Efficacy of KTP Laser-Assisted Marsupialization in the Treatment of Vocal Cysts.

OBJECTIVES: Vocal cysts, common benign laryngeal lesions, often lead to voice disturbances. Total surgical enucleation presents challenges due to the delicate nature of vocal tissues. Conventional surgery carries risks of recurrence and decreased voice quality due to incomplete removal and potential vocal fold damage. This study investigates the efficacy of Potassium-Titanyl-Phosphate (KTP) laser-assisted marsupialization for the treatment of vocal cysts. SUBJECTS AND METHODS: We retrospectively analyzed 78 patients who underwent either conventional surgery or KTP laser-assisted marsupialization to compare the voice outcomes and recurrence rates of the two groups. RESULTS: KTP laser-assisted group (B) demonstrated significantly higher recurrence rates (18.4%) compared to conventional surgery group (5%). The mean time to cyst recurrence were 12.4months in group A and 10.9months in group B. The degree of postoperative improvement in all voice parameters was not significantly different between the two groups. CONCLUSIONS: While KTP laser-assisted marsupialization may offer some advantages such as reduced vocal fold damage and ease technique, the higher recurrence rates observed in this study suggest that this technique may not achieve cure rates comparable to conventional surgery. Therefore, careful consideration is necessary when selecting patients for this procedure, and further research is needed to refine the technique and evaluate its long-term efficacy. LEVEL OF EVIDENCE: Level III.

Deficiency of geranylgeranyl biphosphate synthase in kidney tubules causes cystic kidney disease.

Polycystic kidney disease (PKD) is a common hereditary kidney disease. Although PKD occurrence is associated with certain gene mutations, its onset regulatory mechanisms are still not well understood. Here, we first report that the key enzyme geranylgeranyl diphosphate synthase (GGPPS) is specifically expressed in renal tubular epithelial cells of mouse kidneys. We aimed to explore the role of GGPPS in PKD. In this study, we established a Ggppsfl/fl:Cdh16cre mouse model and compared its phenotype with that of wild-type mice. A Ggpps-downregulation HK2 cell model was also used to further determine the role of GGPPS. We found that GGPPS was specifically expressed in renal tubular epithelial cells of mouse kidneys. Its expression also increased with age. Low GGPPS expression was observed in human ADPKD tissues. In the Ggppsfl/fl:Cdh16cre mouse model, Ggpps deletion in renal tubular epithelial cells induced the occurrence and development of renal tubule cystic dilation and caused the death of mice after birth due to abnormal renal function. Enhanced proliferation of cyst-lining epithelial cells was also observed after the knockout of Ggpps. These processes were related to the increased rate of Rheb on membrane/cytoplasm and hyperactivation of mTORC1 signaling. In conclusion, the deficiency of GGPPS in kidney tubules induced the formation of renal cysts. It may play a critical role in PKD pathophysiology. A novel therapeutic strategy could be designed according to this work.

A case with an ectopic ejaculatory duct opening into the bladder trigone in Zinner syndrome, congenital unilateral renal agenesis, and an ipsilateral seminal vesicle cyst.

Introduction: This report describes a case with an ectopic ejaculatory duct opening into the bladder trigone in Zinner syndrome, congenital unilateral renal agenesis, and an ipsilateral seminal vesicle cyst. Case presentation: The patient was identified when no left kidney was detected in the fetal period. Abdominal ultrasonography and pelvic plain MRI at 6 months old revealed a 10-mm cystic lesion on the dorsal aspect of the bladder. Cysto-urethroscopy at 1 year old revealed a rather short posterior urethra and right and left inferior crests extending from the posterior urethra beyond the bladder neck. The ejaculatory duct opening was identified on the bladder trigone. Conclusion: Anatomical abnormality of the ejaculatory duct may represent a cause of infertility and ejaculatory dysfunction in Zinner syndrome. Endoscopic evaluation should be performed for this rare anomaly, even in children.

