Cerebral palsy is a disorder of movement and posture that arises from a congenital or acquired lesion of the immature brain. While the underlying cause is static, the musculoskeletal manifestations are progressive overtime. A variety of gait abnormalities are common, and orthopedic surgery typically is indicated when contractures or deformities decrease functions, cause pain, or interfere with activities of daily life. Surgical procedures should be scheduled to minimize the number of hospitalizations and interference with school and social activities. They can be divided into several groups of procedures; (1) to correct static or dynamic deformity, (2) balance muscle power across a joint, (3) reduce spasticity, and (4) stabilize uncontrollable joints. The clinical decision-making paradigm, consisting of clinical history, physical examination, diagnostic imaging, quantitative gait analysis, and examination under anesthesia makes it possible for single stage multi-level surgeries to reduce the long-term morbidity.
Anesthesia ; Brain ; Cerebral Palsy ; Congenital Abnormalities ; Contracture ; Diagnostic Imaging ; Gait ; Hospitalization ; Humans ; Joints ; Muscle Spasticity ; Muscles ; Orthopedics ; Paralysis ; Physical Examination ; Posture ; Walking

PURPOSE: The objective of this study was to report the outcomes of patients treated with extracorporeal shock wave therapy (ESWT) for refractory plantar fasciitis of the foot. MATERIALS AND METHODS: From November 2005 to October 2006, a total of sixty-two patients with refractory plantar fasciitis were treated with extracorporeal shock wave therapy. The main outcome measurements were visual analogue scale (VAS) and Roles and Maudsley score evaluated before treatment and at one and six months after treatment. RESULTS: Roles and Maudsley score was excellent (0%), good (6.4%), fair (35.4%) and poor (58.2%) before treatment which improved to excellent (56.5%), good (38.7%), fair (4.8%) and poor (0%) at final follow-up. VAS scores also significantly improved after ESWT (p<0.05). There was no statistically significant correlation between clinical results and body mass index (BMI) (p=0.102). CONCLUSION: Extracorporeal shock wave therapy appears to be an effective and safe treatment modality for refractory plantar fasciitis and may help the patient to avoid surgery for refractory heel pain.
Body Mass Index ; Fasciitis, Plantar* ; Follow-Up Studies ; Foot ; Heel ; Humans ; Shock*

PURPOSE: Using proteomic analysis, this study was performed to see the characteristics of proteins expression in the muscles of spastic cerebral palsy patients. MATERIALS AND METHODS: We studied twelve specimens from six patients with spastic cerebral palsy, three patients with myelomeningocele, and three normal people who underwent orthopaedic surgeries due to trauma. We studied the extracted proteins showing differences in the two-dimensional electrophoresis, and the prominent thirteen proteins were re-evaluated by proteomics and the reverse transcriptional polymerase chain reaction, which was to clarify the relationship between gene and protein expression. RESULTS: Among fifteen proteins, six proteins were found to be higher in normal people, and nine were found to be higher in the groups of patients by spot histogram. The results of proteomic analysis with MALDI-TOF for fifteen proteins showed that the expression of DJ-1 was related to cerebral palsy. CONCLUSION: This study shows that strong expression of DJ-1 is related to spasticity and cerebral palsy. We showed for the first time the possibility of any relationship between spastic condition and DJ-1 expression.
Cerebral Palsy ; Electrophoresis ; Humans ; Meningomyelocele ; Muscle Spasticity ; Muscles ; Polymerase Chain Reaction ; Proteins ; Proteomics

PURPOSE: To date, there have been no studies evaluating the usefulness of allograft as a substitute for autograft in calcaneal neck lengthening osteotomy. This retrospective study examined the results of calcaneal neck lengthening osteotomy using allograft for pathologic flatfoot deformity in children and adolescents with various neuromuscular diseases. MATERIALS AND METHODS: 118 feet in 79 children treated surgically between Mar 2000 and July 2005 were reviewed. The mean age at the time of the operation was 9+3 years (range, 3-17 years) and follow-up averaged 15.4 months (range, 13-21 months) postoperatively. Talo-1st metatarsal angle, talo-calcaneal angle, calcaneal pitch were measured before and after operation and bony union was estimated. RESULTS: Bony union was noted at the latest follow-up and there were no postoperative complications such as reduction loss, infection, nonunion, delayed union or graft loss during the follow-up period in all but one foot. All radiographic indices were improved postoperatively in all cases. CONCLUSION: Our results indicate that use of allograft in calcaneal neck lengthening osteotomy is a useful option for correction of the planovalgus deformity in skeletally immature patients whose enough autobone can not be obtained.
Adolescent ; Bone Diseases/*congenital/radiography/*surgery ; *Bone Lengthening ; *Bone Transplantation ; Calcaneus/*surgery ; Child ; Child, Preschool ; Female ; Humans ; Male ; *Osteotomy ; Transplantation, Homologous

