Initial Experience with Epicardial Ultrasound Scanning in Coronary Artery Bypass Grafting

Background@#The benefits of epicardial ultrasound scanning (EUS) in coronary artery bypass grafting (CABG) have not yet been established. The aim of this study was to evaluate the usefulness of EUS in CABG, including in the assessment of the quality of distal anastomoses, the identification of epicardial target vessels, and the evaluation of any graft issues other than the distal anastomoses. @*Methods@#Fifty-three patients undergoing CABG were enrolled between March 2018 and February 2019. Intraoperative EUS was performed along with transit-time flow measurement (TTFM). Graft evaluations were performed early (shortly after surgery) and 1 year after surgery for 53 (100%) and 47 (88.7%) patients, respectively. @*Results@#EUS was applied to assess the quality of all distal anastomoses, 32 target vessels, and 2 conduit trunks. Insufficient TTFM findings were obtained for 18 grafts. However, graft revision was performed for only 3 distal anastomoses; based on the EUS findings, the remaining 15 sites were not revised. The early and 1-year overall graft patency rates were 100% (141 anastomoses) and 96.1% (122 of 127 anastomoses), respectively. All 15 of the distal anastomoses that were not revised despite insufficient TTFM results were patent at the 1-year mark. @*Conclusion@#The routine application of EUS in CABG could be beneficial by confirming the quality of surgery and reducing unnecessary procedures.

Femoral Neuropathy Secondary to Iliacus Hematoma: A Case Report / 대한고관절학회지

A 17-year-old male patient complained of acutely developed severe paresthesia, pain, and weakness of the right lower extremity. He fell to the ground during performance of hand-stand physical exercise. Despite administration of conservative treatment for two weeks in a private clinic, motor function of the hip flexor and knee extensor were measured as poor grade. EMG showed femoral nerve and lateral femoral cutaneous nerve injury. Findings on MRI and CT revealed a mass measuring 8x5x7 cm in the iliac fossa. After evacuation of the hematoma(400 cc), neurologic dysfunction and thigh circumference were fully recovered, compared with the contralateral side, after one and half year follow up. This condition rarely occurs in individuals without coagulopathy. We reported on a rare case of iliacus hematoma and femoral neuropathy treated by surgical decompression in a patient with no coagulopathy.

The Changes in Neural Foramen Shown on Computed Tomography Depending on the Changes in the Height of Intervertebral Disc after Anterior Cervical Discectomy and Fusion (ACDF)

STUDY DESIGN: A prospective radiological assessment. OBJECTIVES: Changes in the height, area, and width--captured using computed tomography (CT)--of the neural foramen with respect to changes in the intervertebral disc height, after undergoing an anterior cervical disc removal and fusion procedure. SUMMARY OF LITERATURE REVIEW: The multiple authors of this study, by obtaining central canal and area of neural foramen by increasing the disc spacing height and area of the neural foramen, attempted to assess the height increase of disc spacing. It is necessary to consider the synergistic effects of decompression through dissection of the posterior longitudinal ligament (PLL). MATERIALS AND METHODS: The authors studied 17 patient cases that underwent one segment anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease from June 2006 to March 2007. All patient cases underwent autogenous iliac bone graft or cage insertion with plate fixation procedure. We measured the areas of the neural foramen, heights of the vertebra body above and below the removed intervertebral disc with CT before and after ACDF. Radiographic measurements were averaged. RESULTS: Among the 17 cases, the height of the cervical disc increased in 15 cases and decreased in 2 cases. The heights of the neural foramen increased in 19 cases and showed no changes in 13 cases. The areas of the neural foramen increased in 23 cases and decreased in 6 cases. The heights of vertebral body above and below the removed disc increased by 5.4% (p=0.734), and the heights of the neural foramen increased by 13.3% (p=0.002). The area of the neural foramen increased by 13.6% (p=0.192). The widths of the neural foramen increased by 2.3% (p=0.586). The intervertebral disc height, neural foramen height, and neural foramen area increased by 39.6%, 8.4%, and 17.9%, respectively, after a 2mm lengthening of bone transplant. The intervertebral disc height, neural foramen height, and neural foramen area increased by 59.8%, 22.9%, and 10.3%, respectively, after a 3mm lengthening of bone transplant. The height and area of neural foramen increased by 18.3% and 18.2%, respectively, after the PLL removal and dissection. CONCLUSIONS: The follow-up observations of the intervertebral disc height, neural foramen height, and neural foramen area showed increases after one segment ACDF in cervical disease cases, when compared to the preoperative radiographic findings. As the height of bone transplant increased, the intervertebral disc height, neural foramen height, and neural foramen area increased. The neural foramen height and neural foramen area significantly increased, when PLL was dissected.

Spontaneous Rupture of the Extensor Pollicis Longus Tendon in a Tailor

A spontaneous rupture of the extensor pollicis longus (EPL) tendon is associated with rheumatoid arthritis, fractures of the wrist, systemic or local steroids and repetitive, and excessive abnormal motion of the wrist joint. The authors encountered a case of a spontaneous rupture of the EPL tendon. The patient had no predisposing factors including trauma or steroid injection. Although the patient had a positive rheumatoid factor, he did not demonstrate other clinical or radiological findings of rheumatoid arthritis. During surgery, the EPL tendon was found to be ruptured at the extensor retinaculum (third compartment). Reconstruction of the extensor tendon using the palmaris longus tendon was performed. At the 18-month follow-up, the patient showed satisfactory extension of the thumb and 40degrees extension and flexion at the wrist.

Airways are More Reactive to Histamine than to Methacholine in Patients with Mild Airway Hyperresponsiveness, Regardless of Atopy

BACKGROUND: The airway muscles from allergen-sensitized animals in vitro show a heightened response to histamine, but not to carbachol. This study investigated whether the airway responsiveness to histamine in vivo is comparable to that of methacholine in human subjects with varying degrees of atopy. METHODS: One-hundred-and-sixty-eight consecutive adult asthma patients or volunteers underwent bronchoprovocation tests to both histamine and methacholine after determining their blood eosinophil counts, serum total IgE levels and skin test reactivity to 10 common aeroallergens. RESULTS: The responsiveness to histamine was significantly related to that to methacholine (r=0.609, p<0.001), but many individuals with a negative methacholine test response showed a positive response to histamine. The histamine-bronchial reactivity index (BRindex) was significantly higher than the methacholine-BRindex in subjects with a positive response to none (n=69, p<0.01) or only one (n=42, p<0.001) of histamine and methacholine, while there was no significant difference in the subjects with positive responses to both of them (n=57). The histamine-BRindex was significantly higher than the methacholine-BRindex in the subjects with mild histamine hyperresponsiveness (n=58, 1.28+/-0.01 vs. 1.20+/-0.02, respectively, p<0.001). Both histamine and methacholine responsiveness was significantly related to the atopy markers. However, the histamine-BRindex/methacholine-BRindex ratio of the atopics was not significantly different from that of the non-atopics. CONCLUSIONS: The airway responsiveness to histamine is comparable to that of methacholine in the subjects with positive responses to both histamine and methacholine, but the airway responsiveness to histamine is greater than that to methacholine in those subjects with mild airway hyperresponsiveness, regardless of atopy.