Orbital hydatid cyst and its successful treatment: A case report from Afghanistan.

Purpose: This study aims to underscore the rarity of intraorbital hydatid disease caused by Echinococcus granulosus, emphasizing the importance of comprehensive exploration and documentation for effective management. Observations: Clinical presentations include proptosis, visual deterioration, ocular motility disruptions, and chemosis. A case study of an 8-year-old boy with a retroorbital hydatid cyst successfully resected through a right transcaruncular orbitotomy approach is presented, highlighting surgical complexities and the efficacy of pre and post-operative albendazole therapy. Conclusion and Importance: The successful excision and management of the intraorbital hydatid cyst underscore the significance of accurate diagnosis and precise surgical intervention. This case emphasizes the importance of expanding knowledge about this rare manifestation, contributing to enhanced diagnostic and treatment strategies for optimal outcomes in managing global health concerns.

Sclerotherapy with absolute alcohol in a child with spinal aneurysmal bone cyst: A case report.

Aneurysmal bone cyst (ABC) is a benign and locally proliferative vascular disorder in the form of a non-neoplastic bone lesion commonly found in children and young adults. Several treatments and therapeutic options are available. Percutaneous sclerotherapy is an alternative treatment for ABC with less morbidity than other therapies. An 11-year-old girl presented with a lump in her left flank since 10 months ago with paresthesia, and leg weakness. The patient was unable to raise her legs and walk. The patient underwent posterior surgical and stabilization procedures with tumor extirpation. Three months postsurgery, the lump progressively increased and tenderness. MRI showed an expansile destructive lytic lesion, firm borders, regular margins, and multiple septa with clear transition zones, without periosteal reactions, forming a picture of a "soap bubble appearance" surrounding the lumbar paravertebral. The patient underwent sclerotherapy using 5 ml of absolute alcohol under visual fluoroscopy guidance. After the sclerotherapy, the patient showed clinical improvement and decreased lump size. No side effects or massive bleeding were experienced postsclerotherapy. Thoracolumbar x-ray post sclerotherapy showed a decreased mass size in the posterior lumbar area. This case demonstrates that sclerotherapy presents a secure alternative for pediatric patients in contrast to spinal ABC surgery. It offers minimal invasiveness and reduced morbidity. The percutaneous administration of absolute alcohol proves effective in treating spinal ABC. In this case, the patient experienced clinical improvement, leading to a decrease in lump size. There were no instances of significant bleeding around the lump postsclerotherapy.

A rare case of inferior rectus dermoid cyst causing proptosis and optic neuropathy.

Purpose: To report a rare case of orbital dermoid cyst, involving the inferior rectus muscle, in a 26-year-old female presenting with proptosis and blurred vision in her right eye. Observations: The unique features of this case are discussed, including the location and contents of the cyst, the surgical approach, and the postoperative outcome. Conclusion and importance: The importance of considering dermoid cysts in the differential diagnosis of an orbital mass involving extraocular muscles and the need for a thorough evaluation to diagnose and manage these rare lesions.

Influence of a simple cyst on kidney function.

Introduction: The aim of the study was to estimate the influence of a simple kidney cyst on kidney function and to determine indications for surgical treatment. Materials and methods: In this prospective cohort study, we analyze data on 109 patients who sought counseling with a simple kidney cyst. Patients with solitary cyst of the right or left kidney, grade I-IIF according to the Bosniak classification, were included. Split glomerular filtration rate (sGFR) was calculated. The maximum size of the cyst, single kidney volumes (SKV) and the volume of the lost (atrophied) parenchyma were estimated with computed tomography (CT) scan of the urinary tract with contrast. Results: The average difference between the sGFR of a healthy and affected kidney cyst was 11 [8.70; 13.44] ml/min, which is a statistically significant value (p = 0.001). Correlation analysis revealed a statistically significant relationship between the proportion of lost parenchyma and the maximum cyst size: p = 0.37 with 95% CI [0.20; 0.52] (p = 0). A multivariate logistic regression model showed that a statistically significant factor influencing the likelihood of a significant decrease in sGFR is the percentage of lost kidney parenchyma (OR = 1.13; p = 0). Conclusion: The growth of kidney cyst causes atrophy of the renal parenchyma and a decrease in the sGFR of the affected kidney. An increase in the volume of the atrophied parenchyma leads to a decrease in the sGFR of the affected kidney.

