Cheng-Chiang Chang

Short-term effects of self-massage combined with home exercise on pain, daily activity, and autonomic function in patients with myofascial pain dysfunction syndrome.

[Purpose] The aim of the present was to investigate the short-term effects of a program combining self-massage and home exercise for patients with myofascial pain dysfunction syndrome (MPDS). [Subjects and Methods] In this retrospective study, 63 patients were allocated to the experimental (n = 32) and control (n = 31) groups. Both groups received 6 sessions of treatment with physical modalities over the course of two weeks. The experimental group completed an additional program with a combination of self-massage and home exercise. The outcome measurements included a pain scale, pressure pain threshold (PPT), neck disability index (NDI), patient-specific functional scales (PSFS), and heart rate variability (HRV). The interactions between the groups and over time were analyzed using two-way repeated measures ANOVA. [Results] Only the experimental group demonstrated significant improvements in the pain scale with varying conditions. The PPTs of the trigger points increased significantly in the experimental group, and significant functional improvements in NDI and PSFS were observed in the same group. There were significant increases in high-frequency HRV and high-frequency % in the experimental group. [Conclusion] Treatment with physical modalities plus combination of self-massage and home exercise is more effective than the physical modalities treatment alone.

Cerebellar diaschisis and contralateral thalamus hyperperfusion in a stroke patient with complex regional pain syndrome.

We present a right-hemispheric stroke patient with complex regional pain syndrome (CRPS). The regional cerebral blow flow (rCBF) as determined using single photon emission computed tomography (SPECT) showed contralateral increase of tracer uptake in the left thalamus accompanied by crossed cerebellar diaschisis (CCD) in the left cerebellum. After rehabilitation, the CRPS in the right upper extremity recovered, although hemiplegia persisted on the left limbs. The rCBF determined a second time using SPECT showed that uptake was normal in the bilateral thalami, basal ganglia and bilateral cerebella. At a 6-month follow-up, the CRPS had not recurred. Our findings show that analysis of rCBF by SPECT is useful for the clinical evaluation and follow-up of CRPS. To the best of our knowledge, this is the first reported case with this particular pattern of symptoms amd symptom resolution.

Resolution of Intractable Hiccups after Near-Infrared Irradiation of Relevant Acupoints

Background:Intractable hiccups are occasionally encountered in the presence of stroke but are usually difficult to manage. Methods:We describe two stroke patients with intractable hiccups that were refractory to pharmacological treatment but were well resolved by application to relevant acupoints with the modality linear polarized near-infrared ray equipment on PC 6 (Nei Guan), ST 36 (Zu San Li), and DU 9 (Chih Yang), which are the empirical acupoints aimed at regulating gastrointestinal mobility and function of the thoracic organ. Results:The first patient who received the treatment for only one time came out with a dramatic termination of intractable hiccups 3 hours later and with no recurrence thereafter. We applied the same treatment on the second patient once a day for 8 consecutive days, which led to progressive amelioration of intractable hiccups. Conclusions:This is the first report about the complete resolution of intractable hiccups due to stroke using near-infrared irradiation to acupoints, rather than using conventional pharmacologic therapy, traditional acupuncture, or moxibustion. Consequently, these findings suggest that linear polarized near-infrared ray irradiation, with its noninvasive properties, might be an alternative treatment for intractable hiccups after stroke.

Efficacy of near-infrared irradiation on intractable hiccup in custom-set acupoints: Evidence-based analysis of treatment outcome and associated factors

Objective. The condition intractable hiccup (IH) is generally an incapacitating disorder indicating neurologic or non-neurologic disorders. Linearly polarized, near-infrared irradiation (SL) is shown to be effective in the treatment of IH where it is applied on custom-set acupoints. The aim of this study was to investigate the treatment efficacy of IH by SL on the acupoints and to survey the relationship between IH and comorbid-related factors. Material and methods. A total of 35 patients with IH were enrolled prospectively and divided into central and non-central groups. All patients received SL using an SG-type lens unit on the relevant acupoints and were followed-up for up to 6 months for efficacy of the novel therapy. Results. There was no significant difference between patients with IH produced by central or non-central origins (p=0.7105) regarding the therapeutic effect of SL; however, the effects of age, bed-shaking, gun-waving motion and nasogastric (NG)-tube placement were significant. The severity index of IH was analyzed and found to be associated with the seasons. For those patients with elevated levels of aspartate aminotransferase (ASAT) after therapy, it took a significantly shorter (p=0.0029) period of time to treat IH with this novel therapy (p=0.0029). Thirty-four patients had complete resolution of IH within a few days of beginning SL, with partial resolution in 1 patient only. Conclusions. Without potential side effects, SL on custom-set acupoints could be a complementary therapy for patients with IH regardless of central or non-central origins.

