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William R Brugge - One of the best experts on this subject based on the ideXlab platform.
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cyst fluid amylase and cea levels in the differential diagnosis of pancreatic Cysts a single center experience with histologically proven Cysts
Digestive Diseases and Sciences, 2014Co-Authors: Hyun Kang, William R BruggeAbstract:Objective Cyst fluid amylase is a potential marker for pseudoCysts and intraductal papillary mucinous neoplasms (IPMN). This study aimed to evaluate the diagnostic role of cyst fluid amylase and to determine the optimal cutoff values of cyst fluid amylase and carcinoembryonic antigen (CEA) for the differential diagnosis of pancreatic Cysts.
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cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous Cysts
Pancreas, 2011Co-Authors: Sevdenur Cizginer, Martha B. Pitman, Brian G Turner, Reyyan A Bilge, Cetin Karaca, William R BruggeAbstract:Objectives:Endoscopic ultrasound (EUS) may offer a diagnostic tool through the combination of imaging and guided fine-needle aspiration of pancreatic Cysts. The purpose of this investigation was to determine the most accurate test for differentiating mucinous from nonmucinous Cysts.Methods:The resul
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the value of cyst fluid analysis in the pre operative evaluation of pancreatic Cysts
Journal of gastrointestinal oncology, 2011Co-Authors: Martha B. Pitman, William R Brugge, Andrew L WarshawAbstract:Like any clinical diagnostic test, analysis of pancreatic cyst fluid should add value in the decision making process of patient management. Pancreatic Cysts are a complex group of benign, malignant and premalignant lesions with diverse clinical, radiological and pathological features (1). No longer are the vast majority of pancreatic Cysts thought to be pseudoCysts, inclusion Cysts or benign neoplastic Cysts that do not require follow-up. Our knowledge and understanding of neoplastic pancreatic Cysts in general and mucinous pancreatic Cysts in particular has grown exponentially since the recognition of intraductal papillary mucinous neoplasm (IPMN) as a distinct entity from mucinous cystic neoplasm (MCN) (2). Our realization that all neoplastic mucinous Cysts have malignant potential has led to intensive evaluation of patients with both symptomatic and asymptomatic pancreatic Cysts to determine the nature of the cyst, and thus the possible need for resection (3).
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pancreatic cyst fluid dna analysis in evaluating pancreatic Cysts a report of the panda study
Gastrointestinal Endoscopy, 2009Co-Authors: Asif Khalid, William R Brugge, Maliha Zahid, Sydney D Finkelstein, Julia K Leblanc, Neeraj Kaushik, Nuzhat A Ahmad, Steven A Edmundowicz, Robert H Hawes, Kevin McgrathAbstract:Background The role of pancreatic cyst fluid DNA analysis in evaluating pancreatic Cysts remains unclear. Objective Our purpose was to evaluate the utility of a detailed DNA analysis of pancreatic cyst fluid to diagnose mucinous and malignant Cysts. Design Prospective, multicenter study. Patients Patients with pancreatic Cysts presenting for EUS evaluation. Intervention EUS-guided pancreatic cyst aspirates cytology evaluation, carcinoembryonic antigen (CEA) level determination, and a detailed DNA analysis; incorporating DNA quantification, k- ras mutation and multiple allelic loss analysis, mutational amplitude, and sequence determination. Main Outcome Measurements Cyst fluid analysis compared with surgical pathologic or malignant cytologic examination. Results The study cohort consisted of 113 patients with 40 malignant, 48 premalignant, and 25 benign Cysts. Cyst fluid k- ras mutation was helpful in the diagnosis of mucinous Cysts (odds ratio 20.9, specificity 96%), whereas receiver-operator characteristic curve analysis indicated optimal cutoff points for allelic loss amplitude (area under the curve [AUC] 0.79; optimal value > 65%) and CEA (AUC 0.74; optimal value >148 ng/mL). Components of DNA analysis detecting malignant Cysts included allelic loss amplitude over 82% (AUC 0.9) and high DNA amount (optical density ratio >10, AUC 0.79). The criteria of a high amplitude k- ras mutation followed by allelic loss showed maximum specificity (96%) for malignancy. All malignant Cysts with negative cytologic evaluation (10/40) could be diagnosed as malignant by using DNA analysis. Limitations Limited follow-up, selection bias. Conclusions Elevated amounts of pancreatic cyst fluid DNA, high-amplitude mutations, and specific mutation acquisition sequences are indicators of malignancy. The presence of a k- ras mutation is also indicative of a mucinous cyst. DNA analysis should be considered when cyst cytologic examination is negative for malignancy.
