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A 77-year-old man who
received transarterial chemoembolization
for large hepatocellular carcinomas complained of acute pain in the
upper abdomen and suddenly developed severe jaundice, anemia, and massive hematuria. Abdominal computed tomography demonstrated
gas gangrene at the tumor site. Clostridium
perfringens was identified from blood samples and drainage cultures from
the liver abscess. Despite intensive treatment, the patient died 55 hours
after chemoembolization due to multiple
organ failure. When treating patients with large tumors, such as in our
case, this rare but fatal complication that causes sepsis and hemolysis with
lightning-like rapidity should be considered.
We report a case of an asymptomatic 36-year-old man with a bronchial artery aneurysm in the right hilum. Selective angiography revealed a 25mmsaccular aneurysm and an efferent artery of the aneurysm forming a high flow bronchial artery-pulmonary artery fistula. Because of dilatation and tortuosity of the bronchial artery, the microcatheter could reach the efferent artery but not the fistula. Therefore, we embolized the fistula by sending microcoils through the bloodstream from the efferent artery to the fistula (the “flow-dependent” coil embolization technique), and further embolized the aneurysm by coil isolation and packing technique.
Solitary bone cysts are benign, fluid-filled cavities that most often
occur in childhood. Several minimally invasive decompression methods have
been proposed; however, performing a surgical procedure through the thinned
overlying cortex raises the risk of pathological fracture and neurovascular
damage, especially in lesions located in the bone diaphysis. We describe a new
technique that circumvents these problems: tunneling through the normal cortex
and medullary space with a flexible reamer, placing a retrograde medullary
nail for cyst decompression.