Reflex sympathetic dystrophy syndrome in stroke patients with hemiplegia-three phase bone scintigraphy and clinical characteristics.

In an attempt to investigate the correlation between three phase bone scintigraphy (TPBS) and the clinical manifestation of reflex sympathetic dystrophy syndrome (RSDS) in the upper extremity of hemiplegia, we collected 30 patients with cerebral vascular accidents (CVA) confirmed by head computed tomography (infarction or hemorrhage) within 3 months of their CVA event. All patients received TPBS after admission. Clinical assessment for the development of the RSDS was done at least 3 months (268 +/- 120 days) after the stroke. The correlation between the development of RSD and certain clinical variables (including sex, age, side affected, caused of stroke, and motor stage) were analyzed. Twelve patients (40%) manifested definite or probable RSDS, as assessed by Tepperman's criteria, during the follow-up period. Nineteen patients (63%) exhibited radionuclide evidence of RSDS based on delayed bone scan criteria performed within 3 months (43 +/- 25 days) of the stroke. The positive delayed image of TPBS demonstrated a sensitivity = 92%; specificity = 56%; positive predictive value = 58%, and negative predictive value = 91%. The Kappa statistics for agreement between positive bone scan and RSDS development was 70% (Kappa = 0.43, p < 0.05). Neither sex, age, side affected, cause of stroke, or motor stage had a significant correlation with clinical RSDS. In conclusion, TPBS is a useful screening tool for the development of RSD in hemiplegic patients. However, the diagnosis of RSDS depends on the clinical evaluation and that TPBS as an adjunct assessment of RSDS must be interpreted with caution.

The prognosis of patients with cervical spondylotic myelopathy.

We studied 56 patients who received complete neurological examinations, image studies, or electrophysiological studies, and for these cervical spondylotic myelopathy was diagnosed at the Kaohsiung Medical College Hospital during the period 1988 to 1993. For the purposes of identifying possible prognosis factors and comparing the results of patients with conservative treatment versus operative treatment, we designed this study. Informed consent and a completed functional evaluation were obtained from 31 patients via physiatrist's visits. 17 patients (male = 11, female = 6) mean age 52 years old received conservative treatment and 14 patients (male = 11, female = 3) mean age 50 years old received operative treatment. For the conservative group, the average follow-up was 54 months and for the operative group, the average duration (from symptom and sign onset until operation) was 23 months. According to "The Japanese Orthopaedic Association Scale" and "The Recovery Rate Scale", we have evaluated the functional change of patients during the follow-up period and different possible prognosis factors have been analyzed. There is no significant difference in recovery rate whether patient's age is over 50 years old or whether the individual Pavlov ratio is smaller than 0.7. Interestingly, patients who received operation (anterior or posterior approach) within 18 months since symptom and sign onset were found to have a better recovery rate (p = 0.03). In our study, conservative management leads to 35% improvement and the operative management leads to 43% improvement. The results of proper cases selection and operation are superior to conservative treatment. If a patient has received a conservative treatment, routine re-evaluation is then very important for the early detection of progressive compression myelopathy signs.

The role of mucopolysaccharide induction in treatment of experimental osteoarthritis in rats by ultrasound.

Therapeutic ultrasound has been used in the treatment of osteoarthritis for the relief of symptom and improvement of functional status. In recent study, we found that ultrasound enhances cartilage repair in experimental early stage osteoarthritis, and prevents deteriorative changes in later stages. In the present study, we further investigate the bioeffects of ultrasound on cartilage matrix of experimental arthritis. Fifty-four rats with three different degrees of papain induced osteoarthritis classified by 99m-Tc pertechnetate bone scan were collected for ultrasound treatment. The changes in their arthritic severity after sonication treatment and two months after treatment were measured using 99m-Tc bone scan. The histopathological changes were evaluated through light microscope after disarticulation sections (H.E. stain), and the changes in mucopolysaccharide density in cartilage matrix were measured using a Optimas scanner analyzer after Alcian blue staining. The results showed that the density of mucopolysaccharide rose in the initial stage of induced arthritis, and decreased progressively in the later stage. The density of mucopolysaccharide increased upon complete sonication more for the treated rats than for the controls, and this was closely related with the improvement in histopathological findings, but inversely with the changes in arthritic severity. In conclusion, therapeutic ultrasound enhances mucopolysaccharide synthesis of arthritic cartilage, and results in the repair of arthritic cartilage in the early stage of induced arthritis and the prevention of deteriorative changes in later stages.

Predictors of shoulder subluxation in stroke patients.

Shoulder subluxation has been recognized as a major and frequent complication in patients with hemiplegia. It may worsen and may be associated with shoulder and extremity pain, nerve damage, and interfere with functional activities. The overall goal of this study was to examine the significant predictors of shoulder subluxation in stroke patients and to suggest a way of early prevention and management of hemiplegic shoulder subluxation. A retrospective study was performed and backward stepwise logistic regression analysis was used to analyze the available collected data. The result showed that significant predictors of hemiplegic shoulder subluxation were Brunnstrom's arm motor stage (beta = -2.480, the Wald statistic = 10.03, p = 0.0015) and arm sensory (tactile) status (beta = 1.0283, the Wald statistic = 3.93, p = 0.0474). This study supports that sensory (tactile) impairment may be a precipitating factor for hemiplegic shoulder subluxation and it may highlight the importance of both motor and sensory preventive strategies in early prevention and management of shoulder subluxation. The preventive strategies for shoulder subluxation during the acute/flaccid phase of neural recovery are also discussed in this study.

Thalamic hand: a late onset sequela of stroke and its influence on physical function after rehabilitation: two cases report.

Thalamic hemorrhage or infarction is one of the common causes of stroke. People who suffer from this type of cerebrovascular disease may develop thalamic syndrome which includes sensory disturbance, motor deficit and psychological problems. In this report, we introduce two cases of thalamic hemorrhage followed up for more than a half year after stroke. Delayed rigidity and choreodystonic type of involuntary movement over their paretic hand developed gradually. The metacarpophalangeal joints of the affected hand were kept flexed and the proximal and distal interphalangeal joints became extended. Thalamic hand is demonstrated in the appended pictures. Once the patient develops a thalamic hand, activities of daily living will be affected due to poor hand performance despite of high motor recovery stage. Early recognition and proper rehabilitation program for the patients with thalamic hand are emphasized.

[The detection of an early glomerular filtration rate change of spinal cord injury patients by renal scan].

A Technetium-99m DTPA computer-assisted renal scan and CCR studies were performed on 35 spinal cord injured patients who had been hospitalized in the rehabilitation ward of Kaohsiung Medical College Hospital for less than 6 months during the period of August 1988 to March 1990. For each patient, the glomerular filtration rate (GFR), the effective renal plasma flow (ERPF), and the filtration fraction (FF) were obtained by a renal scan. CCR was measured by conventional procedure and was corrected with body length, body weight and body surface. Least square fit linear regression analysis revealed the best correlation between GFR and CCR. Based on GFR values the renal function was classified into four grades from normal to severe damage and the change of renal function was analyzed using four corresponding factors. The results showed that the ratio of GFR impairment in early spinal injury is 48.6% (mostly mild impairment). There are not significant differences between levels of lesion, severity of injury or successfulness of bladder training by Fisher's exact test. Renal function deteriorated proportionally with age and most of those patients having the worst renal function belonged to an old age group. Thus age is also one of the major factors in renal function impairment. Single kidney function impairment was noted in two patients whose total GFR or CCR were in the normal range, which implied the characteristic of early detection of renal dysfunction by renal scan.