Muscular lengthening of the triceps by successive casts in children with cerebral palsy

ThinPrep processing, an automated cytopreparatory method, has been reported to show good correlation with conventional preparations and to reduce the rate of false-negative diagnoses. In a retrospective review of 230 consecutive nongynecologic cytology cases, we compare the ThinPrep (TP) method with conventional preparations (CP). There were 129 fine-needle aspiration (FNA) specimens from various sites, including 51 breasts, 40 thyroids, 14 lungs, 8 livers, and 16 miscellaneous sites. The sources of 101 body cavity fluids included 68 pleural/peritoneal effusions, 25 peritoneal/pelvic washings, and 8 miscellaneous sites. Each case was evaluated for cellularity, morphologic, details, and obscuring background material. Diagnoses of the TP slides were classified as insufficient, normal, benign, suspicious, or malignant. Each case was then correlated with the tissue diagnosis when available. In TP slides, cellular arrangements, nuclear details, and nuclear cytoplasmic ratio were preserved, while blood and diathesis were eliminated. There was no statistically significant difference between TP and CP in the diagnostic categories. However, in six cases of "insufficient for diagnosis" on FNA by CP, TP yielded sufficient cells and tissue fragments for diagnosis. One case each of FNA and body fluid with a diagnosis of "suspicious for malignancy" by CP was considered "positive" on TP slides. The overall sensitivity of TP was 97.6%, and the specificity was 92.9%. The positive predictive value was 93.0%. We conclude that the ThinPrep method shows good correlation with conventional preparations in both FNA and body fluids.     

In vivo measurement of the series elasticity release curve of human triceps surae muscle

The force-extension characteristic of the series-elastic component of the human triceps surae muscle has been measured in vivo by means of a hydraulic controlled-release ergometer in 12 subjects. The SEC characteristic can be described by a linear relation between muscle moment and extension, with a stiffness K1, preceded by a quadratic 'toe' region at low moments. Stiffness K1 increases with the level of activation of the muscle. At an ankle moment of 100 N m, values range between 250 and 400 N m rad(-1). The elastic stretch corresponds then to about 30, which is considerable compared with the total ankle movement range. At moments of 150 and 180 N m, which correspond to the peak moments in walking and running, respectively, the elastic energy stored in the SEC was 23-37 and 31-57 J. These energy values are amply sufficient to enable the conservation of negative (eccentric) work into a subsequent phase of positive (concentric) work in both walking and running.     

Strabismus in children with cerebral palsy

In 48 children with cerebral palsy the characteristics of the squint and amblyopia were analyzed, also with respect to the features of cerebral palsy and to birth weight. Strabismus of congenital esotropia type was found to be common, as was also exotropia of early onset. Spontaneous alternation or an accommodative component of the squint was present only in a few cases. There was no evidence of an accumulation of any strabismus type in the different subgroups of cerebral palsy, whereas amblyopia or an obvious risk for amblyopia was found in the great majority of the cases. Some kind of amblyopia treatment was given to 34. Most of them showed improvement of the visual capacity which encourages treatment of amblyopia, even in children with cerebral palsy.     

Nutrition in children with cerebral palsy

The previously reported earlier onset of pituitary tumours in cross-bred mice inheriting a mutant Rb-1 allele paternally has been ascribed to imprinting of an Rb-1-linked gene. Here, we demonstrate that, as predicted from this mechanism, there is no effect of the parent of origin of the mutation in inbred mice.     

Linear growth velocity in children with cerebral palsy

Retrospective analysis of an anthropometric database collected prospectively in children with cerebral palsy (CP) was carried out to evaluate linear growth velocity and identify risk factors for poor linear growth. Growth velocity measures were compared with published norms for prepubertal growth velocity and z scores were calculated. Mean growth velocity z score (Gvz) was -0.97+/-1.9. Boys grew more slowly than girls (mean Gvz = -1.5+/-1.9 versus -0.3+/-1.7 P = 0.003). Gvz did not correlate with type of CP or presence/absence of microcephaly. Young age was a risk factor for poor linear growth (mean Gvz = -2.40+/-2.6 for children under 2 years of age versus -0.76+/-1.9 ages 2 to 6 and -0.77+/-1.6 ages 6 to 10, P = 0.04). Children at nutritional risk (triceps skinfold thickness < or =55%) grew poorly (mean Gvz = -1.46+/-1.5 versus -0.30+/-1.8, P = 0.01). For children over 2 years, those with cognitive impairments grew more slowly than those with normal cognition (mean Gvz = -1.25+/-1.9 versus -0.12+/-1.8, P = 0.02) and non-ambulatory children grew more slowly than ambulatory children (mean Gvz = -1.20+/-1.5 versus -0.35+/-1.9, P = 0.03). Prepubertal children with CP grow more slowly than expected compared with age- and sex-based standards. Sex, age, cognitive impairment, ambulatory status, and nutritional state are factors which may contribute to slow growth. These results add to the growing data that children with CP have unique growth patterns. Further study is needed to clarify the factors which contribute to poor linear growth in this population.     

