Intervertebral disk degeneration related to reduced vertebral marrow perfusion at dynamic contrast-enhanced MRI.

AJR Am J Roentgenol. 2009 Apr; 192(4): 974-9Liu YJ, Huang GS, Juan CJ, Yao MS, Ho WP, Chan WPOBJECTIVE: The purpose of this study was to use dynamic contrast-enhanced MRI to ascertain the relation between intervertebral disk degeneration and lumbar vertebral marrow blood perfusion. SUBJECTS AND METHODS: We recruited 25 patients (50 vertebral bodies) who underwent dynamic contrast-enhanced MRI of the lumbar spine. The peak signal enhancement of each vertebral body was calculated from the time signal after curve fitting of a pharmacokinetic model. We controlled for other variables that might have affected blood perfusion by assessing two vertebral bodies in each patient. The 25 patients were divided into three groups. In group 1, one of the vertebral bodies (L1 or L3) evaluated was between two adjacent normal disks and the other was between two adjacent degenerated disks. In group 2, each of the two vertebral bodies evaluated was between two normal disks. In group 3 each of the two vertebral bodies evaluated was between two degenerated disks. RESULTS: Without normalization by minimization of other variables, there were no statistically significant differences in original peak enhancement values among groups 1, 2, and 3 (p = 0.179). After normalization, the peak enhancement in group 1 (0.846 +/- 0.060) was significantly lower than that in group 2 (0.988 +/- 0.047) (p = 0.003) or group 3 (0.973 +/- 0.081) (p = 0.008). CONCLUSION: After normalization, lumbar vertebral marrow perfusion correlated well with intervertebral disk degeneration evaluated with dynamic contrast-enhanced MRI. Blood perfusion was 14% less in the vertebral body marrow between two degenerated disks than in vertebral marrow between two normal disks.

[Efficacy and safety of AirWay Scope in using a bronchofiberscope in patients with difficult airway]

Masui. 2009 Mar; 58(3): 346-8Nakasuji M, Tanaka M, Imanaka N, Nakamura M, Higuchi M, Nomura M, Kawashima HCase 1: A 41-year-old woman was scheduled for pinning of fractured finger and repair of a ligamentum. Preoperative problems did not exist except mandibular hypoplasia. General anesthesia was induced and Cormack classification was grade III in laryngeal view by laryngoscope and we tried a new videolaryngoscope PENTAX-AirWay Scope (AWS). We did not catch the epiglottis directly by Intlock and the target mark was not located at the middle of the vocal cord. Bronchofiberscope was guided to the vocal cord through a tracheal tube attached to AWS by another anesthesiologist and the patient was successfully intubated. Case 2: A 46-year-old man was scheduled for anterior screw-plate fixation due to C3/4 herniated disc. AWS using bronchofiberscope procedure was tried to keep the neutral position of the neck. The patient was successfully intubated. We did not view the bronchofiberscope and used it just as a flexible bougie. Case 3: A 56-year-old man was scheduled for free radial forearm flap reconstruction of a diabetic necrotic toe. Ten minutes were needed to finish intubation due to difficult airway (Cormack classification grade III) when free latissimus dorsi flap reconstruction was perfomed two month before. Hence, AWS using a bronchofiberscope procedure was tried first and 39 seconds were needed to intubate. We concluded that AWS using bronchofiberscope procedure was useful for patients with difficult airway, though two anesthesiologist, one keeping AWS and the other using a bronchofiberscope, were needed.