The sphenozygomatic fissure.

The lateral (temporal) wall of the orbit separates it from the temporal fossa and the anterior part of the temporal muscle. Within this wall, the sphenozygomatic suture joins the greater wing of the sphenoid bone and the zygomatic bone. We retrospectively documented in cone-beam computed tomography the anatomy of the orbit in a 56-year-old female and we found a previously unreported anatomic variant. The greater wing of the sphenoid bone and the zygomatic bone were separated, bilaterally, by a large unossified space which we termed the sphenozygomatic fissure. This was merged inferiorly with the inferior orbital fissure. A possible imbalanced mechanism of membranous ossification of both the zygomatic bone and the orbital surface of the greater wing could be speculated as a possible cause for such sphenozygomatic fissure. This previously undocumented anatomic variant is of high clinical relevance, since it may allow orbital fat to herniate (or bulge) toward the temporal fossa, it may be easily damaged during minor trauma and it should be carefully approached during the surgery of the orbit through the lateral wall.

What podoplanin tells us about cells with telopodes.

Telocytes (TCs) are stromal cells with telopodes, which represent long, thin, moniliform cell processes; however, this morphological feature alone is insufficient to define a cell type. Specific markers of lymphatic endothelial cells (LECs), such as Prox-1, podoplanin (D2-40) or LYVE-1, are not usually tested in TCs. We thus aimed at performing a study in light microscopy to evaluate whether or not LECs could be mistaken for TCs. Therefore we used CD34, α-smooth muscle actin and D2-40 for an immunohistochemical study on archived paraffin-embedded samples of uterine leiomyoma. Lymphatic vessels were identified by the expression of D2-40, but on the microscopic slides, false spindle-shaped TCs appearances either corresponded to collapsed lymphatic lumina or were determined by grazing longitudinal cuts of lymphatics. It is therefore mandatory to check the expression of lymphatic markers in telocyte-like cells and, moreover, to carefully examine the bidimensional cuts in order to avoid false results.

Molecular phenotypes of the human kidney: Myoid stromal cells/telocytes and myoepithelial cells.

The connective stromal and epithelial compartments of the kidney have regenerative potential and phenotypic flexibility. A few studies have shown that cells appertaining to both compartments can exhibit myoid phenotypes. The purpose of our study was to investigate the myoid pattern of kidney and its association with the kidney niches containing stromal cells/telocytes (SC/TCs). We performed an immunohistochemical study using a panel of endothelial, myoid, mesenchymal and stem/progenitor markers, namely CD31, CD34, CD105 (endoglin), CD117/c-kit, nestin, desmin, α-smooth muscle actin (α-SMA) and the heavy chain of smooth muscle myosin (SMM). We used histologically normal kidney samples, obtained after nephrectomy, from nine adult patients. The capsular SC/TCs had a strong CD34 and partial nestin and CD105 immunopositivity. Subcapsular and interstitial SC/TCs expressed c-kit, nestin, CD105, but also α-SMA and SMM, therefore having a myoid phenotype. The endothelial SC/TCs phenotype was CD31+/CD34+/CD105+/nestin±/SMM±/α-SMA±. All three myoid markers were expressed in periendothelial SC/TCs. We also found a scarce expression of nestin in parietal epithelial cells of Bowman's capsule, and in podocytes. In epithelial cells, we found a positive expression for CD31, CD117/c-kit, desmin, CD34, SMM, and CD105. In epithelial tubular cells, we found a predominant basal expression of the myoid markers (SMM and desmin). In conclusion, myoepithelial tubular cells, myoid endothelial cells and myoid SC/TCs are normal constituents of the kidney.

The molecular phenotypes of ureteral telocytes are layer-specific.

