minor swelling and no external scar.     

Management of anterior cruciate ligament lesions: surgical fashion, personal whim or scientific evidence? Study of medium- and long-term results.

The medium- and long-term results of conservative and surgical treatment of ACL lesions were evaluated by analysis of the current literature. Only reports with a minimum follow-up of 4 years were taken into account. Concerning conservative treatment, the literature search revealed only 7 papers with a total of 636 cases. Reports on the results of surgical treatment were separated into four categories: primary repair, with 13 papers (1205 cases), extraarticular tenodesis, with 4 papers (232 cases), ACL reconstruction, with 26 papers (2693 cases) and ACL prosthetic replacement (reconstruction using synthetics) with 5 papers (370 cases). The mean functional scores show about 70% good and excellent results for all treatment regimens. Clinical laxity persists in almost all conservatively treated cases, in almost half of the cases with primary repair, extra-articular tenodesis, and synthetic substitution, and in almost one-third of the cases with ACL reconstruction. The incidence of secondary ACL surgery was lowest in the conservative group (4.6%), whereas secondary meniscus surgery was lowest in the ACL reconstruction group (3.5%). Compared with the conservative group (12%), surgical treatment evolved to a higher osteoarthritic morbidity. Sports participation was higher in the ACL reconstruction group. This analysis may provide a more realistic view on the outcome of treatment of ACL lesions, and on the relationship between treatment, activity level and osteoarthritis.     

Differenzialdiagnose einer Mundbodenschwellung

Epidermoid cysts are malformations that are rarely observed in the oral cavity. Histologically, these cysts may be further classified as epidermoid, dermoid, or teratoid depending on the stratified epithelium. We report the case of an 11-year-old girl who had developed an epidermoid cyst over a period of 4 years, which presented as a soft, painless left-sided sublingual swelling without mucosal lesions. Imaging revealed a cystic formation with a central concrement. The lesion was surgically excised via an intraoral approach and after histological examination was diagnosed as an epidermoid cyst. Differential diagnoses for epidermoid cysts include infections, tumors, mucous extravasation, and sialolithiasis or sialoadenitis of the sublingual gland. If tumors are excised completely recurrence is very rare. In cases of postoperative saliva retention with recurrent inflammation of the salivary gland, submandibulectomy is indicated.     

Effect of age on the results of surgical treatment of cancer of the gallbladder

The aim of the study was to define the influence of age on the surgical treatment of cancer of the gall bladder. From a population of 731 patients: 104 were over 80 years (14%) and 230 were between 70 ant 80 years (32%). The histological stages T1, T2, T3, T4 were also distributed throughout the various age groups. There were however significantly more in situ lesions before the age of 70 years than after. The incidence of resection was similar in the various age groups but extended right hepatectomy was only carried out in patients under 70 years. The mortality rate was low for patients who underwent surgery for lesions graded Tis, T1 and T2. High survival rates were only obtained in the Tis and T1 patient groups. T2 grade cancers had a significantly improved prognosis when resection was carried out. Duration of survival after bilio-intestinal anastomosis was very short regardless of the age of the patient. In summary, age did not appear to constitute a contraindication to resection for early lesions, but it did have an effect for the lesions graded T1, T2, on the degree of hepatic resection around the gall bladder. Lesions graded Tis were all treated by simple cholecystectomy regardless of age. Patients with T3 or T4 lesions did not benefit from resection, regardless of age, and in these cases the value of bilio-intestinal anastomosis is debatable.     

Discal cysts

Discal cysts are rare lesions that can result in refractory sciatica. Because they are so rare, their exact origin and details of the clinical manifestations are still unknown. The authors report on five men treated for discal cysts. The mean age of the patients at the time of the surgery was 32 years (range 25-38 years). All patients suffered from lower-extremity pain and the results of the straight leg-raising test were positive in all cases. Three patients reported motor weakness and four had sensory disturbance--symptoms similar to those found in patients with lumbar disc herniation. Magnetic resonance imaging demonstrated spherically shaped extradural lesions of various sizes with low and high signal intensities on T1- and T2-weighted images, respectively. Discography revealed obvious communication between the cyst and the intervertebral disc with reproducible leg pain in all patients. All patients underwent posterior decompression and excision of the cysts either with or without additional discectomy. The radicular symptoms were remarkably improved in all patients immediately after surgery, and no recurrent lesions were noted during follow up.     

