[Distal rectus femoris tendon transfer in cerebral palsy patients]. / Transfer distálního úponu m. rectus femoris u pacientu s detskou mozkovou obrnou.

PURPOSE OF THE STUDY: Cerebral palsy is a serious world-wide problem; its incidence ranges from one to five per thousand of live-born children and is much influenced by gestation age and birth weight. In orthopaedic treatment of lower extremity motor disorders, one of the options for contracture or deformity elimination and for stiff leg gait improvement is rectus femoris tendon transfer. The aim of this study was to evaluate the results of this surgical technique. MATERIAL AND METHODS: In the period from 1993 to 2003, 15 patients of both sexes, aged 5 to 13 years, were treated by the Gage method (22 operations) in our department. The indication for surgery was excessive spasticity of the femoral quadriceps muscle at the beginning of the swing phase of the gait cycle. The spastic syndromes included quadruparesis in seven patients, diparesis in seven patients and hemiparesis in one patient. After surgery, a circular plaster cast was applied for 4 weeks. Following immobilization, all patients received a short-term inpatient and long-term outpatient physical therapy. They were followed- up for 1 to 10 years and gait improvement was analyzed on the basis of three criteria in the swing phase: quality of the initial swing, frequency of tripping over the toe and the degree of knee flexion. The results were evaluated on a 1-to-4 scale (best to worst), categorizing the patients into four groups. RESULTS: The first, second and third categories included eight, five and two patients, respectively. None of the patients was placed in the fourth category. Surgery did not increase the initial range of inner hip rotation. Patients with milder forms of cerebral palsy (diparesis and hemiparesis) achieved better results. CONCLUSIONS: Our results showed that distal rectus femoris tendon transfer significantly improved knee flexion during the swing phase of the gait cycle. The prerequisite for a good outcome of surgery is a pre-operative potential for passive knee extension and stable function of the other lower extremity joints. Key words: cerebral palsy, surgical treatment, quadriceps tendon transfer.

[Knee joint synovectomy in treatment of juvenile idiopathic arthritis]. / Synovektomie kolene v lécení juvenilní idiopatické artritidy.

PURPOSE OF THE STUDY: The objective of this study was to assess short-term outcomes of knee joint synovectomy in a group of patients with juvenile rheumatoid arthritis and to present the authors' view on this approach. MATERIAL: Between 1990 and 1999, synovectomy of the knee joint was performed in a group of 46 children with juvenile rheumatoid arthritis. This group comprised 19 girls and 27 boys aged 4 to 16 years (mean 9.8 years) with all forms of the disease. A total of 85 synovectomy procedures, including repeat operations, were performed on 58 knee joints. METHODS: Arthroscopic synovectomy was used to treat 21 knee joints, open synovectomy from two approaches was indicated, as a primary procedure, in 37 knees. The assessment of subjective and functional conditions of patients was based on a modified rating systems of Lysholm and X-ray films were evaluated by the Larsen classification. The evaluation was carried out at 1 and 2 years after the primary operation. RESULTS: Articular lesions corresponding to mere synovitis were found in 10 knee joints (17.2%), a developing pannus without erosion was seen in 16 (27.6%) and erosion of the articular surface in 32 (55.2%) knee joints. At 1 year, the value of Lysholm's score rose from 47.9 to 84.3 points and was followed by a decrease to 73.2 at 2 years. Within 2 years of the primary operation, the condition recurred in 9 out of 21 knees (42.8%) treated by arthroscopic synovectomy and in 12 cases (32.4%) operated on by open synovectomy. The relapse was observed mostly in patients with an overall high inflammatory activity and polyarticular and systemic progression of the disease. DISCUSSION: We do not agree with the view of some authors that surgical intervention is not indicated until erosions are radiologically manifested. In children, erosions usually present at a late stage, as shown by 12 findings of articular surface destruction in our group that were not detected by radiography. For indication purposes, we distinguished between preventive and therapeutic synovectomy. We found a significant association between the overall activity and early recurrence of the disease. In 60.7% of the cases (28) with excellent outcomes, this activity was low at the time of surgery. On the other hand, in 75% of the cases (8) with poor outcomes, the activity of disease was very high and had a lasting tendency to recur. These findings are in agreement with the conclusions of several other authors who consider the presence of systemic disease to be a contraindication for synovectomy. Advantages of arthroscopic synovectomy reported in adult patients seem to be relative in children. A good view of and accessibility to individual articular components, which are made an advantage of in the adult knee, are rather exceptional in the "tight" child knee. The evaluation of our patients at a short-term follow-up did not give convincing results although the early effect of synovectomy was very good. The poor outcomes seen in our group, which corresponded with observations of other authors, allow us to learn more about the potentials of synovectomy and thus to promote our policy of a thorough consideration of indications for surgery. CONCLUSION: Indications for surgical treatment in patients with juvenile rheumatoid arthritis are evaluated in cooperation with a rheumatologist after an appropriate conservative therapy administered for at least 6 months. Cases with clear signs of plastic synovitis and skeletal lesions shown by radiography as well as all recurrent conditions are treated by open synovectomy. The state of low disease activity is preferred for surgical intervention. It has to be borne in mind that, from whole range of curative procedures, conservative therapy supervised by a pediatric rheumatologist is the method of choice.

