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World Journal of Gastroenterology Nov 2014In the last decades, the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards... (Review)
Review
In the last decades, the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions. Surgical procedures can be avoided in many cases by using endoscopically placed, Endoscopic ultrasonography-guided techniques and drainages. Endoscopic ultrasound enables the placement of transmural plastic and metal stents or nasocystic tubes for the drainage of peripancreatic fluid collections. The development of self-expanding metal stents and exchange free delivering systems have simplified the drainage of pancreatic fluid collections. This review will discuss available therapeutic techniques and new developments.
Topics: Drainage; Endoscopy; Endosonography; Humans; Necrosis; Pancreatic Pseudocyst; Pancreatitis, Chronic; Stents; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25473173
DOI: 10.3748/wjg.v20.i43.16191 -
Zhonghua Wai Ke Za Zhi [Chinese Journal... Apr 2018Pancreatic pseudocyst is the most common pancreatic cystic disease in clinical practice.In the surgical treatment of pancreatic pseudocysts, most surgeons preferred...
Pancreatic pseudocyst is the most common pancreatic cystic disease in clinical practice.In the surgical treatment of pancreatic pseudocysts, most surgeons preferred laparoscopic surgery in recent years.The options and the timing of laparoscopic surgery for pancreatic pseudocysts in different situations are explored in the paper.Pancreatic pseudocysts during the observation period, the imaging examination to detect whether the cyst has disappeared or increased, such as cysts found to be enlarged or still can not dissipate after 6 months, the largest diameter greater than 6 cm, and clinical symptoms, surgical drainage should be considered treatment.Surgery based on the location of the cyst and surgical experience of surgical options.Pancreatic cyst often choose laparoscopic cyst-gastric anastomosis, far from the stomach cyst should choose laparoscopic cyst-jejunal anastomosis.Laparoscopic surgery for the treatment of pancreatic pseudocyst has a unique advantage, short operation time, less bleeding, less trauma, less postoperative complications, rapid recovery, is a safe and effective treatment options.
Topics: Anastomosis, Surgical; Drainage; Humans; Laparoscopy; Pancreatic Pseudocyst
PubMed: 29562410
DOI: 10.3760/cma.j.issn.0529-5815.2018.E004 -
Histopathology May 2018Cystic lesions derived from the synovial and ligamentous structures of the spine have varied histological appearances. Not uncommonly, there is discrepancy between the...
AIMS
Cystic lesions derived from the synovial and ligamentous structures of the spine have varied histological appearances. Not uncommonly, there is discrepancy between the clinicoradiological diagnosis and histology. Therefore, we sought to characterise the histological features of tissue submitted as 'synovial cysts' of the spine.
METHODS AND RESULTS
Resected specimens of the spine labelled 'synovial cysts' and 'lumbar cysts' were histologically evaluated and classified on the basis of histopathological features. Seventy-five histological samples of spinal cysts were identified. Thirty-one were classified as synovial cysts (definite synovial lining), 28 showed pseudocystic degeneration of the ligamentum flavum, seven showed pseudocyst formation without evidence of a synovial lining or degeneration of the ligamentum flavum, and eight showed cyst contents only or no histological evidence of cyst wall for evaluation. Twenty-five cases (33%), especially those showing pseudocystic degeneration of the ligamentum flavum, were associated with very characteristic tumour calcinosis-like calcium deposition with a surrounding foreign-body giant-cell reaction.
CONCLUSION
Histology of 'synovial cysts' of the spine shows varied types of cyst; a large proportion are not synovial-lined cysts, but rather show pseudocystic degenerative changes of the ligamentum flavum, often associated with very characteristic finely granular calcifications and a foreign-body giant-cell reaction. This may have implications not only for understanding the pathogenesis of these lesions, but also for their varied responses to non-surgical interventions.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Spine; Synovial Cyst
PubMed: 29314220
DOI: 10.1111/his.13465 -
Abdominal Radiology (New York) May 2020Inflammation of the pancreas can present with a wide range of imaging findings from mild enlargement of the gland and surrounding infiltrative fat stranding through... (Review)
Review
Inflammation of the pancreas can present with a wide range of imaging findings from mild enlargement of the gland and surrounding infiltrative fat stranding through extensive glandular necrosis. Complications of pancreatitis are varied and include infected fluid collections, pseudocysts, and vascular findings such as pseudoaneurysms and thromboses. Cross-sectional imaging with computed tomography (CT) is one of the mainstays of evaluating patients with pancreatitis. New methods that allow novel visualization volumetric CT data may improve diagnostic yield for the detection of findings that provide prognostic information in pancreatitis patients or can drive new avenues of research such as machine learning. Cinematic rendering (CR) is a photorealistic visualization method for volumetric imaging data that are being investigated for a variety of potential applications including the life-like display of complex anatomy and visual characterization of mass lesions. In this review, we describe the CR appearance of different types of pancreatitis and complications of pancreatitis. We also note possible future directions for research into the utility of CR for pancreatitis.
