[The spastic hand. Postoperative rehabilitation]. / Die spastische Hand. Grundlagen der postoperativen Rehabilitation.

Postoperative rehabilitation starts with preoperative evaluation of the patient. The outcome of rehabilitation measures is strongly dependent on the surgeon's ability to define a realistic rehabilitation aim, i.e., a goal the patient can achieve with a high degree of probability. Therefore, knowledge of the patient's individual basic situation and status as well as of the autonomic development of the different categories of cerebral palsy is of great importance. The operative procedures used are well established in cerebral palsy surgery. They are accepted as standard procedures. The decisive question is to whom they are offered. The same conditions pertain to the postoperative rehabilitation period. During that time a combination of functional bracing and physiotherapy plus occupational therapy is offered after primary cast immobilization. This period is finished when the specific aim has been achieved, i.e., integration of the gained function into everyday life.

Critical aspects of tissue-engineered therapy for bone regeneration.

Recent advances in bone tissue engineering are established on the understanding of an engineered scaffold, the molecular milieu within the osteogenic site, and the cell(s) predisposed to an osteogenic lineage. Advances in the incorporation of a generative vehicle into a skeletal defect require temporal and spatial distribution of the scaffold, growth factor, and cell compatible with enhanced bone healing. Monitoring events culminating in osteogenesis has focused on phenotypic and intracellular indicators. Phenotypic and intracellular indicators include the presence of receptors and intracellular signals that enable cell proliferation and differentiation. Progress in the areas of scaffold design, growth factor utilization, bone cell lineage, and intracellular signaling are reviewed.

Therapeutic potential of bone morphogenetic proteins.

Recently, there has been substantial progress in the area of bone morphogenetic protein (BMP) research. This review serves as an up-to-date summary of the history of BMPs, the mechanisms of BMP signalling and the role of BMPs in adipose, kidney, liver, bone and nervous system. The potential of BMPs as therapeutic agents will also be discussed.

[Zurich Intervention Planning and Evaluation Form (ZIPEF): a procedure for quality control of therapeutic interventions]. / Der Zürcher Interventionsplanungs- und Evaluationsbogen (ZIPEB): Ein Verfahren zur Qualitätskontrolle therapeutischer Massnahmen.

This paper introduces the Zurich Intervention Planning and Evaluation Form (ZIPEF). The instrument covers (1) treatment problems, (2) interventions as to type, duration, and time expenditure, (3) treatment outcome and (4) causal factors. A total of 413 treatment problems were evaluated with the ZIPEF in a public child and adolescent psychiatric service. Depending on the target (e.g. symptoms, personality, relationship) the distribution of types of intervention differed. Time expenditures were significantly higher only for client-centred interventions than for parent counseling and similar for all other interventions. Treatment outcome and cooperation were independent from type of intervention. The main causal factor of treatment outcome for almost all types of interventions was cooperation followed by resources in some types of intervention. Complexity of the treatment problem tended to be another important determinant for treatment outcome. In summary, the ZIPEF can contribute to quality management in the area of intervention planning and evaluation of clienteles with mental health problems.

Lower limb muscle activity in ambulatory children with cerebral palsy before and after the treatment with Botulinum toxin A.

Purpose: The study investigated the effect of Botulinum toxin A on the gait and lower limb muscle activity of ambulatory CP children. Methods: 19 spastic diplegic and 4 left hemiparetic CP children were injected with a mean dose of 23.5 units of Botulinum toxin A/kg body weight into the gastrocnemius and hamstring muscles. Muscle tone and gait analysis including the kinesiological electromyogram of the shank and thigh muscles were assessed before and four weeks after injection and compared with the help of a multivariate analysis (p < 0.05). Results: Botulinum toxin A caused a definite reduction of plantarflexor, knee and hip hypertonia in 21 children, resulting in a more plantar grade and erect gait in 17 children four weeks after injection. Gait analysis showed a statistically significant improvement in peak ankle dorsi-flexion and knee extension during stance, and the length of the force point of action under both feet increased. Electromyography revealed sig-nificantly less co-contraction of the lower leg muscles, due to a more phasic instead of a tonic activity of the tibialis anterior muscle, and an improved activation pattern of the left rectus and biceps femoris muscles. Conclusions: The present study demonstrated that the injection of Botulinum toxin A resulted in a more mature muscle activation pattern of CP children. Most of the children walked more plantigrade and erect, the functional gait parameters, however, did not change.

Botulinum toxin A in the management of spastic gait disorders in children and young adults with cerebral palsy: a randomized, double-blind study of "high-dose" versus "low-dose" treatment.

The present study was performed to assess dose-response relationships of local botulinum toxin A (BtxA) treatment in children and teenagers with spastic gait due to cerebral palsy (CP) in a randomized, double-blind study employing a "high-dose" (200 units Botox per leg) and a "low-dose" (100 units Botox per leg) treatment arm in 33 patients with CP. Response parameters included changes in muscle tone assessed by the Ashworth scale at knee joint, range-of-motion (ROM) measurements at knee and ankle joint, objective analysis of longitudinal gait parameters as well as subjective assessments of improvement. Patients in the "high-dose" arm received 40-80 units Botox/muscle versus 20-40 units Botox/muscle in the "low-dose" group. Patients in both treatment arms showed significant improvement of Ashworth score (p<0.001) and ROM (p<0.01), while gait analysis revealed significant increase in gait velocity (p<0.01) and stride-length (p<0.001) over baseline. Subjects in the "high-dose" group showed significantly greater improvement on objective response measurements compared to "low-dose" patients. Also, children aged 7 years or less had greater functional benefit compared to the subgroup of patients older than 7 years. Incidence and severity of side-effects were similar in both treatment groups. The present study demonstrated dose-dependent functional improvement of dynamic deformities and spastic gait pattern in children and young adults with CP treated with local injections of botulinum toxin. A dose of 200 units Botox per leg distributed to 4 or 5 muscle bellies per leg is superior compared to 100 units Botox per leg without significantly affecting the risk of side-effects.

