OBJECTIVES: To investigate the effects of Computerized Neuropsychologic Test (CNT) on cognitive function and daily life performance in subacute post-stroke patients with cognitive impairment. METHODS: Korean Mini-Mentals State Examination (K-MMSE), Korean version of Modified Barthel Index (K-MBI) were investigated in 125 subacute post-stroke patients with cognitive impairment. We analyzed K-MMSE and K-MBI which were conducted 63 patients who had received CNT and 62 patient who had not received CNT from baseline to 8 weeks follow-up. In the experimental group, initial K-MMSE and K-MBI were conducted 13.3 ± 6.8 weeks after the onset of stroke and their age was 63.4 ± 13.3. In the control group, initial K-MMSE and K-MBI were conducted 13.2 ± 7.7 weeks after the onset of stroke and their age was 65.1 ± 11.6. RESULTS: The 8 weeks follow-up total K-MMSE score and total K-MBI score of experimental group were significantly higher than control group (P < 0.05). In K-MMSE subsection, orientation, judgement, recall, language & visual reconstruction were significantly higher in experimental group than control group (P < 0.05). In K-MBI subsection, personal hygiene, bathing self, toilet, dressing, ambulation, chair/bed transfer were significantly higher in experimental group than control group (P < 0.05). The change of total K-MMSE score of experimental group was significantly correlated with change of total K-MBI score (P < 0.05), but control group was not (P > 0.05). In K-MMSE subsection, change of orientation, registration, language and visual reconstruction were correlated with total K-MBI s core after CNT. Especially, the experimental group, total K-MBI score of the left hemisphere damage group was significantly higher than the right hemisphere damage group (P < 0.05). CONCLUSIONS: This study shows that CNT is effective on subacute post-stroke patients with cognitive impairment. Improvement of cognitive function can expect a positive outcome on daily life performance, in particular, it can be expected to improve the prognosis of patients with stroke, the left hemisphere lesions.
Bandages ; Baths ; Cognition ; Cognition Disorders* ; Cognitive Therapy ; Follow-Up Studies ; Humans ; Hygiene ; Neuropsychological Tests* ; Prognosis ; Stroke ; Walking

Postoperative visual loss is a rare complication of general anesthesia in patients undergoing lung surgery. If the visual complication is permanent, it can greatly affect the patient's quality of life. Posterior reversible encephalopathy syndrome (PRES) leads to visual disturbances and may be associated with hypertension, renal disease, eclampsia, and chemotherapy. Although PRES is usually reversible, delayed diagnosis and treatment can result in permanent damage. We herein report a case of PRES in a patient with no medical history. The patient's symptoms included somnolence, visual loss, and headache. He was treated with conservative therapy, and his vision abruptly recovered three days after surgery. He was discharged from the hospital without neurologic complications 13 days after surgery.
Anesthesia, General ; Blindness ; Delayed Diagnosis ; Drug Therapy ; Eclampsia ; Female ; Headache ; Humans ; Hypertension, Renal ; Lung* ; Posterior Leukoencephalopathy Syndrome* ; Pregnancy ; Quality of Life

BACKGROUND: Laparoscopic appendectomy (LA) is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. We expected that dexmedetomidine would compensate for the problems arising from spinal anesthesia alone. Thus, we performed a feasibility study of spinal anesthesia with intravenous dexmedetomidine infusion. METHODS: Twenty-six patients undergoing LA received spinal anesthesia with intravenous dexmedetomidine infusion. During surgery, the patient's pain or discomfort was controlled by supplemental fentanyl or ketamine injection, and all adverse effects were evaluated. RESULTS: No patient required conversion to general anesthesia, and all operations were completed laparoscopically without conversion to open surgery. Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine. Bradycardia occurred in seven (26.9%) patients. CONCLUSIONS: Spinal anesthesia with dexmedetomidine infusion may be feasible for LA. However, additional analgesia, sedation, and careful attention to the potential development of bradycardia are needed for a successful anesthetic outcome.
Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Appendectomy* ; Bradycardia ; Conversion to Open Surgery ; Dexmedetomidine* ; Feasibility Studies ; Fentanyl ; Humans ; Ketamine

