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PubMed1987

[The quality of primary care of rheumatic diseases in childhood].

Primary treatment of 123 children with joint conditions up to referral to the rheumatological outpatient department of an university hospital was investigated. Only 81 (66%) of the children were referred with a diagnosis. This could in turn be confirmed only in 24 children (20%). The most frequent false diagnoses were "infection arthritis" (18%) and "rheumatic fever" (7%). Inadequate therapies were likewise frequent during primary care: 30 children (24%) received plaster casts which in five children (17%) led to a contracture which was difficult to influence. Only 21 children (17%) received physiotherapy. Twenty-one children (17%) were treated with corticoids, 16 children (13%) with pyrazolidine derivatives and 33 (27%) were treated with antibiotics. Further treatment in the clinic then revealed that corticoids were indicated in only five cases and pyrazolidine derivatives in no case. Acetylsalicylic acid was generally sufficient to eliminate symptoms. Our results indicate that in terms of the early correct diagnosis and commencement of adequate therapy which is important for the prognosis, primary treatment of children with rheumatic diseases is inadequate. Appropriate training and postgraduate education of the doctors concerned is necessary in order to improve the situation.

Anti-Inflammatory Agents↗
PubMed1987

[Results following surgical treatment of ligament ruptures of the ankle joint in children].

A follow-up study was done in 49 children one to five years after surgical repair of traumatic rupture of the fibular ligaments of the ankle joint. Surgery has been performed when the unstable ankle joint showed radiologically a difference in the supinatory subluxation of more than 7 degrees in comparison to the opposite side. 30 children were free of complaints and showed identical stability of both ankle joints. Further eleven patients had minor complaints but the ankle joints were stable, clinically and radiologically. Four patients without complaints had a slightly differing weakness of the ankle joint. Further four patients had substantial complaints. Three of them also showed radiologically instability of the joint. Ruptures of the fibular ligament in childhood are not infrequent. Early operative treatment obviously gives better results when compared with those of conservative plaster cast therapy. The radiologically confirmed difference in supinatory subluxation of the traumatised ankle joint in comparison to the other side provides an excellent parameter for the indication to surgery.

Adolescent↗
PubMed2000

Triangular-shaped incisor crowns and crowding.

The purpose of this study was to establish if there is a correlation between the shape of the labial crowns of the incisors and crowding. Plaster cast models of 69 untreated individuals (30 males and 39 females) were evaluated. The casts were selected randomly from the collection at Seoul National University and Ajou University. With the use of Little's irregularity index, the sample was divided into 2 groups, a crowded group and a normal group. Repeated measurements of the maximum mesiodistal width of the incisal and cervical areas of the incisors were taken by means of a digital vernier caliper and a ratio of these measurements was calculated. The mean value for the crowded group was significantly larger in the incisal area (P <.01) and smaller in the cervical areas (P <.01) than corresponding values in the normal group. These ratios were correlated with the irregularity index (Pearson r(2) from 55% to 65%). The value obtained from the incisor width ratio in the normal group can be useful for the diagnosis and treatment of crowded malocclusion.

Case-Control Studies↗
PubMed2001

Tooth-size discrepancies among different occlusion groups of southern Chinese children.

The purpose of this study was to compare Bolton anterior and overall ratios among different occlusion groups of southern Chinese children. Fifty plaster casts with Class I occlusion, 30 with Class II occlusion, and 30 with Class III occlusion were selected from a random sample of 1247 12-year-old southern Chinese children in early permanent dentition in Hong Kong. For the anterior ratio, a statistically significant difference was found between the Bolton standard and the Class III occlusion group. For the overall ratio, statistically significant differences were found between the Bolton standard and the Class II occlusion group, and between the Class II and the Class III occlusion groups. Thus specific standards are required for Class II and Class III cases from the southern Chinese population.

Asian People↗
PubMed2002

Long-term stability of the leveling of the curve of Spee.

