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PubMed1999

Unique morphological aspects of the rat ventral prostate gland revealed by vascular corrosion casting.

BACKGROUND: There is growing interest as to the potential role of the prostatic vascular system in mediating the effects of androgenic steroids on growth control of the prostate. Here we describe the use of a vascular corrosion casting technique that enables the visual characterization of the vascular system of the rat ventral prostate and the description of some unique morphological features of the mature rat prostate gland that were never previously observed. METHODS: Anesthetized adult male Sprague-Dawley rats were vascularly perfused with a fixative solution and then with a catalyzed methacrylate-based casting solution that was allowed to polymerize in situ. Ventral prostate glands were dissected from these rats and the tissues were subsequently dissolved in a corrosive solution, leaving residual vascular casts. The casts were then examined by scanning electron microscopy for pertinent morphological features. RESULTS: Vascular corrosion casts of individual lobes of the mature rat ventral prostate revealed a complex vascular structure that entered into the prostate near the base of the bladder. The morphological correspondence of the prostatic vasculature to the previously described ductal organization of the prostate was readily apparent. Examination of the entire vascular complex (under low-power scanning electron microscopy) revealed three differing surface features of the tissue and suggested that the glandular elements of the ventral prostate were directionally oriented towards a single surface (the anterior-lateral surface). An opposing face (posterior-medial) of the tissue demonstrated some unique spiral vessels, suggesting the need for a potential stretch-compensation mechanism at the prostate surface immediately adjacent to the bladder. CONCLUSIONS: Vascular casts of the rat ventral prostate gland reveal the obvious ductal organization of the prostatic parenchyma and demonstrate that these ducts are directionally oriented so that the glands of the prostate (at the distal tips of the ducts) uniformly lie near the anterior-lateral surface of the tissue. Unusual spiral arterioles found proximal to the bladder surface suggest that the rat ventral prostate gland has acquired the means to adapt to an anatomical position adjacent to a tissue (bladder) that acutely varies in size during the micturition cycle.

Animals↗
PubMed1998

Structure and blood supply of intrinsic lymph nodes in the wall of the rabbit urinary bladder--studies with light microscopy, electron microscopy, and vascular corrosion casting.

The urinary bladder is especially subject to infection by virtue of its direct connection to the external urethral opening, and it is natural to anticipate the presence of a well-developed immunological mechanism to respond to this potential threat. The present study describes small, very highly vascular lymph nodes located in the wall of the rabbit bladder, which may be involved in a local response to foreign antigens. The vasculature and structure of these lymph nodes was described using a combination of vascular corrosion casting, ink injection, and light and electron microscopy. The distal abdominal aorta was cannulated, and after clearing the bladder vasculature with buffered saline, one of the following procedures was used: 1) the bladder was perfuse-fixed in preparation for light and electron microscopy; 2) the bladder vasculature was filled with India ink for vessel tracing; or 3) vascular corrosion casts of the vasculature were prepared by infusing resin comprised of a mixture of Mercox, methyl methacrylate monomer, and catalyst. The resulting casts were cleaned with KOH, formic acid, and water in preparation for scanning electron microscopy. Vascular casts and India ink injections revealed the presence of a number of isolated capillary tufts consisting of clusters of one to five "glomeruli," closely associated with the major vesicular vessels along the lateral walls of the bladder, and supplied by tertiary branches of these vessels. Light and electron microscopy showed that the capillary tufts represented the blood supply to small, ovoid lymph nodes located near the serosal surface of the bladder wall and usually restricted to the basal half of the bladder. These nodes were encapsulated and exhibited subcapsular sinuses, numerous small blood vessels, a limited number of high endothelial cells, and, occasionally, nerves and a follicular substructure. The nodes contained abundant lymphocytes, stellate stromal cells, macrophages, and eosinophils, but lacked the obvious cortical and medullary organization and germinal centers often seen in larger lymph nodes. Vascular corrosion casts, vascular ink injections, and microscopic examination confirmed the presence of small, highly vascular lymph nodes closely associated with the main vesicular vessels along the lateral walls of the rabbit bladder. A follicular substructure of the nodes appears to correspond with the "glomerular" capillary arrangement within the nodes as seen with corrosion casts. The rich blood supply may be indicative of the high metabolic demand of lymphatic tissue, and may be altered in response to the level of activity of the node. The close association between the lymphatic tissue and the rich blood supply to the nodes may allow a rapid mobilization of lymphocytes during a local immune response to foreign agents.