BACKGROUND: Laparoscopic appendectomy (LA) is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. We expected that dexmedetomidine would compensate for the problems arising from spinal anesthesia alone. Thus, we performed a feasibility study of spinal anesthesia with intravenous dexmedetomidine infusion. METHODS: Twenty-six patients undergoing LA received spinal anesthesia with intravenous dexmedetomidine infusion. During surgery, the patient's pain or discomfort was controlled by supplemental fentanyl or ketamine injection, and all adverse effects were evaluated. RESULTS: No patient required conversion to general anesthesia, and all operations were completed laparoscopically without conversion to open surgery. Seventeen (65.4%) patients required supplemental injection of fentanyl or ketamine. Bradycardia occurred in seven (26.9%) patients. CONCLUSIONS: Spinal anesthesia with dexmedetomidine infusion may be feasible for LA. However, additional analgesia, sedation, and careful attention to the potential development of bradycardia are needed for a successful anesthetic outcome.
Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Appendectomy* ; Bradycardia ; Conversion to Open Surgery ; Dexmedetomidine* ; Feasibility Studies ; Fentanyl ; Humans ; Ketamine

Tracheo-innominate artery fistula (TIAF) is rare, yet the most fatal complication after tracheostomy. In the absence of immediate diagnosis and surgical management, the mortality rate is very high, because the complication can lead to sudden massive tracheal hemorrhage. Tracheal obstruction and hypovolemic shock are the major life threatening conditions. The 46-year-old woman received tracheostomy tube insertion after stroke. Three months later, there was occurrence of active bleeding at the site of tracheostomy in the patient, who participated in comprehensive rehabilitation program. Immediately, the patient received an endotracheal tube insertion into the tracheostomy site and thus massive bleeding was controlled. The patient was transferred to the intensive care unit, where her breathing was maintained by mechanical ventilation. Based on computed tomography and laryngoscopy, no remarkable findings about TIAF were detected. Nevertheless, transfemoral angiography findings revealed that innominate artery made small luminal outpouching to trachea at the carotid artery and at the subclavian artery bifurcation level, based on which a diagnosis of TIAF was made. She had an operation for TIAF, tracheoplasty with bypass graft. Subsequently, she was discharged after 15 weeks. In the present report, we describe a case of TIAF, which can occur in the patients with tracheostomy tube during rehabilitation.
Angiography ; Arteries ; Brachiocephalic Trunk ; Carotid Arteries ; Female ; Fistula ; Hemorrhage ; Humans ; Intensive Care Units ; Laryngoscopy ; Phenobarbital ; Respiration ; Respiration, Artificial ; Shock ; Stroke ; Subclavian Artery ; Trachea ; Tracheostomy ; Transplants

OBJECTIVE: To estimate hours of leisure time physical activity (LTPA) performed by people with chronic spinal cord injury (SCI) and to identify the demographic and injury-related characteristics associated with LTPA of people with chronic SCI. METHOD: Seventy nine persons with SCI living in Busan and Gyongsangnam-do were recruited. They completed a self-administered questionnaire, which consisted of items about personal characteristics, type of LTPA, hours of LTPA, LTPA intensity, and LTPA satisfaction. RESULTS: Most participants (92.4%) did not work. The respondents reported a daily mean of 3.13 hours (+/-1.47) of LTPA; however, 3.8% reported no LTPA whatsoever. Years post-injury, income sources, and type of medical payment emerged as a predictors of LTPA. Years post-injury were positively correlated with amount of leisure activity. In the case of self income, LTPA was longer than for groups with different income sources (e.g.partner, parents). For patients receiving workers' compensation insurance, LTPA was longer than for patients receiving non-WC insurance. Most LTPA was done at a moderate intensity. The three most frequently reported types of LTPA were wheeling (26%), sports (19%), and stretching exercise (15%). There was overall dissatisfaction with LTPA. CONCLUSION: Daily LTPA hours were longer than previously reported, but wheeling accounted for a large part of the activity. Intensity of activity was generally moderate. The employment rate was very low. Clearly, participating in regular LTPA for health purposes is very important to people with chronic SCI, but it is also important for them to have jobs.
Surveys and Questionnaires ; Employment ; Humans ; Insurance ; Korea ; Leisure Activities ; Motor Activity ; Spinal Cord ; Spinal Cord Injuries ; Sports ; Workers' Compensation ; Surveys and Questionnaires

Extensive visceral vein thrombosis, including the femoral vein, iliac vein, superior mesenteric vein, splenic vein and portal vein, is an uncommon type of thrombosis that is associated with significant mortality and morbidity. Making an early diagnosis and adequate management are very important. We present here the case of a 39-year-old woman with extensive visceral vein thrombosis and complicated small bowel necrosis and perforation. She had no known prothrombotic conditions, but the laboratory findings showed an elevated level of factor VIII. The patient's condition improved without complication after resection of the infarcted and perforated small bowel along with immediate postoperative anticoagulant therapy. On the follow up, the size of the thrombosis was decreased and there was no complication.
Adult ; Early Diagnosis ; Factor VIII ; Female ; Femoral Vein ; Follow-Up Studies ; Humans ; Iliac Vein ; Mesenteric Veins ; Necrosis ; Portal Vein ; Splenic Vein ; Thrombosis ; Veins ; Venous Thrombosis

