ABSTRACT
Study DesignRetrospective cohort study.PurposeThis study aimed to evaluate aggravated lateral recess stenosis and clarify the indirect decompression threshold by combined lateral interbody fusion and percutaneous pedicle screw fixation (LIF/PPS).Overview of LiteratureNo previous reports have described an effective radiographic indicator for determining the surgical indication for LIF/PPS.MethodsA retrospective review of 185 consecutive patients, who underwent 1- or 2-level lumbar fusion surgery for degenerative spondylolisthesis (DS). According to their symptomatic improvement, they were placed into either the “recovery” or “no-recovery” group. Preoperative computed tomography (CT) images were evaluated for the position of the superior articular processes at the slipping level, followed by a graded classification (grades 0–3) using the impingement line (I line), a new radiographic indicator. All 432 superior articular facets in 216 slipped levels were classified, and both groups’ characteristics were compared.ResultsThere were 171 patients (92.4%) in the recovery group and 14 patients in the no-recovery group (7.6%). All patients in the no-recovery group were diagnosed with symptoms associated with deteriorated bony lateral recess stenosis. All superior articular processes of the lower vertebral body in affected levels reached and exceeded the I line (I line-; grade 2 and 3) on preoperative sagittal CT images. In the recovery group, most superior articular processes did not reach the I line (I line+; grade 0 and 1; p=0.0233).ConclusionsIn DS cases that are classified as grade 2 or greater, the risk of aggravated bony lateral recess stenosis due to corrective surgery is high; therefore, indirect decompression by LIF/PPS is, in principle, contraindicated.
ABSTRACT
Study DesignRetrospective cohort study.PurposeThis study aimed to evaluate aggravated lateral recess stenosis and clarify the indirect decompression threshold by combined lateral interbody fusion and percutaneous pedicle screw fixation (LIF/PPS).Overview of LiteratureNo previous reports have described an effective radiographic indicator for determining the surgical indication for LIF/PPS.MethodsA retrospective review of 185 consecutive patients, who underwent 1- or 2-level lumbar fusion surgery for degenerative spondylolisthesis (DS). According to their symptomatic improvement, they were placed into either the “recovery” or “no-recovery” group. Preoperative computed tomography (CT) images were evaluated for the position of the superior articular processes at the slipping level, followed by a graded classification (grades 0–3) using the impingement line (I line), a new radiographic indicator. All 432 superior articular facets in 216 slipped levels were classified, and both groups’ characteristics were compared.ResultsThere were 171 patients (92.4%) in the recovery group and 14 patients in the no-recovery group (7.6%). All patients in the no-recovery group were diagnosed with symptoms associated with deteriorated bony lateral recess stenosis. All superior articular processes of the lower vertebral body in affected levels reached and exceeded the I line (I line-; grade 2 and 3) on preoperative sagittal CT images. In the recovery group, most superior articular processes did not reach the I line (I line+; grade 0 and 1; p=0.0233).ConclusionsIn DS cases that are classified as grade 2 or greater, the risk of aggravated bony lateral recess stenosis due to corrective surgery is high; therefore, indirect decompression by LIF/PPS is, in principle, contraindicated.
ABSTRACT
Purpose@#The presentations and geographic incidence of pediatric non-Hodgkin lymphoma (NHL) differfrom those of adults. This study delineated the characteristics and outcomes of pediatricNHL in East Asia. @*Materials and Methods@#Medical records of 749 pediatric patients with NHL treated at participating institutions inmainland China, Japan, Korea, and Taiwan from January 2008 to December 2013 werereviewed. Demographic and clinical features, survival outcomes, and putative prognosticfactors were analyzed. @*Results@#Five hundred thirty patients (71%) were male. The most common pathologic subtypes wereBurkitt lymphoma (BL) (36%). Six hundred seven patients (81%) had advanced diseases atdiagnosis. The 5-year overall survival and event-free survival (EFS) rates were 89% and 84%.The 5-year EFS rates of BL, lymphoblastic lymphoma, and diffuse large B-cell lymphomawere 88%, 88%, and 89%, and those of anaplastic large cell lymphoma (ALCL) and peripheralT-cell lymphoma (PTCL) were 71% and 56% (p 250 IU/mL), and advanced disease at diagnosis( stage III) were associated with poor outcomes (p < 0.05). ALCL and PTCL relapsedmore frequently than other pathologic subtypes (p < 0.001). @*Conclusion@#In East Asia, PTCL was more frequent than in Western countries, and bone marrow involvementdid not affect treatment outcome. This international study should motivate future collaborativestudy on NHL in East Asia.
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This study clarified practices in end-of-life care for non-malignant chronic illness patients by expert nurses in general hospitals. Interviews with 7 chronic illness specialist nurses on practice cases were conducted, and final labels were elicited using a qualitative synthesis method（KJ method）. As patients’ conditions deteriorated, nurses defined the necessary interactions to support patients’ decision-making for living their own way of life and accompany patients and families based on their experience, and using patients’ restoration of self-esteem, sense of satisfaction, and acceptance as indices. In general hospitals, measures to cope with pain for patients not receiving life-prolonging treatment were insufficient;and while it was difficult to agree on care between medical professionals and to maintain care in other facilities, expert nurses grasped patients’ wishes on a daily basis and made arrangements for them to permeate through family and community care systems. In end-of-life care in treatment settings, it is necessary to be supportive so that the family and medical professionals can continue the patient’s care. Medical professionals who have been involved from the initial diagnosis stage need to improve their awareness and support skills as medical professionals to be involved purposefully from an early stage to the final stage.