Soft Tissue Surgery for Equinus Deformity in Spastic Hemiplegic Cerebral Palsy: Effects on Kinematic and Kinetic Parameters

The purpose of this study was to evaluate how soft tissue surgery for correcting equinus deformity affects the kinematic and kinetic parameters of the ankle and proximal joints. Sixteen children with spastic hemiplegic cerebral palsy and equinus deformities (age range 3-16 years) were included. Soft tissue surgeries were performed exclusively on the ankle joint area in all subjects. Using computerized gait analysis (Vicon 370 Motion Analysis System), the kinematic and kinetic parameters during barefoot ambulation were collected preoperatively and postoperatively. In all 16 children, the abnormally increased ankle plantar flexion and pelvis anterior tilting on the sagittal plane were significantly improved without a weakening of push-off (p < 0.05). In a group of 8 subjects with a recurvatum knee gait pattern before operation, the postoperative kinematic and kinetic parameters of the knee joint were significantly improved (p < 0.05). In a group of 8 subjects with ipsilateral pelvic external rotation before operation, the postoperative pelvic deviations on the transverse plane were significantly decreased (p < 0.05). These findings suggest that the soft tissue surgery for correcting equinus deformity improves not only the abnormal gait pattern of the ankle, but also that of the knee and pelvis.

Hemiplegia cruzada associada a impressäo basilar, malformaçäo de Arnold-Chiari e siringomielia: relato de caso / Cruciate hemiplegia associated with basilar impression, Arnold-Chiari malformation and syringomyelia: case report

Os autores apresentam um caso de hemiplegia cruzada associada a impressao basilar, malformaçao de Arnold-Chiari e siringomielia. Discutem as propostas anatômicas e a fiopatogenia desta síndrome de ocorrência bastante rara.

Hemiparesia recorrente como apresentaçäo clínica de osteoma do seio frontal: relato de caso / Recurrent hemiparesis as the clinical presentation of an osteoma of frontal sinus: case report

Relato do caso de paciente portador de osteoma de seio frontal cujo crescimento intracraniano levou à formaçao de pneumoencéfalo intracerebral. A manifestaçao clínica foi a de hemiparesia recorrente. Sao discutidos os mecanismos que explicam a ocorrência do pneumoencéfalo e revisao da literatura é apresentada. A associaçao de osteoma, pneumoencéfalo e hemiparesia foi mencionada em uma ocasiao na literatura, mas sem o caráter recorrente do déficit motor, como no caso relatado.

Transferencia parcial do tendao do tibial posterior no pe varo espastico na paralisia cerebral / Split posterior tibial-tendon transfer in spastic cerebral palsy

Foram efetuadas 51 transferencias parciais do tendao dotibial posterior, geralmente associadas com alongamento do tendao de Aquiles, ocasionalmente com osteotomia valgisante do calcaneo, e, mais raramente, comtransferencia do tendao do tibial anterior para o osso cuneiforme intermedio, empes equino-varo-espasticos de pacientes com paralisia cerebral. Os pacientes foram acompanhados por um periodo minimo de dois anos. Todas as deformidades foramcorrigidas em um so tempo. O caso que apresentou hipercorreçao e cinco outroscom recidiva da deformidade exigiram nova intervençao.

Reason and prospects of surgery by transposition of omentum on the brain in patients after ischemic stroke on the basis of 50 cases operated upon

The results of surgery by transposition of omentum on the surface of ischemic brain in 50 patients have been presented and discussed. The reason of such operation is: 1) recent discoveries in omentum biologically active substances taking part in angiogenesis what allows new vascular connections to develop from omentum to the brain and by this way to augment CBF in low perfused areas. 2) the idea that neurons way survive even by long period of time in condition of lowering metabolism provided perfusion in maintained above critical threshold and in condition of increased CBF the normal matabolic and synaptic functions may be restored. 3) encouraging results of such operations perfomed for the first time by Goldsmith in 1978. 4) results of EC-IC Bypass Study Group suggesting failure of arterial bypass to reduce the risk of ischemic stroke. 5) results of catamnestic investigation of 300 patients treated by STA-MCA anastomosis in our Clinic in Bytom in the period 1979-1990 suggesting that in the region of ischemia specially in patients with deep neurological deficit rather creation the new vascular network than bypass formation in reasonable. Patients in the age from 33 to 66 years old were operated upon in the years 1989-1992. They were characterized mainly by deep and stable neurological deficit and in the majority of cases the surgery was pèrfomed 1-4 months after stroke. In postoperative period 4 patients died, 8 were clinically unchanged, 38 regained varying degree, in some patients suprisingly high motor improvement and in lesser degree the speech improvement was observed