Normal Head Shape Parameters in the First 2 Years of Life and Effect of Helmet Therapy

Objective The treatment of a positional head deformity in infancy is a controversial issue. The aim of this study was to explore the effects of helmet therapy on positional plagiocephaly and brachycephaly. Patients and Methods We determined cranial vault shape parameters in 348 healthy children during the second year of life, combined them with preexisting data from more than 400 subjects younger than 12 months, and related retrospectively the data of 1,531 children obtained before and after treatment with individual molding helmets to these newly generated normative values. Results The number of subjects with cranial vault asymmetry values > 97th percentile decreased by 85.5% from 1,361 before to 197 (p < 0.01) after helmet therapy, while the number of individuals with cranial vault asymmetry index values > 97th percentile declined by 87.7% from 1,353 to 167 (p < 0.01). Similarly, the number of infants with cranial index values > 97th percentile diminished by 66.8% from 885 to 294 (p < 0.01). Conclusions These findings do not finally prove, but they support the idea that helmet treatment is effective and meaningful in preventing permanent head deformities in infants with severe deformation. The normative anthropometric data generated in this study will allow investigating the natural course and effects of various therapies on infant cranial shape objectively.

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Three-dimensional analysis of positional plagiocephaly before and after molding helmet therapy in comparison to normal head growth

Child s Nervous System ◽

10.1007/s00381-013-2030-y ◽

2013 ◽

Vol 29 (7) ◽

pp. 1155-1161 ◽

Cited By ~ 11

Author(s):

Tilmann Schweitzer ◽

Hartmut Böhm ◽

Christian Linz ◽

Beatrice Jager ◽

Lucia Gerstl ◽

...

Keyword(s):

Dimensional Analysis ◽

Three Dimensional ◽

Positional Plagiocephaly ◽

Head Growth ◽

Helmet Therapy ◽

Before And After ◽

Normal Head

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Comparison of 2 Sagittal Craniosynostosis Repair Techniques: Spring-Assisted Surgery Versus Endoscope-Assisted Craniectomy With Helmet Molding Therapy

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620966521 ◽

2020 ◽

pp. 105566562096652

Author(s):

Gary B. Skolnick ◽

Jenny L. Yu ◽

Kamlesh B. Patel ◽

Lisa R. David ◽

Daniel E. Couture ◽

...

Keyword(s):

Computed Tomography ◽

Cranial Vault ◽

Sagittal Synostosis ◽

Time Points ◽

Sagittal Craniosynostosis ◽

Cranial Index ◽

Helmet Therapy ◽

Measurement Consistency ◽

Detectable Bias ◽

Repair Techniques

Introduction: This study compares anthropometric outcomes of 2 sagittal synostosis repair techniques: spring-assisted surgery and endoscope-assisted craniectomy with molding helmet therapy. Methods: Patients undergoing spring-assisted surgery (n = 27) or endoscope-assisted craniectomy with helmet therapy (n = 40) at separate institutions were retrospectively reviewed. Pre- and 1-year postoperative computed tomography (CT) or laser scans were analyzed for traditional cranial index (CI), adjusted cranial index (aCI), and cranial vault volume (CVV). Nine patient-matched scans were analyzed for measurement consistency. Results: The spring-assisted group was older at both time points ( P < .050) and spring-assisted group CVV was larger preoperatively and postoperatively ( P < .01). However, the change in CVV did not differ between the groups ( P = .210). There was no difference in preoperative CI (helmet vs spring: 70.1 vs 71.2, P = .368) between the groups. Postoperatively, helmet group CI (77.0 vs 74.3, P = .008) was greater. The helmet group also demonstrated a greater increase in CI (6.9 vs 3.1, P < .001). The proportion of patients achieving CI of 75 or greater was not significantly different between the groups (helmet vs spring: CI, 65% vs 52%, P = .370). There was no detectable bias in CI between matched CT and laser scans. Differences were identified between scan types in aCI and CVV measurements; subsequent analyses used corrected CVV and aCI measures for laser scan measures. Conclusions: Both techniques had equivalent proportions of patients achieving normal CI, comparable effects on cranial volume, and similar operative characteristics. The study suggests that there may be greater improvement in CI in the helmet group. However, further research should be performed.

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The Effects of Helmet Therapy Relative to the Size of the Anterior Fontanelle in Nonsynostotic Plagiocephaly: A Retrospective Study

Journal of Clinical Medicine ◽

10.3390/jcm8111977 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1977 ◽

Cited By ~ 1

Author(s):

Do Gon Kim ◽

Joon Seok Lee ◽

Jeong Woo Lee ◽

Jung Dug Yang ◽

Ho Yun Chung ◽

...

