Background : Pseudoaneurysm of the internal carotid artery (ICA) is a very rare but potentially fatal complication of deep neck space infection. Methods : This paper describes a very rare case of an ...ICA pseudoaneurysm rupture in the sphenoid sinus caused by a deep neck abscess. Results : A 62-year-old male with a deep neck space infection underwent surgical drainage. On the postoperative 21st day, however, he suddenly had massive epistaxis. A transnasal endoscopic examination found massive bleeding out of the sphenoid sinus. Immediate intra-arterial angiography revealed two pseudoaneurysms of the left ICA at the cavernous segment (C4) and the clinoid segment (C5), which were embolized with coils. The patient made an uneventful recovery after the embolization. Conclusion : We found no reports in the literature that pseudoaneurysms associated with a deep neck infection rupture in the sphenoid sinus. Prompt treatment along with accurate diagnosis is essential for successful management of such cases. J. Med. Invest. 66 : 188-189, February, 2019
Recent studies of spinal cord axon regeneration have reported good long-term results using various types of tissue scaffolds. Olfactory tissue allows autologous transplantation and can easily be ...obtained by a simple biopsy that is performed through the external nares. We performed a clinical pilot study of olfactory mucosa autograft (OMA) for chronic complete spinal cord injury in eight patients according to the procedure outlined by Lima et al. Our results showed no serious adverse events and improvement in both the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and ASIA motor score in five patients. The preoperative post-rehabilitation ASIA motor score improved from 50 in all cases to 52 in case 2, 60 in case 4, 52 in case 6, 55 in case 7, and 58 in case 8 at 96 weeks after OMA. The AIS improved from A to C in four cases and from B to C in one case. Motor evoked potentials (MEPs) were also seen in one patient, reflecting conductivity in the central nervous system, including the corticospinal tract. The MEPs induced with transcranial magnetic stimulation allow objective assessment of the integrity of the motor circuitry comprising both the corticospinal tract and the peripheral motor nerves.We show the feasibility of OMA for chronic complete spinal cord injury.
•Primary histiocytic sarcoma of the central nervous system is extremely rare.•Immunoprofile of CD68 + and CD163 + confirmed the diagnosis of histiocytic sarcoma.•The first pathological anatomy foster ...knowledge of histiocytic sarcoma.
Histiocytic sarcoma (HS) is an extremely rare non-Langerhans histiocyte disorder of unknown origin. Recently, biomarkers for the confirmation of HS diagnosis have been reported. This report describes a case of primary HS of the central nervous system with description of the pathological anatomy. The patient was older than those in other such cases reported in the literature and presented with unspecific symptoms. This case highlights the difficulty in diagnosis and importance of suspicion of HS.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The compressive stiffness in posterior lumbar interbody fusion (PLIF) secure grafts. The cortical bone trajectory (CBT) fixation is effective for the initial fixation. However, it has been reported ...that the bone fusion rate of CBT fixation is lower than traditional pedicle screw fixation. One of these factors is less stability of anterior column in CBT fixation, which leads to the cage displacement.
In this study, to elucidate the instability of anterior column in CBT fixation, we investigated the experimental initial compressive loading and distribution in CBT fixation. Furthermore, to clarify the cage displacement in CBT fixation, we retrospectively studied the relationship between the initial cage position and displacement in CBT fixation.
Comparative study using lumbar vertebrae of pigs and human model bones, and retrospective study to clarify cage stability and interbody pressure distribution in compression.
We inserted screws for lumbar vertebrae of pigs and human model bones by traditional trajectory (n=3) and CBT (n=4). Then we placed the pressure measurement film (PRESCALE; Fujifilm, Tokyo, Japan) into the intervertebral space. We analyzed the initial compression loading and distribution. A total of 67 patients (34 men, 33 women, mean age 66.7 years) who underwent CBT fixation using single polyetheretherketone cage in our institution were retrospectively investigated. A total of 114 lumbar cages were analyzed for place in axial plane of intervertebral space using computed tomography (CT) images. Then, we evaluated the range of displacement within 12 months after surgery.
In the experiment using pig lumbar vertebrae, the average pressure of the anterior column of intervertebral space was significantly lower (p=0.0044) in CBT (0.60±0.01MPa) than traditional trajectory (0.90±0.07MPa), and the compression loading was also significantly lower (p=0.0016) in CBT (12±5N) than traditional trajectory (73±9N). The similar result was observed in the human model bones. In the retrospective study of cage position, cage displacement was observed more frequently in the anterior location (14 cages, 16.3%) than the posterior location (2 cages, 7.1%). However, the cage position was not a significant risk factor for displacement (OR 2.528, 95% CI 0.578-11.75, p=0.227).
These findings suggest that the compression power of the anterior column in compression of CBT fixation is insufficient to grasp the cage followed by the cage instability and displacement.
Unavailable from authors at time of publication.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective: Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy (MT) are effective treatments for acute ischemic stroke (AIS). However, the treatment for AIS ...in pregnancy is not established because no clinical trials have included pregnant patients. We present a case of middle cerebral artery (MCA) M2 segment occlusion in pregnancy treated with IV thrombolysis and endovascular therapy.Case Presentation: A 36-year-old woman being 6 weeks pregnant presented with right-sided hemiparesis and aphasia. MRI showed a high-intensity area on diffusion-weighted imaging of the left parietal lobe, and MRA showed left MCA M2 segment occlusion. She underwent IV rt-PA and MT and achieved thrombolysis in cerebral infarction 2b revascularization without complications. The protein S concentration was lower than that in the physiological changes during pregnancy. She was diagnosed with embolic stroke related to coagulopathy in pregnancy, and she underwent anticoagulation. At the 3-month follow-up, the modified Rankin Scale was 0. She miscarried at 4 months, and the fetal death was presumed to be obstetric cause.Conclusion: IV rt-PA and MT may be effective and safe treatments for pregnant patients. Estimated fetal radiation exposure during MT is low and is presumed not to affect fetal development. We should mitigate the radiation dose and reduce the dose of iodinated contrast agents, particularly in pregnant patients.