[Lengthening Osteotomy of the Calcaneus in the Treatment of the Flat Foot in Children - Short-term Results.]. / Prodluzovací osteotomie patní kosti v lécbe ploché nohy v detském veku - krátkodobé výsledky.

The aim of this communication is to provide both clinical and radiological evaluation of short-term results of the lengthening osteotomy of the anterior part of the calcaneus after Evans in the treatment of the flat foot in children and determine indication criteria of this operation. In the 1996-1999 period 35 feet were operated on in 23 children (13 boys, 10 girls), 12 children underwent bilateral surgery in the interval of 6-12 months. The average age at the time of surgery was 10,5 years and the age range 4,3-18,5. Most operations were performed in the age range of 11-15 years (16 operations). Indication to the operation was a symptomatic flexible pes planus (29 times), the flat foot with a neurogenic defect twice, with talus obliquus twice, deformity after the treatment of pes equinovarus congenitus once and the flat foot after a burn injury once. The period of postoperative follow-up ranged between 3 months and 2,5 years. The evaluation focussed on subjective complaints, clinical finding, plantogram and radiological indicators of flat foot. For the purpose of the objectivization of the shortening of the lateral pillar of the foot the so called talocalcanear differential index was monitored under weightbearing from the lateral radiograph. This index was calculated on the basis of the difference of the distance between the distal edge of talus and the calcaneus against the length of the medial pillar of the foot. The postoperative monitoring did not record any infection complications or failure of the surgical technique. Based on the subjective evaluation the condition in 21 patients with the operation of 32 feet (91 %) improved after the surgery and in 2 patients with the operation of 3 feet (9 %) the condition did not improve. In no patient the complaints were worse. Valgus position of the heel of all patients was corrected after the surgery to the normal. There was no functional limitation of the ankle and subtalar joints in any of the patients. Plantograms changed after the surgery by 2 degrees in 16 feet (52 %), by 1 degree in 13 feet (42 %), the plantogram did not change in 2 feet (6 %). Plantogram got to its normal in 12 feet operated on (38 %). Radiological evaluation showed in all feet operated on a change in the course of the joint line of the Chopart joint in both projections and the monitored angles either improved or became normal. Tolacalcanear differential index descreased except for one foot in all feet operated on. This index was directly proportionate to the preoperative and postoperative clinical finding or to the severity of the flat foot or the correction according to the plantogram and on average it was preoperatively four times higher than in normal healthy feet. In most operated feet a shift was found in the calcaneocuboid joind which did not have any relation to the subjective evaluation. Radiological indicators did not correspond unequivocally to the resulting subjective evaluation of the operation but in the case of a satisfactory clinical correction of the deformity of the foot both the subjective evaluation and radiological correction were mostly very good. The lengthening osteotomy of the calcaneus is a safe surgical method which leads to a significant clinical and radiological correction of the valgus deformity of the hindfoot and elevation of the foot arch. Indicated to the surgery are symptomatic flat feet with the symptoms of eversion in the subtalar joint and shortening of the lateral pillar in the radiograph which are not fixed by articular contractures. It is recommended to evaluate the shortening and lengthening of the lateral pillar of the foot according to the proposed talocalcanear differential index which can be used for the indication consideration as well as for the evaluation of the correction achieved. Key words: flat foot in children, surgical treatment, lengthening osteotomy of the calcaneus, radiological evaluation.

[The relation between the concentration of testosterone in seminal plasma and certain indicators of reproduction in roosters]. / Vztah koncentrácií testosterónu v semennej plazme k niektorým reprodukcným ukazovatel'om kohútov.

Testosterone concentrations in the semen plasma of the cocks of the laying type were analyzed. The levels in semen plasma were substantially lower than in peripheral blood and were found at the interval of 1.58 to 13.30 nmol . 1(-1), the average values amounted to 5.5 nmol . 1(-1). At the repeated samplings of the same animals, considerable variability of hormone levels was observed, which suggested a possibility of the pulsation character of the changes in the androgen also in this biological material. The correlation coefficients between the testosterone levels in semen plasma and ejaculate volume, as well as between the sperm concentration were positive, however, statistically insignificant. The relation between testosterone and the weight of testes was at the significance limit.

[Concentration of plasma testosterone in adult roosters of a low-weight strain]. / Koncentrácie plazmatického testosterónu u dospelých kohútov l'ahkého typu.

