Metabolite alterations in autistic children: a 1H MR spectroscopy study.

PURPOSE: The purpose of this study was to assess the role of proton magnetic resonance spectroscopy (1H MRS) in the detection of changes in cerebral metabolite levels in autistic children. MATERIAL AND METHODS: Study group consisted of 12 children, aged 8-15 years, who were under the care of Pediatric Neurology Department and Pediatric Rehabilitation Department of Medical University of Bialystok. The diagnosis of autism was established by neurologist, psychiatrist and psychologist in every case. All patients matched the clinical criteria of the disease according to International Statistical Classification of Diseases and Related Health Problems (ICD-10). The control group included 16 healthy children aged 7-17. 1H MRS was performed with a single-voxel method (TE-36, TR-1500, NEX-192). The volume of interest (VOI) was located in the frontal lobe regions, separately on each side. RESULTS: We showed lower N-acetylaspartate/creatine (NAA/Cr), γ-aminobutyric acid /creatine (GABA/Cr) and glutamate/creatine (Glx/Cr) in the frontal lobes in the study group comparing with healthy controls. The ratio of myoinositol/creatine (mI/Cr) was increased in autistic children. No differences in choline/creatine (Cho/Cr) ratio in study group and controls were found. There was a correlation between age and NAA/Cr in autistic children (R=0.593 p=0.041). No significant differences in metabolite ratios between right and left hemisphere in ASD and controls were found. CONCLUSIONS: (1)H MRS can provide important information regarding abnormal brain metabolism. Differences in NAA/Cr, GABA/Cr, Glx/Cr and mI/Cr may contribute to the pathogenesis of autism.

Schizencephaly as a cause of spastic cerebral palsy.

PURPOSE: The objective was to investigate the clinical features of schizencephaly in children with spastic cerebral palsy. MATERIAL AND METHODS: The present study included 180 children with cerebral palsy, spastic tetraplegia, diplegia, and hemiplegia. All magnetic resonance (MR) scans were obtained using a 1.5 T MR scanner with the use of a standard circularly polarized head coil. RESULTS: Significant abnormalities relevant to cerebral palsy were evident on MRI in 95%. Periventicular leukomalacia was detected more frequently in children with spastic diplegia than in other patients. Cerebral atrophy was found more often in tetraplegic patients. Porencephalic cysts were detected more often in children with spastic hemiplegia. Congenital brain anomalies were evident in 20 (11.1%) children with spastic cerebral palsy. Twelve patients had schizencephaly with cerebral palsy. Children with spastic diplegia and tetraplegia had bilateral schizencephaly; patients with spastic hemiplegia only had unilateral schizencephaly. Most patients with schizencephaly had epilepsy. CONCLUSIONS: Schizencephaly occurred more often in patients with spastic hemiplegia. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the introduction of appropriate therapy.

Dysphagia in children with infantile cerebral palsy.

PURPOSE: Dysphagia is a significant health problem in children with infantile cerebral palsy (ICP), but not frequently discussed in the literature. The study objective was to analyse dysphagia symptoms in children with a pyramidal form of ICP, including the oral and pharyngeal phases of deglutition and dysarthria severity. We searched for a correlation between dysphagia severity and ICP type, mental development and occurrence of epilepsy. MATERIAL AND METHODS: A total of 67 children with a pyramidal form of infantile cerebral palsy were studied. Data were obtained based on case history elicited from the mothers, analysis of medical and psychological documentation, and logopaedic examination, including an examination of the action of swallowing. RESULTS: Dysphagia symptoms were found in 41 (61%) studied children, most frequently referring only to the oral phase (25 children), with concomitant mild and moderate dysarthria. Oral and pharyngeal dysfunctions were observed in 14 children and coexisted with more pronounced dysarthria symptoms. The most severe disorders were mainly found in the pharyngeal phase in 2 children. A statistically significant correlation was noted between the severity of dysphagia symptoms and the ICP type (p<0.044) and mental development (p<0.00002). CONCLUSIONS: Swallowing dysfunctions occur in the majority of children (>50%) with ICP. More serious disorders involving the oral and pharyngeal phases mainly affect children with tetraplegia and profound mental impairment. These disorders continue from early infancy through childhood and adolescence and improvement has been mainly observed when only the oral phase of swallowing is affected. These are always accompanied by dysarthria symptoms, which are especially severe when dysphagia involves the oral and pharyngeal phases. Early assessment and stimulation of the swallowing function should be a common element in the rehabilitation and care of children with ICP.

