Comparison of Sono-guided Capsular Distension with Fluoroscopically Capsular Distension in Adhesive Capsulitis of Shoulder

OBJECTIVE: To investigate the short-term effects and advantages of sono-guided capsular distension, compared with fluoroscopically guided capsular distension in adhesive capsulitis of shoulder. METHOD: In this prospective, randomized, and controlled trial, 23 patients (group A) were given an intra-articular injection of a mixture of 0.5% lidocaine (9 ml), contrast dye (10 ml), and triamcinolone (20 mg); they received the injection once every 2 weeks, for a total of 6 weeks, under sono-guidance. Twenty-five patients (group B) were treated similarly, under fluoroscopic guidance. Instructions for the self-exercise program were given to all subjects, without physiotherapy and medication. Effects were then assessed using a visual numeric scale (VNS), and the shoulder pain and disability index (SPADI), as well as a range of shoulder motion examinations which took place at the beginning of the study and 2 and 6 weeks after the last injection. Incremental cost-effective ratio (ICER), effectiveness, preference, and procedure duration were evaluated 6 weeks post-injection. RESULTS: The VNS, SPADI, and shoulder motion range improved 2 weeks after the last injection and continued to improve until 6 weeks, in both groups. However, no statistical differences in changes of VNS, SPADI, ROM, and effectiveness were found between these groups. Patients preferred sono-guided capsular distension to fluoroscopically guided capsular distension due to differences in radiation hazards and positional convenience. Procedure time was shorter for sono-guided capsular distension than for fluoroscopically guided capsular distension. CONCLUSION: Sono-guided capsular distension has comparable effects with fluoroscopically guided capsular distension for treatment of adhesive capsulitis of the shoulder. Sono-guided capsular distension can be substituted for fluoroscopic capsular distension and can be advantageous from the viewpoint of radiation hazard mitigation, time, cost-effectiveness and convenience.

Impact of Exercise-based Cardiac Rehabilitation on In-stent Restenosis with Different Generations of Drug Eluting Stent

OBJECTIVE: To compare the rate of restenosis between a cardiac rehabilitation (CR) group and a control group within three different generations of drug eluting stents (DES). METHOD: Patients who received DES due to an acute coronary syndrome were included. They were divided into a CR group and a control group. The CR group received six to eight weeks of early cardiac rehabilitation program in a hospital setting, and sustained a self-exercise program for six months in a community. The control group was instructed to exercise by themselves after leaving the hospital. Nine months after the first onset of disease, we implemented a coronary angiography and compared the two groups. In addition, we divided the patients into three subgroups according to the generation of DES, and compared the rate of restenosis between the CR group and control group within these three subgroups. RESULTS: At 9 months, in-stent restenosis, measured as an in-segment late luminal loss (LLL) of the stented coronary area, was smaller in the CR group (n=52) 0.16+/-0.42 mm compared to the control group (n=51) 0.39+/-0.78 mm (p<0.05). A reduction of LLL in the CR group compared to the control group was consistent among the three different generations of DES. CONCLUSION: The CR program is strongly associated with a significant reduction in LLL in the stented coronary segments, regardless of the generation of DES.

Safety of Monitoring Exercise for Early Hospital-based Cardiac Rehabilitation

OBJECTIVE: To survey the cardiovascular complications induced by cardiac monitoring exercise during 10 years of our cardiac rehabilitation (CR) clinic and report on the safety of monitoring exercise training for early hospital-based CR. METHOD: All cardiac patients who participated in our exercise program from January 2000 through December 2009 were recruited as study subjects. We stratified the exercise risks of cardiac events and conducted the monitoring exercise with individualized prescriptions. We measured all cardiac complications, including death, symptoms, abnormal hemodynamic responses, and electrocardiogram (ECG) abnormality during exercise training, for 10 years. A total of 975 patients (68% male; mean age, 58.9+/-10.6) were included in this study. Initial indications for CR were recent percutaneous transluminal coronary angioplasty (PTCA) (75%), post-cardiac surgery (coronary bypass graft, 13.2%), valvular surgery and other cardiac surgery (4.2%), and others (7.6%). RESULTS: The study population underwent 13,934 patient-hours of monitoring exercise. No death, cardiac arrest or acute myocardial infarction (AMI) occurred during exercise (0/13,934 exercise-hours). Fifty-nine patients experienced 70 cardiovascular events during the 13,934 exercise-hours (1/199 exercise-hours); there were 17 cases of angina only (1/820 exercise-hours), 31 cases of ECG abnormalities only (1/449 exercise-hours), 12 cases of angina with ECG abnormalities (1/1,161 exercise-hours), and 10 cases of abnormal hemodynamic responses (1/1,393 exercise-hours). CONCLUSION: Early hospital-based CR is safe enough that no death, cardiac arrest or AMI occurred during the 13,934 patient-hours of monitoring exercise. However, risk stratification for exercise-induced cardiovascular events, proper exercise prescriptions, and intensive ECG monitoring are required prior to initiation of the monitoring exercise.

Effect of Pre-reperfusion Intravascular Rinsing in a Canine Acute Limb Ischemia Model

PURPOSE: Reperfusion after acute ischemia is associated with high rates of morbidity and mortality due to the ischemic injury itself and the following myonephropathic metabolic syndrome, in spite of complete revascularization. Therefore, we attempted to verify the difference in reperfusion injury with or without pre-reperfusion intravascular rinsing in a canine acute limb ischemia model. METHOD: We used five female mongrel dogs. Complete acute hind limb ischemia was induced by infrarenal aortic and bilateral femoral artery clamping for 8 hours. We divided the dogs into two groups. In the rinse group (RG): three dogs were declamped with intravascular rinsing, and in the non-rinse group (non-RG): two dogs were declamped without any additional procedures. The perfusate solution was infused through both femoral arteries and was drained via both femoral veins. Serial blood samples were obtained four times. The gastrocnemius muscles were biopsied 3 days after reperfusion. RESULT: The results at preischemia, just before, 30 min, and 3 days after reperfusion were as follows: Creatine phosphokinase (CK) was 204, 1031, 1373, and 443 (IU/L) in the RG and 159, 3855, 6345, and 5455 (IU/L) in the non-RG. Lactate dehydrogenase (LDH) was 177, 248, 173, and 232 (IU/L) in the RG and 95, 508, 638, and 878 (IU/L) in the non-RG. Aspartate transaminase (AST) was 23, 50, 43, and 42 (IU/L) in the RG and 19, 118, 154, and 399 (IU/L) in the non-RG. Potassium (K) was 5.7, 5.8, 5.4, and 4.0 (mEq/L) in the RG and 5.4, 5.5, 5.7, and 5.3 (mEq/L) in the non-RG. Muscle injury in the non-RG was more severe than in the RG. CONCLUSION: There was a considerable difference between the groups in the CK, LDH and AST levels and the muscle biopsy findings. The results showed that the intravascular rinsing provided beneficial effects in reperfusion injury acute limb ischemia.