Topics: Contrast Media; Humans; Imaging, Three-Dimensional; Pancreatitis; Severity of Illness Index; Tomography, X-Ray Computed
PubMed: 31696270
DOI: 10.1007/s00261-019-02310-x -
Journal of Clinical Gastroenterology Oct 2018Endoscopic ultrasound-guided transmural drainage using lumen apposing metal stents (LAMSs) is becoming a popular and promising therapeutic approach for drainage of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Endoscopic ultrasound-guided transmural drainage using lumen apposing metal stents (LAMSs) is becoming a popular and promising therapeutic approach for drainage of intra-abdominal fluid collections. There has been an increasing number of studies evaluating LAMS for drainage of pancreatic pseudocysts (PP), walled-off pancreatic necrosis (WOPN), and gallbladder (GB) drainage. The aim of this meta-analysis is to analyze the literature to date regarding the clinical success, technical success, and adverse events of LAMS in treatment of pancreatic fluid collections and GB drainage.
METHODS
A comprehensive search of multiple literature databases through November 2016 was performed. Human studies with at least 10 subjects that examined the clinical success, technical success, and adverse events of LAMS in treating PP, WOPN, and GB drainage were included.
RESULTS
A total of 993 patients (608-WOPN; 204-PP; 181-GB drainage) underwent drainage from 20 trials. For drainage of WOPN, the pooled technical success was 98.9% [95% confidence interval (CI): 98.2% to 99.7%] and clinical success was 90% (95% CI: 87% to 93%) (τ=0.001). For drainage of PP, the pooled technical success was 97% (95% CI: 95% to 99%) and clinical success was 98% (95% CI: 96% to 100%), (τ=0.001). For GB drainage, the pooled technical success was 95% (95% CI: 91% to 99%) and clinical success was 93% (95% CI: 90% to 97%), (τ=0.001). Total adverse events occurred in 11% of patients with higher complication rates observed in GB drainage. There was no evidence of publication bias in this meta-analysis.
CONCLUSIONS
Endoscopic ultrasound-guided transmural drainage using LAMS is becoming a widely accepted therapeutic approach for the treatment of PP, WOPN, and GB drainage with high clinical and technical success rates and acceptable adverse events. Further prospective randomized trials reporting long-term clinical efficacy and cost-effectiveness are needed to validate LAMS as a therapeutic modality for pancreatic and GB collections.
Topics: Drainage; Endosonography; Gallbladder; Humans; Pancreatic Diseases; Pancreatic Pseudocyst; Pancreatitis, Acute Necrotizing; Stents; Treatment Outcome
PubMed: 29016384
DOI: 10.1097/MCG.0000000000000934 -
Gastrointestinal Endoscopy Apr 2015
Review
Topics: Drainage; Endoscopy, Digestive System; Endosonography; Humans; Pancreatic Pseudocyst; Time Factors; Tomography, X-Ray Computed; Ultrasonography, Interventional
PubMed: 25805460
DOI: 10.1016/j.gie.2014.12.026 -
Parasitology Jul 2016Iron is an essential element for the survival of trichomonads during host-parasite interaction. The availability of this metal modulates several metabolic pathways of...
Iron is an essential element for the survival of trichomonads during host-parasite interaction. The availability of this metal modulates several metabolic pathways of the parasites and regulates the expression of virulence factors such as adhesins and proteolytic enzymes. In this study, we investigated the effect of iron depletion on the morphology and life cycle of Tritrichomonas foetus. Scanning and transmission electron microscopy analyses revealed that depletion of iron from the culture medium (named TYM-DIP inducer medium) induces morphological transformation of typical pear-shaped trophozoites into spherical and non-motile pseudocysts. Remarkably, inoculation of pseudocysts into an iron-rich medium (standard TYM medium), or addition of FeSO4 to a TYM-DIP inducer medium reverted the morphological transformation process and typical trophozoites were recovered. These results show that pseudocysts are viable forms of the parasite and highlight the role of iron as a modulator of the parasite phenotype. Although iron is required for the survival of T. foetus, iron depletion does not cause a cellular collapse of pseudocysts, but instead induces phenotypic alterations, probably in order to allow the parasite to survive conditions of nutritional stress. Together, these findings support previous studies that suggest pseudocysts are a resistance form in the life cycle of T. foetus and enable new approaches to understanding the multifactorial role of iron in the cell biology of this protozoan parasite.
Topics: Animals; Culture Media; Humans; Iron; Iron Deficiencies; Life Cycle Stages; Microscopy, Electron, Scanning; Microscopy, Electron, Transmission; Phenotype; Protozoan Infections; Tritrichomonas foetus; Trophozoites
PubMed: 27253439
DOI: 10.1017/S0031182016000573 -
Pediatric Surgery International Jun 2016There are insufficient data on pre-screening for pancreatic pseudocysts (PC) following pancreatic trauma. This study investigated the use of radiological and laboratory...
BACKGROUND
There are insufficient data on pre-screening for pancreatic pseudocysts (PC) following pancreatic trauma. This study investigated the use of radiological and laboratory testing for predicting the development of pancreatic pseudocysts after trauma.
