Search

Introduction: The association of changes in skeletal muscle mass and quality during the waiting time with outcomes of lung transplantation (LT) remains unclear. We aimed to examine the association of changes in skeletal muscle mass and quality during the waiting time, as well as preoperative skeletal muscle mass and quality, with outcomes of LT. Methods: This study included individuals who underwent LT from brain‐dead donors. Skeletal muscle mass (cm2/m2) and quality (mean Hounsfield units [HU]) of the erector spinae muscle at the 12th thoracic level were evaluated using computed tomography. Preoperative skeletal muscle mass and quality, and their changes during the waiting time were calculated. We evaluated the associations among mechanical ventilation (MV) duration, intensive care unit (ICU) length of stay (LOS), hospital LOS, 6‐minute walk distance at discharge, and 5‐year survival after LT. Results: This study included 98 patients. The median waiting time was 594.5 days (interquartile range [IQR], 355.0–913.0). The median changes in skeletal muscle mass and quality were −4.4% (IQR, −13.3–3.1) and −2.9% (IQR, −16.0–4.1), respectively. Severe low skeletal muscle mass at LT was associated with prolonged ICU LOS (B = 8.46, 95% confidence interval [CI]:.51–16.42) and hospital LOS (B = 36.00, 95% CI: 3.23–68.78). Pronounced decrease in skeletal muscle mass during the waiting time was associated with prolonged MV duration (B = 7.85, 95% CI:.89–14.81) and ICU LOS (B = 7.97, 95% CI:.83–15.10). Conclusion: Maintaining or increasing skeletal muscle mass during the waiting time would be beneficial to improve the short‐term outcomes of LT. [ABSTRACT FROM AUTHOR]

Purpose: To investigate if early exercise can help prevent skeletal muscle loss and improve the clinical outcomes of esophageal cancer patients receiving preoperative neoadjuvant chemotherapy (NAC). Methods: This was a single-center, retrospective observational cohort study of 110 patients with advanced esophageal cancer. We analyzed the effect of early exercise on the risk of skeletal muscle loss (defined as > 2.98%) during NAC and the subsequent clinical outcomes. Patients in the early exercise group (n = 71) started exercise therapy 8 days earlier than those the late exercise group (n = 39). Results: The median age of the patients was 65.4 years, the mean BMI was 21.1 kg/m2, and 92 (84%) of the 110 patients were men. Skeletal muscle loss occurred in 34% and 67% of the early and late exercise groups, respectively (p < 0.001). There was a lower risk of surgical site infection in the early exercise group (1% vs 16%, p = 0.021). Multivariate analysis revealed that early exercise reduced the risk of skeletal muscle loss (OR = 0.25, 95% CI 0.09–0.65, p = 0.006). Conclusions: Our results suggest that early exercise reduces the risk of both skeletal muscle loss during NAC and subsequent surgical site infection in patients with esophageal cancer. [ABSTRACT FROM AUTHOR]

Background: Nerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS.Method: Of the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months postoperatively. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement.Results: The average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6-12 months, r = 0.67; 0-12 months, r = 0.60) and DASH (0-12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6-12 months, r = - 0.33; 0-12 months, r = - 0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below.Conclusion: NCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS. [ABSTRACT FROM AUTHOR]