[Current status of orthotic management of children with meningomyelocele]. / Aktueller Stand der apparativen Versorgung von Kindern mit Meningomyelocele.

The supplying of Spina bifida children with orthotic devices leads to a remarkable success only, if it is based on the preexisting possibilities of the overall development and the present situation of the child. To realize the aim of maximum autonomy in standing and walking this overall analytic perspective is a must for all therapeutic planing and decisions. Therefore, static and dynamic orthoses like hip guidance-combined with above-knee orthoses, standing and walking-aids like reciprocating gait orthoses etc. are decisive assumptions. The most important characteristics of all orthoses are, the child to feel the economizing effect concerning standing and walking. Then only optimum acceptance and integration of the orthotic devices into activities of daily living can be achieved.

Surface glycoprotein of influenza C virus: inactivation and restoration of the acetylesterase activity on nitrocellulose.

The influenza C glycoprotein HEF was analyzed for acetylesterase activity after SDS-polyacrylamide gel electrophoresis and transfer to nitrocellulose membranes. Using a histological esterase assay, the glycoprotein was detected as a colored band indicating that it is enzymatically active. The enzyme activity was not affected by low pH, but was abolished after denaturation by SDS as well as after breaking the disulfide bonds by reducing agents. Glycoprotein inactivated by SDS regained its enzyme activity if the ionic detergent was displaced by either bovine serum albumin or a nonionic detergent. The stability of the enzyme combined with the color assay provides a convenient tool to study the acetylesterase activity of the influenza C virus glycoprotein.

The osteogenic potential of two composite graft systems using osteogenin.

The purpose of this study was to determine the quantity of new bone formation in critical sized calvaria defects in rats treated with two composite graft systems. The systems consisted of either a combination of the bone inductive protein (osteogenin) plus type I collagen (Os + C) or the combination of osteogenin with coralline hydroxyapatite (Os + HA). Additional treatments consisted of coralline hydroxyapatite (HA) or untreated control defects. After 28 days the calvaria were recovered and processed for quantitative radiography (radiomorphometry) and histomorphometry. Histomorphometric results were based on quantitation of regenerated trabecular bone. Results indicated that the Os + C combination produced substantially more bone than the Os + HA, HA, or control groups (P less than 0.05). Radiomorphometric assessment was based on the detection of radiopacity in the calvarial wounds. Due to the radiopaque property of HA, it was not possible to accurately quantitate the radiopacity of the regenerating bone from HA and host bone. Therefore, conclusions about the efficacy of the treatments must be derived from histomorphometric data. Results from histometric measurements of healing indicate that the Os + C combination has the greatest potential for regenerating calvarial bone defects. The potential for osteogenin in regenerating alveolar bone lost due to periodontal disease is suggested by these studies.

[Development of operative therapy in a public hospital 1910 to 1980]. / Die Entwicklung der operativen Therapie in einem Versorgungskrankenhaus von 1910 bis 1980.

An analysis of the operation records for the years from 1910 to 1980 shows a considerable increase in the indication for surgical treatment. While the average age of the groups of patients does not increase in general, an increase in the number of patients operated on in higher age can be proved. This paper gives an outline of problems of preparation for operations, the application of narcosis techniques and postoperational care for these groups of patients.

[IgG-IgM cryoglobulinemia with a purpura-arthralgia-nephritis syndrome]. / IgG-IgM-Kryoglobulin ämie mit Purpura-Arthralgie-Nephritis-Syndrom.

The clinical and laboratory features in 7 patients with essential mixed cryoglobulinemia are presented. The clinical picture was characterized by arthralgia, purpura and glomerulonephritis (3 patients). The cryoprecipitate consisted of IgM and IgG, the IgM being monoclonal (3 patients) with anti-IgG activity. Depressed C4 and/or C3 values were detected in 5 patients and were not correlated with the presence of nephritis. The IgM levels were elevated in 5 patients. The possibility that the disorder represents an immune complex mediated vasculitis is supported by the ability of the cryoglobulins to activate the complement system and by the detection of immunoglobulins and/or complement in the vasculitic lesions in the glomerula or the skin. Treatment by plasma exchange, steroids and azathioprine or cyclophosphamide was followed by a definite improvement in the purpura and the arthralgia, whereas the proteinuria, microhematuria and hypocomplementemia were not affected by therapy.

Longitudinal mixing in pulmonary airways--normal subjects respiring at a constant flow.

We have measured the impulse response of helium and sulfur hexafluoride in the airways of five normal human subjects at a respiratory flow of 400 ml/s. The longitudinal mixing of the inert gases was characterized by the increased volume variance of the expired concentration response. This parameter was measured over the largest possible range of airway penetrations, 30-290 ml. Employing a symmetrical model of the airway geometry, we have computed the values of a mean mixing coefficient from the volume variance data. This mixing coefficient is largest in the large airways and decreases rapidly with increasing penetration; it may be as much as 4,000 times greater than the molecular diffusivity; and it is relatively independent of the inert gas tested, at least up to an airway penetration of 180 ml. These observations are consistent with several preivously proposed mixing mechanisms including axial streaming, turbulent dispersion, and mixing by geometric asymmetry. However, the latter observation appears to rule out the importance of laminar dispersion since mixing by this mechanism is inversely dependent on the molecular diffusivity.