Telocytes (TC) are the delicate interstitial (stromal) cells defined by their long, thin and moniliform processes termed telopodes. Numerous studies determined that different subsets of telocytes populate almost all tissues and attempted to relate these subsets to various functions, from cell signaling to tissue repair and regeneration. Extremely few studies addressed the urinary tract though few data on the molecular pattern of the urinary TCs actually exist. We therefore hypothesized that subsets of urinary TCs co-localize within the human ureter and we aimed at performing an immunohistochemical study to evaluate the tissue-specific molecular pattern of TCs. On sample tissues of proximal ureter drawn from ten human adult patients during surgery were applied primary antibodies against CD34, CD105, von Willebrand Factor, the heavy chain of smooth muscle myosin (SMM) and c-erbB-2. The molecular pattern indicated three different subsets of ureteral TCs which are neither endothelial nor epithelial in nature: (a) type I: the CD34-/CD105+ TCs of the superficial layer of lamina propria; (b) type II: the CD34+/CD105± myoid TCs of the deep layer of lamina propria and (c) type III: the CD34+/CD105+ perivascular TCs. Although apparently different, all these subsets of TCs could belong to the stem/progenitor niche of the ureter.

The sheath of Waldeyer is not a specific anatomical trait of the ureterovesical junction.

The function of the ureterovesical junction depends upon a peculiar structure, the adventitial fibromuscular sheath of Waldeyer, which coats the distal end of the ureter. The origin of the smooth muscle of Waldeyer's sheath (WS) is disputed. Evidence points more likely to an ureteral one. In this regard we hypothesized the WS is not specific to the distal ureter but is rather a common trait. We therefore aimed at exploring whether or not the proximal ureter is provided with a similar adventitial fibromuscular coat. We performed an immunohistochemical study on human samples of proximal ureter resulted after nephrectomies in ten patients. We applied myoid immunohistochemical markers: α-smooth muscle actin (α-SMA), desmin, and heavy chain of smooth muscle myosin (SMM) which labeled additional adventitial smooth muscle bundles, a discontinuous inner circular one applied on the muscular coat, and outer longitudinal cords specifically located on one side of the ureter, as is the case for WS. Moreover, the lamina propria myoid deep layer showed isolated smooth muscle fibers and spindle-shaped stromal cells with telocyte morphology. Our results support the idea that WS may not be a specific structure of the distal ureter, instead being just a common anatomical characteristic of the ureter.

Expectations and perspectives of ovarian cancer patients about cancer management in Romania. The international NOGGO-ENGOT trial: EXPRESSION III.

We have investigated a relational model of expectations and preferences among ovarian cancer patients centred on physician-patient communication, treatment approach, and the need for information. Consecutive patients anonymously filled in the EXPRESSION III questionnaire between 2009 and 2012. Following descriptive statistics, structural equation modelling was used to analyse the relationships between physician's evaluation by the patient (PEP), result of therapy (RT), need for changes in treatment (NCT) and patient's desire to be informed (PD). From a total of 108 patients, 53 (49.1%) knew their disease stage, 103 (95.4%) underwent surgery, 91 (84.3%) had chemotherapy and 51 (46.3%) relapsed. The final model demonstrated a good fit of data with fit indices >0.90. There was a significant positive effect of PEP on RT and a significant negative effect of PEP on NCT, with the final model explaining 84% of the NCT variance. Physicians represent the main point of contact, not only as a source of information about the disease and various treatment options, but also in the coping processes. As patients benefit from completeness of medical consultations, their awareness of the treatment outcome increases, while a negative perception of the physician leads to a desire to make changes in therapy.

Telocytes of the mammary gland stroma.