Background: The choice of reconstructive procedure to restore limb function is challenging after internal hemipelvectomy. Hip transposition arthroplasty, also known as resection arthroplasty, removes a malignant or aggressive tumor of the pelvis and acetabulum after which the remaining femoral head is moved proximally to the lateral surface side of the sacrum or the underside of the resected ilium after internal hemipelvectomy. It may provide reasonable functional results and have some advantages such as lowering the risk of an infected implant compared with other reconstructions because no foreign implants are used. Hip transposition is generally managed with prolonged bed rest or immobilization postoperatively to stabilize the soft tissue surrounding the remaining femur. Because enabling patients to be mobile while the soft tissues heal might be advantageous, we reviewed our experience with an external fixation for this procedure.Questions/purposes: (1) Does temporary external fixation facilitate postoperative physiotherapy in patients who undergo hip transposition arthroplasty? (2) What functional Musculoskeletal Tumor Society (MSTS) scores were achieved at short term in a small series of patients treated with hip transposition and temporary external fixation? (3) What were the complications of using external fixation in a small series of patients who received it for malignant tumors?Methods: Between 2008 and 2012, we treated seven patients (three men and four women; median age, 37 years; age range, 18-53 years) with acetabular resection for malignant bone tumors; all were managed with a hip transposition, initially stabilized using external fixation. No other types of procedures were used for this indication in this period. Minimum followup in this retrospective study was 45 months, except for one patient who died at 18 months (range of followup duration, 18-90 months; median followup, 57 months), and no patients were lost to followup. The pins for external fixation were inserted into the affected side of the femur and the healthy contralateral ilium. External fixation was removed 6 weeks postoperatively and weightbearing was started at that time. Preoperative chemotherapy was administrated in four patients, but postoperative chemotherapy was delayed since it was given after external fixation removal in three patients. The postoperative rehabilitation course and functional results were assessed by chart review, functional results were determined using MSTS scores, tallied by physiotherapists who were not part of the surgical team, and complications were ascertained through chart review. Major complications were defined as complications that were treated with additional operations, such as deep infection, or ones that could cause severe postoperative dysfunction, such as nerve injury.Results: With temporary external fixation, standing next to a bed was achieved in median 7 days (range, 6-9 days) postoperatively, transferring to a wheel chair in median 8 days (range, 6-28 days), and gait training using parallel bars in median 15 days (range, 7-48 days). At most recent followup, three patients could walk without a crutch or cane, three could walk with a cane, and one could walk with a crutch. The median MSTS score at most recent followup (median, 57 months) was 63%. Two patients had complications that resulted in reoperations; one had a wound dehiscence, and one had an abdominal herniation that gradually developed, and which was reconstructed using polypropylene mesh 2 years after pelvic resection. Two patients had nerve palsies that recovered by the end of the first year. All patients had pin tract infections that resolved with nonsurgical approaches.Conclusions: Hip transposition with temporary external fixation can stabilize the bone soft tissue after pelvic resection. Although we did not have a comparison group of patients, we believe that external fixation facilitates early postoperative physiotherapy and rehabilitation and provides good functional results without major surgical complications. Because it delays the resumption of chemotherapy, more patients with longer followup are needed to determine whether this will be associated with poorer oncologic results.Level Of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

[Purpose] The aim of this study was to examine the usefulness of 3 isometric strengths (sum) in patients with polymyositis (PM) not only in the acute phase but also in the stable stage. [Subjects] Our subjects were five females (average age 36.2) with PM. [Methods] We traced the change in three isometric strengths (head up, HU; shoulder abduction; straight leg raising) measured by a hand-held dynamometer, creatine kinase level in serum (CK) and prednisone (PSL) dosage for more than 30 weeks. [Results] The change of the sum of 3 isometric strengths was correlated to CK in four patients, however, the correlation coefficient value was low. The individual strength of HU was also correlated to CK in four patients. Furthermore, HU was negatively correlated to PSL dosage in four patients though the sum strength was correlated in only three of five patients. [Conclusion] These results suggest that sequential measurement of the sum of isometric strengths would be effective for predicting the disease progress in the stable stage, though, not as much as in the acute phase. Sequential measurement of HU might be more effective for identifying the CK level or drug effect in stable stage. [ABSTRACT FROM AUTHOR]

[Porpose] The aim of this study was to investigate the relationship between neurogenic intermittent claudication (NIC) and the degree of anterior slippage measured by radiographic findings. [Subjests] Patients were 36 females with 4th lumbar degenerative anterolisthesis. [Methods] We measured neurological symptom limited walking capacity (WC) reflected in NIC by radiographic findings. We examined three points: sagittal anterior deviation in 4th lumbar to 5th in upright, trunk extension, and flexion positions. As physical findings, we used a visual analogue scale (VAS) to evaluate subjective symptom intensity after standing upright for 30 seconds. [Results] None of the 3 radiographic findings were correlated to WC in multiple regression analysis. Only VAS was correlated to WC (r²=0.268, p<0.01). [Conclusion] These results suggest that radiographic findings expressing anterior slippage do not explain NIC dynamic symptoms or signs. [ABSTRACT FROM AUTHOR]

[Purpose] The aim of this study was to investigate the relationship between the degree of instability in the 4th lumbar and neurogenic intermittent claudication (NIC). [Subjects] Patients were 28 females (65.9 ± 7.9 years) with degenerative lumbar spondylolisthesis with instability in the 4th lumbar. [Methods] Instability was measured by radiographic findings in the sagittal plane in three positions: upright, trunk extension, and flexion positions. The difference between maximum anterior deviation of the 4th lumbar to 5th and the minimum in the three positions was defined as instability. We also measured neurological symptoms that limited walking capacity (WC) to evaluate NIC, the finger-floor distance (FFD), and modified functional reach (FR). Furthermore, we used a visual analogue scale (VAS) to evaluate subjective symptom intensity after standing upright for 30 seconds. [Results] The degree of instability was not correlated to WC. Furthermore, FFD, FR and VAS were not also correlated to instability. However, FR (r = 34, p<.01) and VAS (r = -.58, p<.001) were correlated to WC. [Conclusion] These results suggest that radiographic findings expressing lumbar pathology alone cannot explain NIC symptoms or signs. [ABSTRACT FROM AUTHOR]