Keyword(s):

Treatment Initiation ◽

Asymmetry Index ◽

Cranial Vault ◽

Therapeutic Effects ◽

Anterior Fontanelle ◽

Therapy Outcomes ◽

Anatomical Features ◽

Helmet Therapy ◽

Nonsynostotic Plagiocephaly ◽

Treatment Onset

Helmet therapy is an important nonsurgical approach for patients with nonsynostotic plagiocephaly, but its effectiveness may depend on certain anatomical features. We retrospectively examined the effects of helmet therapy according to the size of the anterior fontanelle. Two hundred patients with nonsynostotic plagiocephaly who underwent helmet therapy between 2016 and 2018 were included. Data regarding age at treatment onset and treatment duration were collected. Patients were divided into two groups depending on the age at treatment initiation: the 12–23 weeks group and the >23 weeks group. Patients were also divided based on the anterior fontanelle size to analyze the effects of helmet therapy according to the severity of plagiocephaly in each group as the change in the cranial vault asymmetry index (CVAI). Therapeutic effects were evaluated using the cranial vault asymmetry (CVA), CVAI, anterior symmetry ratio, posterior symmetry ratio (PSR), and overall symmetry ratio at baseline and treatment completion. Treatment initiation at age 12–23 weeks resulted in better effects than that after age 24 weeks. There were no sex-dependent differences in therapeutic effects. Greater changes in the CVA, CVAI, and PSR were associated with larger anterior fontanelles. Therefore, the anterior fontanelle size could be a prognostic factor for estimating helmet therapy outcomes.

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Response to influenza vaccination in immunocompromised children with rheumatic disease: a prospective cohort study

Pediatric Rheumatology ◽

10.1186/s12969-021-00518-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Lotte Jensen ◽

Susan Nielsen ◽

Anne Estmann Christensen ◽

Freddy Karup Pedersen ◽

Ramona Trebbien ◽

...

Keyword(s):

Cohort Study ◽

Rheumatic Disease ◽

Rheumatic Diseases ◽

Haemagglutination Inhibition ◽

Immunosuppressive Drugs ◽

Influenza Viruses ◽

Healthy Children ◽

Influenza Immunization ◽

Before And After ◽

Antibody Titres

Abstract Background Prevention of illness due to infection by influenza viruses is important for children with rheumatic diseases. Biological disease modifying antirheumatic drugs have become increasingly important in the treatment of juvenile idiopathic arthritis, and combinations of immunosuppressive drugs are used for the treatment of systemic disorders, which increase the risk of secondary immunodeficiency. Therefore, we investigated whether children with rheumatic disease can mount a protective antibody response after influenza immunization. Methods The prospective multicentre cohort study was conducted in Denmark during the influenza season 2015–2016. Children with rheumatic disease aged six months to 19 years were eligible. Controls were immunologically healthy children. A blood sample was collected before and after vaccination and analysed by haemagglutination inhibition (HI) assay for the 2015–2016 influenza vaccine-strains. In case of flu-like symptoms the child was tested for influenza. For statistical analyses the patients were grouped according to medical treatment or disease. Results A total of 226 patients and 15 controls were enrolled. No differences were found for the increase of antibodies from pre-vaccine to post-vaccine between the groups in our primary analyses: A/Cal H1N1pdm09 (p = 0.28), A/Swi H3N2 (p = 0.15) and B/Phu Yamagata (p = 0.08). Only when combining patients across groups a lower increase in antibodies was found compared to controls. Among all patients the pre-vaccine rates for seroprotection using the HI-titer cut-off ≥ 40 were 93.1–97.0 % for all three strains. For seroprotection using the HI-titer cut-off ≥ 110 the pre-vaccine rates for all patients were 14.9–43.6 % for all three strains and an increase in the proportions of patients being seroprotected after vaccination was found for A/Cal H1N1pdm09 and A/Swi H3N2. None of the children with flu-like symptoms tested positive for the vaccine strains. Conclusions Children with rheumatic diseases increase in antibody titres after influenza immunization, however, it remains uncertain whether a protective level is achieved.

