Long term results of total hip arthroplasty in patients with ankylosing spondylitis]

The results of total hip arthroplasty with the use of 5 different types of prostheses in 63 hips of 38 patients were presented. The range of follow up was from 7 to 14 years. The evaluation was done with the aid of M. d'Aubigné--Postel criteria and radiological assessment. Patients opinion and his ability to work was taken into consideration. The pain was reduced most significantly. Remarkable improvement was found in the gait and in the range of hip motion. In 24.5% of patients possible, probable or evident radiographic loosening was found. Ectopic ossifications of different degree were found in 38.8% of patients, mostly in hips previously operated on or severely destroyed. Ankylosing hips improved in movement to lesser extent. No deep infection was observed in early or late follow up.     

Altered food preference after cortical infarction: Korean style

BACKGROUND: Altered food preference or preoccupation with certain food after stroke has been rarely described in the literature. METHODS: We report four Korean patients who developed altered food preference secondary to unilateral cortical infarction. RESULTS: Two patients showed preoccupation with meat such as Pulgogi or Kalbi (roast beef flavored with ingredients), which had not been their preference prior to the occurrence of stroke. All the patients became intolerant to the smell and taste of mackerel, and two disfavored hot Kimchi (cabbage salted with hot pepper). Quantitative taste assessment done in the patients revealed decreased taste perception in a variable pattern along with dysgeusia. Imaging studies showed that the region commonly involved was the frontal opercular area corresponding to the taste cortex. CONCLUSION: It is suggested that strokes involving the taste cortex may produce altered food preference associated with decreased taste sensation.     

Poststroke fatigue: characteristics and related factors

BACKGROUND AND PURPOSE: Poststroke fatigue (PoSF) is a common, but poorly studied problem. The purpose of the present study was to elucidate the characteristics of and the factors associated with PoSF. METHODS: We studied 220 consecutive outpatients at an average of 15 months after the onset of stroke. The presence of poststroke depression (PSD) and poststroke emotional incontinence were identified with the use of a standardized questionnaire. The presence of PoSF was assessed using the visual analogue scale and Fatigue Severity Scale. The presence of prestroke fatigue (PrSF) was also assessed. The impact of PoSF on patients' daily activities was also assessed using the Fatigue Impact Scale. RESULTS: One hundred and twenty-five patients (57%) had PoSF, 83 (38%) had PrSF and 53 (24%) had PSD. Thirty-six percent of the patients without PrSF and 50% of the patients without PSD had PoSF. The impact of PoSF on patients' daily activities was more severe in the physical domain as compared with the psychological or cognitive domains (p < 0.01). Multivariate analyses showed that the presence of PrSF (p < 0.01, OR 33.5), high modified Rankin scale (MRS; p < 0.05, OR 3.3), PSD (p < 0.05, OR 2.7) were independently associated with PoSF. Cessation of cigarette smoking (p < 0.05) and the presence of PrSF (p < 0.01) were independently related to PoSF in patients without PSD while decrease in sexual activities (p < 0.05) and the presence of dysarthria (p < 0.05) were related to PoSF in patients without PrSF. CONCLUSIONS: Fatigue is a fairly common sequela of stroke patients, exerting an impact on their daily activities, especially physical ones. PrSF is the most important factor related to PoSF, followed by high MRS and PSD. Nevertheless, the causes of PoSF appear multifactorial. Strategies to improve the PoSF should be individualized according to the causative factors.     

Poststroke emotional incontinence and decreased sexual activity.

BACKGROUND: Although poststroke depression has been shown to be related to decreased sexual activity (SA), the relationship between poststroke emotional incontinence (EI) and SA has not been properly investigated. METHODS: We examined 70 nondepressed, sexually active patients with first-ever stroke approximately 3 months after stroke and conducted a follow-up interview approximately 2 years after stroke in 55 of them. EI (excessive/inappropriate laughing/crying) and SA (libido, coital frequency, erectile function) were assessed with the use of a standardized questionnaire. RESULTS: Of these 70 patients, 24 (34%) had EI 3 months after stroke, which had resolved 2 years after stroke. Libido, coital frequency and erectile function were reported to have declined in 49, 65 and 26% of the patients, respectively, 3 months after stroke, and in 44, 49 and 20% of the patients 2 years after stroke. Multivariate analyses showed that low coital frequency before stroke (CFBS) was significantly (p < 0.05) related to decreased poststroke coital frequency, while the presence of EI (p < 0.05) and low CFBS (p < 0.05) was significantly associated with decreased erectile function 3 months after stroke. Two years after stroke, the presence of EI 3 months after stroke was significantly related to decreased libido, coital frequency and erectile function (p < 0.05 each). Age, gender, laterality of stroke, Barthel Index score, motor dysfunction and the presence of hypertension and diabetes mellitus were not independently related to SA 3 months and 2 years after stroke. CONCLUSION: The presence of EI is a factor related to decreased poststroke SA, more so in chronic than in subacute stages.     

Quality of Life after Epilepsy Surgery in Korea

Background and purpose

Temporal changes in the quality of life (QOL) and the underlying factors after epilepsy surgery might be specific to Korea, where social stigma toward patients with epilepsy is still pronounced.

Methods

The seizure characteristics, number of antiepileptic drugs (AEDs), and the presence of stigma, anxiety, and depression were assessed before and after surgery (at 6 months and around 2 years) in 32 surgery patients and 32 nonsurgery patients. The QOL was compared between these groups using the Epilepsy Surgery Inventory-55 questionnaire. The factors affecting QOL were also evaluated.

Results

The scores in the mental, physical, and role-functioning domains were significantly higher at 6 months (all p<0.01) and around 2 years (all p<0.01) than at baseline in the surgery group but not in the nonsurgery group. The factors related to QOL differed at the two follow-up times, with seizure freedom being important at 6 months, and AEDs and depression being important at around 2 years.

Conclusions

A marked increase in QOL in our population was observed after epilepsy surgery. Although the small sample limits the interpretation of the results, the QOL change in our surgery patients shows similar trends to those reported in Western countries. A full understanding of underlying factors related to QOL might aid the development of optimal strategies for improving the long-term postsurgery QOL in this population.