To predict the probability of lymphedema development in breast cancer patients in the early post-operation stage, we investigated the ability of quantitative lymphoscintigraphic assessment.
This retrospective study included 201 patients without lymphedema after unilateral breast cancer surgery. Lymphoscintigraphy was performed between 4 and 8 weeks after surgery to evaluate the lymphatic system in the early postoperative stage. Quantitative lymphoscintigraphy was performed using four methods: ratio of radiopharmaceutical clearance rate of the affected to normal hand; ratio of radioactivity of the affected to normal hand; ratio of radiopharmaceutical uptake rate of the affected to normal axilla (RUA); and ratio of radioactivity of the affected to normal axilla (RRA). During a 1-year follow-up, patients with a circumferential interlimb difference of 2 cm at any measurement location and a 200-mL interlimb volume difference were diagnosed with lymphedema. We investigated the difference in quantitative lymphoscintigraphic assessment between the non-lymphedema and lymphedema groups.
Quantitative lymphoscintigraphic assessment revealed that the RUA and RRA were significantly lower in the lymphedema group than in the non-lymphedema group. After adjusting the model for all significant variables (body mass index, N-stage, T-stage, type of surgery, and type of lymph node surgery), RRA was associated with lymphedema (odds ratio=0.14; 95% confidence interval, 0.04–0.46; p=0.001).
In patients in the early postoperative stage after unilateral breast cancer surgery, quantitative lymphoscintigraphic assessment can be used to predict the probability of developing lymphedema.
Citations
To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed.
Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated.
Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05).
These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US.
Citations
To evaluate the prevalence and risk factors of peripheral neuropathy in patients with rheumatoid arthritis (RA) treated with leflunomide (LEF) by quantitative sensory testing (QST).
A total of 94 patients were enrolledin this study, out of which 47 patients received LEF. The other 47 patients received alternative disease-modifying antirheumatic drugs and served as the control group. The demographic characteristics, laboratory findings, concomitant diseases, and medication history were evaluated at the time of QST. The cooling (CDT) and vibratory detection threshold (VDT) as the representative components of QST were measured.
Age, gender, RA duration, ESR, and CRP did not show any significant differences between the two groups. VDT did not demonstrate any significant difference in both groups. However, CDT in LEF group was significantly higher than that of the control group (8.6±2.7 in LEF vs. 5.6±3.8 in control). The proportion of RA patients in the LEF group showing abnormally high CDT was over 2 times greater than that of the control group, but these findings were not statistically significant. Age, RA duration (or LEF medication in LEF group), ESR, and CRP did not show significant correlation with CDT in both groups. VDT significantly correlated with age in both groups.
LEF treatment in patients with RA may lead to abnormal CDT in QST. CDT value was not affected by age, RA duration, disease activity, or LEF duration. It remains to be determined whether QST may be a valuable non-invasive instrument to evaluate the early sensory changes in patients with RA taking LEF.
Citations
Method Fifty patients were assigned at random to receive intra-articular shoulder injection. The treatment groups were divided into two groups: BoNT-A group, 200 IU of BoNT-A and 2 ml of normal saline; triamcinolone acetonide (TA) group, 20 mg of triamcinolone and 2 ml of 2% lidocaine. Uptake ratio of quantitative three phase bone scintigraphy (QTPBS) was calculated by dividing the radioactivity count on the affected side by that on the unaffected side. Shoulder pain was assessed by visual analogue scale (VAS) and neuropathic pain scale (NPS). Range of motion (ROM) of shoulder joint and functional independence measurement (FIM) of upper limb were evaluated. All of them were measured before injection, and 4 weeks after injection.
Results After 4 weeks, the uptake ratio of blood pool phase was significantly decreased in hands of BoNT-A group than TA group. VAS, ROM and upper extremity FIM was similarly improved in both groups. Pain intensity and cold pain of NPS were similarly decreased in both groups. Hot pain and dull pain of NPS decreased more significantly in BoNT-A group than TA group.
Conclusion In the short-term, intra-articular BoNT-A shoulder injection maybe has the therapeutic effect on acute CRPS I related stroke. And the uptake ratio of blood pool phase of the hand of QTPBS may be useful to assess the therapeutic effect of CRPS after acute stroke.
