Cerebral Air Embolism After Air-Powder Abrasive Dental Treatment: A Case Report.

Cerebral air embolism (CAE) occurs in various clinical situations such as surgery, angiography, and hemodialysis; most are iatrogenic. Here we report the case of a 57-year-old man who developed CAE immediately after air-powder abrasive treatment, which is commonly used in dentistry. The patient underwent air-powder abrasive treatment for peri-implantitis, and immediately after the treatment, cardiac arrest occurred and cardio- pulmonary resuscitation was performed. After resuscitation, brain computed tomography performed in the emergency room showed scattered dark density presumed to be air. The day after admission, the patient showed right hemiplegia and a multifocal cerebral infarction was observed on brain magnetic resonance imaging. Therefore, CAE was strongly suspected. After hyperbaric oxygen treatment (HBOT), which started 4 days after the incident, the patient regained consciousness and showed improvement in cognitive impairment, and only grade 4 muscle weakness was observed in the right lower extremity on the manual muscle test. This case highlights the importance of considering CAE as a possible cause of neurological symptoms occurring during clinical procedures involving air, and adds to the accumulation of evidence of therapeutic effects of delayed HBOT.

Lymphoscintigraphy in patients with breast cancer-related lymphedema after sentinel lymph node dissection and axillary radiation therapy.

The purpose of this study was to investigate lymphoscintigraphy pattern according to the presence or absence of axillary site radiation therapy (aRTx) in breast cancer-related lymphedema (BCRL) patients who underwent sentinel lymph node dissection (SLND). The participants were patients who visited our facility from July 2014 to June 2021 due to upper extremity edema. Among them, patients who underwent SLND after the diagnosis of breast cancer were included. The participants were divided into a group without aRTx (group A) and a group with aRTx (group B). In each patient's lymphoscintigraphy, axillary lymph node uptake (ALNU), lymphatic flow delay, dermal back flow, and the presence of any collateral pathway were checked. Thirty-three patients were enrolled. In all, 27 patients were classified in Group A, and 6 patients were classified in Group B. Between the 2 groups, we found a significant difference (P value < .05) between groups at ALNU and lymphatic flow delay. However, there was no significant difference between groups at the dermal backflow and the presence of a collateral pathway (P value > .05). And 24.2% of patients who developed lymphedema after SLND showed normal lymphoscintigraphy. In this study we suggest that SLND and aRTx affects the activity of the axillary lymph node and ultimately adversely affects lymphatic flow, becoming a risk factor for lymphedema. In addition, regardless of SLND or aRTx, lymphedema may eventually occur in the patient with normal lymphoscintigraphy.