Return to the Original Work Activity Following the Full-endoscopic Lumbar Surgery under the Local Anesthesia

Transforaminal full-endoscopic spine (TF-FES) surgery is minimally invasive and can be performed under local anesthesia. Thus, it is expected that the patient can return to work (RTW) quickly. However, information in the literature regarding this is sparse. The purpose of this study is to review the timing of RTW after TF-FES surgery. This study involved 50 patients (14 women, 36 men; mean age 44.5 years, age range: 20–65 years) who underwent TF-FES surgery between January 2016 and April 2018. All the patients were active workers. Occupations varied widely (e.g., physician, nurse, helper, clerk, construction worker, chef, and schoolteacher). There were no surgery-related complications. Median time to RTW was 21 days. More than half of the patients could RTW within 21 days. In all, 12 cases (24%) could have RTW within 7 days. Occupations of 12 patients who achieved RTW within 7 days included physician, company owner, and restaurant owner, with 11 in the Light work, 1 was in the Medium work, and none in the Heavy work. All 12 had a quick RTW because their work was Light and they could not take prolonged sick leave. Prompt RTW is possible with TF-FES surgery. The biggest merit of TF-FES surgery is minimal invasiveness to the muscles of the back. Also, it can be performed under local anesthesia. Our findings reveal quicker RTW after surgery, depending on occupational type.     

Magnetic Resonance Imaging Findings Predict the Recurrence of Chronic Subdural Hematoma

The exact predictive factors for postoperative recurrence of chronic subdural hematoma (CSDH) are still unknown. Based on the preoperative magnetic resonance imaging (MRI), low recurrence rate of T₁-hyperintensity hematoma was previously reported. We investigated the other types of radiological findings which are related to the recurrence rate of CSDH in large number of patients analyzed by multivariate logistic regression model. Preoperative MRI and postoperative computed tomography (CT) were performed and the influence of the preoperative use of antiplatelet or anticoagulant drugs was also studied. The overall recurrence rate was 9.3% (47 of 505 hematomas). The MRI T₁-iso/hypointensity group showed a significantly higher recurrence rate (18.2%, 29 of 159) compared to the other groups (5.2%, 18 of 346; p < 0.001). Multivariate logistic regression analysis showed T₁ classification was the solo significant prognostic predictor among various factors such as bilateral hematoma, antiplatelet or anticoagulant drug usage, residual hematoma on postoperative CT, and MRI classification (p < 0.001): adjusted odds ratio for the recurrence in T₁-iso/hypointensity group relative to the T₁-hyperintensity group was 5.58 [95% confidence interval (CI), 2.09–14.86] (p = 0.001). Postoperative residual hematoma and antiplatelet or anticoagulant drug usage did not increase the recurrence risk. The preoperative MRI findings, especially T₁WI findings, have predictive value for postoperative recurrence of CSDH and the T₁-iso/hypointensity group can be assumed to be a high recurrence risk group.     

MEDIASTINAL EMPHYSEMA AFTER ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION: ITS PREVALENCE AND CLINICAL SIGNIFICANCE

Aims: To assess the prevalence and clinical significance of mediastinal emphysema (ME) after esophageal endoscopic submucosal dissection (ESD). Methods: A total of 105 patients in whom assessment of ME was prospectively carried out with multi‐detector row computed tomography (MDCT) after esophageal ESD were included in this study. ME was graded as follows: Grade‐0, no ME; Grade‐I, bubbles around the esophagus; Grade‐II, ME around the thoracic aorta; Grade‐III, ME extending around the heart or beyond the mediastinum into the neck; and Grade‐IV, ME with pneumothorax or subcutaneous emphysema. MDCT grading was compared with the finding of conventional chest X‐ray images (CXR) and clinical symptoms. Results: CXR revealed the presence of ME in 6.6% of the subjects. On MDCT, ME was recognized in 62.9% (Grade‐0, 37.1%; I, 46.7%; II, 10.5%; III, 5.7%; and IV, 0%), most (83.8%) being Grade‐I or 0. CXR was able to visualize ME of Grade‐II or greater. Exposure of the muscularis propria layer and location of the lesion were significant risk factors for development of ME of Grade‐II or greater (P = 0.008 and P = 0.03, respectively). The duration of a fever of 37°C or higher was longer and the serum C‐reactive protein level was higher in patients with a higher grade of ME. Conclusions: MDCT revealed the occurrence of ME in 62.9% of the patients who had undergone esophageal ESD, most of which, however, was clinically silent. Exposure of the muscular layer during ESD and location of the lesion were independent risk factors for the development of ME.     

