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Evaluation of the recovery of waterborne Giardia cysts by freshwater clams and cyst detection in clam tissue.

The Asian freshwater clam, Corbicula fluminea, inhabits environments recognized to be contaminated with waterborne Giardia cysts. Sixty-four tissue samples of Giardia-free clams were spiked with various numbers of Giardia duodenalis cysts within the range of 50-700 cysts. Regression analysis showed that paired numbers of spiked (x) versus recovered (y) cysts regressed significantly (P < 0.01) according to the equation y = 42.57 +/- 1.81x (+/- 64.3). The cyst detection threshold was 43 cysts/clam, the coefficient of determination was 77%, and the overall sensitivity of cyst detection was 42.9%. All 20 values of cyst numbers in clam tissue samples that were processed blind were located within the 95% prediction limits of the linear regression equation. The cyst retention rate of 160 clams kept in an aquarium with 38 l of water spiked with 1.00 x 10(5) G. duodenalis cysts was approximately 1.3 x 10(3) cysts/clam. No waterborne cysts were detected by the membrane filtration method 90 min after spiking the aquarium water. G. duodenalis cysts were detected in clam tissue up to 3 weeks post-exposure. Filtration of water by clams substantially depleted the aquarium water of its particulate matter. The sampling program demonstrated that the population of 160 clams examined during the study could be accurately assessed for exposure to waterborne Giardia cysts by random sampling of 86 (54%) clams. The results indicate that C. fluminea clams can be used for biological monitoring of contamination with Giardia.

Analysis of Variance↗

The chemical composition of the cyst wall of the potato cyst-nematode, Heterodera rostochiensis.

1. Cyst walls of the potato cyst-nematode (Heterodera rostochiensis Woll.) were isolated by sieving a suspension of crushed cysts. About 12mg. of dried cyst walls was obtained from 1000 cysts. 2. The cyst walls contained mainly protein (72%, calculated from nitrogen content). On acid hydrolysis about 77% of the cyst wall went into solution. Of 19 amino acids present, proline, glycine, and alanine were the most abundant, and made up about 50% by weight of the total amino acids. The amino acid composition suggested that collagen-like proteins predominated in the cyst wall and larval cuticle. 3. A small amount of glucosamine (1.5%) was present in the hydrolysates, but chitin was not detected in the cyst walls. 4. Other components of the cyst walls were lipid (2%), carbohydrate (0.5%) and a small amount of inorganic matter (ash, 5%). Polyphenols (2% by wt. of the cyst walls) occurred in the acid hydrolysates. The dark pigments of the cyst wall were not indole-containing melanins.

Amino Acids↗

Cyst function in polycystic kidney disease: nongradient cysts.

Previous studies from this laboratory have demonstrated active sodium transport by cyst epithelia obtained from human polycystic kidneys. Cysts which maintained a steep sodium gradient between cyst fluid and plasma (gradient cysts) exhibited conductive amiloride sensitive sodium transport. Cysts which failed to maintain a sodium gradient between cyst fluid and plasma (nongradient cysts) were insufficiently characterized. In the present study, we report flux and electrical parameters of 23 nongradient cysts studied in vitro. Nongradient cysts exhibit low PD, low Isc, and high conductance. Unidirectional fluxes of sodium and chloride varied from approximately 14.4 to greater than 250 microEq.h-1.cm-2 and net flux was not significantly different from zero. There was no apparent effect on flux or electrical parameters of amiloride, ouabain, acetazolamide, or bumetanide. There was a very high correlation between unidirectional flux of sodium and chloride in individual cysts which was similar to the predicted relationship for diffusional fluxes. This correlation suggested that movement of sodium and chloride across cyst membranes was passive via an aqueous channel. Estimates of ionic permeability exceeded those determined for proximal nephron by almost one order of magnitude. We conclude that nongradient cysts are nonfunctional and, regardless of their origin, do not function analogously to the proximal nephron.

Absorption↗

[A Rathke's cleft cyst with a moving mass in the cyst].