BACKGROUND: Recently, the concept of health is being extended to physical, mental and social aspects, which leads people to pursue health positively behavior. But the evaluation of health condition shows a tendency to be biased to functional side. It means the absence of well being sensation that anyone feels like he has poor health. In this case, even if he is in physically good health, he is not rated as healthy. We analyzed the relationship between one's health state and the factors related with health perception including health behavior, mind and social environment. METHODS: For a month of May 1996, we surveyed those who visited for Periodic medical check-up at one general hospital in Seoul. The questionnaire consisted of the total of 25 items ; diet behavior, weight control, coffee, coke, tea, drug use of, smoking, drinking, exercise, leisure, safety belts use, jay walking, sleep, stress, personality, anxiety, depression, occupational satisfaction, relationships with family and friends. Five point scale is used as the answer of each question item with high point as good living behavior. Among 406 who had sincerely answered the questionnaire, we divided them into healthy and unhealthy group and compared with the point of each question item and with the laboratory data(obesity, blood pressure, hemoglobin, fasting blood sugar, cholesterol and ALT). RESULTS: Among 406, the number of those who perceived themselves to be healthy was 175(43.1%, healthy group) and the one of those who did not was 231(56.9%, unhealthy group), The difference between both groups was not significant in distribution of sex, age, academic career, income and religion. In laboratory data and living behavior they showed same results, also. But the points of unhealthy group were significantly lower than those of healthy group in coffee, coke, tee, drugs usage, exercise, leisure, stress, personality, anxiety, depression, occupational satisfaction and relationship with family and friends. So was the total point of all items of unhealthy group in comparison with that of health group. In the case of male, the points of unhealthy group were significantly lower in smoking, safety belt use, fay walking, sleeping as well as the above items. On the contrary, in the case of female, both groups were not significantly different all item except exercise and leisure. CONCLUSIONS: Health perception is influenced by psychosocial factors and living behavior more than by physical health. Therefore family physician must be concerned about patient's living behavior, mental and social problems and must make an effort to change their perception of health as well as physical improvement.
Anxiety ; Bias (Epidemiology) ; Blood Glucose ; Blood Pressure ; Cholesterol ; Coffee ; Coke ; Depression ; Diet ; Drinking ; Fasting ; Female ; Friends ; Health Behavior ; Hospitals, General ; Humans ; Leisure Activities ; Male ; Physicians, Family ; Psychology ; Sensation ; Seoul ; Smoke ; Smoking ; Social Environment ; Social Problems ; Tea ; Walking ; Surveys and Questionnaires

PURPOSE: Patients with planovalgus show various abnormal gaits and these are affected by the different length and velocity of the muscles around knee and ankle. The purpose of study is to compare the length and velocity of gastrocnemius in cerebral palsy with planovalgus by ankle plantarflexion-knee extension couple. MATERIALS AND METHODS: 22 patients with spastic diplegia who have planovalgus were included. The mean age was 12 years (5 years~18 years). Group I consisted of 7 patients with knee flexion more than 30 degrees and Group II consisted of 15 patients with knee flexion less than 15 degrees during mid-stance phase. Normal groups were consisted of 15 normal children. RESULTS: In patients with planovalgus, ankle dorsiflexion during stance was decreased but ankle plantarflexion was not different compared to normal. There is no difference in the percent length of gastrocnemius compared to normal, but the velocity was decreased. The percent length of gastrocnemius was decreased in group I, but there were no difference in the velocity. CONCLUSION: The decreased velocity of gastrocnemius is the cause of disability of ankle plantarflexion-knee extension couple and the variable length of gastrocnemius is the cause of variability of abnormal gait.
Animals ; Ankle ; Cerebral Palsy ; Child ; Foot ; Foot Deformities ; Gait ; Humans ; Knee ; Muscle, Skeletal ; Muscles

BACKGROUND: It is difficult to choose the appropriate drug when hypotension develops in patients with pulmonary hypertension (PH). There is no known drug to increase the systemic blood pressure (BP) without an increase of pulmonary arterial pressure (PAP). We observed the effects of phenylephrine (PE) and norepinehrine (NE) on systemic and pulmonary hemodynamics when hypotension was treated in patients with PH. METHODS: Patients with PH (mean PAP > or = 25 mmHg, n = 28) were studied. When hypotension occurred (systolic BP < or = 100 mmHg, T1) after the induction of anesthesia, PE or NE was randomly infused to raise the systolic BP above 130 mmHg (T2) and 150 mmHg (T3). Hemodynamic variables were measured at T1, T2 and T3, and the ratio (RBP) of mean PAP to mean BP was calculated. The measurements were performed before skin incision to avoid the effects of surgical stimulation. RESULTS: NE increased BP concomitantly with relatively small increase of PAP, meaning a decrease of RBP (P < 0.05) without any other changes of hemodynamic variables in all patients. However, PE could not raise BP above 130 mmHg in one third of patients, and decreased the cardiac index without a significant decrease of RBP. CONCLUSIONS: NE increased BP and decreased RBP without tachycardia or any other hemodynamic disturbances. NE is considered to be a proper and safe drug to raise BP when hypotension occurs in patients with PH.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Hypotension ; Norepinephrine* ; Phenylephrine* ; Skin ; Tachycardia

