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Australian Journal of General Practice Mar 2019Chronic pilonidal disease is a common debilitating condition often seen in general practice. It is a cause of considerable morbidity and social embarrassment, but recent...
BACKGROUND
Chronic pilonidal disease is a common debilitating condition often seen in general practice. It is a cause of considerable morbidity and social embarrassment, but recent developments in treatment options provide promising solutions to this problem. OBJECTIVE: This article recaps pilonidal sinus development and presentation, details methods of treatment in the primary care setting and explores new specialist management options available in Australia.
DISCUSSION
As a chronic condition, the devastation of recurrence with further pain, embarrassment and time off work - added to the prospect of more surgery - is still common for patients with chronic pilonidal disease. This can be avoided with correct management and timely counselling regarding surgical options available.
Topics: Dermatologic Surgical Procedures; Humans; Inflammation; Pain; Pilonidal Sinus; Wound Healing
PubMed: 31256473
DOI: 10.31128/AJGP-07-18-4649 -
Revista de La Facultad de Ciencias... Dec 2023The paraovarian or paratubarian cysts are both situated in the broad ligament between the ovary and fallopian tube. The diagnosis of adnexal torsion is challenging...
The paraovarian or paratubarian cysts are both situated in the broad ligament between the ovary and fallopian tube. The diagnosis of adnexal torsion is challenging since both symptoms and physical examination are nonspecific. In most cases, the patient presents abdominal pain, followed by nausea and vomiting. Imaging tests, such as ultrasound, are very useful to elucidate the cause of the symptoms in those patients.
Topics: Female; Humans; Ovarian Torsion; Cysts; Abdominal Pain
PubMed: 38150207
DOI: 10.31053/1853.0605.v80.n4.40830 -
The New England Journal of Medicine Jun 2017
Topics: Adult; Arachnoid Cysts; Brain; Headache; Humans; Magnetic Resonance Imaging; Male; Seizures
PubMed: 28591531
DOI: 10.1056/NEJMicm1610483 -
Annals of the Royal College of Surgeons... Mar 2009Choledochal cysts remain relatively uncommon in Western Europe and the US, although they are appreciably more common in Asia. Their aetiology remains obscure although... (Review)
Review
Choledochal cysts remain relatively uncommon in Western Europe and the US, although they are appreciably more common in Asia. Their aetiology remains obscure although abnormalities of the pancreaticobiliary junction may be the primary pathology in some, with biliary dilatation following reflux of activated pancreatic secretions. Most anomalies will present in childhood with obstructive jaundice or abdominal pain; a proportion may only present for the first time during adulthood, and some of these will show malignant transformation. The classical triad of pain, jaundice and a palpable mass is, however, not common. Complete cyst excision, where possible, and biliary reconstruction remain the aims for most types although there is still some controversy about the type of reconstruction. Laparoscopic reconstruction is possible but is still very much an advanced technique. The risk of long-term problems post-surgery is significant. Whether this is due to recurrent pancreatitis secondary to the retained common channel and/or a distal stump, or due to the development of biliary tract malignancy is still a cause for concern and indicates the need for adequate, prolonged follow-up.
Topics: Biliary Tract Neoplasms; Child; Choledochal Cyst; Humans; Postoperative Complications; Risk Factors
PubMed: 19317933
DOI: 10.1308/003588409X391947 -
The Ulster Medical Journal Jan 2023To evaluate the efficacy of ultrasound and fluoroscopic-guided aspiration and therapeutic injection of Baker's cysts in the relief of pain and pressure symptoms. (Review)
Review
Management of symptomatic Baker's cysts with ultrasound and fluoroscopic-guided aspiration followed by therapeutic injection with Depomedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients; A case series and literature review.
PURPOSE
To evaluate the efficacy of ultrasound and fluoroscopic-guided aspiration and therapeutic injection of Baker's cysts in the relief of pain and pressure symptoms.
METHODS
A retrospective, observational, single-arm study of consecutive patients referred from the Orthopaedic service for image-guided aspiration followed by therapeutic injection of symptomatic Baker's cysts was performed with institutional approval in the context of a Quality Improvement project. Patients' pain was graded using a 10-point Likert scale. Under standard sterile conditions, a 10 cm 5 Fr Yueh centesis needle was advanced into the cyst under direct ultrasound guidance, septae disrupted as necessary, the contents of the cyst aspirated, and a sample sent for microbiological analysis. Bursography was performed in an attempt to identify the expected communication with the knee joint, the contrast was aspirated and 40 mg of DepoMedrone and 5 ml of Bupivacaine were injected.
RESULTS
Thirteen patients were referred, nine of whom satisfied the inclusion criteria (all female, average age 63.8 years). Over a 35-month period, 11 procedures were performed (bilateral in 1, repeated in another) yielding an average volume of 20.1 ml (range 10 - 50 mls). In 2/11 procedures the communication with the knee joint was outlined. The average follow up post-procedure was 8.3 months. The average patient's pain score reduced to zero from 5.7 for an average period of 5.96 months. After this period patients reported a gradual return of an ache, but none returned to the pre-procedure severity which, in some cases, had prevented them from sleeping.