We reported a case of Rathke's cleft cyst (RCC) with a moving mass in the cyst. A fifty-eight-year-old woman complaining of headache was admitted to our hospital. She suffered from hyponatremia, hypothalamic hypopituitarism, but did not show any neurological deficits, nor visual field nor visual acuity disturbance. MRI revealed an intrasellar cyst including a mass shadow and the cyst did not compress the hypothalamus. Interestingly, this mass moved gradually from the floor to the posterior wall of the sella turcica according to changes in position from standing to supine. We operated to remove the cyst partially by transsphenoidal approach. Xanthochromic fluid flowed out from the cyst. In addition, a brownish globular mass, 6 mm in diameter, existed within the cyst without connection to the surrounding tissue. Pathological findings showed that the capsule consisted of cuboid epithelium and was partially stratified, which confirmed the diagnosis of Rathke's cleft cyst. However, the mass was homogeneously stained with H.E., containing no cells, cellular debris, nor connective tissue. PAS stain was negative. Though we could not clarify the material in the cyst, this case is very rarely one of Rathke's cleft cyst. This case demonstrated the possibility of hypothalamic hypopituitarism in spite of the cyst being almost located in the sella turcica. We surmise that a cyst near the stalk of the pituitary gland, even if it is not so large, might compress the portal vein, and thus the function of hypothalamus-pituitary axis.

Craniopharyngioma↗

Cyst fluid cytology and chemical features in a case of lymphoepithelial cyst of the pancreas: A rare and difficult preoperative diagnosis.

Most pancreatic cysts (90%) are inflammatory pseudocysts. Approximately 10% of pancreatic cysts are neoplasms, including serous cystadenomas, and mucinous tumors, some of which are malignant. Analysis of pancreatic cyst fluid obtained by percutaneous or endoscopic fine-needle aspiration is increasingly being used for the preoperative diagnosis of pancreatic or peripancreatic cysts. However, cyst fluid chemical and cytologic features in less common types of pancreatic cysts have not been reported. Lymphoepithelial cyst of the pancreas is exceedingly rare, and only occasional individual reports have described cyst fluid findings. We report on a case of lymphoepithelial cyst of the pancreas developing in a middle-aged man. Cyst fluid aspirated under radiological guidance showed elevated levels of carcinoembryonic antigen (CEA), CA19-9, CA 125, and amylase, and a viscosity greater than that of serum. A cell block preparation of a fine-needle aspiration showed tissue fragments with a keratinized squamous lining and a lymphocytic infiltrate in the wall, and abundant background keratinous debris. The cytologic and biochemical findings in this case exhibit similarities to the findings reported in other reports, and may represent a recognizable pattern on cyst fluid analysis.

Amylases↗

Increased concentrations of nitrate and nitrite in the cyst fluid suggesting increased nitric oxide synthesis in solitary bone cysts.

The etiology and treatment of a solitary bone cyst have remained undefined. Surgical treatments have not been encouraging, because a less invasive corticosteroid-injection treatment has afforded good results. However, there has been little scientific rationale supporting corticosteroid treatment. In recent reports, bone-resorbing factors, including matrix metalloproteinases, prostaglandins, interleukin-1, and oxygen free radicals, have been demonstrated in the cyst fluid. To better elucidate the pathophysiology of the solitary bone cyst, we examined the activities of nitric oxide and cytokines in the cyst fluid as well as in the cyst membrane. The levels of nitrate and nitrite were significantly higher in the cyst fluid than in serum. Immunostaining of cells in the stroma and lining cells of the cyst wall was strongly positive for inducible nitric synthase. The levels of interleukin-6 and interleukin-1beta in the cyst fluid were elevated, and cells in the cyst membrane were positive for tumor necrosis factor-alpha, interleukin-6, and interleukin-1beta. Cultured cells from the cyst membrane were induced in the production of nitrate and nitrite in response to cytokine treatment. These findings suggest that the solitary bone cyst was in a state favorable for the production of nitric oxide.

Adolescent↗

Treatment of jaw cysts with an irrigational method. On the significance of the method and the progress of cysts.

It is held that cysts in jaws enlarge as the cyst fluids increase and that the intracystic fluid pressure on the jaw bones increases because of inflammation. According to this investigation, cysts enlarge in the following manner: when a cyst is infected, the cyst wall becomes almost bloodless; cell membranes of the wall are destroyed, and unsaturated fatty acids depart from the membranes; these unsaturated fatty acids generate prostaglandins and lipoperoxides which lower the reaction of cyclic AMP; the result is resorption of the jawbone; therefore, control of the cyst inflammation is the first requirement in the treatment of the cyst. For control of the inflammation, exchanges of cyst fluids for liquids, including antibiotics, were carried out once a week. As a result, the volume of cyst fluids decreased, the cysts diminished in size, and clearing tissues were scarcely seen. It can be maintained that this irrigational method is effective for the treatment of cysts in jaws.

Anti-Bacterial Agents↗

A biochemical study on the nature of jaw cysts (III). Instrumental analysis of the viscous component of fluids in ciliated cysts of the maxilla.