Animals↗
PubMed1992

Microcorrosion casts of hamster luteal and follicular vasculature throughout the estrous cycle.

Golden hamster (Mesocricetus auratus) ovarian microcorrosion casts were studied as a model system to analyze angiogenesis that occurs in the corpus luteum (CL) during the estrous cycle. Growth of the vasculature in the hamster CL occurs rapidly with complete formation and subsequent degeneration occurring during the 4-day estrous cycle. This study followed the growth of these vessels by casting the ovarian vasculature at 4-hour intervals during the formation of the CL, viewing the casts on a Scanning Electron Microscope (SEM), and comparing the consecutive casts. This study revealed that the microvasculature of the CL forms rapidly from the vessels of the theca folliculi of newly ruptured follicles and that this growth is in an internal direction. This method of casting, when used in conjunction with the high magnification provided by the Hitachi field emission high resolution SEM, enabled us to analyze the growing tips of the vascular sprouts. The vasculature of the CL grows throughout day 1 and well into day 2 of the cycle. Flat veins, characteristic of the external surface of a mature CL, formed by the afternoon of day 2. Obvious degeneration of the vasculature of the CL took place throughout day 3. This study provided a detailed description of the angiogenesis that occurred throughout the rapid formation of the hamster CL and showed that this method produced casts of suitable quality for experimental observations.

Animals↗
PubMedDate not supplied

Identification of fenestrated capillary segments in microvascular corrosion casts of the rat exocrine pancreas.

The capillary bed of the rat exocrine pancreas was studied by scanning and transmission electron microscopy of corrosion casts and tissue sections. Two types of capillaries were distinguished in corrosion casts. First, there were straight capillaries of relatively constant width (mean diameter 4.79 +/- 0.87 microns), which were characterized by numerous circular constrictions on their surface. About 37% of the capillaries belonged to this type. Second, there were undulating capillaries which showed smooth surfaced eccentric dilatations defined by similar surface constrictions. The bulging areas measured 8.43 +/- 1.33 microns, the constrictions next to the bulges figured for 6.45 +/- 1.53 microns. About 63% of the capillaries belonged to the second type. Two types of capillaries were also identified in tissue sections. First, there were capillaries with continuous endothelial lining (26% of capillary profiles; mean diameter 5.48 +/- 1.67 microns); 27% of their endothelial lining was provided with underlying pericytes. Second, there were capillaries with fenestrated endothelium (64% of capillary profiles; mean diameter 6.16 +/- 1.75 microns); 12% of their endothelial lining was accompanied by pericytes. According to frequency and dimension of these two types of capillaries, we conclude that bulged and undulating capillary casts correspond to fenestrated capillaries and straight capillary casts of constant width correspond to nonfenestrated capillaries. The frequency of crests on the surface of capillary casts correlates with the different frequency of pericyte processes on fenestrated and nonfenestrated capillaries. It is concluded that pericyte processes beneath the endothelium hold resistance against luminal pressure. Bulging areas of capillary casts correlate with fenestrated areas of endothelial lining, that is, areas which are not reinforced by pericyte processes.

Animals↗
PubMed2000

[Cast immobilization versus vacuum stabilizing system. Early functional results after osteosynthesis of ankle joint fractures].

In a prospective randomized trial the early functional results after immobilisation in a cast were compared to those after using a vacuum stabilizing system. The vacuum stabilizing system Vacoped offers equivalent stability compared to a plaster cast. In contrast to the cast the Vacoped can be removed for body care and physical therapy. Additionally the range of motion for dorsal flexion/extention in the upper ankle joint can be adjusted. From 9/1996 to 7/1997 there were 40 patients included in the study with an operated ankle fracture as monotrauma. Six weeks postoperatively the patients with cast treatment showed significantly higher functional deficits for the upper ankle joint (20%), the lower ankle joint (40%) and muscle atrophy (2.1 cm side difference) than the group with the vacuum stabilizing system (upper ankle joint 15%, lower ankle joint 25%, 1.4 cm muscle atrophy). Five patients out of the group with the vacuum system were already at work three weeks postoperatively. Three months postoperatively the functional results for both groups were approximating. The vacuum stabilizing system Vacoped offers better early functional results than conventional cast treatment after osteosynthesis of ankle fractures. Because of the increased patient comfort and the early ability for physical therapy the vacuum stabilizing system is preferable to cast treatment.