Knut Wester - One of the best experts on this subject based on the ideXlab platform.
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increased nkcc1 expression in arachnoid Cysts supports secretory basis for cyst formation
Experimental Neurology, 2010Co-Authors: Christian A Helland, Mads Aarhus, Per M Knappskog, Lisa K Olsson, Morten Lundjohansen, Mahmood Amirymoghaddam, Knut WesterAbstract:Abstract Arachnoid Cysts (AC) are filled with liquid very similar to cerebrospinal fluid (CSF). The mechanisms of fluid accumulation have remained unknown; previous studies have however indicated both fluid secretion and a one-way valve as a mechanism. If the filling was caused by fluid secretion, mechanisms similar to those underlying CSF production would be anticipated. We have investigated the expression levels of all genes known to be involved in mammalian CSF production in surgically removed AC. Based on mRNA microarray analysis of AC and normal arachnoid tissue, we extracted the RNA expression profiles of all genes known to code for proteins involved in CSF production. A selection of genes was further investigated with quantitative real-time polymerase chain reaction (qRT-PCR). For selected CSF production proteins, electron microscopic immunogold techniques (EM) and Western blots were performed. Seven genes were expressed in both Cysts and controls. The gene encoding the Na + –K + –2Cl − cotransporter NKCC1 was significantly up-regulated in AC. Gene expression data were supported by Western blot. EM demonstrated NKCC1 expressed at the plasma membranes of the cyst-lining cells. This result points at secretion as the main mechanism of cyst filling, and NKCC1 as the key candidate of fluid transport. Based on these findings, we hypothesize that selective NKCC1 inhibitors could be used in preventing expansion of temporal AC.
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a population based study of intracranial arachnoid Cysts clinical and neuroimaging outcomes following surgical cyst decompression in adults
Journal of Neurology Neurosurgery and Psychiatry, 2007Co-Authors: Christian A Helland, Knut WesterAbstract:Background: We have gradually adopted a liberal attitude towards surgical decompression of arachnoid Cysts. This study describes the results from our institution. Methods: Long term clinical and neuroimaging results of 156 adult patients (aged ⩾16 years) operated on for arachnoid Cysts in our department during the period January 1987 to September 2004 were assessed based on their medical and neuroimaging records, and on a questionnaire. Results: The clinical and/or neuroimaging results indicated that the cyst was successfully decompressed in all patients. 82% of patients were asymptomatic or had insignificant complaints at follow-up. 12% reported no symptom relief whereas 6% experienced worsening of symptoms. The cyst disappeared after surgery, or was reduced to Conclusion: Decompression of arachnoid Cysts yields a substantial clinical benefit with a low risk of severe complications.