Gait patterns in children with hemiplegic spastic cerebral palsy

Our objective was to study uterine and umbilical artery flow resistance during the oxytocin challenge test (OCT). The study population was 21 women with suspected placental insufficiency; one woman was excluded because of a positive OCT with reactive fetal heart rate pattern. We carried out simultaneous electronic fetal heart rate monitoring and Doppler velocimetry of uterine and umbilical artery flow during the OCT. The uterine artery flow resistance increased significantly during contractions in both OCT-positive (n = 5) and OCT-negative (n = 15) cases compared with basal values, but the increase was significantly higher in positive cases. The umbilical artery flow resistance increased significantly during contractions in OCT-positive cases, but was almost unchanged in negative cases. During uterine inactivity, there were no differences between the groups for any vessel. This study showed that fetal heart rate decelerations during the OCT are associated with rapid and exaggerated increases of vascular resistance in both uterine and umbilical arteries. The causal relationship is unknown, but the findings indicate pathophysiological mechanisms revealed only during uterine contractions.     

Characteristics of locomotor control in children with cerebral palsy

The typical features of electromyographical (EMG) recordings from children with cerebral palsy (CP) consist of a coactivation of antagonistic leg muscles during the stance phase, a low and tonic activation of extensor EMG, and enhanced stretch reflex excitability with short latency. This characteristic reflex pattern is suggested to reflect an arrested normal maturation. The strong similarity between the walking pattern of CP children (8-16 years of age) and the reflex pattern during the process of learning to walk (7-10 months of age) lets us draw the following conclusion. During normal maturation a close parallelism exists between the control of group I afferent inhibition with the suppression of mono/oligosynaptic stretch reflexes and group II afferent facilitation with the increase of polysynaptic (mainly extensor) EMG responses. This maturation depends on supraspinal control, and does not occur in CP children. In adult patients with a supraspinal lesion, a regression to this early reflex pattern takes place.     

Vitamin D levels in noninstitutionalized children with cerebral palsy

Pendred syndrome is an autosomal recessive condition classically characterized by deafness and goitre. Since both cochlear and thyroid pathology are required to secure the diagnosis, it is unclear whether the condition might present without the classical features. The perchlorate discharge test, the gold-standard investigation for Pendred syndrome, is non-specific, and in the absence of alternative means of confirming the diagnosis, its sensitivity is unknown. We used the recent mapping of the gene to chromosome 7q to identify pedigrees with a likely diagnosis of Pendred syndrome, and assessed the prevalence of clinical parameters of disease in affected patients. Thirty-six familial cases showed co-segregation between disease and the Pendred syndrome locus on chromosome 7q. Clinical and investigative findings were compared in index cases (n = 18) vs. affected siblings (n = 18). The overall prevalence of goitre was 73%, higher in index cases (94%) than in siblings (56%), many of whom had not previously been considered to have the condition. One perchlorate discharge test was false-negative (2.9%). Radiological malformations of the cochlea were identified in 86% of cases. Securing a diagnosis of Pendred syndrome may be difficult, especially in the single case. The perchlorate discharge test, although valuable, is difficult to undertake in the younger patient, and radiology may assist in diagnosing such patients.     

The musculoskeletal management of children with cerebral palsy

Orthopedic management of children with cerebral palsy is best accomplished with a team approach, which generally is effective in the other neuromotor disabilities of childhood, such as myelomeningocele and muscle disease. Because contracture development is inevitable in growing children with spastic musculature or muscle imbalance and is a prime cause of musculoskeletal dysfunction, its control over time using therapy, bracing, and medication is essential. Problems such as severe contracture, joint deformity, and scoliosis interfere with the basic requirement of comfortable seating in children with quadriplegic involvement and frequently require surgery. In ambulatory children, the use of three-dimensional gait analysis has allowed multilevel surgery to be appropriately planned, minimizing exposure to surgery and therapy.     