CONCLUSION
Aspiration of symptomatic Baker's cysts under Ultrasound and fluoroscopic guidance followed by therapeutic injection of DepoMedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients.
Topics: Humans; Female; Middle Aged; Bupivacaine; Retrospective Studies; Popliteal Cyst; Ultrasonography; Pain
PubMed: 36762137
DOI: No ID Found -
The Pan African Medical Journal 2019Spinal schwannomas are benign tumors accounting for 30% of all spinal tumors. They originate from the shwann cells of the spinal roots. We report our experience in...
Spinal schwannomas are benign tumors accounting for 30% of all spinal tumors. They originate from the shwann cells of the spinal roots. We report our experience in managing patients with spinal shwannomas, from diagnosis to treatment modalities, in the Department of Neurosurgery at the University Hospital Hassan II in Fez over a period of 13 years. The patients with spinal shwannomas accounted for 19.5% of those with spinal cord compression treated surgically over the same period. The average age of patients was 45 years, with a discreet female predominance. Spinal schwannomas had an insidious onset, then the median of consultation time was 18 months. The main symptoms were spinal and radicular pain. Half of our patients had neurological deficits. Medullary MRI was performed in all of our patients. Spinal schwannomas occurred predominantly in the chest (40%); 62% of shwannomas were intradural lesions, rarely extradural lesions (8%) and mixed lesions(4%). Complete Surgical resection was performed in 96% of cases with osteosynthesis in two cases and arthrodesis in a single case. Histological examination confirmed the diagnosis of benign neurinoma in 23 cases, malignant shwannoma in one case and neurofibroma in one case. Outcome was favorable in the majority of cases, two patients had complications, an infection of the wall and neurological worsening. The interest in the subject of our study is to highlight the features of these lesions and to compare the results of our case series with the data in the literature.
Topics: Adolescent; Adult; Aged; Child; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurilemmoma; Neurofibroma; Retrospective Studies; Spinal Cord Compression; Spinal Neoplasms; Young Adult
PubMed: 31692754
DOI: 10.11604/pamj.2019.33.199.17921 -
European Journal of Medical Genetics May 2023Surgery is a treatment option for neurofibromatosis type 1 (NF1)-related plexiform neurofibromas (PN), but complete resection is often not feasible. Real-world studies...
Surgery is a treatment option for neurofibromatosis type 1 (NF1)-related plexiform neurofibromas (PN), but complete resection is often not feasible. Real-world studies are warranted to understand disease burden, progression, and need for medical treatment in patients with inoperable PN. CASSIOPEA was a retrospective study of French pediatric patients (aged ≥3 to <18 years) presenting at a national multidisciplinary team (MDT) review with NF1 and ≥1 symptomatic, inoperable PN. Medical records were reviewed from the time of MDT review and over a follow-up period of up to 2 years. Primary objectives were to describe patient characteristics and target PN-associated therapy patterns. A secondary objective was evolution of target PN-related morbidities. Patients with prior, ongoing, or MDT recommendation of mitogen-activated protein kinase kinase (MEK) inhibitor treatment were excluded. Overall, 78 target PN were identified in 76 patients. At MDT review, median age was 8.4 years, with approximately 30% of patients aged 3-6 years. Target PN were primarily internal (77.3%), and 43.2% were progressive. Target PN location was evenly distributed. 34 target PN had documented MDT recommendations; of these, a majority (76.5%) were for non-medication management, including surveillance. At least one follow-up visit was recorded for 74 target PN. Despite initially being considered inoperable, 12.3% of patients underwent surgery for target PN. At MDT review, most (98.7%) target PN were associated with ≥1 morbidity, primarily pain (61.5%) and deformity (24.4%); severe morbidities were identified in 10.3%. Of 74 target PN with follow-up data, 89.2% were associated with ≥1 morbidity, primarily pain (60.8%) and deformity (25.7%). Of 45 target PN associated with pain, pain improved in 26.7%, was stable in 44.4%, and deteriorated in 28.9%. Deformity improved in 15.8% and remained stable in 84.2% of 19 target PN associated with deformity. None deteriorated. In this real-world study in France, NF1-PN disease burden was considerable, and a considerable proportion of patients were very young. Most patients received only supportive care without medication for target PN management. Target PN-related morbidities were frequent, heterogeneous, and generally did not improve during follow-up. These data highlight the importance of effective treatments that target PN progression and improve disease burden.
Topics: Child; Humans; Adolescent; Neurofibromatosis 1; Neurofibroma, Plexiform; Retrospective Studies; Treatment Outcome; Mitogen-Activated Protein Kinase Kinases; Pain
PubMed: 36868501
DOI: 10.1016/j.ejmg.2023.104734 -
Archives of Sexual Behavior Apr 2024Tarlov cysts adjacent to the spinal cord are usually asymptomatic and found incidentally via magnetic resonance imaging. On rare occasions, they increase in size to...
