Neurological Surgery最新文献

Lifestyle-related diseases are also associated with stroke incidence. Among these, hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome have significant impacts on stroke. Hypertension is the greatest risk factor for stroke among lifestyle-related diseases. Among the medical treatments for lifestyle-related diseases, antihypertensive management is the most important. Recently, due to lifestyle changes such as westernization of diet and lack of exercise, the incidence of diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome has been increasing. They significantly affect atherothrombotic cerebral and lacunar infarctions. However, a few patients with lifestyle-related diseases remain untreated. Therefore, the early diagnosis and treatment of lifestyle-related diseases are extremely important to reduce the risk of stroke. Smoking and heavy alcohol consumption are risk factors for stroke. Guidelines for lifestyle factors are important for stroke prevention.

Diabetes management primarily aims to achieve a life expectancy and quality of life similar to that of people without diabetes. The key to achieving this goal is the effective prevention and management of both the microvascular and macrovascular complications associated with diabetes. Although glycated hemoglobin levels of less than 7% are recommended to minimize complications, individual targets should be set considering variables such as age, duration of diabetes, risk of hypoglycemia, organ function, support system, general health status, and social background. Treatment decisions should be individualized according to each patient's diabetes status and guided by the latest evidence on diabetes pharmacotherapy.

Respiratory diseases, such as chronic obstructive pulmonary disease(COPD)and asthma, are becoming increasingly prevalent in super-aging societies. In Japan, the estimated prevalence of COPD among individuals aged 40 years and above is 8.6%, while asthma affects about 10% of adults. These statistics highlight the similarities between COPD and asthma in clinical settings. Both diseases involve chronic airway inflammation and present with symptoms such as chronic cough, sputum production, wheezing, and dyspnea. Exacerbations of these symptoms and complications are critical concerns during the perioperative period. COPD, often caused by long-term smoking, leads to irreversible airway and lung damage, while asthma is characterized by episodic and reversible airway constriction due to chronic inflammation. COPD diagnosis involves spirometry and the exclusion of other diseases, with treatment goals focusing on symptom improvement and risk reduction through smoking cessation, pharmacotherapy(mainly bronchodilators), and non-pharmacological methods(such as pulmonary rehabilitation). Asthma management aims to control inflammation and prevent exacerbations using inhaled corticosteroids and bronchodilators as standard treatments. Perioperative management of both diseases involves improving respiratory function with pharmacotherapy, careful anesthesia selection, and early postoperative mobilization. Consultation with respiratory specialists is recommended for effective management, especially in complex cases.

Gastroesophageal reflux disease(GERD)and functional dyspepsia are common gastrointestinal disorders. GERD primarily manifests as heartburn and regurgitation, whereas functional dyspepsia is diagnosed in the absence of a discernible organic disease, despite persistent epigastric discomfort. Both GERD and functional dyspepsia can substantially worsen the patient's quality of life, although they do not typically influence prognosis. It is crucial to consider organic diseases, such as malignancies, particularly in patients who present with high-risk factors, including advanced age and weight loss. Patients with stable general health who are amenable to regular follow-ups and invasive procedures, such as endoscopy, should be advised to seek care at specialized facilities. This is particularly relevant if the initial treatment regimen fails to alleviate symptoms. This approach ensures optimal patient care and effective symptom management.

Hyperuricemia causes not only gout but also organ damage, such as through cerebrovascular, cardiovascular, and lifestyle-related diseases. The relationship between the serum urate(SUA)level and organ damage has recently been redefined as dysuricemia, as follows: 1)SUA level is positively associated with the occurrence of gout and intra-arterial gout(gout pattern); 2)occurrence of neurodegenerative diseases is negatively correlated with SUA level(ND pattern); and 3)the relationship between SUA level and chronic kidney disease(CKD)and cardiovascular disease(CVD)forms a J-shaped curve(CKD/CVD pattern). CVDs accompanied by dysuricemia include gout, ND, and CKD/CVD patterns; therefore, optimal SUA levels must be maintained to reduce organ damage. Thus, appropriate urate-lowering agents should be selected based on the type of hyperuricemia and prescribed for lowering the SUA levels toward the optimal value. Xanthine oxidase inhibitors are prescribed for hyperuricemic patients with renal overload and uricosuric agents for hyperuricemic patients with renal undersecretion.