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Deformational Posterior Plagiocephaly: Diagnosis and Treatment

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2002_039_0582_dppdat_2.0.co_2 ◽

2002 ◽

Vol 39 (6) ◽

pp. 582-586 ◽

Cited By ~ 20

Author(s):

John F. Teichgraeber ◽

Jeffrey K. Ault ◽

James Baumgartner ◽

Amy Waller ◽

Marion Messersmith ◽

...

Keyword(s):

Prospective Study ◽

Treatment Outcomes ◽

Cranial Base ◽

Anthropometric Measurements ◽

Diagnosis And Treatment ◽

Cranial Vault ◽

Medical Conditions ◽

Deformational Plagiocephaly ◽

Helmet Therapy ◽

Posterior Plagiocephaly

Objective This study was designed to evaluate the effectiveness of helmet therapy (DOC band) in the correction of patients with moderate to severe posterior deformational plagiocephaly. Design In this prospective study, the infants were evaluated using 18 anthropometric measurements. Patients The charts of 248 patients seen between August 1, 1995, and July 31, 1999, were reviewed, and 125 met the criteria for inclusion in the study. All the patients had posterior deformational plagiocephaly with no other craniofacial deformities or medical conditions. Treatment was instituted prior to 1 year of age, and all patients were compliant with DOC band usage and had complete anthropometric measurements. Results The study recorded a 41.56% (p < .001) reduction in cranial vault asymmetry and a 40.23% (p < .001) reduction in cranial base asymmetry. Orbitotragial asymmetry was improved 18.72% (p = .0738). The age at which treatment was begun was not a significant factor in predicting treatment outcomes.

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Improving indicators of tuberculosis program cascades by leveraging HIV program strategies

Public Health Action ◽

10.5588/pha.19.0049 ◽

2019 ◽

Vol 9 (4) ◽

pp. 191-195

Author(s):

S. C. Meribe ◽

E. Harausz ◽

I. Lawal ◽

A. Ogundeji ◽

C. Mbanefo ◽

...

Keyword(s):

Standard Of Care ◽

Rank Test ◽

Military Hospitals ◽

Us Army ◽

Signed Rank ◽

Before And After ◽

Army Medical Research ◽

Signed Rank Test ◽

The Impact ◽

Number Of Individuals

Background: To improve rates of human immunodeficiency virus (HIV) case detection and treatment, the Nigerian Ministry of Defense Health Implementation Program and the US Army Medical Research Directorate-Africa/Nigeria introduced a HIV standard of care (SOC) package. Given the integration of tuberculosis (TB) and HIV programs and evolving policies, we evaluated the impact of this strategy on TB program indicators.Methods: Routine, de-identified program data from 27 Nigerian military hospitals were analyzed. Using Wilcoxon signed-rank test, bivariate analyses were performed to compare data from 12 months before and after implementation of the SOC package.Results: Our data showed improvements post-implementation as follows: the number of individuals receiving antiretroviral therapy (ART) screened for TB increased from 14 530 to 29 467 (P < 0.001); the number of individuals with presumptive TB identified increased from 803 to 1800 (P < 0.001); the number of ART clients bacteriologically tested for TB increased from 746 to 1717 (P < 0.001); and the number of ART clients treated for TB increased from 152 to 282 (P < 0.001). Newly registered or relapsed TB cases increased from 436 to 906 (P < 0.001), the number of TB cases with known HIV status increased from 437 to 837 (P < 0.001), the number of TB-HIV co-infected cases increased from 182 to 301 (P = 0.006), and the number of TB-HIV co-infected clients who started ART increased from 101 to 176 (P = 0.003).Conclusion: The implementation of the updated HIV SOC package led to the improvement in key TB diagnosis and treatment indicators. When emulated, this could help improve the performance of other TB programs in countries other than Nigeria.

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Letter to the Editor concerning “Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects” by JC Le Huec et al. Eur Spine J (2016) 25:3630–3637

European Spine Journal ◽

10.1007/s00586-017-5235-z ◽

2017 ◽

Vol 26 (10) ◽

pp. 2678-2679

Author(s):

Andrea Piazzolla ◽

Giuseppe Solarino ◽

Biagio Moretti

Keyword(s):

Normative Values ◽

Shape Parameters ◽

Spine Shape ◽

Letter To The Editor ◽

Japanese Subjects

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Prevalence and correlates of fatigue in patients with meningioma before and after surgery

Neuro-Oncology Practice ◽

10.1093/nop/npz023 ◽

2019 ◽

Vol 7 (1) ◽

pp. 77-85 ◽

Cited By ~ 1

Author(s):

