Multiloculated Hydrocephalus: Open Craniotomy or Endoscopy?

Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.

A cystic hepatic lesion: when to worry? / La lesión cística del hígado: ¿cuándo preocuparse?

A 16-year old female presented to hospital with abdominal pain. Features on computed tomography raised the possibility of biliary cystadenoma or cystadenocarcinoma. She underwent a liver resection, and histopathology confirmed a serous biliary cystadenoma. This case is presented to highlight the radiological features of this uncommon pre-malignant condition as well as to summarize a management algorithm for cystic liver lesions.

Una mujer de 16 años de edad acudió al hospital con un dolor abdominal. Las características observadas con tomografía computarizada apuntaban a un cistoadenoma biliar o un cistoadenocarcinoma como diagnósticos diferenciales. La paciente fue sometida a una resección del hígado, y la histopatología confirmó un cistoadenoma biliar seroso. Presentamos este caso para resaltar los rasgos radiológicos de esta condición premaligna rara, así como para resumir un algoritmo de tratamiento para las lesiones císticas de hígado.

Preparation of Paracetamol multiloculated implant and its drug release profile in vitro / 西安交通大学学报(医学版)

Objective To prepare Paracetamol (APP) multiloculated implant loaded with poly-lactide-co-glycolide acid (PLGA) and to study the drug release profile in vitro. Methods APP multiloculated implant was fabricated by micro-electro-mechanical system (MEMS), and high-performance liquid chromato graphy (HPLC) measurement was used to investigate in vitro drug release profile. HPLC analysis was carried out by employing C18 column and a mixture of methanol-water (15∶85) as mobile phase. The detection wavelength was 215nm and flow rate was 0.8mL/min. Results With different multiloculated shape, the rate of the drug release in vitro was varied significantly. Moreover, the releasing of APP multiloculated implant with ecto-tetragonum ento-hexagon in vitro conformed to Higuchi equation. Conclusion The technology of the preparations is feasible, and the structural and morphological characteristics of the multiloculated implant have a significant impact on the release speed of the drug delivery system.