Experience of a Special Rating Dementia Service for Family Caregivers of Elderly People with Dementia

PURPOSE: This study tries to explore experiences with a special rating dementia service among family caregivers of elderly people with dementia. METHODS: The participants were 11 family caregivers of elderly people with dementia and had used a day-care service from the special rating dementia service for more than 3 months. Data were collected through individual in-depth interviews and analyzed using content analysis. RESULTS: Three categories emerged: “reminiscence of an entangled life”, “feeling relieved from a stifled life”, and “hope for a better life through help and support” with 8 sub-categories and 23 codes. By using the special rating dementia service, the participants experienced relief from the burden of caring for their elderly family member with dementia and restored their social relations or family relationships. They experienced a positive transition in which their caring for elderly family members with dementia was integrated into their daily lives, and they expressed their desires for better policies. CONCLUSION: These findings imply the importance and necessity of the special rating dementia service. Practical and systematic family support programs are necessary and proactive publicity activities by the government and public agencies are suggested to ensure that family caregivers can easily use the special rating dementia system.

The Effect of GCSB-5 a New Herbal Medicine on Changes in Pain Behavior and Neuroglial Activation in a Rat Model of Lumbar Disc Herniation

OBJECTIVE: Lumbar disc herniation can induce sciatica by mechanical compression and/or chemical irritation. The aim of this study was to compare the effects of GCSB-5 (Shinbaro(R)) and NSAIDs on pain-related behavior and on the expressions of microglia, astrocytes, CGRP, TRPV1, IL-6, and CX3CL1 in a rat model of lumbar disc herniation. METHODS: 112 male Sprague-Dawley rats underwent implantation of nucleus pulposus to a dorsal root ganglion (DRG). Rats were divided into five groups as follows; a saline group (the vehicle control group) (n=27), a 10 mg/kg aceclofenac group (the aceclofenac group) (n=22), and 100, 300 or 600 mg/kg GCSB-5 groups (the GCSB-5 100, 300, or 600 groups) (n=21 for each group). Rats were tested for mechanical allodynia at 3 days after surgery and at 1 day, 3 days, 7 days, 14 days, 21 days, 28 days, 35 days, 42 days, 49 days, and 56 days after treatment commencement. Immunohistochemical staining of microglia (Iba1), astrocytes (GFAP), CGRP, and TRPV1, and PCR for IL-6 and CX3CL1 were performed on spinal dorsal horns and DRGs at 56 days after medication commencement. RESULTS: After 56 days of GCSB-5 300 administration, mechanical withdrawal thresholds were significantly increased (p<0.05), and immunohisto-chemical expressions of Iba1, GFAP, CGRP, and TRPV1 were reduced than other groups, but this difference was not statistically significant. CONCLUSION: These results indicate GCSB-5 reduces mechanical allodynia and downregulates neuroglial activity and the expressions of CGRP and TRPV1 in the spinal segments of a rat model of lumbar disc herniation.

Comparison of the Effects of Ultrasound-Guided Interfascial Pulsed Radiofrequency and Ultrasound-Guided Interfascial Injection on Myofascial Pain Syndrome of the Gastrocnemius

OBJECTIVE: To investigate the comparative treatment effects of ultrasound-guided pulsed radiofrequency treatment (UG-PRF) in the gastrocnemius interfascial space and ultrasound-guided interfascial injection (UG-INJ) on myofascial pain syndrome. METHODS: Forty consecutive patients with myofascial pain syndrome of the gastrocnemius were enrolled and were allocated to one of the two groups. Twenty patients were treated by UG-PRF delivered to the gastrocnemius interfascial space (UG-PRF group) and the other 20 patients were treated by interfascial injection (UG-INJ group). The primary outcome measure was the numeric rating score (NRS) for pain on pressing the tender point in the gastrocnemius, and the secondary outcome measure was health-related quality of life as determined by the Short Form-36 questionnaire (SF-36). NRSs were obtained at the first visit, immediately after treatment, and at 2 and 4 weeks post-treatment, and physical component summary scores (PCS) and mental component summary scores (MCS) of the SF-36 questionnaire were measured at the first visit and at 4 weeks post-treatment. RESULTS: Immediately after treatments, mean NRS in the UG-PRF group was significantly higher than that in the UG-INJ group (p<0.0001). However, at 2 and 4 weeks post-treatment, the mean NRS was significantly lower in the UG-PRF group (both p<0.0001). Similarly, at 4 weeks post-treatment, mean PCS and MCS were significantly higher in the UG-PRF group (p<0.0001 and p=0.002, respectively). CONCLUSION: Based on these results, the authors conclude that ultrasound-guided gastrocnemius interfascial PRF provides an attractive treatment for myofascial pain syndrome of the gastrocnemius.