Risk factors for cerebral palsy in term birth infants.

PURPOSE: The aim of this study was to identify the antenatal, intrapartum and neonatal risk factors in term birth infants for cerebral palsy (CP) among babies in a hospital-based study. MATERIALS AND METHODS: The medical records of children with cerebral palsy referred to our Pediatric Rehabilitation Department in Bialystok were reviewed. Antenatal, intrapartum, and neonatal events were compared among 213 children with CP and 280 controls in a retrospective study. We studied live births >36 weeks gestation born between January 1, 1990, and December 31, 2005. RESULTS: Fifty-seven percent of the infants with CP were male. Spastic tetraplegia 78 (36.61%) and spastic hemiplegia 65 (30.51%) were the dominant types of CP. Factors associated with an increased risk of CP identified as antenatal and intrapartum risk factors were pre-eclampsia, abruptio placenta, and placenta previa. Birth asphyxia occurred significantly more often (p<0.001) in children with CP compared to controls. In the neonatal period, respiratory distress syndrome, meningitis and neonatal seizures were associated with an increased incidence of CP. CONCLUSION: Our findings confirm that several antenatal, intrapartum and neonatal risk factors for CP in term birth infants contribute to the etiology of CP.

Somatosensory evoked potentials in epileptic children treated with carbamazepine or valproate in monotherapy - a preliminary study.

PURPOSE: Data from the literature suggest that long-term therapy with various antiepileptic drugs can be responsible for the functional disturbances within the nervous system e.g. peripheral neuropathy and encephalopathy. Useful and non-invasive instruments for evaluation of even subclinical nerve conduction abnormalities in somatosensory tracts are somatosensory evoked potentials (SEPs). The aim of this study was to assess the potentially drug-induced abnormalities in the SEP parameters in epileptic children, treated chronically in monotherapy with one of the two most often used antiepileptic drugs: valproate (VPA) or carbamazepine (CBZ). MATERIALS AND METHODS: SEP from left median nerve stimulation were recorded in twenty children with idiopathic/cryptogenic epilepsy treated in monotherapy with CBZ (9 patients) or VPA (11 patients). The mean age of the patients was 13.4 ± 2.9 years (range 7-17 years). The plasma concentrations of the drugs were consistently within therapeutic range. The mean duration of treatment was eight months. The control group consisted of twenty-four age-matched children with tension type headache. The latencies of the components: N9, N13, N20, P25 and the peripheral conduction time (PCT) and central conduction time (CCT) were analyzed. RESULTS: No significant differences in all analyzed SEP parameters between the epileptic and control children were found. CONCLUSIONS: Our results indicate that during the first 8 months from the beginning of antiepileptic treatment in children, monotherapy with VPA or CBZ does not induce nerve conduction disturbances within both the peripheral- and the central part of the somatosensory tracts, detected in SEP examination.

Assessment of risk factors for osteoporosis and fractures in children with meningomyelocele.

PURPOSE: Our objective was to assess bone and muscular mass in children with meningomyelocele (MMC), and to analyze risk factors for osteoporosis and fractures based on densitometric examination. MATERIAL AND METHODS: The study group included 30 patients (15 girls and 15 boys) with MMC, aged 6-17 years, treated in the Department of Pediatric Rehabilitation, University Hospital. Physiotherapeutic assessment and laboratory tests (serum parathormone, alkaline phosphatase levels, calcium, and phosphate levels, and urine calcium levels) were performed. Densitometry was measured by dual energy X-ray absorptiometry using a Lunar DPX-L apparatus. Lean mass (fat-free tissue content) and fat mass (% fat content) was evaluated. RESULTS: Femur fractures were the most common 12/30 (40%); 5/30 (17%) of the children with MMC had multiple fractures. The incidence of fractures correlated significantly with BMI and body fat content (p = 0.03) Children with MMC and fractures had a tendency toward higher BMI, despite the same absolute value of body mass, compared to those without fractures. Body fat levels were higher in MMC patients with fractures than in those without fractures (BMI R = 0.393, p = 0.03). Children with MMC and fractures had significantly higher 24 h calcuria values, despite normal renal function indices (p = 0.03). CONCLUSIONS: Low-energetic fractures in MMC children may result from metabolic disturbances that are a consequence of excessive renal calcium loss or excessive fatty tissue content.