Adult↗
PubMed2005

Casting versus surgical fixation for grade IIIA open tibial diaphysial fractures in children: effect on the rate of infection and the need for secondary surgical procedures to promote bone union.

We evaluated 39 grade IIIA open tibial fractures presenting in children younger than 13 years of age, to determine if the mode of fracture stabilization (casting vs. surgical fixation) was related to the rate of infection or the need for secondary surgical procedures to promote bone union. All fractures had wound debridement in the operating room. Thirty patients had manipulation and casting, and nine surgical internal or external fixation. There were two cases of infection in the cast-treated group and two in the surgical fixation group (P=0.17). None of the fractures required a secondary surgical procedure to promote bone union. Three of the fractures treated by manipulation and casting displaced; two required re-manipulation and casting and one was converted to external fixation. In two cases the applied external fixator had to be re-aligned. Our results suggest that manipulation and casting is a reliable treatment for open tibial fractures in children.

Adolescent↗
PubMed1991

Cooling to heat of fusion (HOF), followed by rapid rewarming, does not reduce the integrity of microvascular corrosion casts.

This study utilized microvascular corrosion casting techniques to evaluate changes in the microvascular patency of rat hindpaws cooled to four different subzero temperatures. Left hindpaws of anesthetized rats in group 1 were cooled to -5 degrees C, in group 2 to -15 degrees C, in group 3 to heat of fusion (HOF), and in group 4 to HOF and then to -15 degrees C. Although freezing did not take place in the hindpaws of groups 1 and 2, initiation of freezing in the tissues, as indicated by HOF, did occur in groups 3 and 4. Cooled hindpaws were rapidly rewarmed. Right hindpaws served as controls. Microvascular corrosion casts were made from the left and right hindpaws of all animals. There was no significant difference when the mean cast weights of cooled hindpaws from groups 1, 2, and 3 were compared to the mean cast weights of their respective control hindpaws. In group 4, there was a significant difference (P less than 0.05) when the mean cast weight of the cooled hindpaws (47.69 +/- 9.05, mg +/- SEM) was compared to that of the control hindpaws (80.63 +/- 12.23). Since, in this acute experiment, a loss of vascular integrity occurred when the hindpaws in group 4 were cooled to -15 degrees C after reaching HOF, the initiation of freezing alone was not sufficient to reduce mean cast weight.

Animals↗
PubMed1985

Evaluation of an improved centrifugal casting machine.

A Type III gold alloy, a silver-palladium alloy, and a base metal alloy were cast in two different centrifugal casting machines. With the number of complete cast mesh squares as an indicator of castability, the Airspin casting machine produced superior castings with all three alloys. The base metal alloy produced the greatest number of complete squares with both casting machines.

Centrifugation↗
PubMed1986

Effect of die spacer on the seating of complete cast gold crowns with grooves.

Fifty crowns were constructed with an indirect technique for a standardized Ivorine tooth preparation to determine whether casting relief would improve the seating of complete cast crowns with zinc phosphate cement. The variables were two grooves in the preparations and die spacer casting relief of approximately 20 to 40 micron. The tooth preparations of two groups had no grooves, but castings were made with internal relief for only one group. Three groups had buccal and lingual grooves in the preparation. One group had no relief, a second group had complete relief, and a third group had relief but not in the grooves. The discrepancies noted before and after cementation of the castings were measured. The average discrepancy for each group and the significance between groups was determined. Results of this study demonstrated the following. Die relief significantly improved the seating of complete cast-gold crowns with or without grooves. Omitting die spacer from grooves did not reduce the benefits of relieving the remainder of the die. Partial internal relief was better than no relief. The grooves did not disrupt seating when die spacer application was complete or specifically omitted from the grooves alone.

Crowns↗
PubMed1989

Comparison of casting ability of castable ceramic and type III gold.

This study compared the property of castability of a castable ceramic to an American Dental Association-certified type II casting alloy. A wax pattern was made with a manifold-type structure from which monofilament lines projected approximately 5 to 6 mm. The diameter of the nylon lines ranged from 132 micron to 1270 micron. Each pattern was invested and cast according to the manufacturer's specifications. Each casting was divested and measured for length of casting of the monofilament on a measuring microscope. The castable ceramic and type II gold cast completely at diameters of 1270 micron, and 724 micron, but only type II gold cast completely at the 152 micron and 132 micron diameters.

Ceramics↗
PubMed2005

Effect of surface reaction layer on grindability of cast titanium alloys.

