MRI Findings of Shoulder Pain in Hemiplegic Stroke Patients / The Japanese Journal of Rehabilitation Medicine

The purpose of this study is to evaluate MRI findings for the shoulder pain in hemiplegic stroke patients in relation to clinical characteristics. We studied 18 hemiplegic patients with first-ever stroke presenting with shoulder pain in the affected side (mean age±SD=67.6±10.1years ; 8 men and 10 women ; 12 right and 6 left hemiplegia). All patients had shoulder pain during passive movements and 4 also had pain at rest. The mean duration from stroke onset to MRI was 67±42 days. MRI revealed abnormal findings in all patients. Tendinosis of the long head of the biceps and supraspinatus tendon injuries were most frequently found. The tendinosis of the long head of the biceps was related to hemihypesthesia and a reduced range of motion for external rotation of the shoulder. The supraspinatus tendon injuries were related to older age and lower Fugl-Meyer (FM) and Functional Independence Measure (FIM) scores. The mean number of abnormal findings per patient was 3.2±1.4. The patients with more than 3 abnormal findings were significantly older, had shorter duration from stroke onset and lower FM and FIM scores than those with less findings. It was suggested that those patients with more severe paresis might have more abnormal findings on their MRIs for shoulder pain.

The Usefulness and Limitations of Mechanical Circulatory Assistance for Profound Heart Failure. Simultaneous Use of IABP and PCPS / 日本心臓血管外科学会雑誌

In 5 cases of profound left ventricular failure, simultaneous application of a percutaneous cardiopulmonary support system (PCPS) in which the entire circuit was coated with heparin, and intra-aortic balloon pumping (IABP) were performed. No case responded to therapy consisting of large amounts of inotropic agents, followed by IABP. With the assistance of the PCPS (mean flow rate 2.3<i>l</i>/min) combined with moderate doses of inotropic agents and IABP, the hemodynamics of all 5 patients were stabilized. Using low amounts of heparin, the activated coagulation time during PCPS was maintained between 150 and 200 seconds. No complications directly related to this procedure such as thromboembolism and bleeding were observed. Four cases have been successfully weaned from the PCPS. Of the four, two cases are long-term survivors and are currently functioning normally in society. At present, the indications, optimum parameters for PCPS flow rate, and when to start weaning from the PCPS have not been established. However, we conclude that simultaneous use of PCPS and IABP is useful to maintain adequate systemic circulation in cases not responding to medication and IABP.