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Frontline Gastroenterology Jul 2015Peripancreatic fluid collections are a well-known complication of pancreatitis and can vary from fluid-filled collections to entirely necrotic collections. Although most... (Review)
Review
Peripancreatic fluid collections are a well-known complication of pancreatitis and can vary from fluid-filled collections to entirely necrotic collections. Although most of the fluid-filled pseudocysts tend to resolve spontaneously with conservative management, intervention is necessary in symptomatic patients. Open surgery has been the traditional treatment modality of choice though endoscopic, laparoscopic and transcutaneous techniques offer alternative drainage approaches. During the last decade, improvement in endoscopic ultrasound technology has enabled real-time access and drainage of fluid collections that were previously not amenable to blind transmural drainage. This has initiated a trend towards use of this modality for treatment of pseudocysts. In this review, we have summarised the existing evidence for endoscopic drainage of peripancreatic fluid collections from published studies.
PubMed: 28839811
DOI: 10.1136/flgastro-2014-100444 -
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 -
Current Treatment Options in... Dec 2017Pancreatic fluid collections are a frequent complication of acute pancreatitis. The revised Atlanta criterion classifies chronic fluid collections into pseudocysts and... (Review)
Review
Pancreatic fluid collections are a frequent complication of acute pancreatitis. The revised Atlanta criterion classifies chronic fluid collections into pseudocysts and walled-off pancreatic necrosis (WON). Symptomatic PFCs require drainage options that include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, minimally invasive endoscopic drainage has now become the preferred approach. An endoscopic ultrasonography (EUS)-guided approach for pancreatic fluid collection drainage is now the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WON. Direct endoscopic necrosectomy is often required in WON. Lumen apposing metal stents allow for direct endoscopic necrosectomy and debridement through the stent lumen and are now preferred in these patients. Endoscopic retrograde cholangiopancreatography with pancreatic duct exploration should be performed concurrent to PFC drainage in patients with suspected PD disruption. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Ideally, pancreatic ductal disruption should be bridged with endoscopic stenting.
PubMed: 29103188
DOI: 10.1007/s11938-017-0161-z -
Przeglad Gastroenterologiczny 2021According to the literature exocrine pancreatic insufficiency is relatively common among patients with diabetes mellitus (DM). Pseudocysts are the most common cystic...
INTRODUCTION
According to the literature exocrine pancreatic insufficiency is relatively common among patients with diabetes mellitus (DM). Pseudocysts are the most common cystic lesions and may be formed in the setting of acute or chronic pancreatitis. However, whether DM is involved or not in pancreatic cyst formation is still not well established.
AIM
To investigate the frequency and risk factors of cystic lesions in diabetic patients.
MATERIAL AND METHODS
One hundred and sixty-one patients with DM, with no previous history of pancreatic diseases, were prospectively included in the study. Endosonography followed by fine needle aspiration biopsy was then performed.
RESULTS
Finally, 33 of 161 patients (20.5%) were recognized with cystic lesions of the pancreas. Among them 5 patients were classified as cystic neoplasms, and 28 as pseudocysts. In the group of patients with pseudocysts, cystic lesions were significantly more prevalent in individuals with DM lasting less than 3 years. Prevalence of cystic lesions was significantly higher in metformin users in comparison to other diabetic patients ( < 0.05). Cystic lesions were more frequent in patients above 50 years of age ( < 0.05).
CONCLUSIONS
The prevalence of cystic lesions in the diabetic population is higher than in the general population. DM seems to play a major role in the process of cyst development, especially in patients without previous history of pancreatitis. Higher prevalence of cystic lesions in early diabetes seems to be the first stage of pancreatic injury. The exact role of diabetes duration and type of treatment should be established.