Cyst fluids are composed of electrolytes, proteins, lipids and viscous components. These substances affect the state of jaw cysts. Jaw cysts whose inner wall layer is ciliated epithelium contain high-viscosity fluids. This study comprised 30 cases of the following types of jaw cysts: nasopalatine, mucosal and ciliated cysts of the maxilla. And the author chiefly investigated ciliated cysts of the maxilla. Their fluid contents were extracted and pre-treated for analysis. It was concluded that hyaluronidase in cyst fluids causes cyst walls to decompose hyaluronic acid in the cellular interstitium of cyst walls or in the basement membrane of the cellular layer and convert it into cyst fluid, hence it is confirmed that the main component of viscous cyst fluid is hyaluronic acid.

Chondroitin Sulfates↗

Endoscopic treatment of symptomatic septum pellucidum cysts: with some preliminary observations on the ultrastructure of the cyst wall: two technical case reports.

OBJECTIVE AND IMPORTANCE: We describe two patients with symptomatic septum pellucidum cysts managed by endoscopic fenestration. In each case, tissue from the cyst wall was studied to define the origin of the cyst wall and fluid. CLINICAL PRESENTATION: The patients, a 6-year-old boy and a 42-year-old man, each presented with headaches and a syncopal episode. Imaging studies demonstrated large septum pellucidum cysts with obstruction of the foramina of Monro. INTERVENTION: The patients underwent endoscopic transventricular cyst fenestration with a 4-mm steerable fiberscope. The fenestrations were created to allow communication with the right and left lateral ventricles. In one patient, adhesions between the cyst wall and the foramen of Monro were lysed with endoscopic monopolar cautery. Tissue from the cyst walls was removed for examination by electron microscopy. Postoperatively, the headaches and syncopal episodes resolved in both patients. CONCLUSION: Endoscopic fenestration of symptomatic septum pellucidum cysts produces immediate relief of the mass effect of the cyst and resolution of associated symptoms. Cannulation of the lateral ventricle before cyst fenestration prevents inadvertent injury to the fornices, thalamus, internal capsule, caudate nucleus, and septal and thalamostriate veins. The endoscopic approach allows the surgeon to ensure communication within the ventricular system, thus avoiding placement of a shunt. Preliminary ultrastructural analysis indicates that the cyst walls derive from the septum pellucidum rather than the choroid plexus or arachnoid. The cellular machinery necessary for fluid secretion was identified in some specimens.

Adult↗

Sacral cyst managed with cyst-subarachnoid shunt: a technical case report.

STUDY DESIGN: This report describes the cyst-subarachnoid shunt, a novel surgical treatment, for sacral cysts. OBJECTIVE: To introduce a new surgical technique for sacral cysts. SUMMARY OF BACKGROUND DATA: There is no consensus on the appropriate treatment for symptomatic sacral cysts. The hydrostatic and pulsatile forces of cerebrospinal fluid are attributed to the growth of the cyst and their becoming symptomatic. METHODS: The clinical and radiologic features of a 41-year-old man with a symptomatic sacral cyst are detailed. A cyst-subarachnoid shunt was set to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and the cyst. RESULTS: Immediately after surgery, the patient had no pain in his left leg and was free of pain at 2 years. Magnetic resonance imaging 1 year after surgery showed a decrease in the size of the cyst. CONCLUSION: Although this is a preliminary study, a cyst-subarachnoid shunt can be a useful alternative for symptomatic sacral cysts.

Adult↗

Benign cysts in the central nervous system: neuropathological observations of the cyst walls.

A diverse variety of benign cysts exist in the CNS. Advances in diagnostic radiology have facilitated diagnoses and surgical intervention in many patients with CNS cysts. However, a fundamental understanding of the pathological features of these lesions is clinically vital. From an etiological point of view, the cysts can be divided into two groups. The first includes lesions that arise from within the CNS and may be static structures such as cavities arising from infarcts and other destructive processes while other lesions such as arachnoid cysts, ependymal cysts, cystic hemangioblastoma, cystic cerebellar astrocytoma and infectious processes, are progressive. The second group of cysts arise from the intrusion of non-nervous system tissue into the neuroaxis and are usually midline. They are frequently expanding congenital lesions although some become symptomatic only in adults. Examples include teratomas, dermoid cysts, epidermoid cysts, craniopharyngiomas, Rathke's cleft cysts, and other epithelial cysts presumably derived from the upper respiratory or intestinal tract. Chick embryos exposed to lead have been used as a model of cyst formation.

Animals↗

Stereotactic cyst wall disruption and aspiration of colloid cysts of the third ventricle.