Objective: We report a case of acute middle cerebral artery (MCA) occlusion caused by tumor embolism.Case Presentation: A 64-year-old man with lung cancer presented with sudden onset left-sided ...hemiparesis and sensory disturbance. Diffusion-weighted imaging (DWI) revealed hyper-intense foci in the right MCA territory and magnetic resonance angiography (MRA) demonstrated right MCA M2 segment occlusion. Mechanical thrombectomy (MT) was performed with Thrombolysis in Cerebral Infarction 2B recanalization. On histopathology, thrombus composed of fibrin and squamous cell carcinoma was observed. We diagnosed him with tumor embolism from lung cancer that invaded the pulmonary vein and the left atrium.Conclusion: Tumor cells may be confirmed by pathological examination regardless of the morphology of the embolus. Pathological examination of the cerebral embolus is useful for the accurate diagnosis of ischemic stroke subtypes.
OBJECTIVE Diffuse astrocytomas (DAs) have a high recurrence rate due to diffuse infiltration into the brain and spinal cord. Micro RNAs (miRNAs) are small noncoding RNAs that regulate gene expression ...by binding to complementary sequences of target messenger RNA (mRNA). It has been reported that miRNA-22 (miR-22) is involved in the invasion of some cancer cell lines. The aim of this study was to identify the biological effects of miR-22 in regard to the invasion of human DAs. METHODS The authors evaluated whether the level of miR-22 is elevated in human spinal DAs by using miRNA chips. Next, the role of miR-22 in 1321N1 human astrocytoma cells was investigated. Finally, to elucidate whether miR-22 promotes invasion by astrocytoma cells in vivo, the authors transplanted miR-22 overexpressed astrocytoma cells into mouse thoracic spinal cord. RESULTS The miR-22 significantly upregulated the invasion capacity of 1321N1 cells. Computational in silico analysis predicted that tissue inhibitor of matrix metalloproteinase-2 (TIMP2) is a target gene of miR-22. This was confirmed by quantitative reverse transcription polymerase chain reaction and Western blotting, which showed that miR-22 inhibited TIMP2 mRNA and protein expression, respectively. Luciferase reporter assays demonstrated that miR-22 directly bound the 3'-untranslated regions of TIMP2. The authors further showed that miR-22 promoted invasiveness in 1321N1 astrocytoma cells when transplanted into mouse spinal cord. CONCLUSIONS These data suggest that miR-22 acts to regulate invasion of 1321N1 astrocytoma cells by targeting TIMP2 expression. Additional studies with more cases and cell lines are required to elucidate the findings of this study for a novel treatment target for spinal DAs.
Intramedullary spinal cord metastasis of non-small cell lung cancer is rare, and it has a short prognosis. We report a 53-year-old man diagnosed with cT4N0M0, stage IIIA squamous cell lung cancer. ...Ten months after left pneumonectomy (pT4N0M0), an intramedullary spinal cord tumor developed at the axis level. The intramedullary spinal cord tumor was resected, and he was diagnosed with metastatic squamous cell lung cancer. Radiotherapies and another tumor resection were conducted, as he had a good performance status and the discrete lesion was associated with the risk of brain stem compression. Multimodal local treatments for intramedullary spinal cord metastasis caused the tumor to shrink, and he lived for 25 months after the spinal metastasis occurred.
Clinical Courses of primary immune-mediated hemolytic anemia (pIMHA) in dogs are highly variable, however, limited information is available to predict their accurate prognoses. To evaluate the ...prognostic significance of clinical factors and to propose a scoring system to predict prognoses, the medical records of seventy-one dogs with pIMHA were reviewed. Overall mortality rate of dogs with pIMHA was 39% and most of the dogs died within 3 months from diagnosis. Sex, body weight, seasonality, packed corpuscular volume (PCV), platelet count (PLT), total plasma protein (TP), blood urea nitrogen, albumin, total bilirubin, sodium ion, prothrombin time, and fibrin/fibrinogen degradation products before immunosuppressive treatment can influence on survival time in dogs with pIMHA. A prognostic scoring system using a combination of sex, seasonality, PCV, PLT and TP can be statistically significant for raising the accuracy of prognostic prediction. Using the scoring system for prognostication in dogs with pIMHA may enable veterinarians to predict a prognosis easily and accurately.
Several recent studies have demonstrated the potential therapeutic role of olfactory ensheathing cells in spinal cord injury. The aim of this study was to elucidate whether grafts of nasal olfactory ...mucosa containing olfactory ensheathing cells can repair the injured rat spinal cord as compared with the nasal respiratory mucosa containing no olfactory ensheathing cells. These grafts were then transplanted into the partially removed rat spinal cord. Compared with the respiratory mucosa-transplanted rats, the olfactory mucosa-transplanted rats partially recovered the movement of their hindlimbs and joints. Corticospinal tracing indicated that olfactory mucosa transplantation restored the severed tract. Therefore, olfactory mucosa has potential value in the repair of spinal cord injury.
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