Changes in the Expressions of Iba1 and Calcitonin Gene-Related Peptide in Adjacent Lumbar Spinal Segments after Lumbar Disc Herniation in a Rat Model

Lumbar disc herniation is commonly encountered in clinical practice and can induce sciatica due to mechanical and/or chemical irritation and the release of proinflammatory cytokines. However, symptoms are not confined to the affected spinal cord segment. The purpose of this study was to determine whether multisegmental molecular changes exist between adjacent lumbar spinal segments using a rat model of lumbar disc herniation. Twenty-nine male Sprague-Dawley rats were randomly assigned to either a sham-operated group (n=10) or a nucleus pulposus (NP)-exposed group (n=19). Rats in the NP-exposed group were further subdivided into a significant pain subgroup (n=12) and a no significant pain subgroup (n=7) using mechanical pain thresholds determined von Frey filaments. Immunohistochemical stainings of microglia (ionized calcium-binding adapter molecule 1; Iba1), astrocytes (glial fibrillary acidic protein; GFAP), calcitonin gene-related peptide (CGRP), and transient receptor potential vanilloid 1 (TRPV1) was performed in spinal dorsal horns and dorsal root ganglions (DRGs) at 10 days after surgery. It was found immunoreactivity for Iba1-positive microglia was higher in the L5 (P=0.004) dorsal horn and in the ipsilateral L4 (P=0.009), L6 (P=0.002), and S1 (P=0.002) dorsal horns in the NP-exposed group than in the sham-operated group. The expression of CGRP was also significantly higher in ipsilateral L3, L4, L6, and S1 segments and in L5 DRGs at 10 days after surgery in the NP-exposed group than in the sham-operated group (P<0.001). Our results indicate that lumbar disc herniation upregulates microglial activity and CGRP expression in many adjacent and ipsilateral lumbar spinal segments.

Activations of Deep Lumbar Stabilizing Muscles by Transcutaneous Neuromuscular Electrical Stimulation of Lumbar Paraspinal Regions

OBJECTIVE: To investigate changes in lumbar multifidus (LM) and deep lumbar stabilizing abdominal muscles (transverse abdominis [TrA] and obliquus internus [OI]) during transcutaneous neuromuscular electrical stimulation (NMES) of lumbar paraspinal L4-L5 regions using real-time ultrasound imaging (RUSI). METHODS: Lumbar paraspinal regions of 20 healthy physically active male volunteers were stimulated at 20, 50, and 80 Hz. Ultrasound images of the LM, TrA, OI, and obliquus externus (OE) were captured during stimulation at each frequency. RESULTS: The thicknesses of superficial LM and deep LM as measured by RUSI were greater during NMES than at rest for all three frequencies (p<0.05). The thicknesses in TrA, OI, and OE were also significantly greater during NMES of lumbar paraspinal regions than at rest (p<0.05). CONCLUSION: The studied transcutaneous NMES of the lumbar paraspinal region significantly activated deep spinal stabilizing muscle (LM) and the abdominal lumbar stabilizing muscles TrA and OI as evidenced by RUSI. The findings of this study suggested that transcutaneous NMES might be useful for improving spinal stability and strength in patients having difficulty initiating contraction of these muscles.

Fornix Injury in a Patient with Rotavirus Encephalopathy: Diffusion Tensor Tractography Study

Rotavirus encephalopathy (RE) is a benign afebrile seizure associated with acute gastroenteritis caused by rotavirus infection. We investigated the diffusion tensor tractography (DTT) findings of a patient with RE. The patient was a 30-month-old female that had experienced a brief, generalized convulsive seizure. On the day of admission, the patient had vomiting and experienced watery diarrhea. Her stool was positive for rotavirus antigen. At onset, the patient displayed a drowsy and delirious mental status; later, a splenial lesion of the corpus callosum was found on MRI. One week later, the patient's condition improved and the splenial lesion had disappeared by conventional MRI. Initial DTI showed decreased fractional anisotropy (FA) values of fornix, as well as of the corpus callosum. A follow-up DTT showed a restored interrupted right fonical crus and increased FA values of corpus callosum and fornix. These results highlight the implications of the probability of not only a corpus callosum injury, but a fornix injury as well, in this patient with RE.

Efficacy of Transforaminal Epidural Steroid Injections According to Nerve Root Enhancement

OBJECTIVE: To determine the efficacy of transforaminal epidural steroid injections according to nerve root enhancement in lumbar disc herniations. METHOD: Twenty seven patients who had extruded or seques tered lumbar disc herniations on enhanced MR imaging were investigated: fifteen patients with corresponding nerve root enhancement (enhanced group), and twelve patients without enhancement (non-enhanced group). All patients received transforaminal epidural steroid injection. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry disability index (ODI) before treatment and one month after injection. RESULTS: The averages of VAS for lower extremity and back pain in both groups one month after injection significantly reduced compared to that of pretreatment, respectively (p<0.001). The amount of decrease in pain in enhanced group was larger than that of non-enhanced group (p<0.05). The averages of ODI in both group one month after injection significantly reduced compared to that of pretreatment (p<0.0001), however, there was no difference between the two groups. CONCLUSION: The nerve root enhancement on contrast-enhanced MR imaging indicates the presence of severe inflammatory reaction of nerve root, which means well-responsiveness to anti-inflammatory treatment such as transforaminal epidural steroid injection, even if patients' symptom is very severe.

