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Isomoto S.,Nara Prefecture General Medical Center | Tanaka Y.,Nara Medical University
Brain and Nerve | Year: 2014

Morton's disease refers to neuralgia at the web space of the toes with a pseudo-neuroma. It commonly occurs in the third web space of the foot in middle-aged and older women. The pseudo-neuroma is thought to be a secondary change after entrapment or repeated microtrauma. Patients complain of forefoot pain while walking. Typically, symptoms are caused by tight high-heeled shoes. The physical examination includes palpation of the web spaces and Mulder's test. Weight bearing foot radiographs are used to evaluate the deformity of the foot, especially at metatarsophalangeal (MTP) joints. MRI is useful for differential diagnosis of pseudo-neuroma, MTP joint arthritis, and interdigital bursitis. Conservative treatments are shoe modification, use of orthotic insoles, and injection of corticosteroids and local anesthesia. The injections are useful not only for the treatment but also for diagnosis of Morton's disease. If the local injection is not temporally effective, surgical treatment is not indicated. If the conservative treatment fails, surgical treatment is indicated. The most common surgery is excision of the pseudo-neuroma. The surgery is usually performed using a dorsal approach.

Fujitaka K.,Nara Medical University | Taniguchi A.,Nara Medical University | Isomoto S.,Nara Prefecture General Medical Center | Kumai T.,Nara Medical University | And 3 more authors.
Orthopaedic Journal of Sports Medicine | Year: 2015

Background: The pathogenesis of fifth metatarsal stress fractures remains uncertain. Hypothesis: Physical characteristics and environmental factors, which have received limited attention in the literature thus far, might be involved in the development of fifth metatarsal stress fractures. Study Design: Case-control study; Level of evidence, 3. Methods: To test the study hypothesis, a medical examination and survey of the living environment of collegiate soccer players was conducted and correlated with the existence of fifth metatarsal stress fractures. The survey and measurements were conducted in 273 male athletes from the same college soccer team between 2005 and 2013. A medical examination comprising assessment of stature, body weight, body mass index, foot–arch height ratio, toe-grip strength, quadriceps angle, leg-heel angle, functional reach test, single-leg standing time with eyes closed, straight-leg raise angle, finger-floor distance, heel-buttock distance, ankle joint range of motion, and a general joint laxity test were performed once a year, along with a questionnaire survey. The survey was also repeated when a fifth metatarsal stress fracture was diagnosed. The study participants were separated into a fifth metatarsal stress fracture injury group and a noninjury group. The measurement items and survey items were compared, and the association between the factors and the presence or absence of injuries was analyzed. Results: Toe-grip strength was significantly weaker in the injury group compared with the noninjury group, suggesting that weak toe-grip is associated with fifth metatarsal stress fracture (P <.05). In addition, fifth metatarsal stress fractures were more common in the nondominant leg (P <.05). Between-group comparisons of the other items showed no statistically significant differences. Conclusion: The association between weak toe-grip strength and fifth metatarsal fracture suggests that weak toe-grip may lead to an increase in the load applied onto the lateral side of the foot, resulting in stress fracture. The finding of stress fracture being more common in the nondominant leg needs further study. © 2015, © The Author(s) 2015.

Taniguchi A.,Nara Medical University | Takakura Y.,Nishi Nara Central Hospital | Tanaka Y.,Nara Medical University | Kurokawa H.,Nara Medical University | And 4 more authors.
The Journal of bone and joint surgery. American volume | Year: 2015