Although confusions persist in what concerns the terminologies used for describing the fibroblastoid cells of the stromal compartments, the expression of antigens in such cells gradually directs their diagnosis towards a stem/progenitor phenotype. The stromal cells with long, slender and moniliform prolongations were named "telocytes" (TCs), their cell processes being termed "telopodes". However, the mammary gland TCs were not evaluated for the CD34 expression. Thus an in vivo immunohistochemical study was designed; antibodies against CD10, CD34, CD117/c-kit and vimentin were applied on human mammary gland samples of 8 donor patients. Resident CD34-positive stromal cells positive for the TCs morphology were found building consistent stromal networks and ensheathing microvessels and excretory units. Such cells were CD10±/c-kit-/vimentin+. According to the current concepts regarding the in vivo stem/progenitor cells the CD34+ TCs of the mammary stroma could be actors in the mammary stem niche and their antigens expression could relate to different stages of differentiation.

[CONTROVERSIES REGARDING THE ACCURACY AND LIMITATIONS OF FROZEN SECTION IN THYROID PATHOLOGY: AN EVIDENCE-BASED ASSESSMENT]. / INTÉRÊTS ET LIMITES DE L'EXAMEN EXTEMPORANÉ EN PATHOLOGIE THYROÏDIENNE. Revue systématique de la littérature et évaluation fondée sur les preuves.

Palpable thyroid nodules are present clinically in 4-7% of the population and their prevalence increases to 50%-67% when using high-resolution neck ultrasonography. By contrast, thyroid carcinoma (TC) represents only 5-20% of these nodules, which underlines the need for an appropriate approach to avoid unnecessary surgery. Frozen section (PS) has been used for more than 40 years in thyroid surgery to establish the diagnosis of malignancy. However, a controversy persists regarding the accuracy of FS and its place in thyroid pathology has changed with the emergence of fine-needle aspiration (FNA). A PubMed Medline and SpringerLink search was made covering the period from January 2000 to June 2012 to assess the accuracy of ES, its limitations and indications for the diagnosis of thyroid nodules. Twenty publications encompassing 8.567 subjects were included in our study. The average value of TC among thyroid nodules in analyzed studies was 15.5 %. ES ability to detect cancer expressed by its sensitivity (Ss) was 67.5 %. More than two thirds of the authors considered PS useful exclusively in the presence of doubtful ENA and for guiding the surgical extension in cases confirmed as malignant by FNA; however, only 33% accepted FS as a routine examination for the management of thyroid nodules. The influence of FS on surgical reintervention rate in nodular thyroid pathology was considered to be negligible by most studies, whereas 31 % of the authors thought that FS has a favorable benefit by decreasing the number of surgical re-interventions. In conclusion, the role of FS in thyroid pathology evolved from a mandatory component for thyroid surgery to an optional examination after a pre-operative FNA cytology. The accuracy of FS seems to provide no sufficient additional benefit and most experts support its use only in the presence of equivocal or suspicious cytological features, for guiding the surgical extension in cases confirmed as malignant by FNA and for the identification of other potentially confusing intraoperative findings.

Translating clinical research of Molecular Biology into a personalized, multidisciplinary approach of colorectal cancer patients.

Although multimodal treatment has brought important benefit, there is still great heterogeneity regarding the indication and response to chemotherapy in Stage II and III, and individual variations related to both overall survival and toxicity of new therapies in metastatic disease or tumor relapse. Recent research in molecular biology led to the development of a large scale of genetic biomarkers, but their clinical use is not concordant with the high expectations. The Aim of this review is to identify and discuss the molecular markers with proven clinical applicability as prognostic and/or predictive factors in CRC and also to establish a feasible algorithm of molecular testing, as routine practice, in the personalized, multidisciplinary approach of colorectal cancer patients in our country. Despite the revolution that occurred in the field of molecular marker research, only Serum CEA, Immunohistochemical analysis of mismatch repair proteins and PCR testing for KRAS and BRAF mutations have confirmed their clinical utility in the management of colorectal cancer. Their implementation in the current practice should partially resolve some of the controversies related to this heterogenic pathology, in matters of prognosis in different TNM stages, stage II patient risk stratification, diagnosis of hereditary CRC and likelihood of benefit from anti EGFR therapy in metastatic disease. The proposed algorithms of molecular testing are very useful but still imperfect and require further validation and constant optimization.

