The number of patients with inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), continues to increase in many countries and regions. With recent rapid advances in medical therapies targeting intestinal inflammation, the number of patients with long-term disease duration is also increasing. It is well-recognized that longstanding IBD carries an increased risk of developing gastrointestinal (GI) neoplasia, particularly colorectal cancer. However, compared to sporadic GI tumors, IBD-associated GI tumors are relatively rare, and even among specialists in GI diseases, opportunities to encounter such cases remain limited. In light of this situation, the Japanese Society for Cancer of the Colon and Rectum (JSCCR), in collaboration with the Japanese Inflammatory Bowel Disease Research Group (funded by the Japan Sciences Research Grant for Research on Intractable Diseases affiliated with the Ministry of Health, Labour, and Welfare) launched the Guideline Development Committee for IBD-associated Gastrointestinal Tumors in 2021, with the aim of establishing clinical practice guidelines to support the diagnosis and management of these tumors. The committee-comprising experts in gastroenterology, surgery, pathology, guideline development, and literature review-conducted extensive discussions and successfully published the first Japanese edition of the guidelines in July 2024. We believe that the current edition provides the best possible guidance based on presently available knowledge. Furthermore, the guideline development process highlighted several key issues to be addressed in future research and clinical practice. We are pleased to present here the English version of the JSCCR Guidelines 2024 for the Clinical Practice of IBD-associated Intestinal Neoplasia.
Historically, glenoid bone loss and humeral head defects (Hill-Sachs lesions) were evaluated independently. However, the clinical significance of a Hill-Sachs lesion depends on the morphology of the glenoid: an identical lesion may remain stable with an intact glenoid but become unstable in the presence of glenoid bone loss. Therefore, both lesions must be assessed simultaneously. Traditional dynamic intraoperative examination has an inherent limitation. Engagement can be accurately assessed only after Bankart repair (post-repair examination), whereas remplissage, when required, must be performed before the repair (pre-repair examination). To overcome this dilemma, the ‘glenoid track’ concept was introduced, enabling combined assessment of Hill-Sachs lesions and glenoid bone loss. Since its introduction, the concept has evolved through refinements such as consideration of subcritical glenoid bone loss, subdivision into central and peripheral tracks, and patient-specific adjustment of track width based on the range of motion. Efforts are also underway to establish accurate MRI-based assessment, facilitating widespread radiation-free application. Furthermore, the concept has been extended to posterior shoulder instability through the development of the ‘reverse glenoid track’ concept, broadening its applicability across the spectrum of shoulder instability.
Research on rotator cuff tears in Japan was initially characterized by studies clarifying prevalence, asymptomatic tears, and natural history. It subsequently developed toward evaluation of outcomes after arthroscopic repair, postoperative tendon integrity, and long-term results of conservative treatment. This article reviews clinical and basic research on rotator cuff tears that has been conducted in Japan. Representative examples include arthroscopic superior capsule reconstruction (SCR), rotator cuff reconstruction combined with small-head hemiarthroplasty, arthroscopic muscle advancement, and infraspinatus rotational transfer. More recently, basic research on rotator cuff tears in Japan has shifted its focus from simply how to repair the torn tendon to how closely the tendon-bone insertion can be regenerated toward its native structure, and what biological and mechanical conditions can reduce retear. Because reverse total shoulder arthroplasty (rTSA) was introduced in Japan in 2014, later than in many other countries, several Japan-specific surgical techniques for massive rotator cuff tears were developed during the preceding period.
Background The size and location of the glenoid defect have been extensively studied in patients with anterior shoulder instability. However, in patients with traumatic posterior instability, little is known regarding the location and size of the bony defect of the glenoid. The purpose of the present study was to clarify the location and extent of the glenoid defect in shoulders with traumatic posterior instability with use of CT images. Methods Forty-three shoulders of 42 patients with traumatic posterior instability treated at 7 hospitals were included. Three-dimensional images of the glenoid reconstructed from computed tomography were assessed using image analysis software. The location and size of the glenoid defect were investigated and described on a clock face of the glenoid. Results Thirty-eight of 43 shoulders (88 %) had a glenoid bony defect. Eleven shoulders (26 %) had a bony fragment. The defect width of the glenoid was 2.5 ± 1.3 mm (mean ± standard deviation), which was equivalent to 9.1 ± 5.3 % of the glenoid width. The mean orientation of the defect was pointing toward 8:12, at a mean angle of 246° ± 13.2° from the 12-o'clock direction in the right shoulder. The glenoid defects were located between 5:37 and 10:38. Conclusion The prevalence of the glenoid bony defect in patients with traumatic posterior shoulder instability was as high as that in patients with anterior shoulder instability. However, its size was smaller than the anterior instability and it was located posteroinferiorly. IRB approval #2022-1-1168.
