scholarly journals Multi-Level Fibrotomy for Pediatric Patients with Cerebral Palsy: A Cohort Study

Osteology ◽  
2021 ◽  
Vol 1 (3) ◽  
pp. 141-148
Author(s):  
Pier Francesco Costici ◽  
Sergio De Salvatore ◽  
Rosa Russo ◽  
Leonardo Oggiano ◽  
Aaron Burrofato ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Cohort Study ◽  
Pediatric Patients ◽  
Healing Process ◽  
Surgical Techniques ◽  
Control Group ◽  
Motion Recovery ◽  
Ambulant Patient ◽  
Retrospective Nature

Muscle retraction in Cerebral Palsy (CP) often requires surgical treatment. Multilevel procedures (using open or percutaneous techniques) are commonly performed in the ambulant patient with CP. The necessity to find new surgical techniques, reduce postoperative discomfort, and accelerate the healing process and rehabilitation is mandatory for these patients. A retrospective cohort study with 189 pediatric patients with CP was performed. The multilevel gradual fibrotomy of Ulzibat was modified using an ophthalmic knife. No significant complications were reported using our technique. Opioid drugs were not necessary, and casting time was reduced at the first 24 h. A significant Range of Motion recovery was assessed post-operatory and maintained at the last follow-up. Mean days of hospitalization were 2.2. The mean follow-up was 39 months (6–64 months). The modified multilevel fibrotomy reduces postoperative pain with easier patient management, resulting in a faster discharge from the hospital. However, the retrospective nature and the lack of a control group of the present study did not allow the authors to report significant results. Further studies with longer follow-up are in progress to obtain more certain data that confirm our preliminary results.

Long-Term Follow-Up of Early Cochlear Implant Device Activation

2021 ◽  
pp. 1-11
Author(s):  
Stefanie Bruschke ◽  
Uwe Baumann ◽  
Timo Stöver
Keyword(s):  
Speech Recognition ◽  
Side Effects ◽  
Cochlear Implant ◽  
Surgical Techniques ◽  
Control Group ◽  
First Year ◽  
Safe Procedure ◽  
Sound Processor

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery. Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study. Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery. Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups. Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation.

scholarly journals Motor learning-based activities may improve functional ability in adults with severe cerebral palsy: A controlled pilot study

2021 ◽  
pp. 1-11
Author(s):  
Helle Hüche Larsen ◽  
Rasmus Feld Frisk ◽  
Maria Willerslev-Olsen ◽  
Jens Bo Nielsen
Keyword(s):  
Cerebral Palsy ◽  
Motor Learning ◽  
Motor Function ◽  
Functional Ability ◽  
Active Group ◽  
Control Group ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Learning Principles

BACKGROUND: Cerebral palsy (CP) is a neurodevelopmental disturbance characterized by impaired control of movement. Function often decreases and 15% of adults are classified as severely affected (Gross Motor Function Classification Scale III-V). Little is known about interventions that aim to improve functional abilities in this population. OBJECTIVE: To evaluate a 12-week intervention based on motor learning principles on functional ability in adults with severe CP. METHODS: 16 adults (36±10 years, GMFCS III-V) were enrolled and divided into an intervention group (Active group) and a standard care group (Control group). Primary outcome measure was Gross Motor Function Measure (GMFM-88). Secondary measures were neurological status. The Active group were measured at baseline, after the intervention and at one-month follow-up. The Control group were measured at baseline and after one month. RESULTS: Analysis showed statistically significant improvement in GMFM-88 for the Active group from baseline to post assessment compared with the Control group (group difference: 5 points, SE 14.5, p = 0.008, CI: 1.2 to 8.7). Improvements were maintained at follow-up. Results from the neurological screening showed no clear tendencies. CONCLUSIONS: The study provides support that activities based on motor learning principles may improve gross motor function in adults with severe CP.