Annual variations of quantitative EEG in patients with chronic epilepsy.

PURPOSE: Annual changes in powers of the close-eyed EEG were measured over 12 months in 12 patients with epilepsy. MATERIAL AND METHODS: The present study included 12 patients aged 14.6+/-2.7 years with chronic epilepsy, suffering for 6-14 years. EEGs were recorded every month between 9 and 11 a.m. Five patients had generalized seizures and 7 partial complex seizures secondarily generalized. Visual analysis of EEG was performed before the quantitative assessment. The signals were recorded using a set of 14 (F3, F4, F7, F8, C3, C4, P3, P4, 01, 02, T3, T4, T5, T6) scalp electrodes. For each patient, 20 artifact-free EEG epochs, each of 2 s. duration were selected for spectral analysis to calculate spectral power. The sampling frequency was 240 Hz. Frequencies below 1 Hz and above 70 Hz were eliminated by digital filtering. The channels were recorded relative to a vertex reference. A fast Fourier transformation algorithm of signal processing was used to obtain the power spectrum of each lead. Absolute power spectrum was calculated within 4 frequency bands: delta (1-3.99 Hz), theta (4-7.99 Hz), alpha (8-12.99 Hz), and beta (13-30.99 Hz). RESULTS: We found the abnormalities to be predominantly focal in EEG. None of the EEG recordings were normal, and the power spectra differed over the year. A statistically significant increase of delta and theta bands in May and a decrease of alpha bands in September was found. We did not find positive correlations between the changes in the quantitative EEG analysis and the number of seizures in patients. CONCLUSIONS: These findings suggest the annual variations of EEG in patients with chronic epilepsy. Furthermore studies are needed to clarify the annual variations of EEG among healthy volunteers.

Clinical and neuroimaging profile of congenital brain malformations in children with spastic cerebral palsy.

PURPOSE: Analysis of the incidence of congenital brain malformations in children with spastic cerebral palsy (CP) in a hospital-based study. MATERIAL AND METHODS: The present study included 74 boys and 56 girls with spastic tetraplegia, diplegia, and hemiplegia CP. Magnetic resonance imaging MRI findings were analyzed in children with CP. RESULTS: Significant abnormalities relevant to the CP were evident on MRI in 124 (95.3%) subjects. Periventicular leukomalacia (PVL) was detected more frequently in children with spastic diplegia than in patients with tetraplegia or hemiplegia. Cerebral atrophy was found more often in the tetraplegic group compared to the diplegic patients. Porencephalic cysts were detected more often in children with spastic hemiplegia. Congenital brain anomalies were evident in 15 (10.7%) children with spastic CP. Brain malformations included: schizencephaly (5), agenesis corpus callosum (4), polymicrogyria (2), holoprosencephaly (2) and lissencephaly (2). Intractable epilepsy and mental retardation were observed more often in children with brain anomalies. Twelve patients with congenital brain malformations were born at term and three born at preterm. CONCLUSIONS: Neuroimaging results in children with CP may help determine the etiology and make better prognosis of CP.

Impression cytology of the conjunctival epithelial cells in patients with cystic fibrosis.

PURPOSE: Cystic fibrosis (CF) is the most frequent lethal autosomal recessive hereditary disorder. The disease affects all secretory epithelia, including the eye, and belongs to the group of ocular surface epithelial diseases, termed keratoconjunctivitis sicca or dry eye syndrome. The aim of this study was to evaluate goblet cell population and conjunctival epithelial morphology in patients with CF. METHODS: A total of 20 CF patients and 20 controls underwent conjunctival impression cytology. RESULTS: Impression cytology showed conjunctival squamous metaplasia and goblet cell loss in patients with CF. CONCLUSION: Reduced goblet cell numbers and squamous metaplasia may be indicative of a higher degree of epithelial damage of conjunctival epithelial cells in CF patients, and the presence of neutrophils is a strong sign for an inflammatory background of this disease.In view of the simple, noninvasive nature of impression cytology, this technique may prove to be an important tool for the diagnosis and monitoring of dry eye changes in CF patients.

