Measurement of Vertebral Compression and Kyphosis in the Thoracolumbar and Lumbar Fractures

STUDY DESIGN: A retrospective radiologic study. OBJECTIVES: We wanted to compare the compression ratio and kyphosis of thoracolumbar and lumbar fractures according to the radiologic measuring methods and we wanted to analyze their relationship with the stability of fracture. SUMMARY OF THE LITERATURE REVIEW: There are several methods for measuring the compression ratio and kyphotic angle in thoracolumbar fractures, but no definitive measurements and no different values according to the stability have been established. MATERIALS AND METHODS: From July 2002 to August 2008, the plain films, CT, MRI and medical records of thoracolumbar and lumbar fracture were reviewed. The compression ratio and kyphotic angle were calculated by several different formulas with using the lateral view of the plain X-ray film, the sagittal reconstruction image of CT and the sagittal image of MRI and the results were compared. Each subject was classified according to both McAfee's classification and the TLISS classification. RESULTS: Two hundred forty eight vertebral bodies of 205 thoracolumbar fracture patients were analyzed. The compression ratio according to formula 1, which was calculated as 1-anterior vertebral height/posterior vertebral height, was significantly correlated with Cobb's angle and the local kyphotic angle. There was no significant difference between the Cobb's angle calculated using the lateral X-ray and that using the sagittal view of CT; however, it was significantly less using the sagittal MRI view. The unstable fractures according to McAfee's classification showed a significantly higher compression ratio and kyphotic angle compared to those of the stable fractures. CONCLUSIONS: The compression ratio formula 1 was most significantly correlated with the kyphotic deformity. The unstable fractures showed a mean compression ratio higher than 30%, a mean Cobb's angle of 15degrees and local kyphotic angle of 18degrees. The sagittally reconstructed CT was a useful measuring method for the evaluation of kyphotic deformity, and it was more accurate than that of the plain film.

MRI Patterns in the Acute or Subacute Stage of Osteoporotic Vertebral Fractures / 대한척추외과학회지

STUDY DESIGN: This is a retrospective radiologic study OBJECTIVES: The aim of this study is to analyze the signals and configurations of the MRI findings of osteoporotic vertebral fractures and the clinical consequences of each type of the MRI findings. SUMMARY OF THE LITERATURE REVIEW: There have been some reports that have focused on the MR findings for the differentiation of osteoporotic and metastatic fractures, but there are few reports on the characteristics of the early stage of osteoporotic vertebral fractures. MATERIALS AND METHODS: From July 2002 to April 2008, the MRI findings and medical records of 97 patients who were diagnosed with acute or subacute osteoporotic vertebral fractures and who were followed-up for more than 1 year were analyzed. The patients with minor trauma within 3 months before obtaining MRIs and they had decreased bone density were included in this study. Those with fractures due to severe trauma or pathologic causes or normal bone density were excluded. Three spine surgeons evaluated, at three times per each surgeon, the T1-weighted, T2-weighted and fat suppression T1-enhanced sagittal images for the signal of the vertebral body bone marrow and the type of the intravertebral body lesion shape. The relationships between the type of MRI findings and the time from the trauma and the follow up clinical consequences were analyzed. RESULTS: The MRI patterns of 97 patients with 111 fractures of the vertebrae were divided into three types. There were 56 cases of Type I (50.5%), which was defined as diffuse typical signal intensity in the vertebral body, 39 cases (35.1%) of Type II, which was defined as geographic low signal in the center of the vertebral body with typical signal changes, and 16 cases (14.4%). of type III, which was defined as atypical signal intensity or a shape of lesion that did not correspond to type 1 nor type 2. The average time from trauma was 10.8+/-19.0days (0~90) for type I, 19.1+/-24.9days (0~90) for type III and 37.5+/-31.1days (0~90) for type III, which showed differences among each types (p<0.001). CONCLUSIONS: The analysis of the relationship between the time from trauma and the signal intensity and the type of lesion on MRI examination revealed that the low signal intensity in the typical vertebral body signal or an atypical signal or shape were poor prognostic factors of osteoporotic vertebral fracture

A Case of Coccidioidomycosis Manifested as Solitary Pulmonary Nodule / 결핵

Coccidioidomycosis is a fungal infection acquired by inhalation of the arthrospore of Coccidioides immitis, and endemic disease in specific geographic areas, such as south central California, south Arizona, Nevada, and New Mexico. Approximately 60 percent of infected people is asymptomatic and the remainders mostly exhibit respiratory complaints, from flu-like coughing to overt pneumonia. Usually the infection due to Coccidioides immitis is self-limited. Symptoms resolve within several weeks but radiographic abnormalities could be resolved more slowly. If the radiographic abnormalities persist more than 8 weeks, the term 'chronic pulmonary coccidioidomycosis'is designated. They take forms of nodules, cavities or progressive pneumonia. When manifested as nodule(s), lung malignancy is suspected as a possible diagnosis and histologic confirmation is needed. Here, we report a case of chronic pulmonary coccidioidomycosis manifested as solitary pulmonary nodule in a Korean woman who has traveled in Arizona, which is diagnosed fianlly by lobectomy and histologic examination.

An Analysis of the Social and Clinical Status of Organ Donation from Brain Death Donors / 대한이식학회지

BACKGROUND: Since the first successful kidney transplatation from a brain death donor(BDD) in 1979, organ transplantations from BDD have steadily increased. The legal definition of brain death has not yet been. However the number of BDDs have been increasing year by year. The purpose of this study is to analyze the social and clinical status of organ donation from BDDs. METHODS: We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. RESULTS: The male to female ratio was 3:1, and the age distribution was the highest in twenties. Occupation distribution was the highest in students and distribution of religion was the highest in these who were non-believers. The distribution of cause of brain death was the highest in motor vehicle accidents. The blood type distribution was the highest in type A+, type B+, O+, and AB+ in order. The distribution of days stayed in ICU before organ donation was the highest in 3D, 2D, and 4D in order. The failure of organ donation was mainly very poor organ condition. CONCLUSIONS: We wish that these results were made use of bases of status of organ donation from BDDs.