The basic principles of atrial fibrillation(AF)treatment are stroke prevention with appropriate anticoagulation, rhythm and rate control with drugs, and non-pharmacological therapy. The current guidelines have been presented. Non-pharmacological treatment(catheter ablation)for AF, originally developed to eliminate motivational symptoms, has been shown to improve life outcomes, and indications for ablation are expanding rapidly. Catheter ablation has evolved remarkably from conventional radiofrequency to balloon ablation. Minimal complications are expected to occur with pulsed-field ablation. Ablation strategies for paroxysmal AF are almost established and approaches for persistent AF are becoming increasingly important. Surgical approaches have also evolved significantly, with robotic surgery, the thoracoscopic Wolf-Ohtsuka procedure, and minimally invasive cardiac surgery, becoming less invasive. Future studies should prioritize a system for better function and treatment options for the heart team.

Alcoholic liver disease(ALD)is caused by liver damage due to excessive alcohol consumption in varying forms and severities. In Japan, although overall alcohol consumption is decreasing owing to population decline and aging, the number of heavy drinkers remains almost unchanged. Consequently, the total number of patients with ALD is decreasing, whereas the number of patients with alcoholic cirrhosis is increasing. In a national survey on cirrhosis conducted in 2023, the proportion of alcoholic cirrhosis has increased to 35%, surpassing that of hepatitis C virus-related cirrhosis as the leading cause. The primary treatment for ALD is abstinence from alcohol; however, social and medical approaches to alcohol dependence and nutritional management of improper alcohol intake are essential. Various clinical trials of ALD at different stages are being conducted, particularly in Western countries.

Japan is currently experiencing a significant increase in the number of patients with heart failure driven by its rapidly aging population, a phenomenon termed the heart failure pandemic. This trend is particularly alarming because heart failure severely affects life expectancy, making it a critical public health issue. The rising number of heart failure cases has highlighted the importance of early diagnosis and intervention, with heart failure now classified into distinct stages to better tailor treatment strategies. Recent advancements in treatment, including new pharmacological options such as SGLT2 inhibitors and non-pharmacological approaches such as transcatheter aortic valve implantation and catheter ablation, have significantly improved patient outcomes. These treatments are particularly effective in managing the complexities of heart failure, especially in older patients. However, the success of these treatments also relies on a comprehensive approach involving multidisciplinary teams working together to provide holistic care. These therapeutic innovations underscore the importance of continued adaptation and research to sustain the effectiveness of heart failure treatment in the evolving healthcare environment of Japan's aging population.

Osteoporosis, the most prevalent bone disease, increases an individual's risk of fractures. Various factors, such as a past history of fractures, smoking, alcohol consumption, use of steroid medications, genetic background, and physical activity level, are associated with fracture risk. Notably, reduced physical activity should be emphasized for patients with brain or other neurological disorders, as impaired body balance and decreased muscle strength contribute to falls and fractures. The emergence of many effective treatments for osteoporosis has enabled patient-tailored treatments. Even physicians who do not specialize in osteoporosis, such as neurosurgeons, are expected to assess patient condition, estimate the risk of osteoporosis or fractures, and consult specialists when necessary.

As society ages, the number of people with dementia increases worldwide, and the prevention of dementia has become increasingly important. Lifestyle diseases are associated with the development of dementia, and preventing or controlling lifestyle diseases in middle-aged individuals is particularly important. Hypertension, diabetes, and dyslipidemia are associated with dementia. Hypertension is strongly associated with dementia, and strict blood pressure control is required. Among the drugs used to treat lifestyle diseases, some antihypertensive drugs(e.g., dihydropyridine calcium channel blockers, angiotensin 2 receptor blockers), hypoglycemic drugs(e.g., glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors), and statins may reduce the incidence of dementia. However, individual interventions for lifestyle diseases have only a limited effect in reducing the incidence of dementia. Comprehensive interventions may have significant effects. Clinicians involved in the management of lifestyle diseases need to have sound knowledge of these diseases and provide comprehensive management at an early stage.