Quantifying the Occurrence of Shoulder Pain after Cardiac Surgery in a Cardiac Rehabilitation Population.

Purpose: The aim of this study was to identify the occurrence of shoulder pain after cardiac surgery among cardiac rehabilitation participants (CRPs) and its interaction with cardiac rehabilitation (CR). Method: This was a cross-sectional questionnaire-based study of open-heart surgery patients conducted at the midpoint of a 6-month CR programme. We measured the proportion of patients experiencing shoulder pain, onset, location, impact on rehabilitation, and pain and disability using the Shoulder Pain and Disability Index. Results: Of 70 (76% men) CRPs, 47% (33) reported shoulder pain post-surgery, with most (91%; 29 of 32) remaining symptomatic at the time of questionnaire completion, 14.6 (SD 37.9) months post-surgery. Disability and pain scores were 4.2 (SD 2.8) and 5.7 (SD 2.5), respectively (maximum score 10). Of people with shoulder pain participating in resistance training (RT; 19), 8 (42%) reported it was beneficial for shoulder pain; 7 (37%), no effect or unknown; and 4 (21%), some aggravation. Modifications to RT by programme staff were reported by 47% (8) of participants. Of those with shoulder pain, 10 (31%) reported some benefit; 20 (63%), no effect or unknown; and 2 (6%), aggravation from aerobic training. Conclusions: Almost half of the CRPs who had undergone open-heart surgery reported moderately severe and disabling shoulder pain that persisted for at least 14.6 (SD 37.9) months. Almost half the RT participants were prescribed exercise modifications with few negative effects. Shoulder pain is a significant issue after surgery, and appropriate screening is recommended for safe CR participation.

Objectif : établir l'occurrence de douleur à l'épaule après une chirurgie cardiaque chez des patients en réadaptation cardiaque (PRC) et en déterminer l'interaction avec la réadaptation cardiaque (RC). Méthodologie : étude transversale par questionnaire auprès de patients ayant subi une opération à cœur ouvert qui se trouvaient à mi-parcours d'un programme de RC de six mois. Les chercheurs ont mesuré la proportion de patients ressentant des douleurs à l'épaule, l'apparition de la douleur, son siège, ses répercussions sur la réadaptation, de même que la douleur et l'incapacité d'après le score de douleur à l'épaule et d'incapacité. Résultats : chez les 70 PRC (76 % d'hommes), 47 % (33) ont déclaré ressentir une douleur à l'épaule après l'opération, et la plupart (91 %; 29 sur 32) étaient encore symptomatiques au moment de remplir le questionnaire, 14,6 mois (ÉT 37,9) plus tard. Les scores d'incapacité et de douleur s'établissaient à 4,2 (ÉT 2,8) et 5,7 (ÉT 2,5), respectivement (score maximal de 10). Chez les personnes ressentant une douleur à l'épaule qui ont participé à un entraînement en résistance (ER; 19), huit (42 %) ont déclaré ce type d'entraînement bénéfique, sept (37 %) ont trouvé qu'il n'avait aucun effet ou que cet effet était inconnu et seulement quatre (21 %) ont constaté une certaine aggravation. De plus, 47 % des participants (8) ont indiqué que le personnel du programme avait modifié l'ER. Chez ceux qui ressentaient une douleur à l'épaule, dix (31 %) ont déclaré que l'entraînement aérobique procurait certains avantages, 20 (63 %) ont trouvé qu'il n'avait aucun effet ou que cet effet était inconnu et seulement deux (6 %) ont signalé une aggravation. Conclusion : près de la moitié des PRC qui ont subi une opération à cœur ouvert ont déclaré une douleur à l'épaule modérément grave et incapacitante qui a persisté au moins 14,6 mois (ÉT 37,9). Près de la moitié des participants à un ER se sont fait prescrire des modifications aux exercices et en ont ressenti peu d'effets négatifs. La douleur à l'épaule est un problème important après l'opération. Un dépistage approprié est recommandé pour assurer une participation à la RC en toute sécurité.

Factors Facilitating the Implementation of Church-Based Heart Health Promotion Programs for Older Adults: A Qualitative Study Guided by the Precede-Proceed Model.