Simple Bone Cyst Within Florid Cemento-Osseous Dysplasia: A Report of Two Cases.

Florid cemento-osseous dysplasia (FCOD) can rarely be associated with bone lesions, including simple bone cysts (SBCs). Only a few cases showing the co-occurrence of these two distinct entities have been reported in the literature. This article reports two new cases of SBCs within FCOD. The first case involves a 37-year-old Black female with a large radiolucent lesion around the apex of the right third mandibular molar, accompanied by multiple cemento-osseous lesions around the mandibular teeth. Surgical exploration revealed an empty bone cavity, confirming the diagnosis of an SBC. Curettage of the bone walls was performed to stimulate healing, with promising results observed at the nine-month follow-up. The second case concerns a 44-year-old Black female presenting with a radiolucent lesion at the site of extraction of the left third mandibular molar and a slightly painful radiolucent/radio-opaque lesion in the apical region of the right first mandibular molar. Surgical exploration confirmed an SBC in the region of the left third mandibular molar and a bone biopsy was made. Histopathological analysis confirmed FCOD. Curettage of the bone wall was again used to promote healing through increased bleeding. At the 30-month follow-up, new dysplastic lesions had appeared, the initial SBC had healed completely, and a new SBC seemed to have developed in the apical region of the left second mandibular premolar. These cases highlight the importance of considering SBCs in the differential diagnosis of well-defined radiolucent lesions and demonstrate that surgical intervention for SBC-associated FCOD can yield favorable outcomes. From these cases, we learn the critical need for accurate diagnosis to avoid unnecessary treatments and the value of regular follow-up to monitor for recurrence or new lesions.

Genome Announcement: Draft Genome Assembly of Heterodera humuli Generated Using Long-Read Sequencing.

The hop cyst nematode, Heterodera humuli, is the most common plant-parasitic nematode associated with hop worldwide. This study reports the draft genome of H. humuli generated on the PacBio Sequel IIe System with the ultra-low DNA input HiFi sequencing method, and the corresponding genome annotation. This genome resource will help further studies on H. humuli and other cyst nematodes.

An attempt to generate panoramic radiographs including jaw cysts using StyleGAN3.

OBJECTIVES: The purpose of this study was to generate radiographs including dentigerous cysts by applying the latest generative adversarial network (GAN; StyleGAN3) to panoramic radiography. METHODS: A total of 459 cystic lesions were selected, and 409 images were randomly assigned as training data and 50 images as test data. StyleGAN3 training was performed for 500 000 images. Fifty generated images were objectively evaluated by comparing them with 50 real images according to four metrics: Fréchet inception distance (FID), kernel inception distance (KID), precision and recall, and inception score (IS). A subjective evaluation of the generated images was performed by three specialists who compared them with the real images in a visual Turing test. RESULTS: The results of the metrics were as follows: FID, 199.28; KID, 0.14; precision, 0.0047; recall, 0.00; and IS, 2.48. The overall results of the visual Turing test were 82.3%. No significant difference was found in the human scoring of root resorption. CONCLUSIONS: The images generated by StyleGAN3 were of such high quality that specialists could not distinguish them from the real images.

Discharge of ballast residual sediments during de-ballasting procedures: A more realistic estimate of propagule pressure.