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a population based study of intracranial arachnoid Cysts clinical and neuroimaging outcomes following surgical cyst decompression in children
Journal of Neurosurgery, 2006Co-Authors: Christian A Helland, Knut WesterAbstract:Object. If, when, and how children with arachnoid Cysts should undergo surgery has been a matter of debate. In the present study the authors describe long-term clinical and neuroimaging results in children with intracranial arachnoid Cysts, treated in accordance with the authors' policy of performing surgery in most of these cases. Methods. The study included 48 pediatric patients (age < 16 years of age) who underwent surgery for treatment of an arachnoid cyst at Haukeland University Hospital between January 1987 and September 2004. Forty-one patients underwent. cyst fenestration to the basal cisterns and posterior fossa. Long-term results were assessed retrospectively on the basis of medical and neuroimaging records. Additional information was obtained by means of a check-box questionnaire completed by the patients and their parents. At their follow-up examinations, 82% of the patients had no or insignificant complaints, 14% reported no improvement, and 4% noted a worsening of symptoms. In 56% of the patients with appropriate imaging for analysis, the cyst was no longer visible on neuroimaging studies. In 23%, the postoperative fluid volume was reduced to less than 50% of the original cyst volume, and in another 19%, the volume was reduced but was larger than 50% of the original. The cyst was unchanged in only 2%. There was a significant association between a volume reduction greater than 50% and clinical improvement. Three patients (6%), all with temporal Cysts, had minor complications that led to additional surgery in one patient. No complications caused permanent disability. Eight patients (17%) underwent additional surgery due to suspected or demonstrated treatment failure. Conclusions. Most children who underwent cyst fenestration via a craniotomy experienced a good long-term outcome with no severe complications.
F Maiuri - One of the best experts on this subject based on the ideXlab platform.
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endoscopy versus microsurgical cyst excision and shunting for treating intracranial arachnoid Cysts
Journal of Neurosurgery, 2011Co-Authors: M Gangemi, Giuseppe Colella, Vincenzo Seneca, Valentina Cioffi, Alessia Imperato, F MaiuriAbstract:Object Endoscopic surgery is routinely used to treat intracranial arachnoid Cysts. However, the indications and results with respect to the different cyst locations, compared with those of microsurgical fenestration and cyst shunting, deserve to be discussed. Methods The authors review 18 patients with intracranial arachnoid Cysts treated by pure endoscopic technique in their neurosurgical department. There were 10 male and 8 female patients ranging in age from 2 months to 48 years (median age 19.4 years). The cyst location was suprasellar in 5 cases, quadrigeminal in 5, cortical hemispheric in 2, sylvian region in 3, and posterior fossa in 3. The authors also reviewed the literature, comprising 61 reports for an overall number of 645 patients with intracranial arachnoid Cysts treated by different surgical techniques. These techniques included microsurgical excision or fenestration by craniotomy, cyst shunting, and endoscopic fenestration. The surgical results of the different techniques according to the ...
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suprasellar arachnoid Cysts endoscopy versus microsurgical cyst excision and shunting
British Journal of Neurosurgery, 2007Co-Authors: M Gangemi, Giuseppe Colella, Francesco Magro, F MaiuriAbstract:The aim of this study is to define the indications to endoscopy versus other surgical procedures in the management of suprasellar arachnoid Cysts from a personal series and an extensive literature review. Five symptomatic patients (two children and three adults) with suprasellar arachnoid Cysts were treated by endoscopic fenestration in our neurosurgical unit. The endoscopic procedure consisted of ventricle-cyst-cisternostomy in three cases and ventricle-cystostomy in two. Four patients were cured after the endoscopic procedure alone, whereas another with rhinoliquorrhoea later required a craniotomy. The literature review includes 102 patients treated by endoscopic fenestration and 74 treated by other procedures, including microsurgical cyst resection through craniotomy (38 cases), shunt of the cyst (21 cases) and percutaneous ventricle-cystostomy (15 cases). Among the reviewed cases, the rate of cure or improvement was 90% (92 among 102 cases including ours) after endoscopy and 81% (60 among 74 cases) af...
Daniel F Kelly - One of the best experts on this subject based on the ideXlab platform.
