Imaging-guided treatment of meniscal cysts.
Ontology highlight
ABSTRACT:
SUBMITTER: Chang A
PROVIDER: S-EPMC2642552 | biostudies-other | 2009 Feb
REPOSITORIES: biostudies-other
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2009-11-18 | GSE19060 | GEO
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Project description:Background/objectiveSpinal arachnoid cysts (SAC) are intradural lesions, which may provoke a compression of the spinal cord and roots. Endoscopic techniques are increasingly used to minimize the surgical access and the postoperative scar tissue. Shunts may also represent an option. The aim of this paper is to illustrate the technique of endoscopic-assisted fenestration and positioning of a cysto-peritoneal diversion in a thoracic SAC using a flexible endoscope and to perform a systematic literature review on this subject.Material and methodsWe reported our case and we performed a review of the literature, searching for all the adult cases of Type III SACs in English language treated through endoscopic procedures.ResultsWe found 5 articles matching our search criteria and we included 9 adult patients in our analysis. Six patients were females and the most common localization was the thoracic spine. Six patients underwent selective laminectomies followed by endoscopic fenestration without cyst wall resection. Three patients had a percutaneous endoscopic inspection of the cyst and in two cases a cysto-subarachnoid shunt space was performed. Improvement of pre-operative neurological deficit was reported in six patients, no patients experienced clinical deterioration. The mean follow-up was 22 months and no progression or recurrence was reported.ConclusionThe implementation of endoscopy allows a minimally invasive treatments with good visualization of cyst anatomy and precise shunt positioning under real-time guidance. Endoscopy is technically demanding but it can offer similar clinical outcomes when compared to microscopic procedures with a limited rate of post-operative complications.The long-term risk of recurrence should be established by prospective studies.
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Project description:Menisci play a vital role in load transmission, shock absorption and joint stability. The current dogma is that the menisci simply protects the cartilage and play no role in osteoarthritis (OA) unless they are injured. However, there is increasing evidence suggesting that OA menisci may not merely be bystanders in the disease process of OA. This study sought: 1) to determine the prevalence of meniscal degeneration in OA patients, 2) to examine gene expression in OA meniscal cells compared to normal control meniscal cells, and 3) to test the hypothesis that OA meniscal cells are different from normal meniscal cells. The grades of meniscal degeneration correlated in a positive fashion with the grades of articular cartilage degeneration (r = 0.672; P < 0.0001). Many genes classified in the biological processes of immune response, inflammatory response, biomineral formation and cell proliferation, including major histocompatibility complex, class II, DP alpha 1 (HLA-DPA1), integrin, beta 2 (ITGB2), ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), ankylosis, progressive homolog (ANKH) and fibroblast growth factor 7 (FGF7), were expressed at higher levels compared to normal control meniscal cells. In addition, many genes that were previously implicated in OA were also expressed at higher levels in OA meniscal cells, including ADAM metallopeptidase with thrombospondin type 1 motif, 5 (ADAMTS5). Our findings suggest that OA is a whole joint disease. Meniscal cells may play an active role in the development of OA. Investigation of the gene expression profiles of OA meniscal cells may reveal new therapeutic targets for OA therapy and also may uncover novel disease markers for early diagnosis of OA. Studies were approved by our human subjects Institutional Review Board. Menisci and articular cartilage were collected during joint replacement surgery for OA patients (OA specimens) and lower limb amputation surgery for osteosarcoma patients (normal control specimens), and graded. Meniscal cells were prepared from the meniscal tissues and expanded in monolayer culture. Differential gene expression in OA meniscal cells and normal control meniscal cells was examined using Affymetrix microarray and real time RT-PCR.
2009-11-17 | E-GEOD-19060 | biostudies-arrayexpress
Project description:BACKGROUND: The surgical treatment technique for liver hydatic cyst (LHC) cannot be standardized, and the surgical technique should be tailored according to the extent of the cyst and any adjunct complications of hydatid disease. PATIENTS AND METHODS: All patients were treated with albendazole (10 mg/kg/day) for 15 days preoperatively. Total pericystectomy was performed in three patients (7%). Partial cystectomy and its modifications were performed in the remaining 41 patients (93%). RESULTS: A total of 44 patients were operated on for LHC between December 1998 and October 2004 in our center. Patients were evaluated with ultrasonography and computed tomography scan to determine the extent of the disease and preoperative staging. Twenty-four (53%) of these patients were women and 20 were men (median age, 52.5 years; range, 19-81 years). The majority of patients (n=27) had 1 cyst, and the remaining 17 patients had multiple cysts. In four patients (9.1%), daughter cysts were found in the biliary system, and abscesses were present in three patients (7%). Biliary fistula was the most frequent complication (n=5). Three patients had wound infections. Follow-up was complete for 33 patients (75%). The mean postoperative follow-up was 11.9+/-10.8 months; there were four recurrences during this time. DISCUSSION: The aim should be to provide complete drainage and obliteration of the cavity. Bile leak and biliary obstruction may complicate the postoperative course if bile leakage into the peritoneal cavity and obstruction in the biliary system are missed.
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