[Impact of low level laser therapy on skin blood flow]. / Wplyw niskoenergetycznej laseroterapiina skorny przeplyw krwi.

UNLABELLED: The aim of this study was to objectively assess the impact of low level laser therapy on skin blood flow, in terms of two of its components - the flow and trophic and therapeutic effect. MATERIAL AND METHODS: Nineteen children aged 3-15 years have been included in the study (seven boys and twelve girls) with a diagnosis of meningomyelocele in the lumbosacral area. In nine of them (47.3%) bedsores were found in the area of paresis location. Studies of skin blood flow were performed using xenon 133 clearance in the Department of Nuclear Medicine of the Children's Memorial Health Institute. Xenon 133 radioisotope in saline with intrinsic activity 74 MBq in 1 ml was used as the marker. Laser application was performed immediately prior to the application of the marker with a tag shower 60 mW probe, emitting 680 nm red light with surface power density of 0.5 J/cm2. RESULTS: Within the tested children the laser application resulted in a significantly increased skin blood flow. Average results in tested group before LLLT are 7.47 ml/100 g/min, after LLLT 11.08 ml/100 g/min. CONCLUSIONS: 1. LLLT significantly increases the perfusion of the skin. 2. The effect of the increased perfusion as the result of laserotherapy in the most evident in children with skin trophic abnormalities. 3. Results confirmed by clinical observation indicate, that perfusion increase in relation to LLLT takes place with participation of trophic component of skin blood circulation.

Reference values for the indicators of skeletal and muscular status of healthy Polish children.

Dual-energy X-ray absorptiometry (DXA) results are affected by the growth- and maturation-based anthropometric variances during childhood and adolescence. To address this issue, anthropometric variables were implemented to normative DXA values for the total body (TB) and lumbar spine (S) data obtained from a cross-sectional sample of 562 healthy Caucasian children (278 females) aged 5 to 18 yr who were measured using a pencil-beam DXA device (DPX-L; GE Lunar). Across age or body height (BH) groups, female and male values for TB bone mineral content (TBBMC) (g), TB bone mineral density (TTBMD) (g/cm(2)), SBMC (g), SBMD (g/cm(2)), lean body mass (LBM) (g), TBBMD/LBM (g/g), and SBMC/LBM [(g/g) x 100)] were assessed and compared using ANOVA and t-tests. There was no gender difference in TBBMC until age 16 and in TBBMD until age 17; thereafter, male values were significantly higher. At 12 to 13 yr of age, female SBMD values were significantly higher than male. The BH matching revealed lack of major gender-related differences in TBBMC or TBBMD values across whole height range, whereas at heights of 150 to 175 cm, females had generally higher values of SBMC and SBMD than male counterparts. Further, the LBM values and calculated TBBMC/LBM and SBMC/LBM ratios were considered as the muscle and muscle-bone indicators, respectively. The muscle-bone relationship analysis using LBM and TBBMC/LBM and SBMC/LBM values revealed age- and BH-related differences between genders. At LBM values of 32 kg and above and ages 14 yr and above for the whole skeleton as well as 12 yr and above for spine segment, females accrued significantly more BMC for the LBM unit than males. In order to properly assess children who might be at risk for low bone mass, we provide reference values for BMC and BMD of usually studied sites, expanded by muscle-bone relationship indicators owing to reduced diagnostic errors and distinguished bone disorders.

Evaluation of practical use of bone age assessments based on DXA-derived hand scans in diagnosis of skeletal status in healthy and diseased children.