OBJECTIVE: The purpose of this study was to investigate the effect of the cast surface reaction layer on the grindability of titanium alloys, including free-machining titanium alloy (DT2F), and to compare the results with the grindability of two dental casting alloys (gold and Co-Cr). METHODS: All titanium specimens (pure Ti, Ti-6Al-4V and DT2F) were cast using a centrifugal casting machine in magnesia-based investment molds. Two specimen sizes were used to cast the titanium metals so that the larger castings would be the same size as the smaller gold and Co-Cr alloy specimens after removal of the surface reaction layer (alpha-case). Grindability was measured as volume loss ground from a specimen for 1 min using a handpiece engine with a SiC abrasive wheel at 0.1 kgf and four circumferential wheel speeds. RESULTS: For the titanium and gold alloys, grindability increased as the rotational speed increased. There was no statistical difference (p>0.05) in grindability for all titanium specimens either with or without the alpha-case. Of the titanium metals tested, Ti-6 Al-4V had the greatest grindability at higher speeds, followed by DT2F and CP Ti. The grindability of the gold alloy was similar to that of Ti-6 Al-4V, whereas the Co-Cr alloy had the lowest grindability. SIGNIFICANCE: The results of this study indicated that the alpha-case did not significantly affect the grindability of the titanium alloys. The free-machining titanium alloy had improved grindability compared to CP Ti.

Alloys↗
PubMed2005

Fit of metal ceramic crowns cast in Au-1.6 wt% Ti alloy for different abutment finish line curvature.

OBJECTIVES: The purpose of this study was to evaluate the fit of metal ceramic crowns cast in Au-1.6 wt% Ti alloy and investigate the effect of abutment finish line curvature on the fit of crowns. METHODS: Three types of finish line curvature abutments were prepared (1, 3 and 5mm-curvature). For each type of abutment, five metal ceramic crowns of the facial veneered type were fabricated, which were cast in Au-1.6 wt% Ti alloy. Used as controls, another fifteen specimens were made from a commercially available gold alloy. The fit was measured in the as-cast and after porcelain application. RESULTS: In the as-cast specimens, the greater the finish line curvature was, the larger the gaps exhibited at the mesial and distal margins of copings, compared with labial and lingual margins. The distal margin of copings for 5mm-curvature abutments showed the largest gap (35 (7) microm). After porcelain application, the greater was the finish line curvature, the larger the labial marginal gap became (mean 44, 34, 25 microm, respectively, for 5, 3, 1mm-curvature). However, there was no significant difference on marginal gaps between specimens of Au-1.6 wt% Ti alloy and control gold alloy. SIGNIFICANCE: This study indicated that the metal ceramic crowns cast in Au-1.6 wt% Ti alloy had equivalent accuracy to those that cast in control gold alloy, and the abutment finish line curvature had a significant effect on the marginal fit of metal ceramic crowns.

Crowns↗
PubMed2005

The effect of investment material type on the contamination zone and mechanical properties of commercially pure titanium castings.

STATEMENT OF PROBLEM: Different types of investment materials affect the formation of a surface contamination zone within commercially pure titanium (cpTi) castings. This contamination zone may possibly alter the mechanical properties of cast titanium, which may be problematic for castings used in the fabrication of removable and fixed prostheses. PURPOSE: The purpose of this study was to evaluate the effect of different types of investments on the extent of contamination zone and the modulus of elasticity, yield strength, elongation, and hardness of cpTi castings. MATERIAL AND METHODS: Forty wax patterns were fabricated according to ISO 9693 for tensile testing. The patterns were divided into 2 groups of 20 patterns each, invested, and cast in pairs using cpTi. The first group (P) was invested with a phosphate-bonded silica-based investment material (Ticoat S+L), and the second group (M), with a magnesia-alumina investment material (Rematitan Ultra). Investment materials were examined by x-ray diffraction analysis (XRD). One specimen from each group was sectioned and prepared for metallographic observation. The extent of the contamination zone was determined by scanning electron microscopy, using back-scattering electron imaging and energy dispersive spectroscopy analysis, as well as microhardness testing. The tensile strength of the specimens was determined in a universal testing machine. From the derived tensile curves, the modulus of elasticity, yield strength, and percentage elongation were calculated and statistically evaluated among the groups using the Student t test (alpha=.05). Three fractured specimens from each group were examined by scanning electron microscopy to determine the mode of fracture. RESULTS: XRD analysis showed that silica and magnesia were the dominant phases of Ticoat S+L and Rematitan Ultra, respectively. The contamination zone was found to extend 50 to 80 mum for the P specimens and 15 to 20 mum for the M specimens. No significance difference was found for the modulus of elasticity (P=85 +/- 11 GPa, M=79 +/- 13 GPa), whereas significant differences were found for the yield strength (P=462 +/- 48 MPa, M=321 +/- 54 MPa; P<.001) and percentage elongation (P=12 +/- 2, M=21 +/- 7; P=.002) between the groups tested. The fracture mode was brittle externally and ductile internally for both groups. CONCLUSIONS: According to the results of this study, the extent of the contamination zone as well as the yield strength and percentage elongation of the cpTi castings were significantly affected by the type of the investment material.

