Publications by authors named "Lefor A"

Article Synopsis
  • Remifentanil is an opioid anesthetic known for its fast-acting effects, and this study investigates its use at high doses (0.5 mcg/kg/min or more) in neonatal surgeries to reduce sedation-related complications.
  • The study reviewed 15 cases of neonatal abdominal surgeries conducted between January 2016 and February 2022, noting that while hypotension occurred in 13% of patients, no bradycardia or serious post-operative complications were reported.
  • Although high-dose remifentanil maintained hemodynamic stability, concerns about respiratory depression remain, highlighting the need for further research into its long-term effects on neonates.
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Segmental grafts from living donors have advantages over grafts from deceased donors when used for small intestine transplantation. However, storage time for small intestine grafts can be extremely short and optimal graft preservation conditions for short-term storage remain undetermined. Secreted factors from mesenchymal stem cells (MSCs) that allow direct activation of preserved small intestine grafts.

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Background: The outcomes after liver transplantation have greatly improved, which has resulted in greater focus on improving non-hepatic outcomes of liver transplantation. The present study aimed to evaluate thoracic spine radio density in children and adolescents after liver transplantation.

Methods: A total of 116 patients who underwent living donor liver transplantation were retrospectively analyzed.

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Background: Masks are well accepted in Japan, where they were already part of daily life even before the COVID-19 pandemic. Unlike many other countries where mask mandates were lifted as soon as the pandemic was under control, Japan was one of the last countries to ease mask-wearing guidelines. Even after the formal announcement to allow masks-off in mid-March 2023, many Japanese still voluntarily wear masks.

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Article Synopsis
  • This study investigates the incidence and risk factors of Low Anterior Resection Syndrome (LARS) in Japanese patients who underwent anus-preserving surgery for rectal tumors.
  • The research found that 22% of patients experienced major LARS, with a higher incidence (48%) among those with lower tumors.
  • It also revealed a strong correlation between the severity of LARS and decreased quality of life, particularly in patients with lower rectal tumors.
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Introduction: There are few reports describing the association of naldemedine with defecation in critically ill patients with opioid-induced constipation. The purpose of this study was to determine whether naldemedine is associated with earlier defecation in critically ill patients with opioid-induced constipation.

Methods: In this retrospective cohort study, patients admitted to the Intensive Care Unit (ICU) without defecation for 48 hours while receiving opioids were eligible for enrollment.

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  • * In a study of 451 FAP patients, 59% had duodenal polyps and 18% had ampullary polyps; duodenal cancer incidence was 4.7% and ampullary cancer was 18% in those with respective polyps.
  • * The study suggests that patients with duodenal polyps require regular endoscopic monitoring, especially those with intermediate- or profuse-type APC variants, due to the high rate of progression of these polyps.*
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Small-bowel polyps in patients with Peutz-Jeghers syndrome (PJS) are sometimes difficult to reach using double-balloon enteroscopy (DBE). However, they can induce intussusception, especially when ≧15 mm. This study aimed to review the outcomes of patients with such polyps.

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The prognosis of patients with peritoneal metastases from pancreatic cancer is poor, largely due to massive ascites, which precludes systemic treatment. Two patients with a poor performance status and malignant ascites were treated with cell-free and concentrated ascites reinfusion therapy followed by combined chemotherapy with intraperitoneal paclitaxel, intravenous gemcitabine, and nab-paclitaxel. These patients achieved a survival of 19 and 36 weeks with a relatively good quality of life.

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Article Synopsis
  • * A 30-year-old male patient had Crohn's disease and underwent initial surgery with the Kono-S anastomosis but later developed severe intestinal narrowing, requiring another surgery.
  • * After the second surgery using the Sasaki-W method, the patient had a smooth recovery and showed no signs of obstruction one year later, indicating its effectiveness.
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It is important to assess the prognosis and intervene before and after surgery in patients with hepatocellular carcinoma. This study aims to elucidate the association of outcomes and residual liver function after hepatectomy. A total of 176 patients who underwent the initial resection for hepatocellular carcinoma between January 2011 and March 2021 at Jichi Medical University were included.

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  • Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are serious diabetes complications that need more research on their clinical profiles.
  • A study analyzed the medical records of 771 hospitalized adults in Japan from 2012 to 2016 to compare outcomes among different severity levels of DKA and HHS.
  • Findings revealed that common triggers included poor medication adherence and infections, with ICU admission rates at 44.4% and mortality rates of 2.8% for DKA and 7.1% for HHS, indicating no significant difference in mortality among DKA severity levels.
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  • * Imaging suggested intrapancreatic bile duct stenosis, resembling autoimmune pancreatitis, even though key pancreatic enzyme levels remained normal.
  • * A biopsy revealed inflammation and fibrosis, and the patient responded well to treatment with oral prednisolone, with no signs of recurrent pancreatitis after dosage reduction.
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Introduction And Importance: Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Surgical treatment of unilateral PA usually resolves excessive aldosterone secretion. Obesity is an independent factor for postoperative persistent hypertension for patients with unilateral PA.

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Takayasu's arteritis is a rare vasculitis affecting the aorta and its branches. Disease progression can result in arterial stenosis and subsequent organ dysfunction. Estimating organ perfusion by measuring the peripheral blood pressure can be challenging because it may be altered by arterial stenosis.

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Background: Tumor growth pattern correlates with outcomes in patients with esophageal squamous cell carcinoma (ESCC), however, the clinical significance of the tumor growth pattern in pT1a-lamina propria mucosa (LPM) type of ESCC was unclear. This study was conducted to clarify clinicopathological features of tumor growth patterns in pT1a-LPM type ESCC and the relationship between tumor growth patterns and magnifying endoscopic findings.

Methods: Eighty-seven lesions diagnosed as pT1a-LPM ESCC were included.

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  • * This study analyzed NAFLD patients with type 2 diabetes who had not seen ALT normalization after over a year on SGLT2 inhibitors and were then treated with pemafibrate.
  • * Results showed that after one year of pemafibrate treatment, various liver health markers improved significantly, indicating its potential benefits when SGLT2 therapy alone is insufficient.
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Background: Acute superior mesenteric artery (SMA) occlusion is an uncommon condition associated with high mortality. If extensive bowel resection is performed for patients with acute SMA occlusion and the patient survives, long-term total parenteral nutrition (TPN) may be needed due to short bowel syndrome. This study examined factors associated with the need for long-term TPN after the treatment of acute SMA occlusion.

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  • This study compares the effectiveness of blue laser imaging (laser-BLI) and LED-blue light imaging (LED-BLI) for assessing colorectal polyps using a specific classification system (JNET).
  • A total of 756 images from 63 lesions were analyzed by 12 endoscopists, resulting in a 92.5% agreement rate between the two imaging methods.
  • The findings suggest that both imaging techniques provide very similar evaluations in terms of surface patterns, vessel patterns, and brightness, indicating that laser light could be a viable option for endoscopic examinations.
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