Single stage multiple stenting in Takayasu's arteritis. Case report.

A 32-year-old Filipino female presented with Takayasu's arteritis manifesting as an abrupt onset of syncope. Physical examination revealed diminished consciousness, right hemiparesis, and a large discrepancy in blood pressure between the upper and lower extremities. Magnetic resonance imaging revealed cerebral infarcts in the left basal ganglia and the left temporal lobe. Angiography revealed complete occlusion of the left common carotid artery and severe stenosis of the brachiocephalic artery, the right common carotid artery, and the left subclavian artery. Based on the clinical examination and studies, the diagnosis was Takayasu's arteritis, type I. The patient's condition stabilized after 2 months of prednisone and anti-platelet therapy. Single stage multiple stenting in the brachiocephalic artery, the right common carotid artery, and the left subclavian artery was then performed using high pressure inflation to dilate the arteries due to the remarkably rigid lesions that resulted from extensive and diffuse fibrosis throughout the vessel walls. Although a small intimal flap occurred during inflation of the left subclavian artery, re-dilation was possible with the stent. Even with evidence of notable recovery in blood pressure and cerebral blood flow, no further neurological improvement was observed. In view of the favorable short- and intermediate-term results, single stage multiple stenting may be the optimum treatment option for first-line stent-supported angioplasty in patients with Takayasu's arteritis.

Risks and causes of cervical cord and medulla oblongata injuries due to acupuncture.

BACKGROUND: Acupuncture has become one of the most popular alternative medicines in the world today. Some acupuncturists still intentionally embed entire needles deep in the tissue for treatments, and some patients stick needles into their own bodies on their own. CASE DESCRIPTION: Surgical removal of an accidentally broken acupuncture needle due to self-acupuncture that was embedded in the medulla oblongata and cerebellum was performed. The broken needle migrated further into the brain in a few days. Contrary to expectation, it was extremely laborious to find the needle, which turned out to be completely embedded in the brain. No postoperative complications developed. The patient denied any symptoms and was subsequently discharged. RESULTS: Previously reported cases of 25 patients, in addition to our patient, who suffered from cervical or brain injuries due to acupuncture needles, were retrospectively studied. Embedded needles were the most frequent cause of the injuries and comprised 15 patients (57.7%). Accidentally broken needles came in second, comprising 11 patients (42.3%). Five cases (19.2%) were attributed to self-acupuncture. Sixteen (61.5%) patients developed symptoms more than 30 days after the accident. Twenty-three (88.5%) patients complained of sensory deficits, whereas 11 (42.3%) presented with motor weakness. Surgical removals were performed in 21 patients (80.8%), and 10 patients showed signs of recovery. On the other hand, no patients showed improvements in conservatively treated cases. CONCLUSIONS: Embedded needles in the brain should be urgently removed if possible. Both embedded needle acupuncture and self-acupuncture are extremely dangerous and hazardous to health.

[Case of bilateral subdural empyema complicating Campylobacter fetus subspecies fetus meningitis].

Campylobacter fetus subspecies fetus (C. fetus) is a relatively rare cause of meningitis, with only 3 cases of C. fetus subdural empyema reported to date. We experienced a case of bilateral subdural empyema complicating C. fetus meningitis. A 51-year-old man was found lying unconscious on a street and was brought to the hospital in an ambulance. He had no past history of any underlying disease but he had suffered head trauma approximately 1 month prior to this episode. On admission, he had high fever and developed a convulsion fit. Because the cerebrospinal fluid (CSF) findings showed mononuclear dominant pleocytosis and Gram staining revealed spiral-shaped gram negative bacilli, meningitis caused by C. fetus was suspected. Brain CT preformed on admission did not reveal any obvious abnormality. He was immediately treated with antibiotics effective against C. fetus. His disease was complicated by bilateral subdural empyema; therefore, bilateral burr hole drainage was performed. Durling the operation, a hematoma with an outer membrane and containing yellowish pus was revealed. Infection of a chronic subdural hematoma and consequent formation of subdural empyema was deduced. Eventually, C. fetus was isolated from the CSF arterial blood and subdural empyema. The patient was discharged with no complication after the completion of the treatment.

Effects of moderate hyperthermia on the rabbit sarcoma model.

A method of induction of moderate hyperthermia with a plate heater and a direct current energy source was investigated in the VX-2 rabbit sarcoma model. The theoretical distribution of temperature in the rabbit brain was calculated under various heating conditions. The calculated temperatures coincided well with the temperatures of moderate hyperthermia measured by a thermocouple to a depth of 7 mm under the heater. Moderate hyperthermia was induced in the VX-2 sarcoma. Hyperthermia at 40 degrees C for 20 minutes caused no changes in the lesion. Hyperthermia at 45 degrees C for 20 minutes destroyed the lesion partially to a maximum depth of 3 mm. Hyperthermia at 50 degrees C for 20 minutes caused greater destruction, but also caused edema in the lesion and the surrounding normal brain. Hyperthermia at 55 degrees C for 20 minutes caused severe damage in both the lesion and the surrounding normal brain. Comparison of the actual destruction by hyperthermia and the theoretical temperature distribution indicated that hyperthermia at 43 degrees C for 20 minutes was effective against brain tumor, and destruction reached at least 3 mm from the heater.