Risk Factors of Coronary Artery Bypass Grafting According to Ventricular Function / 대한흉부외과학회지

Patients with coronary artery disease and depressed ventricular function have better long- term benefits after coronary artery bypass grafting compared with medical therapy. But operative mortality remains high. This study was designed to identify the risk factors for coronary artery bypass grafting according to ventricular function. The records of 103 patients who underwent coronary artery bypass grafting from July 1994 to June 1996 were analysed. The patients were divided into two groups based on preoperative ejection fraction: Low EF group(Ejection fraction or= 40%, n=79). The indication of operation was significantly different between the two groups (p=0.00003). Postinfarction angina was frequent in Low EF group but unstable angina was frequent in Normal EF group. The frequency of cardiomegaly(p=0.0012), serum creatinine abnormality(p=0.0473) and preoperative use of IABP(Intra Aortic Balloon Pump, p=0.0095) were higher in Low EF group. The left internal thoracic artery was used less frequently in Low EF group(p=0.00416). The operative mortality was 8.3% in Low EF group and 5.1% in Normal EF group, but without statistical difference(p=0.5492). In Normal EF group, age (p=0.041) was identified as a significant risk factor for operative mortality. In Low EF group, age(p=0.018), preopertive use of IABP(p=0.0036), hypercholesterolemia(p=0.0007), and emergency of operation(p=0.0037) were identified as significant risk factors. Postoperative morbidity was 50% in Low EF group and 33% in Normal EF group, but without statistical significance(p=0.1007). These results suggest that in patients with coronary artery disease and depressed ventricular function, more aggresive coronary artery bypass grafting is needed to improve the symptom and long-term benefit. Risk factor

A Case of Intradural Lipoma of the Lower Thoracic Spinal Cord

A case of intradural spinal lipoma without congenital abnormalities is presented. A 37 year-old male was admitted to our hospital because of paralysis of both legs and sphincteric disturbance. Neurologic findings were spastic paraplegia, hypesthesia on the level of T10, 11 dermatoma, anesthesia below the level of T12 dermatoma, Beevor's sign, bilateral ankle clonus and Babinski sign. Plain thoracolumbar spine X-ray showed widening of the interpedicular distances of T10, 11 in A-P view, and scalloping in the posterior aspect of the bodies of T10, 11 in lateral view. Myelogram showed widening of the dye column and double cup-like filling defect at the level of the T12 spinal body. Total laminectomy was performed from L1 through T9. The tumor located from T10 to T12 of the spinal level intradurally, and also diffusely infiltrated the cord, making complete removal impossible. The histopathologic examination confirmed the lipoma. The patient was discharged without improvement of neurologic deficits.

Intracranial Cysticercosis: Report of 3 Cases

The authors report 3 cases of intracranial cysticercosis simulating brain tumor. The 2 cases of them had parenchymatous huge cysts in the cerebral hemisphere and the other one had large cyst in the 4th ventricle. In one case of parenchymatous cysticercosis, angiographic finding was less significant though C-T scan revealed huge cystic shadow in the frontal lobe bilaterally and multiple small cystic shadow in occipital lobe and cerebellum. The 4th ventricular cysticercosis was well delineated with Conray ventriculography. All cases were proved as cerebral cysticercosis by operation and the patients were uneventful postoperatively.

Two Cases of Intracranial Subdural Empyema

Intracranial subdural empyema is a relatively uncommon complication of paranasal sinusitis and otitic infection. It manifests itself by headache, neck stiffness and pyrexia, symptoms and signs of acutely increased intracranial pressure, convulsions, aphasia and other focal neurological signs. Recently, we have operated upon two cases of intracranial subdural empyema secondary to acute frontal sinusitis and traumatic scalp laceration respectively. Reviewing these two cases and other literatures, we are going to describe about causes, symptoms and signs, and methods of diagnosis and treatment of subdural empyema.