PURPOSE: Thoracic dumbbell tumors are relatively rare, usually arising from neurogenic elements. Methods for surgical removal thereof remain controversial. The purpose of this study was to evaluate the surgical results of a single-stage posterior approach with laminectomy and costotransversectomy only for the management of thoracic dumbbell tumors. MATERIALS AND METHODS: Eight cases of thoracic large dumbbell tumor were analyzed retrospectively: seven men and one woman (mean age, 49 years). Pathologic findings included schwannoma in five patients, neurofibroma in two patients (Recklinghausen in one patient), and ganglioneuroma in one patient. All patients underwent single-stage removal of dumbbell tumors by a posterior approach followed by laminectomy and costotransversectomy combined with instrumentation. Clinical and radiologic outcomes were reviewed, thereafter. RESULTS: Operative time ranged from 185 to 420 minutes (mean, 313 minutes), with estimated blood loss ranging from 71 to 1830 mL (mean, 658 mL). Postoperative complications included atelectasis in one case. All patients had tumors successfully removed with no neurological deterioration. Spinal deformities were not observed in any patients at the last follow-up (mean, 52 months), with instrumentation. CONCLUSION: Single-stage surgery with laminectomy and costotransversectomy may be useful for removing thoracic dumbbell tumors without a combined anterior approach.
Adolescent ; Adult ; Aged ; Female ; Humans ; Laminectomy ; Male ; Retrospective Studies ; Thoracic Neoplasms/*surgery ; Thoracic Vertebrae/*surgery

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disease of the gastrointestinal tract, with increasing prevalence worldwide. IBD Ahead is an international educational program that aims to explore questions commonly raised by clinicians about various areas of IBD care and to consolidate available published evidence and expert opinion into a consensus for the optimization of IBD management. Given differences in the epidemiology, clinical and genetic characteristics, management, and prognosis of IBD between patients in Japan and the rest of the world, this statement was formulated as the result of literature reviews and discussions among Japanese experts as part of the IBD Ahead program to consolidate statements of factors for disease prognosis in IBD. Evidence levels were assigned to summary statements in the following categories: disease progression in CD and UC; surgery, hospitalization, intestinal failure, and permanent stoma in CD; acute severe UC; colectomy in UC; and colorectal carcinoma and dysplasia in IBD. The goal is that this statement can aid in the optimization of the treatment strategy for Japanese patients with IBD and help identify high-risk patients that require early intervention, to provide a better long-term prognosis in these patients.
Asian Continental Ancestry Group ; Colectomy ; Colitis, Ulcerative ; Colorectal Neoplasms ; Consensus ; Crohn Disease ; Disease Management* ; Disease Progression ; Early Intervention (Education) ; Epidemiology ; Expert Testimony ; Gastrointestinal Tract ; Hospitalization ; Humans ; Inflammatory Bowel Diseases* ; Japan* ; Prevalence ; Prognosis

Opioids are known to cause dysfunction of the sphincter of Oddi. However, there are no reports on acute cholangitis due to opioid-induced dysfunction of the sphincter of Oddi. A 75-year-old woman with breast cancer, who had been prescribed oxycodone for lower abdominal pain due to unknown causes for 8 years, suddenly developed hypochondriac pain. We diagnosed the patient as having acute cholangitis and performed endoscopic retrograde pancreatography and technetium hepatobiliary iminodiacetic acid scan. The cause of acute cholangitis was considered to be opioid-induced dysfunction of the sphincter of Oddi. Six and nine days after admission, endoscopic sphincterotomy was performed, after which her upper abdominal pain resolved. Opioids increase biliary pressure and delay bile flow into the duodenum in patients after cholecystectomy. However, the actual clinical outcomes of using opioids for acute cholangitis and pancreatitis remain unknown. Thus, although opioid-induced dysfunction of the sphincter of Oddi is uncommon, it should be assessed in patients who are prescribed opioids.