Efficacy and Safety of Piroxicam Beta-Cyclodextrin Sachets for Treating Chronic Low Back Pain: A Randomized, Parallel, Active-Controlled Trial

Background: The clinical effects of the sachet form of piroxicam beta-cyclodextrin have been studied for their efficacy against acute or osteoarthritic pain in Western populations, but studies are sparse for chronic low back pain. We evaluated the effects of the sachet form on local Asian people with chronic backache, compared with conventional piroxicam tablets. Methods: Forty-seven eligible patients were randomized into a sachet treatment group (n=24) and a tablet treatment group (n=23). Both groups received dosages of 20 mg per day orally for 28 days. Efficacy was evaluated using a pain score and a disability index. Results: The efficacy of the two application methods was compared based on 42 patients included in the per-protocol population. The sachet-form drugs showed greater improvement than tablets in lowering the pain score by 1.93 units. This mode of delivery also showed a greater improvement in the patients’ disability index. Sachet application produced 12.5% of adverse incidences versus 19% for tablets, with no statistically significant difference. Conclusion: Piroxicam betacyclodextrin sachets extended the spectrum of analgesic activity for the treatment of these patients with chronic low back pain and provided a low incidence of side effects.

Multicentric giant cell tumours in an adolescent with haemophilia.

Summary.  ‘‘Multicentric giant cell tumour (GCTs) of the extremity is prone to be distributed over the age range of 20–40 years, but is rare in haemophilia and in the age before 20. We report a case of a 15‐year‐old haemophilia boy who presented initially with two radiolucent loci in the right femur and tibia revealed from the X‐ray films and then another lesion in the posterior femoral shaft shown from MRI by one year. Differential diagnosis of GCTs should be appraised in various aspects. Radiological diagnostic pitfall was avoided by the pathology disclosed GCTs without malignancy. The early diagnosis of GCTs in haemophilia may be delayed unless appearance of symptoms of pathologic fracture. Coincident multicentric GCTs do occur in haemophilic patients and their incidence might be underestimated, as it might not be judged because immediate symptoms of pain would resolve with appropriate factor replacement.”

Relationship of HS CRP and sacroiliac joint inflammation in undifferentiated spondyloarthritis

Abstract Objective Elevation of serum high sensitivity C-reactive protein (hs-CRP) level has been demonstrated as a risk factor for varying diseases, as well as a biomarker for predicting recovery after operation of lumber disc herniation. Our objective was to investigate the relationship between serum hs-CRP and sacroiliac (SI) joint inflammation in patients with undifferentiated spondyloarthritis (uSpA). Methods In this retrospective study, we enrolled patients with uSpA who underwent hs-CRP testing between January 2007 and September 2013. Serum hs-CRP was analyzed at our central laboratory. All enrolled patients underwent skeletal scintigraphic scan with quantitative sacroiliac measurement. Results A total of 29 patients were enrolled with mean age 32.27 years and female:male ratio of 6:23. Pearson’s correlation coefficient showed a significant difference between hs-CRP in serum and SI/S ratio in uSpA, particularly the middle part of the sacroiliac joint, either right side or left side. The significantly high concentration of serum hs-CRP might indicate a systemic inflammatory response to flare-up of the SI joint and might be an indicator of SI inflammation in uSpA.

