The Effect of Carpal Tunnel Release on Neuropathic Pain in Carpal Tunnel Syndrome.

PURPOSE: The aim of this study was to determine the risk factors of neuropathic pain (NP) in the patient with carpal tunnel syndrome (CTS) before and after the carpal tunnel release. MATERIALS AND METHODS: One hundred and two CTS patients were enrolled in the study. The pain score was measured by the visual analogue score. NP was determined by the painDETECT (PD) questionnaire. All subjects were divided into 3 groups at 12 weeks after surgery: an Improved, Unchanged, and Worsened group. The risk factors of worsening NP after surgery were evaluated. RESULTS: We found that 36% and 18% of patients with CTS had neuropathic pain before and 12 weeks after surgery, respectively, and pain was significantly stronger than in those without NP. The PD score of eight hands worsened after surgery. In the "Improved group," the average age at the surgery was younger and the pain score was lower than in the "Unchanged group." Conclusions. The surgery was very effective on NP of CTS; however, the PD in 7% of hands worsened after surgery. Risk factors before surgery that predicted worse NP after surgery were found to be a younger age, weaker pain, and the absence of night pain.

Feasibility and short-term impact of the "case study in-house group training program for family nursing" at medical facilities.

The aim of this study was to evaluate the feasibility and short-term impact of case study training in family nursing care targeting midlevel nursing professionals. The intervention group participated in four 90-minute case study training sessions over 6 months, while the control group participated in two 90-minute lectures. Using primary outcome variables as evaluation indexes, we measured the participants' total scores on the Family Importance in Nursing Care Scale and 4 subitems 3 times (before, immediately after and 1 month after training) from May 2014 to March 2015 and then conducted 2-way repeated-measure analysis of variance. We asked the participants and training planners/managers to provide feedback on their evaluation and then performed content analysis on their responses. Although the primary impact due to the different measurement times was significant, no significant difference was observed in the interaction between measurement time and training differences. Of the 4 subitems, significant interactions because of measurement time and training differences were observed only in Fam-B. Feedback data showed all participants felt that their understanding of the importance of family nursing care was strengthened, and participants in the intervention group specifically described how they were utilizing what they had learned from training in practice.

Histopathology of tenosynovium in trigger fingers.

Stenosing flexor tenosynovitis, trigger finger, is a common clinical disorder causing painful locking or contracture of the involved digits, and most instances are idiopathic. This problem is generally caused by a size mismatch between the swollen flexor tendon and the thickened first annular pulley. Although hypertrophic pulleys have been histologically and ultrasonographically detected, little is known about the histopathology of the tenosynovium covering the tendons of trigger fingers. We identified chondrocytoid cells that produced hyaluronic acid in 23 (61%) fingers and hypocellular collagen matrix in 32 (84%) fingers around the tenosynovium among 38 specimens of tenosynovium from patients with trigger fingers. These chondrocytoid cells expressed the synovial B cell marker CD44, but not the chondrocyte marker S-100 protein. The incidence of these findings was much higher than that of conventional findings of synovitis, such as inflammatory infiltrate (37%), increased vascularity (37%), hyperplasia of synovial lining cells (21%), or fibrin exudation (5%). We discovered the following distinctive histopathological features of trigger finger: hyaluronic acid-producing chondrocytoid cells originated from fibroblastic synovial B cells, and a hypocellular collagen matrix surrounding the tenosynovium. Thus, an edematous extracellular matrix with active hyaluronic acid synthesis might increase pressure under the pulley and contribute to the progression of stenosis.

Clinical characteristics of neuropathic pain in patients with carpal tunnel syndrome.

The purpose of this study was to identify the clinical characteristics of neuropathic pain in patients with carpal tunnel syndrome. We retrospectively reviewed 143 hands in 127 patients with carpal tunnel syndrome. The neuropathic pain was determined by using the painDETECT as a self-administered psychometric questionnaire to distinguish neuropathic pain. There were no significant differences in the characteristics of the patients with and without neuropathic pain. However, there were significant differences in the pain scores between those with and without neuropathic pain (p < 0.01). Furthermore, there was a significant difference between the existence of night pain in these patients (p < 0.01). Based on the results of the current study, we conclude that it is important to be aware of, and consider the existence of neuropathic pain during the treatment of patients with carpal tunnel syndrome with night pain or a high score on the numerical rating scales of pain.