PURPOSE: To describe the factors facilitating the implementation of heart health promotion programs for older adults in Anglican, United, and Catholic churches. DESIGN: The study used qualitative methods comprising semistructured interviews and focus groups. SETTING: The interviews and focus groups were conducted in Anglican, Catholic, and United churches located in the Canadian cities of Toronto and Hamilton, Ontario. PARTICIPANTS: Twelve ordained pastors and 21 older parishioners who attended church regularly and who had no health conditions were recruited to best explain how churches could be suitable locations for health promotion activities targeting older adults. METHODS: Twelve semistructured interviews with the pastors and three focus groups with the 21 parishioners were undertaken. A component of the Precede-Proceed model (a model for planning health education and health promotion programs and policies) was applied to the findings after direct content analysis of the data. RESULTS: Participants identified pastor leadership, funding for a parish nurse, community-focused interventions, secured infrastructure, and social support from congregation members as pertinent factors required for implementing health promotion programs in Anglican, United, and Catholic churches. CONCLUSION: The findings have particular relevance for health promotion and public health because they suggest factors that would be necessary to design church-based heart health promotion programs for older adults at risk of chronic diseases.

[The clinical effect of low-dose FP (5-FU + low-dose CDDP) in patients with far advanced gastric cancer, and their quality of life].

Low-dose FP therapy was carried out in 30 patients with far advanced gastric cancer and assessed according to anti-tumor effect and quality of life (QOL). This therapy consisted of CDDP (3.5-7 mg/m2/day infused on Days 1-5 every week) and continuous infusion of 5-FU (250 mg/m2/day for 28 days). A partial response was observed in 15 cases, so the overall response rate was 50%. The response rates with stomach and lymph node cancers were higher than those of other organs (64.3% and 55.6%). Patients without peritoneal dissemination, with good performance status (PS) (0, 1) and differentiated histologic type showed a significantly higher response rate than patients with peritoneal dissemination, poor PS (2, 3, 4) and undifferentiated histologic type (p = 0.0034, 0.0253, 0.0080). No side effects (> or = WHO grade 3) were observed. The QOL of patients was assessed according to the percentage of patients with an observed improvement of diet, who could be discharged from hospital, and the duration in hospitals in relation to survival time (hospital stay). The QOL of patients with low-dose FP therapy was better than that of patients with usual combination chemotherapy. Low-dose FP therapy is a promising regimen for patients with far advanced gastric cancer.

[Changes in the sleep-wakefulness cycle in experimental Parkinson's syndrome]. / Izmeneniia tsikla bodrstvovanie-son pri éksperimental'nom parkinsonicheskom sindrome.

It was demonstrated in rat experiments that in modelling the akinetico-rigid parkinsonian syndrome by injecting kainic acid into the caudate nuclei the phases of wakefulness and light slow-wave sleep decreased while the phase of deep slow-wave sleep increased. In the tremorogenic from of the parkinsonian syndrome induced by reserpine the phases of wakefulness and deep slow-wave sleep decreased in the rats while the phases of light slow-wave and paradoxical sleep increased. In destruction of the substantia nigra with kainic acid the phase of paradoxical sleep reduced. The results of the study are discussed from the standpoint of the generator mechanisms of the development of neuropathological syndromes and the mechanisms of the interrelations of parkinsonism and epilepsy.

[Effects of extracts of different parts of the brain of kindled animals on seizure activity of recipient rats]. / Vliianie ékstraktov razlichnykh otdelov mozga kindlingovykh zhivotnykhna sudorozhnuiu aktivnost' krys-retsipientov.

The peptide-containing fraction was emitted from the hippocampal and ventral mesencephalic region tissue of rats kindled with subconvulsant doses of corazol. Extracts were prepared by the help of hot acetic acid on the stage of generalized clonic-tonic seizure development. The intraventricular injection of VMR-extracts in relatively high dose increased seizure reactions which were induced in intact recipient rats by intraperitoneal corazol injection. The intraventricular injection of the extract in relatively low dose (100 times less) suppressed corazol-induced seizures in recipients. Data are discussed from the point of view of pathological epileptic system formation and the role played by peptides in supporting it's activity during pharmacological kindling.