Objective: The purpose of this study was to determine whether quantitative sensory test can be used as a screening test of peripheral polyneuropathy in patients with diabetes mellitus, and to evaluate the severity of peripheral polyneuropathy in patients with diabetes mellitus using quantitative sensory test.
Method: We performed nerve conduction study to right upper and left lower extremity of the patients. Quantitative sensory test was performed using TSA-2001 thermal sensory analyser on right thenar and left foot dorsum in both diabetic and control groups.
Results: 1) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than age-matched control group (p＜0.05). 2) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than young-aged control group (p＜0.05). 3) As nerve conduction study results were severe, the cold sense threshold in right thenar were decreased (p＜0.05).
Conclusion: Quantitative sensory study in patients with diabetes mellitus are sensitive to identify neuropathic change; thus, they would be used as the screening method of diabetic peripheral polyneuropathy.
Objective: To investigate the clinical feature and quantitative electromyographic (QEMG) findings in the patients with post-polio syndrome (PPS).
Method: Eleven patients who had clinical evidences of antecedent poliomyelitis were evaluated with standardized clinical history, physical examination and QEMG study. If a patient had fulfilled provisional criteria for PPS, he was regarded as PPS and six patients had fulfilled the criteria. Other patients were treated as control group with stable poliomyelitis. Manual muscle testing and needle EMG study including quantitative motor unit analysis was performed at the tibialis anterior and vastus medialis muscles. The existence of abnormal spontaneous activity and parameters of quantitative motor unit analysis, mean duration and amplitude of motor unit action potentials (MUAPs), were compared between PPS and control groups. The correlation between the muscle strength and parameters of QEMG was investigated.
Results: Abnormal spontaneous activities were noted in 4 out of 11 patients (36.4%) and three of these 4 patients were PPS. Mean duration and amplitude of MUAPs of tibialis anterior and vastus medialis muscles were not different significantly between the PPS and stable poliomyelitis group (p＞0.05). The parameters of MUAPs were poorly correlated with muscle strength.
Conclusion: Distribution of abnormal spontaneous activities and parameters of QEMG study were not different in PPS and stable poliomyelitis patients. QEMG study may not have additional benefit in differentiating PPS from stable poliomyelitis.
Objective: To determine the function of the normal upper trapezius and scalenus medius muscles during neck motion by quantitative eletromyographic analysis.
Method: Nine subjects were evaluated electromyographically with monopolar fine wire electrodes. The isometric tilting and rotation of neck with manual resistance were performed in the sitting position. The Root Mean Square (RMS) and Mean Rectified Voltage (MRV) were recorded.
Results: The RMS and MRV of upper trapezius muscle were significantly higher at each degree of ipsilateral rotation than contralateral rotation. But the RMS and MRV of scalenus medius muscle were significantly higher at each degree of contralateral rotation than ipsilateral rotation. The RMS and MRV of upper trapezius and scalenus medius muscles were significantly higher at ipsilateral tilting than at contralateral tilting.
Conclusion: Based on these results, we concluded that the upper trapezius muscle acts more in ispilateral rotation, while scalenus medius muscle acts in contralateral rotation, and upper trapezius and scalenus medius muscles act in ipsilateral tilting.
Objective: To obtain normal data of quantitative sensory test (QST) in Korean adult.
Method: The subjects were 85 normal adults aging from 30 to 69 years old, who had no abnormal sensory and neurologic problem. We performed following three QSTs on dominant side and one verbal questionnaire. 1) Semmes-Weinstein monofilament wire system (0.05 G, 0.2 G, 2 G, 4 G, 10 G, 300 G) for touch sensation, 2) Rydel-Seiffer Tuning Fork for vibration sensation, 3) TSA-2001 Thermal sensory analyser for thermal sensation, 4)University of Texas Subjective Peripheral Neuropathy verbal questionnaire.
Results: 1) Touch perception score measured with Semmes-Weinstein monofilament wire system, declined with age (p＜0.01). 2) Vibration perception score measured with the tuning fork, declined with age in foot (p＜0.01). 3) Warm sense and heat pain threshold measured with TSA-2001 thermal sensory analyser increased with age, and cold sense and cold pain threshold declined with age. 4) Weight showed negative correlation with vibration perception score in man's foot.
