Pyogenic Spondylitis with Rapid Bone Destruction After Chemoradiotherapy for Tongue Cancer: A Case Report and Literature Review.

Radiation therapy is a frequently used effective treatment for head and neck cancer. It has several adverse effects of which osteomyelitis is a late complication of radiotherapy. Although uncommon, when it occurs in the vertebral body, it results in pyogenic spondylitis, which can be fatal. We report a case of pyogenic spondylitis, observed 2 years and 5 months after chemoradiotherapy following surgery for the treatment of tongue cancer. The initial symptoms were fever and posterior cervical pain. Initial CT images showed no abnormality in the cervical spine. However, when CT and MRI were followed over time, bone destruction and abscess formation were observed at the C3 and C4 vertebral endplates. Hence, CT-guided puncture d rainage was performed from the anterior neck. The collected pus was d iagnosed as Class II pyogenic spondylitis by cytology and the culture test revealed the presence of Streptococcus agalactiae. The infection was successfully treated by drainage and antibacterial chemotherapy.

Thrombectomy for Upper Extremity Artery Occlusion with Major Cerebral Artery Occlusion Using Mechanical Thrombectomy Devices for Acute Ischemic Stroke.

Objective: We report two cases of thrombectomy for upper extremity artery occlusion with major cerebral artery occlusion using mechanical thrombectomy devices for acute ischemic stroke. Case Presentations: Case 1 was a 79-year-old woman admitted for left internal carotid artery occlusion and left upper extremity artery occlusion. Case 2 was an 87-year-old woman admitted for left middle cerebral artery occlusion and bilateral upper extremity artery occlusion. After performing mechanical thrombectomy for the cerebral artery, we achieved good recanalization of the brachial artery using the same devices in Case 1 and Case 2. Conclusions: Thrombectomy using acute ischemic stroke mechanical thrombectomy devices for upper extremity artery occlusion is useful for recanalization.

Contrast transcranial Doppler can diagnose large patent foramen ovale.

BACKGROUND: Contrast transesophageal echocardiography (c-TEE) and contrast transcranial Doppler (c-TCD) are useful diagnostic tools for detecting right-to-left shunts (RLS). However, the diagnostic accuracy of c-TCD for patent foramen ovale (PFO) remains uncertain. We investigated the relationship between the size of PFO determined by c-TEE and c-TCD findings and assessed the detectable rate of RLS by c-TCD. METHODS: We assessed RLS three times using simultaneous c-TCD and c-TEE in 107 patients (321 examinations). We classified all of ultrasound examinations into three groups by size according to microbubbles on c-TEE, such as no PFO (0 microbubble), small PFO (1-29 microbubbles) and large PFO (>or=30 microbubbles). We also calculated the number of microembolic signals (MES) on c-TCD and evaluated the association between PFO size on c-TEE and MES count on c-TCD. RESULTS: In the present study, c-TEE detected RLS in 105 (33%; small PFO, n = 78; large PFO, n = 27), and c-TCD detected RLS in 49 (15%) of 321 examinations. Among 78 examinations with small PFO, MES were found in only 19 (24%) on c-TCD. In contrast, of all 27 examinations with large PFO, MES were found on c-TCD. Also, c-TCD were able to detect MES in 3 of 216 examinations among the no-PFO group. When >or=2 MES on c-TCD was established as the cutoff to predict large PFO on c-TEE, the sensitivity, specificity and accuracy were 96.3, 96.8, and 96.9%, respectively. CONCLUSION: When two or more MES were determined by c-TCD, large PFO could be accurately diagnosed.