PURPOSE: The result of embolization via an external superior ophthalmic vein approach of carotid cavernous sinus fistula was first described around 1970s. We report a case of coil embolization of carotid cavernous sinus fistula using a superior ophthalmic vein approach. METHODS: A 70-year-old female had a 3-month history of headache, periocular pain, and diplopia. Diagnostic orbital contrast-enhanced CT, brain MRI and contrast-angiography and cerebral angiography revealed a carotid cavernous sinus fistula. Fistula occlusion via transfemoral endovascular embolization failed, so we then tried coil embolization using an external superior ophthalmic vein approach of carotid cavernous sinus fistula. RESULTS: The coil embolization via an external superior ophthalmic vein approach was difficult because of venous tortuosity and poor exposure of part of orbital roof area. But, X-ray-guided direct puncture of the superior ophthalmic vein was successful. We thus had good results with coil embolization of carotid cavernous fistula. CONCLUSIONS: The coil embolization via superior ophthalmic vein approach is an effective and challengeable treatment when surgical cauterization or conventional endovascular embolization fails. We suggest that there is need to training ophthalmologists to be experienced in external orbital surgery.
Aged ; Brain ; Carotid-Cavernous Sinus Fistula* ; Cautery ; Cerebral Angiography ; Diplopia ; Embolization, Therapeutic* ; Female ; Fistula ; Headache ; Humans ; Magnetic Resonance Imaging ; Orbit ; Punctures ; Tomography, X-Ray Computed ; Veins*

A 60-year-old woman visited the authors' clinic with low back pain and arthralgia. Her symptoms had occurred 6 months previously, and she was treated with an epidural injection and a balloon dilatation procedure based on the assumption of spinal stenosis, but both treatments were ineffective. Her low back pain was aggravated, accompanied by fever and chills over a period of 4 months. As a result, she visited another referral hospital and was diagnosed with infective spondylitis associated with the invasive procedure. Her symptoms improved with antibiotics, but they recurred. When she visited our clinic, she still had continuous low back pain and febrile senses. Magnetic resonance imaging of her lumbar spine revealed interspinous bursitis, and 18 F-fluorodeoxyglucose positron emission tomography showed multifocal synovial inflammation. She was diagnosed with polymyalgia rheumatica and treatment was started on prednisolone and celecoxib. Her symptoms improved dramatically and the inflammatory markers normalized.
Anti-Bacterial Agents ; Arthralgia ; Back Pain ; Bursitis ; Celecoxib ; Chills ; Dilatation ; Female ; Fever ; Humans ; Inflammation ; Injections, Epidural ; Low Back Pain ; Magnetic Resonance Imaging ; Middle Aged ; Polymyalgia Rheumatica* ; Positron-Emission Tomography ; Prednisolone ; Referral and Consultation ; Spinal Stenosis ; Spine ; Spondylitis*

BACKGROUND: Fexofenadine (Allegra(R)) is a H1-receptor selective antihistamine which exhibits consistent efficacy and safety in the treatment of allergic diseases. We thought that fexofenadine may be useful in treatment of the pruritus associated with eczema. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of fexofenadine in the treatment of pruritus associated with eczema. METHODS: In this study, patients with atopic and allergic contact dermatitis were divided into a group given fexofenadine 180 mg once daily with topical prednicarbate treatment group or a topical prednicarbate treatment only group, for 1 week. The primary efficacy parameter was the mean change from baseline in pruritus score, and the secondary parameters were the mean change in the incidence of scratching, the mean change in visual analogue scale (0~100 mm) of pruritus, and a comparison of patient satisfaction. RESULTS: 435 patients were included and the mean age was 32.9 years old. The mean pruritus score at baseline was 3.55 point in fexofenadine group and 3.51 point in the control group. Regarding the mean change in pruritus score, fexofenadine significantly decreased the severity of pruritus compared with the control group (p<0.05). There were no significant differences in the decrease in the incidence of scratching between the two groups. A decrease in pruritus levels utilizing visual analogue scale was significant in the fexofenadine group (p<0.05) and patient satisfaction was significantly higher in the fexofenadine group (p=0.0192). There was no significant difference in the incidence of adverse events between two groups (p=0.6237). CONCLUSION: Fexofenadine administered 180 mg once daily in combination with topical prednicarbate treatment was effective and well tolerated in this study.
Dermatitis, Allergic Contact ; Dermatitis, Atopic ; Eczema ; Humans ; Incidence ; Patient Satisfaction ; Prednisolone ; Pruritus ; Terfenadine