Dental Alloys↗
PubMed1995

Ipsilateral post-cast hypertrichosis and dyshidrotic dermatitis.

Post-cast hypertrichosis and dyshidrotic dermatitis are not uncommon separately. Yet, the simultaneous occurrence of both conditions in an individual is rare. A patient with both localized hypertrichosis and ipsilateral dyshidrotic dermatitis following multiple fractures and cast application is reported. The clinical presentation, management, spontaneous resolution, and/or response to therapy of post-cast hypertrichosis and dyshidrotic dermatitis that occurred concurrently in an individual were similar to that described when these conditions occur independently. The acquired conditions that may be associated with localized hypertrichosis are summarized and the postulated mechanisms of pathogenesis for dyshidrotic dermatitis are reviewed. The diagnosis of post-cast hypertrichosis in this patient was suspected based upon the distribution and temporal association of the hypertrichosis to the location and placement of his cast, and confirmed by excluding other causes of acquired localized hypertrichosis. Also, the possibility that in this individual either the trauma to his bones, the cast on his arm, or both had an etiologic role in promoting the development of dyshidrotic dermatitis is suggested.

Adrenal Cortex Hormones↗
PubMed1997

Variability of short arm cast application: the influence of experience using fibreglass tape and QuickCast.

A new short arm cast material which is heated to conform to the underlying limb was compared to conventional fibreglass tape. The time required for application, the pressures generated beneath the casts and the availability for digital motion were studied in three groups with varying lengths of casting experience. Results showed that the new immobilizer did not require additional time for application and provided similar interface pressures beneath the casts as compared to fibreglass tape. In addition, metacarpophalangeal joint motion was less restricted with the new casting experience. The shrinkable immobilizer thus offers an alternative to conventional fibreglass tape casts.

Casts, Surgical↗
PubMed2000

Biocompatibility of dental casting alloys: a review.

STATEMENT OF PROBLEM: Dental casting alloys are widely used in applications that place them into contact with oral tissues for many years. With the development of new dental alloys over the past 15 years, many questions remain about their biologic safety. Practitioners must choose among hundreds of alloy compositions, often without regard to biologic properties. PURPOSE: This article is an evidence-based tutorial for clinicians. Concepts and current issues relevant to the biologic effects of dental casting alloys are presented. SUMMARY: The single most relevant property of a casting alloy to its biologic safety is its corrosion. Systemic and local toxicity, allergy, and carcinogenicity all result from elements in the alloy being released into the mouth during corrosion. Little evidence supports concerns of casting alloys causing systemic toxicity. The occurrence of local toxic effects (adjacent to the alloy) is not well documented, but is a higher risk, primarily because local tissues are exposed to much higher concentrations of released metal ions. Several elements such as nickel and cobalt have relatively high potential to cause allergy, but the true risk of using alloys containing these elements remains undefined. Prudence dictates that alloys containing these elements be avoided if possible. Several elements in casting alloys are known mutagens, and a few such as beryllium and cadmium are known carcinogens in different chemical forms. Despite these facts, carcinogenic effects from dental casting alloys have not been demonstrated. Prudent practitioners should avoid alloys containing these known carcinogens. CONCLUSION: To minimize biologic risks, dentists should select alloys that have the lowest release of elements (lowest corrosion). This goal can be achieved by using high-noble or noble alloys with single-phase microstructures. However, there are exceptions to this generality, and selection of an alloy should be made on a case-by-case basis using corrosion and biologic data from dental manufacturers.

Biocompatible Materials↗
PubMed2003

Effects of interfacial variables on ceramic adherence to cast and machined commercially pure titanium.

