Cardiac Sarcoidosis Diagnosed by Histological Assessment of a Left Ventricular Apical Core Excised for Insertion of a Left Ventricular Assist Device.

Cardiac sarcoidosis diagnosed by histological assessment of a left ventricular apical core excised for insertion of a left ventricular assist device.

Filed under: Rehab Centers

Gen Thorac Cardiovasc Surg. 2013 Feb 4;
Ryugo M, Izutani H, Okamura T, Shikata F, Okura M, Nakamura Y, Oogimoto A, Higaki J

A 58-year-old male with no history of heart disease was admitted to hospital for congestive heart failure due to severe left ventricular dysfunction, and clinically diagnosed with dilated cardiomyopathy. He developed recurrent heart failure requiring several admissions to hospital and was finally referred to our institution with severe congestive heart failure. Despite medical treatment with inotropic agents, his symptoms gradually worsened. A left ventricular assist device (LVAD) was implanted together with mitral and tricuspid valve repair at 22 days after hospitalization. A histological assessment of a left ventricular apical core specimen revealed non-caseating granulomas consistent with cardiac sarcoidosis. The postoperative course was uneventful, and he remains under cardiac rehabilitation while waiting for cardiac transplantation.
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Towards an ICF- and IMMPACT-Based Pain Vocational Rehabilitation Core Set in the Netherlands.

Filed under: Rehab Centers

J Occup Rehabil. 2013 Feb 2;
Reneman MF, Beemster TT, Edelaar MJ, van Velzen JM, van Bennekom C, Escorpizo R

Background For clinical use and research of pain within the context of vocational rehabilitation, a specific core set of measurements is needed. The recommendations of the International Classification of Functioning, Disability and Health (ICF) brief Core Set for Vocational Rehabilitation (VR) and those of Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) cover two broad areas. These two sources can be integrated when made applicable to vocational rehabilitation and pain. Objective To develop a core set of diagnostic and evaluative measures specifically for vocational rehabilitation of patients with subacute and chronic musculoskeletal pain, while using the brief ICF core set for VR as the reference framework in VR, and the IMMPACT recommendations in the outcome measurements around pain. Methods Three main steps were taken. The first step was to remove irrelevant and duplicate domains of the brief ICF Core Set for Vocational Rehabilitation and the IMMPACT recommendations around pain. The second step was to match the remaining domains with existing instruments or measures. Instruments were proposed based on availability and its proven use in Dutch practice and based on  proof of sufficient clinimetric properties. In step 3, the preliminary VR-Pain core set was presented to 3 expert panels: proposed users, Dutch pain rehabilitation experts, and international VR experts. Results Experts agreed with the majority of the proposed domains and instruments. The final VR-Pain Core Set consists of 18 domains measured with 12 instruments. All instruments possessed basic clinimetric properties. Conclusion An agreed-upon VR-Pain Core Set with content that covers relevant domains for pain and VR and validated instruments measuring these domains has been developed. The VR-Pain Core Set may be used for regular clinical purposes and research in the field of vocational rehabilitation and pain, but adaptations should be considered for use outside the Netherlands.
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Weak associations between structural changes on MRI and symptoms, function and muscle strength in relation to knee osteoarthritis.

Filed under: Rehab Centers

Knee Surg Sports Traumatol Arthrosc. 2013 Feb 2;
Baert IA, Staes F, Truijen S, Mahmoudian A, Noppe N, Vanderschueren G, Luyten FP, Verschueren SM

PURPOSE: To explore associations between MRI-defined structural abnormalities and clinical features related to knee osteoarthritis (OA). METHODS: Structural and clinical knee OA features were assessed in 87 women (45 with knee OA symptoms). Structural features were quantified by the Kellgren and Lawrence grade on radiography and by the Boston-Leeds Osteoarthritis Knee Score on MRI. Clinical features were assessed using the Knee Injury and Osteoarthritis Outcome Score, functional tests and muscle strength measurements. Associations were examined using regression analyses. RESULTS: Limited significant associations between structural and clinical features were found. An increased meniscal signal was associated with more pain/symptoms (P < 0.027). An anterior cruciate ligament tear was associated with poorer stair climbing test performance (P = 0.045). In a stepwise linear regression model, patellofemoral cartilage integrity and pain explained 28 % of the isometric quadriceps strength variability. The amount of cartilage lesions, loose bodies and pain explained 38 % of the isokinetic quadriceps strength variability. Synovitis/effusion and patellofemoral cartilage integrity combined with pain explained 34 % of the isometric hamstring strength variability. CONCLUSION: Although MRI-detected cartilage lesions, synovitis/effusion and loose bodies did explain part of the muscle strength variability, results suggest that MRI does not improve the link between joint degeneration and the clinical expression of knee OA. MRI contributes less than expected to the understanding of pain and function in knee OA and possibly offers little opportunity to develop structure-modifying treatments in knee OA that could influence the patient's pain and function. LEVEL OF EVIDENCE: Case series with no comparison groups, Level IV. HubMed – rehab


Chronic rhinosinusitis increased the risk of stroke: A 5-year follow-up study.

Filed under: Rehab Centers

Laryngoscope. 2013 Feb 1;
Kang JH, Wu CS, Keller JJ, Lin HC

OBJECTIVES/HYPOTHESIS: It has been recognized that chronic rhinosinusitis (CRS) involves intracranial vessels and may be associated with stroke occurrence. However, the detailed epidemiological profile of stroke risk among patients with CRS is still not well understood. Therefore, this study aimed to explore the frequency and risk for stroke among patients with CRS by conducting a large scale population-based cohort study in Taiwan. METHODS: All study cohorts were retrieved from the Taiwan Longitudinal Health Insurance Database. This study included 15,846 CRS subjects in the study cohort and 47,538 randomly selected subjects in the comparison cohort. We individually tracked each subject in this study for a 5 year period following their index dates to identify each subject that received a subsequent diagnosis of stroke. Stratified Cox proportional hazards regressions were analyzed to compare the 5 year risk of subsequent stroke following a diagnosis of CRS. RESULTS: The incidence rate of stroke during the 5-year follow-up period was 10.65 (95% CI: 9.93-11.41) per 100 person years and 7.53 (95% CI: 7.18-7.89) per 100 person years for the study and comparison cohort, respectively. The covariate-adjusted hazard ratio (HR) for stroke revealed that that subjects with CRS were more likely than comparison subjects to have a diagnosis of ischemic stroke during the 5-year follow-up period (HR = 1.34, 95% CI = 1.18-1.53). However, there was no significant difference in the risk of subarachnoid hemorrhage (HR = 1.52, 95% CI = 0.94-2.47) or intracerebral hemorrhage (HR = 0.96, 95% CI = 0.71-1.31). CONCLUSIONS: Patients with CRS were at higher risk for stroke occurrence during the 5 year follow-up. LEVEL OF EVIDENCE: 2b. Laryngoscope, 2013.
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