Food allergy and asthma morbidity in children.

BACKGROUND: Coexisting food allergy and asthma is a significant problem in the pediatric population. Studies have looked at the association between food sensitization and asthma severity. It is unknown whether specific food allergies are associated with increased asthma morbidity. OBJECTIVE: We studied the independent effect that allergy to egg, milk, fish, and peanut has on the number of hospitalizations and courses of systemic steroids in children with asthma. METHODS: We performed a medical record review to evaluate the effect food allergy to egg, fish, peanut, and milk has on asthma morbidity. We reviewed the records of 201 children aged 3 months to 14 years with the diagnosis of asthma (ICD-9 codes 493.90, 493.91, and 493.92), of which 88 had coexistent food allergy. All children in the food allergy group had food-specific IgE concentrations greater than the 95% positive predictive value. We compared the rate of hospitalizations and use of systemic steroids between children with asthma and food allergies and those without coexisting food allergy using direct-entry, multiple regression analysis. Patients were adjusted for the severity of their asthma based on symptoms documented at their first visit to the allergist according to the National Asthma Education and Prevention Program guidelines and presence of environmental allergy, eczema, smoke exposure, and gastroesophageal reflux. RESULTS: Peanut and milk allergies were both associated with increased number of hospitalizations (P=0.009, 0.016), and milk allergy was associated with increased use of systemic steroids (P=0.001). CONCLUSION: Peanut and milk allergies were associated with increased hospitalization and steroid use and may serve as early markers for increased asthma morbidity.

Lateral acetabular growth stimulation following a labral support procedure in Legg-Calve-Perthes disease.

BACKGROUND: The main goal of containment treatment in cases of Legg-Calvé-Perthes disease is to prevent hip deformity, which leads to arthritis in adulthood. Recently, the shelf arthroplasty (the labral support procedure) has been proposed as a method of containment. The purpose of the present study was to evaluate growth stimulation of the acetabulum in patients with unilateral Legg-Calvé-Perthes disease by measuring acetabular depth and height following treatment with the labral support procedure. Uninvolved, contralateral hips and hips that were treated with proximal femoral varus osteotomy were used to compare growth. METHODS: Sixty-five consecutive patients with unilateral Legg-Calvé-Perthes disease that had been treated with the labral support procedure (forty-nine) or a proximal femoral varus osteotomy (sixteen) were evaluated on the basis of radiographic and clinical data that had been obtained at the time of surgery as well as at one, three, and five years after surgery. Acetabular dimensions (depth, height, and total depth with shelf) were measured and, to eliminate radiographic magnification error, the data were expressed in ratios between the involved and uninvolved sides. RESULTS: Preoperatively, both surgical groups were comparable. Acetabular depth indexes at the time of surgery were not different between the groups (p = 0.46). At one, three, and five years postoperatively, the mean depth indexes in the labral support group were significantly higher than those in the proximal femoral varus osteotomy group (F = 5.417, p = 0.001), and trend analysis showed a significant quadratic effect over time in the labral support procedure group (F = 13.132, p = 0.001). The acetabular height indexes at the time of surgery were not different between groups and showed 11% to 13% acetabular overgrowth. The acetabular height indexes in both groups remained unchanged at the time of follow-up (F = 2.82, p = 0.1). The total depth index showed decreasing linear trend values over the period studied (F = 35.115, p = 0.001). CONCLUSIONS: Overgrowth of the acetabulum occurs naturally and early in the course of Legg-Calvé-Perthes disease and is more pronounced in terms of height. The labral support procedure induces additional lateral growth of the true acetabulum (excluding the shelf) for three years following surgery, whereas a proximal femoral varus osteotomy does not. Thus, beneficial effects of the labral support procedure are lateral acetabular growth stimulation, prevention of subluxation, and shelf resolution after femoral epiphyseal reossification. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Analysis of lower extremity alignment in achondroplasia: interobserver reliability and intraobserver reproducibility.