The aim of the study was to investigate whether the orthodontic leveling of the curve of Spee is a treatment procedure with a stable result on a long-term basis. Measurements were made on the plaster casts of 149 orthodontically treated patients (57 males and 92 females). The mean age before treatment was 12.8 years (range, 8-25 years). Study casts were taken before treatment (T1), at the completion of orthodontic therapy (T2), and 6.7 years (mean) posttreatment (T3). Inclusion criteria were no extractions, all Angle classifications except Class III malocclusions, and all permanent teeth fully erupted except second and third molars. The curve of Spee and the irregularity index were measured on standardized digital photographs of the casts. Overjet and overbite were assessed with a ruler. Changes in the curve of Spee were correlated with changes in irregularity index, overjet, and overbite from T1 to T3. The following results were noted: (1) leveling of the curve of Spee is a relatively stable treatment procedure compared with a return of incisor crowding and deepening of the bite; (2) neither the initial depth of the curve of Spee nor the initial irregularity index is an indicator for the amount of relapse; (3) the amount of leveling is not correlated with the relapse of the 4 tested parameters (curve of Spee, irregularity index, overjet, and overbite); and (4) there is a mild correlation between the relapse of the curve of Spee and the relapse of the irregularity index, overjet, and overbite. According to the results of the study, leveling the curve of Spee during orthodontic treatment seems to be very stable on a long-term basis; it was weakly correlated with the other variables tested.

Adolescent↗
PubMed2002

Evaluation of the relationship between the anterior component of occlusal force and postretention crowding.

The aim of this study was to investigate whether a relationship exists between the anterior component of occlusal force (ACF) and postretention crowding in the mandibular incisor area. The study group comprised 32 adults who had undergone fixed orthodontic treatment in the department clinic at Marmara University in Istanbul, Turkey. In 13 subjects, the mandibular arch was treated without extractions; in 19, it was treated with bilateral first premolar extractions. The average postretention period was 3.5 years. The ACF created in the left side of the mandibular dentition was determined by measuring interdental frictional forces at each contact point mesial to the first molar and distal to the canine. Anatomic contact point displacements between the left mandibular anterior teeth (lateral incisor-canine, central incisor-lateral incisor, and central incisor-central incisor) were measured on plaster casts and summed to provide the irregularity index for these teeth. Correlation analysis was used to assess the relationship between the ACF values at each contact and the irregularity index. In the nonextraction group, statistically significant positive correlations were observed between the ACF and the irregularity index at the 3 contact points that were measured. The strongest correlation was found at the canine-first premolar contact (r = 0.65). In the extraction group, a positive correlation was found between the ACF and the irregularity index (r = 0.49, P <.05) at the second premolar-first molar contact, but no correlation was found at the canine-second premolar contact.

Adolescent↗
PubMedDate not supplied

Surgical results of leg amputation according to Ghormley's technique in the treatment of chronic lower limb ischaemia.

The authors present their experience in the treatment of chronic lower limb ischaemia resulting from atherosclerosis by below knee amputation according to Ghormley's technique, with the immediate application of a semi-rigid plaster cast and early rehabilitation. From a group of 664 patients requiring major amputations, 61 patients (52 men) aged 64 +/- 11 fulfilled the criteria for unilateral below-knee amputation for critical limb ischaemia for atherosclerosis consequences. Peri-operative (30-days) mortality was of 3.28%. Stump healing was very good or good (no need for further surgery) in over 2/3 of patients, but in 20% the need for above-knee amputation developed. Postoperative knee contracture (defined as 15 degrees or more limitation to the movement range) was observed in 11.5% of patients.

Adult↗
PubMed2005

Wear of teeth due to occupational exposure to airborne olivine dust.