MATERIALS AND METHODS
The clinical records of all pediatric patients presenting with pancreatic trauma between January 2003 and December 2014 were reviewed retrospectively. Patients with American Association for the Surgery of Trauma (AAST) scores of Grade 3-5 were enrolled. The patients were divided into groups that developed [Group 1 (n = 20)] and did not develop [Group 2 (n = 18)] PC. The patients were evaluated in terms of their baseline characteristics, additional injuries, Injury Severity Score (ISS), pancreatic injury site, blood amylase levels 2 h and 10-15 days after the trauma, clinical presentation, and duration of intensive care unit (ICU) stay.
FINDINGS
We followed 38 patients. Of the patients in Group 1, 70 % had an injury to the tail of the pancreas. The ISS trauma scores and durations of hospitalization and ICU stay were significantly greater in Group 2 (p < 0.05). The mean blood amylase level on Day 1 was 607 U/L (range 183-801 U/L) in Group 1 and 314 U/L (range 25-631 U/L) in Group 2; the respective levels on Day 10 were 838 U/L (range 123-2951 U/L) and 83.2 U/L (range 35-164 U/L). The serum amylase levels were significantly higher (p < 0.001) in Group 1 than in Group 2 on Days 1 and 10. Four patients developed complications and two patients died.
CONCLUSION
Pancreatic pseudocyst formation is more likely in patients with AAST Grade 3 pancreatic injury, also serum amylase levels ten times greater than normal 2 h after the trauma, and persistently elevated serum amylase levels 10-15 days following the trauma.
Topics: Abdominal Injuries; Adolescent; Child; Female; Humans; Injury Severity Score; Male; Pancreas; Pancreatic Pseudocyst; Retrospective Studies; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 26857478
DOI: 10.1007/s00383-016-3872-7 -
Facial Plastic Surgery : FPS Dec 2014An auricular pseudocyst is a benign cystic lesion of the auricular cartilage. When not recognized, it is a clinical presentation that can easily be misdiagnosed and... (Review)
Review
An auricular pseudocyst is a benign cystic lesion of the auricular cartilage. When not recognized, it is a clinical presentation that can easily be misdiagnosed and subsequently be mistreated leading to unsatisfactory esthetical results or disease recurrence. A patient was presented with bilateral pseudocysts, which were surgically excised. The aim of the treatment of a pseudocyst is to have recurrence-free resolution and to restore the original auricular architecture while removing the cystic lesion. Three alternatives to surgery are described in the literature and all seem not to be sufficient. When the pseudocyst is treated at an early stage, surgical excision shows high success rates and preservation of the auricular architecture. According to the success rate described in the literature combined with the preservation of the auricular architecture, we recommend surgical excision for the management of auricular pseudocysts.
Topics: Aged; Cysts; Ear Auricle; Ear Cartilage; Ear Diseases; Female; Humans
PubMed: 25536139
DOI: 10.1055/s-0034-1396528 -
Surgical Endoscopy Mar 2020Pancreatic fluid collections (PFC) may develop following acute pancreatitis (AP). Endoscopic and laparoscopic internal drainage are accepted modalities for drainage of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pancreatic fluid collections (PFC) may develop following acute pancreatitis (AP). Endoscopic and laparoscopic internal drainage are accepted modalities for drainage of PFCs but have not been compared in a randomized trial. Our objective was to compare endoscopic and laparoscopic internal drainage of pseudocyst/walled-off necrosis following AP.
PATIENTS AND METHODS
Patients with symptomatic pseudocysts or walled-off necrosis suitable for laparoscopic and endoscopic transmural internal drainage were randomized to either modality in a randomized controlled trial. Endoscopic drainage comprised of per-oral transluminal cystogastrostomy. Additionally, endoscopic lavage and necrosectomy were done following a step-up approach for infected collections. Surgical laparoscopic cystogastrostomy was done for drainage, lavage, and necrosectomy. Primary outcome was resolution of PFCs by the intended modality and secondary outcome was complications.
RESULTS
Sixty patients were randomized, 30 each to laparoscopic and endoscopic drainage. Both groups were comparable for baseline characteristics. The initial success rate was 83.3% in the laparoscopic and 76.6% in the endoscopic group (p = 0.7) after the index intervention. The overall success rate of 93.3% (28/30) and 90% (27/30) in the laparoscopic and endoscopic groups respectively was also similar (p = 1.0). Two patients in the laparoscopic group required endoscopic cystogastrostomy for persistent collections. Similarly, two patients in the endoscopic group required laparoscopic drainage. Postoperative complications were comparable between the groups except for higher post-procedure infection in the endoscopic group (19 vs. 9; p = 0.01) requiring endoscopic re-intervention.
CONCLUSIONS
Endoscopic and laparoscopic techniques have similar efficacy for internal drainage of suitable pancreatic fluid collections with < 30% debris. The choice of procedure should depend on available expertise and patient preference.
Topics: Adolescent; Adult; Aged; Drainage; Endoscopy, Digestive System; Female; Humans; Laparoscopy; Male; Middle Aged; Necrosis; Pancreas; Pancreatic Juice; Pancreatic Pseudocyst; Pancreatitis; Postoperative Complications; Young Adult
PubMed: 31140002
DOI: 10.1007/s00464-019-06866-z