Analysis of the incidence of fungal pathogens in air of the Department of Dermatology, Venereology and Allergology of Medical University in Wroclaw.

PURPOSE: Analysis of incidence of fungal pathogens in air of Department of Dermatology, Venereology and Allergology of Medical University in Wroclaw. MATERIAL AND METHODS: Materials for the tests were: the air samples in front of the building, corridors, library, lecture hall, and mycological laboratory. The air pollution was determined using SAS SUPER 100. Humidity and temperature were evaluated by a termohigrometr. Classification of the isolated fungi was made with an accordance to the current procedures. RESULTS: From the air was isolated: in library 69 colonies (mean CFU 138 +/- 41.5), from the bookstands--25 colonies (mean CFU-125 +/- 63.6), lecture hall--119 colonies (mean CFU-380 +/- 98.8), mason room--52 colonies (mean CFU-104 +/- 21.9), mycological laboratory--154 colonies (mean CFU-513 +/- 155.3). Temperature in the tested rooms ranged from 24.5 degrees C (mason room) to 26.1 degrees C (library), humidity ranged from 40.1%-53.1%. Temperature outside of the building was 23.6 degrees C, and humidity 51.6%. Moulds Peniciullium citricum and Aspergillus niger and the yeasts Candida albicans were isolated more frequently. CONCLUSIONS: The highest number of fungi colonies were isolated from the air sampled at the lecture hall and mycological laboratory. Moulds were the most common airborne fungi. Temperature and huimidity in the tested rooms are good conditions for the development of fungi.

Quality of life self-assessment of children living in a children's home, based on own research conducted in the Podlaskie Province.

PURPOSE: The purpose of the study was to diagnose the quality of life (QoL) of children brought up in children's homes, to compare findings with results for peers living in complete families. MATERIAL AND METHODS: In the Stage I was to determine the usefulness of tools for QoL evaluation in a group of 120 children from children's homes in the Podlaskie Province and in a group of 120 children belonging to a control group, brought up in their own families, in the same places where the children's homes were located. Selected research tools were used in Stage II, and the study was carried out in a group of 180 children in the same children's homes and a control group. We used the following survey questionnaires: the standardised CHQ-CF87 survey, standardised KINDL survey and Children's Survey based on WHOQOL-BREF. RESULTS: Significant relationship between the quality of life self-assessment and the place of being brought up for all categories of quality of life was found. A relationship was indicated between the QoL self-assessment and the place of living, age, gender, and physical condition. The charges of a children's home assessed their QoL as significantly lower compared to children living in normal families, mostly in the following categories: health, physical domain and psychological domain, social relations and the ability to function in everyday life. In KINDL survey, strong relationships were found between assessments of QoL categories. CONCLUSIONS: Significant relation between QoL self-assessment and where children were brought up was found. Positive relationship between QoL self-assessment and the place of living, age, gender, and children's physical condition was found.

Relations occurring between health-related behaviour categories and quality of life made by children brought up in a children's home, in the Podlaskie Province.

PURPOSE: The purpose of the study was to determine relations between health-related behaviour categories and quality of life (QoL) categories made by children brought up in a children's home and to compare the results obtained with the results for a group of peers brought up by their own families. MATERIAL AND METHODS: The study was performed on a group of 180 children living in children's homes located in Bialystok, Krasne, Suprasl, Lomza, Nowa Pawlówka; and on a control group of children living with their own families in the same places where children's homes were located. The diagnostic survey method with the Health Behaviour Scale questionnaire, composed of 40 statements defining various behaviours connected with health, and the Children's Questionnaire, based on The World Health Organization Quality of Life (WHOQOL-BREF) was used. RESULTS: Strong correlations between assessments of the Health Behaviour Scale categories and assessments of quality of life categories were found in the group of children living in children's homes, mostly in respect to the relation between health self-assessment and physical activity r = 0.77, mental activity r = 0.74 and environment r = 0.72, and between the physical domain and eating habits r = 0.70, and physical activity and the physical domain r = 0.69. The determination coefficient R2 for the study group had high values for three QoL categories: physical domain 71.5%, mental domain 69.7% and environment 70.1%. CONCLUSIONS: Correlations between Health Behaviour Scale categories and QoL categories were found in the group of children living in children's homes compared to children living with their own families. The relationships for health self-assessment and the physical and mental domains and the environment, and for the physical domain and eating habits and physical activity were found.

