Multiple cerebral infarction coexisted with peripheral arterial occlusion after COVID-19 infection: a case review

Multiple cerebral infarctions coexisting with peripheral artery occlusion have been rarely reported and occur only in specific conditions. Also, the characteristics of thrombosis related to the outbreak of the coronavirus disease 2019 (COVID-19) have been observed and studied recently. We report a case of concurrent multiple cerebral infarctions and peripheral embolism in a patient with a recent history of COVID-19 infection. A 62-year-old male patient who had recently been infected with COVID-19 presented to our emergency department with left hemiparesis. Supportive treatments were given post the diagnosis of multiple cerebral infarctions in the right cerebral hemisphere. During the supportive treatments, motor weakness was seen in the right upper extremity. Computed tomography revealed thrombi in the right axillary, brachiocephalic, and brachial arteries. The patient was already taking antiplatelet and anticoagulant agents and had no other underlying disease to develop such occlusions except his recent history of COVID-19 infection. We checked his laboratory tests for coagulation profiles throughout the hospitalization to verify a possible cause. We believe that large thrombi formation due to COVID-19 can simultaneously cause embolism in the cerebrum and peripheral regions. This pathology can result in symptoms that could make diagnosis difficult, delaying treatment decisions. This report, therefore, suggests that it is necessary to take into account a patient’s history of COVID-19 infection in such situations, especially when the patient presents with symptoms of a stroke.

Features of Golf-Related Shoulder Pain in Korean Amateur Golfers

OBJECTIVE: To investigate the causes and characteristics of golf-related shoulder injuries in Korean amateur golfers. METHODS: Golf-related surveys were administered to, and ultrasonography were conducted on, 77 Korean amateur golfers with golf-related shoulder pain. The correlation between the golf-related surveys and ultrasonographic findings were investigated. RESULTS: The non-dominant shoulder is more likely to have golf-related pain and abnormal findings on ultrasonography than is the dominant shoulder. Supraspinatus muscle tear was the most frequent type of injury on ultrasonography, followed by subscapularis muscle tear. Investigation of the participants' golf-related habits revealed that only the amount of time spent practicing golf was correlated with supraspinatus muscle tear. No correlation was observed between the most painful swing phases and abnormal ultrasonographic findings. Participants who had not previously visited clinics were more likely to present with abnormal ultrasonographic findings, and many of the participants complained of additional upper limb pain. CONCLUSION: Golf-related shoulder injuries and pain are most likely to be observed in the non-dominant shoulder. The supraspinatus muscle was the most susceptible muscle to damage. A correlation was observed between time spent practicing golf and supraspinatus muscle tear.

Clinical Effectiveness of Complex Decongestive Physiotherapy for Malignant Lymphedema: A Pilot Study

OBJECTIVE: To evaluate the effect of complex decongestive physiotherapy (CDPT) on malignant lymphedema patients. METHODS: Patients (n=22) with malignant lymphedema of the upper or the lower limb were assigned to this study. CDPT without manual lymphatic drainage (MLD) was used five times per week for two weeks. The main outcome measurements included measurement of the circumference of the limb (proximal, distal, and total) to assess volume changes. We also employed the visual analog scale (VAS) to evaluate pain, and the short form-36 version 2 questionnaire (SF-36) to assess quality of life (QOL). All items were assessed pre and post-treatment for each patient. RESULTS: There was a statistically significant difference in the volume change of the upper limbs (3.7%, p=0.001) and the lower limbs (10.9%, p=0.001). A 1.5 point reduction on the ten-point VAS was noted after CDPT. The scores on the physical and the mental components of the SF-36 showed statistical improvement after treatment (p=0.006, p=0.001, respectively). CONCLUSION: These results suggest that all components of the CDPT program except MLD are helpful in treating malignant lymphedema in terms of pain reduction and reduction of the volume of the affected upper or lower limb. This treatment regimen also has positive effects on QOL.

The Study of Animal Model of Lymphedema Using the Mouse Tail / 고신대학교의과대학학술지

OBJECTIVES: To investigate the time course of the development of acquired and experimental lymphedema. METHODS: We studied an experimental model of acute post - surgical lymphedema in the tails of female hairless mice. The procedures that remove the skin and subcutaneous tissue in tails of the mice (5-10 mm from tail base) were performed, and then the murine has acquired lymphatic insufficiency. We measured volume of the tails in 2 times per week for 5 weeks, histological biopsy, and lymphoscintigraphy to assess lymphatic flow. RESULTS: There was gradually increased volume of the tails and observed twice volume at post - surgical 18 days. In lymphoscintigraphy, we identified decreased lymphatic flow and dermal back flow in the tails. Histological biopsy showed inflammatory response that was edema and increased neutrophils in epidermis and subdermis, and lymphatic microvascular dilatation. CONCLUSIONS: We have a mouse model of acute acquired lymphedema. This post - surgical murine tail model of lymphedema can be used to simulate an attribute of human lymphedema and provides knowledge about functional and structural alterations of lymphedema.

