Clinical Outcomes of Conservative Treatment and Arthroscopic Repair of Rotator Cuff Tears: A Retrospective Observational Study

OBJECTIVE: To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear. METHODS: In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments. RESULTS: A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear.

Rehabilitation Strategy to Improve Physical Function of Oldest-Old Adults

In recent, oldest-old adults over 85 years are increasing rapidly. Major geriatric problems such as frailty, fall, osteoporosis, sarcopenia, gait disturbance in this population are higher prevalent and more severe than those in older adults under 85 years. Therefore, strategy to evaluate and manage them with combined medical problems and related impairments should be considered to prepare for super aged society in the near future. We introduced comprehensive geriatric physical performance battery to examine a variety of physical function in multidomains, which can be applied to prescribe exercise, nutrition and medications as single or combined therapy specific to the level of physical function. It would be desirable that modality-specific exercise intervention to prevent from functional decline of oldest-old adults will be integrated with clinical setting. Eccentric biased strengthening exercise is highlighted as an appropriate exercise intervention for sarcopenic oldest-old because of low energy expenditure and utilization of the aged muscle stiffness. Furthermore, specially designed exercise machines enabling them to do exercise are developed for severe deconditioned patients that can't participate in the conventional strengthening exercise. Oldest-old adults are expected to become a major patient group in geriatric medicine sooner or later. Basic principles of management for oldest-old adults are not different from geriatric management of frailty and sarcopenia in general old population. Along with the assessment of the multidomain of physical parameters, multidimensional modality-specific interventions should be developed based on each individual physical profiles.

Percutaneous Endoscopic Gastrostomy Versus Percutaneous Radiologic Gastrostomy: A Comparison of Complications in Brain Injured Patients

OBJECTIVE: To compare complications of percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) in brain injured patients. METHOD: The records of brain injured patients who received either PEG or PRG between January 2001 and July 2008 in Busan paik hospital were reviewed retrospectively. Documented complications (infection, leakage, blockage/delayed feeding, aspiration pneumonia, tube displacement, pain, ileus, bleeding, tube fell/pulled out, bradycardia/hypotension) were recorded and compared. RESULTS: There were 44 brain injury patients with dysphagia. All patient received PEG or PRG successfully. (32 PEG, 12 PRG) The incidences of complications were 50% in both PEG group (16 in 32) and PRG group (6 in 12). In PEG group sixteen patients developed complications, 27 minor and two major. In PRG group six patients developed complications, 11 minor and one major. The most common complication of PEG was wound infection (37.9%). But there were no wound infection in PRG group. And there were no deaths in both PEG and PRG group. CONCLUSION: Both endoscopic and radiologic gastrostomy tube placements are safe and effective methods. But in high infection risk group such as old ages, DM or CRF patients who have brain injury with dysphagia, PRG is safer method than PEG.

Changes of Autonomic Nervous Function after Foot Bathing in Normal Adults

OBJECTIVE: To monitor the changes of autonomic nervous function before and after foot bathing through autonomic function tests using electrophysiological instrument. METHOD: Twenty five healthy adults took a foot bathing through popular 'foot bath' for 30 minutes at 43degrees C. Autonomic tests were performed three times before foot bathing, immediately and 15 minutes after foot bathing. Sympathetic skin response (SSR) and blood pressure after sustained grip for sympathetic tone, heart rate variation during deep breathing and Valsalva maneuver for parasympathetic tone (Expiratory/Inspiratory (E/I) ratio, Valsalva ratio) were measured. RESULTS: SSR amplitudes in one hand decreased significantly during foot bathing (p0.05). CONCLUSION: Heat therapy through foot bathing in normal adults reduced sudomotor response to electrical stimuli, which can be considered as reduction of specific sympathetic nervous function. We propose that foot bathing could be promising one of partial heat therapies for pain without cardiovascular complications unlike conventional whole body bathing.

The Effect of Cognitive-behavioral Characteristics on Depression of Caregivers in Brain-injured Patients

OBJECTIVE: To evaluate the relationship between depression and cognitive-behavioral characteristics of caregivers using social problem solving inventory (SPSI), social support or conflict scale (SSS or SCS) and somatic symptoms (SS). METHOD: Fifty five couples of brain-injured patients and caregivers participated in this study. We conducted a questionnaire survey of caregivers with Beck depression index (BDI), SPSI, SSS, SCS and SS for cognitive-behavioral characteristics. And also we studied demographic factors of patients and caregivers, clinical features of brain-injured patients, care- giving duration and time per day through interview and review of medical records. The statistical analyses were performed by independent t-test, one-way ANOVA, Pearson correlation test and linear regression analysis-stepwise method. RESULTS: BDI of the caregivers showed a negative correlation with SPSI, SSS, patients' MMSE and caregivers' education level, also a positive correlation with SCS, SS and patients' GDS (p<0.05). And married caregivers showed more depressive mood (p<0.05). Of these factors, the most influencing factors on BDI were GDS and SCS through linear regression analysis (p<0.01). CONCLUSION: MMSE, GDS and education level as cognitive- mental factors rather than physical and economic strain had a statistical correlation with depression of caregivers. Especially, SPSI, SSS and SCS as cognitive-behavioral characteristics should be considered on evaluation of depression of caregivers and will be helpful for successful rehabilitation for patients and caregivers.

Striatal Hand in Traumatic Brain Injury: A case report

Striatal hand is characterized by flexion in metacarpopharyngeal (MCP) joints and hyperextension in proximal interphalangial (PIP) joints and flexion in distal interphalangeal (DIP) joint. In clinical practice, this problem is often overlooked or misdiagnosed as rheumatoid arthritis and the opportunity for an early diagnosis and a correct management of the patient's is missed. In this report, a case with striatal hand following traumatic brain injury (TBI) without cardinal Parkinsonian signs is presented, and the differential diagnosis of the disease is discussed. A-62-year-old man presented with hemiplegia subsequent to traumatic brain injury. During the last two years, "swan neck" deformity of the hands occurred. We could diagnose this case as striatial hand with exclusion of similar rheumatologic causes by careful study and its characteristic deformity pattern. Clinician should consider the possibility of striatal hand when the patient with TBI presents swan neck deformity for an early diagnosis and a correct management.