A neurosurgical method of the selective posterior rhizotomy (SPR) is used for a treatment of spasticity. The aim of this study is to evaluate an effect of the SPR on the reduction of the spasticity and on functional abilities of patients with cerebral palsy. Five patients (four males and a female) aged from 12 to 21 years with a spastic quadruplegia were tested by an Ashworth scale, modified Ashworth scale, Peacock scale and Barthel index of ADL. An initial assessment was preformed one day before the SPR. First assessment of changes was conducted one week after the SPR. An repeated follow-up assessment was done three to four years after the SPR procedure. In one week after SPR assessment a reduction of spasticity of lower and upper limb muscles and reduction of clonus were seen. A last three-year assessment detected some return of spasticity on hip adductors, plantar and dorsal flexors muscles. However, the return of the hypertonus did not reach initial values of spasticity. Powered by TCPDF (www.tcpdf.org)

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22346号 / 医博第4587号 / 新制||医||1042(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 安達 泰治, 教授 森本 尚樹, 教授 福原 俊一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Although scoliosis is defined as a deviation of the spine in the frontal plane above 10ř according to Cobb, the spine is deformed in three planes. The chest is also affected at the same time. The most common type is idiopathic scoliosis, which has multifactorial etiopathogenesis. The thesis summarizes available information on kinesiology of the spine, classification of idiopathic scoliosis, its incidence, etiology, diagnostics, treatment and specific physiotherapeutic exercises. The practical part is devoted to assessing the symmetry of the patient's torso from the photographic documentation of the posture by SCODIAC 2.3. Indices evaluating hull asymmetry from the back or front (POTSI, ATSI) result from mathematical calculation. The smaller the number, the more symmetrical the posture. Correlation of POTSI index and Cobb angle is explored. 20 patients (18 girls and 2 boys) with idiopathic scoliosis up to 47ř according to Cobb aged between 7 to 18 years were selected for the study. All patients were subjected to anamnestic data collection, kinesiology analysis and a questionnaire. The results were statistically processed. SCODIAC software is one of the options offered to evaluate torso asymmetry and assess posture changes after therapy. It acts as a feedback for a physiotherapist and motivates...

Magister Chirurgiae Dentium (MChD) / The psychological, social, and cultural aspects of facial and dental attractiveness is an integral part of health care. Lay persons perceptions of facial and dental attractiveness are influenced by many factors including age, gender, geographic location (nationally or international), ethnic status, employment status, cultural differences and social class will effect the social impact of the anomalies. In addition, the public response to dental anomalies will vary according to experience of good health or ill health of the individual, relatives and friends. The perception of malocclusion is often seen differently between orthodontists, patients and lay public. The differing perceptions of patients and dental practitioners may influence the delivery of orthodontic care. It has been reported that 70% of orthodontic treatment is dentist induced and that orthodontic treatment may be undertaken without the patient or parents perceiving a problem with the teeth. (DHSS, Schanscheiff Report, 1986). The thresholds of entry and exit for orthodontic care may be different as perceived by orthodontists and lay persons. Orthodontists may pursue full alignment and perfect occlusion whereas lay persons may accept varying degrees of deviation from normal. This current study has assessed and recorded the differences in opinions of professional orthodontists and lay persons on dento-facial aesthetics, orthodontic treatment need and orthodontic treatment outcome. The study was carried out at the Orthodontic Department, University of Wales, College of Medicine, School of Dentistry. The opinions of 56 lay persons (dental technicians, dental nurses and lay persons not involved in the clinical process) and 97 orthodontists was collected by recording judgements using various patient records as stimuli. For each set of records examined, each member of the panel indicated their opinion using Likert scales. Judgements were made by assessments of 68 study casts in respect of:- * the need for orthodontic treatment on dental health grounds. the need for orthodontic treatment on dental aesthetic grounds. deviation from normal occlusion. the decision whether to treat. ** * In addition, judgements were made on a sample of 50 pairs of outline facial profiles before and after treatment in respect of: * * deviation from normal facial aesthetics comparison of aesthetics pre-treatment and post-treatment. Furthermore, assessments on 50 pairs of pre-treatment and post-treatment study casts in respect of: * * degree of improvement as a result of treatment. acceptability of result. Orthodontists subjective judgements are more reliable than lay persons in their assessments of dental aesthetics, dental health and deviation from normal. The level of agreement for the decision to recommend treatment is similar between orthodontists and lay groups ie. lay persons are as reliable as orthodontists in the decision to recommend treatment. Orthodontists tend to recommend 10 - 12 % more treatment than lay persons. The orthodontist group were more reliable than the lay group in assessing degree of improvement and assessment of outcome. Orthodontists reject approximately 25% of cases deemed acceptable by the lay group. Dental aesthetics appeared to be the most important feature in the assessment of treatment outcome by both orthodontists and lay groups.

