[Show abstract][Hide abstract]ABSTRACT: Background:
Angelman syndrome (AS) is a genetic disorder with varying degrees of neurological impairment. It is often associated with ocular involvement.
We present a child diagnosed with AS who had a deletion on the short arm of chromosome 15. The child seemed to be happy, with developmental delay, speech problem, and altering strabismus. To assess the potential presence and degree of damage in the visual pathway, we recorded monocular flash visual evoked potentials (VEPs). Our results revealed the presence of severe central afferent dysfunction in both optical pathways.
VEPs can be used in patients with AS and visual disturbances to assess the integrity of the visual system.
[Show abstract][Hide abstract]ABSTRACT: Aim:
Evaluation of the effectiveness of oral atropine versus surgical therapy for hypertrophic pyloric stenosis (HPS).
A total of 66 consecutive patients with HPS were treated at the University Children's Hospital between January 2006 and December 2011. The diagnosis was initially based on medical history and confirmed by ultrasonography (US). The patients were divided into two groups according to the treatment preferred by their parents. The conservatively treated group, consisting of 33 boys and 7 girls, mean age 22.25 days, was given water-soluble atropine sulfate therapy at an initial dose of 0.05 mg/kg/day divided into 8 single doses, and administered after stomach decompression, 20 minutes prior to feeding. If vomiting persisted, the daily dose was progressively increased up to 0.18 mg/kg. If vomiting did not stop and full oral feeding was not reestablished in a week, surgery was done. The second group of 26 patients, mean age 20.86 days, underwent an operative procedure, Ramstedt extramucosal pyloromyotomy after the initial resuscitation. US evaluation was performed on days 7, 14, and 21. The outcome of the treatment was tested by Yates modification of the χ2 test.
In the group of patients treated with atropine sulfate, 10 (25%) failed to respond to therapy, therefore, 8 boys and 2 girls underwent surgical treatment between the fifth and seventh day following institution of therapy. The remaining patients who received atropine sulfate (75%) were discharged when vomiting ceased, between the sixth and eighth day. They continued to take oral medication for 4 to 6 weeks, and were followed up by an ultrasound examination. The operated patients were discharged between the third and fifth day after surgery. There was a significant statistical difference between the groups regarding the outcome at a significance level of p < 0.05 (Yates χ2 = 5.839), with no complications regardless of the treatment option. However, at the significance level of p < 0.01 (Yates χ2 = 7.661), these methods demonstrate a difference in favor of surgical treatment.
Further investigation of oral, intravenous or combined atropine sulfate treatment may clarify its position as an alternative to pyloromyotomy.
Full-text Article · Feb 2013 · European Journal of Pediatric Surgery
[Show abstract][Hide abstract]ABSTRACT: Aim:
The purpose of the study was to evaluate the influence of four comorbidities from the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and their severity on functional status outcome after a rehabilitation program measured by the Berg Balance Scale (BBS) in patients with hip fracture.
The study included 203 patients whose functional status was evaluated by the BBS at admission (Group 1), at discharge (Group 2) and 3 months after discharge (Group 3). Further comorbidity parameters from the CIRS-G were assessed: musculoskeletal impairment, neurological, vascular and cognitive impairment. For the evaluation of CIRS-G severity degree we used the range 0-4.
At admission there were non-significant differences in mean values of BBS between parameters for the same CIRS-G severity degree. Significant differences between BBS values were noticed in the period after discharge (Group 2((musculoskeletal)); P<0.05, Group 2((neurological and cognitive)); P<0.01) and after 3 months of follow-up (Group 3((musculoskeletal, neurological and cognitive)); P<0.01). Higher effects of CIRS-G severity degree on BBS values in Group 2 and Group 3 for neurological impairment (η(2)(Group2)=29.76 and η(2)(Group3)=28.35) and even higher for cognitive impairment (η(2)(Group2)=34.35 and η(2)(Group3)=40.63) were noticed.
Increase in CIRS-G severity degree of cognitive and neurological impairment in patients after hip fracture that were included in the rehabilitation program correlates closely with functional status after discharge and after 3 months of follow-up. Rehabilitation of patients after hip fracture should be mandatory for functional recovery regardless of the comorbidity and functional status.
Article · Nov 2012 · Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
[Show abstract][Hide abstract]ABSTRACT: Aim: To evaluate the functional status measured by Berg Balance Scale (BBS) in elderly aged more than 65 years after hip fractures, and to evaluate the influence of sex, age and comorbidity on balance function improvement.
Methods: The study included 203 patients with hip fractures. Functional status was evaluated by BBS: at admission (Group 1), at discharge (Group 2) and 3 months after discharge (Group 3). We analyzed three age groups: Group65–74, Group75–84 and Group85-up; female and male sex separately; and for severity index value (SI; total cumulative illness rating scale for geriatrics score divided by number of endorsed categories): group between 0–1.99 (SI1) and group ≥2 (SI2).