BACKGROUND: Current strategies of surgical therapy for colloid cysts have been associated with low rates of initial success and high rates of morbidity, mortality and recurrence of cysts. Cyst recurrence following simple stereotactic aspiration has been hypothesized to be due to regrowth of the epithelium composing the cyst wall. METHODS: We propose a procedure involving stereotactic disruption of the colloid cyst wall with the removal of a portion of the cyst wall followed by aspiration of cyst contents as a surgical therapy for colloid cysts. RESULTS: This procedure was performed in 2 female and 3 male patients who were followed for an average of 49 months with all patients demonstrating immediate improvement of symptoms and resolution of the cyst verified with repeat computerized tomography (CT) scans. There was one incidence of recurrence in an asymptomatic patient at 75 months postoperatively. CONCLUSION: We propose that stereotactic partial cyst wall disruption and content aspiration may limit recurrence of colloid cysts, thus offering an advantage over simple stereotactic aspiration alone.

Adult↗

[Cyst puncture and injection of contrast medium for diagnosis and treatment of pericardial cyst].

We present two cases of pericardial cyst diagnosed by cyst puncture and the injection of contrast medium. The first patient was a 48-year-old man. He was admitted for the evaluation of an abnormal chest X-ray which demonstrated a mass lesion inseparable from the right heart border. CT scan confirmed the mass in the anterior cardiophrenic angle. The mass was quite homogeneous, with an attenuation value of -0.3 HU. Under CT guidance a 21-G needle was inserted into the cyst and 3 ml of clear fluid was obtained, and then contrast medium was injected. A thin smooth walled cyst was outlined by the CT scan. A presumptive diagnosis of pericardial cyst was made. Surgery was performed and the diagnosis was confirmed. The second patient was a 24-year-old woman. An abnormal shadow was noted at annual check up. CT scan confirmed the mass in the anterior cardiophrenic angle. The mass was quite homogeneous, with an attenuation value of +10.4 HY. We made the diagnosis of pericardial cyst by cyst puncture and injection of contrast medium. The CT scan after three months showed no recurrence of the pericardial cyst. We consider that pericardial cyst can be diagnosed clearly by cyst puncture and the injection of contrast medium, and only percutaneous aspiration of the cyst fluid may be sufficient for the treatment.

Adult↗

Postoperative follow-up of patients with type IVA choledochal cysts after excision of extrahepatic cyst.

BACKGROUND: This study concerns patients who have choledochal cyst with intrahepatic and extrahepatic involvement (type IVA cyst). The extent of excision and the necessity of hepatectomy, including the intrahepatic cyst in these patients have not been clarified. STUDY DESIGN: We have performed excision of the extrahepatic cyst with hepaticojejunostomy upon 13 patients with type IVA cyst during a 16 year period. The present study was done to examine the size of the anastomotic opening by direct cholangiography two weeks postoperatively. The long-term results were assessed to find the appropriate operative management for patients with type IVA cysts. RESULTS: Intrahepatic cysts were present in both hepatic lobes in 11 patients (85 percent). None of the patients had carcinoma after excision of extrahepatic cyst during the follow-up period, which ranged from two months to 16 years. Postoperative late complications occurred in three patients (23 percent), hepatolithiasis in two and cholangitis in one. The anastomotic opening of hepaticojejunostomy was 13.3 +/- 4.5 mm in diameter two weeks postoperatively, which was not significantly different when compared with that in ten patients without late complications (13.4 +/- 4.9 mm). The late complications were successfully treated with either antibiotics or percutaneous transhepatic cholangioscopy, and none required a reoperation. CONCLUSIONS: The results suggest that additional hepatectomy is not required because carcinoma has rarely occurred from the intrahepatic cyst. Excision of an extrahepatic cyst with a wide hepaticojejunostomy is an acceptable operative management for patients with type IVA cysts.

Adult↗

Expression of cytokeratins in odontogenic jaw cysts: monoclonal antibodies reveal distinct variation between different cyst types.

