Comparative Study of 2 Skin Incisions for Microscopic Lumbar Discectomy.

OBJECTIVE: Microscopic lumbar discectomy is a common minimally invasive surgery. A transverse skin incision has sound theoretical cosmetic advantages compared with the classic vertical incision. We compared transverse and vertical skin incisions for microscopic discectomy regarding cosmetic outcome, postoperative pain, and the provided surgical cutaneous inlet. METHODS: This prospective study enrolled 86 patients who were randomly assigned to a vertical incision group or a transverse incision group. The maximum surgical cutaneous inlet provided was measured in 2 diameters. Pain was recorded on postoperative days 1, 3, and 7 using a numeric patient rating scale from 0 to 10 with 0 indicating no pain. The cosmetic appearance of the wound was evaluated by a plastic surgeon and by the patients as excellent, very good, good, fair, and poor. RESULTS: Compared with vertical incisions, transverse incisions provide similar surgical cutaneous inlets, cause higher pain scores on postoperative days 1 and 3 but a similar score on postoperative day 7, and ensure significantly better wound cosmesis. CONCLUSIONS: Transverse skin incision for microscopic lumbar discectomy is an applicable alternative to classic midline or paramedian vertical incision with better esthetic results.

Chemoembolization of hepatocellular carcinoma with drug-eluting beads complicated by interstitial pneumonitis.

Transarterial chemoembolization has proven benefit in the treatment of unresectable hepatocellular carcinoma (HCC). Commonly reported symptoms following chemoembolization with or without drug-eluting beads include abdominal pain, nausea, and low-grade fever, which typically limited resolve within a few days. A recent study comparing traditional chemoembolization versus chemoembolization with drug-eluting beads demonstrated similar survival between the two techniques, but improved tolerability when the drug-eluting beads were used. This case report describes a patient with unresectable HCC undergoing chemoembolization with drug-eluting beads. The postprocedure course was complicated by interstitial pneumonitis secondary to shunting of the drug-eluting beads containing doxorubicin to both lungs via tumor vasculature. This case highlights the relationship between the number and size of the tumors to be treated, arteriovenous shunting within the liver/tumors, and the size of the embolization particles.

Mediastinal thymoma invading the superior vena cava and the right atrium.

An 86-year-old male patient presented with a large mediastinal tumor. A needle biopsy was performed and revealed a diagnosis of invasive thymoma. Multidetector computed tomography (MDCT) angiography was performed in order to assess operability of the tumor. This showed a heterogeneously enhancing anterior mediastinal mass. The tumor had invaded the left brachiocephalic vein, presumably via the inferior thymic veins, which is a known feature of these tumors. The thymoma grew then endovenously through the superior vena cava into the right atrium. A pacemaker lead was completely encased by tumor tissue. The patient was deemed inoperable and underwent radiation therapy.

Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting.

A 41-year old alchoholic male with a history of chronic pancreatitis was admitted for nausea, vomiting and weight loss. Angiogram was performed and demonstrated an aneurysmal sac with a narrow neck originating from the inferior aspect of the distal portion of the proper hepatic artery. The origin of the pseudoaneurysm was covered with a 5 mm multiply 2.5 cm Viabahn cover stent (Gore). A repeat angiogram showed some leak and a second stent (6 mm multiply 2.3 cm) was deployed and overlapped with the first stent by 3 mm. Contrast was injected and a repeat angiogram demonstrated complete exclusion of the aneurysm. A repeat computerized axial tomography (CAT) scan of the abdomen after 24 h showed successful stenting. The patient had an uneventful post-operative course.