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Saito T.,Ako Central Hospital | Nishida K.,Okayama University of Science | Hashizume K.,Okayama University of Science | Nakahara R.,Okayama University of Science | And 4 more authors.
Modern Rheumatology | Year: 2016

Objectives. To retrospectively investigate the clinical and radiographic results of partial arthrodesis for the wrists with rheumatoid arthritis (RA).Methods. Forty-one wrists with RA were treated by radiolunate (RL) or radiolunotriquetral (RLT) arthrodesis with ulnar head resection. The average follow-up period after surgery was 7.1 years. Preoperative radiographs of all wrists were classified according to Schulthess classification. We performed RL arthrodesis for all Type II (n = 26) and Type III wrists (n = 7), and RLT arthrodesis for Type III wrists (n = 8). Pre- and postoperative pain score (visual analog scale), grip strength, range of motion, and radiographic parameters were statistically compared.Results. Pain scores in all groups were significantly improved at final follow-up (P < 0.05). Grip strength increased from 5.9 to 12.4 (kg) significantly in Type II wrists (P < 0.01), from 7.2 to 9.1 in Type III wrists after RLT arthrodesis, but decreased from 6.9 to 6.0 in Type III wrists after RL arthrodesis. In all groups, the arc of pronation and supination improved significantly (P < 0.05), and all radiographic parameters improved.Conclusions. RL arthrodesis for Type II wrists showed satisfactory clinical results. RLT arthrodesis would be a reliable method in case of unstable wrist joint. © 2015 Japan College of Rheumatology.


Takahashr K.,Ako Central Hospital | Hayashi M.,Okayama Saiseikai General Hospital | Fujii T.,Okayama Saiseikai General Hospital | Kawamura K.,Kibi International University | Ozaki T.,Okayama University
Acta Medica Okayama | Year: 2012

The objective of early rehabilitation after anterior cruciate ligament (ACL) reconstruction is to increase the muscle strength of the lower extremities. Closed kinetic chain (CKC) exercise induces co-contraction of the agonist and antagonist muscles. The purpose of this study was to compare the postoperative muscle strength/mass of subjects who performed our new CKC exercise (new rehabilitation group: group N) from week 4, and subjects who received traditional rehabilitation alone (traditional rehabilitation group: group T). The subjects stood on the device and maintained balance. Then, low-frequency stimulation waves were applied to 2 points each in the anterior and posterior region of the injured thigh 3 times a week for 3 months. Measurement of muscle strength was performed 4 times (before the start, and then once a month). Muscle mass was evaluated in CT images of the extensor and flexor muscles of 10 knees (10 subjects) in each group. The injured legs of group N showed significant improvement after one month compared to group T. The cross-sectional area of the extensor muscles of the injured legs tended to a show a greater increase at 3 months in group N. This rehabilitation method makes it possible to contract fast-twitch muscles, which may be a useful for improving extensor muscle strength after ACL reconstruction. © 2012 by Okayama University Medical School.


Komatsu S.,Okayama Saiseikai General Hospital | Katayama Y.,Okayama University | Torigoe R.,Ako Central Hospital | Inoue K.,Oguni Hospital | And 4 more authors.
Japanese Journal of Plastic Surgery | Year: 2014

In recent years, "laser toning" using a low fluence, multiple passed Q-switched 1,064 nm Nd:YAG laser has been found to be effective for the treatment of melasma. A total of 105 melasma patients were treated using MedLite C6™ (2.0-2.8 J/cm2, 6-mm spot size for 5 passes with at least 1-week intervals). The mean number of treatment sessions was 7.4 ± 3.3 (range : 4-20). One month before initiating laser toning, patients received oral tranexamic acid (1,500 mg/day), vitamin C (3,000 mg/day), and vitamin E (3,000 mg/day) and topical 1.9% hydroquinone cream. In addition, we advised patients to avoid exposure to ultraviolet light, friction, and self-medication. Assessments were evaluated using the modified Melasma Area and Severity Index (mMASI) scores. The mean mMASI scores decreased from 16.5 ± 9.0 to 7.0 ± 6.0. Excellent improvement (76-100%) was achieved in 33 of 105 patients (31.4%) and good improvement (51-75%) in 35 (33.3%). No cases of mottling hypopigmentation and rebound hyperpigmentation were recorded. Laser toning using MedLite C6™ is an effective and safe treatment regimen for melasma. However, this study assumes that relevant procedures, pretreatment, and differential diagnosis were performed.