Seasonal variation in ischaemic stroke frequency in Podlaskie Province by season.

PURPOSE: The aim of the present study was to assess seasonal differences in ischaemic stroke among patients hospitalized in Department of Neurology in Bialystok during 2002-2005. MATERIAL AND METHODS: To examine the seasonal incidence of ischaemic stroke, we analyzed data from the Department of Neurology in Bialystok in a retrospective study. The year was divided into four seasons: spring (March, April, May), summer (June, July, August), autumn (September, October, November), and winter (December, January, February). Seasonal differences were studied in relation to the following clinical characteristics: age, gender, history of stroke, and time of stroke onset. RESULTS: Age of patients with ischaemic stroke ranged 19 between 101 years, a mean age was 72.4 +/- 12 years. Incidence of ischaemic stroke increased in the last years. We noted a higher incidence of ischaemic stroke in older patients (mean 74.36 years old) during winter months than in patients (71.40 years) in summer months. Gender had no effect on incidence of ischaemic stroke. Significant seasonal variation of ischaemic stroke in all years (p = 0.0010) and for 2005 year (0.0090) were found. Incidence of ischaemic stroke was depend on month of year. Significant increase of ischaemic stroke was noted in December. The lowest incidence of stroke was observed in August and September. CONCLUSION: Incidence of ischaemic stroke increased in the last years. The present findings suggest an increase in the incidence of ischaemic stroke in winter in December.

Cortical somatosensory evoked potentials and spasticity assessment after botulinum toxin type A injection in children with cerebral palsy.

PURPOSE: The mechanism of Botulinum Toxin Type A (BTX-A) action at the neuromuscular junction is well known. But from the introduction of BTX-A, some authors have suggested a central action of BTX-A and possible side effects far from the site of injection. Some studies demonstrate an improvement of cortical SEPs associated with reduction of spasticity after BTX-A injection. The aim of the present study was to determine the effect of BTX-A treatment on cortical somatosensory potentials (SEP). MATERIAL AND METHODS: A group of twenty nine children ranging from 2 to 17 years old with cerebral palsy were studied. Each patients spasticity level was evaluated before, 2 weeks and 6 weeks after BTX-A injection by the Modified Ashworth Scale and modified Gait Physician's Rating Scale. The SEPs from lower and upper extremities were performed before and between 2 and 6 weeks (19.34 +/- 8.82 days) after BTX-A administration. RESULTS: The mean spasitity level was significantly lower 2 and 6 weeks after BTX-A injection. The gait analysis by modified Physician's Rating Scale (PRS) showed significant improvement two weeks and six weeks after BTX-A injection. SEPs results were abnormal before BTX-A injection in 25 children with cerebral palsy. However we didn't find any significant changes of SEPs latencies after BTX-A injection. CONCLUSIONS: The results of SEP after BTX-A administration in children with cerebral palsy do not confirm the central action of BTX-A on somatosensory pathways. We did not find any significant changes of SEP latencies associated with clinical reduction of spasticity. It seems that SEP results could support the opinion, that BTX-A does not have any direct central effect on sensory pathways. Remote side effects may be explained by an indirect mechanism due to modification of the central loops of reflexes or to hematogenous spread of BTX-A.

Magnetic resonance imaging of the cerebellum and brain stem in children with cerebral palsy.

