A Review of Current Perspectives on Motoric Insufficiency Rehabilitation following Pediatric Stroke.

Pediatric stroke (PS) is an injury caused by the occlusion or rupture of a blood vessel in the central nervous system (CNS) of children, before or after birth. Hemiparesis is the most common motoric deficit associated with PS in children. Therefore, it is important to emphasize that PS is a significant challenge for rehabilitation, especially since the consequences may also appear during the child's growth and development, reducing functional capacity. The plasticity of the child's CNS is an important predecessor of recovery, but disruption of the neural network, specific to an immature brain, can have harmful and potentially devastating consequences. In this review, we summarize the complexity of the consequences associated with PS and the possibilities and role of modern rehabilitation. An analysis of the current literature reveals that Constraint-Induced Movement Therapy, forced-use therapy, repetitive transcranial magnetic stimulation, functional electrical stimulation and robot-assisted therapy have demonstrated at least partial improvements in motor domains related to hemiparesis or hemiplegia caused by PS, but they are supported with different levels of evidence. Due to the lack of randomized controlled studies, the optimal rehabilitation treatment is still debatable, and therefore, most recommendations are primarily based on expert consensuses, opinions and an insufficient level of evidence.

The importance of assessing general motor activity in premature infants for predicting neurological outcomes.

INTRODUCTION: Conventional methods of neurological assessment of infants can detect nervous system damage, but also have a weakness, i.e., the inability to make predictions for neurological deficits. Prechtl's general movement assessment is a diagnostic tool for the functional assessment of young nervous system. The aim of the study was to assess the quality of spontaneous motor activity in preterm newborns as well as to determine the neurological outcome at the age of 24 months. After that, the predictive value of spontaneous motor activity for neuro-developmental outcome at the age of 24 months was determined. MATERIAL AND METHODS: The study included 160 pre-terms children, and designed as a prospective clinical study. Observation of spontaneous motor activity was performed according to the principles of Prechtl's method. RESULTS: Spontaneous motor activity was observed in three periods for each newborn: within 5 days of birth, in the period of 44-46 gestation weeks, and in the period of 50-54 gestation weeks of post-menstrual age. Neurological outcome was assessed at the age of 24 months, and was classified as: normal finding, minimal neurological dysfunction, and cerebral palsy. All preterms, who presented normal patterns of spontaneous movements in neonatal and infant periods had a normal neurological functional outcomes at the age of 24 months. Newborns with pathological patterns of movement (cramped synchronized and absence of fidgety movements) in neonate and infant periods in the final outcomes had minimal neurological dysfunction or cerebral palsy. CONCLUSIONS: Assessment of general movement in preterms is a valuable method in prediction of dysfunctions in later neurological development. Early detection of symptoms of minimal neurological deficit and cerebral palsy is of crucial importance since it enables timely inclusion of children into neuro-developmental treatment.

The Quantitative ER Immunohistochemical Analysis in Breast Cancer: Detecting the 3 + 0, 4 + 0, and 5 + 0 Allred Score Cases.

The currently used immunohistochemical approach in determining the estrogen receptor (ER) positivity of breast cancers (BCs) is inherently subjective and additionally limited by its semi-quantitative nature. The application of software in the analysis of digitized slide images may overcome some of these limitations. However, the utilization of such an approach requires that the entire staining procedure is standardized. BACKGROUND AND OBJECTIVES: We aimed to establish a procedure for the photometric and morphometric analysis of BC immunohistochemical parameters that can possibly be used for a diagnostic purpose that is in line with the current semi-quantitative scoring system. MATERIALS AND METHODS: Semi-quantitative analysis of ER-stained tissue sections was performed following the Allred scoring system guidelines. The quantitative analysis was performed in ImageJ software after color deconvolution. The quantitative analysis of 66 cases of invasive lobular BC included: Percent of ER-positive cells, average nuclear coloration intensity, and the quantitative ER score. The percent of ER-positive tumor cells was counted using a standard grid overlay, while optical density (0.0-1.0) was measured within each nucleus at the grid points. RESULTS: A statistical analysis revealed a significant positive correlation (r = 0.886, p < 0.001) between the subjective semi-quantitative and quantitative ER scores, with a large effect size (d = 3.8215). We observed strong statistically significant correlations between individual parameters of the total ER score, percentage of ER-positive nuclei, and color intensity, obtained by the two independent methods. CONCLUSIONS: Additionally, besides excluding subjectivity, the up to now unreported cases of 3 + 0, 4 + 0, and 5 + 0 Allred scores were detected only by the application of the proposed quantitative approach.

