Prognostic Influences of Cardiac Rehabilitation in Korean Acute Myocardial Infarction Patients

OBJECTIVE: To observe the prognostic influences of the cardiac rehabilitation (CR) program in Korean acute myocardial infarction (AMI) patients during the first year after an occurrence of the disease. METHOD: A total of 141 AMI patients who underwent percutaneous coronary intervention (PCI) were recruited consecutively for this study and divided into the CR group and the control group. The CR group completed the phase 2 CR program in the hospital for a period of 6-8 weeks and maintained self-exercise in their community by exercise prescription for a year after AMI. We performed a prospective comparison of the patients' demographic data, high sensitive C-reactive protein (hs-CRP) level after the 4-month CR program, and the rate of recurrence (AMI, re-hospitalization, positive coronary angiogram, needed revascularization procedure, or death) between the two groups. RESULTS: Compared to the control group (0.33+/-0.48 mg/dl), the hs-CRP level was lower in the CR group (0.18+/-0.32 mg/dl) after 4 months of exercise. The recurrence rate was lower (10%, 7/69) in the CR group, compared to the control group (24%, 17/72, p<0.05). The number of disease-free days was larger in the CR group (354+/-38.34), compared to the control group (316+/-99.96, p<0.05). In a comparison of statistical methods used for testing the equality of two survivor distributions, the CR group showed a lower recurrence rate than the control group (p<0.05). CONCLUSION: Participation in the CR program designed for AMI patients who underwent PCI-induced normalization of the serum hs-CRP level and lowering of the recurrence rate by 14% during the first year.

The Impact of Early Regular Cardiac Rehabilitation Program on Myocardial Function after Acute Myocardial Infarction

OBJECTIVE: To determine if an early regular cardiac rehabilitation program would have an adverse effect on myocardial function after acute myocardial infarction (AMI). METHOD: Patients who received percutaneous coronary intervention (PCI) after AMI were divided into the exercise group and control group in accordance with their willingness to participate. Patients in the exercise group (n=18) received ECG monitored exercise for six weeks and were instructed to maintain self exercise in their communities for four months. The control group (n=16) patients were just instructed of risk factor control. All the subjects underwent echocardiography at the time of the AMI as well as six months later. The echocardiography parameters, including the left ventricular ejection fraction (LVEF), stroke volume (SV), left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD), were measured. RESULTS: In the exercise group, the LVEF increased to 59.58+/-9.24% and 61.58+/-9.63% after six weeks and six months, respectively (p0.05). CONCLUSION: Active participation in the cardiac rehabilitation program approximately two weeks after AMI did not have an adverse effect on the size of the left ventricle and myocardial function.

Treatment of Adhesive Capsulitis with Steroid Injection Followed by Hyaluronic Acid Injection

OBJECTIVE: To investigate the effects of sono-guided intraarticular steroid injection followed by sodium hyaluronate injection weekly for 2 weeks on adhesive capsulitis of the shoulder. METHOD: In this prospective randomized controlled trial, 16 patients (group A) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg once a week for 3 weeks, and 13 patients (group B) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg for the first week, and subsequently a mixture of 0.5% lidocaine 8 ml and sodium hyaluronate 2 ml once a week for the next 3 weeks. A self exercise program was instructed for all subjects. The effects were assessed using visual numeric scale (VNS), shoulder pain and disability index (SPADI), and range of shoulder motion (flexion, abduction, internal rotation. external rotation, and extension) at study entry, every week until 2 weeks have passed after the last injection. RESULTS: The VNS, SPADI, and range of shoulder motion improved 1 week after 1st injection and continued to improve until 2 weeks after last injection in both two groups. There were no difference in changes of VNS and SPADI between these two groups, but range of shoulder motion especially in passive and active internal rotation of patients in group A improved more than those in group B. CONCLUSION: Steroid injection combined with hyaluronic acid injection has comparable effects with triamcinolone for treatment of adhesive capsulitis of the shoulder. Sono-guided intraarticular injection of steroid combined with hyaluronic acid can substitute for intraarticular injection of triamcinolone and be useful especially for patients susceptible to adverse effects of steroid injection.

The Safety of Early Exercise Stress Test after Coronary Intervention

OBJECTIVE: To investigate the safety of early symptom limited exercise stress test (GXT) performed within 10 days after coronary intervention in acute coronary syndrome patients. METHOD: Forty-six patients with acute coronary syndrome including unstable angina (UA) and acute myocardial infarction (AMI) were recruited. All of them performed GXT within 10 days after coronary intervention and received cardiac rehabilitation for 6 weeks. RESULTS: Mean age of the patients was 57.6+/-9.8 years (unstable angina 26 patients, acute myocardial infarction 23 patients). The number of the patients complained of cardiac events during GXT was 8 (16%); chest pain (3), ischemic changes on electrocardiogram (2) and hemodynamic instability (3). However, none of them showed any major adverse cardiac events such as acute myocardial infarction (AMI). Major cause of termination of GXT was patient's request such as dyspnea, fatigue, and musculoskeletal pain. After early GXT, there was no significant difference between two groups in all variables (p>0.05). CONCLUSION: Early GXT was safe in acute coronary syndrome patients and did not show any significant difference between UA patients and AMI patients.

CT Guided Botulinum Toxin Injection in Piriformis Syndrome

The traditional treatment of piriformis syndrome includes heat modality, deep muscle massage, slow stretch exercise, injection of local anesthetics, and surgical division of piriformis muscles in some selected cases. More recently, the use of botulinum toxin (BTX) for the treatment of piriformis syndrome has been suggested. We experienced two cases of piriformis syndrome with distinctive clinical feature. The symptoms of these two cases were not controlled by conservative managements including physical therapy, direct injection of lidocaine or steroid, or caudal block. So we injected Type A BTX in the piriformis muscle with the guidance of CT scan. 8 weeks after the botulinum injection, symptoms had almost completely disappeared, and follow up CT scan showed sufficient atrophy of piriformis muscles. The CT guided BTX injection in the piriformis muscle might emerge as a feasible technique to obtain a good local therapeutic effect without risk of imprecise inoculation.