Tuberculosis of the Lower Lumbar Spine with an Atypical Radiological Presentation: A Case Mimicking a Malignancy

A 65-year-old woman was treated for an atypical radiological presentation of spinal tuberculosis. Compared with previously reported cases, the following two different radiographic features were found. 1) Although there was multiple and skipped involvement of the vertebral body, the intervertebral disc was relatively preserved. 2) The presence of an epidural granuloma indicated an epidural extension of the lesion of the adjacent vertebral body. These findings strongly mimicked bone marrow infiltrative disease such as a malignancy. Tuberculosis was confirmed through an open biopsy and the patient was treated successfully with antitubercular chemotherapy. This case highlights the importance of being aware that spinal tuberculosis has many different radiographic features and can mimic a spinal malignancy.

Fixation for Reattachment of Trochanteric Fragment in Pertrochanteric Fracture Treated with Bipolar Hemiarthroplasty

Purpose: To retrospectively compare the fixation methods for reattaching a trochanteric fragment in a pertrochanteric fracture treated with bipolar hemiarthroplasty. Materials and methods: Forty cases of an unstable femur pertrochanteric fracture were analyzed and followed up for average of 19(6~40) months. There were 18 cases fixed with tension band wiring (group 1), 7 cases treated using modified tension band wiring with K-wires (group 2) and 15 cases treated with the GTRD (Greater Trochanteric Reattachment Device) (group 3). Result: Group 1 was treated with simple a surgical procedure and the results were good. The second group had firm fixation postoperatively but required additional surgery in two cases to remove the K-wires because of wire migration after ambulation. Group 3 had relatively good results but required more dissection and a longer operating time. Conclusion: Tension band wiring or GTRD are good fixation methods for reattaching trochanteric fragments in pertrochanteric fractures. Moreover, tension band wiring is recommended for old osteoporotic patients due to a simple procedure and firm fixation. The use of modified tension band wiring using K-wire or a Steinmann-pin should not be used due to the possibility of distant migration.

Availability of the Skeletonized Gastroepiploic Artery as a Free Graft for Coronary Artery Bypass Grafting / 대한흉부외과학회지

BACKGROUND: To maximize the histological advantage and minimize the physiological disadvantage, we have been using the skeletonized gastroepiploic artey (GEA) as a free graft for total arterial revascularization. The aims of the current study was to assess the efficacy of the skeletonized GEA as a composite or extended graft for total arterial revascularization. MATERIAL AND METHOD: Between January 2000 and Feburary 2005, 133 patients (43 female, mean age=61.8 yrs) undergoing coronary artery bypass grafting (CABG) with a skeletonized GEA as free graft (22 extended, 107 composite and 4 others) were enrolled in this study. Coronary angiograms were performed in the immediate (median 14 days, n=86), early (median 366 days, n=56) and midterm (median 984 days, n=29) postoperative periods. RESULT: There were 3 (2.2%) early and 4 (3.3%) late cardiac-related deaths. The mean number of distal anastomoses per patient was 3.34 for total graft and 1.92 for GEA graft. The immediate, early, and midterm GEA patency were 157/159 (98.7%), 106/112 (94.6%), and 53/56 (94.6%), respectively. During follow-up, four patients required percutaneous intracoronary intervention because of GEA and target coronary artery stenosis or competitive flow. CONCLUSION: These data demonstrate satisfactory clinical and angiographic results in the skeletonized GEA as free graft for total arterial revascularization. Although we need a careful longer follow-up, the skeletonized GEA as a free graft will be a valuable option 'to be' for CABG.

Effect of Left Atrial Volume Reduction with Maze Operation on Sinus Conversion and Recovery of Left Atrial Transport Function / 대한흉부외과학회지

BACKGROUND: The Maze procedure considered the most effective method of treatment for atrial fibrillation. However, the sinus conversion rates decreased due to several factors, especially enlarged left atrium. The purpose of this study was to investigate the effects of Maze procedure with left atrial volume reduction plasty on rheumatic mitral valve disease. MATERIAL AND METHOD: From December of 2001 to July of 2004, 45 patients received mitral valve and Maze operation. The patients were placed in either group 1 or group 2, based on the left atrial volume reduction plasty. The presence and onset of sinus rhythm and the incidence of trans mitral A waves were monitored during the postoperative 7 days and throughout the follow up period of 3 and 6 months. Mean follow up periods were 15.8 10.1 months in group 1 and 6.1+/-2.7 months in group 2. RESULT: The sinus onset were 9.88+/-12.2 days in group 1, and 1+/-3.6 days in group 2 (p<0.01). The sinus conversion rates in the group 1 and 2 were 65%, 75% (p=0.07) in the postoperative 7 days, 70.5%, 100% (p<0.01) at postoperative 3 months, and 93%, 100% (p<0.01) at postoperative 6 months, respectively. The wave detection rates in the postoperative 7 days were 31.2% and 63.6%, and continued to improve over time to 83.3% and 100% by 6months, respectively. CONCLUSION: The results suggest that Maze procedure with left atrial volume reduction plasty is effective for inducing sinus rhythm and for restoring left atrial contractile function after concomitant rheumatic mitral valve surgery. However further follow up of this patients for long time is necessary.