The levels of blood-plasma testosterone were studied in the adult light bodied strain cocks. Blood was sampled (1 ml) from the wing vein by means of a heparinized syringe six times within a 24-hour interval. The plasma obtained by centrifugation was kept in a refrigerator at a temperature of --18 degrees C. Testosterone was determined by the radioimmunological method. The testosterone levels were significantly higher (P less than 0.001), 18.8 nmol/l on the average, in the blood samples taken during the dark period of the day (10 o'clock p.m., 2 and 6 o'clock a.m.) than in the samples taken in the light part of the day (8 and 10 o'clock a.m., 2 o'clock p.m.) when the average concentration of the studied hormone was 10.7 nmol/l of plasma. the lowest levels of testosterone were recorded in the morning and the highest values were recorded late in the evening (10 o'clock p.m.). The differences in the levels of the hormone between sampling terms indicate that the testosterone level in adult animals shows diurnal variances. It was found by the study of the concentration of testosterone in the blood plasma of the same individuals within short intervals of time (30-60 min) that testosterone secretion in adult cocks had a pulsatory manner. The evaluation of hormone levels should include not only the diurnal variances but also the pulsatory manner of testosterone secretion.

[Increased hepatic aryl 4-monoxygenase in chickens caused by lipophilic xenobiotics]. / Zvýsená aktivita hepatálnej aryl 4-monooxygenázy u sliepok spôsobená lipofilnými xenobiotikami.

Hens were treated with three types of lipophil xenobiotics - polychlorinated biphenyl (PCB), lindane and hexachlorobenzene (HCB) - to study changes in the levels of microsomal proteins and in the activity of microsomal aryl 4-monooxygenase in liver. The above foreign substances were given in feed at a dose of 50 mg per kg during a fortnight. The level of microsomal proteins in liver increased after seven-day administration of xenobiotics and was always higher in the course of the experiment than in the controls. The activity of the microsomal enzyme (aryl 4-monooxygenase) was significantly higher in treated hens after seven- and 14-day interval, and also seven days after the end of feeding the contaminated feed mixture. Inductive properties were strongest in polychlorinated biphenyl (Delor 103), but lindane and hexachlorobenzene also induced a statistically significant rise, in comparison with the controls. It is shown that the inductive ability of lipophil xenobiotics is stronger in hens than in chicks, which may influence the metabolism of some biologically important substances in poultry organism.

Liver aryl 4-monooxygenase activity in the progeny of hens receiving dietary polychlorinated biphenyls.

1. The effects of relatively small concentrations of polychlorinated biphenyls (PCB) in the diet of hens on the hepatic microsomal aryl 4-monooxygenase [EC 1.14.14.1] activity in their progeny were investigated. 2. PCB caused enhanced activity of aryl 4-monooxygenase in the progeny.

[Induction of hepatic microsomal enzymes in chickens effected by various persistent foreign materials]. / Indukcia mikrozomálnych enzýmov pecene kurciat úcinkom niektorých perzistentných cudzorodých látok.

Changes in the levels of microsomal proteins, in the activity of microsomal aniline hydroxylase, and in the effectivity of Thiopental were studied in chickens given the Czechoslovak-produced type of polychlorinated biphenyls - Delor 103. The increased activity of aniline hydroxylase and the decrease of Thiopental sleeping time in chickens exposed to the action of Delor 103 indicate that this preparation is able to induce liver microsomal enzymes in doses as low as 5 mg per kg of feed. The induction of liver microsomal enzymes appears to be an important factor, able to exercise a direct influence on the biotransformation of various biologically important substances in the organism of chickens.

[Changes in the biological activity of androgens after the exposure of cockerels to lindane]. / Zmeny v biologickej úcinnosti androgénov po expozícii kohútikov lindanu

A biological test was performed to study the changes in the effectiveness of androgens after the administration of different doses of lindane to sexually immature cockerels. Testosterone-propionate and Stenolon were used as reference hormones. The results indicate that the administration of lindane increases the biological effectiveness of testosterone-propionate expressed through the stimulation of the growth of comb. On the other hand, the effect of the insecticide caused a statistically highly significant reduction of androgenic activity when Stenolon was used as a reference preparation. The causes leading to different manifestations of the interactions of lindane with the two hormones tested are analyzed. The paper gives further proofs that the exposure of poultry to relatively low doses of chlorinated insecticides interferes with the biological effectiveness of sex hromones.

[Effect of lindane on the biological effectiveness of estradiol in chickens]. / Vplyv lindanu na biologickú úcinnost estradiolu u kurciat

After exposure of sexually immature chickens to lindan in doses of 2.5 to 25.0 mg kg-1 of feeds, the effect of the insecticide on the biological activity of estradiol was investigated. The changes in the effectiveness of estrogen, expressed by an increase of the mass of the oviduct and of the level of serum calcium, were evaluated by means of comparison of animals exposed to the insecticide with a control group that had been applied only the standard hormone dose. Proofs were obtained for the fact that the application of lindan in the quantity of the mentioned doses for 14 days caused a statistically conclusive depression of the biological effectiveness of estrogens. Compared with the control group, the stimulated mass of the oviduct of animals exposed to the insecticide was smaller by 12.7 to 17.1 p. c. and the average concentration of the serum calcium decreased by 8.0 to 27.6 p. c. The results obtained indicate that the influence of lindan already in relatively low concentrations caused significant changes in the effectiveness of exogenous estrogens.

Distribution of labelled testosterone in Japanese quail using autoradiography of whole body sections.

Auto radiography offers a simple method of giving preliminary information about the metabolism in vivo of steroids. 2. In Japanese quail injected testosterone is metabolised mainly in the gastro-intestinal tract.