Microsatellite instability in the management of stage II colorectal patients.

BACKGROUND: Up-to-date it is unclear whether stage II colorectal cancer patients should receive adjuvant chemotherapy.The presence of high risk features (T4, CEA 5 ng dl, less than 12 lymph nodes examined) is an indication for Oxaliplatin based treatment. In their absence, there is no consensus, 5 Fluorouracil regimens, or observation only being equally recommended by oncologists. Microsatellite instability is associated with good prognosis in stage II colorectal cancer and also with poor response to 5 Fluorouracil and should be used as a predictive marker. METHODS: We performed a prospective descriptive study on 115 consecutive patients who received surgical resection for colorectal cancer in our clinic during 2011 and 2012 using a risk stratification algorithm based on TNM staging, clinico pathologic and molecular markers. RESULTS: From the 44 stage II colorectal cancer patients, 10 cases were classified as high risk, in 26 cases we performed Immunohistochemical analysis that identified 8 patients with low risk microsatellite instability phenotype, with no indication for adjuvant chemotherapy; 26 intermediate risk patients received 5-FluoroUracil regimens. CONCLUSION: We believe that microsatellite instability testing provides a useful tool in the goal of better characterizing patients with stage II colorectal cancer in matters of risk of recurrence and likelihood of benefit from chemotherapy.

Zipper-like series of desmosomes supported by subplasmalemmal actin belts in thymic epithelial reticular cells in the rat.

Remodeling of epithelial tissues requires coordinated cell migration. Most of the mechanisms regulating desmosome assembly and stability in migrating epithelial cells are still unknown. The actin cytoskeleton is a significant component of desmosome assembly and maturation. The association of the actin cytoskeleton with adherens junctions requires additional ultrastructural investigations. A transmission electron microscopic study was performed on five samples of rat thymus. Interepithelial series of desmosomes up to 6.5 µm length were found as were composite series of junctions (tight, adherens, and desmosomes). As a particular feature, subplasmalemmal belts of microfilaments, apparently of actin, ran adjacent to the inner dense plaques of desmosomes, passing beneath and at a distance to the tight junctions. They were not found beneath the adherens junctions. The series of desmosomes were termed zipper-like desmosomes (ZLDs), and were either complete, or imperfect. Terminal imperfect or incomplete desmosomes were found at the ends of the zipper-like series. Alpha-smooth muscle actin immune labeling on six other samples of rat thymus was strongly suggestive of the existence of subplasmalemmal actin belts in the epithelial reticular system. Further studies are needed to establish the exact role of the ZLDs during processes of epithelial remodeling.

Electrical conduction system apoptosis in type II diabetes mellitus.

Even though apoptosis is known to be associated with various cardiovascular pathologies, its presence in cardiac nodal tissue in adults was only scarcely researched. Cardiomyocyte apoptosis was associated with diabetic cardiovascular pathology. Our main objective was to test whether programmed cell death is present in nodal tissue in type II diabetes mellitus and, if present to characterize it. The study was designed as a qualitative one. We used autopsy samples of hearts from 10 patients (56 to 73-year-old, 6:4 male to female ratio), positive for type II diabetes mellitus. Samples from sinoatrial and atrioventricular nodes were stained with Hematoxylin-Eosin. For immunohistochemistry, we used primary antibodies for caspases 3 and 9, cathepsin B, and TRADD. Nodal tissue in all samples was characterized by diffuse interstitial fibrosis and chronic ischemic lesions; nuclear damage and foci of irreversible ischemic necrosis intermingled with isles of relatively morphologically normal myocytes. Sinoatrial and atrioventricular nodes were caspase-3 and -9 positive, and also cathepsin-B-positive, suggesting an overlap between apoptotic and necrotic mechanisms. Central area of the sinus node seemed to have the most severe lesions. As a conclusion, nodal apoptosis is present in nodal tissue in type II diabetes mellitus; it involves the intrinsic pathway and associated concomitant and/or post-apoptotic necrosis.