Asthma and Immunoglobulin E Antibodies After Respiratory Syncytial Virus Bronchiolitis: A Prospective Cohort Study With Matched Controls

PEDIATRICS ◽  
1995 ◽  
Vol 95 (4) ◽  
pp. 500-505 ◽  
Author(s):  
N. Sigurs ◽  
R. Bjarnason ◽  
F. Sigurbergsson ◽  
B. Kjellman ◽  
B. Björkstén
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Respiratory Syncytial Virus ◽  
Prospective Cohort ◽  
Egg White ◽  
Control Group ◽  
Igg Antibodies ◽  
Ige Antibodies ◽  
Syncytial Virus

Objective. To study the occurrence of bronchial obstructive symptoms and immunoglobulin (Ig) E antibodies after respiratory syncytial virus (RSV) bronchiolitis in infancy. Previous studies of this subject have mostly been retrospective or without controls, or the controls have not been followed prospectively. Design. This was a prospective cohort study with matched controls. Participants. Forty-seven infants had experienced RSV bronchiolitis severe enough to cause hospitalization at a mean age of 3½ months. For each child with RSV infection, two controls were acquired from the local Child Health Center and matched for date of birth, sex, and residence. Only one control was obtained for one RSV child, and the control group thus contained 93 children. Methods. All the children underwent two follow-up examinations, the first one at a mean age of 1 year and the second at a mean age of 3 years. At the first follow-up, a skin-prick test against egg white was performed, and serum IgG antibodies against RSV were measured. At the second follow-up, serum IgE antibodies were measured using screening tests for common food and inhalant antibodies, and skin-prick tests against egg white, cat, birch, and mite allergen were performed. Hereditary and environmental factors (passive smoking, indoor furred animals) and duration of breast-feeding were recorded. Results. At the first follow-up, 89% in the RSV group and 27% in the control group had IgG antibodies against RSV (P &lt; .001). At the second follow-up, asthma, defined as three episodes of bronchial obstruction verified by a physician, was found in 11 of 47 children (23%) in the RSV group and in 1 of 93 children (1%) in the control group (P &lt; .001). A positive test for IgE antibodies was noted in 14 of 44 (32%) RSV children and in 8 of 92 (9%) children in the control group (P = .002). An analysis of risk factors for the development of asthma and IgE antibodies on the whole group of 140 children showed that RSV bronchiolitis was the most important risk factor, and a family history of atopy or asthma further increased the risk. Conclusions. Respiratory syncytial virus bronchiolitis during the first year of life apparently is an important risk factor for the development of asthma and sensitization to common allergens during the subsequent 2 years, particularly in children with heredity for atopy/asthma.

Application of a collagen matrix dressing on a neuropathic diabetic foot ulcer: a randomised control trial

2020 ◽  
Vol 29 (Sup3) ◽  
pp. S13-S18 ◽  
Author(s):  
Gholamreza Esmaeeli Djavid ◽  
Seyed Mehdi Tabaie ◽  
Siamak Bashardoust Tajali ◽  
Mehrangiz Totounchi ◽  
Amirreza Farhoud ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Wound Care ◽  
Healing Process ◽  
Collagen Matrix ◽  
Complete Healing ◽  
Randomised Control Trial ◽  
Control Group ◽  
Study Group ◽  
Number Of Patients

Objective: Diabetic foot ulcers (DFU) are often hard-to-heal, despite standard care. With such a complicated healing process, any advanced wound care to aid healing is recommended. Chitosan/collagen composite hydrogel materials have the potential to promote the regenerative process. In this study, the efficacy of a new collagen matrix dressing including chitosan/collagen hydrogel was compared with a standard dressing of saline-moistened gauze for wound healing in patients with a hard-to-heal neuropathic DFU. Method: This is an open labelled, randomised clinical trial. After conventional therapy consisting of debridement, infection control and offloading, patients were randomly allocated to receive either a collagen matrix dressing (the study group, receiving Tebaderm manufacturer) or a saline-moistened gauze dressing (control group) for wound care. The reduction in DFU size and the number of patients with complete healing were measured throughout the treatment and in follow-up. Results: A total of 61 patients with a neuropathic DFU were recruited. Average percentage reduction in DFU size at four weeks was greater in the study group compared with the control group (54.5% versus 38.8%, respectively). Rate of complete healing rate at 20-weeks' follow-up was significantly better in the study group than the control group (60% versus 35.5%, respectively). Conclusion: The collagen matrix dressing used in this study accelerated the healing process of patients with a hard-to-heal DFU. Further research may suggest the used of this dressing to shorten the length of time to achieve complete healing.

