The objective of our study was to examine delays between onset of symptoms and treatment for malignant spinal cord compression （MSCC） and to investigate outcomes of neurological function. We performed a retrospective study of clinical records for 25 patients who had been diagnosed with MSCC at a regional center hospital. Thirteen patients had a history of malignancy at the onset of MSCC and 12 patients had no history. For most patients, pain was the first symptom of MSCC. Pain preceded neurologic symptoms by approximately 2 months. The median delays from onset of symptoms of MSCC to treatment were 49 days for all patients, 79 days for those without a history of malignancy and 41.5 days for those with a history of malignancy. It took 39 days from onset to consultation at the hospital, 7 days from consultation to diagnosis and 11 days from diagnosis to treatment. Neurological status was not exacerbated in 8 of 9 patients who had no other neurologic dysfunction at the time of treatment, while only 4 of 10 patients who had deterioration of motor or sensory function at the time of treatment showed improvement in neurological status. In conclusion, there were many delays in all processes from onset to treatment for MSCC and these delays resulted in poor outcome of neurological function.

The authors examined the frequency of thromboembolism and bleeding complications in cases of mechanical valve replacement during the past 5 years in the Tokyo area. There were 21 cases of thromboembolism and 15 cases of bleeding complications. Analyzing these cases with regard to anticoagulant therapy, 71% of the thromboembolism cases and 47% of the bleeding complication cases had 10∼25% result on the thrombotest at the time of the event. Consequently, in cases of mechanical valve replacement it is necessary to reevaluate the therapeutic range of the thrombotest results. This was a retrospective study of a TAS (The Tokyo area anticoagulation study for cardiac valve replacement by using PT-INR) trial and we intend to carry out a prospective study on the therapeutic range of the thrombotest and PT-INR.

STUDY DESIGN: Retrospective study. PURPOSE: We experienced the situation wherein some patients had new-onset pain or dysesthesia around the ring and little fingers (C8 symptom) or ulnar aspect of the forearm (T1 symptom) after cervical laminoplasty (LP). We investigated the incidence and the cause of new C8 or T1 symptoms and the clinical outcomes after C3–C6 LP or C3–C7 LP. OVERVIEW OF LITERATURE: There were some reports regarding complications after cervical LP. However, there was no report regarding C8 or T1 symptoms after cervical LP. METHODS: Among the 33 patients enrolled in this study, 11 and 22 patients were treated with C3–C6 LP and C3–C7 LP, respectively. We prospectively evaluated C8 or T1 symptoms daily postoperatively for 1 week. The distance of the posterior spinal cord shifting and posterior subarachnoid space from C2 to T1 was measured by T2-weighted midsagittal magnetic resonance imaging (MRI). We evaluated pre- and postoperative axial neck pain, Japanese Orthopaedic Association (JOA) score, and JOA score improvement rate. RESULTS: C8 or T1 symptoms occurred in five and three patients with C3–C6 LP (45.5%) and C3–C7 LP (13.6%), respectively. The distance of the posterior subarachnoid space in C3–C6 LP at C7 was significantly shorter than that in C3–C7 LP at T1 on MRI 24 hours postoperatively (p=0.0448). Postoperative axial neck pain, pre- and postoperative JOA scores, and JOA score improvement rate were not significantly different. CONCLUSIONS: The incidence of C8 or T1 symptoms in C3–C6 LP was higher than that in C3–C7 LP. C8 or T1 symptoms would be caused by the posterior fila radicularia and spinal cord impingement on the intact lower end of the lamina.
Asian Continental Ancestry Group ; Fingers ; Forearm ; Humans ; Incidence ; Laminoplasty ; Magnetic Resonance Imaging ; Neck Pain ; Paresthesia ; Prospective Studies ; Retrospective Studies ; Spinal Cord ; Subarachnoid Space

The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.

Surgery for a shaggy aortic aneurysm requires a meticulous strategy to prevent embolic complications since the complications are associated with longer length of hospital stay and higher mortality. However, until now, there are no established treatment options to prevent embolic complications. We report a case of a 75-year-old man with a descending aortic aneurysm and a shaggy aorta who underwent thoracic endovascular aortic repair (TEVAR) with major branch artery protection. During the procedure, we placed balloon catheters in the left subclavian and left common iliac arteries, a filter device in the superior mesenteric artery, and a sheath at the ostium of the right common iliac artery. The patient did not develop embolic or other complications and was discharged on the eighth postoperative day. Our strategy of using the balloon occlusion technique and filter placement at the major vessels effectively prevented embolic complications during TEVAR for a shaggy aorta.