OBJECTIVES: To clarify whether high tooth wear of employees in a mining industry that extracts the mineral olivine could be associated with airborne dust exposure in their working environment. METHOD: The cumulative exposure to airborne mineral dust for the workers in the company was calculated on the basis of their period of employment multiplied by the airborne olivine-dust concentrations, which have been monitored continuously during the past 20 years for all divisions of the company. After invitation, 85% of the employees (n = 191) were examined clinically and their dentitions were photographed and duplicated in plaster casts. Four clinicians, working independently, examined the sets of casts/photographs for tooth wear and ranked these from most to least. Two groups of employees were compared with regard to tooth wear, i.e. the 30% with the highest (case) and the lowest (control) estimated dust exposure levels. Tooth wear in the case and control groups was compared using a non-parametric test based on rankings (Mann-Whitney test). RESULTS: Tooth wear differed significantly between the workers in the low and the high mineral dust exposure groups (p < 0.001). The differences were also apparent within three age subsets, although statistical significance was reached only in the 34-44 years subset (p = 0.002). Considerable individual variation was noted within the three exposure groups. CONCLUSION: Workers with high exposure to airborne olivine dust may contract considerable tooth wear.

Adolescent↗
PubMed1998

The association between dental arch dimensions and occurrence of Finnish dental consonant misarticulations in cleft lip/palate children.

The aim of this study was to examine whether maxillary and mandibular dental arch width, length, and palatal height dimensions are associated with the occurrence of misarticulations (phonetic or phonologic errors) in the dental consonants /r/, /s/, and /1/ in different cleft types and sexes. The subjects were 263 (109 girls, 154 boys) 6-year-old Finnish-speaking non-syndromic children with isolated cleft palate (CP, n=79), deft lip/alveolus (CL(A), n=77), unilateral (UCLP, n=80), and bilateral (BCLP, n=27) cleft lip and palate. Dental plaster casts were measured by two authors using the technique of Moorrees, and auditive speech was analyzed with high reliability by two speech pathologists. The results showed that the occurrence of misarticulations increased and dental arch dimensions decreased with the severity of the cleft. Narrower and shorter maxillary arches as well as shallower palates were related to problems with the studied dental consonants. Mandibular arch dimensions were not related to the misarticulations. However, statistical analysis did not reveal significant differences in dental arch dimensions between subjects with and without misarticulations when they were compared separately for different cleft types. The etiology of clefting per se--isolated deft palate versus cleft lip with or without deft palate--did not seem to explain the associations between dental arch dimensions and the studied misarticulations.

Articulation Disorders↗
PubMed2000

Function after Achilles tendon rupture in the elderly: 25 patients older than 65 years followed for 3 years.

We retrospectively analyzed the function after Achilles tendon rupture in 25 patients older than 65 years, 3 (1-5) years after the initial treatment. The patients' median age at the time of injury was 71 (65-86) years. The initial management was surgical in 14 patients and non-surgical (8-week immobilization) in 10, 1 patient was not treated. The ratio of the number of heel-raises on the injured to the uninjured side was median 0.64 (0-1.14), showing a reduction in performance. However, in both surgically- and non-surgically-treated patients, the subjective impairment was mild, and the patients were able to perform most walking activities. Only 9 patients reached their previous activity level. Co-morbidity was frequent: 17 patients had other diseases that affected their performance. 14 complications occurred in 11 patients. 5 patients sustained a rerupture (4 following initial closed treatment with plaster), 1 a deep venous thrombosis and 4 had superficial infections requiring antibiotic treatment. 1 patient sustained a fibular nerve injury following compression by the plaster cast and another a sural nerve injury during the operation. 2 patients had symptoms due to adhesions between the tendon and the skin. We conclude that Achilles tendon rupture in patients older than 65 years reduces lower limb function and that complications are common following surgical and non-surgical treatment.

Achilles Tendon↗
PubMed1999

Evaluation of grip strength measurements after Colles' fracture: a methodological study.

Maximal isometric grip strength during short and sustained contractions was registered in 28 females and five males with displaced Colles' fracture involving the distal radio-ulnar joint. After reduction the patients were immobilized with plaster cast or with external fixation. The reliability of the measurements of the uninjured side was high and stable over a two-year follow-up period. The between-occasion reliability of the injured side was lower than that of the uninjured side. At each session the intensity of pain was measured. There was a reduction in pain after two years. The discriminatory ability of the measurements was satisfactory. It is suggested that the measurement methods and the present findings may serve as guidance in physiotherapy for these patients, especially if the uninjured side is used as reference.

