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T Akune

Publications and source records attributed to T Akune.

12 recordsLinked to original sources
PubMed2001

Long-term results of double-door laminoplasty for cervical stenotic myelopathy.

STUDY DESIGN: A retrospective study of the long-term results from double-door laminoplasty (Kurokawa's method) for patients with myelopathy caused by ossification of the posterior longitudinal ligament and cervical spondylosis was performed. OBJECTIVE: To know whether the short-term results from double-door laminoplasty were maintained over a 10-year period and, if not, the cause of late deterioration. SUMMARY OF BACKGROUND DATA: There are few long-term follow-up studies on the outcome of laminoplasty for cervical stenotic myelopathy. METHODS: In this study, 35 patients with cervical myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine and 25 patients with cervical spondylotic myelopathy, including 5 patients with athetoid cerebral palsy, underwent double-door laminoplasty from 1980 through 1988 and were followed over the next 10 years. The average follow-up period was 153 months (range, 120-200 months) in patients with ossification of the posterior longitudinal ligament and 156 months (range, 121-218 months) in patients with cervical spondylotic myelopathy. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopedic Association (JOA score). Patients who showed late deterioration received further examination including computed tomography scan and magnetic resonance imaging of the cervical spine. RESULTS: In 32 of the patients with ossification of the posterior longitudinal ligament and 23 of the patients with cervical spondylotic myelopathy, myelopathy improved after surgery. The improvement of Japanese Orthopedic Association scores was maintained up to the final follow-up assessment in 26 of the patients with ossification of the posterior longitudinal ligament and 21 of the patients with cervical spondylotic myelopathy. Late neurologic deterioration occurred in 10 of the patients with ossification of the posterior longitudinal ligament an average of 8 years after surgery, and in 4 of the patients with cervical spondylotic myelopathy, including the 3 patients with athetoid cerebral palsy, an average of 11 years after surgery. The main causes of deterioration in patients with ossification of the posterior longitudinal ligament were a minor trauma in patients with residual cervical cord compression caused by ossification of the posterior longitudinal ligament and thoracic myelopathy resulting from ossification of the yellow ligament in the thoracic spine. CONCLUSIONS: The short-term results of laminoplasty for cervical stenotic myelopathy were maintained over 10years in 78% of the patients with ossification of the posterior longitudinal ligament, and in most of the patients with cervical spondylotic myelopathy, except those with athetoid cerebral palsy. Double-door laminoplasty is a reliable procedure for individuals with cervical stenotic myelopathy.

Adult↗
PubMed2001

Insulin secretory response is positively associated with the extent of ossification of the posterior longitudinal ligament of the spine.

BACKGROUND: Glucose intolerance is frequently found in patients with ossification of the posterior longitudinal ligament of the spine. This study was undertaken to examine the relationship between glucose intolerance and the extent of ossification in patients with ossification of the posterior longitudinal ligament. METHODS: A total of 100 patients with ossification of the posterior longitudinal ligament (the overall study group), including fifty-two inpatients who were scheduled to have an operation (the inpatient group) and forty-eight outpatients who had undergone an operation, were analyzed. Indices of glucose metabolism-fasting plasma glucose and serum insulin levels, hemoglobin A1c level, and insulinogenic index (a ratio of the increment of the serum level of insulin to that of glucose)-as well as age and body-mass index were correlated with the extent of ossification, as determined by the number of vertebral levels affected with ossification of the posterior longitudinal ligament (extent of ossification), in the inpatient group. In addition, a similar analysis was performed in twenty-eight inpatients (the selected inpatient group) whose ages and body-mass indices were within one standard deviation of the mean values of those of the inpatient group. Association of a polymorphism in the gene of insulin receptor substrate-1, an essential substrate in insulin signaling, with the extent of ossification was evaluated with genomic DNA extracted from the overall study group. RESULTS: Multiple-regression analysis revealed direct correlations of age (p = 0.038), body-mass index (p = 0.006), and insulinogenic index (p = 0.0003) with the extent of ossification of the posterior longitudinal ligament in the inpatient group. The fasting plasma glucose level, the hemoglobin A1c level, and the stage of glucose tolerance were not associated with the extent of ossification. In the analysis of the selected inpatient group, only the insulinogenic index was correlated with the extent of ossification (p = 0.002). However, no significant association was seen between the insulin receptor substrate-1 polymorphism and the extent of ossification. CONCLUSIONS: The insulin secretory response was associated with the extent of ossification of the posterior longitudinal ligament. Since insulin receptor substrate-1 is expressed both in the spinal ligament and in the tissues regulating glucose metabolism, we speculate that some other molecules related to insulin signaling that are impaired only in the tissues regulating glucose metabolism may be responsible for the progression of ossification. We also speculate that the upregulation of insulin production due to the impairment of insulin action may stimulate osteoprogenitor cells in the ligament to induce ossification. CLINICAL RELEVANCE: The insulinogenic index may be useful as a serum marker for the prediction of progression of ossification of the posterior longitudinal ligament. This study may serve as a stimulus for evaluation of the use of various drugs that may improve the response to insulin in the tissues regulating glucose metabolism to prevent the progression of ossification.