Cost-effectiveness of adjunct haemoglobin spray in the treatment of hard-to-heal wounds in a UK NHS primary care setting

2019 ◽  
Vol 28 (12) ◽  
pp. 844-849
Author(s):  
Fredrik Elg ◽  
Gerhard Bothma
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Clinical Evaluation ◽  
Standard Care ◽  
Healing Process ◽  
Intervention Group ◽  
Community Setting ◽  
Control Group ◽  
Care Protocol

Objective: To evaluate the cost-effectiveness of topical haemoglobin spray as adjunct therapy in the treatment of hard-to-heal wounds within a UK National Health Service (NHS) community setting. Method: In a previously published comparative clinical evaluation, 50 consecutive patients treated with topical haemoglobin spray, as adjunct to standard care and followed up over 26 weeks, were compared with 50 consecutive retrospective controls from the same clinic treated with the same standard care protocol in the year prior to the introduction of adjunct topical haemoglobin spray. A de novo cost-effectiveness and break-even analysis were performed, using data from the previously published clinical evaluation, for all patients (intent-to-treat) and for patients with complete follow-up using a micro-costing approach and considering only wound care dressing costs. Results: At 26 weeks, the total cost of dressings for all patients in the intervention group was £6953 with 874 cumulative weeks healed, compared with £9547 with 278 cumulative weeks healed for all patients in the control group. The incremental cost-effectiveness ratio (ICER), the incremental cost per additional week healed with adjunct topical haemoglobin spray, is therefore negative (dominant). Total treatment costs per week were lower from week six onwards, with break-even estimated to be at week 10.2. When considering only patients with complete follow-up, the results were similarly dominant, with a mean 10.9 more weeks healed, a mean dressing cost saving per patient of £81.83 by week 26 (–37%). Cost savings were realised from week five, and a break-even was estimated to occur at week 8.0. Conclusion: Topical haemoglobin spray has the potential to restore the healing process, reduce healing times and reduce dressing costs in a NHS community setting, within a few weeks of adoption.

Survival analysis of maintenance therapy with capecitabine (Cape) in patients with resected pancreatic adenocarcinoma (PAC) after adjuvant therapy: A retrospective cohort study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14658-e14658
Author(s):  
Xuezhong Yang ◽  
Benjamin Weinberg ◽  
Jimmy J. Hwang ◽  
Christina Sing-Ying Wu ◽  
Madeeha Akram ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Maintenance Therapy ◽  
Survival Data ◽  
Prolonged Exposure ◽  
Cancer Center ◽  
Control Group ◽  
Study Group

e14658 Background: The 5-year survival of PAC with surgery alone is below 10%, and with adjuvant chemotherapy increases to about 20%. The original GITSG adjuvant study demonstrating a survival benefit compared to surgery could be attributed to the use of 2-years of weekly IV bolus 5FU, and not only chemoradiation. In theory, the prolonged exposure to therapy could maintain pressure on dormant cancer cells that may remain in G0 arrest, by attacking them as they infrequently enter G1/S phase. To evaluate this hypothesis, we retrospectively evaluated our pts who were treated with or without maintenance Cape. Methods: Pts in the Georgetown/Lombardi Cancer Center EMR since Oct 2007 were sought for PAC that was resected with curative intent, received standard adjuvant chemotherapy with or without chemoradiation. The study group received maintenance cape for at least 2 months, and the control group was monitored until disease recurrence. Only pts with complete follow-up survival data were analyzed. Results: 20 pts met the criteria as study group, and 58 pts as the control group. In the study group, cape was usually given 1000mg orally twice a day, Monday through Friday following adjuvant therapy, for an indefinite period, up to 2 years. Pts received cape for median duration of 12.5 months (2 to 24 months), and the median follow-up duration was 33 months (16 to 78 months). The median overall survival (OS) for the study group was 48 months. The 2 year OS was 94%, and 5 year OS was 40%. The median recurrence free survival (RFS) was 39 months. The 2 year RFS was 67%, and the 5 year RFS was 25%. Common toxicities were mild hand-and-foot syndrome and fatigue. 4 pts discontinued cape due to toxicities: febrile neutropenia, severe fatigue, weight loss and diarrhea. The control group was of comparable staging, and the median OS was 22 months, 5 year OS rate was 16%, median RFS was 13 months, 2 year RFS was 19%. Conclusions: In this single institute retrospective controlled cohort study, Cape maintenance therapy following adjuvant therapy in resected PAC is associated with a significantly (p<0.05) higher OS and PFS compared to the control group. This approach should be studied in a RCT.