Sprouting angiogenesis in human midterm uterus and fallopian tube is guided by endothelial tip cells.

Five samples of human midterm fetal uterus and fallopian tube (four donor bodies) were used to assess whether or not processes of angiogenesis are guided by endothelial tip cells (ETCs), and if cytokine-receptors, such as CD117/c-kit and PDGFR-α, are expressed in the microenvironment of the endothelial tubes. CD34 labeled microvessels in the uterine wall (myometrium and endometrium) and in the wall of the uterine (fallopian) tube, and accurately identified ETCs in both organs. We conclude that sprouting angiogenesis in the developing human female tract is guided by ETCs. Moreover, CD117/c-kit antibodies labeled mural networks of pericytes, α-SMA-positive and desmin-negative, related to the endometrial (but not myometrial) microvessels, and similar labeling was identified in the wall of the uterine tube. PDGFR-α positive labeling, stromal and pericytary, was also found. Thus, sprouting angiogenesis in human fetal genital organs appears to be guided by tip cells and is influenced by tyrosine kinase receptor signaling.

Telocytes form networks in normal cardiac tissues.

Telocytes (TC) are a class of interstitial cells present in heart. Their characteristic feature is the presence of extremely long and thin prolongations (called telopodes). Therefore, we were interested to see whether or not TCs form networks in normal cardiac tissues, as previously suggested. Autopsy samples of cardiac tissues were obtained from 13 young human cadavers, without identifiable cardiac pathology and with a negative personal history of cardiovascular disease. Immunohistochemistry on formalin-fixed paraffin-embedded tissues was performed using monoclonal antibodies for CD117/c-kit. Additionally, ventricular samples from 5 Sprague-Dawley rats were ultrastructurally evaluated under transmission electron microscopy. We found c-kit positive cells with TC features in subepicardium, as well in subepicardial arteries and in subepicardial fat. TCs were also present in the subendocardium. Light and electron microscopy revealed the existence of intramyocardial networks built up by bipolar TCs. Larger c-kit positive multipolar TCs were found between cardiac muscle bundles. Our results support the existence of a cardiac network of telocytes.

The human trigeminal ganglion: c-kit positive neurons and interstitial cells.

OBJECTIVES: The presence of c-kit positive neurons in sensory ganglia has been verified in various species but not in humans. Our aim has been to identify whether human primary trigeminal neurons label with c-kit/CD117 and thus, whether data gathered in animal studies can be extrapolated to humans. We also intended to establish whether, and which non-neuronal cells also label with c-kit in the trigeminal ganglion. METHODS: Human adult trigeminal ganglia from eight cadavers were processed for immunohistochemistry on paraffin embedded samples using monoclonal antibodies for CD117/c-kit, and three additional trigeminal ganglia were used for transmission electron microscopy (TEM). To evaluate which neuronal type (A or B) was labeled with c-kit, we evaluated the same neurons on adjacent sections labeled with antibodies for neurofilaments (NF). RESULTS: c-kit has labeled trigeminal neurons (TNs), mast cells and interstitial cells (ICs) within the trigeminal ganglion. c-kit+TNs were NF-and thus were strongly presumed to be nociceptive, as such neurons are known to be NF-poor. c-kit+ICs with long and moniliform processes intermingled with the satellite glial cells (SGCs) of the neuronal envelopes. TEM evaluations confirmed this mixed composition of the neuronal envelopes and demonstrated that the perineuronal ICs are in fact interstitial Cajal-like cells (ICLCs) and/or telocytes. CONCLUSIONS: c-kit+TNs were objectified in humans and strongly presumed to be nociceptive. TNs envelopes mostly consist of SGCs, but are also combined with ICLCs/telocytes.

Extrahepatic and intrahepatic human portal interstitial Cajal cells.