Ship ballast residual sediments are an important vector of introduction for non-indigenous species. We evaluated the proportion of residual sediments and associated organisms released during de-ballasting operations of a commercial bulk carrier and estimated a total residual sediment accumulation of ∼13 t, with accumulations of up to 20 cm in some tank areas that had accumulated over 11 years. We observed interior hull-fouling (anemones, hydrozoans, and bryozoans) and high abundances of viable invertebrate resting stages and dinoflagellate cysts in sediments. Although we determined that <1 % of residual sediments and associated resting stages were resuspended and released into the environment during individual de-ballasting events, this represents a substantial inoculum of 21 × 107 viable dinoflagellate cysts and 7.5 × 105 invertebrate resting stages with many taxa being nonindigenous, cryptogenic, or toxic/harmful species. The methods used and results will help estimate propagule pressure associated with this pathway and will be relevant for residual sediments and nonindigenous species management.

Macrophage polarization in human periapical lesions in relation to histopathological diagnosis, clinical features and lesion volume: An ex vivo study.

AIM: To evaluate M1 and M2 macrophage polarization in radicular cysts and periapical granulomas through an immunohistochemical analysis and the correlation between macrophage polarization and histopathological diagnosis, clinical characteristics and lesion volume using cone-beam computed tomography. METHODOLOGY: Periapical biopsies diagnosed as radicular cysts (n = 52) and periapical granulomas (n = 51) were analysed by immunohistochemical method. Teeth with periapical lesion with no history of root canal treatment (primary lesion) and lesions persistent to root canal treatment (persistent lesions) were included. Pathological diagnosis, patients' age, gender and clinical characteristics were obtained from treatment records. A cone-beam computed tomographic periapical volume index (CBCTPAVI) score was assigned to each periapical lesion based on the volume of the lesion. Immuno-expressions of CD68 and CD163 were quantified. The CD68/CD163 ratio was adopted to represent M1 or M2 macrophage polarization. Mann-Whitney U test was used to determine the different CD68/CD163 ratio between groups of radicular cyst and periapical granuloma. Spearman's correlation test was performed to assess the correlation between the CD68/CD163 ratio and lesion volume and CBCTPAVI score. RESULTS: Radicular cysts and periapical granulomas had CD68/CD163 median of 2.05 (IQR = 1.33) and 1.26 (IQR = 0.81), respectively. A significantly higher CD68/CD163 ratio was observed in radicular cysts (p < .001). In contrast, periapical granulomas had significantly lower median of CD68/CD163 ratio. Larger lesions had a higher median of CD68/CD163 ratio, while smaller lesions had lower median of CD68/CD163 ratio (p = .007, rs = .262). CD68/CD163 ratio was significantly correlated with the CBCTPAVI score in the overall periapical lesions (p = .002, rs = .306). The higher CD68/CD163 ratio in larger lesions indicated a higher degree of M1 polarization compared to smaller lesions. Regarding the pathological diagnosis, there was a significant positive correlation between CBCTPAVI score and CD68/CD163 ratio in periapical granulomas (p < .001, rs = .453), whereas the negative correlation was observed for radicular cysts (p < .001, rs = -.471). CONCLUSIONS: Periapical granulomas are characterized by a M2-dominant macrophage polarization, while radicular cysts have significantly higher M1 macrophages. The higher degree of M1 macrophage polarization was significantly correlated with larger volume and higher CBCTPAVI scores of overall periapical lesion and periapical granuloma.

Pericardial hydatid cysts presenting with atrial flutter and mitral regurgitation.

Despite being a rare phenomenon, pericardial hydatid cysts present unique diagnostic challenges and require a multimodality imaging as well as a multidisciplinary approach for a curative management. The authors here present a case of a middle aged man who was referred to them for management of new onset atrial flutter with mitral regurgitation.

Pancreas Cyst Diagnosis and Advances in Cyst Fluid Analysis.

Pancreatic Cystic Neoplasms (PCN) represent a diverse group of tumors, some of which may progress to pancreatic cancer. Considering their high prevalence in the general population, the development of reliable biomarkers is crucial. The ideal biomarker will accurately diagnose the subtype of PCN and assess the risk of high-grade dysplasia or invasive cancer. Cyst fluid analysis has emerged as a promising approach to accomplish this goal, yet no single marker has yet gained unanimous support for routine inclusion in PCN evaluation.