Pediatric discharge against medical advice

2019 ◽  
Vol 32 (2) ◽  
pp. 366-374 ◽  
Author(s):  
Emad Al-Mohammadi
Keyword(s):  
Pediatric Patients ◽  
Medical Advice ◽  
Control Group ◽  
Control Groups ◽  
Against Medical Advice ◽  
Content Type ◽  
Discharge Against Medical Advice ◽  
And Control ◽  
Structured Questionnaire

Purpose The purpose of this paper is to identify the reasons for discharges against medical advice (DAMA) and the possible outcomes among pediatric patients. Design/methodology/approach A retrospective cohort study was conducted on all children admitted and then discharged against medical advice in two maternity and children’s hospitals in Jeddah, 2014. Phone interviews were conducted, and medical records were reviewed for DAMA and control groups; a semi-structured questionnaire was used to collect this information. Findings The top three reasons identified for DAMA were parent’s false assumption that their child’s condition had improved (43.8 percent), dissatisfaction with treating/managing team (16.2 percent) and difficulties arranging care for patient’s siblings at home (7.7 percent). The readmission rate was significantly higher among DAMA pediatric patients compared to the control group (28.5 percent vs 11.5 percent) at 30-day follow-up, which highlights the importance for developing interventions aimed at reducing DAMA. Originality/value This study helps us to better understand DAMA reasons and outcomes. Understanding these factors can encourage appropriate interventions and policies for reducing DAMA rates. In this way, pediatric patients can be protected from inappropriate discharge consequences.

339 Outcome of Tibial Selective Motor Fasiculotomy in the Management of Equinovarus Deformity Due to Cerebral Palsy (A Prospective Cohort Study in 14 Children)

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 276-276
Author(s):  
Pavankumar Pelluru ◽  
Aneelkumar Pulugopu ◽  
Aniruddhkumar Purohit ◽  
Naveenkumar Balane
Keyword(s):  
Cerebral Palsy ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Lower Limbs ◽  
Safe Procedure ◽  
Plantar Flexors ◽  
Motor Abilities ◽  
Modified Ashworth Scale

Abstract INTRODUCTION Tibial Selective Motor fasiculotomy involves ablation of hyperexcitable tibial nerve fasicles, which help in reduction of spasticity in ankle plantr flexors METHODS This prospective cohort study included 14 children with cerebral palsy, age ranging from 5–18 (mean 10.21) years and M: F ratio is 5:1 having spasticity in the lower limbs. All the children were assessed pre and post operatively by Modified Ashworth Scale (MAS), Selective Voluntary Control (SVC) grade and locomotor Abilities (kneel walking, squat to stand, standing and walking). Tibial SMF was performed (n = 23) for relief of spasticity in ankle plantar flexors in 14 children and were followed for a mean of 30 (6-60) months. All the children were given physical therapy pre and post operatively. RESULTS >During a mean follow up (30 months) there was statistically significant reduction in spasticity (MAS, P < 0.005) from1.92 to 0.31 in ankle plantar flexors. Pre and post operative SVC grade also improved from 2.65 to 3.35 in ankle plantar flexors (p > 0.005). There were no complications and spasticity did not recur during follow up. 9 children required Z plasty simultaneously to relieve the contracture. CONCLUSION The Tibial SMF of tibial nerves significantly relieves spasticity in the ankle plantar flexors and thereby improves SVC equinous deformity and motor abilities in children having cerebral palsy. It is quite a safe procedure and the spasticity does not recur during a mean follow up of 30 months.

scholarly journals Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study

BMJ ◽  
2021 ◽  
pp. n37
Author(s):  
Alain Weill ◽  
Pierre Nguyen ◽  
Moujahed Labidi ◽  
Benjamin Cadier ◽  
Thibault Passeri ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Skull Base ◽  
Cumulative Dose ◽  
Cyproterone Acetate ◽  
Exposed Group ◽  
Additional Analysis ◽  
Control Group ◽  
High Dose

