COVID-19 vaccines have received authorization worldwide. Vaccines are typically administered to the deltoid muscle, and axillary swelling/tenderness at the first dose (11.6%) and the second dose ...(16%) have been reported as secondary effects. Regional lymphadenopathy in the axilla and supraclavicular region has also been reported with a prevalence of 1.1% and is referred to as COVID-19 vaccine-associated lymphadenopathy (VAL). COVID-19 VAL mimics lymph node (LN) metastases on magnetic resonance imaging, ultrasound, and 18F-fluoro-2-deoxy-Dglucose positron emission tomography. Although several specific findings of VAL on clinical imaging have been reported, the difficulty in differentiating between VAL and LN metastases could lead to false-positive or -negative diagnoses. Here, we report a case of breast cancer with ipsilateral VAL with multimodal imaging including 3D T2-weighted imaging, a new magnetic resonance imaging technique, and discuss the future perspective for differentiating between VAL and LN metastases.
To evaluate risk factors predicting death and complications of primary therapy for hepatic and gastric duodenal artery pseudoaneurysms following endovascular treatment (EVT) after ...pancreaticoduodenectomy (PD).
Between April 2004 and December 2014, 28 patients (mean age, 64.7 y) with post-PD hemorrhage underwent EVT. Prevention of hepatic artery blockage via stents or side-holed catheter grafts was stratified in cases without a replaced hepatic artery. Mortality and major hepatic complications following EVT were evaluated according to age; sex; surgery-EVT interval; presence of portal vein stenosis, shock, and coagulopathy at EVT onset; and post-EVT angiographic findings.
All hemorrhages were successfully treated with microcoils (n = 17; 61%), covered stents (n = 1; 3%), bare stent-assisted coil embolization (n = 5; 18%), or catheter grafts with coil embolization (n = 5; 18%). Hepatic arterial flow was observed after EVT in 18 patients (64%). Mortality and major hepatic complication rates were 28.6% and 32.1%, respectively. Hemorrhagic shock and coagulopathy at EVT onset (n = 8 each; odds ratio OR, 27; 95% confidence interval CI, 3.1-235.7; P < .01) were significantly associated with mortality. Coagulopathy at EVT onset (adjusted OR aOR, 48.1; 95% CI, 3.2-2,931), portal vein stenosis (n = 16; aOR, 16.9; 95% CI, 1.3-721.9), and no visualization of hepatopetal flow through the hepatic arteries (n = 10; aOR, 29.5; 95% CI, 2.1-1,477) were significantly associated with major hepatic complications.
EVT should be performed as soon as possible before the development of shock or coagulopathy. Hepatic arterial flow visualization decreases major hepatic complications.
Superficial temporal artery–middle cerebral artery anastomosis is generally used as the standard surgical treatment for moyamoya disease to prevent cerebral ischemic attacks. Although the main ...potential complications associated with this treatment are cerebral hyperperfusion and ischemia, the adverse impacts of revascularization surgery remain unclear. Of the 142 consecutive surgeries for moyamoya disease at our hospital from 2008, we herein presented 2 cases of adult-onset moyamoya disease that manifested local vasogenic edema at the site of anastomosis without cerebral hyperperfusion; 1 in a 31-year-old woman presented with transient ischemic attack and the other in a 22-year-old man manifested as minor completed stroke. Both patients underwent superficial temporal artery–middle cerebral artery anastomosis, resulting in the formation of a reversible high-signal-intensity lesion at the site of anastomosis on T2-weighted images along with an increase in apparent diffusion coefficient values, whereas diffusion-weighted images showed no changes. Neither hyperperfusion nor hypoperfusion, as assessed by single-photon emission computed tomography with N-isopropyl123I-p-iodoamphetamine, was observed postoperatively. In light of the increased risk of the further progression of vasogenic edema to intracerebral hemorrhage, these patients were treated with prophylactic blood pressure lowering and the intravenous infusion of a free radical scavenger. They did not have any further cerebrovascular events during the follow-up period. Regional vasogenic edema without cerebral hyperperfusion, possibly due to cerebral ischemia/reperfusion injury, may be another novel entity that needs to be considered as a potential complication after extracranial–intracranial bypass for moyamoya disease. Strict postoperative management should be used to avoid hemorrhagic transformation.