Experience of Hyperbaric Oxygen Treatment on a Patient with Acute Ischemic Locked-in Syndrome

The characteristics of locked-in syndrome (LIS) are quadriplegia and anarthria with preservation consciousness. It is difficult to manage these symptoms. There have been several reports revealing the significant effectiveness of hyperbaric oxygen (HBO2) therapy on acute stroke, however, some journals show less favorable results using this treatment. There has also been no definite reporting of which lesions of the stroke are suitable for HBO2 therapy. We present a 65-yearold woman, suffered from acute ventral pontine infarction with LIS. Two days after onset, she received HBO2 therapy. One month later, she showed obvious functional recovery. There has been no previous published report discussing HBO2 therapy for acute ischemic pontine infarction. This is the first report regarding the obvious improvements of LIS using HBO2 therapy. Consequently, these findings suggest that HBO2 therapy could be used in conjunction with physical and rehabilitative therapy in the treatment of acute LIS for maximal functional improvement.

Impairment of static upright posture in subjects with undifferentiated arthritis in sacroiliac joint in conjunction with elevation of streptococcal serology

BACKGROUND AND OBJECTIVES Our latest work has demonstrated a strong correlation between the anti-streptolysin O (ASO) titer and the sacroiliac (SI) joint scintigraphy in subjects with undifferentiated arthritis [Journal of Rheumatology 34 (2007), 1746-1752]. Of a significant percentage in those subjects with sacroiliac disorder reported suffering from postural abnormality. The purpose of this study was to determine whether there was an abnormality of upright postural sway in those subjects. METHODS All subjects who have been examined for ASO titer levels and SI joint scintigraphy were divided into two groups according to the reference level of ASO titer in our central laboratory, and were subjected to ten sway tests to assess static postural sway when they were standing upright. The comparisons of the sway parameters were analyzed by using two sample t-test for continuous variables and repeated-measures analysis of variance (ANOVA) for the degree effect and interaction effect (sloped degree x group) in varying stressful conditions (eyes open vs closed, plantar flexion or dorsiflexion of feet). RESULTS In a total of 84 subjects, mean age was 23 years (range 18.0-36.4). Compared with the low ASO (ASO titer <or=116 IU/mL) group, the two sample t-test showed that high ASO (ASO titer >116 IU/mL) group had 2.76-, 4.46- and 4.59-fold in sway area, 1.32-, 1.50- and 1.61-fold in sway velocity, and 2.02-, 1.97- and 1.70-fold in sway intensity, over the study period at 0 degrees, 10 degrees, and 20 degrees in conditions of eyes open and plantar flexion. The values of sway velocity/intensity obtained with eyes open and plantarflexion/dorsiflexion had lower intensity values when compared with those obtained in closed eyes and plantar flexion/dorsiflexion in high ASO group, but not the same as in low ASO group. Repeated-measures ANOVA showed that the sloped degree only affected the sway area in condition of eyes closed and dorsiflexion (P = 0.016), and affected the velocity/intensity in all conditions tested (all P < 0.0001). In consideration of interaction effect, the sloped degree showed significant difference in sway area in conditions of eyes open and plantar flexion/dorsiflexion (P = 0.03 and P = 0.0113), in sway velocity in most conditions tested (P < 0.05), and in sway intensity in condition of eyes open and dorsiflexion only (P = 0.0004). CONCLUSION Subjects with high level of streptococcal serology demonstrated increased sway on all postural control measures as compared to those with low serology. Proprioceptive deficits in the SI joint might contribute to the postural impairment measured in this study.

First-ever Ischemic Stroke after a Flight in a Patient with Prior Poliomyelitis

Survivors of poliomyelitis sometimes travel by air with mobility assistance. However, prolonged seating during long-haul flights may also possibly produce stroke events on polio-inflicted patients. A 48-year-old polio-inflicted male suffered a stroke after an extended flight. A two-dimensional echocardiography was normal without detected patent foramen ovale or dyskinetic segment. The venodynamic variables were all within normal limits. MR Imaging studies revealed acute cerebral infarction in the distribution of the right middle cerebral artery and posterior watershed area. Hematological examination revealed positive anti-cardiolipin IgG antibody which might contribute to the risk of thrombosis as an underlying condition in addition to immobilization. This is the first presentation of ischemic stroke after a flight in a patient with prior poliomyelitis. In addition to decompression sickness, economy class stroke syndrome and postpoliomyelitis syndrome, the physician should also take other coagulation disorders into consideration during the investigation.