Abstract Objective To assess the risk of meningioma associated with use of high dose cyproterone acetate, a progestogen indicated for clinical hyperandrogenism. Design Observational cohort study. Setting Data from SNDS, the French administrative healthcare database, between 2007 and 2015. Participants 253 777 girls and women aged 7-70 years living in France who started cyproterone acetate between 2007 and 2014. Participants had at least one reimbursement for high dose cyproterone acetate and no history of meningioma or benign brain tumour, or long term disease status. Participants were considered to be exposed when they had received a cumulative dose of at least 3 g during the first six months (139 222 participants) and very slightly exposed (control group) when they had received a cumulative dose of less than 3 g (114 555 participants). 10 876 transgender participants (male to female) were included in an additional analysis. Main outcome measure Surgery (resection or decompression) or radiotherapy for one or more intracranial meningiomas. Results Overall, 69 meningiomas in the exposed group (during 289 544 person years of follow-up) and 20 meningiomas in the control group (during 439 949 person years of follow-up) were treated by surgery or radiotherapy. The incidence of meningioma in the two groups was 23.8 and 4.5 per 100 000 person years, respectively (crude relative risk 5.2, 95% confidence interval 3.2 to 8.6; adjusted hazard ratio 6.6, 95% confidence interval 4.0 to 11.1). The adjusted hazard ratio for a cumulative dose of cyproterone acetate of more than 60 g was 21.7 (10.8 to 43.5). After discontinuation of cyproterone acetate for one year, the risk of meningioma in the exposed group was 1.8-fold higher (1.0 to 3.2) than in the control group. In a complementary analysis, 463 women with meningioma were observed among 123 997 already using cyproterone acetate in 2006 (risk of 383 per 100 000 person years in the group with the highest exposure in terms of cumulative dose). Meningiomas located in the anterior skull base and middle skull base, particularly the medial third of the middle skull base, involving the spheno-orbital region, appeared to be specific to cyproterone acetate. An additional analysis of transgender participants showed a high risk of meningioma (three per 14 460 person years; 20.7 per 100 000 person years). Conclusions A strong dose-effect relation was observed between use of cyproterone acetate and risk of intracranial meningiomas. A noticeable reduction in risk was observed after discontinuation of treatment.

scholarly journals Change in popliteal angle and hamstrings spasticity during childhood in ambulant children with spastic bilateral cerebral palsy. A register-based cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Merete Aarsland Fosdahl ◽  
Reidun Jahnsen ◽  
Are Hugo Pripp ◽  
Inger Holm
Keyword(s):  
Cerebral Palsy ◽  
Cohort Study ◽  
Level Ii ◽  
Modified Ashworth Scale ◽  
Significant Difference ◽  
Second Year ◽  
Level I ◽  
Ashworth Scale ◽  
Gmfcs Level

Abstract Background Muscle contractures are developing during childhood and may cause extensive problems in gait and every day functioning in children with cerebral palsy (CP). The aim of the present study was to evaluate how the popliteal angle (PA) and hamstrings spasticity change during childhood in walking children with spastic bilateral CP. Methods The present study was a longitudinal register-based cohort study including 419 children (1–15 years of age) with spastic bilateral CP, gross motor function classification system (GMFCS) level I, II and III included in the Norwegian CP Follow-up Program (CPOP). From 2006 to 2018 a total of 2193 tests were performed. The children were tested by trained physiotherapists yearly or every second year, depending on GMFCS level and age. The PA and the hamstrings spasticity (Modified Ashworth scale (MAS)) were measured at every time point. Both legs were included in the analysis. Results There was an increase in PA with age for all three GMFCS levels with significant differences between the levels from 1 up to 8 years of age. At the age of 10 years there was no significant difference between GMFCS level II and III. At the age of 14 years all three GMFCS levels had a mean PA above 40° and there were no significant differences between the groups. The hamstrings spasticity scores for all the three GMFCS levels were at the lower end of the MAS (mean < 1+), however they were significantly different from each other until 8 years of age. The spasticity increased the first four years in all three GMFCS levels, thereafter the level I and II slightly increased, and level III slightly decreased, until the age of 15 years. Conclusion The present study showed an increasing PA during childhood. There were significantly different PAs between GMFCS level I, II and III up to 8 years of age. At the age of 14 years all levels showed a PA above 40°. The spasticity increased up to 4 years of age, but all the spasticity scores were at the lower end of the MAS during childhood.

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