Kao-Chung Tsai

Isokinetic muscle strength of the trunk and bilateral knees in young subjects with lumbar disc herniation.

Study Design. Cross-sectional study comparing normal subjects and patients with lumbar disc herniation. Objective. To evaluate trunk and knee muscle strength in patients with L4–L5 and/or L5–S1 disc herniation. Summary of Background Data. Numerous studies have shown that patients with low back pain have weaker trunk muscles. The strength of trunk and knee muscles has not been investigated simultaneously in patients with lumbar disc herniation. Methods. Forty-one controls and 2 patients were included. Isokinetic strength of the trunk and bilateral knees was tested on a calibrated isokinetic testing machine (Biodex System 3 Pro) regardless of the laterality of the radiculopathy. The testing was carrying out at two different velocities: 60° and 120° per second. Results. Total trunk strength and knee strength were significantly lower in these patients (4.34 ± 1.06 and 4.06 ± 1.16 vs. 6.21 ± 1.05 and 5.83 ± 1.09 Nm/kg at 60° and 120° per second, respectively, P < 0.001). In patients with unilateral sciatica, there was no significant difference (P > 0.05) in unilateral knee strength between sciatica-involved and -uninvolved limbs (1.89 ± 0.5, 1.08 ± 0.45, 1.48 ± 0.58, 0.93 ± 0.41 vs. 1.68 ± 0.45, 0.91 ± 0.38, 1.41 ± 0.48, 0.79 ± 0.39 Nm/kg in sciatica-uninvolved vs. sciatica-involved limbs during extension and flexion at 60° and 120° per second, respectively). Total trunk strength was significantly correlated with total knee strength in both groups. Conclusions. In the patients with lumbar disc herniation, muscle strength of the trunk and knees was decreased to a similar extent. Weaker knee strength was found on either side of the lower extremity in the patients with unilateral sciatica, regardless of its location.

Effects of piroxicam-beta-cyclodextrin sachets on abnormal postural sway in patients with chronic low back pain

Backgrounds:  The clinical effects of piroxicam‐beta‐cyclodextrin (PBC) in sachet form have been surveyed in patients with osteoarthritic or acute pain in western countries, but scarcely studied in those with chronic low back pain (LBP), and never investigated in the field of postural sway. The aim of this study was to evaluate the clinical effects of PBC in sachet form prescribed in patients with chronic backache in local Asian when compared with those of plain piroxicam.

Hemichorea associated with gabapentin therapy with hypoperfusion in contralateral basal ganglion - a case of a paraplegic patient with neuropathic pain.

Functional imaging in patients with movement disorders has suggested abnormalities of regional cerebral blood flow (rCBF). We describe a patient with thoracic cord lesion with subsequent severe neuropathic pain. Right hemichorea developed and was related to adjunctive therapy with gabapentin. The patient’s hemichorea decreased gradually after cessation of gabapentin. The study of rCBF revealed hypoperfusion in the contralateral basal ganglia compared with the previous study of rCBF. Our patient is the first patient with neuropathic pain, treated with gabapentin who developed hemichorea, in the absence of brain lesions. Imaging studies of rCBF showed a perfusion defect in the contralateral basal ganglion.

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.

Amelioration of pathological yawning after tracheostomy in a patient with locked-in syndrome.

A 66-year-old female with a past history of hypertension, who initially presented with four limbs weakness for a duration of 3 h, poor visual acuity, ataxia and slurred speech at ER and progressed to drowsiness, tetraplegia with episodes of unjustified excessive and repetitive yawning and acute respiratory failure within few hours. On admission, the patient was drowsy and showed a positive doll s eye sign and positive gag reflex. Her uvula and tongue deviated to the left and weakness of facial muscle caused drooling. The right upper and lower extremity strength were rated 3+/5 and 2+/5 separately. The left upper and lower extremity strength were rated 2+/5 and 0+/5 respectively. Deep tendon reflexes were enhanced and bilateral Babinski signs were present. A brain magnetic resonance imaging (MRI) scan showed an infarct in most parts of the pons and another small lesion in right medial occipital lobe appearing as increased signal intensity on DWI with corresponding low ADC. MRI showed total occlusion of the middle and distal thirds of basilar artery. Besides, the left posterior cerebral artery arose from the left internal carotid artery with focal stenosis at its proximal portion and there was an aneurysm about 3 mm in size located at the anterior communicating artery (Fig. 1). The patient developed acute respiratory failure and progress to flaccid tetraplegia several hours after admission. The frequency of excessive yawning persisted despite adequate sleep at night. An endotracheal tube was inserted as a prerequisite of subsequent ventilatory support. Several days later, she still had limitations

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.

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.

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.