Sonographically Guided Musculocutaneous Nerve Phenol Block for Elbow Flexor Spasticity: Case report

Seven hemiplegic stroke patients suffering elbow flexor spasticity were selected for musculocutaneous nerve (MN) blocks. The MN was identified at the proximal 1/3 area on anteromedial surface of upper arm at supine position. An injectable monopolar EMG needle electrode was inserted into MN under real time ultrasonography. The 7% phenol solution was injected 0.2 ml at a time into MN until biceps brachii and brachialis muscle contractions were completely blocked at a maximum of 5 mA electrical stimulation. The total dose of injected phenol solution was 1.2~2.2 ml. We examined modified Ashworth scale (MAS) of elbow flexor and elbow angle at the standing position. In all the subjects, MAS was decreased and elbow angle was increased after nerve block. Ultrasonography guidance makes it exact to identify MN and to inject neurolytic solution to target. It can lead minimal complications by using the least dosage of neurolytic drug.

The Causes for the Premature Termination of Graded Exercise Test in a Cardiac Rehabilitation Setting

OBJECTIVE: To observe the termination point of graded exercise test (GXT) in cardiac patients and the reasons for the premature termination. METHOD: Cardiac patients taking GXT within 4 weeks after medical intervention or surgery were reviewed. If the GXT was stopped below the respiratory exchange ratio of 1.0, the subjects were chosen as the final study subjects and reviewed for the reason of premature termination. RESULTS: 115 out of a total of 715 subjects terminated GXT prematurely. There were 36 cardiovascular, and 79 non- cardiovascular reasons. The cardiovascular reasons were abnormal blood pressure response (19.1%), dysrhythmia (6.1%), ST abnormality (3.5%), vascular claudication (2.6%). The non-cardio-vascular reasons were subjective dyspnea (45.2%), lower limb fatigue (7.8%), hemiplegic gait (5.2%), arthralgia (3.5%), anxiety (3.5%), neurogenic claudication (2.6%), and abdominal pain (0.9%). The causes of dyspnea were low physical fitness (71.1%), concurrent chronic obstructive pulmonary disease (15.4%), poor motivation (5.8%), and secondary gain (7.7%). CONCLUSION: 16.1% of GXT were terminated prematurely and 68.7% of those for non-cardiovascular reasons. The main causes of the non-cardiovascular premature GXT were subjective dyspnea due to low physical fitness.

Effectiveness of the Cardiac Rehabilitation on Exercise Capacity and Risk Factor in Coronary Artery Obstructive Disease

OBJECTIVE: To evaluate the effectiveness of cardiac rehabilitation (CR) program on the exercise capacity and secondary prevention in coronary artery obstructive disease (CAOD). METHOD: CR group of 48 CAOD patients had underwent regularly supervised exercise training for 6~8 weeks as well as home exercise continued for 1 year. CR group was advised to control their risk factors by nutrition counsel, abstaining from smoking and reducing their weight. Control group of 16 CAOD patients did not participate in the CR program. Two groups were evaluated for their exercise capacity and risk factors at baseline and after 1 year. RESULTS: CR group showed significantly higher maximal oxygen consumption, maximal rate pressure product and ratings of perceived exertion at stage 3 compared with control group (p<0.05). The number of risk factors per person after 1 year in both groups was significantly lower than baseline (p<0.05), but there was no significant difference between the two groups. CONCLUSION: CR program can improve the exercise capacity and level of risk factor in CAOD patients. Therefore, CR program is recommended for helping CAOD patients improve their functional capacity and reduce the possibility of recurrence.

Immediate and Long-term Effect of Exercise on Heart Rate Variability in Coronary Artery Disease

OBJECTIVE: To evaluate the dynamics of autonomic nervous activity at rest and immediately after maximum exercise using heart rate variability (HRV) in coronary artery disease (CAD) and to assess the long-term effect of exercise. METHOD: Time and frequency domain of HRV was measured in 18 normal subjects, 37 CAD patients with percutaneous transluminal angioplasty and 10 CAD patients with coronary artery bypass graft at rest and 1 hour after peak graded treadmill exercise. Nineteen CAD patients were exercised with moderate intensity during 4 month and HRV was measured. RESULTS: At rest, the standard deviation of the NN interval (SDNN) and low frequency was significantly lower in both CAD groups than in normal subjects. At recovery stage after maximum exercise, low frequency and low frequency/high frequency ratio was significantly lower in both CAD groups than in normal subjects. SDNN at recovery stage in normal subjects remained significantly below the baseline. There was no significant change in HRV after long-term exercise even though maximum oxygen uptake had improved. CONCLUSION: This study demonstrated the reduced control of autonomic nervous activity in CAD patients at rest and immediately after peak exercise. There was no change in HRV after long-term exercise.