Surgical strategy for patients with supratentorial spontaneous intracerebral hemorrhage: minimally invasive surgery and conventional surgery

Objective@#The role of surgery in spontaneous intracerebral hemorrhage (sICH) is still controversial. We aimed to investigate the effectiveness of minimally invasive surgery (MIS) compared to conventional surgery (CS) for supratentorial sICH. @*Methods@#The medical data of 70 patients with surgically treated supratentorial sICH were retrospectively reviewed. MIS was performed in 35 patients, and CS was performed in 35 patients. The surgical technique was selected based on the neurological status and radiological findings, such as hematoma volume, neurological status and spot signs on computed tomographic angiography. Treatment outcomes, prognostic factors and the usefulness of the spot sign were analyzed. @*Results@#Clinical states in both groups were statistically similar, preoperatively, and in 1 and 3 months after surgery. Both groups showed significant progressive improvement till 3 months after surgery. Better preoperative neurological status, more hematoma removal and intensive care unit (ICU) stay ≤7 days were the significant prognostic factors for favorable 3-month clinical outcomes (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.10-0.96, p=0.04; OR 1.04, 95% CI 1.01-1.08, p=0.02; OR 26.31, 95% CI 2.46-280.95, p=0.01, respectively). Initial hematoma volume and MIS were significant prognostic factors for a short ICU stay (≤7 days; OR 0.95; 95% CI 0.91-0.99; p=0.01; OR 3.91, 95% CI 1.03-14.82, p=0.045, respectively). No patients in the MIS group experienced hematoma expansion before surgery or postoperative rebleeding. @*Conclusions@#MIS was not inferior to CS in terms of clinical outcomes. The spot sign seems to be an effective radiological marker for predicting hematoma expansion and determining the surgical technique.

Extensive Pituitary Apoplexy after Chemotherapy in a Patient with Metastatic Breast Cancer

Surgery, anticoagulation therapy, pregnancy, and hormone treatments, such as bromocriptine, are well-characterized precipitating factors for pituitary apoplexy. However, whether cytotoxic chemotherapy for systemic cancer could cause pituitary apoplexy has not been investigated. Here, we present a case of a 41-year-old woman who developed a severe headache with decreased visual acuity after intravenous cytotoxic chemotherapy to treat metastatic breast cancer. Preoperative neuroimaging revealed pituitary adenoma with necrosis. Operative findings and pathologic examination concluded extensive necrosis with a small intratumoral hemorrhage in a pre-existing pituitary adenoma. We reviewed two additional previously published cases of pituitary apoplexy after systemic chemotherapy and suggest that cytotoxic chemotherapy may induce pituitary apoplexy.

A Clinical Study of Surgical Management for Meckel's Diverticulum

Meckel's diverticulum is an embryologic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract, affecting 1% to 2% of the general population. Although this prevalence is relatively low, Meckel's diverticulum is occasionally encountered as an incidental identification during abdominal exploration and can be associated with several life-threatening disease states, such as massive intestinal bleeding, intestinal obstruction, or on rare occasion, perforation. The management of a Meckel's diverticulum found incidentally on laparotomy is controversial because the rate of complications developing from the diverticulum remains uncertain. The data in this report are based on 18 cases of Meckel's diverticulum which were treated at the Department of Surgery, InJe University Sanggye Paik Hospital, during the 7 years between January 1990 and December 1996. The results are as follows: 1) The overall sex ratio of males to females was 5 : 1 and in the symptomatic group, the ratio was 6 : 1. 2) Ninety percent of the patients were under 40 years of age, and 56% were under 10. 3) The diverticula were located from 20 cm to 100 cm proximal to the ileocecal valve, and the average range was 53 cm from the ileocecal valve. Fifteen cases were located at the antimesenteric border, and 3 cases at the mesenteric border of the ileum. 4) The lengths of the diverticula ranged from 1cm to 6cm, and the diameters ranged from 0.5 cm to 4.5 cm. 5) Appendicitis and intestinal obstruction were the most frequent preoperative diagnoses in the symptomatic group. 6) The common complications were intestinal obstruction and inflammation. 7) Heterotopic tissues were found in three patients and all of them were ectopic gastric mucosa. 8) The treatment was a diverticulectomy or a segmental resection of the involved bowel. 9) Postoperative complications were found in three of the asymptomatic group: two early intestinal obstructions and one wound infection.