Adult↗
PubMed1998

[Propofol and sevoflurane--a comparison of anesthesia for laryngomicrosurgery].

Laryngomicrosurgery has some special characteristics. It is under much stress such as intubation and direct laryngoscopy during a short operation time. Therefore both adequate anesthesia and quick recovery are needed. Thirty three ASA physical status I patients for laryngomicrosurgery were randomly assigned to receive either anesthesia with propofol and small dose of fentanyl (Group P) or anesthesia with thiopental and sevoflurane (Group S). Group P was induced with propofol 2-3 mg.kg-1 and fentanyl 0.1 mg and maintained with propofol 6 mg.kg-1.h-1 (from 10 mg.kg-1.h-1 by 2 mg.kg-1.h-1 decrement in interval of 10 minutes). No intravenous analgesic was added. Group S was induced with thiopental 4 -5 mg.kg-1 and maintained with sevoflurane 2-3%. We compared emergence time and the state of recovery 5 minutes after extubation and 5 minutes after entering the recovery room. There was no episode of inadequate anesthetic state in both groups. The emergence time was significantly shorter in Group P than in Group S. The state of recovery was much better in Group P compared with Group S in both 5 minutes after extubation and 5 minutes after entering the recovery room. Therefore, anesthesia with propofol and small dose of fentanyl at induction is more adequate compared with anesthesia with sevoflurane in laryngomicrosurgery.

Adolescent↗
PubMed1998

Surgical management of giant schwannoma in the lumbosacral region.

Giant lumbosacral schwannoma is rare and only 11 cases have been reported. We experienced two cases: a 58-year-old woman with recurrent schwannoma from L2 to S3, and a 52-year-old woman with schwannoma from T12 to L5. Total resection was possible in the latter case, which was the patient's first operation. Although she had neurologic deterioration, there was no recurrence during the 4-year follow-up. The recurrent case required a bone graft because of her fragile spine, and she was severely disabled. In the literature, total resection has been confirmed in only two cases of a first operation. Total resection is nonetheless strongly recommended in spite of the risk of leaving a neurologic deficit.

Cauda Equina↗
PubMed1989

[CT-discography for lumbar disc herniation].

1. CTD was carried out on 76 intervertebrae of 66 patients with intervertebral disk hernia and its diagnostic merits were discussed. 2. Views in accordance with CTD and myelography are 85% which shows great importance in the diagnosis of intervertebral disk hernias. 3. CTD depicts the relationship between the intervertebral disk and spinal canal as three-dimensional, and furthermore, across-section image of the intervertebral disk can be obtained which makes it possible to know exactly where the prolapsed region of the hernia is located. This is thought to become extremely useful in the diagnosis of exterior hernias and L5-S hernias which are difficult to detect by myelography. Consequently, it is of great value in supplemental diagnosis, aids in the selection of surgical methods, and can provide other useful information.

Adolescent↗