Treatment of symptomatic liver cysts by percutaneous instillation of minocycline hydrochloride
Second Department of Internal Medicine, Yamagata University School of Medicine, Japan. Digestive Diseases and Sciences
(Impact Factor: 2.61).
12/1994; 39(11):2503-9. DOI: 10.1007/BF02087673
Nine patients with 16 symptomatic nonneoplastic congenital hepatic cysts were treated prospectively by ultrasonically guided percutaneous minocycline hydrochloride injection, and the usefulness of this treatment was evaluated. Seven of the patients had multiple hepatic cysts, and two solitary cysts. All the patients were women, ranging in age from 36 to 81 years. After cystic fluid had been aspirated with a 21-gauge PTC needle, minocycline hydrochloride was injected into all the cysts. The minocycline hydrochloride was dissolved in saline at a concentration of 200 mg in 9 ml, and mixed with 1 ml of 2% mepivacaine hydrochloride. The total quantity of minocycline hydrochloride injected varied from 100 mg to 1200 mg per hepatic cyst, depending on its size. Total or subtotal regression of the cysts was observed in all patients during follow-up periods ranging from 15 to 35 months. Seven patients became symptom-free, one showed symptom reduction, and one showed no change in symptoms. Minor side effects, eg, transient abdominal pain, slight right shoulder pain, and temperature elevation, were noted in three patients respectively. On the basis of these results, we conclude that ultrasonically guided percutaneous minocycline hydrochloride injection is useful for the treatment of symptomatic hepatic cysts.
Available from: Giuseppe Garcea
- "Recurrences due to growth of non-treated cysts Minor Mean of 48 Yamada et al. 51 1994 9 Minocycline Complete or partial regression in all patients Minor 15–35 Montorsi et al. 52 1994 21 Ethanol All patients had resolution of symptoms. "
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Liver cysts are common, occurring in up to 5% of the population. For many types of cysts, a variety of different treatment options exist and the preferred management is unclear.
A PubMed and Medline literature review was undertaken and articles pertaining to the diagnosis and management of cystic lesions within the liver were retrieved.
Therapy for symptomatic cysts may incorporate aspiration with sclerotherapy or de-roofing. Polycystic liver disease presents a unique management problem because of the high morbidity and mortality rates from intervention and high rates of recurrence. Careful patient counselling and assessment of symptom index is essential before embarking on any treatment. New medical treatments may ameliorate symptoms. Acquired cystic lesions in the liver require a thorough work-up to fully characterize the abnormality and direct appropriate treatment. Hydatid cysts are best treated by chemotherapy, followed by some form of surgical intervention (either aspiration and sclerotherapy or surgery). Liver abscesses can be effectively treated by aspiration or drainage.
All patients with cystic lesions in the liver require discussion at multidisciplinary meetings to confirm the diagnosis and determine the most appropriate method of treatment.
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ABSTRACT: We report the case of an 84-year-old woman with abdominal pain, distension and inferior veno-caval compression due to a large non-parasitic hepatic cyst. She was treated by instillation of tetracycline hydrochloride into the hepatic cyst. Six months after treatment, the patient is asymptomatic, with no reaccumulation of the hepatic cyst. We conclude that symptomatic hepatic cysts may be successfully treated by tetracycline hydrochloride instillation sclerosis.
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