Pontine infarction caused by medial branch injury of the basilar artery as a rare complication of cisternal drain placement

We present a rare complication of cisternal drain placement during aneurysm surgery. A ruptured anterior communicating artery aneurysm was clipped through a right pterional approach. A cisternal drain was inserted from the retro-carotid to the prepontine cistern. Postoperatively, a left-sided paresis of the upper extremity had developed. A CT brain scan revealed that the drain was located between the pons and the basilar artery, resulting in a pontine infarction. Vascular neurosurgeons should keep this complication in mind when placing a cisternal drain tube. The drain tube should not be inserted too deep into the prepontine cistern.ArticleJOURNAL OF CLINICAL NEUROSCIENCE. 19(4):592-593 (2012)journal articl

Pontine infarction caused by medial branch injury of the basilar artery as a rare complication of cisternal drain placement

We present a rare complication of cisternal drain placement during aneurysm surgery. A ruptured anterior communicating artery aneurysm was clipped through a right pterional approach. A cisternal drain was inserted from the retro-carotid to the prepontine cistern. Postoperatively, a left-sided paresis of the upper extremity had developed. A CT brain scan revealed that the drain was located between the pons and the basilar artery, resulting in a pontine infarction. Vascular neurosurgeons should keep this complication in mind when placing a cisternal drain tube. The drain tube should not be inserted too deep into the prepontine cistern

Secondary Adrenal Insufficiency Due to Isolated ACTH Deficiency Induced by Pembrolizumab: A Report of Two Cases of Uterine Endometrial Cancer

Immune checkpoint inhibitors (ICIs) enhance antitumoral immune mechanisms and are used to treat various types of solid tumors including those that are microsatellite instability (MSI)-high. Uterine endometrial cancer is one of the most frequent tumor types that shows MSI-high, and, consequently, opportunities to use ICIs for endometrial cancer treatment are increasing. While using ICIs, it is important to monitor and manage various immune-related adverse events (irAEs). Here, we report two cases of secondary adrenal insufficiency during treatment of endometrial cancer with pembrolizumab. Both cases showed appetite loss and general fatigue after the 6th or 12th cycle of pembrolizumab. They were admitted to our hospital because of remarkable hyponatremia. Both cases showed no adrenocorticotropic hormone (ACTH) or cortisol response to CRH loading tests. Other pituitary hormone levels were normal, and MRI revealed no sign of hypophysitis in either patient. They were diagnosed with secondary adrenal insufficiency due to isolated ACTH deficiency and recovered soon after the administration of hydrocortisone and hydration. Thus, we should be aware of irAEs with the use of ICIs. In particular, adrenocortical insufficiency is sometimes lethal without appropriate treatment. Because the clinical symptoms are fatigue, appetite loss, and nausea, patients might be misjudged to have symptoms related to cancer. Checking serum morning cortisol before ICIs use and monitoring serum sodium levels could provide clues to diagnose secondary adrenal insufficiency

Simple hepatic cyst in a 64-year-old woman.

<p>a) Abdominal CT scan shows a well-defined water attenuation lesion in the right hepatic lobe. (b) 3D-image showed a cyst capacity of 1800 ml. Note the Glisson’s pedicle in the base. (c) Laparoscopic aspiration and ethanol sclerosis using sand balloon catheter. (d) Wide unroofing in the right hepatic lobe.</p

Infectious liver cyst in a 71-year-old woman.

<p>(a) Abdominal CT scan showed enhanced cystic wall. (b) Laparotomy view. (c) Intraoperative photograph of post-central hepatectomy. (d) Surgical sample: note the presence of an abscess separated by a septum from the tumor area.</p