[Effect of the destruction and activation of the caudate nuclei on the convulsive action of corazol kindling]. / Vliianie razrusheniia i aktivatsii khvostatykh iader na sudorozhnye éffekty korazolovogo kindlinga.

Chronic experiments on the rats have shown that the pharmacological destruction of caudate nuclei significantly elevates the general brain excitation and induces rapid development of the corazol kindling. The hippocampal destruction exerts an opposite effect. Regression analysis of this processes has shown that mechanism of the general brain excitation and those of epileptogenesis are different on the stage of the developing kindling. Caudate nucleus activation induces powerful inhibition of kindling behavioral convulsive reactions and its electrographic epileptic activity. These data suggest that the caudate nucleus is a significant structure of the antiepileptic brain system and confirm G. N. Kryzhanovsky's concept about the system-antisystem interrelationship in case of neuropathologic syndromes as a result of the system hyperactivity.

[The role of the substantia nigra in the anticonvulsive and antiaggressive effects of diazepam during pharmacological kindling]. / Rol' chernoi substantsii v protivosudorozhnykh i antiagressivnykh éffektakh diazepama pri farmakologicheskom kindlinge.

The seizure activity was investigated on the model of pharmacological kindling which was induced by repeated picrotoxin injections in the subthreshold dose, after the tryptic fragment of T5 protein-human diazepam binding inhibitor (DBI) (10 micrograms) injection into a reticular part of substantia nigra. An increase in the seizure reaction and suppression of the antiseizure diazepam action were observed. Intranigral DBI injection induced no change in a threshold of "attacks" in rats which were induced through electric shocks delivered to animals with an electrode floor and no changes in antiaggressive diazepam action were observed under such conditions.

[Binding of K-18 on the surface of tumor cells--flowcytometrical analysis in vitro].

After K-18 was contacted with various kinds of tumor cell lines in vitro, the binding pattern was examined. K-18 bound on the surface of K-562 cells showed the maximum levels 1 hr later and maintained the binding activity for 24 hrs in the analysis by flowcytometry. K-18 also bound to HeLa S3, KB, RPMI8226, P815, YAC-1 and L1210 cells. Fluorescent intensity on K-562 cells was stronger with whole molecules of K-18 than with F(ab')2 conjugated with melphalan. Normal human IgG could bind more on the surface of K-562 cells than F(ab')2 of IgG. These results suggest that K-18 might bind on tumor cells via IgG Fc receptors on their surface.

[Development of motor and emotional disorders in rats during daily administration of subliminal doses of picrotoxin]. / Formirovanie dvigatel'nykh i émotsional'nykh rasstroistv u krys pri ezhednevnom vvedenii pikrotoksina v podporogovi doze.

It was shown in the experiments on rats, that three neuropathological syndromes develop as a result of daily subthreshold picrotoxin injections (1.25 mg/kg). Maximal expression of syndromes was different during various periods of kindling. The development of seizure syndrome was followed by prevalence of enhanced electrical activity in hippocampus; the development of "akinetic" syndrome was the same in the caudate nuclei. Data are discussed on the positions of theory of the generator, determinant and systemic mechanisms of neuropathological syndromes.

[Metabolic characteristics of the myocardium and muscle tissue of the thigh in rats]. / Metabolicheskie osobennosti myshechnoi tkani serdtsa i bedra u krys.

Myocardium and skeletal muscle of white rats have a number of specific features in metabolism of carbohydrates. The skeletal muscle is characterized by high intensity of glycolytic processes and glycolytic substrate phosphorylation, that is testified to by the activity of the terminal glycolysis stage enzymes (pyruvate kinase, lactate dehydrogenase, its isoenzyme spectrum) and by the content of lactate and pyruvate metabolites. In contrast to skeletal muscles, the activity of NAD-dependent malate dehydrogenase in the myocardium is significant both in cytoplasm and in mitochondria. This activity corresponds to a high level of malate and oxaloacetate metabolites and to the activity of NADP-dependent malate dehydrogenase, playing a connective role between glycolysis, the cycle of tricarboxylic acids and glyconeogenesis. Phosphoenolpyruvate carboxykinase, catalyzing the transformation of cytoplasmatic oxaloacetate into phosphoenolpyruvate is more active in the skeletal muscles where the intensity of the tricarboxylic acids cycle reactions is lower and the activity of glycolysis is higher than that of myocardium.

