REVIEW : Endoscopic Diagnosis of Colorectal Neoplasms Using Autofluorescence Imaging

( Yoji Takeuchi ),( Noriya Uedo ),( Masao Hanafusa ),( Noboru Hanaoka ),( Sachiko Yamamoto ),( Ryu Ishihara ),( Hiroyasu Iishi ) 대한장연구학회 2012 Intestinal Research Vol.10 No.2

Many techniques have been developed to reduce the number of missed lesions during colonoscopy screening. Autofluorescence imaging (AFI) is one of the newly developed image-enhanced endoscopy (IEE) techniques, which functions similar to narrow band imaging (NBI) and flexible spectral imaging color enhancement (FICE), that can improve the detection and characterization of both polypoid and non-polypoid colonic neoplasms by enhancing their macroscopic features. We have previously reported that AFI, when used in combination with a transparent hood mounted on the tip of the endoscope to maintain distance from the colonic mucosa, results in the detection of approximately 1.6 times more colorectal neoplasms than conventional white light (WLI) colonoscopy. We have also revealed that AFI results in a higher flat neoplasm detection rate than WLI. Because the images of colorectal lesions visualized using AFI differ between histological lesion types, AFI also offers the possibility of differentiating neoplastic from non-neoplastic lesions. However, the difference between neoplastic and non-neoplastic lesions in the images generated using AFI relies on the density of the magenta coloring of the image and is therefore somewhat subjective. Recent studies suggest that NBI with magnification may be a superior modality for characterizing the neoplastic status of small colonic polyps. Although further developments are needed, the recent development of IEEs allows us to efficiently detect and differentiate colorectal neoplasms during colonoscopy screening. This article reviews the use of AFI in the diagnosis of colorectal neoplasms and discusses its advantages and limitations. (Intest Res 2012;10:142-151)

Preoperative Low Back Pain Affects Postoperative Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery

Hiranaka Yoshiaki,Miyazaki Shingo,Inoue Shinichi,Ryu Masao,Yurube Takashi,Kakutani Kenichiro,Tadokoro Ko 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.4

Study Design: A single-center retrospective study.Purpose: To research the predictive factors associated with postoperative patient satisfaction 1 year after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), a minimally invasive procedure for lumbar degenerative disease.Overview of Literature: There have been reports of numerous variables influencing patient satisfaction with lumbar surgery; however, there have been few investigations on MIS are limited.Methods: This study included 229 patients (107 men and 122 women; mean age, 68.9 years) who received one or two levels of MISTLIF, and the patient’s age, gender, disease, paralysis, preoperative physical functions, duration of symptom(s), and surgery-associated factors (waiting for surgery, number of surgical levels, surgical time, and intraoperative blood loss) were studied. Radiographic characteristics and clinical outcomes such as Oswestry Disability Index (ODI) scores and Visual Analog Scale (VAS; 0–100) ODI scores for low back pain, leg pain, and numbness were studied. One year following surgery, patient satisfaction (defined as satisfaction for surgery and for present condition; 0–100) was assessed using VAS and its relationships with investigation factors were examined.Results: The mean VAS scores of satisfaction for surgery and for present condition were 88.6 and 84.2, respectively. The results of multiple regression analysis showed that preoperative adverse factors of satisfaction for surgery were being elderly (<i>β </i>=-0.17, <i>p</i> =0.023), high preoperative low back pain VAS scores (<i>β</i> =-0.15, <i>p</i> =0.020), and postoperative adverse factors were high postoperative ODI scores (<i>β </i> =-0.43, <i>p</i> <0.001). In addition, the preoperative adverse factor of satisfaction for present condition was high preoperative low back pain VAS scores (<i>β </i> =-0.21, <i>p</i> =0.002), and postoperative adverse factors were high postoperative ODI scores (<i>β </i> =-0.45, <i>p</i> <0.001) and high postoperative low back pain VAS scores (β =-0.26, p =0.001).Conclusions: According to this study, significant preoperative low back pain and high postoperative ODI score after surgery are linked to patient unhappiness.