Renal Hydatid Cyst: Diagnostic Quandaries and Surgical Strategies.

Renal hydatid cyst, an uncommon manifestation of Echinococcus granulosus infection, presents a diagnostic challenge due to its asymptomatic nature. Here, we report the case of a 34-year-old male who presented with intermittent left flank pain, abdominal fullness, and passage of whitish clots in urine. Physical examination revealed a palpable 15 cm × 11 cm hard mass extending from the left hypochondrium to the left lumbar region. Ultrasonography and contrast-enhanced computed tomography identified a 15 cm Bosniak type 3 complex cystic lesion arising from the left kidney, causing hydronephrosis and hydroureter. The patient underwent a left nephrectomy, and a histopathological examination confirmed a renal hydatid cyst. This case highlights the diagnostic difficulty in differentiating renal hydatid cysts from other renal lesions. Despite suggestive radiological findings, conclusive diagnosis remains elusive, particularly in solitary complex renal cysts. Awareness of renal hydatid cysts in the differential diagnosis is crucial for appropriate management.

Minimally invasive spleen-preserving surgery to treat primary splenic hydatidosis: short and long-term outcomes: a cohort study.

Background: Primary splenic hydatidosis, a rare manifestation of Echinococcus granulosus infection, presents unique diagnostic and therapeutic challenges. This study compares spleen-preserving surgeries with total splenectomy for treating primary splenic hydatid cysts, focusing on short- and long-term outcomes in the Jordanian context, a region particularly affected by this condition. Methods: This retrospective analysis was conducted on 18 patients diagnosed with primary splenic hydatid cysts at two Jordanian hospitals from January 2015 to June 2021. Selection criteria included confirmed diagnosis and complete medical records. Surgical approaches, including laparoscopic partial splenectomy, cystectomy, and cyst deroofing, supplemented by albendazole therapy, were compared based on patient demographics, symptoms, surgical details, complications, and recurrence rates. Results: The study group was composed of (n=7, 38.9%) male and (n=11, 61.1%) female patients, with an average age of 33.7 years. Most presented with left upper quadrant pain. Postoperative complications occurred in 22% of patients, with an 11% recurrence rate during follow-up. No significant statistical difference in recurrence rates was observed between spleen-preserving surgeries and total splenectomy. These findings highlight the efficacy of less invasive, spleen-preserving techniques in managing primary splenic hydatidosis, showing comparable outcomes to total splenectomy with minimal impact on recurrence rates. Conclusion: Spleen-preserving surgery offers a viable alternative to total splenectomy in treating primary splenic hydatid cysts. This approach maintains immune functionality and reduces septic risks, especially in pediatric patients. The study underscores the importance of individualized treatment approaches and suggests further research with larger cohorts for more comprehensive insights into managing this rare condition. The limitations of this study include its small sample size and retrospective nature.

Magnetic resonance imaging features of bilateral multiloculated extraneural ganglion cysts of the occipito-atlanto-axial joint causing hypoglossal nerve paralysis in a dog.

A 14-year-old spayed female Miniature Pinscher presented with tongue curling, dysphagia, hypersalivation, and sublingual gland swelling. Comprehensive evaluation, including neurologic and musculoskeletal examinations, blood work, and urinalysis, revealed no abnormalities other than tongue-related signs. Magnetic resonance imaging (MRI) revealed a multilobed cystic structure in the occipito-atlanto-axial joint, compressing the right hypoglossal canal. The lesion appeared cerebrospinal fluid (CSF)-like on T1-weighted and T2-weighted images, and hyperintense compared with CSF on fluid-attenuated inversion recovery T2-weighted images. The scans suggested mucinous content with enhanced peripheral areas on contrast-enhanced images. Surgical removal and drainage of this cyst were performed, and clinical signs improved markedly. The dorsal cyst was tentatively diagnosed as a ganglion cyst based on histopathologic and imaging findings. Ganglion cysts should be considered in the differential diagnosis for dogs with similar MRI findings and neurologic signs.