[Effect of delta sleep-inducing peptide, anticonvulsant preparations and nicotinamide on generalized seizure activity]. / Vliianie del'ta-sonindutsiruiushchego peptida, protivosudorozhnykh preparatov i nikotinamida na generalizovannuiu sudorozhnuiu aktivnost'.

The influence of delta-sleep inducing peptide (DSIP) upon seizures induced by corazol, bicuculline, picrotoxin, strychnine, thiosemicarbazide were investigated in experiments on F1(CBA X C57 BL/6) mice. It was shown that DSIP increased the latency of first seizure manifestation which were induced by corazol, bicuculline and picrotoxin and also resulted in a suppression of seizure severity of corazol and bicuculline induced seizures. Anticonvulsant action of DSIP was evident under the condition of the mild severity seizures development. The effect of DSIP was mostly pronounced in range of its doses from 10 to 100 mcg/kg. DSIP when combined with phenobarbital, carbamazepine, diphenylhydantoin or nicotinamide enhanced the antiepileptic effects of these anticonvulsant drugs.

Treatment of malignant ascites and pleurisy by a streptococcal preparation OK-432 with fresh frozen plasma--a mechanism of polymorphonuclear leukocyte (PMN) accumulation.

A single injection of a streptococcal preparation, OK-432, with fresh frozen plasma (FFP) (or fresh human serum) into the peritoneal or pleural cavity for the treatment of malignant ascites or pleurisy resulted in a complete reduction of ascitic fluid or pleural effusion in 5 out of 11 patients. FFP was used a further source of complement for the effective accumulation of antitumor polymorphonuclear leukocytes (PMNs) by complement-derived chemotactic factors in the cavity. C5a increased in the fluids 3-9 h after the injection and preceded a massive increase in PMNs. C1 inhibitor (C1INH) and C3b inactivator (C3bINA) decreased in several cases 6 h after the treatment. Chemotactic arachidonic acid metabolites, thromboxane B2(TXB2) as a characteristics of TXA2, and leukotriene B4(LTB4) also increased at the same time even in cases where C5a changed only minimally, and may play a role in accumulating antitumor PMNs in the cavity.

[Microcarcinoma of the pancreas: report of a case].

A 53-year-old man complaining of vertigo initially consulted a nearby hospital. While undergoing a medical examination, which included abdominal ultrasonography and a CT scan, a dilatation of the pancreatic duct was found. The patient was then admitted to our hospital for a more thorough examination. Laboratory findings revealed an elevated elastase-1 level and a DM-pattern of 75 g-OGTT. ERP showed a localized constriction in the main pancreatic duct and diffuse dilatations of the distal main duct. A cytologic examination revealed no malignant cells in the pancreatic juice. Even so, though a carcinoma was not confirmed, a pancreaticoduodenectomy was performed, since a carcinoma of the pancreas head was suspected. A histological examination of the resected specimen uncovered a nonfunctioning islet cell carcinoma, 8 mm in diameter. This case was considered fortunate, in that an early stage pancreatic cancer, adjacent to the main duct, had been detected by imaging diagnoses.

[The effect of delta sleep-inducing peptide on the convulsive activity in corasol kindling]. / Vliianie peptida del'ta sna na sudorozhnuiu aktivnost' pri korazolovom kindlinge.

The influence of intraperitoneal delta-sleep inducing peptide (DSIP) injection (100 micrograms/kg) on the epileptic activity was investigated in the experiments on Wistar rats and (CBA X C57B1/6)F1 mice. The model of chronically developing epileptic activity--the model of pharmacological kindling--was created by daily repeated corasole injections in subconvulsive doses (30 mg/kg). It has been shown that DSIP injection delayed the manifestation of generalized seizures during kindling, led to the suppression of seizure activity and reduced the mortality rate of animals that developed kindled seizures. The antiepileptic effect of DSIP was observed throughout the period of 5 minutes to 24 hours after the injection. Naloxone (2.5 mg/kg) did not change the antiepileptic effect of DSIP.