We attempted to evaluate the effect of a stretching device for treatment of hand spasticity in chronic stroke patients. We recruited 21 chronic hemiplegic stroke patients with severe finger flexor spasticity and randomly assigned them to the intervention group (10 patients) and control group (11 patients). The stretching device consisted of a resting hand splint, finger stretcher, and frame. The stretching state was maintained for 30 seconds and relaxed for the next 30 seconds. This stretching and relaxation were repeated for 20 minutes (one session). The stretching program was practiced 2 sessions/day and 6 days/week for 3 weeks for the patients of the intervention group. The effect of this stretching device was assessed using the modified Ashworth scale (MAS) score of finger flexor muscles. Patients in both groups were assessed six times within an interval of one week and patients in the intervention group were assessed two times before starting the stretching program. The two-way repeated measures analysis of variance (ANOVA) test for evaluation of the effect of intervention across all time-points between the two groups showed a significant interaction between time and effect of intervention (P < 0.001). Within the intervention group, the average of mean MAS score at Pre-1 and Pre-2 were 2.83 and 2.93, respectively (the difference between Pre-1 and Pre-2 was not significant (P > 0.05)), and this improved significantly to 1.97 at Inter-1, 1.55 at Inter-2, 1.20 at Inter-3, and 1.97 at Post-1 (P < 0.001) using the one-way repeated measures ANOVA test for evaluation of the effect of intervention across all time-points. We found that our stretching device was effective in relieving hand spasticity in chronic stroke patients.

ObjectiveTo investigate the efficacy and safety of percutaneous intradiscal monopolar pulsed radiofrequency (PRF) in patients with chronic disabling discogenic back pain.MethodTwenty-six subjects (7 males; mean age 43.2 years) with chronic back pain refractory to active rehabilitative management were recruited. All subjects underwent MRI for evaluation of Modic changes, and monopolar PRF (20 min at 60 V) at the center of target lumbar intervertebral disc confirmed by pressure-controlled provocative discography. Clinical outcomes were measured by the visual analogue scale (VAS), Oswestry disability index (ODI), and sitting tolerance time (ST) for 12 months after treatment. Successful clinical outcome was described as a minimum of 2 point reduction in VAS compared with the baseline at each follow-up period.ResultsThe mean VAS for low back pain reduced significantly from 6.4±1.1 at pre-treatment to 4.4±1.9 at 12 months (p<0.05). The mean ODI score was 47.3±15.4 points at pre-treatment and 36.7±19.5 at 12 months (p<0.001). The ST was 27.8±20.4 minutes at pre-treatment and 71.5±42.2 at 12 months (p<0.001). However, successful clinical outcome was achieved at 58%, 50%, and 42%, measured at 3, 6, and 12 months post-treatment. There were no significant relationship between the clinical outcome and Modic changes; no adverse events were recorded.ConclusionThe results demonstrated that the application of intradiscal monopolar PRF might be relatively effective but limited; successful intervention for chronic refractory discogenic back pain is needed. To achieve the optimal outcome through intradiscal PRF, we suggested further studies about stimulation duration, mode, and intensity of PRF.

Objectives: Using diffusion tensor imaging (DTI), we investigated the state of medial lemniscus (ML), corticospinal tract (CST), and posterior thalamic radiation (PTR), which were expected as probable reasons for clinical hemiplegia in pediatric patients, especially those who showed impaired fine motor control and proprioception, but no definite motor weakness or spasticity. Methods: We recruited 13 hemiplegic patients and 8 age-matched healthy control subjects. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) for the bilateral ML, CST, and PTR were calculated and compared between the affected hemisphere of the patient (AP), the unaffected hemisphere of the patient (UP), and the mean value of the bilateral hemispheres in control subjects (MC). Results: FA and ADC values for the CST and PTR did not differ significantly between the AP, UP, and MC subgroups (p > 0.05). However, the FA value for the ML in AP showed a significant decrease, compared with that in UP (p = 0.012) and MC (p = 0.047). DTT for the CST and PTR showed preserved integrity and ML in the UP also had continuity to the cortex; however, ML in AP showed disruption. Conclusions: Using DTI, we demonstrated that the ML lesion might be related to clinical hemiplegia in pediatric patients.

Rationale:Trans-sacral epiduroscopic laser decompression (SELD) is a noninvasive pain-relieving procedure for treatment of herniated lumbar disc (HLD), and is known to have positive effects in alleviating lower back pain or radicular leg pain after HLD. However, little is known about the possible complications of SELD.Patient concerns:A 51-year-old woman received SELD with a holmium:yttrium-aluminum-garnet laser for controlling radicular pain due to HLD on L5-S1. However, 5 days after SELD, she complained of headache, and 9 days after the SELD, cauda equine syndrome (CES) symptoms, including motor weakness of both lower extremities (manual muscle testing—left: 3, right: 4), voiding and defecation difficulties, and neuropathic pain, were manifested.Diagnoses:Cerebrospinal fluid (CSF) analysis performed 15 days after the SELD revealed elevated white blood cell count 7560 cells/μL. Staphylococcus hominis sensitive to vancomycin was cultured from CSF. The gadolinium-enhanced magnetic resonance imaging showed diffuse leptomeningeal enhancement along the distal cord and cauda equina. The latency of electrically induced bulbocavernosus reflex (BCR) was delayed in the right side and no response of BCR was presented in the left side. Based on the patient's symptoms and the results of the clinical evaluation, we diagnosed the patient as having a bacterial meningitis and CES.Interventions:The patient received 2 g per day of intravenous vancomycin for 2 months.Outcomes:After treatment with intravenous vancomycin for 2 months, all the CES symptoms were completely resolved.Lessons:In this study, we described a patient who had bacterial meningitis after SELD. During SELD, clinicians should keep in mind the possibility of infection.

Background: Stewart-Treves syndrome (STS) is a rare and deadly entity, involving the development of lymphangiosarcoma in chronically lymphedematous upper extremities following mastectomy. Case Description: A 57-year-old woman presented with a 3-month history of rapidly growing, painful skin lesions on her left distal forearm. Fourteen years previously, she had undergone a radical mastectomy with axillary lymph node dissection, adjuvant chemotherapy, and radiation therapy due to invasive left breast cancer. A surgical biopsy specimen obtained from the lesion revealed a high-grade angiosarcoma, indicative of STS. Magnetic resonance imaging and whole-body positron emission tomography revealed that the left distal forearm lesion extended to the condyle of the left humerus. The patient underwent a transhumeral amputation of the left upper limb, and an 8-month combination chemotherapy regimen was scheduled. She is still alive 22 months after the diagnosis of STS. Conclusion: This study may increase the clinician's awareness regarding the occurrence of STS in patients with chronic lymphedema, especially after mastectomy.