Results: BBS values significantly declined in all male groups and female Group 2 and Group 3 in SI2 (P < 0.01). Group65–74 and Group85-up had a significant BBS values decline in Group 2 and Group 3, whereas Group75–84 had a significant decline in all groups in the SI2 group (P < 0.01). Females and males had a significant BBS values increase in the SI1 groups (P < 0.01), and non-significant BBS values increase between Group 2/Group 3 for SI2. Group85-up had a significant BBS values increase in SI1 (Group 1/Group 2 and Group 1/Group 3; P < 0.01); a non-significant increase between Group 1/Group 2 and Group 1/Group 3, and a non-significant decline between Group 2/Group 3 in SI2.
Conclusions: Male sex, increased comorbidity and age more than 85 years could be considered with lower functional recovery capacity potential after hip fracture, and thus should be individually assessed and continuously monitored. Functional status estimation by BBS could be taken as a sensitive predictive value for the evaluation of functional improvement in these patients. Geriatr Gerontol Int 2013; 13: 365–371.
Article · Jul 2012 · Geriatrics & Gerontology International
[Show abstract][Hide abstract]ABSTRACT: The aim of the study was to analyze changes of systolic and diastolic blood pressure values over five and ten years separately
boys and girls and to estimate correlation between them. Three age groups from 8 centers in Serbia were evaluated: Group 1:
10 year old patients, Group 2: 15 year old and Group 3: 20 year old. Group with normal blood pressure values, prehypertensive
and hypertensive group were analyzed. Regarding the period of follow-up we analyzed: 10/15 years period-children between 10
and 15 years, 15/20 years period-children between 15 and 20 years, and 10/20 years period-children between 10 and 20 years.
Significant increase of diastolic blood pressure was noticed for both genders in 10/15 years period of prehypertensive population,
while in hypertensive children, boys showed decline in frequency for systolic and diastolic blood pressure and girls only
for diastolic. In 15/20 years period there was significant decrease of prehypertensive and significant increase of hypertensive
diastolic blood pressure frequency. In 10/20 years period significant reduction in frequency of prehypertensive systolic blood
pressure was noticed, while only hypertensive group of boys showed significant reduction regarding systolic blood pressure
frequency. Prehypertensive diastolic and hypertensive systolic blood pressure fluctuations are more related to age.
KeywordsBlood pressure–Hypertension–School age children–Follow-up
Full-text Article · Oct 2011 · Central European Journal of Medicine
[Show abstract][Hide abstract]ABSTRACT: The purpose of our study was to present results of different surgical orthopaedic approaches in the treatment of children with developmental hip disorder.
At the University Childrens Hospital in Belgrade, 21 young adults diagnosed with developmental hip disorder were treated with double osteotomy and with a modified Smith-Peterson approach during a period of 10 years, from 1997 to 2007. All patients were clinically and radiographically evaluated.
We were successful with 23 hips in 20 patients, since some patients underwent surgery of both hips. The evaluation of improvement was done according to the Merle d'Aubigne and Postel system which indicated very satisfied outcome in five patients, satisfied in 8, fair in 7 and poor in one patient.
In this paper we discuss the advantages and disadvantages of double osteotomy procedures compared with others that are used in the correction of developmental hip disorder. The best solution is adequate and timely diagnosis with proper correction of the deformity.
[Show abstract][Hide abstract]ABSTRACT: The aim of the study was to evaluate the proportion of left and right congenital muscular torticollis (CMT) in both genders and age groups of the patients as well as to evaluate the duration of physical therapy and treatment outcome in observed population.
In our study, 980 children with CMT without hematoma were treated at University children's Hospital of Belgrade (Serbia). They were divided into 2 groups: group with left torticollis and group with right torticollis. Boys and girls were separately evaluated. Patients were classified into 5 age groups: group of children less than one month of life, group above one to 3 months, group above 3 months to 6 months, group above 6 months to 12 months and group of children above 12 months of life. Optimal time for physical therapy was analyzed in every age group.
We diagnosed 496 torticollis in boys and 484 torticollis in girls. There were 458 children with left torticollis and 522 children with right torticollis. In group of children less than one month of life median duration of physical therapy was 1.5+/-0.3 months, in group above one to 3 months of life 5.9+/-0.6, in group above 3 to 6 months 7.2+/-0.6, in group above 6 to 12 months 9.8+/-0.6 and in group of children above 12 months of life 10.3+/-0.8 months.
Right torticollis is frequent in both genders and age groups. Younger children have lower treatment duration and better treatment outcome. Boys have longer treatment duration and not significantly better treatment outcome.