The relationship between neuropathic pain, and the function of the upper limbs based on clinical severity according to electrophysiological studies in patients with carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve, and CTS can cause neuropathic pain. The aim of this study was to evaluate the relationship between neuropathic pain, function of the upper limb, and the electrophysiology in patients with CTS. The terminal latency of median nerve was measured in 34 patients diagnosed with CTS, and they were asked to fill out the Japanese Society for Surgery of the Hand version of the Disability of Arm, Shoulder, and Hand questionnaire (DASH-JSSH) as the patient's assessment of the function of upper limbs and pain DETECT as an assessment for neuropathic pain. There was no significant correlation between the terminal latency and the pain DETECT score, or the terminal latency and the DASH-JSSH score. However, there was a significant correlation between the pain DETECT and DASH-JSSH scores. Neuropathic pain affects the function of the upper extremities in patients with CTS.

Traumatic volar dislocation of the distal ulna with a fracture of the ulnar styloid.

Isolated volar dislocation of the distal ulna without forearm fracture is very rare; however, this injury is incorrectly diagnosed in approximately 50% of cases. This injury can lead to a significant functional disability if left untreated. This report presents a case of isolated volar dislocation of the distal ulna with an ulnar styloid fracture. The dislocation was subsequently reduced, the styloid was surgically repaired, and the patient was satisfied at the last follow-up. The importance of a proper clinical examination and an accurate radiographic position of the wrist are stressed. Furthermore, clinical evaluation of the distal radioular joint after reduction is important in achieving good results. There are various strategies for the treatment of distal radioulnar joint after reduction, including conservative treatment or surgical treatment. We believe that surgical exploration could have been carried out at an earlier stage had such a lesion been suspected. Additional case reports of other instances of successful treatment are needed to educate orthopaedic surgeons and emergency medical technicians on the nature of this type of injury.

Changes of multi-drug resistance pattern in Salmonella enterica subspecies enterica serovar typhimurium isolates from food-producing animals in Japan.

A total of 153 isolates of Salmonella Typhimurium derived from food-producing animals in Japan between 2002 and 2005 were investigated for antimicrobial resistance and phage types related to definitive phage type 104 (DT104). The predominant resistance type was resistance to ampicillin, dihydrostreptomycin, kanamycin, and oxytetracycline in bovine (45.2%, 48/104) and resistance to dihydrostreptomycin and oxytetracycline in porcine isolates (58.7%, 27/48). DT104-related phage type was found in 32 of 104 bovine isolates, two of 48 porcine isolates, and one of eight isolates from poultry, showing that the proportion of the phage type in S. Typhimurium isolates from cattle and pigs significantly (P<0.01) decreased from 71.9% and 31.4% in 1999-2001 to 30.8% and 4.1% in 2002-2005, respectively.

Relationship between electronic structure and cytotoxic activity of tropolones.

A structure-activity relationship of the cytotoxic activity of tropolone derivatives was discussed, using theoretical calculations. In order to clearly divide the tropolones into two structurally analogous groups, four different dipole moments (muG, muESP-G, muW and muESP-W) and heats of formation (deltaHf) of the tropolones [1-21] were calculated in the gas-phase and in water-solution by the conductor-like screening model/parametric method 3 (COSMO/PM3). The cytotoxic activities of the tropolones and 2-methoxytropones seem to be related to the three QSAR parameters deltadeltaHf, HOMO energy (EH) and muw. The cytotoxic activity of the five tropone derivatives [17-21] might depend on the QSAR parameters deltadeltaHf, LUMO energy (EL) and muESP-G. The results of the present study suggest the applicability of theoretical calculations such as frontier molecular orbital, dipole moments and deltadeltaHf in the prediction of the cytotoxic activity of tropolone derivatives.