Colles' Fracture↗
PubMed2002

Unrepaired clefts in the hard palate: speech deficits at the ages of 5 and 7 years and their relationship to size of the cleft.

The purpose of the study was to investigate the relationship between the size of oronasal openings in the hard palate and speech deficits. Audiotape recordings and plaster casts were taken according to standard procedures at 5 and 7 years of age from 22 consecutive children born with complete unilateral cleft lip and palate treated at Sahlgrenska University Hospital, Göteborg, Sweden. The soft palate had been repaired before the age of 12 months, whereas the cleft in the hard palate was left unrepaired, to be closed later. Perceptual judgements of nine speech variables at 5 and 7 years of age were correlated with measures of the area of the residual cleft in the hard palate. "Retracted oral articulation" (to velar place) found in nine of the 22 children correlated significantly with the area of the cleft at the age of 5 years but not later. The establishment of this particular speech error seems to be related to the size of an oronasal opening.

Articulation Disorders↗
PubMed2004

Volar scaphotrapezial dislocation.

We present a case of volar luxation of the scaphotrapezial bone, in which radiographs suggested luxation of the scaphoid, but unclear relations to the other carpal bones. Computer tomographic reconstruction showed an isolated scaphotrapezial luxation. This was treated by closed reduction and a plaster cast, after which the patient regained normal function of her wrist.

Adolescent↗
PubMed2004

Non-surgical management of ankle contracture following acquired brain injury.

BACKGROUND AND PURPOSE: The purpose of this study was to document the outcome of non-surgical management of equinovarus ankle contracture in a cohort of patients with acquired brain injury admitted to a specialist Neurosurgical Rehabilitation Unit. METHODS: This prospective descriptive study examined all patients with a new diagnosis of moderate to severe acquired brain injury (Glasgow Coma Scale score </=12) admitted for rehabilitation over a 1 year period. Ankle dorsiflexion range and plantarflexor/invertor muscle activity were evaluated weekly during the period of hospitalization. Contracture was defined as maximal passive range of motion </= 0 degrees dorsiflexion, with the knee extended, on a minimum of two measurement occasions. Patients were retrospectively allocated to one of four treatment outcome categories according to ankle dorsiflexion range, type of intervention required and response to treatment. RESULTS: Ankle contracture was identified in 40 of the 105 patients studied. Contracture resolved with a standard physiotherapy treatment programme, including prolonged weight-bearing stretches and motor re-education, in 23 patients. Contracture persisted or worsened in 17 of 40 cases, all of whom exhibited dystonic muscle overactivity producing sustained equinovarus posturing. Ten of 17 cases required serial plaster casting (+/- injection of botulinum toxin type A) in order to achieve a functional range of ankle motion. Remediation of ankle contracture was not considered a priority in the remaining seven patients due to the severity of their overall disability. CONCLUSION: The incidence of ankle contracture identified in this population was considerably less than previously reported. Reduced dorsiflexion range was remediated with standard physiotherapy treatment in over half of the cases. Additional treatment with serial casting +/- botulinum toxin type-A injection was required to correct persistent or worsening contracture in one quarter of cases. Dystonic extensor muscle overactivity was a major contributor to persistent or progressive ankle contracture.

Adolescent↗
PubMed1992

Dental arch development in a set of triplets.

A set of male triplets, of whom the two youngest appear to be identical, has been followed and recorded on plaster casts from 1 month to young adulthood. Measurements of tooth size, arch breadth, length, and circumference, as well as arch relationship, were made at five stages of development. There was a general tendency for the identical pair to become more similar after puberty, and less like their dizygotic brother. Attention is drawn to the potential value of a longitudinal study on a sample of sets of similar sex triplets each containing two identical individuals.

Adolescent↗
PubMed2001

Temporomandibular disorders in relation to craniofacial dimensions, head posture and bite force in children selected for orthodontic treatment.