The assessment of bone age is an important factor for the analysis of skeletal maturity, growth, and its aberrations. The classical method of bone age estimations is based on the recognition of changes in the radiographic appearance of the maturity indicators in hand-wrist radiographs by comparison with reference atlas. To apply bone age assessments, based on dual-energy X-ray absorptiometry (DXA)-derived hand scans, in the evaluation of skeletal status, 151 healthy children (4-18 yr old) and 61 with bone disorders (5-20 yr old) were investigated. All measurements were performed using Expert-XL and DPX-L densitometers (GE Lunar). Hand densitometry performed by the Expert-XL machine was used for the evaluation of bone age. Total-body measurements were performed using DPXL to calculate total-body bone mineral density (BMD) Z-score values as standard diagnostic parameters in pediatric densitometry and to verify diagnosis by taking into account assessed bone age. Strong correlations were found between BMD (g/cm2) and bone age in healthy children of both genders. We noted in several cases that low values of Z-scores (<-1) corresponded to delayed bone age in comparison to chronological age. After recalculation of BMD data according to bone age, a marked increase in Z-scores was noted, mainly in multihormonal pituitary-deficient subjects. It can be concluded that the use of hand densitometry in parallel with BMD measurements provide valuable information about skeletal maturation that leads to the improved diagnosis of skeletal status, especially in subjects with constitutional delay in growth.

Anthropometric characteristics of X-linked hypophosphatemia.

An anthropometric study was undertaken to assess head proportions of patients with X-linked hypophosphatemia (XLH). Fourteen morphometric parameters of the head were measured and 10 cephalic indices calculated in 82 affected persons (57 females and 25 males) from 55 unrelated families with XLH, and compared with the results obtained in the group of their healthy relatives (37 females and 33 males), as well as with general population control values. Normalized values (SD, z-score) were analyzed statistically. The group of healthy relatives, both males and females, differed significantly from Polish population control values in most of the normalized variables measured, making population control values useless as a control group for the analyzed XLH group. Intrafamilial values of cephalic parameters in healthy relatives of the XLH patients were finally applied for statistical analysis. Generally patients with XLH showed highly statistically significant increase in head length (males 0.95 +/- 1.07 vs. -0.37 +/- 1.02, females 0.57 +/- 1.59 vs. -0.06 +/- 1.15), significant decrease in occipital breadth (males -0.56 +/- 1.27 vs. 0.70 +/- 1.28, females -0.59 +/- 1.7 vs. 0.13 +/- 1.1) and several milder anomalies of craniofacial proportions. Mean cephalic index was significantly lower in XLH patients when compared with the healthy relatives (males -0.909 vs. 0.278 P < 0.0001, females -0.705 vs. 0.381 P = 0.007). The cephalic changes were found both in XLH children and XLH adults and were more pronounced in affected males than in females. There were no differences between offspring born by hypophosphatemic and normophosphatemic mothers.

Evaluation of the possibility to assess bone age on the basis of DXA derived hand scans-preliminary results.

The classical method of skeletal age assessment is based on the recognition of changes in the radiographic appearance of the maturity indicators in hand-wrist radiographs by comparison with a reference atlas. The purpose of this study was the evaluation of the possibility to assess bone age using a less invasive method such as dual-energy X-ray absorptiometry (DXA). Bone ages of 50 children free of any chronic diseases (5-18 years old) and ten with multihormonal pituitary deficiency (MPD) (8-20 years old) were assessed using an Expert-XL densitometer. Hand scans and classical hand-wrist radiographs were evaluated by two independent observers for bone age by visual comparison with reference standards of skeletal development published in the atlas. The precision errors of duplicate bone age ratings were low both for radiographs (<1%) and DXA hand scans (<0.9%). A high degree of agreement between bone age ratings done by two observers was assessed by intraclass correlation coefficients. The same bone age based on radiographs and DXA hand scans was assessed in 44 of 60 cases (73.3%); in 16 cases the differences between bone age were no higher than 0.5 year. No significant difference between mean bone age based on radiographs and DXA hand scans was observed ( P>0.05). Moreover, there was a very strong correlation between bone age results ( r=0.998; r(2)=0.996; P<0.0001), indicating agreement of bone age assessments based on DXA and radiographic images. Remarkable differences (up to 3 years) between bone age and chronological age were observed in healthy subjects, probably reflecting the effect of the secular trend towards earlier maturation or alterations in pubertal development. The study indicates that evaluation of skeletal maturity using DXA images is less invasive (up to 8 micro Sv) than radiography, giving results comparable to the classical method.