Complications of Posterior Fusion for Atlantoaxial Instability in Children With Down Syndrome

Yoshiki Takeoka,Kenichiro Kakutani,Hiroshi Miyamoto,Teppei Suzuki,Takashi Yurube,Izumi Komoto,Masao Ryu,Shinichi Satsuma,Koki Uno 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

Objective: To clarify the complications of posterior fusion for atlantoaxial instability (AAI) in children with Down syndrome and to discuss the significance of surgical intervention. Methods: Twenty pediatric patients with Down syndrome underwent posterior fusion for AAI between February 2000 and September 2018 (age, 6.1±1.9 years). C1–2 or C1–3 fusion and occipitocervical fusion were performed in 14 and 6 patients, respectively. The past medical history, operation time, estimated blood loss (EBL), duration of Halo vest immobilization, postoperative follow-up period, and intra- and perioperative complications were examined. Results: The operation time was 257.9±55.6 minutes, and the EBL was 101.6±77.9 mL. Complications related to the operation occurred in 6 patients (30.0%). They included 1 major complication (5.0%): hydrocephalus at 3 months postoperatively, possibly related to an intraoperative dural tear. Other surgery-related complications included 3 cases of superficial infections, 1 case of bone graft donor site deep infection, 1 case of C2 pedicle fracture, 1 case of Halo ring dislocation, 1 case of pseudoarthrosis that required revision surgery, and 1 case of temporary neurological deficit after Halo removal at 2 months postoperatively. Complications unrelated to the operation included 2 cases of respiratory infections and 1 case of implant loosening due to a fall at 9 months postoperatively. Conclusion: The complication rate of upper cervical fusion in patients with Down syndrome remained high; however, major complications decreased substantially. Improved intra- and perioperative management facilitates successful surgical intervention for upper cervical instability in pediatric patients with Down syndrome.

Clinical Characteristics, Surgical Outcomes, and Risk Factors for Emergency Surgery in Patients With Spinal Metastases: A Prospective Cohort Study

Yutaro Kanda,Kenichiro Kakutani,Yoshitada Sakai,Takashi Yurube,Yoshiki Takeoka,Kunihiko Miyazaki,Hiroki Ohnishi,Tomoya Matsuo,Masao Ryu,Naotoshi Kumagai,Kohei Kuroshima,Yoshiaki Hiranaka,Ryosuke Kurod 대한척추신경외과학회 2024 Neurospine Vol.21 No.1

Objective: To elucidate the patient characteristics and outcomes of emergency surgery for spinal metastases and identify risk factors for emergency surgery. Methods: We prospectively analyzed 216 patients with spinal metastases who underwent palliative surgery from 2015 to 2020. The Eastern Cooperative Oncology Group performance status, Barthel index, EuroQol-5 dimension (EQ5D), and neurological function were assessed at surgery and at 1, 3, and 6 months postoperatively. Multivariate analysis was performed to identify risk factors for emergency surgery. Results: In total, 146 patients underwent nonemergency surgery and 70 patients underwent emergency surgery within 48 hours of diagnosis of a surgical indication. After propensity score matching, we compared 61 patients each who underwent nonemergency and emergency surgery. Regardless of matching, the median performance status and the mean Barthel index and EQ5D score showed a tendency toward worse outcomes in the emergency than nonemergency group both preoperatively and 1 month postoperatively, although the surgery greatly improved these values in both groups. The median survival time tended to be shorter in the emergency than nonemergency group. The multivariate analysis showed that lesions located at T3–10 (p = 0.002; odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48–5.75) and Frankel grades A–C (p < 0.001; OR, 4.91; 95% CI, 2.45–9.86) were independent risk factors for emergency surgery. Conclusion: Among patients with spinal metastases, preoperative and postoperative subjective health values and postoperative survival are poorer in emergency than nonemergency surgery. Close attention to patients with T3–10 metastases is required to avoid poor outcomes after emergency surgery.