Discal cysts of the lumbar spine. Report of five cases

Discal cysts are rare lesions that can result in refractory sciatica. Because they are so rare, their exact origin and details of the clinical manifestations are still unknown. The authors report on five men treated for discal cysts. The mean age of the patients at the time of the surgery was 32 years (range 25-38 years). All patients suffered from lower-extremity pain and the results of the straight leg-raising test were positive in all cases. Three patients reported motor weakness and four had sensory disturbance-symptoms similar to those found in patients with lumbar disc herniation. Magnetic resonance imaging demonstrated spherically shaped extradural lesions of various sizes with low and high signal intensities on T1- and T2-weighted images, respectively. Discography revealed obvious communication between the cyst and the intervertebral disc with reproducible leg pain in all patients. All patients underwent posterior decompression and excision of the cysts either with or without additional discectomy. The radicular symptoms were remarkably improved in all patients immediately after surgery, and no recurrent lesions were noted during follow up.     

肝囊肿腹腔镜开窗引流术后复发原因的探讨

目的探讨肝囊肿腹腔镜开窗引流术后复发的原因. 方法回顾性总结1998年6月～2003年8月54例肝囊肿腹腔镜下开窗引流术的临床资料. 结果 52例随访1～6年,5例复发,复发率9.6%(5/52).3例由于囊肿位置特殊开窗过小,1例由于多发囊肿之间的透明隔未予切开,1例系多囊肝术后复发. 结论适应证选择不当、囊肿开窗过小、遗漏多发囊肿以及黏膜处理不当是导致复发的主要原因.     

Laparoscopic procedures in focal lesions of the liver

Seventy-three laparoscopic procedures were performed for the treatment of focal lesions of the liver. Fifty-four patients had operations for non-parasitic cysts of the liver and cystic disease. Polycystic disease of the liver was in 8 patients. Multiple cysts were in 19 patients, solitary - in 27. A total of 139 cysts were treated. Surgery was performed with the standard technique. Atypical marginal resection of the liver was performed in 16 patients for hemangioma (n=8), nodular hyperplasia (n=2), hepatic metastases (n=5), hamartoma (n=1). Atypical marginal resection by type of peritumor resection was conducted in 5 cases, and it was similar to segmentectomy in 11 cases. Laparoscopic cryodestruction of benign tumors and hepatic metastases was performed in 3 patients including in combination with atypical marginal resection in 2 cases. There were no intrasurgical complications which required laparotomies. There were no hemotransfusions. Long-term results were followed-up from 1 to 3 years in 25 patients with hepatic cysts and from 3 months to 3 years in 7 patients after marginal resection for hemangiomas and fibronodular hyperplasia. Ultrasonic examination revealed no recurrences of the disease.     

经皮自体骨髓注射治疗单纯性骨囊肿疗效评价

目的评价经皮自体骨髓注射治疗单纯性骨囊肿的疗效，探讨影响疗效的相关因素。方法2000年3月～2005年6月收治单纯性骨囊肿患儿并获随访31例，男18例，女13例。年龄5岁7个月～15岁，平均9岁6个月。肱骨近端18例，股骨近端7例，肱骨干2例，腓骨近端、股骨远端、胫骨远端及跟骨各1例。活动期13例，静止期18例。其中植骨术后复发2例，类固醇注射5次未愈合1例。合并病理性骨折19例。患儿均先抽去囊液后，注入从髂后上棘吸取的骨髓，平均注入骨髓40ml（30～70m1）。结果术中及术后无并发症发生。31例获随访1～5年，平均2．2年。经1次注射后囊腔完全愈合9例，占29．0％；基本愈合7例，占22．6％；部分愈合5例，占16．1％；未愈合8例，占25．8％；无效2例，占6．5％。骨囊肿静止期与活动期疗效差异有统计学意义（P〈0．05）；5～8岁年龄段与9～15岁年龄段、骨髓增生活跃组与增生明显活跃组、肱骨近端病灶与股骨近端疗效比较，差异均无统计学意义（P〉0．05）。结论经皮注射自体骨髓治疗单纯性骨囊肿安全、有效，但1次注射疗效有限，部分需多次注射；静止期疗效优于活动期。     

