Spinal cord ischemia following open surgery of a ruptured isolated internal iliac artery aneurysm: A case report.

INTRODUCTION: Isolated internal iliac artery (IIA) aneurysms (IIIAAs) rarely occur. However, they may enlarge asymptomatically and rupture, causing fatality. Even after successful surgery of ruptured IIIAAs, there might be a potential risk of postoperative spinal cord ischemia (SCI)-related paraplegia, which is extremely rare. However, this paraplegia significantly impacts patients' activities of daily living. PATIENT CONCERNS: A 71-year-old man who had no remarkable medical history was referred to our hospital with sudden lower abdominal pain. DIAGNOSIS: Computed tomography (CT) revealed right IIIAA with small volumes of contrast medium extravasation and hematoma. He presented with cyanosis in the bilateral lower limbs. Moreover, blood gas analysis showed lactic acidosis. Therefore, he was diagnosed with ruptured IIIAA complicated by peripheral circulatory failure. INTERVENTIONS: Considering his pre-shock status, an emergency operation comprising ligation of the proximal neck and suture closure of the distal IIA orifice was successfully performed. OUTCOMES: Immediately after surgery, motor and sensory dysfunction in the bilateral lower limbs occurred. Magnetic resonance imaging confirmed the presence of SCI. The patient could not stand independently and had neurogenic bladder and rectal disorder. CONCLUSION: Postoperative SCI is a serious complication with no definitive predictors, preventive methods, or highly efficacious treatments. Therefore, vascular surgeons should preempt its occurrence and focus on preventing hemodynamic instability and maintain collateral extra-segmental arterial blood flow, especially in ruptured cases.

[A Case of Palbociclib plus Fulvestrant‒Resistant Metastatic Breast Cancer That Responded to Abemaciclib plus Fulvestrant].

We report the case of a 72‒year‒old woman with ER(+), PgR(+), HER2(-)metastatic breast cancer with liver involvement. The patient received palbociclib(125 mg daily po 3 weeks on/1 week off)and fulvestrant(500 mg im on days 1, 15, and 29, and once monthly thereafter)as second‒line endocrine therapy. Her metastatic liver lesions initially decreased in size and the tumor‒marker CA15‒3 level decreased. However, they progressed after seven months of therapy. She was subsequently switched to abemaciclib(150 mg twice/daily po)with fulvestrant as third‒line therapy, resulting in a decrease in the same liver lesions. She has continued treatment for 12 months. Based on this case, abemaciclib may be clinically useful for breast cancer that is not responsive or has become resistant to palbociclib, another selective CDK4/6 inhibitor.

[Aspergillus Empyema with Bronchopleural Fistula due to Destroyed Lung after Postoperative Radiotherapy for Thymoma].

A 35-year-old man underwent adjuvant chemoradiation therapy to the surgical margin of the thymoma. Five years after the therapy, an area of the right upper lung lobe, which was included in the irradiation field, developed destroyed lung, resulting in Aspergillus empyema with bronchopleural fistula. To control the infection, an open window thoracostomy was performed. As the bronchopleural fistula resulted in pneumonia, bronchial embolization was performed with an Endobronchial Watanabe Spigot. After the empyema cavity was cleaned, the empyema space was closed with omental and muscular flap, thoracoplasty. Negative pressure wound therapy was carried out because of poor wound healing. The patient is doing well without relapse 15 months after the thoracoplasty.