Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS)

Purpose: The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shunting on craniometric measurements during the follow-up of a cohort of infants with symptomatic triventricular hydrocephalus secondary to aqueductal stenosis. Methods: We performed a post hoc analysis of data from the International Infant Hydrocephalus Study (IIHS)—a prospective, multicenter study of infants (\u3c 24 months old) with hydrocephalus from aqueductal stenosis who were treated with either an ETV or shunt. During various stages of a 5-year follow-up period, the following craniometrics were measured: HC, HC centile, HC z-score, and frontal-occipital horn ratio (FOR). Data were compared in an analysis of covariance, adjusting for baseline variables including age at surgery and sex. Results: Of 158 enrolled patients, 115 underwent an ETV, while 43 received a shunt. Both procedures led to improvements in the mean HC centile position and z-score, a trend which continued until the 5-year assessment point. A similar trend was noted for FOR which was measured at 12 months and 3 years following initial treatment. Although the values were consistently higher for ETV compared with shunt, the differences in HC value, centile, and z-score were not significant. ETV was associated with a significantly higher FOR compared with shunting at 12 months (0.52 vs 0.44; p = 0.002) and 3 years (0.46 vs 0.38; p = 0.03) of follow-up. Conclusion: ETV and shunting led to improvements in HC centile, z-score, and FOR measurements during long-term follow-up of infants with hydrocephalus secondary to aqueductal stenosis. Head size did not significantly differ between the treatment groups during follow-up, however ventricle size was greater in those undergoing ETV when measured at 1 and 3 years following treatment

Treatment approaches to flexion contractures of the knee

The knee is the most affected joint in children with cerebral palsy. Flexion contracture of the knee is the cause of crouch gait pattern, instability in stance phase of gait, and difficulties during standing and sitting, and for daily living activities. It may also cause patella alta, degeneration of the patellofemoral joint, and stress fractures of the patella and tibial tubercle in young adults. Children with cerebral palsy may even give up walking due to its high energy demand in the adult period. The purpose of this article is to review the causes of the knee flexion contractures, clinical and radiological evaluations, and treatment principles in children with cerebral palsy. The biomechanical reasons of knee flexion deformity are discussed in detail in the light of previous Studies and gait analysis data

Wireless dual accelerometer wearable system for torso-head angle measurement during walking

In the literature, there exists no study examining the effects of looking down gait on gait parameters and foot pressure. This study presents a system that is able to measure head-torso angle during walking. The hardware part of the system is composed of; two 3-axial digital accelerometers that are located in occipital and dorsal regions, a microprocessor, a Bluetooth module and a battery. The acceleration data that is acquired by the microprocessor via I2C protocol is sent to the client computer through Bluetooth module. The reception, angle estimation and visualization are realized by the graphical user interface which is the software part of the system and developed under Python language. Developed system is tested both on a 2 degree-of-freedom arm and during walk on a subject

Interaction of ligament bundles and articular contacts for the simulation of passive knee flexion

The purpose of this study is to investigate the effects of anterior bundle of ACL (aACL), anterior portion of PCL (aPCL), anterior and deep portions of MCL (aMCL, dMCL) and the tibio-femoral articular contacts on to passive knee motion. A three-dimensional simplistic anatomical dynamic model, based on the literature was used as a reference. This reference model attaches the bundles of the ligaments on medial and the lateral spherical condyles of the femur and tibial plateau giving us a representation close enough to a normal natural tibio-femoral joint, but does not allow to study abnormalities of the knee kinematics due to the assumptions of the femur shape. The proposed three-dimensional dynamic tibio-femoral model, however includes the isometric fascicles, aACL, aPCL, aMCL, dMCL, and irregularly shaped medial-lateral contact surfaces. The approach taken in this model is capable of ligament and bone surface modifications that will enable us to analyze bone shape and ligament related abnormalities of knee kinematics

Fludrocortisone treatment in a child with severe cerebral salt wasting

Hyponatremia is a common complication of intracranial disease or surgery. An evaluation should be undertaken to determine whether cerebral salt wasting (CSW) or inappropriate secretion of antidiuretic hormone is present as a cause. Since the treatment principles are completely different in the two pathological states, differential diagnosis is very important. CSW is defined as the renal loss of sodium leading to hyponatremia and decreased extracellular fluid volume. In the literature, it has been noted that mineralocorticoid administration can be useful in CSW cases. We herein present an 11-year-old boy who developed hyponatremic seizures after intracranial tumor resection. He was diagnosed with CSW on the basis of high urinary sodium excretion and increased urine output, together with signs and symptoms of dehydration. Despite intensive fluid and salt therapy, we were unable to decrease the urinary output. Therefore, fludrocortisone therapy was administered and his urinary output and sodium excretion were decreased and his serum sodium level was normalized. In conclusion, in addition to fluid and salt replacement, mineralocorticoid supplementation also seems to be a safe and effective treatment for CSW. Copyright (C) 2001 S. Karger AG, Basel

An atretic parietal cephalocele associated with multiple intracranial and eye anomalies

We present the cranial MRI findings in a 4-month-old girl with an atretic parietal cephalocele associated with multiple cerebral and ocular anomalies including lobar holoprosencephaly, a Dandy-Walker malformation, agenesis of the corpus callosum, grey-matter heterotopia, extra-axial cysts in various locations, bilateral microphthalmia and a retroocular cyst

Effects of back loading on the biomechanics of sit-to-stand motion in healthy children

The goal of the present study was to determine the thus far unstudied effects of back loading on the kinematics and kinetics of sit-to-stand (STS) motion in healthy children. Fifteen children (8 boys, 7 girls, mean age 9.6 years, SD 1.2 years) were tested with no back load and with a back load of 10% and 20% of body weight, respectively. A motion analysis system was used with six infrared cameras and two force plates. Total STS duration did not change; however, differential effects were shown for the durations of its phases. Back loading increased ankle dorsiflexion yielding a greater maximal dorsiflexion angle. Effects on the knee angle were limited except for a significant decrease in final knee flexion. Initial and maximal hip flexion increased but final hip angle did not change. Initial backward pelvic tilt decreased and a shift to forward pelvic tilt occurred at an earlier stage of STS motion. Back loading affected trunk motion: maximal and final forward shoulder tilt increased. Maximal ankle and knee moments and powers increased; however, hip joint kinetics was not affected significantly. Therefore, while maintaining the general pattern of STS motion, participants showed selectively significant adjustments to back loading during its different phases. The main kinematic adjustments were increased trunk flexion and greater ankle dorsiflexion, while the major kinetic adjustment was increased knee extension moment. Increased back loading yielded more pronounced effects, primarily in the ankle. In sum, back loading substantially affected the biomechanics of STS motion even for the lower load level studied. This finding may be of clinical relevance for musculoskeletal disorders, but this needs to be examined. (C) 2007 Elsevier B.V. All rights reserved