Complicated cyst

Simple cyst -Complicated cysts -Cystic end stage KD ( acquired cystic KD ) ... 

On non-enhanced CT scans a hepatic cyst appears as a round or ovoid well-defined lesion, with no evident wall. It has a homogeneous and hypoattenuating content with attenuation values similar to water (<20 HU) (Fig. 7.1c). After contrast media injection, both the wall or its content do not show any enhancement (Fig. 7.1b) (Mathieu et al. 1997). Higher attenuation values (>20 HU) are present in cyst with hemorrhage or inflammation inside in these cases complicated cysts are difficult to differentiate from... 

In a study of the mechanism and frequency of this complication, hormone concentrations in 20 premenopausal women taking tamoxifen (20 mg/day) were compared with those in untreated controls (74). Ovarian cysts were found in 80% of the treated patients but only in 8% of controls, and 17-beta-estradiol concentrations were significantly raised. 

K. Unusual complication of l datid cysts Acute inferior vena caval thrombosis. Dig. Surg. 1993 10 114-115... 

Cutaneous adverse effects were the most frequent problem and (together with hepatic complications) the most serious 63% of 300 patients treated for 6 months complained of one or more adverse effects (total 259 reactions) 70% were cutaneous photosensitivity led to withdrawal in 30% of cases. Multiple subepidermal cysts (milia) on sun-exposed skin areas and onycholysis (13% of patients) were documented. Other skin reactions included rashes, hypertrichosis, erythema multiforme, and Stevens-Johnson sjm-drome (2). Phototoxicity persisted for many months after withdrawal (SEDA-12, 84) although a later study on persistent photosensitivity as a sequel to benoxaprofen in 42 subjects failed to confirm the link between photosensitivity and the drug (3), this was contrary to the overwhehning experience in the field. In retrospect, it seems likely that one problem was that benoxaprofen had largely been studied during the winter months, whereas in the UK it was launched in the summer. 

There have been several studies of the efficacy of albendazole in preventing recurrences of hydatid disease and cyst fluid spillage complications after surgery. In one Turkish study 22 of 36 patients with echinococcosis were treated with albendazole after surgical intervention (8). There was no significant benefit of perioperative albendazole over operation alone, although the recurrence rate of hepatic echinococcosis was lower than in historical controls. In contrast, in another study in 22 patients with... 

Controversies in the management of neurocysticercosis have been described (10-12). The management of the neurological complications of cysticercosis and in particular the role of antiparasitic drugs are issues of debate. It is commonly believed that the use of antiparasitic drugs and steroids should be individualized, based on the presence of active or inactive disease, the location of the cysts, and the presence or absence of complications such as hydrocephalus. 

When 99% ethanol was instilled into renal cysts under ultrasound guidance in 25 cases, there were 12 complications after puncture, either related to the puncture itself or caused by the ethanol (17). They included flank pain. 

Furuta H, Nakada T, Akiya T, Ishikawa N, Satomi S, Sakamoto M, Kohno T, Kazama T, Umeda K, Sasagawa I, et al. [Renal cyst puncture under ultrasound guidance complications of ethanol injection.] Hinyokika Kiyo 1988 34(9) 1575-8. 

The management and operative complications in 70 patients with hydatid disease aged 10-78 years have been studied retrospectively to assess the impact of albendazole and praziquantel compared with surgery (3). In all, 39 patients received albendazole and praziquantel in combination and 19 received albendazole alone none was treated with praziquantel alone. The combined use of albendazole and praziquantel preoperatively significantly reduced the number of cysts that contained viable protoscolices. 

Complications associated with i.m. administration include nerve injury, muscle contracture, and abscess formation. Less common problems include intramuscular hemorrhage, cellulitis, skin pigmentation, tissue necrosis, muscle atrophy, gangrene, and cyst or scar formation. In addition, injury may occur from broken needles and inadvertent injection into a joint or vein. ... 

These small epidermal inclusion cysts " are a relatively common and fortunately benign complication of medium or deep peels, and occur mainly when the peels have been followed by greasy occlusion or occlusive make-up. They can vary in number from a single cyst to several hundred, and usually appear in the midface region or on the cheeks. A latency period of several weeks (3-6) is necessary before they become visible, and it takes 6-12 weeks of patience for them to disappear, unless patients run out of patience and remove them themselves or ask the doctor to do it. 

Albendazole also is the preferred treatment of neurocysticercosis caused by larval forms of T. solium. The recommended dose is 400 mg given twice a day for adults for 8-30 days, depending on the number, type, and location of the cysts. For children, the dose is 15 mg/kg/day (maximum 800 mg) in two doses for 8-30 days. The course can be repeated as necessary, as long as liver and bone marrow toxicides are monitored. To reduce inflammatory side effects, glucocorticoids are usually given for several days before initiating albendazole therapy. Such pretreatment also increases plasma levels of albendazole sulfoxide. Therapy with either albendazole or praziquantel should include consideration of anticonvulsant therapy, the possible development of complications of arachnoiditis, vasculitis, or cerebral edema, and the need for surgical intervention should obstructive hydrocephalus occur. Albendazole, 400 mg/day, also has shown efficacy for therapy of microsporidial intestinal infections in patients with AIDS. 

In a woman with an 18-month history of galactorrhea (inappropriate secretion of breast milk), tests revealed a complicated breast cyst, very high levels of estrogen (543 pg/ml), and low levels of follicle-stimulating hormone (1.2 mlU/ml) and luteinizing hormone (1.7 mlU/ml). The... 

Patients with PLD can present with abdominal pain, hepatomegaly, and symptoms associated with renal involvement. Complications of hepatic cysts include compression of the biliary tree and fever secondary to cyst infection or abscess formation (Fig. 4.5b-d). 

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