Causes of Shoulder Pain in Women with Breast Cancer-Related Lymphedema: A Pilot Study

PURPOSE: To inform on shoulder pathology and to identify the disabilities and level of quality of life (QOL) associated with shoulder pain in patients with breast cancer-related lymphedema (BCRL). MATERIALS AND METHODS: Using patient history, physical examination, and ultrasound (US), we classified patients with BCRL into the following three groups: no pain with normal ultrasound (US), pain with normal US, and pain with abnormal US. We evaluated shoulder pathology using US, pain intensity using a visual analogue scale (VAS), and functional disability using the Korean version of the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire. For assessment of QOL, we used the Korean version of the brief form of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF). RESULTS: 28.9% of patients had no pain and normal US, 31.6% had pain with normal US, and 39.5% had pain with abnormal US. The US findings for those with pain and abnormal US revealed the following: 53.3% had a supraspinatus tear, 13.3% had biceps tenosynovitis, 13.3% had acromioclavicular arthritis, 13.3% had subdeltoid bursitis, and 53.3% had adhesive capsulitis. Patients with shoulder pain and abnormal US findings had significantly higher mean DASH and pain scores. Pain scores were positively correlated with DASH scores and negatively correlated with QOL. CONCLUSION: We found that BCRL with shoulder pain and evidence of shoulder pathology on US was associated with reduced QOL and increased disability. Proper diagnosis and treatment of shoulder pain are necessary to improve QOL and decrease disability in patients with BCRL.

The Effect of Sodium Selenite on Breast Cancer-Related Lymphedema

OBJECTIVE: To investigate the effects of complex decongestive physiotherapy (CDPT) with sodium selenite compared to the effects of CDPT without sodium selenite for the treatment of breast cancer-related lymphedema (BCRL). METHOD: Patients (n=40) who were diagnosed with BCRL were randomly assigned to the two groups: sodium selenite group or the non-sodium selenite group. In the sodium selenite group, sodium selenite was administered for 100 days concurrently with CDPT. In the non-sodium selenite group, only CDPT was administered. The main outcome measurements included limb circumference (proximal, distal and total) to indicate volume changes, the visual analogue scale (VAS) and the short form-36 version 2 questionnaire (SF-36) scores to evaluate the quality of life (QoL) pre-treatment, 100 days post-treatment and 130 days post-treatment for each patient. RESULTS: The sodium selenite group experienced volume reduction of 8.22% and 9.21%, at 100 and 130 days post-treatment, respectively. The non-sodium selenite group experienced 5.57% and 6.11% reduction in swelling at the same periods. Between the two groups, more significant volume reduction was observed in the affected distal limbs of patients assigned to the sodium selenite group compared to patients in the non-sodium group. However, the VAS and the SF-36 scores were not significantly different between the two groups. CONCLUSION: Sodium selenite therapy in combination with CDPT is effective in reducing the volume of upper limb in BCRL, and significantly reduce the volume of the affected distal upper limb compared to CDPT alone.

Strapping on Subluxation of the Hemiplegic Shoulder: Effects of Elasticity Difference Strapped

OBJECTIVE: To investigate the effects of elasticity difference in strapping therapy for 4 weeks in the patients with hemiplegic shoulder. METHOD: Total sixty-two patients with hemiplegic shoulder were randomly enrolled to three groups. In group I, two parts of a Y shaped first tape, were attached from humeral insertion of deltoid muscle to clavicle midline, following anterior and mid deltoid line, respectively, with 125% elasticity. And two parts of a Y shaped second tape were attached horizontally from head of greater tubercle to medial end of scapular spinous process, following supraspinatus and infraspinatus muscles, respectively, with 125% elasticity. Group II patients were applied by the tape with 100% elasticity. Group III was control. The effects of strapping therapy were evaluated by using visual analogue scale (VAS), range of motion (ROM), vertical distance (VD), horizontal distance and joint distance on radiologic findings of plain anteroposterior view and lateral distance on shoulder ultrasonography which was examined between lateral border of acromion and greater tuberosity of humeral head, at entry, 14 and 28 days later. RESULTS: Repeated measured ANOVA indicated that the all groups of the VD showed corrective effect (p<0.05). And for early 14 days, reductions of VAS between the study group I and the other groups were meaningful at this study (p<0.05). CONCLUSION: The strapping therapy is a useful therapeutic tool to decrease the degree of shoulder subluxation and to reduce pain in early rehabilitation therapy of patients with post-stroke hemiplegic subluxation.

The prevalence and risk factors of lower limb lymphedema in the patients with gynecologic neoplasms / 대한산부인과학회지

OBJECTIVE: To identify the prevalence and risk factors for lower limb lymphedema in the patients after gynecologic neoplasms treatment in Korea. METHODS: We retrospectively reviewed the medical records and interviewed 242 gynecologic neoplasms patients who have managed surgically and medically over a 4 year period between January 2003 and December 2006. We identified the patients with lower limb lymphedema as described by the medical records or reported by the interviews. We obtained demographic characteristics, other medical history, cancer type, stage of cancer, lymph node dissection, chemotherapy, radiotherapy, hormone therapy and laboratory findings. Multiple logistic regression analysis was done to evaluate the risk factors for lower limb lymphedema. RESULTS: Forty eight (19.8%) patients out of two hundred forty two had lower limb lymphedema. Those patients with lower limb lymphedema had a higher body mass index, radiotherapy history, chemotherapy history and lymph node dissection history, radical hysterectomy. Multivariate analysis revealed that body mass index, radiotherapy and lymph node dissection were independently risk factors for lower limb lymphedema after gynecologic neoplasms treatment. CONCLUSION: The patients who had radiotherapy, body mass index greater than 25 or lymph node dissection must be considered as potential candidates to have lower limb lymphedema in the patients after gynecologic neoplasms treatment. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measures, and the treatments.