Intoxication with massive doses of amlodipine and candesartan requiring venoarterial extracorporeal membrane oxygenation.

Background: Calcium channel blockers and angiotensin II receptor blockers are commonly prescribed to treat hypertension. Massive overdoses can cause both distributive and cardiogenic shock because of their effects on vascular smooth muscles and severe myocardial depression.

Case Presentation: We present the case of a 46-year-old man who was brought to our emergency department after ingesting 1210 mg amlodipine and 936 mg candesartan.

Direct Carotid-Cavernous Fistula Caused by Internal Carotid Artery Perforation by a Microcatheter Body during Mechanical Thrombectomy.

Rapid advances in emergent mechanical thrombectomy have resulted in a higher occurrence of arterial perforations during neurointerventions. Here, we report a case of internal carotid artery (ICA) perforation during mechanical thrombectomy in a 78-year-old man with a left middle cerebral artery occlusion. The ICA was perforated by a microcatheter during thrombectomy, forming a direct carotid-cavernous fistula.

Arteriovenous fistula of the clival diploic vein associated with arteriovenous fistula of the posterior condylar canal.

We herein report a rare case of a patient with a clival diploic vein arteriovenous fistula (AVF) associated with a posterior condylar canal AVF and discuss the radiological features of clival diploic vein AVF during decision-making on treatment strategies. A 69-year-old male patient with one-year history of pulsatile tinnitus was evaluated with magnetic resonance angiography, which revealed a dilated venous structure. Digital subtraction angiography revealed AVFs located in the clivus and posterior condylar canal.

Mechanical thrombectomy for occlusion near a ruptured intracranial aneurysm: A case report.

Background: While recent randomized clinical trials have shown the efficacy of mechanical thrombectomy for acute large vessel anterior cerebral occlusion, cases in patients with a subarachnoid hemorrhage (SAH) were excluded from the study.

Case Description: A 58-year-old man presented with a SAH as a result of a ruptured middle cerebral artery aneurysm. Coil embolization was performed, and a right intracranial angiography showed remnants of an aneurysmal neck.

Treatment Outcomes of Burr-Hole Surgery for Chronic Subdural Hematoma in the Elderly Living Beyond Life Expectancy: A Study Comparing Cure, Recurrence, and Complications in Patients Aged ≥80 Years versus ≤79 Years.

Background: Few reports have focused on chronic subdural hematoma (CSDH) in the very elderly, who have lived beyond average life expectancy. Our aim is to appraise treatment outcomes of burr-hole craniotomy for CSDH in the elderly, focusing on cure, recurrence, and complications.

Methods: Fifty patients ≤79 years of age (group A) and 73 patients ≥80 years of age (group B) were studied.

Characteristics of Children Cared for by a Physician-Staffed Helicopter Emergency Medical Service.

Objectives: The effectiveness of Japanese helicopter emergency medical services (HEMS) and interventions at the scene is not clear as regard children. For effective use of HEMS at the clinical scene, we need to clarify the characteristics of pediatric patients cared for by HEMS. Therefore, the objective of this study was to describe the characteristics of pediatric scene flights and to describe the procedures performed on the patients.

Endovascular treatments for posterior cerebral artery aneurysms and vascular insufficiency of fetal-type circulation after parent artery occlusion.

We present a retrospective analysis of endovascular treatments for posterior cerebral artery (PCA) aneurysms and discuss the susceptibility of a fetal-type PCA to vascular insufficiency after parent artery occlusion. Among 1207 aneurysms treated with endovascular therapy between March 1997 and March 2013 in our institution, 10 patients (0.8%) presented PCA aneurysms.

Do dispatcher instructions facilitate bystander-initiated cardiopulmonary resuscitation and improve outcomes in patients with out-of-hospital cardiac arrest? A comparison of family and non-family bystanders.

Objectives: Bystander-initiated cardiopulmonary resuscitation (CPR) has been reported to increase the possibility of survival in patients with out-of-hospital cardiopulmonary arrest (OHCA). We evaluated the effects of CPR instructions by emergency medical dispatchers on the frequency of bystander CPR and outcomes, and whether these effects differed between family and non-family bystanders.

Methods: We conducted a retrospective cohort study, using Utstein-style records of OHCA taken in a rural area of Japan between January 2004 and December 2009.

New instrument for creating bone graft cavities for anterior cervical decompression and fusion: the anterior fusion spinal fork.

Sufficient bone decompression of osteophytes is important for positive functional outcomes in anterior cervical spine surgery. Achieving good alignment and bone fusion in anterior cervical decompression and fusion requires a bone graft bed of the optimum size and shape. We have developed a stainless steel instrument named the anterior fusion spinal fork, which is designed to aid in accurately drilling the bone cavity, thus enabling selection of the correct size of bone graft or bone graft substitutes.

Prediction of boron concentrations in blood from patients on boron neutron capture therapy.

Background: In boron neutron capture therapy, blood boron concentration is the key factor to calculate radiation dose, however, blood sampling is difficult during neutron irradiation.

Materials And Methods: The prediction of blood boron concentrations for BNCT treatment planning has been prospectively investigated using patient data obtained at first craniotomy after the infusion of a low dose of sodium undecahydroclosododecaborate.

Results: The boron biodistribution data showed a biexponential pharmacokinetic profile.