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endonasal management of sellar arachnoid Cysts simple cyst obliteration technique
Journal of Neurosurgery, 2012Co-Authors: Nancy Mclaughlin, Alexander Vandergrift, Leo Ditzel F S Filho, Kiarash Shahlaie, Amalia Eisenberg, Ricardo L Carrau, Pejman Cohan, Daniel F KellyAbstract:OBJECT: Symptomatic sellar arachnoid Cysts (ACs) have typically been treated via the transsphenoidal route. After sellar cyst wall fenestration, some authors have advocated cyst wall resection and increasing communication between the AC and suprasellar subarachnoid space (SAS). This study is a report of the authors' experience using a simplified approach to reinforce a defective diaphragma sellae or unseen arachnoid diverticulum by deliberately not enlarging the AC-SAS communication and obliterating the cyst cavity with adipose tissue followed by skull base reconstruction. METHODS: A retrospective analysis was conducted of patients who underwent an endonasal transsphenoidal obliteration of symptomatic ACs with a fat graft and skull base repair. RESULTS: Between July 1998 and September 2010, 8 patients with a sellar AC were identified (6 women and 2 men, mean age 57 years). Clinical presentation included headache, pituitary dysfunction, and visual dysfunction (4 patients each group). Maximal cyst diameter averaged 22 mm (range 15-32 mm). In all cases the sellar communication to the SAS was deliberately not enlarged. The endoscope was used for visualization in 8 of 9 procedures. Postoperatively, headache improved in all 4 patients, vision in all 4 patients, and partial resolution of endocrine dysfunction (hyperprolactinemia and/or recurrent hyponatremia) occurred in 3 (75%) of 4 patients. No new endocrinopathy, CSF leak, meningitis, or neurological deficits occurred. Two patients experienced cyst reaccumulation: 1 symptomatic recurrence was treated with reoperation at 43 months postsurgery, and 1 asymptomatic partial recurrence continued to be monitored at 29 months postsurgery. CONCLUSIONS: Sellar ACs can be effectively treated using endonasal fenestration and obliteration with fat with resultant reversal of presenting symptoms in the majority of patients. This simplified technique of AC cavity obliteration without enlarging communication to the SAS has a low risk of CSF leakage, and in most cases appears to effectively disrupt cyst progression, although longer follow-up is required to monitor for cyst recurrence.
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endonasal management of sellar arachnoid Cysts simple cyst obliteration technique
Journal of Neurosurgery, 2012Co-Authors: Nancy Mclaughlin, Alexander Vandergrift, Leo Ditzel F S Filho, Kiarash Shahlaie, Amalia Eisenberg, Ricardo L Carrau, Pejman Cohan, Daniel F KellyAbstract:Object Symptomatic sellar arachnoid Cysts (ACs) have typically been treated via the transsphenoidal route. After sellar cyst wall fenestration, some authors have advocated cyst wall resection and increasing communication between the AC and suprasellar subarachnoid space (SAS). This study is a report of the authors' experience using a simplified approach to reinforce a defective diaphragma sellae or unseen arachnoid diverticulum by deliberately not enlarging the AC-SAS communication and obliterating the cyst cavity with adipose tissue followed by skull base reconstruction. Methods A retrospective analysis was conducted of patients who underwent an endonasal transsphenoidal obliteration of symptomatic ACs with a fat graft and skull base repair. Results Between July 1998 and September 2010, 8 patients with a sellar AC were identified (6 women and 2 men, mean age 57 years). Clinical presentation included headache, pituitary dysfunction, and visual dysfunction (4 patients each group). Maximal cyst diameter ave...
Christian A Helland - One of the best experts on this subject based on the ideXlab platform.