Laparoscopic liver surgery: analyze the experience on 36 cases

We analyze the experience in laparoscopic liver surgery in the Department of General Surgery and Liver Transplantation of Fundeni Clinical Institute between september 1998 and march 2003. This study includes 36 patients, 24 females (66.7%) and 12 males (33.3%) with ages between 25 and 67 and a mean age of 46 years. From the group of 36 patients with liver pathology considered for laparoscopic treatment 6 cases had multiple hepatic lesions with no preop diagnosis. The postoperative diagnosis was neoplasia in 4 cases, noncellular necrosis with chronic inflammation in one case and focal nodular hyperplasia in another case. The fenestration and drainage were used as laparoscopic treatment in case of 7 patients with nonparasitic liver cysts. Nine patients from our group had hydatid cysts. In 7 patients the treatment consisted in partial pericystectomy after inactivation and parasite evacuation. In 2 patients an ideal pericystectomy was performed for cysts located in segments II and III. The solid lesions selected for laparoscopic treatment were in 3 cases benign symptomatic tumors with no preoperative diagnosis, in 9 cases symptomatic hemangioma and in 2 cases malignant lesions. From these 14 patients in only 2 cases the lesions were located in the right antero lateral segments. Only in the case of metastasis a left lateral sectorectomy was performed, in all other cases a nonanatomical resection being performed. Conversion to open surgery was necessary in 11.11% of cases (2 hemangioma, 2 partial pericystectomies) for bleeding control. In our study we had no mortality and 11.11% morbidity. The follow-up was available in all patients for a mean time of 18 months (10 to 36). A CT scan was made in all patients with solid lesions 6 months after surgery and an ultrasound examination in all other cases. All patients were nonsymptomatic at repeated reevaluations. We are now at the beginning of laparoscopic liver surgery and these results need to be confirmed. The benefits seem to be those of any miniinvasive surgery: reduced trauma to the abdominal wall, early mobilization, shorter hospital stay, better aesthetics.     

Juxtaphyseal aneurysmal bone cysts.

Aneurysmal bone cysts are benign primary or secondary lesions that commonly arise in long bones and often before skeletal maturity. Little has been written about aneurysmal bone cysts that abut the physeal plate. The records of 15 patients with juxtaphyseal aneurysmal bone cysts were reviewed. Fourteen of the patients were referred with abnormal radiographs after evaluation for pain in the affected limb. One patient presented with abnormal radiographs after fracture about the aneurysmal bone cyst. None of the patients had evidence of growth plate disruption. The children's ages ranged from 2 to 14 years, with a mean of 9.8 years. There were 10 boys and five girls. Lesion locations included: six in the proximal tibia, three in the distal fibula, two in the distal tibia, two in the proximal femur, one in the distal femur, and one in the distal radius. All of the lesions abutted the physeal plate and fell into one of the types in Campanacci's classification of juxtaphyseal aneurysmal bone cysts. Three lesions were classified as Type 1, eight were Type 2, and four were Type 3. This study included no cases of Type 4 or 5 lesions. Treatment of all lesions consisted of excision, curettage, and bone grafting with care taken to preserve the growth plate. Adjunctive cauterization was performed in two cases. There were no incidences of postoperative physeal plate arrest. Overgrowth of the fibula occurred in one patient. Three patients experienced recurrent lesions. One of the children underwent repeat curettage and bone grafting with no additional recurrence. In the other two children with recurrence, the lesion had grown away from the physeal plate while remaining static in size and asymptomatic. Based on this study, juxtaphyseal aneurysmal bone cysts may be treated satisfactorily with intralesional surgery and bone grafting with expectation of normal physeal growth.