Article · Jun 2010 · European journal of physical and rehabilitation medicine
[Show abstract][Hide abstract]ABSTRACT: In children with occult spinal dysraphism one of the symptoms is disbalance in bladder emptying and filling. Goal of our study was to estimate the correlation of medicamentous treatment alone and combined medicamentous and physical treatment in patients that are diagnosed with occult spinal dysraphism with non-neurogenic bladder dysphunction.
We evaluated 69 patients aged from 4 to 12 years treated at the University children's Hospital in Belgrade during 2005-2008 years period. In the first group of 29 patients only medicamentous therapy was implemented. In the second group of 40 patients combined medicamentous and physical therapy were applied. Physical therapy methods that were used included: transcutaneal electric nerve stimulation and exponential current. We monitored daily enuresis, enuresis nocturna, urgency and frequency. Urodynamic evaluation included: bladder capacity, onset of unstable contractions, residual urine and detrusor sphincter dyssynergia.
Statistical analysis showed that there is significant improvement (p < 0.001) in all evaluated symptoms after 6 months and for urgency there was significant improvement (p < 0.05) after 3 months from the beginning of the treatment with combined therapy. Our study pointed out significant improvement in the group treated with combined therapy for detrusor sphincter dyssynergia and unstable contractions after 3 months while after 6 months from the beginning of the treatment there was significant improvement (p < 0.001) for all urodynamic parameters.
Combined medicamentous and physical treatment is more beneficial for patients with non-neurogenic bladder instead of medicamentous treatment alone (Tab. 2, Ref. 11).
[Show abstract][Hide abstract]ABSTRACT: The paper presents three children of various ages with tumors of different histology localized in the retroperitoneum. The children underwent investigation as orthopedic cases at the Orthopedic Department of the Belgrade University Childrens' Hospital. All children had orthopedic symptoms and several similar clinical findings: high or increased red blood cell (RBC) sedimentation, increased lactate dehydrogenase (LDH) and hypochromic anemia. Retroperitoneal tumors were diagnosed by echosonography. Further investigations were targeted towards histological verification and treatment protocol for retroperitoneal tumor. Since the children were presented chronologically to the deparmtent, diagnosis was reached more rapidly. It is our aim to draw attention to the possibility that various retroperitoneal tumors can be presented as orthopedic diseases. If symptomatology of retroperitoneal tumors is suspected and particularly in insufficiently clear cases, one should always perform echsonography of the retroperitoneum as a non-agressive, simple, readily available and reliable diagnostic method. This reduces examination time, direction of patients to further treatment according to pathology and also in reduction of risk both for patient and orthopedic surgeon who normally are presented with such diseases (Fig. 2, Ref. 10). Full Text (Free, PDF) www.bmj.sk.
[Show abstract][Hide abstract]ABSTRACT: Introduction:
During invasive and orthopaedic procedure of the joints, physical therapy is a necessary modality for successful recovery, especially in patients with haemophilia. These patients require concurrent substitution therapy. Recombinant activated factor VII (rFVIIa) has been successfully used in treating haemophilia with inhibitor, especially during preoperative preparation. Nevertheless, optimal substitution therapy during perioperative physical therapy has been poorly defined.
In our paper, we review the literature and the course of perioperative rehabilitation after synovectomy in a 16-year-old haemophilic patient with high-titre inhibitor, treated with rFVIIa. Rehabilitation was started on day 3 after surgery, with rFVIIa substitution lasting ten days and followed by intermittent dosages during episodes of pain. After concluding physical treatment, a significantly better function of the operated joint was recorded, which led to the recovery of walking without orthopaedic aid.
Patients with inhibitors require individualized approach of a multidisciplinary team in order to achieve optimal results in elective orthopaedic procedures.
Full-text Article · Sep 2008 · Srpski arhiv za celokupno lekarstvo
[Show abstract][Hide abstract]ABSTRACT: The Aim of our study was to present early rehabilitation protocols for children with and without pulmonary complications after the correction of congenital heart defects and to estimate the optimal time for the initiation of early rehabilitation in both groups of children.
In our study, 176 children treated at the University Children's Hospital in Belgrade were evaluated during the period 2003-2007. All patients were children with the corrected congenital heart defects from birth to 12 months of life.
In the group of patients without pulmonary complications we administered 3.64 +/- 1.02 exercises and in the group with present pulmonary complications we implemented 2.71 +/- 0.79 exercises. The optimal time for the initiation of early rehabilitation is 1.54 +/- 1.37 days for the group of children that did not have pulmonary complications, but for the other group the period was longer: 2.27 +/- 1.68 days.
The optimal number of exercises in children younger than one year of life is from 2 to 4 and the early rehabilitation should start as soon as possible. A desirable time for beginning of such program is within 24 to 48 hours post surgery but it cannot be limited to this interval due to possible complications stating that every child should have an individual approach (Tab. 3, Ref. 14).