PURPOSE: The study aimed to examine the volumes of cerebellum and the brain stem in children with cerebral palsy (CP). MATERIAL AND METHODS: The present study included 21 children with spastic diplegic CP (11 girls and 10 boys). Twenty-one patients with CP were age- and gender-matched with the control patients. All subjects were free from neurological or psychiatric disease, had normal intellectual development, and their brain magnetic resonance imaging (MRI) scans were normal. MRI of forty-two patients were reviewed prospectively. RESULTS: The CP group had significantly smaller mean of the cerebellar hemispheres and the brain stem than did the control group. The cerebellar volumes were positively correlated with age of children with CP and the control group. No significant correlations between gender and the volumes of cerebellar hemispheres and the brain stem in controls and in the CP group were found. No significant correlations between asphyxia and the volumes of cerebellar hemispheres and the brain stem in the CP group were noted. Positive correlation between the cerebellum volume and IQ scores in children with CP was found. Negative relationship between the cerebellar hemispheres volume and Gross Motor Function Classification System in patients with CP was found. No significant correlation between the brain stem volume and IQ scores in the CP group was detected. CONCLUSION: Our data demonstrate that children with CP had smaller volumes of the cerebellum and the brain stem as compared to controls.

Severity of dysarthric speech in children with infantile cerebral palsy in correlation with the brain CT and MRI.

PURPOSE: Dysarthria is a sequel of reduced motor functions and refers to the sound aspect of the language. In children suffering from cerebral palsy, CT (computer tomography) and MRI (magnetic resonance imaging) examinations provide data on the relationship between the range of structural changes detected by neuroimaging investigations and the severity of motor dysfunction. The aim of study was to assess the severity of dysarthria in children with cerebral palsy in correlation with the pattern of morphological changes revealed on CT and MRI. MATERIAL AND METHODS: The study involved 48 children with the pyramidal form of infantile cerebral palsy aged 3-15 years, treated in the Department of Pediatric Neurology and Rehabilitation in Bialystok. All the patients underwent CT examination, 29 of them also had MRI. Severity of speech dysfunction was established based on "Dysarthria profile" by Robertson. The degree of damage severity in the respective brain structures was determined according to the scale Kraegeloh-Mann. Statistical analysis was performed using % calculations, the arithmetic mean, standard deviation, the chi-square test of independence or t-Student test to compare the means of two samples. RESULTS: Significant differences were shown in dysarthria severity depending on lesions seen on CT and their intensity revealed by MRI, which were found to correlate positively with the severity of articulation disorders. CONCLUSIONS: The results indicate that CT and MRI are useful for predicting prognosis of severity of speech disturbances in children and for early programming of the therapeutic process.

Clinical-electroencephalographic analysis of brain bioelectrical activity in children with myelomeningocele and internal hydrocephalus.

PURPOSE: The aim of the current study was the clinical and electroencephalographic (EEG) analysis of the brain bioelectrical activity in patients with myelomeningocele and internal hydrocephalus. MATERIAL AND METHODS: The present study included 86 children (44 boys and 42 girls) with myelomeningocele. The children were aged 1-17 years (mean 7 +/- 4.4 years). Thoracic myelomeningocele was identified in 24 children (28%), lumbar in 53 (62%) and sacral in 9 cases (10%). RESULTS: The standard EEG examination performed in the waking state revealed generalized changes in 53 patients (62%), including 19 (79%) with thoracic, 28 (53%) with lumbar and 6 (66%) with sacral myelomeningocele. Approximately 70% of the patients underwent ventriculoperitoneal shunting and epilepsy was found in 27 children (31.4%). The prevalence of changes detected in the left temporal region did not differ between the respective myelomeningocele types. No correlations were noted between the degree of spinal cord injury and the changes observed in the left temporal region in EEG recording. Likewise, changes found in the centroparietal region in EEG did not correlate with the site of myelomeningocele. Focal changes in the frontotemporal (p < 0.0067) and right temporal region (p < 0.0314) showed a positive correlation with the degree of spinal cord injury and were most frequent in patients with thoracic myelomeningocele. CONCLUSION: The analysis of EEG might facilitate evaluation and prognosis of epileptic seizures in children with myelomeningocele and internal hydrocephalus.

Low back pain in school-age children: risk factors, clinical features and diagnostic managment.

