Natsuko Tomimura

Surgical Results of Lumber Fusion in Hemodialysis Patients

今回，透析患者に対する腰椎固定手術についてその手術成績と問題点について検討した．対象は，2002～2008年に手術を行った30例（男性15例，女性15例）であった．手術時年齢は52～72歳（平均61.8歳），透析歴は6ヶ月～31年（平均13年6ヶ月）であった．術前診断は，破壊性脊椎関節症（DSA）12例，腰椎変性すべり症10例，腰部脊柱管狭窄症4例，腰椎椎間板ヘルニア3例，分離すべり症1例であった．手術方法はPLF 24例，PLF+PLIF 4例，前方固定術2例であった．結果，JOAスコアの改善率50％以上が22例（73.3％）であったが，合併症による死亡が2例（6.7％）あった．透析患者に対する腰椎固定手術は合併症が多く，透析医，麻酔医との連携と十分なインフォームドコンセントが重要である．

A Case Report of Candida Vertebral Osteomyelitis

We report a rare case of candida vertebral osteomyelitis at the multi level lesion. A-58-year old man had complained of low back pain and fever elevation, one month later after abdominal surgery. The findings on plain radiographs and tomograms showed narrowing of the disc space at the Th12/L1, L4/5 and L5/6 levels. MRI showed abnormal signal intensity in the region of the Th12-L1 and L4-6 vertebral bodies. The needle biopsy of the spine grew candida tropicalis. He was managed conservatively with antifungal agents and bed rest. The symptoms reduced gradually. The treatment was successful with no recurrence after follow-up of 10 months.

Eight Cases of Gas Gangrene Experienced at Kagoshima City Hospital

We report eight cases of gas gangrene experienced from 1988 to 1997 in Kagoshima city Hospital and allied hospitals. The injured sites were lower extremity in seven (four cases with popliteal artery injury) and the palm in one. The period from the injury to onset was 2 to 7 days (average; 4.5 days). Our criteria for diagnosis of gas gangrene are as follows; fever, secretion with foul odor, crepitation, serious inflammatory reaction and roentgenogrophic gas. Six patients were treated by amputation of the affected limbs and two cases received a surgical limb salvage procedure. All patients were also treated by hyperbaric oxygen and antibiotics. The hyperbaric oxygen therapy seemed to be effective for borth clostridium and non-clostridium gas gangrene. The prophylactic hyperbaric oxygen therapy for gas gangrene seemed to be effective for cases with diabetes mellitus or poplitial artery injury.