PubMed: 33986890
DOI: 10.5114/pg.2020.96080 -
Presse Medicale (Paris, France : 1983) Nov 2014Myxoid pseudocysts (MPCs) are the most frequent pseudotumors of the digit and dermatologists are frequently referred. It is now believed that MPCs occur as a result of a... (Review)
Review
Myxoid pseudocysts (MPCs) are the most frequent pseudotumors of the digit and dermatologists are frequently referred. It is now believed that MPCs occur as a result of a leakage of synovial fluid through a breach in the joint capsule of the distal interphalangeal joint promoted by osteoarthritis. Many treatments have been proposed from simple repeated punctures, injections of steroids or sclerosants, cryosurgery, laser evaporation, infrared coagulation to surgical excision. Surgical procedures depend on the location of MPCs in the nail apparatus. In this review, we will discuss the best approaches to the treatment of MPCs whereas no guidelines are available for their management.
Topics: Cryosurgery; Cryotherapy; Cysts; Diagnostic Imaging; Drainage; Humans; Laser Therapy; Nail Diseases
PubMed: 25312852
DOI: 10.1016/j.lpm.2014.06.010 -
Revista Espanola de Enfermedades... Oct 2023Pancreatic pseudocysts are very common cystic lesions after any inflammatory process of the pancreas. The majority are asymptomatic and only a small minority present...
Pancreatic pseudocysts are very common cystic lesions after any inflammatory process of the pancreas. The majority are asymptomatic and only a small minority present complications or produce compression symptoms. However, this small minority must receive treatment, which depending on the clinical situation must be endoscopic, surgical or interventional radiology. We present the case of a patient with a ruptured pseudocyst for whom we avoided surgical treatment and opted for conservative treatment, with good evolution.
PubMed: 37882234
DOI: 10.17235/reed.2023.9912/2023 -
Surgical Pathology Clinics Sep 2016Within the past few decades, there has been a dramatic increase in the detection of incidental pancreatic cysts. It is reported a pancreatic cyst is identified in up to... (Review)
Review
Within the past few decades, there has been a dramatic increase in the detection of incidental pancreatic cysts. It is reported a pancreatic cyst is identified in up to 2.6% of abdominal scans. Many of these cysts, including serous cystadenomas and pseudocysts, are benign and can be monitored clinically. In contrast, mucinous cysts, which include intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, have the potential to progress to pancreatic adenocarcinoma. In this review, we discuss the current management guidelines for pancreatic cysts, their underlying genetics, and the integration of molecular testing in cyst classification and prognostication.
Topics: Adenocarcinoma, Mucinous; Biomarkers, Tumor; Carcinoma, Pancreatic Ductal; Carcinoma, Papillary; Chromogranins; GTP-Binding Protein alpha Subunits, Gs; Humans; Incidental Findings; Neoplasm Staging; Pancreatic Cyst; Pancreatic Neoplasms; Pancreatic Pseudocyst; Pathology, Molecular; Prognosis; Proto-Oncogene Proteins p21(ras)
PubMed: 27523971
DOI: 10.1016/j.path.2016.04.008 -
Journal of Gastrointestinal Surgery :... May 2020The prevalence of incidental pancreatic cystic neoplasms (PCNs) has increased dramatically with advancements in cross-sectional imaging. Diagnostic imaging is limited in... (Review)
Review
BACKGROUND
The prevalence of incidental pancreatic cystic neoplasms (PCNs) has increased dramatically with advancements in cross-sectional imaging. Diagnostic imaging is limited in differentiating between benign and malignant PCNs. The aim of this review is to provide an overview of biomarkers that can be used to distinguish PCNs.
METHODS
A review of the literature on molecular diagnosis of cystic neoplasms of the pancreas was performed.
RESULTS
Pancreatic cysts can be categorized into inflammatory and non-inflammatory lesions. Inflammatory cysts include pancreatic pseudocysts. Noninflammatory lesions include both mucinous and non-mucinous lesions. Mucinous lesions include intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm. Non-mucinous lesions include serous cystadenoma and solid-pseudopapillary tumor of the pancreas. Imaging, cyst aspiration, and histologic findings, as well as carcinoembryonic antigen and amylase are commonly used to distinguish between cyst types. However, molecular techniques to detect differences in genetic mutations, protein expression, glycoproteomics, and metabolomic profiling are important developments in distinguishing between cyst types.
