Lymphopenia at 4 Days Postoperatively Is the Most Significant Laboratory Marker for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

Eiichiro Iwata,Hideki Shigematsu,Akinori Okuda,Yasuhiko Morimoto,Keisuke Masuda,Hiroshi Nakajima,Munehisa Koizumi,Yasuhito Tanaka 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.6

Study Design: Case control study. Purpose: To identify the most significant laboratory marker for early detection of surgical site infection (SSI) using multiple logistic regression analysis. Overview of Literature: SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial. Methods: We retrospectively reviewed the laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spinal disease from January 2003 to December 2014. Six laboratory markers for early SSI detection were considered: renewed elevation of the white blood cell count, higher at 7 than 4 days postoperatively; renewed elevation of the C-reactive protein (CRP) level, higher at 7 than 4 days postoperatively; CRP level of >10 mg/dL at 4 days postoperatively; neutrophil percentage of >75% at 4 days postoperatively; lymphocyte percentage of <10% at 4 days postoperatively; and lymphocyte count of <1,000/μL at 4 days postoperatively. Results: Ninety patients were enrolled; five developed deep SSI. Multivariate regression analysis showed that a lymphocyte count of <1,000/μL at 4 days postoperatively was the sole significant independent laboratory marker for early detection of SSI (p =0.037; odds ratio, 11.9; 95% confidence interval, 1.2–122.7). Conclusions: A lymphocyte count of <1,000/μL at 4 days postoperatively is the most significant laboratory marker for early detection of SSI.

Reliability Comparison between “Distal Radius and Ulna” and “Simplified Tanner–Whitehouse III” Assessments for Patients with Adolescent Idiopathic Scoliosis

Okuda Akinori,Shigematsu Hideki,Fujii Hiromasa,Iwata Eiichiro,Tanaka Masato,Morimoto Yasuhiko,Masuda Keisuke,Yamamoto Yusuke,Tanaka Yasuhito 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3

Study Design: This is a retrospective clinical study.Purpose: In this study, we aim to evaluate the reliability of the distal radius and ulna assessment (DRU) and simplified Tanner-Whitehouse III classification (sTW3) in Japanese patients with adolescent idiopathic scoliosis (AIS).Overview of Literature: The greatest curvature of a scoliotic spine occurs at peak-height velocity (PHV), which is the time during which an individual’s height increases at the maximum rate. Diagnosing and appropriately treating AIS before PHV is the most effective way in order to prevent unnecessary deterioration of the scoliosis curve. Although it is difficult to detect scoliosis before PHV, DRU and sTW3, which involve evaluations using a left-hand radiograph, have been reported to be effective.Methods: We retrospectively evaluated 54 hands of 40 girls with AIS who visited Nara Medical University Hospital from 2000 to 2015 using previously collected radiographs. The examiners included a spine surgeon and a pediatric orthopedic surgeon, each with over 10 years of experience. The reliability of the DRU and sTW3 was evaluated using the kappa coefficient.Results: The left-hand radiographs of 40 female patients with AIS (mean age, 13.9±1.7 years; N=54 hands) were evaluated by two blinded examiners using the sTW3 and DRU methods. The highest inter-observer and intra-observer reliabilities (kappa, 0.64 and 0.62, respectively) for radius evaluation were determined. Radius evaluation by the DRU showed the highest agreement rate and smallest error between the inter- and intra-observer examinations.Conclusions: The DRU was the most reliable assessment tool, and it has the potential to be useful for precisely determining the stage of skeletal maturity in outpatient clinics.

Development of Polarized 3He System for Experiment of the Time Reversal Invariance in the Nuclear Reactions

Vadim R. Skoy,Guinyun Kim,Suguru Muto,Takashi Ino,Yasuhito Masuda 한국물리학회 2005 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.46 No.4

A polarized 3He system is being developed for an experiment on time-reversal invariance in nuclear reactions. Spin-exchange optical pumping is employed to polarize the 3He nuclei. A quartz glass cell and a sapphire cell are used as containers for the 3He. With the pulsed neutron beam at High Energy Accelerator Research Organization (KEK), the polarizations of 3He were measured for the quartz glass cell and the sapphire cell at a 3He pressure of 3 atm by employing a frequencynarrowing technique based on an external-cavity and were found to be 0.538 ± 0.004stat ± 0.02sys and 0.627 ± 0.002stat ± 0.01sys, respectively.