Immunostaining with monoclonal antibodies was used to study and compare the cytokeratin content of odontogenic cysts and normal gingival epithelium. Two monoclonal antibodies, PKK2 and KA1, stained the whole epithelium in all cyst samples. In gingiva, PKK2 gave a suprabasal staining and KA1 reacted with all epithelial cell layers. Antibodies PKK1, KM 4.62 and KS 8.12 gave a heterogeneous staining in follicular and radicular cysts. In keratocysts and in gingiva PKK1 and KM 4.62 reacted mainly with basal cells and KS 8.12 gave a suprabasal staining. Antibodies reacting with the simple epithelial cytokeratin polypeptide No. 18 (PKK3, KS 18.18) recognized in gingiva only solitary cells compatible with Merkel cells. In a case of follicular ameloblastoma a distinct staining of tumor epithelium was revealed with these antibodies. In 2 follicular cysts, but not in other cyst types, a layer of cytokeratin 18-positive cells was revealed. KA5 and KK 8.60 antibodies, reacting exclusively with keratinizing epithelia, including normal gingiva, gave no reaction in radicular cysts, keratocysts and ameloblastoma. Two of the follicular cysts, were negative for PKK3 and KS 18.18, but reacted strongly with KA5 and KK 8.60. The present results show that odontogenic jaw cysts have distinct differences in their cytokeratin content. With the exception of some follicular cysts, they lack signs of keratinizing epithelial differentiation. Only follicular cysts appear to share with some types of ameloblastoma the expression of cytokeratin polypeptide No. 18.

Ameloblastoma↗

Interrelationships between water and cellular metabolism in Artemia cysts. IV. Adenosine 5'-triphosphate and cyst hydration.

The concentration of ATP in cysts of the brine shrimp, Artemia salina, has been studied as a function of cyst hydration. Cysts dried over CaSO4 contain 0.02 gH2O/g cysts and 0.54 +/- 0.05 (S.D.) mumoles of ATP/g dried cysts. Addition of water up to 0.05 g/g cysts produced no net change in the level of ATP during incubation. Hydration levels between 0.05 and 0.62 g/g cysts resulted in a net loss of ATP, whereas above 0.65 g/g cysts a net increase was observed with incubation time. No net change in the amount of ATP, compared with dried cysts, was detected between the latter two hydrations. These results, when integrated with those from previous work, indicate that conventional aerobic energy metabolism does not begin until cyst hydrations of about 0.65 g/g are achieved. The fate of ATP in cysts hydrated to levels lower than 0.65 g/g was discussed.

Adenosine Triphosphate↗

The composition of the cyst wall of the beet cyst-nematode Heterodera schachtii.

1. Cyst walls of the beet cyst-nematode (Heterodera schachtii Schmidt) were obtained by sieving a suspension of crushed cysts; about 15mg of dried cyst walls was obtained from 1000 cysts. 2. The cyst walls contained 68% protein calculated from nitrogen content. Glutamic acid, glycine, proline and hydroxyproline made up about 54% by weight of the amino acids obtained on acid hydrolysis. 3. Minor constituents of the cyst wall were hexosamine (3.3%), lipid (6%), carbohydrate (2%) and phenols (2%). The hexosamine was identified as galactosamine. 4. The cyst walls contained inorganic material (ash 17%), most of which was extractable with EDTA, but not with water. Major inorganic components were calcium and phosphorus (1.7% and 1.5% respectively, by weight). Carbon dioxide (about 1% by weight) was liberated from the cyst walls on acidification. 5. The cyst walls of H. schachtii and the potato cyst-nematode (Heterodera rostochiensis) contained different amounts of the same amino acids. They also differed in their inorganic content and in the nature of the hexosamine present.

Amino Acids↗

Diagnosis and treatment of hepatic hydatid cysts with the aid of echo-guided percutaneous cyst puncture.

The usefulness of echo-guided percutaneous cyst puncture in the diagnosis and treatment of hepatic hydatid cysts was assessed in a study of 45 patients referred to the Department of Tropical Medicine at Kasr El Aini Hospital in Cairo. All subjects had at least one hepatic cyst detected by ultrasonography (54 cysts in all), and 42 patients had positive results in serological tests for antibodies to Echinococcus granulosus. The majority of cysts were in the right hepatic lobe (40 cysts), were anechoic (51), and were rounded and smooth (49). All 45 active cysts (44 anechoic, rounded, and smooth; one anechoic and septated) yielded clear watery fluid containing scolices and exhibited elevated pressure on percutaneous puncture. In contrast, all nine inactive cysts yielded cloudy yellowish fluid without detectable scolices and did not display elevated pressure on puncture. The latter cysts were anechoic and elliptical (two cysts); anechoic and septated (one); anechoic with a calcified wall (one) or a detached germinal layer (two); or rounded with coarse echoes (three). Treatment by injection of a scolicidal agent (hypertonic saline) before withdrawal of the needle used for aspiration gave excellent results and was not associated with complications. Forty-three of the 45 patients had no clinical or ultrasonographic evidence of recurrent or new hepatic cysts after 3 years of follow-up.

Animals↗