Mechanical efficiency of children with spastic cerebral palsy

In this feasibility study, the authors compared the mechanical efficiency of nine children with spastic diplegia with that of nine able-bodied children, matched for gender. They also compared resting energy expenditure in the two groups. The children with CP had significant reductions in mechanical efficiency at maximum stable work-load and marginally significant reductions when they were compared at 200 kg-m/min work-load. The efficiency of able-bodied children at 200 kg-m/min was unexpectedly reduced. There were no differences in resting energy expenditure. Mechanical efficiency may be a useful objective technique to assess the effects of interventions intended to improve the efficiency of the movement of children with CP.     

Arousal response to electrical stimulation of the cerebral cortex in cats.

Questions the belief that the arousal response produced by stimulation at various sites in the cortex is due to direct stimulation of the cortical component of a central arousal system. 3 observations of 9 female and 2 male cats were not consistent with this interpretation. Fractionation of the arousal response, subtotal parts of the reaction being produced by varying the intensity of cortical stimulation, occurred only when the S was in the resting state, and the arousal response habituated during repeated cortical stimulation. These observations on the arousal response to cortical stimulation were duplicated closely by the arousal response to an auditory stimulus. In agreement with a 1967 study by H. Ursin, K. Wester, and R. Ursin, it is suggested that the arousal response to stimulation of the cortex is a reflex to a sensory experience created by cortical stimulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Proximal rupture in the triceps surae a typical, but often unrecognized injury

An account is given of 12 high ruptures of the triceps surae, a traumatic lesion of the medial belly of the gastrocnemius, caused by sudden overstreching of the muscle by concomitant ankle dorsiflexion and full knee extension. In all cases the authors found characteristic clinical features. Surgical exploration in 5 of 12 cases verified the ruptures of the musculotendinous junction of the medial gastrocnemius belly. A follow-up study of 2 years showed that the surgical treatment seems to be better, especially in younger and athletic patients.     

Neonatal cytokines and coagulation factors in children with cerebral palsy

We explored the association of inflammatory mediators and markers of autoimmune and coagulation disorders with cerebral palsy (CP), examining 53 analytes in dried neonatal blood of 31 children with spastic CP, most born at term, and 65 control children. Ultramicroanalysis was performed by recycling immunoaffinity chromatography coupled with laser-enhanced fluorescence and chemiluminescence detection. Reactive antibodies to lupus anticoagulant, anticardiolipin, antithrombin III, and the translational product of the factor V Leiden mutation were isolated by recycling immunoaffinity chromatography and measured by capillary electrophoresis with chemiluminescence-enhanced immunoassay. Higher concentrations of interleukins (ILs) 1, 8, 9, tumor necrosis factor-alpha, and RANTES were observed in these children with CP than in any control child. There were also substantial elevations of IL-6, 11, 13, and other chemokines and colony-stimulating factors in children with CP. Antiphospholipid antibody was present in a titer of 1:100 or greater in 4 children with CP and no control child. Using cuts empirically chosen by recursive partitioning, we found higher concentrations of antibody to antithrombin III, to a translational product of factor V Leiden mutation, and to proteins C and S in children with CP than in controls. We conclude that inflammation and these coagulation abnormalities, which have interacting pathways, are important in the etiology of CP.     

Videofluoroscopic assessment in children with severe cerebral palsy presenting with dysphagia

In this study 16 patients with severe spastic cerebral palsy with an age range between 6 months and 16 years were examined using videofluoroscopy and a modified barium meal. All patients were slow, inefficient eaters. Silent aspiration was demonstrated in five cases. The latter five patients demonstrated a delayed swallow reflex but there was little correlation between aspiration and the oral phase of deglutition. Our data confirms the impression that early diagnostic workup including videofluoroscopy is helpful in managing the feeding difficulties in these children, and may prevent chronic aspiration and malnutrition.     