Immunohistochemical features of multifocal and multicentric lobular breast carcinoma.

PURPOSE: Patient age, tumor size, axillary lymph node status, expression of estrogen, progesterone and HER2 receptors, as well as the histological grade, are widely accepted prognostic and predictive parameters in breast carcinoma. In invasive lobular carcinoma (ILC), the prognostic factors, such as nodal status and tumor size are believed to be the most valuable ones. The aim of this was set to determine the possible linkage between MFity/MCity of ILC and immunohistochemical predictive (ER, PR, HER2) and prognostic parameters (BRCA1, p53, E-cadherin, Ki-67). MATERIAL/METHODS: Out of 2486 cases diagnosed with BC from south-eastern Serbia, the presence ILC was noted in 334 cases. Immunohistochemical characterization of predictive and prognostic parameters in ILC was done. RESULTS: The occurrence of multifocal (MFC) and multicentric carcinoma (MCC) was observed in 18.9% of ILC. Bilateral (BL) BCs were found to be statistically significantly more frequent in younger women, compared to those with MFC, MCC or nonMFC/MCC/BL. No significant correlation was found between MFC/MCC and the presence of axillary lymph node metastases, and expression of immunohistochemical predictive and prognostic parameters. Based on literature data and the findings from the current work, MFity/MCtiy might represent negative morphologic prognostic parameters in ILC. CONCLUSIONS: In 334 cases analyzed, no statistically significant correlations were observed between MF/MC and the expression of immunohistochemical predictive and prognostic parameters.

Are Interferential Electrical Stimulation and Diaphragmatic Breathing Exercises Beneficial in Children With Bladder and Bowel Dysfunction?

OBJECTIVE: To evaluate the effects of interferential current (IC) stimulation and diaphragmatic breathing exercises (DBEs) in children with bladder and bowel dysfunction. PATIENTS AND METHODS: Seventy-nine children with dysfunctional voiding and chronic constipation who were failures of primary care interventions were included in the prospective clinical study. All the children were checked for their medical history regarding lower urinary tract symptoms and bowel habits. Physical examination, including abdominal and anorectal digital examination, was performed. Children kept a bladder and bowel diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys, and uroflowmetry with pelvic floor electromyography. Eligible children were divided into 3 groups (A, B, and C). All groups were assigned education and behavioral modifications. Additionally, group A underwent DBEs and IC stimulation, whereas group B received only DBEs. The treatment was conducted for 2 weeks in the clinic in all 3 groups,. The behavioral modifications and DBEs were continued at home for 1 month. Clinical manifestations, uroflowmetry parameters, and postvoided residual urine were analyzed before and after 6 weeks of therapy. RESULTS: After the treatment, significant improvement in defecation frequency and fecal incontinence was noticed only in group A (P < .001 and P < .05, respectively). These children demonstrated significant improvement in lower urinary tract symptoms and postvoided residual urine (P < .001 and P < .05, respectively). Bell-shaped uroflowmetry curve was observed in 73.3% of group A patients (P < .001). CONCLUSION: IC stimulation and DBEs are beneficial in chronically constipated dysfunctional voiders. Further trials are needed to define the long-term effects of this program.

Relationship between fear of falling and functional status in nursing home residents aged older than 65 years.