Does Injured Corticospinal Tract Recover after Rehabilitation Therapy in Patients with Hemiplegic Cerebral Palsy?

OBJECTIVE: To investigate whether injured corticospinal tract (CST) could recover after rehabilitative therapy in hemiplegic patients with cerebral palsy using diffusion tensor tractography (DTT) which is known to be useful in detecting microscopic white matter lesion in vivo. METHOD: Sixteen hemiplegic patients (mean age, 13.6 months) were enrolled. Diffuse tensor image (DTI) and gross motor functional measurement (GMFM) evaluation were performed before rehabilitative therapy and at follow-up. We measured the fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of CST in the affected and unaffected hemisphere. To evaluate asymmetry of affected and unaffected CST, asymmetry index of fractional anisotropy (AA) and asymmetry index of apparent diffusion coefficient (AD) were measured. RESULTS: The FA value of the affected CST was lower than that of the unaffected CST and the ADC value was higher than that of the unaffected CST in initial and follow up DTT (p<0.001). Compared with the result of initial DTT, the results of follow up DTT demonstrated that the FA value of both CST was increased (p=0.000). A significant increase in AA was showed in all patients (p=0.000) and the increase of AA had significant correlation with the increase of FA of affected CST, but not with the unaffected CST (r=0.537, p=0.032). CONCLUSION: DTT would be a powerful modality not only for diagnosis and prognosis of cerebral palsy, but also assessment of microstructural change of CST after rehabilitative therapy.

The Long-Lasting Pattern of the Neuropathic Radicular Pain in An Autologous Nucleus Pulposus Model of Rat

OBJECTIVE: To observe the long-lasting changes of pain progression with time course in an autologous nucleus pulposus model of rat. METHOD: The subjects were 25 Sprague-Dawley (Sprague- Dawley, 250 gm) male rats. They were randomly assigned into either the sham or experimental group. In the experimental group (n=15), autologous nucleus pulposus was harvested from the coccygeal intervertebral disc of the rat and this was grafted on the left L5 dorsal root ganglion. In the sham group (n=10), the left L4 and L5 nerve roots were exposed by laminectomy, but the nucleus pulposus was not grafted. All the rats were evaluated for mechanical allodynia and thermal hyperalgesia at 2 days before surgery, and on days 1, 5, 10, 20, 30, 40 and 50 after surgery. The morphological changes of the spinal nerves were assessed by toluidine blue staining on days 5 after surgery. RESULTS: In the ipsilateral hindpaw of the experimental group, there was a dramatic drop of the mechanical withdrawal threshold and the thermal withdrawal latency on day 1 after surgery, which was maintained at day 50 after surgery. In morphological study, pathological findings such as swelling of the myelin sheath, demyelination, swelling and degeneration of the axoplasm were observed in the spinal nerve at day 5 after surgery. CONCLUSION: The long-lasting pattern of neuropathic radicular pain shown in a rat model of lumbar disc herniations is helpful to understand the natural history of neuropathic radicular pain due to ruptured nucleus pulposus.

Atelectasis and Ventricular Tachycardia after Induction of Anesthesia / 대한마취과학회지

A frequent dilemma facing the anesthesiologist is the patient with respiratory tract symptoms. The risks of anesthesia and surgery in these patients have not been clearly established. We present a case in which a potentially serious respiratory complication had arisen. The patient had symptoms of coughing and mucous production. She was a heavy smoker. However, there was no history of pulmonary disease. This report describes a patient who developed left upper lobar collapse after induction of general anesthesia and tachydysrhythmia resulting in ventricular tachycardia and myocardial ischemia.

CT findings of thoracic involvement of lymphoma

Chest CT scans of 70 patents with malignant lymphoma were reviewed to evaluate the thoacic manifestation of malignant lymphoma. Sixteen patients had Hodgkin's disease and 54 patients had non-Hodgkin's lymphoma. The thoracic involvement of malignant lymphoma was observed i 47 patients (67.1%) and 11 of these patients had Hodgkin's disease, and 36 had non-Hodgkin's lympoma. The most common finding was mediastinal lymphadenopathy and the most frequently involved sites were anterior mediastinal and paratracheal lymph nodes. Pulmonary parenchymal involvement was seen in 11 patients (15.7%), and CT scan showed thickening of bronchovascular bundle, parenchymal consolidation and nodules. Pleural effusion was seen in 18 patients (25.7%), however, without any evidence of parietal pleural thickening in all cases. Involvement of chest wall and breast was seen in two patient(2.9%). The data obtained through the current study showed no differences from those of previous reports, except the fact that there was no CT evidence of pleural thickening in patients who had pleural effusion.