We report a case of acute pancreatitis with diabetic ketoacidosis associated with increased serum myoglobin concentration, acute renal failure, and disseminated intravascular coagulation. A ...49-year-old man suffering from diarrhea, vomiting, and somnolence was admitted to the hospital. He had had flu-like symptoms for 4 days prior to the onset of these symptoms. He was a habitual drinker and had been consuming 360 ml-900 ml of the drink "shochu" (distilled spirits containing 28% alcohol) daily for 30 years. Laboratory data on admission revealed elevated serum levels of pancreatic enzymes, including amylase, trypsin, lipase, pancreatic secretory trypsin inhibitor (PSTI), phospholipase A2 (PLA2), and elastase-1, as well as elevated levels of glucose (373 mg/dl), ketone bodies (3675 mumol/l), and myoglobin (229.8 ng/ml). Treatment with subcutaneous insulin and intravenous administration of electrolyte fluid and the systemic protease inhibitor, gabexate mesilate, was begun immediately. Early after the initiation of treatment, there was an increase in serum creatinine (4.9 mg/dl), and thromobocytopenia (15000/microliters) was observed. The patient completely recovered from renal failure and acute pancreatitis, but required insulin therapy. Alcohol ingestion and dehydration are thought to have played a major role in the triggering of the acute pancreatitis. We examined the relationship among acute pancreatitis, diabetic ketoacidosis, and hypermyoglobinemia in the literature.
A 44-year-old man with von Recklinghausen's disease was admitted to our hospital presenting with left hypochondralgia. Computed tomography showed a large mass at the body and tail of the pancreas, ...with metastatic liver tumors. Endoscopic retrograde pancreatography revealed an obstruction of the main pancreatic duct at the body. In the course of the illness, the patient's serum calcium concentration increased gradually to 13.6 mg/dl, although bone scan with 99mtechnetium demonstrated no accumulation in the bones. Serum levels of parathyroid hormone related-protein and tumor necrosis factor were also elevated. Based on these findings, he was diagnosed as having pancreatic cancer with liver metastases and humoral hypercalcemia of malignancy associated with von Recklinghausen's disease. Postmortem examination revealed a solid tumor, measuring 6.0 x 6.0 x 8.0 cm, in the body and tail of the pancreas. Histologically, the tumor was moderately differentiated adenocarcinoma. The association of von Recklinghausen's disease with malignant neurogenic neoplasms is well established, whereas the association with non-neurogenic malignant neoplasm is considered to coincidental. Our current case suggests a possible relationship between von Recklinghausen's disease and pancreatic cancer.
Abstract Background Superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease prevents cerebral ischemic attack by improving CBF, whereas recent evidence suggests that the ...temporary neurologic deterioration because of postoperative cerebral hyperperfusion could occur despite its low-flow revascularization. The present study investigates the incidence and the risk factors for symptomatic hyperperfusion after STA-MCA anastomosis in patients with moyamoya disease. Methods We prospectively performed N -isopropyl-p-123 Iiodoamphetamine single-photon emission computed tomography 1 and 7 days after STA-MCA anastomosis on 80 hemispheres of 58 consecutive patients with moyamoya disease (approximately 2-62 years old, 34.4 years old in average). Mean follow-up period was 22.7 months. Symptomatic cerebral hyperperfusion was defined as the presence of the significant increase in CBF at the site of the anastomosis that is responsible for the apparent neurologic sign. Results Twenty-one patients (22 sides, 27.5%) temporarily had symptomatic cerebral hyperperfusion, who were subjected to intensive blood pressure control. Postoperative magnetic resonance imaging/angiography showed the thick high signal of bypass without ischemic changes in all 21 patients. Adult-onset ( P = .013) or hemorrhagic-onset patients ( P = .027) had significantly higher risk for symptomatic hyperperfusion. There was no difference in intraoperative temporary occlusion time between each group. No patients had permanent neurologic deficit because of hyperperfusion. Conclusion The STA-MCA anastomosis is a safe and effective treatment of moyamoya disease, although adult-onset and/or hemorrhagic-onset patients had higher risk for symptomatic hyperperfusion. We recommend routine CBF measurement especially for these patients because the management of hyperperfusion is contradictory to that of ischemia.
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