AIM: The present study investigated the relationship between fear of falling and functional status, and sociodemographic and health-related factors in nursing home residents aged older than 65 years. METHODS: The cross-sectional study involved 100 participants who were residents of a nursing home and aged older than 65 years. Fear of falling was assessed using the Falls Efficacy Scale. Functional status was assessed by four performance-based measures. Balance was assessed by the Berg Balance Scale, mobility by the Timed Up and Go test, lower limbs muscle strength by the Chair Rising Test and participants' functional ability by the motor Functional Independence Measure. RESULTS: There was a significant negative correlation between the Falls Efficacy Scale and Berg Balance Scale (P < 0.001), and motor Functional Independence Measure (P < 0.001) scores; and a positive correlation with the Timed Up and Go test (P < 0.001) and Chair Rising Test (P < 0.001) values. Falls Efficacy Scale score increase is associated with age, being a widower/widow and the number of falls in the previous year. Higher fear of falling is associated with an increase in the number of falls in the previous year and with a decrease in Berg Balance Scale score. CONCLUSIONS: The study found a significant associations between Falls Efficacy Scale score and all of the examined parameters of functional status, the number of falls in the previous year, age and marital status of widower/widow. The major finding was that poor balance and an increase in the number of falls in the previous year are independent factors significantly associated with the fear of falling. Geriatr Gerontol Int 2017; 17: 1470-1476.

Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants.

BACKGROUND: Adverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) characteristics as well as with abnormal general movements (GMs) in the 1st month of life. AIMS: To demonstrate to what extent GMs assessment can predict neurological outcome in preterm infants in our clinical setting; and to assess the clinical usefulness of time-domain indices of heart rate variability (HRV) in improving predictive value of poor repertoire (PR) GMs in writhing period. STUDY DESIGN: Qualitative assessment of GMs at 1 and 3 months corrected age; 24h electrocardiography (ECG) recordings and analyzing HRV at 1 month corrected age. SUBJECTS: Seventy nine premature infants at risk of neurodevelopmental impairments were included prospectively. OUTCOME MEASURES: Neurodevelopmental outcome was assessed at the age of 2 years corrected. Children were classified as having normal neurodevelopmental status, minor neurologic dysfunction (MND), or cerebral palsy (CP). RESULTS: We found that GMs in writhing period (1 month corrected age) predicted CP at 2 years with sensitivity of 100%, and specificity of 72.1%. Our results demonstrated the excellent predictive value of cramped synchronized (CS) GMs, but not of PR pattern. Analyzing separately a group of infants with PR GMs we found significantly lower values of HRV parameters in infants who later developed CP or MND vs. infants with PR GMs who had normal outcome. CONCLUSIONS: The quality of GMs was predictive for neurodevelopmental outcome at 2 years. Prediction of PR GMs was significantly enhanced with analyzing HRV parameters.

Scintigraphy evaluation of the types of functional constipation in children with bowel bladder dysfunction.

PURPOSE: To evaluate the types of constipation according to colonic transit time in chronically constipated children with dysfunctional voiding (bowel bladder dysfunction, BBD group) and to compare the results with transit type in children with chronic functional constipation without urinary symptoms (constipation group) and children with normal bowel habits, but with lower urinary tract symptoms (control group). PATIENTS AND METHODS: One-hundred and one children were included and their medical histories were obtained. The BBD group kept a voiding diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys and uroflowmetry with pelvic floor electromyography. Radionuclear transit scintigraphy was performed in all children according to a standardized protocol. Patients were categorized as having either slow-transit (ST), functional fecal retention (FFR) or normal transit. RESULTS: FFR was diagnosed in 31 out of 38 children with BBD, and 34 out of 43 children in the constipation group. ST was found in seven children with BBD, compared with nine children in the constipation group. The control group children demonstrated normal colonic transit. Urgency, daily urinary incontinence and nocturnal enuresis were noted only in children with FFR. Both children with ST constipation and FFR complained of difficulties during voiding, voiding postponement and urinary tract infections. CONCLUSIONS: FFR is the most common form of constipation in children with dysfunctional voiding. However, some children might suffer from ST constipation. Differentiation between these two types of constipation is clinically significant because they require different treatment. Future studies with larger numbers of patients are needed to confirm the noted differences in urological symptoms in these two groups of constipated children..