STATEMENT OF THE PROBLEM: Titanium-ceramic bonding is less optimal than conventional metal-ceramic bonding, due to excessive oxidation of titanium during porcelain firing. PURPOSE: This in vitro study evaluated the effects of porcelain firing atmosphere and gold sputter coating on titanium surfaces on porcelain bonding to machined and as-cast titanium substrates. Material and methods Eight groups of ASTM grade 2 commercially pure (CP) titanium specimens (13 mm x13 mm x1 mm) were prepared (n=10). A conventional Au-Pd-In metal-ceramic alloy (Orion) and an ultra low-fusing porcelain (Finesse) served as the control (n=10). Forty machined titanium specimens were prepared from 1.00-mm thick titanium sheets with a diamond band saw. Forty titanium specimens were produced in a centrifugal dental titanium casting machine. All titanium specimens were airborne particle abraded with 110-microm alumina particles, whereas the control specimens were airborne particle abraded with 50-microm alumina particles. Forty titanium specimens (20 specimens each of as-cast and machined titanium) were randomly selected for gold sputter coating before ceramic firing. An ultra low-fusing porcelain (Vita Titankeramik) was fused on the central 6-mm diameter circular area on each titanium specimen. Porcelain firing environments for the titanium specimens consisted of vacuum and a reduced argon atmosphere. Porcelain was debonded by a biaxial flexure, constant strain test at a cross-head speed of 0.25 mm/min. Specimens were analyzed by standardized SEM/EDS analysis 3 times throughout the study to determine the silicon atomic percentage (Si at %): (1) after airborne particle abrasion, before porcelain application; (2) after the application of the first layer of porcelain; and (3) after the fracture of porcelain from the metal substrate. The titanium-ceramic adhesion was characterized by determining the area fraction of adherent porcelain (AFAP). Results were analyzed by analysis of variance and the Student-Newman-Keuls test (alpha=.05). RESULTS: Statistical analysis showed a significant difference in the AFAP values among all the groups. AFAP value of the control group was significantly higher (135.35 +/- 23.68) than those of the experimental groups (P<.001). For the machined titanium, AFAP value of gold sputter-coated/argon group (91.38 +/- 7.93) was significantly higher than the rest of the groups (P<.001). For the as-cast titanium fired in vacuum, significantly lower AFAP values (P<.001) were found in the gold sputter-coated group (50.2 +/- 11.26 vs 66.15 +/- 10.41). AFAP values between the argon groups with or without the gold coating were not significantly different (P=.303); however, both argon groups (93.83 +/- 4.65 and 98.09 +/- 6.35) showed significantly higher AFAP values compared with the vacuum groups (P<.001). CONCLUSION: Firing porcelain in a reduced argon atmosphere significantly improved titanium-ceramic bonding for machined and as-cast titanium. The sputter-coated gold layer on titanium provided improved titanium-ceramic bonding only when combined with firing porcelain in reduced argon atmosphere. When porcelain was fired in vacuum in the presence of the gold layer, the titanium-ceramic bonding was weakened in as-cast titanium and was not affected in machined titanium. Conventional noble metal-ceramic bonding was superior to titanium-ceramic bonding regardless of the interfacial variables examined in this study.

Aluminum Oxide↗
PubMed2001

A randomized study of combined botulinum toxin type A and casting in the ambulant child with cerebral palsy using objective outcome measures.

It is recognized that objective gait analysis is of great value in planning a multilevel botulinum toxin type A (BTX-A) treatment. After BTX-A treatment, objective outcome measures can provide new and interesting information for each individual child with cerebral palsy (CP). Moreover, by studying group results, we may evaluate our treatment hypotheses. The present prospective study attempts to document the effect of integrated multilevel BTX-A treatment on objective gait parameters and to define the optimal strategy for the combined treatment of BTX-A with casting in children with cerebral palsy. Objective three-dimensional gait analysis (3DGA) data were collected pre- and 2 months post-treatment, in two randomized patient groups: a first group of 17 children treated with lower leg casting prior to BTX-A injections, and a second group of 17 patients who received casting immediately after injections. The present study demonstrates that improved gait can be achieved after a multilevel BTX-A treatment, combined with casting, using a set of 90 gait parameters. The most pronounced improvement was seen at the ankle joint. The results in the knee, hip and pelvis imply that multilevel treatment of the child with CP should start at an early age, in order to prevent development of muscle contractures. Slightly more pronounced benefits, mainly in the proximal joints, were seen for the children who were casted after injections as compared to the children who were casted before injections.

Biomechanical Phenomena↗