Infection by Toxoplasma gondii in children with infantile cerebral palsy

An analytic relationship between positivity of the indirect immunofluorescent test (IIFT) for toxoplasmosis and clinical findings in a population of 328 children with cerebral infantile palsy (CIP) was performed. Children were distributed by age in one of four groups: I (0-2 years); II (3-6 years); III (7-12 years) and IV (13-18 years). One control group of 168 children with no PCI clinical findings was included. 125 sera were positive at 1:64 dilutions. The study of the binomial mother-child of 40 cases rendered 26 mothers with significant titer values. The majority of positive mothers to IIFT correlated with the youngest children (Groups I, II and III), mainly with group I (70.0%), which showed the highest titer ranges. Correlation between positive IIFT and clinical features was as high as 100.0%.     

Pathologic morphology of the dislocated proximal femur in children with cerebral palsy

We describe the gross and microscopic anatomic changes in the hip that result from the deforming forces in children with neuromuscular imbalance. Twelve dislocated proximal femora that had been resected from children with spastic diplegia or tetraplegia were evaluated with respect to their gross, microscopic, and radiographic structure. The epiphyses were wedge shaped with deformation of the femoral head apparent in all cases. In addition to a severe loss of articular cartilage, a furrowed erosion of epiphyseal bone suggested a sustained, blunt, band-like force across the surface of the hip where it opposed the acetabular labrum. The underlying physis of the capital femur was irregular with aberrant histologic structure, whereas that of the lesser trochanter was hypertrophic and angulated in a superior and anterior direction. A significant degree of valgus was not noticeable in most specimens. In summary, the spastic adductor and iliopsoas, responsible for the changes in the lesser trochanter, work in conjunction with the hip flexor and internal rotator muscles to subluxate the proximal femur. In the process, the superior rim of the acetabulum and capsule causes focal deformation of the superolateral femoral head, creating a fulcrum upon which the hip then progressively subluxates. The indentation locks the femoral head at the lateral acetabular margin, preventing complete dislocation, but leading to bone pain consequent to cartilage erosion.     

Pain-related cerebral potentials in response to acute painful electrical stimulation in sheep

OBJECTIVE: To examine associations between late event-related cerebral potential amplitudes and behavioural responses to noxious electrical stimulation as an indicator of acute pain in sheep. DESIGN: Analysis of variance for the effects of stimulus intensity on the behaviour and event-related cerebral potential variables. PROCEDURE: Ninety-six brief constant current electrical pulse trains were presented to the front left leg of eight sheep at four intensities (2.5 to 10 mA) in a randomised order. An event-related cerebral potential and a graded flinch response were recorded for each stimulus and the 24 event-related cerebral potentials at each intensity were averaged to produce a mean waveform. Various components of this waveform were analysed and changes in these measures and the sheep's flinch response, as stimulus intensity increased, were determined. RESULTS: Both the flinch response and some event-related cerebral potential components, that is, peak amplitudes 114 [N1], 187 [P1], 318 [P2] and 230 [Pm] ms after stimulus onset, were significantly affected as stimulus intensity increased. CONCLUSION: These corresponding behavioural and event-related cerebral potential changes indicate the usefulness of using changes in the event-related cerebral potential to measure acute pain in sheep.     

Cocontraction and phasic activity during GAIT in children with cerebral palsy

Simultaneous activity of agonist and antagonistic muscles during a task is known as cocontraction. The primary aim of the present study was to use a cocontraction index (CI) to quantify differences in EMG activity between a group of CP and control children at two different walking speeds. The secondary aim was to compare the amount of time the muscles were activated ("on" thresholds) between the groups. Seventeen subjects volunteered for the study. One group consisted of 9 (7M, 2F) children with CP (age 12.7 +/- 2.8 years, mean +/- SD). The second group consisted of 8 able-bodied controls (7M, 1F). The discontinuous submaximal treadmill walking protocol had two 4min stages at 0% gradient. Speeds selected were 3 km.h-1 and 90% of the pre-determined fastest walking speed (FWS). Two sites of CI were measured from the EMGs of tibialis anterior and soleus (leg) and vastus lateralis and hamstrings (thigh). Significantly (p < 0.05) higher CI values were noted for the CP subjects compared to the controls, irrespective of speed or cocontraction site and there was a significant (p < 0.05) increase in CI values with increased walking speed for both CP and control subjects. Phasic analyses for 5% max EMG and 10% max EMG "on" thresholds demonstrated significant (p < 0.05) main effects for group (CP subjects had a longer time period of muscle activation than controls) and speed (muscles were active longer at 90% FWS than 3 km.h-1). The precise mechanisms by which cocontraction contributes toward abnormal gait and wasted mechanical energy require further research incorporating both electromyographic and kinematic analysis.