Placebo-controlled investigation of low-level laser therapy to treat carpal tunnel syndrome.

OBJECTIVE: This study investigated the short-term efficacy of low-level laser therapy (LLLT) in patients with mild to moderate carpal tunnel syndrome (CTS), lasting for <1 year. METHODS: Seventy-nine patients with CTS were included in this double-blind, placebo-controlled study, and randomly divided in two treatment groups: Experimental group (EG), active laser group (40 patients); and control group (CG), placebo (sham) laser group (39 patients). A GaAlAs diode laser [780 nm, 30 mW continuous wave (CW), 0.785 cm(2), 38.2 mW/cm(2)] was applied in contact with four points perpendicularly to the skin over the carpal tunnel area for 90 sec per point (2.7 J, 3.4 J/cm(2)/point). Both groups were treated five times per week, once a day over 2 weeks, followed by 10 treatments every other day for 3 weeks, that is, for a total of 20 treatments. Clinical assessment, including visual analogue scale (VAS) pain rating, Tinel's sign, and median nerve conduction studies (NCSs) were evaluated before, and 3 weeks after, the last LLLT treatment. RESULTS: Significant reduction in pain, reduction in the percentage of patients with a positive Tinel's sign, and shortening of sensory and motor latency time in the NCS examination was observed in the experimental LLLT group (but not in the control group). CONCLUSIONS: This study has observed and documented the statistically significant short-term effects of LLLT on CTS patients in comparison with a placebo group. The results support this conclusion, especially if the LLLT is applied in the earlier stages of CTS, and with mild to moderate cases.

Effect of periodontal treatment in renal transplant recipients.

OBJECTIVE: To evaluate the effect of periodontal treatment on gingival overgrowth in a group of renal transplant patients. SUBJECTS AND METHODS: Twenty-five renal transplant recipients receiving immunosuppressive therapy with cyclosporine A (CsA) were randomly assigned to 2 groups. Group 1 (n = 15) included patients who had been specifically referred to a dental clinic to prevent gingival overgrowth and were given full periodontal therapy. Group 2 (n = 10) was comprised of patients who did not receive any professional periodontal cleaning. Patients from both groups were examined to determine their periodontal status before and after 3, 6 and 12 months in terms of their plaque index, gingival index and gingival overgrowth. During the examination, their overall health was stable. RESULTS: For group 1, the scores were 1.89 (baseline), 0.98 (6 months) and 0.56 (12 months), and hence there were significant reductions (p = 0.0001). The gingival indices were 1.71 (baseline), 0.76 (6 months) and 0.35 (12 months), and the reductions were also significant (p = 0.0001). A significant association was observed between poor oral hygiene and the degree of gingival overgrowth. The 1-year post-treatment follow-up showed that patients in group 1 did not develop gingival overgrowth due to the use of CsA as group 2 did without prior periodontal therapy. CONCLUSION: Oral hygiene status was the most important variable related to the development and degree of gingival overgrowth due to the use of CsA.

Gigantic ureteral diverticulum or pelvic cyst?

Ureteral diverticulum is a rare anomaly, and very few reported cases concerning it can be found in literature. We report a 3.5-year-old boy who presented with urinary tract infection, rare voiding, and straining during voiding. Ultrasonography and magnetic resonance imaging showed a cystic pelvic mass. At surgical intervention, however, a massive ureteral cystic structure communicating both with the ureteropelvic and ureterovesical portion of the ureter was observed. Finding the presence of a smooth muscle layer, the pathologist confirmed this to be a true diverticulum. The fact that fenoterol (which was used for the prevention of preterm labor in the boy's mother) significantly decreases frequency and amplitude of upper urinary tract contractions suggests that fenoterol treatment might have influenced the occurrence of this abnormality.