Souri M.,Yamagata University | Biswas A.,University of Bonn | Misawa M.,Ako Central Hospital | Omura H.,Tottori Prefectural Central Hospital | Ichinose A.,Yamagata University
Haemophilia | Year: 2014

Factor XIII (FXIII) consists of the A and B subunits (FXIII-A and FXIII-B) and stabilizes fibrin clots. Defects in either the FXIII-A or FXIII-B gene lead to congenital FXIII deficiency, which manifests a life-long haemorrhagic tendency. Thus, prophylactic FXIII replacement therapy is recommended. To establish a management plan for a 30-year-old male patient with 'indefinite' FXIII deficiency (<40% of the normal FXIII), he was characterized by state-of-the-art techniques as guided by the FXIII/Fibrinogen subcommittee of ISTH/SSC. FXIII activity turned out to be virtually undetectable by three functional assays. Four immunological assays detected essentially no FXIII protein, FXIII-A antigen, and A2B2 antigen, but normal FXIII-B antigen. Accordingly, he was diagnosed as a 'severe' FXIII-A deficiency case. He had no anti-FXIII antibodies, because a 1:1 cross-mixing test (ammonia release assay) and a five-step mixing test (amine incorporation assay) between his plasma and normal plasma demonstrated deficiency patterns. Furthermore, a dosing test using plasma-derived FXIII concentrates revealed its normal recovery. DNA sequencing analysis identified two novel mutations, W187X & G273V, in the F13A gene. Genetic analyses confirmed that he was a compound heterozygote and his mother and sister were heterozygotes of either one of these mutations, indicating the hereditary nature of this disorder. Molecular modelling predicted that the G273V mutation would cause clashes with the surrounding residues in the core domain of FXIII-A, and ultimately would result in the instability of the mutant molecule. Detailed characterization of 'indefinite' FXIII deficiency made it possible to make its definite diagnosis and best management plan. © 2013 John Wiley & Sons Ltd.


Iwamuro M.,Okayama University of Science | Okada H.,Okayama University | Kawano S.,Okayama University | Shiode J.,Okayama Saiseikai General Hospital | And 20 more authors.
Oncology Letters | Year: 2015

The importance of enteroscopy examinations to investigate the entire length of the small intestines has been emphasized in follicular lymphoma patients with intestinal involvement. The aim of the present study was to determine the current state of enteroscopy examinations, including the performance rate, and the prevalence of small intestinal lesions in a patient population in Japan. A retrospective multicenter survey of 17 institutions collected the case information of 110 follicular lymphoma patients with gastrointestinal involvement. The results of the enteroscopy examinations were reviewed, and in order to identify potential factors affecting the performance rate of enteroscopy, patient gender, age at lymphoma diagnosis, histopathological grade, clinical stage, the date of the initial diagnosis and the annual volume of enteroscopy at the institution were compared between the patients who underwent one or more enteroscopy procedures and the patients who did not undergo enteroscopy. A total of 34 patients (30.9%) underwent enteroscopy, and 24 of these (70.6%) presented with involvement in the jejunum and/or ileum. It was found that more patients diagnosed in recent years and more patients treated at an ultra-high volume institution (≥101 enteroscopy examinations/year) underwent an enteroscopy. In conclusion, although the prevalence of small intestinal lesions was high (70.6%) in the follicular lymphoma patients presenting with intestinal involvement, the performance rate of enteroscopy was only 30.9%, and thus the majority of the patients have not undergone enteroscopy examinations. Further investigation is required to define the clinical significance of enteroscopy at the initial diagnostic work-up and during the follow-up period of these patients. © 2015, Spandidos Publications. All rights reserved.

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