Tarlov cysts adjacent to the spinal cord are usually asymptomatic and found incidentally via magnetic resonance imaging. On rare occasions, they increase in size to produce symptoms resembling disk herniation. We report a rare case of a sacral cyst resulting in premature ejaculation in a 32-year-old man who presented with pelvic pain and acquired premature ejaculation. Spinal nerve root decompression, excision of intraspinal Tarlov cyst, and spinal nerve root adhesion release surgery significantly improved his pain and premature ejaculation at a six-month follow-up.
Topics: Male; Humans; Adult; Tarlov Cysts; Premature Ejaculation; Pelvic Pain; Magnetic Resonance Imaging
PubMed: 38366312
DOI: 10.1007/s10508-024-02815-7 -
Taiwanese Journal of Obstetrics &... May 2019Endosalpingiosis rarely occurs in the uterus. We report a case and review literature to explore its current clinical diagnosis and treatment. (Review)
Review
OBJECTIVE
Endosalpingiosis rarely occurs in the uterus. We report a case and review literature to explore its current clinical diagnosis and treatment.
CASE REPORT
A 31-year-old woman was admitted to the hospital for suspected uterine leiomyoma with cystic degeneration based on ultrasound and magnetic resonance imaging and surgical treatment. Laparoscopy revealed a large cystic mass protruding from the posterior uterine wall. The mass was resected, and a histologic examination showed that the cyst wall was lined with benign fallopian tube-type ciliated epithelium surrounded by normal myometrium, consistent with the diagnosis of endosalpingiosis of the uterus (also known as a Müllerian cyst). Currently, there are 18 cases (including ours) in the literature. Of these, two had a uterine malignancy, one endometrioid endometrial carcinoma, and another cervical adenocarcinoma. The age at diagnosis varied from 31 to 73, with a mean of 47 ± 8. The typical clinical manifestations were a palpable low abdominal mass, abnormal menstrual bleeding, and pelvic pain. Overall, 75% (12 of 16) of patients underwent a total hysterectomy, while 62.5% (10 in 16) had a concomitant bilateral salpingo-oophorectomy for nonmalignancy. No recurrence was reported.
CONCLUSION
We describe the youngest patient with tumor-like uterine endosalpingiosis. The preoperative diagnosis is challenging because of its rarity. Most patients had a hysterectomy with castration, which may have resulted in overtreatment. Awareness of this lesion is necessary for the differential diagnosis of uterine and adnexal tumors. Review of relevant literature has shown a relationship between endosalpingiosis progression and cancer development, indicating an uncertain and complicated pathology.
Topics: Adult; Cysts; Fallopian Tube Diseases; Female; Humans; Myometrium; Uterine Neoplasms
PubMed: 31122517
DOI: 10.1016/j.tjog.2019.03.006 -
The British Journal of Radiology Nov 2021Determining the prevalence of Tarlov cysts in low back pain patients. (Observational Study)
Observational Study
OBJECTIVE
Determining the prevalence of Tarlov cysts in low back pain patients.
METHODS AND MATERIALS
The picture archiving & communication system (PACS) & hospital information system (HIS) of a corporate hospital were retrospectively analyzed to determine the percentage of Tarlov cysts among patients undergoing spinal MRI for back pain over 3 years (January 2017 to December 2019).
RESULTS
384 patients had undergone spinal MRI for back pain over the study period, and 25 of them (6.51%) had Tarlov cysts. Vast majority (15 cases) showed cysts located at S2/S3 level, and few were found at S1/S2 and other levels. Single cysts were found in most (=18) of the cases, while 7 cases of multiple / bilateral cysts were found. Cyst dimensions were higher in craniocaudal than anteroposterior or transverse directions. In case of multiple cysts, one or two cysts were noted as dominant, having higher dimensions than the others. The study data revealed no gender or age predilection.
CONCLUSIONS
We conclude that including the entire sacrum with a T2 sagittal sequence in all MRI for low back pain can increase detection of Tarlov cysts, and thereby provide more data for further analysis.
ADVANCES IN KNOWLEDGE
We propose the concept of one "dominant" cyst when there are multiple Tarlov cysts. We recommend that diameter or size of Tarlov cysts be specified to their craniocaudal dimension. We also suggest reporting points for contextual structured reporting, viz. presence or absence of bony scalloping, neural foraminal narrowing, nerve root compression or extraforaminal extension.
Topics: Adult; Bangladesh; Causality; Female; Humans; Low Back Pain; Magnetic Resonance Imaging; Male; Middle Aged; Prevalence; Retrospective Studies; Tarlov Cysts; Young Adult
PubMed: 34538080
DOI: 10.1259/bjr.20210505