Marinis Pirpiris

The Functional Mobility Scale (FMS).

We devised a new Functional Mobility Scale (FMS) to describe functional mobility in children with cerebral palsy, as an aid to communication between orthopaedic surgeons and health professionals. The unique feature of the FMS is the freedom to score functional mobility over three distinct distances, chosen to represent mobility in the home, at school and in the wider community. We examined the construct, content, and concurrent validity of the FMS in a cohort of 310 children with cerebral palsy by comparing the FMS to existing scales and to instrumented measures of physical function. We demonstrated the scale to be both valid and reliable in a consecutive population sample of 310 children with cerebral palsy seen in our tertiary referral center. The FMS was useful for discriminating between large groups of children with varying levels of disabilities and functional mobility and sensitive to detect change after operative intervention.

Pressor responsiveness in corticosteroid-induced hypertension in humans.

In previous studies short-term cortisol increased cold pressor responses and the rise in forearm vascular resistance accompanying intra-arterial norepinephrine without an increase in overall resting sympathetic nervous activity. The present study examined whether these alterations in pressor response are glucocorticoid or mineralocorticoid effects, or both. Normal male subjects (n = 12) received either fludrocortisone, 0.3 mg daily (n = 6), or dexamethasone, 3 mg daily (n = 6), for 7 days. Hemodynamic studies were performed before and on day 7 of treatment. Fludrocortisone increased body weight from 69.3 +/- 1.8 to 71.1 +/- 2 kg (p less than 0.001), cardiac output from 5.0 to 6.0 l/min (+/- 0.1, p less than 0.01), mean arterial pressure from 82 +/- 1 to 91 +/- 1 mm Hg (p less than 0.001), cold pressor responsiveness from 13.0 to 39.0 mm Hg/ml per 100 ml per minute (R units) (+/- 4.3, p less than 0.01), and forearm vascular response to intra-arterial norepinephrine (F = 59.4, p less than 0.01) and angiotensin II (F = 30.8, p less than 0.01) infusions. Total peripheral resistance fell from 22.0 to 20.1 mm Hg/l per minute (+/- 0.3, p less than 0.05). Dexamethasone did not increase cardiac output, 5.1 to 5.2 l/min (+/- 0.1), or body weight but did increase mean arterial pressure from 82 +/- 3 to 91 +/- 3 mm Hg (p less than 0.001), cold pressor responsiveness from 8.6 to 17.1 R units (+/- 2.8, p less than 0.05), and forearm vascular response to intra-arterial norepinephrine (F = 33.0, p less than 0.01) and angiotensin II (F = 54.9, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Body mass index in patients with slipped capital femoral epiphysis

Abstract: Approximately 20% of children with idiopathic slipped capital femoral epiphysis (SCFE) have bilateral disease. Predicting which patients will develop problems with both hips remains difficult. This is the first study to evaluate the relationship between body mass index (BMI) and unilateral and bilateral SCFEs. Height and weight measurements of patients presenting with SCFE to our institution were obtained and used to calculate the BMI. Of the 54 patients enrolled in the study, 16 ultimately had bilateral disease. The mean BMI of patients with bilateral disease was significantly greater than that of patients with unilateral disease. In addition, patients presenting with unilateral involvement who progressed to bilateral disease had a significantly greater average BMI than patients who did not progress. Elevated BMI is associated with SCFE, especially bilateral SCFE.

Function and well-being in ambulatory children with cerebral palsy

The purpose of this study was to determine whether there is a significant association between function and well-being in children with cerebral palsy. To determine this, the authors used validated measures of function (Gillette Functional Assessment Questionnaire, Gross Motor Function Classification System, Gross Motor Function Measure, and walking speed) and correlated them to health-related quality of life (HRQOL) measures (Pediatric Outcomes Data Collection Instrument, Pediatric Quality of Life instrument). In a cross-sectional study of ambulatory children with mild to moderate cerebral palsy aged 10.2 ± 3.2 years, mild to moderate decreases in function were found when compared with normative data. As the assessment of HRQOL comprises both functional well-being and psychosocial well-being, the authors decided to specify the aspect of well-being to which they were referring. It was found that the childs function was not correlated to psychosocial well-being. The children with mild cerebral palsy had greater effects on their psychosocial well-being than would be predicted by their functional disability. Functional measures were good at predicting the functional well-being but were weak at predicting the psychosocial arm of well-being.

Health-Related Quality of Life Outcomes Improve After Multilevel Surgery in Ambulatory Children With Cerebral Palsy

Background: Studies evaluating multilevel surgery to treat spastic deformity and functional deficits in cerebral palsy (CP) usually focus on data from instrumented gait analysis and clinical examination without examining functional and health-related quality of life (HRQOL) outcomes. Recently, outcome measures for well-being in children with a variety of musculoskeletal disorders have also been validated specifically for CP. Therefore, this study aimed to investigate the impact of multilevel surgery on the function and HRQOL in a group of ambulatory children with CP. Methods: In a multicenter prospective trial, 57 ambulatory children with CP, mean age 9.5 years, underwent multilevel soft tissue surgery to correct sagittal imbalance. Validated clinical outcome measures for HRQOL were administered preoperatively and postoperatively with an average follow-up time of 15.2 months. The functional and psychosocial components of the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Quality of Life Questionnaire (PedsQL), and the Functional Assessment Questionnaire Walking Score were used. Results: Significant improvements in outcome scores occurred postoperatively in the following: PedsQL parent-total (17.6%; P < 0.001) and parent-physical sections (25.0%; P < 0.001), the Functional Assessment Questionnaire Walking Score (15.3%; P < 0.001), and the PODCI sections for transfers and basic mobility (15.8%; P < 0.001), sports and physical function (23.9%; P = 0.012), and global (12.9%; P < 0.001). Improvements also occurred in the PedsQL child-total (8.4%; P = 0.104) and child-physical sections (8.6%; P = 0.189), but these were not statistically significant. There were no significant changes in the PODCI parent-derived pain (−3.2%; P = 0.504) and happiness sections (1.9%; P = 0.645). Conclusions: Multilevel surgery in ambulatory patients with CP improves function and HRQOL. However, improved functional well-being does not imply improved psychosocial well-being, and patients and their families should be counseled accordingly. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

Uptime in children with cerebral palsy.