Portal interstitial cells of Cajal (PICCs), acting as vascular pacemakers, were previously only identified in nonhumans. Moreover, there is no evidence available about the presence of such cells within the liver. The objective of the study is to evaluate whether or not PICCs are identifiable in humans and, if they are, whether or not they are following the scaffold of portal vein (PV) branches within the liver. We obtained extrahepatic PVs and liver samples from six adult human cadavers, negative for liver disease, in accordance with ethical rules. They were stained with hematoxylin-eosin (HE) and Giemsa, and then we performed immunohistochemistry on formalin-fixed paraffin-embedded specimens for CD117/c-kit, a marker of the Cajal's cells. Immune labeling was also performed for S-100 protein, desmin, glial fibrillary acidic protein (GFAP), neurofilaments, α-smooth muscle actin (α-SMA), and CD34. c-kit-Positive PICCs were identified within the extrahepatic PV, in portal spaces, and septa. On adjacent sections, these PICCs were negative for all the other antibodies used. In conclusion, our study confirms the presence of extrahepatic PICCs on humans, which may act as a possible intrinsic pacemaker in the human PV. However, the intrahepatic PICCs, which were evidenced here for the first time, are in need for further experimental studies to evaluate their functional role. A promising further direction of the study is the PICCs role in the idiopathic portal hypertension.

Chemical stabilization of oils rich in long-chain polyunsaturated fatty acids during storage.

During the microencapsulation process, the fish oil undergoes multiple changes in its physical properties such as bulkiness and dispersibility in aqueous phase and dry matrix. Autoxidation already occurred in the first stages of the microencapsulation process itself during emulsification and spray-drying. An efficient stabilization was achieved using a ternary combination of lipophilic antioxidants, synergistic compounds and a trace metal chelator, e.g. a combination of tocopherols, rich in the δ-derivative and low in the α-derivative, with ascorbyl palmitate and lecithin. Trace metal chelation by, e.g. Citrem or lecithin in combination with ascorbyl palmitate proved to be of particular importance in the emulsion, but not during the storage of the microencapsulated oil. In the microencapsulated oil, the addition of rosemary extract rich in carnosic acid to ternary blends of tocopherols, ascorbyl palmitate and lecithin or Citrem significantly retarded autoxidation.

Anatomical and immunohistochemical considerations on the microinnervation of trachea in humans.

The anatomy of the tracheal microinnervation is understudied in humans; the purpose of our study was to fill this gap by working on human adult tracheas, to compare the results with those obtained from animal studies, and to checking whether or not these studies are suitable to be translated from comparative to the human anatomy. The study was designed as a qualitative one. The present work was performed on human adult tracheas dissected out in 15 human adult cadavers. Microdissections were performed in eight tracheas and revealed the outer peritracheal plexus, segmentally supplied and distributed to trachea and esophagus, with longitudinal intersegmentary anastomoses but also with bilateral interrecurrential anastomoses previously undescribed in anatomy. Seven different tracheas were transversally cut and paraffin embedded. Histological stains (HE, toluidine blue, luxol fast blue, Giemsa on tissues and trichrome Gieson) and immunohistochemistry using primary antibodies for nNOS, neurofilament, SMA and the cocktail of citokeratines CK AE1-AE3+8/18 were done. According to the histological individual variation, the neural layers of the posterior wall of the human trachea could be considered as it follows: (a) an outer neural layer, ganglionated, associated with the connective covering layers, adventitia and the posterior fibroelastic membrane (external elastic lamina); (b) a submucosal ganglionated neural layer, mainly with juxtaglandular microganglia that may expand, as glands do, through the outer covering layers; (c) intrinsic nerves of the transverse trachealis muscle; (d) the neural layer intrinsic to the longitudinal elastic band (internal elastic lamina) and supplied from the inner submucosa; (e) the neural plexus of the lamina propria, with scarcely distributed neurons. We also bring here the first evidences for the in vivo nNOS phenotype of mast cells that were identified, but not exclusively, within the trachealis muscle.