BACKGROUND: Treatment of osteonecrosis of the talus is challenging. Total talar replacement has the potential to restore the function of the ankle joint without an associated leg-length discrepancy. The purpose of the present study was to investigate postoperative function and pain after total talar replacement in patients with osteonecrosis of the talus.METHODS: Fifty-five ankles in fifty-one consecutive patients with osteonecrosis of the talus who were treated with a total talar replacement from 2005 to 2012 were included in the investigation. Scores according to the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and the Ankle Osteoarthritis Scale (AOS) were assessed before surgery and at the final follow-up evaluation.RESULTS: According to the JSSF ankle-hindfoot scale, the score for pain improved from a mean (and standard deviation) of 15 ± 9.4 points (range, 0 to 20 points) to 34 ± 5.6 points (range, 20 to 40 points); the score for function, from 21.2 ± 9.7 points (range, 4 to 38 points) to 45.1 ± 4.0 points (range, 37 to 50 points); the score for alignment, from 6.0 ± 2.8 points (range, 5 to 10 points) to 9.8 ± 0.9 points (range, 5 to 10 points); and the total score, from 43.1 ± 17.0 points (range, 11 to 68 points) to 89.4 ± 8.4 points (range, 76 to 100 points). According to the AOS scale, the score for "pain at its worst" improved from a mean of 6.1 ± 3.3 points (range, 0 to 9.9 points) to 2.0 ± 1.7 points (range, 0 to 6.3 points).CONCLUSIONS: Prosthetic talar replacement is a useful procedure for patients with osteonecrosis of the talus as it maintains ankle function. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Mizuno T.,Gifu University | Suzuki N.,Gifu University | Makino H.,Gifu University | Furui T.,Gifu University | And 12 more authors.
Gynecologic Oncology | Year: 2015

Objective. In ovarian cancer cases, recurrence after chemotherapy is frequently observed, suggesting the involvement of ovarian cancer stem-like cells (CSCs). The chemoresistance of ovarian clear cell carcinomas is particularly strong in comparison to other epithelial ovarian cancer subtypes. We investigated the relationship between a CSC marker, aldehyde dehydrogenase 1 (ALDH1), and clinical prognosis using ovarian clear cell carcinoma tissue samples. Furthermore, we investigated the antioxidant mechanism by which CSCs maintain a lower reactive oxygen species (ROS) level, which provides protection from chemotherapeutic agents. Methods. Immunohistochemical stainingwas performed to examine the CSC markers (CD133, CD44, ALDH1) using ovarian clear cell carcinoma tissue samples (n=81). Clear cell carcinoma cell lines (KOC-7C, OVTOKO) are separated into the ALDH-high and ALDH-low populations by ALDEFLUOR assay and fluorescence-activated cell sorting (FACS). We compared the intracellular ROS level, mRNA level of the antioxidant enzymes and Nrf2 expression of the two populations. Results. High ALDH1 expression levels are related to advanced stage in clear cell carcinoma cases. ALDH1 expression significantly reduced progression free survival. Other markers are not related to clinical stage and prognosis. ALDH-high cells contained a lower ROS level than ALDH-low cells. Antioxidant enzymes were upregulated in ALDH-high cells. ALDH-high cells showed increased expression of Nrf2, a key transcriptional factor of the antioxidant system. Conclusions. ALDH-positive CSCs might have increased Nrf2-induced antioxidant scavengers, which lower ROS level relevant to chemoresistance in ovarian clear cell carcinoma. © 2014 Elsevier Inc.

Minowa H.,Nara Prefecture General Medical Center
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2016

Objective: The objective of this study is to present information on respiratory inhibition after crying (RIAC), feeding hypoxemia, and respiratory inhibition after gastroesophageal reflux (RIGER) to medical staff caring for infants.Methods: The author reviewed investigations of these conditions.Results: These conditions have been observed in full-term healthy infants, and they are accompanied clinically by central cyanosis and a decrease in SpO2 to less than 70%. These conditions are easily diagnosed using pulse oximetry. Among Japanese infants with a gestational age of 36 weeks or older, the incidence of RIAC and feeding hypoxemia is 24% and 32%, respectively. The incidence of RIGER is approximately 4%. Feeding hypoxemia occurs significantly more often during bottle-feeding than during breastfeeding. RIAC, feeding hypoxemia, and RIGER are significantly associated with each other. The risk factors are maternal smoking during pregnancy, threatened premature labor, twin gestation, asymmetric intrauterine growth restriction, and abnormal cranial ultrasound findings. Almost all infants recover from RIAC by day 7 after birth. Some infants with feeding hypoxemia require additional assistance and monitoring by nursing staff until the day of discharge.Conclusions: Medical staff caring for infants should note the presence of RIAC, feeding hypoxemia, and RIGER. © 2015 Taylor & Francis.

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