Conclusion: Normal data of three sensory test obtained from this study could be used for the early detection of peripheral neuropathy or loss of "protective sensation".
Distortion of vowels in dysarthria associated with amyotrophic lateral sclerosis can be detected at the perceptual, physiological, and acoustical levels of analysis. Sound spectrography was used to analyse the formants of vowels which reflect position and space of articulatory organs. We analyse status and progression of dysarthria in 54 year old women with amyotrophic lateral sclerosis using sound spectrography. Target formant frequencies were measured from select words containing the vowels /a/, /e/, /i/, /o/, /u/. Results revealed that dysarthric patient exhibited smaller vowel space areas and less systematic changes in vowel spaces for pronouncing different vowels in comparison with normal control. Changes of vowel formants in sound spectrographic analysis reflected progression of dysarthric symptom in this patient. We conclude that acoustic analysis of vowels using sound spectrography is a useful tool to visualize and quantitatively analyse the severity and progression of dysarthria due to paralytic articulatory organ.
The reference values of motor unit action potentials(MUAP) of first dorsal interosseous and tibialis anterior muscles were measured in 50 healthy subjects. The MUAPs were recorded with a concentric needle electrode and extracted with a decomposition method. Sixty six patients with neuropathy were also studied in the same way with a count of outliers and measurement of mean values.
The mean values of amplitude, area, duration and thickness were 667.74±204.34 ՌV, 992.26±253.18 ՌVms, 9.75±1.95 ms and 1.49±0.26 ms, respectively in the first dorsal interosseous muscles, and 612.88±140.13 ՌV, 1172.84±199.21 ՌVms, 11.41±2.48 ms and 1.93±0.34 ms respectively in the tibialis anterior muscles. There was no significant difference in age and gender of normal subjects. The amplitude was the most sensitive parameter to detect abnormality in a count of outliers and measurement of mean values. The outliers count in duration showed a higher sensitivity than the measurement of mean values(p＜0.05), but not in amplitude, area or thickness.
Based on the results of this study, the count of outliers was more sensitive than the measurement of mean values in the diagnosis of patients with neuropathy. Further more, less numbers of MUAPs were needed for the evaluation of the outliers count. Through this method we could save the evaluation time and the patients felt more comfortable.
Measurements of local shoulder muscle function during shoulder abduction are of a great interest in biomechanics research and in ergonomic applications. There have been so many opinions that the supraspinatus muscle acts in synergy with the deltoid muscle as a single unit throughout the shoulder abduction. However the specific actions of deltoid and supraspinatus muscles have been subjects of controversy. Electromyography is an established evaluation method of biomechanical study. It reflects the electrical activity at the muscle membrane level and indirectly the mechanical output of the muscle. The purpose of this study was to evaluate the role of deltoid and supraspinatus muscles during shoulder abduction by the comparison of motor unit action potentials using a quantitative electromyographic analysis method, to provide a good insight into the biomechanics of shoulder abduction.
Motor unit action potentials of deltoid muscle were seen earlier than those of supraspinatus muscle at the time of initiation of shoulder abduction. The Root Mean Square (RMS) voltage of deltoid muscle was increased gradually from 0o to 90o of shoulder abduction, and then decreased gradually above 90o to 180o of shoulder abduction. The RMS voltages of deltoid muscle were significantly higher than those of supraspinatus muscle at each degree of shoulder abduction wholly. There was no differences in the RMS voltages of deltoid muscle, during shoulder abduction between the loading of 1 kg and without loading. However, the RMS voltages of supraspinatus muscle were significantly higher in the loading state than without loading. The Mean Rectified Voltages (MRV) were similar to the RMS voltages of deltoid and supraspinatus muscles during shoulder abduction.
Based on these results, we concluded that the deltoid muscle was not only an initiator but also a major contributor in shoulder abduction, where as the supraspinatus muscle acts as a secondary muscle for the initiation of shoulder abduction and a supporting muscle when there is a resistance against shoulder abduction.
