Factors associated with health-related quality of life for adults with stroke sequelae / Fatores associados à qualidade de vida relacionada à saúde de adultos com sequelas de AVC

OBJECTIVE: To assess health-related quality of life (HRQoL) among adults with stroke sequelae and to identify the factors that influenced the domains of HRQoL. METHOD: The subjects were adults with stroke who were admitted to a rehabilitation program between March and August 2008. They were investigated using the following instruments: Medical Outcomes 36-Item Short-Form Health Survey (SF-36), Functional Independence Measure (FIM) and Beck Depression Inventory (BDI). Sixty-four adults of mean age 58.8 years were evaluated. RESULTS: The individuals who had had their injuries for longer times and who were more independent and younger had better HRQoL regarding physical functioning. Social participation was associated with better HRQoL, and there was a difference between groups with and without depressive symptoms. CONCLUSION: HRQoL was compromised primarily with regard to functional characteristics. Moreover, the presence of depressive symptoms contributed towards a decline in HRQoL. Rehabilitation needs to focus on improving functionality and social participation, which may stimulate reductions in depressive symptoms and improvement of HRQoL.

OBJETIVO: Avaliar a qualidade de vida relacionada à saúde (QVRS) de adultos com sequelas de acidente vascular cerebral (AVC) e identificar os fatores que influenciam os domínios da QVRS. MÉTODO: Adultos com AVC admitidos para programa de reabilitação de março a agosto de 2008, investigados com os seguintes instrumentos: SF-36, Medida de Independência Funcional e Inventário de Depressão de Beck. Foram estudados 64 adultos, média de idade de 58,8 anos. RESULTADOS: Os indivíduos com maior tempo de lesão, mais independentes e jovens tiveram melhor QVRS na capacidade funcional. Participação social foi associada com melhor QVRS, e houve diferença entre os grupos com e sem sintomas depressivos. CONCLUSÃO: QVRS foi comprometida principalmente em seus aspectos funcionais. Por outro lado, a presença de sintomas depressivos contribuiu para a piora da QVRS. A reabilitação deve buscar a melhora da funcionalidade/participação social, o que pode contribuir na redução de sintomas depressivos e a melhora da QVRS.

MRI findings in the painful hemiplegic shoulder.

AIM: To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. MATERIALS AND METHODS: Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. RESULTS: Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. CONCLUSIONS: Adhesive capsulitis was found to be a possible cause of PHS.

Wound healing of laparoscopic esophageal myotomy with or without an added gastric patch.

BACKGROUND: The purpose of this research is to compare the wound healing of the laparoscopic esophagomyotomy with and without a gastric patch. METHODS: Twelve male pigs were distributed into two groups of six animals. Esophagomyotomy was performed in group A. A gastric patch was associated to the myotomy in group B. On the 21st postoperative day, lumen molding was accomplished to determine the index of stenosis (IS) at the area of myotomy (AM). Macroscopic and microscopic aspects of wound healing were also studied at AM. Three microscopic morphologic patterns were defined for morphometric evaluation: leukocytes (constituted by polymorphonuclear and mononuclear cells), new endothelial cells, and collagen fibers. RESULTS: There was a longer operative duration in group B (93.6 min) than in group A (45 min). At AM, IS was negative (lumen increased) and equivalent in both groups: -11.1% in group A and -12.7% in group B. Mesotelial epithelium covering RM was observed in group A. Inflammatory reaction was greater in group B in comparison with group A (leuCocytes: 22 cells versus 8.6; fibrosis: 25.5 fibers versus 15.6; granulation tissue: 18.7 vessels versus 9.7). CONCLUSION: Esophagomyotomy followed by gastric patch does not heal adequately and is worsened by the presence of foreign body granulomas around stitches. Myotomy without gastric patch is faster and causes lower inflammation. Myotomy alone or with gastric patch does not lead to esophageal stenosis at RM and does not lead to restoration of the esophageal musculature continuity.