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increased nkcc1 expression in arachnoid Cysts supports secretory basis for cyst formation
Experimental Neurology, 2010Co-Authors: Christian A Helland, Mads Aarhus, Per M Knappskog, Lisa K Olsson, Morten Lundjohansen, Mahmood Amirymoghaddam, Knut WesterAbstract:Abstract Arachnoid Cysts (AC) are filled with liquid very similar to cerebrospinal fluid (CSF). The mechanisms of fluid accumulation have remained unknown; previous studies have however indicated both fluid secretion and a one-way valve as a mechanism. If the filling was caused by fluid secretion, mechanisms similar to those underlying CSF production would be anticipated. We have investigated the expression levels of all genes known to be involved in mammalian CSF production in surgically removed AC. Based on mRNA microarray analysis of AC and normal arachnoid tissue, we extracted the RNA expression profiles of all genes known to code for proteins involved in CSF production. A selection of genes was further investigated with quantitative real-time polymerase chain reaction (qRT-PCR). For selected CSF production proteins, electron microscopic immunogold techniques (EM) and Western blots were performed. Seven genes were expressed in both Cysts and controls. The gene encoding the Na + –K + –2Cl − cotransporter NKCC1 was significantly up-regulated in AC. Gene expression data were supported by Western blot. EM demonstrated NKCC1 expressed at the plasma membranes of the cyst-lining cells. This result points at secretion as the main mechanism of cyst filling, and NKCC1 as the key candidate of fluid transport. Based on these findings, we hypothesize that selective NKCC1 inhibitors could be used in preventing expansion of temporal AC.
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a population based study of intracranial arachnoid Cysts clinical and neuroimaging outcomes following surgical cyst decompression in adults
Journal of Neurology Neurosurgery and Psychiatry, 2007Co-Authors: Christian A Helland, Knut WesterAbstract:Background: We have gradually adopted a liberal attitude towards surgical decompression of arachnoid Cysts. This study describes the results from our institution. Methods: Long term clinical and neuroimaging results of 156 adult patients (aged ⩾16 years) operated on for arachnoid Cysts in our department during the period January 1987 to September 2004 were assessed based on their medical and neuroimaging records, and on a questionnaire. Results: The clinical and/or neuroimaging results indicated that the cyst was successfully decompressed in all patients. 82% of patients were asymptomatic or had insignificant complaints at follow-up. 12% reported no symptom relief whereas 6% experienced worsening of symptoms. The cyst disappeared after surgery, or was reduced to Conclusion: Decompression of arachnoid Cysts yields a substantial clinical benefit with a low risk of severe complications.
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a population based study of intracranial arachnoid Cysts clinical and neuroimaging outcomes following surgical cyst decompression in children
Journal of Neurosurgery, 2006Co-Authors: Christian A Helland, Knut WesterAbstract:Object. If, when, and how children with arachnoid Cysts should undergo surgery has been a matter of debate. In the present study the authors describe long-term clinical and neuroimaging results in children with intracranial arachnoid Cysts, treated in accordance with the authors' policy of performing surgery in most of these cases. Methods. The study included 48 pediatric patients (age < 16 years of age) who underwent surgery for treatment of an arachnoid cyst at Haukeland University Hospital between January 1987 and September 2004. Forty-one patients underwent. cyst fenestration to the basal cisterns and posterior fossa. Long-term results were assessed retrospectively on the basis of medical and neuroimaging records. Additional information was obtained by means of a check-box questionnaire completed by the patients and their parents. At their follow-up examinations, 82% of the patients had no or insignificant complaints, 14% reported no improvement, and 4% noted a worsening of symptoms. In 56% of the patients with appropriate imaging for analysis, the cyst was no longer visible on neuroimaging studies. In 23%, the postoperative fluid volume was reduced to less than 50% of the original cyst volume, and in another 19%, the volume was reduced but was larger than 50% of the original. The cyst was unchanged in only 2%. There was a significant association between a volume reduction greater than 50% and clinical improvement. Three patients (6%), all with temporal Cysts, had minor complications that led to additional surgery in one patient. No complications caused permanent disability. Eight patients (17%) underwent additional surgery due to suspected or demonstrated treatment failure. Conclusions. Most children who underwent cyst fenestration via a craniotomy experienced a good long-term outcome with no severe complications.