DISCUSSION
Nomograms incorporating common clinical, laboratory, and imaging findings have been developed in a better effort to predict malignant IPMN. The incorporation of top molecular biomarker candidates to nomograms may improve the predictive ability of current models to more accurately diagnose malignant PCNs.
Topics: Cystadenoma, Serous; Humans; Pancreas; Pancreatic Cyst; Pancreatic Neoplasms; Pancreatic Pseudocyst
PubMed: 32128679
DOI: 10.1007/s11605-020-04537-2 -
Survey of Ophthalmology 2020Age-related macular degeneration is a major cause of blindness worldwide characterized by the presence of drusen and leading to retinal pigment epithelium and outer... (Review)
Review
Age-related macular degeneration is a major cause of blindness worldwide characterized by the presence of drusen and leading to retinal pigment epithelium and outer retinal changes in advanced stages. Approximately 10% of eyes with age-related macular degeneration develop neovascular complications and present with retinal or sub-retinal pigment epithelium exudation, hemorrhage, or both. Recent advances in imaging techniques, especially optical coherence tomography (OCT), help in early identification of disease and guide various treatment decisions; however, not all signs are suggestive of ongoing exudation or neovascular activity. Although uncommon, multiple OCT-based signs are reported that may be difficult to appreciate clinically. Prompt identification of these signs such as outer retinal tubulation, cystoid degeneration, or pseudocysts may avoid unnecessary interventions. Moreover, certain OCT-based features involving the choroid, such as prechoridal cleft and choroidal cavern, have also been found in eyes with age-related macular degeneration. We discuss these unique OCT-based signs, their pathogenesis, clinical relevance, and management.
Topics: Choroid; Humans; Macular Degeneration; Retinal Pigment Epithelium; Tomography, Optical Coherence
PubMed: 31978382
DOI: 10.1016/j.survophthal.2020.01.001 -
The Cochrane Database of Systematic... Apr 2016Pancreatic pseudocysts are walled-off peripancreatic fluid collections. There is considerable uncertainty about how pancreatic pseudocysts should be treated. (Review)
Review
BACKGROUND
Pancreatic pseudocysts are walled-off peripancreatic fluid collections. There is considerable uncertainty about how pancreatic pseudocysts should be treated.
OBJECTIVES
To assess the benefits and harms of different management strategies for pancreatic pseudocysts.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2015, Issue 9, and MEDLINE, EMBASE, Science Citation Index Expanded, and trials registers until September 2015. We also searched the references of included trials and contacted trial authors.
SELECTION CRITERIA
We only considered randomised controlled trials (RCTs) of people with pancreatic pseudocysts, regardless of size, presence of symptoms, or aetiology. We placed no restrictions on blinding, language, or publication status of the trials.
DATA COLLECTION AND ANALYSIS
Two review authors independently identified trials and extracted data. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CI) with RevMan 5, based on an available-case analysis for direct comparisons, using fixed-effect and random-effect models. We also conducted indirect comparisons (rather than network meta-analysis), since there were no outcomes for which direct and indirect evidence were available.