Analysis of insertional activity is a routine part of the clinical electromyogrphic examination. It provides an information of muscle excitability but it's clinical significance has not perfectively accepted yet. This study was designed to evaluate clinical usefulness of insertional activity through quantitative analysis in the diagnostic field of pathology.
Monopolar needle electrode was inserted briefly in the biceps brachii, paralumbar spinal and tibialis anterior muscles of the normal and denervated muscles. Total duration and spike duration of the insertional activity were measured 10 times in each muscle and averaged. Within spike duration we measured turns, mean amplitude, turns/amplitude, RMS, mean frequency and median frequency.
The measured parameters of insertional activities were not significantly different according to the muscle in normal controls. In denervated muscles, the turns, mean amplitude, RMS, mean frequency and median frequency were decreased but turns/amplitude was increased compared to those of normal controls. But there were no difference in total duration and spike duration between normal and denervated muscles. In denervated muscles the muscle power was positively correlated with turns, mean amplitude, RMS, mean frequency and median frequency, and the grade of abnormal spontaneous activities was inversely correlated with turns, mean amplitude, RMS, mean frequency and median frequency.
Therefore quantitative analysis of insertional activity could be a useful method for the diagnosis of neuromuscular disease.
It is often difficult, on the basis of clinical examination and conventional investigations, to evaluate the functional impairment of brain in children with cerebral palsy in which early detection remains a challenge. This study was designed to know the usefulness of single photon emission tomography(SPECT) of the brain with technetium-99 m hexamethylpropyleneamineoxime (99mTc-HMPAO) as a semiquantitative method of determination of right-left asymmetries in tracer uptake and a change in antero-posterior regional cerebral blood flow(rCBF) distribution. We investigated 33 children with cerebral palsy aged from 4 months to 48 months(mean 19.3 months). The results were as follows: right to left ratio and regional index of a transverse view were useful to quantify the decrease of tracer uptake in left hemiplegia, but not in right hemiplegia who were all mild in severity, and in tetra- and diplegia in which cerebral lesions were found bilaterally; cortico-cerebellar ratios of a sagittal view were found useful to detect a decrease of rCBF distribution in tetra- and diplegia ,which was not distinct by means of right to left ratio and regional index on transverse view.
The results suggest that semiquantitative analysis of 99mTc-HMPAO Brain SPECT would be a valuable complementary tool for determination of topographical involvement in cerebral palsy.
Ability to control postural balance is a prerequisite for standing and gait training during the period of rehabilitation in patients with balance disorder. Precise and quantitative assessment of balance deficit as well as development of effective training methods are the important areas of research in this field.
The purposes of this study are ⸁ to assess the test- retest reliability and clinical feasibility of Computerized Balance Evaluation and Training System(COBETS) developed by Department of Medical Engineering and Department of Rehabilitation Medicine at Chonbuk National University and ⸂ to quantitatively assess the static and dynamic postural control ability of the patients with balance disorders due to various causes using COBETS and compare them with the results of normal control subjects.
The subjects consist of 21 patients with brain damage by stroke, head injury, or surgical procedure to control intractable epilepsy, 5 patients with lower extremity amputation, 6 patients with unilateral total hip replacement, and 50 normal control subjects. Fifteen out of 50 normal control subjects performed subsequent two trials to evaluate the test- retest reliability of the COBETS. There was no statistically significant difference between the results of first and second trials in static and dynamic postural sway measured by COBETS. Therefore, the COBETS is considered to have sufficient test- retest reliability. In the patients with brain damage, amputation, and hip joint replacement, static postural sways during comfortable, narrow, and affected one- leg stance were significantly increased than normal control subjects. Abnormal results in somatosensory evoked potential study and presence of motor weakness were negatively influenced to the results of static postural sway. In all the patients groups, the movement time, path error, and peripheral sway were markedly increased in forward and affected lateral directions compared with normal subjects. Abnormal sensory and motor findings also negatively influenced to some parameters of dynamic postural control. However, there was no difference in the postural sway among the patients groups divided by the causes of balance disorder.
The COBETS is considered as a reliable and clinically useful tool for quantitative assessment of static and dynamic postural control in the patients with balance disorders. Its usefulness for the training of balance control is subject to be defined in future.
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