Primary gallbladder melanoma in dysplastic nevus syndrome: report of case and literature review.

A case of gallbladder malignant melanoma in a 62-year-old woman is reported. The gallbladder, resected for tumor mass seen on ultrasound examination, revealed neoplastic epithelioid cells with dark granules in the cytoplasm. These cells with pigment were positive immunohistochemically for S-100, HMB45 and vimentin. The patient, affected by dysplastic nevus syndrome, had a history of a melanoma in situ in her left upper arm that was excised 11 years ago. This is only the second case reported to date of primary malignant melanoma in dysplastic nevus syndrome.

Immunohistohemical evidences of pregnancy in uterine curettage tissue by the use of a double immunocytochemical staining technique using cytokeratin 7 and vimentin antibodies.

BACKGROUND/AIM: Usual histopatological diagnosis of intrauterine pregnancy is made by demonstration of chorionic villi, but in the curettage tissue from intrauterine miscarriage they may not be present in all cases. The use of monoclonal antibody against cytokeratin as a sensitive and reliable marker for the morphologic discrimination between invasive trophoblastic (IT) cells and decidual cells has been well established. The aim of this study was to determine the presence of pregnancy in endometrial curettings when chorionic villi are absent from patients suspected of intrauterine pregnancy. METHODS: Twenty cases of endometrial tissue specimens were investigated for cytokeratin and vimentin expression by a double immunostaining for detection of IT cells. RESULTS: Out of the total number of cases (20) 17 cases expressed cytokeratin 7 positive IT cells, that are an evidence of pregnancy. CONCLUSION: The obtained results indicated, that double immunohistochemical demonstration of cytokeratin and vimentin is useful for identifying pregnancy in all chorionic villi-negative cases.

[Lynch syndrome I: a case report].

INTRODUCTION: Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndromes I and II, accounts for about 5-8% of colorectal cancers. Lynch syndrome I is an autosomal dominant inherited disorder characterized by early onset of colorectal cancer, predominance of proximal and multiple tumors, and microsatellite instability. In order to identify HNPCC, the international "Amsterdam criteria" have been used. CASE REPORT: The proband was a 40-year-old male who was admitted to hospital with a diagnosis of advanced rectal cancer. Left colectomy was carried out. A histopathologic diagnosis of poorly differentiated adenocarcinoma of clinical stage Dukes C was made. The family talking was done and it was revealed that the proband had five family members (one of first degree relative) with colorectal cancer, and two successive generations affected. All malignancy were diagnosed before 45 years of age. In one family member, metachronous transverse cancer was revealed 12 years after surgery for cecal adenocarcinoma. DISCUSSION AND CONCLUSION: The main molecular cause for HNPCC is constitutional mutation in one of the mismatch repair (MMR) genes that regulate the excision of errors occurring during DNA replication. The most often are mutations of MLH1 and MSH2 genes, and microsatellite instability is present in about 90-95% HNPCC. In this report, we present a case of an HNPCC patient who met the Amsterdam criteria for Lynch syndrome I. Family members that fulfil the Amsterdam criteria should be investigated for mutation in MMR genes. The genetic tests are not routinely available, so colonoscopic screening of all asymptomatic family members older than 25 has been recommended.

The value of modified DASH questionnaire for evaluation of elbow function after supracondylar fractures in children.