PURPOSE: Low back pain (LBP) is common in adult population, and it is becoming a serious health concern in adolescents. On surveys, about every fifth child in the school-age reports LBP. The study objective was to analysis the natural history, risk factors, clinical symptoms, causes and diagnostic management in school-age children hospitalized with LBP. MATERIAL AND METHODS: The study group consisted of 36 patients at the age between 10 and 18 years, 22 girls and 14 boys suffering from LBP hospitalized in our Department of Pediatric Neurology and Rehabilitation in years 2000-2004. RESULTS: The mean age of clinical onset of LBP in our group was 14.7 years, earlier in girls, later in boys. We find the family history of LBP in 50% children. Most frequent factors associated with LBP were: spina bifida (16.7%) and incorrect posture (13.9%). Half of patients pointed the factor initialising LBP: rapid, incoordinated move (39%) or heavy load rise (11%). 58% of patients present the symptoms of ischialgia. Diagnostic imaging showed disc protrusion in 11 children (31%) 6 in computed tomography, 4 in magnetic resonance imaging and 1 in X-Ray examination only. Other causes of LBP included: spondylolysis in 2 patients, Scheuermann disease in one case and juvenile reumatoid arthritis in one case. CONCLUSIONS: Some school-age children suffering on low back pain, particulary with sciatic neuralgia symptoms seek medical care in hospital. Althought the main causes are mechanical, associated with lack of physical activity or strenous exercise, serious diagnostic managment is strongly recommended.

Health-related behaviour self-assessment of children living in a children's home; study based on own research realised in the Podlaskie Province.

PURPOSE: The purpose of the study was to diagnose the health-related behaviour of children brought up in children's homes, to compare the obtained results with those obtained from a group of peers brought up in their own families. MATERIAL AND METHODS: The study group included 180 children living in children's homes in the Podlaskie Province and in a control group composed of children brought up in their own families and living in the same places where the children's homes are located. A questionnaire of the Health Behaviour Scale, composed of 40 statements determining health-related issues was used. RESULTS: Self-assessment of health-related behaviour in the studied youth depended on age, for which a statistical significance was shown for: health self-assessment (p = 0.011), categories of stressful situations (p = 0.047), physical activity (p = 0.028) and social support (p = 0.001); gender, for which a statistical significance was shown for the categories of usage of stimulants (p = 0.000) and place of living, in which the factor "place" was significant (p = 0.000) for all categories; and education, where p = 0.000 for the following categories: stressful situations, using stimulants, physical activity, social support and health self-assessment. Relationships between the categories of health-related behaviour were much stronger in the assessments of the children brought up in children's homes were found. CONCLUSIONS: The self-assessment of health-related behaviour of the studied youth depended on age, gender, place of living and education. Relationships between the categories of health-related behaviour were much stronger in assessments of the children brought up in children's homes as compared to controls.

Metabolite Profile in Pyramidal Tracts after Ischemic Brain Stroke Assessed by 1H MRS. A Multicenter Study.

The magnitude of the motor deficit in patients with stroke depends not only on the size and location of the destroyed brain tissue, but also on axonal injury in the descending motor pathways which appears after stroke. After cerebral ischemia, there are no visible abnormalities in conventional MRI in the intact pyramidal tracts despite the process of neuronal destruction by Wallerian degeneration. Conventional MRI is not a sensitive test for Wallerian degeneration in the acute or subacute time period as it shows no changes within the first four weeks. Magnetic resonance spectroscopy (MRS) has been used for better quantification of the extent or severity of fibre damage by evaluating metabolite alterations in normal-appearing corticospinal and corticopontal tracts. This study assessed the role of 1H MRS in the detection of changes in cerebral metabolite levels in pyramidal tracts after cortical/ subcortical infarction and to compare metabolite alterations to clinical outcome (assessed by Barthel index, Scandinavian Stroke Scale). The study included 31 patients who had suffered an ischemic cortical/subcortical stroke involving the motor cortex or the descending fibers. Ratios of NAA/Cr, Cho/Cr, lip/Cr and Lac/Cr from internal capsules and cerebral peduncles were measured and compared with clinical status assessed by Barthel index and Scandinavian Stroke Scale (SSS). The ratio of NAA/Cr was significantly decreased (p<0.001) in the normal-appearing ipsilateral internal capsule in comparison with the control group. Cho/Cr and lac/Cr ratios were increased compared to the control group (p=0.019). Decrease of NAA/Cr ratio correlated with clinical status assessed by Barthel index and there was a correlation between clinical improvement (assessed by SSS) and lac/Cr ratio. Tissue metabolite concentrations distant from the infarcted region correlated with the clinical course and had predictive value. Proton MRS is very useful tool for evaluating major changes in metabolite levels in pyramidal tracts after brain stroke.