OBJECTIVE: To investigate the effect of taping therapy on hemiplegic shoulder subluxation. METHOD: Sixty patients were randomly assigned to three groups. In study group, two parts of the first tape was shaped as letter Y and were attached from humeral insertion of deltoid muscle to extension line of the clavicle midline, following anterior and middle deltoid line, respectively, with 125% elasticity. And two parts of the second tape as same as the first tape were attached horizontally from head of greater tubercle to medial border of scapular, following supraspinatus and infraspinatus muscles, respectively, with 125% elasticity. The placebo group was applied by the tape with 100% and 150% elasticity and control group was not applied. The effects of strapping were evaluated by using visual analogue scale (VAS), passive range of movement (ROM), vertical distance (VD) and horizontal distance (HD) on radiologic findings of plain anteroposterior (AP) view and lateral distance (LD) on shoulder ultrasonography at entry (day 0), 1 and 2 days later. RESULTS: Repeated measured analysis of variances indicated that the study group showed corrective effect in the VAS (p<0.05). The control and placebo groups showed no significant change in any parameters of distance measurements and clinical findings. In every group, spasticity, MMT and Brunnstrom stage were not changed during study. CONCLUSION: The taping therapy with 125% elasticity may be helpful for patients with hemiplegic shoulder to reduce pain.

OBJECTIVE: To evaluate the autonomic nervous function in post-stroke patients. METHOD: A total of 58 subjects, 34 post-stroke patients (mean age of 61.35 years) and 24 healthy subjects (mean age of 34.42 years) were included. The sympathetic skin response (SSR), the R-R interval variation (RRIV) and orthostatic hypotension (OH) were evaluated. Bilateral sympathetic skin responses were recorded on the palm and sole with stimulation of both median and tibial nerves. The obtained SSRs were divided into normal response and abnormal response including no response. The R-R interval variations were estimated during rest, deep breathing and Valsalva maneuver respectively. RESULTS: In all healthy subjects, obtained SSRs were of normal response. Although the rate of abnormal SSR was 75.4% (205 of 272 waves) in stroke patients, the rate of abnormal SSR on affected side (81.6%, 111 of 136 waves) was significantly higher than unaffected side (69.1%, 94 of 136 waves) (p<0.05). The rate of abnormal SSR according to OH was not significantly different (with OH 75.0%, without OH 75.6%) (p>0.05). The RRIV of stroke patients with OH (1.09+/-0.06) was significantly lower than in control (1.14+/-0.05) during rest (p<0.01), and in stroke patients without OH, the RRIV (1.13+/-0.06) was also significantly lower than in control (1.27+/-0.22) during Valsalva maneuver (p<0.01). CONCLUSION: Evaluation of SSR and RRIV could be helpful in detecting dysfunction of autonomic nervous system in post-stroke patients.
Autonomic Nervous System ; Humans ; Hypotension, Orthostatic ; Respiration ; Skin ; Stroke ; Tibial Nerve ; Valsalva Maneuver

OBJECTIVE: To identify the etiology of hemiplegic shoulder pain by magnetic resonance (MR) arthrography. METHOD: The study included seventy-four hemiplegic patients with shoulder pain. After several physical examinations, all patients had fluoroscopically guided injection by a physiatrist with a maximum of 12~15 ml of contrast agent. Then T1-weighted, T2-weighted and fat-suppressed T1-weighted images were taken at the oblique coronal plane. In addition, fat-suppressed T1-weighted images were obtained at the oblique sagittal and oblique coronal plane. RESULTS: Except for the 9 patients who did not finish the study, the mean age of the participants was 61.5+/-8.9 years and mean duration of the cerebrovascular accident (CVA) was 15.7+/-9.7 weeks. The findings were as follows: 40% supraspinatus tendinitis, 30.8% superior labrum anterior to posterior (SLAP) lesion, 29.2% adhesive capsulitis, 24.6% supraspinatus partial tear, 23.1% biceps tendinitis, 13.8% supraspinatus full thickness tear, 7.7% infraspinatus partial tear. The SLAP lesion had significant statistic relationship with biceps tendinitis (p<0.05) but not with rotator cuff lesion. CONCLUSION: We found that causes of hemiplegic shoulder pain were various. The prevalence of the SLAP lesion was high (30.8%). We recommend the MR arthrography when the hemiplegic shoulder pain does not improve by conventional therapy or the cause of the pain is uncertain.
Arthrography ; Bursitis ; Humans ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Physical Examination ; Prevalence ; Rotator Cuff ; Shoulder ; Shoulder Pain ; Stroke ; Tendinopathy