BACKGROUND/AIM: The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire represents a region-specific instrument for functional outcome measurement of hand function. The aim of the study was to analyse the correlation between the values of modified DASH questionnaire and change of elbow function after supracondylar fracture (SCF) of humerus and to analyse the effects of early rehabilitation. METHODS: The study included 35 schoolaged children with flexion of SCF of humerus without lesion of nerves. The patients were divided into two groups: group A in which rehabilitation started up to 14 days after the removal of fixation (20 children), and group B in which rehabilitation started after 15 days and more (15 children). The effects of the applied rehabilitation procedures were analyzed by measuring the range of motion of elbow and using modified DASH questionnaire. Testing was performed during the first examination, on the first day of rehabilitation (retest) and after the rehabilitation. Pearson's coefficient of liner correlation was applied. RESULTS: Statistically significant negative correlation of DASH score and extension was verified in all three measurements. The values for the first test and for the final test were highly significant (p < 0.001), as well as negative correlation of DASH score and flexion on the first test and retest (p < 0.01), and at the end of rehabilitation (p < 0.001) in the group B. For all three tests in the group A negative correlation without significant differences for DASH score and flexion was found. CONCLUSION: A modified DASH questionnaire correlates with objective parameters of final status of elbow after SCF in children and it is applicable to small series of patients. A positive effect of early rehabilitation of children with SCF was found.

Computer-assisted quantitative analysis of Ki-67 antigen in dysplasia--associated lesions or masses in ulcerative colitis.

BACKGROUND/AIM: The aim of this study was to apply computer-assisted methodology in assessment of Ki-67 positivity in "adenoma-like" dysplasia associated lesions or masses (DALMs), and carcinoma in ulcerative colitis (UC), and to determine a new approach to grading of Ki-67 staining intensity. METHODS: Immunohistochemical slides were quantitatively analyzed for estimation of proportion and intensity of Ki-67 positive-stained cells in a total of 50 "adenoma-like" DALMs (27 with low-grade dysplasia and 23 with high-grade dysplasia), and 17 adenocarcinomas associated with UC. The four grades of immunohistochemical staining intensity were established by an automated classification of nuclear optical densities. RESULTS: The Ki-67 labeling index (LI) in low-grade dysplasia was significantly lower than in high-grade dysplasia, and carcinoma (p < 0.001). The Ki-67 LI of carcinomas was not significantly different from the value obtained in high-grade dysplasia (p > 0.05), however having the difference in percentage values of the moderate stained nuclei (p < 0.05). The overall average values of chromogene nuclear optical density, showed statistically significant differences between DALMs and carcinoma (p < 0.05), although not between normal mucosa and low-grade dysplasia (p > 0.05). CONCLUSION: The obtained results imply, according to the overall percentage of labeled nuclei, that high-grade dysplasia is very close to carcinoma, while there is the difference in the percentage of moderately stained nuclei. We showed that Ki-67 positivity have a different internal distribution which could be useful in analysing these lesions. These findings also, indicate the important biological differences between low-grade dysplasia and carcinoma in UC, and a low proliferative potential of the former. Automated image analysis permits an objective [corrected] estimation of Ki-67 immunohistochemical staining in UC-associated dysplasia and carcinoma.

[Preoperative and postoperative histopathological findings in patients with endometrial hyperplasia].

INTRODUCTION: The aim of this study was to analyze and compare the histopathological findings in curettage and hysterectomy specimens, to evaluate the accuracy of histopathological diagnosis in curettage specimens, and to determine the frequency of coexisting endometrial carcinoma in patients with histopathological diagnosis of endometrial hyperplasia. MATERIAL AND METHODS: Curettage and hysterectomy specimens of 135 female patients with initially diagnosed endometrial hyperplasia were retrospectively analyzed and compared. RESULTS: Simple hyperplasia was found in 49 patients (36.3%), complex hyperplasia in 14 (10.4%), simple atypical hyperplasia in 24 (17.8%), and complex atypical hyperplasia in 48 (35.5%) patients. After hysterectomy, 59 (43.7%) patients were found to have simple hyperplasia, 12 (8.9%) complex hyperplasia, 15 (11.1%) simple atypical hyperplasia, 18 (20.7%) complex atypical hyperplasia, and 21 (15.5%) endometrial carcinoma. The accuracy of histopathological diagnosis of endometrial hyperplasia in curettage specimens was 82.2-89.6% and dependent on the types of hyperplasia. The frequency of coexisting endometrial carcinoma was significantly higher (p < 0.001) in patients with atypical hyperplasia than in patients with hyperplasia without cytological atypia. After hysterectomy, coexisting endometrial carcinoma was found in 27.8% of patients with histopathological diagnosis of atypical hyperplasia in curettage specimens. In contrast to simple atypical hyperplasia, the frequency of coexisting endometrial carcinoma was significantly higher (p < 0.05) in complex atypical hyperplasia. CONCLUSION: The frequency of coexisting endometrial carcinoma in hysterectomy specimens in patients with histopathological diagnosis of atypical hyperplasia in curettage specimens was relatively high and it should be taken into account when planning therapy.