Quantitative evaluation of function, in children with physical disabilities, has to date been mainly focused on laboratory-based measures. However, the measurement of activity in the community may have a more direct relationship with physical function, health, and well-being. We assessed the utility of a remote activity monitor, the Uptimer (National Aging Research Institute of Melbourne, Melbourne, Australia), to measure one aspect of physical function, time spent in the upright position, in a consecutive cohort of 300 children with cerebral palsy who attended an orthopedic outpatient department. The Uptimer was found to be a valid and reliable tool to measure the amount of time children spent on their feet each day. Uptime was closely related to the severity of cerebral palsy and had excellent correlations with validated instruments including the Pediatric Orthopaedic Data Collection Instrument (PODCI), the Child Health Questionnaire (CHQ), and the Functional Mobility Scale (FMS). Uptime complements any quantitative functional assessment of impairments in children with cerebral palsy.

Body mass index and Blount disease

Abstract: As the increasing prevalence of overweight and obese children is approaching epidemic proportions in North America, this study was designed to investigate whether Body Mass Index (BMI) and age- and gender-specific percentile Body Mass Index (BMI %) are associated with the likelihood of being listed for surgery for Blount disease after initial presentation to a tertiary referral centre. In a restrospective consecutive sample of 102 children with an average age of 5.9 ± 4.3 years, it was determined that there was a significant association between BMI and BMI% and being listed for surgery, after adjusting for the effects of the childs age and gender, with mean odds ratios of 1.30 (95% confidence interval 1.02-1.60) and 1.05 (95% confidence interval 1.01-1.09) respectively. When the sample was subgrouped into infantile (less than 3 years of age) and late-onset (greater than 3 years of age), BMI and BMI% were still significantly associated with the children being listed for surgery in the late-onset group with mean odds ratios 2.75 (95% confidence interval 1.03-7.33) and 1.09 (95% confidence interval 1.01-1.18) respectively. However, of the two measures only the BMI was significant in the infantile group with an odds ratio of 1.27 (95% confidence interval 1.01-1.60). Should these associations be real then measures aimed at decreasing weight in children may have some effect on the number of children undergoing surgery for the treatment of Blount disease.

Wound blisters post hip surgery: A prospective trial comparing dressings

Introduction:  Wound blisters are formed in the epidermis adjacent to surgicalincisions and are a significant cause of morbidity following hipsurgery. This study was designed to compare two commonly used primarydressings, namely a nonadherent absorbable (NAA) dressing and paraffintulle gras (PTG). Monitoring for the subsequent development of woundblisters in the epidermis adjacent to the surgical incision wasthen undertaken.

The assessment of acetabular index: is there still a place for plain radiography?

Abstract: This is a series of 7 children (14 hips) with a mean age of 7.3 years (range, 3.3-10.5 years) and an underlying diagnosis of developmental dysplasia of the hips and no previous open-hip surgery who underwent plain radiographic and magnetic resonance imaging (MRI) measures of bony acetabular index. There was a significant correlation between the measurement of acetabular index using plain radiography and MRI, with a Spearman correlation coefficient of 0.88 (95% confidence interval, 0.61-0.96; P < 0.001) and a mean difference between the 2 measures of 0.36 ± 6.5 degrees. Furthermore, the bony and cartilaginous acetabular indexes as measured by MRI had a significant correlation with a Spearman correlation coefficient of 0.88 (95% confidence interval, 0.80-0.98; P < 0.001). We suggest that plain radiography is still an appropriate tool for follow-up for the nonoperated hip with developmental dysplasia and may be a good indicator of hip cartilaginous development.

Mineralocorticoid Induced Hypertension and Noradrenaline Spillover In Man

This study examined haemodynamics and noradrenaline spillover in five normal men before and on day 7 of oral fludrocortisone treatment, 0.3 mg/day. Resting systolic (105 to 115 mm Hg, standard error of the difference +/- 2.0, p < 0.01) and diastolic (65 to 73 mm Hg, +/- 3.0, p < 0.05) blood pressure increased, as did cardiac output, from 5.0 to 5.7 L/min (+/- 0.1, p < 0.01). Calculated total peripheral resistance fell from 21.2 to 20.0 mm Hg/L/min (+/- 0.4, p < 0.05). Fludrocortisone produced a fall in plasma potassium, renin and aldosterone concentrations and haematocrit and a rise in body weight. Cold pressor responses were increased by fludrocortisone, from 7.5 to 20 mm Hg (+/- 3.0, p < 0.01), and forearm vascular resistance rose 12 arbitrary resistance units (R) before and 36 R units after treatment (+/- 5.0, p < 0.01). Total body spillover of noradrenaline was decreased from 9.48 to 7.36 ng/kg/min (+/- 0.86, p < 0.05). There were no changes in forearm noradrenaline spillover at rest or during cold pressor stimulation. It appears unlikely that the sympathetic nervous system plays a major role in the pathogenesis of mineralocorticoid hypertension in man.