BACKGROUND: The mechanism by which mutant cartilage oligomeric matrix protein (COMP) induces a pseudoachondroplasia phenotype remains unknown, and the reason why a mutation of a minor protein of the growth plate cartilage causes total disruption of endochondral bone formation has not yet been determined. The current study was performed to investigate the effects of mutated COMP on the synthesis of the cartilage-specific major matrix proteins of Swarm rat chondrosarcoma chondrocytes. METHODS: The Swarm rat chondrosarcoma chondrocytes transfected with a chimeric construct, which consisted of a mutant gene of human COMP and an amino acid FLAG tag sequence, were cultured in agarose gel. Formation of extracellular proteoglycan and type-II collagen by the cells was evaluated by immunohistochemical staining and measuring the (35)S-sulfate incorporation. RESULTS: No difference was observed for the detection of type-II collagen among the cell lines expressing mutant COMP and the control cell lines. Histochemical staining of sulfated proteoglycans with safranin-O showed that lesser amounts of proteoglycans were incorporated into the extracellular matrix of the chondrocytes transfected with the mutant gene. (35)S-sulfate incorporation into the cell/matrix fractions demonstrated markedly lower radiolabel incorporation, as compared to that of the control cells. CONCLUSIONS: Mutation of COMP has an important impact on the processing of proteoglycans, rather than type-II collagen, in the three-dimensional culture of Swarm rat chondrosarcoma chondrocytes.
Aggrecans/analysis/*biosynthesis ; Animals ; Cells, Cultured ; Chondrocytes/*metabolism ; Chondrosarcoma/metabolism ; Collagen Type II/*biosynthesis ; Extracellular Matrix/*metabolism ; Extracellular Matrix Proteins/*genetics ; Glycoproteins/*genetics ; Humans ; Mutation ; Rats ; Transfection

PURPOSE: To evaluate the clinical results of arthroscopic inside-out repair leaving posterior horn tear. MATERIALS AND METHODS: Among the patients taken arthroscopic meniscal repair due to meniscus longitudinal tear from Jan. 1999 to Dec. 2004, total 32 patients were evaluated, and followed at minimum of two years(mean 32 months). Meniscal repair was done as maximum 3mm interval. The length of unrepaired posterior horn was mean 7.5mm. RESULTS: Preoperative Lysholm score was mean 62.5 and postoperative improved to 91.0. Twenty eight cases(87.5%) showed excellent or good results by Tapper and Hoover criteria. In 4 cases, symptoms recurred at 4 to 12 months after repair and 2 cases were combined with ACL deficiency. Second look arthroscopy was performed in 10 cases, 4 cases for recurred symptom and 6 cases for determining whether healing of untreated posterior horn occurred or not. We observed complete healing of 4 cases and incomplete healing of 2 cases on the acquisition of stability. CONCLUSION: It was suggested that meniscal repair leaving posterior horn tear may be healed if both stabilities of the torn area and the knee joint were maintained.
Animals ; Arthroscopy ; Horns* ; Humans ; Knee Joint

The Solid variant of the aneurysmal bone cyst is clinically important, because its solid composition is comparable to that observed in osteosarcoma or osteoblastoma, presenting difficulty for the correct diagnosis. The fluid-fluid level, which is a common sign of the conventional aneurismal bone cyst, is not apparent in radiographs of the solid type. These cysts were localized, equally within the whole spine as compared to most conventional aneurysmal bone cysts in which are localized to the posterior neural arch of the cervical spine. In this particular patient case, a young male aged 11.5 years presented with lower back pain and radiating pain which was misdiagnosed as a malignant bone tumor. Surgical intervention was considered and the incisional biopsy and laminectomy were conducted due to the low possibility of malignancy. We present this case and literature reviews with radiological and pathological findings as an example of the differential diagnosis of malignant tumors.
Aged ; Aneurysm ; Biopsy ; Bone Cysts ; Bone Cysts, Aneurysmal ; Diagnosis, Differential ; Humans ; Laminectomy ; Low Back Pain ; Male ; Osteoblastoma ; Osteosarcoma ; Spine