Clinical diagnostic problems associated with cecal ameboma: case report and review of the literature.

Amebiasis is uncommon in developed countries. Its clinical presentation can be variable and non-specific, and the diagnosis can be easily overlooked. Among the wide variety of clinicopathologic manifestations of the intestinal amebiasis, amebomas occur rarely, resulting from the formation of annular colonic granulation tissue, usually in the cecum or ascending colon. This report describes the case of a 65-year-old female who presented with a painful mass in the right hypochondrium and intermittent abdominal cramping, associated with defecation difficulty. Radiologic examination depicted thickening of the cecal wall and its ring-like stenosis in association with a mesenteric reaction. Because of concentric thickening of the cecal wall and the mass-like appearance, a preliminary clinical diagnosis of cecal cancer was made, and the patient was referred to the Clinic for surgical treatment. Histologic examination of the surgical specimen after segmental colectomy confirmed the diagnosis of cecal ameboma. The authors conclude that multiple granulomas of amebic trophozoites can be better recognized after PAS staining, and that the pathognomonic feature of protozoa-ingested red blood cells was also seen in the surgical specimen.

[Botulinum toxin type A for the treatment of spasticity in children with cerebral palsy].

BACKGROUND/AIM: Cerebral palsy (CP) is the most common physical disability in childhood. Children have problems with motor functions as a result of limbs spasticity, which leads to severe contractures and limbs deformity. There is a growing interest in the therapeutic role of botulinum toxin type A (BTA) in CP. The aim of this study was to examine the effects of BTA on spasticity, active range of motion and functional motor outcomes in children with CP. METHODS: This study included 42 children of both sexes, aged 2-6 years, with spastic CP, divided into two groups: group I (21 child) treated with BTA and physical therapy, and group II (21 child) treated with physical therapy only. The following parameters were analyzed: spasticity; active range of motion of the hip, knee and ankle, and functional motor outcome. These parameters measurements were carried out four times in both groups: before the treatment, three, eight and 16 weeks after the beginning of the treatment. The obtained results were statistically processed and compared. RESULTS: There was no evidence of any significant difference between the groups before the treatment. After eight weeks there was a remarkable difference concerning spasticity reducing on behalf of the group I (group I -- 0.76 +/- 0.51 vs. II group -- 2.17 +/- 0.64; p < 0.0001). There was statistically significant difference concerning active range of motion increasing on behalf of the group I (hip abduction: group I --44.37 +/- 1.13(0) vs. group II -- 32.61 +/- 8.07(0),p < 0,01; knee extension: group I -- 0.77 +/- 1.82(0) vs. II group -- 14.99 +/- 7.61(0), p < 0.01; dorsiflexion of the foot: group I -- 11.50 +/- 6.08(0) vs. group II -- 8.98 +/- 7.85(0), p < 0.01). A statistically significant difference was found after 16 weeks in functional motor outcome as well, on behalf of the group I: functional motor abilities level in the group I was 1.86 vs. 2.71 in the group II, p < 0.05. CONCLUSION: Botulinum toxin type A application leads to an important spasticity decreasing, active range of motion increasing, as well as to functional abilities in children with CP.