A previously healthy 22-year-old man presented with thoracic outlet syndrome manifesting as Raynaud's phenomenon in the left hand and embolic occlusion of the basilar artery. Three-dimensional computed tomography angiography showed that the left subclavian artery was occluded as it passed over the abnormal first rib. Retrograde propagation of the thrombus from the site of arterial occlusion and/or reflux of embolic material was suspected. Medical therapy was started. The patient underwent resection of the anomalous rib. Postoperative angiography demonstrated that the subclavian artery was recanalized with almost normal distal flow. The basilar artery was also recanalized. Thoracic outlet syndrome due to a first rib anomaly may cause stroke.

Wi-Fi-based wireless FEES system, the first of its kind, allowed our multidisciplinary team to easily and effectively assess inpatients with dysphagia by facilitating simple examinations and intensive transprofessional discussions for patient rehabilitation.

Background: Vertebral compression fracture (VCF) is a major injury that occurs in elderly individuals. The aim of this study is to predict the functional outcomes of elderly female patients with acute VCF based on their nutritional status. Methods: A total of 69 female patients with acute VCF were included in the present study. The age, fracture location, body mass index, grasping power, the amount of the patientʼs daily nutritional intake, Mini-Mental State Examination (MMSE) score and nutritional status (determined from laboratory findings) were evaluated at the time of admission. After in-hospital rehabilitation, the patients were divided into two groups based on their motor Functional Independence Measure (mFIM) scores at the time of discharge. A multivariable logistic regression analysis was performed to identify factors that predicted the outcome. Results: The patients were divided into the high mFIM (score ≥ 79, n＝36) and the low mFIM (score＜79, n＝33) groups. The multivariate logistic regression analysis showed that the amount of the patient' s nutritional intake and the MMSE score were associated with the outcome. Conclusions: he cognitive status and the amount of the patient' s nutritional intake were associated with the prognosis of elderly women with acute VCF.

Introduction: Patients with hip osteoarthritis (OA) show abnormal movement patterns, including the leaning of the trunk toward the affected limb (Duchenne limp). Patients with severe OA, especially those with OA due to hip dysplasia, show a lateral pelvic drop (Trendelenburg sign). Aim: The aim of this preoperative study is to investigate the relationship between superior migration of the arthritic femoral head, pain, and hip abductor muscle strength, and to clarify the relationship between the coronal plane gait patterns with pain and hip abductor muscle strength. Methods: The subjects of this study were 18 patients with unilateral hip OA secondary to dysplasia. A radiographic analysis was performed on standardised anteroposterior pelvis films. The abductor muscle strength of the OA hip joint was measured with a handheld dynamometer. The tilt angle of the pelvis and trunk lean angle during gait were obtained using a 3-dimensional motion analysis system. Visual analogue scale (VAS) of pain was obtained after trial. Results: The 2 lateral pelvic angle patterns at the mid-stance of the affected limb during gait were detected. 1 is a pattern that was pelvic rise, and the other was a contralateral pelvic drop. Subjects with pelvic drop showed more superior femoral migration than that with pelvic rise (r = 0.69 p < 0.01). VAS of pain correlate significantly with coronal trunk angle on mid-stance of affected limb during gait (r = 0.761, p < 0.01). Conclusion: The pelvic drop Trendelenburg sign was influenced by superior migration of the femoral head, whereas the trunk lean Duchenne limp was found to be affected by pain.

Summary:We report 2 cases with giant/large thrombosed aneurysm. One patient, who presented with subarachnoid hemorrhage, had a giant thrombosed aneurysm of the middle cerebral artery and underwent surgery. To prepare for the parent artery occlusion, a STA-MCA bypass was set and motor evoked potential (MEP) was monitored. The aneurysm was cut open, the thrombus was removed, and clipping was performed. Another patient, who presented with visual disturbance, had a large thrombosed aneurysm of anterior communicating artery, which occupied the tubercullum sellae. The aneurysm was clipped after removal of the thrombus.Since the wall of a thrombosed aneurysm is too hard to clip, the thrombus must be removed before clipping. To prevent premature rupture, a thrombus should be carefully removed, paying attention to the nature of the thrombus.In preparation for parent artery occlusion, installation of bypass and MEP monitoring is effective. Even after setting a bypass, the blood flow to the perforating arteries should be carefully monitored with MEP.