A Cross Sectional Study on Hand-arm Vibration Syndrome among a Group of Tree Fellers in a Tropical Environment

This study aimed to explore the clinical characteristics of hand arm vibration syndrome (HAVS) in a group of tree fellers in a tropical environment. We examined all tree fellers and selected control subjects in a logging camp of central Sarawak for vibration exposure and presence of HAVS symptoms utilizing vibrotactile perception threshold test (VPT) and cold water provocation test (CWP). None of the subjects reported white finger. The tree fellers reported significantly higher prevalence of finger coldness as compared to the control subjects (OR=10.32, 95%CI=1.21–87.94). A lower finger skin temperature, longer fingernail capillary return time and higher VPT were observed among the tree fellers as compared to the control subjects in all fingers (effect size >0.5). The VPT following CWP of the tree fellers was significantly higher (repeated measures ANOVA p=0.002, partial η²=0.196) than the control subject. The A (8) level was associated with finger tingling, numbness and dullness (effect size=0.983) and finger coldness (effect size=0.524) among the tree fellers. Finger coldness and finger tingling, numbness and dullness are important symptoms for HAVS in tropical environment that may indicate vascular and neurological damage due to hand-transmitted vibration exposure.     

Extracorporeal leukocyte removal therapy for patients with ulcerative colitis

Background: The purpose of the present paper was to investigate efficacy of leukocytapheresis (LCAP) or granulocytapheresis (GCAP) in pediatric patients with ulcerative colitis (UC), including reduction of the total dose and side‐effects of corticosteroids. Methods: Courses of five Japanese adolescents with UC were analyzed. Four patients had recurrent UC with repeated remissions and exacerbations despite therapy including 5‐aminosalicylic acid in combination with a corticosteroid. The other patient had a first attack. Effectiveness of adding LCAP or GCAP was assessed with regard to short‐term changes in clinical activity, complications, and longer‐term outcome. Results: Clinical improvement was attained in three patients, while the other two did not improve and underwent colectomy. One of the two patients had moderately severe complications from LCAP and showed increased clinical activity during LCAP. The other, who began therapy with LCAP alone, had moderate improvement only after addition of a corticosteroid. Conclusion: Additional studies are needed to determine optimum timing of LCAP or GCAP and initiation of remission‐maintenance therapy.     

Evaluation of cardiac reserved function by high-dose dobutamine-stress echocardiography in asymptomatic anthracycline-treated survivors of childhood cancer

BACKGROUND: The aim of this study was to evaluate cardiac function and cardiac reserved function in asymptomatic anthracycline-treated long-time survivors of childhood cancer using dobutamine (DOB) stress echocardiography. METHODS: A total of 26 patients (19 males and 7 females) were divided into four groups according to cumulative dose of anthracycline (ATC): non-anthracycline group (N group), seven cases; low anthracycline cumulative dose group (L group), five cases (or=400 mg/m(2)). DOB infusion was begun at 5 microg/kg per min (gamma) and increased up to 30 gamma. Cardiac function and cardiac reserved function at rest, after low-dose and high-dose DOB stress, were estimated. RESULTS: In the H group, % left ventricular posterior wall thickening (%PWT) at rest and ratio of maximum early filling peak velocity (E) and atrial contraction peak velocity (A) from the left ventricular transmitral flow wave (E/A) and %PWT at DOB 5 gamma stress were significantly lower than in other groups (P<0.05). After DOB 30 gamma stress in groups given>00 mg/m(2) end-systolic wall stress was significantly higher and E/A and %PWT were significantly lower than those of other groups (P<0.05). ATC cumulative dose strongly correlated with %PWT after DOB 30 gamma stress (P<0.001). CONCLUSIONS: Subclinical ATC cardiotoxicity was detected by high-dose DOB stress echocardiography at lower cumulative doses than with other methods. %PWT appears to be a useful index for detection of ATC cardiotoxicity.