Lymphopenia and Elevated Blood C-Reactive Protein Levels at Four Days Postoperatively Are Useful Markers for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

Eiichiro Iwata,Hideki Shigematsu,Munehisa Koizumi,Hiroshi Nakajima,Akinori Okuda,Yasuhiko Morimoto,Keisuke Masuda,Yasuhito Tanaka 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.2

Study Design: Case-control study. Purpose: To identify the characteristics of candidate indexes for early detection of surgical site infection (SSI). Overview of Literature: SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial for the welfare of the patient postoperation. Methods: We retrospectively reviewed laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spine disease. The sensitivity and specificity of six laboratory markers for early detection of SSI were calculated: greater elevation of the white blood cell count at day 7 than at day 4 postoperatively, greater elevation of the C-reactive protein (CRP) level at day 7 than at day 4 postoperatively, a CRP level of >10 mg/dL at 4 days postoperatively, neutrophil percentage of >75% at 4 days postoperatively, a lymphocyte percentage of <10% at 4 days postoperatively, and a lymphocyte count of <1,000/μL at 4 days postoperatively. Statistical analysis was via Fisher’s exact test and a p -value of <0.05 was considered significant. Results: In total, 85 patients were enrolled. Of these, five patients developed deep SSI. The sensitivity and specificity of each index were as follows: index 1, 20.0% and 77.5%; index 2, 20.0% and 83.8%; index 3, 40.0% and 97.5%; index 4, 40.0% and 86.3%; index 5, 0% and 96.3%; and index 6, 80.0% and 80.0%. A significant difference was noted for indexes 3 and 6. Conclusions: A CRP level of >10 mg/dL at 4 days postoperatively would be useful for definitive diagnosis of SSI, and a lymphocyte count of <1,000/μL at 4 days postoperatively would be a useful screening test for SSI. Although laboratory markers for early detection of SSI have been frequently reported, we believe that it is important to understand the characteristics of each index for a precise diagnosis.

Biceps-Related Physical Findings Are Useful to Prevent Misdiagnosis of Cervical Spondylotic Amyotrophy as a Rotator Cuff Tear

Eiichiro Iwata,Hideki Shigematsu,Kazuya Inoue,Takuya Egawa,Masato Tanaka,Akinori Okuda,Yasuhiko Morimoto,Keisuke Masuda,Yusuke Yamamoto,Yoshihiro Sakamoto,Munehisa Koizumi,Yasuhito Tanaka 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.1

Study Design: Case–control study. Purpose: The aim of the present study was to identify physical findings useful for differentiating between cervical spondylotic amyotrophy (CSA) and rotator cuff tears to prevent the misdiagnosis of CSA as a rotator cuff tear. Overview of Literature: CSA and rotator cuff tears are often confused among patients presenting with difficulty in shoulder elevation. Methods: Twenty-five patients with CSA and 27 with rotator cuff tears were enrolled. We included five physical findings specific to CSA that were observed in both CSA and rotator cuff tear patients. The findings were as follows: (1) weakness of the deltoid muscle, (2) weakness of the biceps muscle, (3) atrophy of the deltoid muscle, (4) atrophy of the biceps muscle, and (5) swallow-tail sign (assessment of the posterior fibers of the deltoid). Results: Among 25 CSA patients, 10 (40.0%) were misdiagnosed with a rotator cuff tear on initial diagnosis. The sensitivity and specificity of each physical finding were as follows: (1) deltoid weakness (sensitivity, 92.0%; specificity, 55.6%), (2) biceps weakness (sensitivity, 80.0%; specificity, 100%), (3) deltoid atrophy (sensitivity, 96.0%; specificity, 77.8%), (4) biceps atrophy (sensitivity, 88.8%; specificity, 92.6%), and (5) swallow-tail sign (sensitivity, 56.0%; specificity, 74.1%). There were statistically significant differences in each physical finding. Conclusions: CSA is likely to be misdiagnosed as a rotator cuff tear; however, weakness and atrophy of the biceps are useful findings for differentiating between CSA and rotator cuff tears to prevent misdiagnosis.