Digital mucous cyst marsupialization: Surgical technique.

Digital mucous cysts are benign synovial fluid collections that typically involve the lateral or dorsal surfaces of the distal interphalangeal joints (DIPJs) or beneath the proximal nail fold. They are typically found in the setting of arthritic degeneration of the underlying joint and occur most frequently between the fifth and seventh decades. 1 Many treatment options for digital mucous cysts have been described, ranging from conservative/minimally invasive to complete surgical excision, with no consensus on best technique. Here, a surgical approach is presented which allows access to address the cyst pedicle as well as any underlying osteophyte while preserving the overlying skin with good outcomes even with compromised or involved dermis and epidermis. This is a reproducible, readily adaptable technique. The surgical technique is presented and reviewed in detail.

Efficacy of ranibizumab and aflibercept on reducing maximum diameter of largest cyst in diabetic cystoid macular edema: MARMASIA study group.

PURPOSE: This study aimed to compare the effect of intravitreal aflibercept (IVA) and ranibizumab (IVR) on the maximal diameter of the largest intraretinal cyst (mdIRC), indicating chronicity in patients with diabetic cystoid macular edema (CME). METHODS: This retrospective, comparative study included a subgroup of patients from the MARMASIA Study with treatment-naïve diabetic CME who had IVA (IVA group) or IVR (IVR group) on a pro re nata regimen after a loading dose of 3-monthly injections and followed-up for 24 months. Best-corrected visual acuity (logMAR), central macular thickness (CMT, µm), and mdIRC (µm) and their changes during the study period in the IVA and IVR groups were compared. RESULTS: A total of 175 eyes (65 [37.1%] in IVA and 110 [62.9%] in IVR group) of 113 patients were included in the study analysis. Both groups had statistically significant improvements in BCVA and CMT during the follow-up (p < 0.05 for all), which were comparable between the groups at each time point. However, the mean reduction in mdIRCs was consistently and significantly higher in the IVA group compared to the IVR group at each follow-up examination (F[1, 3.52] = 6.93, p = 0.009). CONCLUSION: IVA seems to have a greater impact in reducing cyst sizes than IVR in diabetic CME.

Repurposing of a library for high-content screening of inhibitors against Echinococcus granulosus.

BACKGROUND: Cystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of the dog tapeworm Echinococcus granulosus sensu lato (E. granulosus), with a worldwide distribution. The current treatment strategy for CE is insufficient. Limited drug screening models severely hamper the discovery of effective anti-echinococcosis drugs. METHODS: In the present study, using high-content screening technology, we developed a novel high-throughput screening (HTS) assay by counting the ratio of propidium iodide-stained dead protoscoleces (PSCs) to the total number of PSCs. In vitro and ex vivo cyst viability assays were utilized to determine the effect of drugs on cyst viability. RESULTS: Using the newly established HTS assay, we screened approximately 12,000 clinical-stage or The Food and Drug Administration (FDA)-approved small molecules from the Repurposing, Focused Rescue, and Accelerated Medchem (ReFRAME) library, as well as the LOPAC1280 and SelleckChem libraries, as a strategic approach to facilitate the drug discovery process. Initial screening yielded 173 compounds with anti-echinococcal properties, 52 of which demonstrated dose-response efficacy against E. granulosus PSCs in vitro. Notably, two agents, omaveloxolone and niclosamide, showed complete inhibition upon further validation in cyst and microcyst viability assays in vitro after incubation for 3 days, and in an ex vivo cyst viability assay using cysts isolated from the livers of mice infected with E. granulosus, as determined by morphological assessment. CONCLUSIONS: Through the development of a novel HTS assay and by repurposing libraries, we identified omaveloxolone and niclosamide as potent inhibitors against E. granulosus. These compounds show promise as potential anti-echinococcal drugs, and our strategic approach has the potential to promote drug discovery for parasitic infections.