[Purpose] In this study, we investigated the postoperative change in muscle strength and the exercise capacity of a patient who received a living-donor lobor lung transplant. We have treated the patient with successive physical therapy for about 8 months. [Subjects] The subject was a female with pulmonary emphysema of unknown origin. [Methods] We measured muscle strength in straight leg raising (SLR), 6-minute walking distance (6MWD) and pulmonary function. [Results] Muscle strength in SLR reached the maximum value at 6-7 months after the lung transplantation, and 6MWD also reached the maximum at 6 months post-op. The postoperative change (12 months after surgery) in SLR strength, and 6MWD were correlated with pulmonary function. However, the value of SLR strength and 6MWD were decreased at 12 months after surgery. [Conclusion] These results suggest that successive physical therapy after lung transplantation facilitates the improvement of physical function and maintains it. [ABSTRACT FROM AUTHOR]

[Purpose] We investigated the factors affecting the days till patients could walk continuously, about 50 m, after lobectomy. [Subjects] Subjects were 60 patients (66.9 ± 11.3 years, 42 males, 18 females) with primary lung cancer. [Methods] We investigated the lung function pre-operation, intervention of physical therapy at pre-operation, operative method, operated lobe, age, sex, and body mass index. We examined the relationship between these factors and the days till patients could walk continuously, about 50 m, after lobectomy. [Results] There were no relationships between the days the subjects could walk continuously, about 100 m, and factors we selected. Five patients took more than one week to be able to walk continuously, about 50 m, 3 were over 80 years old, 1 had air flow limitation (FEV1.0% < 40%) and 2 had low BMI (less than 21 kg/m²) before operation, and 1 had severe pain after the operation. [Conclusion] In patients with multiple risk factors for post-operative complications before operation, early ambulation immediately after the operation and improving exercise capacity before the operation were required as physical therapy treatments. [ABSTRACT FROM AUTHOR]

The article focuses on the study that measures muscle strength of polymyositis and dermatomyositis patients using a hand-held dynamometer in Japan. The sum of the isometric strengths is correlated with creatine kinase that reflects the muscle strengths of an individual whole body and determines the disease progress. Result of the study shows that dynamometer's use in the evaluation of muscle strengths and the treatment effect in acute rehabilitation would be effective.

Examines the walking function and gait characteristics of patients after limb-sparing surgery with sciatic nerve resection. Use of nonparametric objective evaluation system and subjective method of gait analysis; Useful indicators of overall walking efficiency; Change of the magnitude of vertical ground reaction force with variation in gait speed.

Psychological distress is common in patients with soft tissue and bone tumors. We first investigated its frequency and the associated risk factors in patients with pre-operative bone and soft tissue tumors. Participants included 298 patients with bone and soft tissue tumors who underwent surgery in our institution between 2015 and 2020. Psychological distress was evaluated by the Distress and Impact Thermometer (DIT) that consists of two types of questions (questions about the severity of the patient's distress (DIT-D) and its impact (DIT-I)). We used a cut-off point of 4 on the DIT-D and 3 on the DIT-I for screening patients with psychological distress. We therefore investigated: (1) the prevalence of psychological distress as assessed with DIT or distress thermometer (DT), which can be decided by DIT-D ≥ 4, (2) what are the risk factors for the prevalence of psychological distress, and (3) what is the number of patients who consulted a psychiatrist for psychological distress in patients with pre-operative bone and soft tissue tumors. With DIT and DT, we identified 64 patients (21%) and 95 patients (32%), respectively, with psychological distress. Multivariate logistic regression revealed that older age, sex (female), malignancy (malignant or intermediate tumor), a lower Barthel Index, and higher numeric rating scale were risk factors for psychological distress. Two patients (3%) consulted a psychiatrist after surgery. In conclusion, careful attention to psychological distress is needed, especially for female patients, older patients, and those with malignant soft or bone tissue tumors who have more than moderate pain. [ABSTRACT FROM AUTHOR]