RESUMEN
In all 21 children with spastic cerebral palsy (CP) underwent surgery involving selective posterior rhizotomy (SPR), followed by six months intensive physiotherapy (PT). Neurological and physiotherapeutic assessments were made one, three and five years after the operation. The children undergoing surgery were compared to 21 comparison children who took part in a regular physiotherapy programme during the same time period. At the preoperative assessment, the children undergoing surgery were similar to the comparative children in terms of age, sex, type of CP, spasticity of the legs and mean functional scores. The children were selected for SPR on the basis of more than half a year's arrest of motor development, which was the only significant difference to the comparative group. Motor function was measured using two different methods, the Illinois-St Louis Scale and the Gross Motor Functional Classification System (GMFC). Both groups experienced steady development during the five-year follow-up period and no significant differences were observed in the mean functional scores between the groups. We conclude that this comparative study, like most controlled studies, failed to demonstrate any additional effect of SPR on motor development of children with spastic CP. Nevertheless, SPR may contribute to a resumption of motor development in children with arrested motor development despite vigorous conservative therapy. SPR is therefore justified as treatment in selected cases.
Asunto(s)
Parálisis Cerebral/fisiopatología , Parálisis Cerebral/terapia , Actividad Motora/fisiología , Espasticidad Muscular/fisiopatología , Espasticidad Muscular/terapia , Evaluación de Resultado en la Atención de Salud , Modalidades de Fisioterapia , Rizotomía , Adolescente , Parálisis Cerebral/complicaciones , Niño , Preescolar , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Espasticidad Muscular/etiología , Factores de TiempoRESUMEN
The purpose of this work was to determine by ultrasound the volume and echo structure of the thyroid gland in 13-year-old schoolchildren in northern Finland. 76 healthy schoolchildren underwent cervical ultrasound examinations during the period of Jan-Feb 1990, performed with a real-time scanner using a 7.5 MHz linear transducer and direct contact method. The volume of each lobe was calculated according to the formula for a volume of rotation ellipsoid by multiplication of maximal thickness, width and height of the lobe by the correction factor 0.479. Any focal lesion that could be distinguished in the homogenous thyroid parenchyma was assessed for echogenicity as compared with the normal thyroid gland and was measured with electronic calipers. The mean thyroid volume was 6.5 +/- 1.6 ml (mean +/- SD), being 6.3 +/- 1.8 ml in the boys and 6.7 +/- 1.4 ml in the girls. The sex difference was not significant. The right lobe was significantly larger than the left one (mean 3.7 and 2.8 ml, respectively). Thyroid volume was correlated with body weight and body surface area in both sexes. Abnormal lesions in terms of echo structure were noted in one subject (1.3%). Comparing the results with the findings reported from other countries, it can be concluded that the thyroid volume in these 13-year-old Finnish schoolchildren was about 30% less than that reported for the same age group in the FRG (with insufficient iodine intake) and about 35% more than in 13-year-old schoolchildren in Sweden (with sufficient iodine intake).