This study was designed to evaluate the reliability and reproducibility of frontal plane malalignment measurements using the mechanical axis deviation method in achondroplasia and to determine whether the patient's age has any influence on these measurements. A total of 150 anteroposterior standing radiographs of the lower extremities were randomly selected for the study. Radiographs were divided into three groups according to age: group 1, younger than 6 years of age; group 2, 6 to 10 years of age; group 3, older than 10 years of age. Interobserver agreement for the medial proximal tibial angle and the lateral distal tibial angle measurements were poor (0.32 and 0.38, respectively) in group 1, but agreement increased between observers with increasing patient age. Good to excellent intraobserver reproducibility was found in all groups, except measurement of the medial proximal tibial angle in group 1, where the results were poor (0.36). Significant measurement errors in the proximal and distal tibial joint lines are possible in children less than 6 years of age with achondroplasia.

Compliance monitoring of brace treatment for patients with idiopathic scoliosis.

STUDY DESIGN: Prospective, blinded study to evaluate compliance with treatment. OBJECTIVE: To evaluate objectively idiopathic scoliosis patients' compliance with Wilmington brace treatment. SUMMARY OF BACKGROUND DATA: Patients' compliance with brace treatment for idiopathic scoliosis traditionally has been determined from patient or parent interviews or both; however, the hours reported by patients are subjective and consequently are not accurate. METHODS: Study participants were 61 consecutive patients with idiopathic scoliosis: 54 girls and 7 boys. Inclusion criteria were curvature of more than 20 degrees and less than 45 degrees of Cobb angle before brace treatment. Actual hours worn per day were measured using a compliance monitor, and compliance was determined by the percentage of actual hours worn in accordance with the prescribed regimen. Accuracy of compliance from hours reported by patients was compared with actual hours measured by the monitor. Correlations between compliance and prescribed regimen and age were analyzed. RESULTS: The overall compliance measured by the monitor was 75 +/- 27% (mean +/- S.D.), and the frequency distribution was similar to a Gaussian distribution. The compliance determined from hours reported by patients was 85 +/- 24%, which was higher than that from actual hours measured by the monitor (P = 0.01). There was a negative correlation between age and compliance (rho = -0.30, P = 0.025); 10-, 12-, and 14-year-old patients had 84, 77, and 60% average compliance, respectively. Compliance among patients with different prescribed regimens (8, 12, 16, or 23 hours of wear) showed no statistical difference (P = 0.361). CONCLUSIONS: Patients with idiopathic scoliosis complied with 75% of prescribed regimen on average and overreported their hours of brace wear to their physician. Age affected compliance. There was no statistical difference in compliance among patients with different prescribed regimens. The present study confirms the need for a compliance monitor to accurately evaluate use and outcome of brace treatment.

Impact of changing foot progression angle on foot pressure measurement in children with neuromuscular diseases.

To analyze the effect of lower-limb rotation on foot pressure distribution, 16 patients (23 feet) with neuromuscular diseases who received derotation osteotomy of lower limbs without concomitant foot-ankle procedures were included in this retrospective study. The cross-correlation analysis showed that the interval change of the foot progression angle was correlated with the interval change of the medial-lateral foot pressure impulse distribution. The externally rotated foot progression angle tends to introduce higher loading on the medial foot, and the internally rotated foot progression angle shifts the loading to lateral side of the foot. This study provides evidence that the rotational profile of the lower limb has a substantial impact on foot pressure distribution.

Distal hamstring lengthening in ambulatory children with cerebral palsy: primary versus revision procedures.

To document the benefits and limitations of distal hamstring lengthening (HL), 61 children (105 limbs) with cerebral palsy treated by distal HL with complete preoperative and postoperative evaluations were reviewed. There was significant improvement in popliteal angle, fixed knee flexion contracture, knee angle at foot contact (FC), and mid-stance knee extension after HL. On the other hand, the hip power generation peak decreased, and the anterior pelvic tilt increased. For the repeated HL (22 limbs), the fixed knee flexion contracture and knee flexion at FC improved. In a group of ten patients (17 limbs) with further postoperative follow up evaluations, the only significant clinical finding related to hamstring function between the first postoperative and the follow up evaluations with no intervening surgery was an increase in the popliteal angle of 20 degrees. Because the popliteal angle may increase over time after HL with no other directly related gait changes, the indications for repeated HL should include fixed knee flexion contracture and increased knee flexion at FC. The increase in the popliteal angle alone should not be considered an indication for repeated HL.