L’intérêt que porte ce mémoire à la méthodologie de la recherche aristotélicienne de la vérité le confine à un examen précis des étapes préliminaires de cette recherche, dans l’objectif de surmonter une conception trop simplifiée de l’opposition entre la science et l’opinion chez Aristote. S’ancrant dans une présentation des fonctions de la dialectique, telles que décrites par le philosophe dans les Topiques, cette enquête entend fournir une comparaison étroite entre les méthodes dialectique et apodictique. Plus précisément, elle est le lieu d’une déconstruction des préjugés qui sous-tendent une lecture traditionnelle des Seconds analytiques, selon laquelle (1) la méthode apodictique doit guider la recherche scientifique et (2) l’épistémologie d’Aristote est radicalement fondationnaliste. La lecture, alternative, de ce traité que propose ce mémoire lui permet d’assouplir les conditions imposées par Aristote aux prémisses du syllogisme apodictique, de manière à exploiter les nuances qui s’inscrivent dans la distinction qu’il opère entre le mieux connu par nature et le mieux connu pour nous. Ce faisant, la frontière entre la dialectique, qui part des idées accréditées, et l’apodictique, qui part de prémisses vraies, se révèle moins franche et la notion d’epistēmē, moins « scientifique » au sens moderne du terme. Enfin, cette lecture alternative des Seconds analytiques est mise à contribution pour l’examen de l’hypothèse, inspirée d’un essai d’Owen (1961), selon laquelle le chapitre II, 19 de ce traité fournirait les pistes de réflexion permettant d’élucider, en même temps que le rôle de l’induction, celui de la dialectique dans le cheminement vers les premiers principes. / The attention this master’s thesis gives to the aristotelian method towards truth confines it to a precise examination of the preliminary steps of this method, in order to distance itself from an over-simplified opposition between science and opinion in Aristotle. Starting from a presentation of the functions of dialectic, as described by the philosopher in the Topics, this inquiry intends to provide a close comparison between the methods of dialectic and demonstration. More precisely, it aims to deconstruct the presuppositions underlining a traditional reading of the Posterior analytics, according to which (1) demonstrative method should provide a guide for scientific research and (2) Aristotle’s epistemology is radically foundationalist. The alternative reading this study suggests to adopt allows it to ease the conditions imposed by Aristotle on the premises of apodictic syllogism, as ways to exploit the distinction he makes between what is better known by nature and what is better known for us. In doing so, the frontier between dialectic, which starts from accredited ideas, and demonstration, which starts from true premises, appears to be less opaque and the concept of epistēmē, less “scientific” in the modern sense. Finally, this alternative reading of the Posterior analytics is put to contribution in examining the hypothesis, inspired by an essay from Owen (1961), regarding the possibility for the last chapter (II, 19) of this treatise to help us elucidate, both at the same time, the role of induction and that of dialectic in the path towards truth.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18855号 / 医博第3966号 / 新制||医||1007(附属図書館) / 31806 / 京都大学大学院医学研究科医学専攻 / (主査)教授 河野 憲二, 教授 黒田 知宏, 教授 富樫 かおり / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Objetivos: Malformação de Chiari do tipo I (MC-I) é a principal doença malformativa congênita da junção craniovertebral, manifestando-se com ampla variedade de sinais e sintomas neurológicos. A melhor técnica cirúrgica a ser empregada no tratamento dos pacientes com malformação de Chiari do tipo I é ainda controversa. A descompressão das estruturas da fossa craniana posterior com plástica de ampliação dural é considerada procedimento padrão. Embora efetiva e de baixa morbidade, a craniectomia occipital isolada, sem abertura e ampliação dural, implica maior taxa de recidiva dos sintomas. Métodos que selecionam os pacientes quanto a necessidade da duroplastia não foram estabelecidos. O presente trabalho avalia a eficácia da mensuração intraoperatória da velocidade do fluxo do líquido cefalorraquidiano através da ultrassonografia (USG) na seleção da técnica cirúrgica a ser utilizada. Métodos: Foram analisados de forma prospectiva 49 pacientes submetidos à cirurgia para MC-I. A indicação de craniectomia da fossa posterior associada ou não à plástica de ampliação da dura-máter baseou-se na velocidade do fluxo do líquido cefalorraquidiano, mensurada pela ultrassonografia intraoperatória. Dor cervical, cefaleia e qualidade de vida foram avaliadas antes e após o tratamento cirúrgico. Resultados: Dos 49 pacientes incluídos, 36 pacientes (73%) apresentavam fluxo do líquido cefalorraquidiano superior a 3 cm/s e não foram submetidos a duroplastia ampliadora. Nos 13 (27%) pacientes com fluxo inicial inferior a 3 cm/s, indicou-se craniectomia occipital com duroplastia de ampliação. Não houve diferença significativa entre os dois grupos com relação aos parâmetros estudados. Conclusão: A ultrassonografia intraoperatória com avaliação da dinâmica e velocidade do fluxo do líquido cefalorraquidiano da junção craniovertebral auxilia a indicação de duroplastia durante descompressão da fossa craniana posterior em pacientes adultos com MC-I / Objectives: Chiari malformation Type I (CM-I) is the main congenital malformation disease of the craniovertebral junction, and may be responsible for a variety of neurological symptoms. The ideal surgical technique used to treat patients with CM-I is still controversial. Invasive procedures that enters CSF space and are associated with dural repair, are considered the gold standard. Although effective and less morbidity, isolated bone decompression without dural opening, implies greater recurrence of symptoms. Objective parameters to select patients, who need or not to have a duroplasty performed, have not been established. Our study evaluates the efficacy of intra-operative CSF flow measurement through the use of ultrasonography (USG) as a determining parameter in the selection of these patients. Methods: We analyzed prospectively 49 posterior fossa surgeries for patients with CM-I. Patients underwent decompressive surgery with or without opening of the dura mater after conducting USG intra-operatively with measured flow rate, being adopted 3cm/s flow rate as a determining value. The quality of life before and after surgery and the improvement of neck pain and headache were the parameters evaluated. Results: Of the 49 patients enrolled, 36 patients (73%) had adequate CSF flow above 3 cm / s and have not undergone duroplasty. In 13 (27%) patients with initial flow < 3 cm / s an opening in dura mater was performed together with duroplasty. There was no significant difference between the two groups regarding the parameters studied. Conclusion: Intraoperative ultrasound with measurement of CSF flow, having a flow of 3 cm / s as cut-off, allows the proper selection of patients with CM-I that can have a less invasive surgery with bone decompression without duroplasty