Sophie D van der Linden ◽

Karin Gehring ◽

Geert-Jan M Rutten ◽

Willem J Kop ◽

Margriet M Sitskoorn

Keyword(s):

Tumor Volume ◽

Mental Fatigue ◽

Normative Values ◽

Common Symptom ◽

Physical Fatigue ◽

Cognitive Complaints ◽

Time Points ◽

General Fatigue ◽

Before And After ◽

Reduced Activity

Abstract Background Fatigue is a common symptom in patients with brain tumors, but comprehensive studies on fatigue in patients with meningioma specifically are lacking. This study examined the prevalence and correlates of fatigue in meningioma patients. Methods Patients with grade I meningioma completed the Multidimensional Fatigue Inventory (MFI-20) before and 1 year after neurosurgery. The MFI consists of 5 subscales: General Fatigue, Physical Fatigue, Mental Fatigue, Reduced Motivation, and Reduced Activity. Patients’ scores were compared with normative data. Preoperative fatigue was compared with postoperative fatigue. Correlations with sex, age, education, tumor hemisphere, preoperative tumor volume, antiepileptic drugs (AEDs), symptoms of anxiety/depression, and self-reported cognitive complaints were explored. Results Questionnaires were completed by 65 patients preoperatively, and 53 patients postoperatively. Of 34 patients, data from both time points were available. Patients had significantly higher fatigue levels on all subscales compared to normative values at both time points. Mean scores on General Fatigue, Physical Fatigue, and Mental Fatigue remained stable over time and improvements were observed on Reduced Motivation and Reduced Activity. Preoperatively, the prevalence of high fatigue (Z-score ≥ 1.3) varied between 34% for Reduced Motivation and 43% for General Fatigue/Mental Fatigue. The postoperative prevalence ranged from 19% for Reduced Activity to 49% on Mental Fatigue. Fatigue was associated with cognitive complaints, anxiety and depression, but not with education, tumor lateralization, tumor volume, or AEDs. Conclusion Fatigue is a common and persistent symptom in patients with meningioma undergoing neurosurgery. Findings emphasize the need for more research and appropriate care targeting fatigue for meningioma patients.

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Varicella Vaccine (VarilRix) in Children with Acute Lymphoblastic Leukemia.

Blood ◽

10.1182/blood.v104.11.4436.4436 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4436-4436

Author(s):

Teresa Jackowska Ass ◽

Robert Wasilewski ◽

Elzbieta Górska ◽

Maria Wasik ◽

Teresa Loch

Keyword(s):

Acute Lymphoblastic Leukemia ◽

B Lymphocytes ◽

Lymphoblastic Leukemia ◽

Varicella Vaccine ◽

White Blood Cells ◽

Healthy Children ◽

Varicella Zoster ◽

Significant Difference ◽

Before And After ◽

History Of

Abstract Background: To assess the effectiveness of vaccination against varicella in children with acute lymphoblastic leukemia (ALL). Methods: 105 children without a history of varicella, were qualified for immunization against varicella with VARILRIX (Oka-strain varicella vaccine). 48 children had ALL and 57 were healthy. 25 of the children with ALL were receiving maintenance therapy, 23 children were after chemotherapy. Results: White blood cells (WBC), lymphocytes, and sub-populations of T- and B-lymphocytes were compared in the healthy and leukemic children before and after vaccination. The ALL children had significantly lower counts of WBC and lymphocytes before vaccination. After vaccination there were no significant differences in the counts of WBC in the healthy and leukemic children. However the ALL children had significantly lower mean counts of lymphocytes. Before vaccination the leukemic children showed a significantly lowered percentage of T-lymphocytes with decreased CD4+ and increased CD8+, what resulted in a lowered CD4 to CD8 ratio. After vaccination, only increased numbers of T CD8+ lymphocytes and a lowered CD4 to CD8 ratio were present while there was no significant difference in CD4. In the healthy and leukemic children alike there was no statistically significant difference between B-lymphocytes (CD 19+) and NK cells. In 10 children (20%), out of the 48 ALL vaccines, varicelliform rash occurred ~1 month after immunization. No adverse effects we observed in healthy children. Seroconversion to varicella-zoster virus was higher in healthy children and ALL children who had skin rash after vaccination. Two ALL children and three healthy ones had varicella one-two years after the vaccination. Those children received only single vaccine doses (double vaccine doses received children above 12 years). Conclusion: Varicella vaccine was safe and immunogenic in leukemic children during maintenance and after chemotherapy.

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