MAIN RESULTS
We included four RCTs, with 177 participants, in this review. After one participant was excluded, 176 participants were randomised to endoscopic ultrasound (EUS)-guided drainage (88 participants), endoscopic drainage (44 participants), EUS-guided drainage with nasocystic drainage (24 participants), and open surgical drainage (20 participants). The comparisons included endoscopic drainage versus EUS-guided drainage (two trials), EUS-guided drainage with nasocystic drainage versus EUS-guided drainage alone (one trial), and open surgical drainage versus EUS-guided drainage (one trial). The participants were mostly symptomatic, with pancreatic pseudocysts resulting from acute and chronic pancreatitis of varied aetiology. The mean size of the pseudocysts ranged between 70 mm and 155 mm across studies. Although the trials appeared to include similar types of participants for all comparisons, we were unable to assess this statistically, since there were no direct and indirect results for any of the comparisons.All the trials were at unclear or high risk of bias, and the overall quality of evidence was low or very low for all outcomes. One death occurred in the endoscopic drainage group (1/44; 2.3%), due to bleeding. There were no deaths in the other groups. The differences in the serious adverse events were imprecise. Short-term health-related quality of life (HRQoL; four weeks to three months) was worse (MD -21.00; 95% CI -33.21 to -8.79; participants = 40; studies = 1; range: 0 to 100; higher score indicates better) and the costs were higher in the open surgical drainage group than the EUS-guided drainage group (MD 8040 USD; 95% CI 3020 to 13,060; participants = 40; studies = 1). There were fewer adverse events in the EUS-guided drainage with nasocystic drainage group than in the EUS-guided drainage alone (OR 0.20; 95% CI 0.06 to 0.73; participants = 47; studies = 1), or the endoscopic drainage group (indirect comparison: OR 0.08; 95% CI 0.01 to 0.61). Participants with EUS-guided drainage with nasocystic drainage also had shorter hospital stays compared to EUS-guided drainage alone (MD -8.10 days; 95% CI -9.79 to -6.41; participants = 47; studies = 1), endoscopic drainage (indirect comparison: MD -7.10 days; 95% CI -9.38 to -4.82), or open surgical drainage group (indirect comparison: MD -12.30 days; 95% CI -14.48 to -10.12). The open surgical drainage group had longer hospital stays than the EUS-guided drainage group (MD 4.20 days; 95% CI 2.82 to 5.58; participants = 40; studies = 1); the endoscopic drainage group had longer hospital stays than the open drainage group (indirect comparison: -5.20 days; 95% CI -7.26 to -3.14). The need for additional invasive interventions was higher for the endoscopic drainage group than the EUS-guided drainage group (OR 11.13; 95% CI 2.85 to 43.44; participants = 89; studies = 2), and the open drainage group (indirect comparison: OR 23.69; 95% CI 1.40 to 400.71). The differences between groups were imprecise for the other comparisons that could be performed. None of the trials reported long-term mortality, medium-term HRQoL (three months to one year), long-term HRQoL (longer than one year), time-to-return to normal activities, or time-to-return to work.
AUTHORS' CONCLUSIONS
Very low-quality evidence suggested that the differences in mortality and serious adverse events between treatments were imprecise. Low-quality evidence suggested that short-term HRQoL (four weeks to three months) was worse, and the costs were higher in the open surgical drainage group than in the EUS-guided drainage group. Low-quality or very low-quality evidence suggested that EUS-guided drainage with nasocystic drainage led to fewer adverse events than EUS-guided or endoscopic drainage, and shorter hospital stays when compared to EUS-guided drainage, endoscopic drainage, or open surgical drainage, while EUS-guided drainage led to shorter hospital stays than open surgical drainage. Low-quality evidence suggested that there was a higher need for additional invasive procedures with endoscopic drainage than EUS-guided drainage, while it was lower in the open surgical drainage than in the endoscopic drainage group.Further RCTs are needed to compare EUS-guided drainage, with or without nasocystic drainage, in symptomatic patients with pancreatic pseudocysts that require treatment. Future trials should include patient-oriented outcomes such as mortality, serious adverse events, HRQoL, hospital stay, return-to-normal activity, number of work days lost, and the need for additional procedures, for a minimum follow-up period of two to three years.
Topics: Drainage; Humans; Pancreatic Pseudocyst; Pancreatitis; Randomized Controlled Trials as Topic; Ultrasonography, Interventional
PubMed: 27075711
DOI: 10.1002/14651858.CD011392.pub2