The anatomy of the sympathetic pathway through the pterygopalatine fossa in humans.

Generally, sympathetic distribution in the pterygopalatine fossa (PPF) is considered to be via the pterygopalatine ganglion (PPG) sympathetic root and branches. We hypothesized that there may be a dual sympathetic path within the PPF, through the vidian nerve and the PPG and through the periarterial plexuses. We dissected 10 human adult cadavers, fixed and unfixed; we applied antibodies for tyrosine hydroxylase (TH) to 5 human adult samples of PPF contents dissected from cadavers at autopsy. We identified TH(+) nerves and fibers distributed through the neuronal clusters of the PPG and also bundles extrinsic to these clusters, distributed along the maxillary artery. Also, TH(+) reactions were identified at the level of the neuronal capsules of the PPG. All the arteries within the PPF presented TH(+) fibers, periadventitial and intramural-the periarterial plexuses were also identified during dissections, a major one being that along the descending palatine artery, distinctive to the greater palatine nerve. Thus, concerning the sympathetic entry to the PPF, this one seems to use both the path of the external carotid artery (via the maxillary artery plexus) and the path of the internal carotid artery, via the vidian nerve supplying the PPG and reinforcing the maxillary artery plexus. The sympathetic exit of the PPF uses the neural scaffolding of the PPG branches and also the arterial scaffolding. The complex trigeminal-autonomic, anatomic content of the PPF may be involved in several distinctive facial algias and thus the pain may be relieved by routine approaches to the PPF, based on updated anatomical knowledge and a correct diagnostic.

[Intrabiliary rupture of hepatic hydatid cysts: results of 17 years' experience]. / Chisturile hidatice hepatice rupte în arborele biliar: experienta a 17 ani.

UNLABELLED: Between 1990 and 2006 in the III-rd Surgical Clinic Cluj-Napoca, 366 pacients with hepatic hydatid cyst were admitted and underwent surgery; 81 (22.13%) of them, who had a cyst-biliary comunication, were retrospectively reviewed: 52 (64.2%) had an occult communications and 29 (35.8%) had a frank intrabiliary rupture. The sex ratio was M/F=46/35 with a mean age of 44.5 years and with ages between 17 and 73 years. Choledochotomy, evacuation of parasitic material and lavage of the CBP were performed in all patients with frank intrabiliary rupture. In 25 patients, partial pericystectomy and choledochoduodenostomy/T-tube drainage of CBP was performed. Internal drainage by a Roux-en-Y pericystectojejunostomy and biliodigestive anastomosis was carried out in 2 patients, while other two patients underwent external drainage of cystic cavity and T-tube drainage of CBP. 15 patients (51.7%) had postoperative external bile leaks (fistulas). Occult communications were managed by partial pericystectomy +/- narrowing of the residual cavity (capitonage with an omentum flap or invagination of the fibrosis capsule margins into the cavity) in 35 patients (67.3%) while in 10 patients (19.2%) internal drainage by a Roux-en-Y pericystectojejunostomy was carried out. Regional resection of the liver was performed in 4 cases (7.7%) and external drainage of residual cavity in 3 patients (5.7%). 13 patients (25%) had postoperative external bile leaks (fistulas). The mean postoperative hospitalisation was 20 days with the range 5-85 days. The mortality rate was 2.4% (2 patients): one died due to septicemia and MOFS and the other due to pulmonary thromboembolism. CONCLUSION: Postoperative bile leaks (fistulas) fallowing conservative surgery of ruptured hydatid hepatic cyst into the biliary tract are not rare regardless of the type of rupture (frank or occult). Although the opening of the biliary duct is sutured, the risk of biliary fistulas is not clearly corelated with this approach; in such cases internal drainage provides a good alternative with low morbidity.