1,721,014 research outputs found
D.D.S.H. : developmental displasia of the spastic hip : strategies of management in cerebral palsy : a new suggestive algoritm
No full textHip problems in cerebral palsy are relatively frequent (25-75%). Subluxation and dislocation of the hip is proportional to the neuromuscular involvement and is often due to alteration caused by spastic muscle forces acting on the femoral head in the acetabular cavity. The EMMA approach (Early Multilevel Minimally-invasive Approach) has been designed to restore muscle balance, decrease hip migration and prevent bone deformities thereby avoiding future pain with minimal biological cost to the patient. EMMA is suitable for most patients, especially those with increased tone, poor muscle control and selectivity, Reimer Index (R.I.) 20%. We consider age and R.I crucial prerequisites for treatment steps. EMMA 1) age 2-4 years, RI 20%: multilevel injection of botulinum toxin in case of muscular hyperactivity without morphological alterations of the couple muscle-tendon (contractures). EMMA 2) age 4-6, RI 20%: multilevel aponeurectomies in case of muscular hyperactivity with morphological alterations of the couple muscle-tendon (retraction). EMMA 3) early bone surgery (growth plates). This approach has been adopted in the last 4 years to prevent bone deformities and give early mobilisation and early control of the pain. EMMA is simple to apply even in infants, both for hip containment and to decrease spasticity
To fix or not to fix? The role of fibular fixation in distal shaft fractures of the leg
No full textBACKGROUND:
The role of stabilisation of the fibula in distal two-bone fractures of the leg is controversial. Some studies indicate the need for fibular stabilisation in 43 AO fractures, but few studies consider the role of the fibula in 42 AO fractures. The aim of the current paper is to explain the role of stabilisation of the fibula in 42 AO fractures, correlating the rates of healing and non-union between patients with and without fibula fixation.
MATERIALS AND METHODS:
A total of 60 patients with 42 AO (distal) shaft fracture of the tibia with associated fracture of the fibula were selected. Patients were divided into two groups according to whether or not the fibula was fixed: Group I (n=26) comprised patients who had their fibula fixed while Group II (n=34) comprised patients who did not. The fibular fracture was classified according to the AO and related to the level of the tibial fracture. Other parameters examined were the union rate of the two groups correlated to the fracture pattern and position of the fibular fracture; the demographic data, such as age and gender; the presence of an open fracture, and the type of tibial fixation device used (nail or plate).
RESULTS:
None of the parameters considered (open injury, AO classification, device used and level of the fibular fracture relative to the tibial) were shown to have an influence on the development of a non-union.
CONCLUSION:
This study showed a higher non-union rate when the fracture of the tibia and fibula were at the same level, the tibia was fixed with a bridging plate and the fibula left untouched. For this reason, we recommend fibular fixation in all 42 distal fractures when both fractures lie on the same plane and the tibial fracture is relatively stabilised
PREVENTION OF HIP DISLOCATION IN CEREBRAL PALSY : EARLY MULTILEVEL MINIMALLY-INVASIVE APPROACH (E.M.M.A.)
No full textIntroduction
Hip problems in Cerebral Palsy are frequent (25-75%). Subluxation and dislocation of the hip is proportional to the neuromuscular involvement and is often due to the alterate spastic muscles forces acting on the femoral head in the acetabular cavity.
Aim: E.M.M.A approach (Early Multilevel Minimally-invasive Approach) has been designed in 3 different steps and applayed to decrease imbalanced forces due to spasticity acting on the femoral head and therefore to decrease hip migration progression, bone deformities and future pain with the minimal biological cost for the patients.
We consider age and R.I. as crucial discriminants for treatment steps.
All muscles around the hip joint are addressed simultaneously (dductor longus, ileopsoas, medial hamstrings and rectus femoris).
Material and method
E.M.M.A. 1: age 2 - 4 years, RI ≤ 20%: multilevel injection of botulinum toxin in case of muscular hyperactivity without morphological alterations of the couple muscle-tendon (contractures)
E.M.M.A 2: age 4 - 6 , RI ≥ 20%: multilevel aponeurectomies in case of muscular hyperactivity with morphological alterations of the couple muscle-tendon (retraction)
E.M.M.A. 3: AGE 6-8 EMMA 2 associated to early bone surgery (proximal femoral temporary epiphysiorisis with cannulated screw to achieve a progressive correction of valgus deformity).
We adopted this approach to prevent bone deformities with early mobilisation and early control of the pain in the same time
Result
In our department were treated 40 children with hip subluxation and a mean follow-up of 28 months. None of our patients have had a progression to reach hip dislocation.
Conclusion
E.M.M.A seems to be a practical and little invasive approach to achieve hip containment, decrease spasticity and also appears to be satisfactory to prevent progressive acetabular displasia and hip dislocation
THE EFFECT OF INVITRO AND INVIVO CELLULAR AGING ON THE ACTIVE CALCIUM-TRANSPORT IN HUMAN INSIDE-OUT RED-CELL MEMBRANE-VESICLES
Full text linkModelling of the in, vivo and in, vitro aging processes in the human red cell has stressed the following features of the active calcium uptake by inside-out vesicles: 1) it is higher in the outdated, in, vitro aged, than in the fresh red cell (p<0.0005), and in the densest, in, vivo aged fraction than in the lightest, young fraction (p=0.08); 2) it increases following stimulation by excess calmodulin to values that are not significantly different; 3) it decreases to the same value in the absence of endogenous calmodulin and inhibitor, with and without exogenous calmodulin; 4) it is the target of a non-competitive inhibition, that is stronger in the fresh than in the outdated red cell. We conclude that the aging process does not involve neither membrane Ca-ATPase nor calmodulin, but rather the interaction of the calcium pump with the inhibitor of Ca-ATPase
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