The present study examined the associations between craniofacial dimensions, head posture, bite force, and symptoms and signs of temporomandibular disorders (TMD). The sample comprised 96 children (51F, 45M) aged 7-13 years, sequentially admitted for orthodontic treatment of malocclusions entailing health risks. Symptoms and signs of TMD were assessed by 37 variables describing the occurrence of headache and facial pain, clicking, jaw mobility, tenderness of muscles and joints, and the Helkimo Anamnestic and Dysfunction indices. Craniofacial dimensions (33 variables), and head and cervical posture (nine variables) were recorded from lateral cephalometric radiographs taken with the subject standing with the head in a standardized posture (mirror position). Dental arch widths were measured on plaster casts and bite force was measured at the first molars on each side by means of a pressure transducer. Associations were assessed by Spearman correlations and multiple stepwise logistic regression analyses. The magnitudes of the significant associations were generally low to moderate. On average, temporomandibular joint (TMJ) dysfunction was seen in connection with a marked forward inclination of the upper cervical spine and an increased craniocervical angulation, but no firm conclusion could be made regarding any particular craniofacial morphology in children with symptoms and signs of TMJ dysfunction. Muscle tenderness was associated with a 'long face' type of craniofacial morphology and a lower bite force. Headache was associated with a larger maxillary length and increased maxillary prognathism. A high score on Helkimo's Clinical Dysfunction Index was associated with smaller values of a number of vertical, horizontal, and transversal linear craniofacial dimensions and a lower bite force.

Adolescent↗
PubMed2005

Molar bite force in relation to occlusion, craniofacial dimensions, and head posture in pre-orthodontic children.

The present study examined bite force in relation to occlusion, craniofacial dimensions, and head posture. The sample comprised 88 children (48 girls, 40 boys) aged 7-13 years, sequentially admitted for orthodontic treatment of malocclusions entiling health risks. Bite force was measured in the molar region by means of a pressure transducer. Angle classification, number of teeth and contact in the intercuspal position (ICP) were recorded and dental arch widths were measured on plaster casts. Craniofacial dimensions and head posture were recorded from lateral cephalometric radiographs taken with the subject standing with their head in a standardized posture (mirror position). Associations were assessed by Spearman correlations and multiple stepwise regression analyses.The maximum bite force increased significantly with age in girls, with teeth in occlusal contact in boys, and with increasing number of erupted teeth in both genders. Bite force did not vary significantly between the Angle malocclusion types. Only in boys was there a clear correlation between bite force and craniofacial morphology: cranial base length (n-ba, n-ar), posterior face height (s-tgo, ar-tgo), vertical jaw relationship (NL-ML), mandibular inclination (NSL-ML), form (ML-RL) and length (pg-tgo), and inclination of the lower incisors (Ili-ML). Multiple regression analysis showed that the vertical jaw relationship (P < 0.001) and the number of teeth present (P < 0.01) were the most important factors for the magnitude of bite force in boys. In girls, the most important factor was the number of teeth present (P < 0.001). No correlations between bite force and head posture were found.

Adolescent↗
PubMed1989

Effects of upper limb immobilization on isometric muscle strength, movement time, and triphasic electromyographic characteristics.

The effects of short-term immobilization on isometric muscle strength, movement time, and triphasic integrated electromyographic characteristics were assessed during a simple ballistic elbow flexion and extension movement. The nondominant upper limbs in six subjects (two female, four male) were immobilized in a plaster cast for 14 days. Testing consisted of isometric muscle strength output of elbow flexors and extensors; movement time; and IEMG output of the agonist, antagonist, and second agonist contractions during the ballistic movements. An analysis of variance revealed a decrease in flexor strength of the casted limb (p less than .05). Movement time was not significantly slowed. Antagonist IEMG amplitude was decreased (p less than .01) during flexion, and agonist IEMG amplitude (p less than .05) and antagonist IEMG amplitude (p less than .05) were diminished during extension of the casted limb. In conclusion, short-term upper limb immobilization affects primarily elbow flexion strength and some IEMG characteristics during a ballistic forearm movement, suggesting an influence on the neuromuscular aspects of the affected muscles.

Adult↗